bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘I’m fine’: exploring patient and carer assertions of status in advanced chronic obstructive pulmonary disease (COPD) and implications for primary care
Authors: Gardener Carole , Moore Caroline , Farquhar Morag , Ewing Gail , Duschinsky Robbie 
Published: June 2018

BackgroundPatients can be reluctant to say that they need support, telling clinicians they are ‘fine’ despite having unmet needs. Research in mental health settings suggests patients who do this they are less likely to follow treatment plans, and their carers are at a risk of depression. To-date these findings have not been explored in patients with advancing physical health conditions, or their carers.AimTo explore the presence, role and impact of assertions of ‘I’m Fine’ in patients with advanced chronic obstructive pulmonary disease (COPD) and their carers.MethodCriteria based on Attachment Theory were used to identify ‘I’m Fine’ cases from the Living with Breathlessness Study (LwB) dataset of 235 patients and 115 carers. Quantitative analysis explored variables such as health service use between ‘I’m Fine’ and non ‘I’m Fine’ cases, whilst narrative analysis is being used to explore discourses within cases.Results21 patients and six carers asserted they were ‘fine’ despite unmet needs. Patients’ minimised disease impact and symptoms, avoided thinking about the future and used stoical language. Despite ‘I’m Fine’ cases being more likely to report no exacerbations and more likely to score less on the COPD Assessment Test (CAT), all wanted to see more of their GP. Carers focused on the needs of the patient whilst downplaying their own problems.ConclusionThe existence of a sub-group of patients with advanced COPD who assert that they are ‘fine’ may have implications for primary care. This will be explored in planned focus groups with clinicians.
Validation of the Primary Care Patient Measure of Safety (PC PMOS) questionnaire
Authors: Giles Sally J , Parveen Sahdia , Hernan Andrea 
Published: June 2018

BackgroundThe Primary Care Patient Measure of Safety (PC PMOS) questionnaire was developed to collect patient feedback on 15 latent conditions in the primary care environment that influence safety incidents. It provides a way for primary care organisations to learn about safety from the patient perspective, and to then make service improvements with the aim of reducing harm in this setting.AimTo undertake validation testing PC PMOS questionnaire.Method490 adult patients from nine general practices completed the PC PMOS, and 81 practice staff completed the AHRQ medical office survey on patient safety culture. Confirmatory factor analysis (CFA) was undertaken to assess the reliability and validity of the 10 factor PC PMOS.ResultsCFA demonstrated data did not fit the model well (CMIN/DF = 5.68; GFI = 0.61, CFI = 0.57, SRMR = 0.13 and RMSEA = 0.10), thus post hoc model fitting was conducted. This resulted in the removal of 22 items on the basis of large MIs (above 10), and SRs > ±2.58, and assessment of item content. The resulting 9 factor model consisting of 28 items was found to fit the data satisfactorily (CMIN/DF = 2.51; GFI = 0.87, CFI = 0.91, SRMR = 0.04 and RMSEA = 0.05). The new factors demonstrated good internal reliability. The PC PMOS did not demonstrate good convergent validity with the correlation between total PC PMOS score and practice staff patient safety score failing to reach statistical significance (r = −0.64, k = 9, P = 0.06). It demonstrated good discriminant validity between primary care practices (F = 2.64, df = 72, P<0.001).ConclusionValidation of the PC PMOS has led to a reliable and valid 28 item patient measure of patient safety in primary care. It could enhance or complement current data collection methods used in primary care to identify and prevent error, and is also a practical response to the growing need to find appropriate and effective ways of involving patients in improving patient safety.
Doctors with dyslexia: researching experiences and support strategies
Authors: Locke Rachel , Kibble Sharon , Alexander Gail , Scallan Samantha , Mann Richard 
Published: June 2018

