bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monash-Alfred protocol for assessment of atypical parkinsonian syndromes (MAP-APS)
Authors: Siejka Timothy P , Bertram Kelly L , Tang Huiliang M , Thyagarajan Dominic , O’Brien Terence J , Butzkueven Helmut , Vivash Lucy , Harding Ian H 
Published: January 2024

IntroductionAtypical parkinsonian syndromes (APS) are rare neurodegenerative syndromes for which parkinsonism is one significant feature. APS includes progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal syndrome (CBS). The diagnosis of APS remains reliant on clinical features with no available diagnostic or prognostic biomarker. Clinical scales remain the gold standard assessment measures in clinical trials and research. The lack of standardised approach for research cohorts has contributed to shortcomings in disease understanding and limits collaboration between researchers. The primary objectives of this study are to (1) establish an assessment protocol for parkinsonian syndromes and (2) to implement it at a single site to establish the viability and utility of populating a clinical and biological databank of patients with APS.MethodsThe Monash Alfred Protocol for Assessment of APS was devised by expert consensus within a broad multidisciplinary team. Eligible patients are diagnosed as possible or probable PSP, MSA or CBS by a consultant neurologist with expertise in movement disorders. Participants will be assessed at recruitment and then annually for up to 3 years; individuals within 5 years of index symptom onset will also undergo a once-off 6-month assessment.Ethics and disseminationEach participant or their legally authorised representative will provide informed written consent prior to commencement of the study. Data will be stored on a locally hosted Research Electronic Data Capture database.Trial registration numberAustralian New Zealand Clinical Trials Registry (ANZCTN 12622000923763).
Sepsis epidemiology in Australian and New Zealand children (SENTINEL): protocol for a multicountry prospective observational study
Authors: Long Elliot , Borland Meredith L , George Shane , Jani Shefali , Tan Eunicia , Neutze Jocelyn , Phillips Natalie , Kochar Amit , Craig Simon , Lithgow Anna , Rao Arjun , Dalziel Stuart , Oakley Ed , Hearps Stephen , Singh Sonia , Gelbart Ben , McNab Sarah , Balamuth Fran , Weiss Scott , Kuppermann Nathan , Williams Amanda , Babl Franz E 
Published: January 2024

IntroductionSepsis affects 25.2 million children per year globally and causes 3.4 million deaths, with an annual cost of hospitalisation in the USA of US$7.3 billion. Despite being common, severe and expensive, therapies and outcomes from sepsis have not substantially changed in decades. Variable case definitions, lack of a reference standard for diagnosis and broad spectrum of disease hamper efforts to evaluate therapies that may improve sepsis outcomes. This landscape analysis of community-acquired childhood sepsis in Australia and New Zealand will characterise the burden of disease, including incidence, severity, outcomes and cost. Sepsis diagnostic criteria and risk stratification tools will be prospectively evaluated. Sepsis therapies, quality of care, parental awareness and understanding of sepsis and parent-reported outcome measures will be described. Understanding these aspects of sepsis care is fundamental for the design and conduct of interventional trials to improve childhood sepsis outcomes.Methods and analysisThis prospective observational study will include children up to 18 years of age presenting to 12 emergency departments with suspected sepsis within the Paediatric Research in Emergency Departments International Collaborative network in Australia and New Zealand. Presenting characteristics, management and outcomes will be collected. These will include vital signs, serum biomarkers, clinician assessment of severity of disease, intravenous fluid administration for the first 24 hours of hospitalisation, organ support therapies delivered, antimicrobial use, microbiological diagnoses, hospital and intensive care unit length-of-stay, mortality censored at hospital discharge or 30 days from enrolment (whichever comes first) and parent-reported outcomes 90 days from enrolment. We will use these data to determine sepsis epidemiology based on existing and novel diagnostic criteria. We will also validate existing and novel sepsis risk stratification criteria, characterise antimicrobial stewardship, guideline adherence, cost and report parental awareness and understanding of sepsis and parent-reported outcome measures.Ethics and disseminationEthics approval was received from the Royal Children’s Hospital of Melbourne, Australia Human Research Ethics Committee (HREC/69948/RCHM-2021). This included incorporated informed consent for follow-up. The findings will be disseminated in a peer-reviewed journal and at academic conferences.Trial registration numberACTRN12621000920897; Pre-results.
Evaluation of a new patient safety educational programme to reduce adverse events by encouraging staff to speak up: application of the trigger tool methodology
Authors: Nakatani Kaoru , Nakagami-Yamaguchi Etsuko , Hagawa Naohiro , Tokuwame Atsushi , Ehara Shoichi , Nishimura Tetsuro , Mizobata Yasumitsu 
Published: January 2024

