bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding diagnostic processes in emergency departments: a mixed methods case study protocol
Authors: Daniel Michelle , Park SunYoung , Seifert Colleen M , Chandanabhumma P Paul , Fetters Michael D , Wilson Eric , Canvasser Andrew B , Singh Hardeep , Pasupathy Kalyan , Mahajan Prashant 
Published: September 2021

IntroductionDiagnostic processes in the emergency department (ED) involve multiple interactions among individuals who interface with information systems to access and record information. A better understanding of diagnostic processes is needed to mitigate errors. This paper describes a study protocol to map diagnostic processes in the ED as a foundation for developing future error mitigation strategies.Methods and analysisThis study of an adult and a paediatric academic ED uses a prospective mixed methods case study design informed by an ED-specific diagnostic decision-making model (the modified ED-National Academies of Sciences, Engineering and Medicine (NASEM) model) and two cognitive theories (dual process theory and distributed cognition). Data sources include audio recordings of patient and care team interactions, electronic health record data, observer field notes and stakeholder interviews. Multiple qualitative analysis methods will be used to explore diagnostic processes in situ, including systems information flow, human–human and human–system interactions and contextual factors influencing cognition. The study has three parts. Part 1 involves prospective field observations of patients with undifferentiated symptoms at high risk for diagnostic error, where each patient is followed throughout the entire care delivery process. Part 2 involves observing individual care team providers over a 4-hour window to capture their diagnostic workflow, team coordination and communication across multiple patients. Part 3 uses interviews with key stakeholders to understand different perspectives on the diagnostic process, as well as perceived strengths and vulnerabilities, in order to enrich the ED-NASEM diagnostic model.Ethics and disseminationThe University of Michigan Institutional Review Board approved this study, HUM00156261. This foundational work will help identify strengths and vulnerabilities in diagnostic processes. Further, it will inform the future development and testing of patient, provider and systems-level interventions for mitigating error and improving patient safety in these and other EDs. The work will be disseminated through journal publications and presentations at national and international meetings.
Role of neutrophil-to-lymphocyte ratio as a prognostic biomarker in patients with breast cancer receiving neoadjuvant chemotherapy: a meta-analysis
Authors: Zhou Qiong , Dong Jie , Sun Qingqing , Lu Nannan , Pan Yueyin , Han Xinghua 
Published: September 2021

ObjectiveThe neutrophil-to-lymphocyte ratio (NLR) is recognised as a suitable prognostic biomarker in patients with breast cancer. Nevertheless, the efficacy of this biomarker in predicting the pathological complete response (pCR) and survival in patients with breast cancer receiving neoadjuvant chemotherapy (NACT) is still controversial. This meta-analysis aimed to identify the association between baseline NLR and the prognosis of patients with breast cancer treated with NACT.DesignMeta-analysis.Data sourcesRelevant literature published before 1 May 2021 was searched using the Cochrane Library, Embase, PubMed and the Web of Science databases.Eligibility criteriaAll studies involving patients with breast cancer treated with NACT and peripheral blood pretreatment NLR recorded as a dichotomous variable were included.Data extraction and synthesisTwo researchers independently extracted and evaluated OR/HR and its 95% CIs of survival outcomes and clinicopathological parameters.ResultsA total of 19 studies were identified. From each study, the impact of NLR on the pCR, OR and HR, with their 95% CIs were extracted and combined using either a random or fixed-effects model. The results indicate that a higher pCR in patients with a low NLR (OR 1.620, 95% CI 1.209 to 2.169, p＜0.001). In addition, an elevated NLR predicted lower disease-free survival (HR 2.269, 95% CI 1.557 to 3.307, p<0.001) and overall survival (HR 1.691, 95% CI 1.365 to 2.096, p<0.001) in patients with breast cancer treated with NACT.ConclusionsNLR is a suitable biomarker for predicting pCR and survival in patients with breast cancer receiving NACT.
Impact of household shocks on access to healthcare services in Kenya: a propensity score matching analysis
Authors: Njagi Purity , Groot Wim , Arsenijevic Jelena 
Published: September 2021

