bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reflection in the training of general practitioners in clinical practice settings: a scoping review protocol
Authors: Schumann Scheel Linda , Kjaer Niels Kristian , Marnie Casey , Peters Micah D.J. 
Published: February 2023

Objective:
The objective of this scoping review is to explore formalized methods of reflection that are used in clinical settings in general practice when training medical students, postgraduate trainees, general practitioners, and family physicians.

Introduction:
Medical professionals are increasingly required to demonstrate competency in their ability to reflect on clinical practice. To accommodate this, the teaching of reflection is common in medical programs; however, there is a lack of clarity in the literature on how reflection is taught.

Inclusion criteria:
This review will seek evidence describing the tools and approaches to reflection used by medical students, postgraduate trainees, and other registered medical professionals in general practice. The review will also include any evidence from those who teach reflection in a general practice setting. Evidence regarding reflection in training programs for other medical specialties will not be considered for inclusion.

Methods:
This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and the JBI methodology for scoping reviews. Databases to be searched will include MEDLINE (Ovid), Emcare (Ovid), Embase (Ovid), Web of Science, Scopus, and the Cochrane Database of Systematic Reviews. Extracted evidence will be presented using figurative, tabular, and accompanying narrative synthesis, in line with the review questions.

Review registration number:
Open Science Framework https://osf.io/uxw7d
Late-onset sepsis in very preterm infants in Norway in 2009–2018: a population-based study
Authors: Huncikova Zuzana , Vatne Anlaug , Stensvold Hans Jorgen , Lang Astri Maria , Støen Ragnhild , Brigtsen Anne Karin , Salvesen Bodil , Øymar Knut Asbjørn Alexander , Rønnestad Arild , Klingenberg Claus 
Published: February 2023

ObjectiveTo evaluate epidemiology and outcomes among very preterm infants (<32 weeks’ gestation) with culture-positive and culture-negative late-onset sepsis (LOS).DesignCohort study using a nationwide, population-based registry.Setting21 neonatal units in Norway.ParticipantsAll very preterm infants born 1 January 2009–31 December 2018 and admitted to a neonatal unit.Main outcome measuresIncidences, pathogen distribution, LOS-attributable mortality and associated morbidity at discharge.ResultsAmong 5296 very preterm infants, we identified 582 culture-positive LOS episodes in 493 infants (incidence 9.3%) and 282 culture-negative LOS episodes in 282 infants (incidence 5.3%). Extremely preterm infants (<28 weeks’ gestation) had highest incidences of culture-positive (21.6%) and culture-negative (11.1%) LOS. The major causative pathogens were coagulase-negative staphylococci (49%),Staphylococcus aureus(15%), group B streptococci (10%) andEscherichia coli(8%). We observed increased odds of severe bronchopulmonary dysplasia (BPD) associated with both culture-positive (adjusted OR (aOR) 1.7; 95% CI 1.3 to 2.2) and culture-negative (aOR 1.6; 95% CI 1.3 to 2.6) LOS. Only culture-positive LOS was associated with increased odds of cystic periventricular leukomalacia (cPVL) (aOR 2.2; 95% CI 1.4 to 3.4) and severe retinopathy of prematurity (ROP) (aOR 1.8; 95% CI 1.2 to 2.8). Culture-positive LOS-attributable mortality was 6.3%, higher in Gram-negative (15.8%) compared with Gram-positive (4.1%) LOS, p=0.009. Among extremely preterm infants, survival rates increased from 75.2% in 2009–2013 to 81.0% in 2014–2018, p=0.005. In the same period culture-positive LOS rates increased from 17.1% to 25.6%, p<0.001.ConclusionsLOS contributes to a significant burden of disease in very preterm infants and is associated with increased odds of severe BPD, cPVL and severe ROP.
Erythroderma with total scarring alopecia
Authors: Karrakchou Basma , Fliti Amani , Meziane Mariame , Senouci Karima 
Published: January 2023

