bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preparation of 177Lu Using Vacuum Sublimation Technology
Authors: Alekseev I. E. , Krotov S. A. 
Published: May 2023

Abstract
A simple sublimation technology for the lutetium and ytterbium separation was proposed, which already at the stage of preliminary experiments showed effectiveness: (a) the completeness of Yb separation resulted in short-term thermal annealing is at least 98%, the distilled product is completely free from 177Lu, no additional preparation of ytterbium for repeated irradiation is required ; (b) traditional ion-exchange chromatography can be used for the final purification of 177Lu from ytterbium.
Atypical progression of motor symptoms in facio-scapulo-humeral dystrophy: clinical worsening or overlap?
Authors: Calisi Dario , De Rosa Matteo A , Russo Mirella , Sensi Stefano L 
Published: May 2023

Facio-scapulo-humeral dystrophy (FSHD) is a common muscular dystrophy featuring progressive weakness, mostly involving facial muscles and the scapular cingulum. FSHD is an autosomal-dominant inherited disease driven by the contraction of the D4Z4 region of chromosome 4. Patients with FSHD have a high life expectancy, about 20% of FSHD subjects need wheelchairs in their 50s, and extramuscular involvement is rare, however, no epidemiological studies have been carried out on this data.Our case describes a man affected by FSHD who, in his 60s, developed atypical Parkinsonism diagnosed as progressive supranuclear palsy (PSP).FSHD symptoms can hide other neuromuscular diseases developed on ageing. This case highlights the importance of considering possible overlaps with other neurodegenerative diseases.
Clinical lesson to not overlook venous thrombosis: a case of primary antiphospholipid syndrome
Authors: Punjadath Sryla , Aggarwal Mukul , Gupta Gaurav , Baitha Upendra 
Published: May 2023

A man in his early 30s presented to us with progressive shortness of breath limiting activities of daily living. An important clue in history was the episode of a deep vein thrombosis 5 years ago treated with short-term anticoagulation. His echocardiography revealed elevated estimated pulmonary artery systolic pressure. A CT pulmonary angiography confirmed chronic thromboembolic pulmonary hypertension. Blood investigations established primary antiphospholipid syndrome. He underwent pulmonary endarterectomy, relieving his symptoms and was started on indefinite oral anticoagulation with warfarin. He is currently under follow-up with no recurrence of thrombosis.We wish to highlight the importance of an appropriate workup of venous thrombosis in all patients. Antiphospholipid syndrome is a rare disease with important implications in the management of patients with thromboses. The delay in his diagnosis had several causes including the unclear distinction between provoked and unprovoked thrombosis and socioeconomic factors in a developing nation limiting referral and testing.
Effect of a mobile app chatbot and an interactive small-group webinar on COVID-19 vaccine intention and confidence in Japan: a randomised controlled trial
Authors: Kobayashi Takaaki , Tomoi Hana , Nishina Yuka , Harada Ko , Tanaka Kyuto , Sasaki Shugo , Inaba Kanako , Mitaka Hayato , Takahashi Hiromizu , Passanante Aly , Lau Eric H Y , Naito Toshio , Larson Heidi , Wu Joseph , Lin Leesa , Yamada Yuji 
Published: May 2023

