bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a food preparation program on dietary well-being for stroke patients with dysphagia
Authors: Lin Shu-Chi , Lin Kuan-Hung , Tsai Yi-Chi , Chiu En-Chi 
Published: June 2021

Abstract

Background:
Dysphagia is one of the common issues observed in patients with stroke. Stroke patients with dysphagia have to eat blended food or similar types of food for each meal, resulting in dietary dissatisfaction. The purpose of this study was to investigate the effects of a food preparation program on dietary well-being for stroke patients with dysphagia.

Methods:
This study was a pilot randomized clinical trial. Twenty-two patients were assigned randomly into the food preparation group (n = 11) and control group (n = 11). The food preparation group received oral motor exercises, recognition of food texture and thickener, and hands-on food preparation for 6 weeks. Outcome measures included the Dietary Well-Being Scale, brief version of the World Health Organization Quality of life, Swallowing Quality of Life Questionnaire, and Mini Nutritional Assessment.

Results:
Patients in the food preparation group showed significant improvements in the Dietary Well-Being Scale, psychological and environmental domains of the brief version of the World Health Organization Quality of life (P = .001–.024) with small to large effect sizes (success rate difference = 0.23–0.46). The Swallowing Quality of Life Questionnaire and Mini Nutritional Assessment displayed non-significant differences (P = .053–.092) and revealed small to moderate effect sizes (success rate difference = 0.23–0.32).

Conclusions:
The food preparation program showed a positive impact on dietary well-being and a potential improvement in the health-related quality of life, quality of life related to the process of swallowing, and nutritional status for stroke patients with dysphagia. We recommend that stroke patients with dysphagia receive adequate knowledge and hands-on food preparation training to increase their dietary intake and well-being.
Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases
Authors: Baldi Bruno Guedes , Fernandes Caio Júlio César dos Santos , Heiden Gláucia Itamaro , Freitas Carolina Salim Gonçalves , Sobral Juliana Barbosa , Kairalla Ronaldo Adib , Carvalho Carlos Roberto Ribeiro , Souza Rogério 
Published: June 2021

Abstract
To investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs).
We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan–Meier curves.
Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 ± 9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 ± 20% and 38 ± 21% predicted, respectively. PA diameter and PA-Ao ratio were 29 ± 6 mm and 0.95 ± 0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio ≤ 1.
The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.
Reflux esophagitis is associated with higher risks of acute stroke and transient ischemic attacks in patients hospitalized with atrial fibrillation
Authors: Jiang Yi , Damiris Konstantinos , Suero-Abreu Giselle , Xu Binghong , Ahlawat Sushil 
Published: June 2021

Abstract
Reflux esophagitis (RE) is a subset of gastroesophageal reflux disease (GERD) with endoscopic evidence of esophageal inflammation, which has been linked to an increased incidence of atrial fibrillation (AF). However, data on the effect of RE on patient outcomes is limited. We sought to examine the potential association of RE with outcomes of patients with AF in a nationwide study.
The National Inpatient Sample (NIS) database was queried to identify hospitalized adult patients with AF and RE between 2010 and 2014. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. AF related complications such as acute stroke, transient ischemic attack (TIA) and acute heart failure were assessed as secondary outcomes. Propensity score matching and multivariate regression analysis were used.
Six lakh sixty seven thousands five hundred twenty patients were admitted for primary diagnosis of AF out of which 5396 had a secondary diagnosis of RE. In the AF with RE cohort, the average age was 73.6 years, 41.5% were male, and 79.9% were Caucasian. There was a greater prevalence of concomitant dyslipidemia, chronic liver disease and chronic pulmonary disease (P < .01) when compared to the AF without RE cohort. Patients with AF and RE also had higher incidence of acute strokes and TIAs (P < .05), longer LOS (P < .001), and higher hospital charges (P < .05) with no difference in acute heart failure (P = .08), hospital mortality (P = .12), or CHA2DS2-VASc score (P = .67).
In hospitalized patients with AF, RE was associated with a higher rate of acute stroke and TIAs, longer LOS, and greater hospital charges.
Increased hexokinase-2 as a novel biomarker for the diagnosis and correlating with disease severity in rheumatoid arthritis
Authors: Zhou Kai-Long , Zhu Zhen-Hua , Zhou Ju-Pu , Zhao Jia-Ju , Zhang Yong , Jiang Bo 
Published: June 2021

