bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare utilisation and costs associated with poor access to diagnosis and treatment for children and young people with tic disorders
Authors: Hall Charlotte L , Le Novere Marie , Murphy Tara , McNally Emma , Hollis Christopher , Hunter Rachael 
Published: November 2024

BackgroundThere are no specific national guidelines in England to guide healthcare professionals in how to assess or treat young people with tic disorders. Access to evidence-based treatment, including behavioural therapy, is of limited availability.ObjectivesThis study examined the economic impact on services arising from a lack of access to appropriate healthcare services for young people with tic disorders, alongside the impact on school attendance.MethodsThis study used data from the randomised controlled trial ‘ORBIT’ (Online Remote Behavioural Intervention for Tics). ORBIT compared online exposure and response prevention behavioural therapy for tics with online psychoeducation and recruited 224 young people aged 9–17 years in England. Here, we explore costs of health service use and school absenteeism from children who participated in the ORBIT trial and present these alongside the economic impact of including ORBIT within a tic service. We supplement ORBIT data with findings from two case studies.FindingsThe data showed that patients have care from several healthcare professionals and miss school due to accessing care for tics. The case studies suggest that most of these contacts with specialist services are unlikely to be supportive. However, adding ORBIT could save the National Health Service £1 million.ConclusionsYoung people with tic disorders are likely to engage in substantial use of healthcare resources because of inadequate care pathways. The availability of an evidence-based online therapy such as ORBIT could save money to the healthcare system.Clinical implicationsThere is a need to improve service provision and develop national guidelines for tic disorders.Trial registration numberISRCTN70758207,NCT03483493.
Early life adverse environmental, nutrition and infection factors are associated with lower developmental scores in Pakistani children at 5 years: a cohort study
Authors: González-Fernández Doris , Yousafzai Aisha , Cousens Simon , Rizvi Arjumand , Ahmed Imran , Soofi Sajid Bashir , Bhutta Zulfiqar Ahmed 
Published: November 2024

BackgroundThe effects of multiple early adverse psychosocial and biological factors on child development at preschool age in deprived settings are not fully understood.MethodsThe ‘Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development’ (MAL-ED) project followed children from eight countries, recording sociodemographic, nutritional, illness, enteroinfection biomarkers and scores for quality of home environment (Home Observation for Measurement of the Environment (HOME)), development (Bayley) and maternal depression during the first year of life. In the Pakistan cohort, we investigated associations of these early factors with Z-scores (derived from the eight participating countries) of three developmental outcomes at 5 years: Executive Functions (Z-EF), the Wechsler Preschool and Primary Scale for Intelligence (Z-WPPSI) and the externalising behaviours component of the Strength and Difficulties test (Z-externalising behaviours).ResultsMost children had 5-year development measurements below other MAL-ED countries (Z-EF<0, 80.3%, Z-WPPSI<0, 69.3%) and 45.6% had Z-externalising behaviours>0. Higher Z-EF was associated with higher HOME (coeff: 0.03 (95% CI 0.005, 0.05), p=0.017) and Bayley scores (0.01 (0.002, 0.01), p=0.010). Higher Z-WPPSI was associated with more household assets (0.02 (0.01, 0.03), p=0.003), but with lower alpha-1 antitrypsin (µmol/L, protein-losing enteropathy) (−0.01 (−0.02, –0.005), p=0.003). Lower externalising behaviour was associated with female sex (−0.30 (−0.53, –0.08), p=0.009), higher soluble-transferrin-receptors (mg/L) (−0.07 (−0.14, –0.01), p=0.024) and initiation of solids/semisolids≥6 months (−0.16 (−0.31, –0.01), p=0.033), but higher externalising behaviour was associated with underweight (0.35 (0.07, 0.62), p=0.014), more diarrhoeal episodes (0.03 (0.004, 0.06), p=0.022) and higher Maternal Depression Score (0.04 (0.01, 0.07), p=0.003) in the first year.ConclusionAdverse environmental, nutrition and infectious factors, and indicators of deprived early development in the first year of life have a negative association with developmental scores at 5 years. Addressing early stressors, improving diet, infections and environment stimulation early in life could positively impact child development in resource-constrained settings.
Patient and clinician perspectives of an eHealth intervention for supporting cancer treatment in the UK: mixed methods evaluation of the eRAPID randomised controlled trial
Authors: Warrington Lorraine , Holmes Marie , Gibson Andrea , Peacock Rosemary , Rogers Zoe , Dickinson Sarah , Holch Patricia , Hewison Jenny , Hulme Claire , Dawkins Bryony , Woroncow Barbara , Cucchi Virginia , Hudson Eleanor Mae , Brown Julia , Velikova Galina , Absolom Kate 
Published: November 2024

