bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased augmentation index in patients with Ehlers-Danlos syndrome
Authors: Roeder Maurice , Thiel Sira , Baumann Frederic , Sievi Noriane A. , Rohrbach Marianne , Kohler Malcolm , Gaisl Thomas
Published: September 2020

Background

Ehlers-Danlos Syndrome (EDS) comprises a heterogeneous group of diseases characterized by joint hypermobility, connective tissue friability, and vascular fragility. Reliable prognostic factors predicting vascular disease progression (e.g. arterial aneurysms, dissections, and ruptures) in EDS patients are still missing. Recently, applanation tonometry derived augmentation index (AIx), an indirect marker of arterial stiffness, has shown to be positively associated with progression of aortic disease in Marfan syndrome. In this study, we assessed aortic AIx in patients with EDS and matched healthy controls.

Methods

We performed noninvasive applanation tonometry in 61 adults with EDS (43 women and 18 men aged 39.3 ± 14.6 years) and 61 age-, gender-, height-, and weight-matched healthy controls. Radial artery pulse waveforms were recorded and analyzed using the SphygmoCor System (AtCor Medical, Sydney, NSW, Australia). Calculated AIx was adjusted to a heart rate of 75/min. Groups were compared and association between AIx and EDS was determined by univariate and multivariate regression analysis.

Results

EDS patients were categorized in classical type EDS (34%), hypermobile type EDS (43%), vascular type EDS (5%), or remained unassignable (18%) due to overlapping features. EDS patients showed a significantly increased aortic AIx compared to healthy controls (22.8% ± 10.1 vs 14.8% ± 14.0, p < 0.001). EDS showed a positive association with AIx; independent of age, sex, height, blood pressure, medication, and pack years of smoking.

Conclusions

Patients with EDS showed elevated AIx, indicating increased arterial stiffness when compared to healthy controls. Further investigations are needed in order to assess the prognostic value of increased AIx for cardiovascular outcomes in patients with EDS.
Characteristics associated with pediatric growth measurement collection in electronic medical records: a retrospective observational study
Authors: Kosowan Leanne , Page John , Protudjer Jennifer , Williamson Tyler , Queenan John , Singer Alexander
Published: September 2020

Background

Complete growth measurements are an essential part of pediatric care providing a proxy for a child’s overall health. This study describes the frequency of well-child visits, documented growth measurements, and clinic and provider factors associated with measurement.

Methods

Retrospective cross-sectional study utilizing electronic medical records (EMRs) from primary care clinics between 2015 and 2017 in Manitoba, Canada. This study assessed the presence of recorded height, weight and head circumference among children (0–24 months) who visited one of 212 providers participating in the Manitoba Primary Care Research Network. Descriptive and multivariable logistic regression analyses assessed clinic, provider, and patient factors associated with children having complete growth measurements.

Results

Our sample included 4369 children. The most frequent growth measure recorded was weight (79.2%n = 3460) followed by height (70.8%n = 3093) and head circumference (51.4%n = 2246). 67.5% of children (n = 2947) had at least one complete growth measurement recorded (i.e. weight, height and head circumference) and 13.7% (n = 599) had complete growth measurements at all well-child intervals attended. Pediatricians had 2.7 higher odds of documenting complete growth measures within well-child intervals compared to family physicians (95% CI 1.8–3.8). Additionally, urban located clinics (OR 1.7, 95% CI 1.2–2.5), Canadian trained providers (OR 2.3, 95% CI 1.4–3.7), small practice size (OR 1.6, 95% CI 1.2–2.2) and salaried providers (OR 3.4, 95% CI 2.2–5.2) had higher odds of documented growth measures.

Conclusions

Growth measurements are recorded in EMRs but documentation is variable based on clinic and provider factors. Pediatric growth measures at primary care appointments can improve primary prevention and surveillance of child health outcomes.
A case report of intestinal obstruction caused by cryptogenic multifocal ulcerous stenosing enteritis
Authors: Chang Cheng , Jiang Chen , Miao Yaoyao , Fang Bin , Zhang Lili
Published: September 2020

Background

Cryptogenic multifocal ulcer stenosing enteritis (CMUSE) is a rare disease characterized by multiple superficial ulcers, stenosis, and obstruction of the small intestine of unknown origin, and the course can recur.

Case presentation

We encountered a 62-year-old male patient with intestinal obstruction. The patient was admitted to the hospital for surgical treatment due to intestinal obstruction, and was diagnosed with cryptogenic multifocal ulcer stenosis enteritis due to comprehensive surgery and postoperative pathological considerations.

