bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the ripple effects of an Australian hospital redevelopment: a protocol for a longitudinal, mixed-methods study
Authors: Pomare Chiara , Churruca Kate , Long Janet C , Ellis Louise A , Gardiner Brett , Braithwaite Jeffrey 
Published: July 2019

IntroductionHospital redevelopment projects typically intend to improve hospital functioning and modernise the delivery of care. There is research support for the proposition that redevelopment along evidence-based design principles can lead to improved quality and safety. However, it is not clear how redevelopment influences the wider context of the hospital and its functioning. That is, beyond a limited examination of intended outcomes (eg, improved patient satisfaction), are there additional consequences (positive, negative or unintended) occurring within the hospital after the physical environment is changed? Is new always better? The primary purpose of this study is to explore the ripple effects of how hospital redevelopment may influence the organisation, staff and patients in both intended and unintended ways.Methods and analysisWe propose to conduct a longitudinal, mixed-methods, case study of a large metropolitan hospital in Australia. The study design consists of a series of measurements over time that are interrupted by the natural intervention of a hospital redevelopment. How hospital redevelopment influences the wider context of the hospital will be assessed in six domains: expectations and reflections of hospital redevelopment, organisational culture, staff interactions, staff well-being, efficiency of care delivery and patient experience. Methods of data collection include a hospital-wide staff survey, semistructured interviews, a network survey, a patient experience survey, analysis of routinely collected hospital data and observations. In addition to a hospital-level analysis, a total of four wards will be examined in-depth, with two acting as controls. Data will be analysed using thematic, statistical and network analyses, respectively, for the qualitative, quantitative and relational data.Ethics and disseminationThe study has been reviewed and approved by the relevant Ethics Committee in New South Wales, Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations and in report format to the stakeholders.
Does religious involvement affect mortality in low-income Americans? A prospective cohort study
Authors: Wen Wanqing , Schlundt David , Andersen Shaneda Warren , Blot William J , Zheng Wei 
Published: July 2019

ObjectiveThis study aimed to evaluate the impacts of various forms of religious involvement, beyond individual socioeconomic status, lifestyle factors, emotional well-being and social support, on all-cause and cause-specific mortality in socioeconomic disadvantaged neighbourhoods.DesignThis is a prospective cohort study conducted from 2002 through 2015.SettingsThis study included underserved populations in the Southeastern USA.ParticipantsA total of nearly 85 000 participants, primarily low-income American adults, were enrolled. Eligible participants were aged 40–79 years at enrolment, spoke English and were not under treatment for cancer within the prior year.ResultsWe found that those who attended religious service attendance >1/week had 8% reduction in all-cause death and 15% reduction in cancer death relative to those who never attended. This association was substantially attenuated by depression score, social support, and socioeconomic and lifestyle covariates, and further attenuated by other forms of religious involvement. This association with all-cause mortality was found being stronger among those with higher socioeconomic status or healthier lifestyle behaviours.ConclusionOur results indicate that the association between religious services attendance >1/week and lower mortality was moderate but robust, and could be attenuated and modified by socioeconomic or lifestyle factors in this large prospective cohort study of underserved populations in the Southeastern USA.
‘I don’t think anybody explained to me how it works’: qualitative study exploring vaccination and primary health service access and uptake amongst Polish and Romanian communities in England
Authors: Bell Sadie , Edelstein Michael , Zatoński Mateusz , Ramsay Mary , Mounier-Jack Sandra 
Published: July 2019

