bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Outcomes of Bariatric Surgery in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Authors: Wilson Hillary , Verhoeff Kevin , Dang Jerry , Kung Janice Y. , Switzer Noah J. , Birch Daniel , Madsen Karen , Karmali Shahzeer , Mocanu Valentin 
Published: July 2023

Background: The need for surgical management of severe obesity in the context of inflammatory bowel disease (IBD) is becoming an increasingly common clinical scenario, yet has been met with significant reservation due to the paucity of current data from which to inform evidence-based clinical decision making. The aim of our study was to perform a systematic review to characterize and evaluate the safety and efficacy of bariatric surgery in IBD patients. Methods: A medical librarian developed and executed comprehensive searches on November 2, 2021. The population of interest was adult subjects (>18 years) diagnosed with inflammatory bowel disease (IBD) undergoing any type of bariatric surgery. Meta-analysis was used to evaluate outcomes using RevMan 5.4.1. Results: A total of 330 687 patients were identified within the 11 studies included. Within all included studies there were 1595 patients with IBD. Patients had a mean weighted age of 46.0, with a female predominance (n = 1287, 80.7%). The mean duration of follow up was 39.7 months. Metabolic and anthropometric outcomes were only reported in noncomparative studies evaluating only patients with IBD, limiting the ability to complete meta-analysis. Meta-analysis revealed that IBD was associated with increased rates of postoperative complications (RR 2.14; 95% CI 1.87-2.44; P < .00001) in comparison to controls without IBD. Conclusion: While bariatric surgery presents an effective weight loss option for patients with IBD, these patients are associated with higher rates of postoperative complications. This work highlights the need to better delineate the effect of bariatric procedures for patients with IBD with respect to both metabolic and IBD-related outcomes.
Cardiomyopathy as cause of death in Duchenne muscular dystrophy: a longitudinal observational study
Authors: Lechner Annabel , Herzig Joël J. , Kientsch Jacqueline G. , Kohler Malcolm , Bloch Konrad E. , Ulrich Silvia , Schwarz Esther I. 
Published: July 2023

BackgroundCardiomyopathy has become an important life-limiting factor since survival in Duchenne muscular dystrophy (DMD) has greatly increased with long-term ventilation and cough assistance. The aim of this study was to investigate the association between impaired left ventricular ejection fraction (LVEF) and survival.MethodsIn a >20-year observational study in patients with DMD (age ≥16 years) with at least three echocardiograms, the association between LVEF and survival and time to cardiac or non-cardiac death was investigated using Kaplan–Meier survival analysis and Cox regression (for LVEF).ResultsIn 67 DMD patients (430 echocardiograms), the decrease in LVEF over a mean±sdfollow-up period of 9.1±5.1 years was −10.0±13.9% absolute, but LVEF progression varied widely. 84% were receiving an angiotensin-converting enzyme inhibitor and 54% a β-blocker at last follow-up with an LVEF of 37.5±12.4% at that time-point. Median (interquartile range) survival was 33 (25–40) years. 28 out of 67 (42%) of the cohort had died and LVEF was a significant negative predictor of survival (hazard ratio 0.95 (95% CI 0.91–0.99); p<0.007). Those who died of cardiac death (53% of known causes of death) had significantly lower LVEF at the time of death (LVEF −11.0% (95% CI −21.1– −0.9%); p=0.035) compared with non-cardiac death and tended to die at a younger age.ConclusionsCardiomyopathy with systolic heart failure is the leading cause of death and lower LVEF is an independent predictor of mortality at younger ages in patients with DMD. Patients with DMD appear to be undertreated with respect to heart failure drug therapy.
Echocardiographic evaluation of right ventricular diastolic function in pulmonary hypertension
Authors: Yogeswaran Athiththan , Rako Zvonimir A. , Yildiz Selin , Ghofrani Hossein Ardeschir , Seeger Werner , Brito da Rocha Bruno , Gall Henning , Kremer Nils C. , Douschan Philipp , Papa Silvia , Vizza Carmine Dario , Filomena Domenico , Tedford Ryan J. , Naeije Robert , Richter Manuel J. , Badagliacca Roberto , Tello Khodr 
Published: July 2023

