bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abuse in Canadian long-term care homes: a mixed methods study
Authors: Baumann Andrea , Crea-Arsenio Mary , Smith Victoria , Antonipillai Valentina , Idriss-Wheeler Dina 
Published: June 2024

ObjectiveTo examine reported cases of abuse in long-term care (LTC) homes in the province of Ontario, Canada, to determine the extent and nature of abuse experienced by residents between 2019 and 2022.DesignA qualitative mixed methods study was conducted using document analysis and descriptive statistics. Three data sources were analysed: LTC legislation, inspection reports from a publicly available provincial government administrative database and articles published by major Canadian newspapers. A data extraction tool was developed that included variables such as the date of inspection, the type of inspection, findings and the section of legislation cited. Descriptive analyses, including counts and percentages, were calculated to identify the number of incidents and the type of abuse reported.ResultsAccording to legislation, LTC homes are required to protect residents from physical, sexual, emotional, verbal or financial abuse. The review of legislation revealed that inspectors are responsible for ensuring homes comply with this requirement. An analysis of their reports identified that 9% (781) of overall inspections included findings of abuse. Physical abuse was the most common type (37%). Differences between the frequency of abuse across type of ownership, location and size of the home were found. There were 385 LTC homes with at least one reported case of abuse, and 55% of these homes had repeated incidents. The analysis of newspaper articles corroborated the findings of abuse in the inspection reports and provided resident and family perspectives.ConclusionsThere are substantial differences between legislation intended to protect LTC residents from abuse and the abuse occurring in LTC homes. Strategies such as establishing a climate of trust, investing in staff and leadership, providing standardised education and training and implementing a quality and safety framework could improve the care and well-being of LTC residents.
SafeVRwards: Designing a complementary virtual reality module to the Safewards framework intended to relax and manage conflict in mental health wards
Authors: Pardini Susanna , Kim Shua , de Jesus Belmir , Lopes Marilia K S , Leggett Kristine , Falk Tiago H , Smith Christopher , Appel Lora 
Published: June 2024

BackgroundAggression and negative activation in mental health inpatient units pose significant challenges for both patients and staff with severe physical and psychological ramifications. The Safewards model is an evidence-based conflict-containment framework including 10 strategies, such as ‘Calm Down Methods’. As virtual reality (VR) scenarios have successfully enhanced anxiolytic and deactivating effects of therapeutic interventions, they are increasingly considered a means to enhance current models, like Safewards.ObjectivesThe present participatory design investigates the feasibility and user experience of integrating VR therapy as an add-on strategy to the Safewards model, gathering preliminary data and qualitative feedback from bedside staff in an adult inpatient mental health unit.MethodsAn exploratory within-subjects design combining qualitative observations, self-report questionnaires and semistructured interviews is employed with four nurse champions from the mental health unit at Michael Garron Hospital (Toronto, Canada).ResultsA chronological overview of the design process, adaptations and description of the user experience is reported.Conclusion‘SafeVRwards’ introduces VR as a promising conflic-containment strategy complementary to the Safewards model, which can be optimised for deployment through user-oriented refinements and enhanced customisation capacity driven by clinical staff input.
Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project
Authors: Sadasivam S Anuusha , Kumaran Aswin , Manu Ayyan S , Sindujaa S N 
Published: June 2024

