bluuebunny/crossref_metadata_2025 huggingface dataset:
Conceptualising Centres of Clinical Excellence: A Scoping Review
Authors: Kandasamy Thoshenthri , Stockley Rachel C , Hendriks Jeroen M , Fini Natalie Ann , Bulto Lemma N , Lynch Elizabeth A
Published: December 2024

Objectives

Centres of clinical excellence (CoCE) are healthcare facilities that provide excellent healthcare. However, despite their increasing prevalence, it is unclear how CoCE are identified and monitored. This paper explores how CoCE has been described in the literature, including its defining characteristics and selection and monitoring processes.

Design

We conducted a scoping review following Arksey and O’Malley’s framework, enhanced by Levacet al. Additionally, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Data sources

A comprehensive search using MEDLINE Ovid, PubMed, Web of Science, CINAHL and Scopus was conducted to identify relevant literature from January 2010 to June 2022.

Eligibility criteria for selecting studies

We included published studies and grey literature that described how a CoCE was defined, established, monitored or evaluated.

Data extraction and synthesis

Two independent reviewers completed the title and abstract screening, reviewed the full texts and extracted data.

Results

50 records describing 45 initiatives were included. More than half were published in the USA (n=25, 56%). All but one initiative focused on one clinical condition/population, most commonly cardiovascular disease (n=8, 17%), spinal surgeries (n=4, 9%) and pituitary tumours (n=4, 9%). Most initiatives (n=30, 67%) described a structured process to establish CoCE. The definitions of CoCE were not uniform. Common defining features included the volume of patients treated, medical expertise, a highly skilled multidisciplinary team, high-quality care and excellent patient outcomes. Identification as a CoCE varied from self-identification with no explicit criteria to application and assessment by an approval panel.

Conclusion

Despite a growing prevalence of CoCE, there are inconsistencies in how CoCE are established, identified, monitored and evaluated. Common (but not uniform) features of CoCE are highly skilled staff, high-quality care delivery and optimal patient outcomes.
Equity of intensive care unit bed resource allocation in ethnic minority areas of China—an empirical analysis based on geographical and population dimensions
Authors: Zhou Junxu , Peng Rong , Feng Jun , Kang Jing , Deng Meng , Meng Shanshan , Qin Xianjing , Lu Decheng
Published: December 2024

Objective

The purpose of this study is to analyse the changes in the equity of intensive care unit (ICU) bed allocation in 14 cities in China’s Guangxi Zhuang Autonomous Region from 2018 to 2021, to identify the problems in the process of ICU bed allocation in China’s ethnic minority regions.

Design

The Gini coefficient, Theil index, health resource density index, and spatial correlation analysis were used to analyse the current status of ICU bed resource allocation and allocation equity in Guangxi, China, on two dimensions: geography, and population.

Setting

The Guangxi Zhuang Autonomous Region.

Results

The number of ICU beds configured by geographic and population dimensions in Guangxi basically showed a growing trend. The ICU bed allocation by population dimensions was in a state of absolute equity, and the equity of geographic dimension was in a state of basic reasonableness. The contribution rate of intraregional differences is higher than that of inter-regional differences. There is a localised spatial aggregation of ICU bed resource allocation, with a low health resource density index and a higher proportion of lack of ICU beds in cities with a high concentration of ethnic minority populations, such as Hechi, Chongzuo, Baise, Hezhou, and Laibin.

Conclusions

The total amount of ICU bed resources increased, but the regional distribution was not balanced. The equity of ICU beds allocated by population and economy was better than that by geography, the unfairness of ICU bed allocation was mainly caused by intraregional differences, and the lack of the number of ICU beds was greater in the economically underdeveloped ethnic minority areas. Exchanges and cooperation between regions should be strengthened to promote the coordinated development of ICU bed resources between regions.
Improving the accUracy of Referrals to the emerGency departmEnt of patieNts with chesT pain using the modified HEART score in Emergency Medical Transport (URGENT 2.0): protocol for a multicentre randomised controlled trial
Authors: Frenk Lisa D S , Rahel Braim M , de Vos Cees B , van Osch Frits H M , Prestigiacomo Fabiana G , Janssen Marcel J W , Willemsen Robert T A , van 't Hof Arnoud W , Meeder Joan G
Published: December 2024

Introduction

Ischaemic heart disease is the single most common cause of death worldwide. Traditionally, distinguishing patients with cardiac ischaemia from patients with less alarming disease, in prehospital triage of chest pain, is challenging for both general practitioners and ambulance paramedics. Less than 20% of patients with chest pain, transferred to the emergency department (ED), have an acute coronary syndrome (ACS) and the transportation and analysis at the ED of non-ACS patients result in substantial healthcare costs and a great patient burden. Advanced risk stratification, with the help of cardiac troponin measurements, seems crucial to improve prehospital diagnostic accuracy.

