bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and facilitators for strengthening primary health systems for person-centred multimorbid care in low-income and middle-income countries: a scoping review
Authors: Zezai David , van Rensburg André Janse , Babatunde Gbotemi Bukola , Kathree Tasneem , Cornick Ruth , Levitt Naomi , Fairall Lara R , Petersen Inge 
Published: November 2024

ObjectiveTo understand barriers and facilitators for strengthening health systems for person-centred care of people with multiple long-term conditions-multimorbidity (MLTC-M) at the primary healthcare (PHC) level in low-income and middle-income countries (LMICs).DesignA scoping review.MethodsWe adopted a systematic scoping review approach to chart literature guided by Arksey and O'Malley’s methodological framework. The review focused on studies conducted in LMICs’ PHC settings from January 2010 to December 2023. Papers were extracted from the following databases: PubMed, EBSCOhost and Google Scholar. Framework analysis was undertaken to identify barriers and facilitators for strengthening MLTC-M primary care according to the five health system pillars in the Lancet Global Health Commission on High-Quality Health Systems Framework.ResultsThe literature search yielded 4322 citations, evaluated 202 studies and identified 36 for inclusion. Key barriers within the people pillar included poverty, low health education and low health literacy; within the platform pillar, fragmented services and lack of multimorbid care guidelines were mentioned; within the workforce pillar, lack of required skills and insufficient health workers; and in the tools pillar: a shortage of essential medicines and adverse polypharmacy effects were prominent. A lack of political will and the absence of relevant national health policies were identified under the governance pillar. Facilitators within the people pillar included enhancing self-management support; within the platforms, pillar included integration of services; within the tools pillar, included embracing emerging technologies and information and communication technology services; and governance issues included upscaling interventions to respond to multimorbid care needs through enhanced political commitment and financial support.ConclusionsPotential solutions to strengthening the healthcare system to be more responsive to people with MLTC-M include empowering service users to self-manage, developing multimorbid care guidelines, incorporating community health workers into multimorbid care efforts and advocating for integrated person-centred care services across sectors. The need for policies and procedures in LMICs to meet the person-centred care needs of people with MLTC-M was highlighted.
Testing the efficacy of WORK-ON: vocational rehabilitation for people with chronic inflammatory arthritis in Denmark—protocol for a randomised controlled trial
Authors: Madsen Christina Merete Tvede , Primdahl Jette , Christensen Jeanette Reffstrup 
Published: November 2024

IntroductionAmong people with chronic inflammatory arthritis (IA), up to 40% lose their job in the first few years after diagnosis of this condition and are hence at high risk of being permanently excluded from the labour market. Therefore, we developed a new context-specific vocational rehabilitation (VR) for people with IA. This 6 month VR (WORK-ON) includes the following: (1) an initial assessment and goal setting by a coordinating occupational therapist, who supports cooperation and coordination between relevant partners and navigation across primary and secondary care, (2) four group sessions with peers and (3) individual sessions with a social worker, nurse or physiotherapist. The objective of this trial is to test the overall efficacy of WORK-ON as an add-on to usual care and compare it with usual care provided to a control group.Methods and analysisA randomised controlled trial has been planned. Patients with IA, aged at least 18 years and experiencing job insecurity will be randomised to one of two groups: (1) the intervention group receiving WORK-ON VR as an add-on to usual care and (2) the control group receiving usual care. The primary outcome is the difference in work ability 12 months after baseline, which will be measured using the Work Ability Index single item. The key secondary outcome measures are absenteeism, presenteeism, overall work impairment, activity impairment and job loss measured at baseline and at 6, 12, 18 and 30 month follow-up. Secondary outcome measures are quality of life, mental well-being, fatigue, sleep, physical activity, occupational balance and pain, which will be measured at baseline and at 6 and 12 month follow-up.Ethics and disseminationThe Regional Committees on Health Research Ethics in Southern Denmark waived the requirement for a formal approval (Journal number S-20232000-3). The participants will provide informed consent prior to participating in the trial.Trial registration numberNCT06299917.
Rate of decline in kidney function with age: a systematic review
Authors: Guppy Michelle , Thomas Elizabeth Taruna , Glasziou Paul , Clark Justin , Jones Mark , O'Hara Daniel Vincent , Doust Jenny 
Published: November 2024

