bluuebunny/crossref_metadata_2025_split huggingface dataset:
Governance intricacies in implementing regional shared care records: A qualitative study in the national health service, England
Authors: Elizondo Andrey 
Published: October 2024

Objectives This study explores the governance intricacies in establishing a large-scale information infrastructure for integrated care within the National Health Service of England. By focusing on the initial 5 years of a regional interoperability program, we examine the challenges and dynamics of creating a unified system across organizational boundaries. Methods A longitudinal multi-methods approach was utilized, collecting data through interviews with health and social care personnel involved in project governance, meeting observations, and document analysis. This provided an in-depth understanding of the processes and challenges of developing the regional interoperability program. Results This study reveals a dynamic negotiation process and evolving governance structures that must continuously adapt to integrate diverse systems. Key findings include challenges in reconciling multiplicity and heterogeneity, the importance of social learning and stakeholder adaptation, and the role of ongoing negotiation and collaborative group construction in implementing interorganizational infrastructures. Conclusion This study underscores the necessity of continuous adaptation and negotiation among stakeholders in establishing effective governance of integrated care infrastructures. Social learning and active participation play pivotal roles in overcoming the challenges associated with system integration. Strategic insights from this research can guide stakeholders in developing sociotechnical solutions for digital interorganizational infrastructures in integrated care.
Effects of reperfusion grade and reperfusion strategy on the clinical outcome: Insights from ESCAPE-NA1 trial
Authors: Cimflova Petra , Ospel Johanna M , Singh Nishita , Marko Martha , Kashani Nima , Mayank Arnuv , Demchuk Andrew , Menon Bijoy , Poppe Alexandre Y , Nogueira Raul , McTaggart Ryan , Rempel Jeremy L , Tymianski Michael , Hill Michael D , Almekhlafi Mohammed A , Goyal Mayank 
Published: October 2024

Background We evaluated the association of reperfusion quality and different patterns of achieved reperfusion with clinical and radiological outcomes in the ESCAPE NA1 trial. Methods Data are from the ESCAPE-NA1 trial. Good clinical outcome [90-day modified Rankin Scale (mRS) 0–2], excellent outcome (90-day mRS0–1), isolated subarachnoid hemorrhage, symptomatic hemorrhage (sICH) on follow-up imaging, and death were compared across different levels of reperfusion defined by expanded Treatment in Cerebral Infarction (eTICI) Scale. Comparisons were also made between patients with (a) first-pass eTICI 2c3 reperfusion vs multiple-pass eTICI 2c3; (b) final eTICI 2b reperfusion vs eTICI 2b converted-to-eTICI 2c3; (c) sudden reperfusion vs gradual reperfusion if >1 pass was required. Multivariable logistic regression was used to test associations of reperfusion grade and clinical outcomes. Results Of 1037 included patients, final eTICI 0–1 was achieved in 46 (4.4%), eTICI 2a in 76 (7.3%), eTICI 2b in 424 (40.9%), eTICI 2c in 284 (27.4%), and eTICI 3 in 207 (20%) patients. The odds for good and excellent clinical outcome gradually increased with improved reperfusion grades (adjOR ranging from 5.7–29.3 and 4.3–17.6) and decreased for sICH and death. No differences in outcomes between first-pass versus multiple-pass eTICI 2c3, eTICI 2b converted-to-eTICI 2c3 versus unchanged eTICI 2b and between sudden versus gradual eTICI 2c3 reperfusion were observed. Conclusion Better reperfusion degrees significantly improved clinical outcomes and reduced mortality, independent of the number of passes and whether eTICI 2c3 was achieved suddenly or gradually.
Using Focussed Ethnography to Observe and Understand the Actions and Interactions of People With Prader-Willi Syndrome When They Exercise at a Community Gym: A Protocol
Authors: Schofield Cara , Bigby Christine , Downs Jenny , Taylor Nicholas F. , Shields Nora 
Published: October 2024

