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Due to the growing use of high-dimensional data and methodological advances in medical research, reproducibility of research is increasingly dependent on the availability of reproducible code. However, code is rarely made available and too often only partly reproducible. Here, we aim to provide practical and easily implementable recommendations for medical researchers to improve the reproducibility of their code. We reviewed current coding practices in the population-based Rotterdam Study cohort. Based on this review, we formulated the following five recommendations to improve the reproducibility of code used in data analysis: (1) make reproducibility a priority and allocate time and resources; (2) implement systematic code review by peers, as it further strengthens reproducibility. We provide a code review checklist, which serves as a practical tool to facilitate structured code review; (3) write comprehensible code that is well-structured; (4) report decisions transparently, for instance by providing the annotated workflow code for data cleaning, formatting and sample selection; and (5) focus on accessibility of code and data and share both, when possible, via an open repository to foster accessibility. Ideally, this repository should be managed by the institution and should be accessible to everyone. Based on these five recommendations, medical researchers can take actionable steps to improve the reproducibility of their research. Importantly, these recommendations are thought to provide a practical starting point for enhancing reproducibility rather than mandatory guidelines.
Low-value care provides little or no benefit to patients, or its risk of harm outweighs the potential benefits. Non-nursing tasks refer to tasks performed by nurses below their scope of practice. With increasing pressure on the global nursing workforce, it is necessary to identify these concepts to deliver fundamental care.
To assess the prevalence, influencing factors and associations of low-value nursing care, and to identify non-nursing tasks and potential solutions in surgical hospital care settings.
The study followed a cross-sectional study design using a self-developed questionnaire.
A questionnaire on low-value care and non-nursing tasks was distributed to surgical wards in four hospitals in The Netherlands.
A total of 302 nurses responded to the survey. Five most prevalent low-value care practices were identified, including routine preoperative fasting (84.8%), taking over blood glucose monitoring (59.3%) and leaving in place any type of venous catheter (42.1%). These practices were mainly performed due to habitual practice, in accordance with an established protocol, or upon physicians' request. Most reported non-nursing tasks were administrative duties and cleaning patient rooms and equipment. Provided solutions included clearly defining responsibilities and taking personal responsibility.
Low-value care, provided by surgical nurses, is common in daily practice. This requires targeted de-implementation of each low-value care practice, based on influencing factors. Additionally, 85.8% of nurses perform non-nursing tasks daily or several times a day, underlining the need to re-organise nursing tasks.
De-implementing low-value care and reducing non-nursing tasks is necessary to ease pressure on the global nursing workforce and to improve fundamental care.
Low-value nursing care and non-nursing tasks persist when nurses lack leadership responsibility.
STROBE checklist.
No patient contribution.
Muscle-invasive bladder cancer (MIBC) is an aggressive type of cancer. About 50% of patients will die from the disease within 5 years despite radical treatment. This implies that in many patients, the disease has already spread at the time of radical treatment, even though imaging shows no signs of metastasis. We hypothesise that the standard local staging method, transurethral resection of the bladder tumour (TURBT), is partly responsible for tumour cell spread. Furthermore, TURBT (and re-TURBT in many patients) contributes to a significant delay to definitive therapy. The aim of this randomised study is to determine whether multiparametric MRI (mpMRI) of the bladder, in combination with a single outpatient bladder tumour biopsy for histological confirmation, is a safer, faster, less costly and, therefore, more cost-effective diagnostic pathway than TURBT to detect or rule out MIBC.
BladParadigm is a two-arm multicentre randomised controlled trial (RCT) conducted in the Netherlands. Over a 3-year period, patients with clinically suspected MIBC without evidence of metastases will be recruited and randomised 1:1 to either TURBT or 3-Tesla mpMRI with same-day outpatient bladder biopsy. The Vesical Imaging Reporting and Data System (VI-RADS) will be used to standardise mpMRI reporting. Patients will undergo definitive treatment based on the results of the TURBT or mpMRI. The study is powered to demonstrate that the mpMRI-based strategy is at least non-inferior to standard TURBT in patients treated with radical cystectomy alone, assuming a relative hazard of 0.55. The required sample size is 360 patients (180 TURBT, 180 mpMRI). The primary outcome is 2-year progression-free survival. Progression will be assessed by imaging, according to the current standard of care. Secondary outcome measures are time to definitive treatment, quality of life (EuroQol 5D-5L), healthcare costs and cost-effectiveness.
