bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of high-risk prescribing and other factors in relation to receipt of a home medicines review: a prospective cohort investigation among adults aged 45 years and over in Australia
Authors: Du Wei , Gnjidic Danijela , Pearson Sallie-Anne , Hilmer Sarah N , McLachlan Andrew J , Blyth Fiona , Viney Rosalie , Joshy Grace , Day Cathy , Banks Emily 
Published: February 2019

ObjectivesTo quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors.DesignProspective cohort analysis.Settings, participants, measurementsQuestionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009–June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations.Primary outcomeHMR receipt during the 5-year study period.ResultsOver 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using <5 medications at baseline, 6.8% with 5–9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5–9 and ≥10 versus <5 medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus good self-reported health; this association was attenuated substantially following additional adjustment for polypharmacy.ConclusionsHMR was common in individuals using multiple medications, a formal indication for general practitioner referral and, to a lesser extent, with poorer health and other markers of high-risk prescribing. Despite this, HMR use over a 5-year period was generally below 10%, even in high-risk groups, suggesting substantial potential for improvement in uptake and targeting.
New macular findings in individuals with biallelic KLHL7 gene mutation
Authors: Heng Ling Zhi , Kennedy Joanna , Smithson Sarah , Newbury-Ecob Ruth , Churchill Amanda 
Published: February 2019

ObjectiveThe ubiquitin-proteasome system pathway has been recognised as a crucial cellular mechanism for the proper function of photoreceptor cells. In particular, ubiquitin ligases (E3s) recognise and ubiquitinate specific proteins for degradation. The KLHL7 protein (a BTB-Kelch protein) has been found to play an important role in this process. There have been several reports that heterozygous mutations in theKLHL7gene in adults are responsible for a rare cause of late-onset autosomal dominant retinitis pigmentosa with preservation of central vision and homozygous mutations in two young children, with Crisponi syndrome (CS)/cold-induced sweating syndrome type 1, result in a recessive form of early-onset peripheral retinal dystrophy type changes. The majority of children do not survive through to adulthood. The objective of this study is to report the visual symptoms and signs of two young adults clinically diagnosed with overlapping BOS/Cisproni syndrome, expanding the phenotypic presentation of KLHL7 gene mutations.Methods and analysisThis is a case report of the ophthalmic findings of two siblings with biallelic KLHL7 gene mutations. Siblings born to a non-consanguineous family and diagnosed with the overlapping clinical phenotype of Bohring-Opitz and and confirmed biallelic KLHL 7 gene mutation by whole exome sequencing were identified. Ophthlamic history and fundal examination was performed and analysed.ResultsBoth patients had similar retinal findings. The fundus shows confluent hypopigmented/pale yellow lesions in the mid-periphery. The optic disc appears to be pale with a ring of atrophy and vessels appear attenuated. The macular of the younger patient shows a depigmented area around the fovea giving a bull’s-eye appearance while the older sibling shows a fibrotic ring around the fovea suggesting a more advanced pathology.ConclusionThis paper expands the retinal phenotype to include a distinctive maculopathy in a recently described homozygous mutation in theKLHL7gene in two young adults presenting with features that overlap the Bohring-Opitz syndrome and CS.
Use of a maternal newborn audit and feedback system in Ontario: a collective case study
Authors: Reszel Jessica , Dunn Sandra I , Sprague Ann E , Graham Ian D , Grimshaw Jeremy M , Peterson Wendy E , Ockenden Holly , Wilding Jodi , Quosdorf Ashley , Darling Elizabeth K , Fell Deshayne B , Harrold JoAnn , Lanes Andrea , Smith Graeme N , Taljaard Monica , Weiss Deborah , Walker Mark C 
Published: February 2019

