bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-term intraocular pressure changes after intravitreal aflibercept 2 mg, aflibercept 8 mg and faricimab: a prospective, comparative study
Authors: Paris Arianna , Volpe Giulio , Perruchoud-Ader Kathrin , Casanova Alex , Menghini Moreno , Grimaldi Gabriela 
Published: November 2024

Background/aimsIntravitreal injection (IVT) of anti-vascular endothelial growth factor agents is the standard of care for several retinal diseases but can cause intraocular pressure (IOP) elevations. This study investigates short-term postinjection IOP changes following aflibercept 8 mg and faricimab, compared with aflibercept 2 mg.MethodsThis observational, prospective study included 90 patients with age-related macular degeneration or diabetic macular oedema, divided into three groups, receiving aflibercept 2 mg, aflibercept 8 mg or faricimab. IOP was measured using an iCare IC200-tonometer preinjection (T0) and at 30 s (T1), 5 min (T2) and 15 min (T3) postinjection. Primary outcomes included IOP changes at the four time points within and between treatment groups. The incidence of transient visual loss requiring paracentesis was recorded.ResultsAll groups experienced a significant IOP increase at T1, with mean IOP increase being 41.47±12.95 mm Hg for aflibercept 2 mg, 43.46±8.97 mm Hg for aflibercept 8 mg and 32.19±11.06 mm Hg for faricimab. By T2, IOP differences were not significant, and by T3, mean IOP returned within normal limits across all groups. Faricimab showed a smaller initial IOP spike than both aflibercept formulations, but this difference was not statistically significant at T2 and T3.ConclusionTransient IOP spikes are observed post-IVT of aflibercept 8 mg and faricimab, with similar trends to aflibercept 2 mg. The initial IOP elevation normalised within 15 min. Faricimab had a lower initial spike, but overall IOP profiles were comparable across different agents.
Boston Marathon athlete performance outcomes and intra-event medical encounter risk associated with low energy availability indicators
Authors: Whitney Kristin E , DeJong Lempke Alexandra F , Stellingwerff Trent , Burke Louise M , Holtzman Bryan , Baggish Aaron L , D'Hemecourt Pierre A , Dyer Sophia , Troyanos Chris , Adelzadeh Kaya , Saville Grace H , Heikura Ida A , Farnsworth Nicole , Reece Laura , Hackney Anthony C , Ackerman Kathryn E 
Published: November 2024

ObjectiveTo determine the association between survey-based self-reported problematic low energy availability indicators (LEA-I) and race performance and intra-event medical encounters during the Boston Marathon.Methods1030 runners who were registered for the 2022 Boston Marathon completed an electronic survey (1–4 weeks pre-race) assessing LEA-I, training and medical history. De-identified survey data were linked to event wearable timing chips and medical encounter records. LEA-I was defined as: an elevated Eating Disorder Examination Questionnaire score, elevated Low Energy Availability (LEA) in Females Questionnaire score, LEA in Males Questionnaire with a focus on gonadal dysfunction score and/or self-report of diagnosed eating disorder/disordered eating.ResultsThe prevalence of LEA-I was 232/546 (42.5%) in females and 85/484 (17.6%) in males. Athletes without LEA-I (non-LEA-I) achieved significantly better race times versus those with LEA-I (accounting for demographic and anthropomorphic data, training history and marathon experience), along with better division finishing place (DFP) mean outcomes (women’s DFP: 948.9±57.6 versus 1377.4±82.9, p<0.001; men’s DFP: 794.6±41.0 versus 1262.4±103.3, p<0.001). Compared with non-LEA-I athletes, LEA-I athletes had 1.99-fold (95% CI: 1.15 to 3.43) increased relative risk (RR) of an intra-event medical encounter of any severity level, and a 2.86-fold increased RR (95% CI:1.31 to 6.24) of a major medical encounter.ConclusionThis is the largest study to link LEA-I to intra-event athletic performance and medical encounters. LEA-I were associated with worse race performance and increased risk of intra-event medical encounters, supporting the negative performance and medical risks associated with problematic LEA-I in marathon athletes.
Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome secondary to dorsal pontine infarction
Authors: Zhang Lin-Yuan , Zhu Ming , Wang Yu , Wang Guo-Dong , Wang Yan , Wu Yun-Cheng , Zhu Xiao-Ying 
Published: November 2024

