bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin treatment in patients with diabetes mellitus and heart failure in the era of new antidiabetic medications
Authors: Staszewsky Lidia , Baviera Marta , Tettamanti Mauro , Colacioppo Pierluca , Robusto Fabio , D'Ettorre Antonio , Lepore Vito , Fortino Ida , Bisceglia Lucia , Attolini Ettore , Graps Elisabetta Anna , Caldo Gianluca , Roncaglioni Maria Carla , Garattini Silvio , Latini Roberto 
Published: March 2022

BackgroundCoexistent heart failure (HF) and diabetes mellitus (DM) are associated with marked morbidity and mortality. Optimizing treatment strategies can reduce the number and severity of events. Insulin is frequently used in these patients, but its benefit/risk ratio is still not clear, particularly since new antidiabetic drugs that reduce major adverse cardiac events (MACEs) and renal failure have recently come into use. Our aim is to compare the clinical effects of insulin in a real-world setting of first-time users, with sodium-glucose cotransporter-2 inhibitor (SGLT-2i), glucagon-like peptide-1 receptor agonist (GLP-1RA) and the other antihyperglycemic agents (other-AHAs).MethodsWe used the administrative databases of two Italian regions, during the years 2010–2018. Outcomes in whole and propensity-matched cohorts were examined using Cox models. A meta-analysis was also conducted combining the data from both regions.ResultsWe identified 34 376 individuals ≥50 years old with DM and HF; 42.0% were aged >80 years and 46.7% were women. SGLT-2i and GLP-1RA significantly reduced MACE compared with insulin and particularly death from any cause (SGLT-2i, hazard ratio (95% CI) 0.29 (0.23 to 0.36); GLP-1RA, 0.482 (0.51 to 0.42)) and first hospitalization for HF (0.57 (0.40 to 0.81) and 0.67 (0.59 to 0.76)).ConclusionsIn patients with DM and HF, SGLT-2i and GLP-1RA significantly reduced MACE compared with insulin, and particularly any cause of death and first hospitalization for HF. These groups of medications had high safety profiles compared with other-AHAs and particularly with insulin. The inadequate optimization of HF and DM cotreatment in the insulin cohort is noteworthy.
Effects of pericapsular nerve group (PENG) block on postoperative recovery in elderly patients with hip fracture: study protocol for a randomised, parallel controlled, double-blind trial
Authors: Luo Wei , Liang Jianhui , Wu Jieting , Luo Quehua , Wu Huiyi , Ou Yanhua , Li Yuhui , Ma WuHua 
Published: March 2022

IntroductionHip fracture is a common and serious emergency in the elderly, and it is associated with severe pain, significant morbidity and mortality. The use of peripheral nerve block can relieve pain effectively and reduce opioid requirements, which may accelerate patient’s recovery. The pericapsular nerve group (PENG) block has been found to provide an effective blockade to the hip joint with a potential motor-sparing effect, so we hypothesised that the PENG block may be an effective tool to enhance the recovery in elderly patients after hip fracture surgery.Methods and analysisThis study is a single-centred, randomised, parallel controlled, double-blind trial. A total of 92 elderly patients scheduled for hip fracture surgery will be divided into two groups at random to receive either ultrasound-guided femoral nerve block or ultrasound-guided PENG block. The primary outcome will be to compare the Quality of Recovery-15 scores at 24 hours postoperatively between the two groups. The secondary outcomes will include measuring and comparing the strength of the quadriceps, the visual analogue scale at rest and on movement, the total morphine consumption, the rescue analgesic, the first time of postoperative out-of-bed mobilisation and complications.Ethics and disseminationThis study was approved by the Institutional Review Board of the Ethics Committee of The First Affiliated Hospital of Guangzhou University of Chinese Medicine on 15 December 2020 (reference K2020-110). The results of this study will be published in peer-reviewed international journals.Trial registration numberChiCTR2100042341.
Disparities in prevalence of heart failure according to age, multimorbidity level and socioeconomic status in southern Sweden: a cross-sectional study
Authors: Scholten Mia , Midlöv Patrik , Halling Anders 
Published: March 2022

