bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of orlistat initiation on cardiovascular treatment use: a 6-year population-based cohort study
Authors: Czernichow Sébastien , Knol Mirjam J , Fezeu Léopold , Grobbee Diederick E 
Published: April 2011

Background: Trials of weight-loss drugs indicate some benefits on lipids, blood glucose, or blood pressure levels. Since obesity is associated with increased cardiovascular (CV) medication use and pharmaceutical costs, weight-loss drug use could beneficially impact CV medication use. Objective: We examined the temporal associations between CV drugs use 3 years before and after the initiation of orlistat, a weight-loss drug. Design: An historical cohort study in the PHARMO pharmacy registry among new users of orlistat, who were in the database at least 3 years before and after such drug initiation. We assessed the prevalence of use of antihypertensive, antidiabetic, and lipid-lowering drugs within a 6-month period before and after orlistat initiation. Slopes and changes in slopes between these two periods were calculated using logistic generalized estimating equations and odds ratios (OR) with 95% confidence intervals (CI) are presented. Results: A total of 6139 subjects had a prescription of orlistat between January 1992 and May 2009. Mean ± SD age was 46.5 ± 12.5 years, with a majority of female (88.7%). Use of antihypertensive, antidiabetic, and lipid-lowering drugs increased over time, but after start of orlistat the slopes levelled-off. Initiation of orlistat resulted in a significant change in slope for antihypertensive (OR 0.79; 95% CI 0.77–0.81), antidiabetic (0.86; 0.83–0.90), and lipid-lowering drugs (0.84; 0.81–0.88). Conclusions: Our data suggest a potential cost-effectiveness of orlistat, with a reduction in any cardiovascular comedication use over time. By potentially reducing costs of other medications use, orlistat remains as a unique option for tackling the obesity epidemic.
Presenting patient data in the electronic care record: the role of timelines
Authors: Gill Jasdeep , Chearman Tim , Carey Mike , Nijjer Sukhjinder , Cross Frank 
Published: April 2011

Objective To establish the current level of awareness and investigate the use of timelines within clinical computing systems as an organized display of the electronic patient record (EPR). Design Multicentre survey conducted using questionnaires and interview. Setting Seven UK hospitals and several general practice surgeries. Participants A total of 120 healthcare professionals completed a questionnaire which directed structured interviews. Participants fell into two cohorts according to whether or not they had used clinical timelines, which gave 60 ‘timeline users’ and 60 ‘prospective timeline users’. Main outcome measures To investigate the awareness of timelines, and the potential benefits of timelines within clinical computing systems. Results Fifty-eight percent of participants had not heard of the specific term ‘timelines’ despite 75% of users utilizing a form of timeline on a daily basis. The potential benefits of future timelines were clinical audit (95%CI 77.6-91.6), increased time efficiency (95%CI 77.7-91.6%), reduced clinical error (95%CI 71.0-86.7) and improved patient safety (95%CI 70.0-85.9). One continuous timeline view between primary and secondary care was considered to be of great potential benefit in allowing communication via a unified patient record. Conclusions The concept of timelines has enjoyed proven success in healthcare in the USA and in other sectors worldwide. Clinicians are supportive of timelines in healthcare. Formal input from clinicians should be sought when designing and implementing computer systems in healthcare. Timelines in healthcare support clinicians’ cognitive processes by improving the amount of data available and improving the way in which data are presented.
How do the information needs of cancer patients differ at different stages of the cancer journey? A cross-sectional survey
Authors: Mistry A , Wilson S , Priestman T , Damery S , Haque Ms 
Published: April 2011

