bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Time Burden of Office Visits in Contemporary Pituitary Care, 2016 to 2019
Authors: Dimitroyannis Rose C. , Cyberski Thomas F. , Kondamuri Neil S. , Polster Sean P. , Das Paramita , Horowitz Peleg M. , Roxbury Christopher R. 
Published: March 2024

Background The concept of “time toxicity” has emerged to address the impact of time spent in the healthcare system; however, little work has examined the phenomenon in the field of otolaryngology. Objective To validate the use of Evaluation and Management (E/M) current procedural terminology codes as a method to assess time burden and to pilot this tool to characterize the time toxicity of office visits associated with a diagnosis of pituitary adenoma between 2016 and 2019. Methods A retrospective cohort study of outpatient office visits quantified differences between timestamps documenting visit length and their associated E/M code visit length. The IBM MarketScan database was queried to identify patients with a diagnosis of pituitary adenoma in 2016 and to analyze their new and return claims between 2016 and 2019. One-way ANOVA and two-sample t-tests were used to examine claim quantity, time in office, and yearly visit time. Results In the validation study, estimated visit time via E/M codes and actual visit time were statistically different ( P < 0.01), with E/M codes underestimating actual time spent in 79.0% of visits. In the MarketScan analysis, in 2016, 2099 patients received a primary diagnosis of pituitary adenoma. There were 8490 additional-related claims for this cohort from 2016 to 2019. The plurality of new office visits were with endocrinologists (n = 857; 29.3%). Total time spent in office decreased yearly, from a mean of 113 min (2016) to 69 min (2019) ( P < 0.001). Conclusions E/M codes underestimate the length of outpatient visits; therefore, time toxicity experienced by pituitary patients may be greater than reported. Further studies are needed to develop additional assessment tools for time toxicity and promote increased efficiency of care for patients with pituitary adenomas.
The correlation of Rotational Thromboelastometry (ROTEM) derived parameters with severe obstetric haemorrhage
Authors: Tan Hon Sen , Yek Jacklyn Jia Lin , Allen Terrence K , Sultana Rehena , Tan Chin Wen , Sng Ban Leong 
Published: March 2024

Background Prediction of severe obstetric haemorrhage may facilitate timely interventions and reduce maternal morbidity and mortality. Rotational thromboelastometry (ROTEM) provides point-of-care coagulation parameters that may identify patients at risk of severe haemorrhage. Purpose Our aim was to determine the correlation of ROTEM-derived parameters at early stages of postpartum haemorrhage. Research design Retrospective cohort study. Study Sample Patients who utilised ROTEM during postpartum haemorrhage from 2013 to 2021. Data Collection and Analysis Severe harmorrhage was defined as: (1) decrease in haemogoblin concentration >4g.dL-1 within 48 h; (2) packed red blood cell transfusion of >1000 mL; (3) haemostatic intervention such as angiographic embolisation, arterial ligration, or hysterectomy; or (4) death. ROTEM-derived parameters were collected accordingly. Results Data from 36 patients were analysed, of whom 29 (80.6%) developed severe haemorrhage. FIBTEM A5, A10, and A20 were highly correlated (r > +/−0.7) with severe haemorrhage. There were moderate correlations (r = +/− 0.5 to 0.7) between EXTEM A5, A10, A20, maximum clot firmness, maximum lysis, and lysis index-30 with severe haemorrhage. Conclusions These findings are consistent with prior studies reporting associations between fibrinogen concentration, EXTEM A10, and FIBTEM A10 with severe haemorrhage. In conjunction with these studies, our results support the use of FIBTEM A5 and A10 as early biomarkers to predict progression to severe haemorrhage and facilitate timely implementation of appropriate medical or surgical interventions.
Evaluating the risk of developing hyperuricemia in patients with type 2 diabetes mellitus using least absolute shrinkage and selection operator regression and machine learning algorithm
Authors: Chen Qingquan , Hu Haiping , He Qing , Huang Xinfeng , Shi Huanhuan , Cao Xiangyu , Zhang Xiaoyang , Xu Youqiong 
Published: March 2024

