bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews
Authors: Oudbier Susan J , Souget-Ruff Sylvie P , Chen Britney S J , Ziesemer Kirsten A , Meij Hans J , Smets Ellen M A 
Published: June 2024

ObjectivesDigital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs.DesignSystematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Data sourcesEmbase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline.Eligibility criteriaQuantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal.Data extraction and synthesisRegarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators.ResultsThirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients’ aptitude with the technology (n=9/33), and technical issues (n=12/33).ConclusionsThe implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.
Effects of peer-education training on cardiopulmonary resuscitation knowledge and skill retention of secondary school students: a feasibility study
Authors: Spartinou Anastasia , Karageorgos Vlasios , Sorokos Konstantinos , Darivianaki Panagiota , Petrakis Emmanouil C , Papapanagiotou Michalis , Fraidakis Othon , Nyktari Vasileia , Papaioannou Alexandra 
Published: June 2024

ObjectivesThe need for cardiopulmonary resuscitation (CPR) training dissemination in the community could be resolved by mass school training programmes. However, the availability of instructors remains an unsolved problem. Our purpose was to investigate the effects of three different instructor types: healthcare professionals, schoolteachers and peer students, on CPR skills retention of secondary school students 6 months after training.DesignThe study was designed as a prospective randomised single-blinded controlled trial. The study ended before reaching the target sample size for the schoolteacher arm.Setting and participantsStudents from three different secondary schools in Heraklion, Greece, were recruited to attend CPR training.InterventionsAll participants received a manual and a digital video disc demonstrating the CPR/automated external defibrillator (AED) algorithm, followed by hands-on training. They were randomly assigned to receive training by either healthcare professionals, schoolteachers or peer students, who had previously been trained appropriately.Outcome measuresCPR knowledge and skill retention were evaluated immediately (secondary outcome) and 6 months after training (primary outcome), using a knowledge questionnaire, skill checklists and feedback device.Results408 students (199 girls – two non-binary) were enrolled in the study with a median age of 13 (IQR 12–14) years. A total of 255 students (125 girls) were reassessed at 6 months. Preliminary analysis of the data revealed no statistically significant differences between the three groups regarding factual knowledge immediately after training (p=0.226) and at 6 months (p=0.867). Immediately after training, more students trained by healthcare professionals or teachers performed safe defibrillation (p<0.000); however, this finding was dissipated at 6-month reassessment (p=0.202). Compliance with the CPR algorithm and the quality of hands-only CPR were not different (p>0.05) among the groups.ConclusionsThe type of instructor did not affect the CPR knowledge and skill retention of students 6 months after training. Schoolchildren acting as peer instructors could be an effective alternative to healthcare professionals and schoolteachers, although further studies are needed.
ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) randomised controlled trial protocol
Authors: Rezaee Michael E , Mahon Katherine M , Trock Bruce J , Nguyen The-Hung Edward , Smith Armine K , Hahn Noah M , Patel Sunil H , Kates Max 
Published: June 2024

IntroductionTransurethral resection of bladder tumour (TURBT) is one of the more common procedures performed by urologists. It is often described as an ‘incision-free’ and ‘well-tolerated’ operation. However, many patients experience distress and discomfort with the procedure. Substantial opportunity exists to improve the TURBT experience. An enhanced recovery after surgery (ERAS) protocol designed by patients with bladder cancer and their providers has been developed.Methods and analysisThis is a single-centre, randomised controlled trial to investigate the effectiveness of an ERAS protocol compared with usual care in patients with bladder cancer undergoing ambulatory TURBT. The ERAS protocol is composed of preoperative, intraoperative and postoperative components designed to optimise each phase of perioperative care. 100 patients with suspected or known bladder cancer aged ≥18 years undergoing initial or repeat ambulatory TURBT will be enrolled. The change in Quality of Recovery 15 score, a measure of the quality of recovery, between the day of surgery and postoperative day 1 will be compared between the ERAS and control groups.Ethics and disseminationThe trial has been approved by the Johns Hopkins Institutional Review Board #00392063. Participants will provide informed consent to participate before taking part in the study. Results will be reported in a separate publication.Trial registration numberNCT05905276
Head Injury Evaluation and Ambulance Diagnosis (HOME) Study protocol: a feasibility study assessing the implementation of the Canadian CT Head Rule in the prehospital setting
Authors: Alqurashi Naif , Bell Steve , Carley Simon D , Lecky Fiona , Body Richard 
Published: June 2024

