bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of Sweden's first digi-physical hospital-at-home care model for high-acuity patients
Authors: Kastengren Mikael , Frisk Linda , Winterfeldt Linda , Wahlström Gunilla , Dalén Magnus 
Published: March 2024

Aim To evaluate Sweden's first implementation of a 24/7 high-acuity virtual in-patient ward through a digi-physical in-patient care (DPIPC) program, a hospital-at-home care model combining a virtual hospital-based medical command centre and in-person ambulating medical services functioning as an extension of the Department of Medicine at a secondary-level hospital in Stockholm. Methods A single-centre descriptive study where adult patients with acute medical illness requiring inpatient-level care were assessed for voluntary treatment in the DPIPC program as a substitute for traditional in-patient care. The primary outcome was patient satisfaction with care. Secondary outcomes included health care use, safety, and quality during the care episode. Results From October 2022 to June 2023 a total of 200 patients were treated within the DPIPC program. The program covered 63 unique medical conditions, with infectious disease (44%) and pulmonary disease (17%) being the most common. The median length of stay (LOS) in the DPIPC program was 3 days (IQR 3) with a median LOS of 2 days (IQR 3) in the physical hospital prior to inclusion. There were no incidents of patient mortality or hospital-related complications during the DPIPC period. A total of 11 (5.5%) patients were escalated to the traditional hospital, 4 (36.4%) of which required ambulance. The median DPIPC patient satisfaction was 10 (IQR 0) and Net Promotor Score was 88. Conclusions Implementing a 24/7 high-acuity virtual in-patient ward is feasible and safe for selected patients with acute medical illnesses. Patient satisfaction and care quality within the program is high.
The impact of metastasectomy on survival of patients with synchronous metastatic renal cell cancer in Finland: A nationwide study
Authors: Laru Lauri , Ronkainen Hanna , Ohtonen Pasi , Vaarala Markku H. 
Published: March 2024

Background and objective: Most of the studies on metastasectomy in renal cell cancer are based on metachronous, often oligometastatic disease. Prior data on the impact of metastasectomy in synchronous metastatic renal cell cancer (mRCC) is, however, very scarce. We aimed to investigate the role of complete and incomplete metastasectomy in a large, nationwide patient population. Methods: We analyzed nationwide data, including all synchronous mRCC cases in Finland diagnosed during a 6-year period identified from the Finnish Cancer Registry, and complemented with patient records from the treating hospitals. We only included the patients who underwent removal of the primary tumor by nephrectomy. We performed univariate and multivariable adjusted analysis to identify the effect of metastasectomy on overall survival (OS) and cancer-specific survival (CSS). Results: We included 483 patients with synchronous mRCC. Overall, 57 patients underwent complete and 96 incomplete metastasectomy, while 330 patients had no metastasectomy. The median OS was 17.9 and CSS 17.2 months for all patients. The median OS and the median CSS were 59.3 and 60.8 months for the complete, 21.9 and 25.1 for the incomplete, and 14.5 and 14.8 months for the no metastasectomy groups ( p < 0.001 for differences). In both applied multivariable statistical models, the OS and CSS benefit from complete metastasectomy remained significant (hazard ratios (HRs) varied between 0.42 and 0.54, p < 0.001) compared with the no metastasectomy group. However, there was no improvement in survival estimates in the incomplete metastasectomy group compared with the no metastasectomy group (HRs varied between 1.04 and 1.10, p > 0.40). Conclusions: Complete metastasectomy, when possible, can be considered as a treatment option for selected patients with synchronous mRCC who are fit for surgery. By contrast, we found no survival benefit from an incomplete metastasectomy suggesting that such procedures should not be performed for these patients.
White Light Stimulation at Gamma Frequency to Modify the Aβ42 and tau Proteins in SH-SY5Y Cells
Authors: Chang Yang-Pei , Chien Ching-Fang , Huang Ling-Chun , Chuu Chih-Pin , Chang Hsi-Wen , Hour Tzyh-Chyuan , Yang Yuan-Han 
Published: March 2024

