bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic evaluation of proton pump inhibitors in patients with gastro-oesophageal reflux disease: a systematic review
Authors: Tabaeian Seidamir Pasha , Moeini Sajad , Rezapour Aziz , Afshari Somayeh , Souresrafil Aghdas , Barzegar Mohammad
Published: December 2024

Objectives

Our aim was to systematically review the cost-effectiveness of proton pump inhibitor (PPI) therapies and surgical interventions for gastro-oesophageal reflux disease (GORD).

Design

The study design was a systematic review of economic evaluations.

Data sources

We searched PubMed, Embase, Scopus, and Web of Science for publications from January 1990 to March 2023. Only articles published in English were eligible for inclusion.

Eligibility criteria

Studies were included if they were full economic evaluations comparing PPIs with surgical or alternative therapies for GORD. Excluded were narrative reviews, non-peer-reviewed articles, and studies not reporting cost-effectiveness outcomes.

Data extraction and synthesis

Two reviewers independently extracted data on study design, comparators, time horizon, and cost-effectiveness outcomes. The quality of studies was assessed using the Joanna Briggs Institute (JBI) checklist for economic evaluations.

Results

A total of 25 studies met the inclusion criteria. Laparoscopic Nissen fundoplication (LNF) was found to be cost-effective in long-term horizons, while PPIs were preferred for short- to medium-term outcomes. Differences in healthcare settings and methodological approaches influenced the study findings.

Conclusions

Strategic purchasing decisions for GORD treatment should consider the time horizon, healthcare setting, and cost structures. LNF may provide better long-term value, but PPIs remain effective for managing symptoms in the short term.

Study registration

PROSPERO, CRD42023474181.
Helicobacter pyloriinfection and staple-line leak in patients with class III obesity undergoing laparoscopic sleeve gastrectomy: a retrospective study
Authors: Kazim Albaraa H , Bamehriz Fahad Y , Althwanay Aldanah M , Aldohayan Abdullah , Abdullah Al-Bandari Zamil , AlShehri Bandar , AlTuwayr Rakan Masoud , Razack Habeeb I A , Tamim Hani , Alsohaibani Fahad , Alqahtani Saleh A
Published: December 2024

Objective

Globally, over 50% of the population is affected byHelicobacter pylori, yet research on its prevalence and impact in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG) is inconclusive. This study aimed to assess the prevalence ofH. pyloriinfection in individuals with obesity undergoing LSG, evaluate the percentage of postoperative staple-line leaks, and explore the potential link betweenH. pyloriinfection and staple-line leaks.

Methods

This retrospective analysis assessed adult patients with class III obesity who underwent LSG between 2015 and 2020 at a tertiary care hospital in Riyadh, Saudi Arabia. Patient characteristics with and without postoperative staple-line leaks were compared, exploring the link betweenH. pyloriinfection and these leaks.

Results

Of the 2099 patients (mean age, 34.7±12.2 years; female, 53.5%) included, 35% hadH. pyloriinfection and 2% experienced post-LSG staple-line leaks. Patients withH. pyloriwere older (36.1±11.8 vs 34.0±12.3 years, p<0.0001). Patients with leaks were older, mostly male, and had higher body mass index (p<0.05). However, only 29% of those with leaks wereH. pylori-positive. A non-significant association was found betweenH. pyloriinfection and staple-line leaks (adjusted OR 0.73, 95% CI 0.33 to 1.60, accounting for age, body mass index, and sex).

Conclusions

Although over one-third of patients with class III obesity undergoing LSG hadH. pyloriinfection, a non-significant association was observed with post-LSG staple-line leaks, suggesting routine preoperativeH. pyloriscreening may not be necessary.
Gender-transformative HIV and SRHR programme approaches for adolescents and young people: a realist review to inform policy and programmes
Authors: Gourlay Annabelle , Walker Damilola , Singh Sagri , Mata Migena , Birdthistle Isolde
Published: December 2024

Introduction

Gender inequalities continue to drive new HIV and sexually transmitted infections (STIs) at rates too high to achieve global goals. In high HIV-burden jurisdictions, this is particularly true for adolescent girls and young women at disproportionate risk, while social and systemic barriers also impede the engagement of young men and gender minorities with health services. We sought evidence of approaches to promote sexual and reproductive health (SRH) outcomes by addressing gender transformation and removing structural barriers that broadly limit prospects for adolescents and young people.

Methods

We conducted a realist review to identify HIV and SRH-focused interventions with gender transformative mechanisms. Eligible interventions sought to achieve HIV/STI prevention, sexual behaviour or pregnancy outcomes among young people by enhancing agency, resources and social norms supportive of gender transformation. We developed a programme theory to guide the data extraction and synthesis and categorised interventions by strategy, recording impacts on health and/or gender-related outcomes.

Results

We identified 33 eligible interventions, representing diverse programme strategies and outcomes. Most interventions used a combination approach, with economic strengthening as the most common central strategy (n=13), followed by community-based mobilisation for norms change (n=7), then school-based educational curricula (n=6). The majority (n=24) achieved ‘dual effects’, that is, positive effects on both healthandgender-related outcomes; 15 with dual effects specific to HIV prevention. Few evaluations measured or found impacts on HIV/STI incidence. 12 reported positive impacts on condom use alongside improved agency or gender norms.

