bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of three different sets of explicit criteria for assessing inappropriate prescribing in older patients: a nationwide prevalence study of ambulatory care visits in Taiwan
Authors: Chang Chirn-Bin , Yang Shu-Yu , Lai Hsiu-Yun , Wu Ru-Shu , Liu Hsing-Cheng , Hsu Hsiu-Ying , Hwang Shinn-Jang , Chan Ding-Cheng 
Published: November 2015

ObjectiveTo investigate the national prevalence of potentially inappropriate medications (PIMs) prescribed in ambulatory care clinics in Taiwan according to three different sets of regional criteria and the correlates of PIM use.DesignCross-sectional study.SettingThis analysis included older patients who visited ambulatory care clinics in 2009 and represented half of the older population included on the Taiwanese National Health Insurance Research Database.ParticipantsWe identified 1 164 701 subjects who visited ambulatory care clinics and were over 65 years old in 2009.Primary and secondary outcome measuresPIM prevalence according to the 2012 Beers criteria, the PIM-Taiwan criteria and the PRISCUS criteria was estimated separately, and characteristics of PIM users were explored. Multivariate logistic regression analysis was used to determine patient factors associated with the use of at least one PIM. Leading PIMs for each set of criteria were also listed.ResultsThe prevalence of having at least one PIM at the patient level was highest with the Beers criteria (86.2%), followed by the PIM-Taiwan criteria (73.3%) and the PRISCUS criteria (66.9%). Polypharmacy and younger age were associated with PIM use for all three sets of criteria. The leading PIMs detected by the PIM-Taiwan and PRISCUS criteria were all included in the 2012 Beers criteria. Non-COX-selective non-steroidal anti-inflammatory drugs in the Beers criteria and benzodiazepines in the PIM-Taiwan and PRISCUS criteria accounted for most leading PIMs.ConclusionsThe prevalence of PIMs was high among older Taiwanese patients receiving ambulatory care visits. The prevalence of PIM and its associated factors varied according to three sets of criteria at the population level.
Bad apples or spoiled barrels? Multilevel modelling analysis of variation in high-risk prescribing in Scotland between general practitioners and between the practices they work in
Authors: Guthrie Bruce , Donnan Peter T , Murphy Douglas J , Makubate Boikanyo , Dreischulte Tobias 
Published: November 2015

ObjectivesPrimary care high-risk prescribing causes significant harm, but it is unclear if it is largely driven by individuals (a ‘bad apple’ problem) or by practices having higher or lower risk prescribing cultures (a ‘spoiled barrel’ problem). The study aimed to examine the extent of variation in high-risk prescribing between individual prescribers and between the practices they work in.Design, setting and participantsMultilevel logistic regression modelling of routine cross-sectional data from 38 Scottish general practices for 181 010 encounters between 398 general practitioners (GPs) and 26 539 patients particularly vulnerable to adverse drug events (ADEs) of non-steroidal anti-inflammatory drugs (NSAIDs) due to age, comorbidity or co-prescribing.Outcome measureInitiation of a new NSAID prescription in an encounter between GPs and eligible patients.ResultsA new high-risk NSAID was initiated in 1953 encounters (1.1% of encounters, 7.4% of patients). Older patients, those with more vulnerabilities to NSAID ADEs and those with polypharmacy were less likely to have a high-risk NSAID initiated, consistent with GPs generally recognising the risk of NSAIDs in eligible patients. Male GPs were more likely to initiate a high-risk NSAID than female GPs (OR 1.73, 95% CI 1.39 to 2.16). After accounting for patient characteristics, 4.2% (95% CI 2.1 to 8.3) of the variation in high-risk NSAID prescribing was attributable to variation between practices, and 14.2% (95% CI 11.4 to 17.3) to variation between GPs. Three practices had statistically higher than average high-risk prescribing, but only 15.7% of GPs with higher than average high-risk prescribing and 18.5% of patients receiving such a prescription were in these practices.ConclusionsThere was much more variation in high-risk prescribing between GPs than between practices, and only targeting practices with higher than average rates will miss most high-risk NSAID prescribing. Primary care prescribing safety improvement should ideally target all practices, but encourage practices to consider and act on variation between prescribers in the practice.
Healthcare utilisation by pregnant patients with asthma in South Korea: a cohort study using nationwide claims data
Authors: Lee Chang-Hoon , Kim Jimin , Jang Eun Jin , Kim Yun Jung , Choi Seongmi , Lee Joon-Ho , Kim Deog Kyeom , Yim Jae-Joon , Yoon Ho Il 
Published: November 2015

