bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thyroid dysfunction and electrocardiographic changes in subjects without arrhythmias: a cross-sectional study of primary healthcare subjects from Copenhagen
Authors: Tayal Bhupendar , Graff Claus , Selmer Christian , Kragholm Kristian Hay , Kihlstrom Magnus , Nielsen Jonas Bille , Olsen Anne-Marie Schjerning , Pietersen Adrian Holger , Holst Anders G , Søgaard Peter , Christiansen Christine Benn , Faber Jens , Gislason Gunnar Hilmar , Torp-Pedersen Christian , Hansen Steen M 
Published: June 2019

ObjectiveThe objective of the present study was to investigate associations of both overt and subclinical thyroid dysfunction with common ECG parameters in a large primary healthcare population.DesignCross-sectional study.Setting and participantsThe study population comprised of primary healthcare patients in Copenhagen, Denmark, who had a thyroid function test and an ECG recorded within 7 days of each other between 2001 and 2011.Data sourcesThe Danish National Patient Registry was used to collect information regarding baseline characteristics and important comorbidities.Outcome measure and study groupsCommon ECG parameters were determined using Marquette 12SL software and were compared between the study groups. The study population was divided into five groups based on their thyroid status. Euthyroid subjects served as the reference group in all analyses.ResultsA total of 132 707 patients (age 52±17 years; 50% female) were included. Hyperthyroidism was significantly associated with higher heart rate and prolonged QTc interval with significant interaction with age (p<0.009) and sex (p<0.001). These associations were less pronounced for patients with higher age. Subclinical hyperthyroidism was associated with higher heart rate among females, and a similar trend was observed among males. Hypothyroidism was associated with slower heart rate and shorter QTc but only in women. Moreover, longer P-wave duration, longer PR interval and low voltage were observed in patients with both subclinical and overt hypothyroidism. However, the presence of low voltage was less pronounced with higher age (p=0.001).ConclusionBoth overt and subclinical thyroid disorders were associated with significant changes in important ECG parameters. Age and gender have significant impact on the association of thyroid dysfunction particularly on heart rate and QTc interval.
Observational study to determine the utility of hospital administrative data to support case finding of English patients at higher risk of severe healthcare-related harm
Authors: Hogan Helen , Cooke-O’Dowd Nora , Chattopadhyay Kaushik , van der Meulen Jan , Sherlaw-Johnson Christopher , Black Nick 
Published: June 2019

ObjectivesTo identify ways of using routine hospital data to improve the efficiency of retrospective reviews of case records for identifying avoidable severe harmDesignDevelopment and testing of thresholds and criteria for two indirect indicators of healthcare-related harm (long length of stay (LOS) and emergency readmission) to determine the yield of specified harms coded in Hospital Episode Statistics (HES).SettingAcute National Health Service hospitals in England.ParticipantsHES for acute myocardial infarction (AMI), bowel cancer surgery and hip replacement admissions from 2014 to 2015.InterventionsCase-mix-adjusted linear regression models were used to determine expected LOS. Different thresholds were examined to determine the association with harm. Screening criteria for readmission included time to readmission, length of readmission and diagnoses in initial admission and readmission. The association with harm was examined for each criterion.ResultsThe proportions of AMI cases with a harm code increased from 14% among all cases to 47% if a threshold of three times the expected LOS was used. For hip replacement the respective increase was from 10% to 51%. However as the number of patients at these higher thresholds was small, the overall proportion of harm identified is relatively small (15%, 19%, 9% and 8% among AMI, urgent bowel surgery, elective bowel surgery and hip replacement cohorts, respectively). Selection of the time to readmission had an effect on the yield of harms but this varied with condition. At least 50% of surgical patients had a harm code if readmitted within 7 days compared with 21% of patients with AMI.ConclusionsOur approach would select a substantial number of patients for case record review. Many of these cases would contain no evidence of healthcare-related harm. In practice, Trusts may choose how many reviews it is feasible to do in advance and then select random samples of cases that satisfy the screening criteria.
Open-label dose-extending placebos for opioid use disorder: a protocol for a randomised controlled clinical trial with methadone treatment
Authors: Belcher Annabelle M , Cole Thomas O , Greenblatt Aaron D , Hoag Stephen W , Epstein David H , Wagner Michael , Billing Amy S , Massey Ebonie , Hamilton Kristen R , Kozak Zofia K , Welsh Christopher J , Weintraub Eric , Wickwire Emerson M , Wish Eric D , Kaptchuk Ted J , Colloca Luana 
Published: June 2019