ObjectiveThe aim of this study was to compare the prevalence of heart failure (HF) in relation to age, multimorbidity and socioeconomic status of primary healthcare centres in southern Sweden.DesignA cross-sectional study.SettingThe data were collected concerning diagnoses at each consultation in all primary healthcare centres and secondary healthcare in the southernmost county of Sweden at the end of 2015.ParticipantsThe individuals living in southern Sweden in 2015 aged 20 years and older. The study population of 981 383 inhabitants was divided into different categories including HF, multimorbidity, different levels of multimorbidity and into 10 CNI (Care Need Index) groups depending on the socioeconomic status of their listed primary healthcare centre.OutcomesPrevalence of HF was presented according to age, multimorbidity level and socioeconomic status. Logistic regression was used to further analyse the associations between HF, age, multimorbidity level and socioeconomic status in more complex models.ResultsThe total prevalence of HF in the study population was 2.06%. The prevalence of HF increased with advancing age and the multimorbidity level. 99.07% of the patients with HF fulfilled the criteria for multimorbidity. The total prevalence of HF among the multimorbid patients was only 5.30%. HF had a strong correlation with the socioeconomic status of the primary healthcare centres with the most significant disparity between 40 and 80 years of age: the prevalence of HF in primary healthcare centres with the most deprived CNI percentile was approximately twice as high as in the most affluent CNI percentile.ConclusionThe patients with HF were strongly associated with having multimorbidity. HF patients was a small group of the multimorbid population associated with socioeconomic deprivation that challenges efficient preventive strategies and health policies.
Fighting COVID-19: a qualitative study into the lives of intensive care unit survivors in Wuhan, China
Authors: Wu Dong , Ding Hanyue , Lin Jiaye , Xiao Meng , Xie Jing , Xie Feng , Zhang Shuyang 
Published: March 2022

ObjectivesWe aimed to provide an insight into the life of survivors of critical COVID-19 in China.MethodsWe conducted an online survey and qualitative interviews among intensive care unit survivors of critical COVID-19 between November and December 2020 in Wuhan, China. Eligible participants were asked to complete the EQ-5D-5L and the Short Form 36-Item Survey, and invited to participate in a semistructured face-to-face interview. Descriptive analyses and phenomenological approach were adopted to analyse quantitative and qualitative data, respectively.ResultsOf 10 survivors who completed the questionnaire, 8 participated in the interview. The mean scores±SD of EuroQol-5 Dimensions-5 Level utility and EuroQol-Visual Analogue Scale were 0.88±0.15 and 80.9±14.2, respectively. The qualitative interview identified four themes, namely poor physical health, post-traumatic stress, social stigma and family support.ConclusionsCOVID-19 survivors continue fighting physical and psychological impacts. Despite strong family support, these patients are struggling with social stigma. It is a long, challenging journey to recovery for patients and society.
Technology-based group exercise interventions for people living with dementia or mild cognitive impairment: a scoping review protocol
Authors: Hung Lillian , Levine Hannah , Randhawa Paavan , Park Juyoung 
Published: March 2022

IntroductionMore than 50 million people worldwide are living with dementia in 2020, and this number is expected to double every 20 years. Physical exercise is a growing field in non-pharmacological interventions for dementia care. Due to public health measures during the COVID-19 pandemic, more people have considered adapting to technology-based exercise via digital devices. This scoping review will explore evidence relating to the use of technology-based group exercise by people with dementia or mild cognitive impairment.Methods and analysisThis review will follow the Joanna Briggs Institute scoping review methodology to review literature published between June and December 2021. This review is designed to identify existing types of technology-based group exercise interventions for people with dementia. The review will provide a synthesis of current evidence on the outcome and impacts of technology-based group exercise. The context of this review will include homes, assisted living facilities and memory care services but exclude hospitals. The review will include a three-step search strategy: (a) identify keywords from MEDLINE and Embase, (b) search using the identified keywords in databases (MEDLINE/PubMed, CINAHL, Web of Science, Embase, Cochrane Library, PsychInfo and Google) and (c) review references from included studies to identify additional studies. Only studies in English will be included. Four researchers will independently assess titles and abstracts and then review the full text of the selected articles, applying the inclusion criteria. The extracted data will be presented in tables and summarised narratively.Ethics and disseminationScoping review data will be collected from publicly available articles; research ethics approval is not required. The findings will be disseminated to healthcare practitioners and the public through a peer-reviewed publication and conference presentations.
Australian general practice experiences of implementing a structured approach to initiating advance care planning and palliative care: a qualitative study
Authors: Vilapakkam Nagarajan Srivalli , Lewis Virginia , Halcomb Elizabeth J , Rhee Joel , Tieman Jennifer , Clayton Josephine M 
Published: March 2022

