bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP25 Decision-making in ambulance service non-conveyance – the DMASC survey
Authors: Black Sarah , Frampton Ian 
Published: April 2019

BackgroundA variety of factors influence the decision making of pre-hospital clinicians when considering conveying patients to the Emergency Department. This study aimed to explore the utility of a novel psychometric tool that identifies elements involved in the decision to leave a patient at scene following a 999 call.MethodsThe Decision-making in Ambulance Service non-Conveyance (DMASC) Scale was used to survey 350 pre-hospital clinicians from one NHS Ambulance Trust. Items pertaining to four subscales: the autonomy with which non-conveyance decisions were made; steps taken to safeguard those decisions; the impact of previous experience; and patient characteristics influencing the decision, were explored. The DMASC scale was followed by the REI-40, a validated psychometric survey that determines preferred decision-making style.ResultsResponses from 121 participants indicated clinicians felt they make autonomous decisions, with little involvement of other Health Care Professionals. There were no overall significant differences between clinical grades and DMASC scores, although there was a significant interaction between grade and the subscales Experience and Patient Characteristics, more skilled practitioners scored higher. There was no overall difference in the length of service and DMASC score, although there was a significant difference between staff in post <2 years, and those in post for between 7–15 years on the Safety Netting subscale. Scores from the REI-40 showed no overall significant differences between clinical grades, although those with between 3–6 years’ experience scored significantly higher on the Rational scale than those with 7–15 years’ experience.ConclusionsImplications for practice arising from these Results indicate clinical mentorship of newly qualified paramedics should be formalised to support safe decision-making when leaving patients at home. It also suggests that Specialist Paramedics may be using different decision-making heuristics than other grades to inform their confidence in leaving patients at the scene.
PP30 ‘I can’t remember’ – patients views of receiving pain management from paramedics for suspected hip fracture
Authors: Evans Bridie , Brown Alan , Bulger Jenna , Fegan Greg , Ford Simon , Guy Katy , Jones Sian , Keen Leigh , Khanom Ashrafunnesa , Pallister Ian , Rees Nigel , Russell Ian , Seagrove Anne , Snooks Helen 
Published: April 2019

BackgroundUp to 40% of patients with suspected hip fracture report inadequate or no pre-hospital pain management. Morphine may raise risk of complications and may be avoided by paramedics. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture.ObjectiveTo explore patients’ views and experience of care received for suspected hip fracture and in particular FICB before ambulance transport to hospital.MethodWe interviewed six patients and the daughter of a patient who received FICB to manage their suspected hip fracture. Interviews, by telephone or face-to-face, were audio-recorded with consent. We conducted thematic analysis of transcripts. Two researchers, one paramedic and one lay member were in the analysis teamResultsRespondents’ memory of prehospital care was dominated by their experience of extreme pain. While they recalled events before falling, they only had partial memory of care prior to hip surgery. Although they recalled paramedics’ arrival, which they reported was up to six hours after their injury, respondents said they remembered little else. Just one recalled consenting to receiving FICB and could describe the process. Other respondents said they were in too much pain to comprehend what occurred or respond coherently. They explained their priority was to receive pain management and they expected the paramedics to treat them safely and effectively. Respondents appeared to be a stoical and trusting group who accepted the treatment they were offered. They did recall high quality of care and praised paramedics for their reassuring and calm manner.ConclusionsHip fracture patients’ overwhelming memory of injury and treatment was of pain and their priority was to receive pain relief. The quality of care, reassurance and administration of pain management was more important to patients than the mechanism of delivering the intervention.
04 Using electronic patient records collected by ambulance personnel to detect disease outbreaks
Authors: Reich Thilo 
Published: April 2019

