bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland
Authors: Hannah Romanie , Chavasse Richard J P G , Paton James Y , Walton Emily , Roland Damian , Foster Steven , Lyttle Mark D
Published: April 2024

Objective

Recovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing.

Design

Two-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers.

Setting

Secondary and tertiary EDs in rural and urban settings, from Paediatric Emergency Research in the UK and Ireland (PERUKI).

Main outcome measures

Describe practice and variation in discharge advice, treatment recommendations and safety netting provision.

Results

Of 66/71 (93%) participating sites, 62/66 (93.9%) reported providing written safety netting information. 52/66 (78.8%) ‘nearly always’ assessed inhaler/spacer technique; routine medication review (21/66; 31.8%) and adherence (16/66; 21.4%) were less frequent. In phase II, 61/66 (92.4%) submitted their discharge documents; 50/66 (81.9%) included bronchodilator plans. 11/66 (18.0%) provided Personalised Asthma Action Plans as sole discharge information. 45/50 (90%) provided ‘fixed’ bronchodilator dosing regimes; dose tapering was common (38/50; 76.0%). Median starting dose was 10 puffs 4 hourly (27/50, 54.0%); median duration was 4 days (29/50, 58.0%). 13/61 (21.3%) did not provide bronchodilator advice for acute deterioration; where provided, 42/48 (87.5%) recommended 10 puffs immediately. Subsequent dosages varied considerably. Common red flags included inability to speak (52/61, 85.2%), inhalers not lasting 4 hours (51/61, 83.6%) and respiratory distress (49/61, 80.3%).

Conclusions

There is variation in bronchodilator dosing and safety netting content for recovery following acute wheeze and asthma attacks. This reflects a lack of evidence, affirming need for further multicentre studies regarding bronchodilator recovery strategies and optimal safety netting advice.
Parasitic infections: what do paediatricians need to know?
Authors: Eisen Sarah , Nabarro Laura , Godbole Gauri , Ciang-Sang Tan , Chappell Faye , Cohen Jonathan
Published: April 2024

Parasitic infections and the medications used to treat them may be unfamiliar to many paediatricians. Parasitic infections, however, are not uncommonly seen in children in the UK. We summarise infections which are commonly seen, currently recommended treatment and practical guidance on formulations, adverse effects and treatment choice.
Clinicoradiological features of probable chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) syndrome
Authors: John Deepa Susan , Kankara Shreyas Reddy , Palasamudram Kumaran Sunitha , Hussain Adnan Sarfaraz
Published: April 2024

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently described chronic inflammatory central nervous system disease. This case report describes a young female patient presenting with weakness in bilateral upper and lower limbs and tinnitus for 2 months. A neurological examination revealed signs of brainstem and cerebellar involvement. MRI brain showed characteristic features of CLIPPERS, with punctate and nodular enhancement in the pons and cerebellum. Differential diagnoses were systematically considered and excluded. The patient showed significant clinical and radiological improvement with steroid therapy. No clinical or radiological red flags occurred during the follow-up. This case underscores the critical role of integrating clinical and radiological findings to effectively diagnose and manage CLIPPERS. It emphasises the importance of ruling out alternative diagnoses through a thorough evaluation.
Dedifferentiated liposarcoma of the spermatic cord
Authors: Panther Eric James , Lyons Hannah , Shychuk Andrew Jacob
Published: April 2024

A man in his 60s presented to an outside hospital with persistent groin pain and a scrotal mass which was thought to be a recurrent hernia. Three months after initial presentation, the patient was found to have dedifferentiated liposarcoma (LPS) of the spermatic cord. LPS of the spermatic cord is a rare entity; however, clinicians should have LPS on the differential diagnosis especially in men with recurrent scrotal pain and mass. If unrecognised, LPS is associated with a high degree of morbidity and mortality. LPS can be subdivided into well-differentiated LPS, dedifferentiated LPS, myxoid LPS and pleomorphic LPS. In patients with advanced or metastatic LPS, chemotherapy consisting of Adriamycin, ifosfamide and mesna is used despite LPS being relatively chemoresistant. Therapies inhibiting mouse double minute 2 homologue, an oncoprotein that is a negative regulator of the tumour suppressor p53, appear to be promising in preclinical trials.
Cardiovascular safety of evogliptin dual and triple therapy in patients with type 2 diabetes: a nationwide cohort study
Authors: Park Sohee , Jeong Han Eol , Oh In-Sun , Hong Sangmo , Yu Sung Hoon , Lee Chang Beom , Shin Ju-Young
Published: April 2024

Objective

To investigate the risk of cardiovascular events associated with commonly used dual and triple therapies of evogliptin, a recently introduced dipeptidyl peptidase-4 inhibitor (DPP4i), for managing type 2 diabetes in routine clinical practice.

Design

A retrospective cohort study.

Setting

Korean Health Insurance Review and Assessment database.

Participants

Patients who initiated metformin-based dual therapy and metformin+sulfonylurea-based triple therapy in South Korea from 2014 to 2018.

Interventions

Initiation of combination therapy with evogliptin.

