bluuebunny/crossref_metadata_2025_split huggingface dataset:
CRP in the diagnosis of pulmonary embolism
Authors: Hogg Kerstin 
Published: October 2021

BackgroundDiagnosing pulmonary embolism (PE) can be a difficult process for junior doctors, because it relies on clinical probability scoring and knowledge of how to apply and interpret D-dimer, VQ and CT scanning. The THREAD study aimed to assess the potential diagnostic role of novel biomarkers, in attempt to identify a future, more simple test. The aim of this analysis is to assess the potential role of C reactive protein (CRP) in the diagnosis of PE.MethodsThe prospective diagnostic study was conducted at a single general hospital in the UK, between September 2008 and June 2009. All patients investigated for PE were eligible. Exclusions were age <16, lack of capacity and refusal. All patients underwent an evidence based protocol to diagnose or exclude PE, along with a 3 month clinical follow-up period. CRP was not conducted as a blinded research test, instead, the study documented the initial CRP result when the investigating physician ordered the test. Potential for diagnostic use was assessed by constructing receiver operating characteristic (ROC) curves for all patients investigated for PE and emergency department patients investigated for PE.Results411/414 patients investigated for PE were approached for consent and 354 patients investigated for PE were enrolled to the study. PE was diagnosed in 19.2% patients. Of this cohort, 269 patients had CRP testing ordered by their physician. The area under the ROC curve (AUC) for CRP in the diagnosis of PE was 0.72 (95% CI 0.65 to 0.78). The AUC for PE was 0.77 (95% CI 0.69 to 0.84) in patients presenting to the emergency department (n=199).DiscussionThis is a limited exploratory analysis. Results will be available for the full cohort of patients (n=354) by the conference.ConclusionsCRP has a moderate association with PE in emergency department patients, however could not diagnose PE alone.
‘Whole body’ CT scanning following blunt multitrauma: a Delphi study
Authors: Hunt Paul 
Published: October 2021

BackgroundThe 2007 NCEPOD report recommends the routine use of ‘top-to-toe’ scanning in the adult trauma patient if no immediate indication for intervention exists. No specific guidelines currently exist for the use of ‘Whole Body’ CT (WBCT) scanning following blunt multi-trauma. Current clinical practice relies on trauma team leader decision-making although a number of UK institutions have presented WBCT protocols and supporting data. However, there is a paucity of evidence with which to inform best clinical practice.ObjectiveThe aim of this study was to explore the main issues regarding WBCT for blunt multi-trauma as the first stage of a wider research programme aiming to develop a WBCT protocol and recommendations for best clinical practice. A Delphi study was conducted in order to establish national and multidisciplinary consensus on a series of relevant statements which could be used to produce both clinical practice and organisational recommendations, and to highlight areas where further research was required.MethodsInvitations and follow-up questionnaires were sent to a representative sample of consultants working in the fields of Emergency Medicine, trauma surgery, anaesthesia, critical care and radiology from across the UK. A total of 160 statements were generated from the responses to these questionnaires, which contributors were then able to comment on and modify during two subsequent rounds before a list of final ‘consensus’ statements were agreed.Results18/18 of correspondents who replied to the initial invitation completed all three rounds of the study. The results demonstrated considerable agreement on the need for a formal WBCT protocol, evidence-based clinical indicators and an effective clinical governance structure. We present a full description of the consensus statements, initial recommendations and an original WBCT protocol. We believe this is the first systematic attempt to define and identify areas of best clinical practice regarding WBCT for blunt multi-trauma.
Is the diagnostic value of either ESR or CRP sufficient to exclude the need to measure both in paediatric patients presenting with non-traumatic limb pain?
Authors: Robinson Sara 
Published: October 2021

