bluuebunny/crossref_metadata_2025_split huggingface dataset:
Silent uterine rupture in scarred uterus
Authors: Langhe Ream , Shah Umme Farwa , Alfathil Attia , Gannon Michael 
Published: March 2017

Uterine rupture in pregnancy is a rare and catastrophic complication with a high incidence of fetal and maternal morbidity. Very few cases have been reported in the literature.Case presentationA 28-year-old fifth gravid woman with a history of one caesarean section presented to our department at 39 weeks and 6 days gestation with complaints of headache, epigastric pain and nausea. Her blood pressure was elevated and there was proteinuria. Emergency caesarean section was performed in view of symptoms. Uterine rupture was found during the surgery. A live male infant was delivered in good condition. Postnatal recovery was unremarkable and the woman discharged on postoperative day 5.ConclusionRupture of the uterus can present in third trimester even before labour with minimal or no symptoms.
Role of depression in diabetes management in an ethnic minority population: a case of Korean Americans with type 2 diabetes
Authors: Kim Miyong To , Kim Kim Byeng , Ko Jisook , Jang Yuri , Levine David , Lee Hochang Benjamin 
Published: March 2017

BackgroundComorbid depression and diabetes mellitus (DM) compound challenges to disease management such as low health literacy, insufficient access to care, and social or linguistic isolation. Korean Americans (KAs), predominantly first-generation immigrants, suffer from a high prevalence of type 2 DM and depression. Limited research on KAs has prevented the development of effective interventions.ObjectivesTo compare the prevalence of depression in KAs with DM and all Americans with/without DM, and to explore correlates of comorbid DM and depression and strategies to address KAs' DM and depression.MethodsKAs' data were from a clinical trial of a community-based self-help intervention to improve KAs' DM and mental health outcomes. National Health and Nutrition Examination Survey data sets enabled comparison. Clinical indicators included hemoglobin A1C, lipid panel, and body mass index. Psychobehavioral indicators included self-efficacy for DM management, quality of life, and depression (Patient Health Questionnaire-9 (PHQ-9)).ResultsMore KAs with DM had depression (44.2%) than did all Americans with DM (28.7%) or without DM (20.1%). Significantly more KAs with DM had mild (29.3%) or clinical (14.9%) depression than did Americans with DM (mild, 17.2%; clinical, 11.5%) or without (mild, 13.8%; clinical, 6.3%). One of six KAs with DM (16.9%) thought of suicide or self-harm (Americans with/without =5.0%, 2.8%). The self-help intervention reduced the mean PHQ-9 from 5.4 at baseline to 4.1 at 12 months.LimitationsExternal validity might be limited; KAs' data were from one study site.ConclusionsThe prevalence of depression and DM among KAs warrants the development of efficacious interventions.Trial registration numberNCT01264796.
Modelling the health and economic impacts of the elimination of river blindness (onchocerciasis) in Africa
Authors: Kim Young Eun , Stolk Wilma A , Tanner Marcel , Tediosi Fabrizio 
Published: March 2017

BackgroundOnchocerciasis (river blindness) is endemic mostly in remote and rural areas in sub-Saharan Africa. The treatment goal for onchocerciasis has shifted from control to elimination in Africa. For investment decisions, national and global policymakers need evidence on benefits, costs and risks of elimination initiatives.MethodsWe estimated the health benefits using a dynamical transmission model, and the needs for health workforce and outpatient services for elimination strategies in comparison to a control mode. We then estimated the associated costs to both health systems and households and the potential economic impacts in terms of income gains.ResultsThe elimination of onchocerciasis in Africa would avert 4.3 million–5.6 million disability-adjusted life years over 2013–2045 when compared with staying in the control mode, and also reduce the required number of community volunteers by 45–53% and community health workers by 56–60%. The elimination of onchocerciasis in Africa when compared with the control mode is predicted to save outpatient service costs by $37.2 million–$39.9 million and out-of-pocket payments by $25.5 million–$26.9 million over 2013–2045, and generate economic benefits up to $5.9 billion–$6.4 billion in terms of income gains.DiscussionThe elimination of onchocerciasis in Africa would lead to substantial health and economic benefits, reducing the needs for health workforce and outpatient services. To realise these benefits, the support and collaboration of community, national and global policymakers would be needed to sustain the elimination strategies.
Extracardiac approach to functional mitral regurgitation: a cost-effective approach to addressing heart failure
Authors: Padmanabhan Chandrashekar , Jagannathan Raghavan , Talluri Krishna , Raman Jaishankar 
Published: March 2017

