bluuebunny/crossref_metadata_2025_split huggingface dataset:
026 How good is your gestalt in diagnosing acute coronary syndrome? A systematic literature review
Authors: Oliver Govind , Berg Patricia van den , Reynard Charles , Body Richard 
Published: April 2023

Chest pain accounts for 6% of Emergency Departments (ED) attendances. One of the most serious diagnoses clinicians must consider is Acute Coronary Syndrome (ACS). The challenge of early identification and timely but safe discharge of those without ACS, has led to multiple decision rules being developed. Many clinicians prefer and continue to use clinical judgement alone.We aimed to examine the current evidence on the diagnostic accuracy of clinical judgement or gestalt for ‘rule in’ and ‘rule out’ of ACS.A systematic literature review using Ovid Medline, Embase and Cochrane databases was conducted using a pre-defined search strategy. Returned results were independently screened by two reviewers for inclusion followed by a hand search of the grey literature and the references of relevant studies. Quality assessment of potentially eligible studies was carried out using a study-specific QUADAS-2 tool. Results were reported using the PRISMA guidelines.171 studies were screened, 13 underwent full text review, 6 were quality assessed using QUADAS-2 and 2 included. Meta-analysis plans were limited to a narrative description. The two included prospective cohort studies reported on 255 and 458 ED patients with suspected ACS. Gestalt identified 30.1% and 27.1% of patients as low risk. Sensitivity was 86.7% (95% confidence interval 76.8–93.4%) and 93.0% (86.1–97.1%) and negative predicative values (NPV) of 87.3% (79.0–92.7%) and 94.4% (89.0–97.2%) respectively. For the 30.6% and 38.0% of patients identified as high risk by gestalt in each study, specificity was 81.1% (74.6–86.6%) and 70.4% (65.4–75.1%) with positive predictive values of 56.4% (47.5–64.9%) and 39.1% (34.2–44.2%) respectively. A gestalt based rule out strategy incorporating ECG and arrival troponin performed with a sensitivity and NPV of 99.0%.A significant evidence gap has been identified. At present there is insufficient information to draw meaningful conclusion. The little evidence supporting a gestalt-based diagnostic strategy urgently needs prospective validation.
029 An exploration of what health care professionals consider to be good clinical shop floor leadership
Authors: Cantle Fleur 
Published: April 2023

BackgroundA successful shop floor leader must perform many tasks, often simultaneously, and hold an array of skills to complete those tasks. They must deliver clinical care, education and teaching and manage flow and performance. Individuals within an organisation will have differing expectations of the shop floor leader depending on how they are positioned within the organisation. The purpose of this study is to explore what team members within a single organisation, perceive to be good clinical shop floor leadership through semi structured interviews.Method and resultsPurposive, convenience sampling was used to find 12 subjects willing to undergo a semi-structured interview. The intention was to interview a cross section of members of the Emergency Department team, regarding what they understand by good shop floor leadership and exploring what are the perceived challenges for shop floor leadership.A crib of questions was used but this was not strictly adhered to, to allow exploration of themes not predefined by the primary researcher.The interview audio was transcribed and an iterative thematic analysis was then undertaken, with no predefined coding framework. Each transcript was analysed for themes and emergent patterns of commonality.ConclusionsThe theme of clinical leadership was explored, and the breadth of expectation placed on clinical leaders was evident. The importance of role modelling and credibility were highlighted. Clinical leaders described their strategy for shop floor leadership, and those who were led on the shop floor highlighted factors they valued, in particular education and teaching. The tensions between conflicting demands on the shop-floor leaders were demonstrated. The output from the interview enabled recommendations to be made regarding shop floor leadership for the organisation.
039 Peripheral administration of vasopressors in transport
Authors: Gervin Kevin , Corfield Alasdair , Queen Anton 
Published: April 2023

