FreshRSS

🔒
❌ Acerca de FreshRSS
Hay nuevos artículos disponibles. Pincha para refrescar la página.
AnteayerTus fuentes RSS

Developing digital contact tracing tailored to haulage in East Africa to support COVID-19 surveillance: a protocol

Por: Muwonge · A. · Mpyangu · C. M. · Nsangi · A. · Mugerwa · I. · Bronsvoort · B. M. d. · Porphyre · T. · Ssebaggala · E. R. · Kiayias · A. · Mwaka · E. S. · Joloba · M.
Introduction

At the peak of Uganda’s first wave of SARS-CoV-2 in May 2020, one in three COVID-19 cases was linked to the haulage sector. This triggered a mandatory requirement for a negative PCR test result at all ports of entry and exit, resulting in significant delays as haulage drivers had to wait for 24–48 hours for results, which severely crippled the regional supply chain.

To support public health and economic recovery, we aim to develop and test a mobile phone-based digital contact tracing (DCT) tool that both augments conventional contact tracing and also increases its speed and efficiency.

Methods and analysis

To test the DCT tool, we will use a stratified sample of haulage driver journeys, stratified by route type (regional and local journeys).

We will include at least 65% of the haulage driver journeys ~83 200 on the network through Uganda. This allows us to capture variations in user demographics and socioeconomic characteristics that could influence the use and adoption of the DCT tool. The developed DCT tool will include a mobile application and web interface to collate and intelligently process data, whose output will support decision-making, resource allocation and feed mathematical models that predict epidemic waves.

The main expected result will be an open source-tested DCT tool tailored to haulage use in developing countries.

This study will inform the safe deployment of DCT technologies needed for combatting pandemics in low-income countries.

Ethics and dissemination

This work has received ethics approval from the School of Public Health Higher Degrees, Research and Ethics Committee at Makerere University and The Uganda National Council for Science and Technology. This work will be disseminated through peer-reviewed publications, our websites https://project-thea.org/ and Github for the open source code https://github.com/project-thea/.

Attitudes towards coronavirus (COVID-19) vaccine and sources of information across diverse ethnic groups in the UK: a qualitative study from June to October 2020

Por: Sides · E. · Jones · L. F. · Kamal · A. · Thomas · A. · Syeda · R. · Kaissi · A. · Lecky · D. M. · Patel · M. · Nellums · L. · Greenway · J. · Campos-Matos · I. · Shukla · R. · Brown · C. S. · Pareek · M. · Sollars · L. · Pawson · E. · McNulty · C.
Objectives

Across diverse ethnic groups in the UK, explore attitudes and intentions towards COVID-19 vaccination and sources of COVID-19 information.

Design

Remote qualitative interviews and focus groups (FGs) conducted June–October 2020 before UK COVID-19 vaccine approval. Data were transcribed and analysed through inductive thematic analysis and mapped to the Theoretical Domains Framework.

Setting

England and Wales.

Participants

100 participants from 19 self-identified ethnic groups.

Results

Mistrust and doubt were reported across ethnic groups. Many participants shared concerns about perceived lack of information about COVID-19 vaccine safety and efficacy. There were differences within each ethnic group, with factors such as occupation and perceived health status influencing intention to accept a vaccine once made available. Across ethnic groups, participants believed that public contact occupations, older adults and vulnerable groups should be prioritised for vaccination. Perceived risk, social influences, occupation, age, comorbidities and engagement with healthcare influenced participants’ intentions to accept vaccination once available. All Jewish FG participants intended to accept, while all Traveller FG participants indicated they probably would not.

Facilitators to COVID-19 vaccine uptake across ethnic groups included: desire to return to normality and protect health and well-being; perceived higher risk of infection; evidence of vaccine safety and efficacy; vaccine availability and accessibility.

COVID-19 information sources were influenced by social factors and included: friends and family; media and news outlets; research literature; and culture and religion. Participants across most different ethnic groups were concerned about misinformation or had negative attitudes towards the media.

Conclusions

During vaccination rollout, including boosters, commissioners and providers should provide accurate information, authentic community outreach and use appropriate channels to disseminate information and counter misinformation. Adopting a context-specific approach to vaccine resources, interventions and policies and empowering communities has potential to increase trust in the programme.

Soluble CD146 in the detection and grading of intravascular and tissue congestion in patients with acute dyspnoea: analysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort

Por: Jukneviciene · R. · Simonavicius · J. · Mikalauskas · A. · Cerlinskaite-Bajore · K. · Arrigo · M. · Juknevicius · V. · Alitoit-Marrote · I. · Kablucko · D. · Bagdonaite · L. · Vitkus · D. · Balciunas · M. · Zuoziene · G. · Barysiene · J. · Zaliaduonyte · D. · Stasaitis · K. · Kavoliu
Objectives

To evaluate the potential of soluble cluster of differentiation 146 (sCD146) in the detection and grading of congestion in patients with acute dyspnoea.