BackgroundAn increase in the number of medical students disclosing dyslexia as a specific learning difficulty on entering medical school is leading to an increasing number of doctors disclosing dyslexia in the workplace. The degree to which dyslexia has an impact on workplace performance depends on the individual doctor’s level of self-awareness and skill in developing supportive strategies or ‘workarounds’. There is little research on experiences and such strategies in the context of medical education and engaging in research poses challenges.AimResearch was conducted to identify effective workarounds and how they help to minimise the effects of dyslexia for doctors.MethodData was collected in stages: a systematic review, FOI requests and primary data collection. Fourteen doctors took part in the primary data collection through interviews and surveys. Five key informants with knowledge about the support available participated in semi-structured interviews.ResultsAlthough most participants had experienced difficulties they had found individualised ways of coping to overcome the challenge presented by dyslexia. The main ones were to assist with revision and exams, writing and spelling, reading, memory, time management and organisation.ConclusionThe ability to develop such personal strategies can be seen as a positive attribute of dyslexia: ‘The dyslexic learns to adapt and cope and create systems for themselves to get by’ (interviewee).
Improving vaccine uptake: a new uptake reporting tool
Authors: Tessier Elise , Pebody Richard , Boddington Nicki , Edelstein Michael , White Joanne , Rafeeq Sonia , Hopson Tim 
Published: June 2018

BackgroundVaccine uptake data is automatically extracted from all GP practices in England via the web-based reporting system, ImmForm, on behalf of Public Health England. In 2016/17, an Uptake Summary Tool was introduced on ImmForm for practice managers, clinical commissioning groups (CCGs) and screening and immunisation teams (SCRIMMS) to help facilitate local and regional management of the influenza programme. The tool allows practices to view and evaluate influenza uptake rates by target cohorts, comparing them against the previous season and CCG average/overall national uptake each week.AimTo assess how many practices use the Uptake Summary Tool and whether there is a difference in vaccine uptake among practices that use the tool compared with those that don’t during the 2016/17 and 2017/18 influenza seasons.MethodPractice level use of the Uptake Summary Tool was examined for the 2016/17 influenza season and vaccine uptake compared between practices that used the tool and those that did not.ResultsAn average of 1272 practices used the tool each week during the 2016/17. Vaccine uptake was on average 2.9% greater for targeted cohorts in practices that used the tool than practices that did not during the 2016/17 season.ConclusionWhen used on a regular basis the Uptake Summary Tool can help GP practices, CCGs and SCRIMMS monitor vaccine and may be associated with increased vaccine uptake. Uptake for the 2017/18 season will be monitored and assessed throughout the current season. We aim to expand the tool to other vaccine collections in the near future.
The Learning Disabilities Mortality Review (LeDeR) programme
Authors: Heslop Pauline , Hoghton Matt 
Published: June 2018

BackgroundSince the 1990s reports have consistently highlighted health inequalities faced by people with learning disabilities. Data from the Primary Care Research Database suggests an all-cause standardised mortality ratio for people with learning disabilities of 3.18, and that people with learning disabilities die approximately 20 years sooner than people without learning disabilities.AimThis presentation will provide an overview of the Learning Disabilities Mortality Review (LeDeR) programme. LeDeR aims to contribute to improvements in the quality of health and social care for people with learning disabilities in England through retrospective mortality reviews.MethodInitial reviews are undertaken of all deaths notified to the LeDeR programme of people with learning disabilities aged 4 years and over. Where indicated, a full multiagency review is conducted. Deaths of young people aged 18–24, and of people from Black and Minority Ethnic communities are subject to priority themed review; each of these receive a full multiagency review.ResultsThe LeDeR programme will be fully rolled out across England by the end of 2017. In this presentation we will share some of the learning from reviews that are particularly pertinent to GPs, and some of the service improvements that have resulted.ConclusionTo our knowledge, this is the first national programme of mortality reviews of people with learning disabilities in the world. Its focus is service improvement: it is about learning lessons and making changes to improve the lives of, and support for people with learning disabilities.
Uncertainty about cellulitis and unmet patient information needs: a mixed methods study
Authors: Lalonde Anna , Teasdale Emma , Muller Ingrid , Chalmers Joanne , Smart Peter , Hooper Julie , El-Gohary Magdy , Thomas Kim S , Santer Miriam 
Published: June 2018

