bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic inequalities in reach, compliance and effectiveness of lifestyle interventions among workers: protocol for an individual participant data meta-analysis and equity-specific reanalysis
Authors: Oude Hengel Karen M , Coenen Pieter , Robroek Suzan J W , Boot Cecile R L , van der Beek Allard J , Van Lenthe Frank J , Burdorf Alex 
Published: February 2019

IntroductionObesity and unhealthy behaviour are more prevalent among workers with a low compared with a high socioeconomic position (SEP), and thus contribute to socioeconomic health inequalities. The occupational setting is considered an important setting to address unhealthy behaviours due to the possibility to efficiently reach a large group of adults through worksite health promotion. This paper describes the rationale and design for an individual participant data (IPD) meta-analysis and a socioeconomic equity-specific reanalysis aiming to: (1) investigate socioeconomic differences in the effectiveness of interventions aimed at promoting healthy behaviour and preventing obesity, (2) examine socioeconomic differences in reach and compliance and (3) to investigate underlying factors affecting possible socioeconomic differences.Methods and analysisA systematic search was conducted in electronic databases including Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar as well as in grey literature and trial registries. Two researchers have independently selected a total of 34 relevant studies (from 88 articles). Responsible researchers of these eligible studies were asked to provide their study data and an assessment of the methodological criteria was done. The data of the intervention studies will be pooled for the IPD meta-analysis, whereas the socioeconomic equity-specific reanalysis will focus on each study separately, stratified for SEP. Both methods will be conducted to investigate socioeconomic differences in effectiveness, reach and compliance (research aims 1 and 2). For research aim 3, different factors, such as population characteristics, organisational work environment and intervention characteristics, will be investigated as possible moderators in the associations between SEP and effectiveness, reach and compliance.Ethics and disseminationThe Medical Ethical Committee of Erasmus MC declared that the Medical Research Involving Human Subjects Act does not apply to the meta-analyses. The findings will be disseminated through peer-reviewed publications and (inter)national conference presentations.Trial registration numberCRD42018099878.
Contribution of adverse events to death of hospitalised patients
Authors: Haukland Ellinor Christin , Mevik Kjersti , von Plessen Christian , Nieder Carsten , Vonen Barthold 
Published: February 2019

BackgroundThere is no standardised method to investigate death as a patient safety indicator and we need valid and reliable measurements to use adverse events contributing to death as a quality measure.ObjectiveTo investigate the contribution of severe adverse events to death in hospitalised patients and clarify methodological differences using the Global Trigger Tool method on all inpatient deaths compared with a sample of general hospitalised patients.MethodRetrospective records reviewing using the Global Trigger Tool method.ResultsIn 0.3% of hospital admissions, adverse events contribute to inpatient death. Patients who die in hospital have twice the rate of adverse events per 1000 patient days compared with general patients, 76.7 vs 36.5 (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). Patients dying in hospital experience seven times the rate of severe adverse events, 38.4% vs 5.2% (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). For 86 out of 377 inpatient deaths, the adverse event is so severe that it contributes to death. 27.9% of severe adverse events contributing to death originate in primary care. Lower respiratory infections (p<0.001, RR 2.81, 95% CI 1.76 to 4.51), medication harm (p<0.001, RR 5.21, 95% CI 3.04 to 8.94) and pressure ulcers (p=0.04, RR 2.23, 95% CI 1.03 to 4.85) are significantly more frequent for inpatient deaths than in the general sample of hospital patients.ConclusionsPatients dying in hospitals experience seven times the rate of severe adverse events. Reviewing all inpatient death by the Global Trigger Tool method discloses new valid and reliable data of severe adverse events contributing to death which otherwise would be undetected.
Use of WHO standards to improve quality of maternal and newborn hospital care: a study collecting both mothers’ and staff perspective in a tertiary care hospital in Italy
Authors: Lazzerini Marzia , Valente Emanuelle Pessa , Covi Benedetta , Semenzato Chiara , Ciuch Margherita 
Published: February 2019

