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Patient satisfaction with infection prevention and control interventions in acute hospitals: a systematic review and meta-analysis

Por: Skally · M. · Kearney · A. · Strawbridge · J. · Heritage · J. · Cox · C. · Bennett · K. E. · Humpreys · H. · Fitzpatrick · F.
Introduction

Infection prevention and control (IPC) interventions are multifactorial and are used to prevent healthcare-associated infections in healthcare facilities. However, patient views and enabling patient and public involvement (PPI) in their development has been minimal.

Objectives

This systematic review aims to identify peer-reviewed publications reporting patient satisfaction outcomes in the context of IPC interventions, to document the methods used to assess patient satisfaction and to conduct a meta-analysis on reported satisfaction outcomes.

Design

Systematic review and meta-analysis following the Joanna Briggs Institute (JBI) methodology and the PRISMA statement, with oversight from a steering group including PPI partners. Studies in peer-reviewed journals were included based on eligibility criteria.

Data sources

MEDLINE, Scopus, Web of Science, EMBASE, Cochrane Library, CINAHL and PsycINFO were searched in June 2024.

Eligibility criteria

Included studies investigated satisfaction among hospitalised patients in acute care settings following IPC measures, including isolation, cohorting, screening, hand hygiene, antimicrobial stewardship, patient flagging, education, personal protective equipment use, visiting restrictions and treatment delays

Data extraction and synthesis

Titles and abstracts were screened independently by two reviewers; disagreements were resolved by a third. Study quality was assessed using the JBI manual for evidence synthesis. A meta-analysis was conducted where four or more studies used comparable designs and methods within the same areas of IPC, with heterogeneity evaluated using Cochran’s Q statistic and I2 and pooled estimates calculated with 95% CIs using the Wilson (score) method.

Results

Twenty-nine studies were identified. Among IPC measures, isolation precautions were the most commonly reported intervention (11 studies, 38%). The Likert scale was the predominant assessment method (13 studies, 45%). Patient satisfaction with IPC interventions ranged from 58.3% to 97.2%. Meta-analysis of four studies using the Hospital Consumer Assessment of Healthcare Providers and Systems survey showed substantial heterogeneity (I2, 55%, p=0.08) and a pooled patient satisfaction level of 69% (95% CI 63.6% to 74.4%) for isolation precautions.

Conclusion

Sixty-nine percent of isolated patients reported satisfaction with their care. Patient satisfaction with IPC interventions varies widely, highlighting limitations in current measurement approaches. Strengthening PPI in the design and evaluation of satisfaction measures is essential to capture meaningful data and improvements in IPC programmes.

PROSPERO registration number

IS 2024 CRD42024558385.

A multi-image codebook approach for secure text transmission

by Omar Fitian Rashid, Saba A. Tuama, Humam Al-Shahwani

In modern digital communication, Confidentiality of text transmission is remains a concern in the current online communication as cyber threats and intrusion. To address these challenges, this paper proposes a dual-layered security system that integrates cryptography and multi-image steganography to strengthen text protection during transmission. The cryptography layer is done based eight steps; in the first one, the message is converted to ASCII format, then convert the ASCII values into their equivalent binary numbers and make a complement to the binary values where each 0’s becomes 1’s and vice versa. In the next step, it needs to enter a key that includes a combination of characters, numbers, and special characters. This key is also converted to binary, and then the XOR operation is made between the message of the binary values and the key. In the fifth step, switching the values of each two adjacent binary values are together and converted to decimal values. While the second layer embeds the ciphertext in several cover images using a randomized codebook along with the Least Significant Bit (LSB) substitution, thus enhancing undetectability. Experimental evaluation demonstrates fast execution times for both the encryption/decryption processes and the multi-image hiding/extraction procedures. The achieved results validate that the proposed system provides an efficient and highly secure framework for protecting sensitive information.

Preferences and predictors driving opioid-involved polysubstance use profiles and trajectories: a prospective cohort study protocol

Por: Campbell · M. · Lafayette · J. I. · Vallejo Vasquez · K. · Rivard · A. · Diamond · J. · Nguyen · C. · Caputo · D. · Lothumalla · S. · Rodriguez · C. R. · Tomlinson · D. C. · Bonar · E. E. · Goldstick · J. E. · Walton · M. · Lee · S. · Menke · N. · Lin · L. · Coughlin · L. N.
Introduction

Polysubstance use (PSU), particularly opioid-involved and stimulant-involved PSU, is a growing issue in the USA. PSU increases the risk of negative health consequences, including infectious diseases, worsening physical and mental health conditions, and overdose-related deaths. These consequences occur in the context of varying health risk behaviours, substance-related preferences, and treatment engagements among people with PSU. To inform improvements in prevention, harm reduction, and substance use disorder (SUD) treatment, additional research is needed to comprehensively understand the current context and drivers of PSU preferences, motivations, and behaviours.

