bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of Asprosin in patients with dilated cardiomyopathy
Authors: Wen Ming-Shien , Wang Chao-Yung , Yeh Jih-Kai , Chen Chun-Chi , Tsai Ming-Lung , Ho Ming-Yun , Hung Kuo-Chun , Hsieh I-Chang 
Published: September 2020

Abstract
Background
Asprosin is a novel fasting glucogenic adipokine discovered in 2016. Asprosin induces rapid glucose releases from the liver. However, its molecular mechanisms and function are still unclear. Adaptation of energy substrates from fatty acid to glucose is recently considered a novel therapeutic target in heart failure treatment. We hypothesized that the asprosin is able to modulate cardiac mitochondrial functions and has important prognostic implications in dilated cardiomyopathy (DCM) patients.

Methods
We prospectively enrolled 50 patients (86% male, mean age 55 ± 13 years) with DCM and followed their 5-year major adverse cardiovascular events from 2012 to 2017. Comparing with healthy individuals, DCM patients had higher asprosin levels (191.2 versus 79.7 ng/mL, P < 0.01).

Results
During the 5-year follow-up in the study cohort, 16 (32.0%) patients experienced adverse cardiovascular events. Patients with lower asprosin levels (< 210 ng/mL) were associated with increased risks of adverse clinical outcomes with a hazard ratio of 7.94 (95% CI 1.88–33.50, P = 0.005) when compared patients with higher asprosin levels (≥ 210 ng/mL). Using cardiomyoblasts as a cellular model, we showed that asprosin prevented hypoxia-induced cell death and enhanced mitochondrial respiration and proton leak under hypoxia.

Conclusions
In patients with DCM, elevated plasma asprosin levels are associated with less adverse cardiovascular events in five years. The underlying protective mechanisms of asprosin may be linked to its functions relating to enhanced mitochondrial respiration under hypoxia.
A tutorial on methodological studies: the what, when, how and why
Authors: Mbuagbaw Lawrence , Lawson Daeria O. , Puljak Livia , Allison David B. , Thabane Lehana 
Published: September 2020

AbstractBackgroundMethodological studies – studies that evaluate the design, analysis or reporting of other research-related reports – play an important role in health research. They help to highlight issues in the conduct of research with the aim of improving health research methodology, and ultimately reducing research waste.Main bodyWe provide an overview of some of the key aspects of methodological studies such as what they are, and when, how and why they are done. We adopt a “frequently asked questions” format to facilitate reading this paper and provide multiple examples to help guide researchers interested in conducting methodological studies. Some of the topics addressed include: is it necessary to publish a study protocol? How to select relevant research reports and databases for a methodological study? What approaches to data extraction and statistical analysis should be considered when conducting a methodological study? What are potential threats to validity and is there a way to appraise the quality of methodological studies?ConclusionAppropriate reflection and application of basic principles of epidemiology and biostatistics are required in the design and analysis of methodological studies. This paper provides an introduction for further discussion about the conduct of methodological studies.
Feasibility of a mobility programme for people with dementia in the respite care setting: results of the DESKK study
Authors: Heinrich Steffen , Horstmannshoff Caren , Holle Bernhard 
Published: September 2020

Abstract
Background
Caring for people with dementia (PwD) is often challenging for caregiving relatives. Respite care (RC) is a commonly used short-term inpatient service. The provision of RC can serve as a link between home care and institutional care and can help to stabilize the care provided at home. During RC, the everyday functional skills of PwD can be improved or stabilized through systematic mobility training. However, no specific mobility programme exists for this setting. The aim of the DESKK study was to develop and test a mobility training programme for PwD in the RC setting in Germany.

Methods
A quasi-experimental pilot study was conducted in a specialized RC centre for PwD. Qualitative and quantitative data were collected and analysed using a mixed methods design.

Results
The DESKK mobility programme may be introduced in the RC setting depending on the required time and professional resources. The mobility programme had a high acceptance rate among the staff involved. Ongoing documentation of the mobility exercises were challenging. During their stay (2–4 weeks), the physical function level of the included PwD (n = 20) increased regarding leg strength, gross motor coordination, fine coordination of the fingers and hand strength.

Conclusions
The DESKK mobility programme showed a high acceptance rate by the staff and was usable in daily care routine for the most part. These aspects indicate that the programme has the potential to be successfully implemented in the RC setting. The DESKK concept is described in the form of a practice-friendly website to facilitate its use in clinical practice after its successful evaluation.
Accuracy of diagnosis and health service codes in identifying frailty in Medicare data
Authors: Festa Natalia , Shi Sandra M. , Kim Dae Hyun 
Published: September 2020

Abstract
Background
Capturing frailty within administrative claims data may help to identify high-risk patients and inform population health management strategies. Although it is common to ascertain frailty status utilizing claims-based surrogates (e.g. diagnosis and health service codes) selected according to clinical knowledge, the accuracy of this approach has not yet been examined. We evaluated the accuracy of claims-based surrogates against two clinical definitions of frailty.