BackgroundWHO developed a list of standards for improving maternal and newborn hospital care. However, there is little experience on their use, and no precise guidance on their implementation. This study aimed at documenting the use of the WHO standards for improving the quality of maternal and neonatal care (QMNC) in a tertiary hospital, Northeast Italy.MethodsThe study was conducted between May 2016 and May 2018, in three phases: phase I—sensitisation and training of health professionals; phase II—data collection on the WHO standards through a survey among service users and providers; phase III—based on the findings of phase II, development of recommendations for improving the QMNC.ResultsOverall, 101 health professionals were successfully trained. 1050 mothers and 105 hospital staff participated in the survey. Key indicators of QMNC (and related prevalence) from the mothers survey included: caesarean section (23.1%); episiotomy (18.3%); restrictions to free movements during labour (46.5%), lithotomy position for staff choice (69.3%); skin to skin (80.8%); early breast feeding (67.2%); information on newborn danger signs (47.2%); high satisfaction with QMNC (68.8%). Only 1.2% and 0.7% of women respectively reported discrimination or abuse. Key indicators (and prevalence) reported from staff included: availability of clinical protocols (37%); regular training (14%); health information system used for quality improvement (16.3%); training on effective communication (9.7%) and on emotional support (19.6%); protocols to prevent mistreatment and abuse (6.9%). On several indicators, the opinions of mothers on QMNC was better than those of staff. Overall, 55 quality improvement recommendations were agreed.ConclusionsInformation on the WHO standards can be collected from both services users and providers and can be proactively used for planning improvements on QMNC.
Primary palliative care research: opportunities and challenges
Authors: Barclay Stephen , Moran Emily , Boase Sue , Johnson Margaret , Lovick Roberta , Graffy Jonathan , White Patrick L , Deboys Brenda , Harrison Katy , Swash Brooke 
Published: February 2019

IntroductionPrimary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed.The study methodsUsing a mixed-methods approach, quantitative data were extracted from the general practitioner (GP) and district nurse (DN) records of 400 recently deceased patients in 20 GP practices in the East of England. Focus groups were conducted with some GPs and DNs, and individual interviews held with bereaved carers and other GPs and DNs.The challenges addressedConsiderable difficulties were encountered with ethical permissions, with GP, DN and bereaved carer recruitment and both quantitative and qualitative data collection. These were overcome with flexibility of approach, perseverance of the research team and strong user group support. This enabled completion of the study which generated a unique primary palliative care data set.
Digital immunohistochemistry implementation, training and validation: experience and technical notes from a large clinical laboratory
Authors: Williams Bethany Jill , Jayewardene Dharshana , Treanor Darren 
Published: February 2019

AimsTo consider the value proposition of digitisation of clinical immunohistochemistry services, and to develop an approach to digital immunohistochemistry implementation and validation in a large clinical laboratory.MethodsA methodology for slide scanning in the laboratory was developed, in addition to a novel validation exercise, to allow pathologists to identify the strengths and weaknesses of digital immunohistochemistry reporting, and train in digital immunohistochemistry slide assessment.ResultsA total of 1480 digital immunohistochemistry slides were assessed by 24 consultant pathologists, with complete clinical concordance between the digital and the glass slide assessment observed. Certain stains were identified as being difficult/time consuming to assess using ×20 digital slides. These stains were rescanned at ×40, which improved the confidence of the pathologists to make a digital assessment. Full digitisation of immunohistochemistry slides was achieved, introducing six new steps into the pre-existing laboratory workflow.ConclusionsWhile initially encountering challenges in terms of workflow, our experience showed that a well-designed, adequately resourced and well-managed scanning process can minimise the delay in slides being made available for review. Our approach to validation highlighted the need for careful assessment of a digital pathology system and scanning protocols before pathologists are expected to transfer from the light microscope to the digital microscope for routine immunohistochemistry assessment.
Bullying and bystander behaviour and health outcomes among adolescents in Ireland
Authors: Callaghan Mary , Kelly Colette , Molcho Michal 
Published: February 2019

