bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic review of shared decision-making interventions for people living with chronic respiratory diseases
Authors: Barradell Amy C , Gerlis Charlotte , Houchen-Wolloff Linzy , Bekker Hilary L , Robertson Noelle , Singh Sally J 
Published: May 2023

ObjectiveShared decision-making (SDM) supports patients to make informed and value-based decisions about their care. We are developing an intervention to enable healthcare professionals to support patients’ pulmonary rehabilitation (PR) decision-making. To identify intervention components we needed to evaluate others carried out in chronic respiratory diseases (CRDs). We aimed to evaluate the impact of SDM interventions on patient decision-making (primary outcome) and downstream health-related outcomes (secondary outcome).DesignWe conducted a systematic review using the risk of bias (Cochrane ROB2, ROBINS-I) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) tools.Data sourcesMEDLINE, EMBASE, PSYCHINFO, CINAHL, PEDRO, Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform Search Portal, ClinicalTrials.gov, PROSPERO, ISRCTN were search through to 11th April 2023.Eligibility criteriaTrials evaluating SDM interventions in patients living with CRD using quantitative or mixed methods were included.Data extraction and synthesisTwo independent reviewers extracted data, assessed risk of bias and certainty of evidence. A narrative synthesis, with reference to The Making Informed Decisions Individually and Together (MIND-IT) model, was undertaken.ResultsEight studies (n=1596 (of 17 466 citations identified)) fulfilled the inclusion criteria.Five studies included components targeting the patient, healthcare professionals and consultation process (demonstrating adherence to the MIND-IT model). All studies reported their interventions improved patient decision-making and health-related outcomes. No outcome was reported consistently across studies. Four studies had high risk of bias, three had low quality of evidence. Intervention fidelity was reported in two studies.ConclusionsThese findings suggest developing an SDM intervention including a patient decision aid, healthcare professional training, and a consultation prompt could support patient PR decisions, and health-related outcomes. Using a complex intervention development and evaluation research framework will likely lead to more robust research, and a greater understanding of service needs when integrating the intervention within practice.PROSPERO registration numberCRD42020169897.
Clinical emergency care quality indicators in Africa: a scoping review and data summary
Authors: Pickering Ashley E , Malherbe Petrus , Nambuba Joan , Bills Corey B , Hynes Emilie Calvello , Rice Brian 
Published: May 2023

ObjectivesEmergency care services are rapidly expanding in Africa; however, development must focus on quality. The African Federation of Emergency Medicine consensus conference (AFEM-CC)-based quality indicators were published in 2018. This study sought to increase knowledge of quality through identifying all publications from Africa containing data relevant to the AFEM-CC process clinical and outcome quality indicators.DesignWe conducted searches for general quality of emergency care in Africa and for each of 28 AFEM-CC process clinical and five outcome clinical quality indicators individually in the medical and grey literature.Data sourcesPubMed (1964—2 January 2022), Embase (1947—2 January 2022) and CINAHL (1982—3 January 2022) and various forms of grey literature were queried.Eligibility criteriaStudies published in English, addressing the African emergency care population as a whole or large subsegment of this population (eg, trauma, paediatrics), and matching AFEM-CC process quality indicator parameters exactly were included. Studies with similar, but not exact match, data were collected separately as ‘AFEM-CC quality indicators near match’.Data extraction and synthesisDocument screening was done in duplicate by two authors, using Covidence, and conflicts were adjudicated by a third. Simple descriptive statistics were calculated.ResultsOne thousand three hundred and fourteen documents were reviewed, 314 in full text. 41 studies met a priori criteria and were included, yielding 59 unique quality indicator data points. Documentation and assessment quality indicators accounted for 64% of data points identified, clinical care for 25% and outcomes for 10%. An additional 53 ‘AFEM-CC quality indicators near match’ publications were identified (38 new publications and 15 previously identified studies that contained additional ‘near match’ data), yielding 87 data points.ConclusionsData relevant to African emergency care facility-based quality indicators are highly limited. Future publications on emergency care in Africa should be aware of, and conform with, AFEM-CC quality indicators to strengthen understanding of quality.
Unravelling the predictors of late cancer presentation and diagnosis in Jordan: a cross-sectional study of patients with lung and colorectal cancers
Authors: Damsees Rana , Jaghbir Madi , Salam Mahmoud , Al-Omari Amal , Al-Rawashdeh Nedal 
Published: May 2023