Methods and analysis

Herein, we describe the protocol for a prospective cohort study designed to capture detailed patterns, profiles, and trajectories of PSU, with the aim of comprehensively examining the drivers of PSU behaviours and SUD treatment utilisation. Adults (ages 18–75; n=400) who engage in PSU will be recruited from healthcare institutions, an established participant database maintained by an adjacent SUD research team, and online advertisements. Study assessments will capture dynamic patterns, choice preferences, and motivators of PSU via behavioural economic (BE) measures, detailed Timeline Follow-Back (TLFB) interviews, and self-administered surveys. The assessment timeline will include a baseline survey and TLFB interview, weekly TLFB interviews for 4 weeks post-baseline, and follow-up surveys and TLFB interviews at 4-, 8-, and 12-months post-baseline.

Ethics and dissemination

The study is funded through the National Institutes of Health Helping to End Addiction Long-term (HEAL) initiative and was approved by the University of Michigan Medical Institutional Review Board. Findings will be disseminated to academic, clinical, and community partners through the Michigan Innovations in Addiction Care through Research and Education programme. Results from this study will inform actionable and practical insights relevant to the delivery of personalised care in the context of PSU.

Do professional experience and qualification influence knowledge about law concerning informed consent and end-of-life decisions? A quantitative online survey among German intensive care physicians

Por: Schumann · C. · Wachter · M. · Eslauer · E. · Angeli · R. · Girrbach · F. · Weiss · M. · Friedrich · S. · Simon · P. · Heller · A. R.
Background

Recently, legal questions have increasingly arisen in intensive care medicine (ICM), especially when it comes to end-of-life decisions. Still, for Europe, there is not much evidence about doctors’ situational legal knowledge and legal education during medical studies and further qualification. The present study was initiated to analyse these hitherto unexplored aspects in Germany.

Design

A quantitative online survey has been performed among German intensive care physicians. The voluntary participants of the anonymous online survey were asked to answer legal questions related to end-of-life policies, informed consent, surrogate decision making or advance directives. We tested pure factual knowledge in five questions. The other five questions tested situational knowledge using case vignettes. Every question could be answered with ‘yes’, ‘no’ or ‘do not know’. Furthermore, the participants were asked to assess their subjective certainty on a Likert scale and to provide information about their professional experience (PE) and qualification.

Setting

All members of the two German professional societies for anaesthesiology who work in ICM were asked to take part in the survey.

Participants

952 completed questionnaires were analysed. 86% of the participants were specialists, and 56% held the additional qualification in ICM. 78% had more than 10 years of general clinical experience, and 62% had more than 5 years of experience in ICM.

Results

On average, the participants answered the five facts–questions in 90.8% correctly. However, only 73.6% of the five case vignettes were answered correctly. Specialists, physicians with a lot of PE or physicians holding the additional qualification in ICM did not perform better than assistants or physicians with little PE.

Conclusion

German intensive care physicians have relevant gaps regarding situational legal knowledge, which are independent of their PE or qualification and persist. This may be due to difficulties in interpretation and implementation of law. Since these knowledge gaps can lead to liability and criminal prosecution, these gaps should be closed through awareness-raising and continuous education.

Fertility, family planning, pregnancy and motherhood among women doctors working in the EU and UK: a scoping review

Por: Biju · S. · Madden · C. · OConnor · P. · Byrne · D. · Humphries · N. · Jeffrey · G. · Finnegan · J. · ODonoghue · K. · Fitzgibbon · S. · Lydon · S.
Objectives

Women doctors face considerable challenges navigating family planning, pregnancy and motherhood. Their experiences can have relevance for health system functioning, including doctor retention. This scoping review synthesises research on family planning, fertility, pregnancy and motherhood among women doctors in the EU and the UK.

Design

Scoping review conducted according to JBI best practice guidance.

Data sources

MEDLINE, CINAHL, Academic Search Complete, PsycInfo and Web of Science were searched, and supplemented with backwards and forwards citation chasing.

Eligibility criteria

Peer-reviewed, original research, in English, focusing on either fertility and family planning, pregnancy and/or motherhood among women doctors in an EU country(s) and/or the UK.

Data extraction and synthesis

Data were extracted independently by two authors. Data were synthesised using deductive content analysis and collated using narrative synthesis.

Results

In total, 34 studies were identified. Family planning appears complicated by medical careers. Medical specialty choice is particularly impacted, with certain specialties (eg, General Practice) considered particularly family friendly and others markedly less so. Pregnancy complications among women doctors, especially surgeons, were documented. However, women doctors’ and non-doctors’ pregnancy outcomes were overall not significantly different. Notably, doctor-mothers had fewer children and were more likely to report making compromises or facing negative consequences when balancing family and career than doctor-fathers.

Conclusions

Women doctors in the EU and UK report challenges in balancing work and motherhood. With the potential for their experiences to impact on health system functioning and patient outcomes, training bodies and health organisations should take proactive action to better support women doctors and ensure they can remain in the profession and practice in their desired specialty. Future research examining working practices/schedules during pregnancy, breastfeeding experiences, parenting and childcare and maternal mental health will support a better understanding of women doctors’ experiences and facilitate implementation of effective supports.

