bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Outcomes and Quality of Care Among Adult Appendicitis Patients: A Comparative Study of Tertiary Care Hospitals and Regional Hospitals
Authors: Hsiao Ya‐Wen , Hsiao Chih‐Yang , Huang John , Lai Peng‐Sheng , Chen Po‐Yen 
Published: October 2023

AbstractBackgroundAcute appendicitis is one of the most common abdominal emergencies, with management approaches that vary depending on the available resources and setting. However, there is a lack of studies on the differences of surgical outcomes and quality of care between tertiary care hospitals and regional hospitals.MethodsThis multicenter retrospective study included 2158 consecutive adult patients between January 2014 and June 2018 at three hospitals. The patient cohort was divided into regional hospital group (N = 1223) and tertiary care hospital group (N = 935). Baseline characteristics and perioperative outcomes were compared, and factors associated with surgical delay and postoperative complication were investigated.ResultsPatients in tertiary care hospital group had longer surgical waiting time (17.3 vs. 12.0 h, p < 0.001), higher risks of surgical delay exceeding 24 h (OR = 2.94, 95% CI 2.17–4.01, p < 0.001), longer operation time (64 vs. 50 min, p < 0.001), more appendix perforation (22.4 vs. 13.3%, p < 0.001), and higher hospital cost compared with regional hospital group. In multivariate analysis, factors associated with surgical delay were tertiary care hospital (OR = 2.94, 95% CI 2.18–4.01, p < 0.001) and delay diagnosis (OR = 18.7, 95% CI 11.7–30.1, p < 0.001), while those associated with postoperative complications were older age (OR = 1.02, 95% CI 1.00–1.04, p = 0.013), male sex (OR = 2.38, 95% CI 1.11–5.52, p = 0.031), surgical delay (OR = 2.99, 95% CI 1.30–6.47, p = 0.007), and appendix perforation (OR = 5.61, 95% CI 2.72–11.85, p < 0.001).ConclusionsPatients at tertiary care hospitals had longer waiting time, more surgical delays, and appendix perforations, and these were risk factors of postoperative complications. Establishing an effective referral system to redirect appendicitis patients with less complex medical histories from tertiary care hospitals to regional hospitals may enhance the quality of patient care and outcomes, while also reducing medical costs.
The Impact of Age on the Post‐operative Outcomes in Patients Undergoing Resection for Oesophageal and Gastric Cancer
Authors: Law Cameron , Bhimani Nazim , Mitchell David , Yu Mia Yue , Chan Priscilla , Leibman Steven , Smith Garett 
Published: October 2023

AbstractBackgroundWithin our ageing population, there is an increasing number of elderly patients presenting with oesophagogastric cancer. Resection remains the mainstay of curative treatment however it has substantial morbidity. The aim of this study was to assess whether age was an independent predictor of resection related complications in our unit.MethodsA retrospective cohort study of prospectively collated data from 2002 to 2020 of patients undergoing resection for oesophageal and gastric cancers was analysed. Patients aged over 75 and 75 and under were compared for peri‐operative morbidity (via the Clavien‐Dindo classification), length of stay (LOS), unplanned readmission, 30‐ and 90‐day mortality, and use of neoadjuvant therapy.ResultsData for 466 consecutive patients undergoing oesophagogastric resection (277 oesophagectomy and 189 gastrectomy) were available for analysis. 22% of patients were aged over 75 (14% (39/277) of the oesophagectomy cohort, 34% (65/189) of the gastrectomy cohort). Oesophagectomy patients over 75 were more likely to develop post‐operative complications, particularly cardiac or thromboembolic, (69.2%) than those in the younger cohort (50.4%, p = 0.029). There was no difference in complication rates between the younger and older patients undergoing gastrectomy (29.0% vs. 33.9% p = 0.495). The 30‐ and 90‐day mortality rates were 1.4% (n = 4) and 2.5% (n = 7), respectively, for the oesophagectomy cohort and 1.1% (n = 2) and 1.6% (n = 3) for the gastrectomy cohort, with no difference between age groups.ConclusionIn this series, we found that patients over the age of 75 were able to undergo oesophageal and gastric resection with curative intent with acceptable post‐operative morbidity and mortality.
Wie denken Psychotherapeut*innen in Deutschland über die Durchführung von Traumatherapie?
Authors: Gossmann Katharina , Rosner Rita , Barke Antonia 
Published: October 2023

