bluuebunny/crossref_metadata_2025_split huggingface dataset:
The older the better: are elderly study participants more non-representative? A cross-sectional analysis of clinical trial and observational study samples
Authors: Golomb Beatrice A , Chan Virginia T , Evans Marcella A , Koperski Sabrina , White Halbert L , Criqui Michael H 
Published: December 2012

ObjectiveStudy participants can differ from the target population they are taken to represent. We sought to investigate whether older age magnifies such differences, examining age-trends, among study participants, in self-rated level of activity compared to others of the same age.DesignCross-sectional examination of the relation of participant age to reported ‘relative activity’ (ie, compared to others of the same age), a bidirectionally correlated proxy for relative vitality, in exemplars of randomised and observational studies.SettingUniversity of California, San Diego (UCSD)Participants2404 adults aged 40–79 including employees of UCSD, and their partners (San Diego Population Study, observational study). 1016 adults (aged 20-85) not on lipid medications and without known heart disease, diabetes, cancer or HIV (UCSD Statin Study, randomised trial).MeasurementsSelf-rated activity relative to others’ age, 5-point Likert Scale, was evaluated by age decade, and related via correlation and regression to a suite of health-relevant subjective and objective outcomes.ResultsSuccessively older participants reported successively greater activity relative to others of their age (greater departure from the norm for their age), p<0.001 in both studies. Relative activity significantly predicted (in regression adjusted for age) actual activity (times/week exercised), and numerous self-rated and objective health-predictors. These included general self-rated health, CES-D (depression score), sleep, tiredness, energy; body mass index, waist circumference, serum glucose, high-density lipoprotein-cholesterol, triglycerides and white cell count. Indeed, some health-predictor associations with age in participants were ‘paradoxical,’ consistent with greater apparent health in older age—for study participants.ConclusionsStudy participants may not be representative of the population they are intended to reflect. Our results suggest that departures from representativeness may be amplified with increasing age. Consequently, the older the age, the greater the disparity may be between what is recommended based on ‘evidence, ’ and what is best for the patient.Trial RegistrationUCSD Statin Study—Clinicaltrials.gov #NCT00330980(http://ClinicalTrials.gov)
Managing waiting times in diagnostic medical imaging
Authors: Nuti Sabina , Vainieri Milena 
Published: December 2012

ObjectiveThis paper aims to analyse the variation in the delivery of diagnostic imaging services in order to suggest possible solutions for the reduction of waiting times, increase the quality of services and reduce financial costs.DesignThis study provides a logic model to manage waiting times in a regional context. Waiting times measured per day were compared on the basis of the variability in the use rates of CT and MRI examinations in Tuscany for the population, as well as on the basis of the capacity offered with respect to the number of radiologists available. The analysis was performed at the local health authority level to support the decision-making process of local managers.SettingDiagnostic imaging services, in particular the CT and MRI examinations. The study involved all the 12 local health authorities that provide services for 3.7 million inhabitants of the Italian Tuscany Region.Primary and secondary outcome measuresParticipants: the study uses regional administrative data on outpatients and survey data on inpatient diagnostic examinations in order to measure productivity.Primary and secondary outcome measuresThe study uses the volumes per 1000 inhabitants, the days of waiting times and the number of examinations per radiologist. Variability was measured using the traditional SD measures.ResultsA significant variation in areas considered homogeneous in terms of age, gender or mortality may indicate that the use of radiological services is not optimal and underuse or overuse occurs and that there is room for improvement in the service organisation.ConclusionsConsidering that there is a high level of variability among district use rates and waiting times, this study provides managers with a specific tool to find the cause of the problem, identify a possible solution, assess the financial impact and initiate the eventual reduction of waste.
Flemish adolescents’ perceptions of cigarette plain packaging: a qualitative study with focus group discussions
Authors: Van Hal Guido , Van Roosbroeck Sofie , Vriesacker Bart , Arts Matheus , Hoeck Sarah , Fraeyman Jessica 
Published: December 2012

