bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website
Authors: Wallace Paul , Struzzo Pierliugi , Della Vedova Roberto , Scafuri Francesca , Tersar Costanza , Lygidakis Charilaos , McGregor Richard , Scafato Emanuele , Hunter Rachael , Freemantle Nick 
Published: November 2017

BackgroundBrief interventions (BIs) delivered in primary care have been shown to be effective in reducing risky drinking, but implementation is limited. Facilitated access to a digital application offers a novel alternative to face-to-face intervention, but its relative effectiveness is unknown.MethodsPrimary care-based, non-inferiority, randomised controlled trial comparing general practitioner (GP) facilitated access to an interactive alcohol reduction website (FA) with face-to-face BI for risky drinking. Patients screening positive on the short Alcohol Use Disorders Identification Test (AUDIT-C) were invited to participate in the trial. Assessment at baseline, 3 months and 12 months was carried out using AUDIT and EQ-5D-5L questionnaires.Findings58 participating GPs approached 9080 patients of whom 4529 (49.9%) logged on, 3841 (84.8%) undertook screening, 822 (21.4%) screened positive and 763 (19·9%) were recruited. 347 (45.5%) were allocated to FA and 416 (54.5%) to BI. At 3 months, subjects in FA group with an AUDIT score of ≥8 reduced from 95 (27.5%) to 85 (26.8%) while those in BI group increased from 123 (20.6%) to 141 (37%). Differences between groups were principally due to responses to AUDIT question 10. Analysis of primary outcome indicated non-inferiority of FA compared with BI, and prespecified subgroup analysis indicated benefits for older patients and those with higher levels of computer literacy and lower baseline severity. Additional analyses undertaken to take account of bias in response to AUDIT question 10 failed to support non-inferiority within the prespecified 10% boundary.InterpretationPrespecified protocol-driven analyses of the trial indicate that FA is non-inferior to BI; however, identified bias in the outcome measure and further supportive analyses question the robustness of this finding. It is therefore not possible to draw firm conclusions from this trial, and further research is needed to determine whether the findings can be replicated using more robust outcome measures.Trial registration numberNCT01638338; Results.
Perceived barriers to leisure time physical activity in adults with type 2 diabetes attending primary healthcare in Oman: a cross-sectional survey
Authors: Alghafri Thamra , Alharthi Saud M , Al Farsi Yahya Mohd , Bannerman Elaine , Craigie Angela Mary , Anderson Annie S 
Published: November 2017

ObjectivesPhysical activity is fundamental in diabetes management for good metabolic control. This study aimed to identify barriers to performing leisure time physical activity and explore differences based on gender, age, marital status, employment, education, income and perceived stages of change in physical activity in adults with type 2 diabetes in Oman.DesignCross-sectional study using an Arabic version of the ‘Barriers to Being Active’ 27-item questionnaire.SettingSeventeen primary health centres randomly selected in Muscat.ParticipantsIndividuals>18 years with type 2 diabetes, attending diabetes clinic for >2 years and with no contraindications to performing physical activity.Primary and secondary outcome measuresParticipants were asked to rate how far different factors influenced their physical activity under the following categories: fear of injury, lack of time, social support, energy, willpower, skills, resources, religion and environment. On a scale of 0–9, barriers were considered important if scored ≥5.ResultsA total of 305 questionnaires were collected. Most (96%) reported at least one barrier to performing leisure time physical activity. Lack of willpower (44.4%), lack of resources (30.5%) and lack of social support (29.2%) were the most frequently reported barriers. Using χ2test, lack of willpower was significantly different in individuals with low versus high income (54.2%vs40%, P=0.002) and in those reporting inactive versus active stages of change for physical activity (50.7%vs34.7%, P=0.029), lack of resources was significantly different in those with low versus high income (40%vs24.3%, P=0.004) and married versus unmarried (33.8%vs18.5%, P=0.018). Lack of social support was significant in females versus males (35.4%vs20.8%, P=0.005).ConclusionsThe findings can inform the design on physical activity intervention studies by testing the impact of strategies which incorporate ways to address reported barriers including approaches that enhance self-efficacy and social support.
Clinical and economic evaluation of modulated electrohyperthermia concurrent to dose-dense temozolomide 21/28 days regimen in the treatment of recurrent glioblastoma: a retrospective analysis of a two-centre German cohort trial with systematic comparison and effect-to-treatment analysis
Authors: Roussakow Sergey V 
Published: November 2017

