bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of out-of-hospital cardiac arrests caused by anaphylaxis and factors associated with outcomes: an observational study
Authors: Murasaka Kenshi , Yamashita Akira , Wato Yukihiro , Inaba Hideo 
Published: August 2022

ObjectivesDescribe the epidemiologic features of out-of-hospital cardiac arrest (OHCA) caused by anaphylaxis and identify outcome-associated factors.DesignObservational study.SettingData from the Japanese Fire and Disaster Management Agency database.ParticipantsA total of 292 patients from 879 057 OHCA events between 2013 and 2019 with OHCA caused by anaphylaxis and for whom prehospital resuscitation was attempted were included in the analysis.Outcome measuresThe incidence of anaphylaxis-induced OHCA, neurologically favourable 1-month survival, defined as cerebral performance category 1 or 2, and 1-month survival.ResultsThe proportion of OHCAs caused by anaphylaxis was high in non-elderly and male patients from July to September and during business hours. Bystander-witnessed (adjusted OR=4.43; 95% CI 1.84 to 10.7) and emergency medical service-witnessed events (adjusted OR=3.28; 95% CI 1.21 to 8.87) were associated with higher rates of neurologically favourable 1-month survival as well as better 1-month survival. Shockable initial ECG rhythms were recorded in only 19 patients (6.5%), and prehospital defibrillation was attempted in 16 such patients (84.2%). Neither shockable initial rhythms nor prehospital defibrillation was associated with better outcomes. Patients requiring advanced airway management had poor neurological outcomes (adjusted OR=0.17; 95% CI 0.07 to 0.42) and worse 1-month survival (adjusted OR=0.28; 95% CI 0.14 to 0.58).ConclusionsFew cases of OHCA were attributable to anaphylaxis. Witnessed OHCAs, particularly those witnessed by bystanders, were associated with better neurological outcomes. Airway complications requiring advanced airway management were likely associated with poor outcomes.
Spontaneous bladder rupture and associated factors during pregnancy:a systematic review and metanalysis protocol
Authors: Ranjbar Amene , Mehrnoush Vahid , Roozbeh Nasibeh , Banaei Mojdeh , Darsareh Fatemeh 
Published: August 2022

IntroductionSpontaneous bladder rupture during pregnancy is a potentially life-threatening event requiring immediate surgery to reduce morbidity and mortality. This systematic review aims to identify associated factors of spontaneous bladder rupture during pregnancy and propose a diagnostic and therapeutic algorithm.Methods and analysisTo improve the reporting of this protocol, the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 statement was used. The primary objective is to identify and summarise the associated factors with spontaneous bladder rupture during pregnancy. The secondary outcome was to determine the diagnostic and treatment approach. From inception to June 2022, a systematic search of the following electronic databases of peer-reviewed journal articles and online search records will be conducted: the Cochrane Central Register, PubMed, Medline (Via PubMed), Embase (Via Ovid), ProQuest, Scopus, WOS and search engine Google Scholar. All types of studies focusing on spontaneous bladder rupture during pregnancy will be included. Two authors will review the studies based on inclusion and exclusion criteria. Three authors will independently extract data using a researcher-created checklist. In the event of a disagreement, an external reviewer will be used. The Newcastle-Ottawa Scale checklist will be used by two authors to assess the quality of the studies independently. Data analysis will be carried out using STATA V.16.Ethics and disseminationEthical approval is not required, as our review will include published and publicly accessible data. Findings from this review will be disseminated via publication in a peer-review journal.PROSPERO registration numberThe protocol for this review was submitted at PROSPERO on 20 March 2022 with ID number CRD42022319511.
User engagement with technology-mediated self-guided interventions for addictions: scoping review protocol
Authors: Brazeau Brad W , Hodgins David C 
Published: August 2022

