bluuebunny/crossref_metadata_2025_split huggingface dataset:
Point-of-care tests, diagnostic uncertainty and antimicrobial stewardship in the ICU: procalcitonin or PCR to aid antibiotic-stop decisions – an observational cohort study
Authors: Lau Timothy , Nurek Martine , Singhal Archit , Moore Luke , Mughal Nabeela , Singh Suveer 
Published: December 2024

ObjectivesIntensive care unit (ICU) clinicians stop antibiotics more often, with a negative infection: point-of-care test (PCR-POCT). Simulated cases of diagnostic uncertainty regarding infection resolution led clinicians to choose options such as procalcitonin (PCT) and/or PCR-POCTs +/− de-escalation to aid stop decisions. We hypothesised that a direct infection indicator, PCR-POCT, would influence stop judgements more than indirect PCT. Accordingly, we tested antibiotic-stop decisions when presented with a negative PCR-POCT despite borderline-positive PCT.DesignsObservational prospective study.SettingICU.Participants66 ICU clinicians from University hospitals.MethodsClinicians saw four scenarios of different clinico-biological trajectories: (1) clear improvement, (2) clear worsening, (3) discordant—clinically better/biologically worse and (4) discordant—clinically worse/biologically better. Participants gave an initial decision (stop/continue/continue–escalate/continue–de-escalate). Then PCR-POCT and/or PCT was offered (accept/decline). After a negative PCR-POCT and borderline-positive PCT result, a final antibiotic decision was taken.MeasuresProportion of stop decisions before versus after test results per scenario. The association of the final decision with the clinician’s change in confidence, willingness to request the biomarker(s) and the case trajectory was determined.ResultsFewer clinicians than expected stopped antibiotics versus baseline (36%, 94/264 vs 42%, 110/264, p=0.045). This was so in three of four scenarios, significantly less in the improvement (p<0.001) and the discordant clinically better scenario (p=0.024). PCT was requested more frequently than PCR-POCT (61% vs 53%, p<0.001). PCT requesters (vs declining) were significantly less inclined to stop antibiotics (p<0.001), while PCR-POCT requesting led to more stopping (p<0.001), before knowing the test results.ConclusionsA negative PCR-POCT result did not increase clinicians’ inclination to stop antibiotics when alongside a borderline-positive PCT. This reflects clinicians’ natural risk aversion. PCT was more popular than PCR-POCT, but PCR-POCT was more likely to aid stop decisions.Their comparison, role, utility and selective deployment for influencing antibiotic-stop decisions more effectively require a large randomised controlled trial.
Transforming Households with Refraction and Innovative Financial Technology (THRIFT): study protocol for a randomised controlled trial of vision interventions and online banking among the elderly in Kurigram
Authors: Shitol Sharmin Akter , Aftab Ishrat Binte , Piyasena Prabhath , Lohfeld Lynne , Rayasam Sridevi , Challa Nagamani , Sangani Payal , Sigwadhi Lovemore Nyasha , Rahman H M Masudur , Khanna Rohit C , Chan Ving Fai , Barua Mrittika , Pant Sonia , Adhvaryu Achyuta , Nyshadham Anant , Sarker Malabika , Mettla Asha Latha , Haque Enam , MacKenzie Graeme , Alam Sadiq , Gudwin Ella , Clarke Mike , Shonchoy Abu , Rabbani Atonu , Congdon Nathan 
Published: December 2024

