bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time-series cohort study to forecast emergency department visits in the city of Milan and predict high demand: a 2-day warning system
Authors: Murtas Rossella , Tunesi Sara , Andreano Anita , Russo Antonio Giampiero 
Published: May 2022

ObjectivesThe emergency department (ED) is one of the most critical areas in any hospital. Recently, many countries have seen a rise in the number of ED visits, with an increase in length of stay and a detrimental effect on quality of care. Being able to forecast future demands would be a valuable support for hospitals to prevent high demand, particularly in a system with limited resources where use of ED services for non-urgent visits is an important issue.DesignTime-series cohort study.SettingWe collected all ED visits between January 2014 and December 2019 in the five larger hospitals in Milan. To predict daily volumes, we used a regression model with autoregressive integrated moving average errors. Predictors included were day of the week and year-round seasonality, meteorological and environmental variables, information on influenza epidemics and festivities. Accuracy of prediction was evaluated with the mean absolute percentage error (MAPE).Primary outcome measuresDaily all-cause EDs visits.ResultsIn the study period, we observed 2 223 479 visits. ED visits were most likely to occur on weekends for children and on Mondays for adults and seniors. Results confirmed the role of meteorological and environmental variables and the presence of day of the week and year-round seasonality effects. We found high correlation between observed and predicted values with a MAPE globally smaller than 8.1%.ConclusionsResults were used to establish an ED warning system based on past observations and indicators of high demand. This is important in any health system that regularly faces scarcity of resources, and it is crucial in a system where use of ED services for non-urgent visits is still high.
Association of Dietary Inflammatory Index (DII) and depression in the elderly over 55 years in Northern China: analysis of data from a multicentre, cohort study
Authors: Li Ruiqiang , Zhan Wenqiang , Huang Xin , Zhang Zechen , Zhou Meiqi , Bao Wei , Huang Feifei , Ma Yuxia 
Published: May 2022

ObjectivesOur study aimed to assess the association between the Dietary Inflammatory Index (DII) and depression in the elderly over 55 years in Northern China.MethodsWe analysed the data of 2022 Chinese adults aged 55 and over from a community-based neurological disease cohort study from 2018 to 2019. A validated semiquantitative food frequency questionnaire was used to assess eating habits at the time of inclusion. Multiple logistic regression was used for analysis, and social demographics, lifestyle and health-related factors were adjusted.ResultsAmong the included population, the prevalence of depression was 23.39%. Mean (SD) and range of the DII in the included population were 1.70 (1.42) and −5.20 to +5.68. The risk of depression was significantly higher in participants in the most pro-inflammatory group (quartile 4) than in the participants in the most anti-inflammatory group (quartile 1) (OR 1.53; 1.37 to 1.82; p-trend=0.01). The subgroup analysis of body mass index (BMI) showed that there is a significant association between DII and the risk of depression in overweight and obese people (p＜0.05). The restricted cubic spline results show that the OR value of depression possesses an upward trend with the increase of the DII score.ConclusionsAged patients with depression present a higher potential for dietary inflammation. Pro-inflammatory diets might increase the risk of depressive symptoms. Further research in different populations is crucial to confirm the association between DII and depression.
Smartphone standoff: a qualitative study exploring clinician responses when a patient uses a smartphone to record a hospital clinical encounter
Authors: Ryan Laura , Weir Kelly , Maskell Jessica , Le Brocque Robyne 
Published: May 2022

