bluuebunny/crossref_metadata_2025_split huggingface dataset:
An AI Approach for Identifying Patients With Cirrhosis
Authors: Obeid Jihad S. , Khalifa Ali , Xavier Brandon , Bou-Daher Halim , Rockey Don C. 
Published: July 2021

Goal:
The goal of this study was to evaluate an artificial intelligence approach, namely deep learning, on clinical text in electronic health records (EHRs) to identify patients with cirrhosis.

Background and Aims:
Accurate identification of cirrhosis in EHR is important for epidemiological, health services, and outcomes research. Currently, such efforts depend on International Classification of Diseases (ICD) codes, with limited success.

Materials and Methods:
We trained several machine learning models using discharge summaries from patients with known cirrhosis from a patient registry and random controls without cirrhosis or its complications based on ICD codes. Models were validated on patients for whom discharge summaries were manually reviewed and used as the gold standard test set. We tested Naive Bayes and Random Forest as baseline models and a deep learning model using word embedding and a convolutional neural network (CNN).

Results:
The training set included 446 cirrhosis patients and 689 controls, while the gold standard test set included 139 cirrhosis patients and 152 controls. Among the machine learning models, the CNN achieved the highest area under the receiver operating characteristic curve (0.993), with a precision of 0.965 and recall of 0.978, compared with 0.879 and 0.981 for the Naive Bayes and Random Forest, respectively (precision 0.787 and 0.958, and recalls 0.878 and 0.827). The precision by ICD codes for cirrhosis was 0.883 and recall was 0.978.

Conclusions:
A CNN model trained on discharge summaries identified cirrhosis patients with high precision and recall. This approach for phenotyping cirrhosis in the EHR may provide a more accurate assessment of disease burden in a variety of studies.
Mental Health, Social Support, and Death Anxiety in Patients With Chronic Kidney Failure
Authors: Khodarahimi Siamak , Veiskarami Hassan Ali , Mazraeh Nasrollah , Sheikhi Sonay , Rahimian Bougar Mojtaba 
Published: July 2021

Abstract

Purpose: This study aimed to investigate the relationship between mental health, perceived social support, and death anxiety, and the predictive roles of mental health and perceived social support in the explanation of death anxiety in a sample of adults with chronic kidney disease. Methods: A demographic questionnaire, the Symptom Check List−25, the Social Support Survey Scale, and the Death Anxiety Scale (DAS) were used in the present study. The sample consisted of 58 adult patients with chronic kidney failure. Results: Findings showed that mental health had significantly positive relationships to the total score of the death anxiety and the fear of death, the fear of pain and disease, and the death thoughts subscales of the DAS. Social support had a significant negative relationship to the total score of the death anxiety and the fear of pain and disease, the death thoughts, and the transient time and the short life subscales of the DAS. Mental health and combined mental health and social support explained 14% and 21% of death anxiety variation in patients with chronic kidney failure, respectively. Conclusion: Mental health and social support constructs can relatively predict the variations of death anxiety in patients with chronic kidney failure.
Telehealth Educational Resources for Graduate Nurse Faculty
Authors: Chike-Harris Katherine E. , Garber Kelli , Derouin Anne 
Published: July 2021

Background
The rapid acceleration of virtual health care delivery, telehealth, has underlined the pressing need for graduate nursing students to gain skills and competencies that will ensure effective and efficient delivery of telehealth care in future generations.

Problem
There is a need for graduate nursing students to be prepared to use telehealth, but few nursing programs offer this training. Barriers to this implementation may be due to lack of faculty knowledge, telehealth resources, or telehealth opportunities.

Solution
Graduate nursing faculty should use resources and the wisdom of early adopters of telehealth to ensure adequate telehealth preparation is integrated into all graduate nursing programs.

Conclusion
This article describes emerging core competencies for telehealth education and offers guidance, resources, and activities for nurse educators who seek to prepare emerging advanced practice RNs to plan, deliver, and implement effective telehealth practices.
Sigmoid Colon Carcinoma Presenting in Inguinoscrotal Hernia With FDG PET/CT
Authors: Erol Özge , Beyhan Ediz , Şahin Rahime , Baloğlu Mehmet Can , Çermik Tevfik Fikret 
Published: July 2021