IntroductionPresbyopia, difficulty in seeing close-ups, affects a billion people globally. Mobile financial services (MFS) have been mandated since January 2021 for Bangladesh government social safety net payments, including old age allowance (OAA) and widow allowance (WA). We report the protocol for the Transforming Households with Refraction and Innovative Financial Technology randomised trial assessing the impact on the use of online banking of providing presbyopic safety net beneficiaries with reading glasses, and brief smartphone and mobile banking app training.Methods and analysesEligible participants (n=484) are OAA (men aged 65–70 years; women aged 62–70) or WA recipients (women aged 48–60) with presbyopia as their only vision problem, passing a smartphone-based test of numeracy, cognition and dexterity, and not currently owning a smartphone or independently using MFS. All participants receive smartphones loaded with a mobile banking app and a transaction-tracking app and are randomised 1:1 to receive immediate free near-vision glasses and half-day training for smartphone and banking app use (intervention), or glasses and training 12 months later (control). The primary outcome is the mean quarterly number of mobile bank transactions over the 12-month follow-up period, comparing study groups, with and without adjustment. Secondary outcomes include food security, healthcare access and social connectedness.Ethics and disseminationThe protocol was approved by ethics committees at Queen’s University Belfast (reference #MHLS22_69) and BRAC James P Grant School of Public Health (reference #IRB-21 August’22-028). The trial is conducted in accordance with the Declaration of Helsinki and national regulations in Bangladesh, and results will be published in open-access, peer-reviewed journals.Trial registration numberNCT05510687; ClinicalTrials.gov.
Digital health technologies for metabolic disorders in older adults: a scoping review protocol
Authors: Huynh Panitda , Fleisch Elgar , Brändle Michael , Kowatsch Tobias , Jovanova Mia 
Published: December 2024

IntroductionMetabolic disorders (type 2 diabetes, insulin resistance, hyperglycaemia, obesity, hyperlipidaemia, hypertension, non-alcoholic fatty liver disease and metabolic syndrome) are leading causes of mortality and disability worldwide. These disorders disproportionately affect older adults relative to those younger. Digital health technologies (DHTs), such as patient monitoring, digital diagnostics and digital therapeutics, emerge as promising tools for health promotion in day-to-day life. However, their role in targeting metabolic disorders, particularly among a key demographic of older adults, is not yet fully understood. Thus, this study aims to scope the use of DHTs in managing metabolic health disorders among older adults. To our knowledge, this is the first review to categorise DHTs for older adults with metabolic disorders, contributing to the growing literature in the intersection of metabolic disorders and DHTs.Methods and analysisWe will conduct a scoping review following the recommended framework by Arksey and O’Malley. Our search will focus on three primary concepts: metabolic disorders, DHTs and older adults. We plan to search five online databases (Cochrane, ScienceDirect, PubMed, Scopus and Web of Science) to identify original research articles published between January 2014 and January 2024. Two independent reviewers will screen articles based on predefined eligibility criteria, with a third reviewer resolving conflicts. Data will be extracted using a standardised form, and results will be synthesised qualitatively and quantitatively. The database searches, data collection and analysis are planned and have not been conducted.Ethics and disseminationNo ethics approval is required for this protocol and scoping review. Data will be used only from published studies with appropriate ethics approval. Results will be disseminated in a peer-reviewed publication.
Move to improve - Prescribing physical activity and deprescribing paracetamol for low back pain: Protocol for a hybrid type III feasibility study
Authors: Comachio Josielli , Halliday Mark , Ferreira Paulo H , Patterson Thomas , Roberts David , Ho Emma Kwan-Yee , Beckenkamp Paula R 
Published: December 2024

IntroductionPeople experiencing low back pain (LBP) could potentially benefit from multimedia educational resources that integrate self-management strategies and improve awareness of the benefits of staying active and about medications that offer limited benefits, such as paracetamol. Primary care waiting rooms are potential spaces for presenting health promotion resources to improve health literacy through the dissemination of easily accessible health information. This feasibility study aims to explore the feasibility of conducting a large-scale trial to investigate the benefits of multimedia educational resources delivered at outpatient physiotherapy waiting rooms of public hospitals to support patients to participate in physical activity and reduce paracetamol intake for LBP.Methods and analysisA hybrid type III feasibility study will be conducted at a public hospital in Sydney, Australia, from March to September 2024. The multimedia strategy development (pre-implementation) involves collaborative planning among healthcare professionals, policymakers and community stakeholders in physiotherapy practice. Phase II (implementation) will evaluate the acceptability and implementation processes of delivering the multimedia educational resources in the physiotherapy waiting room following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. Findings from the quantitative data will be reported descriptively, and categorical data by counts and percentages. Qualitative (open-ended questions) will be integrated with the feasibility trial outcomes to inform the design of a full-scale randomised controlled trial.Ethics and disseminationThis study has ethical approval from the Sydney Local Health District Human Research Ethics Committee (2023/ETH02683). The findings will be disseminated via peer-reviewed publications, articles in relevant newsletters and presentations at national and international conferences. Social media platforms including X will also be used to generate awareness.
Methods for extrapolating costs and effects in economic evaluations of telehealth interventions: a scoping review protocol
Authors: Raunbak Sabine Michelsen , Weinreich Ulla Møller , Johnsen Søren Paaske , Udsen Flemming Witt 
Published: December 2024

