bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review of exclusive enteral therapy in adult Crohn’s disease
Authors: Mitrev Nikola , Huang Hin , Hannah Barbara , Kariyawasam Viraj Chandana 
Published: September 2021

BackgroundExclusive enteral nutrition (EEN) is a potentially effective but underused therapy for Crohn’s disease (CD) in adults. It is first-line induction treatment for paediatric patients but remains a second-line or third-line therapy in adults.ObjectiveTo analyse the evidence for EEN in adult patients with CD, and summarise this in a narrative review.MethodsIn April/May 2020 and July 2021, a literature search was performed using the Medical Subject Headings (MeSH) terms: ‘Crohn’s disease’, ‘CD’, ‘inflammatory bowel disease’, ‘IBD’, ‘exclusive enteral nutrition’, ‘enteral nutrition’, ‘EEN’, in PubMed, Scopus, Cochrane. Additional studies were obtained from references of search result articles as well as general reading. Studies with adult patients with CD treated with EEN were selected. 79 articles of relevance were found. Where data in adults were lacking, data from paediatric studies as extrapolated with care.ResultsEEN in adult patients been shown to improve clinical, biomarker, endoscopic and radiologic measures of disease activity. EEN avoids the potential adverse effects of recurrent corticosteroids for induction such as metabolic derangements and opportunistic infections. EEN has also demonstrated benefits among adult patients with fistulising and stricturing CD. It may avoid surgery in such patients. Preoperative EEN has also been shown to reduce postoperative complications and recurrence. There appears to be benefits in combing EEN with antitumour necrosis factor agents, however, benefits of combination therapy with other biologics are less clear. A major drawback of EEN therapy in adults has been poor compliance. More palatable polymeric formulations improved patient education and dietitian support may overcome this. Evidence in adults is limited to small studies, often with suboptimal control arms and lack of blinding. Larger scale studies with improved study design are needed to confirm these beneficial effects.ConclusionDespite limitations in evidence EEN should be considered in treating adults with CD.
Incidence and risk factors for hospital-acquired infection among paediatric patients in a teaching hospital: a prospective study in southeast Ethiopia
Authors: Sahiledengle Biniyam , Seyoum Fekadu , Abebe Daniel , Geleta Eshetu Nigussie , Negash Getahun , Kalu Abdurhaman , Woldeyohannes Demelash , Tekalegn Yohannes , Zenbaba Demisu , Edward Quisido Bruce John 
Published: September 2021

ObjectivesIn order to maximise the prevention of hospital-acquired infections (HAIs) and antimicrobial resistance, data on the incidence of HAIs are crucial. In Ethiopia, data about the occurrence of HAIs among hospitalised paediatric patients are lacking. We aim to determine the incidence and risk factors of HAIs among paediatric patients in Ethiopia.DesignA prospective cohort study.SettingA teaching hospital in southeast Ethiopia.Participants448 hospitalised paediatric patients admitted between 1 November 2018 and 30 June 2019.Primary and secondary outcome measuresIncidence and risk factors of hospital-acquired infections.ResultsA total of 448 paediatric patients were followed for 3227 patient days. The median age of the patients was 8 months (IQR: 2–26 months). The incidence rate of HAIs was 17.7 per 1000 paediatric days of follow-up; while the overall cumulative incidence was 12.7% (95% CI 9.8% to 15.8%) over 8 months. Children who stayed greater than 6 days in the hospital (median day) (adjusted risk ratio (RR): 2.58, 95% CI 1.52 to 4.38), and children with underlying disease conditions of severe acute malnutrition (adjusted RR: 2.83, 95% CI 1.61 to 4.97) had higher risks of developing HAIs.ConclusionsThe overall cumulative incidence of HAIs was about 13 per 100 admitted children. Length of stay in the hospital and underlying conditions of severe acute malnutrition were found to be important factors associated with increased risk of HAIs.
Patient-initiated second medical consultations—patient characteristics and motivating factors, impact on care and satisfaction: a systematic review
Authors: Greenfield Geva , Shmueli Liora , Harvey Amy , Quezada-Yamamoto Harumi , Davidovitch Nadav , Pliskin Joseph S , Rawaf Salman , Majeed Azeem , Hayhoe Benedict 
Published: September 2021

