bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of optical coherence tomography (OCT) and OCT angiography prediction model for short-term vitreous haemorrhage secondary to polypoidal choroidal vasculopathy
Authors: Cheng Shiyu , Zhao Xinyu , Zhao Qing , Meng Lihui , Chen Youxin 
Published: August 2024

AimsTo construct and validate an optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) image model for predicting the occurrence of short-term vitreous haemorrhage (VH) in polypoidal choroidal vasculopathy (PCV) patients.MethodsWe retrospectively collected clinical and imaging information from patients diagnosed with PCV at Peking Union Medical College Hospital, Beijing, China, between January 2015 and October 2022. Six different screening strategies, including univariate analysis, multivariate analysis, least absolute shrinkage and selection operator, stepwise logistic regression, random forest and clinical-data-only approach, were used to select variables and build models. The nomogram was constructed based on the model with the best area under the curve (AUC) and was evaluated using receiver operating characteristic curves, calibration curves, decision curve analysis and clinical impact curves.ResultsA total of 147 PCV patients were included and randomly divided into a training set (103 patients) and a validation set (44 patients), with an average follow-up time of 17.56±14.99 months. The optimal model that achieved higher AUC in both training and validation sets incorporated seven significant variables identified through univariate analysis: male [OR=2.76, p=0.022], central macular thickness [OR=1.003, p=0.002], the presence of haemorrhagic pigment epithelial detachment (HPED) [OR=6.99, p<0.001], the height of HPED [OR=1.002, p<0.001], the area of HPED [OR=1.16, p<0.001], the presence of multiple PEDs [OR=2.94, p=0.016] and the presence of subretinal haemorrhage [OR=3.11, p=0.011]. A predictive nomogram based on these variables yielded an AUC of 0.896 (95% CI 0.827 to 0.965) in the training set and 0.861 (95% CI 0.749 to 0.973) in the validation set, demonstrating good calibration and clinical usefulness.ConclusionThe proposed OCT/OCTA-based image nomogram, as a novel and non-invasive tool, achieved satisfactory prediction of VH secondary to PCV.
Association betweenHelicobacter pyloriand its eradication and the development of cancer
Authors: Loosen Sven Heiko , Mertens Alexander , Klein Isabel , Leyh Catherine , Krieg Sarah , Kandler Jennis , Luedde Tom , Roderburg Christoph , Kostev Karel 
Published: August 2024

BackgroundHelicobacter pylori(H. pylori) is a gram-negative gastrointestinal pathogen that colonises the human stomach and is considered a major risk factor for gastric cancer and mucosa-associated lymphoid tissue lymphoma. Furthermore,H. pyloriis a potential trigger of a wide spectrum of extragastric cancer entities, extraintestinal chronic inflammatory processes and autoimmune diseases. In the present study, we evaluated the association betweenH. pyloriinfection and its eradication with the development of subsequent gastrointestinal and non-gastrointestinal cancer.MethodsWe identified 25 317 individuals with and 25 317 matched individuals without a diagnosis ofH. pylorifrom the Disease Analyzer database (IQVIA). A subsequent cancer diagnosis was analysed using Kaplan-Meier and conditional Cox-regression analysis as a function ofH. pyloriand its eradication.ResultsAfter 10 years of follow-up, 12.8% of theH. pyloricohort and 11.8% of the non-H. pyloricohort were diagnosed with cancer (p=0.002). Results were confirmed in regression analysis (HR: 1.11; 95% CI 1.04 to 1.18). Moreover, a non-eradicatedH. pyloristatus (HR: 1.18; 95% CI 1.07 to 1.30) but not an eradicatedH. pyloristatus (HR: 1.06; 95% CI 0.97 to 1.15) was associated with a subsequent diagnosis of cancer. In subgroup analyses,H. pylorieradication was negatively associated with bronchus and lung cancer (HR: 0.60; 95% CI 0.44 to 0.83).ConclusionOur data from a large outpatient cohort in Germany reveal a distinct association betweenH. pyloriinfection and the subsequent development of cancer. These data might help to identify patients at risk and support eradication strategies in the future.
Epidemiological trends of febrile infants presenting to the Paediatric Emergency department, in a tertiary care hospital, Karachi, Pakistan: a retrospective review
Authors: Bushra Quratulain , Fatima Sara , Hameed Ammara , Mukhtar Sama 
Published: August 2024