IntroductionTechnology-mediated self-guided interventions (TMSGIs) for addictive disorders represent promising adjuncts and alternatives to traditional treatment approaches (eg, face-to-face psychotherapy). However, meaningful evaluation of such interventions remains elusive given the lack of consistent terminology and application. Preliminary findings suggest that TMSGIs are useful but engagement remains modest for various reasons reported by users, including lack of personalisation. The aim of this review is to explore how TMSGIs have been defined and applied in addictions populations with an emphasis on technical and logistical features associated with greater user engagement.Methods and analysisThis scoping review protocol was developed in accordance with the Arksey and O’Malley framework. Articles from electronic databases (ie, PsycINFO, Embase, MEDLINE and CINAHL) will be included if they targeted adolescents or adults with one or more substance or behavioural addictions, excessive behaviours or aspects thereof (eg, cravings) using a privately accessible technology-mediated intervention. Two independent reviewers will screen titles and abstracts for relevance before commencing full-text reviews. Extracted data will be presented in descriptive, tabular and graphical summaries as appropriate.Ethics and disseminationEthics committee approval is not required for this study. Review findings will be used to guide the development of preliminary recommendations for real-time addiction intervention development and provision. Emphasis will be placed on practical considerations of user engagement, accessibility, usability and cost. Knowledge users, including clinicians, researchers and people with lived experience, will be engaged for development of one such intervention following publication of review findings.RegistrationThis scoping review was registered with the Open Science Framework on 15 April 2022 and can be located at http://www.osf.io/3utp9/.
COVID-19 vaccine effectiveness among people living with and without HIV in South Carolina, USA: protocol of a population-based cohort study
Authors: Yang Xueying , Zhang Jiajia , Olatosi Bankole , Weissman Sharon , Li Xiaoming 
Published: August 2022

IntroductionDespite the effectiveness of COVID-19 vaccines in preventing severe COVID-19 outcomes, a small percentage of fully vaccinated persons will develop symptomatic or asymptomatic infections with SARS-CoV-2, which is referred to as ‘breakthrough COVID-19’. People living with HIV (PLWH) appear to have an elevated risk of severe COVID-19 outcomes, yet the effectiveness of the COVID-19 vaccine in this population remains unclear due to the limited research efforts in this population in the real world. This study aims to characterise and compare the breakthrough COVID-19 (eg, prevalence and disease severity) between PLWH and non-PLWH and then examine whether HIV markers play a role in COVID-19 vaccine effectiveness within the PLWH population.Methods and analysisThis cohort study will merge electronic health records data from multiple data sources in South Carolina (SC), including the ‘HIV Cohort’ (n=12 203) identified from the statewide Enhanced HIV/AIDS Reporting System, ‘Vaccine Cohort’ from the Statewide Immunisation Online Network which provides patient-level immunisation records (n=~1.71 million), and ‘COVID-19 Cohort’ which includes healthcare encounters and COVID-19 diagnosis information for all individuals who were tested for COVID-19 (n=~3.41 million). The PLWH will be matched with a comparison group of non-PLWH by the propensity score matching method. To distinguish the role of immunity level in affecting the vaccine effectiveness, we will conduct subgroup analyses to compare the outcome of virally controlled and immunosuppressed PLWH with non-PLWH. Conditional logistic regression and generalised linear models will be employed to analyse the relationship between HIV status and protection durability by adjusting for potential confounders.Ethics and disseminationThe study was approved by the Institutional Review Board at the University of South Carolina (Pro00117583) as a Non-Human Subject study. The study’s findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media.
Screen time and its correlates among children aged 3–10 years during COVID-19 pandemic in Nepal: a community-based cross-sectional study
Authors: Shrestha Rajan , Khatri Bijay , Majhi Sangita , Kayastha Manish , Suwal Barsha , Sharma Samata , Suwal Rinkal , Adhikari Santoshi , Shrestha Junu , Upadhyay Madan Prasad 
Published: August 2022

ObjectiveThis study aims to determine the prevalence of high screen time among schoolchildren aged 3–10 years in Bhaktapur, its correlates and the parents’ strategies to reduce screen time during the COVID-19 pandemic in Nepal.Methods and analysisThis cross-sectional descriptive study was conducted during March 2021. A total of 630 households were selected for the study from 21 randomly selected clusters in Bhaktapur, Nepal. Correlates of high screen time were determined using a logistic model. P<0.002 was taken as significant.ResultsAmong all the participants, the mean (SD) age was 7.0 (2.2) years, with 50.3% male participation. Few participants had online classes (n=24, 3.8%). The prevalence of high screen time among the participants was very high (55.2%, 95% CI=51.3% to 59.1%), which is even higher in boys (61.8%, 95% CI=58.0% to 65.6%). The median screen time before the COVID-19 pandemic was 1.0 hours (mean rank=275.8) which increased to 2.2 hours (mean rank=116.6) during the pandemic (p<0.001). Participants having smartphones were about seven times (adjusted OR=6.9, 95% CI=1.5 to 31.3, p=0.013) more likely to have high screen time than those who did not have the device. Most parents used to reprimand and urge their children to play outside to limit their screen usage.ConclusionDuring the COVID-19 pandemic, about one in two schoolchildren of 3–10 years had higher screen time than before the COVID-19 pandemic. Parents’ strategies to reduce screen time were not effective. An intervention study is recommended to design and test effective strategies to reduce screen time and its negative effects on children’s health.
PP25 Activities and experiences of medical student first responders: a mixed methods study
Authors: Orsi Andrew , Watson Adam , Botan Vanessa , Wijegoonewardene Nimali , Lloyd Dylan , Dunbar Nic , Asghar Zahid , Siriwardena Aloysius Niroshan 
Published: August 2022

