bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of maternal lipid levels with birth weight and cord blood insulin: a Bayesian network analysis
Authors: Wang Jingya , Kuang Yashu , Shen Songying , Price Malcolm James , Lu Jinhua , Sattar Naveed , He Jianrong , Pittavino Marta , Xia Huimin , Thomas G.Neil , Qiu Xiu , Cheng Kar Keung , Nirantharakumar Krishnarajah 
Published: December 2022

ObjectiveTo assess the independent association of maternal lipid levels with birth weight and cord blood insulin (CBI) level.SettingThe Born in Guangzhou Cohort Study, Guangzhou, China.ParticipantsWomen who delivered between January 2015 and June 2016 and with umbilical cord blood retained were eligible for this study. Those with prepregnancy health conditions, without an available fasting blood sample in the second trimester, or without demographic and glycaemic information were excluded. After random selection, data from 1522 mother–child pairs were used in this study.Exposures and outcome measuresAdditive Bayesian network analysis was used to investigate the interdependency of lipid profiles with other metabolic risk factors (prepregnancy body mass index (BMI), fasting glucose and early gestational weight gain) in association with birth weight and CBI, along with multivariable linear regression models.ResultsIn multivariable linear regressions, maternal triglyceride was associated with increased birth weight (adjusted β=67.46, 95% CI 41.85 to 93.06 g per mmol/L) and CBI (adjusted β=0.89, 95% CI 0.06 to 1.72 μU/mL per mmol/L increase), while high-density lipoprotein cholesterol was associated with decreased birth weight (adjusted β=−45.29, 95% CI −85.49 to −5.09 g per mmol/L). After considering the interdependency of maternal metabolic risk factors in the Network analysis, none of the maternal lipid profiles was independently associated with birth weight and CBI. Instead, prepregnancy BMI was the global strongest factor for birth weight and CBI directly and indirectly.ConclusionsGestational dyslipidaemia appears to be secondary to metabolic dysfunction with no clear association with metabolic adverse outcomes in neonates. Maternal prepregnancy overweight/obesity appears the most influential upstream metabolic risk factor for both maternal and neonatal metabolic health; these data imply weight management may need to be addressed from the preconception period and during early pregnancy.
Informed self-assessment during the transition to medical school: a longitudinal narrative study
Authors: McDonald Jenny , Ryan Samantha , Heeneman Sylvia , Hu Wendy 
Published: December 2022

ObjectivesTo explore how medical students’ narratives of informed self-assessment (ISA) change during their first 18 months of study.DesignThis longitudinal study used student narratives drawn from qualitative interviews and written reflections during the transition to medical school, to examine changes in ISA. Our analysis was informed by Situated Cognition Theory which recognises the impact and interplay of personal and environmental factors in cognition.SettingTo study medicine, first year students need to adapt their self-regulated learning in the context of a new peer group, study demands and educational culture. During this adaptation, students need to seek and interpret available cues to inform their self-assessment.ParticipantsLongitudinal data were collected at five time points over 18 months from a diverse sample of seven first year medical students in an undergraduate medical programme, including 13.5 hours of interviews and 12 written reflections.ResultsBefore and after starting medical school, the participants’ self-assessments were informed by environmental influences (exam results and comparison with peers), and personal influences (fear of failure and anxiety about not belonging). Early uncertainty meant self-assessments were overestimated and underestimated.By the end of first year, an enhanced sense of belonging coincided with less fear of failure, less emphasis on exam performance and reduced competition with peers. Self-assessments became increasingly informed by evidence of clinical skills and knowledge gained related to future professional competence.ConclusionInfluences on medical students’ ISAs change during the transition to studying medicine. A greater sense of belonging, and evidence of progress towards clinical competence became more important to self-assessment than comparison with peers and exam performance. Our findings reinforce the importance of formative assessments, opportunities to study and socialise with peers and early clinical experiences during first year. These experiences enhance ISA skills during the transition to medical school.
Negative predictive value of the FebriDx host response point-of-care test in patients presenting to a single Australian emergency department with suspected COVID-19: an observational diagnostic accuracy study
Authors: Buntine Paul , Miller Joseph , Pope Alun , Guy Stephen , Wong Fang Qi (Alex) , McDonald Hannah , Ahmed Mania , Teow Kang Hui , Roney Morgan , Mohammadi Farzaneh , Aldridge Emogene , Hackett Liam , Jenner Susanna , Davis Belinda 
Published: December 2022