A woman in her 50s presented with total scarring ulcerated alopecia evolving for 10 years, and a recent budding tumour on the lower lip. Clinical examination revealed an associated exfoliated and infiltrated erythroderma with ulcerated cutaneous tumours of the legs, palmoplantar hyperkeratosis, hepatosplenomegaly and diffuse lymphadenopathies.Dermatoscopy of the scalp, leg tumours and infiltrated skin showed a typical yellowish background overlaid by arborescent vessels and whitish areas. Cutaneous biopsies of the same areas found sarcoidotic granulomas. Lip biopsy found an associated well-differentiated squamous cell carcinoma. Investigations confirmed the diagnosis of systemic sarcoidosis with an elevated converting enzyme level, mediastinal calcified lymphadenopathies in CT scan and deep localisations in positron emission tomography scan (thyroid, lymph nodes, mediastinum, liver, spleen and adrenal glands).The patient was treated with oral prednisone for sarcoidosis and intramuscular bleomycin followed by surgery and radiotherapy for squamous cell carcinoma. Sarcoidotic lesions healed, but a recurrence of her carcinoma led to death.
Pathological response and safety of FOLFOXIRI for neoadjuvant treatment of high-risk relapsed locally advanced colon cancer: study protocol for a single-arm, open-label phase II trial
Authors: Chen Xiaorong , Leng Weibing , Zhou YuWen , Yu Yongyang , Meng Wenjian , Cao Peng , Wang Ziqiang , Qiu Meng 
Published: January 2023

IntroductionNeoadjuvant chemotherapy (NAC) has been demonstrated effective in several tumours, but its benefit has not yet been elucidated in colorectal cancer, especially locally advanced colorectal cancer (LACRC).Methods and analysisThis is a single-arm, open-label, prospective phase II exploratory clinical trial. Patients with LACRC will receive four cycles of NAC with 5-fluorouracil, oxaliplatin and irinotecan (FOLFOXIRI), followed by operation and then adjuvant chemotherapy with capecitabine and oxaliplatin for two to five cycles or single-agent capecitabine for five cycles, or observation. The primary endpoint is the rate of tumour regression grade (TRG) 0–2 in the resected tumour tissue, which is evaluated by experienced pathologists according to the Ryan R TRG grading system. Secondary endpoints include objective response rate, pathologic complete response, microscopically complete resection rate, progression-free survival, distant metastasis-free survival, overall survival, toxicity and compliance to study treatment, molecular markers, quality of life to study treatment and the number of patients with 30-day postoperative mortality. The objective of this study is to analyse the efficacy and safety of FOLFOXIRI as the NAC regimen in patients with LACRC and to identify a promising treatment strategy in this setting.Ethics and disseminationWritten informed consent will be required from and provided by all patients enrolled. The study protocol has been approved by the independent ethics committee of West China Hospital, Sichuan University (approval number: 2021403). This study will demonstrate the potential benefit of NAC with the FOLFOXIRI regimen. Results will be shared with policymakers and the academic community to promote the clinical management of colon cancer.Trial registration numberNCT05018182.
Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study
Authors: Gulamhussein Masuma A , Sawe Hendry Robert , Kilindimo Said , Mfinanga Juma A , Mussa Raya , Hyuha Gimbo M , Rwegoshora Shamila , Shayo Frida , Mdundo Winnie , Sadiq Abid M , Weber Ellen J 
Published: January 2023

ObjectiveWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.DesignProspective cohort studySettingEmergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.ParticipantsInjured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020.MethodsDuring alternating 12-hour shifts, consecutive trauma patients were approached in the ED after stabilisation. A case report form was used to collect social-demographics and patient clinical profile. Total charges billed for ED and in-hospital care and OOP payments were obtained from the hospital billing system. Patients were interviewed by phone to determine the measures they took to pay their bills.Primary outcome measureThe primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income.ResultsWe enrolled 355 trauma patients of whom 51 (14.4%) were insured. The median age was 32 years (IQR 25–40), 238 (83.2%) were male, 162 (56.6%) were married and 87.8% had ≥2 household dependents. The majority 224 (78.3%) had informal employment with a median monthly income of US$86. Overall, 286 (80.6%) had OOP expenses for their care. 95.1% of all patients had an Injury Severity Score <16 among whom OOP payments were US$176.98 (IQR 62.33–311.97). Chest injury and spinal injury incurred the highest OOP payments of US$282.63 (84.71–369.33) and 277.71 (191.02–874.47), respectively. Overall, 85.3% had a CHE. 203 patients (70.9%) were interviewed after discharge. In this group, 13.8% borrowed money from family, and 12.3% sold personal items of value to pay for their hospital bills.ConclusionOOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.
Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals
Authors: Hall Nicola , Rousseau Nikki , Hamilton David W , Simpson A John , Powell Steven , Brodlie Malcolm , Powell Jason 
Published: January 2023