Abstract
Abnormal glucose metabolism brings out joint inflammation and destruction in rheumatoid arthritis (RA). The aim of this study was to evaluate the potential of circulating hexokinase-2 (HK2) in peripheral blood mononuclear cells (PBMCs) of rheumatoid arthritis (RA) patients.
PBMCs were obtained from patients with RA or osteoarthritis (OA) and healthy controls (HCs). The expression of HK2 was assessed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), Calprotectin, rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP) antibody level and 28-joint Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) were measured. Spearman's analysis was performed to determine the association between the level of HK2 and clinical characteristics. A receiver operating characteristic (ROC) curve was employed to evaluate the diagnostic value of HK2 in PBMCs. Logistic regression was used to identify risk factors. Sixty-five RA patients, 35 OA patients, and 40 HCs were included in the study.
HK2 was upregulated in RA and OA patients compared with that in HCs (P < .05). The area under the ROC of HK2 for diagnosing RA and OA was 0.808 and 0.640, respectively. In addition, HK2 levels were increased in active RA compared with those in remittent RA (P = .03). Furthermore, HK2 correlated positively with the DAS28-ESR (P < .001), CDAI (P = .02) and SDAI scores (P = .02). Moreover, HK2 was independently associated with an increased risk of disease activity (DAS28-ESR>3.2, P = .02; CDAI score>10, P = .03; SDAI score>11, P = .04). Additionally, HK2 positivity was more frequently detected in patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) than in those not treated with bDMARDs.
HK2 levels in PBMCs can be considered an ideal biomarker for diagnosing RA and involved in disease activity in RA. Dysregulation of HK2 may participate in the molecular mechanism of RA and could be an attractive selective metabolic target for RA treatment.
Possible effects of agent orange and posttraumatic stress disorder on hyperglycemia in Korean veterans from the US-Vietnam war
Authors: Hong Pa , Song Yun Gyu , Paek Sungwoo 
Published: June 2021

Abstract
This study was conducted to examine whether Korean veterans from the US-Vietnam War who had a diagnosis of type II diabetes mellitus (T2DM) as well as past history of exposure to agent orange (AO) are vulnerable to hyperglycemia when receiving intra-articular corticosteroid injection (IACI) for pain relief.
The current study included a total of 49 patients (n = 49) who received an injection of triamcinolone 20 or 40 mg to the shoulder under sonographic guidance or did that of dexamethasone 10 mg or triamcinolone 40 mg combined with dexamethasone 20 mg to the spine under fluoroscopic guidance. Their 7-day fasting blood glucose (FBG) levels were measured and then averaged, serving as baseline levels. This is followed by measurement of FBG levels for 14 days of IACI. Respective measurements were compared with baseline levels. The patients were also evaluated for whether there are increases in FBG levels depending on insulin therapy as well as HbA1c ≥ 7% or HbA1c < 7%.
Overall, there were significant increases in FBG levels by 64.7 ± 42.5 mg/dL at 1 day of IACI from baseline (P < .05). HbA1c ≥ 7% and HbA1c < 7% showed increases in FBG levels by 106.1 ± 49.0 mg/dL and 46.5 ± 3.8 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). In the presence and absence of insulin therapy, there were significant increases in them by 122.6 ± 48.7 mg/dL and 48.0 ± 20.4 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). But there were decreases in them to baseline levels at 2 days of IACI.
Clinicians should consider the possibility of hyperglycemia when using corticosteroids for relief of musculoskeletal pain in Korean veterans from the US-Vietnam War who had a history of exposure to AO.
Improving Blood Pressure Accuracy in the Outpatient Adolescent Setting
Authors: Woods Jennifer L. , Jacobs Megan D. , Sheeder Jeanelle L. 
Published: June 2021

