bluuebunny/crossref_metadata_2025_split huggingface dataset:
Population-based cross-sectional study of 11 645 Spanish nonagenarians with type 2 diabetes mellitus: cardiovascular profile, cardiovascular preventive therapies, achievement goals and sex differences
Authors: Salinero-Fort Miguel Angel , Mostaza-Prieto Jose M , Lahoz-Rallo Carlos , Vicente Díez José Ignacio , Cárdenas-Valladolid Juan 
Published: September 2019

ObjectivesTo evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences.Design and settingA cross-sectional population study of 11 645 persons aged ≥90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin–angiotensin system blockers and statins had been prescribed for overt cardiovascular disease.ResultsThe prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females.ConclusionOur study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ≥90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.
Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study
Authors: Lugo-Palacios David G , Gannon Brenda , Gittins Matthew , Vail Andy , Bowen Audrey , Tyson Sarah 
Published: September 2019

ObjectiveTo identify the main drivers of inpatient stroke care resource use, estimate the influence of stroke teams on the length of stay (LoS) of its patients and analyse the variation in relative performance across teams.DesignFor each of four types of stroke care teams, a two-level count data model describing the variation in LoS and identifying the team influence on LoS purged of patient and treatment characteristics was estimated. Each team effect was interpreted as a measure of stroke care relative performance and its variation was analysed.SettingThis study used data from 145 396 admissions in 256 inpatient stroke care teams between June 2013 and July 2015 included in the national stroke register of England, Wales and Northern Ireland—Sentinel Stroke National Audit Programme.ResultsThe main driver of LoS, and thus resource use, was the need for stroke therapy even after stroke severity was taken into account. Conditional on needing the therapy in question, an increase in the average amount of therapy received per inpatient day was associated with shorter LoS. Important variations in stroke care performance were found within each team category.ConclusionsResource use was strongly associated with stroke severity, the need for therapy and the amount of therapy received. The variations in stroke care performance were not explained by measurable patient or team characteristics. Further operational and financial analyses are needed to unmask the causes of this unexplained variation.
Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon
Authors: Nansseu Jobert Richie , Assah Felix , Petnga Saint-Just , Kameni Bibiane Siaheu , Tene Hebert Donald Fosso , Nang Francial Terrenstra , Wouna Dominic Leandry Angong , Noubiap Jean Jacques , Kamgno Joseph 
Published: September 2019

ObjectiveTo describe the global cardiovascular disease (CVD) risk distribution in a young adult-aged population living in Yaoundé, Cameroon and depict factors likely influencing this risk distribution.DesignA cross-sectional study between May and July 2017.SettingThe University of Yaoundé I, Cameroon.ParticipantsAny university student aged 18 years and above, with no known history of CVD, found at the campus during recruitment and who voluntarily agreed to be included in the study.Primary and secondary outcome measuresThe global risk of CVD was measured with the non-laboratory-based INTERHEART Modifiable Risk Score.ResultsA total of 949 participants (54% males) were recruited; the median age was 23 (IQR 21–26) years. The CVD risk varied between 2 and 21, with a median of 9 (IQR 7–12); 51.2% of students had a low risk of CVD, 43.7% had a moderate risk and 5.1% presented a high risk of CVD. The number of years since first registration at the university (β=0.08), history of sudden death among biological parents (β=1.28), history of hypertension among brothers/sisters (β=1.33), history of HIV infection (β=4.34), the Alcohol Use Disorder Identification Test-Consumption score (β=0.13), regular exposure to firewood smoke (β=1.29), eating foods/drinks with too much sugar ≥1 time/day (β=0.96), eating foods/snacks with too much oil ≥3 times/week (β=1.20) and eating dairy products≥1 time/day (β=0.61) were the independent factors likely influencing participants’ global risk of CVD.ConclusionAlmost 50% of participants had moderate or high risk of CVD. Specific interventions targeting major CVD risk factors should be put in place among young adults to prevent or reduce this upcoming overburdened picture of CVD.
Effects of antihypertensives, lipid-modifying drugs, glycaemic control drugs and sodium bicarbonate on the progression of stages 3 and 4 chronic kidney disease in adults: a systematic review and meta-analysis
Authors: Taylor Kathryn S , Mclellan Julie , Verbakel Jan Y , Aronson Jeffrey K , Lasserson Daniel S , Pidduck Nicola , Roberts Nia , Fleming Susannah , O'Callaghan Christopher A , Bankhead Clare R , Banerjee Amitava , Hobbs FD Richard , Perera Rafael 
Published: September 2019