IntroductionMore than 2 million individuals in the USA have an opioid use disorder (OUD). Methadone maintenance treatment is the gold standard of medication-based treatment for OUD, but high-dose methadone is associated with cardiotoxicity and respiratory complications, among other side effects. These adverse effects make enhancing the effectiveness of lower doses of methadone an attractive therapeutic goal. Long recognised for its capacity to enhance treatment outcomes for a wide range of neuropsychiatric disorders including pain, the placebo effect offers an as-yet untested avenue to such an enhancement. This approach is particularly compelling given that individuals with substance use disorder tend to have higher salience attribution and may thereby be more sensitive to placebo effects. Our study combines two promising clinical methodologies—conditioning/dose-extension and open-label placebo—to investigate whether placebo effects can increase the effective potency of methadone in treatment-seeking OUD patients.Methods and analysisA total of 120 newly enrolled treatment-seeking OUD patients will be randomly assigned to one of two different groups: either methadone plus daily placebo dose-extension (PDE; treatment group) or methadone/treatment as usual (control). Participants will meet with study team members five times over the course of 3 months of treatment with methadone (baseline, 2 weeks, and 1, 2 and 3 months postbaseline). Throughout this study time period, methadone dosages will be adjusted by an addiction clinician blind to patient assignment, per standard clinical methods. The primary outcome is methadone dose at 3 months. Secondary outcomes include self-report of drug use; 3-month urine toxicology screen results; and treatment retention. Exploratory outcomes include several environmental as well as personality factors associated with OUD and with propensity to demonstrate a placebo effect.Ethics and disseminationHuman subjects oversight for this study is provided by the University of Maryland, Baltimore and University of Maryland, College Park Institutional Review Boards. Additionally, the study protocol is reviewed annually by an independent Data and Safety Monitoring Board. Study results will be disseminated via research conference presentations and peer-reviewed publications.Trial registration numberNCT02941809.
Primary care use of laboratory tests in Northern Ireland’s Western Health and Social Care Trust: a cross-sectional study
Authors: Bucholc Magda , O’Kane Maurice , Mullan Ciaran , Ashe Siobhan , Maguire Liam 
Published: June 2019

ObjectivesTo describe the laboratory test ordering patterns by general practitioners (GPs) in Northern Ireland Western Health and Social Care Trust (WHSCT) and explore demographic and socioeconomic associations with test requesting.DesignCross-sectional study.SettingWHSCT, Northern Ireland.Participants55 WHSCT primary care medical practices that remained open throughout the study period 1 April 2011–31 March 2016.OutcomesTo identify the temporal patterns of laboratory test ordering behaviour for eight commonly requested clinical biochemistry tests/test groups in WHSCT. To analyse the extent of variations in laboratory test requests by GPs and to explore whether these variations can be accounted for by clinical outcomes or geographical, demographic and socioeconomic characteristics.ResultsThe median number of adjusted test request rates over 5 consecutive years of the study period decreased by 45.7% for urine albumin/creatinine ratio (p<0.000001) and 19.4% for lipid profiles (p<0.000001) while a 60.6%, 36.6% and 29.5% increase was observed for HbA1c(p<0.000001), immunoglobulins (p=0.000007) and prostate-speciﬁc antigen (PSA) (p=0.0003), respectively. The between-practice variation in test ordering rates increased by 272% for immunoglobulins (p=0.008) and 500% for HbA1c(p=0.0001). No statistically significant relationship between ordering activity and either demographic (age and gender) and socioeconomic factors (deprivation) or Quality and Outcome Framework scores was observed. We found the rural–urban differences in between-practice variability in ordering rates for lipid profiles, thyroid profiles, PSA and immunoglobulins to be statistically significant at the Bonferroni-adjusted significance level p<0.01.ConclusionsWe explored potential factors of the interpractice variability in the use of laboratory tests and found that differences in requesting activity appear unrelated to either demographic and socioeconomic characteristics of GP practices or clinical outcome indicators.
Dr Foster global frailty score: an international retrospective observational study developing and validating a risk prediction model for hospitalised older persons from administrative data sets
Authors: Soong John T Y , Gammall Jurgita , Liew Danny , Peden Carol Jane , Bottle Alex , Bell Derek , Cooper Carolyn , Hopper Adrian 
Published: June 2019

