bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of multimorbidity networks associated with different factors in Northeast China: a cross-sectional analysis
Authors: Yu Jianxing , Li Yingying , Zheng Zhou , Jia Huanhuan , Cao Peng , Qiangba Yuzhen , Yu Xihe 
Published: November 2021

ObjectivesThis study aimed to identify and study the associations and co-occurrence of multimorbidity, and assessed the associations of diseases with sex, age and hospitalisation duration.DesignCross-sectional.Setting15 general hospitals in Jilin Province, China.ParticipantsA total of 431 295 inpatients were enrolled through a cross-sectional study in Jilin Province, China.Primary outcome measuresThe complex relationships of multimorbidity were presented as weighted networks.ResultsThe distributions of the numbers of diseases differed significantly by sex, age and hospitalisation duration (p<0.001). Cerebrovascular diseases (CD), hypertensive diseases (HyD), ischaemic heart diseases (IHD) and other forms of heart disease (OFHD) showed the highest weights in the multimorbidity networks. The connections between different sexes or hospitalisation duration and diseases were similar, while those between different age groups and diseases were different.ConclusionsCD, HyD, IHD and OFHD were the central points of disease clusters and directly or indirectly related to other diseases or factors. Thus, effective interventions for these diseases should be adopted. Furthermore, different intervention strategies should be developed according to multimorbidity patterns in different age groups.
Cost-effectiveness of custom-made insoles versus usual care in patients with plantar heel pain in primary care: cost-effectiveness analysis of a randomised controlled trial
Authors: Rasenberg Nadine , van Middelkoop Marienke , Bierma-Zeinstra Sita M A , El Alili Mohamed , Bindels Patrick , Bosmans J 
Published: November 2021

ObjectivesTo evaluate the cost-effectiveness of custom-made insoles compared with general practitioner (GP)-led usual care after 26 weeks of follow-up in individuals with plantar heel pain (PHP) from a societal perspective.DesignCost-effectiveness analysis of a double-blinded randomised controlled trial.SettingGeneral practice in the Netherlands.Participants116 participants with PHP for at least 2 weeks, aged 18–65 years and presenting to the GP.InterventionsParticipants were randomised to GP-led usual care (n=46) or referral to a podiatrist for treatment with a custom-made insole (n=70). Participant randomised to a sham insole (n=69) were excluded from this analysis.Primary and secondary outcomesOutcomes comprised pain during rest and activity, and quality of life. Costs included healthcare and lost productivity costs. Statistical uncertainty was estimated using bootstrapping and presented using cost-effectiveness acceptability curves.ResultsParticipants in the custom-made insole group experienced statistically significant more pain during activity at 26 weeks than participants in the usual care group (overall effect 1.06; 95% CI 0.36 to 1.75). There were no significant differences between groups in other outcomes. Total societal costs in the custom-made insole group were non-significantly higher than in the usual care group (mean difference €376; 95% CI −€1775 to €2038). The intervention with custom-made insoles was dominated by usual care by the GP (ie, more expensive and less effective) for pain during activity and quality of life outcomes. For the outcome pain at rest, the intervention was more expensive and more effective than usual care. However, the maximum probability of cost-effectiveness was only 0.59 at very high ceiling ratios.ConclusionsThese findings show that that custom-made insoles are not cost-effective in comparison with GP-led usual care. Clinicians should be reserved in prescribing custom-made insoles for PHP as a primary intervention.Trial registration numberNTR5346.
ROBOCOP II (ROBOtic assisted versus conventional open partial nephrectomy) randomised, controlled feasibility trial: clinical trial protocol
Authors: Kowalewski Karl-Friedrich , Sidoti Abate Marie Angela , Neuberger Manuel , Kirchner Marietta , Krisam Regina , Egen Luisa , Haney Caelan Max , Siegel Fabian , Michel Maurice-Stephan , Honeck Patrick , Nuhn Philipp , Westhoff Niklas , Kriegmair Maximilian Christian 
Published: November 2021