ObjectiveTo determine the distribution of kidney function values as measured by glomerular filtration rate (GFR), and the rate of decline with age in male and female healthy subjects without pre-existing medical conditions.DesignSystematic review and structured synthesis.Search sourcesPubMed, Embase, Cochrane Central Register of Controlled Trials and Web of Science, from database inception to 25 October 2023. Unpublished studies were searched from clinical trial registries and the grey literature.Selection criteriaObservational cohort studies, including non-treatment arms of randomised, pseudorandomised and non-randomised controlled trials that assessed the age-related decline in kidney function over time.Main outcome measuresPrimary outcomes were rate of change of kidney function over time (absolute and relative change) and rate of change of kidney function with age. Secondary outcomes included rate of change of kidney function compared with baseline GFR, gender, ethnicity and proportion of participants >60 years defined as having chronic kidney disease.Data collection and analysisTwo review authors independently screened studies for inclusion, extracted data and assessed risk of bias. Data could not be pooled because of significant heterogeneity. Instead, a descriptive analysis was used to synthesise results.Results12 studies between 1958 and 2021 reported the decline rate of kidney function in healthy individuals: six prospective cohort studies, four retrospective cohort studies and two randomised controlled clinical trials, which included 129 359 healthy participants (range from 15 to 46 682) and ranged from 2 to 23 years duration. Annual decline rates ranged from −0.24 to −3.60 mL/min/1.73 m2/year (−0.37 to −1.07 in subjects without hypertension). Results were mixed as to whether decline rates sped up or slowed down with age, and whether decline rates differed between women and men, with studies showing conflicting results. This study was unable to determine the decline rates in different ethnicities.ConclusionsThis study is the first systematic review to investigate the longitudinal decline in kidney function with age in healthy individuals. The normal decline rate could be considered between −0.37 and −1.07 mL/min/1.73 m2/year in healthy adults without hypertension. Kidney function decline rates in healthy adults may be helpful to clinicians anticipating patients’ kidney trajectory and determining whether chronic kidney disease-specific care is required.PROSPERO registration numberCRD42023096888.
Evaluation of safety and efficacy of intracranial self-expanding drug-eluting stents for symptomatic intracranial atherosclerotic stenosis: a prospective, multicentre, randomised controlled, superiority clinical trial protocol
Authors: Zhu Zhengpeng , He Yanyan , Zhao Jingge , Liu Wenbo , Ding Qianhao , Li Shikai , Pang Yukuan , Zhao Yang , Zhu Liangfu , Wang Ziliang , Li Tianxiao , He Yingkun 
Published: November 2024

BackgroundIn-stent restenosis (ISR) is a crucial factor that affects the long-term efficacy of intracranial bare metal stent (BMS) implantation for intracranial atherosclerotic stenosis (ICAS). Patients with intracranial ISR are at a high risk of recurrent ischaemic events. The NOVA intracranial drug-eluting stent (DES) trial demonstrates that a DES can reduce ISR and stroke recurrence after intracranial bare stent implantation. However, the application of balloon-expanded DES necessitates specific vascular conditions. The objective of this study is to assess the safety and efficacy of self-expanding DES for treating symptomatic ICAS (sICAS).MethodsThis is a prospective, multicentre, randomised, controlled, superiority clinical trial that is conducted in 16 clinical trial centres in China. This study aims to recruit 208 patients with sICAS. Eligible subjects are randomly assigned to two groups at a ratio of 1:1. The experimental group is treated with DES (Xinwei intracranial DES system). The control group is treated with BMS (Wingspan intracranial stent system). All subjects are followed up within 7 days after surgery or before discharge; 30 days after surgery; and 6, 12 and 24 months after surgery. The primary outcome of the trial is the incidence of ISR at 6 months after surgery to verify the safety and efficacy of intracranial DESs. After 6 months of follow-up, the clinical summary report is issued for product registration application, and the follow-up of 12 months and 24 months after operation is conducted to evaluate the medium and long-term efficacy.Ethics and disseminationThe study involving human participants is reviewed and approved by the Ethics Committee of Drugs (devices) Clinical Experiment in Henan Provincial People’s Hospital (reference number: AF/SC-08/05.0) and other research centres participating in the clinical trial (supplemental file 2). The results yield from this study will be presented at international conferences and sent to a peer-reviewed journal to be considered for publication.Trial registration numberRegistered on 2 November 2023 with Chinese clinical trial registry. Registration number is ChiCTR2300077271.
Knowledge, attitude and practice of urticaria patients towards urticaria medication treatment: a cross-sectional study at the first affiliated hospital of Kunming Medical University
Authors: Shen Yan , Zhao Weijia 
Published: November 2024

