bluuebunny/crossref_metadata_2025_split huggingface dataset:
P22 How do we improve gentamicin prescribing and reviewing within colorectal wards—a quality improvement project
Authors: Smith Lauren , Palenzuela Espe , Sutherland Rebekah 
Published: August 2024

Abstract

Objectives
A retrospective study investigating gentamicin prescribing and reviewing, focusing on Trak short code ‘\gent’, across colorectal wards at Western General Hospital, Edinburgh.

Methods
A focussed questionnaire regarding NHS Lothian gentamicin prescribing charts and Trak short code ‘\gent’ was placed around targeted wards in Western General Hospital in November 2023. A retrospective search of HEPMA data including all patients who had received gentamicin in Colorectal wards between 18 August 2023 and 18 December 2023. A total of 100 patients, 25 from each ward, were randomly selected. Trak data was analysed using the search terms; ‘gentamicin’, ‘IVOS’ and ‘\gent’. Patient data including the number of gentamicin doses received, indications for gentamicin prescribing, evidence of documentation of gentamicin reviewing and on what day of the course, and the use of the ‘\gent’ Trak short code was gathered.

Results
Questionnaire results: 33 responses, 75.8% (25) felt the NHS Lothian gentamicin charts are not well designed, 72.7% (23) did not know ‘\gent’ existed. From the HEPMA search, 100 patients were included, of which 59% were male. The median age was 67 years (19–90). The average gentamicin dose received was 3.8 doses, while 52% of patients received 5 doses. Indication of gentamicin; 58% intra-abdominal infection. Sixty-five percent had documented discussion of gentamicin reviewing, 69.2% of these only occurred on the day of dose 5. Thirty-five percent had no documentation of gentamicin reviewing; 80% of the course length prompts occurred on Day 5. There was no documented discussion on Day 3 of gentamicin, as prompted by the NHS Lothian gentamicin chart. Overall use of \gent was 2%.

Conclusions
(i) The Trak short code ‘\gent’, designed to help make prescribing easier, is not being used. (ii) A large proportion of clinical staff are unaware of ‘\gent’. (iii) Clinical teams do not routinely document their gentamicin reviewing. (iv) Delayed gentamicin doses continue to be given due to lack of communication and lack of documentation. Since completing the search, an informative poster has been placed around the same wards to highlight ‘\gent’ and its uses. Further data will be collated, and a second cycle of the project will involve another retrospective HEPMA search and study of gentamicin patients and the use of ‘\gent’ with the aim of an increase in use and discussion of the review process.
P27 Investigation of subtherapeutic vancomycin levels
Authors: Liu Alice 
Published: August 2024

Abstract

Background
A retrospective audit was conducted in a large UK district hospital to assess the reasons behind subtherapeutic vancomycin assay levels and make recommendations as to how to improve the quality of vancomycin prescribing.

Materials and methods
The vancomycin assay levels were extracted from biochemistry data retrospectively in a 6 month period and patients’ notes with prescription charts were examined for low assay levels as defined by the local hospital’s vancomycin protocol.

Results
Twenty-seven percent of assay results (92 out of 337) were found to be at subtherapeutic levels in 57 patients, in which the vancomycin plasma concentration was less than 10 mg/L. Only 45 patient records were able to be retrieved for data analysis, of which 7 patients (16%) received either no or under loading dose during the treatment initiation. In terms of maintenance dose, 12 patients (27%) received under dose and 18 patients (40%) started the dose at the wrong time; half of this group had severely delayed the treatment for more than 4 h. Fifty-five subtherapeutic levels were identified among the 45 patients and the reasons for this included that assay samples were sent too early, dosage was prescribed incorrectly due to misconception of renal function, body weight miscalculation (i.e. ideal body weight versus actual body weight), as well as low dose being started because of acute or chronic renal impairment.

