bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the person’s context influence engagement in life activities following primary knee replacement? Results from a Canadian prospective cohort study
Authors: Davis Aileen M , Venkataramanan Viji , Bytautas-Sillanpää Jessica , Perruccio Anthony V , Wong Rosalind , Carlesso Lisa , Webster Fiona 
Published: August 2017

ObjectiveThe impact of the context of a person’s life on recovery from surgical interventions is not well understood. This study evaluated if people’s social, environmental and biomedical context was associated with change in frequency in engagement in life activities after total knee replacement (TKR).Methods418 people aged 30+ years who had TKR were followed presurgery to 1 year postsurgery. The outcome was change in frequency in engagement in life activities measured by the Late Life Disability Index (LLDI). Predictor variables of interest evaluated in multivariable linear regression analysis were positive and negative life events (Life Experiences Survey), development of a new comorbidity, another joint replacement and complications after TKR surgery.ResultsMean age was 65 years, 36% were male; 22% and 21% had no comorbidity presurgery and postsurgery. Presurgery LLDI frequency was 69.6 (±11.4) and the mean change was 6.1 (±10.2). Thirty-four per cent and 65% reported at least one positive or negative life event. Seven per cent developed hypertension, 6% cardiovascular disease, 2% lung disease and 2% diabetes. Eleven per cent had a complication and 9% another hip or knee replaced. Smaller changes in LLDI frequency were associated with more negative life events (beta=−0.56; 95% CI −0.92 to−0.18) and complications (beta=−4.01; 95% CI −6.63 to –1.38) after adjusting for age, sex, education, body mass index, comorbidities presurgery, number of symptomatic joints and knee-specific pain and function, LLDI limitations and depression. A new comorbidity or another joint replacement was not associated with outcome in unadjusted or adjusted analysis.ConclusionsMultifaceted life experiences shape the context of peoples’ lives impacting their engagement in activities important for healthy living post-TKR.
A retrospective review of paediatric head injuries in Asia – a Pan Asian Trauma Outcomes Study (PATOS) collaboration
Authors: Chong Shu-Ling , Khan Uzma Rahim , Santhanam Indumathy , Seo Jun Seok , Wang Quan , Jamaluddin Sabariah Faizah , Hoang Trong Quoc Ai , Chew Su Yah , Ong Marcus Eng Hock 
Published: August 2017

ObjectiveWe aim to examine the mechanisms of head-injured children presenting to participating centres in the Pan Asian Trauma Outcomes Study (PATOS) and to evaluate the association between mechanism of injury and severe outcomes.Design and settingWe performed a retrospective review of medical records among emergency departments (EDs) of eight PATOS centres, from September 2014 – August 2015.ParticipantsWe included children <16 years old who presented within 24 hours of head injury and were admitted for observation or required a computed tomography (CT) of the brain from the ED. We excluded children with known coagulopathies, neurological co-morbidities or prior neurosurgery. We reviewed the mechanism, intent, location and object involved in each injury, and the patients’ physical findings on presentation.OutcomesPrimary outcomes were death, endotracheal intubation or neurosurgical intervention. Secondary outcomes included hospital and ED length of stay.Results1438 children were analysed. 953 children (66.3%) were male and the median age was 5.0 years (IQR 1.0–10.0). Falls predominated especially among children younger than 2 years (82.9%), while road traffic injuries were more likely to occur among children 2 years and above compared with younger children (25.8% vs 11.1%). Centres from upper and lower middle-income countries were more likely to receive head injured children from road traffic collisions compared with those from high-income countries (51.4% and 40.9%, vs 10.9%, p<0.0001) and attended to a greater proportion of children with severe outcomes (58.2% and 28.4%, vs 3.6%, p<0.0001). After adjusting for age, gender, intent of injury and gross national income, traffic injuries (adjusted OR 2.183, 95% CI 1.448 to 3.293) were associated with severe outcomes, as compared with falls.ConclusionsAmong children with head injuries, traffic injuries are independently associated with death, endotracheal intubation and neurosurgery. This collaboration among Asian centres holds potential for future prospective childhood injury surveillance.
Quality differences between private for-profit, private non-profit and public hospitals in Norway: a retrospective national register-based study of acute readmission rates following total hip and knee arthroplasties
Authors: Holom Geir Hiller , Hagen Terje P 
Published: August 2017