ObjectivesTo determine the negative predictive value (NPV) of the FebriDx point-of-care host response device in patients presenting with symptoms suggestive of COVID-19 infection in a mostly immunised Australian emergency department (ED) population during the late 2021 phase of the COVID-19 pandemic.DesignObservational diagnostic accuracy study comparing FebriDx point-of-care test to SARS-CoV-2 PCR.SettingAn ED in Melbourne, Australia, with 63 000 annual presentations in 2021.ParticipantsPatients aged 16 and over who met the Victorian Department of Health case definition for suspected COVID-19 infection PCR testing. Patients meeting any of the following criteria were excluded: <16 years of age; acute respiratory symptom(s) with onset>14 days prior to testing; current immunosuppressive or interferon therapy; live immunisation within the last 30 days; fever lasting>7 days; antibiotic or antiviral use in the preceding 14 days; experience of major trauma, major surgical intervention or severe burns within the last 30 days.Primary and secondary outcome measuresCOVID-19 PCR results (detected, not detected) and FebriDx results (bacterial positive, viral negative, viral positive).Results94 participants were enrolled (female: 46; male: 48), 34% of participants (tested positive for COVID-19 according to PCR results, with a background incidence among all adult ED attenders of 2.5%. The sensitivity of FebriDx for detection of COVID-19 was 56% (95% CI 40% to 100%) and specificity was 92% (95% CI 84% to 100%). For the population tested, this resulted in an NPV of 80% (95% CI 71% to 100%) and a positive predictive value of 78% (95% CI 60% to 100%).ConclusionsIn the context of a population with low COVID-19 infection rates, an evolved variant of COVID-19 and a very high community COVID-19 vaccination rate, FebriDx demonstrated reduced sensitivity and NPV relative to results from earlier international tests. These contextual factors should be considered during any attempt to generalise the current results.Trial registration numberACTRN12620001029987 (Australian Clinical Trials).
Postsurgery paths and outcomes for hip fracture patients (POST-OP HIP PATHS): a population-based retrospective cohort study protocol
Authors: Backman Chantal , Shah Soha , Webber Colleen , Turcotte Luke , McIsaac D I , Papp Steve , Harley Anne , Beaulé Paul , French-Merkley Véronique , Berdusco Randa , Poitras Stephane , Tanuseputro Peter 
Published: December 2022

IntroductionHip fracture patients receive varying levels of support posthip fracture surgery and often experience significant disability and increased risk of mortality. Best practice guidelines recommend that all hip fracture patients receive active rehabilitation following their acute care stay, with rehabilitation beginning no later than 6 days following surgery. Nevertheless, patients frequently experience gaps in care including delays and variation in rehabilitation services they receive. We aim to understand the factors that drive these practice variations for older adults following hip fracture surgery, and their impact on patient outcomes.Methods and analysisWe will conduct a retrospective population-based cohort study using routinely collected health administrative data housed at ICES. The study population will include all individuals with a unilateral hip fracture aged 50 and older who underwent surgical repair in Ontario, Canada between 1 January 2015 and 31 December 2018. We will use unadjusted and multilevel, multivariable adjusted regression models to identify predictors of rehabilitation setting, time to rehabilitation and length of rehabilitation, with predictors prespecified including patient sociodemographics, baseline health and characteristics of the acute (surgical) episode. We will examine outcomes after rehabilitation, including place of care/residence at 6 and 12 months postrehabilitation, as well as other short-term and long-term outcomes.Ethics and disseminationThe use of the data in this project is authorised under section 45 of Ontario’s Personal Health Information Protection Act and does not require review by a Research Ethics Board. Results will be disseminated through conference presentations and in peer-reviewed journals.
Association of pregnancy complications/risk factors with the development of future long-term health conditions in women: overarching protocol for umbrella reviews
Authors: Singh Megha , Crowe Francesca , Thangaratinam Shakila , Abel Kathryn Mary , Black Mairead , Okoth Kelvin , Riley Richard , Eastwood Kelly-Ann , Hope Holly , Wambua Steven , Healey Jemma , Lee Siang Ing , Phillips Katherine , Vowles Zoe , Cockburn Neil , Moss Ngawai , Nirantharakumar Krishnarajah 
Published: December 2022

