bluuebunny/crossref_metadata_2025 huggingface dataset:
Interventions to improve pharmacists’ competency in chronic disease management: a systematic review of randomized controlled trials
Authors: Rendrayani Farida , Utami Auliasari M. , Insani Widya N. , Puspita Falerina , Alfian Sofa D. , Nguyen Thang , Puspitasari Irma M.
Published: December 2024

Introduction

Effective chronic disease management (CDM) is vital for addressing chronic disease challenges. Given the importance of ensuring pharmacists’ competence in CDM, interventions targeting knowledge, skills, and attitudes are essential. Therefore, a comprehensive and up-to-date study is needed to analyze these interventions’ effect and potential development. Categorizing the interventions based on the Effective Practice and Organization of Care (EPOC) taxonomy is essential for better informing policymakers. The objectives of this systematic review were to identify interventions to improve pharmacists’ competency in chronic disease management based on the EPOC taxonomy and summarize their effectiveness.

Methods

Following methods in the Cochrane Handbook, a systematic search was conducted up to April 2024 on MEDLINE and Scopus. The inclusion criteria were an intervention study with a randomized controlled trial (RCT) design published in English, targeting pharmacists, and measuring knowledge, skills, and attitudes in aspects of CDM. The risk of bias was assessed using Cochrane’s RoB 2 tool for either randomized or cluster-randomized trials. Findings are reported narratively and align with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results

We included 11 RCT studies that focused on various aspects of CDM among community and hospital pharmacists. Implementation strategies and combined implementation strategies–delivery arrangements interventions were identified. Six implementation strategies interventions consistently yielded effective results, with scores ranging from 0.99 to 9.17 (p < 0.05). However, the other two implementation strategies interventions reported mixed results, with no significant improvements in knowledge or skills. Two implementation strategies-delivery arrangements interventions showed improvements, with score differences ranging from 4.5% (95% CI: 1.6%-7.4%) to 30% (95% CI: 29%-40%). Conversely, one implementation strategies-delivery arrangements intervention showed no significant improvement. The risk of bias assessment revealed varying levels of bias across the studies.

Conclusions

Implementation strategies and combined implementation strategies–delivery arrangements interventions improved pharmacists' competency in CDM. Most interventions consistently resulted in significant improvements in pharmacists' knowledge, skills, and attitudes. These findings underscore the potential of tailored, competency-based interventions to improve pharmacist competencies in CDM. Policymakers can use these insights to create guidelines and policies that promote ongoing professional development for pharmacists.
Exploring perspectives of type 2 diabetes prevention program coaches and training delivery staff on e-learning training: a qualitative study
Authors: Cranston Kaela D. , Grieve Natalie J. , Jung Mary E.
Published: December 2024

Background

E-learning can be an effective and efficient mode of training healthcare practitioners. E-learning training for diabetes prevention program coaches was designed and developed with input from end users. Insight from those who deliver the training and coaches who have taken the training can provide critical feedback for further refinement of the e-learning training. The purpose of this study was to understand diabetes prevention coaches’ (i.e., those taking the training) and training delivery staffs’ (i.e., those overseeing the training) perspectives of the coach e-learning training. Individuals wishing to become diabetes prevention program coaches were required to complete and pass the e-learning training to become a certified coach.

Methods

A pragmatic paradigm guided the methodology for this study. Semi-structured interviews were conducted with a purposive sample of diabetes prevention program coaches (n = 8) and diabetes prevention program training staff (n = 3). Interviews were recorded, transcribed verbatim, and analyzed using template analysis. Themes were separately constructed from coach and staff data.

Results

There were seven high order themes constructed from the coach data: (a) training design, (b) “I didn’t know what to expect from the training”, (c) technology usability, (d) learning, (e) coaches’ backgrounds shaped their training experience, (f) support, and (g) coaches valued the training. Two high order themes were constructed from the staff interviews: (a) streamlining the training delivery, and (b) ensuring coaches meet the diabetes prevention program standard.

Conclusions

This study highlights the importance of exploring perspectives of both those receiving and delivering e-learning training to refine content and processes. Qualitatively evaluating the delivery of e-learning training and modifying the training based on the evaluation results can lead to a more acceptable, efficient, and effective e-learning training. Coaches and staff emphasized the benefits of having high-quality online components, and that the brief training promoted gains in knowledge and improvements in skills. Resultswere used to inform modifications to the coach e-learning training for this diabetes prevention program and can be used to inform other healthcare practitioner e-learning trainings.
Investigating the accuracy of adjusting for examiner differences in multi-centre Objective Structured Clinical Exams (OSCEs). A simulation study of video-based Examiner Score Comparison and Adjustment (VESCA)
Authors: Yeates Peter , McCray Gareth
Published: December 2024

Introduction

Ensuring examiner equivalence across distributed assessment locations is a priority within distributed Objective Structured Clinical Exams (OSCEs) but is challenging as examiners are typically fully nested within locations (i.e. no overlap in performances seen by different groups of examiners). Video-based Examiner Score Comparison and Adjustment (VESCA) is a recently developed method which uses video-based linking to compare and (potentially) adjust for the effect of different groups of examiners within OSCEs. Whilst initial research on VESCA has been promising, the accuracy of the resulting adjusted scores is unknown. Given this, we aimed to investigate the accuracy of adjusted scores produced by VESCA under a range of plausible operational parameters.

