bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring what influences the uptake of cancer rehabilitation services: a realist informed mixed-methods study
Authors: Csontos Judit Katalin , Roche Dominic , Watts Tessa 
Published: November 2024

ObjectivesTo investigate how uptake of cancer rehabilitation services is affected by information provision and whether it is influenced by people’s perception and attitudes towards rehabilitation interventions and therapies.DesignThis study followed a realist informed mixed-methods design. Descriptive secondary analysis of a cancer rehabilitation database containing information about number of people attending services, their diagnosis and sex and semi-structured interviews with people affected by cancer (PABC) and healthcare professionals (HCPs) were conducted.SettingCancer rehabilitation services located in two cancer centres in South Wales, UK.ParticipantsPABC who received care from any of the included cancer rehabilitation services. HCPs providing cancer rehabilitation at any of the included services.InterventionsExercise-based cancer rehabilitation, fatigue management, acupuncture and allied health professional support were provided as cancer rehabilitation.ResultsTwenty HCPs and 15 PABC were recruited for semi-structured interviews across the two services. The number of database records used for the secondary analysis ranged from 212 to 347 between 2014 and 2017. Based on descriptive analysis of these records and thematic analysis of HCPs’ interviews, uptake of cancer rehabilitation services often fluctuated. This could be attributed to PABC reporting issues with information provision on available services. Based on PABC’s accounts, they learnt about cancer rehabilitation in various ways, often by chance via word of mouth. Information provision was influenced by several issues including lack of consensus on what cancer rehabilitation means, the wider multidisciplinary team’s (MDT) perception and knowledge on cancer rehabilitation, the prevailing medical model in healthcare and the lack of routine provision of services. The perception and attitude of PABC did not seem to inhibit uptake and information provision.ConclusionsTo modify these inhibiting issues, the education of the wider MDT regarding the aim, modalities and importance of cancer rehabilitation is crucial.
Effect of different durations of preoperative computerised cognitive training on postoperative delirium in older patients undergoing cardiac surgery: a study protocol for a prospective, randomised controlled trial
Authors: Qiu Xinyuan , Wang Lili , Wen Xinge , Meng Qingling , Qi Junwei , Li Chuang , Yin Hua , Ling Fei , Yuhan Qiao , Zhang Wen , Zhang Yueying 
Published: November 2024

IntroductionPostoperative delirium (POD) is a common neurological complication after surgery among older patients, characterised by acute disturbances in consciousness, attention and cognition, usually occurring within 24–72 hours after surgery. POD has a significant impact on the prognosis of older patients undergoing major cardiovascular surgery, including increased length of hospital stay, hospital costs and readmission rates, with an incidence rate as high as 26%–52%. Computerised cognitive training (CCT) refers to difficulty-adaptive training in cognitive domains such as attention, memory and logical reasoning, using systematically designed tasks. Existing studies have shown that CCT has reduced the risk of delirium in non-cardiac surgery patients with at least minimal compliance. The purpose of this study is to investigate the effects of preoperative CCT on the incidence of POD in older patients undergoing elective cardiac surgery, to clarify the dose–effect relationship between different training time of preoperative CCT and POD and to explore the minimum effective time target that can significantly lower the incidence of POD.Methods and analysisThis is a prospective, single-blind, randomised controlled trial that aims to enrol 261 older patients scheduled for elective cardiac surgery at the Affiliated Hospital of Xuzhou Medical University. The patients will be randomised into three groups: group C will be the routine care group (no CCT prior to surgery); group L will be the low-dose time group (with a total of 5 hours of CCT prior to surgery) and group H will be the high-dose time group (with a total of 10 hours of CCT prior to surgery). The primary outcome is the incidence of delirium within 7 days after surgery. Secondary outcomes include postoperative mild neurocognitive disorder (NCD) and postoperative major NCD (30 days up to 1 year), time of onset and duration and severity of delirium, and all-cause mortality within 1 year after surgery. The results of this study are of significant importance for establishing effective, patient-centred and low-risk prevention strategies for POD/postoperative NCD.Ethics and disseminationThis study protocol has been approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Ethics Number: XYFY2023-KL149-01). All participants will provide written informed consent, and the results of the study will be published in international peer-reviewed academic journals and presented at academic conferences.Trial registration numberChiCTR2300072806.
Descriptive qualitative study of breathlessness and its management of Turkish individuals with self-reported heart failure
Authors: Seckin Muzeyyen , Petrie Mark C , Stewart Simon , Johnston Bridget Margaret 
Published: November 2024