ObjectivesInitiation of advance care planning (ACP) and palliative care (PC) assessments in general practice is key to quality end-of-life care. The Advance Project promotes a team-based approach to initiating ACP and PC needs assessment in general practices through training, resources and practical support for implementation from local primary health networks (PHNs). This paper aims to understand: (1) general practice participants’ experiences of undertaking Advance Project training and implementing the Advance Project resources in their practices; (2) barriers and facilitators to implementation of Advance Project resources; and (3) PHN staff experiences of supporting general practices through training and practical support for implementation of the Advance Project resources.DesignQualitative study using semistructured interviews and thematic analysis.SettingTwenty-one general practices and four PHNs from three Australian states were recruited between June 2019 and May 2020.ParticipantsGeneral practitioners (GPs), general practice nurses, practice managers (PMs) and PHN staff.Results45 participants comprising 13 GPs, 13 general practice nurses, 9 PMs, 3 allied health staff and 7 PHN staff were interviewed. The general practice participants generally agreed that the Advance Project training/resources led to changes in their own behaviour and increased their awareness of the importance of ACP/PC discussion with their patients. Participants reported the following benefits for patients: increased awareness of ACP; engagement with families/carers and peace of mind. Key facilitators for successful implementation were a team-based approach, the role of the PHN, the role of practice champions, training facilitators’ ability to influence peers and facilitate change, and mentoring support. Barriers to implementation included issues related to workplace culture, cost, time/workload, patients and health system.ConclusionFindings suggest that the Advance Project approach facilitated successful implementation of ACP and PC needs assessment into usual care in general practices that encouraged teamwork among GPs and general practice nurses. The ability of the practice to make the best use of practical support and guidance available to them through their local PHN both before and during implementation was a key factor in integration of Advance Project resources into routine practice.
LAMP4yaws:Treponema pallidum,Haemophilus ducreyiloop mediated isothermal amplification − protocol for a cross-sectional, observational, diagnostic accuracy study
Authors: Handley Becca Louise , González-Beiras Camila , Tchatchouang Serges , Basing Laud Antony , Hugues Kouadio Aboh , Bakheit Mohammed , Becherer Lisa , Ries Christina , Njih Tabah Earnest , Crucitti Tania , Borst Nadine , Lüert Simone , Frischmann Sieghard , Haerpfer Tamara , Landmann Emelie , Amanor Ivy , Sylla Aboubacar , Kouamé-Sina Mireille S , Ndzomo-Ngono Jean P , Tano Adingra , Arhinful Daniel , Awondo Patrick , Ngazoa Kakou Solange , Eyangoh Sara , Addo Kennedy Kwasi , Harding-Esch Emma Michele , Knauf Sascha , Mitjà Oriol , Marks Michael 
Published: March 2022

IntroductionYaws, caused by the bacteriumTreponema pallidumsubsp.pertenue,is a neglected tropical disease targeted for eradication by 2030. Improved diagnostics will be essential to meet this goal. Diagnosis of yaws has relied heavily on clinical and serological tools. However, the presence of coendemic cutaneous skin ulcer diseases, such as lesions caused byHaemophilus ducreyi(HD), means these techniques do not provide a reliable diagnosis. Thus, new diagnostic tools are needed. Molecular tools such as PCR are ideal, but often expensive as they require trained technicians and laboratory facilities, which are often not available to national yaws programmes.Methods and analysisThe LAMP4yaws project is a cross-sectional, observational, diagnostic accuracy study of a combinedTreponema pallidum(TP) andHDloop mediated isothermal amplification (TPHD-LAMP) test performed under real world conditions in three endemic countries in West Africa. Individuals with serologically confirmed yaws will be recruited in Cameroon, Côte d’Ivoire and Ghana. Each participant will provide paired swabs, one of which will be sent to the respective national reference laboratory for yaws quantitative PCR and the other will be tested for bothTPandHDusing the TPHD-LAMP test at local district laboratories. Sensitivity and specificity of the TPHD-LAMP test will be calculated against the reference standard qPCR. We will also assess the acceptability, feasibility and cost-effectiveness of the test. We anticipate that results from this study will support the adoption of the TPHD-LAMP test for use in global yaws eradication efforts.Ethics and disseminationWe have received ethical approval from all relevant institutional and national ethical committees. All participants, or their parents or guardians, must provide written informed consent prior to study enrolment. Study results will be published in an open access journal and disseminated with partners and the World Health Organization.Trial registration numberNCT04753788.
How do type of preoperative P2Y12receptor inhibitor and withdrawal time affect bleeding? Protocol of a systematic review and individual patient data meta-analysis
Authors: Schoerghuber Michael , Pregartner Gudrun , Berghold Andrea , Lindenau Ines , Zweiker Robert , Voetsch Andreas , Mahla Elisabeth , Zirlik Andreas 
Published: March 2022

