bluuebunny/crossref_metadata_2025_split huggingface dataset:
Basic ENT training for enhanced healthcare worker knowledge, attitudes and practices in a resource-limited setting: a pre-post and post-post cross-sectional study
Authors: Lukama Lufunda , Aldous Colleen , Mbewe Sinoya , Michelo Charles , Kalinda Chester 
Published: December 2024

IntroductionDiagnostic errors in ear, nose and throat (ENT) diseases are prevalent among healthcare workers (HCWs) in resource-limited settings, yet comprehensive data that describe HCW knowledge, attitudes and practices (KAP) regarding ENT disease management remains scarce. Further, the impact of basic ENT training on HCW KAP in such settings is largely undetermined.ObjectiveWe assessed HCW KAP before and after basic training in ENT disease management.MethodsThis questionnaire-based pre-post-test cross-sectional survey employed HCW training in public hospitals in a resource-limited setting. We conducted a 2-day training, preceded by a pretraining survey, followed by immediate and 5-month post-training assessments using a prevalidated questionnaire. 416 HCWs participated and were selected through probability-proportionate-to-size random sampling. Wilcoxon matched-pairs signed-rank and Kruskal-Wallis tests were used to assess pre-post training KAP variations.ResultsAt baseline, the median (IQR) percentage knowledge scores for HCWs in general ENT, ear, sinonasal and head and neck disease management were 60 (40), 55 (18), 58.3 (25) and 56 (22.6), respectively. Only 33.8% (133/394) of HCWs had access to an otoscope, 25.5% (101/396) to a headlight and 12.1% (48/397) to a nasal speculum. While 99.2% (390/393) of HCWs considered ENT important, 57.8% (226/391) of them lacked the confidence to correctly diagnose and manage most ENT conditions. At the immediate post-training assessment, HCWs’ median knowledge scores increased by 20%, 18%, 25% and 33% for general ENT, ear, sinonasal and head and neck disease management, respectively (p<0.001). Further, the proportions of HCWs consistently performing otoscopy and using ENT guidelines increased from 15.1% (43/284) and 13.8% (48/282) to 35.5 (44/124) and 23.9% (27/113) 5 months post-training.ConclusionsThis study underscores the critical need for continuous medical education (CME) to address knowledge gaps and improve HCW attitudes and practices. The findings provide valuable insights for policymakers aiming to enhance ENT healthcare delivery in resource-limited settings.
The MyLungHealth study protocol: a pragmatic patient-randomised controlled trial to evaluate a patient-centred, electronic health record-integrated intervention to enhance lung cancer screening in primary care
Authors: Kukhareva Polina , Balbin Christian , Stevens Elizabeth , Mann Devin , Tiase Victoria , Butler Jorie , Del Fiol Guilherme , Caverly Tanner , Kaphingst Kim , Schlechter Chelsey R , Fagerlin Angela , Li Haojia , Zhang Yue , Hess Rachel , Flynn Michael , Reddy Chakravarthy , Warner Phillip , Choi Joshua , Martin Douglas , Nanjo Claude , Metzger Quyen , Kawamoto Kensaku 
Published: December 2024