ObjectivesDuring 2015–2018, a randomised controlled trial (RCT) evaluated eRAPID, an eHealth intervention designed to capture patient-reported symptoms online during cancer treatment. eRAPID provides patients with advice on when to self-manage or seek medical support. Clinicians accessed symptom reports within electronic patient records. 508 participants starting systemic cancer treatment were recruited and followed for 18 weeks. The intervention group (n=256) was asked to access eRAPID and complete weekly online symptom reports. Clinicians received training on accessing and interpreting symptom reports. Overall, eRAPID had a positive impact on patients’ symptoms, quality of life and self-efficacy, particularly early in treatment and for patients with early-stage disease. Using mixed methods, we aimed to gather insight from patients and clinicians on how eRAPID worked to facilitate the interpretation of RCT findings.MethodsFollowing a concurrent triangulation design, patient experiences of eRAPID were gathered via end-of-study interviews (n=45) and questionnaires (n=186). Clinician experiences were obtained by end-of-study interviews (n=18) and completion, throughout the trial, of feedback questionnaires (n=787 from n=55 clinicians). Framework analysis was applied to examine qualitative data and close-ended questions were descriptively summarised. Findings were mapped against results from the RCT.SettingMedical oncology services, UK cancer centre.ResultsPatient feedback indicated eRAPID was easy to use. Adherence to weekly reporting was influenced by health status, reminders, perceived value and clinical use. Patient-reported benefits of eRAPID included an enhanced connection with the hospital, provision of practical advice and personal monitoring, which provided reassurance and empowerment. Clinicians were positive about the potential for online symptom monitoring but had mixed levels of direct experience with using eRAPID during the trial. Patients echoed this and recommended more explicit clinician use of symptom data.ConclusionsThe mixed-method approach to capturing patient and clinician opinions provided valuable insight into the eRAPID intervention and complementary information on how the intervention was received and functioned.
Theoretically informed codesign of a tailored intervention to support pressure ulcer prevention behaviours by older people living in their own homes in the UK and their lay carers: an intervention codesign study (C-PrUP)
Authors: Woodhouse Marjolein , Cowdell Fiona , Roddis Jennifer , Devrell Anne , Oakley Karen , Dyson Judith 
Published: November 2024

ObjectiveTo codesign a theoretically underpinned, healthcare practitioner-mediated, tailored intervention to support housebound older patients and their lay carers to adopt pressure ulcer prevention behaviours.DesignTheoretical domains framework informed codesign.SettingOne geographical area in the UK, spanning several community National Health Service Trusts.ParticipantsCommunity-dwelling older patients at risk of pressure ulcer development and their lay carers (n=4) and health practitioners (n=6) providing related care.ResultsCodesigners addressed five identified barriers to pressure ulcer prevention, knowledge and beliefs about consequences, social or professional role and influence, motivation and priorities, emotion and environment. Prioritised intervention components were (1) making every contact count, all health and social care workers to be conversant with basic prevention behaviours and to support and reiterate these at every visit (9.1/10), (2) signposting of existing support groups and sitting services (8.4/10), (3) accessible, timely, trustable and relatable written information including the role of patients, carers and staff in prevention and links to other resources (7.7/10) and (4) supporting close family involvement in some of the practical elements of care (5.6/10).ConclusionsOur study sought to codesign a practitioner-mediated, tailored intervention to support housebound older patients and their lay carers to adopt pressure ulcer prevention behaviours. The process of barrier identification and selection of behaviour change techniques for intervention components was theoretically informed. However, further development will be needed to refine the prototype intervention to take into account the complexity of multiple health needs and priorities of patients. The principles of this study are likely to be transferable to similar national and international contexts.
Use of commercially available wearable devices for physical rehabilitation in healthcare: a systematic review
Authors: Latif Ahmed , Al Janabi Hasaneen Fathy , Joshi Meera , Fusari Gianpaolo , Shepherd Leila , Darzi Ara , Leff Daniel R 
Published: November 2024

