bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of the Diabetes Community Exercise and Education Programme (DCEP) for the management of type 2 diabetes: qualitative process evaluation
Authors: Stokes Tim , Wilkinson Amanda , Jayakaran Prasath , Higgs Christopher , Keen Donna , Mani Ramakrishnan , Sullivan Trudy , Gray Andrew R , Doolan-Noble Fiona , Mann Jim , Hale Leigh 
Published: May 2022

ObjectivesTo examine context-specific delivery factors, facilitators and barriers to implementation of the Diabetes Community Exercise and Education Programme (DCEP) for adults with type 2 diabetes (T2D) using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.DesignA qualitative evaluation embedded within the DCEP pragmatic randomised controlled trial. Data collected via focus groups and interviews and analysed thematically.SettingCommunity-based in two cities (Dunedin and Invercargill) in the lower south island of New Zealand.ParticipantsSeventeen adults diagnosed with T2D attending DCEP and 14 healthcare professionals involved in DCEP delivery.InterventionDCEP is a twice weekly session of exercise and education over 12 weeks, followed by a twice weekly ongoing exercise class.ResultsWhile our reach target was met (sample size, ethnic representation), the randomisation process potentially deterred Māori and Pasifika from participating. The reach of DCEP may be extended through the use of several strategies: promotion of self-referral, primary healthcare organisation ownership and community champions. DCEP was considered effective based on perceived benefit. The social and welcoming environment created relationships and connections. People felt comfortable attending DCEP and empowered to learn. Key to implementation and adoption was the building of trusting relationships with local health providers and communities. This takes time and care and cannot be rushed. Training of staff and optimising communication needed further attention. To maintain DCEP, delivery close to where people live and a generic approach catering for people with multiple chronic conditions may be required.ConclusionsFor success, lifestyle programmes such as DCEP, need time and diligence to build and maintain networks and trust. Beyond frontline delivery staff and target populations, relationships should extend to local healthcare organisations and communities. Access and ongoing attendance are enabled by healthcare professionals practicing in a nuanced person-centred manner; this, plus high staff turnover, necessitates ongoing training.Trial registration numberACTRN12617001624370.
Cohort profile: the Swedish Pancreatitis Cohort (SwePan)
Authors: Selin Daniel , Yang Bei , Lindblad Mats , Arnelo Urban , Nilsson Magnus , Sadr-Azodi Omid , Maret-Ouda John 
Published: May 2022

PurposeThe Swedish Pancreatitis Cohort (SwePan) was designed to study long-term outcomes following an episode of acute pancreatitis. It can also be used to study various risk factors for developing acute pancreatitis.ParticipantsThe SwePan is a register-based nationwide matched cohort. It includes all Swedish cases of acute pancreatitis during 1990–2019. It contains 95 632 individuals with acute pancreatitis and 952 783 pancreatitis-free individuals matched on sex, age and municipality of residence. Follow-up was censored at death, emigration or end of study (31 December 2019). The dataset includes comprehensive information based on several registries, and includes diagnoses, prescribed medications and socioeconomic factors both prior to inclusion and during follow-up.Findings to dateDuring the study period, the number of cases of acute pancreatitis in Sweden has more than doubled from 1977 cases in 1990 to 4264 cases in 2019. The median age of first episode of acute pancreatitis has increased from 58 years (IQR 44–73 years) in 1990 to 64 years (IQR 49–76 years) in 2019. Cases with acute pancreatitis were generally less healthy compared with the pancreatitis-free individuals (Charlson Comorbidity Index of 0 in 59.2% and 71.4%, respectively).Future plansSwePan will be used to determine the incidence of acute pancreatitis in Sweden over time and assess long-term all-cause and cause-specific mortality after an episode of acute pancreatitis. Some examples of additional planned studies are (1) assessment of long-term risk of diabetes and (2) risk of malignancy in adjacent organs following acute pancreatitis and (3) assessment of risk factors for development of acute pancreatitis including various drugs.
Evaluating the impact of a maternity and neonatal emergencies education programme in Australian regional and rural health services on clinician knowledge and confidence: a pre-test post-test study
Authors: Cullinane Meabh , Zugna Stefanie A , McLachlan Helen L , Newton Michelle S , Forster Della A 
Published: May 2022