IntroductionRandomised controlled trials comparing robotic-assisted partial nephrectomy (RAPN) and open PN (OPN) are lacking. Therefore, we aim to report the study protocol and a trial update for a randomised controlled feasibility trial comparing RAPN versus OPN for renal neoplasms.Methods and analysisThe ROBOtic assisted versus conventional Open Partial nephrectomy II trial is designed as a single-centre, randomised, open-label, feasibility trial. Participation will be offered to patients with renal neoplasms and deemed feasible for both, OPN and RAPN. We aim to enrol 50 patients within 15 months using a 1:1 allocation ratio. The primary endpoint of the trial is feasibility of recruitment and will be successful if one third of eligible patients agree to participate. Secondary endpoints include perioperative results, health-related quality of life, inflammatory response as well as surgical ergonomics of the operating team. If the primary outcome, feasibility of recruitment, is successful, the secondary results of the trial will be used for planning a confirmative phase III trial.Ethics and disseminationEthical approval was obtained from the local institutional review board (Ethik-Kommission II at Heidelberg University: 2020-542N). Results will be made publicly available in peer-reviewed scientific journals and presented at appropriate congresses and social media.Trial registration numberNCT04534998.
What are healthcare workers’ preferences for hand hygiene interventions? A discrete choice experiment
Authors: Chen Wenlin , Tseng Chung-Li 
Published: November 2021

ObjectivesTo understand the key attributes in designing effective interventions for improving healthcare workers’ (HCWs’) hand hygiene compliance and HCWs’ preference for these attributes.DesignA discrete choice experiment (DCE) was conducted with five attributes extracted from the framework of Total Quality Management that can be applied in the design of hand hygiene interventions. They were hand hygiene monitoring, open discussion, message framing, resources accessibility and top management involvement. An addition attribute, peer hand hygiene performance, was considered as a contextual factor. Data were analysed by a conditional logit model to evaluate how these attributes impact HCWs’ hand hygiene compliance.SettingThe DCE was conducted with participants from a university hospital in Taichung.ParticipantsHCWs involved in daily patient-care activities (N=387).ResultsTo enhance their compliance, HCWs had strong and consistent preferences in having open discussion of hand hygiene problems (β=0.4977,p§amp;lt;0.001), easy access to hand hygiene resources (β=0.5633,p§amp;lt;0.001) and top management involvement (β=0.4779,p§amp;lt;0.001). For hand hygiene monitoring (β=-0.1259,p§amp;lt;0.1), HCWs preferred to be monitored by infection control staff over their department head if their peer hand hygiene performance was low. On the other hand, when the peer performance was high, monitoring by their department head could improve their hand hygiene compliance. Similarly, how educational messages were framed impacted compliance and also depended on the peer hand hygiene performance. When the peer performance was low, HCWs were more likely to increase their compliance in reaction to loss-framed educational messages (β=0.1211,p§amp;lt;0.1). When the peer performance was high, gain-framed messages that focus on the benefit of compliance were more effective in inducing compliance.ConclusionsEach intervention design has its unique impact on HCWs’ hand hygiene compliant behaviour. The proposed approach can be used to evaluate HCWs’ preference and compliance of an intervention before it is implemented.
Sex ratios and ‘missing women’ among Asian minority and migrant populations in Aotearoa/New Zealand: a retrospective cohort analysis
Authors: Simon-Kumar Rachel , Paynter Janine , Chiang Annie , Chabba Nimisha 
Published: November 2021

ObjectivesRecent research from the UK, USA, Australia and Canada point to male-favouring sex ratios at birth (SRB) among their Asian minority populations, attributed to son preference and sex-selective abortion within these cultural groups. The present study conducts a similar investigation of SRBs among New Zealand’s Asian minority and migrant populations, who comprise 15% of the population.Setting and participantsThe study focused on Asian populations of New Zealand and comparisons were made with NZ European, Māori, Pacific Island and Middle-Eastern, Latin American and African groups. Secondary data were obtained from the New Zealand historical census series between 1976 and 2013 and a retrospective birth cohort in New Zealand was created using the Stats NZ Integrated Data Infrastructure from 2003 to 2018.Primary and secondary outcome measuresThe primary outcome measure was SRBs and sex ratios between the ages 0 and 5 by ethnicity. A logistic regression was conducted and adjusted for selected variables of interest including visa group, parity, maternal age and deprivation. Finally, associations between family size, ethnicity and family sex composition were examined in a subset of this cohort (families with two or three children).ResultsThere was no evidence of ‘missing women’ or gender bias as indicated by a deviation from the biological norm in New Zealand’s Asian population. However, Indian and Chinese families were significantly more likely to have a third child if their first two children were female compared with two male children.ConclusionThe analyses did not reveal male-favouring sex ratios and any conclusive evidence of sex-selective abortion among Indian and Chinese populations. Based on these data, we conclude that in comparison to other western countries, New Zealand’s Asian migrant populations present as an anomaly. The larger family sizes for Indian and Chinese populations where the first two children were girls suggested potentially ‘soft’ practices of son preference.
Risk of infection and contribution to transmission of SARS-CoV-2 in school staff: a systematic review
Authors: Karki Sudip Jung , Joachim Alexandar , Heinsohn Torben , Lange Berit 
Published: November 2021

