bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mobile device and app use in paediatric emergency care: a survey of departmental practice in the UK and Ireland
Authors: Jahn Haiko Kurt , Jahn Ingo H , Roland Damian , Lyttle Mark D , Behringer Wilhelm 
Published: July 2019

IntroductionMobile devices and medical apps are used by healthcare professionals in adult and paediatric emergency departments worldwide. Recently, there has been a drive toward increased digitalisation especially in the UK. This point prevalence survey aims to describe hardware and software provision and their use in paediatric emergency care in the UK and Ireland.MethodsA web-based self-report questionnaire of member sites of an international paediatric emergency research collaborative was performed. A lead site investigator completed the survey on behalf of each site.ResultsOf the 54 sites, 46 (85%) responded. At 10 (21.7%) sites, the use of a personal mobile device at the bedside was not allowed; however, this was only enforced at 4 (8.7%) of these sites. Apple iOS devices accounted for the majority (70%) of institutional mobile devices. Most sites provided between 1 and 5 medical apps on the institutional mobile device. The British National Formulary (BNF/BNFc) app was the app which was most frequently provided and recommended. No site reported any harm from medical app use.ConclusionThe breadth of app use was relatively low. There was variability in trust guidance on app use and challenges in accessibility of Wi-Fi and devices.
Patterns of initial opioid prescription and its association with short-term and long-term use among opioid-naïve patients in Malaysia: a retrospective cohort study
Authors: Zin Che Suraya , Nazar Nor Ilyani , Rahman Norny Syafinaz Abdul , Ahmad Wan Rohaidah , Rani Nurul Sahida , Ng Kim Swan 
Published: July 2019

ObjectiveThis study examined opioid prescription initiation patterns and their association with short-term and long-term opioid use among opioid-naïve patients.DesignThis study was designed as a retrospective cohort study.Setting and participantsIn this study, we analysed the prescription databases of tertiary hospitals in Malaysia. This study included patients aged ≥18 years with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1 January 2011 and 31 December 2016. These patients had no opioid prescriptions in the 365 days prior, and were followed up for 365 days after the initial opioid prescription.Main outcome measuresThe main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period and daily dose.ResultsThere were 33 752 opioid-naïve patients who received opioid prescriptions (n=43 432 prescriptions) during the study period. Of these, 29 824 (88.36%) were short-term opioid users and 3928 (11.64%) were long-term opioid users. The majority of these short-term (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3–7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days and long-acting opioids initiated by non-EDs.ConclusionsThe majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-ED hospital departments.
Continuing education for the prevention of mild cognitive impairment and Alzheimer’s-type dementia: a systematic review and overview of systematic reviews
Authors: Matyas Nina , Keser Aschenberger Filiz , Wagner Gernot , Teufer Birgit , Auer Stefanie , Gisinger Christoph , Kil Monika , Klerings Irma , Gartlehner Gerald 
Published: July 2019

ObjectiveTo summarise evidence on the preventive effects of continuing education on mild cognitive impairment and Alzheimer’s-type dementia in adults 45 years or older.DesignSystematic review and overview of systematic reviews.Data sourcesWe systematically searched MEDLINE, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Scopus for published studies and grey literature databases for unpublished studies from January 1990 to April 2018.MethodsTo assess evidence directly addressing our objectives, we conducted a systematic review. Because we were aware of a dearth of direct evidence, we also performed an overview of systematic reviews on leisure activities that mimic formal continuing education. We a priori established the inclusion and exclusion criteria. Two authors independently assessed inclusion and exclusion at the abstract and full-text level, rated the risk of bias, and determined the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation. We resolved all discrepancies by consensus. We synthesised the available evidence narratively.ResultsOur searches identified 4933 citations. For the systematic review, only two publications on the same prospective cohort study (Tasmanian Healthy Brain Project) met the inclusion criteria; for the overview of reviews, we included five systematic reviews. Based on 459 participants, preliminary data of the ongoing cohort study indicated that cognitive reserve statistically significantly increased in persons attending university classes compared with the control group (92.5% vs 55.7%, p<0.01). Likewise, language processing capacities statistically significantly improved (p<0.01). Episodic memory, working memory and executive function did not differ significantly between groups. Systematic reviews consistently reported a positive association between participation in cognitively stimulating leisure activities and reduced incidence of dementia and improved cognitive test performance.ConclusionAvailable results demonstrate that cognitive reserve increases through continuing education and show a positive association of cognitive leisure activities with both improved cognitive function and lower dementia incidence.PROSPERO registration numberCRD42017063944.
Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol
Authors: Jadhakhan Ferozkhan , Lindner Oana C , Blakemore Amy , Guthrie Elspeth 
Published: July 2019

