bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain Outcomes Among Medical Centers With High vs Low Specialist Palliative Care Reach Among People With Heart Failure
Authors: Feder Shelli L. , Han L. , Zhan Yan , Abel Erica A. , Akgün Kathleen M. 
Published: December 2024

Background: Pain affects more than 60% of people with heart failure (HF), with increasing frequency and severity towards the end of life (EOL). We examined if family-rated pain near EOL was associated with rates of specialist palliative care (SPC) among patients with HF. Methods: We conducted a retrospective cohort study among 1095 decedents with advanced HF (aHF = ≥2 hospitalizations) from 83 Veterans Affairs Medical Centers (VAMCs) between 2018-2020. We used multilevel logistic regression to derive facility rates of predicted SPC for each VAMC adjusting for demographic and clinical characteristics. We examined associations between VAMCs in the top 20% (vs bottom 80%) of SPC rates and family-reported pain at the EOL from the Bereaved Family Survey and the interaction between receiving SPC and VAMC-level SPC rates on study outcomes. Analyses were conducted using generalized linear models, adjusting for demographic, clinical, and facility covariates. Results: The sample was 98% male, 73% White, and 20% Black, with a mean age of 79.7+/−10.3 years. Over 77% of the sample had uncontrolled pain at the EOL. In adjusted models, there was no association between family-reported pain and VAMC rates of SPC (Odds Ratio = 1.082, 95% Confidence Interval = 0.706-1.659). Receipt of SPC did not change this relationship (p-interaction = .405). Conclusion: Families of people with aHF cared for in VAMCs with high rates of SPC were as likely to report uncontrolled pain relative to people cared for in VAMCs with lower SPC rates. Research is needed to identify delivery and organizational features associated with improved pain control at the EOL among this symptomatic population.
Effect of direct oral anticoagulants compared to enoxaparin on objective response to immune checkpoint inhibitors in patients with lung cancer
Authors: Karimi Solmaz , Abboud Karen , Umoru Godsfavour , Bernicker Eric H. 
Published: December 2024

Introduction A hypoxic tumor microenvironment inhibits the normal functioning of immune cells. Studies have hypothesized that anticoagulants that can penetrate and bind to factor Xa in the tumor microenvironment, can enhance T-cell function and augment immunotherapy activity. This study compared objective response rate and progression-free survival of lung cancer patients on concomitant immunotherapy treated with direct-acting oral anticoagulants versus enoxaparin. Methods This single-center retrospective study included 73 adults with stage-IV lung cancer who received at least two cycles of immunotherapy and one month of anticoagulant therapy with direct-acting oral anticoagulants (Arm A) versus enoxaparin (Arm B) between June 1, 2016, to September 30, 2022. Primary endpoint was objective response rate, and secondary endpoints were rates of complete response, progression-free survival, incidence of thrombotic events, and major bleeding. Results Objective response rate at 6 months was 24.5% versus 25% while progression-free survival at 6 months was 54.7% versus 45% in Arm A versus Arm B, respectively. Complete response rates at 6 months were 7.5% in Arm A versus 0% in Arm B. One patient in Arm A and two in Arm B had a recurrent deep vein thrombosis. Nine patients in Arm A and two in Arm B were diagnosed with new deep vein thrombosis. One patient in Arm B was diagnosed with new pulmonary embolism. Two major bleeding events occurred in Arm B. Conclusions Our study suggests a trend toward improved progression-free survival at 6 months with no new safety concerns in lung cancer patients on concurrent immunotherapy and direct-acting oral anticoagulants.
Risk of hypertension in patients with multiple sclerosis treated with teriflunomide compared to dimethyl fumarate: A nationwide cohort study in Denmark
Authors: Framke Elisabeth , Sellebjerg Finn , Kant Matthias , Stilund Morten , Jensen Henrik Boye , Illes Zsolt , Asgari Nasrin , Sejbaek Tobias , Roug Lena Christina , Jensen Michael Broksgaard , Schäfer Jakob , Rasmussen Peter Vestergaard , Christensen Jeppe Romme , Weglewski Arkadiusz , Prakash Sivagini , Magyari Melinda , Heick Alex , Jensen Ana Isabel Figueira , Weglewski Arkadiusz , Milthers Ásta , Mærsk-Møller Camilla , Tørring Caroline Winther , Christensen Claudia , Sellebjerg Finn , Sirakov Georgi P. , Nielsen Helle Hvilsted , Jensen Henrik Boye , Mathiesen Henrik Kahr , Roshanisefat Homayoun , Urbonaviciute Inga , Barzinji Ismael , Schäfer Jakob , Christensen Jeppe Romme , Battistini Jette Lautrup , Hansen Julie Richter , Schreiber Karen Ingrid , Svendsen Kristina Bacher , Storr Lars Kristian , Roug Lena Christina , Harper Luke , Poulsen Mai Bang , Falah Masoud , Kant Matthias , Magyari Melinda , Langemark Michael , Jensen Michael Broksgaard , Góra Monika Katarzyna , Blinkenberg Morten , Stilund Morten Leif Munding , Issa Nadia Mubder , Asgari Nasrin , Sørensen Per Soelberg , Rasmussen Peter Vestergaard , Jensen Rikke Marie , Jensen Rikke Marie , Ashna Said , Derakhshan Siavash , Prakash Sivagini , Bramow Stephan , Sejbæk Tobias , Asenov Tsvetomir , Papp Viktoria Papp , Illés Zsolt Laszlo 
Published: December 2024

