bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimorbidity patterns of chronic conditions and geriatric syndromes in older patients from the MoPIM multicentre cohort study
Authors: Baré Marisa , Herranz Susana , Roso-Llorach Albert , Jordana Rosa , Violán Concepción , Lleal Marina , Roura-Poch Pere , Arellano Marta , Estrada Rafael , Nazco Gloria Julia 
Published: November 2021

ObjectivesTo estimate the frequency of chronic conditions and geriatric syndromes in older patients admitted to hospital because of an exacerbation of their chronic conditions, and to identify multimorbidity clusters in these patients.DesignMulticentre, prospective cohort study.SettingInternal medicine or geriatric services of five general teaching hospitals in Spain.Participants740 patients aged 65 and older, hospitalised because of an exacerbation of their chronic conditions between September 2016 and December 2018.Primary and secondary outcome measuresActive chronic conditions and geriatric syndromes (including risk factors) of the patient, a score about clinical management of chronic conditions during admission, and destination at discharge were collected, among other variables. Multimorbidity patterns were identified using fuzzy c-means cluster analysis, taking into account the clinical management score. Prevalence, observed/expected ratio and exclusivity of each chronic condition and geriatric syndrome were calculated for each cluster, and the final solution was approved after clinical revision and discussion among the research team.Results740 patients were included (mean age 84.12 years, SD 7.01; 53.24% female). Almost all patients had two or more chronic conditions (98.65%; 95% CI 98.23% to 99.07%), the most frequent were hypertension (81.49%, 95% CI 78.53% to 84.12%) and heart failure (59.86%, 95% CI 56.29% to 63.34%). The most prevalent geriatric syndrome was polypharmacy (79.86%, 95% CI 76.82% to 82.60%). Four statistically and clinically significant multimorbidity clusters were identified: osteoarticular, psychogeriatric, cardiorespiratory and minor chronic disease. Patient-level variables such as sex, Barthel Index, number of chronic conditions or geriatric syndromes, chronic disease exacerbation 3 months prior to admission or destination at discharge differed between clusters.ConclusionsIn older patients admitted to hospital because of the exacerbation of chronic health problems, it is possible to define multimorbidity clusters using soft clustering techniques. These clusters are clinically relevant and could be the basis to reorganise healthcare circuits or processes to tackle the increasing number of older, multimorbid patients.Trial registration numberNCT02830425.
Prospective pilot study protocol evaluating the safety and feasibility of robot-assisted nipple-sparing mastectomy (RNSM)
Authors: Park Ko Un , Lee Sandy , Sarna Angela , Chetta Matthew , Schulz Steven , Agnese Doreen , Grignol Valerie , Carson William E , Skoracki Roman J 
Published: November 2021

IntroductionNipple-sparing mastectomy (NSM) can be performed for the treatment of breast cancer and risk reduction, but total mammary glandular excision in NSM can be technically challenging. Minimally invasive robot-assisted NSM (RNSM) has the potential to improve the ergonomic challenges of open NSM. Recent studies in RNSM demonstrate the feasibility and safety of the procedure, but this technique is still novel in the USA.Methods and analysisThis is a single-arm prospective pilot study to determine the safety, efficacy and potential risks of RNSM. Up to 12 RNSM will be performed to assess the safety and feasibility of the procedure. Routine follow-up visits and study assessments will occur at 14 days, 30 days, 6 weeks, 6 months and 12 months. The primary outcome is to assess the feasibility of removing the breast gland en bloc using the RNSM technique. To assess safety, postoperative complication information will be collected. Secondary outcomes include defining benefits and challenges of RNSM for both surgeons and patients using surveys, as well as defining the breast and nipple-areolar complex sensation recovery following RNSM. Mainly, descriptive analysis will be used to report the findings.Ethics and disseminationThe RNSM protocol was reviewed and approved by the US Food and Drug Administration using the Investigational Device Exemption mechanism (reference number G200096). In addition, the protocol was registered with ClinicalTrials.gov (NCT04537312) and approved by The Ohio State University Institutional Review Board, reference number 2020C0094 (18 August 2020). The results of this study will be distributed through peer-reviewed journals and presented at surgical conferences.Trial registration numberNCT04537312.
Which outcomes are most important to measure in patients with COVID-19 and how and when should these be measured? Development of an international standard set of outcomes measures for clinical use in patients with COVID-19: a report of the International Consortium for Health Outcomes Measurement (ICHOM) COVID-19 Working Group
Authors: Seligman William H , Fialho Luz , Sillett Nick , Nielsen Christina , Baloch Farhala M , Collis Philip , Demedts Ingel K M , Fleck Marcelo P , Floriani Maiara A , Gabriel Lucinda E K , Gagnier Joel J , Keetharuth Anju , Londral Ana , Ludwig Ingvar I L , Lumbreras Carlos , Moscoso Daza Alejandro , Muhammad Nasreen , Nader Bastos Gisele A , Owen Christine W , Powers John H , Russell Anne-Marie , Smith Michaela K , Wang Tracy Y-P , Wong Evan K , Woodhouse Douglas C , Zimlichman Eyal , Brinkman Kees 
Published: November 2021

