bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of risk-of-bias assessment approaches for selection of studies reporting prevalence for economic analyses
Authors: Glasgow Matthew J , Edlin Richard , Harding Jane E 
Published: September 2020

ObjectivesWithin cost-effectiveness models, prevalence figures can inform transition probabilities. The methodological quality of studies can inform the choice of prevalence figures but no single obvious candidate tool exists for assessing quality of the observational epidemiological studies for selecting prevalence estimates. We aimed to compare different tools to assess the risk of bias of studies reporting prevalence, and develop and compare possible numerical scoring systems using these tools to set a threshold for inclusion of reports of prevalence in an economic analysis of neonatal hypoglycaemia.DesignAssessments of bias using two tools (Joanna Briggs Institute (JBI) Checklist for Prevalence Studies and a modified version of Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I)) were compared for 18 studies relevant to a single setting (neonatal hypoglycaemia). Inclusions of studies for use in a decision analysis model were considered based on summary scores derived from these tools.ResultsBoth tools were considered easy to use and produced dispersed scores for each of the 40 study–outcome combinations. The modified ROBINS-I scores were more skewed than the JBI scores, particularly at higher thresholds. The studies selected for inclusion are generally the same using either tool; if 50% was used as the cut-off threshold using the Applicable Score both tools would yield the same results. However, the JBI tool is shorter and may be easier to interpret and apply to studies that do not involve a control group, while the modified ROBINS-I tool assesses more methodological detail in studies that include a control group.ConclusionBoth tools performed well for systematically assessing studies that report on outcome prevalence and provided similar discrimination between studies for risk of bias. This convergent validity supports use of both tools for the purpose of assessing risk of bias and selecting studies that report prevalence for inclusion in economic analyses.
Exercise barriers and facilitators during hematopoietic stem cell transplantation: a qualitative study
Authors: Yu Mi-Seong , An Ki-Yong , Byeon Jiyong , CHOI Meeok , Cheong June-Won , Courneya Kerry , Jeon Justin Y 
Published: September 2020

ObjectiveAlthough exercise is beneficial in patients undergoing hematopoietic stem cell transplantation (HSCT), motivating patients to exercise is challenging. We aimed to understand exercise barriers and facilitators during HSCT treatment while participating in a daily unsupervised exercise programme.ParticipantsPatients scheduled to have HSCT.Study design6 participants were included in this descriptive qualitative study during HSCT treatment while participating in an exercise programme to identify perceived barriers and facilitators of the exercise. An average of three semi-structured interviews were conducted per patient.SettingExercise during HSCT treatment in an isolated immune room.InterventionDaily unsupervised exercise.ResultsA total of six patients completed a 6-week exercise programme as well as all scheduled interviews, whose compliance to the exercise programme ranged from 12% to 79%. Based on interview results, three themes were identified as barriers to exercise and four themes were identified as facilitators to exercise. Patients experienced physical and psychological barriers such as nausea, vomiting, sore throat, reduced appetite, decreased willpower and anxiety due to feelings of isolation. Environmental factors included negative opinions about exercise programmes and lack of encouragement from the haematologist. Facilitators of exercise included willpower, easy and simple exercise, convincing explanations from haematologists and supervised support from exercise specialists.ConclusionOur study has identified potential barriers and facilitators associated with exercise participation during HSCT. Supervised exercise recommended by a haematologist, convincing explanation on the benefit of exercise by medical personnel, positive feedback from other HSCT survivors and supervision by exercise specialists may increase compliance to the exercise programme during HSCT.Trial registration numberISRCTN61498391.
Epidemiology and management of atopic dermatitis in England: an observational cohort study protocol
Authors: de Lusignan Simon , Alexander Helen , Broderick Conor , Dennis John , McGovern Andrew , Feeney Claire , Flohr Carsten 
Published: September 2020