BackgroundUnderstanding the epidemiological patterns of febrile infants can offer valuable insights for optimising management strategies and developing quality improvement initiatives, aiming to improve healthcare delivery in high-volume, low-resource emergency departments (EDs).ObjectivesTo characterise the epidemiology of febrile infants presenting to the paediatric ED of a tertiary care hospital.MethodsA retrospective chart review of medical records was performed for febrile infants ≤1 year old, at paediatric ED, Indus Hospital and Health Network (IHHN), Karachi, Pakistan (1 January 2020–31 December 2020).ResultsThere were a total of 2311 patients in the study, with a male-to-female ratio of 1.4:1. The mean age of presentation was 4.9±2.7 months. Cough (n=1002, 43.2%) was the most frequent presenting symptom. The most common provisional ED diagnosis in ≤1 month of age was sepsis (n=98, 51%), bronchopneumonia (n=138, 28.6%) in 1.1–3 and 3.1–6 months (n=176, 36.45%); and upper respiratory tract illness (n=206, 47.4%) in 6.1–12 months of age. Age was significantly associated with provisional ED diagnosis and outcomes (p<0.001). Of 175 ED admissions (n=47, 26.8%), patients were discharged with a hospital diagnosis of bronchopneumonia and (n=27, 15.4) of sepsis. The infant mortality rate was 3/1000 live births.ConclusionsThis study is the first of its kind to explore the epidemiology of febrile infants in Pakistan, highlighting the burden and severity of respiratory illnesses and sepsis. It underscores the challenges of resource-limited settings, failing to meet the need for admission of febrile infants presenting to ED, IHHN. Moreover, it has highlighted the necessity to optimise the existing triage systems to effectively allocate resources and manage high patient volumes in low-resource EDs.
Systematic review protocol to determine the most effective pharmacological and non-pharmacological interventions for the management of acute methamphetamine toxicity
Authors: Ghosh Sumantra Monty , Kung Janice Y , Crockford David , Harpur Lisa , Tanguay Robert , Dyer Dianne , Lang Eddy , Ayas Tim , Feng Gregory , VandenBerg Stephanie D 
Published: August 2024

IntroductionThis study describes the protocol for a systematic review. The systematic review will address experiences of managing methamphetamine intoxication, specifically violence and agitation related to intoxication, in the emergency department (ED).Methods and analysisThis study uses the Grading of Recommendations Assessment, Development and Evaluation system to guide the methods in this section. The primary objective of the review is to identify experimental studies assessing the effectiveness of both pharmacological and non-pharmacological strategies to manage acute methamphetamine intoxication in patients presenting violently in the ED. Our secondary objectives will be to assess the impact of specific strategies on the time it takes to achieve de-escalation and/or sedation, the length of stay in the ED, frequency of admission, mortality and provider satisfaction with the intervention.Ethics and disseminationEthics approval has been obtained from the Conjoint Health Research Ethics Board REB21-1387. Results will be published in a peer-reviewed journal and presented at healthcare conferences in Canada.Trial registration numberThe protocol is registered through the International Prospective Register of Systematic Reviews (identification number: CRD42020157938) and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for systematic review protocols.
Mapping cognitive biases in multidisciplinary team (MDT) decision-making for cancer care in Scotland: a cognitive ethnography study protocol
Authors: Dharanikota Harini , Wigmore Stephen J , Skipworth Richard , Yule Steven 
Published: August 2024