BackgroundManagement of shocked patients frequently requires vasopressor (epinephrine/norepinephrine) administration. Although less potent vasoactive agents are commonly delivered peripherally, historical concerns surround peripheral epinephrine and particularly norepinephrine use; these are primarily administered as infusions via central venous catheter (CVC). Concerns centre on potential extravasation and subsequent skin or tissue necrosis. However, recent studies suggest risks maybe lower than perceived. In the pre-hospital setting, circumstance may demand use of epinephrine/norepinephrine but preclude CVC insertion.In this study we assessed current practice for peripheral vasopressor usage in a national pre-hospital and retrieval service and associated complications.Method and resultsA retrospective, cohort study, using routinely collected data from the EMRS electronic record, cross-referenced against contemporaneous paper medical records from 2004–2018. All primary (pre-hospital) and secondary (from remote/rural healthcare facilities) patients over the age of 16 requiring peripheral vasopressors for shock were included.Data was collected on demographic information, retrieval site and mode of transport, vasopressor used, shock type, duration of use and subsequent complications. Complications were defined as immediate, noted by retrieval team on mission paperwork; or delayed, noted at 24-hour follow-up.Descriptive statistics for cohort study have been used and all analyses conducted using Stata v12.0Conclusions6093 missions were reviewed. Vasopressors were administered to 6.8% (417/6093) of patients. Epinephrine infusions were administered to 129 patients and 307 required norepinephrine (19 received both). Peripheral vasopressor infusions were used in 16.1% (67/417) of infusions. Of peripheral infusions, 40 patients received epinephrine and 30 received norepinephrine (three received both). Three epinephrine infusions were during primary missions, all norepinephrine infusions were on secondary retrievals.Distributive shock was the commonest indication for both (47.5% & 73.3%). There were no reported complications during missions or at 24-hours.Results suggest pre-hospital use of peripheral epinephrine/norepinephrine is relatively common and safe, with no complications reported across 15 years of practice.
004 Improving the consideration of non accidental injury in under 1s presenting to the emergency department with apparent trauma
Authors: Lowry Chris , Burton Fiona 
Published: April 2023

Non-accidental injury (NAI) is recognised as a common cause for injuries in children, especially in the very young, immobile child. STAG data from the RHC in Glasgow showed that 8% of paediatric trauma cases were due to NAI. All were under 2 years of age.It is vital that any clinician working in the Emergency Department considers NAI as a differential for the injured child.At Hairmyres it was noted through previous audit work that documentation and understanding of NAI was poor, and the process for highlighting concerns both difficult and confusing. These conclusions showed that consideration of NAI needed to be improved among cliniciansA QIP was undertaken to improve each of the areas identified.A proforma was created to allow a tick–sheet approach to documentation for NAI.A new referral process was introduced to facilitate sharing of information with social work with clear guidance for staff using the Notification of Concern (NOC) form.A multidisciplinary child protection meeting was set up to include staff from social work, paediatrics, child protection and emergency medicine.Over a 8 month period (November 2017 to June 2018):clear documentation of any child protection concerns rose from 0 to 70%.Documenting who accompanied a child rose from 20 to 100%checking for social work involvement rose from 0 to 70%.Documenting time of injury rose from 40 to 85%.Attendance at the child protection meeting improved to the extent that it will extend to be inclusive of two other sites in NHS Lanarkshire.Social work has received 46 NOCs (3 for under 1s), all deemed appropriate.ConclusionDocumentation for consideration of NAI has improved.Communication between respective departments has improved since the meetings commenced allowing collaboration to ensure we are getting it right for every child.
051 The ACUTE (ambulance CPAP: use, treatment effect and economics) feasibility study: a pilot randomised controlled trial of prehospital CPAP for acute respiratory failure
Authors: Fuller Gordon , Keating Sam , Goodacre Steve , Herbert Esther , Perkins Gavin , Ward Matthew , Rosser Andy , Gunson Imogen , Miller Josh , Bradburn Mike , Harris Tim , Marsh Maggie , Cooper Cindy 
Published: April 2023

