bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uveitis as a potential predictor of acute myocardial infarction in patients with Behcet’s disease: a population-based cohort study
Authors: Chen Yu-Yen , Lai Yun-Ju , Yen Yung-Feng , Chen Hsin-Hua , Chou Pesus 
Published: January 2021

ObjectivesTo investigate whether uveitis is a predictor of acute myocardial infarction (AMI) among patients with Behcet’s disease (BD).DesignRetrospective cohort study.SettingPatients with BD were retrieved from the whole population of the Taiwan National Health Insurance Research Database from 1 January 2001 to 31 December 2013.ParticipantsAmong the 6508 patients with BD, 2517 (38.7%) were in the uveitis group and 3991 were in the non-uveitis group.Primary and secondary outcome measuresKaplan-Meier curves were generated to compare the cumulative hazard of AMI in the uveitis and non-uveitis groups. Multivariate Cox regression analysis was used to estimate the adjusted HRs and 95% CI of AMI, and was adjusted for age, gender, systemic comorbidities (eg, hypertension, diabetes, hyperlipidaemia, smoking) and clinical manifestation of BD (eg, oral ulcers, genital ulcers, skin lesions, arthritis and gastrointestinal involvement).ResultsThe mean age of the BD cohort was 38.1±15.1 years. Compared with non-uveitis patients, uveitis patients were significantly younger and male predominant. There was no significant difference between the two groups for most proportions of systemic comorbidities and clinical manifestations. The Kaplan-Meier method with the log-rank test showed that the uveitis group had a significantly higher cumulative hazard for patients with AMI compared with the non-uveitis group (p<0.0001). In the multivariable Cox regression after adjustment for confounding factors, patients with uveitis had a significantly higher risk of AMI (adjusted HR 1.87; 95% CI 1.52 to 2.29). Other significant risk factors for AMI were age, hypertension, smoking, and skin lesions.ConclusionsStatistical analyses from the nationwide database demonstrated that uveitis is a potential predictor of AMI in patients with BD.
Description and prediction of outcome of drowning patients in New South Wales, Australia: protocol for a data linkage study
Authors: Peden Amy E , Sarrami Pooria , Dinh Michael , Lassen Christine , Hall Benjamin , Alkhouri Hatem , Daniel Lovana , Burns Brian 
Published: January 2021

Introduction
Despite being a preventable cause of death, drowning is a global public health threat. Australia records an average of 288 unintentional drowning deaths per year; an estimated annual economic burden of $1.24 billion AUD ($2017). On average, a further 712 hospitalisations occur due to non-fatal drowning annually. The Australian state of New South Wales (NSW) is the most populous and accounts for 34% of the average fatal drowning burden. This study aims to explore the demographics and outcome of patients who are admitted to hospitals for drowning in NSW and also investigates prediction of patients’ outcome based on accessible data.

Methods and analysis
This protocol describes a retrospective, cross-sectional data linkage study across secondary data sources for any person (adult or paediatric) who was transferred by NSW Ambulance services and/or admitted to a NSW hospital for fatal or non-fatal drowning between 1/1/2010 and 31/12/2019. The NSW Admitted Patient Data Collection will provide data on admitted patients’ characteristics and provided care in NSW hospitals. In order to map patients’ pathways of care, data will be linked with NSW Ambulance Data Collection and the NSW Emergency Department Data Collection. Finally patient’s mortality will be assessed via linkage with NSW Mortality data, which is made up of the NSW Register of Births, Deaths and Marriages and a Cause of Death Unit Record File. Regression analyses will be used to identify predicting values of independent variables with study outcomes.

Ethics and dissemination
This study has been approved by the NSW Population & Health Services Research Ethics Committee. Results will be disseminated through peer-reviewed publications, mass media releases and at academic conferences. The study will provide outcome data for drowning patients across NSW and study results will provide data to deliver evidence-informed recommendations for improving patient care, including updating relevant guidelines.
‘Care for Outcomes’: systematic development of a set of outcome indicators to improve patient-relevant outcomes for patients with lung cancer
Authors: Cramer-van der Welle Christine M , van Loenhout Lotte , van den Borne Ben EEM , Schramel Franz MNH , Dijksman Lea M 
Published: January 2021