Protocol for the process evaluation of a randomised clinical trial of incremental-start versus conventional haemodialysis: the TwoPlus study

Por: Murea · M. · Foley · K. L. · Gautam · S. C. · Flythe · J. E. · Raimann · J. G. · Abdel-Rahman · E. · Awad · A. S. · Niyyar · V. D. · Kovach · C. · Roberts · G. V. · Jefferson · N. M. · Conway · P. T. · Rosales · L. M. · Woldemichael · J. · Sheikh · H. I. · Raman · G. · Huml · A. M. · Kni
Introduction

Process evaluation provides insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a hybrid type 1 effectiveness-implementation randomised clinical trial of incremental-start haemodialysis (HD) versus conventional HD delivered to patients starting chronic dialysis (the TwoPlus Study). The trial will simultaneously assess the effectiveness of incremental-start HD in real-world settings and the implementation strategies needed to successfully integrate this intervention into routine practice. This manuscript describes the rationale and methods used to capture how incremental-start HD is implemented across settings and the factors influencing its implementation success or failure within this trial.

Methods and analysis

We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks to inform process evaluation. Mixed methods include surveys conducted with treating providers (physicians) and dialysis personnel (nurses and dialysis administrators); semi-structured interviews with patient participants, caregivers of patient participants, treating providers (physicians and advanced practice practitioners), dialysis personnel (nurses, dieticians and social workers); and focus group meetings with study investigators and stakeholder partners. Data will be collected on the following implementation determinants: (a) organisational readiness to change, intervention acceptability and appropriateness; (b) inner setting characteristics underlying barriers and facilitators to the adoption of HD intervention at the enrollment centres; (c) external factors that mediate implementation; (d) adoption; (e) reach; (f) fidelity, to assess adherence to serial timed urine collection and HD treatment schedule; and (g) sustainability, to assess barriers and facilitators to maintaining intervention. Qualitative and quantitative data will be analysed iteratively and triangulated following a convergent parallel and pragmatic approach. Mixed methods analysis will use qualitative data to lend insight to quantitative findings. Process evaluation is important to understand factors influencing trial outcomes and identify potential contextual barriers and facilitators for the potential implementation of incremental-start HD into usual workflows in varied outpatient dialysis clinics and clinical practices. The process evaluation will help interpret and contextualise the trial clinical outcomes’ findings.

Ethics and dissemination

The study protocol was approved by the Wake Forest University School of Medicine Institutional Review Board (IRB). Findings from this study will be disseminated through peer-reviewed journals and scientific conferences.

Trial registration number

NCT05828823.

Prevalence of depression or depressive symptoms among engineering students: a systematic review and meta-analysis

Por: Gabriel · F. C. · Humes · E. d. C. · Wagner · M. B. · Fraguas · R.
Objectives

To assess the prevalence of depression or depressive symptoms among engineering students.

Design

Systematic review and meta-analysis of prevalence surveys using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources

PubMed, Index Medicus Global, EMBASE, Web of Science, Scopus and PsycINFO were searched from 1 January 2003 to 28 June 2024.

Eligibility criteria

Studies were included if they: (1) reported the prevalence of depression or depressive symptoms among engineering students, (2) used a validated instrument with defined cut-off points to assess depression or depressive symptoms and (3) were published in a peer-reviewed journal.

Data extraction and synthesis

Two researchers independently extracted data using a standardised spreadsheet, collecting information on country of data collection, survey years, year of training, sample size, mean age of participants, number and percentage of male participants, assessment instrument, cut-off points and prevalence estimates. Discrepancies were resolved by a third researcher. Risk of bias was assessed with the Risk of Bias for Studies of the Prevalence of Mental Health Disorders tool. Prevalence estimates were synthesised using random-effects meta-analysis. Between-study heterogeneity was assessed with ² tests and the I² statistic. Subgroup analyses were conducted according to severity cut-off points, and meta-regression was used to explore the influence of study-level characteristics on prevalence estimates.

Results

23 studies involving 12 758 students across 11 countries were analysed. All studies used validated scales with cut-off points to assess depression or depressive symptoms. The overall pooled prevalence was 42.6% (95% CI 32.7 to 53.1) for studies using symptom severity cut-off points at mild or above, and 33.1% (95% CI 25.2 to 42.0) for studies using symptom severity cut-off points at moderate or above. Meta-regression indicated a progressive annual increase in prevalence (OR 1.14, 95% CI 1.01 to 1.28, p=0.034) across studies conducted from 2014 to 2024.

Conclusions

Prevalence of depression and depressive symptoms is high among engineering students, at levels comparable to medical students. Given the substantial impact, further research should investigate risk factors and evaluate preventive, early detection and treatment strategies tailored to engineering students.

PROSPERO registration number

CRD42024571131.

Association between exposure to proton pump inhibitors and hypertension: a descriptive and disproportionality analysis of VigiBase

Por: Chretien · B. · Cacquevel · M. · Kazuki · N. · Guerin · C. · Dolladille · C. · Alexandre · J. · Humbert · X.
Objectives

The potential link between proton pump inhibitors (PPIs) and hypertension remains unclear. It is uncertain whether such an association exists, whether it represents a class-of-PPI effect and whether a dose–response relationship is involved. This study aimed to investigate the potential class-of-PPI effect associating PPIs with hypertension reporting and evaluate whether the association follows a dose-dependent pattern.

