bluuebunny/crossref_metadata_2025_split huggingface dataset:
4 Quality of life assessment in palliative care day services
Authors: Armstrong Mary , Dempster Martin , Donnelly Michael , McCorry Noleen , Graham Lisa 
Published: May 2024

IntroductionThe outcome measure used to assess Quality of Life (QoL) can have a crucial effect on the interpretation of any findings in palliative care.AimsTo compare the sensitivity to change of the Schedule for the Evaluation of Individual Quality of Life-Direct Weighing (SEIQol-DW), the McGill Quality of Life Questionnaire (MQOL) and the Short Form 36 (SF-36) among patients receiving Palliative Care Day Services (PCDS).MethodsPatients were recruited from PCDS. The same questionnaires were administered at 2 time points, approximately 3 weeks apart. A measure of dependency (the Barthel Index) was used to determine whether patients remain stable/deteriorate over time.AnalysisStandardised response mean (SRM) was used to determine the relative sensitivity of each instrument for those patients who had changed in their Barthel scores (Garratt et al 1994).ResultsForty four patients (median 69 years, range 49–86) were recruited. Follow-up data was obtained from 25 (56.8%) patients. Of these 25 patients, 14 (56%) patients changed according to the Barthel Index with 7 (50%) patients defined as increased dependency.The responsiveness of the SEIQoL-DW was larger than those of the other questionnaires (SRM=0.73) for those patients who showed an increased dependency over time. The SF-36 Bodily Pain subscale demonstrated a larger responsiveness than the other questionnaires (SRM=0.82) for those patients who showed a decrease dependency over time.ConclusionsThe SEIQoL appears to be a good outcome measure for charting the progress of patients who are deteriorating over time. However none of the questionnaires were particularly good at demonstrating improvements over time.Reference1. Garratt AM, Ruta DA, Abdalla MI, Russell IT. SF-36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions. Quality in Health Care1994;3:186–192.
49 ’Pic’ your patient: development of a multi-professional handover tool
Authors: Chapman Laura , Mills Mark , Robinson Claire 
Published: May 2024

BackgroundIn a 26 bedded hospice, handovers were excessive and inefficient. Our review revealed over 15 handovers per day between different professionals. The Multi-disciplinary team (MDT) felt frustrated, recognising handovers reduced time for direct patient contact without ensuring timely sharing of crucial information.Staff wanted a single, efficient MDT handover to identify key patient issues.MethodCurrent available tools were reviewed including SBAR1(Situation, Background, Assessment, and Recommendation) but were unsuitable for the hospice. The PIC acronym was created to facilitate nursing presentation of each patient. This prompted discussion of: Plan (Is the patient going anywhere today? Are we planning discharge to their preferred place of care?); Involvement (Are appropriate MDT members involved?); Concerns (Are there any patient or family concerns?). The PIC tool was used at the newly launched ‘Huddle’ – a handover led by a senior nurse and designated consultant, with a representative from each discipline of the MDT occurring each weekday morning.ResultsInformal feedback from staff suggested the Huddle and PIC tool enabled more efficient discharges. It was useful to view the complexity of the patients throughout the hospice and guide admissions. A formal survey of the MDT is being carried out, with results available by October 2017.ConclusionHuddle is reducing the number of handovers each day and increasing the productivity of the hospice. This has benefits for swift discharge and assessing the needs of patients with complex problems. An unintended benefit has been improved nursing confidence in their presenting skills.Reference. Haig K, Sutton S, Whittington J. SBAR: A shared mental model for improving communication between clinicians. The Joint Commission Journal on Quality and Patient Safety 2006;32(3):167–175
52 What is current practice when using sedative medication at the end of life in a london hospice and teaching hospital? a mixed methods investigation for i-can-care
Authors: Vivat Bella , Harrington Jane , Bemand-Qureshi Lucy , Davis Sarah , Stone Patrick 
Published: May 2024

