bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the challenges of implementing e-health: a protocol for an update of a systematic review of reviews
Authors: Ross Jamie , Stevenson Fiona , Lau Rosa , Murray Elizabeth 
Published: April 2015

IntroductionThere is great potential for e-health to deliver cost-effective, quality healthcare and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, the literature often describes problematic and unsuccessful attempts to implement these new technologies into routine clinical practice. To understand and address the challenges of implementing e-health, a systematic review was conducted in 2009, which identified several conceptual barriers and facilitators to implementation. As technology is rapidly changing and new e-health solutions are constantly evolving to meet the needs of current practice, an update of this review is deemed necessary to understand current challenges to the implementation of e-health. This research aims to identify, summarise and synthesise currently available evidence, by undertaking a systematic review of reviews to explore the barriers and facilitators to implementing e-health across a range of healthcare settings.Methods and analysisThis is a protocol for an update of a systematic review of reviews. We will search MEDLINE, EMBASE, CINAHL, PSYCINFO and The Cochrane Library for studies published between 2009 and 2014. We will check reference lists of included studies for further studies. Two authors will independently screen the titles and abstracts identified from the search; any discrepancies will be resolved by discussion and consensus. Full-text papers will be obtained and relevant reviews will be selected against inclusion criteria. Eligible reviews have to be based on the implementation of e-health technologies. Data from eligible reviews will be extracted using a data abstraction form. A thematic analysis of barriers and facilitators to e-health implementation will be conducted.Ethics and disseminationEthical approval is not required. The permission of the original authors to update the review was sought and granted.Trial registration numberPROSPERO CRD42015017661.
The effectiveness of toolkits as knowledge translation strategies for integrating evidence into clinical care: a systematic review
Authors: Yamada Janet , Shorkey Allyson , Barwick Melanie , Widger Kimberley , Stevens Bonnie J 
Published: April 2015

ObjectivesThe aim of this systematic review was to evaluate the effectiveness of toolkits as a knowledge translation (KT) strategy for facilitating the implementation of evidence into clinical care. Toolkits include multiple resources for educating and/or facilitating behaviour change.DesignSystematic review of the literature on toolkits.MethodsA search was conducted on MEDLINE, EMBASE, PsycINFO and CINAHL. Studies were included if they evaluated the effectiveness of a toolkit to support the integration of evidence into clinical care, and if the KT goal(s) of the study were to inform, share knowledge, build awareness, change practice, change behaviour, and/or clinical outcomes in healthcare settings, inform policy, or to commercialise an innovation. Screening of studies, assessment of methodological quality and data extraction for the included studies were conducted by at least two reviewers.Results39 relevant studies were included for full review; 8 were rated as moderate to strong methodologically with clinical outcomes that could be somewhat attributed to the toolkit. Three of the eight studies evaluated the toolkit as a single KT intervention, while five embedded the toolkit into a multistrategy intervention. Six of the eight toolkits were partially or mostly effective in changing clinical outcomes and six studies reported on implementation outcomes. The types of resources embedded within toolkits varied but included predominantly educational materials.ConclusionsFuture toolkits should be informed by high-quality evidence and theory, and should be evaluated using rigorous study designs to explain the factors underlying their effectiveness and successful implementation.
Chronic kidney disease as a risk factor for incident gout among men and women: retrospective cohort study using data from the Framingham Heart Study
Authors: Wang Weiqi , Bhole Vidula Manish , Krishnan Eswar 
Published: April 2015