ObjectivesMeasuring quality of care is important, however many of the quality indicators used do not focus on outcome of treatment and aspects which are valuable for patients and physicians. The project ‘Care for Outcomes’ aims to establish a relevant set of outcome indicators for lung cancer.SettingNetwork of seven large, non-university teaching hospitals in the Netherlands (Santeon).MethodsBy reviewing the literature, a list of potential outcome indicators for patients with lung cancer was composed and subsequently prioritised by expert’s opinion. Three external parties, with expertise on lung cancer, clinical management and public health, evaluated and reduced the list of indicators to a working set. Finally, the resulting selection of outcome indicators was tested for feasibility and discrimination in patient data, by collecting retrospective data and performing regression and survival analyses.ParticipantsDevelopment of the indicator set in six Santeon hospitals. Retrospective cohort study in 5922 patients diagnosed with lung cancer (all types and stages).ResultsSelected outcome indicators were divided into three levels of outcome (tiers). The first tier about survival and the process of recovery include mortality, survival, positive resection margins, rethoracotomy after resection and quality of life at baseline and after 3, 6 and 12 months. Tier 2 concerning the sustainability of the recovery include complications after resection and toxicity after chemotherapy and/or radiation. Tier 3 about sustainability of health revealed no measurable outcomes. The retrospective data collection showed differences between hospitals and variation in case mix.ConclusionA relevant set of outcome indicators for lung cancer was systematically developed. This set has the potential to compare quality of care between hospitals and inform patients with lung cancer about outcomes. The project is ongoing in the current Santeon Value-Based Health Care programme through quality and improvement cycles.
Subcutaneous furosemide in advanced heart failure: service improvement project
Authors: Birch Francesca , Boam Emily , Parsons Sharon , Ghosh Justin , Johnson Miriam J 
Published: January 2021

ObjectivesIn severe heart disease, parenteral administration of loop diuretic is often needed. We present clinical outcomes from episodes of care using subcutaneous continuous subcutaneous infusion of furosemide (CSCI-furosemide).MethodsRetrospective review of service improvement data. The heart failure nurse specialist, supported by the heart failure-palliative care multidisciplinary team, works with the community or hospice staff who administer the CSCI-furosemide. Data collected for consecutive patients receiving CSCI-furosemide included: age, sex, New York Heart Association (NYHA) class, preferred place of care, goal of treatment, infusion-site reactions, and signs and symptoms of fluid retention (including weight and self-reported breathlessness).Results116 people (men 86 (66%); mean age 79 years, 49–97; NYHA class 3 (36/116, 31%) or 4 heart failure (80/116, 69%)) received 130 episodes of CSCI-furosemide (average duration 10 days, 1–49), over half in the patient’s own home/care home (80/129,; 61%) aiming to prevent hospital admission. 40/129 (31%) were managed in the hospice, and 9 (7.0%) in a community hospital. Average daily furosemide dose was 125 mg (40–300 mg). The goal of treatment was achieved in (119/130, 91.5%) episodes.The median reduction in weight was 4 kg (IQR −7 to −2 kgs, −22 to 9 kgs). Self-reported breathlessness reduced from 8.2 (±1.9) to 5.2 (±1.8). Adverse events occurred in 31/130 (24%) episodes; all but 4/130 (3%, localised skin infection) were mild.ConclusionsThese preliminary data indicate that CSCI-furosemide is safe and effective for people with severe heart failure. An adequately powered randomised controlled trial is indicated.
Pneumatic dilation for persistent dysphagia after antireflux surgery, a multicentre single-blind randomised sham-controlled clinical trial
Authors: Schuitenmaker Jeroen M , van Hoeij Froukje B , Schijven Marlies P , Tack Jan , Conchillo José M , Hazebroek Eric J , Smout André J P M , Bredenoord Albert J 
Published: January 2021

