bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of including or excluding both-armed zero-event studies on using standard meta-analysis methods for rare event outcome: a simulation study
Authors: Cheng Ji , Pullenayegum Eleanor , Marshall John K , Iorio Alfonso , Thabane Lehana 
Published: August 2016

ObjectivesThere is no consensus on whether studies with no observed events in the treatment and control arms, the so-called both-armed zero-event studies, should be included in a meta-analysis of randomised controlled trials (RCTs). Current analytic approaches handled them differently depending on the choice of effect measures and authors' discretion. Our objective is to evaluate the impact of including or excluding both-armed zero-event (BA0E) studies in meta-analysis of RCTs with rare outcome events through a simulation study.MethodWe simulated 2500 data sets for different scenarios varying the parameters of baseline event rate, treatment effect and number of patients in each trial, and between-study variance. We evaluated the performance of commonly used pooling methods in classical meta-analysis—namely, Peto, Mantel-Haenszel with fixed-effects and random-effects models, and inverse variance method with fixed-effects and random-effects models—using bias, root mean square error, length of 95% CI and coverage.ResultsThe overall performance of the approaches of including or excluding BA0E studies in meta-analysis varied according to the magnitude of true treatment effect. Including BA0E studies introduced very little bias, decreased mean square error, narrowed the 95% CI and increased the coverage when no true treatment effect existed. However, when a true treatment effect existed, the estimates from the approach of excluding BA0E studies led to smaller bias than including them. Among all evaluated methods, the Peto method excluding BA0E studies gave the least biased results when a true treatment effect existed.ConclusionsWe recommend including BA0E studies when treatment effects are unlikely, but excluding them when there is a decisive treatment effect. Providing results of including and excluding BA0E studies to assess the robustness of the pooled estimated effect is a sensible way to communicate the results of a meta-analysis when the treatment effects are unclear.
Effectiveness of a multidisciplinary critical pathway based on a computerised physician order entry system for ST-segment elevation myocardial infarction management in the emergency department: a retrospective observational study
Authors: Park Yoo Seok , Chung Sung Phil , You Je Sung , Kim Min Joung , Chung Hyun Soo , Hong Jung Hwa , Lee Hye Sun , Wang Jinwon , Park Incheol 
Published: August 2016

ObjectivesThe purpose of this study was to investigate whether a multidisciplinary organised critical pathway (CP) for ST-segment elevation myocardial infarction (STEMI) management can significantly attenuate differences in the duration from emergency department (ED) arrival to evaluation and treatment, regardless of the arrival time, by eliminating off-hour and weekend effects.DesignRetrospective observational cohort study.Setting2 tertiary academic hospitals.ParticipantsConsecutive patients in the Fast Interrogation Rule for STEMI (FIRST) program.InterventionsA study was conducted on patients in the FIRST program, which uses a computerised physician order entry (CPOE) system. The patient demographics, time intervals and clinical outcomes were analysed based on the arrival time at the ED: group 1, normal working hours on weekdays; group 2, off-hours on weekdays; group 3, normal working hours on weekends; and group 4, off-hours on weekends.Primary and secondary outcome measuresClinical outcomes categorised according to 30-day mortality, in-hospital mortality and the length of stay.ResultsThe duration from door-to-data or FIRST activation did not differ significantly among the 4 groups. The median duration between arrival and balloon placement during percutaneous coronary intervention did not significantly exceed 90 min, and the proportions (89.6–95.1%) of patients with door-to-balloon times within 90 min did not significantly differ among the 4 groups, regardless of the ED arrival time (p=0.147). Moreover, no differences in the 30-day (p=0.8173) and in-hospital mortality (p=0.9107) were observed in patients with STEMI.ConclusionsA multidisciplinary CP for STEMI based on a CPOE system can effectively decrease disparities in the door-to-data duration and proportions of patients with door-to-balloon times within 90 min, regardless of the ED arrival time. The application of a multidisciplinary CP may also help attenuate off-hour and weekend effects in STEMI clinical outcomes.
Bayesian model averaging method for evaluating associations between air pollution and respiratory mortality: a time-series study
Authors: Fang Xin , Li Runkui , Kan Haidong , Bottai Matteo , Fang Fang , Cao Yang 
Published: August 2016