Design

Subanalysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort.

Setting

Two Lithuanian university centres.

Participants

Adult patients with acute dyspnoea admitted to the emergency department.

Methods

Congestion was assessed using clinical and sonographic parameters. All patients underwent sCD146 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing.

Results

The median value of sCD146 concentration in the study cohort (n=437) was 405 (IQR 315–509) ng/mL. sCD146 was higher in patients with peripheral oedema than in those without (median (IQR) 472 (373–535) vs 400 (304–501) ng/mL, p=0.009) and with pulmonary rales than in those without (439 (335–528) vs 394 (296–484) ng/mL, p=0.001). We found a parallel increase of estimated right atrial pressure (eRAP) and sCD146 concentration: sCD146 was 337 (300–425), 404 (290–489) and 477 (363–572) ng/mL in patients with normal, moderately elevated and high eRAP, respectively (p=0.001). In patients with low NT-proBNP, high sCD146 distinguished a subgroup with a higher prevalence of oedema as compared with patients with low levels of both biomarkers (76.0% vs 41.0%, p=0.010). Moreover, high sCD146 indicated a higher prevalence of elevated eRAP, irrespective of NT-proBNP concentration (p

Conclusion

sCD146 concentration reflects the degree of intravascular and tissue congestion assessed by clinical and echocardiographic indices, with this association maintained in patients with low NT-proBNP. Our data support the notion that NT-proBNP might represent heart stretch while sCD146 rather represents peripheral venous congestion.

Postnatal maternal depressive symptoms and behavioural outcomes in term-born and preterm-born toddlers: a longitudinal UK community cohort study

Por: Kleine · I. · Vamvakas · G. · Lautarescu · A. · Falconer · S. · Chew · A. · Counsell · S. · Pickles · A. · Edwards · D. · Nosarti · C.
Objectives

To examine the association between maternal depressive symptoms in the immediate postnatal period and offspring’s behavioural outcomes in a large cohort of term-born and preterm-born toddlers.

Design and participants

Data were drawn from the Developing Human Connectome Project. Maternal postnatal depressive symptoms were assessed at term-equivalent age, and children’s outcomes were evaluated at a median corrected age of 18.4 months (range 17.3–24.3).

Exposure and outcomes

Preterm birth was defined as 1/2–5 Total (CBCL) and Quantitative Checklist for Autism in Toddlers (Q-CHAT) scores. Toddlers’ cognition was assessed with the Bayley Scales of Infant and Toddler Development—Third Edition (Bayley-III).

Results

Higher maternal EPDS scores were associated with toddlers’ higher CBCL (B=0.93, 95% CI 0.43 to 1.44, p2=0.05) and Q-CHAT scores (B=0.27, 95% CI 0.03 to 0.52, p=0.031, f2=0.01). Maternal EPDS, toddlers’ CBCL and Q-CHAT scores did not differ between preterm (n=97; 19.1% of the total sample) and term participants. Maternal EPDS score did not disproportionately affect preterm children with respect to CBCL or Q-CHAT scores.

Conclusions

Our findings indicate that children whose mothers reported increased depressive symptoms in the early postnatal period, including subclinical symptoms, exhibit more parent-reported behavioural problems in toddlerhood. These associations were independent of gestational age. Further research is needed to confirm the clinical significance of these findings.

Stockholm score of lesion detection on computed tomography following mild traumatic brain injury (SELECT-TBI): study protocol for a multicentre, retrospective, observational cohort study

Por: Fletcher-Sandersjöö · A. · Tatter · C. · Yang · L. · Ponten · E. · Boman · M. · Lassaren · P. · Forsberg · S. · Grönlund · I. · Tidehag · V. · Rubenson-Wahlin · R. · Strömmer · L. · Westberg · K. · Ängeby · K. · Djärv · T. · Lundblad · O. · Bartek · J. · Thelin · E. P.
Introduction

Mild traumatic brain injury (mTBI) is one of the most common reasons for emergency department (ED) visits. A portion of patients with mTBI will develop an intracranial lesion that might require medical or surgical intervention. In these patients, swift diagnosis and management is paramount. Several guidelines have been developed to help direct patients with mTBI for head CT scanning, but they lack specificity, do not consider the interactions between risk factors and do not provide an individualised estimate of intracranial lesion risk. The aim of this study is to create a model that estimates individualised intracranial lesion risks in patients with mTBI who present to the ED.