ObjectivesHistorically, the nature of association between chronic kidney disease (CKD) and gouty arthritis has been unclear. The goal of the present study was to test the hypothesis that CKD is an independent risk factor for developing incident gout.DesignPatients were from the original Framingham Heart Study cohort. Using Cox proportional hazard models we estimated the HR of CKD to incident gout among men and women separately after adjusting for age, alcohol consumption, smoking, hypertension, diabetes and body mass index.SettingsPatients were all from Framingham, Massachusetts, USA.ParticipantsExcluding patients who had CKD in the first visit from this study, 2159 men and 2558 women were selected covering a 54-year period (1948–2002).ResultsThere were 371 incident cases (231 men and 140 women) of gout over the follow-up of 140 421 person-years. Incidence rates of gout per 1000 person-years for participants with and without CKD were 6.82 (95% CI 5.10 to 9.10) and 2.43 (2.18 to 2.71), respectively. In multivariable Cox models, CKD was associated with gout, with a HR of 1.88 (1.13 to 3.13) among men and 2.31 (1.25 to 4.24) among women. Additional analyses using alternate definitions for CKD and cross-sectional study did not change the results. Sensitivity analysis suggested that the observed findings might be an underestimate of the true relative risk.ConclusionsThe present study provides epidemiological evidence to support the notion that CKD is a risk factor for gout.
Acupuncture for acute migraine attacks in adults: a systematic review protocol
Authors: Du Ruosang , Wang Yang , Liu Xiaoxu , Liu Zhishun 
Published: April 2015

IntroductionAcupuncture has been used worldwide for migraine attacks. This systematic review aims to assess if acupuncture is effective and safe in relieving headache, preventing relapse and reducing migraine-associated symptoms for the treatment of acute migraine attacks in adults.Methods and analysisWe will search the following seven databases from inception to February 2015: MEDLINE (OVID), EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and four Chinese databases (Chinese Biomedical Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database and Wanfang Database). Any randomised controlled trials in English or Chinese related to acupuncture for acute migraine attacks will be included. Conference abstracts and reference lists of included manuscripts will also be searched. The study inclusion, data extraction and quality assessment will be conducted independently by two reviewers. Meta-analysis will be performed using RevMan V.5.3.5 statistical software.DisseminationThe findings will be disseminated through peer-reviewed publication and/or conference presentations.Trial registration numberPROSPERO CRD42014013352.
Effect of glucomannan supplementation on body weight in overweight and obese children: protocol of a randomised controlled trial
Authors: Zalewski Bartłomiej Mateusz , Szajewska Hania 
Published: April 2015

IntroductionGlucomannan (GNN), a water-soluble dietary fibre derived from the plantAmorphophallus konjac, is marketed for weight reduction. The exact mechanisms by which GNN might exert its actions are unclear. However, it has been shown that GNN slows gastric emptying by forming a viscous gel of large volume, which increases the feeling of satiety. Current evidence on the effectiveness of GNN for weight reduction is sparse, and well-designed trials performed in children are needed to assess the efficacy of this modality. We aim to systematically evaluate the efficacy of GNN consumption for the management of children who are overweight or obese.Methods and analysisChildren aged 6–17 years who are overweight or obese (based on the WHO growth criteria) will be randomly assigned to receive GNN or placebo (maltodextrin) (both at a dose of 3 g/day) for 3 months and will be followed-up for 3 months. Before the intervention, all children will receive dietetic advice, and they will be encouraged to engage in physical activity. The primary outcome measure will be the body mass index-for-age z-score difference between the groups at the end of the intervention.Ethics and disseminationThe study was approved by the Bioethics Committee of the Medical University of Warsaw. The findings of this trial will be submitted to a peer-reviewed journal (paediatric, nutrition or gastroenterology). Abstracts will be submitted to relevant national and international conferences.Trial registration numberNCT02280772.
005 PP: THE BENEFITS OF USING QUALITATIVE RESEARCH METHODS TO UNDERSTAND CARE HOME MEDICINE MANAGEMENT SYSTEMS
Authors: Gilmartin JFM , Jani Y , Smith FJ 
Published: April 2015