ObjectivesLate presentation or diagnosis of cancer results in a poor clinical prognosis, negatively affects treatment and subsequently lowers one’s chances of survival. This study aimed to identify the factors associated with late lung and colorectal cancer presentation and diagnosis in Jordan.DesignThis correlational cross-sectional study was based on face-to-face interviews and medical chart reviews from a cancer registry database. A structured questionnaire based on a review of the literature was used.Setting and participantsThe study participants were a representative sample of adult patients with colorectal or lung cancer who visited the outpatient clinics at King Hussein Cancer Center in Amman, Jordan, between January 2019 and December 2020, to get their first medical consultation.Results382 study participants were surveyed, with a response rate of 82.3%. Of these, 162 (42.2%) reported a late presentation and 92 (24.1%) reported a late diagnosis of cancer. The results of backward multivariate logistic regression analyses showed that female gender and not seeking a medical advice when feeling ill combined was associated with an almost three times increased likelihood of reporting a late presentation with cancer (adjusted OR 2.97, 95% CI 1.19 to 7.43). Not having health insurance and not seeking medical advice combined was also associated with late presentation (2.5, 95% CI 1.02 to 6.12). For lung cancer, Jordanians living in rural areas were 9.29 (95% CI 2.46 to 35.1) times more likely to report late diagnosis. Jordanians who did not screen for cancer in the past were 7.02 (95% CI 1.69 to 29.18) times more likely to report late diagnosis. For colorectal cancer, those having no previous knowledge about cancers or screening programmes had increased odds of reporting late diagnosis (2.30, 95% CI 1.06 to 4.97).ConclusionsThis study highlights important factors associated with the late presentation and diagnosis of colorectal and lung cancers in Jordan. Investing in national screening and early detection programmes as well as public outreach and awareness campaigns will have a significant impact on early detection to improve treatment outcomes.
Does reducing out-of-pocket costs for children’s surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study
Authors: Smith Emily R , Kapoor Pranav , Concepcion Tessa , Ramirez Treasure , Mohamed Mubarak , Dahir Shukri , Cotache-Condor Cesia , Adan Ismail Edna , Rice Henry E , Shrime Mark G 
Published: May 2023

ObjectivesAn estimated 1.7 billion children around the world do not have access to safe, affordable and timely surgical care, with the financing through out-of-pocket (OOP) expenses being one of the main barriers to care. Our study modelled the impact of reducing OOP costs related to surgical care for children in Somaliland on the risk of catastrophic expenditures and impoverishment.Design and settingThis cross-sectional nationwide economic evaluation modelled several different approaches to reduction of paediatric OOP surgical costs in Somaliland.Participants and outcome measuresA surgical record review of all procedures on children up to 15 years old was conducted at 15 surgically capable hospitals. We modelled two rates of OOP cost reduction (reduction of OOP proportion from 70% to 50% and from 70% to 30% reduction in OOP costs) across five wealth quintiles (poorest, poor, neutral, rich, richest) and two geographical areas (urban and rural). The outcome measures of the study are catastrophic expenditures and risk of impoverishment due to surgery. We followed the Consolidated Health Economic Evaluation Reporting Standards.ResultsWe found that the risk of catastrophic and impoverishing expenditures related to OOP expenditures for paediatric surgery is high across Somaliland, but most notable in the rural areas and among the poorest quintiles. Reducing OOP expenses for surgical care to 30% would protect families in the richest wealth quintiles while minimally affecting the risk of catastrophic expenditure and impoverishment for those in the lowest wealth quintiles, particularly those in rural areas.ConclusionOur models suggest that the poorest communities in Somaliland lack protection against the risk of catastrophic health expenditure and impoverishment, even if OOP payments are reduced to 30% of surgical costs. A comprehensive financial protection in addition to reduction of OOP costs is required to prevent risk of impoverishment in these communities.
Undiagnosed and ‘overdiagnosed’ COPD using postbronchodilator spirometry in primary healthcare settings: a systematic review and meta-analysis
Authors: Perret Jennifer , Yip Sui Wah Sean , Idrose Nur Sabrina , Hancock Kerry , Abramson Michael J , Dharmage Shyamali C , Walters E Haydn , Waidyatillake Nilakshi 
Published: May 2023