AimsTo explore the experiences of individuals with heart failure, with a specific focus on elucidating the full spectrum of symptoms experienced and their subjective descriptions of breathlessness and self-management strategies regarding socio-cultural-behavioural context.DesignQualitative descriptive study underpinned by critical realism and situation-specific theory of heart failure self-care.SettingParticipants from various settings (hospitals and community) in Southeastern Türkiye.ParticipantsAdults reporting heart failure and breathlessness.MethodsSemi-structured interviews were carried out with 20 individuals (11 women and 9 men). Data were audio-recorded and transcribed. Participants were asked to describe their symptoms, experiences with breathlessness, self-management strategies and health needs from their perspectives. The interview data were analysed using reflexive thematic analysis.ResultsThere were a range (31 physical and 7 psycho-social behavioural) of symptoms experienced by participants. This included fatigue, difficulty sleeping, pain (not including chest pain) and fear about death and dying. Based on reflexive thematic analysis of semi-structured interviews, six main themes were identified. First two themes (knowledge and misconception, and experience of breathlessness) were related to breathlessness experience and knowledge. The third theme (culture and religious consideration) highlighted the importance of cultural and religious perspectives in breathlessness regarding Turkish socio-cultural-behavioural context. Themes four (breathlessness self-management/physical) and five (breathlessness self-management/psychological) were identified as self-management strategies for breathlessness. The need for improved health behaviours (improved health behaviours) was also identified.ConclusionBreathlessness and self-management strategies are affected by individual perspectives in relation to their socio-cultural-behavioural context. Understanding individuals’ unique breathlessness experiences regarding their socio-cultural-behavioural context assists in the identification of possible individualised-care strategies to improve their life and care quality in heart failure. We recommend creating a person-centred symptom assessment strategy with reference to culture or transculture guided by nurses. This will help to understand individuals’ unique symptom profiles and tailor responses to their needs.
Primary prevention of cardiovascular diseases among women in a South Asian population: a descriptive study of modifiable risk factors
Authors: Rauf Rubina , Khan Muhammad Nauman , Sial Jawaid Akbar , Qamar Nadeem , Saghir Tahir , Kazmi Khawar Abbas 
Published: November 2024

ObjectiveThe aim of this study was the assessment of modifiable risk factors of cardiovascular diseases (CVD) among women versus men at a newly developed preventive cardiology clinic of a large tertiary care cardiac centre in Pakistan.DesignObservational study.SettingTertiary care cardiac hospital in Karachi, Pakistan.ParticipantsData for this study were obtained retrospectively from a prospectively collected ongoing registry. We have included all female and male individuals who have presented or were referred to our clinic for primary prevention. All the participants had no history of ischaemic heart disease.Outcome measureIn this study, we evaluated the CVD risk factors, estimated risk of CVD, and glycaemic and cholesterol control at baseline and at subsequent follow-ups for high-risk patients.ResultsA total of 535 patients, 314 females, were included with a mean age of 48.3±12.5 years. At baseline, 57.9% (128) of men versus 73.2% (230) of women (p<0.001) were known cases of hypertension (HTN); 18.1% (40) vs 26.8% (84) (p=0.019) were diabetic; 40.5% (89) vs 9.2% (29) (p<0.001) were tobacco users; 26.0% (56) vs 3.2% (10) (p<0.001) were smokers; and 26.9% (57) vs 50.5% (153) had BMI ≥30 kg/m2, respectively.Baseline atherosclerotic cardiovascular disease (ASCVD) risk score was available for 348 (65%), 61.5% (136) of men versus 67.5% (212) of women. The median ASCVD risk score was 6.8% (2.8%–16.1%) vs 2.25% (1%–5.1%) (p<0.001 for men and women, respectively). The ASCVD risk score was ≥20% (high risk) for 22.1% (30) vs 1.9% (4), while the ASCVD risk score was <5% (low risk) for 40.4% (55) vs 74.1% (157) of men and women, respectively.A repeat ASCVD assessment at a median follow-up of 49.5 (7.0–231) days was available for 259 (48.4%) patients, 26.2% (58) of men vs 64% (201) of women, respectively. The median follow-up ASCVD score was 6.55% (2.8%–15.4%) vs 2.1% (0.9%–4.8%) (p<0.001 with ≥20% (high risk) in 19% (11) vs 2% (4) and <5% (low risk) in 34.5% (20) vs 77.1% (155) of men and women, respectively).Conclusion(s)There is a high prevalence of modifiable risk factors for atherosclerotic CVD such as HTN, diabetes and obesity in women as compared with men, but interestingly, ASCVD risk score at the baseline as well as at the follow-up is high in men versus women. Some other non-modifiable risk factors like age, gender and blood lipid profile may also contribute to this difference between the high prevalence of risk factors and low ASCVD risk score in women. With appropriate follow-up and proper counselling, the looming CVD can be better prevented in this population. A dedicated preventive cardiology clinic for the identification of high-risk women and systematic follow-up is needed to predict their actual CVD risk.Trial registrationNCT06503341.
Exploring whether home-based neuromodulation can boost the analgesic effects of exercise in people with knee osteoarthritis: protocol for a double-blinded, pilot randomised controlled trial
Authors: McNally Keeley R , Summers Simon , Stanton Tasha R , McAuley James , Chang Wei-Ju , Chowdhury Nahian , Cavaleri Rocco 
Published: November 2024