BackgroundThe introduction of electronic patient records in the ambulance service allows to use these to monitor the population. Most patients are discharged at scene therefore this data represents a new source for syndromic disease surveillance. The accessibility and extent of the records allows to apply early event detection (EED) systems to monitor the prehospital population. Here such a system is applied to tympanic temperature readings to detect seasonal influenza.MethodTympanic temperature readings, are recorded for all patients and were used to determine daily and weekly numbers of pyretic patients. A method adapted from Singh et al. (2016) based on case ratios (CR) was used to detect the start of the seasonal influenza outbreak. This method does not rely on thresholds, and was applied in a sliding manor as EED system.ResultsThe data represented annually 15.96% of the population, focused on the elderly. It matched the progress of seasonal influenza cases from sentinel surveillance programs. For the season 2016/17 an increase in cases was detected with an estimated specificity and sensitivity of 99.7% and 100%, up to 9 weeks before sentinel surveillance programs. Furthermore, an unanticipated outbreak of Escherichia coli was detected.ConclusionIt was shown, disease outbreaks can be monitored using prehospital tympanic temperature data. Thus, making the ambulance service an ideal source for syndromic surveillance. The method used was effective and can be easily deployed to monitor specific syndromes to distinguish between infectious agents. The method is easily adapted to sample rates and noisiness of the data to prevent false alarms.
OP5 Rapid analgesia for prehospital hip disruption (RAPID): findings from a randomised feasibility study
Authors: Bulger Jenna , Brown Alan , Evans Bridie , Fegan Greg , Ford Simon , Guy Katy , Jones Sian , Keen Leigh , Khanom Ashrafunnesa , Pallister Ian , Rees Nigel , Russell Ian , Seagrove Anne , Snooks Helen 
Published: April 2019

BackgroundAdequate pain relief in prehospital care is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is routinely undertaken by clinicians in the emergency department for patients with hip fracture, but has not been fully evaluated for use by paramedics in prehospital care.We aimed to test whether FICB for hip fracture pain relief carried out by paramedics in prehospital care was feasible, safe and acceptable, and whether trial Methods were viable, so that we could decide whether to proceed to a fully-powered RCT to evaluate clinical and cost effectiveness.MethodsNineteen paramedics were trained to administer FICB. They randomly allocated eligible patients to FICB or usual care using audited scratchcards. Patients were followed up to assess availability of key outcomes including quality of life, length of hospital stay, pain scores, and adverse events. Findings were analysed against pre-specified feasibility criteria to determine whether it was appropriate to progress to a fully-powered trial.ResultsSeventy-one patients were randomised by paramedics between 28/6/16 and 31/7/17; 57 of these patients consented to follow up. The only outcome which reached a statistically significant difference between groups was the proportion of participants who received morphine (38% difference between groups 95% CI −61.88 to −15.79). There was a difference of approximately nine days in the length of stay between trial arms (mean difference 9.12 (95% CI −20.51 to 2.27).ConclusionsRAPID met its pre-specified progression criteria; a funding application for a fully-powered RCT will therefore be submitted. We will consider the use of length of stay as the primary outcome measure, as feasibility study findings indicated that there was a difference between groups without reaching statistical significance.
Comparative trends in coronary heart disease subgroup hospitalisation rates in England and Australia
Authors: Nedkoff Lee , Goldacre Raphael , Greenland Melanie , Goldacre Michael J , Lopez Derrick , Hall Nick , Knuiman Matthew , Hobbs Michael , Sanfilippo Frank M , Wright F Lucy 
Published: April 2019

BackgroundPopulation-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013.MethodsCHD hospitalisations for individuals aged 35–84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and ‘other CHD’). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression.ResultsFrom 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004–2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: −7.1 %/year, 95% CI −7.2 to –7.0; women: −7.5 %/year, 95% CI −7.7 to –7.3; Australia: men: −8.5 %/year, 95% CI −8.6 to –8.4; women: −8.6 %/year, 95% CI −8.8 to –8.4). Other CHD rates increased in individuals aged 75–84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention.ConclusionsSince 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus.
Cardiac magnetic resonance in patients with elevated troponin and normal coronary angiography
Authors: Bhatia Subir , Anstine Christopher , Jaffe Allan S , Gersh Bernard J , Chandrasekaran Krishnaswamy , Foley Thomas A , Hodge David , Anavekar Nandan S 
Published: April 2019