Conclusions
The audit demonstrated there was a knowledge gap in vancomycin dosing calculation judged by patient’s body weight and renal function and the correct timing of assay. A pragmatic approach including education of junior doctors in antimicrobial prescribing, user-friendly guidelines or algorithmic chart in dosage recommendation, and pre-formatting of electronic prescriptions via EPMA should be adopted to increase the safe usage of vancomycin.
P32 Bloodstream infection following transrectal ultrasound-guided prostate biopsy: antibiotic susceptibility of isolates relative to perioperative antibiotic prophylaxis regimen
Authors: Mulrooney C , Gregg S , Leonard M , O’Loughlin M , Dowling C , Ni Riain U 
Published: August 2024

Abstract

Background
Transrectal ultrasound (TRUS)-guided biopsy of the prostate is a standard investigation for the diagnosis of prostate cancer.1 Perioperative antibiotic prophylaxis is standard of care, notwithstanding which, infection complications post biopsy are reported at 2%–6%.2,3 Single agent ciprofloxacin was used as perioperative antibiotic prophylaxis for TRUS-guided biopsy within our centre until 2011 when data relating increasing rates of fluoroquinolone resistance among Enterobacterales prompted a change. From 2011, prophylaxis changed to dual agent ciprofloxacin plus gentamicin. Scheduled review of the hospital’s empirical antimicrobial guidelines is undertaken every 3 years, most recently in 2024. Review of antibiograms of bloodstream infection isolates is an integral part of the antimicrobial guideline review process, to inform change in empirical regimens, if indicated, based on local antibiotic resistance rates.

Objectives
Specific to TRUS-guided biopsy guidelines, antibiotic susceptibility data for organisms associated with invasive infection post TRUS biopsy from 2021 to 2023 was reviewed.

Methods
Post-procedure surveillance database identified patients who required hospital readmission due to suspected or confirmed infection following TRUS-guided biopsy of prostate between January 2021 and December 2023. Laboratory information systems of all five hospitals in the region were accessed for blood culture results and the organism and antibiogram of any associated positive blood culture was recorded.

Results
Of 2073 patients who underwent TRUS-guided biopsy, 63 (3.04%) patients were readmitted to hospital with suspected infection. Of these readmitted patients, 13/63 had positive blood cultures. All of the isolates (13/13, 100%) were Escherichia coli and 12 of 13 (92.3%) E. coli isolates tested susceptible or susceptible increased exposure to at least one of gentamicin or ciprofloxacin: 12/13 (92.3%) susceptible to gentamicin; 8 (61.5%) susceptible/susceptible increased exposure to ciprofloxacin; 1 (7.7%) resistant to both ciprofloxacin and gentamicin.

Conclusions
The centre’s rate of significant infection complication is in line with published rates. The revised perioperative antibiotic prophylaxis regimen of dual therapy with gentamicin and ciprofloxacin remains appropriate. Following 2073 TRUS-guided biopsies over a 3 year period, only one patient requiring readmission with infection had a bloodstream infection with an organism resistant to both prophylactic agents, while five patients had bloodstream infection with an organism resistant to ciprofloxacin, the previous monotherapy regimen.
Elucidation of factors influencing spinal ankylosis in patients with axial spondyloarthritis
Authors: Izumiyama Takuya , Mori Yu , Kanabuchi Ryuichi , Hatakeyama Hiroshi , Aizawa Toshimi 
Published: August 2024

ABSTRACT

Objectives
Spondyloarthritis encompasses conditions such as ankylosing spondylitis and psoriatic arthritis. Advanced axial spondyloarthritis causes significant spinal fusion, affecting daily activities. Recent therapeutic agents have enhanced the control of inflammation, yet they do not consistently stop the axial progression. This study aimed to identify factors influencing the progression of axial lesions over a 2-year period in Japanese patients with axial spondyloarthritis.

Methods
This retrospective and cross-sectional study included 47 axial spondyloarthritis patients. Spinal lesions were assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Patients were categorized into progressive and nonprogressive groups based on changes in their mSASSS scores. Various clinical parameters were analysed for correlation with ankylosis progression.

Results
The study found no significant correlation between ankylosis progression and traditional factors, including the level of inflammation or the use of biologics. However, modified Health Assessment Questionnaire scores were associated with disease progression. The baseline mSASSS was another significant factor, underscoring the importance of early detection and management.