Background Non-invasive 40 Hz gamma frequency stimulation has shown improved cognition and memory recall in Alzheimer’s disease (AD). Purpose The present study investigates the effects of white light stimulation at gamma frequency on SH-SY5Y cells using Delta M + BrainCare Light without causing discomfort. Methods SH-SY5Y cells were exposed to The Delta M + BrainCare Light for 15, 30, 45, and 60 minutes. The secretion of amyloid-β42 (Aβ42), p-AKT (Ser473), AKT, p-mTOR (Ser2448), mTOR, p-4E-BP1 (Thr37/46), 4E-BP1, p-tau (Thr181), and tau were analyzed. Aβ42 fibril aggregation and phagocytosis of FITC-Aβ42 in BV-2 cells were also observed. Results Delta M + BrainCare Light reduced tau, AKT, and p-mTOR and increased p-4E-BP1 in SH-SY5Y cells. Further, it inhibited secretion and aggregation of Aβ42, alongside increased phagocytosis in microglial cells. Conclusion These findings underscore the potential of the Delta M + BrainCare Light in mitigating the associated proteins and pathways implicated in AD.
Bojungikgi-tang for Chemotherapy-induced Leukopenia: A Systematic Review and Meta-Analysis
Authors: Ahn Lib , Park Song Won , Choi Dong-jun 
Published: March 2024

Chemotherapy-induced leukopenia is a common side effect of cytotoxic anticancer drugs. It can deprive patients of treatment opportunities, resulting in the delay, reduction, or discontinuation of chemotherapy or other anticancer drug administration. Two researchers searched English, Chinese, Japanese, and Korean electronic databases, without limiting the time period and language, using search terms such as “Bojungikgi,” “WBC,” “leuko,” and “neutrop.” Among the human randomized controlled studies in which Bojungikgi-tang was administered to patients who underwent chemotherapy, studies reporting leukopenia-related outcomes were selected, and data extraction, bias risk assessment, and meta-analysis were performed on the selected papers. Ten studies were selected, and a systematic review with meta-analysis was conducted. Nine papers were published in China and the total number of participants was 715. As a result of administering Bojungikgi-tang to these patients, the number of patients with chemotherapy-induced leukopenia significantly decreased (OR: 0.41, 95% CI: 0.27-0.61, P = .0001, I2 = 35%). Further, white blood cell counts were compared with that of the control group, and it showed an effect on prevention (MD: 0.64, 95% CI: 0.46-0.83, P < .00001, I2 = 90%). A pronounced effect was observed, especially when administered after a diagnosis based on the pattern identification, such as Qi deficiency. (OR: 0.32, 95% CI: 0.18-0.58, P = .0002, I2 = 0%). However, all studies had a high risk of bias due to non-blinding, and most studies had a high or uncertain risk of bias in creating random assignment orders and concealing them. Bojungikgi-tang has an effect on the prevention and treatment of chemotherapy-induced leukopenia. The effect rate can be increased when administered after proper diagnosis, and the possibility of adverse reactions and side effects is lower than that of Granulocyte-Colony Stimulating Factor (G-CSF) injection. Bojungikgi-tang appears to be useful in the treatment and prevention of leukopenia caused by cytotoxic anticancer drugs. However, it is necessary to conduct high-quality clinical studies in the future, considering the possibility of local and language bias, heterogeneity of carcinoma and intervention, and the risk of bias. Registration: PROSPERO CRD4202341054.
A safety estimand for late phase clinical trials where the analysis period varies over the subjects
Authors: Hedman Katarina , Lisovskaja Vera , Nyström Per 
Published: March 2024

