bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sustainability of healthcare system improvements, programmes and interventions in acute care settings: protocol for a mixed methods systematic review
Authors: Ramsden Victoria , McInnes Elizabeth , Wilson Peter , Babl Franz E , Kuhn Lisa , Cowie Julie , Campbell Pauline , Middleton Sandy , Wilson Catherine , Straiton Nicola , Tavender Emma 
Published: February 2025

IntroductionSustaining evidence-based care is challenging in all clinical settings. Acute care settings have a unique set of contextual factors that may impact sustainability (eg, fast-paced, regular staff turnover). Much of the previous research explores sustainability across undifferentiated healthcare settings making it difficult to determine factors that influence sustainability in acute care settings. The aim of this review is to identify facilitators and barriers that influence the delivery of sustained healthcare interventions (eg, integration of clinical guidelines) within adult and paediatric hospital-based acute care settings.Methods and analysisA mixed methods systematic review updating Cowieet al’s(which included studies from 2008 to 2017) previously published systematic review will be conducted. The following databases will be searched: Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL and Allied and Complementary Medicine (AMED), from November 2017 to the present for studies published in English. Relevant reference lists of included studies will be manually searched. Empirical quantitative and qualitative studies that report the sustainability of an intervention or programme in acute care settings using a theoretical framework(s), model(s) or theory(ies) to explore facilitators and barriers, will be included. Studies will be exported into Covidence (Melbourne) and pairs of reviewers will independently screen abstracts and full-text studies. The discussion will be used to resolve any disagreements and a third coauthor enlisted should a consensus not be reached. Two independent coauthors will extract key study characteristics and assess each study’s quality. Data will be extracted using Covidence (Melbourne). Evidence tables will be used to present descriptive data. Facilitators and barriers will be mapped to the Consolidated Framework for Sustainability Constructs in Healthcare and a narrative approach will be used to present key findings.Ethics and disseminationNo primary data will be collected so formal ethical approval is not required. Findings will be disseminated through peer-reviewed publications, presented at international conferences and on social media.PROSPERO registration numberPROSPERO CRD42024547535.
Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials
Authors: Gordon Tom C , Hope-Bell Josh , Draper-Rodi Jerry , MacMillan Andrew , Miller Danny , Edwards Darren J 
Published: February 2025

ObjectivesTo evaluate whether osteopathic and related manual interventions improve adult mental health (depression, anxiety, stress) and psychophysiological measures (eg, heart rate variability, skin conductance).DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).Data sourcesPubMed, MEDLINE (Ovid), Scopus, Cochrane, and AMED, searched through September 2024.Eligibility criteriaEnglish-language RCTs with ≥30 participants investigating osteopathic or related manual therapies (eg, myofascial release, high-velocity low-amplitude thrusts) delivered by qualified practitioners, compared with no treatment or sham, and reporting immediate postintervention mental health or psychophysiological outcomes.Data extraction and synthesisFull-text screening, risk-of-bias assessment and data extraction were conducted independently by multiple reviewers using a standardised Joanna Briggs Institute (JBI) Extraction Form. Risk of bias was assessed using the JBI Critical Appraisal Checklist. For meta-analyses, Hedges’g(with 95% CIs) was calculated from postintervention means and SD. Random-effects models accounted for heterogeneity, and prediction intervals were calculated to assess uncertainty in effect estimates.Results20 RCTs were included. Osteopathic interventions reduced depression (Hedges’g=−0.47, 95% CI: −0.86 to –0.09, p=0.02) and increased skin conductance (Hedges’g=0.67, 95% CI: 0.00 to 1.34, p=0.05). Depression improvements were greater in pain populations (Hedges’g=−0.61, 95% CI: –1.06 to –0.17, p=0.01). However, wide prediction intervals and moderate heterogeneity indicate uncertainty in true effect sizes, and limited studies and sample sizes restrict assessment of publication bias.ConclusionsOsteopathic and related manual therapies may reduce depression and influence certain psychophysiological markers, particularly in pain populations, but uncertainty and heterogeneity limit confidence. More rigorous, larger, and longitudinal RCTs are needed.Trial registration numberThis meta-analysis was not formally registered, though the protocol and search strategy can be found at Open Science Framework, registration identification:https://osf.io/jrtpx/.
Developing and piloting a peer quality improvement coaching protocol for front-line healthcare staff
Authors: Popivanov Petar , McCarthy Siobhan Eithne , Finn Mairead 
Published: February 2025

