bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of COVID-19 on utilization of chronic diseases services
Authors: Moradi Ghobad , Piroozi Bakhtiar , Khayyati Fariba , Moradpour Farhad , Safari Hossein , Mohamadi Bolbanabad Amjad , Fattahi Hamed , Younesi Fatemeh , Ebrazeh Ali , Shokri Azad 
Published: July 2023

Objectives The aim of the present study is to evaluate the impact of Covid-19 on utilization of chronic diseases services. Methods Interrupted time-series design was used to examine the utilization of chronic diseases services before and during the Covid-19 pandemic among hospitals in Iran. Chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, heart failure, and chemotherapy were selected as a proxy to indicate the impact of Covid-19 on utilization of chronic diseases services. Data were collected in 24 sites from 12 months before the onset of Covid-19 (from March 2019 to February 2020) to 12 months during the Covid-19 pandemic (February 2020 to March 2021). Results A total of 7,039,378 services were provided, of which 51.92% were provided for women and 62.73% for >65 age group. A sudden decrease was observed in monthly utilization of services during the Covid-19 pandemic; ranging from 13.91 (95% CI = −21.73, 6.10, P = 0.001) for chemotherapy to 606.39 (95% CI = −1040.72, 172.06, P = 0.009) for heart failure services per 100 thousand population. A decrease was observed in COPD services; 15.28 services compared with the period before Covid-19. Subsequently, the monthly utilization trends of asthma, type 2 diabetes, and chemotherapy services increased significantly ( P < 0.05). Discussion Although chronic diseases are a factor in more severe form of Covid-19, their failure to seek diagnostic, prevention and treatment services has somewhat complicated the issue.
Perplexing Initial Presentations of MOGAD in Two Children: Intracranial Hypertension and New-Onset Seizure
Authors: Zhou Daniel J. , Powers Andria M. , Cave Caleb A. , Dickas Emily K. , Rickard Mary C. , Rathore Geetanjali , Wright Rhonda R. , Zabad Rana K. , Koh Sookyong 
Published: July 2023

We report two distinct challenging initial presentations of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Case 1 describes a 12-year-old boy who developed headaches refractory to pain medication followed by cranial neuropathies and intracranial hypertension, confirmed by lumbar puncture with an opening pressure >36 cm H2O. Case 2 describes a 3-year-old boy who developed new-onset seizures refractory to antiseizure medications, a presentation of FLAIR-hyperintense lesions in MOG-antibody associated encephalitis with seizures (FLAMES). On repeat magnetic resonance imaging, both patients were found to have cortical T2 hyperintensities, leptomeningeal contrast enhancement, and bilateral optic nerve enhancement. In the cerebrospinal fluid, both patients had CSF pleocytosis with neutrophilic predominance. The patients were treated with intravenous immunoglobulins, plasma exchange, and high-dose corticosteroids. The first patient achieved disease remission, whereas the second patient required the addition of rituximab for management of seizures. The two cases highlight the pleomorphic clinical phenotypes of MOGAD.
The socioeconomic impact of disability progression in multiple sclerosis: A retrospective cohort study of the German NeuroTransData (NTD) registry
Authors: Dillon Paul , Heer Yanic , Karamasioti Eleni , Muros-Le Rouzic Erwan , Marcelli Giuseppe , Di Maio Danilo , Braune Stefan , Kobelt Gisela , Wasem Jürgen 
Published: July 2023

Background Multiple sclerosis (MS) is a progressively debilitating neurologic disease that poses significant costs to the healthcare system and workforce. Objective To evaluate the impact of MS disease progression on societal costs and quality of life (QoL) using data from the German NeuroTransData (NTD) MS registry. Methods Cross-sectional cohort study. The cost cohort included patients with MS disability assessed using Expanded Disability Status Scale (EDSS) in 2019 while the QoL cohort included patients assessed using EDSS and EuroQol-5 Dimension 5-Levels between 2009 and 2019. Direct and indirect medical, and non-medical resource use was quantified and costs derived from public sources. Results Within the QoL cohort ( n = 9821), QoL worsened with increasing EDSS. Within the cost cohort ( n = 7286), increasing resource use with increasing EDSS was observed. Societal costs per patient, excluding or including disease-modifying therapies, increased from €5694 or €19,315 at EDSS 0 to 3.5 to €25,419 or €36,499 at EDSS 4 to 6.5, and €52,883 or €58,576 at EDSS 7 to 9.5. In multivariate modeling, each 0.5-step increase in EDSS was significantly associated with increasing costs, and worsening QoL. Conclusion This study confirms the major socioeconomic burden associated with MS disability progression. From a socioeconomic perspective, delaying disability progression may benefit patients and society.
Health-economic benefits of anti-CD20 treatments in relapsing multiple sclerosis estimated using a treatment-sequence model
Authors: Smets Ide , Versteegh Matthijs , Huygens Simone , Corsten Cato , Wokke Beatrijs , Smolders Joost 
Published: July 2023

