bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative clinico‐dermoscopic study of intralesional injection of combined digoxin and furosemide, Candida antigen, and vitamin D3 for multiple warts
Authors: Nasr Mohamed , Abdelaty Sara , Elkholy Basma M.
Published: January 2023

Background

Immunostimulatory and antiproliferative therapies have been widely used for the treatment of multiple warts. Recently, anti‐HPV activity of ionic contra viral therapy (ICVT) which is comprised of combined digoxin and furosemide has been demonstrated.

Aim

To evaluate and compare the effectiveness and safety of intralesional injection of Candida antigen, vitamin D3, and combined digoxin and furosemide in the treatment of multiple warts.

Patients and Methods

Seventy‐five patients with numerous warts were randomly assigned to one of three equal groups: Candida antigen, vitamin D3, or a combination of digoxin and furosemide. In the Candida antigen group, injections into the biggest wart were done. In the vitamin D3 and combined digoxin/furosemide groups, the agent was injected into each wart with a maximum of five injected warts. Injections were repeated every 2 weeks until clearance or for a total of five sessions.

Results

There was a statistically significant difference in the overall therapeutic response among the studied groups in favor of the intralesional Candida antigen group (60%), followed by the vitamin D3 group (48%) and the ionic contraviral therapy group (28%) (p = 0.02). However, the difference between both Candida antigen and vitamin D groups was not significant (p = 0.59).

Conclusions

Intralesional Candida antigen immunotherapy and vitamin D3 antiproliferative therapy are significantly more effective than ICVT.

Limitations

Short follow‐up period and relatively small sample size.
Microwave‐assisted and chemically tailored chlorogenic acid‐functionalized silver nanoparticles of Citrus sinensis in gel matrix aiding QbD design for the treatment of acne
Authors: Alam Aftab , Foudah Ahmed I. , Alqarni Mohammed H. , Yusufoglu Hasan S.
Published: January 2023

Background

Numerous studies have shown that various products of Citrus sinensis, for example, crude extracts, essential oil, and purified components, possess anti‐acne properties. However, the development of chlorogenic acid‐functionalized silver nanoparticles of C. sinensis in gel matrix aiding QbD design has not been evaluated for acne treatment.

Aim

In this study, we have developed chlorogenic acid‐functionalized silver nanoparticles of C. sinensis in a gel matrix employing a QbD approach for acne treatment.

Material and Method

Citrus sinensis extract‐loaded silver nanoparticles were functionalized with chlorogenic acid, which acted as a bio‐reducing agent and further improved anti‐acne properties. The developed formulation was optimized via Box‐Behnken Design. The formulation morphology was evaluated by transmission electron microscopy (TEM). The release profile of C. sinensis extract formulation was assessed by an in vitro release study and confocal laser scanning microscopy (CLSM). Moreover, the characterization study of the gel was performed that included an evaluation of the extrudability and spreadability of the developed gel. Furthermore, the anti‐oxidant efficacy of AgN‐CA formulation was validated using the DPPH test.

Results

The results showed a particle size of 71.78 nm, a polydispersity index of 0.297, a zeta potential of −36.12 mV, and an entrapment efficiency of 79.42% ± 6.79%. The results also indicated a uniform particle size. The release profile of C. sinensis extract revealed that 73.95% of the drug was released, whereas CLSM pictures of mice skin evidently demonstrated that the rhodamine B‐treated AgN‐CA gel penetrated much more extensively in comparison to the control. Furthermore, the anti‐oxidant efficacy of AgN‐CA formulation was validated using the DPPH test. Moreover, the characterization study of the developed gel, including its extrudability and spreadability, was found to be 16.02 ± 3.21 g and 30.73 ± 5.94 g cm/s, respectively. Also, texture analysis findings revealed that AgN‐CA gel had firmness, consistency, cohesiveness, and viscosity index of 159.69 g, 634.95 g s, −116.33 g, and −501.80 g s, respectively, indicating that the AgN‐CA gel was stable.

Conclusion

The current study showed that AgN‐CA is an effective drug carrier system for the topical administration of C. sinensis extract for the treatment of acne.
The effect of aromatase inhibitor on controlled ovarian stimulation for oocyte cryopreservation in adolescent and young cancer patients
Authors: Suzuki Reiko , Horage‐Okutsu Yuki , Kawahara Tai , Nakamura Kentaro , Shiraishi Eriko , Iwahata Hideyuki , Suzuki‐Takahashi Yuki , Sugishita Yodo , Takae Seido , Suzuki Nao
Published: January 2023

Aim

To determine the impact of aromatase inhibitor (AI) use in oocyte cryopreservation among Japanese adolescent and young adult (AYA) cancer patients for fertility preservation, we evaluated the oocyte cryopreservation outcomes following AI therapy in combination with the follicular phase start (FPS) and random start (RS) protocols.

Methods

This retrospective study included 81 cycles of controlled ovarian stimulation (COS) among 73 AYA patients with cancer who underwent oocyte cryopreservation to maintain fertility. The outcome measures were the total number of matured oocytes that were retrieved and cryopreserved, as well as their maturation rates. The AI (+) and AI (−) groups were compared using the RS and FPS protocols.

