bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid antibiotic susceptibility testing for urinary tract infections in secondary care in England: a cost-effectiveness analysis
Authors: Booton Ross D , Agnew Emily , Pople Diane , Evans Stephanie , Bock Lucy J , Sutton J Mark , Robotham Julie V , Naylor Nichola R 
Published: November 2024

ObjectivesTo perform a model-based cost-effectiveness evaluation of a rapid antimicrobial susceptibility test.DesignA Markov model of a cohort of hospital inpatients with urinary tract infection (with inpatient numbers based on national administrative data from 1 April 2017 to 31 March 2019).SettingUrinary tract infections (UTI) in acute National Health Service (NHS) Trusts in England, from the perspective of the NHS Healthcare system, at a national level.ParticipantsA simulated cohort of approximately 280 000 non-pregnant adult inpatients within secondary care with a clinical suspicion of UTI.InterventionsEvaluation of the implementation of a fast bacterial impedance cytometry test (BICT) compared with current practice.Primary and secondary outcome measuresIncremental cost, quality-adjusted life years, net monetary benefit, and bed days and appropriateness of antibiotic use per patient. Costs are presented in 2022 GBP.ResultsConsidering benefits arising from reduced time on inappropriate treatment, BICT gives an average net monetary benefit (NMB) over the simulation period of approximately £4.3 million and dominates culture methods (from the healthcare system perspective and with a willingness to pay threshold of £20 000 per quality-adjusted life year). Total inappropriate prescribing days due to the BICT test are reduced by 57%. The extent of the benefit from BICT implementation was strongly dependent on prevalence of resistance, with the NMB increasing sevenfold to over £30 million in a high (40%) resistance prevalence scenario. At the population level, the patient groups with the highest cost and quality-adjusted life year impacts were 65–100-year-old females, followed by males, with uncomplicated UTIs. At an individual patient level, however, 16–64-year-old females with complicated UTIs with oral treatment, followed by 65–100-year-old males with complicated UTIs with oral treatment, were impacted to the greatest degree by the rapid BICT.ConclusionsUnder conservative assumptions and for wide parameter sensitivity, the implementation of BICT would be cost-effective from the NHS healthcare system perspective.
Informed consent and risk communication challenges in antimicrobial clinical trials: a scoping review
Authors: Shou Yiyun , Yeo Joey Elizabeth , Pang Alexander Shao-Rong , Paterson David L. , Mo Yin 
Published: November 2024

Objectives
Randomised trials for the management of drug-resistant infections are challenging to conduct as target patient populations often lack decision-making capacity, and enrolment windows are typically short. Improving informed consent and risk communication in these trials is especially crucial for protecting patient interests and maximising trial efficiency. This study aimed to understand challenges in risk communication and informed consent in antimicrobial clinical trials.

Design
Scoping review.

Data sources
Searches were conducted in Embase, Medline, CINAHL and Web of Science Core for peer-reviewed English articles that were published from January 2000 to April 2023.

Eligibility criteria
Included articles were empirical studies or expert opinions that sought experts’, patients’ or representatives’ opinions on informed consent in the context of clinical trials involving antibiotic/anti-infective agents.

Data extraction and synthesis
Abstract screening, full-text review, data extraction and evidence rating were performed by two independent reviewers. Extracted data were summarised and reported qualitatively based on common themes. A total of 2330 records were retrieved, and 29 articles were included in the review.

Results
Half of the articles involving medical experts and one-third involving patients and representatives reported that full comprehension by patients and representatives was challenging or not achievable. Healthcare providers and consent takers were crucial for the quality of informed consent. The level of trust consent givers placed on healthcare providers had a critical influence on the consent rate. Emotional distress was pervasive among patients/representatives.

