bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic stellate cells: From bad reputation to mediators of liver homeostasis
Authors: Schönberger Katharina , Tchorz Jan S.
Published: May 2023

Organ size and function critically depend on the tight regulation of cellular turnover. In this issue of
Science Signaling,
Trinh
et al
. reveal that hepatic stellate cells play an important role in maintaining liver homeostasis by stimulating midzonal hepatocyte proliferation through the secretion of neurotrophin-3.
Whole-Genome Sequencing of the Novel Pseudomonas Strain TUM22785 Harboring
bla
PAM-1
, Isolated from a Patient with Urinary Tract Infection in Japan
Authors: Ogihara Shinji , Komori Kohji , Miura Shota , Aoki Kotaro , Yamada Kageto , Sasaki Masakazu , Murakami Hinako , Ishii Yoshikazu , Tateda Kazuhiro
Published: May 2023

Pseudomonas
species are Gram-negative aerobic bacteria that cause opportunistic infections. Here, we report the whole-genome sequence of the
Pseudomonas
sp. strain TUM22785, isolated from an outpatient with a urinary tract infection at a medical institution in Japan. This strain harbors a metallo-β-lactamase (MBL)
bla
PAM-1
gene.
Plasmodium falciparum GAP40 Plays an Essential Role in Merozoite Invasion and Gametocytogenesis
Authors: He Lu , Qiu Yue , Pang Geping , Li Siqi , Wang Jingjing , Feng Yonghui , Chen Lumeng , Zhu Liying , Liu Yinjie , Cui Liwang , Cao Yaming , Zhu Xiaotong
Published: May 2023

Red blood cell invasion is central to the pathogenesis of the malaria parasite, and the parasite proteins involved in this process are potential therapeutic targets. Gliding motility powers merozoite invasion and is driven by a unique molecular motor termed the glideosome.
In Vitro
Activity of Cefiderocol Compared to Other Antimicrobials against a Collection of Metallo-Beta-Lactamase-Producing Gram-Negative Bacilli from Southern Spain
Authors: Delgado-Valverde M. , Portillo-Calderón I. , Recacha E. , Pérez-Palacios P. , Pascual A.
Published: May 2023

This article demonstrates the efficacy of cefiderocol against a large collection of well-characterized metallo-beta-lactamase-producing isolates, some of them even producing double carbapenemases. Furthermore, cefiderocol activity is compared to other novel broad-spectrum antimicrobials with activity against carbapenemases.
Application of artificial intelligence system for screening multiple fundus diseases in Chinese primary healthcare settings: a real-world, multicentre and cross-sectional study of 4795 cases
Authors: Gu Chufeng , Wang Yujie , Jiang Yan , Xu Feiping , Wang Shasha , Liu Rui , Yuan Wen , Abudureyimu Nurbiyimu , Wang Ying , Lu Yulan , Li Xiaolong , Wu Tao , Dong Li , Chen Yuzhong , Wang Bin , Zhang Yuncheng , Wei Wen Bin , Qiu Qinghua , Zheng Zhi , Liu Deng , Chen Jili
Published: May 2023

Background/aims

This study evaluates the performance of the Airdoc retinal artificial intelligence system (ARAS) for detecting multiple fundus diseases in real-world scenarios in primary healthcare settings and investigates the fundus disease spectrum based on ARAS.

Methods

This real-world, multicentre, cross-sectional study was conducted in Shanghai and Xinjiang, China. Six primary healthcare settings were included in this study. Colour fundus photographs were taken and graded by ARAS and retinal specialists. The performance of ARAS is described by its accuracy, sensitivity, specificity and positive and negative predictive values. The spectrum of fundus diseases in primary healthcare settings has also been investigated.

Results

A total of 4795 participants were included. The median age was 57.0 (IQR 39.0–66.0) years, and 3175 (66.2%) participants were female. The accuracy, speciﬁcity and negative predictive value of ARAS for detecting normal fundus and 14 retinal abnormalities were high, whereas the sensitivity and positive predictive value varied in detecting different abnormalities. The proportion of retinal drusen, pathological myopia and glaucomatous optic neuropathy was significantly higher in Shanghai than in Xinjiang. Moreover, the percentages of referable diabetic retinopathy, retinal vein occlusion and macular oedema in middle-aged and elderly people in Xinjiang were significantly higher than in Shanghai.

Conclusion

This study demonstrated the dependability of ARAS for detecting multiple retinal diseases in primary healthcare settings. Implementing the AI-assisted fundus disease screening system in primary healthcare settings might be beneficial in reducing regional disparities in medical resources. However, the ARAS algorithm must be improved to achieve better performance.

Trial registration number

NCT04592068.
Improving medication safety in a paediatric hospital: a mixed-methods evaluation of a newly implemented computerised provider order entry system
Authors: Liang Man Qing , Thibault Maxime , Jouvet Philippe , Lebel Denis , Schuster Tibor , Moreault Marie-Pierre , Motulsky Aude
Published: May 2023

Objectives

Computerised provider order entry (CPOE) systems have been implemented around the world as a solution to reduce ordering and transcription errors. However, previous literature documented many challenges to attain this goal, especially in paediatric settings. The objectives of this study were to (1) analyse the impact of a paediatric CPOE system on medication safety and (2) suggest potential error prevention strategies.