ObjectivesTo find out whether there is a potential impact of the appearance of a plain cigarette package on the smoking perceptions and behavioural intentions of Flemish adolescents.DesignWe performed a cross-sectional study using the qualitative method of focus group discussions.SettingFlemish adolescents.ParticipantsWe performed eight focus group discussions, in which 55 adolescents took part, 32 female and 23 male. Inclusion criteria were: Flemish male and female 15-year-olds to 16-year-olds and 17-year-olds to 18-year-olds attending regular high-school education or vocational training who were current or had ever been smokers.Outcome measure (planned as well as measured)The opinions and perceptions of young Flemish smokers regarding the impact of cigarette packaging on their smoking behaviour.ResultsPlain packages are perceived as less attractive, cheap and unreliable for young people. Because of the unattractiveness of the plain packaging, the health warnings catch the eye much more strongly.ConclusionsIn this first scientific study in Flanders on this topic, it emerged that plain packaging could be a strong policy tool to reduce the number of adolescents starting smoking. Validation of these findings by conducting a quantitative survey in the same target group is recommended.
Representativeness of the dabigatran, apixaban and rivaroxaban clinical trial populations to real-world atrial fibrillation patients in the United Kingdom: a cross-sectional analysis using the General Practice Research Database
Authors: Lee Sally , Monz Brigitta U , Clemens Andreas , Brueckmann Martina , Lip Gregory Y H 
Published: December 2012

ObjectiveThree oral anticoagulants have reported study results for stroke prevention in patients with atrial fibrillation (AF) (dabigatran etexilate, rivaroxaban and apixaban); all demonstrated superiority or non-inferiority compared with warfarin (RE-LY, ARISTOTLE and ROCKET-AF). This study aimed to assess the representativeness for the real-world AF population, particularly the population eligible for anticoagulants.DesignA cross-sectional database analysis.SettingDataset derived from the General Practice Research Database (GPRD).Primary and secondary outcomes measureThe proportion of real-world patients with AF who met the inclusion/exclusion criteria for RE-LY, ARISTOTLE and ROCKET-AF were compared. The results were then stratified by risk of stroke using CHADS2and CHA2DS2-VASc.Results83 898 patients with AF were identified in the GPRD. For the population at intermediate or high risk of stroke and eligible for anticoagulant treatment (CHA2DS2-VASc ≥1; n=78 783 (94%)), the proportion eligible for inclusion into RE-LY (dabigatran etexilate) was 68% (95% CI 67.7% to 68.3%; n=53 640), compared with 65% (95% CI 64.7% to 65.3%; n=51 163) eligible for ARISTOTLE (apixaban) and 51% (95% CI 50.7% to 51.4%; n=39 892) eligible for ROCKET-AF (rivaroxaban). Using the CHADS2method of risk stratification, for the population at intermediate or high risk of stroke and eligible for anticoagulation treatment (CHADS2≥1; n=71 493 (85%)), the proportion eligible for inclusion into RE-LY was 74% (95% CI 73.7% to 74.3%; n=52 783), compared with 72% (95% CI 71.7% to 72.3%; n=51 415) for ARISTOTLE and 56% (95% CI 55.6% to 56.4%; n=39 892) for ROCKET-AF.ConclusionsPatients enrolled within RE-LY and ARISTOTLE were more reflective of the ‘real-world’ AF population in the UK, in contrast with patients enrolled within ROCKET-AF who were a more narrowly defined group of patients at higher risk of stroke. Differences between trials should be taken into account when considering the applicability of findings from randomised clinical trials. However, assessing representativeness is not a substitute for assessing generalisibility, that is, how well clinical trial results would translate into effectiveness and safety in everyday routine care.
Assessing the knowledge of sudden unexpected death in the young among Canadian medical students and recent graduates: a cross-sectional study
Authors: Huisma Felicity F , Potts James E , Gibbs Karen A , Sanatani Shubhayan 
Published: December 2012

