bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding exercise referrals in primary care: a qualitative study of GPs and physiotherapists
Authors: Dunphy Rebekah , Blane David 
Published: June 2024

BackgroundPhysical inactivity is estimated to cost the UK NHS over £1 billion per year. Healthcare practitioners have a key role in supporting increases in physical activity (PA) levels, including referring to exercise referral schemes (ERS). To date, there has been little research into practitioner perspectives on referrals to ERS.AimTo explore the views and experiences of GPs and physiotherapists in relation to factors that influence referral and adherence to ERS.MethodQualitative study of primary care-based practitioners in Glasgow, UK. Semi-structured interviews were conducted with 14 practitioners (seven GPs and seven physiotherapists). Interviews were recorded and analysed thematically.ResultsFour themes are presented. First, healthcare practitioners bring inherent biases to a consultation that impact their approach to PA promotion. Second, clinical time pressures are a major barrier to effective PA promotion. Third, patient-led, compassionate care is the most vital component of behaviour change, with suggestions that promoting peer support and the use of personal anecdotes to normalise vulnerabilities might be helpful. Last, providing ongoing support for change was beneficial to PA promotion. This is often accessed through ERS and is improved by better collaboration between exercise providers and referring practitioners.ConclusionPractitioners believed ERS referrals could be improved with more targeted training, support for multidisciplinary working, and enhanced communication between the programmes and referrers. Additionally, supporting behaviour change requires time to develop rapport and understand patients’ motivations and beliefs. Lack of time is the greatest current barrier to effective PA promotion.
A pilot study of electronic blood pressure interpretation of home blood pressure readings in primary care
Authors: Rosen Jake , Rasheed Reshma 
Published: June 2024

BackgroundHome blood pressure (BP) monitoring is an acceptable method with high accuracy and acceptability amongst patients. It has the potential to save many hours of clinical time and is less likely to suffer from white coat bias. However, it can raise anxiety in patients who may not interpret readings immediately.AimA pilot study using an auto formatted excel spreadsheet which gave instantaneous colour coded feedback was sent to patients to assess its acceptability.MethodThis auto interpretation tool was sent to patients with their consent. It enabled patients to receive immediate feedback about this blood pressure control. A follow-up questionnaire was later sent to ask the patients and the staff about their experience.ResultsHypertensive patients under 75 years of age who were sending regular home BP readings were enrolled (n =96); of these, 31 responded within 1 month. Patient satisfaction was high; 74% preferred the electronic tool, 77% found the colour indicator reassuring, and 87% wanted to continue the electronic interpretation tool regardless of their initial preference. Staff satisfaction was excellent at 100%.ConclusionThis hypertension triage tool allows for interpretation by patients and non-clinicians with benefits of instantaneous reassurance, user and provider satisfaction all at reduced costs. Patients without MS Excel could not use this tool. The pilot study reinforced our hypothesis that such a modality has the potential to increase patient satisfaction and safety, and can be applied to a larger number of patients. Eventually an NHS app could be developed and rolled out for the large population.
HIV screening guidance – ignored or forgotten?
Authors: Humphries Hannah Vidis , Hartop Phoebe 
Published: June 2024

BackgroundNICE guidance states new patients aged 15–59 registering at a primary care centre in a high-risk area for HIV, should be offered testing.First, this allows for prompt initiation of antiretroviral therapy, improving the individual’s morbidity and mortality while reducing community transmission. Second, increasing the breadth of the population offered tests would help normalise testing, reducing stigma and increasing uptake.AimTo retrospectively audit adherence to HIV testing guidance in new patients registering at a GP in Walsall, where HIV risk is categorised as high,and to make recommendations based on the results.MethodThe EMIS records of 310 new patients aged 15–59 who registered during a 12-month period (October 2021 to October 2022) were accessed to establish if they were offered HIV testing. A survey was created and distributed to staff in the practice to understand the reason for lack of testing.ResultsThe audit revealed that none of the 310 patients were offered an HIV test. The survey indicated that 75% of staff members were unaware of the guideline, 66.7% never ordered an HIV test, and 83% stated that they do not believe GPs are given enough support to follow guidelines.ConclusionThe guidance for screening for HIV in this primary care centre is therefore not followed due to a lack of awareness of the guideline and HIV risk in the area. We recommend that this audit is conducted across more primary care centres in HIV high-risk areas to assess if this outcome is representative of general adherence to guidance.
The unmet needs of menopausal women in primary care
Authors: Fatima Urooj , Rasheed Reshma 
Published: June 2024

