bluuebunny/crossref_metadata_2025_split huggingface dataset:
Content validity of the Leicester Cough Questionnaire in adults with refractory or unexplained chronic cough: a qualitative interview study
Authors: Martin Nguyen Allison , La Rosa Carmen , Cornell Alexandra G. , Sher Mandel R. , Bernstein Jonathan A. , Birring Surinder S. , (DeMuro) Romano Carla , Mayorga Margaret , Milien Mirline , Ervin Claire 
Published: September 2024

Background: Chronic cough, a cough lasting >8 weeks, includes refractory chronic cough (RCC) and unexplained chronic cough (UCC). Patient-reported outcome (PRO) measures are needed to better understand chronic cough impacts that matter most to patients. The 19-item Leicester Cough Questionnaire (LCQ), an existing PRO measure of chronic cough, assesses impacts of cough across physical, psychological, and social domains. However, the content validity of the LCQ evaluating these concepts in patients with RCC/UCC had not been established. Objectives: To evaluate the content validity of the LCQ in patients with RCC/UCC. Design: A cross-sectional, qualitative interview study. Methods: First, previously completed qualitative interview results in adults with RCC/UCC ( N = 30) were evaluated and mapped to LCQ concepts. Next, a clinical cough expert reviewed each LCQ item and assessed the salience of its concepts for patients with RCC/UCC. Finally, semistructured interviews—including both concept elicitation and cognitive debriefing—were conducted in adults with RCC/UCC ( N = 20) to elicit a comprehensive set of participant experiences and to assess the appropriateness of using the LCQ in this population. Results: Concepts reported in the past and present qualitative interviews were included across all LCQ items, and most impacts reported to be the “most bothersome” were assessed in the LCQ. In the current study, all participants indicated that reduced cough frequency would be an important treatment target. During cognitive debriefing, each LCQ item was endorsed by ⩾70% of participants. Additionally, participants were generally able to understand, recall, and select a response for each LCQ item. All participants and the clinical expert indicated that the LCQ was appropriate and assessed the impacts most relevant to patients with RCC/UCC. Conclusion: Our findings support the content validity of the LCQ and demonstrate that this measure is fit-for-purpose and includes important cough impacts in adults with RCC/UCC.
Association between acute exacerbation and progressive pulmonary fibrosis in interstitial lung disease: a retrospective cohort study
Authors: Zhai Liying , Wang Zhiqiang , Yu Wencheng 
Published: September 2024

Background: Acute exacerbation (AE) refers to rapidly progressive respiratory deterioration in the clinical course of interstitial lung disease (ILD). Progressive pulmonary fibrosis (PPF) is the chronic progressive phenotype of ILD. No study has investigated the relationship between AE and PPF in ILD. Objectives: We aimed to determine the association between AE and PPF in ILD patients. Design: A retrospective cohort study. Methods: A total of 414 patients hospitalised for ILD were included in our study. The clinical presentations, radiographic features and laboratory findings of the patients were reviewed. Results: AE was present in 120 (29.0%) ILD patients and was associated with a higher risk of death than non-AE patients in the whole cohort (HR 2.893; 95% CI, 1.847–4.529; p < 0.001). However, the significant difference disappeared when stratified by PPF (HR 1.192; 95% CI, 0.633–2.247; p = 0.586) and non-PPF (HR 1.113; 95% CI, 0.384–3.223; p = 0.844). In addition, the adverse effect of PPF on prognosis remained consistent in both AE and non-AE patients. Multivariable logistic regression analysis showed that compared with non-PPF patients, only age was a risk factor for PPF in AE-ILD, while the risk factors for PPF in the non-AE group were age, definite usual interstitial pneumonia and mediastinal lymph node enlargement. Conclusion: In the context of ILD, both AE and PPF were found to be associated with poor prognosis. However, the adverse effect of AE on prognosis disappeared when PPF was considered as a stratification feature, whereas the adverse effect of PPF on prognosis persisted in both AE and non-AE individuals. Therefore, it is important to investigate effective strategies to prevent disease progression after AE. Increased recognition and attention to PPF and early antifibrotic therapy at the appropriate time is also warranted.
HER2 becomes a novel survival biomarker for gastric cancer patients: a pooled analysis
Authors: Cheng Ji , Cai Ming , Wang Guobin , Tao Kaixiong 
Published: September 2024