ObjectivesTo review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction and cost effectiveness.Data sourcesEmbase, Medline, PsycINFO and Health Management Information Consortium (HMIC) databases.Study designA systematic literature search was performed for terms related to second opinion and patient characteristics. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.Data collection/extraction methodsWe included articles focused on patient-initiated second opinions, which provided quantitative data on their impact on diagnosis, treatment, prognosis or patient satisfaction, described the characteristics or motivating factors of patients who initiated a second opinion, or the cost-effectiveness of patient-initiated second opinions.Principal findingsThirty-three articles were included in the review. 29 studies considered patient characteristics, 19 patient motivating factors, 10 patient satisfaction and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle-age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reported on the cost effectiveness of patient initiated second opinions.ConclusionsThis review identified several demographic factors associated with seeking a second opinion, including age, gender, health status, and socioeconomic status. Differences in opinion received, and in the impact of change in opinion, varies significantly between medical specialties. More research is needed to understand the cost effectiveness of second opinions and identify patient groups most likely to benefit from second opinions.
Knowledge, attitude and practice of antibiotics and their determinants in Eritrea: an urban population-based survey
Authors: Russom Mulugeta , Bahta Merhawi , Debesai Merhawi , Bahta Iyassu , Kessete Abrahalei , Afendi Aziza , Fitsum Yodit , Nambozi Josephine , Kidane Solyana N , Tesfamariam Eyasu H 
Published: September 2021

ObjectiveTo measure knowledge, attitude and practice of antibiotics and antibiotic resistance (ABR) and their determinants in the Eritrean urban population.DesignA population-based, nation-wide, cross-sectional study.SettingUrban settings of Eritrea.ParticipantsMembers of the general public aged ≥18 years and living in 13 urban places of Eritrea. Three-stage stratified cluster sampling was used to select the study participants.Data collection and analysisDate were collected from July 2019 to September 2019 in a face-to-face interview using a structured questionnaire. The collected data were double entered and analysed using Census and Survey Processing system (V.7.0) and SPSS (V.23), respectively. Descriptive statistics, χ2test, t-tests, analysis of variance, factorial analysis and multivariable logistic regression were performed. All analyses were weighted and p<0.05 was considered significant.Primary and secondary outcome measuresMain outcome variables were knowledge, attitude and practice of antibiotics and ABR. Secondary outcome measure was the determinants of knowledge, attitude and practice.ResultsA total of 2477 adults were interviewed. The mean score of knowledge and attitude of antibiotics and ABR was 10.36/20 (SD=3.51, minimum=0 and maximum=20) and 22.34/30 (SD=3.59, minimum=6 and maximum=30), respectively. Of those who used antibiotics, the proportion of at least one inappropriate practice (use of antibiotics without prescription and/or discontinuation of prescribed antibiotics before completing the full course) was 23.8%. Young age <24 years (adjusted odds ratio (AOR)=1.61, 95% CI: 1.08 to 2.41), male sex (AOR=1.48, 95% CI: 1.14 to 1.91), higher level of education (AOR=1.76, 95% CI: 1.08 to 2.88), and negative attitude towards appropriate use of antibiotics (AOR=0.95, 95% CI: 0.92 to 0.97) were found to be the significant determinants of inappropriate practice of antibiotics.ConclusionThe gap in knowledge and inappropriate practice of antibiotics in the Eritrean urban population was widespread; requiring immediate attention from policy-makers and healthcare professionals.
Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study
Authors: Ngangue Patrice , Brown Judith Belle , Forgues Catherine , Ag Ahmed Mohamed Ali , Nguyen Tu Ngoc , Sasseville Maxime , Loignon Christine , Gallagher Frances , Stewart Moira , Fortin Martin 
Published: September 2021

ObjectiveA patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation.DesignA descriptive qualitative study was conducted in 2016–2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings.SettingThe study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada.ParticipantsTen managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed.ResultsMany key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics—evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting—patients’ needs and resources, external policies and incentives; (3) inner setting—structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs—knowledge and belief about the intervention; (5) process—planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating.ConclusionThis study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care.Trial registration numberNCT02789800.
Prehospital major incident management: how do training and real-life situations relate? A qualitative study
Authors: Hugelius Karin , Edelbring Samuel , Blomberg Karin 
Published: September 2021

