bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticancer drugs are the first cause of drug‐induced liver injury in a reference hospital
Authors: Pocurull Anna , Moreta Maria José , Heitman David , Olivas Ignasi , Collazos Cristina , Canga Elia , Sáez‐Peñataro Joaquin , Andrade Raul J. , Lucena M. Isabel , Mariño Zoe , Díaz Alba , Lens Sabela , Londoño María Carlota , Forns Xavier 
Published: December 2023

AbstractDrug‐induced liver injury (DILI) is a challenging liver disorder for hepatologists. We aimed to assess the pattern and causes of DILI in a tertiary hospital. We registered prospectively all patients referred with suspicion of DILI from 2018 to 2023. A total of 106 patients fulfilled the diagnostic criteria (30 caused by paracetamol were excluded; total number 76). The pattern of liver injury was hepatocellular in 55 (72%). Drugs causing DILI were antineoplastic (26%), antibiotics (24%), analgesics (12%), and recreational drugs (9%). Regarding clinical outcomes, 39 (51%) required hospitalization and 7 (9%) underwent a liver transplantation or died from acute liver injury. We identified 126 additional patients with DILI due to immune check‐point inhibitors who were not referred to a liver disease specialist. Antineoplastic drugs have become the first cause of DILI in hospitals. A multidisciplinary approach and specific educational tools to increase DILI awareness are needed among different specialists.
The microbiome, resistome, and their co-evolution in sewage at a hospital for infectious diseases in Shanghai, China
Authors: Ma Yingying , Wu Nannan , Zhang Tao , Li Yanpeng , Cao Le , Zhang Peng , Zhang Zhigang , Zhu Tongyu , Zhang Chiyu 
Published: December 2023

ABSTRACT

The emergence of antibiotic-resistant bacteria (ARB) caused by the overuse of antibiotics severely threatens human health. Hospital sewage may be a key transmission hub for ARB. However, the complex link between the microbiome and resistomeresistance in hospital sewage remains unclear. In this study, metagenomic assembly and binning methods were used to investigate the microbial community, resistome, and association of antibiotic resistance genes (ARGs) with ARB in sewage from 10 representative sites (outpatient building, surgery building, internal medicine buildings [IMB1-4], staff dormitory, laboratory animal building, tuberculosis building [TBB], and hospital wastewater treatment plant) of a hospital in Shanghai from June 2021 to February 2022. A total of 252 ARG subtypes, belonging to 17 antibiotic classes, were identified. The relative abundance of KPC-2 was higher at IMBs and TBB than at other sites. Of the ARG-carrying contigs, 47.3%-62.6% were associated with mobile genetic elements, and the proportion of plasmid-associated ARGs was significantly higher than that of chromosome-associated ARGs. Although a similar microbiome composition was shared, certain bacteria were enriched at different sites. Potential pathogens
Enterococcus B faecium
and
Klebsiella pneumoniae
were primarily enriched in IMB2 and IMB4, respectively. The same ARGs were identified in diverse bacterial hosts (especially pathogenic bacteria), and accordingly, the latter possessed multiple ARGs. Furthermore, gene flow was frequently observed in the sewage of different buildings. The results provide crucial information on the characterization profiles of resistomes in hospital sewage in Shanghai.

IMPORTANCE

Environmental antibiotic resistance genes (ARGs) play a critical role in the emergence and spread of antimicrobial resistance, which poses a global health threat. Wastewater from healthcare facilities serves as a significant reservoir for ARGs. Here, we characterized the microbial community along with the resistome (comprising all antibiotic resistance genes) in wastewater from a specialized hospital for infectious diseases in Shanghai. Potential pathogenic bacteria (e.g.,
Escherichia coli
,
Pseudomonas aeruginosa
,
Klebsiella pneumoniae
,
Enterococcus B faecium
) were frequently detected in hospital wastewater and carried multiple ARGs. A complex link between microbiome and resistome was observed in the wastewater of this hospital. The monitoring of ARGs and antibiotic-resistant bacteria (ARB) in hospital wastewater might be of great significance for preventing the spread of ARB.
Provenance Evolution and Its Response to Sea Level Change in the South Yellow Sea since 1.0 Ma
Authors: Wang Zhonglei , Zhang Yong , Mi Beibei , Wang Zhongbo , Dou Yanguang , Cong Jingyi , Sun Jun 
Published: December 2023

