bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can a practice pharmacist improve prescribing safety and reduce costs in polypharmacy patients? A pilot study of an intervention in an Irish general practice setting
Authors: Ó Ciardha Darach , Blake Anne-Marie , Creane Dylan , Callaghan Michael Ó , Darker Catherine 
Published: May 2022

ObjectivesThis study aimed to develop and assess the feasibility and cost impact of an intervention involving a practice pharmacist embedded in general practice to improve prescribing safety, deprescribe where appropriate and reduce costs.SettingFour-doctor suburban general practice.ParticipantsInclusion criteria: patients receiving 10+ repeat drugs per month. Exclusion criteria: deceased, <18 years of age, nursing home resident, no longer attending, late-stage life-limiting condition, unsuitable on clinical/capacity grounds. 137 patients were eligible. 78 were recruited as participants, all of whom completed the study.InterventionPharmacist conducting holistic medication reviews in the study group over a 6-month period.Primary outcome measuresAnonymised medication changes, cost, biochemical monitoring and clinical measurements data were collected. Cost analysis of having a pharmacist as part of the general practice team was calculated.ResultsIn total, 198 potentially inappropriate prescriptions (PIPs), and 163 opportunities for deprescribing were identified; 127 PIPs (64.1%) were actioned; 104 deprescribing opportunities were actioned (63.8%). The pharmacist identified 101 instances in which further investigations were warranted prior to prescription issue, of which 80 were actioned (79.2%). It was calculated that monthly savings of €1252 were made as a result of deprescribing.ConclusionsThis study has shown that the integration of pharmacists within general practice in Ireland is feasible and is an effective means of improving prescribing safety and implementing deprescribing through medication reviews. The combination of safety and cost concerns support taking a holistic approach to deprescribing with the patient. This study highlights the ease with which a pharmacist could integrate into the general practice setting in Ireland and points to how this could be sustainably funded.
Factors influencing the implementation of labour companionship: formative qualitative research in Thailand
Authors: Rungreangkulkij Somporn , Ratinthorn Ameporn , Lumbiganon Pisake , Zahroh Rana Islamiah , Hanson Claudia , Dumont Alexandre , de Loenzien Myriam , Betrán Ana Pilar , Bohren Meghan A. 
Published: May 2022

IntroductionWHO recommends that all women have the option to have a companion of their choice throughout labour and childbirth. Despite clear benefits of labour companionship, including better birth experiences and reduced caesarean section, labour companionship is not universally implemented. In Thailand, there are no policies for public hospitals to support companionship. This study aims to understand factors affecting implementation of labour companionship in Thailand.MethodsThis is formative qualitative research to inform the ‘Appropriate use of caesarean section through QUALIty DECision-making by women and providers’ (QUALI-DEC) study, to design, adapt and implement a strategy to optimise use of caesarean section. We use in-depth interviews and readiness assessments to explore perceptions of healthcare providers, women and potential companions about labour companionship in eight Thai public hospitals. Qualitative data were analysed using thematic analysis, and narrative summaries of the readiness assessment were generated. Factors potentially affecting implementation were mapped to the Capability, Opportunity, and Motivation behaviour change model (COM-B).Results127 qualitative interviews and eight readiness assessments are included in this analysis. The qualitative findings were grouped in four themes: benefits of labour companions, roles of labour companions, training for labour companions and factors affecting implementation. The findings showed that healthcare providers, women and their relatives all had positive attitudes towards having labour companions. The readiness assessment highlighted implementation challenges related to training the companion, physical space constraints, overcrowding and facility policies, reiterated by the qualitative reports.DiscussionIf labour companions are well-trained on how to best support women, help them to manage pain and engage with healthcare teams, it may be a feasible intervention to implement in Thailand. However, key barriers to introducing labour companionship must be addressed to maximise the likelihood of success mainly related to training and space. These findings will be integrated into the QUALI-DEC implementation strategies.
Assessing the impact of selective licencing schemes for private rental housing on mental health and well-being: protocol for a mixed-method natural experiment study in Greater London, UK
Authors: Petersen Jakob , Seguin Maureen , Alexiou Alexandros , Cornelsen Laura , Courtin Emilie , Cummins Steven , Marks Dalya , Egan Matt 
Published: May 2022