Methods

Using statistical simulation, we investigated how: 1/proportion of participating examiners, 2/ number of linking videos, 3/baseline differences in examiner stringency between schools (i.e. whether examiners in School A are, on average, more stringent than the examiners in School B), 4/number of OSCE stations and 5/different degrees of random error within examiners’ judgements influenced accuracy of adjusted scores.

We generated distributions of students’ “true” performances across several stations, added examiner error, and simulated linking through crossed video-scoring (as occurs in VESCA). We then used Many Facet Rasch Modelling to produce an adjusted score for each student which we compared with their corresponding original “true” performance score. We replicated this 1000 times for each permutation to determine average error reduction and the proportion of students whose scores became more accurate. Simulation parameters were derived from a real, summative, whole curriculum undergraduate Year 3 OSCE at Keele University School of Medicine.

Results

We found that in all conditions where no baseline difference existed between groups of examiners, score adjustment only minimally improved or even worsened score accuracy. Conversely, as the size of baseline differences between schools increased, adjustment accuracy increased, reducing error by up to 71% and making scores more accurate for up to 93% of students in the 20% baseline-difference condition.

Conclusions

Score adjustment through VESCA has the potential to substantially enhance equivalence for candidates in distributed OSCEs in some circumstances, whilst making scores less accurate in others. These findings will support judgements about when score adjustment may beneficially aid OSCE equivalence.
‘The upside-down’ healthcare professional students’ experiences of delirium: an all-Ireland focus group study
Authors: Mitchell Gary , Graham Margaret , Murphy Jill , Barry Heather E. , Coffey Alice , Boland Pauline , Anderson Tara , Tuohy Dympna , Birch Matt , Tierney Audrey , Stark Patrick , McCurtin Arlene , McMahon James , Creighton Laura , Henderson Elizabeth , Craig Stephanie , McConnell Hannah , Guttridge Heather , Cook Lana , Cunningham Emma , Curran Geoffrey M. , Brown Wilson Christine
Published: December 2024

Background

Delirium is a complex neuropsychiatric syndrome characterised by an acute state of confusion, with a substantial impact on medical inpatients. Despite its growing recognition as a global healthcare concern, delirium remains underdiagnosed, partly due to a lack of awareness among healthcare professionals. The aim of this study was to explore how healthcare professional students experience caring for individuals experiencing delirium, the influence of their current pre-registration healthcare education, and importance of interprofessional teamwork in their role.

Methods

This qualitative study used a focus group approach to collect data from 40 healthcare professional students, including nursing, pharmacy, and medical students, across two universities in Ireland. The focus groups explored participants’ experiences of caring for people with delirium, their delirium education, and their collaboration with interdisciplinary teams. The data were analysed using a reflexive thematic analysis approach.

Results

Following thematic analysis, three themes are reported. The first is “The Upside Down,” revealing student perceptions of caring for people with delirium who are facing distressing situations. The second team reported is, “Teamwork Makes the Dream Work,” emphasising the critical role of interprofessional collaboration in delirium management and patient outcomes. Finally, the theme of “A Little Is Not Enough,” highlighted students’ critiques of current delirium education in their pre-registration training. Collectively, these themes illuminate challenges in delirium care, advocate for teamwork in healthcare settings, and call for improvements in educational preparation for future healthcare professionals.

Conclusions

This study contributes to the existing literature by providing insights into the perspectives of healthcare professional students on delirium care. The findings also highlight the challenging nature of caring for individuals with delirium and the need for improved delirium education and interdisciplinary collaboration.
Uncertainty-aware automatic TNM staging classification for [18F] Fluorodeoxyglucose PET-CT reports for lung cancer utilising transformer-based language models and multi-task learning
Authors: Barlow Stephen H. , Chicklore Sugama , He Yulan , Ourselin Sebastien , Wagner Thomas , Barnes Anna , Cook Gary J.R.
Published: December 2024

Background

[18F] Fluorodeoxyglucose (FDG) PET-CT is a clinical imaging modality widely used in diagnosing and staging lung cancer. The clinical findings of PET-CT studies are contained within free text reports, which can currently only be categorised by experts manually reading them. Pre-trained transformer-based language models (PLMs) have shown success in extracting complex linguistic features from text. Accordingly, we developed a multi-task ‘TNMu’ classifier to classify the presence/absence of tumour, node, metastasis (‘TNM’) findings (as defined by The Eight Edition of TNM Staging for Lung Cancer). This is combined with an uncertainty classification task (‘u’) to account for studies with ambiguous TNM status.

Methods

2498 reports were annotated by a nuclear medicine physician and split into train, validation, and test datasets. For additional evaluation an external dataset (n = 461 reports) was created, and annotated by two nuclear medicine physicians with agreement reached on all examples. We trained and evaluated eleven publicly available PLMs to determine which is most effective for PET-CT reports, and compared multi-task, single task and traditional machine learning approaches.

