bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantifying the impact of taking medicines for primary prevention: a time-trade off study to elicit direct treatment disutility in the UK
Authors: Thompson Alexander , Youn Ji-Hee , Guthrie Bruce , Hainsworth Robert , Donnan Peter , Rogers Gabriel , Morales Daniel , Payne Katherine 
Published: September 2023

BackgroundDirect treatment disutility (DTD) represents an individual’s disutility associated with the inconvenience of taking medicine over a long period of time.ObjectivesThe main aim of this study was to elicit DTD values for taking a statin or a bisphosphonate for primary prevention. A secondary aim was to understand factors which influence DTD values.MethodsDesign:We used a cross-sectional study consisting of time-trade off exercises embedded within online surveys. Respondents were asked to compare a one-off pill (‘Medicine A’) assumed to have no inconvenience and a daily pill (‘Medicine B’) over 10 years (statins) or 5 years (bisphosphonates).Setting:Individuals from National Health Service (NHS) primary care and the general population were surveyed using an online panel company.Participants:Two types of participants were recruited. First, a purposive sample of patients with experience of taking a statin (n=260) or bisphosphonate (n=100) were recruited from an NHS sampling frame. Patients needed to be aged over 30, have experience of taking the medicine of interest and have no diagnosis of dementia or of using dementia drugs. Second, a demographically balanced sample of members of the public were recruited for statins (n=376) and bisphosphonates (n=359).Primary and secondary outcome measures:Primary outcome was mean DTD. Regression analysis explored factors which could influence DTD values.ResultsA total of 879 respondents were included for analysis (514 for statins and 365 for bisphosphonates). The majority of respondents reported a disutility associated with medicine use. Mean DTD for statins was 0.034 and for bisphosphonates 0.067, respectively. Respondent characteristics including age and sex did not influence DTD. Experience of bisphosphonate-use reduced reported disutilities.ConclusionsStatins and bisphosphonates have a quantifiable DTD. The size of estimated disutilities suggest they are likely to be important for cost-effectiveness, particularly in individuals at low-risk when treated for primary prevention.
Game-supported cognitive strategy training for slowed information processing speed after acquired brain injury: study protocol for a randomised controlled trial
Authors: Abelmann Amy C , Kessels Roy P C , Brazil Inti A , Fasotti Luciano , Bertens Dirk 
Published: September 2023

IntroductionMany individuals with acquired brain injury tend to experience problems with slowed information processing speed (IPS). A potentially beneficial and cost-effective supplement for cognitive rehabilitation of impaired IPS may be the implementation of serious gaming that focuses on compensatory learning as part of cognitive training. However, most digital platforms used during cognitive rehabilitation focus on restoring cognitive function and evidence for skill transfer from digital practice to everyday life is lacking. This study aims to investigate the efficacy of a game-supported cognitive strategy training. The training combines a well-validated time pressure management cognitive strategy training, targeting slowed IPS, with a novel game and a mobile application. The game-supported training focuses on the generalisation of strategy-use to untrained tasks in everyday life.Methods and analysisThe study is designed as a randomised controlled trial in which the experimental group (Karman Line — Tempo module: an 8-week game-supported cognitive strategy training) will be compared with an active control group (CogniPlus training: an 8-week computerised cognitive function training). Data from 60 individuals with acquired brain injury (30 per group, ages between 16 and 75) will be collected at baseline (T0), post-treatment (T1) and at 3-month follow-up (T2). The primary outcome measure is an objective assessment of compensatory strategy use in an untrained experimental task. The secondary outcome is the attainment of trained and untrained treatment goals assessed by goal attainment scaling. Pre-training and post-training data will be analysed using a 2×2 repeated measure analysis of variance.Ethics and disseminationThis study has been approved by the medical review ethics committee CMO Region Arnhem and Nijmegen (NL74818.091.20) and is registered in the Netherlands Trial Register. Research findings will be published in peer-reviewed journals and presented at conferences.Trial registration numberNL9437; The Netherlands Trial Register.
Can the date of last menstrual period be trusted in the first trimester? Comparisons of gestational age measures from a prospective cohort study in six low-income to middle-income countries
Authors: Patel Archana , Bann Carla M , Thorsten Vanessa R , Rao Sowmya R , Lokangaka Adrien , Tshefu Kitoto Antoinette , Bauserman Melissa , Figueroa Lester , Krebs Nancy F , Esamai Fabian , Bucher Sherri , Saleem Sarah , Goldenberg Robert L , Chomba Elwyn , Carlo Waldemar A , Goudar Shivaprasad , Derman Richard , Koso-Thomas Marion , McClure Elizabeth , Hibberd Patricia L 
Published: September 2023