Abstract
The sediments provenance of the South Yellow Sea is controlled by many factors such as sea level change, ocean circulation, and neotectonic movement. The short time scale sediments provenance changes in this region since the Holocene have been revealed well, and a unified understanding has been formed that the central muddy area in the South Yellow Sea is a mixed area of the Yellow River sediments and the Yangtze River sediments. However, the contribution of different rivers to the sediments of the South Yellow Sea since late Quaternary is still ambiguous. Through comparative analysis of several boreholes with precise annual data constraints in the central mud area, the process of sediments provenance change at different periods since the late Early Pleistocene (1.0 Ma) was reconstructed, and the coupling mechanism of sediments provenance change and sea level change was established. It is found that during the period from 1.0 to 0.88 Ma, the seawater entered the South Yellow Sea along the Yellow Sea trough from the southeast to north as a channel, and there were different phenomena at the same time in different regions. Since 0.88 Ma, the sea water has been advancing from east to west. In addition, the sediments in the western of Jeju Island are mainly from China, and the sediments in the eastern are mainly from the Korean Peninsula, which roughly coincides with the boundary between the silty area and the sandy area on the eastern of the South Yellow Sea. In the surface sediments, the boundary line between the Yellow River sediments and the Yangtze River sediments is approximately 33.4° N.
The impact of decentralisation on health systems: a systematic review of reviews
Authors: Sapkota Sujata , Dhakal Amshu , Rushton Simon , van Teijlingen Edwin , Marahatta Sujan B , Balen Julie , Lee Andrew CK 
Published: December 2023

BackgroundDecentralisation is a common mechanism for health system reform; yet, evidence of how it impacts health systems remains fragmented. Despite published findings from primary and secondary research illustrating range of impacts, a comprehensive and clear understanding is currently lacking. This review synthesised the existing evidence to assess how decentralisation (by devolution) impacts each of the six WHO building blocks, and the health system.MethodWe systematically searched five electronic databases for reviews exploring impact of decentralisation on health systems, globally. Reviews, both systematic and non-systematic, published in the English language from January 1990 to February 2022 were included. Data were synthesised across each of six building blocks. Quality assessment of the reviews was conducted using Critical Appraisal Skills Program for systematic and Scale for Assessment of Narrative Review Articles for non-systematic reviews.ResultsNine reviews, each addressing somewhat different questions, contexts and issues, were included. A range of positive and negative impacts of decentralisation on health system building blocks were identified; yet, overall, the impacts were more negative. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself.ConclusionsDecentralisation, even if well intentioned, can have unintended consequences. Despite the difficulty of reaching universally applicable conclusions about the pros and cons of decentralisation, this review highlights some of the common potential issues to consider in advance.PROSPERO registration numberCRD42022302013.
Benefits and harms of breast cancer screening revisited: a large, retrospective cross-sectional study quantifying treatment intensity in women with screen-detected versus non-screen-detected cancer in Australia and New Zealand
Authors: Dempsey Kathy , Costa Daniel SJ , Brennan Meagan E , Mann G Bruce , Snook Kylie L , Spillane Andrew J 
Published: December 2023