IntroductionTraumatic brain injury (TBI) is a common presentation in the prehospital environment. At present, paramedics do not routinely use tools to identify low-risk patients who could be left at scene or taken to a local hospital rather than a major trauma centre. The Canadian CT Head Rule (CCHR) was developed to guide the use of CT imaging in hospital. It has not been evaluated in the prehospital setting. We aim to address this gap by evaluating the feasibility and acceptability of implementing the CCHR to patients and paramedics, and the feasibility of conducting a full-scale clinical trial of its use.Methods and analysisWe will recruit adult patients who are being transported to an emergency department (ED) by ambulance after suffering a mild TBI. Paramedics will prospectively collect data for the CCHR. All patients will be transported to the ED, where deferred consent will be taken and the treating clinician will reassess the CCHR, blinded to paramedic interpretation. The primary clinical outcome will be neurosurgically significant TBI. Feasibility outcomes include recruitment and attrition rates. We will assess acceptability of the CCHR to paramedics using the Ottawa Acceptability of Decision Rules Instrument. Interobserver reliability of the CCHR will be assessed between paramedics and the treating clinician in the ED. Participating paramedics and patients will be invited to participate in semistructured interviews to explore the acceptability of trial processes and facilitators and barriers to the use of the CCHR in practice. Data will be analysed thematically. We anticipate recruiting approximately 100 patients over 6 months.Ethics and disseminationThis study was approved by the Health Research Authority and the Research Ethics Committee (REC reference: 22/NW/0358). The results will be published in a peer-reviewed journal, presented at conferences and will be incorporated into a doctoral thesis.Trial registration numberISRCTN92566288.
High-resolution mapping of essential maternal and child health service coverage in Nigeria: a machine learning approach
Authors: Kawakatsu Yoshito , Mosser Jonathan F , Adolph Christopher , Baffoe Peter , Cheshi Fatima , Aiga Hirotsugu , Watkins D A , Sherr Kenneth H 
Published: June 2024

BackgroundNational-level coverage estimates of maternal and child health (MCH) services mask district-level and community-level geographical inequities. The purpose of this study is to estimate grid-level coverage of essential MCH services in Nigeria using machine learning techniques.MethodsEssential MCH services in this study included antenatal care, facility-based delivery, childhood vaccinations and treatments of childhood illnesses. We estimated generalised additive models (GAMs) and gradient boosting regressions (GB) for each essential MCH service using data from five national representative cross-sectional surveys in Nigeria from 2003 to 2018 and geospatial socioeconomic, environmental and physical characteristics. Using the best-performed model for each service, we map predicted coverage at 1 km2and 5 km2spatial resolutions in urban and rural areas, respectively.ResultsGAMs consistently outperformed GB models across a range of essential MCH services, demonstrating low systematic prediction errors. High-resolution maps revealed stark geographic disparities in MCH service coverage, especially between rural and urban areas and among different states and service types. Temporal trends indicated an overall increase in MCH service coverage from 2003 to 2018, although with variations by service type and location. Priority areas with lower coverage of both maternal and vaccination services were identified, mostly located in the northern parts of Nigeria.ConclusionHigh-resolution spatial estimates can guide geographic prioritisation and help develop better strategies for implementation plans, allowing limited resources to be targeted to areas with lower coverage of essential MCH services.
Patient and proxy perspectives in decision-making for geriatric hip fracture management in the Netherlands: a qualitative study
Authors: Laane Duco , Kroes Thamar , van den Berg Arda , de Jongh Mariska , The Regina , Van der Velde Detlef , Nijdam Thomas 
Published: June 2024

