bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis
Authors: Beckenkamp Paula R , Lin Chung-Wei Christine , Macaskill Petra , Michaleff Zoe A , Maher Chris G , Moseley Anne M 
Published: November 2016

ObjectiveTo review the diagnostic accuracy of the Ottawa Ankle and Midfoot Rules and explore if clinical features and/or methodological quality of the study influence diagnostic accuracy estimates.DesignSystematic review with meta-analysis.Data sourcesMEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library.Eligibility criteria for selecting studiesPrimary diagnostic studies reporting the accuracy of the Rules in people with ankle and/or midfoot injury were retrieved. Diagnostic accuracy estimates, overall and for subgroups (patient’s age, profession of the assessor and setting of application), were made. Sensitivity analyses included studies with a low risk of bias and studies where all patients received radiographs.Results66 studies were included. Ankle and Midfoot Rules presented similar accuracies, which were homogeneous and high for sensitivity and negative likelihood ratios and poor and heterogeneous for specificity and positive likelihood ratios (mean, 95% CI pooled sensitivity of Ankle Rules: 99.4%, 97.9% to 99.8%; specificity: 35.3%, 28.8% to 42.3%). Sensitivity of the Ankle Rules was higher in adults than in children, but the profession of the assessor did not appear to influence accuracy. Specificity was higher for Midfoot than for Ankle Rules. There were not enough studies to allow comparison according to setting of application. Studies with a low risk of bias and where all patients received radiographs provided lower accuracy estimates. Specificity heterogeneity was not explained by assessor training, use of imaging in all patients and low risk of bias.ConclusionsStudy features and the methodological quality influence estimates of the diagnostic accuracy of the Ottawa Ankle and Midfoot Rules.
Circulating SerpinB1 levels and clinical features in patients with type 2 diabetes
Authors: Takebayashi Kohzo , Hara Kenji , Terasawa Tomoko , Naruse Rika , Suetsugu Mariko , Tsuchiya Takafumi , Inukai Toshihiko 
Published: November 2016

ObjectiveThe main purpose of this study was to investigate the association of serum SerpinB1 levels and various parameters in patients with type 2 diabetes. The effect of canagliflozin (a sodium glucose cotransporter 2 (SGLT2) inhibitor), which can decrease circulating insulin levels, on serum SerpinB1 levels was also investigated. A recent study suggests that the serum levels of SerpinB1, also known as monocyte neutrophil elastase inhibitor, increase with insulin resistance, may have a protective effect for pancreatic β cells, and may decrease insulin resistance.Research design and methodsThe study included 30 patients with type 2 diabetes hospitalized for glycemic control and 10 control subjects.ResultsSerpinB1 levels were significantly higher in patients with type 2 diabetes, compared with that in heathy control subjects (10.01±3.59 vs 5.69±1.64 ng/mL, p<0.0001). Serum SerpinB1 levels had a significant negative correlation with low-density lipoprotein cholesterol (LDL-C) (p=0.0123). Serum SerpinB1 levels had a significant positive association or trend toward a positive association with age and with hemoglobin A1c (HbA1c), and significant negative association with LDL-C levels in some multiple regression analysis models. Patients treated with statins had a tendency toward higher serum SerpinB1 levels, compared with those patients not treated with statins. During a 3-day observation period both with and without canagliflozin treatment, the serum SerpinB1 levels did not change.ConclusionsSerum SerpinB1 levels are elevated in patients with type 2 diabetes compared with that in healthy subjects and are negatively correlated with serum LDL-C.
Quality of care in rural youth with type 1 diabetes: a cross-sectional pilot assessment
Authors: Stumetz Kyle S , Yi-Frazier Joyce P , Mitrovich Connor , Briggs Early Kathaleen 
Published: November 2016

