bluuebunny/crossref_metadata_2025 huggingface dataset:
Activity of Tigecycline or Colistin in Combination with Zidovudine against Escherichia coli Harboring
tet
(X) and
mcr-1
Authors: Zhou Yu-Feng , Liu Ping , Dai Shu-He , Sun Jian , Liu Ya-Hong , Liao Xiao-Ping
Published: October 2020

Alternative therapeutic options are urgently needed against multidrug-resistant
Escherichia coli
infections, especially in situations of preexisting tigecycline and colistin resistance. Here, we investigated synergistic activity of the antiretroviral drug zidovudine in combination with tigecycline or colistin against
E. coli
harboring
tet
(X) and
mcr-1 in vitro
and in a murine thigh infection model. Zidovudine and tigecycline/colistin combinations achieved synergistic killing and significantly decreased bacterial burdens by >2.
Case Commentary: Imipenem/Cilastatin and Fosfomycin for Refractory Methicillin-Resistant
Staphylococcus aureus
Infection: a Novel Combination Therapy
Authors: Sakoulas George
Published: October 2020

Given that it is unlikely that randomized clinical trials will yield answers for treating the most challenging bacteremic infections caused by methicillin-resistant
Staphylococcus aureus
, clinicians, microbiologists, and pharmacists will have to cooperate to discover novel ways to select successful individualized antimicrobial therapy for these patients. An example of such a strategy was demonstrated in the identification and utilization of imipenem/cilastatin plus fosfomycin to treat a particularly recalcitrant MRSA bacteremia and spinal abscess.
Burkholderia thailandensis Methylated Hydroxyalkylquinolines: Biosynthesis and Antimicrobial Activity in Cocultures
Authors: Klaus Jennifer R. , Majerczyk Charlotte , Moon Stephanie , Eppler Natalie A. , Smith Sierra , Tuma Emily , Groleau Marie-Christine , Asfahl Kyle L. , Smalley Nicole E. , Hayden Hillary S. , Piochon Marianne , Ball Patrick , Dandekar Ajai A. , Gauthier Charles , Déziel Eric , Chandler Josephine R.
Published: October 2020

The soil bacterium
Burkholderia thailandensis
produces 2-alkyl-4(1
H
)-quinolones that are mostly methylated 4-hydroxyalkenylquinolines, a family of relatively unstudied metabolites similar to molecules also synthesized by
Pseudomonas aeruginosa
. Several of the methylated 4-hydroxyalkenylquinolines have antimicrobial activity against other species. We show that
Bacillus subtilis
strain 168 is particularly susceptible to
N
-oxidated methylalkenylquinolines (HMAQ-NOs). We confirmed that HMAQ-NO biosynthesis requires the previously unstudied protein HmqL. These results provide new information about the biology of 2-alkyl-4(1
H
)-quinolones, particularly the methylated 4-hydroxyalkenylquinolines, which are unique to
B. thailandensis
. This study also has importance for understanding
B. thailandensis
secondary metabolites and has implications for potential therapeutic development.
Degradation of Lon in Caulobacter crescentus
Authors: Barros Benjamin B. , Mahmoud Samar A. , Chien Peter , Zeinert Rilee D.
Published: October 2020

Proteases are essential, but unrestrained activity can also kill cells by degrading essential proteins. The quality-control protease Lon must degrade many misfolded and native substrates. We show that Lon is itself controlled through proteolysis and that bypassing this control results in toxic consequences for the cell.
The Nucleoprotein of H7N9 Influenza Virus Positively Regulates TRAF3-Mediated Innate Signaling and Attenuates Viral Virulence in Mice
Authors: Wei Yanli , Zeng Yan , Zhang Xuegang , Xu Shuai , Wang Zhengxiang , Du Yingying , Zhang Bo , Lei Cao-Qi , Zhu Qiyun
Published: October 2020

The NS1, PB2, PA-X, and PB1-F2 proteins of influenza A virus (IAV) are known to employ various strategies to counteract and evade host defenses. However, the viral components responsible for the activation of innate immune signaling remain elusive. Here, we demonstrate for the first time that the NP of H7N9 IAV specifically associates with and stabilizes the important adaptor molecule TRAF3, which potentiates RLR-mediated type I interferon induction. Moreover, we reveal that this H7N9 NP protein prevents the interaction between TRAF3 and cIAP2 that mediates Lys48-linked polyubiquitination of TRAF3 for degradation. The current study revealed a novel mechanism by which H7N9 NP upregulates TRAF3-mediated type I interferon production, leading to attenuation of viral replication and pathogenicity in cells and mice. Our finding provides a possible explanation for virus and host commensalism via viral manipulation of the host immune system.
Phosphorylation of Rhoptry Protein RhopH3 Is Critical for Host Cell Invasion by the Malaria Parasite
Authors: Ekka Roseleen , Gupta Ankit , Bhatnagar Sonika , Malhotra Pawan , Sharma Pushkar
Published: October 2020

Host cell invasion by the malaria parasite is critical for establishing infection in human host and is dependent on discharge of key ligands from organelles like rhoptry and microneme, and these ligands interact with host RBC receptors. In the present study, we demonstrate that phosphorylation of a key rhoptry protein, RhopH3, is critical for host invasion. Phosphorylation regulates its localization to rhoptries and discharge from the parasite.
Fun(gi)omics: Advanced and Diverse Technologies to Explore Emerging Fungal Pathogens and Define Mechanisms of Antifungal Resistance
Authors: Ball B. , Langille M. , Geddes-McAlister J.
Published: October 2020