IntroductionThe efficiency of multidisciplinary teams (MDTs) in cancer care hinges on facilitating clinicians’ cognitive processes as they navigate complex and uncertain judgements during treatment planning. When systems and workflows are not designed to adequately support human judgement and decision-making, even experts are prone to fallible reasoning due to cognitive biases. Incomplete integration of information or biased interpretations of patient data can lead to clinical errors and delays in the implementation of treatment recommendations. Though their impact is intuitively recognised, there is currently a paucity of empirical work on cognitive biases in MDT decision-making. Our study aims to explicate the impact of such biases on treatment planning and establish a foundation for targeted investigations and interventions to mitigate their negative effects.Methods and analysisThis is a qualitative, observational study. We employ cognitive ethnography, informed by the Distributed Cognition for Teamwork framework to assess and evaluate MDT decision-making processes. The study involves in-person and virtual field observations of hepatopancreaticobiliary and upper gastrointestinal MDTs and interviews with their members over several months. The data generated will be analysed in a hybrid inductive/deductive fashion to develop a comprehensive map of potential cognitive biases in MDT decision processes identifying antecedents and risk factors of suboptimal treatment planning processes. Further, we will identify components of the MDT environment that can be redesigned to support decision-making via development of an MDT workspace evaluation tool.Ethics and disseminationThis project has received management and ethical approvals from NHS Lothian Research and Development (2023/0245) and the University of Edinburgh Medical School ethical review committee (23-EMREC-049). Findings will be shared with participating MDTs and disseminated via a PhD thesis, international conference presentations and relevant scientific journals.
Impact of altitude on the development of low bone mineral density and osteoporosis in individuals aged 50 years and older: protocol for a multicentre prospective cohort study
Authors: Zhang Fengying , Chen Yanli , Wang Suyuan , Shi Zhiyou , Zhong Yang , Zhu Suying , Wangmu Ciren , Wu Yunhong 
Published: August 2024

IntroductionOsteoporotic fractures are a leading cause of disability and contribute significantly to medical care costs worldwide. Variations in bone mineral density and the risk of osteoporosis are notably influenced by altitude. This study aims to longitudinally examine individuals with osteoporosis and low bone mass at three different altitudes (low, high and very high) to understand the effects of high-altitude environments on bone density.Methods and analysisThis multicentre, prospective cohort study will involve 893 participants divided into three groups based on altitude: low (500–1500 m), high (2500–4500 m) and very high (4500–5500 m). Participants will undergo comprehensive diagnostic assessments, including demographic data collection, structured questionnaires, medical examinations and clinical laboratory tests. Follow-up visits will occur annually for a minimum of 5 years. The primary outcome will be changes in bone mineral density values. Secondary outcomes will include the incidence of osteoporosis and osteoporotic fractures. Cox proportional hazard models will be used to calculate the risk associated with osteoporotic events and related fractures.Ethics and disseminationThe study has been approved by the Institutional Review Board of the Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region (No: 2024-70). The acquired insights will be disseminated via academic forums, scholarly articles and stakeholder engagement sessions.Trial registrationnumberChiCTR2300078872.
Economic impact of COVID-19 on patients with type 2 diabetes in Kenya and Tanzania: a costing analysis
Authors: Karugu Caroline H , Binyaruka Peter , Ilboudo Patrick G , Sanya Richard E , Mohamed Shukri F , Kisia Lyagamula , Kibe Peter , Mashiashi Irene , Bunn Christopher , Mair F , Agyemang Charles , Mtenga Sally M , Asiki Gershim , Gray Cindy M , Grieve Eleanor , Deidda Manuela 
Published: August 2024

IntroductionCOVID-19 affected healthcare access, utilisation and affordability, especially for patients suffering from chronic diseases, including type 2 diabetes (T2D). This study measured the occurrence and magnitude of changes in healthcare and broader societal costs among patients with T2D before and during COVID-19 in Kenya and Tanzania to understand whether and how COVID-19 affected T2D management in countries implementing different policies during the pandemic.MethodsA cross-sectional study was conducted in Kenya and Tanzania in March–April 2022 among 500 patients with T2D in each country. We interviewed patients on direct healthcare costs (eg, inpatient and outpatient costs), societal costs (eg, productivity loss) and patients’ characteristics before and during the COVID-19 pandemic. We estimated changes over time using the Generalised Linear Model in Kenya and a two-part model in Tanzania, adjusting for patient-level covariates.ResultsThe overall costs of management of T2D in most categories increased in both countries during COVID-19, but some of the increase was not significant. Transport and testing costs increased significantly in Tanzania (I$0.33, p<0.01 and I$0.85, p<0.01) but not in Kenya (I$1.69, p=0.659 and I$0.10, p=0.603). Outpatient costs increased significantly in Tanzania (I$8.84, p<0.01) but there was no significant change in Kenya (I$8.09, p=0.432). T2D medication costs did not change in Tanzania (I$0.19, p=0.197), but decreased significantly in Kenya (I$18.48, p<0.01). Productivity losses increased significantly in both countries.ConclusionThe COVID-19 pandemic is associated with increased direct costs but with a significant increase in many cost categories (transport, testing and outpatient) in Tanzania than in Kenya. A significant increase in productivity loss was observed in both countries. The minimal cost increases in Kenya may be due to the inaccessibility of services associated with lockdown measures and higher insurance coverage compared with Tanzania. Pandemic preparedness initiatives and interventions are needed to safeguard the welfare of patients with chronic conditions during pandemics.
Does arts and cultural group participation influence subsequent well-being? A longitudinal cross-country comparison of older adults in Japan and England
Authors: Bone Jessica K , Noguchi Taiji , Mak Hei Wan , Fancourt Daisy , Kondo Katsunori , Saito Tami 
Published: August 2024

