bluuebunny/crossref_metadata_2025_split huggingface dataset:
A quality improvement programme to reduce hospital-acquired pressure injuries
Authors: Gupta Poonam , Shiju Shiny , Chacko Gracy , Thomas Mincy , Abas Asma , Savarimuthu Indirani , Omari Emad , Al-Balushi Sara , Jessymol Pulikana , Mathew Sunitha , Quinto Marife , McDonald Ian , Andrews William 
Published: July 2020

BackgroundAt Heart Hospital in Doha, Qatar (HH), 127 pressure injuries (PI) were identified in 2014, corresponding to an incidence of 6.1/1000 patient-days in first 4 months of 2014. Hospital-acquired pressure injury (HAPI) is one of the most common preventable complications of hospitalisation. HAPI significantly increases healthcare costs, including use of resources (dressings, support surfaces, nursing care time and medications). They also have a significant impact on patients in terms of pain, worsened quality of life, psychological trauma and increased length of stay. Working with the Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in all In patient Units at HH with the aim of reducing the number of HAPIs by 60% within 2 years.MethodsIn collaboration with IHI, our multidisciplinary clinical and risk assessment teams tested several changes and implemented a successful programme. The Surface, Skin inspection, Keep moving, Incontinence and Nutrition bundle was implemented. Signs, turning clocks and PI incidence ‘calendars’ were used in the units as reminders. Attention was paid to endotracheal tube ties in order to address device-related pressure injuries. Counts of HAPI (incidence) and number of PIs per 100 patients surveyed (prevalence) were prominently displayed. Changes were tested using the Plan-Do-Study-Act methodology. Statistical analysis using the independent t-test was applied to detect the significance of any difference in the incidence of HAPI before and after implementation of the changes.ResultsThe incidence of HAPI dropped from 6.1/1000 patient-days to 1.1/1000 patient-days, an 83.5% reduction. The prevalence, based on quarterly survey fell from 9.7/100 patients surveyed to 2.0/100 patients surveyed, a 73.4% decline.ConclusionsThe interventions proved to be successful, reducing the incidence of PI by >80%. The outcomes were sustained over a 4-year period.
Global prevalence of Barrett’s oesophagus and oesophageal cancer in individuals
with gastro-oesophageal reflux: a systematic review and meta-analysis
Authors: Eusebi Leonardo Henry , Cirota Giovanna Grazia , Zagari Rocco Maurizio , Ford Alexander Charles 
Published: July 2020

Objectives
Chronic gastro-oesophageal reflux might lead to the development of Barrett’s
oesophagus (BO) or even oesophageal adenocarcinoma. There has been no definitive
systematic review and meta-analysis of data to estimate global prevalence of BO or
oesophageal adenocarcinoma in individuals with gastro-oesophageal reflux.

Design
We searched MEDLINE, Embase and Embase Classic to identify cross-sectional
surveys that reported prevalence of BO or oesophageal adenocarcinoma in adults with
gastro-oesophageal reflux. We extracted prevalence for all studies, both for
endoscopically suspected and histologically confirmed cases. We calculated pooled
prevalence according to study location, symptom frequency and sex, as well as ORs with
95% CIs.

Results
Of the 4963 citations evaluated, 44 reported prevalence of endoscopically
suspected and/or histologically confirmed BO. Prevalence of BO among individuals with
gastro-oesophageal reflux varied according to different geographical regions ranging
from 3% to 14% for histologically confirmed BO with a pooled prevalence of 7.2% (95%
CI 5.4% to 9.3%), whereas pooled prevalence for endoscopically suspected BO was 12.0%
(95% CI 5.5% to 20.3%). There was heterogeneity in many of our analyses. Prevalence of
BO was significantly higher in men, both for endoscopically suspected (OR=2.1; 95% CI
1.6 to 2.8) and histologically confirmed BO (OR=2.3; 95% CI 1.7 to 3.2). Dysplasia was
present in 13.9% (95% CI 8.9% to 19.8%) of cases of histologically confirmed BO, 80.7%
of which was low-grade.

