bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long term adjuvant endocrine therapy and risk of cardiovascular disease in female breast cancer survivors: systematic review
Authors: Matthews Anthony , Stanway Susannah , Farmer Ruth E , Strongman Helen , Thomas Sara , Lyon Alexander R , Smeeth Liam , Bhaskaran Krishnan 
Published: October 2018

AbstractObjectiveTo investigate the effect of endocrine therapies on a wide range of specific clinical cardiovascular disease outcomes in women with a history of non-metastatic breast cancer.DesignSystematic review and meta-analysis of randomised controlled trials and observational studies.Data sourcesMedline and Embase up until June 2018.Eligibility criteria for selecting studiesStudies were included if they investigated the risk of a specific cardiovascular disease outcome associated with use of either tamoxifen or an aromatase inhibitor, or compared the two treatments, in women with a history of non-metastatic breast cancer.Appraisal and data extractionRelevant studies were originally identified and results extracted by one researcher, with a full replication of the study identification process by a combination of two other researchers. The Cochrane Collaboration’s tool for assessing risk of bias was used to assess risk of bias in randomised controlled trials, and this tool was adapted to assess risk of bias in observational studies.Results26 studies were identified, with results for seven specific cardiovascular disease outcomes (venous thromboembolism, myocardial infarction, stroke, angina, heart failure, arrhythmia, and peripheral vascular disease). Results suggested an increased risk of venous thromboembolism in tamoxifen users compared with both non-users and aromatase inhibitor users. Results were also consistent with a higher risk of the vascular diseases myocardial infarction and angina in aromatase inhibitor users compared with tamoxifen users, but there was also a suggestion that this may be partly driven by a protective effect of tamoxifen on these outcomes. Data were limited, and evidence was generally inconsistent for all other cardiovascular disease outcomes.ConclusionThis review has collated substantial randomised controlled trial and observational evidence on the effect of endocrine therapies on several specific cardiovascular disease outcomes including venous thromboembolism and myocardial infarction, progressing knowledge. Although the choice of aromatase inhibitor or tamoxifen will primarily be based on the effectiveness against the recurrence of breast cancer, this review shows that the individual patient’s risk of venous or arterial vascular disease should be an important secondary consideration.Systematic review registrationProspero CRD42017065944.
Comparative, cross-sectional study of the format, content and timing of medication safety letters issued in Canada, the USA and the UK
Authors: Bjerre Lise M , Parlow Simon , de Launay David , Hogel Matthew , Black Cody D , Mattison Donald R , Grimshaw Jeremy M , Watson Margaret C 
Published: October 2018

ObjectivesTo assess consistency in the format and content, and overlap of subject and timing, of medication safety letters issued by regulatory health authorities to healthcare providers in Canada, the USA and the UK.DesignA cross-sectional study comparing medication safety letters issued for the purpose of alerting healthcare providers to newly identified medication problems associated with medications already on the market.SettingOnline databases operated by Health Canada, the US Food and Drug Administration and the UK Medicines and Healthcare products Regulatory Agency were searched to select medication safety letters issued between 1 January 2010 and 31 December 2014. Format, content and timing of each medication safety letter were assessed using an abstraction tool comprising 21 characteristics deemed relevant by consensus of the research team.Main outcome measuresMain outcome measures included, first, characteristics (format and content) of medication safety letters and second, overlap of subject and release date across countries.ResultsOf 330 medication safety letters identified, 227 dealt with unique issues relating to medications available in all three countries. Of these 227 letters, 21 (9%) medication problems were the subject of letters released in all three countries; 40 (18%) in two countries and 166 (73%) in only one country. Only 13 (62%) of the 21 letters issued in all three countries were released within 6 months of each other.ConclusionsSignificant discrepancies in both the subject and timing of medication safety letters issued by health authorities in three countries (Canada, the USA and the UK) where medical practice is otherwise comparable, raising questions about why, how and when medication problems are identified and communicated to healthcare providers by the authorities. More rapid communication of medication problems and better alignment between authorities could enhance patient safety.
Testing the information-motivation-behavioural skills model of diabetes self-management among Chinese adults with type 2 diabetes: a protocol of a 3-month follow-up study
Authors: Liu Tingting , Wu Dongmei , Wang Jing , Li Changwei , Yang Rumei , Ge Song , Du Yan , Wang Yanyan 
Published: October 2018

