bluuebunny/crossref_metadata_2025_split huggingface dataset:
Within and post-trial effects of an intensive lifestyle intervention on kidney disease in adults with overweight or obesity and type 2 diabetes mellitus: a secondary analysis of the Look AHEAD clinical trial
Authors: Knowler William C , Chen Haiying , Bahnson Judy L , Kahn Steven E , Lewis Cora E , Nathan David M , Nelson Robert G , Pilla Scott J , Bantle John P 
Published: May 2024

IntroductionThe Look AHEAD randomized clinical trial reported that an 8-year intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) in adults aged 45–76 years with type 2 diabetes and overweight/obesity delayed kidney disease progression. Here, we report long-term post-intervention follow-up for the trial’s secondary outcome of kidney disease.Research design and methodsWe examined effects of ILI (n=2570) versus DSE (n=2575) on decline in estimated glomerular filtration rate (eGFR) to <45 mL/min/1.73 m2or need for kidney replacement therapy (KRT: dialysis or kidney transplant) during intervention and post-intervention follow-up (median 15.6 years overall).ResultsIncidence of eGFR <45 mL/min/1.73 m2was lower in ILI during the intervention (HR=0.80, 95% CI=0.66 to 0.98) but not post-intervention (HR=1.03, 0.86 to 1.23) or overall (HR=0.92, 0.80 to 1.04). There were no significant treatment group differences in KRT. In prespecified subgroup analyses, age×treatment interactions were significant over total follow-up: p=0.001 for eGFR <45 mL/min/1.73 m2and p=0.01 for KRT. The 2205 participants aged >60 years at baseline had benefit in both kidney outcomes during intervention and overall (HR=0.75, 0.62 to 0.90 for eGFR <45 mL/min/1.73 m2; HR=0.62, 0.43 to 0.91 for KRT). The absolute treatment effects were greater post-intervention: ILI reduced the rate of eGFR <45 mL/min/1.73 m2by 0.46 and 0.76 cases/100 person-years during and post-intervention, respectively; and reduced KRT by 0.15 and 0.21 cases/100 person-years. The younger participants experienced no such post-intervention benefits.ConclusionsILI reduced kidney disease progression during and following the active intervention in persons aged ≥60 years. ILI should be considered for reducing kidney disease incidence in older persons with type 2 diabetes.
Plasma angiotensin-converting enzyme 2 (ACE2) is a marker for renal outcome of diabetic kidney disease (DKD) (U-CARE study 3)
Authors: Ueno Asami , Onishi Yasuhiro , Mise Koki , Yamaguchi Satoshi , Kanno Ayaka , Nojima Ichiro , Higuchi Chigusa , Uchida Haruhito A , Shikata Kenichi , Miyamoto Satoshi , Nakatsuka Atsuko , Eguchi Jun , Hida Kazuyuki , Katayama Akihiro , Watanabe Mayu , Nakato Tatsuaki , Tone Atsuhito , Teshigawara Sanae , Matsuoka Takashi , Kamei Shinji , Murakami Kazutoshi , Shimizu Ikki , Miyashita Katsuhito , Ando Shinichiro , Nunoue Tomokazu , Wada Jun 
Published: May 2024

