bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication regimen complexity and its impact on medication adherence and glycemic control among patients with type 2 diabetes mellitus in an Ethiopian general hospital
Authors: Ayele Asnakew Achaw , Tegegn Henok Getachew , Ayele Tadesse Awoke , Ayalew Mohammed Biset 
Published: June 2019

BackgroundDifferent studies reported that higher diabetes-specific Medication Regimen Complexity Index (MRCI) has a negative impact on glycemic control potentially by decreasing medication adherence. However, information about regimen complexity and its association with adherence and glycemic control in Ethiopian patients with diabetes is unknown.AimTo evaluate medication regimen complexity and to assess its impact on medication adherence and glycemic control among patients with type 2 diabetes Mellitus (T2DM).MethodsA hospital-based cross-sectional design was conducted at Debre Tabor General Hospital from 1 May 2018 to 30 June 2018. Medication regimen complexity was evaluated using the 65-item validated tool called Medication Complexity Index (MRCI). Adherence was measured using Morisky Medication Adherence Scale while patients were classified as having poor or good glycemic control based on the recent record of their fasting blood glucose. Multivariable logistic regression analysis was applied to determine the association between predictive variables and outcome variables.ResultsA total of 275 patients with T2DM who meet the inclusion criteria were included in the final analysis. About 22.2% of the participants were classified as having high diabetes-specific MRCI, whereas 35.6% of the participants were classified as having high patient-level MRCI. The majority (70.5%) of the respondents were adherent to their medications, and 42.9% of the total population were categorized as having good glycemic control. According to the result of the multivariate analysis, patients with low-level and moderate-level MRCI of both diabetes-specific and patient-level MRCI were more adherent to their medication compared with patients with high MRCI. High diabetes medication regimen complexity was associated with poor glycemic control in the adjusted analyses (adjusted OR=0.276; 95% CI=0.100 o 0.759).ConclusionThe prevalence of high MRCImedication regimen complexity index is high among patients with T2DM. Patients with low and moderate regimen complexity had improved adherence. High diabetes-specific medication regimen complexity was associated with poor glycemic control. Simplification of a complex medication regimen for patients with diabetes should be sought by physicians and pharmacists to improve medication adherence and subsequent improvement in glycemic control.
Multiple factor analysis of eating patterns to detect groups at risk of malnutrition among home-dwelling older subjects in 2015
Authors: Sanchez Marc-Antoine , Armaingaud Didier , Messaoudi Yasmine , Letty Aude , Mahmoudi Rachid , Sanchez Stéphane 
Published: June 2019

ObjectiveWe aimed to describe eating patterns among home-dwelling older subjects to establish typologies of eaters at higher or lower risk of malnutrition.DesignCross-sectional study between June and September 2015 using a standardised questionnaire. The questionnaire was given to home-help employees (responsible for delivering meals to home-dwelling older persons and helping them to eat). The employees were asked to complete the questionnaire three times during the same week, for the same older adults, in order to identify the totality of their food intake.SettingRegistered customers of the home meal delivery company ‘Azaé’ (France).Participants605 older home-dwelling persons were randomly selected among customers served by the home meal delivery company.OutcomesMultiple factor analysis was used to understand the different modes of food consumption and to establish eating profiles. Hierarchical classification was performed to construct eating profiles corresponding to the dietary habits of the respondents.ResultsAverage age of the older adults was 85.3 years; 73.5% were women. Overall, 59% of participants reported that they ate out of habit, while 33.7% said they ate for pleasure. We identified four different groups of eaters, at varying levels of risk for malnutrition. Individuals in group 4 had the highest food intake in terms of quantity; and were less dependent than individuals in group 1 (p=0.05); group 1 was at highest risk of malnutrition.ConclusionImproved understanding of eating habits can help detect risky behaviours and help caregivers to promote better nutrition among home-dwelling older subjects.
Prevalence of simultaneous use of alcohol and prescription medication in older adults: findings from a cross-sectional survey (Health Survey for England 2013)
Authors: Foster John , Patel Swatee 
Published: June 2019

