bluuebunny/crossref_metadata_2025 huggingface dataset:
The Case for Assessing the Drivers of Measles Vaccine Uptake
Authors: Kaufman Jessica , Rak Ashleigh , Vasiliadis Sophia , Brar Navrit , Atif Eeman , White Jennifer , Danchin Margie , Durrheim David N.
Published: June 2024

Global measles cases are on the rise following disruptions to routine immunisation programs during the COVID-19 pandemic, with devastating consequences. According to the World Health Organization, the behavioural and social drivers of vaccination include what people think and feel about vaccines, social processes, motivation to vaccinate and practical barriers to vaccination. However, the drivers of measles vaccine uptake are not necessarily the same as those for other childhood vaccines, and we lack data on how these drivers specifically have changed during and since the COVID-19 pandemic. Without accurately measuring the behavioural and social drivers for measles vaccination, and ideally measuring them serially over time, countries cannot design, target and implement interventions that effectively increase and sustain measles vaccine coverage. This paper outlines what is and is not known about the behavioural and social drivers of measles vaccination and provides recommendations for improving their post-pandemic assessment.
Addressing the Dangerous Consequences of the Resurgence of Measles and Rubella: The Critical Need for a Global Target
Authors: Andrus Jon Kim
Published: June 2024

I am delighted and honored to be Guest Editor of this Vaccines Special Issue on measles and rubella elimination [...]
Host Functional Response to a Prototypic Orally Delivered Self-Replicating Vaccine Platform
Authors: Vilander Allison C. , Burak Julia , Gilfillan Darby , Dean Gregg A. , Abdo Zaid
Published: June 2024

The development of mucosal vaccines has been limited and could be aided by a systems vaccinology approach to identify platforms and adjuvant strategies that induce protective immune responses. The induction of local immune responses by mucosal-delivered vaccines has been difficult to evaluate from peripheral samples, as systemic responses often do not correlate with the mucosal response. Here, we utilized transcriptomics in combination with Gene Set Enrichment Analysis (GSEA) to assess innate immune activation by an oral probiotic Lactobacillus acidophilus-based vaccine platform in mice. The goal was to explore the earliest immune responses elicited after oral immunization at the Peyer’s patch. Twenty-four hours after oral delivery of the L. acidophilus vaccine platform, we found an abundance of L. acidophilus at Peyer’s patches and detected expression of the vaccine viral proteins and adjuvants, confirming in vivo vaccine delivery. Compared to mice orally dosed with buffer or wild-type L. acidophilus, we identified enhanced responses in immune pathways related to cytokine and gene signaling, T and B cell activation, phagocytosis, and humoral responses. While more work is needed to correlate these pathways with protection from infection and/or disease, they indicate this method’s potential to evaluate and aid in the iterative development of next-generation mucosal vaccines.
Non-pharmacological interventions in the management of dementia-related psychosis
Authors: Burnand Alice , Frost Rachael , Walters Kate , Rookes Tasmin , Davies Nathan
Published: June 2024

Background

It is estimated 20–70% of those living with a dementia diagnosis experience dementia-related psychosis (D-RP). D-RP results in decreased quality of life, increased carer burden, increased rapid cognitive decline, increased need for primary care support, and earlier care/nursing home admission, all which come at a considerable cost to the NHS. Antipsychotic medications prescribed by primary care services are typically used as treatment but have short-term efficacy and dangerous side effects. Effective management with the use of non-pharmacological interventions could safely improve the quality of life of those living with dementia, as well as reduce burden on primary care services and GPs.

Aim

To evaluate the effectiveness of non-pharmacological interventions in the management of D-RP. Studies that measure the effect of non-pharmacological interventions on patient or caregiver quality of life or determine the cost-effectiveness and safety of non-pharmacological interventions against antipsychotic medications will also be included.

Method

A global systematic literature review was conducted in Medline, Embase, PsychInfo, CINAHL, Web of Science, and CENTRAL. Included studies were analysed using meta-analysis and narrative synthesis. The protocol is registered with PROSPERO (ID: CRD42022294750).

Results

Data extraction of 18 included papers revealed 4 interventions to show evidence of efficacy in improving D-RP in older adults. Person-centred care, robot pets, cognitive rehabilitation, and music therapy significantly decreased psychosis in care homes and in participants living at home. These results are discussed, and implications noted.

Conclusion

Future RCTs should focus on specifically improving D-RP, as this was not the primary aim for many interventions.
Risks to patient safety in remote consulting
Authors: Payne Rebecca , Clarke Aileen
Published: June 2024

Background

Remote consulting was rolled out across general practice in 2020 in response to the COVID-19 pandemic. Although most consultations are carried out safely, in some cases remote care has contributed to adverse outcomes.

Aim

To understand where the risks lie in delivering primary care remotely.

Method

Mixed method study in UK primary care settings including general practice, out of hours and 111 services. Data was collated from NHS England complaints quarterly reviews, NHS Resolution cases, 111 Wales, the HSIB report into 111 COVID services and longitudinal case ethnographic cases studies of 11 general practices. 2 reviewers coded the data and identified themes.