Conclusions

Youth-focused interventions that address context-specific economic and social determinants of HIV and SRH risk have proliferated recently, with encouraging impacts on both HIV/SRH and gender-related outcomes. This bodes well for empowering strategies to achieve HIV and STI reduction targets among adolescents and young people, and broader SRH goals. However, most interventions prioritise individual rather than structural change; impeding their ‘gender transformative’ potential.
Effectiveness of a nurse-led coaching in self-care intervention for elderly undergoing total laryngectomy: a randomised controlled trial
Authors: Zheng Liyuan , Chen Jian , Wang Huifen , Peng Danxia , Lu Yuchen , Liu Shu'e , Liu Yan , Li Xue , Ye Sanxia , Mei Zhidan , Wei Lai , Xu Chun
Published: December 2024

Objectives

To evaluate the effectiveness of nurse-led coaching in self-care (SC) interventions for elderly patients undergoing total laryngectomy (TL) using multidimensional parameters.

Design

This was a double-arm randomised, single-centre trial that met the requirements of the CONSORT statement.

Setting

Head and neck department in a tertiary A-level hospital.

Intervention

Elderly patients scheduled for TL were randomly allocated to either the control group (n=24) or the intervention group (n=23). Patients in the control group received routine nursing care during hospitalisation and, subsequently, at home after discharge, received conventional family care without the regular supervision of nurses. Patients in the intervention group received a series of SC interventions led by nurses during hospitalisation and discharge and implemented SC practice using the home SC manual (SC knowledge and SC diary), nurses regularly supervised and evaluated the SC effect. The primary outcome was the SC ability. Secondary outcomes were self- efficacy, quality of life (QoL) and nutritional status.

Results

The SC intervention improved the SC ability, self-efficacy, QoL and nutritional status scores of patients in the intervention group compared with that of patients in the control group (p<0.01). The outcomes showed that the intervention had a significant effect on SC ability, self-efficacy and QoL scores, with both the main effects of time and intervention, as well as their interaction being significant (p<0.05). Nutritional status, as assessed using the PG-SGA, was better in the intervention group than in the control group (p<0.001). No adverse events (AEs) were observed in either group.

Conclusion

Nurse-led SC intervention for elderly patients with TL is an effective strategy that can bring multidimensional benefits, including higher self-efficacy, stronger SC ability to actively solve health problems, better QoL and nutritional status, as well as shorter hospital stays.

Trial registration number

ChiCTR2100043731.
Voice of the nurse in paediatric intensive care: a scoping review
Authors: Masterson Kate , Connolly Michael , Alexander Denise , Brenner Maria
Published: December 2024

Objectives

The objective was to explore how the voice of the nurse in paediatric intensive care units (PICU) is portrayed in the literature.

Design

Scoping review using the six-step scoping review framework outlined by Arksey and O’Malley.

Data sources

PubMed, Nursing (OVID), Medline (OVID), CINHAL (EBSCO), SCOPUS and Web of Science online databases. The initial search was conducted in June 2020 and was repeated in January 2023.

Eligibility criteria

The review included publications in English; published since 2010 in peer-reviewed journals; papers identified nurses in the population studied and conducted in PICU.

Data extraction and synthesis

The papers were screened by abstract and subsequently by reading the full text by two independent reviewers. The literature was imported into the software program NVivo V.12 for thematic analysis.

Results

The scoping review identified 53 articles for inclusion. While the value of seeking the voice of the nurse has been identified explicitly in other healthcare contexts, it has only been identified indirectly in PICU. Four main themes emerged from the data: the voice of the nurse in the organisation of PICU, caring for children in PICU, as a healthcare professional, and communication in PICU.

Conclusion

While this literature suggests many facets of the complex role of the nurse, including partnership with families and advocating for patients, the limited literature on care delivery reduces the capacity to fully understand the voice of the nurse at key junctions of care. Further research is needed on the voice of the nurse in PICU to illuminate the barriers and enablers for nurses using their voices during decision-making.
Development and internal validation of prognostic models for event-free survival in newly diagnosed Ewing sarcoma patients based on routinely collected clinical characteristics from the European randomised controlled trial, EE2012
Authors: Kirton Laura , Riley Richard , Gaunt Piers , Brennan Bernadette , Snell Kym
Published: December 2024

Introduction

Ewing sarcoma is a rare paediatric cancer. Currently, there is no way of accurately predicting these patients’ survival at diagnosis. Disease type (ie, localised disease, lung/pleuropulmonary metastases and other metastases) is used to guide treatment decisions, with metastatic patients generally having worse outcomes than localised disease patients. However, not all patients fit this trend. An accurate prognostic model could be used to guide treatment decisions in clinical practice to avoid patients being incorrectly under or overtreated.

Methods and analysis

This study aims to develop and internally validate prognostic models in newly diagnosed Ewing sarcoma patients, using the EE2012 clinical trial data set. The models will incorporate prognostic factors, identified from a literature review, to predict patients’ probability of event-free survival at clinically important time points. Three models will be developed, for comparison of their performance and stability, using different methods of model selection and penalisation for overfitting (full model or backwards selection applying uniform shrinkage; and lasso variable selection). The models will be internally validated using bootstrapping to give optimism-adjusted performance statistics (calibration and discrimination) and model stability results. Patient and clinical user groups will be asked to determine risk thresholds to guide treatment decisions in clinical practice based on the model. Decision curve analyses will examine clinical utility at these thresholds.

