bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast cancer and its determinants in Ethiopia: a systematic review and meta-analysis
Authors: Shama Adisu Tafari , Terefa Dufera Rikitu , Desisa Adisu Ewunetu , Lema Matiyos , Cheme Melese Chego , Geta Edosa Tesfaye , Feyisa Jira Wakoya , Feyisa Bikila Regassa , Biru Bayise
Published: November 2024

Objectives

Breast cancer is the leading cause of cancer morbidity and mortality among women. Still, there is a paucity of studies to know the magnitude of the problem in Ethiopia. Hence, this review was intended to pool the prevalence and identify the determinants of breast cancer in Ethiopia.

Design

A systematic review and meta-analysis was conducted.

Data sources

Databases like PubMed/MEDLINE, HINARI, Science Direct, and Google Scholar, as well as websites of organisationsI organizations,rewere searched between 25 February and 6 March 2023.

Eligibility criteria

All observational studies in Ethiopia that reported either the magnitude and/or determinants of breast cancer regardless of publication status were included.

Data extraction and synthesis

Two authors independently assessed and extracted the data. The Joanna Briggs Institute meta-analysis of statistics assessment and review instrument quality appraisal tool was used to assess the quality of the articles. Effect estimates were done by using the random-effects model. The meta-analysis results were displayed by using forest plots.

Results

Seventeen articles were reviewed with 24 435 total participants. The pooled proportion of breast cancer morbidity among patients with cancer was 20. 58% (95% CI 17.25%, 23.90%) in Ethiopia. Consuming packed foods (POR=2.12, 95% CI 1.41, 3.17), presence of high cholesterol (POR=4.08; 95% CI 2.75, 6.07), physical inactivity (POR=3.27; 95% CI 1.80, 5.94), high body mass index (BMI) (POR=2.27; 95% CI 0.85, 6.03), postmenopause (POR=2.25; 95% CI 1.63, 3.10), family history of cancer (POR=3.65; 95% CI 0.85, 15.71) and lack of breastfeeding (POR=2.76; 95% CI 0.90, 7.92) were the determinants of breast cancer.

Conclusions

One of five patients with cancer is diagnosed with breast cancer in Ethiopia. Furthermore, more than a quarter of women with cancer suffer from breast cancer. Processed food consumption, high cholesterol in the body, lack of physical activity, high BMI, postmenopause, family history of cancer and lack of breastfeeding were the risk factors for breast cancer. The use of healthy food sources such as fruits and vegetables, and homegrown varieties of crops rather than seeking processed foods would help.

PROSPERO registration number

CRD42023417733
Analysis of rational prescription of medicines by village clinics: a repeated cross-sectional study of a province in eastern China
Authors: Song Chunyan , Chen Zhongming , Yin Wenqiang , Feng Zhiqiang , Hao Xiaoning
Published: November 2024

Objective

To analyse the rational prescription of medicines by village clinics following China’s implementation of the New Healthcare System Reform (NHCSR).

Design

Retrospective study.

Setting

Village clinics in a province in eastern China.

Primary and secondary outcome measures

Our evaluation was based on the core drug use indicators reported in the study ‘How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators’.

Results

The level of rational use of medicines (RUMs) in village clinics improved in 2018 compared with 2009; the average number of drugs per prescription decreased from 3.66 to 2.77, the percentage of prescriptions including antibiotics decreased from 65.40% to 46.00%, and the percentage of prescriptions including injections decreased from 55.75% to 37.48% (all p<0.01), whereas the percentage of drugs prescribed from the list of essential medicines increased from 66.50% to 80.34%, and the percentage of drugs prescribed by generic names increased from 61.29% to 70.65% (all p<0.01).

Conclusion

The level of RUMs improved after the implementation of the NHCSR, however, it was found that there was still a gap between the level of RUMs in 2018 and the international reference value. Financial investments, electronic prescription systems, improved supervision and regular training are essential actions that must be implemented.
Exploring the role of the built environment and psychosocial mediators on knee function in knee osteoarthritis patients in Singapore: a cross-sectional study
Authors: Sahrin Razeena , Ng Claire Jia Yi , Lim Chien Joo , Goh Zack Zhong Sheng , Pua Yong-Hao , Tan Bryan Yijia
Published: November 2024

Objectives

(1) To examine if a more accessible built environment (BE) is significantly associated with better knee function outcomes in knee osteoarthritis (OA) patients. (2) To assess if the relationship between BE and knee function is mediated by fear of movement and self-efficacy.

Design

Cross-sectional study.

Setting

Two tertiary hospitals in Singapore.

Participants

212 knee OA patients (mean: 63.81±8.27 years old), majority female (69.8%). Inclusion criteria: (i) meets National Institute for Health and Care Excellence criteria for knee OA, (ii) independent community ambulant. Exclusion criteria: (i) alternative diagnosis to knee OA, (ii) secondary osteoarthritis, (iii) severe medical and/or cognitive comorbidity impairing activities of daily living, (iv) previous knee arthroplasty, (v) wheelchair bound, or (vi) pregnant.

