bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid ethnographic appraisal of community concepts of and responses to joint pain in Kilimanjaro, Tanzania
Authors: Msoka Elizabeth F , Bunn Christopher , Msoka Perry , Yongolo Nateiya M , Laurie Emma , Wyke Sally , McIntosh Emma , Mmbaga Blandina T
Published: January 2024

Introduction

Musculoskeletal disorders, experienced as joint pain, are a significant global health problem, but little is known about how joint pain is categorised and understood in Tanzania. Understanding existing conceptualisations of and responses to joint pain is important to ensure both research and interventions are equitable and avoid biomedical imposition.

Methods

Rapid ethnographic appraisal was conducted in a periurban and rural community in Kilimanjaro, documenting language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts pain has and how people respond to it. We conducted 66 interviews with community leaders, traditional healers, community members and pharmacists.

Photographs were taken and included in fieldnotes to supplement the interview data and develop thick descriptions. Data were analysed by constant comparison using QDA Miner software.

Results

Across the sample, dominant concepts of joint pain were namedugonjwa wa baridi, cold disease;ugonjwa wa uzee, old age disease;rimatizim, disease of the joints; and gauti, gout. Causes mentioned included exposure to the cold, old age, alcohol and red meat consumption, witchcraft, demons and injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. Perceived impacts of joint pain included loss of mobility, economic and family problems, developing new health conditions, death, reduction in sexual functioning and negative self-perceptions. Responses to joint pain blended biomedical treatments, herbal remedies, consultations with traditional healers and religious rituals.

Conclusions

Conceptualisations of and responses to joint pain in the two communities were syncretic, mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong ‘lay epidemiology’ in these communities. Anthropological methods can support the decolonisation of global health by decentring the imposition of English language biomedicine and pursuing synthetic, dignified languages of care.
Prevalence of anaemia among married women with recent birth history and high-risk fertility behaviour: secondary data analysis of the National Family Health Survey-India (2019–21)
Authors: Das Milan , Verma Madhur , Barman Papai , Behera Deepak Kumar
Published: January 2024

Objectives

To describe the prevalence of anaemia among currently married women with high-risk fertility behaviour (HRFB) based on age, parity and birth spacing indicators.

Design

Cross-sectional study.

Settings and participants

Fifth round of the National Family Health Survey (NFHS) was conducted in India (2019–2021) and included a nationally representative sample of 724, 115 women in the reproductive age group (15–49). Our analysis focused exclusively on married women who had given birth in the preceding 5 years.

Primary and secondary outcome measures

The prevalence of anaemia with HRFB was the primary outcome, and the likelihood of having anaemia due to HRFB was the secondary outcome.

Data and methods

Secondary data analysis of the NFHS-5 (2019–2021) datasets was done using a weighted analysis to determine anaemia prevalence in different HRFB categories. Bivariate analysis was done using the χ2test, and multiple binary logistic regression analyses were done to estimate the odds of having anaemia due to HRFB after adjusting for known confounders. A p value <0.05 was reported as statistically significant.

Results

The final analysis comprised 145,468 women, of whom 59.1% had anaemia. About 53.1% of women depicted ‘No risk’ fertility behaviour, and 34.6% and 12.3% had single and multiple HRFB. Women with ‘no-risk,’ single and multiple HRFB had anaemia prevalence rates of 58.1%, 59.4% and 63.1%, respectively. Women with ‘Single risk’ had an 18% higher likelihood (1.18; 1.13–1.22) of having anaemia after controlling for confounding variables, compared with the HRFB category with ‘No risk.’ Women with ‘Multiple risks’ showed a 6% higher likelihood (adjusted OR 1.06; 95% CI 1.03 to 1.08).

Conclusions

Anaemia remains a prevalent issue in India, and HRFB is observed as a significant contributing factor. This vulnerable group can be targeted through multiple interventions and further our efforts to realise our anaemia-related goals.
Effects of polyphenol supplementation on hepatic steatosis, intima-media thickness and non-invasive vascular elastography in obese adolescents: a pilot study protocol
Authors: Moretti Jean-Baptiste , Drouin Amélia , Truong Caroline , Youn Elizabeth , Cloutier Anik , Alvarez Fernando , Paganelli Massimiliano , Grzywacz Kelly , Jantchou Prevost , Dubois Josee , Levy Emile , El Jalbout Ramy
Published: January 2024

Introduction

Non-alcoholic fatty liver disease (NAFLD) is increasingly prevalent in obese adolescents. Increased systemic inflammation and decreased gut microbial diversity linked to obesity affect the liver and are also associated with cardiovascular diseases in adulthood. However, NAFLD and vascular alterations are reversible.

