bluuebunny/crossref_metadata_2025 huggingface dataset:
Individual and community level predictors of women’s autonomy in health care decision-making among youth in East African countries: a multilevel analysis
Authors: Aragaw Fantu Mamo , Teklu Rediet Eristu , Belay Daniel Gashaneh , Negash Wubshet Debebe , Fetene Samrawit Mihret , Alemu Tewodros Getaneh , Eshetu Habitu Birhan , Fentie Elsa Awoke , Shewarega Ever Siyoum , Asmamaw Desale Bihonegn
Published: July 2023

Objective

The autonomy of young women in healthcare decision-making has been reported to be lower, particularly in low-income and middle-income countries. This study was conducted to estimate the magnitude and the factors associated with autonomy in healthcare decision-making among youth in East African countries.

Design and setting

A population-based, cross-sectional study was conducted with data from the most recent Demographic and Health Surveys conducted in 11 East African countries (Burundi, Ethiopia, Kenya, Comoros, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe) conducted from 2011 to 2019.

Participants

Weighted sample of 24 135 women aged 15–24 years.

Primary outcomes

Healthcare decision-making autonomy.

Methods

A multi-level logistic regression model was used to identify factors associated with women’s autonomy in making decisions about their healthcare. Statistical significance was determined using an adjusted OR with 95% CI at a p value less than 0.05.

Results

Healthcare decision-making autonomy among youth in East Africa was 68.37% (95% CI 68%, 70%). In a multivariable analysis older aged youths (20–24 years) (adjusted OR (AOR)=1.27; 95% CI 1.19, 1.36), youths having an occupation (AOR=1.34; 95% CI 1.25, 1.53), having employed husband (AOR=1.12 95% CI 1.00, 1.26), exposure to media (AOR=1.18 95% CI 1.08, 1.29), rich wealth index 1.18 (AOR=1.18 95% CI 1.08, 1.29), female household head, youths having secondary and higher education, youths whose husband had secondary and higher education, and country were significant predictors of healthcare decision making autonomy.

Conclusion

Almost one-third of young women have no autonomy in healthcare decision-making. Older youth, being educated, having an educated husband, having an occupation, having an employed husband, exposure to media, female household head, rich wealth index and country are significant predictors for being autonomous in healthcare decision-making. Public health interventions should target uneducated and unemployed youth, poor families and those without media exposure to increase autonomy in health decisions.
Quality of life of transgender people under the lens of social determinants of health: a scoping review protocol
Authors: Coswosck Kaio Henrique Cesconetto , Marques-Rocha Jose Luiz , Moreira Juliana Almeida , Guandalini Valdete Regina , Lopes-Júnior Luís Carlos
Published: July 2023

Introduction

There is an urgent need for knowledge about the transgender population to inform the development of clinical protocols and training of health professionals on the unique issues affecting this population. Discussing transgender quality of life (QoL) through the lens of social determinants of health (SDOHs) would enable gender-specific health interventions. Here, we aimed to review the evidence on the QoL of transgender people from an SDOH perspective.

Methods and analysis

A scoping review (ScR) protocol following the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews statement and guided by the Joanna Briggs Institute was used. MEDLINE/PubMed, Cochrane Library, Embase, PsycINFO, Web of Science, Scopus and registry sites such as ClinicalTrials.gov and WHO ICTRP will be searched. Additional sources to be searched include ProQuest Dissertations/Theses Global, British Library, Google Scholar and Preprints for Health Sciences-medRXiv. Two independent researchers will carry out the selection, data charting and data synthesis. No date restriction will be applied in this ScR. The search will be restricted to articles published in English, Spanish and Portuguese. The results will be presented in tables, narrative summaries and graphs and will be graded on the type of data presented and the results. The search strategy will be updated in April 2023. The expected completion date of this ScR is July 2023.

Ethics and dissemination

This ScR protocol does not require ethical approval. Dissemination plans include peer-reviewed publications, conference presentations to be shared with experts in the field, and advisory groups to inform discussions on future research. It is hoped that our findings will be of interest to practitioners, researchers, stakeholders, public and private managers, and the general population concerned with this emerging public health issue.

Trial registration number

osf.io/9ukz6.
Assessment of COVID-19 management and its consequences on healthcare professionals: a cross-sectional study from Bangladesh
Authors: Ara Tasnim , Ferdous Zannatul , Mahi Mahfuza , Amin Emama , Chowdhury Sarah Binte , Shafiur Rahman Md , Rahman Lutfor , Rahman Md Mahabubur
Published: July 2023

Objective

This explorative study aims to identify the gaps in COVID-19 management and their consequences on physicians in terms of contracting infection and psychological well-being during the early phase of the pandemic.

Design, settings and participants

We conducted a nationwide cross-sectional online study to collect information from 420 intern doctors who were at their internship in government medical colleges from February to August 2020.

Methods

We performed univariate and bivariate analyses to assess COVID-19 management. We investigated the consequences of COVID-19 management on infection risk, experiencing stress, developing anxiety, depression and sleep disturbance using five sets of multivariable logistic regression analyses.

