bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reuse of intermittent catheters: a qualitative study of IC users’ perspectives
Authors: Avery Miriam , Prieto Jacqui , Okamoto Ikumi , Cullen Samantha , Clancy Bridget , Moore Katherine N , Macaulay Margaret , Fader Mandy 
Published: August 2018

ObjectivesTo explore the views of intermittent catheter (IC) users regarding the advantages and disadvantages of single-use or reuse of catheters.DesignQualitative study with semi-structured interviews. The interviews were recorded, transcribed and analysed thematically.SettingParticipant’s own homes in Hampshire and Dorset, UK.ParticipantsA convenience sample of 39 IC users, aged 23–86 years, using IC for at least 3 months.ResultsThe analysis revealed four main themes: concerns regarding risk of urinary tract infection (UTI); cleaning, preparation and storage; social responsibility; practicalities and location. The main concern was safety, with the fear that reuse could increase risk of UTI compared with single-use sterile catheters. If shown to be safe then around half of participants thought they might consider reusing catheters. The practicalities of cleaning methods (extra products, time and storage) were considered potentially burdensome for reuse; but for single-use, ease of use and instant usability were advantages. Always having a catheter without fear of ‘running out’ was considered an advantage of reuse. Some participants were concerned about environmental impact (waste) and cost of single-use catheters. The potential for reuse was usually dependent on location. The analysis showed that often the disadvantages of single-use could be off-set by the advantages of reuse and vice versa, for example, the need to take many single-use catheters on holiday could be addressed by reuse, while the burden of cleaning would be obviated by single-use.ConclusionsIf shown to be safe with a practical cleaning method, some participants would find reuse an acceptable option, alongside their current single-use method. The choice to use a mixture of single-use and reuse of catheters for different activities (at home, work or holiday) could optimise the perceived advantages and disadvantages of both. The safety and acceptability of such an approach would require testing in a clinical trial.
Is time to progression associated with post-progression survival in previously treated metastatic non-small cell lung cancer with BRAF V600E mutation? A secondary analysis of phase II clinical trial data
Authors: Li Junlong , Sasane Medha , Zhang Jie , Zhao Jing , Ricculli Marie Louise , Yao Zhiwen , Redhu Suman , Signorovitch James 
Published: August 2018

ObjectiveLonger time to progression (TTP) is associated with prolonged post-progression survival (PPS) in anaplastic lymphoma kinase+non-small cell lung cancer (NSCLC). This study evaluated whether TTP is associated with PPS among previously treated patients with metastatic v-Raf murine sarcoma viral oncogene homolog B V600E NSCLC receiving dabrafenib as monotherapy or in combination with trametinib.DesignSecondary analysis of phase II clinical trial data.SettingPatients who experienced disease progression treated with dabrafenib monotherapy or in combination with trametinib as second line or later in an open-label, non-randomised, phase II study.Primary outcome measuresThe primary outcome was the TTP–PPS association. PPS was assessed with Kaplan-Meier analysis among patients with shorter versus longer TTP (< or ≥6 months). The TTP–PPS association was quantified in the Cox models adjusting for clinical covariates.ResultsOf the 84 included patients who progressed on dabrafenib monotherapy (n=57) or combination therapy (n=27), 60 (71%) died during post-progression follow-up. Patients with TTP ≥6 months experienced significantly longer PPS compared with those with TTP <6 months (median PPS: 9.5 vs 2.7 months, log-rank p<0.001). Each 3 months of longer TTP was associated with a 32% lower hazard of death following progression (HR 0.68, 95% CI 0.52 to 0.88) in the multivariable Cox model. Similar associations were seen in each treatment arm.ConclusionA longer TTP duration after treatment with dabrafenib monotherapy or combination therapy was associated with significantly longer PPS duration.Trial registration numberNCT01336634; Post-results.
Escalation-related decision making in acute deterioration: a retrospective case note review
Authors: Campling Natasha , Cummings Amanda , Myall Michelle , Lund Susi , May Carl R , Pearce Neil W , Richardson Alison 
Published: August 2018