IntroductionAlmost 78 000 women gave birth in the state of Victoria, Australia, in 2019. While most births occurred in metropolitan Melbourne and large regional centres, a significant proportion of women birthed in rural services. In late 2016, to support clinicians to recognise and respond to clinical deterioration, the Victorian government mandated provision of an emergency training programme, called Maternity and Newborn Emergencies (MANE), to rural and regional maternity services across the state. This paper describes the evaluation of MANE.Design and settingA quasi-experimental study design was used; the Kirkpatrick Evaluation Model provided the framework.ParticipantsParticipants came from the 17 rural and regional Victorian maternity services who received MANE in 2018 and/or 2019.Outcome measuresBaseline data were collected from MANE attendees before MANE delivery, and at four time points up to 12 months post-delivery. Clinicians’ knowledge of the MANE learning objectives, and confidence ratings regarding the emergencies covered in MANE were evaluated. The Safety Attitudes Questionnaire (SAQ) assessed safety climate pre-MANE and 6 months post-MANE among all maternity providers at the sites.ResultsImmediately post-MANE, most attendees reported increased confidence to escalate clinical concerns (n=251/259). Knowledge in the non-technical and practical aspects of the programme increased. Management of perinatal emergencies was viewed as equally stressful pre-MANE and post-MANE, but confidence to manage these emergencies increased post-delivery. Pre-MANE SAQ scores showed consistently strong and poor performing services. Six months post-MANE, some services showed improvements in SAQ scores indicative of improved safety climate.ConclusionMANE delivery resulted in both short-term and sustained improvements in knowledge of, and confidence in, maternity emergencies. Further investigation of the SAQ across Victoria may facilitate identification of services with a poor safety climate who could benefit from frequent targeted interventions (such as the MANE programme) at these sites.
Current status of medical device malfunction reporting: using end user experience to identify current problems
Authors: Tase Arkeliana , Ni Melody Z , Buckle Peter W , Hanna George B 
Published: May 2022

IntroductionThe current under-reporting of medical device malfunctions, difficulties with the current system and absence of continuous good-quality data has removed the possibility for constant data interrogation and trend recognition to identify evolving issues. This research used end user experiences aiming to understand causes for the lack of data and knowledge on device performance and associated patient risks. This approach was used to identify existing barriers and methods for improvement.MethodsThis is a qualitative study involving semistructured interviews and surveys with clinicians (15 interviews, 39 surveys) and manufacturers (13 interview participants, 5 surveys). Multiple sources of recruiting were used. Data collected were thematically analysed. Interview results were used to design the surveys. Standards for Reporting Qualitative Research was used.ResultsMedical device use is based on personal experience rather than evidence which is scarce. Multiple barriers to reporting were identified alongside patient safety and system related aspects. Furthermore, the acceptable level of error was variable as were effects on working practice. Many workarounds have been developed to overcome problems and have become normalised in daily work. These factors were found to have a limiting impact on improvements and learning. Greater system transparency, feedback on submitted reports, a more efficient system of reporting and better communication with manufacturers were reported as some of the required improvements.ConclusionsThis study has identified numerous complex issues affecting reporting of medical device performance and their subsequent effect on patient safety and clinical staff. The focus on incidents has created many limitations to learning and development. The rich experience of end users should be appropriately used to identify system weaknesses and seek improvement methods. Better communication methods should be developed between healthcare and MedTech (Medical Technologies) industry.
Personalised multicomponent interventions for tobacco dependence management in low socioeconomic populations: a systematic review and meta-analysis
Authors: Huynh Nina , Tariq Saania , Charron Catherine , Hayes Tavis , Bhanushali Onkar , Kaur Tina , Jama Sadia , Ambade Preshit , Bignell Ted , Hegarty Terry , Shorr Risa , Pakhale Smita 
Published: May 2022