Primary and secondary outcome measures; Statistics

How self-efficacy (Arthritis Self-Efficacy Scale-8 (ASES-8)) and fear of movement (Brief Fear of Movement (BFOM)) mediates impact of overall BE (IPAQ-Environment module: Access to Destinations) and five item-specific domains of BE accessibility on knee function (Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12)). For variables significantly correlated with BE and KOOS-12 in bivariate Pearson correlation tests, mediation analysis was performed with confounders adjusted.

Results

Total BE (r=0.142, p=0.038) and accessibility to transit station (r=0.161, p=0.019) were positively correlated with KOOS-12. Structural barriers (r=−0.138, p=0.045) were negatively correlated with KOOS-12. ASES-8 was a significant mediator in the relationship between accessibility to transit station and KOOS-12 (coeff=0.87, 95% CI=(0.24, 1.69), p=0.005) and between total BE and KOOS-12 (coeff=0.25, 95% CI=(0.10, 0.45), p=0.004). BFOM was a marginally significant mediator between structural barriers and KOOS-12 (coeff=−0.36, 95% CI=(−0.86, –0.02); p=0.054).

Conclusion

More accessible BE and lesser structural barriers in the BE are associated with better knee function. Self-efficacy mediates the relationship between overall BE accessibility and knee function. Fear of movement mediates the negative association between barriers in the BE and knee function.

Applications include assessing BE barriers and psychosocial mediators in clinician consultations, developing multidisciplinary integrated care models and urban designers planning mobility friendly BEs.

Trial registration number

The study has been registered under clinicaltrials.gov registry (Identifier:NCT04942236).
Association between myopia and sleep duration among primary school students in minority regions of Southwest China: a school-based cross-sectional research
Authors: Huang Ying , Ge Zhengyan , Chang Litao , Zhang Qiang , Xiao Jie , Li Peiqian , Ma Zixue , Li Xixi , Luo Xiao , Huang Dafeng , Zhang Jinjiao
Published: November 2024

Objective

To investigate the relationship between sleep duration and myopia among primary school students in minority regions of Southwest China.

Methods

The school-based, cross-sectional study was conducted from October 2020 to January 2021. All participants underwent a comprehensive ocular examination and completed a questionnaire on demographic characteristics, ophthalmological history and major environmental factors for myopia. Spherical equivalent (SE) and ocular biometric parameters were measured after cycloplegia, with myopia being defined as SE ≤−0.5 D (Diopter). Multivariate regression models were used to examine the association of sleep duration with myopia, SE and axial length (AL).

Results

A total of 857 students from grades 2 to 4 were included in the analysis, of which 63.6% were myopic and 62.0% belonged to ethnic minorities. Boys had a slightly higher prevalence of myopia compared with girls (66.7% vs 60.6%, p=0.06). Myopic students had longer AL, deeper anterior chamber depth and thinner central corneal thickness compared with non-myopic students (all p<0.05). There was no significant association between sleep duration and myopia in both boys and girls (p=0.319 and 0.186, respectively). Moreover, girls with a sleep duration of 8–9 hour/day had higher SE and shorter AL compared with those with less than 8 hour/day of sleep (β=0.41 and −0.32, respectively, all p<0.05).

Conclusion

This cross-sectional study did not find a significant association between sleep duration and myopia. However, it suggests that 8–9 hours of sleep per day may have a protective effect on SE progression and AL elongation in girls. Future studies with objectively measured sleep duration are needed to validate the findings.
Evaluating the social return on investment of dance movement for wellbeing in the prevention of burnout among healthcare staff: a study protocol
Authors: Lynch Mary , Filipponi Teresa , Wallace Carolyn
Published: November 2024

Introduction

Improvement in the National Health Service (NHS) employees’ mental well-being and staff retention are current key issues. Evidence indicates that dance movement therapy (DMT) has been effective in improving mental health and well-being; however, a social return on investment (SROI) evaluation on DMT interventions aimed at NHS staff has not been performed. This protocol for an SROI study will explore the social value generated from DMT, specifically ‘The Body Moving Self-Compassion’ programme, as measured by the increase in personal well-being and resilience experienced by participants. The SROI evaluation aims to measure the monetary and social value generated through DMT by placing a monetary value which is essential for sound policy in accessing investment while contributing evidence of dance/movement’s impact on health.

Methods

SROI is a pragmatic form of social cost-benefit analysis which uses quantitative and qualitative methods to value relevant costs, outcomes and associated impact. A mixed-methods approach design (focus group, online questionnaire and semistructured interviews) will be employed in this SROI study. SROI takes a societal perspective and considers relevant and significant outcomes for participants. Monetary values which often do not have a market price are then assigned to these outcomes. Contingent valuation is integrated into this study to estimate individuals’ choices, preferences and values associated with DMT. The social value generated by the identified outcomes will then be estimated in a similar way to cost-benefit analysis, and the ratio of social value generated per £1 invested is then calculated.