AimTo describe how decision making inter-relates with the sequence of events in individuals who die during admission and identify situations where formal treatment escalation plans (TEPs) may have utility.Design and methodsA retrospective case note review using stratified sampling. Two data analysis methods were applied concurrently: directed content analysis and care management process mapping via annotated timelines for each case. Analysis was followed by expert clinician review (n=7), contributing to data interpretation.Sample45 cases, age range 38–96 years, 23 females and 22 males. Length of admission ranged from <24 hours to 97 days.ResultsProcess mapping led to a typology of care management, encompassing four trajectories: early de-escalation due to catastrophic event; treatment with curative intent throughout; treatment with curative intent until significant point; and early treatment limits set. Directed content analysis revealed a number of contextual issues influencing decision making. Three categories were identified: multiple clinician involvement, family involvement and lack of planning clarity; all framed by clinical complexity and uncertainty.ConclusionsThe review highlighted the complex care management and related decision-making processes for individuals who face acute deterioration. These processes involved multiple clinicians, from numerous specialities, often within hierarchical teams. The review identified the need for visible and clear management plans, in spite of the frame of clinical uncertainty. Formal TEPs can be used to convey such a set of plans. Opportunities need to be created for patients and their families to request TEPs, in consultation with the clinicians who know them best, outside of the traumatic circumstances of acute deterioration.
Measuring health-related quality of life of care home residents, comparison of self-report with staff proxy responses for EQ-5D-5L and HowRu: protocol for assessing proxy reliability in care home outcome testing
Authors: Usman Adeela , Lewis Sarah , Hinsliff-Smith Kathryn , Long Annabelle , Housley Gemma , Jordan Jake , Gage Heather , Dening Tom , Gladman John R F , Gordon Adam L 
Published: August 2018

IntroductionResearch into interventions to improve health and well-being for older people living in care homes is increasingly common. Health-related quality of life (HRQoL) is frequently used as an outcome measure, but collecting both self-reported and proxy HRQoL measures is challenging in this setting. This study will investigate the reliability of UK care home staff as proxy respondents for the EQ-5D-5L and HowRu measures.Methods and analysisThis is a prospective cohort study of a subpopulation of care home residents recruited to the larger Proactive Healthcare for Older People in Care Homes (PEACH) study. It will recruit residents ≥60 years across 24 care homes and not receiving short stay or respite care. The sample size is 160 participants. Resident and care home staff proxy EQ-5D-5L and HowRu responses will be collected monthly for 3 months. Weighted kappa statistics and intraclass correlation adjusted for clustering at the care home level will be used to measure agreement between resident and proxy responses. The extent to which staff variables (gender, age group, length of time caring, role, how well they know the resident, length of time working in care homes and in specialist gerontological practice) influence the level of agreement between self-reported and proxy responses will be considered using a multilevel mixed-effect regression model.Ethics and disseminationThe PEACH study protocol was reviewed by the UK Health Research Authority and University of Nottingham Research Ethics Committee and was determined to be a service development project. We will publish this study in a peer-reviewed journal with international readership and disseminate it through relevant national stakeholder networks and specialist societies.
‘Adding another spinning plate to an already busy life’.Benefits and risks in patient partner–researcher relationships: a qualitative study of patient partners’ experiences in a Canadian health research setting
Authors: Leese Jenny , Macdonald Graham , Kerr Sheila , Gulka Lianne , Hoens Alison M , Lum Wendy , Tran Bao Chau , Townsend Anne F , Li Linda C 
Published: August 2018