ObjectivesThis study explored vaccination attitudes and behaviours among Polish and Romanian communities, and related access to primary healthcare services.DesignA qualitative study using in-depth semistructured interviews with Polish and Romanian community members (CMs) and healthcare workers (HCWs) involved in vaccination in areas with large Polish and Romanian communities. CMs discussed their vaccination attitudes and their experiences of accessing vaccinations in England. HCWs shared their experiences in vaccinating Polish and Romanian communities.SettingRecruitment focused on three geographical areas in England with large Polish and Romanian populations (in London, Lincolnshire and Berkshire).Participants20 Polish and 10 Romanian CMs, and 20 HCWs. Most CMs were mothers or pregnant women and were recruited from London or Lincolnshire. HCWs included practice nurses, health visitors and school nurses recruited from the targeted geographical areas.ResultsAlthough most CMs reported vaccinating according to the UK schedule, obstacles to vaccination were highlighted. CMs experienced difficulties navigating and trusting the English primary healthcare system, and challenges in accessing credible vaccination information in Polish and Romanian. CM vaccination expectations, largely built on knowledge and experiences from Poland and Romania, were often unmet. This was driven by differences in vaccination scheduling and service provision in England, such as nurses delivering vaccines instead of doctors. CMs reported lower acceptance of the influenza vaccine, largely due to perceptions around the importance and efficacy of this vaccine. HCWs reported challenges translating and understanding vaccination histories, overcoming verbal communication barriers and ensuring vaccination schedule completeness among families travelling between England and Poland or Romania.ConclusionsThis study identified vaccination uptake and delivery issues and recommendations for improvement. HCWs should discuss health service expectations, highlight differences in vaccination scheduling and delivery between countries, and promote greater understanding of the English primary healthcare system in order to encourage vaccination in these communities.
Patient safety regulation in the NHS: mapping the regulatory landscape of healthcare
Authors: Oikonomou Eirini , Carthey Jane , Macrae Carl , Vincent Charles 
Published: July 2019

ObjectivesThe current research project sought to map out the regulatory landscape for patient safety in the English National Health Service (NHS).MethodWe used a systematic desk-based search using a variety of sources to identify the total number of organisations with regulatory influence in the NHS; we researched publicly available documents listing external inspection agencies, participated in advisory consultations with NHS regulatory compliance teams and reviewed the websites of all regulatory agencies.ResultsOur mapping revealed over 126 organisations who exert some regulatory influence on NHS provider organisations in addition to 211 Clinical Commissioning Groups. The majority of these organisations set standards and collect data from provider organisations and a considerable number carry out investigations. We found a multitude of overlapping functions and activities. The variability in approach and overlapping functions suggest that there is no overall integrated regulatory approach.ConclusionRegulation potentially provides a variety of benefits in terms of maintaining the safety and quality of care by providing an external perspective on the care being delivered. However, the variability, extent and fragmentation of the regulatory system of the NHS make it hard for regulators to act effectively and places a massive burden on NHS provider organisations. Overlapping regulatory requests may distract locally driven initiatives to improve safety and quality. Further research is needed to understand the full extent of regulatory activity and the true benefits and costs incurred.
Multicentre endoscopist-blinded randomised clinical trial to compare two bowel preparations after a colonoscopy with inadequate cleansing: a study protocol
Authors: Sey Michael Sai Lai , von Renteln Daniel , Sultanian Richard , McDonald Cassandra , Martel Myriam , Barkun Alan 
Published: July 2019

IntroductionInadequate bowel preparation is common and negatively impacts colonoscopy quality. The objective of this study is to compare two bowel preparation regimens in cleansing the colon after an index colonoscopy with failed bowel preparation.Methods and analysisThis is a phase III, multicentre, randomised clinical trial comparing two bowel preparation regimens after failure to adequately cleanse at the index colonoscopy. Regimen A consists of 4 L split-dose polyethylene glycol electrolyte solution (PEG-ELS) and Regimen B consists of 6 L split-dose PEG-ELS, both preceded by 15 mg of bisacodyl the day before the procedure along with a low-fibre diet 3 and 2 days before the procedure followed by a clear fluid diet starting the day before the procedure. The primary outcome is adequate bowel preparation, defined as a Boston Bowel Preparation Scale (BBPS) score of ≥6 with each segment score ≥2. Secondary outcomes include mean BBPS score, bowel preparation adequacy using the US Multi-Society Task Force on Colorectal Cancer definition, detection rate by polyp subtype, caecal intubation rate, mean Validated Patient Tolerability Questionnaire for Bowel Preparation score, subject willingness to repeat the preparation and faecal incontinence rate.Ethics and disseminationThe study will be conducted in accordance with Good Clinical Practice guidelines and local institutional standards. Study findings will be disseminated at an international gastroenterology conference and published in peer-reviewed journals.Trial registration numberNCT02976805; Pre-results.
Delayed diagnosis and treatment of pulmonary tuberculosis in high-burden countries: a systematic review protocol
Authors: Teo Alvin Kuo Jing , Singh Shweta R , Prem Kiesha , Hsu Li Yang , Yi Siyan 
Published: July 2019