IntroductionPain, more frequently due to musculoskeletal injuries, is a prevalent concern in emergency departments (EDs). Timely analgesic administration is paramount in the acute setting of ED. Despite its importance, many EDs face challenges in pain management and present opportunities for improvement. This initiative aimed to expedite the administration of the first analgesic in patients with musculoskeletal pain in the ED.Local problemObservations within our ED revealed that patients with musculoskeletal injuries triaged to yellow or green areas experienced prolonged waiting times, leading to delayed analgesic administration, thereby adversely affecting clinical care and patient satisfaction.Specific aimThe aim of our quality improvement (QI) project was to reduce the time to administration of first analgesia by 30% from baseline, in patients with musculoskeletal injuries presenting to our academic ED, in a period of 8 weeks after the baseline phase.MethodsA multidisciplinary QI team systematically applied Point-of-Care Quality Improvement and Plan-Do-Study-Act (PDSA) cycle methodologies. Process mapping and fishbone analyses identified the challenges in analgesia administration. Targeted interventions were iteratively refined through PDSA cycles.InterventionsInterventions such as pain score documentation at triage, fast-tracking of patients with moderate-to-severe pain, resident awareness sessions, a pain management protocol and prescription audits were executed during the PDSA cycles. Successful elements were reinforced and adjustments were made to address the identified challenges.ResultsThe median door-to-analgesia timing during the baseline phase was 55.5 min (IQR, 25.75–108 min). During the postintervention phase, the median was significantly reduced to 15 min (IQR, 5–37 min), exceeding the anticipated outcomes and indicating a substantial 73% reduction (p value <0.001) from baseline.ConclusionImplementing simple change ideas resulted in a substantial improvement in door-to-analgesia timing within the ED. These findings significantly contribute to ongoing discussions on the optimisation of pain management in emergency care.
Long COVID exhibits clinically distinct phenotypes at 3–6 months post-SARS-CoV-2 infection: results from the P4O2 consortium
Authors: Blankestijn Jelle M , Abdel-Aziz Mahmoud I , Baalbaki Nadia , Bazdar Somayeh , Beekers Inés , Beijers Rosanne J H C G , Bloemsma Lizan D , Cornelissen Merel E B , Gach Debbie , Houweling Laura , Holverda Sebastiaan , Jacobs John J L , Jonker Reneé , van der Lee Ivo , Linders Paulien M A , Mohamed Hoesein Firdaus A A , Noij Lieke C E , Nossent Esther J , van de Pol Marianne A , Schaminee Daphne W , Schols Annemie M W J , Schuurman Lisanne T , Sondermeijer Brigitte , Geelhoed J J Miranda , van den Bergh Joop P , Weersink Els J M , de Wit-van Wijck Yolanda , Maitland-van der Zee Anke H 
Published: June 2024

Background
Four months after SARS-CoV-2 infection, 22%–50% of COVID-19 patients still experience complaints. Long COVID is a heterogeneous disease and finding subtypes could aid in optimising and developing treatment for the individual patient.

Methods
Data were collected from 95 patients in the P4O2 COVID-19 cohort at 3–6 months after infection. Unsupervised hierarchical clustering was performed on patient characteristics, characteristics from acute SARS-CoV-2 infection, long COVID symptom data, lung function and questionnaires describing the impact and severity of long COVID. To assess robustness, partitioning around medoids was used as alternative clustering.

Results
Three distinct clusters of patients with long COVID were revealed. Cluster 1 (44%) represented predominantly female patients (93%) with pre-existing asthma and suffered from a median of four symptom categories, including fatigue and respiratory and neurological symptoms. They showed a milder SARS-CoV-2 infection. Cluster 2 (38%) consisted of predominantly male patients (83%) with cardiovascular disease (CVD) and suffered from a median of three symptom categories, most commonly respiratory and neurological symptoms. This cluster also showed a significantly lower forced expiratory volume within 1 s and diffusion capacity of the lung for carbon monoxide. Cluster 3 (18%) was predominantly male (88%) with pre-existing CVD and diabetes. This cluster showed the mildest long COVID, and suffered from symptoms in a median of one symptom category.

Conclusions
Long COVID patients can be clustered into three distinct phenotypes based on their clinical presentation and easily obtainable information. These clusters show distinction in patient characteristics, lung function, long COVID severity and acute SARS-CoV-2 infection severity. This clustering can help in selecting the most beneficial monitoring and/or treatment strategies for patients suffering from long COVID. Follow-up research is needed to reveal the underlying molecular mechanisms implicated in the different phenotypes and determine the efficacy of treatment.
Continuity of care by a primary midwife (caseload midwifery): a cost analysis using results from the COSMOS randomised controlled trial
Authors: Callander Emily J , Jackson Hannah , McLachlan Helen L , Davey Mary-Ann , Forster Della A 
Published: June 2024