Exercise for people with Prader-Willi syndrome (PWS) is important for their health and wellbeing and can provide opportunities for community participation. However, they may find it difficult to participate in some contexts, such as community gyms because social and environmental barriers in these settings may compound difficulties caused by physical impairments or intellectual disability. This study aims to observe and understand the actions and interactions of people with PWS when they exercise in community gyms. A focussed ethnographic study will be conducted. Field notes will be taken in community gyms where people with PWS are participating in a structured exercise program for six months as part of a randomised control trial called PRESTO. Up to ten participants will be observed, with at least three observations planned per participation during the program. Gym sessions observed will be approximately 1 hour long. Within the framework of interpretive description, reflective thematic analysis will be used to interpret observational data. Our findings will inform how best to support people with PWS to exercise at a community gym. Trial Registration Number: ACTRN12620000416998; Australian and New Zealand Clinical Trial Registry.
Effect of dexmedetomidine combined with ropivacaine block on flap blood flow and patient satisfaction after flap transfer for hand trauma: a randomized controlled trial
Authors: Zhao Jinsong , Kong Xionghui , Zheng Zhou , Lv Peijun , Ge Yeying , Huang Jian 
Published: October 2024

The purpose of this study was to assess the effect of dexmedetomidine as a local anaesthetic adjuvant on flap blood flow and patient satisfaction regarding postoperative analgesia anterolateral thigh free flap transfer for hand trauma. A total of 66 patients were randomized into two groups. One group was treated with intermittent 1.0 µg/mL dexmedetomidine + 0.125% ropivacaine bolus at 8 mL/2 h and the other with intermittent 0.2% ropivacaine bolus at 8 mL/2 h, administered via continuous infraclavicular brachial plexus block. Dexmedetomidine had no significant effect on the flap blood supply and had a good safety profile. Moreover, 1.0 µg/mL dexmedetomidine + 0.125% ropivacaine provided similar satisfactory postoperative analgesia as 0.2% ropivacaine ( p > 0.05), reduced hand numbness and motor block, and improved patient satisfaction ( p < 0.05). All the flaps in the dexmedetomidine + ropivacaine group and 30 of 31 flaps in the ropivacaine group survived. The addition of dexmedetomidine to the local anaesthetic infusion appears to be a safe method of improving postoperative symptoms. Level of evidence: I
Empowering youth as Changemakers for gender-transformative action: a play-based participatory approach in South-East Nepal
Authors: Begg S , Jha B , Shah N , Shrestha A , Pulford J , Parker S 
Published: October 2024

Aims: This study explored how youth participatory action research (YPAR) methods, specifically play-based activities integrated with cricket, can engage adolescent girls in Nepal’s Terai region to identify and address gender-related health challenges. It aimed to assess how these methods contribute to empowering girls, developing research capacities, and promoting gender equity through sports. Methods: Three interactive workshops were held with adolescent girls forming ‘Cricket Changemakers’ teams. Through a combination of cricket-based activities, participatory games, and discussions, the workshops aimed to build research skills and explore gender issues in their communities. Qualitative data were gathered through observations, reflective notes, and outputs from play-based tasks. Data were analysed using framework analysis to evaluate the contribution of these activities to key YPAR processes such as power sharing, communication, and strategic thinking. Findings: The play-based methods improved collaboration, networking, and communication among participants. The cricket activities fostered collective power and provided opportunities for girls to reflect on and challenge local gender norms. Participants identified issues including restrictions on mobility, societal expectations, and the unequal distribution of household chores. The workshops facilitated the development of research action plans focused on increasing girls’ participation in cricket and shifting community perceptions of girls’ roles. Conclusions: The integration of play-based YPAR methods shows promise for fostering gender-transformative change among adolescent girls in Nepal. These methods created a space for girls to express challenges and co-develop strategies for social change. Findings suggest that sports-based participatory research can be a valuable tool in public health interventions for gender equity, though more work is needed to address methodological challenges and ensure meaningful participation.
Analysis of Limb Loading and Lower Extremity Strength Recovery Across Time After Anterior Cruciate Ligament Reconstruction
Authors: Bruce Leicht Amelia S. , Thompson Xavier D. , Queen Robin M. , Rodu Jordan S. , Higgins Michael J. , Cross Kevin M. , Werner Brian C. , Resch Jacob E. , Hart Joe M. 
Published: October 2024

