bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hearing threshold levels and hearing loss among people in Zhejiang, China: a population-based cross-sectional study
Authors: Wang Dahui , Zhang Huai , Ma Haiyan , Zhang Long , Yang Lei , Xu Liangwen 
Published: April 2019

Hearing loss (≥26 dB threshold in the better ear), as a common chronic condition in humans, is increasingly gaining attention. Relevant research in China is relatively scarce, so we conduct a population-based study to investigate the prevalence of hearing loss among age groups, genders and ears in Zhejiang province, China, from September 2016 to June 2018.Study designPopulation-based cross-sectional studyParticipantsA total of 3754 participants aged 18–98 years and living in Zhejiang province, China.Outcome measuresPure-tone audiometric thresholds were measured at frequencies of 0.125–8 kHz for each subject. All participants were asked to complete a structured questionnaire, in the presence of a healthcare official.ResultsThe prevalence of speech-frequency and high-frequency hearing loss was 27.9% and 42.9%, respectively, in Zhejiang. There were significant differences in auditory thresholds at most frequencies among the age groups, genders (male vs female: 31.6%vs24.1% at speech frequency; 48.9% vs 36.8% at high frequency) and ears. In addition to the common factors affecting both types of hearing loss, a significant correlation was found between personal income and speech-frequency hearing loss (OR=0.69, 95% CI 0.52 to 0.92), and between hyperlipidaemia and high-frequency hearing loss (OR=1.45, 95% CI 1.02 to 2.07).ConclusionThe prevalence of hearing loss was high among people living in Zhejiang, particularly males, and in the left ear. Moreover, hearing thresholds increased with age. Several lifestyle and environment factors, which can be influenced by awareness and education, were significantly associated with hearing loss.
The National Cohort of Esophageal Cancer-Prospective Cohort Study of Esophageal Cancer and Precancerous Lesions based on High-Risk Population in China (NCEC-HRP): study protocol
Authors: Chen Ru , Ma Shanrui , Guan Chentao , Song Guohui , Ma Qing , Xie Shuanghua , Wang Meng , Shao Dantong , Li Xinqing , Wei Wenqiang 
Published: April 2019

IntroductionOesophageal cancer (OC) is one of the most common cancers worldwide and about 50% of all new cases occurred in China. Population-based screening has been conducted in high-risk areas in China since 1970s, however, a few factors have limited the integration of the results from previous studies and the sharing of existing resources, such as the difference in screening methods and protocols, inconsistencies in questionnaires for risk factors investigation, lack of standards for sample collection and incomplete follow-up information.Methods and analysisThe National Cohort of Esophageal Cancer-Prospective Cohort Study of Esophageal Cancer and Precancerous Lesions based on High-Risk Population (NCEC-HRP) is a prospective cohort study of OC screening based on high-risk population in China supported by the National Key R&D Programme. Eight areas located at eastern, central and western China are selected as screening centres to represent three economical-geographical regions. All local residents aged 40–69 years in the selected areas are invited to take endoscopic examination and risk factors investigation unless they meet the exclusion criteria. The recruitment began on June 2017 and a total of 100 000 participants will be enrolled by December 2020 and all subjects will be followed for a long time. This study is designed as open-ended and has broad research aims. Summary statistics for baseline information will be reported after the completion of recruitment. We will develop a series of standards and guidelines for OC screening during the study. An open and shared research platform linked with epidemiological databases and biobank will be built up for further research.Ethics and disseminationThe study is approved by the Ethics Committee of Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (approval number 16-171/1250). The findings of the study will be disseminated through scientific peer-reviewed journals as well as the public via the study website (http://www.ncec-china.cn).Trial registration numberChiCTR-EOC-17010553; Pre-results.
Suffering measurement instruments in palliative care: protocol for a systematic psychometric review
Authors: Gutiérrez Sánchez Daniel , Gómez García Rafael , López-Medina Isabel María , Cuesta-Vargas Antonio I 
Published: April 2019