ObjectivesTo investigate the concurrent use of ‘at-risk’ (AR) drinking (>10 units of alcohol per week) and prescription medications, while controlling for sociodemographic, and health-related factors, among older adults (aged 65–89 years).DesignCross-sectional survey.SettingData from Health Survey of England, 2013.InterventionsNone.ParticipantsGeneral population survey of 2169 adults aged 65–89 years.Primary outcome measuresAR drinking (>10 units per week). Secondary outcome was AR drinking defined as >14 units of alcohol per week limit (the cut-off used by the Department of Health for AT drinking).ResultsTwenty-seven per cent (n=568) of the sample were AR drinkers. Factors associated with alcohol consumption were gender, age, social class, marital status, rurality of dwelling, deprivation index, self-reported general health, cigarette smoking, body mass index, exercise level, health and well-being scores’ and number of prescription drugs. Logistic regression analysis showed that males were more likely to be AR drinkers (OR 3.44, 95% CI 2.59 to 4.57, p<0.0001) than females. Each year increase in age, lowered the probability of AR drinking by a factor of 0.95 (95% CI 0.93 to 0.98, p<0.0001). Using prescription drugs reduced AR drinking by a factor of 0.92 (95% CI 0.85 to 0.93, p=0.033), after controlling for age, sex and rurality of dwelling. No other predictors were significant. Similar results were obtained for AR drinking of >14units per week.ConclusionAR drinking is more likely in older men than women. The odds of AR drinking lessens, as individuals age, and using prescription drugs also reduces AR drinking.
Cybersecurity features of digital medical devices: an analysis of FDA product summaries
Authors: Stern Ariel Dora , Gordon William J , Landman Adam B , Kramer Daniel B 
Published: June 2019

ObjectivesTo more clearly define the landscape of digital medical devices subject to US Food and Drug Administration (FDA) oversight, this analysis leverages publicly available regulatory documents to characterise the prevalence and trends of software and cybersecurity features in regulated medical devices.DesignWe analysed data from publicly available FDA product summaries to understand the frequency and recent time trends of inclusion of software and cybersecurity content in publicly available product information.SettingThe full set of regulated medical devices, approved over the years 2002–2016 included in the FDA’s 510(k) and premarket approval databases.Primary and secondary outcome measuresThe primary outcome was the share of devices containing software that included cybersecurity content in their product summaries. Secondary outcomes were differences in these shares (a) over time and (b) across regulatory areas.ResultsAmong regulated devices, 13.79% were identified as including software. Among these products, only 2.13% had product summaries that included cybersecurity content over the period studied. The overall share of devices including cybersecurity content was higher in recent years, growing from an average of 1.4% in the first decade of our sample to 5.5% in 2015 and 2016, the most recent years included. The share of devices including cybersecurity content also varied across regulatory areas from a low of 0% to a high of 22.2%.ConclusionsTo ensure the safest possible healthcare delivery environment for patients and hospitals, regulators and manufacturers should work together to make the software and cybersecurity content of new medical devices more easily accessible.
Thresholds for clinically important deterioration versus improvement in COPD health status: results from a randomised controlled trial in pulmonary rehabilitation and an observational study during routine clinical practice
Authors: Alma Harma Johanna , de Jong Corina , Jelusic Danijel , Wittmann Michael , Schuler Michael , Sanderman Robbert , Schultz Konrad , Kocks Janwillem , van der Molen Thys 
Published: June 2019