BackgroundInvasive angiography in the setting of cardiac troponin elevation may reveal non-obstructive coronary arteries leading to uncertainty in diagnosis. Cardiac MR (CMR) may aid in diagnosis, however, the spectrum of diagnostic findings in the patient presenting with symptoms of cardiac ischaemia, elevated cardiac biomarkers and a negative invasive coronary angiogram is yet to be completely described.MethodsWe queried the Mayo Clinic, Rochester inpatient record from 1 January 2000 to 31 December 2016 to identify patients who: (1) had an elevated troponin T during admission, (2) underwent coronary angiography within 30 days of troponin T elevation which was considered negative for obstructive coronary arterial disease and (3) underwent CMR within 30 days of troponin T elevation. CMR diagnoses were classified as either (1) myocarditis, (2) small area myocardial infarction, (3) stress cardiomyopathy, (4) non-ischaemic cardiomyopathy or (5) normal.ResultsOf 215 patients, the spectrum of disease seen on CMR was myocarditis (32%), small area infarction (22%), non-ischaemic cardiomyopathy (20%) and stress cardiomyopathy (9.3%).ConclusionIn the largest single-centre study assessing the role of CMR in patients admitted with elevated troponin T with a non-obstructive coronary disease on an angiogram, small area infarction was seen in 22% of patients.
Sex differences in publication volume and quality in congenital heart disease: are women disadvantaged?
Authors: van Doren Sophie , Brida Margarita , Gatzoulis Michael A , Kempny Aleksander , Babu-Narayan Sonya V , Bauer Ulrike M M , Baumgartner Helmut , Diller Gerhard Paul 
Published: April 2019

BackgroundWomen are underrepresented in leading medical positions and academia. The gender-gap in authorship of congenital heart disease (CHD) publications remains unknown. As determinants of gender equity in this field are poorly characterised, we aimed to quantify and characterise publications in CHD and to assess factors associated with female representation in research.Methods and resultsWe identified 35 118 CHD publications between 2006 and 2015 for which author gender could be ascertained. Overall, 25.0% of all authors were female. Women accounted for 30.2% and 20.8% of all first and senior authorship positions with great geographic heterogeneity. While globally female first and senior authorship increased by 0.8% and 0.6%/year, some geographic regions showed no improvement in gender representation. Significant predictors of female first authorship on logistic regression analysis were country gross domestic product, human development index, gender inequality index and a female senior author (p<0.0001 for all). Publications with a female lead author tended to be published in journals with a higher impact factor (IF) and to attract more citations compared with those with a male author. Mixed gender authorship was associated with higher IF and number of citations. Women were less disadvantaged when the analysis was confined to original research.ConclusionsWhile modest improvement in female authorship over time was noted, women remain underrepresented in contemporary academic CHD. Manuscripts with mixed gender authorship had higher IF and more citations. The main predictor of female first authorship was a female senior author. These data should inform policy recommendations regarding gender parity.
Noticing in neurology
Authors: Lees A J 
Published: April 2019

There are three classes of people: those who see, those who see when they are shown, those who do not seeLeonardo da VinciThe three cardinal qualities necessary for the ideal neurologist are observation, the ability to reason backwards inferentially and specialist knowledge. Modern medical technology has greatly increased the ability to diagnose and treat disease but it has also encouraged a benign variant of abulia, which is killing off the art and science of clinical reasoning. Intent gazing at the unfamiliar with old eyes or a long look at the familiar with new eyes offers the neurologist an opportunity to discover hitherto unnoticed diagnostic signs far beyond the resolution of the brain scanner and even the light microscope. While there may be nothing new under the sun, there are plenty of old things that no one has observed, which have the potential to greatly improve clinical practice.
Predicting precision matrices for color matching problem
Authors: Nakamoto Takayoshi , Nishii Ryuei , Eguchi Shinto 
Published: April 2019

In this paper, as data, ellipsoids in a color coordinate called the Commission Internationale de l’Eclairage (CIE)-Lab system are given as data for 19 colors. Each ellipsoid is a region where all points are visually recognized as the same color at the center of the coordinate system. Our aim here is to predict the shape of an ellipsoid whose center is given by a new color. We proposed two prediction methods of positive definite matrices determining ellipsoids. The first one is a nonparametric method with Gaussian kernel. The prediction is provided as a weighted sum of positive definite matrices corresponding to 19 ellipsoids in the training data. The second one is to use a matrix-valued regression model applied to a logarithm of positive definite matrices where explanatory variables are three elements of color centers. The best result was obtained by the nonparametric methods with three bandwidth parameters. The log normal regression had a weaker performance, but even so the model estimation was easily carried out.
Mendelian Randomization Study for Genetically Predicted Polyunsaturated Fatty Acids Levels on Overall Cancer Risk and Mortality
Authors: Liyanage Upekha E. , Ong Jue-Sheng , An Jiyuan , Gharahkhani Puya , Law Matthew H. , MacGregor Stuart 
Published: April 2019