IntroductionCountries identified to bear the highest tuberculosis (TB) incidence account for approximately 85% of the global TB burden. TB is curable, yet nearly 40% of TB cases remained undiagnosed hence delaying treatment and perpetuating transmission. This systematic review aimed to review current evidence on factors associated with delayed diagnosis and treatment of TB in the high TB-burden countries.Methods and analysisThis systematic review will incorporate qualitative and observational study designs published between 2008 and 2018. Articles will be retrieved from major databases including PubMed, EMBASE, CINAHL and PsycINFO. Reference lists of key articles, including relevant systematic reviews and meta-analysis, will be screened for additional studies. Two independent reviewers will screen and select studies, extract data and assess the quality and risk of bias of each study. Study-specific estimates will be pooled by meta-analysis, and effect sizes will be presented as OR and their 95% CI. Levels of heterogeneity will be evaluated using chi-square statistic Q and I2. Publication bias will be assessed using forest plots and Egger’s tests. Qualitative findings and sample quotes will be extracted. Textual references to the topics of interest will be retrieved and categorised using qualitative thematic analysis. We will triangulate quantitative and qualitative findings for a complete understanding of the reasons for delayed TB diagnosis and treatment. Results will be presented by geographical region.Ethics and disseminationThis study will be conducted based on published data. This systematic review may provide insights into the reasons for delayed TB diagnosis in high-burden countries. These findings will also inform future research and key stakeholders in developing interventions to reach these undiagnosed cases effectively. Findings from this review will be published in a peer-reviewed journal.PROSPERO registration numberCRD42018107237
Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis
Authors: Morello Renata Teresa , Soh Sze-Ee , Behm Kate , Egan Amy , Ayton Darshini , Hill Keith , Flicker Leon , Etherton-Beer Christopher D , Arendts Glenn , Waldron Nicholas , Redfern Julie , Haines Terrence , Lowthian Judy , Nyman Samuel R , Cameron Peter , Fairhall Nicola , Barker Anna Lucia 
Published: July 2019

ObjectiveTo determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall.DesignSystematic review and meta-analyses of randomised controlled trials (RCTs).Data sourcesFour health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018).Study selectionRCTs of multifactorial falls prevention interventions targeting community-dwelling older adults ( ≥ 60 years) presenting to the ED with a fall with quantitative data on at least one review outcome.Data extractionTwo independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third.Data synthesis12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes.ConclusionsThere is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.
Six-month prospective trial in early and long-standing rheumatoid arthritis: evaluating disease activity in the wrist through sequential synovial histopathological analysis, RAMRIS magnetic resonance score and EULAR-OMERACT ultrasound score
Authors: Just Søren Andreas , Nielsen Christian , Werlinrud Jens Christian , Larsen Pia Veldt , Klinkby Camilla Schufri , Schrøder Henrik Daa , Humby Fran , Torfing Trine , Lindegaard Hanne 
Published: July 2019

