bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with wide variation in clinical litigation rates across acute NHS trusts in England: a cross-sectional analysis
Authors: Griggs Beverley , Childs Tristan , Birkinshaw Jamie , Badrinath Padmanabhan 
Published: November 2020

Abstract

Objective
Identify organizational factors associated with high clinical litigation rates among acute National Health Service (NHS) trusts in England.

Design
Cross-sectional analysis using routine data.

Setting
NHS trusts in England.

Participants
A total of 235 NHS trusts used the NHS Clinical Negligence Scheme in 2016–17. Ninety-seven trusts (41.3%) with no maternity services, 2 (0.9%) providing specialized services and 3 (1.2%) without clinical negligence claims were excluded. Hence, the remaining 133 trusts (56.6%) were included.

Intervention(s)
None.

Main Outcome Measures
Rate of clinical litigation by trust per 100 000 occupied bed days.

Results
The mean rate of clinical litigation was 25.4 per 100 000 occupied bed days. In univariable analyses, higher values of summary hospital-level mortality indictor, staff sickness, written complaints, patient safety incidents and being in the North of England led to increased clinical litigation rates. Conversely, higher patient admissions, NHS Staff Survey overall engagement score and occupied bed days led to decreased clinical litigation rates. In the multivariable model, factors associated with increased clinical litigation rates were as follows: summary mortality hospital-level indicator (SHMI) (0.9 increase in litigation rate per 0.05 increase in SHMI; P = 0.012); new written complaints (0.62 increase per 50 complaints higher; P &lt; 0.001); located in the North of England compared to London (5.22 higher; P &lt; 0.001). Conversely, a higher number of occupied bed days (−0.64 change per 50 000 days higher; P = 0.007) was associated with lower clinical litigation rates.

Conclusions
This study identified organizational factors associated with clinical litigation, which will be of interest to clinicians and the NHS. This research also highlights areas for further investigation.
The Interaction between Hb A1C and Selected Genetic Factors in the African American Population in the USA
Authors: Harris Neil S , Weaver Kaitlin D , Beal Stacy G , Winter William E 
Published: November 2020

Abstract

Background
The global prevalence of diabetes mellitus has been growing in recent decades and the complications of longstanding type 2 diabetes continue to place a burden on healthcare systems. The hemoglobin A1c (Hb A1c) content of the blood is used to assess an individual’s degree of glycemic control averaged over 2 to 3 months. In the USA, diabetes is the seventh leading cause of death. Black, indigenous, people of color (BIPOC) are disproportionately affected by diabetes compared to non-Hispanic whites. There are many reports of interaction of Hb A1c and hematologic conditions that have a high prevalence in the Black population; some of these effects are contradictory and not easily explained. This review attempts to document and categorize these apparently disparate effects and to assess any clinical impact.

Methods
Hb A1C can be determined by a variety of techniques including cation-exchange chromatography, electrophoresis, immunoassays, and affinity chromatography. The amount of Hb A1c present in a patient specimen depends not only on blood glucose but is strongly influenced by erythrocyte survival and by structural variations in the globin chains. Sickling hemoglobinopathies are well-represented in the USA in African Americans and the effects of these hemoglobin disorders as well as G6PD deficiency is examined.

Conclusion
Hb A1c measurement should always be performed with a cautious approach. The laboratory scientist should be aware of possible pitfalls in unquestioningly determining Hb A1c without a consideration of hematologic factors, both inherited and acquired. This presents a challenge as often times, the laboratory is not aware of the patient’s race.
Speaking up about patient-perceived serious visit note errors: Patient and family experiences and recommendations
Authors: Lam Barbara D , Bourgeois Fabienne , Dong Zhiyong J , Bell Sigall K 
Published: November 2020

Abstract

Background
Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can inform quality improvements.

Objective
To describe patient and family attitudes, experiences, and barriers related to speaking up about perceived serious note errors.

Methods
Mixed method analysis of a 2016 electronic survey of patients and families at 2 northeast US academic medical centers. Participants had active patient portal accounts and at least 1 note available in the preceding 12 months.