BackgroundDespite chronic obstructive pulmonary disease (COPD) being a major global cause of mortality and hospitalisation, it is often undiagnosed or inaccurately diagnosed in clinical settings.ObjectiveTo systematically synthesise all peer-reviewed papers from primary healthcare settings that have reported data on: (1) undiagnosed COPD, that is, patients with respiratory symptoms and postbronchodilator airflow obstruction consistent with COPD, without a formal clinician’s diagnosis of COPD either documented in health records or reported by patients and (2) ‘overdiagnosed COPD’, that is, clinician’s diagnosis without postbronchodilator airflow obstruction.MethodsStudies investigating these diagnostic metrics in patients from primary healthcare clinics (according to predefined inclusion/exclusion criteria) were sourced from Medline and Embase and assessed for bias (Johanna Briggs Institute tools for prevalence studies and case series). Meta-analyses of studies of adequate sample size used random effect modelling stratified by risk factor categories.ResultsOf 26 eligible articles, 21 cross-sectional studies investigated 3959 cases of spirometry-defined COPD (with or without symptoms), and 5 peer-reviewed COPD case series investigated 7381 patients. The prevalence of spirometry-confirmed COPD without a diagnosis documented in their health records was 14%–26% in studies of symptomatic smokers (N=3). 1 in 4 patients taking inhaled therapies (25% (95% CI 22% to 28%), N=2) and 1 in 6 smokers irrespective of symptoms (16% (95% CI 14% to 18%), N=6) fulfilled diagnostic spirometry criteria but did not report receiving a COPD-related diagnosis. In an adequately powered series of COPD cases documented in primary healthcare records (N=4), only between 50% and 75% of subjects had any airflow obstruction on postbronchodilator spirometry performed by study researchers, therefore, COPD was clinically ‘overdiagnosed’ in 25%–50% of subjects.DiscussionAlthough data were heterogeneous and of modest quality, undiagnosed COPD was common in primary healthcare, especially for symptomatic smokers and patients treated with inhaled therapies. In contrast, frequent COPD ‘overdiagnosis’ may represent treatment of asthma/reversible component or another medical diagnosis.PROSPERO registration numberCRD42022295832.
Lung function and cognitive ability in children: a UK birth cohort study
Authors: Grenville Jack , Granell Raquel , Dodd James 
Published: May 2023

BackgroundDecreased adult lung function is associated with subsequent impairment in cognition. A similar relationship in early life could be of great policy importance, since childhood cognitive ability determines key adult outcomes, including socioeconomic status and mortality. We aimed to expand the very limited data available on this relationship in children, and hypothesised that reduced lung function would be longitudinally associated with decreased cognitive ability.MethodsLung function was measured at age 8 (forced expiratory volume in one second (FEV1), forced vital capacity (FVC); % predicted), and cognitive ability was measured at ages 8 (Wechsler Intelligence Scale for Children, third edition) and 15 (Wechsler Abbreviated Scale of Intelligence), in the Avon Longitudinal Study of Parents and Children. Potential confounders were identified as preterm birth, birth weight, breastfeeding duration, prenatal maternal smoking, childhood environmental tobacco smoke exposure, socioeconomic status and prenatal/childhood air pollution exposure. Univariable and multivariable linear models (n range=2332–6672) were fitted to assess the cross-sectional and longitudinal associations of lung function with cognitive ability, and change in cognitive ability between ages 8 and 15.ResultsIn univariate analyses, both FEV1and FVC at age 8 were associated with cognitive ability at both ages, but after adjustment, only FVC was associated with full-scale IQ (FSIQ) at ages 8 (β=0.09 (95% CI 0.05 to 0.12; p<0.001)) and 15 (β=0.06 (0.03 to 0.10; p=0.001)). We did not find evidence of an association between either lung function parameter and interval change in standardised FSIQ.DiscussionReduced FVC, but not FEV1, is independently associated with decreased cognitive ability in children. This low-magnitude association attenuates between ages 8 and 15, while no association is evident with longitudinal change in cognitive ability. Our results support a link between FVC and cognition across the life course, possibly due to shared genetic or environmental risk, rather than causation.
ROCK STUDY in CF: sustained anti-inflammatory effects of lumacaftor–ivacaftor in sputum and peripheral blood samples of adult patients with cystic fibrosis—an observational study
Authors: Arooj Parniya , Morrissy David V , McCarthy Yvonne , Vagg Tamara , McCarthy Mairead , Fleming Claire , Daly Mary , Eustace Joseph A , Murphy Desmond M , Plant B J 
Published: May 2023

