bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of multimorbidity on healthcare professional task shifting potential in patients with type 2 diabetes in primary care: a French cross-sectional study
Authors: Supper Irène , Bourgueil Yann , Ecochard René , Letrilliart Laurent 
Published: November 2017

ObjectivesTo estimate the transferability of processes of care from general practitioners (GPs) to allied healthcare professionals and the determinants of such transferability.DesignFrench national cross-sectional multicentre studySetting128 family practices providing supervised training for residents in general practice.ParticipantsAll patients consulting with their GP over a total number of 20 days (ie, 1 day a week from December 2011 to April 2012). Encounters where type 2 diabetes was one of the managed health problems were selected for analysis.Primary and secondary outcome measuresProcesses that were associated with specific health problems were collected by 54 residents. Potential process transferability was the main outcome assessed, as well as the professionals involved in the collaboration and the eventual conditions associated with transfer.ResultsFrom 8572 processes of care that concerned 1088 encounters of patients with diabetes, 21.9% (95% CI 21.1% to 22.8%) were considered eligible for transfer from GPs to allied healthcare professionals (78.1% to nurses, 36.7% to pharmacists). Processes were transferable with condition(s) for 70.6% (ie, a protocol, shared record or supervision). The most transferable processes concerned health maintenance (32.1%) and cardiovascular risk factors (hypertension (28.7%), dyslipidaemia (25.3%) and diabetes (24.3%)). Multivariate analysis showed that educational processes or a long-term condition status were associated with increased transferability (OR 3.26 and 1.47, respectively), whereas patients with higher intellectual occupations or those with two or more associated health problems were associated with lower transferability (OR 0.33 and 0.81, respectively).ConclusionsA significant part of GP activity relating to patients with multimorbidity including type 2 diabetes could be transferred to allied healthcare professionals, mainly on prevention and global education to cardiovascular risk factors. The organisational and finance conditions of team work as views of patients and healthcare professionals must be explored before implementation in primary care.
Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England
Authors: Edwards Hannah B , Marques Elsa , Hollingworth William , Horwood Jeremy , Farr Michelle , Bernard Elly , Salisbury Chris , Northstone Kate 
Published: November 2017

ObjectivesEvaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.Design15-month observational study.SettingPrimary care practices in South West England.Results36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.ConclusionsUse of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.
Authorship, plagiarism and conflict of interest: views and practices from low/middle-income country health researchers
Authors: Rohwer Anke , Young Taryn , Wager Elizabeth , Garner Paul 
Published: November 2017

ObjectivesTo document low/middle-income country (LMIC) health researchers’ views about authorship, redundant publication, plagiarism and conflicts of interest and how common poor practice was in their institutions.DesignWe developed a questionnaire based on scenarios about authorship, redundant publication, plagiarism and conflicts of interest. We asked participants whether the described practices were acceptable and whether these behaviours were common at their institutions. We conducted in-depth interviews with respondents who agreed to be interviewed.ParticipantsWe invited 607 corresponding authors of Cochrane reviews working in LMICs. From the 583 emails delivered, we obtained 199 responses (34%). We carried out in-depth interviews with 15 respondents.ResultsSeventy-seven per cent reported that guest authorship occurred at their institution, 60% reported text recycling. For plagiarism, 12% of respondents reported that this occurred ‘occasionally’, and 24% ‘rarely’. Forty per cent indicated that their colleagues had not declared conflicts of interest in the past. Respondents generally recognised poor practice in scenarios but reported that they occurred at their institutions. Themes identified from in-depth interviews were (1) authorship rules are simple in theory, but not consistently applied; (2) academic status and power underpin behaviours; (3) institutions and culture fuel bad practices and (4) researchers are uncertain about what conflict of interests means and how this may influence research.ConclusionsLMIC researchers report that guest authorship is widely accepted and common. While respondents report that plagiarism and undeclared conflicts of interest are unacceptable in practice, they appear common. Determinants of poor practice relate to academic status and power, fuelled by institutional norms and culture.
1 Patient acceptability and feasibility of HIV testing in emergency departments in the UK – a systematic review and meta-analysis
Authors: Lungu Nicola 
Published: November 2017

