bluuebunny/crossref_metadata_2025_split huggingface dataset:
Empirical evaluation of the Q-Genie tool: a protocol for assessment of effectiveness
Authors: Sohani Z N , Sarma S , Alyass A , de Souza R J , Robiou-du-Pont S , Li A , Mayhew A , Yazdi F , Reddon H , Lamri A , Stryjecki C , Ishola A , Lee Y K , Vashi N , Anand S S , Meyre D 
Published: June 2016

IntroductionMeta-analyses of genetic association studies are affected by biases and quality shortcomings of the individual studies. We previously developed and validated a risk of bias tool for use in systematic reviews of genetic association studies. The present study describes a larger empirical evaluation of the Q-Genie tool.Methods and analysisMEDLINE, Embase, Global Health and the Human Genome Epidemiology Network will be searched for published meta-analyses of genetic association studies. Twelve reviewers in pairs will apply the Q-Genie tool to all studies in included meta-analyses. The Q-Genie will then be evaluated on its ability to (i) increase precision after exclusion of low quality studies, (ii) decrease heterogeneity after exclusion of low quality studies and (iii) good agreement with experts on quality rating by Q-Genie. A qualitative assessment of the tool will also be conducted using structured questionnaires.DiscussionThis systematic review will quantitatively and qualitatively assess the Q-Genie's ability to identify poor quality genetic association studies. This information will inform the selection of studies for inclusion in meta-analyses, conduct sensitivity analyses and perform metaregression. Results of this study will strengthen our confidence in estimates of the effect of a gene on an outcome from meta-analyses, ultimately bringing us closer to deliver on the promise of personalised medicine.Ethics and disseminationAn updated Q-Genie tool will be made available from the Population Genomics Program website and the results will be submitted for a peer-reviewed publication.
Does employee participation in workplace health promotion depend on the working environment? A cross-sectional study of Danish workers
Authors: Jørgensen Marie Birk , Villadsen Ebbe , Burr Hermann , Punnett Laura , Holtermann Andreas 
Published: June 2016

ObjectivesTo investigate if participation in workplace health promotion (WHP) depends on the work environment.MethodsQuestionnaire data on participation in WHP activities (smoking cessation, healthy diet, exercise facilities, weekly exercise classes, contact with health professionals, health screenings) and the work environment (social support, fatiguing work, physical, quantitative and emotional demands, job control and WHP availability setting) were collected cross-sectionally in 2010 in a representative sample (n=10 605) of Danish workers. Binary regression analyses of the association between work environment characteristics and participation in WHP were conducted and adjusted for age, gender and industry.ResultsWHP offered during leisure time was associated with lower participation in all measured activities compared with when offered during working hours. Low social support and fatiguing work were associated with low participation in WHP. No associations with participation in WHPs were observed for physical work or quantitative demands, work pace or job strain. However, high physical demands/low job control and high emotional demands/low job control were associated with low participation.ConclusionsLower participation in WHP was associated with programmes during leisure, low social support, very fatiguing work and high physical or emotional demands with low job control. This suggests that to obtain proper effect of health promotion in a workplace setting, a good work environment is essential.
What is the relationship between renal function and visit-to-visit blood pressure variability in primary care? Retrospective cohort study from routinely collected healthcare data
Authors: Lasserson Daniel S , Scherpbier de Haan Nynke , de Grauw Wim , van der Wel Mark , Wetzels Jack F , O'Callaghan Christopher A 
Published: June 2016

ObjectiveTo determine the relationship between renal function and visit-to-visit blood pressure (BP) variability in a cohort of primary care patients.DesignRetrospective cohort study from routinely collected healthcare data.SettingPrimary care in Nijmegen, the Netherlands, from 2007 to 2012.Participants19 175 patients who had a measure of renal function, and 7 separate visits with BP readings in the primary care record.Outcome measuresVisit-to-visit variability in systolic BP, calculated from the first 7 office measurements, including SD, successive variation, absolute real variation and metrics of variability shown to be independent of mean. Multiple linear regression was used to analyse the influence of estimated glomerular filtration rate (eGFR) on BP variability measures with adjustment for age, sex, diabetes, mean BP, proteinuria, cardiovascular disease, time interval between measures and antihypertensive use.ResultsIn the patient cohort, 57% were women, mean (SD) age was 65.5 (12.3) years, mean (SD) eGFR was 75.6 (18.0) mL/min/1.73m2and SD systolic BP 148.3 (21.4) mm Hg. All BP variability measures were negatively correlated with eGFR and positively correlated with age. However, multiple linear regressions demonstrated consistent, small magnitude negative relationships between eGFR and all measures of BP variability adjusting for confounding variables.ConclusionsWorsening renal function is associated with small increases in measures of visit-to-visit BP variability after adjustment for confounding factors. This is seen across the spectrum of renal function in the population, and provides a mechanism whereby chronic kidney disease may raise the risk of cardiovascular events.
Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions: results from the randomised NEWBORN trial
Authors: Brixval Carina Sjöberg , Thygesen Lau Caspar , Axelsen Solveig Forberg , Gluud Christian , Winkel Per , Lindschou Jane , Weber Tom , Due Pernille , Koushede Vibeke 
Published: June 2016