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.
Impact of telephone triage in managing patient demand for same-day appointments? A before-after study in a UK general practice
Authors: Lau Jeffrey Chirk Fan , Rashid Sadia 
Published: June 2018

BackgroundTelephone consultations are increasingly being utilised to manage patient demand for GP appointments. It’s true impact on patient care remains to be answered as existing evidence has shown mixed results.AimTo report the impact of telephone triage on: number of face-to-face (F2F) appointments offered; unplanned re-consultations with GP or urgent care services within 24 hours; and total consultation duration per patient episode.MethodA retrospective cohort study in a single suburban practice in Kent, comparing outcomes between the new telephone triage and old walk-in F2F appointment systems in managing patient requests for same-day appointments. Data was sampled across 1 week, at 3-monthly intervals over each 12-month period before and after the system change-over in April 2016.Results1198 patient encounters matched the inclusion criteria. F2F appointments were offered to 34.7% of patients after telephone triage. Although unplanned re-consultations were four times more prevalent since the system changed compared to the previous year (P<0.001), no difference was seen between those consulted by telephone only, or offered a F2F appointment after telephone triage. Overall, patient consultations by telephone triage were 2.37 minutes shorter than consultations under its predecessor (P <0.001).ConclusionTelephone triage was able to manage majority of patient problems by telephone alone, with significant reduction in consulting time per patient episode. Telephone consulting was not shown accountable for the increase in unplanned re-consultations.
Wales Interventions and Cancer Knowledge about Early Diagnosis (WICKED): findings of work package 2 of the WICKED research programme
Authors: Nafees Sadia , Law Rebecca-Jane , Hendry Maggie , Hiscock Julia , Stanciu Marian A , Lewis Ruth , Surgey Alun , Goulden Nia , Hoare Zoe , Brain Katherine , Smits Stephanie , Yeo Seow T , Edwards Rhiannon Tudor , Williams Lynne , Williams Nefyn , Wilkinson Clare , Neal Richard D 
Published: June 2018

BackgroundCancer outcomes in the UK are worse than many countries with similar health structures. GPs play a pivotal role in improving cancer outcomes through earlier diagnosis.AimTo develop and evaluate a behavioural intervention to enable GPs to expedite cancer diagnosis.MethodThis ongoing programme is divided into four inter-related Work Packages (WPs) using a mixed methods approach. WP 2 comprises an all-Wales online GP questionnaire, 20 GP telephone interviews, and 4 practice-team focus groups. The questionnaire examined GPs’ perceptions and attitudes towards cancer diagnosis, and influences on cancer referral-related behaviour change. GPs’ individual beliefs and behaviours were explored in interviews; practice systems and norms were investigated in focus groups. Quantitative data were analysed descriptively, with conventional content analysis for free-text responses, and Framework analysis was used for qualitative data-sets.ResultsEarly findings show that 269/1993 (13.5%) GPs completed the survey. Most agreed that ‘timelier diagnosis leads to better survival’, perceived themselves to be knowledgeable, confident and capable in managing cancer symptoms, reported recent changes in their cancer-related diagnostic activity, and believed in their ability to influence timely diagnosis. However, many thought that, if given the opportunity and support, there was still room to improve early cancer diagnosis. Preliminary analysis of six interviews revealed 5 themes including; ‘wanting referral behaviour to fit, ‘feeling untrusted by secondary care’, ‘practicing over-defensive medicine’, ‘support from colleagues, and ‘difficulty referring patients with vague symptoms’.ConclusionThese findings will inform the development (WP3), and evaluation (WP4) of a behavioural intervention to expedite referral and diagnosis.
Primary care direct access cerebral imaging in Lothian, Scotland: a 5-year retrospective analysis of referrals, assessment of utility of referral guidelines, and determination of incidence of abnormalities
Authors: Zienius Karolis , Ip Chak , Ozawa Mio , Grant Robin , Ben-Shlomo Yoav , Brennan Paul M 
Published: June 2018