Methods
This cross-sectional study was conducted in a Health and Retirement Study subsample of 3097 participants, aged 65 years or older and with at least 12-months of continuous fee-for-service Medicare enrollment. We defined 18 previously utilized claims-based surrogates of frailty from Medicare data and evaluated each against clinical reference standards, ascertained from a direct examination: a deficit accumulation frailty index (FI) (range: 0–1) and frailty phenotype. We also compared the accuracy of the total count of 18 claims-based surrogates with that of a validated claims-based FI model, comprised of 93 claims-based variables.

Results
19% of participants met clinical criteria for the clinical frailty phenotype. The mean clinical FI for our sample was 0.20 (standard deviation 0.13). Hospital Beds and associated supplies was the claims-based surrogate associated with the highest clinical FI (mean FI 0.49). Claims-based surrogates had low sensitivity ranging from 0.01 (cachexia, adult failure to thrive, anorexia) to 0.38 (malaise and fatigue) and high specificity ranging from 0.79 (malaise and fatigue) to 0.99 (cachexia, adult failure to thrive, anorexia) in discriminating the clinical frailty phenotype. Compared with a validated claims-based FI, the total count of claims-based surrogates demonstrated lower Spearman correlation with the clinical FI (0.41 [95% CI 0.38–0.44] versus 0.59 [95% CI, 0.56–0.61]) and poorer discrimination of the frailty phenotype (C-statistics 0.68 [95% CI, 0.66–0.70] versus 0.75 [95% CI, 0.73–0.77]).

Conclusions
Claims-based surrogates, selected according to clinical knowledge, do not accurately capture frailty in Medicare claims data. A simple count of claims-based surrogates improves accuracy but remains inferior to a claims-based FI model.
Patients’ perceptions of frequent hospital admissions: a qualitative interview study with older people above 65 years of age
Authors: Huang Miaolin , van der Borght Carolien , Leithaus Merel , Flamaing Johan , Goderis Geert 
Published: September 2020

Abstract
Background
Although ‘frequent flyer’ hospital admissions represent barely 3 to 8% of the total patient population in a hospital, they are responsible for a disproportionately high percentage (12 to 28%) of all admissions. Moreover, hospital admissions are an important contributor to health care costs and overpopulation in various hospitals. The aim of this research is to obtain a deeper insight into the phenomenon of frequent flyer hospital admissions. Our objectives were to understand the patients’ perspectives on the cause of their frequent hospital admissions and to identify the perceived consequences of the frequent flyer status.

Methods
This qualitative study took place at the University Hospital of Leuven. The COREQ guidelines were followed to provide rigor to the study. Patients were included when they had at least four overnight admissions in the past 12 months, an age above 65 years and hospital admission at the time of the study. Data were collected via semi-structured interviews and encoded in NVivo.

Results
Thirteen interviews were collected. A total of 17 perceived causes for frequent hospital admission were identified, which could be divided into the following six themes: patient, drugs, primary care, secondary care, home and family. Most of the causes were preventable or modifiable. The perceived consequences of being a frequent flyer were divided into the following six themes: body, daily life functioning, social participation, mental status and spiritual dimension. Negative experiences were linked to frequent flying and could be situated mainly in the categories of social participation, mental status and spiritual dimensions.

Conclusions
Frequent hospital admissions may be conceived as an indicator, i.e., a ‘red flag’, of patients’ situations characterized by physical, mental, spiritual and social deprivation in their home situation.
Hepatitis B, hepatitis C and HIV prevalence and related sexual and substance use risk practices among key populations who access HIV prevention, treatment and related services in South Africa: findings from a seven-city cross-sectional survey (2017)
Authors: Scheibe Andrew , Young Katherine , Versfeld Anna , Spearman C. Wendy , Sonderup Mark W. , Prabdial-Sing Nishi , Puren Adrian , Hausler Harry 
Published: September 2020

Abstract
Background
People who use drugs including people who inject drugs (PWUD/ID), sex workers (SWs) and men who have sex with men (MSM) are at increased risk of HIV and viral hepatitis infection. Limited epidemiological data on the infections exists in key populations (KPs) in South Africa. We investigated the prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV and selected risk factors among these KPs to inform effective responses.