Zusammenfassung
Hintergrund und Zielsetzung
Es findet sich eine mangelhafte Umsetzung von traumafokussierten Behandlungsrationalen in der psychotherapeutischen Praxis. Ein Grund kann die Einstellung der Behandelnden gegenüber der Durchführung von Traumatherapie sein; diese soll im Rahmen dieser Studie abgebildet werden. Zusätzlich werden diverse Therapeut*innencharakteristika als mögliche Einflussfaktoren berücksichtigt.

Methode
In der Studie wurden die Daten von 1326 approbierten oder sich in Ausbildung befindenden Psychotherapeut*innen analysiert. In die deutschlandweite Online-Umfrage wurden verschiedene Fachrichtungen und Behandlungsschwerpunkte (Kinder und Jugendliche vs. Erwachsene) aufgenommen. Die Einstellung gegenüber traumafokussierter Psychotherapie wurde auf 4 visuellen Analogskalen (Behandlungsbereitschaft, Kompetenzerleben, Befürchtungen, Wahrscheinlichkeit einer baldigen Durchführung) erfasst.

Ergebnisse
Es zeigte sich eine insgesamt günstige durchführungsbezogene Einstellung gegenüber Traumatherapie. Relevante Korrelate waren die Zahl der Therapien pro Woche, der Ausbildungsstatus, die psychotherapeutische Fachrichtung und traumafokussierte Zusatzqualifikationen.

Schlussfolgerung
Die Ergebnisse deuten darauf hin, dass die Einstellung von Psychotherapeut*innen zu Traumatherapie signifikant mit einigen Therapeut*innencharakteristika zusammenhängt, obwohl sie insgesamt günstig ausgeprägt ist. Vor allem der hochsignifikante Zusammenhang mit traumafokussierter Zusatzqualifikation impliziert die Notwendigkeit weiterer Studien zur Überprüfung kausaler Zusammenhänge zwischen Training und durchführungsbezogener Einstellung. Dieses Ergebnis verdeutlicht auch die Relevanz von Disseminationsprojekten für traumafokussierte Therapie.
Multiple sclerosis: time for early treatment with high-efficacy drugs
Authors: Selmaj Krzysztof , Cree Bruce A. C. , Barnett Michael , Thompson Alan , Hartung Hans-Peter 
Published: October 2023

AbstractThis review addresses current changes in the approach to treating patients with multiple sclerosis (MS). The widely practiced approach of utilizing agents with lower treatment efficacy (LETA) at onset with subsequent escalation has been challenged by new data suggesting that MS patients derive greater benefit when therapy is initiated with high-efficacy treatment agents (HETA). Several recent studies compared treatment efficacy and safety of early administration of HETA versus LETA. The results of randomized, double blind, phase III studies with LETA as a control arm and population-based larger and longer studies using propensity scoring, marginal structural modeling and weighted cumulative exposure analysis support the benefit of early treatment with HETA. Patients initiating their treatment with HETA, regardless of prognostic factors and MRI burden at baseline, showed significantly lower annualized relapse rate (ARR) and reduced disability progression in follow-up periods of up to 10–15 years. Moreover, the safety profile of recently approved HETA ameliorates concerns about off-target effects associated with a number of earlier high-efficacy drugs. Patient perception has also changed with an increasing preference for medication profiles that both improve symptoms and prevent disease progression. Accumulating data from randomized studies and the results of large population-based studies demonstrating short-term and longer-term patient benefits support the view that HETA should be more widely used. The adoption of early treatment with HETA capitalizes on a window of opportunity for anti-inflammatory drugs to maximally impact disease pathology and heralds a sea change in clinical practice toward pro-active management and away from a philosophy routed in generating clinical benefit as a consequence of treatment failure.
Machine learning using multimodal and autonomic nervous system parameters predicts clinically apparent stroke-associated pneumonia in a development and testing study
Authors: Nelde Alexander , Krumm Laura , Arafat Subhi , Hotter Benjamin , Nolte Christian H. , Scheitz Jan F. , Klammer Markus G. , Krämer Michael , Scheib Franziska , Endres Matthias , Meisel Andreas , Meisel Christian 
Published: October 2023

Abstract
Background
Stroke-associated pneumonia (SAP) is a preventable determinant for poor outcome after stroke. Machine learning (ML) using large-scale clinical data warehouses may be able to predict SAP and identify patients for targeted interventions. The aim of this study was to develop a prediction model for identifying clinically apparent SAP using automated ML.

