bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost of hospital treatment of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) compared to the non-diabetes population: a detailed economic evaluation
Authors: Stedman Mike , Lunt Mark , Davies Mark , Livingston Mark , Duff Christopher , Fryer Anthony , Anderson Simon George , Gadsby Roger , Gibson Martin , Rayman Gerry , Heald Adrian 
Published: May 2020

ObjectivesOther than age, diabetes is the largest contributor to overall healthcare costs and reduced life expectancy in Europe. This paper aims to more exactly quantify the net impact of diabetes on different aspects of healthcare provision in hospitals in England, building on previous work that looked at the determinants of outcome in type 1 diabetes (T1DM) and type 2 diabetes (T2DM).SettingNHS Digital Hospital Episode Statistics (HES) in England was combined with the National Diabetes Audit (NDA) to provide the total number in practice of people with T1DM/T2DM.Outcome measuresWe compared differences between T1DM/T2DM and non-diabetes individuals in relation to hospital activity and associated cost.ResultsThe study captured 90% of hospital activity and £36 billion/year of hospital spend. The NDA Register showed that out of a total reported population of 58 million, 2.9 million (6.5%) had T2DM and 240 000 (0.6%) had T1DM. Bed-day analysis showed 17% of beds are occupied by T2DM and 3% by T1DM. The overall cost of hospital care for people with diabetes is £5.5 billion/year. Once the normally expected costs including the older age of T2DM hospital attenders are allowed for this fell to £3.0 billion/year or 8% of the total captured secondary care costs. This equates to £560/non-diabetes person compared with £3280/person with T1DM and £1686/person with T2DM. For people with diabetes, the net excess impact on non-elective/emergency work is £1.2 billion with additional estimated diabetes-related accident & emergency attendances at 440 000 costing the NHS £70 million/year. T1DM individuals required five times more secondary care support than non-diabetes individuals. T2DM individuals, even allowing for the age, require twice as much support as non-diabetes individuals.ConclusionsThis analysis shows that additional cost of provision of hospital services due to their diabetes comorbidities is £3 billion above that for non-diabetes, and that within this, T1DM has three times as much cost impact as T2DM. We suggest that supporting patients in diabetes management may significantly reduce hospital activity.
How was cognitive behavioural therapy for mood disorder implemented in Japan? A retrospective observational study using the nationwide claims database from FY2010 to FY2015
Authors: Hayashi Yuta , Yoshinaga Naoki , Sasaki Yosuke , Tanoue Hiroki , Yoshimura Kensuke , Kadowaki Yuko , Arimura Yasuji , Yanagita Toshihiko , Ishida Yasushi 
Published: May 2020

ObjectivesTo clarify the dissemination status of cognitive behavioural therapy (CBT) in Japan under the national health insurance scheme.DesignRetrospective observational study.SettingNational Database of Health Insurance Claims and Specific Health Checkups of Japan.ParticipantsPatients who received CBT under the national health insurance scheme from fiscal years (FY) 2010 to 2015.Primary and secondary outcome measuresWe estimated the change rate and the standardised claim ratio (SCR) for the number of patients receiving CBT and analysed the association between the CBT status and several regional factors.ResultsWe found that (a) a total of 60 304 patients received CBT during the study period; (b) the number of patients receiving CBT was highest in the first year (−1.8% from FY2010 to FY2015); (c) the number of patients who received CBT per 100 000 population decreased (or remained at zero) in most prefectures (32 out of 47); (d) there was a maximum 424.7-fold difference between prefectures in the standardised claim ratio for CBT and (e) the number of registered CBT institutions was significantly associated with the number of patients who received CBT.ConclusionsThe provision of CBT did not increase in the first 6 years (FY2010–2015) after its coverage in Japan’s national health insurance scheme. Further studies including a questionnaire survey of registered CBT institutions are required to get more detailed information on the dissemination of CBT in Japan.
Women’s self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria
Authors: Stillman Melissa , Owolabi Onikepe , Fatusi Adesegun O , Akinyemi Akanni I , Berry Amanda L , Erinfolami Temitope P , Olagunju Olalekan S , Väisänen Heini , Bankole Akinrinola 
Published: May 2020

