bluuebunny/crossref_metadata_2025_split huggingface dataset:
Did the accuracy of oral amoxicillin dosing of children improve after British National Formulary dose revisions in 2014? National cross-sectional survey in England
Authors: Rann Olivia , Sharland Mike , Long Paul , Wong Ian C K , Laverty Anthony A , Bottle Alex , Barker Charlotte I , Bielicki Julia , Saxena Sonia 
Published: September 2017

ObjectivesInaccurate antibiotic dosing can lead to treatment failure, fuel antimicrobial resistance and increase side effects. The British National Formulary for Children (BNFC) guidance recommends oral antibiotic dosing according to age bands as a proxy for weight. Recommended doses of amoxicillin for children were increased in 2014 ‘after widespread concerns of under dosing’. However, the impact of dose changes on British children of different weights is unknown, particularly given the rising prevalence of childhood obesity in the UK. We aimed to estimate the accuracy of oral amoxicillin dosing in British children before and after the revised BNFC guidance in 2014.Setting and participantsWe used data on age and weights for 1556 British children (aged 2–18 years) from a nationally representative cross-sectional survey, the Health Survey for England 2013.InterventionsWe calculated the doses each child would receive using the BNFC age band guidance, before and after the 2014 changes, against the ‘gold standard’ weight-based dose of amoxicillin, as per its summary of product characteristics.Primary outcome measureAssuming children of different weights were equally likely to receive antibiotics, we calculated the percentage of the children who would be at risk of misdosing by the BNFC age bands.ResultsBefore 2014, 54.6% of children receiving oral amoxicillin would have been underdosed and no child would have received more than the recommended dose. After the BNFC guidance changed in 2014, the number of children estimated as underdosed dropped to 5.8%, but 0.5% of the children would have received too high a dose.ConclusionsChanges to the BNFC age-banded amoxicillin doses in 2014 have significantly reduced the proportion of children who are likely to be underdosed, with only a minimal rise in the number of those above the recommended range.
Diabetic retinopathy and the use of laser photocoagulation: is it cost-effective to treat early?
Authors: Mistry Hema , Auguste Peter , Lois Noemi , Waugh Norman 
Published: September 2017

Background/aimsThe aim of the study was to explore whether it would be cost-effective to apply panretinal photocoagulation (PRP) at the severe non-proliferative diabetic retinopathy (NPDR) (early treatment) stage, compared with waiting until high-risk proliferative diabetic retinopathy (HR-PDR) characteristics (deferred treatment) developed.MethodsA Markov model with a 30-year time horizon was developed, in which patients presenting with moderate NPDR could progress through all stages of DR (severe NPDR>early PDR>HR-PDR>severe PDR) to severe vision loss and blindness (and to death). A National Health Service and personal social services perspective was adopted. Transition probabilities were mainly derived from the Early Treatment Diabetic Retinopathy Study. Health state utilities, costs and complications were based on information from the literature, supplemented by expert opinion. Costs and outcomes were discounted at 3.5%. Both deterministic and probabilistic sensitivity analyses were conducted.ResultsAdministering PRP at the severe NPDR stage could be more effective and less costly than waiting until HR-PDR developed. Sensitivity analyses gave similar results, with early treatment continuing to dominate deferred treatment. The probabilistic sensitivity analysis suggests that at willingness-to-pay threshold of £20–£30 000 per quality-adjusted life year, the probability of early treatment being cost-effective is 60%.ConclusionPRP administered at the severe NPDR stage is likely to be cost-effective compared with delaying photocoagulation until HR-PDR develops. However, given the limitations of the evidence, these results need to be interpreted with caution. A trial of early versus deferred laser therapy is needed to provide better data based on modern treatments.
PP15 Consent as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review
Authors: Armstrong Stephanie , Langlois Adele , Laparidou Despina , Dixon Mark , Appleton Jason P , Bath Philip M , Snooks Helen , Siriwardena A Niroshan 
Published: September 2017