The landscape of infectious fungal agents includes previously unidentified or rare pathogens with the potential to cause unprecedented casualties in biodiversity, food security, and human health. The influences of human activity, including the crisis of climate change, along with globalized transport, are underlying factors shaping fungal adaptation to increased temperature and expanded geographical regions. Furthermore, the emergence of novel antifungal-resistant strains linked to excessive use of antifungals (in the clinic) and fungicides (in the field) offers an additional challenge to protect major crop staples and control dangerous fungal outbreaks.
Decoding the Architecture of the Varicella-Zoster Virus Transcriptome
Authors: Braspenning Shirley E. , Sadaoka Tomohiko , Breuer Judith , Verjans Georges M. G. M. , Ouwendijk Werner J. D. , Depledge Daniel P.
Published: October 2020

Transcription from herpesviral genomes, executed by the host RNA polymerase II and regulated by viral proteins, results in coordinated viral gene expression to efficiently produce infectious progeny. However, the complete coding potential and regulation of viral gene expression remain ill-defined for the human alphaherpesvirus varicella-zoster virus (VZV), causative agent of both varicella and herpes zoster. Here, we present a comprehensive overview of the VZV transcriptome and the kinetic class of all identified viral transcripts, using two virus strains and two biologically relevant cell types. Additionally, our data provide an overview of how VZV diversifies its transcription from one of the smallest herpesviral genomes. Unexpectedly, the transcript encoding the major viral transactivator protein (pORF62) was expressed with
Late
kinetics, whereas orthologous transcripts in other alphaherpesviruses are typically expressed during the immediate early phase. Therefore, our work both establishes the architecture of the VZV transcriptome and provides insight into regulation of alphaherpesvirus gene expression.
Atribacteria Reproducing over Millions of Years in the Atlantic Abyssal Subseafloor
Authors: Vuillemin Aurèle , Vargas Sergio , Coskun Ömer K. , Pockalny Robert , Murray Richard W. , Smith David C. , D’Hondt Steven , Orsi William D.
Published: October 2020

The deep subseafloor sedimentary biosphere is one of the largest ecosystems on Earth, where microbes subsist under energy-limited conditions over long timescales. It remains poorly understood how mechanisms of microbial metabolism promote increased fitness in these settings. We discovered that the candidate bacterial phylum “
Candidatus
Atribacteria” dominated a deep-sea subseafloor ecosystem, where it exhibited increased transcription of genes associated with acetogenic fermentation and reproduction in million-year-old sediment. We attribute its improved fitness after burial in the seabed to its capabilities to derive energy from increasingly oxidized metabolites via a bacterial microcompartment and utilize a potentially reversible Wood-Ljungdahl pathway to help meet anabolic and catabolic requirements for growth. Our findings show that “
Ca
. Atribacteria” can perform all the necessary catabolic and anabolic functions necessary for cellular reproduction, even under energy limitation in anoxic sediments that are millions of years old.
Chromatin Dynamics Contribute to the Spatiotemporal Expression Pattern of Virulence Genes in a Fungal Plant Pathogen
Authors: Meile Lukas , Peter Jules , Puccetti Guido , Alassimone Julien , McDonald Bruce A. , Sánchez-Vallet Andrea
Published: October 2020

Fungal plant pathogens possess a large repertoire of genes encoding putative effectors, which are crucial for infection. Many of these genes are expressed at low levels in the absence of the host but are strongly induced at specific stages of the infection. The mechanisms underlying this transcriptional reprogramming remain largely unknown. We investigated the role of the genomic environment and associated chromatin modifications of effector genes in controlling their expression pattern in the fungal wheat pathogen
Zymoseptoria tritici
. Depending on their genomic location, effector genes are epigenetically repressed in the absence of the host and during the initial stages of infection. Derepression of effector genes occurs mainly during and after penetration of plant leaves and is associated with changes in histone modifications. Our work demonstrates the role of chromatin in shaping the expression of virulence components and, thereby, the interaction between fungal pathogens and their plant hosts.
Change in clinical knowledge of diabetes among primary healthcare providers in Indonesia: repeated cross-sectional survey of 5105 primary healthcare facilities
Authors: Stein Dorit T , Sudharsanan Nikkil , Dewi Shita , Manne-Goehler Jennifer , Witoelar Firman , Geldsetzer Pascal
Published: October 2020

Introduction

Indonesia is experiencing a rapid rise in the number of people with diabetes. There is limited evidence on how well primary care providers are equipped to deal with this growing epidemic. This study aimed to determine the level of primary healthcare providers’ knowledge of diabetes, change in knowledge from 2007 to 2014/2015 and the extent to which changes in the diabetes workforce composition, geographical distribution of providers, and provider characteristics explained the change in diabetes knowledge.

Research design and methods

In 2007 and 2014/2015, a random sample of public and private primary healthcare providers who reported providing diabetes care across 13 provinces in Indonesia completed a diabetes clinical case vignette. A provider’s diabetes vignette score represents the percentage of all correct clinical actions for a hypothetical diabetes patient that were spontaneously mentioned by the provider. We used standardization and fixed-effects linear regression models to determine the extent to which changes in diabetes workforce composition, geographical distribution of providers, and provider characteristics explained any change in diabetes knowledge between survey rounds, and how knowledge varied among provinces.

