bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiential learning to increase palliative care competence among the Indigenous workforce: an Australian experience
Authors: Shahid Shaouli , Ekberg Stuart , Holloway Michele , Jacka Catherine , Yates Patsy , Garvey Gail , Thompson Sandra C 
Published: January 2018

ObjectivesImproving Indigenous people’s access to palliative care requires a health workforce with appropriate knowledge and skills to respond to end-of-life (EOL) issues. The Indigenous component of the Program of Experience in the Palliative Approach (PEPA) includes opportunities for Indigenous health practitioners to develop skills in the palliative approach by undertaking a supervised clinical placement of up to 5 days within specialist palliative care services. This paper presents the evaluative findings of the components of an experiential learning programme and considers the broader implications for delivery of successful palliative care education programme for Indigenous people.MethodsSemistructured interviews were conducted with PEPA staff and Indigenous PEPA participants. Interviews were recorded, transcribed and key themes identified.ResultsParticipants reported that placements increased their confidence about engaging in conversations about EOL care and facilitated relationships and ongoing work collaboration with palliative care services. Management support was critical and placements undertaken in settings which had more experience caring for Indigenous people were preferred. Better engagement occurred where the programme included Indigenous staffing and leadership and where preplacement and postplacement preparation and mentoring were provided. Opportunities for programme improvement included building on existing postplacement and follow-up activities.ConclusionsA culturally respectful experiential learning education programme has the potential to upskill Indigenous health practitioners in EOL care.
Systematic review of general practice end-of-life symptom control
Authors: Mitchell Geoffrey K , Senior Hugh E , Johnson Claire E , Fallon-Ferguson Julia , Williams Briony , Monterosso Leanne , Rhee Joel J , McVey Peta , Grant Matthew P , Aubin Michèle , Nwachukwu Harriet TG , Yates Patsy M 
Published: January 2018

BackgroundEnd of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice’s role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.ObjectiveTo provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.MethodSystematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.ResultsFrom 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.ConclusionsIt is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.
IMPLSE course: a near-peer simulation course
Authors: Collinson Joseph W , Brown Thomas , Chalmers Louis A , Gales Alistair , Shepherd Laura 
Published: January 2018

BackgroundNear-peer teaching is recognised for its benefit to both students and facilitators when used as an adjunct to traditional teaching. Simulation is an effective tool for teaching acute management. There are currently no published long-term objective data of the efficacy of near-peer simulation teaching.MethodsWe designed the ‘Immediate Management: Peer Led Simulated Emergencies’ course, a near-peer simulation course for medical students run by junior doctors covering common medical and surgical emergencies. Participants and teachers were objectively tested before and after sessions, and participant confidence in various areas was self-assessed. Participants were followed up at 18 months with both repeat testing and analysis of finals examination results.ResultsParticipants’ mean test scores improved significantly postcourse and remained significantly higher than baseline at 18-month follow-up. There was no difference between participants’ and non-participants’ final examination performance. Participant confidence increased in all areas immediately and at 18-month follow-up. Junior doctor facilitator test scores significantly improved after teaching on the course.ConclusionsNear-peer simulation courses can be effectively designed and run by junior doctors and our results suggest that they result in long-term improvement in test scores. Larger studies with randomised control groups are required to confirm the efficacy of such teaching.
Ward calls not so scary for medical students after interprofessional simulation course: a mixed-methods cohort evaluation study
Authors: Jowsey Tanisha , Yu Tsu-Chieh Wendy , Ganeshanantham Gihan , Torrie Jane , Merry Alan F , Bagg Warwick , Bacal Kira , Weller Jennifer 
Published: January 2018

BackgroundAn interprofessional simulation ‘ward call’ course—WardSim—was designed and implemented for medical, pharmacy and nursing students. We evaluated this intervention and also explored students’ experiences and ideas of both the course and of ward calls.MethodsWe used a mixed-methods cohort study design including survey and focus groups. Descriptive statistical analysis and general purpose thematic analysis were undertaken.ResultsSurvey respondents who participated in WardSim subsequently attended more ward calls and took a more active role than the control cohort, with 34% of the intervention cohort attending ward calls under indirect supervision, compared with 15% from the control cohort (P=0.004). Focus group participants indicated that the situation they were most anxious about facing in the future was attending a ward call. They reported that their collective experiences on WardSim alleviated such anxiety because it offered them experiential learning that they could then apply in real-life situations. They said they had learnt how to work effectively with other team members, to take on a leadership role, to make differential diagnoses under pressure and to effectively communicate and seek help.ConclusionsAn interprofessional, simulated ward call course increased medical students’ sense of preparedness for and participation in ward calls in the next calendar year.
A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme
Authors: Donaldson Alex , Callaghan Aisling , Bizzini Mario , Jowett Andrew , Keyzer Patrick , Nicholson Matthew 
Published: January 2018

