bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of a machine learning model for differential diagnosis of malignant pleural effusion using routine laboratory data
Authors: Wei Ting-Ting , Zhang Jia-Feng , Cheng Zhuo , Jiang Lei , Li Jiang-Yan , Zhou Lin 
Published: November 2023

Background: The differential diagnosis of malignant pleural effusion (MPE) and benign pleural effusion (BPE) presents a clinical challenge. In recent years, the use of artificial intelligence (AI) machine learning models for disease diagnosis has increased. Objective: This study aimed to develop and validate a diagnostic model for early differentiation between MPE and BPE based on routine laboratory data. Design: This was a retrospective observational cohort study. Methods: A total of 2352 newly diagnosed patients with pleural effusion (PE), between January 2008 and March 2021, were eventually enrolled. Among them, 1435, 466, and 451 participants were randomly assigned to the training, validation, and testing cohorts in a ratio of 3:1:1. Clinical parameters, including age, sex, and laboratory parameters of PE patients, were abstracted for analysis. Based on 81 candidate laboratory variables, five machine learning models, namely extreme gradient boosting (XGBoost) model, logistic regression (LR) model, random forest (RF) model, support vector machine (SVM) model, and multilayer perceptron (MLP) model were developed. Their respective diagnostic performances for MPE were evaluated by receiver operating characteristic (ROC) curves. Results: Among the five models, the XGBoost model exhibited the best diagnostic performance for MPE (area under the curve (AUC): 0.903, 0.918, and 0.886 in the training, validation, and testing cohorts, respectively). Additionally, the XGBoost model outperformed carcinoembryonic antigen (CEA) levels in pleural fluid (PF), serum, and the PF/serum ratio (AUC: 0.726, 0.699, and 0.692 in the training cohort; 0.763, 0.695, and 0.731 in the validation cohort; and 0.722, 0.729, and 0.693 in the testing cohort, respectively). Furthermore, compared with CEA, the XGBoost model demonstrated greater diagnostic power and sensitivity in diagnosing lung cancer-induced MPE. Conclusion: The development of a machine learning model utilizing routine laboratory biomarkers significantly enhances the diagnostic capability for distinguishing between MPE and BPE. The XGBoost model emerges as a valuable tool for the diagnosis of MPE.
Assessing the reliability and feasibility of frailty screening tools among hospitalised older adults
Authors: Lim Siew Hoon , Malhotra Rahul , Østbye Truls , Ang Shin Yuh , Ng Xin Ping , Agus Nurliyana , Binte Sunari Raden Nurheryany , Aloweni Fazila 
Published: November 2023

Background The 29-item Frail-Physical, Psychological and Social (Frail-PPS) and the 14-item Frailty Assessment Measure (FAM) were developed in Singapore to identify risk of frailty among community dwelling older adults and validated for use among hospitalised older adults. Objectives This study aimed to establish the interrater reliability and feasibility of the two screening tools ‒ FAM and Frail-PPS, for assessing frailty among hospitalized older adults. Methods The FAM and Frail-PPS were administered during the initial nursing assessment by nurses to 62 patients aged 65 years and older within 24 h of admission. Interrater reliability, convergent validity and intraclass correlation coefficients (ICCs) were established. Feasibility was determined by the time of administration. Results ICCs for Frail-PPS and FAM were 0.95 and 0.95 respectively. A positive correlation was established (r = 0.97). The administration time for Frail-PPS averaged 6.7 min, and 3.3 min for FAM. Conclusions The FAM, with its high reliability and convergent validity, as well as shorter administration time, may be the preferred screening tool for use in acute care settings.
DWELL: Design for WELLness. A pilot study of an online Facebook intervention to improve perceptions of knowledge, engagement, and self-efficacy in the creation of healthy home environments
Authors: Aperman-Itzhak Tal , Prilleltensky Isaac , Rosen Laura 
Published: November 2023