Results

The mean unadjusted vignette score decreased from 37.1% (95% CI 36.4% to 37.9%) in 2007 to 29.1% (95% CI 28.4% to 29.8%, p<0.001) in 2014/2015. Vignette scores were, on average, 6.9 (95% CI −8.2 to 5.6, p<0.001) percentage points lower in 2014/2015 than in 2007 after adjusting for provider cadre, geographical distribution, and provider experience and training. Physicians and providers with postgraduate diabetes training had the highest vignette scores.

Conclusions

Diabetes knowledge among primary healthcare providers in Indonesia decreased, from an already low level, between 2007 and 2014/2015. Policies that improve preservice training, particularly at newer schools, and investment in on-the-job training in diabetes might halt and reverse the decline in diabetes knowledge among Indonesia’s primary healthcare workforce.
Healthcare hackathons: fostering medical education through innovation in a developing country: a case study from Pakistan
Authors: Butt Waqaas Akmal , Shahood Qurratulain , Farooqi Walid Hussain , Ghias Kulsoom , Sabzwari Saniya , Mian Asad
Published: October 2020

Background

Hackathons aim to develop solutions to preidentified problem domains and catalyse startup cultures. Recently, the teaching and learning potential of hackathons has also been documented. In this study, we make the case for utilisation of hackathons as an alternative teaching and learning tool geared towards entrepreneurship and as an opportunity for interprofessional integration.

Methods

This research study followed up with participants from the third hackathon at the Aga Khan University in Karachi, Pakistan.
Hack MedEd
was about solutions to problems of undergraduate and postgraduate medical education with an emphasis on low-income to middle-income countries. Participant evaluation data were filled at the end of the hackathon and gathered from three focused group discussions (FGDs): immediately before and after the event, a delayed follow-up after 11 months was recorded.

Results

Of 116 participants, the majority (71%) were under 30 years old, and over half were female. The evaluations provided by hackers were positive overall with a mean score of 4.37 out of 5 on a Likert Scale. During the FGDs, participants spoke positively of the process and felt that, by the end of the hackathon, they had learnt something new. In the delayed follow-up FGD, teams that had undergone incubation expressed that they had gained a critical and simple skillset that they might not have acquired otherwise.

Conclusion

Hackathons business incubation programmes may be considered an alternative teaching and learning tool—especially for individuals studying or working within the healthcare discipline within low-resource settings.
Farming for life: impact of medical prescriptions for fresh vegetables on cardiometabolic health for adults with or at risk of type 2 diabetes in a predominantly Mexican-American population
Authors: Kerr David , Barua Souptik , Glantz Namino , Conneely Casey , Kujan Mary , Bevier Wendy , Larez Arianna , Sabharwal Ashutosh
Published: October 2020

Introduction

Poor diet is the leading cause of poor health in USA, with fresh vegetable consumption below recommended levels. We aimed to assess the impact of medical prescriptions for fresh (defined as picked within 72 hours) vegetables, at no cost to participants on cardiometabolic outcomes among adults (predominantly Mexican-American women) with or at risk of type 2 diabetes (T2D).

Methods

Between February 2019 and March 2020, 159 participants (122 female, 75% of Mexican heritage, 31% with non-insulin treated T2D, age 52.5 (13.2) years) were recruited using community outreach materials in English and Spanish, and received prescriptions for 21 servings/week of fresh vegetable for 10 weeks. Pre-post comparisons were made of weight; waist circumference; blood pressure; Hemoglobin A1c(HbA1c, a measure of long-term blood glucose control); self-reported sleep, mood and pain; vegetable, tortilla and soda consumption. After obtaining devices for this study, 66 of 72 participants asked, agreed to wear blinded continuous glucose monitors (CGM).

Results

Paired data were available for 131 participants. Over 3 months, waist circumference fell (−0.77 (95% CI −1.42 to 0.12) cm, p=0.022), as did systolic blood pressure (SBP) (−2.42 (95% CI −4.56 to 0.28) mm Hg, p=0.037), which was greater among individuals with baseline SBP >130 mm Hg (−7.5 (95% CI −12.4 to 2.6) mm Hg, p=0.005). Weight reduced by −0.4 (−0.7 to –0.04) kg, p=0.029 among women. For participants with baseline HbA1c>7.0%, HbA1cfell by −0.35 (-0.8 to –0.1), p=0.009. For participants with paired CGM data (n=40), time in range 70–180 mg/dL improved (from 97.4% to 98.9%, p<0.01). Food insecurity (p<0.001), tortilla (p<0.0001) and soda (p=0.013) consumption significantly decreased. Self-reported sleep, mood and pain level scores also improved (all p<0.01).

Conclusions

Medical prescriptions for fresh vegetables were associated with clinically relevant improvements in cardiovascular risk factors and quality of life variables (sleep, mood and pain level) in adults (predominantly Mexican-American and female) with or at risk of T2D.

