bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptoms and feelings valued by patients after a percutaneous coronary intervention: a discrete-choice experiment to inform development of a new patient-reported outcome
Authors: Barker Anna L , Peeters Geeske , Morello Renata T , Norman Richard , Ayton Darshini , Lefkovits Jeffrey , Brennan Angela , Evans Sue M , Zalcberg John , Reid Christopher , Ahern Susannah , Soh Sze-Ee , Stoelwinder Johannes , McNeil John J 
Published: October 2018

ObjectiveTo inform the development of a patient-reported outcome measure, the aim of this study was to identify which symptoms and feelings following percutaneous coronary intervention (PCI) are most important to patients.DesignDiscrete-choice experiment consisting of two hypothetical scenarios of 10 symptoms and feelings (pain or discomfort; shortness of breath; concern/worry about heart problems; tiredness; confidence to do usual activities; ability to do usual activities; happiness; sleep disturbance; dizziness or light-headedness and bruising) experienced after PCI, described by three levels (never, some of the time, most of the time). Preference weights were estimated using a conditional logit model.SettingFour Australian public hospitals that contribute to the Victorian Cardiac Outcomes Registry (VCOR) and a private insurer’s claim database.Participants138 people aged >18 years who had undergone a PCI in the previous 6 months.Main outcome measuresPatient preferences via trade-offs between 10 feelings and symptoms.ResultsOf the 138 individuals recruited, 129 (93%) completed all 16 choice sets. Conditional logit parameter estimates were mostly monotonic (eg, moving to worse levels for each individual symptom and feeling made the option less attractive). When comparing the magnitude of the coefficients (based on the coefficient of the worst level relative to best level in each item), feeling unhappy was the symptom or feeling that most influenced perception of a least-preferred PCI outcome (OR 0.42, 95% CI 0.34 to 0.51, p<0.0001) and the least influential was bruising (OR 0.81, 95% CI 0.67 to 0.99, p=0.04).ConclusionThis study provides new insights into how patients value symptoms and feelings they experience following a PCI.
Prognostic utility of the combination of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NSTEMI after primary percutaneous coronary intervention: a retrospective cohort study
Authors: Fan Zeyuan , Li Yang , Ji Hanhua , Jian Xinwen 
Published: October 2018

ObjectivesThis study aimed to evaluate prognostic value of the combination of monocyte-to-lymphocyte ratio (MLR) with neutrophil-to-lymphocyte ratio (NLR) for predicting long-term major adverse cardiac events (MACE) in patients with non-ST elevated myocardial infarction (NSTEMI) who underwent primary percutaneous coronary intervention (PCI).DesignRetrospective cohort study.SettingCivil Aviation General Hospital, Beijing, China.Participants678 patients with NSTEMI undergoing primary PCI between July 2010 and July 2015 were enrolled.Main outcome measuresThe main outcomes were MACE. The cumulative MACE-free survival rates were calculated by Kaplan-Meier analysis and the independent predictors of MACE were assessed by Cox regression analysis.ResultsAccording to the cut-off values of MLR 0.36 and NLR 2.15, the study population was classified into four groups: low MLR + low NLR group (n=319), low MLR + high NLR group (n=126), high MLR + low NLR group (n=102) and high MLR + high NLR group (n=131). The high MLR + high NLR group had a lower MACE-free survival rate than the other three groups (p logrank <0.001). Both MLR (HR 2.128, 95% CI 1.458 to 3.105) and NLR (HR 1.925, 95% CI 1.385 to 2.676) were independent predictors of long-term MACE. Moreover, the patients in the high MLR + high NLR group had an HR of 4.055 (95% CI 2.550 to 6.448) for long-term MACE, with the low-MLR + low NLR group as reference. Comparisons of receiver operating characteristic curves revealed that the combination of MLR with NLR achieved better performance in differentiating long-term MACE, compared with MLR, NLR, high-sensitivity C reactive protein and brain natriuretic peptide alone, and had similar performance to all other pairwise combinations of the four biomarkers.ConclusionsElevated levels of MLR and NLR were independent predictors of long-term MACE in patients with NSTEMI. Moreover, the combination of MLR and NLR could improve the prognostic value in predicting long-term MACE.
Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study
Authors: Ogwang Rodney , Anguzu Ronald , Akun Pamela , Ningwa Albert , Kayongo Edward , Marsh Kevin , Newton Charles R J C , Idro Richard 
Published: October 2018