Methods and analysis

This will be a retrospective cohort study conducted at ED hospitals in Stockholm, Sweden. Eligible patients are adults (≥15 years) with mTBI who presented to the ED within 24 hours of injury and performed a CT scan. The primary outcome will be a traumatic lesion on head CT. The secondary outcomes will be any clinically significant lesion, defined as an intracranial finding that led to neurosurgical intervention, hospital admission ≥48 hours due to TBI or death due to TBI. Machine-learning models will be applied to create scores predicting the primary and secondary outcomes. An estimated 20 000 patients will be included.

Ethics and dissemination

The study has been approved by the Swedish Ethical Review Authority (Dnr: 2020-05728). The research findings will be disseminated through peer-reviewed scientific publications and presentations at international conferences.

Trial registration number

NCT04995068.

EMAeHealth, a digital tool for the self-management of womens health needs during pregnancy, childbirth and the puerperium: protocol for a hybrid effectiveness-implementation study

Por: Espinosa Cifuentes · M. · Artieta-Pinedo · I. · Paz-Pascual · C. · Bully-Garay · P. · Garcia-Alvarez · A. · ema-Q Group · Estalella · Trincado · Cabeza · Gagnon · Fernandez · Lozano · Villanueva · Sanchez · Maquibar · Moreno · Legarra · Mulas · Blas · Amorrortu · Alvarez · Perez
Introduction

EHealth can help health service users take a more active role in decision-making and help health professionals guide the patient in this process. A digital tool has been designed to support maternal education (ME), and it is organised into four areas: (1) information, (2) communication, (3) health self-management and (4) clinical data. The main objective of the study is to evaluate the effectiveness of the EMAeHealth digital tool, and assess its usability and acceptability under routine conditions.

Methods and analysis

Hybrid implementation-effectiveness design: (1) A cluster randomised, prospective, longitudinal, multicentre clinical trial to evaluate the effectiveness of EMAeHealth in (A) improving health-related quality of life (primary outcome), (B) improving self-efficacy for labour and childbirth and self-efficacy in breast feeding and (C) reducing the number of visits to the obstetric emergency services and health centre in situations of ‘non-pathological pregnancy’, ‘false labour pains’ and ‘non-pathological puerperium’. The EMAeHealth intervention plus usual care will be compared with receiving only usual care, which includes traditional ME. N=1080 participants, 540 for each study arm. Two measurements will be made throughout the pregnancy and three in the first 16 weeks post partum. (2) A mixed-method study to evaluate the usability and acceptability of the tool, barriers and facilitators for its use, and implementation in our health system: focus groups (women, professionals and agents involved) and a quantitative analysis of implementation indicators. Analysis: It will be carried out by intention to treat, using mixed models taking into account the hierarchical structure of the data and per protocol to evaluate the effectiveness of the express use of the digital tool.

Ethics and dissemination

Clinical Research Ethics Committee of Euskadi, Spain, (Ref: PI2020044) approved this study. The results will be actively disseminated through manuscript publications and conference presentations.

Trial registration number

NCT04937049.

Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review

Por: Cibralic · S. · Alam · M. · Mendoza Diaz · A. · Woolfenden · S. · Katz · I. · Tzioumi · D. · Murphy · E. · Deering · A. · McNamara · L. · Raman · S. · Eapen · V.
Objective

To examine and synthesise the literature on adverse childhood experience (ACE) screening in clinical and healthcare settings servicing children (0–11) and young people (12–25).

Design

A systematic review of literature was undertaken.

Data source

PsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken.

Eligibility criteria

English language studies were included if they reported results of an ACE tool being used in a clinical or healthcare setting, participants were aged between 0 and 25 years and the ACE tool was completed by children/young people or by parents/caregivers/clinicians on behalf of the child/young person. Studies assessing clinicians’ views on ACE screening in children/young people attending health settings were also included.

Data extraction and synthesis

Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively.

Results

Initial searches identified 5231 articles, of which 36 were included in the final review. Findings showed that the most commonly used tool for assessing ACE was the ACE questionnaire; administering ACE tools was found to be feasible and acceptable; there were limited studies looking at the utility, feasibility and acceptability of assessing for ACE in First Nations people; and while four studies provided information on actions taken following ACE screening, no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services.

Conclusion

As the evidence stands, widespread ACE screening is not recommended for routine clinical use. More research is needed on how and what specific ACE to screen for and the impact of screening on well-being.