Methods
The ML model used clinical and laboratory parameters along with heart rate (HR), heart rate variability (HRV), and blood pressure (BP) values obtained during the first 48 h after stroke unit admission. A logistic regression classifier was developed and internally validated with a nested-cross-validation (nCV) approach. For every shuffle, the model was first trained and validated with a fixed threshold for 0.9 sensitivity, then finally tested on the out-of-sample data and benchmarked against a widely validated clinical score (A2DS2).

Results
We identified 2390 eligible patients admitted to two-stroke units at Charité between October 2020 and June 2023, of whom 1755 had all parameters available. SAP was diagnosed in 96/1755 (5.5%). Circadian profiles in HR, HRV, and BP metrics during the first 48 h after admission exhibited distinct differences between patients with SAP diagnosis vs. those without. CRP, mRS at admission, leukocyte count, high-frequency power in HRV, stroke severity at admission, sex, and diastolic BP were identified as the most informative ML features. We obtained an AUC of 0.91 (CI 0.88–0.95) for the ML model on the out-of-sample data in comparison to an AUC of 0.84 (CI 0.76–0.91) for the previously established A2DS2 score (p < 0.001). The ML model provided a sensitivity of 0.87 (CI 0.75–0.97) with a corresponding specificity of 0.82 (CI 0.78–0.85) which outperformed the A2DS2 score for multiple cutoffs.

Conclusions
Automated, data warehouse-based prediction of clinically apparent SAP in the stroke unit setting is feasible, benefits from the inclusion of vital signs, and could be useful for identifying high-risk patients or prophylactic pneumonia management in clinical routine.
The association between number of steps and the ambulatory blood pressure during leisure vs. work hours among cleaners
Authors: Poulsen Vivian Rueskov , Baumann Mathilde , Korshøj Mette 
Published: October 2023

Abstract
Purpose
The physical activity paradox states occupational physical activity (OPA) to be hazardous and leisure time physical activity (LTPA) to be beneficial for health. Yet, the acute effects of OPA and LTPA on cardiovascular risk factors are sparsely investigated. The aim of this study was to investigate the acute effects on ambulatory blood pressure (ABP) from steps/hour during work and leisure time among cleaners.

Methods
Data were obtained from a cluster randomized worksite intervention among 91 cleaners in Denmark and included a questionnaire, objective physical measurements, ABP (measured across 24 h), and steps/hour (measured during work and leisure time). A preliminary linear regression analysis was conducted as a mixed model including random intercept and slope, allowing for both within- and between-participant variability. We adjusted for sex, age, job seniority, medication use, smoking, self-reported fitness and BMI. Changes in ABP (mmHg) were estimated per 100 steps/hour.

Results
The number of steps taken was not associated with ABP during either work or leisure. Moreover, the ABP did not seem to differ between exposure to steps taken during work (systolic − 0.42 mmHg, 95% Confidence Interval (CI): − 1.10–0.25, diastolic − 0.03 mmHg, 95% CI, − 0.45–0.39) and leisure time (systolic -0.47 mmHg, 95% CI, − 1.66–0.72, diastolic 0.25 mmHg, 95% CI, − 0.46–0.97).

Conclusion
Our findings show no significant association between steps/hour and ABP and no contrasting effects between work and leisure time. These mechanisms fostering the divergent results need to be further investigated to improve the understanding of the physical activity paradox.
Nurturing the next generation of pediatric physician scientists: the Padova Physician Scientist Research Training for pediatric residents
Authors: Galderisi Alfonso , Bressan Silvia , Da Dalt Liviana , Perilongo Giorgio , Baraldi Eugenio 
Published: October 2023

