bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of a smaller target range on the compliance in targeting and distribution of oxygen saturation in preterm infants
Authors: van Zanten Henriëtte Anje , Pauws Steffen C , Stenson Ben J , Walther Frans J , Lopriore Enrico , te Pas Arjan B 
Published: October 2017

BackgroundFollowing recent recommendations, the oxygen saturation (SpO2) target range for preterm infants in our nursery was narrowed towards the higher end from 85%–95% to 90%–95%. We determined the effect of narrowing the SpO2 target range on the compliance in target range and distribution of SpO2 in preterm infants.MethodsBefore and after changing the target range from 85%–95% to 90%–95%, infants <30 weeks of gestation receiving oxygen were compared during their admission on the neonatal intensive care unit. For each infant, distribution of SpO2 was noted by collecting SpO2 samples each minute, and the percentage of time spent with SpO2 within 90%–95% was calculated. Oxygen was manually adjusted. Hypoxaemic events (SpO2 <80%) where oxygen was titrated were analysed.ResultsData were analysed for 104 infants (57 before and 47 after the range was narrowed). The narrower range was associated with an increase in the median (IQR) SpO2 (93% (91%–96%) vs 94% (92%–97%), p=0.01), but no increase in median time SpO2 within 90%–95% (49.2% (39.6%–59.7%) vs (46.9% (27.1%–57.9%), p=0.72). The distribution of SpO2 shifted to the right with a significant decrease in SpO2 <90%, but not <80%. The count of minute values for Sp02 <80% decreased, while the frequency and duration of hypoxaemic events and oxygen titration were not different.ConclusionNarrowing the target range from 85%–95% to 90%–95% in preterm infants was associated with an increase in median SpO2 and a rightward shift in the distribution, but no change in time spent between 90% and 95%.
Retinal hemangioblastoma: prevalence, incidence and frequency of underlying von Hippel-Lindau disease
Authors: Binderup Marie Louise Mølgaard , Stendell Anne-Sophie , Galanakis Michael , Møller Hans Ulrik , Kiilgaard Jens F , Bisgaard Marie Luise 
Published: October 2017

Background and aimsWe aimed to determine the frequency of von Hippel-Lindau disease (vHL) as the underlying cause of retinal hemangioblastoma and to estimate retinal hemangioblastoma incidence and prevalence in a national cohort study.MethodsThrough the national patient register and vHL research database, we identified 81 patients diagnosed with a retinal hemangioblastoma in Denmark between 1977 and 2014. Consent was obtained for 54 living and 10 deceased patients with retinal hemangioblastoma. For each participant, we collected medical records and family information. Almost all (63 of 64) participants were or had previously been tested for mutations in the VHL gene.ResultsOverall, 84% of the participants (54 of the 64) had vHL. Compared with the non-vHL patients, the vHL patients had their first retinal hemangioblastoma at a younger age (22.5 vs 40 years), and were more likely to have an asymptomatic first hemangioblastoma (80% vs 20%). Overall, 76% (41 of 54) of the vHL patients had a family history of vHL, while none of the patients without vHL did. Despite the rarity of the disease, on average more than eight new tumours are diagnosed each year due to multiple tumour development in vHL patients. The estimated prevalence of patients with retinal hemangioblastoma was up to 1 in 73 080 individuals.ConclusionIn the first national study in which almost all participants were genetically tested, vHL was the underlying cause of retinal hemangioblastoma in 84% of cases; more often than previously reported. We recommend that genetic and clinical vHL screening should be performed in all patients with retinal hemangioblastoma.
Interlower and postlower eyelid retractor fat pads: a cadaveric microscopic study
Authors: Mupas-Uy Jacqueline T , Takahashi Yasuhiro , Nakano Takashi , Naito Munekazu , Ikeda Hiroshi , Miyazaki Hidetaka , Kakizaki Hirohiko , Malhotra Raman 
Published: October 2017

