bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of aerobic exercise on cardiometabolic health in postmenopausal females: A systematic review and meta-analysis of randomized controlled trials
Authors: Huynh Eric , Wiley Elise , Noguchi Kenneth S , Fang Hanna , Beauchamp Marla K , MacDonald Maureen J , Tang Ada 
Published: October 2024

Background: After menopause, reductions in ovarian hormones increase the risk of cardiovascular disease. Aerobic exercise training has been shown to reduce cardiovascular risk in older adults, but its effectiveness in postmenopausal females is less definitive. Objectives: The objectives of this study were to examine the: (1) effects of aerobic training, and (2) association between aerobic training intensity and cardiometabolic health outcomes in postmenopausal females. Design: Systematic review and meta-analysis of randomized controlled trials. Data Sources and Methods: Six electronic databases were searched from inception to July 21, 2023 for aerobic training interventions reporting cardiometabolic outcomes in postmenopausal females. Data were synthesized qualitatively and random-effects meta-analyses and subgroup analyses (light, moderate, and vigorous intensity) were performed. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence. Results: Fifty-nine studies ( n = 4,225; 45–78 years old) were identified, 53 ( n = 3,821) were included in the quantitative analyses. Aerobic training interventions varied in frequency (3–21×/week), intensity, type, time (8–60 min/session), and duration (3–52 weeks). Aerobic training improved systolic blood pressure (mean difference (MD) = −4.41 mmHg, 95% confidence interval (95%CI) [−7.29, −1.52], p = 0.01), resting heart rate (MD = −3.08 bpm, 95%CI [−5.11, −1.05], p < 0.01), body mass index (BMI, MD = −0.65 kg/m2, 95%CI [−0.99, −0.31], p < 0.01), waist circumference (MD = −2.03 cm, 95%CI [−2.65, −1.41], p < 0.01), body fat (MD = −2.57 kg, 95%CI [−3.65, −1.49], p < 0.01), low-density lipoprotein cholesterol (MD = −10.46 mg/dL, 95%CI [−16.31, −4.61], p < 0.01), high-density lipoprotein cholesterol (MD = 3.28 mg/dL, 95%CI [0.20, 6.36], p = 0.04) and cardiorespiratory fitness (standardized MD = 1.38, 95%CI [1.13, 1.64], p < 0.01). There was a very low certainty of evidence for all outcomes. In subgroup analyses, light- and vigorous intensities were beneficial for BMI with no effect for moderate-intensity exercise ( p < 0.01). Light intensity showed a beneficial effect ( p = 0.02) for glucose levels ( p < 0.01) and triglycerides; there was no effect with moderate or vigorous intensities. Conclusion: Aerobic training may improve cardiometabolic health outcomes in postmenopausal females. There may be differential effects of exercise intensity on BMI, blood triglycerides, and blood glucose; however, this warrants further investigation. Registration: PROSPERO—CRD42022313350
Management of adult mechanically ventilated patients: A UK-wide survey
Authors: Ward James , Terrington Isis , Preston Katie , Smith Alexander , Roe Thomas , Barnes Jonathan , Allen Emma , Lima Sandra , Cusack Rebecca , Grocott Michael P.W. , Dushianthan Ahilanandan ,   the South-coast Peri-operative Audit and Research Collaborative (SPARC)
Published: October 2024