ObjectiveTo assess the efficacy and cost-effectiveness of modulated electrohyperthermia (mEHT) concurrent to dose-dense temozolomide (ddTMZ) 21/28 days regimen versus ddTMZ 21/28 days alone in patients with recurrent glioblastoma (GBM).DesignA cohort of 54 patients with recurrent GBM treated with ddTMZ+mEHT in 2000–2005 was systematically retrospectively compared with five pooled ddTMZ 21/28 days cohorts (114 patients) enrolled in 2008–2013.ResultsThe ddTMZ+mEHT cohort had a not significantly improved mean survival time (mST) versus the comparator (p=0.531) after a significantly less mean number of cycles (1.56 vs 3.98, p<0.001). Effect-to-treatment analysis (ETA) suggests that mEHT significantly enhances the efficacy of the ddTMZ 21/28 days regimen (p=0.011), with significantly less toxicity (no grade III–IV toxicity vs 45%–92%, p<0.0001). An estimated maximal attainable median survival time is 10.10 months (9.10–11.10). Cost-effectiveness analysis suggests that, unlike ddTMZ 21/28 days alone, ddTMZ+mEHT is cost-effective versus the applicable cost-effectiveness thresholds €US$25 000–50 000/quality-adjusted life year (QALY). Budget impact analysis suggests a significant saving of €8 577 947/$11 201 761 with 29.1–38.5 QALY gained per 1000 patients per year. Cost-benefit analysis suggests that mEHT is profitable and will generate revenues between €3 124 574 and $6 458 400, with a total economic effect (saving+revenues) of €5 700 034 to $8 237 432 per mEHT device over an 8-year period.ConclusionsOur ETA suggests that mEHT significantly improves survival of patients receiving the ddTMZ 21/28 days regimen. Economic evaluation suggests that ddTMZ+mEHT is cost-effective, budget-saving and profitable. After confirmation of the results, mEHT could be recommended for the treatment of recurrent GBM as a cost-effective enhancer of ddTMZ regimens, and, probably, of the regular 5/28 days regimen. mEHT is applicable also as a single treatment if chemotherapy is impossible, and as a salvage treatment after the failure of chemotherapy.
Beyond the diagnosis: a qualitative exploration of the experiences of persons with hepatitis B in the Accra Metropolis, Ghana
Authors: Adjei Charles Ampong , Naab Florence , Donkor Ernestina S 
Published: November 2017

ObjectiveThis study explored the experiences of people with hepatitis B in the Accra metropolis.DesignThe study employed qualitative exploratory descriptive design with purposive sampling technique. Data were collected through face-to-face interview and transcribed verbatim. The data were analysed using content analysis.SettingsParticipants were recruited from one government and one mission hospital in Ghana.ParticipantsFourteen individuals aged between 26 and 45 years with hepatitis B infection were interviewed.ResultsThe findings of the study showed that people with hepatitis B in the Accra metropolis were unclear about the impact of their infection. Furthermore, they experienced psychological and social problems especially when they were initially informed about their hepatitis B status. Sadness, fear, shock, shame and disbelief were some of the experiences reported by participants. Coping strategies adopted include religiosity, denial and lifestyle modification.ConclusionsIt is, therefore, necessary as a country to integrate hepatitis B counselling into the already existing HIV structures in the health delivery system to offer support for individuals diagnosed with hepatitis B. Furthermore, it is important to draw lessons from the process used in the diagnosis of HIV, particularly in ensuring that people provide consent for being tested.
Development of a clinical pharmacy model within an Australian home nursing service using co-creation and participatory action research: theVisitingPharmacist (ViP) study
Authors: Elliott Rohan A , Lee Cik Yin , Beanland Christine , Goeman Dianne P , Petrie Neil , Petrie Barbara , Vise Felicity , Gray June 
Published: November 2017

