bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of combined lumbar and sacral plexus block with sedation versus general anaesthesia on postoperative outcomes in elderly patients undergoing hip fracture surgery (CLSB-HIPELD): study protocol for a prospective, multicentre, randomised controlled trial
Authors: Zhang Junfeng , Wang Xiaofeng , Zhang Hui , Shu Zhuolin , Jiang Wei 
Published: March 2019

IntroductionHip fracture in elderly people is a global public health problem, with substantial associated mortality and disability. Nearly all patients with hip fracture undergo surgical treatment, but optimal anaesthesia for hip fracture surgery in elderly patients is still inconclusive. Ultrasound-guided combined lumbar and sacral plexus block has been widely used in hip fracture surgery in recent years, especially for some high-risk patients. However, it is not clear whether it can improve the postoperative outcomes of elderly patients with hip fracture.Method and analysisThis research project is a two-arm, parallel, multicentre, prospective randomised controlled trail. A total of 1086 patients aged 75 and older scheduled for hip fracture surgery in five clinical trial centres of China will be randomised in a 1:1 ratio to receive either combined lumbar and sacral plexus block plus sedation or general anaesthesia. The primary outcome will be the postoperative 1-year all-cause mortality. The secondary outcomes will be the incidence of postoperative complications, high-sensitivity cardiac troponin T, early mobility after surgery, postoperative Visual Analogue Scale pain scores, postoperative delirium, length of stay in intensive care unit and hospital, cost-effective outcomes, Barthel Index and incidence of adverse events after discharge. Assessments will be conducted in four steps: preoperative, intraoperative, in-hospital data collection and post-discharge telephone follow-up.Ethics and disseminationThis study has been supported by Shanghai Municipal Commission of Health and Family Planning Foundation for Key Developing Disciplines (2015ZB0103) and approved by the Ethics Committee of Shanghai Sixth People’s Hospital [No: 2016–28-(2)]. At the time of manuscript submission, the protocol version is V.1.6 (March 2nd, 2018) with one subsequent approved amendment. Results will be disseminated via an international peer-reviewed publication.Trial registration numberNCT03318133.
Rationale, design and study protocol of the randomised controlled trial: Diabetes Interventional Assessment of Slimming or Training tO Lessen Inconspicuous Cardiovascular Dysfunction (the DIASTOLIC study)
Authors: Gulsin Gaurav Singh , Brady Emer M , Swarbrick Daniel J , Athithan Lavanya , Henson Joseph , Baldry Emma , McAdam John , Marsh Anna-Marie , Parke Kelly S , Wormleighton Joanne V , Levelt Eylem , Yates Thomas , Bodicoat Danielle , Khunti Kamlesh , Davies Melanie J , McCann Gerry P 
Published: March 2019

IntroductionDespite their young age and relatively short duration of disease, younger adults with type 2 diabetes (T2D) already have diastolic dysfunction and may be at risk of incipient heart failure. Whether weight loss or exercise training improve cardiac dysfunction in people with T2D remains to be established.Methods and analysisProspective, randomised, open-label, blind endpoint trial. The primary aim of the study is to determine if diastolic function can be improved by either a meal replacement plan or a supervised exercise programme, compared with guideline-directed care. A total of 90 obese participants with T2D (aged 18–65 years), diabetes duration <12 years and not on insulin treatment will be randomised to either guideline-directed clinical care with lifestyle coaching, a low-energy meal replacement diet (average ≈810 kcal/day) or a supervised exercise programme for 12 weeks. Participants undergo glycometabolic profiling, cardiopulmonary exercise testing, echocardiography and MRI scanning to assesses cardiac structure and function and dual-energy X-ray absorptiometry scanning for body composition. Key secondary aims are to assess the effects of the interventions on glycaemic control and insulin resistance, exercise capacity, blood pressure, changes in body composition and association of favourable cardiac remodelling with improvements in weight loss, exercise capacity and glycometabolic control.Ethics and disseminationThe study has full ethical approval, and data collection was completed in August 2018. The study results will be submitted for publication within 6 months of completion.Trial registration numberNCT02590822; Pre-results.
Effectiveness of interventions for optimising adherence to treatments for the prevention and management of scars: protocol for a systematic review and meta-analysis
Authors: Killey Jessica , Simons Megan , Kimble Roy M , Tyack Zephanie 
Published: March 2019