Results

There are staff, patient, and setting factors that contribute to risk in remote consulting. Staff factors include communication skills, over-reliance on a previous diagnosis made remotely, failure to recognise clinical findings or the urgency of a case, over/under prescribing/investigating and referring and safety netting. Patient factors include impaired communication, repeated telephone consultations, unstable chronic disease, and certain medical conditions such as chest and abdominal pain. Risk was encountered when settings had limited telephone lines, call handlers or clinicians, or where access to appointments was either restricted, hard to navigate, or where inappropriate layers of triage were applied. Processes had not always adapted for remote working, leading to risk in delayed access to acute prescriptions and delayed referrals.

Conclusion

Attention to staff, patient, and setting factors can allow risk to be identified and addressed when providing care remotely.
Assessing the heterogeneity of ethnic categories for patient records in primary care
Authors: Hameed Junaid , Hornby Clare , Rai Tanvi , Hayward Gail , Dixon Sharon
Published: June 2024

Background

UK general practice surgeries collect data regarding patient ethnicities, typically at registration. These data are subsequently used in both clinical care and research, for example, when embedded in risk modelling tools. The published standard list of ethnic categories exists, but little is known about what happens in frontline practice.

Aim

To document the variation in ethnic categories available on online patient registration forms across GP surgeries in Oxfordshire.

Method

Of all 67 GP surgeries in Oxfordshire, 56 had online registration forms that included an option list for ethnicity reporting. The authors compared these against the 2001, 2011, and 2021 UK census ethnic group categorisation.

Results

Significant heterogeneity was identified across practices. The number of options for ethnicity group ranged from 5 to 84, with a median of 14, compared to the census lists that comprise of 19 (2021), 18 (2011), and 16 (2001) groups. Of the 56 practices, six used the 2001 census list, five used the 2011 census list, and none used the 2021 census list. Overall, 45 practices used lists that differed from any census list, including categories not typically considered to be ethnic, for example ‘Muslim’ or ‘Buddhist’, meaning individuals could potentially identify with multiple options.

Conclusion

High-quality research and healthcare data that includes patient ethnicity is essential to understand, document, and mitigate against health inequalities. However, this may be compromised by poorly conceived ethnic categorisations and a lack of standardisation. This pilot/exploratory study suggests that the ethnicity records in primary health care may be neither standardised nor meaningful.
Medical students’ and GP tutors’ experiences of near peer teaching in primary care: a qualitative study
Authors: Mistry Vidya
Published: June 2024

Background

There exists a significant body of literature on the benefits of Peer Assisted Learning (PAL). Near-peer (NP) teaching can be defined as teaching delivered by senior students to younger year students. There are numerous examples in the literature of PAL projects in a non-clinical setting but little research in a clinical setting and even less in primary care. Postgraduate literature suggests that potential benefits include promotion of general practice as a career as well as increasing teaching capacity.

A successful pilot led to the development of a new undergraduate NP teaching Student Selected Component (SSC) in a primary care setting.

Aim

To explore the experiences of medical students and GP tutors who participated in this SSC.

Method

Semi-structured interviews were carried out with year 5 NP student teachers, GP tutors, and year 3 students. Thematic analysis was used to analyse the qualitative data generated.

Results

As well as increasing teaching capacity and consolidating their own knowledge, the findings suggest an impact on the professional identity formation of NP student teachers helping them to prepare to be future doctors. The NP teaching fostered an environment of psychological safety for all students, although there was an additional element of risk management and supervision when teaching with patients.

Conclusion

Undergraduate NP teaching has advantages for student learners, NP student teachers, GP tutors, and practices. The increased teaching capacity has implications for recruitment of practices for teaching and may promote general practice as a future career.
What your patient needs to know about a non-specific symptom pathway referral for suspected cancer
Authors: Black Georgia , Moreland Julie-Ann
Published: June 2024

Background

Non-specific symptom (NSS) pathways were implemented in the UK in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue, or GP ‘gut feeling’.

Aim

To explore patients’ experiences of NSS pathways, and their potential support needs in terms of understanding and navigating these pathways.

Method

This study employed ethnographic methods across four NHS trusts in England, including interviews with 28 patients and 28 professionals, patient shadowing, and clinical care observations, to examine NSS pathways for cancer diagnosis. Analysis focused on patient communication and understanding of care.

Results

Patients found it hard to understand why they were referred. Only a minority of patients appreciated that multiple organs were being investigated for cancer. Progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. Investigations often resulted in incidental findings. Patients whose persistent symptoms were not explained were often unsure what to do following discharge.

Conclusion

The findings resulted in recommended messages for GPs to support patients on referral to NSS pathways, including the nature of the pathway, the team that will be responsible for their care, the multiple organ systems that will potentially be investigated, and what will happen if they don’t find a cancer. Without this support, patients’ difficulties in comprehending previous investigations and findings could result in delays, overtesting, or inadequately targeted investigations, hindering the effective use of their medical history.
Incidence of menstrual symptoms suggestive of possible endometriosis in adolescents: and variance in these by ethnicity and socio-economic status
Authors: Dixon Sharon , Vincent Katy , Hirst Jennifer , Hippisley-Cox Julia
Published: June 2024

Background

Dysmenorrhoea affects up to 94% of adolescents who menstruate; approximately one third miss school and activities. Dysmenorrhoea can occur without identified pelvic pathology (primary dysmenorrhoea) or in association with other conditions (secondary dysmenorrhoea). In adolescence, the commonest cause of secondary dysmenorrhoea is endometriosis. The incidence of symptoms in adolescence suggesting possible endometriosis has not been previously documented in GP records.