IntroductionThe I-CAN-CARE research programme explores care and assessment of dying patients in two under-researched areas: use of sedative medication at the end of life and prognostication. We present findings from an exploration of current practice relating to sedative use.AimsTo explore the understandings of palliative care physicians and nurses in London regarding use of sedatives, and simultaneously audit deceased patient records for documented sedative use.MethodsFocus groups with experienced palliative care physicians and nurses working in a London hospice or hospital/community-based palliative care were audio-recorded, transcribed, and analysed thematically. Deceased patient notes at both sites were audited independently, working backwards from December 2015 to obtain 25 patients at each site who had received continuous sedation at the end of life.ResultsFocus group participants (ten consultants/SpRs; seventeen senior nurses) all said they used sedative medication for managing agitation or distress; aiming for patients to be “comfortable”, “calm”, or “relaxed”, and selecting drugs and dosages as appropriate for patients’ individual needs, aiming to start with the lowest doses possible. None used structured observational tools to assess the effects of sedatives; strongly preferring clinical observation and judgement. The audit found usually low dosages: 10 mg/day median continuous dose midazolam; range 0.35–69.5, with written comments often addressing patients’ perceived comfort.ConclusionsFocus group participants considered the role of sedative medication as primarily symptom management, emphasising individualised care, and using lowest dosages possible to achieve patient comfort, assessed using clinical judgement. Data from patient records corroborated these qualitative findings.
Abstract P494: Gene-Level Gene-Environment Interaction Testing Reveals Rare Variants With Large Impacts on the Omega-3 Fatty Acid-Inflammation Relationship
Authors: Westerman Kenneth E , Patel Chirag , Meigs James , Manning Alisa 
Published: May 2024

Dietary omega-3 fatty acid (dN3FA) intake affects plasma N3FA (pN3FA) concentrations, circulating biomarkers of chronic inflammation such as high-sensitivity C-reactive protein (hsCRP), and ultimately cardiometabolic disease risk. Genetic variation may modify the N3FA-inflammation relationship, facilitating applications in precision medicine and possibly explaining variable intervention trial responses. Here, we explored the dual hypothesis that pN3FA mediates the dN3FA-hsCRP relationship and that genetic variants across the frequency spectrum modify this association.
Regression models in the UK Biobank (N = 342,120) tested main effects of oily fish intake (a primary dietary source of N3FA; measured by food frequency questionnaire) on hsCRP and its mediation by pN3FA (measured by nuclear magnetic resonance; N = 188,701). Three genome-wide interaction studies tested modification of the dN3FA-hsCRP (“full”), dN3FA-pN3FA (“upstream”), and pN3FA-hsCRP (“downstream”) associations. Regression covariates included demographics, lifestyle indicators, socioeconomic measures, and genetic principal components. Variant-specific GWIS were followed by gene-level enrichment testing using the MAGMA tool. Replication of gene-based signals was conducted in the Women’s Genome Health Study (WGHS; N = 23,294) by testing the interaction of the top variant in each gene with total dN3FA impacting hsCRP.

Oily fish intake associated most strongly with hsCRP compared to other questionnaire-based estimates of fish or fish oil intake, with statistical evidence that plasma N3FA mediated approximately 100% of this diet-inflammation relationship. While the “full” genetic interaction analysis did not produce any FDR-significant gene-level interactions, the “upstream” analysis uncovered nine genes, including a cluster containing the biologically-relevant fatty acid desaturases
FADS1
and
FADS2
, and the “downstream” analysis uncovered four genes. Primary variant interaction effect sizes were small (e.g., -0.02 std. dev. bN3FA / std. dev. fish / allele for the top
FADS1
variant rs174560), but in-depth follow-up at these genes revealed allelic spectra including rare variants with substantially larger effects (e.g., -0.11 for a
FADS1
missense variant with allele frequency of 0.14%, after conditioning on rs174560). WGHS results supported the overall robustness of the findings (consistent interaction effect signs at 8/10 loci), replicated specific signals (p = 0.04 for
FADS1
rs174560), and implicated additional inflammatory biomarkers (e.g., fibrinogen and ICAM-1 for the top
GLTSCR1
variant).

