bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early and intermediate survival after transcatheter aortic valve implantation: systematic review and meta-analysis of 14 studies
Authors: Messori Andrea , Trippoli Sabrina , Biancari Fausto 
Published: January 2013

BackgroundTranscatheter aortic valve implants (TAVIs) is indicated as an alternative to surgical valve replacement for patients unfit for surgery. No systematic review has studied survival after 2 years and limited information is available on between-study heterogeneity.ObjectivesA systematic review and meta-analysis on intermediate survival after TAVI.Data sourcesPubMed, EMBASE, Scopus and references of selected articles.Study eligibility criteriaClinical studies evaluating TAVI, published between 2010 and 2012, reporting survival at 2 or more years.ParticipantsAbout 3500 patients from 14 studies.Study appraisal and synthesis methodsProportion meta-analysis with 95% CI and heterogeneity assessment (I2and Cochran's Q). Meta-regression analysis was performed as well.ResultsPooled immediate postoperative death rate was 7.8% (95% CI 6.2% to 9.8%, I2=40.8%; Cochran's Q=97.7 with 92.9 df, p<0.0001) and stroke rate was 3.8% (95% CI 2.8% to 5.0%, I2=34.3%; Cochran's Q=96.5 with 92.9 df, p<0.0001). Pooled death rates at 1, 2 and 3 years were 23.2%, 31.0% and 38.6%, respectively. Among studies reporting on concomitant percutaneous coronary intervention, pooled death rates at 30 days, 1 year and 2 years were 6.3%, 17.8% and 25.8%, respectively.LimitationsAlthough our analysis examined a total of about 3500 patients, only a minority of these were actually followed up after 2 years.ConclusionsPooled survival rates after TAVI (at 2 years: 69.0%; at 3 years: 61.4%) can be considered excellent, particularly in the light of the high-risk profile of this patient population.Implications of key findingsThe favourable intermediate outcome in patients subjected to TAVI seems to justify its use in patients unfit for surgery. Such pooled results indicate that TAVI is a valid alternative to surgical valve replacement, but lack of data on late durability after TAVI prevents its use in low-risk patients with long expectancy of life.
How long has NICE taken to produce Technology Appraisal guidance? A retrospective study to estimate predictors of time to guidance
Authors: Casson Steven G , Ruiz Francis J , Miners Alec 
Published: January 2013

ObjectivesTo assess how long the UK's National Institute for Health and Clinical Excellence's (NICE) Technology Appraisal Programme has taken to produce guidance and to determine independent predictors of time to guidance.DesignRetrospective time to event (survival) analysis.SettingTechnology Appraisal guidance produced by NICE.DatasourceAll appraisals referred to NICE by February 2010 were included, except those referred prior to 2001 and a number that were suspended.Outcome measureDuration from the start of an appraisal (when the scope document was released) until publication of guidance.ResultsSingle Technology Appraisals (STAs) were published significantly faster than Multiple Technology Appraisals (MTAs) with median durations of 48.0 (IQR; 44.3–75.4) and 74.0 (IQR; 60.9–114.0) weeks, respectively (p <0.0001). Median time to publication exceeded published process timelines, even after adjusting for appeals. Results from the modelling suggest that STAs published guidance significantly faster than MTAs after adjusting for other covariates (by 36.2 weeks (95% CI −46.05 to −26.42 weeks)) and that appeals against provisional guidance significantly increased the time to publication (by 42.83 weeks (95% CI 35.50 to 50.17 weeks)). There was no evidence that STAs of cancer-related technologies took longer to complete compared with STAs of other technologies after adjusting for potentially confounding variables and only weak evidence suggesting that the time to produce guidance is increasing each year (by 1.40 weeks (95% CI −0.35 to 2.94 weeks)).ConclusionsThe results from this study suggest that the STA process has resulted in significantly faster guidance compared with the MTA process irrespective of the topic, but that these gains are lost if appeals are made against provisional guidance. While NICE processes continue to evolve over time, a trade-off might be that decisions take longer but at present there is no evidence of a significant increase in duration.
Chronic lower respiratory diseases among demolition and cement workers: a population-based register study
Authors: Mølgaard Ellen Fischer , Hannerz Harald , Tüchsen Finn , Brauer Charlotte , Kirkeskov Lilli 
Published: January 2013