Aim

To document incidence of adolescent endometriosis and symptoms associated with endometriosis in English GP records.

Method

Data from the QResearch primary care database were used for adolescent females aged 10– 19 years between 1 January 2011 and 30 June 2021, reported using descriptive statistics.

Results

The population cohort included 2 843 347 female adolescents; 98 887 participants had coded dysmenorrhoea (3.48%) and 1994 (0.07%) had documented endometriosis. The cumulative incidence for the cohort who turned 10 years old in 2011 was 7.2% for dysmenorrhoea and 0.12% for endometriosis. The period prevalence of coded symptoms during adolescence potentially associated with dysmenorrhoea and endometriosis includes: heavy menstrual bleeding (3.73%), irregular menstrual bleeding (2.21%), pelvic pain (0.63%), dyspareunia (0.40%), premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) (0.22%), cystitis (8.45%), and irritable bowel syndrome (IBS) (1.00%). Disparities in coding were observed for these variables by ethnicity and socioeconomic status. Incidence of prescribed hormonal medication, with and without coded dysmenorrhoea, varied by ethnicity. This was less apparent for non-steroidal anti-inflammatory medications.

Conclusion

Prevalence of coded dysmenorrhoea in GP records is significantly lower than community surveys suggest; however, adolescent menstrual symptoms are commonly encountered in primary care, and deserve specific guidance and resources. There are demographic patterns, likely structural, that warrant further exploration.
Pharmacists’ views on discontinuing long-term use of antidepressants and supporting patients during the discontinuation process: a qualitative study
Authors: Van Leeuwen Ellen , Mehuys Els , Boussery Koen , Christiaens Thierry
Published: June 2024

Background

Long-term antidepressant (AD) use, much longer than recommended by guidelines, may cause harms and generate unnecessary costs. Community pharmacists have frequent contact with AD users and advise them on appropriate and safe medication use. GPs recognised pharmacists as potential sources of additional support for the AD discontinuation process, but there is a lack of knowledge about pharmacists’ views.

Aim

To explore pharmacists’ perspectives on discontinuing long-term use of ADs and supporting patients during the discontinuation process and their barriers and facilitators.

Method

Qualitative study in Belgian pharmacists. The authors conducted 14 semi-structured face-to-face interviews. Interviews were analysed thematically.

Results

The first theme ‘Antidepressants at the pharmacy: a persistent taboo’ described the challenges pharmacists encounter in initiating discussions with patients about their ADs and mental health, and the persistent taboo around ADs at pharmacies. Second, pharmacists were concerned about the risks associated with AD discontinuation but recognise that harm from continuing ADs may outweigh concerns. Third, although pharmacists can be a starting point for discontinuation, they hesitate to do this and question if this is their role. They prefer that GPs have this responsibility.

Conclusion

Deprescribing long-term ADs is a challenging concept for pharmacists, especially when there is no patient request. The taboo around ADs and the fear of relapse of symptoms in a stable patient are important barriers for pharmacists when considering discontinuation. Pharmacist education and confidence-building is essential to involve the pharmacist in the discontinuation process. Findings also highlight a strong need for multidisciplinary collaboration and agreements with GPs to reduce unnecessary antidepressant treatment.
Understanding exercise referrals in primary care: a qualitative study of GPs and physiotherapists
Authors: Dunphy Rebekah , Blane David
Published: June 2024

Background

Physical inactivity is estimated to cost the UK NHS over £1 billion per year. Healthcare practitioners have a key role in supporting increases in physical activity (PA) levels, including referring to exercise referral schemes (ERS). To date, there has been little research into practitioner perspectives on referrals to ERS.

Aim

To explore the views and experiences of GPs and physiotherapists in relation to factors that influence referral and adherence to ERS.

Method

Qualitative study of primary care-based practitioners in Glasgow, UK. Semi-structured interviews were conducted with 14 practitioners (seven GPs and seven physiotherapists). Interviews were recorded and analysed thematically.

Results

Four themes are presented. First, healthcare practitioners bring inherent biases to a consultation that impact their approach to PA promotion. Second, clinical time pressures are a major barrier to effective PA promotion. Third, patient-led, compassionate care is the most vital component of behaviour change, with suggestions that promoting peer support and the use of personal anecdotes to normalise vulnerabilities might be helpful. Last, providing ongoing support for change was beneficial to PA promotion. This is often accessed through ERS and is improved by better collaboration between exercise providers and referring practitioners.

Conclusion

Practitioners believed ERS referrals could be improved with more targeted training, support for multidisciplinary working, and enhanced communication between the programmes and referrers. Additionally, supporting behaviour change requires time to develop rapport and understand patients’ motivations and beliefs. Lack of time is the greatest current barrier to effective PA promotion.
A pilot study of electronic blood pressure interpretation of home blood pressure readings in primary care
Authors: Rosen Jake , Rasheed Reshma
Published: June 2024

Background

Home blood pressure (BP) monitoring is an acceptable method with high accuracy and acceptability amongst patients. It has the potential to save many hours of clinical time and is less likely to suffer from white coat bias. However, it can raise anxiety in patients who may not interpret readings immediately.

