bluuebunny/crossref_metadata_2025_split huggingface dataset:
US emergency care patterns among nurse practitioners and physician assistants compared with physicians: a cross-sectional analysis
Authors: Mafi John N , Chen Alexander , Guo Rong , Choi Kristen , Smulowitz Peter , Tseng Chi-Hong , Ladapo Joseph A , Landon Bruce E 
Published: May 2022

ObjectivesNurse practitioners and physician assistants (NPs/PAs) increasingly practice in emergency departments (EDs), yet limited research has compared their practice patterns with those of physicians.Design, setting and participantsUsing nationally representative data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), we analysed ED visits among NPs/PAs and physicians between 1 January 2009 and 31 December 2017. To compare NP/PA and physician utilisation, we estimated propensity score-weighted multivariable regressions adjusted for clinical/sociodemographic variables, including triage acuity score (1=sickest/5=healthiest). Because NPs/PAs may preferentially consult physicians for more complex patients, we performed sensitivity analyses restricting to EDs with >95% of visits including the NP/PA–physician combination.ExposuresNPs/PAs.Main outcome measuresUse of hospitalisations, diagnostic tests, medications, procedures and six low-value services, for example, CT/MRI for uncomplicated headache, based on Choosing Wisely and other practice guidelines.ResultsBefore propensity weighting, we studied visits to 12 410 NPs/PAs-alone, 21 560 to the NP/PA–physician combination and 143 687 to physicians-alone who saw patients with increasing age (41, 45 and 47 years, p<0.001) and worsening triage acuity scores (3.03, 2.85 and 2.67, p<0.001), respectively. After weighting, NPs/PAs-alone used fewer medications (2.62 vs 2.80, p=0.002), diagnostic tests (3.77 vs 4.66, p<0.001), procedures (0.67 vs 0.77, p<0.001), hospitalisations (OR 0.35 (95% CI 0.26 to 0.46)) and low-value CT/MRI studies (OR 0.65 (95% CI 0.53 to 0.80)) than physicians. Contrastingly, the NP/PA–physician combination used more medications (3.08 vs 2.80, p<0.001), diagnostic tests (5.07 vs 4.66, p<0.001), procedures (0.86 vs 0.77, p<0.001), hospitalisations OR 1.33 (95% CI 1.17 to 1.51) and low-value CT/MRI studies (OR 1.23 (95% CI 1.07 to 1.43)) than physicians—results were similar among EDs with >95% of NP/PA visits including the NP/PA–physician combination.Conclusions and relevanceWhile U.S. NPs/PAs-alone used less care and low-value advanced diagnostic imaging, the NP/PA–physician combination used more care and low-value advanced diagnostic imaging than physicians alone. Findings were reproduced among EDs where nearly all NP/PA visits were collaborative with physicians, suggesting that NPs/PAs seeing more complex patients used more services than physicians alone, but the converse might be true for more straightforward patients.
Comparative clinical studies of primary chemoradiotherapy versus S-1 and nedaplatin chemotherapy against stage IVb oesophageal squamous cell carcinoma: a multicentre open-label randomised controlled trial
Authors: Liu Yun , Beeraka Narasimha M , Liu Junqi , Chen Kuo , Song Bo , Song Zhang , Luo Jianchao , Liu Yang , Zheng Anping , Cui Yanhui , Wang Yang , Jia Zhenhe , Song Xiangyu , Wang Xiaohong , Wang Hongqi , Qi Xuefeng , Ren Jinshan , Wu Liping , Cai Jixing , Fang Xainying , Wang Xin , Sinelnikov Mikhail Y , Nikolenko Vladimir N , Greeshma M V , Fan Ruitai 
Published: May 2022