Conclusion

In the future, we will continue to follow up the patient. The present study aims to remind clinicians of this disease, and reduce the incidence of misdiagnosis.
Comparative performance study of three Ebola rapid diagnostic tests in Guinea
Authors: Moran Zelda , Rodriguez William , Ahmadou Doré , Soropogui Barré , Magassouba N’ Faly , Kelly-Cirino Cassandra , Ben Amor Yanis
Published: September 2020

Background

The 2014/15 Ebola outbreak in West Africa resulted in 11,000 deaths and massive strain on local health systems, and the ongoing outbreak in Democratic Republic of Congo has afflicted more than 3000 people. Accurate, rapid Ebola diagnostics suitable for field deployment would enable prompt identification and effective response to future outbreaks, yet remain largely unavailable. The purpose of this study was to assess the accuracy of three novel rapid diagnostic tests (RDTs): an Ebola, an Ebola-Malaria, and a Fever Panel test that includes Ebola, all from a single manufacturer.

Methods

We evaluated the three RDTs in 109 Ebola-positive and 96 Ebola-negative stored serum samples collected during the outbreak in Guinea in 2014/15, and tested by real-time polymerase chain reaction (RT-PCR). Sensitivity, specificity, and overall percent agreement were calculated for each RDT using RT-PCR as a reference standard, stratified by Ct value ranges.

Results

All tests performed with high accuracy on samples with low Ct value (high viral load). The Fever Panel test performed with the highest accuracy, with a sensitivity of 89.9% and specificity of 90.6%. The Ebola and Ebola-Malaria tests performed comparably to each other: sensitivity was 77.1 and 78% respectively, and specificity was 91.7% for the Ebola test and 95.8% for the Ebola-Malaria test.

Conclusions

This study evaluated the accuracy of three novel rapid diagnostic tests for Ebola. The tests may have significant public health relevance, particularly the Fever Panel test, which detects seven pathogens including Ebola. Given limitations to the study resulting from uncertain sample quality, further evaluation is warranted. All tests performed with highest accuracy on samples with low Ct value (high viral load), and the data presented here suggests that these RDTs may be useful for point-of-care diagnosis of cases in the context of an outbreak. Restrictions to their use in non-severe Ebola cases or for longitudinal monitoring, when viral loads are lower, may be appropriate. Highlighting the challenge in developing and evaluating Ebola RDTs, there were concerns regarding sample integrity and reference testing, and there is a need for additional research to validate these assays.
Distribution pattern of amino acid mutations in chloroquine and antifolate drug resistance associated genes in complicated and uncomplicated Plasmodium vivax isolates from Chandigarh, North India
Authors: Kaur Hargobinder , Sehgal Rakesh , Kumar Archit , Bharti Praveen K. , Bansal Devendra , Mohapatra Pradyumna K. , Mahanta Jagadish , Sultan Ali A.
Published: September 2020

Background

The increasing antimalarial drug resistance is a significant hindrance to malaria control and elimination programs. For the last six decades, chloroquine (CQ) plus pyrimethamine remains the first-line treatment for P. vivax malaria. Regions where both P. falciparum and P. vivax co-exist, P. vivax is exposed to antifolate drugs due to either misdiagnosis or improper treatment that causes selective drug pressure to evolve. Therefore, the present study aims to estimate antimalarial drug resistance among the complicated and uncomplicated P. vivax patients.

Methods

A total of 143 P. vivax malaria positive patients were enrolled in this study, and DNA was isolated from their blood samples. Pvcrt-o, Pvmdr-1, Pvdhps, and Pvdhfr genes were PCRs amplified, and drug resistance-associated gene mutations were analyzed. Statistical analysis of the drug resistance genes and population diversity was performed using MEGA vs. 7.0.21 and DnaSP v software.

Results

Among the CQ resistance marker gene Pvcrt-o, the prevalence of K10 insertion was 17.5% (7/40) and 9.5% (7/73) of complicated and uncomplicated P vivax group isolates respectively. In Pvmdr-1, double mutant haplotype (M958/L1076) was found in 99% of the clinical isolates. Among the pyrimethamine resistance-associated gene Pvdhfr, the double mutant haplotype I13P33F57R58T61N117I173 was detected in 23% (11/48) in complicated and 20% (17/85) in uncomplicated group isolates. In the sulphadoxine resistance-associated Pvdhps gene, limited polymorphism was observed with the presence of a single mutant (D459A) among 16 and 5% of the clinical isolates in the complicated and uncomplicated group respectively.

Conclusion

The study presents the situations of polymorphism in the antimalarial drug resistance-associated genes and emphasizes the need for regular surveillance. It is imperative for the development of suitable antimalarial drug policy in India.
Rasch analysis of the living with chronic illness scale in Parkinson’s disease
Authors: Ambrosio Leire , Rodriguez-Blazquez Carmen , Ayala Alba , Forjaz Maria João
Published: September 2020

Background

Neurologists play an essential role in facilitating the patient’s process of living with Parkinson’s disease (PD). The Living with Chronic Illness Scale-PD (LW-CI-PD) is a unique available clinical tool that evaluates how the patient is living with PD. The objective of the study was to analyse the LW-CI-PD properties according to the Rasch model.

