bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple Gestations: Neonatal and Maternal Characteristics
Authors: Budh Hetal , Sinha Anish , Agrawal Avishek , Jain Gunjan 
Published: January 2024

Introduction Multiple gestation neonates are commonly found in older age women along with increasing use of assisted reproductive techniques. They are at an increased risk of complications and also impose financial, emotional, social, and psychological burdens on the family. There is a paucity of studies on multiple gestations in India, hence this study was conducted to evaluate the clinical profile and associated comorbidities in neonates born through multiple gestations which can help in anticipating, preparing, and managing possible complications. Methodology This was a prospective observational study conducted in a Level III neonatal intensive care unit of a tertiary care hospital. All intramural neonates delivered with multiple gestations were included. Data regarding the antenatal, perinatal, and hospital course of the neonates were documented. Results A total of 75 intramural neonates (36 twins and 1 triplet) were enrolled in the study. About 67.6% were delivered via caesarean section and 81.1% were spontaneous conception. The most common maternal complications observed were hyperemesis gravidarum (56.76%) followed by pregnancy-induced hypertension (PIH) (40.54%). About 80% of twin neonates were diamniotic dichorionic (DADC) and 42% of twin neonates had vertex-vertex presentation. Almost 22.7% of neonates required neonatal resuscitation and 98% had a birth weight <2.5 kg. Initiation of breastfeeding was delayed, and longer hospital stay was observed in preterm neonates with birth weight ≤1.5 kg and birth weight discordance. Conclusion Multiple gestations are associated with significant neonatal complications owing to prematurity and low birth weight. Thorough knowledge of these complications helps in better fetal and neonatal surveillance and prevention of adverse outcomes.
The Impact of Breast Crawl on the Effectiveness of Breastfeeding in the First 48 Hours: A Quasi-experimental Study
Authors: Dhanawade Sara Subodh , Chouksey Ruchika , Bhore Gracy 
Published: January 2024

Background Breast crawl is known to be the most natural, spontaneous, and logical method of initiating breastfeeding; however, not practiced routinely in many labor rooms. Objective The study’s primary objective was to examine the effect of breast crawl on breastfeeding in the first 48 hours. Method 60 mother-infant dyads were included. Thirty infants were assigned to either Group 1 (breast crawl) or Group 2 (standard care) using a quasi-experimental design. All babies were observed for 1 hour. A blinded investigator did the LATCH (Latch Audible Swallowing Type of Nipple Comfort Hold) score and IBFAT (Infant Breast Feeding Assessment Tool) score at 24 and 48 hours. Result Out of 30 babies in the breast crawl group, 25 (83.3%) successfully completed breast crawl. 20 (80%) of 25 babies completed breast crawl within 45 minutes, and 5 (20%) completed within 60 minutes. LATCH and IBFAT scores were significantly higher in the breast crawl group than in the standard care group at 24 and 48 hours ( p > .01). Scores were significantly higher after 48 hours compared to 24 hours in both groups ( p > .01). Conclusion Most babies in the study successfully crawled the breast and took their first feed within 60 minutes. The breast crawl group had better LATCH and IBFAT scores, indicating a positive impact in the early postnatal period.
Information Needed, Sources of Information, and Barriers of Acquiring Required Information by Pregnant Women in Southern Sri Lanka
Authors: Weeramuni Naduni Prasadani , Karunanayaka Athapattu Dona Shashika Shayanthi , Perera Bilesha 
Published: January 2024