ObjectiveTo examine the effect of an antenatal education programme in small classes versus standard auditorium-based lectures.DesignRandomised trial using random-generated web-based 1:1 allocation.SettingThe largest birth site in the Capital Region of Denmark, from August 2012 to May 2014.Participants1766 pregnant women. Inclusion criteria ≥18 years, pregnant with a single child, and able to speak and understand Danish. Women were enrolled in the trial from 10+0 to 20+0 weeks of gestation.InterventionsThe intervention programme consisted of three times 2.5 hours of antenatal education in small classes (n=6–8 women), and focused on improving information and problem-solving skills for expectant parents in order to ease birth and the transition to parenthood. The control group received standard auditorium-based lectures consisting of two times 2 hours in an auditorium with participation of ∼250 people.Main outcome measuresThe primary trial outcome was use of epidural analgesia. Other types of pain relief and obstetric interventions were analysed as explorative outcomes.ResultsThere was no statistically significant difference in use of epidural analgesia between participants in the intervention group (30.9%) versus the control group (29.1%), adjusted OR 1.10 (95% CI 0.87 to 1.34). Also, the two groups did not differ regarding other types of pain relief or obstetric interventions. Concomitant birth preparation was common in both groups and highest in the control group, but did not seem to influence our results noticeably.ConclusionsAntenatal education in small groups versus standard auditorium-based lectures did not differ regarding use of epidural analgesia, other pain relief, or obstetric interventions.Trial registration numberNCT01672437; Results.
Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity
Authors: Mangin Dee , Stephen Gaibrie , Bismah Verdah , Risdon Cathy 
Published: June 2016

ObjectivesTo identify studies of existing instruments available for clinicians to record overall patient preferences and priorities for care, suitable for use in routine primary care practice in patients with multimorbidity. To examine the data for all identified tools with respect to validity, acceptability and effect on health outcomes.DesignSystematic Review.Data sourcesMEDLINE, EMBASE and Cochrane databases, each with a predefined search strategy.Eligibility criteriaCitations were included if they reported a tool used to record patient priorities or preferences for treatment, and quantitative or qualitative results following administration of the tool.ResultsOur search identified 189 potential studies of which 6 original studies and 2 discussion papers were included after screening for relevance. 5 of 6 studies (83%) were of cross-sectional design and of moderate quality. All studies reported on the usability of a tool in order to elicit patient preferences. No studies reported on changes to patient-specific healthcare outcomes as a consequence of recording preferences and priorities. 1 of 6 studies reported on eliciting patient preference in the context of multimorbidity. No studies incorporated patient preferences into an electronic medical record.ConclusionsGiven the importance of eliciting patient priorities and preferences in providing patient-centred care in the context of multimorbidity and polypharmacy, we found surprisingly few relevant tools. Some aspects of the tools used for single-disease contexts may also be useful in the context of multimorbidity. There is an urgent need to develop ways to make patient priorities explicitly visible in the clinical record and medical decision-making and to test the effect on patient-relevant outcomes.
Following young people with perinatal HIV infection from adolescence into adulthood: the protocol for PHACS AMP Up, a prospective cohort study
Authors: Tassiopoulos Katherine , Patel Kunjal , Alperen Julie , Kacanek Deborah , Ellis Angela , Berman Claire , Allison Susannah M , Hazra Rohan , Barr Emily , Cantos Krystal , Siminski Suzanne , Massagli Michael , Bauermeister Jose , Siddiqui Danish Q , Puga Ana , Van Dyke Russell , Seage George R 
Published: June 2016