IntroductionThe UK private rental housing market has poorer quality housing compared with other sectors and is subjected to calls for better regulation. Poor quality housing poses risks to mental and physical health, and housing improvement can potentially benefit health and well-being. Local authorities have powers to implement selective licencing (SL) schemes in specific localities. Such schemes involve landlord registration, payment of licence fees, local authority inspection and requirements that landlords conduct any necessary renovation works to ensure housing standards are met. We aim to evaluate SL in Greater London and to test the feasibility of a national evaluation.Methods and analysisWe will measure individual-level and area-level impacts of SL in Greater London between 2011 and 2019. A difference-in-differences approach with propensity score-matched controls will be used. We propose to exploit data from the Annual Population Survey (APS) and health and social benefit registers to measure mental health and well-being at individual (self-reported anxiety) and area (Small Area Mental Health Index) level. We estimate 633 APS participants in our intervention groups compared with 1899 participants in control areas (1:3 ratio of intervention to control). Secondary outcomes will be self-reported well-being and residential stability at the individual level and incidence of police-recorded antisocial behaviour calls and population turnover at the area level. The study size of the area-level analyses will be 3684 lower layer super output areas (including controls). Qualitative semistructured interviews with lead implementers in several London boroughs will produce insights into variations and commonalities between schemes.Ethics and disseminationEthical approval was obtained from London School of Hygiene and Tropical Medicine’s Ethics Committee (reference number 26481) and London Borough of Hackney. All interviewees will be asked for informed written consent. Study findings will be published in a peer-reviewed journal.
Addressing social determinants of health in primary care: a quasi-experimental study using unannounced standardised patients to evaluate the impact of audit/feedback on physicians' rates of identifying and responding to social needs
Authors: Gillespie Colleen , Wilhite Jeffrey A , Hanley Kathleen , Hardowar Khemraj , Altshuler Lisa , Fisher Harriet , Porter Barbara , Wallach Andrew , Zabar Sondra 
Published: May 2022

BackgroundAlthough efforts are underway to address social determinants of health (SDOH), little is known about physicians’ SDOH practices despite evidence that failing to fully elicit and respond to social needs can compromise patient safety and undermine both the quality and effectiveness of treatment. In particular, interventions designed to enhance response to social needs have not been assessed using actual practice behaviour. In this study, we evaluate the degree to which providing primary care physicians with feedback on their SDOH practice behaviours is associated with increased rates of eliciting and responding to housing and social isolation needs.MethodsUnannounced standardised patients (USPs), actors trained to consistently portray clinical scenarios, were sent, incognito, to all five primary care teams in an urban, safety-net healthcare system. Scenarios involved common primary care conditions and each included an underlying housing (eg, mould in the apartment, crowding) and social isolation issue and USPs assessed whether the physician fully elicited these needs and if so, whether or not they addressed them. The intervention consisted of providing physicians with audit/feedback reports of their SDOH practices, along with brief written educational material. A prepost comparison group design was used to evaluate the intervention; four teams received the intervention and one team served as a ‘proxy’ comparison (no intervention). Preintervention (February 2017 to December 2017) rates of screening for and response to the scripted housing and social needs were compared with intervention period (January 2018 to March 2019) rates for both intervention and comparison teams.Results108 visits were completed preintervention and 183 during the intervention period. Overall, social needs were not elicited half of the time and fully addressed even less frequently. Rates of identifying the housing issue increased for teams that received audit/feedback reports (46%–60%; p=0.045) and declined for the proxy comparison (61%–42%; p=0.174). Rates of responding to housing needs increased significantly for intervention teams (15%–41%; p=0.004) but not for the comparison team (21%–29%; p=0.663). Social isolation was identified more frequently postintervention (53%) compared with baseline (39%; p=0.041) among the intervention teams but remained unchanged for the comparison team (39% vs 32%; p=0.601). Full exploration of social isolation remained low for both intervention and comparison teams.ConclusionsResults suggest that physicians may not be consistently screening for or responding to social needs but that receiving feedback on those practices, along with brief targeted education, can improve rates of SDOH screening and response.
A composite clinical motor score as a comprehensive and sensitive outcome measure for Parkinson’s disease
Authors: Lo Christine , Arora Siddharth , Lawton Michael , Barber Thomas , Quinnell Timothy , Dennis Gary J , Ben-Shlomo Yoav , Hu Michele Tao-Ming 
Published: May 2022