Methods

A pre-post observational study was conducted at the pilot ward (n=60 beds) of a paediatric academic health centre through mixed methods. The implementation project and medication management workflows were described through active participation to the project management team, observation, discussions and analysis of related documents. Furthermore, using incident reports, the nature of each error and error rate was compared between the preperiod and postperiod.

Results

The global error rate was lower, but non-statistically significant, in the post implementation phase, which was mostly driven by a significant reduction in errors during order acknowledgement, transmission and transcription. Few errors occurred at the prescription step, and most errors occurred during medication administration. Furthermore, some errors could have been prevented using a CPOE in the pre-implementation period, and the CPOE led to few technology-related errors.

Discussion and conclusion

This study identified both intended and unintended effects of CPOE adoption through the entire medication management workflow. This study revealed the importance of simplifying the acknowledgement, transmission and transcribing steps through the implementation of a CPOE to reduce medication errors. Improving the usability of the electronic medication administration record could help further improve medication safety.
IT risk management for medical devices in hospital IT networks: a catalogue of measures and indicators
Authors: Richter Stefan , Ammenwerth Elske
Published: May 2023

Objectives

Connecting medical devices to hospital IT networks can create threats that must be covered by IT risk management. In practice, implementing such risk management is not trivial because the IEC 80001-1, as the existing state-of-the-art, do not describe sufficiently concrete implementation measures or evaluation indicators. The aim of the present work was to develop and evaluate a catalogue of measures and indicators to help hospitals implement and evaluate risk management in accordance with IEC 80001-1.

Methods

We conducted a Delphi study with 22 experts. In the first round, we performed interviews to identify implementation measures and evaluation indicators using qualitative content analysis. In the second round, a quantitative experts’ survey confirmed the results of the first survey round and identified relationships between the measures and indicators. Based on these results, we then developed a catalogue containing the identified measures and indicators. Finally, we performed a case study to verify the practicability of this catalogue.

Results

We developed and verified a catalogue of 49 measures and 18 indicators to help hospitals implement and evaluate risk management following IEC 80001-1. The case study confirmed the practicability of the catalogue.

Discussion

Compared with IEC 80001-1, our catalogue goes into further detail to offer hospitals a stepwise implementation and evaluation approach. However, the catalogue must be tested in further case studies and evaluated in terms of generalisation.

Conclusions

The catalogue will enable hospitals to overcome recent difficulties in implementing and evaluating IT risk management for medical devices according to IEC 80001-1.
Keep it simple: designing a user-centred digital information system to support chronic disease management in low/middle-income countries
Authors: Burka Daniel , Gupta Reena , Moran Andrew E , Cohn Jennifer , Choudhury Sohel R , Cheadle Tim , Mullick Rahul , Frieden Thomas R
Published: May 2023

Objective

Implement a user-centred digital health information system to facilitate rapidly and substantially increasing the number of patients treated for hypertension in low/middle-income countries.

Methods

User-centred design of Simple, an offline-first app for mobile devices to record patient clinical visits and a web-based dashboard to monitor programme performance.

Results

The Simple mobile application scaled rapidly over the past 4 years to reach more than 11 400 primary care facilities in four countries with over 3 million patients enrolled. Simple achieved median duration for new patient registration of 76 s (IQR 2 s) and follow-up visit entry of 13 s (IQR 1 s).

Conclusions

A fast, easy-to-use digital information system for hypertension programmes that accommodates healthcare worker time constraints by minimising data entry and focusing on key performance indicators can successfully reach scale in low-resource settings.
Effect of a hospital command centre on patient safety: an interrupted time series study
Authors: Mebrahtu Teumzghi F , McInerney Ciarán D , Benn Jonathan , McCrorie Carolyn , Granger Josh , Lawton Tom , Sheikh Naeem , Randell Rebecca , Habli Ibrahim , Johnson Owen Ashby
Published: May 2023

Background

Command centres have been piloted in some hospitals across the developed world in the last few years. Their impact on patient safety, however, has not been systematically studied. Hence, we aimed to investigate this.

Methods

This is a retrospective population-based cohort study. Participants were patients who visited Bradford Royal Infirmary Hospital and Calderdale & Huddersfield hospitals between 1 January 2018 and 31 August 2021. A five-phase, interrupted time series, linear regression analysis was used.

Results

After introduction of a Command Centre, while mortality and readmissions marginally improved, there was no statistically significant impact on postoperative sepsis. In the intervention hospital, when compared with the preintervention period, mortality decreased by 1.4% (95% CI 0.8% to 1.9%), 1.5% (95% CI 0.9% to 2.1%), 1.3% (95% CI 0.7% to 1.8%) and 2.5% (95% CI 1.7% to 3.4%) during successive phases of the command centre programme, including roll-in and activation of the technology and preparatory quality improvement work. However, in the control site, compared with the baseline, the weekly mortality also decreased by 2.0% (95% CI 0.9 to 3.1), 2.3% (95% CI 1.1 to 3.5), 1.3% (95% CI 0.2 to 2.4), 3.1% (95% CI 1.4 to 4.8) for the respective intervention phases. No impact on any of the indicators was observed when only the software technology part of the Command Centre was considered.