ObjectiveTo estimate standardised hospitalisation ratios (SHR) for chronic lower respiratory diseases among demolition and cement workers in Denmark, 1995–2009.DesignThis is a population-based register study on data from ‘the Occupational Hospitalisation Register’. SHR of chronic obstructive pulmonary disease (COPD) was calculated for both demolition and cement workers.SettingsRegister study with data from all hospitals in Denmark.Participants895 demolition workers and 5633 cement and concrete workers were included in the study and all economical active men were used as reference group.ResultsWe found a statistically significant high SHR for the cement workers, SHR=134 (95% CI 117 to 153). The SHR for demolition workers was 131 (95% CI 87 to 188).ConclusionsWe find a higher risk of being hospitalised due to COPD in cement and concrete workers (significant) and demolition workers (insignificant) compared to gainfully employed men.
Historical data and modern methods reveal insights in measles epidemiology: a retrospective closed cohort study
Authors: Paterson Beverley J , Kirk Martyn D , Cameron A Scott , D'Este Catherine , Durrheim David N 
Published: January 2013

ObjectivesMeasles was endemic in England during the early 1800s; however, it did not arrive in Australia until 1850 whereas other infectious diseases were known to have arrived much earlier—many with the First Fleet in 1788—leading to the question of why there was a difference.DesignShips surgeons’ logbooks from historical archives, 1829–1882, were retrospectively reviewed for measles outbreak data. Infectious disease modelling techniques were applied to determine whether ships would reach Australia with infectious measles cases.SettingHistorical ship surgeon logbooks of measles outbreaks occurring on journeys from Britain to Australia were examined to provide new insights into measles epidemiology.Primary and secondary outcome measuresSerial intervals and basic reproduction numbers (R0), immunity, outbreak generations, age-distribution, within-family transmission and outbreak lengths for measles within these closed cohorts.ResultsFive measles outbreaks were identified (163 cases). The mean serial interval (101 cases) was 12.3 days (95% CI 12.1 to 12.5). Measles R0(95 cases) ranged from 7.7–10.9. Immunity to measles was lowest among children ≤10 years old (range 37–42%), whereas 94–97% of adults appeared immune. Outbreaks ranged from 4–6 generations and, before 1850, were 41 and 38 days in duration. Two outbreaks after 1850 lasted longer than 70 days and one lasted 32 days.ConclusionsMeasles syndrome reporting in a ship surgeon's logs provided remarkable detail on prevaccination measles epidemiology in the closed environment of ship voyages. This study found lower measles R0and a shorter mean clinical serial interval than is generally reported. Archival ship surgeon log books indicate it was unlikely that measles was introduced into Australia before 1850, owing to high levels of pre-existing immunity in ship passengers, low numbers of travelling children and the journey's length from England to Australia.
Is a high level of general practitioner consultations associated with low outpatients specialist clinic use? A cross-sectional study
Authors: Deraas Trygve S , Berntsen Gro R , Hasvold Toralf , Ringberg Unni , Førde Olav Helge 
Published: January 2013