ObjectivesThe COVID-19 pandemic has resulted in widespread morbidity and mortality with the consequences expected to be felt for many years. Significant variation exists in the care even of similar patients with COVID-19, including treatment practices within and between institutions. Outcome measures vary among clinical trials on the same therapies. Understanding which therapies are of most value is not possible unless consensus can be reached on which outcomes are most important to measure. Furthermore, consensus on the most important outcomes may enable patients to monitor and track their care, and may help providers to improve the care they offer through quality improvement. To develop a standardised minimum set of outcomes for clinical care, the International Consortium for Health Outcomes Measurement (ICHOM) assembled a working group (WG) of 28 volunteers, including health professionals, patients and patient representatives.DesignA list of outcomes important to patients and professionals was generated from a systematic review of the published literature using the MEDLINE database, from review of outcomes being measured in ongoing clinical trials, from a survey distributed to patients and patient networks, and from previously published ICHOM standard sets in other disease areas. Using an online-modified Delphi process, the WG selected outcomes of greatest importance.ResultsThe outcomes considered by the WG to be most important were selected and categorised into five domains: (1) functional status and quality of life, (2) mental functioning, (3) social functioning, (4) clinical outcomes and (5) symptoms. The WG identified demographic and clinical variables for use as case-mix risk adjusters. These included baseline demographics, clinical factors and treatment-related factors.ConclusionImplementation of these consensus recommendations could help institutions to monitor, compare and improve the quality and delivery of care to patients with COVID-19. Their consistent definition and collection could also broaden the implementation of more patient-centric clinical outcomes research.
Advance care planning and health literacy in older dialysis patients: qualitative interview study
Authors: O Riordan Julien , Kane P M , Noble Helen , Smyth Andrew 
Published: November 2021

ObjectivesLow health literacy among older adults is associated with limited engagement in end-of-life care planning, higher hospitalisation rates and increased mortality. Frequently, older dialysis patients derive no survival benefit from dialysis and their quality of life often deteriorates further on dialysis. Older dialysis patients’ values and wishes are frequently unknown during key healthcare decision making and many endure medically intensive end-of-life scenarios. The objectives of this study were to explore older dialysis patients’ understanding of haemodialysis, to explore their engagement in end-of-life care planning and to explore their satisfaction with life on haemodialysis.Methods15 older dialysis patients participated in qualitative semistructured interviews in two haemodialysis units in Ireland. Thematic saturation was reached. Thematic analysis, applied inductively, was used to distill the data.ResultsThemes identified included disempowerment among participants reflected limited health literacy, poor advance care planning compromised participant well-being, haemodialysis compromised participants’ core values.ConclusionHealth literacy levels among older dialysis patients are poor, patient empowerment is limited and their participation in shared decision making and advance care planning is suboptimal. Consequently, healthcare decision making, including haemodialysis, may jeopardise patients’ core values. Improving health literacy through enhanced patient education and improved communication skills training for clinicians is necessary to promote patient participation in shared decision making. Clinician training to facilitate discussion of patients’ values and wishes will help guide clinicians and patients towards healthcare decisions most concordant with patients’ core values. This approach will optimise the circumstances for patient-centred care.
Prevalence of cardiac pathology and relation to mortality in a multiethnic population hospitalised with COVID-19
Authors: Bioh Gabriel , Botrous Christina , Howard Emma , Patel Ashish , Hampson Reinette , Senior Roxy 
Published: November 2021