Design

A disproportionality analysis was conducted within VigiBase to identify signals of hypertension reporting associated with individual PPIs by calculating adjusted reporting ORs (aRORs) within a multivariate case/non-case study design. Additionally, the presence of a dose–response relationship was explored.

Setting

Real-world data from VigiBase, the WHO pharmacovigilance database, was used.

Participants

All individual case safety reports with PPI use were included.

Outcome measures

Incident hypertension cases were identified using the Medical Dictionary for Regulatory Activities V.26.1 related to at least one PPI administration that were systematically collected until 28 October 2024. Pharmacovigilance signals between the use of PPIs and hypertension reported and dose dependence between PPI posology and onset or worsening hypertension were analysed.

Results

The database contained 26 587 reports of PPI-associated hypertension (2.3%), predominantly among women (63.3%). Hypertension was most frequently reported in the group aged 45–64 years (41.4%). A significant reporting OR (ROR) was observed for almost all PPIs in both univariable (RORs, 1.32–1.97) and multivariate analyses (aRORs, 1.09–1.35) after adjustments for age group, sex, concurrent antihypertensive medication and drugs known to induce hypertension, with the exception of lansoprazole (aROR 0.99, 95% CI 0.96 to 1.03). A potential trend suggestive of a dose–response relationship was identified, with doses lower than the median associated with a lower aROR for hypertension than doses higher than the median for all PPIs. However, this trend was not statistically significant, potentially due to insufficient statistical power.

Conclusions

This investigation indicates a notable pharmacovigilance safety signal associating PPI usage with hypertension reporting. Although a potential dose–response trend was observed, it was not statistically significant, possibly due to limited statistical power. Further longitudinal studies are warranted.

Disease priorities and rapid diagnostics testing preferences among community members in KwaZulu-Natal, South Africa: a formative qualitative study

Por: Madonsela · T. · Naiken · L. · Mwamba · C. P. · Sharma · A. · Maritim · P. · Tshazi · A. · Bemer · M. · Lauff · A. · Morton · J. F. · van Heerden · A. · Humphries · H. · Drain · P. K. · the DASH 1 study team
Objective

To explore and understand the disease priorities and preferences for rapid diagnostic testings (RDTs) among community members and stakeholders.

Design

Qualitative study using focused group discussions and in-depth interviews. Thematic analysis was applied to identify themes of disease priorities and RDT preferences.

Setting

uMsunduzi Municipality, KwaZulu-Natal, South Africa.

Participants

49 community members and five community stakeholders were recruited through a combination of convenience and purposeful sampling using community events and meetings.

Results

Participants prioritised both communicable diseases (HIV, tuberculosis) and non-communicable diseases (diabetes, cardiovascular disease, hypertension and cancer), aligning with national health priorities. They supported RDTs for early diagnosis and home-based testing to mitigate barriers to accessing diagnostic care. A need for post-test support, such as digital support tools, was also highlighted.

Conclusion

Community perspectives highlighted a demand for accessible, rapid and decentralised diagnostic tools for high-burden diseases in KwaZulu-Natal. RDTs have the potential to improve health outcomes and reduce health disparities through improved access to diagnostic healthcare services. The community members are potential end users of RDTs, especially in resource-constrained settings. Therefore, their perspectives should be considered in the development and implementation of RDTs to enhance acceptability and public health impact.

Burden and predictors of age-related macular degeneration among old age patients with diabetes attending comprehensive specialised hospitals in Northwest Ethiopia: a multicentre cross-sectional prospective study

Por: Shumye · A. F. · Desalegn · G. K. · Tegegn · M. T. · Worku · E. M. · Lorato · M. M. · Bogale · Z. M. · Tegegne · M. M. · Alimaw · Y. A. · Mengistu · H. G. · Bekele · M. M. · Bayabil · A. Z. · Birhan · G. S. · Eticha · B. L.
Objective

This study aims to assess the burden and predictors of age-related macular degeneration (AMD) among older age patients with diabetes attending comprehensive specialised hospitals in Northwest Ethiopia.

Design

A multicentre cross-sectional study was conducted among older patients with diabetes using a systematic random sampling technique.

Setting

The study was conducted at five comprehensive specialised hospitals in Northwest Ethiopia from 8 May to 8 June 2023.

Participants

The study included 832 diabetic individuals aged 40 years and above.

Main outcome measures

Data were collected using a pretested structured questionnaire and physical examinations.

Result

In this study, a total of 832 participants were involved, with a response rate of 96.85%. The burden of AMD was 15.4% (95% CI 13.0% to 18.0%). Male sex (adjusted OR (AOR) 2.04, 95% CI 1.17 to 3.56), older age (AOR 6.91, 95% CI 3.17 to 15.08), diabetes duration of 10 and more years (AOR 3.00, 95% CI 1.91 to 4.69), higher body mass index (AOR 2.56, 95% CI 1.15 to 5.71), presence of hypertension (AOR 2.45, 95% CI 1.56 to 3.85) and family history of diabetes mellitus (DM) (AOR 2.29, 95% CI 1.40 to 3.76) were positively associated with AMD.