IntroductionStandardised scoring systems for rheumatoid arthritis (RA) joint disease activity include Larsen score for radiographs, rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for MRI and using the European League Against Rheumatisms-Outcome Measures in Rheumatology (EULAR-OMERACT) score for ultrasound (US) images. The aim of this prospective study was to investigate the relationship between histological synovitis and radiological synovitis, assessed by conventional X-ray, US and MRI of the wrist radiocarpal joint.Methods20 patients with treatment naive early RA (ERA) and 20 with long-standing RA (LRA) were enrolled in a 6-month prospective study. Patients with RA underwent US-guided synovial biopsy, X-ray and US of the wrist at enrolment and 6 months. MRI at baseline and also at 6 months for the ERA group, and scored with the RAMRIS system. X-ray was scored by Larsen score and US by the EULAR-OMERACT system. Synovial biopsy inflammation was determined by the Krenn score.ResultsIn the ERA group at baseline, Krenn score was correlated strongly with both US combined score (r = 0.77 p < 0.001) and MRI synovitis score (r = 0.85 p < 0.001), while uncorrelated at 6 months. In the LRA group at baseline, these scores correlated strongly (r = 0.83, p < 0.001) to moderately (r = 0.61, p = 0.002), and persisted at 6 months for US score (r = 0.81 p < 0.001). For all patients with RA, change in Krenn score between baseline and 6 months was correlated with both change in US combined score (r = 0.65, p < 0.001) and change in MRI synovitis score (r = 0.50, p = 0.03).ConclusionThe MRI RAMRIS synovitis score and EULAR-OMERACT US scoring system are sensitive measures of histological synovitis in LRA and ERA. After 6 months, this correlation persists in the established RA group, but not in the ERA group. Overall, decreases in MRI/US synovitis are associated with reductions in histological synovitis. The study validates the use of MRI RAMRIS and EULAR-OMERACT US scores as surrogate markers of histological synovitis in established RA and early untreated RA.
Placement of a temporary cholecystostomy tube to relieve pancreatic EHBDO in a dog
Authors: Martiny Pia , Hayes Galina 
Published: July 2019

A 12‐year‐old male neutered labrador retriever was treated for extrahepatic bile duct obstruction (EHBDO) secondary to acute pancreatitis. Supportive care was provided for 14 days, but despite treatment the dog’s clinical condition worsened. A temporary cholecystostomy tube was placed via minilaparotomy to provide extracorporeal diversion of bile until patency of the common bile duct was spontaneously re‐established. Within 24 hours of tube placement, marked improvement in total bilirubin was noted and the dog could be managed as an outpatient. Clinical signs resolved rapidly, and despite complications with the external tubing necessitating replacement after 48 hours the procedure and tube were well tolerated. Patency of the common bile duct was spontaneously re‐established three weeks after tube placement, and the cholecystostomy tube was removed percutaneously. No recurrence of EHBDO was noted in the 13 months following removal of the cholecystostomy tube.
МІСЦЕ АНТИКОАГУЛЯНТІВ У ЛІКУВАННІ ТА ПРОФІЛАКТИЦІ ІШЕМІЧНОГО ІНСУЛЬТУ (огляд доказової бази використання)
Authors: Levytska O. R. , Hromovyk B. P. 
Published: July 2019