Results

Findings indicate a delay in first-case detection and identify people’s tendency to hide COVID-19 symptoms as one of the possible causes of that delay. About 56% of the intern doctors experienced that patients were trying to hide COVID-19 symptoms in the earlier phase of the pandemic. More than half of the respondents did not get any training on COVID-19 from their working institutions. About 30% and 20% of the respondents did not use personal protective equipment (PPE) and masks while treating patients. Respondents who treated patients without PPE, masks, face shields and gloves were almost two times as likely to be infected by COVID-19. The odds of experiencing COVID-19-related stress was almost twofold among respondents who treated patients without wearing PPE and masks. Experiencing COVID-19-related stress was further associated with an increased risk of developing anxiety and depression that led to sleep disturbance.

Conclusion

Ensuring the maximum utilization of limited resources during any public health crisis such as COVID-19 needs developing coping mechanisms by projecting future demand. Ensuring proper training and safety measures can reduce physical and psychological hazards among physicians.
Impact of primary health care reforms in Quebec Health Care System: a systematic literature review protocol
Authors: Landa Paolo , Lalonde Jean-Denis , Bergeron Frédéric , Kassim Said Abasse , Côté André , Gartner Jean-Baptiste , Tanfani Elena , Resta Marina
Published: July 2023

Introduction

During the last decade the Quebec Public Health Care System (QPHCS) had an important transformation in primary care planning activity. The increase of the service demand together with a significant reduction of supply in primary care may be at risk of reducing access to health care services, with a negative impact on costs and health outcomes. The aims of this systematic literature review are to map and aggregate existing literature and evidence on the primary care provided in Quebec, showing the benefits and limitations associated with the health policies developed in the last two decades, and highlighting areas of improvement.

Methods and analysis

PubMed, EMBASE, Web of Science and CINAHL will be searched for articles and government reports between January 2000 and January 2022 using a prespecified search strategy. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols and has been registered with PROSPERO. A wide range of electronic databases and grey literature sources will be systematically searched using predefined keywords. The review will include any study design, with the exclusion of protocols, with a focus on the analysis of health care policies, outcomes, costs and management of the primary health care services, published in either English or French languages. Two authors will independently screen titles, abstracts, full-text articles and select studies meeting the inclusion criteria. A customised data extraction form will be used to extract data from the included studies. Results will be presented in tabular format developed iteratively by the research team.

Ethics and dissemination

Research ethics approval is not required as exclusively secondary data will be used. Review findings will synthesise the characteristics and the impact of the reforms of QPHCS of the last two decades. Findings will therefore be disseminated in peer-reviewed journals, conference presentations and through discussions with stakeholders.

PROSPERO registration number

CRD42023421145.
Developing and testing scales for home support service continuity (HSSC): cross-sectional studies in Canada and UK
Authors: Zhang Jie , Shi Linda
Published: July 2023

Objectives

Ensuring the continuity of home support services has become increasingly important due to challenges arising from ageing demographics and healthcare staffing shortages. However, there is a lack of validated measurements specifically designed for assessing service continuity in this context. The primary objective of this study is to develop and validate scales that capture the multidimensional nature of home support service continuity (HSSC), incorporating informational continuity, management continuity and relational continuity as its underlying components. Subsequently, these scales are employed to measure the overall level of continuity experienced within home support services and investigate its association with service quality.

Methods

This study used a cross-sectional survey design with convenience sampling. Direct caregivers in the UK were recruited through the Prolific UK online platform, while direct caregivers in British Columbia, Canada were recruited through local health authorities and home support agencies. A total of 550 direct caregivers completed the online survey following the approved ethics protocol. Structural equation modelling was employed to evaluate HSSC and it underlying components. Furthermore, the study investigated the influence of HSSC on service quality within these two samples.

Results

The quantitative tests confirmed that HSSC comprises three first-order continuity components. These components showed significant loadings on HSSC in the Canadian sample (N=367) (λinformational=0.81, λmanagement=0.93, λrelational=0.38) at p<0.01 level. This finding was further supported in the UK sample (N=183) (λinformational=0.87, λmanagement=0.90, λrelational=0.93) at p<0.01 level. In both samples, the overall HSSC showed a positive correlation with service quality (path coefficient for the Canadian sample: bHSSC_employee perceived service quality (EPSQ)=0.22, p<0.01; the UK sample: bHSSC_EPSQ=0.70, p<0.01).

Conclusions

The results support the conceptualisation of HSSC as a second-order latent construct. The newly developed and validated scales for the three first-order constructs identify specific items that could be targeted to improve HSSC and service quality.
Effectiveness of Specific Health Check-ups in Japan for the primary prevention of obesity-related diseases: a protocol for a target trial emulation
Authors: Takeuchi Masato , Shinozaki Tomohiro , Kawakami Koji
Published: July 2023

Introduction

Concerns about public health threats have shifted towards obesity-related, non-communicable diseases in both developed and developing countries. Since 2008, Japan has adopted a nationwide universal screening programme called Specific Health check-ups (SHC) for the primary prevention of obesity-related, non-communicable diseases, namely, diabetes, hypertension and hyperlipidaemia. The effectiveness of SHC has not been systemically evaluated to date.

