bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort
Authors: Coelho-Prabhu Nayantara , Shah Nilay D , Van Houten Holly , Kamath Patrick S , Baron Todd H 
Published: June 2013

ObjectiveTo determine utilisation of endoscopic retrograde cholangiopancreatography (ERCP); incidence of inpatient admissions for complications occurring within 30 days of ERCP and risk factors for procedural-related complications, in a population-based study.DesignRetrospective cohort study.SettingOlmsted County, Minnesota.ParticipantsAll adult residents of Olmsted County, Minnesota, who underwent ERCP from 1997 to 2006.InterventionsDiagnostic and therapeutic ERCPs were assessed.Primary and secondary outcome measuresPatient and procedural characteristics and complications within 30 days; and rates of ERCP utilisation and unplanned admissions and risk factors for admissions.ResultsIn 10 years, 1072 ERCPs were performed on 827 individual patients. Average utilisation of ERCP was 83.1 ERCPs/100 000 persons/year, with an increase from 58 to 104.8 ERCPs/100 000 persons/year over time, driven by increases in therapeutic procedures. Within 30 days after 236 procedures, 62 admissions were definitely related to the index ERCP. The complication rate was 5.3%, including pancreatitis (26, 2.4%), infection/cholangitis (16, 1.5%), bleeding (15, 1.4%) and perforation (4, 0.37%). 30-day mortality was 2.4%, none of which was directly related to the ERCP or complications thereof. Risk factors identified through multivariate analysis to be associated with adverse events included: age <45 years (p=0.0498); body mass index ≥35 (p=0.0024); pancreatic duct cannulation (p=0.0026); outpatient procedure (p<0.0001); intraprocedure sphincterotomy bleeding (p<0.0001); difficulty grade (p=0.115) and patient's first ERCP (p=0.0394).LimitationsRetrospective study.ConclusionsPopulation utilisation of ERCP rose during the study period, specifically in therapeutic procedures. Admissions within 30 days of ERCP are common but often unrelated. Complications of ERCP remain infrequent and deaths quite unusual.
Doctors’ understanding of individualisation of drug treatments: a qualitative interview study
Authors: Denford S , Frost J , Dieppe P , Britten N 
Published: June 2013

ObjectiveTo explore doctors’ understanding of individualisation of drug treatments, and identify the methods used to achieve individualisation.DesignIn this exploratory study, we used in-depth qualitative interviews with doctors to gain insight into their understanding of the term ‘individualised treatments’ and the methods that they use to achieve it.Participants16 general practitioners in 6 rural and 10 urban practices, 2 geriatricians and 2 clinical academics were recruited.SettingPrimary and secondary care in South West of England.ResultsUnderstanding of individualisation varied between doctors, and their initial descriptions of individualisation were not always consistent with subsequent examples of the patients they had treated. Understandings of, and methods used to achieve, individualised treatment were frequently discussed in relation to making drug treatment decisions. Few doctors spoke of using strategies to support patients to individualise their own treatments after the consultation.ConclusionsDespite its widespread use, variation in doctors’ understanding of the term individualisation highlights the need for it to be defined. Efforts are needed to develop effective methods that would offer a structured approach to support patients to manage their treatments after consultations.
Selective reporting of outcomes in randomised controlled trials in systematic reviews of cystic fibrosis
Authors: Dwan Kerry , Kirkham Jamie J , Williamson Paula R , Gamble Carrol 
Published: June 2013

BackgroundOutcome reporting bias (ORB) in randomised trials has been identified as a threat to the validity of systematic reviews. Previous work highlighting this problem is limited to considering a single primary review outcome. The aim of this study was to assess ORB across all efficacy outcomes in the Cochrane systematic reviews of cystic fibrosis.MethodsSystematic reviews of interventions for cystic fibrosis published on the Cochrane Library by the Cochrane Cystic Fibrosis and Genetic Disorders Group before 2010 were assessed for discrepancies in outcomes between review protocol and full review. ORB in eligible trials was also assessed for all efficacy review outcomes. Two authors independently classified each outcome using a nine-point classification system developed by the Outcome Reporting Bias In Trials study. These classifications were used to inform the assessment of the risk of bias for selective outcome reporting for each trial.Results–46 Cochrane cystic fibrosis systematic reviews were included. The median number of primary outcomes, number of trials and participants per trial in the reviews were 3 (IQR 2, 3), 4 (IQR 2, 8) and 21 (IQR 14, 41), respectively. 18 reviews (39%, 18/46) had a discrepancy in outcomes between protocol and full review. 37 reviews were eligible to be included in the ORB assessment. When considering review primary outcomes and all review outcomes, ORB was suspected in at least one trial in 86% and 100%, respectively.ConclusionsAssessment of ORB within a systematic review of a single primary outcome underestimates the risk of ORB in comparison to the assessment of multiple primary and secondary outcomes. ORB in trials is highly prevalent within systematic reviews of cystic fibrosis when assessed across all outcomes. This could be reduced by the development of a core outcome set for trials and systematic reviews in cystic fibrosis.
Lay perspectives of successful ageing: a systematic review and meta-ethnography
Authors: Cosco Theodore D , Prina A Matthew , Perales Jaime , Stephan Blossom C M , Brayne Carol 
Published: June 2013