ObjectiveTo develop a collaborative, person-centred model of clinical pharmacy support for community nurses and their medication management clients.DesignCo-creation and participatory action research, based on reflection, data collection, interaction and feedback from participants and other stakeholders.SettingA large, non-profit home nursing service in Melbourne, Australia.ParticipantsOlder people referred to the home nursing service for medication management, their carers, community nurses, general practitioners (GPs) and pharmacists, a multidisciplinary stakeholder reference group (including consumer representation) and the project team.Data collection and analysisFeedback and reflections from minutes, notes and transcripts from: project team meetings, clinical pharmacists’ reflective diaries and interviews, meetings with community nurses, reference group meetings and interviews and focus groups with 27 older people, 18 carers, 53 nurses, 15 GPs and seven community pharmacists.ResultsThe model was based on best practice medication management standards and designed to address key medication management issues raised by stakeholders. Pharmacist roles included direct client care and indirect care. Direct care included home visits, medication reconciliation, medication review, medication regimen simplification, preparation of medication lists for clients and nurses, liaison and information sharing with prescribers and pharmacies and patient/carer education. Indirect care included providing medicines information and education for nurses and assisting with review and implementation of organisational medication policies and procedures. The model allowed nurses to refer directly to the pharmacist, enabling timely resolution of medication issues. Direct care was provided to 84 older people over a 15-month implementation period. Ongoing feedback and consultation, in line with participatory action research principles, informed the development and refinement of the model and identification of enablers and challenges.ConclusionsA collaborative, person-centred clinical pharmacy model that addressed the needs of clients, carers, nurses and other stakeholders was successfully developed. The model is likely to have applicability to home nursing services nationally and internationally.
A systematic approach to injury policy assessment: introducing the assessment of child injury prevention policies (A-CHIPP)
Authors: Alonge Olakunle , Agrawal Priyanka , Meddings David , Hyder Adnan A 
Published: November 2017

IntroductionThis study presents a systematic approach—assessment of child injury prevention policies (A-CHIPP)—to assess and track policies on effective child injury interventions at the national level. Results from an initial pilot test of the approach in selected countries are presented.MethodA literature review was conducted to identify conceptual models for injury policy assessment, and domains and indicators were proposed for assessing national injury policies for children aged 1–9 years. The indicators focused on current evidence-supported interventions targeting the leading external causes of child injury mortality globally, and were organised into a self-administered A-CHIPP questionnaire comprising 22 questions. The questionnaire was modified based on reviews by experts in child injury prevention. For an initial test of the approach, 13 countries from all six WHO regions were selected to examine the accuracy, usefulness and ease of understanding of the A-CHIPP questionnaire.ResultsData on the A-CHIPP questionnaire were received from nine countries. Drowning and road traffic injuries were reported as the leading causes of child injury deaths in seven of these countries. Most of the countries lacked national policies on interventions that address child injuries; supportive factors such as finance and leadership for injury prevention were also lacking. All countries rated the questionnaire highly on its relevance for assessment of injury prevention policies.ConclusionThe A-CHIPP questionnaire is useful for national assessment of child injury policies, and such an assessment could draw attention of stakeholders to policy gaps and progress in child injury prevention in all countries.
Alcohol and other substance use among medical and law students at a UK university: a cross-sectional questionnaire survey
Authors: Bogowicz Paul , Ferguson Jennifer , Gilvarry Eilish , Kamali Farhad , Kaner Eileen , Newbury-Birch Dorothy 
Published: November 2017

