bluuebunny/crossref_metadata_2025_split huggingface dataset:
Declining Use of Prone Positioning After High Initial Uptake in COVID-19 Adult Respiratory Distress Syndrome*
Authors: Hochberg Chad H. , Psoter Kevin J. , Eakin Michelle N. , Hager David N. 
Published: June 2023

OBJECTIVES:
Prone positioning for acute respiratory distress syndrome (ARDS) has historically been underused, but was widely adopted for COVID-19-associated ARDS early in the pandemic. Whether this successful implementation has been sustained over the first 3 years of the COVID-19 pandemic is unknown. In this study, we characterized proning use in patients with COVID-19 ARDS from March 2020 to December 2022.

DESIGN:
Multicenter retrospective observational study.

SETTING:
Five-hospital health system in Maryland, USA.

PATIENTS:
Adults with COVID-19 supported with invasive mechanical ventilation and with a Pa
o
2/Fio
2 ratio of less than or equal to 150 mm Hg while receiving Fio
2 of greater than or equal to 0.6 within 72 hours of intubation.

INTERVENTIONS:
None.

MEASUREMENTS:
We extracted demographic, clinical, and positioning data from the electronic medical record. The primary outcome was the initiation of proning within 48 hours of meeting criteria. We compared proning use by year with univariate and multivariate relative risk (RR) regression. Additionally, we evaluated the association of treatment during a COVID-19 surge period and receipt of prone positioning.

MAIN RESULTS:
We identified 656 qualifying patients; 341 from 2020, 224 from 2021, and 91 from 2022. More than half (53%) met severe ARDS criteria. Early proning occurred in 56.2% of patients in 2020, 56.7% in 2021, and 27.5% in 2022. This translated to a 51% reduction in use of prone positioning among patients treated in 2022 versus 2020 (RR = 0.49; 95% CI, 0.33–0.72; p < 0.001). This reduction remained significant in adjusted models (adjusted RR = 0.59; 95% CI, 0.42–0.82; p = 0.002). Treatment during COVID-19 surge periods was associated with a 7% increase in proning use (adjusted RR = 1.07; 95% CI, 1.02–1.13; p = 0.01).

CONCLUSIONS:
The use of prone positioning for COVID-19 ARDS is declining. Interventions to increase and sustain appropriate use of this evidence-based therapy are warranted.
The Plasma Concentration of Ticagrelor and Aspirin as a Predictor of Bleeding Complications in Chinese Acute Coronary Syndrome Patients With Dual Antiplatelet Therapy: A Prospective Observational Study
Authors: Wang Cui-cui , Zhao Qing , Guo Bing-yan , Hao Jie , Zhao Jia-jia , Ren Jia-liang , Sun Ya-qing , Zhang Xiao-rui , Yang Xiu-ling , Liu Jin-ming 
Published: June 2023

Purpose:
This study evaluated the association among the plasma concentration of ticagrelor, ARC124910XX, aspirin, and salicylic acid with the risk of recent bleeding in patients with the acute coronary syndrome. To this end, we developed an accurate model to predict bleeding.

Methods:
A total of 84 patients included in this study cohort between May 2021 and November 2021. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic curve to verify the accuracy of the prediction model.

Results:
Multivariable logistic analysis showed that ticagrelor concentration (odds ratio [OR]: 2.47, 95% confidence interval [CI], 1.51–4.75, P = 0.002), ST-segment elevation acute myocardial infarction (OR: 32.2, 95% CI, 2.37–780, P = 0.016), and lipid-lowering drugs (OR: 11.52, 95% CI, 1.91–110, P = 0.015) were positively correlated with bleeding. However, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (OR: 0.04, 95% CI, 0.004–0.213, P < 0.001) was negatively correlated with bleeding. The receiver operating characteristic curve analysis showed that ticagrelor concentration and these factors together predict the occurrence of bleeding (area under receiver operating characteristic curve = 0.945, 95% CI, 0.896–0.994) and that ticagrelor concentration >694.90 ng/mL is the threshold of bleeding concentration (area under receiver operating characteristic curve = 0.696, 95% CI, 0.558–0.834).