Methods

An open, international, cross-sectional study was carried out in 324 patients with Parkinson’s disease from four Latin American countries and Spain. Psychometric properties of the LW-CI-PD were tested using Rasch analysis: fit to the Rasch model, item local independency, unidimensionality, reliability, and differential item functioning by age and gender.

Results

Original LW-CI-PD do not fit Rasch model. Modifications emerged included simplifying the response scale and deleting misfit items, the dimensions Acceptance, Coping and Integration showed a satisfactory fit to the Rasch model, with reliability indices greater than 0.70. The dimensions Self-management and Adjustment to the disease did not reach fit to the Rasch model.

Conclusion

Suggestions for improving the LW-CI-PD include a multidimensional and shorter scale with 12 items grouped in three subscales with a simpler response scheme. The final LW-CI-PD Scale version is a reliable scale, with good internal construct validity, that provides Rasch transformed results on linear metric scale.
Plasma-based longitudinal mutation monitoring as a potential predictor of disease progression in subjects with adenocarcinoma in advanced non-small cell lung cancer
Authors: Jiang John , Adams Hans-Peter , Lange Maria , Siemann Sandra , Feldkamp Mirjam , McNamara Sylvie , Froehler Sebastian , Yaung Stephanie J. , Yao Lijing , Balasubramanyam Aarthi , Tikoo Nalin , Ju Christine , Achenbach H. Jost , Krügel Rainer , Palma John F.
Published: September 2020

Background

Identifying and tracking somatic mutations in cell-free DNA (cfDNA) by next-generation sequencing (NGS) has the potential to transform the clinical management of subjects with advanced non-small cell lung cancer (NSCLC).

Methods

Baseline tumor tissue (n = 47) and longitudinal plasma (n = 445) were collected from 71 NSCLC subjects treated with chemotherapy. cfDNA was enriched using a targeted-capture NGS kit containing 197 genes. Clinical responses to treatment were determined using RECIST v1.1 and correlations between changes in plasma somatic variant allele frequencies and disease progression were assessed.

Results

Somatic variants were detected in 89.4% (42/47) of tissue and 91.5% (407/445) of plasma samples. The most commonly mutated genes in tissue were TP53 (42.6%), KRAS (25.5%), and KEAP1 (19.1%). In some subjects, the allele frequencies of mutations detected in plasma increased 3–5 months prior to disease progression. In other cases, the allele frequencies of detected mutations declined or decreased to undetectable levels, indicating clinical response. Subjects with circulating tumor DNA (ctDNA) levels above background had significantly shorter progression-free survival (median: 5.6 vs 8.9 months, respectively; log-rank p = 0.0183).

Conclusion

Longitudinal monitoring of mutational changes in plasma has the potential to predict disease progression early. The presence of ctDNA mutations during first-line treatment is a risk factor for earlier disease progression in advanced NSCLC.
Functional outcomes after combined iris and intraocular lens implantation in various iris and lens defects
Authors: Mayer Christian S. , Hoffmann Andrea M. , Prahs Phillipp , Reznicek Lukas , Khoramnia Ramin
Published: September 2020

Background

To assess the functional outcomes after combined iris and intraocular lens (IOL) repair in aniridia patients.

Methods

Retrospective observational study in 59 aniridic and aphakic eyes for ArtificialIris (AI) and IOL reconstruction. The iris prostheses were placed together with the IOL in the capsular bag using an injection system or were fixed by transscleral suturing of the IOL and AI. The primary outcomes measured were visual acuity, contrast and glare sensitivity (Pelli-Robson chart for photopic and dark adaptometer for mesopic conditions), intraocular pressure, endothelial cell density (ECD) and patient impairment.

Results

Blunt trauma (37 eyes) and penetrating injuries (16 eyes) were observed more frequently than congenital aniridia (1 eye), iatrogenic causes (1 eye), aniridic state after severe iritis (2 eyes) or iris tumor (2 eyes). Monocular CDVA improved significantly (p < 0.0001) from median 0.7 logMAR (0.0–1.98) to 0.3 logMAR (− 0.08–2.0). Median pupillary area could significantly (p < 0.0001) be reduced by 79.3% from 51.27 mm2 (17.91 to 98.23) to 8.81 mm2 (4.16 to 8.84). Median ECD decreased from 2646.0 mm2 to 2497.5 mm2 (p = 0.007). Contrast and glare sensitivity improved significantly (p = 0.008) in photopic light conditions from 0.9 (0.0–1.95) to 1.35 (0.0–1.8). Patients reported to be highly satisfied with the functional improvement.

Conclusion

The flexible ArtificialIris seems to be a safe and effective iris prosthesis in combination with an IOL having functionally and cosmetically exceptional reconstruction options.
Chest x-ray findings and temporal lung changes in patients with COVID-19 pneumonia
Authors: Rousan Liqa A. , Elobeid Eyhab , Karrar Musaab , Khader Yousef
Published: September 2020

Background

Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients.