ObjectivesFew nationwide population-based studies have examined the burden of asthma during pregnancy. Here, we investigated the burden and medical treatment of asthma during pregnancy requiring healthcare utilisation in South Korea.DesignCohort study.SettingNationwide insurance claims database.ParticipantsA total of 1 306 281 pregnant women who delivered in South Korea in 2009–2011.OutcomesThe prevalence and exacerbation rates of asthma requiring healthcare utilisation, and the prescription of antiasthmatic drugs during pregnancy.ResultsThe prevalence of asthma requiring healthcare utilisation was 0.43% among pregnant women. Among those with asthma requiring healthcare utilisation, 6.9% were hospitalised and treated with systemic steroids and short-acting β2-agonists during pregnancy. Oral drugs were prescribed less during the third trimester than during the first trimester (all p values for trends were <0.001). A significant number of patients with asthma were likely to stop taking antiasthmatic drugs after becoming pregnant.ConclusionsThe prevalence of asthma requiring healthcare utilisation during pregnancy was not very high. However, a significant number of women were likely to stop taking antiasthmatic drugs, and those who did tended to experience exacerbations.
New onset diabetes after kidney transplantation in patients with autosomal dominant polycystic kidney disease: systematic review protocol
Authors: Yang Bo , Chen Sixiu , Yang Guang , Mei Changlin , Ong Albert , Mao Zhiguo 
Published: November 2015

IntroductionAutosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder with numerous cysts developing in bilateral kidneys. Meanwhile, ADPKD can also be regarded as a systemic disease because the cystic and non-cystic abnormalities could be identified in multiple organs in patients with ADPKD. Several lines of evidence suggest the risk of post-transplant diabetes mellitus or new-onset diabetes after transplantation (NODAT) is higher in patients with ADPKD compared with non-ADPKD renal recipients, but the available results are conflicting. We describe the protocol of a systematic review and meta-analysis for investigating the risk of NODAT in patients with ADPKD.Methods and analysisPubMed, EMBASE and The Cochrane Library will be searched. Cohort studies irrespective of language and publication status, comparing the incidence of NODAT in renal recipients with ADPKD and other kidney disease will be eligible. We will assess heterogeneity among studies. Along with 95% CIs, dichotomous data will be summarised as risk ratios; numbers needed to treat/harm and continuous data will be given as standard mean differences. Excluding outliers and testing small sample size studies if our results are robust, sensitivity analysis will be carried out.Ethics and disseminationEthical approval is not required because this study includes no confidential personal data or patient interventions. The review findings will be helpful in designing and implementing future studies and will be of interest to a wide range of readers, including healthcare professionals, researchers, health service managers and policymakers. The systematic review will be published in a peer-reviewed journal and disseminated electronically and in print.Trial registration numberThe study protocol has been registered in PROSPERO (http://www.crd.york.ac.uk/PROSPERO/) under registration number CRD42014009677.
A multilevel analysis of mortality following acute myocardial infarction in Norway: do municipal health services make a difference?
Authors: Ambugo Eliva Atieno , Hagen Terje P 
Published: November 2015

ObjectivesStudies link area features such as neighbourhood socioeconomic deprivation to poor health outcomes. However, there is a paucity of research based on representative data investigating the effects of area-level health services on mortality. This study examines the extent to which municipal health services account for municipal variation in all-cause and cardiovascular disease (CVD) mortality. We hypothesise that unfavourable municipal features (eg, fewer available places for rehabilitation) are associated with higher risk of mortality after accounting for patients’ characteristics.DesignPopulation data from Norwegian national/municipal registrars are analysed using multilevel logistic regression in this prospective cohort study.Setting and participantsThe analytic sample (9412 patients aged 18+ from 336 municipalities) constitutes 87.7% of the nationwide population of Norwegian adults who were hospitalised for acute myocardial infarction (AMI) in 2009 and discharged alive.Primary outcome measuresAll-cause and CVD mortality occurring within 365 days after the first day of hospitalisation for AMI.ResultsThere was a small but significant variation at the municipal level in all-cause mortality (0.5%; intraclass correlation coefficient=0.005) but not CVD mortality. There were no significant fixed effects of municipal health services on mortality in bivariate models. Patients’ characteristics (eg, gender, comorbidities) fully accounted for the observed municipal variation in mortality. Being male versus female (OR=1.21, 95% CI 1.02 to 1.43), or having been previously diagnosed with dementia versus not (OR=2.06, 95% CI 1.53 to 2.77) were also linked to higher odds of death.ConclusionsMunicipal variation in all-cause mortality for Norwegian patients with AMI appears to be driven not by differences across municipalities in health service levels, but by differences across municipalities in the composition of patients. Focusing on chronic disease prevention and treatment, and tackling personal and structural risk factors embedded within patients’ sociodemographic characteristics, may be especially beneficial for longevity.
Examination of the community-specific prevalence of and factors associated with substance use and misuse among Rural and Urban adolescents: a cross-sectional analysis in Bosnia and Herzegovina
Authors: Zenic Natasa , Ostojic Ljerka , Sisic Nedim , Pojskic Haris , Peric Mia , Uljevic Ognjen , Sekulic Damir 
Published: November 2015

