bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antihypertensive deprescribing in frail long-term care residents (OptimizeBP): protocol for a prospective, randomised, open-label pragmatic trial
Authors: Kraut Roni Y , Youngson Erik , Sadowski Cheryl A , Bakal Jeffrey A , Faulder Douglas , Korownyk Christina S , Vucenovic Ana , Eurich Dean T , Manca Donna P , Lundby Carina , Kivi Paul , Manville Margaret , Garrison Scott R 
Published: August 2024

IntroductionAlthough antihypertensive medication use is common among frail older adults, observational studies in this population suggest blood pressure (BP) lowering may convey limited benefit and perhaps even harm. This protocol describes an antihypertensive deprescribing trial in frail older adults powered for mortality and morbidity outcomes.Methods and analysisDesign:Prospective, parallel, randomised, open-label pragmatic trial.Participants:Long-term care (LTC) residents ≥70 years of age, diagnosed with hypertension, with mean systolic BP <135 mm Hg, ≥1 daily antihypertensive medication and no history of congestive heart failure.Setting:18 LTC facilities in Alberta, Canada, with eligible residents identified using electronic health services data.Intervention:All non-opted-out eligible residents are randomised centrally by a provincial health data steward to either usual care, or continually reducing antihypertensives provided an upper systolic threshold of 145 mm Hg is not exceeded. Deprescribing is carried out by pharmacists/nurse practitioners, using an investigator-developed algorithm.Follow-up:Provincial healthcare databases tracking hospital, continuing care and community medical services.Primary outcome:All-cause mortality.Secondary outcome:Composite of all-cause mortality or all-cause unplanned hospitalisation/emergency department visit.Tertiary outcomes:All-cause unplanned hospitalisation/emergency department visit, non-vertebral fracture, renal insufficiency and cost of care. Also, as assessed roughly 135-days postrandomisation, fall in the last 30 days, worsening cognition, worsening activities of daily living and skin ulceration.Process outcomes:Number of daily antihypertensive medications (broken down by antihypertensive class) and average systolic and diastolic BP over study duration.Primary outcome analysis:Cox proportional hazards survival analysis.Sample size:The trial will continue until observation of 247 primary outcome events has occurred.Current status:Enrolment is ongoing with ~400 randomisations to date (70% female, mean age 86 years).Ethics and disseminationEthics approval was obtained from the University of Alberta Health Ethics Review Board (Pro00097312) and results will be published in a peer-reviewed journal.Trial registration numberNCT05047731.
Using nicotine replacement therapy for smoking reduction in pregnancy: a qualitative study of pregnant women in the UK who smoke
Authors: Thomson Ross , Phillips Lucy , Orton Sophie , Naughton Felix , Coleman Tim 
Published: August 2024

ObjectivesTo explore the acceptability and perceived motivations and barriers of using nicotine replacement therapy (NRT) to reduce the number of daily cigarettes smoked in pregnancy, rather than for stopping completely.DesignTelephone, semi-structured interviews, audio-recorded and transcribed verbatim. Transcripts were analysed using an inductive thematic analysis.ParticipantsEighteen pregnant women in the UK, who were smoking or had recently stopped smoking, were recruited.ResultsHalf of interviewees reported having used NRT to reduce smoking during their current pregnancy, and there was overwhelming support for the UK National Health Service to recognise this as a potentially useful way to use these products. The cost and stigma associated with purchasing NRT products when pregnant were seen as barriers to using NRT in this way. The early offer of NRT for reduction along with a tailored, structured approach to support was seen as important.ConclusionsUsing NRT to help women, who are unable to stop smoking, to reduce their smoking may be acceptable to pregnant women. This study found women were already using NRT alongside ad hoc strategies to reduce their smoking. Further research evaluating structured smoking reduction support, alongside concurrent NRT use is needed.
Estimating the value of new antibiotic treatment strategies in Zhejiang province, China: cost-effectiveness analysis based on a validated dynamic model
Authors: Yang Wenqianzi , Zhen Xuemei , Sun Xueshan , Khatiwada Shikha Upadhyaya , Yang Danhong , Chen Yixi , Dong Peng , Al-Taie Amer , Gordon Jason , Dong Hengjin 
Published: August 2024

