bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preventing chronic malnutrition in children under 2 years in rural Angola (MuCCUA trial): protocol for the economic evaluation of a three-arm community cluster randomised controlled trial
Authors: Martin-Cañavate Rocio , Custodio Estefania , Trigo Elena , Romay-Barja María , Herrador Zaida , Aguado Isabel , Ramirez Ferran , Faria Lourdes Maria , Silva-Gerardo Ana , Lima Jose Carlos , Iráizoz Eva , Marques Tayná , Vargas Antonio , Gomez Amador , Puett Chloe , Molina Israel 
Published: December 2023

IntroductionChronic malnutrition is a serious problem in southern Angola with a prevalence of 49.9% and 37.2% in the provinces of Huila and Cunene, respectively. The MuCCUA (Mother and Child Chronic Undernutrition in Angola) trial is a community-based randomised controlled trial (c-RCT) which aims to evaluate the effectiveness of a nutrition supplementation plus standard of care intervention and a cash transfer plus standard of care intervention in preventing stunting, and to compare them with a standard of care alone intervention in southern Angola. This protocol describes the planned economic evaluation associated with the c-RCT.Methods and analysisWe will conduct a cost-efficiency and cost-effectiveness analysis nested within the MuCCUA trial with a societal perspective, measuring programme, provider, participant and household costs. We will collect programme costs prospectively using a combined calculation method including quantitative and qualitative data. Financial costs will be estimated by applying activity-based costing methods to accounting records using time allocation sheets. We will estimate costs not included in accounting records by the ingredients approach, and indirect costs incurred by beneficiaries through interviews, household surveys and focus group discussions. Cost-efficiency will be estimated as cost per output achieved by combining activity-specific cost data with routine data on programme outputs. Cost-effectiveness will be assessed as cost per stunting case prevented. We will calculate incremental cost-effectiveness ratios comparing the additional cost per improved outcome of the different intervention arms and the standard of care. We will perform sensitivity analyses to assess robustness of results.Ethics and disseminationThis economic evaluation will provide useful information to the Angolan Government and other policymakers on the most cost-effective intervention to prevent stunting in this and other comparable contexts. The protocol was approved by the República de Angola Ministério da Saúde Comité de Ética (27C.E/MINSA.INIS/2022). The findings of this study will be disseminated within academia and the wider policy sphere.Trial registration numberClinicalTrials.gov Registry (NCT05571280).
Thirty-day hospital readmission predictors in older patients receiving hospital-at-home: a 3-year retrospective study in France
Authors: de Stampa Matthieu , Georges Alexandre , Grino Michel , Cerase Valerie , Baudouin Édouard , Vedel Isabelle 
Published: December 2023

ObjectiveThis study described older patients receiving hospitalisation-at-home (HaH) services and identified factors associated with 30-day hospital readmission.Design3-year retrospective study in 2017–2019 in France.Participants75 108 patients aged 75 years and older who were discharged from hospital medical wards (internal medicine and geriatric units) and admitted to HaH.Primary outcome measure30-day hospital readmission.ResultsThe mean age of patients was 83.4 years (SD 5.7), 52.3% were male and 88.4% lived in a private household. Patients were primarily discharged from the internal medicine unit (85.3%). The top four areas of care in the HaH were palliative care, complex dressing, intravenous therapy and complex nursing care. Overall, 23.5% of patients died during their HaH stay and 27.8% were readmitted to the hospital at 30 days. In the multivariate model, male (OR 1.19, 95% CI 1.16 to 1.23), supportive cancer HaH care (OR 1.78, 95% CI 1.51 to 2.11) and very high intensity care during the previous in-person hospitalisation (OR 1.45, 95% CI 1.34 to 1.57) increased the risk of hospital readmission at 30 days. Older age (OR 0.97, 95% CI 0.97 to 0.98), living in a nursing home (OR 0.51, 95% CI 0.48 to 0.54), postsurgery HaH care (OR 0.49, 95% CI 0.41 to 0.58) and having been previously hospitalised in a geriatric unit (OR 0.81, 95% CI 0.77 to 0.85) decreased the risk of hospital readmission at 30 days.ConclusionsHaH provides complex care to very old patients, which is associated with high mortality. Several factors are associated with rehospitalisation within 30 days that could be avoided with better integration of different services with higher geriatric skills.Trial registration numberCNIL:2228861.
Identifying factors associated with child malnutrition in Ghana: a cross-sectional study using Bayesian multilevel ordinal logistic regression approach
Authors: Iddrisu Wahab Abdul , Gyabaah Opoku 
Published: December 2023