BackgroundAs part of a larger study examining the effectiveness of the Maternal Newborn Dashboard, an electronic audit and feedback system to improve maternal-newborn care practices and outcomes, the purpose of this study was to increase our understanding of factors explaining variability in performance after implementation of the Dashboard in Ontario, Canada.MethodsA collective case study. A maximum variation sampling approach was used to invite hospitals reflecting different criteria to participate in a 1-day to 2-day site visit by the research team. The visits included: (1) semistructured interviews and focus groups with healthcare providers, leaders and personnel involved in clinical change processes; (2) observations and document review. Interviews and focus groups were audio-recorded and transcribed verbatim. Qualitative content analysis was used to code and categorise the data.ResultsBetween June and November 2016, we visited 14 maternal-newborn hospitals. Hospitals were grouped into four quadrants based on their key indicator performance and level of engagement with the Dashboard. Findings revealed four overarching themes that contribute to the varying success of sites in achieving practice change on the Dashboard key performance indicators, namely, interdisciplinary collaboration and accountability, application of formal change strategies, team trust and use of evidence and data, as well as alignment with organisational priorities and support.ConclusionThe diversity of facilitators and barriers across the 14 hospitals highlights the need to go beyond a ‘one size fits all’ approach when implementing audit and feedback systems. Future work to identify tools to assess barriers to practice change and to evaluate the effects of cointerventions to optimise audit and feedback systems for clinical practice change is needed.
Conversion of other opioids to methadone: a retrospective comparison of two methods
Authors: Lukin Bill , Greenslade Jaimi , Kearney Alison Mary , Douglas Carol , Howell Tegwen , Barras Michael , Good Phillip 
Published: February 2019

ContextA rapid method of methadone conversion known as the Perth Protocol is commonly used in Australian palliative care units. There has been no follow-up or validation of this method and no comparison between different methods of conversion.ObjectivesThe primary objective of this study was to test the hypothesis that the achieved doses of methadone are independent of the conversion method (rapid vs slower). The secondary objectives included examining the relationship between calculated target doses, actual achieved doses and duration of conversions.MethodsThis is a retrospective chart audit conducted at two hospital sites in the Brisbane metropolitan area of Australia which used different methadone conversion methods.ResultsMethadone conversion ratios depended on previous opioid exposure and on the method of conversion used. The method most commonly used in Australia for calculating target doses for methadone when converting from strong opioids is a poor predictor of actual dose achieved. More appropriate conversion ratios are suggested.ConclusionFurther research is needed to refine the ratios used in practice when converting patients from strong opioids to methadone. Caution and clinical expertise are required. A palliative methadone registry may provide useful insights.
Effect of apixaban compared with warfarin on coagulation markers in atrial fibrillation
Authors: Christersson Christina , Wallentin Lars , Andersson Ulrika , Alexander John H , Alings Marco , De Caterina Raffaele , Gersh Bernard J , Granger Christopher B , Halvorsen Sigrun , Hanna Michael , Huber Kurt , Hylek Elaine M , Lopes Renato D , Oh Byung-Hee , Siegbahn Agneta 
Published: February 2019

ObjectivesCompare the effect of apixaban and warfarin on coagulation and primary haemostasis biomarkers in atrial fibrillation (AF).MethodsThe biomarker substudy from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial included 4850 patients with AF randomised to treatment with apixaban or warfarin. Sixty per cent of patients used vitamin K antagonist (VKA) within 7 days before randomisation. Prothrombin fragment 1+2 (F1+2), D-dimer, soluble CD40 ligand (sCD40L) and von Willebrand factor (vWF) antigen were analysed at randomisation and after 2 months of study treatment.ResultsIn patients not on VKA treatment at randomisation, F1+2 and D-dimer levels were decreased by 25% and 23%, respectively, with apixaban, and by 59% and 38%, respectively, with warfarin (p<0.0001 for treatment differences for both). In patients on VKA at randomisation, F1+2 and D-dimer levels increased by 41% and 10%, respectively, with apixaban and decreased by 37% and 11%, respectively, with warfarin (p<0.0001 for treatment differences for both). sCD40L levels were slightly increased at 2 months, regardless of VKA or randomised treatment. Apixaban and warfarin also both reduced vWF antigen regardless of VKA treatment. The efficacy (stroke) and safety (bleeding) of apixaban compared with warfarin was similar irrespectively of biomarker levels at 2 months.ConclusionsTreatment with apixaban compared with warfarin for stroke prevention in patients with AF was associated with less reduction in thrombin generation and fibrin turnover. This effect of apixaban could contribute to the clinical results where apixaban was superior to warfarin both in stroke prevention and in reducing bleeding risk.Trial registration numberNCT00412984.
Projecting long-term trends in mobility limitations: impact of excess weight, smoking and physical inactivity
Authors: Härkänen Tommi , Sainio Päivi , Stenholm Sari , Lundqvist Annamari , Valkeinen Heli , Aromaa Arpo , Koskinen Seppo 
Published: February 2019