Ethics and dissemination

Ethical approval for this study has been granted by the Faculty of Life Sciences and Education Ethics Subgroup at the University of South Wales, with Reference No. 230 236LR. The findings from this SROI study will result in a report and academic publications.
Impact of visualising healthcare quality performance: a systematic review
Authors: Yang Zijing , Alveyn Edward , Dey Mrinalini , Arumalla Nikita , Russell Mark D , Norton Sam , Galloway James B
Published: November 2024

Objective

Performance visualisation tools are increasingly being applied in healthcare to enhance decision-making and improve quality of care. However, there is a lack of comprehensive synthesis of their overall effectiveness and the contextual factors that influence their success in different clinical settings. This study aims to provide a broad synthesis of visualisation interventions not limited to a specific department.

Design

Systematic review.

Data sources

MEDLINE and Embase were searched until December 2022.

Eligibility criteria

Randomised controlled trials (RCTs) and observational studies in English involving a visualisation intervention, either alone or as a core intervention, that reported quantitative outcomes including process and outcome indicators.

Data extraction and synthesis

Data on study characteristics, intervention characteristics, outcome measures and results were extracted. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach, and risk of bias was evaluated with Risk of Bias 2 for RCTs and Risk of Bias in Non-randomised Studies - of Interventions for non-randomised studies.

Results 

Of the 12 studies included, 2 were RCTs and 10 were observational studies, including 1 before-after study and 1 interrupted time series study. Five studies (42%) were conducted in teaching hospital settings. Compared with the control group or baseline, 10 studies reported a statistically significant change in at least one of their outcome measures. A majority of the studies reported a positive impact, including prescription adherence (6/10), screening tests (3/10) and monitoring (3/10). Visualisation tool factors like type, clinical setting, workflow integration and clinician engagement, may have some influence on the effectiveness of the intervention, but no reliable evidence was identified.

Conclusion

Performance visualisation tools have the potential to improve clinical performance indicators. More studies with standardised outcome measures and integrating qualitative methods are needed to understand the contextual factors that influence the effectiveness of these interventions.
Effect of exercise referral schemes and self-management strategies on healthcare service utilisation among community-dwelling older adults: secondary analyses of two randomised controlled trials
Authors: Svensson Nanna Herning , Thorlund Jonas Bloch , Øllgaard Olsen Pia , Søndergaard Jens , Wehberg Sonja , Andersen Helene Støttrup , Caserotti Paolo , Thilsing Trine
Published: November 2024

Objective

The objective of this study is to explore whether offering an integrated self-management strategy and exercise referral scheme intervention (ERS+SMS) or a stand-alone ERS intervention is more effective in reducing healthcare service utilisation among community-dwelling older adults over time compared with a stand-alone SMS/control intervention.

Design

Secondary analyses of two randomised controlled trials (RCTs) with linkage to Danish national health registries.

Setting

Three Danish municipalities: Esbjerg, Slagelse and Odense.

Participants

Danish community-dwelling older adults, aged 65 years or older, were included in the study. Participants originated from two completed RCTs: the Welfare Innovation in Primary Prevention (WIPP, n=115) and the SITLESS project (SITLESS, n=333).

Intervention

Participants in the two trials were randomly assigned to one of three intervention groups: ERS in combination with SMS (ERS+SMS), ERS alone or an SMS/control intervention.

Main outcome measure

Annual number of days with contact to general practice (GP) and days hospitalised for all causes.

Results

No statistically significant between-group difference was observed in the annual number of days with contact with GP between participants randomised to ERS+SMS (p=0.759) or ERS only (p=0.156) compared with those randomised to the SMS/control group. In addition, no statistically significant between-group differences in days hospitalised were observed when comparing the ERS+SMS (p=0.222) or ERS only (p=0.060) group to the SMS/control group.

Conclusion

Neither the integrated intervention (ERS+SMS) nor the ERS alone intervention was more effective in reducing healthcare service utilisation during a 2-year follow-up period compared with a stand-alone SMS/control intervention. A potential stabilising effect of ERS and/or SMS interventions on the general age-related increase in healthcare service utilisation cannot be ruled out but needs further exploration in future studies along with the exploration of the effects of long-term interventions.

Trial registration numbers

NCT04531852andNCT02629666.
Barriers and facilitators to antenatal care services utilisation in Somaliland: a qualitative study
Authors: Abdiwali Saad Ahmed , Adesina Olubukola A , Fekadu Gedefaw Abeje , Geta Teshome Gensa
Published: November 2024

Objective

To explore the barriers and facilitators of antenatal care (ANC) utilisation in Somaliland.

Design

An exploratory qualitative study design.

Setting

Various settings were considered for study including maternal and child health clinics, hospitals and community.

Methods

74 study participants including 33 pregnant women, 22 healthcare providers, 10 community elders and ten religious leaders were purposively selected. Data was collected via focus group discussion and in-depth interviews in the local Somali language. The data was audio recorded, transcribed verbatim, translated into English and imported into NVivo V.12 software. Thematic framework analysis was used to assess barriers and facilitators of ANC utilisation.

Results

Six main themes were identified as barriers of ANC utilisation. These include lack of awareness, long distance and lack of transportation access, economic barriers, lack of social support, beliefs and thoughts and health facility-related factors such as caregivers approach, waiting time and inadequate skill of providers. Proper dissemination of ANC information, adequate spousal support and cheap pricing of services were found to be facilitators of ANC uptake.