ObjectivesTo evaluate whether commercially available ‘off-the-shelf’ wearable technology can improve patient rehabilitation outcomes, and to categorise all wearables currently being used to augment rehabilitation, including the disciplines and conditions under investigation.DesignSystematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement checklist, and using the Grading of Recommendations, Assessment, Development and Evaluation approach.Data sourcesEmbase, MEDLINE, Web of Science and the Cochrane Library were searched up to and including July 2023.Eligibility criteriaWe included trials and observational studies evaluating the use of consumer-grade wearables, in real patient cohorts, to aid physical therapy or rehabilitation. Only studies investigating rehabilitation of acute events with defined recovery affecting adult patients were included.Data extraction and synthesisTwo independent reviewers used a standardised protocol to search, screen and extract data from the included studies. Risk of bias was assessed using the Cochrane Methods Risk of Bias in Randomised Trials V.2 and Risk of Bias in Non-Randomised Studies of Interventions tools for randomised controlled trials (RCTs) and observational studies, respectively.ResultsEighteen studies encompassing 1754 patients met eligibility criteria, including six RCTs, six quasi-experimental studies and six observational studies. Eight studies used wearables in Orthopaedics, seven in Stroke Medicine, two in Oncology and one in General Surgery. All six RCTs demonstrated that wearable-driven feedback increases physical activity. Step count was the most common measure of physical activity. Two RCTs in orthopaedics demonstrated non-inferiority of wearable self-directed rehabilitation compared with traditional physiotherapy, highlighting the potential of wearables as alternatives to traditional physiotherapy. All 12 non-randomised studies demonstrated the feasibility and acceptability of wearable-driven self-directed rehabilitation.ConclusionThis review demonstrates that consumer-grade wearables can be used as adjuncts to traditional physiotherapy, and potentially as alternatives for self-directed rehabilitation of non-chronic conditions. Better designed studies, and larger RCTs, with a focus on economic evaluations are needed before a case can be made for their widespread adoption in healthcare settings.PROSPERO registration IDCRD42023459567
Effect of perioperative dexmedetomidine on postoperative delirium in patients with brain tumours: a protocol of a randomised controlled trial
Authors: Zeng Min , Zheng Maoyao , Wang Jie , Li Shu , Ji Nan , Peng Yuming 
Published: November 2024

IntroductionNeurosurgery is a risk factor for postoperative delirium. Dexmedetomidine has a potential effect on reducing postoperative delirium. We aim to test the primary hypothesis that perioperative administration of dexmedetomidine reduces the incidence of postoperative delirium in patients undergoing neurosurgical resections of temporal glioma.MethodsThis is a single-centre, randomised, blinded and parallel-group controlled trial. A total of 366 patients will be randomised to either dexmedetomidine group (n=183) or placebo group (n=183). Subjects assigned to dexmedetomidine group will be given a continuous infusion at 0.4 µg/kg/h after anaesthesia induction until dural closure and then immediately receive an infusion of dexmedetomidine at 0.08 µg/kg/h by intravenous analgesia pump during the first 48 hours postoperatively. Patients in the placebo group will be given comparable volumes of normal saline, and intravenous analgesia pumps contain equal amounts of sufentanil and antiemetics, but no dexmedetomidine. The primary outcome is the incidence of postoperative delirium, which will be assessed with the Confusion Assessment Method two times per day during the first five postoperative days.Ethics and disseminationThe protocol (V.1.1) has been approved by the medical ethics committee of Beijing Tiantan Hospital, Capital Medical University (KY2023-186-02). The findings of this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT06164314.
Link between gender inequality and women’s satisfaction with maternal healthcare services: a cross-sectional study in Khulna, Bangladesh
Authors: Halim Sk. Faijan Bin , Akter Orpa , Islam Md. Karimul 
Published: November 2024