IntroductionOesophageal squamous cell carcinoma (OSCC) is one of the most commonly occurring devastating tumours worldwide, including in China. To date, the standard care of patients with stage IV OSCC is systemic chemotherapy and palliative care, which results in poor prognosis. However, no consensus has been established regarding the role of radiotherapy in targeting the primary tumour in patients with stage IVa OSCC. Thus, the aim of this study is to assess the effectiveness of primary radiotherapy combined with S-1 and nedaplatin (NPD) chemotherapy in the patients with stage IV OSCC.Methods and analysisThe study is a multicentre, open-label, randomised controlled trial. A total of 180 eligible patients with stage IV OSCC will be randomised into a study group (90 patients) and a control group (90 patients). Patients in the study group will receive radiotherapy to the primary tumour at a dose of 50.4 Gy combined with 4–6 cycles of S-1 and NPD chemotherapy. In the control group, patients will only receive 4–6 cycles of S-1 and NPD chemotherapy. The primary and secondary outcomes will be measured. The differences between the two groups will be statistically analysed with regard to overall survival, the progression-free survival and safety. All outcomes will be ascertained before treatment, after treatment and after the follow-up period.The results of this study will provide evidence on the role of radiotherapy in patients with stage IV OSCC in China, which will show new options for patients with advanced oesophageal cancer.Ethics and disseminationThis study was approved by the Institutional Ethics Committee of The First Hospital Affiliated of Zhengzhou University (approval number: SS-2018–04).Trial registrationThe trial has been registered at the Chinese Clinical Trial Registry (ChiCTR1800015765) on 1 November 2018; retrospectively registered,http://www.chictr.org.cn/index.aspx.
Empirical comparisons of meta-analysis methods for diagnostic studies: a meta-epidemiological study
Authors: Rosenberger Kristine J , Chu Haitao , Lin Lifeng 
Published: May 2022

ObjectivesSeveral methods are commonly used for meta-analyses of diagnostic studies, such as the bivariate linear mixed model (LMM). It estimates the overall sensitivity, specificity, their correlation, diagnostic OR (DOR) and the area under the curve (AUC) of the summary receiver operating characteristic (ROC) estimates. Nevertheless, the bivariate LMM makes potentially unrealistic assumptions (ie, normality of within-study estimates), which could be avoided by the bivariate generalised linear mixed model (GLMM). This article aims at investigating the real-world performance of the bivariate LMM and GLMM using meta-analyses of diagnostic studies from the Cochrane Library.MethodsWe compared the bivariate LMM and GLMM using the relative differences in the overall sensitivity and specificity, their 95% CI widths, between-study variances, and the correlation between the (logit) sensitivity and specificity. We also explored their relationships with the number of studies, number of subjects, overall sensitivity and overall specificity.ResultsAmong the extracted 1379 meta-analyses, point estimates of overall sensitivities and specificities by the bivariate LMM and GLMM were generally similar, but their CI widths could be noticeably different. The bivariate GLMM generally produced narrower CIs than the bivariate LMM when meta-analyses contained 2–5 studies. For meta-analyses with <100 subjects or the overall sensitivities or specificities close to 0% or 100%, the bivariate LMM could produce substantially different AUCs, DORs and DOR CI widths from the bivariate GLMM.ConclusionsThe variation of estimates calls into question the appropriateness of the normality assumption within individual studies required by the bivariate LMM. In cases of notable differences presented in these methods’ results, the bivariate GLMM may be preferred.
Predicting diagnoses from illness experiences with common cold symptoms before physician consultation: a mixed-methods research
Authors: Mizoe Atsushi , Isse Naohi 
Published: May 2022

ObjectivesWe aimed to explore whether patients’ illness experiences with common cold symptoms could help with predicting the final diagnosis before consultation.DesignExploratory sequential design of mixed methods: Qualitative and quantitative studies used inductive qualitative content analysis and multinomial regression analysis, respectively.SettingConsecutive patients at the primary care clinic of a general hospital.ParticipantsNew patients aged 15 years or older were included in the study. Of the 1512 eligible patients who received the questionnaire sheet, 408 selected the common cold as their reason for visiting. All 408 patients responded to the questionnaire.Main outcome measuresFirst, factors representing illness experiences in patients with common cold symptoms were explored. Second, variables with significant relative risk ratio (RRR) were used to diagnose common cold, influenza or other diseases.ResultsA total of 171 codes were identified from the responses of 408 patients, which were visually mapped to show their frequencies and occurrence in the same person according to their final diagnoses. Of the 171 codes, 22 found in over nine patients represented the variables for the three independent final diagnoses. The adjusted final model revealed that (1) ‘worry about influenza infection’, ‘want influenza test’ and ‘transmission from a colleague at school or workplace’ predicted the influenza rather than the common cold, when other predicting variables were constant (RRR, 6.20 p<0.001; RRR, 26.1 p<0.01; and RRR, 4.69 p<0.05, respectively); (2) ‘want further examination’ predicted other diseases (RRR, 2.84 p<0.05); and (3) the combination of ‘worry about influenza infection’ and ‘want influenza test’, which predicted the opposite diagnosis: the common cold rather than influenza (RRR, 0.01 p<0.001).ConclusionThese findings provide useful information on how illness experiences before consultation can predict final diagnoses for patients with common cold symptoms.Trial registration numberUMIN000030697.
SPACE FOR COPD delivered as a maintenance programme on pulmonary rehabilitation discharge: protocol of a randomised controlled trial evaluating the long-term effects on exercise tolerance and mental well-being
Authors: Alqahtani Khaled A , Gerlis Charlotte , Nolan Claire M , Gardiner Nikki , Szczepura Ala , Man William , Singh Sally J , Houchen-Wolloff Linzy 
Published: May 2022

