Search Results for: Cardio-oncology: rivista open access

Objective
To synthesise the role of digital technologies in epidemic control and prevention, focussing on Ebola and COVID-19.

Design
A scoping review.

Data sources
A systematic search was done on PubMed, HINARI, Web of Science, Google Scholar and a direct Google search until 10 September 2024.

Eligibility criteria
We included all qualitative and quantitative studies, conference papers or abstracts, anonymous reports, editorial reports and viewpoints published in English.

Data extraction and synthesis
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist was used to select the included study. Data analysis was performed using Gale’s framework thematic analysis method, resulting in the identification of key themes.

Results
A total of 64 articles that examined the role of digital technology in the Ebola and COVID-19 pandemics were included in the final review. Five main themes emerged: digital epidemiological surveillance (using data visualisation tools and online sources for early disease detection), rapid case identification, community transmission prevention (via digital contact tracing and assessing interventions with mobility data), public education messages and clinical care. The identified barriers encompassed legal, ethical and privacy concerns, as well as organisational and workforce challenges.

Conclusion
Digital technologies have proven good for disease prevention and control during pandemics. While the adoption of these technologies has lagged in public health compared with other sectors, tools such as artificial intelligence, telehealth, wearable devices and data analytics offer significant potential to enhance epidemic responses. However, barriers to widespread implementation remain, and investments in digital infrastructure, training and strong data protection are needed to build trust among users. Future efforts should focus on integrating digital solutions into health systems, ensuring equitable access and addressing ethical concerns. As public health increasingly embraces digital innovations, collaboration among stakeholders will be crucial for effective pandemic preparedness and management.

Objective
Screening for cervical cancer has been a globally advocated preventive strategy to reduce cervical cancer morbidity and mortality. This study aimed to describe the prevalence and barriers of cervical cancer screening, and to determine factors associated with cervical cancer screening among women of reproductive age in Moshi municipality, northern Tanzania.

Design
We conducted a cross-sectional study between August and September 2020.

Setting
Moshi municipality, Kilimanjaro, Tanzania.

Participants
Women of ages 15–49 years who live in Moshi municipality.

Results
A total of 300 women participated in the study and 22.7% had ever been screened for cervical cancer. Women below the age of 30 years had 87% lower odds of screening for cervical cancer compared with those aged 30 years and above (OR 0.13; 95% CI 0.04, 0.43). Women who had never heard about cervical cancer had 94% (OR 0.06; 95% CI 0.01, 0.51) lower odds of screening compared with those who ever heard about the disease. In comparison to married women, those who identified as single had 71% lower odds of screening for cervical cancer (OR 0.29; 95% CI 0.10, 0.73). Women without formal education or with only primary-level education had 72% lower odds of screening for cervical cancer compared with those with college or university education (OR 0.28; 95% CI 0.08, 0.98). A lack of awareness on where to screen and a lack of comprehensive knowledge about cervical cancer were reported as screening barriers among those who had never been tested.

Conclusion
Only one in five women have ever been screened for cervical cancer, despite the majority having heard about the disease. Overall knowledge of cervical cancer was low, with many women unaware of its causes, risk factors and preventive measures. Key barriers to screening included a lack of awareness and insufficient medical advice. Factors significantly associated with lower odds of screening were being under age of 30 years, not having heard about cervical cancer, having no formal or only primary education and being single. There is an urgent need for community-based interventions to increase awareness and education about cervical cancer and to improve access to screening services, especially for younger, less educated and single women.

Mahesarajah S, El Asmar ML, Irwin R, et al. Impact of the COVID-19 pandemic on psychotropic prescribing: a systematic review BMJ Open 2024;14:e076791. doi: 10.1136/bmjopen-2023–0 76 791
The article is updated since it was first published. The below mentioned sections have been updated:
Results- Changes in antipsychotic prescribing rates, line 21 and 22, page no. 8.
Results – Changes in antidepressant prescribing rates, line 20, page no. 8.
Discussion – Discussion of findings and implications of selected studies, line 33, page no. 9.
Table 2- Result, last paragraph.

Objectives
To map the scope of available evidence on relationships between multimorbidity patterns and functioning among adults in low- and middle-income countries (LMICs), and describe methods used.

Design
Scoping review guided by a five-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines.

Data sources
PubMed/MEDLINE, Scopus, EBSCOhost (CINAHL) and Cochrane databases were searched from January 1976 to March 2023, plus reference lists of included studies.