Objectives Providing information to cancer patients can have significant benefits to their psychological wellbeing. The aim of this study was to investigate whether and how information needs may differ for patients at different stages of the cancer journey. Design Cross-sectional, self-completed survey using convenience sampling. Setting Oncology outpatients in Wolverhampton, West Midlands. Participants Cancer patients aged 18 years and over. Main outcome measures The survey used Likert scales to determine whether patients wished to know more about 35 items of information categorized under seven domains: cancer (diagnosis); prognosis; treatment; rehabilitation; psychological/spiritual; social/family; and body image/sexuality. Each domain was scored, with higher scores indicating a greater wish for information. Results There were 187 participants (50% response rate). Patients tended to want more information, particularly related to prognosis. Post-treatment patients continued to have information needs comparable to patients undergoing treatment or at the pre-treatment stage, except with reference to treatment-related information (p = <0.01), although as time from diagnosis increased, information needs reduced. Educational attainment, age, treatment status, gender and ethnicity were all significant predictors of scores in various domains. Conclusion This study indicates that the time since diagnosis may interact with various demographic and disease-related factors in contributing to the information needs of cancer patients. The majority of cancer patients wish to know more about a wide range of factors, and such information seeking preferences are present regardless of an individual's stage following diagnosis.
Can a bronchoscopist reliably assess a patient's experience of bronchoscopy?
Authors: Hadzri Hm , Azarisman Sms , Fauzi Arm , Roslan H , Roslina Am , Adina Atn , Fauzi Ma 
Published: April 2011

Objectives Bronchoscopy is an essential investigative tool in many respiratory complaints. The procedure can be unpleasant for both bronchoscopists and patients. To the best of our knowledge, there are only a few studies that correlate the bronchoscopist's satisfaction with that of the patient's during bronchoscopy. The aim of our study is to assess whether or not a bronchoscopist could reliably assess a patient's satisfaction during bronchoscopy. Design Cross-sectional, observational study with convenience sampling. Setting Patients attending flexible fibreoptic bronchoscopy appointments at the bronchoscopy suite, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia between March and September 2006. Participants Sixty patients undergoing bronchoscopy over a 6-month period completed a questionnaire after the procedure. All patients received standard pre-medication with intravenous midazolam. Main outcome measures Bronchoscopists and patients rated the level of satisfaction of the procedure using a 10 cm visual analogue scale (VAS). Lower scores indicated better satisfaction or less discomfort. Patients and bronchoscopists also rated coughing, choking and vomiting perception using the same 10 cm VAS. Reliability analysis (intra-class correlation coefficient [ICC]) was used to analyse the correlation between patients’ and bronchoscopists’ VAS scores. Results All 60 patients answered the questionnaire. The median overall satisfaction scored by bronchoscopists was 2.2 (2.0) with a non-significant (p = 0.880) trend to a better median overall satisfaction of 1.9 (2.3) scored by patients. The VAS scores for cough sensation were 1.9 (2.7) and 1.5 (5.0), respectively. There was positive correlation between bronchoscopists’ and patients’ VAS scores for coughing sensation (p = 0.047, ICC = 0.233). No significant correlation for overall satisfaction, vomiting sensation and choking sensation was found. Conclusion Positive correlation for cough perception suggested that the bronchoscopist could reliably assess the degree of cough discomfort patients experience during bronchoscopy.
Do patients wish to ‘listen in’ when doctors dictate letters to colleagues?
Authors: De Silva Rajith , Misbahuddin Anjum , Mikhail Salwa , Grayson Kate 
Published: April 2011

