bluuebunny/crossref_metadata_2025_split huggingface dataset:
General practitioner workforce sustainability to maximise effective and equitable patient care: a realist review protocol
Authors: Park Sophie , Owen-Boukra Emily , Burford Bryan , Cohen Tanya , Duddy Claire , Dunn Harry , Fadia Vacha , Goodman Claire , Henry Cecily , Lamb Elizabeth I , Ogden Margaret , Rapley Tim , Rees Eliot , Vance Gillian , Wong Geoff 
Published: May 2024

IntroductionThere are not enough general practitioners (GPs) in the UK National Health Service. This problem is worse in areas of the country where poverty and underinvestment in health and social care mean patients experience poorer health compared with wealthier regions. Encouraging more doctors to choose and continue in a GP career is a government priority. This review will examine which aspects of the healthcare system affect GP workforce sustainability, how, why and for whom.Methods and analysisA realist review is a theory-driven interpretive approach to evidence synthesis, that brings together qualitative, quantitative, mixed-methods research and grey literature. We will use a realist approach to synthesise data from the available published literature to refine an evidence-based programme theory that will identify the important contextual factors and underlying mechanisms that underpin observed outcomes relating to GP workforce sustainability. Our review will follow Pawson’s five iterative stages: (1) finding existing theories, (2) searching for evidence, (3) article selection, (4) data extraction and (5) synthesising evidence and drawing conclusions. We will work closely with key stakeholders and embed patient and public involvement throughout the review process to refine the focus of the review and enhance the impact and relevance of our research.Ethics and disseminationThis review does not require formal ethical approval as it draws on secondary data from published articles and grey literature. Findings will be disseminated through multiple channels, including publication in peer-reviewed journals, at national and international conferences, and other digital scholarly communication tools such as video summaries, X and blog posts.PROSPERO registration numberCRD42023395583.
Optimising personal continuity for older patients in general practice: a cluster randomised stepped wedge pragmatic trial
Authors: Groot Lex , Schers Henk , Burgers J S , Smalbrugge Martin , Uijen Annemarie A , Hoogland Jeroen , van der Horst Henriëtte E , Maarsingh Otto R 
Published: May 2024

AimTo evaluate the effectiveness, feasibility and acceptability of a multicomponent intervention for improving personal continuity for older patients in general practice.DesignA cluster randomised three-wedged, pragmatic trial during 18 months.Setting32 general practices in the Netherlands.Participants221 general practitioners (GPs), practice assistants and other practice staff were included. Practices were instructed to include a random sample of 1050 patients aged 65 or older at baseline and 12-month follow-up.InterventionThe intervention took place at practice level and included opTimise persOnal cOntinuity for oLder (TOOL)-kit: a toolbox containing 34 strategies to improve personal continuity.OutcomesData were collected at baseline and at six 3-monthly follow-up measurements. Primary outcome measure was experienced continuity of care at the patient level measured by the Nijmegen Continuity Questionnaire (NCQ) with subscales for personal continuity (GP knows me and GP shows commitment) and team/cross-boundary continuity at 12-month follow-up. Secondary outcomes were measured in GPs, practice assistants and other practice staff and included work stress and satisfaction and perceived level of personal continuity. In addition, a process evaluation was undertaken among GPs, practice assistants and other practice staff to assess the acceptability and feasibility of the intervention.ResultsNo significant effect of the intervention was observed on NCQ subscales GP knows me (adjusted mean difference: 0.05 (95% CI −0.05 to 0.15), p=0.383), GP shows commitment (0.03 (95% CI −0.08 to 0.14), p=0.668) and team/cross-boundary (0.01 (95% CI −0.06 to 0.08), p=0.911). All secondary outcomes did not change significantly during follow-up. Process evaluation among GPs, practice assistants and other practice staff showed adequate acceptability of the intervention and partial implementation due to the COVID-19 pandemic and a high perceived workload.ConclusionAlthough participants viewed TOOL-kit as a practical and accessible toolbox, it did not improve personal continuity as measured with the NCQ. The absence of an effect may be explained by the incomplete implementation of TOOL-kit into practice and the choice of general outcome measures instead of outcomes more specific for the intervention.Trial registration numberInternational Clinical Trials registry Platform (ICTRP), trial NL8132 (URL: ICTRP Search Portal (who.int).
Lived experiences of mothers with postnatal anxiety: a qualitative phenomenology study from Pakistan
Authors: Saeed Qamar , Shafique Kashif , Chaudhry Nasim 
Published: May 2024