ObjectiveThere is no evidence-based treatment for persistent dysphagia after laparoscopic fundoplication. The aim of this study was to evaluate the effect of pneumatic dilation on persistent dysphagia after laparoscopic fundoplication.DesignWe performed a multicentre, single-blind, randomised sham-controlled trial of patients with persistent dysphagia (>3 months) after laparoscopic fundoplication. Patients with an Eckardt symptom score ≥4 were randomly assigned to pneumatic dilation (PD) using a 35 mm balloon or sham dilation. Primary outcome was treatment success, defined as an Eckardt score <4 and a minimal reduction of 2 points in the Eckardt score after 30 days. Secondary outcomes included change in stasis on timed barium oesophagogram, change in high-resolution manometry parameters and questionnaires on quality of life, reflux and dysphagia symptoms.ResultsForty-two patients were randomised. In the intention-to-treat analysis, the success rates of PD (7/21 patients (33%)) and sham dilation (8/21 patients (38%)) were similar after 30 days (risk difference −4.7% (95% CI (−33.7% to 24.2%) p=0.747). There was no significant difference in change of stasis on the timed barium oesophagogram after 2 min (PD vs sham: median 0.0 cm, p25–p75 range 0.0–4.3 cm vs median 0.0 cm, p25–p75 range 0.0–0.0; p=0.122) or change in lower oesophageal sphincter relaxation pressure (PD vs sham: 10.54±6.25 vs 14.60±6.17 mm Hg; p=0.052). Quality of life, reflux and dysphagia symptoms were not significantly different between the two groups.ConclusionPneumatic dilation with a 35 mm balloon is not superior to sham dilation for the treatment of persistent dysphagia after fundoplication.
Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia
Authors: Barcella Carlo Alberto , Mohr Grimur , Kragholm Kristian , Christensen Daniel , Gerds Thomas A , Polcwiartek Christoffer , Wissenberg Mads , Bang Casper , Folke Fredrik , Torp-Pedersen Christian , Kessing Lars Vedel , Gislason Gunnar Hilmar , Bach Søndergaard Kathrine 
Published: January 2021

ObjectivePatients with bipolar disorder and schizophrenia are at high cardiovascular risk; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared with the general population remains scarcely investigated.MethodsWe conducted a nested case-control study using Cox regression to assess the association of bipolar disorder and schizophrenia with the HRs of OHCA of presumed cardiac cause (2001–2015). Reported are the HRs with 95% CIs overall and in subgroups defined by established cardiac disease, cardiovascular risk factors and psychotropic drugs.ResultsWe included 35 017 OHCA cases and 175 085 age-matched and sex-matched controls (median age 72 years and 66.9% male). Patients with bipolar disorder or schizophrenia had overall higher rates of OHCA compared with the general population: HR 2.74 (95% CI 2.41 to 3.13) and 4.49 (95% CI 4.00 to 5.10), respectively. The association persisted in patients with both cardiac disease and cardiovascular risk factors at baseline (bipolar disorder HR 2.14 (95% CI 1.72 to 2.66), schizophrenia 2.84 (95% CI 2.20 to 3.67)) and among patients without known risk factors (bipolar disorder HR 2.14 (95% CI 1.09 to 4.21), schizophrenia HR 5.16 (95% CI 3.17 to 8.39)). The results were confirmed in subanalyses only including OHCAs presenting with shockable rhythm or receiving an autopsy. Antipsychotics—but not antidepressants, lithium or antiepileptics (the last two only tested in bipolar disorder)—increased OHCA hazard compared with no use in both disorders.ConclusionsPatients with bipolar disorder or schizophrenia have a higher rate of OHCA compared with the general population. Cardiac disease, cardiovascular risk factors and antipsychotics represent important underlying mechanisms.
CXCL13 shapes immunoactive tumor microenvironment and enhances the efficacy of PD-1 checkpoint blockade in high-grade serous ovarian cancer
Authors: Yang Moran , Lu Jiaqi , Zhang Guodong , Wang Yiying , He Mengdi , Xu Qing , Xu Congjian , Liu Haiou 
Published: January 2021

BackgroundMost patients with high-grade serous ovarian cancer (HGSC) lack an effective response to immune checkpoint blockade, highlighting the need for more knowledge about what is required for successful treatment. As follicular cytotoxic CXCR5+CD8+T cells are maintained by reinvigoration by immune checkpoint blockade in tumors, we attempted to reveal the relationship between CXCR5+CD8+T cells and the tumor microenvironment to predict immunotherapy responses in HGSC.Methods264 patients with HGSC from two cohorts and 340 HGSC cases from The Cancer Genome Atlas cohort were enrolled. Ex vivo and in vivo studies were conducted with human HGSC tumors and murine tumor models. The spatial correlation between CXC-chemokine ligand 13 (CXCL13), CXCR5, CD8, and CD20 was evaluated by immunohistochemistry and immunofluorescence. Survival was compared between different subsets of patients using Kaplan-Meier analysis. The therapeutic effect of CXCL13 and programmed cell death-1 (PD-1) blockade was validated using human HGSC tumors and murine models.ResultsHigh CXCL13 expression was associated with prolonged survival. Tumors with high CXCL13 expression exhibited increased infiltration of activated and CXCR5-expressing CD8+T cells. Incubation with CXCL13 facilitated expansion and activation of CXCR5+CD8+T cells ex vivo. CXCR5+CD8+T cells appeared in closer proximity to CXCL13 in tumors and chemotaxis towards CXCL13 in vitro. The combination of CXCL13, CXCR5, and CD8+T cells was an independent predictor for survival. In addition, CXCL13 was associated with clusters of CD20+B cells. CD20+B cells predicted better patient survival in the presence of CXCL13. Histological evaluation highlighted colocalization of CXCL13 with tertiary lymphoid structures (TLSs). TLSs carried prognostic benefit only in the presence of CXCL13. CXCL13 in combination with anti-PD-1 therapy retarded tumor growth in a CD8+T-cell-dependent manner, resulting in increased infiltration of cytotoxic CD8+T cells and CXCR5+CD8+T cells.ConclusionsThese data define a critical role of CXCL13 in shaping antitumor microenvironment by facilitating the maintenance of CXCR5+CD8+T cells in TLSs and support a clinical investigation for a combination of CXCL13 and PD-1 blockade therapy in HGSC.
Occupational use of high-level disinfectants and asthma incidence in early- to mid-career female nurses: a prospective cohort study
Authors: Dumas Orianne , Gaskins Audrey J , Boggs Krislyn M , Henn Scott A , Le Moual Nicole , Varraso Raphäelle , Chavarro Jorge E , Camargo Jr Carlos A 
Published: January 2021

