bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poor haemorrhagic stroke outcomes during the COVID-19 pandemic are driven by socioeconomic disparities: analysis of nationally representative data
Authors: Bako Abdulaziz T , Potter Thomas , Pan Alan P , Borei Karim A , Prince Taya , Britz Gavin W , Vahidy Farhaan S 
Published: January 2024

BackgroundNationally representative studies evaluating the impact of the COVID-19 pandemic on haemorrhagic stroke outcomes are lacking.MethodsIn this pooled cross-sectional analysis, we identified adults (≥18 years) with primary intracerebral haemorrhage (ICH) or subarachnoid haemorrhage (SAH) from the National Inpatient Sample (2016–2020). We evaluated differences in rates of in-hospital outcomes between the prepandemic (January 2016–February 2020) and pandemic (March–December 2020) periods using segmented logistic regression models. We used multivariable logistic regression to evaluate differences in mortality between patients admitted from April to December 2020, with and without COVID-19, and those admitted from April to December 2019. Stratified analyses were conducted among patients residing in low-income and high-income zip codes, as well as among patients with extreme loss of function (E-LoF) and those with minor to major loss of function (MM-LoF).ResultsOverall, 309 965 patients with ICH (47% female, 56% low income) and 112 210 patients with SAH (62% female, 55% low income) were analysed. Prepandemic, ICH mortality decreased by ~1% per month (adjusted OR, 95% CI: 0.99 (0.99 to 1.00); p<0.001). However, during the pandemic, the overall ICH mortality rate increased, relative to prepandemic, by ~2% per month (1.02 (1.00 to 1.04), p<0.05) and ~4% per month (1.04 (1.01 to 1.07), p<0.001) among low-income patients. There was no significant change in trend among high-income patients with ICH (1.00 (0.97 to 1.03)). Patients with comorbid COVID-19 in 2020 had higher odds of mortality (versus 2019 cohort) only among patients with MM-LoF (ICH, 2.15 (1.12 to 4.16), and SAH, 5.77 (1.57 to 21.17)), but not among patients with E-LoF.ConclusionSustained efforts are needed to address socioeconomic disparities in healthcare access, quality and outcomes during public health emergencies.
Attitude toward career development in Japanese medical students: a questionnaire survey
Authors: Komasawa Nobuyasu , Yokohira Masanao 
Published: January 2024

ObjectivesThe study aimed to evaluate attitudes of Japanese medical students toward career development, including the acquisition of medical specialty and doctorate degree qualifications.DesignThis involved a web-based questionnaire survey.SettingWe asked medical students about attitudes toward career development after graduation. We also asked them about their intentions to acquire a medical specialty and a doctorate degree using a 5-point Likert scale.ParticipantsAll 699 medical students (from first to sixth grade) in our medical school.ResultsThe overall questionnaire response rate was 66.5% (465 of 699). Over 90.3% (420 of 465) of respondents desired the clinical discipline, while only 10 of 465 respondents (2.2%) did for basic research. Awareness of career development for ≥8 years after graduation was significantly lower compared with that for 1–2 years after graduation among fourth–sixth year students (fourth p=0.0023, fifth p<0.001, sixth p<0.001). Awareness of career development for 3–7 years after graduation was significantly lower compared with that for 1–2 years after graduation among third–sixth year students (third p<0.001, fourth p=0.003, fifth p<0.001, sixth p<0.001). In the sixth year medical students, only 10.3% showed strong awareness of career development for ≥8 years after graduation, while 39.7% of them did for 1–2 years after graduation. Intentions to acquire a doctorate degree were significantly weaker than those for a medical specialty in all years (p<0.001 in all grades).ConclusionMost Japanese medical students concentrated on the 2-year initial training period immediately after graduation, with vague plans for the subsequent years. Intentions to acquire a doctoral degree were significantly lower than those for a medical specialty. Our findings underscore the necessity for a comprehensive, longitudinal and systematic career development programme.
Caregivers with limited language proficiency and their satisfaction with paediatric emergency care related to the use of professional interpreters: a mixed methods study
Authors: Gmünder Myriam , Gessler Noemi , Buser Sina , Feuz Ursula , Fayyaz Jabeen , Jachmann Anne , Keitel Kristina , Brandenberger Julia 
Published: January 2024