Methods and analysis

The URGENT 2.0 trial is a randomised controlled trial in which the primary objective is to reduce the referral of non-cardiac chest pain (NCCP) patients, using a modified HEART score including a high-sensitivity capillary point-of-care high-sensitivity cardiac troponin I measurement. Patients are included by ambulance paramedics and 1:1 randomised for (1) regular care (control group) or (2) modified HEART score analysis (intervention group) and non-referral in case of a low modified HEART score (0–3). In total, 852 patients will be included. Follow-up will be performed at 30 days, 6 months and 12 months. Both referral rates of NCCP patients and the occurrence of major adverse cardiac events are defined as primary outcome measures.

Ethics and dissemination

The medical ethics committee Zuyderland-Zuyd Hogeschool (Netherlands) has approved this trial (reference numbers NL71820.096.19 and METCZ20190139). Written informed consent will be obtained from all participating patients. The results of this trial will be disseminated in one main paper and in additional papers with subgroup analyses.

Trial registration

ClinicalTrials.gov,NCT04904107.
Cross-sectional evaluation of medical reversals among National Institute of Health guideline practices implemented during the COVID-19 pandemic: how often did experts err in a time of crisis?
Authors: Kacew Alec J , Haslam Alyson , Prasad Vinay , Cifu Adam S
Published: December 2024

Objective

The COVID-19 pandemic required the rapid and often widespread implementation of medical practices without robust data. Many of these practices have since been tested in large, randomised trials and were found to be in error. We sought to identify incorrect recommendations, or reversals, among National Institute of Health COVID-19 guidelines and Food and Drug Administration (FDA) approvals and authorisations.

Design

Retrospective cross-sectional study.

Participants

Recommended medical practices and FDA authorisations or approvals for COVID-19 prevention, treatment and/or management.

Main outcome measures

The frequency and characteristics of COVID-19 medical reversals, defined as practices that were implemented and/or recommended during the pandemic, but were later tested in randomised trials that failed to find benefit.

Results

We found 332 COVID-19 recommendations. 85 (25.6%) opposed a medical practice, 23 (6.9%) were to continue a pre-COVID standard of care without deviation and 224 (67.5%) reccommended a new medical practice. We found randomised trials assessing 72 of these practices (32.1%), among which 25 (35%) were found to be in error and deemed medical reversals. Among medical reversals, 21 (84%) were prescription medications and 1 (4%) was convalescent plasma. 17 (68%) were repurposed medications. Two (8%) were procedures or mechanical interventions and one (4%) was a device. 16 (64%) reversals pertained to the hospital setting (4 to intensive care units), 4 (16%) were non-specific (ie, applicable to any setting), 4 (16%) pertained to a non-hospital setting and 1 pertained to healthcare workers.

Conclusion

When faced with a novel pandemic, policymakers rapidly made hundreds of specific medical recommendations. More than two out of three were never robustly tested. Among practices tested in a randomised fashion, one in three was made in error. Pandemic recommendation errors were substantial. Early and coordinated efforts to initiate randomised trials, even during dire situations, may mitigate the perpetuation of ineffective practices.
Understanding the scale and nature of avoidable healthcare-associated harm for prisoners in England: protocol for a retrospective cross-sectional study
Authors: Carson-Stevens Andrew , McFadzean Isobel Joy , Purchase Thomas , Gwyn Sioned , Hellard Stuart , Davies Kate , Ashcroft Darren M. , Avery Anthony , Campbell Stephen , Edwards Adrian , Flynn Sandra , Hewson Thomas , Ibrahim Saied , Jordan Melanie , Keers Richard N. , Millar Tim , Panagioti Maria , Sanders Caroline , Senior Jane , Stevenson Caroline , Thompson Ellie , Walter Florian , de Wet Carl , Wainwright Verity , Shaw Jenny
Published: December 2024

Introduction

Around 1 in 20 patients experience avoidable healthcare-associated harm worldwide. Despite longstanding concerns, there is insufficient information available about the safety of healthcare for prisoners. To address this, this study will investigate the scale and nature of avoidable healthcare-associated harm for prisoners in England.

Methods

We will undertake a large retrospective cross-sectional study involving a case note review of patient healthcare records in 18 prisons in England. Prisons will be purposively sampled for maximum variation of characteristics based on prison category (open, local, training, high security, female), type (publicly and privately run) and prison population size, to sample approximately 15 000 patient records. We will focus on two samples: an enhanced risk sample of prisoners, considered to be at the most risk of healthcare-associated harm, and a random sample of prisoners excluded from the enhanced risk sample, to estimate the incidence of avoidable harm, and express this as ‘per 100 000 patients per year’. Avoidable harms will be characterised by type of incident(s), contributory incident(s), contributory factor(s), outcome(s) and severity of harm, prior to a thematic analysis of the relationships between those variables. Univariable and multivariable analyses will be conducted to identify factors associated with avoidable harm.