BackgroundPrevious studies showed that the combination of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) corrector and potentiator, lumacaftor–ivacaftor (LUMA–IVA) provides meaningful clinical benefits in patients with cystic fibrosis who are homozygous for the Phe508delCFTRmutation. However, little is known about the effect of LUMA–IVA on Proinflammatory Cytokines (PICs).ObjectivesTo investigate the impact of LUMA–IVACFTRmodulation on circulatory and airway cytokines before and after 12 months of LUMA–IVA treatment in a real-world setting.MethodsWe assessed both plasma and sputum PICs, as well as standard clinical outcomes including Forced Expiratory Volume in one second (FEV1) %predicted, Body Mass Index (BMI), sweat chloride and pulmonary exacerbations at baseline and prospectively for one year post commencement of LUMA–IVA in 44 patients with cystic fibrosis aged 16 years and older homozygous for the Phe508delCFTRmutation.ResultsSignificant reduction in plasma cytokines including interleukin (IL)-8 (p<0.05), tumour necrosis factor (TNF)-α (p<0.001), IL-1ß (p<0.001) levels were observed while plasma IL-6 showed no significant change (p=0.599) post-LUMA–IVA therapy. Significant reduction in sputum IL-6 (p<0.05), IL-8 (p<0.01), IL-1ß (p<0.001) and TNF-α (p<0.001) levels were observed after LUMA–IVA therapy. No significant change was noted in anti-inflammatory cytokine IL-10 levels in both plasma and sputum (p=0.305) and (p=0.585) respectively. Clinically significant improvements in FEV1%predicted (mean+3.38%, p=0.002), BMI (mean+0.8 kg/m2, p<0.001), sweat chloride (mean −19 mmol/L, p<0.001), as well as reduction in intravenous antibiotics usage (mean −0.73, p<0.001) and hospitalisation (mean −0.38, p=0.002) were observed after initiation of LUMA–IVA therapy.ConclusionThis real-world study demonstrates that LUMA–IVA has significant and sustained beneficial effects on both circulatory and airway inflammation. Our findings suggest that LUMA–IVA may improve inflammatory responses, which could potentially contribute to improved standard clinical outcomes.
Effect of CD274 (PD-L1) overexpression on survival outcomes in 10 specific cancers: a systematic review and meta-analysis
Authors: Park Ji Hyun , Luchini Claudio , Nottegar Alessia , Tizaoui Kalthoum , Koyanagi Ai , Ogino Shuji , Shin Jae Il , Lim Beom Jin , Smith Lee 
Published: May 2023

AimThe prognostic role of CD274 (programmed cell death ligand 1 (PD-L1)) overexpression has been examined in many studies. However, the results are controversial and conflicting. The present study aims to investigate the potential role of CD274 (PD-L1) immunohistochemical overexpression as a prognostic marker in malignant tumours.MethodsWe searched PubMed, Embase and Web of Science from inception to December 2021 to identify potentially eligible studies. The pooled HRs with 95% CIs were calculated to identify the association between CD274 (PD-L1) overexpression and overall survival (OS), cancer-specific survival, disease-free survival, recurrence-free survival and progression-free survival in 10 lethal malignant tumours. Heterogeneity and publication bias were also analysed.ResultsThe study included 57 322 patients from 250 eligible studies (241 articles). The meta-analysis by tumour type using multivariate HR revealed worse OS in non-small cell lung cancer (HR 1.41, 95% CI 1.19 to 1.68), hepatocellular carcinoma (HR 1.75, 95% CI 1.11 to 2.74), pancreatic cancer (HR 1.84, 95% CI 1.12 to 3.02), renal cell carcinoma (HR 1.55, 95% CI 1.12 to 2.14) and colorectal cancer (HR 1.46, 95% CI 1.14 to 1.88). Estimated HRs showed associations between CD274 (PD-L1) overexpression and worse prognosis across different types of tumours in various survival endpoints, but no inverse correlation was identified. The heterogeneity for most of the pooled results was high.ConclusionsThis large meta-analysis suggests that CD274 (PD-L1) overexpression is a potential biomarker for multiple types of cancers. However, further studies are needed to reduce high heterogeneity.PROSPERO registration numberCRD42022296801.
Cross-cohort analysis identified an immune checkpoint-based signature to predict the clinical outcomes of neuroblastoma
Authors: Zeng Liang , Xu Hui , Li Shu-Hua , Xu Shuo-Yu , Chen Kai , Qin Liang-Jun , Miao Lei , Wang Fang , Deng Ling , Wang Feng-Hua , Li Le , Fu Sha , Liu Na , Wang Ran , Li Ying-Qing , Wang Hai-Yun 
Published: May 2023