Conclusion

Implementation of a hospital Command Centre may have a marginal positive impact on patient safety when implemented as part of a broader hospital-wide improvement programme including colocation of operations and clinical leads in a central location. However, improvement in patient safety indicators was also observed for a comparable period in the control site. Further evaluative research into the impact of hospital command centres on a broader range of patient safety and other outcomes is warranted.
Evaluation of race/ethnicity-specific survival machine learning models for Hispanic and Black patients with breast cancer
Authors: Park Jung In , Bozkurt Selen , Park Jong Won , Lee Sunmin
Published: May 2023

Objectives

Survival machine learning (ML) has been suggested as a useful approach for forecasting future events, but a growing concern exists that ML models have the potential to cause racial disparities through the data used to train them. This study aims to develop race/ethnicity-specific survival ML models for Hispanic and black women diagnosed with breast cancer to examine whether race/ethnicity-specific ML models outperform the general models trained with all races/ethnicity data.

Methods

We used the data from the US National Cancer Institute’s Surveillance, Epidemiology and End Results programme registries. We developed the Hispanic-specific and black-specific models and compared them with the general model using the Cox proportional-hazards model, Gradient Boost Tree, survival tree and survival support vector machine.

Results

A total of 322 348 female patients who had breast cancer diagnoses between 1 January 2000 and 31 December 2017 were identified. The race/ethnicity-specific models for Hispanic and black women consistently outperformed the general model when predicting the outcomes of specific race/ethnicity.

Discussion

Accurately predicting the survival outcome of a patient is critical in determining treatment options and providing appropriate cancer care. The high-performing models developed in this study can contribute to providing individualised oncology care and improving the survival outcome of black and Hispanic women.

Conclusion

Predicting the individualised survival outcome of breast cancer can provide the evidence necessary for determining treatment options and high-quality, patient-centred cancer care delivery for under-represented populations. Also, the race/ethnicity-specific ML models can mitigate representation bias and contribute to addressing health disparities.
Healthcare provider evaluation of machine learning-directed care: reactions to deployment on a randomised controlled study
Authors: Hong Julian C , Patel Pranalee , Eclov Neville C W , Stephens Sarah J , Mowery Yvonne M , Tenenbaum Jessica D , Palta Manisha
Published: May 2023

Objectives

Clinical artificial intelligence and machine learning (ML) face barriers related to implementation and trust. There have been few prospective opportunities to evaluate these concerns. System for High Intensity EvaLuation During Radiotherapy (NCT03775265) was a randomised controlled study demonstrating that ML accurately directed clinical evaluations to reduce acute care during cancer radiotherapy. We characterised subsequent perceptions and barriers to implementation.

Methods

An anonymous 7-question Likert-type scale survey with optional free text was administered to multidisciplinary staff focused on workflow, agreement with ML and patient experience.

Results

59/71 (83%) responded. 81% disagreed/strongly disagreed their workflow was disrupted. 67% agreed/strongly agreed patients undergoing intervention were high risk. 75% agreed/strongly agreed they would implement the ML approach routinely if the study was positive. Free-text feedback focused on patient education and ML predictions.

Conclusions

Randomised data and firsthand experience support positive reception of clinical ML. Providers highlighted future priorities, including patient counselling and workflow optimisation.
Study of decision tree algorithms: effects of air pollution on under five mortality in Ulaanbaatar
Authors: Tileubai Akhit , Tsend Javzmaa , Oyunbileg Bat-Enkh , Luvsantseren Purevdolgor , Luvsan-Ish Ajnai , Chilhaasuren Baasandorj , Puntsagdash Jargalbat , Chuluunbaatar Galbadrakh , Tsagaan Baatarkhuu
Published: May 2023

Objectives

4.2 million people die every year from many diseases due to air pollution. The WHO confirms that 92% of the world’s population lives in areas where the air quality limit is exceeded. In 251 days of 2011, the concentration of fine particulate matter in Ulaanbaatar exceeded the permissible level by 62%–76%. According to the results of the research, the content of fine particles decreased by 37%–46% in 2019. Because it is harmful to the health of children, we aimed to show the effect of air pollution on the mortality through data mining.

Methods

In many countries, research is being conducted to generate effective knowledge from big data using data mining methods. So, we are working to introduce this method to the health sector of Mongolia. In this study, we used the decision tree algorithms.

Results

We collected data on air pollution and under five mortality for 2019–2022 in Ulaanbaatar and created the database, built the models using the algorithms, and compared the results with the Mongolian standard. If the average of PM10 in winter is higher than the concentration specified in the standard, the mortality rate is likely to be high. Mortality is likely to be high if the nitrogen dioxide tolerance is high in the spring.

Conclusion

The accuracy of the models calculated by the C5.0 algorithm is higher than the determined by the CART algorithm, the sensitivity and specificity values are higher than 0.50, so the mortality rates are uniformly predicted and low mortality prevails.
Accuracy of a tool to prioritise patients awaiting elective surgery: an implementation report
Authors: Sharma Videha , Pritchard-Jones Rowan , Scott Sharon , Ainsworth John
Published: May 2023

Study objective

The objective of this study was to evaluate the accuracy of a new elective surgery clinical decision support system, the ‘Patient Tacking List’ (PTL) tool (C2-Ai(c)) through receiver operating characteristic (ROC) analysis.

Methods

We constructed ROC curves based on risk predictions produced by the tool and compared these with actual patient outcomes on a retrospective cohort of patients awaiting elective surgery.