IntroductionArts engagement is a positive health behaviour that could support the mental and social well-being of ageing populations globally. However, research is predominantly from Western countries, leaving it unclear whether arts engagement can support well-being in Japan, where arts are differently valued and engaged with. The social gradient in arts engagement and well-being may also have led to an overestimation of the impact of participation on well-being in Western countries. We therefore tested whether participation in community arts and cultural groups was associated with subjective well-being and social support after removing confounding by demographic, socioeconomic and health-related factors in Japan and England.MethodsWe harmonised longitudinal data from the Japan Gerontological Evaluation Study (JAGES) 2016 and 2019 waves and the English Longitudinal Study of Ageing (ELSA) 2014 and 2018 waves to enable cross-country comparisons. We included 9511 adults aged ≥65 years from JAGES and 3133 participants aged ≥65 years from ELSA. Using inverse probability-weighted regression adjustment, we estimated the effect of arts and cultural groups on subsequent life satisfaction, happiness and depressive symptoms (subjective well-being) as well as social support.ResultsIn JAGES, arts and cultural group participation was associated with higher odds of life satisfaction and higher social support scores. In ELSA participants aged ≥65 years, group participation was only associated with higher depressive symptoms. But, in a sensitivity analysis with the full ELSA sample aged ≥50 years (n=5128), this association was no longer present. Instead, group participation was associated with higher social support scores.ConclusionOur findings indicate that arts and cultural group participation can enhance life satisfaction and social support in Japan, with small but more consistent benefits than in England. Facilitating participation in arts and cultural groups could help older adults to maintain a healthy social support network, which may further support their health as they age.
Black and white: how good are clinicians at diagnosing elbow injuries from paediatric elbow radiographs alone?
Authors: Dann Lisa , Edwards Sarah , Hall Dani , Davis Tessa , Roland Damian , Barrett Michael 
Published: August 2024

ObjectivesPaediatric trauma elbow radiographs are difficult to interpret and there is a potential for harm if misdiagnosed. The primary goal of this study was to assess the ability of healthcare professionals internationally to interpret paediatric trauma elbow radiographs from the radiograph alone by formulating the correct diagnosis.MethodsThis prospective international study was conducted online via the Free Open Access Medical Education platform, Don’t Forget the Bubbles (DFTB, ISSN 2754-5407). Participants were recruited via the DFTB social media accounts between 17 August and 14 September 2021. Submissions that were incomplete or from participants who do not interpret paediatric elbow radiographs in their clinical practice were excluded. Participants completed an online survey of demographic data followed by interpreting 10 trauma-indicated elbow radiographs, by selecting multiple-choice options. The primary outcome was correct diagnosis.ResultsParticipant responses from 18 countries were analysed, with most responses from the UK, Australia and Ireland. Participants had backgrounds in emergency medicine (EM), paediatric emergency medicine (PEM), general practice (GP) and paediatrics, with over 70% having 6+ years of postgraduate experience. 3180 radiographs were interpreted by 318 healthcare professionals. Only nine (2.8%) participants correctly diagnosed all 10. The mean number of radiographs correctly interpreted was 5.44 (SD 2.3). The mean number for those with 6+ years of experience was 6.02 (SD 2.2). On reviewing the normal radiograph, 158 (49.7%) overcalled injuries. Participants with EM or PEM background were equally likely to have more correct answers than those from paediatric or GP backgrounds.ConclusionGlobally, healthcare professional’s success in correctly diagnosing paediatric elbow injuries from radiographs was suboptimal in this non-clinical exercise, despite capturing quite an experienced cohort of clinicians. This study has provided us with detailed baseline data to accurately assess the impact of interventions aimed at improving clinicians’ interpretation of paediatric elbow radiographs in future studies.
“Find Your Y”: histological differences in early stage (pT) and post-treatment (ypT) oesophageal adenocarcinoma with implications for salvage endoscopic resection
Authors: Pacheco Richard R , Lee Goo , Yang Zhaohai , Lin Jingmei , Patil Deepa T , Youssef Mariam , Zhang Qingzhao , Alkashash Ahmad Mahmoud , Li Jingwei , Lee Hwajeong 
Published: August 2024