ObjectivesPatients are initiating recordings of their clinical encounters using a smartphone. While this is an important, universal issue, little is known about the clinician viewpoint. Understanding clinician perspectives and behaviours is key to ensuring the protection of patient and clinician interests. This study aimed to gain a deep understanding of clinician attitudes and behaviours to patient-led recordings of hospital clinical encounters.DesignSemistructured interviews were conducted with 20 hospital clinicians. Participants were recruited using a combination of purposive and snowball sampling. Interviews were digitally recorded and transcribed. Transcripts were analysed using thematic analysis.SettingThis study took place at two hospitals in the metropolitan area of Gold Coast, Australia.ParticipantsParticipants included clinicians with varying levels of experience, or clinical managers in the roles of: medical, nursing and midwifery, and allied health staff.ResultsThe 20 participants interviewed were from a range of health disciplines and clinical areas and most had experienced a patient-led recording. Three themes emerged when exploring participant attitudes. First, that recording was a significant and controversial topic. Second, that experiences often informed clinician attitudes and many clinicians held conflicting views. Finally, a perceived loss of control was a significant stressor. A further three themes emerged relating to clinician behaviours when a patient asks to record. Decision-making involved balancing multiple factors often in pressurised situations. Shared decision-making was shaped by power dynamics and, finally, decision-making was not informed by hospital policy.ConclusionsWhile patient-led recordings were viewed as beneficial, clinician welfare and patient safety may be at risk when a patient records a clinical encounter. Current safeguards, such as hospital policies, are not used and may not meet the needs of clinicians when decision-making is complicated by power dynamics. More research is needed to better understand how clinicians can be supported in this critical domain.
Expediting workflow in the acute stroke pathway for endovascular thrombectomy in the northern Netherlands: a simulation model
Authors: Maas Willemijn J , Lahr Maarten M H , Uyttenboogaart Maarten , Buskens Erik , van der Zee Durk-Jouke 
Published: May 2022

ObjectiveThe objective of this study is to identify barriers for the timely delivery of endovascular thrombectomy (EVT) and to investigate the effects of potential workflow improvements in the acute stroke pathway.DesignHospital data prospectively collected in the MR CLEAN Registry were linked to emergency medical services data for each EVT patient and used to build two Monte Carlo simulation models. The ‘mothership (MS) model’, reflecting patients who arrived directly at the comprehensive stroke centre (CSC); and the ‘drip and ship’ (DS) model, reflecting patients who were transferred to the CSC from primary stroke centres (PSCs).SettingNorthern region of the Netherlands. One CSC provides EVT, and its catchment area includes eight PSCs.Participants248 patients who were treated with EVT between July 2014 and November 2017.Outcome measuresThe main outcome measures were total delay from stroke onset until groin puncture, functional independence at 90 days (modified Rankin Scale 0–2) and mortality.ResultsBarriers identified included fast-track emergency department routing, prealert for transfer to the CSC, reduced handover time between PSC and ambulance, direct transfer from CSC arrival to angiography suite entry, and reducing time to groin puncture. Taken together, all workflow improvements could potentially reduce the time from onset to groin puncture by 59 min for the MS model and 61 min for the DS model. These improvements could thus result in more patients—3.7% MS and 7.4% DS—regaining functional independence after 90 days, in addition to decreasing mortality by 3.0% and 5.0%, respectively.ConclusionsIn our region, the proposed workflow improvements might reduce time to treatment by about 1 hour and increase the number of patients regaining functional independence by 6%. Simulation modelling is useful for assessing the potential effects of interventions aimed at reducing time from onset to EVT.
Associations of presenting symptoms and subsequent adverse clinical outcomes in people with unipolar depression: a prospective natural language processing (NLP), transdiagnostic, network analysis of electronic health record (EHR) data
Authors: Patel Rashmi , Irving Jessica , Brinn Aimee , Taylor Matthew , Shetty Hitesh , Pritchard Megan , Stewart Robert , Fusar-Poli Paolo , McGuire Philip 
Published: May 2022