PROSPERO registration number

University of York Centre for Reviews and Dissemination (CRD42021260420).

Cohort profile: population-based cohorts of patients with colorectal cancer and of their relatives in Geneva, Switzerland

Por: Benhamou · S. · Fournier · E. · Puppa · G. · McKee · T. · Ris · F. · Rubbia-Brandt · L. · Viassolo · V. · Zilli · T. · Zlobec · I. · Chappuis · P. O. · Rapiti · E.
Purpose

Colorectal cancer (CRC) is the third leading cause of cancer death worldwide. Variability between patients in prognosis and treatment response is partially explained by traditional clinicopathological factors. We established a large population-based cohort of patients with CRC and their first-degree and second-degree relatives registered in the Canton of Geneva, to evaluate the role of family history and tumour biomarkers on patient outcomes.

Participants

The cohort includes all patients with CRC diagnosed between 1985 and 2013. Detailed information on patient and tumour characteristics, treatment and outcomes were extracted from the Geneva Cancer Registry database, completed by medical records review and linkage with administrative and oncogenetics databases. Next-generation tissue microarrays were constructed from tissue samples of the primary tumour. A prospective follow-up of the cohort is realised annually to collect data on outcomes. First-degree and second-degree relatives of patients are identified through linkage with the Cantonal Population Office database and information about cancer among relatives is retrieved from the Geneva Cancer Registry database. The cohort of relatives is updated annually.

Findings to date

The cohort includes 5499 patients (4244 patients with colon cancer and 1255 patients with rectal cancer). The great majority of patients were diagnosed because of occurrence of symptoms and almost half of the cases were diagnosed with an advanced disease. At the end of 2019, 337 local recurrences, 1143 distant recurrences and 4035 deaths were reported. At the same date, the cohort of first-degree relatives included 344 fathers, 538 mothers, 3485 children and 375 siblings. Among them, we identified 28 fathers, 31 mothers, 18 siblings and 53 children who had a diagnosis of CRC.

Future plans

The cohort will be used for long-term studies of CRC epidemiology with focus on clinicopathological factors and molecular markers. These data will be correlated with the most up-to-date follow-up data.

Usability and feasibility assessment of a smartphone application (Suhriday) for heart failure self-care remote monitoring in an Indian tertiary health care setting: a pilot mixed-methods study

Por: Bylappa · B. K. · Kamath · D. Y. · Josephine · I. S. · Shaikh · J. · Kamath · A. · Rioniz · P. · Kulkarni · S. · Varghese · K. · Xavier · D.
Background/objectives

Remote monitoring as a component of chronic heart failure (CHF) management programmes has demonstrated utility in reducing the risk of rehospitalisation and mortality. There is little evidence on mobile health app facilitated remote monitoring in India. We conducted a pilot usability and feasibility assessment of a smartphone-based application (Suhriday) to remotely monitor patients with CHF.

Methods

We used a mixed-methods design. Usability testing consisted of the think-aloud approach followed by semistructured in-depth interviews (SSIs) and a satisfaction questionnaire. Feasibility testing was done using acceptability and user satisfaction questionnaires in addition to SSIs. We trained five purposively sampled patients with CHF (based on health literacy and gender) and their caregivers (n=10) in self-care monitoring and app use. Usability was assessed using metrics such as task completion, time required for task completion and user satisfaction using Brooke’s System Usability Scale (SUS). Content analysis of the transcripts with deductive coding was performed for both usability and feasibility interviews. The number and types of medical alerts transmitted through the app were captured and escalated to the treating team.

Results

Critical tasks involving (1) opening the app and identifying task list, (2) reporting blood pressure, weight, heart rate and fluid intake and (3) reporting symptoms were completed within 60 s by four patients. Median (IQR) SUS score was 85 (75–92.5) indicating high level of usability. There were 62 alerts from four patients over 4 weeks, with 36 (58.1%) excess fluid intake alerts and 16 (25.8%) blood pressure variations being the most frequent. One participant had challenges using the app and was monitored through active phone calls.

Conclusion

Overall usability and satisfaction with Suhriday were good and we were able to remotely manage patients. However, patients with limited health literacy and those facing technological challenges required active structured telephone support.