ObjectiveThis study examines the effects of household shocks on access to healthcare services in Kenya. Shocks are adverse events that lead to loss of household income and/or assets.Design and settingThe study used data from the Kenya Integrated Household Budget Survey 2015/2016, a nationally representative cross-sectional survey. A propensity score matching approach was applied for the analysis.ParticipantsThe study sample included 16 297 individuals from households that had experienced shocks (intervention) and those that had not experienced shocks (control) within the last 12 months preceding the survey.Outcome measuresThe outcome of interest was access to healthcare services based on an individual’s perceived need for health intervention.ResultsThe results indicate that shocks reduce access to healthcare services when household members are confronted with an illness. We observed that multiple shocks in a household exacerbate the risk of not accessing healthcare services. Asset shocks had a significant negative effect on access to healthcare services, whereas the effect of income shocks was not statistically significant. This is presumably due to the smoothing out of income shocks through the sale of assets or borrowing. However, considering the time when the shock occurred, we observed mixed results that varied according to the type of shock.ConclusionsThe findings suggest that shocks can limit the capacity of households to invest in healthcare services, emphasising their vulnerability to risks and inability to cope with the consequences. These results provoke a debate on the causal pathway of household economic shocks and health-seeking behaviour. The results suggest a need for social protection programmes to integrate mechanisms that enable households to build resilience to shocks. A more viable approach would be to expedite universal health insurance to cushion households from forgoing needed healthcare when confronted with unanticipated risks.
Seroprevalence of SARS-CoV-2-specific IgG antibodies in Kashmir, India, 7 months after the first reported local COVID-19 case: results of a population-based seroprevalence survey from October to November 2020
Authors: Khan S Muhammad Salim , Qurieshi Mariya Amin , Haq Inaamul , Majid Sabhiya , Ahmad Javid , Ayub Taha , Bhat Ashfaq Ahmad , Fazili Anjum Bashir , Ganai Abdul Majeed , Jan Yasmeen , Kaul Rauf-ur-Rashid , Khan Zahid Ali , Masoodi Muneer Ahmad , Mushtaq Beenish , Nazir Fouzia , Nazir Muzamil , Raja Malik Waseem , Rasool Mahbooba , Asma Anjum , Ayoub Shifana , Aziz Munazza , Bhat Arif Akbar , Chowdri Iqra Nisar , Ismail Shaista , Kawoosa Misbah Ferooz , Khan Mehvish Afzal , Khan Mosin Saleem , Kousar Rafiya , Lone Ab Aziz , Nabi Shahroz , Obaid Mohammad , Qazi Tanzeela Bashir , Sabah Iram , Sumji Ishtiyaq Ahmad 
Published: September 2021

ObjectivesWe designed a population-based survey in Kashmir to estimate the seroprevalence of SARS-CoV-2-specific IgG antibodies in the general population aged 18 years and above.SettingThe survey was conducted among 110 villages and urban wards across 10 districts in Kashmir from 17 October 2020 to 4 November 2020.ParticipantsIndividuals aged 18 years and above were eligible to be included in the survey. Serum samples were tested for the presence of SARS-CoV-2-specific IgG antibodies using the Abbott SARS-CoV-2 IgG assay.Primary and secondary outcome measuresWe labelled assay results equal to or above the cut-off index value of 1.4 as positive for SARS-CoV-2-specific IgG antibodies. Seroprevalence estimates were adjusted for the sampling design and assay characteristics.ResultsOut of 6397 eligible individuals enumerated, 6315 (98.7%) agreed to participate. The final analysis was done on 6230 participants. Seroprevalence adjusted for the sampling design and assay characteristics was 36.7% (95% CI 34.3% to 39.2%). Seroprevalence was higher among the older population. Among seropositive individuals, 10.2% (247/2415) reported a history of COVID-19-like symptoms. Out of 474 symptomatic individuals, 233 (49.2%) reported having been tested. We estimated an infection fatality rate of 0.034%.ConclusionsDuring the first 7 months of the COVID-19 epidemic in Kashmir Valley, approximately 37% of individuals were infected. The reported number of COVID-19 cases was only a small fraction of the estimated number of infections. A more efficient surveillance system with strengthened reporting of COVID-19 cases and deaths is warranted.
Patterns of care for people presenting to Australian general practice with musculoskeletal complaints based on routinely collected data: protocol for an observational cohort study using the Population Level Analysis and Reporting (POLAR) database
Authors: Haas Romi , Busija Ljoudmila , Gorelik Alexandra , O"Connor Denise A , Pearce Christopher , Mazza Danielle , Buchbinder Rachelle 
Published: September 2021