BackgroundClinical trials in the ambulance setting are essential for providing the basis for evidence based healthcare in the prehospital environment. As the number and complexity of ambulance trials increases the ethical issues involved in such trials. We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting.MethodsWe conducted a systematic review of ethical issues considered in randomised controlled trials in ambulance settings. A search of eight databases identified ethical issues discussed in published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and then extracted relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis.ResultsIn all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Several consent models were used ranging from informed consent to exception from informed consent (also termed waiver of consent). Type of consent differed depending on the clinical condition or the intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from informed consent appeared to be most commonly used. Many studies cited international guidelines as informing their choice of consent model and diverse and sometimes confused terms were used to describe these models.ConclusionsConsent was the main ethical consideration in published ambulance based research. A wide range of terms was used to describe consent and terms were sometimes confused or used inconsistently. This suggests that standardisation of consent models and the terminology used to describe them may be helpful for researchers, ethics committees and research participants.
PP23 A comparative evaluation of 999 call-to-needle time of patients presenting with red flag sepsis treated with antibiotics by paramedics and emergency department staff
Authors: Payne Tanya , Chippendale Jonathon , Lloyd Adele 
Published: September 2017

BackgroundNational Institute for Health and Care Excellence guidelines on the recognition, diagnosis and early management of sepsis suggest that in all cases of high risk (or ‘red flag’) sepsis a broad spectrum antibiotic is given without delay and within one hour. For patients identified pre-hospital, GP’s and ambulance services are advised to have mechanisms in place that will allow them to give antibiotics but only where the transfer time is greater than one hour.Whilst one hour is considered the gold standard timeframe in which to receive antibiotics, the 999 call dispatch process is often overlooked and there are no studies to date that examine the 999 call-to-needle time for sepsis patients.The aim of this evaluation was to explore the difference between call-to-needle times of patients who present with ‘red flag’ sepsis receiving antibiotic therapy by a paramedic pre hospital versus Emergency Department (ED) staff.MethodData collected from a feasibility evaluation was used to determine the call-to-needle time of a broad spectrum antibiotic given by a trained paramedic prior to arrival at ED. A random sample of patients arriving in ED by ambulance with high risk (or ‘red flag’) sepsis during the same 6 month period was identified with the call-to-needle time collected retrospectively. A Mann-Whitney U test was performed using SPSS version 22 to determine if there was any significant difference.ResultsOf the patients that were treated (n=140) the median call-to-needle time of patients treated by paramedics was 45:30 min (n=60), compared to a median call-to-needle time by ED staff of 113:30 min (n=80) (p<0.001).ConclusionConsidering the call dispatch challenges that all ambulance services experience, patients with ‘red flag’ sepsis can be treated with an antibiotic within an hour of the 999 call and on average one hour earlier than patients who are treated by ED staff.
PP25 Using a linked health dataset to identify what happens to patients following prehospital care
Authors: Coster Joanne , O’Cathain Alicia , Crum Annabel , Jacques Richard , Nicholl Jon , Turner Janette 
Published: September 2017

BackgroundUK prehospital services receive poor information about what happens to patients beyond the prehospital phase of care; this limits the opportunity to assess patient outcomes following non-conveyance. We aimed to identify what happens to patients after prehospital discharge, as part of two studies 1) to develop better ways of measuring prehospital quality and performance (Prehospital Outcomes for Evidence Based Evaluation, (PhOEBE)) and 2) to assess Variation in Ambulance Non-conveyance decisions (VAN).MethodWe developed a patient level dataset, linking ambulance call and clinical data to subsequent ED, hospital and mortality data. Data for 6 months of 2013 was provided by one ambulance service and linked to national datasets using NHS Digital’s data-linking service. We identified a sub-group of non-conveyed patients and identified recontacts (EMS, ED, hospital admission or death) within 3 days of the call. We traced 24% (2514/10634) of hear and treat calls and 84% (42,796/50894) of see and treat calls.ResultsWithin our sample, 20.6% of see and treat calls had a recontact within 3 days, 6.3% (2694/42.796) were admitted to hospital and 0.3% (129/42796) died. Poor hear and treat linkage rates limited data reliability, therefore we conducted a sensitivity analysis using traced calls only and traced plus non-traced calls as the denominator. We found that hear and treat hospital admissions within 3 days range from 2.5%–10.5% and deaths within 3 days range from 0.06%–0.24%We developed a new indicator to monitor the quality and safety of non-transport decisions “Proportion of calls left at home which result in hospital admission or death within 3 days”.ConclusionsWe linked multiple data sources to identify what happens to patients following prehospital care and identified low rates of hospital admission and death following non-conveyance. We developed a new non-conveyance indicator to assess safety and monitor non-conveyance rates over time.
PP27 Terms used to describe key symptoms in out-of-hospital cardiac arrest by people calling 999 emergency medical services: a qualitative analysis of call recordings to two uk ambulance services
Authors: Gibson Josephine ME , Jones Stephanie P , Hurley Margaret , Auton Mal , Leathley Michael J , Sutton Christopher J , Bangee Munirah , Benedetto Valerio , Chesworth Brigit , Miller Colette , O’Shea Dawn , Quinn Tom , Mackway-Jones Kevin C , Curran Andy , Niroshan Siriwardena A , Davis David , Price Chris , Dewitt David , Barron Tracey , Fox Peter , Watkins Caroline L 
Published: September 2017

