bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overtesting and undertesting in primary care: a systematic review and meta-analysis
Authors: O’Sullivan Jack W , Albasri Ali , Nicholson Brian D , Perera Rafael , Aronson Jeffrey K , Roberts Nia , Heneghan Carl 
Published: February 2018

BackgroundHealth systems are currently subject to unprecedented financial strains. Inappropriate test use wastes finite health resources (overuse) and delays diagnoses and treatment (underuse). As most patient care is provided in primary care, it represents an ideal setting to mitigate waste.ObjectiveTo identify overuse and underuse of diagnostic tests in primary care.DesignSystematic review and meta-analysis.Data sources and eligibility criteriaWe searched MEDLINE and Embase from January 1999 to October 2017 for studies that measured the inappropriateness of any diagnostic test (measured against a national or international guideline) ordered for adult patients in primary care.ResultsWe included 357 171 patients from 63 studies in 15 countries. We extracted 103 measures of inappropriateness (41 underuse and 62 overuse) from included studies for 47 different diagnostic tests.The overall rate of inappropriate diagnostic test ordering varied substantially (0.2%–100%)%).17 tests were underused >50% of the time. Of these, echocardiography (n=4 measures) was consistently underused (between 54% and 89%, n=4). There was large variation in the rate of inappropriate underuse of pulmonary function tests (38%–78%, n=8).Eleven tests were inappropriately overused >50% of the time. Echocardiography was consistently overused (77%–92%), whereas inappropriate overuse of urinary cultures, upper endoscopy and colonoscopy varied widely, from 36% to 77% (n=3), 10%–54% (n=10) and 8%–52% (n=2), respectively.ConclusionsThere is marked variation in the appropriate use of diagnostic tests in primary care. Specifically, the use of echocardiography (both underuse and overuse) is consistently poor. There is substantial variation in the rate of inappropriate underuse of pulmonary function tests and the overuse of upper endoscopy, urinary cultures and colonoscopy.PROSPERO registration numberCRD42016048832.
Carer experience of end-of-life service provision: a social network analysis
Authors: Leonard Rosemary , Horsfall Debbie , Rosenberg John , Noonan Kerrie 
Published: February 2018

ObjectiveTo identify the position of formal service providers in the networks of those providing end-of-life care in the home from the perspective of the informal network.MethodsUsing third-generation social network analysis, this study examined the nature and strength of relationships of informal caring networks with formal service providers through individual carer interviews, focus groups of caring networks and outer network interviews.ResultsService providers were usually highly valued for providing services, equipment, pain management and personalised care for the dying person plus support and advice to the principal carer about both caring tasks and negotiating the health system. However, formal service providers were positioned as marginal in the caring network. Analysis of the relative density of relationships within networks showed that whereas relationships among family and friends had similar density, relationships between service providers and family or friends were significantly lower.ConclusionThe results supported the Circles of Care model and mirror the perspective of formal service providers identified in previous research. The research raises questions about how formal and informal networks might be better integrated to increase their effectiveness for supporting in-home care.
Interaction Between the Sodium‐Glucose–Linked Transporter 2 Inhibitor Dapagliflozin and the Loop Diuretic Bumetanide in Normal Human Subjects
Authors: Wilcox Christopher S. , Shen Wen , Boulton David W. , Leslie Bruce R. , Griffen Steven C. 
Published: February 2018

Background
Dapagliflozin inhibits the sodium‐glucose–linked transporter 2 in the renal proximal tubule, thereby promoting glycosuria to reduce hyperglycemia in type 2 diabetes mellitus. Because these patients may require loop diuretics, and sodium‐glucose–linked transporter 2 inhibition causes an osmotic diuresis, we evaluated the diuretic interaction between dapagliflozin and bumetanide.

