bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimorbidity in patients with atrial fibrillation and community controls: A population-based study
Authors: Chamberlain Alanna M. , Alonso Alvaro , Noseworthy Peter A. , Siontis Konstantinos C. , Gersh Bernard J. , Killian Jill M. , Weston Susan A. , Vaughan Lisa E. , Manemann Sheila M. , Roger Véronique L. , Ryu Euijung 
Published: December 2024

Background Multimorbidity is common in patients with atrial fibrillation (AF), yet comorbidity patterns are not well documented. Methods The prevalence of 18 chronic conditions (6 cardiometabolic, 7 other somatic, 5 mental health) was obtained in patients with new-onset AF from 2013-2017 from a 27-county region and controls matched 1:1 on age, sex, and county of residence. For AF patients and controls separately, clustering of conditions and co-occurrence beyond chance was estimated (using the asymmetric Somers’ D statistic), overall and for ages <65, 65-74, 75-84, and ≥85 years. Results Among 16,509 patients with AF (median age 76 years, 57% men), few (4%) did not have any of the 18 chronic conditions, whereas nearly one-quarter of controls (23%) did not have any chronic conditions. Clustering of cardiometabolic conditions was common in both AF patients and controls, but clustering of other somatic conditions was more common in AF. Although the prevalence of most condition pairs was higher in AF patients, controls had a larger number of condition pairs occurring together beyond chance. In persons aged <65 years, AF patients more frequently exhibited concordance of condition pairs that included either pairs of somatic conditions or a combination of conditions from different condition groups. In persons aged 65-74 years, AF patients more frequently had pairs of other somatic conditions. Conclusion Patterns of co-existing conditions differed between patients with AF and controls, particularly in younger ages. A better understanding of the clinical consequences of multimorbidity in AF patients, including those diagnosed at younger ages, is needed.
Evaluation of the effects of fenestration in Fontan circulation using a lumped parameter model
Authors: Horio Naohiro , Shimizu Shuji , Kotani Yasuhiro , Miyahara Yoshinori , Kasahara Shingo 
Published: December 2024

AbstractFenestration has been reported to enhance Fontan hemodynamics in several cases of Fontan circulation. However, the indication criteria for fenestration remain under discussion. To assess the effectiveness of fenestration in Fontan circulation, we conducted a theoretical analysis using a computational model of the fenestrated Fontan circulation. The cardiac chambers and vascular systems were modeled using the time-varying elastance model and the modified Windkessel model, respectively. When the pulmonary vascular resistance index was 4.01 Wood units m2, fenestration significantly reduced central venous pressure from 18.0 to 16.1 mmHg and decreased stressed blood volume from 610 to 555 ml. However, in the models with reduced ventricular end-systolic elastance, increased ventricular stiffness constant, or heightened systemic vascular resistance, the advantages of fenestration were diminished. Thus, fenestration may effectively improve the hemodynamics of Fontan circulation in patients with elevated pulmonary vascular resistance.
The profound impact of COVID-19 on the control and care of diabetic patients: a comprehensive retrospective cohort study
Authors: Al Rashdi Fakhria , Al Harrasi Salwa , Al Ismaili Mohammed , Yaaqubi AL-Ghaliya AL , Atwan Zeenah , Tabche Celine 
Published: December 2024

Abstract
Background
The COVID-19 pandemic has led to a significant shift in healthcare services, focusing on pandemic response and emergency preparedness. The Oman Ministry of Health implemented various measures to combat and control COVID-19. However, this shift disrupted routine outpatient appointments, particularly for chronic diseases such as diabetes mellitus (DM) and hypertension (HTN). This study aims to assess the pandemic’s effect on diabetes control, by examining glycated haemoglobin (HbA1c), blood pressure (BP), lipid values (particularly low-density lipoprotein (LDL), body weight/ body mass index (BMI), and comparing these measures to pre-pandemic levels.

Methods
A retrospective cohort study of 223 people with diabetes (PwD), aged 20–95 years who underwent a blood workup in 2019 and 2020 and were registered in Al-Khuwair Health Centre from March to December 2020. Data was extracted from the Al Shifa 3plus System and National Diabetic Register (NDR), and analyzed using SPSS.