Results

Our results showed that the combined use of AI and COS decreases serum E2 levels and maintains the number of retrieved and cryopreserved mature oocytes. We also confirmed the efficacy of the RS protocol, which was found to have comparable outcomes to that of the FPS protocol in both AI (+) and AI (−) groups.

Conclusion

The combined use of AI and COS is beneficial for oocyte cryopreservation in patients with estrogen‐sensitive cancer, regardless of the menstrual cycle phase of COS initiation.
“Kill the chicken to scare the monkey”: Heavy penalties, excessive COVID‐19 control mechanisms, and legal consciousness in China
Authors: Liu Qian
Published: January 2023

This study analyses the legal consciousness of Chinese citizens during the COVID‐19 pandemic when the authoritarian state invoked heavy penalties to deter noncompliance with its excessive COVID‐19 restrictions. China used the approach of “killing the chicken to scare the monkey,” publicly punishing those who violated restrictions in order to deter noncompliance. This article explains why ordinary citizens supported this selective application of the law, as well as how the possibility of being the “chicken” contributed to their compliance (or noncompliance) with excessive COVID‐19 restrictions. It suggests that the uncertainty and unpredictability of law in the authoritarian state bred fear, which then led to compliance, regardless of the lack of procedural fairness. People's dissatisfaction with the rules, however, led them to tolerate and even support the noncompliance of people they trusted.
Residents as supervisors: How senior residents make ad hoc entrustment decisions
Authors: Nelson Kayla , McQuillan Sarah , Gingerich Andrea , Regehr Glenn
Published: January 2023

Background

As residency programmes transition to competency‐based medical education, there has been substantial inquiry into understanding how ad hoc entrustment decisions are made by attending supervisors in the clinical context. However, although attendings are ultimately responsible for the decisions and actions of resident trainees, senior residents are often the ones directly supervising junior residents enrolled in competency‐based training programmes. This clinical dynamic has been largely overlooked in the ad hoc entrustment literature. The purpose of this study was to explore the considerations senior residents entertain when making ad hoc entrustment decisions for their junior resident colleagues.

Methods

In semi‐structured interviews, 11 senior resident supervisors (third, fourth and fifth year) in obstetrics and gynaecology described how they entrust junior residents with clinical activities in the moment. Following constructivist grounded theory methodology, data were iteratively collected and coded with constant comparison until theoretical sufficiency was determined.

Results

Senior residents described many similar considerations as attendings regarding ad hoc entrustment of junior residents, including patient safety, desire to optimise the learning environment, junior resident qualities (such as discernment and communication skills), learner handover from colleagues, and situational factors. Uniquely, senior residents discussed how their role as a middle manager and their desire to protect the junior resident (from burnout, becoming a second victim and from attendings) impacts their decisions.

Conclusions

Although senior residents make ad hoc entrustment decisions with some similar considerations to attendings, they also seem to think about additional factors. It may be that these different considerations need to be accommodated in documentation of ad hoc entrustment decisions if these documents are to be used for high‐stakes summative entrustment decisions made by competency committees.
Galactomannan utilization by Cellvibrio japonicus relies on a single essential α‐galactosidase encoded by the aga27A gene
Authors: Novak Jessica K. , Gardner Jeffrey G.
Published: January 2023

Plant mannans are a component of lignocellulose that can have diverse compositions in terms of its backbone and side‐chain substitutions. Consequently, the degradation of mannan substrates requires a cadre of enzymes for complete reduction to substituent monosaccharides that can include mannose, galactose, and/or glucose. One bacterium that possesses this suite of enzymes is the Gram‐negative saprophyte Cellvibrio japonicus, which has 10 predicted mannanases from the Glycoside Hydrolase (GH) families 5, 26, and 27. Here we describe a systems biology approach to identify and characterize the essential mannan‐degrading components in this bacterium. The transcriptomic analysis uncovered significant changes in gene expression for most mannanases, as well as many genes that encode carbohydrate active enzymes (CAZymes) when mannan was actively being degraded. A comprehensive mutational analysis characterized 54 CAZyme‐encoding genes in the context of mannan utilization. Growth analysis of the mutant strains found that the man26C, aga27A, and man5D genes, which encode a mannobiohydrolase, α‐galactosidase, and mannosidase, respectively, were important for the deconstruction of galactomannan, with Aga27A being essential. Our updated model of mannan degradation in C. japonicus proposes that the removal of galactose sidechains from substituted mannans constitutes a crucial step for the complete degradation of this hemicellulose.
Understanding local plant extinctions before it is too late: bridging evolutionary genomics with global ecology
Authors: Exposito‐Alonso Moi
Published: January 2023