ObjectiveTo evaluate the effects of drug interventions that may modify the progression of chronic kidney disease (CKD) in adults with CKD stages 3 and 4.DesignSystematic review and meta-analysis.MethodsSearching MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, International Clinical Trials Registry Platform, Health Technology Assessment, Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index and Clinical Trials Register, from March 1999 to July 2018, we identified randomised controlled trials (RCTs) of drugs for hypertension, lipid modification, glycaemic control and sodium bicarbonate, compared with placebo, no drug or a drug from another class, in ≥40 adults with CKD stages 3 and/or 4, with at least 2 years of follow-up and reporting renal function (primary outcome), proteinuria, adverse events, maintenance dialysis, transplantation, cardiovascular events, cardiovascular mortality or all-cause mortality. Two reviewers independently screened citations and extracted data. For continuous outcomes, we used the ratio of means (ROM) at the end of the trial in random-effects meta-analyses. We assessed methodological quality with the Cochrane Risk of Bias Tool and confidence in the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.ResultsWe included 35 RCTs and over 51 000 patients. Data were limited, and heterogeneity varied. Final renal function (estimated glomerular filtration rate) was 6% higher in those taking glycaemic control drugs (ROM 1.06, 95% CI 1.02 to 1.10, I2=0%, low GRADE confidence) and 4% higher in those taking lipid-modifying drugs (ROM 1.04, 95% CI 1.00 to 1.08, I2=88%, very low GRADE confidence). For RCTs of antihypertensive drugs, there were no significant differences in renal function. Treatment with lipid-modifying drugs led to a 36% reduction in cardiovascular disease and 26% reduction in all-cause mortality.ConclusionsGlycaemic control and lipid-modifying drugs may slow the progression of CKD, but we found no pooled evidence of benefit nor harm from antihypertensive drugs. However, given the data limitations, further research is needed to confirm these findings.PROSPERO registration numberCRD42015017501.
Early invasive strategy in senior patients with non-ST-segment elevation myocardial infarction: is it cost-effective? - a decision-analytic model and value of information analysis
Authors: Simpson Julija , Javanbakht Mehdi , Vale Luke 
Published: September 2019

BackgroundNon-ST-elevation myocardial infarction (NSTEMI) is the most common type of heart attack in the UK and it is becoming increasingly prevalent among older people. An early invasive treatment strategy may be effective and cost-effective for treating NSTEMI but evidence is currently unclear.ObjectivesTo assess the cost-effectiveness of the early invasive strategy versus medical management in elderly patients with NSTEMI and to provide guidance for future research in this area.MethodsA long-term Markov state transition model was developed. Model inputs were systematically derived from a number of sources most appropriate to a UK relevant analysis, such as published studies and national routine data. Costs were estimated from the perspective of National Health Service and Personal Social Services. The model was developed using TreeAge Pro software. Based on a probabilistic sensitivity analysis, a value of information analysis was carried out to establish the value of decision uncertainty both overall and for specific input parameters.ResultsIn 2017 UK £, the incremental cost-effectiveness ratio of the early invasive strategy was £46 916 for each additional quality-adjusted life-year (QALY) gained, with a probability of being cost-effective of 23% at a cost-effectiveness threshold of £20 000/QALY. There was a considerable decision uncertainty with these results. The value of removing all this uncertainty was up to £1 920 000 annually. Most uncertainty related to clinical effectiveness parameters and the optimal study design to remove this uncertainty would be a randomised controlled trial.ConclusionBased on current evidence, the early invasive strategy is not likely to be cost-effective for elderly patients with NSTEMI. This conclusion should be interpreted with caution mainly due to the absence of NSTEMI-specific data and long-term clinical effectiveness estimates.
Group interventions for amyotrophic lateral sclerosis caregivers in Ireland: a randomised controlled trial protocol
Authors: Burke Tom , Wilson O'Raghallaigh Jennifer , Maguire Sinead , Galvin Miriam , Heverin Mark , Hardiman Orla , Pender Niall 
Published: September 2019