IntroductionACE cleaves angiotensin I (Ang I) to angiotensin II (Ang II) inducing vasoconstriction via Ang II type 1 (AT1) receptor, while ACE2 cleaves Ang II to Ang (1–7) causing vasodilatation by acting on the Mas receptor. In diabetic kidney disease (DKD), it is still unclear whether plasma or urine ACE2 levels predict renal outcomes or not.Research design and methodsAmong 777 participants with diabetes enrolled in the Urinary biomarker for Continuous And Rapid progression of diabetic nEphropathy study, the 296 patients followed up for 9 years were investigated. Plasma and urinary ACE2 levels were measured by the ELISA. The primary end point was a composite of a decrease of estimated glomerular filtration rate (eGFR) by at least 30% from baseline or initiation of hemodialysis or peritoneal dialysis. The secondary end points were a 30% increase or a 30% decrease in albumin-to-creatinine ratio from baseline to 1 year.ResultsThe cumulative incidence of the renal composite outcome was significantly higher in group 1 with lowest tertile of plasma ACE2 (p=0.040). Group 2 with middle and highest tertile was associated with better renal outcomes in the crude Cox regression model adjusted by age and sex (HR 0.56, 95% CI 0.31 to 0.99, p=0.047). Plasma ACE2 levels demonstrated a significant association with 30% decrease in ACR (OR 1.46, 95% CI 1.044 to 2.035, p=0.027) after adjusting for age, sex, systolic blood pressure, hemoglobin A1c, and eGFR.ConclusionsHigher baseline plasma ACE2 levels in DKD were protective for development and progression of albuminuria and associated with fewer renal end points, suggesting plasma ACE2 may be used as a prognosis marker of DKD.Trial registration numberUMIN000011525.
Depressed mood as a transdiagnostic target relevant to anxiety and/or psychosis: a scoping review protocol
Authors: Dambi Jermaine , Mavindidze Edwin , Nyamayaro Primrose , Beji-Chauke Rhulani , Tunduwani Tariro Dee , Shava Beatrice K , Mavhu Webster , Abas Melanie , Chibanda Dixon , Nhunzvi Clement 
Published: May 2024

IntroductionDepressed mood is a psychological state characterised by sadness or loss of interest in activities. Depressed mood is a highly prevalent symptom across major mental disorders. However, there is limited understanding of the burden and management of comorbid depressed mood across major mental disorders. Therefore, this scoping review aims to summarise knowledge on depressed mood among persons with anxiety and/or psychosis. The specific aims are to describe the epidemiology and risk factors of depressed mood as a transdiagnostic target among persons with anxiety and/or psychosis, to identify commonly used outcome measures for depressed mood and to outline initial evidence of psychometric robustness and to identify and summarise the effectiveness of commonly applied depressed mood modification interventions. Our hope is that the proposed review will provide insights into the burden of depressed mood in persons with anxiety and psychosis and help to identify evidence gaps and recommendations for future research.Methods and analysisThis scoping review will be conducted per Arksey and O’Malley’s framework. We will first search for peer-reviewed articles and grey literature published from 2004 to 2023 in PubMed, Scopus, Web of Science, Africa-Wide Information, CINAHL, PsycINFO, Academic Search Premier, Humanities International Complete, Sabinet, SocINDEX, Open Grey and Google Scholar. We will include articles reporting depressed mood (subthreshold depression) among persons with anxiety and/or psychosis. Studies recruiting participants meeting depression diagnostic criteria and those published in non-English languages will be excluded. Two independent researchers will extract the data. We will analyse and chart data collaboratively with researchers with lived experiences of depressed mood.Ethics and disseminationThis study does not require ethical approval as it is a literature review. The results will be submitted for publication in a peer-reviewed journal.
Qualitative study exploring the views of patients and healthcare providers on current rehabilitation practices after lumbar fusion surgery
Authors: Thys Tinne , Bogaert Liedewij , Dankaerts Wim , Depreitere Bart , Van Wambeke Peter , Brumangne Simon , Bultheel Michael , Vanden Abeele Vero , Moke Lieven , Spriet Ann , Schelfaut Sebastiaan , Janssens Lotte , Swinnen Thijs Willem 
Published: May 2024

