bluuebunny/crossref_metadata_2025_split huggingface dataset:
Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review
Authors: Braithwaite Jeffrey , Testa Luke , Lamprell Gina , Herkes Jessica , Ludlow Kristiana , McPherson Elise , Campbell Margie , Holt Joanna 
Published: November 2017

IntroductionThe sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system.Methods and analysisThe protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies.Ethics and disseminationAs no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems.
Barriers and facilitators to orthopaedic surgeons’ uptake of decision aids for total knee arthroplasty: a qualitative study
Authors: Bunzli Samantha , Nelson Elizabeth , Scott Anthony , French Simon , Choong Peter , Dowsey Michelle 
Published: November 2017

ObjectivesThe demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons.DesignA qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators.SettingOne tertiary hospital in Australia.ParticipantsTwenty orthopaedic surgeons performing TKA.Outcome measuresBeliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids.ResultsWhile prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified included the perception that one’s patient outcomes were already optimal; a perceived lack of non-operative alternatives for the management of end-stage osteoarthritis, concerns about mandatory cut-offs for patient-centred care and concerns about the medicolegal implications of using a decision aid.ConclusionsMultifaceted implementation interventions are required to ensure that orthopaedic surgeons are ready, willing and able to use a TKA decision aid. Audit/feedback to address current decision-making biases such as overconfidence may enhance readiness to uptake. Policy changes and/or incentives may enhance willingness to uptake. Finally, the design/implementation of effective non-operative treatments may enhance ability to uptake by ensuring that surgeons have the resources they need to carry out decisions.
Social work’s scope of practice in the provision of primary mental health care: protocol for a scoping review
Authors: Ashcroft Rachelle , Kourgiantakis Toula , Brown Judith Belle 
Published: November 2017

IntroductionSocial work is a key member of interprofessional primary healthcare teams and foundational to primary healthcare reforms that aim to improve the provision of mental healthcare. Little is known, however, about social work’s scope of practice within primary healthcare settings, particularly in the provision of mental healthcare. The objective of this study is to identify and describe social work’s scope of practice as it relates to mental healthcare in primary healthcare settings.Methods and analysisA scoping review will be conducted using the methodology established by Arksey and O’Malley. We will search electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Social Services Abstracts and Social Work Abstracts) to identify studies appropriate for inclusion. One reviewer will independently screen all abstracts and full-text studies for inclusion, with supervision by lead investigator. We will include any study that focuses on social work and mental healthcare within primary healthcare settings. All bibliographic data, study characteristics and range of social work practice activities will be collected and analysed using a tool developed by the research team.Ethics and disseminationThe scoping review will synthesise social work’s scope of practice in the provision of mental healthcare within primary healthcare settings. This review will be the first step to formally develop guidelines for social work practice in primary healthcare. The results will be disseminated through a peer-reviewed publication and conference presentations.
Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria
Authors: Swaminathan Lakshmi , Flanders Scott , Rogers Mary , Calleja Yvonne , Snyder Ashley , Thyagarajan Rama , Bercea Priscila , Chopra Vineet 
Published: November 2017

BackgroundAlthough important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing.ObjectiveTo test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use and patient outcomes.DesignQuasi-experimental, interrupted time series design at one study site with nine contemporaneous external controls.SettingTen hospitals participating in a state-wide quality collaborative from 1 August 2014 to 31 July 2016.Patients963 hospitalised patients who received a PICC at the study site vs 6613 patients at nine control sites.InterventionA multimodal intervention (tool, training, electronic changes, education) derived from MAGIC.MeasurementsAppropriateness of PICC use and rates of PICC-associated complications. Segmented Poisson regression was used for analyses.ResultsAbsolute rates of inappropriate PICC use decreased substantially at the study site versus controls (91.3% to 65.3% (−26.0%) vs 72.2% to 69.6% (−2.6%); P<0.001). After adjusting for underlying trends and patient characteristics, however, a marginally significant 13.8% decrease in inappropriate PICC use occurred at the study site (incidence rate ratio 0.86 (95% CI 0.74 to 0.99; P=0.048)); no change was observed at control sites. While the incidence of all PICC complications decreased to a greater extent at the study site, the absolute difference between controls and intervention was small (33.9% to 26.7% (−7.2%) vs 22.4% to 20.8% (−1.6%); P=0.036).LimitationsNon-randomised design limits inference; the most effective component of the multimodal intervention is unknown; effects following implementation were modest.ConclusionsIn a multihospital quality improvement project, implementation of MAGIC improved PICC appropriateness and reduced complications to a modest extent. Given the size and resources required for this study, future work should consider cost-to-benefit ratio of similar approaches.
Exposure to ambient fine particulate matter and semen quality in Taiwan
Authors: Lao Xiang Qian , Zhang Zilong , Lau Alexis K H , Chan Ta-Chien , Chuang Yuan Chieh , Chan Jimmy , Lin Changqing , Guo Cui , Jiang Wun Kai , Tam Tony , Hoek Gerard , Kan Haidong , Yeoh Eng-kiong , Chang Ly-yun 
Published: November 2017