ObjectiveIn developing countries, malnutrition is a noteworthy concern related to the well-being of people, and this study aimed to determine the factors that affect malnutrition among children below 5 years in Ghana.DesignThe study used a secondary data source, specifically the Ghanaian Multiple Indicator Cluster Survey Six (MICS 6), which was conducted by the Ghana Statistical Service in 2017–2018. The MICS data are hierarchical, as children are categorised within households, and households are further grouped within a higher cluster, violating the independence assumption that must be addressed in the analyses. This study used a Bayesian multilevel ordinal logistic regression to model, identify and analyse the factors linked to child malnutrition in Ghana.SettingThe setting of the study was the household level across the previous 10 administrative regions in Ghana.ParticipantsData for 8875 children under 5 years were used for the study. The data were gathered from households in all 10 administrative regions of Ghana using a sampling procedure consisting of stratification and random selection to ensure national representation.ResultsThe results showed that the Northern Region of Ghana had the highest occurrence rate of severe and moderate malnutrition, and factors such as the count of children’s books or picture books, whether the child experienced fever in the last 2 weeks, age and sex of the child, and the child’s household wealth index quintile were strongly linked to malnutrition among Ghanaian children.ConclusionThese findings underscore the intricate interplay of factors contributing to child nutrition in Ghana and suggest that addressing malnutrition necessitates a comprehensive approach that considers factors such as access to healthcare and reading materials, household wealth, and other social and environmental factors.
Optimal treatment of asymptomatic patients with severe aortic stenosis: protocol of a prospective, multicentre, registry study
Authors: Xia Congying , Li Yi-Ming , Xiong Wei , Ma Liqiao , Xiong Tian-Yuan , Zhao Zhen-Gang , Peng Yong , Wei Jiafu , Feng Yuan , Chen Mao 
Published: December 2023

IntroductionDecisions regarding the optimal timing of intervention for asymptomatic aortic stenosis (AS) are controversial. The study aims to identify potential risk factors for asymptomatic patients with severe AS that are associated with worse prognosis and to evaluate the benefits of early interventions for asymptomatic patients presenting with one or more additional risk factors.Methods and analysisThis is a non-interventional, prospective, open-label, multicentre registry study across China. A total of 1000 patients will be enrolled and categorised as symptomatic or asymptomatic. The primary endpoint is the occurrence of all-cause mortality, stroke, acute myocardial infarction and heart failure-related hospitalisation at 1-year follow-up. In asymptomatic severe AS patients presenting with one or more risk factors, the occurrence rate of the primary endpoint between those who undergo transcatheter aortic valve replacement (TAVR) and those who do not will be compared. We will also compare the occurrence rate of the primary endpoint for asymptomatic severe AS patients with additional risk factors who undergo TAVR with those presenting with symptoms. This study is believed to provide additional evidence to help clinicians identify and refer severe AS patients who are asymptomatic but present with additional risk factors for early intervention of TAVR.Ethics and disseminationThe study protocol has been approved by the local ethics committee of each participating site: West China Hospital, Sichuan University; Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Second Hospital of Hebei Medical University; Tianjin Chest Hospital; and First Affiliated Hospital of Nanchang University. All participants will provide written informed consent. Study results will be published through academic conferences and peer-reviewed journals.Trial registrationThis study was registered at the Chinese Clinical Trial Registry (https:// www.chictr.org.cn), with the registration number ChiCTR2200064853.
Prevalence of and factors associated with symptoms consistent with a diagnosis of irritable bowel syndrome among resident physicians in standardised training in China: a cross-sectional study
Authors: Zhao Jun , Li Xia , Yang Jiayi , Hao Xin , Tian Junjian , Wang Xin , Wang Xuefei , Li Ning , Li Zhigang 
Published: December 2023

