bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding the epidemiology of avoidable significant harm in primary care: protocol for a retrospective cross-sectional study
Authors: Bell Brian G , Campbell Stephen , Carson-Stevens Andrew , Evans Huw Prosser , Cooper Alison , Sheehan Christina , Rodgers Sarah , Johnson Christine , Edwards Adrian , Armstrong Sarah , Mehta Rajnikant , Chuter Antony , Donnelly Ailsa , Ashcroft Darren M , Lymn Joanne , Smith Pam , Sheikh Aziz , Boyd Matthew , Avery Anthony J 
Published: February 2017

IntroductionMost patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients.Methods and analysisWe will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to 16 general practices from 3 areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100 000 patients. Our investigations will include an ‘enhanced sample’ of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as ‘per 100 000 patients per year’. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm.Ethics/DisseminationThe decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included, we will follow these instructions. We will produce a report for the Department of Health's Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act 2006 (reference 15/CAG/0182).
Women's experiences with cervical cancer screening in a colposcopy referral clinic in Cape Town, South Africa: a qualitative analysis
Authors: Momberg Mariette , Botha Matthys H , Van der Merwe Frederick H , Moodley Jennifer 
Published: February 2017

ObjectiveThe aim of this study was to explore and understand women's experience with cervical cancer screening and with the referral pathways for abnormal Papanicolau (Pap) smears.Design and settingFocus group discussions were conducted with first time colposcopy clinic attendees at a tertiary hospital colposcopy clinic in Cape Town, South Africa during November 2014. A thematic analysis was conducted to identify key themes. Initial coding categories were drawn from the interview guide.Participants27 women participated in 4 focus group discussions.ResultsParticipants mean age was 34 years, most did not complete secondary level education and were unemployed. Negative community opinions relating to Pap smears and colposcopy referral might deter women from seeking treatment. Having a gynaecological symptom was the most commonly cited reason for having a Pap smear. Fear of having a HIV test performed at the same time as Pap smear and low encouragement from peers, were factors identified as potential access barriers. Participants commented on insufficient or lack of information from primary providers on referral to the colposcopy clinic and concerns and apprehension during waiting periods between receiving results and the colposcopy appointment were discussed.ConclusionsThere is a strong and urgent need to improve current knowledge about cervical cancer and Pap smears and the necessity and benefits of timely access to screening programmes, results and treatment. Strategies such as community health education programmes and mass media interventions could be employed to disseminate cervical cancer information and address negative community perceptions. Better training and support mechanisms to equip healthcare providers with the skills to convey cervical cancer information to women are needed. The use of short message service (SMS) to deliver Pap smear results and provide patients with more information should be considered to improve waiting times for results and alleviate apprehension during waiting periods.
Efficacy and safety of super selective bronchial artery coil embolisation for haemoptysis: a single-centre retrospective observational study
Authors: Ishikawa Hideo , Hara Masahiko , Ryuge Misaki , Takafuji Jun , Youmoto Mihoko , Akira Masanori , Nagasaka Yukio , Kabata Daijiro , Yamamoto Kouji , Shintani Ayumi 
Published: February 2017