Background and aimUnderstanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme.MethodsConcept mapping with data collected from 19 soccer coaches and administrators.ResultsBrainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3–10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the ‘Lack of 11+ knowledge among coaches’ cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the ‘Lack of facilities and resources’ cluster received the lowest mean importance rating (2.23), while statements in the ‘Lack of time at training’ cluster received the lowest mean feasibility rating (2.19).ConclusionsA multistrategy, ecological approach to implementing the 11+—with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership—is required to improve the uptake of the 11+ among the targeted coaches.
Trainee Leadership Board: learning about NHS leadership
Authors: Stegen Gerti , Leveson Daniel , Llewelyn Susan , De Giorgi Riccardo 
Published: January 2018

IntroductionThe development of a new generation of clinical leaders in the NHS has been increasingly endorsed by most recent literature in medical leadership and management. Despite providing academic rationale and argument, however, current training programmes fail to integrate the theoretical and practical aspects of clinical leadership and to implement them in practice within medical training curricula.MethodsIn Oxford Health National Health Service Foundation Trust, a Trainee Leadership Board programme was offered to a small group of next-generation clinical leaders as an opportunity to learn about current leadership and management in the Trust. This programme provided insights and practical experiences through an integrated educational and experiential approach in resolving a real issue facing the Trust.Results and conclusionOverall, the programme proved successful in creating a culture of increased interest and promoting change in attitude and behaviour around leadership and management. Time constraints and implementation of change represented significant challenges for the Trainee Leadership Board. However, the programme holds promise for its diffusion across the country.
Effects of disease severity distribution on the performance of quantitative diagnostic methods and proposal of a novel ‘V-plot’ methodology to display accuracy values
Authors: Petraco Ricardo , Dehbi Hakim-Moulay , Howard James P , Shun-Shin Matthew J , Sen Sayan , Nijjer Sukhjinder S , Mayet Jamil , Davies Justin E , Francis Darrel P 
Published: January 2018

BackgroundDiagnostic accuracy is widely accepted by researchers and clinicians as an optimal expression of a test’s performance. The aim of this study was to evaluate the effects of disease severity distribution on values of diagnostic accuracy as well as propose a sample-independent methodology to calculate and display accuracy of diagnostic tests.Methods and findingsWe evaluated the diagnostic relationship between two hypothetical methods to measure serum cholesterol (Cholrapidand Cholgold) by generating samples with statistical software and (1) keeping the numerical relationship between methods unchanged and (2) changing the distribution of cholesterol values. Metrics of categorical agreement were calculated (accuracy, sensitivity and specificity). Finally, a novel methodology to display and calculate accuracy values was presented (the V-plot of accuracies).ConclusionNo single value of diagnostic accuracy can be used to describe the relationship between tests, as accuracy is a metric heavily affected by the underlying sample distribution. Our novel proposed methodology, the V-plot of accuracies, can be used as a sample-independent measure of a test performance against a reference gold standard.
Early versus newer generation devices for transcatheter aortic valve implantation in routine clinical practice: a propensity score matched analysis
Authors: Pilgrim Thomas , Lee Joe K T , O’Sullivan Crochan J , Stortecky Stefan , Ariotti Sara , Franzone Anna , Lanz Jonas , Heg Dik , Asami Masahiko , Praz Fabien , Siontis George C M , Vollenbroich René , Räber Lorenz , Valgimigli Marco , Roost Eva , Windecker Stephan 
Published: January 2018

AimContemporary data comparing early versus newer generation transcatheter heart valve (THV) devices in routine clinical practice are lacking. We sought to compare the safety and efficacy of early versus newer generation THVs in unselected patients undergoing transcatheter aortic valve implantation (TAVI).Methods and resultsWe performed a propensity score matched analysis of patients undergoing transfemoral TAVI at a single centre with early versus newer generation devices between 2007 and 2016. Patients were matched for balloon-expandable versus self-expandable valves and Society of Thoracic Surgeons score. The primary end point was the Valve Academic Research Consortium (VARC)-2 early safety composite end point at 30 days. Among the 391 matched pairs, no differences between early (21.2%) and newer generation (20.8%) THVs regarding the early safety composite end point (HR 0.98, 95% CI 0.72 to 1.33, P=0.88) were observed. The rates of valve embolisation (0.8% vs 4.2%, P=0.005), bleeding events (24.8% vs 32.0%, P=0.028) and moderate-to-severe paravalvular regurgitation (PVR) (3.1% vs 12.1%, P<0.001) were lower among patients receiving newer generation devices. Conversely, patients treated with early generation THVs less frequently experienced annulus rupture (0% vs 2.0%, P=0.008).ConclusionNewer compared with early generation THV devices were associated with a lower rate of valve embolisation, PVR and bleeding events.
Protocol for a randomized trial of the effect of timing of cholecystectomy during initial admission for predicted mild gallstone pancreatitis at a safety-net hospital
Authors: Mueck Krislynn M , Wei Shuyan , Liang Mike K , Ko Tien C , Tyson Jon E , Kao Lillian S 
Published: January 2018