AbstractLess than 2% of physicians complete a research training (PhD) after the residency with a declining trend in those pursuing a clinical scientist pathway in pediatrics. The exposure to research methodology during the clinical training may play a role in engaging the next generations of pediatric physician scientist. Herein, we describe the experience of the Padova Physician Scientist Research Training (PPSRT) of the pediatric residency program at the University of Padova. The PPSRT was addressed to residents attending PGY2 to PGY4 of the pediatric program and consisted of two cores: a general one including in person or virtual lectures about research methodology in pediatrics including design of a clinical trial, writing of a scientific paper and statistical methods, and a subspecialties core for the discussion of research challenges in each area and the scientific writing activities. The perceived barriers to a research training and an evaluation of the program were assessed by an anonymized questionnaire. Sixty-four out 150 residents registered for the research training with 62/64 completing the two cores. The major perceived barrier to research during clinical training was the absence of protected time (89%) followed by the lack of specific funds (37%). The group activities lead to the publication of 24 papers. Conclusion: This is the first experience in the Italian pediatric training of a dedicated research program within the frame of postgraduate medical education. Our report highlights the need for protected time to promote research interest and nurture a new generation of physician scientists.

What is Known:• Training to medical research is not part of residency program.• The declining trend of physician scientists might be reverted by early exposure to research methodology and challenges during residency.

What is New:• An early exposure to research training during pediatric residency increases the research engagement of pediatric residents.• The lack of protected time for research is perceived as the major barrier to research training during residency.
Effects of high-intensity interval training on functional performance and maximal oxygen uptake in comparison with moderate intensity continuous training in cancer patients: a systematic review and meta-analysis
Authors: Neuendorf T. , Haase R. , Schroeder S. , Schumann M. , Nitzsche N. 
Published: October 2023

Abstract
Introduction
High-intensity interval training (HIIT) is an appropriate training modality to improve endurance and therefore contributes to physical performance. This review investigates the effect of HIIT on functional performance in cancer patients. We reviewed the relative peak oxygen uptake (relV̇O2PEAK) and meta-analytical compared HIIT with moderate intensity continuous training (MICT). Furthermore, we took various training parameters under consideration.

Methods
A systematic literature search was conducted in Scopus, PubMed, and Cochrane Library databases. For the review, we included randomized controlled trials containing HIIT with cancer patients. From this, we filtered interventions with additional MICT for the meta-analysis. Outcomes of interest were various functional performance assessments and V̇O2MAX.

Results
The research yielded 584 records which fit the inclusion criteria, of which 31 studies with n=1555 patients (57.4±8.6 years) could be included in the overall review and 8 studies in the meta-analysis (n=268, 59.11±5.11 years) regarding relV̇O2PEAK. Different functional outcomes were found, of which walking distance (+8.63±6.91% meters in 6-min walk test) and mobility (+2.7cm in sit and reach test) improved significantly due to HIIT. In terms of relV̇O2PEAK, the performance of cancer patients was improved by HIIT (10.68±6.48%) and MICT (7.4±4.29%). HIIT can be favored to increase relV̇O2PEAK (SMD 0.37; 95% CI 0.09–0.65; I2=0%; p=0.009). Effect sizes for relV̇O2PEAK improvements correlate moderately with total training volume (Spearman’s ρ=0.49; p=0.03), whereas percentage increases do not (Spearman’s ρ=0.24; p=0.14).

Conclusion
Functional and physical outcomes were positively altered by different HIIT protocols and forms of implementation, whereas a tendency toward more effectiveness of HIIT vs. MICT was found for relV̇O2PEAK. Future studies should include functional parameters more often, to finally allow a comparison between both training protocols in this regard.
The effect of conditioning regimen and prescribed medications on hyposalivation in haematopoietic cell transplantation (HCT) patients: an 18-month prospective longitudinal study
Authors: Bulthuis Marjolein S. , van Gennip Lucky L. A. , Thomas Renske Z. , Bronkhorst Ewald M. , Laheij Alexa M. G. A. , Raber-Durlacher Judith E. , Rozema Frederik R. , Brennan Michael T. , von Bültzingslöwen Inger , Blijlevens Nicole M. A. , Huysmans Marie-Charlotte D. N. J. M. , van Leeuwen Stephanie J. M. 
Published: October 2023

Abstract
Objectives
Haematopoietic cell transplantation (HCT) preceded by a conditioning regimen is an established treatment option for (non)malignant haematologic disorders. We aim to describe the development of hyposalivation over time in HCT recipients, and determine risk indicators.