Methods and analysis

This pilot study evaluated the feasibility of a prospective open-label randomised controlled trial evaluating the effects of polyphenols on NAFLD and vascular parameters in obese adolescents. Children aged 12–18 years with hepatic steatosis (n=60) will be recruited. The participants will be randomised with a 1:1 allocation ratio to receive polyphenol supplementation one time per day for 8 weeks along with the clinician-prescribed treatment (group B, n=30) or to continue the prescribed treatment without taking any polyphenols (group A, n=30). The outcome measures will be collected from both the groups at day 1 before starting polyphenol supplementation, at day 60 after 8 weeks of supplementation and at day 120, that is, 60 days after supplementation. The changes in hepatic steatosis and vascular parameters will be measured using liver and vascular imaging. Furthermore, anthropometric measures, blood tests and stool samples for gut microbiome analysis will be collected. After evaluating the study’s feasibility, we hypothesise that, as a secondary outcome, compared with group A, the adolescents in group B will have improved NAFLD, vascular parameters, systemic inflammation and gut microbiome.

Ethics and dissemination

This study is approved by Health Canada and the hospital ethics. Participants and their parents/tutors will both provide consent. Trial results will be communicated to the collaborating gastroenterologists who follow the enrolled participants. Abstracts and scientific articles will be submitted to high-impact radiological societies and journals. ClinicalTrials.gov ID:NCT03994029. Health Canada authorisation referral number: 250 811. Protocole version 13, 2 June 2023.

Trial registration number

NCT03994029.
Point-Of-Care low-field MRI in acute Stroke (POCS): protocol for a multicentric prospective open-label study evaluating diagnostic accuracy
Authors: Foschi Matteo , Galante Angelo , Ornello Raffaele , Necozione Stefano , Marini Carmine , Muselli Mario , Achard Paola Olimpia , Fratocchi Luciano , Vinci Sergio Lucio , Cavallaro Marco , Silvestrini Mauro , Polonara Gabriele , Marcheselli Simona , Straffi Laura , Colasurdo Marco , Sorrentino Luca , Franconi Enrico , Alecci Marcello , Caulo Massimo , Sacco Simona
Published: January 2024

Introduction

Fast and accurate diagnosis of acute stroke is crucial to timely initiate reperfusion therapies. Conventional high-field (HF) MRI yields the highest accuracy in discriminating early ischaemia from haemorrhages and mimics. Rapid access to HF-MRI is often limited by contraindications or unavailability. Low-field (LF) MRI (<0.5T) can detect several types of brain injury, including ischaemic and haemorrhagic stroke. Implementing LF-MRI in acute stroke care may offer several advantages, including extended applicability, increased safety, faster administration, reduced staffing and costs. This multicentric prospective open-label trial aims to evaluate the diagnostic accuracy of LF-MRI, as a tool to guide treatment decision in acute stroke.

Methods and analysis

Consecutive patients accessing the emergency department with suspected stroke dispatch will be recruited at three Italian study units: Azienda Sanitaria Locale (ASL) Abruzzo 1 and 2, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital. The estimated sample size is 300 patients. Anonymised clinical and LF-MRI data, along with conventional neuroimaging data, will be independently assessed by two external units: Marche Polytechnic University and ‘G. Martino’ Polyclinic University Hospital. Both units will independently adjudicate the best treatment option, while the latter will provide historical HF-MRI data to develop artificial intelligence algorithms for LF-MRI images interpretation (Free University of Bozen-Bolzano). Agreement with conventional neuroimaging will be evaluated at different time points: hyperacute, acute (24 hours), subacute (72 hours), at discharge and chronic (4 weeks). Further investigations will include feasibility study to develop a mobile stroke unit equipped with LF-MRI and cost-effectiveness analysis. This trial will provide necessary data to validate the use of LF-MRI in acute stroke care.

Ethics and dissemination

The study was approved by the Research Ethics Committee of the Abruzzo Region (CEtRA) on 11 May 2023 (approval code: richyvgrg). Results will be disseminated in peer-reviewed journals and presented in academic conferences.

Trial registration number

NCT05816213; Pre-Results.
Investigating the prevalence of cognitive impairment and dementia in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA): the Harmonised Cognitive Assessment Protocol (HCAP) cross-sectional substudy
Authors: O'Hara Leeanne , Neville Charlotte , Marr Calum , McAlinden Michael , Kee Frank , Weir David , McGuinness Bernadette
Published: January 2024

Introduction

The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) study is the largest study of ageing in Northern Ireland (NI). The Harmonised Cognitive Assessment Protocol (HCAP) is a substudy of NICOLA designed to assess cognitive impairment and dementia in individuals aged 65 and over. The NICOLA-HCAP substudy is funded by the National Institute on Aging as part of a network for enhancing cross-national research within a worldwide group of population-based, longitudinal studies of ageing, all of which are centred around the US-based Health and Retirement Study.

Methods and analysis

The NICOLA-HCAP study will draw on the main NICOLA cohort (of 8283 participants) and randomly sample 1000 participants aged 65 and over to take part in the substudy. Participants will complete a series of cognitive tests (n=19) via a computer-assisted personal interview administered in their home (or alternatively within the research centre) and will be asked to nominate a family member or friend to complete an additional interview of validated instruments to provide information on respondent’s prior and current cognitive and physical functioning and whether the individual requires help with daily activities. The objectives of the study are: to investigate the prevalence of dementia and cognitive impairment in NICOLA; harmonise scoring of the NICOLA-HCAP data to the HCAP studies conducted in Ireland, the USA and England; to explore the validity of dementia estimates; and investigate the risk factors for dementia and cognitive impairment.

