bluuebunny/crossref_metadata_2025_split huggingface dataset:
Covid-19 ICU remote-learning course (CIRLC): Rapid ICU remote training for frontline health professionals during the COVID-19 pandemic in the UK
Authors: Camilleri Matthew , Zhang Xiaoxi , Norris Meriel , Monkhouse Alex , Harvey Alex , Wiseman Allison , Sinha Pratik , Hemsley Alex , Tang Sophie , Menon Arun , Sinmayee Smruti , Jones Mandy , Buckley Jim , Johnson Ruth , Medici Thomas , Corner Evelyn 
Published: November 2020

Background The unprecedented increase in critically ill patients due to the COVID-19 pandemic mandated rapid training in critical care for redeployed staff to work safely in intensive care units (ICU). Methods The COVID-19 ICU Remote-Learning Course (CIRLC) is a remote delivery course developed in response to the pandemic. This was a one-day course focused on the fundamentals of Intensive Care. The course used blended learning with recorded lectures and interactive tutorials delivered by shielding and frontline ICU trained professionals. The course was developed within one week and piloted at three NHS Trusts. It was then made publicly available free of charge to redeployed healthcare professionals across the UK and Ireland. An iterative cycle of improvement was used to update the course content weekly. A course confidence questionnaire with quantitative and qualitative questions was used to evaluate effectiveness. Data is reported as n (%), means (SD) and thematic analysis was used for the open questions. Results 1,269 candidates from 171 organisations completed the course, with 99 volunteer trainers. 96% of respondents rated the course as very or extremely useful. 86% rated the online platform as excellent. Overall confidence improved from 2.7/5 to 3.9/5. Qualitative data showed that the course was pitched at the appropriate level, accessible and built clinicians confidence to work in intensive care. Conclusion This model of educational delivery with a rapid iteration cycle was a pragmatic, effective solution to knowledge-based training under social distancing measures. Whilst full course evaluation was not possible, we believe that this work demonstrates practical guidance on educational response in a pandemic as well as highlighting the altruistic nature of the critical care community.
Beta-blockers in heart failure prognosis: Lessons learned by MECKI Score Group papers
Authors: Cattadori Gaia , Di Marco Silvia , Farina Stefania , Limongelli Giuseppe , Monda Emanuele , Badagliacca Roberto , Papa Silvia , Tricarico Lucia , Correale Michele 
Published: November 2020

Abstract
Heart failure is a complex syndrome affecting several organs including kidney, lungs, liver, brain muscles and sympathetic system. Each of these organs might contribute to its severity and prognosis. The prognosis assessment is critical for a correct heart failure management. It has already been demonstrated that a single parameter is weaker for prognosis than different parameters combined. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has been built and validated for heart failure with reduced ejection fraction (HFrEF) patients by considering cardiopulmonary exercise test data combined with clinical, laboratory and echocardiographic measurements. The betablockers treatment is a milestone in the HFrEF management. In the MECKI score database, the association of betablockers treatment with outcome has been investigated in different settings.
Presence ofPropionibacterium acnesin granulomas associates with a chronic disease course in Dutch sarcoidosis patients
Authors: Beijer Els , Seldenrijk Kees , Eishi Yoshinobu , Uchida Keisuke , Damen Jan , Grutters Jan C. , Veltkamp Marcel 
Published: November 2020

