bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective cohort study on risk of hearing loss in patients with rheumatoid arthritis using claims data
Authors: Huang Chung-Ming , Chen Hsuan-Ju , Huang Po-Hao , Tsay Gregory J , Lan Joung-Liang , Sung Fung-Chang 
Published: January 2018

ObjectivesPopulation studies on hearing loss (HL) associated with rheumatoid arthritis (RA) are lacking. This study investigated the risk of developing HL in patients with RA using a nationwide population cohort.SettingThe population-based insurance claims data in the Taiwan National Health Insurance Research Database.DesignRetrospective cohort study followed up RA cohort and control cohort without RA frequency matched by sex, age and diagnosis year.Study population18 267 patients with RA newly diagnosed in 2000–2006 and 73 068 controls without RA.Main outcomesIncidences of HL by the end of 2011 and the RA cohort to non-RA cohort HRs after adjusting for sex, age and comorbidities.ResultsThe HL incidence was higher in the RA cohort than in the non-RA cohort (3.08 vs 1.62 per 1000 person-years), with an adjusted HR (aHR) of 1.91 (95% CI 1.70 to 2.14) for the RA cohort relative to the non-RA cohort after controlling for age, sex and comorbidities. Men and the elderly are at a higher risk. Cardiovascular comorbidities were associated with a further increased HL risk for patients with RA. Medications were associated with reduced HL incidence; patients with RA who used non-steroidal anti-inflammatory drugs (NSAIDs) had an aHR of 0.12 (95% CI 0.07 to 0.20), compared with non-users.ConclusionsThis study demonstrates that patients with RA are at an increased risk of developing HL. Findings highlight the need of disease-modifying treatment and scheduled auditory examinations for HL prevention and early detection for patients with RA.
Derivation and validation of different machine-learning models in mortality prediction of trauma in motorcycle riders: a cross-sectional retrospective study in southern Taiwan
Authors: Kuo Pao-Jen , Wu Shao-Chun , Chien Peng-Chen , Rau Cheng-Shyuan , Chen Yi-Chun , Hsieh Hsiao-Yun , Hsieh Ching-Hua 
Published: January 2018

ObjectivesThis study aimed to build and test the models of machine learning (ML) to predict the mortality of hospitalised motorcycle riders.SettingThe study was conducted in a level-1 trauma centre in southern Taiwan.ParticipantsMotorcycle riders who were hospitalised between January 2009 and December 2015 were classified into a training set (n=6306) and test set (n=946). Using the demographic information, injury characteristics and laboratory data of patients, logistic regression (LR), support vector machine (SVM) and decision tree (DT) analyses were performed to determine the mortality of individual motorcycle riders, under different conditions, using all samples or reduced samples, as well as all variables or selected features in the algorithm.Primary and secondary outcome measuresThe predictive performance of the model was evaluated based on accuracy, sensitivity, specificity and geometric mean, and an analysis of the area under the receiver operating characteristic curves of the two different models was carried out.ResultsIn the training set, both LR and SVM had a significantly higher area under the receiver operating characteristic curve (AUC) than DT. No significant difference was observed in the AUC of LR and SVM, regardless of whether all samples or reduced samples and whether all variables or selected features were used. In the test set, the performance of the SVM model for all samples with selected features was better than that of all other models, with an accuracy of 98.73%, sensitivity of 86.96%, specificity of 99.02%, geometric mean of 92.79% and AUC of 0.9517, in mortality prediction.ConclusionML can provide a feasible level of accuracy in predicting the mortality of motorcycle riders. Integration of the ML model, particularly the SVM algorithm in the trauma system, may help identify high-risk patients and, therefore, guide appropriate interventions by the clinical staff.
Comparative efficacy and tolerability of new-generation antidepressants for major depressive disorder in children and adolescents: protocol of an individual patient data meta-analysis
Authors: Zhou Xinyu , Cipriani Andrea , Furukawa Toshi A , Cuijpers Pim , Zhang Yuqing , Hetrick Sarah E , Pu Juncai , Yuan Shuai , Del Giovane Cinzia , Xie Peng 
Published: January 2018