ObjectivesEnvironmental exposure to chemicals has been considered a potential factor contributing to deteriorated semen quality. However, previous literature on exposure to air pollution and semen quality is inconsistent. We therefore investigated the health effects of short-term and long-term exposure to fine particulate matter (PM2.5) on semen quality in Taiwanese men from the general population.MethodsA cross-sectional study was conducted among 6475 male participants aged 15–49 years who participated in a standard medical examination programme in Taiwan between 2001 and 2014. Semen quality was assessed according to the WHO 1999 guidelines, including sperm concentration, total motility, progressive motility and morphology. Three-month and 2-year average PM2.5concentrations were estimated at each participant’s address using a spatiotemporal model based on satellite-derived aerosol optical depth data. Multivariable linear and logistic regressions were used to examine the associations between PM2.5and semen quality.ResultsA robust association was observed between exposure to PM2.5and decreased normal morphology. Every increment of 5 µg/m3in 2-year average PM2.5was significantly associated with a decrease of 1.29% in sperm normal morphology and a 26% increased risk of having the bottom 10% of sperm normal morphology, after adjusting for a wide range of potential confounders (p<0.001). On the other hand, an increment of 5 µg/m3in 2-year average PM2.5was associated with an increase of 1.03×106/mL in sperm concentration and a 10% decreased risk of being the bottom 10% of sperm concentration (both p<0.001). Similar results were found for 3-month PM2.5.ConclusionsExposure to ambient PM2.5air pollution is associated with a lower level of sperm normal morphology and a higher level of sperm concentration.
Occupational exposure to asbestos and risk of cholangiocarcinoma: a population-based case–control study in four Nordic countries
Authors: Farioli Andrea , Straif Kurt , Brandi Giovanni , Curti Stefania , Kjaerheim Kristina , Martinsen Jan Ivar , Sparen Pär , Tryggvadottir Laufey , Weiderpass Elisabete , Biasco Guido , Violante Francesco Saverio , Mattioli Stefano , Pukkala Eero 
Published: November 2017

ObjectivesTo assess the association between occupational exposure to asbestos and the risk of cholangiocarcinoma (CC).MethodsWe conducted a case–control study nested in the Nordic Occupational Cancer (NOCCA) cohort. We studied 1458 intrahepatic CC (ICC) and 3972 extrahepatic CC (ECC) cases occurring among subjects born in 1920 or later in Finland, Iceland, Norway and Sweden. Each case was individually matched by birth year, gender and country to five population controls. The cumulative exposure to asbestos (measured in fibres (f)/ml × years) was assessed by applying the NOCCA job-exposure matrix to data on occupations collected during national population censuses (conducted in 1960, 1970, 1980/81 and 1990). Odds ratios (OR) and 95% CI were estimated using conditional logistic regression models adjusted by printing industry work.ResultsWe observed an increasing risk of ICC with cumulative exposure to asbestos: never exposed, OR 1.0 (reference category); 0.1–4.9 f/mL × years, OR 1.1 (95% CI 0.9 to 1.3); 5.0–9.9 f/mL × years, OR 1.3 (95% CI 0.9 to 2.1); 10.0–14.9 f/mL × years, OR 1.6 (95% CI 1.0 to 2.5); ≥15.0 f/mL × years, OR 1.7 (95% CI 1.1 to 2.6). We did not observe an association between cumulative asbestos exposure and ECC.ConclusionsOur study provides evidence that exposure to asbestos might be a risk factor for ICC. Our findings also suggest that the association between ECC and asbestos is null or weaker than that observed for ICC. Further studies based on large industrial cohorts of asbestos workers and possibly accounting for personal characteristics and clinical history are needed.
Information provided by diagnostic and screening tests: improving probabilities
Authors: Weatherall Mark 
Published: November 2017