Eligibility criteria for selecting studies
Peer-reviewed full-text articles or conference proceedings of any design, published in English or Afrikaans, involving adults ( >18 years) with multimorbidity living in LMICs. Studies had to refer to associations between multimorbid patterns of co-occurrence and functioning. Multimorbidity was defined as the coexistence of ≥2 diseases, including any combination of non-communicable, infectious and mental health conditions.

Data extraction and synthesis
Data were extracted independently by two reviewers using a piloted form. Findings were synthesised according to methodological approaches, multimorbidity-pattern epidemiology, evidence gaps/limitations and recommendations for future research. The International Classification of Functioning, Disability and Health framework was used to classify functional problems.

Results
Nine studies (total sample size: 62 003) were included, mainly from upper-middle-income Asian countries. Key methodological inconsistencies were identified in defining and operationalising multimorbidity, conditions included in determining patterns, statistical methods for pattern determination and functioning outcome measures. Five main multimorbidity pattern domains emerged: Cardio-Metabolic and Coronary Atherosclerotic, Musculoskeletal, Respiratory and Digestive/Visceral, Degenerative, and Mental Health-Related. Mobility limitations, instrumental activities of daily living, self-care and bowel/bladder problems were consistently linked to all pattern domains.

Conclusions
The limited and geographically skewed body of literature, along with methodological inconsistencies, hampers a comprehensive understanding of multimorbidity patterns and associations with functioning in LMICs. Future research should explore context-specific multimorbidity definitions, employ transparent methodologies, use standardised measures and incorporate diverse samples to inform tailored interventions and policies.

Studio pubblicato nella rivista Nature Communications

Introduction
Although various sham acupuncture techniques have been employed to ensure blinding in randomised controlled trials (RCTs) of acupuncture, the effectiveness of blinding in these trials and its influence on trial effect size estimates remain unclear. The objectives of this study are the following: (1) to investigate the proportion and study characteristics of sham-controlled trials reporting on blinding assessment, (2) to assess the blinding effectiveness of different types of sham acupuncture, (3) to investigate the relationship between blinding effectiveness and effect sizes in acupuncture RCTs.

Methods and analysis
We will search PubMed and EMBASE from inception to 1 January 2025 to identify RCTs that compared acupuncture with sham acupuncture in humans with any disease or symptom, with no restrictions on language. Paired investigators will independently determine eligibility and use pilot-tested standardised forms for data extraction. We will calculate the proportion of sham-controlled trials that assessed and reported blinding success and conduct descriptive analyses of general study characteristics, acupuncture treatment details, sham acupuncture details and blinding assessments for included trials. We will assess the effectiveness of blinding success using the James blinding index (BI) and Bang BI, and pool data from included trials using random-effects models. We will use Hedges’ g, a standardised mean difference, with its 95% CI, to calculate treatment effects. We will use Pearson’s r correlation coefficient to assess the relationship between blinding effectiveness and trial effect sizes when variable distributions meet the assumptions of normality and linearity; otherwise, we will consider employing non-parametric tests. When sufficient data are available, we will also use random-effects meta-regression to explore the relationship.

Ethics and dissemination
Ethical approval is not required. The findings of this study will be disseminated through peer-reviewed publications, conference presentations and condensed summaries for clinicians, health policymakers and guideline developers regarding the design, conduct, analysis and interpretation of blinded assessment of sham acupuncture RCTs.

Study registration
Open Science Framework (https://doi.org/10.17605/OSF.IO/B3U7K).

Introduction
There is currently limited information regarding the association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score, nutrition delivery and clinical outcomes in critically ill patients admitted to the intensive care unit (ICU) section.

Methods and analysis
The Isfahan-ICU study is a multicentre, prospective observational cohort study that will be conducted on critically ill adults treated in the trauma or medical ICU sections of six hospitals to investigate whether clinical outcomes, including length of ICU stay and 30-day survival, vary by the mNUTRIC score at admission or the 7-day nutrition delivery. This paper outlines the Isfahan-ICU study protocol approved by the ethics committee of Isfahan University of Medical Sciences, Iran. Patient confidentiality is ensured, and study results will be shared at conferences and in medical papers.

