bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training and education of healthcare workers during viral epidemics: a systematic review
Authors: Nayahangan Leizl Joy , Konge Lars , Russell Lene , Andersen Steven 
Published: May 2021

BackgroundIt is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes.ObjectiveTo explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW.Data sourcesSystematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics.Study eligibility criteriaAll studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020.ParticipantsHealthcare workers.InterventionsEducational or training interventions.Study appraisal and synthesis methodsDescriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist.ResultsA total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes.Conclusions and implications of findingsThe included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.
Long-term outcomes of two-stage, immediate and delayed breast reconstruction with polyurethane-covered versus textured implants: protocol of a prospective, multicentre randomised controlled trial (TIPI trial)
Authors: Harmeling J X , Cinca Kevin Peter , Andrinopoulou Eleni-Rosalina , Corten Eveline M L , Mureau M A 
Published: May 2021

IntroductionTwo-stage implant-based breast reconstruction is the most commonly performed postmastectomy reconstructive technique. During the first stage, a tissue expander creates a sufficiently large pocket for the definite breast implant placed in the second stage. Capsular contracture is a common long-term complication associated with implant-based breast reconstruction, causing functional complaints and often requiring reoperation. The exact aetiology is still unknown, but a relationship between the outer surface of the implant and the probability of developing capsular contracture has been suggested. The purpose of this study is to determine whether polyurethane-covered implants result in a different capsular contracture rate than textured implants.Methods and analysisThe Textured Implants versus Polyurethane-covered Implants (TIPI) trial is a multicentre randomised controlled trial with a 1:1 allocation rate and a follow-up of 10 years. A total of 321 breasts of female adults undergoing a two-stage breast reconstruction will be enrolled. The primary outcome is capsular contracture at 10-year follow-up which is graded with the modified Baker classification. It is analysed with survival analysis using a frailty model for clustered interval-censored data, with both an intention-to-treat and per-protocol approach. Secondary outcomes are other complication rates, surgical revision rate, patient satisfaction and quality of life and user-friendliness. Outcomes are measured 2 weeks, 6 months, 1, 2, 3, 5 and 10 years postoperatively. Interim analysis is performed when 1-year, 3-year and 5-year follow-up is completed.Ethics and disseminationThe trial has been reviewed and approved by the Medical Research Ethics Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2018-126) and locally by each participating centre. Written informed consent will be obtained from each study participant. The results will be disseminated by publication in peer-reviewed journals.Trial registrationNTR7265.
Acuity level of care as a predictor of case fatality and prolonged hospital stay in patients with COVID-19: a hospital-based observational follow-up study from Pakistan
Authors: Almas Aysha , Mushtaq Zain , Moller Jette 
Published: May 2021

ObjectivesTo determine if there is an association between acuity level of care (ALC), case fatality and length of stay in patients admitted to hospital due to COVID-19.DesignA hospital-based observational follow-up study.SettingInternal Medicine Service of the Aga Khan University Hospital, Pakistan, from 26 February 2020 to 30 June 2020.ParticipantsAdult patients with confirmed COVID-19, aged ≥18 years.MethodsALC was categorised into low, intermediate and high level and patients were triaged using the standard emergency severity illness score. All patients were followed until the end of hospital admission for the outcome of case fatality and length of stay.ResultsA total of 822 patients with COVID-19 were admitted during the study period and 699 met inclusion criteria. The mean age was 54.5 years and 67% were males; 50.4% were triaged to low, 42.5% to intermediate and 7.2% to high acuity care. The overall case-fatality rate was 11.6%, with the highest (52%) in high acuity level followed by 16.2% in intermediate and 2% in low acuity care. Acuity level was associated with case fatality, with an HR (95% CI) of 5.0 (2.0 to 12.1) for high versus low acuity care and an HR of 2.7 (1.2, 6.4) for intermediate versus low acuity care, after adjusting for age, sex and common comorbidities including diabetes, hypertension, ischaemic heart disease and chronic lung disease. Similarly, acuity level was also associated with length of hospital stay.ConclusionHigh and intermediate acuity level is associated with higher case fatality rate and prolonged length of hospital stay in patients admitted with COVID-19. In resource-limited settings where the provision of high acuity care is limited, the intermediate care acuity could serve as a useful strategy to treat relatively less critical patients with COVID-19.
Realist Process Evaluation of the implementation and impact of an organisational cultural transformation programme in the Children and Young People"s Secure Estate (CYPSE) in England: study protocol
Authors: D"Souza Sophie , Lane Rebecca , Jacob Jenna , Livanou Maria , Riches Wendy , Rogers Andrew , Ullman Roz , Rashid Anisatu , Singleton Rosie , Wheeler James , Bevington Dickon , Deighton Jessica , Fonagy Peter , Fuggle Peter , Law Duncan , Edbrooke-Childs Julian 
Published: May 2021

