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BMC Medicine

Alexandra B Hogan, Peter Winskill, Robert Verity, Jamie T Griffin, Azra C Ghani
BACKGROUND: The RTS,S/AS01 vaccine for Plasmodium falciparum malaria demonstrated moderate efficacy in 5-17-month-old children in phase 3 trials, and from 2018, the vaccine will be evaluated through a large-scale pilot implementation program. Work is ongoing to optimise this vaccine, with higher efficacy for a different schedule demonstrated in a phase 2a challenge study. The objective of our study was to investigate the population-level impact of a modified RTS,S/AS01 schedule and dose amount in order to inform the target product profile for a second-generation malaria vaccine...
July 13, 2018: BMC Medicine
Kirsten M Fiest, Christiane Job McIntosh, Danielle Demiantschuk, Jeanna Parsons Leigh, Henry T Stelfox
BACKGROUND: Caregivers may promote the uptake of science into patient care and the practice of evidence-informed medicine. The purpose of this study was to determine whether caregiver-mediated (non-clinical caregiver-delivered) interventions are effective in improving patient, caregiver, provider, or health system outcomes. METHODS: We searched the MEDLINE, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health, and Scopus databases from inception to February 27, 2017...
July 12, 2018: BMC Medicine
Tadashi Kato, Toshi A Furukawa, Akio Mantani, Ken'ichi Kurata, Hajime Kubouchi, Susumu Hirota, Hirotoshi Sato, Kazuyuki Sugishita, Bun Chino, Kahori Itoh, Yoshio Ikeda, Yoshihiro Shinagawa, Masaki Kondo, Yasumasa Okamoto, Hirokazu Fujita, Motomu Suga, Shingo Yasumoto, Naohisa Tsujino, Takeshi Inoue, Noboru Fujise, Tatsuo Akechi, Mitsuhiko Yamada, Shinji Shimodera, Norio Watanabe, Masatoshi Inagaki, Kazuhira Miki, Yusuke Ogawa, Nozomi Takeshima, Yu Hayasaka, Aran Tajika, Kiyomi Shinohara, Naohiro Yonemoto, Shiro Tanaka, Qi Zhou, Gordon H Guyatt
BACKGROUND: For patients starting treatment for depression, current guidelines recommend titrating the antidepressant dosage to the maximum of the licenced range if tolerated. When patients do not achieve remission within several weeks, recommendations include adding or switching to another antidepressant. However, the relative merits of these guideline strategies remain unestablished. METHODS: This multi-centre, open-label, assessor-blinded, pragmatic trial involved two steps...
July 11, 2018: BMC Medicine
Nicholas L Syn, Andrea Li-Ann Wong, Soo-Chin Lee, Hock-Luen Teoh, James Wei Luen Yip, Raymond Cs Seet, Wee Tiong Yeo, William Kristanto, Ping-Chong Bee, L M Poon, Patrick Marban, Tuck Seng Wu, Michael D Winther, Liam R Brunham, Richie Soong, Bee-Choo Tai, Boon-Cher Goh
BACKGROUND: Genotype-guided warfarin dosing has been shown in some randomized trials to improve anticoagulation outcomes in individuals of European ancestry, yet its utility in Asian patients remains unresolved. METHODS: An open-label, non-inferiority, 1:1 randomized trial was conducted at three academic hospitals in South East Asia, involving 322 ethnically diverse patients newly indicated for warfarin (NCT00700895). Clinical follow-up was 90 days. The primary efficacy measure was the number of dose titrations within the first 2 weeks of therapy, with a mean non-inferiority margin of 0...