Summary Objectives To evaluate the effects on clinical outcome of dictating correspondence in front of patients and sending them copies of letters. Design Observational study of the practices of two consultants, one of whom (RDS) routinely dictated letters in front of his patients and almost always sent them a copy while the other (AM) did neither. Questionnaires were completed anonymously by patients at the end of their consultation. Setting Neurology department of a teaching hospital. Participants Patients attending neurology outpatient clinics. Results Seventy-two percent and 62% of the two consultants’ patients were audited, and the demographic features of the two groups were similar. Eighty-six percent and 25% of RDS's and AM's patients, respectively, said that they wished to be present during dictation (p< 0.001). Within AM's group, those who had had some experience of the practice (with other consultants) were more likely to express a desire to be present during dictation (p = 0.023). Ninety-two percent and 77% of RDS's and AM's patients, respectively, felt that having a copy of their letter would be ‘very useful’ or ‘useful’ (p < 0.001). The perceived usefulness of receiving a copy letter and the desire to be present during dictation were associated for the total group and for RDS's patients. The two groups of patients were asked to express their degree of understanding at the end of the consultation, and 81% and 93% of RDS's and AM's patients, respectively, thought that their understanding was ‘excellent’ or ‘good’. No trends emerged with regard to patients’ preferences (to be present or absent during dictation and to receive or not receive a copy of their letter) and their level of understanding. Conclusions Patients appear to like being present when their letters are dictated, and appreciate receiving copies of these, but their overall understanding is seemingly independent of these variables. The success of the clinical consultation is probably influenced by numerous factors, and the elevation of patients’ presence during dictation of correspondence and receipt of copy letters above all others seems unjustified.
Key components of anaphylaxis management plans: consensus findings from a national electronic Delphi study
Authors: Worth Allison , Nurmatov Ulugbek , Sheikh Aziz 
Published: April 2011

Summary Objectives There is no international consensus on the components of anaphylaxis management plans and responsibility for their design and delivery is contested. We set out to establish consensus among relevant specialist and generalist clinicians on this issue to inform future randomized controlled trials. Design A two-round electronic Delphi study completed by a 25-person, multidisciplinary expert panel. Participants scored the importance of a range of statements on anaphylaxis management, identified from a systematic review of the literature, on a five-point scale ranging from ‘very important’ to ‘irrelevant’. Consensus was defined a priori as being achieved if 80% or more of panel members rated a statement as ‘important’ or ‘very important’ after Round 2. Setting Primary and secondary care and academic settings in the UK and Ireland. Participants Twenty-five medical, nursing and allied health professionals. Main outcome measures Consensus on the key components of anaphylaxis management plans. Results The response rate was 84% ( n = 21) for Round 1 and 96% ( n = 24) for Round 2. The key components of emergency care on which consensus was achieved included: awareness of trigger factors (100%); recognition and emergency management of reactions of different severity (100%); and clear information on adrenaline (epinephrine) use (100%). Consensus on longer-term management issues included: clear written guidelines on anaphylaxis management (96%); annual review of plans (87%); and plans that were tailored to individual needs (82%). Conclusions This national consensus-building exercise generated widespread agreement that emergency plans need to be simple, clear and generic, making them easy to implement in a crisis. In contrast, long-term plans need to be negotiated between patient/carers and professionals, and tailored to individual needs. The effectiveness of this expert-agreed long-term plan now needs to be evaluated rigorously.
An evaluation of an enhanced fracture liaison service as the optimal model for secondary prevention of osteoporosis
Authors: Wallace IR , Callachand F , Elliott J , Gardiner PV 
Published: April 2011

Summary Objective To assess secondary preventative therapy among postmenopausal female inpatients (aged 75 years and over) receiving surgical management for a fractured neck of femur using two service delivery models. Design Practice in two fracture units was audited and compared using the NICE guidelines (TA 87) as an audit standard. Setting Two fracture units: one with a fracture liaison service and one without. Participants Postmenopausal female inpatients (aged 75 years and over) receiving surgical management for a fractured neck of femur. Main outcome measures Rate of anti-resorptive treatment and rate of enquiry into risk factors. Results There was a significantly higher rate of anti-resorptive treatment (90.5% compared to 60.9% with a difference of 29.6%, p < 0.001) and enquiry into risk factors (83% compared to 7%) in the unit with a fracture liaison service. Conclusions We propose that a hospital-based enhanced fracture liaison service may result in higher osteoporosis treatment rates among postmenopausal hospitalized hip fracture patients aged 75 years and over.
The correlation of anxiety and depression levels with response to neoadjuvant chemotherapy in patients with breast cancer
Authors: Chintamani  , Gogne Anupriya , Khandelwal Rohan , Tandon Megha , Jain Sidharth , Kumar Yashwant , Narayan Nikhil , Bamal Rahul , Srinivas S , Saxena Sunita 
Published: April 2011

