bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the impact of diverse mask types on COPD patients: a randomised controlled trial study protocol
Authors: Chen Xuwen , Jiang Xiaomei , Zhang Xuhui , Ren Dong , Wei Caihong , Xu Aihong , Yang Hong , Bai Ruijia , Li Caiyun , Yue Feiyan , Bao Shisan , Shi Jungang , Fan Jingchun 
Published: January 2024

IntroductionWearing masks has proven beneficial in preventing respiratory pathogen infections in individuals with chronic obstructive pulmonary disease (COPD). However, the impact of different mask types on physiological indicators and daily physical activity in COPD patients remains uncertain. This study aims to assess the immediate effects of various mask types on cardiopulmonary function indicators, subjective perceptions and the 6-minute walking distance (6MWD) in individuals with COPD.Methods and analysisThis randomised controlled trial will enrol 129 stable COPD patients. Participants will be randomly divided into three groups: control, N95 mask and surgical mask groups. Each group will undergo both a 6-minute seated test and a 6-minute walk test (6MWT), without or with their respective masks. A 10-minute interval will be provided between the two phases. The primary indicators of the study include the 6MWD and blood oxygen saturation. Secondary outcomes encompass blood pressure, pulse rate, Borg score, Rate of Perceived Exertion (RPE) score and subjective perception score. Oxygen saturation, pulse rate and blood pressure will be recorded four times during the trial, while Borg and RPE scores will be compared before and after the 6MWT. Additionally, subjective perception scores will be collected after each mask-wearing stage.Ethics and disseminationThis study has received approval from the Ethics Committee of the Affiliated Hospital of Gansu University of Chinese Medicine (approval number: 202335). We plan to disseminate research results through publication in a peer-reviewed journal or presentation at a conference.Trial registration numberChiCTR2300074554.
Reduction of hospital length of stay through the implementation of SAFER patient flow bundle and Red2Green days tool: a pre–post study
Authors: Benevides Santos Paiva Mariana , de Gouvêa Viana Luciana , Melo de Andrade Marcus Vinícius 
Published: January 2024

BackgroundIn 2018, the National Health System released the ‘Guide to reducing long hospital stays’ to stimulate improvement and decrease length of stay (LOS) in England hospitals. The SAFER patient flow bundle and Red2Green tool were described as strategies to be implemented in inpatient wards to reduce discharge delays.ObjectiveTo verify if implementing the SAFER patient flow bundle and Red2Green days tool is associated with LOS reduction in the internal medicine unit (IMU) wards of a university hospital in Brazil.MethodsIn this pre post study, we compared the LOS of patients discharged from the IMU wards in 2019, during the implementation of the SAFER bundle and Red2Green tool, to the LOS of patients discharged in the same period in 2018. The Diagnosis-Related Group Brazil algorithm compared groups according to complexity and resource requirements. In-hospital mortality, readmission rates, the number of hospital acquired conditions and the number and causes of inappropriate hospital days were also evaluated.ResultsTwo hundred and eight internal medicine patients were discharged in 2018, and 252 were discharged in 2019. The median hospital LOS was significantly lower during the intervention period (14.2 days (IQR, 8–23) vs 19 days (IQR, 12–32); p<0.001). In-hospital mortality, 30-day mortality, readmission in 30 days and the number of hospital acquired conditions were the same between groups. Of the 3350 patient days analysed, 1482 (44.2%) were classified as green and 1868 (55.8%) as red. The lack of senior review was the most frequent cause of a red day (42.4%).ConclusionThe SAFER patient flow bundle and Red2Green days tool implementation were associated with a significant decrease in hospital LOS in a university hospital IMU ward. There is a considerable improvement opportunity for hospital LOS reduction by changing the multidisciplinary team’s attitude during patient hospitalisation using these strategies.
Person-centred quality indicators are associated with unplanned care use following hospital discharge
Authors: Kemp Kyle , Steele Brian , Ahmed Sadia , Fairie Paul , Santana Maria 
Published: January 2024