ObjectivesTo compare the quality of care—using unplanned acute hospital readmissions as a quality measure—among patients treated at private for-profit hospitals (PFPs), private non-profit hospitals (PNPs) and public hospitals (PUBs) in Norway.DesignA retrospective comparative study using the Norwegian Patient Register. Readmissions were evaluated by logistic regressions both using adjustment for various patient-level and other covariates, and a two-stage model using distance as an instrumental variable.SettingThe Norwegian healthcare system.PopulationAll publicly financed patients having primary total hip (37 897 patients) or primary total knee arthroplasty (25 802 patients) at one of the three hospital types from 2009 to 2014.Primary outcome measure30-day unplanned acute hospital readmission rate.ResultsWe found highest readmission rates among PUBs and lowest among PFPs, for both procedures. However, the patients were on average more than 2 years younger at PFPs. PFPs also treated the least severe patients, while PUBs treated the most severe. Using adjustment for various patient-level and other covariates, compared to PUBs, both PFPs and PNPs had lower odds of readmission following both procedures. However, using the instrumental variable method, the only significant difference found was a lower odds of readmission at PNPs among hip patients when compared with PUBs. No patients in our data set were readmitted to PFPs, those originally treated at PFPs were readmitted to either PNPs or PUBs, and PUBs received most of the readmitted patients across hospital types.ConclusionsQuality differences between hospital types were small; however, PNPs had significantly lower readmission rates compared with PUBs among patients having total hip arthroplasty. PUBs received the larger part of the readmitted patients across hospital types and thus play an essential role in the care of more complex patients and for readmissions, regardless of any quality differences.
Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia
Authors: Myles Paul S , Shulman Mark A , Heritier Stephane , Wallace Sophie , McIlroy David R , McCluskey Stuart , Sillar Isabella , Forbes Andrew 
Published: August 2017

ObjectiveTo evaluate ‘days at home up to 30 days after surgery’ (DAH30) as a patient-centred outcome measure.DesignProspective cohort study.Data sourceUsing clinical trial data (seven trials, 2109 patients) we calculated DAH30from length of stay, readmission, discharge destination and death up to 30 days after surgery.Main outcomeThe association between DAH30and serious complications after surgery.ResultsOne or more complications occurred in 263 of 1846 (14.2%) patients, including 19 (1.0%) deaths within 30 days of surgery; 245 (11.6%) patients were discharged to a rehabilitation facility and 150 (7.1%) were readmitted to hospital within 30 days of surgery. The median DAH30was significantly less in older patients (p<0.001), those with poorer physical functioning (p<0.001) and in those undergoing longer operations (p<0.001). Patients with serious complications had less days at home than patients without serious complications (20.5 (95% CI 19.1 to 21.9) vs 23.9 (95% CI 23.8 to 23.9) p<0.001), and had higher rates of readmission (16.0% vs 5.9%; p<0.001). After adjusting for patient age, sex, physical status and duration of surgery, the occurrence of postoperative complications was associated with fewer days at home after surgery (difference 3.0(95% CI 2.1 to 4.0) days; p<0.001).ConclusionsDAH30has construct validity and is a readily obtainable generic patient-centred outcome measure. It is a pragmatic outcome measure for perioperative clinical trials.
Ten-year follow-up of human papillomavirus vaccine efficacy against the most stringent cervical neoplasia end-point—registry-based follow-up ofthree cohorts from randomized trials
Authors: Lehtinen Matti , Lagheden Camilla , Luostarinen Tapio , Eriksson Tiina , Apter Dan , Harjula Katja , Kuortti Marjo , Natunen Kari , Palmroth Johanna , Petäjä Tiina , Pukkala Eero , Siitari-Mattila Mari , Struyf Frank , Nieminen Pekka , Paavonen Jorma , Dubin Gary , Dillner Joakim 
Published: August 2017

