bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis
Authors: Al-Shakarchi Nader , Obolensky Lucy , Walpole Sarah , Hemingway Harry , Banerjee Amitava 
Published: August 2019

ObjectiveTo assess global health (GH) training in all postgraduate medical education in the UK.DesignMixed methodology: scoping review and curricular content analysis using two GH competency frameworks.Setting and participantsA scoping review (until December 2017) was used to develop a framework of GH competencies for doctors. National postgraduate medical training curricula were analysed against this and a prior framework for GH competencies. The number of core competencies addressed and/or appearing in each programme was recorded.OutcomesThe scoping review identified eight relevant publications. A 16-competency framework was developed and, with a prior 5-competency framework, used to analyse each of 71 postgraduate medical curricula. Curricula were examined by a team of researchers and relevant learning outcomes were coded as one of the 5 or 16 core competencies. The number of core competencies in each programme was recorded.ResultsUsing the 5-competency and 16-competency frameworks, 23 and 20, respectively, out of 71 programmes contained no global health competencies, most notably the Foundation Programme (equivalent to internship), a compulsory programme for UK medical graduates. Of a possible 16 competencies, the mean number across all 71 programmes was 1.73 (95% CI 1.42 to 2.04) and the highest number were in paediatrics and infectious diseases, each with five competencies. Of the 16 core competencies, global burden of disease and socioeconomic determinants of health were the two most cited with 47 and 35 citations, respectively. 8/16 competencies were not cited in any curriculum.ConclusionsEquity of care and the challenges of practising in an increasingly globalised world necessitate GH competencies for all doctors. Across the whole of postgraduate training, the majority of UK doctors are receiving minimal or no training in GH. Our GH competency framework can be used to map and plan integration across postgraduate programmes.
Guidance from key organisations on exploring, confirming and interpreting subgroup effects of medical treatments: a scoping review
Authors: Wijn Stan R W , Rovers Maroeska M , Le Ly H , Belias Michail , Hoogland Jeroen , IntHout Joanna , Debray Thomas , Reitsma Johannes B 
Published: August 2019

ObjectivesWith the increasing interest in personalised medicine, the use of subgroup analyses is likely to increase. Subgroup analyses are challenging and often misused, possibly leading to false interpretations of the effect. It remains unclear to what extent key organisations warn for such pitfalls and translate current methodological research to detect these effects into research guidelines. The aim of this scoping review is to determine and evaluate the current guidance used by organisations for exploring, confirming and interpreting subgroup effects.DesignScoping review.Eligibility criteriaWe identified four types of key stakeholder organisations: industry, health technology assessment organisations (HTA), academic/non-profit research organisations and regulatory bodies. After literature search and expert consultation, we identified international and national organisations of each type. For each organisation that was identified, we searched for official research guidance documents and contacted the organisation for additional guidance.ResultsTwenty-seven (45%) of the 60 organisations that we included had relevant research guidance documents. We observed large differences between organisation types: 18% (n=2) of the industry organisations, 64% (n=9) of the HTA organisations, 38% (n=8) of academic/non-profit research organisations and 57% (n=8) of regulatory bodies provided guidance documents. The majority of the documents (n=33, 63%) mentioned one or more challenges in subgroup analyses, such as false positive findings or ecological bias with variations across the organisation types. Statistical recommendations were less common (n=19, 37%) and often limited to a formal test of interaction.ConclusionsAlmost half of the organisations included in this scoping review provided guidance on subgroup effect research in their guidelines. However, there were large differences between organisations in the amount and level of detail of their guidance. Effort is required to translate and integrate research findings on subgroup analysis to practical guidelines for decision making and to reduce the differences between organisations and organisation types.
Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: protocol for an overview of systematic reviews
Authors: Trentino Kevin M , Farmer Shannon L , Sanfilippo Frank M , Leahy Michael F , Isbister James , Mayberry Rhonda , Hofmann Axel , Murray Kevin 
Published: August 2019