BackgroundCardiac arrest outside hospital is a catastrophic medical emergency experienced by an estimated 60 000 people a year in the UK. The speed and accuracy with which cardiac arrest outside hospital is recognised by 999 call handlers is fundamental to improving the chance of survival, but is extremely challenging. We aimed to identify how cardiac arrest is actually described by callers during dialogues with 999 call handlers.MethodsData was obtained from two acute NHS trusts and their two local ambulance trusts for all cases of suspected or actual out-of-hospital cardiac arrest (OHCA) or imminent medically witnessed cardiac arrest (MWCA) which led to transfer to one of the study hospitals, for a one year period (1/7/2013–30/6/2014). The 999 call recordings were listened to in full; words or phrases used by callers to describe clinical signs and symptoms were identified and clustered into key indicator symptoms using a thematic approach.Findings429 cases of cardiac arrest were identified, of which 246 (57.3%) were dispatched using a ‘cardiac arrest’ code. 6 callers (1.4%) used the term ‘cardiac arrest’ or a synonym. Key indicator symptoms reported most frequently were unconsciousness (64.8%), ineffective breathing (61.9%), and absent breathing (48.8%). Descriptors of conscious level included diverse colloquialisms and terms relating to reduced or fluctuating level of consciousness (17.2%). Descriptors of ineffective breathing included diverse terms relating to slow, fast, irregular, agonal, dyspnoea, and shallow breathing, plus nonspecific terms (e.g. ‘breathing’s funny); and ‘don’t know’ statements.ConclusionCallers’ descriptors of key symptoms of OHCA are varied and include many colloquialisms. Call handler training should include awareness of likely descriptions, particularly of ineffective breathing, which may be more commonly reported than absent breathing.
Impact of QTc formulae in the prevalence of short corrected QT interval and impact on probability and diagnosis of short QT syndrome
Authors: Providência Rui , Karim Nabeela , Srinivasan Neil , Honarbakhsh Shohreh , Vidigal Ferreira Maria João , Gonçalves Lino , Marijon Eloi , Lambiase Pier D 
Published: September 2017

ObjectiveTo assess the prevalence of short corrected QT (QTc) intervals and its impact on short QT syndrome (SQTS) diagnosis using different QT correction formulae.MethodsObservational study. The prevalence of short QTc intervals was estimated using four different QT correction formulae in 14 662 young adults from the ‘Sudden Cardiac Death Screening of Risk FactOrS’ (SCD-SOS) cohort. Then, using data from this cohort and the pooled-cohort analysed by Gollob et al, comprising 61 patients with SQTS, we assessed the impact of the different QTc correction formulae on SQTS probability and diagnosis based on the Expert Consensus recommendations (QTc ≤330 ms or QTc 330–360 ms+1 additional risk feature).ResultsThe prevalence of individuals with a QTc ≤330 and ≤320 ms in the SCD-SOS cohort was extremely low (≤0.07% and≤0.02%, respectively), and these were more frequently identified by the Framingham correction. The different QTc correction formulae led to a shift in SQTS probability in 5%–10% of individuals in both the SCD-SOS and Gollob cohort). Intermediate probability individuals were rare (<0.1%), and no high-SQTS probability individuals were identified in the SCD-SOS cohort. Based on Consensus criteria, instead of 12 (0.08%) individuals being diagnosed with SQTS using the Bazett equation, a different number of individuals would meet diagnostic criteria with the other formulae: 11 (0.08%) using Fridericia, 9 (0.06%) with Hodges and 16 (0.11%) using the Framingham equation.ConclusionPrevalence of SQTS in the apparently healthy adult population is low. Applying different QTc correction formulae leads to significant reclassification of SQTS probability and their impact on predicting outcomes should be assessed.
Achieving comprehensive disease control in patients with early and established rheumatoid arthritis treated with adalimumab plus methotrexate versus methotrexate alone
Authors: Keystone Edward C , Breedveld Ferdinand C , Heijde Désirée van der , van Vollenhoven Ronald F , Emery Paul , Smolen Josef S , Sainsbury Iain , Florentinus Stefan , Kupper Hartmut , Chen Kun , Kavanaugh Arthur 
Published: September 2017