IntroductionThe prevention and relief of suffering are regarded as a goal at the end of life; therefore, suffering assessment at the end of life is essential. In this regard, we need instruments that allow us to evaluate this construct for gathering more evidence, as the assessment of suffering is increasingly used in research and the clinical setting. Many measures have been designed to assess this construct, and the selection of the most appropriate instrument is crucial. The aims of this systematic review are to (1) identify the measures assessing suffering in patients with advanced disease and their psychometric properties and (2) evaluate the methodological quality of studies on measurement properties.Methods and analysisThe protocol of this systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Guidelines. A systematic psychometric review of measures assessing suffering in patients with advanced disease and their psychometric properties will be carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). The search strategy will be performed following the Peer Review of Electronic Search Strategies. Searches will be conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Cochrane Library, SciELO, Open Grey, Scopus, Web of Science and COSMIN database of systematic reviews, and it will be limited by time (1980–2018) and language (only literature in English and Spanish). Literature will be evaluated by two independent reviewers according to the COSMIN checklist, and measurement properties data of each study that meet the inclusion criteria will be scored independently by two researchers according to COSMIN quality ratings.Ethics and disseminationEthical approval is not necessary for systematic review protocols. The results will be disseminated by publication in a peer-reviewed journal and presented at a relevant conference.PROSPERO registration numberCRD42018106488.
Health-related quality of life after camp-based family obesity treatment: an RCT
Authors: Benestad Beate , Karlsen Tor-Ivar , Småstuen Milada Cvancarova , Lekhal Samira , Hertel Jens Kristoffer , Steinsbekk Silje , Kolotkin Ronette L , Ødegård Rønnaug Astri , Hjelmesæth Jøran 
Published: April 2019

ObjectiveTo compare the effects of a 2-year camp-based immersion family treatment for obesity with an outpatient family-based treatment for obesity on health-related quality of life (HRQoL) in two generations.DesignRandomised controlled trial.SettingRehabilitation clinic, tertiary care hospital and primary care.PatientsFamilies with at least one child (7–12 years) and one parent, both with obesity.InterventionsSummer camp for 2 weeks, with four repetition weekends, or lifestyle school, including four outpatient days over 4 weeks. Behavioural techniques to promote a healthier lifestyle.Main outcome measuresChildren’s and parents’ HRQoL were assessed using generic and obesity-specific measures. Outcomes were analysed using linear mixed models according to intention to treat, and multiple imputations were used for missing data.ResultsNinety children (50% girls) with a mean (SD) age of 9.7 (1.2) years and body mass index 28.7 (3.9) kg/m2 were included in the analyses. Summer camp children had an estimated mean (95% CI) of 5.3 (0.4 to 10.1) points greater improvement in adiposity-specific HRQoL score at 2 years compared with the lifestyle school children, and this improvement was even larger in the parent proxy-report, where mean difference was 7.3 (95% CI 2.3 to 12.2). Corresponding effect sizes were 0.33 and 0.44. Generic HRQoL questionnaires revealed no significant differences between treatment groups in either children or parents from baseline to 2 years.ConclusionsA 2-year family camp-based immersion obesity treatment programme had significantly larger effects on obesity-specific HRQoL in children’s self-report and parent proxy-reports in children with obesity compared with an outpatient family-based treatment programme.Trial registration numberNCT01110096.
Prevalence of depression in patients with cancer in Iran: a systematic review and meta-analysis
Authors: Aryankhesal Aidin , Ghashghaee Ahmad , Sardari Elnaz , Mahmoudi Sara , Alihosseini Samira , Dehnad Afsaneh , Roohravan Benis Mahshid , Gharagozlou Dorsa 
Published: April 2019