ObjectiveTo determine the level of knowledge concerning Sudden Unexpected Death in the Young (SUDY) among Canadian medical students and recent graduates (≤5 years after graduating).DesignA cross-sectional study was conducted by distributing a standardised, multiple choice, online questionnaire which assessed basic knowledge of SUDY.SettingCanadian medical schools and residency training programmes.Participants614 Canadian medical students (in either their penultimate or final year) and recent graduates (≤5 years after graduating) completed an anonymous online questionnaire.Primary and secondary outcome measuresThe level of knowledge regarding molecular aetiology, clinical presentation, pharmacological management and modes of inheritance of six of the commonest conditions causing SUDY, including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQT) and Wolff-Parkinson White syndrome (WPW), were compared between medical students and recent graduates. Questions were broken down into basic knowledge and advanced categories and analysed as a secondary outcome measure.ResultsOf 614 responses, approximately two-thirds were answered by recent graduates, who generally scored 10% higher on all subject categories than medical students. Overall, questions regarding HCM were best answered (40%), followed by WPW syndrome (32%), CPVT (30%), ARVC (23%), Brugada syndrome (21%) and LQT syndrome (17%). Questions categorised as basic knowledge were answered 30% and 39% correctly in medical student and recent graduate groups, respectively, and those in the advanced category were answered 20% and 25% correctly.ConclusionsSurvey respondents fared poorly when answering questions regarding SUDY, which may be a reflection of inadequate medical education regarding these disorders. Standardised teaching regarding SUDY needs to occupy a stronger focus in Canadian medical curricula in order to prevent more unnecessary deaths by these syndromes in the future.
Attitudes and beliefs about hand hygiene among paediatric residents: a qualitative study
Authors: Dixit Devika , Hagtvedt Reidar , Reay Trish , Ballermann Mark , Forgie Sarah 
Published: December 2012

BackgroundDespite the knowledge that contaminated hands play an important role in the transmission of healthcare-associated pathogens, and that hand hygiene (HH) reduces the transmission of these organisms, healthcare worker's adherence with HH is poor.ObjectiveTo understand the common beliefs and attitudes held by paediatric residents about HH.DesignQualitative study design.SettingTertiary care paediatric hospital in Edmonton, Canada.MethodsSemistructured interviews were conducted and themes were identified from interviews.Participants22 paediatric residents.ResultsPaediatric residents self-reported their HH adherence at 70–99% and perceived hospital-wide adherence at 45–80%. Four major themes were identified during interviews including the importance of role modelling, balancing time spent on HH with other competing factors, self-protection as a driving factor for HH and cues as an important part of habit that stimulate HH.ConclusionsStaff physicians were viewed as integral to initiating group HH events, but at times, the first person in the room acted as a role model for the rest of the group. In certain instances, such as a cardiac arrest, decreased adherence with HH was viewed as acceptable. Residents engaged in HH to protect their own health. Residents relied on personal cues, which they integrated into their own HH habit. Future HH adherence strategies should ensure that the physician training environments permit the formation of good attitudes and habits towards HH. There are no additional data available.
Interpreting educational evidence for practice: are autopsies a missed educational opportunity to learn core palliative care principles?
Authors: Yardley Sarah 
Published: December 2012