ObjectiveTo demonstrate an application of Bayesian model averaging (BMA) with generalised additive mixed models (GAMM) and provide a novel modelling technique to assess the association between inhalable coarse particles (PM10) and respiratory mortality in time-series studies.DesignA time-series study using regional death registry between 2009 and 2010.Setting8 districts in a large metropolitan area in Northern China.Participants9559 permanent residents of the 8 districts who died of respiratory diseases between 2009 and 2010.Main outcome measuresPer cent increase in daily respiratory mortality rate (MR) per interquartile range (IQR) increase of PM10concentration and corresponding 95% confidence interval (CI) in single-pollutant and multipollutant (including NOx, CO) models.ResultsThe Bayesian model averaged GAMM (GAMM+BMA) and the optimal GAMM of PM10, multipollutants and principal components (PCs) of multipollutants showed comparable results for the effect of PM10on daily respiratory MR, that is, one IQR increase in PM10concentration corresponded to 1.38% vs 1.39%, 1.81% vs 1.83% and 0.87% vs 0.88% increase, respectively, in daily respiratory MR. However, GAMM+BMA gave slightly but noticeable wider CIs for the single-pollutant model (−1.09 to 4.28 vs −1.08 to 3.93) and the PCs-based model (−2.23 to 4.07 vs −2.03 vs 3.88). The CIs of the multiple-pollutant model from two methods are similar, that is, −1.12 to 4.85 versus −1.11 versus 4.83.ConclusionsThe BMA method may represent a useful tool for modelling uncertainty in time-series studies when evaluating the effect of air pollution on fatal health outcomes.
Motion analysis in the field of dentistry: a kinematic comparison of dentists and orthodontists
Authors: Nowak J , Erbe C , Hauck I , Groneberg D A , Hermanns I , Ellegast R , Ditchen D , Ohlendorf D 
Published: August 2016

ObjectivesTo conduct a kinematic comparison of occupational posture in orthodontists and dentists in their workplace.DesignObservational study.SettingDentist surgeries and departments of orthodontics at university medical centres in Germany.ParticipantsA representative sample of 21 (10 female, 11 male) dentists (group G1) and 21 (13 female, 8 male) orthodontists (G2) with one male dropout in G2.Outcome measuresThe CUELA (computer-assisted acquisition and long-term analysis of musculoskeletal loads) system was used to analyse occupational posture. Parallel to the recording through the CUELA system, a software-supported analysis of the activities performed (I: treatment; II: office; III: other activities) was carried out. In line with ergonomic standards the measured body angles are categorised into neutral, moderate and awkward postures. Activities between the aforementioned groups are compared using the stratified van Elteren U test and the Wilcoxon–Mann–Whitney U test. All p values are subject to the Bonferroni–Holm correction. The level of significance is set at 5%.ResultsThe percentage of time spent on activities in categories I–II–III was as follows: dentists 41%–23%–36% and orthodontists 28%–37%–35%. The posture analysis of both groups showed, for all percentiles (P5–95), angle values primarily in the neutral or moderate range. However, depending on the activity performed, between 5% and 25% of working hours were spent in unfavourable postures, especially in the head-and-neck area. Orthodontists have a greater tendency than dentists to perform treatment activities with the head and torso in unfavourable positions. The statistically significant differences between the two groups with regard to the duration and the relevance of the activities performed confirm this assumption for all three categories (p<0.01, p<0.05).ConclusionsGenerally, both groups perform treatment activities in postures that are in the neutral or medium range; however, dentists had slightly more unfavourable postures during treatment for a greater share of their work day.
Improving the performance of community health workers in humanitarian emergencies: a realist evaluation protocol for the PIECES programme
Authors: Gilmore Brynne , Adams Ben Jack , Bartoloni Alex , Alhaydar Bana , McAuliffe Eilish , Raven Joanna , Taegtmeyer Miriam , Vallières Frédérique 
Published: August 2016

