bluuebunny/crossref_metadata_2025_split huggingface dataset:
Esketamine administered epidurally as an adjuvant to epidural ropivacaine for labour analgesia: a prospective, double-blind dose-response study
Authors: Xu Lili , Li Shuxi , Zhang Chenghong , Zhou Yanhong , Chen Xinzhong 
Published: November 2024

ObjectiveTo investigate the efficacy of esketamine as an adjuvant to epidural ropivacaine for labour analgesia by determining its effect on the median effective concentration (EC50) in a 20 ml volume of ropivacaine.DesignA prospective, double-blind dose-response study.SettingThis study was conducted in Women’s Hospital, School of Medicine, Zhejiang University, China.ParticipantsOne hundred and fifty parturients who requested epidural analgesia were recruited in this study to randomly receive epidural ropivacaine alone or with esketamine of 0.2 mg ml−1, 0.3 mg ml−1, 0.4 mg ml−1or 0.5 mg ml−1, respectively.Primary and secondary outcome measuresThe primary outcome, EC50of ropivacaine, was determined using an up-down sequential allocation technique. The secondary outcomes were analgesia characteristics, Ramsay Sedation Scale score, labour duration, caesarean section rate and adverse effects.ResultsThe EC50of ropivacaine with the addition of esketamine at concentrations of 0.3 mg ml−1, 0.4 mg ml−1and 0.5 mg ml−1resulted in significant reductions in the EC50of ropivacaine to 0.050%, 0.044% and 0.043%, respectively, from baseline (esketamine 0 mg ml−1) (p<0.0001). However, reductions of the EC50of ropivacaine were similar among the groups with esketamine of 0.3 mg ml−1, 0.4 mg ml−1and 0.5 mg ml−1(p>0.05). The Ramsay Sedation Scale score was higher and more dizziness was observed in the Group of esketamine 0.5 mg ml−1compared with all other groups (p<0.0001). During the peripartum period, no differences in sensory blockade level, Bromage score, labour duration and percentage of caesarean delivery were found among the groups.ConclusionsUnder the conditions of this study, the addition of epidural esketamine of 0.3 mg⋅mL−1, 0.4 mg⋅mL−1and 0.5 mg⋅mL−1offered a similar ropivacaine dose-sparing effect; 0.5 mg⋅mL−1of esketamine produced more adverse effects.Trial registration numberChiCTR2100054348.
Association ofHelicobacter pyloriinfection and white blood cell count: a cross-sectional study
Authors: Jiao Rui , Ma Xiaojuan , Guo Xiaoqing , Zhu Yanli , Wu Xue , Wang Haiying , Zhang Shaofei , Wang Yahong , Yang Yang , Wang Qiang 
Published: November 2024

IntroductionHelicobacter pyloriis a type of Gram-negative microaerobic bacteria that inhabits the gastric mucosal epithelium. It can cause various gastrointestinal diseases including gastritis, peptic ulcer and gastric cancer. White blood cells (WBC) are common immune cells, the increase in whose countoften indicates the presence of an infection. Currently, the relationship betweenH. pyloriand WBC count remains full of controversy. This study aims to further elucidate the effects ofH. pylorion WBC count in a population undergoing physical examination.Methods and analysisA total of 864 participants who underwent physical examination and14C urea breath test (UBT) were retrospectively enrolled in this study from January to June 2021. The overall population was divided intoH. pylori-negative (Hp−) andH. pylori-positive (Hp+) groups based on the disintegration per minute (DPM) value detected by UBT. Spearman’s correlation analysis was used to assess the correlation between DPM and WBC count. General linear regression models were applied to assess the potential factors contributing to the increase in WBC count. Generalised additive model (GAM) was performed to identify the non-linear relationship between DPM and WBC count. Additionally, a piecewise linear regression was used to examine the threshold effect of the DPM on WBC count.Results403 subjects were diagnosed withH. pyloriinfection. The WBC and platelet (PLT) counts in the Hp+ group were significantly higher than those in the Hp− group. Additionally, the prevalence ofH. pyloriinfection gradually increased with the WBC count quartiles (38.89% and 54.67% in quartile 1 and quartile 4, respectively). Spearman’s correlation analysis showed that the DPM value significantly correlated with WBC count (r=0.089, p=0.009) and PLT count (r=0.082, p=0.017). The linear model revealed a positive independent association ofH. pyloriinfection and DPM with WBC count (βHp+=0.398 (95% CI 0.170, 0.625), p<0.001; βDPM=0.002 (95% CI 0.000, 0.0030), p=0.018). The results of the GAM and the piecewise linear regression suggested that the cut-off points of the association between DPM and WBC count were 40 and 155 of DPM, that is, the effect of DPM on WBC count varied with the difference of DPM <40, 40–155, and >155 (βDPM=−0.005 (95% CI −0.017, 0.007), p=0.423; βDPM=0.006 (95% CI 0.002, 0.013), p=0.047; and βDPM=−0.007 (95% CI −0.012, –0.002), p=0.004, respectively).ConclusionsH. pyloriinfection was independently and positively correlated with WBC count; however, the effect of DPM on WBC count varied across different WBC count intervals, suggesting distinct immunological responses at different stages of infection.
Importance of medical home domains on emergency visits using a cross-sectional national survey of US children
Authors: Rajan Mangala , Baer Benjamin R , Scheinfeld Adina , Abramson Erika L , Kern Lisa , Pinheiro Laura 
Published: November 2024