ObjectiveDue to long lag time between infection/cancer diagnoses human papillomavirus (HPV) vaccination programs will deliver vaccine efficacy (VE) estimates against cancer end-points late. Cancer registry follow-up of population-based, randomised trial cohorts of vaccinated and unvaccinated women was undertaken for the estimation of VE against cervical intraepithelial neoplasia grade three and invasive cancer (CIN3+).MethodsWe report interim results with 98 561 person years of Finnish Cancer Registry -based follow-up of individually and/or cluster randomised cohorts of HPV-16/18 vaccinated and unvaccinated adolescent women enrolled in June 2003/2005, and between May 2004 and April 2005, respectively. The cohorts comprised 15 627 18- to 19-year-old unvaccinated women (NCT01393470), and 2 401 and 64 16- to 17-year-old HPV-16/18 vaccinated women participating the PATRICIA (NCT00122681) and HPV-012 (NCT00169494) trials, respectively. The age-aligned passive follow-up started 6 months after the clinical trials’ end.ResultsDuring the follow-up of 4.5 to 10 years post enrolment we identified 75 cases of cervical intraepithelial neoplasia grade 3 (CIN3) and 4 cases of invasive cervical cancer (ICC) in the unvaccinated cohort, and 4 CIN3 cases in the HPV-16/18 vaccinated women. Diagnostic blocks were available for HPV typing from 87% of the cases. CIN3+ lesions were detectable in 54 cases. HPV16 was found in 26 of 50 unvaccinated CIN3+ cases, and in 3 CIN3+ cases in the HPV-16/18 vaccinated women. The latter were all baseline positive for cervical HPV16 DNA. Baseline data was not available for the unvaccinated women. Intention-to-treat VE against any CIN3+ was 66% (95% CI 8, 88).ConclusionsTen years post vaccination the AS04-adjuvanted HPV-16/18 vaccine shows continued efficacy against CIN3+ irrespectively of HPV type. Vaccine efficacy was not observed in baseline HPV16 DNA positive subjects.Trial registration numberNCT01393470.
Preclinical medical students’ understandings of academic and medical professionalism: visual analysis of mind maps
Authors: Janczukowicz Janusz , Rees Charlotte E 
Published: August 2017

IntroductionSeveral studies have begun to explore medical students’ understandings of professionalism generally and medical professionalism specifically. Despite espoused relationships between academic (AP) and medical professionalism (MP), previous research has not yet investigated students’ conceptualisations of AP and MP and the relationships between the two.ObjectivesThe current study, based on innovative visual analysis of mind maps, therefore aims to contribute to the developing literature on how professionalism is understood.MethodsWe performed a multilayered analysis of 98 mind maps from 262 first-year medical students, including analysing textual and graphical elements of AP, MP and the relationships between AP and MP.ResultsThe most common textual attributes of AP were learning, lifestyle and personality, while attributes of MP were knowledge, ethics and patient-doctor relations. Images of books, academic caps and teachers were used most often to represent AP, while images of the stethoscope, doctor and red cross were used to symbolise MP. While AP-MP relations were sometimes indicated through co-occurring text, visual connections and higher-order visual metaphors, many students struggled to articulate the relationships between AP and MP.ConclusionsWhile the mind maps’ textual attributes shared similarities with those found in previous research, suggesting the universality of some professionalism attributes, our study provides new insights into students’ conceptualisations of AP, MP and AP-MP relationships. We encourage medical educators to help students develop their understandings of AP, MP and AP-MP relationships, plus consider the feasibility and value of mind maps as a source of visual data for medical education research.
Effectiveness of seasonal influenza vaccination in patients with diabetes: protocol for a nested case–control study
Authors: Casanova Ludovic , Cortaredona Sébastien , Gaudart Jean , Launay Odile , Vanhems Philippe , Villani Patrick , Verger Pierre 
Published: August 2017