AbstractPurpose of the studyTo examine the use of alcohol and other substances among medical and law students at a UK university.Study designAnonymous cross-sectional questionnaire survey of first, second and final year medical and law students at a single UK university.Results1242 of 1577 (78.8%) eligible students completed the questionnaire. Over half of first and second year medical students (first year 53.1%, second year 59.7%, final year 35.9%) had an Alcohol Use Disorders Identification Test (AUDIT) score suggestive of an alcohol use disorder (AUDIT≥8), compared with over two-thirds of first and second year law students (first year 67.2%, second year 69.5%, final year 47.3%). Approximately one-quarter of medical students (first year 26.4%, second year 28.4%, final year 23.7%) and over one-third of first and second year law students (first year 39.1%, second year 42.4%, final year 18.9%) reported other substance use within the past year. Over one-third of medical students (first year 34.4%, second year 35.6%, final year 46.3%) and approximately half or more of law students (first year 47.2%, second year 52.7%, final year 59.5%) had a Hospital Anxiety and Depression Scale anxiety score suggestive of a possible anxiety disorder.ConclusionsStudy participants had high levels of substance misuse and anxiety. Some students’ fitness to practice may be impaired as a result of their substance misuse or symptoms of psychological distress. Further efforts are needed to reduce substance misuse and to improve the mental well-being of students.
Clinical indicators of hemorrhagic shock in pregnancy
Authors: Jenkins Peter C , Stokes Samantha M , Fakoyeho Stephen , Bell Teresa M , Zarzaur Ben L 
Published: November 2017

BackgroundSeveral hemodynamic parameters have been promoted to help establish a rapid diagnosis of hemorrhagic shock, but they have not been well validated in the pregnant population. In this study, we examined the association between three measures of shock and early blood transfusion requirements among pregnant trauma patients.MethodsThis study included 81 pregnant trauma patients admitted to a level 1 trauma center (2010–2015). In separate logistic regression models, we tested the relationship between exposure variables—initial systolic blood pressure (SBP), shock index (SI), and rate over pressure evaluation (ROPE)—and the outcome of transfusion of blood products within 24 hours of admission. To test the predictive ability of each measure, we used receiver operating characteristic (ROC) curves.ResultsA total of 10% of patients received blood products in the patient cohort. No patients had an initial SBP≤90, so the SBP measure was excluded from analysis. We found that patients with SI>1 were significantly more likely to receive blood transfusions compared with patients with SI<1 (OR 10.35; 95% CI 1.80 to 59.62), whereas ROPE>3 was not associated with blood transfusion compared with ROPE≤3 (OR 2.92; 95% CI 0.28 to 30.42). Furthermore, comparison of area under the ROC curve for SI (0.68) and ROPE (0.54) suggested that SI was more predictive than ROPE of blood transfusion.ConclusionWe found that an elevated SI was more closely associated with early blood product transfusion than SBP and ROPE in injured pregnant patients.Level of evidencePrognostic, level III
IDO Immune Status after Chemoradiation May Predict Survival in Lung Cancer Patients
Authors: Wang Weili , Huang Lei , Jin Jian-Yue , Jolly Shruti , Zang Yong , Wu Huanmei , Yan Li , Pi Wenhu , Li Lang , Mellor Andrew L. , Kong Feng-Ming (Spring) 
Published: November 2017

Abstract
Host immunity influences the impact of radiotherapy (RT) in cancer, but mechanistic connections remain obscure. In this study, we investigated the relationship of indoleamine 2,3-dioxygenase (IDO) systemic activity on clinical outcomes in RT-treated non–small cell lung cancer (NSCLC). IDO-mediated production of kynurenine and the kynurenine:tryptophan ratio in patient blood serum were determined for stage III NSCLC patients at times before, during, and after RT administration and then correlated to overall survival (OS), progression-free survival, and disease progression rate in patients. We found the impact of RT on these serum IDO markers to be heterogeneous in patients. On average, kynurenine:tryptophan ratios were reduced during RT but restored after RT. Notably, both baseline levels of kynurenine:tryptophan and changes in the levels of kynurenine after RT were significantly associated with OS. When combined, favorable change and favorable baseline corresponded with very long-term OS (median OS was not reached after 57 months of median follow-up). Favorable change combined with unfavorable baseline still corresponded with a lack of distant metastases. Our results suggest that RT alters IDO-mediated immune status in NSCLC patients and that changes in this serum biomarker may be useful to predict outcomes and perhaps personalize RT dosage to improve survival.
Significance: Radiotherapy appears to influence systemic IDO activity and to exert a significant impact on metastatic risk and overall survival, with possible implications for defining a biomarker to optimize radiation dose in patients to improve outcomes. Cancer Res; 78(3); 809–16. ©2017 AACR.
Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension
Authors: Doumas Michael , Tsioufis Costas , Fletcher Ross , Amdur Richard , Faselis Charles , Papademetriou Vasilios 
Published: November 2017

Background

Accumulating evidence indicates that reducing systolic blood pressure (
BP
) to <140 mm Hg improves health outcomes; however, an optimal level has not yet been determined. Many population studies or post hoc analyses suggest a target systolic
BP
between 120 and 140 mm Hg with increased risk above and below that range. We tested the hypothesis that consistent control of systolic
BP
between 120 and 140 mm Hg—time in therapeutic range—is a strong determinant of all‐cause mortality among
US
veterans.

