bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic accuracy of evaluation of suspected syncope in the emergency department: usual practice vs. ESC guidelines
Authors: van Wijnen Veera K. , Gans Reinold O. B. , Wieling Wouter , ter Maaten Jan C. , Harms Mark P. M. 
Published: August 2020

Abstract
Background
Syncope is a frequent reason for referral to the emergency department. After excluding a potentially life-threatening condition, the second objective is to find the cause of syncope. The objective of this study was to assess the diagnostic accuracy of the treating physician in usual practice and to compare this to the diagnostic accuracy of a standardised evaluation, consisting of thorough history taking and physical examination by a research physician.

Methods
This prospective cohort study included suspected (pre) syncope patients without an identified serious underlying condition who were assessed in the emergency department. Patients were initially seen by the initial treating physician and the usual evaluation was performed. A research physician, blinded to the findings of the initial treating physician, then performed a standardised evaluation according to the ESC syncope guidelines. Diagnostic accuracy (proportion of correct diagnoses) was determined by expert consensus after long-term follow-up.

Results
One hundred and one suspected (pre) syncope patients were included (mean age 59 ± 20 years). The usual practice of the initial treating physicians did not in most cases follow ESC syncope guidelines, with orthostatic blood pressure measurements made in only 40% of the patients. Diagnostic accuracy by the initial treating physicians was 65% (95% CI 56–74%), while standardised evaluation resulted in a diagnostic accuracy of 80% (95% CI 71–87%; p = 0.009). No life-threatening causes were missed.

Conclusions
Usual practice of the initial treating physician resulted in a diagnostic accuracy of 65%, while standardised practice, with an emphasis on thorough history taking, increased diagnostic accuracy to 80%. Results suggest that the availability of additional resources does not result in a higher diagnostic accuracy than standardised evaluation, and that history taking is the most important diagnostic test in suspected syncope patients. Netherlands Trial Registration: NTR5651. Registered 29 January 2016,https://www.trialregister.nl/trial/5532
A consensus building exercise to determine research priorities for silver trauma
Authors: Alshibani Abdullah , Banerjee Jay , Lecky Fiona , Coats Timothy J. , Prest Rebecca , Mitchell Áine , Laithwaite Emily , Wensley Matt , Conroy Simon 
Published: August 2020

AbstractBackgroundEmergency care research into ‘Silver Trauma’, which is simply defined as major trauma consequent upon relatively minor injury mechanisms, is facing many challenges including that at present, there is no clear prioritisation of the issues. This study aimed to determine the top research priorities to guide future research.MethodsThis consensus-based prioritization exercise used a three-stage modified Delphi technique. The study consisted of an idea generating (divergent) first round, a ranking evaluation in the second round, and a (convergent) consensus meeting in the third round.ResultsA total of 20 research questions advanced to the final round of this study. After discussing the importance and clinical significance of each research question, five research questions were prioritised by the experts; the top three research priorities were:What are older people’s preferred goals of trauma care?Beyond the Emergency Department (ED), what is the appropriate combined geriatric and trauma care?Do older adults benefit from access to trauma centres? If so, do older trauma patients have equitable access to trauma centre compared to younger adults?ConclusionThe results of this study will assist clinicians, researchers, and organisations that are interested in silver trauma in guiding their future efforts and funding toward addressing the identified research priorities.
Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin
Authors: Müller Martin , Goeldlin Martina B. , Gaschen Janika , Sauter Thomas C. , Stock Stephanie , Wagner Franca , Exadaktylos Aristomenis K. , Fischer Urs , Kalla Roger , Mantokoudis Georgios 
Published: August 2020