BackgroundPolicy makers need disability projections for planning adequate services and measures for health promotion. The aim of this study is to provide projections on severe mobility limitations up to year 2044 and illustrate how the projected prevalence and the number of persons with severe mobility limitations are affected by potential changes in the modifiable risk factors, namely excess weight, physical inactivity and smoking.MethodsWe analysed the nationally representative, repeated measures Health 2000 and 2011 Surveys (BRIF8901) with 8615 and 6740 participants, respectively, aged 18 years and older. Severe mobility limitations were defined as major difficulties or unable to walk about half a kilometre. We applied a multistate model on repeated measures to account for both individual risk factors and their changes over time.ResultsThe number of people with severe mobility limitations was projected to double by the year 2044 in Finland, due to the rapid ageing of the population. Eliminating half of the excess weight would reduce their number by one-fifth, while reductions in the prevalence of smoking and physical inactivity would have a minor impact. Even if excess weight, smoking and physical inactivity were completely eliminated, the number of persons with severe mobility limitations is projected to increase.ConclusionsDesigning and implementing strategies to promote healthy weight are important to slow down the rapid increase in mobility limitations due to population ageing. Providing adequate health and social services for the increasing population with disabilities will nevertheless be an increasing national challenge.
Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials
Authors: Baxter Andrew J , Tweed Emily J , Katikireddi Srinivasa Vittal , Thomson Hilary 
Published: February 2019

BackgroundHomelessness is associated with poor health. A policy approach aiming to end homelessness across Europe and North America, the ‘Housing First’ (HF) model, provides rapid housing, not conditional on abstinence from substance use. We aimed to systematically review the evidence from randomised controlled trials for the effects of HF on health and well-being.MethodsWe searched seven databases for randomised controlled trials of interventions providing rapid access to non-abstinence-contingent, permanent housing. We extracted data on the following outcomes: mental health; self-reported health and quality of life; substance use; non-routine use of healthcare services; housing stability. We assessed risk of bias and calculated standardised effect sizes.ResultsWe included four studies, all with ‘high’ risk of bias. The impact of HF on most short-term health outcomes was imprecisely estimated, with varying effect directions. No clear difference in substance use was seen. Intervention groups experienced fewer emergency department visits (incidence rate ratio (IRR)=0.63; 95% CI 0.48 to 0.82), fewer hospitalisations (IRR=0.76; 95% CI 0.70 to 0.83) and less time spent hospitalised (standardised mean difference (SMD)=−0.14; 95% CI −0.41 to 0.14) than control groups. In all studies intervention participants spent more days housed (SMD=1.24; 95% CI 0.86 to 1.62) and were more likely to be housed at 18–24 months (risk ratio=2.46; 95% CI 1.58 to 3.84).ConclusionHF approaches successfully improve housing stability and may improve some aspects of health. Implementation of HF would likely reduce homelessness and non-routine health service use without an increase in problematic substance use. Impacts on long-term health outcomes require further investigation.Trial registration numberCRD42017064457
Embedding leadership in undergraduate medical students: an active approach
Authors: Selway Joanne L , Ellis Jonathan , Thomas Peter 
Published: February 2019