BackgroundTo report the histological microscopic anatomy of the interlower and postlower eyelid retractor (LER) fat pads.MethodsIn this experimental microscopic study, 31 exenterated orbits from 31 Japanese cadavers (19 right and 12 left; 15 male and 16 female; mean age of death, 81.0±8.8 years; range, 52–97 years) fixed in 10% buffered formalin were used. Masson trichrome was used to stain sagittal full sections of exenterated tissues. Microscopic examination of the lower eyelids was carried out.ResultsThe exenterated orbits demonstrated the presence of the histological existence of inter-LER fat pad (80.6%) and post-LER fat pad (22.6%) in the lower eyelids. The inter-LER fat pad was thick and located between the anterior and posterior layers of the LER, where the blood vessels passed through in 18 specimens (72.0%). The post-LER pad was thin, subtle and located between the posterior layer of the LER and conjunctiva.ConclusionThis study reports a novel finding of the inter-LER and post-LER fat pads. Awareness of these fat layers provides surgeons with additional anatomical detail of lower eyelid anatomy.
MicroRNA-20a-5p suppresses IL-17 production by targeting OSM and CCL1 in patients with Vogt-Koyanagi-Harada disease
Authors: Chang Rui , Yi Shenglan , Tan Xiao , Huang Yang , Wang Qingfeng , Su Guannan , Zhou Chunjiang , Cao Qingfeng , Yuan Gangxiang , Kijlstra Aize , Yang Peizeng 
Published: October 2017

AimTo elucidate the role of microRNA-20a-5p (miR-20a-5p) in the pathogenesis of Vogt-Koyanagi-Harada (VKH) disease.MethodsQuantitative real-time PCR was used to quantify miR-20a-5p expression in CD4+ T cells from patients with active VKH and normal controls. The promoter methylation status of miR-20a-5p was detected by bisulfite sequencing PCR. Targets were evaluated by a luciferase reporter assay. The functional effects of miR-20a-5p on CD4+ T cells from patients with active VKH were assessed by upregulation or downregulation of its expression using liposomes.ResultsThe miR-20a-5p level was significantly decreased in CD4+ T cells from patients with active VKH as compared with normal controls. The two genes, oncostatin M (OSM) and C-C motif chemokine ligand 1 (CCL1), were identified as targets of miR-20a-5p. The upregulation of miR-20a-5p significantly suppressed interleukin 17 (IL-17) production in CD4+ T cells from patients with active VKH, whereas downregulation of miR-20a-5p exhibited an inverse effect. In addition, overexpression of OSM and CCL1 could rescue the effect of the upregulation of miR-20a-5p. Moreover, the level of miR-20a-5p was reduced in response to hypermethylation of the promoter. Further study showed that miR-20a-5p suppressed the activity of the phosphoinositide 3-kinase-AKT pathway.ConclusionsOur findings indicate that downregulation of miR-20a-5p is caused by promoter hypermethylation. MiR-20a-5p could also suppress the production of IL-17 by targeting OSM and CCL1 production in CD4+ T cells in patients with active VKH.
Prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy in South Korea: a nationwide population-based study
Authors: Lee Ju-Yeun , Park Kyung-Ah , Oh Sei Yeul 
Published: October 2017

AimsTo determine the age and sex-specific prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy (NAION) in South Korea.MethodsThis is a nationwide population-based study using data from the Korean national health claims database to identify patients with NAION using the registration programme database, which comprises ophthalmologist-confirmed NAION from 2011 through 2015. We evaluated prevalence and incidence rates using these data.ResultsAmong 25 816 797 of entire population 40 years of age or older, 26 167 patients had NAION (47.8% men) during the 5-year study period. The prevalence in the general population 40 years of age or older was 102.87 (95% CI 95.22 to 110.53) per 100 000 people. In men, it was 111.10 (95% CI 101.19 to 121.02), and in women, it was 94.64 (95% CI 89.25 to 100.03) per 100 000 people. The prevalence increased with advancing age and peaked at 70–74 years in men and 65–69 years in women. The incidence in the general population 40 years of age or older was 11.35 (95% CI 10.37 to 12.33) per 100 000 person-years. In men, it was 14.89 (95% CI 12.26 to 16.91), and in women, it was 9.92 (95% CI 8.85 to 10.99) per 100 000 person-years. The incidence increased with advancing age and peaked at 80–84 years in men and 70–74 years in women.ConclusionsThe prevalence and incidence estimates of NAION are comparable with those of Caucasians. These detailed estimates could promote understanding of the disease’s pathophysiology and allow for appropriate planning within the healthcare system.
The Norwegian patient experiences with GP questionnaire (PEQ-GP): reliability and construct validity following a national survey
Authors: Holmboe Olaf , Iversen Hilde Hestad , Danielsen Kirsten , Bjertnaes Oyvind 
Published: October 2017