Conclusion

A strategy that focuses on raising awareness about ANC, making it accessible by reducing the cost-of-service charge, encouraging partner involvement, improving the quality of services and making it customer-friendly will help to overcome the barriers of antenatal utilisation.
Exploring the barriers to healthcare access among persons with disabilities: a qualitative study in rural Luuka district, Uganda
Authors: Ssemata Andrew Sentoogo , Smythe Tracey , Sande Slivesteri , Menya Abdmagidu , Hameed Shaffa , Waiswa Peter , Bannink Femke , Kuper Hannah
Published: November 2024

Objective

The aim of the research was to explore the barriers to healthcare access for persons with various disabilities in rural Luuka district of Uganda. The findings will assist in appreciating the challenges persons with disabilities face in accessing Healthcare in a rural setting. These insights will contribute to the development of an intervention to improve healthcare access that is affordable, timely and acceptable.

Design and participants

This qualitative study formed the exploratory formative phase of the ‘Missing Billion’ project. A total of 27 participants with disabilities—visual impairment (n=5), physical impairment (n=5), multiple impairments (n=6) and intellectual/ cognitive impairment (n=5) were purposively selected to participate in in-depth interviews conducted by two experienced researchers. Participants were identified through contact lists provided by the district disability focal person and local disability associations, with additional participants identified through snowball sampling. Interviews with persons with hearing impairment (n=6) were conducted by a researcher with hearing impairment. The interviews were audio/video recorded and transcribed to facilitate thematic data analysis. We used the disability-inclusive health ‘Missing Billion’ framework to map and inform the barriers.

Setting

The study was conducted between September and November 2022 in rural communities in Luuka district, Eastern Uganda.

Findings

On the demand side, challenges revolved around autonomy and awareness, limited access to health information, lack of financial capacity and dependence on caregivers for healthcare choices left persons with disabilities feeling disempowered. On the supply side, discrimination and negative attitudes from healthcare workers were reported as prevalent. Absence of healthcare workers and service delivery delays impacted on healthcare access, resulting in poor care. Inaccessible healthcare facilities compounded issues, as they had limited accessibility features.

Conclusions

Complex and interconnected barriers underscore the pressing need for systemic changes to ensure equitable healthcare access for persons with disabilities in rural Uganda.
Validation of the adult asthma epidemiological score: a secondary analysis of the EPI-ASTHMA population-based study
Authors: Laranjeira Catarina , Jácome Cristina , Amaral Rita , Bernardo Filipa , Correia-de-Sousa Jaime , Fonseca Joao A
Published: November 2024

Objective

The A2 score is an eight-question patient-reported outcome measure that has been validated for ruling in (score ≥4) and ruling out (score 0–1) asthma. However, this screening tool has been validated in a cohort similar to the derivation cohort used. This study aims to validate the predictive accuracy of the A2 score in a primary care population against general practitioner (GP) clinical assessment and to determine whether the proposed cut-offs are the most appropriate.

Design

This accuracy study is a secondary analysis of the EPI-ASTHMA population-based study.

Setting

Primary care centres in Portugal.

Participants

Random adult participants answered the A2 score by phone interview.

Outcomes

Those with an A2 score ≥1 (plus 5% with an A2 score of 0) were invited to a diagnostic visit carried out by a GP to confirm or not a diagnosis of asthma. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves.

Results

A total of 1283 participants (median 54 (p25–p75 43–66) years; 60% women) were analysed. The A2 score showed high discriminatory power in identifying asthma, with an area under the ROC curve of 82.9% (95% CI 80.4% to 85.4%). The proposed cut-off ≥4 was the most appropriate to rule in asthma (specificity 83.1%, positive predictive value 62.4%, accuracy 78%). Similarly, the proposed cut-off<2 was the most suitable for excluding asthma (sensitivity 92.7%, negative predictive value 93.7%, accuracy 60.5%).

Conclusions

The A2 score is a useful tool to identify patients with asthma in a primary care population.

Trial registration number

NCT0516961.
Patient-controlled analgesia in cancer pain management across African healthcare settings: a scoping review protocol
Authors: Igibah Christian Osemudiamen , Ojebo Julian , Omoigberale Restoration , Iyoriobhe Iziengbe , Isabu Danibelle , Chukwu Ifeanyichukwu Michael , Okpechukwu Chidubem Peter
Published: November 2024

Background

Cancer pain management is critical, especially at advanced stages. This is particularly important in Africa as most cancers are typically diagnosed at advanced stages. Given the central role of adequate pain management in advanced cancer care, this scoping review aims to examine the utilisation of patient-controlled analgesia (PCA) in cancer pain management within African healthcare settings.

Methods and analysis

This scoping review will apply the Arksey and O’Malley framework. A systematic search will be conducted in PubMed, African Journals Online and Google Scholar, focusing on studies conducted in Africa involving PCA and cancer pain. A two-step screening process will be used, title/abstract screening and full-text screening, with inclusion criteria emphasising relevance to cancer pain, PCA usage and African context. A thematic analysis approach will categorise data into themes related to PCA utilisation, effectiveness, barriers and outcomes. Tables and figures will be used for presentation.