ObjectivePerformance indicators are used to evaluate the quality of healthcare services. The majority of these, however, are derived solely from administrative data and rarely incorporate feedback from patients who receive services. Recently, our research team developed person-centred quality indicators (PC-QIs), which were co-created with patients. It is unknown whether these PC-QIs are associated with unplanned healthcare use following discharge from hospital.DesignA retrospective, cross-sectional study.MethodsSurvey responses were obtained from April 2014 to September 2020 using the Canadian Patient Experiences Survey - Inpatient Care instrument. Logistic regression models were used to predict the link between eight PC-QIs and two outcomes; unplanned readmissions within 30 days and emergency department visits within 7 days.ResultsA total of 114 129 surveys were included for analysis. 6.0% of respondents (n=6854) were readmitted within 30 days, and 9.9% (n=11 287) visited an emergency department within 7 days of their index discharge. In adjusted models, ‘top box’ responses for communication between patients and physicians (adjusted OR (aOR)=0.82, 95% CI: 0.77 to 0.88), receiving information about taking medication (aOR=0.86, 95% CI: 0.80 to 0.92) and transition planning at hospital discharge (aOR=0.79, 95% CI: 0.73 to 0.85) were associated with lower odds of emergency department visit.Likewise, ‘top box’ responses for overall experience (aOR=0.87, 95% CI: 0.82 to 0.93), communication between patients and physicians (aOR=0.73, 95% CI: 0.67 to 0.80) and receiving information about taking medication (aOR=0.90, 95% CI: 0.83 to 0.98), were associated with lower odds of readmission.ConclusionsThis study demonstrates that patient reports of their in-hospital experiences may have value in predicting future healthcare use. In developing the PC-QIs, patients indicated which elements of their hospital care matter most to them, and our results show agreement between subjective and objective measures of care quality. Future research may explore how current readmission prediction models may be augmented by person-reported experiences.
National and provincial prevalence of self-reported diabetes: results from the cross-sectional Demographic and Health Survey in Sri Lanka–2016
Authors: Munasinghe Harshana , Dissanayaka Pansujee , Jayasundara Mangalika , Nugawela Manjula D , Sivaprasad Sobha 
Published: January 2024

IntroductionDiabetes is a major global public health burden. The objective of this study was to estimate the national and provincial-level prevalence of self-reported diabetes and establish the demographic risk factors of diabetes in Sri Lanka.Research design and methodsA nationally representative sample of the population from all nine provinces in Sri Lanka was obtained from the cross-sectional Demographic and Health Survey 2016. Those aged 20 years and older were included in this study. Age, sex, ethnicity, religion, education level, marital status, sector of the resident (urban/rural/estate) and province of residence were included as potential exposures. The outcome was defined as self-reported diabetes.ResultsThe age-adjusted national prevalence of self-reported diabetes was 10.60% (95% CI: 10.59% to 10.602%). Provinces with higher gross domestic product (GDP) per capita showed a higher prevalence of diabetes. The Western province with the highest GDP of 734 094 Sri Lankan rupee showed the highest prevalence of diabetes (13.3%; 95% CI: 13.32% to 13.34%) compared with 8.1% (95% CI: 8.54% to 8.58%) in the Northern province with lowest GDP (321 289 Sri Lankan rupee). Prevalence of diabetes was higher among residents living in urban areas (14.39%; 95% CI: 13.72% to 15.06%) compared with their counterpart. Other risk factors of self-reported diabetes included age, gender, ethnicity, education level and marital status with those aged 55–64 years, females, who belong to Moor ethnicity, had secondary or higher education, and divorced or widowed had higher risk of diabetes compared with their counterparts.ConclusionsSri Lanka has a high prevalence of self-reported diabetes and it differs by province, sector of residence, sex, education level, ethnicity, age and marital status. There is a need for risk stratifying adult Sri Lankan population to help target those at high risk of diabetes so that cost-effective approaches of screening, preventive and treatment options can be initiated.
Characterising COVID-19 school and childcare outbreaks in Canada in 2021: a surveillance study
Authors: Patterson Kaitlin , McGill Erin , Dam Demy , Bellos Anna , Coulby Cameron Mark , McCormick Rachel 
Published: January 2024