ObjectiveThe prevalence of postnatal anxiety is high among women during the first year of childbirth globally. Rates are higher in low and middle-income countries (LMICs), that is, 24%. Existing literature on maternal mood and its impact on child development has largely focused on postnatal depression. Postnatal anxiety has been recognised to have significant independent effects similar to those of postnatal depression, including negative effects on various aspects of maternal well-being including quality of life, parent–child interaction and child development. The evidence exploring lived experiences of postnatal anxiety is limited from LMICs. This study explored the lived experiences of anxiety in postnatal mothers in Pakistan.DesignA phenomenological approach was used for this qualitative study. The audio-recorded interviews were transcribed and analysed using the process of thematic analysis.SettingsThe study was conducted in two community settings in Karachi, Pakistan; the Bin Qasim and Gadap town.ParticipantsWomen who were 18 years of age or older, had a live childbirth within the previous 12 months and had a score of 10 or higher on the Generalised Anxiety Disorder-7.ResultsIn-depth, one-to-one interviews were conducted with 10 participants. The qualitative data comprised of three themes.Theme one: Factors perceived to be associated with postnatal anxiety, Theme two: The perceived impact of postnatal anxietyandTheme three: Support needs. The first theme was further subdivided into two subthemes, that is,Mothers’ perception of navigating domestic responsibilitiesandsociocultural norms of motherhood and financial constraints.ConclusionDespite the high prevalence of postnatal anxiety in LMICs there is not any published evidence on exploring this phenomenon through in-depth research in Pakistan. Understanding the lived experiences will help health professionals to identify women at risk of developing postnatal anxiety and to develop effective culturally appropriate interventions for women with anxiety during this postnatal period.
Protocol for cost-effectiveness analysis of a randomised trial of mHealth coaching (Bump2Baby and Me) compared with usual care for healthy gestational weight gain and postnatal outcomes in at-risk women and their offspring in the UK, Australia, Ireland and Spain
Authors: Nørmark Laura Pirhonen , McAuliffe Fionnuala , Maindal Helle Terkildsen , O'Reilly Sharleen , Davies Anna , Burden Christy , Skinner Timothy C , Vrangbæk Karsten , Callander Emily 
Published: May 2024

IntroductionGestational diabetes mellitus and overweight are associated with an increased likelihood of complications during birth and for the newborn baby. These complications lead to increased immediate and long-term healthcare costs as well as reduced health and well-being in women and infants. This protocol presents the health economic evaluation to investigate the cost-effectiveness of Bump2Baby and Me (B2B&Me), which is a health coaching intervention delivered via smartphone to women at risk of gestational diabetes.Methods and analysisUsing data from the B2B&Me randomised controlled trial, this economic evaluation compares costs and health effects between the intervention and control group as an incremental cost-effectiveness ratio. Direct healthcare costs, costs of pharmaceuticals and intervention costs will be included in the analysis, body weight and quality-adjusted life-years for the mother will serve as the effect outcomes. To investigate the long-term cost-effectiveness of the trial, a Markov model will be employed. Deterministic and probabilistic sensitivity analysis will be employed.Ethics and disseminationThe National Maternity Hospital Human Research and Ethics Committee was the primary approval site (EC18.2020) with approvals from University College Dublin HREC-Sciences (LS-E-20-150-OReilly), Junta de Andalucia CEIM/CEI Provincial de Granada (2087-M1-22), Monash Health HREC (RES-20-0000-892A) and National Health Service Health Research Authority and Health and Care Research Wales (HCRW) (21/WA/0022). The results from the analysis will be disseminated in scientific papers, through conference presentations and through different channels for communication within the project.Trial registration numberACTRN12620001240932.
Coproducing a physical activity referral scheme in Germany: a qualitative analysis of stakeholder experiences
Authors: Klamroth Sarah , Mino Eriselda , Naber Inga , Weissenfels Anja , Geidl Wolfgang , Gelius Peter , Abu-Omar Karim , Pfeifer Klaus 
Published: May 2024

ObjectivesThis study evaluated stakeholders’ experiences of participating in a coproduction process to develop a physical activity referral scheme (PARS) in the German healthcare system. The focus was on examining facilitators and challenges, along with gathering insights on potential modifications to the joint development process, all from the viewpoint of stakeholders.DesignThis qualitative study employed one-to-one semi-structured interviews, and the findings were analysed using summarising qualitative content analysis.SettingThe study focused on the German healthcare system.ParticipantsSeven stakeholders from the coproduction process were purposefully selected for interviews using maximum variation sampling. The interviewees represented different sectors (physician associations, physical activity professionals’ associations, health insurance companies and patient organisations), various positions within their organisations, and different levels of attendance during the coproduction process.ResultsIn almost all interviews, the following factors were highlighted as facilitators of the development process: coproduction approach, process of coproduction, multi-sector stakeholder group, possibility of active participation, coordinating role of researchers, communication, atmosphere and interaction. In contrast, differences in roles and hierarchy, merging of different perspectives, clarification of intervention costs, and competition and conflicting interests were pointed out as challenges. Only a few suggestions regarding adaptations in terms of group composition and cooperation among stakeholders were mentioned.ConclusionsStakeholder experiences with the joint development process were predominantly positive, indicating that coproduction is a beneficial approach for the development of PARS intended for integration into healthcare systems. The effective management of power differences among stakeholders is intricately tied to the coproduction method; therefore, it should be selected carefully. The research team plays a pivotal role in coordinating and negotiating the process, and the team should be equipped with a diverse set of skills and knowledge, particularly to understand the intricacies of the healthcare system where the PARS is intended for implementation.Trial registration numberNCT04947787.
Care for the caregiver: an exploration of caregiver burden of children with chronic medical conditions at a tertiary care hospital in Karachi, Pakistan – a mixed-methods study
Authors: Saeed Sana , Malik Marib Ghulam Rasool , Khan Maryam Hameed , Malik Shahzil Abdur Rehman , Aziz Bisma 
Published: May 2024