Ethics and dissemination

This review will involve a secondary analysis of already published literature; therefore, ethical approval is not required. The findings of our scoping review will be published in an open-access, peer-reviewed journal on completion.
Effects of phrenic nerve magnetic stimulation on respiratory function in stroke patients: study protocol for a randomised controlled trial
Authors: Xu xiaoli , Han Qiong , Yan Zhipeng , Ni Jun , Wang Zhiyong
Published: November 2024

Introduction

Respiratory dysfunction is a notable complication in stroke patients, in which the diaphragm, as the primary respiratory muscle, directly influences lung function. Repetitive peripheral magnetic stimulation (rPMS) is a new, non-invasive approach that is used to treat brain and nerve problems. Few studies have examined the effect of magnetic stimulation on the phrenic nerve, breathing and diaphragm in stroke patients. This study aims to assess the effect of magnetic phrenic nerve stimulation on respiratory muscle function and lung function in adults with stroke. The results of this study may provide a promising approach to managing respiratory dysfunction in stroke patients.

Methods and analysis

This randomised controlled trial is designed to compare the effectiveness of bilateral magnetic phrenic nerve stimulation (rPMS) and conventional rehabilitation training in enhancing respiratory muscle strength, lung function indicators, diaphragmatic excursion and diaphragm thickness in patients with respiratory muscle weakness. Thirty patients admitted to the First Hospital of Fujian Medical University will be included in this study. Participants in the intervention group will undergo daily bilateral magnetic phrenic nerve stimulation for 2 weeks. Stimulation will be administered at a frequency of 25 Hz, with a pulse duration of 1.1 s and an inter-pulse interval of 5.9 s, for 5 days each week. Primary outcome measures will be assessed at baseline and after 2 weeks (end of the intervention) to evaluate the efficacy of rPMS compared with conventional rehabilitation techniques.

Ethics and dissemination

Before commencing the study, all participants will receive a comprehensive explanation of the study procedures, including the assessments. They will also be provided informed consent forms for review, completion and signing. This study was approved by the Ethics Committee for Research at the First Affiliated Hospital of Fujian Medical University (No.: MRCTA, ECFAH of FMU [2021]641, dated 10 November 2023) (Appendix Ⅰ & Ⅱ). The trial protocol will strictly adhere to the Uniform Standards for Reporting of Trials (CONSORT) statement. The trial has been registered with the Chinese Clinical Trial Registry.

Dissemination of individual findings for each participant will be available at the end of the study. The findings will be disseminated to different interest groups, participants or other patients with respiratory dysfunction through journal papers and/or conference presentations. The results of the primary trial will be submitted for publication in a peer-reviewed journal.

Registration

ChiCTR2300075669, registered on 12 September 2023.
Microwave imaging for breast cancer screening: protocol for an open, multicentric, interventional, prospective, non-randomised clinical investigation to evaluate cancer detection capabilities of MammoWave system on an asymptomatic population across multiple European countries
Authors: Álvarez Sánchez-Bayuela Daniel , Fernández Martín Juan , Tiberi Gianluigi , Ghavami Navid , Giovanetti González Rubén , Cruz Hernánez Lina Marcela , Aguilar Angulo Paul Martín , Martínez Gómez Aarón Darío , Rodríguez Sánchez Ana , Bigotti Alessandra , Khalesi Banafsheh , Pontoriero Letizia , Calabrese Massimo , Tagliafico Alberto Stefano , Romero Castellano Cristina
Published: November 2024

Introduction

Microwave imaging presents several potential advantages including its non-ionising and harmless nature. This open, multicentric, interventional, prospective, non-randomised trial aims to validate MammoWave’s artificial intelligence (AI)-based classification algorithm, leveraging microwave imaging, to achieve a sensitivity exceeding 75% and a specificity exceeding 90% in breast screening.

Methods and analysis

10 000 volunteers undergoing regular mammographic breast cancer screening will be recruited across 9 European centres and invited to participate in the clinical study, involving MammoWave testing on both breasts. MammoWave results will be checked against the reference standard, to be intended as the output of conventional breast examination path (with histological confirmation of cancer cases) with 2 years follow-up. Anonymised clinical and MammoWave’s results, including microwave images, associated features and a label provided by the AI-based classification algorithm, will be collected and stored in a dedicated electronic case report form. The prospective study will involve a comparative analysis between the output of the conventional breast examination path (control intervention) and the labels provided by MammoWave’s AI system (experimental intervention). These labels will categorise breasts into two groups: breast With Suspicious Finding, indicating the presence of a suspicious lesion or No Suspicious Finding, indicating the absence of a lesion or the presence of a low-suspicion lesion. This trial aims to provide evidence regarding the novel MammoWave’s AI system for detecting breast cancer in asymptomatic populations during screening.

Ethics and dissemination

This study was approved by the Research Ethics Committee of the Liguria Region (CET), Italy (CET-Liguria: 524/2023—DB id 13399), the Research Ethics Committee of Complejo Hospitalario de Toledo (CEIC), Spain (CEIC-1094), the National Ethics Committee for Clinical Research (CEIC), Portugal (CEIC-2311KC814), the Bioethical Committee of Pomeranian Medical University in Szczecin, Poland (KB-006/23/2024) and the Zurich Cantonal Ethics Commission, Switzerland (BASEC 2023-D0101). The findings of this study will be disseminated through academic and scientific conferences as well as peer-reviewed journals.

