bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can cognitive recovery time be estimated by clinical recovery time in concussion suffered by soccer athletes?
Authors: Silva Neto Moacir , Teixeira Paulo , Collins Michael 
Published: November 2017

ObjectiveDetermine if there is a correlation between the Clinical Recovery Time (CRT) and the Time from CRT to Cognitive Recovery (CGRT).DesignA non-concurrent cohort study.SettingChart review of Soccer Athletes who suffered concussion and were followed in the Concussion Management Program of the University of Pittsburgh Medical Centre.Participants92 charts were reviewed. Average Age was 16.2 (SD=2.7), 62% were females. Both CRT and CGRT were retrieved for 42 athletes.Outcome measuresCRT was determined by the days that were necessary for a list of rated concussion symptoms to be considered normal. Cognitive Recovery Time (CGRT) was determined when the computerised cognitive test used on follow-ups was considered to be back to normal by trained neuropsychologists.Main resultsCRT: Median time=23 days. Mean time=42 (SD=53) days (Minimum=1 day and Maximum 231 days). Time from CRT to CGRT: Median time=10 days. Mean time=17.7 (SD=27) days (Minimum=−7 days and Maximum of 157 days). Bivariate correlation of CRT to Time from CRT to CGRT was 0.195 (p=0.216).ConclusionsBoth CRT ad CGRT vary a lot among soccer players who suffer concussion. Time from CRT to CGRT didn’t correlate with CRT and can’t be estimated based on CRT. Both CRT and CGRT should be evaluated independently during rehabilitation of concussed soccer athletes.Competing interestsNone.Share holder of ImPACT Applications, Inc.
Compliance with and effectiveness of return-to-activity progressions following concussion: a systematic review of the literature
Authors: Valovich McLeod Tamara C , Lewis Joy H , Whelihan Kate , Welch Bacon Cailee E 
Published: November 2017

ObjectiveTo systematically review the literature regarding healthcare provider compliance with and the effectiveness of the graded return-to-activity progression.DesignSystematic Review.Search strategyAn electronic search was conducted in 6 databases. Search terms included: brain concussion AND-rest; concuss*AND-sports-AND-rest, -sports-AND-return-to-play; mild traumatic brain injury AND-return-to-activity, -return-to-play; recurrent concussion-AND-sport. Hand searches were also performed.Study selectionAfter removal of duplicates, initial screen of titles and abstracts was completed by 3 authors, followed by full text review. Articles were included if they were in English and original studies related to the clinical questions. Reviews, editorials, commentaries, and animal research were excluded.Data extractionThe initial search yielded 2851 articles, with 1239 undergoing title/abstract screen, 143 undergoing full-text review, and 21 included in the review. Study design, patient/participant, instrumentation/interventions utilised, outcome measures, main results, and conclusions were extracted. Strength of recommendation (SOR) as outlined by the Oxford Centre for Evidence-Based Medicine was assigned to the body of literature.Data synthesisArticles were categorised based on their ability to answer one of the clinical questions of interest and the conclusions were summarised using a qualitative synthesis of the findings. Data were not appropriate for meta-analysis due to the observational nature of many included studies and heterogeneity of the patients, participants, interventions and outcomes.ConclusionsThe review identified that significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists (SOR=B) and there is little evidence to support the effectiveness of the graded return-to-activity progression (SOR=D).Competing interestsNone.
What is the definition of sports-related concussion: a systematic review
Authors: McCrory Paul , Feddermann-Demont Nina , Dvořák Jiří , Cassidy J David , McIntosh Andrew , Vos Pieter E , Echemendia Ruben J , Meeuwisse Willem , Tarnutzer Alexander A 
Published: November 2017

ObjectivesVarious definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC.DesignThis is a systematic literature review.Data sourcesData sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Clinical Trials and SPORT Discus (accessed 14 September 2016).Eligibility criteria for selecting studiesEligibility criteria were studies reporting (clinical) criteria for diagnosing SRC and studies containing SRC impact data.ResultsOut of 1601 articles screened, 36 studies were included (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular and linear head accelerations linked to clinically confirmed concussions demonstrated considerable individual variation.Summary/conclusionsSRC is a traumatic brain injury that is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces with several common features that help define its nature. Limitations identified include that the current criteria for diagnosing SRC are clinically oriented and that there is no gold/standard to assess their diagnostic properties. A future, more valid definition of SRC would better identify concussed players by demonstrating high predictive positive/negative values. Currently, the use of helmet-based systems to study the biomechanics of SRC is limited to few collision sports. New approaches need to be developed to provide objective markers for SRC.
Dissemination of 2014 dual antiplatelet therapy (DAPT) trial results: a systematic review of scholarly and media attention over 7 months
Authors: Sharp Melissa K , Haneef Romana , Ravaud Philippe , Boutron Isabelle 
Published: November 2017