Results
6913 adult patients (response rate 28%) and 3672 pediatric families (response rate 17%) completed the survey. In total, 8724/9392 (93%) agreed that reporting mistakes improves patient safety. Among 8648 participants who read a note, 1434 (17%) perceived ≥1 mistake. 627/1434 (44%) reported the mistake was serious and 342/627 (56%) contacted their provider. Participants who self-identified as Black or African American, Asian, “other,” or “multiple” race(s) (OR 0.50; 95% CI (0.26,0.97)) or those who reported poorer health (OR 0.58; 95% CI (0.37,0.90)) were each less likely to speak up than white or healthier respondents, respectively. The most common barriers to speaking up were not knowing how to report a mistake (61%) and avoiding perception as a “troublemaker” (34%). Qualitative analysis of 476 free-text suggestions revealed practical recommendations and proposed innovations for partnering with patients and families.

Conclusions
About half of patients and families who perceived a serious mistake in their notes reported it. Identified barriers demonstrate modifiable issues such as establishing clear mechanisms for reporting and more challenging issues such as creating a supportive culture. Respondents offered new ideas for engaging patients and families in improving note accuracy.
Patients’ Preferences for 3 Months vs 6 Months of Adjuvant Chemotherapy for Colon Cancer
Authors: Blinman Prunella , Martin Andrew , Jefford Michael , Goldstein David , Boadle David , Morris Michelle , Tebbutt Niall , Aiken Christine , Harkin Andrea , Segelov Eva , Haydon Andrew , Iveson Tim , Stockler Martin R 
Published: November 2020

Abstract

Background
SCOT was an international, randomized phase 3 trial of 3 months vs 6 months of adjuvant chemotherapy with oxaliplatin and a fluoropyrimidine in patients with colorectal cancer. We sought patients’ preferences for 3 months vs 6 months of adjuvant chemotherapy in the SCOT trial.

Methods
SCOT participants from Australia and New Zealand completed a validated questionnaire (at 3 and 18 months) to elicit the minimum survival benefits judged necessary to make an extra 3 months of adjuvant chemotherapy worthwhile, based on their experience. Standardized hypothetical scenarios used the following baseline survivals (with 3 months of chemotherapy): life expectancies (LE) of 5 years and 15 years and 5-year survival rates (5YS) of 65% and 85%.

Results
Of the 160 participants, 82 were assigned 3 months adjuvant chemotherapy, and 78 were assigned 6 months. Adjuvant chemotherapy was FOLFOX in 121 (75.6%) and XELOX in 39 (24.4%). Preferences varied substantially and did not differ according to treatment group. The median survival benefits judged necessary to make the extra 3 months of chemotherapy worthwhile were an extra 3 years beyond a LE of 5 years; 3 years beyond a LE of 15 years; 15% beyond a 5YS of 65%; and 5% beyond a 5YS of 85%. Preferences were similar at 3 months and 18 months. Preferences were not predicted by participants’ baseline characteristics.

Conclusion
Preferences varied substantially, and the benefits many required to warrant an extra 3 months of adjuvant chemotherapy were larger than the benefits of an extra 3 months of chemotherapy calculated in the International Duration Evaluation of Adjuvant Chemotherapy (IDEA) meta-analysis.
The structure and relations of banking systems: the UK experience and the challenges of ‘levelling-up’
Authors: Mayer Colin , McCann Philip , Schumacher Jacob 
Published: November 2020

Abstract
A decentralized banking system is marked by geographical dispersion of banks with close proximity of banks to their borrowers and strong long-term relationships between banks and their borrowers based on soft, tacit, as well as hard, codified information. It is important for promoting the development of small and medium-sized enterprises (SMEs) particularly in regional locations. In contrast, the UK has a highly centralized, concentrated banking system with weak relationships between banks and their borrowers. This has contributed to the high degree of regional disparity across the UK. The programme of ‘levelling up’ regions will require a more decentralized banking system. The cases of Germany, the US, and the Swedish bank Handelsbanken illustrate the advantages of decentralized banking. They also have important lessons for the way in which decentralized banking systems should be structured and organized and, in particular, for the regulatory arrangements that are conducive to their satisfactory functioning and avoidance of pitfalls to which they can otherwise be prone.
Considering the Feasibility, Tolerability, and Safety of High-Intensity Interval Training as a Novel Treatment for Patients With Intermittent Claudication
Authors: Pymer Sean , Ibeggazene Saïd , Palmer Joanne , Smith George E. , Harwood Amy E. , Carroll Sean , Ingle Lee , Chetter Ian C. 
Published: November 2020

Purpose:
This study assessed the feasibility, tolerability, safety, and potential efficacy of a novel, 6-wk, high-intensity interval training (HIIT) program for patients with intermittent claudication (IC).