BackgroundNeuroblastoma (NB) places a substantial health burden on families worldwide. This study aimed to develop an immune checkpoint-based signature (ICS) based on the expression of immune checkpoints to better assess patient survival risk and potentially guide patient selection for immunotherapy of NB.MethodsImmunohistochemistry integrated with digital pathology was used to determine the expression levels of 9 immune checkpoints in 212 tumor tissues used as the discovery set. The GSE85047 dataset (n=272) was used as a validation set in this study. In the discovery set, the ICS was constructed using a random forest algorithm and confirmed in the validation set to predict overall survival (OS) and event-free survival (EFS). Kaplan-Meier curves with a log-rank test were drawn to compare the survival differences. A receiver operating characteristic (ROC) curve was applied to calculate the area under the curve (AUC).ResultsSeven immune checkpoints, including PD-L1, B7-H3, IDO1, VISTA, T-cell immunoglobulin and mucin domain containing-3 (TIM-3), inducible costimulatory molecule (ICOS) and costimulatory molecule 40 (OX40), were identified as abnormally expressed in NB in the discovery set. OX40, B7-H3, ICOS and TIM-3 were eventually selected for the ICS model in the discovery set, and 89 patients with high risk had an inferior OS (HR 15.91, 95% CI 8.87 to 28.55, p<0.001) and EFS (HR 4.30, 95% CI 2.80 to 6.62, p<0.001). Furthermore, the prognostic value of the ICS was confirmed in the validation set (p<0.001). Multivariate Cox regression analysis demonstrated that age and the ICS were independent risk factors for OS in the discovery set (HR 6.17, 95% CI 1.78 to 21.29 and HR 1.18, 95% CI 1.12 to 1.25, respectively). Furthermore, nomogram A combining the ICS and age demonstrated significantly better prognostic value than age alone in predicting the patients’ 1-year, 3-year and 5-year OS in the discovery set (1 year: AUC, 0.891 (95% CI 0.797 to 0.985) vs 0.675 (95% CI 0.592 to 0.758); 3 years: 0.875 (95% CI 0.817 to 0.933) vs 0.701 (95% CI 0.645 to 0.758); 5 years: 0.898 (95% CI 0.851 to 0.940) vs 0.724 (95% CI 0.673 to 0.775), respectively), which was confirmed in the validation set.ConclusionsWe propose an ICS that significantly differentiates between low-risk and high-risk patients, which might add prognostic value to age and provide clues for immunotherapy in NB.
Improved outcomes for spinal versus general anesthesia for hip fracture surgery: a retrospective cohort study of the National Surgical Quality Improvement Program
Authors: Weinstein Eliana R , Boyer Richard B , White Robert S , Weinberg Roniel Y , Lurie Jacob M , Salvatierra Nicolas , Tedore Tiffany R 
Published: May 2023

BackgroundThere is a lack of consensus in the literature as to whether anesthetic modality influences perioperative complications in hip fracture surgery. The aim of the present study was to assess the effect of spinal anesthesia compared with general anesthesia on postoperative morbidity and mortality in patients who underwent hip fracture surgery using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).MethodsWe used the ACS NSQIP to identify patients aged 50 and older who received either spinal or general anesthesia for hip fracture surgery from 2016 to 2019. Propensity-score matching was performed to control for clinically relevant covariates. The primary outcome of interest was the combined incidence of stroke, myocardial infarction (MI) or death within 30 days. Secondary outcomes included 30-day mortality, hospital length of stay and operative time.ResultsAmong the 40 527 patients aged 50 and over who received either spinal or general anesthesia for hip fracture surgery from 2016 to 2019, 7358 spinal anesthesia cases were matched to general anesthesia cases. General anesthesia was associated with a higher incidence of combined 30-day stroke, MI or death compared with spinal anesthesia (OR 1.219 (95% CI 1.076 to 1.381); p=0.002). General anesthesia was also associated with a higher frequency of 30-day mortality (OR 1.276 (95% CI 1.099 to 1.481); p=0.001) and longer operative time (64.73 vs 60.28 min; p<0.001). Spinal anesthesia had a longer average hospital length of stay (6.29 vs 5.73 days; p=0.001).ConclusionOur propensity-matched analysis suggests that spinal anesthesia as compared with general anesthesia is associated with lower postoperative morbidity and mortality in patients undergoing hip fracture surgery.