Methods and Results

Healthy subjects (n=42) receiving a fixed diet with ≈110 mmol·d
−1
of Na
+
were randomized to bumetanide (1 mg·d
−1
), dapagliflozin (10 mg·d
−1
), or both for 7 days, followed by 7 days of both. There were no meaningful pharmacokinetic interactions. Na
+
excretion increased modestly with the first dose of dapagliflozin (22±6 mmol·d
−1
;
P
<0.005) but by more (
P
<0.005) with the first dose of bumetanide (74±7 mmol·d
−1
;
P
<0.005), which was not significantly different from both diuretics together (80±5 mmol·d
−1
;
P
<0.005). However, Na
+
excretion with dapagliflozin was 190% greater (
P
<0.005) when added after 1 week of bumetanide (64±6 mmol·d
−1
), and Na
+
excretion with bumetanide was 36% greater (
P
<0.005) when added after 1 week of dapagliflozin (101±8 mmol·d
−1
). Serum urate was increased 4% by bumetanide but reduced 40% by dapagliflozin or 20% by combined therapy (
P
<0.05).

Conclusions

First‐dose Na
+
excretion with bumetanide and dapagliflozin is not additive, but the weekly administration of one diuretic enhances the initial Na
+
excretion with the other, thereby demonstrating mutual adaptive natriuretic synergy. Combined therapy reverses bumetanide‐induced hyperuricemia. This requires further study in diabetic patients with hyperglycemia who have enhanced glycosuria and natriuresis with dapagliflozin.

Clinical Trial Registration

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00930865.
Adult Congenital Heart Disease in a Nationwide Population 2000–2014: Epidemiological Trends, Arrhythmia, and Standardized Mortality Ratio
Authors: Wu Mei‐Hwan , Lu Chun‐Wei , Chen Hui‐Chi , Kao Feng‐Yu , Huang San‐Kuei 
Published: February 2018

Background

The adult congenital heart disease (
ACHD
) population will grow with medical advances, but data are limited. We investigated the epidemiological profile of
ACHD
in Taiwan, a country with a congenital heart disease program since 1955, population of 23 million, and easily accessible high‐standard medical care.

Methods and Results

ACHD
patients, born after 1954, were identified from the nationwide database 2000–2014. The
ACHD
prevalence in the population aged 18 to 59 was 140.53, 157.08, 182.45, and 217.00 per 100 000 in 2000, 2005, 2010, and 2014, respectively (increasing time trend,
P
<0.0001). Percentage of severe
ACHD
also increased over time (
P
<0.0001) and was 11.70% in 2014. The 5 leading
ACHD
diagnoses were ventricular septal defect, secundum atrial septal defect, patent ductus arteriosus, pulmonary stenosis, and tetralogy of Fallot. Freedom from tachyarrhythmia at age 50 years was 0.574 and 0.710 for severe and simple
ACHD
, respectively. Cardiac causes accounted for the majority of deaths, followed by malignancy in simple
ACHD
and external causes/sudden death/out‐of‐hospital death in severe
ACHD
patients. The proportion of unexpected death was 10%. Compared with the general population, the standardized mortality ratio was higher not only in severe
ACHD
(3.164; 95% confidence interval, 2.664–3.664), but also in women with simple
ACHD
(1.704; 95% confidence interval, 1.499–1.909), with a higher proportion of cardiac, labor, and sudden death as causes of death.

Conclusions

We demonstrated an increasing trend in
ACHD
prevalence and medical complexity. They are at risk of tachyarrhythmia, higher mortality, and unexpected deaths, suggesting a gap in their medical care.
Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke
Authors: Muruet Walter , Rudd Anthony , Wolfe Charles D.A. , Douiri Abdel 
Published: February 2018

Background and Purpose—
Intravenous thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery because clinical trials follow-up times are limited.

Methods—
Patients registered between January 2005 and December 2015, to the population-based South London Stroke Register of first-ever strokes. Propensity score was used to match thrombolyzed and control cases to a 1:2 ratio by demographical and clinical covariates. The primary outcome was survival up to 10 years using Kaplan–Meier estimates, Cox proportional hazards, and restricted mean survival time. Secondary outcomes included stroke recurrence and functional status (Barthel Index and Frenchay Activities Index scores) at 5 years.