Background The aim was to evaluate and correlate anxiety and depression levels with response to neoadjuvant chemotherapy in patients with breast cancer. The study also assessed the effects of family support on distress levels. Design It was a prospective study in a cohort of 84 patients with locally advanced breast cancer. These assessments were done using the Hospital Anxiety and Depression Scale (HADS). Setting A prospective study in a developing world setting. Participants Eighty-four patients with locally advanced breast cancer receiving neoadjuvant chemotherapy were included after taking an informed consent and ethical committee clearance. Main outcome measures A significant correlation was observed between response to neoadjuvant chemotherapy and depression levels in breast cancer patients. Joint family and literacy levels also had an impact on the levels of depression observed. Results A total of 84 patients receiving neoadjuvant chemotherapy for breast cancer were evaluated using HADS. The effect of family support, literacy levels and employment on the psychological status of these patients were also assessed. Conclusions The response to neoadjuvant chemotherapy had a direct correlation with the levels of depression, the distress levels being lower in responders. This was found to be the most important variable determining the psychological status of the patients. It was also observed that Indian patients in comparison to their Western counterparts react differently to cancer-related stress.
Qigong for healthcare: an overview of systematic reviews
Authors: Lee Myeong Soo , Oh Byeongsang , Ernst Edzard 
Published: April 2011

Summary Objectives Qigong has been recommended to improve health and prevent disease but the evidence is inconclusive. The aim of this overview was to critically evaluate all systematic reviews (SRs) of qigong for the treatment of any condition or symptom. Design Literature searches were carried out in 11 electronic databases for all systematic reviews of the effectiveness of qigong in any indication. Reviews were defined as systematic if they included an explicit and repeatable methods section describing the search strategy and explicit inclusion/exclusion criteria. Setting Retrospective review of medical database. Participants Participants with any type of medical conditions of any severity were included. Main outcome measures Evidence from each systematic review. Results Ten systematic reviews were included. They related to a wide range of conditions. The primary studies and several of the reviews were associated with a high risk of bias. Five reviews concluded that qigong is effective and five reviews were inconclusive. Conclusion The effectiveness of qigong is based mostly on poor quality research. Therefore, it would be unwise to draw firm conclusions at this stage.
Improving transitions in inpatient and outpatient care using a paper or web-based journal
Authors: Singh Ranjit , Roberts Alan C , Singh Ashok , Heider Arvela R , Norris Todd , Porreca Dan , Singh Gurdev 
Published: April 2011

Objective To develop a ‘Transitions Journal’ for inter-unit and inter-setting communication for improving quality and safety of care and patient satisfaction with timely, reliable and meaningful information for all stakeholders. Design Front-line staff were targeted in a series of four team meetings through which this ‘Journal’ was developed iteratively; initially as a paper-based and subsequently as an IT-based tool. Goals were to: (1) develop a standardized tool based on SBAR format (Situation, Background, Assessment, Recommendation); (2) facilitate improved communication at the points of care; (3) use a bottom-up approach; (4) create situational awareness and facilitate team formation; and (5) create visual workflow models to help inculcate a culture of safety. Setting A 183-bed community-hospital and its Primary Care Center, in an urban area in western New York State. Participants Ten nurses and 12 physicians representing both the hospital and primary care center participated voluntarily. Main outcome measures (1) Successful development of the ‘Transitions Journal’; and (2) identification of its potential uses. Results (1) Development: the journal was successfully developed in both paper and web-based formats; (2) identification of uses: participants recommended using the tool as a checklist to verify appropriate communication at both the sending and receiving ends; as an audit tool for retrospective review of handoffs; and as a teaching tool. Conclusions A journal developed by and for front-line staff has the potential to provide opportunities for improvement, instill a systems approach, improve care continuity, improve compliance with safety goals, improve patient and staff satisfaction, reduce duplication and costs, inculcate teamwork, and provide mutual emotional and intellectual support. Further work to evaluate and disseminate this tool is in progress.
The role of cranial CT in the investigation of meningitis
Authors: Nagra Inderjeet , Wee Bernard , Short Jennifer , Banerjee Arpan K 
Published: April 2011

