bluuebunny/crossref_metadata_2025_split huggingface dataset:
Information in summaries of product characteristics about use in children is limited and needs standardisation: a systematic analysis in Switzerland
Authors: Tilen Romy , Berger Christoph , Allemann Samuel , Meyer zu Schwabedissen Henriette 
Published: March 2024

BackgroundA considerable proportion of drugs administered to children are not authorised for this purpose, and consequently off-label use is common in paediatric care. Our aims were to quantify systematically the number of drugs authorised in Switzerland for use in children based on their current summary of product characteristics (SmPC) and to assess the quality of this information.MethodsWe used natural language processing to screen all Swiss SmPCs, available in German language in the open-source drug database, for information about use in children. Based on the SmPCs of the most frequently used drugs in Swiss children’s hospitals, 10 search terms were defined to retrieve this information.ResultsOf the analysed 4214 drugs corresponding to 1553 active substances, 2322 (55.1%) drugs were authorised for use in children. In only 639 (15.2%) SmPCs, information about authorisation for children was found in the section ‘Therapeutic indications’. 320 (13.8%) SmPCs of drugs authorised for use in children contained only verbal age indications such as ‘children’ and ‘adolescents’ without a clear definition of the age or an age range.ConclusionsMost Swiss SmPCs contain information about children, but only a minority refer to an official indication. Even if some SmPCs clearly indicate that use in children is authorised, a clear statement of the age at which the drug may be administered is missing. Standardisation of information about use in children in SmPCs is needed.
Can critical care transport be safely reduced in children intubated during emergency management of status epilepticus in the United Kingdom: a national audit with case–control analysis
Authors: Knight Philip , Norman Victoria , Gully Rochelle , Wood Dora , Raffaj Dusan , Riddick Laura , Hancock Stephen , Revanna Sanjay , Uvaise Mohammed , Herring Sasha , Worrall Mark , Daye Ashley , Terris Mark , O'Brien Cormac , Kumar Ananth , Scott Sophie , Pritchard Lisa , Palaniappan Srinivasan , Hughes Charlotte , Griksaitis Michael J , Riphagen Shelley , Ramnarayan Padmanabhan 
Published: March 2024

Objective
This study describes the baseline clinical characteristics, predictors of successful extubation at referring hospitals and short-term outcomes of children intubated for status epilepticus and referred to United Kingdom (UK) paediatric critical care transport teams (PCCTs).

Design
Multicentre audit with case–control analysis, conducted between 1 September 2018 and 1 September 2020.

Setting
This study involved 10 UK PCCTs.

Patients
Children over 1 month of age intubated during emergency management for status epilepticus (SE), referred to UK PCCTs. Patients with trauma, requiring time-critical neurosurgical intervention or those with a tracheostomy were excluded.

Interventions
No interventions were implemented.

Measurements and main results
Out of the 1622 referrals for SE, 1136 (70%) were intubated at referral. The median age was 3 years (IQR 1.25–6.54 years). Among the intubated children, 396 (34.8%) were extubated locally by the referring team, with 19 (4.8%) requiring reintubation. Therefore, the overall rate of successful extubation was 33% (377/1136). There was significant variation between PCCTs, with local extubation rates ranging from 2% to 74%. Multivariable analyses showed region/PCCT, contributing diagnosis, acute changes on CT, preceding encephalopathy and type of continuous sedation (midazolam) used postintubation were significantly associated with transfer to a critical care unit.