Abstract
Primary carcinoma of the sigmoid colon in an inguinal hernia is a rare condition. We present a 79-year-old man diagnosed with sigmoid colon carcinoma referred to 18F-FDG PET/CT for staging. PET/CT showed the primary lesion in the inguinal hernia into scrotum.
Osteoblastoma of the Lumbar Spine
Authors: Laverde Mächler Alfredo , Suárez Fernández Juan Pablo , Domínguez Grande María Luz , Vigil Díaz Carmen , González García Francisco Manuel 
Published: July 2021

Abstract
Osteoblastoma is an uncommon benign osteoid tissue-forming bone tumor. We present the case of a 16-year-old adolescent boy with lower back pain that radiated down the right thigh. Lumbar MRI and CT findings were consistent with a long-standing osteoid osteoma located in the right laminae and pedicle of L3. SPECT/CT with 99mTc-DPD showed a highly increased osteogenic activity within the lesion, especially in the core region, also suggesting an osteoid osteoma. Surgical en bloc resection was performed with a final histological diagnosis of osteoblastoma.
Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control
Authors: DuBose Joseph J. , Burlew Clay Cothren , Joseph Bellal , Keville Meghan , Harfouche Melike , Morrison Jonathan , Fox Charles J. , Mooney Jennifer , O’Toole Robert , Slobogean Gerard , Marchand Lucas S. , Demetriades Demetrios , Werner Nicole L. , Benjamin Elizabeth , Costantini Todd 
Published: July 2021

ABSTRACT
Major pelvic hemorrhage remains a considerable challenge of modern trauma care associated with mortality in over a third of patients. Efforts to improve outcomes demand continued research into the optimal employment of both traditional and newer hemostatic adjuncts across the full spectrum of emergent care environments. The purpose of this review is to provide a concise description of the rationale for and effective use of currently available adjuncts for the control of pelvic hemorrhage. In addition, the challenges of defining the optimal order and algorithm for employment of these adjuncts will be outlined.

LEVEL OF EVIDENCE
Review, level IV.
Femoral vascular access for endovascular resuscitation
Authors: Manning James E. , Moore Ernest E. , Morrison Jonathan J. , Lyon Regan F. , DuBose Joseph J. , Ross James D. 
Published: July 2021

ABSTRACT
Endovascular resuscitation is an emerging area in the resuscitation of both severe traumatic hemorrhage and nontraumatic cardiac arrest. Vascular access is the critical first procedural step that must be accomplished to initiate endovascular resuscitation. The endovascular interventions presently available and emerging are routinely or potentially performed via the femoral vessels. This may require either femoral arterial access alone or access to both the femoral artery and vein. The time-critical nature of resuscitation necessitates that medical specialists performing endovascular resuscitation be well-trained in vascular access techniques. Keen knowledge of femoral vascular anatomy and skill with vascular access techniques are required to meet the needs of critically ill patients for whom endovascular resuscitation can prove lifesaving. This review article addresses the critical importance of femoral vascular access in endovascular resuscitation, focusing on the pertinent femoral vascular anatomy and technical aspects of ultrasound-guided percutaneous vascular access and femoral vessel cutdown that may prove helpful for successful endovascular resuscitation.
Can RH+ whole blood be safely used as an alternative to RH− product? An analysis of efforts to improve the sustainability of a hospital’s low titer group O whole blood program
Authors: McCoy C. Cameron , Montgomery Kelsey , Cotton Madeline E. , Meyer David E. , Wade Charles E. , Cotton Bryan A. 
Published: July 2021

BACKGROUND
Low-titer group O whole blood (LTO-WB) has recently gained popularity in trauma centers for the acute resuscitation of hemorrhagic shock. However, limited supplies of Rh− product prevent implementation and strain sustainability at many trauma centers. We set out to identify whether Rh+ LTO-WB could be safely substituted for RH− product, regardless of patient’s Rh status.

METHODS
Following Institutional Review Board approval, information on all trauma patients receiving prehospital or emergency department transfusion of uncrossed, emergency release LTO-WB (11/17–10/19) were evaluated. Patients were first divided into those who received Rh− versus Rh+ product, the assessed by Rh of the recipient. Serial hemolysis panels, transfusion reactions, and outcomes were compared.

RESULTS
Six hundred thirty-seven consecutive trauma patients received emergency release LTO-WB. Of these, 448 received Rh+ product, while 189 received Rh− LTO-WB. Patients receiving Rh+ product were more likely to be men (81 vs. 70%) and have lower field blood pressure (median 99 vs. 109) and GCS (median 7 vs. 12); all p < 0.05. There were no differences in blood product volume, hemolysis laboratories, transfusion reactions, complications, or survival. We then separated patients by Rh status (577 were Rh+, 70 were Rh−). Rh− patients were older (median age 54 vs. 39), more likely to be women (57 vs. 26%), and more likely to have sustained blunt trauma than their Rh+ counterparts (92 vs. 70%); all p < 0.05. There were no differences in hemolysis laboratories, transfusion reactions, complications, or survival between Rh+ and Rh− patients, regardless of Rh product received.