BackgroundMedical Student First Responder (MSFR) schemes provide a Community First Responder (CFR) resource to their local ambulance Trust and experience for students. We aimed to investigate the contribution of these schemes and perceptions of students taking part in them.MethodsIn this convergent mixed methods study, we analysed dispatch data from two regional ambulance services and used propensity score matching to adjust for rurality and timing of attendance. MSFR attendances were compared with CFR and ambulance attendances. Multinomial logistic regression identified predictors of MSFR attendance compared with CFR and ambulance staff whilst accounting for confounders. We combined this with semistructured interviews of MSFRs from five schemes across the two regions. Interviews were transcribed verbatim and analysed using the Framework approach supported by NVivo. Final themes and categories were agreed through consensus.ResultsWe included MSFR attendances from 2019 (n = 5817). MSFRs were more likely to attend urgent category 1 and 2 calls (vs ambulance category 3: RRR 4.67, 95%CI 3.08 - 7.07 or category 4: RRR 8.85, 95%CI 1.09 - 71.75) and cardiorespiratory (vs ambulance RRR 0.44, 95%CI 0.35 - 0.56) or neurological/endocrine calls (vs ambulance RRR 0.55, 95%CI 0.41 - 0.74). MSFRs were more likely, compared to CFRs and ambulance staff, to be dispatched to younger patients, those from ethnic minorities and deprived areas.We interviewed 16 MSFRs from 5 medical schools. Participants described routes, requirements and challenges to recruitment. Training, mentorship, shadowing and debriefing were helpful to the role. Despite the risks and stress, most MSFRs enjoyed and valued their experience for enhancing clinical knowledge and skills in emergency care and understanding the wider context of care delivery. MSFRs’ experience also helped prepare for a future career involving emergency care.ConclusionsMSFR schemes provide a valuable contribution to prehospital care and beneficial experiences for medical students.
PP36 Empathy and conscious vicarious pain in emergency ambulance workers
Authors: Brown Alison 
Published: August 2022

BackgroundEmpathy is core to human relationships and essential to patient centred healthcare. However, there are concerns that increased emotional connection increases distress for workers, leading to burnout. Empathy research within the ambulance sector is limited and has primarily involved paramedic students. The range of models and measures used in empathy research have led to mixed results and difficulties interpreting implications. Differentiation of components of empathy is needed. Vicarious pain experience has played a prominent role in empathy research, has bought insight into mechanism and is highly relevant within healthcare. This study uses a multidimensional approach to compare empathy and vicarious pain experience amongst emergency ambulance workers and a general population group.Method128 participants, including 78 emergency ambulance workers were recruited within Yorkshire Ambulance Service and in the South Yorkshire area. Empathy levels were measured using the Interpersonal Reactivity Index subscales of fantasy, perspective taking, empathetic concern and personal distress. Vicarious pain responses were categorised using the Vicarious Pain Questionnaire. The study analysed between group differences in empathy sub-scale levels and the effect of emergency ambulance experience on empathy levels. In addition, between group differences in vicarious pain experience were assessed.ResultsLower levels of empathy were identified for emergency ambulance workers on the fantasy (p=.012, 95%CI=0.09-0.83), empathetic concern (p=.002) and personal distress (p<.001) scales. Perspective taking abilities (p=.303) were not found to be significantly reduced. Amongst emergency ambulance workers levels of personal distress decreased with experience (p=.028). Emergency ambulance workers were less likely to experience conscious vicarious pain than others (p=.02).ConclusionsDifferentiating factors of empathy bought insight. Interventions to increase empathy amongst emergency ambulance workers should focus on building the capacity for empathetic concern, while preserving perspective taking abilities. Work to reduce personal distress of those in the early stages of their career is warranted.
OP07 Barriers to telephone-assisted CPR: results of a qualitative study of UK call-handlers
Authors: Farquharson Barbara , Clegg Gareth , Johnston Marie 
Published: August 2022