IntroductionEarly lung cancer screening (LCS) through low-dose CT (LDCT) is crucial but underused due to various barriers, including incomplete or inaccurate patient smoking data in the electronic health record and limited time for shared decision-making. The objective of this trial is to investigate a patient-centred intervention, MyLungHealth, delivered through the patient portal. The intervention is designed to improve LCS rates through increased identification of eligible patients and informed decision-making.Methods and analysisMyLungHealth is a multisite pragmatic trial, involving University of Utah Health and New York University Langone Health primary care clinics. The MyLungHealth intervention was developed using a user-centred design process, informed by patient and provider focus groups and interviews. The intervention’s effectiveness will be evaluated through a patient-randomised trial, comparing the combined use of MyLungHealth and DecisionPrecision+ (a provider-focused shared decision-making intervention) against DecisionPrecision+ alone. The first study hypothesis is that among patients aged 50–79 with uncertain LCS eligibility (eg, 10–19 pack-years or unknown pack-years or unknown quit date for individuals who used to smoke), MyLungHealth eligibility questionnaires will result in increased identification of LCS-eligible patients (n~26 729 patients). The second study hypothesis is that among patients aged 50–79 with documented LCS eligibility (20+ pack-years, quit within the last 15 years if individuals who used to smoke, and no recent screening or screening discussion), MyLungHealth education will result in increased LDCT ordering (n~4574 patients). Primary outcomes will be identification of LCS-eligible patients among individuals with uncertain LCS eligibility and LDCT ordering rates among individuals with documented LCS eligibility.Ethics and disseminationThe protocol was approved by the University of Utah Institutional Review Board (# 00153806). The patient data collected for this study will not be shared publicly due to the sensitive nature of the patient health information and the fact that we will not be obtaining written informed consent to allow public sharing of their data. Results will be disseminated through peer-reviewed publications.Trial registration numberClinicaltrials.gov,NCT06338592.
Workplace and social support, treatment satisfaction, and their impact on quality of life in Swedish women with multiple sclerosis: a cross-sectional survey study
Authors: Machado Alejandra , Wredendal Elin , Fink Katharina , Friberg Emilie 
Published: December 2024

ObjectiveTo evaluate health-related quality of life (HRQoL), in relation to support from work, social, as well as treatment satisfaction, in women with multiple sclerosis (MS). Further, to predict the satisfaction on these support dimensions based on sociodemographic and clinical variables.DesignCross-sectional survey: a web-based questionnaire conducted in 2021 of people with MS (PwMS) linked to Nationwide Swedish registers.SettingSweden.ParticipantsWorking women with MS, living in Sweden, aged 20–50 responding to the survey during the spring of 2021 (n=2967).Outcome measuresHealth-related quality of life was measured using the EuroQol Visual Analogue Scale (EQ-VAS). Linear regression models were applied to estimate the association between demographic and clinical factors, as well as reported survey answers with HRQoL. Odds of perceived satisfactory support in one, two or all three support dimensions (work, social or treatment) were performed with multinomial logistic regressions.ResultsLower MS severity and fatigue, higher cognitive processing speed, living in cities and higher educational attainment were individually associated with higher levels of HRQoL (p<0.001). Contrary, lower HRQoL was associated with progressive type of MS, self-reported visible or invisible symptoms, and no or unsatisfactory support from work, social and treatment (p<0.001). When explored altogether, higher levels in HRQoL were predominantly explained by lower MS severity (t=−9.318, p<0.001), less fatigue (t=−22.190, p<0.001) and more support from work (t=4.824, p<0.001) and to some extent, social support (t=−2.448, p=0.014). Further, compared with women who reported no support, those experiencing lower fatigue and receiving ongoing treatment were more likely to receive support in one or more of all three dimensions (work, social and satisfaction with their treatment). In contrast, higher HRQoL (OR=1.033; CI=1.015 to 1.052) was only significant when receiving simultaneous support from all three support dimensions.ConclusionClinical factors and support from work and social support are the strongest contributors to HRQoL in working women with MS. Further, support across several life dimensions is essential when assessing HRQoL. Particularly, satisfaction with the perceived support from work, which plays a crucial role in the HRQoL of women with MS. This underscores the importance of prioritising clinical management and strong support systems to significantly improve HRQoL outcomes in patients with MS.
Development of ICF-based patient-reported outcome and experience measures to study social participation among people with chronic diseases: a mixed-methods protocol
Authors: Van den broecke Maxim , de Jong Sarah , Kiasuwa Mbengi Régine , Vanroelen Christophe 
Published: December 2024