IntroductionWith good medical care, most pregnancy complications like pre-eclampsia, gestational diabetes, etc resolve after childbirth. However, pregnancy complications are known to be associated with an increased risk of new long-term health conditions for women later in life, such as cardiovascular disease. These umbrella reviews aim to summarise systematic reviews evaluating the association between pregnancy complications and five groups of long-term health conditions: autoimmune conditions, cancers, functional disorders, mental health conditions and metabolic health conditions (diabetes and hypertension).Methods and analysisWe will conduct searches in Medline, Embase and the Cochrane database of systematic reviews without any language restrictions. We will include systematic reviews with or without meta-analyses that studied the association between pregnancy complications and the future risk of the five groups of long-term health conditions in women. Pregnancy complications were identified from existing core outcome sets for pregnancy and after consultation with experts. Two reviewers will independently screen the articles. Data will be synthesised with both narrative and quantitative methods. Where a meta-analysis has been carried out, we will report the combined effect size from individual studies. For binary data, pooled ORs with 95% CIs will be presented. For continuous data, we will use the mean difference with 95% CIs. The findings will be presented in forest plots to assess heterogeneity. The methodological quality of the studies will be evaluated with the AMSTAR 2 tool or the Cochrane risk of bias tool. The corrected covered area method will be used to assess the impact of overlap in reviews. The findings will be used to inform the design of prediction models, which will predict the risk of women developing these five group of health conditions following a pregnancy complication.Ethics and disseminationNo ethical approvals required. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.
Drug–drug interaction between dexamethasone and direct-acting oral anticoagulants: a nested case–control study in the National COVID Cohort Collaborative (N3C)
Authors: Kravchenko Olga V , Boyce Richard D , Gomez-Lumbreras Ainhoa , Kocis Paul T , Villa Zapata Lorenzo , Tan Malinda , Leonard Charles E , Andersen Kathleen M , Mehta Hemalkumar , Alexander G Caleb , Malone Daniel C 
Published: December 2022

ObjectiveThe goal of this work is to evaluate if there is an increase in the risk of thromboembolic events (TEEs) due to concomitant exposure to dexamethasone and apixaban or rivaroxaban. Direct oral anticoagulants (DOACs), as well as corticosteroid dexamethasone, are commonly used to treat individuals hospitalised with COVID-19. Dexamethasone induces cytochrome P450-3A4 enzyme that also metabolises DOACs apixaban and rivaroxaban. This raises a concern about possible interaction between dexamethasone and DOACs that may reduce the efficacy of the DOACs and result in an increased risk of TEE.DesignWe used nested case–control study design.SettingThis study was conducted in the National COVID Cohort Collaborative (N3C), the largest electronic health records repository for COVID-19 in the USA.ParticipantsStudy participants were adults over 18 years who were exposed to a DOAC for 10 or more consecutive days. Exposure to dexamethasone was at least 5 or more consecutive days.Primary and secondary outcome measuresOur primary exposure variable was concomitant exposure to dexamethasone for 5 or more days after exposure to either rivaroxaban or apixaban for 5 or more consecutive days. We used McNemar’s Χ2test and adjusted logistic regression to evaluate association between concomitant use of dexamethasone with either apixaban or rivaroxaban.ResultsMcNemar’s Χ2test did not find a discernible association of TEE in patients concomitantly exposed to dexamethasone and a DOAC (χ2=0.5, df=1, p=0.48). In addition, a conditional logistic regression model did not find an increase in the risk of TEE (adjusted OR 1.15, 95% CI 0.32 to 4.18).ConclusionThis nested case–control study did not find evidence of an association between concomitant exposure to dexamethasone and a DOAC with an increase in risk of TEE. Due to small sample size, an association cannot be completely ruled out.
Linking knowledge with attitude: a cross-sectional study of public knowledge and attitude towards sleep disturbances and dementia
Authors: Zheng Yong-Bo , Shi Le , Que Jian-Yu , Deng Jia-Hui , Wang Qian-Wen , Su Si-Zhen , Lu Zheng-An , Bao Yan-Ping , Shi Jie , Lu Lin 
Published: December 2022

