bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing outcome measures assessing wound management and patient experience: a mixed methods study
Authors: Elliott Daisy 
Published: February 2018

ObjectivesTo develop outcome measures to assess practical management of primary surgical wounds and patient experience.DesignMixed methods, including qualitative interviews and data extraction from published randomised controlled trials (RCTs).SettingTwo university-teaching NHS hospitals and three district NHS hospitals in the South West and Midlands regions of England.ParticipantsSixty-four patients and 15 healthcare professionals from abdominal general surgical specialities and obstetrics (caesarean section).MethodsMeasures were developed according to standard guidelines to identify issues relevant to patients’ experiences of surgical wounds and dressings, including analysis of existing RCT outcomes and semi-structured interviews. These were written into provisional questionnaire items for a single outcome measure. Cognitive interviews with patients and healthcare professionals assessed face validity, acceptability and relevance. Findings from interviews were regularly shared with the study team who suggested amendments to modify and reword items to improve understanding before further iterative testing with patients and healthcare professionals.ResultsAnalyses of existing RCT outcomes and interviews produced a total of 69 issues. Pretesting and iterative revision established the need for two separate measures. One measure addresses healthcare professionals’ experience of wound management in two key areas: exudate and its impact, and allergic reactions to the dressing. The other measure addresses patients’ experience of wounds in seven key areas: wound comfort, dressing removal, dressings to protect the wound, impact on daily activities, ease of movement, anxiety about the wound and satisfaction with dressing. Each measure took less than five min to complete and both were understood and acceptable to patients and healthcare professionals.ConclusionThis in-depth study has developed two measures to assess practical management of primary surgical wounds and patient experience. Further work to test their validity, reliability and application to other settings is now required.Trial registration numberHTA - 12/200/04; Pre-results.
Cohort profile: LIFEWORK, a prospective cohort study on occupational and environmental risk factors and health in the Netherlands
Authors: Reedijk Marije , Lenters Virissa , Slottje Pauline , Pijpe Anouk , Peeters Petra H , Korevaar Joke C , Bueno-de-Mesquita Bas , Verschuren W M Monique , Verheij Robert A , Pieterson Inka , van Leeuwen Flora E , Rookus Matti A , Kromhout Hans , Vermeulen Roel C H 
Published: February 2018

PurposeLIFEWORK is a large federated prospective cohort established in the Netherlands to quantify the health effects of occupational and environmental exposures. This cohort is also the Dutch contribution to the international Cohort Study of Mobile Phone Use and Health (COSMOS). In this paper, we describe the study design, ongoing data collection, baseline characteristics of participants and the repeatability of key questionnaire items.Participants88 466 participants were enrolled in three cohort studies in 2011–2012. Exposure information was collected by a harmonised core questionnaire, or modelled based on occupational and residential histories; domains include air pollution (eg, nitrogen dioxide (NO2), particulate matter with diameter ≤2.5 µm (PM2.5)), noise, electromagnetic fields (EMF), mobile phone use, shift work and occupational chemical exposures. Chronic and subacute health outcomes are assessed by self-report and through linkage with health registries.Findings to dateParticipants had a median age of 51 years at baseline (range 19–87), and the majority are female (90%), with nurses being over-represented. Median exposure levels of NO2, PM2.5, EMF from base stations and noise at the participants’ home addresses at baseline were 22.9 µg/m3, 16.6 µg/m3, 0.003 mWm2and 53.1 dB, respectively. Twenty-two per cent of participants reported to have started using a mobile phone more than 10 years prior to baseline. Repeatability for self-reported exposures was moderate to high (weighted kappa range: 0.69–1) for a subset of participants (n=237) who completed the questionnaire twice.Future plansWe are actively and passively observing participants; we plan to administer a follow-up questionnaire every 4–5 years—the first follow-up will be completed in 2018—and linkage to cause-of-death and cancer registries occurs on a (bi)annual basis. This prospective cohort offers a unique, large and rich resource for research on contemporary occupational and environmental health risks and will contribute to the large international COSMOS study on mobile phone use and health.
Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? Results from cross-sectional studies in 2010 and 2013
Authors: Chen Mingsheng , Qian Dongfu , Feng Zhanchun , Si Lei 
Published: February 2018