Primary and secondary outcome measures

Hazards of cardiovascular events, a composite endpoint of myocardial infarction, heart failure and cerebrovascular events, and its individual components. Cox proportional hazards model with propensity score-based inverse probability of treatment weighting were used to estimate HRs and 95% CIs.

Results

From the dual and triple therapy cohorts, 5830 metformin+evogliptin users and 2198 metformin+sulfonylurea+evogliptin users were identified, respectively. Metformin+evogliptin users, as compared with metformin+non-DPP4i, had a 29% reduced risk of cardiovascular events (HR 0.71, 95% CI 0.62 to 0.82); HRs for individual outcomes were cerebrovascular events (0.71, 95% CI 0.53 to 0.95), heart failure (0.70, 95% CI 0.59 to 0.82), myocardial infarction (0.89, 95% CI 0.60 to 1.31). Metformin+sulfonylurea+evogliptin users, compared with metformin+sulfonylurea+non-DPP4i, had a 24% reduced risk of cardiovascular events (0.76, 95% CI 0.59 to 0.97); HRs for individual outcomes were myocardial infarction (0.57, 95% CI 0.27 to 1.19), heart failure (0.74, 95% CI 0.55 to 1.01), cerebrovascular events (0.96, 95% CI 0.61 to 1.51).

Conclusions

These findings suggest that dual or triple therapies of evogliptin for the management of type 2 diabetes in routine clinical practice present no cardiovascular harms, but could alternatively offer cardiovascular benefits in this patient population.
Professionals’ perspectives on interventions to reduce problematic alcohol use in older adults: a realist evaluation of working elements
Authors: van den Bulck Fieke A E , Knijff Rikste , Crutzen Rik , van de Mheen Dike , Bovens Rob H L M , Stutterheim Sarah E , Van de Goor Ien , Rozema Andrea D
Published: April 2024

Objectives

This study set out to understand how (which elements), in what context and why (which mechanisms) interventions are successful in reducing (problematic) alcohol use among older adults, from the perspective of professionals providing these interventions.

Design

Guided by a realist evaluation approach, an existing initial programme theory (IPT) on working elements in alcohol interventions was evaluated by conducting semistructured interviews with professionals.

Setting and participants

These professionals (N=20) provide interventions across several contexts: with or without practitioner involvement; in-person or not and in an individual or group setting. Data were coded and links between contexts, elements, mechanisms and outcomes were sought for to confirm, refute or refine the IPT.

Results

From the perspective of professionals, there are several general working elements in interventions for older adults: (1) pointing out risks and consequences of drinking behaviour; (2) paying attention to abstinence; (3) promoting contact with peers; (4) providing personalised content and (5) providing support. We also found context-specific working elements: (1) providing personalised conversations and motivational interviewing with practitioners; (2) ensuring safety, trust and a sense of connection and a location nearby home or a location that people are familiar with in person and (3) sharing experiences and tips in group interventions. Furthermore, the mechanisms awareness and accessible and low threshold participation were important contributors to positive intervention outcomes.

Conclusion

In addition to the IPT, our findings emphasise the need for social contact and support, personalised content, and strong relationships (both between client and practitioner, and client and peers) in interventions for older adults.
Rationale and protocol for a prospective cohort study of respiratory viral infections in patients admitted from emergency departments of community hospitals: Effect of respiratory Virus infection on EmeRgencY admission (EVERY) study
Authors: Morimoto Takeshi , Morikawa Toru , Imura Haruki , Nezu Mari , Hamazaki Kenya , Sakuma Mio , Chaumont Agnès , Moitinho de Almeida Maria , Moreno Victor Preckler , Ho Yufan , Harrington Lauriane , Matsuki Taizo , Nakamura Tsukasa
Published: April 2024

Introduction

Respiratory syncytial virus (RSV) is a causative virus for the common cold worldwide and can result in hospitalisations and even death in patients with high-risk conditions and older adults. However, the relationship between RSV or other incidental respiratory infections and acute exacerbations of underlying conditions has not been well investigated. The primary objective of this study is to estimate RSV prevalence, risk factors for adverse outcomes or hospitalisation and their effect on the hospital course of patients with acute respiratory symptoms admitted from emergency departments. Furthermore, we evaluate the prevalence of other respiratory viruses associated with respiratory symptoms.

Methods and analysis

We are conducting a multicentre prospective cohort study in Japan. We plan to enrol 3000 consecutive patients admitted from emergency departments with acute respiratory symptoms or signs from 1 July 2023 to 30 June 2024. A nasopharyngeal swab is obtained within 24 hours of admission and the prevalence of RSV and other respiratory viruses is measured using the FilmArray Respiratory 2.1 panel. Paired serum samples are collected from patients with suspected lower respiratory infections to measure RSV antibodies at admission and 30 days later. Information on patients’ hospital course is retrieved from the electronic medical records at discharge, death or 30 days after admission. Furthermore, information on readmission to the hospital and all-cause mortality is collected 180 days after admission. We assess the differences in clinical outcomes between patients with RSV or other respiratory viruses and those without, adjusting for baseline characteristics. Clinical outcomes include in-hospital mortality, length of hospital stay, disease progression, laboratory tests and management of respiratory symptoms or underlying conditions.