Conclusions
This study showed that patient-reported outcomes and baseline mSASSS scores are crucial for assessing axial spondyloarthritis progression. This underscores the need for a comprehensive treatment strategy that addresses both clinical indicators and patient-reported outcomes.
Methyl eugenol regulates mating behavior in oriental fruit flies by enhancing lek attractiveness
Authors: Zhang Jie , Liu Wei , Chang Hetan , Wang Qi , Yuan Jinxi , Liu Leyuan , Liu Chenhao , Zhang Yan , Ru Chuanjian , Yan Shanchun , Hansson Bill S , Wang Guirong 
Published: August 2024

ABSTRACT
Plant-produced volatiles play a pivotal role as mediators in complex interactions between insects and plants. Despite the widespread recognition that these compounds serve as cues for herbivorous insects to locate their preferred host plants, their effects on insect mating behavior are less understood. Here, we show that male oriental fruit flies (Bactrocera dorsalis) are highly attracted to the host plant volatile compound methyl eugenol (ME), which enhances the attractiveness of male leks to females. To elucidate the molecular underpinnings of this phenomenon, we identify the olfactory receptor BdorOR94b1 responsible for detecting ME. Genetic disruption of BdorOR94b1 leads to a complete abolition of both physiological and behavioral responses to ME. Additionally, we confirm that, through digestion, male flies convert ME to (E)-coniferyl alcohol, a compound that enhances the attractiveness of their leks to females. This increased attractiveness allows females to select optimal mates, thereby enhancing their reproductive success. The impairment of ME detection significantly diminishes the mating advantage within the leks, as males are unable to locate and utilize ME effectively. Our findings unveil a novel mechanism through which plant volatile compounds regulate the mating behavior of the economically important oriental fruit fly and provide new insights into the general ecology of insect–plant interactions.
Systemic inflammation and changes in physical well-being in patients with breast cancer: a longitudinal study in community oncology settings
Authors: Gilmore Nikesha , Li Yue , Seplaki Christopher L , Sohn Michael , Wang Ying , Li Chin-Shang , Loh Kah Poh , Lin Po-Ju , Kleckner Amber , Mohamed Mostafa , Vertino Paula , Peppone Luke , Mustian Karen , Kadambi Sindhuja , Corso Steven W , Esparaz Benjamin , Giguere Jeffrey K , Mohile Supriya , Janelsins Michelle C 
Published: August 2024

Abstract

Background
Chemotherapy adversely affects physical well-being and inflammation may be related to changes in physical well-being. We evaluated the association of systemic inflammation with changes in physical well-being.

Methods
In a prospective study of 580 patients with stages I-III breast cancer we assessed immune cell counts, neutrophil:lymphocyte ratio (NLR), lymphocyte:monocyte ratio (LMR), and platelet:lymphocyte ratio (PLR) within 7 days before chemotherapy (pre-chemotherapy). Physical well-being was assessed using the Functional Assessment of Cancer Therapy: General—Physical Well-being subscale (FACT-PWB) pre-chemotherapy and 1 month and 6 months post-chemotherapy. Clinically meaningful decline in physical well-being was determined as decreasing FACT-PWB by more than one point from pre-chemotherapy level, and non-resilience defined as having decline post-chemotherapy and not returning to within one-point of pre-chemotherapy FACT-PWB by 6 months post-chemotherapy. Multivariable logistic regressions examined the association between inflammation and changes in physical well-being, adjusting for sociodemographic and clinical characteristics.

Results
Fifty-nine percent (310/529) and 36% (178/501) of participants had physical well-being decline post-chemotherapy and 6 months post-chemotherapy, respectively. Fifty percent (147/294) were non-resilient. Low NLR and PLR were associated with 1.78 (P = .01) and 1.66 (P = .02) fold greater odds of having a decline in physical well-being 6 months post-chemotherapy compared to those with high NLR and PLR, respectively. Low NLR and PLR were associated with 1.92 (P = .02) and 2.09 (P = 0.01) fold greater odds of being non-resilient 6 months post-chemotherapy compared to those with high NLR and PLR, respectively.