Background: Evidence as to how patient thigh muscle strength and limb loading (LL) during a squatting task recovers throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR) is lacking. Hypothesis: Patients will improve LL and strength throughout rehabilitation. Changes in LL and strength over time will be positively correlated. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A total of 60 participants (28 male/32 female; age, 22.5 ± 9.35 years) participated in 2 visits post-ACLR, assessing LL and strength. Using an instrumented pressure mat, patients completed 3 sets of 3 repetitions of bodyweight squats. Peak force (N), unilateral cumulative load (%), and quadriceps and hamstring isokinetic peak torque (N·m) were calculated and recorded bilaterally. LL and peak torque were compared over time and between limbs. Results: A significant limb-by-time interaction was observed for LL peak force (N), where patients underloaded the ACLR limb at visit 1 compared with the contralateral limb ( P < 0.01). Patients increased their ACLR LL across visits ( P = 0.04). A limb-by-time interaction for quadriceps peak torque (N·m) was observed where the ACLR limb increased peak torque across visits ( P < 0.01); however, strength deficits persisted at visit 2 ( P < 0.01) when compared with the nonoperative limb. Weak correlations were observed between all change scores metrics ( r, 0.20-0.25). Conclusion: Patients recovering from ACLR exhibited more symmetric loading during a squatting task and improved their lower extremity strength over time. Changes in strength were not related to changes in LL during a squatting task over time. Clinical Relevance: Squatting tasks are safe and easily implemented throughout ACLR recovery. As changes in functional LL and strength recovery are not related, both should be considered in serial postoperative testing for more comprehensive function and strength assessments.
Web-based telemedicine approach for treatment of post-COVID-19 in Thuringia (WATCH)
Authors: Reuken Philipp A , Besteher Bianca , Bleidorn Jutta , Brockmann Dirk , Finke Kathrin , Freytag Antje , Lehmann-Pohl Katja , Lemhöfer Christiana , Mikolajczyk Rafael , Puta Christian , Scherag André , Wiedermann Marc , Zippel-Schultz Bettina , Stallmach Andreas 
Published: October 2024

Objective After infection with SARS-CoV-2, a substantial proportion of patients develop long-lasting sequelae. These sequelae include fatigue (potentially as severe as that seen in ME/CFS cases), cognitive dysfunction, and psychiatric symptoms. Because the pathophysiology of these sequelae remains unclear, existing therapeutic concepts address the symptoms through pacing strategies, cognitive training, and psychological therapy. Methods Here, we present a protocol for a digital multimodal structured intervention addressing common symptoms through three intervention modules: BRAIN, BODY, and SOUL. This intervention includes an assessment conducted via a mobile “post-COVID-19 bus” near the patient's home, as well as the use of wearable devices and mobile applications to support pacing strategies and collection of data, including ecological momentary assessment. Results We will focus on physical component subscore of the SF36 as Quality of Life parameter as the primary outcome parameter for WATCH to take into account the holistic approach that is necessary for care of post-COVID patients Conclusion In the current project, we present a protocol for a holistic and multimodal structured therapeutic concept which is easily accessible, and scalable for post-COVID patients.
Anomalous Aortic Origin of a Coronary Artery: Results from a Single Surgical Team in Spain
Authors: Barca Laura Varela , Hernández-Estefanía Rafael , Orejas Miguel Orejas , Miñambres Alicia Donado , Mallebrera Marta Tomás , Romero Pilar Calderón , Yung Angeles Heredero , Aldámiz-Echevarría Gonzalo 
Published: October 2024