Background: A correct understanding of pregnancy and related issues would facilitate pregnant women to manage their pregnancies well. The objective of this study was to assess the pregnancy-related information needed by pregnant women in Sri Lanka and the obstacles that they face when acquiring such information. Materials and Methods: A descriptive cross-sectional study was conducted among 420 pregnant women admitted to a teaching hospital in Southern Sri Lanka. Data related to demography, information needed, sources of information seeking, and barriers that they face in acquiring such information were collected using an interviewer-administered questionnaire. Mean scores of the information needed (ranges 0–4) in different areas and a total score of the information needed were calculated. Regression analysis was used to identify possible predictors of information needed by the target group. Results: Family members, visiting obstetrician and gynecologist, antenatal clinical staff, and midwives were the common sources of information for nearly 80% of the participants. Psychological and physical complications after delivery (2.61 ± 1.21), special tests during pregnancy (2.44 ± 1.26), development and growth of the fetus (2.40 ± 1.26), and nutrition during pregnancy (2.36 ± 1.26) were the main areas where accurate and more information was sought by the participants. Failures in making a distinction between correct and incorrect information received ( n = 113 [26.9%]) and poor interactions between healthcare providers and pregnant women ( n = 103 [24.5%]) were the main barriers identified in acquiring trustworthy information. About one-fourth of the participants had used pregnancy-related apps. Information needs were high among pregnant women with less number of children ( β = −0.14, p < .01). Age, income, and area of living (rural or urban) did not significantly predict information needs in this target population. Conclusion: The free maternal and child healthcare system prevailing in the country seems to be the main source of information gathering for pregnant mothers. Physical, psychological, and nutritional facts related to pregnancy and its management should be increased among pregnant mothers, and it is imperative to empower them in the identification of correct information from authenticated sources. Primigravida women need more educational support. Electronic platforms should be effectively used in the future to disseminate information required by pregnant women in the country.
Assessment of Respiratory Functions, Activities of Daily Living, and Quality of Life of the Post-mechanical Ventilated Patients
Authors: Kaur G. , Kaur S. , Dhandapani M. , Yaddanapudi N. 
Published: January 2024

Background: The fundamental goal of mechanical ventilation is to restore and improve respiratory functions and relieve respiratory distress, thus permitting lungs and airways to heal in acute and chronic respiratory failure conditions. Associated post-mechanical ventilation complications may increase the chance of re-intubation, poor quality of life, hospital stay and hospital costs, and so on. Objective: To assess the respiratory functions, activities of daily living, and quality of life of the post-mechanical ventilated patients. Methods: Using a purposive sampling technique, 72 patients after 24 h of weaning from the ventilator were enrolled in the study. Their socio-demographic profile, respiratory functions, activities of daily living, and quality of life were assessed using validated tools. Results: The mean respiratory rate per minute and oxygen saturation were 21.69 ± 4.10 and 93.58 ± 3.73, respectively. A total of 58.9% of the patients had dyspnea, 18.1% had abnormal breathing sound, 22.3% were using accessory muscles during breathing, 20.9% had pain during breathing, and 18.1% had cough with sputum production after extubation. Three fourth of the patients had complete dependency (75%) to perform activities of daily living. More than half (59.8%) of the patients had good quality of life scores as per the SF-36 item scale. Conclusion: There is a need to plan nursing interventions for patients in order to decrease post-mechanical ventilation complications.
Cost-effectiveness and Side Effects of Using Heparin and Enoxaparin as a Treatment for COVID-19-associated Coagulopathy
Authors: Idris Nurul Iska Ulmarika , Purba Abdul Khairul Rizki , Mustika Arifa , Veterini Anna Surgean , Alsagaff Mochamad Yusuf , Qorib Mohammad 
Published: January 2024

