bluuebunny/crossref_metadata_2025_split huggingface dataset:
PrEP risk perception and adherence among men who have sex with men: a prospective cohort study based on growth mixture model
Authors: Lin Bing , Liu Jiaxiu , Zhong Xiaoni 
Published: December 2022

Abstract
Background
It can be considered that pre-exposure prophylaxis (PrEP) risk perception is the negative experiences or concerns about taking PrEP. The aim of this study is to explore the longitudinal trajectory of PrEP risk perception among men who have sex with men (MSM) and its impact on adherence.

Methods
Data related to PrEP risk perception and adherence were derived from a prospective cohort study in Western China from 2013 to 2015. Subjects were categorized into the time-driven, event-driven and blank control groups. Tenofovir disoproxil fumarate (TDF) was administered to subjects in the time-driven and event-driven groups, and all subjects were followed up every 12 weeks. The PrEP risk perception scale was constructed, and the growth mixture model (GMM) was used to classify longitudinal PrEP risk perception. The effect of different levels of PrEP risk perception on drug adherence was explored using generalized estimating equations (GEE) with relative risk (RR) and 95% confidence interval (CI).

Results
The PrEP risk perception scale consists of 4 dimensions and 16 items with Cronbach's alpha = 0.828 and a good model fit. According to the GMM analysis, the subjects' PrEP risk perceptions were separated into two groups: a "high-risk perception group" (n = 133) and a "low-risk perception group" (n = 493), where the proportion of high levels of drug adherence were 57.89% and 68.35%, respectively (p = 0.024). High levels of PrEP risk perception in the MSM population hinder drug adherence (RR = 0.71, 95% CI 0.50 to 0.99, p = 0.046). The results of this study were validated in the subsequent PrEP projects conducted in 2019 to 2021.

Conclusion
This study demonstrates that high levels of PrEP risk perception in the MSM population are an obstacle to drug adherence, emphasizing the necessity of focusing on PrEP risk perception in this population and the value of its application in the current context.
Cardiovascular events and mortality in chronic kidney disease in primary care patients with previous type 2 diabetes and/or hypertension. A population-based epidemiological study (KIDNEES)
Authors: Cunillera-Puértolas Oriol , Vizcaya David , Cerain-Herrero M. Jesús , Gil-Terrón Neus , Cobo-Guerrero Silvia , Salvador-González Betlem 
Published: December 2022

Abstract
Background
Chronic Kidney Disease (CKD), Type 2 Diabetes (T2D) and Hypertension (HTN) are frequently associated with adverse outcomes. We aimed to estimate the impact of a prior diagnosis of T2D and/or HTN on clinical characteristics, cardiovascular events (CVE) and all-cause mortality (ACM) of patients with CKD.

Methods
We conducted a retrospective cohort study based on primary care electronic health records of people without atherosclerotic cardiovascular disease, aged 18–90 years with incident CKD between January 1, 2007, and December 31, 2017. The association between CKD groups classified according to prior diagnosis of T2D and/or HTN and risk of ACM and CVE at follow-up was evaluated with Cox and Fine-Gray regression models, respectively.

Results
398,477 patients were included. Median age was 74 years and 55.2% were women. Individuals were classified as CKD with HTN (51.9%), CKD with T2D (3.87%), CKD with HTN/T2D (31.4%) and CKD without HTN/T2D (12.9%). In the multivariate analysis, with the CKD without HTN/T2D group as reference, the ACM Hazard Ratio (HR) was 0.74 (95%CI 0.72–0.75) for the CKD with HTN group, 0.81 (95%CI 0.79–0.83) for CKD with HTN/T2D and 1.14 (95%CI 1.10–1.19) for the CKD with T2D group. The sub distribution HRs for CVE were 1.40 (95%CI 1.34–1.47), 1.70 (95%CI 1.61–1.80) and 1.37 (95%CI 1.26–1.48), respectively.