IntroductionCurrently, China leads the world in the number of people with diabetes, making it home to a third of the global diabetic population. Persons with diabetes have to carry out 95% of their self-care. As an important component of diabetes care, diabetes self-management (DSM) is defined as everyday behaviours that persons carry out to control diabetes. Consistent findings have been reported that level of compliance to suggested DSM behaviours is not considered optimal among Chinese adults with type 2 diabetes (T2D). The underlying reasons for suboptimal DSM behaviours among Chinese adults are not well known and no conceptual model has been developed to guide DSM interventions in this population. Although the information-motivation-behavioural skills model has been tested among Chinese adults with T2D, some key components of the original model were not tested. In this proposed study protocol, we will refine and test a culturally tailored model of DSM longitudinally among 250 Chinese adults residing in China.Methods and analysisThis is a descriptive, repeated-measure study to be conducted at a tertiary hospital in Chengdu, China. A total of 250 adults with T2D will be enrolled and followed for 3 months in this study. Information of multiple domains will be collected, including demographics, diabetes knowledge, health education form, provider-patient communication, health beliefs, social support, diabetes self-efficacy, the medical coping modes, the diabetes self-care, depression, diabetes-dependent quality of life, haemoglobin A1c, blood pressure and blood lipids at baseline and 3-month follow-up. Main analyses comprise linear regression modelling controlling for covariates and structural equation modelling.Ethics and disseminationEthical approval has been obtained through the Fourth People’s Hospital of Chengdu Research Ethics Committee (study approval number 2017017). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media.Trial registration numberChiCTR-ROC-17013592.
Do changing medical admissions practices in the UK impact on who is admitted? An interrupted time series analysis
Authors: Fielding Shona , Tiffin Paul Alexander , Greatrix Rachel , Lee Amanda J , Patterson Fiona , Nicholson Sandra , Cleland Jennifer 
Published: October 2018

IntroductionMedical admissions must balance two potentially competing missions: to select those who will be successful medical students and clinicians and to increase the diversity of the medical school population and workforce. Many countries address this dilemma by reducing the heavy reliance on prior educational attainment, complementing this with other selection tools. However, evidence to what extent this shift in practice has actually widened access is conflicting.AimTo examine if changes in medical school selection processes significantly impact on the composition of the student population.Design and settingObservational study of medical students from 18 UK 5-year medical programmes who took the UK Clinical Aptitude Test from 2007 to 2014; detailed analysis on four schools.Primary outcomeProportion of admissions to medical school for four target groups (lower socioeconomic classes, non-selective schooling, non-white and male).Data analysisInterrupted time-series framework with segmented regression was used to identify the impact of changes in selection practices in relation to invitation to interview to medical school. Four case study medical schools were used looking at admissions within for the four target groups.ResultsThere were no obvious changes in the overall proportion of admissions from each target group over the 8-year period, averaging at 3.3% lower socioeconomic group, 51.5% non-selective school, 30.5% non-white and 43.8% male. Each case study school changed their selection practice in decision making for invite to interview during 2007–2014. Yet, this within-school variation made little difference locally, and changes in admission practices did not lead to any discernible change in the demography of those accepted into medical school.ConclusionAlthough our case schools changed their selection procedures, these changes did not lead to any observable differences in their student populations. Increasing the diversity of medical students, and hence the medical profession, may require different, perhaps more radical, approaches to selection.
Examining the risk of depression or self-harm associated with incretin-based therapies used to manage hyperglycaemia in patients with type 2 diabetes: a cohort study using the UK Clinical Practice Research Datalink
Authors: Gamble John-Michael , Chibrikov Eugene , Midodzi William K , Twells Laurie K , Majumdar Sumit R 
Published: October 2018