Results—
From 2052 ischemic strokes, 246 treated patients were matched to 492 controls. Median follow-up time 5.45 years (interquartile range, 4.56). Survival was higher in the treatment group (median, 5.72 years) compared with control group (4.98 years, stratified log-rank test <0.001). The number needed to treat to prevent 1 death at 5 years was 12 and 20 at 10 years. After Cox regression analysis, thrombolysis reduced risk of mortality by 37% (hazard ratio, 0.63; 95% confidence interval [CI], 0.48–0.82) at 10 years; however, after introducing a multiplicative interaction term into the model, mortality risk reduction was 42% (hazard ratio, 0.58; 95% CI, 0.40–0.82) at 10 years for those arriving within 3 hours to the hospital. On average, in a 10-year period, treated patients lived 1 year longer than controls. At 5 years, thrombolysis was associated with independence (Barthel Index≥90; odds ratio, 3.76; 95% CI, 1.22–13.34) and increased odds of a higher Frenchay Activities Index (proportional odds ratio, 2.37; 95% CI, 1.16–4.91). There was no difference in stroke recurrence.

Conclusions—
Thrombolysis with intravenous alteplase is associated with improved long-term survival and functional status after ischemic stroke.
New York City Impacts on a Regional Heat Wave
Authors: Ortiz Luis E. , Gonzalez Jorge E. , Wu Wei , Schoonen Martin , Tongue Jeffrey , Bornstein Robert 
Published: February 2018

ABSTRACTHeat waves are projected to increase in magnitude and frequency throughout this century because of increasing global temperatures, making it critically important to acquire improved understanding of their genesis and interactions with large cities. This study presents an application of the method of factor separation to assess combined impacts of a synoptic-scale heat wave, urban land cover, and urban energy and momentum fluxes on temperatures and winds over New York City, New York, via use of high-resolution simulations (1-km grid spacing) with an urbanized version of the Weather Research and Forecasting (WRF) Model. Results showed that factors behaved different throughout the day, with synoptic conditions dominating afternoon temperature contributions (>7°C). At night, combined urban surface factors contributed over 5°C during the heat wave and up to 1.5°C on non-heat-wave days. Positive interactions among all factors during morning and nighttime indicate an amplification of the urban heat island of up to 4°C during the heat wave. Midtown Manhattan vertical cross sections, where urban canopies are most dense, showed a change in the sign (from positive to negative) of the contribution of the urban fluxes between night and day below 500 m, possibly as a result of decreased radiative cooling from trapping by buildings and increased thermal storage by buildings as well as frictional effects that oppose the incoming warm air.
Direct Numerical Simulations to Investigate Energy Transfer between Meso- and Synoptic Scales
Authors: Eghdami Masih , Bhushan Shanti , Barros Ana P. 
Published: February 2018

Abstract
Understanding the development of the atmospheric energy spectrum across scales is necessary to elucidate atmospheric predictability. In this manuscript, the authors investigate energy transfer between the synoptic scale and the mesoscale using direct numerical simulations (DNSs) of two-dimensional (2D) turbulence transfer under forcing applied at different scales. First, DNS results forced by a single kinetic energy source at large scales show that the energy spectra slopes of the direct enstrophy cascade are steeper than the theoretically predicted −3 slope. Second, the presence of two inertial ranges in 2D turbulence at intermediate scales is investigated by introducing a second energy source in the meso-α-scale range. The energy spectra for the DNS with two kinetic energy sources exhibit flatter slopes that are closer to −3, consistent with the observed kinetic energy spectra of horizontal winds in the atmosphere at synoptic scales. Further, the results are independent of model resolution and scale separation between the two energy sources, with a robust transition region between the lower synoptic and the upper meso-α scales in agreement with classical observations in the upper troposphere. These results suggest the existence of a mesoscale feedback on synoptic-scale predictability that emerges from the concurrence of the direct (downscale) enstrophy transfer in the synoptic scales and the inverse (upscale) kinetic energy transfer from the mesoscale to the synoptic scale in the troposphere.
Pain Exposure Physical Therapy versus conventional treatment in complex regional pain syndrome type 1—a cost-effectiveness analysis alongside a randomized controlled trial
Authors: Barnhoorn Karlijn , Staal J Bart , van Dongen Robert TM , Frölke Jan Paul M , Klomp Frank P , van de Meent Henk , Adang Eddy , Nijhuis-van der Sanden Maria WG 
Published: February 2018

