bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers and facilitators of lung cancer screening uptake: protocol of a mixed methods systematic review
Authors: Lin Yu-an , Hong Yu ting , Chen Bo ni , Xiao Hui min , Huang Fei fei
Published: April 2022

Introduction

The global uptake rates of lung cancer screening (LCS) with low-dose CT remain low. Since numerous factors contribute to the underuse of LCS, a theory-informed approach to identify and address the uptake of LCS barriers and facilitators is required. This study aims to document the methods which were used to identify, appraise, and synthesise the available qualitative, quantitative, and mixed methods evidence, addressing the barriers and facilitators at the individual and healthcare provider level, according to the social–ecological model, before identifying gaps to aid future practices and policies.

Methods and analysis

The following databases will be searched: PubMed, Ovid (Journals @ Ovid Full Text and Ovid MEDLINE), EMBASE, CINAHL, PsycINFO, Cochrane Library, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, and Wanfang database, from their creation up to 31 December 2020. Two reviewers will be involved in independently screening, reviewing, and synthesising the data; and calibration exercises will be conducted at each stage. Disagreements between the two reviewers will be resolved by arbitration by a third reviewer. The Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute, the Critical Appraisal Skills Programme criteria adapted for qualitative studies, and the 16-item Quality Assessment Tool (QATSDD) will be used in the quality assessment of primary studies. We will perform data synthesis using the Review Manager software, V.5.3.

Ethics and dissemination

This study is a review of published data and therefore needs no ethical approval. The findings of this systematic review will be published in a peer-reviewed journal.

Trial registration number

CRD42020162802.
Health workers’ Perceptions and REsponses in implementing COVID-19 Immunisation StratEgy in South Western Sydney (PRECISE): an observational study
Authors: Chow Josephine Sau Fan , D'Souza Annamarie , Lane Brian , Descallar Joseph , Ford Megan , Marshall Sonia , Pennings Susan
Published: April 2022

Objectives

To understand the views and motivations of healthcare workers at a vaccination hub who received a COVID-19 vaccination in March–May 2021.

Study design

This is an observational study via an anonymous electronic survey of seven questions focus on where survey recipients received information about the vaccine roll-out, their motivations for receiving the vaccine and their level of comfort in receiving the vaccine.

Setting

The Liverpool Vaccination Hub is located in South Western Sydney.

Participants

Participants were healthcare workers who received the first dose of a COVID-19 vaccine in the Australian Government’s Phase 1a and 1b priority categories. The majority of survey respondents (70%) were female (median aged between 35 and 44 years). The majority of survey respondents were clinical workers, such as nurse, paramedics and doctors.

Outcome measures

χ2analysis was used for analysis of survey responses in univariate analysis. Logistic regression was used to analyse survey responses, adjusting for week, type of health worker and age.

Results

4746 healthcare workers responded to the survey after receiving their first vaccine dose, a response rate of 23%. Over 90% of respondents said that COVID-19 vaccination information from their organisation was easily available. Most of them reported that they were comfortable receiving a COVID-19 vaccine. The majority of respondents were motivated to receive the vaccine due to concern about contracting COVID-19 themselves (75%), or concerns about transmitting it to other people such as patients (52%), family members (65%) or other community members (54%). Younger respondents were more likely to have preferred more information on vaccine safety (p<0.0001) and the effectiveness of the vaccine (p<0.0001).

Conclusion

The majority of healthcare workers who received a COVID-19 vaccine reported that it was easy to find useful information about the vaccination roll-out and they had a positive experience being vaccinated.
Effectiveness of the eVISualisation of physical activity and pain intervention (eVIS) in Swedish Interdisciplinary Pain Rehabilitation Programmes: study protocol for a registry-based randomised controlled clinical trial
Authors: Sjöberg Veronica , Tseli Elena , Monnier Andreas , Westergren Jens , LoMartire Riccardo , Äng Björn O , Hagströmer Maria , Björk Mathilda , Vixner Linda
Published: April 2022

Introduction

Living with chronic pain often involves negative consequences. Interdisciplinary Pain Rehabilitation Programmes (IPRP) is considered superior to single-treatment measures in patients with chronic pain. Despite this, effects emerge suboptimal and more than 20% of patients deteriorate in patient-reported physical health outcomes after IPRP. A novel e-Health intervention, eVISualisation (eVIS) of physical activity and pain, was systematically developed to facilitate individualisation of physical activity levels. By adding elements of data collection, visualisation and communication of objectively measured physical activity and patient-reported outcomes (pain intensity, interference of pain, pharmaceutical consumption) to existing treatment modalities in IPRP, the IPRP team acquires prerequisites to adapt advice and physical activity prescriptions and to evaluate set activity goals. The overall aim is twofold. First, the aim is to evaluate the feasibility of the subsequent registry-based randomised controlled clinical trial (R-RCT). Second, the aim is to prospectively evaluate the effectiveness of the eVIS-intervention as a supplement to IPRP on our defined primary (physical health) and secondary outcomes.