IntroductionKnee osteoarthritis (OA) represents a leading cause of disability globally. Exercise has been demonstrated to improve pain and function in people with knee OA. However, when in pain, commencement of exercise is difficult, and clinical effects with such interventions are often modest. Recently, transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, has been shown to bolster the pain-relieving effect of exercise in experimental settings. While promising, the utility of employing this approach beyond the research environment is yet to be elucidated. Therefore, this pilot study aims to investigate the feasibility, safety, adherence, tolerability and preliminary efficacy of tDCS and exercise in home-based settings to improve pain and function in people with knee OA.Methods and analysisThis protocol is for a pilot randomised, double-blinded, sham-controlled trial. 24 individuals with idiopathic knee OA will be randomised to receive either active tDCS+exercise (Intervention) or sham tDCS+exercise (Control) at home. Participants will receive 20 min of tDCS 5 days per week for the first 2 weeks of this 8-week trial. Participants in both groups will complete a lower limb strengthening programme 3 days per week for the entire 8 weeks. Outcome measures of feasibility (acceptability, satisfaction, retention), safety, adherence and tolerability will be assessed throughout the trial period, with clinical outcomes of pain and function assessed before and following the intervention. Feasibility, safety, adherence and tolerability outcomes will be explored descriptively using frequencies and percentages. To examine preliminary efficacy, within-group and between-group changes in pain and functional measures will be analysed.Ethics and disseminationThis protocol obtained ethical approval from the Queensland University of Technology Human Research Ethics Committee (HREA 2024-8302-20200). All participants will provide written informed consent. The findings of the study will be disseminated via journal publications and international conference proceedings.Trial registration numberACTRN12624000397516p.
Qualitative exploration of the barriers and facilitators to community pharmacy PrEP delivery for UK pharmacists and underserved community members using the COM-B model of behaviour change
Authors: Harrison China , Family Hannah , Kesten Joanna , Denford Sarah , Scott Jennifer , Sabin Caroline , Copping Joanna , Harryman Lindsey , Cochrane Sarah , Saunders John , Hamilton-Shaw Ross , Horwood Jeremy 
Published: November 2024