IntroductionTreatments used in the management of scarring following wounds of the skin can be complex and time consuming, and patients may experience difficulties adhering to these treatments. Therefore, the aim of this systematic review is to identify the types of interventions that have been used to optimise adherence to treatment for preventing or reducing skin scars in adults and children and to determine the effectiveness of these interventions.Methods and analysisDatabases (PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and OTSeeker) will be searched using the developed search strategy to identify eligible randomised trials. Adults and children using scar treatments to prevent or manage scarring as a result of a dermal wound (which may occur following burn injury, surgery, lacerations, piercings, vaccinations, acne and other conditions affecting the skin) will be included. Any intervention with the potential to effect adherence will be included. Titles and abstracts located through searching will be screened by two independent reviewers. Full text of studies will also be screened to determine eligibility for final inclusion. Two reviewers will assess the quality of included studies using the Cochrane ‘risk of bias’ tool. Data extraction forms will be developed and two reviewers will extract the data. A third reviewer will be used at each stage to ensure consensus is achieved. Meta-analysis and meta-regression will be completed if appropriate, otherwise a narrative synthesis of results will be undertaken.Ethics and disseminationNo ethical approval is necessary for this systematic review as no patients will be directly involved. Results of this systematic review will be disseminated through journal publications and relevant conference presentations.PROSPERO registration numberCRD42018095082.
Synthesising evidence on patient portals: a protocol for an umbrella review
Authors: Petrovskaya Olga , Lau Francis , Antonio Marcy 
Published: March 2019

IntroductionOver the last two decades, patient portals have emerged as a noticeable eHealth strategy. To date, research on patient portals has been rapidly increasing. Our umbrella review aims to provide a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews (SRs).MethodsWe will employ a modified version of the Joanna Briggs Institute umbrella review method. The search strategy encompasses multiple databases. The inclusion criterion is specific to SRs focused on patient portal. Patients or public were not involved in this work.AnalysisTwo researchers will independently screen titles/abstracts and then full-text articles against the inclusion/exclusion criteria. Methodological quality of included reviews will be assessed and data will be extracted from the final selection of reviews. These reviews will be categorised into quantitative, qualitative and/or mixed-synthesis groups based on information about the design of primary studies provided in the reviews. Correspondingly, we will create quantitative, qualitative and/or mixed-synthesis Excel data-extraction tables. Within each table, data will be extracted with the reference to primary studies as reported in the reviews, and will be synthesised into themes and then a smaller number of findings/outcomes. Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence in the Evidence from Reviews of Qualitative research (CERQual) tools will be applied to assess the strength of evidence at the level of each finding/outcome. The output of our umbrella review will consist of summary of findings tables and evidence profile tables. A narrative meta-level synthesis will be provided. We will use the clinical adoption meta-model as an organising framework.Ethics and disseminationAs an outcome of this review, we will create a guidance and roadmap to be used in a future Delphi study to gather feedback from Canadian eHealth stakeholders. We will also present at conferences and publish the final report. The umbrella review does not require ethical approval.PROSPERO registration numberCRD42018096657.
Impact of red meat, processed meat and fibre intake on risk of late-onset chronic inflammatory diseases: prospective cohort study on lifestyle factors using the Danish ‘Diet, Cancer and Health’ cohort (PROCID-DCH):protocol
Authors: Rasmussen Nathalie Fogh , Rubin Katrine Hass , Stougaard Maria , Tjønneland Anne , Stenager Egon , Lund Hetland Merete , Glintborg Bente , Bygum Anette , Andersen Vibeke 
Published: March 2019