Methods and analysis

In the R-RCT, recruitment of 400 patients with chronic pain will be performed at 15 IPRP units. A random allocation to either IPRP + eVIS or to control group that will receive IPRP only will be performed. Data from the initial 30 participants completing the study period (6 months) will be included in a pilot study, where key feasibility outcomes (recruitment, randomisation, implementation, treatment integrity, data collection procedure, preliminary outcome measures) will be evaluated. Outcome variables will be extracted from the web application Pain And TRaining ON-line (PATRON) and from six national registries. Multivariate statistics and repeated measure analyses will be performed. Quality-adjusted life years and incremental cost-effectiveness ratio will be calculated for cost-effectiveness evaluation.

Ethics/dissemination

The Swedish Ethics Review Board granted approval (Dnr 2021/02109). Results will be disseminated through peer-reviewed journals.

Trial registration number

NCT05009459. Protocol V.1.
Research outcomes of linked prescription drug monitoring program data: a scoping review protocol
Authors: Cummins Mollie , Turcotte Catherine , McFarland Mary M , Staes Catherine
Published: April 2022

Introduction

The objective of this scoping review is to describe the extent and nature of research studies based on linked prescription drug monitoring program (PDMP) data; defined as PDMP data linked to other clinical, administrative or public health data sets. The population is prescribed and dispensed controlled substances. The concept is analysis of linked PDMP data to other clinical, administrative or public health data sets. The context is the USA.

Methods and analysis

The scoping review will be conducted with guidance from the latest version of the JBI Manual for Evidence Synthesis, using the framework as outlined by Arksey and O’Malley. Search strategies will be peer-reviewed according to the Peer Review of Electronic Search Strategies (PRESS) guidelines. For transparency and reproducibility, we will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines in reporting results. Two reviewers will independently screen titles and abstracts, then independently review full text to select papers or studies for inclusion. When consensus cannot be reached with discussion, a third reviewer will resolve the conflicts. From our included studies, we will extract variables describing aspects of population, concept and context (USA).

Ethics and dissemination

Ethical approval was not required for this review. This scoping review entails analysis of previously published, peer-reviewed research. We intend to publish findings in a peer-reviewed journal.
Sex differences in outcomes after mechanical thrombectomy for acute ischemic stroke in the ‘real world’: protocol for a systematic review and meta-analysis study
Authors: Xu Lixin , Li Binglong , Zhang Xiao , Bai Xuesong , Dmytriw Adam Andrew , Wang Tao , Wang Xue , Yang Kun , Min Xiaoli , Jiao Liqun
Published: April 2022

Introduction

Mechanical thrombectomy (MT) had been regarded as the first-line therapy for acute ischaemic stroke patients. The sex differences in post-MT treatment outcomes were analysed by randomised controlled trial (RCT) studies with inconsistent conclusions. We suggest the results from the real-world data may differ from RCT containing studies. Therefore, the sex difference in non-clinical trial populations needs to be clarified.

Methods and analysis

In order to obtain relative studies comprehensively, we will search the main document databases, consisting of Web of Science, Medline in Ovid, Embase in Ovid and Cochrane Library, and trials registers, including Clinical Trails register. The clinical outcomes of real-world studies published between January 2015 and March 2022 will be included. The assessment methods of bias risk will be performed according to study type. The inclusion of studies, evaluation of risk and publication bias, data extraction will be implemented by two reviewers, respectively. The primary outcomes include successful recanalisation and 90-day favourable outcome. Secondary outcomes include vascular complication, hospital-related complications, death during hospital stay and follow-up, and intracerebral haemorrhage. The risk bias of observational studies will be evaluated by Newcastle-Ottawa Scale. I2 statistic will be used to perform the assessment of study heterogeneity.

Ethics and dissemination

With no need of ethics approval in this review, results in this review ground on public data. The results of the study will be eventually presented at international conferences or in a related journal.

PROSPERO registration number

CRD42021242597.
Prevalence and associated factors of external hernia among adult patients visiting the surgical outpatient department at the University of Gondar Comprehensive Specialised Hospital, Northwest Ethiopia: a cross-sectional study
Authors: Kibret Anteneh Ayelign , Tekle Solomon Yirdaw , H/Mariam Miklol Mengistu , Worede Amanuel Girma , Dessie M A
Published: April 2022

Objectives

This study was aimed to assess the prevalence and associated factors of external hernia among adult patients visiting the surgical outpatient department (OPD) at the University of Gondar Comprehensive Specialised Hospital (UOGCSH), Northwest Ethiopia.

Study design

Institution-based cross-sectional study was conducted from 5 April 2020 to 22 June 2020.

Study setting

UOGCSH.

Participants

All adult patients above 18 years of age who visited the surgical OPD at the UOGCSH.

Outcome

Prevalence of external hernia.

Result

A total of 403 study participants were involved in this study with a response rate of 100%. The prevalence of external hernia was 11.7% (95% CI 8.8% to 15.1%). The epigastric hernia had the highest prevalence 16 (34%), followed by inguinal hernia 14 (29.8%). Old age (adjusted OR (AOR) =2.47, 95% CI 1.06 to 5.78), constipation (AOR 3.67, 95% CI 1.68 to 8.11), chronic cough (AOR 5.18, 95% CI 2.17 to 12.3) and lifting of heavy objects (AOR 7.39, 95% CI 3.36 to 16.2) had a statistically significant association with external hernia.