Methods
We used convenience sampling to recruit a targeted 3500 KPs accessing HIV-related health services across Cape Town (SWs, MSM, PWUD/ID), Durban (SWs, PWUD/ID), Pietermaritzburg (SWs), Mthatha (SWs), Port Elizabeth (SWs), Johannesburg (MSM) and Pretoria (MSM and PWUD/ID) into a cross-sectional survey. An interviewer questionnaire to assess socio-demographic characteristics, drug use and sexual risk practices, was administered. HBV surface antigen (HBsAg); HCV antibody, viral load and genotype, and HIV antibody, was tested.

Results
Among the 3439 people included in the study (1528 SWs, 746 MSM, 1165 PWUD/ID) the median age was 29 years, most participants were black African (60%), and 24% reported homelessness. 82% reported substance use in the last month, including alcohol (46%) and heroin (33%). 75% were sexually active in the previous month, with condom use at last sex at 74%. HIV prevalence was 37% (highest among SWs at 47%), HBsAg prevalence 4% (similar across KPs) and HCV prevalence was 16% (highest among PWUD/ID at 46%).

Conclusions
HBV, HCV and HIV pose a health burden for KPs in South Africa. While HIV is key for all included KPs, HCV is of particular importance to PWUD/ID. For KPs, HBV vaccination and behavioural change interventions that support consistent condom and lubricant access and use are needed. Coverage of opioid substitution therapy and needle and syringe services, and access to HCV treatment for PWUD/ID need to be expanded.
Comparative efficacy of placebos in short-term antidepressant trials for major depression: a secondary meta-analysis of placebo-controlled trials
Authors: Holper Lisa , Hengartner Michael P. 
Published: September 2020

Abstract
Background
The issue of unblinded outcome-assessors and patients has repeatedly been stressed as a flaw in allegedly double-blind antidepressant trials. Unblinding bias can for example result from a drug‘s marked side effects. If such unblinding bias is present for a given drug, then it might be expected that the placebos of that drug are rated significantly less effective than that of other antidepressants.

Methods
To test this hypothesis, the present exploratory analysis conducted a Bayesian network meta-analysis (NMA) comparing the efficacy of 19 different placebos in placebo-controlled trials provided in the dataset by Cipriani et al. (Lancet 2018; 391: 1357–66). Primary outcome was efficacy (continuous) estimated on the standardized mean difference (SMD) scale and defined as the pre-post change on the Hamilton Depression scale (HAMD-17), on which information was available in N = 258 trials.

Results
Comparative placebo ranking suggested mirtazapine-placebo (SMD -2.0 [− 5.0–1.0 95% CrI]) to be the most, and amitriptyline- (SMD 1.2 [− 1.6–3.9 95% CrI]) and trazodone- (SMD 2.1 [− 0.9–5.2 95% CrI]) placebos to be the least effective placebos. Other placebos suggested to be more effective than amitriptyline- and trazodone-placebos (based on 95% CrIs excluding zero) were citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, sertraline, and venlafaxine placebos. These NMA results were corroborated by the observation that the relative efficacy between drug and placebo was considerably larger for amitriptyline and trazodone than for instance mirtazapine, duloxetine, and venlafaxine, supported by a small and insignificant correlation between drug-efficacy and placebo-efficacy (r = − 0.202, p = 0.408).

Discussion
The present exploratory NMA indicates that distinguishable side effects of older drugs may unblind outcome-assessors thus resulting in overestimation of the average drug-placebo difference and underrating bias in placebo-arms, particularly for the older antidepressant drugs amitriptyline and trazodone. If confirmed in prospective studies, these findings suggest that efficacy rankings for antidepressants are susceptible to bias and should be considered unreliable or misleading. The analysis is limited by the focus on the single-comparison placebos (76%, i.e., placebos assessed in two-arm trials), since double-comparison placebos (25%, i.e., placebos assessed in three-arm trials) are hard to interpret and therefore not included in the present interpretation. Another limitation is the problem of multiplicity, which was only approximately accounted for in the Bayesian NMA by modelling treatment effects as exchangeable.
The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective
Authors: Sharma Sudesh Raj , Matheson Anna , Lambrick Danielle , Faulkner James , Lounsbury David W. , Vaidya Abhinav , Page Rachel 
Published: September 2020

AbstractBackgroundTobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal.MethodThe study adopted a qualitative study design guided by theSystemic Interventionmethodology. The study involved key informant interviews (n = 63) and focus group discussions (n = 12) at different levels (national, district and/or community) and was informed by the adaptedSocial Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders.ResultsThree key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use.ConclusionTobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.
Comparison of oral health behaviour between dental and non-dental undergraduates in a university in southwestern China——exploring the future priority for oral health education
Authors: Li Mingming , Wu Zhiwu , Zhang Rui , Lei Lei , Ye Siqi , Cheng Ran , Hu Tao 
Published: September 2020

Abstract
Background
Based on a national survey in 2015, people’s oral health behaviour (OHB) has not kept up with the pace of knowledge and attitudes in China after decades of oral health education (OHE). Thus, we need to improve OHE to strengthen people’s OHB. Undergraduates are regarded as the best candidates for the improvement of OHE. The objective of this study is to determine undergraduates’ oral health status and existing problems in OHB by comparing dental and non-dental students at Sichuan University. We hope to provide some suggestions for future OHE to improve people’s OHB.

