bluuebunny/crossref_metadata_2025_split huggingface dataset:
Joint observation in NICU (JOIN): study protocol of a clinical randomised controlled trial examining an early intervention during preterm care
Authors: Schneider Juliane , Borghini Ayala , Morisod Harari Mathilde , Faure Noemie , Tenthorey Chloé , Le Berre Aurélie , Tolsa Jean-François , Horsch Antje 
Published: March 2019

IntroductionPreterm birth may generate significant distress among the parents, who often present with difficulties in appropriating their parental role. Parental stress and low perceived parental self-efficacy may interfere with the infant’s socioemotional and cognitive development, particularly through disrupted parent–infant interactions. Perceived parental self-efficacy represents the belief of efficacy in caring for one’s own infant and successful incarnation of the parental role, as well as the perception of one’s own abilities to complete a specified task. Interventions to support parental role, as well as infant development, are needed, and parental self-efficacy represents a useful indicator to measure the effects of such early interventions.Methods and analysisThis study protocol describes a randomised controlled trial that will test an early intervention in the neonatal intensive care unit (NICU) (JOIN: Joint Observation In Neonatology) carried out by an interdisciplinary staff team. Mothers of preterm neonates born between 28 and 32 6/7 weeks of gestational age are eligible for the study. The intervention consists of a videotaped observation by a clinical child psychologist or child psychiatrist and a study nurse of a period of care delivered to the neonate by the mother and a NICU nurse. The care procedure is followed by an interactive video guidance intended to demonstrate the neonate’s abilities and resources to his parents. The primary outcome will be the difference in the perceived maternal self-efficacy between the intervention and control groups assessed by self-report questionnaires. Secondary outcomes will be maternal mental health, the perception of the parent– infant relationship, maternal responsiveness and the neurodevelopment of the infant at 6 months corrected age.Ethics and disseminationEthical approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 496/12). Results from this study will be disseminated at national and international conferences, and in peer-reviewed journals.Trial registration numberNCT02736136, Pre-results.
Aetiology and risks factors associated with the fatal outcomes of childhood pneumonia among hospitalised children in the Philippines from 2008 to 2016: a case series study
Authors: Dembele Bindongo Price Polycarpe , Kamigaki Taro , Dapat Clyde , Tamaki Raita , Saito Mariko , Saito Mayuko , Okamoto Michiko , Igoy Mary Ann U , Mercado Edelwisa Segubre , Mondoy Melisa , Tallo Veronica L , Lupisan Socorro P , Egawa Shinichi , Oshitani Hitoshi 
Published: March 2019

ObjectivePneumonia remains the leading cause of hospitalisations and deaths among children aged <5 years. Diverse respiratory pathogens cause acute respiratory infections, including pneumonia. Here, we analysed viral and bacterial pathogens and risk factors associated with death of hospitalised children.DesignA 9-year case series study.SettingTwo secondary-care hospitals, one tertiary-care hospital and one research centre in the Philippines.Participants5054 children aged <5 years hospitalised with severe pneumonia.MethodsNasopharyngeal swabs for virus identification, and venous blood samples for bacterial culture were collected. Demographic, clinical data and laboratory findings were collected at admission time. Logistic regression analyses were performed to identify the factors associated with death.ResultsOf the enrolled patients, 57% (2876/5054) were males. The case fatality rate was 4.7% (238/5054), showing a decreasing trend during the study period (p<0.001). 55.0% of the patients who died were either moderately or severely underweight. Viruses were detected in 61.0% of the patients, with respiratory syncytial virus (27.0%) and rhinovirus (23.0%) being the most commonly detected viruses. In children aged 2–59 months, the risk factors significantly associated with death included age of 2–5 months, sensorial changes, severe malnutrition, grunting, central cyanosis, decreased breath sounds, tachypnoea, fever (≥38.5°C), saturation of peripheral oxygen <90%, infiltration, consolidation and pleural effusion on chest radiograph.Among the pathogens, adenovirus type 7, seasonal influenza A (H1N1) and positive blood culture for bacteria were significantly associated with death. Similar patterns were observed between the death cases and the aforementioned factors in children aged <2 months.ConclusionMalnutrition was the most common factor associated with death and addressing this issue may decrease the case fatality rate. In addition, chest radiographic examination and oxygen saturation measurement should be promoted in all hospitalised patients with pneumonia as well as bacteria detection to identify patients who are at risk of death.
Escape into patient safety: bringing human factors to life for medical students
Authors: Backhouse Adam , Malik Myra 
Published: March 2019