BackgroundTelephone-assisted CPR (t-CPR), where ambulance-service call-handlers provide instructions to callers on how to perform CPR, increases rates of CPR and survival. However, up to 1/3 of bystanders do not deliver CPR even when provided instructions. If the proportion of people who initiate CPR could be increased, lives would be saved. As a part of a larger project aimed at increasing rates of CPR, we conducted a qualitative study to identify call-handlers’ perceptions of the main barriers to CPR and what they think helps people to initiate CPR.MethodsSemi-structured qualitative interviews were conducted with 30 call-handlers from seven UK ambulance services, purposively selected to ensure diversity in terms of age, gender, years of experience, geographical location, population served (size/rurality), dispatch software used (MPDS and Pathways), published outcomes for ROSC and Care Quality Commission Rating.ResultsThirty call-handlers (19F, 10M, 1 non-binary; aged 22-59) participated. Participants had between 6mths and 25yrs experience and rated their confidence in providing CPR instructions between 3 and 10/10 (mean: 9). The barriers to CPR identified most commonly were the physical challenges of getting people flat on ground; the extreme emotional state of the caller and agonal breathing leading callers to believe that CPR was not required. Call-handlers described various techniques (some suggested by protocol and some not) used to encourage people to initiate/continue CPR. Data relating to the impact of pandemic-related pressures on call-handlers’ experiences of the role also emerged.ConclusionsProviding t-CPR instructions is a challenging but rewarding and valued aspect of call-handlers role. By synthesising the collective experience of a representative sample of call-handlers we have identified techniques used to overcome barriers to CPR initiation, many of which are consistent with behavioural theory. Additional opportunities to use behavioural techniques have been identified and will be developed in partnership with call-handlers.
Performance evaluation and clinical impact of the Oncomine Myeloid Research Assay for gene expression analysis in myeloid haematologic malignancies
Authors: Jeon Min Ji , Yu Eun Sang , Kim Dae Sik , Choi Chul Won , Kim Ha Nui , Ah Kwon Jeong , Yoon Soo-Young , Yoon Jung 
Published: August 2022

AimGene expression analysis facilitates the detection of diagnostic and prognostic biomarkers for myeloid haematological malignancies. The Oncomine Myeloid Research Assay (OMA; Thermo Fisher Scientific, Massachusetts, USA) provides a comprehensive analysis of gene expression of five target genes, along with gene alteration and fusion. Here, we present the performance of the OMA for gene expression analysis.MethodsIn total, 53 RNA samples from patients diagnosed with acute myeloid leukaemia (AML) or myelodysplastic syndrome were included. Of these 53 samples, 3 were evaluated for reproducibility and 50 were evaluated for comparison with RNA-sequencing (RNA-seq). The prognostic impact of the gene expression profile produced by both OMA and RNA-seq in AML was investigated using follow-up data from 33 patients with AML.ResultsThe OMA showed good intrarun and interrun reproducibility. Compared with the RNA-seq results, high correlations were found inBAALC,MECOMandWT1(all r>0.9), with moderate correlations inMYC(r=0.75, p<0.001) andSMC1A(r=0.42, p=0.002). The agreement between OMA and RNA-seq in classifying the dysregulated expression group was almost perfect, except forSMC1A(κ=0.175). Among these five genes, onlyBAALCshowed a significant clinical impact in patients with AML. Patients with highBAALCexpression showed significantly shorter overall survival based on both OMA (p=0.037) and RNA-seq (p=0.003).ConclusionsOMA gene expression analysis offers reproducible and accurate gene expression data for most targeted genes and demonstrates the utility ofBAALCexpression as a prognostic marker in AML.
Outcomes of stage IV melanoma in the era of immunotherapy: a National Cancer Database (NCDB) analysis from 2014 to 2016
Authors: Sussman Tamara A , Knackstedt Rebecca , Wei Wei , Funchain Pauline , Gastman Brian R 
Published: August 2022