IntroductionWe investigated the effect of social media-based interventions on COVID-19 vaccine intention (VI) and confidence in Japan.MethodsWe conducted a three-arm randomised controlled trial between 5 November 2021 and 9 January 2022 during a low incidence (<1000/day) of COVID-19 in Japan in the midst of the second and the third waves. Japanese citizens aged ≥20 who had not received any COVID-19 vaccine and did not intend to be vaccinated were randomly assigned to one of the following three groups: (1) a control group, (2) a group using a mobile app chatbot providing information on COVID-19 vaccines and (3) a group using interactive webinars with health professionals. VI and predefined Vaccine Confidence Index (VCI) measuring confidence in the importance, safety and effectiveness were compared before and after the interventions under intention-to-treat principle. Logistic regression models were used to investigate the effect of each intervention on postintervention VI and changes of VCI compared with control.ResultsAmong 386 participants in each group, 359 (93.0%), 231 (59.8%) and 207 (53.6%) completed the postsurvey for the control, chatbot and webinar groups, respectively. The average duration between the intervention and the postsurvey was 32 days in chatbot group and 27 days in webinar group. VI increased from 0% to 18.5% (95% CI 14.5%, 22.5%) in control group, 15.4% (95% CI 10.8%, 20.1%) in chatbot group and 19.7% (95% CI 14.5%, 24.9%) in webinar group without significant difference (OR for improvement=0.8 (95% CI 0.5, 1.3), p=0.33 between chatbot and control, OR=1.1 (95% CI 0.7, 1.6), p=0.73 between webinar and control). VCI change tended to be larger in chatbot group compared with control group without significant difference (3.3% vs −2.5% in importance, OR for improvement=1.3 (95% CI 0.9, 2.0), p=0.18; 2.5% vs 1.9% in safety, OR=1.1 (95% CI 0.7, 1.9), p=0.62; −2.4% vs −7.6% in effectiveness, OR=1.4 (95% CI 0.9, 2.1), p=0.09). Improvement in VCI was larger in webinar group compared with control group for importance (7.8% vs −2.5%, OR=1.8 (95% CI 1.2, 2.8), p<0.01), effectiveness (6.4% vs −7.6%, OR=2.2 (95% CI 1.4, 3.4), p<0.01) and safety (6.0% vs 1.9%, OR=1.6 (95% CI 1.0, 2.6), p=0.08).ConclusionThis study demonstrated that neither the chatbot nor the webinar changed VI importantly compared with control. Interactive webinars could be an effective tool to change vaccine confidence. Further study is needed to identify risk factors associated with decreased vaccine confidence and investigate what intervention can increase VI and vaccine confidence for COVID-19 vaccines.Trial registration numberUMIN000045747.
DETECT: DEveloping and testing a model to identify preventive vision loss among older paTients in gEneral praCTice – protocol for a complex intervention in Denmark
Authors: Sandholdt Catharina Thiel , Jønsson Alexandra Brandt Ryborg , Reventlow Susanne , Bach-Holm Daniella , Line Kessel , Kolko Miriam , Jacobsen Marie Honoré , Mathiesen Olivia Hjulsager , Waldorff Frans Boch 
Published: May 2023

IntroductionThe number of people living with visual impairment is increasing. Visual impairment causes loss in quality of life and reduce self-care abilities. The burden of disease is heavy for people experiencing visual impairment and their relatives. The severity and progression of age-related eye diseases are dependent on the time of detection and treatment options, making timely access to healthcare critical in reducing visual impairment. General practice plays a key role in public health by managing preventive healthcare, diagnostics and treatment of chronic conditions. General practitioners (GPs) coordinate services from other healthcare professionals. More involvement of the primary sector could potentially be valuable in detecting visual impairment.MethodsWe apply the Medical Research Council framework for complex interventions to develop a primary care intervention with the GP as a key actor, aimed at identifying and coordinating care for patients with low vision. The development process will engage patients, relatives and relevant health professional stakeholders. We will pilot test the feasibility of the intervention in a real-world general practice setting. The intervention model will be developed through a participatory approach using qualitative and creative methods such as graphical facilitation. We aim to explore the potentials and limitations of general practice in relation to detection of preventable vision loss.Ethics and disseminationEthics approval is obtained from local authority and the study meets the requirements from the Declaration of Helsinki. Dissemination is undertaken through research papers and to the broader public through podcasts and patient organisations.
Changes in private health service utilisation and access to the Italian National Health Service between 2006 and 2019: a cross-sectional comparative study
Authors: Maietti Elisa , Sanmarchi Francesco , Toth Federico , de Pietro Carlo , Fantini Maria Pia , Golinelli Davide 
Published: May 2023