IntroductionCaseload midwifery (continuity of midwifery carer) offers benefits including lower caesarean section rates, lower risks of preterm birth and stillbirth, and improved maternal satisfaction of care. Despite these advantages, concerns about additional costs hinder widespread implementation. This study examines the cost of caseload midwifery compared with standard maternity care from the perspective of both public hospitals and public funders.MethodsA cost analysis was conducted using data from a randomised controlled trial of 2314 low-risk pregnant women in Melbourne, Australia. Women randomised to caseload care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a ‘back-up’ midwife. Women in standard care received midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care. The cost analysis compared differences in mean costs of health resources to public hospitals and to public funders. Additionally, a budget impact analysis estimated total costs to the health system between 2023 and 2027.ResultsFor public hospitals, there was no significant difference in overall costs between women receiving caseload midwifery (n=1146) versus standard care (n=1151) ($A12 363 (SD: $A4967) vs $A12 323 (SD: $A7404); p=0.85). Conversely, public funders incurred lower expenditures for women receiving caseload midwifery ($A20 330 (SD: $A8312)) versus standard care ($A21 637 (SD: $A11 818); p <0.001). The budget impact analysis estimated savings of $A625 million to the health system over the next 5 years with expanded access to caseload midwifery in Australia.ConclusionCaseload midwifery in low-risk women is cost-neutral to public hospitals and cost-saving to public funders.Tweetable abstractContinuity of midwifery for low-risk women reduces costs to public funders, with no additional costs to hospitals.
Invasion risk of cutaneous squamous cell carcinoma in situ by histological subtype: a retrospective cohort study
Authors: Stamer Danielle K , Goldsmith Joshua , Dodge Laura E , Tahan Steven R 
Published: June 2024

AimsCutaneous squamous cell carcinoma in situ (SCCis) can be classified histopathologically into four subtypes: full-thickness (FT), hypertrophic actinic keratosis (HAK), Bowenoid, and acantholytic types. 3%–5% of SCCis lesions progress to invasive squamous cell carcinoma (iSCC), however progression risk by subtype has not been assessed. Aim one of this study is to quantitatively assess the risk of iSCC associated with each histological subtype of SCCis. Aim two is to evaluate if the histological grade of iSCC differs among subtypes of the associated SCCis.MethodsThe pathology information system at our institution was queried for cutaneous SCCis cases with and without associated iSCC from 2020 to 2022. The study group consisted of 65 cases of SCCis with associated iSCC and control group 65 randomly selected cases of SCCis without invasion. For each case SCCis subtype was classified as FT, HAK, Bowenoid or acantholytic type. iSCCs were classified as low grade if well to moderately differentiated (LG) and high grade (HG) if moderately to poorly differentiated.ResultsiSCC was most often associated with HAK-type SCCis, followed by acantholytic and FT-type SCCis, with Bowenoid type rarely associated with iSCC. 41% (14/34) of iSCCs associated with HAK-type SCCis were HG compared with 84% (21/25) for FT-type SCCis.ConclusionsiSCC is most often associated with HAK-type SCCis, followed by acantholytic and FT-types, and rarely with Bowenoid type. HG invasive SCC is most often associated with FT-type, and LG with HAK-type SCCis. Stratifying SCCis by subtype can inform clinical management.
Gender-specific aspects of socialisation and risk of cardiovascular disease among community-dwelling older adults: a prospective cohort study using machine learning algorithms and a conventional method
Authors: Teshale Achamyeleh Birhanu , Htun Htet Lin , Owen Alice J. , Ryan Joanne , Baker JR , Vered Mor , Reid Christopher M , Woods Robyn L. , Berk Michael , Tonkin Andrew , Neumann Johannes T , Kilkenny Monique F , Phyo Aung Zaw Zaw , Nelson Mark R , Stocks Nigel , Britt Carlene , Freak-Poli Rosanne 
Published: June 2024

BackgroundGender influences cardiovascular disease (CVD) through norms, social relations, roles and behaviours. This study identified gender-specific aspects of socialisation associated with CVD.MethodsA longitudinal study was conducted, involving 9936 (5,231 women and 4705 men) initially healthy, community-dwelling Australians aged 70 years or more from the ASPirin in Reducing Events in the Elderly (ASPREE) study and ASPREE Longitudinal Study of Older Persons, with a median follow-up time of 6.4 years. Variable categorisation, variable selection (using machine learning (ML) models; Elastic Net and extreme gradient boosting) and Cox-regression were employed separately by binary gender to identity socialisation factors (n=25 considered) associated with CVD.ResultsDifferent socialisation factors were identified using the ML models. In the Cox model, for both genders, being married/partnered was associated with a reduced risk of CVD (men: HR 0.76, 95% CI 0.60 to 0.96; women: HR 0.67, 95% CI 0.58 to 0.95). For men, having 3–8 relatives they felt close to and could call on for help (HR 0.76, 95% CI 0.58 to 0.99; reference <3 relatives), having 3–8 relatives they felt at ease talking with about private matters (HR 0.70, 95% CI 0.55 to 0.90; reference <3 relatives) or playing games such as chess or cards (HR 0.82, 95% CI 0.67 to 1.00) was associated with reduced risk of CVD. For women, living with others (HR 0.71, 95% CI 0.55 to 0.91) or having ≥3 friends they felt at ease talking with about private matters (HR 0.74, 95% CI 0.58 to 0.95; reference <3 friends) was associated with a lower risk of CVD.ConclusionsThis study demonstrates the need to prioritise gender-specific social factors to improve cardiovascular health in older adults.
Ethnicity and deprivation negatively impact the access to disease-modifying therapy for relapsing-remitting multiple sclerosis: a retrospective, single-centre study
Authors: Das Joyutpal , Mallawaarachchi Gagana , Grimshaw Jack , Jackson Thomas , Talbot Paul , Sharaf Nazar , Kalatha Thaleia , Lord Lindsay , Pace Adrian , Mihalova Tatiana , Heal Calvin , Rog David 
Published: June 2024