ObjectivesNon-mortality benefits of breast cancer screening are rarely considered in assessments of benefits versus harms. This study aims to estimate the rate of overdiagnosis in women with screen-detected breast cancer (SDBC) by allocating cases to either possibly overdiagnosed (POD) or not overdiagnosed categories and to compare treatment recommendations for surgery and adjuvant treatments by category, age at diagnosis and cancer stage.Methods and analysisRetrospective secondary analysis of 10 191 women diagnosed with breast cancer in Australia and New Zealand in 2018. Treatment recommendations for 5226 women with SDBC and 4965 women with non-SDBC (NSDBC) were collated and analysed. Descriptive statistics were used to calculate proportions and risk ratios (RRs).ResultsThe POD rate was 15.8%. Screening detected 66.3% of stage 0 tumours, 59% of stage 1, 40% of stage 2 and 27.5% of stage 3 tumours. Women with SDBC were less likely than their NSDBC counterparts to receive chemotherapy (RR 0.60 Aus/0.53 NZ), immunotherapy (mostly human epidermal growth factor 2 receptor therapy) (RR 0.58 Aus/0.82 NZ), mastectomy (RR 0.55 Aus/0.63 NZ) and axillary lymph node dissection (RR 0.49 Aus/0.52 NZ), or to require both mastectomy and radiotherapy (RR 0.41 Aus/0.34 NZ). Less than 1% of POD women were recommended chemotherapy, 9.5% radiotherapy, 6.4% endocrine therapy, 2.2% mastectomy and 0.5% axillary lymph node dissection.ConclusionsWomen with SDBCs required less intensive treatment; rates of possible overtreatment of SDBCs are relatively low and may be minimised through multidisciplinary discussion and shared decision-making. Reduced treatment intensity should be considered when balancing the potential benefits and harms of screening.
Contribution of hospitals and clinical services to global warming: protocol for a scoping review
Authors: Merino-Urrutia Waldo , Cárcamo-Fuentes Claudio , Peña Mauricio , Martinez-Zapata María José 
Published: December 2023

IntroductionClimate change is one of the greatest threats to public health today, placing considerable pressure on the healthcare sector. During patient care processes, hospital facilities contribute to greenhouse gas emissions through the use of greater resources and higher energy consumption. Consequently, there is growing interest among researchers, universities, organisations and governments to study the impact of the healthcare sector on the environment and to develop strategies to mitigate its effects. The aim of this scoping review is to determine the extent and nature of current literature on global warming from hospitals and clinical services, and ways in which they contribute to its effect. Planning and execution of future research are possible once those areas with existing gaps are identified.Methods and analysisA broad literature search will be carried out to illustrate the ways in which hospitals and clinical services, processes and activities contribute to climate change. Our protocol was drafted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The final protocol was registered prospectively with the Open Science Framework. All identified studies indexed in Medline, Scopus and Embase will be examined.Ethics and disseminationThis project is literature-based research; therefore, it does not require ethical approval. The results will be presented to researchers as well as policymakers in this particular area, via conferences, webinars, podcasts and online events. A peer-reviewed publication will be submitted to specific journals of interest.
Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis
Authors: Liu Qianqian , Huang Min , Yang Jing , Jiang Mengyuan , Zhao Ziru , Zhao Haitong , He Tingting , Bai Yuping , Zhang Rui , Zhang Min 
Published: December 2023

ObjectiveClinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.DesignSystematic review and meta-analysis of primary studies.Data sourcesPubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.Eligibility criteria for selecting studiesStudies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.Data extraction and synthesisOR with 95% conference intervals was extracted and pooled.ResultsA total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph–vascular invasion were not significantly associated with the lymph node yield.ConclusionsThe study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.
Nationwide survey of physicians’ familiarity and awareness of diabetes guidelines in China: a cross-sectional study
Authors: Jia Li-yan , Huang Cao-xin , Zhao Neng-jiang , Lai Bao-yong , Zhang Zhi-hai , Li Le , Zhan Na , Lin Yuan-bing , Cai Miao-na , Wang Shun-qin , Yan Bing , Liu Jian-ping , Yang Shu-yu 
Published: December 2023