BackgroundPoor communication contributes to adverse events (AEs). In our hospital, following an experience of a fatal incident in 2014, we developed an educational programme aimed at improving communication for better teamwork that led to a reduction in AEs.MethodsWe developed and implemented an intervention bundle comprising external investigation committee reviews, the establishment of a working group (WG), standards and emergency response guidelines, as well as educational programmes and tools. To determine the effectiveness of the educational programmes, we measured communication abilities among doctors and nurses by administering psychological scales focused on their confidence in speaking up. Furthermore, we applied the trigger tool methodology in a retrospective study to determine if our interventions had reduced AEs.ResultsThe nurses’ scores for ‘perceived barriers to speaking up’ and ‘negative attitude toward voicing opinions in the healthcare team’ decreased significantly after the training from 3.20 to 3.00 and from 2.47 to 2.29 points, respectively. The junior doctors’ scores for the same items also decreased significantly after the training from 3.34 to 2.51 and from 2.42 to 2.11 points, respectively. The number of AEs was 32.1 (median) before the WG, 39.9 (median) before the general training, 22.2 (median) after the general training and 18.4 (median) after implementing the leadership educational programmes. During the intervention period the hospital’s incident reports per employee kept increasing.ConclusionOur new educational programmes improved junior doctors and nurses’ perceptions of speaking up. We speculated that our intervention may have improved staff communication, which in turn may have led to a reduction in AEs and a sustained increase in incident reports per employee.
Longer work experience and age associated with safety attitudes in operating room nurses: an online cross-sectional study
Authors: Nyberg Anette , Olofsson Birgitta , Fagerdahl Ami , Haney Michael , Otten Volker 
Published: January 2024

BackgroundPatient safety is fundamental when providing care in the operating room. Still, adverse events and errors are a challenge for patient safety worldwide. To avoid preventable patient harm, organisations need a positive safety culture, the measurable component of which is known as the safety climate. To best improve the safety climate the current attitudes to safety must first be understood.AimTo explore operating room nurses’ safety attitudes and their views on how to improve patient safety in operating rooms.MethodA cross-sectional study using the Swedish-translated version of the Safety Attitudes Questionnaire, Operating Room version. Data were collected using an online survey platform.Results358 operating room nurses completed the questionnaire. The results show that the older age group rated their working conditions and management support as better than the younger age groups. The older age group also rated their stress recognition as lower compared with the younger age groups. The same pattern was seen in terms of work experience, with more-experienced respondents showing a higher mean score for the factor working conditions and a lower mean score for the factor stress recognition as compared with their less-experienced colleagues. When comparing hospital types, county hospital employees had higher factor scores for safety climate, job satisfaction and working conditions than university hospital employees. The respondents’ most recurring recommendations for improving patient safety were ‘Having better and clearer communication’ followed by ‘Having enough time to do things the way they should be done’.ConclusionMore focus on safety with increasing age and experience was observed in this cohort. Need for improvements is reported for patient safety in operating rooms, mainly when it comes to communication and workload. To improve and develop patient safety in the operating room, the organisational safety climate needs to be actively managed and developed. One step in actively managing the safety climate may be efforts to retain experienced operating room nurses.
Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT Study
Authors: Jacobs An , Warnants Maarten , Vollmuth Veronika , Winkler Christiane , Weiss Andreas , Ziegler Anette-Gabriele , Lundgren Markus , Elding Larsson Helena , Kordonouri Olga , von dem Berge Thekla , Zielmann Marie-Luise , Bonifacio Ezio , Hommel Angela , Ołtarzewski Mariusz , Szypowska Agnieszka , Besser Rachel , Todd John A. , Casteels Kristina 
Published: January 2024

BackgroundVitamin D insufficiency (VDI) may be a factor in the development of type 1 diabetes (T1D). The aim of this study is to investigate the presence and persistence of VDI in a large cohort of infants with increased risk of developing T1D, in light of the differences in local supplementation guidelines.MethodsIn the POInT Study, a multicentre primary prevention study between February 2018 and March 2021 in Germany, Poland, Belgium, England and Sweden, including infants aged 4–7 months at high genetic risk of developing β-cell autoantibodies, vitamin D levels were analysed at each study visit from inclusion (4–7 months) until 3 years, with an interval of 2 months (first three visits) or 4–6 months (visits 4–8). The protocol actively promotes vitamin D sufficiency to optimise immune tolerance. VDI was defined as a concentration below 30 ng/mL and was treated according to local guidelines of participating centres. Recovery from VDI was defined as a concentration above or equal to 30 ng/mL on the subsequent visit after VDI.Results1050 infants were included, of which 5937 vitamin D levels were available for analyses. VDI was observed in 1464 (24.7%) visits and 507 (46.1%) of these were not resolved at the next visit. The risk of having VDI was independently associated with season (higher in winter), weight (higher with increased weight), age (higher with increased age) and country (higher in England). The risk of not recovering from VDI was independently associated with the season of the previously determined VDI, which was higher if VDI was identified in winter.ConclusionsVDI is frequent in infants with increased risk of developing T1D. Treatment guidelines for VDI do not seem effective. Increasing supplementation dosages in this patient population seems warranted, especially during winter, and increasing dosages more aggressively after VDI should be considered.
Gastroenterology trainee experience, confidence and satisfaction in nutrition training: a cross-sectional survey in the UK
Authors: Sartain Stephanie , Wong Charlotte , Murray Emma , Raju Suneil A , Woods Amy , Ashmore Daniel , Dyall Lovesh , Kokwaro Flora , McGowan Eilidh , Leiberman David , Routledge Emma , Clarke Emily , Smith Trevor R 
Published: January 2024

