bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in urine sampling rates of general practice patients with suspected lower urinary tract infections in England, 2015–2022: a population-based study
Authors: Ciaccio Laura , Fountain Holly , Beech Elizabeth , Brown Colin S , Demirjian Alicia , Gerver Sarah , Muller-Pebody Berit , Bou-Antoun Sabine 
Published: August 2024

ObjectivesInappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice.DesignA retrospective population-based study using administrative data.SettingIQVIA Medical Research Database (IMRD) data from general practices in England, 2015–2022.ParticipantsPatients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD.Outcome measuresTrends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test.ResultsThere were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016–2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds.ConclusionUrine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.
Optimal approach to ultrasound-guided quadratus lumborum blocks for postoperative analgesia in elective caesarean section: protocol for systematic review and meta-analysis
Authors: Li Yan , Zhang Donghang , Wang Na 
Published: August 2024

IntroductionUltrasound-guided quadratus lumborum blocks are commonly used for postoperative analgesia during caesarean section. Ultrasound-guided quadratus lumborum blocks can be performed through four approaches, including lateral, posterior, anterior, and intramuscular quadratus lumborum blocks. This systematic review and meta-analysis aims to determine the optimal approach to ultrasound-guided quadratus lumborum blocks for postoperative analgesia in elective caesarean section.Methods and analysisThe PubMed, EMBASE, Cochrane Library and Web of Science databases will be systematically searched from their inception to 30 July 2024. Randomised controlled trials that compared the analgesic effects of different ultrasound-guided quadratus lumborum block approaches in elective caesarean section will be included. Only publications in English will be eligible for inclusion. The total postoperative analgesic consumption over 24 hours will be the primary outcome. The time to first analgesic request, postoperative pain scores at rest and during movement, and incidence of adverse effects will be secondary outcomes. RevMan V.5.4 will be used for the statistical analysis. Network meta-analysis will be used for indirect comparisons between different approaches across studies. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to assess the quality of evidence for each outcome.Ethics and disseminationEthical approval was not required. The results of this study will be submitted to peer-reviewed journals.PROSPERO registration numberCRD42024503694.
Role of men in women’s health service utilisation in northern Nigeria: a qualitative study of women, men and provider perspectives
Authors: Sinai Irit , Azogu Olajumoke , Dabai Shehu Salisu , Waseem Saba 
Published: August 2024

BackgroundThe 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men’s decision-making role in the family significantly contribute to this phenomenon.ObjectivesThe assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement.DesignQualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states.SettingPrimary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto.ParticipantsWomen who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48).ResultsWe found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband’s permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands’ presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men.ConclusionDespite years of programming, barriers to women’s family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.
Political economy analysis of health taxes (tobacco, alcohol drink and sugar-sweetened beverage): qualitative study of three provinces in Indonesia
Authors: Ahsan Abdillah , Amalia Nadira , Rahmayanti Krisna Puji , Adani Nadhila , Wiyono Nur Hadi , Endawansa Althof , Utami Maulida Gadis , Miranti Yuniar Adela , Anastasia Erika Valentina , Pertiwi Yuyu Buono Ayuning 
Published: August 2024

ObjectiveEfforts to implement health tax policies to control the consumption of harmful commodities and enhance public health outcomes have garnered substantial recognition globally. However, their successful adoption remains a complex endeavour. This investigates the challenges and opportunities surrounding health tax implementation, with a particular focus on subnational government in Indonesia, where the decentralisation context of health tax remains understudied.DesignEmploying a qualitative methodology using a problem-driven political economy analysis approach.SettingWe are collecting data from a total of 12 focus group discussions (FGDs) conducted between July and September 2022 in three provinces—Lampung, Special Region of/Daerah IstimewaYogyakarta and Bali, each chosen to represent a specific commodity: tobacco, sugar-sweetened beverages (SSBs) and alcoholic beverages—we explore the multifaceted dynamics of health tax policies.ParticipantThese FGDs involved a mean of 10 participants in each FGD, representing governmental institutions, non-governmental organisations and consumers.ResultsOur findings reveal that health tax policies have the potential to contribute significantly to public health. Consumers understand tobacco’s health risks, and cultural factors influence both tobacco and alcohol consumption. For SSBs, the consumers lack awareness of long-term health risks is concerning. Finally, bureaucratic complexiting and decentralised government hinder implementation for all three commodities.ConclusionFurthermore, this study underscores the importance of effective policy communication. It highlights the importance of earmarking health tax revenues for public health initiatives. It also reinforces the need to see health taxes as one intervention as part of a comprehensive public health approach including complementary non-fiscal measures like advertising restrictions and standardised packaging. Addressing these challenges is critical for realising the full potential of health tax policies.
Evaluation of the knowledge, attitude and practice towards ischaemic stroke among healthcare workers in neurology and neurosurgery department: a cross-sectional study in Shaanxi province, China
Authors: Chen Wanhong , Li Wenqiang , Wang Yugang , Chen Dan , Yu Liping , Yuan Xingyun 
Published: August 2024

