bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating patient attitudes and barriers towards smart technology for cardiac monitoring: results from a prospective multicentre study
Authors: Koshy Anoop N , Ko Jefferson , Sajeev Jithin K , Rajakariar Kevin , Roberts Louise , Cooke Jennifer , Teh Andrew W 
Published: September 2019

ObjectivesRemote assessment of heart rate and rhythm using smart technology (ST) holds promise in screening and monitoring of atrial fibrillation (AF). However, patient engagement is paramount to the success of ST interventions.MethodsWe assessed the attitudes and potential barriers towards ST for arrhythmia monitoring in an elderly, multimorbidity cohort. Consecutive inpatients were recruited across three hospitals and administered a standardised survey regarding attitudes towards ST for arrhythmia detection.ResultsOf 363 participants (median age 68 years (IQR: 55–80 years), mean CHA2DS2VASC score 3±2), 68.9% were interested in ST for cardiac monitoring. Those with underlying AF (n=112) and younger (<65 years) patients were more likely to be interested in using ST for cardiac monitoring (p for both <0.001). Complexity (71.1%) of ST was identified as a major barrier to its adoption, particularly in older participants (p=0.02). While only 52% of participants trusted the accuracy of ST, over 90% would seek medical attention based on aberrant readings.ConclusionWe report a high level of interest among an older, high-risk patient cohort in using ST for cardiac monitoring. Despite a level of distrust in these devices, abnormal readings would still prompt the overwhelming majority of patients to seek medical attention. This highlights a need for physicians to validate the accuracy and clinical effectiveness of ST-derived physiological measurements, an area which remains unclear due to the paucity of trials.Trial registration numberACTRN: 12616991374459.
Longitudinal Study of music Therapy’s Effectiveness for Premature infants and their caregivers (LongSTEP): protocol for an international randomised trial
Authors: Ghetti Claire , Bieleninik Łucja , Hysing Mari , Kvestad Ingrid , Assmus Jörg , Romeo Renee , Ettenberger Mark , Arnon Shmuel , Vederhus Bente Johanne , Söderström Gaden Tora , Gold Christian 
Published: September 2019

IntroductionPreterm birth has major medical, psychological and socioeconomic consequences worldwide. Music therapy (MT) has positive effects on physiological measures of preterm infants and maternal anxiety, but rigorous studies including long-term follow-up are missing. Drawing on caregivers’ inherent resources, this study emphasises caregiver involvement in MT to promote attuned, developmentally appropriate musical interactions that may be of mutual benefit to infant and parent. This study will determine whether MT, as delivered by a qualified music therapist during neonatal intensive care unit (NICU) hospitalisation and/or in home/municipal settings following discharge, is superior to standard care in improving bonding between primary caregivers and preterm infants, parent well-being and infant development.Methods and analysisDesign:international multicentre, assessor-blind, 2×2 factorial, pragmatic randomised controlled trial; informed by a completed feasibility study.Participants:250 preterm infants and their parents.Intervention:MT focusing on parental singing specifically tailored to infant responses, will be delivered during NICU and/or during a postdischarge 6-month period.Primary outcome:changes in mother–infant bonding at 6-month corrected age (CA), as measured by the Postpartum Bonding Questionnaire.Secondary outcomes: mother–infant bonding at discharge and at 12-month CA; child development over 24 months; and parental depression, anxiety and stress, and infant rehospitalisation, all over 12 months.Ethics and disseminationThe Regional Committees for Medical and Health Research Ethics approved the study (2018/994/REK Nord, 03 July 2018). Service users were involved in development of the study and will be involved in implementation and dissemination. Dissemination of findings will apply to local, national and international levels.Trial registration numberNCT03564184
A comprehensive validation of very early rule-out strategies for non-ST-segment elevation myocardial infarction in emergency departments: protocol for a multicentre prospective cohort study
Authors: Tada Masafumi , Azuma Hiroyuki , Yamada Naoki , Kano Ken-ichi , Nagai Hideya , Maeda Shigenobu , Ishida Hiroshi , Aoyama Takahiko , Okada Ryota , Kawano Takahisa , Kobuchi Taketsune , Uzui Hiroyasu , Matano Hideyuki , Iwasaki Hose , Maeno Koji , Shimada Yoshimitsu , Yoshida Hiroyuki , Ando Masaki , Murakami Yoshimasa , Iwakami Naotsugu , Kishimoto Sanae , Iwami Taku , Tada Hiroshi , Chapman Andrew , Mills Nicholas , Hayashi Hiroyuki , Furukawa Toshi A , Watanabe Norio 
Published: September 2019