IntroductionSeasonal influenza vaccination (SIV) is recommended for people with diabetes, but its effectiveness has not been demonstrated. All of the available studies are observational and marred with the healthy vaccine bias, that is, bias resulting from the generally better health behaviours practised by people who choose to be vaccinated against influenza, compared with those who do not. This protocol is intended to study the effectiveness of SIV in people with treated diabetes and simultaneously to control for bias.Methods and analysesThis case-control study is nested in a historical cohort and is designed to study vaccine effectiveness (VE) assessed by morbidity, mortality and anti-infective drug use. The cohort will comprise a representative sample of health insurance beneficiaries in France and will cover 10 consecutive epidemic seasons. It will include all patients reimbursed three separate times for drugs to treat diabetes. The first study of VE will use reasons for hospitalisation as the primary end point, and the second with the use of neuraminidase inhibitors and of antibiotics as the end points. A case will be defined as any person in the cohort reaching any end point at a given date. The case patient will be matched with the largest possible number of controls (individuals not reaching the end point by this date) according to the propensity score method with an optimal calliper width. A conditional logistic model will be used to estimate ORs to take into account both the matching and the repetition of measurements. The model will be applied separately during and outside of epidemic periods to estimate the residual confounding.Ethics and disseminationThe study has been approved by the French Commission on Individual Data Protection and Public Liberties (ref: AT/CPZ/SVT/JB/DP/CR05222O). The study's findings will be published in peer-reviewed journals and disseminated at international conferences and through social media.
Evidence of pharmacological and non-pharmacological interventions for the management of dental fear in paediatric dentistry: a systematic review protocol
Authors: Cianetti Stefano , Paglia Luigi , Gatto Roberto , Montedori Alessandro , Lupatelli Eleonora 
Published: August 2017

IntroductionSeveral techniques have been proposed to manage dental fear/dental anxiety (DFA) in children and adolescents undergoing dental procedures. To our knowledge, no widely available compendium of therapies to manage DFA exists. We propose a study protocol to assess the evidence regarding pharmacological and non-pharmacological interventions to relieve dental anxiety in children and adolescents.Methods and analysisIn our systematic review, we will include randomised trials, controlled clinical rials and systematic reviews (SRs) of trials that investigated the effects of pharmacological and non-pharmacological interventions to decrease dental anxiety in children and adolescents. We will search the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of Reviews of Effects=, the Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Web of Science for relevant studies. Pairs of review authors will independently review titles, abstracts and full texts identified by the specific literature search and extract data using a standardised data extraction form. For each study, information will be extracted on the study report (eg, author, year of publication), the study design (eg, the methodology and, for SRs, the types and number of studies included), the population characteristics, the intervention(s), the outcome measures and the results. The quality of SRs will be assessed using the A Measurement Tool to Assess Reviews instrument, while the quality of the retrieved trials will be evaluated using the Cochrane Handbook for Systematic Reviews of Interventions criteria.Ethics and disseminationApproval from an ethics committee is not required, as no participants will be included. Results will be disseminated through a peer-reviewed publications and conference presentations.
Effectiveness of a pragmatic school-based universal resilience intervention in reducing tobacco, alcohol and illicit substance use in a population of adolescents: cluster-randomised controlled trial
Authors: Hodder Rebecca Kate , Freund Megan , Bowman Jenny , Wolfenden Luke , Campbell Elizabeth , Dray Julia , Lecathelinais Christophe , Oldmeadow Christopher , Attia John , Wiggers John 
Published: August 2017