Pessary or progesterone to prevent preterm birth in women with short cervical length: protocol of the 4-6 year follow-up of a randomised controlled trial (Quadruple-P)

Por: van Limburg Stirum · E. V. J. · van der Windt · L. I. · van Dijk · C. E. · van Baar · A. L. · Leemhuis · A. G. · van Wely · M. · de Boer · M. A. · van 't Hooft · J. · Oudijk · M. A. · Pajkrt · E. · Quadruple-P study group · van den Akker · Bekker · de Boer · Evers · Gordijn · Her
Introduction

Vaginal progesterone and a cervical pessary are both interventions that are investigated for the prevention of preterm birth (PTB). Thus far, beneficial or harmful effects of these interventions on long-term child health and development are described, but evidence is not robust enough to draw firm conclusions. With this follow-up study, we intent to investigate if progesterone or a pessary is superior for the prevention of PTB considering the child’s health at 4–6 years of corrected age.

Methods and analysis

This study is a follow-up study of the Quadruple-P trial; a multicentre, randomised clinical trial (NL42926.018.13, Eudractnumber 2013-002884-24) which randomises women with an asymptomatic midtrimester short cervix to daily progesterone or a pessary for the prevention of PTB. All children born to mothers who participated in the Quadruple-P study (n=628 singletons and n=332 multiples) will be eligible for follow-up at 4–6 years of corrected age. Children will be assessed using parental questionnaires. Main outcomes are child (neuro)development and behaviour. Other outcomes include child mortality, growth and general health. A composite of adverse child outcomes will be compared between the progesterone and pessary groups reporting OR and the corresponding 95% CI. Analyses will be performed separately for singletons and multiples and using the intention-to-treat approach.

Ethics and dissemination

The Medical Research Ethics Committee from Amsterdam UMC confirmed that de Medical Research Involving Human Subjects Act (WMO) did not apply to our study (W20_481 #20.531). Results will be published in a peer-reviewed journal and shared with stakeholders and participants. This protocol is published before analysis of the results.

Trial registration number

Dutch Trial Register (NL9646).

Effectiveness of exercise and physical activity interventions to improve long-term patient-relevant cognitive and non-cognitive outcomes in people living with mild cognitive impairment: a protocol of a systematic review and meta-analysis

Por: Dieckelmann · M. · Gonzalez-Gonzalez · A. I. · Banzer · W. · Berghold · A. · Jeitler · K. · Pantel · J. · Schall · A. · Tesky · V. A. · Siebenhofer · A.
Introduction

Mild cognitive impairment (MCI) is a clinical syndrome characterised by persistent cognitive deficits that do not yet fulfil the criteria of dementia. Delaying the onset of dementia using secondary preventive measures such as physical activity and exercise can be a safe way of reducing the risk of further cognitive decline and maintaining independence and improving quality of life. The aim is to systematically review the literature to assess the effectiveness of physical activity and exercise interventions to improve long-term patient-relevant cognitive and non-cognitive outcomes in people living with MCI, including meta-analyses if applicable.

Methods and analysis

We will systematically search five electronic databases from 1995 onward to identify trials reporting on the effectiveness of physical activity and exercise interventions to improve long-term (12+ months) patient-relevant cognitive and non-cognitive outcomes in adults (50+ years) with MCI. Screening procedures, selection of eligible full-texts, data extraction and risk of bias assessment will be performed in dual-review mode. Additionally, the reporting quality of the exercise interventions will be assessed using the Consensus on Exercise Reporting Template. A quantitative synthesis will only be conducted if studies are homogeneous enough for effect sizes to be pooled. Where quantitative analysis is not applicable, data will be represented in a tabular form and synthesised narratively. People living with MCI will be involved in defining outcome measures most relevant to them in order to assess in how far randomised controlled trials report endpoints that matter to those concerned.

Ethics and dissemination

Results will be disseminated to both scientific and lay audiences by creating a patient-friendly video abstract. This work will inform professionals in primary care about the effectiveness of physical activity and exercise interventions and support them to make evidence-based exercise recommendations for the secondary prevention of dementia in people living with MCI. No ethical approval required.

PROSPERO registration number

CRD42021287166.

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 stud

Por: Hjorth · T. · Schadow · A. · Revheim · I. · Spielau · U. · Thomassen · L. M. · Meyer · K. · Piotrowski · K. · Rosendahl-Riise · H. · Rieder · A. · Varela · P. · Lysne · V. · Ballance · S. · Koerner · A. · Landberg · R. · Buyken · A. · Dierkes · J.
Introduction

In 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 analysis

The 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 dissemination

The 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 number

NCT04994327.

Nursing, frailty, functional decline and models of care in relation to older people receiving long-term care: a scoping review protocol

Por: Flyum · I. R. · Gjevjon · E. R. · Josse-Eklund · A. · Laerum-Onsager · E. · Borglin · G.
Introduction

Older people receiving healthcare in long-term care contexts (eg, home healthcare, sheltered housing and nursing home contexts) are especially vulnerable to developing frailty and functional decline. Considering the negative effects associated with these conditions and the possibility of preventing them from progressing, it is vital that nurses possess a broad knowledge base related to them. Particularly as prevention related to these conditions lies well within their remit. Such knowledge could guide the development of effective models of care, ensuring continuity and, hence, quality of care. Our objective will be to review published literature on existing models of care targeting frailty and/or functional decline and how these conditions are described by older people themselves, significant others and nurses in relation to long-term care.

