bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness of GeneXpert Omni compared with GeneXpert MTB/Rif for point-of-care diagnosis of tuberculosis in a low-resource, high-burden setting in Eastern Uganda: a cost-effectiveness analysis based on decision analytical modelling
Authors: Ejalu David Livingstone , Irioko Aaron , Kirabo Rhoda , Mukose Aggrey David , Ekirapa Elizabeth , Kagaayi Joseph , Namutundu Juliana 
Published: August 2022

ObjectiveTo determine the cost-effectiveness of Xpert Omni compared with Xpert MTB/Rif for point-of-care diagnosis of tuberculosis among presumptive cases in a low-resource, high burden facility.DesignCost-effectiveness analysis from the provider’s perspective.SettingA low-resource, high tuberculosis burden district in Eastern Uganda.ParticipantsA provider’s perspective was used, and thus, data were collected from experts in the field of tuberculosis diagnosis purposively selected at the local, subnational and national levels.MethodsA decision analysis model was contracted from TreeAge comparing Xpert MTB/Rif and Xpert Omni. Cost estimation was done using the ingredients’ approach. One-way deterministic sensitivity analyses were performed to identify the most influential model parameters.Outcome measureThe outcome measure was incremental cost per additional test diagnosed expressed as the incremental cost-effectiveness ratio.ResultsThe total cost per test for Xpert MTB/Rif was US$14.933. Cartridge and reagent kits contributed to 67% of Xpert MTB/Rif costs. Sample transport costs increased the cost per test of Xpert MTB/Rif by $1.28. The total cost per test for Xpert Omni was $16.153. Cartridge and reagent kits contributed to over 71.2% of Xpert Omni’s cost per test. The incremental cost-effectiveness ratio for using Xpert Omni as a replacement for Xpert MTB/Rif was US$30.73 per additional case detected. There was no dominance noted in the cost-effectiveness analysis, meaning no strategy was dominant over the other.ConclusionThe use of Xpert Omni at the point-of-care health facility was more effective but with an increased cost compared with Xpert MTB/Rif at the centralised referral testing facility.
Association between mental health and executive dysfunction and the moderating effect of urban–rural subpopulation in general adolescents from Shangrao, China: a population-based cross-sectional study
Authors: Lin Qingmin , Abbey Cody , Zhang Yunting , Wang Guanghai , Lu Jinkui , Dill Sarah-Eve , Jiang Qi , Singh M K , She Xinshu , Wang Huan , Rozelle Scott , Jiang Fan 
Published: August 2022

ObjectivesTo examine the association between mental health and executive dysfunction in general adolescents, and to identify whether home residence and school location would moderate that association.DesignA population-based cross-sectional study.SettingA subsample of the Shanghai Children’s Health, Education, and Lifestyle Evaluation-Adolescents project. 16 sampled schools in Shangrao city located in downstream Yangtze River in southeast China (December 2018).Participants1895 adolescents (48.8% male) which were divided into three subpopulations: (A) adolescents who have urban hukou (ie, household registration in China) and attend urban schools (UU, n=292); (B) adolescents who have rural hukou and attend urban schools (RU, n=819) and (C) adolescents who have rural hukou and attend rural schools (RR, n=784).MeasuresThe Depression Anxiety and Stress Scale-21 was used to assess adolescent mental health symptoms, and the Behaviour Rating Inventory of Executive Function (parent form) was applied to measure adolescent executive dysfunction in nature setting.ResultsMental health symptoms were common (depression: 25.2%, anxiety: 53.0%, stress: 19.7%) in our sample, and the prevalence rates were lower among UU adolescents than those among the RR and RU, with intersubgroup differences in screen exposure time explaining most of the variance. We found the three types of symptoms were strongly associated with executive dysfunction in general adolescents. We also observed a marginal moderating effect of urban–rural subgroup on the associations: UU adolescents with depression (OR 6.74, 95% CI 3.75 to 12.12) and anxiety (OR 5.56, 95% CI 1.86 to 16.66) had a higher executive dysfunction risk when compared with RR youths with depression (OR 1.93, 95% CI 0.91 to 4.12) and anxiety (OR 1.80, 95% CI 1.39 to 2.33), respectively.ConclusionsRural adolescents experienced more mental health symptoms, whereas urban individuals with mental health problems had a higher executive dysfunction risk.
CXCR4-directed [68Ga]Ga-PentixaFor PET/CT versus adrenal vein sampling performance: a study protocol for a randomised two-step controlled diagnoStic Trial Ultimately comparing hypertenSion outcome in primary aldosteronism (CASTUS)
Authors: Chaman Baz Amir Hossein , van de Wiel Elle , Groenewoud Hans , Arntz Mark , Gotthardt Martin , Deinum Jaap , Langenhuijsen Johan 
Published: August 2022