ObjectivesPrevious research highlighted that in the early 2000s a significant share of the Italian population used and paid out of pocket for private healthcare services even when they could potentially have received the same treatments from the National Health Service (NHS). The decrease in public investments in healthcare and the increase in health needs due to the population ageing may have modified the use of private health services and equity of access to the Italian NHS. This study aims to investigate the change in the prevalence of individuals who have fully paid out of pocket for accessing healthcare services in Italy between 2006 and 2019 and the main reasons behind this choice.DesignCross-sectional comparative study.Participants and comparisonTwo representative samples of the Italian population were collected in 2006 and 2019.Outcome measuresPrevalence of access to fully paid out-of-pocket private health services; type of service of the last fully paid out-of-pocket access; main reasons for the last fully paid out-of-pocket access.ResultsWe found an increase in the prevalence of people who declared having fully paid out of pocket at least one access to health services during their lifetime from 79.0% in 2006 to 91.9% in 2019 (adjusted OR 2.66; 95% CI 1.98 to 3.58). ‘To avoid waiting times’ was the main reason and it was significantly more frequent in 2019 compared with 2006 (adjusted OR 1.75; 95% CI 1.45 to 2.11).ConclusionsThis comparative study, conducted the year before the outbreak of the COVID-19 pandemic, highlighted an increase in the prevalence of Italian residents who have fully paid out of pocket for access to health services to overcome long waiting times. Our findings may indicate a reduced access and possible worsening of the equity of access to the public and universalistic Italian NHS between 2006 and 2019.
Refractive error, eye care needs and attitude towards spectacle wearing among older Zanzibari craftswomen and implications for developing women-targeted services: a cross-sectional study
Authors: Chan Ving Fai , Omar Fatma , Farmer Adrianna , Othman Omar , Yong Ai Chee , Graham Christine , Price-Sanchez Carlos , Graham Ronnie , Fernandes Martins Michelle , Mashayo Eden 
Published: May 2023

BackgroundAged Zanzibari women are in a disadvantaged position, having high demand for near-vision spectacles. Currently, there is no information on the eye health status of craftswomen, which makes planning a women-targeted project to deliver eye health services to older craftswomen in Zanzibar difficult. We assessed the prevalence of vision impairment, refractive error, presbyopia, effective spectacle coverage (distance and near) and attitude towards spectacle wearing among older Zanzibari craftswomen.Methods and analysisThis was a cross-sectional study. Unaided and presenting distance and near vision of craftswomen 35 years and older were assessed at the women’s co-operatives. We determined the number of those with distance vision poorer than 6/12 and their causes (distance-vision impairment), the number of those with near vision poorer than N8 at 40 cm (presbyopia) and the number of those whose distance and/or near-vision needs were met adequately with their habitual spectacles (effective distance and near spectacle coverages). A piloted and validated questionnaire (15 statements) was used to determine their attitude towards spectacle wearing.ResultsIn all, 263 craftswomen participated in the survey (mean age 52.1 years±9.4 years). The prevalence of distance vision impairment among the craftswomen was 29.7% (95% CI 24.2% to 35.6%), the primary cause being uncorrected refractive error (n=51, 65.4%), and none were corrected. The prevalence of presbyopia was 86.6% (95% CI 81.5% to 90.7%, n=231) and the effective near spectacle coverage was 0.99%. The craftswomen showed a positive attitude towards spectacle wearing (strongly agree or agree) based on 12 out of 15 statements.ConclusionThe high burden of vision impairment, uncorrected distance refractive error and presbyopia, and a positive attitude towards spectacle wearing among older craftswomen in Zanzibar indicated the need for women-targeted eye health programmes in low-resource settings.
Implementation of medication reconciliation in outpatient cancer care
Authors: Powis Melanie , Dara Celina , Macedo Alyssa , Hack Saidah , Ma Lucy , Mak Ernie , Morley Lyndon , Kukreti Vishal , Dave Hemangi , Kirkby Ryan , Krzyzanowska Monika K 
Published: May 2023

BackgroundMedication reconciliation (MedRec) is a process where providers work with patients to document and communicate comprehensive medication information by creating a complete medication list (best possible medication history (BPMH)) then reconciling it against what patient is actually taking to identify potential issues such as drug-drug interactions. We undertook an environmental scan of current MedRec practices in outpatient cancer care to inform a quality improvement project at our centre with the aim of 30% of patients having a BPMH or MedRec within 30 days of initiating treatment with systemic therapy.MethodsWe conducted semi-structured interviews with key stakeholders from 21 cancer centres across Canada, probing on current policies, and barriers and facilitators to MedRec. Guided by the findings of the scan, we then undertook a quality improvement project at our cancer centre, comprising six iterative improvement cycles.ResultsMost institutions interviewed had a process in place for collecting a BPMH (81%) and targeted patients initiating systemic therapy (59%); however, considerable practice variation was noted and completion of full MedRec was uncommon. Lack of resources, high patient volumes, lack of a common medical record spanning institutions and settings which limits access to medication records from external institutions and community pharmacies were identified as significant barriers. Despite navigating challenges related to the COVID-19 pandemic, we achieved 26.6% of eligible patients with a documented BPMH. However, uptake of full MedRec remained low whereby 4.7% of patients had a documented MedRec.ConclusionsRealising improvements to completion of MedRec in outpatient cancer care is possible but takes considerable time and iteration as the process is complex. Resource allocation and information sharing remain major barriers which need to be addressed in order to observe meaningful improvements in MedRec.
Comparison analysis of safety outcomes and the rate of subsequent spinal procedures between interspinous spacer without decompression versus minimally invasive lumbar decompression
Authors: Rosner Howard L , Tran Oth , Vajdi Tina , Vijjeswarapu Mary A 
Published: May 2023