ObjectivesThe aim of this study was to test the reliability and validity of a new questionnaire for measuring patient experiences with general practitioners (PEQ-GP) following a national survey.SettingPostal survey among patients on any of 500 GPs patient lists in Norway. GPs were stratified by practice size and geographical criteria.Participants4964 patients who had at least one consultation with their regular GP in the foregoing 12 months were included in the study. The patients were randomly selected after the selection of GPs. 2377 patients (49%) responded to the survey.Primary and secondary outcome measuresThe items were assessed for missing data and ceiling effects. Factor structure was assessed using exploratory factor analyses. Reliability was tested with item–total correlation, Cronbach’s alpha and test–retest correlations. Item discriminant validity was tested by correlating items with all scales. Construct validity was assessed through associations of scale scores with health status, the patients’ general satisfaction with the services, whether the patient had been incorrectly treated by the GP and whether the patient would recommend the GP to others.ResultsItem missing varied from 1.0% to 3.1%, while ceiling effects varied from 16.1% to 45.9%. The factor analyses identified three factors. Reliability statistics for scales based on these three factors, and two theoretically derived scales, showed item–total correlations ranging from 0.63 to 0.85 and Cronbach’s alpha values from 0.77 to 0.93. Test–retest correlation for the five scales varied from 0.72 to 0.88. All scales had the expected association with other variables.ConclusionsThe PEQ-GP has good evidence for data quality, internal consistency and construct validity. The PEQ-GP is recommended for use in local, regional and national surveys in Norway, but further studies are needed to assess the instrument’s ability to detect differences over time and between different GPs.
People’s experiences of hospital care on the weekend: secondary analysis of data from two national patient surveys
Authors: Graham Chris 
Published: October 2017

ObjectiveTo determine whether patients treated in hospital on the weekend report different experiences of care compared with those treated on weekdays.DesignThis is a secondary analysis of the 2014 National Health Service (NHS) adult inpatient survey and accident and emergency (A&E) department surveys. Differences were tested using independent samples t-tests and multiple regression, adjusting for patient age group, sex, ethnicity, proxy response, NHS trust, route of admission (for the inpatient survey) and destination on discharge (for the A&E survey).SettingThe inpatient survey included 154 NHS hospital trusts providing overnight care; the A&E survey 142 trusts with major emergency departments.ParticipantsThree cohorts were analysed: patients attending A&E, admitted to hospital and discharged from hospital. From the inpatient survey’s 59 083 responses, 10 382 were admitted and 11 542 discharged on weekends or public holidays. The A&E survey received 39 320 responses, including 11 542 (29.4%) who attended on the weekend or on public holidays. Weekday and weekend attendees’ response rates were similar once demographic characteristics were accounted for.Main outcome measuresFor the A&E survey, six composite dimensions covered waiting times, doctors and nurse, care and treatment, cleanliness, information on discharge, and overall experiences. For the inpatient survey, three questions covered admissions and two dimensions covered information about discharge and about medicines.ResultsPeople attending A&E on weekends were significantly more favourable about ‘doctors and nurses’ and ‘care and treatment’. Inpatients admitted via A&E on a weekend were more positive about the information given to them in A&E than others. Other dimensions showed no differences between people treated on weekdays or on weekends.ConclusionsPatients attending emergency departments or admitted to or discharged from an inpatient episode on weekends and public holidays report similar or more positive experiences of care to other patients after adjusting for patient characteristics.
Effects of efforts to optimise morbidity and mortality rounds to serve contemporary quality improvement and educational goals: a systematic review
Authors: Smaggus Andrew , Mrkobrada Marko , Marson Alanna , Appleton Andrew 
Published: October 2017