Results
Out of 260 PwD identified, 223 met the inclusion criteria, while 37 were excluded due to recent diagnoses or missing follow-up in 2019. Significant changes were observed in HbA1C, systolic blood pressure (SBP), and BMI from 2019 to 2020. Mean HbA1c increased from 6.9% in 2019 to 7.2% in 2020. Mean SBP rose from 131.22 mmHg in 2019 to 134.84 mmHg in 2020, while mean BMI increased from 30.49 to 30.80. No significant changes were found in LDL levels or diastolic BP.

Conclusion
The COVID-19 pandemic disrupted healthcare systems globally, and the consequences on health and mortality were not only due to the direct impact of the virus, but also to the modifications in priorities. These interruptions in inconsistent care, had consequences for non-communicable diseases (NCDs) like diabetes. Future strategic plans should be prepared and implemented to manage NCD cases in case of pandemics.
Incidence of primary care chest pain consultations during the COVID-19 pandemic: an interrupted time series analysis with routine care data
Authors: van den Bulk Simone , van Egeraat Jasper W. A. , Petrus Annelieke H. J. , Numans Mattijs E. , Bonten Tobias N. 
Published: December 2024

Abstract
Background
The COVID-19 lockdown had profound effects on society and healthcare. Cardiology departments reported declines in chest pain evaluations and acute coronary syndrome (ACS) diagnoses. However, the pattern of chest pain in primary care is not clear yet. This study aims to assess the impact of the COVID-19 lockdown on the number of patients presenting with chest pain in primary care.

Methods
Routine primary care data from the Extramural LUMC (Leiden University Medical Center) Academic Network (ELAN) in the Netherlands were used. Chest pain consultations from January 2017 to December 2020 were included. An interrupted time series analysis was performed to compare the incidence rate (IR) of chest pain consultations during the COVID-19 lockdown to the expected IR. Secondary outcomes were the type of consultations, referral proportions, and the IR of registered ACS diagnoses.

Results
In total 9,908 chest pain consultations were included. During the COVID-19 lockdown the IR was 6.16 per 1000 person-years while the expected IR was 7.55 (95% CI 7.03–8.12). The immediate effect of the lockdown yielded an incidence rate ratio (IRR) of 0.62 (95% CI 0.50–0.77). A similar decrease was seen for ACS diagnoses (IRR 0.62, 95% CI 0.48–0.79), with no compensatory increase after the lockdown (IRR 1.04, 95% CI 0.89–1.21). Face-to-face consultations shifted to telephone consultations (p < 0.001) and hospital referrals decreased (9.9% vs. 19.0% (p < 0.001)).

Conclusions
During the COVID-19 lockdown the number of chest pain consultations and registered ACS diagnoses in primary care decreased significantly. In addition, fewer patients were assessed face-to-face and fewer patients were referred to the hospital.
Providing ‘professionalism with compassion’; how the time for caring communication can improve experiences at the end-of-life at home, findings from a realist evaluation
Authors: McEwan Kathryn , Atkinson Joanne , Clarke Amanda , Bate Angela , Jeffery Caroline , Dalkin Sonia 
Published: December 2024

Abstract
Background
For many patients and caregivers, attending to dying and death at home will be a new and fearful experience. This research brings new evidence on the central support of the Rapid Response Service (RRS), provided to those who chose to die at home. RRS’s are variable, although all seek to avoid unwanted hospital admissions and to respond flexibly to suit individual preferences for support. Staffed by specialist palliative and end-of-life care nurses, the RRS works alongside primary and acute care, but little is known on their impact.

Methods
Realist evaluation is a theory driven approach which identifies patterns of generative causation; this approach ascertains what works, for who, why, and in what circumstances. In this study, initial theories were developed by the research team and subsequently tested through semi-structured realist interviews with patients, caregivers, RRS staff, and other health practitioners. Iterative rounds of data analysis were undertaken to tease out contexts, mechanisms and outcomes, testing and revising the theories, including the application of substantive theory. Finally, we produced refined programme theories (PTs) which provide the basis for wider application of findings.