BackgroundTo evaluate factors affecting the utilization of immunotherapy and to stratify results based on the approval of ipilimumab in 2011 and programmed death-1 inhibitors in 2014, an analysis of available data from the National Cancer Database (NCDB) was performed.MethodsThe NCDB was analyzed to identify patients with stage IV melanoma from 2004 to 2016. Patients were categorized during the time periods 2004–2010, 2011–2014, and 2015–2016. Overall survival (OS) was analyzed by Kaplan-Meier, log-rank, and Cox proportional hazard models; IO status was analyzed using logistic regression.Results24,544 patients were analyzed. Overall, 5238 patients (21.3%) who received IO had improved median OS compared with those who did not (20.2 months vs 7.4 months; p<0.0001). Between 2004 and 2010, 9.7% received immunotherapy; from 2011 to 2014, 21.9% received immunotherapy; and from 2015 to 2016, 43.5% received immunotherapy. Three-year OS significantly improved in patients treated with IO across treatment years: 31% (95% CI 29% to 34%) from 2004 to 2010, 35% (95% CI 33% to 37%) from 2011 to 2014, and 46% (95% CI 44% to 48%) from 2015 to 2016 (p<0.0001). Survival was worse in patients who did not receive IO during these treatment years: 16% (15%–17%), 21% (20%–22%), and 27% (25%–28%), respectively. In the overall cohort, age <65 years, female gender, private insurance, no comorbidities, residence in metropolitan area, and treatment at academic centers were associated with better OS (p<0.0001 for all). In the multivariate analysis, receipt of IO from 2015 to 2016 was associated with age <65 years (OR 1.27, 95% CI 1.08 to 1.50), African American race (OR 5.88, 95% CI 1.60 to 28.58), lack of comorbidities (OR 1.43, 95% CI 1.23 to 1.66), and treatment at academic centers (OR 1.44, 95% CI 1.26 to 1.65) (p<0.05 for all).ConclusionsOS improved in patients with stage IV melanoma receiving IO, with the highest OS rate in 2015–2016. Our findings, which represent a real-world population, are slightly lower than recent trials, such as KEYNOTE-006 and CheckMate 067. Significant socioeconomic factors may impact receipt of IO and survival.
Derivo embolization device for intracranial aneurysms: a Spanish multicenter retrospective study
Authors: Piñana Carlos , Remollo Sebastian , Zamarro Joaquín , Werner Mariano , Espinosa de Rueda Mariano , Vega Pedro , Hernandez David , Murias Eduardo , Rivera Eila , Olier Jorge , San Roman Luis , Páez-Carpio Alfredo , Requena Manuel , Aixut Sonia , de Dios Lascuevas Marta , Moreu Manuel , Rosati Santiago , Gramegna Laura Ludovica , Castaño Carlos , Tomasello Alejandro 
Published: August 2022

BackgroundFlow diverters have emerged in recent years as a safe and effective treatment for intracranial aneurysms, with expanding indications. The Derivo embolization device (DED) is a second-generation flow diverter with a surface finish that may reduce thrombogenicity. We report our multicenter experience evaluating its safety and efficacy.MethodsWe retrospectively analyzed all patients treated with the DED in eight centers in Spain between 2016 and 2020. Demographics, clinical data, procedural complications, morbidity and aneurysm occlusion rates were collected.ResultsA total of 209 patients with 250 aneurysms were treated (77.5% women). The majority of aneurysms were located in the internal carotid artery (86.8%) and most (69.2%) were small (<10 mm) with a median maximum diameter of 5.85 mm and median neck size of 4 mm. DED deployment was successful in all cases, despite two malfunctioning devices (1%). Major complications occurred in nine patients (4.3%), while mild neurologic clinical events were registered in 23 (11%); four patients died (1.9%). A total of 194 aneurysms had an angiographic follow-up at 6 months and showed complete aneurysm occlusion in 75% of cases. Twelve-month follow-up was available for 112 of the treated aneurysms, with a total occlusion rate of 83%.ConclusionThe DED is a second-generation surface-modified flow diverter that presents an option for treatment of intracranial aneurysms with comparable safety and efficacy to other available flow diverter devices. Nonetheless, risks are not negligible, and must be balanced against the natural history risk of cerebral aneurysms, considering the tendency to widen indications for treatment of smaller and less complex lesions in day-to-day use.