ObjectivesThis study aimed to examine the prevalence of frailty coding within the Dr Foster Global Comparators (GC) international database. We then aimed to develop and validate a risk prediction model, based on frailty syndromes, for key outcomes using the GC data set.DesignA retrospective cohort analysis of data from patients over 75 years of age from the GC international administrative data. A risk prediction model was developed from the initial analysis based on seven frailty syndrome groups and their relationship to outcome metrics. A weighting was then created for each syndrome group and summated to create the Dr Foster Global Frailty Score. Performance of the score for predictive capacity was compared with an established prognostic comorbidity model (Elixhauser) and tested on another administrative database Hospital Episode Statistics (2011-2015), for external validation.Setting34 hospitals from nine countries across Europe, Australia, the UK and USA.ResultsOf 6.7 million patient records in the GC database, 1.4 million (20%) were from patients aged 75 years or more. There was marked variation in coding of frailty syndromes between countries and hospitals. Frailty syndromes were coded in 2% to 24% of patient spells. Falls and fractures was the most common syndrome coded (24%). The Dr Foster Global Frailty Score was significantly associated with in-hospital mortality, 30-day non-elective readmission and long length of hospital stay. The score had significant predictive capacity beyond that of other known predictors of poor outcome in older persons, such as comorbidity and chronological age. The score’s predictive capacity was higher in the elective group compared with non-elective, and may reflect improved performance in lower acuity states.ConclusionsFrailty syndromes can be coded in international secondary care administrative data sets. The Dr Foster Global Frailty Score significantly predicts key outcomes. This methodology may be feasibly utilised for case-mix adjustment for older persons internationally.
Here one year, gone the next? Investigating persistence of frequent emergency department attendance: a retrospective study in Australia
Authors: Lago Luise , Westley-Wise Victoria , Mullan Judy , Lambert Kelly , Zingel Rebekah , Carrigan Thomas , Triner Wayne , Eagar Kathy 
Published: June 2019

ObjectivesPatients are presenting to emergency departments (EDs) with increasing complexity at rates beyond population growth and ageing. Intervention studies target patients with 12 months or less of frequent attendance. However, these interventions are not well targeted since most patients do not remain frequent attenders. This paper quantifies temporary and ongoing frequent attendance and contrasts risk factors for each group.DesignRetrospective population-based study using 10 years of longitudinal data.SettingAn Australian geographic region that includes metropolitan and rural EDs.Participants332 100 residents visited any ED during the study period.Main outcome measureFrequent attendance was defined as seven or more visits to any ED in the region within a 12-month period. Temporary frequent attendance was defined as meeting this threshold only once, and ongoing more than once. Risk factors for temporary and ongoing frequent attenders were identified using logistic regression models for adults and children.ResultsOf 8577 frequent attenders, 80.1% were temporary and 19.9% ongoing (12.9% repeat, 7.1% persistent). Among adults, ongoing were more likely than temporary frequent attenders to be young to middle aged (aged 25–64 years), and less likely to be from a high socioeconomic area or be admitted. Ongoing frequent attenders had higher rates of non-injury presentations, in particular substance-related (OR=2.5, 99% CI 1.1 to 5.6) and psychiatric illness (OR=2.9, 99% CI 1.8 to 4.6). In comparison, children who were ongoing were more likely than temporary frequent attenders to be aged 5–15 years, and were not more likely to be admitted (OR=2.7, 99% CI 0.7 to 10.9).ConclusionsFuture intervention studies should distinguish between temporary and ongoing frequent attenders, develop specific interventions for each group and include rigorous evaluation.
Prevalence of frailty in older adults in outpatient physiotherapy in an urban region in the western part of Germany: a cross-sectional study
Authors: Braun Tobias , Thiel Christian , Ziller Carina , Rasche Julia , Bahns Carolin , Happe Lisa , Retzmann Theresa , Grüneberg Christian 
Published: June 2019