ObjectiveThe community of residence (ie, urban vs rural) is one of the known factors of influence on substance use and misuse (SUM). The aim of this study was to explore the community-specific prevalence of SUM and the associations that exist between scholastic, familial, sports and sociodemographic factors with SUM in adolescents from Bosnia and Herzegovina.MethodsIn this cross-sectional study, which was completed between November and December 2014, the participants were 957 adolescents (aged 17 to 18 years) from Bosnia and Herzegovina (485; 50.6% females). The independent variables were sociodemographic, academic, sport and familial factors. The dependent variables consisted of questions on cigarette smoking and alcohol consumption. We have calculated differences between groups of participants (gender, community), while the logistic regressions were applied to define associations between the independent and dependent variables.ResultsIn the urban community, cigarette smoking is more prevalent in girls (OR=2.05; 95% CI 1.27 to 3.35), while harmful drinking is more prevalent in boys (OR=2.07; 95% CI 1.59 to 2.73). When data are weighted by gender and community, harmful drinking is more prevalent in urban boys (OR=1.97; 95% CI 1.31 to 2.95), cigarette smoking is more frequent in rural boys (OR=1.61; 95% CI 1.04 to 2.39), and urban girls misuse substances to a greater extent than rural girls (OR=1.70; 95% CI 1.16 to 2.51,OR=2.85; 95% CI 1.88 to 4.31,OR=2.78; 95% CI 1.67 to 4.61 for cigarette smoking, harmful drinking and simultaneous smoking-drinking, respectively). Academic failure is strongly associated with a higher likelihood of SUM. The associations between parental factors and SUM are more evident in urban youth. Sports factors are specifically correlated with SUM for urban girls.ConclusionsLiving in an urban environment should be considered as a higher risk factor for SUM in girls. Parental variables are more strongly associated with SUM among urban youth, most probably because of the higher parental involvement in children’ personal lives in urban communities (ie, college plans, for example). Specific indicators should be monitored in the prevention of SUM.
Prediction of individual combined benefit and harm for patients with atrial fibrillation considering warfarin therapy: a study protocol
Authors: Li Guowei , Holbrook Anne , Delate Thomas , Witt Daniel M , Levine Mitchell AH , Thabane Lehana 
Published: November 2015

IntroductionClinical prediction rules have been validated and widely used in patients with atrial fibrillation (AF) to predict stroke and major bleeding. However, these prediction rules were not developed in the same population, and do not provide the key information that patients and prescribers need at the time anticoagulants are being considered—what is the individual patient-specific risk of both benefit (decreased stroke) and harm (increased major bleeding). In this study, our primary objective is to develop and validate a prediction model for patients’ individual combined benefit and harm outcomes (stroke, major bleeding and neither event) with and without warfarin therapy. Our secondary outcome is all-cause mortality.Methods and analysisWe will use data from the Kaiser Permanente Colorado (KPCO) anticoagulation management databases and electronic medical records. Patients with a primary or secondary diagnosis during an ambulatory KPCO medical office visit, emergency department visit, or inpatient stay between 1 January 2005 and 31 December 2012 with no AF diagnosis in the previous 180 days will be included. Patients’ demographic characteristics, laboratory data, comorbidities, warfarin medication data and concurrent use of medication will be used to construct the prediction model. For primary outcomes (stroke with no major bleeding, and major bleeding with no stroke), we will perform polytomous logistic regression to develop a prediction model for patients’ individual combined benefit and harm outcomes, taking neither event group as the reference group. As regards death, we will use Cox proportional hazards regression analysis to build a prediction model for all-cause mortality.Ethics and disseminationThis study has been approved by the KPCO Institutional Review Board and the Hamilton Integrated Research Ethics Board. Results from this study will be published in a peer-reviewed journal electronically and in print. The prediction models may aid in patient-physician shared decision-making when they are considering warfarin therapy.
What are the effects of varenicline compared with nicotine replacement therapy on long-term smoking cessation and clinically important outcomes? Protocol for a prospective cohort study
Authors: Davies Neil M , Taylor Gemma , Taylor Amy E , Thomas Kyla H , Windmeijer Frank , Martin Richard M , Munafò Marcus R 
Published: November 2015