ObjectiveTo summarise the comparative risk of infection in school staff and their contribution to SARS-CoV-2 transmission.DesignSystematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.Data sourcesMEDLINE, WHO COVID-19 database and preView were searched on 29 January 2021.Eligibility criteriaWe included studies that reported risk of SARS-CoV-2 infection in school staff or transmission of SARS-CoV-2 in school settings.Data extraction and synthesisData extraction was done in duplicates. Data synthesis was qualitative. We report attack rates and infection risk in school settings for staff and students stratified by control measures taken and infection dynamics at the point of data collection.ResultsEighteen studies were included. Three studies in low incidence settings showed low attack rates similar for teachers and students. Five studies in medium incidence settings and two studies in high incidence settings showed secondary attack rates up to 16% in school staff.Seroprevalence studies, two in each low and high incidence settings showed an infection risk of 0%–0.2% and 1.7%–28% for teachers.The risk of infection for teachers compared with students were similar in one study in low incidence setting, higher in three studies (RR 1.2–4.4) and lower in three studies in medium to high incidence settings. The risk of infection for teachers in a high infection environment is higher in face-to-face than in distance classes when compared with general population groups. The risk of infections as well as risk of hospitalisation both increased for teachers during school openings compared with school closure.ConclusionWhile in low incidence settings there is little evidence for school staff to be at high risk of SARS-CoV-2 infection, in high incidence settings there is an increased risk of SARS-CoV-2 infection in school staff teaching face-to-face compared to staff teaching digitally and general population.PROSPERO registration numberCRD42021239225.
Characteristics, interventions and outcomes of patients with valvular heart disease hospitalised in China: a cross-sectional study
Authors: Huang Xinghe , Dhruva Sanket S , Yuan Xin , Bai Xueke , Lu Yuan , Yan Xiaofang , Liu Jiamin , Li Wei , Hu Danli , Ji Runqing , Gao Min , Miao Fengyu , Li Jiaying , Ge Jinzhuo , Krumholz Harlan M , Li Jing 
Published: November 2021

ObjectivesLittle is known about contemporary characteristics and management of valvular heart disease (VHD) in China. This study aimed to examine the clinical characteristics, aetiology and type of VHD, interventions and in-hospital outcomes of patients with VHD hospitalised in China.MethodsWe used a two-stage random sampling design to create a nationally representative sample of patients with VHD hospitalised in 2015 in China and included adult patients with mild, moderate or severe VHD. We abstracted data from medical records, including echocardiogram reports, on patient characteristics, aetiology, type and severity of VHD, interventions and in-hospital outcomes. We weighted our findings to estimate nationally representative hospitalisations. We performed multivariable logistic regression analysis to identify factors associated with valve intervention.ResultsIn 2015, 38 841 patients with VHD were hospitalised in 188 randomly sampled hospitals, representing 662 384 inpatients with VHD in China. We sampled 9363 patients, mean age 68.7 years (95% CI 42.2 to 95.2) and 46.8% (95% CI 45.8% to 47.8%) male, with an echocardiogram. Degenerative origin was the predominant aetiology overall (33.3%, 95% CI 32.3% to 34.3%), while rheumatic origin was the most frequent aetiology among patients with VHD as the primary diagnosis (37.4%, 95% CI 35.9% to 38.8%). Rheumatic origin was also the most common aetiology among patients with moderate or severe VHD (27.3%, 95% CI 25.6% to 29.0% and 33.6%, 95% CI 31.9% to 35.2%, respectively). The most common VHD was mitral regurgitation (79.1%, 95% CI 78.2% to 79.9%), followed by tricuspid regurgitation (77.4%, 95% CI 76.5% to 78.2%). Among patients with a primary diagnosis of severe VHD who were admitted to facilities capable of valve intervention, 35.6% (95% CI 33.1% to 38.1%) underwent valve intervention during the hospitalisation. The likelihood of intervention decreased significantly among patients with higher operative risk.ConclusionsAmong patients with VHD hospitalised in China, the predominant aetiology was degenerative in origin; among patients with moderate or severe VHD, rheumatic origin was the most common aetiology. Targeted strategies and policies should be promoted to address degenerative VHD. Patients with severe VHD may be undertreated, particularly those with high operative risk.
Evaluation of an early career clinical academic training programme using the CIPP model
Authors: Burke Elaine , Hennessy Martina 
Published: November 2021