Several studies demonstrated thatPropionibacterium acnesmay be involved in sarcoidosis pathogenesis. Presence ofP. acneswas found in granulomas of the majority of Japanese sarcoidosis patients. However, presence ofP. acnesin tissue has never been related to sarcoidosis phenotypes and clinical outcome. Therefore, the aims of our study were to demonstrate whetherP. acnescan be detected in granulomas of Dutch sarcoidosis patients and to investigate whether its presence is related to a clinical phenotype and/or course of disease.Sections of formalin-fixed paraffin-embedded tissue blocks of 76 sarcoidosis patients were examined by immunostaining with aP. acnes-specific monoclonal antibody (PAB antibody) using a Ventana BenchMark ULTRA. Clinical outcome status (COS) was determined and classified into two phenotype groups: A: resolved, minimal or persistent disease without treatment (COS 1–6) and B: persistent disease with need for treatment (COS 7–9).P. acneswas detected in samples of 31 patients (41%) and located within granulomas in samples of 13 patients (17%). The frequency ofP. acnesdetected in granulomas at diagnosis was significantly higher in patients with phenotype B compared to patients with phenotype A (29%versus0%, p=0.021).Presence ofP. acnesin granulomas can be confirmed in Dutch sarcoidosis patients. It is intriguing that presence ofP. acnesin granulomas is more frequently found in patients with chronic disease requiring treatment. This adds to the rationale that a subgroup of sarcoidosis patients might benefit from antibiotic therapy.
A syndromic approach to assess diagnosis and management of patients presenting with respiratory symptoms to healthcare facilities in Vietnam
Authors: Huang Wan-Chun , Fox Gregory J. , Pham Ngoc Yen , Nguyen Thu Anh , Vu Van Giap , Ngo Quy Chau , Nguyen Viet Nhung , Jan Stephen , Negin Joel , Le Thi Tuyet Lan , Marks Guy B. 
Published: November 2020

BackgroundThe aim of the study was to establish syndromic diagnoses in patients presenting with respiratory symptoms to healthcare facilities in Vietnam and to compare the diagnoses with facility-level clinical diagnoses and treatment decisions.MethodsA representative sample of patients aged ≥5 years, presenting with dyspnoea, cough, wheezing, and/or chest tightness to healthcare facilities in four provinces of Vietnam were systematically evaluated. Eight common syndromes were defined using data obtained.ResultsWe enrolled 977 subjects at 39 facilities. We identified fixed airflow limitation (FAL) in 198 (20.3%) patients and reversible airflow limitation (RAL) in 26 (2.7%) patients. Patients meeting the criteria for upper respiratory tract infection (URTI) alone constituted 160 (16.4%) patients and 470 (48.1%) did not meet the criteria for any of the syndromes. Less than half of patients with FAL were given long-acting bronchodilators. A minority of patients with either RAL or FAL with eosinophilia were prescribed inhaled corticosteroids. Antibiotics were given to more than half of all patients, even among those with URTI alone.ConclusionThis study identified a substantial discordance between prescribed treatment, clinician diagnosis and a standardised syndromic diagnosis among patients presenting with respiratory symptoms. Increased access to spirometry and implementation of locally relevant syndromic approaches to management may help to improve patient care in resource-limited settings.
The role of chest radiography in the diagnosis of bacteriologically confirmed pulmonary tuberculosis in hospitalised Xpert MTB/RIF-negative patients
Authors: Kebede Wakjira , Abebe Gemeda , Gudina Esayas Kebede , Kedir Elias , Tran Thuy Ngan , Van Rie Annelies 
Published: November 2020

The role of chest radiography to diagnose active tuberculosis in symptomatic patients who have a negative Xpert MTB/RIF (Xpert) test result is unclear. This study aimed to assess the performance of chest radiography and the value of chest radiography findings for a prediction tool to identify cases of active pulmonary tuberculosis among symptomatic, Xpert-negative hospitalised patients.Xpert-negative patients hospitalised between January and July 2019 at Jimma University Medical Center in Ethiopia were assessed by mycobacterial culture and chest radiography. Chest radiography was interpreted by a clinician for clinical decision making and by a radiologist for research purposes. Using bacteriological confirmation as the reference standard, the performance of chest radiography to diagnose active tuberculosis was assessed by the area under the receiver operating characteristic curve (AUC); predictors of active tuberculosis were identified using bivariate and multivariate logistic regression analyses.Of 247 Xpert-negative patients, 38% and 40% were classified as suggestive of tuberculosis by clinician and radiologist, respectively. Of the 39 (15.8%) bacteriologically confirmed cases, 69% and 79% were classified as having chest radiography findings suggestive of tuberculosis by clinician or radiologist, respectively. While there was a strong association between bacteriologically confirmed tuberculosis and chest radiography classified by clinician as suggestive of tuberculosis (adjusted OR 2.7, 95% CI 1.2–6.6), chest radiography with signs typical of tuberculosis (adjusted OR 5.3, 95% CI 2.1–14.4) or compatible with tuberculosis (adjusted OR 5.1, 95% CI 1.3–20.0), the positive predictive value of the chest radiography was low (27% and 34% for classification by clinician and radiologist, respectively). The addition of chest radiography findings by clinician or radiologist to clinical characteristics did not improve the performance of the prediction tool, with similar risk classification distribution, AUCs and negative and positive prediction values.Despite the strong association between chest radiography findings and active tuberculosis among hospitalised Xpert negative individuals, chest radiography findings did not improve the performance of a risk prediction tool based solely on clinical symptoms. Countries with a high tuberculosis/HIV burden should urgently replace Xpert by the more sensitive Xpert Ultra assay to improve the diagnosis of active tuberculosis.
Patient-specific record linkage between emergency department and hospital admission data for a cohort of people who inject drugs: methodological considerations for frequent presenters
Authors: Di Rico Rehana , Nambiar Dhanya , Gabbe Belinda , Stoové Mark , Dietze Paul 
Published: November 2020