BackgroundWall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is an uncommon ocular motor disorder which is featured by binocular exotropia and bilateral internuclear ophthalmoplegia.MethodsA 71-year-old man with hypertension presented to the emergency department with sudden-onset diplopia. Neurological examination, neuroimaging, blood and cerebrospinal fluid (CSF) testing were performed.ResultsWe presented a typical WEBINO syndrome case with a clear dorsal pontine infarction involving bilateral medial longitudinal fasciculi (MLF) on brain MR scan. The patient’s eye movement abnormalities improved and MR lesions disappeared at 60-day follow-up after treatment of clopidogrel and atorvastatin. Furthermore, we summarised the aetiology and pathophysiology of WEBINO by retrospectively analysing all published WEBINO cases. We found that WEBINO can result from various underlying pathologies, with inflammation most common in the young, and stroke most common in the elderly. Simultaneous lesions of bilateral MLF definitely contribute to the pathophysiology of WEBINO.ConclusionsThis case underscores the importance of early recognising WEBINO in the emergency department. A timely diagnosis of stroke-induced WEBINO is important so that acute treatment can be considered and for initiating secondary stroke preventive measures to potentially improve the prognosis.
Global trends in the burden of rheumatoid arthritis by sociodemographic index: a joinpoint and age–period–cohort analysis based on the Global Burden of Disease Study 2019
Authors: Chen Cheng , Shi QiLin , He WenBao , Tian HaoJun , Ye TianBao , Yang YunFeng 
Published: November 2024

ObjectiveTo describe temporal trends in the incidence and disability-adjusted life years (DALYs) of rheumatoid arthritis (RA) across sociodemographic index (SDI) quintiles and sexes from 1990 to 2019.MethodsData on RA incidence and DALYs with a 95% uncertainty interval from 1990 to 2019 were extracted from the Global Burden of Disease 2019. Subsequently, trends across SDI quintiles and sexes from 1990 to 2019 were determined using joinpoint regression and age–period–cohort analyses.ResultsA significant upward trend in the global age-standardised incidence rate (ASIR) of RA was observed for both sexes from 1990 to 2019 (average annual per cent change (AAPC): 0.214, 95% CI 0.179 to 0.249, p<0.001). Specifically, the ASIR of RA for both sexes demonstrated a significant increasing trend at all SDI levels, with the highest AAPC observed in the low SDI regions. A non-significant increasing trend in the global age-standardised DALYs rate (ASDR) of RA was observed for both sexes from 1990 to 2019 (AAPC: 0.017, 95% CI −0.051 to 0.085, p=0.621). Varying trends in ASDR were observed for both sexes and across SDI quintiles. Additionally, diverse age–period–cohort patterns in incidence and DALYs were observed across SDI quintiles and sexes.ConclusionThe significant heterogeneity observed in the temporal trends of the incidence and DALYs of RA across SDI quintiles and sexes suggests potential disparities in the prevention, management and treatment of RA. Therefore, establishment of practical and customised healthcare initiatives for specific populations across SDI quintiles and sexes and allocation of supplementary health resources to high-risk populations are crucial for effective management of RA.
Atezolizumab monotherapy as first-line treatment for non-small cell lung cancer ineligible for treatment with a platinum-containing regimen (IPSOS): a cost-effectiveness analysis in the USA
Authors: Li Biao , Rong Dingchao , Lin Hui 
Published: November 2024