ObjectiveThis study aims to investigate physicians’ familiarity and awareness of four diabetes guidelines and their practice of the recommendations outlined in these guidelines.DesignA cross-sectional study.SettingAn online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians.Participants1150 physicians from 192 cities across 30 provinces in China provided complete data.ResultsTertiary care hospital physicians (TCPs) exhibited the highest familiarity with the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China (91.3%), followed by the National Guidelines for the Prevention and Control of Diabetes in Primary Care (76.8%), the Standards of Medical Care in Diabetes (72.2%) and the Guidelines for Prevention and Treatment of Diabetes in Chinese Medicine (63.8%). Primary care practitioners (PCPs) exhibited familiarity with these four guidelines at about 50% or less. Self-reported reference to modern diabetes guidelines by physicians is more frequent than traditional Chinese medicine (TCM) diabetes guidelines, with rates at 73.2% and 33.8%, respectively. Approximately 90% of physicians provided instructions on self-monitoring of blood glucose to their patients with diabetes. Less than one-third of physicians referred patients to a specialised nutritionist. In terms of health education management, TCPs reported having a diabetes health management team at the rate of 75.7%, followed by secondary care hospital physicians at 57.0% and PCPs at 27.5%. Furthermore, approximately 40% of physicians did not fully grasp hypoglycaemia characteristics.ConclusionsFamiliarity and awareness of the screening guidelines varied among physicians in different hospital settings. Importantly, significant discrepancies were observed between physicians’ awareness and their self-reported reference to modern medicine guidelines and TCM guidelines. It is essential to consistently provide education and training on diabetes management for all physicians, particularly PCPs.
Prevalence of psychological distress in nurses, physicians and leaders working in intensive care units during the COVID-19 pandemic: a national one-year follow-up study
Authors: Hovland Ingvild Strand , Skogstad Laila , Stafseth Siv , Hem Erlend , Diep Lien M , Ræder Johan , Ekeberg Øivind , Lie Irene 
Published: December 2023

ObjectiveTo report and compare psychological distress as symptoms of anxiety, depression and post-traumatic stress among intensive care units’ (ICU) nurses, physicians and leaders at 12 months after the baseline survey (spring 2020), during the COVID-19 pandemic in Norway. Furthermore, to analyse which baseline demographic and COVID ICU-related factors have a significant impact on psychological distress at 12 months.DesignProspective, longitudinal, observational cohort study.SettingNationwide, 27 of 28 hospitals with COVID ICUs in Norway.ParticipantsNurses, physicians and their leaders. At 12 month follow-up 287 (59.3%) of 484 baseline participants responded.Primary and secondary outcome measuresSymptoms of anxiety and depression using the Hopkins Symptoms Checklist-10 (HSCL-10). Symptoms of post-traumatic stress using the post-traumatic stress disease checklist for the Diagnostic and Statistical Manual of Mental Disorders 5 (PCL-5).Demographics (included previous symptoms of anxiety and depression) and COVID ICU-related factors (professional preparations, emotional experience and support) impacting distress at 12 months.ResultsPsychological distress, defined as caseness on either or both HSCL-10 and PCL-5, did not change significantly and was present for 13.6% of the participants at baseline and 13.2% at 12 month follow-up. Nurses reported significantly higher levels of psychological distress than physicians and leaders. Adjusted for demographics and the COVID ICU-related factors at baseline, previous symptoms of depression and fear of infection were significantly associated with higher levels of anxiety and depression at 12 months. Previous symptoms of depression, fear of infection and feeling of loneliness was significantly associated with more symptoms of post-traumatic stress.ConclusionOne year into the COVID-19 pandemic 13.2% of the ICUs professionals reported psychological distress, more frequently among the nurses. Fear of infection, loneliness and previous symptoms of depression reported at baseline were associated with higher levels of distress. Protective equipment and peer support are recommended to mitigate distress.Trial registration numberClinicalTrials.gov. Identifier:NCT04372056.
Study protocol for a national observational cohort investigating frailty, delirium and multimorbidity in older surgical patients: the third Sprint National Anaesthesia Project (SNAP 3)
Authors: Swarbrick Claire , Poulton Tom , Martin Peter , Partridge Judith , Moppett Iain Keith 
Published: December 2023