IntroductionGeneral practice is integral to the Australian healthcare system. Outcome Health’s POpulation Level Analysis and Reporting (POLAR) database uses de-identified electronic health records to analyse general practice data in Australia. Previous studies using routinely collected health data for research have not consistently reported the codes and algorithms used to describe the population, exposures, interventions and outcomes in sufficient detail to allow replication. This paper reports a study protocol investigating patterns of care for people presenting with musculoskeletal conditions to general practice in Victoria, Australia. Its focus is on the systematic approach used to classify and select eligible records from the POLAR database to facilitate replication. This will be useful for other researchers using routinely collected health data for research.Methods and analysisThis is a retrospective cohort study. Patient-related data will be obtained through electronic health records from a subset of general practices across three primary health networks (PHN) in southeastern Victoria. Data for patients with a low back, neck, shoulder and/or knee condition and who received at least one general practitioner (GP) face-to-face consultation between 1 January 2014 and 31 December 2018 will be included. Data quality checks will be conducted to exclude patients with poor data recording and/or non-continuous follow-up. Relational data files with eligible and valid records will be merged to select the study cohort and the GP care received (consultations, imaging requests, prescriptions and referrals) between diagnosis and 31 December 2018. Number and characteristics of patients and GPs, and number, type and timing of imaging requests, prescriptions for pain relief and referrals to other health providers will be investigated.Ethics and disseminationEthics approval was obtained from the Cabrini and Monash University Human Research Ethics Committees (Reference Numbers 02-21-01-19 and 16975, respectively). Study findings will be reported to Outcome Health, participating PHNs, disseminated in academic journals and presented in conferences.
Improving communication on medical ward rounds with patients who speak limited English with implementation of medical communication charts
Authors: D'Souza Amrita Naomi , Canoso Ana , Smith Laura-Jane 
Published: September 2021

AimTo improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart.Local problemKing’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations.MethodsFace-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Preintervention and postintervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles.ResultsAt baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only two of eight doctors felt they could communicate effectively with patients. In PDSA 1, four of five patients reported high satisfaction in communicating physical symptoms, anxieties or concerns preintervention with five of five postchart implementation. Five of five patients reported high satisfaction in communicating ongoing needs preintervention but only three of five postintervention. In PDSA 2, two of five patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with four of four doctors reporting improved satisfaction in communication in PDSA 2 and two of three doctors reporting higher satisfaction in communication in PDSA 3.ConclusionUsing communication charts in patients with limited English can improve bidirectional communication on medical ward rounds.
Frequency, severity and costs of flares increase with disease severity in newly diagnosed systemic lupus erythematosus: a real-world cohort study, United States, 2004–2015
Authors: Hammond Edward R , Desta Barnabas , Near Aimee M , Wang Xia , Jiang Miao 
Published: September 2021