ObjectivesWe examined gestational age (GA) estimates for live and still births, and prematurity rates based on last menstrual period (LMP) compared with ultrasonography (USG) among pregnant women at seven sites in six low-resource countries.DesignProspective cohort studySetting and participantsThis study included data from the Global Network’s population-based Maternal and Newborn Health Registry which follows pregnant women in six low-income and middle-income countries (Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan and Zambia). Participants in this analysis were 42 803 women, including their 43 230 babies, who registered for the study in their first trimester based on GA estimated either by LMP or USG and had a live or stillbirth with an estimated GA of 20–42 weeks.Outcome measuresGA was estimated in weeks and days based on LMP and/or USG. Prematurity was defined as GA of 20 weeks+0 days through 36 weeks+6 days, calculated by both USG and LMP.ResultsOverall, average GA varied ≤1 week between LMP and USG. Mean GA for live births by LMP was lower than by USG (adjusted mean difference (95% CI) = −0.23 (–0.29 to –0.17) weeks). Among stillbirths, a higher GA was estimated by LMP than USG (adjusted mean difference (95% CI)= 0.42 (0.11 to 0.72) weeks). Preterm birth rates for live births were significantly higher when dated by LMP (adjusted rate difference (95% CI)= 4.20 (3.56 to 4.85)). There was no significant difference in preterm birth rates for stillbirths.ConclusionThe small differences in GA for LMP versus USG in the Guatemalan and Indian sites suggest that LMP may be a useful alternative to USG for GA dating during the first trimester until availability of USG improves in those areas. Further research is needed to assess LMP for first-trimester GA dating in other regions with limited access to USG.Trial registration numberNCT01073475.
Safety and efficacy of steerable versus non-steerable sheaths for catheter ablation of atrial fibrillation systematic review and meta-analysis
Authors: Jin Xinyao , Zhou Yuqing , Wu Yuanhong , Xie Mingbin 
Published: September 2023

ObjectivesWith the development of radiofrequency (RF) ablation technology. In recent years, more and more patients with atrial fibrillation (AF) have been treated with RF ablation. Steerable sheaths (SS) have been widely used in RF ablation of AF. The aim of this meta-analysis was to compare the efficacy and safety of AF ablation using SS and non-steerable sheaths (NSS).MethodsFrom the beginning to March 2022, we conducted a comprehensive, systematic search of the databases PubMed, MEDLINE, EMBASE, Web of Science and the Cochrane Library to finish the study. For categorical and continuous data, we used ORs and mean difference to calculate the effect. We also estimated the 95% CI.ResultsFive studies of RF ablation of AF were selected, three prospective and two retrospective, involving 282 SS and 236 NSS ablation patients. The rate of recurrence of AF or atrial arrhythmias was 27.3% versus 42.8% (OR: 0.52, 95% CI 0.36, 0.76, z=3.41, p=0.0006) and acute pulmonary vein (PV) reconnection (8.7% vs 17.4%, OR: 0.47, 95% CI 0.23, 0.95, z=2.10, p=0.04). In the SS group and the NSS group, the total ablation time (p=0.25), fluoroscopy time (p=0.26) and total operative time (p=0.35) were not significantly different.ConclusionsCompared with the use of NSS, the use of SS for RF ablation of AF can effectively reduce the recurrence rate of AF and the occurrence of acute PVs reconnection events. However, there is no advantage in shortening the total RF time, fluoroscopy time, total surgical time and reducing complications.
Qualitative process evaluation of the EmpaTeach intervention to reduce teacher violence in schools in Nyarugusu Refugee Camp, Tanzania
Authors: Bakari Mtumwa , Shayo Elizabeth H , Barongo Vivien , Kiwale Zenais , Fabbri Camilla , Turner Ellen , Eldred Emily , Mubyazi Godfrey M , Rodrigues Katherine , Devries Karen 
Published: September 2023