ObjectiveTo investigate the associations of symptoms of mania and depression with clinical outcomes in people with unipolar depression.DesignA natural language processing electronic health record study. We used network analysis to determine symptom network structure and multivariable Cox regression to investigate associations with clinical outcomes.SettingThe South London and Maudsley Clinical Record Interactive Search database.ParticipantsAll patients presenting with unipolar depression between 1 April 2006 and 31 March 2018.Exposure(1) Symptoms of mania: Elation; Grandiosity; Flight of ideas; Irritability; Pressured speech. (2) Symptoms of depression: Disturbed mood; Anhedonia; Guilt; Hopelessness; Helplessness; Worthlessness; Tearfulness; Low energy; Reduced appetite; Weight loss. (3) Symptoms of mania or depression (overlapping symptoms): Poor concentration; Insomnia; Disturbed sleep; Agitation; Mood instability.Main outcomes(1) Bipolar or psychotic disorder diagnosis. (2) Psychiatric hospital admission.ResultsOut of 19 707 patients, at least 1 depression, overlapping or mania symptom was present in 18 998 (96.4%), 15 954 (81.0%) and 4671 (23.7%) patients, respectively. 2772 (14.1%) patients subsequently developed bipolar or psychotic disorder during the follow-up period. The presence of at least one mania (HR 2.00, 95% CI 1.85 to 2.16), overlapping symptom (HR 1.71, 95% CI 1.52 to 1.92) or symptom of depression (HR 1.31, 95% CI 1.07 to 1.61) were associated with significantly increased risk of onset of a bipolar or psychotic disorder. Mania (HR 1.95, 95% CI 1.77 to 2.15) and overlapping symptoms (HR 1.76, 95% CI 1.52 to 2.04) were associated with greater risk for psychiatric hospital admission than symptoms of depression (HR 1.41, 95% CI 1.06 to 1.88).ConclusionsThe presence of mania or overlapping symptoms in people with unipolar depression is associated with worse clinical outcomes. Symptom-based approaches to defining clinical phenotype may facilitate a more personalised treatment approach and better predict subsequent clinical outcomes than psychiatric diagnosis alone.
Exploration of the uptake of asymptomatic COVID-19 lateral flow testing in Birmingham, UK: survey and qualitative research
Authors: Mathers Jonathan , Poyner Christopher , Thompson Dean , Rudge Gavin , Pritchett Ruth V 
Published: May 2022

AimTo examine public perspectives on lateral flow testing (LFT) for COVID-19.DesignOnline survey with nested semi-structured interviews.SettingBirmingham, UK.Participants220 Birmingham residents, 21 of whom took part in an interview.ResultsFifty-six per cent of respondents had taken an LFT. Reasons for not testing included adherence to other government COVID-19 guidance, having had a vaccination and not thinking LFTs were accurate. In 16% of households with children nobody, including children, was testing. In households where children were testing, their parents or other adults were often not. Those who were testing and eligible for workplace and school testing were more likely to be testing twice weekly. In other settings, respondents were more likely to be testing on a one-off or ad hoc basis. Approximately half of respondents said that they were likely to visit friends and family after a negative test result and 10% that they were unlikely to self-isolate following a positive test result. In interviews, participants who were testing described the peace of mind that testing afforded them prior to activities or interactions with family and friends, including those they considered to be vulnerable. Interviewees who were not testing described concerns about test accuracy and also cited a lack of face-to-face interaction with others precluding the need to test. Participants were often testing flexibly according to circumstances and perceived risk of COVID-19 transmission.ConclusionsWhile some choose not to test, others are doing so in order to provide peace of mind to engage in personal interactions they might otherwise have avoided. This peace of mind may be a necessary pre-requisite for some to more fully re-engage in pre-pandemic activities. Despite clear concerns about test accuracy among those not testing, those who are testing held generally positive attitudes towards the continued use of LFTs.
Eczema Care Online: development and qualitative optimisation of an online behavioural intervention to support self-management in young people with eczema
Authors: Greenwell Kate , Ghio Daniela , Sivyer Katy , Steele Mary , Teasdale Emma , Ridd Matthew J , Roberts Amanda , Chalmers Joanne R , Lawton Sandra , Langan Sinead , Cowdell Fiona , Le Roux Emma , Wilczynska Sylvia , Jones Hannah , Whittaker Emilia , Williams HC , Thomas Kim Suzanne , Yardley Lucy , Santer Miriam , Muller Ingrid 
Published: May 2022

