bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paediatric enteral feeding at home: an analysis of patient safety incidents
Authors: Page Bethan , Nawaz Rasanat , Haden Sarah , Vincent Charles , Lee Alex C H 
Published: June 2019

AimsTo describe the nature and causes of patient safety incidents relating to care at home for children with enteral feeding devices.MethodsWe analysed incident data relating to paediatric nasogastric, gastrostomy or jejunostomy feeding at home from England and Wales’ National Reporting and Learning System between August 2012 and July 2017. Manual screening by two authors identified 274 incidents which met the inclusion criteria. Each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome.ResultsThe most common problems in care related to equipment and devices (n=98, 28%), procedures and treatments (n=86, 24%), information, training and support needs of families (n=54, 15%), feeds (n=52, 15%) and discharge from hospital (n=31, 9%). There was a clearly stated harm to the child in 52 incidents (19%). Contributory factors included staff/service availability, communication between services and the circumstances of the family carer.ConclusionsThere are increasing numbers of children who require specialist medical care at home, yet little is known about safety in this context. This study identifies a range of safety concerns relating to enteral feeding which need further investigation and action. Priorities for improvement are handovers between hospital and community services, the training of family carers, the provision and expertise of services in the community, and the availability and reliability of equipment. Incident reports capture a tiny subset of the total number of adverse events occurring, meaning the scale of problems will be greater than the numbers suggest.
Genetic background of high blood pressure is associated with reduced mortality in premature neonates
Authors: Göpel Wolfgang , Müller Mirja , Rabe Heike , Borgmann Johannes , Rausch Tanja K , Faust Kirstin , Kribs Angela , Dötsch Jörg , Ellinghaus David , Härtel Christoph , Roll Claudia , Szabo Miklos , Nürnberg Peter , Franke Andre , König Inke R , Turner Mark A , Herting Egbert 
Published: June 2019

ObjectiveThe aim of our study was to determine if a genetic background of high blood pressure is a survival factor in preterm infants.DesignProspective cohort study.SettingPatients were enrolled in 53 neonatal intensive care units.PatientsPreterm infants with a birth weight below 1500 g.ExposuresGenetic score blood pressure estimates were calculated based on adult data. We compared infants with high genetic blood pressure estimates (>75th percentile of the genetic score) to infants with low genetic blood pressure estimates (<25th percentile of the genetic score).Main outcome measuresLowest blood pressure on the first day of life and mortality.Results5580 preterm infants with a mean gestational age of 28.1±2.2 weeks and a mean birth weight of 1022±299 g were genotyped and analysed. Infants with low genetic blood pressure estimates had significantly lower blood pressure if compared with infants with high genetic blood pressure estimates (27.3±6.2vs 27.9±6.4, p=0.009, t-test). Other risk factors for low blood pressure included low gestational age (−1.26 mm Hg/week) and mechanical ventilation (−2.24 mm Hg, p<0.001 for both variables, linear regression analysis). Mortality was significantly reduced in infants with high genetic blood pressure estimates (28-day mortality: 21/1395, 1.5% vs 44/1395, 3.2%, p=0.005, Fisher’s exact test). This survival advantage was independent of treatment with catecholamines.ConclusionsOur study provides first evidence that a genetic background of high blood pressure may be beneficial with regard to survival of preterm infants.
Heat stress and fetal risk. Environmental limits for exercise and passive heat stress during pregnancy: a systematic review with best evidence synthesis
Authors: Ravanelli Nicholas , Casasola William , English Timothy , Edwards Kate M , Jay Ollie 
Published: June 2019