Introduction:
Hypertension (HTN) is increasing in the pediatric population, and hypertensive children become hypertensive adults. Blood pressure (BP) is often overlooked due to factors including distrust in readings, lack of time in visits, and discomfort prescribing antihypertensive medications. The objective of our multistage, clinically based quality improvement project was to improve BP measurement and HTN diagnosis and intervention in adolescents.

Methods:
Study investigators performed interventions in an adolescent medicine clinic at Children’s Hospital Colorado (ages 12–24 years), which included equipment inventory, mapping clinic processes, manual/automated BP training for staff, education of faculty/staff on guidelines, and creation/implementation of updated best practice alerts (BPAs) based on age-appropriate guidelines for stage 1, 2 HTN in patients younger/older 18years.

Results:
With equipment updates, medical assistant manual BP certifications, educational sessions for faculty/staff, and creation of a BPA with instruction before the go-live date, confidence in using automated and manual BP measurements increased for faculty/staff. The number of unique patient visits presenting with elevated BPs decreased significantly in the postintervention period reflecting the education/training. Staff used the new order set minimally, but there was an increase in correct diagnoses of elevated BP and laboratory workup.

Conclusions:
Having appropriate equipment while introducing BP guideline education in the ambulatory setting with electronic health record reminders and utility of BPAs can decrease erroneous BP values saving providers and staff encounter time. Real-time alerts can aid in accurate diagnosis rates and improved intervention for youth with elevated BP readings. Providers still inconsistently interact with order sets despite such parameters
Prevention of Latent Safety Threats: A Quality Improvement Project to Mobilize a Portable CT
Authors: Lawrence Julia F. , Tsang Rocky , Fedee George , Musick Matthew A. , Lichliter Royanne L. , Bastero Patricia , Pedroza McDonald Nadia , Wallin Kelly , Doughty Cara 
Published: June 2021

Introduction:
Transporting critically ill patients to diagnostic imaging for needed studies can be challenging and even prohibitive. A portable computerized tomography (CT) scanner allows the patient to remain in the intensive care unit, but presents new positioning and team challenges. Before activation of a portable CT scanner in our pediatric intensive care unit and through the use of iterative simulation-based Plan-Do-Study-Act (PDSA) cycles in the clinical environment, a multidisciplinary team of bedside caregivers determined optimal patient positioning, equipment needs, and specific staffing and choreography to develop detailed portable CT guidelines.

Method:
Our team engaged stakeholders from radiology, critical care, respiratory therapy, environmental services, facilities operations, and the CT vendor to develop scenarios. Simulations included infant and pediatric patients who required critical invasive monitoring and treatment devices, such as ventilators, and high-risk intracardiac and intravascular lines. Scenario objectives centered on the safe positioning, transfer, and scanning of the patient. Trained simulation specialists from the hospital’s simulation center facilitated simulation sessions.

Results:
Simulation-based PDSA testing identified 31 latent safety threats, including the need for a custom bed adapter due to pediatric patients’ variable size. We paused portable CT activation pending the custom adapter’s availability and remediation of other latent safety threats. Additional simulation-based PDSA cycles further refined the process once the custom adapter was available.

Conclusions:
Simulation identified unanticipated latent safety threats before the implementation of a portable CT scanner.
Increasing Use of Ambulatory Video Visits for Pediatric Patients by Using Quality Improvement Methods
Authors: Rosenthal Jennifer L. , Sigal Ilana S. , Kamerman-Kretzmer Rory , Say Daphne S. , Castellanos Bianca , Nguyen Stephanie , Nakra Natasha A. , Restrepo Bibiana , Crossen Stephanie S. 
Published: June 2021

Introduction:
Live video visits for ambulatory encounters offer potential benefits, including access to remote subspecialty services, care coordination between providers, and improved convenience for patients. We aimed to increase the utilization of video visits for pediatric patients at our medical center using an iterative quality improvement process.