Trial registration number

ClinicalTrials.gov Identifier:NCT03940300.
Association between dementia and depression: a retrospective study using the Korean National Health Insurance Service-National Sample Cohort database
Authors: Yu Ok-Cheol , Jung Boyoung , Go Hoyeon , Park Minjung , Ha In-Hyuk
Published: October 2020

Objectives

Dementia is common in people over the age of 65 years, with 80% of people with dementia older than 75 years. Previous studies have linked dementia to late-life depression, but the association between dementia and mid-life depression is poorly understood. Depression is a preventable and treatable medical condition, which means it is a modifiable factor that can potentially prevent or delay dementia. This study aimed to identify the association between dementia and depression within the life course.

Design

A nationwide, retrospective propensity score matched cohort study associating dementia with depression. Depression diagnosed between the ages of 45 and 64 years was classified as ‘mid-life’ and ‘late-life’ if diagnosed at 65 years or older. Patients were considered to have depression when one or more International Statistical Classification of Diseases and Related Health Problems, 10th revision codes for depression were recorded as primary or secondary diagnosis.

Setting

National Health Insurance Service-National Sample Cohort database of the National Health Insurance Service in South Korea, containing patient data from 2002 to 2013.

Participants

The study included 1824 and 374 852 patients in the case and control groups, respectively. A logistic regression analysis with complex sampling design was performed after adjusting for covariates, using the propensity score matching method without callipers, with a 1:1 nearest neighbour matching algorithm.

Primary and secondary outcome measures

The association of mid-onset and late-onset depression with dementia in terms of sociodemographic characteristics, such as sex and age, within the Korean population.

Results

Dementia was significantly associated with the presence of depression (OR=2.20, 95% CI=1.53–3.14); in particular, female patients with depression and patients aged 45–64 years with depression had increased odds of dementia (OR=2.65, 95% CI=1.78–3.93 and OR=2.72, 95% CI=1.41–5.24, respectively)

Conclusion

Depression is an associated factor for dementia, especially among people aged 45–64 years (mid-life).
Validation study of German inpatient administrative health data for epidemiological surveillance and measurement of quality of care for sepsis: the OPTIMISE study protocol
Authors: Schwarzkopf Daniel , Fleischmann-Struzek Carolin , Schlattmann Peter , Dorow Heike , Ouart Dominique , Edel Andreas , Gonnert Falk A , Götz Jürgen , Gründling Matthias , Heim Markus , Jaschinski Ulrich , Lindau Simone , Meybohm Patrick , Putensen Christian , Sander Michael , Reinhart Konrad
Published: October 2020

Introduction

Sepsis is a major cause of preventable deaths in hospitals. This study aims to investigate if sepsis incidence and quality of care can be assessed using inpatient administrative health data (IAHD).

Methods and analysis

Design: Retrospective observational validation study using routine data to assess the diagnostic accuracy of sepsis coding in IAHD regarding sepsis diagnosis based on medical record review. Procedure: A stratified sample of 10 000 patients with an age ≥15 years treated in between 2015 and 2017 in 10 German hospitals is investigated. All available information of medical records is screened by trained physicians to identify true sepsis cases (‘gold standard’) both according to current (‘sepsis-1’) definitions and new (‘sepsis-3’) definitions. Data from medical records are linked to IAHD on patient level using a pseudonym. Analyses: Proportions of cases with sepsis according to sepsis-1 and sepsis-3 definitions are calculated and compared with estimates from coding of sepsis in IAHD. Predictive accuracy (sensitivity, specificity) of different coding abstraction strategies regarding the gold standard is estimated. Predictive accuracy of mortality risk factors obtained from IAHD regarding the respective risk factors obtained from medical records is calculated. An IAHD-based risk model for hospital mortality is compared with a record-based risk model regarding model-fit and predicted risk of death. Analyses adjust for sampling weights. The obtained estimates of sensitivity and specificity for sepsis coding in IAHD are used to estimate adjusted incidence proportions of sepsis based on German national IAHD.

Ethics and dissemination

The study has been approved by the ethics commission of the Jena University Hospital (No. 2018-1065-Daten). The results of the study will be discussed in an expert panel to write a memorandum on improving the utility of IAHD for epidemiological surveillance and quality management of sepsis care.

Trial registration number

DRKS00017775; Pre-results.
HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey
Authors: Alexander Ishungisa Mwijage , Moen Kare , Leyna Germana , Makyao Neema , Ramadhan Angela , Lange Theis , Meyrowitsch Dan Wolf , Mizinduko Mucho , Likindikoki Samuel , Leshabari Melkzedeck , Mmbaga Elia John
Published: October 2020

Objectives

To estimate HIV prevalence and associated risk factors among men who have sex with men (MSM) in Dar es Salaam, Tanzania following the implementation of the national comprehensive package of HIV interventions for key population (CHIP).

Design

A cross-sectional survey using respondent-driven sampling.

Setting

Dar es Salaam, Tanzania’s largest city.

Participants

Men who occasionally or regularly have sex with another man, aged 18 years and above and living in Dar es Salaam city at least 6 months preceding the study.

Primary outcome measure

HIV prevalence was the primary outcome. Independent risk factors for HIV infection were examined using weighted logistics regression modelling.