Conclusion
This study highlights wide regional variation in early extubation practices. Regions with high successful extubation rates have established extubation guidelines from PCCTs. Successful extubation represents critical care transports that have been avoided.
Continuous oxygen saturation and risk of retinopathy of prematurity in a Japanese cohort
Authors: Kubota Hiroshi , Fukushima Yoko , Kawasaki Ryo , Endo Takao , Hatsukawa Yoshikazu , Ineyama Hiromi , Hirata Katsuya , Hirano Shinya , Wada Kazuko , Nishida Kohji 
Published: March 2024

Background/aimsWe assessed the associations between retinopathy of prematurity (ROP) and continuous measurements of oxygen saturation (SpO2), and developed a risk prediction model for severe ROP using birth data and SpO2data.MethodsThis retrospective study included infants who were born before 30 weeks of gestation between August 2009 and January 2019 and who were screened for ROP at a single hospital in Japan. We extracted data on birth weight (BW), birth length, gestational age (GA) and minute-by-minute SpO2during the first 20 days from the medical records. We defined four SpO2variables using sequential measurements. Multivariate logistic regression was used to develop a model that combined birth data and SpO2data to predict treatment-requiring ROP (TR-ROP). The model’s performance was evaluated using the area under the receiver operating characteristic curve (AUC).ResultsAmong 350 infants, 83 (23.7%) required ROP treatment. The SpO2variables in infants with TR-ROP differed significantly from those with non-TR-ROP. The average SpO2and high SpO2showed strong associations with GA (r=0.73 and r=0.70, respectively). The model incorporating birth data and the four SpO2variables demonstrated good discriminative ability (AUC=0.83), but it did not outperform the model incorporating BW and GA (AUC=0.82).ConclusionData obtained by continuous SpO2monitoring demonstrated valuable associations with severe ROP, as well as with GA. Differences in the distribution of average SpO2and high SpO2between infants with TR-ROP and non-TR-ROP could be used to establish efficient cut-off values for risk determination.
Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review
Authors: George Tina , Manski-Nankervis Jo-Anne , Klaic Marlena , Kang Gagandeep , Sudarsanam Thambu David 
Published: March 2024

IntroductionMultimorbidity, the coexistence of two or more chronic conditions in the same individual, is a major public health problem in low-income and middle-income countries (LMICs). The use of single-disease guidelines contributes to polypharmacy, fragmented care and increased treatment burden. Health systems in LMICs are very different from those in high-income countries, and adapting interventions from one to the other may not be feasible. This review aims to systematically present the current evidence for interventions for multimorbidity in the LMIC setting.Methods and analysisIn this mixed-methods systematic review, we will include all studies of interventions for the care of adults (>18 years of age) with multimorbidity (defined as the presence of two or more chronic illnesses in an individual) in any healthcare organisation (primary, secondary or tertiary care) in an LMIC (as defined by the World Bank), published between 2000 and March 2023. All primary study designs will be included. Studies reported in languages other than English and those describing interventions classified as ‘financial’ or ‘governance arrangement’ according to the Cochrane Effective Practice and Organisation of Care classification will be excluded. MEDLINE, PubMed, Cochrane Library, TRIP, SCOPUS and the 3ie databases will be searched. The titles will be screened by one author, and two authors will independently screen all included abstracts and full texts. A third author will resolve conflicts at every stage. Studies will be reviewed for quality of evidence using appropriate tools. Epidemiological, intervention and outcome data will be extracted and summarised. Outcomes of interest for LMICs defined by the Global Alliance for Chronic Diseases research group will be analysed. Subgroup analysis according to study types and study settings will be done.Ethics and disseminationNo ethics approval is required for this systematic review. Results will be disseminated through publication in an open-access journal and presentation at conferences.PROSPERO registration numberCRD42023391897.
Impact of the economic crisis, COVID-19 and the Beirut explosion on ophthalmology training in Lebanon: an observational cohort survey-based study
Authors: Ghannam Alaa Bou , Ibrahim Hanadi Ahmad , Hammoud Bassel , Hamam Rola 
Published: March 2024