IntroductionAlthough previous conventional meta-analyses and network meta-analyses have provided some important findings about pharmacological treatments for children and adolescents with depressive disorders in the past decades, several questions still remain unsolved by the aggregate data from those meta-analyses. Individual participant data meta-analysis (IPD-MA) enables exploration of the impacts of individual characteristics on treatment effects, allowing matching of treatments to specific subgroups of patients. We will perform an IPD-MA to assess the efficacy and tolerability of new-generation antidepressants for major depressive disorder in children and adolescents.Methods and analysisWe will systematically search for all double-blind randomised controlled trials (RCTs) that have compared any new-generation antidepressant with placebo for the acute treatment of major depressive disorder in children and adolescents, in the following databases: PubMed, EMBASE, the Cochrane Library, PsycINFO, Web of Science, CINAHL, LILACS and ProQuest Dissertations. We will contact all corresponding authors of included RCTs and ask for their cooperation in this project by providing individual participant data from the original trials. The primary outcomes will include efficacy, measured as the mean change of depression symptoms by Children’s Depression Rating Scale Revised (CDRS-R), and tolerability, measured as the proportion of patients who withdrew from the trials early due to adverse effects. The secondary outcomes will include response rates, remission rates, deterioration rate, all-cause discontinuation, suicidal-related outcomes and global functioning outcome. Using the raw de-identified study data, we will use mixed-effects logistic and linear regression models to perform the IPD-MAs. The risk of bias of included studies will be assessed using the Cochrane risk of bias tool. We will also detect the publication bias and effects of non-participation of eligible studies.DisseminationEthical approval is not required given that informed consent has already been obtained from the patients by the trial investigators before the included trials were conducted. This study may have considerable implications for practice and help improve patient care.PROSPERO registration numberCRD42016051657.
Developing professional caregivers’ empathy and emotional competencies through mindfulness-based stress reduction (MBSR): results of two proof-of-concept studies
Authors: Lamothe Martin , McDuff Pierre , Pastore Yves D , Duval Michel , Sultan Serge 
Published: January 2018

ObjectivesTo assess the feasibility and acceptability of a mindfulness-based stress reduction (MBSR)-based intervention and determine if the intervention is associated with a significant signal on empathy and emotional competencies.DesignTwo pre–post proof-of-concept studies.SettingParticipants were recruited at the University of Montreal’s Psychology Department (Study 1) and the CHU Sainte-Justine Department of Hematology-Oncology (Study 2).ParticipantsStudy 1: 12 students completed the 8-week programme (mean age 24, range 18–34). Study 2: 25 professionals completed the 8-week programme (mean age 48, range 27–63).InterventionStandard MBSR programme including 8-week mindfulness programme consisting of 8 consecutive weekly 2-hour sessions and a full-day silent retreat.Outcomes measuresMindfulness as measured by the Mindful Attention Awareness Scale; empathy as measured by the Interpersonal Reactivity Index (IRI)’s Perspective Taking and Empathic Concern subscales; identification of one’s own emotions and those of others as measured by the Profile of Emotional Competence (PEC)’s Identify my Emotions and Identify Others’ Emotions subscales; emotional acceptance as measured by the Acceptance and Action Questionnaire-II (AAQ-II) and the Emotion Regulation Scale (ERQ)’s Expressive Suppression subscale; and recognition of emotions in others as measured by the Geneva Emotion Recognition Test (GERT).ResultsIn both studies, retention rates (80%–81%) were acceptable. Participants who completed the programme improved on all measures except the PEC’s Identify Others’ Emotions and the IRI’s Empathic Concern (Cohen’s d median=0.92, range 45–1.72). In Study 2, favourable effects associated with the programme were maintained over 3 months on the PEC’s Identify my Emotions, the AAQ-II, the ERQ’s Expressive Suppression and the GERT.ConclusionsThe programme was feasible and acceptable. It was associated with a significant signal on the following outcomes: perspective taking, the identification of one’s own emotions and emotional acceptance, thus, justifying moving towards efficacy trials using these outcomes.
Physician engagement in hospitals: a scoping review protocol
Authors: Perreira Tyrone , Perrier Laure , Prokopy Melissa , Jonker Anthony 
Published: January 2018