ObjectivesSleep disturbances increase the risk of dementia; however, there is insufficient information regarding this. We aimed to investigate public knowledge on the relationship between sleep disturbances and dementia, as well as attitudes towards improving sleep quality and obtaining knowledge on dementia.Design and settingA cross-sectional web-based questionnaire was administered between May and October 2019.ParticipantsAll participants provided informed consent and were able to respond to the survey.Primary outcomesFactors associated with the knowledge that sleep disturbances are risk factors for dementia and proportions of individuals with this knowledge; attitudes towards improving sleep quality and obtaining knowledge about dementia.ResultsOf the 3329 eligible samples, 72.57% correctly recognised that sleep disturbances increased the risk of dementia. In total, 92.97% of participants were willing to take at least one measure to improve sleep quality, and the percentages of those adopting these measures are as follows: 78.73% would lead a regular life, 67.88% would engage in strengthening exercise, 28.84% would undergo psychotherapy and 19.41% would take medication. The awareness regarding sleep disturbances increasing the risk of dementia was the only factor associated with the willingness to improve sleep quality in all four categories of measures. Almost all participants (95.25%) were willing to take at least one measure to acquire knowledge about dementia, with the following participants displaying higher willingness to obtain knowledge about dementia: female, had contact with dementia and considered sleep disturbances to increase the risk of dementia.ConclusionsOur findings indicate an association between people’s knowledge and attitudes, suggesting the importance of disseminating knowledge about sleep disturbances and dementia to achieve dementia prevention in future.
External validation of the Maternal Severity Index for predicting maternal death following potentially life-threatening complications during pregnancy and childbirth: a single-centre, prospective observational study
Authors: Keepanasseril Anish , Balachandran Divya Mecheril , Sharma Jyotsna , Maurya Dilip Kumar , Kar Sitanshu Sekhar 
Published: December 2022

ObjectivesTo perform an external validation to assess the usefulness of the Maternal Severity Index (MSI) in predicting maternal death among women with potentially life-threatening complications during pregnancy or childbirth.DesignProspective observational study.SettingA tertiary referral centre in southeastern India.Participants1833 women with potentially life-threatening complications identified using the WHO criteria.Predictor assessedMSI calculated based on the severity markers of the WHO criteria for maternal near-miss.Primary outcomeMaternal death.Statistical analysisReceiver operating characteristics (ROC) curve analysis was performed to assess discriminative performance, and agreement between expected and observed deaths was plotted to determine calibration.ResultsThe incidence of severe maternal outcomes was 10 per 1000 live births. There were 57 (151 per 100 000 live births) maternal deaths during the study period. Maternal Severity Score was significantly higher among those who died (2.8±1.3 vs 2.0±1.2, p<0.001). The mean MSI value was 1.03% (95% CI 0.7% to 1.2%). ROC curve analysis showed good discrimination (AUC(Area Under the Curve): 0.962, 95% CI 0.952 to 0.970); however, overfitting was seen with higher probabilities. The standardised mortality ratio (SMR) was 0.02 (95% CI 0.01 to 0.02), indicating good quality of care.ConclusionsThe MSI has good discriminative performance in distinguishing who succumbs to life-threatening complications, but needs recalibration to avoid overfitting. SMR of less than 0.5 indicates fewer than expected deaths, suggesting good quality of care in reducing maternal mortality in the study population.
Clinical outcomes and factors associated with pulmonary infarction following acute pulmonary embolism: a retrospective observational study at a US academic centre
Authors: Lio Ka U , O’Corragain Oisin , Bashir Riyaz , Brosnahan Shari , Cohen Gary , Lakhter Vladimir , Panaro Joseph , Rivera-Lebron Belinda , Rali Parth 
Published: December 2022