Conclusion

Regardless of hardly any significant gender difference, the overall prevalence of external hernia was high. Old age, constipation, chronic cough and lifting of heavy objects were found to have a significant association with an external hernia. Patients who have constipation and cough should get appropriate treatment early.
Understanding the importance of social determinants and rurality for the long-term outcome after acute myocardial infarction: study protocol for a single-centre cohort study
Authors: Sasko Benjamin , Jaehn Philipp , Müller Rhea , Andresen Henrike , Müters Stephan , Holmberg Christine , Ritter Oliver , Pagonas Nikolaos
Published: April 2022

Introduction

Acute myocardial infarction (AMI) is a major public health issue in Germany with considerable regional differences in morbidity and mortality. Possible reasons for regional differences include a higher prevalence of cardiovascular risk factors, infrastructural deficits, different levels of healthcare quality or social determinants. We aim to study associations of social determinants and of rural infrastructure with the quality of medical care (eg, time to reperfusion or medication adherence) and on the long-term outcome after myocardial infarction.

Methods and analysis

We will employ a prospective cohort study design. Patients who are admitted with AMI will be invited to participate. We aim to recruit a total of 1000 participants over the course of 5 years. Information on outpatient care prior to AMI, acute healthcare of AMI, healthcare-related environmental factors and social determinants will be collected. Baseline data will be assessed in interviews and from the electronic data system of the hospital. Follow-up will be conducted after an observation period of 1 year via patient interviews. The outcomes of interest are cardiac and all-cause mortality, changes in quality of life, changes in health status of heart failure, major adverse cardiovascular events and participation in rehabilitation programmes.

Ethics and dissemination

Ethical approval was obtained from the Ethics Committee of Brandenburg Medical School (reference: E-01-20200923). Research findings will be disseminated and shared in different ways and include presenting at international and national conferences, publishing in peer-reviewed journals and facilitating dissemination workshops within local communities with patients and healthcare professionals.

Trials registration number

DRKS00024463.
Association between PCV13 pneumococcal vaccination and risk of hospital admissions due to pneumonia or sepsis among patients with haematological malignancies: a single-centre retrospective cohort study in Israel
Authors: Draliuk Regina , Shadmi Efrat , Preis Meir , Dagan Efrat
Published: April 2022

Objectives

Patients with haematological malignancies receiving immunosuppressive therapy are at highest risk of invasive pneumococcal disease. Our goal was to investigate whether vaccination of haematological patients with pneumococcal 13-valent conjugated vaccine (PCV13) prior to therapy initiation is associated with decreased hospital admissions due to pneumonia or sepsis within 12 months.

Design and setting

A longitudinal retrospective cohort study was conducted at the haematology unit of Carmel Medical Center, Israel.

Participants

Information on adult patients (>18 years) who were diagnosed between 1 January 2009 and 30 December 2019 with haematological malignancies and received immunosuppressive therapy was retrieved from the electronic health records. Patients with haematological malignancies who received the PCV13 vaccination during or after initiation of the immunosuppressive therapy were excluded from the study.

Outcome measures

A multivariate logistic regression model was performed to determine whether PCV13 vaccination is associated with fewer hospital admissions due to pneumonia or sepsis.

Results

The cohort included 616 patients, of which 418 (67%) patients were not vaccinated and 198 (33%) were vaccinated. Within 12 months, 15.1% (n=63) of non-vaccinated patients compared with only 7.1% (n=14) of the vaccinated patients were hospitalised due to pneumonia or sepsis. The logistic regression analysis demonstrated that receiving PCV13 vaccination is associated with 45% (OR=0.45, 95% CI: 0.246 to 0.839, p=0.012) reduced odds of being hospitalised due to pneumonia or sepsis in patients with haematological malignancies receiving immunosuppressive therapy.

Conclusion

This is the first observational study to demonstrate the association between PCV13 vaccination and hospital admissions in patients with haematological malignancies receiving immunosuppressive therapy. Patients receiving PCV13 vaccination before immunosuppressive therapy initiation had significantly reduced odds of hospitalisation due to pneumonia or sepsis compared with non-PCV13-vaccinated patients.
Allophone immigrant women’s knowledge and perceptions of epidural analgesia for labour pain: a qualitative study
Authors: Dominicé Dao Melissa , Gerosa Désirée , Pélieu Iris , Haller Guy
Published: April 2022

Objectives

To explore allophone immigrant women’s knowledge and perceptions of epidural analgesia for labour pain, in order to identify their information needs prior to the procedure.

Design

We conducted focus groups interviews with allophone women from five different linguistic immigrant communities, with the aid of professional interpreters. Thematic analysis of focus group transcripts was carried out by all authors.

Setting

Women were recruited at two non-profit associations offering French language and cultural integration training to non-French speaking immigrant women in Geneva.

Participants

Forty women from 10 countries who spoke either Albanian, Arabic, Farsi/Dari, Tamil or Tigrigna took part in the five focus groups. Four participants were nulliparous, but all others had previous experience of labour and delivery, often in European countries. A single focus group was conducted for each of the five language groups.