IntroductionThere has been a significant increase in the number of systematic reviews and meta-analyses of randomised controlled trials investigating thresholds for red blood cell transfusion. To systematically collate, appraise and synthesise the results of these systematic reviews and meta-analyses, we will conduct an overview of systematic reviews.Methods and analysisThis is a protocol for an overview of systematic reviews. We will search five databases: MEDLINE, Embase, Web of Science Core Collection, PubMed (for prepublication, in process and non-Medline records) and Google Scholar. We will consider systematic reviews and meta-analyses of randomised controlled trials evaluating the effect of haemoglobin thresholds for red blood cell transfusion on mortality. Two authors will independently screen titles and abstracts retrieved in the literature search and select studies meeting the eligibility criteria for full-text review. We will extract data onto a predefined form designed to summarise the key characteristics of each review. We will assess the methodological quality of included reviews and the quality of evidence in included reviews.Ethics and disseminationFormal ethics approval is not required for this overview as we will only analyse published literature. The findings of this study will be presented at relevant conferences and submitted for peer-review publication. The results are likely to be used by clinicians, policy makers and developers of clinical guidelines and will inform suggestions for future systematic reviews and randomised controlled trials.PROSPERO registration numberCRD42019120503.
Frailty Levels In Geriatric Hospital paTients (FLIGHT)—the prevalence of frailty among geriatric populations within hospital ward settings: a systematic review protocol
Authors: Doody Paul , Aunger Justin , Asamane Evans , Greig Carolyn A , Lord Janet , Whittaker Anna 
Published: August 2019

IntroductionFrailty is a common and clinically significant condition in geriatric populations, associated with adverse health outcomes such as hospitalisation, disability and mortality. Although there are systematic reviews/meta-analyses assessing the prevalence of frailty in community-dwelling older adults, nursing home residents, and cancer and general surgery patients, there are none assessing the overall prevalence of frailty in geriatric hospital inpatients.Methods and analysisThis review will systematically search and analyse the prevalence of frailty within geriatric hospital inpatients within the literature. A search will be employed on the platforms of Ovid, Web of Science and databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, SCOPUS and the Cochrane Library. Any observational or experimental study design which utilises a validated operational definition of frailty, reports the prevalence of frailty, has a minimum age ≥65 years, attempts to assess the whole ward/clinical population and occurs in hospital inpatients, will be included. Title and abstract and full-text screenings will be conducted by three reviewers. Methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal tool. Data extraction will be performed by two reviewers. If sufficient data are available, a meta-analysis synthesising pooled estimates of the prevalence of frailty and pre-frailty, as well as the prevalence of frailty stratified by age, sex, operational frailty definition, prevalent morbidities, ward type and location, among older hospitalised inpatients will be conducted. Clinical heterogeneity will be assessed by two reviewers. Statistical heterogeneity will be assessed through a Cochran Q test, and an I2test performed to assess its magnitude.Ethics and disseminationEthical approval was not required as primary data will not be collected. Findings will be disseminated through publication in peer reviewed open access scientific journals, public engagement events, conference presentations and social media.PROSPERO registration number79202.
Developing and testing a matrix to achieveready-everyday nursing standards(RENS): an observational study protocol
Authors: Ratsch Angela , Sewell Fiona , Pennington Adrian 
Published: August 2019