ObjectivesCommunication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy.DesignA mixed-methods study.SettingPaediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland.Participants and methodsCaregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted.ResultsThe study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy.ConclusionThe use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well—positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety.
Adherence Monitoring Package (AMoPac) in patients suspected of non-response to antihypertensive treatment: perceived usefulness by general practitioners
Authors: Dietrich Fine , Zeller Andreas , Hersberger Kurt E , Arnet Isabelle 
Published: January 2024

BackgroundNon-adherence to antihypertensive agents is common, mainly because of the low perceived burden of high blood pressure. General practitioners (GPs) are unable to predict whether patients are adhering to a recommended treatment. Knowledge about adherence might be of clinical interest in patients non-responding to antihypertensive treatment.AimTo assess the usefulness of an Adherence Monitoring Package (AMoPac) to identify non-adherence in patients non-responding to antihypertensive treatment.MethodsAMoPac consists of (1) 4 weeks of electronic adherence monitoring, (2) pharmacist’s feedback on patient’s intake behaviour and (3) adherence metrics including clinical-pharmaceutical recommendations to the GP. AMoPac-HYP (‘AdherenceMonitoringPackage to identify non-adherence in ambulatoryHYPertensive patients’) is an observational study among GPs and ambulatory patients with hypertension in a real-world setting. The primary outcome was GPs’ perceived usefulness of AMoPac. Secondary outcomes were (1) frequency of medication problems and prescribing errors; (2) types of pharmacist’s’ recommendations; (3) acceptance of the recommendations by GPs; (4) medication adherence and (5) patients’ satisfaction. Outcomes are reported descriptively. Data were collected with questionnaires and electronic monitoring of medicine intake.ResultsFifteen GPs and 15 patients with hypertension participated in the AMoPac-HYP Study. Patients were on average 62 years old, and mean blood pressure was 137/83 mmHg. All GPs rated AMoPac as useful. The most frequently mentioned use was excluding non-adherence in patients with hypertension (93%). Medication problems and prescribing errors were observed in 80% of the patients. The study pharmacist recommended adherence support (N=9 patients) and treatment optimisation (N=8 patients). The recommendations were accepted and implemented in 10 of 17 cases by the GP. Patients’ mean taking and timing adherence were 90% and 86%, respectively. Satisfaction with the study procedures among patients was high.ConclusionAMoPac was rated as useful for identifying and excluding non-adherence in patients with hypertension and was highly accepted among patients. Including adherence data in clinical decision-making could contribute to optimising patient care.
Standardised training for endoscopic mucosal resection of large non-pedunculated colorectal polyps to reduce recurrence (*STAR-LNPCP study): a multicentre cluster randomised trial
Authors: Meulen Lonne W T , Bogie Roel M M , Siersema Peter D , Winkens Bjorn , Vlug Marije S , Wolfhagen Frank H J , Baven-Pronk Martine , van der Voorn Michael , Schwartz Matthijs P , Vogelaar Lauran , de Vos tot Nederveen Cappel Wouter H , Seerden Tom C J , Hazen Wouter L , Schrauwen Ruud W M , Alvarez Herrero Lorenza , Schreuder Ramon-Michel M , van Nunen Annick B , Stoop Esther , de Bruin Gijs J , Bos Philip , Marsman Willem A , Kuiper Edith , de Bièvre Marc , Alderlieste Yasser A , Roomer Robert , Groen John , Bargeman Marloes , van Leerdam Monique E , Roberts-Bos Linda , Boersma Femke , Thurnau Karsten , de Vries Roland S , Ramaker Jos M , Vleggaar Frank P , de Ridder Rogier J , Pellisé María , Bourke Michael J , Masclee Ad A M , Moons Leon M G 
Published: January 2024

Objective
Endoscopic mucosal resection (EMR) is the preferred treatment for non-invasive large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) but is associated with an early recurrence rate of up to 30%. We evaluated whether standardised EMR training could reduce recurrence rates in Dutch community hospitals.

Design
In this multicentre cluster randomised trial, 59 endoscopists from 30 hospitals were randomly assigned to the intervention group (e-learning and 2-day training including hands-on session) or control group. From April 2019 to August 2021, all consecutive EMR-treated LNPCPs were included. Primary endpoint was recurrence rate after 6 months.