BackgroundRight ventricular (RV) diastolic dysfunction may be prognostic in pulmonary hypertension (PH). However, its assessment is complex and relies on conductance catheterisation. We aimed to evaluate echocardiography-based parameters as surrogates of RV diastolic function, provide validation against the gold standard, end-diastolic elastance (Eed), and define the prognostic impact of echocardiography-derived RV diastolic dysfunction.MethodsPatients with suspected PH who underwent right heart catheterisation including conductance catheterisation were prospectively recruited. In this study population, an echocardiography-based RV diastolic function surrogate was derived. Survival analyses were performed in patients with precapillary PH in the Giessen PH Registry, with external validation in patients with pulmonary arterial hypertension at Sapienza University (Rome).ResultsIn the derivation cohort (n=61), the early/late diastolic tricuspid inflow velocity ratio (E/A) and early tricuspid inflow velocity/early diastolic tricuspid annular velocity ratio (E/e′) did not correlate with Eed (p>0.05). Receiver operating characteristic analysis revealed a large area under the curve (AUC) for the peak lateral tricuspid annulus systolic velocity/right atrial area index ratio (S′/RAAi) to detect elevated Eed (AUC 0.913, 95% confidence interval (CI) 0.839–0.986) and elevated end-diastolic pressure (AUC 0.848, 95% CI 0.699–0.998) with an optimal threshold of 0.81 m2·s−1·cm−1. Subgroup analyses demonstrated a large AUC in patients with preserved RV systolic function (AUC 0.963, 95% CI 0.882–1.000). Survival analyses confirmed the prognostic relevance of S′/RAAi in the Giessen PH Registry (n=225) and the external validation cohort (n=106).ConclusionsOur study demonstrates the usefulness of echocardiography-derived S′/RAAi for noninvasive assessment of RV diastolic function and prognosis in PH.
Diabetes in a hospital cohort of persons living with HIV: a descriptive and comparative study in French Guiana
Authors: Nacher Mathieu , Rabier Sebastien , Lucarelli Aude , Hureau Louise , Adenis Antoine , Hafsi Nezha , Sabbah Nadia 
Published: July 2023

Abstract
Background
In French Guiana (population 294,000) the prevalence of type 2 diabetes (10%) and of HIV(1.1%) are very high. Our objective was to determine the prevalence of diabetes and its complications in a HIV cohort.

Materials and methods
We enrolled HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals between January 1, 1992 and December 31, 2021 in the French Hospital Database for HIV (FHDH) a national database compiling data from all French regions.

Results
There was no difference of diabetes prevalence between men (8.2%) and women (8.8%), P = 0.4. Patients with diabetes were older (56 years ± 13.4) than those without diabetes (44.7 years ± 13.6) and prevalence increased with age. The proportion of persons with diabetes was greater among virologically suppressed persons (10%) than those with a detectable viral load under antiretroviral treatment (5.8%). Persons with diabetes had substantially greater CD4 counts at diagnosis than persons without diabetes. The majority of macro and microvascular complications were observed in people with diabetes. Persons with diabetes and HIV were significantly less likely to have had AIDS (1.6 versus 2.2 per 100 person-years, respectively). Overall, 374 persons living with HIV of 4167 had died (9%) the proportion of persons with diabetes among the dead was greater than those who did not die 11.7% versus 8.1%, respectively, p = 0.017. However, persons with diabetes were older and hence died older, 62.3 years (SD = 1.9) for deceased persons with diabetes versus 50.4 years (SD = 0.8), P < 0.0001. However, using Cox regression to adjust for age, initial CD4 count, country of birth there was no significant difference in the Hazard for death between persons with diabetes and persons without diabetes (aHR = 0.99, 95%CI = 0.65–1.5), P = 0.9.