BackgroundDirect Access Cerebral Imaging (DACI) from Primary Care has been recommended by NICE for patients with symptoms suspicious of cancer.AimWe analysed the predictive value of the NICE (2005) and Kernick referral guidance for suspicion of brain tumour in a real-world settingMethodDACI referrals from Lothian-based GPs (31/3/2010 to 1/4/2015) were categorised according to the symptom classifications of NICE 2005 and Kernick referral guidelines. Radiological findings were grouped into 1) normal/non-significant-incidental, 2) abnormal-significant, 3) intracranial tumour.ResultsIn total, 3257 head scans were performed, and after exclusions, 2938 records were analysed. Mean age was 55.6 (SD 18.56), 1748 (60%) females. Forty-two scans (1.43%) revealed significant intracranial tumours, including 17 (40%) metastases, 10 primary intracerebral tumours (24%), 8 pituitary (19%), 7 meningioma (17%). Non-significant incidental findings were observed on 571 (19%) scans, of which 175 (6%) correlated with symptoms. Based on NICE (2005) guidelines, 39% referrals were for ‘symptoms related to the CNS’, 16% for ‘Headache of raised ICP’, 18% for ‘Sub-acute deficits’ and 27% for ‘Unexplained headache’. Kernick guidelines classified 39% referrals red-flag, 25% orange-flag, and 36% yellow-flag symptoms. NICE ‘Symptoms related to CNS’ (OR 5.21, 95% CI = 1.81 to 14.9; PPV 2.9, 95% CI 2.0 to 4.0) and Kernick’s red-flag symptoms (OR 5.73, 95% CI =2.21 to 14.84; PPV 2.8, 95% CI = 1.9 to 3.9) were the only features to have significantly increased risk of brain tumour.ConclusionReferral guidelines confirm the urgency for rapid access head imaging for symptoms ‘highly suspicious’ of brain tumour. We are now assessing diagnostic value of different symptom complexes for intracranial tumour including headache-plus.
Arterial hypertension. Does the J curve exist? And then?
Authors: Mureddu Gian Francesco 
Published: June 2018

The concept that â€˜the lower the blood pressure (BP) achieved the better the outcomeâ€™ rests on the demonstration of a direct relationship between BP and incident outcomes, down to levels of 115 mmHg of systolic BP (sBP) and 75 mmHg of diastolic BP (dBP) carried out in 1 million individuals from 61 cohorts recruited between 1950 and 1990 and followed for about 14 years. The alternative to the â€˜lower the betterâ€™ concept is the hypothesis of a J-shaped relationship, according to which the benefits of reducing sBP or dBP to low values may be dangerous leading even to an increase in total mortality and/or in CV outcomes. Data from contemporary epidemiologic observations,Â (CALIBER study), showed that the relationships between rising BPÂ and increased incidence of outcomes rise continuous even over 85 years of age without the evidence of aÂ J-shapedÂ associationÂ withÂ anyÂ ofÂ theÂ outcomes at any age strata. In the English LongitudinalÂ StudyÂ ofÂ AgeingÂ study (ELSA), a tailored analysis for octogenarians showed that the increase in mortality rates associated with BP ranges appears at sBPÂ <110 mmHg and â‰¥170 mmHg.Â In randomized controlled trials (SPRINT, HYVET and INVEST), the J curve seems to concern mainly patients with anÂ extensive atherosclerotic burden, rather than. An impaired autoregulation of coronary blood flow (CBF) leading to a fall in diastolic BP and resulting in a lowering in the perfusion pressure distal to the epicardial coronary artery stenosis, can eventually leadÂ to myocardial ischemia.Â Diastolic dysfunction can concur in worsening CBF in diastole.Â These features are often seen in elderly patients with heart failure with preserved ejection fraction. The steeper position of the slope of the end-systolic elastance can lead to dramatic increases and decreases in BP for the same change in afterload or preload. This may explain why elderly hypertensives are more prone to suffer of hypertensive crisis and/or hypotension than younger hypertensives. â€œPseudo-hypertensionâ€ caused by structural sclerotic changes in the brachial artery wall may cause overtreatment related falls in blood pressure. Thus, the J curve exists but only in patients with multiple comorbidities and/or extensive atherosclerotic burden.
Perspectives from comparisons of the Hebrew l-suffix with the Shona h-suffix features
Authors: Mushayabasa Godwin 
Published: June 2018