Methods

From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients’ demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients’ symptoms.

Results

A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19. Their age ranged from 3 to 80 years (35.2 ± 18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6–11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12–17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6–11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P = 0.005).

Conclusion

Almost half of patients with COVID-19 have abnormal chest x-ray findings with peripheral GGO affecting the lower lobes being the most common finding. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.
Gradient boosting for Parkinson’s disease diagnosis from voice recordings
Authors: Karabayir Ibrahim , Goldman Samuel M. , Pappu Suguna , Akbilgic Oguz
Published: September 2020

Background

Parkinson’s Disease (PD) is a clinically diagnosed neurodegenerative disorder that affects both motor and non-motor neural circuits. Speech deterioration (hypokinetic dysarthria) is a common symptom, which often presents early in the disease course. Machine learning can help movement disorders specialists improve their diagnostic accuracy using non-invasive and inexpensive voice recordings.

Method

We used “Parkinson Dataset with Replicated Acoustic Features Data Set” from the UCI-Machine Learning repository. The dataset included 44 speech-test based acoustic features from patients with PD and controls. We analyzed the data using various machine learning algorithms including Light and Extreme Gradient Boosting, Random Forest, Support Vector Machines, K-nearest neighborhood, Least Absolute Shrinkage and Selection Operator Regression, as well as logistic regression. We also implemented a variable importance analysis to identify important variables classifying patients with PD.

Results

The cohort included a total of 80 subjects: 40 patients with PD (55% men) and 40 controls (67.5% men). Disease duration was 5 years or less for all subjects, with a mean Unified Parkinson’s Disease Rating Scale (UPDRS) score of 19.6 (SD 8.1), and none were taking PD medication. The mean age for PD subjects and controls was 69.6 (SD 7.8) and 66.4 (SD 8.4), respectively. Our best-performing model used Light Gradient Boosting to provide an AUC of 0.951 with 95% confidence interval 0.946–0.955 in 4-fold cross validation using only seven acoustic features.

Conclusions

Machine learning can accurately detect Parkinson’s disease using an inexpensive and non-invasive voice recording. Light Gradient Boosting outperformed other machine learning algorithms. Such approaches could be used to inexpensively screen large patient populations for Parkinson’s disease.
Marketing communications in health and medicine: perspectives from Willis-Knighton Health System
Authors: Elrod James K. , Fortenberry John L.
Published: September 2020

Background

Communications prowess is a key ingredient of productive healthcare delivery pursuits, with associated successes clearly positioning health and medical establishments for growth and prosperity. Many conveyance mechanisms are at the disposal of healthcare providers, permitting numerous opportunities for engaging current and prospective patients. For the best communicative outcomes, all must be considered when formulating marketing communications initiatives, with consideration first, of course, requiring that healthcare providers acquire an understanding of communications options and associated fundamentals.

Discussion

In pursuing knowledge of communications options and related guidance, healthcare providers can benefit greatly by gaining operational perspectives from peer institutions. Over many decades, through scores of deployments, Willis-Knighton Health System has acquired significant communications prowess, prompting development of this special supplement in BMC Health Services Research, entitled “Marketing communications in health and medicine: perspectives from Willis-Knighton Health System,” with this particular article supplying a brief profile of the contents included in the associated supplement. Across the pages of the collection of articles contained in the supplement, attention specifically is directed toward the components of the marketing communications mix, foundational elements of communication, the patronage process, and the necessity for integrating marketing communications.

Conclusions

Establishing an effective dialogue with current and prospective patients is an absolute necessity for healthcare organizations, warranting intensive efforts to master marketing communications. Given the imperative for excellence in marketing communications, it is hoped that the light shed by this supplement and its collection of articles will help healthcare providers better understand marketing communications and deploy associated initiatives successfully, affording greater patient engagement opportunities.
Advertising in health and medicine: using mass media to communicate with patients
Authors: Elrod James K. , Fortenberry John L.
Published: September 2020

Background

Advertising—a marketing communications method involving the paid use of mass media to deliver messages to desired audiences—represents one of the most common and effective avenues for engaging current and prospective patients. Although late to proliferate in the health services industry due to tradition, the medium of communication is now firmly established and routinely deployed by health and medical organizations far and wide. Despite widespread use, healthcare providers must take opportunities, when and where possible, to stay abreast of the latest details concerning advertising and its associated applications, increasing the likelihood of successful audience engagements.

Discussion

Maintaining an awareness of current developments in health services advertising can be facilitated by acquiring operational perspectives and practices from peer institutions. Most any healthcare provider can benefit from experiential views as they can shape and hone advertising approaches. Gaining such insights can be difficult, given competitive sensitivities, but occasionally healthcare institutions are compelled to share knowledge in published accounts, with this particular article following suit. Specifically, insights and experiences from Willis-Knighton Health System’s extensive and historic use of advertising are shared, bolstering the experiential accounts available in the literature and supplying operational guidance for health and medical providers.