IntroductionUnderstanding what enhances the motivation and performance of community health workers (CHWs) in humanitarian emergencies represents a key research gap within the field of human resources for health. This paper presents the research protocol for the Performance ImprovEment of CHWs in Emergency Settings (PIECES) research programme. Enhancing Learning and Research in Humanitarian Action (ELRHA) funded the development of this protocol as part of their Health in Humanitarian Crises (R2HC) call (No.19839). PIECES aims to understand what factors improve the performance of CHWs in level III humanitarian emergencies.Methods and analysisThe suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. Based on this initial theory, this protocol proposes a combination of semistructured interviews, life histories and critical incident narratives, surveys and latent variable modelling of key constructs to explain how contextual factors work to trigger mechanisms for specific outcomes relating to IMC's 300+ CHWs' performance. Participants will also include programme staff, CHWs and programme beneficiaries. Realist approaches will be used to better understand ‘what works, for whom and under what conditions’ for improving CHW performance within humanitarian contexts.Ethics and disseminationTrinity College Dublin's Health Policy and Management/Centre for Global Health Research Ethics Committee gave ethical approval for the protocol development phase. For the full research project, additional ethical approval will be sought from: Université St. Joseph (Lebanon), the Ethics Committee of the Ministry of Health in Baghdad (Iraq) and the Middle East Technical University (Turkey). Dissemination activities will involve a mixture of research feedback, policy briefs, guidelines and recommendations, as well as open source academic articles.
Compliant flooring to prevent fall-related injuries: a scoping review protocol
Authors: Lachance Chantelle C , Jurkowski Michal P , Dymarz Ania C , Mackey Dawn C 
Published: August 2016

IntroductionFall-related injuries can have serious consequences for older adults, including increased risk of dependence in daily activities and mortality. Compliant flooring is a passive intervention that may reduce the incidence and severity of fall-related injuries in healthcare settings, including acute and long-term care, but few sites have implemented compliant flooring, in part because synthesised evidence about key performance aspects has not been available.Methods and analysisWe will conduct a scoping review to address the question: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries? We will conduct a comprehensive and systematic literature search of academic databases (AgeLine, CINAHL, EBM Reviews, MEDLINE (Ovid), SportDiscus and Web of Science) and grey literature (clinical trial registries, theses/dissertations, abstracts/conference proceedings and relevant websites). 2 team members will independently screen records (first titles and abstracts, then full text) and extract data from included records. Numerical and narrative analyses will be presented by theme (biomechanical efficacy, clinical effectiveness, cost-effectiveness, workplace safety).Ethics and disseminationThis scoping review responds to the information needs of healthcare decision-makers tasked with preventing fall-related injuries. This review will summarise evidence about compliant flooring as a potential intervention for preventing fall-related injuries in older adults and identify gaps in evidence and new avenues for research. Results will be especially useful in long-term care, but also applicable in acute care, assisted living and home care. We will disseminate the review's findings via open-access publications, conference presentations, a webinar, a Stakeholder Symposium and a Knowledge-to-Action Report.
Trend study on the association between hospital admissions and the health of Dutch older adults (1995–2009)
Authors: Galenkamp Henrike , Deeg Dorly J H , de Jongh Renate T , Kardaun Jan W P F , Huisman Martijn 
Published: August 2016