In conclusion, we report (1) the novel epidemiological finding that pN3FA fully mediates the dN3FA-hsCRP relationship, and (2) specific genes with large-effect rare variants that modify the upstream (absorption) and downstream (inflammatory pathways) components of this relationship.
Social Determinants of Health and Incident Apparent Treatment‐Resistant Hypertension Among White and Black US Adults: The REGARDS Study
Authors: Akinyelure Oluwasegun P. , Jaeger Byron C. , Safford Monika M. , Oparil Suzanne , Carson April P. , Sims Andrew , Hannon Lonnie , Howard George , Muntner Paul , Hardy Shakia T. 
Published: May 2024

Background
We examined the association of multilevel social determinants of health with incident apparent treatment‐resistant hypertension (aTRH).

Methods and Results
We analyzed data from 2774 White and 2257 Black US adults from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study taking antihypertensive medication without aTRH at baseline to estimate the association of social determinants of health with incident aTRH. Selection of social determinants of health was guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Blood pressure (BP) was measured during study visits, and antihypertensive medication classes were identified through a pill bottle review. Incident aTRH was defined as (1) systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease while taking ≥3 classes of antihypertensive medication or (2) taking ≥4 classes of antihypertensive medication regardless of BP level, at the follow‐up visit. Over a median 9.5 years of follow‐up, 15.9% of White and 24.0% of Black adults developed aTRH. A percent of the excess aTRH risk among Black versus White adults was mediated by low education (14.2%), low income (16.0%), not seeing a friend or relative in the past month (8.1%), not having someone to care for them if ill or disabled (7.6%), lack of health insurance (10.6%), living in a disadvantaged neighborhood (18.0%), and living in states with poor public health infrastructure (6.0%).

Conclusions
Part of the association between race and incident aTRH risk was mediated by social determinants of health.
Arterial Recanalization During Interhospital Transfer for Thrombectomy
Authors: Seners Pierre , Wouters Anke , Ter Schiphorst Adrien , Yuen Nicole , Mlynash Michael , Arquizan Caroline , Heit Jeremy J. , Kemp Stephanie , Christensen Soren , Sablot Denis , Wacongne Anne , Lalu Thibault , Costalat Vincent , Lansberg Maarten G. , Albers Gregory W. 
Published: May 2024

BACKGROUND:
Patients with acute ischemic stroke harboring a large vessel occlusion admitted to nonendovascular-capable centers often require interhospital transfer for thrombectomy. We evaluated the incidence and predictors of arterial recanalization during transfer, as well as the relationship between interhospital recanalization and clinical outcomes.

METHODS:
We analyzed data from 2 cohorts of patients with an anterior circulation large vessel occlusion transferred for consideration of thrombectomy to a comprehensive center, with arterial imaging at the referring hospital and on comprehensive stroke center arrival. Interhospital recanalization was determined by comparison of the baseline and posttransfer arterial imaging and was defined as revised arterial occlusive lesion (rAOL) score 2b to 3. Pretransfer variables independently associated with interhospital recanalization were studied using multivariable logistic regression analysis.

RESULTS:

Of the 520 included patients (Montpellier, France, n=237; Stanford, United States, n=283), 111 (21%) experienced interhospital recanalization (partial [rAOL=2b] in 77% and complete [rAOL=3] in 23%). Pretransfer variables independently associated with recanalization were intravenous thrombolysis (adjusted odds ratio, 6.8 [95% CI, 4.0–11.6]), more distal occlusions (intracranial carotid occlusion as reference: adjusted odds ratio, 2.0 [95% CI, 0.9–4.5] for proximal first segment of the middle cerebral artery, 5.1 [95% CI, 2.3–11.5] for distal first segment of the middle cerebral artery, and 5.0 [95% CI, 2.1–11.8] for second segment of the middle cerebral artery), and smaller clot burden (clot burden score 0–4 as reference: adjusted odds ratio, 3.4 [95% CI, 1.5–7.6] for 5–7 and 5.6 [95% CI, 2.4–12.7] for 8–9). Recanalization on arrival at the comprehensive center was associated with less interhospital infarct growth (rAOL, 0–2a: 11.6 mL; rAOL, 2b: 2.2 mL; rAOL, 3: 0.6 mL;
P
trend
<0.001) and greater interhospital National Institutes of Health Stroke Scale score improvement (0 versus −5 versus −6;
P
trend
<0.001). Interhospital recanalization was associated with reduced 3-month disability (adjusted common odds ratio, 2.51 [95% CI, 1.68–3.77]) with greater benefit from complete than partial recanalization.