IntroductionRecent advances in troponin sensitivity enabled early and accurate judgement of ruling-out myocardial infarction, especially non-ST elevation myocardial infarction (NSTEMI) in emergency departments (EDs) with development of various prediction-rules and high-sensitive-troponin-based strategies (hs-troponin). Reliance on clinical impression, however, is still common, and it remains unknown which of these strategies is superior. Therefore, our objective in this prospective cohort study is to comprehensively validate the diagnostic accuracy of clinical impression-based strategies, prediction-rules and hs-troponin-based strategies for ruling-out NSTEMIs.Methods and analysisIn total, 1500 consecutive adult patients with symptoms suggestive of acute coronary syndrome will be prospectively recruited from five EDs in two tertiary-level, two secondary-level community hospitals and one university hospital in Japan. The study has begun in July 2018, and recruitment period will be about 1 year. A board-certified emergency physician will complete standardised case report forms, and independently perform a clinical impression-based risk estimation of NSTEMI. Index strategies to be compared will include the clinical impression-based strategy; prediction rules and hs-troponin-based strategies for the following types of troponin (Roche Elecsys hs-troponin T; Abbott ARCHITECT hs-troponin I; Siemens ADVIA Centaur hs-troponin I; Siemens ADVIA Centaur sensitive-troponin I). The reference standard will be the composite of type 1 MI and cardiac death within 30 days after admission to the ED. Outcome measures will be negative predictive value, sensitivity and effectiveness, defined as the proportion of patients categorised as low risk for NSTEMI. We will also evaluate inter-rater reliability of the clinical impression-based risk estimation.Ethics and disseminationThe study is approved by the Ethics Committees of the Kyoto University Graduate School and Faculty of Medicine and of the five hospitals where we will recruit patients. We will disseminate the study results through conference presentations and peer-reviewed journals.
The Children and Young People’s Health Partnership Evelina London Model of Care: process evaluation protocol
Authors: Satherley Rose-Marie , Green Judith , Sevdalis Nick , Newham James Joseph , Elsherbiny Mohamed , Forman Julia , Wolfe Ingrid , Lingam Raghu 
Published: September 2019

IntroductionChildren and young people (CYP) in the UK have poor health outcomes, and there is increasing emergency department and hospital outpatient use. To address these problems in Lambeth and Southwark (two boroughs of London, UK), the local Clinical Commissioning Groups, Local Authorities and Healthcare Providers formed The Children and Young People’s Health Partnership (CYPHP), a clinical-academic programme for improving child health. The Partnership has developed the CYPHP Evelina London model, an integrated healthcare model that aims to deliver effective, coordinated care in primary and community settings and promote better self-management to over approximately 90 000 CYP in Lambeth and Southwark. This protocol is for the process evaluation of this model of care.Methods and analysisAlongside an impact evaluation, an in-depth, mixed-methods process evaluation will be used to understand the barriers and facilitators to implementing the model of care. The data collected mapped onto a logic model of how CYPHP is expected to improve child health outcomes. Data collection and analysis include qualitative interviews and focus groups with stakeholders, a policy review and a quantitative analysis of routine clinical and administrative data and questionnaire data. Information relating to the context of the trial that may affect implementation and/or outcomes of the CYPHP model of care will be documented.Ethics and disseminationThe study has been reviewed by NHS REC Cornwall & Plymouth (17/SW/0275). The findings of this process evaluation will guide the scaling up and implementation of the CYPHP Evelina London Model of Care across the UK. Findings will be disseminated through publications and conferences, and implementation manuals and guidance for others working to improve child health through strengthening health systems.Trial registration numberNCT03461848
Key stakeholders’ perspectives and experiences with defining, identifying and displaying gaps in health research: a qualitative study protocol
Authors: Nyanchoka Linda , Tudur-Smith Catrin , Porcher Raphaël , Hren Darko 
Published: September 2019

IntroductionIdentifying research gaps can inform the design and conduct of health research, practice and policies by informing the current body of evidence. Audiences including researchers, clinical guideline developers, clinicians, policymakers, research regulatory bodies, funders and patients/the public can also benefit from understanding the status of research and research gaps to make informed choices. This study aims to explore how key informants define research gaps and characterise methods/practices used to identify and display gaps in health research to inform future research practice and policies.Methods and analysisThis is an exploratory qualitative study using semi-structured in-depth interviews. The participants will be recruited by purposive sampling from initiatives and organisations previously identified in a scoping review on methods to identify, prioritise and display gaps in health research. We anticipate performing up to 28 interviews with the different key informant groups who are involved in using evidence to inform health policy, practice and research. Interviews will be thematically analysed as outlined by Braun and Clarke. The qualitative data-analysis software NVivo V.12 Pro will be used to aid data management and analysis.DiscussionThis is the protocol for a follow-up study that aims to complement and enrich the findings of the scoping review on methods to identify, prioritise and display gaps in health research. The overall project aims to develop methodological guidance for describing, identifying and displaying gaps in health research.Ethics and disseminationThe research obtained ethical approval from the University of Liverpool, UK. The findings will be disseminated via conferences, meetings (organised by the Methods in Research on Research project), peer-reviewed publications and lay magazines because the study participants will include the public/patients.
How patient acceptability affects access to breast reconstruction: a qualitative study
Authors: Retrouvey Helene , Zhong Toni , Gagliardi Anna R , Baxter Nancy N , Webster Fiona 
Published: September 2019