ObjectiveWe explored the experiences and perceptions of school staff and students with the EmpaTeach intervention to prevent teachers’ violence against school students.DesignThis qualitative study involved in-depth interviews with 58 and 39 participants at midline and endline, respectively, with Burundian and Congolese intervention schools in Nyarugusu refugee camp. They comprised three education coordinators of primary and secondary schools, 29 EmpaTeach intervention coordinators, 14 stakeholders including headteachers and discipline teachers, 25 classroom teachers and 26 students. Thematic analysis was used to develop codes by examining the content of quotes to capture key themes in line with the key elements of the programme theory.ResultsCoordinators and teachers widely reported positive experiences with the EmpaTeach programme. The intervention sessions enabled teachers to reflect on their own values and experiences of corporal punishment and equipped them with useful and acceptable classroom management and alternative discipline strategies. Teachers adopted the use of counselling, praise and reward, and joint discussions with students and parents. On the other hand, several teachers reported persistent use of corporal punishment which they attributed to children’s (mis)behaviours and strong beliefs that beating was a positive approach to disciplining students.ConclusionThe majority of coordinators and teachers widely accepted the EmpaTeach intervention as it offered useful and relevant knowledge and skills on alternative disciplinary methods. Students noticed some positive changes on the way they were being disciplined by teachers, where non-violent methods were used. Further research is needed to understand how violence prevention interventions can successfully lead to reductions in violence in fragile settings.Trial registration numberNCT03745573.
Parents’ experiences and need for social support after pregnancy termination for fetal anomaly: a qualitative study in China
Authors: Sun Shiwen , Sun Yaping , Qian Jialu , Tian Yanping , Wang Fang , Yu Qing , Yu Xiaoyan 
Published: September 2023

ObjectiveThe aim of this study was to explore the experiences and need for social support of Chinese parents after termination of pregnancy for fetal anomalies.DesignA qualitative study using semistructured, in-depth interviews combined with observations. Data were analysed by Claizzi’s phenomenological procedure.SettingA large, tertiary obstetrics and gynaecology hospital in China.ParticipantsUsing purposive sampling approach, we interviewed 12 couples and three additional women (whose spouses were not present).ResultsFour themes were identified from the experiences of parents: the shock of facing reality, concerns surrounding termination of pregnancy, the embarrassment of the two-child policy and the urgent need for social support.ConclusionParents experienced complicated and intense emotional reactions, had concerns surrounding the termination of pregnancy and an urgent need for social support. Paternal psychological reactions were often neglected by healthcare providers and the fathers, themselves. These findings suggest that both mothers and fathers should receive appropriate support from family, medical staff and peers to promote their physical and psychological rehabilitation.
Distinctive model for HIV index testing (IT) in Eastern Europe: results of Ukraine’s physician-led, integrated IT programme
Authors: Ihnatiuk Alyona P , Shapoval Anna Y , Kazanzhy Anna P , Kuzin Igor V , Riabokon Sergii V , Shotorbani Solmaz , McDowell Misti R , Golden Matthew R , Puttkammer Nancy H 
Published: September 2023