Ethics and dissemination

This study is a secondary analysis of EE2012 clinical trial data. The EE2012 trial received ethical approval from the competent authorities (UK ethics reference approval number 12/NW/0827). This study is covered by the trial ethics in place. The results from this study will be published in peer-reviewed journals to act as a benchmark for future studies.

Trial registration number

EudraCT number 2012-002107-17. ISRCTN number 92192408.
Determining the intention of receiving the influenza vaccine: a cross-sectional survey among international and domestic college students in the USA
Authors: Liu ChengChing , Chen Angela Chia-Chen , Ling Jiying , Liu Charles , Zahry Nagwan , Ammigan Ravichandran , Kaur Loveleen
Published: December 2024

Objective

Vaccination is the most effective strategy for preventing infectious diseases, yet it is underused in young adults. College students are important targets for the influenza vaccine given this population’s low vaccination rates; however, limited research has focused on international college students’ vaccination status. This study examined the relationships between the theory of planned behaviour (TPB; attitudes, perceived behavioural control (PBC) and subjective norms) and students’ intention of receiving an influenza vaccine.

Design, setting and participants

A cross-sectional study was conducted with a convenience sample of 222 domestic students recruited via Amazon Mechanical Turk and 197 international students recruited through the Registrar’s Office at a Midwest university.

Results

International students had higher levels of PBC, intention and attitudes towards receiving an influenza vaccine compared with domestic students. Being Hispanic (β=−5.33; 95% CI −9.84 to −0.81, p=0.021), up-to-date vaccination status (β=−1.60; 95% CI −2.99 to −0.17, p=0.028) and identifying as smokers (β=−2.94; 95% CI −5.72 to −0.15, p=0.039) significantly lowered college students’ intention. Attitudes (international: β=0.14; 95% CI 0.04 to 0.23, p=0.003; domestic: β=0.14; 95% CI 0.07 to 0.22, p<0.001), subjective norms (international: β=0.40; 95% CI 0.29 to 0.51, p<0.001; domestic: β=0.34; 95% CI 0.23 to 0.44 p<0.001), and PBC (international: β=0.09; 95% CI 0.004 to 0.18, p=0.042; domestic: β=0.10; 95% CI 0.01 to 0.19, p=0.019) were significantly associated with both domestic and international students’ intention of receiving an influenza vaccine.

Conclusion

Findings support the TPB’s potential utility to enhance domestic and international college students’ influenza vaccination rates.
Oral antihypertensive agents and diuretics in the management of hypertension in postpartum women: a systematic review and meta-analysis
Authors: Hup Rosalie J , Paauw Nina D , Lely A Titia , Depmann Martine
Published: December 2024

Objective

In the puerperium, women with hypertensive disease of pregnancy remain at risk for maternal complications. The antihypertensive agent prescribed antepartum is usually continued postpartum; however, evidence regarding the most effective treatment is lacking. Therefore, we aimed to investigate which antihypertensive agent results in optimal treatment (both effectiveness and safety) of postpartum hypertension.

Design

Systematic review and meta-analysis.

Data sources

MEDLINE (Ovid), Embase.com and CENTRAL were searched through 22 August 2024.

Eligibility criteria

Randomised controlled trials (RCTs) evaluating oral antihypertensives and diuretics in postpartum hypertensive women published after 1990, performing BP measurements in the postpartum period, were identified.

Data extraction and synthesis

Two independent reviewers extracted data and assessed risk of bias. Pooled data were calculated as risk ratio or mean difference using a random effect model.

Results

Fourteen RCTs (1651 women) were included. Seven RCTs compared diuretics with placebo or antihypertensive controlled, two RCTs compared oral antihypertensives with placebo and five RCTs compared labetalol with nifedipine. Pooled data demonstrated a significantly lower BP on day 3 in cases with pre-eclampsia using furosemide (mean difference −4.06, 95% CI −6.81 to −1.31). Furosemide had no significant effect on any of the other outcomes. Faster BP control was observed for labetalol over nifedipine in a single RCT (mean difference 5.20, 95% CI 4.36 to 6.04). No other significant effects were observed.

Conclusions

In this extensive literature review, no medication preference could be stated and a lack of high-quality studies was revealed. Some evidence demonstrates a positive effect on BP control in women with pre-eclampsia using furosemide. Therefore, adding furosemide to initial treatment is considerable. However, antihypertensive preference and furosemide effectiveness should be further researched. We propose a retrospective cohort study using real-life hospital data (from health records), utilising clinical variance in therapeutic strategies currently present.

PROSPERO registration number

CRD42023410765.
Urban-rural disparities in the association between social trust patterns and changes in depressive symptoms: longitudinal evidence from an elderly Chinese population
Authors: Wang Ting , Li Qiaosheng , Zhang Shouchuang , Wei Yuehui , Jian Weiyan
Published: December 2024

Objective

To examine the relationship between social trust and depressive symptoms among China’s elderly, placing special emphasis on the disparities between urban and rural settings.