Ethics and dissemination

The study received ethical approval from the Faculty of Medicine, Health and Life Sciences Research Ethics Committee, Queen’s University Belfast. We will provide data from the Northern Irish HCAP to the research community via data repositories such as the Dementias Platform UK and Gateway to Global Aging to complement existing public data resources and support epidemiological research by others. Findings will also be disseminated through peer-reviewed publications and at international conferences.
Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial
Authors: Cochrane Madeleine , Drake Marcus J , Worthington Jo , Frost Jessica , Cotterill Nikki , Fader Mandy , McGeagh Lucy , Hashim Hashim , Lane Athene , Macaulay Margaret , MacNeill Stephanie , Rees Jonathan , Ridd Matthew J , Robles Luke A , Sanderson Emily , Taylor Gordon , Taylor Jodi , Noble Sian
Published: January 2024

Objectives

To estimate the cost-effectiveness of a primary care intervention for male lower urinary tract symptoms (LUTS) compared with usual care.

Design

Economic evaluation alongside a cluster randomised controlled trial from a UK National Health Service (NHS) perspective with a 12-month time horizon.

Setting

Thirty NHS general practice sites in England.

Participants

1077 men aged 18 or older identified in primary care with bothersome LUTS.

Interventions

A standardised and manualised intervention for the treatment of bothersome LUTS was compared with usual care. The intervention group (n=524) received a standardised information booklet with guidance on conservative treatment for LUTS, urinary symptom assessment and follow-up contacts for 12 weeks. The usual care group (n=553) followed local guidelines between general practice sites.

Measures

Resource use was obtained from electronic health records, trial staff and participants, and valued using UK reference costs. Quality-adjusted life-years (QALYs) were calculated from the EQ-5D-5L questionnaire. Adjusted mean differences in costs and QALYs and incremental net monetary benefit were estimated.

Results

866 of 1077 (80.4%) participants had complete data and were included in the base-case analysis. Over the 12-month follow-up period, intervention and usual care arms had similar mean adjusted costs and QALYs. Mean differences were lower in the intervention arm for adjusted costs −£29.99 (95% CI −£109.84 to £22.63) while higher in the intervention arm for adjusted QALYs 0.001 (95% CI −0.011 to 0.014). The incremental net monetary benefit statistic was £48.01 (95% CI −£225.83 to £321.85) at the National Institute for Health and Care Excellence UK threshold of £20 000 per QALY. The cost-effectiveness acceptability curve showed a 63% probability of the intervention arm being cost-effective at this threshold.

Conclusions

Costs and QALYs were similar between the two arms at 12 months follow-up. This indicates that the intervention can be implemented in general practice at neutral cost.

Trial registration number

ISRCTN11669964.
International consensus statement on the design, delivery and evaluation of sport-based interventions aimed at promoting social, psychological and physical well-being in prison
Authors: Murray Conor , Coyle Brendan , Morgan Haydyn , Marder Ian , Woods David , Haughey Tandy , Maycock Matthew , Genovesi Federico , Meek Rosie , Parker Andrew , Smith Andy , Kay Chris , Brink Gerko , Rovers Hubert , Haudenhuyse Rein , Roe Daniel , Contreras-Osorio Falonn , Donohue Brad , Bohall Greg , Martinez Nagore , Martos-Garcia Daniel , Whitley Meredith , Norman Mark , Demalija Rifat , Sherry Emma , Chitsawang Nathee , Adebayo Aderonmu Kehinde , Breslin Gavin
Published: January 2024

Objective

To develop an international consensus statement to advise on designing, delivering and evaluating sport-based interventions (SBIs) aimed at promoting social, psychological and physical well-being in prison.

Design

Modified Delphi using two rounds of survey questionnaires and two consensus workshops.

Participants

A multidisciplinary panel of more than 40 experts from 15 international jurisdictions was formed, including representation from the following groups and stakeholders: professionals working in the justice system; officials from sport federations and organisations; academics with research experience of prisons, secure forensic mental health settings and SBIs; and policy-makers in criminal justice and sport.

Results

A core research team and advisory board developed the initial rationale, statement and survey. This survey produced qualitative data which was analysed thematically. The findings were presented at an in-person workshop. Panellists discussed the findings, and, using a modified nominal group technique, reached a consensus on objectives to be included in a revised statement. The core research team and advisory board revised the statement and recirculated it with a second survey. Findings from the second survey were discussed at a second, virtual, workshop. The core research team and advisory board further revised the consensus statement and recirculated it asking panellists for further comments. This iterative process resulted in seven final statement items; all participants have confirmed that they agreed with the content, objectives and recommendations of the final statement.

