bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between nephrotoxicity and area under the concentration–time curve of vancomycin in critically ill patients: a multicenter retrospective study
Authors: Ishigo Tomoyuki , Matsumoto Kazuaki , Yoshida Hiroaki , Tanaka Hiroaki , Ibe Yuta , Fujii Satoshi , Fukudo Masahide , Fujihara Hisato , Yamaguchi Fumihiro , Ebihara Fumiya , Maruyama Takumi , Hamada Yukihiro , Samura Masaru , Nagumoi Fumio , Komatsu Toshiaki , Tomizawa Atsushi , Takuma Akitoshi , Chiba Hiroaki , Nishi Yoshifumi , Enoki Yuki , Taguchi Kazuaki , Suzuki Ayako 
Published: May 2024

ABSTRACT

We aimed to assess the frequency of acute kidney injury (AKI) in different areas under the concentration–time curve (AUC) values of vancomycin (VAN) using a two-point blood collection method, allowing for accurate AUC assessment in critically ill patients. This multicenter retrospective observational study was conducted in eight hospitals. We retrospectively analyzed the data of patients who had received VAN in an intensive care unit (ICU) between January 2020 and December 2022. The primary outcome was the incidence of AKI. Patients were classified into three groups according to the AUC
24–48h
at the initial therapeutic drug monitoring (TDM) as follows: <500, 500–600, and ≥600 µg·h/mL. The AUC
24–48h
values were calculated using the Bayesian estimation software Practical AUC-guided TDM. Among 146 patients [median age (interquartile range), 67 (56–78) years; 39% women], the AUC
24–48h
<500 µg·h/mL had an AKI rate of 6.5% (7/107), the AUC
24–48h
500–600 µg·h/mL had an AKI rate of 28.0% (7/25), and the AUC
24–48h
≥600 µg·h/mL had an AKI rate of 42.9% (6/14). In multivariate Cox proportional hazard analysis, the AUC
24–48h
500–600 µg·h/mL [hazard ratio 5.4, 95% confidence interval (CI) 1.64–17.63] and the AUC
24–48h
≥600 μg·h/mL (hazard ratio 7.0, 95% CI 2.31–21.18) significantly correlated with a higher incidence of AKI compared with the AUC
24-48h
<500 μg·h/mL. In conclusion, we identified an association between AUC on day 2 and the risk of AKI in ICU patients, suggesting that not only AUCs above 600 µg·h/mL but also those between 500 and 600 µg·h/mL pose a risk for AKI.

IMPORTANCE

Vancomycin (VAN) is a glycopeptide antibiotic and one of the most commonly used antibiotics for severe infections caused by methicillin-resistant
Staphylococcus aureus
. However, higher VAN concentrations have been associated with an increased risk of acute kidney injury (AKI). Herein, we aimed to assess the frequency of AKI in different areas under the concentration–time curve (AUC) values of VAN using a two-point blood collection method, allowing for accurate AUC assessment in critically ill patients. We identified an association between AUC on day 2 and the risk of AKI in intensive care unit patients, suggesting that not only AUCs above 600 µg·h/mL but also those between 500 and 600 µg·h/mL pose a risk for AKI. Therefore, individualized dosing is feasible, with pharmacists being able to optimize VAN doses to attain appropriate targets.
Hydrochemical evolution and source mechanisms governing the unusual lithium and boron enrichment in salt lakes of northern Tibet
Authors: Shi Zhiwei , Tan Hongbing , Xue Fei , Li Yulong , Zhang Xiying , Cong Peixin , Santosh M. , Zhang Yu 
Published: May 2024