Conclusion
The prevalence of Barrett’s oesophagus among individuals with gastro-oesophageal
reflux varied strikingly among countries, broadly resembling the geographical
distribution of gastro-oesophageal reflux itself. Prevalence of BO was significantly
higher in men.
Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching
Authors: Lee Seung Won , Ha Eun Kyo , Yeniova Abdullah Özgür , Moon Sung Yong , Kim So Young , Koh Hyun Yong , Yang Jee Myung , Jeong Su Jin , Moon Sun Joon , Cho Joo Young , Yoo In Kyung , Yon Dong Keon 
Published: July 2020

ObjectiveThe adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing.DesignData were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death).ResultsIn the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19.ConclusionPatients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit–risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.
Genotype-first in a cohort of 95 fetuses with multiple congenital abnormalities: when exome sequencing reveals unexpected fetal phenotype-genotype correlations
Authors: Lefebvre Mathilde , Bruel Ange-Line , Tisserant Emilie , Bourgon Nicolas , Duffourd Yannis , Collardeau-Frachon Sophie , Attie-Bitach Tania , Kuentz Paul , assoum Mirna , Schaefer Elise , El Chehadeh Salima , Antal Maria Cristina , Kremer Valérie , Girard-Lemaitre Françoise , Mandel Jean-Louis , Lehalle Daphne , Nambot Sophie , Jean-Marçais Nolwenn , Houcinat Nada , Moutton Sébastien , Marle Nathalie , Lambert Laetita , Jonveaux Philippe , Foliguet Bernard , Mazutti Jean-Pierre , Gaillard Dominique , Alanio Elisabeth , Poirisier Celine , Lebre Anne-Sophie , Aubert-Lenoir Marion , Arbez-Gindre Francine , Odent Sylvie , Quélin Chloé , Loget Philippe , Fradin Melanie , Willems Marjolaine , Bigi Nicole , Perez Marie-José , Blesson Sophie , Francannet Christine , Beaufrere Anne-Marie , Patrier-Sallebert Sophie , Guerrot Anne-Marie , Goldenberg Alice , Brehin Anne-Claire , Lespinasse James , Touraine Renaud , Capri Yline , Saint-Frison Marie-Hélène , Laurent Nicole , Philippe Christophe , Tran Mau-them Frederic , Thevenon Julien , Faivre Laurence , Thauvin-Robinet Christel , Vitobello Antonio 
Published: July 2020

PurposeMolecular diagnosis based on singleton exome sequencing (sES) is particularly challenging in fetuses with multiple congenital abnormalities (MCA). Indeed, some studies reveal a diagnostic yield of about 20%, far lower than in live birth individuals showing developmental abnormalities (30%), suggesting that standard analyses, based on the correlation between clinical hallmarks described in postnatal syndromic presentations and genotype, may underestimate the impact of the genetic variants identified in fetal analyses.MethodsWe performed sES in 95 fetuses with MCA. Blind to phenotype, we applied a genotype-first approach consisting of combined analyses based on variants annotation and bioinformatics predictions followed by reverse phenotyping. Initially applied to OMIM-morbid genes, analyses were then extended to all genes. We complemented our approach by using reverse phenotyping, variant segregation analysis, bibliographic search and data sharing in order to establish the clinical significance of the prioritised variants.ResultssES rapidly identified causal variant in 24/95 fetuses (25%), variants of unknown significance in OMIM genes in 8/95 fetuses (8%) and six novel candidate genes in 6/95 fetuses (6%).ConclusionsThis method, based on a genotype-first approach followed by reverse phenotyping, shed light on unexpected fetal phenotype-genotype correlations, emphasising the relevance of prenatal studies to reveal extreme clinical presentations associated with well-known Mendelian disorders.
Data-driven modelling of mutational hotspots and in silico predictors in hypertrophic cardiomyopathy
Authors: Waring Adam , Harper Andrew , Salatino Silvia , Kramer Christopher , Neubauer Stefan , Thomson Kate , Watkins Hugh , Farrall Martin 
Published: July 2020