BackgroundThe average age for menopause is 51 years, this is preceded by a transitional perimenopausal stage, with vasomotor symptoms, muscular and joint pain, lowered libido and disordered sleep, impacting on mental health. In some women, the quality of life is considerably affected. This remains under-reported. There is no national screening service, or specialised clinics for menopausal services available in primary care.AimWe undertook a survey of women in primary care as part of a needs assessment to understand the prevalence of peri- and menopausal symptoms, women’s knowledge of these symptoms, and available treatment options.MethodA questionnaire was sent to women aged 45–65 years registered with the practice.ResultsOf a total of 73 women, 78.1% complained of >4 symptoms. The most common symptoms were memory problems and brain fog (80.6%), sleep disturbance (72.1%) and muscle/joint pain (72.1%). Women were asked to rate their knowledge of therapy options on a self-reported scale of 0–10; a high proportion (64.3%) rated <4 points. They had better knowledge of symptoms, 79.3% rated >4 points. A high proportion (58.9%) rated inadequate support received from primary care and 75.3% felt they had no support at all.ConclusionOur results of this preliminary study showed the vast majority of women were unaware of treatment options for their menopausal symptoms and felt they received inadequate to no support from primary care providers. The present ongoing study highlights lack of resource allocation to women’s health and insufficient commissioning of services to address this health need.
A ‘smear campaign’ against patient-excluded policy changes: a reflection on the language used in cervical screening programmes
Authors: Morse Iris-Mae , Amiry Jack 
Published: June 2024

BackgroundCervical screening has transformed the diagnosis of cervical cancer. However, uptake within the national screening programme is not uniform across demographics. This raises the question of whether medical language, which conveys essential information but also shapes attitudes towards engaging with healthcare, is part of the problem. The term “smear test” has been used for generations and is embedded in colloquial and medical vocabulary. However, there is a danger that the phrase may conjure images of an unpleasant or even reckless ordeal, potentially contributing to unnecessary patient anxiety.AimTo evaluate patient attitudes towards the terms “cervical smear” and “cervical brush”.MethodFemale participants from a single GP surgery were randomly sampled. Data from questionnaires were then subjected to thematic analysis.ResultsHalf of patients interviewed did not feel either term would significantly influence cervical screening uptake. Equal numbers of patients expressed an overall preference for each of the two terms, and the remaining 28% expressed no preference. Qualitative data revealed some patients favoured the familiarity of the term “cervical smear”, and others preferred the descriptive accuracy of “cervical brush”.ConclusionIt is imperative to consult target groups and use inclusive language that minimises stigmatising or negative connotations. Modifying language alone is unlikely to remedy the current access barriers in UK cervical screening. Instead, a multifaceted approach that also targets education and addresses systemic issues could offer a more sustainable strategy. Ultimately, prioritising a patient-centred approach could improve access to life-saving screening.
What interventions are effective in reducing development of hypertension and other cardiovascular complications in women who have had hypertensive disorders of pregnancy? A systematic review
Authors: Harvey Kathryn , Parikh Chinar , Hill Ruaraidh , Williams Nefyn 
Published: June 2024

BackgroundHypertensive disorders of pregnancy (HDP) affect approximately 10–15% of pregnancies and pre-eclampsia affects 3–5% of pregnancies. Women with previous pre-eclampsia or HDP are at increased risk of hypertension (2 to 5 times) and major cardiovascular disease (1.5 to 3 times). There is little guidance on how to reduce this risk.AimTo establish if there are interventions in women with previous HDP or pre-eclampsia that reduce the risk of developing adverse cardiovascular outcomes.MethodA protocol was submitted to PROSPERO; inclusion and exclusion criteria were determined and a search strategy implemented. Primary outcomes were: development of hypertension or change in blood pressure and development of other cardiovascular complications. Records and full texts were screened independently by two reviewers. The Cochrane Risk of Bias tool was used for quality assessment.Results3593 articles were screened. Nine articles were included. There were seven randomised-controlled trials and two quasi-experimental studies. One study trialled antihypertensive use, two studies looked at blood pressure monitoring and six studies focused on lifestyle interventions. Three trials reported significant reductions in diastolic blood pressure in the experimental group. No studies looked at the optimal time of intervention or the impact of interventions on the development of other long-term cardiovascular complications. Five studies reported participant feedback. The majority of studies were of low quality.ConclusionFurther research needs to explore potential interventions and optimal timing of interventions to reduce cardiovascular risk. Women also need to be consulted about their preferences for discussions about cardiovascular risk and potential interventions.
Evaluating adherence to ECG monitoring protocols for methadone patients in primary care
Authors: Robinson Lani , McNamara Paul 
Published: June 2024