ObjectiveTo investigate the prevalence of frailty in older people in outpatient physiotherapy services in an urban region in the western part of Germany.DesignCross-sectional study.SettingOutpatient physiotherapy clinics were recruited in the municipal area of the city of Bochum, Germany, and selected randomly.ParticipantsOlder adults aged 65 years and older seeking outpatient physiotherapy.Primary and secondary outcome measuresPrevalence of frailty was assessed based on the frailty phenotype model of physical frailty and the accumulation of deficit model, expressed as a Frailty Index. Prevalence was calculated for the whole sample and according to age-related, sex-related and diagnosis-related subgroups.ResultsA total of 258 participants (74±6 years, 62% female) from 11 out of 130 (8%) different physiotherapy clinics were included. Participants’ main indication for physiotherapy was an orthopaedic or surgical condition (75%). According to the model of a physical frailty phenotype, 17.8% (95% CI 13.2 to 22.5) participants were frail and 43.4% (95% CI 37.4 to 49.5) were prefrail. The Frailty Index identified 31.0% (95% CI 25.4 to 36.7) of individuals as frail. In both models, prevalence increased with age and was higher in women than in men. Slow gait speed (34%), reduced muscle strength (34%) and exhaustion (28%) were the most prevalent indicators of physical frailty.ConclusionsFrailty is comparatively common in older patients attending physiotherapy care in Germany, with one out of three individuals being frail and every second individual being physically frail or prefrail.Trial registration numberDRKS00009384; Results.
Research priorities and potential methodologies to inform care in subsequent pregnancies following stillbirth: a web-based survey of healthcare professionals, researchers and advocates
Authors: Wojcieszek Aleena M , Heazell Alexander EP , Middleton Philippa , Ellwood David , Silver Robert M , Flenady Vicki 
Published: June 2019

ObjectivesTo identify research priorities and explore potential methodologies to inform care in subsequent pregnancies following a stillbirth.DesignWeb-based survey by invitation.ParticipantsMultidisciplinary panel of 79 individuals involved in stillbirth research, clinical practice and/or advocacy from the international stillbirth research community (response rate=64%).Outcome measuresImportance of 16 candidate research topics and perceived utility and appropriateness of randomised controlled trial (RCT) methodology for the evaluation of four pertinent interventions: (1) medical therapies for placental dysfunction (eg, antiplatelet agents); (2) additional antepartum fetal surveillance (eg, ultrasound scans); (3) early planned birth from 37 weeks’ gestation and (4) different forms of psychosocial support for parents and families.ResultsCandidate research topics that were rated as ‘important and urgent’ by the greatest proportion of participants were: medical therapies for placental dysfunction (81%); additional antepartum fetal surveillance (80%); the development of a core outcomes dataset for stillbirth research (79%); targeted antenatal interventions for women who have risk factors (79%) and calculating the risk of recurrent stillbirth according to specific causes of index stillbirth (79%). Whether RCT methodologies were considered appropriate for the four selected interventions varied depending on the criterion being assessed. For example, while 72% of respondents felt that RCTs were ‘the best way’ to evaluate medical therapies for placental dysfunction, fewer respondents (63%) deemed RCTs ethical in this context, and approximately only half (52%) felt that such RCTs were feasible. There was considerably less support for RCT methodology for the evaluation of different forms of psychosocial support, which was reinforced by free-text comments.ConclusionsFive priority research topics to inform care in pregnancies after stillbirth were identified. There was support for RCTs in this area, but the panel remained divided on the ethics and feasibility of such trials. Engagement with parents and families is a critical next step.
Unmet care needs of community-dwelling stroke survivors: a protocol for systematic review and theme analysis of quantitative and qualitative studies
Authors: Lin Beilei , Ding Chunge , Mei Yongxia , Wang Panpan , Ma Fayang , Zhang Zhen-Xiang 
Published: June 2019