ObjectivesThis analysis aims to better reflect the value of new antibiotic treatment strategies, thereby informing clinical antibiotic use, antimicrobial reimbursement and/or hospital formulary decision-making in China.DesignWe adapted a published and validated dynamic disease transmission and cost-effectiveness model to evaluate the clinical and economic outcomes of introducing a new antibiotic, ceftazidime/avibactam (CAZ-AVI) for treating resistant infections in Zhejiang province, China. Outcomes were assessed over a 10-year infectious period and an annual discount rate of 5%. Costs were extracted from the hospital’s Health Information System (HIS) and obtained after data cleaning, aggregation and discounting.SettingThe Chinese healthcare system perspective.Participants10 905 patients in a Chinese tier-3 hospital from 2018 to 2021 with any of the three common infections (complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) and infections with limited treatment options (LTO)) caused by three common resistant pathogens (Escherichia coli, Klebsiellaspp.and Pseudomonas aeruginosa).Interventions(1) Current treatment strategy (piperacillin-tazobactam (pip/taz) and meropenem); (2) CAZ-AVI at the third line; (3) CAZ-AVI at the second line; (4) CAZ-AVI at the first line; (5) CAZ/AVI first line, two lines diversified (i.e., equal pip/taz and CAZ-AVI at the first line; meropenem at the last line) and (6) CAZ/AVI first line, all-lines diversified.Primary outcome measuresQuality-adjusted life years (QALYs) lost, hospitalisation costs and incremental net monetary benefit (INMB) were used to assess cost-effectiveness.ResultsOver 10 years, the introduction of CAZ-AVI to the current treatment strategy led to lower hospitalisation costs and more QALYs across all five treatment strategies, with between 68 284 and 78 571 QALYs gained whilst saving up to US$236.37 for each additional QALY gained. The INMB of introducing CAZ-AVI is estimated up to US$3 550 811 878.ConclusionsIntroducing CAZ-AVI had a positive impact on clinical and economic outcomes for treating antimicrobial resistance, and diversifying the antibiotics use early in the treatment might yield the best benefits.
Comparison of outcomes of open, laparoscopic and robot-assisted laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: protocol for a systematic review and meta-analysis
Authors: Nikolinakos Panagiotis , Chatzikrachtis Nikolaos , Chatterjee Abhisekh , Donkov Ivo , Bishara Samuel , Kotsi Elisavet , Alexandrou Ioannis , Zavras Nikolaos , Norris Joseph M 
Published: August 2024

IntroductionThe treatment of children with pelviureteric junction obstruction (PUJO) has naturally progressed from open, to minimally invasive approaches, including laparoscopic pyeloplasty and robot-assisted laparoscopic pyeloplasty (RALP). The RALP is now considered to be the gold standard for paediatric patients with PUJO, except for smaller infants due to size limitations. Our systematic review aims to synthesise all the available evidence regarding key postoperative outcomes for the three surgical approaches to pyeloplasties in children. Our outcomes of interest include, but are not limited to, the reoperation rate, length of hospital stay and postoperative complications as classified by the Clavien-Dindo grading system. A comprehensive assessment of all three methods in paediatric patients has yet to be conducted in the literature to date.Methods and analysisA systematic search of the MEDLINE, PubMed, EMBASE and Cochrane databases will be conducted. Screening, data extraction, statistical analysis and reporting will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included papers will be full-text manuscripts written between 1947 and March 2024, comparing the outcomes and complications of open, laparoscopic and RALP. Quality and study bias will be assessed using the Newcastle-Ottawa score and, if relevant, the Cochrane risk of bias tool for randomised trials. This present protocol is written in accordance with the PRISMA Protocol 2015 checklist, ensuring that the highest methodological standards are adhered to.Ethics and disseminationNo ethical approval shall be required, as this is a review of already published literature. Findings will be disseminated through publications in peer-reviewed journals and presentations at international and national conferences.PROSPERO registration numberCRD42023456779.
Family-centred interventions for people with substance use disorders in low-income and middle-income country settings: a scoping review protocol
Authors: Sharma Ashley , Mita Carol , Kumar Satish , Mayer Kenneth , O’Cleirigh Conall , Solomon Sunil S , Bagley Sarah , Batchelder Abigail , Sullivan Matthew C , Hassan Areej , Ganapathi Lakshmi 
Published: August 2024