Methods and analysis

The scoping review will be conducted in accordance with Arksey and O’Malley’s methodological framework. Recent methodological developments will be considered. PubMed, CINAHL and PsycINFO will be searched. Eligibility criteria will be peer-reviewed papers and written in English. All types of study designs will be eligible and included papers will be quality and ethically assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Protocol checklist for protocols and the PRISMA for Scoping Reviews checklist were followed in this paper.

Ethics and dissemination

As the study outlined in this protocol is a scoping review, no ethics approval was needed for this protocol nor for the upcoming study. The findings will be published in an open-access, peer-reviewed journal. Additionally, the findings will guide a research project following the Medical Research Council’s framework for developing and evaluating complex interventions. Thus, supporting us in developing a model of care related to the detection and prevention of frailty and/or functional decline among older people in a long-term care context.

Developing a communication-skills training curriculum for resident-physicians to enhance patient outcomes at an academic medical centre: an ongoing mixed-methods study protocol

Por: Shahbaz · H. · Noorali · A. A. · Inam · M. · Qadeer · N. · Merchant · A. A. H. · Khan · A. A. · Afzal · N. · Abdul Rahim · K. · Munaf · I. · Ahmad · R. · Tariq · M. · Haider · A. H.
Introduction

Effective physician–patient communication is directly linked to enhanced patient safety, improved healthcare quality and health outcomes. Numerous studies have been done to implement and reinforce communication skills as core competencies to be acquired during residency training for providing culturally competent care. Pakistan has an ethnically diverse culture with people from varying diasporas. Hence there is a need to develop a curriculum that teaches cultural competency to residents. Thus, the aim of this study is (1) the identification of existing problems of communication skills among residents across various specialties, and (2) to strategise a communication skills curriculum by organising a conference of experts based on the Delphi method/estimate-talk-estimate method.

Methods and analysis

This study is divided into two phases. The first phase will employ a mixed-methods approach whereby the perceptions of attendings, residents, fellows, nurses, medical students and patients about resident–patient communication will be assessed via validated surveys, focused group discussions and in-depth interviews. Quantitative and qualitative data will be analysed using Stata and NVivo, respectively. The second phase is the development of a communication skills curriculum for residents based on results from phase one and a Delphi consensus involving medical education experts. Both phases will be conducted at a tertiary care hospital in Karachi, Pakistan.

Ethics and dissemination

This study has received ethical approval from the Ethical Review Committee at the Aga Khan University (2021-6041-17126). All participants will be mandated to provide informed consent and their confidentiality will be maintained by using de-identifiers and limiting access of the data to the research team only. The findings from this study will be presented in the form of original research papers.

Public views of and reactions to the COVID-19 pandemic in England: a qualitative study with diverse ethnicities

Por: McNulty · C. · Sides · E. · Thomas · A. · Kamal · A. · Syeda · R. B. · Kaissi · A. · Lecky · D. M. · Patel · M. · Campos-Matos · I. · Shukla · R. · Brown · C. S. · Pareek · M. · Sollars · L. · Nellums · L. · Greenway · J. · Jones · L. F.
Objectives

To explore public reactions to the COVID-19 pandemic across diverse ethnic groups.

Design

Remote qualitative interviews and focus groups in English or Punjabi. Data were transcribed and analysed through inductive thematic analysis.

Setting

England and Wales, June to October 2020.

Participants

100 participants from 19 diverse ‘self-identified’ ethnic groups.

Results

Dismay, frustration and altruism were reported across all ethnic groups during the first 6–9 months of the COVID-19 pandemic. Dismay was caused by participants’ reported individual, family and community risks, and loss of support networks. Frustration was caused by reported lack of recognition of the efforts of ethnic minority groups (EMGs), inaction by government to address COVID-19 and inequalities, rule breaking by government advisors, changing government rules around: border controls, personal protective equipment, social distancing, eating out, and perceived poor communication around COVID-19 and the Public Health England COVID-19 disparities report (leading to reported increased racism and social isolation). Altruism was felt by all, in the resilience of National Health Service (NHS) staff and their communities and families pulling together. Data, participants’ suggested actions and the behaviour change wheel informed suggested interventions and policies to help control COVID-19.