BackgroundThere remains a disproportionally high tobacco smoking rate in low-income populations. Multicomponent tobacco dependence interventions in theory are effective. However, which intervention components are necessary to include for low socioeconomic status (SES) populations is still unknown.ObjectiveTo assess the effectiveness of multicomponent tobacco dependence interventions for low SES and create a checklist tool examining multicomponent interventions.MethodsEMBASE and MEDLINE databases were searched to identify randomised controlled trials (RCTs) published with the primary outcome of tobacco smoking cessation measured at 6 months or post intervention. RCTs that evaluated tobacco dependence management interventions (for reduction or cessation) in low SES (experience of housing insecurity, poverty, low income, unemployment, mental health challenges, illicit substance use and/or food insecurity) were included. Two authors independently abstracted data. Random effects meta-analysis and post hoc sensitivity analysis were performed.ResultsOf the 33 included studies, the number of intervention components ranged from 1 to 6, with smoking quit rates varying between 1% and 36.6%. Meta-analysis revealed that both the 6-month and 12-month outcome timepoints, multicomponent interventions were successful in achieving higher smoking quit rates than the control (OR 1.64, 95% Cl 1.41 to 1.91; OR 1.74, 95% Cl 1.30 to 2.33). Evidence of low heterogeneity in the effect size was observed at 6-month (I2=26%) and moderate heterogeneity at 12-month (I2=56%) outcomes.ConclusionMulticomponent tobacco dependence interventions should focus on inclusion of social support, frequency and duration of components. Employing community-based participatory-action research approach is essential to addressing underlying psychosocioeconomic-structural factors, in addition to the proven combination pharmacotherapies.PROSPERO registration numberCRD42017076650.
Phase II trial of efficacy, safety and biomarker analysis of sintilimab plus anlotinib for patients with recurrent or advanced endometrial cancer
Authors: Wei Wei , Ban Xiaohua , Yang Fan , Li Jibin , Cheng Xiaqin , Zhang Rong , Huang Xin , Huang Yongwen , Li Qiaqia , Qiu Ya , Zheng Min , Zhu Xiaofeng , Li Jundong 
Published: May 2022

BackgroundAlthough co-inhibition of the angiogenesis and programmed death 1 (PD-1) pathways is proposed as an effective anticancer strategy, studies in Chinese patients with endometrial cancer are sufficient. Anlotinib is an oral multi-targeted tyrosine kinase inhibitor affecting tumor angiogenesis and proliferation; sintilimab is an anti-PD-1 monoclonal antibody.MethodsThis was a phase II trial using Simon’s two-stage design. This study enrolled patients with endometrial cancer who had progressed after platinum-based chemotherapy. Sintilimab 200 mg was administered intravenously on day 1 every 3 weeks, and anlotinib 12 mg was administered on days 1–14 in a 21-day cycle. The primary endpoint was the objective response rate (ORR) using the immune-related Response Evaluation Criteria in Solid Tumors criteria. Immunohistochemistry and whole-exome sequencing were used as correlative investigations.ResultsBetween November 2019 and September 2020, 23 eligible patients were enrolled. The ORR and disease control rates were 73.9% (95% CI, 51.6 to 89.8) and 91.3% (95% CI, 72.0 to 98.9), respectively, with 4 complete and 12 partial responses. With a median follow-up of 15.4 months (95% CI, 12.6 to 18.3), the median progression-free survival was not reached, and the probability of PFS >12 months was 57.1% (95% CI, 33.6 to 75.0). Exploratory analysis revealed that mutations in the homologous repair pathway showed a trend for higher ORR (100% vs 0%, p=0.07). Treatment-related grade 3/4 adverse events were observed in 50.0% of the patients.ConclusionsSintilimab plus anlotinib demonstrated robust therapeutic benefits with tolerable toxicity in endometrial cancer.Trial registration numberNCT04157491.
064  Imilimumab/nivolumab induced paraspinal myositis causing dysphagia
Authors: Warner Graham 
Published: May 2022

Immune checkpoint inhibitors have transformed metastatic melanoma treatment. Imilimumab/Nivolumab combination increases progression-free survival [1], but Imilimumab can cause immune-related condi- tions including hepatitis, colitis and dermatitis[2]. We present a case of Imilimumab/Nivolumab-induced posterior paraspinal muscles myositis.A 78 year-old man with metastatic melanoma with hepatic, osseous, and lymph node spread had 3 weeks of dysphagia to solids but not liquids, 2 months after his last cycle of immunotherapy. He complained of hoarse voice, weight loss, unsteadiness and falls.Examination revealed symmetrical, normal palatal rise without tongue wasting or fasciculation. Speech was hypernasal with poor pharyngeal phonation. There was no fatigue nor ptosis nor extra-ocular motor weakness. Small muscle hand wasting was modest in keeping with general cachexia. Power in all limbs was preserved with no fasciculation.CK was mildly elevated at 522 u/l. Brain MRI showed a normal brain stem with scant cerebral white matter ischaemia. Neck imaging showed no pharyngeal infiltration but extensive muscular oedema involving trapezii and para-spinal muscles (skull base to sacrum), consistent with myositis secondary to immunotherapy.He received 13 days Methylprednisolone 2mg/kg and speech and swallow improved markedly on serial SALT assessments.Inflammatory myopathy is recognised with novel metastatic melanoma treatments, others reporting dysphagia[3] or limb-girdle weakness[4]. Our case highlights the evolving recognition of immunotherapy side effects and awareness for myositis in these patients.graham.warner@nhs.net
066  Clinical and imaging findings in MOG antibody positive patients presenting to Kings College Hospital
Authors: Raftopoulos Rhian , Williams Victoria , Brex Peter , O’Sullivan Eoin 
Published: May 2022