BackgroundThere is evidence-based consensus for laparoscopic cholecystectomy during index admission for predicted mild gallstone pancreatitis, defined by the absence of organ failure and of local or systemic complications. However, the optimal timing for surgery within that admission is controversial. Early cholecystectomy may shorten hospital length of stay (LOS) and increase patient satisfaction. Alternatively, it may increase operative difficulty and complications resulting in readmissions.MethodsThis trial is a single-center randomized trial of patients with predicted mild gallstone pancreatitis comparing laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) at index admission within 24 hours of presentation versus after clinical resolution on clinical and patient-reported outcomes (PROs). The primary endpoint is 30-day LOS (hours) after initial presentation, which includes the index admission and readmissions. Secondary outcomes are conversion to open, complications, time from admission to cholecystectomy, initial hospital LOS, number of procedures within 30 days, 30-day readmissions, and PROs (change in Gastrointestinal Quality-of-Life Index).DiscussionThe primary goal of this research is to obtain the least biased estimate of effect of timing of cholecystectomy for mild gallstone pancreatitis on clinical and PROs; the results of this trial will be used to inform patient care locally as well as to design future multicenter effectiveness and implementation trials. This trial will provide data regarding PROs including health-related quality of life that can be used in cost-utility and cost-effectiveness analyses.Trial registration numberNCT02806297, ClinicalTrials.gov.
Occurrence of preterm calving in Great Britain and associations with milk production and reproductive performance in dairy cattle
Authors: Damaso Angela Filipa , Velasova Martina , Van Winden Steven , Chang Yu‐mei , Guitian Javier 
Published: January 2018

This study describes the occurrence of preterm calving in Great Britain and evaluates its associations with subsequent milk production and reproductive performances and survival on farm of dairy cows. A total of 53 British dairy farms and 5759 animals with detailed breeding and milk recording data available were used to form two study groups: preterm calving (calving occurring between days 266 and 277 of gestation) and full‐term calving (calving occurring at 278 days of gestation and over). Mixed effects models were implemented to compare milk production, clinical cases of mastitis and number of services per conception between groups. Kaplan‐Meier curves and Cox regression analyses compared time from calving to conception, calving interval and survival on farm between groups. Preterm calving cows showed significantly lower milk yield (P<0.01) and butter fat per cent (P=0.02), increased milk protein per cent (P=0.01), longer survival on farm (P<0.01), and a tendency for shorter calving to conception intervals and fewer services per conception, although other factors were involved in the reproduction outcomes. Experiencing a preterm calving is associated with lower milk production and longer survival times on farm. Potential risk factors for preterm calving, such as infectious diseases, diet and husbandry practices, should be further investigated.
Preplant followed by postemergence herbicide programs and biologically effective rate of metribuzin for control of glyphosate-resistant common ragweed (Ambrosia artemisiifolia) in soybean
Authors: Byker Holly P. , Van Wely Annemarie C. , Jhala Amit J. , Soltani Nader , Robinson Darren E. , Lawton Mark B. , Sikkema Peter H. 
Published: January 2018

With no new herbicides with a novel mode of action in the marketplace in corn–soybean cropping systems, control of glyphosate-resistant (GR) weeds requires the re-evaluation of existing herbicides. This necessitates a renewed focus on using herbicide tank-mixes and sequential herbicide programs while also striving to minimize the environmental impact of weed management. Preliminary research identified four preplant (PP) herbicides (2,4-D, saflufenacil/dimethenamid-P, linuron, and metribuzin) and one postemergence (POST) herbicide (fomesafen) that provided good but inconsistent control of GR common ragweed when applied alone in soybean. The objectives of this study were to determine the biologically effective rate of metribuzin and evaluate PP followed by POST herbicide programs for control of GR common ragweed in soybean. The aforementioned PP herbicides reduced GR common ragweed density and aboveground biomass by 82%–94% and 55%–89%, respectively. In contrast, a PP herbicide followed by fomesafen applied POST decreased common ragweed densities and aboveground biomass by 97%–99% and 93%–98%, respectively. Metribuzin applied at 824 and 1015 g a.i. ha−1 controlled GR common ragweed 90% at 4 and 8 wk after application, respectively. This study concludes that GR common ragweed can be controlled with a PP followed by POST herbicide program and metribuzin has potential for control of GR common ragweed in soybean.
Witnessing matrix identities and proof complexity
Authors: Li Fu , Tzameret Iddo 
Published: January 2018