BackgroundLaboratory tests for cases of suspected orthopaedic infection usually include measurement of both the erythrocyte sedimentation rate (ESR) and the C reactive protein (CRP). This has a time and cost implication for the laboratories. The measurement of both also requires a larger volume blood sample, which can be difficult to obtain.ObjectiveTo assess if the measurement of either CRP or ESR individually has a likelihood ratio equivalent to that of the measurement of both.SettingEmergency Department of a Paediatric Teaching Hospital.Study designRetrospective study of Case Notes for patients attending the Emergency Department with a complaint of atraumatic limb pain and in whom both ESR and CRP were measured at the time of presentation. Laboratory results at the time of presentation were recorded along with the final diagnosis. Receiver operating characteristic (ROC) curves were created using the data. Likelihood Ratios for ESR and CRP individually and in combination were calculated.Results259 patients were included in the study of whom 17 were considered to have an Orthopaedic infection. The ROC curves revealed the best results were obtained using cut off values of CRP>7 and ESR>12. The combination of a CRP>7 and an ESR>12 gave the best positive Likelihood Ratio at 6.26 (Likelihood ratio 5.34 (CRP>7) vs 2.57 (ESR>12)) For ruling out disease the combination of CRP≤7 and an ESR≤12 also outperformed either variable individually (negative likelihood ratio 0.09 (CRP≤7 and ESR≤12) vs 0.34 (CRP≤7) vs 0.18 (ESR≤12)).ConclusionA raised CRP is a more specific indicator of orthopaedic infection than a raised ESR; however the ESR is more sensitive. Thus the Likelihood Ratios produced by the combination of the two results are superior to those of either measurement individually. The measurement of both CRP and ESR should be considered an important aid in the investigation of atraumatic limb pain.
The management of children in unscheduled care services by emergency care practitioners
Authors: O'Keefe Colin 
Published: October 2021

Background/objectivesEmergency Care Practitioners (ECPs) are an example of a new role in healthcare. ECPs are substituting for standard providers such as doctors in various unscheduled care services. In these services ECPs are managing paediatric cases, although there is no evidence for their effective management of this patient group. As part of a multi-centre trial we evaluated ECP effectiveness in the discharge of children following a minor illness or injury care episode.MethodsThree pairs of unscheduled services (urgent care, minor injury unit and out of hours) were included in the trial. Each pair comprised an intervention ECP service and a matched control service employing standard non-ECP providers. All care episodes of patients under the age of 16 were identified from the three pairs of services. The primary outcome was percentage of patients discharged after consultation.ResultsAcross all services the percentage of patients discharged by ECPs was significantly less than the percentage discharged by standard non-ECP providers (59% vs 66%; X2 = 10.1; df=1; p<0.05). ECPs discharged fewer patients in all three pairs of services and in the Out of Hours (X2=4.1; df=1; p< 0.05) and the Urgent Care Centre (X2=4.7; df=1; p<0.05) pairs the difference in discharge rates was statistically significant.ImplicationsECPs do not appear to be as effective as standard health providers in discharging children after care. ECPs may be better targeted at patients groups in which there is better evidence of their effectiveness.LimitationsFindings for these services individually may not be generalisable to other similar service settings. However, nationally, the participating services were not considered atypical in how ECP services had developed. It was not possible to design a randomised study in the context of ECP working because the services were already operational.
Comparing paediatric hospital admission rates between emergency departments in england – a descriptive analysis using hospital episode statistics data
Authors: Thompson Mary 
Published: October 2021

AimTo investigate whether children living near paediatric emergency departments have lower paediatric admission rates than children living near general emergency departments.Design(i) Descriptive analysis of paediatric admissions using routine hospital episode statistics data (HES data). (ii) Spatial analysis of paediatric and general emergency departments and census output areas using Geographical Information Systems.SubjectsAll paediatric emergency admissions of 0–14 year olds in the financial years 2001/2002 –2005/2006 in all hospitals in England.HypothesisNull (H0): there is no difference in paediatric admission rates between children living near paediatric emergency departments and children living near general emergency departments. (H1): children living near paediatric emergency departments are less likely to be admitted than populations of children living near general emergency departments.Main outcome measuresRRs of admission with adjustment for age, sex, deprivation and year of admission, both overall and for specific disease categories: asthma, respiratory diseases, gastroenteritis, other infections, signs and symptoms, injuries and other admissions.ResultsThere were 3 156 479 admissions over the 5-year period. Children living near paediatric emergency departments have a lower risk of admission (RR 0.77, 95% CI 0.76 to 0.77) compared with children living nearby general emergency departments. The highest admission rates came from the most deprived areas (Carstairs 5) and the lowest from the least deprived (Carstairs 1). Boys had higher admission rates than girls for all diagnoses and the under-1s had the highest admission rates followed by the 10–14 year olds.ConclusionsPaediatric emergency departments may have a significant impact in reducing childhood admissions.
Impact of ambulatory intravenous antibiotic therapy for children with pre-septal cellulitis
Authors: Brugha Rossa 
Published: October 2021