Conclusion
In patients with CKD, the risk of ACM and CVE differed in patients with previous HTN and/or T2D. These comorbidities can help identify individuals at higher risk of adverse outcomes and improve the management of patients with CKD in primary care.
Conversion of unresponsiveness to immune checkpoint inhibition by fecal microbiota transplantation in patients with metastatic melanoma: study protocol for a randomized phase Ib/IIa trial
Authors: Borgers J. S. W. , Burgers F. H. , Terveer E. M. , van Leerdam M. E. , Korse C. M. , Kessels R. , Flohil C. C. , Blank C. U. , Schumacher T. N. , van Dijk M. , Henderickx J. G. E. , Keller J. J. , Verspaget H. W. , Kuijper E. J. , Haanen J. B. A. G. 
Published: December 2022

Abstract
Background
The gut microbiome plays an important role in immune modulation. Specifically, presence or absence of certain gut bacterial taxa has been associated with better antitumor immune responses. Furthermore, in trials using fecal microbiota transplantation (FMT) to treat melanoma patients unresponsive to immune checkpoint inhibitors (ICI), complete responses (CR), partial responses (PR), and durable stable disease (SD) have been observed. However, the underlying mechanism determining which patients will or will not respond and what the optimal FMT composition is, has not been fully elucidated, and a discrepancy in microbial taxa associated with clinical response has been observed between studies. Furthermore, it is unknown whether a change in the microbiome itself, irrespective of its origin, or FMT from ICI responding donors, is required for reversion of ICI-unresponsiveness. To address this, we will transfer microbiota of either ICI responder or nonresponder metastatic melanoma patients via FMT.

Methods
In this randomized, double-blinded phase Ib/IIa trial, 24 anti-PD1-refractory patients with advanced stage cutaneous melanoma will receive an FMT from either an ICI responding or nonresponding donor, while continuing anti-PD-1 treatment. Donors will be selected from patients with metastatic melanoma treated with anti-PD-1 therapy. Two patients with a good response (≥ 30% decrease according to RECIST 1.1 within the past 24 months) and two patients with progression (≥ 20% increase according to RECIST 1.1 within the past 3 months) will be selected as ICI responding or nonresponding donors, respectively. The primary endpoint is clinical benefit (SD, PR or CR) at 12 weeks, confirmed on a CT scan at 16 weeks. The secondary endpoint is safety, defined as the occurrence of grade ≥ 3 toxicity. Exploratory endpoints are progression-free survival and changes in the gut microbiome, metabolome, and immune cells.

Discussion
Transplanting fecal microbiota to restore the patients’ perturbed microbiome has proven successful in several indications. However, less is known about the potential role of FMT to improve antitumor immune response. In this trial, we aim to investigate whether administration of FMT can reverse resistance to anti-PD-1 treatment in patients with advanced stage melanoma, and whether the ICI-responsiveness of the feces donor is associated with its effectiveness.

Trial registration
ClinicalTrials.gov: NCT05251389 (registered 22-Feb-2022). Protocol V4.0 (08–02-2022).
SPP1 is a prognostic related biomarker and correlated with tumor-infiltrating immune cells in ovarian cancer
Authors: Gao Wen , Liu Dongli , Sun Haiyan , Shao Zhuyan , Shi Peipei , Li Tingting , Yin Sheng , Zhu Tao 
Published: December 2022

Abstract
Background
Secreted phosphoprotein 1 (SPP1) plays a vital role in tumor progression of multiple cancer types However, it still awaits further exploration whether SPP1 is a bystander or an actual player in the modulation of immune infiltration in ovarian cancer.

Methods
In this study, the expression level of SPP1 was identified by Oncomine, GEPIA and TIMER databases, and the result of SPP1 immumohistochemical staining was acquired by The HPA database. The impact of SPP1 expression level on the clinical outcome of ovarian cancer patients were evaluated via Kaplan–Meier Plotter and PrognoScan dataset. Immune infiltration analyses were conducted using TIMER and TISIDB dataset. In addition, Functional enrichment analyses were performed with Metascape and GeneMANIA database. To verify these findings from the public database, the results were validated in a cohort of ovarian cancer patients.

Results
SPP1 was found to be overexpressed in ovarian tumor tissues and high SPP1 expression was correlated with shorter survivals. Notably, SPP1 expression was positively correlated with infiltrating levels of CD4 + T cells, CD8 + T cells, macrophages, neutrophils, and dendritic cells. Furthermore, SPP1 expression level showed strong correlation with diverse immune cells in ovarian cancer. Of note, functional enrichment analysis suggested that SPP1 was strongly correlated with immune response.

Conclusions
These findings imply that SPP1 is correlated with prognosis and immune cell infiltrating, offering a new potential immunotherapeutic target in ovarian cancer.

Trial registration
Not applicable.
Infant in extremis: respiratory failure secondary to lower airway infantile hemangioma
Authors: MacDougall Matthew S. , Afzal Sarah Y. , Freedman Michael S. , Han Peggy 
Published: December 2022

Abstract
Background
Infantile hemangiomas (IHs) are vascular tumors that commonly affect infants and usually regress spontaneously or can be easily treated as an outpatient with topical beta-blockers. However, IHs that present in the airway may cause life-threatening symptoms due to airway obstruction or risk of bleeding. Here we present the first documented case of an infant with rapid deterioration and acute respiratory failure secondary to a lower airway hemangioma.