ObjectivesUK policy requires undergraduate medical curricula to equip students to care for dying patients. The educational potential of autopsy attendance during authentic early experience to learn about the social context of death and dying has not been fully explored. In this paper the author: (1) explores how meaning is created from autopsies in authentic early experience; (2) compares views of students, curriculum designers and pathology supervisors; and (3) identifies actual/potential learning about death and dying.MethodsThis paper is based on a qualitative study of authentic early experiences situated in a UK medical school. Semistructured interviews were conducted with students in year two (n=12), workplace supervisors (n=2) and curriculum designers (n=13). Narrative analysis was used to contrast empirical data with socio-cultural perspectives on learning. Language and metaphor were used as tools to interpret knowledge construction and meaning-making in addition to a thematic approach.ResultsThe autopsy enabled students to learn about death and dying in a social context. Variance between groups in perceptions of autopsy experiences may reduce educational value. Autopsies were considered by students to be opportunities for ‘meeting’ real people, albeit dead ones, and learning from them. Tensions between lay and medical perspectives influenced learning.ConclusionsIncreasing communication and collaboration between medical school curriculum designers and disciplines such as Palliative Medicine as well as Pathology could address concerns regarding student/doctor competencies to deal with death and dying. Further research is needed to evaluate changes in curriculum design and to establish if similar concerns are found in other settings.
Palliative care education in neonatal units: impact on knowledge and attitudes
Authors: Twamley Katherine , Kelly Paula , Moss Rebecca , Mancini Alexandra , Craig Finella , Koh Michelle , Polonsky Reen , Bluebond-Langner Myra 
Published: December 2012

ObjectiveTo facilitate improved and earlier access to palliative care for babies, a 4-h workshop on the principles, practice and resources in palliative care was delivered in 21 neonatal units across London. This paper assesses the impact of these workshops.DesignAs part of mixed methods, processual evaluation of a series of education workshops, a pre and post survey instrument was developed, consisting of open and closed questions assessing knowledge of services and attitudes towards palliative care. Before and after each workshop attendees were invited to complete the survey.SettingNeonatal units in hospitals across London, including examples of intensive care, high dependency and special care units.Results331 healthcare professionals attended the sessions, and 264 (80%) completed questionnaires. The majority of attendees were experienced neonatal nurses working in neonatal intensive care (61% more than 7 years) but with limited experience of palliative care services. Over 79% of respondents reported that the workshop completely met their learning needs. Post-session 80% of respondents felt confident referring to palliative care services, compared with 46% before (p<0.001). Analysis of open and closed text responses revealed a shift in attitude after the sessions from a focus on dying/end-of-life, towards integrating palliative care as part of a holistic treatment plan.ConclusionsA short (half day), locally delivered workshop can change attitudes and increase knowledge in neonatal staff. Such a workshop can serve as a first step in facilitating access to and utilisation of a variety of palliative care services.
Medical specialists’ motivations for referral to specialist palliative care: a qualitative study
Authors: Kirby Emma , Broom Alex , Good Phillip , Wootton Julia , Adams Jon 
Published: December 2012

ObjectivesThe decision to refer a patient to palliative care is complex and often highly variable between medical specialists. In this paper, we examine medical specialists’ motivations and triggers underpinning decision-making around referral to palliative care in order to facilitate improvements in referral practices.MethodsWe completed semistructured, qualitative interviews with 20 referring medical specialists. Medical specialists were recruited from a range of specialties in a major metropolitan area in Australia. Participants were sampled through having referred at least one patient to the specialist palliative care unit during the previous 12 months. Analysis consisted of the framework approach augmented by NVivo 9 data analysis software. Key themes were identified and tested for rigour through inter-rater reliability and constant comparison.ResultsThe major motivations/triggers identified were: (a) disease-based (eg, pain management and symptom control); (b) pre-emptive/strategic (eg, anticipation of need, preparatory objective); (c) crisis/parallel (eg, physical and psychosocial issues); and (d) team-based (eg, referral as policy/team strategy).ConclusionsReferral to palliative care is motivated by a range of individual, interpersonal and organisational factors. In order to improve the care and quality of life of patients and family caregivers, further work is needed to develop streamlined practices that are sensitive to physical and psychosocial considerations, and patient/family caregiver desires.
Diarrhoeal episodes in travellers suffering from IBD
Authors: Ellul Pierre , Fenech Valerie Anne , Azzopardi Christine , Callus Lara , Delicata Nicholas , Muscat Jeffrey , Azzopardi Neville , Vassallo Mario 
Published: December 2012

