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The DEXACELL trial--a protocol for a pragmatic, multicentre, double-blind, placebo-controlled, randomised, parallel group, phase 3 superiority trial to assess the effectiveness and cost-effectiveness of DEXAmethasone as an adjunctive therapy for the manag

Por: Joyce · K. · Lear · R. · Hamilton · F. W. · Arnold · D. · Chaudhuri · E. · Connors · J. · Cook · H. · Creanor · S. · Dawe · P. · Goodwin · E. · Hawton · A. · Hayward · C. · Lasserson · D. S. · Ridd · M. J. · Rowe · D. · Shipley · D. · Taylor · H. · Wainman · H. E. · Williams · O. M. · Carlto
Introduction

Cellulitis is a common bacterial skin infection causing significant pain, swelling and impact on daily activities, frequently leading to emergency department presentations and hospital admissions. While antibiotics are the mainstay of treatment, they do not directly address inflammation, often resulting in persisting or worsening symptoms in the initial days. Corticosteroids, with their potent anti-inflammatory effects, have shown benefit in other acute infections but are not currently standard care for patients with cellulitis. This trial aims to determine if adjunctive oral dexamethasone can reduce pain and improve outcomes in adults with cellulitis presenting to UK urgent secondary care settings.

Methods and analysis

This is a pragmatic, multicentre, double-blind, placebo-controlled, randomised, parallel group, phase 3 superiority trial, with an internal pilot and parallel health economic evaluation. Adult patients (≥16 years) with a clinical diagnosis of cellulitis (at any body site except the orbit) presenting to urgent secondary care will be screened for eligibility. 450 participants will be randomised (1:1) to receive either two 8 mg doses of oral dexamethasone or matched placebo, administered approximately 24 hours apart, in addition to standard antibiotic therapy. The primary outcome is total pain experienced over the first 3 days postrandomisation, calculated using the standardised area under the curve from pain scores (Numerical Rating Scale 0–10) across up to seven timepoints. Secondary outcomes include health-related quality of life (EuroQol 5 Dimension 5 Level), patient global impression of improvement, analgesia and antibiotic usage, hospital (re)admissions, complications, unscheduled healthcare use, cellulitis recurrence and cost-effectiveness at 90 days. The primary estimand will apply a treatment policy approach to intercurrent events.

Ethics and dissemination

The trial has received ethical approval from South Central—Oxford B Research Ethics Committee (reference: 24/SC/0289) and will be conducted in compliance with Good Clinical Practice and applicable regulations. Informed consent will be obtained from all participants. A model consent form can be seen in . Findings will be disseminated through peer-reviewed publications and conference presentations, and to patient groups and relevant clinical guideline committees.

Trial registration number

ISRCTN76873478.

Effective coverage of antenatal care services in post war Tigray, Northern Ethiopia: An analysis of community and health facility–based surveys

by Hailay Gebretnsae, Abadi Kidanemariam Berhe, Mache Tsadik, Akeza Awealom Asgedom, Mengistu Hagazi Tequare, Gebregziabher Berihu Gebrekidan, Gebru Hailu Redae, Tedros Bereket, Gebrekiros Gebremichael Meles, Mohamedawel Mohamedniguss Ebrahim, Yemane Berhane Tesfau, Gebremedhin Gebreegziabher Gebretsadik, Muzey Gebremichael Berhe, Hagos Degefa Hidru, Meresa Gebremedhin Weldu, Micheale Hagos Debesay, Gebrehaweria Gebrekurstos, Rieye Esayas, Haftom Gebrehiwot Woldearegay

Background

Although promoting high–quality care is particularly important in post–conflict settings, little is known about the effective coverage of antenatal care (ANC) services in post war Tigray. Thus, our study was aimed to assess the effective coverage of ANC services in post war Tigray, Northern Ethiopia.

