1,987 results match your criteria BMC Medicine[Journal]

Being pragmatic about healthcare complexity: our experiences applying complexity theory and pragmatism to health services research.

BMC Med 2018 Jun 20;16(1):94. Epub 2018 Jun 20.

Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.

Background: The healthcare system has proved a challenging environment for innovation, especially in the area of health services management and research. This is often attributed to the complexity of the healthcare sector, characterized by intersecting biological, social and political systems spread across geographically disparate areas. To help make sense of this complexity, researchers are turning towards new methods and frameworks, including simulation modeling and complexity theory. Read More

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Simple rules for evidence translation in complex systems: A qualitative study.

BMC Med 2018 Jun 20;16(1):92. Epub 2018 Jun 20.

National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Chelsea, London, UK.

Background: Ensuring patients benefit from the latest medical and technical advances remains a major challenge, with rational-linear and reductionist approaches to translating evidence into practice proving inefficient and ineffective. Complexity thinking, which emphasises interconnectedness and unpredictability, offers insights to inform evidence translation theories and strategies. Drawing on detailed insights into complex micro-systems, this research aimed to advance empirical and theoretical understanding of the reality of making and sustaining improvements in complex healthcare systems. Read More

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Studying complexity in health services research: desperately seeking an overdue paradigm shift.

BMC Med 2018 Jun 20;16(1):95. Epub 2018 Jun 20.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

Complexity is much talked about but sub-optimally studied in health services research. Although the significance of the complex system as an analytic lens is increasingly recognised, many researchers are still using methods that assume a closed system in which predictive studies in general, and controlled experiments in particular, are possible and preferred. We argue that in open systems characterised by dynamically changing inter-relationships and tensions, conventional research designs predicated on linearity and predictability must be augmented by the study of how we can best deal with uncertainty, unpredictability and emergent causality. Read More

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Outcomes of neonates born following transfers of frozen-thawed cleavage-stage embryos with blastomere loss: a prospective, multicenter, cohort study.

BMC Med 2018 Jun 19;16(1):96. Epub 2018 Jun 19.

International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910 Hengshan Rd, Shanghai, 200030, China.

Background: Despite limited information on neonatal safety, the transfer of frozen-thawed cleavage-stage embryos with blastomere loss is common in women undergoing in vitro fertilization. We aimed to evaluate the pregnancy outcomes and safety of frozen-thawed cleavage-stage embryos with blastomere loss.

Methods: This prospective, multicenter, cohort study included all frozen-thawed cleavage-stage embryo transfer (FET) cycles between 2002 and 2012. Read More

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Chronic hepatitis B virus infection and risk of chronic kidney disease: a population-based prospective cohort study of 0.5 million Chinese adults.

BMC Med 2018 Jun 18;16(1):93. Epub 2018 Jun 18.

Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.

Background: Existing evidence remains inconclusive as to the association between chronic hepatitis B virus (HBV) infection and the risk of chronic kidney disease (CKD). We prospectively examined the association between chronic HBV infection and CKD risk, and the joint associations of HBV infection with established risk factors of several lifestyle factors and prevalent diseases on CKD risk.

Methods: Participants from the China Kadoorie Biobank were enrolled during 2004-2008 and followed up until 31 December 2015. Read More

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June 2018
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Innovative health financing for refugees.

BMC Med 2018 Jun 15;16(1):90. Epub 2018 Jun 15.

Johns Hopkins Bloomberg School of Public Health and Center for Humanitarian Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.

Background: More than 65 million persons are currently forcibly displaced, of whom more than 22 million are refugees. Conflicts are increasing, and existing ones are becoming more protracted; a refugee remains a refugee for more than 10 years. Funding for refugee assistance comes primarily from high-income countries after an emergency has occurred. Read More

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Abortion-related emergency department visits in the United States: An analysis of a national emergency department sample.

BMC Med 2018 Jun 14;16(1):88. Epub 2018 Jun 14.

Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.

Background: Media depictions and laws passed in state legislatures regulating abortion suggest abortion-related medical emergencies are common. An accurate understanding of abortion-related emergencies is important for informing policy and practice. We assessed the incidence of abortion-related emergency department (ED) visits in the United States (U. Read More

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June 2018
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Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study.