Design

We employed latent profile analysis to categorise individual patterns of social trust. Subsequently, multiple linear regression analysis was employed to determine if there was an association between these identified social trust patterns and depressive symptoms. Additionally, we examined the potential interactive effects between urban-rural differences and patterns of social trust on depressive symptoms.

Setting

The China Family Panel Studies (CFPS) database.

Participants

The data was sourced from the CFPS for the years 2018 and 2020, encompassing a total of 5645 participants aged 60 and above.

Outcome measures

Depressive symptoms were evaluated employing an eight-item adaptation of the Centre for Epidemiologic Studies Depression Scale. The scores from these eight items were aggregated to create an index of depressive symptoms, which was used to quantify the severity of depressive symptoms.

Results

The findings demonstrate a significant link between patterns of social trust and depressive symptoms, with individuals manifesting high social trust (HST) showing a lower propensity for depressive symptoms (Beta=−2.26, 95% CI=−2.62, –1.92). Furthermore, a marked association is apparent between social trust patterns and the changes in depressive symptoms. Additionally, urban dwellers (Beta=−0.67, 95% CI=−1.23, –0.11) demonstrate a more pronounced correlation between patterns of social trust and depressive symptoms, particularly within the HST group.

Conclusion

Our findings highlight a strong link between social trust patterns and depressive symptoms, particularly regarding their changes. Urbanites, notably within the HST group, show a lower risk of experiencing depressive symptoms. There is an urgent requirement to establish social trust-specific interventions to decrease susceptibility to depressive symptoms among the rural populace.
Protocol for the impact of machine learning-based clinician decision support algorithims in perioperative care (IMAGINATIVE) in Singapore general hospital : a large prospective randomised controlled trial
Authors: Abdullah Hairil Rizal , Brenda Tan Pei Yi , Loh Celestine , Ong Marcus , Lamoureux Ecosse , Lim Gek Hsiang , Lum Elaine
Published: December 2024

Introduction

As surgical accessibility improves, the incidence of postoperative complications is expected to rise. The implementation of a precise and objective risk stratification tool holds the potential to mitigate these complications by early identification of high-risk patients. Moreover, it could address the escalating costs from resource misallocation. In Singapore General Hospital (SGH), we introduced the Combined Assessment of Risk Encountered in Surgery-Machine Learning (CARES-ML) in June 2023, focusing on predicting 30-day postoperative mortality and the need for post-surgery intensive care unit (ICU) stays. The IMAGINATIVE Trial aims to evaluate the efficacy of such systems in a large academic medical centre.

Methods and analysis

This study adopts type 1 effectiveness-implementation study design within a randomised controlled trial framework. Patients will be randomly assigned in a 1:1 ratio to either the CARES-guided group (unblinded to risk level) or the unguided group (blinded to the risk level). A total of 9200 patients will be enrolled in the study, with the inclusion criteria encompassing individuals aged 21–100 years old undergoing elective surgeries except for neurology and cardiology surgeries at SGH. The primary outcome is to evaluate the effectiveness of the Machine Learning Clinical Decision Support (ML-CDS) algorithm in improving perioperative mortality rates when integrated into the clinical workflow.

Ethics and dissemination

The study has been approved by the SingHealth Centralised Institutional Review Board (CIRB Ref: 2023:2114) and is registered on ClinicalTrials.gov (trial number:NCT05809232). All patients will sign an informed consent form before recruitment and translators will be made available to non-English-speaking participants. This study is funded by the National Medical Research Council, Singapore (HCSAINV22jul-0002) and the findings will be published in peer-reviewed journals and presented at academic conferences.

Trial registration number

NCT05809232.
Factors associated with in-hospital mortality of newborns admitted to a special care newborn unit of a tertiary care hospital in southern Bangladesh: a retrospective cohort study
Authors: Abbas Md Golam , Haque Aysha , Khan Md Abdullah Saeed , Alam Mohammed Zahidul , Thamima Ummay , Wahiduzzaman Md , Zerin Tahmina , Das Siddhartha Sankar , Rahman Md Mostafizur
Published: December 2024

Objectives

The objective of this study was to identify factors associated with in-hospital deaths of newborns admitted to a special care newborn unit (SCANU) in southern Bangladesh.

Design

Retrospective cohort.

Setting

SCANU of Patuakhali Medical College Hospital, Patuakhali, Bangladesh.

Participants

Records of 930 neonates admitted to the SCANU from August to December 2022 were included in the study. The inclusion criteria consisted of neonates admitted during the specified period, while the exclusion criteria excluded records of newborns who were referred to intensive care units or who left against medical advice.

Primary and secondary outcome measures

Primary outcome: In-hospital neonatal mortality. Secondary outcomes: Specific conditions or factors affecting the in-hospital deaths.

Results

Of the 930 neonates analysed, 3.44% died in the hospital. Factors significantly associated with shorter survival time and increased in-hospital mortality included low birth weight (p=0.004), preterm delivery (p=0.022) and respiratory distress syndrome (RDS) (p=0.002). RDS showed an independent association with death in the hospital (adjusted HR: 3.39; 95% CI: 1.11 to 10.35). Newborns delivered at home or in an ambulance had a 2.90 times higher hazard of dying in the hospital (95% CI: 1.17 to 7.17) compared with those delivered at the hospital.