IntroductionAmyotrophic lateral sclerosis (ALS) is a rapid and fatal motor disease marked by progressive physical impairment due to muscle weakness and wasting. It is multidimensional with many patients presenting with cognitive and/or behavioural impairment. Caregivers of patients with ALS, commonly non-paid immediate family members, often take primary responsibility for the complex care needs of patients in non-medicalised setting, and many as a consequence experience caregiver burden, anxiety, and/or depression.Methods and analysisThis randomised controlled trial (RCT) will use randomisation to allocate n=75 caregivers of patients with ALS from the national ALS clinic into three groups with an equal distribution. The RCT consists of two intervention groups and a wait list control (treatment as usual [TAU]) group. The intervention arms of the trial consist of a ‘mindfulness-based stress reduction’ and ‘building better caregivers’ manualised group-based intervention, with 9 and 6 weekly sessions, respectively. The TAU group will have access to intervention at the end of the trial period. Primary outcomes are self-report questionnaires on anxiety and depression symptoms, with caregiver burden and quality of life considered secondary outcomes. Assessment will commence at baseline, immediately following the intervention period, and after a period of 12 weeks to assess the effectiveness and efficacy of participating in an intervention. Patient cognitive and behavioural data will also be considered. Means of treatment and control groups at Time 0 and 1 will be analysed using mixed model multivariate analysis of variance followed by analysis of variance, and treatment effect-sizes will be calculated. This RCT protocol is pre-results and has been registered with an international database resulting in an International Standard Randomised Controlled Trials Number (ISRCTN53226941).Ethics and disseminationEthics approval was obtained from the Beaumont Hospital Medical Research Ethics Committee. Results of the main trial will be submitted for publication in a peer-reviewed journal.
Feasibility of individualised severe traumatic brain injury management using an automated assessment of optimal cerebral perfusion pressure: the COGiTATE phase II study protocol
Authors: Beqiri Erta , Smielewski Peter , Robba Chiara , Czosnyka Marek , Cabeleira Manuel Teixeira , Tas Jeanette , Donnelly Joseph , Outtrim Joanne G , Hutchinson Peter , Menon David , Meyfroidt Geert , Depreitere Bart , Aries Marcel J , Ercole Ari 
Published: September 2019

IntroductionIndividualising therapy is an important challenge for intensive care of patients with severe traumatic brain injury (TBI). Targeting a cerebral perfusion pressure (CPP) tailored to optimise cerebrovascular autoregulation has been suggested as an attractive strategy on the basis of a large body of retrospective observational data. The objective of this study is to prospectively assess the feasibility and safety of such a strategy compared with fixed thresholds which is the current standard of care from international consensus guidelines.Methods and analysisCPPOpt Guided Therapy: Assessment of Target Effectiveness (COGiTATE) is a prospective, multicentre, non-blinded randomised, controlled trial coordinated from Maastricht University Medical Center, Maastricht (The Netherlands). The other original participating centres are Cambridge University NHS Foundation Trust, Cambridge (UK), and University Hospitals Leuven, Leuven (Belgium). Adult severe TBI patients requiring intracranial pressure monitoring are randomised within the first 24 hours of admission in neurocritical care unit. For the control arm, the CPP target is the Brain Trauma Foundation guidelines target (60–70 mm Hg); for the intervention group an automated CPP target is provided as the CPP at which the patient’s cerebrovascular reactivity is best preserved (CPPopt). For a maximum of 5 days, attending clinicians review the CPP target 4-hourly. The main hypothesis of COGiTATE are: (1) in the intervention group the percentage of the monitored time with measured CPP within a range of 5 mm Hg above or below CPPopt will reach 36%; (2) the difference in between groups in daily therapy intensity level score will be lower or equal to 3.Ethics and disseminationEthical approval has been obtained for each participating centre. The results will be presented at international scientific conferences and in peer-reviewed journals.Trial registration numberNCT02982122
Healthcare resource use and costs of diabetic macular oedema for patients with antivascular endothelial growth factor versus a dexamethasone intravitreal implant in Korea: a population-based study
Authors: Cho HyunJeong , Choi Kyung Seek , Lee Joo Yong , Lee Donghwan , Choi Nam-Kyong , Lee YouKyung , Bae SeungJin 
Published: September 2019

ObjectivesTo estimate the costs and healthcare resources of patients with diabetic macular oedema (DME) who received intravitreal antivascular endothelial growth factor (anti-VEGF) agents or a dexamethasone intravitreal implant (DEX-implant) in Korea.DesignRetrospective cohort study.SettingThe Korean National Health Insurance claim data from 1 January 2015 to 30 June 2017 were retrieved from the Health Insurance Review and Assessment Service.ParticipantsAdult patients with DME who were diagnosed with diabetic retinopathy or DME and received ranibizumab, aflibercept or a DEX-implant in conjunction with intravitreal injection were included. Patients whose primary diagnoses were age-related macular degeneration or retinal vein occlusion were excluded.Main outcome measuresHealthcare resource utilisation and costs related to DME in the 12-month postindex period.ResultsDuring the study period, 182 patients and 414 patients were identified in the anti-VEGF and DEX-implant groups, respectively, and there was no significant difference in the demographic characteristics between the two groups. The outpatient eye care-related medical costs were US$3002.33 for the anti-VEGF group vs US$2250.35 for the DEX-implant group (p<0.0001). After adjusting the relevant covariates based on the generalised linear model, the estimated outpatient eye care-related medical costs were 33% higher in the anti-VEGF group than in the DEX-implant group (p<0.0001, 95% CI 22% to 45%). The utilisation pattern of the two groups showed no significant difference except for the number of intravitreal injections, which was higher in the anti-VEGF group (2.69±2.29) than in the DEX-implant group (2.09±1.37, p<0.001).ConclusionThe average annual eye-related medical cost of the DEX-implant group was significantly lower than that of the anti-VEGF group during the study period, which was mainly due to decreased utilisation of eye care-related injections. Further long-term studies are needed.
Association between physician characteristics and payments from industry in 2015–2017: observational study
Authors: Inoue Kosuke , Blumenthal Daniel M , Elashoff David , Tsugawa Yusuke 
Published: September 2019