AbstractUncertainty in clinical encounters is inevitable and despite this uncertainty clinicians must still work with patients to make diagnostic and treatment decisions. Explicit diagnostic reasoning based on probabilities will optimise information in relation to uncertainty. In clinical diagnostic encounters, there is often pre-existing information that reflects the probability any particular patient has a disease. Diagnostic testing provides extra information that refines diagnostic probabilities. However, in general diagnostic tests will be positive in most, but not all cases of disease (sensitivity) and may not be negative in all cases of disease absence (specificity). Bayes rule is an arithmetic method of using diagnostic testing information to refine diagnostic probabilities. In this method, when probabilities are converted to odds, multiplication of the odds of disease before diagnostic testing, by the positive likelihood ratio (LR+), the sensitivity of a test divided by 1 minus the specificity refines the probability of a particular diagnosis. Similar arithmetic applies to the probability of not having a disease, where the negative likelihood ratio is the specificity divided by 1 minus the sensitivity. A useful diagnostic test is one where the LR+ is greater than 5–10. This can be clarified by creating a contingency table for hypothetical groups of patients in relation to true disease prevalence and test performance predicted by sensitivity and specificity. Most screening tests in populations with a low prevalence of disease have a very high ratio of false positive results to true positive results, which can also be illustrated by contingency tables.
Efficacy and safety outcomes of recanalisation procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis
Authors: Jimenez David , Martin-Saborido Carlos , Muriel Alfonso , Zamora Javier , Morillo Raquel , Barrios Deisy , Klok Frederikus A , Huisman Menno V , Tapson Victor , Yusen Roger D 
Published: November 2017

BackgroundWe aimed to review the efficacy and safety of recanalisation procedures for the treatment of PE.MethodsWe searched PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through 31 July 2015 and included randomised clinical trials that compared the effect of a recanalisation procedure versus each other or anticoagulant therapy in patients diagnosed with PE. We used network meta-analysis and multivariate random-effects meta-regression to estimate pooled differences between each intervention and meta-regression to assess the association between trial characteristics and the reported effects of recanalisation procedures versus anticoagulation.ResultsFor all-cause mortality, there were no significant differences in event rates between any of the recanalisation procedures and anticoagulant treatment (full-dose thrombolysis: OR 0.60; 95% CI0.36 to 1.01; low-dose thrombolysis: 0.47; 95% CI 0.14 to 1.59; and catheter-associated thrombolysis: 0.31; 95% CI 0.01 to 7.96). Full-dose thrombolysis increased the risk of major bleeding (2.00; 95% CI 1.06 to 3.78) compared with anticoagulation. Catheter-directed thrombolysis was associated with the lowest probability of dying (surface under the cumulative ranking curve (SUCRA), 0.67), followed by low-dose thrombolysis (SUCRA, 0.66) and full-dose thrombolysis (SUCRA, 0.55). Similarly, low-dose thrombolysis was associated with the lowest probability of major bleeding (SUCRA, 0.61), followed by catheter-directed thrombolysis (SUCRA, 0.54) and full-dose thrombolysis (SUCRA, 0.17). The results were similar in sensitivity analyses based on restricting only to studies in haemodynamically stable patients with PE.ConclusionsIn the treatment of PE, recanalisation procedures do not seem to offer a clear advantage compared with standard anticoagulation. Low-dose thrombolysis was associated with the lowest probability of dying and bleeding.Trial registration numberPROSPERO CRD42015024670.
Intracranial Internal Carotid Artery Wall Calcification in Ischemic Strokes Treated with Thrombolysis
Authors: Tábuas-Pereira Miguel , Sargento-Freitas João , Silva Fernando , Parra Joana , Mendes Patrícia , Seara Vera , Mesquita Miguel , Baptista Mariana , Cordeiro Gustavo , Cunha Luis 
Published: November 2017