IntroductionNutrition is an essential part of gastroenterology specialist training. There is limited evidence of trainee experience in this area. The shorter training programme introduced in 2022 may lead to reduced exposure to this subspecialty. We aimed to explore and describe current nutrition training experiences, confidence and satisfaction to inform future improvements.MethodsGastroenterology trainees were invited to participate in an online survey from 20 May 2022 to 18 July 2022. The questionnaire consisted of 27 questions with a range of free-text and Likert scale responses.Results86 responses were received. 39.5% had undertaken an advanced training programme or core placement in nutrition. 52.9% of these felt ‘fairly confident’ or ‘very confident’ in managing intestinal failure vs 5.8% of those who had not completed a nutrition placement. Obesity and eating disorders management received the lowest ratings. Nutrition training was described as ‘fairly important’ or ‘very important’ by 98.8% and 47.0% included nutrition as part of their preferred future practice. 53.1% of ST6/7 trainees were ‘fairly confident’ or ‘very confident’ their training offered adequate experience in nutrition. Participants reported barriers including a lack of education and training opportunities, and limited early rotations offering nutrition training.ConclusionGastroenterology trainees believe nutrition training to be important. Nutrition placements increase trainee confidence, knowledge and experiences overall, but there is variability in this. Improved structuring of placements, increased educational opportunities and exposure to this subspecialty at an earlier stage are required to ensure competency in nutrition is reliably achieved during gastroenterology training.
COVID-19 patient experiences in prehospital pathways: a processual approach using life-events calendar method and state sequence analysis shows detrimental delays
Authors: Lutaud Romain , Cortaredona Sebastien , Delorme Lea , Peretti-watel Patrick , Mirouse Juliette , Borg Manon , Cattaneo Lucie , Thery Didier , Gentile Gaetan , Pradier Christian , Irit Touitou , Brouqui Philippe , Tardieu Sophie , Carles Michel , Gentile Stéphanie 
Published: January 2024

ObjectivesTo our best knowledge, no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19. ‘Patients’ voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes.DesignCross-sectional online survey using life-event calendars.SettingAll patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France.Participants312 patients responded to the survey.Main outcome measuresFrom the day of symptom onset to the day of hospitalisation, we defined a symptom sequence as the time-ordered vector of the successive symptom grades (grade 1, grade 2, grade 3). State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences. Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit (ICU) and COVID-19 sequelae after hospitalisation.ResultsThree clusters of symptom sequences were identified among 312 complete prehospital pathways. A specific group of patients (29%) experienced extended symptoms of severe COVID-19, persisting for an average duration of 7.5 days before hospitalisation. This group had a significantly higher probability of being admitted to ICU (adjusted OR 2.01). They were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. Similarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation.Conclusion and relevanceThis study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors, such as lower education levels and limited connections to the medical field, on patients’ experiences.
Plasma cell-free DNA hydroxymethylation profiling reveals anti-PD-1 treatment response and resistance biology in non-small cell lung cancer
Authors: Guler Gulfem D , Ning Yuhong , Coruh Ceyda , Mognol Giuliana P , Phillips Tierney , Nabiyouni Maryam , Hazen Kyle , Scott Aaron , Volkmuth Wayne , Levy Samuel 
Published: January 2024

