bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time is tissue. Want to save millions in wound care? Start early: a QI project to expedite referral of high-risk wound care patients to specialised care
Authors: Hwang John Muen 
Published: March 2023

IntroductionWound care is a multibillion-dollar industry, and most research and treatment are geared towards late-stage or end-stage care. The longer a patient has a wound, the more likely it is that complications (like sepsis or vascular compromise) will occur that will both extend treatment and multiply costs. We postulated that much of the suffering and healthcare costs of chronic wounds could be avoided by early identification of high-risk patients and subsequent earlier intervention. In an established regional wound clinic, our aim was to decrease referral times by 50% within 1 year, and to demonstrate the beneficial outcomes on wound healing and total cost of care.MethodsA prospective interventional quality improvement study was performed between June 2017 and June 2018. We determined baseline referral times to the clinic and then performed three interventions. The effects on referral time, healing time and number of home care visits to achieve wound healing were collected and displayed on annotated control charts. The cost of care and potential for cost avoidance was determined by an analysis of the medical encounters of twenty chronic wound patients.ResultsWe achieved a 53.6% reduction in average referral times to the clinic, a 59.6% reduction in average healing times and a 66.0% reduction in the average number of home care visits required to achieve healing. Our cost analysis suggested the potential for significant cost avoidance (87.7%) compared with delayed treatment outside the clinic.ConclusionsEarly identification and treatment of patients at high risk for wound chronicity and complications, followed by early referral to and treatment at a specialised wound clinic, resulted in faster healing and reduced health system costs.
Impact of alcohol taxes on violence in Hong Kong: a population-based interrupted time series analysis
Authors: Ng Carmen S , Au Minnie , Tian Linwei , Quan Jianchao 
Published: March 2023

BackgroundInterpersonal violence is a major public health concern with alcohol use a known risk factor. Despite alcohol taxation being an effective policy to reduce consumption; Hong Kong, contrary to most developed economies, embarked on an alcohol tax reduction and elimination policy.MethodsTo assess the impact of the alcohol tax reductions, we analysed population-based hospitalisation data for assault from the Hong Kong Hospital Authority, and violent and sexual crimes recorded by the Hong Kong Police Force (2004–2018). We conducted an interrupted time series using seasonal autoregressive integrated moving average models on monthly rates. Breakpoints in March 2007 and March 2008 were applied separately.ResultsThe 2007 tax cut was associated with sustained increases in violence-related hospitalisation rates for 35–49 age group (female: 0.19%, p=0.007; male: 0.22%, p<0.001; overall: 0.16%, p=0.007); and an immediate increase of 51.3% (p=0.005) in the rate of sexual crimes reported. Results for the 35–49 age group after the 2008 tax cut were similar with sustained increases in hospitalisation rates (female: 0.21%, p=0.010; male: 0.23%, p<0.001; overall: 0.17%, p<0.001). The 2008 tax cut was also associated with immediate increases in hospitalisation rates in children (female: 33.1%, p=0.011; male: 49.2%, p<0.001, overall: 31.5%, p=0.007). For both tax cuts, results were insignificant in males and females for other age groups (15–34 and 50+ years).ConclusionsBoth alcohol tax reductions in 2007 and 2008 were in some age groups associated with increases in violence-related hospitalisations and reports of sexual assault even in an environment of low crime.
Poor adherence to dust, noise and safety regulations predict injury rates in underground coal mines
Authors: Friedman Lee S , Shannon Brett , Go Leonard H T , Shao Yuan , Almberg Kirsten S , Cohen Robert A 
Published: March 2023