ObjectiveTo investigate the association between physician characteristics and the value of industry payments.DesignObservational study.Setting and participantsUsing the 2015–2017 Open Payments reports of industry payments linked to the Physician Compare database, we examined the association between physician characteristics (physician sex, years in practice, medical school attended and specialty) and the industry payment value, adjusting for other physician characteristic and institution fixed effects (effectively comparing physicians practicing at the same institution).Main outcome measuresOur primary outcome was the value of total industry payments to physicians including (1) general payments (all forms of payments other than those classified for research purpose, eg, consulting fees, food, beverage), (2) research payments (payments for research endeavours under a written contract or protocol) and (3) ownership interests (eg, stock or stock options, bonds). We also investigated each category of payment separately.ResultsOf 544 264 physicians treating Medicare beneficiaries, a total of $5.8 billion in industry payments were made to 365 801 physicians during 2015–2017. The top 5% of physicians, by cumulative payments, accounted for 91% of industry payments. Within the same institution, male physicians, physicians with 21–30 years in practice and physicians who attended top 50 US medical schools (based on the research ranking) received higher industry payments. Across specialties, orthopaedic surgeons, neurosurgeons and endocrinologists received the highest payments. When we investigated individual types of payment, we found that orthopaedic surgeons received the highest general payments; haematologists/oncologists were the most likely to receive research payments and surgeons were the most likely to receive ownership interests compared with other types of physicians.ConclusionsIndustry payments to physicians were highly concentrated among a small number of physicians. Male sex, longer length of time in clinical practice, graduated from a top-ranked US medical school and practicing certain specialties, were independently associated with higher industry payments.
Health-related behaviours and perceptions among physicians: results from a cross-sectional study in Israel
Authors: Wilf Miron Rachel , Malatskey Lilach , Rosen Laura J 
Published: September 2019

ObjectivesPhysicians’ demanding work conditions may reduce the time and energy required for maintaining healthy lifestyles. This study examined health-related behaviours, perceived health status and emotional stress among physicians, and analysed the effects of personal and work characteristics on these endpoints.DesignA cross-sectional study using a digital questionnaire.Setting and participantsAll 25 590 physicians who were members of the Israeli Medical Association in 2015 were invited to participate by email. Of 14 694 who opened the e-mail, 4832 (32.9%) responded.Outcome measuresSurvey topics included physical activity (PA), nutrition and eating habits, smoking, sleep, perceived health status and emotional stress, body mass index (BMI) and contact with a regular physician, as well as personal and work characteristics. Univariate and multivariate analyses were performed.ResultsOf the 4832 respondents, 21% reported poor or fair health status, 36% felt considerable emotional stress, 57% were overweight or obese (according to BMI≥25 kg/m2), 71% did not meet the recommended PA level, 79% did not meet a composite measure of healthy nutrition, 8% were current smokers, 25% slept 5 hours or less and 57% did not have a regular physician. Residents and hospital physicians reported significantly less healthy lifestyles, lower perceived health status and higher stress levels, compared with senior and community physicians. Multivariate analysis demonstrated that being female (OR=0.74, 95% CI=0.64 to 0.85), younger (0.69, 0.64 to 0.74), having poor nutrition (0.66, 0.55 to 0.78), not meeting PA targets (0.68, 0.57 to 0.82), inadequate sleep (0.54, 0.40 to 0.56) and perceived poor health status (0.48, 0.40 to 0.56) were significantly associated with high stress levels (p<0.001).ConclusionsThe unfavourable health behaviours reported among Israeli physicians may have negative effects on their health and well-being. An intervention program to help physicians to adopt a healthier lifestyle is urgently needed.