Methods

A combined community and health facility–based cross–sectional study design was conducted in 24 randomly selected districts of Tigray, Northern Ethiopia from 29/01/2024–26/02/2024. Using multi–stage cluster sampling method, 2340 mothers of children under one year, 32 health facilities and 250 antenatal care (ANC) clients from the selected health facilities were included in the study. A pre–tested and structured questionnaire was used to collect the households’ data. Additionally, checklists were used to collect data on facility readiness and process quality. Data were collected by Open Data Kit (ODK) and analyzed using SPSS version 27. The effective coverage of antenatal care (ANC) services was analyzed among the target group of women by computing the proportion who received four or more ANC visits multiplied by the average facility readiness score, received iron–folate supplementation, and the average process quality score.

Results

In this study, 87.4% (95% Confidence Interval (CI): 86.1–88.8%) of women received their first antenatal care visit. However, only 10.7% (95% CI: 9.5–12.0%) of the women had their first visit before 12 weeks of gestation and the coverage of fourth and more ANC visits was 15.7% (95% CI: 14.2–17.2%). The overall ANC service readiness mean score was 55.6% (95%CI: 45.8–65.4%). Input–and intervention–adjusted ANC coverage was 8.7% and 7.1% respectively. The mean process quality score was 53.8% (95%CI: 51.0–56.6%), and the overall effective ANC coverage was 3.8%.

Conclusions

The effective coverage of ANC services in post war Tigray is very low. To improve ANC uptake and ensure that pregnant women complete the recommended number of visits, it is crucial to enhance facility readiness by equipping essential ANC tracer items in conflict–affected Tigray region. Additionally, on-the-job training for healthcare providers working in maternal and neonatal departments is crucial to reinforce the basic components of ANC services and ensure adherence to standard protocols for delivering high quality of ANC services. Promoting early ANC initiation at health posts and encouraging pregnant women to maintain continuity in their ANC visits at nearest health centers/hospital are also vital for improving ANC4 + coverage and overall effective coverage of ANC services.

Evaluation of a digital health decision intervention to support management decision-making for adults with hearing loss: protocol for the HearChoice randomised controlled trial

Por: Ferguson · M. A. · Sherman · K. A. · Bothe · E. · Timmer · B. H. · Dawes · P. · Myers · B. · Norman · R. · Mejia · J. · Bennett · R. J. · Mottershaw · A. L. · zu Brickwedde · E. M. · Convery · E. · Gyani · A.
Introduction

Hearing loss is highly prevalent and impacts many aspects of a person’s life, including communication, social engagement, employment, general health and well-being. Yet, many people do not access hearing healthcare and are unaware of the range of hearing healthcare options available. Barriers to hearing healthcare include poor understanding of hearing loss and its impact; poor knowledge of help-seeking for hearing healthcare options; minimal support to help decide which option is best; and stigma related to hearing loss. These barriers lead to many people not receiving the hearing healthcare they need. Guided by theories of behaviour change and implementation science, HearChoice, an online tailored decision support intervention, has been co-developed to empower adults with hearing difficulties by offering them choice and control over their own hearing healthcare. HearChoice aims to facilitate informed decisions, accessibility and uptake of hearing healthcare, including a wide range of interventions, for adults with hearing difficulties. The objectives of the trial are to evaluate the effectiveness, health economics and feasibility of HearChoice.

Methods and analysis

This online randomised controlled trial will recruit participants with hearing difficulties across Australia, with an anticipated sample size of 640. Participants will be randomised to either HearChoice (treatment) or an Australia-specific Hearing Option Grid (active control), both delivered online. Outcomes will be assessed at baseline when the interventions will be offered, at 7 days post-intervention (primary endpoint) and at 3 months post-intervention. An email reminder will be sent at 1-month post-intervention. The primary outcome is decisional conflict. Secondary outcomes include measures of readiness and self-efficacy to take action, hearing-related quality of life and empowerment, assessment of the value and impact of HearChoice, work performance and health, and feasibility measures. Primary analysis will compare outcomes between HearChoice and the active control at the primary endpoint.

Ethics and dissemination

The study was approved by the Curtin University Human Ethics Committee (HRE2023-0024). All participants will provide written informed consent prior to participation. A broad dissemination plan of the study findings includes peer-reviewed publications, scientific conference presentations, articles and presentations for the wider community and public written in lay and accessible language, and social media.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12624001139561).

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