Results

A total of 777 MSM with a mean age of 26 years took part in the study. The weighted HIV prevalence was 8.3% (95% CI: 6.3%–10.9%) as compared with 22.3% (95% CI: 18.7%–26.4%) observed in a similar survey in 2014. Half of the participants had had sex with more than two partners in the month preceding the survey. Among those who had engaged in transactional sex, 80% had used a condom during last anal sex with a paying partner. Participants aged 25 and above had four times higher odds of being infected than those aged 15–19 years. HIV infection was associated with multiple sexual partnerships (adjusted OR/AOR, 3.0; 95% CI: 1.8–12.0), not having used condom during last sex with non-paying partner (AOR, 4.1; 95% CI: 1.4–7.8) and ever having engaged in group sex (AOR, 3.4; 95% CI: 1.7–3.6).

Conclusion

HIV prevalence among MSM in Dar es Salaam has decreased by more than a half over the past 5 years, coinciding with implementation of the CHIP. It is nonetheless two times as high as that of men in the general population. To achieve the 2030 goal, behavioural change interventions and roll out of new intervention measures such as pre-exposure prophylaxis are urgently needed.
Rates of rehospitalisation in the first 2 years among preterm infants discharged from the NICU of a tertiary children hospital in Vietnam: a follow-up study
Authors: Do Chuong Huu Thieu , Børresen Malene Landbo , Pedersen Freddy Karup , Geskus Ronald Bertus , Kruse Alexandra Yasmin
Published: October 2020

Objectives

To describe the characteristics of rehospitalisation in Vietnamese preterm infants and to examine the time-to-first-readmission between two gestational age (GA) groups (extremely/very preterm (EVP) vs moderate/late preterm (MLP)); and further to compare rehospitalisation rates according to GA and corrected age (CA), and to examine the association between potential risk factors and rehospitalisation rates.

Design and setting

A cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children’s hospital in Vietnam.

Participants

All preterm newborns admitted to the NICU from July 2013 to September 2014.

Main outcomes

Rates, durations and causes of hospital admission during the first 2 years.

Results

Of 294 preterm infants admitted to NICU (all outborn, GA ranged from 26 to 36 weeks), 255 were discharged alive, and 211 (83%) NICU graduates were followed up at least once during the first 2 years CA, of whom 56% were hospital readmitted. The median (IQR) of hospital stay was 7 (6–10) days. Respiratory diseases were the major cause (70%). Compared with MLP infants, EVP infants had a higher risk of first rehospitalisation within the first 6 months of age (p=0.01). However, the difference in risk declined thereafter and was similar from 20 months of age. There was an interaction in rehospitalisation rates between GA and CA. Longer duration of neonatal respiratory support and having older siblings were associated with higher rehospitalisation rates. Lower rates of rehospitalisation were seen in infants with higher cognitive and motor scores (not statistically significant in cognitive scores).

Conclusions

Hospital readmission of Vietnamese preterm infants discharged from NICU was frequent during their first 2 years, mainly due to respiratory diseases. Scale-up of follow-up programmes for preterm infants is needed in low-income and middle-income countries and attempts to prevent respiratory diseases should be considered.
Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia
Authors: Tahhan Nina , Ford Belinda Kate , Angell Blake , Liew Gerald , Nazarian Joseph , Maberly Glen , Mitchell Paul , White Andrew J R , Keay Lisa
Published: October 2020

Objectives

To determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use resources, compared with hospital-based care.

Design

Retrospective audit of medical and financial records to compare two models of care.

Setting

A large, urban tertiary Australian publicly funded hospital.

Intervention

C-EYE-C is a collaborative care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. The C-EYE-C model of care was implemented from January to October 2017.

Participants

New low-risk patient referrals with diabetes received at a tertiary hospital ophthalmology unit.

Primary and secondary outcomes

Historical standard hospital care was compared with C-EYE-C for attendance, wait-times, outcomes and costs. Clinical concordance between the optometrist and ophthalmologist diagnosis and management was assessed using weighted kappa statistic.

Results

There were 133 new low-risk referrals, managed in standard hospital care (n=68) and C-EYE-C (n=65). Attendance rates were similar between the models of care (72.1% hospital vs 67.7% C-EYE-C, p=0.71). C-EYE-C had shorter appointment wait-time (53 vs 118 days, p<0.01). In the C-EYE-C model of care, 68.2% of patients did not require hospital appointments and costs were 43% less than hospital care. There was substantial agreement between optometrists and ophthalmologists for diagnosis (κ=0.64, CI 0.47–0.81) and management (κ=0.66, CI 0.45–0.87).

Conclusion

This Australian study showed that collaborative eye care resulted in reduced patient waiting times and considerable cost-savings, while maintaining a high standard of patient care compared with traditional hospital-based care in the management of low-risk hospital referrals with diabetic eye disease. The improved access and reduced costs were largely the result of better task allocation through greater utilisation of primary eye care professionals to provide services for low-risk patients. Better resource use may free up further resources for other eye care services.
Scalable solution for delivery of diabetes self-management education in Thailand (DSME-T): a cluster randomised trial study protocol
Authors: Angkurawaranon Chaisiri , Papachristou Nadal Iliatha , Mallinson Poppy Alice Carson , Pinyopornpanish Kanokporn , Quansri Orawan , Rerkasem Kittipan , Srivanichakorn Supattra , Techakehakij Win , Wichit Nutchanath , Pateekhum Chanapat , Hashmi Ahmar H , Hanson Kara , Khunti Kamlesh , Kinra Sanjay
Published: October 2020

Introduction

Type 2 diabetes mellitus is among the foremost health challenges facing policy makers in Thailand as its prevalence has more than tripled over the last two decades, accounting for considerable death, disability and healthcare expenditure. Diabetes self-management education (DSME) programmes show promise in improving diabetes outcomes, but this is not routinely used in Thailand. This study aims to test a culturally tailored DSME model in Thailand, using a three-arm cluster randomised controlled trial comparing a nurse-led model, a peer-assisted model and standard care. We will test which model is effective and cost effective to improve cardiovascular risk and control of blood glucose among people with diabetes.