Results

We find that a multi-task approach with GatorTron as PLM achieves the best performance, with an overall accuracy (all four tasks correct) of 84% and a Hamming loss of 0.05 on the internal test dataset, and 79% and 0.07 on the external test dataset. Performance on the individual TNM tasks approached expert performance with macro average F1 scores of 0.91, 0.95 and 0.90 respectively on external data. For uncertainty an F1 of 0.77 is achieved.

Conclusions

Our ‘TNMu’ classifier successfully extracts TNM staging information from internal and external PET-CT reports. We concluded that multi-task approaches result in the best performance, and better computational efficiency over single task PLM approaches. We believe these models can improve PET-CT services by assisting in auditing, creating research cohorts, and developing decision support systems. Our approach to handling uncertainty represents a novel first step but has room for further refinement.
Assessing caregiver stress and resource needs in pediatric cancer care
Authors: Amin Shaimaa Mohamed , Khedr Mahmoud Abdelwahab , Mansy Azza Medhat Aziz , El-Monshed Ahmed Hashem , Malek Mohamed Gamal Noaman , El-Ashry Ayman Mohamed
Published: December 2024

Background

Caregivers of pediatric cancer patients often face significant stress and emotional strain, which can negatively impact their well-being and the quality of care provided to their children. Understanding the socio-demographic factors influencing caregiver stress and identifying the specific needs and resources required by caregivers are crucial for improving support systems in pediatric cancer care.

Aim of the study

This study aimed to analyze the levels of caregiver stress and their resource needs within pediatric cancer care.

Methods

A cross-sectional descriptive design was used, and the study was conducted at El-Minia Oncology Center outpatient clinics, Egypt. The sample included 258 pediatric cancer caregivers selected based on predefined eligibility criteria. Data were collected using the Caregiver Needs and Resources Assessment (CNRA) and the King Stone Caregiver Stress Scale (KCSS), both of which demonstrated strong reliability and validity. Descriptive statistics, t-tests, ANOVA, and Pearson correlation coefficients were employed for data analysis using SPSS version 29, with a significance level set at p < 0.05.

Results

Caregivers reported moderate to high stress levels, with an average stress score of 34.59 (SD = 7.649). Age, education level, marital status, and income were significant predictors of caregiver stress (p < 0.001), with lower income and higher educational levels contributing to increased stress. The number of children, child’s age, and duration since cancer diagnosis also significantly impacted stress levels (p < 0.001). Correlation analysis revealed that psychological needs were positively related to stress (r = 0.488, p < 0.001), while spirituality was negatively associated with stress (r = -0.241, p < 0.001). Regression analysis indicated that physiological needs (ß = 0.331) and role conflict (ß = 0.294) were the strongest predictors of stress (R² = 0.636).

Conclusion and implications

This study emphasizes the impact of socio-demographic factors on caregiver stress in pediatric cancer care. Targeted interventions that address caregivers’ psychological, social, and financial needs are essential to alleviate stress. Implementing caregiver-centered support programs in pediatric oncology can enhance the well-being of both caregivers and patients. Future research should explore sustainable strategies to further reduce caregiver burden.

Clinical trial number

Not applicable.
Impact of COVID-19 on nurse outcomes in the private sector of South Africa: a cross-sectional study
Authors: Gohentsemang Granny Solofelang , Coetzee Siedine Knobloch , Botha Stephani , Fourie Erika
Published: December 2024

Background

This study explored and described the impact of the COVID-19 pandemic on nurse outcomes in the private sector of South Africa. National research shows that nurses had poor nurse outcomes prior to the pandemic, amidst these issues the COVID-19 pandemic occurred, with nurses having to play a key role in the public health response. International studies have shown that although nurses were willing to serve in this manner, they experienced moderate to high burnout, anxiety, depression, fear and exhaustion. However, this topic has received comparatively little attention in African countries.

Methods

A cross-sectional survey design was conducted. Multistage sampling was applied in selection of provinces, hospital groups, hospitals, units, and nursing personnel. Valid and reliable tools were used to measure nurse outcomes. Data was collected from April 2021 until January 2022.

Results

Nurses described having high levels of compassion satisfaction, moderate levels of compassion fatigue, and high levels of burnout. Nurses appeared satisfied with their job and career. Almost a quarter of nurses reported the intention to leave their job, and of those about a fifth indicated that they intended to leave the profession. The nurses who routinely cared for COVID-19 patients had a small statistically significant increase in compassion fatigue, compassion satisfaction, emotional exhaustion and, job turnover intention, and a small statistically significant decrease in job satisfaction. Increased exposure to death and dying showed small correlations with emotional exhaustion and career turnover intentions.

Conclusion

The results of this study show that nurses were impacted by COVID-19 and death and dying during the pandemic, and that follow-up studies are needed post-pandemic.