ObjectivesThe objective of the study is to investigate the effects of the COVID-19 pandemic, the economic crisis and the Beirut explosion on the training and work of ophthalmology residents and faculty in Lebanon.DesignThis is an observational cohort survey-based research conducted between January and December 2022.SettingThe study targeted all ophthalmology residents and core faculty in Lebanon.ParticipantsA total of 52 participants, including 27 residents and 25 core faculty members, completed the survey.Primary outcome measurePrimary outcomes comprised the subjectively reported effect of the three major external stressors on the training and well-being of ophthalmology trainees and educators in Lebanon.ResultsThe study found that the majority of ophthalmology residents and core faculty members were significantly affected by the COVID-19 pandemic, Beirut explosion and the economic crisis in Lebanon. Significant percentage reported financial burden, decrease in outpatient and surgical load and educational activities. Furthermore, most participants reported higher levels of stress, anxiety and depression during the time of crises.ConclusionsThis study emphasises the need to support healthcare professionals during times of crisis, as they are on the frontlines and can experience high levels of stress, anxiety and depression. By providing support and resources to healthcare professionals, they can better cope with the challenges they face and continue to provide essential care to their patients.
Development and feasibility of a conceptual model for planning individualised physical exercise training (IPET) for older adults: a cross-sectional study
Authors: Teljigovic Sanel , Dalager Tina , Nielsen Nina Odgaard , Holm Lars , Ejvang Mette Bahn , Sjøgaard Gisela , Søgaard Karen , Sandal Louise Fleng 
Published: March 2024

ObjectiveOlder adults constitute a heterogeneous group, and the focus of the individual physical exercise is often subject to the reasoning and experience of health professionals or exercise physiologists who prescribe them. Thus, this is the first effort to explicitly conceptualise the planning of individualised physical exercise training (IPET) for older adults in an outpatient setting and investigate individual exercise preferences.DesignThe concept ofIPET was developed by researchers, exercise physiologists and health professionals from a real-life outpatient setting using an iterative approach. Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites form the basis of physical exercise recommendations. A cross-sectional study was conducted to assess the basis of implementingIPET.SettingOutpatient setting.ParticipantsWe included 115 older adults (70 females) from an outpatient setting with a median age of 74 years.Outcome measuresHealth indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites were collected and informed the concept ofIPET that structures exercise programmes based on the individual citizen’s needs and physical exercise preferences. Exceeding a health indicator cut-point results in exercise content mitigating the risk associated with the health indicator.ResultsWe included 115 older adults (70 females) from an outpatient setting median age of 74 years. Approximately two-thirds of participants exceeded at least one health indicator cut-point for aerobic training. One-third of the participants exceeded the cut-point for upper extremity strength, and almost all participants >99% exceeded the cut-point for lower extremity strength. Approximately two-thirds of the participants exceeded the cut-point for functional/balance training. The most prevalent site of musculoskeletal pain was the lower extremities. Eight of 20 training combinations were used, clustering the 115 participants primarily in three main training combinations.DiscussionThis study shows that older adults vary in physical functioning, indicating that exercise preferences and rehabilitation needs are individual.Trial registration numberNCT04862481.
University staff perspectives on determinants of high-quality health professions student placements in regional, rural and remote Australia: protocol for a mixed-method study
Authors: Quilliam Claire , Green Elyce , Rasiah Rohan L , Sheepway Lyndal , Seaton Catherine , Moore Leigh , Bailie Jodie , Matthews Kylie Maree , Ferns Jane , Debenham James , Taylor Carolyn , Fitzgerald Kathryn , Ridd Melissa 
Published: March 2024