ObjectivesOccupational use of disinfectants among healthcare workers has been associated with asthma. However, most studies are cross-sectional, and longitudinal studies are not entirely consistent. To limit the healthy worker effect, it is important to conduct studies among early- to mid-career workers. We investigated the prospective association between use of disinfectants and asthma incidence in a large cohort of early- to mid-career female nurses.MethodsThe Nurses’ Health Study 3 is an ongoing, prospective, internet-based cohort of female nurses in the USA and Canada (2010–present). Analyses included 17 280 participants without a history of asthma at study entry (mean age: 34 years) and who had completed ≥1 follow-up questionnaire (sent every 6 months). Occupational use of high-level disinfectants (HLDs) was evaluated by questionnaire. We examined the association between HLD use and asthma development, adjusted for age, race, ethnicity, smoking status and body mass index.ResultsDuring 67 392 person-years of follow-up, 391 nurses reported incident clinician-diagnosed asthma. Compared with nurses who reported ≤5 years of HLD use (89%), those with >5 years of HLD use (11%) had increased risk of incident asthma (adjusted HR (95% CI), 1.39 (1.04 to 1.86)). The risk of incident asthma was elevated but not statistically significant in those reporting >5 years of HLD use and current use of ≥2 products (1.72 (0.88 to 3.34)); asthma risk was significantly elevated in women with >5 years of HLD use but no current use (1.46 (1.00 to 2.12)).ConclusionsOccupational use of HLDs was prospectively associated with increased asthma incidence in early- to mid-career nurses.
Slip-resistant footwear reduces slips among National Health Service workers in England: a randomised controlled trial
Authors: Cockayne Sarah , Fairhurst Caroline , Frost Gillian , Liddle Mark , Cunningham-Burley Rachel , Zand Michael , Hewitt Catherine , Iles-Smith Heather M , Green Lorraine , Torgerson David J 
Published: January 2021

ObjectivesAssess the effectiveness of 5* GRIP-rated slip-resistant footwear in preventing slips in the workplace compared to usual footwear (control group).MethodsA multicentre, randomised controlled trial; 4553 National Health Service (NHS) staff were randomised 1:1 to the intervention group (provided with 5* GRIP-rated slip-resistant footwear) or the control group. The primary outcome of incidence rate of self-reported slips in the workplace over 14 weeks was analysed using a mixed-effects negative binomial model. Secondary outcome measures included incidence rate of falls from a slip, falls not from a slip, proportion of participants reporting a slip, fall or fracture and time to first slip and fall.Results6743 slips were reported: 2633 in the intervention group (mean 1.16 per participant, range 0 to 36) and 4110 in the control group (mean 1.80 per participant, range 0 to 83). There was a statistically significant reduction in slip rate in the intervention group relative to the control group (incidence rate ratio (IRR) 0.63, 95% CI 0.57 to 0.70, p<0.001). Statistically significant differences, in favour of the intervention group, were observed in falls from a slip (IRR 0.51, 95% CI 0.28 to 0.92, p=0.03), the proportion of participants who reported a slip (OR 0.58, 95% CI 0.50 to 0.66, p<0.001) or fall (OR 0.73, 95% CI 0.54 to 0.99, p=0.04) and time to first slip (HR 0.73, 95% CI 0.67 to 0.80, p<0.001).ConclusionsThe offer and provision of 5* GRIP-rated footwear reduced slips in NHS staff in the workplace.Trial registration numberISRCTN33051393.
Changes in UK medical trainees' perceptions of workplace-based assessments across 10 years: results from two cross-sectional studies
Authors: Cheston Hannah , Graham David , Johnson Gavin , Woodland Philip 
Published: January 2021