Background: Teriflunomide has been associated with an increased risk of hypertension. Real-world studies including adequate control groups are lacking. We hypothesized that patients with multiple sclerosis (MS) treated with teriflunomide would be at higher risk of developing hypertension than those treated with dimethyl fumarate. Methods: We conducted a cohort study linking the Danish Multiple Sclerosis Registry with national health registries during a 10-year period. Teriflunomide ( N = 2656) and dimethyl fumarate ( N = 2237) exposure was defined by the first treatment record lasting ⩾ 3 months, at which time follow-up started. We included 4893 adult patients without hypertension at baseline. Hypertension was defined as an International Classification of Diseases 10th Revision code for hypertension and by dispensed prescription drugs identified by the respective Anatomical Therapeutic Chemical codes. We used multivariable-adjusted Cox regression. Results: We found 40.6 (teriflunomide) and 13.1 (dimethyl fumarate) hypertension events per 1000 person-years. Compared to dimethyl fumarate-treated patients, patients treated with teriflunomide had a higher risk of developing hypertension (adjusted hazard ratio = 2.80; 95% confidence interval = 2.19–3.56). The number needed to harm was 16 and 9 at 3 and 5 years of follow-up, respectively. Conclusion: We found an increased risk of hypertension in adult patients with MS treated with teriflunomide.
The impact of game play on dementia knowledge: A student evaluation of the Dementia Inequalities Game
Authors: Giebel Clarissa , Marshall Helen , Cannon Jacqui , Donnellan Warren , Bullen Heather , Lomas Elizabeth , Porritt Bridget , Rees Anna , Curran Simon , Tetlow Hilary , Gabbay Mark 
Published: December 2024

Background: People with dementia and carers can face many barriers, or inequalities, in accessing a diagnosis or care. These barriers are unjust and can be addressed by the right interventions, to ensure that everyone receives equitable access to diagnosis and care. A lack of knowledge about dementia in the health and social care workforce is a recognised barrier. The Dementia Inequalities Game was co-produced with people with personal, professional, and voluntary sector experiences of dementia, and offers an educational tool to educate people about dementia and associated inequalities and overcome this knowledge gap in the current and future (in training) workforce. Aims: The aim of this study was to assess the impact of playing the co-produced Dementia Inequalities Game on knowledge about dementia and associated inequalities in health care, allied health professional, nursing and psychology students. Methods: We conducted 11 game play workshops as part of regular teaching in undergraduate and postgraduate courses in psychology, nursing, occupational therapy, physiotherapy, orthoptics, and radiography at one University in the North of England. Students did not have to partake in the workshops. Participating students completed a brief before and after knowledge questionnaire about dementia and inequalities. Paired samples t-tests were used to compare ratings of knowledge of dementia and associated inequalities before and after game play. Findings: Three-hundred-and-eighteen students took part in the workshops, with 312 fully completed questionnaires. The largest cohort of students (49%) were studying for a degree in nursing. Playing the game significantly increased knowledge about dementia ( p < .001) and dementia inequalities ( p < .001). Implications: Playing the Dementia Inequalities Game is an effective tool to improve knowledge about dementia and associated inequalities in health care and psychology students. Using the game as an educational and sociable intervention in health and social care professionals is a next avenue to test.
Personal variation in patient-centered relevance Index based on individual characteristics and medical conditions among patients with diabetes Mellitus in Korea
Authors: Park Hyeki , Park Eun-Cheol , Lee Woo-Ri , Chun Sungyoun 
Published: December 2024

