bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global epidemiology and patterns of cerebral venous thrombosis: a systematic review and meta-analysis protocol
Authors: Danwang Celestin , Mazou Temgoua Ngou , Tochie Joël Noutakdie , Tankeu Ronni , Bigna Jean Joel 
Published: April 2018

IntroductionVenous thrombosis can affect all veins in the body including cerebral veins, where it causes cerebral venous thrombosis (CVT). CVT is an aetiology of stroke, particularly in children and young adults. Its clinical features vary widely according to the occluded vessel. Data concerning the epidemiology of CVT are scant. This protocol for a systematic review and meta-analysis aims to critically synthesise data concerning prevalence, incidence, risk factors, anatomical patterns, diagnostic and therapeutic delays, and mortality rate of CVT in the global population.Methods and analysisMEDLINE, EMBASE and ISI Web of Science databases will be searched for relevant abstracts of studies published between 1 January 1990 and 31 October 2017, without language restriction. After the screening of abstracts, study selection, data extraction and assessment of risk of bias, we will assess studies individually for heterogeneity. Random effects meta-analysis will then be used to pool studies judged to be clinically homogenous. Funnel plot analysis and Egger’s test will be used to detect publication bias. Results will be presented according to economic level of the various countries (high-income vs low/middle-income countries).Ethics and disseminationSince the current study will be based on published data, ethical approval is not required. This review is expected to provide relevant data to help in evaluating the global burden of CVT. The final report of this study will be published in a peer-reviewed journal.PROSPERO registration numberCRD42017074266.
Role of maternal characteristics and epidural analgesia on caesarean section rate in groups 1 and 3 according to Robson’s classification: a cohort study in an Italian university hospital setting
Authors: Triunfo Stefania , Ferrazzani Sergio , Draisci Gaetano , Zanfini Bruno Antonio , Scambia Giovanni , Lanzone Antonio 
Published: April 2018

ObjectiveTo investigate the role of maternal characteristics and epidural analgesia (EA) on caesarean section (CS) rates in selected groups by using the Robson 10-Group Classification System (RTGCS).DesignCohort study.SettingDepartment of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Rome, Italy.PatientsA total of 12 098 deliveries in periods I (1998–1999) and II (2010–2011).Main outcome measuresCS rates in groups 1 and 3 of RTGCS.ResultsIn group 1, 1144 (20%) patients were assigned to period I and 1302 (20.4%) to period II, while in group 3, 1587 (27.8%) were assigned to period I and 1502 (23.5%) to period II. CS rates were 16.4% and 23.1% in group 1 and 12.7% and 10.9% in group 3 in periods I and II, respectively. In group 1, significant and independent contributions to CS rate were provided by maternal age (p=0.018; OR 0.95 (95% CI 0.85 to 0.97)), body mass index (BMI) (p=0.022; OR 0.89 (95% CI 0.85 to 0.91)) and EA administration (p=0.037; OR 0.59 (95% CI 0.43 to 0.77)). In group 3, maternal age (p<0.001; OR 0.93 (95% CI 0.89 to 0.96)) and BMI (p=0.023; OR 0.98 (95% CI 0.96 to 0.99)) were found to be significantly associated with CS.ConclusionsRTGCS is an effective tool for analysing changes in obstetric care, allowing for the recognition of maternal age, BMI and EA administration in the strategic planning for mitigation of CS rates in selected groups.
Protocol for a mixed methods study of hospital readmissions: sensemaking in Veterans Health Administration healthcare system in the USA
Authors: Penney Lauren S , Leykum Luci K , Noël Polly , Finley Erin P , Lanham Holly Jordan , Pugh Jacqueline 
Published: April 2018

IntroductionEffective delivery of healthcare in complex systems requires managing interdependencies between professions and organisational units. Reducing 30-day hospital readmissions may be one of the most complex tasks that a healthcare system can undertake. We propose that these less than optimal outcomes are related to difficulties managing the complex interdependencies among organisational units and to a lack of effective sensemaking among individuals and organisational units regarding how best to coordinate patient needs.Methods and analysisThis is a mixed method, multistepped study. We will conduct in-depth qualitative organisational case studies in 10 Veterans Health Administration facilities (6 with improving and 4 with worsening readmission rates), focusing on relationships, sensemaking and improvisation around care transition processes intended to reduce early readmissions. Data will be gathered through multiple methods (eg, chart reviews, surveys, interviews, observations) and analysed using analytic memos, qualitative coding and statistical analyses. We will construct an agent-based model based on those results to explore the influence of sensemaking and specific care transition processes on early readmissions.Ethics and disseminationEthical approval has been obtained through the Institutional Review Board of the University of Texas Health Science Center at San Antonio (approval number: 14–258 hour). We will disseminate our findings in manuscripts in peer-reviewed journals, professional conferences and through short reports back to participating entities and stakeholders.
Effects of dietary antioxidant vitamins on lung functions according to gender and smoking status in Korea: a population-based cross-sectional study
Authors: Hong Ji Young , Lee Chang Youl , Lee Myung Goo , Kim Young Sam 
Published: April 2018