BackgroundPatient safety is at the core of the General Medical Council (GMC) standards for undergraduate medical education. It is recognised that patient safety and human factors’ education is necessary for doctors to practice safely. Teaching patient safety to medical students is difficult. Institutions must develop expertise and build curricula while students must also be able to see the subject as relevant to future practice. Consequently graduates may lack confidence in this area.MethodWe used gamification (the application of game design principles to education) to create a patient safety simulation for medical students using game elements. Gamification builds motivation and engagement, whilst developing teamwork and communication. We designed an escape room—a team-based game where learners solve a series of clinical and communication-based tasks in order to treat a fictional patient while avoiding ‘clinician error’. This is followed up with an after action review where students reflect on their experience and identify learning points.OutcomeStudents praised the session’s interactivity and rated it highly for gaining new knowledge and skills and for increasing confidence to apply patient safety concepts to future work.ConclusionOur findings are in line with existing evidence demonstrating the success of experiential learning interventions for teaching patient safety to medical students. Where the escape room has potential to add value is the use of game elements to engage learners with the experience being recreated despite its simplicity as a simulation. More thorough evaluation of larger pilots is recommended to continue exploring the effectiveness of escape rooms as a teaching method.
COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months
Authors: Sivapalan Pradeesh , Ingebrigtsen Truls Sylvan , Rasmussen Daniel Bech , Sørensen Rikke , Rasmussen Christian Madelaire , Jensen Camilla Bjørn , Allin Kristine Højgaard , Eklöf Josefin , Seersholm Niels , Vestbo Joergen , Jensen Jens-Ulrik Stæhr 
Published: March 2019

IntroductionA large group of patients with chronic obstructive pulmonary disease (COPD) are exposed to an overload of oral corticosteroids (OCS) due to repeated exacerbations. This is associated with potential serious adverse effects. Therefore, we evaluated the impact of a recommended reduction of OCS duration in 2014 on the risk of pneumonia hospitalisation and all-cause mortality in patients with acute exacerbation of COPD (AECOPD).MethodsThis was a nationwide observational cohort study that was based on linked administrative registry data between 1 January 2010 and 31 October 2017. 10 152 outpatients with COPD (median age 70 years) treated with either a short (≤250 mg) or long course (>250 mg) of OCS for AECOPD were included in the study. Cox proportional hazards regression models were used to derive an estimation of multivariable adjusted HRs (aHRs) for pneumonia hospitalisation or all-cause mortality combined and pneumonia hospitalisation and all-cause mortality, separately.ResultsThe long course of OCS treatment for AECOPD was associated with an increased 1-year risk of pneumonia hospitalisation or all-cause mortality (aHR 1.3, 95% CI 1.1 to 1.4; p<0.0001), pneumonia hospitalisation (aHR 1.2, 95% CI 1.0 to 1.3; p=0.0110) and all-cause mortality (aHR 1.8, 95% CI 1.5 to 2.2; p<0.0001) as compared with the short course of OCS treatment. These results were confirmed in several sensitivity analyses.ConclusionThe change of recommendations from long courses to short courses of OCS for AECOPD in 2014 was strongly associated with a decrease in pneumonia admissions and all-cause mortality, in favour of short courses of OCS.
Antithrombotic therapy after femoropopliteal artery stenting: 12-month results from Japan Postmarketing Surveillance
Authors: Kawarada Osami , Nakai Michikazu , Nishimura Kunihiro , Miwa Hideki , Iwasaki Yusuke , Kanno Daitaro , Nakama Tatsuya , Yamamoto Yoshito , Ogata Nobuhiko , Nakamura Masato , Yasuda Satoshi 
Published: March 2019