BackgroundHeart failure is frequently associated with severely impaired ventricular function and manifests often with functional mitral regurgitation (FMR). This is a complex syndrome that is primarily due to abnormal function of the ventricular muscle in the presence of normal mitral leaflets and annulus. Present surgical treatment options approach the problem through mitral valve annulus and leaflets, rather than ventricular muscle. We developed a concept that provides a ventricular solution to this problem.MethodsAfter early proof-of-concept studies with polyester mesh, the BACE (Basal Annuloplasty of the Cardia Externally) device was developed along these lines—an adjustable silicone band that is implanted by means of slim polyester belt loops, and secured at the base of the heart. This device can be adjusted remotely under echocardiographic guidance, by inflating the inbuilt balloons that are connected to subcutaneous ports. Initial evaluation in animals showed long-term device safety. Safety and efficacy studies were performed in patients at 4 centres in India. They all underwent coronary artery bypass graft and implantation of the BACE device to correct mitral regurgitation (MR) on a beating heart.ResultsThe animal evaluation included 2 components—a group of animals with severe FMR induced by rapid ventricular pacing with long-term implants to establish safety and efficacy and a group of normal animals implanted in a GLP laboratory to ensure device safety for regulatory purposes. The patient population included 11 patients, with a mean age of 58. The mean presurgical left ventricular ejection fraction was 31.8%. The mean MR grade (3.3±0.6) improved to 0.6±0.5 post-BACE implantation (p<0.05). The mean number of bypass grafts was 2.5. The effective improvement in MR was sustained at 6 months in the patients that had completed that duration of the study. All patients were followed up after surgery clinically and echocardiographically. Heart failure symptoms were reduced in all surviving patients with all of them being in NYHA Class I or II at 1-year follow-up.ConclusionsEpicardial application and adjustment of the BACE device can be performed safely on a beating heart with effective reduction in FMR and sustained benefit in preventing heart failure progression. This early clinical trial shows encouraging results with this approach. This is the first epicardial device for treatment of FMR that can be remotely adjusted. This capability suggests that correction of MR under echocardiograph guidance is feasible.
American football and other sports injuries may cause migraine/persistent pain decades later and can be treated successfully with electrical twitch-obtaining intramuscular stimulation (ETOIMS)
Authors: Chu J , McNally S , Bruyninckx F , Neuhauser D 
Published: March 2017