BackgroundOpioid Agonist Treatment (OAT) is the gold standard for managing Opioid Use Disorder (OUD). It is highly effective at reducing all-cause mortality and drug-related harms. Prescribing OAT, particularly methadone, is becoming increasingly complex as Scotland’s OUD population ages. Older patients, with increased polypharmacy and multimorbidity, are more susceptible to QTc interval prolongation associated with methadone use. Therefore, adherence to ECG monitoring guidelines for patients prescribed methadone is crucial, though insights from substance use services indicate suboptimal compliance. Medically Assisted Treatment guidelines established by the Scottish Government advocate for shared care agreements, thus transferring OAT prescribing responsibilities to primary care. Understanding ECG monitoring guideline implementation in non-specialist services is vital for developing safe OAT services in primary care.AimThis audit assessed adherence to NICE guidelines for ECG monitoring in OUD patients prescribed methadone in a Scottish primary care practice.MethodThe notes of patients prescribed methadone were assessed using NICE criteria to determine eligibility for ECG monitoring. Eligible patients’ medical records were reviewed to identify previous ECG investigations.ResultsOf 21 patients prescribed methadone, 16 qualified for ECG monitoring. Only 25% of eligible patients received ECG monitoring per NICE guideline, meaning 75% did not.ConclusionThese findings highlight that the issue of poor compliance with ECG monitoring guidelines is not limited to specialist services, but also affects primary care. Further exploration of barriers to guideline implementation is essential. Perhaps more resources are needed to integrate OAT services into primary care, which has taken on increased responsibilities without corresponding investment.
Advancing familial hypercholesterolaemia (FH) screening in primary care: an updated systematic review of systematic screening methods for identificaton of FH
Authors: Ayoub Aya , Akyea Ralph K , Silva Luisa , Qureshi Nadeem , Molokhia Mariam 
Published: June 2024

BackgroundFamilial Hypercholesterolaemia (FH) is a greatly underdiagnosed and treatable genetic lipid disorder which significantly increases risk of premature cardiovascular disease. The prevalence of monogenic FH is thought to be 1 in 250–350. The NHS Long Term Plan aims to increase FH detection to at least 25% over 5 years in collaboration with primary care, supported by the NHS genomics programme.AimThis systematic review evaluates systematic screening methods for FH in adults aged ≥18 years in primary care.MethodSeven databases [Cochrane, PubMed, Ovid, CINAHL, ProQuest, Web of Science, Scopus], four clinical trial registries [ISRCTN, ANZCTR, Clinicaltrials.gov, WHO-ICTRP] and relevant grey literature [OpenGrey] from March 2020 to May 2023 were searched. Only studies including adults were eligible. Risk of bias was assessed using ROBINS-I.Results831 records were screened. No randomised, controlled studies were identified. From full-text review, five eligible non-randomised studies out of 57 (6.90%) were identified. The included studies all used automated FH case-identification from electronic medical records (EMR) and were high quality studies with a moderate risk of bias. Narrative synthesis reported outcomes which included three algorithmic studies, with a pooled detection rate, DR 14.4% (95%CI 11.67–16.62), one supervised Machine Learning [Ensemble] study, DR 15.5% (95%CI 15.47–15.53) and one study utilising a hybrid diagnostic EMR model and/or FH genotype confirmation DR 25.0% (95%CI 16.30–35.8). No adverse effects were reported in these studies.ConclusionIncorporating automated case-finding from EMR with clinical follow-up in primary care can enhance FH identification. Pathways incorporating genotyping showed the best detection rate.
A cost-effectiveness analysis of the use of oral ibrexafungerp versus fluconazole for acute vulvovaginal candidiasis in the UK NHS primary care service
Authors: Shah Viraj , Cyril Anjali , Koleoso Peter , Ragutharan Arunesh , Faiz Mohammed , Pushpakanthan Pathusha 
Published: June 2024