Objective: To analyze cost-effectiveness of Pain Exposure Physical Therapy compared to conventional treatment alongside a randomized controlled trial (NCT00817128) in patients with complex regional pain syndrome type 1, where no clinical difference was shown between the two groups in an intention-to-treat analysis. Design: Randomized controlled trial with 9 months follow-up. Setting: Patients were recruited from hospitals and general practitioners in the region around a university hospital. Subjects: A total of 56 patients, 45 (80.4%) female, were randomized. About 4 patients in the intervention and 11 patients in the conventional group switched groups. The mean (SD) age was 44.3 (16.6) years, and in 37 (66.1%) patients, the upper extremity was affected. Interventions: Patients received either Pain Exposure Physical Therapy (maximum of five sessions), or conventional treatment conforming with the Dutch multidisciplinary guideline. Main measures: For the economic evaluation difference between the groups in health-related quality of life (quality-adjusted life years (QALYs)), and the clinical outcomes Impairment level Sum Score—Restricted Version and Pain Disability was determined based on the intention-to-treat analysis as well as differences in both healthcare-related costs and travel expenses. Cost-effectiveness planes were constructed using bootstrapping to compare effects and costs. Results: No significant effects were found for QALYs (mean difference = −0.02; 95% confidence interval (CI) −0.10 to 0.04) and clinical outcomes. A cost minimization analysis showed a significant difference in costs between groups. The conventional treatment was 64% more expensive than the Pain Exposure Physical Therapy. Conclusion: This economic analysis shows that Pain Exposure Physical Therapy compared to conventional treatment is cost-effective.
Assessment and management of constipation for patients receiving palliative care in specialist palliative care settings: A systematic review of the literature
Authors: Muldrew Deborah HL , Hasson Felicity , Carduff Emma , Clarke Mike , Coast Jo , Finucane Anne , Graham Lisa , Larkin Philip , McCorry Noleen K. , Slater Paul , Watson Max , Wright Eileen , McIlfatrick Sonja 
Published: February 2018

Background: Constipation is an important issue for patients receiving palliative care within specialist palliative care settings. Questions and ambiguity, however, persist about international best practice and management. Aim: To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a specialist palliative care setting. Design: This is a systematic review. Data sources: MEDLINE, Embase, CINAHL, Scopus and Cochrane databases were systematically searched in April 2017 for empirical studies, written in English, on the assessment and management of constipation in specialist palliative care settings, published between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction, and undertook a thematic analysis. Results: In total, 13 studies were included in the review comprising randomised trials ( n = 3), observational ( n = 4) and descriptive studies ( n = 6). Most research was conducted in specialist palliative care units, targeting either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation, raising questions on the existence and comparability of baseline prevalence figures, the physical and psychological impact on patients, resource impact on staff and service, the subjective and objective methods of assessing constipation, and key aspects of constipation management, including a lack of focus on non-pharmacological management in this setting. Conclusion: The results of this review are being used to inform the development of an educational intervention targeting healthcare professionals. Gaps in the evidence base include lack of consistent definition of constipation, constipation prevention, non-pharmacological management, and the consideration of the management of constipation for the dying patient.
Relationship between diverticulosis and nonalcoholic fatty liver disease in elderly patients
Authors: Sahin Abdurrahman , Tunc Nurettin , Demirel Ulvi , Kursat Poyrazoglu Orhan , Yalniz Mehmet , Halil Bahcecioglu Ibrahim 
Published: February 2018

Objective To compare clinical and laboratory features of elderly patients with and without diverticulosis and assess factors related to hepatosteatosis. Method This retrospective case–control study analysed the clinical and laboratory data, colonoscopy and abdominal ultrasonography records of patients >65 years who underwent colonoscopies. Subjects were categorized according to the presence and absence of colonic diverticulosis. Univariate/multivariate logistic regression analyses were performed to evaluate the independent predictive factors of hepatosteatosis. Results A total of 355 patients were enrolled in the study: 169 had colonic diverticulosis; and 186 without colonic diverticulosis formed the control group. Age, sex and chronic disorders associated with the metabolic syndrome did not differ between the diverticulosis and control groups. The rate of hepatosteatosis was lower in patients with diverticulosis compared with the control group (27% versus 42%, respectively). Diabetes mellitus, hyperlipidaemia and hepatosteatosis were more common among patients aged <75 years. In the multivariate logistic regression analysis, diverticulosis remained an independent predictor of hepatosteatosis (odds ratio 0.529; 95% confidence interval 0.323, 0.866). Other independent predictive factors in the multivariate analysis were triglyceride and albumin. Conclusion Diverticulosis in the elderly was found to be a negative predictor of hepatosteatosis. Higher values of albumin and triglyceride in conjunction with the absence of diverticulosis may be suggestive of nonalcoholic fatty liver disease in the elderly.
Lay Patient Navigators’ Perspectives of Barriers, Facilitators and Training Needs in Initiating Advance Care Planning Conversations With Older Patients With Cancer
Authors: Niranjan Soumya J. , Huang Chao-Hui S. , Dionne-Odom J. Nicholas , Halilova Karina I. , Pisu Maria , Drentea Patricia , Kvale Elizabeth A. , Bevis Kerri S. , Butler Thomas W. , Partridge Edward E. , Rocque Gabrielle B. 
Published: February 2018