IntroductionYoung people in contact with the youth justice system are more likely to present with complex ongoing needs than young people in the general population. To address this, the Framework for Integrated Care (SECURE STAIRS) is being implemented in the Children and Young People"s Secure Estate: a ‘whole systems’ approach to support secure settings to develop trauma-informed and relationally based environments, supporting staff to provide consistent, therapeutic care. This paper aims to present the protocol for a national cohort study examining the impact and implementation of this cultural transformation programme.Methods and analysisA mixed-methods realist evaluation will be conducted. Data collection will take place between August 2018 and December 2020. Eighteen sites will collect routine service activity data and questionnaires completed by young people, parents/guardians and staff. Semi-structured interviews and non-participant observations will be conducted across five qualitative focus sites with young people and staff. An economic evaluation will examine value for money. The results will be triangulated at the analysis stage to gain an in-depth understanding of experiences.Ethics and disseminationEthical approval was granted by the Health Research Authority, Her Majesty’s Prison and Probation Service and UCL Ethics Committee. Findings will be disseminated via project reports, site feedback, peer-reviewed journal publications and conference presentations.
Impact of The Daily Mile on children’s physical and mental health, and educational attainment in primary schools: iMprOVE cohort study protocol
Authors: Ram Bina , Chalkley Anna , van Sluijs Esther , Phillips Rachel , Venkatraman Tishya , Hargreaves Dougal S , Viner Russell M , Saxena Sonia 
Published: May 2021

IntroductionSchool-based active mile initiatives such as The Daily Mile (TDM) are widely promoted to address shortfalls in meeting physical activity recommendations. The iMprOVE Study aims to examine the impact of TDM on children’s physical and mental health and educational attainment throughout primary school.Methods and analysisiMprOVE is a longitudinal quasi-experimental cohort study. We will send a survey to all state-funded primary schools in Greater London to identify participation in TDM. The survey responses will be used for non-random allocation to either the intervention group (Daily Mile schools) or to the control group (non-Daily Mile schools). We aim to recruit 3533 year 1 children (aged 5–6 years) from 77 primary schools and follow them up annually until the end of their primary school years. Data collection taking place at baseline (children in school year 1) and each primary school year thereafter includes device-based measures of moderate-to-vigorous physical activity (MVPA) and questionnaires to measure mental health (Strengths and Difficulties Questionnaire) and educational attainment (ratings from ‘below expected’ to ‘above expected levels’). The primary outcome is the mean change in MVPA minutes from baseline to year 6 during the school day among the intervention group compared with controls. We will use multilevel linear regression models adjusting for sociodemographic data and participation in TDM. The study is powered to detect a 10% (5.5 min) difference between the intervention and control group which would be considered clinically significant.Ethics and disseminationEthics has been approved from Imperial College Research Ethics Committee, reference 20IC6127. Key findings will be disseminated to the public through research networks, social, print and media broadcasts, community engagement opportunities and schools. We will work with policy-makers for direct application and impact of our findings.
Experience of establishing and coordinating a nationwide network for bidirectional intussusception surveillance in India: lessons for multisite research studies
Authors: Das Manoja Kumar 
Published: May 2021