AimTo assess the impact of ambulatory intravenous antibiotic therapy for children with preseptal cellulitis.DesignRetrospective audit of 62 patients presenting with preseptal cellulitis over a 12 month period.SettingPaediatric Emergency Department, Chelsea and Westminster Hospital, London.Results62 patients identified from discharge summary coding. On review of medical notes 59 patients fulfilled criteria for preseptal cellulitis. Patients were attributed a modified severity score out of seven, based on signs and symptoms as previously1 19 patients (32%) were discharged home on oral antibiotics, one patient (2%) on topical therapy only, and 39 patients (66%) were started on intravenous antibiotics. There was a significant difference in symptom score between children started on oral versus intravenous antibiotic therapy (2.47 vs 3.21, p=0.021). Of the patients started on intravenous antibiotics, 22 children (56%) were managed on an ambulatory basis and 17 children (44%) were admitted. The management guideline allowed for ambulatory care, provided specified clinical factors were not present. The mean duration of antibiotic therapy was not different between the two groups (2.90 vs 2.75 days, p=0.79). Only three children in the study required imaging and there were no intracranial complications in either group. On a crude cost benefit analysis, the net fiscal benefit of a 3 day course of ambulatory versus inpatient intravenous therapy was calculated as £1672 per patient. For the study group, this represented a saving to the commissioning Trust of £36 784.ConclusionsIn this study group, children requiring intravenous antibiotics for uncomplicated preseptal cellulitis were safely managed on an ambulatory basis. This conveyed a considerable financial benefit to the health economy, in addition to a reduction in the burden of hospitalisation placed upon children and their families.
Massive transfusion in paediatric trauma: a single centre experience
Authors: Hearn Robert 
Published: October 2021

AimsTo report the occurrence of major haemorrhage in children following major trauma, the practice of blood products transfusion including monitoring of laboratory parameters in such patients and the outcomes.MethodsWe retrospectively analysed the local paediatric trauma database of all children following trauma call activation on arrival to the Emergency Department in a major urban trauma centre in London. We studies over a period of 15 months, May 2008–August 2009. We defined massive transfusion as packed red cells >40 ml/kg in the first 4 h or >80 ml/kg in the first 24 h.Results227 children presented to the accidents and emergency during this period following major trauma call activation. The median age at presentation was 10.2 years. 13 (5.7%) children had major haemorrhage. The median ISS WAS 35 (IQR 10–60). All but one were males. Three had penetrating trauma, one of whom made it to theatre but all died. Four had emergency damage control surgery. Abnormal results were seen in three patients, each having one abnormal result (INR=1.9 and APTT=86, low Hb=7.6, thrombocytopaenia =63). 8/13 patients received additional blood products such as Fresh Frozen Plasma (FFP), platelets and Cryoprecipitate. However, no patient received the ration of blood products RBC:FFP of 1:1 as practised in adult trauma. Two patients had no admission bloods done. Worsening coagulation parameters were seen in two patients when measure post-transfusion and the remaining 11 patients did not have routine monitoring of blood parameters post-transfusion. 8 (62%) patients died of which 7 died in the Emergency Department.ConclusionsMajor haemorrhage is associated with a very high mortality in severely injured children. There is a need for instituting a major haemorrhage policy in paediatric trauma and consideration of point-of-care testing of blood parameters.
‘More than just chitchat’: a qualitative study concerning the need and potential format of a peer mentor programme for patients with early rheumatoid arthritis
Authors: Van der Elst Kristien , De Cock Diederik , Bangels Lore , Peerlings Lianne , Doumen Michael , Bertrand Delphine , De Caluwé Lies , Langers Ilse , Stouten Veerle , Westhovens René , Verschueren P 
Published: October 2021