IntroductionIn order to reduce the risk of bleeding in patients on P2Y12receptor inhibitors presenting for non-emergent coronary artery bypass grafting (CABG), current guidelines recommend a preoperative discontinuation period of at least three, five and seven days for ticagrelor, clopidogrel and prasugrel, respectively, to allow for recovery of platelet function. However, there is still substantial interinstitutional variation in preoperative management and relevant covariates of CABG-related bleeding are largely elusive so far.Methods and analysisWe will search PubMed (July 2013 to November 2021) and EMBASE (January 2014 to November 2021) using the following terms, MeSH terms and their synonyms: clopidogrel, prasugrel, ticagrelor, dual antiplatelet, P2Y12receptor inhibitor, CABG, bleeding, haemorrhage. Two independent reviewers will screen all abstracts and full papers for eligibility. Disagreements will be solved by consulting with a third reviewer.The primary outcome is the incidence of Bleeding Academic Research Consortium type-4 bleeding depending on type of P2Y12receptor inhibitor and preoperative withdrawal period. The secondary outcomes are mortality and ischaemic events according to the Academic Research Consortium 2 Consensus Document. We will perform an individual patient data meta-analysis (IPD-MA) with drug-specific preoperative withdrawal time and adjust for demographic and procedural variables. Subgroup analyses will be performed for anaemic patients and patients undergoing non-emergent versus urgent/emergent surgery.Ethics and disseminationThis IPD-MA consists of secondary analyses of existing non-identifiable data and meets the criteria for waiver of ethics review by the local Research Ethics Committee. Data sharing and transfer will be subject to a confidentiality agreement and a data use agreement. Findings will be disseminated through peer-reviewed publication and conference presentation.PROSPERO registration numberCRD42022291946.
Assessment of the readability and quality of online patient education materials for the medical treatment of open-angle glaucoma
Authors: Crabtree Lois , Lee Edward 
Published: March 2022

ObjectivePatient adherence to glaucoma medications is poor, and is linked to low literacy levels. Patients commonly use the internet to access health information, and it is recommended that patient information is written at an 11-year-old reading level. The aim of this study is to assess the readability and quality of online patient education materials for the medical management of open angle glaucoma.Methods and analysisThe top 10 relevant Google searches for nine glaucoma medications (timolol, brimonidine, apraclonidine, dorzolamide, latanoprost, bimatoprost, travoprost, tafluprost and brinzolamide) and three generic searches were analysed for readability and accountability. Readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI) and Simple Measure of Gobbledygook Index (SMOG). Webpages were classified by source and assessed using Journal of the American Medical Association (JAMA) benchmarks of accountability.Results111 articles were included in the analysis. Mean readability scores were: FRES 55.5 (95% CI 53.4 to 57.5); FKGL 9.7 (95% CI 9.3 to 10.0); GFI 12 (95% CI 11.6 to 12.4) and SMOG 9.3 (95% CI 8.9 to 9.6). One-way analysis of variance demonstrated no significant difference in readability score between source type. 9% of the webpages satisfied all 4 JAMA benchmarks. Pearson’s correlation coefficient showed a correlation between the FRES and accountability score (r=0.19, p=0.045).ConclusionThe majority of online patient education materials for the medical treatment of glaucoma are written at a level too difficult for the general population and fail to meet accountability standards.
Influence of context on quality improvement priorities: a qualitative study of three facility types in Lagos State, Nigeria
Authors: Olaniran Abimbola Ayodele , Oludipe Modupe , Hill Zelee , Ogunyemi Adedoyin , Umar Nasir , Ayorinde Rebecca , Ohiri Kelechi , Schellenberg Joanna , Marchant Tanya 
Published: March 2022