ObjectiveThe objective of this study was to explore the perspectives with the decision-making process between surgery and palliative, non-operative management of geriatric hip fracture patients and their proxies.DesignAqualitative interview study was performed. Patients and proxies were asked to participate in semi-structured interviews. Data were analysed using reflexive thematic analysis according to Braun and Clarke’s six-step guide.Setting and participantsHip fracture patients in the Netherlands were eligible for inclusion. For hip fracture patients with a pre-existing diagnosis of dementia and for patients who opted for palliative, non-operative management, proxies were included.ResultsA total of 16 interviews were conducted, consisting of 4 patient interviews and 12 proxy interviews. Five themes were identified during thematic analysis: (1) underlying patient values, (2) the provision of information, (3) reasons to consider either palliative, non-operative management or surgery, (4) involvement in decision and (5) realisation of expectations. Information provided by the physician varied in terms of desired level of detail but involved discussing the advantages and disadvantages of surgery and palliative, non-operative management. Patients and proxies underscored the importance of achieving optimal quality of life, and the disparity between expected and actual treatment outcomes was unpleasant and negatively influenced the overall experience.ConclusionsIn-depth analysis provided a unique insight into the patient and proxy perspectives in shared decision-making for geriatric hip fracture management in the acute setting. Overall, there were differences between reported experiences and preferences of participants. This heterogeneity stresses the importance of keeping a person-centred approach during shared decision-making. Other key considerations during shared decision-making include physicians informing patients from professional experience and communicating sensitively about both treatment options and prognosis. Physicians should aim to provide realistic, sensitive and timely information to both patients and proxies during the choice between curation and palliation for their hip fracture.
Can the 128-Hz tuning fork be an alternative to the biothesiometer for diabetic peripheral neuropathy screening? A cross-sectional study in a tertiary hospital in East India
Authors: Chattopadhyay Sujaya , Goswami Soumik , Sengupta Nilanjan , Baidya Arjun 
Published: June 2024

IntroductionDiabetic neuropathy is frequently underdiagnosed and undertreated. Logistic problems accompany the routine use of the biothesiometer. Hence, we attempted to find a more easily available alternative.Research design and methods149 patients with diabetes visiting the outpatient endocrinology clinic were assessed for vibration sense using a 128-Hz tuning fork (absolute timing method) and a biothesiometer. A reading of >25 V on the biothesiometer (known as vibration perception threshold or VPT) was taken as the diagnostic criterion for severe neuropathy while >15 V was used as an indicator of the mild form. The sensitivity and specificity were calculated by constructing the receiver operating characteristic curve (ROC). A p value of <0.05 was considered as statistically significant.ResultsThe timed tuning fork (TTF) test showed a statistically significant correlation with the VPT measurements (r=−0.5, p=0.000). Using the VPT findings as a reference, a timed tuning fork cut-off of 4.8 s was 76% sensitive and 77% specific in diagnosing mild neuropathy while absent tuning fork sensation demonstrated 70% sensitivity and 90% specificity in detecting severe neuropathy.ConclusionsThe tuning fork test demonstrated significant sensitivity and specificity in diagnosing diabetic peripheral neuropathy when compared against the biothesiometer. A cut-off of 4.8 s can be a useful indicator of the early stages of onset of the condition.
Global prevalence ofBorrelia burgdorferiandAnaplasma phagocytophilumcoinfection inIxodestick populations: protocol for a systematic review and meta-analysis
Authors: Luo Suyi , Bao Fukai , Wu Hanxin , Ma Weijie , Zhu Liangyu , Huang Xun , Yang Rui , Peng Li , Gao Li , Wu Xinya , Zhong Lei , Dong Yan , Li Bingxue , Ma Weijiang , Liu Aihua 
Published: June 2024

IntroductionIxodesticks are pivotal in transmitting diseases like Lyme disease and human granulocytic anaplasmosis, caused byBorrelia burgdorferiandAnaplasma phagocytophilum, respectively. These pathogens not only affect humans through single or multiple tick bites but also pose risks to animal hosts, leading to potential coinfections. Despite regional studies indicating significant prevalence, their global coinfection data remain sparse. This study aims to bridge this gap through a systematic review and meta-analysis ofB. burgdorferiandA. phagocytophilumcoinfections inIxodesticks worldwide. Addressing data limitations and study variability, it seeks to provide a nuanced understanding of coinfection patterns, their epidemiological implications and inform targeted prevention strategies.Methods and analysisFollowing Preferred Reporting Items for Systematic Review and Meta-analysis Protocols 2015 guidelines and PROSPERO registration, this study will undertake a thorough database search without constraints on language or publication date, using standardised screening and data extraction protocols. The quality and bias of studies will be evaluated using Joanna Briggs Institute tools. In the statistical analysis phase, conducted in R, we will initially determine the use of fixed or random-effects models based on the assessment of data heterogeneity. This choice will guide the framework for subsequent analyses. Within the selected model’s framework, we will perform subgroup analyses and meta-regression to investigate the effects of various factors, ensuring that each step is tailored to the initial model selection to maintain analytical consistency.Ethics and disseminationAs this study does not involve clinical research or data collection from subjects, ethical approval is not required. We will uphold ethical standards in synthesising and reporting data. Study outcomes will be published in peer-reviewed journals, communicating findings to the scientific community and contributing to the understanding ofIxodestickborne diseases.PROSPERO registration numberCRD42023449735.
Career choice motivation and professionalism in medical students in China: a gender-stratified analysis
Authors: Shi Yan , Gao Hunmin , Yan Yumeng , Li Xue , Ping Weiwei , Yang Hui , Du Yiqian 
Published: June 2024