BackgroundAn unmet need remains for sensitive outcome measures in neuroprotective trials. The study aims to determine whether a composite clinical motor score, combining the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III motor examination score, Purdue Pegboard Test, and Timed Up and Go, provides greater sensitivity in detecting motor change in early disease than the MDS-UPDRS III alone.MethodsThe Oxford Discovery longitudinal cohort study involves individuals with isolated rapid eye movement sleep behaviour disorder (iRBD) (n=272, confirmed polysomnographically, median follow-up: 1.6 years), idiopathic Parkinson’s disease (PD) (n=909, median follow-up: 3.5 years, baseline: <3.5 years disease duration) and controls (n=316, age-matched and sex-matched, without a first-degree family history of PD). Motor and non-motor assessments were performed at each in-person visit.ResultsCompared with the MDS-UPDRS III, the composite clinical motor score demonstrated a wider score distribution in iRBD and controls, lower coefficient of variation (37% vs 67%), and higher correlation coefficients with self-reported measures of motor severity (0.65 vs 0.61) and overall health status (−0.40 vs −0.33). Greater score range in mild to moderate PD, higher magnitude of longitudinal change in iRBD and longitudinal score linearity suggest better sensitivity in detecting subtle motor change. The composite clinical motor score was more accurate than the MDS-UPDRS III in predicting clinical outcomes, requiring 64% fewer participants with PD and 51% fewer participants with iRBD in sample size estimations for a hypothetical 18-month placebo-controlled clinical trial.ConclusionThe composite clinical motor score may offer greater consistency and sensitivity in detecting change than the MDS-UPDRS III.
Dissecting the autoantibody repertoire in CASPR2-antibody encephalitis
Authors: Sun Bo , Akdeniz Deniz , Kienzler Anne-Katrin , Tan Jeanne , Ramberger Melanie , Dawes John , Trendafilova Teodora , Bennett David , Waters Patrick , Irani Sarosh 
Published: May 2022

Autoantibodies to contactin-associated protein 2 (CASPR2) are found in patients with an immunothe- rapy-responsive encephalitis, and show a strong HLA-DRB1*11:01 restriction. However, no studies have focussed on how the autoreactive B cells are produced and perpetuate longitudinal autoantibody production. This question has therapeutic implications.To isolate B-cells reactive to CASPR2, we cultured naïve and memory B-cells from two CASPR2-antibody encephalitis patients and two healthy donors with screening for CASPR2-reactivity on live-cell based assays. CASPR2-reactive immunoglobulins were cloned and recombinantly expressed as monoclonal antibodies (mAbs). Naïve B-cell CASPR2-reactivity was detected in both patients and healthy donors, both at a frequency of ~ 1/250 B cells. However, memory B-cell CASPR2-reactivity was exclusive to patients at a frequency of ~1/250. CASPR2-specific mAbs showed discrete domain-specificities between the antigen-specific naïve and memory B-cell derived clones. Furthermore, only memory B-cell-derived CASPR2-specific mAbs were able to bind live rat hippocampal neurons and induce internalisation of surface CASPR2.In summary, we show that early B-cell tolerance against the neuronal antigen CASPR2 is not counter-se- lected in health; however, only patients have CASPR2-specific memory B-cells, suggesting that late B-cell tolerance dysfunction may have a key role in disease pathogenesis.bo.sun@ndcn.ox.ac.uk
067  Mycoplasma auto-immune mediated encephalitis
Authors: Diyab Mohamed , Bose Sumanjeet , Zukos Ioannis , Dasari Ravi , Awad Ezzat , Saltogiannis Dmitry Ostrovsky G 
Published: May 2022

49 Year old male police officer, presented with acute onset fever, headache, arthralgia, ataxia, dysar- thria, opthalmoplegia, and diplopia, on a background of a 3 day skin erythematous skin rash, which was previously treated as SWEET syndrome. Physical examination further showed cerebellar syndrome, with no pyramidal signs. Blood tests showed raised inflammatory markers. Patient was initially treated for meningoencephalitis, with no change in symptoms after antibiotics and antivirals were administered. MRI revealed hyper intensity at the right pons and cerebellar peduncles, raising concerns of subacute infarct or demyelination. Lumbar puncture showed high protein of 1.15 mg/dL, and no other findings. However, when PCR was performed on the cerebrospinal fluid, mycoplasma pneumoniae was successfully isolated. IV prednisolone 1g was initially trialled, with no obvious therapeutic response after 5 days. As antibiotics and steroids had proved ineffective, decision was made to trial IV-IG. Two courses of IV-IG were trialled on suspicion of mycoplasma auto-immune mediated encephalitis, and symptoms subsequently resolved after 5 days. MRI was repeated after neurorehabilitation, and the hyper intensity found on the previous MRI had resolved completely. (Full Case Report Available on Request)d.mosh666@yahoo.com
069  Co-existent autoimmune disease in AQP4-IgG, MOG-IgG and seronegative NMOSD
Authors: Linaker Samantha , Kelly Patricia , Gibbons Emily , Campagna Giovanna , Whittam Daniel , Karthikeayan Venkatra- man , Mutch Kerry , Jacob Anu , Huda Saif 
Published: May 2022