BackgroundWhile safety in US coal mining has improved over the past two decades, general occupational health research shows that risk of injury varies across individual worksites and is influenced by worksite safety cultures and practices.MethodsIn this longitudinal study, we evaluated whether mine-level characteristics reflecting poor adherence to health and safety regulations in underground coal mines are associated with higher acute injury rates. We aggregated Mine Safety and Health Administration (MSHA) data by year for each underground coal mine for the period 2000–2019. Data included part-50 injuries, mine characteristics, employment and production, dust sampling, noise sampling, and violations. Multivariable hierarchical generalised estimating equations (GEE) models were developed.ResultsBased on the final GEE model, despite an average annual decline in injury rates by 5.5%, the following indicators of inadequate adherence to health and safety regulations were associated with increased average annual injury rates: +2.9% for each 10% increase in dust samples exceeding the permissible exposure limit; +0.6% for each 10% increase of permitted 90 dBA 8-hour noise exposure dose; +2.0% for every 10 substantial-significant MSHA violations in a year; +1.8% for each rescue/recovery procedure violation; +2.6% for each safeguard violation. If a fatality occurred in a mine, injury rates increased by 11.9% in the same year, but declined by 10.4% in the following year. The presence of safety committees was associated with a 14.5% decline in injury rates.DiscussionIn US underground coal mines, injury rates are associated with poor adherence to dust, noise and safety regulations.
Late-onset and classic phenotypes of Fabry disease in males with theGLA-Thr410Ala mutation
Authors: Valtola Kati , Hedman Marja , Kantola Ilkka , Walls Susanne , Helisalmi Seppo , Maria Maleeha , Raivo Joose , Auray-Blais Christiane , Kuusisto Johanna 
Published: March 2023

ObjectiveTo present phenotypic characteristics and biomarkers of a family with the rare mutation Thr410Ala of theα-galactosidase Agene (T410A/GLA) causing Fabry disease (FD).Methods and resultsIn a woman in her 60s with hypertrophic cardiomyopathy, T410A/GLAwas found in screening for variants in 59 cardiomyopathy-related genes. Her son in his 40s, two granddaughters and two great grandsons carried T410A/GLA. The son had a history of hypertension and paroxysmal AF but no microalbuminuria or classic symptoms or signs of FD. Baseline α-galactosidase A enzyme (α-Gal A) activity varied from 0% to 26.5%. Cardiac MRI showed mild Fabry cardiomyopathy (FC). During 11 years of enzyme replacement therapy (ERT), FC progressed and he suffered sudden cardiac death in his 50s. The great grandsons with T410A/GLAhad no active α-Gal A, high lyso-Gb3levels and normal cardiac imaging. They suffered from neuropathic pain and gastrointestinal symptoms and were started with ERT at the age under 10. Granddaughters with T410A/GLAhad α-Gal A activities of 8–18 and 10% of normal. The older granddaughter in her 30s was diagnosed with incipient FC. Plasma lyso-Gb3analogues were elevated, markedly in the elder male with FC and moderately in the elder granddaughter. In young males with classic phenotype, plasma lyso-Gb3analogues were only slightly elevated.ConclusionsThe T410A/GLAmutation caused late-onset FD with progressive cardiomyopathy in elder male, and classic FD in young males of the same family. Varying levels of α-Gal A and lyso-Gb3analogues reflected variable phenotype of FD in the family.
Serum B-type natriuretic peptide levels (BNP) can be used as a predictor of complications in patients undergoing non-cardiac surgery: a prospective observational study
Authors: Singh Abhishek , Kumar Anil , Hai Ahmed Abdul , Masihullah Masihullah , Tripathy Nishant , Singh Pintu Kumar 
Published: March 2023