Background and objectivesReceiving care at patient-centred medical homes (PCMH) is associated with reduced emergency department (ED) visits among children. Adverse social determinants of health (SDoH), such as lower socioeconomic status and household poverty, are associated with increased ED visits in children. The objective of this study is to use machine learning techniques to understand the relative importance of each PCMH component among different populations with adverse SDoH on the outcome of ED visits.Methods: design, setting and participantsThis study used the 2018–2019 pooled data from the National Survey of Children’s Health (NSCH), an annual survey of parents and caregivers of US children from birth to 17 years. PCMH components were operationalised by classifying parent/caregiver responses into five domains: care coordination (CC), having a personal doctor or nurse, having a usual source of care, family-centred care and ease of getting referrals. SDoH included five categories: (1) social and community context, (2) economic stability, (3) education access and quality, (4) healthcare access and quality and (5) neighbourhood and built environment.Primary outcome measureWe used a split-improvement variable importance measure based on random forests to determine the importance of PCMH domains on ED visits overall and stratified by SDoH.ResultsOverall, between 3% and 28% experienced one or more gaps in PCMH domains. Models show that problems with referrals (rank, 2; Gini, 83.5) and gaps in CC (rank, 3; Gini, 81.0) were the two most important domains of PCMH associated with ED visits in children. This result was consistent among black and Hispanic children and among children with lower socioeconomic status.ConclusionsOur study findings underscore the importance of poor CC and referrals on ED visits for all children and those from disadvantaged populations. Initiatives for expanding the reach of PCMH should consider prioritising these two domains, especially in areas with significant minority populations.
Impact of virtual consultations on quality of care in type 2 diabetes: a systematic review and narrative synthesis protocol
Authors: Aldakhil Reham , Lammila-Escalera Elena , Hayhoe Benedict , Majeed Azeem , Greenfield Geva , Neves Ana Luisa 
Published: November 2024

BackgroundAround 463 million people globally have diabetes, of which over 90% have type 2 diabetes (T2D). Projections indicate an expected increase to 700 million by 2045. The COVID-19 pandemic accelerated digital health uptake, establishing virtual consultations as a feasible alternative to traditional in-person care. Despite promising preliminary evidence, a comprehensive review is needed to fully assess the impact of virtual consultations on diabetes care. This review aims to systematically evaluate the impact of remote consultations on the quality of care provided to persons with T2D, by mapping impacts against the six quality domains outlined by the National Academy of Medicine (NAM) (ie, patient-centeredness, effectiveness, efficiency, timeliness, equity and safety).Methods and analysisPubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), COCHRANE Library, EMBASE (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Web of Science will be searched for studies published between 2010 and 2024. Primary outcomes will include any quality measures pertaining to the NAM domains for adult patients accessing virtual consultations. The Cochrane Collaboration’s tool will be used to assess the quality of the randomised studies, and the Risk of Bias in Non-Randomised Studies of Interventions will be used for non-randomised studies. The findings will be summarised as a narrative synthesis. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews on 15 November 2023 (registration number: CRD42023474219).Ethics and disseminationThis review will not include primary data and therefore does not require ethical approval. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Findings will be disseminated as academic publications and conference presentations and summarised into patient-led lay summaries.
A person-centred primary care pharmacist-led osteoporosis review for optimising medicines (PHORM): a protocol for the development and co-design of a model consultation intervention
Authors: Sturrock Andrew , Grabrovaz Meaghan , Bullock Laurna , Clark Emma , Finch Tracy , Haining Shona , Helliwell Toby , Horne Robert , Hyde Robin , Maidment Ian , Pryor Claire , Statham Louise , Paskins Zoe 
Published: November 2024

IntroductionAdherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context.A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol.Methods and analysisWe will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues.We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team.Ethics and disseminationEthical approval was obtained from NHS North West—Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.
Development of the continuous ambulatory vestibular assessment (CAVA) system to provide an automatic diagnosis for vestibular conditions: protocol for a multicentre, single-arm, non-randomised clinical trial
Authors: Phillips John S , Cox Stephen J , Howard Gregory , High Juliet , Murdin Louisa , Nunney Ian , Rea Peter , Shepstone Lee 
Published: November 2024