Objective: To analyze the cost-effectiveness and side effects of Heparin and Enoxaparin anti-coagulants in patients with COVID-19-associated coagulopathy (CAC). Materials and Methods: This was an observational study with a retrospective design of CAC patients from May 2020 to May 2022 in Surabaya, Indonesia, who received Heparin and Enoxaparin. Effectiveness was comprehensively evaluated as clinical outcomes including mortality, length of stay (LOS), laboratory results, and side effects. Pharmacoeconomic evaluation was analyzed by constructing Decision Tree modeling followed by Cost-Effectiveness Analysis (CEA) considering Quality-Adjusted Life Year (QALY), and Incremental Cost-Effectiveness Ratio (ICER). In addition, probability sensitivity analysis was performed to consider the cost-effective intervention. Results: A number of 274 samples were included from Medical Records and finance reports. Heparin has a higher mortality rate compared to Enoxaparin (13.9% vs. 23.9; p = 0.040), with no difference in the side effects ( p = 0.056). D-Dimer reported a significant change in values after receiving Heparin (2271.01 ± 4595.50 ng/mL) and Enoxaparin (2140.95 ± 5681.98 ng/mL), p = 0.019. Enoxaparin was more cost-effective in pharmacoeconomic analysis, with a US$130.58/QALY ACER value, while Heparin was US$138.67/QALY. Conclusion: Enoxaparin therapy has better effectiveness, while side effects and costs are similar to Heparin. However, Enoxaparin is far more cost-effective to use against CAC conditions than Heparin.
Caring for Patients Requiring Venous Arterial Extracorporeal Membrane Oxygenation: Can Upstream Palliative Care Make a Difference?
Authors: Stevens Katie , Anandan Samuel R. , Rahman Husneara , Parikh Sima , Leung An Gao , Benintendi Andrea , Van Ogtrop Katlynn M. , Stancavage Alyssa , Magalee Christopher J. , Manetta Frank , Saikus Christina , Lopez Santiago 
Published: January 2024

Objective Palliative care consultation is relevant for patients requiring Venous-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO); however, evidence is limited to support its value. For this population, we compared length of stay (LOS) (primary outcome), operational metrics and goals of care (GOC) frequency before and after a collaboration between cardiothoracic (CT) surgery and Geriatrics and Palliative Medicine (GaP). Methods Retrospective chart review of patients (18+) admitted to a quaternary center that required VA-ECMO between 2019-2021 and received GaP consultation. Demographics, LOS, times to consult, illness severity, GOC, and outcomes were analyzed. Results 120 patients met inclusion criteria and 64 (53.3%) had GaP consultation. No differences were observed regarding demographics and insertion status (emergent vs elective). Median (IQR) days to GaP consult for 2019, 2020 and 2021 were 6.5 (4.0-14.5), 5.0 (2.0-11.0) and 3.0 (2.0-5.0), respectively ( P = .006). Median days from insertion to consult for 2019, 2020 and 2021 were 6.0 (4.0-20.0), 3.0 (1.0-6.0) and 2.0 (1.0-4.0) ( P = .003). Among survivors, over the 3-year course, median LOS was not statistically different. Between expired patients, median (IQR) LOS for 2019, 2020, and 2021 was 28.5 (23.0-40.0), 12.0 (8.0-14.0), 11.0 (5.0-17.0) days ( P = .013). For patients not seen by GaP, 8 (14.3%) GOC notes were documented, compared with 42 (65.6%) for patients seen. Mortality was similar (53.6% vs 53.1% [GaP]). Conclusion For patient on VA-ECMO, early GaP consultation may improve hospital LOS and GOC rates. We suggest organizations consider early palliative integration when instituting mechanical circulatory support.
Correlation analysis of EGFR gene mutation abundance and the efficacy of targeted therapy with osimertinib in nonsmall cell lung cancer—a case control study
Authors: Yan Haiqiang , Peng Jigui , Zhou Wang , Chen Hui , He Changjin 
Published: January 2024