Ethics and dissemination

The decision regarding participation by prisons within the study will be voluntary, and their consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review of their records, but if patients respond to publicity about the project and inform us that they do not wish their records to be included, we will adhere to their wishes. We will produce a report for the Department of Health’s Policy Research Programme and several peer-reviewed publications. The study has been granted a favourable opinion by Wales Research Ethics Committee 3 (reference 19/WA/0291), Her Majesty’s Prison and Probation Service (reference 2019–332) and the Confidentiality Advisory Group (CAG) to access the medical records without individual consent under Section 251 of the National Health Service Act 2006 (reference 19/CAG/0214).
‘We are not trained to do clinical work’: security staff providing physical restraint for NGT feeding in English paediatric wards—a qualitative multi-informant study
Authors: Fuller Sarah , Sheridan Emerie , Tan Jacinta , Nicholls Dasha
Published: December 2024

Objective

To gain insights into the experience, and impact, of using security staff to facilitate physical restraints for nasogastric tube feeding.

Design

A cross-sectional design using 39 individual interviews, three online focus groups and three written submissions involving young people with lived experience (PWLE), parents/carers, paediatric staff and security staff involved in nasogastric feeding under restraint in paediatric settings in England. Qualitative semistructured interviews were transcribed and thematically analysed.

Participants

53 individuals participated: seven security staff (all men); nine PWLE who experienced the intervention between the ages of 9 and 17 (all female); 20 parents (15 mothers, 5 fathers) and 20 paediatric staff (5 men, 15 women).

Results

Regarding the involvement of security staff, participants spoke in relation to two primary themes (1) short-term impact and (2) long-term impact. Short-term themes included that the intervention felt inappropriate and traumatic while also recognising its lifesaving nature and the fact that involving security guards preserved positive relationships with nursing staff. Longer-term themes included the development of trauma symptoms, while also acknowledging the skill development and improved professional relationships that could result from delivering the intervention.

Conclusions

This lifesaving clinical intervention can negatively impact security staff as much as the patient, parents/carers and paediatric staff. A prebrief and debrief should be seen as part of the ‘process’. Further research is needed to better understand what else can mitigate negative impacts.
Association between oral microbiome diversity and all-cause mortality: a longitudinal study of NHANES, 2009–2012
Authors: Yu Ju , Lin Bo , Zhang Zhanqiang , Chen Wanna , Lv Weiming , Zheng Liang
Published: December 2024

Objective

The study investigates the association between oral microbiome diversity and all-cause mortality.

Design

Population-based cohort study.

Setting

US National Health and Nutrition Examination Survey (2009–2010 and 2011–2012).

Participants

A total of 8224 participants who had valid data on the oral microbiome diversity and survival through 31 December 2019 were included in this study.

Primary and secondary outcome measures

Oral microbiome diversity was measured using the observed number of amplicon sequence variant (ASV) and grouped into quartiles. Cox proportional hazards regression models were used to estimate the HR and 95% CI for all-cause mortality according to the quartiles of ASV number, adjusted for potential confounders.

Results

Among the 8224 participants (mean (SD) age: 42.0 (15.1) years; 49.9% male; 37.2% white, 23.8% black, 27.2% Hispanic and 11.8% other race/ethnicity), the median follow-up time was 108 months (IQR, 95–120 months) and 429 (5.2%) deaths were identified. Participants with a higher ASV number were more likely to be poor, non-Hispanic black or Hispanic, uninsured and current smokers, more likely to have poor self-rated oral health and periodontitis and less likely to use dental floss. However, compared with the lowest quartile of the ASV number, a suggestive association was observed for the second quartile (HR=0.80, 95% CI: 0.60 to 1.08), a significant reduction in all-cause mortality was observed for the third (HR=0.55, 95% CI: 0.37 to 0.82) and the fourth (HR=0.58, 95% CI: 0.38 to 0.89) quartile. The dose–response association for all-cause mortality risk was curvilinear; the protective association plateaued when the number of ASVs was larger than 120.

Conclusion

Despite being linked to greater socioeconomic disadvantages and poorer oral health, higher oral microbiome diversity was significantly associated with a substantial reduction in all-cause mortality.
Factors influencing access, quality and utilisation of primary healthcare for patients living with hypertension in West Africa: a scoping review
Authors: Amarteyfio Kezia Naa Amerley Akosua , Bondzie Eugene Paa Kofi , Reichenberger Veronika , Afun Nana Efua Enyimayew , Cofie Albert Kofi Mensah , Agyekum Mary Pomaa , Lamptey Paul , Ansah Evelyn K , Agyepong Irene Akua , Mirzoev Tolib , Perel Pablo
Published: December 2024

Objectives

Hypertension is one of the most prevalent non-communicable diseases in West Africa, which responds to effective primary care. This scoping review explored factors influencing primary care access, utilisation and quality for patients with hypertension in West Africa.

Design

Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews.

Data sources

Published literature from PubMed, Embase, Scopus, Cairn Info and Google Scholar, between 1 January 2000 and 31 December 2023.

Eligibility criteria

Systematic reviews, observational studies and reports involving participants aged 18 years and above, written in English, French or Portuguese, were included. Clinical case series/case reports, short communications, books, grey literature, randomised control trials, clinical trials, quasi-experiments, conference proceedings and papers on gestational hypertension and pre-eclampsia were excluded.

Data extraction and synthesis

Data from included studies were extracted onto an Excel spreadsheet and synthesised qualitatively using thematic analysis structured by the components of the overall review question.