BMC Med 2018 Jun 13;16(1):91. Epub 2018 Jun 13.

Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.

Background: Polypharmacy is an increasing challenge for primary care. Although sometimes clinically justified, polypharmacy can be inappropriate, leading to undesirable outcomes. Optimising care for polypharmacy necessitates effective targeting and monitoring of interventions. Read More

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Using flawed, uncertain, proximate and sparse (FUPS) data in the context of complexity: learning from the case of child mental health.

BMC Med 2018 Jun 13;16(1):82. Epub 2018 Jun 13.

Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.

The use of routinely collected data that are flawed and limited to inform service development in healthcare systems needs to be considered, both theoretically and practically, given the reality in many areas of healthcare that only poor-quality data are available for use in complex adaptive systems. Data may be compromised in a range of ways. They may be flawed, due to missing or erroneously recorded entries; uncertain, due to differences in how data items are rated or conceptualised; proximate, in that data items are a proxy for key issues of concern; and sparse, in that a low volume of cases within key subgroups may limit the possibility of statistical inference. Read More

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Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews.

BMC Med 2018 Jun 12;16(1):89. Epub 2018 Jun 12.

Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.

Background: Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. Read More

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Avoidable waste of research related to outcome planning and reporting in clinical trials.

BMC Med 2018 Jun 11;16(1):87. Epub 2018 Jun 11.

INSERM, U1153, Hôpital Hôtel-Dieus, 1, place du parvis Notre Dame, 75004, Paris, France.

Background: Inadequate planning, selective reporting, and incomplete reporting of outcomes in randomized controlled trials (RCTs) contribute to the problem of waste of research. We aimed to describe such a waste and to examine to what extent this waste could be avoided.

Methods: This research-on-research study was based on RCTs included in Cochrane reviews with a summary of findings (SoF) table. Read More

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Trends in, and factors associated with, HIV infection amongst tuberculosis patients in the era of anti-retroviral therapy: a retrospective study in England, Wales and Northern Ireland.

BMC Med 2018 Jun 7;16(1):85. Epub 2018 Jun 7.

National Infections Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.

Background: HIV increases the progression of latent tuberculosis (TB) infection to active disease and contributed to increased TB in the UK until 2004. We describe temporal trends in HIV infection amongst patients with TB and identify factors associated with HIV infection.

Methods: We used national surveillance data of all TB cases reported in England, Wales and Northern Ireland from 2000 to 2014 and determined HIV status through record linkage to national HIV surveillance. Read More

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Four-year effects of exercise on fatigue and physical activity in patients with cancer.

BMC Med 2018 Jun 8;16(1):86. Epub 2018 Jun 8.

Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands.

Background: In the earlier randomized controlled Physical Activity during Cancer Treatment (PACT) study, we found beneficial effects of an 18-week supervised exercise program on fatigue in patients with newly diagnosed breast or colon cancer undergoing adjuvant treatment. The present study assessed long-term effects of the exercise program on levels of fatigue and physical activity 4 years after participation in the PACT study.

Methods: The original study was a two-armed, multicenter randomized controlled trial comparing an 18-week supervised exercise program to usual care among 204 breast cancer patients and 33 colon cancer patients undergoing adjuvant treatment. Read More

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June 2018
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Transient portal vein thrombosis in liver cirrhosis.

BMC Med 2018 Jun 5;16(1):83. Epub 2018 Jun 5.

Service d'hépatologie, Hôpital Beaujon, APHP, Clichy-la-Garenne, Paris, France.

In real-world clinical practice, the acceptance of anticoagulation therapy in the management of portal vein thrombosis (PVT) in patients with cirrhosis is limited by the fear of an increased bleeding risk. Additionally, accumulating evidence indicates that spontaneous recanalization of PVT may occur in the absence of antithrombotic treatment. Therefore, risk stratification based on outcomes in such patients is crucial for determining a therapeutic strategy. Read More

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June 2018
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Zika vaccines and therapeutics: landscape analysis and challenges ahead.

BMC Med 2018 Jun 6;16(1):84. Epub 2018 Jun 6.

Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam.

Background: Various Zika virus (ZIKV) vaccine candidates are currently in development. Nevertheless, unique challenges in clinical development and regulatory pathways may hinder the licensure of high-quality, safe, and effective ZIKV vaccines.