IntroductionAtopic dermatitis (AD) is one of the most common inflammatory skin conditions in both children and adults. Despite this, contemporary descriptions of the incidence, prevalence and current management of the condition in the UK are lacking.Methods and analysisWe will perform a series of retrospective studies using a large population-based cohort derived from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database to explore two key research themes: AD epidemiology and AD management.In the epidemiology theme, we will describe the incidence and prevalence of AD in children and adults in England from 2009 to 2018 inclusive. We will stratify findings by age, national Index of Multiple Deprivation (IMD), ethnicity, urban-rural environment and geographic location; and explore independent associations of these features with AD in multivariable models.In the management theme, we will explore healthcare utilisation and treatment in people with AD. Regarding healthcare utilisation, we will evaluate rates of AD-associated primary care visits and specialist dermatology referrals in people with AD. Rates will be stratified by age, gender, socioeconomic IMD quintile and ethnicity. We will describe contemporary treatment by estimating prescribing rates across medication classes used in AD (emollients, topical corticosteroids by potency, topical calcineurin inhibitors, topical antimicrobials, antihistamines, oral corticosteroids and systemic immunomodulatory therapies) overall, and by age and sociodemographic groupings. We will also examine trends in prescribing over the study period. In people first diagnosed with AD during the study period, we will describe differences in treatment escalation by sociodemographic factors using time-to-event analysis.Ethics and disseminationThe Health Research Authority decision tool classed this a study of ‘usual practice’, ethics approval was not required. Study approval was granted by the RCGP RSC Study Approval Committee. Results will be disseminated through peer-reviewed publications.Trial registration numberNCT03823794.
Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences
Authors: Dooley Jemima , Booker Matthew , Barnes Rebecca , Xanthopoulou Penny 
Published: September 2020

ObjectivesPeople with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals.DesignScoping review. The search strategy and data synthesis were informed by people with dementia and carers.Data sourcesSearches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019.Eligibility criteriaEmpirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion.Data extraction and synthesisData were extracted using charting techniques and findings were synthesised according to content and themes.ResultsOf 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress.ConclusionsThe scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.
Could the arm blood pressure measured with simultaneous bilateral arm method be used for hypertension diagnosis?
Authors: Wan Taixuan , Wu Yuanhao , He Ziqiang , Su Hai 
Published: September 2020

ObjectiveSimultaneous bilateral arm blood pressure (BP) measurement (bilateral arm method) is suggested for the first BP measurement in clinical practice, but whether the arm BP measured with bilateral arm method (RA-2) is similar to that with unilateral arm method (RA-1) is unclear.DesignQuantitative research, paired sample T-test, Bland-Altman and multivariate linear regression analyses were used.SettingThis study included 295 subjects (18–90 years, 60.0±14.6 years old, 126 males) in the clinic of cardiovascular medicine of the Second Affiliated Hospital of Nanchang University. They were randomly instructed to one of two BP measurement proposals: (1) right-arm–bilateral arm–right-arm–bilateral arm, or (2) bilateral arm–right-arm–bilateral arm–right-arm to attenuate bias induced by BP measurement order.ParticipantsFrom June to October of 2019, 295 outpatients (18–90 years, 60.0±14.6 years old, 126 males and 169 females) with sinus rhythm (SR) were enrolled. The exclusion criteria were acute myocardial infarction, congenital heart disease, acute heart failure, syncope, hemiplegia, arrhythmia and pulseless (by palpation).Outcome measuresWe compared the BP differences between bilateral arm method and unilateral arm method. The difference between RA-2 and RA-1 was calculated as Dif-RA. Data are expressed as means±SD for continuous variables. The percentage increase (PI) was calculated on the formula: (RA-2−RA-1)/RA-1.ResultsThe RA-2 on systolic blood pressure (SBP)/diastolic blood pressure (DBP) was slightly, but statistically higher by 1.2/0.4 mm Hg against the RA-1. Multivariate regression analyses showed that hypertension therapy type was positive impact factor, but RA-1 was negative factor for PI of Dif-RA on SBP, DBP and pulse pressure.ConclusionThe SBP and DBP of right arm measured with bilateral arm method are slightly, but statistically higher (1.2 and 0.4 mm Hg) than those with the unilateral arm BP method.
Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol
Authors: Alves Maíra Ramos , Bergamaschi Cristiane de Cássia , Sorrilha Flávia Blaseck , Fulone Izabela , Barberato-Filho Silvio , Mayer Rejane Coan Ferretti , Melo Daniela Oliveira de , Lopes Luciane 
Published: September 2020