ObjectivesThe aim of the current study was to conduct a systematic review of lay perspectives of successful ageing (SA), synthesise these data using a metaethnographic framework and to provide a snapshot of extant lay perspectives of SA.DesignA systematic review of layperson perspectives of SA was conducted across MEDLINE, PsycInfo, CINAHL, EMBASE and ISI Web of Knowledge.ParticipantsPeer-reviewed studies conducting qualitative investigations of lay perspectives of SA were included. Included studies were coded and analysed using NVivo V.9 to examine underlying themes of SA.ResultsThe search strategy identified 7285 articles; 26 articles met the inclusion criteria. Laypersons identified psychosocial components, notably engagement (eg, social engagement), and personal resources (eg, attitude) as integral components of SA more often than ‘physiological’ components, such as longevity or physical functioning. These results also highlight the profound under-representation of non-Western countries and the cultural homogeneity of research participants.ConclusionsThe current study reveals the importance laypersons place on incorporating psychosocial components into multidimensional models of SA, as well as highlighting the need for increased research with under-represented populations.
An observational study of malaria in British travellers:Plasmodium ovale wallikeriandPlasmodium ovale curtisidiffer significantly in the duration of latency
Authors: Nolder Debbie , Oguike Mary C , Maxwell-Scott Hector , Niyazi Hatoon A , Smith Valerie , Chiodini Peter L , Sutherland Colin J 
Published: June 2013

ObjectivesOvale malaria is caused by two closely related species of protozoan parasite:Plasmodium ovale curtisiandPlasmodium ovale wallikeriAlthough clearly distinct genetically, there have been no studies comparing the morphology, life cycle or epidemiology of these parasites. We tested the hypothesis that the two species differ in the duration of latency prior to presentation with symptoms of blood-stage infection.DesignPCR was used to identifyP ovale curtisiandP ovale wallikeriinfections among archived blood from UK malaria patients. Latency periods, estimated as the time between entry into the UK and diagnosis of malaria, were compared between the two groups.SettingUK National Reference Laboratory.ParticipantsNone. Archived parasite material and surveillance data for 74P ovale curtisiand 60P ovale wallikeriinfections were analysed. Additional epidemiological data were taken from a database of 1045 imported cases.OutcomesNone.ResultsNo differences between the two species were identified by a detailed comparison of parasite morphology (N=9, N=8, respectively) and sex ratio (N=5, N=4) in archived blood films. The geometric mean latency period inP ovale wallikeriwas 40.6 days (95% CI 28.9 to 57.0), whereas that forP ovale curtisiwas more than twice as long at 85.7 days (95% CI 66.1 to 111.1; p=0.002). Further, the proportion of ovale malariasensu latowhich occurred in patients reporting chemoprophylaxis use was higher than forPlasmodium falciparum(OR 7.56; p<0.0001) orP vivax(OR 1.82; p<0.0001).ConclusionsThese findings provide the first difference of epidemiological significance observed between the two parasites which cause ovale malaria, and suggest that control measures aimed atP falciparummay not be adequate for reducing the burden of malaria caused byP ovale curtisiandP ovale wallikeri.
Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011
Authors: Clarke Aileen , Taylor-Phillips Sian , Swan Jacky , Gkeredakis Emmanouil , Mills Penny , Powell John , Nicolini Davide , Roginski Claudia , Scarbrough Harry , Grove Amy 
Published: June 2013

ObjectivesTo investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work.DesignCross-sectional survey of 345 National Health Service (NHS) staff members.SettingThe study was conducted across 11 English Primary Care Trusts between 2010 and 2011.ParticipantsA total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey.Main outcome measuresParticipants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role.ResultsThe extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (p<0.0005, commissioning and contracts OR   0.32, 95%CI   0.18 to 0.57, finance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades).ConclusionsThose trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for Clinical Excellence (NICE) guidance and government publications (eg, National Service Frameworks) are important for decision-making, but practical sources of evidence such as local intelligence, benchmarking data and expert advice are also influential. New Clinical Commissioning Groups will need a variety of different evidence sources and expert involvement to ensure that effective decisions are made for their populations.
Prenatal alcohol exposure and childhood balance ability: findings from a UK birth cohort study
Authors: Humphriss Rachel , Hall Amanda , May Margaret , Zuccolo Luisa , Macleod John 
Published: June 2013