ObjectivePregnant women are advised to avoid heat stress (eg, excessive exercise and/or heat exposure) due to the risk of teratogenicity associated with maternal hyperthermia; defined as a core temperature (Tcore) ≥39.0°C. However, guidelines are ambiguous in terms of critical combinations of climate and activity to avoid and may therefore unnecessarily discourage physical activity during pregnancy. Thus, the primary aim was to assess Tcoreelevations with different characteristics defining exercise and passive heat stress (intensity, mode, ambient conditions, duration) during pregnancy relative to the critical maternal Tcoreof ≥39.0°C.DesignSystematic review with best evidence synthesis.Data sourcesEMBASE, MEDLINE, SCOPUS, CINAHL and Web of Science were searched from inception to 12 July 2017.Study eligibility criteriaStudies reporting the Tcoreresponse of pregnant women, at any period of gestation, to exercise or passive heat stress, were included.Results12 studies satisfied our inclusion criteria (n=347). No woman exceeded a Tcoreof 39.0°C. The highest Tcorewas 38.9°C, reported during land-based exercise. The highest mean end-trial Tcorewas 38.3°C (95% CI 37.7°C to 38.9°C) for land-based exercise, 37.5°C (95% CI 37.3°C to 37.7°C) for water immersion exercise, 36.9°C (95% CI 36.8°C to 37.0°C) for hot water bathing and 37.6°C (95% CI 37.5°C to 37.7°C) for sauna exposure.ConclusionThe highest individual core temperature reported was 38.9°C. Immediately after exercise (either land based or water immersion), the highest mean core temperature was 38.3°C; 0.7°C below the proposed teratogenic threshold. Pregnant women can safely engage in: (1) exercise for up to 35 min at 80%–90% of their maximum heart rate in 25°C and 45% relative humidity (RH); (2) water immersion (≤33.4°C) exercise for up to 45 min; and (3) sitting in hot baths (40°C) or hot/dry saunas (70°C; 15% RH) for up to 20 min, irrespective of pregnancy stage, without reaching a core temperature exceeding the teratogenic threshold.
1 The integrity of the scapholunate ligament in competitive divers
Authors: Beck AJ 
Published: June 2019

AimWrist pain and injury is common condition in competitive, elite divers. Literature has shown that divers sustain high impacts of force through the wrists on water entry. It is likely this and the repetitive nature of the sport that results in wrist injuries.1 2No studies have yet looked at the structures injured when divers have wrist pain. This study was conducted to ascertain the demographics of the diving population within the United Kingdom at competitive level and how many of them experienced wrist pain. It was also used to investigate if one of the crucial stabilising ligaments in the wrist was disrupted, the scapholunate ligament (SLL).MethodsData was collected at the British Diving Championships, 2018. 51 divers were eligible for inclusion and 43 divers took part. Two divers were excluded due to previous wrist surgery. Participants completed a questionnaire on diving career to date and wrist injuries. They then underwent wrist examination using Watson’s test and ultrasound imaging of both SLL.ResultsThis study found that 78% of divers had disruption of one or both SLL. Of these, 65.9% had disruption of the ligament in the supporting hand rather than the entry hand. No significant difference was found between springboard and platform divers. Those divers who taped were found to reduce ligament disruption by 28 times over those who did not (OR 27.9, 95% CI 3.31 to 234, P=0.002). It was demonstrated that Watson’s test has poor sensitivity and specificity, with reasonable positive predicted value.ConclusionSpringboard and Platform divers at a competitive level are at high risk of SLL disruption. The supporting hand is more at risk than the entry hand. Taping confers a significant reduction in risk of disruption and should be used to prevent injury. Watson’s test is a poor clinical test in diagnosis of SLL disruption.ReferencesHarrison S, Cohen R, Cleary P, et al. A coupled biomechanical-smoothed particle hydrodynamics model for predicting the loading on the body during elite platform diving.Appl Math Model2015;40:3812–31.Prien A, Mountjoy M, Miller J, et al. Injury and illness in aquatic sport: how high is the risk? A comparison of results from three FINA world championships.Br J Sports Med2016;51:277–82.
4 Relationship between childhood overweight/obesity indicators and vigorous physical activity among NHANSE III boys (8 to 11 years old): different interpretation between body mass index and subcutaneous adiposity size and shape
Authors: Kim H , Petherick E , Varela-Silva I 
Published: June 2019