ObjectivesTo compare population-based incidence rates of new-onset depression or self-harm in patients initiating incretin-based therapies with that of sulfonylureas (SU) and other glucose-lowering agents.DesignPopulation-based cohort study.SettingPatients attending primary care practices registered with the UK-based Clinical Practice Research Datalink (CPRD).ParticipantsUsing the UK-based CPRD, we identified two incretin-based therapies cohorts: (1) dipeptidyl peptidase-4 inhibitor (DPP-4i)-cohort, consisting of new users of DPP-4i and SU and (2) glucagon-like peptide-1 receptor agonists (GLP-1RA)-cohort, consisting of new users of GLP-1RA and SU, between January 2007 and January 2016. Patients with a prior history of depression, self-harm and other serious psychiatric conditions were excluded.Main outcome measuresThe primary study outcome comprised a composite of new-onset depression or self-harm. Unadjusted and adjusted Cox proportional hazards regression was used to quantify the association between incretin-based therapies and depression or self-harm. Deciles of High-Dimensional Propensity Scores and concurrent number of glucose-lowering agents were used to adjust for potential confounding.ResultsWe identified new users of 6206 DPP-4i and 22 128 SU in the DPP-4i-cohort, and 501 GLP-1RA and 16 409 SU new users in the GLP-1RA-cohort. The incidence of depression or self-harm was 8.2 vs 11.7 events/1000 person-years in the DPP-4i-cohort and 18.2 vs 13.6 events/1000 person-years in the GLP-1RA-cohort for incretin-based therapies versus SU, respectively. Incretin-based therapies were not associated with an increased or decreased incidence of depression or self-harm compared with SU (DPP-4i-cohort: unadjusted HR 0.70, 95% CI 0.51 to 0.96; adjusted HR 0.80, 95% CI 0.57 to 1.13; GLP-1RA-cohort: unadjusted HR 1.36, 95% CI 0.72 to 2.58; adjusted HR 1.25, 95% CI 0.63 to 2.50). Consistent results were observed for other glucose-lowering comparators including insulin and thiazolidinediones.ConclusionsOur findings suggest that the two incretin-based therapies are not associated with an increased or decreased risk of depression or self-harm.
Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China
Authors: Zhang Lin , Zhu Xi , Qiu Xiangmiao , Li Yajiao , Chen Yucheng , Wang Hui , He Shixu , Lai Wanlin , Peng Anjiao , Ning Mingming , Chen Lei 
Published: October 2018

ObjectivesTo investigate the relationship between right-to-left shunt and migraine to account for the unexplained high prevalence of migraine in patients with epilepsy.DesignThis is a cross-sectional study. The diagnosis and interview process of patients with migraine was based on the International Classification of Headache Disorders-3 beta in patients with epilepsy. Participants underwent transthoracic echocardiography (TTE) with contrast medium to identify right-to-left shunt. The highest number of microbubbles were recorded in the left atrium before the complete microbubble outflow of the right atrium. A moderate-to-large shunt was defined as the presence of 10 or more microbubbles.SettingA single-centre, cross-sectional study in China, 2015–2017.ParticipantsPatients with epilepsy.Primary and secondary outcome measuresThe primary outcome measures were the prevalence of migraine, the prevalence of right-to-left shunt in patients with migraine and those without migraine, and the prevalence of migraine in different degrees of shunting.ResultsThree hundred thirty-nine participants with epilepsy who completed TTE were included in the analysis. The overall prevalence of migraine was 23.0%. One-third of the migraineurs had mild right-to-left shunt and one-fifth of the migraineurs had moderate-to-large right-to-left shunt. Patients with mild shunt did not have a higher prevalence of migraine than those without shunt (26.3% vs 18.1%, p=0.102); however, a higher prevalence of migraine was found in patients with moderate-to-large shunt (39.0% vs 18.1%, OR=2.90, 95% CI=1.41 to 5.98, p=0.003). Patients with migraine and patients without migraine had similar prevalence of mild shunt; however, patients with migraine had more moderate-to-large shunt (20.5% vs 9.6%, p=0.002). Right-to-left shunt and female were factors predicting migraine prevalence.ConclusionsOne-fifth of migraineurs were correlated with moderate-to-large right-to-left shunt which could be an underlying cause of migraine in epilepsy.
Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty
Authors: Calderwood Michael S , Yokoe Deborah S , Murphy Michael V , DeBartolo Katherine O , Duncan Kathy , Chan Christina , Schneider Eric C , Parry Gareth , Goldmann Don , Huang Susan 
Published: October 2018