Results

The search yielded a total of 5846 studies, 45 papers were selected for full review and 16 papers were eventually included. Macro (contextual) barriers included economic, funding and geographical barriers. Meso (health system) factors include access to medications, tools, equipment and other supplies, out-of-pocket payments, availability of health insurance, health workers numbers, capacity and distribution. Micro (community and patient factors) barriers included financial barriers and limited knowledge, whereas facilitators included the availability of alternative providers and community and household support. These factors are interconnected and complex and should be addressed as a whole to reduce the burden of hypertension in West Africa.

Conclusion

Multiple complex and interrelated factors at contextual, health systems, community and patient levels act as barriers and enablers to access, utilisation and quality of primary care for hypertension in West Africa. Improving primary care and outcomes will, therefore, require multilevel multifaceted interventions.
Efficacy of susceptibility-guided quadruple therapy with antibiotic resistance using the string test coupled with quantitative PCR forHelicobacter pylorieradication: a protocol of a multicentre, open, randomised clinical trial
Authors: Cui Yi , Zhang Shenke , Hu Shuqin , Fei Sujuan , Yang Geliang
Published: December 2024

Introduction

Helicobacter pyloriis a major health problem, with the high prevalence ofH. pyloriand the increasing antibiotic resistance rate in China. Antibiotic resistance is the main reason for the failure ofH. pylorieradication. This study aims to evaluate the efficacy and safety of susceptibility-guided quadruple therapy with antibiotic resistance using the string test coupled with quantitative PCR (qPCR) forH. pylorieradication.

Methods and analysis

This is a multicentre, open, randomised clinical trial that will enroll 324 patients withH. pyloriinfection. Patients will be randomised to two groups for a 14-day treatment: Treatment group will be treated with proton pump inhibitor (PPI), bismuth with two different kinds of antibiotics susceptibly guided by string test coupled with qPCR, while control group will be treated empirically with PPI, bismuth with two different kinds of antibiotics. The types and dosages of bismuth, PPI and antibiotics administered in this trial are based on the 2022 Chinese Guidelines for the treatment ofH. pyloriinfection and the Sixth Chinese National Consensus Report on the management ofH. pyloriinfection. The primary endpoint is the eradication rate, while secondary endpoints include compliance, the incidence of adverse events and adverse drug reactions.

Ethics and dissemination

This study was approved by the ethics committee of the Third People’s Hospital of Zhengzhou (No. 2024-04-001-K02). The results will be published in the appropriate peer-reviewed journal.

Trial registration number

ChiCTR2400082768.
Predictive accuracy of lactate albumin ratio for mortality in intensive care units: a nationwide cohort study
Authors: Suzuki Yasuhito , Aoki Yoshitaka , Shimizu Mikihiro , Nakajima Mikio , Imai Ryo , Okada Yohei , Mimuro Soichiro , Nakajima Yoshiki
Published: December 2024

Background

The lactate albumin ratio (LAR), a simple prognostic marker used in intensive care units (ICUs), combines lactate and serum albumin levels to predict patient outcomes. Despite its potential, the predictive accuracy of the LAR remains insufficiently explored. This study aimed to assess the usefulness of the LAR in predicting mortality among patients in the ICU.

Methods

This retrospective study conducted a secondary analysis of prospectively obtained clinical data from the Japanese Intensive Care Patient Database. We included all patients admitted to ICUs between 2015 and 2021, excluding those under the age of 16 years. The main outcome was in-hospital mortality. The LAR predictive value for this outcome was assessed by examining the area under the receiver operating characteristic curve and comparing it against prognostic indicators such as age, lactate, albumin and Sequential Organ Failure Assessment score. LAR shape was assessed using unrestricted spline curves, and the optimal cut-off value was identified from sensitivity and negative likelihood ratio. Subgroup analysis was used to evaluate the predictive accuracy of the LAR across different patient attributes and clinical scenarios.

Results

Of 2 34 774 cases analysed, in-hospital mortality was 8.8% (20 723 deaths). The LAR had an area under the curve of 0.761 (95%CI 0.757 to 0.765), indicating a fair predictive performance for in-hospital mortality. Unrestricted spline curves demonstrated that LAR can predict mortality through a monotonic positive dose–response relationship with 0.4 as the optimal cut-off value. In subgroup analysis, areas under the curve were significantly higher in subgroups defined by younger age, female sex, unplanned ICU admission, non-surgical patients, non-infectious patients, non-heart failure patients and lack of end-stage renal disease.

Conclusions

The LAR might be a useful predictor for screening mortality in ICU patients. However, further research to establish appropriate cut-off values for the LAR and identify the optimal target population is warranted.
Exploring perceptions of diabetes distress and its care in Japan: a qualitative study of patients and physicians
Authors: Akano Kyoko , Sugihara Taro
Published: December 2024

Objectives

This study aimed to identify the obstacles preventing care of diabetes distress from being integrated into diabetes management, as perceived by both patients and healthcare professionals. By conducting interviews with people with type 2 diabetes (PWD) and physicians, this study aimed to gain insight into the current state of care for diabetes distress in diabetes management and propose targeted interventions to improve patients’ overall well-being and treatment outcomes.