BackgroundType 1 diabetes mellitus (T1DM) presents a significant health burden for patients and families. The quality of care (QOC) among those living in rural communities is thought to be subpar compared with those in urban communities; however, little data exist to reflect this, especially in pediatric diabetes.ObjectiveThe purpose of this pilot study was to investigate diabetes QOC among families living in rural versus urban areas. 6 QOC markers were used to compare youth with T1DM: appointment adherence, patient–provider communication, diabetes education during clinic visit, congruency with diabetes standards of care, diabetes self-management behaviors, and diabetes-related hospitalizations.Research design and methodsParticipants were rural or urban adult caregivers of youth ages 2–18 with ≥10-month history of T1DM receiving treatment at Seattle Children's Hospital, USA. Participants were from rural areas of central Washington, or urban areas of western Washington. Caregivers completed a 26-item survey pertaining to the 6 QOC markers. The 6 QOC markers were compared across 61 participants (34 rural, 27 urban), to determine how diabetes care quality and experiences differed. Data were collected over 12 months. Groups were compared using t-tests and χ2tests, as appropriate.ResultsCompared with urban families, rural families reported significantly lower income and a 4-fold greater usage of public insurance. Among the QOC measures, rural participants were significantly worse off in the appointment adherence, patient–provider communication, and hospitalizations categories. Congruence with diabetes standards of care (foot care only) was also significantly poorer in rural participants.ConclusionsThe burden of travel in conjunction with the lack of resources in this rural population of families with T1DM youth is cause for concern and warrants further research.
Trends and level of control of hypertension among adults attending an ambulatory HIV clinic in Kampala, Uganda: a retrospective study
Authors: Kalyesubula Robert , Kayongo Alex , Semitala Fred Collins , Muhanguzi Asaph , Katantazi Nehemiah , Ayers Dieter , Forrest Jamie I , Mills Edward J 
Published: November 2016

BackgroundWith an ageing HIV-positive population, sub-Saharan Africa is now facing a dual epidemic of communicable and non-communicable diseases (NCDs). This study aimed to assess trends in the prevalence of hypertension and factors associated with hypertension, among adults attending an ambulatory HIV clinic in Kampala, Uganda.MethodsWe conducted a retrospective chart review to identify patients with hypertension. We used a random number generator to select 400 patient charts from each year from 2009 to 2014. Blood pressure, age, body mass index (BMI), WHO disease stage and Karnofsky scores were extracted. Logistic regression was used to estimate the strength of the association between each of these factors and the presence of hypertension.ResultsIn total, 1996 charts were included in this analysis. The mean age of participants was 31 years and 1311/1996 (65.7%) were female. The overall prevalence of hypertension was 418/1996 (20.9%). This rose from 16.9% in 2009 to 32.3% in 2013. Of the patients with hypertension, 96/418 (23.0%) were receiving adequate treatment. Patients >50 years of age had 3.12 times the odds of hypertension compared with patients aged 20–29 years (95% CI 2.00 to 4.85). Men had 1.65 times the odds of hypertension compared with women (95% CI 1.34 to 2.03) and patients with a BMI of 35–39 kg/m2had 3.93 times the odds of hypertension compared with patients with a BMI <25 kg/m2.ConclusionsThe prevalence of hypertension is rising in the Ugandan HIV-positive population. There remains inadequate management and control of hypertension in this group highlighting the need to better integrate NCD care within the HIV clinical settings.
Towards the genetic basis of cerebral venous thrombosis—the BEAST Consortium: a study protocol
Authors: Cotlarciuc Ioana , Marjot Thomas , Khan Muhammad S , Hiltunen Sini , Haapaniemi Elena , Metso Tiina M , Putaala Jukka , Zuurbier Susanna M , Brouwer Matthijs C , Passamonti Serena M , Bucciarelli Paolo , Pappalardo Emanuela , Patel Tasmin , Costa Paolo , Colombi Marina , Canhão Patrícia , Tkach Aleksander , Santacroce Rosa , Margaglione Maurizio , Favuzzi Giovanni , Grandone Elvira , Colaizzo Donatella , Spengos Kostas , Arauz Antonio , Hodge Amanda , Ditta Reina , Debette Stephanie , Zedde Marialuisa , Pare Guillaume , Ferro José M , Thijs Vincent , Pezzini Alessandro , Majersik Jennifer J , Martinelli Ida , Coutinho Jonathan M , Tatlisumak Turgut , Sharma Pankaj 
Published: November 2016