BackgroundImproving the quality of patient care remains a global necessity. Despite system and professional benefits, current evidence indicates that the spread of improvement principles among front-line healthcare workers remains poor.While education and training alone are unlikely to result in consistent improvement practice, coaching can play a critical role in sustainable, evidence-based improvement implementation. Peer quality improvement coaching (PQIC) places the power and agency in the shared relationship between coach and coachee to shape coachee quality improvement (QI) outcomes.Study objective was to develop and pilot an evidence-based protocol for implementation and evaluation of a PQIC for front-line staff engaged in small to intermediate improvement efforts.MethodsWe conducted a multistage case-study design and implementation process. First, a systematised literature review identified themes about the theory and practice of QI coaching (QIC). Second, these themes guided the development of a PQIC protocol. Finally, the protocol was piloted and evaluated among staff in a single-centre tertiary maternity hospital. PQIC effectiveness was assessed using evaluation tools identified in the literature.ResultsEffectiveness; strategies and models; moderating factors and methods for evaluation of QIC emerged from the literature. Together with Bloom’s taxonomy and Kirkpatrick’s educational model, these themes informed the development of this PQIC protocol. It was piloted in three steps: education, coaching and evaluation. A survey revealed that the participants in the education step achieved excellent scores. Following the coaching journey, the coached multidisciplinary team leaders completed their improvement initiatives and demonstrated increased QI knowledge and skills measured by the ‘IHI improvement advisor self-assessment tool’ and ‘IHI assessment scale for collaboratives’.ConclusionBuilt on established education, peer coaching and QI concepts, this evidence-based PQIC protocol adds to international evidence on how to support front-line healthcare workers in their improvement efforts. Future research needs to assess protocol effectiveness across different settings.
UK policymaker and expert perspectives on the smoke-free generation policy: a qualitative study
Authors: Davies Nathan , Murray Rachael L , Langley Tessa , Morling Joanne , Bains Manpreet 
Published: February 2025

IntroductionThe UK smoke-free generation (SFG) proposal seeks to ban the sale of tobacco products to those born in or after 2009. There is substantial evidence for the benefits of raising the age of sale of tobacco but, despite several governments proposing SFG, the policy has faced significant challenge and has not been implemented at nation-state level. This study explores the context in which UK may be the first country to introduce SFG, identifies potential barriers and facilitators to SFG implementation and outlines possible approaches to SFG policy design.MethodsWe conducted 19 qualitative semistructured interviews with policymakers and health leaders in England, Scotland and Wales, including politicians, public health experts, academics, trading standards experts (responsible in UK for enforcing age restrictions on products), clinicians and civil society (charity sector) representatives. Data were analysed through Kingdon’s three policy streams (problem, policy and political) and organised using the framework approach.ResultsParticipants conceptualised SFG as both addressing youth tobacco initiation and shifting societal norms. They agreed that all tobacco products should be included but had differing views on including e-cigarettes. Opinions on enforcement varied. Some believed minimal enforcement would suffice due to anticipated compliance, while others stressed the need for strong enforcement. All agreed enforcement should target retailers, not individuals. Politically, participants noted the rapid shift from advocates supporting Tobacco 21 to embracing SFG after government endorsement. Cohesive public health advocacy, maintaining cross-party support and public opinion and developing broader tobacco control policies were considerations for successful implementation.ConclusionsWidespread support for SFG across expert, political and public opinion provides a strong foundation for its passing into law. UK public health actors swiftly took advantage of the opening of a tobacco control policy window. Those implementing SFG must carefully consider product coverage and its approach to enforcement.
Factors influencing the natural history of non-IgE-mediated gastrointestinal food allergies in paediatric age: a prospective multicentre cohort study
Authors: Carucci Laura , Nocerino Rita , Coppola Serena , Bedogni Giorgio , Capasso Pasqualina , Giglio Veronica , Berni Canani Roberto 
Published: February 2025