Summary Objective To assess the usage of cranial computed tomography (CT) in patients admitted with meningitis. Design Retrospective study. Setting Heart of England NHS foundation trust, a teaching hospital in the West Midlands. Participants Two groups of adult patients admitted with meningitis between April 2001 and September 2004 and from September 2006 until September 2009. Main outcome measures The numbers of patients having cranial CT and lumbar puncture and whether any complications had arisen following lumbar puncture. The appropriateness of the CT request according to local criteria. Results A total of 111 patients were admitted in the initial time period and 47 patients in the second time period. In the first group, 67 patients underwent CT (61%), compared with 36 patients (80%) in the second group. There were eight abnormal scans (12%) in the initial group including three patients with radiological features of cerebral oedema. Of these patients, one underwent lumbar puncture and had no neurological sequelae. In the second group, there were five abnormal scans (14%) with one presenting a contraindication for lumbar puncture due to mild ventricular dilatation. A lumbar puncture was performed in this patient without complication. All patients with abnormal scans had clinical features to suggest raised intracranial pressure. CT scan requests were considered inappropriate in 26% of patients in the initial study period and 56% of patients in the second study period. Conclusion More patients with meningitis are undergoing CT and the number of inappropriate requests are increasing. There are few abnormal CT scans presenting a contraindication for lumbar puncture and the majority of these patients usually have clinical signs to suggest raised intracranial pressure.
Evidence that central sensitisation is present in patients with shoulder impingement syndrome and influences the outcome after surgery
Authors: Gwilym S. E. , Oag H. C. L. , Tracey I. , Carr A. J. 
Published: April 2011

Impingement syndrome in the shoulder has generally been considered to be a clinical condition of mechanical origin. However, anomalies exist between the pathology in the subacromial space and the degree of pain experienced. These may be explained by variations in the processing of nociceptive inputs between different patients. We investigated the evidence for augmented pain transmission (central sensitisation) in patients with impingement, and the relationship between pre-operative central sensitisation and the outcomes following arthroscopic subacromial decompression. We recruited 17 patients with unilateral impingement of the shoulder and 17 age- and gender-matched controls, all of whom underwent quantitative sensory testing to detect thresholds for mechanical stimuli, distinctions between sharp and blunt punctate stimuli, and heat pain. Additionally Oxford shoulder scores to assess pain and function, and PainDETECT questionnaires to identify ‘neuropathic’ and referred symptoms were completed. Patients completed these questionnaires pre-operatively and three months post-operatively. A significant proportion of patients awaiting subacromial decompression had referred pain radiating down the arm and had significant hyperalgesia to punctate stimulus of the skin compared with controls (unpaired t-test, p < 0.0001). These are felt to represent peripheral manifestations of augmented central pain processing (central sensitisation). The presence of either hyperalgesia or referred pain pre-operatively resulted in a significantly worse outcome from decompression three months after surgery (unpaired t-test, p = 0.04 and p = 0.005, respectively). These observations confirm the presence of central sensitisation in a proportion of patients with shoulder pain associated with impingement. Also, if patients had relatively high levels of central sensitisation pre-operatively, as indicated by higher levels of punctate hyperalgesia and/or referred pain, the outcome three months after subacromial decompression was significantly worse.