Methods:
A multispecialty improvement team identified opportunities to increase video visit utilization and prioritized interventions using benefit-effort analyses. Interventions focused on 6 key drivers. The outcome measure was the percentage of ambulatory encounters conducted by video. The process measure was the percentage of ambulatory pediatricians conducting video visits. The balancing measure was the percentage of no-shows among scheduled video visits. All measures were analyzed using statistical process control.

Results:
Interventions were associated with increases in our outcome and process measures from 0.1% to 1.2% and 0.6% to 6.3%, respectively, during the first 8 months. Subsequently, the novel coronavirus (COVID-19) pandemic was associated with further increases in these measures to 41.8% and 73.5%, respectively, over 3 months. The balancing measure increased from 0% at baseline to 14.7% with no special cause variation during the intervention period. The most impactful interventions included clinician training outreach, providing equipment, and streamlining MyChart patient enrollment.

Conclusions:
This improvement project effectively increased pediatric ambulatory video visit utilization, although the most significant driver of utilization was the COVID-19 pandemic. Project interventions implemented before COVID-19 facilitated rapid video visit adoption during the pandemic. A similar improvement process may be beneficial for other medical centers aiming to improve video visit utilization.
Reduction in left frontal alpha oscillations by transcranial alternating current stimulation in major depressive disorder is context-dependent in a randomized-clinical trial
Authors: Riddle Justin , Alexander Morgan L. , Schiller Crystal Edler , Rubinow David R. , Frohlich Flavio 
Published: June 2021

AbstractBackgroundLeft frontal alpha oscillations are associated with decreased approach motivation and have been proposed as a target for non-invasive brain stimulation for the treatment of depression and anhedonia. Indeed, transcranial alternating current stimulation (tACS) at the alpha frequency reduced left frontal alpha power and was associated with a higher response rate than placebo stimulation in patients with major depressive disorder (MDD) in a recent double-blind placebo controlled clinical trial.MethodsIn this current study, we aimed to replicate such successful target engagement by delineating the effects of a single session of bifrontal tACS at the individualized alpha frequency (IAF-tACS) on alpha oscillations in patients with MDD. Electrical brain activity was recorded during rest and while viewing emotionally-salient images before and after stimulation to investigate if the modulation of alpha oscillation by tACS exhibited specificity with regards to valence.ResultsIn agreement with the previous study of tACS in MDD, we found that a single session of bifrontal IAF-tACS reduced left frontal alpha power during the resting state when compared to placebo. Furthermore, the reduction of left frontal alpha oscillation by tACS was specific for stimuli with positive valence. In contrast, these effects on left frontal alpha power were not found in healthy control participants.ConclusionTogether these results support an important role of tACS in reducing left frontal alpha oscillations as a future treatment for MDD.National Clinical TrialNCT03449979, “Single Session of tACS in a Depressive Episode (SSDE)”https://www.clinicaltrials.gov/ct2/show/NCT03449979
Big Data Analysis of Electronic Health Records: Clinically interpretable representations of older adult inpatient trajectories using time-series numerical data and Hidden Markov Models
Authors: Herrero-Zazo Maria , Fitzgerald Tomas , Taylor Vince , Street Helen , Chaudhry Afzal N , Bradley John , Birney Ewan , Keevil Victoria L 
Published: June 2021

