bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral antihypertensive agents and diuretics in the management of hypertension in postpartum women: a systematic review and meta-analysis
Authors: Hup Rosalie J , Paauw Nina D , Lely A Titia , Depmann Martine 
Published: December 2024

ObjectiveIn the puerperium, women with hypertensive disease of pregnancy remain at risk for maternal complications. The antihypertensive agent prescribed antepartum is usually continued postpartum; however, evidence regarding the most effective treatment is lacking. Therefore, we aimed to investigate which antihypertensive agent results in optimal treatment (both effectiveness and safety) of postpartum hypertension.DesignSystematic review and meta-analysis.Data sourcesMEDLINE (Ovid), Embase.com and CENTRAL were searched through 22 August 2024.Eligibility criteriaRandomised controlled trials (RCTs) evaluating oral antihypertensives and diuretics in postpartum hypertensive women published after 1990, performing BP measurements in the postpartum period, were identified.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias. Pooled data were calculated as risk ratio or mean difference using a random effect model.ResultsFourteen RCTs (1651 women) were included. Seven RCTs compared diuretics with placebo or antihypertensive controlled, two RCTs compared oral antihypertensives with placebo and five RCTs compared labetalol with nifedipine. Pooled data demonstrated a significantly lower BP on day 3 in cases with pre-eclampsia using furosemide (mean difference −4.06, 95% CI −6.81 to −1.31). Furosemide had no significant effect on any of the other outcomes. Faster BP control was observed for labetalol over nifedipine in a single RCT (mean difference 5.20, 95% CI 4.36 to 6.04). No other significant effects were observed.ConclusionsIn this extensive literature review, no medication preference could be stated and a lack of high-quality studies was revealed. Some evidence demonstrates a positive effect on BP control in women with pre-eclampsia using furosemide. Therefore, adding furosemide to initial treatment is considerable. However, antihypertensive preference and furosemide effectiveness should be further researched. We propose a retrospective cohort study using real-life hospital data (from health records), utilising clinical variance in therapeutic strategies currently present.PROSPERO registration numberCRD42023410765.
Urban-rural disparities in the association between social trust patterns and changes in depressive symptoms: longitudinal evidence from an elderly Chinese population
Authors: Wang Ting , Li Qiaosheng , Zhang Shouchuang , Wei Yuehui , Jian Weiyan 
Published: December 2024

ObjectiveTo examine the relationship between social trust and depressive symptoms among China’s elderly, placing special emphasis on the disparities between urban and rural settings.DesignWe employed latent profile analysis to categorise individual patterns of social trust. Subsequently, multiple linear regression analysis was employed to determine if there was an association between these identified social trust patterns and depressive symptoms. Additionally, we examined the potential interactive effects between urban-rural differences and patterns of social trust on depressive symptoms.SettingThe China Family Panel Studies (CFPS) database.ParticipantsThe data was sourced from the CFPS for the years 2018 and 2020, encompassing a total of 5645 participants aged 60 and above.Outcome measuresDepressive symptoms were evaluated employing an eight-item adaptation of the Centre for Epidemiologic Studies Depression Scale. The scores from these eight items were aggregated to create an index of depressive symptoms, which was used to quantify the severity of depressive symptoms.ResultsThe findings demonstrate a significant link between patterns of social trust and depressive symptoms, with individuals manifesting high social trust (HST) showing a lower propensity for depressive symptoms (Beta=−2.26, 95% CI=−2.62, –1.92). Furthermore, a marked association is apparent between social trust patterns and the changes in depressive symptoms. Additionally, urban dwellers (Beta=−0.67, 95% CI=−1.23, –0.11) demonstrate a more pronounced correlation between patterns of social trust and depressive symptoms, particularly within the HST group.ConclusionOur findings highlight a strong link between social trust patterns and depressive symptoms, particularly regarding their changes. Urbanites, notably within the HST group, show a lower risk of experiencing depressive symptoms. There is an urgent requirement to establish social trust-specific interventions to decrease susceptibility to depressive symptoms among the rural populace.
Protocol for the impact of machine learning-based clinician decision support algorithims in perioperative care (IMAGINATIVE) in Singapore general hospital : a large prospective randomised controlled trial
Authors: Abdullah Hairil Rizal , Brenda Tan Pei Yi , Loh Celestine , Ong Marcus , Lamoureux Ecosse , Lim Gek Hsiang , Lum Elaine 
Published: December 2024