Background Hyperuricemia is a common complication of type 2 diabetes mellitus and can lead to serious consequences such as gout and kidney disease. Methods Patients with type 2 diabetes mellitus from six different communities in Fuzhou were recruited from June to December 2022. Questionnaires, physical examinations, and laboratory tests were conducted to collect data on various variables. Variable screening steps were performed using univariate and multivariate stepwise regression, least absolute shrinkage and selection operator (LASSO) regression, and Boruta feature selection. The dataset was divided into a training-testing set (80%) and an independent validation set (20%). Six machine learning models were built and validated. Results A total of 8243 patients with type 2 diabetes mellitus were included in this study. According to Occam's razor method, the LASSO regression algorithm was determined to be the optimal risk factors selection method, and nine variables were identified as parameters for the risk assessment model. The absence of diabetes medication and elevated fasting blood glucose levels exhibited a negative correlation with the risk of hyperuricemia. Conversely, seven other variables demonstrated a positive association with the risk of hyperuricemia among patients diagnosed with type 2 diabetes mellitus. Among the six machine learning models, the artificial neural network (ANN) model demonstrated the highest performance. It achieved an areas under curve of 0.736, accuracy of 68.3%, sensitivity of 65.0%, specificity of 72.2%, precision of 73.6% and F1-score of 69.0%. Conclusions We developed an ANN model to better evaluate the risk of hyperuricemia in the type 2 diabetes population. In the type 2 diabetes population, women should pay particular attention to their uric acid levels, and type 2 diabetics should not neglect their obesity level, blood pressure, kidney function and lipid profile during their regular medical check-ups, in order to do their best to avoid the risks associated with the combination of type 2 diabetes and hyperuricemia.
Rural patients’ experiences with anesthesia and surgical consultations in British Columbia: A survey-based comparison between virtual and in-person modalities
Authors: Kornelsen Jude , Taylor Matilda , Ebert Sean , Skinner Tom , Stoll Kathrin 
Published: March 2024

Introduction Rural patients face barriers to accessing surgical care and often need to travel long distance for pre- or post-surgical consultations. Although adaptation to the COVID-19 pandemic has demonstrated the efficacy of virtual care, there is minimal data available to evaluate patient satisfaction with this modality and consequent health service utilization if virtual services are not available. Methods An online survey was conducted with participants living in rural British Columbia, Canada who had undergone surgery within 12 months of data collection and had either virtual or face-to-face pre- or post-surgical consultations. It was supplemented by an in-person survey administered in two rural sites to all patients who had a virtual visit prior to undergoing procedural care. A ten-point scale was used to assess satisfaction. Quantitative and qualitative data were collected and analyzed. Results Findings from the province-wide survey (n = 163) revealed no significant differences in average satisfaction ratings between people with in-person and virtual surgical consultations (8.03 versus 8.38, p = 0.26). However, most participants indicated that virtual appointments saved them time traveling, energy, and money and made them less dependent on others, accruing significant social benefit. In the community-focused sample (n = 71), 38% said they would not have had the procedure without a virtual visit option and 21% said that they would have delayed the procedure. Virtual consultations saved patients an average of 9 h (range 1–90). Participants traveled an average of 427 kilometers round trip to have the procedures. Conclusion Findings reveal costs and time saved in accessing care due to the introduction of pre- and post-operative virtual care visits, and further investments in virtual care are warranted. This will contribute to promoting equitable access to healthcare for rural residents.
Early Childhood Development and Social Mobility in China
Authors: Wu (吴晓刚) Xiaogang , Li (李欣) Xin , Miao (缪佳) Jia 
Published: March 2024