Background In high-income countries, four anti-CD20 monoclonal antibodies (mAbs) are used or in the pipeline for relapsing MS: ocrelizumab, ofatumumab (both registered), ublituximab (awaiting registration) and rituximab (off-label). List prices differ significantly between registered and off-label drugs. Objective Comparing differences in benefits between anti-CD20 mAbs from a health-economic and societal perspective. Methods To reflect lifetime use of DMTs, we used a treatment-sequence model to compare ocrelizumab/ofatumumab and eight other drug classes in terms of health (lifetime relapses, time to Expanded Disability Status Scale [EDSS] 6, lifetime quality-adjusted life years) and cost-effectiveness (net health benefit). To become cost-effective compared to ocrelizumab, we modelled the list price of ublituximab and desired effect on EDSS progression of rituximab. Results Although drug sequences with ocrelizumab in first- and second-line were more cost-effective than ofatumumab, our probabilistic analysis suggests this outcome was very uncertain. To be more cost-effective than ocrelizumab, ublituximab needs to be about 25% cheaper whilst rituximab needs to equal the effect on disability progression seen with first-line treatments. Conclusions Our model showed no clear difference in cost-effectiveness between ocrelizumab and ofatumumab. Hence, prescribing the least costly anti-CD20 mAb can democratise MS care without a loss in health benefits.
Determinants of enrollment in community based health insurance program among households in East Wollega Zone, west Ethiopia: Unmatched case-control study
Authors: Desalegn Mengistu , Lemu Teferi , Tadesse Bekuma , Olana Tariku , Kaba Zalalem , Tolossa Tadesse 
Published: July 2023

Background: Ethiopia has launched a community-based health insurance (CBHI) since 2011, which is an innovative financing mechanism to enhance domestic resource mobilization and sustainable health financing. This study assessed determinants of CBHI enrollment among HHs (households) of East Wollega, Ethiopia, 2022. Method and materials: Community based unmatched 1:2 case-control study design was conducted between Jan 7and Feb 5/2022 among 428 HHs (144 cases and 284 controls). Cases were selected from HHs who registered for CBHI and currently using CBHI. Controls were from those who do not registered for CBHI membership. Data collected using a semi-structured, interview administered questionnaire. Multivariable logistic regression with SPSS version 25 was employed for analysis and variables were declared statistical significant association at p-value < 0.05, 95% CI. Result: Data from 428 (144 cases and 284 controls to CBHI) were collected; a response rate of 98.8%. Statistically lower odds of CBHI enrollment was observed among HHs who have poor knowledge [AOR = 0.48 (95% CI:0.27, 0.85)], perceived not respectful care [AOR = 0.44 (95% CI :0.24, 0.81)], unavailability of laboratory services [AOR = 0.37(95% CI:0.21, 0.66)], inappropriate time of premium payment [AOR = 0.31(95% CI:0.18, 0.52)]. In addition, medium wealth status category [AOR = 0.11(95% CI: 0.03, 0.45)]. Higher odd of CBHI enrollment observed among who have formal education [AOR = 2.39(95% CI: 1.28, 4.48)]. Conclusion and recommendation: Educational level, knowledge, time of membership payment, laboratory test availability, perception of respectful care and wealth status were significant determinants of CBHI enrollment status. Hence, the responsible bodies should discuss and decide with community on the appropriate time of premium payment collection, and enhance community education on CBHI benefit package.
Posterior Hip Impingement at Maximal Hip Extension in Female Patients With Increased Femoral Version or Increased McKibbin Index and Its Effect on Sports Performance
Authors: Boschung Adam , Antioco Tiziano , Steppacher Simon D. , Tannast Moritz , Novais Eduardo N. , Kim Young-jo , Lerch Till D. 
Published: July 2023