IntroductionIt is generally accepted that depression, affecting the quality of life, is a serious and common complication in patients with cancer. Given that there is no integrated study on this topic in Iran, the present study sought to investigate the prevalence of depression in patients with cancer by a systematic review and meta-analysis.MethodsTo meet the study objectives, all English and Persian papers published from 2000 to January 2018 were systematically collected and the data were extracted for analysis.ResultsThere were 14 studies which were selected on the basis of the inclusion and exclusion criteria. A total number of 2831 patients with cancer had participated in the studies. The prevalence of depression among Iranian patients with cancer was 35% (95% CI 16% to 70%) based on random effects model. Among various types of cancer, the highest prevalence of depression appeared to patients suffering from breast cancer.ConclusionThe prevalence of depression among patients with cancer in Iran was higher than the developed countries. As depression affects the quality of life of patients with cancer, the results can help policymakers and service providers in planning to reduce the prevalence of depression.
Community paramedics treat high acuity conditions in the home: a prospective observational study
Authors: Abrashkin Karen Anna , Poku Asantewaa , Ramjit Alyeah , Washko Jonathan , Zhang Jenny , Guttenberg Michael , Smith Kristofer Lawrence 
Published: April 2019

ObjectivesAs the US population ages and healthcare reimbursement shifts, identifying new patient-centred, cost-effective models to address acute medical needs will become increasingly important. This study examined whether community paramedics can evaluate and treat, under the direction of a credentialed physician, high acuity medical conditions in the home within an advanced illness management (AIM) practice.MethodsA prospective observational study of an urban/suburban community paramedicine (CP) programme, with responses initiated based on AIM-practice protocols and triaged prior to dispatch using the Advanced Medical Priority Dispatch System (AMPDS). Primary outcome was association between AMPDS acuity levels and emergency department (ED) transport rates. Secondary outcomes were ED presentations at 24 and 48 hours post-visit, and patient/caregiver survey results.Results1159 individuals received 2378 CP responses over 4 years. Average age was 86 years; dementia, heart failure and asthma/chronic obstructive pulmonary disease were prevalent. Using AMPDS, most common reasons for dispatch included ‘breathing problems’ (28.2%), ‘sick person’ (26.5%) and ‘falls’ (13.1%). High acuity responses were most prevalent. 17.9% of all responses and 21.0% of high acuity responses resulted in ED transport. Within 48 hours of the visit, only 5.7% of the high acuity responses not initially transported were transported to the ED. Patient/caregiver satisfaction rates were high.ConclusionCommunity paramedics, operating within an AIM programme, can evaluate and treat a range of conditions, including high acuity conditions, in the home that would typically result in ED transport in a conventional 911 system. This model may provide an effective means for avoiding hospital-based care, allowing older adults to age in place.
Spiritual care provided by nursing home physicians: a nationwide survey
Authors: Gijsberts Marie-José H E , van der Steen Jenny T , Hertogh Cees M P M , Deliens Luc 
Published: April 2019

ObjectiveTo examine perceptions and experiences regarding providing spiritual care at the end of life of elderly care physicians practising in nursing homes in the Netherlands, and factors associated with spiritual care provision.MethodsA cross-sectional survey was sent to a representative sample of 642 elderly care physicians requesting information about their last patient who died and the spiritual care they provided. We compared their general perception of spiritual care with spiritual and other items abstracted from the literature and variables associated with the physicians’ provision of spiritual care. Self-reported reasons for providing spiritual care were analysed with qualitative content analysis.ResultsThe response rate was 47.2%. Almost half (48.4%) provided spiritual end-of-life care to the last resident they cared for. Half (51.8%) identified all 15 spiritual items, but 95.4% also included psychosocial items in their perception of spirituality and 49.1% included other items. Physicians who included more non-spiritual items reported more often that they provided spiritual care, as did more religious physicians and those with additional training in palliative care. Reasons for providing spiritual care included a request by the resident or the relatives, resident’s religiousness, fear of dying and involvement of a healthcare chaplain.ConclusionMost physicians perceived spirituality as a broad concept and this increased self-reported spiritual caregiving. Religious physicians and those trained in palliative care may experience fewer barriers to providing spiritual care. Additional training in reflecting upon the physician’s own perception of spirituality and training in multidisciplinary spiritual caregiving may contribute to the quality of end-of-life care for nursing home residents.
01 Development and validation of a pragmatic prehospital tool to identify stroke MIMIC patients
Authors: McClelland Graham , Flynn Darren , Rodgers Helen , Price Chris 
Published: April 2019