IntroductionMedically unexplained symptoms (MUS) are common in primary-care and secondary-care settings. Persistent symptoms of MUS are associated with a variety of poor outcomes including increased disability, poor quality of life and high healthcare costs. The aim of this systematic review is to review the relevant literature to determine the prevalence of MUS in patients who are high users of healthcare and/or who accrue high healthcare costs.Methods and analysisThis review will include studies with cases that are either high users of general healthcare or are patients who accrue high healthcare costs, aged ≥18 years and where a recognised measure of MUS, either a standardised clinical interview or questionnaire, was employed. The following citation databases MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and the Cochrane library will be systematically searched from inception to 30 June 2018. The Cochrane library was included because of the significant proportion of non-observational studies currently published in the database. The prevalence of MUS and associated disorders along with the costs or use of healthcare associated with the presence of MUS will be estimated with 95% CI. If possible, study results will be pooled into a meta-analysis. However, if heterogeneity is high, data analysis will be presented descriptively.Ethics and disseminationEthical approval is not required for this systematic review since only data from existing studies will be used. Results of this review will be disseminated in peer-reviewed publications and at national and international conferences.PROSPERO registration numberCRD42018100388
Individual mortality information in the German Pharmacoepidemiological Research Database (GePaRD): a validation study using a record linkage with a large cancer registry
Authors: Langner Ingo , Ohlmeier Christoph , Zeeb Hajo , Haug Ulrike , Riedel Oliver 
Published: July 2019

ObjectiveClaims data need to be validated to assess their use for epidemiological research. This study aimed to examine the validity of mortality information in the German Pharmacoepidemiological Research Database (GePaRD).DesignValidation study, secondary data, medical claims.SettingClaims data of two German nationwide acting statutory health insurance providers (SHIs) contributing data for GePaRD; record linkage with epidemiological cancer registry providing individual official mortality information.ParticipantsAll women insured with the two SHIs whose insurance coverage ended in the period 2006–2013 and who were residents of North Rhine Westphalia.MeasuresDescriptive statistics were used to analyse the performance of the linkage procedure. Further, we calculated measures of agreement between the official and the GePaRD-based vital status and assessed differences between the official and the GePaRD-based date of death.ResultsOf the 256 111 women of the linkage sample, 25 528 were classified as ‘deceased’ in GePaRD and the others as ‘alive’. Compared with the official data, the GePaRD-based vital status showed a sensitivity of 95.9% and a specificity of 99.4%. The negative predictive value was 99.6% and the positive predictive value 94.3%. The date of death agreed in 96.3% between both data sources.ConclusionsThe vital status recorded in GePaRD was of high accuracy and discrepancies between dates of death in GePaRD and official dates were rare. This underlines the potential of the database for conducting large cohort studies with mortality as the endpoint.
Leverage points to improve smoking cessation treatment in a large tertiary care hospital: a systems-based mixed methods study
Authors: Ramsey Alex T , Prentice Donna , Ballard Ellis , Chen Li-Shiun , Bierut Laura J 
Published: July 2019

ObjectivesTo generate system insights on patient and provider levers and strategies that must be activated to improve hospital-based smoking cessation treatment.DesignMixed methods study including a series of in-depth group model building sessions, which informed the design of an online survey completed by healthcare providers and a structured interview protocol administered at the bedside to patients who smoke.SettingLarge, tertiary care hospital in the Midwestern United States.ParticipantsGroup model building: 28 healthcare providers and 22 previously-hospitalised patients;Online survey: 308 healthcare providers;Bedside interviews: 205 hospitalised patients.Primary and secondary outcome measuresHypothesis-generating, participatory qualitative methods informed the examination of the following quantitative outcomes: patient interest versus provider perception of patient interest in smoking cessation and treatment; patient-reported receipt versus provider-reported offering of inpatient smoking cessation interventions; and priority ratings of importance and feasibility of strategies to improve treatment.ResultsSystem insightsincluded patients frequently leaving the floor to smoke, which created major workflow disruption.Leverage pointsincluded interventions to reduce withdrawal symptoms, andaction ideasincluded nurse-driven protocols for timely administration of nicotine replacement therapy. Quantitative data corroborated system insights; for instance, 80% of providers reported that patients frequently leave the floor to smoke, leading to safety risks, missed assessments and inefficient use of staff time. Patients reported significantly lower rates of receiving any smoking cessation interventions, compared with provider reports (mean difference=17.4%–33.7%, p<0.001). Although 92% of providers cited patient interest as a key barrier, only 4% of patients indicated no interest in quitting or reducing smoking.ConclusionsEngaging hospital providers and patients in participatory approaches to develop an implementation strategy revealed discrepant perceptions of patient interest and frequency of hospital-based treatment for smoking. These findings spurred adoption of standardised point-of-care treatment for cigarette smoking, which remains highly prevalent yet undertreated among hospitalised patients.
Content analysis of tobacco in episodic programming popular among youth and young adults
Authors: Rath Jessica Miller , Bennett Morgane , Vallone Donna , Hair Elizabeth C 
Published: July 2019