Implications of study

It is important that burnout and compassion fatigue be addressed on an organizational level, as nurse outcomes were already negative prior to the pandemic, and all global evidence points to the worsening of these outcomes post-pandemic. There were many psychological support interventions with proven effectiveness that should be explored and applied for the South African context.
Development of a psychometrically valid and reliable measure of primary care providers’ willingness to engage with value based payments and innovations in care coordination
Authors: Atherly Adam , van den Broek-Altenburg Eline , Jacobs Alicia , Mueller Josiah , Wulfman Carrie , van Eeghen Constance
Published: December 2024

Background

Most approaches to healthcare reform envision an enhanced role for primary care providers, supported by innovative payment methodology and improved resources. However, there are currently no instruments to measure providers’ ability and willingness to work with existing tools provided by payers, such as Accountable Care Organizations (ACO). In this study, we develop and psychometrically test a new instrument to measure provider engagement with ACOs.

Methodology/ approach

The instrument was developed based on a self-efficacy theory of the adoption of innovations. We hypothesized two underlying constructs: Ease of Use (“Ease”) and Perceived Usefulness (“Usefulness”). Constructs were tested using confirmatory factor analysis. Reliability was assessed with Cronbach's Alpha and convergent and divergent validity. Survey subjects were Primary Care Providers engaged with an ACO.

Results

Eigenvalue and scree plots indicated the hypothesized two factor model was appropriate. Four questions failed to load onto a single factor – three from Ease and one from Usefulness. Both scales have outstanding reliability, with an Alpha of 0.951 for Usefulness and 0.831 for Ease. For validity, the results are consistent with our prior hypotheses for convergent and divergent validity.

Conclusions

The new instrument is a valid and reliable measure of providers’ ability to work with and gain value from ACO participation.

Practice implications

The success of any health care reform will be highly dependent on primary care providers’ willingness and ability to engage with payers. This instrument provides a new tool to measure the value and difficulty of that engagement by primary care providers.
From applause to disappointment – appreciation among healthcare providers that provided end-of-life care during the COVID-19 pandemic and its impact on well-being – a longitudinal mixed methods study (the CO-LIVE study)
Authors: Zee Masha S. , Philipsen Bregje D. Onwuteaka , Witkamp Erica , Becqué Yvonne N. , Goossensen Anne , Pasman H. Roeline
Published: December 2024

Background

The healthcare sector is facing increasing work pressure, making a healthy workforce essential. Appreciation is a factor influencing well-being, and the COVID-19 pandemic offers valuable insights into this. This study aims to: 1) describe to what extent end-of-life care providers felt appreciated and understood during the first 18 months of the pandemic, 2) examine the impact of appreciation on their well-being, and 3) explore their perceptions of what appreciation should look like.

Methods

A longitudinal mixed methods study among healthcare providers in the Netherlands delivering end-of-life care during the COVID-19 pandemic. Surveys were conducted at four timepoints (n = 302), and interviews were conducted at three timepoints (n = 17) during the first 18 months of the pandemic. Generalized Estimating Equations analysis was performed on the quantitative data and thematic analysis was conducted on the interview data.

Results

This study shows that feeling of appreciation among healthcare providers peaked in the first wave of the pandemic, but significantly dropped in the second wave, with only about half of the healthcare providers feeling appreciated. This slightly improved afterwards. Furthermore, nearly half of healthcare providers felt misunderstood during the first 18 months of the pandemic. Additionally, this study shows that between September 2020 and September 2021 about 1 in 3 healthcare providers had a score on the Well-Being Index indicating higher risk for burnout. Feeling appreciated and not feeling understood were both significantly associated with worse well-being. Interviews revealed that nurses did not always feel understood and appreciated by society, employers, patients and their families, as well as their own friends and family, leading to feelings of sadness, anger, and frustration. Three major themes emerged: ‘recognizing real needs, ‘we are not in this together’ and ‘short-lived appreciation that failed to lead to structural changes’.

Conclusions

This study shows that during the COVID-19 pandemic, healthcare providers often felt neither appreciated nor understood, which is associated with lower scores of well-being. The expressed appreciation often did meet their needs or expectations, from both employers and society. With healthcare provider well-being still under strain, sustained attention to appreciation and understanding is important for retaining the workforce.
Are urban residents seeking appropriate care for malaria? evidence from an exploratory qualitative study in two cities in nigeria
Authors: Ogunwale Akintayo , Ajayi IkeOluwapo , Bamgboye Eniola , Adamu Al-Mukhtar , Bello Musa , Olawuwo Morenikeji , Fagbamigbe Adeniyi , Akinyemi Joshua , Ozodiegwu Ifeoma
Published: December 2024

Background

Unplanned and rapid urbanization within Nigerian cities with the attendant environmental consequences may hinder achieving malaria elimination goal. Presently, there are limited qualitative studies on malaria case management and care-seeking patterns by settlement type in urban areas in Nigeria. This study, investigated malaria-related health seeking behaviours among different settlement types in Ibadan and Kano metropolises, Nigeria.

Methods

This qualitative study involved conduct of nine Focus Group Discussions (FGDs) sessions among community members and 20 Key Informant interviews (KIIs) with healthcare providers and community stakeholders in each metropolis. Participants were purposively drawn from three settlement types – formal, informal and urban slum. Pretested FGD and KII guides were used to collect data. Data were subjected to thematic content analysis.