CONCLUSION
When Rh− whole blood is unavailable or in short supply, Rh+ LTO-WB appears to be a safe alternative for the resuscitation of hemorrhagic shock in both Rh+ and Rh− patients. Use of Rh+ product may help trauma centers incorporate LTO-WB into their hospital and improve sustainability of such programs.

LEVEL OF EVIDENCE
Therapeutic, Level III
In-house intensivist presence does not affect mortality in select emergency general surgery patients
Authors: Rushing Amy P. , Strassels Scott A. , Ricci Kevin B. , Daniel Vijaya T. , Ingraham Angela M. , Paredes Anghela Z. , Diaz Adrian , Oslock Wendelyn M. , Baselice Holly E. , Heh Victor K. , Santry Heena P. 
Published: July 2021

BACKGROUND
This study aimed to assess the relationship between availability of round-the-clock (RTC) in-house intensivists and patient outcomes in people who underwent surgery for a life-threatening emergency general surgery (LT-EGS) disease such as necrotizing soft-tissue infection, ischemic enteritis, perforated viscus, and toxic colitis.

METHODS
Data on hospital-level critical care structures and processes from a 2015 survey of 2,811 US hospitals were linked to patient-level data from 17 State Inpatient Databases. Patients who were admitted with a primary diagnosis code for an LT-EGS disease of interest and underwent surgery on date of admission were included in analyses.

RESULTS
We identified 3,620 unique LT-EGS admissions at 368 hospitals. At 66% (n = 243) of hospitals, 83.5% (n = 3,021) of patients were treated at hospitals with RTC intensivist-led care. These facilities were more likely to have in-house respiratory therapists and protocols to ensure availability of blood products or adherence to Surviving Sepsis Guidelines. When accounting for other key factors including overnight surgeon availability, perioperative staffing, and annual emergency general surgery case volume, not having a protocol to ensure adherence to Surviving Sepsis Guidelines (adjusted odds ratio, 2.10; 95% confidence interval, 1.12–3.94) was associated with increased odds of mortality.

CONCLUSION
Our results suggest that focused treatment of sepsis along with surgical source control, rather than RTC intensivist presence, is key feature of optimizing EGS patient outcomes.

LEVEL OF EVIDENCE
Therapeutic, level III.
ABO Mismatch in Allogeneic Hematopoietic Stem Cell Transplant: Effect on Short- and Long-term Outcomes
Authors: Valentini Caterina Giovanna , Metafuni Elisabetta , Gallo Lorenzo , Giammarco Sabrina , Orlando Nicoletta , Bianchi Maria , Sica Simona , Bacigalupo Andrea , Chiusolo Patrizia , Teofili Luciana 
Published: July 2021

Background.
The impact of ABO incompatibility (ABO-I) on hematopoietic stem cell transplant outcomes is still debated.

Methods.
We retrospectively investigated 432 consecutive transplants performed at our center (2012–2020). All patients but 6 were affected by hematologic malignancies. The effect of different ABO match combinations on engraftment rate, transfusion support, acute and chronic graft-versus-host disease incidences, nonrelapse mortality (NRM), disease-free survival, and overall survival was assessed in univariate and multivariate analysis. Significance was set at P < 0.05.

Results.
ABO match distribution among transplants was as follows: 223 ABO-compatible, 94 major ABO-I, 82 minor ABO-I, and 33 bidirectional ABO-I. At univariate analysis, major ABO-I delayed the engraftment of neutrophils, platelets, and erythroid cells. At multivariate analysis, major ABO-I transplants displayed delayed erythroid engraftment (odds ratio [OR], 0.51; 95% confidence intervals [CIs], 0.38-0.70; P < 0.0001) and hindered transfusion independence for both red blood cells (OR, 0.52; 95% CI, 0.37-0.72; P = 0.0001) and platelets (0.60; 95% CI, 0.45-0.86; P = 0.0048). Moreover, major ABO-I transplants received greater amounts of blood products (P < 0.0001 for red blood cells and P = 0.0447 for platelets). In comparison with other ABO matches, major ABO-I was associated with an increased NRM (OR, 1.67; 95% CI, 1.01-2.75; P = 0.0427). No effects of ABO-mismatch were found on graft-versus-host disease, disease-free survival, and overall survival.