Methods and analysis

We will use the employment-based health insurance database, which includes both records of receipt versus non-receipt of SHC and healthcare claims. The study design adopts the target trial emulation framework to minimise the bias inherent to the observational study (eg, time-related bias and its consequences). The key components of trial emulation—eligibility criteria, treatment strategy, assignment procedure, follow-up period, outcome, causal contrast of interest and analysis plan—are detailed, along with the ideal target trial protocol. Briefly, we will conduct the nested-trial emulation approach that allows multiple trial entries. Persons aged 40–74 years will be eligible if they do not have a documented diagnosis of hypertension and diabetes and a history of receiving SHC at baseline. Participants will be classified according to the receipt or non-receipt of SHC service and followed for a maximum of 10 years until the withdrawal from the insurance plan, the outcome occurrence or the administrative censoring (the end of the available data, expected to be March 2022), whichever comes first. The 10-year incidence of diabetes/hypertension will be compared between SHC recipients and non-recipients using pooled logistic regression with adjustments for baseline confounders. Five sensitivity analyses are employed, including per-protocol analysis, changing eligibility criteria and negative outcome control analysis.

Ethics and dissemination

This protocol obtained the approval from Kyoto University Graduate School and Faculty of Medicine, Ethics Committee (R2448). The findings will be disseminated to academic conferences, and published in a peer-reviewed journal.
Acceptability of surgical care in Uganda: a qualitative study on users and providers
Authors: Rauschendorf Paula , Nume Rosette , Bruchhausen Walter
Published: July 2023

Objectives

This study was conducted to assess acceptability of surgical care in Eastern Uganda and enable better allocation of resources, and to guide health policy towards increased surgical care seeking.

Design

This qualitative study used semistructured in-depth interviews that were transcribed and analysed by coding according to grounded theory.

Setting

The study was set in Eastern Uganda in the districts of Jinja, Mayuge, Kamuli, Iganga, Luuka, Buikwe and Buvuma.

Participants

Interviews were conducted with 32 past surgical patients, 16 community members who had not undergone surgery, 17 healthcare professionals involved in surgical treatment and 7 district health officers or their deputies.

Results

The five intersecting categories that emerged were health literacy, perceptions, risks and fears, search for alternatives, care/treatment and trust in healthcare workers. It was also demonstrated that considering the user and provider side at the same time is very useful for a more extensive understanding of surgical care-seeking behaviour and the impact of user–provider interactions or lack thereof.

Conclusion

While affordability and accessibility are well defined and therefore easier to assess, acceptability is a much less quantifiable concept. This study breaks it down into tangible concepts in the form of five categories, which provide guidance for future interventions targeting acceptability of surgical care. We also demonstrated that multiple perspectives are beneficial to understanding the multifactorial nature of healthcare seeking and provision.
Prevalence and incidence of symptomatic pulmonary tuberculosis based on repeated population screening in a district in Ethiopia: a prospective cohort study
Authors: Banti Abiot Bezabeh , Winje Brita Askeland , Hinderaker Sven Gudmund , Heldal Einar , Abebe Markos , Dangisso Mesay Hailu , Datiko Daniel Gemechu
Published: July 2023

Objective

In Ethiopia, one-third of the estimated tuberculosis cases are not detected or reported. Incidence estimates are inaccurate and rarely measured directly. Assessing the ‘real’ incidence under programme conditions is useful to understand the situation. This study aimed to measure the prevalence and incidence of symptomatic pulmonary tuberculosis (PTB) during 1 year in the adult population of Dale in Ethiopia.

Design

A prospective population-based cohort study.

Setting

Every household in Dale was visited three times at 4-month intervals.

Participants

Individuals aged ≥15 years.

Outcome measures

Microscopy smear positive PTB (PTB s+), bacteriologically confirmed PTB (PTB b+) by microscopy, GeneXpert, or culture and clinically diagnosed PTB (PTB c+).

Results

Among 136 181 individuals, 2052 had presumptive TB (persistent cough for 14 days or more with or withouthaemoptysis, weight loss, fever, night sweats, chest pain or difficulty breathing), in the first round of household visits including 93 with PTB s+, 98 with PTB b+ and 24 with PTB c+; adding those with PTB who were already on treatment, the total number of PTB was 201, and the prevalence was 147 (95% CI: 127 to 168)/100 000 population. Out of all patients with PTB, the proportion detected by symptom screening was in PTB s+ 65%, PTB b+ 67% and PTB c+44%. During 96 388 person-years follow-up, 1909 had presumptive TB, 320 had PTB and the total incidence of PTB was 332 (95% CI: 297 to 370)/100 000 person-years, while the incidence of PTB s+, PTB b+ and PTB c+ was 230 (95% CI: 201 to 262), 263 (95% CI: 232 to 297) and 68 (95% CI: 53 to 86)/100 000 person-years, respectively.

Conclusion

The prevalence of symptomatic sputum smear-positive TB was still high, only one-third of prevalent PTB cases notified and the incidence rate highest in the age group 25–34 years, indicating ongoing transmission. Finding missing people with TB through repeated symptom screening can contribute to reducing transmission.
Factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City, Northern Uganda: a facility-based cross-sectional study
Authors: Acup Walter , Opollo Marc Sam , Akullo Betty Nancy , Musinguzi Marvin , Kigongo Eustes , Opio Bosco , Kabunga Amir
Published: July 2023

Objective

This study aimed at assessing factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City.