ObjectiveCigarette smoke-induced oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Dietary antioxidants are thought to prevent smoke-induced oxidative damage. The aim of this study was to investigate associations between lung function and the consumption of antioxidant vitamins in Korean adults.MethodsIn total, 21 148 participants from the Korean National Health and Nutrition Examination Survey (2007–2014) were divided into four groups based on smoking history and gender. Multivariate regression models were used to evaluate associations between lung function and intake of dietary antioxidants.ResultsSubjects in the highest intake quintile (Q5) of vitamin A, carotene and vitamin C intake had mean forced expiratory volume in 1 s (FEV1) measurements that were 30 mL, 32 mL and 36 mL higher than those of individuals in the lowest intake quintile (Q1), respectively (p for trend; p=0.008, p=0.010 and p<0.001, respectively). The risks of COPD for male smokers in Q1 increased 7.60-fold (95% CI 5.92 to 9.76), 7.16-fold (95% CI 5.58 to 9.19) and 7.79-fold (95% CI 6.12 to 9.92), for vitamin A, carotene and vitamin C, respectively, compared with those of female non-smokers in Q5. Among patients with COPD, men who smoked >20 pack-years had mean FEV1measurements that were 192 mL, 149 mL and 177 mL higher than those of patients in Q1 (p for trend; p=0.018, p=0.024 and p=0.043, for vitamin A, carotene and vitamin C, respectively).ConclusionsThese findings indicate that the influence of antioxidant vitamins on lung function depends on gender and smoking status in the Korean COPD population.
Building motivation to participate in a quality improvement collaborative in NHS hospital trusts in Southeast England: a qualitative participatory evaluation
Authors: Lalani Mirza , Hall Kate , Skrypak Mirek , Laing Chris , Welch John , Toohey Peter , Seaholme Sarah , Weijburg Thomas , Eyre Laura , Marshall Martin 
Published: April 2018

ObjectivesThis study explores the barriers and facilitators that impact on the motivation of practitioners to participate in a quality improvement collaborative.DesignA qualitative and formative evaluation using a participatory approach, the researcher-in-residence model which embraces the concept of ‘coproducing’ knowledge between researchers and practitioners using a range of research methods such as participant observation, interviews and documentary analysis. The design, creation and application of newly generated evidence are facilitated by the researcher through negotiation and compromise with team members.ParticipantsSenior and middle managers, doctors and nurses.SettingTwo hospitals in Southeast England participating in a Patient Safety Improvement Collaborative and the facilitator (host) of the collaborative, based in Central London.ResultsThe evaluation has revealed facilitators and barriers to motivation categorised under two main themes: (1) inherent motivation and (2) factors that influence motivation, interorganisational and intraorganisational features as well as external factors. Facilitators included collaborative ‘champions,’ individuals who drove the quality improvement agenda at a local level, raising awareness and inspiring colleagues. The collaborative itself acted as a facilitator, promoting shared learning as well as building motivation for participation. A key barrier was the lack of board engagement in the participating National Health Service organisations which may have affected motivation among front-line staff.ConclusionsCollaboratives maybe an important way of engaging practitioners in quality improvement initiatives. This study highlights that despite a challenging healthcare environment in the UK, there remains motivation among individuals to participate in quality improvement programmes as they recognise that improvement approaches may facilitate positive change in local clinical processes and systems. Collaboratives can harness this individual motivation to facilitate spread and adoption of improvement methodology and build engagement across their membership.
Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study
Authors: Lyons Imogen , Furniss Dominic , Blandford Ann , Chumbley Gillian , Iacovides Ioanna , Wei Li , Cox Anna , Mayer Astrid , Vos Jolien , Galal-Edeen Galal H , Schnock Kumiko O , Dykes Patricia C , Bates David W , Franklin Bryony Dean 
Published: April 2018

IntroductionIntravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error.ObjectivesTo determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation, including the contribution of smart pumps.MethodsWe conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs.ResultsData were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8).ConclusionErrors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations.
Development and validation of an admission prediction tool for emergency departments in the Netherlands
Authors: Kraaijvanger Nicole , Rijpsma Douwe , Roovers Lian , van Leeuwen Henk , Kaasjager Karin , van den Brand Lillian , Horstink Laura , Edwards Michael 
Published: April 2018

ObjectiveEarly prediction of admission has the potential to reduce length of stay in the ED. The aim of this study is to create a computerised tool to predict admission probability.MethodsThe prediction rule was derived from data on all patients who visited the ED of the Rijnstate Hospital over two random weeks. Performing a multivariate logistic regression analysis factors associated with hospitalisation were explored. Using these data, a model was developed to predict admission probability. Prospective validation was performed at Rijnstate Hospital and in two regional hospitals with different baseline admission rates. The model was converted into a computerised tool that reported the admission probability for any patient at the time of triage.ResultsData from 1261 visits were included in the derivation of the rule. Four contributing factors for admission that could be determined at triage were identified: age, triage category, arrival mode and main symptom. Prospective validation showed that this model reliably predicts hospital admission in two community hospitals (area under the curve (AUC) 0.87, 95% CI 0.85 to 0.89) and in an academic hospital (AUC 0.76, 95% CI 0.72 to 0.80). In the community hospitals, using a cut-off of 80% for admission probability resulted in the highest number of true positives (actual admissions) with the greatest specificity (positive predictive value (PPV): 89.6, 95% CI 84.5 to 93.6; negative predictive value (NPV): 70.3, 95% CI 67.6 to 72.9). For the academic hospital, with a higher admission rate, a 90% probability was a better cut-off (PPV: 83.0, 95% CI 73.8 to 90.0; NPV: 59.3, 95% CI 54.2 to 64.2).ConclusionAdmission probability for ED patients can be calculated using a prediction tool. Further research must show whether using this tool can improve patient flow in the ED.
Essential medicines for emergency care in Africa
Authors: Broccoli Morgan C , Pigoga Jennifer L , Nyirenda Mulinda , Wallis Lee , Calvello Hynes Emilie J 
Published: April 2018

ObjectivesEssential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.MethodsWe undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process.ResultsThe final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres).ConclusionThe 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa.
Combined healthy lifestyle behaviours and incident disability in an elderly population: the Ohsaki Cohort 2006 Study
Authors: Zhang Shu , Tomata Yasutake , Newson Roger B , Sugawara Yumi , Tsuji Ichiro 
Published: April 2018

BackgroundThe joint impact of healthy lifestyle behaviours (HLBs) on incident disability among elderly populations is still uncertain. This cohort study was conducted to estimate the population-attributable fraction (PAF) of combined HLBs for disability reduction in elderly Japanese.MethodsWe analysed 10-year follow-up data for 9910 community-dwelling elderly people (≥65 years) in a prospective cohort study. Information on lifestyle behaviours and food consumption was collected via a questionnaire in 2006. The exposure variable was defined as a healthy lifestyle index (HLI), which represented the summed number of HLBs (‘never or former smoker’, ‘time spent walking ≥0.5 hour/day’ and ‘vegetable and fruit consumption volume ≥median’). Data on incident disability were retrieved from the public Long term Care Insurance database. HRs and 95% CIs were estimated by Cox proportional regression and the PAFs and their 95% CIs were estimated with the multivariate-adjusted model.ResultsThe 10-year incidence of disability was 35.7%. An inverse dose–response relationship was observed (HR (95% CI): 0.85(0.81 to 0.90) for each one-point increase of the HLI score, p-trend <0.001). Based on multivariate-adjustment, adherence to each one additional HLB gives PAF of 10.5%(95% CI 9.0% to 12.0%) for disability reduction. The PAF would have been 25.9%(14.2% to 36.0%) if all subjects had adhered to all three HLBs.ConclusionCombined HLBs may have a substantial impact on reducing the risk of incident disability among elderly people. Even having one more healthy lifestyle habit may bring considerable benefit.
Neuro Elutax SV drug-eluting balloon versus Wingspan stent system in symptomatic intracranial high-grade stenosis: a single-center experience
Authors: Gruber Philipp , Garcia-Esperon Carlos , Berberat Jatta , Kahles Timo , Hlavica Martin , Anon Javier , Diepers Michael , Nedeltchev Krassen , Remonda Luca 
Published: April 2018