ObjectivesGovernment healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China’s rural ethnic minority areas.SettingInner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province.DesignTwo rounds of cross-sectional study.ParticipantsOne thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed.MethodsBenefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted.FindingsThe overall CI for outpatient care was –0.0146 (P>0.05) in 2010 and –0.0992 (P<0.01) in 2013. In 2010, the CI was –0.0537 (P<0.01), –0.0085 (P>0.05) and −0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was –0.1353 (P<0.05), –0.0695 (P>0.05) and –0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively.ConclusionImplementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients’ care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution.
The attitudes towards defensive medicine among physicians of obstetrics and gynaecology in China: a questionnaire survey in a national congress
Authors: Zhu Lan , Li Lei , Lang Jinghe 
Published: February 2018

ObjectiveThe study aimed to determine prevalence, patterns and risk factors of defensive medicine by obstetricians and gynaecologists across China.DesignThis is a questionnaire survey by written and on-line interview for participants.ParticipantsAmong 1804 registered physicians participating at the 2017 Congress of Chinese Obstetricians and Gynecologists Association in Chengdu City, Sichuan Province, China, from 17 to 20 August 2017, 1486 participants (82.4%) responded the survey.Main outcome measuresParticipants’ strongly disagreed/disagreed and strongly agreed/agreed options were compared to determine specific factors contributing to their preferences towards defensive medicine.ResultsIn the whole cohort of 1486 participants, 903/1486 (60.8%), 283/1486 (19.0%) and 170/283 (60.1%) participants had experienced at least one medical dispute, lawsuit or loss of a lawsuit, respectively; and 1284 (86.4%) participants had witnessed their colleagues exposed to medical disputes, lawsuits or loss of a lawsuit. Generally, 62.9% of the participants strongly agreed or agreed with defensive medicine. Gender, administration duty, employment hospital, education status, subspecialty, exposure to any medical disputes, lawsuits or loss of a lawsuit, and colleagues’ experiences were independent risk factors relevant to participants’ preferences about defensive medicine in a multivariate model. Participants were more prone to accept or endorse defensive medicine if they were female physicians; without administrative duties; working in non-tertiary hospitals; with an undergraduate degree; with any exposure to medical disputes, lawsuits or loss of a lawsuit; or having witnessed colleagues’ similar experiences.ConclusionsAbout two-thirds of Chinese physicians practising obstetrics and gynaecology in our survey agreed with the practice of defensive medicine, but they had diverse preferences and understanding of specific practices, harms of defensive medicine and physician’s roles.
Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control
Authors: Hollesen Rikke von Benzon , Johansen Rie Laurine Rosenthal , Rørbye Christina , Munk Louise , Barker Pierre , Kjaerbye-Thygesen Anette 
Published: February 2018

BackgroundA safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%.MethodsThe change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a ‘delivery bundle’, an ‘oxytocin bundle’ and a ‘vacuum extraction bundle’; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming’s system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar <7 after 5 min or pH <7) were analysed using statistical process control.ResultsCompliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH <7 and Apgar <7 after 5 min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions.ConclusionThis QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems.
Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey
Authors: Stoklosa Hanni , Scannell Meredith , Ma Zheng , Rosner Bernard , Hughes Ashley , Bohan J Stephen 
Published: February 2018

ObjectivesOur aim was to determine whether emergency physicians (EPs) felt their standard patient evaluation practice was modified by two non-private clinical encounters: hallway encounters and encounters during which a companion was present.MethodsWe administered an iteratively developed cross-sectional survey at an annual national professional meeting. We used logistic regression to compare relationships among non-private clinical encounters and predictors of interest.Results409 EPs completed the survey. EPs deviated from standard history-taking when practising in a hallway location (78%) and when patients had a companion (84%). EPs altered their standard physical exam when practising in a hallway location (90%) and when patients had a companion (77%). EPs with at least a decade of experience were less likely to alter history-taking in the hallway (OR 0.55, 95% CI 0.31 to 0.99). Clinicians who frequently evaluated patients in the hallway reported delays or diagnostic error-related to altered history-taking (OR 2.34, 95% CI 1.33 to 4.11). The genitourinary system was the most common organ system linked to a delay or diagnostic error. Modifications in history-taking were linked to delays or failure to diagnose suicidal ideation or self-harm (25%), intimate partner violence (40%), child abuse (12%), human trafficking (8%), substance abuse (47%) and elder abuse (17%).ConclusionsOur study suggests that alterations in EP usual practice occurs when the doctor–patient dyad is disrupted by evaluation in a hallway or presence of a companion. Furthermore, these disruptions are associated with delays in care and failure to diagnosis medical, social and psychiatric conditions.
Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis
Authors: Foo Chee Yoong , Bonsu Kwadwo Osei , Nallamothu Brahmajee K , Reid Christopher M , Dhippayom Teerapon , Reidpath Daniel D , Chaiyakunapruk Nathorn 
Published: February 2018