IntroductionPrimary aldosteronism (PA) is the most common form of secondary hypertension. It is caused by overproduction of aldosterone by either a unilateral aldosterone-producing adenoma (APA) or by bilateral adrenal hyperplasia (BAH). Distinction is crucial, because PA is cured by adrenalectomy in APA and is treated by mineralocorticoid receptor antagonists in BAH. The distinction is currently made by adrenal vein sampling (AVS). AVS is a costly, invasive and complex technical procedure with limited availability and is not superior in terms of outcomes to CT scan-based diagnosis. Thus, there is a need for a cheaper, non-invasive and readily available diagnostic tool in PA. We propose a new diagnostic imaging modality employing the positron emission tomography (PET) tracer [68Ga]Ga-PentixaFor. This tracer has high focal uptake in APAs, whereas low uptake was shown in patients with normal adrenals. Thus, [68Ga]Ga-PentixaFor PET/CT is an imaging modality with the potential to improve subtyping of PA. It is readily available, safe and, as an out-patient procedure, much cheaper diagnostic method than AVS.Methods and analysisWe present a two-step randomised controlled trial (RCT) protocol in which we assess the accuracy of [68Ga]Ga-PentixaFor PET/CT in the first step and compare [68Ga]Ga-PentixaFor PET/CT to AVS in the second step. In the first step, the concordance will be determined between [68Ga]Ga-PentixaFor PET/CT and AVS and a concordance probability is calculated with a Bayesian prediction model. In the second step, we will compare [68Ga]Ga-PentixaFor PET/CT and AVS for clinical outcome and intensity of hypertensive drug use defined as daily defined doses in a RCT.Ethics and disseminationEthics approval was acquired from the medical ethical committee East-Netherlands (METC Oost-Nederland). Results will be disseminated through peer-reviewed articles.Trial registration numberNL9625.
Identifying requisite learning health system competencies: a scoping review
Authors: McDonald Paige L , Phillips Jessica , Harwood Kenneth , Maring Joyce , van der Wees Philip J 
Published: August 2022

ObjectivesLearning health systems (LHS) integrate knowledge and practice through cycles of continuous quality improvement and learning to increase healthcare quality. LHS have been conceptualised through multiple frameworks and models. Our aim is to identify and describe the requisite individual competencies (knowledge, skills and attitudes) and system competencies (capacities, characteristics and capabilities) described in existing literature in relation to operationalising LHS.MethodsA scoping review was conducted with descriptive and thematic analysis to identify and map competencies of LHS for individuals/patients, health system workers and systems. Articles until April 2020 were included based on a systematic literature search and selection process. Themes were developed using a consensus process until agreement was reached among team members.ResultsEighty-nine articles were included with most studies conducted in the USA (68 articles). The largest number of publications represented competencies at the system level, followed by health system worker competencies. Themes identified at the individual/patient level were knowledge and skills to understand and share information with an established system and the ability to interact with the technology used to collect data. Themes at the health system worker level were skills in evidence-based practice, leadership and teamwork skills, analytical and technological skills required to use a ‘digital ecosystem’, data-science knowledge and skill and self-reflective capacity. Researchers embedded within LHS require a specific set of competencies. Themes identified at the system level were data, infrastructure and standardisation; integration of data and workflow; and culture and climate supporting ongoing learning.ConclusionThe identified individual stakeholder competencies within LHS and the system capabilities of LHS provide a solid base for the further development and evaluation of LHS. International collaboration for stimulating LHS will assist in further establishing the knowledge base for LHS.
Sixteen-week multicentre randomised controlled trial to study the effect of the consumption of an oat beta-glucan-enriched bread versus a whole-grain wheat bread on glycaemic control among persons with pre-diabetes: a study protocol of the CarbHealth study
Authors: Hjorth Therese , Schadow Alena , Revheim Ingrid , Spielau Ulrike , Thomassen Lise M , Meyer Klara , Piotrowski Katja , Rosendahl-Riise Hanne , Rieder Anne , Varela Paula , Lysne Vegard , Ballance Simon , Koerner Antje , Landberg Rikard , Buyken Anette , Dierkes Jutta 
Published: August 2022