Conclusions

Advertising, if well devised and deployed, offers healthcare providers opportunities to dramatically improve their fortunes by successfully engaging current and prospective patients, hastening exchange and building vital market share. In pursuit of advertising excellence, health and medical establishments can bolster associated endeavors by tapping into the experiences of other healthcare providers, permitting insights which might potentially be incorporated into communicative pathways. This account sheds light on the advertising operations of a major health system, supplying food for thought for the advancement of advertising acumen.
Public relations in health and medicine: using publicity and other unpaid promotional methods to engage audiences
Authors: Elrod James K. , Fortenberry John L.
Published: September 2020

Background

Public relations—a marketing communications method involving the use of publicity and other unpaid promotional methods to deliver messages—historically has served as the communicative workhorse of the health services industry, representing the predominant pathway over many decades by which health and medical facilities conveyed stories to the public. While other components of the marketing communications mix, perhaps most notably that of advertising, have now captured a significant portion of interest, attention, and use by healthcare establishments, public relations remains a valuable communicative avenue when deployed properly.

Discussion

As an unpaid method of promotion, public relations is uniquely positioned among its counterparts in the marketing communications mix which require direct expenditures to reach audiences. Typically effected by preparing and submitting press releases to news media firms in hopes that they, in turn, will present given stories to their audiences, limitations are somewhat obvious as transmission control rests with external entities. But overcoming limitations is possible with prudent strategies. This article presents Willis-Knighton Health System’s associated strategies, along with a range of public relations insights from decades of deployment experience.

Conclusions

Prudently deployed and led by guiding strategies, public relations offers health and medical organizations opportunities to engage audiences in an efficient and highly credible manner. Courtesy of its unique properties, public relations capably can complement other marketing communications, operating synergistically to help healthcare institutions achieve their conveyance goals, fostering exchange and bolstering market share. Careful operationalization of this marketing communications avenue can help healthcare establishments realize their full communicative potential.
Economic impact of clinical decision support interventions based on electronic health records
Authors: Lewkowicz Daniel , Wohlbrandt Attila , Boettinger Erwin
Published: September 2020

Background

Unnecessary healthcare utilization, non-adherence to current clinical guidelines, or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to improve quality of care and thereby yield substantial effects on reducing healthcare expenditure. In this article, we evaluate the economic impact of clinical decision support (CDS) interventions based on electronic health records (EHR).

Methods

We searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registry databases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practice application areas and categorized the investigated interventions according to an existing taxonomy of front-end CDS tools.

Results and discussion

Twenty-seven studies are investigated in this review. Of those, twenty-two studies indicate a reduction of healthcare expenditure after implementing an EHR based CDS system, especially towards prevalent application areas, such as unnecessary laboratory testing, duplicate order entry, efficient transfusion practice, or reduction of antibiotic prescriptions. On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance costs of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance of further high-quality economic evaluations for these CDS systems.

Conclusion

Current research studies lack consideration of comparative cost-outcome metrics as well as detailed cost components in their analyses. Nonetheless, the positive economic impact of EHR based CDS interventions is highly promising, especially with regard to reducing waste in healthcare.
Effectiveness and cost-effectiveness of treatment with additional enrollment to a homeopathic integrated care contract in Germany
Authors: Kass Benjamin , Icke Katja , Witt Claudia M. , Reinhold Thomas
Published: September 2020

Background

A number of German statutory health insurance companies are offering integrated care contracts for homeopathy (ICCHs) that cover the reimbursement of homeopathic treatment. The effectiveness and cost-effectiveness of these contracts are highly debated.

Methods

To evaluate the effectiveness and cost-effectiveness of treatment after an additional enrollment in an ICCH, a comparative, prospective, observational study was conducted in which participants in the ICCH (HOM group) were compared with matched (on diagnosis, sex and age) insured individuals (CON group) who received usual care alone.

Those insured with either migraine or headache, allergic rhinitis, asthma, atopic dermatitis and depression were included. Primary effectiveness outcomes were the baseline adjusted scores of diagnosis-specific questionnaires (e.g. RQLQ, AQLQ, DLQI, BDI-II) after 6 months. Primary cost-effectiveness endpoints were the baseline adjusted total costs from an insurer perspective in relation to the achieved quality-adjusted life years (QALYs). Costs were derived from health claims data and QALYs were calculated based on SF-12 data.