Conclusion:
In patients with acute coronary syndrome treated with dual antiplatelet therapy, ticagrelor concentration >694.90 ng/mL was an independent risk factor for bleeding (OR: 2.47, 95% CI, 1.51–4.75, P = 0.002), but ARC124910XX and salicylic acid concentration did not affect bleeding risk (P > 0.05).
An Umbrella Review of Self-Management Interventions for Health Conditions With Symptom Overlap With Traumatic Brain Injury
Authors: Sander Angelle M. , Pappadis Monique R. , Bushnik Tamara , Chiaravalloti Nancy D. , Driver Simon , Hanks Robin , Lercher Kirk , Neumann Dawn , Rabinowitz Amanda , Seel Ronald T. , Weber Erica , Ralston Rick K. , Corrigan John , Kroenke Kurt , Hammond Flora M. 
Published: June 2023

Objective:
To synthesize evidence for the effectiveness of self-management interventions for chronic health conditions that have symptom overlap with traumatic brain injury (TBI) in order to extract recommendations for self-management intervention in persons with TBI.

Design:
An umbrella review of existing systematic reviews and/or meta-analyses of randomized controlled trials or nonrandomized studies targeting self-management of chronic conditions and specific outcomes relevant to persons with TBI.

Method:
A comprehensive literature search of 5 databases was conducted using PRISMA guidelines. Two independent reviewers conducted screening and data extraction using the Covidence web-based review platform. Quality assessment was conducted using criteria adapted from the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2).

Results:
A total of 26 reviews met the inclusion criteria, covering a range of chronic conditions and a range of outcomes. Seven reviews were of moderate or high quality and focused on self-management in persons with stroke, chronic pain, and psychiatric disorders with psychotic features. Self-management interventions were found to have positive effects on quality of life, self-efficacy, hope, reduction of disability, pain, relapse and rehospitalization rates, psychiatric symptoms, and occupational and social functioning.

Conclusions:
Findings are encouraging with regard to the effectiveness of self-management interventions in patients with symptoms similar to those of TBI. However, reviews did not address adaptation of self-management interventions for those with cognitive deficits or for populations with greater vulnerabilities, such as low education and older adults. Adaptations for TBI and its intersection with these special groups may be needed.
Racial Variation in Visual Impairment of Patients With Keratoconus at Presentation
Authors: Nugent Liam , Son Hyeck-Soo , Wang Jiangxia , Varadaraj Varshini , Smith Kerry , Soiberman Uri S. , Srikumaran Divya 
Published: June 2023

Purpose:
This study aimed to investigate racial disparities in the severity of keratoconus (KCN) at presentation, their intersection with socioeconomic variables, and other factors associated with visual impairment.

Methods:
This retrospective cohort study examined medical records of 1989 patients (3978 treatment-naive eyes) with a diagnosis of KCN seen at Wilmer Eye Institute between 2013 and 2020. A multivariable regression model adjusting for age, sex, race, insurance type, KCN family history, atopy, smoking status, and vision correction method examined factors associated with visual impairment, defined as a best available visual acuity of worse than 20/40 in the better eye.

Results:
Demographically, Asian patients were the youngest (33.4 ± 14.0 years) (P < 0.001), and Black patients had the highest median area deprivation index (ADI) of 37.0 [interquartile range (IQR): 21.0–60.5] (P < 0.001). Multivariable analysis showed a higher risk of visual impairment for Black (OR 2.25, 95% CI, 1.71–2.95) versus White patients. Medicaid (OR 2.59, 95% CI, 1.75–3.83) and Medicare (OR 2.48, 95% CI, 1.51–4.07) were also associated with a higher odds of visual impairment compared with private insurance, and active smokers were more likely to have visual impairment than those with no prior smoking history (OR 2.17, 95% CI, 1.42–3.30). Eyes of Black patients had the highest maximum keratometry (Kmax) (56.0 ± 11.0D) (P = 0.003) and the lowest thinnest pachymetry (463.2 ± 62.5 µm) (P = 0.006) compared with eyes of other races.