Conclusions

This study found that the prevalence of AMD among patients with diabetes was 15.4%. Older age, male sex, longer DM duration, higher body mass index, presence of hypertension and family history of DM were significantly associated with AMD. Targeted screening of at-risk individuals for AMD, public health awareness campaigns focusing on these factors and further research to understand the burden and underlying mechanisms of these associations with AMD are recommended.

Transgenerational consequences of grandparents smoking on grandchildrens development: a systematic review

Por: Ratih · S. P. · Choo · W. Y. · Nik Farid · N. D. · Romadlona · N. A. · Humairo · M. V. · Suprobo · N. R.
Objective

Research on the impact of smoking behaviour across generations has primarily focused on grandmaternal smoking during pregnancy. However, the broader multigenerational effects of smoking behaviour, notably through environmental and behavioural pathways, remain underexplored. This study evaluated previous studies on the possibility of transgenerational transmission, rather than in utero transmission, regarding the effects of grandparental smoking behaviour on offspring’s development outcomes.

Design

This study is a systematic review with qualitative evidence synthesis.

Data sources

A comprehensive search was conducted across multiple online databases, including PubMed, EBSCOhost, Web of Science and Scopus. To ensure a broad scope of relevant studies, publication dates, study locations and language were restricted to English only.

Study selection

After duplicates were removed, 3916 articles remained from the 4133 identified articles. Based on the predefined eligibility criteria, 38 articles were selected for full-text assessment. The selection process involved multiple reviewers, with disagreements resolved through consensus.

Data extraction

Multiple reviewers independently extracted data using a standardised protocol. The Joanna Briggs Institute critical appraisal tool was used to assess the quality of the included studies, with inter-rater reliability tests indicating moderate-to-high agreement. Extracted data included study design, participant demographics, exposure details and measured outcomes.

Data synthesis

This systematic review included seven studies because of heterogeneity in reported outcomes and effect measures. Three independent reviewers extracted data using a standardised coding sheet. The synthesis compared methodologies, identified gaps, key findings and conclusions across studies.

Results

Seven included articles examined grandchildren’s behaviour, such as hyperactivity disorder, oppositional defiant disorder and conduct problems, body composition and IQ concerning grandparents’ smoking habits. Most studies used robust statistical methods; two included parental factors as mediators. The synthesis of results indicated that the associations were primarily indirect. Key findings revealed that grandparents’ smoking status was significantly associated with their grandchildren’s physical and cognitive outcomes. Furthermore, the reviewed studies demonstrated sex-specific transgenerational effects of ancestral smoking on grandchildren’s health, with stronger effects often observed in male descendants.

Conclusions

This review highlights the methods and findings of previous studies on the potential transgenerational transmissions through which grandparents’ smoking behaviour may influence grandchildren’s behavioural, physical and cognitive development. Although the findings emphasise the importance of environmental and behavioural factors, further research is needed to address existing gaps and clarify mechanisms.

Protocol registration

This systematic review protocol was registered in the PROSPERO database under registration number CRD42024571725.

Prevalence of eye care service utilisation and associated factors among healthcare professionals in Gondar city, northwest Ethiopia, 2024: community-based cross-sectional study

Por: Bekele · M. M. · Munaw · M. B. · Etsub · S. A. · Tegegn · M. T. · Shumye · A. F. · Alemu · D. S.
Objective

This study aimed to assess the prevalence of eye care service utilisation and associated factors among healthcare professionals in Gondar city, northwest Ethiopia.

Design

An institution-based cross-sectional study was conducted using a systematic random sampling method.

Setting

The study was conducted at public healthcare facilities in Gondar city, orthwest Ethiopia.

Participants

The study included 607 healthcare professionals who worked in public healthcare facilities in Gondar ity.

Main outcome measures

Data were collected using personal interview using a pretested and structured questionnaire.

Results

A total of 607 study participants took part in this study with a response rate of 91.97%. The median age of the participants was 32 years (IQR 30–36; range ±6). The proportion of eye care services utilisation in this study was 27.68% (95% CI 24.11% to 31.25%). Being masters or higher degree educational status (adjusted OR (AOR)=4.81, 95% CI: 2.01, 11.46), having more than ten years of working experience in healthcare (AOR3.01, 95% CI: 1.51 to 5.99), being affiliated with general hospital (AOR 4.02, 95% CI 1.51 to 10.68) and specialised hospital (AOR 3.02, 95% CI 1.55 to 5.89), obtaining prior eye healthcare training (AOR 1.90, 95% CI 1.20 to 3.00) and having a higher monthly household income (AOR 3.59, 95% CI 1.89 to 6.81) were positively associated with eye care service utilisation.

Conclusion

This study revealed that the proportion of eye care service utilisation among study participants was low. Holding a master or higher degree, more than 10 years of working experience in healthcare, affiliation with general or specialised healthcare facility, obtaining prior eye healthcare training and higher monthly household income were significantly associated with a good level of eye care service utilisation.