Objectives This study aimed to identify patients at higher risk for regional disengagement from health services using the Patient-centered Relevance Index (P-RI). Methods This nationwide retrospective cohort study analyzed the relationship between the P-RI and individual patient characteristics, including medical conditions and healthcare utilization patterns. The National Health Insurance Service claims database was used to characterize healthcare utilization by 3,046,914 patients with DM from 2017 to 2020. Results As compared to the mild condition group, all other groups had a lower P-RI. Significant differences were observed among the groups with P-RI lower by 16.5%, 14%, 13%, 0.4%, and 0.6% in the repeated inpatient treatment (β = −0.165, P < 0.001), complication (β = −0.141, P < 0.001), extended long-term care stay (β = −0.130, P < 0.001), comorbidity (β = −0.041, P < 0.001), and other (β = −0.058, P < 0.001) groups, respectively. Additionally, the P-RI was high among low-income and older patients with high acuity. Discussion South Korea's healthcare delivery system is not regionally self-sufficient. A relatively low P-RI in the high income and younger groups indicates healthcare access inequity. Therefore, a continuous management system that ensures uniform healthcare access needs to be established.
Using ring-pins for the treatment of ulnar styloid fractures
Authors: Sakamoto Sotetsu , Hattori Yasunori , Doi Kazuteru 
Published: December 2024

We report the use of 1.0 mm ring-pins for ulnar styloid fractures. Ten patients treated with ring-pins showed good clinical results, achieving bone union without complications. Ring-pins offer a simple, reliable alternative to traditional tension band wiring. Level of evidence: IV
The practical and ethical challenges of identifying, accessing and obtaining school canteen transactional data for public health research
Authors: Gilmour Alice , Fairchild Ruth 
Published: December 2024

Objective The purpose of the study was to investigate the feasibility of using existing data to better understand what pupils purchase during the school day and its nutritional quality. This report highlights the ethical challenges experienced in attempting to obtain anonymised school canteen transaction data for public health research. Methods Semi-structured interviews were conducted before a variety of approaches were tried to recruit secondary schools for the study via purposive sampling. Results Barriers encountered included (i) identifying data providers, (ii) identifying data owners, (iii) data sharing and (iv) engaging stakeholders. The approaches taken to mitigate each of these barriers and subsequent ethical issues are summarised so that future researchers are aware of any potential problems. Failure to overcome these blockages meant that the original study had to be curtailed. Conclusions School canteen transactional big data remains an underutilised research resource which has immense potential for understanding adolescents’ dietary choices and nutritional intake across the school day. The inaccessibility of anonymised datasets for public health research and complex political issues surrounding data ownership and sharing must be discussed and effort should be made to circumvent barriers. Establishing the current landscape of school food and drink would be beneficial for policymakers, educators and public health researchers.
Differences in teletherapy and telecare?—Experiences of health professionals and patients with video communication in nursing, physiotherapy, occupational therapy, and speech therapy
Authors: Lichtenauer Norbert , Schlachetzki Felix , Eberl Inge , Meussling-Sentpali Annette 
Published: December 2024

