bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of English general practice level data linking medication levels, service activity and demography to levels of glycaemic control being achieved in type 2 diabetes to improve clinical practice and patient outcomes
Authors: Heald Adrian , Davies Mark , Stedman Mike , Livingston Mark , Lunt Mark , Fryer Anthony , Gadsby Roger 
Published: September 2019

ObjectiveEvaluate relative clinical effectiveness of treatment options for type 2 diabetes mellitus (T2DM) using a statistical model of real-world evidence within UK general practitioner practices (GPP), to quantify the opportunities for diabetes care performance improvement.MethodFrom the National Diabetes Audit in 2015–2016 and 2016–2017, GPP target glycaemic control (TGC—%HbA1c ≤58 mmol/mol) and higher glycaemic risk (HGR —%HbA1c results >86 mmol/mol) outcomes were linked using multivariate linear regression to prescribing, demographics and practice service indicators. This was carried out both cross-sectionally (XS) (within year) and longitudinally (Lo) (across years) on 35 indicators. Standardised β coefficients were used to show relative level of impact of each factor. Improvement opportunity was calculated as impact on TGC & HGR numbers.ResultsValues from 6525 GPP with 2.7 million T2DM individuals were included. The cross-sectional model accounted for up to 28% TGC variance and 35% HGR variance, and the longitudinal model accounted for up to 9% TGC and 17% HGR variance. Practice service indicators including % achieving routine checks/blood pressure/cholesterol control targets were positively correlated, while demographic indicators including % younger age/social deprivation/white ethnicity were negatively correlated. The β values for selected molecules are shown as (increased TGC; decreased HGR), canagliflozin (XS 0.07;0.145/Lo 0.04;0.07), metformin (XS 0.12;0.04/Lo –;–), sitagliptin (XS 0.06;0.02/Lo 0.10;0.06), empagliflozin (XS–;0.07/Lo 0.09;0.07), dapagliflozin (XS –;0.04/Lo –;0.4), sulphonylurea (XS −0.18;−0.12/Lo–;–) and insulin (XS−0.14;0.02/ Lo−0.09;–). Moving all GPP prescribing and interventions to the equivalent of the top performing decile of GPP could result in total patients in TGC increasing from 1.90 million to 2.14 million, and total HGR falling from 191 000 to 123 000.ConclusionsGPP using more legacy therapies such as sulphonylurea/insulin demonstrate poorer outcomes, while those applying holistic patient management/use of newer molecules demonstrate improved glycaemic outcomes. If all GPP moved service levels/prescribing to those of the top decile, both TGC/HGR could be substantially improved.
Socioeconomic determinants of chronic health diseases among older Indian adults: a nationally representative cross-sectional multilevel study
Authors: Singh Prashant Kumar , Singh Lucky , Dubey Ritam , Singh Shalini , Mehrotra Ravi 
Published: September 2019

ObjectiveStudy uses multilevel modelling to examine the effect of individual, household and contextual characteristics on chronic diseases among older Indian adults.DesignNationally representative cross-sectional study.ParticipantsData from the nationally representative, India Human Development Survey conducted in 2011–2012 was used in this study. The survey asked information related to the diagnosed chronic illnesses such as cataract, tuberculosis, hypertension, heart disease and others. The sample size of this study comprised 39 493 individuals who belonged to the age group 50 years and above.MeasuresSelf-reported diagnosed chronic illness.MethodConsidering the hierarchal structure of the data multilevel logistic regression analysis was applied to attain the study objective.ResultsOlder adults aged 80 years and older were found with three times more chances (OR: 3.99, 95% CI 2.91 to 5.48) of suffering from a chronic ailment than 50–54 years old. Lifestyle risk factors such as alcohol and tobacco (smoked and smokeless) consumption were noted to be significantly associated with the presence of chronic illness whereas older adults who have never consumed smokeless tobacco stood 20% fewer chances (OR: 0.80, 95% CI 0.68 to 0.94) of having any chronic illness. Contextual level variables such as older adults residing in the rural areas were found with 17% fewer chances (OR: 0.83, 95% CI 0.70 to 0.97) of suffering from a chronic illness.ConclusionEven after controlling for various characteristics at the individual, household and contextual levels, significant variations in chronic illness remain unexplained at the community and state level, respectively. The findings of this study could effectively be utilised to consider more contextual variables to examine the chronic health status among the growing older population of India.
Pharmaceutical payments to certified oncology specialists in Japan in 2016: a retrospective observational cross-sectional analysis
Authors: Ozaki Akihiko , Saito Hiroaki , Onoue Yosuke , Sawano Toyoaki , Shimada Yuki , Somekawa Yurie , Tsuji Aritsune , Tanimoto Tetsuya 
Published: September 2019