Results

We identified five main themes: (1) Women’s partial knowledge of epidural analgesia procedures; (2) Strong fears of short-term and long-term negative consequences of epidural analgesia during childbirth; (3) Reliance on multiple sources of information regarding epidural analgesia for childbirth; (4) Presentation of salient narratives of labour pain to justify their attitudes toward epidural analgesia; and (5) Complex community positioning of pro-epidural women.

Conclusions

Women in our study had partial knowledge of epidural analgesia for labour pain and held perceptions of a high risk-to-benefits ratio for this procedure. Diverse and sometimes conflicting information about epidural analgesia can interfere with women’s decisions regarding this treatment option for labour pain. Our study suggests that women need comprehensive but also tailored information in their own language to support their decision-making regarding epidural labour analgesia.
Estimating excess visual loss from neovascular age-related macular degeneration in the UK during the COVID-19 pandemic: a retrospective clinical audit and simulation model
Authors: Thomas Darren S , Warwick Alasdair , Olvera-Barrios Abraham , Egan Catherine , Schwartz Roy , Patra Sudeshna , Eleftheriadis Haralabos , Khawaja Anthony , Lotery Andrew , Muller Philipp L , Hamilton Robin , Preston Ella , Taylor Paul , Tufail Adnan
Published: April 2022

Objectives

To report the reduction in new neovascular age-related macular degeneration (nAMD) referrals during the COVID-19 pandemic and estimate the impact of delayed treatment on visual outcomes at 1 year.

Design

Retrospective clinical audit and simulation model.

Setting

Multiple UK National Health Service (NHS) ophthalmology centres.

Participants

Data on the reduction in new nAMD referrals were obtained from four NHS Trusts comparing April 2020 with April 2019. To estimate the potential impact on 1-year visual outcomes, a stratified bootstrap simulation model was developed drawing on an electronic medical records dataset of 20 825 nAMD eyes from 27 NHS Trusts.

Main outcome measures

Simulated mean visual acuity and proportions of eyes with vision ≤6/60, ≤6/24 and ≥6/12 at 1 year under four hypothetical scenarios: 0-month, 3-month, 6-month and 9-month treatment delays. Estimated additional number of eyes with vision ≤6/60 at 1 year nationally.

Results

The number of nAMD referrals dropped on average by 72% (range 65%–87%). Simulated 1-year visual outcomes for 1000 nAMD eyes with a 3-month treatment delay suggested an increase in the proportion of eyes with vision ≤6/60 from 15.5% (13.2%–17.9%) to 23.3% (20.7%–25.9%), and a decrease in the proportion of eyes with vision ≥6/12 (driving vision) from 35.1% (32.1%–38.1%) to 26.4% (23.8%–29.2%). Outcomes worsened incrementally with longer modelled delays. Assuming nAMD referrals are reduced to this level for 1 month nationally, these simulated results suggest an additional 186–365 eyes with vision ≤6/60 at 1 year.

Conclusions

We report a large decrease in nAMD referrals during the COVID-19 lockdown and provide an important public health message regarding the risk of delayed treatment. As a conservative estimate, a treatment delay of 3 months could lead to a >50% relative increase in the number of eyes with vision ≤6/60 and 25% relative decrease in the number of eyes with driving vision at 1 year.
Performance and resource requirements of in-person versus voice call versus automated telephone-based socioeconomic data collection modalities for community-based health programmes: a systematic review protocol
Authors: Allen Luke Nelson , Mackinnon Shona , Gordon Iris , Blane David , Marques Ana Patricia , Gichuhi Stephen , Mwangi Alice , Burton Matthew J , Bolster Nigel , Macleod David , Kim Min , Ramke Jacqueline , Bastawrous Andrew
Published: April 2022

Introduction

Gathering data on socioeconomic status (SES) is a prerequisite for any health programme that aims to assess and improve the equitable distribution of its outcomes. Many different modalities can be used to collect SES data, ranging from (1) face-to-face elicitation, to (2) telephone-administered questionnaires, to (3) automated text message-based systems. The relative costs and perceived benefits to patients and providers of these different data collection approaches is unknown. This protocol is for a systematic review that aims to compare the resource requirements, performance characteristics, and acceptability to participants and service providers of these three approaches to collect SES data from those enrolled in health programmes.

Methods and analysis

An information specialist will conduct searches on the Cochrane Library, MEDLINE, Embase, Global Health, ClinicalTrials.gov, the WHO ICTRP and OpenGrey. All databases will be searched from 1999 to present with no language limits used. We will also search Google Scholar and check the reference lists of relevant articles for further potentially eligible studies. Any empirical study design will be eligible if it compares two or more modalities to elicit SES data from the following three; in-person, voice call, or automated phone-based systems. Two reviewers will independently screen titles, abstracts and full-text articles; and complete data extraction. For each study, we will extract data on the modality characteristics, primary outcomes (response rate and equivalence) and secondary outcomes (time, costs and acceptability to patients and providers). We will synthesise findings thematically without meta-analysis.

Ethics and dissemination

Ethical approval is not required, as our review will include published and publicly accessible data. This review is part of a project to improve equitable access to eye care services in low-ioncome and middle-income countries. However, the findings will be useful to policy-makers and programme managers in a range of health settings and non-health settings. We will publish our findings in a peer-reviewed journal and develop an accessible summary of results for website posting and stakeholder meetings.

