bluuebunny/crossref_metadata_2025_split huggingface dataset:
Boosting weight loss after conversional Roux-en-Y Gastric Bypass with liraglutide and placebo use. A double-blind-randomized controlled trial
Authors: Hany Mohamed , Torensma Bart , Ibrahim Mohamed , Zidan Ahmed , Agayby Ann S.S. , Abdelkhalek Mohamed H. , El Sayed Iman 
Published: December 2023

Background:
Conversional bariatric surgery inherently has less weight loss (WL) compared to primary procedures. Adjunctive use of the GLP-1 analog, liraglutide with conversional Roux-en-Y Gastric Bypass (cRYGB) may maximize the WL benefits of surgery.

Material and methods:
This single-center randomized double-blind placebo-controlled trial included 80 patients randomized into two groups; the liraglutide group (40 patients) who received daily injections of liraglutide, and the placebo group (40 patients) who received normal saline starting at 6 weeks from cRYGB and continued for 6 months. After discontinuing the drugs at 6 months and unblinding, the patient were followed up to 12 months. The endpoints were percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL), and changes in the metabolic biomarkers, and complications within 30 and 90 days according to the global outcome benchmark (GOB) stratification.

Results:
In total, 38 patients in the liraglutide group and 31 in the placebo group completed the 24 weeks. Liraglutide group experienced better WL with a significantly higher mean %TWL at 1 month (10.27±1.39 vs. 8.41±2.08), at 6 weeks (12.65±1.77 vs. 10.47±2.23), at 6 months (18.29 ±1.74 vs. 15.58 ±1.65), and at 12 months 24.15±2.35 versus 22.70±2.13 (all P<0.001). For %EWL, this was also significantly higher in the liraglutide group at all time points. A %TWL of greater than 20% at 6 months of treatment was recorded in six (15.8%) patients in the liraglutide group and none in the placebo group (P=0.029). Both groups had comparable changes in metabolic biomarkers. Adverse events were recorded in 11 (27.5%) patients in the liraglutide, with no adverse events in the placebo group (P<0.001). Both groups had Clavien–Dindo scores I and II (5.0 and 2.5%), and GOB values indicated that 90.0 and 97.5% were low-risk patients.

Conclusion:
Adjunctive use of liraglutide with cRYGB gives significantly higher WL and resolution of associated medical problems.
Comparative efficacy and safety of Faricimab and other anti-VEGF therapy for age-related macular degeneration and diabetic macular edema: A systematic review and meta-analysis of randomized clinical trials
Authors: Li Guoxian , Zhu Ning , Ji Aimin 
Published: December 2023

Introduction:
A systematic review and meta-analysis were conducted to evaluate the efficacy and the overall safety of Faricimab compared with other anti-vascular endothelial growth factors (VEGF) therapy for neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME).

Materials and methods:
A systematic literature search of a comprehensive electronic database was performed to identify randomized clinical trials published from January 2013 to January 2023 for Faricimab in AMD and DME. Weighted mean differences and risk ratios were used to integrate the different studies.

Results:
A total of 4 randomized controlled trials (RCTs) with 1678 AMD patients and 3 RCTs with 20 DME patients were included in the meta-analysis.
In patients with AMD, a significant difference was found in the number of injections between Faricimab and other anti-VEGF therapy (MD = −2.42, 95% CI [−3.93 to −0.90], P = .002).No significant difference was found for the change in best corrected visual acuity (BVCA), central subfoveal thickness (CST), and gaining 15 or more letters. Similarly, no significant difference was found for adverse events.
In patients with DME, a significant difference was observed for CST (MD = −22.41, 95% CI [−29.95 to −14.86], P < .00001) and the number of injections(MD = −0.93, 95% CI [−1.33 to −0.54], P < .00001). No significant difference was found for BVCA and gaining 15 or more letters, and no significant difference was found for adverse events.

Conclusions:
Comprehensive evidence confirms that Faricimab achieves non-inferior or even better CST improvement than other anti-VEGF therapies with extended dosing intervals, but more long-term follow-up studies are needed to support our conclusions.
Comparative effectiveness of intra-articular therapies in knee osteoarthritis: a meta-analysis comparing platelet-rich plasma (PRP) with other treatment modalities
Authors: Khalid Saad , Ali Abraish , Deepak FNU , Zulfiqar Muhammad Sibtain , Malik Laiba Urooj , Fouzan Zubaida , Nasr Rabiya Ali , Qamar Maryam , Bhattarai Pratik 
Published: December 2023

Introduction:
Knee osteoarthritis (KOA) is a progressive joint disease commonly treated with intra-articular injections, including platelet-rich plasma (PRP), hyaluronic acid (HA), or corticosteroids (CS). This updated meta-analysis aims to enhance the statistical power of the results and provide comprehensive clinical evidence that reflects the most current research. By doing so, the authors aim to suggest a reliable estimate for the development of guidelines, addressing the pressing need for effective and minimally invasive treatment options.