ObjectivesTo explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers.DesignQualitative semistructured interview study.SettingOne region in England covered by a tertiary care centre that includes urban and remote rural areas and has a high level of deprivation.ParticipantsA purposive sample of health professionals and parents who care for children who have, or have had, tracheostomies and who received care at the tertiary care centre.InterventionInterviews undertaken by telephone or video link.Primary and secondary outcome measuresQualitative reflexive thematic analysis with QSR Nvivo 12.ResultsThis paper outlines key determinants and mediators of the experiences of caregiving and the impact on psychological and physical health and quality of life of parents and their families, confidence of healthcare providers and perceived quality of care. For parents, access to care packages and respite care at home as well as communication and relationships with healthcare providers are key mediators of their experience of caregiving, whereas for health professionals, an essential influence is multidisciplinary team working and support. We also highlight a range of challenges focused on the shared care space, including: a lack of standardisation in access to different support teams, care packages and respite care, irregular training and updates, and differences in health provider expertise and experiences across departments and shift patterns, exacerbated in some settings by limited contact with children with tracheostomies.ConclusionsUnderstanding the experiences of caregiving can help inform measures to support caregivers and improve quality standards. Our findings suggest there is a need to facilitate further standardisation of care and support available for parent caregivers and that this may be transferable to other regions. Potential solutions to be explored could include the development of a paediatric tracheostomy service specification, increasing use of paediatric tracheostomy specialist nurse roles, and addressing the emotional and psychological support needs of caregivers.
Immune and genomic biomarkers of immunotherapy response in cancer of unknown primary
Authors: Posner Atara , Sivakumaran Tharani , Pattison Andrew , Etemadmoghadam Dariush , Thio Niko , Wood Colin , Fisher Krista , Webb Samantha , DeFazio Anna , Wilcken Nicholas , Gao Bo , Karapetis Christos S , Singh Madhu , Collins Ian M , Richardson Gary , Steer Christopher , Warren Mark , Karanth Narayan , Fellowes Andrew , Fox Stephen B , Hicks Rodney J , Schofield Penelope , Bowtell David , Prall Owen W J , Tothill Richard William , Mileshkin Linda 
Published: January 2023

BackgroundCancer of unknown primary (CUP) is a heterogeneous group of metastatic cancers where a primary tissue of origin (TOO) is uncertain. Most patients with CUP have limited treatment options and poor survival outcomes. Immune checkpoint inhibitors (ICIs) can be efficacious in some patients with CUP, but the optimal predictive biomarkers are unknown. We therefore assessed immune and genomic biomarkers as well as predicted TOO in patients with CUP, including a subset treated with ICIs.MethodsPatients with CUP were subject to gene-expression profiling (GEP) and DNA panel sequencing. Immune and stromal-related gene expression was explored by NanoString, including genes associated with immunotherapy response (IR) in other solid malignancies. ICI responsive cancer types were assigned based on Food and Drug Administration-approved indications, and either detection of a latent primary tumor or the TOO was suspected based on genomics informed pathology review. Tumor mutation burden (TMB) and gene mutations were also assessed.ResultsA total of 219 patients with CUP were included, 215 assessed for TOO in a previous study, with the majority (163) receiving both RNA and DNA tests. Of GEP profiled cases, 33% (59/175) had a high IR gene-expression score. Of the DNA sequenced cases, 16% (32/203) had high TMB (>10 mutations/Mb), including two with mismatch repair deficiency. Low correlation was observed between TMB and an IR score (R=0.26, p<0.001). Among 110 CUPs with a latent primary or suspected TOO, 47% (52/110) belonged to ICI-responsive cancer types. More than half of the CUPs had at least one feature that may predict ICI response (high IR score, high TMB, ICI-responsive cancer type). Among patients with CUP treated with ICIs, 8/28 (29%) responded (2 complete responses and 6 partial responses). Among non-responders, 9 had stable and 11 had progressive disease. All responders had a high IR score (7/8) and/or high TMB (3/8), while most (5/8) belonged to ICI-responsive cancer types. These features were detected at a lower frequency in non-responders and mostly in patients with stable disease.ConclusionsA significant fraction of CUP tumors had genomic features previously associated with ICI response. High IR score was the most sensitive predictive feature of ICI response, warranting evaluation in a larger patient series.
Molecular endotypes of type 1 and type 2 SLE
Authors: Robl Robert , Eudy Amanda , Bachali Prathyusha S , Rogers Jennifer L , Clowse Megan , Pisetsky David , Lipsky Peter 
Published: January 2023