Ethics and dissemination

The study protocol was approved by the institutional review boards of participating hospitals. Our study reports will be published in academic journals as well as international meetings.

Trial registration number

NCT05913700.
Systematic RADaR analysis of responses to the open-ended question in the Culture of Care Barometer survey of a Dutch hospital
Authors: Maassen Susanne M , Spruit-van Bentvelzen Lotte , Weggelaar-Jansen Anne Marie J W M , Vermeulen Hester , Oostveen Catharina J van
Published: April 2024

Objectives

Systematically measuring the work environment of healthcare employees is key to continuously improving the quality of care and addressing staff shortages. In this study, we systematically analyse the responses to the one open-ended question posed in the Dutch version of the Culture of Care Barometer (CoCB-NL) to examine (1) if the responses offered new insights into healthcare employees’ perceptions of their work environment and (2) if the original CoCB had any themes missing.

Design

Retrospective text analysis using Rigorous and Accelerated Data Reduction technique.

Setting

University hospital in the Netherlands using the CoCB-NL as part of the annual employee survey.

Participants

All hospital employees were invited to participate in the study (N=14 671). In total, 2287 employees responded to the open-ended question.

Results

2287 comments were analysed. Comments that contained more than one topic were split according to topic, adding to the total (n=2915). Of this total, 372 comments were excluded because they lacked content or respondents indicated they had nothing to add. Subsequently, 2543 comments were allocated to 33 themes. Most comments (n=2113) addressed the 24 themes related to the close-ended questions in the CoCB-NL. The themes most commented on concerned questions on ‘organisational support’. The remaining 430 comments covered nine additional themes that addressed concerns about work environment factors (team connectedness, team effectiveness, corporate vision, administrative burden and performance pressure) and themes (diversity and inclusion, legal frameworks and collective bargaining, resilience and work–life balance, and personal matters).

Conclusions

Analysing responses to the open-ended question in the CoCB-NL led to new insights into relevant elements of the work environment and missing themes in the COCB-NL. Moreover, the analysis revealed important themes that not only require attention from healthcare organisations to ensure adequate improvements in their employees’ work environment but should also be considered to further develop the CoCB-NL.
Effects of a therapeutic lifestyle modification intervention on cardiometabolic health, sexual functioning and health-related quality of life in perimenopausal Chinese women: protocol for a randomised controlled trial
Authors: Wang Yuru , Miao Xiaoling , Viwattanakulvanid Pramon
Published: April 2024

Introduction

Perimenopause is a critical transitional period in reproductive ageing. A set of physiological and psychological changes can affect perimenopausal women’s quality of life and further threaten their older adult health conditions. In China, less than one-third of midlife women with menopausal symptoms have actively sought professional healthcare. Regarding the public health significance of comprehensive menopause management, the current study aims to investigate the effects of a therapeutic lifestyle modification (TLM) intervention on cardiometabolic health, sexual functioning and health-related quality of life among perimenopausal Chinese women.

Method and analysis

A randomised controlled trial with two parallel arms will be conducted at the gynaecology outpatient department of Yunnan Provincial Hospital of Traditional Chinese Medicine in China. 94 eligible perimenopausal women aged between 40 and 55 years will be recruited for the study. The TLM intervention consists of four elements: menopause-related health education, dietary guidance, pelvic floor muscle training and Bafa Wubu Tai Chi exercise. Participants will be randomly assigned (1:1) to receive either the 12-week TLM intervention or routine care via stratified blocked randomisation. The primary outcome is quality of life; secondary outcomes of interest include sexual functioning and cardiometabolic health. The outcome measures will be assessed at baseline and post-intervention. To explore the effects of the intervention, linear mixed models will be applied to test the changes between the two groups over time in each outcome based on an intention-to-treat analysis.

Ethics and dissemination

The Research Ethics Review Committee of Chulalongkorn University (COA No 178/66) and the Medical Ethics Committee of Yunnan Provincial Hospital of Traditional Chinese Medicine (IRB-AF-027-2022/02-02) approved the study protocol. Written informed consent will be obtained from all participants. Results will be published in peer-reviewed journals and disseminated through conferences.

Trial registration number

ChiCTR2300070648.
Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention
Authors: Forster Corey M , Halls Shannon , Allarakhia Sabrina , Modi Dimpy , Chung Wiley , Derry Kendra , Digby Genevieve , Flemming Jennifer , McGugan John , Mackulin Heather , Montague Steven , Sibley Stephanie , Silver Samuel A , Sirosky-Yanyk Angela , Stevens Andrew , de Wit Kerstin , Zhang Liying , Callum Jeannie
Published: April 2024

Background

Intravenous albumin has limited indications supported by randomised controlled trials, yet it is often prescribed for indications not supported by evidence.

Aim

To reduce unnecessary transfusion of albumin.

Interventions

Under the leadership of a multidisciplinary quality improvement team, evidence-based recommendations were disseminated in tandem with a new electronic order set, an educational strategy, qualitative interviews with prescribers and a return policy change to reduce wastage.