Conclusion
The findings indicate that strengthening consent takers’ communication skills in providing emotional support to patients and their representatives may improve informed consent. More research is needed to understand informed consent in low-income and middle-income and non-English-speaking countries.
Prevalence of physical inactivity and associated factors among adults in Eastern African countries: a systematic review and meta-analysis protocol
Authors: Abuhay Habtamu Wagnew , Derseh Nebiyu Mekonnen , Kolbe-Alexander Tracy L , Gyawali Prajwal , Yenit Melaku Kindie 
Published: November 2024

IntroductionPhysical inactivity is a major global public health concern, increasing the risk factor of non-communicable diseases (NCDs) and mortality. The WHO has initiated the Global Action Plan on Physical Activity to reduce global physical inactivity by 15% by 2030. Rapid urbanisation and insufficient physical activity in the Global South have significant implications for public health, leading to increased NCDs. Understanding physical inactivity and related risk factors among adults is essential in addressing the growing NCD epidemic. This study aims to estimate the pooled prevalence of physical inactivity and its associated risk factors among adults in Eastern African countries.Methods and analysisThis review protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (2020) Guideline. A comprehensive search will be conducted using the CoCoPop (condition, context, population) frameworks to include all observational studies published from 1 January 2010 to 31 October 2024. Databases such as PubMed, Scopus, Embase, CINAHAL, Web of Science, Science Direct and Google Scholar will be searched. Studies with citations without an abstract or full text and qualitative studies will be excluded. The Joanna Briggs Institute critical appraisal tool will be used to assess the quality of each study. The heterogeneity of studies will be quantified using the I2statistic, and a fixed-effects or random-effects model will be used for the pooled analysis. Publication bias will be assessed using visual (funnel plot) and statistical methods. The study countries will be the basis for subgroup analysis, and sensitivity analysis will be used to see how one study’s results may affect the estimate as a whole.Ethics and disseminationEthical approval is not required for this systematic review. The results will be disseminated through peer-reviewed publications and conference presentations. Furthermore, this systematic review and meta-analysis will be used to generate comprehensive and robust evidence for public health interventions.PROSPERO registration numberCRD42024567592
Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
Authors: Sewell Bernadette , Francis Nick , Harris Shaun , Gillespie David , Bates Janine , White Patrick , Alam Mohammed Fasihul , Hood Kerenza , Butler Christopher C , Fitzsimmons Deborah 
Published: November 2024

Objectives
Many patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care do not benefit from antibiotics. Excessive use wastes resources, promotes antimicrobial resistance and can harm patients.

Design
We conducted a within-trial economic evaluation, using a UK National Health Service perspective, as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial.

Setting
Participating general practices in primary care.

Participants
PACE included 324 and 325 consenting participants presenting with AECOPD in the usual-care and CRP-guided groups, respectively.

Intervention
We assessed the cost-effectiveness (CE) of a C-reactive protein point-of-care-test (CRP-POCT) in addition to usual clinical assessment to guide antibiotic prescribing for AECOPD in primary care.

Primary and secondary outcome measures
A cost-effectiveness analysis (CEA) of incremental cost per 1% antibiotic consumption reduction at 4 weeks and a cost-utility analysis (CUA) at 6 months were performed, based on a modified intention-to-treat population. Sensitivity analyses assessed the impact of uncertainty on the results. CE acceptability curves represent the probability of CRP-POCT being cost-effective at different willingness-to-pay (WTP) thresholds.

Results
Both groups had similar clinical outcomes, but a 20% absolute reduction in antibiotic consumption was observed in the CRP-guided group. CRP-POCT costs of £11.31 per test were largely offset by savings in healthcare resource use related to COPD. The mean incremental CE ratios of CRP-POCT were £120 per 1% absolute reduction in antibiotic consumption at 4 weeks and £1054 per quality-adjusted life-year (QALY) gained at 6 months. Sensitivity analysis showed that the CEA results were most affected by changes in healthcare costs, while CUA was sensitive due to marginal differences in costs and outcomes. There is a 73% probability of CRP-POCT being cost-effective at WTP ≤£20 000 per QALY gained.

Conclusion
CRP-POCT is a cost-effective intervention for safely reducing antibiotic consumption in patients with AECOPD.