AbstractBackground:Observational studies evaluating the link between polyunsaturated fatty acids (PUFA) and cancers have yielded mixed findings. We used Mendelian randomization (MR) to evaluate whether genetic evidence supports a causal role for PUFAs on overall cancer outcomes.Methods:We identified genetic instruments for six PUFAs from previous literature and evaluated their association with overall cancer risk (46,155 cases, 270,342 controls) and cancer mortality (6,998 deaths, 270,342 controls) among the UK Biobank cohort. We used the inverse variance weighted model to combine SNP estimates, and derived log (OR) estimates per SD change in each PUFA.Results:None of the six PUFAs showed association with overall cancer risk or mortality, with narrow confidence interval (CI) ruling out all but very small effects, for example, arachidonic acid (AA) overall cancer risk (OR, 1.02; 95% CI, 1.00–1.03). Sex-specific analysis revealed no associations except α-linolenic acid for potentially reducing cancer risk in men (OR, 0.92; 95% CI, 0.86–0.98; P = 0.02); however, this was nonsignificant after multiple testing correction. From individual cancers, only colorectal cancer showed evidence for a causal association for higher AA levels (OR, 1.05; 95% CI, 1.03–1.07), with similar results for the other correlated PUFAs.Conclusions:Our study provides no support for the hypothesis that PUFAs reduce overall cancer risk or mortality. Higher AA levels increased the risk for colorectal cancer.Impact:Our well-powered MR study provides robust causal inferences for the PUFAs on overall cancer risk and mortality. Future larger studies are warranted to replicate the individual cancer findings.
НОВІТНІ МЕТОДИ СТРИМУВАННЯ ІНФЕКЦІЙ, ЩО ПЕРЕДАЮТЬСЯ СТАТЕВИМ ШЛЯХОМ
Authors: Mavrov H. I. , Shcherbakova Yu. V. , Osinska T. V. 
Published: April 2019

Кожен день більше 1 млн осіб заражаються на інфекції, що передаються статевим шляхом (ІПСШ), які становлять значну частину захворюваності людства, а також підвищують ризик придбання вірусу імунодефіциту людини (ВІЛ). Існуючі стратегії профілактики та запобігання ІПСШ, включаючи зміну поведінки, розповсюдження презервативів і своєчасну терапію, не привели до їх суттєвого скорочення, що вказує на необхідність пошуку нових стратегій.
Мета цього огляду – узагальнити нові біомедичні підходи до профілактики ІПСШ, включаючи багатоцільові технології, а також виявити наукові та організаційні перешкоди, які необхідно подолати.
Матеріали і методи. За період 1990-2018 рр. аналізувалися результати власних досліджень, статті, знайдені в базі даних PubMed, глобальні звіти UNAIDS (ЮНЕЙДС) – агентства об’єднаних націй з боротьби зі СНІДом, звіти окремих країн, матеріали Всесвітньої організації охорони здоров’я (ВООЗ).
Результати. Проведено систематичний аналіз клінічних досліджень жіночих презервативів, місцевих мікробіцидів на основі гелю, вагінальних кілець, таблеток, плівок та нановолокон. Проаналізовано стан хімічної профілактики генітального герпесу, трихомонозу. Наведено принципи багатоцільової технології профілактики (БТП) та перспективи досліджень.
Висновок. ВІЛ та інші ІПСШ є частиною глобальної кризи охорони здоров’я. В даний час розробляються нові БТП для захисту від ВІЛ й ІПСШ з урахуванням механізмів зараження та культурних і соціальних чинників.
НЕВРОЛОГІЧНІ УСКЛАДНЕННЯ КОРУ У ДІТЕЙ
Authors: Prokopiv O. V. , Lysheniuk S. A. , Prykuda N. M. 
Published: April 2019