Protocol for an economic evaluation alongside the Re-Evaluating the Inhibition of Stress Erosions (E-REVISE) trial

Por: Humphries · B. · Zytaruk · N. · Heels-Ansdell · D. · Lau · V. · Rochwerg · B. · Fowler · R. · Yao · Y. · Cook · D. J. · Xie · F.
Introduction

Economic evaluations in healthcare can guide practice and inform policy. The objective of this paper is to present the protocol for a health economic evaluation comparing the cost-effectiveness of prophylactic treatment using pantoprazole 40 mg daily compared with no pantoprazole to prevent upper gastrointestinal (GI) bleed among invasively ventilated patients.

Methods and analysis

This is an economic evaluation conducted alongside the Re-Evaluating the Inhibition of Stress Erosions (REVISE) trial (ClinicalTrials.gov NCT03374800). The primary outcome is the incremental cost per clinically important upper GI bleed prevented. The base-case analysis will focus on the entire international cohort of 4821 REVISE patients. The analysis will be conducted from a healthcare payer perspective over a time horizon of ICU admission to hospital discharge or death. To facilitate comparisons across countries given the international scope of the REVISE trial, costs will be presented in United States dollars. The study protocol was developed following the Professional Society for Health Economics and Outcomes Research guidelines.

Ethics and dissemination

The trial was approved by each participating institution; this economic evaluation was approved by the Hamilton Integrated Research Ethics Board. Given widespread daily use of proton pump inhibitors for critically ill patients, the results of this economic evaluation will be of high relevance to patients, family members, physicians, pharmacists, policymakers and guideline developers. Integrated knowledge translation will involve periodic progress reports to collaborators. End-of-study knowledge translation will include rounds, videoconferences, abstracts and slide-decks for intensive care unit quality councils and healthcare organisations, and open-access publications. Patient and family partners will co-create lay language summaries for traditional and social media to help inform all interest groups.

Effect of foliar application of potassium on wheat tolerance to salt stress

by Fiza Noor, Humera Nawaz, Ameer Khan, Muhammad Yousaf Shani, Muhammad Azmat, Syed Mohsin Abbas, Iqra Arshad, Robina Aziz, Muhammad Saleem, Francesco De Mastro, Muhammad Yasin Ashraf, Gennaro Brunetti, Claudio Cocozza

Salinity stress severely hampers wheat productivity by impairing growth, photosynthesis, and metabolic balance. Potassium nutrition, however, can mitigate these effects by supporting physiological and biochemical stability. This study assessed the impact of foliar potassium application (0, 200 and 400 ppm) on two wheat cultivars, Galaxy-13 and Uqab-2000, exposed to normal (0 mM NaCl) and saline conditions (100 and 150 mM NaCl, respectively). Salinity significantly reduced root and shoot growth, biomass, chlorophyll content, photosynthetic rate, and stomatal conductance. Potassium supplementation, particularly at 400 ppm, alleviated these reductions, with Galaxy-13 showing a 32.01% increase in shoot length and a 45.11% increase in shoot dry weight compared to Uqab-2000. Biochemical analyses revealed that Galaxy-13 sustained higher nitrate and nitrite reductase activities (6.23 and 3.63 μmol NO2 g-1 FW h-1, respectively) and total soluble proteins (10.1 mg g-1 FW), whereas Uqab-2000 accumulated more soluble sugars and free amino acids under stress (9.8 and 19.8 mg g-1 FW, respectively). Oxidative stress indicators (malondialdehyde and hydrogen peroxide) rose under salinity, but potassium reduced their levels, with Galaxy-13 exhibiting stronger antioxidant regulation. Nutrient profiling further demonstrated that Galaxy-13 maintained higher N, P, and K contents and minimized Na uptake, unlike Uqab-2000, which showed severe ionic imbalance. Multivariate analyses (PCA, heatmap, and correlation) highlighted strong positive associations of potassium, especially K400, with biomass accumulation, photosynthetic efficiency, and nutrient homeostasis. The findings establish that Galaxy-13 possesses superior salinity tolerance and responds more favorably to potassium nutrition. This study provides novel evidence that cultivar-specific potassium management can enhance wheat resilience in saline environments, offering a practical strategy for sustaining yield under stress.

Cleft@18-23 study research clinics: a protocol for a multicentre observational study across UK cleft centres to understand variation in outcomes at the end of routine cleft care

Por: Vadlamudi · A. · van Eeden · S. · Spry · J. · Humphries · K. · Roosbey · A. · Baxter · E. · Leary · S. · Wren · Y.
Introduction

Cleft lip and/or palate (CL/P) is a lifelong condition affecting one in 700 births. In the UK, individuals born with CL/P follow a care pathway at specialist regional cleft centres, which includes input from a range of professionals including surgeons, speech and language therapists, cleft specialist nurses, orthodontists, dentists and clinical psychologists. The cleft centres provide care from diagnosis to early adulthood. Individuals born with CL/P are typically discharged from routine care at their cleft centre between the ages of 15 and 25 years.

Outcome measures of cleft care are currently gathered at different timepoints across the treatment pathway nationally and include outcomes for speech, growth, dental health and psychosocial well-being. However, there is no consistent reporting of outcomes for young adults when they complete routine care, meaning we do not know whether variation in outcomes exists and what this might look like.