ObjectivesTo explore the knowledge, attitudes and practices (KAP) of urticaria patients regarding the medication treatment.Methods designA cross-sectional study.SettingAt the Dermatology Department of the First Affiliated Hospital of Kunming Medical University from 15 June 2023 to 12 March 2024.ParticipantsUrticaria patients.Primary and secondary outcome measuresThe primary outcome was KAP of urticaria patients using a self-administered questionnaire. The secondary outcomes were factors associated with KAP.ResultsA total of 497 valid responses were collected. Of these respondents, 333 (67.0%) were female, and 375 (75.5%) lived in urban areas. The median KAP scores were 1.00 [0.00, 3.00] (possible range: 0–8), 23.00 [18.00, 26.00] (possible range: 10–50) and 32.00 [31.00, 36.00] (possible range: 8–40), respectively. Most patients (91.7%) clearly needed to understand the aetiology and treatment process related to urticaria. Less than half (43.5%) of patients believed that their healthcare providers offered comprehensive information about the knowledge and procedures related to urticaria medication. Demographic analysis uncovered substantial variations in knowledge and attitude scores across different education levels, age groups, occupations and residential areas (p<0.001 for all). In contrast, the impact on practice scores was less significant, particularly concerning educational diversity. Multivariate logistic regression analysis revealed that a higher knowledge score (OR=1.17, 95% CI: [1.03 to 1.33], p=0.014) and age between 35–65 years (OR=1.78, 95% CI: [1.16 to 2.74], p=0.009) were independently associated with proactive practices.ConclusionUrticaria patients exhibit insufficient knowledge, unfavourable attitudes and proactive practices concerning medication treatment. Enhancing patient education and targeted interventions are essential to improve the knowledge and attitudes towards medication treatment, ultimately promoting better self-management practices among urticaria patients.
Effect of desflurane, sevoflurane or propofol on the incidence of postoperative delirium in older adults undergoing moderate- to high-risk major non-cardiac surgery: study protocol for a prospective, randomised, observer-blinded, clinical trial (RAPID-II trial)
Authors: Taschner Alexander , Fleischmann Edith , Kabon Barbara , Sinner Barbara , Eckhardt Christine , Horvath Katharina , Adamowitsch Nikolas , Hantakova Nicole , Hochreiter Beatrix , Zotti Oliver , Fraunschiel Melanie , Graf Alexandra , Reiterer Christian 
Published: November 2024