IntroductionSmoking is a major avoidable cause of ill-health and premature death. Treatments that help patients successfully quit smoking have an important effect on health and life expectancy. Varenicline is a medication that can help smokers successfully quit smoking. However, there are concerns that it may cause adverse effects, such as increase in the occurrence of depression, self-harm and suicide and cardiovascular disease. In this study we aim to examine the effects of varenicline versus other smoking cessation pharmacotherapies on smoking cessation, health service use, all-cause and cause-specific mortality and physical and mental health conditions.MethodsIn this project we will investigate the effects of varenicline compared to nicotine replacement therapies on: (1) long-term smoking cessation and whether these effects differ by area level deprivation; and (2) the following clinically-important outcomes: rate of general practice and hospital attendance; all-cause mortality and death due to diseases of the respiratory system and cardiovascular disease; and a primary care diagnosis of respiratory illness, myocardial infarction or depression and anxiety. The study is based on a cohort of patients prescribed these smoking cessation medications from the Clinical Practice Research Datalink (CPRD). We will use three methods to overcome confounding: multivariable adjusted Cox regression, propensity score matched Cox regression, and instrumental variable regression. The total expected sample size for analysis will be at least 180 000. Follow-up will end with the earliest of either an ‘event’ or censoring due to the end of registration or death.Ethics and disseminationEthics approval was not required for this study. This project has been approved by the CPRD's Independent Scientific Advisory Committee (ISAC). We will disseminate our findings via publications in international peer-reviewed journals and presentations at international conferences.
Educational differentials in disability vary across and within welfare regimes: a comparison of 26 European countries in 2009
Authors: Cambois Emmanuelle , Solé-Auró Aïda , Brønnum-Hansen Henrik , Egidi Viviana , Jagger Carol , Jeune Bernard , Nusselder Wilma J , Van Oyen Herman , White Chris , Robine Jean-Marie 
Published: November 2015

BackgroundSocial differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to asdisability disadvantage)and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes.MethodsCross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30–79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups.ResultsThe relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0–1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7–2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8–1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4–0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups.ConclusionsThe country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.
Endovascular reconstruction of unruptured intradural vertebral artery dissecting aneurysms with the Pipeline embolization device
Authors: Kühn Anna Luisa , Kan Peter , Massari Francesco , Lozano J Diego , Hou Samuel Y , Howk Mary , Gounis Matthew J , Wakhloo Ajay K , Puri Ajit S 
Published: November 2015

BackgroundDissecting aneurysms of the vertebral artery (VA) are difficult to treat using current surgical and endovascular techniques.ObjectiveTo analyze retrospectively the efficacy and safety of flow diverters in the treatment of dissecting aneurysms of the vertebral artery.MethodsWe identified six patients with six unruptured VA dissecting aneurysms either arising from the V4 or V3–V4 junction that were treated with the Pipeline embolization device (PED) at our institution between July 2012 and February 2015. Among other parameters, technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated.ResultsPED placement was achieved in all cases and immediate angiography follow-up demonstrated intra-aneurysmal contrast stasis with parent artery preservation. A temporary episode of dysarthria was noted in one patient. Major procedure-related complications were not observed. The 6-month follow-up (n=6) demonstrated complete/near-complete aneurysm obliteration in five patients and partial obliteration in one. At the 1-year follow-up (n=5) stable complete aneurysm occlusion was seen in two patients. Two cases showed progression from near complete occlusion and partial occlusion at 6 months to complete occlusion and near complete occlusion. One cases showed unchanged near complete occlusion. No aneurysmal bleeding, in-stent stenosis or thromboembolic complication was seen. National Institutes of Health Stroke Scale and modified Rankin scale scores remained unchanged from admission to discharge.ConclusionsOur preliminary experience with the use of PED for the treatment of intradural VA dissecting aneurysms shows promising short-term results, making this technique a feasible and safe treatment option in patients suitable for this approach. However, long-term and larger cohort studies are needed to validate these results.