IntroductionReviews of economic evaluations of telehealth interventions found that the current evidence is inconsistent with standard guidelines for conducting economic evaluation. The reviews conclude that most economic evaluations of telehealth interventions are small-scale and short-term. The choice of time horizon in economic evaluation, in general, is an important part. When using longer time horizons, it often involves extrapolating costs and effects, where assumptions are taken. Different tools for extrapolating cost and effects in economic evaluations exist. However, there is a heterogeneity in the methods used, which can create different results. Therefore, this study aims to review the design and conduct of existing long-term economic evaluations of telehealth interventions using extrapolation methods. Furthermore, the aim is to map the methods used for extrapolation.Methods and analysisA scoping review is conducted to investigate the aim of this study. To identify relevant studies for inclusion in the scoping review, a systematic literature search will be conducted in the electronic databases: Embase (Elsevier), PubMed (National Library of Medicine), EconLit (ProQuest), Web of Science (Clarivate), NHS Economic Evaluation Database (NHS Centre for Reviews and Dissemination) and CINAHL (EBSCO Industries). A grey literature search will be conducted in Google Scholar. The search will be supplemented with studies identified by reviewing the references in the included studies and reviewing the citations of the included studies. The extracted data from the studies in the scoping review will be presented in relevant descriptive tables and summarising descriptions. The results will be reported in correspondence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline.Ethics and disseminationHence, the methodology used is a scoping review of the existing literature; no ethical or safety considerations are identified for this study. The plan for dissemination includes a peer-reviewed publication and possible poster or oral presentations.
Performance Understanding and Learning System (PULSE-KEY): development of a framework for implementation and performance evaluation of healthcare delivery models of care
Authors: Mutsekwa Rumbidzai N , Campbell Katrina L , Canavan Russell , Angus Rebecca L , McBride Liza-Jane , Byrnes Joshua 
Published: December 2024

ObjectivesEfficient performance evaluation is essential for driving improvement, ensuring accountability and optimisation of outcomes in healthcare delivery. However, its complexity often leads to ineffective implementation. This article aims to advance the field of performance measurement within alternative healthcare delivery models of care through the development and validation of a comprehensive evaluation framework.Design and participantsA seven-stage methodological approach was adapted from the Health Care Quality Indicators Project and a conceptual analysis method. The first three stages, which have been previously published, included: (1) an extensive literature review, (2) engagement with consumers and patients through interviews and a discrete choice experiment and (3) involvement of stakeholders across the healthcare system via interviews and surveys. Building on this previous work, the present study advances the framework development through four additional stages: (4) development of a conceptual framework (identifying, categorising, synthesising concepts into outcome domains), (5) expert consultation, (6) validation using a real-world case study and (7) refinement for practical applicability and effectiveness in evaluating alternative healthcare delivery models of care.ResultsThe framework was developed by synthesising insights from phases 1–3 of our previously published work and refined through consultations with 25 experts, confirming its relevance, clarity and suitability for diverse audiences. This study also details the framework’s validation, refinement and finalisation process. The final framework is structured around eight primary domains, covering implementation outcomes, effectiveness, safety, patient-centredness, healthcare provider experience, access, service delivery and economic evaluation. Within the implementation outcomes domain, three subdomains—adoptability, implementability and sustainability—are further delineated, providing a comprehensive assessment.ConclusionsThe comprehensive evaluation framework developed in this study provides a vital tool for enhancing implementation and performance measurement in alternative healthcare delivery models. By integrating insights from various stakeholders, the framework promotes data-driven decisions on adopting, implementing and sustaining various healthcare delivery models. Through systematic application, this framework aims to drive tangible enhancements in patient outcomes, improve healthcare provider experiences, and optimise overall healthcare system efficiency.
Interventions to enhance the core competencies of clinical nursing preceptors: a protocol for a systematic review
Authors: Liu Ke , Wang Shuyi , Halili Xirongguli , Chen Qirong , Liu Minhui 
Published: December 2024