Results
A total of 1412 LNPCPs were included; 699 in the intervention group and 713 in the control group (median size 30 mm vs 30 mm, 45% vs 52% size, morphology, site and access (SMSA) score IV, 64% vs 64% proximal location). Recurrence rates were lower in the intervention group compared with controls (13% vs 25%, OR 0.43; 95% CI 0.23 to 0.78; p=0.005) with similar complication rates (8% vs 9%, OR 0.93; 95% CI 0.64 to 1.36; p=0.720). Recurrences were more often unifocal in the intervention group (92% vs 76%; p=0.006). In sensitivity analysis, the benefit of the intervention on recurrence rate was only observed in the 20–40 mm LNPCPs (5% vs 20% in 20–29 mm, p=0.001; 10% vs 21% in 30–39 mm, p=0.013) but less evident in ≥40 mm LNPCPs (24% vs 31%; p=0.151). In a post hoc analysis, the training effect was maintained in the study group, while in the control group the recurrence rate remained high.

Conclusion
A compact standardised EMR training for LNPCPs significantly reduced recurrences in community hospitals. This strongly argues for a national dedicated training programme for endoscopists performing EMR of ≥20 mm LNPCPs. Interestingly, in sensitivity analysis, this benefit was limited for LNPCPs ≥40 mm.

Trial registration number
NTR7477.
TCCIA: a comprehensive resource for exploring CircRNA in cancer immunotherapy
Authors: Wang Shixiang , Xiong Yi , Zhang Yihao , Wang Haitao , Chen Minjun , Li Jianfeng , Luo Peng , Luo Yung-Hung , Hecht Markus , Frey Benjamin , Gaipl Udo , Li Xuejun , Zhao Qi , Ma Hu , Zhou Jian-Guo 
Published: January 2024

BackgroundImmunotherapies targeting immune checkpoints have gained increasing attention in cancer treatment, emphasizing the need for predictive biomarkers. Circular RNAs (circRNAs) have emerged as critical regulators of tumor immunity, particularly in the PD-1/PD-L1 pathway, and have shown potential in predicting immunotherapy efficacy. Yet, the detailed roles of circRNAs in cancer immunotherapy are not fully understood. While existing databases focus on either circRNA profiles or immunotherapy cohorts, there is currently no platform that enables the exploration of the intricate interplay between circRNAs and anti-tumor immunotherapy. A comprehensive resource combining circRNA profiles, immunotherapy responses, and clinical outcomes is essential to advance our understanding of circRNA-mediated tumor-immune interactions and to develop effective biomarkers.MethodsTo address these gaps, we constructed The Cancer CircRNA Immunome Atlas (TCCIA), the first database that combines circRNA profiles, immunotherapy response data, and clinical outcomes across multicancer types. The construction of TCCIA involved applying standardized preprocessing to the raw sequencing FASTQ files, characterizing circRNA profiles using an ensemble approach based on four established circRNA detection tools, analyzing tumor immunophenotypes, and compiling immunotherapy response data from diverse cohorts treated with immune checkpoint blockades (ICBs).ResultsTCCIA encompasses over 4,000 clinical samples obtained from 25 cohorts treated with ICBs along with other treatment modalities. The database provides researchers and clinicians with a cloud-based platform that enables interactive exploration of circRNA data in the context of ICB. The platform offers a range of analytical tools, including browse of identified circRNAs, visualization of circRNA abundance and correlation, association analysis between circRNAs and clinical variables, assessment of the tumor immune microenvironment, exploration of tumor molecular signatures, evaluation of treatment response or prognosis, and identification of altered circRNAs in immunotherapy-sensitive and resistant tumors. To illustrate the utility of TCCIA, we showcase two examples, including circTMTC3 and circMGA, by employing analysis of large-scale melanoma and bladder cancer cohorts, which unveil distinct impacts and clinical implications of different circRNA expression in cancer immunotherapy.ConclusionsTCCIA represents a significant advancement over existing resources, providing a comprehensive platform to investigate the role of circRNAs in immuno-oncology.
Nitroglycerin use and adverse clinical outcomes in elderly patients with acute coronary syndrome
Authors: Komaki Soichi , Matsuura Yunosuke , Tanaka Hiroki , Moribayashi Kohei , Yamamura Yoshimasa , Kurogi Kazumasa , Ideguchi Takeshi , Yamamoto Nobuyasu , Nakai Michikazu , Tsuruda Toshihiro , Kaikita Koichi 
Published: January 2024