Results

Data from 2524 participants (1543 HOM group) were analyzed. The primary effectiveness outcomes after six months were statistically significant in favor of the HOM group for migraine or headache (Δ = difference between groups, days with headache: − 0.9, p = 0.042), asthma (Δ-AQLQ(S): + 0.4, p = 0.014), atopic dermatitis (Δ-DLQI: − 5.6, p ≤ 0.001) and depression (Δ-BDI-II: − 5.6, p ≤ 0.001). BDI-II differences reached the minimal clinically important difference. For all diagnoses, the adjusted mean total costs over 12 months were higher in the HOM group from an insurer perspective, with migraine or headache, atopic dermatitis and depression suggesting cost-effectiveness in terms of additional costs per QALY gained.

Conclusion

After an additional enrollment in the ICCH, the treatment of participants with depression showed minimally clinically relevant improvements. From an insurer perspective, treatment with an ICCH enrollment resulted in higher costs over all diagnoses but seemed to be cost-effective for migraine or headache, atopic dermatitis and depression according to international used threshold values. Based on the study design and further limitations, our findings should be considered cautiously and no conclusions regarding the effectiveness of specific treatment components can be made. Further research is needed to overcome limitations of this study and to confirm our findings.

Trial registration

clinicaltrials.gov, NCT01854580. Registered 15 March 2013 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01854580
Automatic detection of intracranial aneurysms in 3D-DSA based on a Bayesian optimized filter
Authors: Hu Tao , Yang Heng , Ni Wei , Lei Yu , Jiang Zhuoyun , Shi Keke , Yu Jinhua , Gu Yuxiang , Wang Yuanyuan
Published: September 2020

Background

Intracranial aneurysm is a common type of cerebrovascular disease with a risk of devastating subarachnoid hemorrhage if it is ruptured. Accurate computer-aided detection of aneurysms can help doctors improve the diagnostic accuracy, and it is very helpful in reducing the risk of subarachnoid hemorrhage. Aneurysms are detected in 2D or 3D images from different modalities. 3D images can provide more vascular information than 2D images, and it is more difficult to detect. The detection performance of 2D images is related to the angle of view; it may take several angles to determine the aneurysm. As the gold standard for the diagnosis of vascular diseases, the detection on digital subtraction angiography (DSA) has more clinical value than other modalities. In this study, we proposed an adaptive multiscale filter to detect intracranial aneurysms on 3D-DSA.

Methods

Adaptive aneurysm detection consists of three parts. The first part is a filter based on Hessian matrix eigenvalues, whose parameters are automatically obtained by Bayesian optimization. The second part is aneurysm extraction based on region growth and adaptive thresholding. The third part is the iterative detection strategy for multiple aneurysms.

Results

The proposed method was quantitatively evaluated on data sets of 145 patients. The results showed a detection precision of 94.6%, and a sensitivity of 96.4% with a false-positive rate of 6.2%. Among aneurysms smaller than 5 mm, 93.9% were found. Compared with aneurysm detection on 2D-DSA, automatic detection on 3D-DSA can effectively reduce the misdiagnosis rate and obtain more accurate detection results. Compared with other modalities detection, we also get similar or better detection performance.

Conclusions

The experimental results show that the proposed method is stable and reliable for aneurysm detection, which provides an option for doctors to accurately diagnose aneurysms.
Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems
Authors: van Roode Thea , Pauly Bernadette M. , Marcellus Lenora , Strosher Heather Wilson , Shahram Sana , Dang Phuc , Kent Alex , MacDonald Marjorie
Published: September 2020

Background

Health system policies and programs that reduce health inequities and improve health outcomes are essential to address unjust social gradients in health. Prioritization of health equity is fundamental to addressing health inequities but challenging to enact in health systems. Strategies are needed to support effective prioritization of health equity.

Methods

Following provincial policy recommendations to apply a health equity lens in all public health programs, we examined health equity prioritization within British Columbia health authorities during early implementation. We conducted semi-structured qualitative interviews and focus groups with 55 senior executives, public health directors, regional directors, and medical health officers from six health authorities and the Ministry of Health. We used an inductive constant comparative approach to analysis guided by complexity theory to determine critical elements for prioritization.

Results

We identified seven critical elements necessary for two fundamental shifts within health systems. 1) Prioritization through informal organization includes creating a systems value for health equity and engaging health equity champions. 2) Prioritization through formal organization requires explicit naming of health equity as a priority, designating resources for health equity, requiring health equity in decision making, building capacity and competency, and coordinating a comprehensive approach across levels of the health system and government.