Background: Mechanical ventilation is a common and often lifesaving intervention that is utilised in intensive care. However, the practices can vary between centres. Through this national survey we aim to gain more information about different strategies adopted across the UK. Methods: All adult intensive care units in the UK were approached to participate. The questionnaire was developed with an electronic survey engine and conducted between 09/11/2023 and 01/04/2024 (Survey Monkey®). The survey included questions on ventilator modes, settings, protocols/pathways, rescue strategies, immediate post-extubation period and follow-up. Results: There were 196 responses from 104 hospitals. The most widely adopted start-up ventilation mode was pressure-regulated volume-controlled mode. For acute hypoxaemic respiratory failure (AHRF), most of respondents reported full (39.8%) or partial compliance (58.1%) with the ARDSnet protocol, with PEEP settings being the commonest deviation. Prone positioning (99.0%), followed by recruitment manoeuvres (91.3%) were commonly used rescue measures during AHRF. APRV (55.7%), inhaled (51.3%) and systemic pulmonary vasodilators (44.1%) were also commonly used. Conservative oxygen targets (SaO2 of 88%–92%) were commonly adopted (70.6%). As a care bundle, intermittent ETT cuff pressure monitoring was more common (65.5%) than continuous cuff pressure monitoring (20.0%). Propofol and alfentanil were the most common initial sedative and analgesia (99.5% and 56.9%) respectively. Routine volatile anaesthetic use was rare. Conclusions: Our survey has shown significant variation of practice in common but crucial elements of management of patients receiving mechanical ventilation. We hope the results in our survey highlight potential future areas of research. Collaborators South-coast Peri-operative Audit and Research Collaborative (SPARC) Severn Trainee Anaesthetic and Critical Care Research group (STAR) Collaborative research in Anaesthesia in the Northeast (CRANE)
Trapeziometacarpal total joint arthroplasty, with or without supervised hand rehabilitation: A quasi-experimental trial
Authors: Bonhof-Jansen Elske EDJ , Brink Sander M , de Jong Tjeerd R , van Uchelen Jeroen H , Bakker Eric WP 
Published: October 2024

Introduction Aim of this study was to determine whether postoperative supervised rehabilitation improves functional outcomes after trapeziometacarpal (TMC) total joint arthroplasty (TJA), compared to education alone. Method A quasi-experimental before-after trial included 31 women (≥40 years) per group diagnosed with trapeziometacarpal osteoarthritis who underwent TJA. A cohort ( n = 31) who was given education alone was compared to a cohort ( n = 31) who were subjected to supervised rehabilitation. Primary outcome was the difference in hand function 3 months postoperatively, measured by the Michigan Hand Outcomes Questionnaire (MHOQ). Other outcomes were the MHOQ subscale scores, the active range of motion, strength, time to return to work, satisfaction and complications. Results Patients in the education group had a significantly higher median delta MHOQ score when compared to the rehabilitation group at 3 months; 28.5 (20.5-31.3) versus 15.8 (1.9-21.1), ( p = <0.01) and at 12 months 36.6 (26.8 - 47.2) versus 27.4 (14.5 - 33.0), ( p = 0.01). Only the secondary outcomes the MHOQ subscales hand function, ADL and satisfaction revealed significant differences in favor of the education group. The education method reduced the median number of hand therapy sessions with eight visits. Conclusion The present study does not show a significant or clinically relevant benefit from supervised rehabilitation in terms of functional outcomes following TJA compared to education alone. Based on this, it seems safe to leave patients unsupervised in their recovery following TJA and to suffice with just education, however further exploration of effectiveness and safety of this intervention is recommend in larger trials.
Plasma Radiofrequency Tuboplasty and Cartilage Underlay Myringoplasty for Repairing Chronic Large Perforation with Eustachian Tube Dysfunction
Authors: Lou Zhengcai , Lou Zihan , Lv Tian , Chen Zhengnong 
Published: October 2024