Understanding evolutionary genomic and population processes within a species range is key to anticipating the extinction of plant species before it is too late. However, most models of biodiversity risk under global change do not account for the genetic variation and local adaptation of different populations. Population diversity is critical to understanding extinction because different populations may be more or less susceptible to global change and, if lost, would reduce the total diversity within a species. Two new modeling frameworks advance our understanding of extinction from a population and evolutionary angle: Rapid climate change‐driven disruptions in population adaptation are predicted from associations between genomes and local climates. Furthermore, losses of population diversity from global land‐use transformations are estimated by scaling relationships of species' genomic diversity with habitat area. Overall, these global eco‐evolutionary methods advance the predictability – and possibly the preventability – of the ongoing extinction of plant species.
Examining need and capacity for the development of a pediatric liver transplantation program in Kenya
Authors: Muncner Susan , Dell Angela J. , Mwita Clifford , Bigam David , Saleh Abdullah
Published: January 2023

Background

In Africa, pediatric liver transplantation (PLT) is currently only performed in Egypt and South Africa, leaving those who require treatment in Kenya to travel abroad. The aim of this study was to determine whether sufficient capacity and need exists in Kenya to establish a safe and sustainable PLT program.

Methods

A descriptive analysis of the intensive care unit (ICU) beds, surgical workforce, current hepatobiliary volume, and estimated prevalence of pediatric liver disease (PLD) was conducted across 17 hospitals in Kenya between July and September 2020. Data were collected from medical superintendents, directors of surgical departments, or nominated proxies at Kenyan Level 5 and 6 hospitals via a web‐based survey.

Results

A total of 165 ICU beds were reported at 17 facilities, with 15 facilities reporting five or more beds. About 39% of general surgeons at responding hospitals performed hepatobiliary procedures, and 30% performed pediatric surgeries. Only 10% of surgeons had pediatric training. Over half (57%) of hospitals performed hepatobiliary procedures; at the maximum, 1–5 cases were performed per week including cholecystectomy to Kasai portoenterostomy and hepatectomy. Across 13 hospitals, there were an estimated 192–570 cases of PLD seen per month. The most common PLDs were hepatitis B, neonatal hepatitis, cirrhosis, and acute hepatic failure. Overall, two hospitals possessed the minimum workforce and resources to attempt PLT.

Conclusions

In Kenya, ICU bed availability, pediatric surgical training, and hepatobiliary volume are limited. However, the high prevalence of PLD demonstrated a significant need for PLT across all Kenyan hospitals.
Dental trauma in children and adolescents with attention‐deficit/hyperactivity disorder: A systematic review and meta‐analysis
Authors: Drumond Victor Zanetti , de Oliveira Thaynara Nascimento , de Arruda José Alcides Almeida , Mesquita Ricardo Alves , Abreu Lucas Guimarães
Published: January 2023

Aim

Attention‐deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder primarily characterized by inattention and hyperactivity that affects approximately 7.2% of children and adolescents worldwide. This study aimed to assess whether children and adolescents with ADHD were more likely to have dental trauma when compared to their healthy peers.

Methods

This study was reported following the statements proposed in MOOSE (Meta‐analyses Of Observational Studies in Epidemiology). PubMed, Web of Science, Scopus, Embase, APA PsycINFO, LILACS, and grey literature were searched until October 2022. Observational studies with a control group were eligible. The risk of bias was assessed using the Newcastle‐Ottawa Scale. The meta‐analysis was performed using the R language. GRADE (Grading of Recommendations Assessment, Development and Evaluation) was applied.

Results

A total of 239 studies were detected; of these, six were included in the qualitative synthesis and four were merged in the meta‐analysis (OR = 1.80 [1.16–2.80]; I2 = 18.6% [0.0%–87.5%]). The risk of bias was high. The strength of the evidence was “very low.”

Conclusion

Children and adolescents with ADHD are more likely to have dental trauma than their non‐ADHD peers. However, due to limitations in the design of the included studies, a causal relationship cannot be established.
The allopolyploid origin of Euphorbia stevenii and E. boöphthona (Euphorbiaceae)
Authors: PARK Ki-Ryong
Published: January 2023

To elucidate the ancestry of the allopolyploids E. stevenii and E. boöphthona, I examined eleven isozyme loci and 24 morphological characters from 28 populations representing five related Euphorbia species from Australia. According to an analysis of genetic and morphological data, three diploid species differentiated recently, but two independent polyploid species are estimated to have differentiated a relatively long time ago. Fixed heterozygosity for most isozymes in E. stevenii and E. boöphthona strongly suggests that these two species are allopolyploids rather than autopolyploids. The isozyme profiles of E. stevenii indicate that it is an allopolyploid that evolved from interspecific hybridization between the diploid E. tannensis and unidentified or extinct tetraploid species. In addition, isozyme patterns strongly suggest that E. stevenii was one of the ancestors of E. boöphthona. However, E. boöphthona showed a large number of fixed alleles that were not detected in any other Australian Eremophyton species. The most likely hypothesis for the origin of E. boöphthona is that it was formed by hybridization and chromosomal doubling between an extinct diploid species and the hexaploid E. stevenii.
Enumeration of edible and useful ferns (Pteridophytes) in the Bhutan Himalayas
Authors: DORJI Rinchen , GYELTSHEN Choki , PHUENTSHO  , WANGMO Karma Ugyen , DORJI encho
Published: January 2023