IntroductionDizziness is a common symptom that can occur in an unpredictable and episodic manner leading to the imprecise reporting of symptoms. Patients will often see many specialists before receiving a diagnosis and treatments can vary in terms of risk and invasiveness which places a significant burden on health services. Achieving an early precise diagnosis could be key in reducing the impact of symptoms on patients and health services.Methods and analysisThe continuous ambulatory vestibular assessment (CAVA) trial is a single-arm, non-randomised, multicentre diagnostic accuracy device trial that aims to quantify the extent to which the CAVA system can differentiate three common inner-ear causes of dizziness: Ménière’s disease, vestibular migraine and benign paroxysmal positional vertigo. 85 participants with an established diagnosis from each of the three dizziness conditions, a total of 255 participants, will be recruited from ear, nose and throat, audiology and audiovestibular medicine departments in National Health Service (NHS) sites across the UK. The CAVA device is composed of two components: A set of bespoke single-use sensor arrays that adhere to the left and right side of the participant’s face; and a small reusable module fitting over the ear that contains a battery, a data storage facility and connection ports for the arrays. The CAVA device will be worn by all participants for up to 30 days with the aim of capturing eye movement data during a dizzy attack. The first objective is to develop an algorithm that can discriminate between the three dizziness conditions listed above. The second is to quantify the financial and patient benefits of deployment in the NHS. The final objective is to expedite a plan to deploy the system in the NHS.Ethics and disseminationThe trial was approved by the West Midlands—South Birmingham Research Ethics Committee and the Medicines and Healthcare products Regulatory Agency (MHRA). REC reference: 22/WM/0229, IRAS Project ID: 317899, and MHRA: CI/2022/0062 /GB. Participants will provide full informed consent and can withdraw for any reason without it affecting their standard care. Dissemination will include publication in peer-reviewed journals, presentations at academic and public conferences including patients and the public and to policymakers and practitioners.Trial registration numberISRCTN81218533, trial protocol V.3.1 (25 January 2024).
Development of gout in people with asymptomatic hyperuricemia: study protocol for a 5-year prospective cohort
Authors: Stewart Sarah , Gamble Greg , Taylor William , Su Isabel , Merriman Tony , Mihov Borislav , Horne Anne , Stamp Lisa , Pascart Tristan , Andrés Mariano , Peral-Garrido Maria-Luisa , Neogi Tuhina , Norkuviene Eleonora , Vazquez-Mellado Janitzia , FitzGerald John D , Terslev Lene , Hammer Hilde Berner , Uhlig Tillman , D’Agostino Maria-Antonietta , Martin Julia , Sun Mingshu , Li Changgui , Dalbeth Nicola 
Published: November 2024

IntroductionThe central biochemical cause of gout is hyperuricemia (elevated serum urate levels). Ultrasound features of monosodium urate (MSU) crystal deposition are common in people with asymptomatic hyperuricemia. However, it is unclear whether this is a precondition for the development of gout. This study aims to determine whether ultrasound imaging evidence of MSU crystal deposition predicts development of symptomatic gout over 5 years, in people who already have an increased risk of gout due to elevated serum urate concentrations (≥8 mg/dL).Methods and analysisThis is a prospective, international, multicentre study. The study population comprises over 250 participants with asymptomatic hyperuricemia (serum urate ≥8.0 mg/dL). After the baseline assessments, participants are followed for 5 years or until the development of gout, defined by the 2015 American College of Rheumatology/European Alliance of Associations for Rheumatology gout classification criteria. Baseline assessments include anthropomorphic measures, laboratory tests, questionnaires, blood and urine specimen collection, plain radiographs of the feet and standardised ultrasound scans of the lower limbs, scored according to the Outcomes in Rheumatology (OMERACT) gout ultrasound scoring system. The primary outcomes are the development of gout and time course for development of gout in people with and without ultrasound evidence of MSU crystal deposition. Exploratory analyses will examine clinical, genetic and biological factors associated with development of MSU crystal deposition and gout.Ethics and disseminationThis study protocol was approved by the New Zealand Ministry of Health Southern Health and Disability Ethics Committee (MEC/05/10/130/AM16) on 18 December 2018. The findings from this study will be published in peer-reviewed journals and will be presented at national and international conferences.Trial registration numberACTRN12619000915156.
Investigating the effects of simulated high altitude on colour discrimination
Authors: Liu Siru , Wang Yuchen , Yu Xinli , Li Jiaxi , Zhou Jun , Li Yuanhong , Wang Zesong , Zhou Chengkai , Xie Jiaxing , Guo Anqi , Zhou Xinzuo , Ding Yi , Li Xuemin , Ding Li 
Published: November 2024