Design

This qualitative study used semistructured interviews with patients and physicians. The interviews followed a guide with open-ended questions to gather detailed, reflective responses about participant experiences, perceptions and attitudes towards the research topic.

Setting

This study targeted stakeholders in type 2 diabetes care in Japan.

Participants

Nine PWD and nine physicians participated in the interviews. The patients had been receiving treatment for more than 5 years, and the physicians had at least 1 year of clinical experience in diabetes treatment and had treated a minimum of five PWD per month. The physicians were recruited through snowball sampling.

Results

This study uncovered four primary themes. Patients and physicians had differing perceptions of diabetes distress, with patients experiencing psychological challenges, such as anxiety over self-management and fluctuating blood glucose levels, while physicians focused on poor adherence and financial constraints. PWD often felt responsible for managing their condition, leading to self-blame and reluctance to seek emotional support from healthcare providers (HCPs). Physicians faced constraints in providing psychosocial support owing to limited resources and insufficient training. HCPs support affected patient motivation and clinic visits, with positive reinforcement and understanding fostering self-management, whereas one-sided guidance had negative effects. Patients frequently used self-tracking data to enhance their self-management and effectively communicate with HCPs. These data provided valuable insights for treatment planning and helped bridge gaps in the monthly laboratory results.

Conclusion

This study highlights significant discrepancies between patients’ and physicians’ perceptions of diabetes distress. Effective communication and trust building are essential for addressing the psychological needs of patients. The integration of self-tracking data can enhance patient–HCP interactions and support better diabetes management. Addressing these gaps can improve care of diabetes distress in clinical practice, leading to better quality of life and treatment outcomes for PWD.
Respiratory rehabilitation techniques for patients with cystic fibrosis: a protocol for a systematic review and network meta-analysis
Authors: Lin Na , Wang Xinyu , Tang Yilong , Chen Xuefeng
Published: December 2024

Introduction

Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, primarily affecting the respiratory and digestive systems. Respiratory rehabilitation techniques play a crucial role in managing pulmonary symptoms and maintaining lung function in CF patients. Although various techniques have been developed and applied, there is currently no globally recognised optimal respiratory rehabilitation regimen. This study intends to conduct a network meta-analysis to comprehensively evaluate and compare the effectiveness of different respiratory rehabilitation techniques in CF patients.

Methods and analysis

The following key electronic bibliographic databases will be searched from inception to September 2024: Medline, Embase, Cochrane Library, Web of Science, CINAHL and Physiotherapy Evidence Database. We will include randomised controlled trials (RCTs) and quasi-RCTs that compare the efficacy of various respiratory rehabilitation techniques in CF patients, such as airway clearance techniques, exercise training and inspiratory muscle training. The primary outcomes will be lung function (forced expiratory volume in 1 s and forced vital capacity) and exercise capacity (VO2 max and 6 min walk test). Secondary outcomes will include quality of life, frequency of pulmonary exacerbations, hospitalisation rates and adverse events. If permitted, data will be synthesised using traditional pairwise meta-analysis and network meta-analysis, with the quality of evidence assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Ethics and dissemination

Ethical approval will not be required for this protocol. The results of the final review will be disseminated via peer-reviewed journals and conference presentations.

PROSPERO registration number

CRD42024574551.
Follow-up of immediate postpartum intrauterine device insertion: a scoping review protocol
Authors: Herculano Thuany Bento , Amaral-Moreira Carolina de Freitas Alves , Bennini Júnior João Renato , Surita Fernanda G
Published: December 2024

Introduction

The intrauterine device (IUD) inserted immediately after delivery is a safe and effective measure for preventing unplanned pregnancies. Despite exhibiting a higher expulsion rate compared with later insertions, it proves cost-effective due to the high rate of continuity of the method. There is still a gap in the literature regarding the optimal strategy for monitoring these patients, whether it should be through clinical examination, ultrasound or both. The aim of this review is to map the available evidence regarding the proper clinical and ultrasound follow-up procedures of IUDs inserted immediately post partum.

Methods and analysis

Using the well-established scoping review methodology outlined by the Joanna Briggs Institute, a five-stage review is outlined: (1) determining the research question, (2) search strategy, (3) inclusion criteria, (4) data extraction and (5) analysis and presentation of the results. The search strategy will be applied to nine databases reflecting empirical and grey literature. A two-step screening process will be used to determine eligibility of articles. To be included in the review, articles must describe how postpartum women (adolescents or adults) who had an IUD inserted immediately after birth (vaginal or caesarean) were followed up. All articles will be independently assessed for eligibility, and data from eligible articles will be extracted and charted using a standardised form. Extracted data will be analysed using narrative and descriptive analyses.