Bhutan is endowed with rich biodiversity with several edible and useful fern species. Ferns have been used by local communities for centuries as vegetables, ethnobotanical artifacts, and as medicines. Owing to the limited study of edible and useful pteridophytes in the country, the knowledgebase remains poor. In this study, we attempt to document edible and useful fern species in the country scientifically while also providing an annotated checklist.
A new record of Carex foraminata (Cyperaceae) in Korean flora
Authors: KIM Jung-Hyun , KIM Jin-Seok , HYUN Chang Woo , CHOI Bongsu
Published: January 2023

We report a new distribution of Carex foraminata C. B. Clarke on the Korean Peninsula. This species was first reported in China and is distributed in Jiangxi and Zhejiang Provinces. We found this species on Hongdo Island in Heuksan-myeon, Shinan-gun, Jeollanam- do in Korea. Carex foraminata is similar to the related taxa C. brevispicula G. H. Nam & G. Y. Chung, C. chungii Z. P. Wang, and C. genkaiensis Ohwi in that its achenes are constricted in the middle part. However, C. foraminata is distinguished from C. brevispicula and C. chungii by its pistillate scale apexes, which are acute or shortly awned and by its achene apexes, which are shortly cylindrical; C. foraminata is distinguished from C. genkaiensis by its pistillate scale and achene shape. A precise description, illustration, photographs, and a key to related taxa are provided.
Clerodendrum ervatamioides (Lamiaceae): A new record to the flora of Vietnam
Authors: KIM Heyjoong , HAI Do Van , THIEN Tran Duc , BACH Tran The , QUANG Bui Hong , HOAN Duong Thi , HAN Le Ngoc , BINH Tran Duc , CHOUDHARY Ritesh Kumar , LEE Joongku
Published: January 2023

Clerodendrum ervatamioides C. Y. Wu was described in 1977 with its type locality in Yunnan, China. During our floristic investigation in the Muong Nhe Nature Reserve of Vietnam of Dien Bien province and in the Muong Te district of the Lai Chau province, we collected several specimens of Clerodendrum ervatamioides, marking the first record of its occurrence in Vietnam. In this paper, details of the morphological features, distribution, ecology, photo plates, and a table comparing the morphological features with its ally Clerodendrum garrettianum Craib are provided.
Complete chloroplast genome sequence of Clematis calcicola (Ranunculaceae), a species endemic to Korea
Authors: PARK Beom Kyun , JANG Young-Jong , SON Dong Chan , GIL Hee-Young , KIM Sang-Chul
Published: January 2023

The complete chloroplast genome (cp genome) sequence of Clematis calcicola J. S. Kim (Ranunculaceae) is 159,655 bp in length. It consists of large (79,451 bp) and small (18,126 bp) single-copy regions and a pair of identical inverted repeats (31,039 bp). The genome contains 92 protein-coding genes, 36 transfer RNA genes, eight ribosomal RNA genes, and two pseudogenes. A phylogenetic analysis based on the cp genome of 19 taxa showed high similarity between our cp genome and data published for C. calcicola, which is recognized as a species endemic to the Korean Peninsula. The complete cp genome sequence of C. calcicola reported here provides important information for future phylogenetic and evolutionary studies of Ranunculaceae.
The complete chloroplast genome sequence of Dracocephalum rupestre (Lamiaceae)
Authors: KIM Young-Soo , KIM Sang-Chul , HA Young-Ho , KIM Hyuk-Jin
Published: January 2023

Dracocephalum rupestre Hance is a perennial herb distributed across China, Mongolia, and Korea. This study reports the first complete chloroplast genome sequence of D. rupestre. The plastome is 151,230 bp long and exhibits a typical quadripartite structure comprising a large single-copy region of 82,536 bp, a small single-copy region of 17,408 bp, and a pair of identical inverted repeat regions of 25,643 bp each. It contains 130 genes, comprising 85 protein-coding genes, 37 tRNA genes, and eight rRNA genes. Phylogenetic analysis of D. rupestre and related species of Lamiaceae showed that the genus Dracocephalum is a monophyletic group, and D. rupestre is most closely related to D. psammophilum.
The Importance of Quantum Information in the Stock Market and Financial Decision Making in Conditions of Radical Uncertainty
Authors: Njegovanović Ana
Published: January 2023