ObjectiveTo investigate the association of prenatal alcohol exposure with balance in10-year-old children.DesignPopulation-based prospective longitudinal study.SettingFormer Avon region of UK (Southwest England).Participants6915 children from the Avon Longitudinal Study of Parents and Children who had a balance assessment at age 10 and had data on maternal alcohol consumption.Outcome measures3 composite balance scores: dynamic balance (beam-walking), static balance eyes open, static balance eyes closed (heel-to-toe balance on a beam and standing on one leg, eyes open or closed).ResultsMost mothers (95.5%) consumed no-to-moderate amounts (3–7 glasses/week) of alcohol during pregnancy. Higher total-alcohol consumption was associated with maternal-social advantage, whereas binge drinking (≥4 units/day) and abstinence were associated with maternal social disadvantage. No evidence was found of an adverse effect of maternal-alcohol consumption on childhood balance. Higher maternal-alcohol use during pregnancy was generally associated with better offspring outcomes, with some specific effects appearing strong (static balance eyes open and moderate total alcohol exposure at 18 weeks, adjusted OR 1.23 (95% CI 1.01 to 1.49); static balance eyes closed and moderate total alcohol exposure at 18 weeks, adjusted OR 1.25 (95% CI 1.06 to 1.48). Similar results were found for both paternal and postnatal maternal alcohol exposure. A Mendelian-randomization approach was used to estimate the association between maternal genotype and offspring balance using the non-synonymous variant rs1229984*A (ADH1B) to proxy for lower maternal alcohol consumption; no strong associations were found between this genotype/proxy and offspring balance.ConclusionsNo evidence was found to indicate that moderate maternal alcohol consumption in this population sample had an adverse effect on offspring balance at age 10. An apparent beneficial effect of higher total maternal alcohol consumption on offspring balance appeared likely to reflect residual confounding.
Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study
Authors: Ruiz Jonatan R , Segura-Jiménez Víctor , Ortega Francisco B , Álvarez-Gallardo Inmaculada C , Camiletti-Moirón Daniel , Aparicio Virginia A , Carbonell-Baeza Ana , Femia Pedro , Munguía-Izquierdo Diego , Delgado-Fernández Manuel 
Published: June 2013

ObjectivesTo characterise levels of objectively measured sedentary time and physical activity in women with fibromyalgia.DesignCross-sectional study.SettingLocal Association of Fibromyalgia (Granada, Spain).ParticipantsThe study comprised 94 women with diagnosed fibromyalgia who did not have other severe somatic or psychiatric disorders, or other diseases that prevent physical loading, able to ambulate and to communicate and capable and willing to provide informed consent.Primary outcome measuresSedentary time and physical activity were measured by accelerometry and expressed as time spent in sedentary behaviours, average physical activity intensity (counts/minute) and amount of time (minutes/day) spent in moderate intensity and in moderate-to-vigorous-intensity physical activity (MVPA).ResultsThe proportion of women meeting the physical activity recommendations of 30 min/day of MVPA on 5 or more days a week was 60.6%. Women spent, on average, 71% of their waking time (approximately 10 h/day) in sedentary behaviours. Both sedentary behaviour and physical activity levels were similar across age groups, waist circumference and percentage body fat categories, years since clinical diagnosis, marital status, educational level and occupational status, regardless of the severity of the disease (all p>0.1). Time spent on moderate-intensity physical activity and MVPA was, however, lower in those with greater body mass index (BMI) (−6.6 min and −7 min, respectively, per BMI category increase, <25, 25–30, >30 kg/m2; p values for trend were 0.056 and 0.051, respectively). Women spent, on average, 10 min less on MVPA (p<0.001) and 22 min less on sedentary behaviours during weekends compared with weekdays (p=0.051).ConclusionsThese data provide an objective measure of the amount of time spent on sedentary activities and on physical activity in women with fibromyalgia.
An assessment of the iPad as a testing platform for distance visual acuity in adults
Authors: Black J M , Jacobs R J , Phillips G , Chen L , Tan E , Tran A , Thompson B 
Published: June 2013