IntroductionThe inclusion of leadership within the General Medical Council Outcomes has encouraged UK medical schools to incorporate leadership into curricula, although it is often delivered in classroom environments. In order to illustrate to our clinical students that leadership skills are useful irrespective of positional authority, the University of Buckingham Medical School has developed a week-long programme illustrating the impact that junior and trainee doctors can have on the National Health Service environment (in a week).MethodsStudents received lectures on leadership principles and conducted focus groups and 1 min interviews to assess the values at Milton Keynes University Hospital (MKUH). Students collated the responses, and all MKUH staff, including the executive board, were invited to hear the feedback.Findings and conclusionsThe students concluded that a review of the hospital’s values was required and the executive board committed to a review which has been completed, with the values redefined and reworded. At the end of the week, 92.3% of students felt their perspective had been broadened and some reported feeling empowered by the impact that a weeks’ work could achieve. This short course has illustrated that an active approach to leadership can demonstrate to students that leadership is not just for those in positions of responsibility and change can be achieved by anyone with ambition.
Near-peer mentorship: a pilot programme to improve support for new doctors
Authors: Peterson Alexandra , Monaghan Hannah 
Published: February 2019

IntroductionTransition from medical student to Foundation Year 1 (FY1) doctor is often challenging. New doctors commonly report feeling stressed and unsupported.1–4 In order to improve support for FY1s, we piloted a peer mentorship scheme. We evaluated the impact of having a near-peer mentor in Foundation Year 2 (FY2) in addition to the traditional Educational Supervisor on FY1s’ experience of their first year of practice.Methods190 Foundation Year doctors (FYs) volunteered (95 FY1s, 95 FY2s). FY1-FY2 dyads were assigned according to similar rotation assignments in the FY1 year. Dyads were encouraged to communicate informally as well as meet face-to-face three times over the one-year mentorship period. Feedback was sought regularly via online survey.ResultsResponse to a one-year evaluation survey was 32/95 FY1s, 65/95 FY2s. 94% of respondents reported having both mentor and Educational Supervisor was beneficial. 84.4% of FY1s reported ‘having a peer mentor helped [them] feel supported in the transition from medical student to FY1.' 99% of respondents recommended the programme should continue.The programme is currently running for a second year. 61% of 2017/2018 FY1 participants (58/95) have volunteered as FY2-mentors in 2018/2019.ConclusionsNear-peer mentorship enhances support for FY1 doctors. This intervention was widely accepted and received positive evaluations from participants. We provide a simple, low-cost model that could be replicated and adapted to improve support for doctors in training.
Job-exposure matrix for historical exposures to rubber dust, rubber fumes and n-Nitrosamines in the British rubber industry
Authors: Hidajat Mira , McElvenny Damien Martin , Mueller William , Ritchie Peter , Cherrie John W , Darnton Andrew , Agius Raymond M , Kromhout Hans , de Vocht Frank 
Published: February 2019

ObjectivesTo develop a quantitative historical job-exposure matrix (JEM) for rubber dust, rubber fumes and n-Nitrosamines in the British rubber industry for 1915–2002 to estimate lifetime cumulative exposure (LCE) for a cohort of workers with 49 years follow-up.MethodsData from the EU-EXASRUB database—rubber dust (n=4157), rubber fumes (n=3803) and n-Nitrosamines (n=10 115) collected between 1977 and 2002—were modelled using linear mixed-effects models. Sample year, stationary/personal measurement, industry sector and measurement source were included as fixed explanatory variables and factory as random intercept. Model estimates and extrapolations were used to construct a JEM covering all departments in both sectors of the rubber manufacturing industries for the years 1915–2002. JEM-estimates were linked to all cohort members to calculate LCE. Sensitivity analyses related to assumptions about extrapolation of time trends were also conducted.ResultsChanges in rubber dust exposures ranged from −6.3 %/year (crude materials/mixing) to −1.0 %/year (curing) and −6.5 %/year (crude materials/mixing) to +0.5 %/year (finishing, assembly and miscellaneous) for rubber fumes. Declines in n-Nitrosamines ranged from −17.9 %/year (curing) to −1.3 %/year (crude materials and mixing). Mean LCEs were 61 mg/m3-years (rubber dust), 15.6 mg/ m3-years (rubber fumes), 2483.2 µg/m3-years (n-Nitrosamines sum score), 18.6 µg/m3-years (N-nitrosodimethylamine) and 15.0 µg/m3-years (N-itrosomorpholine).ConclusionsAll exposures declined over time. Greatest declines in rubber dust and fumes were found in crude materials and mixing and for n-Nitrosamines in curing/vulcanising and preprocessing. This JEM and estimated LCEs will allow for evaluation of exposure-specific excess cancer risks in the British rubber industry.
Night shift work and abnormal liver function: is non-alcohol fatty liver a necessary mediator?
Authors: Wang Feng , Zhang Liuzhuo , Wu Suyang , Li Wentao , Sun Miaomiao , Feng Wenting , Ding Ding , Yeung-shan Wong Samuel , Zhu Peng , Evans Greg J , Wing Yun Kwok , Zhang Jihui , Vlaanderen Jelle J , Vermeulen Roel C H , Zhang Yanfang , Chan Emily Ying-yang , Li Zhimin , Tse Lap Ah 
Published: February 2019