Case presentation
This 3-month-old male initially presented in respiratory distress with symptoms consistent with a viral respiratory infection, however showed no clinical improvement with standard therapies. An urgent CT scan revealed a mass occluding the right mainstem bronchus. Upon transfer to a tertiary care facility, he developed acute respiratory failure requiring emergent intubation and single lung ventilation. The availability of multiple subspecialists allowed for stabilization of a critically ill child, expedited diagnosis, and ultimately initiation of life-saving treatment with beta blockers. After 17 total hospital days, he was extubated successfully and discharged home in good condition.

Conclusions
While IH is a rare cause of infantile respiratory distress, we present multiple pearls for the general pediatrician for management of IHs of the airway.
ARIMA model for predicting chronic kidney disease and estimating its economic burden in China
Authors: Jian Yining , Zhu Di , Zhou Dongnan , Li Nana , Du Han , Dong Xue , Fu Xuemeng , Tao Dong , Han Bing 
Published: December 2022

Abstract
Background
Chronic kidney disease (CKD) is an important global public health issue. In China, CKD affects a large number of patients and causes a huge economic burden. This study provided a new way to predict the number of patients with CKD and estimate its economic burden in China based on the autoregressive integrated moving average (ARIMA) model.

Methods
Data of the number of patients with CKD in China from 2000 to 2019 were obtained from the Global Burden of Disease. The ARIMA model was used to fit and predict the number of patients with CKD. The direct and indirect economic burden of CKD were estimated by the bottom-up approach and the human capital approach respectively.

Results
The results of coefficient of determination (0.99), mean absolute percentage error (0.26%), mean absolute error (343,193.8) and root mean squared error (628,230.3) showed that the ARIMA (1,1,1) model fitted well. Akaike information criterion (543.13) and Bayesian information criterion (546.69) indicated the ARIMA (1,1,1) model was reliable when analyzing our data. The result of relative error of prediction (0.23%) also suggested that the model predicted well. The number of patients with CKD in 2020 to 2025 was predicted to be about 153 million, 155 million, 157 million, 160 million, 163 million and 165 million respectively, accounting for more than 10% of the Chinese population. The total economic burden of CKD from 2019 to 2025 was estimated to be $179 billion, $182 billion, $185 billion, $188 billion, $191 billion, $194 billion and $198 billion respectively.

Conclusion
The number of patients with CKD and the economic burden of CKD will continue to rise in China. The number of patients with CKD in China would increase by 2.6 million (1.6%) per year on average from 2020 to 2025. Meanwhile, the total economic burden of CKD in China would increase by an average of $3.1 billion per year. The ARIMA model is applicable to predict the number of patients with CKD. This study provides a new perspective for more comprehensive understanding of the future risk of CKD.
Comparison of periodontal status and salivary IL-15 and -18 levels in cigarette-smokers and individuals using electronic nicotine delivery systems
Authors: Ali Dena , Kuyunov Isaac , Baskaradoss Jagan Kumar , Mikami Toshinari 
Published: December 2022

Abstract
Background
It is hypothesized that periodontal status is compromised and whole salivary (WS) interleukin (IL)-15 and IL-18 levels are higher among cigarette-smokers and electronic-nicotine-delivery-systems (ENDS)-users than never-smokers. The aim of the present case–control study was to compare the periodontal status and WS IL-15 and -18 levels among cigarette-smokers, ENDS-users and controls (never-smokers).

Methods
Participants were divided into 4 groups as follows: Group-1:Current cigarette-smokers; Group-2:ENDS-users; Group-3:Never-smokers with periodontitis; and Group-4: Never-smokers without periodontitis. Demographic data was collected and plaque index (PI), gingival index (GI), probing-depth (PD), clinical attachment-loss (AL), and marginal bone loss (MBL) were measured. Number of missing teeth were recorded and WS IL-15 and IL-18 levels were determined. Group-comparisons were done and P < 0.01 was selected as an indicator of statistical analysis.