ObjectivesTo explore the views of patients and healthcare providers on current rehabilitation after lumbar fusion surgery (LFS) to fuel the development of a novel rehabilitation care pathway.DesignA cross-sectional, qualitative study with an interpretive descriptive design.SettingAcademic and non-academic hospital setting in Belgium.Participants31 caregivers from (non)-academic settings and 5 patients with LFS were purposefully sampled and in-depth interviewed.ResultsOut of the data of all interviews, participants reported opinions on 23 thematic clusters that were expressed in a time-contingent manner from the preoperative, perioperative to postoperative phase. Afterwards, themes were mapped to the Consolidated Framework for Implementation Research, with a larger role for concepts related to the innovation, inner and individual domain. As an overarching theme, the importance of an ‘individualised, patient-centred rehabilitation built on a strong therapeutic alliance with an accessible interprofessional team’ was stressed for patients undergoing LFS. Specifically, participants stated that a biopsychosocial approach to rehabilitation should start in the preoperative phase and immediately be continued postoperatively. No consensus was observed for movement restrictions postoperatively. Uniform communication between the involved caregivers was considered essential for optimal therapeutic alliance and clinical outcome. The precise role and competence of each member of the interprofessional team needs, therefore, to be clearly defined, respected and discussed. An accessible case manager to guide the patient trajectory and tackle problems could further support this. Interestingly, only patients, psychologists and physiotherapists addressed return to work as an important outcome after LFS.ConclusionsThis qualitative study identified key experiences and points to consider in the current and future rehabilitation pathway for LFS. Future research should incorporate these findings to build a novel rehabilitation pathway for LFS and evaluate its feasibility and cost-effectiveness.Trial registration numberThis study was registered at clinicaltrials.gov (NCT03427294).
Electronic health record-based behaviour change interventions aimed at general practitioners in the UK: a mixed methods systematic review using behaviour change theory
Authors: Soames Jamie , Pettigrew Luisa M 
Published: May 2024

ObjectivesElectronic health record (EHR) systems are used extensively in healthcare; their design can influence clinicians’ behaviour. We conducted a systematic review of EHR-based interventions aimed at changing the clinical practice of general practitioners in the UK, assessed their effectiveness and applied behaviour change theory to identify lessons for other settings.DesignMixed methods systematic review.Data sourcesMEDLINE, EMBASE, CENTRAL and APA PsycINFO were searched up to March 2023.Eligibility criteriaQuantitative and qualitative findings from randomised controlled trials (RCTs) controlled before-and-after studies and interrupted time series of EHR-based interventions in UK general practice were included.Data extraction and synthesisQuantitative synthesis was based on Cochrane’s Synthesis without Meta-analysis. Interventions were categorised using the Behaviour Change Wheel and MINDSPACE frameworks and effectiveness determined by vote-counting using direction of effect. Inductive thematic synthesis was used for qualitative studies.ResultsDatabase searching identified 3824 unique articles; 10 were included (from 2002 to 2021), comprising eight RCTs and two associated qualitative studies. Four of seven quantitative studies showed a positive effect on clinician behaviour and three on patient-level outcomes. Behaviour change techniques that may trigger emotions and required less cognitive engagement appeared to have positive effects. Qualitative findings indicated that interventions reassured clinicians of their decisions but were sometimes ignored.ConclusionDespite widespread use, there is little high quality, up-to-date experimental evidence evaluating the effectiveness of EHR-based interventions in UK general practice. The evidence suggested EHR-based interventions may be effective at changing behaviour. Persistent, simple action-oriented prompts appeared more effective than complex interventions requiring greater cognitive engagement. However, studies lacked detail in intervention design and theory behind design choices. Future research should seek to optimise EHR-based behaviour change intervention design and delineate limitations, providing theory-based justification for interventions. This will be of increasing importance with the growing use of EHRs to influence clinicians’ decisions.PROSPERO registration numberCRD42022341009.
Exploring what GP registrars consider distinctive to consultations with Aboriginal and Torres Strait Islander patients: a mixed-methods study
Authors: Brumpton Kay , Woodall Hannah , Evans Rebecca , Neill Henry , Sen Gupta Tarun , McArthur Lawrie , Ward Raelene 
Published: May 2024

Background and objectiveUnderstanding what general practice (GP) registrars consider as distinctive in their consultations with Aboriginal and Torres Strait Islander patients may help bridge the gap between patient-determined cultural safety and current medical and behavioural practice. This project seeks to explore what GP registrars perceive as distinctive to their consultations with Aboriginal and Torres Strait Islander patients.MethodsThis mixed-methods study involved a survey considering demographic details of GP registrars, questionnaire regarding attitude and cultural capability, and semistructured interviews.Results26 registrars completed the survey. 16 registrars completed both the survey and the interview. Despite recognising a need to close the gap on health outcomes for Aboriginal and Torres Strait Islander peoples and wanting to do things differently, most registrars adopted a generic approach to all consultations.DiscussionThis study suggests that overall, GP registrars want to improve the health of Aboriginal and Torres Strait Islander patients, but do not want their consultations with Aboriginal and Torres Strait Islander patients to be distinctive. Registrars appeared to approach all consultations in a similar manner using predominantly patient-centred care principles. Given the importance of a culturally safe consultation, it is important for us to consider how to increasingly transform these learners and teach cultural safety in this context.
Characterising incident opioid use among incident users of prescription sedative hypnotics: A national cohort study
Authors: Thornton James Douglas , Varisco Tyler , Patel Harshil , Shrestha Mina , Wanat Matthew , Schaefer Eric , Leslie Douglas , Zhao Hui , Saadi Randa Al , Shen Chan 
Published: May 2024