ObjectivePlasmodium falciparumis epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship betweenP. falciparuminfection and seizure control in children with a unique epilepsy type, the nodding syndrome.DesignThis cross-sectional study was nested in an ongoing trial ‘Doxycycline for the treatment of nodding syndrome (NCT02850913)’. We hypothesised that, in patients with epilepsy, infection byP. falciparum,including asymptomatic infections, increases the risk of seizures and impairs seizure control.Setting and participantsParticipants were Ugandan children with nodding syndrome, age ≥8 years, receiving sodium valproate. All had standardised testing including documentation of the number of seizures in the past month, a rapid malaria test and if positive, the peripheral blood parasite density.OutcomesThe primary outcome was the number of seizures in the past month (30 days).ResultsA total of 164/240 (68%) had malaria. Asymptomatic infections (without fever) were seen in 160/240 (67%) and symptomatic infections in 4/240 (2.7%). In participants without malaria, the median (IQR) number of seizures in the past month was 2.0 (1.0–4.0) and it was 4.0 (2.0–7.5) in participants with malaria, p=0.017. The number of seizures in asymptomatic persons was 3.0 (IQR 2.0–7.3) and 6.0 (IQR 4.0–10.0) in symptomatic individuals, p=0.024. Additionally, in asymptomatic patients, a positive correlation was observed between the parasite density and number of seizures, r=0.33, p=0.002.ConclusionIn patients with nodding syndrome, both asymptomatic and symptomatic malaria are associated with an increased risk of seizures and poorer seizure control. Similar effects should be examined in other epilepsy disorders. Malaria prevention should be strengthened for these patients and chemotreatment and prevention studies considered to improve seizure control.
Evaluating the effects of community treatment orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study
Authors: Weich Scott , Duncan Craig , Bhui Kamaldeep , Canaway Alastair , Crepaz-Keay David , Keown Patrick , Madan Jason , McBride Orla , Moon Graham , Parsons Helen , Singh Swaran , Twigg Liz 
Published: October 2018

IntroductionSupervised community treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of community treatment orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of sociospatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data.Methods and analysisFour years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models. Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first readmission and mortality. Outputs from these models will be used to populate predictive models of healthcare resource use.Ethics and disseminationEthical approval has been granted by the National Health Service Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure microdata laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy-makers and other stakeholders.
Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews
Authors: Taylor Cath , Xyrichis Andreas , Leamy Mary C , Reynolds Ellie , Maben Jill 
Published: October 2018

Objectives(i) To synthesise the evidence-base for Schwartz Center Rounds (Rounds) to assess any impact on healthcare staff and identify key features; (ii) to scope evidence for interventions with similar aims, and compare effectiveness and key features to Rounds.DesignSystematic review of Rounds literature; scoping reviews of comparator interventions (action learning sets; after action reviews; Balint groups; caregiver support programme; clinical supervision; critical incident stress debriefing; mindfulness-based stress reduction; peer-supported storytelling; psychosocial intervention training; reflective practice groups; resilience training).Data sourcesPsychINFO, CINAHL, MEDLINE and EMBASE, internet search engines; consultation with experts.Eligibility criteriaEmpirical evaluations (qualitative or quantitative); any healthcare staff in any healthcare setting; published in English.ResultsThe overall evidence base for Rounds is limited. We developed a composite definition to aid comparison with other interventions from 41 documents containing a definition of Rounds. Twelve (10 studies) were empirical evaluations. All were of low/moderate quality (weak study designs including lack of control groups). Findings showed the value of Rounds to attenders, with a self-reported positive impact on individuals, their relationships with colleagues and patients and wider cultural changes. The evidence for the comparative interventions was scant and also low/moderate quality. Some features of Rounds were shared by other interventions, but Rounds offer unique features including being open to all staff and having no expectation for verbal contribution by attenders.ConclusionsEvidence of effectiveness for all interventions considered here remains limited. Methods that enable identification of core features related to effectiveness are needed to optimise benefit for individual staff members and organisations as a whole. A systems approach conceptualising workplace well-being arising from both individual and environmental/structural factors, and comprising interventions both for assessing and improving the well-being of healthcare staff, is required. Schwartz Rounds could be considered as one strategy to enhance staff well-being.
Hypermobility and sports injury
Authors: Nathan Joseph Alexander , Davies Kevin , Swaine Ian 
Published: October 2018