IntroductionThe benefits achieved during pulmonary rehabilitation (PR) are known to be sustained for 6–12 months after the initial programme. Several maintenance trials have been conducted but were heterogeneous in terms of duration, frequency and labour cost. There is no consensus on one best strategy. SPACE FOR COPD (Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease) is a home-based self-management programme, which has been shown previously to be effective in primary and secondary care settings and is to be tested here as a maintenance programme. The aim is to evaluate the efficacy of the SPACE FOR COPD programme (manual and group sessions), on exercise tolerance and mental well-being, compared with usual care following PR in patients with COPD.Methods and analysisA prospective, multicentre, single-blinded randomised controlled trial requiring 116 participants with a clinical diagnosis of COPD who have finished PR within 4 weeks will be randomised 1:1 to either a usual care group or a SPACE FOR COPD programme group. The intervention comprises a home-based manual and 4, 2-hour group sessions adopting motivational interviewing techniques over 12 months. The primary outcome is endurance capacity measured by the Endurance Shuttle Walking Test at 12 months. Secondary outcomes are: maximal exercise capacity, health-related quality of life, mood, patient activation, physical activity, lung function and healthcare costs. The measures will be taken at baseline, 6 and 12 months. Patient interviews and staff focus groups will be conducted to explore barriers, facilitators and views about the intervention at the end of the study. A framework analysis will be used for the interpretation of qualitative data.Ethics and disseminationThe trial was granted ethical approval from Health Research Authority and Health and Care Research Wales (HCRW19/EM/0267 on 10 October 2019). Results will be made available to all stakeholders through a dissemination event, conferences and peer-reviewed publications.Trial registration numberISRCTN30110012.
Glial-modulating agents for the treatment of pain: protocol for a systematic review
Authors: Gilron Ian , Xiao Maggie Z X , Balanaser Marielle , Carley Meg , Ghasemlou Nader , Salter Michael W , Hutchinson Mark R , Moulin Dwight E , Moore R Andrew , Ross-White Amanda 
Published: May 2022

IntroductionEvidence suggests a role for Central nervous system glia in pain transmission and in augmenting maladaptive opioid effects. Identification of drugs that modulate glia has guided the evaluation of glial suppression as a pain management strategy. This planned systematic review will describe evidence of the efficacy and adverse effects of glial-modulating drugs in pain management.Methods and analysisA detailed search will be conducted on the Cochrane Central Register of Controlled Trials, Medline, and Embase from their inception until the date the final searches are run to identify relevant randomised controlled trials. The reference lists of retrieved studies, as well as online trial registries, will also be searched. English language, randomised, double-blind trials comparing various glial-modulating drugs with placebo and/or other comparators, with participant-reported pain assessment, will be included. Two reviewers will independently evaluate studies for eligibility, extract data and assess trial quality and potential bias. Risk of bias will be assessed using criteria outlined in theCochrane Handbook for Systematic Review of Interventions. Primary outcomes for this review will include any validated measure of pain intensity and/or pain relief. Dichotomous data will be used to calculate risk ratio and number needed to treat or harm. The quality of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis systematic review does not require formal ethics approval. The findings will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42021262074.
The CLASS Study (Circadian Light in Adolescence, Sleep and School): protocol for a prospective, longitudinal cohort to assess sleep, light, circadian timing and academic performance in adolescence
Authors: Stone Julia E , Wiley Joshua , Chachos Evangelos , Hand Anthony J , Lu Sinh , Raniti Monika , Klerman Elizabeth , Lockley Steven W , Carskadon Mary A , Phillips Andrew J K , Bei Bei , Rajaratnam Shantha M W 
Published: May 2022