Implementation and evaluation

Interventions were introduced in a staggered fashion. The primary outcome, appropriate use of albumin, was monitored and quantified using pre-intervention and post-intervention audits. Process measures included statistical process run charts of monthly usage of 5% and 25% albumin and wastage. Data on length of stay (hospital and intensive care), new inpatient starts on kidney replacement and mortality were collected as balancing measures.

Results

Appropriate albumin usage based on indication increased from 30% to 50% (p<0.0001). There was significantly less overall albumin usage in the post-intervention period compared with the pre-intervention period (negative coefficient, p<0.0001), driven by a major reduction in the utilisation of the 5% formulation (p<0.0001). Overall albumin usage was significantly lower in the post-intervention period, decreasing from 800 to 450 vials per month. The intervention resulted in significantly less wastage (negative coefficient, p=0.017). Mortality, length of stay and new starts on kidney replacement therapy remained constant throughout the study period.

Conclusion

Improved prescribing of albumin was achieved with a multifaceted approach. Substantial and sustained reductions in usage were achieved without negatively impacting patient-important outcomes. The estimated annual savings for the purchase cost of albumin was CAN $300 000. We provide a structured process for other organisations to optimise their use of albumin.
Calculating the cost of medication errors: A systematic review of approaches and cost variables
Authors: Ranasinghe Sakunika , Nadeshkumar Abarna , Senadheera Savini , Samaranayake Nithushi
Published: April 2024

Introduction

Medication errors are an unnecessary cost to a healthcare system and patients of a country. This review aimed to systematically identify published cost variables used to calculate the cost of medication errors and to explore any updates on findings already known on calculating the cost of medication errors during the past 10 years.

Methods

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases, PubMed, Scopus, Emerald and JSTOR were searched, using keywords “medication error” AND “cost” and predetermined inclusion criteria. Duplicate articles were removed. Quality check was done using 10 criteria. Cost variables used in calculating the cost of medication errors were extracted from each article.

Results

Among 3088 articles, 33 articles were selected for review. Most studies were conducted in Western countries. Cost variables used (types and number) by different studies varied widely. Most studies (N=29) had used direct costs only. A few studies (N=4) had used both direct and indirect costs for the purpose. Perspectives considered when calculating cost of medication errors also varied widely. A total of 35 variables used to calculate medication error costs were extracted from selected articles.

Conclusion

Variables used to calculate the cost of medication errors were not uniform across studies. Almost a decade after systematic reviews previously reporting on this area, a validated methodology to calculate the cost of medication errors has still not been reported to date and highlights the still pending necessity of a standard method to be established.
Contact patterns between index patients and their close contacts and assessing risk for COVID-19 transmission during different exposure time windows: a large retrospective observational study of 450 770 close contacts in Shanghai
Authors: Zheng Yaxu , Zheng Bo , Gong Xiaohuan , Pan Hao , Jiang Chenyan , Mao Shenghua , Lin Sheng , Jin Bihong , Kong Dechuan , Yao Ye , Zhao Genming , Wu Huanyu , Wang Weibing
Published: April 2024

Introduction

To characterise age-mixing patterns among index cases and contacts of COVID-19, and explore when patients are most infectious during the disease process.

Methods

This study examined all initial 90 885 confirmed index cases in Shanghai and their 450 770 close contacts. A generalised additive mixed model was used to analyse the associations of the number of close contacts with different demographic and clinical characteristics. The effect of different exposure time windows on the infection of close contacts was evaluated using a modified mixed-effects Poisson regression.

Results

Analysis of contacts indicated that 82 467 (18.29%; 95% CI 18.17%, 18.42%) were second-generation cases. Our result indicated the q-index was 0.300 (95% CI 0.298, 0.302) for overall contact matrix, and that assortativity was greatest for students (q-index=0.377; 95% CI 0.357, 0.396) and weakest for people working age not in the labour force (q-index=0.246; 95% CI 0.240, 0.252). The number of contacts was 4.96 individuals per index case (95% CI 4.86, 5.06). Contacts had a higher risk if they were exposed from 1 day before to 3 days after the onset of symptoms in the index patient, with a maximum at day 0 (adjusted relative risk (aRR)=1.52; 95% CI 1.30, 1.76). Contacts exposed from 3 days before to 3 days after an asymptomatic index case had a positive reverse transcriptase-PCR (RT-PCR) result had a higher risk, with a maximum on day 0 (aRR=1.48; 95% CI 1.37, 1.59).

Conclusions

The greatest assortativity was for students and weakest for people working age not in the labour force. Contact in the household was a significant contributor to the infection of close contacts. Contact tracing should focus on individuals who had contact soon before or soon after the onset of symptoms (or positive RT-PCR test) in the index case.
Epidemiological and sociodemographic description of snakebite envenoming cases in Paraguay reported between 2015 and 2021
Authors: Ardiles-Ruesjas Sofia , Sanabria Edgar , Segovia Portillo Victor Hugo , Jara Oroa Lorena , de Egea Viviana , Sequera Guillermo , Alonso-Padilla Julio , Losada Irene , Pinazo María Jesús
Published: April 2024

Introduction

Snakebite envenoming (SBE) is a public health problem in Paraguay where the presence of 15 medically important snake species has been reported. Blessed with large forested areas, its economy largely relies on agricultural production which increases the exposure of outdoor workers to the morbidity and mortality of SBE. Lack of sufficient and accurate epidemiological data highlights the importance of drawing an updated picture of SBE burden in the country.