We identified all patients testing positive for MOG antibodies at KCH and reviewed their clinical phenotype and imaging findings. 22 patients tested positive for MOG antibodies between Jan 2015 and Aug 2019 (11 female, mean age 39 (SD 18)). The majority of patients 15/22 presented with optic neuritis, 3 patients bilateral, 2 bilateral sequential. Other presentations included LETM (2), ADEM(2), brain stem syndrome (1), lower cord/conus syndrome (1) seizures (1). Mean logMar visual acuity at nadir in patients present- ing with an optic neuritis was 0.69 (SD 0.58). Mean logMar visual acuity at recovery was logMAR 0.1 (SD 0.54), 12/15 eyes had documented optic disc swelling. MRI brain was performed in 20 patients and was normal in 10, 6 had non-specific white matter changes the remainder had inflammatory brainstem and ADEM –like changes. MRI orbits was performed in 13 patients, 4 had bilateral optic nerve involvement and 5 had longitudinally extensive optic nerve lesions. Spinal cord imaging was performed in 9 patients, 2 had a LETM, 1 multifocal signal change and the remainder normal imaging. The cervical cord was the most frequently involved region of the spinal cord. 5 patients developed relapses (all optic neuritis), 3 relapses occurred off treatment.r.raftopoulos@ucl.ac.uk
072  The oblique path of a transverse lesion
Authors: Kesserwani Jad , Cooper Rebecca , Wickremaratchi Mirdhu , Palace Jaqueline , Fisniku Leonora 
Published: May 2022

A 38-year-old man presented in September 2016 with left hand numbness which progressed over 2 days to disabling weakness of his left arm and leg. He initially presented to a stroke unit, stroke being ruled out by brain MRI. An MRI spine showed an intramedullary lesion extending from C2-C7. He was referred to neurosurgery who queried an astrocytoma and performed a biopsy. Biopsy demonstrated a demyelinat- ing lesion leading to referral to neurology.Following a battery of investigations, visual evoked potentials showed left sided delay and positive serum aquaporin-4 antibodies (AQP4-Abs). A diagnosis of Neuromyelitis Optica Spectrum Disorder (NMOSD) was made.He received dexamethasone and his symptoms dramatically improved. He deteriorated on weaning but responded well to subsequent plasma exchange.He remained clinically and radiologically stable on azathioprine and prednisolone until Spring 2019 before suffering two clinical and radiological relapses. Both relapses involved sensory disturbance and mild weakness in his left upper and lower limbs, responding to pulsed methylprednisolone. Rituximab treatment is being set up.This case highlights that NMOSD can mimic both stroke and spinal cord tumour and needs to be con- sidered in similar presentations to avoid unnecessary morbidity from cord biopsy, and to enable prompt initiation of immunotherapeutic treatment.Rebeccacooper@doctors.org.uk
076  Increased physiological responses to threat in Duchenne muscular dystrophy: a potential CNS outcome measure
Authors: Maresh Kate E , Papageorgiou Andriani , Ridout Deborah , Harrison Neil A , Mandy William , Skuse David , Muntoni Francesco 
Published: May 2022