Trial registration number

NCT24346473
Cohort profile: the WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) to identify predictors of mortality through early childhood
Authors: Schwinger Catherine , Kaldenbach Siri , Berkley James A , Walson Judd L , Argaw Alemayehu , Chowdhury Ranadip , Strand Tor A , Rollins Nigel 
Published: November 2024

PurposeTo provide details of a pooled data set that will be used to estimate absolute and relative mortality risks and other outcomes among children less than 59 months of age and the predictive performance of common risk exposures, both individually and in combination.ParticipantsChildren from birth to 5 years of age recruited at health facilities or community settings into 33 longitudinal observational or intervention studies in 17 low- and middle-income countries.Findings to dateThe data set includes 75 287 children with a median age of 3 months (IQR 1–12) at first measurement. In the pooled sample, 2805 (3.7%) of the study children died. Data on birth weight was recorded in 19 studies, and gestational age in 13 studies. Among these, 14% of the included children were reported as having low birth weight, and 14% had preterm birth. At first measurement, 33% of the children were stunted, 24% were wasted and 35% underweight. 13% and 7% of caregivers reported that their child had acute diarrhoea or acute lower respiratory tract infection before the study visit, respectively. The proportion of children reported as breastfed at any study visit decreased from 99% at age <6 months to 77% in the age group 12–23 months. Child characteristics differed considerably between studies in the community and healthcare settings. The median study period was 15 months (IQR 7.6–18.4 months).Future plansPlanned analyses will examine knowledge gaps with the aim of informing global guidelines and their derivatives such as clinical management tools and implementation guidance, and to inform future research agendas. We aim to estimate absolute mortality risks associated with child age, anthropometry, birth characteristics and feeding practices as planned by the WHO-Risk Stratification Working Group. In the future, other data sets may be added and further questions on survival and growth will be investigated.
Sustained impacts of the COVID-19 pandemic on medical student learning and well-being in rural Australia: findings from a repeated national multicentre survey
Authors: Martin Priya , McGrail Matthew R , Fox Jordan , Doyle Zelda , Ostini Remo , Beattie Jessica , Fuller Lara , Allen Penny , Kondalsamy-Chennakesavan Srinivas 
Published: November 2024

ObjectiveThe impact of COVID-19 on medical students has predominantly been assessed by one-off survey studies at the pandemic onset. This national study investigated the sustained impacts of the COVID-19 pandemic on medical students’ rural clinical placement learning and well-being.DesignRepeated cross-sectional survey design.SettingAnnual Federation of Rural Australian Medical Educators (FRAME) survey across 2020 to 2022.ParticipantsMedical students completing an extended (mostly 12 months) rural placement.Outcome measureA mixed-methods survey with closed-ended and open-ended question. Quantitative data were analysed using χ2and Kruskal-Wallis tests. Qualitative responses were analysed through content analysis.ResultsQuantitative findings: in 2022 (43%), respondents were more likely to interact with COVID-19 patients in a clinical capacity compared with 2020 (26%) and 2021 (23%; p<0.001). Respondents were more likely to be concerned about missed clinical learning in 2020 (58%) than in 2021 (40%) and 2022 (44%; p<0.001). Respondents in 2020 (41%) and 2022 (39%) were more likely to feel that their performance on assessments was affected by COVID-19 compared with 2021 respondents (28%; p<0.001). Respondents in 2022 (38%) and 2021 (31%) were more likely to report being exposed to an increased breadth of cases than 2020 respondents (13%; p<0.001) and also reported more exposure to community-based placements (2022: 38%, 2021: 31%, 2020: 19%; p<0.001).Qualitative findings: three categories were developed from the data—mental health and well-being impacts, learning preferences at play, and concerns about flow-on effects.ConclusionsWhile the pandemic has now become the ‘new normal’, the mental well-being and learning concerns raised by students in rural Australia, and their concerns about sustained impacts into their internship cannot be ignored. Healthcare organisations need to ensure that when impacted students enter the workforce the practice context is supportive, with mechanisms such as effective clinical supervision in place.
Effectiveness of glucagon-like peptide-1 receptor agonists for reduction of body mass index and blood glucose control in patients with type 2 diabetes mellitus and obesity: A retrospective cohort study and difference-in-difference analysis
Authors: Siriyotha Sukanya , Anothaisintawee Thunyarat , Looareesuwan Panu , Nimitphong Hataikarn , McKay Gareth J , Attia John , Thakkinstian Ammarin 
Published: November 2024

Objective
This study aimed to evaluate the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RA) in reducing body mass index (BMI) and blood glucose levels in individuals with type 2 diabetes mellitus (T2DM) using the difference-in-differences (DID) technique.