Conclusions
The prevalence of diabetes in our HIV cohort was high. Persons with diabetes had greater CD4 counts, earlier care, and greater virological suppression than persons without diabetes. There were no significant differences between persons with diabetes and without diabetes in terms of survival.
Clinical effect of early enteral nutrition support on critically ill neonates with extracorporeal membrane oxygenation
Authors: Lin Ze-Wei , Liu Ying-Ying , Chen Xiu-Hua , Zheng Yi-Rong , Cao Hua , Chen Qiang 
Published: July 2023

Abstract
Objective
To investigate the feasibility and clinical outcomes of early enteral nutrition (EN) in critically ill neonates supported by extracorporeal membrane oxygenation (ECMO).

Methods
We retrospectively analyzed the clinical data of 16 critically ill neonates who received ECMO support for respiratory and circulatory failure from July 2021 to December 2022 at our center. The patients were divided into two groups: the early EN group (< 24 h) and the late EN group (> 24 h). The related clinical and nutrition-related indicators between the groups were compared.

Results
There was a significant difference in the time from ECMO treatment to the start of EN between the early EN group (9 patients, 56.2%) and the late EN group (7 patients, 43.8%) (P < 0.05). However, there were no significant differences in ECMO duration, hospitalization time, vasoactive-inotropic score (VIS), intestinal oxygen saturation, or routine stool occult blood (OB) test between the two groups (all P > 0.05). The incidence of complications such as intestinal obstruction, abdominal distension, diarrhea, and necrotizing enterocolitis (NEC) was slightly lower in the early EN group, but the differences were not statistically significant (all P > 0.05). The early EN group had a shorter time [3.6 (3.5, 5) vs. 7.5 (5.9, 8.5) d] to reach full gastrointestinal nutrition compared to the late EN group (P < 0.05).

Conclusion
Providing early nutritional support through enteral feeding to critically ill neonates receiving ECMO treatment is both safe and practical, but close monitoring of clinical and nutritional indicators is essential.
Changes in the patterns of respiratory support and incidence of bronchopulmonary dysplasia; a single center experience
Authors: Algarni Saleh S. , Ali Kamal , Alsaif Saif , Aljuaid Nemer , Alzahrani Raghad , Albassam Maha , Alanazi Rawan , Alqueflie Dana , Almutairi Maather , Alfrijan Hessah , Alanazi Ahmad , Ghazwani Abadi , Alshareedah Saad , Alotaibi Tareq F , Alqahtani Mohammed M , Aljohani Hassan , Ismaeil Taha T , Alwadeai Khalid S , Siraj Rayan A , Alsaif Abdurahman , Asiri Sabreen , Halabi Shaimaa , Alanazi Abdullah M M 
Published: July 2023

Abstract
Background
With the advances in neonatal intensive care, the survival rate of extremely preterm infants is increasing. However, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity among infants in this group. This study examined the changes in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC), and their association with BPD incidence among preterm infants born at < 29 weeks of gestation.

Method
This population-based retrospective cohort study included infants born at < 29 weeks of gestation between 2016 and 2020. Data regarding the use and duration of respiratory support modalities were obtained, including mechanical ventilation, continuous positive airway pressure, HHHFNC, and low-flow oxygen therapy. Additionally, the incidence of BPD was determined in the included infants. Trend analysis for each respiratory support modality and BPD incidence rate was performed to define the temporal changes associated with changes in BPD rates. In addition, a logistic regression model was developed to identify the association between BPD and severity grade using HHHFNC.

Results
Three Hundred and sixteen infants were included in this study. The use and duration of HHHFNC therapy increased during the study period. Throughout the study period, the overall incidence of BPD was 49%, with no significant trends. The BPD rate was significantly higher in the infants who received HHHFNC than in those who did not (52% vs. 39%, P = 0.03). Analysis of BPD severity grades showed that both grade 1 BPD (34% vs. 21%, P = 0.03) and grade 2 BPD (12% vs. 1%, P < 0.01) were significantly more common among infants who received HHHFNC than among those who did not. In contrast, the incidence of grade 3 BPD was lower in infants who received HHFNC (6% vs. 17%, P < 0.01). The duration in days of HHHFNC was found to significantly predict BPD incidence (OR 1.04 [95%CI: 1.01–1.06], P < 0.01) after adjusting for confounding variables.