Ethics and dissemination

Ethics approval is not required. The results will be disseminated to the health science community through professional networks, conference presentations and publication in a scientific journal.
Diagnosing and managing patients with heart failure with preserved ejection fraction: a consensus survey
Authors: Austin Rosalynn , Khair Eva , Blakeman Thomas , Hossain Muhammad Zakir , Sowden Emma , Chew-Graham Carolyn , Forsyth Faye , Deaton Christi
Published: December 2024

Aim

As heart failure (HF) with preserved ejection fraction (HFpEF) prevalence increases, it remains frequently underdiagnosed and poorly managed. Recent positive pharmacological trials have increased interest in HFpEF but challenges of diagnosis and management remain. The survey aim was to examine consensus between primary and secondary care providers regarding HFpEF diagnosis and management.

Methods

As part of a larger programme of work, survey questions were developed in an online format and piloted with healthcare providers (HCPs). The survey link was distributed via professional networks and social media. Analysis included frequencies of responses, comparison by main professional groups and thematic analysis free-text responses. A virtual workshop of HCPs was conducted to discuss and refine survey findings.

Results

HCPs (n=66) across the UK participated: 19 general practitioners (GPs), 20 HF specialist nurses (HFSN), 17 cardiologists and 10 others. Consensus was high (92%) that diagnosing the type of HF was very important and most favoured inclusion of HFpEF in Quality Outcome Framework indicators. No clear consensus was reached that ongoing management should be in primary care (47.5% of GPs, 35% of HFSN and 31.3% of cardiologists ‘somewhat agreed’). Opinions differed between GPs (52.3)% and specialists (HFSN 80% and cardiologists 81.3%) for practice nurses to be upskilled and assume HFpEF management. No HCPs reported any level of disagreement for HFSN management of HFpEF. Free-text comments highlighted resource barriers to HFpEF diagnosis and management and confirmed the need to develop better HFpEF services.

Conclusions

Consensus was reached regarding importance of diagnosing HFpEF, but agreement on methods and responsibilities for diagnosis and management varied. Free-text comments identified HCPs concerns related to overwhelmed primary and secondary care services and lack of sufficient resources to meet existing patient demands. Creation of collaborative care pathways is needed to support the increasing number of older patients with HFpEF.

Trial registration number

ClinicalTrials. gov (reference number:NCT03617848).
Retrospective observational cohort study of premature neonates screened for ROP with 7 years of follow-up assessing the visual outcomes and adequacy of preschool visual screening
Authors: Simpson Alasdair Innes , McAllister Emma , Hamilton Ruth , Wright Jacqueline , Millar Eoghan
Published: December 2024

Background

Very premature infants screened for retinopathy of prematurity (ROP) that do not develop ROP still experience serious visual developmental challenges, and while it is recommended that all children in the UK are offered preschool visual screening, we aimed to explore whether this vulnerable group requires dedicated follow-up.

Methods

We performed a real-world retrospective observational cohort study of children previously screened for ROP in NHS Greater Glasgow and Clyde (Scotland) between 2013 and 2015. We excluded those with any severity of ROP identified during screening. Electronic patient records were searched for preschool orthoptic visual screening (See4School) results and results of referral to the hospital eye service (HES).

Results

222 children met the inclusion criteria. Their median birth weight was 1200 g and median gestational age was 31 weeks. A total of 111 (50%) of these children had been referred to HES nationally. 103 were referred within the health board where ROP screening took place; of these, 47% (48/103) were referred from the See4School programme, 31% (31/103) from paediatric clinics, 13% (13/103) from primary care and 11% (11/103) from community optometrists. 42 of these 103 referrals (41%) to HES had occurred before the age (3½ years) when children became eligible for See4School screening. At hospital review, 55% (55/99) patients had a glasses prescription issued for refractive error, 22% were estimated to have amblyopia and 30% had a diagnosis of strabismus.

Conclusion

In this non-controlled study we found premature infants that do not develop ROP still face considerable visual morbidity and dedicated follow-up may be warranted.
Bacteraemia after transcatheter aortic valve implantation: a nationwide cohort study
Authors: Hadji-Turdeghal Katra , Petersen Jeppe K , Graversen Peter Laursen , Butt Jawad Haider , Strange Jarl Emanuel , Ihlemann Nikolaj , Dahl Jordi Sanchez , Povlsen Jonas Agerlund , Voldstedlund Marianne , Terkelsen Christian Juhl , Møller Christian H , Freeman Philip , Nissen Henrik , De Backer Ole , Koeber Lars , Østergaard Lauge , Fosbøl Emil Loldrup
Published: December 2024

Background

Bacteraemia and infective endocarditis (IE) are rare but severe complications of transcatheter aortic valve implantation (TAVI). Limited data exist on the incidence and microbiological profile of early bacteraemia in this population. This study aimed to evaluate the 6-month incidence of bacteraemia, IE and associated mortality following TAVI.

Methods

Using Danish nationwide registries, all patients who underwent TAVI from 2012 to 2021 were identified and matched 1:1 by age, sex and index year with patients who underwent elective coronary angiography (CAG). Outcomes were assessed with cumulative incidence functions and adjusted HRs.