Trial registration number

NCT06291896.
Evaluation of occupational therapy in persons with COVID-19: a pre-post observational cohort study
Authors: Cup Edith H C , Fleuren-Lemmers Janneke W B , Wassink Theodora J , van de Ven-Stevens Lucelle A W , van der Wees Philip J , Kalf Johanna G , Graff Maud J L
Published: November 2024

Background

Persons with COVID‐19 may experience limitations in daily functioning and can be referred to occupational therapy.

Objectives

To evaluate changes in daily functioning, cognitive complaints, fatigue and self-management of persons with COVID-19 who received occupational therapy in primary care.

To get insights in the volume and duration of occupational therapy.

Design

A pre-post observational cohort study from October 2020 until April 2021.

Setting

Fifty-eight occupational therapy practices in primary care throughout the Netherlands participated with 68 occupational therapists.

Participants

228 adults (≥18 years) with COVID-19, referred to occupational therapy, gave informed consent and participated in the pre-post evaluation. The mean age was 49 years (SD 13) and 79% of the patients was female. The most frequently reported complaints included fatigue and cognitive complaints.

Interventions

Occupational therapy using Dutch guidelines for occupational therapy in clients with COVID-19.

Outcome measures

Performance and satisfaction with performance using the Canadian Occupational Performance Measure (COPM); the impact of Cognitive Complaints on Participation (CoCo-P); and daily activities, self-management and perceived contribution of occupational therapy using the Patient Reported Outcome Measure for Occupational Therapy (PROM-OT).

Results

COPM-performance score improved with a mean difference of 2.9 points (95% CI 2.7 to 3.2), and COPM-satisfaction score improved with 3.2 points (95% CI 2.9 to 3.5). CoCo-P score improved with a mean difference of 20.9 points (95% CI from 14.4 to 27.4), and PROM-OT improved with 42.8 points (95% CI from 40.2 to 45.4). Participants received a median of seven sessions of occupational therapy (IQR 5–10) with a median duration of 18 weeks (IQR 12–25). They valued the contribution of occupational therapy to their improved functioning with a mean score of 8 (SD 1.4) and recommended this to others with a mean score of 9 (SD 1.2).

Conclusions

Persons with COVID-19 who received occupational therapy in primary care improved significantly in daily functioning and highly valued occupational therapy.
Evaluating the effectiveness of recovery-oriented interventions for youth who vape nicotine: a systematic review protocol
Authors: Kaltabanis Demo , Smye Victoria , Oudshoorn Abe , Jackson Kimberley T
Published: November 2024

Introduction

The increase in nicotine vaping among youth has emerged as a critical public health concern. Vaping among youth is linked to adverse health outcomes, including nicotine addiction, cardiovascular and pulmonary diseases and mental health challenges. Recently, there has been a growing demand for research to expand on treatments to enhance the recovery process from vaping nicotine in youth. To this date, no comprehensive review identifies all interventions available for vaping recovery and compares their effectiveness in youth. This proposed systematic review seeks to identify all recovery-oriented interventions for youth aged 10–24 that facilitate vaping recovery and evaluate the measured effectiveness. This review will serve to support healthcare practitioners, nurses and policymakers to further understand recovery interventions and aid in improving vaping recovery among youth.

Method and analysis

This protocol, registered with PROSPERO, adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) framework, and the final review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to ensure quality and replicability. The review will comprise studies including youth aged 10–24 engaging in nicotine vaping. A comprehensive search will be conducted across MEDLINE, Embase, PsycINFO, Scopus and CINAHL, with no restrictions on the date range due to the recency of the topic. Two independent reviewers will screen the identified research for eligibility at the title and abstract levels, with any disagreements resolved by a third reviewer. The review will include randomised control trials and quasi-experimental studies. Full-text review and data extraction will be standardised and completed by the primary researcher. Additionally, studies will be assessed for quality and potential biases.

Ethics and dissemination

Given that this is a review of existing literature, no ethics approval is required. The focus on youth necessitates careful consideration of ethical standards. This review is committed to contributing responsibly to public health knowledge regarding youth vaping recovery. The results from this review will be disseminated through publication in an open-access, peer-reviewed journal and likely through posters and presentations at scientific conferences.

PROSPERO registration number

CRD42024543994.
Perspectives and insights of critical care clinicians, patients and families from culturally and linguistically diverse backgrounds around end-of-life care in an ICU: a scoping review protocol
Authors: Sundararajan Krishnaswamy , Raith Eamon , Hu Rebecca , Damarell Raechel A , Subramaniam Ashwin , Anderson Natalie , Phelan Caroline
Published: November 2024

Objective

Protocol to explore what is known about communication between critical care providers and patients and families from culturally and linguistically diverse backgrounds (defined as people who are either from minority ethnic groups, non-English-speaking backgrounds who may have diverse cultural, linguistic, spiritual and religious affiliations and opinions) about death, dying, end-of-life care and organ donation in the intensive care unit (ICU).