IntroductionChronic inflammatory diseases (CIDs) (Crohn’s disease, ulcerative colitis, psoriasis, psoriatic arthritis, rheumatoid arthritis and multiple sclerosis) are diseases of the immune system that have some shared genetic and environmental predisposing factors, but still few studies have investigated the effects of lifestyle on disease risk of several CIDs. The primary aim of this prospective cohort study is to investigate the impact of fibre, red meat and processed meat on risk of late-onset CID, with the perspective that results of this study can contribute in supporting future diet recommendations for effective personalised prevention.Methods and analysisThe study will use data from 57 053 persons from the prospective Danish cohort study ‘Diet, Cancer and Health’ together with National Health Registry data. The follow-up period is from December 1993 to December 2018. Questionnaire data on diet and lifestyle were collected at entry to the Diet, Cancer and Health study. The outcome CID is defined as having a diagnosis of one of the CIDs registered in the National Patient Registry or, for multiple sclerosis, in the Danish Multiple Sclerosis Registry during follow-up and being treated with a drug used for the specific disease. The major outcome of the analyses will be to detect variability in risk of late onset of any CID and, if power allows, disease risk of late onset of each CID diagnosis between persons with different fibre and red meat, and processed meat intake. The outcome will be adjusted for age, sex, body mass index, physical activity, energy, alcohol, fermented dairy products, education, smoking status, hormone replacement therapy and comorbidity.Ethics and disseminationThe study is approved by the Danish Data Protection Agency (2012-58-0018). The core study is an open register-based cohort study. The study does not need approval from the Ethics committee or Institutional Review Board by Danish law. Study findings will be disseminated through peer-reviewed journals, patient associations and presentations at international conferences.Trial registration numberNCT03456206; Post-results.
The impact of decentralising colposcopy services from tertiary-level to primary-level care in inner-city Johannesburg, South Africa: a before and after study
Authors: Maimela Gloria , Nene Xolisile , Mvundla Nontuthuko , Sawry Shobna , Smith Trudy , Rees Helen , Kachingwe Elizabeth , Chersich Matthew 
Published: March 2019

ObjectiveTo assess whether decentralising colposcopy services to a primary care facility in inner-city Johannesburg, South Africa raises access to colposcopy.DesignBefore–after study comparing 2 years before and 2 years after decentralisation, using clinical records and laboratory data on cervical cytology and histology.Primary outcomeThe proportion of all women attending Hillbrow Community Health Centre (HCHC) with an abnormal Papanikolaou (Pap) smear who had a colposcopy post-decentralisation.SettingCharlotte Maxeke Johannesburg Academic Hospital (CMJAH) has provided colposcopy services for several decades. HCHC, located about 3 km away, began colposcopy services in 2014.ParticipantsWomen, aged above 18 years, who had a colposcopy for diagnosis and treatment of precancerous cervical lesions following a Pap smear, from 2012 to 2016 at CMJAH or HCHC.ResultsPre-decentralisation at CMJAH, 910 women had colposcopy (2012–2014). Post-decentralisation (2014–2016), 721 had colposcopy at CMJAH and 399 at HCHC, the decentralised facility. The number who had a Pap smear at HCHC and then a colposcopy rose threefold post-decentralisation (114 vs 350). Post-decentralisation, 43 women at HCHC were referred to CMJAH for colposcopy, compared with 114 pre-decentralisation. Post-decentralisation, 47.3% of women at CMJAH waited >6 months for colposcopy, while 35.5% did at HCHC (p<0.001). Across all three groups, 26.9%–30.3% of women had cervical intraepithelial neoplasia III lesions or carcinoma on colposcopy. The proportion of invalid specimens was similar at CMJAH and HCHC (1.8%–2.8%). Of 401 women who had an abnormal Pap smear at HCHC post-decentralisation, 267 had colposcopy (66.6%).ConclusionDecentralisation can decrease the time to colposcopy and reduce the workload of tertiary hospitals. Overall, more women accessed services. Colposcopy coverage at HCHC is higher than other sites, but could be further improved. Decentralisation did not appear to undermine the quality of services and this model could be extended to similar settings in South Africa and elsewhere.
Comparison of three video laryngoscopes and direct laryngoscopy for emergency endotracheal intubation: a retrospective cohort study
Authors: Suzuki Kei , Kusunoki Shinji , Tanigawa Koichi , Shime Nobuaki 
Published: March 2019