Мета роботи – вивчити клінічний перебіг неврологічних ускладнень кору у дітей, які перебували на стаціонарному лікуванні у Львівській обласній інфекційній клінічній лікарні (ЛОІКЛ) у 2018 р.
Пацієнти і методи. Спостереження проведено у 10 дітей з неврологічними ускладненнями кору віком від 3 до 16 років. Діагноз кору базувався на типових клінічних проявах хвороби, даних епідеміологічного анамнезу, результатах загальноприйнятих лабораторних та імунологічних досліджень.
Результати досліджень та їх обговорення. Упродовж 2018 р. на стаціонарному лікуванні у ЛОІКЛ перебувало 5 дітей з коровим енцефалітом, 3 – з менінгітом і 2 дітей з енцефаломієлітом. Переважали діти віком 3-6 років. Ураження нервової системи виникали на 6-14-у добу хвороби. Описано випадок корового енцефаломієліту у вакцинованого хлопчика віком 16 років, хворого на розсіяний склероз.
Висновки. З-поміж неврологічних ускладнень домінував енцефаліт, що розвинувся у дітей із середньотяжкою формою кору на 10-14-у добу хвороби. Ведучим початковим симптомом в усіх хворих були зорові галюцинації. Ураження нервової системи у вигляді енцефаломієліту є тяжким ускладненням, що характеризується тривалим перебігом. За умов своєчасного інтенсивного лікування можливе повне видужання з відновленням порушених функцій. На сьогодні необхідним є перманентне виконання комплексу планових профілактичних щеплень з метою запобігання кору, насамперед дотримання термінів схем вакцинації, з обов’язковим виконанням протиепідемічних заходів в осередку інфекції.
ОСОБЛИВОСТІ ПЕРЕБІГУ КОРУ В ЕПІДСЕЗОНІ 2017-2018 рр. – РОЗВИТОК АСОЦІЙОВАНОГО З ВІРУСОМ КОРУ УРАЖЕННЯ ПЕЧІНКИ
Authors: Smyrnova D. D. , Usachova O. V. , Firulina O. M. 
Published: April 2019

Мета – вивчення зв’язку гепатоцитолітичного синдрому, виявленого у хворих на кір в епідемічному сезоні 2017-2018 рр., з вірусною етіологією основного захворювання.
Матеріали і методи. Ретроспективно були вивчені історії хвороби 100 пацієнтів із встановленим діагнозом кору, які перебували на лікуванні у ЗОІКЛ в період з вересня 2017 по березень 2018 рр. Всі пацієнти, за результатами підвищення активності ферменту аланінамінотрансферази (АЛТ), були розділені на дві групи: з підтвердженим цитолізом (Г1, n=54) та з нормальними показниками АЛТ (Г2, n=46).
Результати досліджень та їх обговорення. Загальна кількість ускладнень кору була вища у пацієнтів Г1 (88,8 %). Для цієї групи також була більш характерна гепатомегалія (59,3 %). За результатами загального аналізу крові пацієнтів були визначені непрямі ознаки, що свідчать про спрямованість імунної відповіді на вірус кору. За порівнянням відношення показників лімфоцитопенія/лімфоцитоз у Г1 була виявлена сповільнена противірусна імунна реакція, на відміну від Г2. Оцінка синдрому цитолізу проводилась у порівнянні АЛТ першого біохімічного аналізу на 1-2-у добу (АЛТ-1) та повторного тесту на 5-7-у добу госпіталізації (АЛТ-2) у пацієнтів Г1. Було встановлено, що цитоліз легкого ступеня важкості (АЛТ>в 1-2 рази) швидко знижувався у динаміці: АЛТ-1 72,2 % проти АЛТ-2 46,9 %, на відміну від ураження середнього (АЛТ>2,5-5 разів) та важкого (АЛТ>5-10 раз) ступеня, що зберігався без значних змін і на 7-й день госпіталізації.
Висновки. Сучасна особливість кору – ураження печінки, що реєструється у 54 % випадків. Розвиток реактивного гепатиту пов’язаний з прямою цитопатичною дією вірусу кору. Легкий ступінь підвищення АЛТ та його подальша нормалізація на 5-7-у добу вказують на сприятливий перебіг процесу та швидке відновлення функції органа. При розвитку реактивного гепатиту у хворих на кір сповільнюється швидкість імунної відповіді. Можливо, з цим пов’язана і більша кількість пацієнтів з бактерійними ускладненнями у Г1. Згідно з цими висновками, пацієнтів з кором та реактивним гепатитом слід відносити до групи ризику за розвитком бактерійних ускладнень.