IntroductionThe number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents.Methods and analysisCPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations.Ethics and disseminationEthical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations.Protocol registration numberCRD42020164899.
Support for mobilising medical students to join the COVID-19 pandemic emergency healthcare workforce: a cross-sectional questionnaire survey
Authors: Astorp Mike Sæderup , Sørensen Gustav Valentin Blichfeldt , Rasmussen Sten , Emmersen Jeppe , Erbs Alexander Wolfhagen , Andersen Stig 
Published: September 2020

ObjectiveTo identify what motivates medical students to join a pandemic emergency healthcare workforce.DesignCross-sectional study.SettingAalborg University, Denmark.ParticipantsAll medical students.Main outcome measuresMotivational points as perceived by the students to be important. Demographic characteristics and 11 motivational domains scored on a Visual Analog Scale from 0 (low) to 100 (high) responding to the question: ‘To what degree are the following statements important for you to join a national emergency preparedness workforce?’ The questionnaire was developed by an expert panel in a process of four iterations.ResultsA total of 486 students of 688 (70.6%) completed the survey within 7 days in March 2020. 80% had decided to join the pandemic emergency healthcare workforce. Ranked median scores for motivational statements in each domain were: care, 100; learn, 90; pride, 83; team, 77; needed, 75; safety, 75; supervision, 75; job, 73; duty, 66; salary, 62; historic, 50. Supervision (p<0.001), salary (p<0.001) and duty (p=0.001) were given increasing priority with advancing study years. Interestingly, students added that support by the university and clarification of study plans were priorities.ConclusionsResults guide decision-makers and colleagues on how to motivate or reinforce medical students in joining the pandemic emergency healthcare workforce. Importantly, students emphasised protection for themselves.
Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers
Authors: Asgary Ramin , Lawrence Katharine 
Published: September 2020

IntroductionData regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.MethodsWe conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.Results61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks.ConclusionsEthical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.
Identifying common baseline clinical features of COVID-19: a scoping review
Authors: Ferreira-Santos Daniela , Maranhão Priscila , Monteiro-Soares Matilde 
Published: September 2020

ObjectivesOur research question was: what are the most frequent baseline clinical characteristics in adult patients with COVID-19? Our major aim was to identify common baseline clinical features that could help recognise adult patients at high risk of having COVID-19.DesignWe conducted a scoping review of all the evidence available at LitCovid, until 23 March 2020.SettingStudies conducted in any setting and any country were included.ParticipantsStudies had to report the prevalence of sociodemographic characteristics, symptoms and comorbidities specifically in adults with a diagnosis of infection by SARS-CoV-2.ResultsIn total, 1572 publications were published on LitCovid. We have included 56 articles in our analysis, with 89% conducted in China and 75% containing inpatients. Three studies were conducted in North America and one in Europe. Participants’ age ranged from 28 to 70 years, with balanced gender distribution. The proportion of asymptomatic cases were from 2% to 79%. The most common reported symptoms were fever (4%–99%), cough (4%–92%), dyspnoea/shortness of breath (1%–90%), fatigue (4%–89%), myalgia (3%–65%) and pharyngalgia (2%–61%), while regarding comorbidities, we found cardiovascular disease (1%–40%), hypertension (0%–40%) and cerebrovascular disease (1%–40%). Such heterogeneity impaired the conduction of meta-analysis.ConclusionsThe infection by COVID-19 seems to affect people in a very diverse manner and with different characteristics. With the available data, it is not possible to clearly identify those at higher risk of being infected with this condition. Furthermore, the evidence from countries other than China is, at the moment, too scarce.
Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system
Authors: Brown Craig S , Vu Joceline V , Howard Ryan A , Gunaseelan Vidhya , Brummett Chad M , Waljee Jennifer , Englesbe Michael 
Published: September 2020