Purpose Infancy and early childhood are critical stages for the development of both cognitive and socioemotional skills, which are predictive of subsequent academic success, labor market outcomes, and socioeconomic achievement. Empirical research both in China and in other countries has revealed that nurturing quality is increasingly divergent among social classes, leading to intergenerational accumulation of advantage/disadvantage, declining social mobility, and exacerbating class inequality. The article aims to systematically examine existing theoretical and empirical research on early childhood development and social mobility and provide a holistic comparative and analytical framework for future research in the context of China. Design/Approach/Methods This article systematically reviews relevant theories and empirical research in the field and provides preliminary findings of early childhood education investment in China, using the data from the China Family Panel Studies (CFPS). Specifically, the article focuses on the differences in early childhood education investment and child development among families of different socioeconomic statuses and discusses the potential impact of these differences on children's future development. Findings The findings of this study reveal distinct patterns in early childhood education investment and child development across diverse socioeconomic strata in China. China's initiatives to enhance children's education and human capital have robust theoretical foundations and timely policy implications. However, despite the ongoing efforts, early childhood parenting and education programs lack systematic research, emphasizing the urgent need for intervention programs and comprehensive databases to inform evidence-based policymaking. Originality/Value The article concludes with a comprehensive analytical framework for the study of early childhood development and social mobility in China, which has implications for promoting human capital investment and facilitating social mobility.
Geriatric Vertebral Compression Fracture: A Database Study Characterizing Use and Trends for Prescribed Thoracic/Lumbar Orthoses
Authors: Halperin Scott J. , Dhodapkar Meera M. , Moran Jay , Jeong Seongho , Grauer Jonathan N. , Varthi Arya 
Published: March 2024

Study Design Retrospective cohort study. Objective Geriatric vertebral compression fractures are the most common fracture associated with osteoporosis. Using a large national database, the current study aimed to examine and characterize bracing trends for geriatric thoracic/lumbar compression fracture management. Methods The current study utilized the PearlDiver database from 2015-2021. Patients who suffered thoracic/lumbar compression fractures (fifth thoracic to the fifth lumbar vertebra [T5-L5]) were identified. Exclusion criteria included patients less than 65 years old or an indication of infection or neoplasm. Patients who received a brace within 90-days after the initial diagnosis of thoracic/lumbar compression fracture were abstracted and characterized overall and by fracture level. Multivariable logistic regression was performed to assess for correlation with bracing trends. Results In total 290 388 patients met inclusion criteria and suffered a thoracic/lumbar compression fracture (greatest incidence at the thoracolumbar junction). Of these, bracing was only prescribed for 4263 (1.5%), with the greatest variance of 1.5% by level. Independent predictors of bracing were geographic region (relative to northeast, west WE odds ratio [OR] 1.31, Midwest OR 1.20), younger age (OR 1.27 per decade), female sex (OR 1.17), and ECI (OR 1.02 per 2-point increase) ( P < .05 for each). Conclusion Overall, the current study examined over a quarter of a million patients who suffered a T5-L5 compression fractures and found that only 1.5% of patients were braced. This low percentage, and that greatest predictor for bracing was non-clinical (geographic region), highlight the inconsistency of this practice and may be useful for developing treatment algorithms.
Symptom Burden and Quality of Life Among Patients With Heart Failure
Authors: Al-Sutari Manal Mohammed , Abdalrahim Maysoon S. 
Published: March 2024

Introduction Heart failure is a debilitating condition that is associated with several burdensome symptoms that impede patients’ quality of life. However, patients’ experience of distressing symptoms and their impacts on their quality of life is not studied in Jordan. Objectives To assess the severity of distressing symptoms and to assess the relationships between these symptoms and the quality of life among patients with heart failure in Jordan. Methods A descriptive cross-sectional design was used. A convenience sampling approach was used to recruit the participants. Heart failure patients (n  =  167) who visited the outpatient clinics in three hospitals in Amman between July and November 2021 were included. The Edmonton Symptom Assessment System and Short-Form 36 tool were used. Results Participants were more likely males with a mean age of 55.2 years (SD  =  13.7). The most distressing symptoms among patients with heart failure were tiredness (M  =  4.56, SD  =  3.24), worse well-being (M  =  4.34, SD  =  2.52), and drowsiness (M  =  3.5, SD  =  3.06), respectively. Symptoms burden were negatively associated with the physical and the mental components summary of the quality of life. Pain, tiredness, nausea, loss of appetite, anxiety, and poor well-being were significant predictors of the physical components. The predictors of the mental components were tiredness, nausea, loss of appetite, and anxiety. Conclusions This study revealed that patients with heart failure facing significant symptom burden. The patients showed inadequate quality of life in both physical and mental components that were inversely associated with symptom burden. Given the debilitating effects of symptom burden on heart failure patients’ quality of life, therefore, symptom assessment and management have to be a priority.
A Systematic Review and Meta-Analysis on the Impact of Preserving the Hepatic Branch of the Vagus Nerve in Upper Gastrointestinal Surgeries
Authors: Jia Dong James Wang , Fahim Shaik Ansari Ahamed , Yong’an Matthew Tham , Yin Liu Yu , Kon Voi Tay 
Published: March 2024