IntroductionLiterature on healthcare reforms highlights the importance of physician engagement, suggesting that it is a critical factor for lowering costs while improving efficiency, quality of care, patient safety, physician satisfaction and retention. As a result, many hospitals have adopted physician engagement as a top strategic priority, but little is known about the actual evidence, making it difficult for hospital leadership to identify relationships between true physician ‘work engagement’ and work outcomes. The aim of this scoping review is to identify factors associated with, and tools used to measure, physician engagement.Methods and analysisThis scoping review will be conducted as per Arksey and O’Malley (2005). The electronic databases that will be searched from inception onwards include MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Grey literature will be searched via websites of relevant agencies such as Agency for Healthcare Research and Quality. Conferences and abstracts will be viewed and full paper requests made as required. Supplementary articles may be obtained by contacting field experts and searching references of relevant articles. All quantitative and qualitative study designs will be eligible that describe factors associated with, and tools used to measure, hospital physician engagement. After a small calibration exercise, screening and abstraction will be completed separately by two individuals, with discrepancies resolved by a third. Quantitative (frequencies) and qualitative analyses (generation of descriptives) will be conducted. Thematic analysis will be used to evaluate and categorise study findings.Implications and disseminationThis project is part of the Ontario Hospital Association’s (OHA) initiative to improve its understanding of physician engagement. The review findings will be shared with all Ontario hospitals. Dissemination will occur through peer-reviewed publications and to the OHA membership through the OHA Learning and Engagement team.
Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: a propensity score matched study
Authors: Wiegerinck Melanie M J , van der Goes Birgit Y , Ravelli Anita C J , van der Post Joris A M , Buist Fayette C D , Tamminga Pieter , Mol Ben W 
Published: January 2018

ObjectiveTo compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care.Study designWe performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major risk factors with singleton pregnancies who gave birth at term between 2005 and 2008 in the Amsterdam region of the Netherlands. Major risk factors comprised non-vertex position of the fetus, previous Caesarean birth, hypertension, (gestational) diabetes mellitus, post-term pregnancy (≥42 weeks), prolonged rupture of membranes (>24 hours), vaginal bleeding in the second half of pregnancy or induced labour. Groups were devided by midwife-led versus obstetrician-led care at the onset of labour. The primary outcome was intrapartum and neonatal (<28 days) mortality. Secondary outcomes included obstetric interventions, 5 min Apgar scores<7 and neonatal intensive care admittance for >24 hours.ResultsWe studied 57 396 women. Perinatal mortality occurred in 30 of 46 764 (0.64‰) women in midwife-led care and in 2 of 10 632 (0.19‰) women in obstetrician-led care (OR 3.4, 95% CI 0.82 to 14.3). A propensity score matched analysis in a 1:1 ratio with 10 632 women per group revealed an OR for perinatal mortality of 4.0 (95% CI 0.85 to 18.9).ConclusionAmong low-risk women, midwife-led care at the onset of labour was associated with a statistically non-significant higher mortality rate.
Nurse compliance with a protocol for safe injectable medication administration: comparison of two multicentre observational studies
Authors: Schutijser Bernadette , Klopotowska Joanna Ewa , Jongerden Irene , Spreeuwenberg Peter , Wagner Cordula , de Bruijne Martine 
Published: January 2018