AbstractObjectivesWorkplace-based assessments (WPBAs) have become embedded in the training and assessment of UK medical trainees since the onset of the 21st century. When first introduced WPBA required a significant adjustment in both trainees' and educators' training behaviour, and was met with scepticism in some quarters. In this study, we aimed to evaluate how trainees' perceptions of WPBAs have evolved over a 10-year period, as experience with them has increased.DesignTwo online questionnaires were constructed and distributed to UK trainees. The first was distributed in 2008, the second in 2018. Questions related to trainees' perception of WPBAs as a learning process and as a reflection of their competence.Setting and participantsAll UK medical trainees were eligible to respond. In 2008, 482 trainees from 96 hospitals completed the questionnaire. In 2018, 356 trainees from 103 hospitals completed the questionnaire.Main outcome measuresData were analysed both quantitatively and qualitatively. A comparison between the numbers of each WPBA modality completed in 2008 and 2018 was assessed using chi-squared test. Comparisons of Likert scale values between 2008 and 2018 were assessed using unpaired t-test. Thematic analysis was carried out on free-text answers.ResultsThe number of forms completed per participant increased significantly from 2008 to 2018. In 2008, forms were most commonly completed immediately after a learning observation (34%). In 2018, forms were most commonly completed between 1 week and 1 month after observation (58%). In 2018, significantly fewer WPBAs were followed by an educational/beneficial discussion in comparison to 2008 data. The most common free-text theme in the 2008 data set was ‘supervisor issues’ whereas in 2018 the most commonly noted theme was ‘limited educational benefit’.ConclusionsOur study suggests trainees' perspectives of WPBAs have not changed in the 10 years since implementation. Trainees do not perceive WPBA as an accurate reflection of their competency but instead as a ‘tick-box’ bureaucratic exercise to enable career progression. Development of educator training and trainer and trainee job-planning is required to ensure that WPBAs are genuinely educational activities that offer an accurate reflection of trainees' medical competence.
Efficacy and safety of caudal dexmedetomidine in pediatric infra-umbilical surgery: a meta-analysis and trial-sequential analysis of randomized controlled trials
Authors: Shah Ushma Jitendra , Nguyen Derek , Karuppiaah Niveditha , Martin Janet , Sehmbi Herman 
Published: January 2021

BackgroundDexmedetomidine is used as a local-anesthetics adjuvant in caudal block to prolong analgesia in pediatric infra-umbilical surgery.ObjectiveWe evaluated the analgesic efficacy and safety of the addition of caudal dexmedetomidine to local anesthetics (vs local anesthetics alone) in pediatric infra-umbilical surgery.Evidence reviewWe searched 10 databases for randomized controlled trials (RCTs) of pediatric patients undergoing infra-umbilical surgery, comparing caudal block with and without dexmedetomidine as local anesthetic adjuvant. We performed a frequentist random-effects meta-analysis (R statistical package). We analyzed continuous outcomes as a ratio of means (ROM) and dichotomous data as relative risk (RR), along with 95% CI. We included 19 RCTs (n=1190 pediatric patients) in the meta-analysis. The primary outcome was duration of analgesia (defined as ‘the time from caudal injection to the time at which the study-specific pain score was greater than a cut-off threshold’).FindingsData from 19 included RCTs (n=1190) suggested that compared with control (mean duration 346 min), the addition of caudal dexmedetomidine significantly prolonged the duration of analgesia (ratio of means 2.14, 95% CI 1.83 to 2.49, p<0.001; ‘moderate’ evidence). Trial-sequential analysis showed adequate ‘information size’ for the primary outcome. Caudal dexmedetomidine also reduced the number of analgesic administrations (‘low’ evidence), total acetaminophen dose (‘moderate’ evidence) and the risk of emergence delirium (‘moderate’ evidence). There were no significant differences in adverse effects such as hypotension, bradycardia, post-operative nausea and vomiting, urinary retention and respiratory depression.ConclusionsOur results suggest that the addition of dexmedetomidine to local anesthetic in caudal block significantly improves the duration of analgesia and reduces the analgesic requirements, while maintaining a similar risk-profile compared with local anesthetic alone. Further data on neurological safety are needed.