ObjectiveThis study explores the cost-effectiveness of atezolizumab monotherapy compared with chemotherapy as first-line treatment for stage IIIB or IV non-small cell lung cancer (IIIB/IV-NSCLC) ineligible for platinum-based chemotherapy from a US payer perspective.DesignThis is based on the IPSOS clinical trial. We conducted a comprehensive assessment of the cost-effectiveness of atezolizumab monotherapy versus single-agent chemotherapy over a 15-year duration. Employing a robust Markov model incorporating data from 453 patients, we calculated total costs, life-years (LYs), quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of $150 000 per QALY. We performed one-way, two-way and probabilistic sensitivity analyses to validate our model.SettingThe US payer perspective.ParticipantsA cohort with NSCLC ineligible for treatment with a platinum-containing regimen from IPSOS clinical trial.InterventionsAtezolizumab monotherapy versus chemotherapy.Primary outcome measureCost, QALYs, LYs and ICER.ResultChemotherapy resulted in an average survival of 0.930 QALYs (1.528 LYs) per patient at an average cost of $67 579. Atezolizumab treatment provided an additional 0.309 QALYs but incurred an extra cost of $66 472, leading to an ICER of $215 069 per QALY compared with chemotherapy. The cost of atezolizumab had the most significant impact on the model outcomes. Probabilistic sensitivity analysis showed that atezolizumab had a 30.2% probability of being considered cost-effective at a WTP threshold of $150 000 per QALY in the USA. These results remained consistent across various scenarios and sensitivity analyses employing both deterministic and probabilistic approaches.ConclusionThe current price of atezolizumab renders it an unlikely cost-effective treatment option for patients with IIIB/IV-NSCLC from the payer’s perspective in the USA. To achieve cost-effectiveness, substantial discounts are necessary.Trial registration numberThe IMpower-110, an open-label, randomised, phase 3 clinical trial (NCT02409342). The IPSOS clinical trial (NCT03191786).
Prevalence of comorbidities among patients with rheumatoid arthritis in the UAE: a case–control study
Authors: Al-Saleh Jamal , Ali Khan Naureen , Zamani Noura , AlSaidi Hend , Rachidi Wafae 
Published: November 2024

ObjectivesData on the rate of comorbidities in Arab patients with rheumatoid arthritis (RA) are limited, and extrapolating the prevalence of comorbidities from international studies is challenging. This study aimed to investigate the prevalence of comorbidities in patients with RA, compare it with that in non-RA controls and explore the association between the body mass index of patients with RA and comorbidities.DesignThis is a retrospective, case–control study.SettingThis study included patients receiving secondary care at the Rheumatology Department of a public hospital in the Emirate of Dubai. The controls were recruited from patients receiving primary and secondary care at the Dubai Academic Health Corporation in the fourth quarter of 2022.ParticipantsThis study included all consecutive UAE national patients with RA who visited the rheumatology clinic. The study included 1756 participants in an age-matched and sex-matched control group and 439 patients with RA. Of these, 88.6% were female, and the median age was 55 years. Each RA case was randomly matched with four controls of the same age and sex. All relevant information, including case and control demographics and comorbidities, was retrieved from the electronic medical record.Primary and secondary outcome measuresThe relative risk of comorbidities was compared between patients with RA and age-matched controls. The relationship between obesity in RA and the frequency of comorbidities was determined.ResultsThis study revealed that 188 (42.8%) patients with RA had at least one comorbidity, whereas only 636 (36.2%) individuals in the control group had at least one comorbidity (OR 1.3; 95% CI 1.1 to 1.6, p<0.01). Patients with RA were more likely to have ischaemic heart disease (OR 3.9; 95% CI 2.3 to 6.6, p<0.0001), fibromyalgia (OR 25; 95% CI 13 to 34, p<0.0001), cataract (OR 5.8; 95% CI 4 to 8.5, p<0.0001), osteoporosis (OR 6.8; 95% CI 4.6 to 10, p<0.0001) and knee osteoarthritis (OR 6.1; 95% CI 4.8 to 7.8, p<0.0001).ConclusionsPatients with RA were more likely to have cardiovascular, pulmonary and musculoskeletal comorbidities compared with the control group. Obese patients with RA had a higher incidence of comorbidity than non-obese patients with RA.
‘If you’ve lost your personality, there’s no point in changing the valve’—a qualitative study of older adults’ attitudes towards treatment of aortic stenosis with comorbid dementia
Authors: Skaar Elisabeth , Rostoft Siri , Cruz-Jentoft Alfonso , Jackson Thomas , Bleie Øyvind , Packer Erik , Øksnes Anja , Schaufel Margrethe Aase 
Published: November 2024