Results

A total of 11 837 patients were included across three National Health Service (NHS) hospitals in England. ROC analysis revealed an area under the curve of 0.95 (95% CI 0.92 to 0.98) for mortality and 0.8 (95% CI 0.78 to 0.82) for complications.

Discussion

The PTL tool was successfully integrated into existing data infrastructures, allowing real-time clinical decision support and a low barrier to implementation. ROC analysis demonstrated a high level of accuracy to predict the risk of mortality and complications after elective surgery. As such, it may be a valuable adjunct in prioritising patients on surgical waiting lists.

Health systems, such as the NHS in England, must look at innovative methods to prioritise patients awaiting surgery in order to best use limited resources. Clinical decision support tools, such as the PTL tool, can improve prioritisation and thus positively impact clinical care and patient outcomes.

Conclusions

The high level of accuracy for predicating mortality and complications after elective surgery using the PTL tool indicates the potential for clinical decision support tools to help tackle rising waiting lists and improve surgical planning.
Routine health information use among healthcare providers in Ethiopia: a systematic review and meta-analysis
Authors: Tadele Maru Meseret , Yilma Tesfahun Melese , Mekonnen Zeleke Abebaw , Tilahun Binyam
Published: May 2023

Introduction

Healthcare policy formulation, programme planning, monitoring and evaluation, and healthcare service delivery as a whole are dependent on routinely generated health information in a healthcare setting. Several individual research articles on the utilisation of routine health information exist in Ethiopia; however, each of them revealed inconsistent findings.

Objective

The main aim of this review was to combine the magnitude of routine health information use and its determinants among healthcare providers in Ethiopia.

Methods

Databases and repositories such as PubMed, Global Health, Scopus, Embase, African journal online, Advanced Google Search and Google Scholar were searched from 20 to 26 August 2022.

Result

A total of 890 articles were searched but only 23 articles were included. A total of 8662 (96.3%) participants were included in the studies. The pooled prevalence of routine health information use was found to be 53.7% with 95% CI (47.45% to 59.95%). Training (adjusted OR (AOR)=1.56, 95% CI (1.12 to 2.18)), competency related to data management (AOR=1.94, 95% CI (1.35 to 2.8)), availability of standard guideline (AOR=1.66, 95% CI (1.38 to 1.99)), supportive supervision (AOR=2.07, 95% CI (1.55 to 2.76)) and feedback (AOR=2.20, 95% CI (1.30 to 3.71)) were significantly associated with routine health information use among healthcare providers at p value≤0.05 with 95% CI.

Conclusion

The use of routinely generated health information for evidence-based decision-making remains one of the most difficult problems in the health information system. The study’s reviewers suggested that the appropriate health authorities in Ethiopia invest in enhancing the skills in using routinely generated health information.

PROSPERO registration number

CRD42022352647.
Involving multiple stakeholders in assessing and reviewing a novel data visualisation tool for a national neonatal data asset
Authors: Lammons William Bishop , Moss Becky , Bignell Charlie , Gale Chris , MacBride Adam , Ribas Ricardo , Battersby Cheryl , Modi Neena
Published: May 2023

Objectives

We involved public and professional stakeholders to assess a novel data interrogation tool, the Neonatal Health Intelligence Tool, for a National Data Asset, the National Neonatal Research Database.

Methods

We recruited parents, preterm adults, data managers, clinicians, network managers and researchers (trialists and epidemiologists) for consultations demonstrating a prototype tool and semi-structured discussion. A thematic analysis of consultations is reported by stakeholder group.

Results

We held nine on-line consultations (March–December 2021), with 24 stakeholders: parents (n=8), preterm adults (n=2), data managers (n=3), clinicians (n=3), network managers (n=2), triallists (n=3) and epidemiologists (n=3). We identified four themes from parents/preterm adults: struggling to consume information, Dads and data, bring data to life and yearning for predictions; five themes from data managers/clinicians/network managers: benchmarking, clinical outcomes, transfers and activity, the impact of socioeconomic background and ethnicity, and timeliness of updates and widening availability; and one theme from researchers: interrogating the data.

Discussion

Other patient and public involvement (PPI) studies have reported that data tools generate concerns; our stakeholders had none. They were unanimously supportive and enthusiastic, citing visualisation as the tool’s greatest strength. Stakeholders had no criticisms; instead, they recognised the tool’s potential and wanted more features. Parents saw the tool as an opportunity to inform themselves without burdening clinicians, while clinicians welcomed an aid to explaining potential outcomes to parents.

Conclusion

All stakeholder groups recognised the need for the tool, praising its content and format. PPI consultations with all key groups, and their synthesis, illustrated desire for additional uses from it.
Predicting healthcare professionals’ acceptance towards electronic personal health record systems in a resource-limited setting: using modified technology acceptance model
Authors: Walle Agmasie Damtew , Ferede Tigist Andargie , Baykemagn Nebebe Demis , Shimie Aynadis Worku , Kebede Shimels Derso , Tegegne Masresha Derese , Wubante Sisay Maru , Yehula Chalachew Msganaw , Demsash Addisalem Workie , Melaku Mequannent Sharew , Mengistie Muluken Belachew
Published: May 2023

Objectives

Personal health record systems allow users to manage their health information in a confidential manner. However, there is little evidence about healthcare providers’ intentions to use such technologies in resource-limited settings. Therefore, this study aimed to assess predicting healthcare providers’ acceptance of electronic personal health record systems.