BackgroundQuality improvement (QI) collaboratives are increasingly popular. However, there is a need for an in-depth understanding of the influence of context on its implementation. We explored the influence of context on the change concepts considered by public primary (primary health centres), public secondary (public hospitals) and private (private facilities) collaboratives established to improve maternal and newborn health outcomes in Lagos State, Nigeria.MethodsBetween February 2019 and January 2020, we conducted a qualitative study using meeting reports, key informant interviews and participant observation. Data were analysed using the high-quality health system framework for assessing health system and user experience that distinguished three quality domains: quality impacts, processes of care and health system foundations.ResultsNineteen change concepts and 158 change ideas were observed across 28 facility QI teams. Change concepts and ideas prioritised were influenced by government and non-governmental leaders but ultimately shaped by facility QI capacity, time allocated for QI activities and availability of local data. Of the three quality domains, process of care, including patient satisfaction, received the most attention across facility types. There was considerable variation in the change concepts considered across domains. For example, more public hospitals focused on complication management because of a relatively high prevalence of and capacity to manage maternal complications; primary health centres focused more on complication referrals, while private facilities prioritised revenue generation. Problems with availability of resources were particularly highlighted in primary health centres which had relatively less financial commitment from stakeholders.ConclusionOur findings provide insights into QI collaboratives’ mechanism of change in which external stakeholders, including government, drove QI priorities for action but the ultimate decisions depended on local realities of facilities. Our findings underscore the need for strong QI leadership and sufficient resources to enable facility QI teams to prioritise change concepts for greater health impact.
Transcatheter aortic valve implantation in patients with rheumatic aortic stenosis
Authors: Okuno Taishi , Tomii Daijiro , Buffle Eric , Lanz Jonas , Ryffel Christoph , Demirel Caglayan , Hashemi Suliman , Hagemeyer Daniel , Papadis Athanasios , Heg Dik , Praz Fabien , Stortecky Stefan , Windecker Stephan , Pilgrim Thomas 
Published: March 2022

BackgroundRheumatic heart disease (RHD) accounts for the highest number of deaths from valvular heart disease globally. Yet, rheumatic aortic stenosis (AS) was excluded from landmark studies investigating the safety and efficacy of transcatheter aortic valve implantation (TAVI). We aimed to describe the clinical and anatomical characteristics of patients with rheumatic AS undergoing TAVI, and to compare procedural and clinical outcomes with patients undergoing TAVI for degenerative AS.MethodsIn a prospective TAVI registry, patients with rheumatic AS were identified based on International Classification of Diseases version 10 codes and/or a documented history of acute rheumatic fever and/or the World Heart Federation criteria for echocardiographic diagnosis of RHD, and were propensity score-matched in a 1:4 ratio to patients with degenerative AS.ResultsAmong 2329 patients undergoing TAVI, 105 (4.5%) had rheumatic AS. Compared with patients with degenerative AS, patients with rheumatic AS were more commonly female, older, had higher surgical risk and more commonly suffered from multivalvular heart disease. In the unmatched cohort, both technical success (85.7% vs 85.9%, p=0.887) and 1-year cardiovascular mortality (10.0% vs 8.6%; HR 1.16, 95% CI 0.61 to 2.18, p=0.656) were comparable between patients with rheumatic and degenerative AS. In contrast, patients with rheumatic AS had lower rates of 30-day and 1-year cardiovascular mortality compared with matched patients with degenerative AS (1.9% vs 8.9%, adjusted HR (HRadj) 0.18, 95% CI 0.04 to 0.80, p=0.024; and 10.0% vs 20.3%, HRadj0.44, 95% CI 0.24 to 0.84, p=0.012, respectively).ConclusionTAVI may be a safe and effective treatment strategy for selected elderly patients with rheumatic AS.Trial registration numberNCT01368250.