BackgroundGender inequality within households remains a significant barrier to accessing maternal healthcare services in many low-resource settings, including Bangladesh. Understanding the relationship between the gender inequality faced by women in households and their perceived satisfaction with maternal healthcare services is important.ObjectiveThis study aims to identify the factors influencing gender inequality and investigate the association between gender inequality faced by women within households and their perceived satisfaction with maternal healthcare services.DesignConducted between October and November 2022, employing a cross-sectional design.Settings and participants150 women who are at their prenatal or postnatal stages are systematically sampled fromKhalishpurmunicipality andDighaliasubdistrict from Khulna, Bangladesh.Outcome measuresGender inequality within the households is assessed using a validated five-point Likert scale of five items. Participants with an average score below or equal to the median value are considered to be facing gender inequality within households. Satisfaction with maternal healthcare services is measured across five variables using a similar scale. Based on the responses, a standardised score is generated to measure the satisfaction level with maternal healthcare services.ResultsWe find that women are around seven times more likely to experience gender inequality in their households if their husbands are engaged in self-employed jobs or skilled labour compared with unemployment (p<0.10). Coercive actions, such as physical assault (odds: 6.428, p<0.01) and preventing women from financially supporting their maternal kin (odds: 14.909; p<0.01), are positively related to gender inequality. Such inequality negatively relates to women’s perceived satisfaction with their maternal healthcare services (−1.851, p<0.01). Additionally, traditional home delivery, verbal abuse and the forced use of traditional medication reduce satisfaction levels. On the other hand, increased prenatal care is expected to increase satisfaction with maternal services as perceived by women (0.545, p<0.10).ConclusionsThe study prioritises promoting equity in opportunities for both males and females, with access to maternal health, and educational opportunities within households. Reduced inequality within households may help minimise the extent of coercive behaviour against women. The national maternal health strategy should focus on basic health services for pregnant women, with free prenatal and postnatal check-ups for pregnant mothers to improve their perinatal healthcare services.
‘This is PEEP’ participatory qualitative study: learning from a provincial consultation and advisory group of people with lived and living experience of substance use in British Columbia, Canada
Authors: Daowd Kerolos , Lock Kurt , Danaei Amirnima , Burmeister Charlene , Choisil Paul , Haywood Elizabeth , Henderson Iesha , Lamb Jessica , McDougall Jenny , Sedgemore Kali , Buxton Jane A 
Published: November 2024

ObjectivesTo summarise PEEP’s (Professionals for Ethical Engagement of Peers—a group of consultants with lived and living experience of substance use) outputs and gain insights into PEEP’s impact and suggestions for the future.DesignIncluded an environmental scan to collate PEEP activities and outputs and a participatory qualitative design using thematic analysis.SettingBritish Columbia, Canada.ParticipantsEight members of PEEP and nine staff/people who consulted PEEP were interviewed.ResultsPEEP members are co-authors/acknowledged for their input in 25 peer review publications and 16 reports; PEEP members co-presented or were co-authors on 33 presentations. PEEP meets by Zoom two times per week and is paid monthly via honorarium from the Provincial Health Service Authority at a current rate of $C30 per hour. Four themes emerged from our interviews: (1) What is PEEP? (PEEP provides a sense of community, holds systems accountable and inspires others), (2) PEEP Process (suggestions for improvement: consultants should be prepared and involve PEEP throughout the process and report how PEEP’s insights were used), (3) PEEP Outcomes (PEEP members gain skills and confidence, PEEP provides a reality check, consultants learn from PEEP, and input leads to practice changes) and (4) Future of PEEP (sustainable funding and opportunities for growth are critical).ConclusionPEEP is a cohesive group whose input is well-respected and influences policy and programmes. Given the ongoing drug toxicity emergency, it is critical to continue to support and expand PEEP.
Exploring organisational support to apply best practice in the sick leave and rehabilitation process from a multiprofessional front-line perspective: a qualitative study
Authors: Löfgren Märit , Gyllenhammar Daniel , Hange Dominique , Nordeman Lena , Rembeck Gun , Björkelund Cecilia , Svenningsson Irene , Törnbom Karin 
Published: November 2024