ObjectivesVisual acuity is a common measurement in general practice, and the advent of new technology such as tablet computers offers a change in the way in which these tests are delivered. The aim of this study was to assess whether measurements of distance visual acuity using LogMAR letter charts displayed on an iPad tablet computer were in agreement with standard clinical tests of visual acuity in adults with normal vision.DesignBlinded, diagnostic test study.SettingSingle centre (University) in Auckland, New Zealand.ParticipantsUniversity staff and students (n=85). Participants were required to have visual acuity better than 6/60 and wear habitual refractive correction during testing. Participants were excluded if there was any history of ocular pathology.Primary and secondary outcome measuresVisual acuity measured under a number of conditions.ResultsThe iPad tablet with its glossy screen was highly susceptible to glare resulting in acuity measurements that were significantly poorer (approximately 2 LogMAR lines) than those made using an ETDRS chart and a standard computerised testing system (n=56). However, fitting the iPad with an antiglare screen and positioning the device away from sources creating reflected (veiling) glare resulted in acuity measurements that were equivalent those made using gold standard charts (n=29).ConclusionsTablet computers are an attractive option for visual acuity measurement due to portability, the ability to randomise letters, automated scoring of acuity and the ability to select from a range of charts. However, these devices are only suitable for use in situations where sources of glare can be eliminated.
Parental comprehension of the benefits/risks of first-line randomised clinical trials in children with solid tumours: a two-stage cross-sectional interview study
Authors: Chappuy Hélène , Bouazza Naim , Minard-Colin Veronique , Patte Catherine , Brugières Laurence , Landman-Parker Judith , Auvrignon Anne , Davous Dominique , Pacquement Hélène , Orbach Daniel , Tréluyer Jean Marc , Doz François 
Published: June 2013

ObjectivesTo analyse the parental understanding of informed consent information in first-line randomised clinical trials (RCTs) including children with malignant solid tumours and to assess parents’ needs for decision-making.DesignObservational prospective study.Setting3 paediatric oncology centres in the Parisian region in France.Participants53 parents were approached to participate in a RCT for their child with malignant solid tumour, over a 1-year period. 40 parents have been interviewed in our study.Primary and secondary outcome measuresParental understanding of information in RCTs, parents’ needs for decision-making. Parents were questioned by a psychologist, independent of the paediatric oncology teams, using a semidirected interview, 1 (M1) and 6 months (M6) after the consent was sought.Results18 parents (45%) did not understand the concept of randomisation. Half of the parents could explain neither the aim of the clinical trial nor the potential benefit to their child of inclusion. 35 parents (87.5%) expressed very few specific risks related to the trial. Being mostly French-speaking (p=0.03) and the reading of the information sheet by the parents (p=0.0025) improved their understanding. The parental comprehension did not differ between M1 and M6. The principal factors underlying their decision were confidence in the medical team (39%), wish to access to the best treatment (37%) and the best quality of life (37%).ConclusionsDespite medical explanations, parents have limited knowledge in some areas in first-line RCTs and improvements of information process are required. The risks specific to the randomised trial are underestimated by parents and the unproven nature of the treatment is not well-known or understood.
Assessment of blood clot formation and platelet receptor function ex vivo in patients with primary Sjögren's syndrome
Authors: Collins K S , Balasubramaniam K , Viswanathan G , Natasari A , Tarn J , Lendrem D , Mitchell S , Zaman A , Ng W F 
Published: June 2013

ObjectivesPrimary Sjögren's syndrome (pSS) shares clinical features and pathogenetic mechanisms with systemic lupus erythematosus (SLE). SLE is associated with an increased thromboembolic risk; however, it is unclear whether pSS patients are susceptible to thromboembolic diseases. In this study, we examined ex vivo blood clot formation (clot strength, rates of clot formation and lysis) in pSS using thromboelastography (TEG) and platelet aggregation to common agonists using multiple electrode aggregometry (MEA). We also investigated the relationship between TEG/MEA parameters and clinical/laboratory features of pSS.DesignCase control.SettingSecondary care, single centre.Participants34 pSS patients, 11 SLE patients and 13 healthy volunteers (all women) entered and completed the study.Primary and secondary outcome measuresPrimary outcomes: TEG and MEA parameters between three subject groups. Secondary outcomes: The relationships between TEG/MEA and clinical/laboratory parameters analysed using bivariate correlation analysis with corrections for multiple testing.ResultsAll TEG and MEA parameters were similar for the three subject groups. After corrections for multiple testing, interleukin (IL)-1α and Macrophage inflammatory proteins (MIP)-1α remain correlated inversely with clot strength (r=−0.686, p=0.024 and r=−0.730, p=0.012, respectively) and overall coagulability (r=−0.640, p=0.048 and r=−0.648, p=0.048). Stepwise regression analysis revealed that several cytokines such as MIP-1α, IL-17a, IL-1α and Interferon (IFN)-γ may be key predictors of clot strength and overall coagulability in pSS.ConclusionsClot kinetics and platelet receptor function are normal in pSS. Several cytokines correlate with clot strength and overall coagulability in pSS.