Background In nonsmall cell lung cancer (NSCLC), epidermal growth factor receptor (EGFR) mutation is the primary cancer-causing mutation. But whether the practical effectiveness of EGFR tyrosine kinase inhibitors (TKIs) can be influenced by plasma EGFR mutation abundance when treating patients with advanced NSCLC remains unanswered. Therefore, this research was intended to reveal the connection between plasma EGFR mutation abundance and clinical outcomes in osimertinib-treated patients with advanced NSCLC. Methods A total of 120 patients with advanced NSCLC were retrospectively analyzed, and 56 patients with EGFR-mutation-positive NSCLC receiving osimertinib first-line therapy were eventually screened and included. The baseline status and abundance of plasma EGFR in patients with NSCLC were detected by cSMART, and the ratio of 0.1 was the critical value. Imaging examinations were performed every 8–12 weeks for the assessment of tumor response. The relationship between baseline EGFR mutation abundance and clinical outcomes of TKI therapy was analyzed. Results The objective response rates (ORR) of EGFR-mutant patients in the high-/low-abundance groups were 69.2% and 40.0%, respectively. The high abundance group had an obviously higher ORR than the low abundance group ( P = 0.029). A much longer median progression-free survival (mPFS) was demonstrated in patients with high mutation abundance than in patients with low abundance (11.2 months vs 7.1 months, P = 0.0133). As for the median overall survival (mOS), it showed the same trend as mPFS in patients from different groups (15.5 vs 10.7 months, P = 0.0028). The role of plasma mutation abundance as an independent prognostic factor for both PFS (hazard ratios [HR]: 0.30, P = 0.006) and OS (HR: 0.35, P = 0.004) was demonstrated by multivariate Cox regression analysis. Conclusion There is a close connection between plasma EGFR mutation abundance and survival benefit in patients with NSCLC, which can be used for predicting the efficacy of EGFR-TKI targeted therapy. Our study is expected to provide a research basis for screening patients to whom the EGFR-TKI therapy is beneficial.
An Objective Assessment of Effect of Stimulants on Attention in Individuals With ADHD
Authors: Elliott Glen R. , Diner Adi , Sitbon Einat 
Published: January 2024

Introduction: Currently, assessing ADHD treatment response to stimulants relies on rating scales and subjective questionnaires and sometimes a CPT. Such tools fall short of objective, quantifiable measurement of effect, especially in natural settings and can result in inconsistent treatment. Method: We report results from two studies using a novel proof-of-concept approach. A preliminary trial of 10 individuals used a high-fidelity eye tracker; a second study of 100 individuals used webcams at the participants’ homes. Results: Both studies evaluated stimulant effect using reading behavior analysis, being an ADHD symptom that stimulants affect and a major symptom patients want to improve. Both showed a significant change in reading behavior related to medication state, suggesting a clear, objective measure of stimulant effect. Conclusion: Using ubiquitous hardware, investigators created a user-friendly treatment assessment platform where individuals can collect their own objective data within minutes in any setting where they have access to a web camera and computer.
Women and Treatment for Opioid Use Disorder: Contributors to Treatment Success From the Perspectives of Women in Recovery, Women With Past Attempts in Drug Treatment, and Health and Criminal Justice Professionals
Authors: Skogseth Emma M , Brant Kristina , Harrison Eric , Apsley Hannah B , Crowley Max , Schwartz Robert P , Jones Abenaa A 
Published: January 2024

Introduction: The disproportionate incidence of opioid use disorder (OUD) and the alarming increases in opioid-related overdose deaths among women highlight a clear need for the expansion of effective harm reduction and treatment practices. Research supports medications for opioid use disorders (MOUD) as an effective intervention; however, with low rates of utilization of such, there is a need to identify factors that facilitate MOUD treatment uptake and retention for women. Thus, the current study examines contributors to treatment success through the triangulation of perspectives from affected women as well as health and criminal justice professionals. Methods: Interviews (N = 42) were conducted from May to July 2022 with women in recovery who previously used or currently use MOUD (N = 10), women who currently use opioids who terminated a MOUD program previously (N = 10), SUD treatment professionals (N = 12), and criminal justice professionals who work with women who use opioids (N = 10). Interviews for all participants centered around their backgrounds, perceived barriers and facilitators to MOUD treatment, and issues specific to women in treatment for substance use disorder. We used a thematic qualitative data analysis process to analyze transcripts. Results: Participants highlighted contributors to treatment success from 3 domains: (1) internal processes (including promoting self-efficacy and setting realistic goals), (2) access to resources (including material resources, such as food and shelter, educational resources and social support), and (3) treatment structure (such as treatment type and protocol). Conclusion: Internal processes, access to resources, and treatment structure contribute to MOUD treatment success for women with OUD. Structured support where experiences are shared, and realistic goals are set, may promote feelings of acceptance and empowerment, thereby bolstering chances of treatment success. Additionally, the court system can promote evidence-based and trauma-informed substance use treatment and provide accessible educational resources related to substance use to extend these benefits to more women.
Opioid Overdose Hospitalizations During COVID-19: The Experience of Pennsylvania
Authors: Shen Chan , Thornton James Douglas , Li Ning , Zhou Shouhao , Wang Li , Leslie Douglas L. , Kawasaki Sarah S. 
Published: January 2024