BackgroundNICE 2016 HIV testing guidelines now include the recommendation to offer HIV testing in Emergency Departments, in areas of high prevalence,1to everyone who is undergoing blood tests. 23% of England’s local authorities are areas of high HIV prevalence (>2/1000) and are therefore eligible.2So far very few Emergency Departments have implemented routine HIV testing. This systematic review assesses evidence for two implementation considerations: patient acceptability (how likely a patient will accept an HIV test when offered in an Emergency Department), and feasibility, which incorporates staff training and willingness, and department capacity, (how likely Emergency Department staff will offer an HIV test to an eligible patient), both measured by surrogate quantitative markers.Methods and resultsThree medical databases were systematically searched for reports of non-targeted HIV testing in UK Emergency Departments. A total of 1584 unique papers were found, 9 full text articles were critically appraised, and 7 studies included in meta-analysis. There is a combined patient sample of 1 01 975. The primary outcome, patient acceptability of HIV testing in Emergency Departments (number of patients accepting an HIV test, as a proportion of those offered) is 54.1% (CI 40.1, 68.2). Feasibility (number of tests offered, as a proportion of eligible patients) is 36.2% (CI 9.8, 62.4).ConclusionsFor an Emergency Department considering introducing routine HIV testing, this review suggests an opt-out publicity-lead strategy. Utilising oral fluid and blood tests would lead to the greatest proportion of eligible patients accepting an HIV test. For individual staff who are consenting patients for HIV testing, it may be encouraging to know that there is >50% chance the patient will accept an offer of testing.Table 1Summary table of data extracted from final 7 studies, with calculated acceptability and feasibility if appropriate, and GRADE score. Studies listed in chronological order of data collection. GRADE working group evidence grades: 4= high quality, 3= moderate quality, 2= low quality, 1 or below = very low quality. (*study conclusion reports this figure is inaccurate)Figure 1Patients accepting HIV tests, and being offered HIV tests, as a proportion of the eligible sampleReferencesNational Institute for Health and Care Excellence, Public Health England.HIV testing: Increasing uptake among people who may have undiagnosed HIV. 2016 1 December 2016.Public Health England.HIV prevalence by Local Authority of residence to end December 2015. Table No.1: 2016. Public Health Engand; 2016.
10 Decision analysis modelling of diagnostic strategies for suspected pulmonary embolism in pregnancy: the DiPEP economic evaluation
Authors: Pollard Daniel , Goodacre Steve , Stevenson Matthew , Fuller Gordon 
Published: November 2017

BackgroundUsing diagnostic imaging for suspected pulmonary embolism (PE) in pregnancy involves weighing the benefits, harms and costs of different approaches to selecting women for imaging.ObjectivesTo estimate the effectiveness of diagnostic strategies for PE in pregnancy and postpartum, in terms of adverse outcomes from venous thromboembolism, bleeding and radiation exposure, and cost effectiveness, measured as the incremental cost per quality-adjusted life year (QALY).MethodsDecision-analysis modelling was used to estimate costs incurred and expected outcomes from thromboembolism, bleeding and radiation exposure if a hypothetical cohort of pregnant or postpartum women based on the Diagnosis of PE in Pregnancy (DiPEP) study population were investigated for suspected PE using different strategies, including no imaging, selective imaging based on a clinical decision rule and imaging for all. Outcomes were modelled to estimate the quality-adjusted life years (QALYs) accrued by each strategy and the incremental cost per QALY gained by each strategy compared to the next most effective alternative. Threshold analysis explored the parameters required for a hypothetical clinical decision rule to be cost-effective.ResultsDecision analysis showed that a nonselective strategy of scanning all women with suspected PE accrued more QALYs and incurred fewer costs than any selective strategy based on a clinical decision rule and was therefore the dominant strategy. This finding was robust in sensitivity analysis and scenario analysis exploring assumptions in the model. Threshold analysis showed that a clinical decision rule to select women for imaging would need to have sensitivity exceeding 97.5% to be cost-effective compared to nonselective use of scanning.Figure 1ConclusionThere is little potential for selective imaging based on a clinical decision rule to be cost-effective compared to a strategy of nonselective imaging for all women with suspected PE in pregnancy and postpartum.
11 Topical nsaids for analgesia in traumatic corneal abrasions: a systematic review and meta-analysis
Authors: Lawrenson Annali , Wakai Abel 
Published: November 2017