BackgroundDuring adolescence, sleep and circadian timing shift later, contributing to restricted sleep duration and irregular sleep-wake patterns. The association of these developmental changes in sleep and circadian timing with cognitive functioning, and consequently academic outcomes, has not been examined prospectively. The role of ambient light exposure in these developmental changes is also not well understood. Here, we describe the protocol for the Circadian Light in Adolescence, Sleep and School (CLASS) Study that will use a longitudinal design to examine the associations of sleep-wake timing, circadian timing and light exposure with academic performance and sleepiness during a critical stage of development. We also describe protocol adaptations to enable remote data collection when required during the COVID-19 pandemic.MethodsApproximately 220 healthy adolescents aged 12–13 years (school Year 7) will be recruited from the general community in Melbourne, Australia. Participants will be monitored at five 6 monthly time points over 2 years. Sleep and light exposure will be assessed for 2 weeks during the school term, every 6 months, along with self-report questionnaires of daytime sleepiness. Circadian phase will be measured via dim light melatonin onset once each year. Academic performance will be measured via national standardised testing (National Assessment Program-Literacy and Numeracy) and the Wechsler Individual Achievement Test—Australian and New Zealand Standardised Third Edition in school Years 7 and 9. Secondary outcomes, including symptoms of depression, anxiety and sleep disorders, will be measured via questionnaires.DiscussionThe CLASS Study will enable a comprehensive longitudinal assessment of changes in sleep-wake timing, circadian phase, light exposure and academic performance across a key developmental stage in adolescence. Findings may inform policies and intervention strategies for secondary school-aged adolescents.Ethics and disseminationEthical approval was obtained by the Monash University Human Research Ethics Committee and the Victorian Department of Education. Dissemination plans include scientific publications, scientific conferences, via stakeholders including schools and media.Study datesRecruitment occurred between October 2019 and September 2021, data collection from 2019 to 2023.
Hospital-based patient navigation programmes for patients who experience injury-related trauma and their caregivers: a scoping review protocol
Authors: Doucet Shelley , Luke Alison , Anthonisen Grailing , Witherspoon Richelle , MacNeill A Luke , MacNeill Lillian , Kelly Katherine J , Fearon Taylor 
Published: May 2022

IntroductionPatients who experience injury-related trauma tend to have complex care needs and often require support from many different care providers. Many patients experience gaps in care while in the hospital and during transitions in care. Providing access to integrated care can improve outcomes for these patients. Patient navigation is one approach to improving the integration of care and proactively supporting patients and their caregivers as they navigate the healthcare system. The objective of this scoping review is to map the literature on the characteristics and impact of hospital-based patient navigation programmes that support patients who experience injury-related trauma and their caregivers.Methods and analysisThis review will be conducted in accordance with Joanna Briggs Institute methodology for scoping reviews. The review will include primary research studies, unpublished studies and evaluation reports related to patient navigation programmes for injury-related trauma in hospital settings. The databases to be searched will include CINAHL (EBSCO), EMBASE (Elsevier), ProQuest Nursing & Allied Health, PsycINFO (EBSCO) and MEDLINE (Ovid). Two independent reviewers will screen articles for relevance against the inclusion criteria. Results will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews (PRISMA-ScR) flow diagram and follow the PRISMA-ScR checklist. The extracted data will be presented both tabularly and narratively.Ethics and disseminationEthics approval is not required, as the scoping review will synthesise information from publicly available material. To disseminate the findings of this review, the authors will submit the results for publication in a medical or health sciences journal, present at relevant conferences and use other knowledge translation strategies to reach diverse stakeholders (eg, host webinars, share infographics).
Ability of the National Early Warning Score and its respiratory and haemodynamic subcomponents to predict short-term mortality on general wards: a prospective three-centre observational study in Finland
Authors: Loisa Eetu , Kallonen Antti , Hoppu Sanna , Tirkkonen Joonas 
Published: May 2022