AbstractBackgroundPeople who inject drugs (PWID) have been identified as frequent users of emergency department (ED) and hospital inpatient services. The specific challenges of record linkage in cohorts with numerous administrative health records occurring in close proximity are not well understood. Here, we present a method for patient-specific record linkage of ED and hospital admission data for a cohort of PWID.MethodsData from 688 PWID were linked to two state-wide administrative health databases identifying all ED visits and hospital admissions for the cohort between January 2008 and June 2013. We linked patient-specific ED and hospital admissions data, using administrative date-time timestamps and pre-specified linkage criteria, to identify hospital admissions stemming from ED presentations for a given individual. The ability of standalone databases to identify linked ED visits or hospital admissions was examined.ResultsThere were 3459 ED visits and 1877 hospital admissions identified during the study period. Thirty-four percent of ED visits were linked to hospital admissions. Most links had hospital admission timestamps in-between or identical to their ED visit timestamps (n = 1035, 87%). Allowing 24-h between ED visits and hospital admissions captured more linked records, but increased manual inspection requirements. In linked records (n = 1190), the ED ‘departure status’ variable correctly reflected subsequent hospital admission in only 68% of cases. The hospital ‘admission type’ variable was non-specific in identifying if a preceding ED visit had occurred.ConclusionsLinking ED visits with subsequent hospital admissions in PWID requires access to date and time variables for accurate temporal sorting, especially for same-day presentations. Selecting time-windows to capture linked records requires discretion. Researchers risk under-ascertainment of hospital admissions if using ED data alone.
An elderly female with adult-onset Still’s disease initially misdiagnosed as prosthetic joint infection after total knee arthroplasty: lessons in differential diagnosis and treatment
Authors: Jiao Xufeng , Li Zheng , An Shuai , Huang Jiang , Yang Guangzhong , Zhao Yi , Shen Jianghua , Chu Yanqi , Yang Charlie C. , Cao Guanglei 
Published: November 2020

Abstract
Background
High fever, knee swelling and pain after knee arthroplasty are often considered as symptoms of acute prosthetic joint infection. However, similar symptoms can also present as primary manifestations of adult-onset Still’s disease, which creates some interference in differential diagnosis. To our knowledge, this is the first published case of misdiagnosis of adult Still’s disease after total knee arthroplasty, who was initially misdiagnosed as an prosthetic joint infection due to the above-mentioned symptoms. The symptoms of the knee infection was not relieve after several revisions and continous antibiotic treatment. Finally, after several consultations and repeated evaluation it was diagnosed as adult-onset Still’s disease.

Case presentation
A 77-year-old female who underwent bilateral total knee arthroplasty 6 years ago was admitted to our hospital with high fever, right knee effusion and painful knee. Based on the results of joint fluid aspiration and culture, we treated the right knee as acute hematogenous prosthetic joint infection. After three debridement and revision surgeries, the patient’s symptoms continued to persist. Subsequent manifestations of other symptoms such as typical rash and sore throat and laboratory examination suggested the possibility of adult-onset Still’s disease. So she underwent diagnostic steroid hormone therapy at the recommendation of a rheumatologist, and a final revision was performed after symptom was controlled. At the one-year follow-up, the patient’s symptoms completely resolved and the knee revision was functioning well.