BackgroundTraumatic corneal abrasions are common ocular presenTations in the ED. There is no consensus regarding the most appropriate analgesia for this condition. Topical non-steroidal anti-inflammatory drugs (NSAIDs) have been suggested as pain-relief to minimise systemic adverse events associated with oral analgesia.AimTo identify and evaluate all randomised controlled trials (RCTs) comparing the use of topical NSAIDs with placebo or any alternative analgesic interventions in adults with traumatic corneal abrasions (including corneal abrasions arising from foreign body removal), to reduce pain, and its effects on healing time.MethodsWe searched MEDLINE, EMBASE, Cochrane Library and clinical trials registers up to 30/03/17. We did not use any date or language restrictions in the electronic searches for trials. We checked the reference lists of identified trials to search for further potentially relevant studies. Two review authors independently performed data extraction and assessed risks of bias in the included studies. We assessed risk of bias using the Cochrane risk of bias tool and rated the certainty of the evidence using GRADE.ResultsWe included nine studies that met the inclusion criteria, reporting data on 637 participants. These studies compared five types of topical NSAIDs (0.1% indomethacin, 0.03% flurbiprofen, 0.5% ketorolac, 1% indomethacin, 0.1% diclofenac) to control (consisting of standard care and in four studies used placebo eye drops). Overall, the studies were at an unclear or high risk of bias (particularly selection and reporting bias). None of the included studies reported the primary outcome measures of this review, namely participant-reported pain intensity reduction of 30% or more or 50% or more at 24 hours. Four trials, that included data on 481 participants receiving NSAIDs or control (placebo/standard care), reported on the use of ‘rescue’ analgesia at 24 hours as a proxy measure of pain control. Topical NSAIDs were associated with a reduction in the need for oral analgesia compared with control (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.34 to 0.61; low-certainty evidence). Approximately 4 out of 10 people in the control group used rescue analgesia at 24 hours. No data were available on the use of analgesia at 48 or 72 hours. There was no evidence from the included trials of an effect of topical NSAIDS on healing time and possible drug-related adverse events were low and balanced across intervention and control groups.ConclusionsThe findings of the included studies do not provide strong evidence to support the use.
12 A multi-centre randomised feasibility study evaluating the impact of a prognostic model for management of blunt chest wall trauma patients: stumbl trial
Authors: Battle Ceri , Hutchings Hayley , Abbott Zoe , O’neill Claire , Groves Sam , Watkins Alan , Lecky Fiona , Jones Sally , Gagg James , Body Rick , Evans Phillip 
Published: November 2017

IntroductionA new prognostic model has been developed and externally validated, the aim of which is to assist in the management of the blunt chest wall trauma patient in the Emergency Department (ED). A definitive randomised controlled trial (impact trial), is required to assess the clinical and cost effectiveness of the new model, before it can be accepted in clinical practice. The purpose of this trial is to assess the feasibility and acceptability of such a definitive trial and inform its design.Methods and analysisThis feasibility trial is designed to test the methods of a multi-centre, cluster-randomised (stepped wedge) trial, with a substantial qualitative component. Four EDs in England and Wales will collect data for all blunt chest wall trauma patients over a five month period; in the initial period acting as the controls (normal care) and the second period, acting as the interventions (in which the new model will be used). Baseline measurements including completion of the SF-12v2 will be obtained on initial assessment in the ED. Patient outcome data will then be collected for any subsequent hospitalisations. Data collection will conclude with a six week follow-up completion of two surveys (SF-12v2 and Client Services Receipt Inventory).Analysis of outcomes will focus on feasibility, acceptability and trial processes and will include recruitment and retention rates, attendance at clinician training rates and use of model in the ED. Qualitative feedback will be obtained through clinician interviews and a research nurse focus group. An evaluation of the feasibility of health economics outcomes data will be completed.Ethics and disseminationWales Research Ethics Committee 6 granted approval for the trial in September 2016. Health Care Research Wales Research Permissions and the HRA have granted approval for the study. Patient recruitment commenced in February 2017. Planned dissemination is through publication in a peer-reviewed Emergency Medicine Journal, presentation at appropriate conferences and to stakeholders at Professional Meetings.
14 Prediction of massive blood transfusion in battlefield trauma: development and validation of the military acute severe haemorrhage (MASH) score
Authors: Mclennan Jackie , Smith Jason , Mackway-jones Kevin 
Published: November 2017