Methods:
PubMed, Scopus, clinicaltrials.gov, Cochrane Central were searched until March 2023, for randomized controlled trials (RCTs) comparing the effectiveness of intra-articular injectable therapies, including PRP, HA, CS, and placebo, in KOA. Data extraction involved baseline characteristics and outcome measures [Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, Visual Analog Scale (VAS) pain scores, KOOS, and IKDC scores] at 1, 3, 6 and 12 months. Statistical analysis, including subgroup analysis, assessment of heterogeneity, and publication bias, was conducted using Review Manager.

Results:
Our meta-analysis of 42 studies involving 3696 patients demonstrated that PRP treatment resulted in significant pain relief compared to HA injections, as evidenced by improved WOMAC pain (MD: −0.74; 95% CI: −1.02 to −0.46; P≤0.00001; I
2=94%) and VAS pain (MD: −0.65; 95% CI: −1.24 to −0.06; P=0.03; I2=97%) outcomes. Similarly, PRP showed greater efficacy in reducing WOMAC pain (MD: −8.06; 95% CI: −13.62 to −2.51: P=0.004; I
2=96%) and VAS pain (MD: −1.11; 95% CI: −1.64 to −0.59; P≤0.0001; I
2=68%) compared to CS injections, with the most significant improvement observed at 6 months.

Conclusions:
PRP is an effective treatment for KOA. It provides symptomatic relief, has the potential to reduce disease progression, and has sustained effects up to 12 months. PRP offers superior pain relief and functional enhancement compared to CS and HA injections.
Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
Authors: Teede Helena J. , Tay Chau Thien , Laven Joop , Dokras Anuja , Moran Lisa J. , Piltonen Terhi T. , Costello Michael F. , Boivin Jacky , Redman Leanne M. , Boyle Jacqueline A. , Norman Robert J. , Mousa Aya , Joham Anju E. ,   on behalf of the International PCOS Network
Published: December 2023

(Abstracted from Hum Reprod 2023;38(9):1655–1679)
Polycystic ovary syndrome (PCOS) has a prevalence of 10% to 13%, making it the most common endocrinopathy affecting reproductive-aged women. The etiology of PCOS is complex, and its presentation is heterogeneous with reproductive, metabolic, and psychological features.
Clinical presentations and treatment outcomes of Mycoplasma genitalium infections at a large New York City healthcare system
Authors: Mullis Caroline E. , Marlow Kerry A. , Maity Aloke , Fazzari Melissa , Zingman Barry S. , Keller Marla J. , Meyerowitz Eric A. 
Published: December 2023

Abstract

Background

Mycoplasma genitalium (MG) is an emerging sexually transmitted infection. Treatment of MG is complicated by increasing resistance to primary treatment regimens, including macrolides and fluoroquinolones. Understanding the various clinical presentations and relative effectiveness of treatments for MG is crucial to optimizing care.

Methods
Patients with a positive MG Nucleic Acid Amplification Test (NAAT) between July 1, 2019 and June 30, 2021 at a large health system in New York City were included in a retrospective cohort. Demographics, clinical presentations, coinfections, treatment, and follow-up microbiologic tests were obtained from the electronic medical record. Associations with microbiologic cure were evaluated in bivariate and multivariable logistic regression models.

Results
Five-hundred and two unique patients had a positive MG NAAT during the study period. Males presented predominantly with urethritis (117/187, 63%) and females with vaginal symptoms (142/315, 45%). Among patients with follow-up testing who received a single antibiotic at the time of treatment, 43% (90/210) had persistent infection and 57% (120/210) had microbiologic cure. Eighty-two percent of patients treated with moxifloxacin had microbiologic cure compared to 41% of patients receiving azithromycin regimens (p < 0.001). In multivariable analysis, treatment with moxifloxacin was associated with four times the odds of microbiologic cure relative to low-dose azithromycin (aOR 4.18, 95% CI 1.73-10.13, p < 0.01).