Objectives Anomalous aortic origin of a coronary artery is a rare congenital lesion in which a coronary artery arises from an anomalous location within the aorta. Anomalous aortic origin of a coronary artery has been associated with myocardial ischemia and it is considered the second most common cause of sudden cardiac arrest in young athletes. When surgical repair is indicated, surgical unroofing is the most commonly employed technique. Our objective is to describe the outcomes of our surgically treated patients. Methods We present a series of 16 adult patients who underwent surgical repair of anomalous aortic origin of a coronary artery. Patients were treated in three different institutions by the same surgeon. Surgical unroofing of the anomalous coronary artery was the surgical technique chosen in the majority of the patients. Follow-up was performed. Results Unroofing of an intramural anomalous coronary artery was the procedure performed in 11 patients. Three patients underwent neo-ostium creation; one patient underwent a David procedure with coronary reimplantation; and one patient was treated with coronary bypass grafting due to severe coronary atheromatous lesions. There were no perioperative deaths, and no major postoperative complications. Follow-up period was 73.8 months, the survival rate was 100%, and there were neither ischemia or heart failure reports. Conclusions The surgical repair of anomalous aortic origin of a coronary artery by coronary unroofing or neo-ostium creation has demonstrated excellent early and late outcomes. Late survival was excellent. The follow-up period revealed no significant morbidity or complications.
The Problems and Needs of Self-Management Among Indonesian Older Adults With Hypertension: A Qualitative Study
Authors: Khasanah Uswatun , Kelliat Budi Anna , Afiyanti Yati , Besral Besral , Sari Dianis Wulan 
Published: October 2024

Introduction Hypertension is the most common older adults’ health problem in Indonesia. Older adults experience various changes in their life that often contribute to their ability to manage health problems, especially in chronic diseases. Objectives This study aimed to understand the problems and needs of self-management of older adults with hypertension. Methods This was a qualitative exploratory descriptive design. Data collection was conducted among 62 participants. Participants were 15 older adults with hypertension and 11 older adults’ families, 12 primary care nurses, seven medical doctors, 11 health volunteers, three heads of primary care, and three district health officials selected by purposeful sampling. Data were collected using semistructured, face-to-face interviews (older adults and their families) and focus group discussion (healthcare workers). Data analysis was carried out qualitatively descriptively using an inductive thinking process; Colaizzi's measures were used for analysis. Results This study identified eight main themes: (1) complaints related to aging and hypertension, (2) knowledge and beliefs about hypertension, (3) behavior changes after hypertension, (4) disease management support; access to health services for older adults, (5) the need to manage hypertension for older adults, (6) disease management support, (7) hypertension self-management behavior, and (8) compliance with medication. Conclusion This study provided evidence regarding older adults’ problems and needs in managing hypertension. These findings should be considered while providing nursing care at the community level to initiate the self-management of hypertension in older adults.
Getting Back on Track: Meanings of Recovery After Critical Illness Caused by COVID-19
Authors: Juuso Päivi , Engström Åsa , Strömbäck Ulrica , Andersson Maria , Nordin Anna 
Published: October 2024

Introduction Being critically ill in need of intensive care, lead to a challenging way back after survival, so also for survivors of COVID-19. The process to recovery can be long. Objectives The aim of our qualitative study was to elucidate meanings of recovery for people who were once critically ill with COVID-19. Method We conducted qualitative individual interviews with 13 individuals who had been critically ill with COVID-19, following a narrative approach. The data collected from the interviews, were analyzed according to phenomenological hermeneutic interpretation. Results The participants, although feeling alone in the process of recovery, had willpower to return to normal life but struggled to keep pace with others. They strived for balance in everyday life and to regain strength despite being exhausted after having COVID-19. The participants were grateful for their survival but displayed a need to understand what had happened. They longed for social contact, expressed feelings of abandonment, and wished for follow-up dialogues with healthcare professionals to better understand their situation. However, because support from healthcare was insufficient, the participants ultimately needed to develop their own strategies to cope with their questions, fears, and weakness. Conclusion Meanings of recovery for people once critically ill with COVID-19, is to strive for balance in everyday life. In their recovery process, healthcare professionals should seek to understand what the illness means for the ill person, and in mutual understanding support them based on their needs.
Guideline-recommended basic parameter adherence in neurocritical care stroke patients: Observational multicenter individual participant data analysis
Authors: Mrochen Anne , Alhaj Omar Omar , Pelz Johann O , Michalski Dominik , Neugebauer Hermann , Lehrieder Dominik , Knier Benjamin , Ringmaier Corinna , Stetefeld Henning , Schönenberger Silvia , Chen Min , Schneider Hauke , Alonso Angelika , Lesch Hendrik , Totzeck Andreas , Erdlenbruch Friedrich , Hiller Benedikt , Diel Norma J , Worm André , Claudi Christian , Gerner Stefan T , Huttner Hagen B , Schramm Patrick 
Published: October 2024