AimsCurrent guidelines offer limited strategies for managing recurrent/persistent oesophageal adenocarcinoma (EAC). Salvage endoscopic mucosal/submucosal resection (ER) shows promise in oesophageal squamous cell carcinoma, however its success in EAC is limited. We aimed to elucidate histological characteristics influencing salvage ER success in patients with low-stage, pretreated EAC.MethodsWe retrospectively reviewed 272 EAC tumours postoesophagectomy from five US centres and collected clinicopathological data including discontinuous growth (DG), defined as separate tumour foci ≥2 mm from the main tumour. We selected 101 patients with low-stage disease and divided them into treatment-naïve (n=70) and neoadjuvant therapy (n=31) groups. We compared the two groups and differences in clinical, histological and outcome characteristics were identified.ResultsIn the entire cohort (n=272), DGs were identified in 22% of cases. Multivariate analysis revealed DGs as an independent prognostic factor for recurrence and positive oesophagectomy margins. Lymphovascular invasion (LVI) and background intestinal metaplasia predicted DG presence and absence, respectively. Compared with the treatment-naïve low T-stage subgroup, the pretreated subgroup exhibited higher incidence of poorly differentiated carcinoma (16% vs 46%, p=0.007), larger tumours (14 vs 30 mm, p<0.001), higher tumour, node, metastases stage (7% vs 30%, p=0.004), more nodal disease (7% vs 36%, p<0.001) and frequent DGs (1% vs 13%, p=0.030).ConclusionsIn treated low T-stage EACs, DGs may contribute to suboptimal outcomes following salvage ER. Presence of LVI (as a surrogate for DGs) and poor differentiation in the absence of intestinal metaplasia in biopsy samples may serve as histological poor prognosticators in treated patients with EAC being considered for salvage ER.
Frailty index is an independent predictor of all-cause and cardiovascular mortality in Eastern Europe: a multicentre cohort study
Authors: Court Tatyana , Capkova Nadezda , Pająk Andrzej , Tamosiunas Abdonas , Bobák Martin , Pikhart Hynek 
Published: August 2024

BackgroundThis study investigates the association between frailty and mortality in Eastern European populations, which remains largely unexplored compared with Western Europe. The aim is to assess the risk of all-cause and cardiovascular mortality associated with varying levels of frailty.MethodsA prospective multicentre cohort study was conducted, involving random population samples from the Czech Republic, Poland and Lithuania. The baseline survey (2002–2005) included 26 746 individuals aged 45–69 years, with an average follow-up of 13 years. Frailty was measured using a Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI), calculating the number of deficits in each domain. Cox proportional regression models and inverse probability weighting (IPW) were employed to account for risk factor differences among the frailty groups: robust, prefrail, mild, moderate and severe.ResultsThe study included 14 287 people, among whom 891 were frail, with a total of 2402 deaths.Compared with non-frail persons, those with mild (IPW HR 2.06, 95% CI 1.60 to 2.66) and severe (IPW HR 2.71, 95% CI 1.45 to 5.07) frailty had more than twofold elevated risk of all-cause mortality. For cardiovascular mortality, the corresponding HRs were (IPW HR 3.05, 95% CI 2.14 to 4.35) and (IPW HR 3.88, 95% CI 1.95 to 7.74). Men exhibited a higher mortality risk at all frailty levels only in unweighted analysis. Country-specific differences were not significant.ConclusionsA CGA-based FI is an independent predictor of all-cause and cardiovascular mortality, with even mild frailty increasing the risk. Implementing frailty assessments can improve health risk prediction in older adults from Eastern Europe.