ObjectivesTo describe the development of Eczema Care Online (ECO), an online behaviour change intervention for young people with eczema (phase I); and explore and optimise the acceptability of ECO among this target group using think-aloud interviews (phase II).MethodsTheory-based, evidence-based and person-based approaches to intervention development were used. In phase I, a qualitative systematic review and qualitative interviews developed an in-depth understanding of the needs and challenges of young people with eczema. Guiding principles highlighted key intervention design objectives and features to address the needs of this target group to maximise user engagement. Behavioural analysis and logic modelling developed ECO’s hypothesised programme theory. In phase II, qualitative think-aloud interviews were carried out with 28 young people with eczema and the intervention was optimised based on their feedback.ResultsThe final intervention aimed to reduce eczema severity by supporting treatment use (emollients, topical corticosteroids/topical calcineurin inhibitors), management of irritants/triggers, emotional management and reducing scratching. Generally, young people expressed positive views of intervention content and design in think-aloud interviews. Quotes and stories from other young people with eczema and ECO’s focus on living with eczema (not just topical treatments) were valuable for normalising eczema. Young people believed ECO addressed knowledge gaps they had from childhood and the safety information about topical corticosteroids was reassuring. Negative feedback was used to modify ECO.ConclusionsA prototype of the ECO intervention was developed using rigorous and complementary intervention development approaches. Subsequent think-aloud interviews helped optimise the intervention, demonstrated ECO is likely to be acceptable to this target group, and provided support for our guiding principles including key design objectives and features to consider when developing interventions for this population. A randomised controlled trial and process evaluation of the intervention is underway to assess effectiveness and explore user engagement with the intervention’s behavioural goals.
Systematic review protocol of the effectiveness of HIV prevention interventions for reducing risky sexual behaviour among youth globally
Authors: Mbengo Fungai , Zgambo Maggie , Afrifa-Yamoah Ebenezer , Kalembo Fatch Welcome , Honda Takanori , Shimpuku Yoko , Chen Sanmei 
Published: May 2022

IntroductionHuman immunodeficiency virus (HIV) prevention interventions focused at reducing risky sexual behaviours are an important strategy for preventing HIV infection among youth (15–24 years) who continue to be vulnerable to the disease. This systematic review aims to synthesise current global evidence on the effectiveness of HIV prevention interventions for reducing risky sexual behaviour among youth in the last decade.Methods and analysisMEDLINE/PubMed, EMBASE, PsychINFO, ProQuest Central, CINAHL and Web of Science databases, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform and reference lists of included studies and systematic reviews on effectiveness of HIV prevention interventions for reducing risky sexual behaviour among youth will be searched for articles published from August 2011 to August 2021. Eligible studies will be longitudinal studies including randomised controlled trials and quasi-experimental studies that examined the effectiveness of HIV prevention interventions among youth populations (15–24 years) with risky sexual behaviour as a primary or secondary outcome. Study selection and quality assessment will be undertaken independently by three reviewers and disagreements will be resolved through consensus. Data analysis will be undertaken using RevMan software V.5.3.3. A random effects meta-analysis will be conducted to report heterogeneous data where statistical pooling is achievable. We will use I2 statistics to test for heterogeneity. Where appropriate, a funnel plot will be generated to assess publication bias. Where statistical pooling is unachievable, the findings will be reported in a narrative form, together with tables and figures to assist in data presentation if required. Reporting of the systematic review will be informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Ethics and disseminationEthical approval is not required. Findings of the systematic review will be published in a peer-reviewed journal. The findings will be of interest to researchers, healthcare practitioners and policymakers.PROSPERO registration numberCRD42021271774.
Platelet-rich fibrin/anorganic bovine bone mineral complex as grafting materials in endodontic microsurgery with a large lesion size: study protocol for a randomised controlled trial
Authors: Han Bing , Wang Yuhan , Chen Zhibin , Zheng Chunyan , Zhang Zhichun , Liu Yingyi , Liu Kaining , Wang Zuhua , Wang Xiaoyan 
Published: May 2022