Results

Government-owned health facilities especially Primary Health Care (PHC) facilities was a major place identified as where many community members prefer to seek care for suspected malaria infection. Reasons adduced included proximity of facilities and services affordability. A common viewpoint was that most community members in informal and slum communities in both metropolises often patronize Proprietary Patent Medicine Vendors (PPMVs) or drug sellers as the first point for treatment of suspected malaria infection. Adduced reasons included poverty and non-availability of 24 h services in PHC facilities. High cost of treatment, poor attitude of health workers, long waiting time and cultural beliefs were identified as key factors influencing community members’ decision not to seek care in health facilities. It was noted that the rich prefer to seek treatment in private hospitals, while the poor usually visit PHCs or resort to other options like buying drugs from PPMVs or use herbal drugs.

Conclusion

The standard practice of seeking care in health facilities was influenced by diverse factors including treatment cost, health workers’ attitude and waiting time in health facilities. A commoner practice of seeking care from patent medicine vendors and herbal drug sellers among informal settlements and slums dwellers calls for public health interventions. Specifically, the provision of free or affordable malaria care in health facilities and patient-friendly environments; and training of non-formal care providers on appropriate malaria care and referral to health facilities are recommended.
Examining patient choice and provider competition under the National Health Insurance Fund outpatient cover in Kenya: does it enhance access and quality of care?
Authors: Kazungu Jacob , Barasa Edwine , Quaife Matthew , Nonvignon Justice
Published: December 2024

Background

While patient choice and provider competition are predicted to influence provider behaviour for enhancing access and quality of care, evidence on provider perceptions and response to patient choice and provider competition is largely missing in low-resource settings such as Kenya. We examined provider and purchaser perceptions about whether patient choice and provider competition influenced provider behaviour and enhanced access and quality of outpatient care in Kenya.

Methods

We conducted a qualitative study to explore this across two purposefully selected counties. We conducted 15 in-depth interviews (IDIs) with health facility managers and National Health Insurance Fund (NHIF) staff across the two counties. We examined these across five areas summarised as either local market conditions or patient feedback following the Vengberg framework.

Results

NHIF members’ choice of outpatient facilities compelled private and faith-based providers to compete for members while public providers did not view choice as a way of spurring competition. Besides, all providers did not receive any information regarding the exit of NHIF members from their facilities. Providers felt that that information would be crucial for their planning, especially in enhancing service accessibility and quality of care. Most providers ensured the availability of drugs, provided a wider range of services and leveraged on marketing to attract and retain NHIF members. Finally, providers highlighted their redesign of service delivery to meet NHIF members’ needs whilst enhancing the quality-of-care aspects such as waiting time and having qualified health workers.

Conclusion

There is a need for NHIF to share NHIF members’ exit information with providers to support their service delivery arrangements in response to NHIF members’ needs. Besides, this study contributes evidence on patient choice and provider competition and their influence on access and quality of care from a low-resource setting country which is crucial as NHIF transitioned to the Social Health Authority.
Aging in (a meaningful) place – appropriateness and feasibility of Outdoor Reablement in a rural Arctic setting
Authors: Eliassen Marianne , Hartviksen Trude Anita , Holm Solrun , Sørensen Bodil Anita , Zingmark Magnus
Published: December 2024

Background

As populations age in the Western world, interventions aiming for ‘aging in place’, such as reablement, have gained prominence. Reablement programs have focused on enabling older people to maintain independence in their home environment. However, while a growing body of research points to the considerable benefits of engaging in outdoor environments, reablement rarely addresses outdoor activities. People living in rural Arctic areas often tend to have strong cultural, social, and emotional attachments to outdoor places, emphasizing the outdoors as a meaningful arena for engagement. Concurrently, rural Arctic communities face unique obstacles in facilitating outdoor activities, such as geographic isolation, limited access to services, harsh climate conditions, and seasonal variations. Recognizing these challenges, our study sought to tailor an outdoor reablement model that is appropriate and feasible for the context of a rural Arctic setting.

Methods

The study design was inspired by a co-design methodology, incorporating data creation through workshops, focus groups, and individual interviews conducted over an eleven-month period. Three municipalities in rural Arctic Norway were involved, with a total of 35 participants, including older people receiving reablement services and healthcare professionals. A socioecological theory supported the thematic data analysis.

Results

The study yielded experiences that generated a comprehensive model for implementing outdoor reablement that meet the specific needs that the participants experienced in the rural Arctic setting. The model includes the individual level, accounting for physical and mental functioning; the organizational level, necessitating access to aids and equipment and cross-sectorial collaboration; and the environmental level, adapting to climatic, seasonal, and geographic challenges.

Conclusion

This study contributes with knowledge that broadens the scope of reablement as an initiative to support aging in place to include outdoor environments. The tailored outdoor reablement model developed in this study addresses the complexity of aging in place in rural Arctic settings. The study underscores the importance of context-specific strategies that support older people in maintaining a healthy and meaningful life through active engagement with the outdoors.
Computer-assisted medical history taking prior to patient consultation in the outpatient care setting: a prospective pilot project
Authors: Hauber Roman , Schirm Maximilian , Lukas Mirco , Reitelbach Clemens , Brenig Jonas , Breunig Margret , Brenner Susanne , Störk Stefan , Puppe Frank
Published: December 2024

Background

Feeding patients’ self-reported medical history into the diagnostic care process may accelerate workflows in clinical routine.