Results

Among 5990 patients with first-time TAVI (57% male, mean age 80 years, SD 6.9), bacteraemia occurred in 4.2% within 6 months, compared with 2.6% in the CAG group (adjusted HR 1.57, 95% CI 1.26 to 1.96). Common pathogens post-TAVI included Streptococci (20%), Coagulase-negative staphylococci (19%) and Enterococci (18%), differing from the CAG group, where Coagulase-negative staphylococci (22%) andStaphylococcus aureus(16%) predominated. IE developed in 1.1% of patients with TAVI versus 0.1% of patients with CAG (adjusted HR 20.01, 95% CI 5.97 to 67.48).

Conclusion

Bacteraemia and IE rates are substantially elevated within 6 months following TAVI compared with elective CAG. The bacterial profile post-TAVI suggests that current prophylactic antibiotic regimens may not provide adequate coverage.
Equitable and effective clinical guidance development and dissemination: trauma aims to lead the way
Authors: LaGrone Lacey N , Stein Deborah M , Wilson Danielle J , Bulger Eileen M , Farley Ashley , Rubiano Andrés M , Michaels Maria , Lane-Fall Meghan B , Person Michael A , Ho Vanessa P , Reinhart Linda , Haut Elliott R
Published: December 2024

Thirty-four per cent of deaths among Americans aged 1–46 are due to injury, and many of these deaths could be prevented if all hospitals performed as well as the highest-performing hospitals. The Institute of Medicine and the National Academies of Science, Engineering and Medicine have called for learning health systems, with emphasis on clinical practice guidelines (CPGs) as a means of limiting preventable deaths. Reduction in mortality has been demonstrated when evidence-based trauma CPGs are adhered to; however, guidelines are variably updated, redundant, absent, inaccessible, or perceived as irrelevant. Ultimately, these barriers result in poor guideline implementation and preventable patient deaths. This multidisciplinary group of injury providers, clinical guidance developers and end users, public health and health policy experts and implementation scientists propose key areas for consideration in the definition of an ideal future state for clinical guidance development and dissemination. Suggestions include (1): professional societies collaborate rather than compete for guideline development.(2) Design primary clinical research for implementation, and where relevant, with guideline development in mind.(3) Select clinical topics for guideline development through systematic prioritization, with an emphasis on patient-centered outcomes.(4) Develop guideline authorship groups with a focus on transparency, equity of opportunity and diversity of representation.(5) Establish a plan for regular review and updating and provide the date the guideline was last updated for transparency.(6) Integrate options for adapting the guideline to local resources and needs at the time of development.(7) Make guidelines available on a platform that allows for open feedback and utilization tracking.(8) Improve discoverability of guidelines.(9) Optimize user-experience with a focus on inclusion of bedside-ready, mobile-friendly infographics, tables or algorithms when feasible.(10) Use open access and open licenses.(11) Disseminate clinical guidance via comprehensive and equitable communication channels. Guidelines are key to improve patient outcomes. The proposed focus to ensure trauma guidelines are equitably and effectively developed and disseminated globally.
Local Edge Dynamics and Opinion Polarization
Authors: Bhalla Nikita , Lechowicz Adam , Musco Cameron
Published: December 2024

The proliferation of social media platforms, recommender systems, and their joint societal impacts have prompted significant interest in opinion formation and evolution within social networks. We study how
local edge dynamics
can drive opinion polarization. In particular, we introduce a variant of the classic Friedkin-Johnsen opinion dynamics, augmented with a simple time-evolving network model. Edges are iteratively added or deleted according to simple rules, modeling decisions based on individual preferences and network recommendations.

Via simulations on synthetic and real-world graphs, we find that the combined presence of two dynamics gives rise to high polarization: 1)
confirmation bias
– i.e., the preference for nodes to connect to other nodes with similar expressed opinions and 2)
friend-of-friend link recommendations
, which encourage new connections between closely connected nodes. We show that our model is tractable to theoretical analysis, which helps explain how these local dynamics erode connectivity across opinion groups, affecting polarization and a related measure of disagreement across edges. Finally, we validate our model against real-world data, showing that our edge dynamics drive the structure of arbitrary graphs, including random graphs, to more closely resemble real social networks. Our code and supplemental materials are available at

https://github.com/adamlechowicz/opinion-polarization/
.

1
Patient-centric Summarization of Radiology Findings using Two-step Training of Large Language Models
Authors: Tariq Amara , Trivedi Shubham , Urooj Aisha , Ramasamy Gokul , Fathizadeh Sam , Stib Matthew , Tan Nelly , Patel Bhavik , Banerjee Imon
Published: December 2024