IntroductionAs surgical accessibility improves, the incidence of postoperative complications is expected to rise. The implementation of a precise and objective risk stratification tool holds the potential to mitigate these complications by early identification of high-risk patients. Moreover, it could address the escalating costs from resource misallocation. In Singapore General Hospital (SGH), we introduced the Combined Assessment of Risk Encountered in Surgery-Machine Learning (CARES-ML) in June 2023, focusing on predicting 30-day postoperative mortality and the need for post-surgery intensive care unit (ICU) stays. The IMAGINATIVE Trial aims to evaluate the efficacy of such systems in a large academic medical centre.Methods and analysisThis study adopts type 1 effectiveness-implementation study design within a randomised controlled trial framework. Patients will be randomly assigned in a 1:1 ratio to either the CARES-guided group (unblinded to risk level) or the unguided group (blinded to the risk level). A total of 9200 patients will be enrolled in the study, with the inclusion criteria encompassing individuals aged 21–100 years old undergoing elective surgeries except for neurology and cardiology surgeries at SGH. The primary outcome is to evaluate the effectiveness of the Machine Learning Clinical Decision Support (ML-CDS) algorithm in improving perioperative mortality rates when integrated into the clinical workflow.Ethics and disseminationThe study has been approved by the SingHealth Centralised Institutional Review Board (CIRB Ref: 2023:2114) and is registered on ClinicalTrials.gov (trial number:NCT05809232). All patients will sign an informed consent form before recruitment and translators will be made available to non-English-speaking participants. This study is funded by the National Medical Research Council, Singapore (HCSAINV22jul-0002) and the findings will be published in peer-reviewed journals and presented at academic conferences.Trial registration numberNCT05809232.
Factors associated with in-hospital mortality of newborns admitted to a special care newborn unit of a tertiary care hospital in southern Bangladesh: a retrospective cohort study
Authors: Abbas Md Golam , Haque Aysha , Khan Md Abdullah Saeed , Alam Mohammed Zahidul , Thamima Ummay , Wahiduzzaman Md , Zerin Tahmina , Das Siddhartha Sankar , Rahman Md Mostafizur 
Published: December 2024

ObjectivesThe objective of this study was to identify factors associated with in-hospital deaths of newborns admitted to a special care newborn unit (SCANU) in southern Bangladesh.DesignRetrospective cohort.SettingSCANU of Patuakhali Medical College Hospital, Patuakhali, Bangladesh.ParticipantsRecords of 930 neonates admitted to the SCANU from August to December 2022 were included in the study. The inclusion criteria consisted of neonates admitted during the specified period, while the exclusion criteria excluded records of newborns who were referred to intensive care units or who left against medical advice.Primary and secondary outcome measuresPrimary outcome: In-hospital neonatal mortality. Secondary outcomes: Specific conditions or factors affecting the in-hospital deaths.ResultsOf the 930 neonates analysed, 3.44% died in the hospital. Factors significantly associated with shorter survival time and increased in-hospital mortality included low birth weight (p=0.004), preterm delivery (p=0.022) and respiratory distress syndrome (RDS) (p=0.002). RDS showed an independent association with death in the hospital (adjusted HR: 3.39; 95% CI: 1.11 to 10.35). Newborns delivered at home or in an ambulance had a 2.90 times higher hazard of dying in the hospital (95% CI: 1.17 to 7.17) compared with those delivered at the hospital.ConclusionsAddressing preterm birth, low birth weight and respiratory distress, along with promoting institutional deliveries, is crucial for reducing neonatal mortality rates in resource-limited settings like Bangladesh.
Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up
Authors: Stegemann Jill , Affeldt Anna Maria , Mück Luisa , Ferring Anne , Gerhards Laura , Pickert Lena , Bausch Annika , Benzing Thomas , Antczak Philipp , Polidori M Cristina 
Published: December 2024