ObjectivesChronic Obstructive Pulmonary Disease (COPD) is a progressive disease. Preventing deterioration of health status is therefore an important therapy goal. (Minimal) Clinically Important Differences ((M)CIDs) are used to interpret changes observed. It remains unclear whether (M)CIDs are similar for both deterioration and improvement in health status. This study investigates and compares these clinical thresholds for three widely-used questionnaires.Design and settingData were retrospectively analysed from an inhouse 3-week pulmonary rehabilitation (PR) randomised controlled trial in the German Klinik Bad Reichenhall (study 1), and observational research in Dutch primary and secondary routine clinical practice (RCP) (study 2).ParticipantsPatients with COPD aged ≥18 years (study 1) and aged ≥40 years (study 2) without respiratory comorbidities were included for analysis.Primary outcomesThe COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and St George’s Respiratory Questionnaire (SGRQ) were completed at baseline and at 3, 6 and 12 months. A Global Rating of Change scale was added at follow-up. Anchor-based and distribution-based methods were used to determine clinically relevant thresholds.ResultsIn total, 451 patients were included from PR and 207 from RCP. MCIDs for deterioration ranged from 1.30 to 4.21 (CAT), from 0.19 to 0.66 (CCQ), and from 2.75 to 7.53 (SGRQ). MCIDs for improvement ranged from −3.78 to −1.53 (CAT), from −0.50 to −0.19 (CCQ), and from −9.20 to −2.76 (SGRQ). Thresholds for moderate improvement versus deterioration ranged from −5.02 to −3.29 vs 3.89 to 8.14 (CAT), from −0.90 to −0.72 vs 0.42 to 1.23 (CCQ), and from −15.85 to −13.63 vs 7.46 to 9.30 (SGRQ).ConclusionsMCID ranges for improvement and deterioration on the CAT, CCQ and SGRQ were somewhat similar. However, estimates for moderate and large change varied and were inconsistent. Thresholds differed between study settings.Trial registration numberRoutine Inspiratory Muscle Training within COPD Rehabilitation trial: #DRKS00004609; MCID study: #UMCG201500447.
Evidence available for patient-identified priorities in depression research: results of 11 rapid responses
Authors: Sebastianski Meghan , Gates Michelle , Gates Allison , Nuspl Megan , Bialy Liza M , Featherstone Robin M , Breault Lorraine , Mason-Lai Ping , Hartling Lisa 
Published: June 2019

ObjectivesPatient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence.DesignEleven rapid responses.Data sourcesSingle electronic database (PubMed).Eligibility criteriaEach rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary.ResultsFor all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0–179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects.ConclusionsWe identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.
Area deprivation, screen time and consumption of food and drink high in fat salt and sugar (HFSS) in young people: results from a cross-sectional study in the UK
Authors: Thomas Fiona , Thomas Christopher , Hooper Lucie , Rosenberg Gillian , Vohra Jyotsna , Bauld Linda 
Published: June 2019

ObjectivesTo investigate associations between deprivation in young people and consumption of foods high in fat, salt and sugar (HFSS), screen time exposure and health knowledge.DesignAn online cross-sectional survey with people aged 11–19 years in the UK, where participants reported consumption behaviours across 13 HFSS and two non-HFSS groups; screen time for commercial television and streaming services; and knowledge of health conditions and their links to obesity.SettingUKParticipantsA total of 3348 young people aged 11–19 years across the UK.Main outcome measuresThe study assessed the consumption behaviours, commercial screen time exposure and the health knowledge of 3348 people aged 11–19 years. Multivariate binary regression analysis, controlling for age and gender, was performed.ResultsDeprivation level was associated with increases in consumption of six of the HFSS products including energy drinks (OR: 2.943, p<0.001) and sugary drinks (OR: 1.938, p<0.001) and a reduction in consumption in the two non-HFSS products included in the study, fruit (OR: 0.668, p=0.004) and vegetables (OR: 0.306, p<0.001). Deprivation was associated with high weekly screen time of both television (OR: 2.477, p<0.001) and streaming (OR: 1.679, p=0.001). Health knowledge was also associated with deprivation. There was lower awareness of the association of obesity and cancer (OR: 0.697, p=0.003), type 2 diabetes (OR: 0.64, p=0.004) and heart disease (OR: 0.519, p<0.001) in the most deprived.ConclusionsYoung people from the more deprived areas of the UK were more likely to consume a range of HFSS products, report increased exposure to HFSS advertising and have a poorer awareness of health conditions associated with overweight and obesity. The findings suggest that population-level measures addressing childhood obesity should account for consumption patterns among different groups of children and young people and the factors that may influence these.
Knowledge mobilisation: an exploratory qualitative interview study to confirm and envision modification of lay and practitioner eczema mindlines to improve consultation experiences and self-management in primary care in the UK
Authors: Cowdell Fiona 
Published: June 2019