IntroductionSubstance use disorder (SUD) and problematic substance use are global public health concerns with significant multifaceted implications for physical health and psychosocial well-being. The impact of SUD extends beyond the individual to their family while imposing financial and social burdens on the community. Though family-centred interventions have shown promise in addressing SUD, their implementation and impact in low-income and middle-income countries (LMICs) remain underexplored.Methods and analysisPer Joanna Briggs Institute’s scoping review protocol, a systematic search strategy was employed across OVID Medline, Embase, PsycINFO, Web of Science–Core Collection, Global Health and CINAHL from 22 February 2024 to 26 February 2024, to identify relevant studies focused on family-centred interventions for SUD in LMIC, devoid of publication time and language constraints. Two independent reviewers will screen the titles, abstracts and full texts, with discrepancies resolved through discussion or third-party reviews. The extracted data charted in a structured form will be visualised by diagrams or tables, focusing on the feasibility and impact of family-centred interventions for SUD in LMIC. For qualitative studies, the findings will be synthesised and presented in thematic clusters, and for studies that report quantitative outcomes, specific health, including SUD and psychosocial, outcomes will be synthesised, aligning with the Population, Concept and Context framework.Ethics and disseminationThese data on substance use, psychosocial outcomes and perspectives of individuals with SUD and their families will be presented in narrative format, highlighting patterns and identifying research gaps. This review aims to synthesise the existing evidence on family-centred interventions for improving substance use and/or psychosocial outcomes in individuals with SUD in LMIC and seeks to inform future policy and practice. Ethics approval is not required for this scoping review, and modifications to the review protocol will be disclosed. Findings will be disseminated through conference proceedings and peer-reviewed publication.
Implementation of the WHO Standards to assess quality of paediatric care at the facility level using service users’ perspective as source of data: a multicentre quality improvement study in Italy
Authors: Bressan Silvia , Sartor Giada , Dalena Paolo , Balestra Elia , Madera Anna , Marchetti Federico , Finocchiaro Maria Carla , Tirelli Francesca , Felici Enrico , Marcellino Alessia , Fasoli Silvia , Cogo Paola , Parrino Roberta , Castaldo Benmario , Santangelo Rosa , Toniutti Maristella , De Rosa Giuseppina , Baltag Valentina , Lazzerini Marzia 
Published: August 2024

ObjectivesThere is little experience in the use of the WHO Standards for improving the quality of care (QOC) for children at the facility level. We describe the use of 75 WHO Standard based Quality Measures to assess paediatric QOC, using service users as a source of data, in Italy.Study designIn a cross-sectional study including 12 hospitals, parents/caregivers of admitted children completed a validated questionnaire including 75 Quality Measures: 40 pertinent to the domain of experience of care; 25 to physical/structural resources; 10 to COVID-19 reorganisational changes. Univariate and multivariate analyses were conducted.ResultsAnswers from 1482 service users were analysed.Physical resourceswas the domain with the higher frequency of reported gaps in QOC, with key gaps (higher rates of responders reporting need for improvement and low variability across centres) being: (1) quality of meals (48.1%; range across facilities: 35.3%–61.7%); (2) presence of cooking areas (50.9%; range: 34.6%–70.0%); (3) spaces for family/friends (51.3%; range: 31.8%–77.4%). Forexperience of care, the most critical gap was the information on the rights of the child (76.6%; range: 59.9%–90.4%), with most other Quality Measures showing an overall frequency of reported need for improvement ranging between 5% and 35%. Forreorganisational changes due to COVID-19an improvement was felt necessary by <25% of responders in all Quality Measures, with low variability across centres. At the multivariate analyses, factors significantly associated with the QOC Index largely varied by QOC domain.ConclusionsThe use of the 75 prioritised Quality Measures, specific to service users’ perspective, enabled the identification of both general and facility-specific gaps in QOC. Based on these findings, quality improvement initiatives shall focus on a core list of selected Quality Measures common to all facilities, plus on an additional list of Quality Measures as more relevant in each facility.
Design of the 18-year follow-up of the Danish COPSAC2000birth cohort
Authors: Mølbæk-Engbjerg Trine , Vahman Nilo , Mikkelsen Marianne , Fink Nadia Rahman , Christensen Emil Dalgaard , Brustad Nicklas , Sass Lærke , Løvenhøj Hedda , Strandberg-Larsen Katrine , Groot Jonathan , Andersen Anne-Marie Nybo , Vinding Rebecca , Schoos Ann-Marie Malby , Stokholm Jakob , Bønnelykke Klaus , Chawes Bo 
Published: August 2024

