bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacovigilance Consideration for Ayurvedic Medicines in Pediatric Practice: Developing Protocols for Documenting Clinical Safety
Authors: Subramanian Dinesh Karayil , Balakrishnan Geethu 
Published: September 2024

Background The rising global trend of traditional medicine and complementary and alternative medicine use necessitates a structured approach to ensure patient safety and efficacy. Due to its unique theoretical framework, directly applying modern pharmacovigilance principles to Ayurveda may be insufficient. Purpose This study aims to highlight the need for a collaborative approach that integrates traditional Ayurvedic knowledge with modern safety and efficacy evaluation methods. It critiques the limitations of current pharmacovigilance practices, especially in the context of Ayurveda, and proposes improvements to better capture the complexities of traditional medicine. Methodology An analysis of the “AyushSuraksha” program, a key initiative for the pharmacovigilance of Ayurveda, Siddha, Unani, and homoeopathy (ASU&H) medicines in India, was conducted. The program’s focus areas, including monitoring medications, specific materials, and procedure-based therapies, were reviewed in light of their efficacy and safety reporting mechanisms. Additionally, the applicability of current pharmacovigilance methodologies, particularly in the context of personalized Ayurveda treatments, was evaluated through case studies and literature reviews. Results The “AyushSuraksha” program, while focused on medication and therapy monitoring, overlooks the safety of food items used in Ayurveda. Current pharmacovigilance systems, designed for standardized medications, may be inadequate for Ayurveda, as demonstrated by positive outcomes in autism treatment despite the presence of microbiologically harmful products. Furthermore, existing pharmacovigilance proformas lack a distinction between physicians’ and end-users perspectives, limiting the reporting scope. Conclusion A transition to a holistic, evidence-based pharmacovigilance approach that incorporates Ayurvedic assessments and nonlinear herbal interactions is crucial. Separate proformas for physicians and end-users, along with disease-specific questions, are recommended to improve reporting accuracy. Expanding the scope of pharmacovigilance beyond standardized medication monitoring is essential for the evolution and refinement of Ayurvedic science.
Creating a mental health talanoa to promote a collaborative approach to wellbeing across Pacific peoples
Authors: Ravulo Jioji 
Published: September 2024

Objective Promoting holistic health and wellbeing is a shared conversation, or talanoa, requiring collaboration between individuals, their families and wider communities. This paper will explore various community-based initiatives privileging Pacific epistemologies and ontologies that promote and provide accessible resources improving mental health literacies. Method Three specific initiatives are discussed in this paper; Mental Health Talanoa (MHT), Open Worksheet and Wellbeing Talanoa. These provide a platform to understand practical ways to support Pacific peoples in various contexts. Results The MHT project offers a nuanced understanding of symptomatology related to common mental disorders amongst Pacific peoples, a nuanced understanding of the barriers and enablers to health literacies and help seeking behaviour, and a series of infographics, including the Pacific Mental Health Lexicons (PIMHL). The Open Worksheet is a dynamic tool underpinned by a dialogical and relationally driven way to understanding individual and familial narratives. The Wellbeing Talanoa supports a communally orientated opportunity to enhance a sense of connection to self and others whilst therapeutically reviewing social and welfare needs and solutions. Conclusion Developing and implemented Pacific approaches that are grounded in Pacific values and practices can lead to enhanced help seeking behaviour, engagement, service retention and provision.
Advance Care Planning in Nursing Homes: Comparing Characteristics and Outcomes of Participants and Non-Participants
Authors: Zhou Yi , Zailan Liyana Binte , Tan Laurence , Chung Salina Yee Hung Annaliese , Chua Alecia Qin Ying , Magpantay Gerlie Contreras , Sim Lai Kiow , Muthusamy Thilagavathy , Low James Alvin 
Published: September 2024