IntroductionAutonomous twitch elicitation at myofascial trigger points from spondylotic radiculopathies-induced denervation supersensitivity can provide favourable pain relief using electrical twitch-obtaining intramuscular stimulation (ETOIMS).AimTo provide objective evidence that ETOIMS is safe and efficacious in migraine and persistent pain management due to decades-old injuries to head and spine from paediatric American football.Methods and materialsAn 83-year-old mildly hypertensive patient with 25-year history of refractory migraine and persistent pain self-selected to regularly receive fee-for-service ETOIMS 2/week over 20 months. He had 180 sessions of ETOIMS. Pain levels, blood pressure (BP) and heart rate/pulse were recorded before and immediately after each treatment alongside highest level of clinically elicitable twitch forces/session, session duration and intervals between treatments. Twitch force grades recorded were from 1 to 5, grade 5 twitch force being strongest.ResultsInitially, there was hypersensitivity to electrical stimulation with low stimulus parameters (500 µs pulse-width, 30 mA stimulus intensity, frequency 1.3 Hz). This resolved with gradual stimulus increments as tolerated during successive treatments. By treatment 27, autonomous twitches were noted. Spearman's correlation coefficients showed that pain levels are negatively related to twitch force, number of treatments, treatment session duration and directly related to BP and heart rate/pulse. Treatment numbers and session durations directly influence twitch force. At end of study, headaches and quality of life improved, hypertension resolved and antihypertensive medication had been discontinued.ConclusionsUsing statistical process control methodology in an individual patient, we showed long-term safety and effectiveness of ETOIMS in simultaneous diagnosis, treatment, prognosis and prevention of migraine and persistent pain in real time obviating necessity for randomised controlled studies.
Defining patient centricity with patients for patients and caregivers: a collaborative endeavour
Authors: Yeoman Guy , Furlong Patricia , Seres Michael , Binder Helena , Chung Helena , Garzya Vincenzo , Jones Rachel RM 
Published: March 2017

BackgroundPatient engagement is an essential aspect in the research/development of biopharmaceutical products and disease management. Improving the lives of patients requires a deep understanding of their medical conditions, experiences, needs and priorities. However, a consistent definition of patient centricity is lacking. A series of initiatives was conducted to define patient centricity and its important principles impacting the biopharmaceutical industry.MethodsInterviews, questionnaires and literature reviews were conducted involving key stakeholders to initially identify issues of importance to patients, healthcare providers and payers. Subsequently, two identical workshops which included 22 patients/carers created a definition of patient centricity and the healthcare values important to patients/caregivers. Outputs were tested in a validation exercise involving patients in predominantly US (n=470) and European (n=703) patient forums.ResultsInitial research provided deeper understanding of patient needs and key topics of interest that were used to cocreate a definition of patient centricity and 10 associated principles of importance to the biopharmaceutical industry. Wider testing of these outputs among predominantly US/European patient communities confirmed their validity. Patient centricity should be defined as ‘Putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family’. Important principles for patients focused on education/information, cocreation, access and transparency.ConclusionsThe development of a consistent definition of patient centricity and its associated principles provides an opportunity for biopharmaceutical companies to adopt and use these as a reference point for consistent patient engagement throughout the product life cycle.
Association between physical activity and body fat percentage, with adjustment for BMI: a large cross-sectional analysis of UK Biobank
Authors: Bradbury Kathryn E , Guo Wenji , Cairns Benjamin J , Armstrong Miranda E G , Key Timothy J 
Published: March 2017

ObjectivesThe objective of this study was to examine if, in the general population, physically active adults have less body fat after taking body mass index (BMI) into account.DesignA cross-sectional analysis of participants recruited into UK Biobank in 2006–2010.SettingUK Biobank assessment centres throughout the UK.Participants119 230 men and 140 578 women aged 40–69 years, with complete physical activity information, and without a self-reported long-term illness, disability or infirmity.ExposuresPhysical activity measured as excess metabolic equivalent (MET)-hours per week, estimated from a combination of walking, and moderate and vigorous physical activity. BMI from measured height and weight.Main outcome measureBody fat percentage estimated from bioimpedance.ResultsBMI and body fat percentage were highly correlated (r=0.85 in women; r=0.79 in men), and both were inversely associated with physical activity. Compared with <5 excess MET-hours/week at baseline, ≥100 excess MET-hours/week were associated with a 1.1 kg/m2lower BMI (27.1 vs 28.2 kg/m2) and 2.8 percentage points lower body fat (23.4% vs 26.3%) in men, and 2.2 kg/m2lower BMI (25.6 vs 27.7 kg/m2) and 4.0 percentage points lower body fat (33.9% vs 37.9%) in women. For a given BMI, greater physical activity was associated with lower average body fat percentage (for a BMI of 22.5–24.99 kg/m2: 2.0 (95% CI 1.8 to 2.2), percentage points lower body fat in men and 1.8 (95% CI 1.6 to 2.0) percentage points lower body fat in women, comparing ≥100 excess MET-hours per week with <5 excess MET-hours/week).ConclusionsIn this sample of middle-aged adults, drawn from the general population, physical activity was inversely associated with BMI and body fat percentage. For people with the same BMI, those who were more active had a lower body fat percentage.
Use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation
Authors: Miles A , Chronakis I , Fox J , Mayer A 
Published: March 2017