Conclusions

Addressing preterm birth, low birth weight and respiratory distress, along with promoting institutional deliveries, is crucial for reducing neonatal mortality rates in resource-limited settings like Bangladesh.
Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up
Authors: Stegemann Jill , Affeldt Anna Maria , Mück Luisa , Ferring Anne , Gerhards Laura , Pickert Lena , Bausch Annika , Benzing Thomas , Antczak Philipp , Polidori M Cristina
Published: December 2024

Objective

The prognosis of older adults is strongly influenced by the relation of multifactorial geriatric syndromes (GS) and their health-maintaining counterparts, geriatric resources (GR). The present analysis aimed to identify clusters of comorbidities, GS and GR, and to measure their multidimensional prognostic signature in older patients admitted to different healthcare settings.

Design

Pooled secondary analysis of three longitudinal interventional studies with the 3- and 6-month follow-up data collection on mortality and rehospitalisation.

Setting

Inpatients in an internal medicine ward (n=495), inpatients in an ageing medicine ward (n=123) and outpatients from a general practice (n=105).

Participants

A total of 734 patients with multimorbidity who aged over 60 years were recruited between August 2016 and July 2020 (mean age 77.8 years, SD 6.2 and 43% female).

Outcome measures

Comprehensive Geriatric Assessment (CGA), including Cumulative Illness Rating Scale (CIRS), 17 GS and 10 GR, and the CGA-based Multidimensional Prognostic Index (MPI) as a measure of multidimensional prognosis and frailty were assessed. Based on a general linear model and a hierarchical clustering method, clusters of comorbidities, GS and GR were obtained.

Results

The study identified five clusters of GR-related GS, namely, psychosocial, iatrogenic, neurovegetative, sensorimotor and fluid dysbalance, along with two clusters related to GR, focusing on independence achievement and requirements- circumstances. Additionally, two clusters were identified pertaining to the CIRS, encompassing sensory-vegetative and heart-kidney morbidity. Patients within the iatrogenic cluster exhibited significantly higher MPI and readmissions during follow-up compared with those outside this cluster (p<0.001). Furthermore, membership in the fluid dysbalance or psychosocial cluster was associated with a significantly increased mortality rate during follow-up (p<0.001).

Conclusions

A feasible combination of GR and GS in clinical routine enables the identification of clusters with clear prognostic relevance, which may improve prognosis through tailored treatment.

Trial registration numbers

DRKS00010606/DRKS00013791/DRKS00017094MPI_InGAH, DRKS00012820MPI_NoGePand DRKS00015996VNKN.
Risk perception among healthcare professionals working in emergency care in remote locations: a scoping review protocol
Authors: Queirós Célia Maria , Martins Teresa , Correia Tiago
Published: December 2024

Introduction

Providing healthcare in emergency services is a multifaceted challenge that demands prompt approaches. Ensuring safety and efficacy becomes even more challenging in ‘remote locations’, referring to geographical areas located far from urban centres or densely populated regions, often characterised by insufficient access to services, infrastructure and communication channels. Despite the pivotal role of healthcare professionals’ skills and knowledge in risk management in these contexts, academic literature has largely overlooked this aspect. Thus, addressing healthcare professionals’ perceptions of risks within remote areas is crucial for informed decision-making and improved service administration.

Methods and analysis

This scoping review protocol adopts the methodology outlined by the Joanna Briggs Institute. The objective is to delineate the current scientific evidence regarding the perception of both direct and indirect risks associated with healthcare practice in remote emergency settings. Employing the Population, Concept, and Context dimensions, inclusion criteria were established for each dimension: Population—nurses or other healthcare professionals with overlapping roles; Concept—perception of risk; Context—remote community or site and emergency care. The search will encompass the Scopus, PubMed, LILACS, Cochrane, CINAHL and Web of Science databases. A specific time frame for the selection of articles was not delimited. Observational, quantitative, qualitative studies and reviews will be eligible for inclusion if they meet the predetermined criteria. Two reviewers will undertake the document review process. Eligible documents may be in English or Portuguese, and only those subjected to peer review will be considered for inclusion.

Ethics and dissemination

Ethical approval will not be necessary for this study as it entails a scoping review based on previously published evidence. The findings from the scoping review will be disseminated through scientific conferences and published in academic journals.
Mental health interventions for adolescents living with HIV/AIDS in sub-Saharan Africa: protocol for a systematic review
Authors: Boakye Dorothy Serwaa , Xatse Eugenia , Akorli Vincent Valentine , Adjorlolo Paul Kwame , Battanis Yvonne Yawa , Frempong Abigail Bempomaa , Ocansey Lydia Kaki , Yeboah Cecillia , Adjorlolo Samuel
Published: December 2024

Introduction

Adolescents living with HIV/AIDS in sub-Saharan Africa have heightened risk for mental health and psychosocial burden owing to their exposure to a multiplicity of adverse conditions such as stigma and discrimination. However, there is no comprehensive evidence synthesis and evaluation of the effectiveness of mental health interventions for adolescents living with HIV/AIDS in this region. We aim to conduct a systematic review to synthesise the literature on existing mental health interventions for adolescents living with HIV/AIDS in sub-Saharan Africa.