ObjectivesExpanding delivery of oral pre-exposure prophylaxis (PrEP) to community pharmacies could improve access, aligning well with the UK government’s goals to eliminate new HIV acquisitions by 2030. Using the Capability, Opportunity, Motivation, Behaviour (COM-B) model for behaviour change, the aim of this research was to explore the barriers and facilitators of community pharmacy PrEP delivery, for pharmacists and community members.MethodsCommunity members at elevated risk of acquiring HIV and community pharmacists were recruited to participate in semi-structured interviews. Interviews were recorded, transcribed, and thematically analysed within the framework of the COM-B model.Results17 interviews with pharmacists (pharmacy owners n=7; employed pharmacists n=6; locums n=4) and 24 with community members (black African women n=6; other women n=2; young adults aged 18–25 years n=6; transgender people n=6; female sex workers n=4) were carried out. Capability barriers included suboptimal awareness and knowledge of PrEP, pharmacy facilities and pharmacist roles in delivering public health services. Opportunity barriers included a lack of staff capacity, privacy and pharmacy screening and monitoring facilities. Motivational barriers included a concern that increased access could increase sexually transmitted infections and involve a financial cost. Capability facilitators included awareness raising, HIV and PrEP training and education. Opportunity facilitators included PrEP appointments and the accessibility of pharmacies. Motivational facilitators included a preference for pharmacy delivery over other models (eg, sexual health, General Practitioner (GP)), and a belief that it would be discrete and less stigmatising.ConclusionPharmacy PrEP delivery is acceptable but for it to be feasible, results point to the need for the development of a behaviour change intervention focusing on education, training and awareness raising, targeting pharmacists and community members to stimulate patient activation and de-stigmatise HIV. This intervention would need to be facilitated by system and environmental changes (eg, commissioning service).
Timeliness of Lung Cancer Care and Area-Level Determinants in Victoria: A Bayesian Spatiotemporal Analysis
Authors: Tesema Getayeneh Antehunegn , Tessema Zemenu Tadesse , Heritier Stephane , Stirling Rob G. , Earnest Arul 
Published: November 2024

Abstract

Background:
The reports have stated that the timeliness of lung cancer care varies significantly across different regions. According to the Victorian Lung Cancer Registry report, the timeliness of lung cancer care in Victoria has changed over time. Therefore, we aimed to quantify the extent of these spatial inequalities over time and to identify area-level determinants contributing to these changes.

Methods:
The study analyzed lung cancer cases reported to the Victorian Lung Cancer Registry between 2011 and 2022. Bayesian spatiotemporal conditional autoregressive models were fitted, incorporating spatial random effects, temporal random effects, and spatiotemporal interactions. The best performing model was selected using the deviance information criterion. For the final best fit model, the adjusted RRs and their 95% credible intervals were reported.

Results:
More than half (51.24%) of patients with lung cancer experienced treatment delays, whereas approximately one third (30.98%) encountered diagnostic delays. Moderate spatiotemporal variations were observed in both delayed diagnosis and treatment. In the final best fit model for treatment delay, an increase in the percentage of smokers was significantly associated with a higher risk of treatment delay (RR = 2.13; 95% credible interval, 1.13–4.20).

Conclusions:
Identifying high-risk areas provides useful information for policymakers, helping in the reduction of delays in lung cancer diagnosis and treatment.

Impact:
This study has revealed spatiotemporal inequalities in diagnostic and treatment delays, providing valuable insights for identifying areas that should be prioritized to ensure timely care for lung cancer.
Metabolic Phenotype and Risk of Obesity-Related Cancers in the Women’s Health Initiative
Authors: Karra Prasoona , Hardikar Sheetal , Winn Maci , Anderson Garnet L. , Haaland Benjamin , Shadyab Aladdin H. , Neuhouser Marian L. , Seguin-Fowler Rebecca A. , Thomson Cynthia A. , Coday Mace , Wactawski-Wende Jean , Stefanick Marcia L. , Zhang Xiaochen , Cheng Ting-Yuan David , Karanth Shama , Sun Yangbo , Saquib Nazmus , Pichardo Margaret S. , Jung Su Yon , Tabung Fred K. , Summers Scott A. , Holland William L. , Jalili Thunder , Gunter Marc J. , Playdon Mary C. 
Published: November 2024