Background: The location of posterior hip impingement at maximal extension in patients with posterior femoroacetabular impingement (FAI) is unclear. Purpose: To investigate the frequency and area of impingement at maximal hip extension and at 10° and 20° of extension in female patients with increased femoral version (FV) and posterior hip pain. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Osseous patient-specific 3-dimensional (3D) models were generated of 50 hips (37 female patients, 3D computed tomography) with a positive posterior impingement test and increased FV (defined as >35°). The McKibbin index (combined version) was calculated as the sum of FV and acetabular version (AV). Subgroups of patients with an increased McKibbin index >70° (24 hips) and FV >50° (20 hips) were analyzed. A control group of female participants (10 hips) had normal FV, normal AV, and no valgus deformity (neck-shaft angle, <139°). Validated 3D collision detection software was used for simulation of osseous impingement-free hip extension (no rotation). Results: The mean impingement-free maximal hip extension was significantly lower in patients with FV >35° compared with the control group (15° ± 15° vs 55° ± 19°; P < .001). At maximal hip extension, 78% of patients with FV >35° had osseous posterior extra-articular ischiofemoral hip impingement. At 20° of extension, the frequency of posterior extra-articular ischiofemoral impingement was significantly higher for patients with a McKibbin index >70° (83%) and for patients with FV >35° (76%) than for controls (0%) ( P < .001 for both). There was a significant correlation between maximal extension (no rotation) and FV ( r = 0.46; P < .001) as well as between impingement area at 20° of extension (external rotation [ER], 0°) and McKibbin index (0.61; P < .001). Impingement area at 20° of extension (ER, 0°) was significantly larger for patients with McKibbin index >70° versus <70° (251 vs 44 mm2; P = .001). Conclusion: The limited hip extension found in our study could theoretically affect the performance of sports activities such as running, ballet dancing, or lunges. Therefore, although not examined directly in this study, these activities are not advisable for these patients. Preoperative evaluation of FV and the McKibbin index is important in female patients with posterior hip pain before hip preservation surgery (eg, hip arthroscopy).
What would other emergency stroke teams do? Using explainable machine learning to understand variation in thrombolysis practice
Authors: Pearn Kerry , Allen Michael , Laws Anna , Monks Thomas , Everson Richard , James Martin 
Published: July 2023

Introduction: The aim of this work was to understand between-hospital variation in thrombolysis use among emergency stroke admissions in England and Wales. Patients: A total of 88,928 patients who arrived at all 132 emergency stroke hospitals in England Wales within 4 h of stroke onset, from 2016 to 2018. Methods: Machine learning was applied to the Sentinel Stroke National Audit Programme (SSNAP) data set, to learn which patients in each hospital would likely receive thrombolysis. We used XGBoost machine learning models, coupled with a SHAP model for explainability; Shapley (SHAP) values, providing estimates of how patient features, and hospital identity, influence the odds of receiving thrombolysis. Results: Thrombolysis use in patients arriving within 4 h of known or estimated stroke onset ranged 7% -49% between hospitals. The odds of receiving thrombolysis reduced 9-fold over the first 120 min of arrival-to-scan time, varied 30-fold with stroke severity, reduced 3-fold with estimated rather than precise stroke onset time, fell 6-fold with increasing pre-stroke disability, fell 4-fold with onset during sleep, fell 5-fold with use of anticoagulants, fell 2-fold between 80 and 110 years of age, reduced 3-fold between 120 and 240 min of onset-to-arrival time and varied 13-fold between hospitals. The majority of between-hospital variance was explained by the hospital, rather than the differences in local patient populations. Conclusions: Using explainable machine learning, we identified that the majority of the between-hospital variation in thrombolysis use in England and Wales may be explained by differences in in-hospital processes and differences in attitudes to judging suitability for thrombolysis.
Republication of “Percutaneous Basal Closing Wedge Osteotomy of the First Metatarsal in the Treatment of Moderate to Severe Hallux Valgus and Its Short-Term Clinical Outcomes”
Authors: Chan K. B. , Yeung Raymond 
Published: July 2023