Conclusion

To improve trust and compliance future reports or guidance should clearly explain any stated differences in health outcomes by ethnicity or other risk group, including specific messages for these groups and concrete actions to minimise any risks. Messaging should reflect the uncertainty in data or advice and how guidance may change going forward as new evidence becomes available. A contingency plan is needed to mitigate the impact of COVID-19 across all communities including EMGs, the vulnerable and socially disadvantaged individuals, in preparation for any rise in cases and for future pandemics. Equality across ethnicities for healthcare is essential, and the NHS and local communities will need to be supported to attain this.

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study

Por: Castano-Leon · A. M. · Paredes · I. · Lagares · A. · Gomez · P. A. · Gonzalez-Leon · P. · Perez-Nunez · A. · Jimenez-Roldan · L. · Delgado-Fernandez · J. · Eiriz Fernandez · C. · Garcia-Perez · D. · Moreno-Gomez · L. M. · Esteban-Sinovas · O. · Delgado-Lopez · P. D. · Martin-Alon
Objectives

The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery.

Design

This was an observational retrospective study.

Settings

A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020.

Participants

A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease.

Primary and secondary outcome measures

The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection.

Results

More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p

Conclusions

Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.

Supporting direct support professionals in enabling people with intellectual disabilities to engage in meaningful activities: protocol for the Meaningful Activities 4 All (MA4A) study based on the human-centred design process

Por: Wille · C. · De Clerck · I. · Van Hove · G. · Van Loon · J. · Van de Velde · D. · De Vriendt · P.
Introduction

Meaningful activities (MA) have a positive impact on identity, well-being, participation and inclusion. Although people with intellectual disabilities (PID) depend on their direct support professionals (DSPs) to engage in MA, the DSPs need support which could enable them to offer more qualitative care and support.

Methods and analysis

To identify DSPs’ needs, and to develop a tool/service, an innovative and iterative approach is developed, based on the human-centred design (HCD) process, combined with traditional qualitative and quantitative research methods. In the inspiration phase (needs analysis), in-depth interviews will be conducted in two day care centres in Flanders using an interpretative phenomenological analyses, one with a supply-driven approach and the other with a demand-driven approach, followed by a survey sent to all Flemish day care centres. In the ideation phase, the insights of phase 1 will guide a cocreation process (comprising a World Cafe, brainstorm and prototype sessions) with the DSPs, PID and other stakeholders. In the implementation phase, the solution will be tested in the two day care centres from phase 1 by means of living labs and a realist evaluation. By adopting this protocol, the functionality, quality, usability and acceptance are expected to increase. This protocol adopts all phases of the HCD process and shows the complementarity of HCD with traditional research methods. PID and the DSPs will benefit as the end result is truly grounded in their specific needs and wishes.

Ethics and dissemination

Ethical approval by the Ethics Committee of the University Hospital Ghent, Belgium (reference numbers: B670202042983 and PA2021-091). All participants will sign informed consent forms. Results of this study will be submitted for publication in relevant peer-reviewed journals and will be presented at relevant conferences.

Incorporating value-based healthcare projects in residency training: a mixed-methods study on the impact of participation on understanding and competency development

Por: Vaassen · S. · Essers · B. A. B. · Stammen · L. A. · Walsh · K. · Kerssens · M. · Evers · S. M. A. A. · Heyligers · I. · Stassen · L. P. S. · van Mook · W. N. K. A. · Noben · C. Y. G.
Objectives

Stimulating the active participation of residents in projects with societally relevant healthcare themes, such as value-based healthcare (VBHC), can be a strategy to enhance competency development. Canadian Medical Education Directions for Specialists (CanMEDS) competencies such as leader and scholar are important skills for all doctors. In this study, we hypothesise that when residents conduct a VBHC project, CanMEDS competencies are developed. There is the added value of gaining knowledge about VBHC.

Design

An explorative mixed-methods study assessing residents’ self-perceived learning effects of conducting VBHC projects according to three main components: (1) CanMEDS competency development, (2) recognition of VBHC dilemmas in clinical practice, and (3) potential facilitators for and barriers to implementing a VBHC project. We triangulated data resulting from qualitative analyses of: (a) text-based summaries of VBHC projects by residents and (b) semistructured interviews with residents who conducted these projects.

Setting

Academic and non-academic hospitals in the Netherlands.

Participants

Out of 63 text-based summaries from residents, 56 were selected; and out of 19 eligible residents, 11 were selected for semistructured interviews and were included in the final analysis.