Objective: The COVID-19 pandemic placed extreme burden on hospitals, while opioid overdose is another challenging public health issue. This study aimed to examine the trends and outcomes of opioid overdose hospitalizations in Pennsylvania during 2018 to 2021. Design: We identified opioid overdose hospitalizations in the state of Pennsylvania using the state-wide hospital discharge database (PHC4) 2018 to 2021. We examined the number of opioid overdose hospitalizations, the corresponding mortality and discharges against medical advice comparing the pre-COVID period (2018-2019) and the COVID period (2020-2021). We also assessed what patient and hospital characteristics were associated with in-hospital death or leaving against medical advice. Results: A total of 13 446 opioid-related hospitalizations were identified in 2018 to 2021. Compared to pre-pandemic, a higher percentage of cases involving synthetics (17.0%vs 10.3%, P < .0001) were observed during COVID. After controlling for covariates, there was no significant difference in opioid overdose in-hospital deaths in the years 2020 to 2021 compared to 2018 to 2019 (OR = 0.846, 95% CI: 0.71-1.01, P = .065). The COVID period was significantly associated with more leaving against medical advice compared to years 2018 to 2019 (OR = 1.265, 95% CI: 1.11-1.44, P = .0003). Compared to commercial insurance, Medicaid insurance was associated with higher odds of both in-hospital death (OR = 1.383, 95% CI: 1.06-1.81, P = .0176) and leaving against medical advice (OR = 1.903, 95% CI: 1.56-2.33, P < .0001). Conclusion: There were no substantial changes in the number of overall opioid overdose cases and deaths at hospitals following the outbreak of COVID-19 in Pennsylvania. This observation suggests that an increased number of patients may have succumbed to overdoses outside of hospital settings, possibly due to a higher severity of overdoses. Further, we found that patients were more likely to leave against medical advice during the COVID-19 pandemic.
Hierarchical Bayesian modeling of heterogeneous outcome variance in cluster randomized trials
Authors: Tong Guangyu , Tong Jiaqi , Jiang Yi , Esserman Denise , Harhay Michael O , Warren Joshua L 
Published: January 2024

Background: Heterogeneous outcome correlations across treatment arms and clusters have been increasingly acknowledged in cluster randomized trials with binary endpoints, where analytical methods have been developed to study such heterogeneity. However, cluster-specific outcome variances and correlations have yet to be studied for cluster randomized trials with continuous outcomes. Methods: This article proposes models fitted in the Bayesian setting with hierarchical variance structure to quantify heterogeneous variances across clusters and explain it with cluster-level covariates when the outcome is continuous. The models can also be extended to analyzing heterogeneous variances in individually randomized group treatment trials, with arm-specific cluster-level covariates, or in partially nested designs. Simulation studies are carried out to validate the performance of the newly introduced models across different settings. Results: Simulations showed that overall the newly introduced models have good performance, reporting low bias and approximately 95% coverage for the intraclass correlation coefficients and regression parameters in the variance model. When variances are heterogeneous, our proposed models had improved model fit over models with homogeneous variances. When used to analyze data from the Kerala Diabetes Prevention Program study, our models identified heterogeneous variances and intraclass correlation coefficients across clusters and examined cluster-level characteristics associated with such heterogeneity. Conclusion: We proposed new hierarchical Bayesian variance models to accommodate cluster-specific variances in cluster randomized trials. The newly developed methods inform the understanding of how an intervention strategy is implemented and disseminated differently across clusters and can help improve future trial design.