Background/Aims Evaluating safety is as important as evaluating efficacy in a clinical trial, yet the tradition for safety analysis is rudimentary. This article explores more complex methodologies for safety evaluation, with the aim of improving the interpretability, as well as generalizability, of the results. Methods For studies where the analysis periods vary over the subjects, using the International Council for Harmonisation estimand framework, we construct a formal estimand that could be used in the setting of safety surveillance that answers the clinical question of ‘What is the magnitude of the increase in risk of experiencing an adverse event if the treatment is taken, as prescribed, for a specific period of time?’. Estimation methodologies for this estimand are also discussed. Results The proposed estimand is similar to that found in the efficacy analyses of time to event data (e.g. in outcome studies), with the key difference of utilization of hypothetical intercurrent event strategy for the intercurrent event of treatment discontinuation. This is motivated by what we perceive to be a key difference for the safety objective compared to efficacy objectives, namely a desire for sensitivity (i.e. greater possibility of detecting a negative impact of the drug, if such exists) as opposed to the need to prove a positive effect of the drug in a conservative manner. Conclusion It is valuable, and possible, to use the International Council for Harmonisation estimand framework not only for efficacy but also for safety evaluation, with the estimand driven by an interpretable, and relevant, clinical question.
Prevalence and patterns of laxative use in subjects with self-reported constipation: results from a multinational digestive health survey
Authors: Lacy Brian E. , Delfini Régis , Fladung Bernward , Lange Robert 
Published: March 2024

Background: Constipation is characterized by symptoms of straining, hard stool, difficult evacuation, and infrequent bowel movements. Online surveys provide valuable information about patients’ perspectives, symptoms, management, treatment satisfaction, and risk factors. Methods: This survey explored subject experiences involving 20 gastrointestinal (GI) conditions. In total, 20,099 respondents in seven countries with varied cultural and socioeconomic backgrounds participated. Post hoc analysis of ‘self-reported constipation’ and related symptoms experienced within the past 6 months and the last episode of constipation provided data on prevalence, demographics, frequency and duration of episodes and related symptoms, impact on quality of life (QoL), management with or without laxatives, and resulting treatment satisfaction. Results: In total, 10,425 subjects reported constipation within 6 months and 2637 at the last episode. Prevalence was highest in females and younger adults. Most subjects reported various coexisting GI symptoms. Almost 80% of 6865 episodes reported by 5337 subjects occurred every 2–3 months to every 2–3 weeks. A higher frequency of constipation correlated with a greater impact on QoL. On a 10-point scale, the mean impact was 6.4. More than 90% of respondents had episodes ranging from 1 day to 1 week. More than 90% took action; 16% used laxatives, of whom 80.3% were satisfied. Conclusion: Constipation, a highly prevalent disorder, spans cultures and socioeconomic classes. Its chronic recurrence has a significant impact on QoL, resulting in symptom self-management in >90% of subjects. Significantly higher satisfaction rates in subjects treated with than without laxatives reflect subjects’ reports that self-reported constipation can be treated effectively with laxatives.
Effectiveness and safety of azathioprine for inflammatory pouch disorders: results from the RESERVO study of GETECCU
Authors: Mesonero Francisco , Zabana Yamile , Fernández-Clotet Agnès , Leo-Carnerero Eduardo , Caballol Berta , Núñez-Ortiz Andrea , García María José , Bertoletti Federico , Mínguez Alejandro , Suris Gerard , Casis Begoña , Ferreiro-Iglesias Rocío , Calafat Margalida , Jiménez Itxaso , Miranda-Bautista José , Lamuela Luis Javier , Fajardo Ingrid , Torrealba Leyanira , Nájera Rodrigo , Sáiz-Chumillas Rosa María , González Irene , Vicuña Miren , García-Morales Natalia , Gutiérrez Ana , López-García Alicia , Benítez José Manuel , Rubín de Célix Cristina , Tejido Coral , Brunet Eduard , Hernández-Camba Alejandro , Suárez Cristina , Rodríguez-Lago Iago , Piqueras Marta , Castaño Andrés , Ramos Laura , Sobrino Ana , Rodríguez-Grau María Carmen , Elosua Alfonso , Montoro Miguel , Baltar Ruth , Huguet José María , Hermida Benito , Caballero-Mateos Antonio , Sánchez-Guillén Luis , Bouhmidi Abdel , Pajares Ramón , Baston-Rey Iria , López-Sanromán Antonio , Albillos Agustin , Barreiro-de Acosta Manuel 
Published: March 2024