Background Many factors in the environment influence healthy behaviors. Designing user-friendly environments, by changing the way choices are presented in the environment, may result in behavioral changes and promote the well-being. Objectives To run a pilot study to evaluate the feasibility and acceptability of DWELL (Design for WELLness), which is an online Facebook intervention to improve perceptions of knowledge, engagement, and self-efficacy in the creation of healthy home environments. Methods Both quantitative and qualitative methods were used to evaluate this 7.5-week pilot study. The intervention was conducted during the first wave of COVID-19 lockdown in Israel. Participants answered an online questionnaire at the beginning and end of the pilot. Afterwards, eleven semi-structured telephone interviews were conducted with some of the participants. Results There were 36 mothers who participated in the study. The overall DWELL index increased by 15.43 points ( p < 0.001) from the beginning of the pilot [Mean(SD) = 48.14(17.91)] to the end [Mean(SD) = 63.57(11.98]. There were significant increases in all 5 items of DWELL ( p < 0.05). Positive feedback was obtained from interviewees about their experience with the program, including being interested with the posts and having a mutual learning experience with other members. The intervention was found to be beneficial to most families during COVID-19 lockdown time. Conclusions DWELL was found to be a promising intervention for improving perceptions regarding designing home environments for wellness. These results justified the continuation of the program toward its next phase of the RCT.
Development and Assessment of Simulation-Based Point-of-Care Ultrasound Curriculum in Undergraduate Medical Education
Authors: Hagood Nancy L. , Klaybor Monica , Srivastava Romik , McManigle William , Huggins John Terrill , Shah Pranav V. , Heincelman Marc E. , Thomas Meghan K. 
Published: November 2023

OBJECTIVES Implementation barriers and lack of standardized point-of-care ultrasound (POCUS) curricula make the development of effective POCUS curricula and methods of assessment challenging. The authors aim to develop a longitudinal POCUS curriculum through staged intervention. In the first stage, the authors hypothesized that the use of high-fidelity ultrasound simulation during the Internal Medicine clerkship would improve POCUS confidence and knowledge among medical students, minimizing the need for trained faculty. METHODS A quasi-experimental study of third-year students on the Internal Medicine clerkship at a large academic medical center in the United States was performed assessing the efficacy of ultrasound simulation use. The control group consisted of students who received baseline POCUS education during teaching rounds but did not have access to the ultrasound simulator. The experimental group consisted of students who, in addition to baseline POCUS education, had access to a high-fidelity ultrasound simulator throughout the clerkship for a minimum of 1 hour per week. Students in both the control and experimental groups completed a pre- and post-intervention confidence survey and knowledge-based examination. RESULTS Eighty-two percent (50/61) of students completed pre- and post-tests, with the control group demonstrating no significant difference in POCUS confidence or knowledge. After exposure to the ultrasound simulator, the experimental group demonstrated statistically significant improvement in POCUS confidence and overall POCUS knowledge ( p < .01). CONCLUSION The use of high-fidelity ultrasound simulation can improve POCUS confidence and knowledge among medical students while addressing common barriers to the implementation of a POCUS curriculum. Despite showing statistically significant improvement in overall knowledge, the results did not appear to hold educational significance. Additional POCUS educational methods are necessary to overcome cognitive bias and potential overconfidence. The next stage of curriculum development will include resident-led POCUS workshops to supplement simulation.
Best step-up treatments for children with uncontrolled asthma: a systematic review and network meta-analysis of individual participant data
Authors: Cividini Sofia , Sinha Ian , Donegan Sarah , Maden Michelle , Rose Katie , Fulton Olivia , Culeddu Giovanna , Hughes Dyfrig A. , Turner Stephen , Tudur Smith Catrin 
Published: November 2023

BackgroundThere is uncertainty about the best treatment option for children/adolescents with uncontrolled asthma despite inhaled corticosteroids (ICS) and international guidelines make different recommendations. We evaluated the pharmacological treatments to reduce asthma exacerbations and symptoms in uncontrolled patients age <18 years on ICS.MethodsWe searched MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Web of Science, National Institute for Health and Care Excellence Technology Appraisals, National Institute for Health and Care Research Health Technology Assessment series, World Health Organization International Clinical Trials Registry, conference abstracts and internal clinical trial registers (1 July 2014 to 5 May 2023) for randomised controlled trials of participants age <18 years with uncontrolled asthma on any ICS dose alone at screening. Studies before July 2014 were retrieved from previous systematic reviews/contact with authors. Patients had to be randomised to any dose of ICS alone or combined with long-acting β2-agonists (LABA) or combined with leukotriene receptor antagonists (LTRA), LTRA alone, theophylline or placebo. Primary outcomes were exacerbation and asthma control. The interventions evaluated were ICS (low/medium/high dose), ICS+LABA, ICS+LTRA, LTRA alone, theophylline and placebo.ResultsOf the 4708 publications identified, 144 trials were eligible. Individual participant data were obtained from 29 trials and aggregate data were obtained from 19 trials. Compared with ICS Low, ICS Medium+LABA was associated with the lowest odds of exacerbation (OR 0.44, 95% credibility interval (95% CrI) 0.19–0.90) and with an increased forced expiratory volume in 1 s (mean difference 0.71, 95% CrI 0.35–1.06). Treatment with LTRA was the least preferred. No apparent differences were found for asthma control.ConclusionsUncontrolled children/adolescents on low-dose ICS should be recommended a change to medium-dose ICS+LABA to reduce the risk for exacerbation and improve lung function.
Asthma and incident coronary heart disease: an observational and Mendelian randomisation study
Authors: Valencia-Hernández Carlos A. , Del Greco M Fabiola , Sundaram Varun , Portas Laura , Minelli Cosetta , Bloom Chloe I. 
Published: November 2023