BackgroundLittle is known about the impact of being a bystander to bullying. This study compared health outcomes among bullies, victims and bystanders, and investigated actions taken by bystanders when they saw bullying.MethodParticipants included 7522 students aged 12–18 years that completed self-report questionnaires in the 2013/2014 Health Behaviour in School-aged Children survey. Binary logistic regression models (controlled for bully, victim, bystander status and demographic variables) were used to investigate the associations between participation in bullying as a bully, victim and bystander and health outcomes.ResultsOverall, 13.3% of adolescents reported being a bully, 25.1% reported being a victim and 30.5% reported that they saw bullying, in the last couple of months. Bystanders were significantly more likely to experience psychological symptoms (OR 1.355), somatic symptoms (OR 1.392) and low life satisfaction (OR 1.268) than those who were not bystanders. Helping the victim was significantly associated with experiencing psychological symptoms (OR 1.240), somatic symptoms (OR 1.251) and low life satisfaction (OR 1.198). Being a bully was significantly associated with experiencing psychological symptoms (OR 1.382) and not having excellent health (OR 1.252). Victims were significantly more likely to experience psychological symptoms (OR 2.437), somatic symptoms (OR 2.364), low life satisfaction (OR 2.564) and not having excellent health (OR 1.559).ConclusionIn Ireland, being a bystander to bullying is more prevalent in schools than bullying perpetration or victimisation. The impact of being a bystander to bullying needs to be highlighted and included in intervention development.
Measuring network disruption in neurodegenerative diseases: New approaches using signal analysis
Authors: McMackin Roisin , Muthuraman Muthuraman , Groppa Sergiu , Babiloni Claudio , Taylor John-Paul , Kiernan Matthew C , Nasseroleslami Bahman , Hardiman Orla 
Published: February 2019

Advanced neuroimaging has increased understanding of the pathogenesis and spread of disease, and offered new therapeutic targets. MRI and positron emission tomography have shown that neurodegenerative diseases including Alzheimer’s disease (AD), Lewy body dementia (LBD), Parkinson’s disease (PD), frontotemporal dementia (FTD), amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) are associated with changes in brain networks. However, the underlying neurophysiological pathways driving pathological processes are poorly defined. The gap between what imaging can discern and underlying pathophysiology can now be addressed by advanced techniques that explore the cortical neural synchronisation, excitability and functional connectivity that underpin cognitive, motor, sensory and other functions. Transcranial magnetic stimulation can show changes in focal excitability in cortical and transcortical motor circuits, while electroencephalography and magnetoencephalography can now record cortical neural synchronisation and connectivity with good temporal and spatial resolution.Here we reflect on the most promising new approaches to measuring network disruption in AD, LBD, PD, FTD, MS, and ALS. We consider the most groundbreaking and clinically promising studies in this field. We outline the limitations of these techniques and how they can be tackled and discuss how these novel approaches can assist in clinical trials by predicting and monitoring progression of neurophysiological changes underpinning clinical symptomatology.
TM1-1 Seizure prophylaxis in gliomas (SPRING): a phase III randomised controlled trial comparing prophylactic levetiracetam versus no prophylactic anti-epileptic drug in glioma surgery
Authors: Jenkinson MD , Watts C , Marson AG , Hill R , Murray K , Vale L , Bulbeck H , Grant R 
Published: February 2019