Methods

An institutional-based cross-sectional study was conducted from 19 July to 23 August 2022 at teaching hospitals in the Amhara regional state of Ethiopia. A total of 638 health professionals participated in the study. Simple random sampling techniques were used to select the study participants. Structural equation modelling analysis was employed using AMOS V.26 software.

Result

Perceived ease of use had a significant effect on the intention to use electronic personal health records (β=0. 377, p<0.01), perceived usefulness (β=0.104, p<0.05) and attitude (β=0.204, p<0.01); perceived ease of use and information technology experience had a significant effect on perceived usefulness (β=0.077, p<0.05); and digital literacy (β=0.087, p<0.05) and attitude had also a strong effect on intention to use electronic personal health records (β=0.361, p<0.01). The relationship between perceived ease of use and the intention to use was mediated by attitude (β=0.076, p<0.01).

Conclusion

Perceived ease of use, attitude and digital literacy had a significant effect on the intention to use electronic personal health records. The perceived ease of use had a greater influence on the intention to use electronic personal health record systems. Thus, capacity building and technical support could enhance health providers’ acceptance of using electronic personal health records in Ethiopia.
Survival and health economic outcomes in heart failure diagnosed at hospital admission versus community settings: a propensity-matched analysis
Authors: Bachtiger Patrik , Kelshiker Mihir A , Petri Camille F , Gandhi Manisha , Shah Moulesh , Kamalati Tahereh , Khan Samir Ali , Hooper Gareth , Stephens Jon , Alrumayh Abdullah , Barton Carys , Kramer Daniel B , Plymen Carla M , Peters Nicholas S
Published: May 2023

Background and aims

Most patients with heart failure (HF) are diagnosed following a hospital admission. The clinical and health economic impacts of index HF diagnosis made on admission to hospital versus community settings are not known.

Methods

We used the North West London Discover database to examine 34 208 patients receiving an index diagnosis of HF between January 2015 and December 2020. A propensity score-matched (PSM) cohort was identified to adjust for differences in socioeconomic status, cardiovascular risk and pre-diagnosis health resource utilisation cost. Outcomes were stratified by two pathways to index HF diagnosis: a ‘hospital pathway’ was defined by diagnosis following hospital admission; and a ‘community pathway’ by diagnosis via a general practitioner or outpatient services. The primary clinical and health economic endpoints were all-cause mortality and cost-consequence differential, respectively.

Results

The diagnosis of HF was via hospital pathway in 68% (23 273) of patients. The PSM cohort included 17 174 patients (8582 per group) and was matched across all selected confounders (p>0.05). The ratio of deaths per person-months at 24 months comparing community versus hospital diagnosis was 0.780 (95% CI 0.722 to 0.841, p<0.0001). By 72 months, the ratio of deaths was 0.960 (0.905 to 1.020, p=0.18). Diagnosis via hospital pathway incurred an overall extra longitudinal cost of £2485 per patient.

Conclusions

Index diagnosis of HF through hospital admission continues to dominate and is associated with a significantly greater short-term risk of mortality and substantially increased long-term costs than if first diagnosed in the community. This study highlights the potential for community diagnosis—early, before symptoms necessitate hospitalisation—to improve both clinical and health economic outcomes.
The 8 January 2020 theatre ballistic missile attack on US soldiers stationed at Al Asad Air Base, Iraq: case series using a concussion subtypes framework to approach a real-world, chaotic blast-related TBI mass casualty event
Authors: Hainsworth Jeffrey Brian , Johnson Alan , Godfred-Cato Shana , Smolinski George J , Jorgensen-Wagers Kendra
Published: May 2023

Objectives

This study aims to describe which concussion subtype(s) result specifically from the explosions of theatre ballistic missiles (TBMs) blast waves, an extremely rare occurrence in modern warfare. We provide feedback from using the US military’s standard acute concussion screening tool, the Military Acute Concussion Examination version 2, in a deployed, chaotic, real-world environment.

Background

Iran launched 27 professionally manufactured TBMs into Iraq on 8 January 2020. Eleven detonated within Al Asad Air Base, exposing approximately 330 soldiers to TBM-blast waves. The concussion subtype(s) resultant from TBM blast-related concussion is not known.

Methods

Case series from the Al Asad TBM-blast exposed cohort who evacuated to Landstuhl Regional Medical Center (LRMC), Germany up to 3 months following the attack and were diagnosed with concussion. Around 4 weeks, TBM-blast exposed individuals still present on Al Asad were screened with the Neurobehavioural Symptom Inventory (NSI) and vestibular ocular motor screening (VOMS); positive screens evacuated to LRMC. Data from 8 January 2020 to 7 April 2020 were cross-sectionally analysed.

Results

35/38 patients met criteria for mild traumatic brain injury/concussion. 34/35 were within a 100 m blast radius. Migraine/headache, cognitive and mood/anxiety subtypes were common. VOMS was abnormal in 18/18 tested; 16 deferred due to overt symptoms. The 4-week screen identified nine additional concussed individuals.