Discussion: Implementing phase 3 efficacy trials will be difficult given the challenges of the spatio-temporal heterogeneity of ZIKV transmission, the unpredictability of ZIKV epidemics, the broad spectrum of clinical manifestations making a single definite endpoint difficult, a lack of sensitive and specific diagnostic assays, and the need for inclusion of vulnerable target populations. Read More

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June 2018
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Measuring and mapping the global burden of antimicrobial resistance.

BMC Med 2018 Jun 4;16(1):78. Epub 2018 Jun 4.

Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Seattle, WA, 98121, USA.

The increasing number and global distribution of pathogens resistant to antimicrobial drugs is potentially one of the greatest threats to global health, leading to health crises arising from infections that were once easy to treat. Infections resistant to antimicrobial treatment frequently result in longer hospital stays, higher medical costs, and increased mortality. Despite the long-standing recognition of antimicrobial resistance (AMR) across many settings, there is surprisingly poor information about its geographical distribution over time and trends in its population prevalence and incidence. Read More

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June 2018
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Efficacy and safety of ascending doses of praziquantel against Schistosoma haematobium infection in preschool-aged and school-aged children: a single-blind randomised controlled trial.

BMC Med 2018 Jun 1;16(1):81. Epub 2018 Jun 1.

Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.

Background: Despite decades of experience with praziquantel treatment in school-aged children (SAC) and adults, we still face considerable knowledge gaps relevant to the successful treatment of preschool-aged children (PSAC). This study aimed to assess the efficacy and safety of escalating praziquantel dosages in PSAC infected with Schistosoma haematobium.

Methods: We conducted a randomised, dose-finding trial in PSAC (2-5 years) and as comparator a cohort of SAC (6-15 years) infected with S. Read More

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June 2018
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Is telephone health coaching a useful population health strategy for supporting older people with multimorbidity? An evaluation of reach, effectiveness and cost-effectiveness using a 'trial within a cohort'.

BMC Med 2018 May 30;16(1):80. Epub 2018 May 30.

NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.

Background: Innovative ways of delivering care are needed to improve outcomes for older people with multimorbidity. Health coaching involves 'a regular series of phone calls between patient and health professional to provide support and encouragement to promote healthy behaviours'. This intervention is promising, but evidence is insufficient to support a wider role in multimorbidity care. Read More

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Switching to dual/monotherapy determines an increase in CD8+ in HIV-infected individuals: an observational cohort study.

BMC Med 2018 May 29;16(1):79. Epub 2018 May 29.

Clinic of Infectious Diseases, Department of Health Sciences San Paolo Hospital, DIBIC Luigi Sacco, University of Milan, Milan, Italy.

Background: The CD4/CD8 ratio has been associated with the risk of AIDS and non-AIDS events. We describe trends in immunological parameters in people who underwent a switch to monotherapy or dual therapy, compared to a control group remaining on triple antiretroviral therapy (ART).

Methods: We included patients in Icona who started a three-drug combination ART regimen from an ART-naïve status and achieved a viral load ≤ 50 copies/mL; they were subsequently switched to another triple or to a mono or double regimen. Read More

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Patterns of adiposity, vascular phenotypes and cognitive function in the 1946 British Birth Cohort.

BMC Med 2018 May 28;16(1):75. Epub 2018 May 28.

National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, 1 St Martin le Grande, London, EC1A 4NP, UK.

Background: The relationship between long-term exposure to whole body or central obesity and cognitive function, as well as its potential determinants, remain controversial. In this study, we assessed (1) the potential impact of 30 years exposure to different patterns of whole body and central adiposity on cognitive function at 60-64 years, (2) whether trajectories of central adiposity can provide additional information on later cognitive function compared to trajectories of whole body adiposity, and (3) the influence of vascular phenotypes on these associations.

Methods: The study included 1249 participants from the prospective cohort MRC National Survey of Health and Development. Read More

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May 2018
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A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants.

BMC Med 2018 May 25;16(1):74. Epub 2018 May 25.

Department of Exercise Health Science, National Taiwan University of Sport, No. 16, Section 1, Shuang-Shih Rd., Taichung, 404, Taiwan.