ObjectiveVideo laryngoscopes are used for managing difficult airways. This study compared three video laryngoscopes’ (Pentax-Airway Scope [Pentax], King Vision[King] and McGrath MAC [McGrath]) performances with the Macintosh direct laryngoscope (Macintosh) as emergency tracheal intubations (TIs) reference.DesignRetrospective cohort study.SettingThe emergency department (ED) and the intensive care unit (ICU) of two Japanese tertiary-level hospitals.ParticipantsAll consecutive video-recorded emergency TI cases in EDs and ICUs between December 2013 and June 2015.Primary outcome measuresThe primary study endpoint was first-pass intubation success. A subgroup analysis examined the first-pass intubation success of expert versus non-expert operators. A logistic regression analysis was performed to identify the predictors of first-pass intubation success.ResultsA total of 287 emergency TIs were included. The first-pass intubation success rates were 78%, 58%, 78% and 58% for the Pentax, King, McGrath and Macintosh instruments, respectively (p=0.004, Fisher’s exact test). The non-expert operators’ success rates were significantly higher (p=0.00004, Fisher’s exact test) for the Pentax (87%) and McGrath (78%) instruments than that for the King (50%) and Macintosh (46%) instruments, unlike that of the experts (67%, 67%, 78% and 78% for Pentax, McGrath, King and Macintosh, respectively; p=0.556, Fisher’s exact test). After TI indication, difficult airway characteristics, and expert versus non-expert operator parameters adjustments, the Pentax (OR=3.422, 95% CI 1.551 to 7.550; p=0.002) and McGrath (OR= 3.758, CI 1.640 to 8.612; p=0.002) instruments showed significantly higher first-pass intubation success odds when compared with the Macintosh laryngoscope (reference, OR=1). The King instrument, however, (OR=1.056; 95% CI 0.487 to 2.289, p=0.889) failed to show any significant superiority.ConclusionThe Pentax and McGrath laryngoscopes showed significantly higher emergency TI first-pass intubation success rates than the King laryngoscope when compared with the Macintosh laryngoscope, especially for non-expert operators.Trial registration numberUMIN000027925; Results.
Knowledge and use of evidence-based medicine in daily practice by health professionals: a cross-sectional survey
Authors: Lafuente-Lafuente Carmelo , Leitao Catia , Kilani Insaf , Kacher Zineb , Engels Cynthia , Canouï-Poitrine Florence , Belmin Joël 
Published: March 2019

ObjectivesHealthcare professionals are expected to firmly ground their practice in sound evidence. That implies that they know and use evidence-based medicine (EBM). In this study, our aim was to know how often health professionals actually made use of EBM in their daily practice.DesignA questionnaire survey of healthcare professionals.ParticipantsHealthcare professionals who attended six university postgraduate courses. 226 answered the questionnaire (144 physicians, 64 nurses and 24 pharmacists; response rate 63.3%).Setting56.5% of respondents worked in hospitals (mostly non-teaching), 25.0% in nursing homes and 10.2% in primary care. All participants were French-speaking and lived in France or Switzerland.MeasuresDeclared degree of knowledge and use of EBM, use of EBM-related information sources.ResultsOverall, 14.2% of respondents declared to use EBM regularly in their daily practice and 15.6% declared to use EBM only occasionally. The remaining respondents declared they: knew about EBM but did not use it (33.1%), had just heard about EBM (31.9%) or did not know what EBM is (4.0%). Concerning the use of EBM-related information sources, 83.4% declared to use at least monthly (or more often) clinical guidelines, 47.1% PubMed, 21.3% the Cochrane Library and 6.4% other medical databases.Fewer pharmacists (12%) declared to use EBM in their practice than nurses (22%) or doctors (36%). No difference appeared when analysed by gender, work setting or years after graduation. The most frequent obstacles perceived for the practice of EBM were: lack of general knowledge about EBM, lack of skills for critical appraisal and lack of time.ConclusionsOnly a minority of health professionals—with differences between physicians, nurses and pharmacists—declare to regularly use EBM in their professional practice. A larger proportion appears to be interested in EBM but seems to be deterred by their lack of knowledge, skills and personal time.
Determining acute nurse staffing: a hermeneutic review of an evolving science
Authors: Leary Alison , Punshon Geoffrey 
Published: March 2019