ObjectivesThis study describes the successful implementation and outputs of a combined clinical academic training programme for doctors in their first postgraduate year in Ireland, the Academic Internship Track (AIT).DesignThe AIT was evaluated using the Context, Input, Process and Product model. Literature reviews, meetings with key stakeholders, reviews of similar established programmes overseas, a survey of undergraduate medical students, exit survey, scientific outputs and career trajectory monitoring were all implemented in the programme evaluation.SettingThe AIT represents collaboration amongst all six intern training networks in Ireland.ResultsKey stakeholders indicated support and significant interest in establishing the AIT. The input evaluation informed programme design which incorporates protected time to carry out a research project, a named supervisor, a bursary and access to dedicated study days. Since the programme’s launch in 2017, there has been 100% uptake of posts and 0% attrition. Exiting participants indicate high levels of satisfaction with the programme; 92% reported having benefited from participation. Over 90% intend remaining in Ireland in both the immediate and longer terms. Fifty-seven per cent of participants in the first 3 years of the programme had succeeded in publishing a research article or review paper in a peer-reviewed journal.ConclusionsNow in its fourth year, AIT remains a highly sought-after programme and is perceived to be beneficial to one’s career. Participants in the programme have contributed significantly to their field of interest despite being in the earliest career stages. The programme has the potential to help retain medical talent in Ireland.
Healthcare utilisation of patients with cholecystolithiasis in primary care: a multipractice comparative analysis
Authors: Thunnissen Floris Martijn , Drager Luuk David , Braak Breg , Drenth Joost P H , van Laarhoven Cornelis J H M , Schers Henk J , de Reuver Philip R 
Published: November 2021

ObjectivesTo examine general practitioners’ (GP) management of cholecystolithiasis and to evaluate persisting abdominal complaints in the years after the diagnosis.DesignRetrospective analysis of registry data and a subset of individual medical records.SettingSeventeen primary care practices affiliated with the Radboudumc Practice Based Research Network in the Netherlands.Participants633 patients with cholecystolithiasis diagnosed between 2012 and 2016.Primary and secondary outcome measuresThe primary outcome of this study was the healthcare utilisation of patients with cholecystolithiasis diagnosed by the GP in terms of referrals to secondary care, laboratory diagnostics, prescribed medication and the prevalence of concomitant abdominal-related diagnoses in a time interval of 3 years before and 3 years after diagnosis of cholecystolithiasis. For secondary outcomes, electronic medical records were studied from seven practices to assess emergency department visits, operation rates and repeat visits for persistent abdominal symptoms. We compared the non-referred group with the referred group.ResultsIn 57% of patients, concomitant abdominal-related diagnoses were recorded besides the diagnosis cholecystolithiasis. In-depth analyses of 294 patients showed a referral rate of 79.3% (n=233); 62.9% (n=185) underwent cholecystectomy. After referral, 55.4% (129/233) returned to the GP for persistent abdominal symptoms. Patients returning after referral were more often treated for another abdominal-related diagnosis before cholecystolithiasis was recorded (51.9% vs 28.8%, p<0.001).ConclusionsThe majority of patients in general practice with gallstones are referred and undergo cholecystectomy. Patients with concomitant abdominal-related diagnoses are likely to return to their physician. GPs should inform patients about these outcomes to improve the shared decision-making process before gallbladder surgery.
Preparing social workers to address health inequities emerging during the COVID-19 pandemic by building capacity for health policy: a scoping review protocol
Authors: Ashcroft Rachelle , Lam Simon , Kourgiantakis Toula , Begun Stephanie , Nelson Michelle L A , Adamson Keith , Cadell Susan , Walsh Benjamin , Greenblatt Andrea , Hussain Amina , Sur Deepy , Sirotich Frank , Craig Shelley L 
Published: November 2021