BackgroundA growing body of evidence suggests inequitable access to disease-modifying therapies (DMTs) for multiple sclerosis (MS) in publicly funded healthcare systems. This retrospective study examined the impact of ethnicity and deprivation on the access to DMTs.MethodsAll adults diagnosed with relapsing-remitting MS between 2010 and 2020 were included. The impact of ethnicity and deprivation on being offered and starting any DMTs and high-efficacy DMTs were measured using binary, multinomial logistic and Cox regression models. These analyses were adjusted for sex, age at diagnosis and year of diagnosis.Results164/1648 people with MS (PwMS) were from non-white ethnicities. 461/1648 who were living in the most deprived areas, were less likely to be offered DMTs, with an OR of 0.66 (95% CI 0.47 to 0.93), less likely to start high-efficacy DMTs with an OR of 0.67 (95% CI 0.48 to 0.93) and more likely to experience a delay in starting high-efficacy DMTs with an HR of 0.76 (95% CI 0.63 to 0.92), when also adjusted for ethnicity. Although the offer of DMTs did not depend on ethnicity, PwMS from non-white ethnicities were more likely to decline DMTs, less likely to start any DMTs and high-efficacy DMTs with ORs of 0.60 (95% CI 0.39 to 0.93) and 0.61 (95% CI 0.38 to 0.98), respectively, and more likely to experience a delay in starting DMTs with an HR of 0.79 (95% CI 0.66 to 0.95), when also adjusted for deprivation.ConclusionsIn a publicly funded healthcare system, the access to DMTs varied depending on ethnicities and levels of deprivation.
Phenotypic spectrum of myelin protein zero-related neuropathies: a large cohort study from five mutation clusters across Italy
Authors: Bertini Alessandro , Gentile Luca , Cavallaro Tiziana , Tozza Stefano , Saveri Paola , Russo Massimo , Massucco Sara , Falzone Yuri Matteo , Bellone Emilia , Taioli Federica , Geroldi Alessandro , Occhipinti Giuseppe , Ferrarini Moreno , Cavalca Eleonora , Crivellari Luca , Mandich Paola , Balistreri Francesca , Magri Stefania , Taroni Franco , Previtali Stefano Carlo , Schenone Angelo , Grandis Marina , Manganelli Fiore , Fabrizi Gian Maria , Mazzeo Anna , Pareyson Davide , Pisciotta Chiara 
Published: June 2024

BackgroundWe aimed to investigate the clinical features of a large cohort of patients with myelin protein zero (MPZ)-related neuropathy, focusing on the five main mutation clusters across Italy.MethodsWe retrospectively gathered a minimal data set of clinical information in a series of patients with these frequent mutations recruited among Italian Charcot-Marie-Tooth (CMT) registry centres, including disease onset/severity (CMTES-CMT Examination Score), motor/sensory symptoms and use of orthotics/aids.ResultsWe collected data from 186 patients: 60 had the p.Ser78Leu variant (‘classical’ CMT1B; from Eastern Sicily), 42 the p.Pro70Ser (CMT2I; mainly from Lombardy), 38 the p.Thr124Met (CMT2J; from Veneto), 25 the p.Ser44Phe (CMT2I; from Sardinia) and 21 the p.Asp104ThrfsX13 (mild CMT1B; from Apulia) mutation. Disease severity (CMTES) was higher (p<0.001) in late-onset axonal forms (p.Thr124Met=9.2±6.6; p.Ser44Phe=7.8±5.7; p.Pro70Ser=7.6±4.8) compared with p.Ser78Leu (6.1±3.5) patients. Disease progression (ΔCMTES/year) was faster in the p.Pro70Ser cohort (0.8±1.0), followed by p.Ser44Phe (0.7±0.4), p.Thr124Met (0.4±0.5) and p.Ser78Leu (0.2±0.4) patients. Disease severity (CMTES=1.2±1.5), progression (ΔCMTES/year=0.1±0.4) and motor involvement were almost negligible in p.Asp104ThrfsX13 patients, who, however, frequently (78%, p<0.001) complained of neuropathic pain. In the other four clusters, walking difficulties were reported by 69–85% of patients, while orthotic and walking aids use ranged between 40–62% and 16–28%, respectively.ConclusionsThis is the largestMPZ(and late-onset CMT2) cohort ever collected, reporting clinical features and disease progression of 186 patients from five different clusters across Italy. Our findings corroborate the importance of differentiating between ‘classical’ childhood-onset demyelinating, late-onset axonal and mildMPZ-related neuropathy, characterised by different pathomechanisms, in view of different therapeutic targets.
Participation in staff engagement campaigns at large healthcare organisations: a focus group study
Authors: James Richard , Lewis Jenny , Stroud Laura 
Published: June 2024