ObjectiveTo evaluate frequency, severity and costs of flares in US patients with newly diagnosed SLE.MethodsAdults diagnosed with SLE between January 2005 and December 2014 were identified from US commercial claims data linked to electronic medical records. Disease and flare severity during 1 year after diagnosis were classified as mild, moderate or severe using a claims-based algorithm. Study outcomes included frequency and severity of flares stratified by disease severity during the 1-year post-diagnosis period and all-cause healthcare costs of flares by severity at 30, 60 and 90 days after flare.ResultsAmong 2227 patients, 26.3%, 51.0% and 22.7% had mild, moderate and severe SLE, respectively. The overall annual flare rate was 3.5 and increased with disease severity: 2.2, 3.7 and 4.2, respectively, for mild, moderate and severe SLE (p<0.0001). Patients with severe SLE had a higher annual severe flare rate (0.6) compared with moderate (0.1) or mild SLE (0; p<0.0001). Mean total all-cause costs at 30, 60 and 90 days after flare were $16 856, $22 252 and $27 468, respectively, for severe flares (mild flares: $1672, $2639 and $3312; moderate flares: $3831, $6225, $8582; (p<0.0001, all time points)). Inpatient costs were the primary driver of the increased cost of severe flares.ConclusionsFlare frequency and severity in newly diagnosed patients with SLE increase with disease severity. After a flare, healthcare costs increase over the following 90 days by disease severity. Preventing flares or reducing flare rates and duration may improve outcomes and reduce healthcare costs.
Investigating the efficacy of chest pressure for direct current cardioversion in atrial fibrillation: a randomised control trial protocol (Pressure-AF)
Authors: Ferreira David , Mikhail Philo , McGee Michael , Boyle Andrew , Sverdlov Aaron , William Maged , Jackson Nicholas , Barlow Malcolm , Leitch James , Collins Nicholas , Ford Thomas , Wilsmore Bradley 
Published: September 2021

IntroductionAtrial fibrillation (AF) is the most common sustained arrhythmia worldwide. Direct current cardioversion is commonly used to restore sinus rhythm in patients with AF. Chest pressure may improve cardioversion success through decreasing transthoracic impedance and increasing cardiac energy delivery. We aim to assess the efficacy and safety of routine chest pressure with direct current cardioversion for AF.Methods and analysisMulticentre, double blind (patient and outcome assessment), randomised clinical trial based in New South Wales, Australia. Patients will be randomised 1:1 to control and interventional arms. The control group will receive four sequential biphasic shocks of 150 J, 200 J, 360 J and 360 J with chest pressure on the last shock, until cardioversion success. The intervention group will receive the same shocks with chest pressure from the first defibrillation. Pads will be placed in an anteroposterior position. Success of cardioversion will be defined as sinus rhythm at 1 min after shock. The primary outcome will be total energy provided. Secondary outcomes will be success of first shock to achieve cardioversion, transthoracic impedance and sinus rhythm at post cardioversion ECG.Ethics and disseminationEthics approval has been confirmed at all participating sites via the Research Ethics Governance Information System. The trial has been registered on the Australia New Zealand Clinical Trials Registry (ACTRN12620001028998). De-identified patient level data will be available to reputable researchers who provide sound analysis proposals.
Discrepancy between left ventricular hypertrophy by echocardiography and electrocardiographic hypertrophy: clinical characteristics and outcomes
Authors: Seko Yuta , Kato Takao , Yamaji Yuhei , Haruna Yoshisumi , Nakane Eisaku , Haruna Tetsuya , Inoko Moriaki 
Published: September 2021