BackgroundStroke mimics (SM) are non-stroke conditions producing similar symptoms to stroke. Prehospital stroke identification tools prioritise sensitivity over specificity, therefore >25% of prehospital suspected stroke patients are SM. Failure to identify SM Results in inefficient use of ambulances and specialist stroke services. We developed a pragmatic tool for paramedics, using information often available in the prehospital setting, to identify SM amongst suspected stroke patients.MethodsThe initial tool was developed using a systematic literature review to identify SM characteristics, a survey of UK paramedics to explore the acceptability of SM identification and regression analysis of clinical variables documented in ambulance records of suspected stroke patients linked to their primary hospital diagnoses (n=1,650, 40% SM).The initial tool was refined using two focus groups with paramedics (n=3) and hospital clinicians (n=9) and analysis of an expanded prehospital dataset (n=3,797, 41% SM) to produce the final STEAM tool.ResultsSTEAM scores six variables:1 point for Systolic blood pressure <90 mmHg1 point for Temperature >38.5°C with heart rate >90 bpm1 point for seizures or 2 points for seizures with diagnosed Epilepsy1 point for Age <40 years or 2 points for age <30 years1 point for headache with diagnosed Migraine1 point for FAST–veA score of ≥2 on STEAM predicted SM diagnosis in the expanded derivation dataset with 5.5% sensitivity, 99.6% specificity and positive predictive value (PPV) of 91.4%. STEAM was validated using an external dataset (n=1,848, 33% SM) of prehospital suspected stroke patients where STEAM was 5.5% sensitive, 99.4% specific with a PPV of 82.5%.ConclusionsSTEAM uses common clinical characteristics to identify a small number of SM patients with a high level of certainty. The benefits of reducing SM admissions to specialist stroke services should be weighed against delayed admission for the small number of stroke patients identified as a SM.
PP10 ‘The ones that don’t say’; challenges in managers identifying potentially traumatised ambulance staff
Authors: Miller Joshua ,   Paramedic
Published: April 2019

BackgroundStress and psychological illness among emergency services personnel is reported at higher prevalence than the general population, with one UK ambulance service ascribing it to 15% of staff sickness. Research in this field has focused on ambulance crew views, while manager experiences are limited to EMS systems outside the UK. This qualitative study explored how UK ambulance service managers try to identify staff at risk of becoming traumatised by their work.MethodsFace-to-face, semi-structured interviews were audio-recorded with a purposive sample of six paramedic managers working for an NHS ambulance service. The author transcribed these interviews and analysed them using framework analysis. Ethical approval and informed consent were obtained.ResultsAll participants claimed to see the identification of potentially traumatised staff as a vital part of their role. They outlined the use of case factors such as visceral elements and child involvement, and staff factors such as home life and resilience. Interviewees talked about their changing roles as managers, peers, parent figures, clinicians, and adjudicators.Factors found as enabling the identification of potentially traumatised staff included: knowing the staff, formalising handover to other managers, and manager presence – both at incidents and on station. Disabling factors included: atypical cases, hierarchical culture, and isolated remote staff. All participants reported concerns about staff being reluctant to report distress.ConclusionsLimitations of this study include the small sample size, possible response bias, and respondents conforming to social norms, as their practice was self-reported, rather than observed. Manager presence was highlighted as very important by participants; services should consider this in their structures and policies. Further studies could examine staff reluctance to report psychological distress, as well as staff resilience, which participants saw as beneficial, yet difficult to define or predict.
PP11 The use of prehospital 12-lead electrocardiograms in acute stroke patients
Authors: Munro Scott , Cooke Debbie , Joy Mark , Smith Adam , Poole Kurtis , Perciato Laurence , Holah Janet , Speirs Ottilia , Quinn Tom 
Published: April 2019