BackgroundObservational studies suggest asthma is a risk factor for coronary heart disease (CHD) and sex modifies the risk, but they may suffer from methodological limitations. To overcome these, we applied a “triangulation approach”, where different methodologies, with different potential biases, were leveraged to enhance confidence in findings.MethodsFirst, we conducted an observational study using UK medical records to match asthma patients 1:1, by age, sex and general practitioner (GP) practice, to the general population. We measured the association between asthma and incident CHD (myocardial infarction: hospitalisation/death) by applying minimal sufficient adjustment: model 1, smoking, body mass index, oral corticosteroids, atopy and deprivation; model 2, additionally adjusting for healthcare behaviour (GP consultation frequency). Second, we conducted a Mendelian randomisation (MR) study using data from the UK Biobank, Trans-National Asthma Genetic Consortium (TAGC) and Coronary Artery Disease Genome-wide Replication and Meta-analysis consortium (CARDIoGRAM). Using 64 asthma single nucleotide polymorphisms, the effect of asthma on CHD was estimated with inverse variance-weighted meta-analysis and methods that adjust for pleiotropy.ResultsIn our observational study (n=1 522 910), we found asthma was associated with 6% increased risk of CHD (model 1: HR 1.06, 95% CI 1.01–1.13); after accounting for healthcare behaviour, we found no association (model 2: HR 0.99, 95% CI 0.94–1.05). Asthma severity did not modify the association, but sex did (females: HR 1.11, 95% CI 1.01–1.21; males: HR 0.91, 95% CI 0.84–0.98). Our MR study (n=589 875) found no association between asthma and CHD (OR 1.01, 95% CI 0.98–1.04) and no modification by sex.ConclusionsOur findings suggest that asthma is not a risk factor for CHD. Previous studies may have suffered from detection bias or residual confounding.
Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study
Authors: Batista Ricardo , Reaume Michael , Roberts Rhiannon , Seale Emily , Rhodes Emily , Sucha Ewa , Pugliese Michael , Kendall Claire E. , Bjerre Lise M. , Bouchard Louise , Prud’homme Denis , Manuel Douglas G. , Tanuseputro Peter 
Published: November 2023

Abstract
Background
Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group.

Methods
Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of ‘severe’ multimorbidity (defined as the presence of five or more chronic diseases).

Results
The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02–1.06]).

Conclusions
The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.
Association between chronic obstructive pulmonary disease and 28-day mortality in patients with sepsis: a retrospective study based on the MIMIC-III database
Authors: Chen Yubiao , Lu Lifei , Li Xicong , Liu Baiyun , Zhang Yu , Zheng Yongxin , Zeng Yuan , Wang Ke , Pan Yaru , Liang Xiangning , Wu Zhongji , Fu Yutian , Huang Yongbo , Li Yimin 
Published: November 2023

Abstract
Background
Sepsis is a common cause of mortality in critically ill patients, and chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in septic patients. However, the impact of COPD on patients with sepsis remained unclear. Therefore, the purpose of this study aimed to assess the effect of COPD on the prognosis of septic patients based on Medical Information Mart for Intensive Care (MIMIC-III) database.

Methods
In this retrospective study based on the (MIMIC)-III database version 1.4 (v1.4), we collected clinical data and 28-day all-cause mortality from patients with sepsis in intensive care unit (ICU) and these patients met the diagnostic criteria of Sepsis 3 on ICU admission between 2008 and 2012. International Classification of Diseases (ICD-9) (4660, 490, 4910, 4911, 49120, 49121, 4918, 4919, 4920, 4928, 494, 4940, 4941, 496) was used to identified COPD. We applied Kaplan–Meier analysis to compare difference of 28-day all-cause mortality between septic patients with and without COPD. Cox proportional-hazards model was applied to explore the risk factor associated with 28-day all-cause mortality in patients with sepsis.