ObjectiveThis study investigated payments made by pharmaceutical companies to oncology specialists in Japan, what the payments were for and whether the receipt of such payments contravened any conflict of interest (COI) regulations.Design, setting and participantsPayment data to physicians, as reported by all pharmaceutical companies belonging to the Japan Pharmaceutical Manufacturers Association, were retrospectively extracted for 2016. Of the named individual recipients of payments, all certified oncologists were identified, using certification data from the Japanese Society of Medical Oncology (JSMO). The individual specialisations of each of the oncologists was also identified.OutcomePayments to individual cancer specialists and what they were for were identified. Factors associated with receipt of higher value payments and payment flows to specialties were determined. Companies selling oncology drugs with annual sales of ≥5 billion yen (£33.9 million, €40.2 million and $46.0 million) (high revenue-generating drugs) were identified.ResultsIn total, 59 companies made at least one payment to oncologists. Of the 1080 oncology specialists identified, 763 (70.6%) received at least one payment, while 317 received no payment. Of the 763, some 142 (13.1%) receiving at least 1 million yen (£6,800, €8,000 and $9200) accounted for 71.5% of the total. After adjustment of covariates, working for university hospitals and cancer hospitals and male gender were key factors associated with larger monetary payments. Payments preferentially targeted on cancer specialties using high revenue-generating drugs. The JSMO has its own COI policy for its members, but the policy did not mention any specific guidelines for certified oncology specialists.ConclusionFinancial relationships were identified and quantified between pharmaceutical companies and oncology specialists, but the extent and worth varied significantly. Given the frequency and amounts of money involved in such linkages, it would be beneficial for specific COI regulations to be developed and policed for oncologists.
Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis
Authors: van Hout Denise , Plantinga Nienke L , Bruijning-Verhagen Patricia C , Oostdijk Evelien A N , de Smet Anne Marie G A , de Wit G Ardine , Bonten Marc J M , van Werkhoven Cornelis H 
Published: September 2019

ObjectiveTo determine the cost-effectiveness of selective digestive decontamination (SDD) as compared to selective oropharyngeal decontamination (SOD) in intensive care units (ICUs) with low levels of antimicrobial resistance.DesignPost-hoc analysis of a previously performed individual patient data meta-analysis of two cluster-randomised cross-over trials.Setting24 ICUs in the Netherlands.Participants12 952 ICU patients who were treated with ≥1 dose of SDD (n=6720) or SOD (n=6232).InterventionsSDD versus SOD.Primary and secondary outcome measuresThe incremental cost-effectiveness ratio (ICER; ie, costs to prevent one in-hospital death) was calculated by comparing differences in direct healthcare costs and in-hospital mortality of patients treated with SDD versus SOD. A willingness-to-pay curve was plotted to reflect the probability of cost-effectiveness of SDD for a range of different values of maximum costs per prevented in-hospital death.ResultsThe ICER resulting from the fixed-effect meta-analysis, adjusted for clustering and differences in baseline characteristics, showed that SDD significantly reduced in-hospital mortality (adjusted absolute risk reduction 0.0195, 95% CI 0.0050 to 0.0338) with no difference in costs (adjusted cost difference €62 in favour of SDD, 95% CI –€1079 to €935). Thus, SDD yielded significantly lower in-hospital mortality and comparable costs as compared with SOD. At a willingness-to-pay value of €33 633 per one prevented in-hospital death, SDD had a probability of 90.0% to be cost-effective as compared with SOD.ConclusionIn Dutch ICUs, SDD has a very high probability of cost-effectiveness as compared to SOD. These data support the implementation of SDD in settings with low levels of antimicrobial resistance.
Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools
Authors: Harris Isobel Marion , Beese Sophie , Moore David 
Published: September 2019

ObjectiveThis systematic review aimed to evaluate the ability of risk tools to predict the future episodes of suicide/self-harm in adolescents.DesignSystematic review.Data sourcesMEDLINE, EMBASE, CINAHL and PsycINFO were searched from inception to 3 March 2018.Eligibility criteria for selecting studiesCohort studies, case–control studies and randomised controlled trials of adolescents aged 10–25 who had undergone risk assessment in a clinical setting following an episode of self-harm were included.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias. Data were grouped by tool and narrative synthesis undertaken, with studies appraised using a checklist combining the QUIPS (Quality In Prognosis Studies) and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tools.ResultsOf the 17 137 articles initially identified, 11 studies evaluating 10 separate tools were included. The studies varied in setting, population and outcome measure. The majority of the studies were rated as having an unclear risk of bias, and meta-analysis was not possible due to high variability between studies.The ability of the tools to correctly identify those adolescents going on to make a self-harm/suicide attempt ranged from 27% (95% CI 10.7% to 50.2%) to 95.8% (95% CI 78.9% to 99.9%). A variety of metrics were provided for 1–10 points increases in various tools, for example, odds and HRs.ConclusionsThis systematic review is the first to explore the use of assessment tools in adolescents. The predictive ability of these tools varies greatly. No single tool is suitable for predicting a higher risk of suicide or self-harm in adolescent populations.PROSPERO registration numberCRD42017058686
Effectiveness of pharmacological treatments in Duchenne muscular dystrophy: a protocol for a systematic review and meta-analysis
Authors: Pascual Morena Carlos , Martinez-Vizcaino Vicente , Álvarez-Bueno Celia , Fernández Rodríguez Ruben , Jiménez López Estela , Torres-Costoso Ana Isabel , Cavero-Redondo Iván 
Published: September 2019