Methods

We prospectively piloted a novel medical history documentation system in a German cardiological outpatient practice and evaluated its feasibility and perceived usefulness. Based on a generic software that allows to record structured information, a customized solution for the cooperating practice was developed and implemented. Prior to the consultation of the physician, the patient used a tablet that guided the user through a structured comprehensive workflow to document the medical history. The retrieved information was arranged by the software into a ready-to-use text format, presented to the physician in an editable form and added to her report. Three user-centered endpoints were explored: i) Appropriateness—measured by the duration of a patient interview; ii) Patient acceptance—assessed by three questions to patients; iii) Usefulness—operationalized by multiple ratings of the physician.

Results

A total of 2,513 patients were approached of which 2,415 provided complete histories. The system was assessed as appropriate for the practical workflow in terms of time and workflows. The patient-system interaction was rated favourably by patients including elderly ones. The system was regarded useful by the physician, reducing her daily workload by about one hour.

Conclusions

Automated history-taking tools deployed before consultation could support physicians in obtaining patients’ medical histories, thereby reducing professionals’ perceived workload. The technical and methodological limitations of our study should be respected, calling for additional future evaluations.
Feasibility of a Pharmabuddy Care Service for patients with Parkinson’s disease
Authors: Stuijt C. C. M. , Karapinar-Çarkit F. , van de Steeg – van Gompel C. , van Laar T. , van den Bemt B. J. F. , Heringa M.
Published: December 2024

Background

Pharmaceutical care for patients with Parkinson’s disease (PD) is complex. Specialized pharmaceutical care provided by a dedicated pharmacy team member (pharmabuddy) for these patients may reduce medication-related problems. The feasibility of this service for PD patients is unknown.

Objective

To evaluate the feasibility of a Pharmabuddy Care Service (PCS) for PD patients in primary care pharmacies.

Methods

Pharmabuddies who offered PCS were invited to fill in a questionnaire to evaluate the feasibility of PCS. Patients received a patient questionnaire and were invited for an interview. Patient records provided information on medication-related problems and interventions. Feasibility was evaluated conform four domains of Bowen’s Framework. First, acceptability included patients’ satisfaction ratings and experiences, Pharmabuddy impression on start and continuation of the service. Second, demand included use by patients and provision by pharmabuddies. Third, implementation/practicality: implementation indicators and barriers and facilitators from patient- and pharmabuddy perspective and fourth limited efficacy: effect of the PCS on PD symptoms, medication related problems identified and interventions from patient records.

Results

Twenty-three (59%) patients completed the questionnaire, 9 were interviewed, 12 (67%) pharmabuddies responded. Acceptability was high among patients (mean 9.5 (SD 1.3) out of 10), 6 (50%) pharmacies (still) provided PCS. Demand: 56% of patients had 1–2 contact moments, 28% two or more. Ten pharmacies provided up to 14 patients per pharmacy with PCS, one up to 24. Implementation/practicality: important barriers were time constraints and perception of other healthcare professionals. Positive reactions from patients encouraged pharmabuddies to carry out their PCS-activities. Patients were positive about pharmabuddy’s listening competency while knowledge could be improved. Limited efficacy: from patient records, 89 interventions were made in response to 93 (median 3 per patient (range 1–16)) medication related problems or questions, with 20 (87%) patients reporting a positive effect from their interaction with a pharmabuddy.

Conclusion

This study shows PCS is highly appreciated by responding patients and can be feasible for primary care pharmacies. Several implementation issues are still present. Future studies should focus on quantifiable effects of PCS services as well as resource and perception hurdles.
Collaborative design of a care pathway for pharmacy-based PrEP delivery in Nigeria: insights from stakeholder consultation
Authors: Ekwunife Obinna I. , Omenoba Theodora C. , Eyong Ugochi , Okelu Valentine , Alagbile Michael , Ume Ifeanyi , Eze Ambrose , Fisayo Aderinola , Aidoo-Frimpong Gloria , Shroff Farah , Anyakora Chimezie
Published: December 2024

Background

HIV remains a significant public health problem, particularly in Africa, where two-thirds of global cases occur. Nigeria is among the three countries with the highest burden. Despite free access to pre- and post-exposure prophylaxis (PrEP and PEP) in Nigerian hospitals, stigma, distance, and restrictive clinic hours hinder uptake, especially among vulnerable populations. Building on the successful pilot implementation of pharmacy-based PrEP delivery in Kenya, we engaged Nigerian stakeholders in adapting the model, addressing user and provider concerns to ensure effective implementation in Nigeria.