IntroductionClinical nursing preceptors (CNPs) teach nursing skills to students in real medical scenarios and develop their professionalism. The adequacy of CNPs’ teaching competencies affects the effectiveness of student learning, so it is crucial to seek the best evidence for teaching competency interventions. This report describes a protocol for a systematic review to identify and analyse interventions to enhance the teaching competencies of CNPs. The aims of this systematic review are to (1) summarise the characteristics, quality, effectiveness and limitations of existing intervention programmes that support or train CNPs in teaching competencies; and (2) identify knowledge gaps related to teaching competencies interventions for CNPs, thereby supporting future research on constructing and improving preceptor intervention programmes.Methods and analysisThis protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols 2015 checklist. We will report this systematic review following the updated PRISMA 2020 checklist. Between 1 May 2024 and 30 May 2024, we will search PubMed, Web of Science, CINAHL, MEDLINE, EMBASE and ProQuest (Health & Medical Collection). The intervention studies that focus on enhancing and supporting the core competencies of CNPs will be included. The two researchers will conduct the study screening, data extraction and quality appraisal independently. Disagreements will be addressed by discussion or the involvement of a third researcher. We will evaluate the quality of the included studies using the modified Educational Interventions Critical Appraisal Tool. Furthermore, we will label the training programme levels using Kirkpatrick’s Four Levels of Training Evaluation Model.Ethics and disseminationEthical approval is not applicable to this study. We will share the findings from the study at national and/or international conferences and in a peer-reviewed journal in the field of nurse education.
Childhood early oral ageing syndrome: prevalence and association with possible aetiological factors and consequences for the vertical dimension of occlusion: protocol for a cross-sectional study
Authors: Spinola Sandra Gouveia , Sobral Ana Paula Taboada , Mandetta Amanda Rafaelly Honório , Gimenez Thais , Gonçalves Marcela Letícia Leal , Soares Paulo Vinícius , Santos Elaine Marcilio , Imparato José Carlos Pettorossi , Horliana Anna Carolina Ratto Tempestini , Mesquita-Ferrari Raquel Agnelli , Motta Lara Jansiski , Fernandes Kristianne Porta Santos , Bussadori Sandra Kalil 
Published: December 2024

IntroductionChildhood early oral ageing syndrome (CEOAS) is a condition involving oral abnormalities resulting from systemic diseases of different origins that are related to the current lifestyle of the paediatric population. Enamel defects associated with intrinsic and extrinsic factors promote the early loss of tooth structure at an accelerated pace, with negative impacts on function, aesthetics and quality of life. The aim of the study is to identify the prevalence of early tooth wear in childhood and its severity using the CEOAS index, which is a tool for the diagnosis of the condition and for epidemiological surveys, involving the investigation of abnormalities of the oral cavity in the paediatric population and possible factors associated with the severity of the condition.Methods and analysisChildren aged 3–6 years will be recruited from the paediatric clinic of Universidade Nove de Julho. Children with amelogenesis imperfecta, dentinogenesis imperfecta and genetic syndromes, as well as those undergoing orthodontic treatment will be excluded. A questionnaire will be administered addressing general health, sleep quality, dietary habits, oral hygiene habits and parafunctional habits. Clinical examinations will then be performed using the novel CEOAS index to assess tooth wear (scores 0–3) and determine the occurrence of enamel defects (scores I–III). The vertical dimension of occlusion (VDO) will also be measured. The CEOAS scores will be computed for the deciduous dentition and analysed statistically, with the significance level set at 5% (p<0.05).Ethics and disseminationThis protocol has been approved by the institutional review board of Universidade Nove de Julho (process number: 6.713.724. Approved on 20 March 2024). The results will be submitted to international peer-reviewed journals and presented at international conferences.Trial registration numberwww.clinicaltrials.gov,NCT06381414. Registered 23 April 2024.
Comparison of the analgesic efficacy of intra-articular steroid injections and its combination with suprascapular nerve block for adhesive capsulitis of the shoulder joint: a randomized clinical trial
Authors: Elango Yaal , S Adinarayanan , Swaminathan Srinivasan , Govindaraj Kirthiha , Nema Sandeep , Kumar Navin 
Published: December 2024