IntroductionThe first generation of adolescents born with HIV infection has reached young adulthood due to advances in treatment. It is important to continue follow-up of these individuals to assess their long-term medical, behavioural and mental health and ability to successfully transition to adulthood while coping with a chronic, potentially stigmatising condition. To accomplish this, and to maintain their interest in long-term research participation, we need to accommodate the changing lifestyles and interests of young adult study participants while ensuring valid data collection. We report the protocol for Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) Up, a prospective cohort study enrolling young adult participants for long-term follow-up.Methods and analysisAMP Up is recruiting 850 young men and women 18 years of age and older—600 perinatally HIV-infected and a comparison group of 250 perinatally HIV-exposed, uninfected—at 14 clinical research sites in the USA and Puerto Rico. Recruitment began in April 2014 and is ongoing, with 305 participants currently enrolled. Planned follow-up is ≥6 years. Data are collected with a flexible hybrid of online and in-person methods. Outcomes include: transition to adult clinical care and retention in care; end-organ diseases; malignancies; metabolic complications; sexually transmitted infections; reproductive health; mental health and neurocognitive functioning; adherence to antiretroviral treatment; sexual behaviour and substance use; hearing and language impairments; and employment and educational achievement.Ethics and disseminationThe study received ethical approval from the Harvard T.H. Chan School of Public Health's institutional review board (IRB), and from the IRBs of each clinical research site. All participants provide written informed consent; for cognitively impaired individuals with legally authorised representatives, legal guardian permission and participant assent is obtained. Findings will be disseminated through peer-reviewed journals, conference presentations and participant summaries.
Prescribing antibiotics to ‘at-risk’ children with influenza-like illness in primary care: qualitative study
Authors: Ashdown Helen F , Räisänen Ulla , Wang Kay , Ziebland Sue , Harnden Anthony ,   for the ARCHIE investigators*
Published: June 2016

ObjectivesNational Institute for Health and Care Excellence guidelines recommend immediate antibiotic treatment of respiratory tract infections in ‘at-risk’ individuals with comorbidities. Observational evidence suggests that influenza particularly predisposes children to bacterial complications. This study investigates general practitioners’ (GPs’) accounts of factors influencing their decision-making about antibiotic prescribing in the management of at-risk children with influenza-like illness (ILI).DesignQualitative interview study using a maximum variation sample with thematic analysis through constant comparison.SettingSemistructured telephone interviews with UK GPs using a case vignette of a child with comorbidities presenting with ILI.ParticipantsThere were 41 GPs (41.5% men; 40 from England, 1 from Northern Ireland) with a range of characteristics including length of time in practice, paediatrics experience, practice setting and deprivation.ResultsThere was considerable uncertainty and variation in the way GPs responded to the case and difference of opinion about how long-term comorbidities should affect their antibiotic prescribing pattern. Factors influencing their decision included the child's case history and clinical examination; the GP's view of the parent's ability to self-manage; the GP's own confidence and experiences of managing sick children and assessment of individual versus abstract risk. GPs rarely mentioned potential influenza infection or asked about immunisation status. All said that they would want to see the child; views about delayed prescribing varied in relation to local health service provision including options for follow-up and paediatric services.ConclusionsThe study demonstrates diagnostic uncertainty and wide variation in GP decision-making about prescribing antibiotics to children with comorbidity. Future guidelines might encourage consideration of a specific diagnosis such as influenza, and risk assessment tools could be developed to allow clinicians to quantify the levels of risk associated with different types of comorbidity. However, the wide range of clinical and non-clinical factors involved in decision-making during these consultations should also be considered in future guidelines.
Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria
Authors: Schneider Antonius , Donnachie Ewan , Tauscher Martin , Gerlach Roman , Maier Werner , Mielck Andreas , Linde Klaus , Mehring Michael 
Published: June 2016

ObjectivesThe efficiency of a gatekeeping system for a health system, as in Germany, remains unclear particularly as access to specialist ambulatory care is not restricted. The aim was to compare the costs of coordinated versus uncoordinated patients (UP) in ambulatory care; with additional subgroup analysis of patients with mental disorders.DesignRetrospective routine data analysis of patients with statutory health insurance, using claims data held by the Bavarian Association of Statutory Health Insurance Physicians. A patient was defined as uncoordinated if he or she visited at least 1 specialist without a referral from a general practitioner within a quarter. Outcomes were compared with propensity score matching analysis.ParticipantsThe study encompassed all statutorily insured patients in Bavaria contacting at least 1 ambulatory specialist in the first quarter of 2011 (n=3 616 510).Primary and secondary outcome measuresPrimary outcome was total costs of ambulatory care; secondary outcomes were financial claims of general physicians, specialists and for medication.ResultsThe average age was 55.3 years for coordinated patients (CP, n=1 629 302), 48.3 years for UP (n=1 825 840). CP more frequently had chronic diseases (85.4%) as compared with UP (67.5%). The total unadjusted financial claim per patient was higher for UP (€234.52) than for CP (€224.41); the total adjusted difference was −€9.65 (95% CI −11.64 to −7.67), indicating lower costs for CP. The cost differences increased with increasing age. Total adjusted difference per patient with mental diseases as documented with an International Classification of Diseases (ICD)-10 F-diagnosis, was −€20.31 (95% CI −26.43 to −14.46).ConclusionsCoordination of care is associated with lower ambulatory healthcare expenditures and is of particular importance for patients who are more vulnerable to medical interventions, especially for elderly and patients with mental disorders. The role of general practitioners as coordinators should be strengthened to improve care for these patients as this could also help to frame a more efficient health system.
‘He's going to be a doctor in August’: a narrative interview study of medical students' and their educators' experiences of aligned and misaligned assistantships
Authors: Jones Owen Meurig , Okeke Chiemeka , Bullock Alison , Wells Stephanie E , Monrouxe Lynn V 
Published: June 2016