AimThe aim of this study was to investigate whether the relationship between BMI and vigorous physical activity (VPA) differs when both the overall and regional distribution of subcutaneous adiposity (SA) are considered as alternative fatness indicators of BMI.MethodsThe sample data were obtained from the third National Health and Nutrition Examination Survey (NHANES III). Four skinfolds (triceps, subscapular, supraspinal, thigh), BMI, age, race/ethnicity, height, and VPA (i.e., times per week exercise made you sweat) data of 1,028 boys (8–11 yrs) were extracted. The overall and regional distribution of the four skinfolds were calculated into Subcutaneous Adiposity Size and Shape (SASS) variables based on the description provided in Healy and Tanner’s method (1): transform all four skinfolds into logarithms, 2) calculate average (SA-size estimation), 3) calculate difference between the average and each log-transformed skinfold, 4) run principal component analysis (SA-shape estimation). The samples were categorized into three groups based on participants’ VPA levels (very-active: VPA>5 times, active: 2<VPA<4 times, non-active: VPA<1 time). Then, MANCOVA/ANCOVA (BMI) were conducted separately to ascertain whether the fatness indicators provide consistent interpretations of the relationship with VPA.ResultsThe MANCOVA showed significant interaction between the SASS and VPA (p<0.05). The MANCOVA Bonferroni-adjustment results indicated that SA-size (F(2,938)=5.528, p<0.005; partial η2=0.012) and subscapular-to-thigh SA-shape was significantly associated with VPA (F(2,938)=9.587,p<0.0005; partial η2=0.020), but not triceps-supraspinal SA-shape (F(2,938)=1.485,p=0.227; partial η2=0.003). This means that the very active and active boys had significantly larger SA-size and larger thigh and smaller subscapular SA-shape than the non-active boys. The ANCOVA result showed no BMI difference between the VPA groups (F(2,1024)=1.296, p=0.274).ConclusionIt was concluded that the interpretations made via SASS and BMI when associated with VPA are different. Future studies need to further investigate whether tackling childhood obesity by focusing on BMI-based obesity is affective approach to reduce body fat.ReferenceHealy MJR, Tanner JM. Size and shape in relation to growth and form.Symp Zool Soc Lond1981;46:19–35.
Dietitians can improve accuracy of prescribing by interacting with electronic prescribing systems
Authors: De Waal Susan , Lucas Laurie , Ball Simon , Pankhurst Tanya 
Published: June 2019

BackgroundDietitians increasingly interact with electronic health records (EHRs) and use them to alert prescribers to medication inaccuracies.ObjectiveTo understand renal dietitians’ use of electronic prescribing systems and influence on medication accuracy in inpatients. In outpatients to determine whether renal dietitians’ use of the electronic medication recording might improve accuracy.MethodsIn inpatients we studied the impact of dietetic advice on medical prescribing before and after moving from paper recommendations to ePrescribing. In outpatients, when dietitians recommended changes in dialysis units, we assessed the time to patients receiving the new medications. We trained dietitians to use the ePrescribing system and assessed accuracy of medication lists at the start and end of the study period.ResultsInpatients: before the use of EHRs, 25% of proposals were carried out and took an average of 20 days. This rose to 38% using an EHR and took an average of 4 days.Outpatients: in dialysis units dietitians recommend initiating and stopping medications and advise on repeat medications. Most recommendations were during multidisciplinary team (MDT) meetings; the average time to receive medications was 10 days. Drug histories updated by dietitians increased after the start of the study and accuracy of medication lists improved from 2.4 discrepancies/patient to 0.4.ConclusionDietitians can make medication suggestions directly using EHR, delivering more timely change to patient care and improving accuracy of patients’ medication lists. Allowing the whole of the MDT to contribute to the EHR improves data completeness and therefore patient care is likely to be enhanced.
Metabolic syndrome and risk of cancer: a study protocol of case–control study using data from the Information System for the Development of Research in Primary Care (SIDIAP) in Catalonia
Authors: Puente Diana , López-Jiménez Tomàs , Cos-Claramunt Xavier , Ortega Yolanda , Duarte-Salles Talita 
Published: June 2019