Background: Upper gastrointestinal surgeries encompass procedures on the esophagus, stomach, liver, pancreas, and gallbladder. To access the surgical area, it is standard to dissect the hepatogastric ligament, transecting the hepatic branch of the vagus nerve contained within it. Yet, the hepatic branch, which innervates the liver and gallbladder, contributes to digestion, bile secretion, and glucose metabolism. Hence, recent surgical studies have explored the potential benefits of hepatic branch preservation in comparison to non-preservation. This systematic review and meta-analysis endeavors to compile and analyze the outcomes of these studies. Methods: PubMed, EMBASE, Scopus, and Cochrane, were searched for cohort studies and randomized control trials comparing hepatic nerve preservation and division during upper gastrointestinal surgery in adults, up to April 2023. Two independent reviewers evaluated abstracts and full-text reviews, extracted pertinent information, and conducted risk-of-bias assessments using the RoB 2 and Newcastle-Ottawa instruments. Results: Thirteen studies involving 3001 participants were included for meta-analysis. Hepatic branch preservation was linked to a decrease in appetite loss (OR 0.04, 95% CI 0.01-0.18), reflux symptoms (OR 0.16, 95% CI 0.06-0.43) and gallstone formation (OR 0.25, 95% CI 0.09-0.69). However, preservation was associated with an increased incidence of Clavien-Dindo Grade 2 complications (OR 1.73, 95% CI 1.01-2.96) in gastrectomies. Conclusion: Hepatic branch preservation is associated with favorable post-surgical metabolic outcomes, notably appetite preservation. This may be due to the hepatic branch’s role in facilitating brain-liver crosstalk, thus, influencing homeostatic processes like appetite control and glucose metabolism. Reduced gallstone incidence is likely due to preservation of gallbladder motility and function, achieved through retention of parasympathetic innervation.
Effect of lactoferrin treatment on symptoms and physical performance in long COVID patients: a randomised, double-blind, placebo-controlled trial
Authors: Redel Anne-Lotte , Miry Fatana , Hellemons Merel Elise , Oswald Laurien Maria Amarentia , Braunstahl Gerrit Johannes 
Published: March 2024

BackgroundLong COVID is a heterogeneous condition with a variety of symptoms that persist at least 3 months after SARS-CoV-2 infection, often with a profound impact on quality of life. Lactoferrin is an iron-binding glycoprotein with anti-inflammatory and antiviral properties. Current hypotheses regarding long COVID aetiology include ongoing immune activation, viral persistence and auto-immune dysregulation. Therefore, we hypothesised that long COVID patients may potentially benefit from lactoferrin treatment. The aims of the present study were to investigate the effect of lactoferrin on various long COVID domains: fatigue, anxiety, depression, cognitive failure and muscle strength.MethodsWe performed a randomised, double-blind, placebo-controlled trial in long COVID patients aged 18–70 years within 12 months after proven SARS-CoV-2 infection. Patients were randomised (1:1) to 6 weeks of lactoferrin (1200 mg daily) or placebo. At three hospital visits (T0, T6 and T12 weeks), patient-reported outcome measures were collected, physical performance tests were performed and blood was drawn. The difference in fatigue at T6 was the primary outcome.Results72 participants were randomised to lactoferrin (n=36) or placebo (n=36). We found a significant decrease in fatigue, as measured with the Fatigue Assessment Scale, between T0 and T6 in both study arms, but without significant difference between the study arms (lactoferrin: 3.9, 95% CI 2.3–5.5, p=0.007; placebo: 4.1, 95% CI 2.3–5.9, p=0.013). No significant differences were found in any of the other outcomes in favour of the lactoferrin arm at T6 or T12.ConclusionAlthough both long COVID arms showed improved clinical outcomes at T6, the improvement did not continue until T12. Lactoferrin provided no benefit in terms of fatigue, other patient-reported outcome measures or physical functioning.
Lung cancer among outpatients with COPD: a 7-year cohort study
Authors: Bang Henriksen Margrethe , Hansen Torben Frøstrup , Jensen Lars Henrik , Brasen Claus Lohman , Borg Morten , Hilberg Ole , Løkke Anders 
Published: March 2024