Methods

We performed a retrospective descriptive study on secondary SBE data reported to the national surveillance system between 2015 and 2021. We addressed the availability and quality of the data and assessed its epidemiological and sociodemographic burden in Paraguay over that time period.

Results

In total, 1651 cases of SBE were reported between 2015 and 2021 representing an average of 235 cases per year (3.33 cases per 100 000 population). Overall, young males (68%, n=1125) of productive age (25 years old, IQR 29) in agricultural and/or livestock settings (47%, n=653) were the most affected population. Departments with a higher number of notifications were San Pedro (12%, n=191), Caazapá and Alto Paraná (10%, n=163). Regarding data quality, variables about clinical outcomes, treatment administration and case management were the worst reported.

Conclusion

SBE is a public health issue that affects young workers in rural areas in Paraguay. It mostly remains unattended and improvements in its reporting need to be done in order to gain a better insight into both the health and social burden of this neglected disease.
Understanding the factors that shape vaccination ecosystem resilience: a qualitative assessment of international expert experiences and perspectives
Authors: May Suepattra , Roach Meaghan , Maravic Melissa , Mitrovich Rachel , Wilson Rozanne , Prood Nadya , Eiden Amanda L
Published: April 2024

Introduction

‘Shocks’ or external stressors to vaccination programmes can lead to decreased vaccination coverage rates. The capacity of vaccination ecosystems to effectively respond and adapt to shocks demonstrates programme resilience. This study sought to describe components that contribute to resilience in national immunisation programmes.

Methods

Mixed-methods study comprising in-depth interviews and surveys with n=30 vaccination programme experts in eight countries (Brazil, Costa Rica, Greece, Japan, Nigeria, Philippines, Spain and the USA). We elicited data on country-specific shocks, associated effects and factors that facilitated or impeded programme resilience. Interviews and open-ended survey responses were analysed qualitatively, with closed-ended survey questions analysed using descriptive statistics.

Results

Experts described immediate effects of shocks including decreased vaccine uptake and negative perceptions of vaccination from the public and media. Late emerging impacts included increased vaccine hesitancy and vaccine-preventable disease (VPD) rates. Stakeholder education, immunisation information systems (IIS) and programme financing were key factors to strengthening programme resilience. Appropriately trained frontline healthcare personnel can counter vaccine misinformation that otherwise erodes trust and contributes to hesitancy. The COVID-19 pandemic also exposed structural weaknesses in programme resilience, with experts highlighting the need for robust IIS and workforce support to mitigate burnout and strengthen resilience when a shock occurs.

Conclusions

Our findings provide preliminary insights into factors that experts believe to be associated with vaccination programme resilience. Anticipating, adapting and responding to shocks is central to strengthening systems, ensuring ecosystem resilience and protecting against current and future VPD threats.
Qualitative study of factors affecting engagement with a hospital-based violence intervention programme in Indianapolis, Indiana
Authors: Ortiz Damaris , Magee Lauren A , Adams Zachary W , Marriott Brigid R , Moore Reilin J , Brooks Blakney Q , Boustani Malaz , Simons Clark J
Published: April 2024

Background

There are few qualitative studies of firearm injury survivors and hospital-based violence intervention programme (HVIP) participants. The original study aimed to identify facilitators and barriers to survivors’ utilisation of mental health services. This secondary analysis aimed to identify factors that may impact engagement with an HVIP.

Study design

This study was a subanalysis of an original qualitative study that used a community-based participatory research approach to conduct semistructured interviews with English-speaking, intentional firearm injury survivors aged 13 and older within Indianapolis, Indiana between 2021 and 2022. Participants were recruited by a community organisation through a snowball sampling method. Interviews were analysed using manual thematic analysis. Themes were analysed and discussed in relation to HVIPs.

Results

A total of 18 interviews were completed. The majority of participants identified as black (17/18, 94.4%). Nearly all (75%) participants were between the ages of 13 and 24 years of age at the time of their shooting. During content analysis, five themes were identified: (1) delayed readiness to change, (2) desire for independence, (3) lack of trust, (4) persistent emotional and physical effects of trauma and (5) unawareness of HVIP resources.

Conclusions

This qualitative analysis of firearm injury survivor experiences provided insights for improved engagement with HVIPs. Continued pursuit of survivors for several years after their injury, improved dissemination of resources, establishing trust, and addressing persistent physical and psychological symptoms while respecting participants’ desire for independence may lead to increased engagement of firearm injury survivors with HVIPs.
Knowledge about Rh-incompatibility and its associated factors among antenatal care recipients in public hospitals of Wolaita zone, 2022: facility-based cross-sectional study
Authors: Geta Temesgen , Atinafu Bizuayehu , Kassa Tsiyon
Published: April 2024

Background

Lack of awareness about the Rh-incompatibility problem is one of the factors hindering early prevention in Ethiopia. Thus, the objective of this study is to determine what was known about Rh-incompatibility disorders and their associated factors among pregnant women participating in prenatal care in southern Ethiopia.