Aim

A pilot study using an auto formatted excel spreadsheet which gave instantaneous colour coded feedback was sent to patients to assess its acceptability.

Method

This auto interpretation tool was sent to patients with their consent. It enabled patients to receive immediate feedback about this blood pressure control. A follow-up questionnaire was later sent to ask the patients and the staff about their experience.

Results

Hypertensive patients under 75 years of age who were sending regular home BP readings were enrolled (n =96); of these, 31 responded within 1 month. Patient satisfaction was high; 74% preferred the electronic tool, 77% found the colour indicator reassuring, and 87% wanted to continue the electronic interpretation tool regardless of their initial preference. Staff satisfaction was excellent at 100%.

Conclusion

This hypertension triage tool allows for interpretation by patients and non-clinicians with benefits of instantaneous reassurance, user and provider satisfaction all at reduced costs. Patients without MS Excel could not use this tool. The pilot study reinforced our hypothesis that such a modality has the potential to increase patient satisfaction and safety, and can be applied to a larger number of patients. Eventually an NHS app could be developed and rolled out for the large population.
HIV screening guidance – ignored or forgotten?
Authors: Humphries Hannah Vidis , Hartop Phoebe
Published: June 2024

Background

NICE guidance states new patients aged 15–59 registering at a primary care centre in a high-risk area for HIV, should be offered testing.First, this allows for prompt initiation of antiretroviral therapy, improving the individual’s morbidity and mortality while reducing community transmission. Second, increasing the breadth of the population offered tests would help normalise testing, reducing stigma and increasing uptake.

Aim

To retrospectively audit adherence to HIV testing guidance in new patients registering at a GP in Walsall, where HIV risk is categorised as high,and to make recommendations based on the results.

Method

The EMIS records of 310 new patients aged 15–59 who registered during a 12-month period (October 2021 to October 2022) were accessed to establish if they were offered HIV testing. A survey was created and distributed to staff in the practice to understand the reason for lack of testing.

Results

The audit revealed that none of the 310 patients were offered an HIV test. The survey indicated that 75% of staff members were unaware of the guideline, 66.7% never ordered an HIV test, and 83% stated that they do not believe GPs are given enough support to follow guidelines.

Conclusion

The guidance for screening for HIV in this primary care centre is therefore not followed due to a lack of awareness of the guideline and HIV risk in the area. We recommend that this audit is conducted across more primary care centres in HIV high-risk areas to assess if this outcome is representative of general adherence to guidance.
The unmet needs of menopausal women in primary care
Authors: Fatima Urooj , Rasheed Reshma
Published: June 2024

Background

The average age for menopause is 51 years, this is preceded by a transitional perimenopausal stage, with vasomotor symptoms, muscular and joint pain, lowered libido and disordered sleep, impacting on mental health. In some women, the quality of life is considerably affected. This remains under-reported. There is no national screening service, or specialised clinics for menopausal services available in primary care.

Aim

We undertook a survey of women in primary care as part of a needs assessment to understand the prevalence of peri- and menopausal symptoms, women’s knowledge of these symptoms, and available treatment options.

Method

A questionnaire was sent to women aged 45–65 years registered with the practice.

Results

Of a total of 73 women, 78.1% complained of >4 symptoms. The most common symptoms were memory problems and brain fog (80.6%), sleep disturbance (72.1%) and muscle/joint pain (72.1%). Women were asked to rate their knowledge of therapy options on a self-reported scale of 0–10; a high proportion (64.3%) rated <4 points. They had better knowledge of symptoms, 79.3% rated >4 points. A high proportion (58.9%) rated inadequate support received from primary care and 75.3% felt they had no support at all.

Conclusion

Our results of this preliminary study showed the vast majority of women were unaware of treatment options for their menopausal symptoms and felt they received inadequate to no support from primary care providers. The present ongoing study highlights lack of resource allocation to women’s health and insufficient commissioning of services to address this health need.
A ‘smear campaign’ against patient-excluded policy changes: a reflection on the language used in cervical screening programmes
Authors: Morse Iris-Mae , Amiry Jack
Published: June 2024

Background

Cervical screening has transformed the diagnosis of cervical cancer. However, uptake within the national screening programme is not uniform across demographics. This raises the question of whether medical language, which conveys essential information but also shapes attitudes towards engaging with healthcare, is part of the problem. The term “smear test” has been used for generations and is embedded in colloquial and medical vocabulary. However, there is a danger that the phrase may conjure images of an unpleasant or even reckless ordeal, potentially contributing to unnecessary patient anxiety.

Aim

To evaluate patient attitudes towards the terms “cervical smear” and “cervical brush”.

Method

Female participants from a single GP surgery were randomly sampled. Data from questionnaires were then subjected to thematic analysis.

Results

Half of patients interviewed did not feel either term would significantly influence cervical screening uptake. Equal numbers of patients expressed an overall preference for each of the two terms, and the remaining 28% expressed no preference. Qualitative data revealed some patients favoured the familiarity of the term “cervical smear”, and others preferred the descriptive accuracy of “cervical brush”.