In United Kingdom care homes (CHs), multi-compartment compliance aid (MCA) medicine management systems are more commonly used than original medicine packaging (OP), to organise and administer the large volume of medicines used by residents. This study aimed to understand how these two systems (MCAs and OP) impact on CH medicine administration.This was a mixed methods study. The quantitative component involved direct observation to identify discrepancies in medicine administration. The qualitative component involved an ethnographic approach and interviews to understand the medicine administration process and identify associated barriers/facilitators. In September and October 2014, a pharmacist researcher spent 1–3 days observing 17 nurses administer medicines and interviewing 15 nurses, at 4 purposively sampled CHs around Greater London that used either MCAs or OP. Ethical approval was obtained from the University College London Research Ethics Committee.The ethnographic approach allowed the researcher to immerse themselves into the work environment of the nurses. This facilitated a comprehensive understanding of the MCA and OP medicine management systems under research, at all times of the day and under all possible work conditions that could arise. The observations allowed the researcher to identify practices that may contribute to medicine administration discrepancies. These practices may not have been discussed at all, or in any great detail, during nurse interviews. Potential challenges of this qualitative research include participant apprehensiveness concerning the observations in general, or observations interfering with daily work practices. These were managed by ensuring observations were minimally intrusive and all participating CHs and nurses remained anonymous.The qualitative research methods used in this study helped explain the quantitative data and provided a rich and comprehensive understanding of the systems under research, which is unlikely to have occurred using quantitative research methods alone.
002 OP: EXPLAINING DISCREPANT RESULTS FROM QUESTIONNAIRES AND INTERVIEWS CONCERNING HELP-SEEKING: ARE ‘PUBLIC’ AND ‘PRIVATE’ ACCOUNTS THE KEY?
Authors: Dobson CM , Brown SR , Russell AJ , Rubin GP 
Published: April 2015

Social surveys and interviews are staple methods within health research. One of the perceived merits of the postal questionnaire is the anonymity it affords to participants, enabling people to provide honest accounts, particularly in relation to sensitive topics. Interviewing can potentially introduce bias to participants' accounts because of a compulsion to provide socially desirable responses. Here we examine these assumptions through a comparison of questionnaire and interview accounts of the help-seeking experiences of people with symptoms of cancer.Public discourses of early diagnosis of cancer are increasingly commonplace, particularly after the ‘Be Clear on Cancer’ campaigns, which reinforced the importance of consulting quickly when experiencing cancer symptoms. This study aimed to explore the help-seeking experiences of people with symptoms of lung or colorectal cancer by inviting patients to complete a questionnaire about their symptom onset and first consultation with a health care practitioner. A sub sample of these participants were interviewed about their help-seeking experiences, with the interviews taking place within 8 weeks of the questionnaires being returned.We found that the reported length of the help-seeking interval (time from first symptom to first consultation with a health care practitioner) differed in questionnaire and interview accounts for the majority of participants. Whilst we may have expected participants to report longer intervals in the questionnaire, because of its perceived ability to reduce social desirability bias, we found that the converse was true; for most of the cases where there was a discrepancy in interval length between questionnaire and interview, longer help-seeking intervals were reported in the interview.We shall consider possible explanations for these unexpected results, suggesting that the concept of ‘public accounts’ and ‘private accounts’ provides insight into these discrepant participant responses. The formality of the questionnaire and the closed nature of questioning may encourage participants to report more socially acceptable behaviours in order to conform to public discourses around early help-seeking and early diagnosis. Whereas in interviews, participants were able to report more deviant accounts because they were within the private setting (their homes) and were able to narrate their stories and detail their reasoning.
005 OP: ON THE NEED FOR PRACTICE THEORIES IN HEALTH SERVICES AND POLICY RESEARCH: LESSONS FROM QUALITATIVE INQUIRY
Authors: Shaw J 
Published: April 2015