ObjectivesTo develop a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer, and examine perceived usefulness, acceptability and areas for improvement of the DA.DesignMixed methods.SettingSingle outpatient oncology department in central London.ParticipantsConsecutive recruitment of 13 patients with stage II colorectal cancer, 12 of whom completed the study. Inclusion criteria were: age >18 years; complete resection for stage II adenocarcinoma of the colon or rectum; patients within 14–56 days after surgery; no contraindication to adjuvant chemotherapy; able to give written informed consent. Exclusion criterion: previous chemotherapy.Primary outcomesPatient perceived usefulness (assessed by the PrepDM questionnaire) and acceptability of the DA.ResultsPrepDM scores, measuring the perceived usefulness of the DA in preparing the patient to communicate with their doctor and make a health decision, were above those reported in other patient groups. Patient acceptability scores were also high; however, interviews showed that there was evidence of a lack of understanding of key information among some patients, in particular their baseline risk of recurrence, the net benefit of combination chemotherapy and the rationale for having chemotherapy when cancer had apparently gone.ConclusionsPatients found the DA acceptable and useful in supporting their decision about whether or not to have adjuvant chemotherapy. Suggested improvements for the DA include: sequential presentation of treatment options (eg, no treatment vs 1 drug, 1 drug vs 2 drugs) to enhance patient understanding of the difference between combination and single therapy, diagrams to help patients understand the rationale for chemotherapy to prevent a recurrence and inbuilt checks on patient understanding of baseline risk of recurrence and net benefit of chemotherapy.
Perspectives on procedure-based assessments: a thematic analysis of semistructured interviews with 10 UK surgical trainees
Authors: Shalhoub Joseph , Marshall Dominic C , Ippolito Kate 
Published: March 2017

ObjectivesThe introduction of competency-based training has necessitated development and implementation of accompanying mechanisms for assessment. Procedure-based assessments (PBAs) are an example of workplace-based assessments that are used to examine focal competencies in the workplace. The primary objective was to understand surgical trainees' perspective on the value of PBA.DesignSemistructured interviews with 10 surgical trainees individually interviewed to explore their views. Interviews were audio-recorded and transcribed; following this, they were open and axial coded. Thematic analysis was then performed.ResultsSemistructured interviews yielded several topical and recurring themes. In trainees' experience, the use of PBAs as a summative tool limits their educational value. Trainees reported a lack of support from seniors and variation in the usefulness of the tool based on stage of training. Concerns related to the validity of PBAs for evaluating trainees' performance with reports of ‘gaming’ the system and trainees completing their own assessments. Trainees did identify the significant value of PBAs when used correctly. Benefits included the identification of additional learning opportunities, standardisation of assessment and their role in providing a measure of progress.ConclusionsThe UK surgical trainees interviewed identified both limitations and benefits to PBAs; however, we would argue based on their responses and our experience that their use as a summative tool limits their formative use as an educational opportunity. PBAs should either be used exclusively to support learning or solely as a summative tool; if so, further work is needed to audit, validate and standardise them for this purpose.
Global cardiovascular risk assessment in the primary prevention of cardiovascular disease in adults: systematic review of systematic reviews
Authors: Collins Dylan R J , Tompson Alice C , Onakpoya Igho J , Roberts Nia , Ward Alison M , Heneghan Carl J 
Published: March 2017