Conclusions
Clinical presentations of MG vary, with urethritis or vaginal symptoms in most cases. Among patients who received a single antibiotic, only treatment with moxifloxacin was significantly associated with microbiologic cure relative to low-dose azithromycin.
Association of Medicaid Expansion with Reduction in Racial Disparities in the Timely Delivery of up-front Surgical Care for Patients with Early-Stage Breast Cancer
Authors: Tamirisa Nina , Lei Xiudong , Malinowski Catalina , Li Meng , Bedrosian Isabelle , Chavez-MacGregor Mariana 
Published: December 2023

Objective:We evaluated the association between Medicaid expansion and time to surgery among patients with early-stage breast cancer (BC)Summary Background Data:Delays in surgery are associated to adverse outcomes. It is known that underrepresented minorities are more likely to experience treatment delays. Understanding the impact of Medicaid expansion on reducing racial and ethnic disparities in healthcare delivery is critical.Methods:This was a population-based study including women ages 40-64 with stage I-II BC who underwent upfront surgery identified in the National Cancer Database (2010-2017) residing in states that expanded Medicaid on January 1, 2014. Difference-in-difference (DID) analysis compared rates of delayed surgery (>90 d from pathological diagnosis) according to time period (pre-expansion [2010-2013] and post-expansion [2014-2017]) and race/ethnicity (White vs. racial and ethnic minority), stratified by insurance type (private vs. Medicaid/uninsured). Secondary analyses included logistic and Cox proportional hazards regression. All analyses were conducted among a cohort of patients in the non-expansion states as a falsification analysis. Finally, a triple-differences approach compared pre-expansion with the post-expansion trend between expansion and non-expansion states.Results:Among Medicaid expansion states, 104,569 patients were included (50,048 pre- and 54,521 post-expansion). In the Medicaid/uninsured subgroup, Medicaid expansion was associated with a −1.8% point (95% CI -3.5% to −0.1,P=0.04) reduction of racial disparity in delayed surgery. Cox regression models demonstrated similar findings (adjusted DID hazard ratio 1.12 [95% CI 1.05-1.21]). The falsification analysis showed significant racial disparity reduction among expansion states but not among non-expansion states, resulting in a triple-difference estimate of −2.5% points (95% CI −4.9% to -0.1%,P=0.04) in this subgroup.Conclusions:As continued efforts are being made to increase access to healthcare, our study demonstrates a positive association between Medicaid expansion and a reduction in the delivery of upfront surgical care, reducing racial disparities among patients with early-stage BC.
Protect or prevent? A practicable framework for the dilemmas of COVID-19 vaccine prioritization
Authors: Arghal Raghu , Rubin Harvey , Bidokhti Shirin Saeedi , Sarkar Saswati 
Published: December 2023

1AbstractDetermining COVID-19 vaccination strategies presents many challenges in light of limited vaccination capacity and the heterogeneity of affected communities. Who should be prioritized for early vaccination when different groups manifest different levels of risks and contact rates? Answering such questions often becomes computationally intractable given that network size can exceed millions. We obtain a framework to compute the optimal vaccination strategy within seconds to minutes from among all strategies, including highly dynamic ones that adjust vaccine allocation as often as required, and even with modest computation resources. We then determine the optimal strategy for a large range of parameter values representative of various US states, countries, and case studies including retirement homes and prisons. The optimal is almost always one of a few candidate strategies, and, even when not, the suboptimality of the best among these candidates is minimal. Further, we find that many commonly deployed vaccination strategies, such as vaccinating the high risk group first, or administering second doses without delay, can often incur higher death rates, hospitalizations, and symptomatic counts. Our framework can be easily adapted to future variants or pandemics through appropriate choice of the compartments of the disease and parameters.
A Clinical Audit on Longer-Term Stroke Management as A Specific Service in A Primary Care Setting: Assessing Adherence of Service and Clinical Parameters
Authors: Mostapha Gadaffi , Aziz Noor Azah Abd , Ali Mohd Fairuz 
Published: December 2023