IntroductionHealthcare organisations work better with an engaged workforce, and staff-engagement campaigns offer a method to build this engagement. Leeds Teaching Hospitals NHS Trust (LTHT), one of the UK’s largest Trusts, provides an example of where an organisation-wide engagement intervention has been used in a healthcare setting. This study aimed to understand why staff participate, or do not participate, in staff-engagement campaigns, supporting healthcare leaders to increase participation in future campaigns.MethodsScenario-based focus groups were carried out across five different organisational units within LTHT. The data from these were transcribed, coded and analysed using reflective thematic analysis.ResultsParticipation in staff-engagement campaigns is dependent on campaign awareness, staff perceptions of the campaign and the practicalities associated with participation. Perceptions of the campaign are further subdivided into the campaign’s perceived effectiveness, purpose and relevance.ConclusionsStaff engagement was a powerful driver of participation, which presents a conundrum: how do you encourage participation in staff-engagement campaigns, if engagement is a prerequisite for participation? The answer lies in taking advantage of organisational belongingness and visible leadership, supported by communications that take control of the narrative around the campaign. Behavioural science models may guide leaders across the organisation in mapping where these approaches can have the greatest impact within their existing spheres of influence. Further, considering inequalities around participation across different groups may help target action to the areas of greatest need. Accordingly, the research provides pragmatic guidance for leaders in thinking about how to use staff-engagement campaigns more effectively.
Onabotulinum toxin injections for shoulder and chest wall muscle pain in breast cancer survivors: retrospective study – preliminary report
Authors: Fu Jack B , Manne Radhika , Ngo-Huang An , Tennison Jegy M , Ng Amy H , Andersen Clark , Woodward Wendy A , Bruera Eduardo 
Published: June 2024

ObjectivesThe primary objective of this retrospective review is to describe patient-reported improvement in muscular pain after initial treatment with onabotulinum toxin. A secondary objective was to determine other physiatry (physical medicine & rehabilitation (PM&R)) interventions ordered.MethodsPreliminary retrospective review of physiatry interventions for 47 patients referred by breast radiation oncology to PM&R at a tertiary referral-based academic cancer centre clinic from 1 January 2018 to 31 December 2021 for muscular shoulder/chest wall pain.ResultsPatients were most commonly diagnosed with muscle spasm 27/47 (58%), lymphedema 21/47 (45%), myalgia/myofascial pain 16/47 (34%), radiation fibrosis 14/47 (30%), fatigue/deconditioning 13/47 (28%), neurological impairment 11/47 (23%) and joint pathology 3/47 (6%). The top three physiatric interventions were home exercise programme education (17/47, 36%), botulinum toxin injection (17/47, 36%) and physical or occupational therapy referral (15/47, 32%). Patients who had muscle spasms documented were more likely to have botulinum toxin recommended by physiatry (24/24) compared with those with questionable spasms (4/7) and those without spasms(0/16) (p=0.0005). 17/28 (60.7%) received botulinum toxin injection, and a total of 35 injections were performed during the study period. 94% (16/17) of patients who received botulinum toxin injection voiced improvement in pain after injection.ConclusionBotulinum toxin injections may play a role in the treatment of muscle spasm-related pain in breast cancer survivors. Additional blinded controlled research on the effectiveness of botulinum toxin injection after breast cancer treatment with spastic muscular shoulder/chest wall pain is needed.