Methods and analysis

This review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines. Eligible studies will include those investigating the effectiveness of psychosocial, psychological or other forms of interventions on mental health outcomes, conducted in sub-Saharan African countries and involving adolescents (aged 10–19 years) living with HIV/AIDS. Comprehensive searches will be conducted in electronic databases (PubMed, MEDLINE, CINAHL, Scopus and PsycINFO) and grey literature sources. The search will be restricted to studies published from 2004 onwards and in the English language. Study authors will be contacted, and reference lists of retrieved articles will be reviewed for additional papers. Study selection and data extraction will be performed by two independent reviewers, with any disagreements resolved by consensus or involving a third party. A narrative synthesis will be conducted, and if possible, meta-analyses will be performed to estimate the overall effect sizes of interventions on mental health outcomes. Eligible studies will undergo quality assessment using standardised criteria appropriate for each respective study design.

Ethics and dissemination

No primary data collection will be undertaken; therefore, no ethical approval is required. The findings of this review will be disseminated through publication in a peer-reviewed journal and presented at relevant conferences.

PROSPERO registration number

CRD42024538975
Syphilis Point of Care Rapid Test and Immediate Treatment Evaluation (SPRITE) study: a mixed-methods implementation science research protocol of eight public health units in Ontario, Canada
Authors: Mackrell Lucy , Carter Megan , Hoover Maggie , O'Byrne Patrick , Larkin Natasha , Magpantay Felicia Maria G , Zhao Sicheng , Stoner Bradley , Richard-Greenblatt Melissa , Mandryk Kira , Belanger Kandace , Burbidge Jennifer , Charette Gilles , Deschenes Gabrielle , Dinh Duy A , Featherstone Amanda , Khandakar Farhan , Martinez-Cajas Jorge , Tran Vanessa , Szumlanski Nicole , Vance Stephanie , Saeed Sahar
Published: December 2024

Introduction

Urgent, tailored and equitable action is needed to address the alarming rise in syphilis rates in Canada. In the last decade, the rates of infectious syphilis have increased by 345% in Ontario, Canada. Underserved populations—people who use drugs, un(der)housed individuals and those living in rural and remote areas—face unique social and healthcare challenges that increase their vulnerability to syphilis infections and hinder their access to timely diagnosis and treatment. This study assesses the real-world implementation and effectiveness of using a recently approved syphilis point-of-care test in conjunction with public health outreach to break barriers and bring services to the population at the highest risk.

Methods and analysis

The Syphilis Rapid Point-of-Care Testing and Immediate Treatment Evaluation (SPRITE) study includes eight public health units in Ontario, Canada. Implementation and evaluation of this rapid ‘test and treat’ outreach model of care will be assessed using the Practical, Robust Implementation and Sustainability Model (PRISM)/Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework, following a community-based participatory approach. Network models will be used to estimate the population-level impact of implementing this model of care to curb transmission. Knowledge mobilisation will be assessed using the Reciprocity, Externalities, Access, and Partnership (REAP) Self-Assessment Model.

Ethics and dissemination

The SPRITE study was approved by the Queen’s University Research Ethics Board (REB) and is to be conducted in accordance with the Canadian Tri-Council Policy Statement V.2 and the latest Seoul revision of the Declaration of Helsinki. Knowledge generated from this study will be mobilised through community-based organisations and the broader public health community.
Efficacy and safety of various regional nerve blocks for postoperative analgesia in paediatric patients undergoing developmental dysplasia of the hip surgery: a protocol for systematic review and network meta-analysis
Authors: Zhang Yu , Fu Chen , Junxia Wang , Yang Lei , Qin Zhijun
Published: December 2024

Introduction

Alleviating postoperative pain from developmental dysplasia of the hip (DDH) surgery is beneficial for paediatric patients. The most commonly used anaesthetic approach currently is general anaesthesia combined with regional nerve blocks. Existing research primarily focuses on studies comparing regional nerve blocks with placebo controls, or studies comparing two different regional nerve blocking techniques. However, the conclusions from these studies offer limited assistance to clinicians in selecting the safest and most effective nerve block. Therefore, we plan to conduct a systematic review and network meta-analysis to compare the efficacy and safety of different regional nerve blocks in managing postoperative pain in children undergoing surgery for DDH.

Methods and analysis

We will systematically search the following databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials via Ovid, as well as the Chinese databases CNKI and Wanfang. We will comprehensively search from the inception of each database to April 2024 and will include randomised controlled trials without restrictions on language or publication status. The primary outcome are postoperative pain scores at 4 hours following surgery. The quality of all included trials will be assessed using version 2 of the Cochrane Randomised Trial Risk of Bias Tool. We will employ the GeMTC package in R software for both direct and indirect comparisons within a Bayesian framework using a random effects model. Additionally, the Confidence in Network Meta-Analysis method will be employed to assess the quality of evidence.

Ethics and dissemination

Ethical approval is not required for this study, as it exclusively involves the compilation of published data. We plan to submit our review to academic conferences and peer-reviewed scholarly journals.