Conclusion

It is imperative to consult target groups and use inclusive language that minimises stigmatising or negative connotations. Modifying language alone is unlikely to remedy the current access barriers in UK cervical screening. Instead, a multifaceted approach that also targets education and addresses systemic issues could offer a more sustainable strategy. Ultimately, prioritising a patient-centred approach could improve access to life-saving screening.
What interventions are effective in reducing development of hypertension and other cardiovascular complications in women who have had hypertensive disorders of pregnancy? A systematic review
Authors: Harvey Kathryn , Parikh Chinar , Hill Ruaraidh , Williams Nefyn
Published: June 2024

Background

Hypertensive disorders of pregnancy (HDP) affect approximately 10–15% of pregnancies and pre-eclampsia affects 3–5% of pregnancies. Women with previous pre-eclampsia or HDP are at increased risk of hypertension (2 to 5 times) and major cardiovascular disease (1.5 to 3 times). There is little guidance on how to reduce this risk.

Aim

To establish if there are interventions in women with previous HDP or pre-eclampsia that reduce the risk of developing adverse cardiovascular outcomes.

Method

A protocol was submitted to PROSPERO; inclusion and exclusion criteria were determined and a search strategy implemented. Primary outcomes were: development of hypertension or change in blood pressure and development of other cardiovascular complications. Records and full texts were screened independently by two reviewers. The Cochrane Risk of Bias tool was used for quality assessment.

Results

3593 articles were screened. Nine articles were included. There were seven randomised-controlled trials and two quasi-experimental studies. One study trialled antihypertensive use, two studies looked at blood pressure monitoring and six studies focused on lifestyle interventions. Three trials reported significant reductions in diastolic blood pressure in the experimental group. No studies looked at the optimal time of intervention or the impact of interventions on the development of other long-term cardiovascular complications. Five studies reported participant feedback. The majority of studies were of low quality.

Conclusion

Further research needs to explore potential interventions and optimal timing of interventions to reduce cardiovascular risk. Women also need to be consulted about their preferences for discussions about cardiovascular risk and potential interventions.
Evaluating adherence to ECG monitoring protocols for methadone patients in primary care
Authors: Robinson Lani , McNamara Paul
Published: June 2024

Background

Opioid Agonist Treatment (OAT) is the gold standard for managing Opioid Use Disorder (OUD). It is highly effective at reducing all-cause mortality and drug-related harms. Prescribing OAT, particularly methadone, is becoming increasingly complex as Scotland’s OUD population ages. Older patients, with increased polypharmacy and multimorbidity, are more susceptible to QTc interval prolongation associated with methadone use. Therefore, adherence to ECG monitoring guidelines for patients prescribed methadone is crucial, though insights from substance use services indicate suboptimal compliance. Medically Assisted Treatment guidelines established by the Scottish Government advocate for shared care agreements, thus transferring OAT prescribing responsibilities to primary care. Understanding ECG monitoring guideline implementation in non-specialist services is vital for developing safe OAT services in primary care.

Aim

This audit assessed adherence to NICE guidelines for ECG monitoring in OUD patients prescribed methadone in a Scottish primary care practice.

Method

The notes of patients prescribed methadone were assessed using NICE criteria to determine eligibility for ECG monitoring. Eligible patients’ medical records were reviewed to identify previous ECG investigations.

Results

Of 21 patients prescribed methadone, 16 qualified for ECG monitoring. Only 25% of eligible patients received ECG monitoring per NICE guideline, meaning 75% did not.

Conclusion

These findings highlight that the issue of poor compliance with ECG monitoring guidelines is not limited to specialist services, but also affects primary care. Further exploration of barriers to guideline implementation is essential. Perhaps more resources are needed to integrate OAT services into primary care, which has taken on increased responsibilities without corresponding investment.
Advancing familial hypercholesterolaemia (FH) screening in primary care: an updated systematic review of systematic screening methods for identificaton of FH
Authors: Ayoub Aya , Akyea Ralph K , Silva Luisa , Qureshi Nadeem , Molokhia Mariam
Published: June 2024

Background

Familial Hypercholesterolaemia (FH) is a greatly underdiagnosed and treatable genetic lipid disorder which significantly increases risk of premature cardiovascular disease. The prevalence of monogenic FH is thought to be 1 in 250–350. The NHS Long Term Plan aims to increase FH detection to at least 25% over 5 years in collaboration with primary care, supported by the NHS genomics programme.

Aim

This systematic review evaluates systematic screening methods for FH in adults aged ≥18 years in primary care.

Method

Seven databases [Cochrane, PubMed, Ovid, CINAHL, ProQuest, Web of Science, Scopus], four clinical trial registries [ISRCTN, ANZCTR, Clinicaltrials.gov, WHO-ICTRP] and relevant grey literature [OpenGrey] from March 2020 to May 2023 were searched. Only studies including adults were eligible. Risk of bias was assessed using ROBINS-I.