Background: The appropriate limit to the amount of daily sedentary time (ST) required to minimize mortality is uncertain. This meta-analysis aimed to quantify the dose-response association between daily ST and all-cause mortality and to explore the cut-off point above which health is impaired in adults aged 18-64 years old. We also examined whether there are differences between studies using self-report ST and those with device-based ST. Read More

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High burden of birthweight-lowering genetic variants in Africans and Asians.

BMC Med 2018 May 24;16(1):70. Epub 2018 May 24.

School of Medicine, University of Adelaide, Adelaide, SA, Australia.

Background: Birthweight is an important predictor of infant morbidity and mortality, and is associated with cardiovascular diseases, obesity, and diabetes in childhood and adulthood. Birthweight and fetal growth show regional and population variations even under similar maternal conditions, and a large proportion of these differences are not explained by environmental factors. Whether and to what extent population genetic variations at key birthweight-associated loci account for the residual birthweight disparities not explained by environmental determinants is unknown. Read More

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Associations of discretionary screen time with mortality, cardiovascular disease and cancer are attenuated by strength, fitness and physical activity: findings from the UK Biobank study.

BMC Med 2018 May 24;16(1):77. Epub 2018 May 24.

BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK.

Background: Discretionary screen time (time spent viewing a television or computer screen during leisure time) is an important contributor to total sedentary behaviour, which is associated with increased risk of mortality and cardiovascular disease (CVD). The aim of this study was to determine whether the associations of screen time with cardiovascular disease and all-cause mortality were modified by levels of cardiorespiratory fitness, grip strength or physical activity.

Methods: In total, 390,089 participants (54% women) from the UK Biobank were included in this study. Read More

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Spatio-temporal mapping of Madagascar's Malaria Indicator Survey results to assess Plasmodium falciparum endemicity trends between 2011 and 2016.

BMC Med 2018 May 23;16(1):71. Epub 2018 May 23.

Malaria Atlas Project, Oxford Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Background: Reliable measures of disease burden over time are necessary to evaluate the impact of interventions and assess sub-national trends in the distribution of infection. Three Malaria Indicator Surveys (MISs) have been conducted in Madagascar since 2011. They provide a valuable resource to assess changes in burden that is complementary to the country's routine case reporting system. Read More

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Effective coverage of essential inpatient care for small and sick newborns in a high mortality urban setting: a cross-sectional study in Nairobi City County, Kenya.

BMC Med 2018 May 22;16(1):72. Epub 2018 May 22.

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Background: Effective coverage requires that those in need can access skilled care supported by adequate resources. There are, however, few studies of effective coverage of facility-based neonatal care in low-income settings, despite the recognition that improving newborn survival is a global priority.

Methods: We used a detailed retrospective review of medical records for neonatal admissions to public, private not-for-profit (mission) and private-for-profit (private) sector facilities providing 24×7 inpatient neonatal care in Nairobi City County to estimate the proportion of small and sick newborns receiving nationally recommended care across six process domains. Read More

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Informing real-world practice with real-world evidence: the value of PRECIS-2.

BMC Med 2018 May 21;16(1):76. Epub 2018 May 21.

, Seattle, WA, USA.

Real-world evidence is needed to inform real-world practice. Pragmatic controlled trials are intended to provide such evidence by assessing the effectiveness of medicines and other interventions in real-world settings, as opposed to explanatory trials that assess efficacy in highly controlled settings. Dal-Ré and colleagues (BMC Med 16:49, 2018) recently performed a literature review of studies published between 2014 and 2017 to assess the degree to which studies that self-identified as pragmatic were truly so. Read More

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May 2018
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Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis.

BMC Med 2018 May 21;16(1):73. Epub 2018 May 21.

Medical and Biological Sciences, School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK.

Background: Chest radiographs are used for diagnosis and severity assessment in tuberculosis (TB). The extent of disease as determined by smear grade and cavitation as a binary measure can predict 2-month smear results, but little has been done to determine whether radiological severity reflects the bacterial burden at diagnosis.

Methods: Pre-treatment chest x-rays from 1837 participants with smear-positive pulmonary TB enrolled into the REMoxTB trial (Gillespie et al. Read More

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Serum magnesium levels and risk of coronary artery disease: Mendelian randomisation study.