PROSPERO registration number

CRD42021251959.
Types of anticipated affect that encourage and discourage vaccination: a scoping review protocol
Authors: Okuhara Tsuyoshi , Okada Hiroko , Goto Eiko , Tsunezumi Aiko , Kagawa Yumi , Kiuchi Takahiro
Published: April 2022

Introduction

Various cognitive behavioural models and theories have been used to address vaccine hesitancy. However, those models and theories have been criticised for focusing on cognitive influences on health behaviours at the expense of affective influences. Recent studies have highlighted the importance of affective elements as complementary predictors of health behaviours. Anticipated affect (ie, an expectation of one’s affective response to the target behaviour) has received the most scrutiny. This scoping review will analyse studies of anticipated affect that aimed to encourage vaccination and organise implications for future research and practice in vaccine communication. Our report will focus on exploring the usefulness of affective influence in terms of a comparison with the cognitive influence on vaccination.

Methods and analysis

We will search several databases (MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, Embase, Scopus, Web of Science and Google Scholar) and identify additional literature by searching the reference lists of eligible studies. Eligible studies are those that quantitatively or qualitatively examined anticipated affect and aimed to encourage vaccination. Only papers written in English will be included. We will include all eligible publications from database inception up to the date of the final database search. Two independent reviewers will screen the titles, abstracts and full texts of all identified studies. Two independent reviewers will share responsibility for data extraction and verification. Discrepancies will be resolved through discussion to reach consensus. We will extract data such as study characteristics, type of vaccine, type of anticipated affect, participant characteristics, methodology and main results. Data will be extracted using a customised extraction template on Covidence. The findings will be synthesised in a descriptive, narrative review.

Ethics and dissemination

This work does not warrant any ethical or safety review. This scoping review will be presented at a relevant conference and published in a peer-reviewed journal.
Why ‘one size fits all’ is not enough when designing COVID-19 immunity certificates for domestic use: a UK-wide cross-sectional online survey
Authors: Niculaescu Corina Elena , Sassoon Isabel , Landa-Avila Irma Cecilia , Colak Ozlem , Jun Gyuchan Thomas , Balatsoukas Panagiotis
Published: April 2022

Objectives

The present study explored public’s willingness to use COVID-19 immunity certificates across six different domestic scenarios.

Design

Cross-sectional online survey.

Setting

UK representative survey conducted on 3 August 2021.

Participants

534 UK residents over 18 years old.

Interventions

Participants replied to the same set of questions.

Primary and secondary outcome measures

The primary outcome measure was willingness to use immunity certificates across three different domestic settings: (1) visiting the general practitioner (GP) for a non-urgent health issue; (2) dining in a restaurant and (3) attending a performance in a theatre. For each setting two options, one prioritising convenience (option A) and the other privacy (option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; attitudes towards sharing immunity status with service providers; prior to COVID-19 lifestyle. In addition, we recorded data about respondents’ sociodemographic characteristics.

Results

Respondents were more willing to use immunity certificates that prioritised convenience (92%), rather than privacy (76%), when visiting their GP . However, privacy was more favourable in the other two settings (dining in a restaurant (84%) and going to a theatre (83%)) compared with convenience (38% and 39% respectively). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across sociodemographics and lifestyle.

Conclusions

The findings of this survey suggest that there is not one-size-fits-all solution for designing immunity certificates. Immunity certificates are complex sociotechnical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (like convenience or privacy) and personal beliefs about the pandemic should inform their design.
Quality and reliability evaluation of online videos on carpal tunnel syndrome: a YouTube video-based study
Authors: Kwak Donghee , Park Jong Woong , Won Yousun , Kwon Yeongkeun , Lee Jung Il
Published: April 2022

Objectives

With the increasing popularity of searches for medical information on YouTube, the availability of videos concerning carpal tunnel syndrome (CTS) is increasing. This study aimed to evaluate the quality and reliability of YouTube videos on CTS.

Setting and participants

No participants were included.

Primary and secondary outcome measures

We searched YouTube on 1 April 2021 using the keywords “carpal tunnel syndrome” and “carpal tunnel release” and evaluated the first 55 retrieved videos. We summarised the video characteristics including Video Power Index (VPI), which was designed to evaluate video popularity based on the number of likes and views. We categorised them based on source and content. Video quality and reliability were evaluated using the Journal of the American Medical Association (JAMA) benchmark criteria, the Global Quality Score (GQS) and the Carpal Tunnel Syndrome-Specific Score (CTS-ss) .

Results

The mean (range: minimum–maximum) of JAMA scores, GQS and CTS-ss were 2.13 (1–4), 2.69 (1–5), and 5.0 (1–15), respectively. The most common source of video was from allied health workers, and academically sourced videos had the highest JAMA score and GQS. Three scores were significantly correlated with each other. Multiple linear regression analysis showed that a higher JAMA score was associated with a higher likes ratio, and a higher GQS was associated with a longer video running time and greater number of comments. However, a higher VPI was not associated with higher video quality or reliability represented by the three scores.