BackgroundAlthough rare missense variants in Mendelian disease genes often cluster in specific regions of proteins, it is unclear how to consider this when evaluating the pathogenicity of a gene or variant. Here we introduce methods for gene association and variant interpretation that use this powerful signal.MethodsWe present statistical methods to detect missense variant clustering (BIN-test) combined with burden information (ClusterBurden). We introduce a flexible generalised additive modelling (GAM) framework to identify mutational hotspots using burden and clustering information (hotspotmodel) and supplemented by in silico predictors (hotspot+model). The methods were applied to synthetic data and a case–control dataset, comprising 5338 hypertrophic cardiomyopathy patients and 125 748 population reference samples over 34 putative cardiomyopathy genes.ResultsIn simulations, theBIN-testwas almost twice as powerful as the Anderson-Darling or Kolmogorov-Smirnov tests;ClusterBurdenwas computationally faster and more powerful than alternative position-informed methods. For 6/8 sarcomeric genes with strong clustering,Clusterburdenshowed enhanced power over burden-alone, equivalent to increasing the sample size by 50%.Hotspot+models that combine burden, clustering and in silico predictors outperform generic pathogenicity predictors and effectively integrate ACMG criteria PM1 and PP3 to yield strong or moderate evidence of pathogenicity for 31.8% of examined variants of uncertain significance.ConclusionGAMs represent a unified statistical modelling framework to combine burden, clustering and functional information.Hotspotmodels can refine maps of regional burden andhotspot+models can be powerful predictors of variant pathogenicity. TheBIN-testis a fast powerful approach to detect missense variant clustering that when combined with burden information (ClusterBurden) may enhance disease-gene discovery.
Quality of life outcomes after globus pallidus internus deep brain stimulation in idiopathic or inherited isolated dystonia: a meta-analysis
Authors: Tsuboi Takashi , Cauraugh James H , Wong Joshua K , Okun Michael S , Ramirez-Zamora Adolfo 
Published: July 2020

BackgroundSeveral studies reported the beneficial effects of globus pallidus internus deep brain stimulation (GPi DBS) on health-related quality of life (HRQoL) in patients with inherited or idiopathic isolated dystonia. However, the impact of this intervention on physical and mental/psychological domains and the effects over time remain unclear.MethodsWe conducted a systematic literature review from January 2000 to May 2019 and performed a meta-analysis of HRQoL outcomes based on the Short Form Health Survey-36 (SF-36) after GPi DBS in patients with inherited or idiopathic isolated dystonia to evaluate the effects of DBS on physical and mental QoL.ResultsSeven studies comprising 144 patients with dystonia (78, generalised; 34, segmental; and 32, focal cervical) were included in this comprehensive analysis. The mean (SD) age at DBS implantation was 41.0 (11.4) years, and the follow-up period after implantation was 3.2 (3.8) years. The random effects model meta-analysis revealed that both physical and mental domains of SF-36 improved following DBS with a significantly larger effect size for the physical domains (effect size=0.781; p<0.0001) compared with the mental domains (effect size=0.533; p<0.0001). A moderator variable analysis demonstrated that effect sizes for HRQoL improvement were maintained over time.ConclusionsThis is the first meta-analysis that demonstrates significant benefits in HRQoL following DBS in patients with inherited or idiopathic isolated dystonia. The benefits are greater for physical QoL domains compared with mental/psychological QoL. These findings highlight the importance of a comprehensive multidisciplinary approach to improve mental/psychological QoL.
Role of the central autonomic nervous system intrinsic functional organisation and psychosocial factors in primary microvascular angina and Takotsubo syndrome
Authors: Cattaneo Magdalena Maria , Pravatà Emanuele , Provenzi Micol , Moccetti Marco , Kaelin Alain , Sudano Isabella , Biasucci Luigi , Gallino Camilla , Limoni Costanzo , Calanchini Carlo , Gallino Augusto , Crea Filippo , Cattaneo Mattia 
Published: July 2020