IntroductionCerebral venous thrombosis (CVT) is a rare cerebrovascular condition accounting for <1% of all stroke cases and mainly affects young adults. Its genetic aetiology is not clearly elucidated.Methods and analysisTo better understand the genetic basis of CVT, we have established an international biobank of CVT cases, Biorepository to Establish the Aetiology of Sinovenous Thrombosis (BEAST) which aims to recruit highly phenotyped cases initially of European descent and later from other populations. To date we have recruited 745 CVT cases from 12 research centres. As an initial step, the consortium plans to undertake a genome-wide association analysis of CVT using the Illumina Infinium HumanCoreExome BeadChip to assess the association and impact of common and low-frequency genetic variants on CVT risk by using a case–control study design. Replication will be performed to confirm putative findings. Furthermore, we aim to identify interactions of genetic variants with several environmental and comorbidity factors which will likely contribute to improve the understanding of the biological mechanisms underlying this complex disease.Ethics and disseminationBEAST meets all ethical standards set by local institutional review boards for each of the participating sites. The research outcomes will be published in international peer-reviewed open-access journals with high impact and visibility. The results will be presented at national and international meetings to highlight the contributions into improving the understanding of the mechanisms underlying this uncommon but important disease. This international DNA repository will become an important resource for investigators in the field of haematological and vascular disorders.
Real-world evidence studies into treatment adherence, thresholds for intervention and disparities in treatment in people with type 2 diabetes in the UK
Authors: McGovern Andrew , Hinton William , Correa Ana , Munro Neil , Whyte Martin , de Lusignan Simon 
Published: November 2016

PurposeThe University of Surrey-Lilly Real World Evidence (RWE) diabetes cohort has been established to provide insights into the management of type 2 diabetes mellitus (T2DM). There are 3 areas of study due to be conducted to provide insights into T2DM management: exploration of medication adherence, thresholds for changing diabetes therapies, and ethnicity-related or socioeconomic-related disparities in management. This paper describes the identification of a cohort of people with T2DM which will be used for these analyses, through a case finding algorithm, and describes the characteristics of the identified cohort.ParticipantsA cohort of people with T2DM was identified from the Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) data set. This data set comprises electronic patient records collected from a nationally distributed sample of 130 primary care practices across England with scope to increase the number of practices to 200.Findings to dateA cohort (N=58 717) of adults with T2DM was identified from the RCGP RSC population (N=1 260 761), a crude prevalence of diabetes of 5.8% in the adult population. High data quality within the practice network and an ontological approach to classification resulted in a high level of data completeness in the T2DM cohort; ethnicity identification (82.1%), smoking status (99.3%), alcohol use (93.3%), glycated haemoglobin (HbA1c; 97.9%), body mass index (98.0%), blood pressure (99.4%), cholesterol (87.4%) and renal function (97.8%). Data completeness compares favourably to other, similarly large, observational cohorts. The cohort comprises a distribution of ages, socioeconomic and ethnic backgrounds, diabetes complications, and comorbidities, enabling the planned analyses.Future plansRegular data uploads from the RCGP RSC practice network will enable this cohort to be followed prospectively. We will investigate medication adherence, explore thresholds and triggers for changing diabetes therapies, and investigate any ethnicity-related or socioeconomic-related disparities in diabetes management.
ACCESS HD pilot: A randomised feasibility trial Comparing Catheters with fistulas in Elderly patientS Starting haemodialysis
Authors: Quinn Robert , Ravani Pietro 
Published: November 2016