IntroductionIn 2012, the estimated global prevalence of pre-diabetes was 280 million, and the prevalence is expected to rise to 400 million by 2030. Oat-based foods are a good source of beta-glucans, which have been shown to lower postprandial blood glucose. Studies to evaluate the effectiveness of the long-term intake of beta-glucan-enriched bread as part of a habitual diet among individuals with pre-diabetes are needed. Therefore, we designed a multicentre intervention study in adults with pre-diabetes to investigate the effects of consumption of an oat-derived beta-glucan-enriched bread as part of a normal diet on glycated haemoglobin (HbA1c) in comparison to consumption of whole-grain wheat bread.Methods and analysisThe CarbHealth trial is a multicentre double-blind randomised controlled 16-week dietary intervention trial in participants 40–70 years of age with a body mass index of ≥27 kg/m2 and HbA1c of 35–50 mmol/mol. The study is conducted at four universities located in Norway, Sweden and Germany and uses intervention breads specifically designed for the trial by Nofima AS. The aim is to recruit 250 participants. The primary outcome is the difference in HbA1c between the intervention and the control groups. The main analysis will include intervention group, study centre and baseline HbA1c as independent variables in an analysis of covariance model.Ethics and disseminationThe study protocol was approved by respective ethical authorities in participating countries. The results of the study will be communicated through publication in international scientific journals and presentations at (inter)national conferences.Trial registration numberNCT04994327.
Perioperative mental health intervention bundle for older surgical patients: protocol for an intervention development and feasibility study
Authors: Abraham Joanna , Holzer Katherine J , Lenard Emily M , Freedland Kenneth E , Tellor Pennington Bethany R , Wolfe Rachel C , Cordner Theresa A , Baumann Ana A , Politi Mary , Avidan Michael Simon , Lenze Eric 
Published: August 2022

IntroductionThe perioperative period is high risk for older adults. Depression and anxiety are common perioperative problems, frequently coexisting with cognitive impairment. Older patients with these conditions are more likely than younger patients to experience postoperative delirium, long hospital stays, poor quality of life and rehospitalisation. These experiences can, in turn, exacerbate anxiety and depressive symptoms. Despite these risks, little is known about how to treat perioperative anxiety and depression among older adults.Methods and analysisWe designed a feasibility study of a perioperative mental health intervention bundle to improve perioperative mental health, specifically depression and anxiety. The overarching goals of this study are twofold: first, to adapt and refine an intervention bundle comprised of behavioural activation and medication optimisation to meet the needs of older adults within three surgical patient populations (ie, orthopaedic, oncological and cardiac); and second, to test the feasibility of study procedures and intervention bundle implementation. Quantitative data on clinical outcomes such as depression, anxiety, quality of life, delirium, falls, length of stay, hospitalisation and pain will be collected and tabulated for descriptive purposes. A hybrid inductive–deductive thematic approach will be employed to analyse qualitative feedback from key stakeholders.Ethics and disseminationThe study received approval from the Washington University Institutional Review Board. Results of this study will be presented in peer-reviewed journals, at professional conferences, and to our perioperative mental health advisory board.Trial registration numberNCT05110690.
Effectiveness of a perioperative support programme to reduce psychological distress for family caregivers of patients with early-stage lung cancer: study protocol for a randomised controlled trial
Authors: Zhu Song , Yang Chen , Chen Shihao , Kang Lu , Li Tong , Li Jina , Li Lezhi 
Published: August 2022