Introduction and objectiveDysfunctional central autonomic nervous system network (CAN) at rest may result in aberrant autonomic responses to psychosocial stressors. We hypothesised that patients with primary microvascular angina (MVA) or Takotsubo syndrome (TTS) would exhibit a peculiar functional organisation of the CAN, potentially associated with psychological patterns.MethodsPatients underwent a psychosocial evaluation: a clinical diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y and Short Form 36 Health Survey (SF-36). The strength of intrinsic functional connectivity (FC) between various nodes of the CAN was investigated using cerebral resting state functional MRI (RS-fMRI).ResultsWe evaluated 50 (46 women) stable patients: 16 patients with MVA, 17 patients with TTS and 17 patients with previous acute myocardial infarction (AMI). Compared with AMI, patients with MVA showed a lower (higher impairment) SF-36 Body-Pain score (p 0.046) and a higher SF-36 Mental-Health score (p 0.039). Patients with TTS showed the strongest FC between two nodes of the CAN (sympathetic midcingulate cortex and parasympathetic primary motor area) (F 6.25, p 0.005) using RS-fMRI.ConclusionsThe study implements an innovative collaborative research among cardiologists, neuroscientists and psychiatrists (‘Neuro-psycho-heart Team’). MVA showed a discrepancy between the highest level of self-reported body pain and the best mental health score, which might suggest a mechanism of somatisation. TTS exhibited an increased functional integration between two areas of the CAN involved in interoceptive pain awareness and negative emotional status. We implemented an innovative research collaboration among cardiologists, neuroscientists and psychiatrists. These data are hypothesis generating and suggest potential prospective investigations on pathophysiology and implementation of psychotherapy and stress-reducing techniques as therapeutic strategies.Trial registration numberNCT02759341.
Pectoral block versus paravertebral block: a systematic review, meta-analysis and trial sequential analysis
Authors: Jin Zhaosheng , Durrands Thomas , Li Ru , Gan Tong Joo , Lin Jun 
Published: July 2020

BackgroundPectoral (PECs) block was first described by Blancoet alfor postoperative analgesia in breast surgery. It was proposed to be an easier and safer alternative to thoracic epidural or paravertebral block (PVB). In this systematic review and meta-analysis, we compare the perioperative analgesic efficacy and adverse events of PECs block and PVB.MethodsWe systematically searched PubMed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, US clinical trials register, Wanfang database, as well as recent conference abstracts, for clinical studies comparing the two techniques. Analgesic efficacy was assessed according to the time to first rescue analgesia and 24 hours opioid consumption. Adverse events from the trials were recorded and reported descriptively.ResultsThe literature search was last updated on 20 February 2020. We identified a total of 10 randomized controlled trials (RCTs) comparing PECs to PVB with 252 and 250 patients, respectively. There was no difference in 24 hours opioid consumption between PECs and PVB. There was no significant difference in the time to rescue analgesia between the two cohorts. The most common adverse event noted was postoperative nausea and vomiting). Trial sequence analysis indicate that further studies are unlikely to alter the conclusion regarding opioid requirement.ConclusionOur systematic review suggests that PECs and PVB are comparable in postoperative analgesia efficacy for mastectomy, and further studies are unlikely to alter the conclusion. The choice of technique should, therefore, be based on practitioner skill and institutional guidelines.PROSPERO registration numberCRD42020165137.
Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries
Authors: Okoli Chinyere , Van de Velde Nicolas , Richman Bruce , Allan Brent , Castellanos Erika , Young Benjamin , Brough Garry , Eremin Anton , Corbelli Giulio Maria , Mc Britton Marta , Hardy W. David , de los Rios Patricia 
Published: July 2020