ObjectiveThe prognosis of older adults is strongly influenced by the relation of multifactorial geriatric syndromes (GS) and their health-maintaining counterparts, geriatric resources (GR). The present analysis aimed to identify clusters of comorbidities, GS and GR, and to measure their multidimensional prognostic signature in older patients admitted to different healthcare settings.DesignPooled secondary analysis of three longitudinal interventional studies with the 3- and 6-month follow-up data collection on mortality and rehospitalisation.SettingInpatients in an internal medicine ward (n=495), inpatients in an ageing medicine ward (n=123) and outpatients from a general practice (n=105).ParticipantsA total of 734 patients with multimorbidity who aged over 60 years were recruited between August 2016 and July 2020 (mean age 77.8 years, SD 6.2 and 43% female).Outcome measuresComprehensive Geriatric Assessment (CGA), including Cumulative Illness Rating Scale (CIRS), 17 GS and 10 GR, and the CGA-based Multidimensional Prognostic Index (MPI) as a measure of multidimensional prognosis and frailty were assessed. Based on a general linear model and a hierarchical clustering method, clusters of comorbidities, GS and GR were obtained.ResultsThe study identified five clusters of GR-related GS, namely, psychosocial, iatrogenic, neurovegetative, sensorimotor and fluid dysbalance, along with two clusters related to GR, focusing on independence achievement and requirements- circumstances. Additionally, two clusters were identified pertaining to the CIRS, encompassing sensory-vegetative and heart-kidney morbidity. Patients within the iatrogenic cluster exhibited significantly higher MPI and readmissions during follow-up compared with those outside this cluster (p<0.001). Furthermore, membership in the fluid dysbalance or psychosocial cluster was associated with a significantly increased mortality rate during follow-up (p<0.001).ConclusionsA feasible combination of GR and GS in clinical routine enables the identification of clusters with clear prognostic relevance, which may improve prognosis through tailored treatment.Trial registration numbersDRKS00010606/DRKS00013791/DRKS00017094MPI_InGAH, DRKS00012820MPI_NoGePand DRKS00015996VNKN.
Risk perception among healthcare professionals working in emergency care in remote locations: a scoping review protocol
Authors: Queirós Célia Maria , Martins Teresa , Correia Tiago 
Published: December 2024

IntroductionProviding healthcare in emergency services is a multifaceted challenge that demands prompt approaches. Ensuring safety and efficacy becomes even more challenging in ‘remote locations’, referring to geographical areas located far from urban centres or densely populated regions, often characterised by insufficient access to services, infrastructure and communication channels. Despite the pivotal role of healthcare professionals’ skills and knowledge in risk management in these contexts, academic literature has largely overlooked this aspect. Thus, addressing healthcare professionals’ perceptions of risks within remote areas is crucial for informed decision-making and improved service administration.Methods and analysisThis scoping review protocol adopts the methodology outlined by the Joanna Briggs Institute. The objective is to delineate the current scientific evidence regarding the perception of both direct and indirect risks associated with healthcare practice in remote emergency settings. Employing the Population, Concept, and Context dimensions, inclusion criteria were established for each dimension: Population—nurses or other healthcare professionals with overlapping roles; Concept—perception of risk; Context—remote community or site and emergency care. The search will encompass the Scopus, PubMed, LILACS, Cochrane, CINAHL and Web of Science databases. A specific time frame for the selection of articles was not delimited. Observational, quantitative, qualitative studies and reviews will be eligible for inclusion if they meet the predetermined criteria. Two reviewers will undertake the document review process. Eligible documents may be in English or Portuguese, and only those subjected to peer review will be considered for inclusion.Ethics and disseminationEthical approval will not be necessary for this study as it entails a scoping review based on previously published evidence. The findings from the scoping review will be disseminated through scientific conferences and published in academic journals.
Mental health interventions for adolescents living with HIV/AIDS in sub-Saharan Africa: protocol for a systematic review
Authors: Boakye Dorothy Serwaa , Xatse Eugenia , Akorli Vincent Valentine , Adjorlolo Paul Kwame , Battanis Yvonne Yawa , Frempong Abigail Bempomaa , Ocansey Lydia Kaki , Yeboah Cecillia , Adjorlolo Samuel 
Published: December 2024