Design

A cross-sectional study.

Settings

The study was conducted in health facilities offering ANC services in Lira City, Northern Uganda.

Participants

The study was among 368 pregnant mothers attending their first ANC in the three selected facilities (Lira Regional Referral Hospital, Ober Health Center IV and Pentecostal Assembly of God Mission Health Center IV) in Lira City.

Primary and secondary outcome measures

Level of first ANC attendance within 12 weeks of pregnancy and associated factors.

Results

Early ANC attendance was 36.1%. Women who were: unmarried (adjusted OR (aOR): 0.40, 95% CI: 0.16 to 0.99), took >2 hours to reach a health facility (aOR: 0.21, 95% CI: 0.07 to 0.62), or not visited by village health teams or healthcare workers at home (aOR: 0.33, 95% CI: 0.12 to 0.92) were less likely to attend their first ANC early. On the other hand, women who were: not knowing first that ANC guides parents on infant care (aOR: 2.22, 95% CI: 1.06 to 4.67); pregnant without consent of spouse (aOR: 4.29, 95% CI: 1.75 to 10.55); attending ANC from a private facility (aOR: 2.89, 95% CI: 1.27 to 6.15); and having two to three healthcare workers present at the ANC clinic (aOR: 1.79, 95% CI: 1.03 to 3.13) were more likely to attend ANC early.

Conclusions

Despite the fact that the WHO recommends that all women begin ANC within 12 weeks after conception, Lira City in Northern Uganda had a low overall incidence of timely ANC initiation. Being unmarried, distance to reach a health facility, and being visited by village health teams or healthcare workers at home were all linked to timely ANC commencement. As a result, intervention efforts should concentrate on the highlighted determinants in order to promote ANC initiation in Lira City, Northern Uganda. This can be accomplished by providing information and education to the community on the timing and necessity of ANC in Northern Uganda.
Development of a person-centred digital platform for the long-term support of people living with an adult-onset genetic disease predisposition: a mixed-methods study protocol
Authors: Best Stephanie , Al Mahmud Abdullah , Tyagi Shivani , Wheeler Jack C W , Forkan Abdur Rahim Mohammad , Lewis Alexandra , Shuakat Nadeem , Kaul Rohit , Ward Aisha , Wickramasinghe Nilmini , Jayaraman Prem Prakash , Trainer Alison H
Published: July 2023

Introduction

Individuals at an inherited high-risk of developing adult-onset disease, such as breast cancer, are rare in the population. These individuals require lifelong clinical, psychological and reproductive assistance. After a positive germline test result, clinical genetic services provide support and care coordination. However, ongoing systematic clinical follow-up programmes are uncommon. Digital health solutions offer efficient and sustainable ways to deliver affordable and equitable care. This paper outlines the codesign and development of a digital health platform to facilitate long-term clinical and psychological care, and foster self-efficacy in individuals with a genetic disease predisposition.

Methods and analysis

We adopt a mixed-methods approach for data gathering and analysis. Data collection is in two phases. In phase 1, 300 individuals with a high-risk genetic predisposition to adult disease will undertake an online survey to assess their use of digital health applications (apps). In phase 2, we will conduct focus groups with 40 individuals with a genetic predisposition to cardiac or cancer syndromes, and 30 clinicians from diverse specialities involved in their care. These focus groups will inform the platform’s content, functionality and user interface design, as well as identify the barriers and enablers to the adoption and retention of the platform by all endusers. The focus groups will be audiorecorded and transcribed, and thematic and content data analysis will be undertaken by adopting the Unified Theory of Acceptance and Use of Technology. Descriptive statistics will be calculated from the survey data. Phase 3 will identify the core skillsets for a novel digital health coordinator role. Outcomes from phases 1 and 2 will inform development of the digital platform, which will be user-tested and optimised in phase 4.

Ethics and dissemination

This study was approved by the Peter MacCallum Human Research Ethics Committee (HREC/88892/PMCC). Results will be disseminated in academic forums, peer-reviewed publications and used to optimise clinical care.
Changes of colistin pharmacokinetics in critically ill patients due to the extracorporeal membrane oxygenation: protocol for the COL-ECMO2022 trial – a prospective, non-randomised, open-label phase IV pharmacokinetic clinical trial
Authors: Suk Pavel , Rychlíčková Jitka , Součková Lenka , Kubíčková Vendula , Urbánek Karel
Published: July 2023

Introduction

Colistin is a lipopeptide antibiotic administered as an inactive prodrug—colistin methanesulfonate (CMS). Colistin is a drug with a narrow therapeutic window; the limiting factors are mainly nephrotoxicity and neurotoxicity, dependent on plasma concentrations. The number of patients with infections caused by multidrug-resistant Gram-negative bacteria sensitive only to colistin and the number of patients requiring extracorporeal membrane oxygenation (ECMO) support for severe respiratory failure increased significantly in association with COVID-19-induced infections. ECMO can generally affect the pharmacokinetics of drugs by creating a new compartment.