AbstractBackgroundPrimary-care long-term stroke care service offers comprehensive management at the community level. A clinical audit was carried out to assess the services of this clinic as compared to the established standardized criteria for longer-term stroke care.MethodsA retrospective audit was performed to evaluate the adherence to service parameters based on eleven criteria adapted from the Canadian Post-Stroke Checklist. The following clinical parameters were audited using the Malaysian CPG on Cardiovascular Disease 2017 and Malaysian CPG on Ischemic Stroke 2020: systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), HbA1c, and weight, and smoking status. 113 registered patients from the 2022 clinic census were audited using paired Student’st-test and McNemar’s test.ResultsOverall, only 2 out of 11 criteria for service parameters did not meet the standard: inquiring about patient fatigue (43.4%) and access to community resources (26.5%). The attainment of the target for BP and HbA1c meets the standards set for this audit. Patients experienced reduced SBP, DBP, LDL-C, and HbA1c levels, and a statistically significant reduction was observed in DBP (4.15 mmHg, p<0.05) and LDL-C (0.30 mmol/L, p<0.05). A notable reduction in the percentage of smokers (p<0.05) was also seen.ConclusionsPost-stroke patients at a specific-service clinic within the primary care setting benefited from clinicians’ high adherence to clinical guidelines, observed from improved clinical parameters. These may serve as an impetus for clinicians to include long-term stroke service as a specialized service within primary care specialties.
Augmentation of ChatGPT with Clinician-Informed Tools Improves Performance on Medical Calculation Tasks
Authors: Goodell Alex J , Chu Simon N , Rouholiman Dara , Chu Larry F 
Published: December 2023

AbstractPrior work has shown that large language models (LLMs) have the ability to answer expert-level multiple choice questions in medicine, but are limited by both their tendency to hallucinate knowledge and their inherent inadequacy in performing basic mathematical operations. Unsurprisingly, early evidence suggests that LLMs perform poorly when asked to execute common clinical calculations. Recently, it has been demonstrated that LLMs have the capability of interacting with external programs and tools, presenting a possible remedy for this limitation. In this study, we explore the ability of ChatGPT (GPT-4, November 2023) to perform medical calculations, evaluating its performance across 48 diverse clinical calculation tasks. Our findings indicate that ChatGPT is an unreliable clinical calculator, delivering inaccurate responses in one-third of trials (n=212). To address this, we developed an open-source clinical calculation API (openmedcalc.org), which we then integrated with ChatGPT. We subsequently evaluated the performance of this augmented model by comparing it against standard ChatGPT using 75 clinical vignettes in three common clinical calculation tasks: Caprini VTE Risk, Wells DVT Criteria, and MELD-Na. The augmented model demonstrated a marked improvement in accuracy over unimproved ChatGPT. Our findings suggest that integration of machine-usable, clinician-informed tools can help alleviate the reliability limitations observed in medical LLMs.
Compliance to food safety standards - Determining the barriers within the hotel industry
Authors: Segbedzi Cynthia Esinam , Ansah Edward Wilson , Apaak Daniel 
Published: December 2023

AbstractThe safety of food served to customers is obligatory for all food service establishments for public health effects. However, workplace barriers have led to noncompliance with safety standards resulting in food contamination and outbreak of foodborne diseases. This study assessed the compliance of restaurant facilities to standards by the Food and Drugs Authority’s (FDA) code of standards, awareness and training on the code and the workplace barriers to compliance. The study involved 233 respondents, 205 food handlers, 10 managers, and 18 officers from the regulatory authorities, who were at work after the COVID-19 restrictions. Questionnaire was used to obtain data from the food handlers and face-to-face interview for managers/chefs and officers from the regulatory authorities. Data was analysed using frequencies and percentages, and thematic content analysis. Results revealed that majority of the hotels did not comply with the FDA’s code of standards on the provision of facilities. However, in segregating the items individually, 70% of the hotels had high compliance with the provision of proper storage facilities for raw and cooked food, 81.5% of the food handlers had in-service training, but this was not routine. Most of the food handlers were aware of the FDA’s code on hygiene for food service establishments, but only a few were trained on it. The food handlers reported unconducive working environment, poor monitoring and supervision, inadequate supply of equipment, time pressure and workplace policy as barriers to compliance with food safety standards. We recommend that hotel owners/managers should be adequately trained to provide the required training and supervision for food handlers, provide the needed tools/equipment to enhance work flow and safe food to consumers. Also, regulatory authorities are encouraged to conduct regular and effective monitoring/supervision to ensure adherence to standards, to improve the safety of food served to the public.
Uptake and safety of pneumococcal vaccination in adults with immune mediated inflammatory diseases: a nationwide observational study using data from the Clinical Practice Research Datalink (Gold) in the UK
Authors: Nakafero Georgina , Grainge Matthew J. , Card Tim , Christian D. Mallen , Nguyen Van-Tam Jonathan S. , Abhishek Abhishek 
Published: December 2023

