bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study
Authors: Zweiker David , Zweiker Robert , Winkler Elisabeth , Roesch Konstantina , Schumacher Martin , Stepan Vinzenz , Krippl Peter , Bauer Norbert , Heine Martin , Reicht Gerhard , Zweiker Gudrun , Sprenger Martin , Watzinger Norbert 
Published: May 2024

ObjectiveOral anticoagulation (OAC) is state-of-the-art therapy for atrial fibrillation (AF), the most common arrhythmia worldwide. However, little is known about the perception of patients with AF and how it correlates with risk scores used by their physicians. Therefore, we correlated patients’ estimates of their own stroke and bleeding risk with the objectively predicted individual risk using CHA2DS2-VASc and HAS-BLED scores.DesignCross-sectional prevalence study using convenience sampling and telephone follow-up.SettingsEight hospital departments and one general practitioner in Austria. Patients’ perception of stroke and bleeding risk was opposed to commonly used risk scoring.ParticipantsPatients with newly diagnosed AF and indication for anticoagulation.Main outcome measuresComparison of subjective risk perception with CHA2DS2-VASc and HAS-BLED scores showing possible discrepancies between subjective and objective risk estimation. Patients’ judgement of their own knowledge on AF and education were also correlated with accuracy of subjective risk appraisal.ResultsNinety-one patients (age 73±11 years, 45% female) were included in this study. Subjective stroke and bleeding risk estimation did not correlate with risk scores (ρ=0.08 and ρ=0.17). The majority of patients (57%) underestimated the individual stroke risk. Patients feared stroke more than bleeding (67% vs 10%). There was no relationship between accurate perception of stroke and bleeding risks and education level. However, we found a correlation between the patients’ judgement of their own knowledge of AF and correct assessment of individual stroke risk (ρ=0.24, p=0.02). During follow-up, patients experienced the following events: death (n=5), stroke (n=2), bleeding (n=1). OAC discontinuation rate despite indication was 3%.ConclusionsIn this cross-sectional analysis of OAC-naive patients with AF, we found major differences between patients’ perceptions and physicians’ assessments of risks and benefits of OAC. To ensure shared decision-making and informed consent, more attention should be given to evidence-based and useful communication strategies.Trial registration numberNCT03061123.
Effects of a 12-week cardiovascular rehabilitation programme on systemic inflammation and traditional coronary artery disease risk factors in patients with rheumatoid arthritis (CARDIA trial): a randomised controlled trial
Authors: Heinze-Milne Stefan , Bakowsky Volodko , Giacomantonio Nicholas , Grandy Scott A 
Published: May 2024

IntroductionPatients with systemic inflammatory diseases such as rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) above the baseline risk attributable to traditional CVD risk factors seen in the general population. Exercise in cardiac rehabilitation (CR) is designed specifically for high-risk primary prevention and those with established CVD. Even though the European League Against Rheumatism guidelines state that exercise is safe for individuals with RA and exercise can reduce CVD risk, patients with RA rarely participate in CR. Thus, little is known about CR’s impact on inflammatory and CVD risk in the RA population. The purpose of this trial is to determine the feasibility of a 12-week CR programme for patients with RA and whether it decreases CVD risk without exacerbating RA.Methods and analysisThis is a randomised controlled trial whereby 60 participants with RA will be recruited and randomly assigned to either standard of care (SOC) treatment or SOC plus a 12-week CR programme (60 min of education plus two 60 min aerobic exercise sessions/week). Exercise will be performed at 60%–80% of heart rate reserve. Outcome measures (Framingham Risk Score, resting heart rate, blood pressure, blood lipids, markers of systemic inflammation (ie, interleukin (IL) 6 and tumour necrosis factor-α (TNF-α), Clinical Disease Assessment Index, Disease Activity Score-28, physical activity levels and peak cardiorespiratory fitness) will be assessed preintervention (week-0), postintervention (week-13) and 6 months postintervention.Ethics and disseminationEthical approval was obtained from the Nova Scotia Health Authority Research Ethics Board. Results will be submitted for publication in an appropriate peer-reviewed journal.Trial registration numberNCT01534871; Pre-results
Reasons for unsuccessful recruitment of children with atopic dermatitis in primary care in the Netherlands to a cohort study with an embedded pragmatic, randomised controlled open-label trial: a survey
Authors: van Halewijn Karlijn F , Bohnen Arthur M , Pasmans Suzanne G M A , Bindels Patrick J E , Elshout Gijs 
Published: May 2024