ObjectiveThis study aims to determine the relationship between door-to-balloon delay in primary percutaneous coronary intervention and ST-elevation myocardial infarction (MI) outcomes and examine for potential effect modifiers.MethodsWe conducted a systematic review and meta-analysis of prospective observational studies that have investigated the relationship of door-to-balloon delay and clinical outcomes. The main outcomes include mortality and heart failure.Results32 studies involving 299 320 patients contained adequate data for quantitative reporting. Patients with ST-elevation MI who experienced longer (>90 min) door-to-balloon delay had a higher risk of short-term mortality (pooled OR 1.52, 95% CI 1.40 to 1.65) and medium-term to long-term mortality (pooled OR 1.53, 95% CI 1.13 to 2.06). A non-linear time–risk relation was observed (P=0.004 for non-linearity). The association between longer door-to-balloon delay and short-term mortality differed between those presented early and late after symptom onset (Cochran’s Q 3.88, P value 0.049) with a stronger relationship among those with shorter prehospital delays.ConclusionLonger door-to-balloon delay in primary percutaneous coronary intervention for ST-elevation MI is related to higher risk of adverse outcomes. Prehospital delays modified this effect. The non-linearity of the time–risk relation might explain the lack of population effect despite an improved door-to-balloon time in the USA.Clinical trial registrationPROSPERO (CRD42015026069).
Antiretroviral therapy suppresses rectal HIV-RNA shedding despite inflammation in MSM with rectalC. trachomatisandN. gonorrhoeaeinfections—a cross-sectional, single-center study
Authors: Storim Julian , Verheyen Jens , Wolff Eva , Wohlschlaeger Jeremias , Heintschel von Heinegg Evelyn , Schadendorf Dirk , Esser Stefan 
Published: February 2018

ObjectivesRectal infections withChlamydia trachomatisand/orNeisseria gonorrhoeae(CT/NG) are common in men who have sex with men (MSM) and are linked to HIV transmission. However, rectal CT/NG infections are often asymptomatic and it is not known how they contribute to HIV transmission. We assessed clinical and cytological signs of inflammation as well as rectal HIV-RNA in HIV-infected MSM with and without CT/NG infection.Methods112 HIV-positive MSM with or without rectal symptoms and with or without antiretroviral therapy who underwent high-resolution anoscopy (HRA) at the proctological outpatient centre of the University Hospital Essen, Germany, between November 2013 and February 2014 were included in this cross-sectional study. During the examination, rectal swabs for the assessment of CT/NG, HIV-RNA and inflammatory cells (granulocytes, lymphocytes, histiocytes) were collected. 110 patients were assessed according to the study protocol, and no imputation of missing data was performed.ResultsRectal infections with CT or NG were detected in 17 participants, and 4 participants were coinfected. Only symptomatic CT/NG infections (8/17) showed signs of inflammation in HRA. Symptomatic CT/NG infections were also associated with the detection of lymphocytes and histiocytes in rectal cytology (both P<0.001). In contrast, asymptomatic CT/NG infections neither resulted in clinical nor cytological signs of inflammation. Rectal HIV-RNA was undetectable in all participants with rectal CT/NG infections who received combined antiretroviral therapy (ART) when plasma HIV-RNA was below the limit of detection (n=13). Besides rectal CT/NG infections, syphilis (n=4) and HPV-associated lesions (n=37) were frequently detected, and proctological symptoms were associated with simultaneous infection with ≥2 STDs.ConclusionsOnly symptomatic but not asymptomatic rectal infections with CT and/or NG were associated with clinical and cytological signs of inflammation. Rectal HIV shedding was not promoted by CT/NG infections in patients receiving ART with suppressed plasma HIV-RNA.Trial registration numberUTN: U1111-1150-4804. German Clinical Trials Register (DRKS): DRKS00005468.
Does the location of concentrate provision affect voluntary visits, and milk and milk component yield for cows in an automated milking system?
Authors: Hare K. , DeVries T.J. , Schwartkopf-Genswein K.S. , Penner G.B. 
Published: February 2018