Background: The usefulness of thiopurines has been poorly explored in pouchitis and other pouch disorders. Objective: To evaluate the effectiveness and safety of azathioprine as maintenance therapy in inflammatory pouch disorders. Design: This was a retrospective and multicentre study. Methods: We included patients diagnosed with inflammatory pouch disorders treated with azathioprine in monotherapy. Effectiveness was evaluated at 1 year and in the long term based on normalization of stool frequency, absence of pain, faecal urgency or fistula discharge (clinical remission), or any improvement in these symptoms (clinical response). Endoscopic response was evaluated using the Pouchitis Disease Activity Index (PDAI). Results: In all, 63 patients were included [54% males; median age, 49 (28–77) years]. The therapy was used to treat pouchitis ( n = 37) or Crohn’s disease of the pouch ( n = 26). The rate of clinical response, remission and non-response at 12 months were 52%, 30% and 18%, respectively. After a median follow-up of 23 months (interquartile range 11–55), 19 patients (30%) were in clinical remission, and 45 (66%) stopped therapy. Endoscopic changes were evaluated in 19 cases. PDAI score decreased from 3 (range 2–4) to 1 (range 0–3). In all, 21 patients (33%) presented adverse events and 16 (25%) needed to stop therapy. Conclusion: Azathioprine may be effective in the long term for the treatment of inflammatory pouch disorders and could be included as a therapeutic option.
A Detailed Analysis of Workplace Foot and Ankle Injuries
Authors: Galasso Annemarie , Caughman Alexander M. , Griffith Adam , Hoch Caroline , Rex James , Scott Daniel J. , Gross Christopher E. 
Published: March 2024

Introduction This study analyzes the incidence rate and median workdays missed due to foot and ankle injuries across age groups, sexes, and industries. Methods Workplace injury data from 2003 to 2019 were obtained using the Nonfatal Cases Involving Day Away from Work: Selected Characteristics database provided by the Bureau of Labor Statistics (BLS). The data were grouped by injury location (ie, foot, ankle), injury type (ie, fracture, sprain), and industry, and reported with injury incidence rates and median workdays missed. Results The incidence rate of foot and ankle injuries significantly decreased from 2003 to 2019 (P < .001). With increasing age, the incidence rate of foot and ankle injuries decreased (P < .001) and median workdays missed increased (P < .001). Men had significantly higher rates of foot and ankle injuries (P < .001). Agriculture, forestry, fishing, and hunting (foot=10.23%, ankle=10.41%); construction (foot=8.14%, ankle=8.68%); and transportation and warehousing (foot=11.06%, ankle=13.80%) industries had the highest injury incidence rates. Transportation and warehousing (foot=16.8 days, ankle=16.3 days), mining (foot=44.9 days, ankle=17.1 days), and utilities (foot=26.7 days, ankle=24.4 days) industries had the highest median workdays missed. Conclusion Increased incidence and severity of workplace foot and ankle injuries are associated with male sex and heavy labor industries. Age was positively associated with severity and negatively associated with incidence of workplace ankle injuries. Levels of Evidence: Level III, Retrospective cohort study
Epidemiology of gout – Global burden of disease research from 1990 to 2019 and future trend predictions
Authors: Han Tingfen , Chen Wenli , Qiu Xiasang , Wang Weijie 
Published: March 2024

Background: Understanding the global burden of gout in the past and future can provide important references for optimizing prevention and control strategies in healthcare systems. Objectives: This study aimed to report variations in the global disease burden and risk factors of gout in 204 countries and territories from 1990 to 2019. Design: We conducted a retrospective analysis of gout based on the latest Global Burden of Disease (GBD) 2019 database. Methods: We collected data on the prevalence, incidence, and disability-adjusted life years (DALYs) of gout from 1990 to 2019. The data were then stratified by age, sex, and economic development level. Decomposition analysis, frontier analysis, and prediction models were used to analyze the changes and influencing factors influencing each indicator. Results: Globally, there were 53,871,846.4 [95% uncertainty interval (UI): 43,383,204.6–66,342,327.3] prevalent cases, 92,228,86.8 (95% UI: 7419,132.1–11,521,165) incident cases, and 1673,973.4 (95% UI: 1,068,061.1–2,393,469.2) cases of DALYs of gout in 2019, more than double those in 1990. Moreover, the pace of increase in the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), and age-standardized DALY rate (ASDR) accelerated during 1990–2019, with estimated annual percentage changes (EAPC) of 0.94 [95% confidence interval (CI): 0.85–1.03], 0.77 (95% CI: 0.69–0.84), and 0.93 (95% CI: 0.84–1.02), respectively, especially among men. The disease burden of gout has increased in all the other 20 GBD regions in the past 30 years, except Western Sub-Saharan Africa. The highest risk of high body mass index (BMI) and kidney dysfunction was in high-income countries such as North America and East Asia. The global prevalence rate, incidence rate, and DALYs rate of gout in 2030 will reach 599.86, 102.96 per 100,000 population, and 20.26 per 100,000 population, respectively, roughly the same as in 2019. Conclusion: With the development of society, the disease burden of gout will become increasingly severe. It is very important to study the accurate epidemiological data on gout for clinical diagnosis and treatment and health policy.
Patient-reported outcomes on sleep quality and circadian rhythm during treatment with intravenous ketamine for treatment-resistant depression
Authors: Yan Raymond , Marshall Tyler , Khullar Atul , Nagle Travis , Knowles Jake , Malkin Mai , Chubbs Brittany , Swainson Jennifer 
Published: March 2024