PROSPERO registration number

CRD42024527459.
Transition to home after very preterm birth: improving outcomes of children and their families—a systematic review protocol
Authors: Engel Vivienne , Mauron-Papadimitriou Valentina , Bührer Lea , Ebner Laura , Keller Lena , Gosteli Martina , Siegfried Sandra , Latal Beatrice , Kiechl-Kohlendorfer Ursula , Held Ulrike
Published: December 2024

Introduction

Medical progress has significantly improved the survival rates of very preterm-born infants in recent decades. Nevertheless, these infants are still at increased risk for long-term impairments as compared with term-born infants. While the homecoming of a preterm-born infant is long-awaited and brings relief to families, it also marks the end of intensive monitoring and highly specialised professional care. This situation often leaves parents coping with anxiety and a sense of unpreparedness, as they navigate the transition to home. Correspondingly, the WHO advocates for additional support for parents of preterm infants following the transition to home. According to the WHO, preparation for this transition yields positive effects on crucial aspects such as nutrition, parent–child interaction and parental well-being. However, there is significant heterogeneity as to which interventions are in place and regarding their level of efficacy. Consequently, we aimed to provide an overview of existing transition-to-home interventions and their efficacy by conducting a systematic review of the literature.

Methods and analysis

We will perform a systematic review of interventions aiming at improving the transition to home process for very preterm-born infants and their parents and will search the following databases: Cochrane, Medline, CINAHL, EMBASE and PsycINFO. Our main aim is to provide an overview of existing transition-to-home interventions and their efficacy in categories of intervention types. We will not predefine specific outcomes, but we will describe, assess and summarise the outcomes of the included studies. All reported outcomes will be recalculated to the scale of standardised mean differences. Meta-analysis will be performed with a random-effects model to account for expected large between-study heterogeneity.

Ethics and dissemination

No ethics approval was necessary for this study. The aim of our systematic review is to provide a comprehensive overview of current interventions designed to improve the transition from hospital to home. Subsequently, it will show the individual effect of these interventions and pool effect sizes if possible. The most promising interventions will then be combined and used as the basis of a subsequent randomised controlled trial of a new transition-to-home intervention. The results of the study will be published in a peer-reviewed journal.

PROSPERO registration number

The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 30 August 2023. PROSPERO CRD42023455401.
Self-advocacy positive perceptions and stage experiences in patients who had a stroke: a qualitative study in China
Authors: Zhao Zhixin , Wang Xiaoxuan , Zhang Chunhui , Wang Shanshan , Zhang Zhen-Xiang , Lin Bei-Lei , Mei Yong-Xia , Jiang Hu
Published: December 2024

Objectives

This study explored the perceptions and experiences of self-advocacy among patients who had a stroke in China.

Design

A descriptive phenomenological qualitative study was performed. Colaizzi’s seven-step method was used to analyse the data.

Setting

Two hospitals in Zhengzhou and Luoyang City, Henan Province, China.

Participants

19 patients who had a stroke were recruited and interviewed face-to-face between October 2023 and February 2024.

Results

The findings revealed two categories: positive perceptions and stage experiences. Three themes of positive perceptions were extracted: ‘accept the facts of illness while maintaining inner integrity’ with three subthemes (disease cognition, firm faith and positive attitude); ‘clarify one’s own needs and strive for them’ with four subthemes (self-care knowledge, effective communication, independent decision-making and power from relation); ‘enhancing subjective initiative and maintaining healthy behaviours’ with three subthemes (active participant in disease management, increased treatment compliance and increased initiative in rehabilitation exercises). Three stage experiences themes were motivation, response and stabilisation stage.

Conclusions

In this study, patients who had a stroke showed more positive perceptions of self-advocacy. Self-advocacy is a dynamic and progressive process of accepting their disease and actively participating in disease treatment. In addition, patients’ health behaviours are improved and maintained when they engage in self-advocacy.
Novel prehospital lactate cut-off estimation for mortality: a multicentre observational study
Authors: Martín-Rodríguez Francisco , Sanz-Garcia Ancor , Zalama-Sánchez Daniel , de Santos Castro Pedro Ángel , Silva Alvarado Eduardo , Gracia Villar Santos , Dzul López Luis Alonso , Aparicio Obregón Silvia , Calderon Iglesias Rubén , del Pozo Vegas Carlos , López-Izquierdo Raúl
Published: December 2024

Objectives

Point-of-care testing available in prehospital settings requires the establishment of new medical decision points. The aim of the present work was to determine the cut-off of the lactate threshold that activates alert triggers for all-cause 2-day mortality.

Design

Multicentre, prospective, ambulance-based, observational study.

Setting

Patients treated via emergency medical services (EMSs) and delivered to the emergency department between 2019 and 2023 were selected in Spain.

Participants

Adults with any acute disease.

Primary and secondary outcome measures

Epidemiological data, vital signs and prehospital point-of-care glucose and lactate levels were obtained. The outcome was all-cause 2-day in-hospital mortality. The cut-offs were obtained via three different methods: (i) indirect (which considers survivors and non-survivors), direct (which considers only survivors) assessment and lactate quartile. Additionally, the quartile approach was used to determine the differences in lactate distribution between survivors and non-survivors. Three different back-to-back studies with the same methodology were used.