Design, setting and participants

A facility-based cross-sectional study was employed in four selected hospitals during 1–30 August 2022. The systematic random sampling method was used as a technique of selecting the study participants. The study was performed using a structured questionnaire. The data were coded and entered into EPI DATA V.4.6, and then the analysis was done using SPSS V.23 software program. Adjusted OR with 95% CI was the measurement unit of association between independent variables and outcome variables. The significance level was established as p<0.05.

Result

414 women took the survey, which corresponds to a response rate of 98.1%. Of those who responded, only 48% knew their blood group. The study found that 35.3% (95% CI: 31% to 40%) of women had a good knowledge of Rh-incompatibility. Maternal educational level above secondary school, multigravida women, blood type screening in the maternity ward, early counselling on Rh status and Rh-incompatibility and a positive attitude among women were significantly associated with pregnant women’s knowledge of Rh-incompatibility.

Conclusion

The majority of pregnant women had poor knowledge regarding Rh-incompatibility. Therefore, all responsible organisations should focus on expanding pregnant women’s knowledge of Rh-incompatibility and the factors significantly associated with knowledge of Rh-incompatibility.
Adherence patterns, risk factors and complications among patients with tuberculosis: a cross-sectional study at Nsawam Government Hospital
Authors: Nortey Abraham Norman , Adjoda Amanda , Alhassan Amidu , Scott Godfred Yawson
Published: April 2024

Background

Tuberculosis (TB) is the ninth leading cause of death worldwide, and the leading cause of death from a single infectious agent prior to COVID-19 pandemic. TB substantially affects adults during their most productive years. However, all age groups are at risk. More than 25% of cases and deaths occur in Africa. People infected with HIV are 20–30 times more likely to develop active TB. In this study, we determined the level of TB medication adherence, risk factors and complications of TB in outpatients attending the Nsawam Government Hospital.

Method

This cross-sectional study randomly recruited 277 patients with TB attending the Nsawam Government Hospital for care. Structured questionnaires were used to collect sociodemographic information, adherence and lifestyle characteristics. Associations and multivariate logistic regression analysis were performed with 95% CIs. All p<0.05 were considered statistically significant.

Results

Majority (36.1%) of the patients were between the ages of 29 and 38. Majority (63.9%) of them had high adherence to TB medication. Participants earning less than 500 Ghana Cedis (Ghc) (adjusted OR (aOR)=8.85. 95% CI (1.59 to 49.24), p=0.013), patients with TB who indicated having complication (joint pain, spinal pain, heart disorders, liver or kidney problems) as a result of TB (aOR=2.81, 95% CI (1.58 to 4.99), p<0.001), respondents who mentioned living with people infected with TB (aOR=3.23. 95% CI (1.24 to 8.37), p=0.016) were the independent predictors of adherence to TB medication.

Conclusion

The study findings revealed that participants exhibited commendable adherence to TB medication. Notably, adherence levels were found to be linked to several factors, including income, medication side effects and cohabitation with individuals infected with TB. The positive trend in adherence underscores the importance of considering socioeconomic factors, as lower income was identified as a potential barrier to consistent medication adherence
Children’s cognition and attitudes during long-term cancer treatment: an ethnographic study
Authors: Michinobu Ryoko , Yamamoto Masaki , Igarashi Keita , Sakai Yoshiyuki , Akane Yusuke , Yamamoto Dai , Takebayashi Akira , Mikami Takahiro , Tsutsumi Hiroyuki , Tsugawa Takeshi
Published: April 2024

Background

Cancer treatment for children is typically long-term and difficult, and the experience is unique for each child. When designing child-centred care, individuals’ values and preferences are considered equally important as the clinical evidence; therefore, understanding children’s thoughts and attitudes while they receive long-term treatment could offer valuable insights for better clinical practice.

Methods

We conducted long-term consecutive participatory observations and interviews with seven children, who were hospitalised and receiving cancer treatment for the first time. The daily observational data on those children’s discourses, behaviours and interactions with health professionals were systematically collected and thematically examined. The analysis was expanded to explore significant narratives for each child to capture their narrative sequence over time.

Results

The initial analysis identified 685 narrative indexes for all observation data, which were categorised into 21 sub-codes. Those sub-codes were assembled into five main themes by thematic analysis: making promises with health professionals, learning about the treatment procedures through participation, taking care of oneself, increasing the range of activities one can perform and living an ordinary life.