ObjectiveTo determine the prevalence of cardiac abnormalities and their relationship to markers of myocardial injury and mortality in patients admitted to hospital with COVID-19.MethodsA retrospective and prospective observational study of inpatients referred for transthoracic echocardiography for suspected cardiac pathology due to COVID-19 within a London NHS Trust. Echocardiograms were performed to assess left ventricular (LV), right ventricular (RV) and pulmonary variables along with collection of patient demographics, comorbid conditions, blood biomarkers and outcomes.ResultIn the predominant non-white (72%) population, RV dysfunction was the primary cardiac abnormality noted in 50% of patients, with RV fractional area change <35% being the most common marker of this RV dysfunction. By comparison, LV systolic dysfunction occurred in 18% of patients. RV dysfunction was associated with LV systolic dysfunction and the presence of a D-shaped LV throughout the cardiac cycle (marker of significant pulmonary artery hypertension). LV systolic dysfunction (p=0.002, HR 3.82, 95% CI 1.624 to 8.982), pulmonary valve acceleration time (p=0.024, HR 0.98, 95% CI 0.964 to 0.997)—marker of increased pulmonary vascular resistance, age (p=0.047, HR 1.027, 95% CI 1.000 to 1.055) and an episode of tachycardia measured from admission to time of echo (p=0.004, HR 6.183, 95% CI 1.772 to 21.575) were independently associated with mortality.ConclusionsIn this predominantly non-white population hospitalised with COVID-19, the most common cardiac pathology was RV dysfunction which is associated with both LV systolic dysfunction and elevated pulmonary artery pressure. The latter two, not RV dysfunction, were associated with mortality.
Assessment of Impact of Patient Recruitment Volume on Risk Profile, Outcomes, and Treatment Effect in a Randomized Trial of Ticagrelor Versus Prasugrel in Acute Coronary Syndromes
Authors: Ndrepepa Gjin , Neumann Franz‐Josef , Menichelli Maurizio , Bernlochner Isabell , Richardt Gert , Wöhrle Jochen , Witzenbichler Bernhard , Mayer Katharina , Cassese Salvatore , Gewalt Senta , Xhepa Erion , Kufner Sebastian , Sager Hendrik B. , Joner Michael , Ibrahim Tareq , Laugwitz Karl‐Ludwig , Schunkert Heribert , Schüpke Stefanie , Kastrati Adnan 
Published: November 2021

BACKGROUND
Whether there are differences in the risk profile and treatment effect in patients recruited in a low recruitment center (LRC) versus patients recruited in a high recruitment center (HRC) in a randomized multicenter trial remains unknown.

METHODS AND RESULTS

This study included 4018 patients with acute coronary syndrome recruited in the ISAR‐REACT 5 (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5) trial. The primary end point was a composite of all‐cause death, myocardial infarction, or stroke. Overall, 3011 patients (75%) were recruited in the HRCs (7 centers recruiting 258 to 628 patients; median, 413 patients) and 1007 patients (25%) were recruited in the LRCs (16 centers recruiting 5 to 201 patients; median, 52 patients). Patients recruited in the LRCs had more favorable cardiovascular risk profiles than patients recruited in the HRCs. The primary end point occurred in 72 patients in the LRCs and 249 patients in the HRCs (cumulative incidence, 7.3% and 8.4%;
P
=0.267). All‐cause mortality was lower among patients recruited in the LRCs (n=29) than among patients recruited in the HRCs (n=134; cumulative incidence 2.9% versus 4.5%;
P
=0.031). There was no significant interaction between the treatment effect of ticagrelor versus prasugrel and patient recruitment category (LRC versus HRC) regarding the primary efficacy end point (LRC: hazard ratio [HR], 1.42 [95% CI, 0.89–2.28]; HRC: HR, 1.33 [95% CI, 1.04−1.72];
P
for interaction=0.800).