IntroductionStroke is a leading cause of disability worldwide. The average hospital length of stay ranges from 3 to 28 days, and after discharge home the stroke survivors will live with physical, cognitive, even psychological disorders for the rest of their lives. It is essential to review the unmet needs of stroke survivors.Methods and analysisA systematic review of previous quantitative and qualitative studies reporting the unmet needs of stroke survivors in their homes will be conducted. The following six databases will be searched from inception to December 2018 for relevant articles: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and China Biology Medicine. We will include studies limited to human and published in English or Chinese, and the patients with stroke should discharge home rather than any other professional organisations including nursing homes or community rehabilitation units and so on. Data of quantitative research will be standardised for comparison, thematic analysis will be used for qualitative data and a narrative synthesis and pooled analysis of the main outcomes will be reported.Ethics and disseminationThis review will be submitted to an international professional journal, and the detailed search strategies and analysis flowchart will be openly included as supplements. This study does not require ethical approval as no patient’s identifiable data will be used. Our findings will give a new look at the aspect of stroke survivors’ unmet needs in their long-term recovery stage, especially the trajectories of unmet needs at different timepoints. What is more, this review will demonstrate the long-term unmet needs of stroke survivors from different countries, will compare any variations between high-income and low-income regions, and the geographical differences of needs will be mapped if necessary. We will endeavour to provide as much information as possible to healthcare professionals and public health policy makers in order to promote further medical reform.Trial registration numberCRD42018112181.
Joint impact of dementia and frailty on healthcare utilisation and outcomes: a retrospective cohort study of long-stay home care recipients
Authors: Maxwell Colleen J , Mondor Luke , Hogan David B , Campitelli Michael A , Bronskill Susan E , Seitz Dallas P , Wodchis Walter P 
Published: June 2019

ObjectivesTo examine the associations between dementia and 1-year health outcomes (urgent hospitalisation, long-term care (LTC) admission, mortality) among long-stay home care recipients and the extent to which these associations vary by clients’ frailty level.DesignA retrospective cohort study using linked clinical and health administrative databases.SettingHome care in Ontario, Canada.ParticipantsLong-stay (≥60 days) care clients (n=153 125) aged ≥50 years assessed between April 2014 and March 2015.Main outcome measuresDementia was ascertained with a validated administrative data algorithm and frailty with a 66-item frailty index (FI) based on a previously validated FI derived from the clinical assessment. We examined associations between dementia, FI and their interactions, with 1-year outcomes using multivariable Fine-Gray competing risk (urgent hospitalisation and LTC admission) and Cox proportional hazards (mortality) models.ResultsClients with dementia (vs without) were older (mean±SD, 83.3±7.9 vs 78.9±11.3 years, p<0.001) and more likely to be frail (30.3% vs 24.2%, p<0.001). In models adjusted for FI (as a continuous variable) and other confounders, clients with dementia showed a lower incidence of urgent hospitalisation (adjusted subdistribution HR (sHR)=0.84, 95% CI: 0.83 to 0.86) and mortality rate (adjusted HR=0.87, 95% CI: 0.84 to 0.89) but higher incidence of LTC admission (adjusted sHR=2.60, 95% CI: 2.53 to 2.67). The impact of dementia on LTC admission and mortality was significantly modified by clients’ FI (p<0.001 interaction terms), showing a lower magnitude of association (ie, attenuated positive (for LTC admission) and negative (for mortality) association) with increasing frailty.ConclusionsThe strength of associations between dementia and LTC admission and death (but not urgent hospitalisation) among home care recipients was significantly modified by their frailty status. Understanding the public health impact of dementia requires consideration of frailty levels among older populations, including those with and without dementia and varying degrees of multimorbidity.