BackgroundWe aimed at identifying the factors influencing the natural history of non-IgE-mediated gastrointestinal food allergies (non-IgE-GIFA), a group of common paediatric conditions including food protein–induced: enteropathy (FPE), allergic proctocolitis (FPIAP), enterocolitis syndrome (FPIES), and motility disorders (FPIMD).MethodsProspective multicentre cohort study involving paediatric patients (both sexes, aged ≤14 y) with non-IgE-GIFA diagnosed and followed for 24 months at a Tertiary Centre for Paediatric Allergy, Gastroenterology and Nutrition. Anamnestic and clinical data were collected from all enrolled patients.Results123 non-IgE-GIFA patients were enrolled (56% male, median age (IQR) 150 (60–300) days): FPE (39%), FPIES (17%), FPIAP (16%) and FPIMD (28%). 42% of patients had multiple food allergies (FAs) at baseline, and 64% had a positive family history of allergy. Male sex (OR = 2.24, 95% CI 1.07 to 4.71) and every 1 month of diagnostic delay (OR=1.09, 95% CI 1.01 to 1.18) were positively associated with the occurrence of multiple FAs. At 24-month follow-up, 54% of patients acquired immune tolerance. This rate was higher in FPIAP (75%), when compared with FPIMD (62%), FPE (54%) and FPIES (24%). The odds of 24-month immune tolerance acquisition rate was lower in children with family history of allergy (OR=0.41, 95% CI 0.19 to 0.89) and in those with multiple FAs at baseline (OR=0.24, 95% CI 0.11 to 0.51). At 24-month follow-up, the rate of patients with allergic march was 0.46 (95% CI 0.38 to 0.55, n=57/123), without differences comparing the four phenotypes. The presence of multiple FAs at baseline was associated with an increased risk of developing allergic march (OR=2.22, 95% CI 1.07 to 4.61) at 24-month follow-up.ConclusionsThe results of the study suggest the potential role of modifiable and non-modifiable risk factors influencing the natural history of paediatric patients affected by non-IgE-GIFA.
Maternal knowledge, attitude and practice regarding commercial oral rehydration salt solution: experience from a diarrhoeal disease hospital in Bangladesh
Authors: Nuzhat Sharika , Islam Md Ridwan , Al Fidah Md Fuad , Islam Shoeb Bin , Rahman Md Mushfiqur , Paul Sneha , Nesa Mahfuz-Un , Chowdhury Devjani , Nabi Shayontan Fardin , Awn Awni Mokhtar Sallam Ali , Khan Liaquat Ali , Kawser Chowdhury Ali , Chisti Mohammod Jobayer , Ahmed Tahmeed 
Published: February 2025

BackgroundDespite oral rehydration salt (ORS) solution being a life-saving medication, mothers of affected children often lack proper knowledge and exhibit improper practice of using ORS in sachets. We aimed to assess maternal knowledge, attitude and practice towards commercially available ORS and its use in treating under-5 children with diarrhoea.MethodsThe study was conducted at the Dhaka Hospital, Bangladesh. We included 350 mothers of under-5 children suffering from diarrhoea. Data were collected using a pretested questionnaire and modified Bloom’s cut-off was used to determine adequate knowledge (≥80%), positive attitude (≥90%) and proper practice (≥75%). Logistic regression models were developed after adjusting for confounding variables. Adjusted ORs (AORs) and their 95% CIs were reported.ResultsThe prevalence of inadequate knowledge, negative attitude and improper practice was 88.0%, 59.1% and 72.5%, respectively. Participants with up to the higher secondary level of education had significantly higher odds of possessing adequate knowledge (AOR 7.47; 95% CI 2.76 to 20.12) and following proper practice (AOR 3.04; 95% CI 1.66 to 5.77). The majority (97.4%) reported being aware of the process of ORS preparation. Only 2.9% correctly knew all recommended steps. Approximately half (51.1%) knew the purpose of ORS use, and 24.6% believed that antibiotics are more helpful than ORS.ConclusionsThe findings of the study emphasise the need for substantial improvements to the existing health education program with a focus on parental education. Emphasis should be given to reading instruction on the sachet and promoting access to information via mass media outlets.
Association between the use of daily injury risk estimation feedback (I-REF) based on machine learning techniques and injuries in athletics (track and field): results of a prospective cohort study over an athletics season
Authors: Dandrieux Pierre-Eddy , Navarro Laurent , Blanco David , Ruffault Alexis , Ley Christophe , Bruneau Antoine , Iatropoulos Spyridon (Spyros) , Chapon Joris , Hollander Karsten , Edouard Pascal 
Published: February 2025