Introduction The spread and implementation of digital synchronous video communication in telecare and teletherapy has recently increased significantly, not just because of COVID-19 but also due to a global trend towards more digital healthcare services in the last two decades. This shift prompts the question of how digital telesetting differs from a face-to-face setting and which aspects are fundamental. Methods As the first part of a mixed-method study, qualitative interviews ( n = 20) were conducted from July 2021 to January 2022. Health professionals ( n = 13) and patients ( n = 7) from occupational therapy, physiotherapy, speech therapy, and nursing were interviewed. All interviewees came from Germany, Austria, and Switzerland. The results were categorized using structured content analysis. Results Six main categories and 20 sub-categories were summarized, which can act as barriers or resources in a telesetting. Both sides described a high level of acceptance and approval of telesetting. Motivation and digital skills were of great importance. Furthermore, special features in communication and interaction were described, as well as changes in organizational procedures and a specific process flow in telesetting. Including relatives was more feasible, although several environmental factors should be considered. Discussion A number of specific changes in a telesetting compared to a face-to-face setting show the need for a structured guide for interested parties. Appropriate basic principles must be taught in training and further education to support the spread of this new form of care. Furthermore, it is crucial to adapt the methodological and content-related aspects of telesetting and develop new approaches that specifically integrate audio-visual possibilities.
CNS B cell infiltration in tumefactive anti-myelin oligodendrocyte glycoprotein antibody-associated disease
Authors: Ikeguchi Ryotaro , Kanda Natsuki , Kobayashi Masaki , Masui Kenta , Nitta Masayuki , Misu Tatsuro , Muragaki Yoshihiro , Kawamata Takakazu , Shibata Noriyuki , Kitagawa Kazuo , Shimizu Yuko 
Published: December 2024

Background Few studies have examined B cells among patients with anti-myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD), including brain pathology. Objective To describe cases of tumefactive MOGAD with B-cell dominant central nervous system (CNS) infiltration. Methods In this study, we reviewed three cases with clinical and brain histopathological features with tumefactive MOGAD. Results Forty-nine cases of tumefactive brain lesions (TBL) between January 2003 and December 2023 were included; of these, seven had MOGAD. Three underwent a brain biopsy. B-cell dominant CNS infiltration was observed in two cases. In two cases with B-cell dominant CNS infiltration, symptoms included fever, headache, nausea, somnolence, and focal neurological deficits. Cerebrospinal fluid examination revealed both mild pleocytosis and negative oligoclonal IgG bands. Magnetic resonance imaging of the brain revealed large abnormal lesions extending from the basal ganglia to the parietotemporal lobe in both cases. These cases showed a good response to steroids; however, one case relapsed. Brain pathology showed demyelination and perivascular lymphocytic infiltration. One showed small vessel vasculitis. Deposition of the activated complement component was absent or rarely observed. Loss of MOG was observed in two cases. Conclusion MOGAD could exhibit B-cell dominant CNS infiltration and small vessel vasculitis. MOGAD should be considered in differential diagnosis of TBL.
The Relationship Between Quality of Life and Social Support Among Pregnant Women: A Cross-Sectional Study
Authors: Nazzal Sukayna , Ayed Ahmad , Zaben Kefah Jehad , Abu Ejheisheh Moath , ALBashtawy Mohammed , Batran Ahmad 
Published: December 2024

Introduction Pregnant women require social support and healthcare treatments that are specifically designed to address their quality of life (QoL) during this time, as this will help them get through this crucial stage with more resilience and comfort. Objective This study aimed to assess the relationship between the QoL of pregnant women and social support. Methods A cross-sectional study was conducted involving 423 pregnant women. Data were gathered through the SF-36 scale and the “Multidimensional Scale of Perceived Social Support” in the period of June 1 to September 1, 2023. Results The physical health level was moderate ( M = 46.22 ± 16.1), and the mental health level was also moderate ( M = 46.12 ± 21.8). Social support was rated high ( M = 5.3 ± 1.0), with the highest score in the significant other subscale ( M = 5.9 ± 1.2) and the lowest in the friend's subscale ( M = 4.4 ± 1.6). Furthermore, the analysis revealed a significant positive association between the QoL scores and social support ( p < .05). Conclusions The study confirmed that Palestinian pregnant women had a moderate level of QoL and a high level of perceived social support. Additionally, it established a significant small positive relationship between the QoL scores and social support among pregnant women.
Impact of Platelet Transfusion and Bleeding Risk Stratification in Patients with Immune Thrombocytopenia before Procedures: A Nationwide Population-Based Cohort Study
Authors: Kang Ka-Won , Choi Yumin , Lim Hyung-Jun , Kwak Kunye , Choi Yoon Seok , Park Yong , Kim Byung Soo , Lee Kwang-Sig , Ahn Ki Hoon 
Published: December 2024