Conclusions

Among TBM-blast concussion patients, migraine/headache, cognitive, mood/anxiety and likely vestibular/ocular motor subtypes were predominant. Our study supports postconcussion screening that includes both a subjective symptom inventory, for example, NSI, and a performance-based ocular motor/vestibular screening examination, for example, VOMS, to help identify patients who may under recognise or under-report/minimise symptoms.
Sequential Organ Failure Assessment (SOFA) Score for predicting mortality
in patients with sepsis in Vietnamese intensive care units: a multicentre,
cross-sectional study
Authors: Do Son Ngoc , Dao Co Xuan , Nguyen Tuan Anh , Nguyen My Ha , Pham Dung Thi , Nguyen Nga Thi , Huynh Dai Quang , Hoang Quoc Trong Ai , Bui Cuong Van , Vu Thang Dinh , Bui Ha Nhat , Nguyen Hung Tan , Hoang Hai Bui , Le Thuy Thi Phuong , Nguyen Lien Thi Bao , Duong Phuoc Thien , Nguyen Tuan Dang , Le Vuong Hung , Pham Giang Thi Tra , Bui Giang Thi Huong , Bui Tam Van , Pham Thao Thi Ngoc , Nguyen Chi Van , Nguyen Anh Dat , Phua Jason , Li Andrew , Luong Chinh Quoc
Published: May 2023

Objectives

To compare the accuracy of the Sequential Organ Failure Assessment
(SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II)
Scores in predicting mortality among intensive care unit (ICU) patients
with sepsis in a low-income and middle-income country.

Design

A multicentre, cross-sectional study.

Setting

A total of 15 adult ICUs throughout Vietnam.

Participants

We included all patients aged ≥18 years who were admitted to ICUs
for sepsis and who were still in ICUs from 00:00 to 23:59 of the
specified study days (ie, 9 January, 3 April, 3 July and 9 October of
the year 2019).

Primary and secondary outcome measures

The primary outcome was hospital all-cause mortality (hospital
mortality). We also defined the secondary outcome as all-cause deaths in
the ICU (ICU mortality).

Results

Of 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs.
SOFA Score (areas under the receiver operating characteristic curve
(AUROC): 0.688 (95% CI 0.618 to 0.758); cut-off value≥7.5;
PAUROC<0.001) and APACHE II Score (AUROC:
0.689 (95% CI 0.622 to 0.756); cut-off value ≥20.5;
PAUROC<0.001) both had a poor discriminatory
ability for predicting hospital mortality. However, the discriminatory
ability for predicting ICU mortality of SOFA (AUROC: 0.713 (95% CI 0.643
to 0.783); cut-off value≥9.5; PAUROC<0.001) was
fair and was better than that of APACHE II Score (AUROC: 0.672 (95% CI
0.603 to 0.742); cut-off value≥18.5;
PAUROC<0.001). A SOFA Score≥8 (adjusted OR
(AOR): 2.717; 95% CI 1.371 to 5.382) and an APACHE II Score≥21 (AOR:
2.668; 95% CI 1.338 to 5.321) were independently associated with an
increased risk of hospital mortality. Additionally, a SOFA Score≥10
(AOR: 2.194; 95% CI 1.017 to 4.735) was an independent predictor of ICU
mortality, in contrast to an APACHE II Score≥19, for which this role did
not.

Conclusions

In this study, SOFA and APACHE II Scores were worthwhile in
predicting mortality among ICU patients with sepsis. However, due to
better discrimination for predicting ICU mortality, the SOFA Score was
preferable to the APACHE II Score in predicting mortality.

Clinical trials registry – India:NCT016898.
Neoadjuvant camrelizumab plus chemotherapy for locally advanced cervical cancer (NACI Study): a study protocol of a prospective, single-arm, phase II trial
Authors: Chen Jing , Han Yingyan , Hu Yingjie , Feng Xue , Meng Xiaolin , Guo Shuaiqingying , Sun Chaoyang , Chen Gang , Li Kezhen
Published: May 2023

Introduction

Neoadjuvant chemotherapy (NACT) is an emerging approach for locally advanced cervical cancer (LACC). However, the clinical response and postoperative adjuvant radiation or chemoradiation trimodality treatment resulted in controversy. PD-1 inhibitors have shown promising role in recurrent or metastatic cervical cancer, and there is preclinical evidence of the activation and synergistic effects of NACT on PD-1 inhibitors. This study aims to evaluate the efficacy and safety of the preoperative PD-1 inhibitor camrelizumab combined with NACT for LACC.

Methods and analysis

The study is designed as a multicentre, open-label, single-arm, prospective phase II study. A total of 82 patients will receive neoadjuvant chemo-immunotherapy, defined as one cycle of cisplatin (75–80 mg/m2, intravenously) plus nab-paclitaxel (260 mg/m2, intravenously) NACT and subsequent two cycles of camrelizumab (200 mg, intravenously) combined with NACT. After neoadjuvant chemo-immunotherapy, patients exhibiting complete response and partial response will undergo radical surgery and subsequent adjuvant therapy. In contrast, patients with stable disease and progressive disease will transfer to concurrent chemoradiotherapy (CCRT). Following surgery, patients will receive adjuvant CCRT or radiotherapy. The primary endpoint is the objective response rate. The secondary endpoints are the pathological complete response, patients requiring postoperative adjuvant therapy, safety of neoadjuvant chemo-immunotherapy, surgical complication, event-free survival, and overall survival. An additional aim is to dynamically evaluate peripheral immune responses and local immunological microenvironments and their association with neoadjuvant immunotherapy.