BackgroundPatients recently diagnosed with rheumatoid arthritis (RA) have specific educational and supportive needs. These could partly be addressed with mentoring by other patients living with RA. This qualitative study explores stakeholder perceptions towards peer mentoring in early RA care.MethodsTwo focus groups with patients with early RA (n=10), one with patient organisation representatives (n=5), one with rheumatologists (n=8) and one with rheumatology nurses (n=5) were held. Two patient research partners supported analysis and interpretation.ResultsFour overarching themes were found: added value, experience with peer mentoring, concerns and need in daily care. Patients and patient organisation representatives confirmed the potential of peer mentoring especially regarding sensitive topics not easily discussed with professionals. Patients felt it could provide additional understanding and recognition. Nurses and rheumatologists were less convinced of the added value of peer mentoring because patients never mentioned it and they were concerned about the loss of control over correct information provision. The need for peer mentoring was perceived as person and disease phase-dependent and should therefore be optional, rather than a care standard. The requirements for a peer mentorship programme remained challenging to define for stakeholders. However, all expressed the need for supervision by healthcare professionals and that peer mentors should be carefully selected, educated and matched to newly diagnosed patients.ConclusionPeer mentoring and its implementation remain vague concepts, especially for healthcare providers. However, patients are interested in mentoring by peers, and the current results may support in effectively implementing such programmes early in the disease.
Controlling the process of muon formation for muon-catalyzed fusion: method of non-destructive average muon sign detection
Authors: Holmlid Leif 
Published: October 2021

AbstractThe recent development of intense muon sources (Holmlid, Swedish Patent SE 539,684 C 2 (2017)) is crucial for the use of muon-catalyzed fusion reactors (L. Holmlid, Fusion Science and Technology 75, 208 (2019)) which are likely to be the first generation of practical fusion reactors. For this purpose, only negative muons are useful. For existing sources where negative muons can be ejected (if not formed) preferentially, it is necessary to know the amount of negative muons to determine and optimize the fusion reactor efficiency on-line. Here, a method is developed to measure the absolute muon flux and its average sign without collecting or deflecting the muons. The muons from the patented muon generator have an energy of 100 MeV and above and an intensity of 1013 muons per laser pulse. Here, the detection of the relativistic laser-induced muons from H(0) is reported with a standard particle beam method, using a wire coil on a ferrite toroid as detector for the relativistic particles. The coil detection method shows that these relativistic particles are charged, thus not photons, neutrinos or neutral kaons. This makes the coil method superior to scintillator methods and it is the only possible method due to the large muon intensity. If an equal number of positive and negative mouns passed the coil, no signal would be observed. The signal at the coil in the case shown here is due to relativistic positive muons as concluded from a signal charge sign verification in the coil.
The Domain-General Multiple Demand Network Is More Active in Early Balanced Bilinguals Than Monolinguals During Executive Processing
Authors: Malik-Moraleda Saima , Cucu Theodor , Lipkin Benjamin , Fedorenko Evelina 
Published: October 2021

AbstractThe bilingual experience may place special cognitive demands on speakers and has been argued to lead to improvements in domain-general executive abilities, like cognitive control and working memory. Such improvements have been argued for based on both behavioral and brain imaging evidence. However, the empirical landscape is complex and ridden with controversy. Here we attempt to shed light on this question through an fMRI investigation of relatively large, relatively homogeneous, and carefully matched samples of early balanced bilinguals (n = 55) and monolinguals (n = 54), using robust, previously validated individual-level markers of neural activity in the domain-general multiple demand (MD) network, which supports executive functions. We find that the bilinguals, compared to the monolinguals, show significantly stronger neural responses to an executive (spatial working memory) task, and a larger difference between a harder and an easier condition of the task, across the MD network. These stronger neural responses are accompanied by better behavioral performance on the working memory task. We further show that the bilingual-vs.-monolingual difference in neural responses is not ubiquitous across the brain as no group difference in magnitude is observed in primary visual areas, which also respond to the task. Although the neural group difference in the MD network appears robust, it remains difficult to causally link it to bilingual experience specifically.
Pancretic Fat Accummulation is Associated with Subclinical Atherosclerosis
Authors: Sahin Sinan , Karadeniz Aysegul 
Published: October 2021