ObjectivesThis study aims to investigate the incidence of and factors associated with irritable bowel syndrome (IBS) among resident physicians in standardised training at eight traditional Chinese medicine (TCM) hospitals in China.DesignA cross-sectional survey was administered to resident physicians in their first to third years of standardised training at eight TCM hospitals.Participants and settingA total of 514 resident physicians in standardised training were included.MeasuresThe questionnaire consisted of two sections, namely: section A collected basic information, and section B included the four-item Perceived Stress Scale (PSS-4), the Patient Health Questionnaire-4 (PHQ-4), the Pittsburgh Sleep Quality Index (PSQI) and the Rome IV criteria for IBS. Univariate and multivariate logistic regression models were constructed to assess the associations of age, sex, body mass index, stress, depression, anxiety, sleep quality and IBS.ResultsOf the included resident doctors, 77.2% were female, 20.4% were obese or underweight and 8.6% had symptoms consistent with a diagnosis of IBS. There were no statistically significant differences in lifestyle factors (night shift work, overtime work or working efficiency during the COVID-19 pandemic) between patients with IBS and participants without IBS (hereafter, non-IBS participants) (p=0.429, p=0.572 or p=0.464, respectively). Notably, compared with non-IBS participants, patients with IBS had significantly higher mean scores on the PSS-4 and PHQ-4 (p=0.028 and p=0.012, respectively); however, there was not a significant difference in PSQI scores between these two groups (p=0.079). Depression symptoms were significantly associated with IBS (unadjusted OR 0.498, 95% CI 0.265 to 0.935, p=0.030).ConclusionThese findings suggest that IBS is common among resident physicians in standardised training. Future studies should investigate emotional distress, especially stress and depression, in the development of prevention or treatment of IBS.
Opportunities to improve opioid use disorder care for hospitalised patients with endocarditis
Authors: French Rachel , Compton Peggy , Clapp Justin , Buttenheim Alison , Schachter Allison , Uhley Olivia , Mandell David 
Published: December 2023

BackgroundDriven by increased injection opioid use, rates of hospitalisation for infective endocarditis, an infection associated with injection drug use, are increasing. In the USA, 1 in 10 hospitalised patients for opioid use disorder-associated infective endocarditis (OUD-IE) die in the hospital and 1 in 20 have a patient-directed discharge. Emerging models of care reveal opportunities for healthcare systems to meet the complex care needs of these patients. We characterised promising practices of staff who care for these patients and identified areas for improvement.MethodsWe conducted a qualitative study with 1-hour semistructured virtual interviews between October 2021 and March 2022. Participants included 26 healthcare staff who care for patients with OUD-IE at the Hospital of the University of Pennsylvania. We used thematic analysis of interviews guided by an abductive approach. Interviews were digitally recorded and transcribed and analysed using NVivo software.ResultsInterviews were characterised by three major themes: (1) care rooted in interdisciplinary collaboration; (2) managing OUD and its sequelae in a setting not designed to treat OUD; and (3) clinician needs and barriers to change.ConclusionsThese findings highlight the facilitators of high-quality treatment for patients with OUD-IE, as well as the key areas for improvement. Findings add context to the complexity that both the healthcare staff and patients navigate during and following hospitalisation for OUD-IE. Needed changes include training staff to talk with patients about preparing for a return to drug use following hospitalisation, and changing discharge facilities’ practices that hinder access for patients with OUD-IE.
Multicentre positive deviance seminar to generate best practice recommendations to reduce anastomotic leak and length of stay for patients undergoing oesophagectomy
Authors: Jones Daniel , Gingrich Molly , Anstee Caitlin , Najmeh Sara , Safieddine Najib , Darling Gail , Malthaner Richard , Finley Christian , French Daniel G , Ferri Lorenzo , Seely Andrew 
Published: December 2023