Objectives‘Undetectable equals Untransmittable’ (U=U) is an empowering message that may enable people living with HIV (PLHIV) to reach and maintain undetectability. We estimated the percentage of PLHIV who ever discussed U=U with their main HIV care provider, and measured associations with health-related outcomes. Secondarily, we evaluated whether the impact of the U=U message varied between those who heard it from their healthcare provider (HCP) vs from elsewhere.MethodsData were from the 25-country 2019 Positive Perspectives Survey of PLHIV on treatment (n=2389). PLHIV were classified as having discussed U=U with their HCP if they indicated that their HCP had ever told them about U=U. Those who had not discussed U=U with their HCP but were nonetheless aware that ‘My HIV medication prevents me from passing on HIV to others’ were classified as being made aware of U=U from non-HCP sources. Multivariable logistic regression was used to measure associations between exposure to U=U messages and health outcomes.ResultsOverall, 66.5% reported ever discussing U=U with their HCP, from 38.0% (South Korea) to 87.3% (Switzerland). Prevalence was lowest among heterosexual men (57.6%) and PLHIV in Asia (51.3%). Compared with those unaware of U=U, those reporting U=U discussions with their HCP had lower odds of suboptimal adherence (AOR=0.59, 95% CI 0.44 to 0.78) and higher odds of self-reported viral suppression (AOR=2.34, 95% CI 1.72 to 3.20), optimal sexual health (AOR=1.48, 95% CI 1.14 to 1.92) and reporting they ‘always shared’ their HIV status (AOR=2.99, 95% CI 1.42 to 6.28). While exposure to U=U information from non-HCP sources was beneficial too, the observed associations were attenuated relative to those seen with reported discussions with HCPs.ConclusionHCP discussion of U=U with PLHIV was associated with favourable health outcomes. However, missed opportunities exist since a third of PLHIV reported not having any U=U discussion with their HCP. U=U discussions with PLHIV should be considered as a standard of care in clinical guidelines.
Collecting data on organizational structures of trauma centers: the CAFE web service
Authors: Brochhausen Mathias , Ball Jane W , Sanddal Nels D , Dodd Jimm , Braun Naomi , Bost Sarah , Utecht Joseph , Winchell Robert J , Sexton Kevin W 
Published: July 2020

BackgroundDuring the past several decades, the American College of Surgeons has led efforts to standardize trauma care through their trauma center verification process and Trauma Quality Improvement Program. Despite these endeavors, great variability remains among trauma centers functioning at the same level. Little research has been conducted on the correlation between trauma center organizational structure and patient outcomes. We are attempting to close this knowledge gap with the Comparative Assessment Framework for Environments of Trauma Care (CAFE) project.MethodsOur first action was to establish a shared terminology that we then used to build the Ontology of Organizational Structures of Trauma centers and Trauma systems (OOSTT). OOSTT underpins the web-based CAFE questionnaire that collects detailed information on the particular organizational attributes of trauma centers and trauma systems. This tool allows users to compare their organizations to an aggregate of other organizations of the same type, while collecting their data.ResultsIn collaboration with the American College of Surgeons Committee on Trauma, we tested the system by entering data from three trauma centers and four trauma systems. We also tested retrieval of answers to competency questions.DiscussionThe data we gather will be made available to public health and implementation science researchers using visualizations. In the next phase of our project, we plan to link the gathered data about trauma center attributes to clinical outcomes.
Prolonged survival of a 7‐year‐old vizsla with histiocytic sarcoma affecting the spinal cord and protein‐losing nephropathy after lomustine treatment
Authors: Orgonikova Ivona , Rosati Marco , Reed Nicki , Tappin Simon , Palus Viktor 
Published: July 2020

A 7‐year‐old male entire vizsla, diagnosed with protein‐losing nephropathy (PLN) one month previously, presented with lumbar hyperaesthesia. MRI of the lumbar spine revealed an extradural mass at the level of L3 vertebra. Most of the mass was surgically excised during left‐sided pediculectomy at L3 and left‐sided L2‐L3 mini‐hemilaminectomy. Histopathology revealed a moderately proliferative, lymphocyte/plasmacyte‐rich, mesenchymo‐invasive localised histiocytic sarcoma affecting the spinal cord. Chemotherapy with lomustine (1‐(2‐chloroethyl)‐3‐cyclohexyl‐1‐nitrosurea) was commenced for treatment of the histiocytic sarcoma and during therapy the persistent proteinuria resolved, having previously only shown an improvement with symptomatic treatment. The dog survived 881 days after diagnosis, which is exceptional in cases of histiocytic sarcomas affecting CNS.