AbstractBackgroundVestibular symptoms are a frequent reason for presenting at the emergency department (ED). Underlying conditions range in severity from life-threatening to benign, but often remain undiagnosed despite extensive investigations. We aimed to identify clinical characteristics that are associated with ED consultations by patients with vestibular symptoms of unknown origin (VUO) and to quantify the ED resources consumed during the investigations.MethodsThis retrospective one-year, single-centre, cross-sectional study assessed ED consultations with patients whose chief complaint was ‘vestibular symptoms’. Data on risk factors, clinical characteristics, management and ED resources were extracted from the administrative database and medical records. Consultations were grouped according to the discharge diagnosis as either VUO or non-VUO. We determined clinical factors associated with VUO and compared ED resource consumption by the two patient groups using multivariable analysis.ResultsA total of 1599 ED consultations were eligible. Of these, 14.3% (n = 229) were consultations with patients with VUO. Clinical characteristics included in the final multivariable model to determine associations with VUO were sensory disorders, aural fullness, improvement at rest, absence of situational provocation, pre-existing neurological conditions, and age < 65 years. Patients with VUO had higher total ED resource consumption in terms of physicians’ work and radiology resources, as a result of more use of computed tomography and magnetic resonance imaging.ConclusionOne in seven emergency patients with vestibular symptoms is dismissed without a diagnosis. Clinical characteristics of VUO patients are distinct from patients in whom a diagnosis was made in the ED. VUO triggers higher ED resource consumption, which can be justified if appropriately indicated.
Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise
Authors: Lecky Fiona E. , Reynolds Teri , Otesile Olubukola , Hollis Sara , Turner Janette , Fuller Gordon , Sammy Ian , Williams-Johnson Jean , Geduld Heike , Tenner Andrea G. , French Simone , Govia Ishtar , Balen Julie , Goodacre Steve , Marahatta Sujan B. , DeVries Shaheem , Sawe Hendry R. , El-Shinawi Mohamed , Mfinanga Juma , Rubiano Andrés M. , Chebbi Henda , Do Shin Sang , Ferrer Jose Maria E. , Haddadi Mashyaneh , Firew Tsion , Taubert Kathryn , Lee Andrew , Convocar Pauline , Jamaluddin Sabariah , Kotecha Shahzmah , Yaqeen Emad Abu , Wells Katie , Wallis Lee 
Published: August 2020

Abstract
Background
More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions.

Methods
The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings.

Results
The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care – all within LMICs.

Conclusions
Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities.
Healthcare providers’ perspectives on family presence during resuscitation in the emergency departments of the Kingdom of Bahrain
Authors: Abuzeyad Feras H. , Elhobi Ahmed , Kamkoum Wael , Bashmi Luma , Al-Qasim Ghada , Alqasem Leena , Mansoor Naser Mohamed Ali , Hsu Stephanie , Das Priya 
Published: August 2020

Abstract
Background
Worldwide, policies exist on family presence during resuscitation (FPDR), however, this is still lacking in the Gulf Corporation Countries (GCC) in general and in the Kingdom of Bahrain in particular. The aim of this study is to assess the perspectives of healthcare providers (HP) on FPDR among those working in the emergency departments (EDs) in the Kingdom.

Methods
A self-administered anonymous electronic survey was collected from 146 HPs (emergency physicians and nurses) working in the three major EDs in the Kingdom of Bahrain. Besides demographic data, 18 items measuring HPs’ perceptions of FPDR were generated using the 5-point Likert scale.

Results
Surveys (n = 146) from physicians and nurses were analysed (45.9% vs. 54.1%, respectively). There were significant differences between physicians and nurses in terms of personal beliefs, FPDR enhancing professional satisfaction and behaviour, and the importance of a support person and saying goodbye (p < 0.001). However, general responses demonstrated that the majority of HPs encouraged and supported FPDR, but with greater support from physicians than nurses.

Conclusion
The study reflects that many HPs in EDs participated in and are familiar with FPDR, with the majority of ED physicians supporting it. Further studies should investigate the reasons for the lack of support from nurses. Results may contribute to the development of hospital ED policies that allow FPDR in the region.
Group penalized generalized estimating equation for correlated event-related potentials and biomarker selection
Authors: Lin Ye , Zhou Jianhui , Kumar Swapna , Xie Wanze , G. Jensen Sarah K. , Haque Rashidul , Nelson Charles A. , Petri Jr William A. , Ma Jennie Z. 
Published: August 2020

AbstractBackgroundEvent-related potentials (ERP) data are widely used in brain studies that measure brain responses to specific stimuli using electroencephalogram (EEG) with multiple electrodes. Previous ERP data analyses haven’t accounted for the structured correlation among observations in ERP data from multiple electrodes, and therefore ignored the electrode-specific information and variation among the electrodes on the scalp. Our objective was to evaluate the impact of early adversity on brain connectivity by identifying risk factors and early-stage biomarkers associated with the ERP responses while properly accounting for structured correlation.MethodsIn this study, we extend a penalized generalized estimating equation (PGEE) method to accommodate structured correlation of ERPs that accounts for electrode-specific data and to enable group selection, such that grouped covariates can be evaluated together for their association with brain development in a birth cohort of urban-dwelling Bangladeshi children. The primary ERP responses of interest in our study are N290 amplitude and the difference in N290 amplitude.ResultsThe selected early-stage biomarkers associated with the N290 responses are representatives of enteric inflammation (days of diarrhea, MIP1b, retinol binding protein (RBP), Zinc, myeloperoxidase (MPO), calprotectin, and neopterin), systemic inflammation (IL-5, IL-10, ferritin, C Reactive Protein (CRP)), socioeconomic status (household expenditure), maternal health (mother height) and sanitation (water treatment).ConclusionsOur proposed group penalized GEE estimator with structured correlation matrix can properly model the complex ERP data and simultaneously identify informative biomarkers associated with such brain connectivity. The selected early-stage biomarkers offer a potential explanation for the adversity of neurocognitive development in low-income countries and facilitate early identification of infants at risk, as well as potential pathways for intervention.Trial registrationThe related clinical study was retrospectively registered withhttps://doi.org/ClinicalTrials.gov, identifier NCT01375647, on June 3, 2011.
Hepatocellular carcinoma in adult thalassemia patients: an expert opinion based on current evidence
Authors: Mangia Alessandra , Bellini Davide , Cillo Umberto , Laghi Andrea , Pelle Giuseppe , Valori Vanna Maria , Caturelli Eugenio 
Published: August 2020