ObjectiveTo better understand, based on patient partners’ experiences, benefits and risks in patient partner–researcher relationships in a health research setting.DesignQualitative interviews with thematic analysis informed by a relational ethics lens.SettingA multidisciplinary health research centre in Vancouver, Canada. This study was codeveloped by patient partners and researchers at the centre.Participants22 people living with arthritis, with experience as members of a patient advisory board at the research centre from 1 month to 10 years.ResultsWe identified three main themes: (1) Being Heard: Participants had experienced uncomfortable emotions (eg, feelings of insecurity) in their relationships with researchers. The discomfort, however, was minimised by the demonstration of mutual respect in their interactions. Specifically, participants valued environments without a hierarchy between patient partners and researchers, where contributions of each party were considered equally important, and where patients’ voices were heard; (2) Cobuilding social relations: Participants valued building social relations with researchers beyond their expected interactions as partners in research and (3) Adding another spinning plate to an already busy life: Participants valued relationships with researchers who had cocreated environments that minimised the risks of physical and emotional impacts (eg, fatigue, stress, guilt) on them while juggling multiple obligations, priorities and their health.ConclusionsFindings provide valuable insights to guide relationship building between patient partners and researchers. Informed by a relational ethics lens, these findings are a critical step in supporting an ethically sound practice of patient engagement in research that prioritises patients’ perspectives.
Psychiatry as a career choice among medical students: a cross-sectional study examining school-related and non-school factors
Authors: Seow Lee Seng Esmond , Chua Boon Yiang , Mahendran Rathi , Verma Swapna , Ong Hui Lin , Samari Ellaisha , Chong Siow Ann , Subramaniam Mythily 
Published: August 2018

ObjectivesGiven the low recruitment to psychiatry worldwide, the current study aimed to examine how premedical and intramedical school factors, perception of career aspects, attitudes towards psychiatry, stigma towards mental illness and personality traits may affect the likelihood of psychiatry as a career choice.DesignCross-sectional online study.Participants502 medical students from two public medical institutions in Singapore.MethodsWe critically examined existing literature for factors identified to influence psychiatry as a career choice and explored their effects in a group of medical students in Singapore. To avoid overloading the regression model, this analysis only included variables shown to have significant association (p<0.05) with the outcome variable from the initial Χ2test and independent t-test analyses.ResultsA considerable number of non-medical school factors such as preschool influence and interest, personality traits and importance of a high status specialty in medicine were found to affect students’ choice of psychiatry as a career. Among medical school factors, attending a psychiatry/mental health club was the only influential factor. Negative attitudes towards psychiatry, but not stigma towards people with mental illness, significantly predicted the likelihood of not choosing psychiatry as a career.ConclusionsImproving educational environment or teaching practice in psychiatric training may aid in future recruitment for psychiatrists. While the changing of premedical school influences or personality factors may be infeasible, medical schools and psychiatry institutes could play a more critical role by enhancing enrichment activities or clerkship experience to bring about a more positive attitudinal change towards psychiatry among students who did consider a career in psychiatry.
Systematic review to identify proxy indicators to quantify the impact of eHealth tools on maternal and neonatal health outcomes in low-income and middle-income countries including Delphi consensus
Authors: Perrin Caroline , Hounga Lothaire , Geissbuhler Antoine 
Published: August 2018

ObjectiveTo identify interventions that could serve as reliable proxy indicators to measure eHealth impact on maternal and neonatal outcomes.DesignSystematic review and Delphi study.MethodsWe searched PubMed, Embase and Cochrane from January 1990 to May 2016 for studies and reviews that evaluated interventions aimed at improving maternal/neonatal health and reducing mortality. Interventions that are not low-income and middle-income context appropriate and that cannot currently be diagnosed, managed or impacted by eHealth (eg, via telemedicine distance diagnostic or e-learning) were excluded. We used the Cochrane risk of bias, Risk Of Bias In Non- randomised Studies - of Interventions and ROBIS tool to assess the risk of bias. A three-step modified Delphi method was added to identify additional proxy indicators and prioritise the results, involving a panel of 13 experts from different regions, representing obstetricians and neonatologists.ResultsWe included 44 studies and reviews, identifying 40 potential proxy indicators with a positive impact on maternal/neonatal outcomes. The Delphi experts completed and prioritised these, resulting in a list of 77 potential proxy indicators.ConclusionsThe proxy indicators propose relevant outcome measures to evaluate if eHealth tools directly affect maternal/neonatal outcomes. Some proxy indicators require mapping to the local context, practices and available resources. The local mapping facilitates the utilisation of the proxy indicators in various contexts while allowing the systematic collection of data from different projects and programmes. Based on the mapping, the same proxy indicator can be used for different contexts, allowing it to measure what is locally and temporally relevant, making the proxy indicator sustainable.PROSPERO registration numberCRD42015027351.
Utilisation willingness for institutional care by the elderly: a comparative study of empty nesters and non-empty nesters in Shandong, China
Authors: Qian Yangyang , Qin Wen , Zhou Chengchao , Ge Dandan , Zhang Li , Sun Long 
Published: August 2018