Introduction

Patients from culturally and linguistically diverse backgrounds experience barriers to optimised care when admitted to the ICU. These barriers appear to derive from differences in language, cultural, societal and ethical expectations between patients, their families and healthcare professionals. These barriers may significantly impact the delivery of end-of-life care to patients from culturally and linguistically diverse backgrounds. Therefore, this has the potential for inadequate management of medical, psychological and existential distress.

Inclusion criteria

Studies of all designs reporting for adult (age ≥18 years) patients and family members from culturally and linguistically diverse backgrounds at end-of-life in the ICU setting will be included. Studies that report results for patients aged <18 years or that are based outside the ICU will be excluded.

Methods

Relevant sources will be retrieved, and their citation details will be imported into the Joanna Briggs Institute (JBI) System for the Unified Management, Assessment and Review of Information. This scoping review was guided by the JBI methodology for scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A systematic search was conducted in EBSCOhost, Web of Science, PubMed Central and SciELO, OVID Medline, CINAHL, and Scopus, limited to English-language publications, without date limitation. Key study characteristics and findings will be extracted using a data extraction tool developed by the reviewers. Anticipating heterogeneous study designs, findings will be presented as a thematic synthesis.

Ethics and dissemination

This is a protocol for a scoping review, formal ethics approval from the Human Research Ethics Committee (HREC) of the Local Health Network will be obtained for research projects that could potentially stem from this review and will then be subsequently disseminated through proper channels.
DELirium treatment with Transcranial Electrical Stimulation (DELTES): study protocol for a multicentre, randomised, double-blind, sham-controlled trial
Authors: van der A Julia , Lodema Yorben , Ottens Thomas H , Schutter Dennis J L G , Emmelot-Vonk Marielle H , de Haan Willem , van Dellen Edwin , Tendolkar Indira , Slooter Arjen J C
Published: November 2024

Introduction

Delirium, a clinical manifestation of acute encephalopathy, is associated with extended hospitalisation, long-term cognitive dysfunction, increased mortality and high healthcare costs. Despite intensive research, there is still no targeted treatment. Delirium is characterised by electroencephalography (EEG) slowing, increased relative delta power and decreased functional connectivity. Recent studies suggest that transcranial alternating current stimulation (tACS) can entrain EEG activity, strengthen connectivity and improve cognitive functioning. Hence, tACS offers a potential treatment for augmenting EEG activity and reducing the duration of delirium. This study aims to evaluate the feasibility and assess the efficacy of tACS in reducing relative delta power.

Methods and analysis

A randomised, double-blind, sham-controlled trial will be conducted across three medical centres in the Netherlands. The study comprises two phases: a pilot phase (n=30) and a main study phase (n=129). Participants are patients aged 50 years and older who are diagnosed with delirium using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria (DSM-5-TR), that persists despite treatment of underlying causes. During the pilot phase, participants will be randomised (1:1) to receive either standardised (10 Hz) tACS or sham tACS. In the main study phase, participants will be randomised to standardised tACS, sham tACS or personalised tACS, in which tACS settings are tailored to the participant. All participants will undergo daily 30 min of (sham) stimulation for up to 14 days or until delirium resolution or hospital discharge. Sixty-four-channel resting-state EEG will be recorded pre- and post the first tACS session, and following the final tACS session. Daily delirium assessments will be acquired using the Intensive Care Delirium Screening Checklist and Delirium Observation Screening Scale. The pilot phase will assess the percentage of completed tACS sessions and increased care requirements post-tACS. The primary outcome variable is change in relative delta EEG power. Secondary outcomes include (1) delirium duration and severity, (2) quantitative EEG measurements, (3) length of hospital stay, (4) cognitive functioning at 3 months post-tACS and (5) tACS treatment burden. Study recruitment started in April 2024 and is ongoing.

Ethics and dissemination

The study has been approved by the Medical Ethics Committee of the Utrecht University Medical Center and the Institutional Review Boards of all participating centres. Trial results will be disseminated via peer-reviewed publications and conference presentations.

Trial registration number

NCT06285721.
Click and learn: a longitudinal interprofessional case-based sepsis education curriculum
Authors: Heslin Samita M , Qadeer Asem , Kotarba AnnMarie E , Ahmad Sahar , Morley Eric J
Published: November 2024

Background

Sepsis is a global healthcare challenge and a leading cause of morbidity and mortality. In the USA, the Centers for Medicare & Medicaid Services has integrated the Severe Sepsis and Septic Shock Management Bundle (SEP-1) into their Core Quality Measures, which has been linked to lower mortality rates. However, SEP-1’s multiple bundle elements present compliance challenges without comprehensive education and a collaborative approach involving nurses and providers (attending physicians, resident physicians, nurse practitioners and physician assistants).

Methods

We developed a virtual longitudinal, case-based curriculum using Kern’s six-step approach to curriculum development and evaluated its effectiveness using the Kirkpatrick model. The curriculum was distributed hospital-wide over a 32-month period.