Objective The objective of this study was to compare the outcomes of endoscopic cartilage myringoplasty (ECM) with or without plasma radiofrequency (RF) tuboplasty (PRT) for repairing chronic large perforation with Eustachian tube dysfunction (ETD). Materials and methods Chronic large perforations with ETD were randomly divided into receiving ECM or ECM plus PRT. During the 24 months follow-up, the Eustachian tube score (ETS), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), ET inflammation scale, hearing results, and graft success rate of the patients were analyzed. Results A total of 61 subjects were included in the study. Difference of ETS was significant before and after surgery in the ECM + PRT group ( P < .05) but the ECM group was not ( P > .05). Also, significant between-group difference was found regardless of post-24 months ETS and improvement value. Postoperative ETDQ-7 scores were significantly reduced compared with preoperative ETDQ-7 scores in both groups ( P < .05), also, significant between-group difference was found regardless of post-24 months ETDQ-7 scores and improvement value. The graft success rate was 86.7% in the ECM group and 96.8% in the ECM + PRT group at postoperative 24 months ( P > .05). In addition, although the ECM + PRT group showed a better air-bone gap improvement than the ECM group, the difference was not significant (13.01 ± 2.97 vs 10.92 ± 0.69 dB; P > .05). No PRT procedure-related serious adverse events were reported during the follow-up process. No patients developed atelectasis or otitis media with effusion in either group. Conclusion ECM combined with low-temperature PRT did not affect the graft success rate but showed a better long-term improvement in ETS and ETDQ-7 than cartilage myringoplasty for the treatment of chronic perforation with ETD. In addition, although PRT showed a better hearing improvement, the difference was not significant between the 2 groups.
Assessing the feasibility of the GOTT (Gabapentinoid and Opioid Tapering Toolkit) in a primary care setting in North-East England
Authors: Johnson Lucy , Cole Frances , Kinchin Rebecca , Francis Andrea , Winiarek Konrad , Hampshire Kate , Chazot Paul 
Published: October 2024

Objective To assess the feasibility and possible impacts of implementation of systematic non-pharmacological interventions to reduce the level of prescribing of opioid and gabapentinoid analgesics for chronic non-cancer pain (CNCP), particularly high-dose prescriptions, through a proof-of-concept study in a deprived area (second lowest decile) primary care practice in North-East England. Participant Twenty-five primary care staff (clinical and non-clinical) of which 18 clinicians received the intervention. Intervention used in this study practice known as GOTT (Gabapentinoid and Opioid Toolkit) All clinicians received an educational skills programme to support patient pain self-management, tailored on the clinicians’ self-assessment of their learning needs, embedding both clinician skill learning and patient self-care resources for rapid access within consultations into a GP clinical management computer system. Outcome measures Clinical staff completed questionnaires before and after the GOTT intervention to assess levels of knowledge and confidence in their own skills to support chronic pain self-management across several domains. Prescription data were used to measure changes in opioid and gabapentinoid prescribing at the practice across the 12-month intervention and 30-month follow-up period. Results Prescribing of opioid and gabapentinoid/pregabalin decreased substantially in the practice across the intervention period (c. 90% in high-dose opioid [ p = .0118], and 15% gabapentin/pregabalin prescriptions, respectively), over a one-year period during the COVID-19 pandemic. Follow-up analysis showed 100% and c.50% reductions, respectively, in December 2022. The questionnaire data showed an increase in clinician confidence in skills to enable self-management over the intervention period, overall ( p = .044) and, specifically across three of the five domains measured: supporting behavioural change ( p = .028), supporting self-care ( p = .008), and managing difficult consultations ( p = .011). Conclusion The GOTT intervention program provided some initial evidence of a proof-of-concept for the implementation of a systematic non-pharmacological pain management skills and resources programme addressing lack of confidence in skills to introduce and support self-management and reduce use of strong opioids and gabapentinoids.
Acute Allograft Rejection in Kidney Transplant Recipients Treated With Immune Checkpoint Inhibitors: An Educational Case Report
Authors: Morrison Steven A. , Vinson Amanda J. 
Published: October 2024