ObjectiveTo explore the relationship between preparations and real-life experiences among prehospital major incident commanders.DesignAn explorative, qualitative design was used.SettingPrehospital major incidents in Sweden. Data were collected between December 2019 and August 2020.ParticipantsPrehospital major incident commanders (n=15) with real-life experiences from major events, such as fires, bus accidents, a bridge collapse and terrorist attacks, were included. All but one had participated in 2-day training focusing on the prehospital management of major incidents. In addition, about half of the participants had participated in simulation exercises, academic courses and other training in the management of major incidents.MethodsData from two-session individual interviews were analysed using inductive thematic analysis.ResultsThe conformity between real-life major incidents and preparations was good regarding prehospital major incident commanders’ knowledge of the operational procedures applied in major incidents. However, the preparations did not allow for the complexities and endurance strategies required in real-life incidents. Personal preparations, such as mental preparedness or stress management, were not sufficiently covered in the preparations. To some extent, professional experience (such as training) could compensate for the lack of formal preparations.ConclusionsThis study identified perceived gaps between preparations and real-life experiences of being a prehospital major incident commander. To minimise the gaps between demands and expectations on perceived control and to better prepare individuals for being prehospital major incident commanders, the training and other preparations should reflect complexities of real-life incidents. Preparations should develop both technical skills required, such as principles and methodology used, and personal preparedness. Personal preparations should include improving one’s mental preparedness, self-knowledge and professional self-confidence required to successfully act as a prehospital incident commander. Since little is known about what pedagogical methods that should be used to enhance this, further research is needed.
Preferences for pre-exposure prophylaxis (PrEP) among men who have sex with men and transgender women at risk of HIV infection: a multicentre protocol for a discrete choice experiment in Brazil
Authors: Pereira Claudia Cristina de Aguiar , Torres Thiago Silva , Luz Paula Mendes , Hoagland Brenda , Farias Alessandro , Brito Jose David Urbaez , Guimarães Lacerda Marcus Vinícius , da Silva Daila Alena Raenck , Benedetti Marcos , Pimenta Maria Cristina , Grinsztejn Beatriz , Veloso Valdilea Gonçalves 
Published: September 2021

IntroductionPre-exposure prophylaxis (PrEP) is an important and well-established prevention strategy for sexual acquisition of HIV. In Brazil, transgender women (TGW) and men who have sex with men (MSM) bear the largest burden among key populations. Little is known about preferences for PrEP characteristics in these vulnerable populations in Latin America. The goal of this study is to investigate preferences of TGW and MSM with respect to PrEP characteristics, whether current user or not, and to assess any attributes and levels that may improve the decision to start using PrEP (uptake) and optimal continuity of use (adherence), which are important dimensions for PrEP success.Methods and analysisWe hereby outline the protocol of a discrete choice experiment (DCE) to be conducted among TGW and MSM in Brazil. The study will be carried out in two phases. The first phase involves literature review and qualitative approaches including in-depth interviews to inform the development of the DCE (attributes and levels). The second phase entails the DCE survey and supporting questions pertaining to sociodemographic and risk behaviour information. The survey is aimed at current PrEP users and non-users, consisting of two modes of administration: face to face in five Brazilian capitals (Rio de Janeiro, Brasília, Manaus, Porto Alegre and Salvador) and online targeting the entire country. A D-efficient zero-prior blocked experimental design will be used to select 60 paired-profile DCE choice tasks, in which participants will be randomly assigned to one of four groups and presented with a set of 15 choice tasks. The planned sample size is 1000 volunteers.Ethics, timeline and disseminationThe study was approved by Comitê de Ética em Pesquisa—Instituto Nacional de Infectologia Evandro Chagas—INI/FIOCRUZ, CEP/INI, CAAE 28416220.2.1001.5262, approval number 3.979.759 in accordance with the Comissão Nacional de Ética em Pesquisa (CONEP—Brazilian National Board of Research Ethics). The study will be conducted between 2020 and 2021. The results will be disseminated to the scientific community and to the public in general through publications in published in peer-reviewed journals and in scientific conferences.
Temocillin versus meropenem for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistantEnterobacterales(ASTARTÉ): protocol for a randomised, pragmatic trial
Authors: Marín-Candón Alicia , Rosso-Fernández Clara M , Bustos de Godoy Natalia , López-Cerero Lorena , Gutiérrez-Gutiérrez Belén , López-Cortés Luis Eduardo , Barrera Pulido Lydia , Borreguero Borreguero Irene , León María José , Merino Vicente , Camean-Fernández Manuel , Retamar Pilar , Salamanca Elena , Pascual Alvaro , Rodriguez-Baño Jesús 
Published: September 2021