BackgroundWhile evidence exists supporting a causal relationship between exposure to tobacco content in movies and youth smoking, research is limited on the prevalence and impact of tobacco content in episodic programming aired on television (TV) and online streaming platforms. The purpose of this study was to analyse episodic programming popular among young people to estimate the prevalence of tobacco imagery.MethodsAn online survey of participants aged 15–24 years (n=750) recruited from an existing panel was used to gauge viewership of episodic programming aired on Netflix, broadcast TV and cable TV. Two trained coders independently watched the entire 2015/2016 and 2016/2017 seasons of 14 programmes aired on a streaming platform, Netflix, and across broadcast and cable TV. The coding scheme was based on existing methods which involve documenting both the type of tobacco product featured and, if applicable, user information.ResultsEighty-six per cent of Netflix programmes and 86% of broadcast and cable TV programmes had at least one occurrence of tobacco. Netflix programmes had more total occurrences (n=1185) compared with the broadcast or cable programmes (n=482). Most of the tobacco occurrences included cigarettes being actively used by a character.ConclusionsGiven the high prevalence of tobacco use found in these entertainment channels, the level of exposure to tobacco use among youth and young adults is very concerning and is serving to circumvent the restrictions of tobacco advertising on broadcast TV. Further research is needed to understand the influence of this exposure on smoking behaviour.
Characterization and mechanism of the esophago-esophageal contractile reflex of the striated muscle esophagus
Authors: Lang Ivan M. , Medda Bidyut K. , Shaker Reza 
Published: July 2019

An esophago-esophageal contractile reflex (EECR) of the cervical esophagus has been identified in humans. The aim of this study was to characterize and determine the mechanisms of the EECR. Cats ( n = 35) were decerebrated, electrodes were placed on pharynx and cervical esophagus, and esophageal motility was recorded using manometry. All areas of esophagus were distended to locate and quantify the EECR. The effects of esophageal perfusion of NaCl or HCl, vagus nerve or pharyngoesophageal nerve (PEN) transection, or hexamethonium administration (5 mg/kg iv) were determined. We found that distension of the esophagus at all locations activated EECR rostral to stimulus only. EECR response was greatest when the esophagus 2.5–11.5 cm from cricopharyngeus (CP) was distended. HCl perfusion activated repetitively an EECR-like response of the proximal esophagus only within 2 min, and after ~20 min EECR was inhibited. Transection of PEN blocked or inhibited EECR 1–7 cm from CP, and vagotomy blocked EECR at all locations. Hexamethonium blocked EECR at 13 and 16 cm from CP but sensitized its activation at 1–7 cm from CP. EECR of the entire esophagus exists, which is directed in the orad direction only. EECR of striated muscle esophagus is mediated by vagus nerve and PEN and inhibited by mechanoreceptors of smooth muscle esophagus. EECR of smooth muscle esophagus is mediated by enteric nervous system and vagus nerve. Activation of EECR of the striated muscle esophagus is initially sensitized by HCl exposure, which may have a role in prevention of supraesophageal reflux.NEW & NOTEWORTHY An esophago-esophageal contractile reflex (EECR) exists, which is directed in the orad direction only. EECR of the proximal esophagus can appear similar to and be mistaken for secondary peristalsis. The EECR of the striated muscle is mediated by the vagus nerve and pharyngoesophageal nerve and inhibited by mechanoreceptor input from the smooth muscle esophagus. HCl perfusion initially sensitizes activation of the EECR of the striated muscle esophagus, which may participate in prevention of supraesophageal reflux.
Starting Renal Replacement Therapy: Is It About Time?
Authors: Ku Elaine , McCulloch Charles E. , Johansen Kirsten L. 
Published: July 2019