BackgroundThe Rotterdam Eczema Study was an observational cohort study with an embedded pragmatic randomised controlled open-label trial. It was conducted in children with atopic dermatitis (AD) in the Dutch primary care system. The objective of the trial was to determine whether a potent topical corticosteroid (TCS) is more effective than a low-potency TCS.ObjectiveWe are aiming to communicate transparently about the poor recruitment for the trial part and to explore the reasons why recruitment was weak.DesignWe used a survey to find out what patients in the cohort did when they experienced a flare-up.MethodsDescriptive statistics were used to present the baseline characteristics of participants in the trial and the results of the survey.ResultsIn total, 367 patients were included in the cohort. Of these, 32 were randomly assigned to a trial treatment; they had a median age of 4.0 years (IQR 2.0–9.8). A total of 69 of the 86 children (80.2%) who could participate in the survey responded. 39 (56.5%) suffered a flare-up during the follow-up (making them potentially eligible for inclusion in the trial). 26 out of 39 (66.7%) increased their use of an emollient and/or TCS themselves. Only 12 of the 39 (30.7%) contacted their general practitioner (GP) as instructed in the study protocol, but 8 out of these 12 did not meet the inclusion criteria for the trial.ConclusionThe main reason why cohort participants did not take part in the trial was that they did not contact their GPs when they experienced an AD flare-up. Furthermore, the majority of patients who contacted their GPs did not match the inclusion criteria of the trial. We expect that the lessons learnt from this study will be useful when developing future studies of children with AD in primary care.
Physicians’ emotion awareness and emotion regulation training during medical education: a systematic scoping review protocol
Authors: Lange Anna , Bonvin Raphaël , Guttormsen Schär Sissel , Zambrano Sofia C 
Published: May 2024

IntroductionThe objective of this systematic scoping review is to identify what approaches have been implemented in medical education programmes to teach medical students the skills to identify and manage emotions that may be elicited in them during physician–patient interactions and in the clinical environment. Emotions of all involved in the clinical encounter are central to the process of clinical care. However, a gap remains addressing and teaching medical students about recognising and dealing with their own emotions.Methods and analysisThis scoping review will follow the updated JBI (The Johanna Briggs Institute) methodology guidance for the conduct and reporting of systematic scoping reviews, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A search strategy was developed and applied to five databases. Terms used included medical education, medical curriculum, medical students, emotion (regulation), psychological well-being and mental health. Additionally, a grey literature and reference list search will be conducted. Two independent reviewers will first screen titles and abstracts followed by a second, full-text screening phase. Publications to be included will contain information and data about teaching approaches such as lectures, and other teaching material on physicians’ emotion awareness and emotion regulation training in medical education.Ethics and disseminationThis study will review existing literature on emotion awareness and emotion regulation training in medical education, and a systematic scoping review does not require ethical approval. The results of this scoping review will be submitted for publication to relevant peer-reviewed journals and will be used to inform the development and implementation of training programmes and research studies aimed at preparing medical students to identify and manage their own emotions in the clinical environment.
Performance of glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) biomarkers in predicting CT scan results and neurological outcomes in children with traumatic brain injury (BRAINI-2 paediatric study): protocol of a European prospective multicentre study
Authors: Lorton Fleur , Lagares Alfonso , de la Cruz Javier , Méjan Odile , Pavlov Vladislav , Sapin Vincent , Poca Maria Antonia , Lehner Markus , Biberthaler Peter , Chauviré-Drouard Anne , Gras-Le-Guen Christèle , Scherdel Pauline 
Published: May 2024