Conclusions

The statement can be used to assist those that design, deliver and evaluate SBIs by providing guidance on: (1) minimum levels of competence for those designing and delivering SBIs; (2) the design and delivery of inclusive programmes prioritising disadvantaged groups; and (3) evaluation measures which are carefully calibrated both to capture proposed programme outcomes and to advance an understanding of the systems, processes and experiences of sport engagement in prison.
Association between kimchi consumption and obesity based on BMI and abdominal obesity in Korean adults: a cross-sectional analysis of the Health Examinees study
Authors: Jung Hyein , Yun Ye-Rang , Hong Sung Wook , Shin Sangah
Published: January 2024

Objective

Previous animal studies have shown the anti-obesity effect of kimchi-derived probiotic lactic acid bacteria. However, only a few epidemiological studies have investigated the association between kimchi consumption and obesity. Therefore, we aim to assess this relationship in Korean adults.

Design

Cross-sectional study.

Setting

The Health Examinees study was conducted from 2004 to 2013.

Participants

This study analysed 115 726 participants aged 40–69 years enrolled in the Health Examinees study in Korea.

Primary and secondary outcome measures

Obesity was defined as body mass index ≥25 kg/m2, and abdominal obesity was defined as waist circumference ≥90 cm in men and ≥85 cm in women. Kimchi consumption was assessed by the validated food frequency questionnaire.

Results

In men, total kimchi consumption of 1–3 servings/day was related to a lower prevalence of obesity (OR: 0.875 in 1–2 servings/day and OR: 0.893 in 2–3 servings/day) compared with total kimchi consumption of <1 serving/day. Also, men with the highest baechu kimchi (cabbage kimchi) consumption had 10% lower odds of obesity and abdominal obesity. Participants who consumed kkakdugi (radish kimchi) ≥median were inversely associated with 8% in men and 11% in women with lower odds of abdominal obesity compared with non-consumers, respectively.

Conclusions and relevance

Consumption of 1–3 servings/day of total kimchi was associated with a lower risk of obesity in men. Baechu kimchi was associated with a lower prevalence of obesity in men, and kkakdugi was associated with a lower prevalence of abdominal obesity in both men and women. However, since all results showed a ‘J-shaped’ association, it is recommended to limit excessive kimchi intake.
Implementation of a nurse-led, multidisciplinary model of care for older adults with cancer: a process evaluation protocol
Authors: Dufton Polly Hypatia , Tarasenko Elena , Midgley Katrina , Lee Kathryn , Kelly Ray , Rodrigues Jeremy , Yates Paul , Arulananda Surein , Parakh Sagun
Published: January 2024

Introduction

Cancer is predominantly a disease of older adults, with an increasing number of cancer diagnoses in individuals aged 65 or older. Multiple geriatric factors have been shown to impact patient outcomes in cancer treatment. However, oncology specialists are not well adapted to incorporate geriatric assessment into practice due to a lack of resources and knowledge of the specialty.

The primary aim of this study is to implement and evaluate a nurse-led, multidisciplinary model of care for older adults with cancer at two public tertiary hospitals in Melbourne, Australia.

Methods and analysis

This study will aim to assess 200 patients across 2 sites. Both sites will assess individuals with lung cancer; the second site will also include individuals with genitourinary, upper gastrointestinal and colorectal cancers.

This process evaluation will use quantitative and qualitative methods to explore the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of the nurse-led, multidisciplinary model of care.

Ethics and dissemination

Ethical approval and local governance approvals have been obtained by Austin Health and Monash Health Human Research Ethics committees. Dissemination will occur via publications, conferences, social medical and local engagement with clinicians, consumers and managers.
Estimating the effectiveness of an enhanced ‘Improving Access to Psychological Therapies’ (IAPT) service addressing the wider determinants of mental health: a real-world evaluation
Authors: Porter Alice , Franklin Matthew , De Vocht Frank , d'Apice Katrina , Curtin Esther , Albers Patricia , Kidger Judi
Published: January 2024

Background

Addressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health.

Objectives

To estimate the effectiveness of an enhanced ‘Improving Access to Psychological Therapies’ (IAPT) mental health service compared with traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included well-being support and community service links.

Design

A real-world evaluation using IAPT’s electronic health records.

Setting

Three National Health Service IAPT services in England.

Participants

Data from 17 642 service users classified as having a case of depression and/or anxiety at baseline.

Intervention

We compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical control), and the IAPT service with traditional treatment before additional support was introduced (historical control).

Primary outcome measures

Patient Health Questionnaire-9 (PHQ-9) Depression Scale (score range: 0–27) and Generalised Anxiety Disorder-7 (GAD-7) Anxiety Scale (score range: 0–21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed effects regression models.

Results

Small improvements (mean, 95% CI) were observed for PHQ-9 (depression) (−0.21 to –0.32 to −0.09) and GAD-7 (anxiety) (−0.23 to –0.34 to −0.13) scores in the intervention group compared with the historical control. There was little evidence of statistically significant differences between intervention control and geographical control.