Conclusion

We observed a forward-looking attitude toward understanding cancer, accepting treatment and looking forward to the future among children undergoing in-hospital cancer treatment. In addition, the children developed cognitively, affectively and relationally throughout cancer treatment processes. These findings have implications for better clinical practice in child-centred care, including children’s participation in shared decision-making in paediatric oncology.
Comparison of singleton and twin birth weight reference percentile curves by gestational age and sex in extremely preterm infants: a population-based study
Authors: Song Shuting , Zhu Zhicheng , Mao Weiying , Zhu Yan , Zhang Rong , Bu Xinghe , Li Heqin , Han Yanqing , Cao Yuntao , Gao Yuan , Qiu Yin-Ping , Wei Guangyou , Zhang Pingping , Xie Jijian , Wang Min , Chen Chao , Zhu Li
Published: April 2024

Background

With the increasing survival rate of smaller newborns and twins, previous growth curves may not accurately assess the growth of extremely preterm infants (EPIs). Our study aimed to establish birth weight percentile curves for singletons and twins in EPIs from China and the USA and compare the differences between them.

Methods

In China, EPIs were from 31 provinces, from 2010 to 2021. The collected information was sex, gestational age, birth weight, singletons and twins. We used the generalised additive models for location scale and shape method to construct the birth weight percentile curves by gestational age and sex for EPIs. The National Vital Statistics System database from 2016 to 2021 was also analysed. We compared the differences between the 50th birth weight percentile curves of the two databases.

Results

We identified 8768 neonates in China (5536 singletons and 3232 twins) and 121 933 neonates in the USA (97 329 singletons and 24 604 twins). We established the 3rd, 10th, 25th, 50th, 75th, 90th and 97th birth weight reference curves for China and the USA. The results showed that males had higher birth weights than females. In China, for the same gestational age and sex, birth weights in singletons and twins were found to be similar, though singleton males born in China had slightly higher birth weights than male twins. In the USA, birth weights were also similar for females and males, with the same gestational age in singletons and twins.

Conclusion

We established birth weight reference percentile curves by gestational age and sex for singletons and twins among EPIs in China and the USA.
Validity and reliability of outcome measures to assess dysfunctional breathing: a systematic review
Authors: Mohan Vikram , Rathinam Chandrasekar , Yates Derick , Paungmali Aatit , Boos Christopher
Published: April 2024

Objective

This study aimed to systematically review the psychometric properties of outcome measures that assess dysfunctional breathing (DB) in adults.

Methods

Studies on developing and evaluating measurement properties to assess DB were included. The study investigated the empirical research published between 1990 and February 2022, with an updated search in May 2023 in the Cochrane Library database of systematic reviews and the Cochrane Central Register of Controlled Trials, the Ovid Medline (full), the Ovid Excerta Medica Database, the Ovid allied and complementary medicines database, the Ebscohost Cumulative Index to Nursing and Allied Health Literature and the Physiotherapy Evidence Database. The included studies’ methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Data analysis and synthesis followed the COSMIN methodology for reviews of outcome measurement instruments.

Results

Sixteen studies met the inclusion criteria, and 10 outcome measures were identified. The psychometric properties of these outcome measures were evaluated using COSMIN. The Nijmegen Questionnaire (NQ) is the only outcome measure with ‘sufficient’ ratings for content validity, internal consistency, reliability and construct validity. All other outcome measures did not report characteristics of content validity in the patients’ group.

Discussion

The NQ showed high-quality evidence for validity and reliability in assessing DB. Our review suggests that using NQ to evaluate DB in people with bronchial asthma and hyperventilation syndrome is helpful. Further evaluation of the psychometric properties is needed for the remaining outcome measures before considering them for clinical use.

PROSPERO registration number

CRD42021274960.
Respiratory-related deaths and associated factors in Alicho-Weriro district, southern Ethiopia: verbal autopsy data analysis
Authors: Belete Netsanet , Tadesse Sebsibe , Hailu Mulugeta
Published: April 2024

Background

Respiratory diseases disproportionately affect people living in resource-limited settings. However, obtaining information that explains respiratory-related deaths has been difficult, mainly due to a lack of medical certification of death and the fact that most deaths occur outside of health institutions. This study aimed to determine the proportion of respiratory-related deaths and identify associated factors in Alicho-Weriro district, southern Ethiopia, using the verbal autopsy method.

Methods

A community-based cross-sectional study was conducted from April to June 2022. All deceased people in the study area from January 2020 to December 2021 were included in the study. Trained physicians ascertained the cause of death from verbal autopsy data that were collected using a pre-tested and modified WHO-designed questionnaire. The binary logistic regression models were used to identify factors associated with respiratory-related deaths.

Results

Respiratory-related deaths accounted for 25% of the deaths from all causes, with 20.8% of male and 29.5% of female deaths. Of which, 9.7% were from tuberculosis, 8.3% were from asthma and 6.2% were from acute lower-respiratory tract infections. Moreover, being female (adjusted OR, AOR: 3.3; 95% CI: (1.75 to 6.22)), age 50–64 years (AOR: 9.3; 95% CI: (1.16 to 73.90)), age above 64 years (AOR: 8.9; 95% CI: (1.130 to 70.79)), family size of five persons or more (AOR: 1.9; 95% CI: (1.15 to 3.29)), smoking (AOR: 3.9; 95% CI: (1.86 to 8.35)), using wood and/or animal dung for household cooking (AOR: 6.6; 95% CI: (1.92 to 22.59)) and poor house ventilation (AOR: 3.1; 95% CI: (1.75 to 5.38)) were significantly associated with increased odds of dying from respiratory-related diseases.