Materials and methods
A multi-centre prospective longitudinal observational study was conducted. Unstimulated (UWS) and stimulated (SWS) whole saliva was collected before HCT, early post-HCT, and after 3, 6, 12, and 18 months. The effect of type of transplantation (allogeneic vs autologous) and intensity (full vs reduced) of the conditioning regimen on hyposalivation (UWS < 0.2 mL/min; SWS < 0.7 mL/min) was explored.

Results
A total of 125 HCT recipients were included. More than half of the patients had hyposalivation early post-HCT; a quarter still had hyposalivation after 12 months. The conditioning intensity was a risk indicator in the development of hyposalivation of both UWS (OR: 3.9, 95% CI: 1.6–10.6) and SWS (OR: 8.2, 95% CI: 2.9–24.6). After 3 and 12 months, this effect was not statistically significant anymore.

Conclusions
Hyposalivation affects the majority of patients early post-HCT. The conditioning intensity and the type of transplantation were significant risk indicators in the development of hyposalivation. The number of prescribed medications, total body irradiation as part of the conditioning regimen and oral mucosal graft-versus-host disease did not influence hyposalivation significantly.

Clinical relevance
Because of the high prevalence of hyposalivation, HCT recipients will have an increased risk of oral complications. It might be reasonable to plan additional check-ups in the dental practice and consider additional preventive strategies.
Five-year stroke prognosis. Influence of post-stroke delirium and post-stroke dementia on mortality and disability (Research Study – Part of the PROPOLIS Study)
Authors: Droś Jakub , Segiet Natalia , Początek Gabriela , Klimkowicz-Mrowiec Aleksandra 
Published: October 2023

Abstract
Introduction
With increasing life expectancy and the rising incidence of stroke in young adults, it is important to know the long-term prognosis of this condition. Post-stroke delirium and post-stroke dementia are common complications of stroke that negatively affect prognosis. The purpose of this study was to evaluate five-year mortality from stroke and to assess the influence of post-stroke delirium and post-stroke dementia on mortality and disability over the five-year period.

Methods
Consecutive patients admitted to the stroke unit for acute stroke or transient ischemic attacks were screened for in-hospital delirium. At the three- and twelve-month follow-up, the same patients underwent neurocognitive testing. Diagnoses of in-hospital delirium and dementia after three and twelve months based on DSM-5 criteria. Five years after stroke surviving patients were reevaluated. Outcome assessment included place of stay, current functional status assessed by the modified Rankin Scale (mRS), or death.

Results
At the five-years of follow-up, data were collected from 575 of 750 patients originally included in the study (76.67%). The mortality rate was 51.65%. In-hospital post-stroke delirium and post-stroke dementia diagnosed three and twelve months after stroke were independent risk factors for death and an increase in mRS score of ≥ 1 or ≥ 2 points. There was no significant association with institutionalization rate.

Conclusions
More than half of post-stroke patients die within five years of follow-up. Post-stroke delirium and post-stroke dementia are associated with an increased risk of death and disability.
Integrated maintenance and production scheduling for unrelated parallel machines with setup times
Authors: Geurtsen Michael , Adan Jelle , Akçay Alp 
Published: October 2023

AbstractThis paper considers jointly scheduling the production and resource-constrained maintenance activities in a manufacturing setting with unrelated parallel machines. In particular, a single maintenance activity needs to be scheduled on each machine in one of its available time windows, and the maintenance activities require a scarce resource, thereby limiting the number of maintenance activities that can be scheduled simultaneously on different machines. In addition, machine- and sequence-dependent setup times, machine eligibility constraints and job-specific release and due dates are considered. A mixed-integer linear program is formulated with objectives including the makespan and, motivated from practice, a weighted sum of total production completion times at machines and total job tardiness. Additionally, a hybrid genetic algorithm with a novel solution representation is proposed for solving industry-scale large instances. A case study is performed with real-world data from a semiconductor manufacturer, where production and maintenance are scheduled separately. The benefit of simultaneously scheduling production and maintenance is investigated. Tests with real-world data show that the proposed model results in schedules that substantially improve the current factory practice.