ObjectivesThis study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.DesignThis was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.SettingData were collected in 2018 in six local government areas in Lagos State.ParticipantsDrug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18–49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.Primary and secondary outcome measuresUsing self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.ResultsAlthough drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.ConclusionsDrug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.
Nasal fentanyl alone plus buccal midazolam: an open-label, randomised, controlled feasibility study in the dying
Authors: Perkins Paul , Parkinson Anne , Akyea Ralph Kwame , Husbands Emma 
Published: May 2020

IntroductionMany patients want to stay at home to die. They invariably become unable to take oral medication during their terminal phase. Symptoms are usually controlled by subcutaneous medications. There have been no studies on nasal fentanyl (NF) or buccal midazolam (BM) to control symptoms in the dying.ObjectiveTo establish how best to conduct a definitive, randomised controlled trial (RCT) to determine whether NF and BM administered by families, for patients dying at home, lead to faster and better symptom control and fewer community nursing visits than standard breakthrough medication by healthcare professionals.MethodsThis open-label mixed-method feasibility RCT compared the efficacy of NF and BM by family members to standard breakthrough medication by nurses for the terminally ill in a specialist palliative care unit. Partway through the study, a third observational arm was introduced where BM alone was used. The primary outcomes were whether recruitment and randomisation were possible, assessment of withdrawal and drop-out, and whether the methods were acceptable and appropriate.ResultsAdministration of NF and BM was acceptable to patients and families. Both were well tolerated. We were unable to obtain quality of life data consistently but did get time period data for dose-controlled symptoms.ConclusionsStudy participation in a hospice population of the dying was acceptable. The results will help guide future community study planning.Trial registration numberNCT02009306.
Efficacy of naloxegol on symptoms and quality of life related to opioid-induced constipation in patients with cancer: a 3-month follow-up analysis
Authors: Cobo Dols Manuel , Beato Zambrano Carmen , Cabezón Gutiérrez Luis , Chicas Sett Rodolfo , Blancas López-Barajas María Isabel , García Navalón Francisco , Fírvida Pérez José Luis , Serrano Bermúdez Gala , Togores Torres Pilar , Delgado Mingorance Ignacio , Giraldo Marín Alexandra , Librán Oriol Anna , Paredes Lario Alfredo , Sánchez Mauriño Pedro , Higuera Gómez Oliver , Moreno Muñoz Diana , Jiménez López Antonio Javier , Huerta González Ibone , Sanz Yagüe Almudena , Soler López Begoña 
Published: May 2020

ObjectivesOpioid-induced constipation (OIC) can affect up to 63% of all patients with cancer. The objectives of this study were to assess quality of life as well as efficacy and safety of naloxegol, in patients with cancer with OIC.MethodsAn observational study was made of a cohort of patients with cancer and with OIC exhibiting an inadequate response to laxatives and treated with naloxegol. The sample consisted of adult outpatients with a Karnofsky performance status score ≥50. The Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) and the Patient Assessment of Constipation Symptoms (PAC-SYM) were applied for 3 months.ResultsA total of 126 patients (58.2% males) with a mean age of 61.3 years (range 34–89) were included. Clinically relevant improvements (>0.5 points) were recorded in the PAC-QOL and PAC-SYM questionnaires (p<0.0001) from 15 days of treatment. The number of days a week with complete spontaneous bowel movements increased significantly (p<0.0001) from 2.4 to 4.6 on day 15, 4.7 after 1 month and 5 after 3 months. Pain control significantly improved (p<0.0001) during follow-up. A total of 13.5% of the patients (17/126) presented some gastrointestinal adverse reaction, mostly of mild (62.5%) or moderate intensity (25%).ConclusionsClinically relevant improvements in OIC-related quality of life, number of bowel movements and constipation-related symptoms were recorded as early as after 15 days of treatment with naloxegol in patients with cancer and OIC, with a good safety profile.
Whole blood transfusion versus component therapy in adult trauma patients with acute major haemorrhage
Authors: Avery Pascale , Morton Sarah , Tucker Harriet , Green Laura , Weaver Anne , Davenport Ross 
Published: May 2020