ObjectivesThere has been limited research on the acceptability of breast reconstruction (BR) to breast cancer patients. We performed interviews to explore breast cancer patients’ acceptability of BR.DesignQualitative study.SettingRecruitment from six Ontario hospitals across the province (Toronto, Ottawa, Hamilton, London, Thunder Bay and Windsor) as well as key breast cancer organisations between November 2017 and June 2018.ParticipantsWomen of any age with a diagnosis of breast cancer planning to undergo or having undergone a mastectomy with or without BR.InterventionSixty-minute semi-structured interviews were analysed using qualitative descriptive methodology that draws on inductive thematic analysis.OutcomeIn the telephone interviews, participants discussed their experience with breast cancer and accessing BR, focusing on the acceptability of BR as a surgical option post-mastectomy.ResultsOf the 28 participants, 11 had undergone BR at the time of the interview, 5 at the time of mastectomy and 6 at a later date. Four inter-related themes were identified that reflected women’s evolving ideas about BR as they progressed through different stages of their disease and treatment. The themes we developed were: (1) cancer survival before BR, (2) the influence of physicians on BR acceptability, (3) patient’s shift to BR acceptance and (4) women’s need to justify BR. For many women, access to BR surgery became more salient over time, thus adding a temporal element to the existing access framework.ConclusionIn our study, women’s access to BR was negatively influenced by the poor acceptability of this surgical procedure. The acceptability of BR was a complex process taking place over time, from the moment of breast cancer diagnosis to BR consideration. BR access may be improved through enhancing patient acceptability of BR. We suggest adapting the current access to care frameworks by further developing the concept of acceptability.
Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis
Authors: Chew Derek , Somayaji Ranjani , Conly John , Exner Derek , Rennert-May Elissa 
Published: September 2019

ObjectivesInitial management of cardiac implantable electronic device (CIED) infection requires removal of the infected CIED system and treatment with systemic antibiotics. However, the optimal timing to device reimplantation is unknown. The aim of this study was to quantify the incidence of reinfection after initial management of CIED infection, and to assess the effect of timing to reimplantation on reinfection rates.DesignSystematic review and meta-analysis.InterventionsA systematic review and meta-analysis was performed of studies published up to February 2018. Inclusion criteria were: (a) documented CIED infection, (b) studies that reported the timing to device reimplantation and (c) studies that reported the proportion of participants with device reinfection. A meta-analysis of proportions using a random effects model was performed to estimate the pooled device reinfection rate.Primary and secondary outcome measuresThe primary outcome measure was the rate of CIED reinfection. The secondary outcome was all-cause mortality.ResultsOf the 280 screened studies, 8 met inclusion criteria with an average of 96 participants per study (range 15–220 participants). The pooled incidence rate of device reinfection was 0.45% (95% CI, 0.02% to 1.23%) per person year. A longer time to device reimplantation >72 hours was associated with a trend towards higher rates of reinfection (unadjusted incident rate ratio 4.8; 95% CI 0.9 to 24.3, p=0.06); however, the meta-regression analysis was unable to adjust for important clinical covariates. There did not appear to be a difference in reinfection rates when time to reimplantation was stratified at 1 week. Heterogeneity was moderate (I2=61%).ConclusionsThe incident rate of reinfection following initial management of CIED infection is not insignificant. Time to reimplantation may affect subsequent rates of device reinfection. Our findings are considered exploratory and significant heterogeneity limits interpretation.PROSERO registration numberCRD4201810960.
Health-related preferences of older patients with multimorbidity: the protocol for an evidence map
Authors: González-González Ana Isabel , Schmucker Christine , Blom Jeanet , van den Akker Marjan , Nguyen Truc Sophia , Nothacker Julia , Meerpohl Joerg J , Röttger Kristian , Wegwarth Odette , Hoffmann Tammy , Straus Sharon E , Gerlach Ferdinand M , Muth Christiane 
Published: September 2019