ObjectivesEvidence on the safety and long-term efficacy of super selective bronchial artery embolisation (ssBAE) using platinum coils in patients with haemoptysis is insufficient. The objective of the present study was to evaluate the safety and the 3-year postprocedure haemoptysis-free survival rate of de novo elective ssBAE using platinum coils rather than particles for the treatment of haemoptysis.DesignA single-centre retrospective observational study.SettingHemoptysis and Pulmonary Circulation Center in Japan.ParticipantsA total of 489 consecutive patients with massive and non-massive haemoptysis who underwent de novo elective ssBAE without malignancy or haemodialysis.InterventionsssBAE using platinum coils. All patients underwent CT angiography before the procedure for identifying haemoptysis-related arteries (HRAs) and for procedural planning.Primary and secondary outcome measuresThe composite of the 3-year recurrence of haemoptysis and mortality from the day of the last ssBAE session. Each component of the primary end point and procedural success defined as successful embolisation of all target HRAs were also evaluated.ResultsThe median patient age was 69 years, and 46.4% were men. The total number of target vessels was 4 (quartile 2–7), and the procedural success rate was 93.4%. There were 8 (1.6%) major complications: 1 aortic dissection, 2 symptomatic cerebellar infarctions and 5 mediastinal haematoma cases. The haemoptysis-free survival rates were estimated by the Kaplan-Meier analysis at 86.9% (95% CI 83.7% to 90.2%) at 1 year, 79.4% (74.8% to 84.3%) at 2 years and 57.6% (45.1% to 73.4%) at 3 years. Although not statistically significant by the adjusted analysis of variance with multiple imputation of missing variables, cryptogenic haemoptysis tended to show the most favourable outcome and non-tuberculous mycobacterium showed the worst outcome (adjusted p=0.250).ConclusionsWe demonstrated the safety and long-term efficacy of elective ssBAE using platinum coils and established that it can be a valuable therapeutic option for treating patients with haemoptysis.
Costs of Family Caregiving in Palliative Care (COFAC) questionnaire: development and piloting of a new survey tool
Authors: Gardiner Clare , McDermott Chris , Hulme Claire 
Published: February 2017

BackgroundFamily caregivers play an important role in the care of patients receiving palliative care, yet little is known about the financial impact of family caregiving in this context. A lack of existing validated tools for collecting data on the costs of family caregiving in palliative care has resulted in a weak and limited evidence base. The aim of the study was to describe the development and initial piloting of a new survey tool which captures data on the costs of family caregiving in palliative care: the Costs of Family Caregiving (COFAC) questionnaire.MethodsDevelopment and piloting of the COFAC questionnaire involved 2 phases: (1) questionnaire development based on published evidence and cognitive interviews with service users; and (2) validity testing involving expert review and piloting with bereaved caregivers.ResultsQuestionnaire content was generated from previously published research and related to work-related costs, carer time costs and out-of-pocket expenses. 2 group cognitive interviews with 15 service users refined content of the draft questionnaire. Face validity was established through expert review with 9 academics and clinicians. Piloting with 8 bereaved caregivers established acceptability and feasibility of administration.ConclusionsThe COFAC tool has been shown to be valid, acceptable to bereaved caregivers and feasible to administer. The COFAC questionnaire is recommended for economic research in palliative care which seeks to capture data from a broad societal perspective which includes family caregiver costs.
Gut microbial profile is altered in primary biliary cholangitis and partially restored after UDCA therapy
Authors: Tang Ruqi , Wei Yiran , Li Yanmei , Chen Weihua , Chen Haoyan , Wang Qixia , Yang Fan , Miao Qi , Xiao Xiao , Zhang Haiyan , Lian Min , Jiang Xiang , Zhang Jun , Cao Qin , Fan Zhuping , Wu Maoying , Qiu Dekai , Fang Jing-Yuan , Ansari Aftab , Gershwin M Eric , Ma Xiong 
Published: February 2017