Conclusions.
Major ABO mismatch delays multilineage engraftment hinders transfusion independence and increases NRM. The prognostic impact of transfusion burden in hematopoietic stem cell transplantation deserves to be explored.
Successful Use of Minocycline for the Treatment of Methamphetamine-Induced Psychosis and Cognitive Impairments: An Open-Label Case Series
Authors: Alavi Sasan , Darharaj Mohammad , Bilehsavar Shirin Haghshenas , Amini Mahdi , Zafarghandi Mohammad Bagher Saberi , Berenji Vahid , Arezoomandan Reza 
Published: July 2021

Aim
Methamphetamine-induced psychosis and neuropsychological impairments are common among patients with methamphetamine use disorder. Given some preclinical and clinical studies reporting potential effects of minocycline, a second-generation tetracycline, on correcting manifestations of drug addiction, this study aimed to examine the effectiveness of minocycline in attenuating psychotic symptoms and neuropsychological impairments in chronic methamphetamine users.

Method
Five men with treatment-resistant methamphetamine use disorder and psychotic symptoms were selected using a convenience sampling method, and they were administered a daily dose of 200-mg minocycline for 8 weeks; within this period, psychiatric and neuropsychological assessments (including memory and executive functions) were carried out at the baseline, week 2, week 4, week 8, and 2-month follow-up.

Results
The findings showed that minocycline attenuated both positive (Cohen d = 0.63) and negative (Cohen d = 0.53) methamphetamine-induced psychotic symptoms and also improved patients' neuropsychological functions, particularly their auditory working memory (Cohen d = 0.45).

Conclusions
These results provide promising evidence regarding the positive effects of minocycline as adjunctive pharmacotherapy for patients with methamphetamine use disorder. However, given that this was an open-label study, further research is warranted to draw a firm conclusion about the effectiveness of minocycline for methamphetamine-induced psychosis and neuropsychological deficits.
Real World Pharmacological First Treatment Patterns of Patients With Parkinson Disease and Disease Duration: A Large-Scale Cohort Study Using an Health Maintenance Organization Database
Authors: Faust-Socher Achinoam , Gurevich Tanya , Rozani Violetta , Giladi Nir , Hemo Beatriz , Peretz Chava 
Published: July 2021

Objectives
Real-world data were used to describe first antiparkinsonian drug (FAPD) prescription patterns among Parkinson disease (PD) patients and to evaluate disease duration until levodopa (l-DOPA) treatment and until death, as related to FAPD, by age group.

Methods
The community-based cohort (2000–2012) included 6243 patients, members of an Israeli Health Maintenance Organizations. Time from FAPD purchase to 2 end points (l-DOPA purchase and death) was calculated. Cox regressions were used to estimate adjusted heart rate (HR) to either end point as related to FAPD type, by age group.

Results
During a mean follow-up of 4.8 ± 3.2 years, one third of the cohort died. The percent of l-DOPA use as a start drug increased with age, whereas the percent of dopamine agonists (DAs) and monoamine oxidase inhibitor B inhibitor (MAO-BI) decreased with age. Younger women were treated more often with DA as a start drug compared with younger men. In ages of younger than 50 years, time to l-DOPA start in the initial DA-group was 4 times longer than in the initial MAO-BI group (HR, 0.23; 95% confidence interval, 0.08–0.43; 1/0.23, 4.35). All age groups exhibited a similar survival time trend associated with initial drug type. An age-pooled HR with initial l-DOPA-group as a reference group yielded that survival time was 2.4 times longer for the initial DA group (HR, 0.41; 95% confidence interval, 0.31–0.55; 1/0.41, 2.44), 1.9 times and 1.4 times for initial MAO-BI or amantadine, respectively.