Background: Intravenous (IV) ketamine is a rapid acting antidepressant used primarily for treatment-resistant depression (TRD). It has been suggested that IV ketamine’s rapid antidepressant effects may be partially mediated via improved sleep and changes to the circadian rhythm. Objectives: This study explores IV ketamine’s association with changes in patient-reported sleep quality and circadian rhythm in an adult population with TRD. Methods: Adult patients (18–64 years) with TRD scheduled for IV ketamine treatment were recruited to complete patient rated outcomes measures on sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and circadian rhythm using the Morningness–Eveningness Questionnaire (MEQ). Over a 4-week course of eight ketamine infusions, reports were obtained at baseline (T0), prior to second treatment (T1), prior to fifth treatment (T2), and 1 week after eighth treatment (T3). Results: Forty participants with TRD (mean age = 42.8, 45% male) were enrolled. Twenty-nine (72.5%) had complete follow-up data. Paired t tests revealed statistically significant improvements at the end of treatment in sleep quality (PSQI) ( p = 0.003) and depressive symptoms (Clinically Useful Depression Outcome Scale-Depression, p < 0.001) while circadian rhythm (MEQ) shifted earlier ( p = 0.007). The PSQI subscale components of sleep duration ( p = 0.008) and daytime dysfunction ( p = 0.001) also improved. In an exploratory post hoc analysis, ketamine’s impact on sleep quality was more prominent in patients with mixed features, while its chronobiotic effect was prominent in those without mixed features. Conclusion: IV ketamine may improve sleep quality and advance circadian rhythm in individuals with TRD. Effects may differ in individuals with mixed features of depression as compared to those without. Since this was a small uncontrolled study, future research is warranted.
Barriers and facilitators to acceptance and implementation of eMental-health intervention among older adults: A qualitative systematic review
Authors: Peng Ruotong , Li Xiaoyang , Guo Yongzhen , Ning Hongting , Huang Jundan , Jiang Dian , Feng Hui , Liu Qingcai 
Published: March 2024

Objective Electronic mental health interventions are effective but not well promoted currently among older adults. This study sought to systematically review and summarize the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults. Methods We comprehensively retrieved six electronic databases from January 2012 to September 2022: PubMed, Web of Science, Embase, Scopus, PsycINFO, and CINAHL. The JBI-QARI was used to assess the quality of the research methodology of each publication. Eligible studies underwent data coding and synthesis aligned to inductive and deductive methods. The Consolidated Framework for Implementation Research 2.0 was used as a deductive framework to guide a more structured analysis. Results The systematic review screened 4309 articles, 17 of which were included (eight with mixed methods and nine with qualitative methods). We identified and extracted the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults: (1) innovation: technology challenges, optimized functions, and contents, security and privacy; (2) outer setting: community engagement and partnerships, financing; (3) inner setting: leadership engagement, available resources, incompatibility, intergenerational support, training and guidance; (4) individuals: perceptions, capability, motivation of older adults and healthcare providers; and (5) implementation process: recruit, external assistance, and team. Conclusion These findings are critical to optimizing, promoting, and expanding electronic mental health interventions among older adults. The systematic review also provides a reference for better evidence-based implementation strategies in the future.