BackgroundNeuromyelitis Optica Spectrum Disorder (NMOSD) is an autoimmune inflammatory disorder of the central nervous system (CNS), and in most cases is associated with Aquaporin-4 antibodies (AQP4- IgG). Severe optic neuritis, longitudinally extensive myelitis and brain involvement is characteristic. Similarly presenting patients may not have detectable AQP4-IgG (seronegative NMOSD) or have Myelin Oligo- dendrocyte Glycoprotein IgG (MOG-IgG).MethodA retrospective study of AQP4-IgG, MOG-IgG, and seronegative NMOSD patients attending the highly specialised NMOSD service between September 2010-August 2019 was performed. In particular, the presence of coexistent autoimmunity was assessed.ResultsCoexistent autoimmunity in AQP4-IgG patients was higher as compared to MOG-IgG and seron- egative NMOSD (30% vs. 8% vs. 8%). Some AQP4-IgG patients had 2nd and 3rd autoimmune diseases (7% and 1% respectively). In contrast no patients with MOG-IgG or seronegative NMOSD had 2 or more other autoimmune diseases.ConclusionCoexistent autoimmunity in AQP4-IgG NMOSD is more common that in seronegative NMOSD and patients with MOG-IgG. It is reasonable to periodically assess for coexistent autoimmunity in AQP4-IgG NMOSD as it is present in almost a third of patients. Finally the detection of ≥2 autoimmune diseases in newly presenting cases provides a useful clue to AQP4-IgG NMOSD whilst antibody results are awaited.giovanna.campagna@thewaltoncentre.nhs.uk
071  Causes of death in AQP4-IgG neuromyelitis optica spectrum disorder
Authors: Gibbons Emily , Everett Rosie , Whittam Daniel , Karthikeayan Venkatraman , Messina Silvia , Radu Simona , Leite Maria Isabel , Palace Jacqueline , Huda Saif , Jacob Anu 
Published: May 2022

ObjectiveTo evaluate causes of death in Aquaporin-4 antibody positive Neuromyelitis Optica Spectrum Disorder (AQP4-IgG NMOSD) patients treated in the National NMOSD service.MethodRetrospective review of Liverpool and Oxford patient databases (NMOSD national referral centres) between January 2010–2020.ResultsAQP4-IgG NMOSD=414 patients attended the NMOSD Service and 34 died. Of these, 32/34(94%) were female with a median disease duration of 10 years (0.5–19.1). The median age at death was 67.1(45.1–88.3) years. Median EDSS score prior to death was 8(2–9.5). The median number of relapses from disease onset to death was 3(0–10), with 94% of patients experiencing at least 1 relapse. All but one patient was immunosuppressed (Azathioprine=15, Mycophenolate=3, Rituximab=7, Methotrexate=4, IVIg=1, Ciclosporin=1, Eculizumab=1, Prednisolone=1). Causes of death were available in 31/34 patients; infections=18, coronary artery disease=5, malignancy=4, bowel obstruction=1 and respiratory failure=2. Only one patient died from an acute brain stem relapse.ConclusionApproximately 1 in 10 AQP4-NMOSD patients died over a 10-year period. The majority of patients had significant disability, suggesting possible association with NMOSD mortality. Infection was the leading cause of death, suggesting a possible relationship with immunosuppression. Striking a balance between disease suppression and mitigation of side effects poses a significant challenge in autoimmune neurological conditions.emily.gibbons@doctors.org.uk
073  Posterior reversible encephalopathy syndrome (PRES) complicating anti-NMDA receptor encephalitis (NMDARE) with ovarian teratoma
Authors: Vinayan Changaradil D , Abdulla N , Kyaw K , Kumar G , Sreedharan H , Moran N , Flores Caimanque L 
Published: May 2022