ObjectivesThere is no consensus regarding the need for prophylactic anti-epileptic drug (AED) in seizure-naive newly-diagnosed glioma patients. Data regarding prophylactic AED use are scant and inconclusive from older, small studies that enrolled patients with brain metastases, benign tumours and gliomas. A definitive randomised controlled trial (RCT) is needed to determine whether the policy of prophylactic AED therapy reduces the risk of first seizures in this population.DesignMulti-centre RCT.SubjectsInclusion criteria: i. seizure-naive, ii. supratentorial glioma suitable for surgery (biopsy/resection), iii. age ≥16 years; iv. Karnofsky performance status >60.MethodsPatients are randomised 1:1. Levetiracetam 500 mg bd for 2 weeks, increased to 750 mg bd thereafter for 1 year. Non-blinded. No placebo. Primary Outcome: one year risk of first seizure. Secondary outcomes: time to first seizure, time to first tonic-clonic seizure, mood, fatigue, quality of life, progression free survival, overall survival and incremental cost per QALY. Estimate of 1 year seizure rate in glioma after surgery is 20%. Based on a reduction in seizure rate to 10% a total of 806 patients will be recruited.ResultsGrant awarded by NIHR. Feasibility questionnaire demonstrated prophylactic AED rarely used. Neurosurgeons willing to randomise. 15 UK centres have expressed interest in participating.ConclusionsSPRING will establish class I evidence for the use of seizure prophylaxis in glioma surgery. The trial will open to recruitment in January 2019.
TP1-3 Final phase of recruitment and statistics analysis plan for Dex-CSDH trial
Authors: Edlmann E , Kolias A , Thelin E , Gatt D , Al-Tamimi Y , Owusu-Agyemang K , Suttner N , Holton P , Bulters D , Allison A , Bond S , Tarantino S , Davis-Wilkie C , Pantaleo B , Turner C , Hutchinson PJ ,   Dex-CSDH collaborative group,   BNTRC
Published: February 2019

ObjectivesReview recruitment progression and statistical analysis plan for Dex-CSDH trial.DesignA UK multi-centre, randomised, double-blind, placebo-controlled trial of dexamethasone versus placebo for CSDH.SubjectsSymptomatic, adult CSDH patients admitted to a participating neurosurgical unit.MethodsTrial participants receive a 2 week course of dexamethasone in addition to standard care, including surgery. The primary outcome measure is the modified Rankin Scale (mRS) at 6 months. An mRS of 0–3 requires the patient to be independently mobile and we have considered this a favourable outcome, with scores 4–6 (non-mobile) as unfavourable. The primary analysis will be performed on an intention-to-treat basis, estimating the absolute difference between the two treatment arms in the proportions achieving a favourable outcome. Secondary analysis will be done with an ordinal analysis of mRS scores and proportional odds logistic regression of the original mRS score adjusting for baseline covariates (age, GCS).Results629/750 patients (84%) have been recruited to the Dex-CSDH trial which is on-going as of 20-06-2018. Recruitment progress and follow-up at time of presentation will be reviewed alongside full statistical analysis plan.ConclusionsThe Dex-CSDH trial is drawing close to target following excellent recruitment across 22 UK centres. Transparent communication of the statistical analysis plan is essential prior to unblinding of the data. Up-to-date recruitment and primary endpoint completion rates will also be reviewed.
TM3-4 The effect of acetazolamide on intracranial pressure: primary study with prolonged continuous intracranial pressure monitoring
Authors: Thompson S , Chan H , Thorne L , Watkins L , Toma A 
Published: February 2019

ObjectivesAcetazolamide has frequently been used as a first-line treatment for idiopathic Intracranial Hypertension (IIH) and other disorders which lead to a non-acute rise in intracranial pressure (ICP). The effect of acetazolamide has been observed through lumbar puncture, however the effect of acetazolamide on ICP has not been studied in continuous ICP measurement.DesignA retrospective study of a prospectively built ICP databaseSubjectsAll patients with continuous ICP monitoring demonstrating 24 hours on and 24 hours off acetazolamide were included in the study.MethodsPatients median ICP and median pulse amplitude over 24 hour monitoring period on and off Diamox was assessed.Results12 patients (9F, 3M) underwent ICP monitoring with data collected during the same admission. 8 patients had IIH, 1 Chiari Malformation, 3 new diagnostic ICP procedures. 10 patients saw a reduction in ICP while on acetazolamide. Overall, patients experienced a Median reduction of 1.14 mmHg (Mean 1.16 mmHg, Range 4.24 to −4.445 mmHg). Patients (n9) who were on ≥1 g of acetazolamide per day experienced a median reduction in ICP of 1.595 mmHg (Mean 1.91 mmHg, Range 4.24–0.5 mmHg).ConclusionsOur data suggests acetazolamide can reduce ICP quickly following commencement, however this reduction was relatively small. The effect seems greater with a higher dose. Larger numbers of patients are required to gain a greater understanding into the significance of acetazolamide on ICP, particularly the affect at larger doses.
Dietary patterns in relation to inflammation in shift workers
Authors: Khorasaniha Reihane , Siassi F , Khajehnasiri F , Qorbani M , Sotoudeh G 
Published: February 2019