Background There is an increasing need to integrate Advance Care Planning (ACP) in nursing homes (NH) due to rapid aging and burden of multimorbidity. This study examines differences in the characteristics and outcomes of NH residents enrolled in a palliative care programme who have completed ACP and those who did not. Method We conducted a retrospective cohort analysis of 294 deceased residents enrolled into a palliative programme from 8 nursing homes in Singapore. Comparison was made between residents who completed an ACP and those who did not. Treatment preferences and place of death preferences were examined and concordance to these preferences were analyzed. Results ACP completion rate was 81% in the cohort. Residents opting for comfort measures only had high concordance (92%) for their preferred place of death (PPOD). However, residents opting for limited intervention showed lower PPOD concordance (77%), with many dying in hospitals despite a preference for dying in the NH. Residents with ACP were significantly more likely to die in NH (68.2% vs. 36.4%) and had a longer median programme enrolment duration (131 vs. 53 days) compared to those who did not complete ACP. Conclusion Despite high ACP completion rate in our cohort, challenges remain in aligning treatment preferences with actual care provided, particularly for residents opting for limited intervention. Future efforts should focus on increasing ACP participation and addressing systemic barriers to improve end-of-life care outcomes for NH residents.
Improving Prediction of Complications Post-Proton Therapy in Lung Cancer Using Large Language Models and Meta-Analysis
Authors: Chao Pei-Ju , Chang Chu-Ho , Wu Jyun-Jie , Liu Yen-Hsien , Shiau Junping , Shih Hsin-Hung , Lin Guang-Zhi , Lee Shen-Hao , Lee Tsair-Fwu 
Published: September 2024

Purpose This study enhances the efficiency of predicting complications in lung cancer patients receiving proton therapy by utilizing large language models (LLMs) and meta-analytical techniques for literature quality assessment. Materials and Methods We integrated systematic reviews with LLM evaluations, sourcing studies from Web of Science, PubMed, and Scopus, managed via EndNote X20. Inclusion and exclusion criteria ensured literature relevance. Techniques included meta-analysis, heterogeneity assessment using Cochran’s Q test and I2 statistics, and subgroup analyses for different complications. Quality and bias risk were assessed using the PROBAST tool and further analyzed with models such as ChatGPT-4, Llama2-13b, and Llama3-8b. Evaluation metrics included AUC, accuracy, precision, recall, F1 score, and time efficiency (WPM). Results The meta-analysis revealed an overall effect size of 0.78 for model predictions, with high heterogeneity observed (I2 = 72.88%, P < 0.001). Subgroup analysis for radiation-induced esophagitis and pneumonitis revealed predictive effect sizes of 0.79 and 0.77, respectively, with a heterogeneity index (I2) of 0%, indicating that there were no significant differences among the models in predicting these specific complications. A literature assessment using LLMs demonstrated that ChatGPT-4 achieved the highest accuracy at 90%, significantly outperforming the Llama3 and Llama2 models, which had accuracies ranging from 44% to 62%. Additionally, LLM evaluations were conducted 3229 times faster than manual assessments were, markedly enhancing both efficiency and accuracy. The risk assessment results identified nine studies as high risk, three as low risk, and one as unknown, confirming the robustness of the ChatGPT-4 across various evaluation metrics. Conclusion This study demonstrated that the integration of large language models with meta-analysis techniques can significantly increase the efficiency of literature evaluations and reduce the time required for assessments, confirming that there are no significant differences among models in predicting post proton therapy complications in lung cancer patients.
Abnormal serum Magnesium Level is Associated with the Coagulopathy in Traumatic Brain Injury Patients
Authors: Wang Ruoran , Xu Jianguo , He Min 
Published: September 2024