BackgroundAcute respiratory failure (ARF) is a common and life-threatening medical emergency. Continuous positive airway pressure (CPAP) is a potentially beneficial prehospital treatment, but it is uncertain whether this could improve important outcomes in NHS ambulance services.MethodsAn individually randomised, external pilot study was conducted to test the feasibility of a definitive pragmatic trial. Adults with respiratory distress and peripheral oxygen saturations below British Thoracic Society target levels were recruited from the West Midlands Ambulance Service between August 2017 and July 2018. Participants were randomised 1:1 to prehospital CPAP or standard oxygen therapy. Feasibility objectives estimated the: incidence of eligible patients; proportion recruited and allocated to treatment appropriately; adherence to allocated treatment; retention and data completeness; and 30-day mortality, as a potential primary outcome for a definitive trial.ResultsOver 12 months, 77 patients were enrolled (CPAP arm 42, standard oxygen arm 35 cases, target 120). CPAP was fully delivered as planned in 74% (target 75%). There were no major protocol violations/non-compliances (target 0%). Full data were available for key outcomes (target ≥90%). Mortality was higher than expected (overall 27.3%, CPAP arm 28.6% n=12/42, standard care arm 25.7% n=9/35). Of deceased patients, 14/21 (68%) either did not have a respiratory condition or had ceiling of treatment decisions excluding hospital non-invasive ventilation and critical care. Two patients required emergency department treatment for a pneumothorax, neither having received prehospital CPAP. There were no other serious adverse events.ConclusionsThe lower than expected recruitment rate, limited compliance with CPAP, and the difficulty in identifying patients who could benefit from CPAP, indicate limited potential for prehospital CPAP to reduce mortality. A definitive effectiveness trial is therefore not recommended. These findings also argue against routine implementation of CPAP into NHS ambulance services.
Helicobacter pyloripromotes colorectal carcinogenesis by deregulating intestinal immunity and inducing a mucus-degrading microbiota signature
Authors: Ralser Anna , Dietl Alisa , Jarosch Sebastian , Engelsberger Veronika , Wanisch Andreas , Janssen Klaus Peter , Middelhoff Moritz , Vieth Michael , Quante Michael , Haller Dirk , Busch Dirk H , Deng Li , Mejías-Luque Raquel , Gerhard Markus 
Published: April 2023

ObjectiveHelicobacter pyloriinfection is the most prevalent bacterial infection worldwide. Besides being the most important risk factor for gastric cancer development, epidemiological data show that infected individuals harbour a nearly twofold increased risk to develop colorectal cancer (CRC). However, a direct causal and functional connection betweenH. pyloriinfection and colon cancer is lacking.DesignWe infected twoApc-mutant mouse models and C57BL/6 mice withH. pyloriand conducted a comprehensive analysis ofH. pylori-induced changes in intestinal immune responses and epithelial signatures via flow cytometry, chip cytometry, immunohistochemistry and single cell RNA sequencing. Microbial signatures were characterised and evaluated in germ-free mice and via stool transfer experiments.ResultsH. pyloriinfection accelerated tumour development inApc-mutant mice. We identified a uniqueH. pylori-driven immune alteration signature characterised by a reduction in regulatory T cells and pro-inflammatory T cells. Furthermore, in the intestinal and colonic epithelium,H. pyloriinduced pro-carcinogenic STAT3 signalling and a loss of goblet cells, changes that have been shown to contribute—in combination with pro-inflammatory and mucus degrading microbial signatures—to tumour development. Similar immune and epithelial alterations were found in human colon biopsies fromH. pylori-infected patients. Housing ofApc-mutant mice under germ-free conditions ameliorated, and early antibiotic eradication ofH. pyloriinfection normalised the tumour incidence to the level of uninfected controls.ConclusionsOur studies provide evidence thatH. pyloriinfection is a strong causal promoter of colorectal carcinogenesis. Therefore, implementation ofH. pyloristatus into preventive measures of CRC should be considered.
Elevated plasma p-tau181 levels unrelated to Alzheimer’s disease pathology in amyotrophic lateral sclerosis
Authors: Vacchiano Veria , Mastrangelo Andrea , Zenesini Corrado , Baiardi Simone , Avoni Patrizia , Polischi Barbara , Capellari Sabina , Salvi Fabrizio , Liguori Rocco , Parchi Piero 
Published: April 2023