IntroductionIn light of the burden of traumatic brain injury (TBI) in children and the excessive number of unnecessary CT scans still being performed, new strategies are needed to limit their use while minimising the risk of delayed diagnosis of intracranial lesions (ICLs). Identifying children at higher risk of poor outcomes would enable them to be better monitored. The use of the blood-based brain biomarkers glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1) could help clinicians in this decision. The overall aim of this study is to provide new knowledge regarding GFAP and UCH-L1 in order to improve TBI management in the paediatric population.Methods and analysisWe will conduct a European, prospective, multicentre study, the BRAINI-2 paediatric study, in 20 centres in France, Spain and Switzerland with an inclusion period of 30 months for a total of 2880 children and adolescents included. To assess the performance of GFAP and UCH-L1 used separately and in combination to predict ICLs on CT scans (primary objective), 630 children less than 18 years of age with mild TBI, defined by a Glasgow Coma Scale score of 13–15 and with a CT scan will be recruited. To evaluate the potential of GFAP and UCH-L1 in predicting the prognosis after TBI (secondary objective), a further 1720 children with mild TBI but no CT scan as well as 130 children with moderate or severe TBI will be recruited. Finally, to establish age-specific reference values for GFAP and UCH-L1 (secondary objective), we will include 400 children and adolescents with no history of TBI.Ethics and disseminationThis study has received ethics approval in all participating countries. Results from our study will be disseminated in international peer-reviewed journals. All procedures were developed in order to assure data protection and confidentiality.Trial registration numberNCT05413499.
Exposure to needlestick injury among healthcare support staff in Greater Accra, Ghana: a cross-sectional study
Authors: Tawiah Philip Apraku , Appiah-Brempong Emmanuel , Okyere Paul , Ashinyo Mary Eyram 
Published: May 2024

ObjectivesThis study aims to determine the prevalence and predisposing factors of a needlestick injury (NSI) among healthcare support staff in the Greater Accra region, Ghana.MethodsAn analytical cross-sectional survey was carried out from 30 January 2023 to 31 May 2023, involving 10 major health facilities. A multistage sampling method was adopted. The data analyses were performed using STATA V.15 software. χ2, Fisher’s exact and Mann-Whitney U tests were used to identify the preliminary association between the outcome variables and predisposing factors. Log-binomial regression analyses were used to confirm factors associated with NSI at a significance level of p<0.05.ResultsThe study was conducted among 149 healthcare support staff. The 1-year exposure to NSI was 68 (45.6%) (95% CI (37.5% to 54.0%)). Being a healthcare assistant (APR=2.81 (95% CI 1.85 to 4.25)), being married (APR=0.39 (95% CI 0.25 to 0.63)), being a supervisor (APR=0.34 (95% CI 0.20 to 0.57)), had training on standard precaution (APR=0.27 (95% CI 0.14 to 0.57)) and non-existence of needlestick reporting system (APR=0.46 (95% CI 0.29 to 0.74)) were significantly associated with NSI.ConclusionThe prevalence of NSI was high compared with other regional studies, and the risk factors were related to sociodemographic, behavioural and organisational factors. The study recommends guidelines that are geared towards NSI exposure among healthcare support staff.
25 Family caregiver socio-economic status, access to palliative care and patients’ place of death: a health survey for england study
Authors: Johnson Miriam , Allgar Victoria , Chen Hong , Dunn Laurie , Macleod Una , Currow David 
Published: May 2024

BackgroundThe personal impact is considerable for family caregivers at the end-of-life.AimsTo i) describe family caregivers at the end-of-life, ii) those willing to repeat this role under similar circumstances; iii) investigate associations between caregivers’ household income, patients’ access to palliative care services (PCS) and place of patients’ death.MethodsEnd-of-life caregiver questions in the Health Survey for England: had someone close to them died of a terminal illness within past 5 years?; intensity of care?; PCS accessed?; place of death?; willingness to care again?. Associations were explored using univariable analyses and multiple logistic regression.Results2167/8861 (25%) respondents had someone close die; 645/8861 (7.3%) provided personal care (caregivers). Younger caregiver age (≤65; OR 2.79; 95% CI 1.36, 5.74) and use of PCS (OR: 1.95, 95% CI: 1.09, 3.48) were associated with willingness to caregive again. 55% of decedents accessed PCS. PCS access reduced hospital (p<0.001), and increased home (p<0.001) deaths. Overall, respondents’ income (adjusted for PCS) was unrelated to decedents’ place of death but those with the most affluentcaregiverswereleastlikely to die at home (p=0.069).ConclusionsMost who have provided end-of-life care for someone close would be willing to provide care again; more likely for younger caregivers and when PCS was accessed.PCS access was associated with fewer hospital deaths and more home deaths. Decedents with more affluentcaregiverswere theleastlikely to die at home. Such caregivers are likely to be powerful patient advocates; ensuring correct understanding of goals of care is important.
40 Caring for carers: a social worker and nurse-led hospice model
Authors: Thomas Glyn , Harris Louise , Thomas Liz , Davidson Jason , Gishen Faye 
Published: May 2024