Background: Although percutaneous surgery for the treatment of hallux valgus is popular in Europe, there is sparse English written literature documenting its efficacy. This study described the operative techniques using percutaneous basal closing wedge osteotomy of the first metatarsal in correction of moderate to severe hallux valgus (HV) and its short-term clinical outcomes. We postulated that satisfactory correction of hallux valgus (HV) angle, intermetatarsal (IM) angle, and patients’ clinical outcomes could be achieved with this technique. Methods: We conducted a retrospective review of 25 feet in 23 patients who underwent a percutaneous basal closing wedge osteotomy of the first metatarsal (MT1) combined with a mini-open modified McBride procedure and mini-open resection of medial eminence. Follow-up averaged 21.5 months. Radiographic outcomes included pre- and postoperative HV angle, IM angle, absolute and relative shortening of MT1, and time to union. American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared between pre- and postoperatively. Results: The average HV angle improved from 39.4 (range, 29-58.3) degrees preoperatively to 14.7 (range, 0.1-23.2) degrees postoperatively ( P < .05). IM angle improved from 14.9 (range, 6.7-22.4) degrees to 6.6 (range, 0.9-14.8) degrees ( P < .05). The average absolute shortening was 3.8 (range, 0.27-12.91) mm and the relative shortening was 0.8 (range, 0.05-1.91) mm. There was no delayed union or malunion at the osteotomy site. The average AOFAS score improved from 39 (range, 12-50) to 81 (range, 70-93) ( P < .05). Conclusions: Satisfactory hallux valgus deformity correction and patients’ outcomes were achieved with this technique. Our results are similar to results reported in other studies using open techniques. There was no malunion or delayed union of the osteotomy. Level of Evidence: Level IV, case series study.
The lived experiences of metal hypersensitivity
Authors: Dordunoo Dzifa , Doane Gweneth , Carey Jett , Lagura Jell Adrienne , Mallidou Anastasia , van der Merwe Jans , Schroeder Scott 
Published: July 2023

Background Immunological responses to metal ions can occur in people with metal implantable devices. Nevertheless, patients are not routinely asked about metal hypersensitivity nor tested for it prior to surgical procedures. Moreover, we have not identified any published literature on patients’ experiences with this condition. We undertook this study to better understand the experiences of patients with metal hypersensitivity and to determine what information would help them make an informed decision about implantable medical devices with metal compositions. Methods This is a patient-oriented research using an interpretative phenomenological methodology. We enrolled 16 people from five countries (Canada, New Zealand, Spain, the UK, and the USA) who experienced metal hypersensitivity following implantable medical device. We collected data from in-depth, semi-structured interviews focused on pre-procedural patient education and postoperative experiences to elucidate the barriers and opportunities related to metal hypersensitivity. We analyzed the data using interpretative phenomenological analysis. Results The majority were white biological women between the ages of 34 and 65. None of the participants were informed about immunological responses to metals in implants during the consenting process. They encountered many challenges when symptoms of metal hypersensitivity occurred. The outcomes for the few who had the implants removed were mixed. Conclusion Hypersensitivity reactions to metal need to be discussed as part of the consenting process, and additional strategies are needed to mitigate this issue in the health system.
The effect of clinical risk management training on patient safety competency and related aspects in nursing students
Authors: Padash Mahnaz , Miri Sakineh , Azizzadeh Forouzi Mansooreh , Jouparinejad Somayeh , Farokhzadian Jamileh 
Published: July 2023