ObjectivesInitiation of tobacco, alcohol and illicit substance use typically occurs during adolescence, with the school setting recommended to reduce adolescent substance use. Strengthening individual (eg, problem solving) and environmental (eg, caring relationships at school) resilience protective factors of adolescents has been suggested as a strategy for reducing substance use by adolescents; however, few studies have examined this potential. A study was conducted to investigate the effectiveness of a pragmatic school-based universal ‘resilience’ intervention in reducing the prevalence of tobacco, alcohol and illicit substance use, and increasing the individual and environmental protective factors of students.DesignA cluster-randomised controlled trial.SettingThirty-two Australian secondary schools (20 intervention; 12 control).ParticipantsCohort of grade 7 students followed-up in grade 10 (2014; aged 15–16 years).InterventionA pragmatic intervention involving school staff selection and implementation of available programmes and resources targeting individual and environmental ‘resilience’ protective factors for all grade 7–10 students was implemented in schools (2012–2014). School staff were provided implementation support.MeasurementsAn online survey collected baseline and follow-up data for primary outcomes: tobacco (ever, recent) and alcohol (ever, recent, ‘risk’) use, and secondary outcomes: marijuana and other illicit substance use, and individual (six-factor subscales, aggregate) and environmental (three-factor subscales, aggregate) protective factor scores. Generalised and linear mixed models examined follow-up differences between groups.ResultsFollow-up data from 2105 students (intervention=1261; control=844; 69% of baseline cohort) were analysed. No significant differences were found between intervention and control students for any primary (ever tobacco: OR 1.25, 95% CI 0.92 to 1.68, p=0.14; recent tobacco: OR 1.39, 95% CI 0.84 to 2.31, p=0.19; recent ever alcohol: OR 1.11, 95% CI 0.83 to 1.48, p=0.46; alcohol: OR 1.13, 95% CI 0.78 to 1.62, p=0.51; ‘risk’ alcohol: OR 0.98, 95% CI 0.70 to 1.36, p=0.89) or secondary outcomes (marijuana: OR 1.12, 95% CI 0.74 to 1.68, p=0.57; other illicit substance: OR 1.19, 95% CI 0.67 to 2.10, p=0.54; individual protective factors: MD=0, 95% CI −0.07 to 0.06, p=0.89; environmental protective factors: MD: −0.02, 95% CI −0.09 to 0.06, p=0.65).ConclusionsThe universally implemented pragmatic school-based intervention was not effective in reducing the prevalence of tobacco, alcohol or illicit substance use, or in increasing the protective factors of students.Trial registrationAustralia and New Zealand Clinical Trials Register reference: ACTRN12611000606987
The association between intensive care unit-acquired hypernatraemia and mortality in critically ill patients with cerebrovascular diseases: a single-centre cohort study in Japan
Authors: Imaizumi Takahiro , Nakatochi Masahiro , Fujita Yoshiro , Nomura Rie , Watanabe Kenshi , Maekawa Michitaka , Yamakawa Taishi , Katsuno Takayuki , Maruyama Shoichi 
Published: August 2017

ObjectivesHypernatraemia is one of the major electrolyte disorders associated with mortality among critically ill patients in intensive care units (ICUs). It is unclear whether this applies to patients with cerebrovascular diseases in whom high sodium concentrations may be allowed in order to prevent cerebral oedema. This study aimed to examine the association between ICU-acquired hypernatraemia and the prognosis of patients with cerebrovascular diseases.DesignA retrospective cohort study.SettingThe incidence of ICU-acquired hypernatraemia was assessed retrospectively in a single tertiary care facility in Japan.ParticipantsAdult patients (≥18 years old) whose length of stay in ICU was >2 days and those whose serum sodium concentrations were 130–149 mEq/L on admission to ICU were included.Outcome measures28-day in-hospital mortality risk was assessed by Cox regression analysis. Hypernatraemia was defined as serum sodium concentration ≥150 mEq/L. Using multivariate analysis, we examined whether ICU-acquired hypernatraemia and the main symptom present at ICU admission were associated with time to death among ICU patients. We also evaluated how the maximum and minimum sodium concentrations during ICU stay were associated with mortality, using restricted cubic splines.ResultsOf 1756 patients, 121 developed ICU-acquired hypernatraemia. Multivariate Cox proportional hazard analysis revealed an association between ICU-acquired hypernatraemia and 28-day mortality (adjusted HR, 3.07 (95% CI 2.12 to 4.44)). The interaction between ICU-acquired hypernatraemia and cerebrovascular disease was significantly associated with 28-day mortality (HR, 3.03 (95% CI 1.29 to 7.15)). The restricted cubic splines analysis of maximum serum sodium concentration in ICU patients determined a threshold maximum of 147 mEq/L. There was no significant association between minimum sodium concentration and mortality.ConclusionsICU-acquired hypernatraemia was associated with an increased mortality rate among critically ill patients with cerebrovascular diseases; the threshold maximum serum sodium concentration associated with mortality was 147 mEq/L.