bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of pulse oximetry on hospital referral acceptance in children under 5 with severe pneumonia in rural Pakistan (district Jamshoro): protocol for a cluster randomised trial
Authors: Mir Fatima , Ali Nathwani Apsara , Chanar Suhail , Hussain Amjad , Rizvi Arjumand , Ahmed Imran , Memon Zahid Ali , Habib Atif , Soofi Sajid , Bhutta Zulfiqar Ahmed 
Published: September 2021

BackgroundPneumonia is a leading cause of death among children under 5 specifically in South Asia and sub-Saharan Africa. Hypoxaemia is a life-threatening complication among children under 5 with pneumonia. Hypoxaemia increases risk of mortality by 4.3 times in children with pneumonia than those without hypoxaemia. Prevalence of hypoxaemia varies with geography, altitude and severity (9%–39% Asia, 3%–10% African countries). In this protocol paper, we describe research methods for assessing impact of Lady Health Workers (LHWs) identifying hypoxaemia in children with signs of pneumonia during household visits on acceptance of hospital referral in district Jamshoro, Sindh.Methods and analysisA cluster randomised controlled trial using pulse oximetry as intervention for children with severe pneumonia will be conducted in community settings. Children aged 0–59 months with signs of severe pneumonia will be recruited by LHWs during routine visits in both intervention and control arms after consent. Severe pneumonia will be defined as fast breathing and/or chest in-drawing, and, one or more danger sign and/or hypoxaemia (Sa02 <92%) in PO (intervention) group and fast breathing and/or chest in-drawing and one or more danger sign in clinical signs (control) group. Recruits in both groups will receive a stat dose of oral amoxicillin and referral to designated tertiary health facility. Analysis of variance will be used to compare baseline referral acceptance in both groups with that at end of study.Ethics and disseminationEthical approval was granted by the Ethics Review Committee of the Aga Khan University (4722-Ped-ERC-17), Karachi. Study results will be shared with relevant government and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals.Trial registration numberNCT03588377.
Comparison of three different exercise training modalities (aerobic, strength and mixed) in patients with schizophrenia: study protocol for a multicentre randomised wait-list controlled trial
Authors: García-Garcés Laura , Lacamara Cano Sergio , Cebolla Meliá Yago , Sánchez-López María I , Marqués Azcona David , Lisón Juan Francisco , Peyró-Gregori Loreto 
Published: September 2021

IntroductionNumerous studies support the practice of different physical exercise modalities as an effective treatment to address the problems associated with schizophrenia, reporting that they result in improvements in patient symptoms and quality of life. Given the lack of studies comparing different types of training in controlled environments, the aim of this proposed study will be to compare the effects of three physical exercise programmes (strength, aerobic and mixed) on the symptoms, body composition, level of physical activity and health-related quality of life of patients with schizophrenia.Methods and analysisA multicentre, single-blinded (evaluator), randomised, wait-list controlled (ratio 2:2:2:1) trial will be conducted with 105 patients recruited from different psychosocial care centres. The participants will be randomised into three 16-week training groups comprising 48 sessions lasting 1 hour each, or to the wait-list control group. The training groups will complete aerobic, strength or mixed (aerobic+strength) training. The participants will be assessed before, immediately after and 6 months after the end of the intervention. The patients in the wait-list control group (n=15) will receive one of the three trainings immediately after the intervention. The study variables will include positive, negative and general symptomology (Positive and Negative Syndrome Scale) as the primary outcome; as secondary outcome: body composition (by assessing body mass index, body fat mass and waist circumference), physical activity levels (International Physical Activity Questionnaire-Short Form) and quality of life (abbreviated WHO Quality of Life questionnaire).Ethics and disseminationThis study was approved by the ethics committees for Biomedical Research at the CEU Cardenal Herrera University of Valencia, Spain (CEI18/215). Participants will be fully informed of the purpose and procedures of the study, and written informed consent will be obtained. The results from this study will be published in peer-reviewed journals and presented in scientific conferences.Trial registration numberNCT04987151.
Integrated Measurement for Early Detection (MIDO) as a digital strategy
for timely assessment of non-communicable disease profiles and factors
associated with unawareness and control: a retrospective observational study
in primary healthcare facilities in Mexico
Authors: Gallardo-Rincón Héctor , Montoya Alejandra , Saucedo-Martínez Rodrigo , Mújica-Rosales Ricardo , Suárez-Idueta Lorena , Martínez-Juárez Luis Alberto , Razo Christian , Lozano Rafael , Tapia-Conyer Roberto 
Published: September 2021

Objectives
The Carlos Slim Foundation implemented the Integrated Measurement
for Early Detection (MIDO), a screening strategy for non-communicable
diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital
health services focusing on healthcare delivery and
prevention/management of NCDs. We investigated the disease profile of
the screened population and evaluated MIDO’s contribution to the
continuum of care of the main NCDs.