AbstractBeta-thalassemia represents a heterogeneous group of haemoglobin inherited disorders, among the most common genetic diseases in the world, frequent in the Mediterranean basin. As beta-thalassemia patients’ survival has increased over time, previously unknown complications are observed with increasing frequency. Among them, an increased risk of hepatocellular carcinoma (HCC) has been registered. Our aim is to reduce inequalities in diagnosis and treatment and to offer patients univocal recommendations in any institution.The members of the panel - gastroenterologists, radiologists, surgeons and oncologists -were selected on the basis of their publication records and expertise. Thirteen clinical questions, derived from clinical needs, and an integration of all the committee members’ suggestions, were formulated. Modified Delphi approach involving a detailed literature review and the collective judgement of experts, was applied to this work.Thirteen statements were derived from expert opinions’ based on the current literature, on recently developed reviews and on technological advancements. Each statement is discussed in a short paragraph reporting the current key evidence. As this is an emerging issue, the number of papers on HCC in beta-thalassemia patients is limited and based on anecdotal cases rather than on randomized controlled studies. Therefore, the panel has discussed, step by step, the possible differences between beta-thalassemia and non beta-thalassemia patients. Despite the paucity of the literature, practical and concise statements were generated.This paper offers a practical guide organized by statements describing how to manage HCC in patients with beta-thalassemia.
Gastropathy associated with lanthanum phosphate deposition that was endoscopically tracked for 3 years. A case report
Authors: Ohno Akiko , Miyoshi Jun , Tanabe Hidesato , Kusuhara Mitsunori , Toki Masao , Chiba Tomohiro , Shimoyamada Hiroaki , Shibahara Junji , Hisamatsu Tadakazu 
Published: August 2020

Abstract
Background
With the recent increased use of lanthanum carbonate, several cases of lanthanum phosphate deposition to gastric mucosa in dialysis patients have been reported. However, the endoscopic appearance of the early-stage lesion and the over-time alterations of endoscopic findings due to the progression of lanthanum phosphate deposition remain unclear.

Case presentation
An 80-year-old man receiving dialysis and taking lanthanum carbonate as a phosphate binder over a 4-year period underwent upper gastrointestinal endoscopy four times beginning 1 year after initiation of treatment. The first endoscopic examination (after 1 year of exposure to lanthanum carbonate) revealed rough mucosa with a few areas of white granular mucosa. Over the 3 years of endoscopic follow-up, the white granular mucosa spread and multiple erosions appeared. Histopathological findings of biopsy specimens from an erosion showed extensive infiltration by histiocytes containing deposits. Scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX) revealed that the presence of the deposits containing phosphorus and lanthanum in the gastric mucosa.
On the basis of these results, the patient was diagnosed with gastropathy associated with lanthanum phosphate deposition.

Conclusions
Over a 3-year period, endoscopic findings associated with lanthanum deposition gradually changed and expanded from the early stage.
Effect of body mass on future long-term care use
Authors: Nizalova Olena , Gousia Katerina , Forder Julien 
Published: August 2020

Abstract
Background
Obesity is a known predictor of disability and functional limitations, and, in turn, of health care use. In this study, we aim to explore whether obesity is also a significant risk factor for future long-term care use, overall and by type of care.

Methods
We use multinomial logistic regression analysis on data from the English Longitudinal Study of Ageing (ELSA) for individuals aged 65 and older between 2002 and 2011. Selection issues are tackled using the rich set of control variables, exploiting the data’s longitudinal structure and accounting for loss to follow-up (including death). Control factors include health-related behaviours (physical activity, alcohol and tobacco consumption), functional limitations (related to ADLs, iADLs and mobility) and specific existing health conditions, notably diabetes, high blood pressure and cardio-vascular diseases.