IntroductionInstitutional care has been strongly promoted in China to meet seniors’ long-term care needs. Empty-nest elderly, in comparison with their counterparts, have less social support and fewer caring networks. This study aimed to compare the utilisation willingness for institutional care and its predictors between empty-nest and non-empty-nest seniors.MethodsA total of 3923 seniors were included in the analysis. Binary logistic regression models were used to understand the association between the living arrangements of the elderly households and willingness for institutional care and to identify the predictors of the utilisation willingness for institutional care among empty nesters and non-empty nesters.ResultsOur study found that approximately 8.5% of the seniors had a willingness for institutional care in Shandong, China. Empty-nest singles (OR 5.301; 95% CI 2.838 to 9.904) and empty-nest couples (OR 1.547; 95% CI 1.135 to 2.107) were found to be more willing to receive institutional care. Our results also showed that residence was a key determinant for institutionalisation willingness in empty-nest and non-empty-nest elderly. Among empty-nest singles, psychological stress was a positive determinant for institutional care. Factors, including education attainment, relationship with adult children, household income and per capita living space, were determinants for empty-nest couple willingness for institutionalisation. Age, number of children and self-reported health status were found to be associated factors for willingness among non-empty nesters.ConclusionsThe government should pay more attention to institutional care in rural areas where there is still a gap in elder care compared with that in urban areas. Targeted policies should be made for different types of seniors to offer appropriate institutional care.
Impact of adverse media reporting on public perceptions of the doctor–patient relationship in China: an analysis with propensity score matching method
Authors: Sun Jing , Liu Shiyang , Liu Qiannan , Wang Zijuan , Wang Jun , Hu Cecile Jia , Stuntz Mark , Ma Jing , Liu Yuanli 
Published: August 2018

ObjectivesNumerous studies indicate that the doctor–patient relationship in China is facing serious challenges. This study examined the impact of China Central Television’s negative coverage of high medicines prices on both doctors’ and patients’ opinions of the doctor–patient relationship.SettingData were collected in a national survey conducted during 19 December 2016 to 11 January 2017 which targeted 136 public tertiary hospitals across the country.ParticipantsAll patients and doctors who submitted completed questionnaire were retrieved from the survey database.InterventionThe study used propensity score matching method to match the respondents before and after China Central Television’s news report about high medicines prices which was given at 00:00 hours on 24 December 2016.Outcome measurePerception scores were calculated based on the five-point Likert scales to measure the opinions of the doctor–patient relationship.ResultsThe perception scores of the doctor–patient relationship were significantly affected by the negative media coverage for hospitalised patients, who scored 1.18 lower on the doctor–patient relationship following the report (p=0.006, 95% CI 0.34 to 2.02), and doctors who scored 5.96 points lower on the same scale (p<0.001, 95% CI 4.11 to 7.82). Score for the ambulatory patients was unaffected by exposure to the adverse news report (p=0.05).ConclusionChinese national media’s reporting of adverse news negatively affected the perceptions of the doctor–patient relationship among both inpatients and doctors. A better understanding of the role of mass media in the formation of opinion and trust between doctors and patients may permit strategies for managing the media, in order to improve public perceptions of the doctor–patient relationship.
Small volume plasma exchange for Guillain-Barré syndrome in resource-limited settings: a phase II safety and feasibility study
Authors: Islam Badrul , Islam Zhahirul , Rahman Shafiqur , Endtz Hubert P , Vos Margreet C , van der Jagt Mathieu , van Doorn Peter A , Jacobs Bart C , Mohammad Quazi Deen 
Published: August 2018