IntroductionMarie Curie recognises the contribution that carers make to the support and wellbeing of those diagnosed with terminal illness.1Their 2012 report highlighted a lack of support for carers as well as the associated negative social and economic impact of caring for a dying relative. The Carers UK Report, 20142found that nearly 6000 people become carers every day, with £1.1 billion of Carers’ Allowance going unclaimed each year.AimsThe understanding and appreciation of challenges faced by carers led to the establishment of a dedicated Carers’ Clinic at Marie Curie Hospice, Hampstead, London in April 2016. The aim was to support carers, with the focus on answering their questions and addressing their concerns.MethodsThe model was social worker and nurse-led. A modified version of the Carers Support Needs Assessment Tool (CSNAT) was used as the basis for the consultation3and a questionnaire evaluation was completed following the clinic appointment.ResultsBetween April 2016 and March 2017 there were 31 consultations with 23 evaluations completed. Both quantitative and qualitative data was captured. 83% of respondents said that the clinic met their needs. Many carers requested follow-up sessions. The key themes identified were around financial advice, carers’ health needs and support with managing their relatives’ illness.ConclusionThe Carers Clinic is now established in the hospice. Further developments include the establishment of a new service enabling carers to be referred for six sessions of pre-bereavement support, as well as a plan to implement an 8 week mindfulness programme.References. Marie Curie (2012)Committed to Carers; Supporting Carers of People at the End of Life, Marie Curie. pp.4-5, 7-8, 11–12. Carers UK (2014)Need to know; Transitions in and out of Caring: The Information Challenge. Carers UK. pp.4.. Ewing, G & Grande, G. (2013)Development of a Carer Support Needs Assessment Tool (CSNAT) for End-of-Life Care Practice at Home: A Qualitative Study. Palliative Medicine; 27 (3) pp.244–256.
5 Advance care planning for people with dementia in long term care settings: an explanatory mixed methods study of health care professionals’ and families’ perspectives
Authors: Beck Esther Ruth , McIlfatrick Sonja , Hanson Felicity 
Published: May 2024

IntroductionAdvance care planning is advocated for people with dementia, yet discussions with this group are rare, particularly in long-term care settings. The role of health care professionals and family are pivotal, therefore further understanding of their perspective is needed.AimTo examine the understanding and experience of family caregivers of people with dementia and health care professionals regarding the process of advance care planning.MethodsSequential explanatory mixed methods design incorporating 3 phases was adopted.ResultsAll three groups had poor knowledge of advance care planning, particularly the legal aspects. Whilst health care professionals and families considered there were benefits, there were challenges to implementation in this setting. These included: concerns regarding the ability of the person with dementia to engage, the increased role of the family, a lack of context specific guidance, and a knowledge deficit regarding dementia and advance care planning.There was widespread variations in perspectives, including when it should be implemented, who should be responsible and what it should focus on. The GP played a key role, whilst nursing staff remained on the periphery. Families were central in the decision making process, yet their ability was influenced by a limited awareness of dementia, decisional burden due to guilt and anticipatory grief, and a limited ability to reflect the wishes of the person with dementia.ConclusionsAdvance care planning for people with dementia is a complex process within nursing homes, influenced by multiple factors related to the setting, the perspectives of those involved and the context of dementia itself.
Comprehensive profiling of cancer neoantigens from aberrant RNA splicing
Authors: Wickland Daniel P , McNinch Colton , Jessen Erik , Necela Brian , Shreeder Barath , Lin Yi , Knutson Keith L , Asmann Yan W 
Published: May 2024