ObjectivesWorldwide, an estimated 10 million adults annually experience significant myocardial injury after non-cardiac surgery. Our aim is to assess whether preoperative and postoperative serum B-type natriuretic peptides levels (BNP) could be used as a predictor of postoperative complications in hypertensive and diabetic patients post non-cardiac surgery.DesignProspective observational study.SettingSingle tertiary-care centre in northern India.ParticipantsThis study included 260 adult participants with known hypertension and diabetes who were planned for elective non-cardiac surgery.InterventionsA preoperative BNP level (baseline BNP) was measured within 24 hours of surgery and another postoperative BNP level was measured within 24 hours of surgery.Main outcome measuresThe primary outcome was the change in BNP levels (delta BNP) between the postoperative and the preoperative BNP levels (baseline BNP) with respect to the baseline BNP and the development of postoperative complications within 30 days of surgery.ResultsThe study established a correlation between delta BNP and baseline BNP (Pearson’s correlation coefficient=0.60; p=0.01). Our study found an increased serum BNP both in the preoperative period and the postoperative period in the patient group that developed complications, respectively (152.02 pg/mL±106.56 vs 44.90 pg/mL±44.22; t=4.120; p≤0.001); (313.99 pg/mL±121.29 vs 83.95 pg/mL±70.19; t=7.73; p≤0.001).ConclusionsWe found that an increased serum baseline and postoperative BNP is potentially important predictor for the development of postoperative complications. Serum BNP has the potential to emerge as a cost-effective test for risk-stratification for postoperative complications in patients undergoing non-cardiac surgery. It has promising prognostic advantages including modification of surgical procedures, deferral of surgery and the ability to tailor therapy postoperatively.
Crystallization of short-acting and intermediate-acting local anesthetics when mixed with adjuvants: a semiquantitative light microscopy analysis
Authors: Hoerner Elisabeth , Stundner Ottokar , Fiegl Heidi , Gasteiger Lukas 
Published: March 2023

IntroductionThe addition of adjuvants to short-acting local anesthetics (LA) is common practice in clinical routine to speed up block onset and decrease pain on injection. In a previous study, we observed the development of microscopic crystal precipitations after bupivacaine or ropivacaine were mixed with adjuvants; this follow-up study is intended to clarify whether crystallization (A) also occurs in short-acting or intermediate-acting LA-adjuvant mixtures, (B) changes over time, and (C) is associated with the solutions’ pH.MethodsLidocaine 2%, prilocaine 2%, mepivacaine 2%, procaine 2% and chloroprocaine 2% were individually mixed with clonidine, dexamethasone, dexmedetomidine, epinephrine, fentanyl, morphine or sodium bicarbonate 8.4% in clinically established ratios. For each mixture, we measured initial pH and recorded crystallization patterns at 0, 15, 30 and 60 min using a standardized, semiquantitative light microscopy approach.ResultsLidocaine 2% and mepivacaine 2% plus sodium bicarbonate 8.4%, and mepivacaine 2% plus dexamethasone developed delayed grade 5 crystallization over 1 hour. Prilocaine-based, procaine-based and chloroprocaine-based mixtures showed much less pronounced crystallization, with a maximum of grade 2. Initial pH and grade of crystallization showed weak monotonic relationships at time points t0, t15and t30(ρ=−0.17, 0.31 and 0.32, (all p>0.05)) and a moderate relationship time point t60(ρ=0.57 (p=0.0003))ConclusionsOur study revealed high grades of crystallization in lidocaine/mepivacaine-bicarbonate and mepivacaine-dexamethasone mixtures, although these were previously considered safe for local, perineural or neuraxial use. Our findings cast particular doubt on the safety of preparing these formulations for later use.
Work participation in patients with axial spondyloarthritis: high prevalence of negative workplace experiences and long-term work impairment
Authors: Kiltz Uta , Hoeper Kirsten , Hammel Ludwig , Lieb Sebastian , Hähle Andreas , Meyer-Olson Dirk 
Published: March 2023

IntroductionAxial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects people in their second and third decades of life, which are important years for establishing a professional career. We aim to study outcomes of work participation (WP) and their associations with demographic and clinical confounders, in addition to prevalence of negative workplace experiences in axSpA.MethodsIn total, 770 patients with axSpA participated in the multicentre, observational ATTENTUS–axSpA survey in Germany. Demographic information, clinical parameters and patient-related outcomes (including disease activity and function) with a focus on WP were prospectively recorded.ResultsA high prevalence of negative workplace experiences was reported among the 770 patients analysed. Overall, 23.4% of patients were not employed and 6.5% received disability pensions. Current work cessation was prevalent in 120 patients, and 28 of those were out of work for 10 years or longer. Of the 590 currently employed patients, 31.9% reported absenteeism and 35.9% reported presenteeism for >1 month within the past year. Multivariate logistic regression identified low disease activity (Bath Ankylosing Spondylitis Disease Activity Index), better physical function (Bath Ankylosing Spondylitis Functional Index) and better global functioning (Assessment of SpondylAarthritis International Society–Health Index) as the main predictors for unimpaired WP (n=242). Importantly, biological treatment, disease duration, age, sex, education level and body mass index were not reliable predictors.DiscussionDespite improvements in pharmacological treatment options, we still observed substantially impaired WP in patients with axSpA. These data emphasise the high unmet need for targeted strategies to provide improved medical and social care.
Impact of patient ancestry on heterogeneity of Sjögren’s disease
Authors: Beydon Maxime , Seror Raphaele , Le Guern Véronique , Chretien Pascale , Mariette Xavier , Nocturne Gaetane 
Published: March 2023