BackgroundPhosphorylated-tau181 (p-tau181), a specific marker of Alzheimer’s disease (AD) pathology, was found elevated in plasma but not in cerebrospinal fluid (CSF) of patients with amyotrophic lateral sclerosis (ALS). We expanded these findings in a larger patient cohort, exploring clinical/electrophysiological associations, prognostic value and longitudinal trajectories of the biomarker.MethodsWe obtained baseline plasma samples from 148 ALS, 12 spinal muscular atrophy (SMA), and 88 AD patients, and 60 healthy controls. Baseline CSF and longitudinal plasma samples were from 130 and 39 patients with ALS. CSF AD markers were measured with the Lumipulse platform, and plasma p-tau181 with SiMoA.ResultsPatients with ALS showed higher plasma p-tau181 levels than controls (p<0.001) and lower than AD participants (p=0.02). SMA patients had higher levels than controls (p=0.03). In patients with ALS, CSF p-tau and plasma p-tau181 did not correlate (p=0.37). Plasma p-tau181 significantly increased with the number of regions showing clinical/neurophysiological lower motor neurons (LMN) signs (p=0.007) and correlated with the degree of denervation in the lumbosacral area (r=0.51, p<0.0001). Plasma p-tau181 levels were higher in classic and LMN-predominant than in bulbar phenotype (p=0.004 and p=0.006). Multivariate Cox regression confirmed plasma p-tau181 as an independent prognostic factor in ALS (HR 1.90, 95% CI 1.25 to 2.90, p=0.003). Longitudinal analysis showed a significant rise in plasma p-tau181 values over time, especially in fast progressors.ConclusionsPlasma p-tau181 is elevated in patients with ALS, independently from CSF levels, and is firmly associated with LMN dysfunction. The finding indicates that p-tau181 of putative peripheral origin might represent a confounding factor in using plasma p-tau181 for AD pathology screening, which deserves further investigation.
Training obstetrician gynaecologists in HIV PrEP (pre-exposure prophylaxis): a 2-year experience
Authors: Silvestri Francesca , Alvarez Natalie , Afzal Omara , Urbina Antonio E , Dolan Siobhan M , Ramirez Zamudio Andres 
Published: April 2023

ObjectiveWe aimed to evaluate the efficacy of PrEP (pre-exposure prophylaxis) training sessions for OBGYN (obstetrician gynaecologist) providers given underutilisation of PrEP among women despite a high HIV burden.MethodsThree separate training sessions were held for providers in the OBGYN department at an academic medical centre in New York City from 2019 to 2021. The 1-hour training sessions were conducted by HIV specialists as in-person lectures or online live lectures. Participants were surveyed after the training on metrics of PrEP awareness, knowledge and comfort with management. Two-sample t-tests were used to compare difference in proportions of binomial variables and difference in means of Likert-scored answers pretraining and post-training events.Results63 respondents completed the surveys. There were low rates (13%) of past PrEP prescription among the respondents, while awareness of PrEP as an HIV prevention strategy was high before (95%) and after (98%) the training. After the training, there was an increase in understanding the epidemiology of HIV transmission (40% to 97%, p<0.00), familiarity with the PrEP clinical trials (18% to 97%, p<0.00), comfort in determining PrEP candidacy (mean score 2.3 to 4.1, p<0.00) and comfort prescribing PrEP (mean score 2.0 to 3.6, p<0.00). After the trainings, the majority of participants reported feeling ‘comfortable’ or ‘very comfortable’ in determining candidacy for PrEP and prescribing PrEP with follow-up.ConclusionImplementation of PrEP training courses for OBGYN providers increased knowledge and comfort in identifying and managing patients who may benefit from PrEP services. Increasing training among OBGYN providers serving women at risk for HIV infection is an effective tool to narrow gaps in PrEP access.
Cumulative cigarette discount coupon exposure and trajectories of cigarette smoking: a longitudinal analysis in US adults
Authors: Hamilton-Moseley Kristen R , McNeel Timothy S , Choi Kelvin 
Published: April 2023

Introduction
Exposure to cigarette discount coupons is associated with short-term increase in cigarette smoking; however, long-term impact is unclear. This study examined associations of cumulative exposure to cigarette coupons with trajectories of cigarette smoking in US adults.