Conclusions

YouTube videos on CTS have low quality and reliability. Video popularity was not significantly correlated with quality or reliability. Our findings suggest that expert groups should provide and promote high-quality video content to YouTube users and patients.
Protocol for SYNchronising Exercises, Remedies in GaIt and Cognition at
Home (SYNERGIC@Home): feasibility of a home-based double-blind randomised
controlled trial to improve gait and cognition in individuals at risk for
dementia
Authors: McGibbon Chris , Jarrett Pam , Handrigan Grant , Bouchard Danielle , Tranchant Carole C , Sexton Andrew M , Yetman Linda , Robinson Bryn , Crapoulet Stephanie , Chamard-Witkowski Ludivine , Liu-Ambrose Teresa , Middleton Laura Elizabeth , Almeida Quincy J , Bherer Louis , Lim Andrew , Speechley Mark , Kamkar Nellie , Montero Odasso Manuel
Published: April 2022

Introduction

Physical exercise and cognitive training have the potential to
enhance cognitive function and mobility in older adults at risk of
Alzheimer’s disease and related dementia (ADRD), but little is known
about the feasibility of delivering multidomain interventions in home
settings of older adults at risk of ADRD. This study aims to assess the
feasibility of home-based delivery of exercise and cognitive
interventions, and to evaluate the relationship between participants’
intervention preferences and their subsequent adherence. Secondary
objectives include the effect of the interventions on ADRD risk factors,
including frailty, mobility, sleep, diet and psychological
health.

Methods and analysis

The SYNchronising Exercises, Remedies in GaIt and Cognition at Home
(SYNERGIC@Home) feasibility trial is a randomised control trial that
follows a 2×2 factorial design, with a 16-week home-based intervention
programme (3 sessions per week) of physical exercises and cognitive
training. Participants will be randomised in blocks of four to one of
the following four arms: (1) combined exercise (aerobic and
resistance)+cognitive training (NEUROPEAK); (2) combined
exercise+control cognitive training (web searching); (3) control
exercise (balance and toning)+cognitive training; and (4) control
exercise+control cognitive training. SYNERGIC@Home will be implemented
through video conferencing. Baseline and post-intervention assessments
at 4-month and 10-month follow-up will include measures of cognition,
frailty, mobility, sleep, diet and psychological health. Primary
feasibility outcome is adherence to the interventions. Primary analytic
outcome is the relationship between pre-allocation preference for a
given intervention and subsequent adherence to the allocated
intervention. A series of secondary analytic outcomes examining the
potential effect of the individual and combined interventions on
cognitive, mobility and general well-being will be measured at baseline
and follow-up.

Ethics and dissemination

Ethics approval was granted by the relevant research ethics boards.
Findings of the study will be presented to stakeholders and published in
peer-reviewed journals and at provincial, national and international
conferences.

Trial registration number

NCT04997681, Pre-results.
Transplantation Without Overimmunosuppression (TWO) study protocol: a phase 2b randomised controlled single-centre trial of regulatory T cell therapy to facilitate immunosuppression reduction in living donor kidney transplant recipients
Authors: Brook Matthew Oliver , Hester Joanna , Petchey William , Rombach Ines , Dutton Susan , Bottomley Matthew James , Black Joanna , Abdul-Wahab Seetha , Bushell Andrew , Lombardi Giovanna , Wood Kathryn , Friend Peter , Harden Paul , Issa Fadi
Published: April 2022

Introduction

Regulatory T cell (Treg) therapy has been demonstrated to facilitate long-term allograft survival in preclinical models of transplantation and may permit reduction of immunosuppression and its associated complications in the clinical setting. Phase 1 clinical trials have shown Treg therapy to be safe and feasible in clinical practice. Here we describe a protocol for the TWO study, a phase 2b randomised control trial of Treg therapy in living donor kidney transplant recipients that will confirm safety and explore efficacy of this novel treatment strategy.

Methods and analysis

60 patients will be randomised on a 1:1 basis to Treg therapy (TR001) or standard clinical care (control). Patients in the TR001 arm will receive an infusion of autologous polyclonal ex vivo expanded Tregs 5 days after transplantation instead of standard monoclonal antibody induction. Maintenance immunosuppression will be reduced over the course of the post-transplant period to low-dose tacrolimus monotherapy. Control participants will receive a standard basiliximab-based immunosuppression regimen with long-term tacrolimus and mycophenolate mofetil immunosuppression. The primary endpoint is biopsy proven acute rejection over 18 months; secondary endpoints include immunosuppression burden, chronic graft dysfunction and drug-related complications.

Ethics and dissemination

Ethical approval has been provided by the National Health Service Health Research Authority South Central—Oxford A Research Ethics Committee (reference 18/SC/0054). The study also received authorisation from the UK Medicines and Healthcare products Regulatory Agency and is being run in accordance with the principles of Good Clinical Practice, in collaboration with the registered trials unit Oxford Clinical Trials Research Unit. Results from the TWO study will be published in peer-reviewed scientific/medical journals and presented at scientific/clinical symposia and congresses.