ObjectivesDue to prognostic uncertainty and limited decision-making capacity, the choice to perform transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) and comorbid dementia is challenging. This study explores older adults’ perspectives on complex decision-making preceding TAVI in the hypothetical setting of comorbid dementia.DesignQualitative study entailing semistructured interviews. Analysis was by systematic text condensation. The interview guide addressed their attitudes regarding treatment dilemmas before TAVI in patients living with dementia.SettingPatients were recruited from the TAVI outpatient clinic at a university hospital performing TAVI.ParticipantsA purposive sample of 10 older adults (5 women) with AS and without dementia (range 77–94 years), where 8/10 had undergone TAVI were included.ResultsThree main challenges were identified: (1) Risk assessment. Participants found it hard to compare the burden of aortic stenosis vs dementia. They acknowledged the dilemma of implanting a new heart valve to achieve symptom relief while risking severe dementia in the future due to prolonged life span. (2) Autonomous capacity. A profound uncertainty was described regarding who should participate in decision-making if the person was incapacitated due to dementia. (3) Customised information. Participants advocated for thorough information describing facts and uncertainty, aiming to protect and support the person living with dementia.ConclusionOlder adults with severe aortic stenosis find it hard relating to dilemmas arising from providing TAVI in patients living with dementia. There is a need for tailor-made information to support autonomy and decision-making under uncertainty.
Burden and determinants of scabies in a pastoralist community: a case–control study from Southwest Ethiopia
Authors: Shifera Nigusie , Yosef Tewodros 
Published: November 2024

BackgroundScabies is a skin infestation caused by the human itch mite, affecting people globally across all demographics. However, it is more prevalent among children, individuals with poor hygiene, those in overcrowded or slum areas and people affected by drought and war. There is limited research on scabies in Ethiopia and none specifically focused on marginalised communities. This study aimed to assess the burden of scabies and its contributing factors among pastoralist communities in Ethiopia.MethodsA community-based, unmatched case–control study (1:2 ratio) was conducted in Meinit Goldiya District to assess risk factors for scabies. The researchers collected line-listed data on scabies and conducted face-to-face interviews from January to February 2023, with a sample of 156 cases and 312 controls. Data were gathered using a structured questionnaire and analysed with SPSS V.22. OR, p values and 95% CI were calculated to identify associated factors. Independent factors were determined using a p value of <0.05 and the corresponding 95% CI in the multivariable model.ResultsA total of 4269 scabies cases were reported in the district, with an attack rate of 7.9%. Of the reported cases, 52.8% (2254 cases) were male. The multivariable analysis identified several factors significantly associated with scabies: sleeping with infected individuals (adjusted OR (AOR)=3.70 (2.08, 6.61)), sharing washing facilities with patients with scabies in the past 6 months (AOR=4.05 (2.30, 7.13)), placing clothes together with infected individuals’ clothes (AOR=4.71 (2.64, 8.42)) and households with a daily water consumption of ≥25 L per person per day, which was a protective factor (AOR=0.06 (0.03, 0.12)).ConclusionScabies is a public health issue in the district, with significant risk factors including sleeping, washing and contact with patients with scabies, as well as daily water consumption levels. To address this, the study recommends strengthening active case surveillance, offering health education and ensuring health facilities are stocked with treatment medications.
Validating the recording of exacerbations of asthma in electronic health records: a systematic review protocol
Authors: Moore Elizabeth , Gassasse Zakariah Z , Quint Jennifer K 
Published: November 2024

IntroductionAsthma exacerbations or ‘attacks’ can vary in severity from mild worsening of symptoms to life-threatening changes that require urgent hospital care. Understanding these exacerbations is crucial to improving treatment and support for patients. Electronic health records (EHR) using anonymised data from people with asthma in primary and secondary care can be used to understand exacerbations and outcomes. However, previous studies found significant heterogeneity in the algorithms used to define asthma exacerbations. Validating definitions of asthma exacerbations in EHR will lead to more robust and comparable evidence in future research.Methods and analysisMedline and Embase will be searched for the key concepts relating to asthma exacerbations, EHR and validation. All studies that validate exacerbations of asthma in EHR and administrative claims databases published before 30 May 2024 and written in English will be considered. Validated algorithms for asthma exacerbations or attacks must be compared against a reference or gold standard definition, and a measure of validity must be included. Articles will be screened for inclusion by two independent reviewers with any disagreements resolved by consensus or arbitration by a third reviewer. Study details will be extracted, and the risk of bias will be assessed using a QUADAS-2 tailored to this review.Ethics & disseminationNo ethical approval is required as this is a review of previously published literature. Results will be disseminated in a peer-reviewed journal with the aim of being used in future research to help identify asthma exacerbation in EHR.PROSPERO registration numberCRD42024545081
Attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals: a cross-sectional survey
Authors: Kakemam Edris , Miri Farzaneh , Sadeghpour Sevda , Mirzaei Alireza , Saeidpour Jalal 
Published: November 2024