IntroductionLiving with a chronic disease impacts many aspects of life, including the ability to participate in activities that enable interactions with others in society, that is, social participation (SP). Despite efforts to monitor the quality of care and life of chronically ill people in Belgium, no disease-specific patient-reported measures (PRMs) have been used. These tools are essential to understand SP and to develop evidence-based recommendations to support its improvement. This protocol presents the phases for the disease-specific development of patient-reported outcome and experience measures to assess SP and its potential determinants among people living in Belgium with cancer, cystic fibrosis, diabetes, HIV or a neuromuscular disease.Methods and analysisThis protocol applies the PROMIS Instrument Development and Validation Scientific Standards and COnsensus-based Standards for the selection of health Measurement INstruments to develop PRMs in a disease-specific manner to quantify the components of the International Classification of Functioning, Disability and Health (ICF). A mixed-method approach is used to create broad initial item pools based on patient (focus groups) and literature perspectives which are compared within ICF-standardised language by applying the refined ICF linking rules. An item set is first created based on this cross-matching exercise and then validated by multidisciplinary expert panels. Cognitive assessment and pilot testing are followed by the dissemination of the survey to a representative sample in Belgium. Advanced psychometric testing (classical test theory and item response theory) is applied to inform an item reduction strategy for the final measures and to develop scales for the ICF components.Ethics and disseminationEthical approval was granted by the Ethics Committee of the Ghent University Hospital on 20 February 2023 to organise the patient focus groups (ONZ-2022-0470). Ethical approval for dissemination of the PRMs and psychometric testing will be sought at the Ghent University Hospital Ethics Committee at the start of Phase 6. Results will be disseminated through peer-reviewed journals and professional conferences.
Managing the work of living with heart failure: a qualitative study using the cumulative complexity model from Southeastern Minnesota
Authors: Smith Jamie , Shippee Nathan , Finnie Dawn , Killian Jill M , Montori Victor M , Redfield Margaret M , Dunlay Shannon 
Published: December 2024

ObjectivePatients with heart failure (HF) perform a variety of self-care activities to control symptoms and minimise the risk of HF decompensations. The objective of this study was to understand how patients build capacity and manage the work of living with HF.DesignA qualitative study using semi-structured telephone interviews. The interview guide was informed by the Cumulative Complexity Model, a conceptual framework that focuses on a patient’s workload and their capacity to manage that work. Interview transcripts were analysed using a mixed inductive and deductive coding approach with organisation into larger thematic categories.SettingSoutheastern Minnesota USA (11 counties) with capture of data from local community healthcare providers under the auspices of the Rochester Epidemiology Project.ParticipantsIntentional sampling of local patients with HF (n=24, median age 69.5 years, 54% women, 63% rural, 54% preserved ejection fraction) who reported high treatment burden and/ or poor health status on a questionnaire.ResultsThree major themes emerged: using capacity to manage workload, disruptions resulting in workload exceeding capacity and regaining workload-capacity balance. Participants described routinising the daily tasks associated with living with HF to minimise the associated burden and identified disruptions to their routines, including hospitalisations, emergency room visits, worsening health status and changes in healthcare access. To accommodate disruptions and regain workload-capacity balance, participants decreased workload and/or transferred tasks to others to maximise capacity.ConclusionsParticipants with HF described managing patient workload in times of stable health, but they sometimes struggled to accommodate disruptions and worsening health status. These findings can inform the design of interventions to minimise workload, maximise capacity and improve quality of life for patients with HF.
Randomised, multicentre, placebo-controlled trial of fenofibrate for treatment of diabetic macular oedema with economic evaluation (FORTE study): study protocol for a randomised control trial
Authors: Nguyen Helen , Kha Richard , Gopinath Bamini , Mitchell Paul , Liew Gerald 
Published: December 2024