IntroductionThe Australian Council on Healthcare Standards (ACHS) set criteria for the delivery of healthcare services in Australia. While a voluntary process, continual accreditation with ACHS is an expectation of, and for, Australian healthcare providers. Juxtapositioned with the ACHS, the Nursing and Midwifery Board of Australia (NMBA) set the mandatory practice requirements of, and for, Australian nurses. Despite these overarching quality and governance directives, a regional Queensland Hospital and Health Service (HHS) demonstrated deficits in the quality of nursing care. Accordingly, a HHS project was commissioned with the aim of producing a quantum shift in the quality of nursing services such that the service wasready-everydayfor accreditation assessment, and nursing practice exemplified the NMBA standards.Several barriers to achieving the aim were identified and it was considered that the implementation of critical system changes would structurally and operationally support the achievement of the aim. The system changes are pivoted around an interactive matrix that links nursing care services to the array of nursing professional and practice standards and provides real-time quantitative output measures. This paper outlines the protocol that will be used to establish, implement and evaluate the matrix.Methods and analysisA participatory action research design with a modified Delphi methodology will be used for the development the matrix. The organisational change management around the matrix implementation will be informed by Kotter’s model and supported by the use of the McKinsey 7S. The matrix implementation phase will be conducted using a modifiedPromoting Action on Research Implementation in Health Servicesmodel. Quantitative and qualitative data will be collected over a 12 month pre-test/post-test design to measure the statistical significance of the matrix in supporting compliance with nursing standards and the achievement of quality nursing care. Quantitative data from quality of care assessments will be analysed using descriptive and comparative statistics. Qualitative data from staff surveys will be analysed by content analysis of the major themes (n~200).Ethics and disseminationThe project has ethics approval from a Queensland Health Human Research Ethics Committee. Results will be reported to participants and other stakeholders at seminars and conferences and through peer-reviewed publications.
The value of Facebook in nation-wide hospital quality assessment: a national mixed-methods study in Norway
Authors: Bjertnaes Oyvind , Iversen Hilde Hestad , Skyrud Katrine Damgaard , Danielsen Kirsten 
Published: August 2019

ObjectivesThe objective was to assess the possibility of using a combination of official and unofficial Facebook ratings and comments as a basis for nation-wide hospital quality assessments in Norway.MethodsAll hospitals from a national cross-sectional patient experience survey in 2015 were matched with corresponding Facebook ratings. Facebook ratings were correlated with both case-mix adjusted and unadjusted patient-reported experience scores, with separate analysis for hospitals with official site ratings and hospitals with unofficial site ratings. Facebook ratings were also correlated with patient-reported incident scores, hospital size, 30-day mortality and 30-day readmission. Facebook comments from 20 randomly selected hospitals were analysed, contrasting the content and sentiments of official versus unofficial Facebook pages.ResultsFacebook ratings were significantly correlated with most patient-reported indicators, with the highest correlations relating to unadjusted scores for organisation (0.60, p<0.000) and nursing services (0.57, p<0.000). Facebook ratings were significantly correlated with hospital size (−0.40, p=0.003) and 30-day mortality (0.31, p=0.040). Sentiment analysis showed that 84.7% of the comments from unofficial Facebook sites included neutral comments that did not give any specific description of experiences of the quality of care at the hospital. Content analysis identified common themes on official and unofficial Facebook pages.ConclusionsFacebook ratings were associated with patient-reported indicators, hospital size, and 30-day mortality. Qualitative comments from official Facebook are more relevant for hospital evaluation than unofficial sites. More research is needed on using Facebook ratings as a standalone indicator of patient experiences in national quality measurement, and such ratings should be reported together with research-based patient experience indicators and with explicit criteria for the inclusion of unofficial sites.
Say what? Patients have poor immediate memory of major risks of interscalene block disclosed during the informed consent discussion
Authors: Bai Johnny Wei , Abdallah Faraj W , Cohn Melanie , Ladowski Stephanie , Madhusudan Poorna , Brull Richard 
Published: August 2019