ObjectiveTo analyse the association between the level of use of injury risk estimation feedback (I-REF) provided to athletes and the injury burden during an athletics season.MethodWe conducted a prospective cohort study over a 38-week follow-up period on athletes competing at the French Federation of Athletics. Athletes completed daily questionnaires on their athletics activity, psychological state, sleep, self-reported level of I-REF use, and injuries. I-REF provided a daily estimation of the injury risk for the next day, ranging from 0% (no risk of injury) to 100% (maximum risk of injury). The primary outcome was the injury burden during the follow-up, defined as the number of days with injury per 1000 hours of athletics activity. A negative binomial regression model was used to analyse the association between self-reported I-REF use and the injury burden.ResultsOf the 897 athletes who met the inclusion criteria, 112 (38% women) were included in the analysis. The mean daily response rate of the follow-up was 37%±30%. The primary analysis found no significant association between the self-reported I-REF use and the injury burden (n=112,eβ: 0.992, 95% CI: 0.977 to 1.007; p=0.308). However, when considering athletes’ daily response rate in secondary analysis, for a response rate of at least 9%, we observed a significant association between the self-reported level of I-REF use and the injury burden (n=76,eβ: 0.981, 95% CI: 0.965 to 0.998; p=0.027).ConclusionsDaily injury risk estimation feedback using machine learning was not associated with reducing injury burden.
Novel method for risk stratifying suspected acute non-variceal upper GI bleeds using a blood-detection capsule: first UK hospital experience
Authors: D'Cunha Kamath Adnan , Friel Joseph Harry , Braddy-Green Cameron 
Published: February 2025

IntroductionAcute upper gastrointestinal bleeding (AUGIB) remains a common presentation accounting for 0.1% of acute medical admissions. Current risk stratification to guide management is weighted on patient factors (eg, Glasgow-Blatchford Score, GBS, or Rockall Score, RS). With an increasingly comorbid population these scores may have less utility. We assess blood-detection capsules (BDC) to triage low-risk, non-variceal, AUGIB referrals.MethodsA prospective service evaluation was performed at a district general hospital in East London. All AUGIB referrals received during the evaluation period were screened for suitability. The BDC was administered while participants wore an external receiver. If positive, participants underwent inpatient gastroscopy; if negative, they were managed as outpatients. Subsequent results, including complications and mortality, were recorded.Results21 referrals were screened during the evaluation period. 11 were excluded with the most common reasons being pacemaker incompatibility or haemodynamic instability. 10 participants with a median age of 76.5 years, Charlson Comorbidity Index of 5.5, GBS 9 and RS 4 were included. Six participants had a negative BDC. Four had a positive BDC; one non-bleeding duodenal ulcer, one oozing Roux-en-Y anastomotic ulcer and two normal examinations. The 90-day mortality was 0% and there were no adverse events among the participants.ConclusionIntroduction of a BDC as a triage tool may reduce the need for inpatient gastroscopies, otherwise indicated by high GBS/RS. We propose patients with suspected non-variceal AUGIB and a negative BDC can be safely managed as outpatients, irrespective of GBS/RS. Larger cohort data is needed to assess the long-term benefit, cost-effectiveness and complication rates.
Panenteric capsule endoscopy in patients with melaena and a negative oesophagogastroduodenoscopy: a multi-centre real-world study
Authors: Yeo Jie Han , Choon Xin Yi , Seward Edward , McCartney Sara , Anderson Simon H C , Bloom Stuart , Willsmore James , Zissimopoulos Alexandra , Villa Miguela , Borrow Dean-Martin , Harrow Paul , Parisi Ioanna 
Published: February 2025