BackgroundVulvovaginal Candidiasis (VVC) is a fungal infection causing inflammation of the vagina and/or the vulva. Symptoms include itching, irritation, and discharge. VVC presents commonly across primary care and, despite its mild symptoms, carries psychological burden and has a significant impact on women’s quality of life. UK guidelines support treatment via oral or topical azole antifungal agents. Recent evidence attests to the superiority of novel non-azole antifungals. Thus, rigorous financial assessment of both antifungals is necessary for optimal VVC treatment allocation in UK primary care.AimTo evaluate the cost-effectiveness of ibrexafungerp against the gold standard fluconazole as first-line treatment of VVC within the NHS.MethodA systematic review on the efficacy of ibrexafungerp and fluconazole in acute VVC was conducted. Cost-effectiveness analysis was initiated using health outcome data from the DOVE trial, a Phase 2 RCT. Costs in pound sterling were ascertained in monetary units, and effectiveness determined as reduced need for follow-up medication.ResultsAn incremental cost-effectiveness ratio of £2185.74 was determined. This suggests oral ibrexafungerp being largely more costly yet slightly more effective than fluconazole, and thus has unfavourable net benefit. Two sensitivity analyses were conducted considering follow-up medication combination and market price, which provided confidence in the calculated cost-effectiveness ratio.ConclusionThis analysis highlights fluconazole’s cost-effectiveness in current UK guidelines and favourability.
Análise comportamental para validação da ferramenta QualificaURB, com enfoque na categoria “sociabilidade, usos e atividades”
Authors: Jesus Luciana Aparecida Netto de , Ramos Larissa Leticia Andara , Stein Livia , Secco Iasmin Tamanini 
Published: June 2024

A valorização dos espaços públicos, bem como a necessidade de que tais locais sejam de qualidade, é uma demanda crescente e está diretamente relacionada ao desenvolvimento urbano. Assim, é importante que esses contenham atributos que propiciem uma melhor vivência e que fomentem a sua apropriação, de modo a atender de maneira satisfatória a população. Para tal, o presente trabalho concentra-se na relação entre espaço público e sociabilidade urbana e visa validar os resultados da avaliação das praças da Região Administrativa 9 – Jardim da Penha, Vitória-ES, a partir da aplicação da ferramenta analítica classificatória de avaliação da qualidade socioambiental de praças urbanas, denominada QualificaURB. A ferramenta é dividida em quatro categorias: Proteção e Segurança; Conforto e Imagem; Acessos e Conexões; e Sociabilidade, Usos e Atividades. Este artigo traz como enfoque a categoria “Sociabilidade, Usos e Atividades”, a qual avalia as características relativas aos equipamentos e usabilidades destes espaços, critérios importantes acerca da qualidade dos espaços e indicadores quanto ao uso dos mesmos. Os resultados encontrados demonstram que o contexto em que a praça está inserida impacta diretamente no uso, permanência e apropriação por parte dos seus usuários. Também expõe como os indicadores dessa categoria podem influenciar na maneira com que o usuário se relaciona com o espaço.
Targeting Reprogrammed Cancer-Associated Fibroblasts with Engineered Mesenchymal Stem Cell Extracellular Vesicles for Pancreatic Cancer Treatment
Authors: Zhou Pengcheng , Ding Xian’guang , Du Xuanlong , Wang Lianhui , Zhang Yewei 
Published: June 2024