ObjectiveA close relationship between gut microbiota and some chronic liver disorders has recently been described. Herein, we systematically performed a comparative analysis of the gut microbiome in primary biliary cholangitis (PBC) and healthy controls.DesignWe first conducted a cross-sectional study of 60 ursodeoxycholic acid (UDCA) treatment-naïve patients with PBC and 80 matched healthy controls. Second, an independent cohort composed of 19 treatment-naïve patients and 34 controls was used to validate the results. Finally, a prospective study was performed in a subgroup of 37 patients with PBC who underwent analysis before and after 6 months of UDCA treatment. Faecal samples were collected, and microbiomes were analysed by 16S ribosomal RNA gene sequencing.ResultsA significant reduction of within-individual microbial diversity was noted in PBC (p=0.03). A signature defined by decreased abundance of four genera and increased abundance of eight genera strongly correlated with PBC (area under curve=0.86, 0.84 in exploration and validation data, respectively). Notably, the abundance of six PBC-associated genera was reversed after 6 months of UDCA treatment. In particular, Faecalibacterium, enriched in controls, was further decreased in gp210-positive than gp210-negative patients (p=0.002). Of interest was the finding that the increased capacity for the inferred pathway, bacterial invasion of epithelial cells in PBC, highly correlated with the abundance of bacteria belonging to Enterobacteriaceae.ConclusionsThis study presents a comprehensive landscape of gut microbiota in PBC. Dysbiosis was found in the gut microbiome in PBC and partially relieved by UDCA. Our study suggests that gut microbiota is a potential therapeutic target and diagnostic biomarker for PBC.
Effects of dabigatran according to age in atrial fibrillation
Authors: Lauw Mandy N , Eikelboom John W , Coppens Michiel , Wallentin Lars , Yusuf Salim , Ezekowitz Michael , Oldgren Jonas , Nakamya Juliet , Wang Jia , Connolly Stuart J 
Published: February 2017

ObjectiveThe prevalence of atrial fibrillation (AF) and the risk of stroke and bleeding vary according to age. To estimate effects of dabigatran, compared with warfarin, on stroke, bleeding and mortality in patients with AF in the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial according to age, we analysed treatment effects using age as a continuous variable and using age categories.MethodsRE-LY included 10 855 (59.9%) patients aged <75 years, 4231 patients (23.4%) aged 75–79 years, 2305 (12.7%) aged 80–84 years and 722 (4.0%) aged ≥85 years at baseline.ResultsBenefits of dabigatran versus warfarin regarding stroke (HR range 0.63 (95% CI 0.46 to 0.86) to 0.70 (0.31 to 1.57) for dabigatran 150 mg twice daily), HR range 0.52 (0.21 to 1.29) to 1.08 (0.73 to 1.60) for dabigatran 110 mg twice daily) and intracranial bleeding were maintained across all age groups (interaction p values all not significant). There was a highly significant interaction (p value interaction <0.001) between age and treatment for extracranial major bleeding, with lower rates with both doses of dabigatran compared with warfarin in younger patients (HR 0.78 (0.62 to 0.97) for 150 mg twice daily, HR 0.72 (0.57 to 0.90) for 110 mg twice daily) but similar (HR 1.50 (1.03 to 2.18) for 110 mg twice daily) or higher rates (HR 1.68 (1.18 to 2.41) for 150 mg twice daily) in older patients (≥80 years).ConclusionEffects of dabigatran compared with warfarin on stroke prevention and intracranial bleeding are consistent across all age groups. Effects of dabigatran on extracranial major bleeding are age dependent, supporting selection of dabigatran 110 mg twice daily for elderly patients (age ≥80 years).Trial registration numberClinical trial registration number: https://clinicaltrials.govNCT00262600.
Primary care requests for anaemia chemistry tests in Spain: potential iron, transferrin and folate over-requesting
Authors: Salinas Maria , López-Garrigós Maite , Flores Emilio , Leiva-Salinas Carlos 
Published: February 2017

AimTo study the regional variability of requests for anaemia chemistry tests in primary care in Spain and the associated economic costs of potential over-requesting.MethodsRequests for anaemia tests were examined in a cross-sectional study. Clinical laboratories from different autonomous communities (AACCs) were invited to report on primary care anaemia chemistry tests requested during 2014. Demand for iron, ferritin, vitamin B12 and folate tests per 1000 inhabitants and the ratios of the folate/vitamin B12 and transferrin/ferritin requests were compared between AACCs. We also calculated reagent costs and the number of iron, transferrin and folate tests and the economic saving if every AACC had obtained the results achieved by the AACC with best practice.Results110 laboratories participated (59.8% of the Spanish population). More than 12 million tests were requested, resulting in reagent costs exceeding €16.5 million. The serum iron test was the most often requested, and the ferritin test was the most costly (over €7 million). Close to €4.5 million could potentially have been saved if iron, transferrin and folate had been appropriately requested (€6 million when extrapolated to the whole Spanish population).ConclusionsThe demand for and expenditure on anaemia chemistry tests in primary care in Spain is high, with significant regional differences between different AACCs.
Effectiveness of Acarbose in Treating Elderly Patients with Diabetes with Postprandial Hypotension
Authors: Zhang Jie , Guo Lixin 
Published: February 2017