Methods

The stakeholder meeting took place in Abuja, Nigeria, which is selected for its central location and accessibility to various stakeholders, particularly those involved in HIV prevention efforts. The participants were purposefully selected to ensure diverse representations, including youth who are potential PrEP users, pharmacy providers, regulators, and representatives from civil society organizations. The meeting utilized the Nominal Group Technique (NGT)—a structured method for facilitating group decision-making and prioritizing ideas—to adapt the Kenyan pharmacy-delivered PrEP model for implementation in the Nigerian context. Mock role play was conducted to help participants understand the care pathway. The discussions culminated in identifying challenges and viable strategies for implementing the model in Nigeria.

Results

The one-day stakeholder meeting on 9 October 2024 was attended by 20 participants from various sectors involved in HIV prevention services. Stakeholders expressed enthusiasm for pharmacy-based PrEP delivery while acknowledging challenges associated with clinic-based services, such as stigma, limited hours, and long wait times. The key recommendations included training pharmacy providers, increasing awareness, ensuring confidentiality, establishing referral linkages, and integrating program data into the Health Management Information System (HMIS) as well as ensuring commodity availability and access. To enhance the success of the pilot study, stakeholders proposed engaging a research assistant, forming a monitoring team, and submitting the results to the Pharmacy Council of Nigeria (PCN) for review.

Conclusions

The identified challenges and strategies for implementing the model in Nigeria will inform the development of a refined pharmacy-delivered PrEP framework that is ready for pilot testing and potential scaling across the country.
Functional omics of ORP7 in primary endothelial cells
Authors: Taskinen Juuso H. , Holopainen Minna , Ruhanen Hanna , van der Stoel Miesje , Käkelä Reijo , Ikonen Elina , Keskitalo Salla , Varjosalo Markku , Olkkonen Vesa M.
Published: December 2024

Background

Many members of the oxysterol-binding protein-related protein (ORP) family have been characterized in detail over the past decades, but the lipid transport and other functions of ORP7 still remain elusive. What is known about ORP7 points toward an endoplasmic reticulum and plasma membrane-localized protein, which also interacts with GABA type A receptor-associated protein like 2 (GABARAPL2) and unlipidated Microtubule-associated proteins 1A/1B light chain 3B (LC3B), suggesting a further autophagosomal/lysosomal association. Functional roles of ORP7 have been suggested in cholesterol efflux, hypercholesterolemia, and macroautophagy. We performed a hypothesis-free multi-omics analysis of chemical ORP7 inhibition utilizing transcriptomics and lipidomics as well as proximity biotinylation interactomics to characterize ORP7 functions in a primary cell type, human umbilical vein endothelial cells (HUVECs). Moreover, assays on angiogenesis, cholesterol efflux, and lipid droplet quantification were conducted.

Results

Pharmacological inhibition of ORP7 leads to an increase in gene expression related to lipid metabolism and inflammation, while genes associated with cell cycle and cell division were downregulated. Lipidomic analysis revealed increases in ceramides and lysophosphatidylcholines as well as saturated and monounsaturated triacylglycerols. Significant decreases were seen in all cholesteryl ester and in some unsaturated triacylglycerol species, compatible with the detected decrease of mean lipid droplet area. Along with the reduced lipid stores, ATP-binding cassette subfamily G member 1 (ABCG1)-mediated cholesterol efflux and angiogenesis decreased. Interactomics revealed an interaction of ORP7 with AKT1, a central metabolic regulator.

Conclusions

The transcriptomics results suggest an increase in prostanoid as well as oxysterol synthesis, which could be related to the observed upregulation of proinflammatory genes. We envision that the defective angiogenesis in HUVECs subjected to ORP7 inhibition could be the result of an unfavorable plasma membrane lipid composition and/or reduced potential for cell division. To conclude, the present study suggests multifaceted functions of ORP7 in lipid homeostasis, angiogenic tube formation, and gene expression of lipid metabolism, inflammation, and cell cycle in primary endothelial cells.
Reduced plastid genomes of colorless facultative pathogens Prototheca (Chlorophyta) are retained for membrane transport genes
Authors: Maciszewski Kacper , Wilga Gabriela , Jagielski Tomasz , Bakuła Zofia , Gawor Jan , Gromadka Robert , Karnkowska Anna
Published: December 2024

Background

Plastids are usually involved in photosynthesis, but the secondary loss of this function is a widespread phenomenon in various lineages of algae and plants. In addition to the loss of genes associated with photosynthesis, the plastid genomes of colorless algae are frequently reduced further. To understand the pathways of reductive evolution associated with the loss of photosynthesis, it is necessary to study a number of closely related strains. Prototheca, a chlorophyte genus of facultative pathogens, provides an excellent opportunity to study this process with its well-sampled array of diverse colorless strains.

Results

We have sequenced the plastid genomes of 13 Prototheca strains and reconstructed a comprehensive phylogeny that reveals evolutionary patterns within the genus and among its closest relatives. Our phylogenomic analysis revealed three independent losses of photosynthesis among the Prototheca strains and varied protein-coding gene content in their ptDNA. Despite this diversity, all Prototheca strains retain the same key plastid functions. These include processes related to gene expression, as well as crucial roles in fatty acid and cysteine biosynthesis, and membrane transport.