Methods and analysis

The COL-ECMO2022 study is a prospective, non-randomised, single-centre, phase IV pharmacokinetic clinical trial designed to assess the influence of ECMO on the pharmacokinetics of colistin and CMS. Up to 30 patients treated with colistin will be included in the study and assigned to one of two arms, depending on the presence/absence of ECMO. All study participants will receive standard CMS dose intravenously. The plasma concentrations of colistin and CMS taken at defined intervals will be assessed by high-performance liquid chromatography-mass spectrometry. Patients will participate in the clinical trial for a maximum of three monitored dosing intervals. A population pharmacokinetic model will be developed to assess the influence of ECMO on pharmacokinetics. A difference greater than 25% is considered clinically significant.

Ethics and dissemination

The study has been approved by the Ethics Committee of St. Anne’s University Hospital Brno (Number 10ML/2022-AM). Related manuscripts will be submitted to peer-review journals.

Trial registration numbers

EudraCT Number 2022-000291-19;NCT05542446.
Application of the multiphase optimisation strategy (MOST) to optimise HIV prevention targeting people on medication for opioid use disorder (MOUD) who have cognitive dysfunction: protocol for a MOST study
Authors: Mistler Colleen B , Shrestha Roman , Gunstad John , Collins Linda , Madden Lynn , Huedo-Medina Tania , Sibilio Brian , Copenhaver Nicholas M , Copenhaver Michael
Published: July 2023

Introduction

People who inject drugs (PWID) have remained a contributor to the consistent HIV incidence rates in the US for decades. Pre-exposure prophylaxis (PrEP) is a promising biomedical intervention for HIV prevention among individuals at risk for HIV infection, including PWID. However, PWID report the lowest rates of PrEP uptake and adherence among at-risk groups. Tailored HIV prevention interventions must include strategies that compensate for cognitive dysfunction among PWID.

Methods and analysis

Using the multiphase optimisation strategy, we will be conducting a 16-condition factorial experiment to investigate the effects of four different accommodation strategy components to compensate for cognitive dysfunction among 256 PWID on medication for opioid use disorder. This innovative approach will inform optimisation of a highly effective intervention to enhance PWID’s ability to process and utilise HIV prevention content to improve PrEP adherence and HIV risk reduction in a drug treatment setting.

Ethics and dissemination

The institutional review board at the University of Connecticut approved this protocol (H22-0122) with an institutional reliance agreement with APT Foundation Inc. All participants are required to sign an informed consent form prior to engaging in any study protocols. The results of this study will be disseminated on national and international platforms through presentations at major conferences and journals.

Trial registration number

NCT05669534.
Frailty among middle-aged and older women and men in India: findings from wave 1 of the longitudinal Ageing study in India
Authors: Ghosh Arpita , Kundu Monica , Devasenapathy Niveditha , Woodward Mark , Jha Vivekanand
Published: July 2023

Objectives

Few studies have examined frailty in Indian adults, despite an increasing population of older adults and an escalating burden of chronic diseases. We aimed to study the prevalence and correlates of frailty in middle-aged and older Indian adults.

Setting

Cross-sectional data from Wave 1 of Longitudinal Ageing Study in India, conducted in 2017–2018 across all states and union territories, were used.

Participants

The final analytical sample included 57 649 participants aged 45 years and above who had information on frailty status.

Primary outcome measure

The deficits accumulation approach to measuring frailty was employed, creating a frailty index between 0 and 1, based on 40 deficits. Individuals with a frailty index of 0.25 or more were defined as ‘frail’.

Results

Prevalence of frailty among 45+ adults was 30%. 60+ women were two times as likely to be frail compared with 60+ men, after adjusting for a wide range of sociodemographic, economic and lifestyle factors. The sex difference was more pronounced in adults aged 45–59 years. Odds of hospitalisation in the last 12 months, and having falls in the past 2 years, were two times as high in frail adults compared with non-frail adults. Frail middle-aged and older adults had 33% and 39% higher odds, respectively, of having poor cognition than non-frail adults. The relative increase was higher in women for all three outcomes, although not statistically significant.

Conclusions

There needs to be careful consideration of sex differences when addressing frailty, particularly for optimising frailty interventions. Frailty, although typically assessed in older adults, was shown in this study to be also prevalent and associated with adverse outcomes in middle-aged Indian adults. More research into assessment of frailty in younger populations, its trajectory and correlates may help develop public health measures for prevention of frailty.
Cerebrospinal fluid biomarkers of neuroinflammation and postoperative neurocognitive disorders in patients undergoing orthopaedic surgery: protocol for a systematic review and meta-analysis
Authors: Feng Huiru , Liu Yang , Wang Xue , Wang Chunxiu , Wang Tianlong
Published: July 2023

Introduction

Postoperative neurocognitive disorders (PNDs) are characterised by gradual cognitive decline or change occurring after anaesthesia and surgery, and they are common in patients undergoing orthopaedic surgery. The onset of PNDs has been associated with dementia or other types of neurocognitive disorders in later life. Moreover, cerebrospinal fluid (CSF) biomarkers of neuroinflammation, including amyloid beta-40 peptide, amyloid beta-42 peptide, total tau protein, phosphorylated tau protein and neurofilament light chain, have been reported to be crucial in several high-quality clinical studies on PNDs. However, the role of these biomarkers in the onset of PNDs remains controversial. Therefore, this study aims to determine the association between CSF biomarkers of neuroinflammation and the onset of PNDs in patients undergoing orthopaedic surgery, which will provide novel insights for investigating PNDs and other types of dementia.