Abstract
The large-scale salt lakes widely distributed in the Tibetan Plateau provide unique and potential resources for lithium (Li) and boron (B). The concentration and characteristics of elements in these salt lakes resemble those found in geothermal water in northern Tibet, which highlights both as crucial sources of rare elements. This study presents comprehensive analyses of the hydrochemical composition and isotopes of B, strontium (Sr), hydrogen (H), and oxygen (O) in typical salt lakes, along with samples from surrounding springs and rivers in the Bangong-Nujiang suture zone of northern Tibet. The results reveal an extremely negative and anomalous distribution pattern of B isotopes in Zabuye Salt Lake that is closely associated with geothermal water. The enrichment of these elements in other salt lakes in the region is attributed to concentration of evaporation and sediment adsorption. Given the very high elevation of the recharge for geothermal water, the infiltration of salt lakes obviously cannot feed geothermal springs. On the contrary, we correlate the unusual enrichment of Li and B and other resources in salt lakes to geothermal spring discharge. The ultimate origin of these elements lies in magmatic sources, with later water-rock interaction leading to significant enrichment of incompatible elements such as Li, rubidium (Rb), cesium (Cs), and B in the geothermal system. The geothermal springs directly or indirectly fed the salt lakes, and with further evaporation, they became super-scale brine deposits.
Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study
Authors: Hawthorne A Barney , Arms-Williams Bradley , Cannings-John Rebecca , Pollok Richard C G , Berry Alexander , Harborne Philip , Trivedi Anjali 
Published: May 2024

ObjectiveIt is unclear whether widespread use of biologics is reducing inflammatory bowel disease (IBD) surgical resection rates. We designed a population-based study evaluating the impact of early antitumour necrosis factor (TNF) on surgical resection rates up to 5 years from diagnosis.DesignWe evaluated all patients with IBD diagnosed in Cardiff, Wales 2005–2016. The primary measure was the impact of early (within 1 year of diagnosis) sustained (at least 3 months) anti-TNF compared with no therapy on surgical resection rates. Baseline factors were used to balance groups by propensity scores, with inverse probability of treatment weighting (IPTW) methodology and removing immortal time bias. Crohn’s disease (CD) and ulcerative colitis (UC) with IBD unclassified (IBD-U) (excluding those with proctitis) were analysed.Results1250 patients were studied. For CD, early sustained anti-TNF therapy was associated with a reduced likelihood of resection compared with no treatment (IPTW HR 0.29 (95% CI 0.13 to 0.65), p=0.003). In UC including IBD-U (excluding proctitis), there was an increase in the risk of colectomy for the early sustained anti-TNF group compared with no treatment (IPTW HR 4.6 (95% CI 1.9 to 10), p=0.001).ConclusionsEarly sustained use of anti-TNF therapy is associated with reduced surgical resection rates in CD, but not in UC where there was a paradoxical increased surgery rate. This was because baseline clinical factors were less predictive of colectomy than anti-TNF usage. These data support the use of early introduction of anti-TNF therapy in CD whereas benefit in UC cannot be assessed by this methodology.
Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study
Authors: Fritz Manuela , Grimm Michael , My Hanh Hoang Thi , Koot Jaap A R , Nguyen Giang Hoang , Nguyen Thi-Phuong-Lan , Probandari Ari , Widyaningsih Vitri , Lensink Robert 
Published: May 2024