ObjectiveTo assess the safety and feasibility of small volume plasma exchange (SVPE) for patients with Guillain-Barré syndrome (GBS).DesignNon-randomised, single-arm, interventional trial.SettingNational Institute of Neurosciences and Hospital, Dhaka, Bangladesh.ParticipantsTwenty adult (>18 years) patients with GBS presented within 2 weeks of onset of weakness who were unable to walk unaided for more than 10 m.InterventionsSVPE involves blood cell sedimentation in a blood bag and removal of supernatant plasma after blood cells are retransfused. This procedure was repeated three to six times a day, for eight consecutive days. Fresh frozen plasma (FFP) and normal saline were used as replacement fluid.Outcome measuresSerious adverse events (SAEs) were defined as severe sepsis and deep venous thrombosis related to the central venous catheter (CVC) used during SVPE. SVPE was considered safe if less than 5/20 patients experienced an SAE, and feasible if 8 L plasma could be removed within 8 days in at least 15/20 patients.ResultsMedian patient age 33 years (IQR 23–46; range 18–55); 13 (65%) were male. Median Medical Research Council (MRC) sum score was 20 (IQR 0–29; range 0–36); three (15%) patients required mechanical ventilation. One patient developed SAE (severe sepsis, possibly related to CVC). The median plasma volume exchanged was 140 mL/kg (range 110–175) and removal of 8 L plasma was possible in 15 (75%) patients. Patients received a median 1 g/kg IgG via FFP although a substantial proportion of IgG was probably removed again by the SVPE sessions. GBS disability score improved by at least one grade in 14 (70%) patients 4 weeks after SVPE started. No patients died.ConclusionSVPE seems a safe and feasible alternative treatment to standard plasma exchange (PE) or intravenous immunoglobulin (IVIg) for GBS; further studies of clinical efficacy in low-income and middle-income countries are warranted.Trial registration numberNCT02780570.
Utilisation of primary care before a childhood cancer diagnosis: do socioeconomic factors matter?: A Danish nationwide population-based matched cohort study
Authors: Friis Abrahamsen Christina , Ahrensberg Jette Møller , Vedsted Peter 
Published: August 2018

ObjectivesEarly diagnosis of childhood cancer is critical. Nevertheless, little is known about the potential role of inequality. This study aims to describe the use of primary care 2 years before a childhood cancer diagnosis and to investigate whether socioeconomic factors influence the use of consultations and diagnostic tests in primary care.DesignA national population-based matched cohort study.Setting and participantsThis study uses observational data from four Danish nationwide registers. All children aged 0–15 diagnosed with cancer during 2008–2015 were included (n=1386). Each case was matched based on gender and age with 10 references (n=13 860).Primary and secondary outcome measuresThe primary outcome was additional rates for consultations and for invoiced diagnostic tests for children with cancer according to parental socioeconomic factors. Furthermore, we estimated the association between socioeconomic factors and frequent use of consultations, defined as at least four consultations, and the odds of receiving a diagnostic test within 3 months of diagnosis.ResultsChildren with cancer from families with high income had 1.46 (95% CI 1.23 to 1.69) additional consultations 3 months before diagnosis, whereas children from families with low income had 1.85 (95% CI 1.60 to 2.11) additional consultations. The highest odds of frequent use of consultations was observed among children from low-income families (OR: 1.94, 95% CI 1.24 to 3.03). A higher odds of receiving an invoiced diagnostic test was seen for children from families with mid-educational level (OR: 1.46, 95% CI 1.09 to 1.95).ConclusionWe found a socioeconomic gradient in the use of general practice before a childhood cancer diagnosis. This suggests that social inequalities exist in the pattern of healthcare utilisation in general practice.