IntroductionTreatment for degenerative lumbar spinal stenosis (LSS) typically begins with conservative care and progresses to minimally invasive procedures, including interspinous spacer without decompression or fusion (ISD) or minimally invasive lumbar decompression (MILD). This study examined safety outcomes and the rate of subsequent spinal procedures among LSS patients receiving an ISD versus MILD as the first surgical intervention.Methods100% Medicare Standard Analytical Files were used to identify patients with an ISD or MILD (first procedure=index date) from 2017 to 2021. ISD and MILD patients were matched 1:1 using propensity score matching based on demographics and clinical characteristics. Safety outcomes and subsequent spinal procedures were captured from index date until end of follow-up. Cox models were used to analyze rates of subsequent surgical interventions, LSS-related interventions, open decompression, fusion, ISD, and MILD. Cox models were used to assess postoperative complications during follow-up and logistic regression to analyze life-threatening complications within 30 days of index procedure.ResultsA total of 3682 ISD and 5499 MILD patients were identified. After matching, 3614 from each group were included in the analysis (mean age=74 years, mean follow-up=20.0 months). The risk of undergoing any intervention, LSS-related intervention, open decompression, and MILD were 21%, 28%, 21%, and 81% lower among ISD compared with MILD patients. Multivariate analyses showed no significant differences in the risk of undergoing fusion or ISD, experiencing postoperative complications, or life-threatening complications (all p≥0.241) between the cohorts.ConclusionsThese results showed ISD and MILD procedures have an equivalent safety profile. However, ISDs demonstrated lower rates of open decompression and MILD.
Rationale and design of Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events III (TRACE III): a randomised, phase III, open-label, controlled trial
Authors: Xiong Yunyun , Campbell Bruce C V , Fisher Marc , Schwamm Lee H , Parsons Mark , Li Hao , Pan Yuesong , Meng Xia , Zhao Xingquan , Wang Yongjun 
Published: May 2023

Background and purposeRecombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) was not inferior to alteplase for ischaemic stroke within 4.5 hours. Our study aimed to investigate the efficacy and safety of rhTNK-tPA in patients who had an ischaemic stroke due to large vessel occlusion (LVO) of anterior circulation beyond 4.5 hours.Methods and designTenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events-III (TRACE III) is a multicentre, prospective, randomised, open-label, blind endpoint, controlled clinical trial. Patients who had an ischaemic stroke due to anterior circulation LVO (internal carotid artery, middle cerebral artery M1 and M2 segments) within 4.5–24 hours from last known well (including wake-up stroke and no witness stroke) and with salvageable tissue (ischaemic core volume <70 mL, mismatch ratio ≥1.8 and mismatch volume ≥15 mL) based on CT perfusion or MRI perfusion-weighted imaging (PWI) were included and randomised to rhTNK-tPA 0.25 mg/kg (single bolus) to a maximum of 25 mg or standard medical therapy. Specially, we will exclude patients who are intended for direct thrombectomy. All will be followed up for 90 days.Study outcomesPrimary efficacy outcome is modified Rankin Scale (mRS) score ≤1 at 90 days. Secondary efficacy outcomes include ordinal distribution of mRS at 90 days, major neurological improvement defined by a decrease ≥8 points compared with the initial deficit or a score ≤1 on the National Institutes of Health Stroke Scale (NIHSS) at 72 hours, mRS score ≤2 at 90 days, the rate of improvement on Tmax >6 s at 24 hours and NIHSS score change from baseline at 7 days. Safety outcomes are symptomatic intracerebral haemorrhage within 36 hours and mortality at 90 days.DiscussionTRACE III will provide evidence for the efficacy and safety of rhTNK-tPA in patients who had an ischaemic strokes due to anterior circulation LVO beyond 4.5 hours.Trial registration numberNCT05141305.
Early anticoagulation in patients with stroke and atrial fibrillation is associated with fewer ischaemic lesions at 1 month: the ATTUNE study
Authors: Sharobeam Angelos , Lin Longting , Lam Christina , Garcia-Esperon Carlos , Gawarikar Yash , Patel Ronak , Lee-Archer Matthew , Wong Andrew , Roizman Michael , Gilligan Amanda , Lee Andrew , Tan Kee Meng , Day Susan , Levi Christopher , Davis Stephen M , Parsons Mark , Yan Bernard 
Published: May 2023