BMC Med 2018 May 17;16(1):68. Epub 2018 May 17.

Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Background: Observational studies have shown that serum magnesium levels are inversely associated with risk of cardiovascular disease, but whether this association is causal is unknown. We conducted a Mendelian randomisation study to investigate whether serum magnesium levels may be causally associated with coronary artery disease (CAD).

Methods: This Mendelian randomisation analysis is based on summary-level data from the CARDIoGRAMplusC4D consortium's 1000 Genomes-based genome-wide association meta-analysis of 48 studies with a total of 60,801 CAD cases and 123,504 non-cases. Read More

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Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study.

BMC Med 2018 May 16;16(1):69. Epub 2018 May 16.

Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.

Background: Previous studies on high-risk opioid use have only focused on patients diagnosed with an opioid disorder. This study evaluates the impact of various high-risk prescription opioid use groups on healthcare costs and utilization.

Methods: This is a retrospective cohort study using QuintilesIMS health plan claims with independent variables from 2012 and outcomes from 2013. Read More

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May 2018
2 Reads
7.25 Impact Factor

Guillain-Barré syndrome risk among individuals infected with Zika virus: a multi-country assessment.

BMC Med 2018 May 15;16(1):67. Epub 2018 May 15.

Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.

Background: Countries with ongoing outbreaks of Zika virus have observed a notable rise in reported cases of Guillain-Barré syndrome (GBS), with mounting evidence of a causal link between Zika virus infection and the neurological syndrome. However, the risk of GBS following a Zika virus infection is not well characterized. In this work, we used data from 11 locations with publicly available data to estimate the risk of GBS following an infection with Zika virus, as well as the location-specific incidence of infection and the number of suspect GBS cases reported per infection. Read More

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May 2018
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Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework.

BMC Med 2018 May 14;16(1):66. Epub 2018 May 14.

Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.

Background: Failures and partial successes are common in technology-supported innovation programmes in health and social care. Complexity theory can help explain why. Phenomena may be simple (straightforward, predictable, few components), complicated (multiple interacting components or issues) or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Read More

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The Syrian conflict: a case study of the challenges and acute need for medical humanitarian operations for women and children internally displaced persons.

BMC Med 2018 May 11;16(1):65. Epub 2018 May 11.

Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA.

Background: After 7 years of increasing conflict and violence, the Syrian civil war now constitutes the largest displacement crisis in the world, with more than 6 million people who have been internally displaced. Among this already-vulnerable population group, women and children face significant challenges associated with lack of adequate access to maternal and child health (MCH) services, threatening their lives along with their immediate and long-term health outcomes.

Discussion: While several health and humanitarian aid organizations are working to improve the health and welfare of internally displaced Syrian women and children, there is an immediate need for local medical humanitarian interventions. Read More

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The Daily Mile makes primary school children more active, less sedentary and improves their fitness and body composition: a quasi-experimental pilot study.

BMC Med 2018 May 10;16(1):64. Epub 2018 May 10.

Faculty of Health Sciences and Sport, University of Stirling, Scotland, FK9 4LA, UK.

Background: The Daily Mile is a physical activity programme made popular by a school in Stirling, Scotland. It is promoted by the Scottish Government and is growing in popularity nationally and internationally. The aim is that each day, during class time, pupils run or walk outside for 15 min (~1 mile) at a self-selected pace. Read More

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Clinical trial registration and reporting: a survey of academic organizations in the United States.

BMC Med 2018 May 2;16(1):60. Epub 2018 May 2.

Johns Hopkins University School of Medicine, Baltimore, USA.

Background: Many clinical trials conducted by academic organizations are not published, or are not published completely. Following the US Food and Drug Administration Amendments Act of 2007, "The Final Rule" (compliance date April 18, 2017) and a National Institutes of Health policy clarified and expanded trial registration and results reporting requirements. We sought to identify policies, procedures, and resources to support trial registration and reporting at academic organizations. Read More

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Human antibodies activate complement against Plasmodium falciparum sporozoites, and are associated with protection against malaria in children.

BMC Med 2018 Apr 30;16(1):61. Epub 2018 Apr 30.

Burnet Institute, Melbourne, Australia.