Conclusions

Embedding additional health and well-being (H&W) support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared with the geographical control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional H&W support is clinically superior to traditional IAPT models.
Neighbourhood environments for a healthy lifestyle among young single-person households experiencing housing poverty in Seoul, South Korea: a spatiotemporal qualitative study protocol
Authors: Kim Dong Ha , Lee Jihyun , Yoo Seunghyun
Published: January 2024

Introduction

The number of single-person households is increasing globally—including in South Korea, where they account for over 30% of all households. Young single-person households in South Korea face health problems and housing challenges. Both the perceived and objective aspects of the neighbourhood environment, as a community asset, play a significant role in sustaining a healthy lifestyle. This study aims to explore and describe the meaning, roles and spatiotemporal characteristics of neighbourhood environments for a healthy lifestyle in young single-person households experiencing housing poverty in Seoul, South Korea.

Methods and analysis

This ongoing study uses an extended qualitative geographic information systems approach to explore a district in the city of Seoul that has the highest population density of young single-person households experiencing housing poverty. The study sample comprises young single-person households aged 19–39 years who are experiencing housing poverty in the study area, with an expected saturation point of approximately 55 participants. We employ online and offline recruitment strategies to ensure the inclusion of diverse perspectives and a multimethod approach that combines descriptive and spatiotemporal data collection techniques (eg, individual in-depth interviews, field observations and mobile global positioning system tracking). The data analysis encompasses thematic and content analyses to understand the neighbourhood environment’s perceived attributes and the spatiotemporal characteristics of healthy lifestyles. In the integrated analysis, we plan to combine the qualitative findings with living space and daily-life patterns using qualitative software and a hybrid relational database.

Ethics and dissemination

The Institutional Review Board of Seoul National University approved the research protocol on 18 May 2021. The findings will be shared at international conferences and published in academic journals. Additionally, an online seminar will be conducted to share the results with policy-makers, researchers, community organisations and health workers working with young single-person households experiencing housing poverty.
Facilitators and barriers of digital health technologies implementation in hospital settings in lower-income and middle-income countries since the COVID-19 pandemic: a scoping review protocol
Authors: Yew Sheng Qian , Trivedi Daksha , Adanan Nurul Iman Hafizah , Chew Boon How
Published: January 2024

Introduction

The implementation of digital health technologies (DHTs) in hospitals worldwide has been uneven since the COVID-19 pandemic. Ambiguity in defining the landscape of DHTs adds to the complexity of this process. To address these challenges, this scoping review aims to identify the facilitators and barriers of implementing DHTs in hospitals in lower-income and middle-income countries (LMIC) since COVID-19, describe the DHTs that have been adopted in hospital settings in LMIC during this period, and develop a comprehensive classification framework to define the landscape of DHTs implemented in LMIC.

Methods and analysis

We will conduct a systematic search in PubMed, Scopus, Web of Science and grey literature. Descriptive statistics will be used to report the characteristics of included studies. The facilitators and barriers to DHTs implementation, gathered from both quantitative and qualitative data, will be synthesised using a parallel-results convergent synthesis design. A thematic analysis, employing an inductive approach, will be conducted to categorise these facilitators and barriers into coherent themes. Additionally, we will identify and categorise all available DHTs based on their equipment types and methods of operation to develop an innovative classification framework.

Ethics and dissemination

Formal ethical approval is not required, as primary data collection is not involved in this study. The findings will be disseminated through peer-reviewed publications, conference presentations and meetings with key stakeholders and partners in the field of digital health.
Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study
Authors: Langley Jodi , Urquhart Robin , Tschupruk Cheryl , Christian Erin , Warner Grace
Published: January 2024

Objective

Integrating a palliative approach to care into primary care is an emerging evidence-based practice. Despite the evidence, this type of care has not been widely adopted into primary care settings. The objective of this study was to examine the barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices by applying an implementation science framework.

Design

This convergent mixed methods study analysed semistructured interviews and expression of interest forms to evaluate the implementation of a protocol, linked to implementation strategies, for a palliative approach to care called Early Palliation through Integrated Care (EPIC) in three primary care practices. This study assessed barriers to and facilitators of implementation of EPIC and was guided by the Consolidated Framework for Implementation Research (CFIR). A framework analysis approach was used during the study to determine the applicability of CFIR constructs and domains.

Setting

Primary care practices in Canada. Interviews were conducted between September 2020 and November 2021.

Participants

10 individuals were interviewed, who were involved in implementing EPIC. Three individuals from each practice were reinterviewed to clarify emerging themes.

Results

Overall, there were implementation barriers at multiple levels that caused some practices to struggle. However, barriers were mitigated when practices had the following facilitators: (1) a high level of intra-practice collaboration, (2) established practices with organisational structures that enhanced communications, (3) effective leveraging of EPIC project supports to transition care, (4) perceptions that EPIC was an opportunity to make a long-term change in their approach to care as opposed to a limited term project and (5) strong practice champions.