Background:
As one of the most aggressive and lethal cancers, pancreatic cancer is highly associated with cancer-associated fibroblasts (CAFs) that influence the development and progression of cancer. Targeted reprogramming of CAFs may be a promising strategy for pancreatic cancer. This study aims to construct engineered extracellular vesicles (EVs) with surface modification of integrin α5 (ITGA5)-targeting peptide and high internal expression of miR-148a-3p by endogenous modification for targeted reprogramming of pancreatic CAFs.
Methods:
Bone marrow mesenchymal stem cells (BMSCs) and pancreatic CAFs were cocultured to examine the effect of BMSC-derived EVs on the expression levels of CAF markers. miR-148a-3p was identified as a functional molecule. The mechanism of miR-148a-3p was elucidated using the dual-luciferase reporter assay. BMSCs were infected with TERT-encoding and miR-148a-3p-encoding lentiviruses. Subsequently, BMSCs were modified with ITGA5-specific targeting peptide. The supernatant was ultracentrifuged to obtain the engineered EVs (ITGA5-EVs
-148a
), which were used to reprogram CAFs.
Results:
BMSCs modulated CAF marker expressions through EVs. miR-148a-3p was up-regulated in BMSCs. The expression of miR-148a-3p in pancreatic CAFs was down-regulated when compared with that in normal fibroblasts (NFs). Mechanistically, ITGA5-EVs
-148a
effectively suppressed the proliferation and migration of pancreatic CAFs by targeting ITGA5 through the TGF-β/SMAD pathway. ITGA5-EVs
-148a
was associated with enhanced cellular uptake and exhibited enhanced in vitro and in vivo targeting ability. Moreover, ITGA5-EVs
-148a
exerted strong reconfiguration effects in inactivating CAFs and reversing tumor-promoting effects in 3D heterospheroid and xenograft pancreatic cancer models.
Conclusions:
This targeted CAF reprogramming strategy with genetically engineered ITGA5-EVs
-148a
holds great promise as a precision therapeutics in clinical settings.
Biomimetic Marine-Sponge-Derived Spicule-Microparticle-Mediated Biomineralization and YAP/TAZ Pathway for Bone Regeneration In Vivo
Authors: Choi Sumi , Kim Jung Hun , Kang Tae Hoon , An Young-Hyeon , Lee Sang Jin , Hwang Nathaniel S. , Kim Su-Hwan 
Published: June 2024

Marine-sponge-derived spicule microparticles (SPMs) possess unique structural and compositional features suitable for bone tissue engineering. However, significant challenges remain in establishing their osteogenic mechanism and practical application in animal models. This study explores the biomimetic potential of SPM in orchestrating biomineralization behavior and modulating the Yes-associated protein 1/transcriptional coactivator with PDZ-binding motif (YAP/TAZ) pathway both in vitro and in vivo. Characterization of SPM revealed a structure comprising amorphous silica oxide mixed with collagen and trace amounts of calcium and phosphate ions, which have the potential to facilitate biomineralization. Structural analysis indicated dynamic biomineralization from SPM to hydroxyapatite, contributing to both in vitro and in vivo osteoconductions. In vitro assessment demonstrated dose-dependent increases in osteogenic gene expression and bone morphogenetic protein-2 protein in response to SPM. In addition, focal adhesion mediated by silica diatoms induced cell spreading on the surface of SPM, leading to cell alignment in the direction of SPM. Mechanical signals from SPM subsequently increased the expression of YAP/TAZ, thereby inducing osteogenic mechanotransduction. The osteogenic activity of SPM-reinforced injectable hydrogel was evaluated in a mouse calvaria defect model, demonstrating rapid vascularized bone regeneration. These findings suggest that biomimetic SPM holds significant promise for regenerating bone tissue.
COMPREHENSIVE STUDY OF THE TELEGRAPH MESSAGE SWITCHBOARD
Authors: Соболь В.М. , Ударцев И.В. 
Published: June 2024

Рассматриваются вопросы организации исследования телеграфного коммутационного комплекса специализированной автоматизированной системы. Излагаются возможности применения аппаратно-программного имитатора, интерпретирующего регламенты абонентского протокола документального обмена. Проведение исследования предусматривает задание сценариев автономных и комплексных проверок путем воспроизведения трафика телеграфного обмена. Отмечается, что интерпретатор стал неотъемлемым инструментом проведения предварительных, межведомственных и государственных испытаний.
The issues of organizing the study of the telegraph switching complex of a specialized automated system are considered.The possibilities of using a hardware and software simulator that interprets the regulations of the subscriber protocol for documentary exchange are outlined. The study involves setting scenarios for autonomous and complex checks by reproducing telegraph exchange traffic. It is noted that the interpreter has become an integral tool for conducting preliminary, interdepartmental, and state tests.