Eight Holstein cows were used in a cross-over design to test whether concentrate allocation in an automated milking system (AMS) affects dry matter intake (DMI) and milk production. Cows were fed a high-energy partial mixed ration (HE-PMR) with 0.5 kg of AMS concentrate or a low-energy PMR (LE-PMR) with 5.0 kg of AMS concentrate. The AMS concentrate intake was greater and PMR intake was reduced for LE-PMR than HE-PMR. Milk, fat, and protein yields were not affected by treatment. In a guided-traffic flow barn, providing a PMR with greater energy density increases DMI, but has no effect on milk and milk component yield.
Atrial Fibrillation and Cause‐Specific Risks of Pulmonary Embolism and Ischemic Stroke
Authors: Hald Erin M. , Rinde Ludvig B. , Løchen Maja‐Lisa , Mathiesen Ellisiv B. , Wilsgaard Tom , Njølstad Inger , Brækkan Sigrid K. , Hansen John‐Bjarne 
Published: February 2018

Background

Atrial fibrillation (
AF
) is a well‐established risk factor for ischemic stroke (
IS
). Emerging evidence also indicates an association between
AF
and pulmonary embolism (
PE
). Because
IS
may potentially mediate the observed risk of
PE
in
AF
, we aimed to assess the impact of
AF
on the cause‐specific risks of
PE
and
IS
in a large cohort recruited from the general population.

Methods and Results

We observed 29 842 participants from 3 surveys of the Tromsø study (inclusion in 1994–1995, 2001–2002, and 2007–2008) to the end of 2012. Incident events of
AF
,
IS,
and
PE
during follow‐up were recorded, and information on potential confounders was obtained at baseline. Cox regression models, with
AF
as a time‐dependent variable, were used to calculate cause‐specific hazard ratios (
HR
s) with 95% confidence intervals (
CI
s) for
PE
and
IS
. There were 2067 participants diagnosed as having
AF
, 296 with
PE
and 1164 with
IS,
during a median of 17.6 years of follow‐up. The risks of
PE
(
HR,
10.88; 95%
CI
, 6.23–18.89) and
IS
(
HR,
6.16; 95%
CI
, 4.47–8.48) were substantially increased during the first 6 months after
AF
diagnosis, with crude incidence rates of 18.5 per 1000 person‐years for
PE
and 52.8 per 1000 person‐years for
IS
. The risk estimates remained elevated for both
PE
(
HR
, 1.72; 95%
CI,
1.10–2.71) and
IS
(
HR,
2.45; 95%
CI,
2.05–2.92) throughout the study period.

Conclusions

AF
was associated with increased cause‐specific risks of both
PE
and
IS
. Our findings infer that the risk of
PE
in
AF
is not explained by intermediate
IS
.
Integrating mammographic breast density in glandular dose calculation
Authors: Suleiman Moayyad E , Brennan Patrick C , Ekpo Ernest , Kench Peter , McEntee Mark F 
Published: February 2018

Objective:
This work proposes the use of mammographic breast density (MBD) to estimate actual glandular dose (AGD), and assesses how AGD compares to mean glandular dose (MGD) estimated using Dance et al method.

Methods:
A retrospective sample of anonymised mammograms (52,405) was retrieved from a central database. Technical parameters and patient characteristics were exported from the Digital Imaging and Communication in Medicine (DICOM) header using third party software. LIBRA (Laboratory for Individualized Breast Radiodensity Assessment) software package (University of Pennsylvania, Philadelphia, USA) was used to estimate MBDs for each mammogram included in the data set. MGD was estimated using Dance et al method, while AGD was calculated by replacing Dance et al standard glandularities with LIBRA estimated MBDs. A linear regression analysis was used to assess the association between MGD and AGD, and a Bland-Altman analysis was performed to assess their mean difference.

Results:
The final data set included 31,097 mammograms from 7728 females. MGD, AGD, and MBD medians were 1.53 , 1.62 mGy and 8% respectively. When stratified per breast thickness ranges, median MBDs were lower than Dance’s standard glandularities. There was a strong positive correlation (R 2 = 0.987, p &lt; 0.0001) between MGD and AGD although the Bland-Altman analysis revealed a small statistically significant bias of 0.087 mGy between MGD and AGD (p &lt; 0.001).

Conclusion:
AGD estimated from MBD is highly correlated to MGD from Dance method, albeit the Dance method underestimates dose at smaller CBTs.

Advances in knowledge:
Our work should provide a stepping-stone towards an individualised dose estimation using automated clinical measures of MBD.