Methods:
Patients referred to a usual-care supervised exercise program were invited to undertake a HIIT program. All recruited patients performed a baseline cardiopulmonary exercise test (CPX) to inform their exercise prescription. HIIT involved 10, 1-min high-intensity cycling intervals interspersed with 1-min recovery intervals, performed 3 d/wk for 6 wk. Outcomes included feasibility, tolerability, safety, walking distance, and quality of life.

Results:
A total of 144 patients with IC were referred, 95 met initial eligibility criteria (66%) and 30 (32%) were recruited for HIIT, of which 15 (50%) completed. Of the recruited patients, 90% were on optimal medical therapy and 40% had concomitant cardiac, cerebrovascular, and/or respiratory disease. Patients who completed the program attended 100% of the sessions and one serious adverse event was recorded. Improvements in walking distances and quality of life were observed. Following recruitment of the first 20 patients, the inclusion criteria were refined on the basis of CPX, leading to improved completion rates.

Conclusions:
This study provides preliminary findings indicating that patients with IC can complete a short-term HIIT program. We provide very early evidence that HIIT may be safe and well-tolerated. In addition, walking distances seem to improve following HIIT. After a small change in the exclusion criteria, the intervention and inclusion/exclusion criteria now seem appropriate for this population, meaning further research to evaluate HIIT in patients with IC is warranted.
Predictors of Exercise Maintenance 6 Months After Comprehensive Cardiac Rehabilitation
Authors: Ghisi Gabriela Lima de Melo , Alavinia Mohammad , Aultman Crystal , Rouleau Fanny , Ross Marie-Kristelle , Dufour-Doiron Monique , Belliveau Sylvie L. , Brideau Jean-René , Oh Paul 
Published: November 2020

Purpose:
The objectives of this study were (1) to assess the effects of a comprehensive education intervention on maintenance of knowledge, exercise behavior, heart-healthy food intake, self-efficacy, and health literacy 6 mo after comprehensive cardiac rehabilitation (CR), and (2) to identify predictors of exercise maintenance 6 mo after comprehensive CR.

Methods:
A prospective longitudinal study was conducted to test the effects of a structured educational curriculum in three CR programs in Canada. Participants completed surveys pre-, post-CR and 6 mo post-discharge to assess knowledge, heart-healthy food intake, self-efficacy, and health literacy. Exercise behavior was measured by number of steps/d using a pedometer.

Results:
One hundred twenty participants completed the final survey. Increases in disease-related knowledge and self-efficacy, as well as behavior changes (increases in exercise and heart-healthy food intake), were achieved in comprehensive CR and sustained 6 mo post-program. Exercise maintenance was predicted by changes in heart-healthy food intake, self-efficacy, health literacy, and exercise-related knowledge.

Conclusions:
In this three-site study focusing on patient education for CR patients in Canada, the benefits of an education intervention in maintaining knowledge, exercise, healthy food intake, and self-efficacy were supported.
Continued Age Shift of Confirmed Positive COVID-19 Incidence Over Time to Children and Young Adults: Washington State March - August 2020
Authors: Malmgren Judith , Guo Boya , Kaplan Henry G. 
Published: November 2020