ObjectivesHealthcare workers play an important role in the timely recognition and treatment of patients who had an ischaemic stroke. However, their knowledge, attitude and practice (KAP) towards ischaemic stroke have not been well studied. This study aimed to assess the KAP towards ischaemic stroke among healthcare workers in the neurology and neurosurgery department in Shaanxi province, China.DesignCross-sectional study.SettingMedical centres in Shaanxi province.ParticipantsHealthcare workers in the neurology and neurosurgery department at Shaanxi province.Primary and secondary outcome measuresDemographic characteristics and KAP towards ischaemic stroke were collected by a self-designed questionnaire.ResultsA total of 259 (96.6%) valid questionnaires were collected. Their mean KAP scores were 19.56±3.72 (total score: 23), 36.56±3.56 (total score: 40) and 27.45±3.00 (total score: 30), respectively. Multivariate logistic regression analysis demonstrated that education (bachelor’s degree or above vs college or below: OR=2.704 (1.286–5.685), p=0.009), gender (female vs male: OR=0.401 (0.227–0.710), p=0.002) and professional title (intermediate vs no title: OR=0.280 (0.107–0.731), p=0.009) were independently associated with good knowledge; knowledge score (OR=1.266 (1.157–1.387), p<0.001) and hospital (private hospital vs public hospital: OR=0.544 (0.313–0.944), p=0.030) were independently associated with good attitude; and attitude score (OR=1.480 (1.326–1.652), p<0.001), gender (female vs male: OR=0.511 (0.264–0.993), p=0.047) and occupation (other healthcare workers vs physicians: OR=0.252 (0.129–0.495), p<0.001) were independently associated with good practice.ConclusionThe healthcare workers in the neurology and neurosurgery department demonstrated a satisfactory KAP towards ischaemic stroke. Targeted and tailored training programmes might be an optional way to improve their practice.
Formative qualitative evaluation of an improvement programme delivered in an English hospital trust to reduce harm from pressure ulcers
Authors: Dallow Anna , Goldthorpe Katharine , Murphy Peter , Phipps Denham , Rostami Paryaneh 
Published: August 2024

BackgroundPressure ulcers (PUs) are a leading cause of preventable harm globally and can cause patients significant pain, infection and, in rare incidents, death. There is a strong evidence base for how to improve PUs and one UK healthcare trust used this evidence to develop a quality improvement (QI) programme using the Institute of Healthcare Improvement’s Breakthrough Series collaborative model. 20 teams, from both acute and community settings, participated in the first two phases of the collaborative. The delivery of both phases used virtual delivery using the Institute of Healthcare Improvement’s improvement model. This study sought to formatively evaluate the early phases of the collaborative, to support learning and continual improvements to the collaborative programme and other collaboratives delivered by the organisation based on the formative evaluation.MethodsSemi-structured interviews were conducted with purposively sampled participants to explore their perspectives about the implementation of the programme, interventions tested as part of the ‘change package’ provided and the pandemic’s impact.ResultsA total of seven participants were interviewed, including acute ward managers, a charge nurse (deputy ward manager), a wound healing community nurse and a team leader community nurse. Interview durations varied from 9 min to 28 min. The interviews were kept short and stopped when data saturation was achieved as it was an extremely pressurised time for the organisation where the highest escalation alert was triggered on numerous occasions.ConclusionA sustained reduction in PUs was achieved during the evaluation period and participants felt that the approach helped to achieve this, regardless of the adaptations made to the delivery method due to the pandemic. To support improvements, it is vital to ensure systems such as data collection are accurate and timely. The necessity for building strong foundations for QI capability must not be underestimated, as greater QI knowledge leads to better engagement and outcomes.
Family-centred care interventions in neonatal intensive care units: a scoping review of randomised controlled trials providing a menu of interventions, outcomes and measurement methods
Authors: Mariani Ilaria , Vuillard Cecilia Laure Juliette , Bua Jenny , Girardelli Martina , Lazzerini Marzia 
Published: August 2024