CONCLUSIONS:
Recanalization is frequently observed during interhospital transfer for thrombectomy and is strongly associated with favorable outcomes, even when partial. Broadening thrombolysis indications in primary centers, and developing therapies that increase recanalization during transfer, will likely improve clinical outcomes.
Emergency medical services in Armenia: national call trends and future directions
Authors: Arzoumanian Ani , Agopian Anya , Hovhannisyan Marine , Chekijian Sharon , Baghdassarian Aline 
Published: May 2024

Abstract
Background
Emergency medical services (EMS) are paramount to boosting health indices in lower-middle income countries (LMICs); however, lack of uniform data collection and analysis hinders system improvement efforts. In the present study, we describe patterns of EMS utilization in the Republic of Armenia and provide key insight into the quality of digital data collection methods.

Results
For calls logged in the capital city, Yerevan, the majority had at least one missing field. The predominant complaint was high blood pressure among adults (34.4%) and fever among pediatrics (65.9%). A majority of patients were female (57.6%), adults (90.2%), and not transported to a hospital (85.0%). In the rural provinces, the data was largely intact. The predominant complaints were unspecified acute condition (27.4%) and high blood pressure (26.2%) among adults, and fever (43.9%) and unspecified acute condition (22.1%) among pediatrics. A majority of patients were female (57.1%), adults (94.2%), and not transported to a hospital (78.9%).

Conclusions
Our study reveals that the majority of calls to the EMS system are for concerns not needing in-hospital treatment and for acute exacerbation of chronic conditions. Our study also provides a critical foundation for the improvement of EMS systems in Armenia and in other nations in transition. The Locator software has the potential to be a valuable tool to the MoH if it is improved for surveillance purposes, and future synchronization of digital systems would provide easy access to critical information on population health needs and the effectiveness of public health interventions.
Genomic analysis of severe COVID-19 considering or not asthma comorbidity: GWAS insights from the BQC19 cohort
Authors: Amri Omayma , Madore Anne-Marie , Boucher-Lafleur Anne-Marie , Laprise Catherine 
Published: May 2024

Abstract
Background
The severity of COVID-19 is influenced by various factors including the presence of respiratory diseases. Studies have indicated a potential relationship between asthma and COVID-19 severity.

Objective
This study aimed to conduct a genome-wide association study (GWAS) to identify genetic and clinical variants associated with the severity of COVID-19, both among patients with and without asthma.

Methods
We analyzed data from 2131 samples sourced from the Biobanque québécoise de la COVID-19 (BQC19), with 1499 samples from patients who tested positive for COVID-19. Among these, 1110 exhibited mild-to-moderate symptoms, 389 had severe symptoms, and 58 had asthma. We conducted a comparative analysis of clinical data from individuals in these three groups and GWAS using a logistic regression model. Phenotypic data analysis resulted in the refined covariates integrated into logistic models for genetic studies.

Results
Considering a significance threshold of 1 × 10−6, seven genetic variants were associated with severe COVID-19. These variants were located proximal to five genes: sodium voltage-gated channel alpha subunit 1 (SCN10A), desmoplakin (DSP), RP1 axonemal microtubule associated (RP1), IGF like family member 1 (IGFL1), and docking protein 5 (DOK5). The GWAS comparing individuals with severe COVID-19 with asthma to those without asthma revealed four genetic variants in transmembrane protein with EGF like and two follistatin like domains 2 (TMEFF2) and huntingtin interacting protein-1 (HIP1) genes.

Conclusion
This study provides significant insights into the genetic profiles of patients with severe forms of the disease, whether accompanied by asthma or not. These findings enhance our comprehension of the genetic factors that affect COVID-19 severity.