Trial registration number

ISRCTN: 11038572; Pre-results.
Scale-up of ABC care bundle for intracerebral haemorrhage across two hyperacute stroke units in one region in England: a mixed methods evaluation of a quality improvement project
Authors: Brunton Lisa , Sammut-Powell Camilla , Birleson Emily , Boaden Ruth , Knowles Sarah E , McQuaker Clare , Cross Stephen , Greaves Natalie , Paroutoglou Kyriaki , Alzouabi Omran , Patel Hiren C , Suman Appukuttan , Kawafi Khalil , Parry-Jones Adrian R
Published: April 2022

Background

Intracerebral haemorrhage (ICH) accounts for 10%–15% of strokes in the UK, but is responsible for half of all annual global stroke deaths. The ABC bundle for ICH was developed and implemented at Salford Royal Hospital, and was associated with a 44% reduction in 30-day case fatality. Implementation of the bundle was scaled out to the other hyperacute stroke units (HASUs) in the region from April 2017. A mixed methods evaluation was conducted alongside to investigate factors influencing implementation of the bundle across new settings, in order to provide lessons for future spread.

Methods

A harmonised quality improvement registry at each HASU captured consecutive patients with spontaneous ICH from October 2016 to March 2018 to capture process and outcome measures for preimplementation (October 2016 to March 2017) and implementation (April 2017 to March 2018) time periods. Statistical analyses were performed to determine differences in process measures and outcomes before and during implementation. Multiple qualitative methods (interviews, non-participant observation and project document analysis) captured how the bundle was implemented across the HASUs.

Results

HASU1 significantly reduced median anticoagulant reversal door-to-needle time from 132 min (IQR: 117–342) preimplementation to 76 min (64–113.5) after implementation and intensive blood pressure lowering door to target time from 345 min (204–866) preimplementation to 84 min (60–117) after implementation. No statistically significant improvements in process targets were observed at HASU2. No significant change was seen in 30-day mortality at either HASU. Qualitative evaluation identified the importance of facilitation during implementation and identified how contextual changes over time impacted on implementation. This identified the need for continued implementation support.

Conclusion

The findings show how the ABC bundle can be successfully implemented into new settings and how challenges can impede implementation. Findings have been used to develop an implementation strategy to support future roll out of the bundle outside the region.
Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity
Authors: Davidson Christina , Denning Stacie , Thorp Kristin , Tyer-Viola Lynda , Belfort Michael , Sangi-Haghpeykar Haleh , Gandhi Manisha
Published: April 2022

The objective of this study was to evaluate the impact of quality improvement (QI) and patient safety initiatives and data disaggregation on racial disparities in severe maternal morbidity from hemorrhage (SMM-H).

Our hospital began monitoring and reporting on SMM-overall and SMM-H rates in 2018 using administrative data. In March 2019, we began stratifying data by race and ethnicity and noted a disparity in rates, with non-Hispanic Black women having the highest SMM rates. The data was presented as run charts at monthly department meetings. During this time, our hospital implemented several QI and patient safety initiatives around obstetric hemorrhage and used the stratified data to inform guideline development to reduce racial disparity. The initiatives included implementation of a hemorrhage patient safety bundle and in-depth case reviews of adverse patient outcomes with a health equity focus. We then retrospectively analyzed our data. Our outcome of interest was SMM-H prior to data stratification (pre-intervention: June 2018-February 2019) as compared to after data stratification (post-intervention: March 2019-June 2020).

During our study time period, there were 13,659 deliveries: 37% Hispanic, 35% White, 20% Black, 7% Asian and 1% Other. Pre-intervention, there was a statistically significant difference between Black and White women for SMM-H rates (p<0.001). This disparity was no longer significant post-intervention (p=0.138). The rate of SMM-H in Black women decreased from 45.5% to 31.6% (p=0.011).

Our findings suggest that QI and patient safety efforts that incorporate race and ethnicity data stratification to identify disparities and use the information to target interventions have the potential to reduce disparities in SMM.
Burnout in Palliative Care - Difficult Cases: Qualitative Study
Authors: Koh Mervyn Yong Hwang , Gallardo Marysol Dalisay , Khoo Hwee Sing , Hum Allyn
Published: April 2022

Objectives

Burnout is common among palliative care clinicians, occurring as a result of emotions experienced in caring for challenging patients or families. Awareness of these scenarios helps clinicians and teams appropriately manage their own emotions and prevent burnout. We studied challenging clinical situations and the emotions encountered by experienced palliative care clinicians which could potentially contribute to burnout.

Methods

A qualitative study was conducted using semistructured interviews with purposive sampling of 18 palliative care clinicians—5 doctors, 10 nurses and 3 social workers who worked in various palliative care settings (hospital palliative care team, home hospice and inpatient hospice). The interviews were recorded verbatim, transcribed and analysed using a thematic analysis approach.

Results

The mean age of the interviewees was 52 years old and the mean number of years practising palliative care was 15.7 years (ranging from 10 to 25 years). The following clinical situations were reported by our respondents as particularly challenging, potentially leading to burnout: (1) abusive patients and families, (2) ‘bad deaths’, (3) death of young patients, (4) complex cases, and (5) having multiple deaths or difficult cases at any one time. Emotions encountered in the course of care of these cases included: (1) feeling overwhelmed, (2) having a sense of helplessness and failure, as well as (3) a sense of injustice.