Design
Using data from MIDO and the chronic diseases information system, we
quantified the proportion of the population screened and diagnosed with
NCDs, and measured care linkage/retention and level of control achieved.
We analysed comorbidity patterns and estimated prevalence of predisease
stages. Finally, we estimated characteristics associated with
unawareness and control of NCDs, and examined efficacy of the CASALUD
model in improving NCD control.

Setting
Public primary health centres in 27/32 Mexican states.

Participants
Individuals aged ≥20 years lacking healthcare access.

Results
From 2014 to 2018, 743 000 individuals were screened using MIDO. A
predisease or disease condition was detected in ≥70% of the population
who were unaware of their NCD status. The screening identified 38 417
new cases of type 2 diabetes, 53 133 new cases of hypertension and
208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of
individuals with available blood samples. Comorbidities were highly
prevalent, especially in people with obesity. Only 5.47% (n=17 774) of
individuals were linked with their corresponding primary health centre.
Factors associated with unawareness of and uncontrolled NCDs were sex,
age, and social determinants, for example, rural/urban environment,
access to healthcare service, and education level. Patients with type 2
diabetes treated at clinics under the CASALUD model were more likely to
achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61).

Conclusion
Patient-centred screening strategies such as MIDO are urgently
needed to improve screening, access, retention and control for patients
with NCDs.
Effectiveness and safety of ivermectin in the treatment of COVID-19: protocol for a systematic review and meta-analysis
Authors: Machado Maria Letícia de Lima , Souza Amaxsell Thiago Barros , Linhares Paula Vívian Andrade , Martins Ferreira Caio Fernando , Oliveira Silva David Franciole , Martins Rand Randall , Cobucci Ricardo Ney 
Published: September 2021

IntroductionIvermectin is a drug with antiviral properties and has been proposed as an alternative treatment for patients with COVID-19, in some countries; however, there is limited evidence to support its clinical use. Accordingly, the aim of this review and meta-analysis is to obtain superior evidence on the effectiveness and safety of ivermectin in treatment of COVID-19.Methods and analysisWe will search in the medical databases and International Clinical Trials Registry Platform databases for randomised clinical trials and quasi-randomised trials published from December 2019. The criteria for inclusion are that infection needs to be confirmed by a real-time PCR or serology test, and the effect of ivermectin has been compared with placebo, symptomatic treatment or no treatment. We will exclude observational studies and clinical trials that involved patients with symptoms suggestive of COVID-19, but without a laboratorial diagnosis. Outcomes of interest include mortality, time to symptom resolution, time of hospitalisation, frequency of invasive mechanical ventilation and extracorporeal membrane oxygenation, incidence of severe acute respiratory syndrome, admission to intensive care unit, viral load, PCR-negative status, percentage of infection after prophylactic use, and total incidence of adverse and side effects. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers will independently select the studies and assess their eligibility. Two other reviewers will independently extract data from each study. Meta-analysis will then be carried out using fixed-effects or random-effects model, using the mean difference for continuous outcomes and the relative risk for dichotomous outcomes. Bias risk will be assessed using the Cochrane risk-of-bias tool. The quality of evidence for each outcome will be assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Review Manager V.5.3.5 will be used for synthesis and subgroup analysis.Ethics and disseminationOwing to the nature of the review, ethical approval is not required. The results will be disseminated through peer-reviewed publications.PROSPERO registration numberCRD42020197395.
The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH): protocol for a prospective longitudinal cohort study of healthcare and ancillary workers in UK healthcare settings
Authors: Woolf Katherine , Melbourne Carl , Bryant Luke , Guyatt Anna L , McManus I Chris , Gupta Amit , Free Robert C , Nellums Laura , Carr Sue , John Catherine , Martin Christopher A , Wain Louise V , Gray Laura J , Garwood Claire , Modhwadia Vishant , Abrams Keith R , Tobin Martin D , Khunti Kamlesh , Pareek Manish 
Published: September 2021