BackgroundBenefits of different types of family-centred care (FCC) interventions in neonatal intensive care units (NICUs) have been reported. However, a comprehensive review of existing FCC intervention studies was lacking.ObjectiveThis review aimed at synthesising the characteristics of FCC interventions, related outcomes and measurement methods in randomised controlled trials (RCTs) in NICU, and providing menus of options to favour implementation and further research.MethodsWe searched PubMed, EMBASE, Web of Science and the Cochrane Library up to 31 January 2022. Interventions were mapped according to five categories as defined by a previous Cochrane review. We described outcome types, measurement populations, measurement methods and timelines. Subgroup analyses were also performed.ResultsOut of 6583 studies identified, 146 met eligibility criteria. Overall, 52 (35.6%) RCTs tested more than one category of intervention, with a large variety of combinations, with the most frequent category of intervention being the educational (138 RCTs, 94.5%). We identified a total of 77 different intervention packages, and RCTs comparing the same interventions were lacking. The 146 RCTs reported on 425 different outcomes, classified in 13 major categories with parental mental health (61 RCTs, 41.8% of total RCTs) being the most frequent category in parents, and neurobehavioural/developmental outcomes being the most frequent category in newborns (62 RCTs, 42.5%). For several categories of outcomes almost every RCT used a different measurement method. Educational interventions targeting specifically staff, fathers, siblings and other family members were lacking or poorly described. Only one RCT measured outcomes in health workers, two in siblings and none considered other family members.ConclusionsA large variety of interventions, outcomes and measurement methods were used in FCC studies in NICU. The derived menus of options should be helpful for researchers and policy makers to identify interventions most suitable in each setting and to further standardise research methods.
Understanding the challenges and successes of implementing ‘hybrid’ interventions in healthcare settings: findings from a process evaluation of a patient involvement trial
Authors: Hampton Sarah , Murray Jenni , Lawton Rebecca , Sheard Laura 
Published: August 2024

Introduction‘Hybrid’ interventions in which some intervention components are fixed across sites and others are flexible (locally created) are thought to allow for adaptation to the local context while maintaining fidelity. However, there is little evidence regarding the challenges and facilitators of implementing hybrid interventions. This paper reports on a process evaluation of a patient safety hybrid intervention called Your Care Needs You (YCNY). YCNY was tested in the Partners at Care Transitions (PACT) randomised controlled trial and aimed to enhance older patients and their families’ involvement in their care in order to achieve safer transitions from hospital to home.MethodsThe process evaluation took place across eight intervention wards taking part in the PACT trial. 23 interviews and 37 informal conversations were conducted with National Health Service (NHS) staff. Patients (n=19) were interviewed twice, once in hospital and once after discharge. Interviews with staff and patients concerned the delivery and experiences of YCNY. Ethnographic observations (n=81 hours) of relevant activities (eg, multidisciplinary team meetings, handovers, etc) were undertaken.ResultsThe main finding relates to how staff understood and engaged with YCNY, which then had a major influence on its implementation. While staff broadly valued the aims of YCNY, staff from seven out of the eight wards taking part in the process evaluation enacted YCNY in a mostly task-based manner. YCNY implementation often became a hurried activity which concentrated on delivering fixed intervention components rather than a catalyst for culture change around patient involvement. Factors such as understaffing, constraints on staff time and the COVID-19 pandemic contributed towards a ‘taskification’ of intervention delivery, which meant staff often did not have capacity to creatively devise flexible intervention components. However, one ward with a sense of distributed ownership of YCNY had considerable success implementing flexible components.DiscussionHybrid interventions may allow aspects of an intervention to be adapted to the local context. However, the current constrained and pressured environment of the NHS left staff with little ability to creatively engage with devising flexible intervention components, despite recognising the need for and being motivated to deliver the intervention.
Structural housing elements associated with injuries in older adults in the USA
Authors: Shields Wendy , Omaki Elise , Aassar Mia Lalor , Blue Taneka , Brooks Brianna , O'Hara Jack , Perona Rica Yssabel 
Published: August 2024