ObjectivesWe aimed to compare disease characteristics between primary Sjögren’s syndrome (pSS) patients of African ancestry (AA) and Caucasian ancestry.MethodsWe conducted a retrospective, case–control study in a French national and European referral centre for pSS. All patients with pSS of AA were matched with two Caucasians patients having similar follow-up duration. We explored clinical and biological parameters associated with a cumulative EULAR Sjögren’s Syndrome Disease Activity Index (cumESSDAI ≥5) (consisting of individual clinESSDAI domain maximum throughout follow-up).ResultsWe identified 74 patients of AA matched with 148 Caucasian. Median age at pSS diagnosis was younger in AA patients (43 years (IQR 33–51) vs 56 years (44.8–59.2), p<0.001). AA patients presented higher median titre of gammaglobulins (18.5 g/L (IQR 15–22.8) vs 13.4 g/L (9.9–16.9), p<0.001), more frequently positive for anti-SSA (88% vs 72%, p=0.007) and anti-RNP (11% vs 2.7%, p=0.023) antibodies. During the follow-up (median: 6 years (IQR 2–11)), AA patients presented more systemic complications: arthritis, myositis, interstitial lung disease, lymphadenopathy, central nervous system involvement. Median cumESSDAI score was higher in AA patients (7.5 (IQR 3.2–16.0) vs 4.0 (IQR 2.0–9.0), p=0.002). Interestingly, in multivariate analyses, factors associated with disease activity were sub-Saharan AA (OR 2.65 (95% CI 1.06 to 6.94)), rheumatoid factor (OR 2.50 (95% CI 1.28 to 4.96)) and anti-RNP positivity (OR 11.1 (95% CI 1.88 to 212)).ConclusionPatients of AA display higher disease activity with a hallmark of higher B-cell activation. Studies to investigate biological drivers behind such differences are needed.
Measuring quality STI care among adolescent female primary care patients in Philadelphia
Authors: Teixeira da Silva Daniel , Makeneni Spandana , Wall Hannah , Bauermeister José A. , Wood Sarah 
Published: March 2023

ObjectivesEngagement in guideline-recommended sexually transmitted infection (STI) care is fundamental to ending the STI epidemic in the USA. However, the US 2021–2025 STI National Strategic Plan and STI surveillance reports do not include a framework to measure quality STI care delivery. This study developed and applied an STI Care Continuum that can be used across settings to improve STI care quality, assess adherence to guideline-recommended care and standardise the measurement of progress towards National Strategic goals.MethodsReview of the Centers for Disease Control and Prevention STI Treatment guidelines identified seven distinct steps of STI care for gonorrhoea, chlamydia and syphilis: (1) STI testing indication, (2) STI test completion, (3) HIV testing, (4) STI diagnosis, (5) partner services, (6) STI treatment and (7) STI retesting. Steps 1–4, 6 and 7 for gonorrhoea and/or chlamydia (GC/CT) were measured among females aged 16–17 years with a clinic visit at an academic paediatric primary care network in 2019. We used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7.ResultsAmong 5484 female patients aged 16–17 years, an estimated 44% had an STI testing indication. Among those patients, 17% were tested for HIV, of whom none tested positive, and 43% were tested for GC/CT, 19% of whom were diagnosed with GC/CT. Of these patients, 91% received treatment within 2 weeks and 67% were retested within 6 weeks to 1 year after diagnosis. On retesting, 40% were diagnosed with recurrent GC/CT.ConclusionsLocal application of an STI Care Continuum identified STI testing, retesting and HIV testing as areas for improvement. The development of an STI Care Continuum identified novel measures for monitoring progress towards National Strategic indicators. Similar methods can be applied across jurisdictions to target resources, standardise data collection and reporting and improve STI care quality.
Expanding the pipeline for multipurpose prevention technologies: compounds with potential activity to prevent or treat HIV and other STIs
Authors: Young Holt Bethany , Hemmerling Anke , Moore Susanna , Yang Katherine 
Published: March 2023