Results
Overall, 36 participants contributed, and six areas of inquiry were developed. This paper sets out the data from one area, PT Skilled Communication. Several benefits arose from RRS staff having the time to talk to and with patients and caregivers: specifically, that this communication improved knowledge in a tailored and compassionate manner. These exchanges allayed fears and reduced uncertainty, improving confidence to care. This was particularly embedded in one RRS because of their holistic approach.

Conclusions
Supporting death and dying at home is a novel and difficult experience for many; skilled communication, provided by specialist palliative care staff, can make a positive difference. Through their provision of compassionate support, RRS staff can help caregivers to recognise and respond to different symptoms and situations, reducing fear. By responding rapidly, only on request, they also meet individual preferences for contact. Together, this improves the opportunity for the last days and hours of life to be experienced, at home, in as affirmative a manner as possible.
Ethical implications of AI-driven clinical decision support systems on healthcare resource allocation: a qualitative study of healthcare professionals’ perspectives
Authors: Elgin Cansu Yüksel , Elgin Ceyhun 
Published: December 2024

Abstract
Background
Artificial intelligence-driven Clinical Decision Support Systems (AI-CDSS) are increasingly being integrated into healthcare for various purposes, including resource allocation. While these systems promise improved efficiency and decision-making, they also raise significant ethical concerns. This study aims to explore healthcare professionals’ perspectives on the ethical implications of using AI-CDSS for healthcare resource allocation.

Methods
We conducted semi-structured qualitative interviews with 23 healthcare professionals, including physicians, nurses, administrators, and medical ethicists in Turkey. Interviews focused on participants’ views regarding the use of AI-CDSS in resource allocation, potential ethical challenges, and recommendations for responsible implementation. Data were analyzed using thematic analysis.

Results
Participant responses are clustered around five pre-determined thematic areas: (1) balancing efficiency and equity in resource allocation, (2) the importance of transparency and explicability in AI-CDSS, (3) shifting roles and responsibilities in clinical decision-making, (4) ethical considerations in data usage and algorithm development, and (5) balancing cost-effectiveness and patient-centered care. Participants acknowledged the potential of AI-CDSS to optimize resource allocation but expressed concerns about exacerbating healthcare disparities, the need for interpretable AI models, changing professional roles, data privacy, and maintaining individualized care.

Conclusions
The integration of AI-CDSS into healthcare resource allocation presents both opportunities and significant ethical challenges. Our findings underscore the need for robust ethical frameworks, enhanced AI literacy among healthcare professionals, interdisciplinary collaboration, and rigorous monitoring and evaluation processes. Addressing these challenges proactively is crucial for harnessing the potential of AI-CDSS while preserving the fundamental values of equity, transparency, and patient-centered care in healthcare delivery.
Patient cost analysis of a community-based teledermatology service versus conventional outpatient appointments in East Kent: a retrospective study through a societal lens to reduce health inequalities
Authors: Nizar Nurul Ain , Farooki Roopa , Mahapatra Piyush , Halpern Saul , Hoogenboom Tim C. H. 
Published: December 2024

Abstract
Background
The UK's National Health Service (NHS) is grappling with rising demand and limited dermatologists, leading to longer waiting times. This is particularly concerning for conditions like malignant melanoma, where early diagnosis is crucial. Teledermatology is being introduced to address these issues, but its impact on patients’ monetary and time costs, especially in deprived areas, is under-researched. This study investigates the impact of a community-based teledermatology model in East Kent, a coastal region with high cross-regional health inequalities.

Methods
We analysed the financial costs and time invested by patients undergoing community-based teledermatology versus if they were to attend traditional appointments. Data were gathered from 1368 referrals, from May 2022 to January 2024 at a secondary care provider in the region. We considered the diagnosis method, appointments, travel, monetary cost of time, parking costs and Index of Multiple Deprivation Deciles (IMDD).

Results
Our study showed the community teledermatology model significantly reduced the active patient’s time and cost to obtain a diagnosis. Average time was 38.1 min, compared to 96.7 min in traditional clinics, saving 58.4 min (95% CI -62.3 to -54.5, p < 0.001). Patients saved £17.9 per diagnosis with this model (95% CI -£19.2 to -£16.6, p < 0.001). Time savings were more substantial for patients from more deprived regions (IMDD 1–3).