Background Coagulopathy is associated with poor prognosis of traumatic brain injury (TBI) patients. This study is performed to explore the association between serum magnesium level and the risk of coagulopathy in TBI. Methods TBI patients from the Medical Information Mart for Intensive Care-III database were included for this study. Logistic regression analysis was performed to explore risk factors and develop a predictive model for coagulopathy in TBI. The restricted cubic spline (RCS) was utilized to analyze the association between serum magnesium level and the development of coagulopathy. Receiver operating characteristic curve was drawn to evaluate the performance of the predictive model for coagulopathy. Results The incidence of coagulopathy in TBI was 32.6%. The RCS indicated the association between magnesium and coagulopathy was U-shaped. Multivariate logistic regression confirmed age, coronary heart disease, cerebral vascular disease, chronic liver disease, GCS, ISS, epidural hematoma, hemoglobin, shock index and magnesium level were independently associated with the coagulopathy in TBI. Compared with patients of magnesium level between 1.7 and 2.3 mg/dL, those with magnesium level below 1.7 mg/dL or above 2.2 mg/dL had a higher risk of coagulopathy. Conclusion Both hypermagnesemia and hypomagnesemia are associated with higher risk of coagulopathy in TBI patients. Physicians should pay more attention on preventing coagulopathy in TBI patients with hypomagnesemia or hypermagnesemia.
Drug induced lupus associated with Trastuzumab emtansine in a patient with metastatic breast cancer
Authors: Yıldız Oğuzhan , Gürbüz Ali Fuat , Karakurt Eryılmaz Melek , Araz Murat , Aykut Talat , Şahin Özlem , Büyükboyacı Naciye Hilal , Çelik Zeliha , Artaç Mehmet 
Published: September 2024

Introduction Ado-trastuzumab emtansine (T-DM1) is employed in the treatment of patients with HER2-positive breast cancer. The most common side effects are fatigue, diarrhoea, anaemia, transaminase elevation and drug-induced thrombocytopenia. This report describes a patient with metastatic breast cancer who developed drug-induced lupus due to T-DM1. Case Report A 54-year-old woman was diagnosed with breast cancer in March 2018. She underwent modified radical mastectomy and axillary lymph node dissection (pT2N1aM0). Following supraclavicular lymph node metastasis in May 2018, she received 8 cycles of docetaxel, trastuzumab, and pertuzumab. In December 2020, the patient presented with axillary and intra-abdominal lymph node metastases, along with bone metastases observed on PET/CT scan. Treatment with T-DM1 and zoledronic acid was initiated. After 18 months on T-DM1, she developed drug-induced lupus. Her symptoms resolved with hydroxychloroquine treatment and discontinuation of T-DM1. Discussion Drug-induced lupus is a clinical syndrome that shares similar features with systemic lupus erythematosus (SLE). The majority of patients present with symptoms such as arthralgia and myalgia. Hydralazine and procainamide are high-risk drugs for drug-induced lupus. Symptoms usually develop after months or years of use, but may also develop suddenly. Our patient also received TDM-1 treatment for 18 months. We present a case of TDM-1-associated drug-induced lupus in a patient with metastatic breast cancer. This is the first case of TDM-1-related drug-induced lupus reported in the literature.
Identifying risk factors of dose reduction or treatment discontinuation due to fatigue or gastrointestinal symptoms in patients receiving lenvatinib treatment for hepatocellular carcinoma
Authors: Kimura Michio , Yamada Shiori , Go Makiko , Yasuda Satoshi , Toyoda Hidenori , Usami Eiseki 
Published: September 2024

Introduction Lenvatinib (LEN) is the standard treatment for hepatocellular carcinoma (HCC). In clinical practice, gastrointestinal (GI) symptoms such as fatigue and loss of appetite often lead to dose reduction or treatment discontinuation. This study aimed to identify the predictors of patients who will experience dose reduction or treatment discontinuation owing to fatigue or GI symptoms during LEN treatment for HCC. Methods We retrospectively identified 99 patients who received LEN at the Ogaki Municipal Hospital (Ogaki, Japan) between April 2018 and December 2023. To investigate the risk factors for treatment discontinuation or dose reduction due to fatigue or GI symptoms during LEN administration, patients were divided into two groups based on whether treatment discontinuation or dose reduction occurred due to fatigue or GI symptoms during LEN administration (37 patients) or not (62 patients). We compared baseline characteristics between the two groups. Results Multivariate analysis revealed that body weight (odds ratio 4.310, 95% confidence interval 1.380–13.500; P = 0.002) was an independent risk factor that significantly contributed to treatment discontinuation or dose reduction owing to fatigue or GI symptoms during LEN administration. The cut-off value calculated using the body weight curve was 55.0 kg. Using this cutoff value, the sensitivity and specificity of body weight to detect treatment discontinuation or dose reduction due to fatigue or GI symptoms during LEN administration were 83.9% and 56.8%, respectively. Conclusion In clinical practice, patients weighing less than 55 kg who start with a full dose will likely experience weight loss or discontinuation during treatment.
The management of anticoagulated fragility femoral fracture patients
Authors: Farhan-Alanie Muhamed M , Eardley William G P 
Published: September 2024