Results
Six thousand two hundred fifty seven patients with sepsis were included in this study, including 955 (15.3%) patients with COPD and 5302 patients without COPD (84.7%). Compared with patients without COPD, patients with COPD were older (median: 73.5 [64.4, 82.0] vs 65.8 [52.9, 79.1], P < 0.001), had higher simplified acute physiology score II (SAPSII) (median: 40.0 [33.0, 49.0] vs 38.0 [29.0,47.0], P < 0.001) and greater proportion of mechanical ventilatory support (MV) (55.0% vs 48.9%, P = 0.001). In our study, septic patients with COPD had higher 28-day all-cause mortality (23.6% vs 16.4%, P < 0.001) than patients without COPD. After adjusting for covariates, the results showed that COPD was an independent risk factor for the 28-day all-cause mortality of patients with sepsis (HR 1.30, 95%CI: 1.12–1.50, P = 0.001).

Conclusions
COPD was an independent risk factor of 28-day all-cause mortality in septic patients. Clinically, septic patients with COPD should be given additional care.
Home care nurses facilitating planned home deaths. A focused ethnography
Authors: Sørstrøm Anne Kristine , Ludvigsen Mette Spliid , Kymre Ingjerd Gåre 
Published: November 2023

Abstract
Background
Home care nurses provide complex palliative care for patients who want to die in their own homes. This study aimed to explore home care nurses’ facilitation of planned home death to better understand nursing practices.

Methods
Data were collected between March 2019 and March 2020 using participant observations and semi-structured interviews. In addition, the number of planned home deaths was recorded. The analysis was guided by Roper and Shapira`s framework on focused ethnography.

Results
Twenty home care nurses (three men) in eight home care areas in two Norwegian municipalities met the inclusion criteria. Eight home deaths were registered, seven participatory observations were performed, and 20 semi-structured interviews were completed. Home care nurses find facilitating planned home deaths to be rewarding work, to the point of going above and beyond. At the same time, they describe facilitating planned home deaths as demanding work due to organizational stressors such as staff shortages, heavy workloads, and time restraints. While they tend to patients’ needs, they also express concern for the wellbeing of the next of kin. They find it challenging to juggle the needs of the patients with the needs of next of kin, as these are not always correlated.

Conclusion
Home care nurses are pushing the boundaries of their practice when facilitating planned home deaths while compensating for a fragile system by going above and beyond for patients and their next of kin. Providing insights into the work of home care nurses providing palliative care in patients’ homes can impact recruiting and retaining nurses in the workforce and influence local practices and policies.
Small intestinal strangulation in 60 cattle – clinical, laboratory and ultrasonographic findings, treatment and outcome
Authors: Braun Ueli , Gerspach Christian , Loss Sandra , Hilbe Monika , Nuss Karl 
Published: November 2023

AbstractBackgroundIntestinal strangulation is constriction of the intestine by a band of tissue, ligament or blood vessel causing partial or complete intestinal obstruction. This retrospective study describes the clinical, laboratory and ultrasonographic findings, treatment and outcome of 60 cows with intestinal strangulation.ResultsThe general condition was abnormal in all cows (60/60), 23.3% (14/60) had nonspecific signs of pain, 40.0% (24/60) had signs of colic and 48.3% (29/60) had signs of somatic (parietal) pain. The most common digestive tract abnormalities were, in decreasing frequency, reduced or absent intestinal motility (100%, 60/60), reduced or absent faecal output (98.3%, 59/60), reduced or absent rumen motility (93.4%, 56/60), dilated small intestines on transrectal palpation (63.3%, 38/60), positive ballottement and swinging auscultation (BSA) and/or percussion and simultaneous auscultation (PSA) on the right side of the abdomen (58.3%, 35/60) and at least one positive foreign body test, most commonly the back grip, in 33.9% (20/59) of the cows. Other common findings were reduced skin surface temperature (67.8%, 40/59), reduced skin turgor (51.7%, 31/60), prolonged capillary refill time (49.2%, 29/59), enophthalmus (48.3%, 29/60) and moderate to severe scleral injection (46.6%, 27/58). The most common laboratory findings were hypokalaemia (58.3%, 35/60), haemoconcentration (57.6%, 34/59), base excess (51.1%, 24/47), hyperproteinaemia (45.8%, 27/59), hyperbilirubinaemia (43.3%, 26/60), acidosis (42.6%, 20/47) and azotaemia (38.3%, 23/60). The principal ultrasonographic findings were subjectively reduced or absent small intestinal motility and dilated small intestines, but the strangulation could not be visualised by ultrasonography. With one exception, all cows underwent a right flank laparotomy to resolve the strangulation by transection or resection of the impinging tissue. Forty-nine (81.7%) cows were discharged and 11 (18.3%) were euthanized before, during or after surgery.ConclusionsWithout laparotomy, intestinal strangulation could be clinically (transrectally) diagnosed in only 10% of the cows. A laparotomy is therefore essential for the correct diagnosis. The prognosis is good with prompt surgical treatment.