Conclusions

Future implementation work should consider assessing facilitators identified in our results to better gauge primary care pre-implementation readiness. In addition, providing primary care practices with support to help offset the additional work of implementing innovations and networking opportunities where they can share strategies may improve implementation success.
Co-designing action-oriented mental health conversations between care providers and ageing Canadians in the community: a participatory mixed-methods study protocol
Authors: Giosa Justine L , Kalles Elizabeth , McAiney Carrie , Oelke Nelly D , Aubrecht Katie , McNeil Heather , Habib Perez Olinda , Holyoke Paul
Published: January 2024

Introduction

The mental health of ageing Canadians is a growing concern, particularly post-pandemic. Older adults face systemic ageism and mental health stigma as pervasive barriers to seeking needed mental health support, care and treatment within health and social care systems. These barriers are exacerbated when service providers focus on physical healthcare needs or lack the skills and confidence to talk about and/or address mental health during routine visits. This study aims to co-design and test an evidence-based approach to mental health conversations at the point-of-care in home and community settings with older adults, family and friend caregivers and health and social care providers that could facilitate help-seeking activities and care access.

Methods and analysis

A participatory mixed-methods study design will be applied, guided by a Working Group of experts-by-experience (n=30). Phase 1 engages ageing Canadians in four online workshops (n=60) and a national survey (n=1000) to adapt an evidence-based visual model of mental health for use with older adults in home and community care. Phase 2 includes six co-design workshops with community providers (n=90) in rural and urban sites across three Canadian provinces to co-design tools, resources and processes for enabling the use of the adapted model as a conversation guide. Phase 3 involves pilot and feasibility testing the co-designed conversations with older adult clients of providers from Phase 2 (n=180).

Ethics and dissemination

Phases 1 and 2 of this study have received ethics clearance at the University of Waterloo (ORE #44187), University of British Columbia (#H22-02306) and St. Francis Xavier University (#26075). While an overview of Phase 3 is included, details will rely on Phase 2 outcomes. Knowledge mobilisation activities will include peer-reviewed publications, conference presentations, webinars, newsletters, infographics and policy briefs. Interested audiences may include community organisations, policy and decision-makers and health and social care providers.
Effects of six teaching strategies on medical students: protocol for a systematic review and network meta-analysis
Authors: Zhang Shuailong , Zhu Dongmei , Wang Xiaqing , Liu Tianyao , Wang Lian , Fan Xiaotang , Gong Hong
Published: January 2024

Introduction

Mounting evidence has suggested that novel teaching strategies have a positive impact on the quality and efficiency of medical education. However, the comprehensive evidence about the superiority among various strategies is not clear. To address this issue, we aim to conduct a systematic review and network meta-analysis (NMA) to evaluate the effects of six main strategies on medical education, including case-based learning, problem-based learning, team-based learning, flipped classrooms, simulation-based education and bridge-in, objective, preassessment, participatory learning, postassessment and summary.

Methods and analysis

A systematic search will be conducted in PubMed, Embase, Web of Science and the Cochrane Library, covering studies published from database inception to November 2023. Randomised controlled trials which evaluated the different teaching methods and meet the eligibility criteria will be included. The effectiveness of medical students’ learning, which is evaluated by theoretical test score, experimental or practical test score, will be analysed as the primary outcomes. Besides, the secondary outcomes consist of learning satisfaction of students and formative evaluation score. The study selection and data extraction will be independently performed by two authors. The risk of bias in each study will be assessed using V.2 of the Cochrane risk-of-bias tool for randomised controlled trials. To compare the effects of six teaching strategies, pairwise meta-analysis and NMA will be performed using Rev Man, STATA and R software. Statistical analyses including homogeneity tests, sensitivity analysis, consistency tests, subgroup analysis, Egger’s test and publication bias will also be completed.

Ethics and dissemination

No formal research ethics approval is required because this study is a meta-analysis based on published studies. The results will be disseminated to a peer-reviewed journal for publication.

Protocol registration number

CRD42023456050.
Impact of left atrial appendage thrombus location on diagnostic accuracy of cardiac CT: a single-centre case-control study
Authors: Guo Chuxian , Jiang Zhi , He Jionghong , Ma Haiyan , Wang Yuquan , Tan Jing , Ou Qiaoqiao , Tian Ye , Tian Longhai , Liu Qifang , Huang Jing , Yang Long
Published: January 2024

Objective

Cardiac CT (CCT) is an emerging non-invasive modality for assessing left atrial appendage (LAA) thrombus, but the results were conflicting. Our study aims to evaluate the accuracy of CCT for detecting LAA thrombus in patients undergoing catheter ablation of atrial fibrillation, using trans-oesophageal echocardiography (TEE) as the reference standard.

Design

Case-control study.

Setting

Patient data were collected from a tertiary hospital in China between 2017 and 2022.

Participants

The study enrolled 726 patients (male: 60.2%, age: 61±11 years) who had both TEE and CCT before catheter ablation of atrial fibrillation.