IntroductionIn rural areas, work-integrated learning in the form of health student placements has several potential benefits, including contributing to student learning, enhancing rural health service capacity and attracting future rural health workforce. Understanding what constitutes a high-quality rural placement experience is important for enhancing these outcomes. There is no current standardised definition of quality in the context of rural health placements, nor is there understanding of how this can be achieved across different rural contexts. This study is guided by one broad research question: what do university staff believe are the determinants of high-quality health professions student placements in regional, rural and remote Australia?Methods and analysisThis study will adopt a convergent mixed-method design with two components. Component A will use explanatory sequential mixed methods. The first phase of component A will use a survey to explore determinants that contribute to the development of high-quality health student placements from the perspective of university staff who are not employed in University Departments of Rural Health and are involved in the delivery of health student education. The second phase will use semistructured interviews with the same stakeholder group (non-University Department of Rural Health university staff) to identify the determinants of high-quality health student placements. Component B will use a case study Employing COnceptUal schema for policy and Translation Engagement in Research mind mapping method to capture determinants that contribute to the development of high-quality health student placements from the perspective of University Department of Rural Health university staff.Ethics and disseminationThe University of Melbourne Human Ethics Committee approved the study (2022-23201-33373-5). Following this, seven other Australian university human research ethics committees provided external approval to conduct the study. The results of the study will be presented in several peer-review publications and summary reports to key stakeholder groups.
Knowledge, attitude and practices of insulin therapy among patients with type 2 diabetes: a cross-sectional study
Authors: Almheiri Ayesha , Binjab Eman Ali , Albloushi Maha Murad , Alshamsi Mohamed Taryam , Khansaheb Hamda Hassan , Zidan Marwan , Hassoun Ahmed Abdul Karim 
Published: March 2024

ObjectivesThis study aimed to assess the knowledge, attitude and practices of patients with type 2 diabetes on insulin regarding insulin therapy.DesignA cross-sectional study.SettingThis study was conducted at the Dubai Diabetes Center from 1 December 2018 to 1 March 2020.ParticipantsFace-to-face interviews were conducted for 350 participants with type 2 diabetes at the Dubai Diabetes Center. Interviews followed the structured format of a questionnaire designed to obtain demographic details and score participants on knowledge, attitude and practices. We included patients aged >18 years and receiving insulin therapy. Patients with type 1 diabetes, pregnant women with gestational diabetes, those aged <18 years or those with a history of dementia were excluded.ResultsThe median age of participants was 61 years (first quartile, 53 years; third quartile, 67 years); 35.7% were male individuals and 64.3% were female individuals. The median percentage scores for knowledge, attitude and practices were 62.5% (62.5%, 75%), 85.7% (71.4%, 100%) and 77.7% (66.6%, 88.8%), respectively. Highly educated participants had a high level of knowledge. Significant negative correlations were found between the percentage knowledge scores and participants’ age and between the participants’ percentage attitude scores and haemoglobin A1C levels; Spearman’s correlations were −0.182 (p<0.001) and −0.14 (p=0.008), respectively. A significant positive Spearman’s correlation of 0.123 (p=0.021) was found between the percentage knowledge and percentage practice scores. No correlations were found among knowledge levels, participants’ haemoglobin A1c levels and duration of insulin use.ConclusionPatients with type 2 diabetes receiving insulin therapy and attending the Dubai Diabetes Center had adequate knowledge, a positive attitude and correct practice regarding insulin therapy. However, knowledge of specific facts did not always translate into correct behaviours and practices.
Self-management needs, strategies and support for sickle cell disease in developing countries: a scoping review protocol
Authors: Druye Andrews Adjei , Boso Christian Makafui , Amoadu Mustapha , Obeng Paul , Nabe Bernard , Kagbo Justice Enock , Doe Patience Fakornam , Okantey Christiana , Ofori Godson Obeng , Opoku-Danso Rita , Agyare Dorcas Frempomaa , Osei Berchie Gifty , Owusu Gifty , Nsatimba Frederick , Abraham Susanna Aba 
Published: March 2024