BackgroundEmergency medical services (EMS) play a vital role in the recognition, management and transportation of acute stroke patients. UK guidelines recommend clinicians consider performing a prehospital 12-lead electrocardiogram (PHECG) in patients with suspected stroke, but this recommendation is based on expert consensus, rather than robust evidence.The aim of this study was to investigate the association between PHECG and modified Rankin scale (mRS). Secondary outcomes included in-hospital mortality, EMS and in-hospital time intervals and rates of thrombolysis received.MethodsA multicentre retrospective cohort study was undertaken.The data collection period spanned from 29/12/2013–30/01/2017. Participants were identified through secondary analysis of hospital data routinely collected as part of the Sentinel Stroke National Audit Programme (SSNAP) and linked to EMS clinical records (PCRs) via EMS incident number.ResultsPHECG was performed in 558 (48%) of study patients. PHECG was associated with an increase in mRS (aOR 1.30, 95% CI 1.01 to 1.66, p=0.04) and in-hospital mortality (aOR 1.83, 95% CI 1.26–2.67, p=0.002). There was no association between PHECG and administration of thrombolysis (aOR 1.06, 95% CI 0.75–1.52, p=0.73).Patients who had a PHECG recorded spent longer under the care of EMS (median 49 vs 43 min, p=0.007). No difference in times to receiving brain scan (Median 28 with PHECG vs 29 min no PHECG, p=0.32) or median door-to-needle time (median 46 min vs 48 min, p=0.37) were observed.ConclusionThis is the first study of its kind to investigate the association between PHECG and functional outcome in stroke patients attended by EMS. Although there are limitations in regard to the retrospective study design, the findings challenge current guideline recommendations regarding PHECG in patients with acute stroke.
PP21 Rapid assessment of membrane osmotic pressure as a guide to resuscitation in the acutely shocked patient
Authors: Prior Frank , Clegg Gareth , McRaild Alan 
Published: April 2019

BackgroundResuscitation of the shocked patient presents a dilemma for the prehospital resuscitation team. Selection of the appropriate type and quantity of resuscitation fluid is not supported by evidence based consensus and discussions such as the ‘crystalloid colloid debate’ have been prolonged and unhelpful. We are seeking a straightforward way of guiding resuscitation of shocked patients.The Prior Hypothesis suggests that capillary blood pressure and membrane osmotic pressure (MOP) must be equal and opposite to achieve fluid balance in the microcirculation. Membrane osmotic pressure is critically dependant on the pore size of small vessels – larger pores allowing the egress of large molecules from capillaries and therefore lowering capillary MOP. Our studies suggest that shocked patients fall into two groups: a ‘dry shock’ group with elevated MOP, and a ‘leaky shock’ group with a low MOP. The ability to identify these different groups has implications for treatment– both choice of resuscitation fluid, and the use of other vasoactive pharmacological agents which influence capillary pore size.MethodsConcurrent blood pressure and MOP were measured in 57 shocked patients on presentation to the Emergency Department. MOPs were measured using a process taking less than 5 min with a standalone osmometer requiring as little as 50 µl of serum.ResultsIn the patients tested two distinct patterns of abnormal MOP were distinguishable. 20 patients fell into the ‘leaky’ shock group (MOP 19–24 mmHg), 9 in the ‘dry’ shock group (MOP 27–30 mmHg) with a further 16 having MOP in the normal range (24–27 mmHg).ConclusionOur findings are consistent with the use of a rapid MOP test to categorise acutely presenting patients into ‘dry’ and ‘leaky’ shock depending on capillary pore size. Further work is required to test the utility of near patient MOP testing as a guide to effective therapy during emergency resuscitation.