Methods and analysis

This systematic review and meta-analysis will be conducted in accordance with the Preferred Reporting Items for Systematic Reviewd and Meta-Analyses 2020 statement. Moreover, we will search MEDLINE (via OVID), EMBASE and the Cochrane Library without any language and date restrictions. Observational studies will be included. Two reviewers will independently perform the entire procedure, and disagreements will be settled by discussion between them and consultation with a third reviewer. Standardised electronic forms will be generated to extract data. The risk of bias in the individual studies will be evaluated using the Newcastle-Ottawa scale. All statistical analyses will be performed using the RevMan software or the Stata software.

Ethics and dissemination

This study will include peer-reviewed published articles; thus, no ethical issues will be involved. Further, the final manuscript will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42022380180.
Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis
Authors: Lin Jin-Wei , Chen Chung-Ting , Hsieh Ming-Shun , Lee I-Hsin , Yen David Hung-Tsang , Cheng Hao-Min , Hsu Teh-Fu
Published: July 2023

Objective

To compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.

Design

Systematic review, meta-analysis and trial sequential analysis.

Data sources

PubMed, Web of Science, Cochrane Library, Embase, Airiti Library and ClinicalTrials.gov were searched from their inception up to 16 March 2022.

Eligibility criteria

Randomised controlled trials that compared PCD to PNA for liver abscess were considered eligible, without restriction on language.

Data extraction and synthesis

Primary outcome was treatment success rate. Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.

Results

Ten trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p<0.001). In comparison to PNA, pooled analysis indicated a significant benefit of PCD on time to achieve clinical improvement or complete clinical relief (mean differences (MD) −2.53 days; 95% CI −3.54 to –1.52) in six studies with 1000 patients; time to achieve a 50% reduction in abscess size (MD −2.49 days; 95% CI −3.59 to –1.38) in five studies with 772 patients; and duration of intravenous antibiotic use (MD −4.04 days, 95% CI −5.99 to −2.10) in four studies with 763 patients. In-hospital mortality and complications were not different.

Conclusion

In patients with liver abscess, ultrasound-guided PCD raises the treatment success rate by 136 in 1000 patients, improves clinical outcomes by 3 days and reduces the need for intravenous antibiotics by 4 days.

PROSPERO registration number

CRD42022316540.
Rural and Urban patients’ Requirements and Experiences of Out-of-hours medical care after cancer (RUREO): a questionnaire study
Authors: Duncan Lisa , Murchie Peter , Khor Wei Lynn , Fielding Shona , Evans Jillian , Adam Rosalind
Published: July 2023

Objective

To investigate how individuals diagnosed with cancer use out-of-hours (OOH) medical services, describe the behavioural determinants of OOH service use and explore whether there are differences between urban and rural dwellers.

Design and setting

A cross-sectional questionnaire study conducted in Northeast Scotland.

Participants

The questionnaire was sent to 2549 individuals diagnosed with cancer in the preceding 12 months identified through the National Health Service Grampian Cancer Care Pathway database. 490 individuals returned the questionnaire (19.2% response rate), 61.8% were urban and 34.9% were rural.

Outcomes

Outcomes were differences in frequency of medical service use and attitudes towards OOH services between urban and rural participants. Patient experience (qualitative data) was compared.

Results

Daytime services were used much more frequently than OOH services—83.3% of participants had never contacted an OOH primary care service in the preceding 12 months but 44.2% had used their daytime general practitioner at least four times. There were no significant differences between urban and rural dwellers in the patterns of OOH or daytime service use, the behavioural determinants of service use or the experiences of OOH services. Rural dwellers were significantly less likely to agree that OOH services were close by and more likely to agree that where they lived made it difficult to access these services. Rural dwellers were no more likely to agree or disagree that distance would affect their decision to contact OOH services. Qualitative results highlighted barriers to accessing OOH services exist for all patients but that long travel distances can be offset by service configuration, travel infrastructure and access to a car.

Conclusions

Urban and rural dwellers have similar beliefs, attitudes towards and patterns of OOH service use. In Northeast Scotland, place of residence is unlikely to be the most important factor in influencing decisions about whether to access OOH medical care.
Association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury receiving renal replacement therapy: a retrospective observational cohort study based on MIMIC-IV database
Authors: Li Caifeng , Ren Qian , Li Xin , Han Hongqiu , Xie Keliang , Wang Guolin
Published: July 2023

Objective

To investigate the association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury (SAKI) receiving renal replacement therapy (RRT).

Design

A retrospective observational cohort study.

Setting

The data were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, which contains clinical data from more than 380 000 patients admitted to the intensive care units (ICUs) of the Beth Israel Deaconess Medical Center from 2008 to 2019.