Key messages

Seven genetic variants were associated with the severe form of COVID-19;

Four genetic variants were associated with the severe form of COVID-19 in individuals with comorbid asthma;

These findings help define the genetic component of the severe form of COVID-19 in relation to asthma as a comorbidity.
Identification of four mitochondria-related genes in sepsis based on RNA sequencing technology
Authors: ShilinLi  , Hu Yingchun 
Published: May 2024

Abstract
Objectives
The purpose of this study was to identify and analyze the mitochondrial genes associated with sepsis patients in order to elucidate the underlying mechanism of sepsis immunity and provide new ideas for the clinical treatment of sepsis.

Methods
The hospitalized cases of sepsis (n = 20) and systemic inflammatory response syndrome (SIRS) (n = 12) admitted to the Emergency Intensive Care Unit (EICU) of the Affiliated Hospital of Southwest Medical University from January 2019 to December 2019 were collected consecutively. RNA-seq was used to sequence the RNA (mRNA) of peripheral blood cells. Bioinformatics techniques were used to screen and identify differentially expressed RNAs, with an absolute value of fold change (FC) greater than or equal to 1.2 and a false discovery rate (FDR) less than 0.05. At the same time, mitochondrial genes were obtained from the MitoCarta 3.0 database. Differential genes were then intersected with mitochondrial genes. The resulting crossover genes were subjected to GO, KEGG, and PPI analysis. Subsequently, the GSE65682 dataset was downloaded from the GEO database for survival analysis to assess the prognostic value of core genes, and GSE67652 was downloaded for ROC curve analysis to validate the diagnostic value of core genes. Finally, the localization of core genes was clarified through 10X single-cell sequencing.

Results
The crossing of 314 sepsis differential genes and 1136 mitochondrial genes yielded 28 genes. GO and KEGG analysis showed that the crossover genes were mainly involved in the mitochondrion, mitochondrial matrix, and mitochondrial inner membrane. Survival analysis screened four genes that were significantly negatively associated with the prognosis of sepsis, namely FIS1, FKBP8, GLRX5, and GUK1. A comparison of peripheral blood RNA-seq results between the sepsis group and the SIRS group showed that the expression levels of these four genes were significantly decreased in the sepsis group compared to the SIRS group. ROC curve analysis based on GSE67652 indicates these four genes’ high sensitivity and specificity for sepsis detection. Additionally, single-cell RNA sequencing found that the core genes were mainly expressed in macrophages, T cells, and B cells.

Conclusions
Mitochondria-related genes (FIS1, FKBP8, GLRX5, GUK1) were underexpressed in the sepsis group, negatively correlated with survival, and mainly distributed in immune cells. This finding may guide studying the immune-related mechanisms of sepsis. This study protocol was reviewed by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (ethics number: KY2018029), the clinical trial registration number is ChiCTR1900021261, and the registration date is February 4, 2019.
Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review
Authors: Mahura Melanie , Karle Brigitte , Sayers Louise , Dick-Smith Felicity , Elliott Rosalind 
Published: May 2024

Abstract
Background
In order to mitigate the distress associated with life limiting conditions it is essential for all health professionals not just palliative care specialists to identify people with deteriorating health and unmet palliative care needs and to plan care. The SPICT™ tool was designed to assist with this.

Aim
The aim was to examine the impact of the SPICT™ on advance care planning conversations and the extent of its use in advance care planning for adults with chronic life-limiting illness.

Methods
In this scoping review records published between 2010 and 2024 reporting the use of the SPICT™, were included unless the study aim was to evaluate the tool for prognostication purposes. Databases searched were EBSCO Medline, PubMed, EBSCO CINAHL, APA Psych Info, ProQuest One Theses and Dissertations Global.

Results
From the search results 26 records were reviewed, including two systematic review, two theses and 22 primary research studies. Much of the research was derived from primary care settings. There was evidence that the SPICT™ assists conversations about advance care planning specifically discussion and documentation of advance care directives, resuscitation plans and preferred place of death. The SPICT™ is available in at least eight languages (many versions have been validated) and used in many countries.

Conclusions
Use of the SPICT™ appears to assist advance care planning. It has yet to be widely used in acute care settings and has had limited use in countries beyond Europe. There is a need for further research to validate the tool in different languages.