Мета роботи. Розбір та систематизація даних кокранівських (КО) і систематичних (СО) оглядів та мета-аналізів (МА) щодо застосування антикоагулянтів (АК) при ішемічному інсульті (İİ) з орієнтацією на нові дані доказової медицини. Матеріали і методи. Матеріалами для дослідження слугували публікації (КО, СО, МА) в базах даних DORIS та Medline щодо застосування АК при İİ, розширений пошук яких здійснено у березні 2019 р. У дослідження включено 6 КО, 8 СО і 4 МА (повнотекстові огляди або абстракти). Використано методи: інформаційного пошуку, аналізу, синтезу та узагальнення. Систематизація даних здійснювалася за видом антитромботичного засобу, його дозуванням тощо. Результати й обговорення. Проаналізовано та систематизовано дані щодо ефективності та безпеки використання парентеральних АК (нефракціонованого гепарину (НГ), низькомолекулярних гепаринів (НМГ), гепариноїдів) та пероральних АК (антагоністів вітаміну К, інгібіторів тромбіну чи фактора згортання крові Ха) в гострому періоді İİ та його вторинній профілактиці. При гострому İİ АК не мають переваг перед антитромбоцитарними засобами у зниженні смертності та залежності; антикоагулянтна терапія (АКТ) не зменшує смертність від усіх причин; вона дещо зменшує частоту повторних İİ, більше зменшує емболію легень і тромбози глибоких вен. В останньому випадку НМГ або гепариноїди перевершують НГ. АКТ при гострому İİ збільшувала кількість внутрішньочерепних (ВЧК), екстракраніальних чи внутрішньомозкових (ВМК) крововиливів. Вищі дози АК збільшують ризик ВМК чи ВЧК та не поліпшують загальний результат лікування пацієнтів з гострим İİ. Не виявлено користі від тривалої АКТ з метою вторинної профілактики некардіоемболічного İİ або транзиторної ішемічної атаки. Висновки. Розвиток наукових досліджень у питанні АКТ при İİ, еволюція поглядів щодо ролі АК у лікуванні та профілактиці даної патології засвідчують, що вивчення ефективності та безпеки цієї групи лікарських засобів у сучасній інсультології були та залишаються актуальним напрямом. Враховуючи поповнення доказової бази результатами нових клінічних досліджень, які уже знайшли відображення в рекомендаціях американських асоціацій серця та інсульту, доцільно переглянути та доповнити вітчизняні медико-технологічні документи, які регламентують клінічні аспекти надання медичної допомоги при İİ.
ДОСЛІДЖЕННЯ ВПЛИВУ ДОПОМІЖНИХ РЕЧОВИН НА ФАРМАКО-ТЕХНОЛОГІЧНІ ВЛАСТИВОСТІ ПОРОШКОВИХ МАС ІЗ РОСЛИННИМИ ЕКСТРАКТАМИ ТА ЕФІРНОЮ ОЛІЄЮ
Authors: Hordiienko O. I. , Hroshovyi Т. А. 
Published: July 2019

Мета роботи. Дослідити вплив допоміжних речовин (ДР) на фармако-технологічні властивості порошкових мас із рослинними екстрактами та ефірною олією.
Матеріали і методи. У склад порошкових мас входили такі діючі речовини, як сухий екстракт трави герані криваво-червоної, сухий екстракт трави герані сибірської та ефірна олія шавлії мускатної у співвідношенні – 3:1:1,2. Для експерименту обрано 30 ДР, які використовують для отримання таблеток методом прямого пресування. Усі вони розділені на 6 груп по 5 речовин у кожній. Вивчення впливу ДР на фармако-технологічні властивості порошкових мас здійснювалось завдяки визначенню насипної густини, густини після усадки, текучості, кута природнього укосу (ДФУ 2 видання).
Результати й обговорення. Результати дисперсійного аналізу експериментальних даних показали, що найбільше значення вільної насипної густини порошкових мас із рослинними екстрактами та ефірною олією отримали при використанні магній карбонат основного, МКЦ бурст, натрій крохмальгліколяту, лудіпресу, перлітолу 500 DС, компактролу і натрій лаурилсульфату. При наявності у порошкових масах неусіліну UFL 2, МКЦ бурст, натрій крохмальгліколяту, лудіпресу, МагГран і кислоти стеаринової було одержано найкращі показники густини після усадки. На текучість порошкових мас найбільш позитивно впливають магній карбонат основний, МКЦ бурст, натрій карбоксиметилкрохмаль, лудіпрес, емкомпрес та кальцій стеарат.
Найменше значення кута природного укосу порошкових мас отримували при використанні неусіліну UFL 2, мікроцелаку 100, МКЦ бурст, крохмалю прежелатинізованого, кальцій гідрофосфату безводного та кислоти стеаринової.
Висновки. Проведені дослідження дозволили встановити вплив 30 ДР на основні фармако-технологічні показники порошкових мас із сухими екстрактами трави герані криваво-червоної і герані сибірської, а також ефірною олією шавлії мускатної.