Participants

All adult patients with SAKI receiving RRT were enrolled. Data for each patient within the first 24 hours of ICU admission were extracted from the MIMIC-IV database.

Primary and secondary outcome measures

The primary outcome was in-hospital mortality, and the secondary outcome was the length of hospital stay, length of ICU stay, RRT-free time and ventilator-free time. Logistic regression was used to investigate the association between furosemide administration and in-hospital mortality. Subgroup analysis was employed to explore the potential sources of heterogeneity.

Results

A total of 1663 patients with SAKI receiving RRT were enrolled in the study, of whom 991 patients (59.6%) were retrospectively allocated to the Furosemide group and 672 (40.4%) patients to the non-furosemide group. Univariate and multivariate logistic regression showed that furosemide administration was associated with reduced in-hospital mortality, respectively ((OR 0.77; 95% CI 0.63 to 0.93; p=0.008 < 0.05), (OR 0.59; 95% CI 0.46 to 0.75; p<0.001)). The association remained robust to different ways of adjusting for baseline confounding (all p<0.05). Subgroup analysis suggested that AKI-stage may be a source of heterogeneity. Patients in the furosemide group also had longer RRT-free time (p<0.001) and longer ventilator-free time (p<0.001) than those in the non-furosemide group.

Conclusions

Furosemide is associated with decreased in-hospital mortality, longer RRT-free time and ventilator-free time in patients with SAKI receiving RRT.
Improving Peer Online Forums (iPOF): protocol for a realist evaluation of peer online mental health forums to inform practice and policy
Authors: Lobban Fiona , Coole Matthew , Donaldson Emma , Glossop Zoe , Haines Jade , Johnston Rose , Jones Steven H , Lodge Christopher , Machin Karen , Marshall Paul , Meacock Rachel , Penhaligon Kate , Rakić Tamara , Rawsthorne Mat , Rayson Paul , Robinson Heather , Rycroft-Malone Jo , Semino Elena , Shryane Nick , Wise Sara
Published: July 2023

Introduction

Peer online mental health forums are commonly used and offer accessible support. Positive and negative impacts have been reported by forum members and moderators, but it is unclear why these impacts occur, for whom and in which forums. This multiple method realist study explores underlying mechanisms to understand how forums work for different people. The findings will inform codesign of best practice guidance and policy tools to enhance the uptake and effectiveness of peer online mental health forums.

Methods and analysis

In workstream 1, we will conduct a realist synthesis, based on existing literature and interviews with approximately 20 stakeholders, to generate initial programme theories about the impacts of forums on members and moderators and mechanisms driving these. Initial theories that are relevant for forum design and implementation will be prioritised for testing in workstream 2.

Workstream 2 is a multiple case study design with mixed methods with several online mental health forums differing in contextual features. Quantitative surveys of forum members, qualitative interviews and Corpus-based Discourse Analysis and Natural Language Processing of forum posts will be used to test and refine programme theories. Final programme theories will be developed through novel triangulation of the data.

Workstream 3 will run alongside workstreams 1 and 2. Key stakeholders from participating forums, including members and moderators, will be recruited to a Codesign group. They will inform the study design and materials, refine and prioritise theories, and codesign best policy and practice guidance.

Ethics and dissemination

Ethical approval was granted by Solihull Research Ethics Committee (IRAS 314029). Findings will be reported in accordance with RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) guidelines, published as open access and shared widely, along with codesigned tools.

Trial registration number

ISRCTN 62469166; the protocol for the realist synthesis in workstream one is prospectively registered at PROSPERO CRD42022352528.
Enteral supplementation with high-dose docosahexaenoic acid on the risk of bronchopulmonary dysplasia in very preterm infants: a collaborative study protocol for an individual participant data meta-analysis
Authors: Marc Isabelle , Lavoie Pascal M , McPhee Andrew J , Collins Carmel T , Simonyan David , Pronovost Etienne , Guillot Mireille , Gould Jacqueline F , Mohamed Ibrahim , Beltempo Marc , Boutin Amélie , Fortier Isabel , Sullivan Thomas R , Moore Lynne , Makrides Maria
Published: July 2023

Introduction

Severe bronchopulmonary dysplasia (BPD) is a well-known factor consistently associated with impaired cognitive outcomes. Regarding reported benefits on long-term neurodevelopmental outcomes, the potential adverse effects of high-dose docosahexaenoic acid (DHA) supplementation on this short-term neonatal morbidity need further investigations in infants born very preterm. This study will determine whether high-dose DHA enteral supplementation during the neonatal period is associated with the risk of severe BPD at 36 weeks’ postmenstrual age (PMA) compared with control, in contemporary cohorts of preterm infants born at less than 29 weeks of gestation.