CONCLUSIONS
Patients with acute coronary syndrome recruited in a LRC appear to have more favorable cardiovascular risk profiles and lower 1‐year mortality rates compared with patients recruited in a HRC. The recruitment volume did not interact with the treatment effect of ticagrelor versus prasugrel.

REGISTRATION

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01944800.
MSWX: Global 3-Hourly 0.1° Bias-Corrected Meteorological Data Including Near-Real-Time Updates and Forecast Ensembles
Authors: Beck Hylke E. , van Dijk Albert I. J. M. , Larraondo Pablo R. , McVicar Tim R. , Pan Ming , Dutra Emanuel , Miralles Diego G. 
Published: November 2021

Abstract
We present Multi-Source Weather (MSWX), a seamless global gridded near-surface meteorological product featuring a high 3-hourly 0.1° resolution, near-real-time updates (∼3-h latency), and bias-corrected medium-range (up to 10 days) and long-range (up to 7 months) forecast ensembles. The product includes 10 meteorological variables: precipitation, air temperature, daily minimum and maximum air temperature, surface pressure, relative and specific humidity, wind speed, and downward shortwave and longwave radiation. The historical part of the record starts 1 January 1979 and is based on ERA5 data bias corrected and downscaled using high-resolution reference climatologies. The data extension to within ∼3 h of real time is based on analysis data from GDAS. The 30-member medium-range forecast ensemble is based on GEFS and updated daily. Finally, the 51-member long-range forecast ensemble is based on SEAS5 and updated monthly. The near-real-time and forecast data are statistically harmonized using running-mean and cumulative distribution function-matching approaches to obtain a seamless record covering 1 January 1979 to 7 months from now. MSWX presents new and unique opportunities for hydrological modeling, climate analysis, impact studies, and monitoring and forecasting of droughts, floods, and heatwaves (within the bounds of the caveats and limitations discussed herein). The product is available at www.gloh2o.org/mswx.
Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty
Authors: Starr Nicole C. , Creel Liza , Harryman Christopher , Gupta Nikita 
Published: November 2021

Background: Human cadaveric allograft (HCA) and costal cartilage autograft (CCA) have been described for reconstruction during rhinoplasty. Neither are ideal due to infection, resorption, and donor site morbidity. The clear superiority of 1 graft over the other has not yet been demonstrated. This study assesses comparative costs associated with current grafting materials to better explore the cost ceiling for a theoretical tissue engineered implant. Materials and methods: A cost utility analysis was performed. Initial procedure costs include physician fees (CPT 30420), hospital outpatient prospective payments, ambulatory surgical center payments, and fees for the following: rib graft (CPT 20910), hospital observation, and DRG (155) for inpatient admission. Additional costs for revision procedure, included the following fees: physician (CPT 30345), rib graft, hospital outpatient prospective payment, and ambulatory surgical center payments. Total costs under each scenario were calculated with and without the revision procedure. Comparison of total costs for each potential outcome to the estimated health utility value allowed for comparison across rhinoplasty subgroups. Results: The mean cost of primary outpatient rhinoplasty using HCA and CCA were $8075 and $8342 respectively. Revision outpatient rhinoplasty averaged $7447 and increased to $8228 if costal cartilage harvest was required. Hospital admission increased the cost of primary rhinoplasty with CCA to $8609 for observational admission and to $13653 for 1 day inpatient admission. Revision CCA rhinoplasty with an inpatient admission complicated by pneumothorax increased costs to $21 099. Conclusion: Cost of rhinoplasty without hospitalization was similar between HCA and CCA and this cost represents the lower limit of a practical cost for an engineered graft. Considering complications such as need for revision or for admission after CCA due to surgical morbidity, the upper limit of cost for an engineered implant would approximately double.
Disrupted dynamic pattern of regional neural activity in early-stage cognitively normal Parkinson's disease
Authors: Zhang Yi , Wang Xiulan , Li Yuan 
Published: November 2021