ObjectiveThe primary care for acute coronary syndrome (ACS) includes the administration of nitroglycerin (GTN). This study aimed to investigate the association between the use of GTN before percutaneous coronary intervention (PCI) for ACS and clinical outcomes.MethodsNine-hundred and forty-seven patients who underwent PCI for ACS were examined and classified into two groups: those who were treated with GTN before PCI (GTN group) and those who were not (non-GTN group). The incidence of major adverse cardiovascular events (MACE), which consist of all-cause mortality, non-fatal myocardial infarction, stroke and rehospitalisation for heart failure at 1 year, was compared between the two groups.ResultsThis study identified 289 patients with ACS who used GTN preceding PCI. Pre-PCI systolic blood pressure was significantly lower in the GTN group than in the non-GTN group (median (IQR); 132.0 (110.0–143.5) mm Hg vs 134.0 (112.0–157.0) mm Hg, respectively, p=0.03). Multivariate Cox regression analysis indicated that GTN use preceding PCI showed an independent association with the incidence of MACE (HR 1.57; 95% CI 1.09–2.28; p=0.016). Overall, the incidence of MACE 1 year after PCI for ACS was significantly higher in the GTN group than in the non-GTN group (log-rank test, p=0.024); however, this trend was consistently found in elderly patients aged ≥75 years (p=0.002) but not in non-elderly patients aged <75 years (p=0.773).ConclusionsGTN use preceding PCI for ACS is associated with lower blood pressure and adverse clinical outcomes in elderly patients.
Fluoroquinolones do not provide added risk of out-of-hospital cardiac arrest: a nationwide study
Authors: Ellenardóttir Viktoría , Coronel Ruben , Folke Fredrik , Halili Andrim , Arulmurugananthavadivel Anojhaan , Parveen Saaima , Andersen Mikkel Porsborg , Schou Morten , Torp-Pedersen Christian , Gislason Gunnar , Eroglu Talip E 
Published: January 2024

AimConflicting results have been reported regarding the association between fluoroquinolones (FQs) and the risk of out-of-hospital cardiac arrest (OHCA). In particular, it has not become clear whether OHCA in FQ users is related to the inherent comorbidities or whether there is a direct pro-arrhythmic effect of FQs. Therefore, we studied the relation between FQs and OHCA in the general population.MethodsThrough Danish nationwide registries, we conducted a nested case–control study with OHCA cases of presumed cardiac causes and age/sex/OHCA date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the OR with 95% CI of OHCA comparing FQs with amoxicillin.ResultsThe study population consisted of 46 578 OHCA cases (mean: 71 years (SD: 14.40), 68.8% men) and 232 890 matched controls. FQ was used by 276 cases and 328 controls and conferred no increase in the odds of OHCA compared with amoxicillin use after controlling for the relevant confounders (OR: 0.91 (95% CI: 0.71 to 1.16)). The OR of OHCA associated with FQ use did not vary significantly by age (OR≤65: 0.96 (95% CI: 0.53 to 1.74), OR>65: 0.88 (95% CI: 0.67 to 1.16), p value interaction=0.7818), sex (ORmen: 0.96 (95% CI: 0.70 to 1.31), ORwomen: 0.80 (95% CI: 0.53 to 1.20), p value interaction=0.9698) and pre-existing cardiovascular disease (ORabsent: 1.02 (95% CI: 0.57 to 1.82), ORpresent: 0.98 (95% CI: 0.75 to 1.28), p value interaction=0.3884), including heart failure (ORabsent: 0.93 (95% CI: 0.72 to 1.22), ORpresent: 1.11 (95% CI: 0.61 to 2.02), p value interaction=0.7083) and ischaemic heart disease (ORabsent: 0.85 (95% CI: 0.64 to 1.12), ORpresent: 1.38 (95% CI: 0.86 to 2.21), p value interaction=0.6230).ConclusionOur findings do not support an association between FQ exposure and OHCA in the general population. This lack of association was consistent in men and women, in all age categories, and in the presence or absence of cardiovascular disease.
Determination of the factors associated with antigen-specific CD4+ T-cell responses to BNT162b2 in patients with rheumatoid arthritis
Authors: Sagawa Fumiaki , Yamada Hisakata , Ayano Masahiro , Kimoto Yasutaka , Mitoma Hiroki , Ono Nobuyuki , Arinobu Yojiro , Kondo Masakazu , Nakashima Yasuharu , Akashi Koichi , Horiuchi Takahiko , Niiro Hiroaki 
Published: January 2024