BackgroundCalculating nurse staffing in the acute hospital has become a key issue but solutions appear distant. Community, mental health and areas such as learning disability nursing have attracted less attention and remain intractable. This review aims to examine current approaches to the issue across many disciplines.DesignThe approach taken is iterative and in the form of a hermeneutic review. 769 pieces of evidence were reviewed from across disciplines such as nursing, medicine, engineering, statistics, population science, computer science and mathematics where hospital nurse staffing was the subject of the study.ResultsA number of themes emerged. The first iteration showed the predominance of unit base approaches (eg, nurse numbers, ratios, activity and workload) and the second was the development of methodologies. Subsequent iterations examined issues such as demand, safety, nurse education, turnover, patient outcomes, patient or staff satisfaction, workload and activity. The majority of studies examined (n=767) demonstrated some association between staffing (units or type/skill) and various factors such as staff or patient satisfaction, working conditions, safety parameters, outcomes complexity of work achieved, work left undone or other factors. Many potential areas such as operational safety research were not utilised.ConclusionAlthough the relationship between staffing in acute care and factors such as units, safety or workload is complex, the evidence suggests an interdependent relationship which should only be dismissed with caution. The nature of these relationships should be further examined in order to determine nurse staffing. The body of knowledge appears substantial and complex yet appears to have little impact on policy.
Socioeconomic inequalities in obesity: modelling future trends in Australia
Authors: Hayes Alison , Tan Eng Joo , Killedar Anagha , Lung Thomas 
Published: March 2019

ObjectivesTo develop a model to predict future socioeconomic inequalities in body mass index (BMI) and obesity.DesignMicrosimulation modelling using BMI data from adult participants of Australian Health Surveys, and published data on the relative risk of mortality in relation to BMI and socioeconomic position (SEP), based on education.SettingAustralia.Participants74 329 adults, aged 20 and over from Australian Health Surveys, 1995–2015.Primary and secondary outcome measuresThe primary outcomes were BMI trajectories and obesity prevalence by SEP for four birth cohorts, born 10 years apart, centred on 1940, 1950, 1960 and 1970.ResultsSimulations projected persistent or widening socioeconomic inequality in BMI and obesity over the adult life course, for all birth cohorts. Recent birth cohorts were predicted to have greater socioeconomic inequality by middle age, compared with earlier cohorts. For example, among men, there was no inequality in obesity prevalence at age 60 for the 1940 birth cohort (low SEP 25% (95% CI 17% to 34%); high SEP 26% (95% CI 19% to 34%)), yet for the 1970 birth cohort, obesity prevalence was projected to be 51% (95% CI 43% to 58%) and 41% (95% CI 36% to 46%) for the low and high SEP groups, respectively. Notably, for more recent birth cohorts, the model predicted the greatest socioeconomic inequality in severe obesity (BMI >35 kg/m2) at age 60.ConclusionsLower SEP groups and more recent birth cohorts are at higher risk of obesity and severe obesity, and its consequences in middle age. Prevention efforts should focus on these vulnerable population groups in order to avoid future disparities in health outcomes. The model provides a framework for further research to investigate which interventions will be most effective in narrowing the gap in socioeconomic disparities in obesity in adulthood.