Background Students’ exposure to clinical risk management during their studentships can improve their safety competency, comfort speaking up about patient safety, and attitudes toward patient safety education. This study aimed to determine the effect of clinical risk management training on nursing students’ patient safety competency, attitudes toward broader aspects of patient safety in professional education, and comfort in speaking up about patient safety. Methods This experimental study used stratified sampling to assign 56 nursing students to intervention and control groups (28 students in each group). The intervention group received clinical risk management training in three three-hour sessions. The Health Professional Education in Patient Safety Survey was used to collect data from both groups before and one month after the intervention. Results The study found no statistically significant difference in patient safety competency and its subscales between the intervention and control groups in the pretest stage, but these competencies increased significantly in the intervention group in the post-test stage compared to the control group. The mean scores of attitudes toward broader aspects of patient safety in professional education and comfort speaking up about patient safety did not differ significantly between the intervention and control groups in the pre-test stage, but they increased significantly in the intervention group in the post-test stage compared with the control group. Conclusion It is recommended that clinical risk management and patient safety training be applied to the nursing curriculum so that nursing students become competent to provide safe care in clinical settings.
Speech Analysis of Patients with Cleft Palate Using Artificial Intelligence Techniques: A Systematic Review
Authors: Zhang Andi , Pyon Rachel E. , Chen Kevin , Lin Alexander Y. 
Published: July 2023

Introduction: This systematic review examines the use of machine learning (ML) algorithms to detect hypernasal speech in patients with cleft palate (CP), which can persist after primary repair surgery, and require revision. Due to a shortage of speech language pathologists (SLPs), automated detection tools could help improve access to care in underserved areas. The study compares the characteristics and accuracy of different types of machine learning algorithms. Methods: On August 18, 2021, searches were conducted across 8 databases: PubMed, SCOPUS, Cochrane, IEEE, ACM, L&LB, PsychInfo, and CINAHL. Search terms used were: (Artificial Intelligence OR Machine Learning OR Neural networks AND Cleft lip OR Cleft palate OR Hypernasality OR Velopharyngeal Insufficiency). To be included, papers needed to describe ML algorithms for CP speech detection and report concordance to human professional speech clinicians. Results: Database searches yielded 135 unique articles. Five articles met full inclusion criteria and 3 additional articles were identified by hand searching references of articles that passed initial screening. These algorithms were categorized as either Feature Dependent non-Deep learning (n = 5) or Feature Dependent deep learning (n = 2) algorithms or Feature Independent deep learning (n = 3) algorithms. Their pooled average concordance were 0.85, 0.93, and 0.91 respectively. Their average training database sizes were 3587, 3921, and 6306 speech samples respectively. Conclusion: Machine learning algorithms have been shown to be an effective tool for the evaluation of hypernasal speech. This systematic review has shown that ML algorithms are able to detect hypernasality with high concordance, consistent with professional speech language clinicians in a rapid, and autonomous manner. ML algorithms can extend the reach of speech language pathologists and complement their gold standard, this long-term outcome monitoring has great potential to improve treatment outcomes.
Mobile X-ray services in nursing homes as an enabler to healthcare-in-place for residents: informal carers’ views
Authors: Dollard Joanne , Edwards Jane , Yadav Lalit , Gaget Virginie , Tivey David , Maddern Guy J. , Visvanathan Renuka 
Published: July 2023

Abstract
Background
Informal carers (ICs) of residents living in nursing homes (NH) have a key role in the care of residents, including making decisions about and providing care. As radiology has a role in decision making about care, it is important to understand IC’s perspectives about resident’s use of mobile X-ray services (MXS). The aim was to explore the perspectives of ICs of residents living in nursing homes about the use of MXS.

Methods
From November 2020 to February 2021, twenty ICs of residents living in four nursing homes in different areas of one Australian city participated. Their perspectives of MXS, including benefits and barriers, were explored in semi-structured interviews. Data were analysed using thematic analysis.

Results
ICs were resident’s children (80%) and spouses (20%). One resident had received a MXS. Four themes were developed: (1) a priority for resident well-being, where ICs were positive about using MXS, because residents could receive healthcare without transfer; (2) MXS could reduce carer burden; (3) economic considerations, where MXS could reduce health system burden but the MXS call-out fee could result in health inequities; and (4) pathways to translation, including the need to improve consumer awareness of MXS, ensure effective processes to using MXS,, consider nursing home staff levels to manage MXS and ICs expectations about quality and availability of MXS.

Conclusions
ICs consider MXS can benefit resident well-being by potentially reducing transfers to hospital or radiology facilities and advocated equitable access. ICs cautioned that the quality and safety of healthcare delivered in nursing homes should equal what they would receive in hospitals.