Ethics and dissemination

This trial was approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (S2020-112). This study is among the first to evaluate the efficacy and safety of neoadjuvant chemo-immunotherapy in LACC. The findings of this research will promote neoadjuvant anti-PD-1 immunotherapy with radical surgery as a new therapeutic strategy.

Trial registration number

ClinicalTrials.gov Registry (NCT04516616).
Protocol for a comprehensive prospective cohort study of trio-based whole-genome sequencing for underlying cancer predisposition in paediatric and adolescent patients newly diagnosed with cancer: the PREDICT study
Authors: Fuentes Bolanos Noemi Auxiliadora , Padhye Bhavna , Daley Macabe , Hunter Jacqueline , Hetherington Kate , Warby Meera , Courtney Eliza , Kirk Judy , Josephi-Taylor Sarah , Chen Yuyan , Alvaro Frank , Barlow-Stewart Kristine , Wong-Erasmus Marie , Barahona Paulette , Ajuyah Pamela , Altekoester Ann-Kristin , Tyrrell Vanessa J , Lau Loretta M S , Wakefield Claire , Sylvester Dianne , Tucker Katherine , Pinese Mark , Dalla Pozza Luciano , O’Brien Tracey A
Published: May 2023

Introduction

Identifying an underlying germline cancer predisposition (CP) in a child with cancer has potentially significant implications for both the child and biological relatives. Cohort studies indicate that 10%–15% of paediatric cancer patients carry germline pathogenic or likely pathogenic variants in cancer predisposition genes, but many of these patients do not meet current clinical criteria for genetic testing. This suggests broad tumour agnostic germline testing may benefit paediatric cancer patients. However, the utility and psychosocial impact of this approach remain unknown. We hypothesise that an approach involving trio whole-genome germline sequencing (trio WGS) will identify children and families with an underlying CP in a timely fashion, that the trio design will streamline cancer risk counselling to at-risk relatives if CP was inherited, and that trio testing will not have a negative psychosocial impact on families.

Method and analysis

To test this, we present the Cancer PREDisposition In Childhood by Trio sequencing study (PREDICT). This study will assess the clinical utility of trio WGS to identify CP in unselected patients with cancer 21 years or younger in New South Wales, Australia. PREDICT will perform analysis of biological parents to determine heritability and will examine the psychosocial impact of this trio sequencing approach. PREDICT also includes a broad genomics research programme to identify new candidate genes associated with childhood cancer risk.

Ethics and dissemination

By evaluating the feasibility, utility and psychosocial impact of trio WGS to identify CP in paediatric cancer, PREDICT will inform how such comprehensive testing can be incorporated into a standard of care at diagnosis for all childhood cancer patients.

Trial registration number

NCT04903782.
Demographic trends of patients undergoing ophthalmic surgery in Ontario, Canada: a population-based study
Authors: Balas Michael , Vasiliu Diana , Austria Gener , Felfeli Tina
Published: May 2023

Objective

In this study, we investigated the demographic trends of patients undergoing ophthalmic surgeries based on geographic region, priority level, and sex.

Methods and analysis

This population-based retrospective cohort study used the Ontario Health Wait Times Information System (WTIS) database from 2010 to 2021. The WTIS contains non-emergent surgical case volume and wait time data for 14 different regions, three priority levels (high, medium and low) and six ophthalmic subspecialty procedures.

Results

Over the study period, on average 83 783 women and 65 555 men underwent ophthalmic surgery annually in Ontario. Overall, women waited an aggregate mean of 4.9 days longer than men to undergo surgery, and this disparity persisted across all geographic and priority stratifications. The average age at the time of surgery has been increasing slowly at a rate of 0.02 years/year (95% CI 0.00 to 0.05), with women being 0.6 years older than men overall.

Conclusion

These findings indicate that women have consistently longer wait times than men. The results of this study may be a sign of systemic sex-based differences that could be affecting women who need to be further explored for health equity.
Long-term outcomes in patients with immune checkpoint inhibitor induced pneumonitis
Authors: Davis Puente Andrea , Johnson Douglas B , Bastarache Julie A
Published: May 2023

Introduction

Immune checkpoint inhibitors (ICI) have improved outcomes for patients with many malignancies. However, these treatments are associated with immune-related adverse events, including pulmonary toxicity (pneumonitis). Pneumonitis is associated with significant short-term morbidity and mortality, but long-term outcomes are not well described.

Methods

We used the Vanderbilt Synthetic Derivative, a deidentified electronic health record database of >2.5 million patients seen at Vanderbilt, to identify patient charts that included treatment with pembrolizumab, nivolumab, ipilimumab, ipilimumab and nivolumab, atezolizumab or durvalumab by keyword search and ICD-10 codes for acute respiratory failure and/or bronchoalveolar lavage. We manually reviewed these charts and identified 78 subjects who met criteria for probable pneumonitis which included patients presenting with symptoms (dyspnoea, hypoxia, cough) and/or CT imaging consistent with this diagnosis. We collected data on demographics, ICI regimen, hospital admissions and long-term survival.