ObjectivesCaregiver burden often goes unrecognised and can substantially affect caregivers’ physical, psychological and financial well-being, thereby impacting quality of care. This study investigates burden among caregivers of children with chronic medical conditions in a tertiary care hospital in Pakistan. The study aims to assess the extent of burden, explore influencing factors and recommendations for interventions.DesignMixed-methods study, comprising of an in-person paper-based survey, employing the Zarit Burden Interview scale to assess burden scores. Qualitative component included thematic analysis of semi-structured in-depth interviews with caregivers.Participants383 caregivers of children admitted to the inpatient paediatric services at our tertiary care centre were surveyed. In-depth interviews were conducted with 19 caregivers.ResultsThe survey revealed a mean burden score of 35.35±15.14, with nearly half of the participants (46%, n=177) experiencing mild burden, while 37% (n=140) reporting moderate-to-severe burden. The most common diagnosis was cancer (24%, n=92), while the highest burden (42.97±15.47) was noted for congenital cardiac disease. Greater burden was significantly associated with lower caregiver education, young age of the child at diagnosis and increased number of hospital visits (p<0.05). Caregivers highlighted financial strain, psychosocial effects and impact on lifestyle and relationships as key challenges. They emphasised the need for improved medical coordination, financial support and enhanced hospital services.ConclusionsThe study elucidates the multifaceted nature of caregiver burden in the context of paediatric chronic illnesses in Pakistan. Interventions should emphasise financial aid, educational support and development of system-level changes to improve access to resources and medical care coordination. These insights call for policy and practice integration to support caregivers effectively.
Exploration of registration and the risk of bias in acupuncture randomised controlled trials: a systematic review protocol
Authors: Duan Yuting , Deng Yuening , Tang Binbin , Xu Zhirui , Ye Xiaolin , Lu Manyi , Liu Shujuan , Xiong Linghui , Zhu Weifeng , Yu Lin , Zhao Pinge 
Published: May 2024

BackgroundRandomised controlled trials (RCTs) are the predominant type in acupuncture clinical research, and the publications have increased rapidly in recent years, but there is a prevalence of the high risk of bias and poor methodological design in acupuncture RCTs. Clinical trial registration can improve the transparency and credibility of studies by disclosing key information in advance. However, the registration in acupuncture RCTs is not satisfactory, as there is widespread of the under-registration, inconsistency with published studies and insufficient disclosure of key methodological information. Whether registration can reduce the risk of bias in acupuncture RCTs and improve data transparency has not been fully explored. Therefore, we constructed this study to investigate the association between registration and risk of bias and data sharing level in acupuncture RCTs.MethodsSeven databases including MEDLINE, EMBASE, CENTRAL, CBM, CNKI, Wanfang and VIP databases will be systematically searched between 1 January 2014 and 31 March 2024, for acupuncture RCTs. Two reviewers will independently extract data using a predefined standardised format and perform secondary validation. The characteristics and data sharing level of the included studies will be summarised. The risk of bias of included RCTs will be assessed by the revised Cochrane risk-of-bias tool for randomised trials. The risk of bias and registration in acupuncture RCTs will be analysed by logistic or quantile regression analyses (depending on the number of minimum events). The data sharing level and registration will be analysed by quantile regression analyses.Ethics and disseminationAs the systematic review aims to consolidate info from published sources, ethical approval is not necessary for this study. The study’s findings will be submitted to a peer-reviewed academic journal and disseminated via conference presentations. This protocol has been registered in Open Science Framework Registries.
Cross-sectional examination of commercial milk formula industry funding of international, regional and national healthcare professional associations: protocol
Authors: Henke-Ciążyńska Katarzyna , Fober Iwo , Munblit Daniel , Fabbri Alice , Grundy Quinn , Bero Lisa , Boyle Robert J , Helfer Bartosz 
Published: May 2024