ObjectiveTo explore how the results from the 2014 dual antiplatelet therapy (DAPT) trial were disseminated to the scientific community and online media.DesignA a systematic review of scholarly and public attention surrounding the DAPT study.SettingsData were collected from the ISI Web of Knowledge, Google Scholar, PubMed Commons, EurekAlert, the DAPT study website (www.daptstudy.org) and theNew England Journal of Medicinewebsite (for scholarly attention) and Altmetric Explorer, Snap Bird, YouTube (for public attention) citing DAPT study results appearing from 16 November 2014 to 10 June 2015.ParticipantsNo participants were involved in this study.Main outcome measureProportion of contents highlighting the increased risk of mortality and critical to the author’s interpretation of the results.ResultsWe identified 425 items reported by seven sources; 164 (39%) disseminated the authors’ interpretation via an electronic link or a reference, with no additional text. Among 81 items (19 %), the message favoured prolonged treatment and consequently overstated the article conclusions. Among 119 items (28 %), the text was uncertain about the benefit of prolonged treatment but was reported with no or inappropriate mention of increased risk of mortality. Only 34 items (8 %) were uncertain about the benefit of prolonged treatment and mentioned increased risk of mortality. In all, 27 items (6 %) did not favour prolonged treatment, and only 12 of these (3 %) clearly raised some concerns about the reporting of increased risk of death.ConclusionDissemination of the DAPT study results to the scientific community and on different media sources rarely criticised the interpretation of the study results.
Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review
Authors: Abdel-All Marwa , Putica Barbara , Praveen Deversetty , Abimbola Seye , Joshi Rohina 
Published: November 2017

IntroductionCommunity health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.MethodsA search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.ResultsThe search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.ConclusionThe results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
Collective leadership and safety cultures (Co-Lead): protocol for a mixed-methods pilot evaluation of the impact of a co-designed collective leadership intervention on team performance and safety culture in a hospital group in Ireland
Authors: McAuliffe Eilish , De Brún Aoife , Ward Marie , O’Shea Marie , Cunningham Una , O’Donovan Róisín , McGinley Sinead , Fitzsimons John , Corrigan Siobhán , McDonald Nick 
Published: November 2017

IntroductionThere is accumulating evidence implicating the role of leadership in system failures that have resulted in a range of errors in healthcare, from misdiagnoses to failures to recognise and respond to patient deterioration. This has led to concerns about traditional hierarchical leadership structures and created an interest in the development of collective ways of working that distribute leadership roles and responsibilities across team members. Such collective leadership approaches have been associated with improved team performance and staff engagement. This research seeks to improve our understanding of collective leadership by addressing two specific issues: (1) Does collective leadership emerge organically (and in what forms) in a newly networked structure? and (2) Is it possible to design and implement collective leadership interventions that enable teams to collectively improve team performance and patient safety?Methods and analysisThe first phase will include a social network analysis, using an online survey and semistructured interviews at three time points over 12 months, to document the frequency of contact and collaboration between senior hospital management staff in a recently configured hospital group. This study will explore how the network of 11 hospitals is operating and will assess whether collective leadership emerges organically. Second, collective leadership interventions will be co-designed during a series of workshops with healthcare staff, researchers and patient representatives, and then implemented and evaluated with four healthcare teams within the hospital network. A mixed-methods evaluation will explore the impact of the intervention on team effectiveness and team performance indicators to assess whether the intervention is suitable for wider roll-out and evaluation across the hospital group.Ethics and disseminationFavourable ethical opinion has been received from the University College Dublin Research Ethics Committee (HREC-LS-16–116397/LS-16-20). Results will be disseminated via publication in peer-reviewed journals, national and international conferences, and to relevant stakeholders and interest groups.
Public views towards community health and hospital-based outpatient services and their utilisation in Zhejiang, China: a mixed methods study
Authors: Wu Dan , Lam Tai Pong , Lam Kwok Fai , Zhou Xu Dong , Sun Kai Sing 
Published: November 2017