ObjectivesAn increase in hospital admission rates in older people may reflect improved access to healthcare, but also declining health trends in the older population. Owing to a lack of individual-level data, the latter possibility has received little attention. The current study examines associations between health status and hospitalisation rates of older adults in the Netherlands.DesignObservational individual-level data linked to hospital register data.SettingData from 1995 to 2009 from the nationally representative Longitudinal Aging Study Amsterdam were linked to the Dutch Hospital Discharge Register.ParticipantsA total of 5681 observations of 2520 respondents across 4 measurement points (each with a follow-up of 36 months; ages 65–88 years).Outcome measuresThe contribution of health, demographic, psychosocial and lifestyle characteristics to time trends in hospitalisation was assessed in multivariate models.ResultsBetween 1995 and 2009, the percentage with 1 or more overnight admissions (planned or acute) increased slightly from 38.1% to 39.7%. This was due to an increase in acute admission only (22.2–27.0%). Increased prevalences of chronic diseases, functional limitations and polypharmacy accounted for part of the observed increase in acute admissions. In addition, a more than doubled prevalence of day admissions over time was observed (12.3–28.3%), a trend that was unrelated to changes in individual characteristics.ConclusionsThis trend study showed a contribution of declines in population health to increases in acute hospital admissions. Since these declines did not provide a full explanation, healthcare reforms and increases in treatment possibilities in this period are likely to have contributed as well.
Parent and caregiver perspectives on home-based newborn care in low-income settings: protocol for a systematic review of qualitative studies
Authors: Bazzano Alessandra N , Felker-Kantor Erica , Kaji Aiko , Saldanha Lisa 
Published: August 2016

IntroductionNewborn health and survival are closely linked to essential newborn care provided within the first days and weeks of an infant's life by parents and caregivers at home and within the community. Newborn care practices are often socially and culturally determined and have been explored in qualitative and formative research related to improving neonatal survival. We aim to provide a comprehensive review of qualitative studies on parent and caregiver experiences of newborn care practices with a view to identifying barriers and facilitators that may impact on newborn health. The rationale is that providing this information will be useful for intervention design and programme scale up for newborn survival.Methods and analysisWe will systematically review qualitative studies reporting on newborn care practices. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement will be used for reporting the stages of the review and dissemination. The search period will include all studies published from 2006 to 2016. Study selection will incorporate the ENTREQ and Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines and quality assessment will be completed using Critical Appraisal Skills Programme (CASP) guidelines. Pending the identification of sufficient data of good quality, we will conduct a full synthesis of the studies identified by the review.Ethics and disseminationThe results will be disseminated through peer-reviewed publications, conference presentation and directly to organisations involved in newborn health. Formal ethical approval from the author's institution is not required, as no primary data or identifying data will be collected.Trial registration numberCRD42016035674.
Mobility, proprioception, strength and FMS as predictors of injury in professional footballers
Authors: Yeung Jonathan , Cleves Andrew , Griffiths Hywell , Nokes Len 
Published: August 2016

BackgroundThe premise of this study was to investigate if anthropometric variables such as mobility, proprioception, strength and modified Functional Movement Screen (mFMS) could be used as primary indicators of injury risk in an English Championship division football team. This study focused on moderate injuries occurring in the lower extremities, during the 2014/2015 competitive season.MethodsTo differentiate between minor, moderate and severe injuries, this study classified moderate injuries as an injury with an average injury severity of 2–28 days. This study is composed of 4 individual investigations. Each variable was assessed against 2 groups: injured (n=6) and non-injured (n=10). The 2 groups were compiled from the first team, with the criteria that each participant of this study required: full preseason assessment and injury history for the time period, 1 July 2014 to 19 March 2015. A Mann-Whitney U test (0.05% significance) was applied to statistically analyse if each variable showed any variation across the 2 groups. Effect size was estimated with Cliff's d.ResultsStrength asymmetry displayed significant difference (p=0.007), mobility, proprioception and mFMS did not (p=0.263, p=0.792 and p=0.181, respectively). Mean scores for mobility, proprioception, strength asymmetry and mFMS for injured versus non-injured players (effect size) were: 40.00 vs 38.00 (0.37), 10.33 vs 10.20 (0.10), 61.13 vs 30.40 (0.80) and 7.33 vs 8.90 (−0.4), respectively.ConclusionsThis study found no relationship between mobility/proprioception and injury risk; however, strength asymmetry was statistically significant in predicting injury and mFMS exhibited enough positive difference for recommendation of further investigation.
Exploring the association of hospice care on patient experience and outcomes of care
Authors: Kleinpell Ruth , Vasilevskis Eduard E , Fogg Louis , Ely E Wesley 
Published: August 2016