Rationale: Kidney transplant (KT) recipients have an increased risk of malignancy due to chronic immunosuppression. The emerging use of immune checkpoint inhibitors (ICIs) has been a promising development for the treatment of malignancy, but their use adds to the complexity of immunosuppression management for KT recipients. This case report describes 2 cases of acute rejection in KT recipients following ICI initiation and discusses the balance of malignancy treatment with adequate immunosuppression. Presenting Concerns of Patients: The first patient is a 44-year-old male KT recipient with a diagnosis of metastatic renal cell carcinoma presenting with acute kidney injury 6 days following initiation of an ICI. The second patient is a 73-year-old male KT recipient with a diagnosis of squamous cell carcinoma presenting with acute kidney injury 2 weeks following initiation of an ICI. Diagnoses: Both patients were diagnosed with acute rejection in the setting of reduced immunosuppression and initiation of an ICI. Interventions: Both cases received an increased dose of steroid without improvement of graft function. The first patient subsequently underwent a delayed graft nephrectomy due to complications of acute rejection, whereas the second patient did not undergo nephrectomy. Outcomes: The first patient experienced complications including perioperative bleeding requiring multiple operations, but ultimately stabilized on hemodialysis and showed a durable response to ICI. The second patient remained dialysis-dependent post-ICI treatment and was readmitted with allograft complications leading to his eventual death. Teaching Points: This study underscores the complexity of managing KT recipients diagnosed with malignancy and receiving ICIs. The balance between immunosuppression reduction to treat malignancy and preventing allograft rejection presents a significant challenge. Key considerations include the risk of acute allograft rejection and patient-centered decision-making. These cases highlight the need for further research to develop evidence-based guidelines for managing this patient population. In addition, the patient perspective in this study highlights the importance of careful risk-benefit analysis and the impact of treatment decisions on patient-focused outcomes.
Unsupervised SapBERT-based bi-encoders for medical concept annotation of clinical narratives with SNOMED CT
Authors: Abdulnazar Akhila , Roller Roland , Schulz Stefan , Kreuzthaler Markus 
Published: October 2024

Objective Clinical narratives provide comprehensive patient information. Achieving interoperability involves mapping relevant details to standardized medical vocabularies. Typically, natural language processing divides this task into named entity recognition (NER) and medical concept normalization (MCN). State-of-the-art results require supervised setups with abundant training data. However, the limited availability of annotated data due to sensitivity and time constraints poses challenges. This study addressed the need for unsupervised medical concept annotation (MCA) to overcome these limitations and support the creation of annotated datasets. Method We use an unsupervised SapBERT-based bi-encoder model to analyze n-grams from narrative text and measure their similarity to SNOMED CT concepts. At the end, we apply a syntactical re-ranker. For evaluation, we use the semantic tags of SNOMED CT candidates to assess the NER phase and their concept IDs to assess the MCN phase. The approach is evaluated with both English and German narratives. Result Without training data, our unsupervised approach achieves an F1 score of 0.765 in English and 0.557 in German for MCN. Evaluation at the semantic tag level reveals that “disorder” has the highest F1 scores, 0.871 and 0.648 on English and German datasets. Furthermore, the MCA approach on the semantic tag “disorder” shows F1 scores of 0.839 and 0.696 in English and 0.685 and 0.437 in German for NER and MCN, respectively. Conclusion This unsupervised approach demonstrates potential for initial annotation (pre-labeling) in manual annotation tasks. While promising for certain semantic tags, challenges remain, including false positives, contextual errors, and variability of clinical language, requiring further fine-tuning.
The invisible work of video consultation use in Danish general practice: An ethnographic study
Authors: Lüchau Elle Christine , Olesen Finn , Atherton Helen , Søndergaard Jens , Hvidt Elisabeth Assing 
Published: October 2024

Objective To delineate the characteristics of the work undertaken by general practitioners (GPs) and staff in implementing and utilising video consultation within their situated clinical contexts. Methods The data material comprises 33 semi-structured interviews with GPs and staff and 132 hours of ethnographic fieldwork across seven clinics in Denmark. The data collection period spanned from June 2021 to August 2022. Reflexive thematic analysis was employed to analyse the data, drawing inspiration from the concept of invisible work as proposed by Susan Leigh Star and Anselm Strauss. Results Four types of invisible work were identified through the analysis: (1) the work of introducing video consultations, (2) the work of stabilising video consultation use, (3) the work of coordinating users and systems, (4) the work of repair as a response to breakdowns. Conclusions The video consultation changes the organisational structure and leads to a reconfiguration of professional roles and existing work practices. Moreover, implementing and using video consultations demands articulation, inclusion and affective work by GPs and staff, and this work includes allocating time to coordinate tasks, do workarounds and repair breakdowns.
Role of mobile health applications in prevention and detection of pandemic disease: A population perspective
Authors: Elbilgahy Amal Ahmed , Alenezi Mada Huwaydi , Alruwaili Aseel Hamed , Alhathal Sarah Muteb 
Published: October 2024