ObjectiveTo explore final-year students’ and clinical supervisors’ experiences of alignment and misalignment with future Foundation Year 1 (F1) posts in an assistantship programme in the UK.SettingAssistantships are clinical placements in which students assist junior doctors by undertaking similar duties under supervision. Models of assistantship programmes vary across curricula. Some actively seek to align with students’ initial postgraduate F1 post. To date, no research has examined the implications of this association for teaching and learning. Qualitative individual and group narrative interviews were conducted with students and supervisors of 2 Welsh medical schools to address: RQ1: How do students and supervisors understand the purpose of the longitudinal assistantship? RQ2: Does alignment/misalignment of the assistantship with students’ initial F1 post influence students’ and supervisors’ teaching and learning experiences? Audio-recordings of interviews were transcribed, participants anonymised and framework analysis was used.ParticipantsA convenience sample of 4 participant groups comprised (1) final-year medical students whose assistantship and F1 post were aligned (n=27), (2) final-year medical students whose assistantship and F1 post were misaligned (n=18) and (3) supervisors (n=10, junior doctors; n=11, consultants).ResultsAll participant groups highlighted increased student confidence in undertaking the duties of an F1 doctor arising from their assistantship period. Learning transferable skills was also highlighted. Many students considered themselves to be team members, ‘learning the trade’ as they shadowed their F1. Opportunities for caring for acutely unwell patients were scarce. The evidence shows enhanced engagement for students aligned to their first F1 post with greater opportunities for workplace acclimatisation. Those who were misaligned were perceived as being disadvantaged.ConclusionsOur findings suggest that alignment with students’ first F1 post enhances the assistantship experience. Further longitudinal assessment is required to examine whether and how this translates into improvements in functioning and reductions in stress and anxiety during this transitional period.
Theory-based and evidence-based design of audit and feedback programmes: examples from two clinical intervention studies
Authors: Hysong Sylvia J , Kell Harrison J , Petersen Laura A , Campbell Bryan A , Trautner Barbara W 
Published: June 2016

BackgroundAudit and feedback (A&F) is a common intervention used to change healthcare provider behaviour and, thus, improve healthcare quality. Although A&F can be effective its effectiveness varies, often due to the details of how A&F interventions are implemented. Some have suggested that a suitable conceptual framework is needed to organise the elements of A&F and also explain any observed differences in effectiveness. Through two examples from applied research studies, this article demonstrates how a suitable explanatory theory (in this case Kluger & DeNisi's Feedback Intervention Theory (FIT)) can be systematically applied to design better feedback interventions in healthcare settings.MethodsCase 1: this study's objective was to reduce inappropriate diagnosis of catheter-associated urinary tract infections (CAUTI) in inpatient wards. Learning to identify the correct clinical course of action from the case details was central to this study; consequently, the feedback intervention featured feedback elements that FIT predicts would best activate learning processes (framing feedback in terms of group performance and providing of correct solution information). We designed a highly personalised, interactive, one-on-one intervention with healthcare providers to improve their capacity to distinguish between CAUTI and asymptomatic bacteruria (ASB) and treat ASB appropriately. Case 2: Simplicity and scalability drove this study's intervention design, employing elements that FIT predicted positively impacted effectiveness yet still facilitated deployment and scalability (eg, delivered via computer, delivered in writing). We designed a web-based, report-style feedback intervention to help primary care physicians improve their care of patients with hypertension.ResultsBoth studies exhibited significant improvements in their desired outcome and in both cases interventions were received positively by feedback recipients.SummaryA&F has been a popular, yet inconsistently implemented and variably effective tool for changing healthcare provider behaviour and, improving healthcare quality. Through the systematic use of theory such as FIT, robust feedback interventions can be designed that yield greater effectiveness. Future work should look to comparative effectiveness of specific design elements and contextual factors that identify A&F as the optimal intervention to effectuate healthcare provider behaviour change.Trial registration numberNCT01052545,NCT00302718; post-results.