Researchers in the fields of health services and policy generally focus on optimizing the organization and practice of health care in order to ensure best possible outcomes for patients and the public. This broad mandate variably entails evaluating the feasibility of new service delivery models, devising interventions that achieve better outcomes, and studying populations to tailor specific health care initiatives and programs. Implied in these various foci of health services and policy research is a normative logic of implementation, which can be formulated something like this: If researchers find the truth, then practitioners should use it. However, the widely discussed and longstanding “gap” between evidence and practice strongly suggests that this “logic” of implementation must not be very logical at all.In this paper I suggest that the lack of “uptake” of research findings in practice provides a gateway to elaborating on two key conceptual issues in health services and policy research. The first issue is regarding what constitutes knowledge in everyday health care practice, otherwise known as epistemologies of practice. The second issue, building on the first, is regarding how the practice of health care providers actually comes to be and thus how it can be changed. Understanding the knowledge and practice of health care providers requires an understanding of practice in its broadest theoretical sense, as the coordinated activities of everyday experience through which our ongoing lives derive their meaning.Drawing on the findings of a comparative qualitative case study of transitions from hospital to home in London, UK and Toronto, Canada, I will illustrate how conceptual advances in theories of practice provide great insight into (a) the knowledge that health care providers create and use in their everyday practice, (b) why health care is practiced exactly the way it is, and (c) how it might be changed for the better. Demonstrating the value of insights from qualitative applications of practice theories, as demonstrated by the qualitative findings presented in this paper, I call for a shift toward the more systematic use of practice theories in health services and policy research.
African Americans and Hispanics Remain at Lower Risk of Ovarian Cancer Than Non-Hispanic Whites after Considering Nongenetic Risk Factors and Oophorectomy Rates
Authors: Wu Anna H. , Pearce Celeste L. , Tseng Chiu-Chen , Pike Malcolm C. 
Published: April 2015

Abstract
Background: Risk factors for invasive epithelial ovarian cancer (IEOC) among Hispanics and African Americans are understudied despite notable differences in incidence relative to non-Hispanic whites.
Methods: We used multivariate logistic regression to examine parity, oral contraceptive use, tubal ligation, endometriosis, family history of ovarian cancer, and talc use and risk of IEOC among Hispanics (308 cases and 380 controls), African Americans (128 cases and 143 controls), and non-Hispanic whites (1,265 cases and 1,868 controls) using four case–control studies we conducted in Los Angeles County. We expressed each of these factors in the form of increasing risk and calculated population attributable risk percentage (PAR%) estimates for the six risk factors separately and jointly in the three groups.
Results: The risk associations with these six well-accepted factors were comparable in the three groups. The significant racial/ethnic differences in the prevalence of these factors and differences in their oophorectomy rates explained 31% of the lower incidence in African Americans compared with non-Hispanic whites, but only 13% of the lower incidence in Hispanics. The PAR%s ranged from 27.5% to 31.0% for no tubal ligation, 15.9% to 22.2% for not using oral contraceptives, and 12.2% to 15.1% for using talc in the three groups.
Conclusions: All six risk factors are comparably important in the three groups. Differences in the prevalence of these factors and their oophorectomy rates explained approximately one third of the difference in incidence between African Americans and non-Hispanic whites.
Impact: Devising strategies to lessen the burden of IEOC will be applicable to all three racial/ethnic groups. Cancer Epidemiol Biomarkers Prev; 24(7); 1094–100. ©2015 AACR.
Direct Attack on RAS: Intramolecular Communication and Mutation-Specific Effects
Authors: Marcus Kendra , Mattos Carla 
Published: April 2015