Methods and Results

A total of 689 051 individuals from 15 Veterans Administration Medical Centers were followed over a 10‐year period. Participants were classified as hypertensive, intermediate hypertensive, and normotensive according to the number of elevated
BP
recordings (>3, 1 or 2, and none, respectively). Time within, above, or below therapeutic range (120–140 mm Hg) was considered in quartiles and related to all‐cause mortality. The study population consisted of 54% hypertensive, 19.9% intermediate, and 26.1% normotensive participants; the corresponding mortality rates for the 3 groups were 11.5%, 8%, and 1.9%, respectively (
P
<0.0001 for all comparisons). Mortality rates for hypertensive participants with
BP
consistently within, above, or below the therapeutic range were 6.5%, 21.9%, and 33.1%, respectively (
P
<0.0001 for all comparisons). Mortality rates in hypertensive participants increased from 6.5% in the most consistently controlled quartile (>75%) to 8.9%, 15.6%, and 23.5% towards the less consistently controlled quartiles (50–75%, 25–50%, and <25%, respectively;
P
<0.0001 for all comparisons).

Conclusions

An inverse and gradual association between time in therapeutic range and all‐cause mortality was observed in this large veteran cohort. Consistency of
BP
control over time is a strong determinant of all‐cause mortality, and consistency of
BP
control should be monitored in everyday clinical practice.
Redescription and new records of Jansen’s goatfish, Parupeneus jansenii (Mullidae), from the Western Pacific and Eastern Indian Ocean
Authors: UIBLEIN FRANZ , HOANG TUAN ANH , GLEDHILL DANIEL 
Published: November 2017

For Jansen’s goatfish, Parupeneus jansenii (Mullidae), taxonomic knowledge has been rather poor and occurrence information restricted to a few localities only, with verified records from northern Sulawesi and Sunda Street (Indonesia), and Luzon (Philippines). This species is here included in the so-called “heptacanthus” group together with the Indo-Pacific cinnabar goatfish, P. heptacanthus, and five Indian Ocean congenerics, based on an evenly, symmetrically rounded posterior maxilla margin and similarities in meristic characters and preserved colour. In total 29 P. jansenii and 53 P. heptacanthus consisting of types, recently collected material from south-central Vietnam, southern Indonesia, and NE Australia, and geographically related reference material were studied along with single types of the other five heptacanthus-group species and P. angulatus, a morphologically similar Western Indian Ocean species. In total 62 quantitative meristic and morphometric characters including standard length (SL) were analysed after splitting the data into two size classes (small-sized fish, < 110 mm SL, vs. large-sized fish > 110 mm SL) to account for size-related differences due to allometry. Diagnoses for P. jansenii and P. heptacanthus and a redescription for P. jansenii were prepared. Fresh-fish colour descriptions for both large- and small-sized voucher specimens of P. jansenii are provided and the effects of freshness status on colour patterns is documented. New records for P. jansenii for Vietnam, southern Indonesia and NE Australia (= first verified record for Australia) are reported and depth information (24–100 m depth range) is given for the first time. P. jansenii differs from the co-occurring P. heptacanthus - independently of size - in shallower body and caudal peduncle, smaller maximum head depth, shorter barbels, caudal and pelvic fins, shallower first dorsal fin, shallower first ray of second dorsal fin, and lack of small dark red or reddish-brown spot on or just below the eighth lateral-line scale. The populations of P. jansenii from Vietnam and Australia differ from each other in a single character, the height of the eighth dorsal-fin ray, but both overlap with the intermediate population from Indonesia. This comprehensive alpha-taxonomic approach provides a useful tool for uncovering the diversity of Parupeneus goatfishes.