BackgroundThe predominant cause of preventable death from trauma is bleeding. Many patients need resuscitation with massive blood transfusion (MBT). In some theatres of military operation there is limited blood product availability and walking donor panels can be required. This study aimed to produce a tool to predict the need for MBT using information available on patient arrival at the ED for patients sustaining battlefield trauma.MethodsA retrospective database analysis was undertaken using the UK Joint Theatre Trauma Registry (JTTR) to provide derivation and validation datasets. Regression analysis of potential predictive factors was performed. MBT was defined either as receiving 6 or more units of red blood cells (RBCs) in 4 hours or 10 units of RBCs in 24 hours. Predictive factors were analysed through multi-logistic regression analysis to build predictive models; sensitivity and specificity of these models was assessed, and the best fit models were analysed in the validation dataset.ResultsThe derivation dataset was made up of 1298 casualties with a massive blood transfusion rate of 21.2% (n=275). The validation dataset contained 1186; MBT rate 6.7% (n=79). The majority of patients were young, male and with penetrating injury. Univariate regression analyses showing the predictive value of the variables within the MASH score are shown in table 1. A decision rule was produced using a combination of injury pattern, clinical observations and pre-hospital interventions. The test characteristics for three cut off thresholds for the rule are shown in Table 2 alongside the sensitivity analysis. The proposed rule, using a score of 3 or greater, demonstrated a sensitivity of 82.7% and a specificity of 88.8% for prediction of MBT, with an AUROC of 0.93 (95% CI:0.91 to 0.95).Table 1Univariate regression analysis of variables included in the MASH score in the derivation dataset which predict the requirement for 6 units of pRBCs in 4 hours or 10 units of pRBCs in 24 hoursTable 2Performance of the MASH score in derivation and validation datasets showing test characteristics for three values of the MASH score with 95% confidence intervals with sensitivity analysis for a score of 3 in the validation datasetConclusionsThis study has produced the first military scoring system that uses clinical observations, injuries sustained and pre-hospital interventions to predict the need for MBT and therefore the requirement for an emergency donor panel in resource-limited environments. The MASH score has higher sensitivity and specificity than previous military prediction tools, and has the advantage of only using information which is rapidly available in the resuscitation bay. This is of importance to civilian practitioners with increasing possibility of major terrorist attacks.
18 How do public attitudes to automated external defibrillators affect their use in out-of-hospital cardiac arrest?
Authors: Choi Hyun , Bosompra Nana , Updyke Mathew , Adebowale Adesina 
Published: November 2017

IntroductionSudden cardiac death is one of the leading causes of mortality in the UK. The incidence of out-of-hospital cardiac arrest (OHCA) in the UK is approximately 30 000. The initial cardiac rhythm in these cases is often a ventricular tachyarrhythmia which requires electrical defibrillation. The efficacy of defibrillation is dependent on its timely use, with the odds of survival decreasing by up to 10% for every minute of delay. The use of AEDs has been shown to significantly improve neurologically intact survival in OHCA. Significant progress has been made regarding the provision of AEDs in public places but it is questioned whether sufficient public education has been undertaken in order to support this strategy. This study aims to explore the attitudes of the general public in order to inform public education strategies, increase AED use and ultimately improve survival of OHCA.MethodsA questionnaire was devised and presented to a convenience sample of adult patients and their relatives presenting to the Emergency Department Urgent Care Centre at University Hospital Lewisham over a 3 month period from January-March 2017. Participants were asked about their age, educational background, previous resuscitation training and knowledge of AED. Those with correct knowledge of AEDs were also asked about their willingness to operate one and to give reasons if reluctant to use an AED in an OHCA.Institutional ethical approval was obtained.ResultsA total of 216 responses were obtained. 12 were excluded in the analysis as the questionnaires were not fully complete and thus 204 were included in the final data analysis. 32% of the study participants reported knowing about AEDs but only 23% correctly described its use. 19% of the study participants had both accurate knowledge and a willingness to operate an AED. 66% of those correctly describing AEDs and willing to use them had some form of resuscitation training. 6% of the study sample had no resuscitation training but correctly described AEDs and were willing to operate one.Common reasons for unwillingness to operate AEDs were fear of causing more harm, fear of doing it incorrectly, perceived danger of the equipment and lack of training.ConclusionThe level of knowledge of AEDs is low amongst the general public. Majority of the study population who knew about AEDs had some degree of resuscitation training. Further research is required to ascertain how to translate knowledge into optimal use of AEDs in practice.