ObjectiveTo character the molecular landscape of patients with type 1 and type 2 SLE by analysing gene expression profiles from peripheral blood.MethodsFull transcriptomic RNA sequencing was carried out on whole blood samples from 18 subjects with SLE selected by the presence of manifestations typical of type 1 and type 2 SLE. The top 5000 row variance genes were analysed by Multiscale Embedded Gene Co-expression Network Analysis to generate gene co-expression modules that were functionally annotated and correlated with various demographic traits, clinical features and laboratory measures.ResultsExpression of specific gene co-expression modules correlated with individual features of type 1 and type 2 SLE and also effectively segregated samples from patients with type 1 SLE from those with type 2 SLE. Unique type 1 SLE enrichment included interferon, monocytes, T cells, cell cycle and neurotransmitter pathways, whereas unique type 2 SLE enrichment included B cells and metabolic and neuromuscular pathways. Gene co-expression modules of patients with type 2 SLE were identified in subsets of previously reported patients with inactive SLE and idiopathic fibromyalgia (FM) and also identified subsets of patients with active SLE with a greater frequency of severe fatigue.ConclusionGene co-expression analysis successfully identified unique transcriptional patterns that segregate type 1 SLE from type 2 SLE and further identified type 2 molecular features in patients with inactive SLE or FM and with active SLE with severe fatigue.
Non-steroidal anti-inflammatory drugs for pain in hospice/palliative care: an international pharmacovigilance study
Authors: McNeill Richard , Boland Jason W , Wilcock Andrew , Sinnarajah Aynharan , Currow David C 
Published: January 2023

ObjectivesTo describe the current, real-world use of non-steroidal anti-inflammatory drugs for pain and the associated benefits and harms.MethodsA prospective, multicentre, consecutive cohort pharmacovigilance study conducted at 14 sites across Australia, Aotearoa/New Zealand and the UK including hospital, hospice inpatient and outpatient services. Pain scores and harms were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events at baseline, 2 days and 14 days. Ad-hoc safety reporting continued until day 28.ResultsData were collected from 92 patients between March 2018 and October 2021. Most patients had cancer (91%) and were coprescribed opioids (90%). At 14 days, 83% of patients had benefit from non-steroidal anti-inflammatory drugs and 22% had harm. The most common harms were nausea (8%), vomiting (3%), acute kidney injury (3%) and non-gastrointestinal bleeding (3%); only 2% were severe and no patients ceased their non-steroidal anti-inflammatory drugs due to toxicity. Overall, 65% had benefit without harm and 3% had harm without benefit.ConclusionsMost patients benefited from non-steroidal anti-inflammatory drugs with only one in five patients experiencing tolerable harm. This suggests that short-term use of non-steroidal anti-inflammatory drugs in patients receiving palliative care is safer than previously thought and may be underused.
How do people who smoke perceive a tobacco retail outlet reduction policy in Aotearoa New Zealand? A qualitative analysis
Authors: Graham-DeMello Anna , Hoek Janet 
Published: January 2023