BackgroundOpioids are prescribed in excess after surgery. We leveraged our continuous quality improvement infrastructure to implement opioid prescribing guidelines and subsequently evaluate changes in postoperative opioid prescribing, consumption and patient satisfaction/pain in a statewide regional health system.MethodsWe collected data regarding postoperative prescription size, opioid consumption and patient-reported outcomes from February 2017 to May 2019, from a 70-hospital surgical collaborative. Three iterations of prescribing guidelines were released. An interrupted time series analysis before and after each guideline release was performed. Linear regression was used to identify trends in consumption and patient-reported outcomes over time.ResultsWe included 36 022 patients from 69 hospitals who underwent one of nine procedures in the guidelines, of which 15 174 (37.3%) had complete patient-reported outcomes data following surgery. Before the intervention, prescription size was decreasing over time (slope: −0.7 tablets of 5 mg oxycodone/month, 95% CI −1.0 to −0.5 tablets, p<0.001). After the first guideline release, prescription size declined by −1.4 tablets/month (95% CI −1.8 to −1.0 tablets, p<0.001). The difference between these slopes was significant (p=0.006). The second guideline release resulted in a relative increase in slope (−0.3 tablets/month, 95% CI −0.1 to −0.6, p<0.001). The third guideline release resulted in no change (p=0.563 for the intervention). Overall, mean (SD) prescription size decreased from 25 (17) tablets of 5 mg oxycodone to 12 (8) tablets. Opioid consumption also decreased from 11 (16) to 5 (7) tablets (p<0.001), while satisfaction and postoperative pain remained unchanged.ConclusionsThe use of procedure-specific prescribing guidelines reduced statewide postoperative opioid prescribing by 50% while providing satisfactory pain care. These results demonstrate meaningful impact on opioid prescribing using evidence-based best practices and serve as an example of successful utilisation of a regional health collaborative for quality improvement.
Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda
Authors: Espey Julie , Ingabire Rosine , Nyombayire Julien , Hoagland Alexandra , Da Costa Vanessa , Mazzei Amelia , Haddad Lisa B , Parker Rachel , Mukamuyango Jeannine , Umutoni Victoria , Allen Susan , Karita Etienne , Tichacek Amanda , Wall Kristin M 
Published: September 2020

IntroductionPostpartum family planning (PPFP) is critical to reduce maternal–child mortality, abortion and unintended pregnancy. As in most countries, the majority of PP women in Rwanda have an unmet need for PPFP. In particular, increasing use of the highly effective PP long-acting reversible contraceptive (LARC) methods (the intrauterine device (IUD) and implant) is a national priority. We developed a multilevel intervention to increase supply and demand for PPFP services in Kigali, Rwanda.MethodsWe implemented our intervention (which included PPFP promotional counselling for clients, training for providers, and Ministry of Health stakeholder involvement) in six government health facilities from August 2017 to October 2018. While increasing knowledge and uptake of the IUD was a primary objective, all contraceptive method options were discussed and made available. Here, we report a secondary analysis of PP implant uptake and present already published data on PPIUD uptake for reference.ResultsOver a 15-month implementation period, 12 068 women received PPFP educational counselling and delivered at a study facility. Of these women, 1252 chose a PP implant (10.4% uptake) and 3372 chose a PPIUD (27.9% uptake). On average providers at our intervention facilities inserted 83.5 PP implants/month and 224.8 PPIUDs/month. Prior to our intervention, 30 PP implants/month and 8 PPIUDs/month were inserted at our selected facilities. Providers reported high ease of LARC insertion, and clients reported minimal insertion anxiety and pain.ConclusionsPP implant and PPIUD uptake significantly increased after implementation of our multilevel intervention. PPFP methods were well received by clients and providers.