Methods
A quasi-experimental study designed with a pre-test and post-test group was conducted. A total of 217 dental students and 135 non-dental students were enrolled. They were administered an OHE course focused on OHB. A survey about oral health behaviour and knowledge was conducted before and after the course.

Results
According to the pre-course survey, dental students surpassed non-dental students in terms of toothbrushing frequency, method, and time, but unfortunately, flossing was overlooked by all the students. After the course, both dental and non-dental students showed strong willingness to improve their OHB. More non-dental students than dental students were willing to use toothpicks and Chinese herbal toothpaste before and after the course.

Conclusions
OHE focused on behaviour has a positive effect on university students. Future OHE and interventions should focus on flossing, toothbrushing methods, toothpicks, Chinese herbal toothpaste and modifications to adopt new media.
Development, implementation, and prospective validation of a model to predict 60-day end-of-life in hospitalized adults upon admission at three sites
Authors: Major Vincent J. , Aphinyanaphongs Yindalon 
Published: September 2020

Abstract
Background
Automated systems that use machine learning to estimate a patient’s risk of death are being developed to influence care. There remains sparse transparent reporting of model generalizability in different subpopulations especially for implemented systems.

Methods
A prognostic study included adult admissions at a multi-site, academic medical center between 2015 and 2017. A predictive model for all-cause mortality (including initiation of hospice care) within 60 days of admission was developed. Model generalizability is assessed in temporal validation in the context of potential demographic bias. A subsequent prospective cohort study was conducted at the same sites between October 2018 and June 2019. Model performance during prospective validation was quantified with areas under the receiver operating characteristic and precision recall curves stratified by site. Prospective results include timeliness, positive predictive value, and the number of actionable predictions.

Results
Three years of development data included 128,941 inpatient admissions (94,733 unique patients) across sites where patients are mostly white (61%) and female (60%) and 4.2% led to death within 60 days. A random forest model incorporating 9614 predictors produced areas under the receiver operating characteristic and precision recall curves of 87.2 (95% CI, 86.1–88.2) and 28.0 (95% CI, 25.0–31.0) in temporal validation. Performance marginally diverges within sites as the patient mix shifts from development to validation (patients of one site increases from 10 to 38%). Applied prospectively for nine months, 41,728 predictions were generated in real-time (median [IQR], 1.3 [0.9, 32] minutes). An operating criterion of 75% positive predictive value identified 104 predictions at very high risk (0.25%) where 65% (50 from 77 well-timed predictions) led to death within 60 days.

Conclusion
Temporal validation demonstrates good model discrimination for 60-day mortality. Slight performance variations are observed across demographic subpopulations. The model was implemented prospectively and successfully produced meaningful estimates of risk within minutes of admission.
Trends in the use of computerized physician order entry by health-system affiliated ambulatory clinics in the United States, 2014–2016
Authors: Fischer Shira H. , Rudin Robert S. , Shi Yunfeng , Shekelle Paul , Amill-Rosario Alejandro , Scanlon Dennis , Damberg Cheryl L. 
Published: September 2020

Abstract
Background
Computerized provider order entry (CPOE) can help providers deliver better quality care. We aimed to understand recent trends in use of CPOE by health system-affiliated ambulatory clinics.

Methods
We analyzed longitudinal data (2014–2016) for 19,109 ambulatory clinics that participated in all 3 years of the Healthcare Information and Management Systems Society Analytics survey to assess use of CPOE and identify characteristics of clinics associated with CPOE use.
We calculated descriptive statistics to examine overall trends in use, location of order entry (bedside vs. clinical station), and system-level use CPOE across all clinics. We used linear probability models to explore the association between clinic characteristics (practice size, practice type, and health system type) and two outcomes of interest: CPOE use at any point between 2014 and 2016, and CPOE use beginning in 2015 or 2016.

Results
Between 2014 and 2016, use of CPOE increased more than 9 percentage points from 58 to 67%. Larger clinics and those affiliated with multi-hospital health systems were more likely to have reported use of CPOE. We found no difference in CPOE use by primary care versus specialty care clinics. When used, most clinics reported using CPOE for most or all of their orders. Health systems that used CPOE usually did so for all system-affiliated clinics.

Conclusions
Small practice size or not being part of a multi-hospital system are associated with lower use of CPOE between 2014 and 2016. Less than optimal use in these environments may be harming patient outcomes.