Conclusions
When joint swelling and pain occurs after knee arthroplasty, the possibility of joint infection should not only be considered, but rheumatic autoimmune diseases should also be differentiated. Because the manifestations of joint infection and rheumatic immune disease sometimes overlap highly, when reasonable treatment over a period of time fails to relieve symptoms and signs, we should notice subtle differences in symptoms and laborotary tests and look for other diagnostic possibilities in time.
Risk factors for mortality in hospitalized patients with COVID-19 at the start of the pandemic in Belgium: a retrospective cohort study
Authors: van Halem Karlijn , Bruyndonckx Robin , van der Hilst Jeroen , Cox Janneke , Driesen Paulien , Opsomer Matthias , Van Steenkiste Eveline , Stessel Björn , Dubois Jasperina , Messiaen Peter 
Published: November 2020

Abstract
Background
Belgium was among the first countries in Europe with confirmed coronavirus disease 2019 (COVID-19) cases. Since the first diagnosis on February 3rd, the epidemic has quickly evolved, with Belgium at the crossroads of Europe, being one of the hardest hit countries. Although risk factors for severe disease in COVID-19 patients have been described in Chinese and United States (US) cohorts, good quality studies reporting on clinical characteristics, risk factors and outcome of European COVID-19 patients are still scarce.

Methods
This study describes the clinical characteristics, complications and outcomes of 319 hospitalized COVID-19 patients, admitted to a tertiary care center at the start of the pandemic in Belgium, and aims to identify the main risk factors for in-hospital mortality in a European context using univariate and multivariate logistic regression analysis.

Results
Most patients were male (60%), the median age was 74 (IQR 61–83) and 20% of patients were admitted to the intensive care unit, of whom 63% needed invasive mechanical ventilation. The overall case fatality rate was 25%. The best predictors of in-hospital mortality in multivariate analysis were older age, and renal insufficiency, higher lactate dehydrogenase and thrombocytopenia. Patients admitted early in the epidemic had a higher mortality compared to patients admitted later in the epidemic. In univariate analysis, patients with obesity did have an overall increased risk of death, while overweight on the other hand showed a trend towards lower mortality.

Conclusions
Most patients hospitalized with COVID-19 during the first weeks of the epidemic in Belgium were admitted with severe disease and the overall case fatality rate was high. The identified risk factors for mortality are not easily amenable at short term, underscoring the lasting need of effective therapeutic and preventative measures.
Machine learning algorithm for early detection of end-stage renal disease
Authors: Segal Zvi , Kalifa Dan , Radinsky Kira , Ehrenberg Bar , Elad Guy , Maor Gal , Lewis Maor , Tibi Muhammad , Korn Liat , Koren Gideon 
Published: November 2020

Abstract
Background
End stage renal disease (ESRD) describes the most severe stage of chronic kidney disease (CKD), when patients need dialysis or renal transplant. There is often a delay in recognizing, diagnosing, and treating the various etiologies of CKD. The objective of the present study was to employ machine learning algorithms to develop a prediction model for progression to ESRD based on a large-scale multidimensional database.

Methods
This study analyzed 10,000,000 medical insurance claims from 550,000 patient records using a commercial health insurance database. Inclusion criteria were patients over the age of 18 diagnosed with CKD Stages 1–4. We compiled 240 predictor candidates, divided into six feature groups: demographics, chronic conditions, diagnosis and procedure features, medication features, medical costs, and episode counts. We used a feature embedding method based on implementation of the Word2Vec algorithm to further capture temporal information for the three main components of the data: diagnosis, procedures, and medications. For the analysis, we used the gradient boosting tree algorithm (XGBoost implementation).