Conclusions:
Black race, government-funded insurance, and active smoking were significantly associated with increased odds of visual impairment in adjusted analyses. Black race was also associated with higher Kmax and lower thinnest pachymetry, suggesting that Black patients have more severe disease at presentation.
Relapsing autoimmune inner ear disease with significant response to methotrexate and azathioprine combination therapy: A case report and mini literature review
Authors: Huang Kuan-Hsuan , Lin Hsiao-Ching , Lin Chia-Der , Wu Po-Chang 
Published: June 2023

Rationale:
Autoimmune inner ear disease typically presents with bilateral hearing loss that progresses over weeks or months though its mechanisms are unknown. Corticosteroids are the first-line treatment, but their responses are variable and relapses are frequent. Thus, many experts have sought to replace corticosteroids with immunosuppressive agents.

Patient concerns:
A 35-year-old woman experienced a progressive hearing impairment, initially on the left side and later becoming bilateral. Her response to corticosteroid monotherapy was temporary, and there have been two relapse episodes over several months.

Diagnoses:
Autoimmune inner ear disease was considered due to evidence of autoimmunity combined with a clinical course of bilateral and recurrent sensorineural hearing loss and a partial response to corticosteroid therapy.

Interventions:
The patient received a 3-day mini-pulse of methylprednisolone at 250 mg/d, followed by 12 mg/d maintenance, and concurrently began an azathioprine regimen gradually increasing to 100 mg/day as a corticosteroid-sparing agent.

Outcomes:
Three weeks after immunosuppressive therapy, hearing and pure-tone audiometry improved, and after 7 weeks, methylprednisolone was tapered to 8 mg/d. The dosage was further reduced by adding methotrexate at 7.5 mg/week, resulting in a reduction to 4 mg/d as maintenance therapy after 4 weeks.

Lessons:
For patients who are unresponsive to corticosteroids or experience difficulty tolerating them, a combination therapy of methotrexate and azathioprine is recommended as a viable alternative as this regimen is well-tolerated and yields positive outcomes.
Integrative medicine using East Asian herbal medicine for inflammatory pain in patients with rheumatoid arthritis: A protocol for systematic review and meta-analysis integrated with multiple data mining for core candidate discovery
Authors: Jo Hee-Geun , Seo Jihye , Baek Eunhye , Hwang Ji-Hye , Lee Donghun 
Published: June 2023

Background:
Rheumatoid arthritis is a chronic inflammatory autoimmune disease characterized by a wide range of clinical symptoms affecting various bodily functions, including skeletal, vascular, metabolic, and cognitive functions. This review aimed to evaluate the efficacy and safety of integrative medicine (East Asian herbal medicine combined with conventional medicine) used for the treatment of inflammatory pain in rheumatoid arthritis and to identify key candidate drugs based on the data.

Methods:
A comprehensive literature search will be conducted in 4 core databases (PubMed, Excerpta Medica database, Cochrane Library, and Cumulative Index to Nursing & Allied Health Literature) 4 Korean databases (Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, Research Information Service System, and Korea Citation Index), 2 Chinese databases (Chinese National Knowledge Infrastructure Database and Wanfang data), and 1 Japanese database (Citation Information by National Institute of Informatics) for randomized controlled trials from December 13, 2022. Statistical analysis will be performed using R version 4.1.2 and R Studio program. The American College of Rheumatology 20/50/70 score and rate of adverse events will be the primary outcomes. All outcomes will be analyzed using a random-effects model to produce more statistically conservative results. Sensitivity, meta-regression, and subgroup analyses will be used to identify the sources of any heterogeneity in the study. The revised tool for assessing the risk of bias in randomized trials, version 2.0, will be used to evaluate methodological quality. The overall quality of evidence will be assessed according to the Grading of Recommendations Assessment, Development, and Evaluation Pro Framework.

Ethics and dissemination:
There are no ethical issues, as no primary data will be collected directly from the participants. The results of this review will be reported in a peer-reviewed scientific journal.