Background: Although anti-HER2 therapies have been widely used against gastric carcinoma, the prognostic significance of HER2 overexpression remains unclear. Previous studies failed to provide convincible evidence due to inconsistent HER2 evaluation criteria and heterogeneous clinical characteristics. Objectives: To figure out the prognostic significance of HER2 expression in gastric cancer, we rigorously designed and conducted this study. Design: Meta-analysis. Data sources and methods: Record retrieval was performed by searching PubMed, Web of Science, Cochrane Library, Embase, ASCO, and ESMO meeting libraries from inception to November 2022. Cohort studies investigating overall survival comparison between HER2-positive and HER2-negative gastric cancer patients were included. Both resectable and advanced cases were separately collected while HER2 evaluation standards should be consistent across eligible studies. Newcastle–Ottawa Scale was used for quality assessment. Overall survival was the only endpoint and effect size was presented by hazard ratio (HR) with its 95% confidence interval. The pooled calculation was conducted on Review Manager 5.4. Results: Thirty studies were eligible, including 9945 patients. Eligible studies were mostly high quality ( n = 31). Regarding resectable cases ( n = 22), HER2-positive groups had significantly worse prognosis than HER2-negative counterparts (HR 1.56, 95%CI 1.32–1.85, p < 0.00001). For HER2-positive patients with advanced gastric cancer ( n = 10), HER2 overexpression was also an unfavorable survival indicator (HR 1.70, 95%CI 1.23–2.35, p = 0.001). Potential heterogeneous studies had been eliminated while outcomes remained stable by sensitivity analysis. Subgroup analysis suggested HER2-positive patients had a poorer prognosis in both East Asian (resectable: HR 1.56; advanced: HR 1.32) and non-East Asian countries (HR 1.58; HR 3.27). Conclusion: As a novel survival biomarker in gastric cancer, HER2 overexpression indicates unfavorable prognosis among both resectable and advanced patients, irrespective of East Asian or non-East Asian populations. Trial registration: PROSPERO (CRD42020168051).
The socioeconomic status of patients with ankylosing spondylitis and its association with the burden of the disease and permanent disability: a cross-sectional cluster analysis
Authors: Ruiz-Vilchez Desirée , Ladehesa-Pineda Lourdes , Puche-Larrubia María Ángeles , Ábalos-Aguilera María Carmen , Font-Ugalde Pilar , Escudero-Contreras Alejandro , Collantes-Estévez Eduardo , López-Medina Clementina 
Published: September 2024

Background: Few studies have been conducted to investigate the socioeconomic profiles of patients with ankylosing spondylitis (AS) and their associations with disease severity and disability. Objectives: The objectives of this study were to identify clusters of patients with AS according to their socioeconomic characteristics and to evaluate the associations between these clusters and the severity of the disease and permanent disability. Design: This was a cross-sectional and multicentre study. Methods: Patients with AS from the REGISPONSER study were included in this analysis. A cluster analysis was conducted using information on sociodemographic (age, sex, race, marital status, education) and socioeconomic (employment, profession, housing conditions and social level) characteristics. Disease burden and permanent disability were compared between the different clusters using logistic regression adjusted for disease duration and disease activity. Results: A total of 866 patients with AS were included. Two clusters were identified according to socioeconomic characteristics: Cluster 1 ( n = 476), with a predominantly low socioeconomic profile, and Cluster 2 ( n = 390), with a predominantly high socioeconomic profile. After adjusting for disease duration, patients in Cluster 1 had a longer diagnosis delay, greater body mass index and greater structural damage than those in Cluster 2. Access to biologic disease-modifying anti-rheumatic drugs (bDMARDs) was similar for both groups. However, patients in Cluster 1 had a greater prevalence of permanent disability than those in Cluster 2 after adjusting for disease duration and disease activity (30.8% vs 13.2%, odds ratio 2.58 (95% confidence interval 1.76–3.83)). Conclusion: This study suggests that the socioeconomic status of patients with AS may have implications for disease severity and permanent disability, despite the similar use of bDMARDs.
Time to Moderate and Severe Hyperglycemia and Ketonemia Following an Insulin Pump Occlusion
Authors: Klonoff David C. , Ayers Alessandra T. , Ho Cindy N. , Fabris Chiara , Villa-Tamayo María Fernanda , Allen Eleanor , Cengiz Eda , Ekhlaspour Laya , Wong Jenise C. , Heineman Lutz , Kohn Michael A. 
Published: September 2024