IntroductionEndodontic microsurgery is a treatment of last resort for preserving natural teeth. According to radiographic evaluation, the percentage of complete healing after endodontic microsurgery is only 74.3%. The use of regenerative techniques in endodontic microsurgery for large lesions (>10 mm diameter) is therefore recommended. The most frequently used bone graft in endodontic microsurgery is anorganic bovine bone mineral (ABBM) but this only has an osteoconductive effect. Thus, when platelet-rich fibrin (PRF), a reservoir of growth factors, is used together with ABBM, it increases the regenerative effect. This study is devoted to comparing the clinical outcomes of PRF with/without ABBM as grafting biomaterials in endodontic microsurgery cases with large lesion size to provide some valuable reference data for dentists.Methods and analysisSixteen patients who are in need of endodontic microsurgery will be recruited. The patients will be randomly assigned to one of two groups: an experimental group, treated with PRF/ABBM complex and collagen membrane, and a control group, treated with ABBM and collagen membrane. Clinical examination including percussion, mobility testing and presence/absence of sinus will be recorded at 7 days, and at 3, 6 and 12 months after endodontic microsurgery. A Visual Analogue Scale will be used by the patients to evaluate pain at 1, 3 and 7 days after endodontic microsurgery. Routine paralleling radiographs will be obtained before and at 3, 6 and 12 months follow-up after endodontic microsurgery. Cone-beam CT (CBCT) scans will be obtained at the 12-month follow-up. Bone formation will be evaluated according to CBCT and paralleling radiographs. The study execute time including follow-ups last from 1 June 2021 to 31 December 2024.Ethics and disseminationThis study received approval from the Ethics Committee of Peking University School and Hospital of Stomatology. The results will be disseminated through scientific journals.Trial registration numberResearch data will be registered with the International Clinical Trials Registry Platform (ICTRP), ID: ChiCTR2100046684.
Predictive performance of comorbidity for 30-day and 1-year mortality in patients with bloodstream infection visiting the emergency department: a retrospective cohort study
Authors: Schuttevaer Romy , Boogers William , Brink Anniek , van Dijk Willian , de Steenwinkel Jurriaan , Schuit Stephanie , Verbon Annelies , Lingsma Hester , Alsma Jelmer 
Published: May 2022

ObjectivesTo investigate whether the Charlson Comorbidity Index (CCI) predicted short-term and long-term mortality in patients with a bloodstream infection visiting the emergency department (ED) and compare it to the often-validated National Early Warning Score (NEWS).DesignA retrospective cohort study.SettingA tertiary hospital in the Netherlands.ParticipantsAdult patients attending the ED with a blood culture-proven infection between 2012 and 2017 were included. We collected the comorbidities from the CCI and the vital signs from the NEWS.Main outcomesShort-term mortality (30-day) and long-term mortality (1 year). We assessed the predictive performance by discrimination, expressed as the area under the curve (AUC).ResultsWe included 1039 patients with a blood culture-proven infection. Mortality was 10.4% within 30 days and 27.8% within 1 year. On average patients had two comorbidities (ranging from 0 to 6). Highly prevalent comorbidities were malignancy (30.2%) and diabetes mellitus (20.5%). The predictive performance of the CCI was highest for 1-year mortality (AUC 0.696 (95%CI) (0.660 to 0.732)) and better compared with the NEWS (AUC (95% CI) 0.594 (0.555 to 0.632)). For prediction of 30-day mortality, the NEWS was superior (AUC (95% CI) 0.706 (0.656 to 0.756)) to the comorbidities of the CCI (AUC (95% CI) 0.568 (0.507 to 0.628)).ConclusionsWe found that presenting comorbidity (ie, the CCI) is most useful to prognosticate long-term outcome in patients with bloodstream infection in the ED. Short-term mortality is more accurately predicted by deviating vital signs (ie, the NEWS).