BackgroundCancer neoantigens arise from protein-altering somatic mutations in tumor and rank among the most promising next-generation immuno-oncology agents when used in combination with immune checkpoint inhibitors. We previously developed a computational framework, REAL-neo, for identification, quality control, and prioritization of both class-I and class-II human leucocyte antigen (HLA)-presented neoantigens resulting from somatic single-nucleotide mutations, small insertions and deletions, and gene fusions. In this study, we developed a new module, SPLICE-neo, to identify neoantigens from aberrant RNA transcripts from two distinct sources: (1) DNA mutations within splice sites and (2) de novo RNA aberrant splicings.MethodsFirst, SPLICE-neo was used to profile all DNA splice-site mutations in 11,892 tumors from The Cancer Genome Atlas (TCGA) and identified 11 profiles of splicing donor or acceptor site gains or losses. Transcript isoforms resulting from the top seven most frequent profiles were computed using novel logic models. Second, SPLICE-neo identified de novo RNA splicing events using RNA sequencing reads mapped to novel exon junctions from either single, double, or multiple exon-skipping events. The aberrant transcripts from both sources were then ranked based on isoform expression levels and z-scores assuming that individual aberrant splicing events are rare. Finally, top-ranked novel isoforms were translated into protein, and the resulting neoepitopes were evaluated for neoantigen potential using REAL-neo. The top splicing neoantigen candidates binding to HLA-A*02:01 were validated using in vitro T2 binding assays.ResultsWe identified abundant splicing neoantigens in four representative TCGA cancers: BRCA, LUAD, LUSC, and LIHC. In addition to their substantial contribution to neoantigen load, several splicing neoantigens were potent tumor antigens with stronger bindings to HLA compared with the positive control of antigens from influenza virus.ConclusionsSPLICE-neo is the first tool to comprehensively identify and prioritize splicing neoantigens from both DNA splice-site mutations and de novo RNA aberrant splicings. There are two major advances of SPLICE-neo. First, we developed novel logic models that assemble and prioritize full-length aberrant transcripts from DNA splice-site mutations. Second, SPLICE-neo can identify exon-skipping events involving more than two exons, which account for a quarter to one-third of all skipping events.
Frequency of deployed emergency donor panel use prior to implementation of the low titre group O whole blood program
Authors: Lin Catherine Y , Hamm J D , Fisher A D , Rizzo J A , Corley J B , April M D , Schauer S G 
Published: May 2024

IntroductionThe US military has frequently used a ‘walking blood bank’, formally known as an ‘emergency donor panel’ (EDP) to obtain warm fresh whole blood (WFWB) which is then immediately transfused into the casualty. We describe the frequency of EDP activation by the US military.MethodsWe analysed data from 2007 to 2015 within the Department of Defense Trauma Registry for US, Coalition and US contractor casualties that received at least 1 unit of blood product within the first 24 hours and described the frequency of WFWB use.ResultsThere were 3474 casualties that met inclusion, of which, 290 casualties (8%) required activation of the EDP. The highest proportion of EDP events was in 2014, whereas the highest number of EDP events was in 2011. Median injury severity scores were higher in the recipients, compared with non-EDP recipients (29 vs 20), as were proportions with serious injuries to the abdomen (43% vs 19%) and extremities (77% vs 65%). The median number of units of all blood products, except for packed red blood cells, was higher for WFWB recipients. Of the WFWB recipients, the median was 5 units (IQR 2–10) with a maximum documented 144 units. There were four documented cases of EDP recipients receiving >100 units of WFWB with only one surviving to hospital discharge. During the study period, there were a total of 3102 (3%) units of WFWB transfused among a total of 104 288 total units.ConclusionsWe found nearly 1 in 11 casualties who received blood required activation of the EDP. Blood from the EDP accounted for 3% of all units transfused. These findings will enable future mission planning and medical training, especially for units with smaller, limited blood supplies. The lessons learned here can also enable mass casualty planning in civilian settings.