Conclusion
The community-based teledermatology model proves to be cheaper for patients, providing a convenient alternative to traditional clinics, particularly benefiting patients from deprived backgrounds by improving healthcare accessibility and offering flexible consultation options.
Factor structure of the HIV-SM LMIC self-management questionnaire for people living with HIV in low- and middle-income countries
Authors: Dadi Tegene Legese , Medhin Girmay , Spigt Mark 
Published: December 2024

Abstract
Introduction
Despite the need for reliable questionnaires to monitor self-management in chronic disease patients, such tools are lacking in developing countries. This study aims to pilot and assess the construct validity of the HIV-SM LMIC questionnaire.

Method
The validation of the HIV-SM LMIC questionnaire involved two cross-sectional studies in Ethiopia. The first round, for exploratory factor analysis (EFA), included 261 patients, while the second round, for confirmatory factor analysis (CFA), included 300 patients. Data was collected using the Kobo Collect electronic data entry template.

Result
The sample adequacy test showed a good value of 0.82. In the first round, 6 of the 32 items were not loaded, forming three factors in the EFA. Four of these items were dropped, but two (PSMB2 and PSMB12) were retained for their content. In the second round, CFA on the remaining 28 items led to dropping 8 more items due to conceptual overlap, resulting in a 20-item questionnaire. The final items were structured into three dimensions: awareness and well-being (4 items), self-regulation (6 items), and self-management practices (10 items).

Conclusion
The study refined the original 32-item HIV-SM LMIC questionnaire to a validated 20-item, three-dimensional tool with an acceptable goodness of fit. The authors recommend further cross-cultural and predictive validation and adaptation for newly diagnosed HIV patients, those with poor treatment outcomes.
Effectiveness of dolutegravir-based regimens compared to raltegravir-, elvitegravir-, bictegravir, and darunavir-based regimens among older adults with HIV in the Veterans Aging Cohort Study (VACS)
Authors: Yan Lei , Henegar Cassidy E. , Marconi Vincent C. , Gordon Kirsha S. , Hicks Charles , Vannappagari Vani , Justice Amy C. , Aslan Mihaela 
Published: December 2024

Abstract
Background
Real-world data on treatment patterns and clinical outcomes for newer drugs, including integrase strand transfer inhibitors, among older people with human immunodeficiency virus (PWH) are limited.

Methods
This cohort study included PWH enrolled in the Veterans Aging Cohort Study (VACS) who were prescribed a standard 3-drug antiretroviral therapy (ART) regimen containing dolutegravir (DTG), bictegravir (BIC), cobicistat boosted elvitegravir (EVG), raltegravir (RAL), or darunavir/ritonavir (DRV) plus 2 nucleoside reverse transcriptase inhibitors between January 1, 2014, and March 31, 2020, and who were ≥50 years at regimen initiation. The association between regimen and virologic effectiveness or discontinuation was assessed using logistic regression models with inverse probability of treatment weights. Pairwise comparisons were made between DTG-based regimen and each of the other 3-drug regimens, stratified by ART experience.

Results
Among 15,702 PWH (across treatment groups, median age 58–62 years; 94–98% male; 5–11% Hispanic; 44–60% Black; 29–42% White), 5,800 received DTG-based regimens, 2,081 BIC-based regimens, 4,159 EVG-based regimens, 1,607 RAL-based regimens, and 2,055 received DRV-based regimens. Among ART-naïve PWH, there were no statistical differences in the odds of virologic suppression, and 6- and 12-month discontinuations were higher in those on DRV. Among ART-experienced PWH, compared to DTG, those on RAL and DRV were less likely to be suppressed at 6 months (RAL vs DTG: aOR 0.64, 95% CI 0.51–0.81; DRV vs DTG: aOR 0.63, 95% CI 0.51–0.76) and those on EVG and DRV were less likely suppressed at 12 months (EVG vs DTG: aOR 0.82, 95% CI 0.68–0.99; DRV vs DTG: aOR 0.64, 95% CI 0.52–0.80). Those on DRV were more likely to have virologic failure within 12 months (aOR 1.96, 95% CI 1.30–2.97). Six- and 12-month discontinuations were higher in those on RAL and DRV, but less likely for BIC-based regimens.