Approximately 20% of patients sustaining a fragility femur fracture use an anticoagulant, and over 30% use an antiplatelet medication, both of which can result in surgical delay. Previously confined to fractures of the proximal femur, performance assessment, outcome and surgical delay is now assessed for all fractures of the femur in older patients, including those involving implants. This narrative review draws together all literature pertaining to anticoagulation and antiplatelet management in older patients with a fracture of the femur to address 5 key points: prevalence of anticoagulant and antiplatelet use; analysis of management protocols; collation of national guidelines; comparison of perioperative management; timing of surgery and perioperative outcomes. Our review found that the prevalence of fragility femur fracture patients taking anticoagulant and antiplatelet medication ranges from 20–40% and 25–35% respectively. More anticoagulated patients are taking direct oral anticoagulants compared to vitamin k antagonists with growing implications for variation in practice and delays to surgery. Several national guidelines exist although these are characterised by marked variation, there is little standardisation, and none are generalised across all fragility femur fractures. Expedited surgery within 36 hours of admission in patients taking an anticoagulant or antiplatelet medication is safe and has been demonstrated in fractures of the proximal femur across many small number studies although no such evidence exists in non-proximal femur fractures despite this population sharing similar characteristics. There is a need for all fractures of the femur in older people to be considered when researching and assessing performance in this population to prevent needless variation and delay.
The L1 spino-pelvic (L1SP) angle: a simplified approach for the assessment of the PI-LL mismatch in hip surgery
Authors: Boudali A Mounir , Chai Yuan , Farey John E , Vigdorchik Jonathan , Walter William L 
Published: September 2024

Introduction: Pelvic incidence - lumbar lordosis (PI-LL) mismatch is often considered when assessing spinopelvic alignment in the sagittal plane. The mismatch is conventionally obtained by measuring 2 separate angles on lateral spinopelvic radiographs. This study describes a simplified approach for assessing spinopelvic mobility and measuring the PI-LL mismatch through the evaluation of the L1-spinopelvis angle (L1SP). Methods: 96 standing lateral radiographs were obtained from consecutive patients presenting for total hip arthroplasty between November 2020 and July 2021. 3 operators were recruited to annotate landmarks on digital radiographs. Correlation analysis and error analysis were applied. Measurement reproducibility was assessed using intraclass correlation coefficient (ICC). Results: The correlation coefficients of the 3 variables were respectively 0.87 for PI, 0.94 for LL, and 0.96 for L1SP. The normalised root mean square error between the 2 measurement sets was 9.96% for PI, 5.97% for LL, and 4.41% for L1SP. The absolute error was 3.49° ± 4.63° for PI, 3.23° ± 3.78° for LL, 2.68° ± 3.19° for PI-LL conventional, and 2.35° ± 2.88° for PI-LL via L1SP, respectively. In terms of reproducibility, measurement of L1SP outperformed that of PI and LL (ICC = 0.97 versus 0.83 and 0.93, respectively). Conclusion: The simplified L1SP method, through the measurement of a single angle, produced similar measurements to the conventional PI-LL method. The measurement repeatability between operators was improved using the L1SP method. From a clinical practice perspective, both methods are equivalent. The new method is readily reproducible using commercially available PACS software during preoperative templating.
Analysis of Serum Bile Acid Profile Characteristics and Identification of New Biomarkers in Lean Metabolic Dysfunction-Associated Fatty Liver Disease Based on LC-MS/MS
Authors: Wang Bing , Zhang Fei , Qiu Hong , He Yujie , Shi Haotian , Zhu Yuerong 
Published: September 2024