BackgroundThe optimal time to commence anticoagulation in patients with atrial fibrillation (AF) after ischaemic stroke or transient ischaemic attack (TIA) is unclear, with guidelines differing in recommendations. A limitation of previous studies is the focus on clinically overt stroke, rather than radiologically obvious diffusion-weighted imaging ischaemic lesions. We aimed to quantify silent ischaemic lesions and haemorrhages on MRI at 1 month in patients commenced on early (<4 days) vs late (≥4 days) anticoagulation. We hypothesised that there would be fewer ischaemic lesions and more haemorrhages in the early anticoagulant group at 1-month MRI.MethodsA prospective multicentre, observational cohort study was performed at 11 Australian stroke centres. Clinical and MRI data were collected at baseline and follow-up, with blinded imaging assessment performed by two authors. Timing of commencement of anticoagulation was at the discretion of the treating stroke physician.ResultsWe recruited 276 patients of whom 208 met the eligibility criteria. The average age was 74.2 years (SD±10.63), and 79 (38%) patients were female. Median National Institute of Health Stroke Scale score was 5 (IQR 1–12). Median baseline ischaemic lesion volume was 5 mL (IQR 2–17). There were a greater number of new ischaemic lesions on follow-up MRI in patients commenced on anticoagulation ≥4 days after index event (17% vs 8%, p=0.04), but no difference in haemorrhage rates (22% vs 32%, p=0.10). Baseline ischaemic lesion volume of ≤5 mL was less likely to have a new haemorrhage at 1 month (p=0.02). There was no difference in haemorrhage rates in patients with an initial ischaemic lesion volume of >5 mL, regardless of anticoagulation timing.ConclusionCommencing anticoagulation <4 days after stroke or TIA is associated with fewer ischaemic lesions at 1 month in AF patients. There is no increased rate of haemorrhage with early anticoagulation. These results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated with AF might be safe, but randomised controlled studies are needed to inform clinical practice.
Application of COOK® cervical ripening balloon combined with artificial rupture of membranes and oxytocin in labor induction for full-term pregnancy
Authors: Dong Ying , Li Chuyu , Zhao Xin , Zhang Lin , Jia Xiaojun , Fu Zhongxing , Du Yan , Wang Ling 
Published: May 2023

Objective: The use of COOK[Formula: see text] balloon in the process of induction of labor is gradually promoted. This study was conducted to investigate the safety and efficacy of COOK[Formula: see text] double balloon in promoting the maturity of uterine neck, and whether COOK[Formula: see text] double balloon can improve the success rate of induced labor. Methods: A total of 343 pregnant women with full-term pregnancy in Shanghai Putuo Maternity & Infant Health Hospital from January 1st to September 30th of 2016 were enrolled. Of all the pregnant women, 166 had labor induction, which included the use of a COOK[Formula: see text] balloon, the implementation of artificial rupture of membranes (AROM) and oxytocin intravenous (IV) drip (COOK[Formula: see text] group). The other 177 pregnant women with spontaneous rupture of membranes (SROM) and mature cervix only were administrated with oxytocin IV drip to promote regular uterus contraction (oxytocin group). Maternal adverse reactions, mode of delivery and delivery outcomes of two groups were subsequently compared between the two groups. Results: There were significant differences of maternal age ([Formula: see text] versus [Formula: see text] years, [Formula: see text]), gestational age ([Formula: see text] versus [Formula: see text] years, [Formula: see text]) and birth weight ([Formula: see text] versus [Formula: see text][Formula: see text]g, [Formula: see text]) between the COOK[Formula: see text] group and the oxytocin group. There were no significant differences in terms of gravidity, parity, mode of delivery, analgesia, 1 min and 5 min Apgar score, labor time, postpartum hemorrhage, and adverse events. Conclusion: Use of a COOK[Formula: see text] balloon may help in full-term pregnancy for women with immature cervix and to obtain the same pregnancy results as those with mature cervix, without extra occurrence of adverse events.