ObjectiveTo identify, critically appraise and summarise existing systematic reviews on the impact of global cardiovascular risk assessment in the primary prevention of cardiovascular disease (CVD) in adults.DesignSystematic review of systematic reviews published between January 2005 and October 2016 in The Cochrane Library, EMBASE, MEDLINE or CINAHL databases, and post hoc analysis of primary trials.Participants, interventions, outcomesSystematic reviews of interventions involving global cardiovascular risk assessment relative to no formal risk assessment in adults with no history of CVD. The primary outcomes of interest were CVD-related morbidity and mortality and all-cause mortality; secondary outcomes were systolic blood pressure (SBP), cholesterol and smoking.ResultsWe identified six systematic reviews of variable but generally of low quality (mean Assessing the Methodological Quality of Systematic Reviews 4.2/11, range 0/11 to 7/11). No studies identified by the systematic reviews reported CVD-related morbidity or mortality or all-cause mortality. Meta-analysis of reported randomised controlled trials (RCTs) showed small reductions in SBP (mean difference (MD) −2.22 mm Hg (95% CI −3.49 to −0.95); I2=66%; n=9; GRADE: very low), total cholesterol (MD −0.11 mmol/L (95% CI −0.20 to −0.02); I2=72%; n=5; GRADE: very low), low-density lipoprotein cholesterol (MD −0.15 mmol/L (95% CI −0.26 to −0.05), I2=47%; n=4; GRADE: very low) and smoking cessation (RR 1.62 (95% CI 1.08 to 2.43); I2=17%; n=7; GRADE: low). The median follow-up time of reported RCTs was 12 months (range 2–36 months).ConclusionsThe quality of existing systematic reviews was generally poor and there is currently no evidence reported in these reviews that the prospective use of global cardiovascular risk assessment translates to reductions in CVD morbidity or mortality. There are reductions in SBP, cholesterol and smoking but they may not be clinically significant given their small effect size and short duration. Resources need to be directed to conduct high-quality systematic reviews focusing on hard patient outcomes, and likely further primary RCTs.Trial registration numberCRD42015019821.
Designing a physical activity intervention for children with asthma: a qualitative study of the views of healthcare professionals, parents and children with asthma
Authors: Jago Russell , Searle Aidan , Henderson A John , Turner Katrina M 
Published: March 2017

ObjectivesQualitative methods were used to examine: (1) the attitudes of health professionals to promoting physical activity for children with asthma; (2) reasons why children with asthma are less active and (3) how a physical activity programme for children with asthma could be designed.DesignSemistructured interviews were conducted with health professionals, children with asthma and their parents between October 2015 and March 2016. Interviews were transcribed verbatim and thematically analysed.SettingPrimary and secondary care in Bristol (UK).ParticipantsInterviews were held with 8 primary care practitioners (5 general practitioners, 2 nurse practitioners and 1 practice nurse), 9 parent–child dyads (2 fathers, 7 mothers, 6 sons, 3 daughters) of children aged 6–7 who had asthma and 4 secondary care professionals (2 respiratory consultants, 2 specialist nurses).ResultsHealth professionals reported that physical activity was beneficial for children with asthma and if managed appropriately, children with asthma could be as active as children without asthma. Current promotion of physical activity for children with asthma was limited and restricted by NHS staff time, access to inhalers at school and a lack of parental knowledge. Potentially important components of a new programme include parental education on the possibilities of activity for children with asthma and the difference between exercise-induced breathlessness and asthma symptoms. Other important elements include how to use inhalers as a preventive measure, coping with exacerbations and practical solutions (such as clearing sputum), managing transitions from warm to cold climates and general symptom control.ConclusionsThere is a need to build on current asthma programmes to increase the support for children with asthma to be physically active. Future programmes could consider working more closely with schools, increasing parental knowledge and providing children with practical support to help be physically active.