BackgroundMetabolic syndrome (MS) is defined by the clustering of specific metabolic disorders in one subject. MS is highly prevalent globally and currently considered a growing public health concern. MS comprises obesity, hypertension, dyslipidaemia and insulin resistance. Mechanisms linking MS with cancer are poorly understood, and it is as yet unknown if MS confers a greater risk than the risk entailed by each of its separate components. The main objective of this study is to compare the association between MS and 14 site-specific cancer against the association between one or two individual components of MS and cancer. The secondary objective is to evaluate the time elapsed since the diagnosis of MS and the subsequent onset of cancer within the 2006–2017 period by sex.Methods and analysisA case–control study will be conducted for the main objective and a cohort of patients with MS will be followed for the evaluation of the second objective. Incident cases of fourteen types of cancer in patients ≥40 years of age diagnosed prospectively will be selected from electronic primary care records in the Information System for Research in Primary Care (SIDIAP database;www.sidiap.org). The SIDIAP database includes anonymous data from 6 million people (80% of the Catalan population) registered in 286 primary healthcare centres. Each matched control (four controls for each case) will have the same inclusion date, the same sex and age (±1 year) than the paired case. Logistic regression and a descriptive analysis and Kaplan-Meier analysis will be performed, in accordance with the objectives.Ethics and disseminationThe protocol of the study was approved by the IDIAP Jordi Gol Clinical Research Ethics Committee (protocol P17/212). The study’s findings will be published in a peer-reviewed journal and disseminated at national and international conferences and oral presentations to researchers, clinicians and policy makers.
Assessment of the methodological quality of local clinical practice guidelines on the identification and management of gestational diabetes
Authors: Daley Bridget , Hitman Graham , Fenton Norman , McLachlan Scott 
Published: June 2019

ObjectiveGestational diabetes is the most common metabolic disorder of pregnancy, and it is important that well-written clinical practice guidelines (CPGs) are used to optimise healthcare delivery and improve patient outcomes. The aim of the study was to assess the methodological quality of hospital-based CPGs on the identification and management of gestational diabetes.DesignWe conducted an assessment of local clinical guidelines in English for gestational diabetes using the Appraisal of Guidelines for Research and Evaluation (AGREE II) to assess and validate methodological quality.Data sources and eligibility criteriaWe sought a representative selection of local CPGs accessible by the internet. Criteria for inclusion were (1) identified as a guideline, (2) written in English, (3) produced by or for the hospital in a Western country, (4) included diagnostic criteria and recommendations concerning gestational diabetes, (5) grounded on evidence-based medicine and (6) accessible over the internet. No more than two CPGs were selected from any single country.ResultsOf the 56 CPGs identified, 7 were evaluated in detail by five reviewers using the standard AGREE II instrument. Interrater variance was calculated, with strong agreement observed for those protocols considered by reviewers as the highest and lowest scoring based on the instrument. CPG results for each of the six AGREE II domains are presented categorically using a 5-point Likert scale. Only one CPG scored above average in five or more of the domains. Overall scores ranged from 91.6 (the strongest) to 50 (the weakest). Significant variation existed in the methodological quality of CPGs, even though they followed the guideline of an advising body. Specifically, appropriate identification of the evidence relied on to inform clinical decision making in CPGs was poor, as was evidence of user involvement in the development of the guideline, resource implications, documentation of competing interests of the guideline development group and evidence of external review.ConclusionsThe limitations described are important considerations for updating current and new CPGs.
Does a novel diagnostic pathway including blood-based risk prediction and MRI-targeted biopsies outperform prostate cancer screening using prostate-specific antigen and systematic prostate biopsies? - protocol of the randomised study STHLM3MRI
Authors: Nordström Tobias , Jäderling Fredrik , Carlsson Stefan , Aly Markus , Grönberg Henrik , Eklund Martin 
Published: June 2019