Trial registration:
PROSPERO registration number: CRD42023412385.
Impact of surgical resection on the survival in Mexican patients with gastric cancer: A meta-analysis and systematic review
Authors: Gutiérrez-Solis Ana Ligia , Pacheco-Can Oscar Daniel , Vázquez-Segura Hayde Sara Leticia , Pech-Aguilar Alfredo Geovanny , Franco-González Carlos David , Avila-Nava Azalia , Lugo Roberto 
Published: June 2023

Background:
Gastric cancer (GC) is one of the most frequent cancer types in Mexico. The primary method used as a treatment is surgical resection. The role of surgery in increasing survival is controversial. This study aimed to determine whether surgical resection increases the survival of patients with GC in a Mexican population.

Methods:
A systematic review of literature searches (Evidence-based MEDLINE/PubMed, Web of Science, Cochrane Library, and SciELO) and meta-analysis were performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria. The published articles from 2000 to the current time were divided into cross-sectional and randomized studies. The inclusion criteria were survival, surgical resections, patients treated in Mexico, and primary GC. The effect estimation was calculated using the risk ratio (RR). The random-effects model and a confidence interval (CI) of 95% were used.

Results:
The RR of the pooled studies was 1.09 (95% CI, 0.71–1.67). RR of 0.82 (95% CI, 0.63–1.07) was obtained in cross-sectional studies, and randomized studies showed a RR of 2.08 (95% CI, 0.25–17.07).

Conclusion:
This work is the first systematic study that assesses the role of surgery on the survival of patients with GC in the Mexican population, the results showed that surgical resection did not improve survival in patients with GC.
Coping strategy for work-family conflict and burnout in construction industrial adult workers: A philosophical highlight
Authors: Okereke Godwin Keres Okoro , Ede Moses Onyemaechi , Adejo Ode Ogbole , Nwadi Lebechukwu Calister , Oneli Joy Obiageli , Nwahunanya Innocent , Kontei Ebiegberi , Oguejiofor Ikechukwu Victor , Nkemjika Ogechi , Okereke Joy Anuri , Iliya John , Udogu Kingsley , Ike Joshua Onyekachi , Areji Anthony 
Published: June 2023

Background:
The work environment in Nigeria is demanding and could lead to psychological disturbances. Evidentially, construction workers have confirmed the horrible job stress and work-family conflict they experience in the workplace. This has led to work-related burnout. As a matter of importance, this study was conducted.

Methods:
A pure experimental design was used, which helped to randomly assigned recruited 98 construction industry adult workers to 2 arms (treatment and waitlisted control groups). Two dependent measures were distributed before, immediately after, and 4 weeks after completion of intervention with 12 sessions that were given to the treatment group.

Results:
This study found that cognitive behavior therapy is beneficial in the management of work-family conflict and work burnout among construction industry workers. Therefore, there is a need for advancement and adequate implementation of cognitive behavior therapy in industries for psychological functioning of workers.
Neurokinin 1/3 receptor antagonists for menopausal women: A current systematic review and insights into the investigational non-hormonal therapy
Authors: Hassan Fatima , Saleem Anam , Samuel Sehar Saba , Sarfraz Zouina , Sarfraz Azza , Sarfraz Muzna , KC Manish 
Published: June 2023

Background:
Over 75% of menopausal women experience vasomotor symptoms (VMS), such as night sweats and hot flashes. Despite the prevalence of these symptoms, there is limited data on non-hormonal therapies to alleviate them.

Methods:
PubMed, Cochrane, Scopus, Ovid, Web of Science, and ClinicalTrials.Gov were searched for relevant studies. The search was performed using the following keywords, which were customized to suit the specific databases/registers: menopause, women, neurokinin 3, and/or Fezolinetant. The search was conducted until December 20, 2022. This systematic review was conducted in compliance with the PRISMA Statement 2020 guidelines.

Results:
A total of 326 records were found, with 10 studies (enrolling 1993 women) selected for inclusion. The women received 40-mg doses of NK1/3 receptor antagonists twice daily, with follow-ups at 1 to 3 weeks. Moderately strong evidence was found suggesting that NK1/3 receptor antagonists can help limit the frequency and severity of hot flashes in menopausal women.