We use results from the theory of algebras with polynomial identities (PI-algebras) to study the witness complexity of matrix identities. A matrix identity of [Formula: see text] matrices over a field [Formula: see text]is a non-commutative polynomial (f(x1, …, xn)) over [Formula: see text], such that [Formula: see text] vanishes on every [Formula: see text] matrix assignment to its variables. For every field [Formula: see text]of characteristic 0, every [Formula: see text] and every finite basis of [Formula: see text] matrix identities over [Formula: see text], we show there exists a family of matrix identities [Formula: see text], such that each [Formula: see text] has [Formula: see text] variables and requires at least [Formula: see text] many generators to generate, where the generators are substitution instances of elements from the basis. The lower bound argument uses fundamental results from PI-algebras together with a generalization of the arguments in [P. Hrubeš, How much commutativity is needed to prove polynomial identities? Electronic colloquium on computational complexity, ECCC, Report No.: TR11-088, June 2011].We apply this result in algebraic proof complexity, focusing on proof systems for polynomial identities (PI proofs) which operate with algebraic circuits and whose axioms are the polynomial-ring axioms [P. Hrubeš and I. Tzameret, The proof complexity of polynomial identities, in Proc. 24th Annual IEEE Conf. Computational Complexity, CCC 2009, 15–18 July 2009, Paris, France (2009), pp. 41–51; Short proofs for the determinant identities, SIAM J. Comput. 44(2) (2015) 340–383], and their subsystems. We identify a decrease in strength hierarchy of subsystems of PI proofs, in which the [Formula: see text]th level is a sound and complete proof system for proving [Formula: see text] matrix identities (over a given field). For each level [Formula: see text] in the hierarchy, we establish an [Formula: see text] lower bound on the number of proof-steps needed to prove certain identities.Finally, we present several concrete open problems about non-commutative algebraic circuits and speed-ups in proof complexity, whose solution would establish stronger size lower bounds on PI proofs of matrix identities, and beyond.
Cardiovascular Safety, Long‐Term Noncardiovascular Safety, and Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus: A Systemic Review and Meta‐Analysis With Trial Sequential Analysis
Authors: Zhang Xin‐Lin , Zhu Qing‐Qing , Chen Yu‐Han , Li Xue‐Ling , Chen Fu , Huang Jian‐An , Xu Biao 
Published: January 2018

Background

The cardiovascular and long‐term noncardiovascular safety and efficacy of
SGLT
2 (sodium–glucose cotransporter 2) inhibitors have not been well documented.

Methods and Results

For cardiovascular outcomes, we performed a meta‐analysis with trial sequential analysis of randomized controlled trials and adjusted observational studies, each with a minimum of 26 weeks and 2000 patient‐years of follow‐up. For long‐term noncardiovascular safety and efficacy outcome analyses, we included only randomized controlled trials with at least 2 years and 1000 patient‐years of follow‐up. Five studies with 351 476 patients were included in cardiovascular outcomes analysis. Meta‐analyses showed that
SGLT
2 inhibitors significantly reduced the risks of major adverse cardiac events (hazard ratio [
HR
]: 0.80; 95% confidence interval [
CI
], 0.69–0.92;
P
=0.002), all‐cause mortality (
HR
: 0.67; 95%
CI
, 0.54–0.84;
P
<0.001), cardiovascular mortality (
HR
: 0.77; 95%
CI,
0.60–0.98;
P
=0.03), nonfatal myocardial infarction (
HR
: 0.86; 95%
CI
, 0.76–0.98;
P
=0.02), hospitalization for heart failure (
HR
: 0.62; 95%
CI
, 0.55–0.69;
P
<0.001), and progression of albuminuria (
HR
: 0.68; 95%
CI
, 0.58–0.81;
P
<0.001). No significant difference in nonfatal stroke was found. Analyses limited to randomized controlled trials showed similar findings. Trial sequential analysis provided firm evidence of a 20% reduction in major adverse cardiac events, all‐cause mortality, and hospitalization for heart failure with
SGLT
2 inhibitors, but evidence remains inconclusive for cardiovascular mortality. Nine randomized controlled trials contributed to long‐term noncardiovascular and efficacy analyses.
SGLT
2 inhibitors reduced incidence of hypoglycemia and acute kidney injury but increased the risks of urinary tract and genital infections.

Conclusions

SGLT
2 inhibitors showed remarkable cardiovascular‐ and renal‐protective effects and good long‐term noncardiovascular safety with sustained efficacy.