ObjectiveTo examine the associations between career choice motivation and professionalism among medical students based on gender in the context of COVID-19.DesignCross-sectional study.SettingThe study was conducted at a medical school in China.MethodsA total of 1421 second-year to fourth-year medical students participated in the survey using cluster sampling. They were asked to complete questionnaires on demographic information, career choice motivation and professionalism. Linear regression models were used to analyse the relationship between career choice motivations and professionalism based on gender differences.ResultsFemale medical students outperformed males in professionalism (p<0.001). Third-year medical students have the lowest level of professionalism irrespective of gender. In addition, females have more intrinsic career choice motivation than males. Students motivated bypersonal interesthad the highest level of professionalism, while those whogo with the flowhad the lowest. According to the linear regression analysis, the motivationadvice from parentswas the factor of professionalism in male medical students (p<0.05). However, the motivationgo with the flownegatively influenced the professionalism of female medical students (p<0.05).ConclusionThe level of professionalism differed between genders based on different career choice motivations. Career choice motivation can be used as an entry point for professionalism education among medical students. Targeted interventions should be implemented to improve professionalism, especially for male medical students and unmotivated students.
Feasibility and acceptability of a telerehabilitation intervention on patients undergoing total knee arthroplasty in Iran: randomised controlled trial protocol
Authors: Farrokhi Navvab , Sarzaeem Mohammad Mahdi , Feizi Davood 
Published: June 2024

IntroductionTelerehabilitation is a promising avenue to enhance post-total knee arthroplasty (TKA) rehabilitation by improving accessibility, convenience and cost-effectiveness. Despite its potential benefits, its application in the context of TKA in Iran is in its early stages, lacking comprehensive studies on feasibility, acceptance and programme adherence. This article outlines a protocol for an open-label, parallel-group, randomised controlled trial investigating the impact of a 4 week telerehabilitation programme alongside usual care.MethodsThirty patients (aged 50–90) undergoing TKA for severe Knee Osteoarthritis at Atiyeh Hospital in Tehran, Iran, will be recruited using block randomisation. Participants will be assigned to either the intervention group, receiving telerehabilitation or the control group without telerehabilitation. The intervention will include virtual physiotherapy sessions thrice weekly, lasting 30–45 min each, over 4 weeks. The primary objective is to assess the feasibility and acceptability of telerehabilitation, measured through recruitment and attrition rates, questionnaire completion rates, patient satisfaction using appropriate questionnaire and adherence to the intervention. Secondary outcomes encompass four Knee Injury and Osteoarthritis Outcome Score questionnaire subscales (function in Activities of Daily Living, Pain, Symptoms, Quality of Life). Patient global assessment will use a standardised question. An online survey will evaluate walking assistant device usage, exercise adherence and adverse events. The number of individuals receiving in-person rehabilitation will be documented after the first postoperative surgeon visit. Assessments occur at baseline and 4 weeks postsurgery.AnalysisStatistical analysis, including independent samples t-test, paired samples t-test, χ2 test, Fisher’s exact test, analysis of covariance and multiple linear regression, will use SPSS software version 16, with significance set at p<0.05.Ethics and disseminationApproved by AJA University of Medical Sciences Ethics Committee (IR.AJAUMS.REC.1402.126), trial results will be presented to relevant groups and published in peer-reviewed journals.Trial registration numberTCTR20231020004.