BackgroundAotearoa New Zealand plans to greatly reduce tobacco retail outlets, which are concentrated in areas of higher deprivation and perpetuate health inequities caused by smoking and borne particularly by Māori. However, we lack in-depth analyses of how this measure could affect people who smoke.MethodsWe undertook in-depth interviews with 24 adults from two urban areas who smoke. We used a novel interactive mapping approach to examine participants’ current retail outlets and their views on a scenario where very few outlets would sell tobacco. To inform policy implementation, we probed participants’ anticipated responses and explored the measure’s wider implications, including unintended impacts. We used qualitative description to interpret the data.ResultsMost participants anticipated accommodating the changes easily, by using alternative outlets or bulk-purchasing tobacco; however, they felt others would face access problems and increased costs, and greater stress. They thought the policy would spur quit attempts, reduce relapse among people who had quit and protect young people from smoking uptake, and expected more people to switch to alternative nicotine products. However, most foresaw unintended social outcomes, such as increased crime and reduced viability of local businesses.ConclusionsMany participants hoped to become smoke-free and thought retail reduction measures would prompt quit attempts and reduce relapse. Adopting a holistic well-being perspective, such as those developed by Māori, could address concerns about unintended adverse outcomes and provide comprehensive support to people who smoke as they adjust to a fundamental change in tobacco availability.
Air pollution associated with incidence and progression trajectory of chronic lung diseases: a population-based cohort study
Authors: Wang Xiaojie , Chen Lan , Cai Miao , Tian Fei , Zou Hongtao , Qian Zhengmin (Min) , Zhang Zilong , Li Haitao , Wang Chongjian , Howard Steven W , Peng Yang , Zhang Li’e , Bingheim Elizabeth , Lin Hualiang , Zou Yunfeng 
Published: February 2023

BackgroundNo prior study has examined the effects of air pollution on the progression from healthy to chronic lung disease, subsequent chronic lung multimorbidity and further to death.MethodsWe used data from the UK Biobank of 265 506 adults free of chronic lung disease at recruitment. Chronic lung multimorbidity was defined as the coexistence of at least two chronic lung diseases, including asthma, chronic obstructive pulmonary disease and lung cancer. The concentrations of air pollutants were estimated using land-use regression models. Multistate models were applied to assess the effect of air pollution on the progression of chronic lung multimorbidity.ResultsDuring a median follow-up of 11.9 years, 13 863 participants developed at least one chronic lung disease, 1055 developed chronic lung multimorbidity and 12 772 died. We observed differential associations of air pollution with different trajectories of chronic lung multimorbidity. Fine particulate matter showed the strongest association with all five transitions, with HRs (95% CI) per 5 µg/m3increase of 1.31 (1.22 to 1.42) and 1.27 (1.01 to 1.57) for transitions from healthy to incident chronic lung disease and from incident chronic lung disease to chronic lung multimorbidity, and 1.32 (1.21 to 1.45), 1.24 (1.01 to 1.53) and 1.91 (1.14 to 3.20) for mortality risk from healthy, incident chronic lung disease and chronic lung multimorbidity, respectively.ConclusionOur study provides the first evidence that ambient air pollution could affect the progression from free of chronic lung disease to incident chronic lung disease, chronic lung multimorbidity and death.
The Ordovician System: Key concepts, events and its distribution across Europe
Authors: Harper David A. T. , Lefebvre Bertrand , Percival Ian G. , Servais Thomas 
Published: January 2023

Abstract

The Ordovician was a key period in the biological and geological history of the planet. ‘A Global Synthesis of the Ordovician System’ is presented in two volumes of
The Geological Society, Special Publications
. This first volume (SP532) charts the history of the Ordovician System and explores significant advances in our understanding of the period's biostratigraphy, including more precise calibration of its timescale with tephra chronology and regional alignments using astrochronology and cyclostratigraphy. Changes in the world's oceans, their shifting currents and sea levels, the biogeography of their biotas and the ambient climate are described and discussed against a background of changing palaeogeography. This first volume also includes syntheses of Ordovician geology of most European countries, including historical key areas, such as the British Isles, Baltoscandia and Bohemia.