<b><i>Background:</i></b> Studies of the timing of end-stage renal disease (ESRD) have primarily defined “early” versus “late” initiation of dialysis using estimated glomerular filtration rate (eGFR)-based criteria. Our objective was to determine the theoretical <i>time</i> that could be spent in chronic kidney disease (CKD) stage 5 prior to reaching a conservative eGFR threshold of 5 mL/min/1.73 m<sup>2</sup> compared to the actual time spent in CKD stage 5 by risk factors of interest. <b><i>Methods:</i></b> Eight-hundred and seventy Chronic Renal Insufficiency Cohort participants with CKD stage 5 who started renal replacement therapy (RRT) were included for retrospective study. We used mixed models to estimate the person-specific trajectory of renal function. We then used these individual trajectories to estimate the amount of time that would be spent in CKD stage 5 (between eGFR of 15 and 5 mL/min/1.73 m<sup>2</sup>) and compared this estimate to the actual time spent in CKD stage 5 prior to ESRD (between eGFR of 15 mL/min/1.73 m<sup>2</sup> and ESRD). <b><i>Results:</i></b> We found the median observed time between eGFR of 15 mL/min/1.73 m<sup>2</sup> to RRT was 9.6 months, but the median predicted time between eGFR of 15 mL/min/1.73 m<sup>2</sup> to eGFR of 5 mL/min/1.73 m<sup>2</sup> was 17.7 months. Some of the largest differences between the predicted and actual amount of time spent in CKD stage 5 were noted among those with systolic blood pressure &#x3c;140 mm Hg (9.7 months longer predicted compared to actual), proteinuria &#x3c;1 g/g (9.1 months), and serum albumin ≥3.5 g/dL (9.0 months). <b><i>Conclusion:</i></b> We found marked differences between the actual and predicted time spent in CKD stage 5 based on risk factors of interest. We believe that placing timing of dialysis initiation in the perspective of time is novel and may identify subgroups of patients who may derive particular benefit from a more concerted effort to delay RRT.
Feasibility of an Entirely Extracardiac, Minimally Invasive,Temporary Pacing System
Authors: Quast Anne-Floor B.E. , Beurskens Niek E.G. , Ebner Adrian , Wasley Richard , Vehmeijer Jim T. , Marcovecchio Alan , Sanghera Rick , Knops Reinoud E. , Burke Martin C. 
Published: July 2019

Background:
A completely extracardiac pacing system provides the potential for clinical advantages over existing device alternatives that require intravascular, endocardial, or epicardial contact. Preliminary studies evaluating the feasibility of cardiac pacing with a lead in the anterior mediastinum, outside the pericardium and circulatory system have been completed. These studies examined (1) the anatomic access route, (2) the usability of a delivery tool to facilitate lead placement, and (3) the pacing performance of the extracardiac lead.

Methods:
Feasibility evaluations included (1) a retrospective computed tomography analysis to characterize anatomic variations related to lead access, (2) accessing the anterior mediastinum in cadavers and human subjects using a custom delivery tool, and (3) acute clinical pacing performance.

Results:
Major findings: (1) A total of 166 (95%) out of 174 patients had a viable lead access path through the fourth, fifth, or sixth intercostal space. (2) Access to the targeted implant location using a delivery tool was successful in all 5 cadavers and 3 humans without use of fluoroscopy and with an average lead delivery time of 121±52 s. No damage to the lung, pericardium, heart, or internal thoracic vessels occurred. (3) Pacing performance was tested in 6 human subjects showing a threshold voltage of 4.7 V (2.7–6.7), threshold pulse width of 1.8 ms (1.0–2.5), and an impedance of 1205 Ω (894–1786). R-wave amplitudes measured 9.6 mV (5.6–12.0).

Conclusions:
Results support the feasibility for this completely extracardiac pacing method in a heterogeneous patient population, using a minimally invasive, parasternal, delivery approach and with adequate sensing and thresholds suited for temporary pacing.
Prognostically Significant Myocardial Injury in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Sharma Vikram , Dey Tanujit , Sankaramangalam Kesavan , Alansari Shehab A. R. , Williams Louis , Mick Stephanie , Krishnaswamy Amar , Svensson Lars G. , Kapadia Samir 
Published: July 2019

Background
Troponin elevation occurs commonly in the setting of transcatheter aortic valve replacement (TAVR). There is a lack of information on the extent of troponin elevation post TAVR that is prognostically significant. We assessed the optimal cutoff for post‐TAVR troponin T elevation that correlates with long‐term mortality. We also examined the relationship between coronary artery disease (CAD) and prognostically significant myocardial injury in TAVR.

Methods and Results

This is a retrospective, observational single‐center study involving patients who underwent TAVR at Cleveland Clinic between 2010 and 2015. Five hundred ten patients were included (mean follow‐up of 2.6±1.3 years). Receiver operating characteristic analysis showed that troponin T elevation ≥3× upper limit of normal was the best predictor of long‐term mortality post TAVR with area under the curve of 0.57, with transapical TAVR patients excluded. Multivariate analyses confirmed that troponin T elevation ≥3× upper limit of normal was significantly associated with increased long‐term mortality post TAVR (hazard ratio 1.57, CI 1.04–2.38,
P
=0.03). The most common causes for the presence of unrevascularized CAD included the presence of chronic total occlusion in the native/graft vessels (49.7%) and diffuse/complex CAD unsuitable for PCI (24.6%). The presence of unrevascularized CAD and significant left main disease correlated with increased mortality, but not with the presence of prognostically significant myocardial injury.

Conclusions

Troponin T elevation of
≥
3× upper limit of normal is associated with increased long‐term mortality after TAVR, except for the transapical approach. This prognostically significant myocardial injury does not appear to be secondary to severe CAD/unrevascularized CAD or left main disease, but rather is associated with other factors such as post‐TAVR complications.