IntroductionInteraction of conditions and treatments, complicated care needs and substantial treatment burden make patient–physician encounters involving multimorbid older patients highly complex. To optimally integrate patients’ preferences, define and prioritise realistic treatment goals and individualise care, a patient-centred approach is recommended. However, the preferences of older patients, who are especially vulnerable and frequently multimorbid, have not been systematically investigated with regard to their health status. The purpose of this evidence map is to explore current research addressing health-related preferences of older patients with multimorbidity, and to identify the knowledge clusters and research gaps.Methods and analysisTo identify relevant research, we will conduct searches in the electronic databases MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL, Social Science Citation Index, Social Science Citation Index Expanded and the Cochrane library from their inception. We will check reference lists of relevant articles and carry out cited reference research (forward citation tracking). Two independent reviewers will screen titles and abstracts, check full texts for eligibility and extract the data. Any disagreement will be resolved and consensus reached with the help of a third reviewer. We will include both qualitative and quantitative studies, and address preferences from the patients’ perspectives in a multimorbid population of 60 years or older. There will be no restrictions on the publication language. Data extraction tables will present study and patient characteristics, aim of study, methods used to identify preferences and outcomes (ie, type of preferences). We will summarise the data using tables and figures (ie, bubble plot) to present the research landscape and to describe clusters and gaps.Ethics and disseminationDue to the nature of the proposed evidence map, ethics approval will not be required. Results from our research will be disseminated by means of specifically prepared materials for patients, at relevant (inter)national conferences and via publication in peer-reviewed journals.
Investigating the mechanism of impact of the Quality Premium initiative on antibiotic prescribing in primary care practices in England: a study protocol
Authors: Anyanwu Philip Emeka , Tonkin-Crine Sarah , Borek Aleksandra , Costelloe Ceire 
Published: September 2019

IntroductionThe persistent development and spread of resistance to antibiotics remain an important public health concern in the UK and globally. About 74% of antibiotics prescribed in England in 2016 was in primary care. The Quality Premium (QP) initiative that rewards Clinical Commissioning Groups (CCGs) financially based on the quality of specific health services commissioned is one of the National Health Service (NHS) England interventions to reduce antimicrobial resistance through reduced prescribing. Emerging evidence suggests a reduction in antibiotic prescribing in primary care practices in the UK following QP initiative. This study aims to investigate the mechanism of impact of this high-cost health-system level intervention on antibiotic prescribing in primary care practices in England.Methods and analysisThe study will constitute secondary analyses of antibiotic prescribing data for almost all primary care practices in England from the NHS England Antibiotic Quality Premium Monitoring Dashboard and OpenPrescribing covering the period 2013 to 2018. The primary outcome is the number of antibiotic items per Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) prescribed monthly in each practice or CCG. We will first conduct an interrupted time series using ordinary least square regression method to examine whether antibiotic prescribing rate in England has changed over time, and how such changes, if any, are associated with QP implementation. Single and sequential multiple-mediator models using a unified approach for the natural direct and indirect effects will be conducted to investigate the relationship between QP initiative, the potential mediators and antibiotic prescribing rate with adjustment for practice and CCG characteristics.Ethics and disseminationThis study will use secondary data that are anonymised and obtained from studies that have either undergone ethical review or generated data from routine collection systems. Multiple channels will be used in disseminating the findings from this study to academic and non-academic audiences.
Mapping the concept, content and outcome of wilderness therapy for childhood cancer survivors: protocol for a scoping review
Authors: Jong Miek C , Lown Anne , Schats Winnie , Otto Heather Rose , Jong Mats 
Published: September 2019

IntroductionLong-term childhood cancer survivors are at risk for frailty and have significant health-related issues in adulthood. Various health promotion interventions have been proposed to enhance quality of life including wilderness therapy, which applies the impact of nature on health in a therapeutic context. Previous studies have described positive outcomes linked with various wilderness-related therapies for cancer survivors. However, there is no clarity on the role these therapies play in childhood cancer. The current scoping review aims to systematically map the concept, content and outcome of wilderness therapy for childhood cancer survivors.Methods and analysisThis review will be guided by the Joanna Briggs Institute Reviewers’ manual for scoping reviews. A systematic literature search using medical subject headings (MeSH) and text words related to wilderness therapy and childhood cancer survivors will be performed in EMBASE, ERIC, Medline, Psycinfo, CINAHL, Scopus, Web of Science, SPORTDiscus and Svemed+, Sociological Abstracts, supplemented by grey literature searches. Eligible quantitative and qualitative studies will be screened, included, assessed for quality and extracted for data by two reviewers independently. Results will be described in a narrative style, reported in extraction tables and diagrams, and where appropriate in themes and text.Ethics and disseminationThis study describes a protocol for a scoping review that will undertake secondary analysis of data already published in literature and is therefore exempt from medical ethical review. The scoping review will inform understanding of the benefits and risks of wilderness therapy for childhood cancer survivors, their families, practitioners, clinicians and researchers, and will help elucidate the steps necessary for building its evidence base going forward. Results will be published in a peer-reviewed scientific journal.