Introduction: Neurocritical care patients with neurovascular disease often face poor long-term outcomes, highlighting the pivotal role of evidence-based interventions. Although International Guidelines emphasize managing basic physiological parameters like temperature, blood glucose, blood pressure, and oxygen levels, physician adherence to these targets remains uncertain. This study aimed to assess adherence to guideline-based treatment targets for basic physiological parameters in neurocritical care. Patients and Methods: This multicenter observational study was conducted across eight tertiary University Hospitals in Germany analyzed 474 patients requiring mechanical ventilation (between January 1st and December 31st, 2021). Adherence was defined as the rate of measurements within therapeutic ranges for systolic blood pressure (situation-adapted), mean blood pressure (MAP, 60–90 mmHg), glucose levels (80–180 mg/dl), body temperature (<37.5°C), partial arterial pressure of oxygen (PaO2) 80–120 mmHg und partial arterial pressure of carbon dioxide (PaCO2) 35–45 mmHg during the initial 96 h of hospitalization in 4 hour-intervals. Results: Overall, 70.7% of all measurements were within the predetermined therapeutic ranges including SBP (71.3%), temperature (68.3%), MAP (71.4%), PaO2 (65.2%), PaCO2 (75.0%) and blood glucose (80.7%). Discussion and Conclusion: This multicenter study demonstrates adherence to guideline-based treatment targets, underscoring the high standards maintained by neurological intensive care units. Our study offers valuable insights into adherence to guideline-based treatment targets for neurocritical care patients in Germany. To improve patient care and optimize therapeutic strategies in neurovascular diseases, further research is needed to examine the impact of these adherence parameters on long-term outcomes.
Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database
Authors: Ishiguchi Hironori , Huang Bi , El-Bouri Wahbi K. , Lip Gregory Y. H. , Abdul-Rahim Azmil H. , Lees (Chair) K.R. , Alexandrov A. , Bath P.M. , Bluhmki E. , Bornstein N. , Chen C. , Claesson L. , Curram J. , Davis S.M. , Diener H-C. , Donnan G. , Fisher M. , Ginsberg M. , Gregson B. , Grotta J. , Hacke W. , Hennerici M.G. , Hommel M. , Kaste M. , Lyden P. , Marler J. , Muir K. , Roffe C. , Sacco R. , Shuaib A . , Teal P. , Venketasubramanian N. , Wahlgren N.G. , Warach S. 
Published: October 2024

Background: The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk. Methods: We gathered data on patients with AIS from the Virtual International Stroke Trials Archive, a global repository of clinical trial data. We examined cardiac complications within 30 days post-stroke, including acute coronary syndrome, heart failure, arrhythmias and cardiorespiratory arrest. We employed hierarchical cluster analysis to define distinct phenotypic risk profiles. The incidence/risk of SHS and 90-day mortality were compared across these profiles. Results: We included 12,482 patients (mean age 69 ± 12 years; 55% male), yielding five phenotypes: Profile 1 (‘ elderly and AF’), Profile 2 (‘ young and smoker’), Profile 3 (‘ young’), Profile 4 (‘ cardiac comorbidities’) and Profile 5 (‘ hypertension with atherosclerotic comorbidities’). Profiles 4 and 1 exhibited the highest risk for SHS (adjusted HR (95% CI): 2.01 (1.70–2.38) and 1.26 (1.05–1.51), respectively, compared to Profile 3), while Profiles 5 and 2 showed moderate risk and Profile 3 had the lowest risk. Although Profiles 1 and 4 were at the highest risk for most SHS presentations, Profile 5 had the highest risk for cardiorespiratory arrest (adjusted HR (95% CI): 2.99 (1.22–7.34)). The 90-day mortality risk was stratified by phenotype, with the highest risk observed in Profiles 5, and 4. Conclusions: Hierarchical cluster analysis effectively identified phenotypes with the highest risk of SHS and early mortality in patients with AIS.