ObjectiveTo determine whether there is an association between hypermobility and sports injury.MethodsA quantitative observational approach using a cross-sectional survey was adopted. Individuals were identified as hypermobile or not. All participants were asked to complete two questionnaires: one asking demographic information and the other injury-specific. Fisher’s exact test was used for statistical analysis.Results114 individuals participated in the study, 62 women and 52 men. 26% of the participants were hypermobile. There was no significant association between hypermobility and sports injury (p=0.66). There was a significant increase in joint and ligament sprain among the non-hypermobile (NH) group covering all sports (p=0.03). Joint dislocation was found exclusively among hypermobile individuals. The duration of injury in hypermobile individuals was higher than NH. The use of oral painkillers or anti-inflammatories in the semiprofessional group was greater than the general population.ConclusionHypermobility is relatively common among individuals, and there is a lot of anecdotal evidence associating it with increased rates of injuries. This project finds that NH individuals are more likely to sustain a ligament or joint sprain in sports. This is due to increased joint laxity and flexibility preventing injury. There were important limitations to this study which will be addressed in further work. These include assessing for pauciarticular hypermobility and focusing on one sport to investigate its association with sports injury in those who are hypermobile or not. It would also be important to focus on one specific joint, assessing its flexibility and association with injury.
Estimation of quadriceps femoris muscle dysfunction in the early period after surgery of the knee joint using shear-wave elastography
Authors: Kawai Makoto , Taniguchi Keigo , Suzuki Tomoyuki , Katayose Masaki 
Published: October 2018

ObjectivesOrthopaedic surgery of the knee joint results in functional deterioration of the quadriceps femoris muscle. However, little is known about quadriceps femoris muscle dysfunction in the early postsurgical period. Therefore, we examined the stiffness of the quadriceps femoris muscle in the early postsurgical period.MethodsSeven patients and seven healthy controls performed quadriceps contraction exercises. In resting and contraction conditions, the shear modulus, muscle thickness and pennation angle were measured for the vastus medialis (VM), vastus lateralis (VL) and the rectus femoris (RF) using ultrasound elastography.ResultsThe shear moduli of the VM, VL and RF in the control group did not significantly interact, while the shear moduli in the patient group did show a significant interaction. In the resting condition, there was no difference between the unaffected and affected sides in the patient group, but the shear moduli of the VM and VL in the contraction condition was significantly lower on the affected side than the unaffected side.The contraction ratios between muscles by limbs did not significantly interact. However, there were main effects due to muscle and limb factors. The VM and VL had a significantly higher contraction ratio than the RF, and the control and unaffected limbs had a higher contraction ratio than the affected limb.ConclusionThe results demonstrated a decrease in muscle stiffness during contraction in patients with quadriceps femoris dysfunction. Measurement of the shear modulus has potential as a new evaluation index and with high sensitivity to decreases in muscle contraction.
Physical inactivity: productivity losses and healthcare costs 2002 and 2016 in Sweden
Authors: Bolin Kristian 
Published: October 2018

ObjectivesTo estimate the costs associated with physical inactivity in Sweden for the year 2016.MethodsThe costs associated with insufficient physical activity was calculated employing population attributable fractions (PAFs) and register information on healthcare utilisation, mortality and disability pensions. The PAFs were calculated using information on exercise habits and morbidity-specific relative risks. The healthcare cost components were calculated based on registry data on inpatient-care, outpatient-care and primary care utilisation. Registry data on cause-specific mortality and granted disability pensions were used to calculate the productivity loss components. Costs associated with pharmaceutical utilisation were not included due lack of data.ResultsPhysical exercise habits improved somewhat between 2002 and 2016. Thus, the associated morbidity-specific PAFs decreased over the same time period.ConclusionsThe economic costs attributable to insufficient physical activity decrease between the year 2002 and 2016. Healthcare costs attributable to insufficient physical activity as share of total healthcare expenses increased from 0.86 % in 2002 to 0.91 % in 2016.
WED 016 A service evaluation of the acute neurology clinic
Authors: Ray Wynford-Thomas , Ann Johnston 
Published: October 2018

RationaleNeurological symptoms are a common presentation in primary care and emergency medicine. The acute clinic provides a rapid access service, aimed at reducing unnecessary admissions, outpatient waiting times, inappropriate investigations and achieving a prompt diagnosis. Data on service utilisation will inform future service design and delivery.AimTo evaluate the acute neurology clinic service and training experience in the University Hospital of Wales.MethodData was collected prospectively on acute referrals over 6 months.Results52 patients were seen; 51% were referred from primary care. The median slots filled per clinic was 3 (range 1–6). Median time from referral to review was 3 days (range 1–7). The most common presenting symptom was headache (38%), followed by limb weakness (25%). The commonest clinical syndrome was a myelopathy (15%) and 62% had abnormal neurological signs. 75% of patients were investigated, 10% admitted and 7% discharged. In retrospect, 56% of patients warranted urgent referral.ConclusionThe acute neurology clinic provides a useful service to primary care. This data suggests it is presently under-utilised and that similar clinics and novel strategies could be enlisted to help reduce admissions and waiting times, and help manage patients with neurological symptoms in primary care.
WED 209 A case report of hyperhomocystinemia due to homozygous MTHFR mutation
Authors: Saadia Afzal , Tom Hayton , Piers Newman , Charlotte Dawson , Mary O’Driscol 
Published: October 2018