BackgroundTreatment with immune checkpoint inhibitors (ICIs) targeting programmed death-1 (PD-1) can yield durable antitumor responses, yet not all patients respond to ICIs. Current approaches to select patients who may benefit from anti-PD-1 treatment are insufficient. 5-hydroxymethylation (5hmC) analysis of plasma-derived cell-free DNA (cfDNA) presents a novel non-invasive approach for identification of therapy response biomarkers which can tackle challenges associated with tumor biopsies such as tumor heterogeneity and serial sample collection.Methods151 blood samples were collected from 31 patients with non-small cell lung cancer (NSCLC) before therapy started and at multiple time points while on therapy. Blood samples were processed to obtain plasma-derived cfDNA, followed by enrichment of 5hmC-containing cfDNA fragments through biotinylation via a two-step chemistry and binding to streptavidin coated beads. 5hmC-enriched cfDNA and whole genome libraries were prepared in parallel and sequenced to obtain whole hydroxymethylome and whole genome plasma profiles, respectively.ResultsComparison of on-treatment time point to matched pretreatment samples from same patients revealed that anti-PD-1 treatment induced distinct changes in plasma cfDNA 5hmC profiles of responding patients, as judged by Response evaluation criteria in solid tumors, relative to non-responders. In responders, 5hmC accumulated over genes involved in immune activation such as inteferon (IFN)-γ and IFN-α response, inflammatory response and tumor necrosis factor (TNF)-α signaling, whereas in non-responders 5hmC increased over epithelial to mesenchymal transition genes. Molecular response to anti-PD-1 treatment, as measured by 5hmC changes in plasma cfDNA profiles were observed early on, starting with the first cycle of treatment. Comparison of pretreatment plasma samples revealed that anti-PD-1 treatment response and resistance associated genes can be captured by 5hmC profiling of plasma-derived cfDNA. Furthermore, 5hmC profiling of pretreatment plasma samples was able to distinguish responders from non-responders using T cell-inflamed gene expression profile, which was previously identified by tissue RNA analysis.ConclusionsThese results demonstrate that 5hmC profiling can identify response and resistance associated biological pathways in plasma-derived cfDNA, offering a novel approach for non-invasive prediction and monitoring of immunotherapy response in NSCLC.
National burden of rheumatoid arthritis in Canada, 1990–2019: findings from the Global Burden of Disease Study 2019 – a GBD collaborator-led study
Authors: Hassen Nejat , Lacaille Diane , Xu Alice , Alandejani Amani , Sidi Sophia , Mansourian Marjan , Butt Zahid A , Cahill Leah E , Iyamu Ihoghosa Osamuyi , Lang Justin J , Rana Juwel , Somayaji Ranjani , Sarrafzadegan Nizal , Kopec Jacek A 
Published: January 2024

ObjectiveThe objectives of this study were: (1) to describe burden of rheumatoid arthritis (RA) and trends from 1990 to 2019 using the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) data, (2) to describe age and sex differences in RA and (3) to compare Canada’s RA burden to that of other countries.MethodsDisease burden indicators included prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life-years (DALYs). GBD estimated fatal and non-fatal outcomes using published literature, survey data and health insurance claims. Data were analysed by Bayesian meta-regression, cause of death ensemble model and other statistical methods. DALYs for Canada were compared with DALYs of countries with similarly high Socio-Demographic Index values.ResultsIn Canada, the RA prevalence rate increased by 27% between 1990 and 2019, mortality rate decreased by 27%, YLL rate decreased by 30%, YLD increased by 27% and DALY rate increased by 13%, all age standardised. The decline in RA mortality and YLL rates was especially pronounced after 2002. The disease burden was higher in females for all indicators, and DALY rates were higher among older age groups, peaking at age 75–79 years. Prevalence and DALYs were higher in Canada compared with global rates.ConclusionTrends in RA burden indicators over time and differences by age and sex have important implications for Canadian policy-makers, researchers and care providers. Early identification and management of RA in women may help reduce the overall burden of RA in Canada.
Tobacco product litter as a form of postconsumption marketing: an observational study in India
Authors: Grilo Graziele , Kaplan Bekir , Cohen Joanna E , Bhattacharya Paramita , Mukherjee Nirmalya , Welding Kevin , Kennedy Ryan David 
Published: January 2024

BackgroundTobacco product litter may be a form of postconsumption marketing if the littered items are branded. We conducted an observational study in India to assess the presence of tobacco product litter and determine the proportion that included branding.MethodsDuring November–December 2022, we identified tobacco product litter (cigarette/bidi butts and packaging; smokeless tobacco packaging) in nine Indian cities: Bengaluru, Bhubaneswar, Chennai, Delhi, Guwahati, Hyderabad, Lucknow, Mumbai and Patna. In each city, we conducted observations along 15 different routes, each approximately 250 m in distance, for a total of 135 observational routes. Data collectors classified each piece of tobacco litter (product/packaging) and recorded if the litter had visible branding, such as brand names and/or logos.ResultsThe study identified 17 261 pieces of tobacco product litter; SLT packaging comprised the largest proportion of the sample (62%), followed by cigarette butts (26%), bidi butts (8%), cigarette packaging (3%) and bidi packaging (1%). Across the sample, 81% (n=13 924) of the litter was branded. A brand was visible on most packaging for cigarettes (98%), bidis (97%) and SLT (86%), and present on 82% of cigarette butts and 26% of bidi butts.ConclusionThis study found that the majority of tobacco product litter in India is branded, which could function as a form of postconsumption marketing. Plain and standardised packaging and banning branding features on filters would reduce tobacco litter branding.