IntroductionSickle cell disease (SCD) poses a significant global health burden, particularly affecting individuals in developing countries with constrained healthcare resources. While research on self-management in the context of SCD is emerging, it has predominantly focused on primary studies, and there is a notable dearth of evidence synthesis on SCD self-management in developing countries. This scoping review aims to identify and map self-management needs of individuals living with SCD, the strategies they employed to meet those needs, and the support systems available to them.Methods and analysisThe review will be conducted following the Arksey and O’Malley’s (2005) 29 framework to comprehensively examine the landscape of SCD self-management research. Searches will be performed in PubMed, Scopus, Embase and Dimensions AI, with additional searches in other databases and grey literature. Indexed literature published in English from inception to January 2024 will be included. Reference list from included studies will also be searched manually. Two teams will be constituted to independently screen titles, abstracts and full text against the eligible criteria. Data will be extracted from included studies onto a customised data extraction form.Ethics and disseminationEthical approval is not required for this review due to the fact that it synthesises information from available publications. The findings will be disseminated through publication in a peer-reviewed journal. Also, the findings will possibly be presented at relevant international and national conferences. This protocol has already been registered with the Open Science Framework. The study characteristics such as design and setting will be descriptively analysed and presented as graphs, tables and figures. Thematic analysis will also be conducted based on the study objectives and presented as a narrative summary.
A realist synthesis of multicentre comparative audit implementation: exploring what works and in which healthcare contexts
Authors: McGlacken-Byrne Sinéad M , Murphy Nuala P , Barry Sarah 
Published: March 2024

BackgroundMulticentre comparative clinical audits have the potential to improve patient care, allow benchmarking and inform resource allocation. However, implementing effective and sustainable large-scale audit can be difficult within busy and resource-constrained contemporary healthcare settings. There are little data on what facilitates the successful implementation of multicentre audits. As healthcare environments are complex sociocultural organisational environments, implementing multicentre audits within them is likely to be highly context dependent.ObjectiveWe aimed to examine factors that were influential in the implementation process of multicentre comparative audits within healthcare contexts—what worked, why, how and for whom?MethodsA realist review was conducted in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards reporting standards. A preliminary programme theory informed two systematic literature searches of peer-reviewed and grey literature. The main context-mechanism-outcome (CMO) configurations underlying the implementation processes of multicentre audits were identified and formed a final programme theory.Results69 original articles were included in the realist synthesis. Four discrete CMO configurations were deduced from this synthesis, which together made up the final programme theory. These were: (1) generating trustworthy data; (2) encouraging audit participation; (3) ensuring audit sustainability; and (4) facilitating audit cycle completion.ConclusionsThis study elucidated contexts, mechanisms and outcomes influential to the implementation processes of multicentre or national comparative audits in healthcare. The relevance of these contextual factors and generative mechanisms were supported by established theories of behaviour and findings from previous empirical research. These findings highlight the importance of balancing reliability with pragmatism within complex adaptive systems, generating and protecting human capital, ensuring fair and credible leadership and prioritising change facilitation.
RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments
Authors: Humphries Christopher , Gillings Marianne 
Published: March 2024

Cannabinoid hyperemesis syndrome (CHS) is an episodic syndrome of cyclic vomiting in the context of the prolonged use of cannabis. The Royal College of Emergency Medicine Toxicology Special Interest Group has produced guidance to support emergency medicine clinicians with the recognition and treatment of people experiencing CHS.Considerations regarding recognition, investigation and communication are discussed, and recommendations regarding treatment options (which include haloperidol and capsaicin) are made. There is a focus on making recommendations on the best available evidence.
Liver outcomes following proctocolectomy in patients with primary sclerosing cholangitis and ulcerative colitis
Authors: Ryan Thomas , Segal Jonathan P 
Published: March 2024

BackgroundThe aims of this narrative review are to examine the impact of proctocolectomy on the liver in patients with primary sclerosing cholangitis and ulcerative colitis (PSC-UC), mainly focusing on graft loss, and to compare the different proctocolectomy techniques to help determine which is the best for PSC-UC patients.MethodsA literature search was performed using the online databases MEDLINE and Embase. Studies found via the search were evaluated against both inclusion and exclusion criteria by two independent reviewers (TR and JS). Relevant studies were included in the review.ResultsSeven studies were deemed relevant through the literature search and review process and another one was included via other sources, therefore, eight studies were included in the final review.ConclusionsProctocolectomy does not appear to have a negative impact on the liver and ileostomy appears to have better outcomes in terms of graft loss compared with ileal pouch-anal anastomosis. However, more high-quality studies on this topic are required as the existing literature is limited, and therefore, the findings should not be overinterpreted.