This research programme will investigate whether outcomes vary based on factors such as geographical location, biological sex, socioeconomic status or ethnicity. By understanding how outcomes might vary, and the scale and type of variation, we plan to work with young adults born with CL/P and specialist clinicians to develop ways to ensure that everyone born with CL/P in the UK receives the optimum care to meet their needs.

Methods and analysis

Cleft@18–23 is an observational study of young adults born with CL/P. Recruitment is planned across all regions of the UK, beginning in April 2025 with research clinics scheduled to run between June 2025 and May 2027. The recruitment target is 640 participants born with CL/P. Participants with all cleft diagnoses, including those with additional syndromic diagnoses, will be eligible for recruitment. We will recruit participants from all ethnic and socioeconomic backgrounds. Data collection will include self-report participant questionnaires, speech samples, a hearing screen, two-dimensional and three-dimensional medical photographs, an intraoral scan and a dental assessment. A range of descriptive and inferential statistical analyses will explore variation in outcomes across different groups.

Ethics and dissemination

The Cleft@18–23 study obtained ethical approval from the South West-Frenchay Research Ethics Committee on 26 November 2024 (REC reference: 24/SW/0128). Informed consent will be required for participation. Findings from the Cleft@18–23 study will be disseminated through peer-reviewed publications, conference presentations, newsletters, the study website (https://www.bristol.ac.uk/cleft18-23) and social media.

Trial registration number

ISRCTN34027276.

An exploratory machine learning study on paediatric abdominal pain phenotyping and prediction

by Kazuya Takahashi, Michalina Lubiatowska, Huma Shehwana, James K. Ruffle, John A. Williams, Animesh Acharjee, Shuji Terai, Georgios V. Gkoutos, Humayoon Satti, Qasim Aziz

Background

The exact mechanisms underlying paediatric abdominal pain (AP) remain unclear due to patient heterogeneity. This preliminary study aimed to identify AP phenotypes and develop predictive models to explore associated factors, with the goal of guiding future research.

Methods

In 13,790 children from a large birth cohort, data on paediatric and maternal demographics and comorbidities were extracted from general practitioner records. Machine learning (ML) clustering was used to identify distinct AP phenotypes, and an ML-based predictive model was developed using demographics and clinical features.

Results

1,274 children experienced AP (9.2%) (average age: 8.4 ± 1.1 years, male/female: 615/659), who clustered into three distinct phenotypes: Phenotype 1 with an allergic predisposition (n = 137), Phenotype 2 with maternal comorbidities (n = 676), and Phenotype 3 with minimal other comorbidities (n = 340). As the number of allergic diseases or maternal comorbidities increased, so did the frequency of AP, with 17.6% of children with ≥ 3 allergic diseases and 25.6% of children with ≥ 3 maternal comorbidities. The predictive model demonstrated moderate performance in predicting paediatric AP (AUC 0.67), showing that a child’s ethnicity, paediatric allergic diseases, and maternal comorbidities were key predictive factors. When stratified by ML-predicted probability, observed AP rates were 18.9% in the  60% group.

Conclusions

This study identified distinct AP phenotypes and key risk factors using ML. Furthermore, the predictive ML model enabled risk stratification for paediatric AP. These analyses provide valuable insights to guide future investigations into the mechanisms of AP and may facilitate research aimed at identifying targeted interventions to improve patient outcomes.

Effects of aromatherapy on agitation and aggression in cognitive impairment: A meta‐analysis

Abstract

Aims and objectives

To evaluate the effectiveness of aromatherapy on agitation and aggression in patients with cognitive impairment.

Background

The impact of aromatherapy on agitation and aggression has been evaluated in various studies, but there is uncertainty about their impact.

Design

A meta-analysis of randomised controlled trials was undertaken.

Methods

This meta-analysis was conducted under PRISMA guidelines. Following eight electronic literature databases were searched: Web of Science, PubMed, PsycINFO, Embase, Cochrane Library, Chinese Wanfang database, CNKI and VIP digital database from the inception of the databases up to 27 February 2021. Two reviewers assessed the risk of bias of the included studies independently using the Cochrane Collaboration tool. Overall, meta-analysis and three subgroup analyses regarding the type of aroma preparations, delivery mode and session length were performed using RevMan5.3 and stata14.0. Publication bias was assessed by visual inspection of the funnel plot asymmetry and Egger's regression test.

Results

Fifteen studies comprising 693 participants were included. The meta-analysis indicated that aromatherapy could ameliorate agitation and aggression for cognitive impairment. The subgroup analysis based on the type of aroma preparations showed that lavender oil could significantly improve agitation and aggression. Most delivery modes of aromatherapy, including smearing and inhalation, were effective. Moreover, less length (≤4 weeks) aromatherapy showed a better effect on agitation behaviour than aromatherapy more than 4 weeks.

Conclusions

Despite the meta-analysis indicating that aromatherapy could alleviate agitation and aggression especially short-term (≤4 weeks) aromatherapy inhalation in different conditions, further researches are needed to investigate the appropriate dosage of essential oils and the side effects. More well-designed randomised controlled trials containing participants from more countries are needed to verify our findings before we can make strong recommendations.