Introduction: Insulin pump therapy can be adversely affected by interruption of insulin flow, leading to a rise in blood glucose (BG) and subsequently of blood beta-hydroxybutyrate (BHB) ketone levels. Methods: We performed a PubMed search for English language reports (January 1982 to July 2024) estimating the rate of rise in BG and/or BHB after ≥ 60 minutes of interruption of continuous subcutaneous insulin infusion (CSII) in persons with type 1 diabetes (PwT1D). We also simulated the rise in BG in a virtual population of 100 adults with T1D following suspension of continuous subcutaneous insulin infusion. Results: We identified eight relevant studies where BG and BHB (seven of these eight studies) were measured following suspension of CSII as a model for occlusion. After 60 minutes post-suspension, the mean extracted rates of rise averaged 0.62 mg/dL/min (37 mg/dL/h) for BG and 0.0038 mmol/L/min (0.20 mmol/L/h) for BHB. Mean estimated time to moderately/severely elevated BG (300/400 mg/dL) or BHB (1.6/3.0 mmol/L) was, respectively, 5.8/8.5 and 8.0/14.2 hours. The simulation model predicted moderately/severely elevated BG (300/400 mg/dL) after 9.25/12, 6.75/8.75, and 4.75/5.75 hours in the virtual subjects post-interruption with small (5th percentile), medium (50th percentile), and large (95th percentile) hyperglycemic changes. Discussion: Clinical studies and a simulation model similarly predicted that, following CSII interruption, moderate/severe hyperglycemia can occur within 5-9/6-14 hours, and clinical studies predicted that moderate/severe ketonemia can occur within 7-12/13-21 hours. Patients and clinicians should be aware of this timing when considering the risks of developing metabolic complications after insulin pump occlusion.
The Effects of Ketogenic Diets and Ketone Supplements on the Aerobic Performance of Endurance Runners: A Systematic Review
Authors: Sun Kexin , Choi Yee Tung , Yu Clare Chung Wah , Nelson Edmund Anthony Severn , Goh Jorming , Dai Siyu , Hui Lai Ling 
Published: September 2024

Context: Ketogenic diets and ketone supplements have gained popularity among endurance runners given their purported effects: potentially delaying the onset of fatigue by enabling the increased utilization of the body’s fat reserve or external ketone bodies during prolonged running. Objective: This systematic review was conducted to evaluate the effects of ketogenic diets (>60% fat and <10% carbohydrates/<50 g carbohydrates per day) or ketone supplements (ketone esters or ketone salts, medium-chain triglycerides or 1,3-butadiol) on the aerobic performance of endurance runners. Data Sources: A systematic search was conducted in PubMed, Web of Science, Pro Quest, and Science Direct for publications up to October 2023. Study Selection: Human studies on the effects of ketogenic diets or ketone supplements on the aerobic performance of adult endurance runners were included after independent screening by 2 reviewers. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Primary outcomes were markers of aerobic performance (maximal oxygen uptake [VO2max], race time, time to exhaustion and rate of perceived exertion). Results: VO2max was assessed by incremental test to exhaustion. Endurance performance was assessed by time trials, 180-minute running trials, or run-to-exhaustion trials; 5 studies on ketogenic diets and 7 studies on ketone supplements involving a total of 132 endurance runners were included. Despite the heterogeneity in study design and protocol, none reported benefits of ketogenic diets or ketone supplements on selected markers of aerobic performance compared with controls. Reduction in bodyweight and fat while preserving lean mass and improved glycemic control were reported in some included studies on ketogenic diets. Conclusion: This review did not identify any significant advantages or disadvantages of ketogenic diets or ketone supplements for the aerobic performance of endurance runners. Further trials with larger sample sizes, more gender-balanced participants, longer ketogenic diet interventions, and follow-up on metabolic health are warranted.
Optimizing Subsequent CARdiovascular Medication Reintroduction in the Intensive Care Unit
Authors: Dahel Hadjer , Tabbara Najla , Burry Lisa , Hornstein Gabrielle , Williamson David , Wang Han Ting 
Published: September 2024