Background The Saudi government and the MOH launched six mobile application help in tracking positive cases, get medical consultation from home, and vaccination for coronavirus disease 2019 (COVID-19). Our study was conducted to evaluate the role of mobile health applications in the prevention and detection of pandemic disease from population perspectives. Methods A cross-sectional descriptive exploratory research design was utilized in this study. Based on the sample size calculation (described below), we recruited a convenience sample of 462 participants from the Northern Border Region according to the set of inclusion and exclusion criteria: Anyone over 12 years of age, including both genders and both Saudi citizens and non-Saudi citizens, were eligible to participate during the period from March 2022 to the end of July. Results In total 462 were participated, and 79.2% of them were females. There was a statistically significant difference between educational level and the overall score of public satisfaction with the ease of use of mobile health applications as well as overall satisfaction with the services provided by mobile health apps during the COVID-19 pandemic. Additionally, there was a statistically significant difference between gender and the role of mobile applications in the prevention of COVID-19 ( p = 0.028). Conclusion The study found that most participants agree that the mobile health applications launched by the Saudi government and Ministry of Health have been successful in aiding the anticipation and early detection of COVID-19 cases, as well as facilitating access to healthcare services. Over half of the participants strongly agree that these mobile applications have been very effective and beneficial for their health and have helped save time.
Clinician Awareness of Patient-Reported Health-Related Social Needs: There’s Room for Improvement
Authors: Nederveld Andrea , Bertin Kaitlyn Booske , Dickinson Louise Miriam , Beall Shivani , Nelson Jordan , Glasgow Russell E. , Huebschmann Amy G. 
Published: October 2024

Introduction: People experiencing health-related social needs (HRSNs), such as transportation insecurity, are less likely to undergo preventive health screenings. They are more likely to have worse health outcomes overall, including a higher rate of late-stage cancer diagnoses. If primary care clinicians are aware of HRSNs, they can tailor preventive care, including cancer screening approaches. Accordingly, recent guidelines recommend that clinicians “adjust” care based on HRSNs. This study assessed the level of clinician awareness of patient-reported HRSNs and congruence between clinician perception and patient-reported HRSNs. Methods: We surveyed patients aged 50 to 85 years and their clinicians in 3 primary care clinics that routinely screen patients for HRSNs. Patients and clinicians reported the presence/absence of 6 HRSNs, including food, transportation, housing and financial insecurity for medications/healthcare, financial insecurity for utilities, and social isolation. Kappa statistics assessed the concordance of reported HRSNs between patients and clinicians. Results: Across 237 paired patient-clinician surveys, mean patient age was 65 years, and 62% and 13% of patients were female and Latinx/Hispanic, respectively. Concordance between clinician- and patient-reported HRSNs varied by HRSN, with the lowest agreement for food insecurity (kappa = .08; 95% CI: 0.00, 0.17; P = .01) and highest agreement for transportation insecurity (kappa = .39; 95% CI: 0.18, 0.59; P < .001). The other HRSNs assessed were housing insecurity (kappa = .30; 95% CI: 0.05, 0.55; P < .001), social isolation (kappa = .24; 95% CI: 0.03, 0.45; P < .001), financial insecurity for utilities (kappa = .21; 95% CI: −0.02, 0.45; P < .001), and financial insecurity for healthcare/medications (kappa = .12; 95% CI: −0.02, 0.27; P < .001). In particular, discrepancies were noted in food insecurity prevalence: patient-reported food insecurity was 29% whereas clinician-reported food insecurity was only 3%. Discussion: Clinician awareness of patients’ social needs was only modest to fair, and varied by specific HRSN. In order to adjust care for HRSNs, clinics need processes for increased sharing of patient-reported HRSNs screening information with the entire clinical team. Future research should explore options for sharing HRSN data across teams and evaluate whether better HRSN data-sharing impacts outcomes.