IntroductionDiabetic macular oedema (DMO), a serious ocular complication of diabetic retinopathy (DR), is a leading cause of vision impairment worldwide. If left untreated or inadequately treated, DMO can lead to irreversible vision loss and blindness. Intravitreal injections using antivascular endothelial growth factor (anti-VEGF) and laser are the current standard of treatment for DMO. These treatments are costly and invasive and must be repeated over several years with a high service load. Fenofibrate has been shown to reduce the progression of DR. However, there is a lack of high-quality data on the effects of fenofibrate on established DMO. This study aims to evaluate the effectiveness of oral fenofibrate for the treatment of DMO.Methods and analysisThis randomised double-blind, placebo-controlled trial recruited 204 patients with DMO across three different clinics in Sydney. Participants will be randomly allocated in a 1:1 ratio to intervention and control groups. The intervention group will receive oral fenofibrate (145 mg) taken once daily for 24 months, while the control group will receive placebo tablets taken once daily for 24 months. Standard care with anti-VEGF injections, focal lasers or observation will also be provided to all participants regardless of their group allocation. The primary outcome is the reduction in DMO measured using central macular subfield thickness (CSMT) on optical coherence tomography imaging at 24 months. Secondary outcomes at 24 months include the proportion of eyes with CSMT <250 µm, number of anti-VEGF injections, number of laser sessions needed, best-corrected visual acuity letter score gains, rates of adverse events, progression in DR lesions and changes in quality of life measures. Comparison between groups will be evaluated using analysis of variance. Multiple regression analyses adjusting for age, glycated haemoglobin, number of injections and other covariates will also be performed.Ethics and disseminationEthics approval has been granted by the University of Sydney Human Ethics Committee (HREC-2019/892), and the trial has been registered with the Australia New Zealand Clinical Trials Registry (ACTRN12618000592246). The study adheres to the principles of the Helsinki Declaration and the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research. Trial results will be disseminated to the public in de-identified form through publications in peer-reviewed journals.Trial registry nameAustralian New Zealand Clinical Trials Registry.Trial registration numberACTRN12618000592246.
Impact of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine combination for epidural labour analgesia on neonatal outcomes: a pilot randomised clinical trial
Authors: Jin Ke-Xin , Deng Chun-Mei , Ding Ting , Qu Yuan , Wang Dong-Xin 
Published: December 2024

ObjectiveTo investigate the impact of dexmedetomidine-ropivacaine combination versus sufentanil-ropivacaine combination for epidural labour analgesia on neonatal and maternal outcomes and test the feasibility of a future large, randomised trial.DesignA randomised, double-blind, pilot clinical trial from 16 March 2023 to 15 June 2023.SettingA tertiary-care hospital in Beijing, China.Participants200 women aged≥18 years who had full-term single pregnancy and were scheduled for vaginal delivery with epidural analgesia.InterventionsEligible participants were randomly assigned in a 1:1 ratio to receive self-controlled epidural labour analgesia using ropivacaine supplemented with either dexmedetomidine (0.45 µg/mL for induction and 0.36 µg/mL for maintenance) or sufentanil (0.45 µg/mL for induction and 0.36 µg/mL for maintenance).Main outcomes and measuresThe primary endpoint was a composite of neonatal morbidity, including 1- or 5 min Apgar score<7, umbilical artery PH<7.1, requirement for immediate assisted ventilation and admission to neonatal ward or intensive care unit within 24 hours. Secondary and other endpoints included effect of analgesia and occurrence of adverse events. The feasibility of implementing the protocol was evaluated.ResultsAll 200 women were included in the intention-to-treat analysis. Composite neonatal morbidity occurred in 14.0% (14/100) of women with dexmedetomidine versus 17.0% (17/100) of women with sufentanil: relative risk 0.82, 95% CI 0.43 to 1.58. Women in the dexmedetomidine group had a comparable area under curve of pain intensity (median difference −2.0 point⋅h, 95% CI −9.9 to 5.9, p=0.638), required more self-controlled boluses (median difference two boluses, 95% CI 0 to 3, p=0.040) and epidural analgesics (median difference 17 mL, 95% CI 4 to 29, p=0.007), and experienced less pruritus (0.0% (0/100) vs 30.0% (30/100), p<0.001) but more lower limb weakness (13.0% (13/100) vs 1.0% (1/100), p<0.001). Recruitment rate was satisfactory (87.7%); the protocol was well accepted by anaesthesiologists and nurses.ConclusionsCompared with sufentanil-ropivacaine combination, use of dexmedetomidine-ropivacaine combination for epidural labour analgesia was associated with a 18% decrease in composite neonatal endpoint and deserve further investigation. The dexmedetomidine-ropivacaine combination provided comparable analgesia but increased mild motor block. The conduct of a large, randomised trial using same protocol requires careful re-evaluation.Trial registration numberNCT05698407.
Acupuncture for angina post percutaneous coronary intervention: a protocol for systematic review and meta-analysis
Authors: Zhou Xin , Li Yanwei , Yin Yongjun , Wang Yilan , Xie Wen , Ren Yulan 
Published: December 2024