ObjectivesTo investigate whether initial eczema mindlines, ‘collectively reinforced, internalised, tacit guidelines’, are an accurate representation of the experiences of lay people and practitioners in primary care and to explore how these mindlines may best be revised to improve eczema care.DesignExploratory qualitative interviews with constant comparative analysis and data mining.SettingUK, primary care.ParticipantsPeople with eczema or parents of children with eczema (n=19) and primary care practitioners (n=13).ResultsInterview data were analysed using constant comparison of new data with existing initial eczema mindlines to identify areas of agreement and disagreement. Data were mined for participant’s thoughts aboutwhosemindlines should be modified,howthis may be achieved andwhatcore content is essential. Eczema mindlines and the spiral of knowledge creation, from which they evolved, intuitively made sense. Participants offered examples of how their eczema knowledge is continually produced and transformed as they interact with others. They reported diverse and wide-ranging influences on their thinking and recognised the critical relationship between lay and practitioner mindlines. For this reason they advocated modifying lay and practitioner mindlines in parallel. Participants advised amendment based on consistent information directed to all who influence eczema care. Information should come from trusted sources and be easy to access, distilled, practical, contextually relevant and amenable to assimilation.ConclusionsThe purpose here is to improve primary care consultation experiences and self-management in eczema. The remaining challenge is to find novel, simple and pragmatic methods of modifying eczema mindlines to instil shared and consistent understanding. Given the prevalence of eczema and the scope of people who influence self-care, interventions should transcend patient-practitioner boundaries and address the wider community. One conceptually congruent approach is to create aBa, which in this case would be a virtual space for generating and sharing eczema knowledge.
Post-traumatic growth in mental health recovery: qualitative study of narratives
Authors: Slade Mike , Rennick-Egglestone Stefan , Blackie Laura , Llewellyn-Beardsley Joy , Franklin Donna , Hui Ada , Thornicroft Graham , McGranahan Rose , Pollock Kristian , Priebe Stefan , Ramsay Amy , Roe David , Deakin Emilia 
Published: June 2019

ObjectivesPost-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems.DesignQualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery.SettingEngland.ParticipantsParticipants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British.ResultsComponents of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process.ConclusionsPost-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery.Trial registration numberISRCTN11152837
What is the best catheter lock solution in preventing catheter-related blood infections? A protocol for a Bayesian network meta-analysis of randomised controlled trials
Authors: Dang Fangping , Li Huiju , Tian Jinhui , Wang Ruijuan , Ren Jingjie 
Published: June 2019

IntroductionCatheter-related bloodstream infection (CRBSI) is a major complication after central venous catheter insertion, which is associated with significant morbidity, mortality and additional medical costs. Many lock solutions for CRBSI have been evaluated. However, using traditional pairwise meta-analyses to summarise the evidence does not allow the inclusion of data from treatments that have not been compared head to head, which could impact the precision of pooled estimates in a meta-analysis. Therefore, we evaluated the efficacy and safety of the different lock solutions for CRBSI through a network meta-analysis.Methods and analysisThe primary outcome of this network meta-analysis is the CRBSI. The secondary outcomes are exit-site infection and catheter-related thrombosis. We will search the PubMed, Embase, Web of Science and the Cochrane Library databases for recent relevant meta-analysis and their reference lists to include randomised controlled trials (RCTs) that compared lock solutions for CRBSI prevention. Two individuals will independently extract data from each included RCT according to a predesigned Excel spreadsheet and will assess the methodological quality using the Cochrane risk of bias tool. We will analyse the data using WinBUGS (V.1.4.3) and Stata (V.15.0). We will also estimate the pooled direct and indirect effects for all lock solutions using the network meta-analysis.Ethics and disseminationAs the present meta-analysis is performed based on previous published studies, no ethical approval and patient safety considerations are required. This study commenced on 18 January 2019, and its expected completion date is 1 December 2019. We will disseminate the results of our network meta-analysis through an international peer-reviewed journal.PROSPERO registration numberCRD42019121089.