ObjectiveTo evaluate the achievement of comprehensive disease control (CDC) following 1 year of treatment with adalimumab+methotrexate versus methotrexate alone and whether early achievement of remission (at week 24 or 26) is associated with CDC at week 52 in patients with either early or established rheumatoid arthritis (RA).MethodsPost hoc analyses were conducted in three clinical studies assessing treatment with adalimumab+methotrexate: DE019 (NCT00195702) enrolled patients with established RA who were methotrexate inadequate responders; OPTIMA (NCT00420927) and PREMIER (NCT00195663) enrolled methotrexate-naive patients with early RA. In OPTIMA, patients not achieving stable low disease activity at weeks 22 and 26 in the placebo+methotrexate group could receive open-label adalimumab+methotrexate for 52 weeks (Rescue ADA arm). CDC was defined as the simultaneous achievement of clinical remission (DAS28(CRP)<2.6), normal function (HAQ-DI<0.5) and absence of radiographic progression (ΔmTSS≤0.5).ResultsRegardless of disease duration, significantly more patients receiving adalimumab+methotrexate achieved CDC compared with methotrexate alone. In the adalimumab+methotrexate group, a numerically greater proportion of patients with early RA (~25%) versus established RA (14%) achieved CDC at 1 year; achievement of CDC was notably greater among patients who met criteria for remission at week 24 or 26 (~50% of patients with early RA and 39% with established RA).ConclusionTreatment with adalimumab+methotrexate increases the likelihood of achieving CDC in patients with either early or established RA. Clinical remission at week 24 or 26 is associated with achievement of CDC at week 52.Trial registration numberDE019 (NCT00195702), OPTIMA (NCT00420927), PREMIER (NCT00195663); Post-results.
Pharmacokinetics of marbofloxacin administered via intravenous regional limb perfusion in dairy cows: evaluation of two different tourniquets
Authors: Celani Gianluca , Tulini Serena Maria Rita , Montesano Camilla , Zezza Daniela , Sergi Manuel , Varasano Vincenzo , Mortellaro Carlo Maria , Compagnone Dario , Amorena Michele , Petrizzi Lucio 
Published: September 2017

ObjectivesThis study evaluated synovial and systemic plasma pharmacokinetic variables of marbofloxacin after a single intravenous regional limb perfusion (IVRLP) performed using two different tourniquets in clinically healthy, standing, non‐sedated dairy cows. The authors hypothesised that the type of tourniquet used for IVRLP would influence the synovial fluid concentration of marbofloxacin in the perfused distal limb.DesignThe study had a randomised parallel‐group design.MethodsTen adult dairy cows were included. Unilateral hindlimb IVRLP through the dorsal common digital III vein was performed in two groups of five cows (group 1: wide rubber tourniquet; group 2: manual pneumatic tourniquet) using 0.67 mg/kg of marbofloxacin. The tourniquet was applied proximal to the tarsus and maintained for 30 minutes. Samples of jugular blood and synovial fluid from the tibiotarsal joints of the perfused limb were obtained before and at intervals after IVRLP. All samples were analysed for drug concentrations using liquid chromatography tandem mass spectrometry. Pharmacokinetic parameters were determined to establish the influence of tourniquet types. Differences were considered significant at P≤0.05.ResultsNo adverse effects from the procedure or marbofloxacin were observed in any animal. Significant differences in synovial concentrations and pharmacokinetic parameters were measured. The mean ± sd areas under the concentration versus time curve from time 0 to 24 hours were 178.98±58.08 µg hour/ml for group 2 and 21.11±9.93 µg hour/ml for group 1. The mean ± sd maximum marbofloxacin concentrations were 75.50±10.19 µg/ml for group 2 and 6.35±1.47 µg/ml for group 1.ConclusionsPerforming IVRLP using the dorsal common digital III vein and a manual pneumatic tourniquet set at 300 mmHg above the tarsus in standing cows resulted in significantly higher marbofloxacin concentrations in the tibiotarsal joint compared with those with the wide rubber tourniquet.Trial registrationLocal ethical committee (number 41/2012/CEISA).
Factors related to work and life satisfaction of veterinary practitioners in Germany
Authors: Kersebohm Johanna C , Lorenz Timo , Becher Anne , Doherr Marcus G 
Published: September 2017