Results

Regarding CanMEDS competency development, the competencies ‘leader’, ‘communicator’ and ‘collaborator’ scored the highest. Opportunities to recognise VBHC dilemmas in practice were mainly stimulated by analysing healthcare practices from different perspectives, and by learning how to define costs and relate them to outcomes. Finally, implementation of VBHC projects is facilitated by a thorough investigation of a VBHC dilemma combined with an in-depth stakeholder analysis.

Conclusion

In medical residency training programmes, competency development through active participation in projects with societally relevant healthcare themes—such as VBHC—was found to be a promising strategy. From a resident’s perspective, combining a thorough investigation of the VBHC dilemma with an in-depth stakeholder analysis is key to the successful implementation of a VBHC project.

Exploring COVID-19 vaccine uptake, confidence and hesitancy among people experiencing homelessness in Toronto, Canada: protocol for the Ku-gaa-gii pimitizi-win qualitative study

Por: Jenkinson · J. I. R. · Sniderman · R. · Gogosis · E. · Liu · M. · Nisenbaum · R. · Pedersen · C. · Spandier · O. · Tibebu · T. · Dyer · A. · Crichlow · F. · Richard · L. · Orkin · A. · Thulien · N. · Kiran · T. · Kayseas · J. · Hwang · S. W.
Introduction

People experiencing homelessness are at high risk for COVID-19 and poor outcomes if infected. Vaccination offers protection against serious illness, and people experiencing homelessness have been prioritised in the vaccine roll-out in Toronto, Canada. Yet, current COVID-19 vaccination rates among people experiencing homelessness are lower than the general population. This study aims to characterise reasons for COVID-19 vaccine uptake and hesitancy among people experiencing homelessness, to identify strategies to overcome hesitancy and provide public health decision-makers with information to improve vaccine confidence and uptake in this priority population.

Methods and analysis

The Ku-gaa-gii pimitizi-win qualitative study (formerly the COVENANT study) will recruit up to 40 participants in Toronto who are identified as experiencing homelessness at the time of recruitment. Semistructured interviews with participants will explore general experiences during the COVID-19 pandemic (eg, loss of housing, social connectedness), perceptions of the COVID-19 vaccine, factors shaping vaccine uptake and strategies for supporting enablers, addressing challenges and building vaccine confidence.

Ethics and dissemination

Approval for this study was granted by Unity Health Toronto Research Ethics Board. Findings will be communicated to groups organising vaccination efforts in shelters, community groups and the City of Toronto to construct more targeted interventions that address reasons for vaccine hesitancy among people experiencing homelessness. Key outputs will include a community report, academic publications, presentations at conferences and a Town Hall that will bring together people with lived expertise of homelessness, shelter staff, leading scholars, community experts and public health partners.

Long-term spill-over impact of COVID-19 on health and healthcare of people with non-communicable diseases: a study protocol for a population-based cohort and health economic study

Por: Youn · H. M. · Quan · J. · Mak · I. L. · Yu · E. Y. T. · Lau · C. S. · Ip · M. S. M. · Tang · S. C. W. · Wong · I. C. K. · Lau · K. K. · Lee · M. S. F. · Ng · C. S. · Grepin · K. A. · Chao · D. V. K. · Ko · W. W. K. · Lam · C. L. K. · Wan · E. Y. F.
Introduction

The COVID-19 pandemic has a significant spill-over effect on people with non-communicable diseases (NCDs) over the long term, beyond the direct effect of COVID-19 infection. Evaluating changes in health outcomes, health service use and costs can provide evidence to optimise care for people with NCDs during and after the pandemic, and to better prepare outbreak responses in the future.

Methods and analysis

This is a population-based cohort study using electronic health records of the Hong Kong Hospital Authority (HA) CMS, economic modelling and serial cross-sectional surveys on health service use. This study includes people aged ≥18 years who have a documented diagnosis of diabetes mellitus, hypertension, cardiovascular disease, cancer, chronic respiratory disease or chronic kidney disease with at least one attendance at the HA hospital or clinic between 1 January 2010 and 31 December 2019, and without COVID-19 infection. Changes in all-cause mortality, disease-specific outcomes, and health services use rates and costs will be assessed between pre-COVID-19 and-post-COVID-19 pandemic or during each wave using an interrupted time series analysis. The long-term health economic impact of healthcare disruptions during the COVID-19 pandemic will be studied using microsimulation modelling. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be used to evaluate the effect of different modes of supplementary care on health outcomes.

Ethics and dissemination

The study was approved by the institutional review board of the University of Hong Kong, the HA Hong Kong West Cluster (reference number UW 21–297). The study findings will be disseminated through peer-reviewed publications and international conferences.

❌