ObjectivesMedication administration errors with injectable medication have a high risk of causing patient harm. To reduce this risk, all Dutch hospitals implemented a protocol for safe injectable medication administration. Nurse compliance with this protocol was evaluated as low as 19% in 2012. The aim of this second evaluation study was to determine whether nurse compliance had changed over a 4-year period, what factors were associated over time with protocol compliance and which strategies have been implemented by hospitals to increase protocol compliance.MethodsIn this prospective observational study, conducted between November 2015 and September 2016, nurses from 16 Dutch hospitals were directly observed during intravenous medication administration. Protocol compliance was complete if nine protocol proceedings were conducted correctly. Protocol compliance was compared with results from the first evaluation. Multilevel logistic regression analyses were used to assess the associations over time between explanatory variables and complete protocol compliance. Implemented strategies were classified according to the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultsA total of 372 intravenous medication administrations were observed. In comparison with 2012, more proceedings per administration were conducted (mean 7.6, 95% CI 7.5 to 7.7 vs mean 7.3, 95% CI 7.3 to 7.4). No significant change was seen in complete protocol compliance (22% in 2016); compliance with the proceedings ‘hand hygiene’ and ‘check by a second nurse’ remained low. In contrast to 2012, the majority of the variance was caused by differences between wards rather than between hospitals. Most implemented improvement strategies targeted the organisation component of the SEIPS model.ConclusionsCompliance with ‘hand hygiene’ and ‘check by a second nurse’ needs to be further improved in order to increase complete protocol compliance. To do so, interventions focused on nurses and individually tailored to each ward are needed.
Implementation of diagnostic pauses in the ambulatory setting
Authors: Huang Grace C , Kriegel Gila , Wheaton Carolyn , Sternberg Scot , Sands Kenneth , Richards Jeremy , Johnston Katherine , Aronson Mark 
Published: January 2018

BackgroundDiagnostic errors result in preventable morbidity and mortality. The outpatient setting may be at increased risk, where time constraints, the indolent nature of outpatient complaints and single decision-maker practice models predominate.MethodsWe developed a self-administered diagnostic pause to address diagnostic error. Clinicians (physicians and nurse practitioners) in an academic primary care setting received the tool if they were seeing urgent care patients who had previously been seen in the past two weeks in urgent care. We used pre–post-intervention surveys, focus groups and chart audits 6 months after the urgent care visit to assess the impact of the intervention on participant perceptions and actions.ResultsWe piloted diagnostic pauses in two phases (3 months and 6 months, respectively); 9 physicians participated in the first phase, and 16 physicians and 2 nurse practitioners in the second phase. Subjects received 135 alerts for diagnostic pauses and responded to 82 (61% response). Thirteen per cent of alerts resulted in clinicians reporting new actions as a result of the diagnostic pauses. Thirteen per cent of cases at a 6-month chart audit resulted in diagnostic discrepancies, defined as differences in diagnosis from the initial working diagnosis. Focus groups reported that the diagnostic pauses were brief and fairly well integrated into the overall workflow for evaluation but would have benefited as a real-time application for patients at higher risk for diagnostic error.ConclusionThis pilot represents the first known examination of diagnostic pauses in the outpatient setting, and this work potentially paves the way for more broad-based systems and/or electronic interventions to address diagnostic error.
Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: a 5-year prospective study of 1755 patients
Authors: Rugge Massimo , Meggio Alberto , Pravadelli Cecilia , Barbareschi Mattia , Fassan Matteo , Gentilini Maria , Zorzi Manuel , Pretis Giovanni De , Graham David Y , Genta Robert M 
Published: January 2018