Abstract
Body mass index (BMI) may misclassify obesity-related cancer (ORC) risk, as metabolic dysfunction can occur across BMI levels. We hypothesized that metabolic dysfunction at any BMI increases ORC risk compared with normal BMI without metabolic dysfunction. Postmenopausal women (n = 20,593) in the Women’s Health Initiative with baseline metabolic dysfunction biomarkers [blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, fasting glucose, homeostatic model assessment for insulin resistance (HOMA-IR), and high-sensitive C-reactive protein (hs-CRP)] were included. Metabolic phenotype (metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy overweight/obese, and metabolically unhealthy overweight/obese) was classified using four definitions of metabolic dysfunction: (i) Wildman criteria, (ii) National Cholesterol Education Program Adult Treatment Panel III, (iii) HOMA-IR, and (iv) hs-CRP. Multivariable Cox proportional hazards regression, with death as a competing risk, was used to assess the association between metabolic phenotype and ORC risk. After a median (IQR) follow-up duration of 21 (IQR, 15–22) years, 2,367 women developed an ORC. The risk of any ORC was elevated among metabolically unhealthy normal weight (HR = 1.12, 95% CI, 0.90–1.39), metabolically healthy overweight/obese (HR = 1.15, 95% CI, 1.00–1.32), and metabolically unhealthy overweight/obese (HR = 1.35, 95% CI, 1.18–1.54) individuals compared with metabolically healthy normal weight individuals using Wildman criteria. The results were similar using Adult Treatment Panel III criteria, hs-CRP alone, or HOMA-IR alone to define metabolic phenotype. Individuals with overweight or obesity with or without metabolic dysfunction were at higher risk of ORCs compared with metabolically healthy normal weight individuals. The magnitude of risk was greater among those with metabolic dysfunction, although the CIs of each category overlapped.
Prevention Relevance: Recognizing metabolic dysfunction as a significant risk factor for ORCs underscores the importance of preventive measures targeting metabolic health improvement across all BMI categories.
Abstract 4138113: C-X-C Motif Chemokine Receptor 4-directed Molecular Imaging of Mediastinal Lymph Nodes after Acute Myocardial Infarction in Patients
Authors: Reiter Theresa , Kosmala Aleksander , Doerrler Anna Lena , Hasenauer Natalie , Kraus Nils , Serfling Sebastian , Hartrampf Philipp E. , Bauer Wolfgang R. , Hofmann Ulrich , Buck Andreas , Higuchi Takahiro , Werner Rudolf A. 
Published: November 2024

Purpose:
After acute myocardial infarction (MI), lymphocytes play a pivotal role in the scar formation and remodeling of the remote myocardium. Activation of lymphocytes takes places in mediastinal lymph nodes (MLN). Therefore, imaging of MLN as a read-out of the adaptive immune response to MI may identify subjects at increased risk for cardiac functional decline.

Methods:
The on-going prospective study (NCT05519735) enrolls patients with acute ST-elevation MI followed by complete reperfusion and multimodal imaging with C-X-C motif chemokine receptor 4 (CXCR4)-directed PET/CT and cardiac MRI (CMR) as baseline imaging. Follow-up (FU) CMR scans are repeated after 6 and 12 months. The CMR scans are analyzed regarding LV function, myocardial and LGE mass. Tracer uptake (SUVpeak) in the myocardium and MLN (defined as LN with most intense uptake) are determined. Infarct/remote myocardial (IRR), MLN/Remote LN (LNR) ratios and the overall LNR (including uptake from all LN) are calculated. Association of uptake with the function CMR parameters is tested.

Results:
Currently, 41 patients (29 males, median age 59 yo) were enrolled in the study (6 months FU 27/41, 12 months FU 17/41). At baseline, the median CMR EF was 49% and improved with the FUs (6mo: 52.8%, 12 mo 53.2%). LGE mass was 30.3 g and declined to 13.8 g after 12 months (LGE/Myocardial 15.8%). SUV
peak
from infarcted myocardium and mediastinal LN were consistently >1, indicating increased uptake relative to background.

Changes of LVEF correlated with LNR (6 mo FU: %LVEF, r= - 0.48; P = 0.01, 12 mo FU: %LVEF, r= - 0.55; P = 0.02) and overall LNR (6 mo FU: %LVEF, r= - 0.52; P< 0.01; 12 mo FU: %LVEF; r= - 0.61; P = 0.01), but not with IRR (P= 0.498).
LNR was increased in subjects with decreased LVEF. In logistic regression analysis, increasing LNR and overall LNR were significantly associated with decreased LVEF at the 12 months FU (LNR OR 1.32 (95% CL: 1.06-1.81, p = 0.03), Overall LNR OR 1.36 (95 % CL: 1.09-1.92, p = 0.03)).

Conclusion:
CXCR4-directed imaging of MLN provides information on the extent of local and systemic tissue inflammation in patients after acute MI. Especially MLN CXCR4 uptake holds predictive potential for cardiac adverse remodelling during follow up (LVEF decline) and may be used to identify patients who benefit from a selective immune modulation after acute MI.

Funding:
German Research Foundation (453989101).