BackgroundQuality improvement (QI) campaigns appear to increase use of evidence-based practices, but their effect on health outcomes is less well studied.ObjectiveTo assess the effect of a multistate QI campaign (Project JOINTS, Joining Organizations IN Tackling SSIs) that used the Institute for Healthcare Improvement’s Rapid Spread Network to promote adoption of evidence-based surgical site infection (SSI) prevention practices.MethodsWe analysed rates of SSI among Medicare beneficiaries undergoing hip and knee arthroplasty during preintervention (May 2010 to April 2011) and postintervention (November 2011 to September 2013) periods in five states included in a multistate trial of the Project JOINTS campaign and five matched comparison states. We used generalised linear mixed effects models and a difference-in-differences approach to estimate changes in SSI outcomes.Results125 070 patients underwent hip arthroplasty in 405 hospitals in intervention states, compared with 131 787 in 525 hospitals in comparison states. 170 663 patients underwent knee arthroplasty in 397 hospitals in intervention states, compared with 196 064 in 518 hospitals in comparison states. After the campaign, patients in intervention states had a 15% lower odds of developing hip arthroplasty SSIs (OR=0.85, 95% CI 0.75 to 0.96, p=0.01) and a 12% lower odds of knee arthroplasty SSIs than patients in comparison states (OR=0.88, 95% CI 0.78 to 0.99, p=0.04).ConclusionsA larger reduction of SSI rates following hip and knee arthroplasty was shown in intervention states than in matched control states.
National hospital mortality surveillance system: a descriptive analysis
Authors: Cecil Elizabeth , Wilkinson Samantha , Bottle Alex , Esmail Aneez , Vincent Charles , Aylin Paul P 
Published: October 2018

ObjectiveTo provide a description of the Imperial College Mortality Surveillance System and subsequent investigations by the Care Quality Commission (CQC) in National Health Service (NHS) hospitals receiving mortality alerts.BackgroundThe mortality surveillance system has generated monthly mortality alerts since 2007, on 122 individual diagnosis and surgical procedure groups, using routinely collected hospital administrative data for all English acute NHS hospital trusts. The CQC, the English national regulator, is notified of each alert. This study describes the findings of CQC investigations of alerting trusts.MethodsWe carried out (1) a descriptive analysis of alerts (2007–2016) and (2) an audit of CQC investigations in a subset of alerts (2011–2013).ResultsBetween April 2007 and October 2016, 860 alerts were generated and 76% (654 alerts) were sent to trusts. Alert volumes varied over time (range: 40–101). Septicaemia (except in labour) was the most commonly alerting group (11.5% alerts sent). We reviewed CQC communications in a subset of 204 alerts from 96 trusts. The CQC investigated 75% (154/204) of alerts. In 90% of these pursued alerts, trusts returned evidence of local case note reviews (140/154). These reviews found areas of care that could be improved in 69% (106/154) of alerts. In 25% (38/154) trusts considered that identified failings in care could have impacted on patient outcomes. The CQC investigations resulted in full trust action plans in 77% (118/154) of all pursued alerts.ConclusionThe mortality surveillance system has generated a large number of alerts since 2007. Quality of care problems were found in 69% of alerts with CQC investigations, and one in four trusts reported that failings in care may have an impact on patient outcomes. Identifying whether mortality alerts are the most efficient means to highlight areas of substandard care will require further investigation.
Balloon remodeling-assisted Woven EndoBridge technique: description and feasibility for complex bifurcation aneurysms
Authors: Mihalea Cristian , Escalard Simon , Caroff Jildaz , Ikka Léon , Rouchaud Aymeric , Da Ros Valerio , Pagiola Igor , Marenco de la Torre Joaquin Jose , Yasuda Thomas , Popa Bogdan Valeriu , Ples Horia , Benachour Nidhal , Ozanne Augustin , Moret Jacques , Spelle Laurent 
Published: October 2018