IntroductionLung cancer (LC) is the most common cause of cancer-related deaths worldwide, and its prognosis upon metastasis remains poor. Patients with COPD face a significantly elevated LC risk, up to six times greater than those with normal lung function. We aimed to investigate LC prevalence and stage distribution among COPD outpatients. Furthermore, we aimed to outline the COPD-related variables associated with referral for LC examination.MethodsWe conducted a retrospective analysis encompassing the period from 1 January 2012 to 31 December 2018 on all outpatients with COPD and LC and individuals referred for LC examinations.ResultsAmong all COPD outpatients, 2231 patients (18%) were referred for LC examinations and 565 (4.6%) were diagnosed with LC. LC patients with COPD were more likely to be stage I–II, in contrast to the non-COPD LC population (46%versus26%, p<0.001 for all). Patients referred for LC examinations exhibited higher use of COPD-related medications, reported more severe dyspnoea (69%versus66% with Medical Research Council dyspnoea score >2) and experienced a greater frequency of exacerbations (30%versus24% with two or more exacerbations).ConclusionOur study revealed a notably high LC incidence among COPD outpatients. LC patients with COPD were diagnosed at earlier stages, and outpatients with more pronounced COPD symptoms were more inclined to undergo LC diagnostics. The overrepresentation of LC cases among COPD outpatients emphasises the importance of tailoring specific screening initiatives for this demographic.
Increased bronchiectasis risk and related risk factors in inflammatory bowel disease: a 10-year Korean national cohort study
Authors: Lee Jun Su , Yang Bumhee , Shin Hye Soon , Lee Heajung , Chai Hyun Gyung , Choi Hayoung , Han Joung-Ho , Yoon Jai Hoon , Kim Eung-Gook , Lee Hyun 
Published: March 2024

BackgroundThe association between inflammatory bowel disease (IBD) and an increased risk of bronchiectasis, as well as contributing factors, remains unclear. Additionally, whether bronchiectasis increases disease burden in IBD remains unknown. Therefore, this study aimed to: 1) assess whether IBD increases the risk of incident bronchiectasis; 2) compare the risk of bronchiectasis between individuals with Crohn's disease (CD) and those with ulcerative colitis (UC); 3) identify risk factors for bronchiectasis in individuals with IBD; and 4) examine the disease burden in individuals with IBD and bronchiectasisversusthose without.MethodsWe conducted a population-based matched cohort study involving adults aged ≥20 years with IBD, using data acquired from the Korean National Health Insurance Service-National Sample Cohort database between 2002 and 2012.ResultsDuring the mean follow-up of 9.6 years, the incidence rate of bronchiectasis was 419.63 out of 100 000 person-years (PY) and 309.65 out of 100 000 PY in the IBD and matched cohorts (adjusted hazard ratio (aHR) 1.21, 95% CI 1.05–1.39), respectively. UC was associated with increased bronchiectasis risk (aHR 1.42, 95% CI 1.19–1.69), but CD was not. Multivariate Cox regression analyses showed that age, male sex, medical aid, underweight status, COPD and diabetes mellitus were associated with an increased risk of bronchiectasis in the IBD cohort (p<0.05). The mortality, emergency department visit and hospitalisation rates were significantly higher for individuals with IBD and bronchiectasis compared with those without bronchiectasis (p<0.05).ConclusionIBD is associated with increased risk of bronchiectasis, which results in a greater disease burden in individuals with IBD.