Context: Respecting Choices is an evidence-based model of facilitating advance care planning (ACP) conversations between health-care professionals and patients. However, the effectiveness of whether lay patient navigators can successfully initiate Respecting Choices ACP conversations is unknown. As part of a large demonstration project (Patient Care Connect [PCC]), a cohort of lay patient navigators underwent Respecting Choices training and were tasked to initiate ACP conversations with Medicare beneficiaries diagnosed with cancer. Objectives: This article explores PCC lay navigators’ perceived barriers and facilitators in initiating Respecting Choices ACP conversations with older patients with cancer in order to inform implementation enhancements to lay navigator-facilitated ACP. Methods: Twenty-six lay navigators from 11 PCC cancer centers in 4 states (Alabama, George, Tennessee, and Florida) completed in-depth, one-on-one semistructured interviews between June 2015 and August 2015. Data were analyzed using a thematic analysis approach. Results: This evaluation identifies 3 levels—patient, lay navigator, and organizational factors in addition to training needs that influence ACP implementation. Key facilitators included physician buy-in, patient readiness, and navigators’ prior experience with end-of-life decision-making. Lay navigators’ perceived challenges to initiating ACP conversations included timing of the conversation and social and personal taboos about discussing dying. Conclusion: Our results suggest that further training and health system support are needed for lay navigators playing a vital role in improving the implementation of ACP among older patients with cancer. The lived expertise of lay navigators along with flexible longitudinal relationships with patients and caregivers may uniquely position this workforce to promote ACP.
The Value of Orthodontics: Do Parents’ Willingness-to-Pay Values Reflect the IOTN?
Authors: Vernazza C.R. , Anderson L. , Hunter A.I. , Leck H.C. , O’Connor S.D. , Smith G.R. , Stokes R.J. , Rolland S.L. 
Published: February 2018

Given the limited evidence about the benefits of orthodontic treatment, many health care systems have rationed access to orthodontic care, with the Index of Orthodontic Treatment Need (IOTN) being one tool used to attempt to allocate resources based on need. However, it is not clear whether patient and public valuations of different levels of need (as described by the IOTN) reflect the resource allocation decisions. The aim of this project was therefore to determine the values parents placed on correction of malocclusions at different IOTN levels using the willingness-to-pay (WTP) technique. In total, 401 parents of children attending hospital-based orthodontic clinics in the North of England were recruited to complete a questionnaire eliciting WTP for the correction of seven malocclusions with different IOTN scores. In addition, demographic and orthodontic history characteristics were collected. Results were analyzed with appropriate pairwise significance tests and regression. A significant difference in WTP was noted between all the possible pairs of malocclusions with the exception of overjets with moderate versus great need of treatments. At moderate levels, correction of crowding was valued less than overjet, but this was reversed at great need levels. Very little of the variance in WTP was explained by the variables collected. When looking at factors affecting percentage difference between values for different pairs of malocclusions, in general, no factors predicted the magnitude of difference. Median valuations for correction of malocclusions varied significantly for different levels of need (as judged by IOTN), with increasing levels of need generating higher values. However, there was a limited effect of demographic or orthodontic characteristics on the magnitude of percentage difference in values for correcting malocclusions at different levels of need. Knowledge Transfer Statement: The results of this study can be used by dental policy makers to determine how much resource should be allocated to orthodontic services for different malocclusions. They can also inform clinicians about the relative demand for treating different malocclusions, which may aid shared decision making.