ObjectiveTo investigate the effects of antithrombotic therapy on target lesion revascularisation (TLR) and major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months after femoropopliteal intervention with second-generation bare metal nitinol stents.MethodsA total of 277 lesions in 258 limbs of 248 patients with de novo atherosclerosis in the above-the-knee femoropopliteal segment were analysed from the Japan multicentre postmarketing surveillance.ResultsAt discharge, dual antiplatelet therapy (DAPT) was prescribed in 68.5% and cilostazol in 30.2% of patients. At 12 months of follow-up, prescriptions of DAPT significantly (p=0.0001) decreased to 51.2% and prescription of cilostazol remained unchanged (p=0.592) at 28.0%. Prescription of warfarin also remained unchanged (14.5% at discharge, 13.3% at 12 months, p=0.70). At 12 months, freedoms from TLR and MACCE were 89.4% and 89.7%, respectively. In a multivariate Cox proportional hazards model, neither DAPT nor cilostazol at discharge was associated with both TLR and MACCE at 12 months. However, warfarin at discharge was only independently associated with TLR at 12 months. Kaplan-Meier estimates demonstrated that warfarin at discharge yielded a significantly (p=0.013) lower freedom from TLR at 12 months than no warfarin at discharge. Freedom from TLR at 12 months by the Kaplan-Meier estimates was 77.8% (95% CI 59.0% to 88.8%) in patients with warfarin at discharge and 91.2% (95% CI 86.3% to 94.3%) in those without warfarin at discharge.ConclusionsClinical benefits of DAPT or cilostazol might be small in terms of TLR and MACCE at 12 months. Anticoagulation with warfarin at discharge might increase TLR at 12 months.
Age-specific incidence of injury-related hospital contact after release from prison: a prospective data-linkage study
Authors: Young Jesse T , Borschmann Rohan , Preen David B , Spittal Matthew J , Brophy Lisa , Wang Emily A , Heffernan Ed , Kinner Stuart A 
Published: March 2019

BackgroundIn population studies, the risk of injury declines after early adulthood. It is unclear if a similar age difference in the risk of injury exists among people released from prison.MethodsPrerelease survey data collected between 1 August 2008 and 31 July 2010, from a representative cohort of sentenced adults (≥18 years) in Queensland, Australia, were linked prospectively and retrospectively to person-level emergency department, inpatient hospital and correctional records. To ascertain predictors of injury-related hospital contact, we fit a multivariate Andersen-Gill model and tested the interactions between age group (<25 years, ≥25 years) and each variable.ResultsIn 1307 adults released from prison, there were 3804 person-years of follow-up. The crude injury rate was 385 (95% CI 364 to 407) per 1000 person-years and did not differ according to age group. Factors associated with increased injury-related hospital contact included a history of mental illness, preincarceration injury, a history of incarceration, release from a short prison sentence (<90 days), being reincarcerated during follow-up and identifying as Indigenous. The effect of mental illness, risky alcohol use, prior incarceration and intellectual disability differed across age group and predicted increased risk of injury among people aged ≥25 years compared with their counterparts without these characteristics.ConclusionsUnlike in the general population where the risk of injury declines with age, older adults released from prison are at similar risk compared with their younger peers. Adults released from prison with mental illness, a history of injury-related hospital contact and who identify as Indigenous are particularly indicated groups for injury prevention.
Developing drowning prevention strategies for rivers through the use of a modified Delphi process
Authors: Peden Amy E , Franklin Richard C , Leggat Peter A 
Published: March 2019