Research design and methods
This retrospective cohort study included patients with T2DM, receiving GLP1-RA or other second-line antidiabetic treatments between 2010 and 2023. A linear mixed-effect regression with heterogeneous augmented inverse probability weighting DID analysis was used to compare the effectiveness of GLP-1RA and other second-line treatments in reducing BMI, fasting plasma glucose (FPG) and haemoglobin A1C (HbA1c) in patients with T2DM. An average treatment effect on the treated (ATET) for each outcome was estimated.

Results

1000 patients with T2DM (GLP-1RA=220, non-GLP-1RA=880) were included. Compared with other second-line drugs, GLP-1RA significantly reduced BMI by approximately 1.02 kg/m
2
(95% CI −1.46 to –0.58) over 24 months of treatment. Additionally, GLP-1RA significantly decreased FPG and HbA1c levels, compared with other second-line treatments with overall ATETs (95% CI) of −21.34 mg/dL (−29.53 to –13.15) and −0.58% (–0.77% to –0.38%), respectively.

Conclusions
Our results indicate that patients with T2DM treated with GLP-1RA had a significantly greater reduction in BMI, FPG and HbA1C levels compared with those receiving other second-line antidiabetic therapies. As such, GLP-1RA might be considered the preferred treatment for obese patients with T2DM who fail to sufficiently respond to metformin monotherapy.
iDiabetes platform—enhanced phenotyping of patients with diabetes for precision diagnosis, prognosis and treatment: study protocol for a cluster-randomised controlled study in Tayside, Scotland
Authors: Lin YeunYi , Leith Damien , Abbott Michael , Barrett Rachael , Bell Samira , Croudace Tim J , Cunningham Scott , Dillon John , Donnan Peter , Farre Albert , Hernández Rodolfo , Lang Chim , McKenzie Stephanie , Mordi Ify , Morrow Susan , Munro Cameron , Philip Sam , Ryan Mandy , Wake Deborah , Wang Huan , Win Mya , Pearson Ewan 
Published: November 2024

Introduction and aimDiabetes is a global health emergency with increasing prevalence and diabetes-associated morbidity and mortality. One of the challenges in optimising diabetes care is translating research advances in this heterogeneous disease into clinical care. A potential solution is the introduction of precision medicine approaches into diabetes care.We aim to develop a digital platform called ‘intelligent Diabetes’ (iDiabetes) to support a precision diabetes care model in Scotland and assess its impact on the primary composite outcome of all-cause mortality, hospitalisation rate, renal function decline and glycaemic control.Methods and analysisThe impact of iDiabetes will be evaluated through a cluster-randomised controlled study, recruiting up to 22 500 patients with diabetes. Primary care general practices (GPs) in the National Health Service (NHS) Scotland Tayside Health Board are the units (clusters) of randomisation. Each primary care GP will form one cluster (approximately 400 patients per cluster), with up to 60 clusters recruited. Randomisation will be toiDiabetes (guideline support),iDiabetesPlusorusual diabetes care(control arm). Patients of participating primary care GPs are automatically enrolled on the study when they attend for their annual diabetes screening or are newly diagnosed with diabetes. A composite hierarchical primary outcome, evaluated using Win-Ratio statistical methodology, will consist of (1) all-cause mortality, (2) all-cause hospitalisation rate, (3) proportion with >40% estimated glomerular filtration rate [eGFR] reduction from baseline or new development of end-stage renal disease, (4) proportion with absolute HbA1C reduction >0.5%. Outcomes will be evaluated after a 2-year median follow-up period. Comprehensive qualitative and health economic analyses will be conducted, assessing the cost-effectiveness, budget impact and user acceptability of the iDiabetes platform.Ethics and disseminationThis study was reviewed by the NHS Health Research Authority and approved by the East of Scotland Research Ethics Committee (reference: 23/ES/0008). Study findings will be disseminated via publications, presented at scientific conferences and shared with patients and the public on the study website and social media.Trial registration numberISRCTN18000901.
Does hospital strategic alliance affect the paediatric service capacity of local hospitals? A difference-in-differences econometric analysis
Authors: Zhang Li , Xiao Cuiping , Fu Qian , Yang Cuili , Yu Xiaolu , Feng Zhanchun 
Published: November 2024