IntroductionFamily caregivers play a key role in providing ongoing long-term care and assistance to their loved ones during cancer treatment. However, family caregivers of patients with lung cancer are frequently unprepared for their roles and they may undergo psychological distress, thus reducing their own quality of life while affecting patients’ health outcomes. Interventions that specifically target this population are lacking. This study aims to evaluate the effectiveness of a perioperative support programme on family caregivers of patients with early-stage lung cancer.Methods and analysisThis study is guided by the Stress-Coping Model. Family caregivers of patients diagnosed with early-stage lung cancer and those who are scheduled for lung resection treatment will be invited to participate. Participants will be randomised to groups that either receive the perioperative support programme or usual care. The intervention consists of four face-to-face intervention sessions during the hospital stay and two weekly telephone follow-up sessions after discharge. Primary and secondary outcomes will be assessed at baseline and at 4 and 12 weeks after the intervention. Primary outcomes will include psychological distress and secondary outcomes will include caregiving burden, quality of life, coping style and social support. Generalised estimation equation model will be used to analyse the intervention effects.Ethics and disseminationThe study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (LYG2022003). The authors will disseminate the study’s findings by publishing them in international scientific journals.Trial registration numberChiCTR2200058280.
01 ‘Between a rock and a hard place’: Care home staff perceptions of balancing risks during resident transfer decisions
Authors: Harrad-Hyde Fawn , Williams Chris , Armstrong Natalie 
Published: August 2022

BackgroundCare home residents are more likely to attend and be admitted to hospital in unplanned, emergency situations than age-matched people living in their own homes, yet some transfers and admissions can be burdensome, leading to declines in health and well-being. Existing research has acknowledged the importance of understanding the local context in which transfers occur, yet research conducted in England is lacking.MethodsTo develop an in-depth understanding of care home staff transfer decisions in England, data collection occurred in two phases. Firstly, semi-structured interviews were carried out with 30 care home staff across six care homes in the East and West Midlands. Secondly, 113 hours of ethnographic work (consisting of observations, documentary analysis and informal conversations) occurred across three of the six homes. Data gathered in both phases were analysed together using the Straussian approach to grounded theory.ResultsStaff preferred to care for residents in the care home where possible. Transfers often occurred following a series of escalations in which staff sought to balance a number of risks. Staff primarily understood risk by drawing on their experiential knowledge of what was usual for each resident, yet also drew upon advance care plans and observations of early warning signs. Staff sought to manage risks by involving others in decision-making (colleagues, residents, relatives, healthcare professionals), yet this required staff to anticipate and mitigate potential disagreements.ConclusionsThis study highlights a substantial amount of work care home staff undertake prior to calling external services and offers a novel approach to understanding hospital transfers from care homes, by foregrounding the different forms of risk staff feel responsible for balancing. Further research is needed to assess the ways new and existing interventions enable care home staff to manage risk during transfer decisions. The implications for emergency care services will be discussed.
EP10 Community first responders‘ contribution to rural emergency medical service provision in the UK
Authors: Botan Vanessa , Asghar Zahid , Rowan Elise , Smith Murray D , Patel Gupteswar , Phung Viet-Hai , Trueman Ian , Spaight Robert , Brewster Amanda , Mountain Pauline , Orner Roderick , Siriwardena Aloysius Niroshan 
Published: August 2022