Conclusions
First antiparkinsonian drug choice might be associated with time until l-DOPA initiation but may represent disease severity at the time of prescription, thus also affecting survival time as well. Real-world data illustrated that this choice is also age and sex dependent.
Mortality among Care Home Residents in England during the first and second waves of the COVID-19 pandemic: an analysis of 4.3 million adults over the age of 65
Authors: Schultze Anna , Nightingale Emily , Evans David , Hulme William , Rosello Alicia , Bates Chris , Cockburn Jonathan , MacKenna Brian , Curtis Helen J , Morton Caroline E , Croker Richard , Bacon Seb , McDonald Helen I , Rentsch Christopher T , Bhaskaran Krishnan , Mathur Rohini , Tomlinson Laurie A , Williamson Elizabeth J , Forbes Harriet , Tazare John , Grint Daniel , Walker Alex J , Inglesby Peter , DeVito Nicholas J , Mehrkar Amir , Hickman George , Davy Simon , Ward Tom , Fisher Louis , Green Amelia CA , Wing Kevin , Wong Angel YS , McManus Robert , Parry John , Hester Frank , Harper Sam , Evans Stephen JW , Douglas Ian J , Smeeth Liam , Eggo Rosalind M , Goldacre Ben , Leon David A 
Published: July 2021

AbstractBackgroundResidents in care homes have been severely impacted by the COVID-19 pandemic. We describe trends in risk of mortality among care home residents compared to residents in private homes in England.MethodsOn behalf of NHS England, we used OpenSAFELY-TPP, an analytics platform running across the linked electronic health records of approximately a third of the English population, to calculate monthly age-standardised risks of death due to all causes and COVID-19 among adults aged >=65 years between 1/2/2019 and 31/03/2021. Care home residents were identified using linkage to the Care and Quality Commission.FindingsWe included 4,329,078 people aged 65 years or older on the 1st of February 2019, 2.2% of whom were classified as residing in a care or nursing home. Age-standardised mortality risks were approximately 10 times higher among care home residents compared to non-residents in February 2019 residents (CMF = 10.59, 95%CI = 9.51, 11.81 among women, CMF = 10.82, 95%CI = 9.89, 11.84 among men). This increased to more than 17 times in April 2020 (CMF = 17.52, 95%CI = 16.38, 18.74 among women, CMF = 18.12, 95%CI = 17.17 – 19.12 among men) before returning to pre-pandemic levels in June 2020. CMFs did not increase during the second wave, despite a rise in the absolute age-standardised COVID-19 mortality risks.InterpretationThe first COVID-19 wave had a disproportionate impact on care home residents in England compared to older private home residents. A degree of immunity, improved protective measures or changes in the underlying frailty of the populations may explain the lack of an increase in the relative mortality risks during the second wave. The care home population should be prioritised for measures aimed at controlling the spread of COVID-19.FundingMedical Research Council MR/V015737/1
Deaths in Children and Young People in England following SARS-CoV-2 infection during the first pandemic year: a national study using linked mandatory child death reporting data
Authors: Smith C , Odd D , Harwood R , Ward J , Linney M , Clark M , Hargreaves D , Ladhani SN , Draper E , Davis PJ , Kenny SE , Whittaker E , Luyt K , Viner RM , Fraser LK 
Published: July 2021

AbstractBackgroundDeaths in children and young people (CYP) following SARS-CoV-2 infection are rare. Quantifying the risk of mortality is challenging because of high relative prevalence of asymptomatic and non-specific disease manifestations. Therefore, it is important to differentiate between CYP who have died of SARS-CoV-2 and those who have died of an alternative disease process but coincidentally tested positive.MethodsDuring the pandemic, the mandatory National Child Mortality Database (NCMD) was linked to Public Health England (PHE) testing data to identify CYP (<18 years) who died with a positive SARS-CoV-2 test. A clinical review of all deaths from March 2020 to February 2021 was undertaken to differentiate between those who died of SARS-CoV-2 infection and those who died of an alternative cause but coincidentally tested positive. Then, using linkage to national hospital admission data, demographic and comorbidity details of CYP who died of SARS-CoV-2 were compared to all other deaths. Absolute risk of death was estimated where denominator data were available.Findings3105 CYP died from all causes during the first pandemic year in England. 61 of these deaths occurred in CYP who tested positive for SARS-CoV-2. 25 CYP died of SARS-CoV-2 infection; 22 from acute infection and three from PIMS-TS. 99·995% of CYP with a positive SARS-CoV-2 test survived. The 25 CYP who died of SARS-CoV-2 equates to a mortality rate of 2/million for the 12,023,568 CYP living in England. CYP >10 years, of Asian and Black ethnic backgrounds, and with comorbidities were over-represented compared to other children.InterpretationSARS-CoV-2 is very rarely fatal in CYP, even among those with underlying comorbidities. These findings are important to guide families, clinicians and policy makers about future shielding and vaccination.FundingRH is in receipt of a fellowship from Kidney Research UK. JW is in receipt of a Medical Research Council Fellowship. LF is in receipt of funding from Martin House Childrens Hospice.