Results
The C-statistic for the model was 0.93 [(0.916–0.943) 95% confidence interval], with a sensitivity of 0.715 and specificity of 0.958. Positive Predictive Value (PPV) was 0.517, and Negative Predictive Value (NPV) was 0.981. For the top 1 percentile of patients identified by our model, the PPV was 1.0. In addition, for the top 5 percentile of patients identified by our model, the PPV was 0.71.
All the results above were tested on the test data only, and the threshold used to obtain these results was 0.1. Notable features contributing to the model were chronic heart and ischemic heart disease as a comorbidity, patient age, and number of hypertensive crisis events.

Conclusions
When a patient is approaching the threshold of ESRD risk, a warning message can be sent electronically to the physician, who will initiate a referral for a nephrology consultation to ensure an investigation to hasten the establishment of a diagnosis and initiate management and therapy when appropriate.
The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study
Authors: Liang Silin , Shi Mai , Bai Yunpeng , Deng Yujun , Fang Miaoxian , Li Jiaxin , Wu Yijin , Peng Wenying , Hou Yating , Fang Heng , Zhang Huidan , Chen Chunbo 
Published: November 2020

AbstractBackgroundGlucocorticoids may impact the accuracy of serum cystatin C (sCysC) in reflecting renal function. We aimed to assess the effect of glucocorticoids on the performance of sCysC in detecting acute kidney injury (AKI) in critically ill patients.MethodsA prospective observational cohort study was performed in a general intensive care unit (ICU). Using propensity score matching, we successfully matched 240 glucocorticoid users with 960 non-users among 2716 patients. Serum creatinine (SCr) and sCysC were measured for all patients at ICU admission. Patients were divided into four groups based on cumulative doses of glucocorticoids within 5 days before ICU admission (Group I: non-users; Group II: 0 mg < prednisone ≤50 mg; Group III: 50 mg < prednisone ≤150 mg; Group IV: prednisone > 150 mg). We compared the performance of sCysC for diagnosing and predicting AKI in different groups using the area under the receiver operator characteristic curve (AUC).ResultsA total of 240 patients received glucocorticoid medication within 5 days before ICU admission. Before and after matching, the differences of sCysC levels between glucocorticoid users and non-users were both significant (P <  0.001). The multiple linear regression analysis revealed that glucocorticoids were independently associated with sCysC (P <  0.001). After matching, the group I had significantly lower sCysC levels than the group III and group IV (P <  0.05), but there were no significant differences in sCysC levels within different glucocorticoids recipient groups (P > 0.05). Simultaneously, we did not find significant differences in the AUC between any two groups in the matched cohort (P > 0.05).ConclusionsGlucocorticoids did not impact the performance of sCysC in identifying AKI in critically ill patients.
Risk factors for pregnancy-related pelvic girdle pain: a scoping review
Authors: Wuytack Francesca , Begley Cecily , Daly Deirdre 
Published: November 2020

Abstract
Background
Pregnancy-related Pelvic Girdle Pain (PPGP) is a common complaint. The aetiology remains unclear and reports on risk factors for PPGP provide conflicting accounts. The aim of this scoping review was to map the body of literature on risk factors for experiencing PPGP.

Methods
We searched the databases PubMed, Embase, CINAHL, PsycINFO, MIDIRS, and ClinicalTrial.gov (3 August 2020). We selected studies with two reviewers independently. Observational studies assessing risk factors for PPGP were included. Studies examining specific diagnostic tests or interventions were excluded.

Results
We identified 5090 records from databases and 1077 from ClinicalTrial.gov. Twenty-four records met the inclusion criteria. A total of 148 factors were examined of which only 14 factors were examined in more than one study. Factors that were positively associated with PPGP included a history of low back or pelvic girdle pain, being overweight/obese, already having a child, younger age, lower educational level, no pre-pregnancy exercise, physically demanding work, previous back trauma/disease, progestin-intrauterine device use, stress, depression and anxiety.

Conclusions
A large number of factors have been examined as potential risk factors for PPGP, but there is a lack of repetition to be able to draw stronger conclusions and pool studies in systematic reviews. Factors that have been examined in more than five studies include age, body mass index, parity and smoking. We suggest a systematic review be conducted to assess the role of these factors further in the development of PPGP.