Results

Of the 78 patients (48 males; median age 64 (range 28–81)), 52 patients required at least 1 hospital admission related to pneumonitis. A total of 25 patients experienced poor short-term outcomes (including 6 referred to hospice, 11 discharged to rehabilitation and 9 deaths). There was no association with these outcomes by patient age (p=0.96), sex (p=0.60), smoking status (p=0.63) or cancer type (p=0.13). Median duration of follow-up was 8.3 months (range 0.2–110.6 months), and 29 patients (37%) were alive at last follow-up. Patients admitted to the hospital were more likely to die (p=0.002) and less likely to receive additional treatment (p<0.0001) or survive for ≥12 months with no evidence of disease (p=0.02). There were no differences in long-term outcomes for patients with underlying pulmonary comorbidities.

Discussion

ICI-pneumonitis has a high likelihood of causing hospitalisation and poor outcomes, including death. While there appears to be no difference in outcomes for patients with underling pulmonary comorbidities, those requiring admission have worse outcomes.
The ethics of firing unvaccinated employees
Authors: Smith Maxwell J
Published: May 2023

Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide whetherexistingemployees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not behiredif they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk beingfired. The latter seems worse than the former. Hence, objections to vaccination mandates commonly centre on the harms that will be visited on existing employees who are unwilling to be vaccinated. However, because this objection does not necessarily entail the claim that vaccination is unnecessary for the effective and safe performance of certain jobs, those making this objection should have less of an objection, or no objection at all (at least on these grounds), to introducing vaccination requirements in some cases forprospectiveemployees. Yet, in this paper, I shall argue that if one has reason to believe vaccination requirements can be justified for prospective employees, one should also believe they are justified for existing employeesdespiteany asymmetry in consequences experienced by the two groups. As a consequence, common objections made against vaccination mandates grounded solely in the harms that may be experienced by existing employees who are unwilling to be vaccinated should be considered unpersuasive.
(Post)confessional mode and psychological surveillance inThe CrownandFleabag
Authors: Hagaman Sarah
Published: May 2023

Contemporary television’s portrayals of psychotherapy reveal anxieties surrounding surveillance and intimate self-disclosure in clinical and therapeutic settings. This paper analyses two twenty-first century television series featuring therapy sessions that observe and monitor mental states for prognostic purposes, engaging in what Alan Westin terms psychological surveillance: Peter Morgan’sThe Crown(2016–2023) and Phoebe Waller-Bridge’sFleabag(2016–2019). These shows feature contrasting modes of intimate self-disclosure—confessions and postconfessions—that emerge in psychotherapy. The confessional mode emphasises authenticity and a desire for healing. Postconfessions, on the other hand, are a parodical mode of revelation that refuse the authenticity and intimacy elicited by therapy and traditional confessional modes. Confessional discourses inThe Crownreveal that state power, reinforced by genetic authentication, can benefit from psychological surveillance. In contrast,Fleabaguses postconfessional discourse to implicate the audience in the therapeutic encounter, capitalising on the increasingly decentralised self-care modalities sustained through social media, television and other audience-driven mediums.
Variability in firearm injury among major pediatric trauma centers across the USA
Authors: Fraser Doh Kiesha , Chaudhary Sofia , Ruest Stephanie M , Shaahinfar Ashkon , Chun Thomas , Cooper Nicholas , Fein Joel , Feng Alayna , Feske-Kirby Katherine , Figueroa Janet , Gutman Colleen K , Grupp-Phelan Jacqueline , Kanaan Ghid , Keathley Nora , Khan Naghma , McGlamry Katherine , Myers Sage , Nance Michael , Russell Katherine , Rowker Kelli , Sheline Erica , Simon Harold K , Morris Claudia R
Published: May 2023

Objectives

In 2020, firearm injuries surpassed automobile collisions as the leading cause of death in US children. Annual automobile fatalities have decreased during 40 years through a multipronged approach. To develop similarly targeted public health interventions to reduce firearm fatalities, there is a critical need to first characterize firearm injuries and their outcomes at a granular level. We sought to compare firearm injuries, outcomes, and types of shooters at trauma centers in four pediatric health systems across the USA.

Methods

We retrospectively extracted data from each institution’s trauma registry, paper and electronic health records. Study included all patients less than 19 years of age with a firearm injury between 2003 and 2018. Variables collected included demographics, intent, resources used, and emergency department and hospital disposition. Descriptive statistics were reported using medians and IQRs for continuous data and counts with percentages for categorical data. χ2test or Fisher’s exact test was conducted for categorical comparisons.

Results

Our cohort (n=1008, median age 14 years) was predominantly black and male. During the study period, there was an overall increase in firearm injuries, driven primarily by increases in the South (S) site (β=0.11 (SE 0.02), p=<0.001) in the setting of stable rates in the West and decreasing rates in the Northeast and Mid-Atlantic sites (β=−0.15 (SE 0.04), p=0.002; β=−0.19 (SE0.04), p=0.001). Child age, race, insurance type, resource use, injury type, and shooter type all varied by regional site.

Conclusion

The incidence of firearm-related injuries seen at four sites during 15 years varied by site and region. The overall increase in firearm injuries was predominantly driven by the S site, where injuries were more often unintentional. This highlights the need for region-specific data to allow for the development of targeted interventions to impact the burden of injury.

Level of Evidence: II, retrospective study