Methods
Data were from the US Population Assessment of Tobacco and Health Study Adult Surveys (n=19 824; waves 2–5). We examined the number of waves participants received cigarette discount coupons/promotions during waves 2–4 and smoking behaviours at wave 5. Weighted logistic multivariable regression models were used, adjusting for wave 2 demographics and stratified by wave 2 smoking status.

Results
Among wave 2 adults who never smoked, each increment wave of exposure to cigarette discount coupons was associated with greater odds of wave 5 current smoking (adjusted OR (aOR)=2.09, 95% CI 1.24–3.52). Among wave 2 adults who smoked daily, each wave of coupon exposure was associated with lower odds of quitting smoking at wave 5 (aOR=0.67, 95% CI 0.62—0.73). Among wave 2 adults who had quit smoking, each increment wave of exposure was associated with greater odds of wave 5 current smoking (aOR=1.61, 95% CI 1.41—1.85). Additionally, women (vs men) and adults with lower socioeconomic status (SES) (vs higher SES) were more frequently exposed to cigarette coupons for a higher number of waves (p<0.05).

Discussion
Exposure to cigarette coupons exhibited a dose–response relationship with changes in cigarette smoking behaviours over time, promoting smoking progression and hindering smoking cessation especially among women and people with lower SES. Prohibiting these coupons can be an important tobacco control strategy.
Supplementary Materials and Methods; Supplementary Figures S1-S5; and Supplementary Tables S1-S5 from α<sub>V</sub>β<sub>3</sub> Integrin-Targeted Radionuclide Therapy with <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub>
Authors: Jin Zhao-Hui , Furukawa Takako , Degardin Mélissa , Sugyo Aya , Tsuji Atsushi B. , Yamasaki Tomoteru , Kawamura Kazunori , Fujibayashi Yasuhisa , Zhang Ming-Rong , Boturyn Didier , Dumy Pascal , Saga Tsuneo 
Published: April 2023

<p>The files contain (1) Supplementary Materials and Methods for Î±<sub>V</sub>Î²<sub>3</sub> expression analysis, autoradiography and histological analysis, and hematology and hepatorenal function; (2) Supplementary Tables S1-S5; and (3) Supplementary Figures S1-S5.	Table S1â^'Effects of 37 MBq (1 nmole) of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub> {plus minus} GF/Lys on hepatorenal functions of U87MG tumor-bearing mice; Table S2â^'Blood cell counts of U87MG tumor-bearing mice at various time points post-injection of 37 MBq (1 nmole) of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub> {plus minus} GF/Lys; Table S3â^'Blood cell counts of U87MG tumor-bearing mice at various time points after single dose administrations of 37 and 74 MBq of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub>; Table S4â^'Effects of 74 MBq (2 nmole) of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub> + GF/Lys on hepatorenal functions of normal mice; Table S5â^'Human absorbed doses extrapolated from the biodistribution data of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub> in U87MG tumor-bearing mice; Figure S1â^'The treatment outcomes of radiotherapy with 37 MBq (1 nmole) of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub>; Figure S2â^'Toxicity studies in normal mice that were injected with 74 MBq of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub>; Figure S3â^'Preliminary study of U87MG tumors excised at day 13 p.i. of 37 MBq of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub> for the changes in microvasculature; Figure S4â^'Positive correlation between the tumor volume and the corresponding WBC in U87MG tumor-bearing mice; Figure S5â^'Biodistribution of <sup>64</sup>Cu-cyclam-RAFT-c(-RGDfK-)<sub>4</sub> at various peptide doses (0.005â^'10 nmole) in U87MG tumor-bearing mice.</p>