The Universe is a coin that’s already been flipped, heads or tails predetermined: all we’re doing is uncovering it the ‘paradox’ is only a conflict between reality and your feeling of what reality ‘ought to be’.Richard FeynmanThe aim of the research takes place through two parallel directions. The first is gaining an understanding of the applicability of quantum mechanics/quantum physics to human decision-making processes in the stock market with quantum information as a decision-making lever, and the second direction is neuroscience and artificial intelligence using postulates analogous to the postulates of quantum mechanics and radical uncertainty in conditions of radical uncertainty.The world of radical uncertainty (radical uncertainty is based on the knowledge of quantum mechanics from the claim that there is no causal certainty). it is everywhere in our world. "Radical uncertainty is characterized by vagueness, ignorance, indeterminacy, ambiguity and lack of information. He prefers to create 'mysteries' rather than 'puzzles' with defined solutions. Mysteries are ill-defined problems in which action is required, but the future is uncertain, the consequences unpredictable, and disagreement inevitable. "How should we make decisions in these circumstances?" (J. Kay and M. King, 2020), while "uncertainty and ambiguity are at the very core of the stock market. "Narratives are the currency of uncertainty" (N. Mangee, 2022).
Humbang Hasundutan Regional Head Election In 2020: Empty Box Volunteer Political Communication Movement
Authors: Nasution Faiz Albar , Thamrin Muhammad Husni , Sinaga Randa Putra Kasea , Saraan Muhammad Imanuddin Kandias , Indainanto Yofiendi Indah
Published: January 2023

The occurrence of a single candidate in the 2020 Humbang Hasundutan District Head Election has spawned political communication to choose an empty box. The empty box volunteer political movement influences voters to vote for blank ballots in the name of ideal democracy. This study examines how empty-box volunteers convey their political messages in music to voters. Qualitative research methods with framing analysis approaches are used to analyze data or political messages in songs against political movements of empty box volunteers. Data collection techniques through literature studies show five songs about the Empty Boxes in the 2020 Humbang Hasundutan Regional Head Election. The results show that the Empty Boxes volunteers place the issue of Empty Boxes Democracy as the main issue with various frames of political messages in the Empty Boxes song. The five songs of empty box volunteer articulate, frame, highlight, and disseminate political messages on three themes, among others, ideal democracy, democracy becomes a movement for change and democracy against political elites.
Surface property control for 193 nm immersion resist by addition of Si compound
Authors: Tang Chen , Sekiguchi Atsushi , Ohta Yosuke , Hirai Yoshihiko , Yasuda Masaaki
Published: January 2023

In ArF immersion lithography, the presence of immersion liquid between the resist surface and the lens causes problems, such as the leaching of the photoacid generator into the liquid and the presence of residual liquid on the resist surface, which can result in watermarks and other defects. One method to address such issues is adding an F-based compound with low dry-etch resistance to the resist. In the present study, we developed a novel resist for ArF immersion exposure that replaces the F compound with an Si (dimethylpolysiloxane)-based additive to enhance dry-etch resistance. We experimentally evaluated contact angles with respect to water and developer solution, depth concentration of the additives (segregation), agent dissolution (leaching), dry-etch resistance, and spectral transmittance of the comparative resists. Simulation studies were performed to evaluate pattern profiles. The developed resist with the Si-based additive showed improved properties compared with that with the F-based additive.
Multiplexing mRNAs builds a “broad-immunity wall” against the flu
Authors: Catanzaro Nicholas J. , Martinez David R.
Published: January 2023

Delivery of mRNAs encoding influenza HA antigens covering all known subtypes and lineages elicits cross-reactive and protective immunity.
Understanding maternity care providers’ use of data in Southern Tanzania
Authors: Unkels Regine , Alwy Al-Beity Fadhlun , Julius Zamoyoni , Mkumbo Elibariki , Pembe Andrea B , Hanson Claudia , Molsted-Alvesson Helle
Published: January 2023

Introduction

Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers’ perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use.

Methods

We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards to understand maternity providers’ interaction with data in two rural hospitals in Southern Tanzania. Constant comparative data analysis was applied to develop initial and focused codes, subcategories and categories were continuously validated through peer and member checks.

Results

Maternity care providers found routine health information data of little use to reconcile demands from managers, the community and their challenging working environment within their daily work. They thus added informal narrative documentation sources. They created alternative narratives through data of a maternity care where mothers and babies were safeguarded. The resulting documentation system, however, led to duplication and increased systemic complexity.

Conclusions

Current health information systems may not meet all data demands of maternity care providers, or other healthcare workers. Policy makers and health information system specialists need to acknowledge different ways of data use beyond health service planning, with an emphasis on healthcare providers’ data needs for clinical documentation.
SOBRINA Spanish study—analysing the frequency, cost and adverse events
associated with overuse in primary care: protocol for a retrospective cohort
study
Authors: Mira José Joaquín , Carrillo Irene , Gea Velázquez de Castro María Teresa , Silvestre Carmen , Olivera Guadalupe , Caro-Mendivelso Johanna , Pérez-Pérez Pastora , Agra Yolanda , Fernández Ana Mª , Aranaz-Andrés Jesús Maria
Published: January 2023

Introduction

Several institutions and quality national agencies have fostered the
creation of recommendations on what not to do to reduce overuse in
clinical practice. In primary care, their impact has hardly been
studied. The frequency of adverse events (AEs) associated with doing
what must not be done has not been analysed, either. The aim of this
study is to measure the frequency of overuse and AEs associated with
doing what must not be done (commission errors) in primary care and
their cost.