BackgroundWe describe a novel process using positive deviance (PD) with the Canadian Association of Thoracic Surgeons members, to identify perioperative best practice to minimise anastomotic leak (AL) and length of stay (LOS) following oesophagectomy. To our knowledge, this is the first National combination of level 1 evidence with expert opinion (ie, PD seminar) aimed at reducing AL and LOS in oesophageal surgery. Our primary hypothesis is that a multicentre National PD seminar is feasible, and could lead to the generation of best practices recommendations aimed at reducing AL and LOS in patients with oesophageal cancer.MethodsAdverse events, LOS and AL incidence/severity following oesophagectomy were prospectively collected from seven Canadian thoracic institutions using Thoracic Morbidity and Mortality classification system (2017–2020). Anonymised display of centre’s data were presented, with identification of centres demonstrating PD. Surgeons from PD sites discussed principles of care, culminating in the consensus recommendations, anonymously rated by all (5-point Likert scale).ResultsData from 795 esophagectomies were included, with 25 surgeons participating. Two centres were identified as having the lowest AL rates 44/395 (11.1%) (vs five centres 71/400 (17.8%) (p<0.01)) and shortest LOS 8 days 45 (IQR: 6–14) (vs 10 days (IQR: 8–18) (p<0.001)). Recommendations included preoperative (prehabilitation, smoking cessation, chemotherapy for patients with dysphagia, minimise stents/feeding tubes), intraoperative (narrow gastric conduit, intrathoracic anastomosis, avoid routine jejunostomy, use small diameter closed-suction drains), postoperative day (POD) (early (POD 2–3) enteral feeding initiation, avoid routine barium swallow studies, early removal of tubes/drains (POD 2–3)). All ranked above 80% (4/5) in agreement to implement recommendations into their practice.ConclusionWe report the feasibility of a National multicentre PD seminar with the generation of best practice recommendations aimed at reducing AL and LOS following oesophagectomy. Further research is required to demonstrate whether National PD seminars can be an effective quality improvement tool.
Impact of an injury hospital admission on childhood academic performance: a Welsh population-based data linkage study
Authors: Dipnall Joanna F , Lyons Jane , Lyons Ronan A , Ameratunga Shanthi , Brussoni Mariana , Lecky Fiona E , Beck Ben , Schneeberg Amy , Harrison James E , Gabbe Belinda J 
Published: December 2023

BackgroundWhile injuries can impact on children’s educational achievements (with threats to their development and employment prospects), these risks are poorly quantified. This population-based longitudinal study investigated the impact of an injury-related hospital admission on Welsh children’s academic performance.MethodsThe Secure Anonymised Information Linkage databank, 55 587 children residing in Wales from 2006 to 2016 who had an injury hospital admission (58.2% males; 16.8% born in most deprived Wales area; 80.1% one injury hospital admission) were linked to data from the Wales Electronic Cohort for Children. The primary outcome was the Core Subject Indicator reflecting educational achievement at key stages 2 (school years 3–6), 3 (school years 7–9) and 4 (school years 10–11). Covariates in models included demographic, birth, injury and school characteristics.ResultsEducational achievement of children was negatively associated with: pedestrian injuries (adjusted risk ratio, (95% CIs)) (0.87, (0.83 to 0.92)), cyclist (0.96, (0.94 to 0.99)), high fall (0.96, (0.94 to 0.97)), fire/flames/smoke (0.85, (0.73 to 0.99)), cutting/piercing object (0.96, (0.93 to 0.99)), intentional self-harm (0.86, (0.82 to 0.91)), minor traumatic brain injury (0.92, (0.86 to 0.99)), contusion/open wound (0.93, (0.91 to 0.95)), fracture of vertebral column (0.78, (0.64 to 0.95)), fracture of femur (0.88, (0.84 to 0.93)), internal abdomen/pelvic haemorrhage (0.82, (0.69 to 0.97)), superficial injury (0.94, (0.92 to 0.97)), young maternal age (<18 years: 0.91, (0.88 to 0.94); 19–24 years: 0.94, (0.93 to 0.96)); area based socioeconomic status (0.98, (0.97 to 0.98)); moving to a more deprived area (0.95, (0.93 to 0.97)); requiring special educational needs (0.46, (0.44 to 0.47)). Positive associations were: being female (1.04, (1.03 to 1.06)); larger pupil school sizes and maternal age 30+ years.ConclusionThis study highlights the importance on a child’s education of preventing injuries and implementing intervention programmes that support injured children. Greater attention is needed on equity-focused educational support and social policies addressing needs of children at risk of underachievement, including those from families experiencing poverty.VIBES-Junior Study protocolhttp://dx.doi.org/10.1136/bmjopen-2018-024755
As low as reasonably practicable (ALARP): a moral model for clinical risk management in the setting of technology dependence
Authors: Turnham Helen Lynne , Bowen Sarah-Jane , Ramdas Sitara , Smith Andrew , Wilkinson Dominic , Harrop Emily 
Published: December 2023