ObjectivesTo assess and compare attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals and to identify factors associated with attitudes towards patient safety.DesignAn institution-based, cross-sectional survey was carried out from July to August 2023.Setting10 governmental teaching hospitals in Tehran, Iran.ParticipantsThe study participants comprised a random sample of 186 nurses and 90 physicians who had worked for at least 6 months in their current hospitals.Outcome measuresThe primary outcome measures were mean and SD scores for individual items and the nine main patient safety domains assessed by the Attitudes Toward Patient Safety Questionnaire-III. The secondary outcome measure was the proportion of physicians and nurses who responded positively to each item, expressed as percentages for each group.ResultsPhysicians and nurses exhibited moderately positive attitudes towards patient safety (mean scores of 3.79±0.33 and 3.83±0.36, respectively). Both professional groups reported the most positive attitudes in the same dimensions: ‘team functioning’ and ‘working hours as a cause for error’ (mean scores of >4 out of 5). Conversely, the lowest scores were observed in ‘importance of patient safety in the curriculum’, indicating potential gaps in their understanding of patient safety (mean scores of <3.5 out of 5). Physicians displayed significantly more positive attitudes in the domain of ‘error inevitability’, while nurses held more positive attitudes in ‘error reporting confidence’ and ‘disclosure responsibility’ (p<0.05). Multiple linear regression analysis demonstrated that the factors associated with more positive attitudes towards patient safety included lower workload (B=0.131; 95% CI 0.047 to 0.215; p=0.002), reporting of adverse events (B=0.100; 95% CI 0.009 to 0.191; p=0.030) and receiving patient safety training (B=0.134; 95% CI 0.019 to 0.249; p< 0.023).ConclusionBoth professional groups demonstrated moderately positive attitudes towards patient safety. However, the findings highlighted the need for future patient safety training to prioritise enhancement of healthcare professionals’ understanding of medical errors. Such training initiatives should be engaging and directly relevant to the specific needs of both nurses and physicians, ensuring its perceived value to their ongoing professional development. Furthermore, fostering a supportive and blame-free environment that encourages the reporting of medical errors is crucial.
ICU follow-up services and their impact on post-intensive care syndrome: a scoping review protocol
Authors: Zhang Rui-xue , Xu Yu , Tian Yongming , He Lin , Chu Yuan 
Published: November 2024

IntroductionPost-intensive care syndrome (PICS) seriously affects the quality of life of intensive care unit (ICU) survivors, their ability to return to work and society and the quality of life of their families, increasing overall care costs and healthcare expenditures. ICU follow-up services have important potential to improve PICS. However, the best clinical practice model of ICU follow-up service has not been fully defined and its benefits for ICU survivors are not clear. This review will synthesise and map the current types of follow-up services for ICU survivors and summarise the impact of follow-up services on PICS.Methods and analysisThis scoping review will be conducted by applying the five-stage protocol proposed by Arksey and O’Malley in an updated version of the Joanna Briggs Institute. Eight academic databases including the Cochrane Library, MEDLINE, Web of Science, Embase, EBSCO Academic, CINAHL, PsycInfo and SinoMed (China Biology Medicine) will be systematically searched from inception to the present. Peer-reviewed literature and grey literature will be included. Qualitative, quantitative and mixed methods studies will be included. Studies published in English or Chinese will be included. There will be no time restriction. Two reviewers will screen and select the articles independently and if there is any disagreement, the two reviewers will discuss or invite a third reviewer to make decisions together. Descriptive analysis will be used to conduct an overview of the literature. The results will be presented in a descriptive format in response to the review questions accompanied by the necessary tables or charts.Ethics and disseminationEthical approval is not required for this scoping review because data could be obtained by reviewing published primary study results and do not involve human participants. Findings should be disseminated at scientific meetings and published in peer-reviewed journals.