Methods and analysis

A coordinated, multicentric, national project. A retrospective
cohort study using computerised databases of primary care medical
records from national agencies and regional health services will be
conducted to analyse the frequency of the overuse due to ignore the
do-not-do recommendations, and immediately afterwards, depending on
their frequency, a representative random sample of medical records will
be reviewed with algorithms (triggers) that determine the frequency of
AEs associated with these recommendations. Cost will determine by
summation of the direct costs due to the consultation, pharmacy,
laboratory and imaging activities according to the cases.

Ethics and dissemination

The study protocol has been approved by the Ethics Committee of
Primary Care Research of the Valencian Community. We aim to disseminate
the findings through international peer-reviewed journals and on the
website (http://www.nohacer.es/).Outcomes will be used to
incorporate algorithms into the electronic history to assist in making
clinical decisions.

Trial registration number

NCT03482232; Pre-results.
Qualitative study of pathways to care among adults with diabetes in rural Guatemala
Authors: Chary Anita Nandkumar , Nandi Meghna , Flood David , Tschida Scott , Wilcox Katharine , Kurschner Sophie , Garcia Pablo , Rohloff Peter
Published: January 2023

Objective

The burden of diabetes mellitus is increasing in low-income and middle-income countries (LMICs). Few studies have explored pathways to care among individuals with diabetes in LMICs. This study evaluates care trajectories among adults with diabetes in rural Guatemala.

Design

A qualitative investigation was conducted as part of a population-based study assessing incidence and risk factors for chronic kidney disease in two rural sites in Guatemala. A random sample of 807 individuals had haemoglobin A1c (HbA1c) screening for diabetes in both sites. Based on results from the first 6 months of the population study, semistructured interviews were performed with 29 adults found to have an HbA1c≥6.5% and who reported a previous diagnosis of diabetes. Interviews explored pathways to and experiences of diabetes care. Detailed interview notes were coded using NVivo and used to construct diagrams depicting each participant’s pathway to care and use of distinct healthcare sectors.

Results

Participants experienced fragmented care across multiple health sectors (97%), including government, private and non-governmental sectors. The majority of participants sought care with multiple providers for diabetes (90%), at times simultaneously and at times sequentially, and did not have longitudinal continuity of care with a single provider. Many participants experienced financial burden from out-of-pocket costs associated with diabetes care (66%) despite availability of free government sector care. Participants perceived government diabetes care as low-quality due to resource limitations and poor communication with providers, leading some to seek care in other health sectors.

Conclusions

This study highlights the fragmented, discontinuous nature of diabetes care in Guatemala across public, private and non-governmental health sectors. Strategies to improve diabetes care access in Guatemala and other LMICs should be multisectorial and occur through strengthened government primary care and innovative private and non-governmental organisation care models.
Acceptability and feasibility of tuberculosis and diabetes mellitus bidirectional screening and joint treatment services in Malawi: a cross-sectional study and a policy document review
Authors: Nyirenda John LZ , Mbemba Erasmo , Chirwa Marumbo , Mbakaya Balwani , Ngwira Bagrey , Wagner Dirk , Toews Ingrid , Lange Berit
Published: January 2023

Objectives

A cross-sectional and a policy document review study was performed to investigate perceived acceptability and feasibility to implementing different integration measures for tuberculosis (TB) and diabetes mellitus (DM) healthcare among healthcare workers (HCWs) and health managers, and to describe policy influence through a policy documents review in Malawi.

Setting

The survey was performed at eight hospitals, ministry of health offices and 10 non-governmental organisations. We collected data in March and April 2021.

Participants

Of 95 HCWs and health managers invited; 92 participated. 21/92 (23%) were female, and 17/92 (18%) participants were from clinics that piloted the integrated care for TB and DM.

Outcome measures

We described awareness levels on TB/DM comorbidity, perceptions and experiences in TB/DM care. Furthermore, development processes and contents of included documents were analysed.

Results

16/17 (94%) of HCWs from clinics piloting integrated care and 65/75 (86%) HCWs from hospitals that do not use integrated care for TB and DM responded that integrated care was acceptable and feasible. In qualitative data, shortage of resources, inadequate information sharing were common themes. We included seven relevant documents for the analysis. On development process and content, six of seven documents were scored ≥70%. In these documents, DM is a recognised risk factor for TB, and integration of healthcare services for infectious diseases and non-communicable diseases is recommended, however, these documents lacked information specifically on integrated care for TB and DM.

Conclusion

In this study, we identified inadequate information sharing, and lack of resources as major factors impeding implementation of integration of services, however, awareness on TB/DM comorbidity was high.
Barriers and enablers to implementing clinical practice guidelines in primary care: an overview of systematic reviews
Authors: Wang Tao , Tan Jing-Yu (Benjamin) , Liu Xian-Liang , Zhao Isabella
Published: January 2023

Objectives

To identify the barriers and enablers to implementing clinical practice guidelines (CPGs) recommendations in primary care and to provide recommendations that could facilitate the uptake of CPGs recommendations.

Design

An overview of systematic reviews.

Data sources

Nine electronic databases (PubMed, Cochrane Library, CINAHL, MEDLINE, PsycINFO, Web of Science, Journals @Ovid Full Text, EMBase, JBI) and three online data sources for guidelines (Turning Research Into Practice, the National Guideline Clearinghouse and the National Institute for Health and Care Excellence) were searched until May 2021.