ObjectivesAccumulated evidence implies that night shift work may trigger liver dysfunction. Non-alcoholic fatty liver (NAFL) is suggested to be a necessary mediator in this process. This study aimed to examine the relationship between night shift work and elevated level of alanine transaminase (e-ALT) of workers and investigate the potential mediation effect of NAFL.MethodsThis study included all male workers from the baseline survey of a cohort of night shift workers. Information on demographics, lifestyle and lifetime working schedule was collected by face-to-face interview. Liver sonography was used to identify NAFL cases. Serum ALT level was detected by an automatic biochemical analyser. e-ALT was defined as ALT >40 U/L. Logistic regression models were used to evaluate ORs, and mediation analysis was employed to examine the mediation effect.ResultsAmong 4740 male workers, 39.5% were night shift workers. Night shift workers had an increased risk of e-ALT (OR, 1.19, 95% CI 1.00 to 1.42). With the increase in night shift years, the OR of e-ALT increased from 1.03 (95% CI 0.77 to 1.36) to 1.60 (95% CI 1.08 to 2.39) among workers without NAFL. A similar trend was not found among workers with NAFL. In addition, no significant mediation effect of NAFL in the association between night shift work and e-ALT was found.ConclusionsNight shift work is positively associated with abnormal liver function, in particular among workers without NAFL. Shift work involving circadian disruption is likely to exert a direct effect on liver dysfunction rather than rely on the mediation effect of NAFL.
Occupational cannabis exposure and allergy risks
Authors: Decuyper Ine Ilona , Van Gasse Athina , Faber Margaretha Antje , Mertens Christel , Elst Jessy , Rihs Hans-Peter , Sabato Vito , Lapeere Hilde , Hagendorens Margo , Bridts Chris , De Clerck Luc , Ebo Didier 
Published: February 2019

ObjectivesCannabis allergy has mainly been described following recreational use but some cases also point to cannabis sensitisation as a result of occupational exposure. As a consequence, little is known on the prevalence and clinical phenotype of occupational cannabis allergy. Therefore, this study aims to explore the allergy-associated health risks of occupational cannabis exposure in Belgian police force personnel.Methods81 participants, active in the police force, reporting regular occupational cannabis exposure during the past 12 months, were included. History was combined with a standardised questionnaire on allergies and cannabis exposure.Basophil activation tests (BATs) with a crude cannabis extract and rCan s 3 were performed. In addition, specific (s)IgE rCan s 3 as well as sIgE to house dust mite, six pollen and three mould allergens were quantified.ResultsAlthough 42% of the participants reported respiratory and/or cutaneous symptoms on occupational cannabis exposure, all cannabis diagnostics were entirely negative, except one symptomatic case demonstrating a borderline result. Furthermore, there is no significant difference between the groups with and without symptoms on cannabis exposure in terms of allergenic sensitisations.ConclusionsThe origins of the reported respiratory and cutaneous symptoms during cannabis exposure remain elusive but are probably due to non-immune reactions. It should be noted that the study was volunteer-based possibly reflecting an excessive number of symptomatic individuals. Nevertheless, as only one participant reported using fully protective gear, much improvement is needed for reducing the number of symptoms reported on duty, independent of their origin.