Results

A total of 3616 responses were received for the Sepsis Case-Based Curriculum modules, with 47% from nurses and 53% from providers. Responses were distributed similarly among medical and surgical specialties, as well as intensive care units. Nurses’ responses were 56% correct, and providers’ responses were 51% correct. Most respondents expressed a likelihood of applying the learning to their practice and reported increased knowledge of sepsis. Themes from participant feedback indicated that they found the activity informative and applicable to real-world cases. Additionally, the hospital’s SEP-1 bundle compliance improved from 71% (Q1 2021) to 80% (Q3 2023) during the study period.

Conclusion

Meeting SEP-1 bundle elements requires a team-based approach involving providers and nurses. Given the busy hospital environment and diverse care providers, a longitudinal, engaging and concise educational curriculum related to real-life scenarios can enhance sepsis and SEP-1 education.
Randomised trial of Mentored ‘Planning to be Active+Family’ [MPBA+F] for Appalachian youth at risk for diabetes: virtual delivery protocol
Authors: Smith Laureen H , Petosa Rick L , Tan Alai , Shankle Shawnice , Phosri Yoottapichai
Published: November 2024

Introduction

Obesity (OB) in children remains a national epidemic. This trial targets children suffering from overweight (OW) and OB living in rural Appalachia. Rural Appalachia is fraught with unhealthy behaviours, high rates of OB, pre-diabetes and type 2 diabetes among children. Diabetes prevalence in Appalachia is nearly double that of other regions. The prevalence of Appalachian children suffering from OB and extreme obesity (EO) increases the severity of diabetes.

Methods and analysis

We will conduct a stratified randomised-controlled trial to evaluateMentored Planning to be Active+Family (MPBA+F) among seventh grade children with OW/OB/EO from rural Appalachian counties. Based on the Social Cognitive Theory,MPBA+Fcurriculum is a self-regulation approach to physical activity (PA) developed at The Ohio State University and successfully tested for feasibility in rural Appalachian middle schools.MPBA+F(a) incorporates active skill-building activities; (b) reinforces self-regulating activities; (c) engages in individual and group PA; (d) builds the link between PA, hydration and physical health and (e) actively supports weekly PA goals. Weekly skills are incorporated into reinforcement assignments verified at the beginning the following week. The primary outcome is the average daily minutes of moderate-vigorous PA. We will stratify by sex assigned at birth and conduct intent-to-treat analysis. We use descriptive statistics to summarise cohort and group (MPBA+F or comparison) baseline characteristics and examine variable distributions. Bivariate tests examine the balance of baseline characteristics by intervention groups. Mixed-effects linear modelling will be our more primary regression strategy. A potential problem is loss of curricular integrity. Our process assessment, structured mentor training and Instructor’s Guide reduce this concern. Another concern may be the lack of reliable broadband access. Participating counties exceed 75% broadband access. Those who lose internet access may have materials mailed to their home or accessed on the study website.

Ethics and dissemination

This study was reviewed and approved by the American Diabetes Association Grants Review Committee (Grant number 11-22-ICTSN-30), the host institution’s Social and Behavioral Human Subjects Review Committee (Protocol 2022B0149) and is registered on ClinicalTrials.gov (ProtocolNCT05758441). All data that can be shared without compromising human subject protections will be shared to an approved open data repository within six months of publication or 18 months of the conclusion of the funding period (November 2025) if the study remains unpublished. Dissemination to families and stakeholders is by project newsletters. Public presentation of findings will be shared at the Annual Appalachian Translational Research Network and local health department meetings.

Trial registration number

NCT05758441.
Association between perceived discrimination and pulse wave velocity: a scoping review
Authors: Pagan Lassalle Patricia , Paterson Craig , Kerr Zachary Yukio , Barone Gibbs Bethany , Moore Justin B , Meyer Michelle L , Stoner Lee
Published: November 2024

Racial discrimination is a chronic stressor that may contribute to cardiovascular disease (CVD) disparities in non-Hispanic Black (NHB) adults. NHB adults experience greater perceived discrimination (PD) and CVD risk compared with non-Hispanic White adults. Although the association between PD and some subclinical CVD markers has been examined, the relationship between PD and arterial stiffness has not been established, limiting our understanding of the impact of PD on CVD.

Objective

The objective of this review was to summarise the literature on the relationship between PD and arterial stiffness.

Design

Systematic scoping review.

Data sources

PubMed, Embase, SPORTDiscus with full text and CINALH+ with full text databases were searched from inception to 10 July 2023.

Eligibility criteria

Adults (≥18 years), arterial stiffness measured as pulse wave velocity (PWV), PD assessment, and randomised control trial or observational study designs.

Data extraction and synthesis

Of 453 articles identified, four studies were included. Two studies were cross-sectional (United States, Brazil), one was longitudinal (United Kingdom), and another was a randomized control trial (United States).

Results

The age of the study populations ranged from 18 years to 75 years and one study evaluated a clinical population. All studies used different PWV devices and PD assessments. Associations between PD and PWV varied by geographical region, sex, clinical status and study design.

Conclusion

Research evaluating the association between PD and PWV is scarce and heterogeneous in PD and PWV assessments. There is an inconclusive association between PD and PWV.