ObjectivesThe effectiveness of HIV index testing (IT) in Eastern Europe has not been described. This study reports the performance of a scaled IT programme in Ukraine.DesignThis observational study included clients enrolled in IT services in 2020, and used routinely collected data from programme registers and the national electronic health record system.SettingThe study covered 39 public-sector health facilities where IT services were integrated into medical visits for persons living with HIV (PLHIV) already enrolled in HIV care.ParticipantsParticipants included PLHIV with both recent (<6 months) and previously established (≥6 months) HIV diagnoses.InterventionUkraine’s physician-led IT model involves a cascade of steps including voluntary informed consent, partner elicitation, selection of partner notification method and follow-up with clients to ensure partners are notified, tested for HIV and linked to HIV prevention and treatment services, as needed.Primary and secondary outcome measuresOutcomes included contact index, testing, index and HIV case-finding index disaggregated by index client (IC) subgroups, including people with current or past injection drug use (PWID) and men who have sex with men (MSM).ResultsOf 14 525 ICs offered index testing, 51.9% accepted, of whom 98.3% named at least one sexual, injection or biological child partner. In total, 14.9% of ICs were PWID and 3.5% were MSM. Clients named 8448 unique partners (contact index=1.14). HIV case finding averaged 0.14 cases per client, and was highest among clients with recent HIV diagnosis (0.29) and among PWID (0.23), and lower among clients with established HIV diagnosis (0.07). More than 90% of all partners with new HIV diagnoses were linked to care.ConclusionsThere was a high case-finding index among ICs with recent HIV and high linkage to care for all partners, demonstrating the effectiveness of this integrated, physician-led model implemented in 39 health facilities in Ukraine.
Health data ecosystem in Pakistan: a multisectoral qualitative assessment of needs and opportunities
Authors: Mahmood Sana , Noorali Ali Aahil , Manji Afshan , Afzal Noreen , Abbas Saadia , Qamar Javeria Bilal , Siddiqi Sameen , Hoodbhoy Zahra , Virani Salim S , Bhutta Zulfiqar A , Samad Zainab 
Published: September 2023

ObjectiveData are essential for tracking and monitoring of progress on health-related sustainable development goals (SDGs). But the capacity to analyse subnational and granular data is limited in low and middle-income countries. Although Pakistan lags behind on achieving several health-related SDGs, its health information capacity is nascent. Through an exploratory qualitative approach, we aimed to understand the current landscape and perceptions on data in decision-making among stakeholders of the health data ecosystem in Pakistan.DesignWe used an exploratory qualitative study design.SettingThis study was conducted at the Aga Khan University, Karachi, Pakistan.ParticipantsWe conducted semistructured, in-depth interviews with multidisciplinary and multisectoral stakeholders from academia, hospital management, government, Non-governmental organisations and other relevant private entities till thematic saturation was achieved. Interviews were recorded and transcribed, followed by thematic analysis using NVivo.ResultsThematic analysis of 15 in-depth interviews revealed three major themes: (1) institutions are collecting data but face barriers to its effective utilisation for decision-making. These include lack of collection of needs-responsive data, lack of a gender/equity in data collection efforts, inadequate digitisation, data reliability and limited analytical ability; (2) there is openness and enthusiasm for sharing data for advancing health; however, multiple barriers hinder this including appropriate regulatory frameworks, platforms for sharing data, interoperability and defined win-win scenarios; (3) there is limited capacity in the area of both human capital and infrastructure, for being able to use data to advance health, but there is appetite to improve and invest in capacity in this area.ConclusionsOur study identified key areas of focus that can contribute to orient a national health data roadmap and ecosystem in Pakistan.
Resilience perspective on healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis
Authors: Knutsen Glette Malin , Ludlow Kristiana , Wiig Siri , Bates David Westfall , Austin Elizabeth E 
Published: September 2023