BackgroundPoor memory of disclosed risks can undermine informed consent and create medicolegal challenges. The extent to which patients remember the risks of peripheral nerve blockade following the informed consent discussion is unknown. This prospective cohort study evaluated patients’ immediate memory of risks related to interscalene block (ISB) that were disclosed during the preoperative informed consent discussion.MethodsUsing a standardized script, patients scheduled for arthroscopic shoulder surgery were informed of the risks of ISB by an anesthesiologist in the preoperative assessment clinic. Immediately thereafter, consenting participants were asked to identify the risks of ISB from a printed list of nine true risks (four major and five minor) and nine ‘distractor’ items, which were unrelated adverse events and not disclosed. The primary outcome was the proportion of participants who remembered all four true major risks includinglong-term nerve damage, seizure, life-threatening event, and damage to the covering of the lung.ResultsAmong 125 participants, only 26 (21%) remembered all four major risks of ISB. The mean number of major risks remembered was 2±1 out of 4. Fifteen (12%) participants remembered all nine true risks. The mean number of true risks remembered was 6±2 out of 9. Multivariable analysis revealed that participants’ self-rated assessment of their memory was not associated with actual recall.ConclusionPatients have poor immediate memory of the major risks related to ISB disclosed during the informed consent discussion. Under the present study conditions, the validity of the informed consent process for patients undergoing ISB may be undermined.
NT‐proBNP and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study
Authors: Nagata Takuya , Ohara Tomoyuki , Hata Jun , Sakata Satoko , Furuta Yoshihiko , Yoshida Daigo , Honda Takanori , Hirakawa Yoichiro , Ide Tomomi , Kanba Shigenobu , Kitazono Takanari , Tsutsui Hiroyuki , Ninomiya Toshiharu 
Published: August 2019

Background

Epidemiological evidence implies a link between heart disease and dementia. However, few prospective studies have assessed the association between serum
NT
‐pro
BNP
(N‐terminal pro–B‐type natriuretic peptide) levels and dementia.

Methods and Results

A total of 1635 community‐dwelling Japanese elderly aged ≥60 years without dementia (57% women, mean age±SD 70.8±7.7 years) were followed up for 10 years. Serum
NT
‐pro
BNP
levels were divided into 4 categories (≤54, 55‐124, 125‐299, and ≥300 pg/mL). The hazard ratios were estimated using a Cox proportional hazards model. During the follow‐up period, 377 subjects developed all‐cause dementia, 247 Alzheimer disease, and 102 vascular dementia. The age‐ and sex‐adjusted incidence of all‐cause dementia was 31.5 per 1000 person‐years and increased significantly with higher serum
NT
‐pro
BNP
levels, being 16.4, 32.0, 35.7, and 45.5, respectively (
P
for trend <0.01). Subjects with serum
NT
‐pro
BNP
levels of ≥300 pg/mL had a significantly higher risk of all‐cause dementia (hazard ratio=2.46, 95% CI 1.63‐3.71) than those with serum
NT
‐pro
BNP
levels of ≤54 pg/
mL
after adjusting for confounders. Similar risks were observed for Alzheimer disease and vascular dementia. Incorporation of the serum
NT
‐pro
BNP
level into a model with known risk factors for dementia significantly improved the predictive ability for incident dementia (c‐statistics 0.780‐0.787,
P
=0.02; net reclassification improvement 0.189,
P
=0.001; integrated discrimination improvement 0.011,
P
=0.003).

Conclusions

Higher serum
NT
‐pro
BNP
levels were significantly associated with an increased risk of dementia. Serum
NT
‐pro
BNP
could be a novel biomarker for predicting future risk of dementia in the general elderly population.
The War-Trumpet and the Sound of Domination in Ancient Greek Thought
Authors: Nooter Sarah 
Published: August 2019

Abstract
In this piece, I contend that the war-trumpet (salpinx) was understood in ancient Greek literature as connected to the divine and invincible. I show how this understanding arose from a focus on the sound of the war-trumpet, accompanied by silence around the physical act of playing it, inasmuch as this act, in the parallel case of the aulos, reveals embodiment and vulnerability. In archaic and classical texts, ranging among Aristophanes, Thucydides, Homer, Aeschylus, Sophocles and Aristotle, we see that the sound of the salpinx is both infallible and capable of connoting the domination of Greek males in several fields: battles, courts of law, and the imagining of human and nonhuman ontology.
Reading and Writing, Singing and Playing on Three Early Red-Figure Vases
Authors: Pöhlmann Egert 
Published: August 2019