Education level or socio-economic background of patients may dictate their ability to understand medical jargon. Inability to understand primary findings from a radiology report may lead to unnecessary anxiety among patients or missed follow up. We aim to meet this challenge by developing a patient-sensitive summarization model for radiology reports. We selected computed tomography (CT) exams of chest as a use-case and collected 7000 studies from Mayo Clinic. Summarization model was built on top of the T5 large language model (LLM) as our experiments indicated that its text-to-text transfer architecture was suited for abstractive text summarization, resulting in a model with 0.77B trainable parameters. Noisy groundtruth for model training was collected by prompting LLaMA-13B model. We recruited experts (board-certified radiologists) and laymen to manually evaluate model-generated summaries generated by model. Our model rarely missed information as marked by majority opinion of radiologists. Laymen indicated 63% improvement in their understanding by reading model-generated layman summaries. Comparison with zero-shot performance of ChatGPT indicated that the proposed model reduced the rate of hallucination by half and rate of missing important information by fivefold. The proposed model can generate reliable summaries for radiology reports understandable by patients with vastly different levels of medical knowledge.
MiniScope
: Automated UI Exploration and Privacy Inconsistency Detection of MiniApps via Two-phase Iterative Hybrid Analysis
Authors: Wang Shenao , Li Yuekang , Wang Kailong , Liu Yi , Li Hui , Liu Yang , Wang Haoyu
Published: December 2024

The advent of MiniApps, operating within larger SuperApps, has revolutionized user experiences by offering a wide range of services without the need for individual app downloads. However, this convenience has raised significant privacy concerns, as these MiniApps often require access to sensitive data, potentially leading to privacy violations. Despite existing privacy regulations and platform guidelines, there is a lack of effective mechanisms to safeguard user privacy fully. To address this critical gap, we introduce
MiniScope
, a novel two-phase hybrid analysis approach, specifically designed for the MiniApp environment. This approach overcomes the limitations of existing static analysis techniques by incorporating UI transition states analysis, cross-package callback control flow resolution, and automated iterative UI exploration. This allows for a comprehensive understanding of MiniApps’ privacy practices, addressing the unique challenges of sub-package loading and event-driven callbacks. Our empirical evaluation of over 120K MiniApps using
MiniScope
demonstrates its effectiveness in identifying privacy inconsistencies. The results reveal significant issues, with 5.7% of MiniApps over-collecting private data and 33.4% overclaiming data collection. We have responsibly disclosed our findings to 2,282 developers, receiving 44 acknowledgments. These findings emphasize the urgent need for more precise privacy monitoring systems and highlight the responsibility of SuperApp operators to enforce stricter privacy measures.
Photoacoustic imaging of metabolic activities across biological length scales
Authors: Mankovskii Gabriella , Hysi Eno
Published: December 2024

Imaging is ubiquitous with biomedical research and discovery. This article surveys the role of imaging in our understanding of metabolism, and introduces photoacoustic imaging as a compelling candidate for providing high-resolution, label-free, and real-time insights into metabolic processes. As a rapidly evolving modality, photoacoustics holds promising preclinical and clinical potential in imaging of metabolism as well as metabolism-related changes.
Assessing the Risk of Antimicrobial Resistance Through Bacterial Contamination in Caregiving Environments at Jimma University Specialized Hospital
Authors: Jemal Temima , Eshetu Tizita Teshome , Olani Dessalegn Dadi , Deti Mulunesh , Mekonnen Zeleke , Tucho Gudina Terefe
Published: December 2024

Background: Patient caregivers are highly likely to be contaminated with antimicrobial‐resistant microorganisms in the hospital wards. Many of these microorganisms can cause food‐borne infections, affecting admitted patients. Food quality, safety, and contributing factors in Ethiopian health institutions where food is served to in‐patients are poorly understood. Nevertheless, contamination and antimicrobial resistance (AMR) levels could vary from place to place. Infections by these antimicrobial‐resistant pathogens cause prolonged hospital stays, high rates of mortality, and affect individual and country economies in greater amounts.

Objective: Identification and antimicrobial susceptibility testing of bacteria isolated from family caregivers and food serving utensils in Jimma University specialized hospital.

Methods: This study used a cross‐sectional study design to determine the bacteriological contamination of family caregivers (caregivers) and food serving utensils (utensils) and their antimicrobial susceptibility from February to April 2020 at in‐patient pediatric wards of Jimma University Medical Center (JUMC). The study took swab samples from 60 of the caregivers’ hands and utensils who fulfilled the inclusion criteria. The laboratory study was supported by survey data taken through questionnaires and managed using EPi data software version 3.1 and SPSS version 21. The data was analyzed using descriptive analysis and presented according to frequency distribution.

Results: The findings show that 33.3% and 23.3% of caregivers were contaminated with Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli), respectively. Similarly, the study identified E. coli (30%), Klebsiella pneumonia (K. pneumoniae; 26.6%), and Pseudomonas aeruginosa (P. aeruginosa; 23.3%) from the utensils. Antibacterial sensitivity test results showed that over 75% of the identified E.coli from caregivers’ and utensils were resistant to ampicillin, ceftriaxone, cefixime, co‐trimoxazole, and cefotaxime. Similarly, over 65% of the identified S. aureus from the caregivers and utensils were resistant to erythromycin, chloramphenicol, tetracycline, and penicillin. All Salmonella group A identified from utensils were also resistant to Augmentin and cefotaxime.

Conclusion: As shown in the result, many isolated bacteria were resistant to the standard antibiotics commonly used to treat most diseases. Hence, admitted patients, particularly children, are at risk of infection with these antimicrobial‐resistant bacteria. Due attention must be given to hygienic practices of the hospital environment and individuals to reduce the risks of contamination and transmission.