Homocycteine is metabolized via two pathways, remethylation or trans-sulfuration. The former requires 5-methyltetrahydrofolate reductase (MTHFR) and Vitamin B12, the later requires cystathione–beta-synthetase and Vitamin B6. Mutations in the MTHFR genes affect the enzyme activity to various degree and manifestations can be neuropsychiatric, vascular and neurodegenerative. Here we report a case of severe homocysteinemia secondary to two homozygous MTHFR gene mutations.32 year old pregnant female initially presented in 2014 with grand mal seizure. After being seizure free on antiepileptics, she was admitted again to hospital in January 2017 with headaches, confusion, slurred speech and neuropathic pain in feet. She developed spastic paraparesis and her condition remained critical for several weeks due to refractory seizures and low GCS.She was on warfarin for recurrent DVTs and had family history of mental health problems. Homocysteinemia was discovered when he was screened for metabolic causes and leucodystrophies. MRI of the brain showed cerebral, cerebellar and brain stem atrophy. Neurophysiological studies were normal. Genetic testing found her to be homozygous for 2 MTHFR mutations. She was commenced on calcium folinate and parenteral B12, to which she responded really well.Thorough history, targeted investigations and systematic approach are keys for diagnosis of rare metabolic disorders.
THUR 219 Myopathic manifestations in haematological conditions
Authors: Vinojini Vivekanandam , H Devine , J Holton , Z Jaunmuktane , C Turner , P Machado , H Manji , C McNamara , S D’Sa , A Carr 
Published: October 2018

Neurological complications of haematological malignancies are wide ranging but isolated myopathy as a presenting complaint is rare.Cases: 63 year-old lady with progressive proximal upper then lower limb weakness over 7 years to wheelchair-dependence and hoist-transfers. Muscle biopsy revealed nemalin rods, HIV negative, IgG kappa paraprotein=6 g/L. Late-onset nemalin rod myopathy was diagnosed; function is stable 6/12 post-autologous bone marrow transplant.56 year-old lady with limb-girdle weakness leading to immobility over 2 years and IgG lambda MGUS. Re-examination of muscle biopsy revealed amyloid deposition, SAP scan negative for systemic AL amyloid. Treated with velcade and dexamethasone but died from amyloid cardiomyopathy 6/12 later.73 year-old man with painless deltoid weakness. Muscle biopsy revealed plasma cells infiltrate and lightchain deposition with matched lightchain restriction in bone marrow, IgG kappa paraprotein=8 g/L. Cyclosporin and dexamethasone were recommended for infiltrative multifocal, myopathic plasmacytoma.28 year-old female with pain, fatigue and pelvic-girdle weakness was diagnosed with haemophagocytic lymphohistiocytosis without systemic lymphoma or connective tissue disease. Muscle biopsy demonstrated T-cell and macrophage infiltration. Muscle symptoms are responding to steroids, mycophenolate, cyclosporine and etopiside. An allogenic bone marrow transplant is planned.We describe four cases of progressive myopathic weakness as the primary manifestation of an underlying haematological disorder.
WED 240 An audit of unplanned admissions in myasthenia gravis patients
Authors: M Talaei , G Burke 
Published: October 2018

BackgroundUnplanned admissions of neuromuscular patients adversely affect patients and NHS. Muscular dystrophy UK designed an audit of unplanned admissions of neuromuscular patients in 2012 and 2017.AimWe aimed to compare unplanned admissions amongst myasthenia gravis (MG) patients, in two different hospitals in Wessex, Southampton general hospital (SGH) and Queen Alexandra service (QAH).MethodsData was collected from patients attending neurology clinics in conjunction with hospital database.Results240 adult patients were included in the audit. 60 unplanned hospital admissions were identified, but only 22 (37%) were judged to be potentially avoidable. 8 admissions were due to myasthenia relapse, 8 occurred in patients with severe myasthenia on dual immunosuppression. 9 admissions were due to pneumonia in elderly patients with multiple comorbidities but well controlled myasthenia. 2 admissions were anxiety related and 3 were due to falls and fracture despite appropriate bone protection.ConclusionOur preventable admission rate for MG patients is less compared to MDUK data (37% vs 68.7% and 59.4% in 2012 and 2017). Pneumonia is common in elderly myasthenic patients who have other comorbidities. Fragility fractures can occur despite bone protection and falls advice is necessary during consultation.