AbstractBackgroundAs the coronavirus (COVID-19) epidemic passed the initial infection peak in Washington State, phased re-opening lifted stay-at-home orders and restrictions leading to increased non-essential work, social activities and gathering, especially among younger persons.MethodsA longitudinal cohort analysis of Washington State Department of Health COVID-19 confirmed case age distribution 1) March-April 2020 (N=13,934) and 2) March-August 2020 (N=76,032) for proportional change over time using chi square tests for significance.ResultsFrom March 1st to April 19, 2020 COVID-19 case positive age distribution shifted with a 10% decline in cases age 60 years and older and a 20% increase in age 0-19/20-39 years (chi-square = 223.10, p <.001). Number of cases over the eight-week analysis period were 0-19 years n = 515, 20-39 years n = 4078, 40-59 years n =4788, 60-79 years n = 3221, 80+ years n = 1332. After the peak (March 22, 2020), as incidence declined in older age groups, the combined percentage of cases age 0-19 and 20-39 increased from 20% to 40% of total cases. During this time testing expanded with more testing among older age groups while case positivity shifted young. Percent positive cases by age through August 2020 increased to a consistent average of 60% less than age 40 [age 0-19 increased to 19% (N = 10257), age 20-39 increased to 42% (N = 30215)].ConclusionsAn increased share of COVID-19 incidence among children (age 0-19) and young adults (age 20-39) indicates their elevated role in propagating the epidemic by creating a reservoir of disease with risk of spillovers to more vulnerable older persons and those with comorbid conditions. Media savvy and age appropriate COVID-19 messaging may increase mitigation compliance among these less vulnerable, more mobile and lower priority vaccination age groups. As vaccines become available, mitigation will continue to be a priority to reduce overall population incidence.
Relation of Quantitative Histologic and Radiologic Breast Tissue Composition Metrics with Invasive Breast Cancer Risk
Authors: Abubakar Mustapha , Fan Shaoqi , Bowles Erin Aiello , Widemann Lea , Duggan Máire A. , Pfeiffer Ruth M. , Falk Roni T. , Lawrence Scott , Richert-Boe Kathryn , Glass Andrew G. , Kimes Teresa M. , Figueroa Jonine D. , Rohan Thomas E. , Gierach Gretchen L. 
Published: November 2020

AbstractPurposeBenign breast disease (BBD) is a strong breast cancer risk factor but identifying patients that might develop invasive breast cancer remains a challenge.MethodsBy applying machine-learning to digitized H&E-stained biopsies and computer-assisted thresholding to mammograms obtained circa BBD diagnosis, we generated quantitative tissue composition metrics and determined their association with future invasive breast cancer diagnosis. Archival breast biopsies and mammograms were obtained for women (18-86 years) in a case-control study, nested within a cohort of 15,395 BBD patients from Kaiser Permanente Northwest (1970-2012), followed through mid-2015. Cases (n=514) who developed incident invasive breast cancer and controls (n=514) were matched on BBD diagnosis age and plan membership duration.ResultsIncreasing epithelial area on the BBD biopsy was associated with increasing breast cancer risk [Odds ratio(OR) 95% confidence interval(CI) Q4 vs Q1=1.85(1.13-3.04);Ptrend=0.02]. Conversely, increasing stroma was associated with decreased risk in non-proliferative, but not proliferative, BBD (Pheterogeneity=0.002). Increasing epithelium-to-stroma proportion [OR(95%CI)Q4 vs Q1=2.06(1.28-3.33);Ptrend=0.002] and percent mammographic density (MBD) [OR(95%CI)Q4 vs Q1=2.20(1.20-4.03);Ptrend=0.01] were independently and strongly predictive of increased breast cancer risk. In combination, women with high epithelium-to-stroma proportion/high MBD had substantially higher risk than those with low epithelium-to-stroma proportion/low MBD [OR(95%CI)=2.27(1.27-4.06);Ptrend=0.005], particularly among women with non-proliferative [Ptrend=0.01] versus proliferative [Ptrend=0.33] BBD.ConclusionAmong BBD patients, increasing epithelium-to-stroma proportion on BBD biopsies and percent MBD at BBD diagnosis were independently and jointly associated with increasing breast cancer risk. These findings were particularly striking for women with non-proliferative disease (comprising ∼70% of all BBD patients), for whom relevant predictive biomarkers are lacking.
Artificial intelligence-enabled event adjudication: estimating delayed cardiovascular effects of respiratory viruses
Authors: Goto Shinichi , Homilius Max , John Jenine E. , Truslow James G. , Werdich Andreas A. , Blood Alexander J. , Park Brian H. , MacRae Calum A. , Deo Rahul C. 
Published: November 2020