Ethics and dissemination
This study protocol was reviewed and approved by the ethics committee of the Isfahan University of Medical Sciences, Isfahan, Iran (IR.MUI.RESEARCH.REC.1401.184). The patient’s identity will be considered confidential and will not be revealed or published under any circumstances; all provisions of laws governing personal data protection will be observed. Patient data recorded in the electronic survey will be documented pseudonymously using de-identified patient ID codes, and authorised staff at each participating site will have access to only their identifiable data. Results from the study will be disseminated at national and international conferences and in medical papers.

Trial registration number
Ethics committee of the Isfahan University of Medical Sciences, Isfahan, Iran (IR.MUI.RESEARCH.REC.1401.184).

Objective
To assess the acceptance of multiple micronutrient supplements and current iron and folic acid supplement utilisation among pregnant and lactating women in rural Ethiopia.

Design
Community-based cross-sectional study using a mixed method.

Setting
This study was carried out in five regions (Oromia, Gambela, Sidama, SNNPR (Southern Nations, Nationalities and Peoples Region) and Somali) of Ethiopia, 2022. A multistage random sampling technique was employed. A structured questionnaire was used to collect data from 410 pregnant and lactating women. A purposive sampling technique was used to select participants for the five Focused Group Discussions and fifteen Key Informant Interviews. Both bivariable and multivariable logistic regression analysis was conducted with a p value

Introduction
Cultural humility practices are shown to be effective when working with diverse populations in healthcare settings. Research recruitment and retention among minoritised groups are essential to address health inequities. Given the successful application to healthcare settings, cultural humility practices may hold promise for recruiting and retaining minoritised individuals. However, little is known about how these practices may be applied to health research. The objective of this scoping review is to understand the extent to which cultural humility practices are applied to health research and how they may be leveraged to optimise recruitment and retention among minoritised populations.

Methods and analysis
This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews. Databases to be searched will include Medline (Ovid), CINAHL (EBSCOhost), EMBASE (Ovid), PsycINFO (Ovid) and Web of Science Core Collection. Literature from 1993 to 2024 that captures the concept of cultural humility in health research with racial and ethnic or gender and sexual minoritised populations in the USA will be considered. The identified pool of records will be imported to Covidence, an online data management software. At the first screening stage, two independent reviewers will screen for title and abstract relevance. A third reviewer will be recruited to resolve discrepancies, if any. Records achieving consensus will have their full texts screened against the eligibility criteria and included in the final pool. Two tables will be developed to guide the data extraction process. The tabular format will be piloted and agreed on by all research team members. Descriptive content analysis will outline the operationalisation of cultural humility and identify strategies found effective in improving the representation of minoritised populations.

Ethics and dissemination
Ethical approval is not required in line with the scoping review methodology. Dissemination of the findings mapping the cultural humility strategies found effective in health research will be conducted through a peer-reviewed publication.

Trial registration number
Open Science Framework https://osf.io/vra7h.

Introduction
The aim of this scoping review is to connect theoretical research related to stress with practical applications to supervision experiences within allied health professions. Understanding the implications of stress between clinical supervisors and allied health students will allow for better insights to improve supervisory methods within clinical training, stronger mentorship and lead to better quality patient care.

Methods and analysis
This review is conducted according to Joanna Briggs Institute (JBI) methodology for scoping reviews, which includes defining the research question, developing inclusion criteria and searching for, selecting, extracting and analysing the evidence. A literature search will be conducted in MEDLINE (PubMed), CINAHL (EBSCO), ERIC (EBSCO), PsycINFO (EBSCO) and Embase (Elsevier), as well as various grey literature resources. Studies will be included if they focus on undergraduate or graduate allied health students in a clinical setting and allied health clinical educators, and report on outcomes related to stress dynamics between these two populations. Results will pass through title/abstract and full-text screening before data are extracted using a tool developed by the reviewers. Data will be analysed and summarised descriptively and presented in both tabular and narrative formats.

Ethics and dissemination
Ethical approval is not required for this scoping review. Results will be disseminated in peer-reviewed publications and professional conferences.

Trial registration number
The protocol was registered with Open Science Framework on 2 October 2024 (https://doi.org/10.17605/OSF.IO/REK7Z).

Introduction
Surgical trauma induces a metabolic stress response, resulting in reduced insulin sensitivity and hyperglycaemia. Postoperative insulin resistance (IR) is associated with postoperative complications, and extended preoperative fasting may further aggravate the postoperative metabolic stress response. Nutritional strategies, such as carbohydrate loading (CHL), have been successfully used to attenuate postoperative IR. Recent evidence suggests that time-restricted feeding (TRF), a form of intermittent fasting, improves IR in the general population, even after a short period of TRF. We hypothesise that TRF, as well as CHL, improve postoperative IR.