IntroductionAdolescents living with HIV/AIDS in sub-Saharan Africa have heightened risk for mental health and psychosocial burden owing to their exposure to a multiplicity of adverse conditions such as stigma and discrimination. However, there is no comprehensive evidence synthesis and evaluation of the effectiveness of mental health interventions for adolescents living with HIV/AIDS in this region. We aim to conduct a systematic review to synthesise the literature on existing mental health interventions for adolescents living with HIV/AIDS in sub-Saharan Africa.Methods and analysisThis review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines. Eligible studies will include those investigating the effectiveness of psychosocial, psychological or other forms of interventions on mental health outcomes, conducted in sub-Saharan African countries and involving adolescents (aged 10–19 years) living with HIV/AIDS. Comprehensive searches will be conducted in electronic databases (PubMed, MEDLINE, CINAHL, Scopus and PsycINFO) and grey literature sources. The search will be restricted to studies published from 2004 onwards and in the English language. Study authors will be contacted, and reference lists of retrieved articles will be reviewed for additional papers. Study selection and data extraction will be performed by two independent reviewers, with any disagreements resolved by consensus or involving a third party. A narrative synthesis will be conducted, and if possible, meta-analyses will be performed to estimate the overall effect sizes of interventions on mental health outcomes. Eligible studies will undergo quality assessment using standardised criteria appropriate for each respective study design.Ethics and disseminationNo primary data collection will be undertaken; therefore, no ethical approval is required. The findings of this review will be disseminated through publication in a peer-reviewed journal and presented at relevant conferences.PROSPERO registration numberCRD42024538975
Syphilis Point of Care Rapid Test and Immediate Treatment Evaluation (SPRITE) study: a mixed-methods implementation science research protocol of eight public health units in Ontario, Canada
Authors: Mackrell Lucy , Carter Megan , Hoover Maggie , O'Byrne Patrick , Larkin Natasha , Magpantay Felicia Maria G , Zhao Sicheng , Stoner Bradley , Richard-Greenblatt Melissa , Mandryk Kira , Belanger Kandace , Burbidge Jennifer , Charette Gilles , Deschenes Gabrielle , Dinh Duy A , Featherstone Amanda , Khandakar Farhan , Martinez-Cajas Jorge , Tran Vanessa , Szumlanski Nicole , Vance Stephanie , Saeed Sahar 
Published: December 2024

IntroductionUrgent, tailored and equitable action is needed to address the alarming rise in syphilis rates in Canada. In the last decade, the rates of infectious syphilis have increased by 345% in Ontario, Canada. Underserved populations—people who use drugs, un(der)housed individuals and those living in rural and remote areas—face unique social and healthcare challenges that increase their vulnerability to syphilis infections and hinder their access to timely diagnosis and treatment. This study assesses the real-world implementation and effectiveness of using a recently approved syphilis point-of-care test in conjunction with public health outreach to break barriers and bring services to the population at the highest risk.Methods and analysisThe Syphilis Rapid Point-of-Care Testing and Immediate Treatment Evaluation (SPRITE) study includes eight public health units in Ontario, Canada. Implementation and evaluation of this rapid ‘test and treat’ outreach model of care will be assessed using the Practical, Robust Implementation and Sustainability Model (PRISM)/Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework, following a community-based participatory approach. Network models will be used to estimate the population-level impact of implementing this model of care to curb transmission. Knowledge mobilisation will be assessed using the Reciprocity, Externalities, Access, and Partnership (REAP) Self-Assessment Model.Ethics and disseminationThe SPRITE study was approved by the Queen’s University Research Ethics Board (REB) and is to be conducted in accordance with the Canadian Tri-Council Policy Statement V.2 and the latest Seoul revision of the Declaration of Helsinki. Knowledge generated from this study will be mobilised through community-based organisations and the broader public health community.
Efficacy and safety of various regional nerve blocks for postoperative analgesia in paediatric patients undergoing developmental dysplasia of the hip surgery: a protocol for systematic review and network meta-analysis
Authors: Zhang Yu , Fu Chen , Junxia Wang , Yang Lei , Qin Zhijun 
Published: December 2024