Relevance to clinical practice

This meta-analysis suggested that aromatherapy should be considered as a complementary programme for patients with cognitive impairment patients. Medical workers could apply aromatherapy into daily routine cares for cognitive impairment patients.

Mapping the global implementation of parent-focused infant-centred and family-centred developmental care (IFCDC) principles: a scoping review protocol

Por: Düzenli · A. · Kemper · R. · Grüger · J. · Hoffmann · J. · Hummler · H. · Mader · S. · Tischer · C.
Introduction and objectives

Infant-centred and family-centred developmental care (IFCDC) within the frame of special intensive care prioritises a holistic approach to caring for infants by addressing their developmental and emotional needs. A key principle of IFCDC is the active involvement of parents in care, which promotes better long-term outcomes for both the infant and their caregivers. This scoping review aims to examine parental satisfaction and the challenges associated with their involvement in infant care by assessing the global implementation of the IFCDC principle of parental involvement in specialised intensive care settings.

Methods and analysis

The scoping review will follow the methodological framework outlined by Khalil et al and the Joanna Briggs Institute methodology. Literature from 2014 to 2025 will be searched for relevant papers across PubMed (MEDLINE). Two reviewers will independently screen titles, abstracts and full texts, with a third reviewer resolving conflicts. Key findings and results from eligible papers will be analysed and summarised in line with the scoping review’s objectives.

Ethics and dissemination

No ethical approval is needed. We intend to submit the paper for publication and thus to present the results in a peer-reviewed journal. This scoping review is registered at OSFREGISTRIES (https://osf.io/h94qr/?view_only=a08b30a5eb3a4a3d97aeda7c6d7e157d).

Diagnosing deep vein thrombosis early in critically ill patients (DETECT) trial: a protocol for a randomised controlled trial

Por: Arabi · Y. M. · Alenezi · F. · Al-Hameed · F. · al Humedi · H. I. · Kharaba · A. · Alhazzani · W. · Alshahrani · M. S. S. · Algethamy · H. · Maghrabi · K. · Chalabi · J. · Ardah · H. I. · Alahmari · A. M. · AlQahtani · R. M. · Ababtain · A. A. · Al-Filfil · W. A. M. · Al-Fares · A. A.
Introduction

Deep vein thrombosis (DVT) in critically ill patients is often undetected. However, it is unclear whether ultrasound surveillance for early detection of DVT in high-risk medical-surgical intensive care unit (ICU) patients improves patients’ outcomes. The DETECT trial (Diagnosing deep-vein thrombosis early in critically ill patients) evaluates the effect of twice-weekly bilateral lower limb ultrasound compared to usual care on 90-day mortality of critically ill adult patients admitted to medical, surgical and trauma ICUs.

Methods and analysis

The DETECT trial is an international, parallel-group, open-label, randomised trial, which will recruit 1800 critically ill adults from over 14 hospitals in Saudi Arabia and Kuwait. Eligible patients will be allocated to twice-weekly bilateral lower limb ultrasound or usual care. The primary outcome is 90-day mortality. Secondary outcomes include lower limb proximal DVT, pulmonary embolism and clinically important bleeding. The first patient was enrolled on 21 March 2023. As of 8 April 2025, 711 patients have been enrolled from 14 centres in Saudi Arabia and Kuwait. The first interim analysis was conducted on 14 May 2025. We expect to complete recruitment by December 2026.

Ethics and dissemination

Institutional review boards (IRBs) of each participating institution approved the study. We plan to publish the results in peer-reviewed journals and present the findings at international critical care conferences.

Trial registration number

Clinicaltrials.gov: NCT05112705, registered on 9-11-2021.

Gender and age differences in hand disinfection behaviour during the COVID-19 pandemic: field data from Swiss retail stores

Por: von Bieberstein · F. · Kulle · A.-C. · Schumacher · S.
Objectives

To inform about behavioural gender and age differences in compliance with hand hygiene recommendations during the COVID-19 pandemic in Switzerland.

Design

Observational study (24–25 June and 1–3 July 2020); validation study (4 December 2020); gender and age group estimated by observers.

Setting

Observations occurred in five supermarkets.

Participants

All customers entering the supermarkets during a 3-hour period per day (n=8245 main study) and during 1 day (n=1918 validation study).

Main outcome measures

We observed whether people disinfected their hands.

Results

The study reveals considerable differences with respect to gender and age: For women, 58.7% (95% CI 57.3 to 60.0%) were disinfecting their hands vs 50.4% (95% CI 48.6 to 52.2%) of men. With respect to age, we identified a steep increase across age groups up to the age of 60 years and older with 35.5% (95% CI 30.7 to 40.5%) of youth (12-17 yrs) disinfecting their hands, 50.5% (95% CI 49.1 to 51.9%) of adults (18-59 yrs) vs 69.0% (95% CI 67.1 to 70.9%) of the golden age group (60-74 yrs) and 67.2% (95% CI 61.1 to 72.9%) of people older than 75 years. The validation study confirmed these differences.

Conclusions

The study documents substantial differences in hand hygiene compliance between gender and age groups. This should be considered in the design of protective measures to ensure clean and safe hands.

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