Conclusion

The challenging cases we described evoke strong emotional reactions from palliative care clinicians that need to be adequately addressed to prevent burnout.
Infantile dural sinus malformation: curative embolization in two stages with the Scepter mini balloon microcatheter
Authors: Matsoukas Stavros , Rossitto Christina P , Berenstein Alejandro , Fifi Johanna T
Published: April 2022

Endovascular embolization is the mainstay for treatment of infantile dural sinus malformations.1 2 Distal access and flow control are limiting factors in controlled embolization.3–6 The Scepter mini catheter (Microvention, Aliso Viejo, California, USA) is a low-profile, dual-lumen balloon microcatheter designed to provide navigability in small-caliber, tortuous intracranial vessels. In this technical video, we demonstrate the staged embolization of a dural sinus malformation with multiple arteriovenous fistulae using the Scepter mini catheter (video 1). In the newborn patient, embolizations were performed through the parietal branches of the left and right middle meningeal arteries. The catheter easily navigated into the small feeding arteries. No neurological complications occurred due to the procedures. Post-embolization injections demonstrated significant flow reduction into the malformation. Three-month follow-up angiography illustrated resolution of the previously dilated left transverse sinus. Complete obliteration of the dural sinus malformation was achieved in the newborn patient.

Video 1

Curative embolization in two stages with the Scepter mini balloon microcatheter. ΑP, anteroposterior; CCA, common carotid artery.
Emergent microsurgical intervention for acute stroke after mechanical thrombectomy failure: a prospective study
Authors: Fiedler Jiří , Roubec Martin , Grubhoffer Marek , Ostrý Svatopluk , Procházka Václav , Langová Kateřina , Školoudík David
Published: April 2022

Background

Despite all the gains that have been achieved with endovascular mechanical thrombectomy revascularization and intravenous thrombolysis logistics since 2015, there is still a subgroup of patients with salvageable brain tissue for whom persistent emergent large vessel occlusion portends a catastrophic outcome.

Objective

To test the safety and efficacy of emergent microsurgical intervention in patients with acute ischemic stroke and symptomatic middle cerebral artery occlusion after failure of mechanical thrombectomy.

Methods

A prospective two-center cohort study was conducted. Patients with acute ischemic stroke and middle cerebral artery occlusion for whom recanalization failed at center 1 were randomly allocated to the microsurgical intervention group (MSIG) or control group 1 (CG1). All similar patients at center 2 were included in the control group 2 (CG2) with no surgical intervention. Microsurgical embolectomy and/or extracranial–intracranial bypass was performed in all MSIG patients at center 1.

Results

A total of 47 patients were enrolled in the study: 22 at center 1 (12 allocated to the MSIG and 10 to the CG1) and 25 patients at center 2 (CG2). MSIG group patients showed a better clinical outcome on day 90 after the stroke, where a modified Rankin Scale score of 0–2 was reached in 7 (58.3%) of 12 patients compared with 1/10 (10.0%) patients in the CG1 and 3/12 (12.0%) in the CG2.

Conclusions

This study demonstrated the potential for existing microsurgical techniques to provide good outcomes in 58% of microsurgically treated patients as a third-tier option.
Emergent carotid stenting versus no stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis
Authors: Diana Francesco , Romoli Michele , Toccaceli Giada , Rouchaud Aymeric , Mounayer Charbel , Romano Daniele Giuseppe , Di Salle Francesco , Missori Paolo , Zini Andrea , Aguiar de Sousa Diana , Peschillo Simone
Published: April 2022

Background

Emergent carotid artery stenting (eCAS) is performed during mechanical thrombectomy for acute ischemic stroke due to tandem occlusion. However, the optimal management strategy in this setting is still unclear.

Objective

To carry out a systematic review and meta-analysis to investigate the safety and efficacy of eCAS in patients with tandem occlusion.

Methods

Systematic review followed the PRISMA guidelines. Medline, EMBASE, and Scopus were searched from January 1, 2004 to March 7, 2022 for studies evaluating eCAS and no-stenting approach in patients with stroke with tandem occlusion. Primary endpoint was the 90-day modified Rankin Scale score 0–2; secondary outcomes were (1) symptomatic intracerebral hemorrhage (sICH), (2) recurrent stroke, (3) successful recanalization (Thrombolysis in Cerebral Infarction score 2b–3), (4) embolization in new territories, and (5) restenosis rate. Meta-analysis was performed using the Mantel-Haenszel method and random-effects modeling.

Results

Forty-six studies reached synthesis. eCAS was associated with higher good functional outcome compared with the no-stenting approach (OR=1.52, 95% CI 1.19 to 1.95), despite a significantly increased risk of sICH (OR=1.97, 95% CI 1.23 to 3.15), and higher successful recanalization rate (OR=1.91, 95% CI 1.29 to 2.85). Restenosis rate was lower in the eCAS group than in the no-stenting group (2% vs 9%, p=0.001). Recanalization rate was higher in retrograde than antegrade eCAS (OR=0.51, 95% CI 0.28 to 0.93). Intraprocedural antiplatelets during eCAS were associated with higher rate of good functional outcome (60% vs 46%, p=0.016) and lower rate of sICH (7% vs 11%; p=0.08) compared with glycoprotein IIb/IIIa inhibitors.

Conclusions

In observational studies, eCAS seems to be associated with higher good functional outcome than no-stenting in patients with acute ischemic stroke due to tandem occlusion, despite the higher risk of sICH. Dedicated trials are needed to confirm these results.