Objectives: Plasma bile acid (BA) has been widely studied as pathophysiological factors in chronic liver disease. But the changes of plasma BA level in lean metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. Here, we clarified the BA metabolic characteristics of lean MAFLD and explored its significance and mechanism as a marker. Methods: We employed ultra-performance liquid chromatography tandem mass spectrometry based on BA metabonomics to characterize circulating bile acid in lean MAFLD patients. Explore its significance as serum biomarkers by further cluster analysis, functional enrichment analysis, and serum concentration change analysis of differential BAs. Evaluation of diagnostic value of differential BAs by ROC analysis. Results: A total of 65 BAs were detected and 17 BAs were identified which showed different expression in the lean-MAFLD group compared with the normal group. Functional annotation and enrichment analysis of KEGG and HMDB showed that differential BAs were mainly related to bile acid biosynthesis, bile secretion, cholesterol metabolism, and familial hypercholangitis, involving diseases including but not limited to cirrhosis, hepatocellular carcinoma, chronic active hepatitis, colorectal cancer, acute liver failure, and portal vein obstruction. ROC analysis displayed that the 6 BA metabolites (GCDCA-3S, GUDCA-3S, CDCA-3S, NCA, TCDCA, and HDCA) exhibited well differential diagnostic ability in discriminating between lean MAFLD patients and normal individuals with an area under the curve (AUC) ⩾0.85. Conclusions: We delineated the characteristics of BA level in patients with lean MAFLD, and identified 6 potential plasma BA biomarkers of lean MAFLD.
Development and validation of the Telehealth Etiquette Competency Checklist: A Delphi study
Authors: Pittmann Rachel , Danaher-Garcia Nicole , Adair White Bobbie Ann , Thompson Anne 
Published: September 2024

Background Providing telehealth care requires unique professionalism skills (i.e. telehealth etiquette) to ensure patients have a positive experience. Given the effect of patient–provider relationships on healthcare outcomes and the limited evidence for healthcare professionals to learn and practice these skills, developing a telehealth etiquette competency tool is necessary. Methods This multiround Delphi study utilized subject matter experts’ opinions to validate a telehealth etiquette competency checklist, using Lawshe's content validity measurements. Panelists were diverse in professional backgrounds, years of experience, telehealth teaching, clinical experience, and involvement in telehealth professional society and governmental policy making. Results Consensus and validation were achieved on the checklist by the 17 panelists in Round 1 for 19 of 20 competencies. Following revisions based on their expert opinions, consensus was achieved by all 16 panelists in Round 2 for 20 competencies. Discussion The Telehealth Etiquette Competency Checklist (TECC) provides a validated telehealth etiquette tool that can be used by health professionals to improve their telehealth videoconsultations, thus enhancing patient satisfaction.
What is a sustainable diet in the Norwegian context?
Authors: Meltzer Helle Margrete , Abel Marianne H. , Knutsen Helle K. , Amberntsson Anna , Brantsæter Anne Lise , Budin-Ljøsne Isabelle , Husøy Trine , Iszatt Nina , Lund-Iversen Kaja , Paulsen Mari M. , Thomsen Cathrine , Torheim Liv Elin , Haug Line S. 
Published: September 2024

Introduction: Sustainable diets promote health and wellbeing and have low environmental impact. They should be accessible, affordable, safe, equitable and culturally acceptable. Translating these general principles into Norwegian-specific dietary recommendations is essential, as foods beneficial for health tend to also be environmentally sustainable. Following the dietary recommendations is an important step towards sustainability. Aim: To identify challenges and potential solutions for transitioning towards more sustainable diets in Norway. Methods: We used scientific articles, reports, policy documents, and statistics on Norwegian food production and consumption to discuss a sustainable diet in a Norwegian context. Results and discussion: There is a large gap between dietary guidelines and actual consumption. More than 60% of the calories in the Norwegian diet are based on imported foods and feed. Changing people’s diet is identified as central in transforming the food system to become more sustainable, as is prioritizing the use of local resources. Good animal health and welfare are also fundamental premises for a sustainable food system. Conclusions: Transitioning to a more sustainable diet requires comprehensive efforts at multiple levels. There is considerable room for action to increase the use of Norwegian resources in a sustainable and responsible way. Potential strategies include reducing meat intake in favour of plant-based foods and fish, consuming more local products, decreasing food waste and supporting agricultural practices that promote environmental and social sustainability. A more sustainable diet may also lead to significantly increased self-sufficiency and food security in Norway.