Background: Antibodies targeting Plasmodium falciparum sporozoites play a key role in human immunity to malaria. However, antibody mechanisms that neutralize sporozoites are poorly understood. This has been a major constraint in developing highly efficacious vaccines, as we lack strong correlates of protective immunity. Read More

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When complexity science meets implementation science: a theoretical and empirical analysis of systems change.

BMC Med 2018 Apr 30;16(1):63. Epub 2018 Apr 30.

Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia.

Background: Implementation science has a core aim - to get evidence into practice. Early in the evidence-based medicine movement, this task was construed in linear terms, wherein the knowledge pipeline moved from evidence created in the laboratory through to clinical trials and, finally, via new tests, drugs, equipment, or procedures, into clinical practice. We now know that this straight-line thinking was naïve at best, and little more than an idealization, with multiple fractures appearing in the pipeline. Read More

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April 2018
3 Reads

Migration and tuberculosis transmission in a middle-income country: a cross-sectional study in a central area of São Paulo, Brazil.

BMC Med 2018 Apr 30;16(1):62. Epub 2018 Apr 30.

Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.

Background: Little is known about the impact of growing migration on the pattern of tuberculosis (TB) transmission in middle-income countries. We estimated TB recent transmission and its associated factors and investigated the presence of cross-transmission between South American migrants and Brazilians.

Methods: We studied a convenient sample of cases of people with pulmonary TB in a central area of São Paulo, Brazil, diagnosed between 2013 and 2014. Read More

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Efficacy and safety of methylene blue in the treatment of malaria: a systematic review.

BMC Med 2018 Apr 25;16(1):59. Epub 2018 Apr 25.

Institute of Public Health, Medical School, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.

Background: Methylene blue (MB) was the first synthetic antimalarial to be discovered and was used during the late 19th and early 20th centuries against all types of malaria. MB has been shown to be effective in inhibiting Plasmodium falciparum in culture, in the mouse model and in rhesus monkeys. MB was also shown to have a potent ex vivo activity against drug-resistant isolates of P. Read More

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The cost-effectiveness of oral HIV pre-exposure prophylaxis and early antiretroviral therapy in the presence of drug resistance among men who have sex with men in San Francisco.

BMC Med 2018 Apr 24;16(1):58. Epub 2018 Apr 24.

Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, 30602, USA.

Background: Poor adherence to either antiretroviral treatment (ART) or pre-exposure prophylaxis (PrEP) can promote drug resistance, though this risk is thought to be considerably higher for ART. In the population of men who have sex with men (MSM) in San Francisco, PrEP coverage reached 9.6% in 2014 and has continued to rise. Read More

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Differences in the health transition patterns of migrants and non-migrants aged 50 and older in southern and western Europe (2004-2015).

BMC Med 2018 Apr 23;16(1):57. Epub 2018 Apr 23.

Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.

Background: Most previous research on migrant health in Europe has taken a cross-sectional perspective, without a specific focus on the older population. Having knowledge about inequalities in health transitions over the life course between migrants and non-migrants, including at older ages, is crucial for the tailoring of policies to the demands of an ageing and culturally diverse society. We analyse differences in health transitions between migrants and non-migrants, specifically focusing on the older population in Europe. Read More

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Ethnic minority inequalities in access to treatments for schizophrenia and schizoaffective disorders: findings from a nationally representative cross-sectional study.

BMC Med 2018 Apr 18;16(1):55. Epub 2018 Apr 18.

Centre for Psychiatry, Imperial College London, London, UK.

Background: Ethnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care. There have been no recent studies assessing access to evidence-based treatments for psychosis amongst the main ethnic minority groups in the UK.

Methods: Data from nationally representative surveys from England and Wales, for 10,512 people with a clinical diagnosis of schizophrenia or schizoaffective disorders, were used for analyses. Read More

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April 2018
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Performance of InSilicoVA for assigning causes of death to verbal autopsies: multisite validation study using clinical diagnostic gold standards.

BMC Med 2018 Apr 19;16(1):56. Epub 2018 Apr 19.

School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.

Background: Recently, a new algorithm for automatic computer certification of verbal autopsy data named InSilicoVA was published. The authors presented their algorithm as a statistical method and assessed its performance using a single set of model predictors and one age group.