IntroductionInternationally, rivers are a leading drowning location, yet little evidence exists evaluating river drowning prevention strategies. This study aims to use expert opinion to identify strategies more likely to be effective.MethodsUsing a modified Delphi process, a virtual panel of 30 experts from 12 countries considered, grouped and prioritised strategies for river drowning prevention. Proposed strategies were assessed against known evidence and suitability in high-income countries (HICs) as well as low-income and middle-income countries (LMICs) using expert opinion. The final phase consolidated a list of strategies whose effectiveness was assessed against 10 evidence-based river drowning scenarios.ResultsAn initial list of 424 prevention strategies was refined to 22. After being assessed against the 10 scenarios, a final list of 13 strategies was derived. Strategies addressed alcohol consumption around rivers, flood mitigation, improving child supervision, learning to swim, increased lifejacket wear and achieving community-wide resuscitation skills.DiscussionWhile all 13 strategies were assessed as being effective in both LMICs and HICs by at least 60% of the respondents, further work is required to define river drowning at a country level and therefore allow for effective solutions to be developed, particularly in LMICs. No strategy will be effective in isolation and must be implemented alongside policy and behaviour change, public awareness and education. Evaluation should be incorporated as part of any future implementation of strategies.ConclusionThis Delphi process identified 13 drowning prevention strategies for rivers. Further research is required to validate the efficacy of these findings through implementation and evaluation.
Neighbourhood disadvantage and depressive symptoms among adolescents followed into emerging adulthood
Authors: Goldstein Rise B , Lee Awapuhi K , Haynie Denise L , Luk Jeremy W , Fairman Brian J , Liu Danping , Jeffers Jacob S , Simons-Morton Bruce G , Gilman Stephen E 
Published: March 2019

BackgroundResidents of disadvantaged neighbourhoods report higher levels of depressive symptoms; however, few studies have employed prospective designs during adolescence, when depression tends to emerge. We examined associations of neighbourhood social fragmentation, income inequality and median household income with depressive symptoms in a nationally representative survey of adolescents.MethodsThe NEXT Generation Health Study enrolled 10th-grade students from 81 US high schools in the 2009–2010 school year. Depressive symptoms were assessed with the Modified Depression Scale (wave 1) and the paediatric Patient-Reported Outcome Measurement Information System (waves 2–6). Neighbourhood characteristics at waves 1, 3, 4, and 5 were measured at the census tract level using geolinked data from the American Community Survey 5-year estimates. We used linear mixed models to relate neighbourhood disadvantage to depressive symptoms controlling for neighbourhood and individual sociodemographic factors.ResultsNone of the models demonstrated evidence for associations of social fragmentation, income inequality or median household income with depressive symptoms.ConclusionDespite the prospective design, repeated measures and nationally representative sample, we detected no association between neighbourhood disadvantage and depressive symptoms. This association may not exist or may be too small to detect in a geographically dispersed sample. Given the public health significance of neighbourhood effects, future research should examine the developmental timing of neighbourhood effects across a wider range of ages than in the current sample, consider both objective and subjective measures of neighbourhood conditions, and use spatially informative techniques that account for conditions of nearby neighbourhoods.
Heart rate variability and peripheral nerve conduction velocity in relation to blood lead in newly hired lead workers
Authors: Yu Cai-Guo , Wei Fang-Fei , Yang Wen-Yi , Zhang Zhen-Yu , Mujaj Blerim , Thijs Lutgarde , Feng Ying-Mei , Staessen Jan A 
Published: March 2019