ObjectiveTo examine if increased general practice activity is associated with lower outpatient specialist clinic use.DesignCross-sectional population based study.SettingAll 430 Norwegian municipalities in 2009.ParticipantsAll Norwegians aged ≥65 years (n=721 915; 56% women—15% of the total population).Main outcome measureSpecialised care outpatient clinic consultations per 1000 inhabitants (OPC rate). Main explanatory: general practitioner (GP) consultations per 1000 inhabitants (GP rate).ResultsIn total, there were 3 339 031 GP consultations (57% women) and 1 757 864 OPC consultations (53% women). The national mean GP rate was 4625.2 GP consultations per 1000 inhabitants (SD 1234.3) and the national mean OPC rate was 2434.3 per 1000 inhabitants (SD 695.3). Crude analysis showed a statistically significant positive association between GP rates and OPC rates. In regression analyses, we identified three effect modifiers; age, mortality and the municipal composite variable of ‘hospital status’ (present/not present) and ‘population size’ (small, medium and large). We stratified manually by these effect modifiers into five strata. Crude stratified analyses showed a statistically significant positive association for three out of five strata. For the same three strata, those in the highest GP consultation rate quintile had higher mean OPC rates compared with those in the lowest quintile after adjustment for confounders (p<0.001). People aged ≥85 in small municipalities had approximately 30% lower specialist care use compared with their peers in larger municipalities, although the association between GP-rates and OPC-rates was still positive.ConclusionsIn a universal health insurance system with high GP-accessibility, a health policy focusing solely on a higher activity in terms of GP consultations will not likely decrease OPC use among elderly.
The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes
Authors: Low Lee-Fay , Brodaty Henry , Goodenough Belinda , Spitzer Peter , Bell Jean-Paul , Fleming Richard , Casey Anne-Nicole , Liu Zhixin , Chenoweth Lynn 
Published: January 2013

ObjectivesTo determine whether humour therapy reduces depression (primary outcome), agitation and behavioural disturbances and improves social engagement and quality-of-life in nursing home residents.DesignThe Sydney Multisite Intervention of LaughterBosses and ElderClowns study was a single-blind cluster randomised controlled trial of humour therapy.Setting35 Sydney nursing homes.ParticipantsAll eligible residents within geographically defined areas within each nursing home were invited to participate.InterventionProfessional ‘ElderClowns’ provided 9–12 weekly humour therapy sessions, augmented by resident engagement by trained staff ‘LaughterBosses’. Controls received usual care.MeasurementsDepression scores on the Cornell Scale for Depression in Dementia, agitation scores on the Cohen-Mansfield Agitation Inventory, behavioural disturbance scores on the Neuropsychiatric Inventory, social engagement scores on the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and self-rated and proxy-rated quality-of-life scores on a health-related quality-of-life tool for dementia, the DEMQOL. All outcomes were measured at the participant level by researchers blind to group assignment.RandomisationSites were stratified by size and level of care then assigned to group using a random number generator.ResultsSeventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Groups did not differ significantly over time on the primary outcome of depression, or on behavioural disturbances other than agitation, social engagement and quality of life. The secondary outcome of agitation was significantly reduced in the intervention group compared with controls over 26 weeks (time by group interaction adjusted for covariates: p=0.011). The mean difference in change from baseline to 26 weeks in Blom-transformed agitation scores after adjustment for covariates was 0.17 (95% CI 0.004 to 0.34, p=0.045).ConclusionsHumour therapy did not significantly reduce depression but significantly reduced agitation.Trial registrationAustralian New Zealand Clinical Trials Registry -ACTRN12611000462987.
IFN production ability and healthy ageing: mixed model analysis of a 24 year longitudinal study in Japan
Authors: Uno Kazuko , Yagi Katsumi , Yoshimori Masayo , Tanigawa Mari , Yoshikawa Toshikazu , Fujita Setsuya 
Published: January 2013