BackgroundWoven EndoBridge (WEB) deployment remains challenging in aneurysms with a complex shape or orientation.ObjectiveTo show that embolization of wide-neck bifurcation aneurysms using the WEB device balloon remodeling-assisted technique is a feasible and elegant endovascular solution compared with other techniques, such as balloon remodeling or stent-assisted coiling.Materials and methods10 cases (10 aneurysms in 9 patients) of balloon remodeling-assisted WEB treatment of unruptured complex bifurcation aneurysms were treated in our institution and retrospectively analyzed. Details of clinical presentations, technical details, perioperative and postoperative complications, and outcomes were collected. Immediate and long-term angiographic results were also evaluated.ResultsAneurysms included six middle cerebral artery aneurysms, one anterior communicating artery aneurysm, one posterior communicating artery aneurysm, one basilar artery aneurysm, and one T-shaped carotid aneurysm. Mean dome width was 6.55 mm, mean neck size 4.5 mm, mean height 4.79 mm, and mean dome-to-neck ratio was 1:1.46. Treatment was performed exclusively with the balloon remodeling-assisted WEB technique in all cases. The device was successfully deployed in every case. Periprocedural thromboembolic or hemorrhagic events did not occur. The modified Rankin Scale score at discharge was 0 for all patients. At mid-term or long-term angiographic follow-up, adequate occlusion was observed in 7 aneurysms from 8 controlled cases (87.5%), and one patient (2 aneurysms) did not have angiographic follow-up.ConclusionThe balloon remodeling-assisted WEB technique seems to be a safe and effective solution for endovascular treatment of unruptured wide-neck bifurcation aneurysms with specific complex anatomy. However, further studies are needed to evaluate the rate of complications and long-term efficacy.
Vertebral body stent augmentation to reconstruct the anterior column in neoplastic extreme osteolysis
Authors: Cianfoni Alessandro , Distefano Daniela , Pravatà Emanuele , Espeli Vittoria , Pesce Gianfranco , Mordasini Pasquale , La Barbera Luigi , Scarone Pietro , Bonaldi Giuseppe 
Published: October 2018

BackgroundExtensive lytic lesions of the vertebral body (VB) increase risk of fracture and instability and require stabilization of the anterior column. Vertebral augmentation is an accepted treatment option, but when osteolysis has extensively destroyed the VB cortical boundaries (a condition herein defined as ‘extreme osteolysis’), the risk of cement leakage and/or insufficient filling is high. Vertebral body stents (VBSs) might allow partial restoration of VB height, cement containment, and reinforcement, but their use in extreme osteolysis has not been investigated.ObjectiveTo assess retrospectively the feasibility and safety of VBS augmentation in patients with ‘extreme osteolysis’ of the VB.MethodsWe retrospectively analyzed 41 treated vertebrae (from T1 to L5). VB reconstruction was assessed on postprocedure CT images and rated on a qualitative 4-point scale (poor-fair-good-excellent). Clinical and radiological follow-up was performed at 1 month and thereafter at intervals in accordance with oncological protocols.ResultsVBS augmentation was performed at 12 lumbar and 29 thoracic levels, with bilateral VBS in 23/41. VB reconstruction was judged satisfactory (good or excellent) in 37/41 (90%) of levels. Bilateral VBS received higher scores than unilateral (p=0.057, Pearson’s X2). We observed no periprocedural complications. Cement leaks (epidural or foraminal) occurred at 5/41 levels (12.2%) without clinical consequences. Follow-up data were available for 27/29 patients, extending beyond 6 months for 20 patients (7–28 months, mean 15.3 months). VBS implant stability was observed in 40/41 cases (97.5%).ConclusionsOur results support the use of VBS as a minimally invasive, safe and effective option for reconstructing the anterior column in prominent VB osteolysis.