Results

831 records were screened. No randomised, controlled studies were identified. From full-text review, five eligible non-randomised studies out of 57 (6.90%) were identified. The included studies all used automated FH case-identification from electronic medical records (EMR) and were high quality studies with a moderate risk of bias. Narrative synthesis reported outcomes which included three algorithmic studies, with a pooled detection rate, DR 14.4% (95%CI 11.67–16.62), one supervised Machine Learning [Ensemble] study, DR 15.5% (95%CI 15.47–15.53) and one study utilising a hybrid diagnostic EMR model and/or FH genotype confirmation DR 25.0% (95%CI 16.30–35.8). No adverse effects were reported in these studies.

Conclusion

Incorporating automated case-finding from EMR with clinical follow-up in primary care can enhance FH identification. Pathways incorporating genotyping showed the best detection rate.
A cost-effectiveness analysis of the use of oral ibrexafungerp versus fluconazole for acute vulvovaginal candidiasis in the UK NHS primary care service
Authors: Shah Viraj , Cyril Anjali , Koleoso Peter , Ragutharan Arunesh , Faiz Mohammed , Pushpakanthan Pathusha
Published: June 2024

Background

Vulvovaginal Candidiasis (VVC) is a fungal infection causing inflammation of the vagina and/or the vulva. Symptoms include itching, irritation, and discharge. VVC presents commonly across primary care and, despite its mild symptoms, carries psychological burden and has a significant impact on women’s quality of life. UK guidelines support treatment via oral or topical azole antifungal agents. Recent evidence attests to the superiority of novel non-azole antifungals. Thus, rigorous financial assessment of both antifungals is necessary for optimal VVC treatment allocation in UK primary care.

Aim

To evaluate the cost-effectiveness of ibrexafungerp against the gold standard fluconazole as first-line treatment of VVC within the NHS.

Method

A systematic review on the efficacy of ibrexafungerp and fluconazole in acute VVC was conducted. Cost-effectiveness analysis was initiated using health outcome data from the DOVE trial, a Phase 2 RCT. Costs in pound sterling were ascertained in monetary units, and effectiveness determined as reduced need for follow-up medication.

Results

An incremental cost-effectiveness ratio of £2185.74 was determined. This suggests oral ibrexafungerp being largely more costly yet slightly more effective than fluconazole, and thus has unfavourable net benefit. Two sensitivity analyses were conducted considering follow-up medication combination and market price, which provided confidence in the calculated cost-effectiveness ratio.

Conclusion

This analysis highlights fluconazole’s cost-effectiveness in current UK guidelines and favourability.
Penerapan Konseling Kelompok Teknik Reframing untuk Menurunkan Perilaku Toxic friendship pada Siswa Sma Negeri 3 Makassar
Authors: Yakin Ummul
Published: June 2024

This study aims to determine 1) The level of Toxic friendship behavior among students of SMA Negeri 3 Makassar, 2) The implementation of the Reframing Technique among students of SMA Negeri 3 Makassar, 3) Whether the Reframing Technique can reduce Toxic friendship among students of SMA Negeri 3 Makassar. The experimental design used is a true experimental design. The research results show that: 1) The level of toxic friendship among students in the pretest phase was in the high category for both the experimental and control groups, while in the posttest phase, the level of toxic friendship among students in the experimental group decreased to a medium level, whereas the control group remained in the high category, 2) The implementation of group guidance using the reframing technique was conducted in one treatment session with two meetings, 3) The use of group counseling with the reframing technique significantly affects the reduction of toxic friendship among students of SMA Negeri 3 Makassar.
Self-Management Strategies and Mastery Learning's Impacts on Civic Education Among Senior Secondary School Students
Authors: Lasisi Adekola Kamil , Ibraheem Islamiyyah Olajire , Muibudeen Ismail Alabi
Published: June 2024

This study examined self-management strategies and mastery learning's impacts on learning outcomes in civic education among senior secondary school students in Ilorin metropolis. The study employed a pretest, post-test and control group quasi-experimental design using a 3 x 2 x 3 factorial matrix. The population of this study comprised all the SS2 students in public senior secondary schools in Ilorin South. Stratified random sampling techniques were used to select the 75 SS2 students for the study. Data collected was analysed using t-test and analysis of variance (ANOVA). The result of the findings revealed that both self-management strategies and mastery learning significantly contribute to improved learning outcomes in civic education. Students who engaged in self-directed learning and mastery-oriented approaches demonstrated enhanced understanding and mastery of civic education concepts. It was recommended that there is a need to raise student awareness about the benefits of self-management and mastery learning. Encouraging students to take ownership of their learning, set goals, and adopt strategies that align with their learning styles.
Upaya Mengatasi Kecemasan Peserta Didik Kelas IX dalam Menghadapi Ujian Sekolah Melalui Bimbingan Klasikal di SMP Negeri 1 Semarang
Authors: Setiawati Palupi Dwi , Suhendri Suhendri , Indraswati Veronica
Published: June 2024

The aim of this research is to overcome anxiety in facing final exams in class IX students at SMP Negeri 1 Semarang by providing classical guidance services. Based on existing phenomena in the field, the percentage of students' anxiety in class IX of SMP Negeri 1 Semarang is 3.34%, which is included in the very high category. This research uses the action research method. The selected population was class IX students at SMP Negeri 1 Semarang. In taking samples, researchers used purposive sampling techniques. The instruments used in this research were observation, questionnaires and interviews. Based on the pre-test carried out, the results showed that students experienced anxiety at a very high level of 3.5%, whereas after being given classical guidance services which were carried out in two cycles, the results of the post-test were that students experienced a decrease in anxiety levels to 1.8% including in the low category.
Konseling Kelompok Berbasis Islam Dengan Pendekatan Cognitive Behavior Therapy (Cbt) dalam Meningkatkan Kematangan Karir Siswa
Authors: Aini Jannatun , Ristianti Dina Hajja , Azwar Beni
Published: June 2024