IntroductionNon-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades. Despite the escalating burden, screening for NCDs remains at very low levels, resulting in undetected cases, premature mortality and high public healthcare costs. We investigate whether community-based NCD prevention and management programmes are an effective solution.MethodsIn Indonesia, we compare participants in the community-based NCD screening and management programmePos Pembinaan Terpadu-Penyakit Tidak Menularwith matched non-participants with respect to their uptake of screening activities, health-related behaviour and knowledge and metabolic risk factors. We use statistical matching to redress a possible selection bias (n=1669). In Viet Nam, we compare members ofIntergenerational Self-Help Clubs, which were offered similar NCD health services, with members of other community groups, where such services were not offered. We can rely on two waves of data and use a double-difference approach to redress a possible selection bias and to measure the impacts of participation (n=1710). We discuss strengths and weaknesses of the two approaches in Indonesia and Viet Nam.ResultsIn Indonesia, participants have significantly higher uptake of screening for hypertension and diabetes (+13% from a control mean of 88% (95% CI 9% to 17%); +93% from a control mean of 48% (95% CI 79% to 108%)). In both countries, participants show a higher knowledge about risk factors, symptoms and complications of NCDs (Indonesia: +0.29 SD (0.13–0.45), Viet Nam: +0.17 SD (0.03–0.30)). Yet, the improved knowledge is only partly reflected in improved health behaviour (Viet Nam: fruit consumption +0.33 SD (0.15–0.51), vegetable consumption +0.27 SD (0.04–0.50)), body mass index (BMI) (Viet Nam: BMI −0.07 SD (−0.13 to −0.00)) or metabolic risk factors (Indonesia: systolic blood pressure: −0.13 SD (−0.26 to −0.00)).ConclusionCommunity-based NCD programmes are well suited to increase screening and to transmit health knowledge. Due to their extensive outreach within the community, they can serve as a valuable complement to the screening services provided at the primary healthcare level. Yet, limited coverage, insufficient resources and a high staff turnover remain a problem.Trial registration numberNCT05239572.
Regular use of fish oil supplements and course of cardiovascular diseases: prospective cohort study
Authors: Chen Ge , Qian Zhengmin (Min) , Zhang Junguo , Zhang Shiyu , Zhang Zilong , Vaughn Michael G , Aaron Hannah E , Wang Chuangshi , Lip Gregory YH , Lin Hualiang 
Published: May 2024

ObjectiveTo examine the effects of fish oil supplements on the clinical course of cardiovascular disease, from a healthy state to atrial fibrillation, major adverse cardiovascular events, and subsequently death.DesignProspective cohort study.SettingUK Biobank study, 1 January 2006 to 31 December 2010, with follow-up to 31 March 2021 (median follow-up 11.9 years).Participants415 737 participants, aged 40-69 years, enrolled in the UK Biobank study.Main outcome measuresIncident cases of atrial fibrillation, major adverse cardiovascular events, and death, identified by linkage to hospital inpatient records and death registries. Role of fish oil supplements in different progressive stages of cardiovascular diseases, from healthy status (primary stage), to atrial fibrillation (secondary stage), major adverse cardiovascular events (tertiary stage), and death (end stage).ResultsAmong 415 737 participants free of cardiovascular diseases, 18 367 patients with incident atrial fibrillation, 22 636 with major adverse cardiovascular events, and 22 140 deaths during follow-up were identified. Regular use of fish oil supplements had different roles in the transitions from healthy status to atrial fibrillation, to major adverse cardiovascular events, and then to death. For people without cardiovascular disease, hazard ratios were 1.13 (95% confidence interval 1.10 to 1.17) for the transition from healthy status to atrial fibrillation and 1.05 (1.00 to 1.11) from healthy status to stroke. For participants with a diagnosis of a known cardiovascular disease, regular use of fish oil supplements was beneficial for transitions from atrial fibrillation to major adverse cardiovascular events (hazard ratio 0.92, 0.87 to 0.98), atrial fibrillation to myocardial infarction (0.85, 0.76 to 0.96), and heart failure to death (0.91, 0.84 to 0.99).ConclusionsRegular use of fish oil supplements might be a risk factor for atrial fibrillation and stroke among the general population but could be beneficial for progression of cardiovascular disease from atrial fibrillation to major adverse cardiovascular events, and from atrial fibrillation to death. Further studies are needed to determine the precise mechanisms for the development and prognosis of cardiovascular disease events with regular use of fish oil supplements.
Dimethyl fumarate treatment for unruptured intracranial aneurysms: a study protocol for a double-blind randomised controlled trial
Authors: Huang Jiliang , Zhang Yisen , Turhon Mirzat , Zheng Zhaoxu , Li Wenqiang , Kang Huibin , Wang Chao , Liu Jian , Jiang Peng 
Published: May 2024