IntroductionProstate cancer is a leading cause of cancer death among men in the Western world. Early detection of prostate cancer has been shown to decrease mortality, but has limitations with low specificity leading to unnecessary biopsies and overdiagnosis of low-risk cancers. The STHLM3 trial has paved way for improved specificity in early detection of prostate cancer using the blood-based STHLM3 test for identifying men at increased risk of harbouring significant prostate cancer. Targeted prostate biopsies based on MRI images have shown non-inferior sensitivity to detect significant prostate cancer and decrease the number of biopsies and non-significant cancers among men referred for prostate biopsy in clinical practice. The strategy of the STHLM3-MRI project is to study an improved diagnostic pathway including an improved blood-based test for identification of men with increased risk of prostate cancer and use of MRI to select men for diagnostic workup with targeted prostate biopsies.MethodsThis study compares prostate cancer detection using prostate-specific antigen (PSA) and systematic biopsies to the improved pathway for prostate cancer detection using the STHLM3 test and targeted biopsies in a screening context. The study will recruit 10 000 participants during 1 June 2018 to 1 June 2020 combining a paired and randomised design. Participants are grouped by PSA and Stockholm3 test level. Men with Stockholm3 ≥11% or PSA ≥3 ng/mL are randomised to systematic or MRI-targeted biopsies. This protocol follows SPIRIT guidelines. Endpoints include the number of detected prostate cancers, number of performed biopsy procedures and number of performed MRIs. Additional aims include to assess the health economic consequences and development of automated image-analysis.Ethics and disseminationThe study is approved by the regional ethical review board in Stockholm (2017-1280/31). The study findings will be published in peer-review journals. Findings will also be disseminated by conference/departmental presentations and by media.Trial registration numberNCT03377881; Pre-results.
Enhancing intrinsic motivation for physical activity among adolescents with cystic fibrosis: a qualitative study of the views of healthcare professionals
Authors: Denford Sarah , Mackintosh Kelly A , McNarry Melitta A , Barker Alan R , Williams Craig Anthony 
Published: June 2019

ObjectiveTo explore the views of healthcare professionals from cystic fibrosis (CF) multidisciplinary teams (MDT) on physical activity for adolescents with CF, the specific strategies used for physical activity promotion and associated challenges.DesignIn this exploratory study, in-depth qualitative interviews were conducted with 15 healthcare professionals from CF MDTs to explore their views surrounding physical activity promotion for adolescents with CF.ParticipantsEleven physiotherapists (nine female), two consultants (both male) and two dieticians (both female) provided written informed consent and participated in the study.SettingCF clinics in the UK.ResultsWhile healthcare professionals highlighted the importance of physical activity in the management of CF, they noted that very few patients were motivated solely by (CF or general) health reasons. Healthcare professionals discussed the need for physical activity to be an enjoyable and routine part of their life, undertaken with significant others, outside the clinic whenever possible. Adopted approaches for physical activity promotion focused on providing individualised recommendations that suit the patients’ individual needs and goals and enhance intrinsic motivation for physical activity.ConclusionOur research offers valuable information for those seeking to develop interventions to promote physical activity among adolescents with CF. Specifically, intervention developers should focus on developing individualised interventions that focus on enhancing intrinsic motivation and support the integration of physical activity into everyday life.
Lifetime cancer risks from hazardous air pollutants in US public school districts
Authors: Grineski Sara Elizabeth , Collins Timothy 
Published: June 2019

BackgroundChildren are sensitive to the health impacts of environmental contaminants, but research assessing outdoor environmental exposures for children and schools is underdeveloped. There are no national-level studies examining geographical and social disparities in air pollution exposure for children in school districts. Focusing on school districts is important because they are meaningful decision-making entities for schools.MethodsUsing data from the National Air Toxics Assessment, we spatially reallocated lifetime cancer risk (LCR) from hazardous air pollutants (HAPs) within US school district boundaries, and paired those estimates with school district level sociodemographic measures obtained through the Integrated Public Use Microdata Series National Historic Geographic Information System. We employed local Moran’s I to identify district-level hotpots and generalised estimating equations (GEEs) to quantify risk disparities.ResultsWe identified hotspots of elevated LCR from all sources of HAPs (called ‘total’). A regional hotspot extends throughout the southeastern USA and smaller regional hotspots are present in southern Arizona, southern California and in California’s central valley. School districts with higher proportions of children, children with disabilities, foreign-born children, black children and multiracial/other race children, and lower proportions of Native American children, had greater total LCR (p<0.001). The effect of poverty on total LCR (p<0.001) was nonlinear; the lowest and highest poverty districts had lower total LCR.ConclusionsGeographical and social disparities in LCR across US school districts may be affecting children’s health and future potential. This new knowledge can inform policy changes, as school districts can advocate for the environmental health of children.