This study has received ethical approval from the Medical Ethical Committee Oost-Nederland (NL83685.091.23). All participants will provide written informed consent prior to inclusion. Findings of this study will be disseminated through peer-reviewed, open-access publications, presentations at scientific conferences and stakeholder briefings.
Health advocacy (HA) is acknowledged as a core competence in medical education. However, varying and sometimes conflicting conceptualisations of HA exist, making it challenging to integrate the competence consistently. While this diversity highlights the need for a deeper understanding of HA conceptualisations, a comprehensive analysis across the continuum of medical education is absent in the literature. This protocol has been developed to clarify the conceptual dimensions of the HA competence in literature as applied to medical education.
The review will be conducted in line with the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. A comprehensive literature search was developed and already carried out in eight academic databases and Google Scholar, without restrictions on publication date, geography or language. Articles that describe the HA role among students and physicians who receive or provide medical education will be eligible for inclusion. Two independent reviewers will independently complete title and abstract screening prior to full-text review of selected articles and data extraction on the final set. A descriptive-analytical approach will be applied for summarising the data.
This scoping review does not involve human participants, as all evidence is sourced from publicly available databases. Therefore, ethical approval is not required for this study. The findings from this scoping review will be disseminated through submission to a high-quality peer-reviewed journal and presented at academic conferences. By clarifying the conceptualisations of HA, this review aims to contribute to a shared narrative that will strengthen the foundation for integrating the HA role into medical education.
A preliminary version of this protocol was registered on the Open Science Framework on 9 December 2024, and can be accessed at the following link: https://osf.io/ed2br. We have also registered our scoping review protocol as a preprint at medRxiv:
Our objectives were (1) to characterise the age-sex-standardised prevalence of comorbidities among people living with HIV (PLWH) and people not living with HIV (PnLWH) between 2001 and 2019 and (2) to examine the effect of comorbidities on direct healthcare costs among PLWH and PnLWH.
This was a retrospective, matched cohort study conducted with the Comparative Outcomes and Service Utilisation Trends (COAST) cohort, which contained all known PLWH in British Columbia (BC), Canada and a general population sample.
BC, Canada.
A total of 9554 PLWH and 47 770 PnLWH from the COAST cohort were followed between 2001 and 2019. Participants were at least 19 years old and 82% male in both groups.
The primary outcomes were the age-sex-standardised prevalence of 16 comorbidities, calculated annually, among PLWH and PnLWH. Secondary outcomes included direct healthcare costs associated with each comorbidity among PLWH and PnLWH. Outcomes were ascertained from administrative health databases.
PLWH exhibited a higher age-sex-standardised prevalence of most comorbidities compared with PnLWH over the study period. Relative disparities in liver and kidney diseases markedly decreased since 2008. Disparities in the prevalence of mental health disorders and substance use disorder (SUD) were consistently large throughout the study period. Comorbidities were associated with high healthcare costs, especially among PLWH.
This study underscores the persistent and evolving burden of non-AIDS-defining comorbidities among PLWH, even in the context of improved HIV management. The high prevalence of mental health disorders and SUD, coupled with the substantial healthcare costs associated with these conditions, emphasises the need for holistic and integrated care models that address the full spectrum of health challenges faced by PLWH.
During the COVID-19 pandemic, a substantial decrease was observed in hospital admissions and in-hospital procedures for patients with acute cardiovascular diseases (CVDs). The extent to which measures to prevent COVID-19 transmission, for example, lockdowns, affected the outpatient care of patients at higher cardiovascular risk remains unclear. We aimed to compare outpatient department (OPD) attendance, cardiovascular risk management (CVRM) and cardiovascular health (CVH) of patients at higher cardiovascular risk referred to an OPD of a tertiary care centre between preCOVID-19, during and postCOVID-19 periods.
We included all adult patients at higher cardiovascular risk referred to the cardiology, vascular medicine, diabetology, geriatrics, nephrology or multidisciplinary vascular surgery OPDs of the University Medical Centre Utrecht, the Netherlands, between March 2019 and December 2022, in a prospective cohort study.