AbstractThe implementation of Electronic Health Records (EHR) in UK hospitals provides new opportunities for clinical ‘big data’ analysis. The representation of observations routinely recorded in clinical practice is the first step to use these data in several research tasks. Anonymised data were extracted from 11 158 first emergency admission episodes (AE) in older adults. Irregular records from 23 laboratory blood tests and vital signs were normalized and regularised into daily bins and represented as numerical multivariate time-series (MVTS). Unsupervised Hidden Markov Models (HMM) were trained to represent each day of each AE as one of 17 state spaces. The visual clinical interpretation of these states showed remarkable differences between patients who died at the end of the AE and those who were discharged. All states had marked features that allowed their clinical interpretation and differentiation between those associated with the patients’ disease burden, their physiological response to this burden or the stage of admission. The most evident relationships with hold-out clinical information were also confirmed by Chi-square tests, with two states strongly associated with inpatient mortality (IM) and 12 states (71%) associated with at least one admission diagnosis. The potential of these data representations on prediction of hospital outcomes was also explored using Logistic Regression (LR) and Random Forest (RF) models, with higher prediction performance observed when models were trained with MVTS data compared to HMM state spaces. However, the outputs of generative and discriminative analyses were complementary. For example, highest ranking features of the best performing RF model for IM (ROC-AUC 0.85) resembled the laboratory blood test and vital sign variables characterising the ‘Early Inflammatory Response-like’ state, itself strongly associated with IM. These results provide evidence of the capability of generative models to extract biological signals from routinely collected clinical data and their potential to represent interpretable patients’ trajectories for future research in hypothesis generation or prediction modelling.
Insights on Genetic and Environmental Factors in Parkinson’s Disease from a regional Swedish Case-Control Cohort
Authors: Brolin Kajsa , Bandres-Ciga Sara , Blauwendraat Cornelis , Widner Håkan , Odin Per , Hansson Oskar , Puschmann Andreas , Swanberg Maria 
Published: June 2021

AbstractBACKGROUNDRisk factors for Parkinson’s disease (PD) can be more or less relevant to a population due to population-specific genetic architecture, local lifestyle habits, and environmental exposures. Therefore, it is essential to study PD at a local, regional, and continental scale in order to increase the knowledge on disease etiology.OBJECTIVEWe aimed to investigate the contribution of genetic and environmental factors to PD in a new Swedish case-control cohort.METHODSPD patients (n=929) and matched population-based controls (n=935) from the southernmost county in Sweden were included in the cohort. Information on environmental exposures was obtained using questionnaires at inclusion. Genetic analyses included a genome-wide association study (GWAS), haplotype assessment, and a risk profile analysis using cumulative genetic risk scores.RESULTSThe cohort is a representative PD case-control cohort (64% men, mean age at diagnosis=67 years, median Hoehn and Yahr score=2.0), in which previously reported associations between PD and environmental factors, such as tobacco, could be confirmed. We describe the first GWAS of PD solely composed of PD patients from Sweden, and confirm associations to well-established risk alleles inSNCA. In addition, we nominate an unconfirmed and potentially population-specific genome-wide significant association in thePLPP4locus (rs12771445).CONCLUSIONSThis work provides an in-depth description of a new PD case-control cohort from southern Sweden, giving insights into environmental and genetic risk factors of PD in the Swedish population.
Threshold concepts in medical education: A scoping review protocol
Authors: Jones Helen , Hammond Lucy 
Published: June 2021

AbstractThreshold concepts are attracting increasing attention as a framework for improving medical education practice. A growing number of studies in recent years have explored the role of threshold concepts in knowledge and skill acquisition amongst medical students and physicians. However, no review has utilised a systematic approach to examine the literature in this area. The author therefore proposes to undertake a scoping review to explore and describe the current research regarding threshold concepts in medical education and identify gaps in the existing literature. Medical and education databases will be searched for studies exploring threshold concepts in undergraduate, graduate and continuing medical education contexts. The findings will be presented in the form of a descriptive numerical summary and a narrative synthesis. The review will provide a comprehensive overview of how the threshold concept framework is currently being utilised and applied, and provide recommendations for how medical educators can employ the framework in their own practice. Exploration of the research approaches being used, and identification of gaps in the literature, will help inform future research, including determining focus for future systematic reviews.