ObjectiveChina is engaged in promoting community health services (CHS) nationwide. This study examines the public’s views towards CHS and their utilisation of community-based and hospital-based outpatient services.DesignA mixed methods study using qualitative interviews and a cross-sectional survey.Study setting and participantsThe study was conducted among the public between September 2014 and September 2015 in Zhejiang province, China. Six focus groups and 13 individuals were interviewed. The questionnaire was completed by 1248 respondents (response rate: 83%).Primary outcome measuresUtilisation of community-based and hospital-based outpatient services.ResultsFunctions of CHS perceived by the public included provision of minor illness management, coordination, drug dispensing, follow-up care and patient education. However, many also showed a distrust in primary care providers’ (PCPs) competence for confirming the initial diagnosis and management plan. As coordinators, PCPs’ integrity was challenged, and PCPs were thought to be potential ‘tuo er’ (cunning agents who tried to lead patients to some notorious hospitals to make money). Survey results showed that 800 (64.1%) respondents visited hospital-based clinics and 688 (55.1%) visited CHS at least once in the past year. Compared with the uninsured group, those covered by Urban Resident Medical Insurance (adjusted OR (AOR)=1.95, 95% CI 1.24 to 3.07) and Urban Employee Medical Insurance (AOR=2.59, 95% CI 1.59 to 4.24) were more likely to use hospital-based services. Respondents who had a chronic condition were more likely than their counterparts to use both hospital-based services (AOR=1.72, 95% CI 1.18 to 2.49) and CHS (AOR=1.66, 95% CI 1.19 to 2.32). Income levels were positively associated with the likelihood of visiting hospital-based clinics (AOR=1.67, 95% CI 1.15 to 2.42) but negatively associated with the likelihood of using CHS (AOR=0.68, 95% CI 0.48 to 0.96).ConclusionsDemand of hospital-based outpatient services is much higher than the community-based outpatient services. Policy reformers need to take further actions to address the public distrust in PCPs to facilitate their gatekeeping role.
Post-operative patient-related risk factors for chronic pain after total knee replacement: a systematic review
Authors: Wylde Vikki , Beswick Andrew D , Dennis Jane , Gooberman-Hill Rachael 
Published: November 2017

ObjectiveTo identify postoperative patient-related risk factors for chronic pain after total knee replacement (TKR).DesignThe systematic review protocol was registered on the International Prospective Register of Systematic Reviews (CRD42016041374). MEDLINE, Embase and PsycINFO were searched from inception to October 2016 with no language restrictions. Key articles were also tracked in the Institute for Scientific Information (ISI) Web of Science. Cohort studies evaluating the association between patient-related factors in the first 3 months postoperatively and pain at 6 months or longer after primary TKR surgery were included. Screening, data extraction and assessment of methodological quality were undertaken by two reviewers. The primary outcome was pain severity in the replaced knee measured with a patient-reported outcome measure at 6 months or longer after TKR. Secondary outcomes included adverse events and other aspects of pain recommended by the core outcome set for chronic pain after TKR.ResultsAfter removal of duplicates, 16 430 articles were screened, of which 805 were considered potentially relevant. After detailed evaluation of full-text articles, 14 studies with data from 1168 participants were included. Postoperative patient-related factors included acute pain (eight studies), function (five studies) and psychosocial factors (four studies). The included studies had diverse methods for assessment of potential risk factors and outcomes, and therefore narrative synthesis was conducted. For all postoperative factors, there was insufficient evidence to draw firm conclusions about the association with chronic pain after TKR. Selection bias was a potential risk for all studies, as none were reported to be conducted at multiple centres.ConclusionThis systematic review found insufficient evidence to draw firm conclusions about the association between any postoperative patient-related factors and chronic pain after TKR. Further high-quality research is required to provide a robust evidence base on postoperative risk factors, and inform the development and evaluation of targeted interventions to optimise patients’ outcomes after TKR.
Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data
Authors: Avaldi Vera Maria , Lenzi Jacopo , Urbinati Stefano , Molinazzi Dario , Descovich Carlo , Campagna Anselmo , Taglioni Martina , Fioritti Angelo , Fantini Maria Pia 
Published: November 2017