IntroductionAlleviating postoperative pain from developmental dysplasia of the hip (DDH) surgery is beneficial for paediatric patients. The most commonly used anaesthetic approach currently is general anaesthesia combined with regional nerve blocks. Existing research primarily focuses on studies comparing regional nerve blocks with placebo controls, or studies comparing two different regional nerve blocking techniques. However, the conclusions from these studies offer limited assistance to clinicians in selecting the safest and most effective nerve block. Therefore, we plan to conduct a systematic review and network meta-analysis to compare the efficacy and safety of different regional nerve blocks in managing postoperative pain in children undergoing surgery for DDH.Methods and analysisWe will systematically search the following databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials via Ovid, as well as the Chinese databases CNKI and Wanfang. We will comprehensively search from the inception of each database to April 2024 and will include randomised controlled trials without restrictions on language or publication status. The primary outcome are postoperative pain scores at 4 hours following surgery. The quality of all included trials will be assessed using version 2 of the Cochrane Randomised Trial Risk of Bias Tool. We will employ the GeMTC package in R software for both direct and indirect comparisons within a Bayesian framework using a random effects model. Additionally, the Confidence in Network Meta-Analysis method will be employed to assess the quality of evidence.Ethics and disseminationEthical approval is not required for this study, as it exclusively involves the compilation of published data. We plan to submit our review to academic conferences and peer-reviewed scholarly journals.PROSPERO registration numberCRD42024527459.
Transition to home after very preterm birth: improving outcomes of children and their families—a systematic review protocol
Authors: Engel Vivienne , Mauron-Papadimitriou Valentina , Bührer Lea , Ebner Laura , Keller Lena , Gosteli Martina , Siegfried Sandra , Latal Beatrice , Kiechl-Kohlendorfer Ursula , Held Ulrike 
Published: December 2024

IntroductionMedical progress has significantly improved the survival rates of very preterm-born infants in recent decades. Nevertheless, these infants are still at increased risk for long-term impairments as compared with term-born infants. While the homecoming of a preterm-born infant is long-awaited and brings relief to families, it also marks the end of intensive monitoring and highly specialised professional care. This situation often leaves parents coping with anxiety and a sense of unpreparedness, as they navigate the transition to home. Correspondingly, the WHO advocates for additional support for parents of preterm infants following the transition to home. According to the WHO, preparation for this transition yields positive effects on crucial aspects such as nutrition, parent–child interaction and parental well-being. However, there is significant heterogeneity as to which interventions are in place and regarding their level of efficacy. Consequently, we aimed to provide an overview of existing transition-to-home interventions and their efficacy by conducting a systematic review of the literature.Methods and analysisWe will perform a systematic review of interventions aiming at improving the transition to home process for very preterm-born infants and their parents and will search the following databases: Cochrane, Medline, CINAHL, EMBASE and PsycINFO. Our main aim is to provide an overview of existing transition-to-home interventions and their efficacy in categories of intervention types. We will not predefine specific outcomes, but we will describe, assess and summarise the outcomes of the included studies. All reported outcomes will be recalculated to the scale of standardised mean differences. Meta-analysis will be performed with a random-effects model to account for expected large between-study heterogeneity.Ethics and disseminationNo ethics approval was necessary for this study. The aim of our systematic review is to provide a comprehensive overview of current interventions designed to improve the transition from hospital to home. Subsequently, it will show the individual effect of these interventions and pool effect sizes if possible. The most promising interventions will then be combined and used as the basis of a subsequent randomised controlled trial of a new transition-to-home intervention. The results of the study will be published in a peer-reviewed journal.PROSPERO registration numberThe systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 30 August 2023. PROSPERO CRD42023455401.