We assessed trends in the number of first and follow-up appointments and in the completeness of extractable CVRM indicators from the electronic health record (EHR) as a proxy for CVRM guideline adherence. CVH was determined using the Life’s Essential 8 metric (score 0–100, the higher score, the better). We investigated whether CVH differed between COVID-19 periods compared with the reference period (ie, 2019) and stratified by OPDs, using multivariable linear regression, adjusted for age, gender, CVD history and whether the patient had a previous appointment before the reference period.
Among 15 143 patients, we observed a 33% reduction in the weekly number of first appointments during the COVID-19 pandemic, with the largest reductions in the cardiology and nephrology OPDs, with no differences between women and men. Follow-up appointments conducted remotely, compared with before the COVID-19 pandemic, increased significantly for all OPDs. CVRM indicators were up to 11% less extractable during the first lockdown yet returned to prepandemic levels directly after the first lockdown period. The CVH score of patients visiting the nephrology, vascular medicine and geriatrics OPDs during the first lockdown was 11.23 (95% CI 2.74 to 19.72), 5.68 (95% CI 0.82 to 10.54) and 5.66 (95% CI 0.01 to 11.31) points higher, respectively, compared with the prepandemic period. In between the second and third lockdowns, the CVH score was comparable to the preCOVID reference period, yet for the cardiology OPD it was significantly higher (5.54, 95% CI 2.04 to 9.05).
During the COVID-19 pandemic, weekly numbers of first appointments to OPDs decreased, and a population with a higher CVH score (ie, better CVH) visited certain OPDs, especially during the first lockdown period. These suggest that patients with poorer CVH more often avoided or were unable to visit OPDs, which might have resulted in missed opportunities to control cardiovascular risk factors and potentially may have led to preventable disease outcomes. For future epidemics and pandemics, it seems vital to develop a strategy that includes an emphasis on seeking healthcare when needed, with specific attention to patients at higher CVD risk.
The World Health Organization defines quality of care as providing effective, evidence-based care, and avoiding harm. Low-value care provides little or no benefit to the patient, causes harm, and wastes limited resources. In 2017, shortly after the start of the International Choosing Wisely campaign, the first Dutch nursing “Do-not-do” list was published and has become a widely used practical tool for nurses working in daily practice. However, over the last years new guidelines are published. Therefore, an update of the list is necessary with an addition of high-value care recommendations as alternative care practices for low-value care.
In this study, a combination of designs was used. First, we searched Dutch clinical practice guidelines for low-value or high-value care recommendations. All nursing care recommendations were assessed and specified to several healthcare sectors, including hospital care, district care, nursing home care, disability care, and mental health care. Second, a prioritization among nurses regarding low-value care recommendations was done by a cross-sectional survey for each healthcare sector.
In total, 66 low-value care recommendations were found, for example, “avoid unnecessary layers under the patient at risk of pressure ulcers” and “never flush the bladder to prevent urinary tract infection.” Furthermore, 414 high-value care recommendations were selected, such as “use the Barthel Index to assess and to evaluate the degree of ADL independence” and “application of cold therapy may be considered for oncological patients with pain.” In total, 539 nurses from all healthcare sectors prioritized the low-value care recommendations, resulting in a top five low-value care practices per healthcare sector. The top five low-value care recommendations differed per healthcare sector, although “do not use physical restraints in case of a delirium” was prioritized by four out of five sectors.
Assessing low-value and high-value care recommendations for nurses will help and inspire nurses to deliver fundamental care for their patients. These initiatives regarding low-value and high-value care are essential to generate a culture of continuous quality improvement based on evidence. This is also essential to meeting the current challenges of the healthcare delivery system.
This paper provides an update of low-value care recommendations for nurses based on Dutch guidelines from 2017 to 2023, specified to five healthcare sectors, including hospital care, district care, nursing home care, disability care and mental health care, with an accompanying prioritization of these low-value care recommendations to facilitate de-implementation. This paper provides a first overview of high-value care recommendations to reflect on and create alternative care practices for low-value care. The recommendations regarding low-value and high-value care are essential to generate a culture of continuous improvement of appropriateness based on evidence, finally leading to better quality of care and improving patient outcomes.
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