IntroductionThe effect of different anaesthetics on the incidence of postoperative delirium is still not entirely clear. Therefore, we will evaluate the effect of desflurane versus sevoflurane versus propofol for the maintenance of anaesthesia on the incidence of postoperative delirium in older adults undergoing moderate- to high-risk major non-cardiac surgery. We will further compare the incidences of delayed neurocognitive recovery, long-term postoperative neurocognitive disorder, postoperative nausea and vomiting between the groups.Methods and analysisIn this multicentre, prospective, observer-blinded, randomised controlled clinical trial, we will include 1332 patients ≥65 years of age undergoing moderate- to high-risk major non-cardiac surgery lasting at least 2 hours. Patients will be randomly 1:1:1 assigned to receive desflurane, sevoflurane or propofol for anaesthesia. Maintenance of anaesthesia will be performed in a goal-directed manner using processed electroencephalography with an intraoperative goal of bispectral index 40–60. Our primary outcome will be the incidence of postoperative delirium within the first five postoperative days. Postoperative delirium will be assessed using the three-dimensional-confusion assessment method (3D-CAM) or CAM-intensive care unit (ICU) in the morning and evening of the first five postoperative days by blinded study personnel. The primary outcome, the incidence of postoperative delirium, will be compared between the three study groups using a χ2test. Furthermore, a logistic regression model for the incidence of postoperative delirium will be performed, accounting for randomised groups as well as other predefined confounding factors.Ethics and disseminationThis clinical trial has been approved by the ethics committee and the Federal Office for Safety in Healthcare as the competent authority for clinical trials in Austria. The results of this trial will be published in a peer-reviewed journal.Trial registration numberClinicalTrials.govNCT05990790.
Implementation strategies for providing optimised tuberculosis and diabetes integrated care in LMICs (POTENTIAL): protocol for a multiphase sequential and concurrent mixed-methods study
Authors: Afaq Saima , Zala Zala , Aleem Saima , Qazi Fatima Khalid , Jamal Syeda Fatima , Khan Zohaib , Sarfraz Mariyam , Niazi Asima Khan , Safdar Nauman , Basit Abdul , Ul-Haq Zia , Iqbal Romaina , Fatima Razia , Hewitt Catherine , Siddiqi Najma , Parrott Steve , Siddiqi Kamran 
Published: November 2024

IntroductionAlmost a quarter of patients with tuberculosis (TB) in Pakistan may also have diabetes, with an additional quarter in a pre-diabetic state. Diabetes is a risk factor for TB. When it co-occurs with TB, it leads to poorer outcomes for both conditions, considerably increasing the burden on individuals, families and the healthcare system. We aim to improve health, quality of life and economic outcomes for people with TB and diabetes by optimising diabetes prevention, screening and management within TB care. The objectives of this study are to: (1) design an integrated optimised tuberculosis-diabetes care package (Opt-TBD) and its implementation strategies; (2) pilot and refine these implementation strategies and (3) implement and evaluate the Opt-TBD care package in 15 TB care facilities in Pakistan.Methods and analysisWe will work with the TB programme across two provinces of Pakistan: Khyber Pakhtunkhwa and Punjab. TB care facilities will be selected from urban and rural settings of these provinces and will include three levels: primary, secondary and tertiary care settings. This multiphase mixed-method study has three sequential phases. Once ready, the care package and its implementation strategies will be piloted to inform further refinement. The package will be implemented in 15 urban and rural TB care facilities and evaluated for its Reach, Effectiveness, Adoption, Implementation and Maintenance, and potential for scale-up. Quantitative data will assess provider adoption and the package’s accessibility and effectiveness for patients with TB and with diabetes and pre-diabetes. Qualitative data will explore barriers and facilitators for successful implementation and scale-up. Data will be analysed using statistical methods—including descriptive and inferential statistics—for quantitative data and framework analysis for qualitative data, with triangulation to integrate findings.Ethics and disseminationEthics approval was granted by the National Bioethics Committee of Pakistan (NBCR-1010). Findings will be shared through academic publications, conferences and public outreach.
Quality improvement initiative: use of the STOP-BANG score and monitoring to reduce adverse events in hospitalised patients at risk of obstructive sleep apnoea
Authors: Lauer Kathryn K , Zhang Donglin , Lunar Lauren , Landry Curtis , Welter Jennifer , Flemming Kellianne , Franco Rose , Siclovan Danielle , Avdeev Jamie , Woodson B Tucker , Szabo Aniko , Truwit Jonathon D , Hainsworth Keri R 
Published: November 2024