BackgroundIn January 2021, the Public Health Agency of Canada launched the Canadian COVID-19 Outbreak Surveillance System to monitor outbreaks by setting. Schools and childcare centres were identified as settings of interest, as children play a key role in the transmission chain of other respiratory illnesses. This paper describes outbreak trends observed in school and childcare settings from January to December 2021 when many public health measures were in place.MethodsSchool and childcare outbreak data from five jurisdictions were included, representing 76% of the total Canadian population. Epidemiological curves were generated, trends in outbreak settings and cases’ age distribution over time were examined and descriptive statistics on outbreak size were calculated.ResultsIn 2021, most school and childcare outbreaks were in primary schools (42%). Severity was low in school and childcare settings (0.40% of outbreak cases hospitalised, <0.01% of outbreak cases deceased). Most school and childcare outbreaks reported fewer than 10 cases per outbreak. During the start of the 2021–2022 school year (September 2021), there were fewer outbreaks in secondary schools and fewer cases among those aged 12+ years compared with January–June of 2021.ConclusionDuring the study period, there was no observed association between an increase in school and childcare outbreaks and an increase in incidence rates in community case data. Children remain a population of interest for SARS-CoV-2; however, severity in paediatric populations remained low throughout 2021 and the risk of transmission in Canadian schools was low.
Impact of the COVID-19 pandemic on young people living with HIV in Lesotho: a qualitative study
Authors: Shepherd Thomas , Robinson Michelle E , Ramaema Maema , Rakuoane Moraoetsi , Moletsane Ntoli , Mpholo Rafiloe , Mallen Christian , Leigh Graham 
Published: January 2024

IntroductionThere is a growing body of research evidencing the detrimental impact of the COVID-19 pandemic on the mental health and well-being of young people. This impact may be worse in low-resource settings, especially those in sub-Saharan Africa, where pandemic impacts may be exacerbated by poverty, limited healthcare access and other health epidemics including HIV. We explored the COVID-19 pandemic impacts on young people living with HIV in Lesotho to understand the experiences of HIV management, well-being, financial stability and education status.MethodsThirty-one semistructured, face-to-face interviews were conducted with young people aged 15–19 years of age living with HIV from eight districts across Lesotho. Interviews were conducted in Sesotho, audio-recorded, later transcribed and translated to English prior to analysis. Analysis consisted of a thematic analysis using principles of constant comparison to explore key and emerging themes.ResultsAnalysis revealed five major themes: ‘financial instability and food insecurity’, ‘challenges to health and well-being’, ‘changing relationship dynamics’, ‘loss of educational opportunities’ and ‘understanding the threat of COVID-19’.ConclusionsWhile participants discussed being able to access antiretroviral therapy, this study highlights the significant impact of the COVID-19 pandemic and associated lockdown measures on the mental health and well-being, financial stability and educational development of young people living with HIV in Lesotho.
Sleeplessness and incident diabetes above the Arctic circle: a secondary analysis of cohort data from the Tromsø Study
Authors: Uthaikhaifar Nick Chindanai , Iakunchykova Olena , Cook Sarah , Warren-Gash Charlotte 
Published: January 2024