Methods and analysis

As part of an Australian–Canadian collaboration, we will conduct an individual participant data (IPD) meta-analysis of randomised controlled trials targeting infants born at less than 29 weeks of gestation and evaluating the effect of high-dose DHA enteral supplementation in the neonatal period compared with a control. Primary outcome will be severe grades of BPD (yes/no) at 36 weeks’ PMA harmonised according to a recent definition that predicts early childhood morbidities. Other outcomes will be survival without severe BPD, death, BPD severity grades, serious brain injury, severe retinopathy of prematurity, patent ductus arteriosus and necrotising enterocolitis requiring surgery, sepsis, combined neonatal morbidities and growth. Severe BPD will be compared between groups using a multivariate generalised estimating equations log-binomial regression model. Subgroup analyses are planned for gestational age, sex, small-for-gestational age, presence of maternal chorioamnionitis and mode of delivery.

Ethics and dissemination

The conduct of each trial was approved by institutional research ethics boards and written informed consent was obtained from participating parents. A collaboration and data sharing agreement will be signed between participating authors and institutions. This IPD meta-analysis will document the role of DHA in nutritional management of BPD. Findings will be disseminated through conferences, media interviews and publications to peer-reviewed journals.

PROSPERO registration number

CRD42023431063.

Trial registration number

NCT05915806.
Clinical characteristics of patients with a risk of pulmonary artery hypertension secondary to ARDS in a high-altitude area
Authors: Zhu Peng , Zhu Jing , Tong Shijun , She Xiaobin , Qi Zhenyuan , Xu Qianjin , Shi Zhongshan , Si Lining , Hou Ming , Gan Guifen , Pan Chun
Published: July 2023

Background

Hypoxaemia plays an important role in the development of pulmonary artery hypertension (PAH). Patients with acute respiratory distress syndrome (ARDS) in a high-altitude area have different pathophysiological characteristics from those patients in the plains. The goal of our study was to explore the clinical characteristics of PAH secondary to ARDS in a high-altitude area.

Methods

This was a prospective study conducted in the affiliated Hospital of Qinghai University. Two investigators independently assessed pulmonary artery pressure (PAP) and right ventricular function by transthoracic echocardiography. Basic information and clinical data of the patients who were enrolled were collected. A multivariable logistic regression model was used to evaluate the risk factors for PAH secondary to ARDS in the high-altitude area.

Results

The incidence of PAH secondary to ARDS within 48 hours in the high-altitude area was 44.19%. Partial pressure of oxygen/fraction of inspired oxygen <165.13 mm Hg was an independent risk factor for PAH secondary to ARDS in the high-altitude area. Compared with the normal PAP group, the right ventricular basal dimensions were significantly larger and the right ventricular tricuspid annular plane systolic excursion was lower in the PAH group (right ventricular basal dimensions: 45.47±2.60 vs 40.67±6.12 mm, p=0.019; tricuspid annular plane systolic excursion (TAPSE): 1.82±0.40 vs 2.09±0.32 cm, p=0.021). The ratio of TAPSE to systolic PAP was lower in the PAH group (0.03±0.01 vs 0.08±0.03 cm/mm Hg, p<0.001).

Conclusions

The incidence of PAH in patients with ARDS in our study is high. PAH secondary to ARDS in a high-altitude area could cause right ventricular dysfunction.

Trial registration number

NCT05166759.
Feasibility of home initiation of an airway clearance device (SIMEOX) by telecare in people with non-cystic fibrosis bronchiectasis: a pilot study
Authors: Hamidfar Rebecca , Murris-Espin Marlene , Mahot Marie , Abouly Raphael , Gauchez Hughes , Jacques Sophie , Joffray Eloise , Arnol Nathalie , Morin Laurent , Leroy Sylvie , Borel Jean-Christian
Published: July 2023

Background

Mucociliary clearance is a cornerstone of the management of people with non-cystic fibrosis bronchiectasis (NCFB). SIMEOX, an innovative device, could facilitate autonomous airway clearance, but its use requires specific training. We hypothesised that telecare would be an effective means to train people with NCFB in the handling of device and to monitor and promote device adherence.

Objectives

(1) To evaluate frequency of use of the SIMEOX for 10 weeks after telecare training. (2) To assess user satisfaction and clinical efficacy of the SIMEOX+telecare.

Methods

Multicentre, prospective, pilot study in adults with NCFB. A SIMEOX was provided to each participant at inclusion. Physiotherapists performed telecare sessions the first 2 weeks (3–5 sessions) for device training and every 10 days to reinforce motivation and provide technical support.

Results

22 individuals were included, 21 analysed (38% male; mean±SD age 53±18 years; Bronchiectasis Severity Index 6.6±3.5). Fourteen participants (66.7%; 95% CI 43.1% to 84.5%) performed ≥3 SIMEOX sessions/week (self-reported adherence, primary outcome). Median (Q1; Q3) number of self-reported sessions/week for the whole group was 3.7 (1.8; 5.7). Adherence including web registration was 80.9%. At week 12, participant satisfaction rating was 9.0 (7.9; 10.0) on a 10-point visual analogue scale; respiratory function did not change but quality of life improved (COPD Assessment Test score −4.7, 95% CI −7.7 to −1.6, p=0.023; St Georges Respiratory Questionnaire −5.8, 95% CI −10.8 to −0.9, p=0.005).

Conclusion

Adherence to and satisfaction with the SIMEOX airway clearance device supported by telecare were high in people with NCFB. The clinical efficacy needs to be confirmed in a randomised controlled trial.

Trial registration number

NCT04742270.