ObjectiveTo evaluate co-prescribing of sedatives hypnotics and opioids.DesignRetrospective study evaluating the association of patient characteristics and comorbidities with coprescribing.Setting and participantsUsing the national Merative MarketScan Database between 2005 and 2018, we identified patients who received an incident sedative prescription with or without subsequent, incident opioid prescriptions within a year of the sedative prescription in the USA.Outcome measuresCoprescription of sedative-hypnotics and opioids.ResultsA total of 2 632 622 patients (mean (SD) age, 43.2 (12.34) years; 1 297 356 (62.5%) female) received incident prescriptions for sedatives over the course of the study period. The largest proportion of sedative prescribing included benzodiazepines (71.1%); however, z-drugs (19.9%) and barbiturates (9%) were also common. About 557 845 (21.2%) patients with incident sedatives also received incident opioid prescriptions. About 59.2% of these coprescribed patients received opioids coprescription on the same day. Multivariate logistic regression findings showed that individuals with a comorbidity index score of 1, 2 or ≥3 (aOR 1.19 (95% CI 1.17 to 1.21), 1.17 (95% C 1.14 to 1.19) and 1.25 (95% C 1.2 to 1.31)) and substance use disorder (1.21 (95% C 1.19 to 1.23)) were more likely to be coprescribed opioids and sedatives. The likelihood of receiving both opioid and sedative prescriptions was lower for female patients (aOR 0.93; 95% CI 0.92 to 0.94), and those receiving a barbiturate (aOR 0.3; 95% CI 0.29 to 0.31) or z-drugs (aOR 0.67; 95% CI 0.66 to 0.68) prescriptions at the index date.ConclusionsCoprescription of sedatives with opioids was associated with the presence of comorbidities and substance use disorder, gender and types of sedatives prescribed at the index date. Additionally, more than half of the coprescribing occurred on the same day which warrants further evaluation of current prescribing and dispensing best practice guidelines.
Abnormal uterine bleeding and associated factors: a cross-sectional study in high-performance Peruvian athletes
Authors: Querevalú-Pancorbo Ivanna , Rojas-Cama Luis F , Soncco-Llulluy Fernando , Li Jair , Rosales-Rimache Jaime 
Published: May 2024

BackgroundAbnormal uterine bleeding (AUB) is a problem that affects women and can cause outcomes such as anaemia, affecting women’s quality of life. In high-performance athletes, this problem can be further exacerbated by intense physical activity, strict nutritional regimens and physical stress.HypothesisThere are factors that increase the risk of occurrence of AUB in high-performance Peruvian athletes.Study designCross-sectional study.Level of evidenceLevel 4.MethodsWe applied an online questionnaire with questions to identify AUB according to the International Federation of Gynecology and Obstetrics criteria, demographic characteristics, sport practised and evaluation of the risk of an eating disorder using the Eating Attitudes Test questionnaire. We used a generalised linear model to identify factors associated with AUB.ResultsWe evaluated 101 participants whose mean age was 22.3±4.3 years. The body mass index had a mean of 22.6±2.4 kg/m2. From the total of athletes, 68.3% (95% CI 58.6% to 76.7%) presented AUB. The bivariate analysis showed that the type of sport and the duration of the sporting activity were associated (p<0.05) with AUB, with AUB frequencies of 76.5% observed in athletes who practised anaerobic sports. The multivariate analysis did not report factors significantly associated with AUB.ConclusionWe found a high frequency of AUB in high-performance Peruvian athletes, especially in those who practice anaerobic and resistance sports.Clinical relevanceHigh-performance female athletes health must be evaluated periodically, and immediate actions are taken to control and treat AUB.
Human enteric nervous system progenitor transplantation improves functional responses in Hirschsprung disease patient-derived tissue
Authors: Jevans Benjamin , Cooper Fay , Fatieieva Yuliia , Gogolou Antigoni , Kang Yi-Ning , Restuadi Restuadi , Moulding Dale , Vanden Berghe Pieter , Adameyko Igor , Thapar Nikhil , Andrews Peter W , De Coppi Paolo , Tsakiridis Anestis , McCann Conor J 
Published: May 2024