ObjectiveTo track changes in interferon (IFN) production in healthy individuals to shed light on the effect these changes have on the course of healthy ageing.DesignStudy is based on data that were collected over 24 years from a cohort of individuals whose IFN-α production was quantified as a part of their annual routine health check-up.SettingAll individuals in this study underwent regular health check-ups at Louis Pasteur Center for Medical Research.Participants295 healthy individuals (159 males and 136 females) without a history of cancer, autoimmune diseases and hepatitis C virus (HCV) whose IFN-α production was quantified more than five times within 24 years were selected. Finally, 29 males and 4 females whose IFN-α production was quantified more than 25 times were selected and their data were analysed using a mixed model.Main outcome measuresHVJ stimulated IFN-α production was quantified. Healthy individual's periodical log transformed IFN-α values (y) were plotted versus age (x) and fitted to linear (y=mx+n) and quadratic formula (y=ax2+bx+c) expressions to reveal changes in the IFN-α production in these healthy individuals.ResultsThe linear expression showed that log (IFN-α) had a slight tendency to decline (3% over 10 years). However, the quadratic formula analysis showed the quadratic expression to be more positive than negative (a concave U-shaped pattern) which means that individuals’ once declining IFN production recovered as they aged.ConclusionsAlthough we observed a marginal decline in IFN-α production, we also observed that IFN production recovered even in individuals in their mid50s to early 60s. These results combined with our previous cross-sectional studies of patients with various diseases suggest that in healthy individuals, the impairment of IFN production is triggered more by the onset of disease (notwithstanding the cause) rather than by ageing.
Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study
Authors: Rio Alan , Whelan Kevin , Goff Louise , Reidlinger Dianne Patricia , Smeeton Nigel 
Published: January 2013

BackgroundRefeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement.ObjectiveTo determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support.DesignProspective cohort study.SettingLarge, single site university teaching hospital. Recruitment period 2007–2009.Participants243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care.Main outcome measuresPrimary outcome: occurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality.Results133 participants had one or more of the following risk factors: body mass index <16–18.5≥(kg/m2), unintentional weight loss >15% in the preceding 3–6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2% 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3% 13/243) participants died during the feeding period and (28% 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes.ConclusionsRefeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.
Current state of knowledge of post-traumatic stress, sleeping problems, obesity and cardiovascular disease in paramedics
Authors: Hegg-Deloye Sandrine , Brassard Patrice , Jauvin Nathalie , Prairie Jérôme , Larouche Dominique , Poirier Paul , Tremblay Angelo , Corbeil Philippe 
Published: January 2013

PurposeThe impacts of emergency work on firefighters have been well documented and summarised, but this is not the case for paramedics. This paper explores the literature regarding the impact of work stress on paramedics.ObjectiveTo identify the literature available on the effect of paramedics’ jobs on their health status.MethodsElectronic database used: MEDLINE (Ovid, PubMed, National Library of Medicine) between 2000 and 2011. Key words used for the computer searches were: paramedics, emergency responders, emergency workers, shift workers, post-traumatic symptoms, obesity, stress, heart rate variability, physiological response, blood pressure, cardiovascular and cortisol. Exclusion criteria were: studies in which participants were not paramedics, participants without occupational exposure, physical fitness assessment in paramedics and epidemiological reports regarding death at work.ResultsThe electronic databases cited 42 articles, of which we excluded 17; thus, 25 articles are included in this review. It seems clear that paramedics accumulate a set of risk factors, including acute and chronic stress, which may lead to development of cardiovascular diseases. Post-traumatic disorders, sleeping disorders and obesity are prevalent among emergency workers. Moreover, their employers use no inquiry or control methods to monitor their health status and cardiorespiratory fitness.ConclusionsMore studies are needed to characterise paramedics’ behaviour at work. These studies could allow the development of targeted strategies to prevent health problems reported in paramedics.
Trauma survival prediction in Asian population: a modification of TRISS to improve accuracy
Authors: Chan Canon King On , Yau Kelvin KW , Cheung Moon-Tong 
Published: January 2013