IntroductionOlder surgical patients are more likely to be living with frailty and multimorbidity and experience postoperative complications. The management of these conditions in the perioperative pathway is evolving. In order to support objective decision-making for patients, services and national guidance, accurate, contemporary data are needed to describe the impact and associations between frailty, multimorbidity and healthcare processes with patient and service-level outcomes.Methods and analysisThe study is comprised of an observational cohort study of approximately 7500 patients; an organisational survey of perioperative services and a clinician survey of the unplanned, medical workload generated from older surgical patients. The cohort will consist of patients who are 60 years and older, undergoing a surgical procedure during a 5-day recruitment period in participating UK hospitals. Participants will be assessed for baseline frailty and multimorbidity; postoperative morbidity including delirium; and quality of life. Data linkage will provide additional details about individuals, their admission and mortality.The study’s primary outcome is length of stay, other outcome measures include incidence of postoperative morbidity and delirium; readmission, mortality and quality of life. The cohort’s incidence of frailty, multimorbidity and delirium will be estimated using 95% CIs. Their relationships with outcome measures will be examined using unadjusted and adjusted multilevel regression analyses. Choice of covariates in the adjusted models will be prespecified, based on directed acyclic graphs.A parallel study is planned to take place in Australia in 2022.Ethics and disseminationThe study has received approval from the Scotland A Research Ethics Committee and Wales Research Ethics Committee 7.This work hopes to influence the development of services and guidelines. We will publish our findings in peer-reviewed journals and provide summary documents to our participants, sites, healthcare policy-makers and the public.Trial registration numberISRCTN67043129.
Prevalence and factors associated with hypertension among adolescents in Sudan: a cross-sectional school-based study
Authors: Hassan Ahmed Ali , Al-Nafeesah Abdullah , AlEed Ashwaq , Adam Ishag 
Published: December 2023

ObjectivesThere is an increasing rate of elevated blood pressure, or hypertension, in children and adolescents worldwide, including Sub-Saharan Africa (SSA). Only a few data on adolescent hypertension in SSA, including Sudan, have been published. The aim of the present study was to investigate the prevalence and associated factors of hypertension among adolescent schoolchildren (within the ages of 10 to 19 years) in Sudan.DesignA cross-sectional school-based study was conducted from June to September 2022.SettingsSix randomly selected schools in Almatamah, River Nile State, Sudan.ParticipantsAdolescent schoolchildren (within the ages of 10 to 19 years).Main outcome measuresSociodemographic information. Anthropometric and blood pressure measurements were performed in accordance with the standard procedures. An adjusted logistic regression analysis was performed.ResultsOf the 384 enrolled adolescents, 166 (43.2%) and 218 (56.8%) were boys and girls, respectively. The median (IQR) age and body mass index (BMI) were 15.2 years (14.0‒16.4 years) and 18.5 kg/m2(16.4‒21.5 kg/m2), respectively. Of the 384 adolescents, 240 (62.5%) and 255 (66.4%) had educated mothers and fathers (≥secondary), respectively. 38 adolescents (9.9%) had hypertension (≥95th percentile). The multivariable logistic regression analysis revealed that age, sex and maternal educational level were not associated with hypertension. Paternal educational level according to secondary education attainment (adjusted OR (AOR), 2.72; 95% CI 1.36‒5.46) and increasing BMI (AOR, 1.12; 95% CI 1.02‒1.20) were associated with hypertension.Conclusion1 in 10 adolescents in northern Sudan was hypertensive. Low paternal educational level and increasing BMI were significantly associated with hypertension. The introduction of interventional nutritional programmes at early ages is needed to ensure that adolescents are healthy in their present and later lives. To sustain such programmes, involving all educational parties at early stage is essential.