IntroductionAlternatives to carbapenems are needed in the treatment of third-generation cephalosporin-resistantEnterobacterales(3GCR-E). Temocillin is a suitable candidate, but comparative randomised studies are lacking. The objective is to investigate if temocillin is non-inferior to carbapenems in the targeted treatment of bacteraemia due to 3GCR-E.Methods and analysisMulticentre, open-label, randomised, controlled, pragmatic phase 3 trial. Patients with bacteraemia due to 3GCR-E will be randomised to receive intravenously temocillin (2 g three times a day) or carbapenem (meropenem 1 g three times a day or ertapenem 1 g once daily). The primary endpoint will be clinical success 7–10 days after end of treatment with no recurrence or death at day 28. Adverse events will be collected; serum levels of temocillin will be investigated in a subset of patients. For a 10% non-inferiority margin, 334 patients will be included (167 in each study arm). For the primary analysis, the absolute difference with one-sided 95% CI in the proportion of patients reaching the primary endpoint will be compared in the modified intention-to-treat population.Ethics and disseminationThe study started after approval of the Spanish Regulatory Agency and the reference institutional review board. Data will be published in peer-reviewed journals.Trial registration numberNCT04478721.
Assessing knowledge, attitude, practice and training related to COVID-19: a cross-sectional survey of frontline healthcare workers in Nigeria
Authors: Iheanacho Theddeus , Stefanovics Elina , Okoro Ugochi Genevieve , Anyaehie Udo Ego , Njoku Paschal Okuchi , Adimekwe Anthony Ikenna , Ibediro Kingsley , Stefanovics Glenn A , Haeny Angela , Jackson Asti , Unamba Norbert Ndubuisi , Isiguzo Godsent , Chukwu Chinedu Chukwukiro , Anyaehie Ugochukwu Bond , Mbam Thomas Terence , Osy-Eneze Chinyere , Ibezim Ebere Otuomasirichi 
Published: September 2021

ObjectivesHealthcare workers (HCWs) are at the frontline of efforts to treat those affected by COVID-19 and prevent its continued spread. This study seeks to assess knowledge, attitude and practice (KAP) as well as training needs and preferences related to COVID-19 among frontline HCWs in Nigeria.SettingA cross-sectional survey was carried out among 1852 HCWs in primary, secondary and tertiary care settings across Nigeria using a 33-item questionnaire.ParticipantsRespondents included doctors, nurses, pharmacy and clinical laboratory professionals who have direct clinical contact with patients at the various healthcare settings.AnalysisExploratory factor analysis (EFA) was used to establish independent factors related to COVID-19 KAP. Analysis of variance was used to identify any differences in the factors among different categories of HCWs.ResultsEFA identified four factors: safety and prevention (factor 1), practice and knowledge (factor 2), control and mitigation (factor 3) and national perceptions (factor 4). Significant group differences were found on three factors: Factor 1 (F(1,1655)=5.79, p=0.0006), factor 3 (F(1,1633)=12.9, p<0.0.0001) and factor 4 (F(1,1655)=7.31, p<0.0001) with doctors scoring higher on these three factors when compared with nurses, pharmaceutical workers and medical laboratory scientist. The most endorsed training need was how to reorganise the workplace to prevent spread of COVID-19. This was chosen by 61.8% of medical laboratory professionals, 55.6% of doctors, 51.7% of nurses and 51.6% of pharmaceutical health workers. The most preferred modes of training were webinars and conferences.ConclusionThere were substantial differences in KAP regarding the COVID-19 pandemic among various categories of frontline HCWs surveyed. There were also group differences on COVID-19 training needs and preferences. Tailored health education and training aimed at enhancing and updating COVID-19 KAP are needed, particularly among non-physician HCWs.
Assessment of time-related deficits in older adults: a scoping review protocol
Authors: Dsouza Sebestina Anita , Ramachandran Meena , Nishiura Yuko , Venkatesh Bhumika Tumkur , Dahlberg Lena 
Published: September 2021

IntroductionPeople with cognitive impairments often have difficulties in managing their time for daily activities. In older adults with cognitive impairments such as dementia and stroke, these may present as disorientation, poor time awareness, time perception, daily time management and so on. Time-related deficits and associated behaviours impede independent living and add considerably to caregiver strain. Several interventions are being investigated to help people with cognitive impairments orient and navigate time and do their daily activities. The provision of interventions requires the use of sound assessment tools. However, it is not clear how time-related concepts are specifically evaluated in practice, what are the available assessments and how these assessments should be selected.Method and analysisThis protocol follows the Joanna Briggs Institute Reviewer’s Manual (2020) for scoping reviews and is registered with the Open Science Framework (https://osf.io/4ptgy/). We will include the following databases: PubMed, CINAHL, Scopus, Web of Science and PsycINFO. Two reviewers will independently screen eligible studies for inclusion against the selection criteria and then review the full-text of the selected studies. We will extract the bibliographic data, study design and setting, and details of assessments used in the studies to evaluate time-related concepts including format, mode and duration of administration, psychometric properties and so on. The identified assessments will be mapped with regard to time-related concepts being evaluated and described using narrative synthesis.Ethics and disseminationAs secondary data analysis, ethics approval is not required for this scoping review. We plan to disseminate the results through peer-reviewed journals and conferences targeting health professionals working with older adults.