IntroductionIn recent years, important advances have been made in the treatment of Duchenne muscular dystrophy (DMD). This protocol proposes a methodology for carrying out a systematic review and meta-analysis that aims to: (1) improve the evidence of the benefits of different pharmacological treatments in boys with DMD, and (2) compare the benefit of treatments specifically aimed at delaying the progression of disease in the functional outcomes.Methods and analysisThis protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and by the Cochrane Collaboration Handbook. A thorough selection of the literature will be done through the MEDLINE, EMBASE and Web of Science databases. The search will be conducted in English and Spanish. The Risk of Bias 2.0 tool from the Cochrane Collaboration will be used to assess the risk of bias. A narrative synthesis of the data will be performed. Meta-analysis will be conducted for effect of treatment on the 6 min walking distance (6MWD), North Star Ambulatory Assessment and Timed Functional Tests. Subgroup analyses will be performed by age or baseline values of the 6MWD, and overall bias.Ethics and disseminationThe approval of an ethical committee is not required. All the included trials will comply with the current ethical standards and the Declaration of Helsinki. The results of this proposed systematic review and meta-analysis will provide a general overview and evidence concerning the effectiveness of pharmacological treatments in Duchenne muscular dystrophy. Findings will be disseminated to academic audiences through peer-reviewed publications, as well as to clinical audiences, patients’ associations and policy makers, and may influence guideline developers in order to improve outcomes for these patients.PROSPERO registration numberCRD42018102207
Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis
Authors: Izudi Jonathan , Semakula Daniel , Sennono Richard , Tamwesigire Imelda K , Bajunirwe Francis 
Published: September 2019

ObjectivesTo summarise treatment success rate (TSR) among adult bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients in sub-Saharan Africa (SSA).DesignWe searched MEDLINE, EMBASE, Google Scholar and Web of Science electronic databases for eligible studies published in the decade between 1 July 2008 and 30 June 2018. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. We used random-effects model to pool TSR in Stata V.15, and presented results in a forest plot with 95% CIs and predictive intervals. We assessed heterogeneity with Cochrane’s (Q) test and quantified with I-squared values. We checked publication bias with funnel plots and Egger’s test. We performed subgroup, meta-regression, sensitivity and cumulative meta-analyses.SettingSSA.ParticipantsAdults 15 years and older, new and retreatment BC-PTB patients.OutcomesTSR measured as the proportion of smear-positive TB cases registered under directly observed therapy in a given year that successfully completed treatment, either with bacteriologic evidence of success (cured) or without (treatment completed).Results31 studies (2 cross-sectional, 1 case–control, 17 retrospective cohort, 6 prospective cohort and 5 randomised controlled trials) involving 18 194 participants were meta-analysed. 28 of the studies had good quality data. Egger’s test indicated no publication bias, rather small study effect. The pooled TSR was 76.2% (95% CI 72.5% to 79.8%; 95% prediction interval, 50.0% to 90.0%, I2statistics=96.9%). No single study influenced the meta-analytical results or conclusions. Between 2008 and 2018, a gradual but steady decline in TSR occurred in SSA but without statistically significant time trend variation (p=0.444). The optimum TSR of 90% was not achieved.ConclusionOver the past decade, TSR was heterogeneous and suboptimal in SSA, suggesting context and country-specific strategies are needed to end the TB epidemic.PROSPERO registration numberCRD42018099151.
Exploring healthcare providers’ perspectives of the paediatric discharge process in Uganda: a qualitative exploratory study
Authors: Nemetchek Brooklyn , Khowaja Asif , Kavuma Anthony , Kabajaasi Olive , Olirus Owilli Alex , Ansermino J Mark , Fowler-Kerry Susan , Jacob Shevin T , Kenya-Mugisha Nathan , Kabakyenga Jerome , Wiens Matthew O 
Published: September 2019