Objective
Hirschsprung disease (HSCR) is a severe congenital disorder affecting 1:5000 live births. HSCR results from the failure of enteric nervous system (ENS) progenitors to fully colonise the gastrointestinal tract during embryonic development. This leads to aganglionosis in the distal bowel, resulting in disrupted motor activity and impaired peristalsis. Currently, the only viable treatment option is surgical resection of the aganglionic bowel. However, patients frequently suffer debilitating, lifelong symptoms, with multiple surgical procedures often necessary. Hence, alternative treatment options are crucial. An attractive strategy involves the transplantation of ENS progenitors generated from human pluripotent stem cells (hPSCs).

Design
ENS progenitors were generated from hPSCs using an accelerated protocol and characterised, in detail, through a combination of single-cell RNA sequencing, protein expression analysis and calcium imaging. We tested ENS progenitors’ capacity to integrate and affect functional responses in HSCR colon, after ex vivo transplantation to organotypically cultured patient-derived colonic tissue, using organ bath contractility.

Results
We found that our protocol consistently gives rise to high yields of a cell population exhibiting transcriptional and functional hallmarks of early ENS progenitors. Following transplantation, hPSC-derived ENS progenitors integrate, migrate and form neurons/glia within explanted human HSCR colon samples. Importantly, the transplanted HSCR tissue displayed significantly increased basal contractile activity and increased responses to electrical stimulation compared with control tissue.

Conclusion
Our findings demonstrate, for the first time, the potential of hPSC-derived ENS progenitors to repopulate and increase functional responses in human HSCR patient colonic tissue.
Use of artificial intelligence chatbots in clinical management of immune-related adverse events
Authors: Burnette Hannah , Pabani Aliyah , von Itzstein Mitchell S , Switzer Benjamin , Fan Run , Ye Fei , Puzanov Igor , Naidoo Jarushka , Ascierto Paolo A , Gerber David E , Ernstoff Marc S , Johnson Douglas B 
Published: May 2024

BackgroundArtificial intelligence (AI) chatbots have become a major source of general and medical information, though their accuracy and completeness are still being assessed. Their utility to answer questions surrounding immune-related adverse events (irAEs), common and potentially dangerous toxicities from cancer immunotherapy, are not well defined.MethodsWe developed 50 distinct questions with answers in available guidelines surrounding 10 irAE categories and queried two AI chatbots (ChatGPT and Bard), along with an additional 20 patient-specific scenarios. Experts in irAE management scored answers for accuracy and completion using a Likert scale ranging from 1 (least accurate/complete) to 4 (most accurate/complete). Answers across categories and across engines were compared.ResultsOverall, both engines scored highly for accuracy (mean scores for ChatGPT and Bard were 3.87 vs 3.5, p<0.01) and completeness (3.83 vs 3.46, p<0.01). Scores of 1–2 (completely or mostly inaccurate or incomplete) were particularly rare for ChatGPT (6/800 answer-ratings, 0.75%). Of the 50 questions, all eight physician raters gave ChatGPT a rating of 4 (fully accurate or complete) for 22 questions (for accuracy) and 16 questions (for completeness). In the 20 patient scenarios, the average accuracy score was 3.725 (median 4) and the average completeness was 3.61 (median 4).ConclusionsAI chatbots provided largely accurate and complete information regarding irAEs, and wildly inaccurate information (“hallucinations”) was uncommon. However, until accuracy and completeness increases further, appropriate guidelines remain the gold standard to follow