The ethical dative or dativus ethicus is a feature used with certain verbs in Biblical Hebrew, which, however, has continued to pose difficulties to grammarians as to its syntactic and semantic references. The feature is also present in other Semitic languages, namely, Syriac and other Aramaic dialects including Persian. Although quite a common feature, the ethical dative is seemingly difficult to translate into English, while its identification as an ethical dative is a widely accepted misnomer. This study attempts to resolve the identification of the feature’s grammatical role by seeking to relate it with a similar grammatical feature from Shona, a language from the Central and Southern African group of languages. Although there are some differences between the compared features, the similarities will go a long way to clarify the nature of the Semitic enigma that is currently known as the ethical dative in Hebrew and in other related Semitic languages.
Esthetic restorative materials and glass ionomer cements: Influence of acidic drink exposure on bacterial adhesion
Authors: Poggio Claudio , Vialba Lodovico , Marchioni Riccardo , Colombo Marco , Pietrocola Giampiero 
Published: June 2018

ABSTRACT
Objective: The purpose of this research was to evaluate and compare bacterial adhesion on five esthetic restorative materials, three glass ionomer cements (GIC), and two GIC with coat. All the materials were considered after acidic drink exposure. Materials and Methods: Thirty cylindrical sample of each of the 10 materials were prepared and then divided into three groups: group 1 (baseline), Group 2 (1 day in acidic soft drink), and Group 3 (7 days in acidic soft drink). Bacterial suspension of Streptococcus mutans was cultured and deposited onto each material, and the adhesion was evaluated through the colony-forming units determination. One-way ANOVA and Bonferroni's post hoc tests were applied to estimate significant differences between the esthetic materials. Results: The highest amount of S. mutans was recorded in Group 3 and the lowest in Group 1 (baseline). In general, the GIC showed bacterial adhesion values higher than the ones related to composites both in Group 2 than in Group 3. Acidic soft drinks lead a time-dependent degradation of restorative materials causing an increase of the surface rugosity. In fact, a general increase in S. mutans cells adhesion to treated samples was observed. Conclusions: The use of acidic soft drink resulted in a degradation of the surface layer of the restorative material with consequent increase of bacterial adhesion. The GIC can be considered a more friendly environment for bacterial adhesion. This is true in particular if acid substances have already deteriorated the surface.
Oxidative stress in chronic periodontitis patients with type II diabetes mellitus
Authors: Vincent Ruby Ramya , Appukuttan Devapriya , Victor Dhayanand John , Balasundaram Aruna 
Published: June 2018

ABSTRACT
Objective: Oxidative stress (OS) refers to the disequilibrium between free radicals and antioxidant defense mechanisms and is significantly implicated in the pathogenesis of chronic degenerative and inflammatory diseases such as chronic periodontal disease (CP) and diabetes mellitus (DM). This study aimed to evaluate the total antioxidants capacity (TAOC) and total oxidants status (TOS) in the gingival crevicular fluid (GCF) in CP participants with type II DM. Materials and Methods: A total of 80 participants were allotted into four groups as follows: Group 1: Generalized CP (GCP) without type II DM (n = 20); Group 2: GCP with type II DM (n = 20); Group 3: Type II DM without CP (n = 20); and Group 4: Systemically and periodontally healthy (PH) (n = 20). Clinical parameters such as plaque index, gingival index, probing pocket depth, and clinical attachment level were recorded. Pooled GCF was collected followed by the estimation of TAOC, TOS, and OS index (OSI) using Erel O Colorimetric analysis. Results: The clinical parameters recorded showed the statistically significant difference (P < 0.001) between the groups. The mean TAOC value was the highest in PH group. The mean TOS and OSI were higher in Group 1, 2, and 3 participants when compared to the PH participants. All the biochemical parameters evaluated showed a statistically significant difference (P < 0.001) between groups. Conclusions: The study further validates the use of OSI as a marker for periodontal disease activity and emphasizes the role of OS in the pathogenesis of Type II diabetic patients with the chronic periodontal disease.