ObjectiveIn the era of damage control resuscitation of trauma patients with acute major haemorrhage, transfusion practice has evolved to blood component (component therapy) administered in a ratio that closely approximates whole blood (WB). However, there is a paucity of evidence supporting the optimal transfusion strategy in these patients. The primary objective was therefore to establish if there is an improvement in survival at 30 days with the use of WB transfusion compared with blood component therapy in adult trauma patients with acute major haemorrhage.MethodologyA systematic literature search was performed on 15 December 2019 to identify studies comparing WB transfusion with component therapy in adult trauma patients and mortality at 30 days. Studies which did not report mortality were excluded. Methodological quality of included studies was interpreted using the Cochrane risk of bias tool, and rated using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsSearch of the databases identified 1885 records, and six studies met the inclusion criteria involving 3255 patients. Of the three studies reporting 30-day mortality (one randomised controlled trial (moderate evidence) and two retrospective (low and very low evidence, respectively)), only one study demonstrated a statistically significant difference between WB and component therapy, and two found no statistical difference. Two retrospective studies reporting in-hospital mortality found no statistical difference in unadjusted mortality, but both reported statistically significant logistic regression analyses demonstrating that those with a WB transfusion strategy were less likely to die.ConclusionRecognising the limitations of this systematic review relating to the poor-quality evidence and limited number of included trials, it does not provide evidence to support or reject use of WB transfusion compared with component therapy for adult trauma patients with acute major haemorrhage.PROSPERO registration numberCRD42019131406.
Health service usage and re-referral rates: comparison of a dietitian-first clinic with a medical specialist-first model of care in a cohort of gastroenterology patients
Authors: Mutsekwa Rumbidzai , Ostrowski Szymon , Canavan Russell , Ball Lauren , Angus Rebecca 
Published: May 2020

BackgroundThe dietitian-first gastroenterology clinic (DFGC) is an expanded scope of practice initiative implemented in response to increased gastroenterology specialist demand. This study examined re-referral rates to gastroenterology and overall health service usage up to 24 months post management in DFGC compared with a traditional, gastroenterology specialist-first model.MethodsPatients discharged from DFGC in the first year were matched with those seen in the traditional model. Demographic, clinical and process-related service characteristics were compared, and logistic regression analysis was undertaken to model re-presentation and model of care (MoC) as the variable of interest considering covariates in univariate analyses. Analyses were performed at 12, 18 and 24 months post discharge.ResultsThe DFGC (122 patients) and traditional-model (62 patients) cohorts had similar baseline demographic characteristics. Wait-times (68.6 vs 272.9 days; p<0.001), treatment-times (89.4 vs 259.9 days; p<0.001) and usage of other services (1.4 vs 2.1 specialities; p=0.01) were lower in DFGC. Re-referral rates were low in both DFGC and traditional models at 12 months (0.82% vs 1.61%), 18 months (2.46% vs 6.45%) and 24 months (4.91% vs 8.06%), respectively, with no significant difference between the models at any time point.ConclusionMost patients do not re-present for similar conditions within 2 years when managed in the DFGC or traditional medical model. Patients managed in DFGC have lower overall health service usage compared with patients managed in the traditional model. These findings support the safety and effectiveness of a DFGC model as one strategy to manage specialist gastroenterology service demands.
Exclusion versus preservation of the left atrial appendage in rheumatic mitral valve surgery
Authors: Kim Wan Kee , Kim Ho Jin , Kim Joon Bum , Jung Sung Ho , Choo Suk Jung , Chung Cheol Hyun , Lee Jae Won 
Published: May 2020