ObjectivesVeterinary practitioners’ working situation is both challenging and changing. They have higher levels of work‐related stress and suicide risk than the general population. The proportion of women is increasing, and in Germany especially women and employed veterinarians are reported to be less satisfied than comparable subgroups of the general population. In this study we identified key factors associated with work and life satisfaction among veterinary practitioners in Germany.DesignQuestionnaire‐based cross‐sectional survey.SettingAll veterinary practitioners registered in Germany in 2016.ParticipantsThere were 2549 respondents, of whom 1930 met the inclusion criteria for further analysis. They had a median age of 37 and the majority of respondents were women (79.3 per cent). Almost two‐thirds (63.8 per cent) worked as employed veterinarian.Primary outcomesImportance of different job characteristics measured in 5‐point Likert items, work satisfaction measured on a 5‐point Likert item and life satisfaction measured in 11‐point Likert items.Secondary outcomesFacets such as satisfaction with leisure time, family life, health and standard of living, information on working conditions such as working time, income, as well as year of birth and other demographic data.ResultsA ‘good working atmosphere’ was the most relevant job characteristic for all veterinary practitioners. Work satisfaction of employed practitioners is closely linked to satisfaction with their colleagues. This link is less pronounced for self‐employed practitioners. A ‘reasonable salary’ was the second and ‘holidays and leisure time’ was the third most important job characteristics for employed practitioners. A ‘good working atmosphere’ and ‘family friendly arrangements’ were statistically significantly more important for women than for men, while a ‘reasonable salary’ was more important for men.ConclusionsOur results indicate strong associations between levels of work satisfaction and various work‐related factors in subgroups of veterinary practitioners in Germany that reduce life satisfaction. The strength of some associations differs between men and women, as well as between self‐employed and employed veterinarians. Outgoing students should be better prepared for the challenging working conditions that they face in veterinary practice. Salary levels should be improved and the working conditions adapted to the respective subgroups in order to increase work and life satisfaction.
T-joins in strongly connected hypergraphs
Authors: Calinescu Gruia 
Published: September 2017

Given an edge-weighted undirected hypergraph [Formula: see text] and an even-sized set of vertices [Formula: see text], a T-cut is a partition of [Formula: see text] into two parts [Formula: see text] and [Formula: see text] such that [Formula: see text] is odd. A T-join in [Formula: see text] for [Formula: see text] is a set of hyperedges [Formula: see text] such that for every T-cut [Formula: see text] there is a hyperedge [Formula: see text] intersecting both [Formula: see text] and [Formula: see text]. A directed hypergraph has for every hyperedge exactly one vertex, called the head, and several vertices, that are tails. A directed hypergraph is strongly connected if there exists at least one directed path between any two vertices of the hypergraph, where a directed path is defined to be a sequence of vertices and hyperedges for which each hyperedge has as one of its tails the vertex preceding it and as its head the vertex following it in the sequence. Orienting an undirected hypergraph means choosing a head for each hyperedge. We prove that every edge-weighted undirected hypergraph that admits a strongly connected orientation has a T-join of total weight at most [Formula: see text] times the total weight of all the edges of the hypergraph, and sketch an improvement to [Formula: see text]. We also exhibit a series of example showing that one cannot improve the constant above to [Formula: see text].