ObjectivePulmonary infarction is a common clinical and radiographic finding in acute pulmonary embolism (PE), yet the clinical relevance and prognostic significance of pulmonary infarction remain unclear. The study aims to investigate the clinical features, radiographic characteristics, impact of reperfusion therapy and outcomes of patients with pulmonary infarction.Design, setting and participantsA retrospective cohort study of 496 adult patients (≥18 years of age) diagnosed with PE who were evaluated by the PE response team at a tertiary academic referral centre in the USA. We collected baseline characteristics, laboratory, radiographic and outcome data. Statistical analysis was performed by Student’s t-test, Mann-Whitney U test, Fischer’s exact or χ2test where appropriate. Multivariate logistic regression was used to evaluate potential risk factors for pulmonary infarction.ResultsWe identified 143 (29%) cases of pulmonary infarction in 496 patients with PE. Patients with infarction were significantly younger (52±15.9 vs 61±16.6 years, p<0.001) and with fewer comorbidities. Most infarctions occurred in the lower lobes (60%) and involved a single lobe (64%). The presence of right ventricular (RV) strain on CT imaging was significantly more common in patients with infarction (21% vs 14%, p=0.031). There was no significant difference in advanced reperfusion therapy, in-hospital mortality, length of stay and readmissions between groups. In multivariate analysis, age and evidence of RV strain on CT and haemoptysis increased the risk of infarction.ConclusionsRadiographic evidence of pulmonary infarction was demonstrated in nearly one-third of patients with acute PE. There was no difference in the rate of reperfusion therapies and the presence of infarction did not correlate with poorer outcomes.
Quality of evidence supporting the role of non-steroidal anti-inflammatory drugs for the treatment of anxious depression: a protocol for an overview of systematic reviews and meta-analyses
Authors: Dong Chengda , Shi Hongshuo , Yan Zhaojun , Si Guomin , Liu Jianmin 
Published: December 2022

IntroductionThere have been several studies showing the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) for anxious depression. We aimed to summarise the evidence and evaluate the methodological quality regarding the effectiveness and safety of NSAIDs for anxious depression from systematic reviews/meta-analyses (SRs/MAs).Methods and analysisTwo researchers searched seven databases for SRs/MAs, which are randomised controlled trials on NSAIDs for anxious depression. Two investigators used the Assessment System for Evaluating Methodological Quality 2, the Risk of Bias in Systematic reviews tool, the list of preferred reporting items for SRs/MAs and the Grading of Recommendations, Assessment, Development and Evaluation system to assess the included SRs/MAs.Ethics and disseminationThe findings of the study will be disseminated through peer-reviewed journals, and national and international conference presentations.
Individualised follow-up for head and neck cancer—design of a prospective cohort study to assess its feasibility
Authors: van de Weerd Cecile , van Tol-Geerdink Julia J. , van den Broek Guido B. , Kaanders Johannes H.A.M. , Marres Henri A.M. , Hermens Rosella P.M.G. , Takes Robert P. 
Published: December 2022

IntroductionIt is a common practice for many cancer types to monitor patients after treatment to detect new disease manifestations early. For head and neck cancer (HNC), however, long-term routine follow-up is up for debate for several reasons. The benefits of prolonged routine follow-up on survival have not been proven. Also, cancer follow-up is putting increasing pressure on healthcare resources due to rising incidence and survival rates. Therefore, this study investigates a novel follow-up approach among HNC patients, giving them the opportunity to choose their own follow-up programme.Methods and analysisHNC patients are offered a decision-aided choice between standardised or individualised follow-up after 1.5 years of uncomplicated guideline-prescribed follow-up. Standardised follow-up entails continuing the 5-year guideline-prescribed schedule. Individualised follow-up means the patient only attends the outpatient clinic on their own initiative in case of physical symptoms or supportive care needs. Patients are educated on self-examination and when a control visit is necessary. The primary outcome measure is the feasibility of offering patients this choice. Secondary outcome measures are quality of life, costs, productivity loss and detection of new disease.Ethics and disseminationWe believe that it is essential to let patients determine their follow-up programme based on their own values and preferences. If this choice is feasible, it can be implemented and investigated in other HNC care centres.Trial registration numberNCT05386225.