AbstractIntroductionThe uptake and safety of pneumococcal vaccination in people with immune mediated inflammatory diseases (IMIDs) is poorly understood. We investigated the UK wide pneumococcal vaccine uptake in adults with IMIDs and explored the association between vaccination and IMID flare.MethodsAdults with IMIDs diagnosed on or before 01/09/2018, prescribed steroid-sparing drugs within the last 12 months and contributing data to the Clinical Practice Research Datalink Gold were included. Vaccine uptake was assessed using a cross-sectional study design. Self-controlled case series (SCCS) analysis investigated the association between pneumococcal vaccination and IMID flare. The SCCS observation period was up-to six-month before and after pneumococcal vaccination. This was partitioned into 14-day pre-vaccination, 90-days post-vaccination exposed, and the remaining unexposed period.ResultsWe included 32,277 patients, 14,151 with RA, 13,631 with IBD, 3,804 with axial spondyloarthritis and 691 with SLE. Overall, 50% of patients were vaccinated against pneumococcus. Vaccine uptake was lower in those younger than 45 years (30%), with IBD (38%), and without additional indication(s) for vaccination (43%). In the vaccine-safety study, data for 1001, 854, 424 vaccinated patients with primary-care consultations for joint pain, AIRD flare and IBD flare respectively were included. Vaccination against pneumococcal pneumonia was not associated with primary-care consultations for joint pain, AIRD flare and IBD flare in the exposed period with incidence rate ratios (95% Confidence Interval) 0.95 (0.83-1.10), 1.07 (0.93-1.22), and 0.82 (0.64-1.06) respectively.ConclusionUptake of pneumococcal vaccination in UK patients with IMIDs was suboptimal. Vaccination against pneumococcal disease was not associated with disease flare.
Equitable Artificial Intelligence for Glaucoma Screening with Fair Identity Normalization
Authors: Shi Min , Luo Yan , Tian Yu , Shen Lucy , Elze Tobias , Zebardast Nazlee , Eslami Mohammad , Kazeminasab Saber , Boland Michael V. , Friedman David S. , Pasquale Louis R. , Wang Mengyu 
Published: December 2023

AbstractObjectiveTo develop an equitable artificial intelligence model for glaucoma screening.DesignCross-sectional study.Participants7,418 optical coherence tomography (OCT) paired with reliable visual field (VF) measurements of 7,418 patients from the Massachusetts Eye and Ear Glaucoma Service between 2021 and 2023.MethodsWe developed fair identify normalization (FIN) module to equalize the feature importance across different identity groups to improve model performance equity. EfficientNet served as the backbone model to demonstrate the effect of FIN on model equity. The OCT-derived retinal nerve fiber layer thickness (RNFLT) maps and corresponding three-dimensional (3D) OCT B-scans were used as model inputs, and a reliable VF tested within 30 days of an OCT scan was used to categorize patients into glaucoma (VF mean deviation < -3 dB, abnormal glaucoma hemifield test (GHT) and pattern standard deviation (PSD) < 5%) or non-glaucoma (VF mean deviation ≥ -1 dB and normal GHT and PSD results). The area under the receiver operating characteristic curve (AUC) was used to measure the model performance. To account for the tradeoff between overall AUC and group disparity, we proposed a new metric called equity-scaled AUC (ES-AUC) to compare model performance equity. We used 70% and 30% of the data for training and testing, respectively.Main Outcome MeasuresThe glaucoma screening AUC in different identity groups and corresponding ES-AUC.ResultsUsing RNFLT maps with FIN for racial groups, the overall AUC and ES-AUC increased from 0.82 to 0.85 and 0.76 to 0.81, respectively, with the AUC for Blacks increasing from 0.77 to 0.81. With FIN for ethnic groups, the overall AUC and ES-AUC increased from 0.82 to 0.84 and 0.77 to 0.80, respectively, with the AUC for Hispanics increasing from 0.75 to 0.79. With FIN for gender groups, the overall AUC and ES-AUC increased from 0.82 to 0.84 and 0.80 to 0.82, respectively, with an AUC improvement of 0.02 for both females and males. Similar improvements in equity were seen using 3D OCT B scans. All differences regarding overall-and ES-AUCs were statistically significant (p < 0.05).ConclusionsOur deep learning enhances screening accuracy for underrepresented groups and promotes identity equity.