Methods and analysis

21 primary care units in northern Thailand will be randomised to one of three interventions, enrolling a total of 693 patients. The primary care units will be randomised (1:1:1) to participate in a culturally-tailored DSME intervention for 12 months. The three-arm trial design will compare effectiveness of nurse-led, peer-assisted (Thai village health volunteers) and standard care. The primary trial outcomes are changes in haemoglobin A1c and cardiovascular risk score. A process evaluation and cost effectiveness evaluation will be conducted to produce policy relevant guidance for the Thai Ministry of Public Health. The planned trial period will start in January 2020 and finish October 2021.

Ethics and dissemination

Ethical approval has been obtained from Thailand and the UK. We will share our study data with other researchers, advertising via our publications and web presence. In particular, we are committed to sharing our findings and data with academic audiences in Thailand and other low-income and middle-income countries.

Trial registration number

NCT03938233.
Patient and public involvement in the development of clinical practice guidelines: a scoping review protocol
Authors: Bryant Elizabeth Ann , Scott Anna Mae , Thomas Rae
Published: October 2020

Introduction

Clinical practice guidelines (CPGs) are intended to optimise patient care by recommending care pathways based on the best available research evidence and practice experience. Patient and public involvement (PPI) in healthcare is recommended based on the expectation that it will improve the quality and relevance of outcomes. There is no consensus on what constitutes meaningful and effective PPI in CPG. We will conduct a scoping review to identify and synthesise knowledge in four key areas: who have been the patients and public previously involved in CPG development, how were they recruited, at what stage in the CPG process were they involved and how were they involved. This knowledge will inform a general model of PPI in CPG to inform CPGs development.

Methods and analysis

We will conduct a scoping review using the Methodology for Scoping Reviews refined by the Joanna Briggs Institute. Searches will be conducted in electronic databases (PubMed, Embase, CINAHL and PsycINFO). National standards for developing CPGs from Australia, UK, Canada and the USA will also be identified. A forward and backward citation search will be conducted on the included studies and national standards. Abstracts and full-text studies will be independently screened by two researchers. Extracted data will include study details, type of clinical guideline and the four key areas, which patients and public were involved, how were they recruited, at what stage were they included and how they were involved. Data will be narratively synthesised.

Ethics and dissemination

As a scoping review, this study does not require ethics approval. We intend to disseminate the results through publication in a peer-reviewed journal and conference presentations. Furthermore, we will use the findings from our scoping review to inform future research to fill key evidence gaps identified by this review.
Information sharing challenges in end-of-life care: a qualitative study of patient, family and professional perspectives on the potential of an Electronic Palliative Care Co-ordination System
Authors: Standing Holly , Patterson Rebecca , Lee Mark , Dalkin Sonia Michelle , Lhussier Monique , Bate Angela , Exley Catherine , Brittain Katie
Published: October 2020

Objectives

To explore current challenges in interdisciplinary management of end-of-life care in the community and the potential of an Electronic Palliative Care Co-ordination System (EPaCCS) to facilitate the delivery of care that meets patient preferences.

Design

Qualitative study using interviews and focus groups.

Setting

Health and Social Care Services in the North of England.

Participants

71 participants, 62 health and social care professionals, 9 patients and family members.

Results

Four key themes were identified: information sharing challenges; information sharing systems; perceived benefits of an EPaCCS and barriers to use and requirements for an EPaCCS. Challenges in sharing information were a source of frustration for health and social care professionals as well as patients, and were suggested to result in inappropriate hospital admissions. Current systems were perceived by participants to not work well—paper advance care planning (ACP) documentation was often unavailable or inaccessible, meaning it could not be used to inform decision-making at the point of care. Participants acknowledged the benefits of an EPaCCS to facilitate information sharing; however, they also raised concerns about confidentiality, and availability of the increased time and resources required to access and maintain such a system.

Conclusions

EPaCCS offer a potential solution to information sharing challenges in end-of-life care. However, our findings suggest that there are issues in the initiation and documentation of end-of-life discussions that must be addressed through investment in training in order to ensure that there is sufficient information regarding ACP to populate the system. There is a need for further qualitative research evaluating use of an EPaCCS, which explores benefits and challenges, uptake and reasons for disparities in use to better understand the potential utility and implications of such systems.
Cognitive behavioural therapy in groups for medicated adults with attention deficit hyperactivity disorder: protocol for a randomised controlled trial
Authors: Pan Mei-Rong , Zhao Meng-Jie , Liu Lu , Li Hai-Mei , Wang Yu-Feng , Qian Qiu-Jin
Published: October 2020

Introduction

Cognitive behavioural therapy (CBT) is an evidence-based treatment for adults with attention deficit hyperactivity disorder (ADHD). However, it is still inconsistent whether a combination of CBT would have additive effects in medicated ADHD in adulthood. And if CBT would have additional effects, what kind and which dimension would CBT play a part? This study estimates the efficacy of CBT in stable medicated adult ADHD, using long-term outcomes and multidimensional evaluations.