IntroductionIntracranial aneurysm (IA) is a common cerebrovascular disease. Considering the risks and benefits of surgery, a significant proportion of patients with unruptured IA (UIA) choose conservative observation. Previous studies suggest that inflammation of aneurysm wall is a high-risk factor of rupture. Dimethyl fumarate (DMF) acts as an anti-inflammatory agent by activating nuclear factor erythroid 2-related factor 2 (Nrf2) and other pathways. Animal experiments found DMF reduces the formation and rupture of IAs. In this study, DMF will be evaluated for its ability to reduce inflammation of the aneurysm wall in high-resolution vessel wall imaging.Methods and analysisThis is a multi-centre, randomised, controlled, double-blind clinical trial. Three hospitals will enrol a total of 60 patients who have UIA with enhanced wall. Participants will be assigned randomly in a 1:1 proportion, taking either 240 mg DMF or placebo orally every day for 6 months. As the main result, aneurysm wall enhancement will be measured by the signal intensity after 6 months of DMF treatment. Secondary endpoints include morphological changes of aneurysms and factors associated with inflammation. This study will provide prospective data on the reduction of UIA wall inflammation by DMF.Ethics and disseminationThis study has been approved by Medical Ethics Committee of the Beijing Tiantan Hospital, Capital Medical University (approval no: KY2022-064-02). We plan to disseminate our research findings through peer-reviewed journal publication and relevant academic conferences.Trial registration numberNCT05959759.
Medical students’ attitudes towards well-being and welfare: a systematic review protocol
Authors: Mazzoleni Adele , Garg Sakshi , Bhatia Shreya , Kumar Niraj S 
Published: May 2024

IntroductionMedical education poses serious stressors on medical students, as they report overall higher rates of psychiatric comorbidities compared with students enrolled in other university-level courses. The high rates of poor well-being reported should be considered a concern, as students represent the future workforce of healthcare professionals. Although there has been an increased interest towards well-being and burn-out in medical students, there is still much to be elucidated. Indeed, there is an overall lack of understanding of which attitudes medical students have towards well-being and welfare, something that could be used to develop targeted practice to improve medics’ quality of life and reduce overall burn-out.This review will aim at evaluating and reporting the current research available on medical students’ attitudes towards well-being and welfare. We will take into account which countries have published data on the topic, and we will analyse papers written during the COVID-19 period separately, giving this particular time frame a separate outlook.Methods and analysisThis systematic review protocol has been developed following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. A systematic search including “medical students” AND “wellbeing” AND “perceptions” was carried out on MEDLINE, Embase and Scopus databases. The Mixed Method Appraisal Tool will be used to assess the quality of the available studies and risk of bias. Studies will be screened using predetermined inclusion and exclusion criteria. Data will be summarised narratively and in tabular forms. A narrative subgroup analysis of the COVID-19 period will be carried out, and a country-wise approach will be used to describe which areas have published relevant studies.Ethics and disseminationThis will be the first systematic review looking at the reported attitudes that medical students have towards well-being and welfare. This will provide an account of the available data on the topic, and a starting point to understand where further research is needed in the future.PROSPERO registration numberCRD42023471022.
Lifelong development in medicine: a thematic analysis of coaching goals throughout medical careers
Authors: Stojanović Ana , Fris Daan A H , Solms Lara , van Hooft Edwin A J , De Hoog Matthijs , de Pagter Anne P J 
Published: May 2024