Conclusions

Although creating a shared value for health equity is essential, health equity - underpinned by social justice - needs to be embedded at the structural level to support effective prioritization. Prioritization within government and ministries is necessary to facilitate prioritization at other levels. All levels within health systems should be accountable for explicitly including health equity in strategic plans and goals. Dedicated resources are needed for health equity initiatives including adequate resourcing of public health infrastructure, training, and hiring of staff with equity expertise to develop competencies and system capacity.
Comparison of life loss per death attributable to ambient temperature among various development regions: a nationwide study in 364 locations in China
Authors: Chen Siqi , Xiao Yize , Zhou Maigeng , Zhou Chunliang , Yu Min , Huang Biao , Xu Yanjun , Liu Tao , Hu Jianxiong , Xu Xiaojun , Lin Lifeng , Hu Ruying , Hou Zhulin , Li Junhua , Jin Donghui , Qin Mingfang , Zhao Qinglong , Gong Weiwei , Yin Peng , Xu Yiqing , Xiao Jianpeng , Zeng Weilin , Li Xing , Guo Lingchuan , Zhang Yonghui , Huang Cunrui , Ma Wenjun
Published: September 2020

Background

Several studies have investigated the associations between ambient temperature and years of life lost (YLLs), but few focused on the difference of life loss attributable to temperature among different socioeconomic development levels.

Objectives

We investigated the disparity in temperature-YLL rate relationships and life loss per death attributable to nonoptimal temperature in regions with various development levels.

Methods

Three hundred sixty-four Chinese counties or districts were classified into 92 high-development regions (HDRs) and 272 low-development regions (LDRs) according to socioeconomic factors of each location using K-means clustering approach. We used distributed lag non-linear models (DLNM) and multivariate meta-analysis to estimate the temperature-YLL rate relationships. We calculated attributable fraction (AF) of YLL and temperature-related average life loss per death to compare mortality burden of temperature between HDRs and LDRs. Stratified analyses were conducted by region, age, sex and cause of death.

Results

We found that non-optimal temperatures increased YLL rates in both HDRs and LDRs, but all subgroups in LDRs were more vulnerable. The disparity of cold effects between HDRs and LDRs was significant, while the difference in heat effect was insignificant. The overall AF of non-optimal temperature in LDRs [AF = 12.2, 95% empirical confidence interval (eCI):11.0–13.5%] was higher than that in HDRs (AF = 8.9, 95% eCI: 8.3–9.5%). Subgroups analyses found that most groups in LDRs had greater AFs than that in HDRs. The average life loss per death due to non-optimal temperature in LDRs (1.91 years, 95% eCI: 1.72–2.10) was also higher than that in HDRs (1.32 years, 95% eCI: 1.23–1.41). Most of AFs and life loss per death were caused by moderate cold in both HDRs and LDRs.

Conclusions

Mortality burden caused by temperature was more significant in LDRs than that in HDRs, which means that more attention should be paid to vulnerable populations in LDRs in planning adaptive strategies.
Dynamic changes of lipid profile in severe hypertriglyceridemia-induced acute pancreatitis patients under double filtration plasmapheresis: a retrospective observational study
Authors: Zheng Huijun , Wang Donghai , Wang Xiaoling , Lin Yongjun , Lu Zhihua , Chen Yueliang , Feng Guo , Yang Na
Published: September 2020

Background

To investigate the dynamic change of lipid profile under double filtration plasmapheresis (DFPP) in severe hypertriglyceridemia-induced acute pancreatitis (sHTGP) patients and ascertain the association between these changes and the clinical prognosis.

Methods

sHTGP patients admitted within 72 h after disease onset were included, and all the patients received DFPP within 24 h after admission. Lipid profile were detected on admission, consecutive 4 days after DFPP and at discharge.

Results

There were 47 sHTGP patients enrolled in this study. At admission, all the parameters of lipid profile changed significantly except for low density lipoprotein. In the first day after DFPP, the serum level of TG, cholesterol and very low density lipoprotein declined significantly, while the high-density lipoprotein (HDL) as well as apoprotein A1 elevated obviously (P < 0.05). TG maintained the downward trend in the following three days and the other parameters kept steady. Linear regression analysis showed that HDL was negatively correlated with the duration of hospitalization among three adjusted models (P = 0.043, P = 0.029, P = 0.025 respectively).

Conclusion

There was distinct fluctuation of the lipid profile upon the burst of sHTGP and the parameters changed significantly in the first day after DFPP. Among these parameters, HDL may serve as a biomarker for disease prognosis in patients with sHTGP.
Hafnium (IV) oxide obtained by atomic layer deposition (ALD) technology promotes early osteogenesis via activation of Runx2-OPN-mir21A axis while inhibits osteoclasts activity
Authors: Seweryn A. , Alicka M. , Fal A. , Kornicka-Garbowska K. , Lawniczak-Jablonska K. , Ozga M. , Kuzmiuk P. , Godlewski M. , Marycz K.
Published: September 2020

Background

Due to increasing aging of population prevalence of age-related disorders including osteoporosis is rapidly growing. Due to health and economic impact of the disease, there is an urgent need to develop techniques supporting bone metabolism and bone regeneration after fracture. Due to imbalance between bone forming and bone resorbing cells, the healing process of osteoporotic bone is problematic and prolonged. Thus searching for agents able to restore the homeostasis between these cells is strongly desirable.