ObjectiveTo quantify the unintentional injuries associated with housing elements among older adults treated in US hospital emergency departments (EDs). To identify modifiable home hazards.MethodsThe National Electronic Injury Surveillance System (NEISS) coding manual was reviewed to identify all codes associated with housing elements that were permanently attached to a home. We queried the 2020 NEISS data for older adults (aged 65 and older) to determine the number of injuries associated with each element. The 10 elements involved in the most hospitalisations and the most ED visits were each tabulated by the number of records in the NEISS sample and national estimate, yielding two separate lists of 10 housing elements. A review of case narratives was conducted on a random selection constituting 10% of all records or a minimum of 100 records to determine common precipitating factors and prevention recommendations.ResultsFrom the two lists, we identified 11 housing elements most commonly associated with housing-related injuries, resulting in ED visits or hospitalisations. The housing element most associated with housing-related injuries was floor, leading to 929 937 ED visits. Subsequent case narrative review yielded prevention recommendations, including modifications that support balance and fall recovery, reduce the need to reach and improve visibility.ConclusionsHousing element-related injuries affect hundreds of thousands of older adults. Case narratives reveal falls, tripping/slipping and sliding injuries that can potentially be prevented with home modification. NEISS is a valuable tool to identify injury risks in the home.
Safety and efficacy of GD-11 in patients with ischaemic stroke: a multicentre, double-blind, randomised, placebo-controlled, phase 2 trial
Authors: Zhang Runhua , Liu Gaifen , Zhao Xingquan , Wang Yilong , Li Zixiao , Chen Guofang , Liu Bo , Ling Yun , Wang Yongjun , Li Shuya 
Published: August 2024

BackgroundGD-11, a novel brain cytoprotective drug, was designed to be actively taken up and transported across the blood-brain barrier via the glucose transporter. This study aimed to evaluate the safety and efficacy of GD-11 for improving the recovery of patients with acute ischaemic stroke (AIS).MethodsA double-blind, randomised, placebo-controlled, phase 2 trial was conducted at 15 clinical sites in China. Patients aged 18–80 years with AIS within 48 hours were randomly assigned (1:1:1) to receive 160 mg GD-11, 80 mg GD-11 and placebo, two times a day for 10 days. The primary endpoint was a modified Rankin Scale (mRS) score of 0–1 at 90 days after treatment. The safety outcome was any adverse events within 90 days.ResultsFrom 17 November 2022 to 22 March 2023, a total of 80 patients in the 160 mg GD-11 group, 79 patients in the 80 mg GD-11 group and 80 patients in the placebo group were included. The proportion of an mRS score of 0–1 at day 90 was 77.5% in the 160 mg GD-11 group, 72.2% in the 80 mg GD-11 group and 67.5% in the placebo group. Though no significant difference was found (p=0.3671), a numerically higher proportion was observed in the GD-11 group, especially in the 160 mg GD-11 group. The incidence of adverse events was similar across the three groups (p=0.1992).ConclusionGD-11 was safe and well-tolerated. A dosage of GD-11 160 mg two times a day was recommended for a large trial to investigate the efficacy.
A novel methodology for the diffusion coefficient determination in porous media by X-ray high-resolution radiographies
Authors: Santini M. , Fest-Santini S. , Cossali G. E. , Casatta N. , Lupo C. 
Published: August 2024

AbstractThe first step in diagnosing a patient with cancer is the biopsy and the study of the tissue sample taken, suitably processed, is essential for a correct diagnosis. Tissue processors are machines that automatically perform the entire processing protocol, often relying on empirical timing related to chemical diffusions in the biological samples. The determination of the diffusion coefficient in porous materials, such as histological tissue, is still under study with multiple methods often resulting in inaccurate predictions and with few amounts of literature data for biological samples. The authors present an experimental technique, based on a multitude of X-ray radiographs acquired over time, where the intensity of the attenuation to the ionising beam is proportional to the concentration of the solvent that diffuses in the histological preparation. The paper so describes a proof-of-concept of a novel method to estimate the diffusion coefficient in a histological sample, based on the acquisition of time-dependent X-ray radiographs and the solution of an inverse diffusion problem.