IntroductionThe burden of childhood mortality continues to be born largely by low-income and middle-income countries. The critical postdischarge period has been largely neglected despite evidence that mortality rates during this period can exceed inpatient mortality rates. However, there is a paucity of data on the paediatric discharge process from the perspective of the healthcare provider. Provider perspectives may be important in the development of an improved understanding of the barriers and facilitators to improving the transition from hospital to home.ObjectivesTo explore healthcare providers’ and facility administrators’ perspectives of the paediatric discharge process with respect to: (1) current procedures, (2) barriers and challenges, (3) ideas for change, (4) facilitators for change and (5) the importance of discharge planning.DesignA qualitative exploratory approach using focus groups (14) and in-depth interviews (7).SettingThis study was conducted at seven hospitals providing paediatric care in Uganda.ResultsCurrent discharge procedures are largely based on hospital-specific protocols or clinician opinion, as opposed to national guidelines. Some key barriers to an improved discharge process included caregiver resources and education, critical communication gaps, traditional practices, and a lack of human and physical resources. Teamwork and motivation to see improved paediatric transitions to home were identified as facilitators to implementing the ideas for change proposed by participants. The need for a standardised national policy guiding paediatric discharges, implemented through education at many levels and coupled with appropriate community referral and follow-up, was broadly perceived as essential to improving outcomes for children.ConclusionsAlthough significant challenges and gaps were identified within the current health system, participants’ ideas and the identified facilitators provide a significant basis from which change may occur. This work can facilitate the development of sustainable and effective interventions to improve postdischarge outcomes in Uganda and other similar settings.
Trends in educational and wealth inequalities in adult tobacco use in Nepal 2001–2016: secondary data analyses of four Demographic and Health Surveys
Authors: Sreeramareddy Chandrashekhar T , Harper Sam 
Published: September 2019

ObjectiveTo measure trends in socioeconomic inequalities tobacco use in Nepal.SettingAdults interviewed during house-to-house surveys.ParticipantsWomen (15–45 years) and men (15–49 years) surveyed in four Nepal Demographic and Health Surveys done in 2001, 2006, 2011 and 2016.Outcome measureCurrent tobacco use (in any form).ResultsThe prevalence of tobacco use for men declined from 66% in 2001 to 55% in 2016, and declined from 29% to 8.4% among women. Across both education and wealth quintiles for both men and women, the prevalence of tobacco use generally declines with increasing education or wealth. We found persistently larger absolute inequalities by education than by wealth among men. Among women we also found larger educational than wealth-related gradients, but both declined over time. For men, the Slope Index of Inequality (SII) for education was larger than for wealth (44% vs 26% in 2001) and changed very little over time. For women, the SII for both education and wealth were similar in magnitude to men, but decreased substantially between 2001 and 2016 (from 44% to 16% for education; from 37% to 16% for wealth). Women had a larger relative index of inequality than men for both education (6.5 vs 2.0 in 2001) and wealth (4.8 vs 1.5 in 2001), and relative inequality increased between 2001 and 2016 for women (from 6.5 to 16.0 for education; from 4.8 to 12.0 for wealth).ConclusionIncreasing relative inequalities indicates suboptimal reduction in tobacco use among the vulnerable groups suggesting that they should be targeted to improve tobacco control.
The use of the environmental scan in health services delivery research: a scoping review protocol
Authors: Charlton Patricia , Doucet Shelley , Azar Rima , Nagel Daniel A , Boulos Leah , Luke Alison , Mears Kim , Kelly Katherine J , Montelpare William J 
Published: September 2019

IntroductionThe environmental scan has been described as an important tool to inform decision-making on policy, planning and programme development in the healthcare sector. Despite the wide adoption of environmental scans, there is no consensus on a working definition within the health services delivery context and methodological guidance on the design and implementation of this approach is lacking in the literature. The objectives of this study are to map the extent, range and nature of evidence that describe the definitions, characteristics, conceptualisations, theoretical underpinnings, study limitations and other features of the environmental scan in the health services delivery literature and to propose a working definition specific to this context.Methods and analysisThis protocol describes a scoping review based on the methodology outlined by Khalil and colleagues. A comprehensive search strategy was developed by experienced health science librarians in consultation with the research team. A Peer Review of Electronic Search Strategies (PRESS) was completed. Two reviewers will independently screen titles, abstracts and full-text articles and select studies meeting the inclusion criteria from seven electronic databases: Academic Search Premier, Canadian Business & Current Affairs (CBCA), CINAHL, ERIC, Embase, MEDLINE and PsycINFO. The grey literature and reference lists of included articles will also be searched. The data will be analysed and presented in tabular format, and will include a descriptive numerical summary as well as a qualitative thematic analysis.Ethics and disseminationThis protocol provides an audit trail for a scoping review that will advance understanding about the environmental scan and its application in the health services delivery context. The review will propose a working definition and will inform future research to explore the development of a conceptual framework in this context. Findings will be disseminated through a peer-reviewed journal and conference presentations. The scoping review does not require ethics approval.