Conclusion
Low NLR and PLR were associated with chemotherapy-induced changes in physical well-being independent of sociodemographic and clinical risk factors.
Race and Superfund site remediation
Authors: Topaz Chad M , Garcia Nueva Berenize , Izidro de Souza Patrick , Schumann Jesse , Shvedova Leah , Cai Xizhen , Ning Shaoyang 
Published: August 2024

Abstract
Superfund is a federal program established in 1980 to manage the cleanup of hazardous waste sites across the United States. Given the health and economic costs borne by people living near these sites, any demographic disparities within the Superfund program are issues of environmental justice. We investigate whether racial demographics local to a Superfund site are associated with its cleanup status, and if so, how. Our work addresses gaps in the literature by using detailed geospatial processing, comprehensive data, and a more complete set of racial/ethnic categorizations. We study 1,688 Superfund sites across the country. Under a wide variety of modeling scenarios, we consistently find that the proportion of the nearby population that is Asian is negatively associated with the probability of a Superfund site being cleaned up. This association has remained unidentified until now, possibly because earlier research on Superfund sites did not distinguish Asian populations as a separate group. Our result underscores the need for specific measurement and inclusion of diverse populations in environmental studies.
Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy
Authors: Boggess KA , Valint A , Refuerzo JS , Zork N , Battarbee AN , Eichelberger K , Ramos GA , Olson G , Durnwald C , Landon MB , Aagaard KM , Wallace K , Scifres C , Rosen T , Mulla W , Valent A , Longo S , Young L , Marquis MA , Thomas S , Britt A , Berry D 
Published: August 2024

(JAMA. 2023;330(22):2182–2190. doi:10.1001/jama.2023.22949)
Higher risks are associated with pregnancies in which the mother has a diagnosis of diabetes, whether preexisting type 2 diabetes mellitus (T2DM) or gestational diabetes diagnosed before 23 weeks gestation (EgD). Management of maternal diabetes is the best way to limit adverse pregnancy and birth outcomes for both mother and child and includes blood glucose monitoring, dietary modification, and insulin therapy to optimize glycemic control. This study tested the impact of adding metformin to insulin therapy on the risk of adverse neonatal outcomes. The Medical Optimization of Management of Overt Type 2 Diabetes in Pregnancy, hereafter referred to as the MOMPOD trial, implemented at 17 clinical U.S. sites, utilized a randomized, double-blinded, placebo-controlled protocol. Participants were pregnant between June 2017 and November 2021, aged 18 to 45 years, with singleton gestation pregnancies in the 10 to 22 weeks 6 days range and a diagnosis of T2DM or EgD requiring insulin therapy.
Prenatal Enzyme-Replacement Therapy
Authors: van der Ploeg AT 
Published: August 2024

(N Engl J Med. 2022;387(23):2189–2193. doi: 10.1056/NEJMe2211515)
Genetic diseases are difficult to treat, and though treatments have been developed none are curative. One still developing treatment is enzyme replacement therapy, and it is currently the standard of care for several lysosomal disorders. A recent study reported the first use of in utero enzyme replacement therapy for Pompe disease, which significantly mitigated symptoms and prolonged the life of the fetus that underwent treatment. This article is an editorial that describes the origin, development, mechanisms, and implications of enzyme replacement therapy and discusses the implications of this recently published study.
Investigation of Video Ocular Counter-Roll Findings According to Head and Body Tilt Positions in Healthy Subjects
Authors: Kartal Özcan Ahsen , Satici Sema , Akbulut Ahmet Alperen , Kiliç Mert , Çankaya Sare , Polat Zahra 
Published: August 2024

Objectives:
A vestibulo-ocular reflex called the ocular counter-roll can be used to assess how well the otolith organs are functioning. The video ocular counter-roll (vOCR) test is a recent addition to the videonystagmography test battery that allows for video recording and quantitative ocular counter-roll analysis. The purpose of this study is to investigate potential discrepancies in vOCR measurements obtained from a 30° lateral head tilt in the roll plane versus measurements obtained from a 30° tilt of the head and body.

Design:
Thirty otologically, and neurologically healthy subjects aged 18 to 30 (M = 23.32 years, SD = 2.66 years; 8 men, 22 women) participated in this study. Pure-tone audiometry, oculomotor tests, and vOCR evaluation were performed for all participants. The vOCR assessment was performed in 2 positions, 30° lateral head tilt, and 30° body tilt position. The degree of static vOCR eye position and vOCR asymmetry in both positions were calculated and compared.

Results:
There was no statistically significant difference between the vOCR findings obtained in the right and left 30° lateral head tilt (p = 0.546) and body tilt (p = 0.114). vOCR asymmetry was determined as median (interquartile range) 0.08 (0.07) in lateral head tilt position and 0.09 (0.06) in body tilt position. The degree of static vOCR (8.75° [1.91]) detected during body tilt was statistically greater than the static vOCR (6.62 [1.69]) detected during head tilt (p < 0.001). There was no statistically significant difference in terms of ocular counter-roll asymmetry detected between head tilt and body tilt (p = 0.918).