ObjectivesTo evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF).DesignRetrospective observational study based on administrative data.SettingLocal Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants.ParticipantsAll patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015.Primary and secondary outcome measuresMultivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge.ResultsThe study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) were seen by a cardiologist during follow-up. Inpatient and outpatient cardiologist care was associated with an increased likelihood of adherence to ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and aldosterone antagonists after discharge. The risk of mortality was significantly lower among patients adherent to ACEIs/ARBs and/or β-blockers (–53% and –28%, respectively); the risk of hospital readmission was significantly lower among patients adherent to ACEIs/ARBs (–28%).ConclusionsCompared with non-specialist care, cardiologist care improves patient adherence to evidence-based medications and might thus favourably affect mortality and readmission following HF.
Protocol for the HAPPY Hearts study: cardiovascular screening for the early detection of future adverse cardiovascular outcomes in middle-aged and older women: a prospective, observational cohort study
Authors: Boreskie Kevin F , Kehler D Scott , Costa Eduardo C , Cortez Pedro C , Berkowitz Ivan , Hamm Naomi C , Moffatt Teri L , Stammers Andrew N , Kimber Dustin E , Hiebert Brett M , Kent David E , Cornish Denise E , Blewett Heather , Nguyen Thang , Arora Rakesh C , Strachan Shaelyn M , Semenchuk Brittany N , Hay Jacqueline L , Cohn Jay N , Duhamel Todd A 
Published: November 2017

IntroductionEfforts to identify individuals at a higher risk for adverse cardiovascular outcomes focus on traditional risk factors, such as age, sex, smoking status, blood pressure and and cholesterol; however, this approach does not directly assess cardiovascular function and may underestimate the risk of experiencing adverse cardiovascular outcomes in women. This prospective, observational cohort study will examine the ability of the Heart Attack Prevention Program for You (HAPPY) Hearts screening protocol, a series of non-invasive procedures to identify middle-aged and older women who are at an elevated risk for experiencing an adverse cardiovascular event in the 5-year period after screening. The predictive value of the HAPPY Hearts protocol will also be compared with the Framingham Risk Score to determine the sensitivity for estimating risk for an adverse cardiovascular outcome.Methods and analysisOne thousand women 55 years of age or older will be recruited to be screened by the HAPPY Hearts protocol. This involves the cardiovascular assessment of resting blood pressure, blood pressure response to 3 min of moderate intensity exercise and large and small arterial elasticity. The participants will be classified into risk categories based on these measures. The incidence of the following adverse cardiovascular outcomes will be assessed in the 5-year period after screening in both groups: ischaemic heart disease, acute myocardial infarction, stroke, percutaneous coronary intervention, coronary bypass surgery, congestive heart failure and new hypertension.Ethics and disseminationInformation gathered in this research will be published in peer-reviewed journals and presented in a programme evaluation report to inform Manitoba Health and key stakeholders about the outcomes of the study. The University of Manitoba Health Research Ethics Board has approved the study protocol V.2.0, dated 29 September 2014 (H2014:224).Trial registration numberNCT02863211.
Quantifying the role of modifiable risk factors in the differences in cardiovascular disease mortality rates between metropolitan and rural populations in Australia: a macrosimulation modelling study
Authors: Alston Laura , Peterson Karen Louise , Jacobs Jane P , Allender Steven , Nichols Melanie 
Published: November 2017

ObjectivesThe study aimed (1) to quantify differences in modifiable risk factors between urban and rural populations, and (2) to determine the number of rural cardiovascular disease (CVD) and ischaemic heart disease (IHD) deaths that could be averted or delayed if risk factor levels in rural areas were equivalent to metropolitan areas.SettingNational population estimates, risk factor prevalence, CVD and IHD deaths data were analysed by rurality using a macrosimulation Preventable Risk Integrated Model for chronic disease risk. Uncertainty analysis was conducted using a Monte Carlo simulation of 10 000 iterations to calculate 95% credible intervals (CIs).ParticipantsNational data sets of men and women over the age of 18 years living in urban and rural Australia.ResultsIf people living in rural Australia had the same levels of risk factors as those in metropolitan areas, approximately 1461 (95% CI 1107 to 1791) deaths could be delayed from CVD annually. Of these CVD deaths, 793 (95% CI 506 to 1065) would be from IHD. The IHD mortality gap between metropolitan and rural populations would be reduced by 38.2% (95% CI 24.4% to 50.6%).ConclusionsA significant portion of deaths from CVD and IHD could be averted with improvements in risk factors; more than one-third of the excess IHD deaths in rural Australia were attributed to differences in risk factors. As much as two-thirds of the increased IHD mortality rate in rural areas could not be accounted for by modifiable risk factors, however, and this requires further investigation.