ObjectiveTo identify, review and synthesise qualitative literature on healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic.DesignSystematic review with meta-synthesis.Data sourcesAcademic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus.Eligibility criteriaQualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic.Data extraction and synthesisData were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis.ResultsForty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services.ConclusionHealthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals’ experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.
Healthcare resilience: a meta-narrative systematic review and synthesis of reviews
Authors: Tan Mark Z Y , Prager Gabrielle , McClelland Andrew , Dark Paul 
Published: September 2023

ObjectivesThe COVID-19 pandemic has tested global healthcare resilience. Many countries previously considered ‘resilient’ have performed poorly. Available organisational and system frameworks tend to be context-dependent and focus heavily on physical capacities. This study aims to explore and synthesise evidence about healthcare resilience and present a unified framework for future resilience-building.DesignSystematic review and synthesis of reviews using a meta-narrative approach.SettingHealthcare organisations and systems.Primary and secondary outcome measuresDefinitions, concepts and measures of healthcare resilience. We used thematic analysis across included reviews to summarise evidence on healthcare resilience.ResultsThe main paradigms within healthcare resilience include global health, disaster risk reduction, emergency management, patient safety and public health. Definitions of healthcare resilience recognise various hierarchical levels: individual (micro), facility or organisation (meso), health system (macro) and planetary or international (meta). There has been a shift from a focus on mainly disasters and crises, to an ‘all-hazards’ approach to resilience. Attempts to measure resilience have met with limited success. We analysed key concepts to build a framework for healthcare resilience containing pre-event, intra-event, post-event and trans-event domains. Alongside, we synthesise a definition which dovetails with our framework.ConclusionResilience increasingly takes an all-hazards approach and a process-oriented perspective. There is increasing recognition of the relational aspects of resilience. Few frameworks incorporate these, and they are difficult to capture within measurement systems. We need to understand how resilience works across hierarchical levels, and how competing priorities may affect overall resilience. Understanding these will underpin interdisciplinary, cross-sectoral and multi-level approaches to healthcare resilience for the future.PROSPERO registration numberCRD42022314729.
Smartphone application-based rehabilitation in patients with chronic respiratory and cardiovascular diseases: a randomised controlled trial study protocol
Authors: Chung Chiwook , Kim Ah-Ram , Jang Il-Young , Jo Min-Woo , Lee Seongho , Kim Dongbum , Kwon Hee , Kang Do-Yoon , Lee Sei Won 
Published: September 2023

IntroductionRehabilitation is well known to improve clinical symptoms and decrease the risk of mortality in patients with chronic respiratory or cardiovascular diseases. We will evaluate the efficacy of smartphone application-based rehabilitation programmes in patients with chronic respiratory or cardiovascular diseases.Methods and analysisThis single-centre single-blind randomised controlled trial will recruit a total of 162 participants from Asan Medical Center (81 patients each for pulmonary and cardiac rehabilitation, respectively). Participants will be assigned to the pulmonary or cardiac rehabilitation groups based on their underlying disease. Participants will be allocated randomly into the intervention or control groups at the ratio of 2:1 (54 and 27 patients). The intervention group will be provided with a smartphone application and undergo smartphone application-based rehabilitation for 12 weeks. The control group will receive the usual outpatient medical treatment without rehabilitation. Participants will be evaluated at baseline and at the end of the rehabilitation. The primary outcomes will be exercise capacity, such as maximal oxygen consumption on cardiopulmonary exercise test for both groups, chronic obstructive pulmonary disease assessment test for the pulmonary rehabilitation group, and Health-related Quality of Life Instrument with 8 Items questionnaires for the cardiac rehabilitation group. The secondary outcomes will include quality of life questionnaires, symptom scores, pulmonary function test and limb muscle test.Ethics and disseminationThe study protocol was approved by the Institutional Review Board of Asan Medical Center. Written informed consent will be obtained from all participants prior to inclusion. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences.Trial registration numberNCT05610358.