Background Neuroimaging studies on Parkinson's disease (PD) mainly focus on static neural activity. However, the dynamic pattern of regional brain activity in early-stage cognitively normal PD has rarely been elucidated. Purpose To identify altered dynamic amplitude of low-frequency fluctuation (dALFF) in PD before the onset of cognitive impairment and verify its differentiating ability between patients with PD and healthy controls (HC). Material and Methods dALFF and static ALFF (sALFF) derived from functional magnetic resonance imaging data of 51 patients with PD and 50 matched HCs were analyzed. The correlations between aberrant regions and clinical performance were investigated using Spearman correlation analysis. Multivariate pattern analysis was conducted to detect the differentiating ability of both ALFF features. Results Compared with HCs, patients with PD demonstrated reduced dALFF variance in bilateral lingual gyrus, left middle occipital gyrus, left postcentral gyrus (PcG), and right supplementary motor area (SMA); and increased dALFF variability in bilateral parahippocampal gyrus. Besides overlapping with these distributions of altered dALFF, the aberrant regions of sALFF were more extensive with decreased sALFF in the right middle temporal gyrus and right PcG, and increased sALFF in the left inferior temporal gyrus and left thalamus were observed in patients with PD. dALFF values in right SMA and left PcG were correlated with UPDRS-III scores ( ρ =  −0.29, P = 0.041; ρ =  −0.33, P = 0.018, respectively). Conclusion This study provides novel insights into the neural basis underlying PD as well as the potential role of dynamic neural activity in the diagnosis and prediction of the disease.
The Effects of Using Tranexamic Acid in Tumescent Solution During Rhytidectomy Surgery
Authors: Fathimani Kayvan , Perenack Jon , Christensen Brian J. 
Published: November 2021

Introduction: Tranexamic acid (TXA) is a common adjunct to assist in hemostasis in a wide variety of applications. Although TXA has gained more popularity in facial cosmetic surgery, there are limited studies evaluating the effects of TXA in rhytidectomy patients, especially when used in tumescent solution. Purpose: The purpose of this study was to evaluate the effects of TXA on surgical time, postoperative ecchymosis, and need for aspiration when used in tumescent solution during cervicofacial rhytidectomy procedures. Materials and Methods: The authors designed a retrospective cohort study from an eligible population of all patients treated with cervicofacial rhytidectomy using tumescent solution at Williamson Cosmetic Center in Baton Rouge, LA, from January 1, 2019, to December 31, 2019. The outcome variables were surgical time, need for postoperative aspiration, and the duration of bruising postoperatively. The primary predictor variable was the use of TXA in the tumescent solution. Statistical analysis was performed using t tests and chi-square analyses. Results: Overall, 70 patients were included in the study with a mean age of 61.4 ± 7.2 years and 90% were female. Forty-five patients were in the TXA group and 25 in the non-TXA group. The use of TXA in tumescent solution was statistically significant for reducing ecchymosis ( p < .001). The majority of patients in the TXA group (60%) had bruising cleared by day 7, whereas the majority of patients in the non-TXA group (52%) had bruising cleared by day 28. There was a statically significant reduction in frequency of postoperative aspiration in the TXA group (8.9% in TXA group vs 40.0% in the non-TXA group, P = .002). The study did not demonstrate a significant difference in surgical time between the two groups. Discussion: Although there is a lack of recognition of the potential benefits of TXA, there has been an increased off-label use by numerous surgical specialties. Routes of administration include topical, oral, intravenous, local infiltrative, and by tumescent anesthesia. Improvements in intraoperative hemostasis and postoperative ecchymosis are some of the main benefits of TXA. Conclusions: Utilizing TXA in tumescent solution in patients undergoing cervicofacial rhytidectomy procedures is associated with an improvement in postoperative ecchymosis duration and a decreased need for postoperative aspiration compared with the non-TXA group.