BackgroundGastrointestinal (GI) bleeding is a common event that can be life-threatening. Mussettoet aldemonstrated the feasibility of panenteric capsule endoscopy (PCE) in patients with melaena and a negative oesophagogastroduodenoscopy (OGD)—the bleeding source was identified in 80% of patients and colonoscopy was avoided in 50%. However, there are no large prospective trials and limited real-world data.At two tertiary centres in the UK, we retrospectively evaluated the outcomes of patients who underwent an inpatient PCE following a negative OGD for suspected upper GI bleeding.MethodsCapsule databases at each institution were reviewed from 2021 to 2024. The inclusion criteria were patients who had a suspected upper GI bleed (melaena and haemoglobin drop of >10 g/L) and underwent an inpatient PCE following a negative OGD. Data was extracted from the patient’s electronic health records.Results23 patients met the inclusion criteria. The mean age was 56 years. The median time from OGD to capsule ingestion was 4 days. The source of bleeding was identified by PCE in 70% of cases. A small bowel source was identified in 43%. PCE prevented unnecessary lower GI endoscopy in 70%. Capsule retention occurred in 1 patient and was managed conservatively. Rebleeding rates at 30 days, 6 months and 12 months were 9%, 4% and 0%.ConclusionPCE is an option for patients presenting with melaena and has a negative upper GI endoscopy. The findings from this study are promising with a diagnostic yield of 70%. Large, multi-centre randomised studies are required to further investigate this strategy.
Prognostic implications of iron deficiency in patients with atrial fibrillation, with and without chronic heart failure
Authors: Mohamed Abdullahi Ahmed , Christensen Daniel Mølager , Mohammad Milan , Torp-Pedersen Christian , Koeber Lars , Biering-Sørensen Tor , Hansen Morten Lock , Lamberts Morten , Binding Casper , Jensen Mads Hashiba , Elmegaard Mariam , Nouhravesh Nina , Holt Anders , Schou Morten , Gislason Gunnar 
Published: February 2025

BackgroundIron deficiency (ID) is common in patients with atrial fibrillation/flutter (AF), but its prognostic implications and optimal diagnostic criteria, particularly in those with and without heart failure (HF), remain unclear. This study assessed the associations between different ID definitions and clinical outcomes in patients with AF.MethodsThis Danish nationwide cohort study included 10 834 patients with AF who underwent iron studies between 2008 and 2019, stratified by HF status. ID was defined using four criteria: European Society of Cardiology (ESC) guidelines, ferritin <100 ng/mL, transferrin saturation (TSAT) <20% and serum iron ≤13 µmol/L. Associations between ID definitions and all-cause mortality, cardiovascular mortality and all-cause hospitalisation were evaluated using Cox regression models, adjusted for confounders.ResultsPrevalence of ID varied substantially across definitions, ranging from 36.2% to 62.7%. Over a median follow-up of 31 months, TSAT <20% was associated with increased all-cause and cardiovascular mortality in both HF (HR 1.25, 95% CI 1.14 to 1.37 and HR 1.31, 95% CI 1.14 to 1.49, respectively) and patients without HF (HR 1.39, 95% CI 1.18 to 1.64 and HR 1.54, 95% CI 1.18 to 2.00, respectively). Similarly, serum iron ≤13 µmol/L was associated with higher all-cause and cardiovascular mortality in HF (HR 1.44, 95% CI 1.31 to 1.58 and HR 1.42, 95% CI 1.24 to 1.63, respectively) and patients without HF (HR 1.67, 95% CI 1.41 to 1.97 and HR 1.46, 95% CI 1.13 to 1.89, respectively). ID defined by ESC guidelines or ferritin <100 ng/mL was not associated with mortality in either group but was linked to higher all-cause hospitalisation in patients with HF (HR 1.15, 95% CI 1.08 to 1.23 and HR 1.16, 95% CI 1.09 to 1.23, respectively).ConclusionsID defined by TSAT <20% or serum iron ≤13 µmol/L is associated with increased mortality in patients with AF, irrespective of HF status, highlighting these criteria as clinically relevant for risk stratification.