Postprandial hypotension (PPH) is a common condition that occurs primarily in elderly patients with type 2 diabetes mellitus (T2DM). This study aimed to assess the effectiveness of acarbose for PPH; it also investigated possible mechanisms behind PPH development. This single-blind, randomized controlled trial included 91 elderly patients with T2DM, aged between 60 and 80 years, who were inpatients at Beijing Hospital between March 2012 and November 2014. The patients were included into one of three groups: Group A, patients with T2DM without PPH; Group B, patients with T2DM with PPH receiving placebo; and Group C, patients with T2DM with PPH receiving acarbose. After an overnight fast, patients received a single dose of acarbose (100 mg) or placebo and then consumed a standardized 450 kcal meal. Blood pressure, glucose levels, heart rate (HR), and catecholamine levels were evaluated. Acarbose ameliorated PPH as determined by significant improvements in the duration and maximal fall in blood pressure (both p<0.001); however, no differences in HR and blood glucose levels were observed. In patients with PPH, blood pressure was correlated with blood glucose and HR variability values (p<0.05). Correlations between epinephrine and glucagon-like peptide-1 with blood pressure in groups A and C were largely lost in group B. Acarbose reduced postprandial blood pressure fluctuations in elderly patients with diabetes. PPH may be related to impaired autonomic nervous system function, reduced catecholamine secretion, and postprandial fluctuations in blood glucose levels. Trial registration number Chinese Clinical Trial Registry ChiCTR-IPR-15006177.
Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials
Authors: Boulouis Gregoire , Morotti Andrea , Goldstein Joshua N , Charidimou Andreas 
Published: February 2017

IntroductionIt is unclear whether intensive lowering of blood pressure (BP) at the acute phase of intracerebral haemorrhage (ICH) is beneficial. We performed a meta-analysis of randomised controlled trials (RCTs) to assess whether intensive BP lowering in patients with acute ICH is safe and effective in improving clinical outcomes.MethodsWe searched PubMed, EMBASE and the Cochrane databases for relevant RCTs and calculated pooled OR for 3-month mortality (safety outcome) and 3-month death or dependency (modified Rankin Scale (mRs) ≥3;efficacy outcome), in patients with acute ICH randomised to either intensive BP-lowering or standard BP-lowering treatment protocols. We also investigated the association between treatment arm and ICH expansion at 24 hours. Random effects models with DerSimonian-Laird weights were used.ResultsFive eligible studies including 4360 patients with acute ICH were pooled in meta-analysis. The risk of 3-month mortality was similar between patients randomised to intensive BP-lowering treatment and standard BP-lowering treatment (OR: 0.99; 95% CI: 0.82 to 1.20, p=0.909). Intensive BP-lowering treatment showed a (non-significant) trend for an association with lower 3-month death or dependency risk compared with standard treatment (OR: 0.91; 95% CI: 0.80 to 1.02), p=0.106). Intensive BP reduction was associated with a trend for lower risk of significant ICH expansion compared with standard treatment (OR: 0.82; 95% CI: 0.68 to 1.00, p=0.056), especially in larger RCTs.ConclusionsFor patients with acute ICH similar to those included in RCTs and without contraindication to acute BP treatment, intensive acute BP lowering is safe, but does not seem to provide an incremental clinical benefit in terms of functional outcomes. The effect of intensive BP lowering on significant haematoma expansion at 24 hours warrants further investigation.
Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a systematic review
Authors: Ilyas Adeel , Chen Ching-Jen , Raper Daniel M , Ding Dale , Buell Thomas , Mastorakos Panogiotis , Liu Kenneth C 
Published: February 2017

BackgroundCerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that, when severe, can be a therapeutic challenge. Endovascular mechanical thrombectomy (EMT) techniques have significantly evolved over the past decade, but data regarding the efficacy and safety of EMT for CVST are poorly defined.ObjectiveTo summarize the large number of case series on this relatively rare condition and establish trends in the outcomes of EMT for CVST.MethodsA literature review was performed using PubMed and Medline to identify reports of three or more patients with CVST treated with EMT. Baseline and outcomes data, including radiographic resolution, neurological outcome, recurrence, and treatment-related complications, were extracted for analysis.ResultsA total of 17 studies comprising 235 patients treated with EMT were included for analysis. Based on pooled data, 40.2% of patients presented with encephalopathy or coma. Concurrent endovascular thrombolysis was employed in 87.6% of patients. Complete radiographic resolution of CVST was achieved in 69.0% of patients. At follow-up (range 0.5–3.5 years), 34.7% of patients were neurologically intact and the mortality rate was 14.3%. CVST recurrence was evident in 1.2%. Worsening or new intracranial hemorrhage (ICH) occurred in 8.7% of cases. ORs of good outcome (modified Rankin Scale score 0–2) and development of ICH with sole EMT versus concurrent thrombolytic therapy were 1.51 (95% CI 0.29 to 8.15, p=0.61) and 1.15 (95% CI 0.12 to 10.80, p=0.90), respectively.ConclusionsEMT is an effective salvage therapy for refractory CVST, with a reasonable safety profile. Chemical thrombolysis, in conjunction with EMT, did not appear to result in additional harm or benefit. Further analysis is warranted to determine predictors of success after EMT for CVST.
Inferring the properties of the pterosaur wing membrane
Authors: Palmer Colin 
Published: February 2017

Abstract
The preservation of the wing membrane of pterosaurs is very poor and the available fossil evidence does not allow its properties to be reconstructed. In contrast, the fossil record for the wing bones is relatively good and the advent of CT scanning has made it possible to build high-fidelity structural models of the wing spar. The bending strength of the wing spar of a 6 m wingspan ornithocheirid pterosaur is used to infer the likely membrane tension. The tensions required to suppress aeroelastic flutter and to minimize ballooning of the membrane under flight loads are also estimated. All three estimates are of similar magnitude and imply that the membrane must have contained high-modulus material, supporting the view that the reinforcing aktinofibrils were keratinous.
A novel method of standardized myocardial infarction in aged rabbits
Authors: Morrissey Patrick J. , Murphy Kevin R. , Daley Jean M. , Schofield Lorraine , Turan Nilufer N. , Arunachalam Karuppiah , Abbott J. Dawn , Koren Gideon 
Published: February 2017

The incidence of both myocardial infarction (MI) and sudden cardiac death increases with age. Here, we describe the development of a minimally invasive large animal model of MI that can be applied to young or aged animals. We demonstrate that rabbit coronary anatomy is highly variable, more so than described in previous literature. In this work, we categorize the coronary pattern of 37 young rabbits and 64 aged rabbits. Aged rabbits had a higher degree of branching from the left main coronary artery. Standardizing the model across age cohorts required a new approach, targeting an area of myocardium rather than a specific vessel. Here, we present a method for achieving a reproducible infarct size, one that yielded a consistent scar encompassing ~30% of the apical left ventricular free wall. The model’s consistency allowed for more valid comparisons of MI sequelae between age cohorts.NEW & NOTEWORTHY This study describes the coronary angiographic imaging of young and aged rabbits. We developed and improved a novel minimally invasive approach for coil embolization that targets a specific area of myocardium and yielded a consistent scar encompassing ~30% of the left ventricular free wall of young and aged rabbit hearts.