AbstractHealthcare systems ideally should be able to draw lessons from historical data, including whether common exposures are associated with adverse clinical outcomes. Unfortunately, structured clinical data, such as encounter diagnostic codes in electronic health records, suffer from multiple limitations and biases, limiting effective learning. We hypothesized that a machine learning approach to automate ascertainment of clinical events and disease history from medical notes would improve upon using structured data and enable the estimation of real-world risks. We sought to test this approach to address a timely goal: estimating the delayed risk of adverse cardiovascular events (i.e. after the index infection) in patients infected with respiratory viruses. Using 4,151 cardiologist-labeled notes as gold standard, we trained a series of neural network models to automate event adjudication for heart failure hospitalization, acute coronary syndrome, stroke, and coronary revascularization and to identify past medical history for heart failure. Though performance varied by task, in nearly all cases, our models surpassed the use of structured data in terms of sensitivity for a given specificity level and enabled principled evaluation of classification thresholds, which is typically impossible to do with diagnostic codes. Deploying our models on more than 17 million notes for 267,596 patients across an extensive integrated delivery network, we found that patients infected with respiratory syncytial virus had a 23% increased risk of delayed heart failure hospitalization over a subsequent 4-year period compared with propensity-score matched patients who had the same test but with negative results (p = 0.003, log-rank). In contrast, we found no such increased risk in patients with a positive influenza viral test compared with a negative test (rate ratio 0.98, p = 0.71). We conclude that convolutional neural network-based models enable accurate clinical labeling at scale, thereby unlocking timely insights from unstructured clinical data.
Clinical subgroup clustering analysis in a systemic lupus erythematosus cohort from Western Pennsylvania
Authors: Coit Patrick , Ruffalo Lacy , Sawalha Amr H 
Published: November 2020

AbstractObjectiveSystemic lupus erythematosus (SLE) is a complex heterogenous autoimmune disease that can affect multiple organs. We performed clinical clustering analysis to describe a lupus cohort from the University of Pittsburgh Medical Center.MethodsA total of 724 patients who met the ACR classification criteria for SLE were included in this study. Clustering was performed using the ACR classification criteria and the partitioning around medoid method. Correlation analysis was performed using the Spearman’s Rho test.ResultsPatients with SLE in our cohort identify 3 district clinical disease subsets. Patients in Cluster 1 were significantly more likely to develop renal and hematologic involvement, and had overrepresentation in African-American and male lupus patients. Clusters 2 and 3 identified a milder disease, with a significantly less likelihood of organ complications. Patients in Cluster 2 are characterized by malar rash and photosensitivity, while patients in Cluster 3 are characterized by oral ulcers which is present in ∼90% of patients within this cluster. The presence of photosensitivity or oral ulcers appears to be protective against the development of lupus nephritis in our cohort.ConclusionsWe describe a large cohort of SLE from Western Pennsylvania and identify 3 distinct clinical disease subgroups. Clustering analysis might help to better manage and predict disease complications in heterogenous diseases like lupus.
A genome wide association study of frozen shoulder identifies a common variant of WNT7B and diabetes as causal risk factors
Authors: Green Harry D , Jones Alistair , Evans Jonathan P , Wood Andrew R , Beaumont Robin N , Tyrrell Jessica , Frayling Timothy M , Smith Chris , Weedon Michael N 
Published: November 2020

AbstractFrozen shoulder is a painful condition that often requires surgery and affects up to 5% of individuals aged 40-60 years. Little is known about the causes of the condition, but diabetes is a strong risk factor. To begin to understand the biological mechanisms involved, we aimed to identify genetic variants associated with frozen shoulder and to use Mendelian randomization to test the causal role of diabetes.We performed a genome wide association study (GWAS) of frozen shoulder in the UK Biobank using data from 2064 cases identified from ICD-10 codes. We used data from FinnGen for replication. We used one-sample and two-sample Mendelian randomization approaches to test for a causal association of diabetes with frozen shoulder.We identified a single genome-wide significant locus (lead SNP rs62228062; OR=1.34 [1.28-1.41], p=2×10−16) that contained WNT7B. A recent transcriptome study identified WNT7B as amongst the most enriched transcripts in anterior capsule tissue in patients undergoing arthroscopic capsulotomy surgery for frozen shoulder suggesting WNT7B as a potential causal gene at the locus. The lead SNP was also strongly associated with Dupuytren’s contracture (OR=2.61 [2.50, 2.72], p<1×10−100). The Mendelian randomization results provided evidence that type 1 diabetes is a causal risk factor for frozen shoulder (OR=1.04 [1.02-1.07], p=6×10−5). There was no evidence that obesity was causally associated with frozen shoulder, suggesting that diabetes influences risk of the condition through glycemic rather than mechanical effects.We have identified the first genetic variant associated with frozen shoulder. WNT7B is a potential causal gene at the locus. Diabetes is a likely causal risk factor. Our results provide evidence of biological mechanisms involved in this common painful condition.