Children dependent on life-prolonging medical technology are often subject to a constant background risk of sudden death or catastrophic complications. Such children can be cared for in hospital, in an intensive care environment with highly trained nurses and doctors able to deliver specialised, life-saving care immediately. However, remaining in hospital, when life expectancy is limited, can considered to be a harm in of itself. Discharge home offers the possibility for an improved quality of life for the child and their family but comes with significant medical risks.When making decisions for children, two ethical models predominate, the promotion of the child’s best interests or the avoidance of harm. However, in some circumstances, particularly for children with life-limiting and/or life-threatening illness, all options may be associated with risk. There are no good options, only potentially harmful choices.In this paper, we explore decisions made by one family in such circumstances. We describe a model adopted from risk management programmes beyond medicine, which offers a potential framework for identifying risks to the child that are morally permissible. Some risks and harms to a child, not ordinarily permitted, may be acceptable when undertaken in the pursuit of a specified desired good, so long as they are as low as reasonably practicable.
Cardiac MR modelling of systolic and diastolic blood pressure
Authors: Assadi Hosamadin , Matthews Gareth , Zhao Xiaodan , Li Rui , Alabed Samer , Grafton-Clarke Ciaran , Mehmood Zia , Kasmai Bahman , Limbachia Vaishali , Gosling Rebecca , Yashoda Gurung-Koney , Halliday Ian , Swoboda Peter , Ripley David Paul , Zhong Liang , Vassiliou Vassilios S , Swift Andrew J , Geest Rob J van der , Garg Pankaj 
Published: December 2023

AimsBlood pressure (BP) is a crucial factor in cardiovascular health and can affect cardiac imaging assessments. However, standard outpatient cardiovascular MR (CMR) imaging procedures do not typically include BP measurements prior to image acquisition. This study proposes that brachial systolic BP (SBP) and diastolic BP (DBP) can be modelled using patient characteristics and CMR data.MethodsIn this multicentre study, 57 patients from the PREFER-CMR registry and 163 patients from other registries were used as the derivation cohort. All subjects had their brachial SBP and DBP measured using a sphygmomanometer. Multivariate linear regression analysis was applied to predict brachial BP. The model was subsequently validated in a cohort of 169 healthy individuals.ResultsAge and left ventricular ejection fraction were associated with SBP. Aortic forward flow, body surface area and left ventricular mass index were associated with DBP. When applied to the validation cohort, the correlation coefficient between CMR-derived SBP and brachial SBP was (r=0.16, 95% CI 0.011 to 0.305, p=0.03), and CMR-derived DBP and brachial DBP was (r=0.27, 95% CI 0.122 to 0.403, p=0.0004). The area under the curve (AUC) for CMR-derived SBP to predict SBP>120 mmHg was 0.59, p=0.038. Moreover, CMR-derived DBP to predict DBP>80 mmHg had an AUC of 0.64, p=0.002.ConclusionCMR-derived SBP and DBP models can estimate brachial SBP and DBP. Such models may allow efficient prospective collection, as well as retrospective estimation of BP, which should be incorporated into assessments due to its critical effect on load-dependent parameters.