BackgroundContinued high incidence of HIV and other STIs, paired with rising antibiotic resistance to a number of existing treatments, warrants the development of new pharmaceutical approaches for STI prevention. Multipurpose prevention technologies (MPTs) offer an innovative approach for expanding HIV/STI prevention. The majority of MPT product candidates currently in development include HIV prevention, while only half include compounds active against non-HIV STIs.MethodsThis narrative review focuses on compounds in preclinical development (in vitro and in vivo) through phase 3 clinical trials with activity against one or more of the following infections: HIV, HSV-1, HSV-2, Chlamydia trachomatis,Neisseria gonorrhoeae,Treponema pallidum, andTrichomonas vaginalis.Bacterial vaginosis is included due to its association with increased risk of STIs. The focus is on compounds with novel mechanisms of action and prophylactic and/or therapeutic potential. Articles published in PubMed between 2011 and 2021, NIH RePorter and conference abstracts and proceedings between 2020 and 2021 were searched. Excluded from the review are compounds that are already being used in MPT product candidates.Main resultsThere is a growing pipeline of compounds targeting viral STIs, many of which have successfully transitioned from preclinical to clinical stages of development. However, the product development pipeline remains limited for compounds that target bacterial STIs.ConclusionsThe paucity of new pharmaceutical approaches for STI prevention, particularly non-HIV STIs, remains a public health gap. Future funding priorities should include STI prevention research. Despite limited attention to STI prevention in the development of MPTs, many research institutions worldwide are working on discoveries of new compounds, exploring new indications for existing drugs or on innovative drug delivery mechanisms. Our findings can be used to connect researchers across the globe to advance the development of compounds that have potential as active pharmaceutical ingredients in future MPTs.
Dexamethasone-free antiemetic strategy for highly emetogenic chemotherapy: safety and efficacy-pilot study
Authors: Sharma Vinod , Kumar Akash , Baa Annie , Kirar Sudhir , Sharma Atul , Bakhshi Sameer , Gogia Ajay , Malik Prabhat Singh , Rastogi Sameer , Batra Atul , Pushpam Deepam , Kataria Babita , Sagiraju Hari , Sharma Aparna , Singh Vishwajeet 
Published: March 2023

ObjectivesDexamethasone sparing strategies have shown success. The feasibility of a dexamethasone-free antiemetic strategy remains undetermined. A prospective, single-arm, pilot study was planned to determine the efficacy of an olanzapine-based, dexamethasone-free, three-drug antiemetic regimen.MethodsChemotherapy naïve, adult patients (≥18 years) who received ondansetron, aprepitant and olanzapine during the first cycle of highly emetogenic chemotherapy were enrolled. The primary endpoint was the rate of complete response (CR: no vomiting and no use of rescue medications) during the overall period (0–120 hours).ResultsOut of the total of 101 patients enrolled, most were women (82%) and received anthracycline cyclophosphamide (73%) combination therapy. The rate of CR for the overall period was 65% (95% CI 55.2% to 74.5%). The rate of CR for the acute and delayed period was 79% (95% CI 70% to 86.7%) and 76% (95% CI 66.7% to 84.1%). The rate of nausea control rates for the acute, delayed and overall periods were 34%, 29% and 24%, respectively. The grade I, II and III sedation rates over the 5 days were 8%, 5% and 1%, respectively.ConclusionsThe dexamethasone-free antiemetic strategy showed modest efficacy with low incidence of clinically significant somnolence. There is a need to prospectively investigate the role of dexamethasone in the era of newer potent antiemetics in a randomised fashion.Trial registration numberCTRI/2021/07/034813.