Humans cannot be free from problems, whether they realize it or not, children, teenagers, adults and even old people can definitely have problems in their lives. Adolescence is the most formative period, especially in terms of the ability to choose a path to adult life and the possibility of employment at risk of developing as a teenager, accompanied by the need to start preparing for future employment. Group counseling services are a type of service that can help teenagers overcome obstacles that prevent them from achieving career maturity. A review of relevant literature is used as an approach, and is supported by the findings of a number of papers, journals, books and other supporting documents. One approach from group guidance services that can help with career maturity issues is the Cognitive Behavior Therapy (CBT) approach. Cognitive Behavioral Therapy is effective in increasing career maturity.
Design para experiência do usuário
Authors: Alves Daniela Estaregue , Santos Berenice Gonçalves , Gonçalves Marília Matos
Published: June 2024

Diversas áreas do conhecimento buscam compreender como a experiência se insere no contexto sócio cultural atual, representando mudanças nos modos do ser humano consumir, perceber e interagir em sociedade. Através da compreensão desse relacionamento, o Design para experiência do usuário busca explorar maneiras de criar e moldar experiências através de produtos, serviços e espaços – independente da área em que estão sendo empregados. Nesta direção, o objetivo deste artigo é apresentar um conjunto de premissas relacionadas ao design para experiência do usuário para apoiar o processo de organização de eventos turísticos. Para tal, realizou-se uma revisão sistemática de literatura a respeito de instrumentos conceituais e aplicados direcionados ao processo de Design para a experiência do usuário juntamente com uma revisão de literatura na área do turismo de experiência. Com isso, foi possível relacionar as duas áreas do conhecimento e verificar as principais premissas presentes no processo de design para experiência do usuário que possam ser aplicados no segmento de eventos. Contribuindo assim, para alicerçar ações futuras a respeito dos aspectos do Design para experiência do usuário no segmento de eventos turísticos.
Aplicabilidade dos métodos ergonômicos sob a perspectiva da gestão do design
Authors: Cruz Tiago André da , Santos Flavio Anthero N. Vianna dos , Reis Alexandre Amorim dos
Published: June 2024

Este artigo apresenta um estudo teórico para determinar graus de aplicabilidade (baixa, média e alta) de métodos ergonômicos nos níveis organizacionais (operacional, tático e estratégico) sob a perspectiva da Gestão de Design. São apresentadas as bases conceituais da Ergonomia e da Gestão do Design, com respectivamente os seus escopos (posto de trabalho, situação de trabalho e contexto organizacional) e níveis organizacionais, bem como uma integração teórica destes dois campos de atuação. Por fim, um quadro é montado com a combinação entre níveis organizacionais ergonômicos a partir de ponderação do grau de adequação entre eles, seguida de uma posterior discussão de resultados com uso de gráficos para mostrar os graus de aplicabilidade de diferentes métodos das ergonomias (física, cognitiva e organizacional) em cada nível organizacional.
Inovação urbana
Authors: Gomes Mayara Carvalho , Colchete Filho Antonio Ferreira
Published: June 2024

A complexidade e diversidade presentes no cotidiano das cidades ressaltam a importância vital dos espaços públicos e do mobiliário urbano na promoção de uma melhor qualidade de vida urbana, impactando diretamente o bem-estar e a interação social dos cidadãos. O objetivo deste artigo é analisar práticas de mobiliário urbano acessível e de fácil execução como potenciais para ações do tipo DIY (Do it yourself ou faça você mesmo), que tem por princípio a simplicidade, a acessibilidade dos materiais, a adaptabilidade, instruções claras de execução e foco na participação comunitária. Metodologicamente são repassados cinco critérios de análise para três mobiliários: Apresentação, Instalação, Execução, Localização e Processos, aplicados em casos de estudo-chave que abrangem diversas formas de incentivo à intervenção de baixo custo e alto impacto, com o intuito de ampliar a compreensão e a valorização dessas práticas. Os resultados revelam que tais práticas promovem a participação cidadã e a cocriação de espaços públicos, fortalecendo a identidade local e disseminando conhecimento e habilidades entre os participantes. Conclui-se que essa abordagem colaborativa e educativa contribui para uma cidade mais inclusiva e adaptada às necessidades da comunidade, reformulando as relações entre cidadãos, autoridades e ambiente construído. A pesquisa ressalta a importância de estratégias criativas na transformação dos espaços urbanos, destacando seu potencial de inovação e colaboração.
O mapeamento do comportamento espacial do usuário no ambiente construído hospitalar
Authors: Rangel Márcia Moreira , Mont’Alvão Cláudia Renata
Published: June 2024