BackgroundHealth inequality caused by the scarcity and uneven distribution of paediatric service resources is common worldwide. The hospital strategic alliance may improve paediatric service capacity and health equity, but this hypothesis has not yielded consistent results. Here, we examine the hospital strategic alliance’s effect on local hospitals’ paediatric service capacity.MethodsThe paediatric monitoring data of 119 local hospitals from 14 cities between 2015 and 2019 were obtained from the Hubei Pediatric Quality Control Center and the Provincial Statistical Yearbook. We employed the difference-in-differences model with multiple periods. The samples were divided into three groups—close cooperation group, loose-knit cooperation group and control group—differentiated by hierarchical clustering based on the implementation of core initiatives. The number of outpatient visits and the number of inpatient visits were used as the outcomes. The ‘available beds’ and the ‘health personnel per 1000 resident population’ were chosen as the control variables.ResultsThe cross-over Treat×Post coefficient was significantly positive at a 1% level in Models 1 and 3, with or without control variables. Specifically, the coefficient for the number of outpatients in Model 2 was significantly positive at the 5% level, supporting Hypothesis H1. Model 4 confirmed a significantly positive cross-over Treat×Post coefficient at a 1% level, and Model 3 showed a larger coefficient than Model 2, indicating greater benefits for the loose-knit cooperation model, supporting Hypothesis H2.ConclusionsThe hospital strategic alliance enhanced the paediatric service capacity of local hospitals. Furthermore, the close cooperation model appears to be a more effective solution for addressing health inequality caused by the scarcity and uneven distribution of paediatric service resources.
Virological failure and associated factors among patients receiving anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis
Authors: Aytenew Tigabu Munye , Asferie Worku Necho , Ejigu Netsanet , Birhane Binyam Minuye , Tiruneh Yenework Mulu , Kassaw Amare , Asnakew Sintayehu , Legas Getasew , Munie Birhanu Mengist , Belay Bekalu Mekonnen , Ewunetu Mengistu , Kefale Demewoz , Kebede Solomon Demis 
Published: November 2024

ObjectiveThis study aimed to pool the prevalence of virological failure and associated factors.DesignSystematic review and meta-analysis.Primary outcome measurePrevalence of virological failure.Secondary outcome measureFactors affecting virological failure.AnalysisThe extracted data were exported to STATA V.17 for statistical analysis. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of virological failure.SettingEthiopia.ParticipantsPatients receiving anti-retroviral therapy.ResultsA total of 51 primary studies with a sample size of 38, 789 participants were included in the final meta-analysis. The pooled prevalence of virological failure among patients receiving anti-retroviral therapy (ART) in Ethiopia was 15.95% (95% CI: 12.63, 19.27; I2=97.99%; p<0.001). Substance use (adjusted OR (AOR)=2.37, 95% CI: 1.28, 4.39), non-disclosure of HIV status (AOR=4.63, 95% CI: 3.51, 6.11), interruption of ART (AOR=2.61, 95% CI: 1.55, 4.40), poor adherence to ART (AOR=4.31, 95% CI: 2.73, 6.79), baseline CD4 cell count <200 cells/mm3(AOR=2.65, 95% CI: 1.62, 4.33), baseline advanced WHO clinical stage (WHO clinical stages III and IV) (AOR=3.02, 95% CI: 1.67, 5.45), baseline viral load >1000 copies/mL (AOR=4.63, 95% CI: 2.60, 8.26), opportunistic infections (AOR=3.58, 95% CI: 2.58, 4.96) and TB-HIV coinfection (AOR=3.97, 95% CI: 2.41, 6.54) were significantly associated with virological failure among patients receiving anti-retroviral therapy in Ethiopia.ConclusionsThe pooled prevalence of virological failure among patients receiving anti-retroviral therapy was high in Ethiopia. Therefore, due attention should be given to patients with these identified factors. Moreover, we recommend researchers to conduct a triangulated study that can address additional factors associated with virological failure.PROSPERO registration numberThe protocol was registered with the Prospero database (PROSPERO, 2024: CRD42024512411).