Methods and analysis

It is a two-armed, randomised controlled trial on the superiority of the efficacy of 12 weeks of CBT on medicated adult ADHD. We compare the short-term and long-term outcomes between CBT combined with medication (CBT+M) group and the medication-only (M) group, including ADHD core symptoms, emotional symptoms, executive function, self-esteem, life quality and brain function using functional near-infrared spectroscopy data. Participants are outpatients of the Peking University Sixth Hospital and those recruited online, diagnosed as adult ADHD and with stable medication treatment. We estimate ADHD core symptoms and combined symptoms at baseline (T1) and week 12 (T2), week 24 (T3), week 36 (T4) and week 48 (T5).

Ethics and dissemination

This trial has been approved by the Ethics and Clinical Research Committees of Peking University Sixth Hospital and will be performed under the Declaration of Helsinki with the Medical Research Involving Human Subjects Act (WMO). The results will be disseminated in a peer-reviewed journal and a conference presentation.

Trial registration number

ChiCTR (ChiCTR1900021705).
5-HT3receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials
Authors: Shen Qi-Hong , Li Hui-Fang , Zhou Xuyan , Lu Yaping , Yuan Xiao-Zong
Published: October 2020

Objective

Perioperative shivering (POS) is a common complication in patients undergoing spinal anaesthesia. The present study investigated the efficacy of 5-HT3receptor antagonists in preventing POS following spinal anaesthesia.

Design

Systematic review and meta-analysis.

Data sources

Pubmed, Embase, the Web of Science and Cochrane Library were searched from database establishment on 31 July 2019.

Eligibility criteria

Randomised controlled trials that reported the effects of 5-HT3receptor antagonists in the prevention of POS in patients after spinal anaesthesia.

Data extraction and synthesis

Two reviewers independently extracted data. The primary outcome of the present study was the incidence of POS. The risk of bias for the included studies was assessed according to the Cochrane Handbook. The quality of primary outcome was evaluated by Grading of Recommendations Assessment, Development and Evaluation. Trial sequential analysis for the primary outcome was performed to reduce the type 1 error caused by repeated meta-analysis and the required information size was calculated.

Results

A total of 13 randomised controlled trials consisting of 1139 patients were included. The overall incidence of POS was significantly lower in the 5-HT3receptor antagonists group (risk ratio 0.31; 95% CI 0.26 to 0.38; p<0.01; I2=0%). Subgroup analysis for different types of 5-HT3receptor antagonists and timing of administration produced similar results. Also, patients had a lower incidence of postoperative nausea and vomiting after administrating 5-HT3 receptor antagonists. No statistically significant differences in drug-related adverse effects were observed. Grading of Recommendations Assessment, Development and Evaluation revealed a high level of evidence. The cumulative z-curve crossed the trial sequential monitoring boundary.

Conclusions

The present study revealed that prophylactic 5-HT3receptor antagonists were an effective measure for reducing the incidence of POS in patients after spinal anaesthesia. However, further studies investigating the different types of surgeries are required.

PROSPERO registration number

CRD42019148191.
Incremental effect of non-invasive oscillating device on chest physiotherapy in critically ill children: a cross-over randomised trial
Authors: Kawaguchi Atsushi , Bernier Gabrielle , Adler Andy , Emeriaud Guillaume , Jouvet Philippe A
Published: October 2020

Introduction

Chest physiotherapy (CPT) and intrathoracic percussion ventilation have been recognised as to encourage dislodging the secretions; nonetheless, the tolerance to the procedure and its efficiency have not been proven to be sufficient.

Method and analyses

This study aims to examine the tolerance, feasibility and physiological effects in airway clearance by using a novel extrathoracic non-invasive oscillating transducer device (NIOD) in critically ill children. A two-stage cross-over randomised controlled study in a paediatric intensive care unit in a Canadian Academic Children’s Hospital will be applied. Children under 24 months old, for whom CPT is prescribed for airway clearance, will be included. The study consists of two stages; (1) Stage 1 ‘Frequency Level’: we will apply two different frequencies of the NIOD (40 Hz vs 60 Hz) for 12 min each, on each patient 3 hours apart, and (2) Stage 2 ‘NIOD versus CPT’: we will implement NIOD and CPT alternatingly for 3 hours apart. The order of the procedures will be randomly allocated for each case. We will compare the average Δchanges of tidal lung volume measured by a 3D imaging system and regional lung functions using electrical impedance tomography, between the two different frequencies and between the NIOD periods and the CPT periods. We will also examine tolerance by seeing COMFORT Scales and related complications during the procedures. We estimate necessary sample size as 6 for each arm (Total 12 cases) for stage 1 and 48 cases for Stage 2, with power of 0.8 and alpha of 0.05.

Ethics and dissemination

This study has been approved by the Health Research Ethics Board of University of Montreal, Canada (REB number: 2020-2471). We will disseminate our findings through peer-reviewed publications and conference presentations in paediatric or/and critical care fields.