Conclusions

The retention of vestigial genomes in colorless plastids is typically associated with the biosynthesis of secondary metabolites. In contrast, the remarkable conservation of plastid membrane transport system components in the nonphotosynthetic genera Prototheca and Helicosporidium provides an additional constraint against the loss of ptDNA in this lineage. Furthermore, these genes can potentially serve as targets for therapeutic intervention, indicating their importance beyond the evolutionary context.
The association of HDL-cholesterol levels with incident major adverse cardiovascular events and mortality in 0.6 million individuals with type 2 diabetes: a population-based retrospective cohort study
Authors: Lui David Tak Wai , Li Lanlan , Liu Xiaodong , Xiong Xi , Tang Eric Ho Man , Lee Chi Ho , Woo Yu Cho , Lang Brian Hung Hin , Wong Carlos King Ho , Tan Kathryn Choon Beng
Published: December 2024

Background

High levels of high-density lipoprotein cholesterol (HDL-C) are previously considered protective against cardiovascular diseases (CVD), but recent studies suggest an increased risk of adverse events at very high HDL-C levels in the general population. It remains to be elucidated such a relationship in diabetes, a condition with high cardiovascular risks. We examined the association of HDL-C levels with the risk of major adverse cardiovascular events (MACE) and mortality in type 2 diabetes.

Methods

This retrospective cohort study identified individuals with type 2 diabetes who had HDL-C records (2008–2020) from the electronic health record database of the Hong Kong Hospital Authority. They were classified into three groups based on their first-recorded HDL-C levels following diabetes diagnosis: low (≤ 40 mg/dL), medium (> 40 and ≤ 80 mg/dL) and high HDL-C (> 80 mg/dL) groups. The primary outcome was incident MACE (composite of myocardial infarction, stroke, heart failure, and cardiovascular mortality). Cox regression model and restricted cubic spline analysis were employed to assess the relationship between HDL-C and adverse outcomes.

Results

Among 596,943 individuals with type 2 diabetes included, 168,931 (28.30%), 412,863 (69.16%), and 15,149 (2.54%) were classified as low HDL-C, medium HDL-C, and high HDL-C groups, respectively. Over a median follow-up of 79.5 months, both low and high HDL-C groups had higher risk of incident MACE compared to the medium HDL-C group (HR 1.24, 95% CI 1.23–1.26, P < 0.001; HR 1.09, 95% CI 1.04–1.13, P < 0.001). The spline curves revealed a U-shaped association between HDL-C levels and incident MACE (non-linear p < 0.001). Similar U-shaped relationship was observed for all-cause and non-cardiovascular mortality.

Conclusions

Our study demonstrated a U-shaped association between HDL-C levels and incident MACEs and all-cause and non-cardiovascular mortality in individuals with type 2 diabetes, highlighting the need for mechanistic studies on the adverse outcomes seen at high HDL-C levels in type 2 diabetes.
Pilot introduction of long-lasting insecticidal nets and hammock nets in the indigenous Comarca of Guna Yala, Panama
Authors: González A. Oscar E. , Perez Carmen , Blanco Tania , Ayarza Cipriano , Chérigo Santiago , Ávila Mario , Montoya Lucía Fernández , Presley Nicholas A. , Espinosa Bernardo García , Renteria Mariela Mosquera
Published: December 2024

Background

After almost 70 years of using indoor residual spraying (IRS) as the primary intervention for malaria vector control, the Republic of Panama wanted to evaluate the operational feasibility and acceptability of distributing long-lasting insecticidal hammock nets (LLIHNs) and long-lasting insecticidal nets (LLINs) in the country.

Methods

A pilot study conducted in 2019 distributed LLINs and LLIHNs to cover all sleeping spaces in 15 high burden localities of the indigenous Comarca of Guna Yala and measured retention, coverage, use and physical deterioration, washing and drying practices, as well as people’s satisfaction with product characteristics post-distribution.

Results

Overall, 89.9% of enumerated sleeping spaces were covered during the campaign. Monitoring post-distribution showed that 82.7% of the population received messages about the campaign before it happened and 92.4% claimed to know the purpose of the net and how to care for and repair it. Mild adverse reactions, specifically skin irritation associated with the insecticide in LLINs and LLIHNs, were reported by 38.4% of households. Two years after distribution, 86.3% of the LLIHN/LLINs were retained. Use was very high right after distribution (85%) but decreased to 57% six months after distribution and to 38% two years after distribution. The main reason for not using the LLIHN/LLINs was the reported absence of mosquitoes. Two years post-distribution, LLIHN/LLINs were preserved in good physical condition (4% torn), very few were washed with insecticide-damaging products (chlorine or detergent) (9%) or dried under the sun (15%), and LLIHN/LLINs were washed on average less than once every two months. The average number of people per sleeping space was 1.34.

Conclusion

Although the distribution of LLIHN/LLINs was operationally feasible and LLIHN/LLINs were initially well-accepted and cared for by these communities, use decreased drastically over the two years of follow up after distribution. Hence, should there be future LLIHN/LLIN distributions in this area, sufficient resources and efforts need to be allocated to promoting LLIHN/LLIN use. Further investigation into the reasons for low LLIHN/LLIN use are needed to guide such efforts.