BackgroundThe clinical significance of the discrepancy between left ventricular hypertrophy (LVH) by echocardiography and ECG remains to be elucidated.MethodsAfter excluding patients who presented with pacemaker placement, QRS duration ≥120 ms and cardiomyopathy and moderate to severe valvular disease, we retrospectively analysed 3212 patients who had undergone both scheduled transthoracic echocardiography (echo) and ECG in a hospital-based population. Cornell product >2440 mm · ms was defined as ECG-based LVH; left ventricular mass index >115 g/m2for men and >95 g/m2for women was defined as echo-based LVH. The study population was categorised into four groups: patients with both ECG-based and echo-based LVH (N=131, 4.1%), those with only echo-based LVH (N=156, 4.9%), those with only ECG-based LVH (N=409, 12.7%) and those with no LVH (N=2516, 78.3%).ResultsThe cumulative 3-year incidences of a composite of all-cause death and major adverse cardiovascular events were 32.0%, 33.8%, 19.2% and 15.7%, respectively. After adjusting for confounders, the HRs relative to that in no LVH were 1.63 (95% CI 1.16 to 2.28), 1.68 (95% CI 1.23 to 2.30) and 1.09 (95% CI 0.85 to 1.41) in patients with both ECG-based and echo-based LVH, those with only echo-based LVH, and those with only ECG-based LVH, respectively.ConclusionsEcho-based LVH without ECG-based LVH was associated with a significant risk of adverse clinical events, and the risk was comparable to that in patients with both echo-based and ECG-based LVH.
Arctic Alaska Basin, Hanna Trough and Beaufortian Rifted Margin Composite Tectono-Sedimentary Elements
Authors: Houseknecht David W. 
Published: September 2021

Abstract
The Arctic Alaska region includes three composite tectono-sedimentary elements (CTSEs): (1) the Arctic Alaska Basin (AAB), (2) the Hanna Trough (HT) and (3) the Beaufortian Rifted Margin (BRM) CTSEs. These CTSEs comprise Mississippian–Lower Cretaceous (Neocomian) strata beneath much of the Alaska North Slope, the Chukchi Sea and westernmost North Slope, and the Beaufort Sea, respectively. These sedimentary successions rest on Devonian and older sedimentary and metasedimentary rocks, considered economic basement, and are overlain by Cretaceous–Cenozoic syn- and post-tectonic strata deposited in the foreland of the Chukotka and Brooks Range orogens and in the Amerasia Basin. (1) The Mississippian–Neocomian AAB CTSE includes two TSEs: (a) the Ellesmerian Platform TSE, comprising mainly shelf strata of Mississippian–Middle Jurassic age, and including a relatively undeformed domain in the north and a fold-and-thrust domain in the south; and (b) the Beaufortian Rift-Shoulder TSE, which includes Middle Jurassic–Neocomian deposits related to rift-shoulder uplift. (2) The HT CTSE includes four TSEs: (a) the Ellesmerian Synrift TSE, which comprises Late Devonian(?)–Middle Mississippian growth strata deposited in graben and half-graben during intracontinental rifting; (b) the Ellesmerian–Beaufortian Sag-Basin TSE, which comprises Middle Mississippian–Upper Triassic strata deposited in a sag basin following cessation of rifting; (c) the Beaufortian Synrift TSE, comprising Jurassic–Neocomian graben-fill deposits related to rifting in the Amerasia and North Chukchi basins; and (d) the Beaufortian Rift-Shoulder TSE, which comprises Jurassic–Neocomian strata related to rifting and deposited outside rift basins. (3) The BRM CTSE includes two TSEs: (a) the Beaufortian Synrift TSE, comprising Middle Jurassic–Neocomian synrift strata deposited on attenuated continental crust associated with opening of the Amerasia Basin; and (b) the Ellesmerian Platform TSE, comprising mainly shelf strata of Mississippian–Middle Jurassic age that lie beneath Beaufortian synrift strata.
The AAB, HT and BRM CTSEs contain oil-prone source rocks in Triassic, Jurassic and Cretaceous strata, and proven reservoir rocks spanning Mississippian–Lower Cretaceous strata. A structurally high-standing area in the northern AAB CTSE, northern HT CTSE and southernmost BRM CTSE lies in the oil window, whereas all other areas lie in the gas window. Known hydrocarbon accumulations in the three CTSEs total more than 30 Bboe, and yet-to-find estimates suggest that a similar volume remains to be discovered.