Measures

The CCT protocol consisted of one angiographic phase and one delayed scan 30 s later. LAA thrombi were defined as solid masses on TEE or persistent defects on CCT. The thrombus dimension and location, the LAA filling and emptying flow velocity were assessed by TEE.

Results

Of the 57 (7.9%) patients with LAA thrombi identified by TEE, 29 (50.9%) were located at the LAA ostium, and 28 (49.1%) were in the LAA. The former showed higher motility following blood flow and heartbeats than the latter. The CCT detected 14 (48.3%) of the LAA-ostium thrombi but 25 (89.3%) of those in the LAA (p=0.001). The LAA-ostium thrombi with the LAA mean flow velocity >0.35 m/s and maximum diameters <10 mm were more prone to have CCT false-negative results.

Conclusion

For patients undergoing catheter ablation for atrial fibrillation, CCT with a 30 s delay scan is less sensitive to LAA thrombi than TEE, especially for LAA-ostium thrombi with smaller sizes and higher LAA flow velocity.
Descriptive analysis to assess seasonal patterns of COVID-19 and influenza in low-income and middle-income countries in Asia, the Middle East and Latin America
Authors: Kyaw Moe H , Spinardi Julia Regazzini , Jagun Oladayo , Franco Villalobos Conrado , Kapetanakis Venediktos , Sharf-Williams Ruth , Yarnoff Benjamin
Published: January 2024

Objectives

Understanding disease seasonality can help predict the occurrence of outbreaks and inform public health planning. Respiratory diseases typically follow seasonal patterns; however, knowledge regarding the seasonality of COVID-19 and its impact on the seasonality of influenza remains limited. The objective of this study was to provide more evidence to understand the circulation of SARS-CoV-2, the virus responsible for COVID-19, in an endemic scenario to guide potential preventive strategies.

Design

In this study, a descriptive analysis was undertaken to describe seasonality trends and/or overlap between COVID-19 and influenza in 12 low-income and middle-income countries using Our World in Data and FluMart data sources. Plots of COVID-19 and influenza cases were analysed.

Setting

Singapore, Thailand, Malaysia, the Philippines, Argentina, Brazil, Mexico, South Africa, Morocco, Bahrain, Qatar and Saudi Arabia.

Outcome measures

COVID-19 cases and influenza cases.

Results

No seasonal patterns of SARS-CoV-2 or SARS-CoV-2/influenza cocirculation were observed in most countries, even when considering the avian influenza pandemic period.

Conclusions

These results can inform public health strategies. The lack of observed seasonal behaviour highlights the importance of maintaining year-round vaccination rather than implementing seasonal campaigns. Further research investigating the influence of climate conditions, social behaviour and year-round preventive measures could be fundamental for shaping appropriate policies related to COVID-19 and respiratory viral disease control in low-income and middle-income countries as COVID-19 variant data and epidemiologic patterns accrue over time.
What is the coverage of retina screening services for people with diabetes? Protocol for a systematic review and meta-analysis
Authors: Chabba Nimisha , Silwal Pushkar Raj , Bascaran Covadonga , McCormick Ian , Goodman Lucy , Gordon Iris , Burton Matthew J , Keel Stuart , Evans Jennifer , Ramke Jacqueline
Published: January 2024

Introduction

Diabetic retinopathy is a leading cause of vision impairment globally. Vision loss from diabetic retinopathy can generally be prevented by early detection and timely treatment. The WHO included a measure of service access for diabetic retinopathy as a core indicator in the Eye Care Indicator Menu launched in 2022:retina screening coverage for people with diabetes. The aim of this review is to provide a comprehensive global and regional summary of the available information on retina screening coverage for people with diabetes.

Methods and analysis

A search will be conducted in five databases without language restrictions for studies from any country reporting retina screening coverage for adults with any type of diabetes at the national or subnational level using data collected since 1 January 2000 until the search date. We will also seek reports and coverage statistics from government websites of all WHO member states. Two investigators will independently screen studies, extract relevant data and assess risk of bias of included studies. The results of the review will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. We will summarise the range of coverage definitions reported across included studies and present the median retina screening coverage in WHO regions and by World Bank country income level. Depending on the availability of data, we will conduct meta-analysis to assess disparities in retina screening coverage for people with diabetes by factors in the PROGRESS framework (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital).

Ethics and dissemination

This review will only include published data thus no ethical approval will be sought. The findings of this review will be published in a peer-reviewed journal and presented at relevant conferences.

Protocol registration number

OSF registration 17/10/2023:https://osf.io/k5p69.
Improving food insecurity screening across a health system throughout the COVID-19 pandemic
Authors: Kroese Lani , Lobo Kenia , Meyer Mary , Tate Jordan , Mays Mitra , Adye Rebecca , Qureshi Henna , Al-Shammaa Bann , Brito Albert , Seo-Mayer Patty , Moyer Katherine , Port Courtney
Published: January 2024

Background

Food insecurity has direct and indirect negative outcomes on the physical and mental health of children, with impacts throughout adult life. Rates of food insecurity have increased dramatically since the start of the COVID-19 pandemic. The American Academy of Pediatrics recommends paediatricians screen and intervene to address food insecurity. We aimed to increase the percentage of patient encounters with food insecurity screening completion at the paediatric medical home from 0% to 85% by July 2020 with extension to the paediatric emergency department (ED) and paediatric specialty clinic in the following year.