BackgroundThe quality and safety movement has reinvigorated interest in optimising morbidity and mortality (M&M) rounds. We performed a systematic review to identify effective means of updating M&M rounds to (1) identify and address quality and safety issues, and (2) address contemporary educational goals.MethodsRelevant databases (Medline, Embase, PubMed, Education Resource Information Centre, Cumulative Index to Nursing and Allied Health Literature, Healthstar, and Global Health) were searched to identify primary sources. Studies were included if they (1) investigated an intervention applied to M&M rounds, (2) reported outcomes relevant to the identification of quality and safety issues, or educational outcomes relevant to quality improvement (QI), patient safety or general medical education and (3) included a control group. Study quality was assessed using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. Given the heterogeneity of interventions and outcome measures, results were analysed thematically.ResultsThe final analysis included 19 studies. We identified multiple effective strategies (updating objectives, standardising elements of rounds and attaching rounds to a formal quality committee) to optimise M&M rounds for a QI/safety purpose. These efforts were associated with successful integration of quality and safety content into rounds, and increased implementation of QI interventions. Consistent effects on educational outcomes were difficult to identify, likely due to the use of methodologies ill-fitted for educational research.ConclusionsThese results are encouraging for those seeking to optimise the quality and safety mission of M&M rounds. However, the inability to identify consistent educational effects suggests the investigation of M&M rounds could benefit from additional methodologies (qualitative, mixed methods) in order to understand the complex mechanisms driving learning at M&M rounds.
Wisdom of patients: predicting the quality of care using aggregated patient feedback
Authors: Griffiths Alex , Leaver Meghan P 
Published: October 2017

BackgroundThe Care Quality Commission (CQC) is responsible for ensuring the quality of healthcare in England. To that end, CQC has developed statistical surveillance tools that periodically aggregate large numbers of quantitative performance measures to identify risks to the quality of care and prioritise its limited inspection resource. These tools have, however, failed to successfully identify poor-quality providers. Facing continued budget cuts, CQC is now further reliant on an ‘intelligence-driven’, risk-based approach to prioritising inspections and a new effective tool is required.ObjectiveTo determine whether the near real-time, automated collection and aggregation of multiple sources of patient feedback can provide a collective judgement that effectively identifies risks to the quality of care, and hence can be used to help prioritise inspections.MethodsOur Patient Voice Tracking System combines patient feedback from NHS Choices, Patient Opinion, Facebook and Twitter to form a near real-time collective judgement score for acute hospitals and trusts on any given date. The predictive ability of the collective judgement score is evaluated through a logistic regression analysis of the relationship between the collective judgement score on the start date of 456 hospital and trust-level inspections, and the subsequent inspection outcomes.ResultsAggregating patient feedback increases the volume and diversity of patient-centred insights into the quality of care. There is a positive association between the resulting collective judgement score and subsequent inspection outcomes (OR for being rated ‘Inadequate’ compared with ‘Requires improvement’ 0.35 (95% CI 0.16 to 0.76), Requires improvement/Good OR 0.23 (95% CI 0.12 to 0.44), and Good/Outstanding OR 0.13 (95% CI 0.02 to 0.84), with p<0.05 for all).ConclusionsThe collective judgement score can successfully identify a high-risk group of organisations for inspection, is available in near real time and is available at a more granular level than the majority of existing data sets. The collective judgement score could therefore be used to help prioritise inspections.
The civilian validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to primary major incident triage
Authors: Vassallo James , Smith Jason , Bouamra Omar , Lecky Fiona , Wallis Lee A 
Published: October 2017

IntroductionTriage is a key principle in the effective management of a major incident. Existing triage tools have demonstrated limited performance at predicting need for life-saving intervention (LSI). Derived on a military cohort, the Modified Physiological Triage Tool (MPTT) has demonstrated improved performance. Using a civilian trauma registry, this study aimed to validate the MPTT in a civilian environment.MethodsRetrospective database review of the Trauma Audit and Research Network (TARN) database for all adult patients (>18 years) between 2006 and 2014. Patients were defined as Priority One if they received one or more LSIs from a previously defined list. Only patients with complete physiological data were included. Patients were categorised by the MPTT and existing triage tools using first recorded hospital physiology. Performance characteristics were evaluated using sensitivity, specificity and area under receiver operating characteristic (AUROC).ResultsDuring the study period, 218 985 adult patients were included in the TARN database. 127 233 (58.1%) had complete data: 55.6% male, aged 61.4 (IQR 43.1–80.0) years, Injury Severity Score 9 (IQR 9–16), 96.5% suffered blunt trauma and 24 791 (19.5%) were Priority One. The MPTT (sensitivity 57.6%, specificity 71.5%) outperformed all existing triage methods with a 44.7% absolute reduction in undertriage compared with existing UK civilian methods. AUROC comparison supported the use of the MPTT over other tools (P<0.001.)ConclusionWithin a civilian trauma registry population, the MPTT demonstrates improved performance at predicting need for LSI, with the lowest rates of undertriage and an appropriate level of overtriage. We suggest the MPTT be considered as an alternative to existing triage tools.
Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial
Authors: Lv Yong , Qi Xingshun , He Chuangye , Wang Zhengyu , Yin Zhanxin , Niu Jing , Guo Wengang , Bai Wei , Zhang Hongbo , Xie Huahong , Yao Liping , Wang Jianhong , Li Tao , Wang Qiuhe , Chen Hui , Liu Haibo , Wang Enxing , Xia Dongdong , Luo Bohan , Li Xiaomei , Yuan Jie , Han Na , Zhu Ying , Xia Jielai , Cai Hongwei , Yang Zhiping , Wu Kaichun , Fan Daiming , Han Guohong 
Published: October 2017