Background and aimsThere is limited data on the risk of developing diarrhoea in travelling patients with inflammatory bowel disease (IBD). We analysed the rate of developing diarrhoea among travellers suffering from IBD and their healthy controls.MethodsWe performed a retrospective case-controlled study among 78 patients with IBD and their healthy travelling companion controls, thus matching both groups to the same environmental conditions. Data was retrieved through a structured questionnaire, interview and clinical case notes review.ResultsSixteen (20.5%) patients with IBD developed diarrhoea while abroad (p −0.0001) Statistical analysis using a χ2test for independence (with Yates Continuity Correction). Prior to travelling, they were in clinical remission. Only one healthy control (1.3%) developed diarrhoea while abroad. In 11 patients (14.1%), the duration of diarrhoea was 3 days or less, and resolved on its own without antibiotics, any increase in their IBD medications and without a medical consultation. The other five patients had a flare-up of their disease and needed medications to put them back into remission. There was no statistically significant difference between patients having immunomodulator medications versus those having aminosalicylates only in developing diarrhoea when abroad.ConclusionsPatients with IBD have a higher rate of developing diarrhoea compared with controls when travelling. Thus, such patients must always seek a pretravel medical consultation.
Improving access to treatment for patients with chronic hepatitis C through outreach
Authors: Elsharkawy Ahmed Mohamed , Miller Carolyn , Hearn Andrea , Buerstedde Gertrud , Price Ashley , McPherson Stuart 
Published: December 2012

BackgroundChronic hepatitis C infection (HCV) is common in injecting drug users and is a major cause of liver disease. Antiviral treatment can ‘cure’ HCV, but is frequently associated with side effects and requires regular monitoring. Non-attendance at hospital appointments is frequent. To try and improve attendance and increase the number of current and previous injecting drug users treated we developed three outreach clinics.ObjectiveTo review the outcome of patients referred to the outreach clinics.MethodsRetrospective service review of three clinics at drug treatment centres in Newcastle and Northumberland. Data was collected on attendance rates, patient demographics, treatment rates and outcomes.Results141 referrals were received across the three sites with an overall attendance rate of 75% (106 patients, 79% men and median age 36), which compared favourably with that at our hospital (50%). All patients were on methadone/subutex. 45% were infected with Genotype 1 HCV. 10% were cirrhotic. To date, 30% have started treatment and 21% are waiting to start or are still in workup. 13% elected to delay treatment due to early stage disease and 11% were not ready for treatment on psychological or social grounds. Only 12% failed to attend follow up after initial assessment. To date, 24 patients have completed full courses of treatment with sustained viral response in 13 patients. Results are awaited for seven patients.ConclusionsThe development of outreach clinics for HCV in drug treatment centres can substantially improve clinic attendance and increase access to treatment in this marginalised group.
Uptake and continuation rates of the intrauterine system in a university student general practice population in the UK
Authors: Armitage Catherine Marie , Mitchell Carolyn , Wigan Caroline , Smith Debbie A 
Published: December 2012

ObjectiveTo follow a series of 100 women attending for fitting of the levonorgestrel-releasing intrauterine system (LNG IUS) registered at a single urban general practice serving the students of the local universities and higher education colleges.MethodsThis was a prospective observational study. A questionnaire was completed by the fitter in discussion with the patient at the time of attendance for IUS fitting. Follow up was by telephone at 6 weeks, 6 months and 9–12 months after fitting.ResultsThe age range of women within the series was 18–38 years. 97 women were nulliparous. 37 women selected the IUS as their preferred method of contraception. 12 women chose the IUS primarily for non-contraceptive reasons. 75 women still had the IUS at 12 months’ follow up with 11 lost to follow up at this point. No pregnancies or perforations were reported.ConclusionsThe IUS is an acceptable form of contraception in young women, including nulliparous women, and should be offered alongside other methods as first line without restriction when offering contraceptive options to this age group.