Conclusion:
While the results should be interpreted with caution until further clinical trials validate the efficacy and safety of NK1/3 receptor antagonists among menopausal women, these findings suggest that they are promising targets for future pharmacological and clinical studies in addressing vasomotor symptoms.
Immunized Patients Face Reduced Access to Transplantation in the Eurotransplant Kidney Allocation System
Authors: de Ferrante Hans , Smeulders Bart , Tieken Ineke , Heidt Sebastiaan , Haasnoot Geert W. , Claas Frans H.J. , Vogelaar Serge , Spieksma Frits 
Published: June 2023

Background.
The presence of donor-specific HLA antibodies before transplantation is associated with poor transplantation outcomes. Unacceptable antigens can be assigned for Eurotransplant kidney transplant candidates to prevent kidney offers against which the candidate has developed clinically relevant HLA antibodies. This retrospective cohort study aimed to assess to what degree unacceptable antigens affect access to transplantation in the Eurotransplant Kidney Allocation System (ETKAS).

Methods.
Candidates who underwent kidney-only transplantation between 2016 and 2020 were included (n = 19 240). Cox regression was used to quantify the relationship between the relative transplantation rate and virtual panel-reactive antibodies (vPRAs), which is the percentage of the donor pool with unacceptable antigens. Models used accrued dialysis time as the timescale; were stratified by country and blood group of patient and were adjusted for nontransplantable status, patient age, sex, history of kidney transplantations, and prevalence of 0 HLA-DR–mismatched donors.

Results.
Transplantation rates were 23% lower for vPRA 0.1% to 50%, 51% lower for vPRA 75% to 85%, and decreased rapidly for vPRA of >85%. Prior studies showed significantly lower ETKAS transplantation rates only for highly sensitized patients (vPRA of >85%). The inverse relationship between transplantation rate and vPRA is independent of Eurotransplant country, listing time, and 0 HLA-DR–mismatched donor availability. Results were similar when quantifying the relationship between vPRA and attainment of a sufficiently high rank for an ETKAS offer, suggesting lower transplantation rates for immunized patients are due to current ETKAS allocation.

Conclusions.
Immunized patients face lower transplantation rates across Eurotransplant. The current ETKAS allocation mechanism inadequately compensates immunized patients for reduced access to transplantation.
Sociodemographic Variables in Canadian Organ Donation Organizations: A Health Information Survey
Authors: Leeies Murdoch , Ho Julie , Wilson Lindsay C. , Lalani Jehan , James Lee , Carta Tricia , Gruber Jackie , Shemie Sam D. , Hrymak Carmen 
Published: June 2023

Background.
Health systems must collect equity-relevant sociodemographic variables to measure and mitigate health inequities. The specific variables collected by organ donation organizations (ODOs) across Canada, variable definitions, and processes of the collection are not defined. We undertook a national health information survey of all ODOs in Canada. These results will inform the development of a standard national dataset of equity-relevant sociodemographic variables.

Methods.
We conducted an electronic, self-administered cross-sectional survey of all ODOs in Canada from November 2021 to January 2022. We targeted key knowledge holders familiar with the data collection processes within each Canadian ODO known to Canadian Blood Services. Categorical item responses are presented as numbers and proportions.

Results.
We achieved a 100% response rate from 10 Canadian ODOs. Most data were collected by organ donation coordinators. Only 2 of 10 ODOs reported using scripts explaining why sociodemographic data are being collected or incorporated training in cultural sensitivity for any given variable. A lack of cultural sensitivity training was endorsed by 50% of respondents as a barrier to the collection of sociodemographic variables by ODOs, whereas 40% of respondents identified a lack of training in sociodemographic variable collection as a significant barrier.

Conclusions.
Few programs routinely collect sufficient data to examine health inequities with an intersectional lens. Most data collection occurs midway through the ODO interaction, creating a missed opportunity to better understand differences in social identities of patients who register their intention to donate in advance or who decline the donation. National standardization of equity-relevant data collection definitions and processes of the collection is needed.