ObjectivesTo document and share the process of establishing the nationally representative multisite surveillance network for intussusception in India, coordination, data management and lessons learnt from the implementation.DesignThis study combined both retrospective and prospective surveillance approaches.Setting19 tertiary care institutions were selected in India considering the geographic representation and public and private mixParticipantsAll children under-2 years of age with intussusceptionPrimary and secondary outcome measuresThe experience of site selection, regulatory approvals, data collection, quality assurance and network coordination were documented.ResultsThe site selection process involved systematic and objective four steps including shortlisting of potential institutions, information seeking and telephonic interaction, site visits and site selection using objective criteria. Out of over 400 hospitals screened across India, 40 potential institutions were shortlisted and information was sought by questionnaire and interaction with investigators. Out of these, 25 institutes were visited and 19 sites were finally selected to participate in the study. The multistep selection process allowed filtering and identification of sites with adequate capacity and motivated investigators. The retrospective surveillance documented 1588 cases (range: 14–652 cases/site) and prospective surveillance recruited 621 cases (range: 5–191 cases/site). The multilayer quality assurance measures monitored and ensured protocol adherence, complete record retrieval and data completeness. The key challenges experienced included time taken for obtaining regulatory and ethical approvals, which delayed completion of the study. Ten sites continued with another multisite vaccine safety surveillance study.ConclusionThe experience and results of this systematic and objective site selection method in India are promising. The systematic multistep site selection and data quality assurance methods presented here are feasible and practical. The lessons from the establishment and coordination of this surveillance network can be useful in planning, selecting the sites and conducting multisite and surveillance studies in India and developing countries.
Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross-sectional web-based survey
Authors: Wente-Schulz Sarah , Aksenova Marina , Awan Atif , Ambarsari Cahyani Gita , Becherucci Francesca , Emma Francesco , Fila Marc , Francisco Telma , Gokce Ibrahim , Gülhan Bora , Hansen Matthias , Jahnukainen Timo , Kallash Mahmoud , Kamperis Konstantinos , Mason Sherene , Mastrangelo Antonio , Mencarelli Francesca , Niwinska-Faryna Bogna , Riordan Michael , Rus Rina R , Saygili Seha , Serdaroglu Erkin , Taner Sevgin , Topaloglu Rezan , Vidal Enrico , Woroniecki Robert , Yel Sibel , Zieg Jakub , Pape Lars 
Published: May 2021

BackgroundAcute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses of acute TIN.Patients, design and settingWe collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate.ResultsThirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m23–6 months later (p<0.001). After 3–6 months, eGFR normalised in 41% of patients (eGFR ≥90 mL/min/1.73 m2), with only 3% having severe or end-stage impairment of renal function (<30 mL/min/1.73 m2). 80% of patients received corticosteroid therapy. Median eGFR after 3–6 months did not differ between steroid-treated and steroid-untreated patients. Other immunosuppressants were used in 18% (n=31) of patients, 21 of whom received mycophenolate mofetil.ConclusionsDespite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3–6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.
Perceived effectiveness of public health measures and positive attitudes during a pandemic: a large cross-sectional study in Shanghai, China
Authors: Chu Qiao , Gu Tian , Li Anqi , Chen Junjie , Wang Hui , Liu Ningning , Wu Ruijun , He Yaping 
Published: May 2021

ObjectivesBuilding individuals’ positive attitudes during a pandemic is essential for facilitating psychological resilience. However, little is known about how public health measures may improve people’s positive attitudes during a pandemic. We investigated the potential mechanism underlying the association between individuals’ perceived effectiveness of public health measures and positive attitudes towards the success of pandemic control during the COVID-19 pandemic, by examining the parallel mediating effects of three types of threat appraisals: concerns about contracting the virus, perceived impact of the pandemic on life and estimated duration of the pandemic.Design, setting and participantsIn February 2020 when the COVID-19 infection was spreading rapidly in China, a large cross-sectional survey was conducted among 132 054 adults from the 16 districts in Shanghai, China.Outcome measuresPerceived effectiveness of the public health measures, positive attitudes towards the success of pandemic control and threat appraisals.ResultsResults of structural equation modelling supported the hypothesised mediation model: perceived effectiveness of public health measures was associated with lower levels of concerns about contracting the virus (β=−0.20), perceived impact of the pandemic (β=−0.13) and perceived duration of the pandemic (β=−0.20), which were then associated with higher levels of positive attitudes towards the success of pandemic control (βs=−0.12 to −0.25).ConclusionsThe findings suggest that threat appraisals may be important pathways through which individuals’ evaluations of prevention strategies may influence their attitudes towards the success of pandemic control. The health authorities should consider reducing people’s inappropriate threat appraisals when designing public health policies to facilitate people’s positive attitudes during a pandemic.
Exenatide once weekly over 2 years as a potential disease-modifying treatment for Parkinson’s disease: protocol for a multicentre, randomised, double blind, parallel group, placebo controlled, phase 3 trial: The ‘Exenatide-PD3’ study
Authors: Vijiaratnam Nirosen , Girges Christine , Auld Grace , Chau Marisa , Maclagan Kate , King Alexa , Skene Simon , Chowdhury Kashfia , Hibbert Steve , Morris Huw , Limousin Patricia , Athauda Dilan , Carroll Camille B , Hu Michele T , Silverdale Monty , Duncan Gordon W , Chaudhuri Ray , Lo Christine , Del Din Silvia , Yarnall Alison J , Rochester Lynn , Gibson Rachel , Dickson John , Hunter Rachael , Libri Vincenzo , Foltynie Thomas 
Published: May 2021

