Rivasbengtsson9253

To measure lookup rates of externally held primary care records accessed in emergency care and identify patient characteristics, conditions and potential consequences associated with access.

Rates of primary care record access and re-presentation to the emergency department (ED) within 30 days and hospital admission.

A retrospective observational study of 77 181 ED presentations over 4 years and 9 months, analysing 8184 index presentations in which patients' primary care records were accessed from the ED. Data were compared with 17 449 randomly selected index control presentations. Analysis included propensity score matching for age and triage categories.

6.3% of overall ED presentations triggered a lookup (rising to 8.3% in year 5); 83.1% of patients were only looked up once and 16.9% of patients looked up on multiple occasions. Lookup patients were on average 25 years older (z=-9.180, p<0.001, r=0.43). Patients with more urgent triage classifications had their records accessed more frequently (z=-36.47, p<0.001, r=0.23). Record access was associated with a significant but negligible increase in hospital admission (χ

(1, n=13 120)=98.385, p<0.001, phi=0.087) and readmission within 30 days (χ

(1, n=13 120)=86.288, p<0.001, phi=0.081).

Emergency care clinicians access primary care records more frequently for older patients or those in higher triage categories. Increased levels of inpatient admission and re-presentation within 30 days are likely linked to age and triage categories.

Further studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.

Further studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.

A mixed-method, co-design approach to studying the adoption of mobile health (mHealth) technology among African-American (AA) women has not been fully explored. Qualitative data may contextualise existing knowledge surrounding perceptions of mHealth among AA women as part of formative work for designing a physical activity application (app).

A convenience sample of 16 AA women completed an informatics survey prior to participating in focus groups exploring their use of mobile technology and health apps. Survey responses provided frequency data, while iterative transcript analysis of focus groups identified themes.

The majority of participants (mean age=62.1 years, SD=6.6) felt comfortable using a tablet/smartphone (75.0%). Most (68.8%) reported using health-related apps, primarily focused on physical activity and nutrition. Focus groups revealed four overarching concepts, including (1) user attachment, (2) technology adoption, (3) potential facilitators and (4) potential barriers. Important features which may serve as facilitators or barriers to future adoption of a mobile app for an mHealth intervention include individual app tailoring and software concerns, respectively.

Thematic analysis revealed high user attachment to smartphones and described participants' process for adopting new mHealth technology.

Early engagement of target end users as a part of a broader co-design and community-based participatory research process for developing mHealth technologies may be useful for sustained adoption of these tools in future mHealth behavioural interventions.

Early engagement of target end users as a part of a broader co-design and community-based participatory research process for developing mHealth technologies may be useful for sustained adoption of these tools in future mHealth behavioural interventions.

Overuse of diagnostic imaging for patients with low back pain remains common. The underlying beliefs about diagnostic imaging that could drive overuse remain unclear. We synthesised qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain.

A qualitative evidence synthesis using a thematic analysis.

We searched MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to 17 June 2019. Qualitative studies that interviewed clinicians, patients and/or general public exploring beliefs about diagnostic imaging for low back pain were included. Four review authors independently extracted data and organised these according to themes and subthemes. We used the Critical Appraisal Skills Programme tool to critically appraise included studies. To assess confidence in review findings, we used the GRADE-Confidence in the Evidence from Reviews of Qualitative Research method.

We included 69 qualitative studies with 1747 participants. Key findings included Patients and clinicians believe diagnostic imaging is an important test to locate the source of low back pain (33 studies, high confidence); patients with chronic low back pain believe pathological findings on diagnostic imaging provide evidence that pain is real (12 studies, moderate confidence); and clinicians ordered diagnostic imaging to reduce the risk of a missed diagnosis that could lead to litigation, and to manage patients' expectations (12 studies, moderate confidence).

Clinicians and patients can believe that diagnostic imaging is an important tool for locating the source of non-specific low back pain. Patients may underestimate the harms of unnecessary imaging tests. These beliefs could be important targets for intervention.

CRD42017076047.

CRD42017076047.Magnesium (Mg) based temporary implants are an appealing new solution to counter the problems associated with the currently available temporary orthopaedic implants, used in fracture fixing. To make the extensive use of Mg-based implants in-vivo, mechanical integrity in the physiological environment is a prerequisite. click here This study presents an insight into the biomechanical stability of Mg-3Zn/HA (0, 5, and 15 wt % of HA) composites in two different milieus (simulated body fluid (SBF) and serum contained SBF (m-SBF)). After 14 days of static immersion in SBF, ~65% mechanical strength was compromised in the case of 15 wt % HA reinforcement. However, the degradation rate was slowed down by ~35% with the addition of 15 wt % HA in Mg-3Zn. Mg-3Zn/HA composite, when soaked in both fluids, was found to induce apatite layer formation on the surfaces for several days. However, in the case of m-SBF immersion, 15 wt % HA facilitated less precipitation of apatite growth when compared to SBF immersion. Nevertheless, m-SBF immersed 15 wt % HA composite facilitated better corrosion resistance and excellent mechanical stability after 14 days of immersion.