Results
Nineteen, 18, 19 and 19 individuals were enrolled in groups 1, 2, 3 and 4, respectively. Scores of PI, clinical AL, PD, and number of missing-teeth were elevated in groups 1(P < 0.001), 2 (P < 0.001) and 3 (P < 0.001) than -4. Scores of PI, clinical AL, PD, MBL and missing teeth were comparable among patients in groups 1, 2 and 3. Levels of IL-15 and IL-18 were elevated in groups 1 (P < 0.001) and 2 (P < 0.001) than groups 3 and 4. The levels of IL-15 and -18 were higher in Group-3 than in Group-4 (P < 0.001).

Conclusion
Clinically, cigarette-smokers and never-smokers demonstrate similar periodontal statuses; however, WS immunoinflammatory biomarkers (IL-15 and -18) are elevated in these individuals than non-smokers.
Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study
Authors: Bidner Amber , Bezak Eva , Parange Nayana 
Published: December 2022

AbstractBackgroundThere is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically.MethodsThis prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees’ knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees’ clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees.ResultsPre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8,P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence.ConclusionThis study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS.
Perceptions of portfolio assessment in family medicine graduates: a qualitative interview study
Authors: AlRadini Faten A. 
Published: December 2022

Abstract
Background
The use of the portfolio methodology in medical education can serve as a tool for learning, assessment, and reflection on practice. This study concentrates on perceptions of the portfolio assessment methodology among participants in the Saudi Diploma of Family Medicine program.

Methods
In this qualitative interview study, data were collected and analysed using a grounded theory approach.

Results
Nine codes emerged: (1) Importance of understanding the definition, objectives, and process of portfolio assessment, (2) Impact of different understandings on the part of various trainers, (3) Role of the type of assessment, (4) Workload and stress of portfolio assessment, (5) Effectiveness of the portfolio contents, (6) Role of the mentor’s feedback, (7) Role in the learning process, (8) Role in practice, (9) Suggestions for portfolio improvement. Open codes were then regrouped into three axial codes: context, strategy, and outcome of portfolio assessment.

Conclusion
This study explored a general explanation of portfolio assessment shaped by the postgraduate students. It identifies the importance of portfolio understanding in student acceptability of the portfolio assessment methodology. Thus, proper implementation is vital for the success of assessing the student by the portfolio methodology. The students perceived reflection as the most valuable part of the process, which facilitated their learning, confidence, and self-assessment. Mentor feedback is a good strategy for coping with portfolio challenges. Our findings provide some evidence of positive outcomes of portfolio assessment in practice and professional development.
Exploring sustainable care pathways - a scoping review
Authors: Sather Eva Walderhaug , Iversen Valentina Cabral , Svindseth Marit Folsvik , Crawford Paul , Vasset Frøydis 
Published: December 2022

Abstract
Background
Patients with mental health problems experience numerous transitions into and out of hospital.

Aim
The review studies assessing clinical care pathways between psychiatric hospitalization and community health services.

Methods
We used publications between 2009–2020 to allow a broad scoping review of the published research. Sixteen review-articles were identified, 12 primary studies were chosen, both on care pathways in the transition between psychiatric hospital and community.

Results
Organizational issues: Systems and procedures to ensure clear responsibilities and transparency at each stage of the pathways of care. Resources: Information-technology in objectively improving patient outcome. Information/documentation: Providing patients with adequate structured information and documented plans at the appropriate time. Patient/families: Continuous collaborative decision-making. Clinical care and teamwork: Collaboration between mental health and other professionals to guarantee that planned activities meet patient need. Ethical issues: Respectful communication and patient-centred, non-humiliating care.

Conclusions
System and procedures ensure clear responsibilities and transparency. Information technology support decision-making and referral and objectively improve patient outcomes in care pathways. Collaboration between mental health and other professionals guarantee that planned activities meet patients’ needs along with regular meetings sharing key information. Around-the-clock ambulant-teams important to transition success. Informed-shared decision-making between parties, support patient participation and respectful communication.
How a point-of-care dashboard facilitates co-production of health care and health for and with individuals with psychotic disorders: a mixed-methods case study
Authors: Gremyr Andreas , Holmberg Christopher , Thor Johan , Malm Ulf , Gäre Boel Andersson , Andersson Ann-Christine 
Published: December 2022

Abstract
Background
Individuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden’s largest department specializing in psychotic disorders sought to improve patients’ health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics.

Methods
This study evaluates the dashboard by addressing two questions:

Can differences in health-related outcome measures be attributed to the use of the dashboard?

How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders?

This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients.

Results
Compared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients’ health. The dashboard helped users identify critical changes and enabled joint planning and evaluation.

Conclusion
Dashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients’ health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.