ObjectiveOperative link on gastritis assessment (OLGA) staging for gastritis ranks the risk for gastric cancer (GC) in progressive stages (0–IV). This prospective study aimed at quantifying the cancer risk associated with each gastritis stage.DesignA cohort of 1755 consecutive patients with dyspepsia underwent initial (T-0) oesophagogastroduodenoscopy with mapped gastric biopsies, OLGA staging and assessment ofHelicobacter pyloriinfection. Patients were followed for 55 months (median); patients with stages II III and IV underwent a second endoscopy/restaging (T-1), and those with stages 0 and I were followed clinically and through in-depth clinical and record checking. Endpoints were OLGA stage at T-1 and development of gastric epithelial neoplasia.ResultsAt T-0, 77.6% of patients had stage 0, 14.4% stage I, 5.1% stage II, 2.1% stage III and 0.85% stage IV.H. pyloriinfection was detected in 603 patients at T-0 and successfully eradicated in 602 of them; 220 had a documented history ofH. pylorieradication; and 932 wereH. pylorinaïve-negative. Incident neoplastic lesions (prevalence=0.4%; low-grade intraepithelial neoplasia (IEN)=4; high-grade IEN=1; GC=2) developed exclusively in patients with stages III–IV. The risk for epithelial neoplasia was null in patients at stages 0, I and II (95% CI 0 to 0.4), 36.5 per 1000 person-years in patients at stage III (95% CI 13.7 to 97.4) and 63.1 per 1000 person-years in patients at stage IV (95% CI 20.3 to 195.6).ConclusionsThis prospective study confirms that OLGA staging reliably predicts the risk for development of gastric epithelial neoplasia. Although no neoplastic lesions arose inH. pylori-naïve patients, theH. pylorieradication in subjects with advanced stages (III–IV) did not abolish the risk for neoplastic progression.
PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL): study protocol
Authors: Carpenter Hannah , Audsley Sarah , Coupland Carol , Gladman John , Kendrick Denise , Lafond Natasher , Logan Philippa , Skelton Dawn A , Timblin Clare , Timmons Stephen , Ward Derek , Orton Elizabeth 
Published: January 2018

BackgroundFalls in older people are a leading causes of unintentional injury. Due to an ageing population, injuries are likely to increase unless more is done to reduce older people’s falls risk. In clinical trials, the Falls Management Exercise (FaME) programme has reduced the rate of falls and falls-related injuries in community-dwelling older adults. However, the commissioning of FaME is inconsistent across England, potentially due to a lack of evidence that FaME can be delivered effectively in a ‘real world’ setting. The PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL) study is designed to study the implementation of FaME in a range of different settings in England.MethodsThe PHISICAL study will use a mixed-methods, triangulation, multilevel design to explore the implementation of FaME. Framework analysis of semistructured interviews with up to 90 stakeholders (exercise programme users, service providers, referrers and commissioners) and observational data from locally led communities of practice will identify the factors that influence FaME’s implementation. Quantitative, anonymised, routine service data from up to 650 exercise programme users, including measures of falls and physical activity, will allow assessment of whether the benefits of FaME reported in clinical trials translate to the ‘real world’ setting.ConclusionThe findings from this study will be used to develop a toolkit of resources and guidance to inform the commissioning and delivery of future FaME programmes. This study has the potential to inform public health prevention strategies, and in doing so may reduce the number of falls in the older population while delivering cost savings to health and social care services.
Leisure-time vigorous physical activity is associated with better lung function: the prospective ECRHS study
Authors: Fuertes Elaine , Carsin Anne-Elie , Antó Josep M , Bono Roberto , Corsico Angelo Guido , Demoly Pascal , Gislason Thorarinn , Gullón José-Antonio , Janson Christer , Jarvis Deborah , Heinrich Joachim , Holm Mathias , Leynaert Bénédicte , Marcon Alessandro , Martinez-Moratalla Jesús , Nowak Dennis , Pascual Erquicia Silvia , Probst-Hensch Nicole M , Raherison Chantal , Raza Wasif , Gómez Real Francisco , Russell Melissa , Sánchez-Ramos José Luis , Weyler Joost , Garcia Aymerich Judith 
Published: January 2018

ObjectiveWe assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort.MethodsFEV1 and FVC were measured in 3912 participants at 27–57 years and 39–67 years (mean time between examinations=11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity ≥2 times and ≥1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV1 and FVC.ResultsPhysical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV1 (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV1 and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline.ConclusionLeisure-time vigorous physical activity was associated with higher FEV1 and FVC over a 10-year period among current smokers, but not with FEV1 and FVC decline.