Results

In the present study, using ALD technology, we obtained homogeneous, amorphous layer of hafnium (IV) oxide (HfO2). Considering the specific growth rate (1.9Å/cycle) for the selected process at the temperature of 90 °C, we performed the 100 nm deposition process, which was confirmed by measuring film thickness using reflectometry. Then biological properties of the layer were investigated with pre-osteoblast (MC3T3), pre-osteoclasts (4B12) and macrophages (RAW 264.7) using immunofluorescence and RT-qPCR. We have shown, that HfO2 (i) enhance osteogenesis, (ii) reduce osteoclastogenesis (iii) do not elicit immune response and (iv) exert anti-inflammatory effects.

Conclusion

HfO2 layer can be applied to cover the surface of metallic biomaterials in order to enhance the healing process of osteoporotic bone fracture.
Plastic lengthening amputation with vascularized bone grafts in children with bone sarcoma: a preliminary report
Authors: Zhao Zhiqiang , Jin Qinglin , Xie Xianbiao , Wang Yongqian , Lin Tiao , Yin Junqiang , Huang Gang , Zou Changye , Shen Jingnan
Published: September 2020

Background

At present, amputation was widely adopted for young patients when limb salvage was deemed risky with several surgical strategy such as rotationplasty. However, leg length discrepancies and unfavorable cosmetic results were indispensable complication of this strategy. The purpose of this study was to propose a novel reconstruction strategy and evaluate the early clinical and functional outcomes of the strategy.

Methods

Plastic lengthening amputation (PLA) has been developed by lengthening the stump to preserve one additional distal joint for fixing the artificial limb well. The surgical technique and postoperative management were documented, and the functional outcomes were compared with those of traditional amputation (TA). Six pairs of patients matched for age, sex, location, pathological type, and final prosthesis underwent individually designed plastic lengthening amputation with vascularized autografts or traditional amputation between January 2005 and December 2007. All patients were followed, and the locomotor index and the musculoskeletal tumor society score (MSTS) were used to describe and quantitatively grade limb functional outcomes after amputation. The complications and functional outcomes of the patients taken two kinds of procedures were compared.

Results

Twelve patients with osteosarcoma or Ewing’s sarcoma of either the femur or tibia were included in the study. Six patients underwent plastic lengthening amputations, three of whom also underwent vascular anastomosis. Patients were followed for an average of 48.17 months; bone healing required an average of 3.3 months. No local recurrence was found. The average postoperative locomotor index functional score of the affected limb was 32.67 ± 5.89 in the plastic lengthening amputation group while was 19.50 ± 7.87 in the traditional amputation group. The MSTS functional scores were 22.67 ± 1.33 and 24.17 ± 1.45 at 6 and 12 months for patients in PLA group while 17.00 ± 1.549 and 17.83 ± 1.64 at 6 and 12 months for patients in TA group.

Conclusions

Plastic lengthening amputations with vascularized autografts could preserve the knee joint to improve the function of the amputated limb in selected bone sarcoma patients.
An expert-based mapping of healthcare system strategies to support rational drug prescribing in primary care across 13 European countries
Authors: Rotar Alexandru M. , van den Berg Michael J. , Klazinga Niek S.
Published: September 2020

Background

Irrational prescribing has received increasing attention among policy-makers to improve drug safety and effectiveness while avoiding economic waste. The policies intended to rationalise prescribing have been grouped by WHO under a taxonomy, classifying them into two types of strategies – (1) targeted approaches (micro level) and (2) system-oriented approaches (macro level). The extent to which countries implement strategies and the existing types is currently unknown. This paper explores the following research question via expert opinions: to what extent have European countries implemented strategies to support rational prescribing (targeted and system oriented) and what are the types implemented?

Methods

We assessed the available information on policies intended to promote rational prescribing. We used the WHO taxonomy to explore our research question as the basis for a standardised questionnaire. The data were collected between August 2018 and April 2019. The questionnaire consisted of questions that solicited the opinion of experts on the implementation of prescribing control mechanisms in primary care in their respective countries. Experts were identified through the literature and relevant networks. The questionnaire was sent to 17 identified country experts from 17 different countries; 15 responded and 13 were used in our analysis. Answers were validated through follow-up correspondence, interviews and presentation at an OECD meeting.

Results

Expert-reported data shows that all 13 countries included in our study have several mechanisms in place for enhancing rational prescribing in primary care. All approaches were reported to have been implemented in at least two countries. We identified two groups of countries, namely a small group of countries (n = 3) with fewer mechanisms in place and a larger group of countries (n = 10) with a large number of strategies with accompanying instruments at both the micro and macro levels.

Conclusions

The data reported by the experts suggests that all 13 countries included in our study have several mechanisms in place for enhancing rational prescribing in primary care on both the micro and macro levels. With respect to the extent of mechanisms being in place, two groups of countries were identified. This initial mapping of strategies forms a basis for more in-depth research to be able to assess the impact of bundles of strategies on system and targeted level on rational drug prescribing in primary care in Europe.