IntroductionThe COVID-19 pandemic has resulted in significant morbidity and mortality and devastated economies globally. Among groups at increased risk are healthcare workers (HCWs) and ethnic minority groups. Emerging evidence suggests that HCWs from ethnic minority groups are at increased risk of adverse COVID-19-related outcomes. To date, there has been no large-scale analysis of these risks in UK HCWs or ancillary workers in healthcare settings, stratified by ethnicity or occupation, and adjusted for confounders. This paper reports the protocol for a prospective longitudinal questionnaire study of UK HCWs, as part of the UK-REACH programme (The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers).Methods and analysisA baseline questionnaire will be administered to a national cohort of UK HCWs and ancillary workers in healthcare settings, and those registered with UK healthcare regulators, with follow-up questionnaires administered at 4 and 8 months. With consent, questionnaire data will be linked to health records with 25-year follow-up. Univariate associations between ethnicity and clinical COVID-19 outcomes, physical and mental health, and key confounders/explanatory variables will be tested. Multivariable analyses will test for associations between ethnicity and key outcomes adjusted for the confounder/explanatory variables. We will model changes over time by ethnic group, facilitating understanding of absolute and relative risks in different ethnic groups, and generalisability of findings.Ethics and disseminationThe study is approved by Health Research Authority (reference 20/HRA/4718), and carries minimal risk. We aim to manage the small risk of participant distress about questions on sensitive topics by clearly participant information that the questionnaire covers sensitive topics and there is no obligation to answer these or any other questions, and by providing support organisation links. Results will be disseminated with reports to Government and papers submitted to pre-print servers and peer reviewed journals.Trial registration numberISRCTN11811602; Pre-results.
Facilitators and barriers to using telepresence robots in aged care settings: a scoping review protocol
Authors: Smith Chelsea , Gregorio Mario , Hung Lillian 
Published: September 2021

IntroductionSocial isolation is a significant issue in aged care settings (eg, long-term care (LTC) and hospital) and is associated with adverse outcomes such as reduced well-being and loneliness. Loneliness is linked with depression, anxiety, cognitive decline, weakened immune system, poor physical health, poor quality of life and mortality. The use of robotic assistance may help mitigate social isolation and loneliness. Although telepresence robots have been used in healthcare settings, a comprehensive review of studies focusing on their use in aged care for reducing social isolation requires further investigation. This scoping review will focus on the use of telepresence robots to support social connection of older people in care settings.Methods and analysisThis scoping review will follow Joanna Briggs Institute scoping review methodology. The review team consists of patient partners and family partners, a nurse researcher and a group of students. In the scoping review, we will search the following databases: MEDLINE (Ovid), CINAHL, PsycINFO (EBSCO), Web of Science and ProQuest Dissertations & Theses Global. Google and Google Scholar will be used to search for additional literature. A handsearch will be conducted using the reference lists of included studies to identify additional relevant articles. The scoping review will consider studies of using a telepresence robotic technology with older adults in care settings (ie, LTC and hospital), published in English.Ethics and disseminationSince the methodology of the study consists of collecting data from publicly available articles, it does not require ethics approval. By examining the current state of using telepresence to support older people in care settings, this scoping review can offer useful insight into users’ needs (eg, patients’ and care providers’ needs) and inform future research and practice. We will share the scoping review results through conference presentations and an open access publication in a peer-reviewed journal.
Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2)
Authors: Marschner Simone , Chow Clara , Thiagalingam Aravinda , Simmons David , McClean Mark , Pasupathy Dharmintra , Smith Ben J , Flood Victoria , Padmanabhan Suja , Melov Sarah , Ching Cellina , Cheung N Wah 
Published: September 2021

IntroductionGestational diabetes (GDM) contributes substantially to the population burden of type 2 diabetes (T2DM), with a high long-term risk of developing T2DM. This study will assess whether a structured lifestyle modification programme for women immediately after a GDM pregnancy, delivered via customised text messages and further individualised using data from activity monitors, improves T2DM risk factors, namely weight, physical activity (PA) and diet.Methods and analysisThis multicentre randomised controlled trial will recruit 180 women with GDM attending Westmead, Campbelltown or Blacktown hospital services in Western Sydney. They will be randomised (1:1) on delivery to usual care with activity monitor (active control) or usual care plus activity monitor and customised education, motivation and support delivered via text messaging (intervention). The intervention will be customised based on breastfeeding status, and messages including their step count achievements to encourage PA. Messages on PA and healthy eating will encourage good lifestyle habits. The primary outcome of the study is healthy lifestyle composed of weight, dietary and PA outcomes, to be evaluated at 6 months. The secondary objectives include the primary objective components, body mass index, breastfeeding duration and frequency, postnatal depression, utilisation of the activity monitor, adherence to obtaining an oral glucose tolerance test post partum and the incidence of dysglycaemia at 12 months. Relative risks and their 95% CIs will be presented for the primary objective and the appropriate regression analysis, adjusting for the baseline outcome results, will be done for each outcome.Ethics and disseminationEthics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee (2019/ETH13240). All patients will provide written informed consent. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences.Trial registration numberACTRN12620000615987; Pre-results.
Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme
Authors: Jacob Prasobh , Gupta Poonam , Shiju Shiny , Omar Amr Salah , Ansari Syed , Mathew Gigi , Varghese Miki , Pulimoottil Jinsograce , Varkey Sumi , Mahinay Menandro , Jesus Darlene , Surendran Praveen 
Published: September 2021

Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient’s physical and psychological recovery following surgery. We observed that patients admitted to the cardiothoracic intensive care unit (CTICU) following cardiac surgery had only bed exercises and were confined to bed until the chest tubes were removed, which may have delayed patients achieving functional independence. Therefore, the CTICU team implemented a quality improvement (QI) project aimed at the early mobilisation of patients after cardiac surgery.A retrospective analysis was undertaken to define the current mobilisation practices in the CTICU. The multidisciplinary team identified various practice gaps and tested several changes that led to the implementation of a successful early mobility programme. The tests were carried out and reported using rapid cycle changes. A model for improvement methodology was used to run the project. The outcomes of the project were analysed using standard ‘run chart rules’ to detect changes in outcomes over time and Welch’s t-test to assess the significance of these outcomes.This project was implemented in 2015. Patient compliance with early activity and mobilisation gradually reached 95% in 2016 and was sustained over the next 3 years. After the programme was implemented, the mean hours required for initiating out-of-bed-mobilisation was reduced from 22.77 hours to 11.74 hours. Similarly, functional independence measures and intensive care unit mobility scores also showed a statistically significant (p<0.005) improvement in patient transfers out of the CTICU.Implementing an early mobility programme for post-cardiac surgery patients is both safe and feasible. This QI project allowed for early activity and mobilisation, a substantial reduction in the number of hours required for initiating out-of-bed mobilisation following cardiac surgery, and facilitated the achievement of early ambulation and functional milestones in our patients.
Palliative medicine education—Bed Race, The End of Life Board Game in undergraduates
Authors: Harris Dylan G , Atkinson Clea 
Published: September 2021

BackgroundEducational board games facilitate active learning to conceptualise knowledge, and, promote collaborative learning and team work. Despite increasing interest in them, use in palliative and end of life care has been very limited to date.MethodIn ‘Bed race, The End of Life Game’, participants are divided into four teams who move a model hospital bed around a board to collect items (syringe driver; Do Not Attempt Resuscitation form; oral hydration gel; a ‘heart’; Just In Case medicines). To obtain items at themed ‘checkpoints’, each team needs to answer quiz questions, which require application of clinical knowledge and/or communication skills. Pregame and postgame quiz scores and feedback were collected from 12 game sessions involving 251 year 5 medical students.Results169 (67%) of students completed pregame and postgame anonymous quiz questions and free-text feedback. Postgame quiz scores were higher for each topic, and the difference in the paired pregame and postgame questionnaires was statistically significant (p<0.05). Themes from the free-text feedback included ‘engaging and fun’; ‘relevant learning’; ‘peer learning and team work’.ConclusionsEducational board games are not a new panacea for education, but the concept can be successfully applied in palliative care.
Late complication rates after aortic coarctation repair in patients with or without a bicuspid aortic valve
Authors: Lim Michelle S , Cordina Rachael , Kotchetkova Irina , Celermajer David S 
Published: September 2021

ObjectivePatients with previously repaired aortic coarctation (CoA) are at risk of developing late surgical complications. Many patients with CoA also have a bicuspid aortic valve (BAV). We sought to determine in patients with repaired CoA whether the presence of BAV is associated with more cardiovascular reinterventions during follow-up.MethodsAdults with previously repaired simple CoA were recruited from our Adult Congenital Heart Disease database (Sydney, Australia). The incidence of complications relating to the ‘CoA-site’ (descending aortic aneurysm or dissection, or recoarctation) and the ‘AV/AscAo’ (aortic valve or ascending aortic pathology) that required intervention was compared between those with BAV (‘CoA-BAV’) and without BAV (‘CoA-only’).ResultsOf 146 patients with repaired CoA, 101 (69%) had BAV. Age at CoA repair was similar (median 6.0 (IQR 0.5–14.0) years vs 5.0 (IQR 0.5–11.0) years, p=0.44), as was the distribution of repair types, with end-to-end repair the most common in both groups (45.9% vs 45.6%). At a median of 28 years following initial repair, a significantly higher proportion of patients with CoA-BAV required cardiovascular reintervention (45.5% vs 20.0%, p=0.003). Whereas ‘CoA-site’ complications were more common than ‘AV/AscAo’ complications in patients with CoA only (13.3% and 0%, respectively), patients with CoA-BAV had a high prevalence of both ‘CoA-site’ as well as ‘AV/AscAo’ complications (19.8% and 21.8%, respectively). Overall survival was similar (p=0.42).ConclusionIn adults with repaired CoA, patients with CoA-BAV are more than twice as likely to require cardiovascular reintervention by early-to-mid-adult life compared with those with CoA alone. Despite this, no difference in survival outcomes was observed.