We investigated the relationship between pancreatic fat accumulation and markers of atherosclerosis among patients with nonalcoholic fatty liver disease (NAFLD). Patients with NAFLD have been reported to be at an increased risk of vascular events. We grouped 183 patients in whom we detected and graded hepatosteatosis (HS) on transabdominal ultrasonography into 2 groups based on the presence/absence of pancreatic fat. There were 85 participants (50 female; mean age: 53.6 ± 9.7 years) who were nonalcoholic fatty pancreas disease (NAFPD) positive and 98 participants (56 female; mean age: 51.4 ± 9.3 years) who were NAFPD negative. Carotid intima media thickness (cIMT) was significantly greater in the group where HS was accompanied by NAFPD (0.51 [0.40–0.62] vs 0.45 [0.35–0.55] mm; P < .001). Multivariable analyses showed that the independent predictors of increased cIMT were age (odds ratio [OR]: 1.108; 95% CI: 1.059–1.158, P = .001), hypertension (OR: 2.244; 95% CI: 1.099–4.579, P = .026), and the presence of NAFPD (OR: 3.078; CI 95% CI: 1.531–6.190, P = .0002). In the present study we demonstrated that, in patients with NAFLD, pancreatic fat accumulation was significantly associated with cIMT, a marker of early atherosclerosis. NAFPD may increase the risk of vascular events associated with NAFLD.
Testing for Hepatitis C Virus Infection Among Adults Aged ≥18 in the United States, 2013-2017
Authors: King Hope , Soh J.E. , Thompson William W. , Brown Jessica Rogers , Rapposelli Karina , Vellozzi Claudia 
Published: October 2021

Objective Approximately 2.4 million people in the United States are living with hepatitis C virus (HCV) infection. The objective of our study was to describe demographic and socioeconomic characteristics, liver disease–related risk factors, and modifiable health behaviors associated with self-reported testing for HCV infection among adults. Methods Using data on adult respondents aged ≥18 from the 2013-2017 National Health Interview Survey, we summarized descriptive data on sociodemographic characteristics and liver disease–related risk factors and stratified data by educational attainment. We used weighted logistic regression to examine predictors of HCV testing. Results During the study period, 11.7% (95% CI, 11.5%-12.0%) of adults reported ever being tested for HCV infection. Testing was higher in 2017 than in 2013 (adjusted odds ratio [aOR] = 1.27; 95% CI, 1.18-1.36). Adults with ≥some college were significantly more likely to report being tested (aOR = 1.60; 95% CI, 1.52-1.69) than adults with ≤high school education. Among adults with ≤high school education (but not adults with ≥some college), those who did not have health insurance were less likely than those with private health insurance (aOR = 0.78; 95% CI, 0.68-0.89) to get tested, and non–US-born adults were less likely than US-born adults to get tested (aOR = 0.77; 95% CI, 0.68-0.87). Conclusions Rates of self-reported HCV testing increased from 2013 to 2017, but testing rates remained low. Demographic characteristics, health behaviors, and liver disease–related risk factors may affect HCV testing rates among adults. HCV testing must increase to achieve hepatitis C elimination targets.
Implementation of Mobile Audiometry During the COVID‐19 Pandemic
Authors: Garcia Alejandro , Chari Divya A. , Stankovic Konstantina M. , Lee Daniel J. , Kozin Elliott D. , Franck Kevin H. 
Published: October 2021

During the COVID‐19 pandemic, the utility of portable audiometry became more apparent as elective procedures were deferred in an effort to limit exposure to health care providers. Herein, we retrospectively evaluated mobile‐based audiometry in the emergency department and outpatient otology and audiology clinics. Air conduction thresholds with mobile audiometry were within 5 dB in 66% of tests (95% CI, 62.8%‐69.09%) and within 10 dB in 84% of tests (95% CI, 81.4%‐86.2%) as compared with conventional audiometry. No significant differences were noted between mobile‐based and conventional audiometry at any frequencies, except 8 kHz (P <. 05). The sensitivity and specificity for screening for hearing loss were 94.3% (95% CI, 91.9%‐96.83%) and 92.3% (95% CI, 90.1%‐94.4%), respectively. While automated threshold audiometry does not replace conventional audiometry, mobile audiometry is a promising screening tool when conventional audiometry is not available.