IntroductionThe selection of the type of vascular access for haemodialysis is an important intervention question. However, only observational studies are available to inform decision-making in this area, and they are at high risk of selection bias. While a clinical trial comparing the effects of the 2 most frequently chosen strategies for haemodialysis access (fistulas and catheters) on patient important and ‘hard’ clinical end points is needed, the feasibility of such a trial is uncertain.Methods and analysisThis open-label pilot randomised controlled trial will test the feasibility and safety of randomising elderly people (≥65 years) who start haemodialysis with a central venous catheter (the most common initial type of haemodialysis access), and are eligible to receive a fistula, to a catheter-based strategy (comparator) or to a fistula-based strategy (intervention). We will enrol 100 patients at 10 centres across Canada. Participants assigned to the catheter-strategy arm will continue to use catheters; participants assigned to the fistula-strategy arm will receive a surgical attempt at fistula creation. The inclusion criteria are designed to minimise the risk of protocol violation and attrition. The primary outcome is feasibility, which we will assess by measuring: (1) the proportion of participants deemed eligible for the trial who consent to randomisation; and (2) the proportion of participants randomised to the intervention who receive the fistula surgery within 90 days of randomisation. Secondary outcomes will include safety outcomes, the reasons people and healthcare providers may not accept randomisation, and the reasons sites may not adhere to the trial protocol.Ethics and disseminationThe Conjoint Health Research Ethics Board at the University of Calgary approved the study protocol. We will submit the results of this feasibility study in a peer-reviewed journal.Trial registration numberNCT02675569, Pre-results.
Narrative medicine and death in the ICU: word clouds as a visual legacy
Authors: Vanstone Meredith , Toledo Feli , Clarke France , Boyle Anne , Giacomini Mita , Swinton Marilyn , Saunders Lois , Shears Melissa , Zytaruk Nicole , Woods Anne , Rose Trudy , Hand-Breckenridge Tracey , Heels-Ansdell Diane , Anderson-White Shelley , Sheppard Robert , Cook Deborah 
Published: November 2016

ObjectiveThe Word Cloud is a frequent wish in the 3 Wishes Project developed to nurture peace and ease the grieving process for dying critically ill patients. The objective was to examine whether Word Clouds can act as a heuristic approach to encourage a narrative orientation to medicine. Narrative medicine is an approach which can strengthen relationships, compassion and resilience.DesignWord Clouds were created for 42 dying patients, and we interviewed 37 family members and 73 clinicians about their impact. We conducted a directed qualitative content analysis, using the 3 stages of narrative medicine (attention, representation, affiliation) to examine the narrative medicine potential of Word Clouds.ResultsThe elicitation of stories for the Word Cloud promotes narrative attention to the patient as a whole person. The distillation of these stories into a list of words and the prioritisation of those words for arrangement in the collage encourages a representation that did not enforce a beginning, middle or end to the story of the patient's life. Strong affiliative connections were achieved through the honouring of patients, caring for families and sharing of memories encouraged through the creation, sharing and discussion of Word Clouds.ConclusionsIn the 3 Wishes Project, Word Clouds are 1 way that families and clinicians honour a dying patient. Engaging in the process of making a Word Cloud can promote a narrative orientation to medicine, forging connections, making meaning through reminiscence and leaving a legacy of a loved one. Documenting and displaying words to remember someone in death reaffirms their life.
Clinical metrics in emergency medicine: the shock index and the probability of hospital admission and inpatient mortality
Authors: Balhara Kamna S , Hsieh Yu-Hsiang , Hamade Bachar , Circh Ryan , Kelen Gabor D , Bayram Jamil D 
Published: November 2016

Study objectivesThe shock index (SI), defined as the ratio of HR to systolic BP, has been studied as an alternative prognostic tool to traditional vital signs in specific disease states and subgroups of patients. However, literature regarding its utility in the general ED population is lacking. Our main objective was to determine the probability of admission and inpatient mortality based on the first measured SI at initial presentation in the general adult ED population in our tertiary care centre.MethodsA retrospective chart review of all adult patients (≥18 years old) presenting to the ED at our tertiary care centre over a 12-month period was conducted. Likelihood ratios (LRs) were calculated in order to determine the optimal SI cut-off for predicting hospital admission and inpatient mortality.ResultsWe reviewed 58 336 ED patient encounters occurring between 1 October 2012 and 30 September 2013. SI >1.2 was associated with a large increase in the likelihood of hospital admission, with a positive LR (+LR) of 11.69 (95% CI 9.50 to 14.39) and a moderate increase in the likelihood of inpatient mortality with a +LR of 5.82 (95% CI 4.31 to 7.85). SI >0.7 and >0.9, the traditional ‘normal’ cut-offs cited in the literature, were only associated with minimal to small increases in the likelihood of admission and inpatient mortality.ConclusionsIn our single-centre study, the initial SI recorded in the ED shows promise as a clinical metric in the general adult ED population, increasing the probability of both hospital admission and inpatient mortality, specifically at a threshold of SI >1.2.
Cross-sectional and longitudinal associations of neighbourhood social environment and smoking behaviour: the multiethnic study of atherosclerosis
Authors: Mayne Stephanie L , Auchincloss Amy H , Moore Kari A , Michael Yvonne L , Tabb Loni Philip , Echeverria Sandra E , Diez Roux Ana V 
Published: November 2016