IntroductionRotational shift work has a considerable effect on immune function and cause inflammation. In addition, it may lead to unhealthy dietary intake. No earlier study has examined the association between dietary patterns and inflammation in rotational shift workers. Therefore, this study was conducted to investigate the association between dietary patterns and circulating proinflammatory cytokines among shift workers.MethodsThis cross-sectional study was conducted among 257 male shift workers. Dietary intake of participants was examined using the semiquantitative Food Frequency Questionnaire. Serum concentrations of interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (hs-CRP) were measured using suitable commercial kits.ResultsThree main dietary patterns included green vegetables, yellow vegetables and cruciferous vegetables (VEG), liquid oils and mayonnaise, fast food and eggs (LFE), as well as tea and coffee, refined grains and spice (TRS). Subjects with the highest adherence to VEG dietary pattern had a significantly lower concentration of IL-6 (p<0.01) and TNF-α (p<0.001) as compared with those with the lowest adherence. On the other hand, a significant negative association was found between LFE dietary pattern and serum concentrations of IL-6 (p=0.01) and TNF-α (p=0.02). However, no significant association was found between adherence to VEG (p=0.34) or LFE (p=0.99) dietary patterns and levels of hs-CRP and between adherence to TRS dietary pattern and any of the inflammatory cytokines.ConclusionAdherence to VEG and LFE dietary patterns was inversely and directly associated to serum IL-6 and TNF-α concentrations in shift workers, respectively. However, no significant association was found between adherence to these two dietary patterns and serum hs-CRP concentrations and between TRS dietary pattern and any of the inflammatory cytokines.
Evaluation of the Psychiatric Decisions Unit (PDU): effect on emergency department presentations and psychiatric inpatient admissions
Authors: Trethewey Samuel P , Deepak Shantal , Saad Samuel , Hughes Ellen , Tadros George 
Published: February 2019

AbstractBackgroundBusy emergency departments (EDs) are not the optimum environment for assessment of patients in mental health crisis. The Psychiatric Decisions Unit (PDU) was developed by the Birmingham and Solihull Mental Health Foundation Trust as an enhanced assessment service to ensure patients in mental health crisis receive optimal care.AimsTo evaluate the activities of the PDU and its impact on the frequency of ED presentations and inpatient admissions, and to explore patient satisfaction.MethodsData were collected over a 6-month period during 2015 regarding patient demographics, referral sources, length of stay, and frequency of mental health-related ED presentations and inpatient psychiatric admissions. Comparison group data were used to evaluate the impact of the PDU. Patient satisfaction was measured using the ‘Friends and Family Test’ and structured feedback forms.ResultsIn total, 385 patients were referred to the PDU during the study period. Implementation of the PDU was associated with a 39% decrease in the number of patients taken to the ED by Street Triage and a 26% fall in inpatient psychiatric admissions via the Trusts’ in-hospital liaison psychiatry team. Ninety-eight per cent of patients surveyed felt that they were treated with respect and understanding, and 94% reported that they were likely or extremely likely to recommend the service to friends and family.ConclusionsImplementation of the PDU was associated with a reduction in the frequency of ED presentations and inpatient psychiatric admissions. This study suggests that patients are satisfied with the care provided at the PDU.