Este trabalho apresenta um recorte de um estudo de caso desenvolvido em um ambiente construído hospitalar, com a técnica de observação com registros do comportamento espacial do usuário, denominada como mapeamento do comportamento espacial (MCE). O MCE sistematiza a observação da tarefa de se deslocar no ambiente construído, buscando verificar a autonomia do deslocamento na interação usuário/ambiente/cor, por meio da observação da ação do usuário perante à informação e à cor-informação, advinda dos diversos estímulos e seus códigos de cores pertinentes ao ambiente. O artigo tem como objetivo apresentar a aplicação e os resultados verificados pelo MCE. Os dados coletados possibilitaram [1] ratificar os pontos de decisão levantados nas observações gerais, [2] verificar a ação da cor-informação nos sistemas de informação (arquitetura, objetos e sinalização) no deslocamento espacial autônomo e [3] repensar o projeto ponto a ponto.
Análise comportamental para validação da ferramenta QualificaURB, com enfoque na categoria “sociabilidade, usos e atividades”
Authors: Jesus Luciana Aparecida Netto de , Ramos Larissa Leticia Andara , Stein Livia , Secco Iasmin Tamanini
Published: June 2024

A valorização dos espaços públicos, bem como a necessidade de que tais locais sejam de qualidade, é uma demanda crescente e está diretamente relacionada ao desenvolvimento urbano. Assim, é importante que esses contenham atributos que propiciem uma melhor vivência e que fomentem a sua apropriação, de modo a atender de maneira satisfatória a população. Para tal, o presente trabalho concentra-se na relação entre espaço público e sociabilidade urbana e visa validar os resultados da avaliação das praças da Região Administrativa 9 – Jardim da Penha, Vitória-ES, a partir da aplicação da ferramenta analítica classificatória de avaliação da qualidade socioambiental de praças urbanas, denominada QualificaURB. A ferramenta é dividida em quatro categorias: Proteção e Segurança; Conforto e Imagem; Acessos e Conexões; e Sociabilidade, Usos e Atividades. Este artigo traz como enfoque a categoria “Sociabilidade, Usos e Atividades”, a qual avalia as características relativas aos equipamentos e usabilidades destes espaços, critérios importantes acerca da qualidade dos espaços e indicadores quanto ao uso dos mesmos.  Os resultados encontrados demonstram que o contexto em que a praça está inserida impacta diretamente no uso, permanência e apropriação por parte dos seus usuários. Também expõe como os indicadores dessa categoria podem influenciar na maneira com que o usuário se relaciona com o espaço.
Analysis and description of mass customization as a system – a review
Authors: Brasil Alexander Lopes de Aquino , Martinez Andressa Carmo Pena , Santos Denise Mônaco dos
Published: June 2024

A customização em massa é um termo cunhado há quase quatro décadas e, apesar da sua maturidade, o conceito ainda é controverso. A falta de homogeneidade da sua definição dificulta o avanço das pesquisas sobre o tema e sua adoção. Nesse sentido, o presente trabalho busca mapear as definições de customização em massa com uma clara divisão dos seus subtemas, a partir da sistematização das contribuições de autores de diferentes campos de conhecimento, dentre os quais Design e Arquitetura, que forneceram uma definição conceitual de customização em massa e seus aspectos internos. Em seguida, com base nas informações coletadas, utiliza-se o recurso gráfico do diagrama como ferramenta para análise e representação do conceito de customização em massa enquanto um sistema composto por diversos subsistemas conectados. O trabalho resulta em uma coleção de definições e um sistema de classificação que pode ser usado para análise e definições de trabalhos existentes e futuros.
Design & relações de uso
Authors: Everling Marli Teresinha , Pereira Ghianny Lopes , Bosco Glória Lopes Dal , Vegini Ani Priscila , Vela João Carlos
Published: June 2024

o artigo apresenta os resultados do grupo de estudos Design & Relações de Uso, destacando três trabalhos que se relacionam com o contexto socioambiental; o artigo também considera ampliações teóricas para apoiar o grupo em estudos com abordagem de sociedade, futuro e crise ecológica. A metodologia inclui consulta a documentos, relatórios e artigos publicados pela equipe; utilizamos, ainda, revisão de literatura e visitas a publicações anteriores entre os anos de 2000 e 2023 para ampliar os fundamentos teóricos. Embora a análise dos casos relatados contribua para ilustrar alguns movimentos orientados para a sociedade, a expansão teórica visa trazer à luz outras possibilidades.
Modelamento não linear neural de um túnel psicrométrico
Authors: Riul José Antonio , Montenegro Paulo Henrique de Miranda
Published: June 2024

O objetivo do presente trabalho é o modelamento não linear neural de um túnel psicrométrico. A identificação é realizada usando um arquivo de dados de entrada (alimentação da turbina) e saída (temperatura do túnel) coletados no túnel. A turbina tem a função de gerar um fluxo variável de ar na temperatura ambiente do interior do duto do túnel e a temperatura é medida na extremidade final do túnel. O modelo neural é obtido utilizando-se uma rede neural em duas fases. Na primeira fase, que é a de treinamento, iterações são realizadas até que a saída da rede se aproxima da saída real do túnel. Com esta aproximação, os pesos da última iteração são gravados e utilizados na segunda fase, que representa o modelo neural, que pode ser usado como por exemplo, na aplicação de controle de temperatura do túnel.