Conclusions
DTG-based regimens demonstrated higher levels of effectiveness and durability compared to DRV- or RAL-based regimens and had similar treatment responses as BIC- and EVG-based regimens among ART-experienced older PWH.
Upper extremity function and disability recovery with vibration therapy after stroke: a systematic review and meta-analysis of RCTs
Authors: Lu Yueh-Hsun , Chen Hung-Ju , Liao Chun-De , Chen Po-Jung , Wang Xin-Miao , Yu Chieh-Hsiang , Chen Po-Yin , Lin Chueh-Ho 
Published: December 2024

Abstract
Background
This study aimed to investigate the therapeutic effects of vibration therapy for improving upper extremity motor impairment, function, and disability recovery in people with stroke.

Design
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, EMBASE, the Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Knowledge Resource Integrated Database, and Google Scholar were searched from inception to May 31, 2024. Randomized controlled trials (RCTs) that evaluated the effects of vibration therapy on upper extremity motor impairment, function, and disability recovery post-stroke were analyzed.

Setting and participants
Participants with a diagnosis of stroke with hemiplegia (or hemiparesis) were recruited.

Methods
Methodological quality assessment was performed using the PEDro quality score. Upper extremity motor impairment, function, and disability were the primary outcomes. Upper extremity motor impairment was measured using the Fugl-Meyer Assessment scale and other methods. Upper extremity functions were evaluated using the Wolf Motor Function test or other tools assessing manipulative activities. Disability was assessed using the Functional Independence Measure, Barthel index, and other methods.

Results
Overall, 30 RCTs including 1621 people with stroke were selected. Compared with the control, vibration therapy exerted significant effects on upper extremity motor impairment [standardized mean difference (SMD) = 1.19; p < 0.00001)], function (SMD = 0.62; p < 0.00001), and disability recovery (SMD = 1.01; p < 0.00001). The subgroup analysis revealed that focal vibration therapy (SMD = 2.14) had favorable effects on disability recovery compared with whole-body vibration therapy (SMD = 2.0). Interventions lasting 4–8 weeks showed significant improvements in motor impairment (SMD = 1.19), motor function (SMD = 0.57), and disability (SMD = 0.84); additionally, the effects of vibration therapy combined with conventional rehabilitation (SMD = 1.03) were superior to those of vibration therapy alone (SMD = 0.21).

Conclusions
Vibration therapy may be a reliable rehabilitation program to improve upper extremity motor functions and disabilities. Furthermore, vibration therapy should be performed at the earliest possibility after stroke for at least 4–8 weeks.
Trial registration The protocol of this study was registered with PROSPERO (Registration number: CRD42022301119).
The current troubled state of the global pathology workforce: a concise review
Authors: Walsh Elizabeth , Orsi Nicolas M 
Published: December 2024

AbstractThe histopathology workforce is a cornerstone of cancer diagnostics and is essential to the delivery of cancer services and patient care. The workforce has been subject to significant pressures over recent years, and this review considers them in the UK and internationally. These pressures include declining pathologist numbers, the increasing age of the workforce, and greater workload volume and complexity. Forecasts of the workforce’s future in numerous countries are also not favourable – although this is not universal. Some in the field suggest that the effects of these pressures are already coming to bear, such as the financial costs of the additional measures needed to maintain clinical services. There is also some evidence of a detrimental impact on service delivery, patient care and pathologists themselves. Various solutions have been considered, including increasing the number of training places, enhancing recruitment, shortening pathology training and establishing additional support roles within pathology departments. A few studies have examined the effect of some of these solutions. However, the broader extent of their implementation and impact, if any, remains to be determined. In this regard, it is critical that future endeavours should focus on gaining a better understanding of the benefits of implemented workforce solutions, as well as obtaining more detailed and updated pathology workforce numbers. With a concentrated effort in these areas, the future of the pathology workforce could become brighter in the face of the increased demands on its services.