ObjectivesThis study aimed to evaluate the impact of left atrial appendage exclusion on clinical outcomes in patients with atrial fibrillation (AF) undergoing rheumatic mitral surgery.MethodsWe retrospectively reviewed 1226 consecutive patients with AF (54.5±11.6 years; 68.2% females) who underwent rheumatic mitral valve (MV) surgery from 1997 to 2016. The left atrial appendage was preserved in 836 (68.2%) and excluded in 390 (31.8%) patients. Surgical AF ablation was performed in 506 (60.5%) and 304 (77.9%) patients with preserved and excluded left atrial appendage, respectively. For baseline adjustment, propensity matching was used.ResultsDuring a median follow-up of 63.4 months (IQRs, 20–111 months), there were no significant intergroup differences in the risks of mortality (2.77% vs 3.03%/patient-years) and thromboembolic events (0.91% vs 1.02%/patient-years). In the 258 pairs of propensity-score matched patients, death (2.77% vs 3.03%/patient-years) and thromboembolism (1.36% vs 0.82%/patient-years) outcomes were comparable for both groups. In a subgroup undergoing ablation (n=810), there were no significant differences in the adjusted risks of death (HR, 0.67; 95% CI, 0.34 to 1.32) and thromboembolism (HR, 0.47; 95% CI, 0.18 to 1.26). In a subgroup not undergoing ablation (n=416), however, left atrial appendage preservation tended to have higher adjusted risks for death (HR, 2.24; 95% CI, 0.98 to 5.13) and thromboembolism (HR, 4.41; 95% CI, 0.97 to 20.1).ConclusionsLeft atrial appendage preservation did not seem to have greater risks of adverse clinical events in patients with AF undergoing rheumatic MV surgery particularly when ablation procedure is combined.
Clinicopathological and molecular features of hereditary leiomyomatosis and renal cell cancer-associated renal cell carcinomas
Authors: Furuya Mitsuko , Iribe Yasuhiro , Nagashima Yoji , Kambe Naotomo , Ohe Chisato , Kinoshita Hidefumi , Sato Chika , Kishida Takeshi , Okubo Yoichiro , Numakura Kazuyuki , Nanjo Hiroshi , Nakaigawa Noboru , Makiyama Kazuhide , Hasumi Hisashi , Iwashita Hiromichi , Ohta Junichi , Kitamura Hiroshi , Nakajima Takahiko , Yoshida Takahiro , Nakagawa Masahiro , Tanaka Reiko , Yao Masahiro 
Published: May 2020

AimsHereditary leiomyomatosis and renal cell cancer (HLRCC) is an autosomal dominant disorder caused by germline mutations in fumarate hydratase (FH). Affected families have an increased risk of renal cell carcinoma (RCC). HLRCC-associated RCC (HLRCC-RCC) is highly aggressive. Clinicopathological information of genetically diagnosed patients with HLRCC-RCC contributes to the establishment of effective therapies.MethodsTen Japanese patients with HLRCC-RCC were enrolled in the study. Genetic testing forFHwas carried out. Somatic mutations inFHand immunohistochemical analyses of FH and B7 family ligands (PD-L1 and B7-H3) were investigated in 13 tumours. Copy number variations were evaluated in two tumours.ResultsAll patients hadFHgermline mutations. Regarding histology, most tumours had type 2 papillary architecture or tubulocystic pattern or both. All tumours were FH deficient by immunohistochemistry. Ten tumours were positive for PD-L1, and 12 tumours were positive for B7-H3. Somatic mutation analysis demonstrated loss of heterozygosity ofFHin 10 tumours. Copy number variation analysis revealed uniparental disomy between 1q24.2 and 1q44 encompassingFH; gain of chromosome 2 p was also common. All patients had either metastases or residual tumours. Three patients died of HLRCC-RCC and one of colon cancer, whereas the other six are currently alive, including two without recurrence.ConclusionsHLRCC-RCCs appear to have unique molecular profiles, including PD-L1 expression. One patient had complete response to immunotherapy, which may be an option for HLRCC-RCC.
Detection of COX-2 in liquid biopsy in patients with breast cancer
Authors: de Souza Camilla Paulla , Alves Beatriz , Waisberg Jaques , Fonseca Fernando , Carmo Alipio de Oliveira , Gehrke Flavia 
Published: May 2020