Importance: Hospital admission for a critical illness episode creates communication breakpoints and can lead to medication discrepancies during hospital stays. Due to the patient’s underlying condition and the care setting, chronic medications such as cardiovascular medication are often held, discontinued, or changed to alternative administration routes. Unfortunately, data on the optimal timing of cardiovascular drug reinitiation among intensive care unit (ICU) survivors are lacking. Objective: The primary objective of this study was to describe the prevalence of chronic cardiovascular medication taken before hospital admission and discontinued at ICU discharge and hospital discharge for critically ill patients. A secondary objective was to assess factors associated with medication discontinuation. Design setting and participants: We conducted a multicentered retrospective cohort study at 2 tertiary academic hospitals in Canada. All adult patients taking cardiovascular medication before ICU admission and surviving to hospital discharge between April 1, 2016, and April 1, 2017, were eligible. Main outcomes and measures: The main outcome of the study was the discontinuation of cardiovascular medication prescribed before ICU admission. The outcome was assessed through participants’ chart review. Results: We included 352 patients with a median age of 71.0 years. A total of 155 patients (44.03%) had at least 1 cardiovascular medication discontinued during their stay. Our adjusted model uncovered 3 factors associated with cardiovascular medication discontinuation: male sex (odds ratio [OR] = 0.564, 95% confidence interval [CI] = 0.346-0.919), number of cardiovascular medications taken preadmission (OR = 1.669, 95% CI = 1.003-2.777 for 2 medications and OR = 3.170, 95% CI = 1.325-7.583), and the use of vasopressors (OR = 1.770, 95% CI = 1.045-2.997). Conclusion: Our study uncovered that cardiovascular medication discontinuation for ICU patients is frequent, especially for renin-angiotensin system (RAS) blockers. Data from our study could be used to reinforce site-specific protocols of medication reconciliation and optimization, as well as inform future protocols aimed at RAS blocker reinitiation follow-up.
Disease characteristics influence the privacy calculus to adopt electronic health records: A survey study in Germany
Authors: von Kalckreuth Niklas , Feufel Markus A. 
Published: September 2024

Background The electronic health record (EHR) is integral to improving healthcare efficiency and quality. Its successful implementation hinges on patient willingness to use it, particularly in Germany where concerns about data security and privacy significantly influence usage intention. Little is known about how specific characteristics of medical data influence patients’ intention to use the EHR. Objective This study aims to validate the privacy calculus model (PCM) regarding EHRs and to assess how personal and disease characteristics, namely disease-related stigma and disease time course, affect PCM predictions. Methods An online survey was conducted to empirically validate the PCM for EHR, incorporating a case vignette varying in disease-related stigma (high/low) and time course (acute/chronic), with N = 241 participants, aged 18 years and older residing in Germany with no previous experience with the diseases mentioned in the respective medical reports. Participants were randomized (single-blinded) into four groups in parallel: high stigma and acute time course ( n = 74), high stigma and chronic time course ( n = 56), low stigma and acute time course ( n = 62) and low stigma and chronic time course ( n = 49). The data were analyzed using structural equation modeling with partial least squares. Results The model explains R² = 71.8% of the variance in intention to use. The intention to use is influenced by perceived benefits, data privacy concerns, trust in the provider, and social norms. However, only the disease's time course, not stigma, affects this intention. For acute diseases, perceived benefits and social norms are influential, whereas for chronic diseases, perceived benefits, privacy concerns, and trust in the provider influence intention. Conclusions The PCM validation for EHRs reveals that personal and disease characteristics shape usage intention in Germany. The need for tailored EHR adoption strategies that address specific needs and concerns of patients with different disease types. Such strategies could lead to a more successful and widespread implementation of EHRs, especially in privacy-conscious contexts.
Feasibility and acceptability of a dengue self-monitoring system to reduce treatment delay in Malaysia: A single-centre pilot randomised controlled trial
Authors: Ng Wei Leik , Ng Chirk Jenn , Teo Chin Hai , Ang Tan Fong , Lee Yew Kong , Abdul Hadi Haireen , Chiang De Min , Mohd Noor Mohd Khairi , Syed Omar Sharifah Faridah , Ong Hang Cheng , Wong Pui Li , Kukreja Anjanna , Chiew Thiam Kian , Ong Sim Ying , Noor Azhar Abdul Muhaimin 
Published: September 2024