BackgroundAtopic diseases, obesity and neuropsychiatric disorders are lifestyle-related and environmental-related chronic inflammatory disorders, and the incidences have increased in the last years.ObjectiveTo outline the design of the 18-year follow-up of the Copenhagen Prospective Study on Asthma in Childhood (COPSAC2000) birth cohort, where risk factors of atopic diseases, obesity and neuropsychiatric disorders are identified through extensive characterisation of the environment, along with deep clinical phenotyping and biosampling for omics profiling.MethodsCOPSAC2000is a Danish prospective clinical birth cohort study of 411 children born to mothers with asthma who were enrolled at 1 month of age and closely followed at the COPSAC clinical research unit through childhood for the development of atopic diseases. At the 18-year follow-up visit, biomaterial (hair, blood, urine, faeces, throat, and skin swabs, nasal lining fluid and scraping, and hypopharyngeal aspirates) and extensive information on environmental exposures and risk behaviours were collected along with deep metabolic characterisation and multiorgan investigations including anthropometrics, heart, lungs, kidneys, intestines, bones, muscles and skin. Neuropsychiatric diagnoses were captured from medical records and registers accompanied by electronic questionnaires on behavioural traits and psychopathology.ResultsA total of 370 (90%) of the 411 cohort participants completed the 18-year visit. Of these, 25.1% had asthma, 23.4% had a body mass index >25 kg/m2and 16.8% had a psychiatric diagnosis in childhood. A total of 68.7% drank alcohol monthly, and when drinking, 22.2% drank >10 units. Of the participants, 31.4% were currently smoking, and of these, 24.1% smoked daily. A total of 23.8% had tried taking drugs, and 19.7% reported having done self-destructive behaviour. The mean screen time per day was 6.0 hours.ConclusionThis huge dataset on health and habits, exposures, metabolism, multiorgan assessments and biosamples from COPSAC2000by age 18 provides a unique opportunity to explore risk factors and underlying mechanisms of atopic disease and other lifestyle-related, non-communicable diseases such as obesity and neuropsychiatric disorders, which are highly prevalent in the community and our cohort.
Percutaneous coronary intervention plus medical therapy versus medical therapy alone in chronic coronary syndrome: a propensity score-matched analysis from the Swedish Coronary Angiography and Angioplasty Registry
Authors: von Koch Sacharias , Koul Sasha , Grimfjärd Per , Andersson Jonas , Jernberg Tomas , Omerovic Elmir , Fröbert Ole , Erlinge David , A Mohammad Moman 
Published: August 2024

BackgroundPercutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone.MethodsWe conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio analysis, a statistical method that ranks the components of the composite by clinical importance. The primary outcome was net adverse clinical event (NACE) within 5 years. In the win ratio analysis, the components of NACE were ranked as follows: (1) all-cause mortality, (2) myocardial infarction (MI), (3) bleeding and (4) urgent revascularisation. Secondary outcomes were the individual components of NACE, major adverse cardiovascular events (MACE) and cardiovascular mortality.ResultsAfter PS matching, two groups of 7220 patients each were formed. The hierarchical outcome analysis of NACE and MACE showed that PCI was associated with improved outcome (matched win ratio: 1.28 (95% CI 1.20 to 1.36, p<0.001) and matched win ratio: 1.38 (95% CI 1.29 to 1.48, p<0.001), respectively). The use of PCI was associated with higher win ratio of MI (matched win ratio: 1.15, 95% CI 1.04 to 1.28, p=0.008), urgent revascularisation (matched win ratio: 1.85, 95% CI 1.69 to 2.03, p<0.001) and cardiovascular mortality (matched win ratio: 1.15, 95% CI 1.00 to 1.34, p=0.044). No difference in win ratio was observed for all-cause mortality or bleeding.ConclusionsIn this study, which sought to evaluate the outcomes of patients with CCS using a hierarchical approach, patients selected for revascularisation with PCI experienced better outcome compared with MT alone.
System-level trends in ischemic stroke admissions after adding endovascular stroke capabilities in community hospitals
Authors: Kumar Prateek , Salazar-Marioni Sergio , Dhanjani Saagar , Iyyangar Ananya , Abdelkhaleq Rania , Tariq Muhammad Bilal , Niktabe Arash , Ballekere Anjan N , Le Ngoc Mai , Azeem Hussain , McCullough Louise , Sheth Sunil A , Lee Eunyoung 
Published: August 2024