Results

A total of 11 713 patients fulfilled the inclusion criteria. The mortality rate was 4.6% (542 patients). The difference in the median prehospital lactate concentration (mmol/L) between survivors and non-survivors was statistically significant (p<0.001): 2.29 (95% CI 1.43 to 3.38) and 7.14 (95% CI 5.11 to 9.71), respectively. Globally, the cut-off for all the studies combined was estimated by the direct method to be 3.71 mmol/L (95% CI 2.92 to 3.91), which was similar to the indirect value of 3.07 (95% CI 2.95 to 5.49) and the third quartile of 4.00. The mortality rate in patients who were less than 3.71 mmol/L was 0.004%, and that above that cut-off was 18%.

Conclusions

This study established a real-world lactate cut-off for 2-day in-hospital mortality of 3.71 mmol/L (95% CI 2.92 to 3.91) on the basis of data from the EMS. Considering this cut-off point could improve patient management via EMS services, allowing quick identification of patients at high risk of clinical worsening.

Trial registration number

ISRCTN Registry (ISRCTN17676798,ISRCTN48326533,ISRCTN49321933).
Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography
Authors: Playford David , Stewart Simon , Harris Sarah Ann , Scalia Gregory , Celermajer David S , Thomas Liza , Paratz Elizabeth Davida , Chan Yih-Kai , Strange Geoff
Published: December 2024

Background

Although the prognostic implications of severe mitral regurgitation (MR) are well recognised, they are less clear in moderate MR. We therefore explored the prognostic impact of both moderate and severe MR within the large National Echocardiography Database Australia cohort.

Methods

Echocardiography reports from 608 570 individuals were examined using natural language processing to identify MR severity and leaflet pathology. Atrial (aFMR) or ventricular (vFMR) functional MR was assessed in those without reported leaflet pathology. Using individual data linkage over median 1541 (IQR 820 to 2629) days, we examined the association between MR severity and all-cause (153 612/25.2% events) and cardiovascular-related mortality (47 840/7.9% events).

Results

There were 319 808 men and 288 762 women aged 62.1±18.5 years, of whom 456 989 (75.1%), 102 950 (16.9%), 38 504 (6.3%) and 10 127 (1.7%) individuals had no/trivial, mild, moderate and severe MR, respectively, reported on their last echo. Compared with those with no/trivial MR (26.5% had leaflet pathology, 19.2% died), leaflet pathology (51.8% and 78.9%, respectively) and actual 5-year all-cause mortality (54.6% and 67.5%, respectively) increased with MR severity. On an adjusted basis (age, sex and leaflet pathology), long-term mortality was 1.67-fold (95% CI 1.65 to 1.70) and 2.36-fold (95% CI 2.30 to 2.42) higher in moderate and severe MR cases (p<0.001) compared with no/trivial MR. The prognostic pattern for moderate and severe MR persisted for cardiovascular-related mortality and within prespecified subgroups (leaflet pathology, vFMR or aFMR, and age<65 years).

Conclusions

Within a large real-world clinical cohort, we confirm that conservatively managed severe MR is associated with a poor prognosis. We further reveal that moderate MR is associated with increased mortality, irrespective of underlying aetiology.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12617001387314)
Popliteal plexus block in total knee arthroplasty: a single-center randomized controlled double-blinded trial
Authors: Stebler Kevin , Elia Nadia , Zaccaria Isabelle , Fournier Roxane Michelle
Published: December 2024

Introduction

Whether a popliteal plexus block improves postoperative pain following total knee arthroplasty remains debated. This randomized trial tested if adding a popliteal plexus block to a continuous femoral nerve block decreases postoperative opioid requirement.

Methods

We included 66 patients undergoing total knee arthroplasty. 32 received continuous femoral nerve block and popliteal plexus block (intervention), and 34 received continuous femoral nerve block alone (control). The primary endpoint was the 12-hour postoperative morphine-equivalent consumption (mg). Secondary outcomes included opioid consumption, Visual Analog Pain Score (0–10), and sensorimotor extension of the block in postanesthesia care unit, at 12 hours, 24 hours and 48 hours postoperatively.

Results

66 patients with a median body mass index of 28.7 (IQR 26.3–33.8) were included in the study. In an intention-to-treat analysis, the median 12-hour morphine-equivalent consumption was lower in the intervention group (6.1 mg (0.5–14.5) vs 10 mg (5.0–17.3); one-sided Wilcoxon test (p=0.04)). The average pain intensity experienced in postanesthesia care unit was lower in the intervention group (median: 3.0 (3.0–5.0) vs 2.0 (1.0–4.0), two-sided Wilcoxon p=0.01) and fewer patients reported lateroposterior pain of the knee (11 (34.4%) vs 21 (61.8%) p=0.03). These benefits disappeared after 24 hours. The median duration of the popliteal plexus block procedure was 5.0 min (2.0–5.0).

Conclusions

Adding a popliteal plexus block to a continuous femoral nerve block decreases 12-hour opioid utilization, but the effect size is small, calling into question its clinical relevance.

Trial registration number

NCT04048889.