Conclusion
The use of HHHFNC in extremely preterm infants born at < 29 weeks of gestation is increasing. There was a significant association between the duration of HHHFNC therapy and the development of BPD in extremely preterm infants born at < 29 weeks of gestation.
Factors affecting survival and prognosis in surgically treated patients with spinal metastases arising from renal cell carcinoma
Authors: Lei Ming , Miao Jun 
Published: July 2023

Abstract
Background
The objective of this study was to explore the prognostic factors for renal cell carcinoma (RCC) patients with spinal metastasis who underwent surgical treatment in our hospital.

Methods
We retrospectively analyzed the clinical data and survival status of 49 patients with spinal metastases arising from RCC. All patients with spinal metastases underwent surgical treatment. We analyzed a range of factors that may affect the prognosis of patients with RCC. Using Kaplan-Meier method to perform univariate analysis of the factors that might affect spine metastasis free survival (SMFS)and survival after spinal metastasis (OS) respectively. Establish Cox proportional hazards model to extract independent prognostic factors for SMFS and OS.

Results
The mean time of SMFS was 27 months (median 8, range 0–180 months). The mean time of OS was 12.04 months (median 9, range 2–36 months). RCC with visceral metastasis (p = 0.001,HR 11.245,95%CI 2.824–44.776) and AJCC RCC Stage (p = 0.040,HR 2.809,95%CI 1.046–7.543) can significantly affect SMFS. Furthermore, WHO/ISUP Grade (p < 0.001, HR 2.787,95%CI 1.595–4.870), ECOG Score (p = 0.019, HR 0.305,95%CI 0.113–0.825) and multiple spinal metastases (p < 0.001, HR 0.077,95%CI 0.019–0.319) have significant effects on OS.

Conclusions
RCC with visceral metastasis and AJCC RCC Stage were independent prognostic factors for SMFS. WHO/ISUP Grade, ECOG Scores and multiple spinal metastases were independent prognostic factors for OS.
Effect of a Baduanjin intervention on the risk of falls in the elderly individuals with mild cognitive impairment: a study protocol for a randomized controlled trial
Authors: Wu Ziyi , Kuang Yuxing , Wan Yiwen , Shi Jiao , Li Shuqian , Xia Rui , Wan Mingyue , Chen Shangjie 
Published: July 2023

Abstract
Background
Falls are a global public problem and may be an important cause of death in older adults. However, older adults with mild cognitive impairment(MCI) are more likely to fall and suffer more damage than older adults with normal cognitive function, which shows the importance of preventing falls. More and more evidence shows that Baduanjin can improve the balance function of the elderly and reduce the risk of falls in the elderly with MCI, but the mechanism is still unclear. The main purpose of this study is to verify the intervention effect of Baduanjin training on the risk of falls in elderly people with MCI and to elucidate the underlying mechanism of Baduanjin training in reducing the risk of falls in MCI patients.

Methods
In this prospective study, outcome assessor-blind, three-arm randomized controlled trial, a total of 72 eligible participants will be randomly allocated (1:1:1) into the 12-week Baduanjin exercise intervention (60 min per session, three sessions per week), the 12-week brisk walking group(60 min per session, three sessions per week) or the 12-week health education group. Primary outcome is the Fall-Risk Self-Assessment Questionnaire(FRQ), and secondary outcomes are fall efficacy index, gait assessment, balance function, lower limb muscle strength, cognitive function, activities of daily living(ADL) and MRI scans. In addition to the MRI scans, which will be measured before and after the intervention,other primary and secondary outcomes will be assessed at baseline, 6 weeks, and 12 weeks (at the end of the intervention) and after an additional 12-week follow-up period. The mixed linear model will be conducted to observe the intervention effects.

Discussion
This trial will investigate the effect of Baduanjin exercise on the prevention of falls in elderly individuals with MCI, explore the imaging mechanism of Baduanjin exercise to reduce the risk of falls in elderly individuals with MCI from the perspective of vestibular neural network, and provide strong evidence for Baduanjin exercise to reduce the risk of falls in elderly individuals with MCI, as well as provide new ideas and approaches for the central mechanism of Traditional Chinese Medicine(TRC) rehabilitation methods to intervene in falls in elderly.