ObjectiveTo examine the association of the use of hospice care on patient experience and outcomes of care. Promoting high-value, safe and effective care is an international healthcare imperative. However, the extent to which hospice care may improve the value of care is not well characterised.MethodsA secondary analysis of variations in care was conducted using the Dartmouth Atlas Report, matched to the American Hospital Association Annual Survey Database to abstract organisational characteristics for 236 US hospitals to examine the relationship between hospice usage and a number of variables that represent care value, including hospital care intensity index, hospital deaths, intensive care unit (ICU) deaths, patient satisfaction and a number of patient quality indicators. Structural equation modelling was used to demonstrate the effect of hospice use on patient experience, clinical and efficiency outcomes.ResultsHospice admissions in the last 6 months of life were correlated with a number of variables, including increases in patient satisfaction ratings (r=0.448, p=0.01) and better pain control (r=0.491, p=0.01), and reductions in hospital days (r=−0.517, p=0.01), fewer hospital deaths (r=−0.842, p=0.01) and fewer deaths occurring with an ICU admission during hospitalisation (r=−0.358, p=0.01). The structural equation model identified that use of hospice care was inversely related to hospital mortality (−0.885) and ICU mortality (−0.457).ConclusionsThe results of this investigation demonstrate that greater use of hospice care during the last 6 months of life is associated with improved patient experience, including satisfaction and pain control, as well as clinical outcomes of care, including decreased ICU and hospital mortality.
Comprehensive profiling of metaplastic breast carcinomas reveals frequent overexpression of programmed death-ligand 1
Authors: Joneja Upasana , Vranic Semir , Swensen Jeffrey , Feldman Rebecca , Chen Wangjuh , Kimbrough Jeffrey , Xiao Nianqing , Reddy Sandeep , Palazzo Juan , Gatalica Zoran 
Published: August 2016

AimsMetaplastic breast carcinoma (MBC) is a rare subtype of breast carcinoma less responsive to conventional chemotherapy than ductal carcinoma. In molecular terms, MBCs usually cluster with triple-negative breast cancers (TNBCs), but have a worse prognosis than TNBCs. Studies investigating MBCs for specific biomarkers of therapy response are rare and limited by the methodological approaches. The aim of the present study was to characterise MBCs on a molecular level and test programmed death-ligand 1 (PD-L1) biomarker expression in MBCs for future therapeutic interventions.MethodsWe profiled 297 samples (MBC (n=75), TNBC (n=106), human epidermal growth factor receptor 2 (HER2)-positive breast cancers (n=32) and hormone-positive breast cancers (n=84)) by next-generation sequencing. Immunohistochemistry for PD-L1 and programmed cell death 1 (PD-1) expression was performed using automated procedures.ResultsThe most commonly mutated genes in MBCs includedTP53(56%) andPIK3CA(23%). Pathogenic mutations in other genes, includingHRAS,FBXW7,PTEN,AKT1andSMAD4, were rare. PD-L1 expression was detected in a significantly higher proportion of MBCs (46%) than in other subtypes (6% each in hormone-positive and HER2-positive breast cancers, and 9% in TNBC, not otherwise specified, p<0.001). PD-1-positive tumour infiltrating lymphocytes (TILs) varied greatly in MBCs.ConclusionsComprehensive profiling of a large cohort of this rare subtype of breast carcinoma highlighted the predominance ofTP53mutation and increased PD-L1 expression in carcinoma cells. These results can be exploited in clinical trials using immune checkpoint inhibitors.