BackgroundAdhesive capsulitis is a distressing ailment that progressively limits the active and passive mobility of the shoulder joint. Physical therapy (PT) combined with intra-articular steroid (IAS) injection and suprascapular nerve block (SSNB) has shown improved functional outcomes. We aimed to assess whether providing both IAS injection and SSNB improved outcomes compared with IAS injection alone.MethodsNinety-six patients with adhesive capsulitis were randomized into three groups consisting of group IAS, group IAS+SSNB and group PT (control). All patients were assessed on day 0, week 2, 6 and 12 postintervention. The primary outcome was an improvement in Shoulder Pain and Disability Index (SPADI) scores at week 12 postintervention. Secondary outcomes were Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, Constant-Murley Range of Motion (ROM) scores, Quality of life (QoL) and Medication Quantification Scale (MQS) 3.ResultsOn combining IAS and SSNB, we found a statistically significant improvement in SPADI scores over IAS only at week 2 postintervention (33.6±8.0 vs 38.3±8.9, p=0.04) but not beyond. A significant reduction in SPADI, VAS and QuickDASH scores, along with an improvement in Constant-Murley ROM scores, was observed on day 0 and at weeks 2, 6 and 12 in both group IAS and group IAS+SSNB (p<0.05). MQS 3 scores significantly decreased up to week 6 in both groups. However, the addition of SSNB to IAS did not demonstrate a clinically significant difference in the study outcomes, except for a notable decrease in VAS in the immediate postintervention period. Additionally, no significant changes in QoL were observed among the groups (p>0.05).ConclusionBoth IAS and IAS+SSNB improved analgesia, reduced disability and enhanced ROM. However, adding SSNB to IAS did not yield a clinically meaningful benefit in the study outcomes.Trial registration numberTrial registration numberCTRI/2022/08/044519.
Opioid consumption in the first 30 days after surgery was independently associated with new persistent opioid use
Authors: Ervin-Sikhondze Brittany A , Gunaseelan Vidhya , Chua Kao-Ping , Bicket Mark C , Waljee Jennifer F , Englesbe Michael J , Brummett Chad M 
Published: December 2024

Introduction
Previous studies suggest that new persistent opioid use (NPOU) after surgery was associated with larger perioperative opioid prescriptions, but the association between NPOU and postoperative opioid consumption is unknown.

Methods
This retrospective study included opioid naïve individuals aged 18–64 who underwent surgical procedures across 70 Michigan hospitals between July 1, 2018 and November 15, 2021 and were prescribed opioids at discharge. We used clinical and patient-reported opioid consumption data from the Michigan Surgical Quality Collaborative, a statewide surgical registry, linked with the state Prescription Drug Monitoring Program. Multivariable logistic regression modeling was used to assess the association between patient-reported opioid consumption during the 30 days after discharge and NPOU, defined as having an opioid fill during both 31–120 days and 121–210 days after discharge.

Results
Among 36,271 patients included, 482 (1.3%) developed NPOU. These patients consumed more opioid pills in the first 30 days postoperatively than those without NPOU (mean (SD): 7.3 (8.4) 5 mg oxycodone equivalent pills vs 4.1 (5.5), SMD=−0.41). In adjusted analyses, each additional opioid pill consumed in the 30-day postoperative period was associated with a 0.05 percentage-point increase in the predicted probability of NPOU (95% CI 0.04 to 0.07 percentage points). Thus, holding all other variables constant, a 10-pill increase in consumption would be associated with a 0.5 percentage-point increase in the probability of NPOU, or a 38.4% increase relative to the baseline rate of 1.3%.

Conclusion
Demonstrating that opioid consumption in the first 30 days after surgery was independently associated with NPOU underscores the importance of perioperative opioid prescribing on long-term outcomes.