Results
We find that obese older people are 25% (p < 0.01) more likely to receive informal or privately-paid care in the future, but this does not hold for formal care. This is an additional direct effect after controlling for a wide range of health conditions and functional limitations. We document some evidence that this effect is due to the development of new functional limitations. Sensitivity analyses suggest that the results are robust to controlling for prediabetes, subjective health, depression, or unobserved heterogeneity.

Conclusions
This study provides new evidence of a positive direct effect of obesity on the future use of long-term care services. Accordingly, it adds evidence of further economic benefits to any overall evaluation of policies to promote a healthy weight in the population, particularly in the older population.
Association between change in lifestyle and cognitive functions among elderly Koreans: findings from the Korean longitudinal study of aging (2006–2016)
Authors: Lee Hyeon Ji , Jang Jieun , Choi Dong-Woo , Chae Wonjeong , Park Eun-Cheol , Jang Sung-In 
Published: August 2020

Abstract
Background
South Korea is an aged society that continues to age rapidly. Therefore, the purpose of this study was to investigate the association between changes in lifestyle and cognitive functions in the South Korean elderly using a nationally representative survey.

Methods
We analyzed data from the Korean Longitudinal Study of Aging (KLoSA) 2006–2016, a biannual panel survey. Multiple linear regression analysis was performed with repeated measurements data to examine the association between lifestyle change and cognitive functions over 2 years. Lifestyle combined the scores of four factors (smoking status, alcohol drinking status, body weight, and exercise), and then categorized them into four groups (Good→Good, Bad→Good, Good→Bad, and Bad→Bad) according to the two-year change. Cognitive functions were set according to the scores measured through the Korean Mini-Mental State Examination (K-MMSE).

Results
Among females, the K-MMSE score was the highest in the Bad→Good group compared to the reference group, Bad→Bad (β = 0.914; SD = 3.744; p < .0001). The next highest scores were in the Good→Good group (β = 0.813; SD = 4.654; p = 0.0005) and the Good→Bad group (β = 0.475; SD = 4.542; p = 0.0481). Among males, only the K-MMSE of the Good→Good group was statistically significant (β = 0.509; SD = 3.245; p = 0.0077). The results of subgroup analysis showed that the K-MMSE scores of females who did not participate in any social activities were more affected by their lifestyle (Good-Good: β = 1.614; SD = 4.270; p = 0.0017, Bad-Good: β = 1.817; SD = 3.945; p < .0001). Subgroup analysis showed that females who started drinking more than a moderate amount of alcohol had lower K-MMSE scores (Good-Bad: β = − 2.636; SD = 2.915; p = 0.0011). Additionally, in both sexes, exercising, among the four lifestyle options, had a strong and significant association with higher K-MMSE scores.

Conclusions
Following a healthy lifestyle or improving an unhealthy lifestyle can help people prevent or slow down cognitive decline. Regularly engaging in an adequate amount of exercise can help the cognitive function of the elderly. Females, specifically, can experience positive effects on their cognitive function if they participate in social activities while maintaining healthy lifestyles, in particular not drinking too much alcohol.
Developing evidence-based clinical imaging guidelines of justification for radiographic examination after dental implant installation
Authors: Kim Min-Ji , Lee Sam-Sun , Choi Miyoung , Yong Hwan Seok , Lee Chena , Kim Jo-Eun , Heo Min-Suk 
Published: August 2020

Abstract
Background
This study aimed to develop evidence-based clinical imaging guidelines to assess the proper implant location following implant surgery and identify potential complications during follow-up.

Methods
The guideline development process employed an adaptation methodology in accordance with the Korean clinical imaging guidelines (K-CIG). Core (Ovid-Medline, Ovid-Embase, National Guideline Clearinghouse, and Guideline International Network) and domestic databases (KoreaMed, KMbase, and KoMGI) were searched used to retrieve guidelines, and two reviewers analyzed the retrieved articles. The articles were included in this review using well-established inclusion criteria.

Results
Our online search identified 66 articles, of which 3 were selected for the development of the guidelines. Consequently, based on these three guidelines, we formulated distinct recommendations regarding the appropriate imaging modalities that should be used following implant placement.

Conclusions
Conventional imaging (e.g., periapical or panoramic radiography) should be the first choice for assessing the implant following its placement and osseointegration. The metal artifacts in Cone Beam Computed Tomography (CBCT) should be considered. However, CBCT is recommended for patients with sensory abnormalities following dental implant surgery to evaluate and identify the underlying cause of implant complications and to determine the appropriate treatment.