Methods

This multicentre project occurred in three sites within our health system: a teaching safety-net, paediatric medical home; a paediatric ED; and five divisions within paediatric specialty medical clinics. A screening tool was created using the validated Hunger Vital Sign Questionnaire. A standard screening, documentation and referral process was developed. The Model for Improvement was used testing changes via Plan-Do-Study-Act cycles.

Results

The percentage of households screened for food insecurity increased from a median of 0% to 30% for all sites combined. There was significant variability in screening with the ED screening a median of 24% and the medical home screening 80% by the end of the study period. A total of 9842 households (20.9%) screened were food insecure. During the study period, 895 families with 3925 household members received 69 791 pounds of food from our primary community resource using our clinic’s food prescription. Of these families, 44% (398) also qualified for the US Department of Agriculture programme ensuring ongoing food distribution up to twice a month.

Discussion

Using quality improvement methodology to address a critical community need, we implemented food insecurity screening across a hospital system including multiple sites and specialties and provided critical resources to households in need.
Time is a terrible thing to waste: optimising use of intraoperative monitoring practitioner time towards maximising in-house IOM service provision and reducing spend on external provision
Authors: Lodwick Stuart James , Antonacci Grazia , Proudlove Nathan
Published: January 2024

Intraoperative monitoring (IOM) during orthopaedic and neurosurgical operations informs surgeons about the integrity of patients’ central and peripheral nervous systems. It is provided by IOM practitioners (IOMPs), who are usually neurophysiology healthcare scientists. Increasing awareness of the benefits for patient safety and surgical outcomes, along with post-COVID-19 service recovery, has resulted in a material increase in demand for IOM provision nationally, and particularly at Salford Royal Hospital (SRH), which is a regional specialist neurosciences centre.

There is a shortage of IOMPs in the UK National Health Service (NHS). At SRH, this is exacerbated by staff capacity shortage, requiring £202 800 of supplementary private provision in 2022.

At SRH, IOMPs work in pairs. Our productive time is wasted by delays to surgical starts beyond our control and by paired working for much of a surgery session. This quality improvement (QI) project set out to release productive time by: calling the second IOMP to theatre only shortly before start time, the other IOMP returning to the office during significant delays, releasing an IOMP from theatre when appropriate and providing a laptop in theatre for other work.

We tested and refined these change ideas over two plan–do–study–act improvement cycles. Compared with complete paired working, we increased the time available for additional productive work and breaks from an average of 102 to 314 min per operating day, not quite achieving our project target of 360 min.

The new ways of working we developed are a step towards ability (when staff capacity increases) to test supporting two (simultaneous) operations with three IOMPs (rather than two pairs of IOMPs). Having significantly improved the use of staff time, we then also used our QI project data to make a successful business case for investment in two further IOMP posts with a predicted net saving of £20 000 per year along with other associated benefits.
Developing a framework of concerns from people living with frailty, for the Measure Yourself Concerns and Wellbeing (MYCaW) person-centred outcome measure
Authors: Polley Marie J , Barker Ruth E , Collaco Niçole B , Cam Christine , Appleton Joanne , Seers Helen E
Published: January 2024

Introduction

Measure Yourself Concerns and Wellbeing is a validated person-centred outcome measure, piloted as a core monitoring tool to understand what matters to people living with frailty in Gloucestershire. This paper describes the acceptability of MYCaW used in this setting, and the development of a framework for analysing personalised concerns from people living with frailty.

Methods

MYCaW was implemented in the Complex Care at Home service and South Cotswold Frailty Service from November 2020 onwards. MYCaW was completed at the person’s first meeting with a community matron and then 3 months later. Nineteen staff completed an anonymous survey to provide feedback on the acceptability of the tool. A framework of concerns bespoke to people living with frailty was created via iterative rounds of independent coding of 989 concerns from 526 people. The inter-rater reliability of the framework was determined by using the Cronbach alpha test.

Results

MYCaW was simple to use and helped health professionals’ discussions to be patient focused. A pictorial scale accompanying the Numerical Rating Scale was developed and tested to help people engage with scoring their concerns and well-being more easily. A framework of concerns from people living with frailty was produced with five main supercategories: Mental and Emotional Concerns; Physical Concerns; Healthcare and Service Provision Concerns, Concerns with General Health and Well-being and Practical Concerns. Inter-rater reliability was kappa=0.905.

Conclusions

MYCaW was acceptable as a core monitoring tool for people living with frailty and enabled a systematic approach to opening ‘What Matters to Me’ conversations. The personalised data generated valuable insights into how the frailty services positively impacted the outcomes for people living with frailty. The coding framework demonstrated a wide range of concerns—many linked to inequalities and not identified on existing outcome measures recommended for people living with frailty.