Eligibility criteria

Systematic reviews, meta-analyses or other types of systematic synthesis of quantitative, qualitative or mixed-methods studies on the topic of barriers and/or enablers for CPGs implementation in primary care were included.

Data extraction and synthesis

Two authors independently screened the studies and extracted the data using a predesigned data extraction form. The methodological quality of the included studies was appraised by using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Content analysis was used to synthesise the data.

Results

Twelve systematic reviews were included. The methodological quality of the included reviews was generally robust. Six categories of barriers and enablers were identified, which include (1) political, social and culture factors, (2) institutional environment and resources factors, (3) guideline itself related factors, (4) healthcare provider-related factors, (5) patient-related factors and (6) behavioural regulation-related factors. The most commonly reported barriers within the above-mentioned categories were suboptimal healthcare networks and interprofessional communication pathways, time constraints, poor applicability of CPGs in real-world practice, lack of knowledge and skills, poor motivations and adherence, and inadequate reinforcement (eg, remuneration). Presence of technical support (‘institutional environment and resources factors’), and timely education and training for both primary care providers (PCPs) (‘healthcare provider-related factors’) and patients (‘patient-related factors’) were the frequently reported enablers.

Conclusion

Policy-driven strategies should be developed to motivate different levels of implementation activities, which include optimising resources allocations, promoting integrated care models, establishing well-coordinated multidisciplinary networks, increasing technical support, encouraging PCPs and patients’ engagement in guideline development, standardising the reporting of guidelines, increasing education and training, and stimulating PCPs and patients’ motivations. All the activities should be conducted by fully considering the social, cultural and community contexts to ensure the success and sustainability of CPGs implementation.
Factors influencing participation in randomised clinical trials among patients with early Barrett’s neoplasia: a multicentre interview study
Authors: Peerally Mohammad Farhad , Jackson Clare , Bhandari Pradeep , Ragunath Krish , Barr Hugh , Stokes Clive , Haidry Rehan , Lovat Laurence B , Smart Howard , De Caestecker John
Published: January 2023

Objectives

Strong recruitment and retention into randomised controlled trials involving invasive therapies is a matter of priority to ensure better achievement of trial aims. The BRIDE (Barrett’s Randomised Intervention for Dysplasia by Endoscopy) Study investigated the feasibility of undertaking a multicentre randomised controlled trial comparing argon plasma coagulation and radiofrequency ablation, following endoscopic resection, for the management of early Barrett’s neoplasia. This paper aims to identify factors influencing patients’ participation in the BRIDE Study and determine their views regarding acceptability of a potential future trial comparing surgery with endotherapy.

Design

A semistructured telephone interview study was performed, including both patients who accepted and declined to participate in the BRIDE trial. Interview data were analysed using the constant comparison approach to identify recurring themes.

Setting

Interview participants were recruited from across six UK tertiary centres where the BRIDE trial was conducted.

Participants

We interviewed 18 participants, including 11 participants in the BRIDE trial and 7 who declined.

Results

Four themes were identified centred around interviewees’ decision to accept or decline participation in the BRIDE trial and a potential future trial comparing endotherapy with surgery: (1) influence of the recruitment process and participant–recruiter relationship; (2) participants’ views of the design and aim of the study; (3) conditional altruism as a determining factor and (4) participants’ perceptions of surgical risks versus less invasive treatments.

Conclusion

We identified four main influences to optimising recruitment and retention to a randomised controlled trial comparing endotherapies in patients with early Barrett’s-related neoplasia. These findings highlight the importance of qualitative research to inform the design of larger randomised controlled trials.
Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries
Authors: Joseph Jessica , Demke Owen , Ameyan Lola , Bitilinyu-Bango Joseph , Bourgoin Blandine , Diop Mamadou , Guèye Babacar , Kama Jibrin , Lubega Marvin , Madzima Bernard , Maparo Tatenda , Mhizha Tasimba , Musoke Andrew , Nabadda Susan , Phiri Twambilire , Tchereni Timothy , Wiwa Owens , Hariharan Karen , Peter Trevor , Khan Shaukat
Published: January 2023

Objectives

To demonstrate acceptability and operational feasibility of introducing human papillomavirus (HPV) testing as a principal cervical cancer screening method in public health programmes in sub-Saharan Africa.

Setting

45 primary and secondary health clinics in Malawi, Nigeria, Senegal, Uganda and Zimbabwe.

Participants

15 766 women aged 25–54 years presenting at outpatient departments (Senegal only, general population) or at antiretroviral therapy clinics (all other countries, HIV-positive women only). Eligibility criteria followed national guidelines for cervical cancer screening.

Interventions

HPV testing was offered to eligible women as a primary screening for cervical cancer, and HPV-positive women were referred for visual inspection with acetic acid (VIA), and if lesions identified, received treatment or referral.

Primary and secondary outcome measures

The primary outcomes were the proportion of HPV-positive women who received results and linked to VIA and the proportion of HPV-positive and VIA-positive women who received treatment.