BackgroundIntracranial atherosclerotic disease is a well-known cause of ischemic stroke. Following the SAMMPRIS trial, medical treatment is favored over stenting. Drug-eluting balloons (DEB) are widely used in coronary angioplasty, showing better results than bare-surface balloons. There is little evidence of DEB employment in intracranial stenosis, especially of paclitaxel-eluted balloons (pDEB). The Neuro Elutax SV (Aachen Resonance) is the first CE certificated pDEB for intracranial use.ObjectiveTo compare pDEB Neuro Elutax SV (ElutaxDEB) with the Wingspan/Gateway stent system (WingspanStent).Materials and methodsA single-center, open-label, retrospective cohort study of 19 patients with symptomatic atherosclerotic intracranial high-grade stenosis treated with either ElutaxDEB or WingspanStent from a tertiary stroke center in Switzerland.ResultsEight patients (42%) received ElutaxDEB. Median clinical follow-up was 10 months for the WingspanStent and 9.5 months for ElutaxDEB (P=0.36). No differences were found in the clinical baseline characteristics, with a median stenosis grade of 80% for the WingspanStent and 81% for the ElutaxDEB (P=0.87). The compound endpoint ‘ischemic re-event and/or restenosis’ was significantly lower for ElutaxDEB (13% vs 64%; P=0.03, OR 0.08 (95% CI 0.007 to 0.93; P=0.043) than for the WingspanStent.ConclusionsThe ElutaxDEB may be a promising alternative treatment for patients with symptomatic high-grade intracranial stenosis showing a significantly lower rate of ischemic re-events or restenosis in comparison with the WingspanStent-treated patients with a similar safety profile. Further studies will be needed to definitively elucidate the role of pDEB in the management of symptomatic intracranial high-grade stenosis.
Airway epithelial phosphoinositide 3-kinase-δ contributes to the modulation of fungi-induced innate immune response
Authors: Jeong Jae Seok , Lee Kyung Bae , Kim So Ri , Kim Dong Im , Park Hae Jin , Lee Hern-Ku , Kim Hyung Jin , Cho Seong Ho , Kolliputi Narasaiah , Kim Soon Ha , Lee Yong Chul 
Published: April 2018

BackgroundRespiratory fungal exposure is known to be associated with severe allergic lung inflammation. Airway epithelium is an essential controller of allergic inflammation. An innate immune recognition receptor, nucleotide-binding domain, leucine-rich-containing family, pyrin-domain-containing-3 (NLRP3) inflammasome, and phosphoinositide 3 kinase (PI3K)-δ in airway epithelium are involved in various inflammatory processes.ObjectivesWe investigated the role of NLRP3 inflammasome in fungi-induced allergic lung inflammation and examined the regulatory mechanism of NLRP3 inflammasome, focusing on PI3K-δ in airway epithelium.MethodsWe used two in vivo models induced by exposure to Aspergillus fumigatus (Af) and Alternaria alternata (Aa), as well as an Af-exposed in vitro system. We also checked NLRP3 expression in lung tissues from patients with allergic bronchopulmonary aspergillosis (ABPA).ResultsAssembly/activation of NLRP3 inflammasome was increased in the lung of Af-exposed mice. Elevation of NLRP3 inflammasome assembly/activation was observed in Af-stimulated murine and human epithelial cells. Similarly, pulmonary expression of NLRP3 in patients with ABPA was increased. Importantly, neutralisation of NLRP3 inflammasome derived IL-1β alleviated pathophysiological features of Af-induced allergic inflammation. Furthermore, PI3K-δ blockade improved Af-induced allergic inflammation through modulation of NLRP3 inflammasome, especially in epithelial cells. This modulatory role of PI3K-δ was mediated through the regulation of mitochondrial reactive oxygen species (mtROS) generation. NLRP3 inflammasome was also implicated in Aa-induced eosinophilic allergic inflammation, which was improved by PI3K-δ blockade.ConclusionThese findings demonstrate that fungi-induced assembly/activation of NLRP3 inflammasome in airway epithelium may be modulated by PI3K-δ, which is mediated partly through the regulation of mtROS generation. Inhibition of PI3K-δ may have potential for treating fungi-induced severe allergic lung inflammation.