Objective Most dengue cases are managed in an outpatient setting, where patients are advised to return to the clinic daily for monitoring. Some patients can develop severe dengue at home and fail to recognise the deterioration. An application called DengueAid was designed as a self-monitoring tool for patients to reduce delay in seeking timely treatment. This study aimed to assess the feasibility of conducting a randomised controlled trial to determine the effectiveness of the DengueAid application. Methods Dengue patients were recruited from a public health clinic in Malaysia and randomised to either use the DengueAid application plus standard care for dengue or receive only the standard care. The outcomes evaluated were the (1) feasibility of recruitment, data collection and follow-up procedures; (2) preliminary clinical outcome measures; and (3) acceptability of DengueAid. Qualitative interviews were conducted for participants in the intervention arm to assess the acceptability of DengueAid. Results Thirty-seven patients were recruited with 97% ( n = 36) retention rates. The recruitment rate was low (63% refusal rate, n = 62/99) with difficulty in data collection and follow-up due to the variable interval of care for dengue in an outpatient setting. DengueAid application was acceptable to the participants, but preliminary clinical outcomes and qualitative data suggested limited utility of the application. Unwell conditions of patients and limited access to healthcare are important factors impacting the application's utility. Conclusion The feasibility trial uncovered issues with recruitment, data collection and follow-up processes. Further research and modification to the application are needed to improve its utility and usability.
Chinese colposcopists' attitudes toward the colposcopic artificial intelligence auxiliary diagnostic system (CAIADS): A nation-wide, multi-center survey
Authors: Wang Huike , Ye Zichen , Zhang Peiyu , Cui Xiaoli , Chen Mingyang , Wu Aiyuan , Riggs Sara Lu , Xue Peng , Qiao Youlin 
Published: September 2024

Objective The objective of this study was to assess the attitudes toward the Colposcopic Artificial Intelligence Auxiliary Diagnostic System (CAIADS) of colposcopists working in mainland China. Methods A questionnaire was developed to collect participants' sociodemographic information and assess their awareness, attitudes, and acceptance toward the CAIADS. Results There were 284 respondents from 24 provinces across mainland China, with 55% working in primary care institutions. Participant data were divided into two subgroups based on their colposcopy case load per year (i.e. ≥50 cases; <50 cases). The analysis showed that participants with higher loads had more experience working with CAIADS and were more knowledgeable about CAIADS and AI systems. Overall, in both groups, about half of the participants understood the potential applications of big data and AI-assisted diagnostic systems in medicine. Although less than one-third of the participants were knowledgeable about CAIADS and its latest developments, more than 90% of the participants were open with the idea of using CAIADS. Conclusions While a related lack of acknowledgement of CAIADS exists, the participants in general had an open attitude toward CAIADS. Practical experience with colposcopy or CAIADS contributed to participants' awareness and positive attitudes. The promotion of AI tools like CAIADS could help address regional health inequities to improve women's well-being, especially in low- and middle-income countries.