Abstract
The crystal structure of RAS was first solved 25 years ago. In spite of tremendous and sustained efforts, there are still no drugs in the clinic that directly target this major driver of human cancers. Recent success in the discovery of compounds that bind RAS and inhibit signaling has fueled renewed enthusiasm, and in-depth understanding of the structure and function of RAS has opened new avenues for direct targeting. To succeed, we must focus on the molecular details of the RAS structure and understand at a high-resolution level how the oncogenic mutants impair function. Structural networks of intramolecular communication between the RAS active site and membrane-interacting regions on the G-domain are disrupted in oncogenic mutants. Although conserved across the isoforms, these networks are near hot spots of protein–ligand interactions with amino acid composition that varies among RAS proteins. These differences could have an effect on stabilization of conformational states of interest in attenuating signaling through RAS. The development of strategies to target these novel sites will add a fresh direction in the quest to conquer RAS-driven cancers. Clin Cancer Res; 21(8); 1810–8. ©2015 AACR.
See all articles in this CCR Focus section, “Targeting RAS-Driven Cancers.”
RAS Synthetic Lethal Screens Revisited: Still Seeking the Elusive Prize?
Authors: Downward Julian 
Published: April 2015

Abstract
The RAS genes are critical oncogenic drivers activated by point mutation in some 20% of human malignancies. However, no pharmacologic approaches to targeting RAS proteins directly have yet succeeded, leading to suggestions that these proteins may be “undruggable.” This has led to two alternative indirect approaches to targeting RAS function in cancer. One has been to target RAS signaling pathways downstream at tractable enzymes such as kinases, particularly in combination. The other, which is the focus of this review, has been to seek targets that are essential in cells bearing an activated RAS oncogene, but not those without. This synthetic lethal approach, while rooted in ideas from invertebrate genetics, has been inspired most strongly by the successful use of PARP inhibitors, such as olaparib, in the clinic to treat BRCA defective cancers. Several large-scale screens have been carried out using RNA interference-mediated expression silencing to find genes that are uniquely essential to RAS-mutant but not wild-type cells. These screens have been notable for the low degree of overlap between their results, with the possible exception of proteasome components, and have yet to lead to successful new clinical approaches to the treatment of RAS-mutant cancers. Possible reasons for these disappointing results are discussed here, along with a reevaluation of the approaches taken. On the basis of experience to date, RAS synthetic lethality has so far fallen some way short of its original promise and remains unproven as an approach to finding effective new ways of tackling RAS-mutant cancers. Clin Cancer Res; 21(8); 1802–9. ©2015 AACR.
See all articles in this CCR Focus section, “Targeting RAS-Driven Cancers.”
KRAS as a Therapeutic Target
Authors: McCormick Frank 
Published: April 2015

Abstract
KRAS proteins play a major role in human cancer, but have not yielded to therapeutic attack. New technologies in drug discovery and insights into signaling pathways that KRAS controls have promoted renewed efforts to develop therapies through direct targeting of KRAS itself, new ways of blocking KRAS processing, or by identifying targets that KRAS cancers depend on for survival. Although drugs that block the well-established downstream pathways, RAF–MAPK and PI3K, are being tested in the clinic, new efforts are under way to exploit previously unrecognized vulnerabilities, such as altered metabolic networks, or novel pathways identified through synthetic lethal screens. Furthermore, new ways of suppressing KRAS gene expression and of harnessing the immune system offer further hope that new ways of treating KRAS are finally coming into view. These issues are discussed in this edition of CCR Focus. Clin Cancer Res; 21(8); 1797–801. ©2015 AACR.
See all articles in this CCR Focus section, “Targeting RAS-Driven Cancers.”
A relação entre duas síndromes pró-inflamatórias da atualidade: sepse e obesidade
Authors: Terra Fernanda , Terumi Marcelli , Bottura Guilherme , Geise Bruno , Câmara Niels Olsen Saraiva , Latancia Marcela 
Published: April 2015

<p>Estudos mostram que pacientes obesos têm maior chance de serem acometidos pela sepse, além de possuírem maiores riscos de mortalidade. A sepse, sendo uma infecção sistêmica que culmina na modulação da ativação de células e secreção de citocinas pró-inflamatórias e a obesidade, reconhecida como síndrome metabólica caracterizada, também, como pró-inflamatória. Esta revisão tem o objetivo de esclarecer e apontar relações entre duas síndromes dos tempos modernos.</p>