Results

A total of 15 766 women were screened and tested for HPV, among whom 14 564 (92%) had valid results and 4710/14 564 (32%) were HPV positive. 13 837 (95%) of valid results were returned to the clinic and 3376 (72%) of HPV-positive women received results. Of women receiving VIA (n=2735), 715 (26%) were VIA-positive and 622 (87%) received treatment, 75% on the same day as VIA.

Conclusions

HPV testing was found to be feasible across the five study countries in a public health setting, although attrition was seen at several key points in the cascade of care, namely results return to women and linkage to VIA. Once women received VIA, if eligible, the availability of on-site cryotherapy and thermal ablation allowed for same-day treatment. With sufficient resources and supportive infrastructure to ensure linkage to treatment, use of HPV testing for cervical cancer screening as recommended by WHO is a promising model in low-income and middle-income countries.
Stress and coping strategies among parents of children with cancer at Tikur Anbessa Specialized Hospital paediatric oncology unit, Ethiopia: a phenomenological study
Authors: Deribe Leul , Addissie Adamu , Girma Eshetu , Abraha Aynalem , Adam Haileyesus , Berbyuk Lindström Nataliya
Published: January 2023

Objective

This study explores sources of stress, conditions that help reduce stress levels and coping strategies among parents of children with cancer receiving chemotherapy at Tikur Anbessa Specialized Hospital (TASH) in Ethiopia.

Design

A qualitative phenomenological approach was used.

Setting

Parents of children receiving chemotherapy at the TASH paediatric oncology unit.

Participants

Fifteen semistructured in-depth interviews were conducted with nine mothers and six fathers of children with cancer from November 2020 to January 2021.

Results

Sources of stress related to child’s health condition as the severity of the child’s illness, fear of treatment side effects and loss of body parts were identified. Parents mentioned experiencing stress arising from limited access to health facilities, long waiting times, prolonged hospital stays, lack of chemotherapy drugs, and limited or inadequate information about their child’s disease condition and treatment. Other sources of stress were insufficient social support, stigmatisation of cancer and financial problems. Conditions decreasing parents’ stress included positive changes in the child’s health, receiving cancer treatment and access to drugs. Receiving counselling from healthcare providers, getting social support and knowing someone who had a positive treatment outcome also helped reduce stress. Coping strategies used by parents were religious practices including prayer, crying, accepting the child’s condition, denial and communication with health providers.

Conclusion

The main causes of stress identified by parents of children with cancer in Ethiopia were the severity of their child’s illness, expectations of poor treatment outcomes, unavailability of cancer treatment services and lack of social/financial support. Measures that should be considered to reduce parents’ stress include providing psycho-oncological care for parents and improving the counselling available to parents concerning the nature of the child’s illness, its treatment, diagnostic procedures and treatment side effects. It may also be helpful to establish and strengthen family support groups and parent-to-parent communication, improve the availability of chemotherapy drugs and offer more education on coping strategies.
Family bereavement and organ donation in Spain: a mixed method, prospective cohort study protocol
Authors: Martinez-Lopez Maria Victoria , Coll Elisabeth , Cruz-Quintana Francisco , Dominguez-Gil Beatriz , Hannikainen Ivar R , Lara Rosales Ramón , Pérez-Blanco Alicia , Perez-Marfil Maria Nieves , Pérez-Villares Jose Miguel , Uruñuela David , Rodríguez-Arias David
Published: January 2023

Introduction

There is a discrepancy in the literature as to whether authorising or refusing the recovery of organs for transplantation is of direct benefit to families in their subsequent grieving process. This study aims to explore the impact of the family interview to pose the option of posthumous donation and the decision to authorise or refuse organ recovery on the grieving process of potential donors’ relatives.

Methods and analysis

A protocol for mixed methods, prospective cohort longitudinal study is proposed. Researchers do not randomly assign participants to groups. Instead, participants are considered to belong to one of three groups based on factors related to their experiences at the hospital. In this regard, families in G1, G2 and G3 would be those who authorised organ donation, declined organ donation or were not asked about organ donation, respectively. Their grieving process is monitored at three points in time: 1 month after the patient’s death, when a semistructured interview focused on the lived experience during the donation process is carried out, 3 months and 9 months after the death. At the second and third time points, relatives’ grieving process is assessed using six psychometric tests: State-Trait Anxiety Inventory, Beck Depression Inventory-II, Inventory of Complicated Grief, The Impact of Event Scale: Revised, Posttraumatic Growth Inventory and Connor-Davidson Resilience Scale. Descriptive statistics (means, SDs and frequencies) are computed for each group and time point. Through a series of regression models, differences between groups in the evolution of bereavement are estimated. Additionally, qualitative analyses of the semistructured interviews are conducted using the ATLAS.ti software.

Ethics and dissemination

This study involves human participants and was approved by Comité Coordinador de Ética de la Investigación Biomédica de Andalucía (CCEIBA) ID:1052-N-21. The results will be disseminated at congresses and ordinary academic forums. Participants gave informed consent to participate in the study before taking part.