BackgroundSocial features of neighbourhood environments may influence smoking by creating a stressful environment or by buffering stress through social cohesion. However, the association of the overall neighbourhood social environment (NSE) with smoking, and the association of specific neighbourhood social factors with change in smoking behaviour over time, has rarely been examined.MethodsThis study included 5856 adults aged 45–84 years from the Multi-Ethnic Study of Atherosclerosis (2000–2012, average follow-up: 7.8 years). Outcomes included current smoking status and smoking intensity (average number of cigarettes smoked per day among baseline smokers). NSE was assessed as a composite score composed of aesthetic quality, safety and social cohesion scales (derived from neighbourhood surveys). Generalised linear mixed models evaluated the association of baseline NSE (composite score and individual scales) with current smoking (modified Poisson models) and smoking intensity (negative binomial models) cross-sectionally and longitudinally.ResultsEach SD increase in baseline NSE composite score was associated with 13% lower prevalence of smoking at baseline (adjusted prevalence ratio (aPR) 0.87 (95% CI 0.78 to 0.98). Neighbourhood safety and aesthetic quality were similarly associated with lower smoking prevalence (aPR 0.87 (0.78 to 0.97) and aPR 0.87 (0.77 to 0.99), respectively) but the association with social cohesion was weaker or null. No significant associations were observed for smoking intensity among baseline smokers. Baseline NSE was not associated with changes in smoking risk or intensity over time.ConclusionsResults suggest that neighbourhood social context influences whether older adults smoke, but does not promote smoking cessation or reduction over time.
Educational needs of health professionals working in rheumatology in Europe
Authors: Vliet Vlieland Theodora P M , van den Ende Cornelia H.M , Alliot-Launois Francoise , Beauvais Catherine , Gobbo Milena , Iagnocco Annamaria , Lundberg Ingrid E , Munuera-Martínez Pedro V , Opava Christina H , Prior Yeliz , Redmond Anthony , Smucrova Hana , Wiek Dieter 
Published: November 2016

ObjectiveTo explore the availability of postgraduate education for health professionals (HPs) working in rheumatology in Europe, and their perceived educational needs and barriers for participation in current educational offerings.MethodsStructured interviews were conducted with national representatives of rheumatology HPs' organisations and an online survey among individual HPs was disseminated through existing European League Against Rheumatism (EULAR) networks (10 languages including English). These comprised questions on: availability of postgraduate education, familiarity with EULAR and its educational offerings, unmet needs regarding the contents and mode of delivery and potential barriers to participate in education (0–10 scales).ResultsAccording to 17 national representatives, postgraduate rheumatology education was most common for nurses, physical and occupational therapists. There were 1041 individuals responding to the survey, of whom 48% completed all questions. More than half (56%) were familiar with EULAR as an organisation, whereas <25% had attended the EULAR congress or were familiar with EULAR online courses. Educational needs regarding contents were highest for ‘inflammatory arthritis’ and ‘connective tissue diseases’ and regarding modes of delivery for ‘courses organised in own country’ and ‘online courses’. Important barriers to participation included lack of ‘resources’, ‘time’ and ‘English language skills’. Overall, there was considerable variation in needs and barriers among countries.ConclusionsThere is a lack of postgraduate rheumatology education for HPs in most countries. There are opportunities to raise awareness regarding EULAR educational offerings and to develop courses provided in HPs' own country, tailored to national needs and barriers and taking language barriers into consideration.