ObjectivesUnderstanding interpatient variation in CD4+T-cell responses is the bases for understanding the pathogenesis and management of rheumatoid arthritis (RA). We examined immune responses to SARS-CoV-2 vaccine in a cohort of patients with RA and determined factors associated with the responses.MethodsFour hundred and thirty-one patients with RA having received two doses of BNT162b2, a messenger RNA-based vaccine for SARS-CoV-2, were included. Vaccine antigen-specific IgG was detected by ELISA, and antigen-specific CD4+T cells were detected by CD154 expression in response to antigenic stimulation. Expression of cytokines was concomitantly detected by intracellular staining. Associations among background variables, antigen-specific antibody production and the CD4+T-cell responses were analysed. Unsupervised hierarchical clustering was performed based on the profiles of antigen-specific cytokine production by CD4+T cells to stratify patients with RA.ResultsMultivariate analysis indicated that ageing negatively affects CD4+T-cell response as well as antibody production. No association was detected between the presence or the levels of rheumatoid factor/anti-cyclic citrullinated peptide antibody and anti-vaccine immune responses. Methotrexate and prednisolone reduced B cell but not T-cell responses. Conventional immunophenotyping by the expression of chemokine receptors was not associated with the actual CD4+T-cell response, except for T helper cells (Th1). Functional immunophenotyping based on the profiles of antigen-specific cytokine production of CD4+T cells stratified patients with RA into three clusters, among which Th1-dominant type less frequently underwent joint surgery.ConclusionsClinical and immunological variables that are associated with antigen-specific CD4 T-cell responses in patients with RA were determined by analysing immune responses against SARS-CoV-2 vaccine.
Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome
Authors: Wohlgemut Jared M , Pisirir Erhan , Stoner Rebecca S , Kyrimi Evangelia , Christian Michael , Hurst Thomas , Marsh William , Perkins Zane B , Tai Nigel R M 
Published: January 2024

BackgroundHemorrhage is the most common cause of potentially preventable death after injury. Early identification of patients with major hemorrhage (MH) is important as treatments are time-critical. However, diagnosis can be difficult, even for expert clinicians. This study aimed to determine how accurate clinicians are at identifying patients with MH in the prehospital setting. A second aim was to analyze factors associated with missed and overdiagnosis of MH, and the impact on mortality.MethodsRetrospective evaluation of consecutive adult (≥16 years) patients injured in 2019–2020, assessed by expert trauma clinicians in a mature prehospital trauma system, and admitted to a major trauma center (MTC). Clinicians decided to activate the major hemorrhage protocol (MHPA) or not. This decision was compared with whether patients had MH in hospital, defined as the critical admission threshold (CAT+): administration of ≥3 U of red blood cells during any 60-minute period within 24 hours of injury. Multivariate logistical regression analyses were used to analyze factors associated with diagnostic accuracy and mortality.ResultsOf the 947 patients included in this study, 138 (14.6%) had MH. MH was correctly diagnosed in 97 of 138 patients (sensitivity 70%) and correctly excluded in 764 of 809 patients (specificity 94%). Factors associated with missed diagnosis were penetrating mechanism (OR 2.4, 95% CI 1.2 to 4.7) and major abdominal injury (OR 4.0; 95% CI 1.7 to 8.7). Factors associated with overdiagnosis were hypotension (OR 0.99; 95% CI 0.98 to 0.99), polytrauma (OR 1.3, 95% CI 1.1 to 1.6), and diagnostic uncertainty (OR 3.7, 95% CI 1.8 to 7.3). When MH was missed in the prehospital setting, the risk of mortality increased threefold, despite being admitted to an MTC.ConclusionClinical assessment has only a moderate ability to identify MH in the prehospital setting. A missed diagnosis of MH increased the odds of mortality threefold. Understanding the limitations of clinical assessment and developing solutions to aid identification of MH are warranted.Level of evidenceLevel III—Retrospective study with up to two negative criteria.Study typeOriginal research; diagnostic accuracy study.