Methods: We perform a standard procedure for analyzing the predictive accuracy of verbal autopsy classification methods using the same data and the publicly available implementation of the algorithm released by the authors. Read More

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April 2018
1 Read

Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study.

BMC Med 2018 Apr 13;16(1):53. Epub 2018 Apr 13.

Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.

Background: Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia. Read More

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April 2018
1 Read

Small contribution of gold mines to the ongoing tuberculosis epidemic in South Africa: a modeling-based study.

BMC Med 2018 Apr 12;16(1):52. Epub 2018 Apr 12.

Institute for Disease Modeling, Bellevue, Washington, USA.

Background: Gold mines represent a potential hotspot for Mycobacterium tuberculosis (Mtb) transmission and may be exacerbating the tuberculosis (TB) epidemic in South Africa. However, the presence of multiple factors complicates estimation of the mining contribution to the TB burden in South Africa.

Methods: We developed two models of TB in South Africa, a static risk model and an individual-based model that accounts for longer-term trends. Read More

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April 2018
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The perceived organizational impact of the gender gap across a Canadian department of medicine and proposed strategies to combat it: a qualitative study.

BMC Med 2018 Apr 10;16(1):48. Epub 2018 Apr 10.

Department of Medicine, University of Toronto, Toronto, ON, M5G2C4, Canada.

Background: Despite the gender parity existing in medical schools for over three decades, women remain underrepresented in academic medical centers, particularly in senior ranks and in leadership roles. This has consequences for patient care, education, research, and workplace culture within healthcare organizations. This study was undertaken to explore the perspectives of faculty members at a single department of medicine on the impact of the existing gender gap on organizational effectiveness and workplace culture, and to identify systems-based strategies to mitigate the gap. Read More

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April 2018
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General and disease-specific pain trajectories as predictors of social and political outcomes in arthritis and cancer.

BMC Med 2018 Apr 9;16(1):51. Epub 2018 Apr 9.

School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.

Background: While the heterogeniety of pain progression has been studied in chronic diseases, the extent to which patterns of pain progression among people in general as well as across different diseases affect social, civic and political engagement is unclear. We explore these issues for the first time.

Methods: Using data from the English Longitudinal Study of Ageing, latent class growth models were used to estimate trajectories of self-reported pain in the entire cohort, and within subsamples reporting diagnoses of arthritis and cancer. Read More

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April 2018
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Consumption of meat in relation to physical functioning in the Seniors-ENRICA cohort.

BMC Med 2018 Apr 5;16(1):50. Epub 2018 Apr 5.

Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo, 4, 28029, Madrid, Spain.

Background: Meat is an important source of high-quality protein and vitamin B but also has a relatively high content of saturated and trans fatty acids. Although protein and vitamin B intake seems to protect people from functional limitations, little is known about the effect of habitual meat consumption on physical function. The objective of this study was to examine the prospective association between the intake of meat (processed meat, red meat, and poultry) and physical function impairment in older adults. Read More

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April 2018
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Real-world evidence: How pragmatic are randomized controlled trials labeled as pragmatic?

BMC Med 2018 Apr 3;16(1):49. Epub 2018 Apr 3.

Departments of Medicine, Health Research and Policy, Biomedical Data Science, Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, 94305, USA.

Introduction: Pragmatic randomized controlled trials (RCTs) mimic usual clinical practice and they are critical to inform decision-making by patients, clinicians and policy-makers in real-world settings. Pragmatic RCTs assess effectiveness of available medicines, while explanatory RCTs assess efficacy of investigational medicines. Explanatory and pragmatic are the extremes of a continuum. Read More

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April 2018
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Hepatitis B in Moroccan-Dutch: a quantitative study into determinants of screening participation.

BMC Med 2018 03 29;16(1):47. Epub 2018 Mar 29.

National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.

Background: In November 2016, the Dutch Health Council recommended hepatitis B (HBV) screening for first-generation immigrants from HBV endemic countries. However, these communities show relatively low attendance rates for screening programmes, and our knowledge on their participation behaviour is limited. We identified determinants associated with the intention to request an HBV screening test in first-generation Moroccan-Dutch immigrants. Read More

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March 2018
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