IntroductionCommercial milk formula manufacturers often emphasise their role in supporting infant and young child nutrition and breastfeeding, but their commercial goals to increase volume and profit margin of formula sales conflict with these declarations. Healthcare professional associations have an important role in healthcare worker education, shaping clinical practice. When healthcare professional associations enter into financial relationships with formula manufacturers, conflicts of interest arise, which may undermine education and practice that promotes optimal infant and young child feeding. The World Health Assembly calls on all parties to avoid such conflicts of interest, but it is uncertain how often this recommendation is followed. This protocol documents a systematic method to identify funding from the commercial milk formula industry among international, regional and national associations of healthcare professionals.Methods and analysisUsing systematic search strategies in the Gale Directory Library and Google, we will identify international healthcare professional associations relevant to maternal and child health. Data regarding funding relationships with the commercial milk formula industry over the past 24 months will be extracted from the official websites or, in their absence, social media accounts by two independent analysts. The analysis will focus on the presence of conflict of interest or sponsorship policies and type of funding, such as sponsorship or payment for services.Ethics and disseminationThis study does not require ethical approval and will use data available in the public domain. The results will be disseminated through peer-reviewed journal articles, at conferences and among the healthcare professional associations.
Comorbidities among adult patients with psoriasis in Tianjin: a cross-sectional analysis of the Health Database study
Authors: Zhang Yiming , Guo Yali , Zhang Kaiyue , Fan Liyun , Ma Jingyue , Li Yan , Zhou Quan , Zhao Qian , Hou Shuping , Wang Huiping 
Published: May 2024

ObjectivesThis study aims to examine the prevalence of comorbidities in adult patients with psoriasis and compare them with those in control subjects without psoriasis in Tianjin, China.DesignThe study is a cross-sectionalanalysis.ParticipantsThe participants were established by identifying all patients (age ≥18 years) who visited hospitals and clinics in Tianjin between 1 January 2016 and 31 October 2019.SettingThe study group consisted of 20 678 adult patients with psoriasis, and a comparison group was created after 1:1 propensity score matching. Logistic regression analyses were conducted to examine the risk of 22 comorbidities for these two groups.ResultsPatients with psoriasis had a significantly higher prevalence of 11 comorbidities and a lower prevalence of 2 comorbidities within 12 months of follow-up. Our results also showed that the proportion of psoriatic arthritis might account for approximately 2% of all patients with psoriasis. This psoriatic arthritis group had a higher average age and CCI (Charlson Comorbidity Index) index score (2.27 >1.62, p <0.001) than the non-arthritis group.ConclusionsThis study showed that psoriasis in Tianjin is associated with various comorbidities. It also emphasises the importance of clinical treatment in improving therapeutic effects and reducing the burden of psoriasis in China.
Compassionate Communication and Advance Care Planning to improve End-of-life Care in Treatment of Haematological Disease ‘ACT’: Study Protocol for a Cluster-randomized trial
Authors: Borregaard Myrhøj Cæcilie , Clemmensen Stine Novrup , Jarden Mary , Johansen Christoffer , von Heymann Annika 
Published: May 2024

IntroductionTo support the implementation of advance care planning and serious illness conversations in haematology, a previously developed conversation intervention titled ‘Advance Consultations Concerning your Life and Treatment’ (ACT) was found feasible. This study aims to investigate the effect of ACT on the quality of end-of-life care in patients with haematological malignancy and their informal caregivers.Methods and analysisThe study is a nationwide 2-arm cluster randomised trial randomising 40 physician–nurse clusters across seven haematological departments in Denmark to provide standard care or ACT intervention. A total of 400 patients with haematological malignancies and their informal caregivers will be included. The ACT intervention includes an ACT conversation that centres on discussing the patient’s prognosis, worries, hopes and preferences for future treatment. The intervention is supported by clinician training and supervision, preparatory materials for patients and informal caregivers, and system changes including dedicated ACT-conversation timeslots and templates for documentation in medical records.This study includes two primary outcomes: (1) the proportion of patients receiving chemotherapy within the last 30 days of death and (2) patients’ and informal caregivers’ symptoms of anxiety (General Anxiety Disorder-7) at 3 6, 9, 12 and 18 months follow-up. Mixed effects models accounting for clusters will be used.Ethics and disseminationThe Declaration of Helsinki and the European GDPR regulations as practised in Denmark are followed through all aspects of the study. Findings will be made available to the participants, patient organisations, funding bodies, healthcare professionals and researchers at national and international conferences and through publication in peer-reviewed international journals.Registration detailsThe study is registered at ClinicalTrials.gov (NCT05444348). The Regional Ethics Committee of the Capital Region of Denmark (record no: 21067634) has decided that approval is not necessary as per Danish legislation. Study approval has been obtained from The Capital Region of Denmark Data Protection Agency (record no: P-2022-93).Trial registration numberNCT05444348.