ObjectivesHealthcare grapples with staff shortages and rising burnout rates for medical students, residents and specialists. To prioritise both their well-being and the delivery of high-quality patient care, it becomes imperative to deepen our understanding of physicians’ developmental aims and needs. Our first aim is, therefore, to gain comprehensive insights into the specific developmental aims physicians prioritise by examining the coaching goals they set at the beginning of coaching. Since physicians face distinct roles as they advance in their careers, our second aim is to highlight similarities and differences in developmental aims and needs among individuals at various medical career stages.DesignWe conducted a qualitative analysis of 2571 coaching goals. We performed an inductive thematic analysis to code one-half of coaching goals and a codebook thematic analysis for the other half. Our interpretation of the findings was grounded in a critical realist approach.SettingSixteen hospitals in the Netherlands.ParticipantsA total of 341 medical clerkship students, 336 medical residents, 122 early-career specialists, 82 mid-career specialists and 57 late-career specialists provided their coaching goals at the start of coaching.ResultsThe findings revealed that coachees commonly set goals about their career and future, current job and tasks, interpersonal work relations, self-insight and development, health and well-being, nonwork aspects and the coaching process. Furthermore, the findings illustrate how the diversity of coaching goals increases as physicians advance in their careers.ConclusionsOur findings underscore the significance of recognising distinct challenges at various career stages and the necessity for tailoring holistic support for physicians. This insight holds great relevance for healthcare organisations, enabling them to better align system interventions with physicians’ needs and enhance support. Moreover, our classification of coaching goals serves as a valuable foundation for future research, facilitating a deeper exploration of how these goals influence coaching outcomes.
Breaking bad news in oncology practice: experience and challenges of oncology health professionals in Ethiopia – an exploratory qualitative study
Authors: Mulugeta Tefera , Alemu Wudma , Tigeneh Wondemagegnehu , Kaba Mirgissa , Haileselassie Werissaw 
Published: May 2024

ObjectiveTo explore the experience and challenges health professionals face during breaking bad news (BBN) to patients with cancer in the oncology centre of Black Lion Specialized Hospital (BLSH), Addis Ababa, Ethiopia 2019.DesignAn exploratory qualitative phenominological study using in-depth interviews was carried out in the only radiotherapy integrated oncology centre in Ethiopia during March 2019. Purposeful maximum variation sampling was used to select participants. OpenCode (V.4.02) assisted thematic analysis approach was employed to analyse the data.ParticipantsEleven oncology health practitioners (oncologists, residents and nurses) working at the oncology centre were interviewed. Repeated interviews and analysis were done until theoretical saturation.ResultsAll participants were cognisant of the positive outcome of proper and effective practice of BBN. However, they were practicing it empirically, no standardised protocols or guidelines were in place. Four dimensions of challenges were mentioned: (1) setup centric: unconducive environment, lack of protocols or guidelines, inaccessible treatment, and psychotherapy or counselling services; (2) health care centric, such as inadequate expertise, inadequate time due to patient load,treatment backlog, and referral system; (3) patients/family centric: poor medical literacy level, poor compliance, and family interference; and (4) sociocultural: wrong perception of families on BBN and treatment modalities, and opposition from religious leaders.ConclusionBBN is challenging for professionals caring for patients in the oncology centre of BLSH. Hence, there is a critical need to improve practices. Change efforts may focus on the development of contextualised, content and context specific practice oriented training programmes and curriculum interventions. Raising awareness of the community and religious leaders regarding the nature and treatment of cancer may also be a helpful adjunct.
When do medical operators choose to use, or not use, video in emergency calls? A case study
Authors: Harring Astrid Karina V , Idland Siri , Dugstad Janne 
Published: May 2024

BackgroundAn evaluation report for a pilot project on the use of video in medical emergency calls between the caller and medical operator indicates that video is only used in 4% of phone calls to the emergency medical communication centre (EMCC). Furthermore, the report found that in half of these cases, the use of video did not alter the assessment made by the medical operator at the EMCC.We aimed to describe the reasons for when and why medical operators choose to use or not use video in emergency calls.MethodThe study was conducted in a Norwegian EMCC, employing a thematic analysis of notes from medical operators responding to emergency calls regarding the use of video.ResultInformants reported 19 cases where video was used and 46 cases where it was not used. When video was used, three main themes appeared: ‘unclear situation or patient condition’, ‘visible problem’ and ‘children’. When video was not used the following themes emerged: ‘cannot be executed/technical problems’, ‘does not follow instructions’, ‘perceived as unnecessary’. Video was mostly used in cases where the medical operators were uncertain about the situation or the patients’ conditions.ConclusionThe results indicate that medical operators were selective in choosing when to use video. In cases where operators employed video, it provided a better understanding of the situation, potentially enhancing the basis for decision-making.