ObjectivesTo validate the ability of the National Early Warning Score (NEWS) to predict short-term mortality on hospital wards, with a special reference to the NEWS’s respiratory and haemodynamic subcomponents.DesignA large, 1-year, prospective, observational three-centre study. First measured vital sign datasets on general wards were prospectively collected using a mobile solution system during routine patient care. Area under receiver operator characteristic curves were constructed, and comparisons between ROC curves were conducted with Delong’s test for two correlated ROC curves.SettingOne university hospital and two regional hospitals in Finland.ParticipantsAll 19 001 adult patients admitted to 45 general wards in the three hospitals over the 1-year study period. After excluding 102/19 001 patients (0.53%) with data on some vital signs missing, the final cohort consisted of 18 889 patients with full datasets.Primary and secondary outcome measuresThe primary outcome measure was 1-day mortality and secondary outcomes were 2-day and 30-day mortality rates.ResultsPatients’ median age was 70 years, 51% were male and 31% had a surgical reason for admission. The 1-day mortality was 0.36% and the 30-day mortality was 3.9%. The NEWS discriminated 1-day non-survivors with excellent accuracy (AUROC 0.91, 95% CI 0.87 to 0.95) and 30-day mortality with acceptable accuracy (0.75, 95% CI 0.73 to 0.77). The NEWS’s respiratory rate component discriminated 1-day non-survivors better (0.78, 95% CI 0.72 to 0.84) as compared with the oxygen saturation (0.66, 95% CI 0.59 to 0.73), systolic blood pressure (0.65, 95% CI 0.59 to 0.72) and heart rate (0.67, 95% CI 0.61 to 0.74) subcomponents (p<0.01 in all ROC comparisons). As with the total NEWS, the discriminative performance of the individual score components decreased substantially for the 30-day mortality.ConclusionsNEWS discriminated general ward patients at risk for acute death with excellent statistical accuracy. The respiratory rate component is especially strongly associated with short-term mortality.Trial registration numberNCT04055350.
Characteristics of participants who take up screening tests for diabetes and lipid disorders: a systematic review
Authors: Ding Hanyue , Huang Junjie , Deng Yunyang , Tin Sze Pui Pamela , Wong Martin Chi-Sang , Yeoh Eng-kiong 
Published: May 2022

ObjectivesTo perform a systematic review on the characteristics of participants who attended screening programmes with blood glucose tests, lipid profiles or a combination of them, respectively.DesignSystematic review following the Meta-analysis Of Observational Studies in Epidemiology checklist.Data sourcesPubMed and Medline databases for English literature from 1 January 2000 to 1 April 2020.Eligibility criteriaOriginal observational studies that reported baseline characteristics of apparently healthy adult participants screening for diabetes and lipid disorders were included in this review.Data extractionWe examined their sociodemographic characteristics, including age, gender, body mass index (BMI) and lifestyle habits. The quality of the included articles was evaluated by the Appraisal of Cross-sectional Studies.ResultsA total of 33 articles involving 38 studies in 22 countries were included and analysed in this systematic review. Overall, there was a higher participation rate among subjects who were female in all screening modalities (female vs male: 46.6%–63.9% vs 36.1%–53.4% for diabetes screening; 48.8%–58.4% vs 41.6%–51.2% for lipid screening; and 36.4%–76.8% vs 23.2%–63.6% for screening offering both). Compared with the BMI standard from the WHO, participants in lipid screening had lower BMI (male: 23.8 kg/m2 vs 24.2 kg/m2, p<0.01; female: 22.3 kg/m2 vs 23.6 kg/m2, p<0.01). Furthermore, it is less likely for individuals of lower socioeconomic status to participate in diabetes or lipid screening in developed areas.ConclusionsWe identified that individuals from lower socioeconomic groups were less likely to take up programmes for diabetes and/or lipid screening in developed areas. These populations are also likely to be at higher risk of non-communicable diseases. Future studies should investigate the barriers and facilitators of screening among non-participants, where targeted interventions to enhance their screening uptake are warranted.