PurposeTo quantify changes in colour vision immediately after exposure to different altitudes of low-pressure hypoxia.MethodsThe study involved 35 healthy participants (ages 20–26). Colour vision was assessed using the Farnsworth-Munsell 100-Hue test at eight different altitudes (condition 1: ground, condition 2: 3500 m, condition 3: 3500 m after 40 min, condition 4: 4000 m, condition 5: 4000 m after 40 min, condition 6: 4500 m, condition 7: 4500 m after 40 min, condition 8: back to the ground). Data were analysed using Analysis of Variance (ANOVA), paired t-test, and χ2test .ResultsTotal Error Score (TES) increased with altitude and hypoxia duration, with higher TES in condition 8 than in condition 1. There were significant TES differences between conditions 3 and 7, as well as 4 and 7. Friedman and repeated ANOVA tests revealed significant sector differences, with Blue-Yellow Partial Error Score (PES) greater than Red-Green PES, particularly on conditions 4, 5 and 8. Significant Red-Green PES differences were found between conditions 4 and 7, and Blue-Yellow PES between conditions 3 and 5, 7, 8. Tritan (Blue-Yellow) shift was most pronounced at high altitudes.ConclusionsThis experiment investigated acute low-pressure hypoxia’s effects on colour vision, supplementing chronic hypoxia research. Increased altitudes and exposure duration worsen colour vision, with effects persisting post-recovery. Tritan axis loss is most significant under hypoxia.
Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life
Authors: Kinsman Leigh David , Mooney Graeme , Whiteford Gail , Lower Tony , Hobbs Megan , Morris Bev , Bartlett Kerry , Jacob Alycia , Curley Dan 
Published: November 2024

BackgroundAn advance care plan outlines a patient’s wishes regarding medical treatment or goals of care in the case that they become unable to communicate or to make decisions. An advance care directive (ACD) is an advance care plan that has been formally recorded and has legal status. Despite ACDs playing an important role in person-centred end-of-life care, an earlier retrospective medical records audit demonstrated that only 11% (58/531) of people who died due to a terminal illness had an ACD.The aim of this project was to increase the proportion of patients with a terminal illness completing an ACD. A secondary outcome was to measure the impact of ACDs on hospital and intensive care unit (ICU) admissions in the last 6 months of life.This multifaceted project comprised (1) education for health professionals and the public; (2) individual support for patients on request; (3) development of online resources for health professionals and the general public; and (4) monthly team meetings.MethodThe proportion of ACDs completed and hospital and ICU admissions during the last 6 months of life, were extracted via medical record audits.Written consent was required for patients to participate, including being contacted by the project team and accessing their medical records.Results112 patients consented to participate in the project and 109 (97%) completed an ACD. There was no reduction in the average number of hospital admissions, while ICU admissions reduced from 14% (n=74) to 0%.ConclusionThe targeted, multifaceted approach to education and support for completion of ACDs, resulted in a significant increase in ACD completion and a major reduction in ICU admissions.
Getting it Right from the Start (GIRFTS): protocol for a stepped-wedge cluster randomised controlled trial of a school-based framework to improve children’s oral language and reading outcomes
Authors: Quach Jon , Siew Melissa L , Sinclair Cecilia , Snow Pamela , Eadie Patricia , Poed Shiralee , Shingles Beth , Gold Lisa , Orsini Francesca , Connell Judy , Edwards Stuart , Goldfeld Sharon 
Published: November 2024

IntroductionStrong oral language and reading skills are important for child development. The response to intervention (RTI) framework supports schools to apply evidence-based practices and interventions to proactively meet the learning needs of all students and identify and support students at risk of learning difficulties. Getting it Right from the Start (GIRFTS) aims to implement a codesigned RTI framework in the first 2 years of formal schooling (foundation and grade 1) to improve oral language and reading skills. GIRFTS includes an implementation evaluation.Methods and analysisGIRFTS is a stepped-wedge cluster randomised trial conducted in Victoria, Australia, over 3 years. Clusters are primary schools. The intervention is to implement tiers 1 and 2 of the RTI framework into foundation and grade 1 according to RTI principles. The primary outcome is reading comprehension by the start of grade 2. Secondary outcomes include listening comprehension, word and non-word reading and phonological awareness. An implementation evaluation will also be conducted with the study to understand schools’ RTI implementation process and enablers and barriers to implementation. Strategies used by schools to overcome implementation challenges will also be investigated.Ethics and disseminationThis trial was approved by the Royal Children’s Hospital Human Research Ethics Committee (HREC/58832/RCHM-2019). Investigators will communicate the results to stakeholders, collaborators and participating schools and teachers through presentations and publications.Trial registration numbersISRCTN91164066, ACTRN12622000146796.