Conclusions:
Our study shows a significant difference in the vOCR responses during head tilt and body tilt, a finding that should be considered during clinical evaluation of vestibular function. There was no significant asymmetry between the responses with either head or body tilt.
Clinical endpoints in myositis: challenges and ways forward
Authors: Ricco Cristina , Stone Caroline J. , Werth Victoria P. 
Published: August 2024

Purpose of review
This review addresses the challenges and advances in clinical endpoints for myositis, with a particular focus on ensuring comprehensive assessment of both muscle and skin disease activity. The relevance of this review stems from recent developments in outcome measures and their implications for clinical trial design and patient inclusivity. While quality of life (QoL) and lung involvement are also important aspects of myositis, they are beyond the scope of this review and need to be addressed in future studies.

Recent findings
Traditional outcome measures like the Total Improvement Score (TIS) have limitations, especially for patients with skin-predominant dermatomyositis (DM). Recent studies highlight the importance of incorporating skin-specific measures such as the Cutaneous Disease Area and Severity Index (CDASI) and the novel composite measure, Dermatomyositis Outcomes for Muscle and Skin (DMOMS). These measures provide a more balanced assessment of disease activity. Clinical trial data analyzed using these measures have demonstrated significant benefits for patients with both classic and amyopathic DM, emphasizing the need for their broader adoption.

Summary
Advancements in outcome measures are crucial for inclusive and effective myositis clinical trials. Incorporating comprehensive tools like the DMOMS can enhance the assessment of both muscle and skin disease activities, potentially leading to better therapeutic strategies and improved patient outcomes. This shift is essential for addressing the needs of all Idiopathic inflammatory myopathy patients, including those with skin-predominant DM.
Interfacility Transfer of Pediatric Supracondylar Elbow Fractures: Transfer by Ambulance Shows No Advantage in Speed of Transfer or Prevention of Complications
Authors: Richardson Spencer M. , Levey Sarah T. , Suryavanshi Joash R. , Parihar Amrit S. , Vrabec Curtis , Tysklind R. Gunnar , Bielski Robert J. 
Published: August 2024

Background:
The treatment of supracondylar humerus (SCH) fractures is increasingly centralized in tertiary centers. Interfacility transfer from other facilities may occur by ground ambulance or privately owned vehicle (POV). The objective of this study was to determine if interfacility transfer by POV is equivalent in transfer time and perioperative complications compared with ground ambulance.

Methods:
This was a single-institution, retrospective study of SCH fractures with an intact pulse transferred by POV or ground ambulance. Transfer time points were collected to determine transfer time and speed. Associated injuries of ipsilateral fracture, skin at risk, and motor nerve palsy were recorded from orthopaedic documentation at the presentation. Insurance status and the Area Deprivation Index (ADI) were used as measures of socioeconomic disparity.

Results:
676 “urgent” Type III, IV, and flexion type SCH fractures and 167 “nonurgent” Type II SCH fractures were transferred by ambulance or POV. Open reduction was similar between urgent transfers transported by ambulance or POV (10% vs. 9%, P=0.344). There was no difference in transfer time (P=0.391) or transfer speed (P=0.416) between transfer groups. POV transfers were independently associated with no skin at risk (OR 2.1; 95% CI: 1.3-3.3, P=0.003), neurovascularly intact (OR 2.5; 95% CI: 1.4-4.4, P=0.001), and patients in the low (OR 1.9; 95% CI: 1.3-2.5, P=0.041) and moderate deprivation (OR 1.9; 95% CI: 1.1-3.5, P=0.034) compared with the high deprivation group. Medicaid insurance was associated with a lower odds ratio of private transport compared with commercial insurance (OR 0.54; 95% CI: 0.38-0.76, P=<0.001).

Conclusions:
Interfacility transfer of nonemergent SCH fractures by privately owned vehicles has a similar speed of transfer and perioperative complication rate to transfer by ground ambulance. Our findings allow the triaging of nonemergent SCH fractures for potential interfacility transfer by privately owned vehicles and bring attention to disparities in interfacility transfer methods.

Level of Evidence:
Level III- Retrospective cohort study.