BackgroundObstructive sleep apnoea increases risk of respiratory depression with administration of sedatives, narcotics or anxiolytics. To reduce adverse events during hospital admission, we implemented STOP-BANG screening to prompt respiratory monitoring for inpatients receiving these medications. This study reports on protocol development, implementation and an initial analysis over 5 years to evaluate implementation success and outcomes.InterventionThe STOP-BANG measure was embedded in the nurse navigator at admission. If the score was ≥3 and sedatives, narcotics and/or anxiolytics were ordered, the provider was prompted to monitor patients with continuous pulse oximetry and/or capnography.MethodsWe assessed the impact of the intervention using a retrospective pre–post design. Preprotocol data from all adult inpatients over a 2.5-year period, and postprotocol data from all adult inpatients from over a 5-year period, were extracted from the electronic health record. Outcomes included use of monitoring; adverse events during hospitalisation were included to evaluate the effects of the intervention: mortality, rate of rapid response team events, reversal and/or rescue, intensive care unit admission and orders for positive airway pressure equipment.ResultsThe combined preprotocol and postprotocol sample included 254 121 patients. After protocol implementation, overall mortality for patients receiving sedatives, narcotics or anxiolytics decreased slightly from 2.1% to 1.9% (p<0.001). In the postprotocol cohort only (n=193 744), monitored patients had a higher probability of experiencing all adverse events. Among monitored patients, mortality was lowest in the high-risk group (STOP-BANG≥5).DiscussionTriaging by STOP-BANG coupled with monitoring appeared to be helpful for patients at highest risk of obstructive sleep apnoea. Given the complexity of obstructive sleep apnoea, further pursuit of subphenotypes is warranted.
Implementing and validating newborn screening for inborn errors of metabolism in South India: a 2-year observational study at a tertiary care hospital
Authors: Chikkalingaiah Manju Hosuru , Bevinakoppamath Supriya , Archana Surajj S , Kapa Aishwarya , Kempegowda Swetha N , Shivashankar Kusuma K , Ramachandra Shobha C , K Basavarajaiah Suma , Nataraj Suma , Prashant Akila 
Published: November 2024

IntroductionNewborn screening (NBS) is an essential public health initiative for early diagnosis of inborn errors of metabolism (IEM), where timely intervention can reduce morbidity and mortality. While routine in developed countries, NBS is not widely practised in India. This study aimed to implement NBS programme in a tertiary care hospital in South India and validate predetermined cut-off values tailored to the regional population.MethodsBetween 2020 and 2022, 5157 neonates were screened for congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH), cystic fibrosis (CF), glucose-6-phosphate dehydrogenase (G6PD) deficiency (G6PDD), phenylketonuria (PKU), galactosemia and biotinidase deficiency. Screening was performed using dissociation-enhanced lanthanide fluorescent immunoassay technology on Victor2D platform (Revvity). Markers assessed included 17-α-OH progesterone, neonatal thyroid stimulating hormone, total galactose, immunoreactive trypsinogen, G6PD enzyme, biotinidase enzyme and phenylalanine levels. Data analysis was conducted using R V.4.1.1 software.ResultsOf the 5157 neonates, the recall rates were consistent with those reported in similar studies. However, only 26.7% of screen-positive newborns returned for retesting, indicating a significant gap in awareness about IEMs and the importance of follow-up. Of these, none were diagnosed with CAH; however, four were found to have CH, two had galactosemia, three had G6PDD, one had CF, one had PKU and none had biotinidase deficiency. The confirmed cases were promptly treated and monitored regularly. The distribution of each marker’s values fell within 2.5th–97.5th percentiles suggesting consistency.ConclusionThe reference ranges provided by the manufacturer appear valid in the Indian context. A key challenge identified was low follow-up compliance for screen-positive infants, highlighting the need for enhanced public education on IEM and NBS. Future research will focus on determining the incidence of IEMs and improving parental awareness and follow-up rates.