July 10, 2018: BMC Medicine
Karen M Edmond, Khaksar Yousufi, Zelaikha Anwari, Sayed Masoud Sadat, Shah Mansoor Staniczai, Ariel Higgins-Steele, Alexandra L Bellows, Emily R Smith
BACKGROUND: The effects of community health worker (CHW) home visiting during the antenatal and postnatal periods in fragile- and conflicted-affected countries such as Afghanistan are not known. METHODS: We conducted a non-randomised population-based intervention study from March 2015 to February 2016. Two intervention and two control districts were selected. All female CHWs in the intervention districts were trained to provide eight home visits and behaviour change communication messages from pregnancy to 28 days postpartum...
July 9, 2018: BMC Medicine
Sascha Ludwig, Nikolai Schuelper, Jamie Brown, Sven Anders, Tobias Raupach
BACKGROUND: The Choosing Wisely campaign highlights the importance of clinical reasoning abilities for competent and reflective physicians. The principles of this campaign should be addressed in undergraduate medical education. Recent research suggests that answering questions on important steps in patient management promotes knowledge retention. It is less clear whether increasing the authenticity of educational material by the inclusion of videos further enhances learning outcome. METHODS: In a prospective randomised controlled cross-over study, we assessed whether repeated video-based testing is more effective than repeated text-based testing in training students to choose appropriate diagnostic tests, arrive at correct diagnoses and identify advisable therapies...
July 6, 2018: BMC Medicine
Florian Büttner, Stefan Winter, Steffen Rausch, Jörg Hennenlotter, Stephan Kruck, Arnulf Stenzl, Marcus Scharpf, Falko Fend, Abbas Agaimy, Arndt Hartmann, Jens Bedke, Matthias Schwab, Elke Schaeffeler
BACKGROUND: Stratification of cancer patients to identify those with worse prognosis is increasingly important. Through in silico analyses, we recently developed a gene expression-based prognostic score (S3-score) for clear cell renal cell carcinoma (ccRCC), using the cell type-specific expression of 97 genes within the human nephron. Herein, we verified the score using whole-transcriptome data of independent cohorts and extend its application for patients with metastatic disease receiving tyrosine kinase inhibitor treatment...
July 5, 2018: BMC Medicine
Angela Y Chang, Carlos Riumallo-Herl, Joshua A Salomon, Stephen C Resch, Logan Brenzel, Stéphane Verguet
BACKGROUND: Equitable access to vaccines has been suggested as a priority for low- and middle-income countries (LMICs). However, it is unclear whether providing equitable access is enough to ensure health equity. Furthermore, disaggregated data on health outcomes and benefits gained across population subgroups are often unavailable. This paper develops a model to estimate the distribution of childhood disease cases and deaths across socioeconomic groups, and the potential benefits of three vaccine programs in LMICs...
July 4, 2018: BMC Medicine
Affan Shoukat, Thomas Vilches, Seyed M Moghadas
BACKGROUND: A number of Zika vaccine platforms are currently being investigated, some of which have entered clinical trials. We sought to evaluate the cost-effectiveness of a potential Zika vaccine candidate under the WHO Vaccine Target Product Profile for outbreak response, prioritizing women of reproductive age to prevent microcephaly and other neurological disorders. METHODS: Using an agent-based simulation model of ZIKV transmission dynamics in a Colombian population setting, we conducted cost-effectiveness analysis with and without pre-existing herd immunity...
July 3, 2018: BMC Medicine
T Heunis, C Aldrich, J M Peters, S S Jeste, M Sahin, C Scheffer, P J de Vries
BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a worldwide prevalence of 1-2%. In low-resource environments, in particular, early identification and diagnosis is a significant challenge. Therefore, there is a great demand for 'language-free, culturally fair' low-cost screening tools for ASD that do not require highly trained professionals. Electroencephalography (EEG) has seen growing interest as an investigational tool for biomarker development in ASD and neurodevelopmental disorders...