IntroductionCircadian misalignment and sleep quality are intertwined processes that are both associated with diabetes. The association between sleep quality and incident diabetes has not been previously investigated in populations living at polar latitudes who experience extreme seasonal daylight variation and may be at greater risk of circadian misalignment. Using data from adult residents of Tromsø, Norway, this study investigates the association of poor sleep quality, as indicated by self-reported sleeplessness, and incident diabetes above the Arctic circle.Research design and methodsSecondary analysis of cohort data from the Tromsø Study. The study cohort consists of adults who attended both the fourth (Tromsø4) and seventh (Tromsø7) surveys conducted in 1995 and 2016, respectively. Only individuals with complete data were included. Multivariable logistic regression was used to examine the association between sleeplessness measured in Tromsø4 and incident diabetes measured in participants followed up to Tromsø7, adjusted for other diabetes risk factors.ResultsAmong 10 875 individuals (mean 41 years of age at baseline, 53.6% women), 21.2% (n=2302) reported experiencing sleeplessness at baseline. Diabetes incidence risk over follow-up (20 years) was 7.2% (n=784); incidence risk among individuals reporting sleeplessness was 8.8%, compared with 6.8% among unexposed individuals. After adjustment, sleeplessness-exposed individuals in the study cohort were found to have 23% greater odds (ORadj1.23, 95% CI 1.03 to 1.47, p=0.022) of incident diabetes.ConclusionsSleep quality is associated with incident diabetes in a population living above the Arctic circle. The direction and strength of association is consistent with findings from other geographical regions.
Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units
Authors: Selinger Christian , Bottle Alex , Lamb Christopher A , Ainley Rachel , Wakeman Ruth , Hawthorne Barney 
Published: January 2024

BackgroundKey performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI.MethodsIBD emergency admissions for 2018–2019 from Hospital Episodes Statistics for England were compared per population and per IBD cases with patient-reported quality of care from the IBD Patient Survey 2019. Patient-reported accident and emergency (A&E) attendances and hospital admissions for IBD were also compared with patient-reported quality of care.ResultsFor 124 IBD services within England we found only a weak and not statistically significant correlation between IBD admissions per 100 000 population and patient-rated quality of care (Spearman’s rho=0.171; p=0.057). Similarly, there was no significant correlation between IBD admissions per case and patient-rated quality of care (Spearman’s rho=0.164; p=0.113). Patients with ≥2 A&E attendances (OR: 0.72, 95% CI: 0.57 to 0.91; p<0.001) were less likely to report quality of IBD care as good or very good compared with those without A&E attendances. Patients with ≥2 admissions were less likely to rate their care as good or very good (OR: 0.75, 95% CI: 0.65 to 0.88; p<0.0001) compared with those without hospital admissions.ConclusionsThere is a clear association for individual patients with ≥2 admissions or A&E attendances with a lower perceived quality of care. In contrast we found no correlation on a per-unit basis for IBD admissions derived from Hospital Episode Statistics with patient-assessed quality of care. Further work is required to determine whether hospital admissions could be a useful KPI for IBD.
Attitudes, beliefs, behaviours and perspectives on barriers and enablers of Australian general practitioners towards non-drug interventions: a national survey
Authors: Albarqouni Loai , Greenwood Hannah , Dowsett Caroline , Hoffmann Tammy , Thomas Rae , Glasziou Paul 
Published: January 2024

BackgroundMany guidelines recommend non-drug interventions (NDIs) for managing common conditions in primary care. However, compared with drug interventions, NDIs are less widely known, promoted and used. We aim to (1) examine general practitioners’ (GPs’) knowledge, attitudes and practices for NDIs, including their use of the Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions (HANDI), and (2) identify factors influencing their use of NDIs and HANDI.MethodsWe conducted a web-based cross-sectional survey of practicing GP members in Australia during October–November 2022. The survey contained five sections: characteristics of GP; knowledge and use of NDIs; attitudes towards NDIs; barriers and enablers to using HANDI; and suggestions of NDIs and ideas to improve the uptake of NDIs in primary care.ResultsOf the 366 GPs who completed the survey, 242 (66%) were female, and 248 (74%) were ≥45 years old. One in three GPs reported that they regularly (‘always’) recommend NDIs to their patients when appropriate (34%), whereas one-third of GPs were unaware of HANDI (39%). GPs identified several factors that improve the uptake of HANDI, including ‘access and integration of HANDI in clinical practice’, ‘content and support to use in practice’ and ‘awareness and training’.ConclusionsWhile many GPs are aware of the effectiveness of NDIs and often endorse their use, obstacles still prevent widespread adoption in primary care. The results of this survey can serve as a foundation for developing implementation strategies to improve the uptake of effective evidence-based NDIs in primary care.
Endothelial Activation and Stress Index (EASIX) to predict mortality after allogeneic stem cell transplantation: a prospective study
Authors: Penack Olaf , Luft Thomas , Peczynski Christophe , Benner Axel , Sica Simona , Arat Mutlu , Itäla-Remes Maija , Corral Lucia López , Schaap Nicolaas P M , Karas Michal , Raida Ludek , Schroeder Thomas , Dreger Peter , Metafuni Elisabetta , Ozcelik Tulay , Sandmaier Brenda M , Kordelas Lambros , Moiseev Ivan , Schoemans Hélène , Koenecke Christian , Basak Grzegorz W , Peric Zinaida 
Published: January 2024