IntroductionThe COVID-19 pandemic has brought tremendous changes in healthcare delivery and exacerbated a wide range of inequities. Social workers across a broad range of healthcare settings bring an expertise in social, behavioural and mental healthcare needed to help address these health inequities. In addition, social workers integrate policy-directed interventions and solutions in clinical practice, which is a needed perspective for recovery from the COVID-19 pandemic. It remains unclear, however, what the most pressing policy issues are that have emerged during the COVID-19 pandemic. In addition, many social workers in health settings tend to underuse policy in their direct practice. The objectives of this scoping review are to: (1) systematically scope the literature on social work, COVID-19 pandemic and policy; and (2) describe the competencies required by social workers and the social work profession to address the policy issues emerging during the COVID-19 pandemic.Methods and analysisThe scoping review follows Arksey and O’Malley’s five-stage framework. Identification of literature published between 1 December 2019 and the search date, 31 March 2021, will take place in two stages: (1) title and abstract review, and (2) full-text review. In partnership with a health science librarian, the research team listed keywords related to social work and policy to search databases including Medline, Embase, PsycINFO, CINAHL, Social Services Abstract and Social Work Abstracts. Two graduate-level research assistants will conduct screening and full-text review. Data will then be extracted, charted, analysed and summarised to report on our results and implications on practice, policy and future research.Ethics and disseminationResults will help develop a policy practice competence framework to inform how social workers can influence policy. We will share our findings through peer-reviewed publications and conference presentations. This study does not require Research Ethics Board approval as it uses publicly available sources of data.
Efficacy of anti-TNF dosing interval lengthening in adolescents and young adults with inflammatory bowel disease in sustained remission (FREE-study): protocol for a partially randomised patient preference trial
Authors: Bouhuys Marleen , Lexmond Willem S , Dijkstra Gerard , Lobatón Triana , Louis Edouard , van Biervliet Stephanie , Groen Henk , Guardiola Jordi , Rheenen Patrick van 
Published: November 2021

IntroductionAnti-tumour necrosis factor (TNF) therapy has greatly improved treatment outcomes in patients with inflammatory bowel disease (IBD), but long-term use is associated with cutaneous reactions, susceptibility to infections and frequent injections or hospital visits. Several non-controlled studies have demonstrated that dose reduction is feasible for a subset of patients, provided that early detection of a disease flare is possible. Here, we aim to compare the effectiveness of interval lengthening with standard dosing in maintaining remission in young patients with IBD.Methods and analysisIn this international, prospective, non-inferiority, partially randomised patient preference trial, we aim to recruit 148 patients aged 12–25 years with luminal Crohn’s disease or ulcerative colitis in sustained remission (ie, three consecutive in-range faecal calprotectin (FC) results or recently confirmed endoscopic remission). In the interventional arm, the dosing interval will be lengthened from 8 to 12 weeks for infliximab users and from 2 to 3 weeks for adalimumab users. In the control group, standard dosing will be continued. Rapid tests will be performed for FC every 4 weeks and for anti-TNF trough levels every 12 weeks. The primary outcome is the cumulative incidence of out-of-range FC results at 48-week follow-up. Secondary endpoints include time to get out-of-range FC results, cumulative incidence of adverse effects, proportion of patients progressing to loss of response and identification of predictors of successful interval lengthening.Ethics and disseminationThe protocol has been approved by the Medical Ethics Review Committee of the University Medical Centre Groningen and is pending at the other participating centres. Results will be disseminated in peer-reviewed journals and presented at scientific meetings.Trial registration numberEudraCT number: 2020-001811-26; ClinicalTrials.gov Identifier:NCT04646187. Protocol version 4, date 17 September 2021.