Methods and analysis
This open-label, single-centre, randomised controlled trial will compare the effect of short-term preoperative TRF, CHL and standard preoperative fasting on perioperative IR. A total of 75 orthopaedic patients presenting for elective intermediate to major surgery at a Dutch academic hospital will be randomly assigned to a control group (standard preoperative fasting), a TRF group or a CHL group. The primary outcome is postoperative IR, based on the updated homeostasis model assessment of IR, on the first day after surgery. Statistical analyses are performed using Student’s t-tests or Mann-Whitney U tests.

Ethics and dissemination
The local medical ethics committee of the Amsterdam UMC, the Netherlands, approved the trial protocol in January 2023 (NL81556.018.22). No publication restrictions apply, and the results of the study will be disseminated through a peer-reviewed journal.

Trial registration number
NCT05760339.

Objectives
The Assessment of Burden of Chronic Conditions (ABCC) tool is developed to facilitate a personalised approach to care through assessment and visualisation of a patient’s experienced burden of disease, and integrating this in the conversation based on shared decision-making and individualised care plans. An indispensable step in the implementation process is an understanding of the context. The aim of this study is to perform a context analysis to identify barriers and facilitators to the implementation of the ABCC tool by healthcare providers (HCPs) in Dutch primary care.

Design
A qualitative context analysis was performed among HCPs prior to using the ABCC tool. The Consolidated Framework for Implementation Research was used to map contextual influences through semistructured interviews. A deductive coding process and content analysis was applied to identify barriers and facilitators for the implementation of the ABCC tool.

Participants
HCPs who participated as interventionists in an effectiveness study were recruited for this study.

Results
17 HCPs (16 practice nurses and 1 general practitioner) participated. Data saturation was reached at the 11th interview. HCPs expected several major barriers to the implementation of the ABCC tool:too many different digital environments, high complexity in access, lack of time, no integration of the ABCC tool in guidelines and care standards, and patients not willing to adopt an active role in their care process. The major facilitators for implementation were a clear perception of the ABCC tool’s benefits, high compatibility with and relative advantage over current practices and being part of a progressive work culture that stimulates innovation.

Conclusions
This study provides insight in the barriers and facilitators to the implementation of an intervention in the patient–HCP conversation. Barriers were present in complexity, available resources, patient needs and resources, and external policies and incentives while facilitators were present in knowledge and beliefs, implementation climate and culture. These barriers and facilitators provide opportunities for the selection and tailoring of implementation strategies for the ABCC tool.

Introduction
Despite its therapeutic advantages, postmastectomy radiotherapy (PMRT) increases the risk of complications and often leads to poor cosmesis in women undergoing breast reconstruction. Preoperative radiotherapy followed by skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction is technically feasible, with low rates of surgical complications and good short-term oncological outcomes. Further evaluation in a randomised trial comparing preoperative radiotherapy versus conventional PMRT in breast reconstruction is required to assess both oncological and patient-reported outcomes (PROs).

Methods and analysis
The CAPPELLA trial is a prospective, multicentre, open-label, randomised controlled trial across nine centres comparing PROs and safety outcomes between preoperative and postoperative radiotherapy in patients with locally advanced breast cancer requiring immediate DIEP flap reconstruction. Female patients aged >18 years with breast cancer who are treated with neoadjuvant systemic treatment, require both mastectomy and radiotherapy and are suitable for DIEP flap reconstruction will be included. Patients will be randomly assigned (1:1) to a preoperative radiotherapy group or a postoperative radiotherapy group. Stratification will be performed by cancer centre at initial diagnosis. The radiation volumes will include the ipsilateral breast/chest wall, supraclavicular lymph nodes, undissected axilla and internal mammary nodes. The dose regimen will be 42.56 Gy in 16 fractions. The primary endpoint will be satisfaction with the breast domain of the BREAST-Q at 2 years postoperatively. The secondary endpoints will include PROs at 3, 12 and 24 months postoperatively in both groups, aesthetic assessment, complication rates, rates of total pathological complete response (tpCR) and tumour safety. All patients will be followed up for 36 months postoperatively. The app software will be used to collect all data prospectively. Data will be analysed using SPSS and Stata software. The target sample size will be 80 participants.