IntroductionAnti-N-methyl-D-aspartate receptor antibody-associated encephalitis (NMDARE) is a form of autoimmune encephalitis typically affecting young women, often associated with an ovarian teratoma. Clinical features include psychiatric disturbances, seizures, dyskinesia, dysautonomia, and cardiac dys- rhythmias. Here we present a case of NMDARE complicated by posterior reversible encephalopathy syndrome (PRES). This complication has not been reported previously.CaseA 17-year-old girl presented with acute psychosis. The neurological examination was unremark- able. MRI brain revealed left hippocampal T2 signal hyperintensity; there was a CSF lymphocytosis. NMDA-receptor antibodies in serum and CSF were detected and intravenous methylprednisolone was commenced. Progressive agitation lead to ITU admission. Plasma exchange and intravenous immuno- globulins were administered. MRI pelvis revealed a left ovarian cyst which was removed (laparoscopic salpingo-oophrectomy). Gross inspection and histopathology confirmed an ovarian teratoma. Persistently elevated blood pressure was noted for a week on ITU, associated with clinical deterioration. Rituximab was administered. A repeat MRI brain the next day revealed hyperintensities in temporo-parietal and occipital regions consistent with PRES. The second dose of rituximab was withheld. Clinical and radiologi- cal improvement was noted after a week, and the patient was discharged home.DiscussionEncephalitis mediated dysautonomia may lead to disruption of cerebral autoregulation cul- minating in PRES. The administration of rituximab may also have contributed. This case exemplifies the uncommon complications associated with NMDARE.dr.dvinayan@gmail.com
077  Long-term safety and efficacy of mexiletine for patients with myotonic dystrophy type 1 and 2
Authors: Mousele Christina , McDonald Susan , Pitcheathly Robert , Hanna Michael , Turner Christopher , Matthews Emma , Carr Aisling 
Published: May 2022

IntroductionMyotonic dystrophies type 1 and 2 (DM1 and DM2) are progressive, inherited multisys- tem disorders characterized by muscle weakness, myotonia and life-threatening cardiac dysrythmias. Treatment of myotonia is important for quality of life, mobility, and functional independence. Mexiletine is a sodium channel blocker, which has so far been shown to be effective in myotonia management in non-dystrophic myotonias. However, cardiac side effects are reported. Its long-term safety and efficacy in DM1 has not been established.Methods25 patients with DM1 or DM2 have been treated with mexiletine in the NHNN cohort. Efficacy and tolerance was determined by patient report. PR interval, QRS duration and corrected QT interval (QTc) were noted.ResultsMean duration of treatment was 32.9 months. 21/25 patients reported efficacy, 3/25 partial efficacy, and 4/25 discontinued treatment due to gastrointestinal side effects.Mexiletine did not precipitate symptomatic arrhythmia in any patient. Paired assessment of ECG param- eters at baseline and at the highest treatment dose revealed no significant change in PR interval, QRS complex duration, or QTc.ConclusionsThis small retrospective analysis suggests long-term efficacy and cardiac safety of mexiletine for treatment of myotonia in patients with myotonic dystrophies.christinamousele92@gmail.com
079  Unmasking of motor neuron disease by botulinum toxin therapy
Authors: Paluri Srinivasa , Hassan Muha , Lambert Tom 
Published: May 2022

A 75 year-old male with a history of a right hemiparesis due to past h/o stroke sustained a T3 vertebral body compression fracture after a fall and was treated conservatively. Six months later, in a rehabilita- tion clinic he reported that following discharge there had been a gradual deterioration in his mobility and strength, particularly on the right side. His right upper limb had become more stiff and painful with decreased range of movements. Two months later he received Dysport injections to the right elbow flexors, right brachioradialis, soleus and right flexor carpi radialis. Four days later, he developed worsening right sided weakness, slurred quiet speech, head drop and difficulty swallowing and this persisted. On review in neurology clinic there was a head drop with neck extensor weakness, spasticity and severe weakness in his right upper and lower limbs. There were also upper and lower motor neuron signs in his left upper and lower limbs. Neurophysiology studies eventually revealed fasciculation potentials and active den- ervation changes in the left upper and lower limb raising ‘the strong suspicion of generalized anterior horn cell disease’. He continued to progress and eventually passed away with pneumonia a year after the original fall. We believe this is a case of incipient motor neuron disease unmasked by botulinum toxin treatment. This is not a recognized phenomenon though it has previously been reported.s.paluri@nhs.net