Trial registration
Chictr.org.cn, ID: ChiCTR2200057520. Registered on 14 March 2022, https://www.chictr.org.cn/showproj.html?proj=146592.
Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal
Authors: Ortet Yasmara , Seringa Joana , Santana Rui 
Published: July 2023

Abstract
Background
The number of people with chronic diseases has increased globally, as has the number of chronic diseases per person. Faced with this reality, the term “complex patient” is current and actual.
The healthcare costs associated with these patients are high and are expected to increase since most healthcare systems are not yet ready to provide integrated long-term care. In Portugal, several health institutions have made efforts to provide integrated care: case management models have been implemented to complex patients follow-up. However, studies related to cost of these programs are still limited. Therefore, a qualitative investigation was conducted, approaching the design criteria of a case study research, to design a case management program for complex patients and determine its direct costs, following the Time-Driven Activity-Based Costing methodology, in Local Health Unit setting.

Method
The direct costs of providing care to a complex patient involved in a case management program were determined, using the Time-Driven Activity-Based Costing methodology.
A map of the complex patient was drawn, considering a standard flow in the program. Times and costs were allocated to the activities on the map, following Portuguese and international practices of case management models.

Results
A total of 684,45€/year is spent for each new patient in the case management program, of which 452,65€ corresponds to cost of remuneration of professionals involved; and 663,85€/year, for each patient who is in the case management program (over 1 year), where 432,05€ corresponds to cost of the remuneration of the professionals involved.
Follow-up is the most costly phase (80.82%) and where more time is spent (85.62%).

Conclusion
The time spent by professionals and resources involved and the costs associated with each patient were obtained. The economic impact of the analysed activities was not studied, however, according to international authors, when well applied and selected, integrated care models lead to cost reduction and improved health outcomes.
Saying and doing are different things: a scoping review on how health equity is conceptualized when considering healthcare system performance
Authors: Lee-Foon Nakia K. , Haldane Victoria , Brown Adalsteinn 
Published: July 2023

AbstractIntroductionEnsuring healthcare systems provide equitable, high quality care is critical to their users’ overall health and wellbeing. Typically, systems use various performance frameworks and related indicators to monitor and improve healthcare. Although these frameworks usually include equity, the extent that equity is reflected in these measurements remains unclear. In order to create a system that meets patients’ needs, addressing this uncertainty is important. This paper presents findings from a scoping review that sought to answer the question ‘How is equity conceptualized in healthcare systems when assessing healthcare system performance?’.MethodsLevac’s scoping review approach was used to locate relevant articles and create a protocol. Included, peer-reviewed articles were published between 2015 to 2020, written in English and did not discuss oral health and clinician training. These healthcare areas were excluded as they represent large, specialized bodies of literature beyond the scope of this review. Online databases (e.g., MEDLINE, CINAHL Plus) were used to locate articles.ResultsEight thousand six hundred fifty-five potentially relevant articles were identified. Fifty-four were selected for full review. The review yielded 16 relevant articles. Six articles emanated from North America, six from Europe and one each from Africa, Australia, China and India respectively. Most articles used quantitative methods and examined various aspects of healthcare. Studies centered on: indicators; equity policies; evaluating the equitability of healthcare systems; creating and/or testing equity tools; and using patients’ sociodemographic characteristics to examine healthcare system performance.ConclusionAlthough equity is framed as an important component of most healthcare systems’ performance frameworks, the scarcity of relevant articles indicate otherwise. This scarcity may point to challenges systems face when moving from conceptualizing to measuring equity. Additionally, it may indicate the limited attention systems place on effectively incorporating equity into performance frameworks. The disjointed and varied approaches to conceptualizing equity noted in relevant articles make it difficult to conduct comparative analyses of these frameworks. Further, these frameworks’ strong focus on users’ social determinants of health does not offer a robust view of performance. More work is needed to shift these narrow views of equity towards frameworks that analyze healthcare systems and not their users.