<b><i>Background:</i></b> Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications. <b><i>Objectives:</i></b> To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death. <b><i>Methods:</i></b> We included 396 consecutive ischemic stroke patients submitted to recombinant tissue plasminogen activator treatment between January 2011 and September 2014. Admission CT-scans were reviewed to calculate the Total Carotid Syphon Calcification score. Patients were followed for up to at least 6 months post-stroke or until death. Outcome measures included evaluation of recanalization on the first 24 h (transcranial color coded Doppler or angio-CT), sICH, and assessment of functional outcome at 3 months after stroke (using modified Rankin scale). <b><i>Results:</i></b> Carotid artery wall calcification did not predict sICH, recanalization or any good outcome. However, it was a statistically significant predictor of death (OR 1.102, 95% CI [1.004–1.211], <i>p</i> = 0.042). <b><i>Discussion:</i></b> Intracranial carotid artery calcification does not increase the risk of thrombolysis-induced sICH. Patients with higher grade of carotid artery wall calcification may have a higher mortality rate.
Dizziness and the Acute Vestibular Syndrome at the Emergency Department: A Population-Based Descriptive Study
Authors: Ljunggren Micaela , Persson Julia , Salzer Jonatan 
Published: November 2017

<b><i>Background:</i></b> Dizziness is a common occurrence witnessed at emergency departments (EDs). This study aims to describe the epidemiology and management of dizzy patients with and without an acute vestibular syndrome (AVS) in the ED at Umeå University Hospital. <b><i>Methods:</i></b> A total of <i>n</i> = 2,126 ED dizziness visits during 3 years were identified. Data were obtained through retrospective review of medical records. Cases were stratified based on presentation, including AVS and neurological deficits. The outcomes analyzed included cerebrovascular causes of dizziness. A Poisson distribution was assumed when calculating incidence CIs. <b><i>Results:</i></b> Dizziness accounted for 2.1% of all ED visits, incidence 477/100,000 inhabitants (95% CI 457–498). Among dizzy patients, 19.2% had an AVS, incidence 92/100,000 inhabitants (95% CI 74–113). Top medical diagnostic groups were otovestibular (15.1%), cardiovascular (8.7%) and neurological diseases (7.7%), including stroke and transitory ischemic attack (4.8%). Cerebrovascular causes of dizziness were more common among those with an AVS (10.0%) vs. those without (3.6%), <i>p</i> &#x3c; 0.01. <b><i>Conclusion:</i></b> The risk for cerebrovascular causes of dizziness, although low in an unselected cohort, increases with the presence of neurological signs and an AVS. These population-based data may be useful when planning and implementing dizziness and AVS management algorithms at EDs.
Two new cryptic species of Artemia (Branchiopoda, Anostraca) from Mongolia and the possibility of invasion and disturbance by the aquaculture industry in East Asia
Authors: Naganawa Hidetoshi , Mura Graziella 
Published: November 2017

Among each of the two different bisexual clades of the brine shrimp Artemia in Asia, at least two cryptic species of Artemia (one in each clade) were found in Mongolia in the present study. As in other, similar cases, once the discreteness of such units at species level is known, meticulous observations using light microscopy will reveal distinguishable morphological differences with other congeners, slight as those features may be. In such classifications, the emphasis usually lies on structures of the copulatory organs, as the small differences present in most cases are best expressed in those organs that primarily ensure the species’ reproductive isolation. Since physical differences in the reproductive organs will tend to (partly) obstruct effective mating, it may be presumed this is likely to result in (some degree of) reproductive isolation, the prime criterion for recognizing biological species.
Two cryptic species from Mongolia are described herein, and our results also showed for one of them an extremely rapid individual growth and very early maturity: in fact it makes the most extreme r-strategist documented, at least, as far as we know. One of the consequences of this observation could be, that where such Artemia cysts (i.e., resting eggs) are used as inoculations in aquaculture activities, these should be monitored closely and, as required, be subjected to adequate, perhaps more stringent regulations. The present authors are not aquaculture scientists but researchers of the genus Artemia, so for us, inoculation under natural conditions in the field is our direct concern. We report a highly reproductive Artemia species as new to science, but at the same time, we worry that this new species could escape from the aquaculture industry into the natural environment. This is because in this type of aquaculture no isolated basins are used but only incompletely separated, i.e., only partially screened off, parts of natural water bodies. Artemia franciscana Kellogg, 1906, as well as parthenogenetic populations of Artemia could be disturbed by escapees of that extremely prolific new species.