BackgroundCommunity First Responders (CFRs) are volunteers dispatched by Emergency Medical Services (EMS) to potentially life-threatening emergencies to provide care until the ambulance staff arrive. Previous qualitative research described CFRs’ role, perceptions, and motivations, but quantitative evidence on their contribution to rural healthcare provision is lacking. We aimed to investigate the number, types, and location of calls (rural or urban), and characteristics of patients attended.MethodsWe used a retrospective observational design analysing routine data from six of ten ambulance services in England during 2019. Descriptive statistics were used to directly compare incidents where CFRs attended first with attendances from ambulance staff. A multiple logistic regression model was used to identify the main predictors of CFR attendance.ResultsThe data included 4.5 million incidents over one year. CFRs attended first a significantly higher proportion of calls in rural areas compared to urban areas (3.90% vs 1.48%, p<0.05). The main predictors of CFR presence were rurality (Odds Ratio [OR] 2.05, 95% Confidence Interval [CI] 1.99-2.11, p<0.001), conditions including cardiorespiratory (OR 9.20, 95%CI 5.08-16.64, p<0.001) or neurological/endocrine (OR 9.26, 95%CI 5.12-16.77, p<0.001) and the most urgent call category 1 (OR 5.19, 95%CI 3.86-6.99, p<0.001) and call category 2 (OR 4.44, 95%CI 3.31-5.96 p<0.001). CFRs were also less likely to attend patients from minority ethnic backgrounds, those younger than 39 years, and incidents in more deprived areas.ConclusionsCFRs play an important role in EMS delivery, supporting the work of ambulance services, especially in rural areas. The work of CFRs has expanded from its original purpose to attend out-of-hospital cardiac arrest to more types of emergencies. Future development of CFR schemes should prioritise training for a range of conditions, and access to more deprived and ethnically diverse areas.
PP21 Factors affecting community first responders’ role in rural emergencies: a qualitative interview study
Authors: Patel Gupteswar , Phung Viet-Hai , Julie Pattinson J , Trueman Ian , Ørner Roderick , Botan Vanessa , Asghar Zahid , Smith Murray D , Ridyard Colin , Rowan Elise , Brewster Amanda , Mountain Pauline , Evans Jason , Spaight Robert , Niroshan Siriwardena Aloysius 
Published: August 2022

BackgroundCommunity first responders (CFRs) are volunteers delivering emergency medical assistance and maintaining a patient’s condition until an ambulance arrives. Previous research has highlighted the CFR role and relationships, motivations, practice and perceptions, and need for mental health support. However, factors influencing CFR practise in the field are a relatively underexplored area. We aimed to explore the factors embedded in CFR implementation processes that either facilitated or hindered CFRs’ activities and practice in the UK.MethodIn a qualitative study, we conducted interviews with CFRs and CFR leads, paramedics and ambulance clinicians, commissioners, patients and relatives across six English ambulance service regions. Thematic analysis, supported by NVivo, enabled the identification codes and themes.ResultOverall, 47 participants were interviewed including CFR leads (15), CFRs (21), ambulance staff (4), and commissioners (2) from six ambulance services with patients and relatives (5) from the same regions. The findings revealed multi-layered factors influencing effective CFR functioning at three levels, namely individual, institutional, and societal. CFRs’ local expertise helped them to navigate operational challenges. Use of a personal vehicle and navigation software aided CFRs’ ability to respond promptly. Continuing training improved CFRs’ skills. CFR functioning was facilitated by positive relationships with ambulance crews. Identification and recognition by patients were important and aided by wearing uniforms. Community support was a facilitator for CFR activities in rural areas. In contrast, limited communication in remote regions, long waits for an ambulance, and reliance on community donations impeded CFRs’ care function. Volunteer shortages and lack of access to a blue light while using trusts’ car hindered CFRs’ ability to respond quickly. Negative relationships with ambulance crews also hampered CFRs’ involvement.ConclusionThis study highlights factors associated with effective CFR functioning and the requirement for supportive institutional and societal contexts for CFRs to assist patients in medical emergencies.