IntroductionParkinson’s disease (PD) is a common neurodegenerative disorder with substantial morbidity. No disease-modifying treatments currently exist. The glucagon like peptide-1 receptor agonist exenatide has been associated in single-centre studies with reduced motor deterioration over 1 year. The aim of this multicentre UK trial is to confirm whether these previous positive results are maintained in a larger number of participants over 2 years and if effects accumulate with prolonged drug exposure.Methods and analysisThis is a phase 3, multicentre, double-blind, randomised, placebo-controlled trial of exenatide at a dose of 2 mg weekly in 200 participants with mild to moderate PD. Treatment duration is 96 weeks. Randomisation is 1:1, drug to placebo. Assessments are performed at baseline, week 12, 24, 36, 48, 60, 72, 84 and 96 weeks.The primary outcome is the comparison of Movement Disorders Society Unified Parkinson’s Disease Rating Scale part 3 motor subscore in the practically defined OFF medication state at 96 weeks between participants according to treatment allocation. Secondary outcomes will compare the change between groups among other motor, non-motor and cognitive scores. The primary outcome will be reported using descriptive statistics and comparisons between treatment groups using a mixed model, adjusting for baseline scores. Secondary outcomes will be summarised between treatment groups using summary statistics and appropriate statistical tests to assess for significant differences.Ethics and disseminationThis trial has been approved by the South Central-Berkshire Research Ethics Committee and the Health Research Authority. Results will be disseminated in peer-reviewed journals, presented at scientific meetings and to patients in lay-summary format.Trial registration numbersNCT04232969,ISRCTN14552789.
Misconceptions about COVID-19 among older Rohingya (forcefully displaced Myanmar nationals) adults in Bangladesh: findings from a cross-sectional study
Authors: Mistry Sabuj Kanti , Ali A R M Mehrab , Yadav Uday Narayan , Ghimire Saruna , Hossain Md. Belal , Saha Manika , Reza Sompa , Bakshi Progati , Bhuiyan Abu Toha M R H , Harris Mark 
Published: May 2021

ObjectivesDue to low health literacy and adverse situation in the camps, there are possibilities of misconceptions related to COVID-19 among the older Rohingya (forcefully displaced Myanmar nationals or FDMNs) adults in Bangladesh. The present research aimed to assess the level of misconceptions and the factors associated with it among the older FDMNs in Bangladesh.DesignCross-sectional.SettingA selected Rohingya camp situated in Cox’s Bazar, a southeastern district of Bangladesh.ParticipantsInformation was collected from 416 conveniently selected FDMNs who were aged 60 years and above.Primary and secondary outcome measuresThe primary outcome was misconceptions related to the spread, prevention and treatment of COVID-19. Information on 14 different locally relevant misconceptions was gathered, each was scored as one, and obtained a cumulative score, ranging from 0 to 14, with a higher score indicating a higher level of misconceptions. A multiple linear regression model explored the factors associated with misconceptions.ResultsThe participants had an average of five misconceptions. The most prevalent misconceptions were: everyone should wear personal protective equipment when outside (84.6%) and its prevention by nutritious food (62.5%) and drinking water (59.3%). Other notable misconceptions included the spread of COVID-19 through mosquito bites (42%) and its transmissions only to the non/less religious person (31.4%). In regression analyses, memory or concentration problems, communication frequency with social networks, pre-existing conditions and receiving information from health workers were significantly associated with higher COVID-19 misconceptions. These misconceptions were less likely among those overwhelmed by COVID-19, having COVID-19 diagnosed friends or family members and receiving information from friends and family.ConclusionsOverall, we found that misconceptions were prevalent among the older FDMNs in Bangladesh. The associations have important implications for programmes to prevent and manage COVID-19 in these settings. Health workers need to be adequately trained to provide clear communication and counter misconceptions.