ObjectivesTo explore the experiences of organisational support to apply best practices held by front-line employees working with patients in the sick leave and rehabilitation process (SRP).DesignQualitative study design. Data were collected with focus group interviews in Region Västra Götaland, Sweden. Participants discussed their perceptions of organisational support to apply the best SRP practice in a primary healthcare context.ParticipantsPurposive sampling was conducted to capture a range of experiences among various professionals, including general practitioners (n=6), rehabilitation coordinators, other primary healthcare professionals (n=13) and caseworkers from the Social Insurance Agency, Employment Agency and Social Services (n=12).ResultsInformants perceived that their good intentions to work for the best interests of each patient were not enough to overcome inadequate organisational prerequisites. Identified themes described unequal care due to significant practice variation, conflicting messages, a situation where the patient loses control and mismatch between available support and patient needs. Perceived potential consequences for the patients included legal uncertainty of assessments, harmful passivity of the individual through misapplied sick leave and the risk of overlooking non-medical factors that could be managed in a safer and more well-adapted way.ConclusionsNeither guidelines on person-centred approaches, nor laws regulating the right to coordinated individual planning, seem to have fulfilled the intended purpose. The informants depicted an SRP obstructing individualised care, thus risking worsening patients’ well-being and abilities. The opportunities to improve the quality of the processes within the SRP, and simultaneously make them more effective, appear to be extensive.
Cohort profile: the Nanjing Diabetes Cohort database – a population-based surveillance cohort
Authors: Feng Wei , Yin Yuechuchu , Gu Chunyan , Mu Yuan , Zhang Duxiao , Tao Zhenhuan , Yin Weidong , Zhang Xin , Yu Yun , Hu Jie , Wan Cheng , Liu Yun 
Published: November 2024

PurposeTo study epidemiology, complications, risk factors, clinical course and treatment patterns of diabetes, the Nanjing Diabetes Cohort (NDC) was established using anonymised electronic health records from 650 hospitals and primary care since 2020. This cohort provides valuable data for researchers and policy-makers focused on diabetes management and public health strategies.ParticipantsDiabetes was defined as having inpatient or outpatient encounters with a diagnosis of diabetes International Classification of Diseases-9/10 codes, any use of insulin or oral hypoglycaemic drugs, or one encounter with haemoglobin A1C >4.8 mmol/mol or 6.5%. Patients with diabetes have been continuously enrolled on hospitals and primary care in Nanjing since 2020. Demographic, medications and comorbidities data were extracted from clinical notes, diagnostic codes, labs, prescriptions and vital signs among different types of diabetes.Findings to dateThe NDC consisted of 1 033 904 patients from 1 January 2020 to 31 December 2022, the majority were male (50.62%) and from the Gulou district (30.79%). The clinical characteristics and medication usage of patients with type 1 diabetes, type 2 diabetes, gestational diabetes and other diabetes were assessed. The prevalences of hypertension, ischemic heart disease, and cerebrovascular disease were 49.72%, 17.85% and 24.90%, respectively.Future plansNDC will annually enrol eligible patients and include socioeconomic data in future updates. The data of NDC are maintained by the Department of Medical Informatics at Nanjing Medical University.