Ethics and dissemination
This study will be performed according to the Helsinki Declaration. All patients will be asked to provide informed consent before enrolment. Approval for this study was provided by the independent ethics committee and institutional review board of Fudan University Shanghai Cancer Centre. We will present the study results at national and international meetings and publish them in a scientific peer-reviewed journal.

Trial registration number
NCT05512286.

Objectives
While Colombians gained broad legal access to abortion in 2022, people still lack knowledge about its availability and face variable quality of care at health facilities. This study sought to understand whether online sellers provide the instructions and medication dosages necessary for effective medication abortions.

Design
The study design involved mystery clients contacting sellers identified across websites and social media platforms (Facebook, Instagram, and TikTok) to purchase abortion pills. Unique sellers were contacted with two profiles (first and second trimester pregnancy gestational ages). Mystery clients documented information received on physical effects, complications and how to take the pills from the sellers in a predesigned survey in SurveyCTO.

Setting
The study was conducted in Colombia from July to September 2023. We documented and described sellers’ conversations with mystery clients and pills received. We identified 161 sellers across platforms, which resulted in 65 unique sellers after deduplication. We attempted to contact each unique seller twice.

Results
Almost all sellers screened for gestational age using last menstrual period. Bleeding (84.6%) and cramping (66.7%) were the physical effects most commonly mentioned to mystery clients, although pain was mentioned to second trimester clients more often than first (40.5% vs 22.0%). Less than 17% of sellers highlighted possible complications that could require medical attention. Almost 90% of purchases were received (88.9%). All contained manufacturer-branded misoprostol and 77.5% were undamaged aluminium blister packages. While 82.6% of first trimester clients were instructed to take an initial misoprostol dosage in line with Colombia’s Ministry of Health guidelines, all second trimester clients were told to take a dosage exceeding the recommended amount. Although most sellers provided appropriate information on administration routes for the pills, sellers also provided contradictory and unnecessary instructions.

Conclusion
Online sellers of abortion pills may persist even as legal abortion becomes more widely available in Colombia. While misoprostol was received from many of these sellers, they did not provide sufficient information about potential complications or accurate dosing instructions to second trimester clients. Accurate medication abortion information specific to Colombia should be made more accessible so that people can more easily navigate the new care landscape.

Objectives
This qualitative study explored public and prescriber awareness of pharmaceutical pollution in the water environment and eco-directed sustainable prescribing (EDSP) as a mitigation strategy to reduce the environmental impact of prescribing in Scotland.

Design
Focus groups explored prescriber and public perceptions of the topic. Common questions were asked through semistructured facilitation. Focus groups were digitally recorded and transcribed verbatim using an artificial intelligence system, then anonymised and thematically analysed using NVivo software. Data were iteratively analysed using the one sheet of paper technique.

Setting
Public focus groups were held in-person (Inverness, Scotland, April 2023), and prescriber focus groups were held virtually (MS Teams, August 2023).

Participants
Nine public representatives and 17 NHS Scotland prescribers participated in one of four focus groups. Purposive and opportunistic sampling approaches were used to recruit participants through social media and other channels (ie, community groups, professional emails, general practitioner and hospital flyers). Prescriber representatives registered interest through an online survey to gather information about their professional background. Responses were reviewed to ensure representation of a mixture of medical backgrounds, experience, sectors and health boards.

Results
There is growing awareness among the public and healthcare professionals of pharmaceutical pollution in the environment, but further education is required on the drivers, potential effects and possible interventions. Suggestions for more sustainable healthcare included public health awareness campaigns, better provision for pharmacy take-back schemes, clear medicine/packaging labelling, regular medicines reviews and more considered patient-centred care. From the prescriber perspective, EDSP resonated well with current sustainability initiatives (eg, Realistic Medicine, switching to dry-powder inhalers), but barriers to EDSP included lack of knowledge, confidence, time and resources to implement changes. Although the public representatives were generally open to the concept of EDSP, this decision required weighing pros/cons considering personal health choices, information accessibility and transparency, and trust in and time with prescribers.

Conclusions
This study identified new insights from prescribers and the public related to the concept of, and barriers to, EDSP in Scotland, as well as perspectives regarding knowledge support tools and information communication. Cross-sector and transdisciplinary collaborative approaches are needed to address the challenges identified here. Nonetheless, EDSP merits further exploration in developing more sustainable, appropriate and effective healthcare which contributes to improved public and planetary health.