Trial registration number

ClinicalTrials.gov Registry (NCT03821389).
Social work leadership competencies in health and mental healthcare: a scoping review protocol
Authors: Hussain Amina , Ashcroft Rachelle
Published: October 2020

Introduction

Leadership skills are an integral part of effective social work practice in health and mental healthcare settings. Social workers require critical leadership skills to effectively support, treat and advocate for the complex needs of those most vulnerable. Despite an increasing focus on social work leadership within the last decade, there has been a paucity of research on social work leadership competencies within the realm of health and mental health service provision. To bridge this gap, this scoping review will synthesise and map the current literature on social work leadership competencies in health and mental healthcare.

Methods and analysis

Arksey and O’Malley’s five-stage framework for scoping reviews will guide our search of six academic databases including: PsycINFO, OVID Social Work Abstracts, OVID Medline, Sociological Abstracts, Social Services Abstracts and CINAHL Plus with Full Text. Selected articles that meet inclusion criteria will then be reviewed and charted. Recurrent themes will be reviewed through a qualitative thematic analysis, and reported in both text and figures.

Ethics and dissemination

Findings will highlight key social work leadership competencies as they relate to social work practice, team dynamics, and client outcomes within health and mental healthcare. Material retrieved in this scoping review was selected from publicly available sources, and thus as an obtrusive research method, this review does not warrant ethics approval. Findings from this review will be disseminated through published scholarly material, as well as presented at conferences pertaining to social work research, practice and education.
A multicentre, randomised trial of stabilisation with nasal high flow during neonatal endotracheal intubation (the SHINE trial): a study protocol
Authors: Hodgson Kate A , Owen Louise S , Kamlin Camille Omar , Roberts Calum T , Donath Susan M , Davis Peter G , Manley Brett James
Published: October 2020

Introduction

Neonatal endotracheal intubation is an essential but potentially destabilising procedure. With an increased focus on avoiding mechanical ventilation, particularly in preterm infants, there are fewer opportunities for clinicians to gain proficiency in this important emergency skill. Rates of successful intubation at the first attempt are relatively low, and adverse event rates are high, when compared with intubations in paediatric and adult populations. Interventions to improve operator success and patient stability during neonatal endotracheal intubations are needed. Using nasal high flow therapy extends the safe apnoea time of adults undergoing upper airway surgery and during endotracheal intubation. This technique is untested in neonates.

Methods and analysis

The Stabilisation with nasal High flow during Intubation of NEonates (SHINE) trial is a multicentre, randomised controlled trial comparing the use of nasal high flow during neonatal intubation with standard care (no nasal high flow). Intubations are randomised individually, and stratified by site, use of premedications, and postmenstrual age (<28 weeks’ gestation; ≥28 weeks’ gestation). The primary outcome is the incidence of successful intubation on the first attempt without physiological instability of the infant. Physiological instability is defined as an absolute decrease in peripheral oxygen saturation >20% from preintubation baseline and/or bradycardia (<100 beats per minute).

Ethics and dissemination

The SHINE trial received ethical approval from the Human Research Ethics Committees of The Royal Women’s Hospital, Melbourne, Australia and Monash Health, Melbourne, Australia. The trial is currently recruiting in these two sites. The findings of this study will be disseminated via peer-reviewed journals and presented at national and international conferences.

Trial registration number

ACTRN12618001498280.
Marriage-based pilot clean household fuel intervention in India for improved pregnancy outcomes
Authors: Pillarisetti Ajay , Roy Sudipto , Diamond-Smith Nadia , Ghorpade Makarand , Dhongade Arun , Balakrishnan Kalpana , Sambandam Sankar , Patil Rutuja , Levine David I , Juvekar Sanjay , Smith Kirk R
Published: October 2020

Introduction

Health interventions often target pregnant women and their unborn children. Interventions in rural India targeting pregnant women, however, often do not cover the critical early windows of susceptibility during the first trimester and parts of the second trimester. This pilot seeks to determine if targeting newlyweds could protect entire pregnancies with a clean stove and fuel intervention.

Methods

We recruited 50 newlywed couples who use biomass as a cooking fuel into a clean cooking intervention that included a liquefied petroleum gas (LPG) stove, two gas cylinders, a table to place the stove on and health education. We first evaluated whether community health workers in this region could identify and recruit couples at marriage. We quantified how many additional days of pregnancy could be covered by an intervention if we recruited at marriage versus recruiting after detection of pregnancy.

Results

On average, we identified and visited newlywed couples within 40 (SD 21) days of marriage. Of the 50 couples recruited, 25 pregnancies and 18 deliveries were identified during this 1-year study. Due to challenges securing fuel from the LPG supply system, not all couples received their intervention prior to pregnancy. Regardless, couples recruited in the marriage arm had substantially more days with the intervention than couples recruited into a similar arm recruited at pregnancy (211 SD 46 vs 120 SD 45). At scale, a stove intervention targeting new marriages would cover about twice as many weeks of first pregnancies as an intervention recruiting after detection of pregnancy.

Conclusions

We were able to recruit in early marriage using existing community health workers. Households recruited early in marriage had more days with clean fuel coverage than those recruited at pregnancy. Our findings indicate that recruitment at marriage is feasible and warrants further exploration for stove and other interventions targeting pregnancy-related outcomes.