Abstract
The tools for reading and writing, the writing tablets and the papyrus scroll, were inherited by Greece from the East together with the Phoenician alphabet. The oldest papyrus scroll and writing tablets with Greek text were found in the tomb of a musician in Daphne dated to 430 BC. After 700 BC writing tablets were ubiquitous in Greece. However, black figure vases do not depict them. The first writing tablet appears on a red figure kylix of the Euergides Painter from Vulci (520). The first papyrus scrolls appear, together with writing tablets and the lyre, on a kylix from Ferrara (c. 480-70). Papyrus scrolls, writing tablets, the lyre and aulos appear together on the famous Berlin kylix of Douris from Caere (480).
On Kinesias’ Musicopoetic Paranomia
Authors: Hadjimichael Theodora A. 
Published: August 2019

Abstract
In this article I focus on the New Poet Kinesias and on the ways in which he was depicted, ridiculed, and criticized in our sources. I contextualize his depiction as a poetic and musical corrupter and as a thin and disabled individual within the criticism of the New Music in late fifth- and early fourth-century philosophical works, namely those by Plato and Aristotle, to argue that he was considered the poet who embodied the musicopoetic paranomia and the lack of orthotēs in the New Music. I also bring into my analysis a fragment from a speech of Lysias against Kinesias, where I focus on the accusations against the poet, in order to show that both his political actions (as described in the fragment and in Athenaeus who transmits the passage) and his experimentations with the chorus and with poetic performances were interpreted as a threat to the coherence and stability of the community.
Irish Quaker Identities: Complex Identity in the Religious Society of Friends
Authors: Kennedy Maria 
Published: August 2019

Abstract
This work is a sociological study of Quakers, which investigates the impact that sectarianism has had on identity construction within the Religious Society of Friends in Ireland. The research highlights individual Friends’ complex and hybrid cultural, national and theological identities, mirrored by the Society’s corporate identity. This publication focuses specifically on examples of political and theological hybridity. These hybrid identities resulted in tensions that impact on relationships between Friends and the wider organisation. How Friends negotiate and accommodate these diverse identities is explored. It is argued that Irish Quakers prioritise ‘relational unity’ and have developed a distinctive approach to complex identity management. It is asserted that in the two Irish states, ‘Quaker’ represents a meta-identity, which is counter-cultural in its non-sectarianism, although this is more problematic within the organisation. Furthermore, by modelling an alternative, non-sectarian identity, Quakers in Ireland contribute to building capacity for transformation from oppositional, binary identities to more fluid and inclusive ones.
Obesity Is the Most Common Risk Factor for Chronic Liver Disease: Results From a Risk Stratification Pathway Using Transient Elastography
Authors: Harris Rebecca , Card Timothy R. , Delahooke Toby , Aithal Guruprasad P. , Guha Indra N. 
Published: August 2019

INTRODUCTION:
Obesity has been associated with liver fibrosis, yet guidelines do not emphasize it as an independent risk factor in which to have a high index of suspicion of advanced disease. We aimed to elucidate the effect of a raised body mass index on the risk of liver disease using data from a community risk stratification pathway.

METHODS:
We prospectively recruited patients from a primary care practice with hazardous alcohol use and/or type 2 diabetes and/or obesity. Subjects were invited for a transient elastography reading. A threshold of ≥8.0 kPa defined an elevated reading consistent with clinically significant liver disease.

RESULTS:
Five hundred seventy-six patients participated in the pathway; of which, 533 patients had a reliable reading and 66 (12.4%) had an elevated reading. Thirty-one percent of patients with an elevated reading had obesity as their only risk factor. The proportion of patients with an elevated reading was similar among those with obesity (8.9%) to patients with more recognized solitary risk factors (type 2 diabetes 10.8%; hazardous alcohol use 4.8%). Obesity in combination with other risk factors further increased the proportion of patients with an elevated reading. In multivariate logistic regression, increasing body mass index and type 2 diabetes were significantly associated with an elevated reading.

DISCUSSION:
Obesity as a single or additive risk factor for chronic liver disease is significant. Future case-finding strategies using a risk factor approach should incorporate obesity within proposed algorithms.