IntroductionIschaemic heart disease (IHD) is a pathological process characterised by a blockage or non-obstructive accumulation of atherosclerotic plaques in the epicardial arteries. Percutaneous coronary intervention (PCI) is widely used in clinical practice to treat IHD. However, angina post PCI (APPCI) impairs quality of life and portends a worse prognosis. Hence, an effective and safe treatment option remains an urgent need for patients with APPCI. In recent years, there has been an increasing body of clinical trials regarding the use of acupuncture for the prevention and treatment of APPCI, and the results have indicated it might be a promising therapeutic intervention. However, to our knowledge, the potential benefits of acupuncture for the prevention and treatment of APPCI to justify either their recommendation or their clinical role have not been evaluated.Methods and analysisPubMed, Embase, Cochrane Library, Web of Science Core Collection, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Wanfang Database and VIP Database will be searched from inception to 8 June 2024 without language restrictions. Two investigators will independently screen studies, extract data, assess the risk of bias from randomised controlled trials (RCTs) and assess the risk of bias. The third reviewer will arbitrate any disagreements. Data synthesis and analysis will be conducted using the RevMan V.5.4 software. Subgroup analyses, sensitivity analysis, meta-regression and bias reporting assessments will be performed if necessary and appropriate. Finally, the quality of evidence from RCTs will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation System tool.Ethics and disseminationEthical approval is unnecessary since no private or confidential patient data will be included. The systematic review will be published in peer-reviewed journals.PROSPERO registration numberCRD42024562116.
Development and validation of a pragmatic measure of cocreation in research engagement: a study protocol
Authors: Perez Jolles Monica , Willging Cathleen , Tufte Janice , Ostendorf Danielle , Kwan Bethany M , Sevick Carter , Dorsey Holliman Brooke , Weiner Bryan J 
Published: December 2024

IntroductionCocreation, a collaborative process of key interested partners working alongside researchers, is fundamental to community-engaged research. However, the field of community-engaged research is currently grappling with a significant gap: the lack of a pragmatic and validated measure to assess the quality of this process. This protocol addresses this significant gap by developing and testing a pragmatic cocreation measure with diverse community and research partners involved in participatory health-related research. A valid measure for evaluating the quality of the cocreation process can significantly promote inclusive research practices and outcomes.Methods and analysisThe measure consists of two components: (1) an iterative group assessment to prioritise cocreation principles and identify specific activities for achieving those principles and (2) a survey assessing individual partner experience. An expert panel of 16–20 patients, community, healthcare providers and research partners, will participate in a modified Delphi process to assist in construct delineation and assess content validity using group discussions and rating exercises. We will compute survey items using an Item-Level Content Validity Index and a modified kappa statistic to adjust for chance agreement with panel members’ ratings. We will then conduct cognitive interviews with a new group of 40 participants to assess survey item comprehension and interpretation, applying an iterative coding process to analyse the data. Finally, we will assess the measure’s psychometric and pragmatic characteristics with a convenience sample of 300 participants and use the Psychometric and Pragmatic Evidence Rating Scale. Construct validity will be assessed by examining survey data using confirmatory and exploratory factor analysis.Ethics and disseminationThis funded study (years 2024–2025) has been approved by the Institutional Review Board at the University of Colorado, Denver. The team will share the study findings online, with key partners, and by publishing results in a peer-reviewed journal.