Dystrophin is expressed in brain as well as muscle, and its loss in Duchenne muscular dystrophy (DMD) causes CNS disturbance in addition to muscle pathology. A DMD mouse model (mdx) exhibits exagger- ated fear responses to threat, which normalise with postnatal dystrophin-restoration therapies.To investigate whether fear responses are abnormal in DMD patients, we tested 31 DMD and 25 male control participants aged 7–12 years using a fear conditioning task. Participants viewed trials of two neutral visual stimuli: one ‘safe’ stimulus and one paired with a ‘threat’ (aversive noise) to enable fear condi- tioning. Both stimuli were subsequently presented without the noise to assess extinction of conditioned autonomic fear responses (skin conductance).The initial (unconditioned) response to threat was significantly greater in DMD than controls (p=0.016). Both groups similarly acquired conditioned fear responses (p=0.55). These were retained in controls during early extinction, and later extinguished, however DMD participants showed no significant discrimination between threat/safe stimuli in extinction.This study is the first to investigate fear responses in DMD boys, showing exaggerated unconditioned responses to threat, similar to mdx mice, and abnormalities of fear extinction. Establishing this objective measure of a potentially reversible CNS phenotype will benefit clinical trials of CNS-targeted dystrophin- restoration therapies.drkatemaresh@gmail.com
102  The cost of misdiagnosis in POEMS syndrome
Authors: Keddie Stephen , Marsh Eleanor , D’Sa Shirley , Terris-Prestholt Fern , Lunn Michael 
Published: May 2022

BackgroundPOEMS syndrome is a rare cause of neuropathy misdiagnosed as Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) in 60% of cases. Ineffective CIDP directed therapy is expensive, introduces risk of complications, and often results in disease progression. Vascular endothelial growth factor (VEGF) is a sensitive and specific biomarker in the diagnosis of POEMS syndrome costing approximately £50. Introducing early directed screening with VEGF more accurately distinguishes POEMS syndrome from CIDP than the current standard of care (SOC).Methods100 cases from the UCLH POEMS database were selected. We grouped patients according to diagnostic pathway and compared health outcomes. We conducted a model-based cost-effectiveness analysis to compare diagnostic outcomes and costs of the current SOC with intervention pathways using VEGF screening. We used a study cohort of 1,250 patients with polyneuropathy (UK incidence) and conducted costing from a health-services perspective.ResultsTreatments associated with POEMS misdiagnosis led to a total healthcare expenditure in our cohort of £808,550-£1,111,756 over 20 years, with an average cost-per-POEMS-syndrome-patient misdiagnosed of£14,701-£20,214. Our intervention pathway which introduces VEGF screening into the current SOC results in 4 additional early POEMS diagnoses per year and a cost-saving of almost £40,000 through avoidance of non-POEMS directed therapy and related hospital costs.ConclusionVEGF testing should be routine for patients presenting with an acquired demyelinating neu- ropathy. This will improve early diagnosis of POEMS syndrome, enable effective therapy and reduce cos8ts5.stephen.keddie@nhs.net
106  Inflammatory peripheral neuropathy in haematological malignancies
Authors: Zirra Alexandra , Baheerathan Aravindhan , D’Sa Shirley , Lunn Michael 
Published: May 2022

BackgroundWe report the case of a 62-year-old female with demyelinating sensorimotor polyneuropathy in the context of lymphoplasmacytic lymphoma.Case Presentation62-year-old woman presenting with distal lower limb numbness bilaterally, with a 9-year progressive course. Over the next 3 years, foot drop developed with gradual lower and upper limb involvement.Investigations showed raised IgM paraprotein, 20 g/dL. Bone marrow biopsy identified 2-B cell clonal populations with positive MYD88 mutation in keeping with lymphoplasmacytic lymphoma (LPL). Neuro- physiological studies showed very severe length-dependent, sensorimotor neuropathy. She was VEGF/anti-MAG negative, but anti-GM2 positive. Widely-spaced myelin and moderate axonal loss were seen on sural nerve biopsy.She was diagnosed with a progressive demyelinating neuropathy in the context of LPL.Initial IVIG treatment failed.Second line treatment – cyclophosphamide/rituximab/dexamethasone, improved her lower limb weakness. Ibrutinib later stabilised her weakness in the lower but not upper limbs.Plexus nerve biopsy showed general inflammation, excluding direct clonal infiltration and amyloid deposi- tion. This reconfirmed the diagnosis: inflammatory neuropathy driven by a haematological malignancy. She received further treatment with rituximab-bendamustine.ConclusionUnderstanding the pathological mechanism of polyneuropathies in haematological malignan- cies is of paramount importance for choosing the most effective therapy, as illustrated by the above cas8e7.a.zirra@nhs.net