ObjectivesPrevious studies relating nervous activity to blood lead (BL) levels have limited relevance, because over time environmental and occupational exposure substantially dropped. We investigated the association of heart rate variability (HRV) and median nerve conduction velocity (NCV) with BL using the baseline measurements collected in the Study for Promotion of Health in Recycling Lead (NCT02243904).MethodsIn 328 newly hired men (mean age 28.3 years; participation rate 82.7%), we derived HRV measures (power expressed in normalised units (nu) in the high-frequency (HF) and low-frequency (LF) domains, and LF/HF) prior to long-term occupational lead exposure. Five-minute ECG recordings, obtained in the supine and standing positions, were analysed by Fourier transform or autoregressive modelling, using Cardiax software. Motor NCV was measured at the median nerve by a handheld device (Brevio Nerve Conduction Monitoring System, NeuMed, West Trenton, NJ, USA). BL was determined by inductively coupled plasma mass spectrometry.ResultsMean BL was 4.54 µg/dL (IQR 2.60–8.90 µg/dL). Mean supine and standing values of LF, HF and LF/HF were 50.5 and 21.1 nu and 2.63, and 59.7 and 10.9 nu and 6.31, respectively. Orthostatic stress decreased HF and increased LF (p<0.001). NCV averaged 3.74 m/s. Analyses across thirds of the BL distribution and multivariable-adjusted regression analyses failed to demonstrate any association of HRV or NCV with BL.ConclusionsAt the exposure levels observed in our study, autonomous nervous activity and NCV were not associated with BL.Trial registration numberNCT02243904
Work participation and working life expectancy after a disabling shoulder lesion
Authors: Sirén Maria , Viikari-Juntura Eira , Arokoski Jari , Solovieva Svetlana 
Published: March 2019

ObjectiveTo examine the impact of a disabling non-traumatic shoulder lesion on work participation and working life expectancy.MethodsFrom a 70% random sample of the Finnish population, we selected 30–59-year-old wage earners with prolonged sickness absence due to a shoulder lesion (n=7644). We followed the persons from 2006 to 2014 and calculated the proportion of time a person spent in different work participation statuses. The associations of potential determinants with a preterm exit from paid employment were tested using Cox regression. Years expected to be spent in different work participation statuses were estimated applying the Sullivan method for healthy life expectancy.ResultsDuring 9 years of follow-up time spent at work was reduced from 77.7% to 46.7%, and 15.8% of the persons were granted disability retirement, mostly due to shoulder and other musculoskeletal diseases. Compared with the general population persons with a disabling shoulder disease are expected to lose from 1.8 to 8.1 years of working life, depending on their age. Age, gender, education, duration of initial sickness absence due to the shoulder lesion, not being able to return to work sustainably and participation in vocational rehabilitation predicted preterm exit from work. Heavy lifting increased the risk of preterm exit marginally.ConclusionsWorking life expectancy is markedly reduced in persons with a disabling shoulder lesion, mainly because of disability retirement due to musculoskeletal problems. Clinicians should consider interventions targeted at improving musculoskeletal functioning and necessary work modifications before shoulder problems become chronic or the persons develop disabling comorbid musculoskeletal conditions.
Falling hospital and postdischarge mortality following CABG in New South Wales from 2000 to 2013
Authors: Brieger David B , Ng Austin C C , Chow Vincent , D'Souza Mario , Hyun Karice , Bannon Paul G , Kritharides Leonard 
Published: March 2019

ObjectivesTo describe changes in mortality among patients undergoing coronary artery bypass grafting (CABG) in New South Wales (NSW) Australia from 2000 to 2013.MethodsPatients undergoing CABG were identified from the NSW Admission Patient Data Collection (APDC) registry, linked to the NSW state-wide death registry database. Changes in all-cause mortality over time were observed following stratification of the study cohort into two year groups.ResultsWe identified 54 767 patients undergoing CABG during the study period. The risk profile of patients increased over time with significant increases in age, comorbidities and concomitant valve surgery (all p < 0.0001). During a median follow-up period of 6 years, a total 12 161 (22.2%) of patients had died. Survival curves and adjusted analyses showed a steady fall in mortality rate: those operated on during 2012–2013 had 40 % lower mortality than those operated on during 2000–2001 (HR 0.61; 95% CI 0.53 to 0.69). This was contributed to both by a fall in mortality both in hospital (HR 0.48, 95% CI 0.37 to 0.62) and postdischarge (HR 0.73; 95% CI 0.61 to 0.86).ConclusionsWe report a consistent reduction in medium-term mortality among a large unselected cohort of NSW patients undergoing CABG between 2000 and 2013. This fall is attributable both to an improvement in outcomes in hospital and in the postdischarge period.