Conclusion

This study has determined that about a quarter of deaths from all causes were due to respiratory diseases, mainly tuberculosis, asthma and acute lower respiratory tract infections. Therefore, interventions to reduce this burden should focus on supporting early case detection and treatment, promoting healthy lifestyles, exercising women’s equality at the household level and improving housing conditions.
British Society of Gastroenterology guidelines for the management of hepatocellular carcinoma in adults
Authors: Suddle Abid , Reeves Helen , Hubner Richard , Marshall Aileen , Rowe Ian , Tiniakos Dina , Hubscher Stefan , Callaway Mark , Sharma Dinesh , See Teik Choon , Hawkins Maria , Ford-Dunn Suzanne , Selemani Sarah , Meyer Tim
Published: April 2024

Deaths from the majority of cancers are falling globally, but the incidence and mortality from hepatocellular carcinoma (HCC) is increasing in the United Kingdom and in other Western countries. HCC is a highly fatal cancer, often diagnosed late, with an incidence to mortality ratio that approaches 1. Despite there being a number of treatment options, including those associated with good medium to long-term survival, 5-year survival from HCC in the UK remains below 20%. Sex, ethnicity and deprivation are important demographics for the incidence of, and/or survival from, HCC. These clinical practice guidelines will provide evidence-based advice for the assessment and management of patients with HCC. The clinical and scientific data underpinning the recommendations we make are summarised in detail. Much of the content will have broad relevance, but the treatment algorithms are based on therapies that are available in the UK and have regulatory approval for use in the National Health Service.
Increased apathy post-interstitial laser capsulotomy for refractory obsessive–compulsive disorder
Authors: Hagy Hannah A , Lacy Maureen , Turchmanovych-Hienkel Nataliya , Grant Jon E , Biro Daniel , Warnke Peter C
Published: April 2024

Background

MRI guided laser interstitial thermal therapy (M-LITT) capsulotomy has proven to be efficacious in decreasing refractory obsessive-compulsive disorder (OCD) related symptomatology yet capsulotomy either via radiosurgery or radiofrequency ablation has in some patients led to increased apathy following surgery. The current case series aims to investigate objective patient-reported change in apathy, disinhibition, depression, and executive dysfunction following anterior capsulotomy via M-LITT for OCD.

Methods

Ten consecutive patients pre- and post-M-LITT completed measures of OCD, apathy, disinhibition, executive dysfunction, and depression (Mtime between= 1.3 years; 0.42-3.7 years). Reliable Change Index (RCI) was used to evaluate change in pre- and post-M-LITT. OCD symptom response was evaluated using percent change (Y-BOCS scores: 24-34 % reduction indicating partial response; ≥35% reduction indicating full response).

Results

Positive post-surgical change was noted in OCD symptomatology with >65% reporting a partial or full response. However, six patients endorsed increased apathy with half of the non-responders (e.g., less than <24% score reduction on Y-BOCS) reporting increases in apathy. Patients reported relatively stable disinhibition and executive dysfunction, while over half reported a decrease in depression symptoms. Two of the non-responders and one responder endorsed increased apathy despite stable or improved depression symptoms, disinhibition, and executive dysfunction.

Conclusions

Most patients in the current cohort achieved full-or-partial OCD recovery. Yet, 60% of patients also reported significant increases in apathy, despite experiencing a decrease in depression symptoms, with stable disinhibition and executive dysfunction. Despite these promising improvements in OCD symptomatology following M-LITT, further investigations of the impact of surgery and lesion location on apathy levels is clearly warranted using objective, quantifiable methods.
Patient experiences of randomised placebo-controlled trial participation during end-of-life palliative cancer care
Authors: Klasson Caritha , Helde Frankling Maria , Lundh Hagelin Carina , Björkhem-Bergman Linda , Alvariza Anette
Published: April 2024

Background

Performing clinical trials in palliative cancer care is known to be challenging.

Objective

This study aimed to explore how patients with advanced cancer experienced their participation in a randomised, placebo-controlled trial while receiving palliative cancer care at end of life.

Method

A descriptive design with a qualitative approach was used. 14 patients who had participated in the ‘Palliative-D’ study were interviewed. Data were analysed using content analysis.

Results

Three categories were identified understanding the study design, willingness to participate and collaboration with the research team alongside standard care. Being randomised, with the risk of receiving placebo, was perceived as non-problematic since it was understood as being important for the quality of the research. Patients showed a willingness to participate for the sake of others and also for their own sake, hoping for a cure or at least to live as long as possible. Patients felt proud of being useful and contributing to research. Consent to participate was made autonomously without discussing with others. Patients considered the study design uncomplicated and well-integrated into the standard care.

Conclusion

Study participation in a randomised, placebo-controlled trial can be a positive and meaningful experience for patients despite advanced cancer in end of life. Participation may support patients’ autonomy and give hope, and therefore, might have a positive effect on quality of life. A carefully planned and simple study design, well integrated into standard care, can facilitate the feasibility of clinical studies in specialised palliative home care.