ObjectiveLimited data are available on the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This study aimed to compare transjugular intrahepatic portosystemic shunt (TIPS) with covered stents versus endoscopic band ligation (EBL) plus propranolol for the prevention of variceal rebleeding among patients with cirrhosis and PVT.DesignConsecutive cirrhotic patients (94% Child-Pugh class A or B) with PVT who had variceal bleeding in the past 6 weeks were randomly assigned to TIPS group (n=24) or EBL plus propranolol group (EBL+drug, n=25), respectively. Primary endpoint was variceal rebleeding. Secondary endpoints included survival, overt hepatic encephalopathy (OHE), portal vein recanalisation and rethrombosis, other complications of portal hypertension and adverse events.ResultsDuring a median follow-up of 30 months in both groups, variceal rebleeding was significantly less frequent in the TIPS group (15% vs 45% at 1 year and 25% vs 50% at 2 years, respectively; HR=0.28, 95% CI 0.10 to 0.76, p=0.008), with a significantly higher portal vein recanalisation rate (95% vs 70%; p=0.03) and a relatively lower rethrombosis rate (5% vs 33%; p=0.06) compared with the EBL+drug group. There were no statistically significant differences in survival (67% vs 84%; p=0.152), OHE (25% vs 16%; p=0.440), other complications of portal hypertension and adverse events between groups.ConclusionCovered TIPS placement in patients with PVT and moderately decompensated cirrhosis was more effective than EBL combined with propranolol for the prevention of rebleeding, with a higher probability of PVT resolution without increasing the risk of OHE and adverse effects, but this benefit did not translate into improved survival.Trial registration numberClinicalTrials.gov: NCT01326949.
Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement
Authors: Masri Ahmad , Abdelkarim Islam , Sharbaugh Michael S , Althouse Andrew D , Xu Jeffrey , Han Wei , Chan Stephen Y , Katz William E , Crock Frederick W , Harinstein Matthew E , Kliner Dustin E , Navid Forozan , Lee Joon S , Gleason Thomas G , Schindler John T , Cavalcante João L 
Published: October 2017

ObjectivesTo determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-term mortality.MethodsConsecutive patients who underwent TAVR from July 2011 through January 2016 were studied. The prevalence of baseline PH (mean pulmonary artery pressure ≥25 mm Hg on right heart catheterisation) and the prevalence and the predictors of persistent≥moderate PH (pulmonary artery systolic pressure (PASP)>45 mm Hg on 1 month post-TAVR transthoracic Doppler echocardiography) were collected. Cox models quantified the effect of persistent PH on subsequent mortality while adjusting for confounders.ResultsOf the 407 TAVR patients, 273 (67%) had PH at baseline. Of these, 102 (25%) had persistent≥moderate PH. Mortality at 2 years in patients with no baseline PH versus those with PH improvement (follow-up PASP≤45 mm Hg) versus those with persistent≥moderate PH was 15.4%, 16.6% and 31.3%, respectively (p=0.049). After adjusting for Society of Thoracic Surgeons Predicted Risk of Mortality and baseline right ventricular function (using tricuspid annular plane systolic excursion), persistent≥moderate PH remained associated with all-cause mortality (HR=1.82, 95% CI 1.06 to 3.12, p=0.03). Baseline characteristics associated with increased likelihood of persistent≥moderate PH were ≥moderate tricuspid regurgitation, ≥moderate mitral regurgitation, atrial fibrillation/flutter, early (E) to late (A) ventricular filling velocities (E/A ratio) and left atrial volume index.ConclusionsPersistency of even moderate or greater PH at 1 month post-TAVR is common and associated with higher all-cause mortality.