The probability of survival (PS) in blunt trauma as calculated by Trauma and Injury Severity Score (TRISS) has been an indispensable tool in trauma audit. The aim of this study is to explore the predictive performance of the latest updated TRISS model by investigating the Age variable recategorisations and application of local Injury Severity Score (ISS) and Revised Trauma Score (RTS) coefficients in a logistic model using a level I trauma centre database involving Asian population.MethodsProspectively and consecutively collected 5684 trauma patients’ data over a 10-year period at a regional level I trauma centre were reviewed. Four modified TRISS (mTRISS) models using Age coefficient from reclassifications of the Age variable according to their correlation with survival by logistic regression on the local dataset were acquired. RTS and ISS coefficients were derived from the local dataset and then applied to the mTRISS models. mTRISS models were compared with the existing Major Trauma Outcome Study (MTOS)-derived TRISS (eTRISS) model. Model 1=Age effect taken as linear; Model 2=Age classified into two groups (0–54, 55+); Model 3=Age classified into four groups (0–15, 16–54, 55–79, 80+) and Model 4=Age classified into two groups (0–69, 70+). Performance measures including sensitivity, specificity, accuracy and area under the Receiver Operating Characteristic (ROC) curve were used to assess the various models. The cross-validation procedure consisted of comparing the PSobtained from mTRISS Models 1 and 2 with the PSobtained from the MTOS derived from eTRISS.ResultsA 5147 blunt trauma patients’ dataset was reviewed. Model 1, where Age was taken as a scale variable, demonstrated a substantial improvement in the survival prediction with 91.6% accuracy in blunt injuries as compared with 89.2% in the MTOS-derived TRISS. The 95% CI for ROC derived from mTRISS Model 1 was (0.923, 0.940), when compared with the hypothesised ROC value 0.886 obtained from eTRISS, it clearly indicated a significant improvement in predicting survival at 5% level. Furthermore, ROCs have shown clearly the superiority of Model 1 over Model 2, and of Model 2 over MTOS-derived TRISS. The recategorisation of the Age variable (Models 3 and 4) also demonstrated improved performance, but their strength was not as intense as in Model 1. Overall, the results point to the adoption of Model 1 as the best model for PS. Cross-validation analysis has further assured the validity of these findings.ConclusionsThe present study has demonstrated that (1) having the Age variable being dichotomised (cut-off at 55 years) as in the eTRISS, but with the application of a local dataset-derived coefficients give better TRISS survival prediction in Asian blunt trauma patients; (2) improved performance are found with certain recategorisation of the Age variable and (3) the accuracy can further be enhanced if the Age effect is taken to be linear, with the application of local dataset-derived coefficients.
Systematic review and meta-analysis of routine total body CT compared with selective CT in trauma patients
Authors: Healy Donagh A , Hegarty Aidan , Feeley Iain , Clarke-Moloney Mary , Grace Pierce A , Walsh Stewart R 
Published: January 2013

BackgroundFull-body CT scanning is increasingly being used in the initial evaluation of severely injured patients. We sought to analyse the literature to determine the benefits of full-body scanning in terms of mortality and length of time spent in the emergency department (ED).MethodsA systematic search of the Pubmed and Cochrane Library databases was performed. Eligible studies compared trauma patients managed with selective CT scanning with patients who underwent immediate full-body scanning. Using random effects modelling, the pooled OR was used to calculate the effect of routine full-body CT on mortality while the pooled weighted mean difference was used to analyse the difference in ED time.ResultsFive studies (8180 patients) provided mortality data while four studies (6073 patients) provided data on ED time. All were non-randomised cohort studies and were prone to several sources of bias. There was no mortality difference between groups (pooled OR=0.68; 95% CI 0.43 to 1.09, p=0.11). There was a significant reduction in the time spent in the ED when patients underwent full-body CT (pooled effect size of weighted mean difference=−32.39 min; 95% CI −51.78 to −13.00; p=0.001).ConclusionsWe eagerly await the results of randomised controlled trials. Firm clinical outcome data are expected to emerge in the near future, though data on cost and radiation exposure will be needed before definitive conclusions can be made.