Background: The main treatment goal for immune thrombocytopenia (ITP) is to reduce bleeding risk, requiring extra precautions during procedures. Adjusting platelet thresholds with ITP treatments is usually recommended, but platelet transfusions are commonly used despite their controversial benefits. This study aims to evaluate the effectiveness of platelet transfusion in reducing post-procedure bleeding risk and to identify predictive indicators of post-procedure bleeding.
Methods: This study used a nationally representative database to develop a model to predict the risk of post-procedure bleeding in patients with ITP. Machine learning analyses, including random forest feature importance and Shapley additive explanations (SHAP) values, were employed. This contained a total of 34 post-procedural bleeding risk factors, including the amount of platelet transfusion.
Results: The random forest model had an area under the receiver-operating characteristic curve of 93.6%. The analysis identified the following variables as most important: amount of platelet transfusion, high-risk procedure, use of anticoagulant drugs, no use of antiplatelet or anticoagulant drugs, anemia, age, low-risk procedure, moderate-risk procedure, ITP treatment, and newly diagnosed ITP. Amount of platelet transfusion, high-risk procedures, use of anticoagulant drugs, anemia, ITP treatment, and newly diagnosed ITP positively correlated with post-procedure bleeding risk. In contrast, no use of antiplatelet or anticoagulant drugs and moderate- or low-risk procedures were negatively associated with post-procedure bleeding risk. In the SHAP dependence plot, the amount of platelet transfusion was associated with high-risk procedures. Additionally, among patients undergoing high-risk procedures, the likelihood of post-procedure bleeding increased with age.
Conclusions: Platelet transfusion does not significantly reduce the risk of post-procedural bleeding in patients with ITP. The risk of post-procedural bleeding is more closely related to the bleeding risk of the procedure and the patient's medical condition. Minimizing inappropriate platelet transfusions and addressing factors that can increase bleeding risk before procedures are crucial.
Keywords: Immune thrombocytopenia, Procedure, Platelet transfusion, Bleeding risk, Machine learning analysis
Improving Thrombotic Thrombocytopenic Purpura Outcomes with a TMA Team and TTP Pathway
Authors: Yu Stephen , Webber Sylvia E , Gotses John , Platt Emma , Arays Ruta , Shmookler Aaron Daniel , Merrill Sam A 
Published: December 2024

Background: Providing optimal care for patients with thrombotic thrombocytopenic purpura (TTP) is challenging but using a multidisciplinary team to develop a systematic process could improve TTP care by reducing morbidity and mortality.
Objectives: To develop a thrombotic microangiopathy (TMA) Team and implement a TTP Pathway to improve TTP care by reducing TTP relapse or TTP-related death (TTP-RRD) at a rural, Appalachian, tertiary medical center.
Methods: Prospective quality improvement project using the DMAIC (Define, Measure, Analyze, Improve, Control) methodology to develop a multi-disciplinary TMA team and a TTP Pathway. The TMA team comprised Hematology, Nephrology, Laboratory Medicine, and Pharmacy members who guided the Hematology/Oncology consult service. Pathway care included standardized plasma exchange (PEX), rituximab, caplacizumab, improved coordination between medical services, and regular outpatient biochemical TTP surveillance. TMA outcomes were determined by retrospective chart review for patients with acute TTP treated with usual care (N=16) and the TTP Pathway (N=16) between 2016 and 2023.
Results and conclusions: Patients were predominantly women (63.2%), Caucasian (88.5%), located far (85%) from the medical center and low-income (46.2%) based on insurance. All patients had acquired TTP. TTP-RRD at 90 days was reduced from 56% with usual care to 6% with Pathway care (95% CI 0.23 to 0.77, P=0.022); TTP relapse alone at 90 days was reduced from 50% to 0% (95% CI 0.26 to 0.74, P= 0.0011) with TTP Pathway care. On Kaplan Meier analysis, TTP-RRD was significantly lower throughout the intervention with TTP Pathway care (P=0.018). With TTP Pathway, the duration of PEX increased (median 6 vs 12 sessions, P&lt;0.05), as did the usage of rituximab (31.3% vs 93.8%, 95% CI -0.36 to -0.88, P=0.003) and caplacizumab (6.3% vs 62.5%, 95% CI -.027 to -0.81, P=0.001). All TTP Pathway patients underwent biochemical surveillance in remission, and 31% of patients had pre-emptive rituximab to reduce the possibility of clinical relapse.
This study shows that a TMA team utilizing a protocol-based TTP Pathway can reduce TTP morbidity and improve care for this rare hematologic disease. This approach can improve the care of other multisystem hematologic diseases.