BackgroundWe previously reported that the “Endothelial Activation and Stress Index” (EASIX; ((creatinine×lactate dehydrogenase)÷thrombocytes)) measured before start of conditioning predicts mortality after allogeneic hematopoietic stem cell transplantation (alloSCT) when used as continuous score. For broad clinical implementation, a prospectively validated EASIX-pre cut-off is needed that defines a high-risk cohort and is easy to use.MethodIn the current study, we first performed a retrospective cohort analysis in n=2022 alloSCT recipients and identified an optimal cut-off for predicting non-relapse mortality (NRM) as EASIX-pre=3. For cut-off validation, we conducted a multicenter prospective study with inclusion of n=317 first alloSCTs from peripheral blood stem cell in adult patients with acute leukemia, lymphoma or myelodysplastic syndrome/myeloproliferative neoplasms in the European Society for Blood and Marrow Transplantation network.ResultsTwenty-three % (n=74) of alloSCT recipients had EASIX-pre ≥3 taken before conditioning. NRM at 2 years was 31.1% in the high EASIX group versus 11.5% in the low EASIX group (p<0.001). Patients with high EASIX-pre also had worse 2 years overall survival (51.6% vs 70.9%; p=0.002). We were able to validate the cut-off and found that EASIX ≥3 was associated with more than twofold increased risk for NRM in multivariate analysis (HR=2.18, 95% CI 1.2 to 3.94; p=0.01). No statistically significant difference could be observed for the incidence of relapse.ConclusionsThe results of this study provide a prospectively validated standard laboratory biomarker index to estimate the transplant-related mortality risk after alloSCT. EASIX ≥3 taken before conditioning identifies a population of alloSCT recipients who have a more than twofold increased risk of treatment-related mortality.
Double microcatheter reduction using partially deployed Atlas stents in treating a large dysplastic MCA bifurcation aneurysm with Y stent assisted coiling
Authors: Gaub Michael , Leary Jonathan , Birnbaum Lee A , Al Saiegh Fadi , Mascitelli Justin R 
Published: January 2024

Treatment of large dysplastic middle cerebral artery (MCA) aneurysms can be challenging.1 2 Catheterization of M2 branches at hyperacute angles often requires an ‘around the world’ approach/microcatheter reduction, which can be accomplished with rapid pull,3 balloon anchor,4 and stent anchor5 techniques. In this video video 1, Atlas stents (Stryker) are used for double microcatheter reduction along with Y stent assisted coil embolization (Video 1). Steps include (1) catheterization of the more difficult M2 branch with ‘around the world’ maneuver; (2) reduction/stent deployment; (3) similar catheterization of the second M2 branch; (4) microcatheter reduction/stent deployment; (5) coil embolization (jailed). Important nuances include: (1) low threshold for a staged procedure; (2) awareness of the possibility of stent twisting; (3) jailed coiling. Final views show adequate treatment of the aneurysm dome with stent protection of the dysplastic neck without thromboembolic complications. Given the residual near the base, close angiographic follow-up is important.

Video 1

Technical video demonstrating double stent reduction technique