July 2, 2018: BMC Medicine
Cecilia Galbete, Janine Kröger, Franziska Jannasch, Khalid Iqbal, Lukas Schwingshackl, Carolina Schwedhelm, Cornelia Weikert, Heiner Boeing, Matthias B Schulze
BACKGROUND: The Mediterranean Diet (MedDiet) has been acknowledged as a healthy diet. However, its relation with risk of major chronic diseases in non-Mediterranean countries is inconclusive. The Nordic diet is proposed as an alternative across Northern Europe, although its associations with the risk of chronic diseases remain controversial. We aimed to investigate the association between the Nordic diet and the MedDiet with the risk of chronic disease (type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer) in the EPIC-Potsdam cohort...
June 27, 2018: BMC Medicine
Mohammed H Al Zahrani, Abdiasiis I Omar, Abdelmohsin M O Abdoon, Ali Adam Ibrahim, Abdullah Alhogail, Mohamed Elmubarak, Yousif Eldirdiry Elamin, Mohammed A AlHelal, Ali M Alshahrani, Tarig M Abdelgader, Ibrahim Saeed, Tageddin B El Gamri, Mohammed S Alattas, Abdu A Dahlan, Abdullah M Assiri, Joseph Maina, Xiao Hong Li, Robert W Snow
Malaria at international borders presents particular challenges with regards to elimination. International borders share common malaria ecologies, yet neighboring countries are often at different stages of the control-to-elimination pathway. Herein, we present a case study on malaria, and its control, at the border between Saudi Arabia and Yemen. Malaria program activity reports, case data, and ancillary information have been assembled from national health information systems, archives, and other related sources...
June 26, 2018: BMC Medicine
Charlotte Probst, Charles D H Parry, Hans-Ulrich Wittchen, Jürgen Rehm
BACKGROUND: Globally, illness and life expectancy follow a social gradient that puts people of lower socioeconomic status (SES) at higher risk of dying prematurely. Alcohol consumption has been shown to be a factor contributing to socioeconomic differences in mortality. However, little evidence is available from low- and middle-income countries. The objective of this study was to quantify mortality attributable to alcohol consumption in the adult (15+ years) general population of South Africa in 2015 by SES, age, and sex...
June 25, 2018: BMC Medicine
Katrina M Long, Fiona McDermott, Graham N Meadows
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...
June 20, 2018: BMC Medicine
Julie E Reed, Cathy Howe, Cathal Doyle, Derek Bell
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...
June 20, 2018: BMC Medicine
Trisha Greenhalgh, Chrysanthi Papoutsi
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...
June 20, 2018: BMC Medicine
Yan-Ting Wu, Cheng Li, Yi-Min Zhu, Shu-Hua Zou, Qiong-Fang Wu, Li-Ping Wang, Yan Wu, Rong Yin, Chao-Yi Shi, Jing Lin, Zi-Ru Jiang, Yi-Jing Xu, Yun-Fei Su, Jian Zhang, Jian-Zhong Sheng, William D Fraser, Zhi-Wei Liu, He-Feng Huang
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. Pregnancy outcomes and subsequent neonatal outcomes were compared between FET cycles with intact embryos and those with blastomere loss...
June 19, 2018: BMC Medicine
Jiahui Si, Canqing Yu, Yu Guo, Zheng Bian, Chenxi Qin, Ling Yang, Yiping Chen, Li Yin, Hui Li, Jian Lan, Junshi Chen, Zhengming Chen, Jun Lv, Liming Li
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...
June 18, 2018: BMC Medicine
Paul Spiegel, Rebecca Chanis, Antonio Trujillo
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. The United Nations High Commissioner for Refugees spent approximately 12% of its budget on health, nutrition, food security, water, and sanitation in 2016...
June 15, 2018: BMC Medicine
Ushma D Upadhyay, Nicole E Johns, Rebecca Barron, Alice F Cartwright, Chantal Tapé, Alyssa Mierjeski, Alyson J McGregor
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.S.). METHODS: We used a retrospective observational study design using 2009-2013 data from the Nationwide Emergency Department Sample, a nationally representative sample of U...
June 14, 2018: BMC Medicine
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