BackgroundThere is substantial interest in adding endovascular stroke therapy (EST) capabilities in community hospitals. Here, we assess the effect of transitioning to an EST-performing hospital (EPH) on acute ischemic stroke (AIS) admissions in a large hospital system including academic and community hospitals.MethodsFrom our prospectively collected multi-institutional registry, we collected data on AIS admissions at 10 hospitals in the greater Houston area from January 2014 to December 2022: one longstanding EPH (group A), three community hospitals that transitioned to EPHs in November 2017 (group B), and six community non-EPHs that remained non-EPH (group C). Primary outcomes were trends in total AIS admissions, large vessel occlusion (LVO) and non-LVO AIS, and tissue plasminogen activator (tPA) and EST use.ResultsAmong 20 317 AIS admissions, median age was 67 (IQR 57–77) years, 52.4% were male, and median National Institutes of Health Stroke Scale (NIHSS) was 4 (IQR 1–10). During the first 12 months after EPH transition, AIS admissions increased by 1.9% per month for group B, with non-LVO stroke increasing by 4.2% per month (P<0.001). A significant change occurred for group A at the transition point for all outcomes with decreasing rates in admissions for AIS, non-LVO AIS and LVO AIS, and decreasing rates of EST and tPA treatments (P<0.001).ConclusionUpgrading to EPH status was associated with a 2% per month increase in AIS admissions during the first year post-transition for the upgrading hospitals, but decreasing volumes and treatments at the established EPH. These findings quantify the impact on AIS admissions in hospital systems with increasing EST access in community hospitals.
Dexamethasone as a perineural adjuvant to a ropivacaine popliteal sciatic nerve block for pediatric foot surgery: a randomized, double-blind, placebo-controlled trial
Authors: Reysner Malgorzata , Reysner Tomasz , Janusz Piotr , Kowalski Grzegorz , Shadi Milud , Daroszewski Przemysław , Wieczorowska-Tobis Katarzyna , Kotwicki Tomasz 
Published: August 2024

BackgroundThis study assessed the effect of perineural dexamethasone on block duration, opioid requirement, blood glucose levels, and stress response to surgery as measured by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), following pediatric foot and ankle surgery.MethodsIn this parallel, double-blinded randomized controlled trial, 90 children (ages 2–5 years, >5 kg) scheduled for foot or ankle surgery under spinal anesthesia with ultrasound-guided single-shot popliteal sciatic nerve block were randomized into 3 groups: 0.5% ropivacaine with saline (control), 0.5% ropivacaine plus dexamethasone 0.1 mg/kg (DEX0.1), and 0.5% ropivacaine plus dexamethasone 0.05 mg/kg (DEX0.05). Primary outcome was the time to first rescue opioid analgesia. Secondary outcomes included motor block duration, pain scores, NLR, PLR, and blood glucose levels.ResultsTime to first rescue opioid analgesia was significantly longer in the DEX0.1 group compared with the DEX0.05 group (18.4 hours, SD 2.6 hours vs 16 hours, SD 2.8 hours), with a mean difference of 2.2 hours (95% CI 0.7 to 3.6), p<0.01; and the control group (8.5 hours, SD 1.5 hours), with a mean difference of −9.9 (95% CI −11.4 to −8.4), p<0.001. Motor block was significantly longer in the DEX0.1 group (17.3 hours, SD 2.5 hours) compared with the DEX0.05 (15.2 hours, SD 2.7 hours; p<0.01) and control groups (7.8±1.1, p<0.001). Total opioid consumption was significantly lower in the DEX0.1 group compared with the control group (p=0.01). NLR, PLR, and glucose levels did not differ significantly between the groups at baseline, 24 hours, and 48 hours post surgery.ConclusionsPerineural dexamethasone significantly prolonged postoperative motor block duration and did not influence blood glucose, NLR, or PLR levels.Trial registration numberNCT06086418.