AimsTo determine the expression of the cyclooxygenase-2 (COX-2) gene in patients with breast cancer attended at the Centro Universitário Saúde ABC/Faculdade de Medicina do ABC (CUS-ABC/FMABC) outpatient clinic. Breast cancer is the most common cancer in women worldwide. More than two million new cases are reported annually. An overexpression ofCOX-2has been observed in many cancers.COX-2is related to parameters of cancer aggressiveness, including tumour size, positive nodal state and lower survival, and to angiogenesis and resistance to apoptosis.Methods15 mL of peripheral blood was obtained from 34 patients and 21 healthy women. The extracellular RNA of QIAamp RNA was submitted to an RNA sequestration kit for RNA reverse transcriptase. Quantitative real-time PCR was performed usingCOX-2-specific oligonucleotides and the endogenousGlyceraldehyde-3-Phosphate Dehydrogenasegene.ResultsThe mean remission time was 53 years. The mean progression time was 33 months. The difference observed between the patient and control groups in medianCOX-2expression (p<0.001) was significant.ConclusionsPatients with breast cancer showed a higher meanCOX-2expression in peripheral blood samples at diagnosis than the control group. Since this information could prove important in the diagnosis and prognosis of breast cancer, further research is required on larger patient samples.
15q11.2 deletion is enriched in patients with total anomalous pulmonary venous connection
Authors: Li Xiaoliang , Shi Guocheng , Li Yang , Zhang Xiaoqing , Xiang Ying , Wang Teng , Li Yanxin , Chen Huiwen , Fu Qihua , Zhang Hong , Wang Bo 
Published: May 2020

IntroductionCNV is a vital pathogenic factor of congenital heart disease (CHD). However, few CNVs have been reported for total anomalous pulmonary venous connection (TAPVC), which is a rare form of CHD. Using case-control study, we identified 15q11.2 deletion associated with TAPVC. We then used a TAPVC trio as model to reveal possible molecular basis of 15q11.2 microdeletion.MethodsCNVplex and Chromosomal Microarray were used to identify and validate CNVs in samples from 231 TAPVC cases and 200 healthy controls from Shanghai Children’s Medical Center. In vitro cardiomyocyte differentiation of induced pluripotent stem cells from peripheral blood mononuclear cells for a TAPVC trio with paternal inherited 15q11.2 deletion was performed to characterise the effect of the deletion on cardiomyocyte differentiation and gene expression.ResultsThe 15q11.2 microdeletion was significantly enriched in patients with TAPVC compared with healthy control (13/231 in patients vs 0/200 in controls, p=5.872×10−2, Bonferroni adjusted) using Fisher’s exact test. Induced pluripotent stem cells from the proband could not differentiate into normal cardiomyocyte. Transcriptomic analysis identified a number of differentially expressed genes in the 15q11.2 deletion carriers of the family. TAPVC disease-causing genes such asPITX2,NKX2-5andANKRD1showed significantly higher expression in the proband compared with her healthy mother. Knockdown of TUBGCP5 could lead to abnormal cardiomyocyte differentiation.ConclusionWe discovered that the 15q11.2 deletion is significantly associated with TAPVC. Gene expression profile that might arise from 15q11.2 deletion for a TAPVC family was characterised using cell experiments.
Leadership development in undergraduate medical education: evaluation of students’ perceptions of a student-selected leadership module
Authors: Chapman Ann LN , Christie Ross , Lamont Ross , Lewandowska Marta , Tong Luan , Tsim Fiona , Abul Mohammad , Mackie Helen 
Published: May 2020

BackgroundThere is increasing recognition of the importance of leadership development within undergraduate medical training. One method of doing this is through student-selected components (SSCs), optional modules that allow students to explore an area in greater depth than in the core curriculum. An SSC in medical leadership has been offered at the University of Glasgow since 2015. We evaluated students’ perceptions of this SSC.MethodsStudents are required to submit a written reflective report on the SSC. These were analysed thematically to determine students’ lived experience. Respondent validation and independent anonymised feedback to the university were used for triangulation.ResultsStudents reported that the SSC allowed them to experience aspects of healthcare not encountered elsewhere in their training. Three themes were derived from the analysis, relating to SSC structure, areas of learning and personal development/impact. Students recognised that leadership development is important within the curriculum and felt that it should be available to all medical students.ConclusionThis evaluation of students’ perceptions of a leadership SSC identified characteristics of the module that were felt by students to be valuable in leadership development and will support development of similar leadership modules at undergraduate and postgraduate levels.