bluuebunny/crossref_metadata_2025_split huggingface dataset:
Towards PErsonalised PRognosis for children with traumatic brain injury: the PEPR study protocol
Authors: Kooper Cece C , Oosterlaan Jaap , Bruining Hilgo , Engelen Marc , Pouwels Petra J W , Popma Arne , van Woensel Job B M , Buis Dennis R , Steenweg Marjan E , Hunfeld Maayke , Königs Marsh 
Published: June 2022

IntroductionTraumatic brain injury (TBI) in children can be associated with poor outcome in crucial functional domains, including motor, neurocognitive and behavioural functioning. However, outcome varies between patients and is mediated by complex interplay between demographic factors, premorbid functioning and (sub)acute clinical characteristics. At present, methods to understand let alone predict outcome on the basis of these variables are lacking, which contributes to unnecessary follow-up as well as undetected impairments in children. Therefore, this study aims to develop prognostic models for the individual outcome of children with TBI in a range of important developmental domains. In addition, the potential added value of advanced neuroimaging data and the use of machine learning algorithms in the development of prognostic models will be assessed.Methods and analysis210 children aged 4–18 years diagnosed with mild-to-severe TBI will be prospectively recruited from a research network of Dutch hospitals. They will be matched 2:1 to a control group of neurologically healthy children (n=105). Predictors in the model will include demographic, premorbid and clinical measures prospectively registered from the TBI hospital admission onwards as well as MRI metrics assessed at 1 month post-injury. Outcome measures of the prognostic models are (1) motor functioning, (2) intelligence, (3) behavioural functioning and (4) school performance, all assessed at 6 months post-injury.Ethics and disseminationEthics has been obtained from the Medical Ethical Board of the Amsterdam UMC (location AMC). Findings of our multicentre prospective study will enable clinicians to identify TBI children at risk and aim towards a personalised prognosis. Lastly, findings will be submitted for publication in open access, international and peer-reviewed journals.Trial registration numberNL71283.018.19 and NL9051.
Determining whether ethnic minorities with severe obesity face a disproportionate risk of serious disease and death from COVID-19: outcomes from a Southern California-based retrospective cohort study
Authors: Patel Hemesh Mahesh , Khandwala Shefali , Somani Poonam , Li Qiaowu , Tovar Stephanie , Montano Alejandra 
Published: June 2022

ObjectiveObesity has been recognised as a risk factor for poor outcomes associated with COVID-19. Ethnic minorities with COVID-19 have been independently found to fare poorly. We aim to determine if ethnic minorities with severe obesity—defined as a body mass index (BMI) above 40 kg/m²—experience higher rates of hospitalisation, invasive ventilation and death.Design and settingRetrospective cohort study from 1 March 2020 to 28 February 2021 within an integrated healthcare organisation in Southern California.ParticipantsWe identified 373 831 patients by COVID-19 diagnosis code or positive laboratory test.MethodsMultivariable Poisson regression with robust error variance estimated adjusted risks of hospitalisation, invasive ventilator use and death within 30 days. Risks were stratified by ethnicity and BMI.ResultsWe identified multiple differences in risk of poor outcomes across BMI categories within individual ethnic groups. Hospitalisation risk with a BMI over 45 kg/m² was greater in Asian (RR 2.31, 95% CI 1.53 to 3.49; p<0.001), Hispanic (RR 3.22, 95% CI 2.99 to 3.48; p<0.001) and Pacific Islander (RR 3.79, 95% CI 2.49 to 5.75; p<0.001) patients compared with White (RR 2.04, 95% CI 1.79 to 2.33; p<0.001) and Black (RR 2.00, 95% CI 1.70 to 2.34; p<0.001) patients. A similar trend was observed with invasive ventilation risk. The risk of death was greater in Asian (RR 3.96, 95% CI 1.88 to 8.33; p<0.001), Hispanic (RR 3.03, 95% CI 2.53 to 3.61; p<0.001) and Pacific Islander (RR 4.60, 95% CI 1.42 to 14.92; p=0.011) patients compared with White (RR 1.47, 95% CI 1.13 to 1.91; p=0.005) and Black (RR 2.83, 95% CI 1.99 to 4.02; p<0.001) patients with a BMI over 45 kg/m².ConclusionsEthnic minorities with severe obesity, particularly Asian, Hispanic and Pacific Islander patients, had a statistically significant higher risk of hospitalisation, invasive ventilator use and death due to COVID-19. Potential explanations include differences in adipose tissue deposition, overall inflammation and ACE-2 receptor expression.
Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study
Authors: Heinonen Essi , Forsberg Lisa , Nörby Ulrika , Wide Katarina , Källén Karin 
Published: June 2022

ObjectiveTo investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy.DesignA population-based register study.SettingInformation on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants’ health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy.ParticipantsThe cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy.Outcome measuresThe primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities.ResultsOf the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy.ConclusionFetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies.
Effect of bortezomib on the treatment of multiple myeloma: a systematic review protocol
Authors: Cantadori Lucas Oliveira , Gaiolla Rafael Dezen , Nunes-Nogueira Vania dos Santos 
Published: June 2022

IntroductionMultiple myeloma (MM) is an incurable malignant neoplasm that accounts for approximately 1% of all cancers and 10% of haematological malignancies. Bortezomib is one of the most commonly used medications in first-line treatment and subsequent relapses, either as a single agent or in combination with other therapies. This study aims to assess the effects of bortezomib on the overall survival (OS), progression-free survival, overall response rate, time to next treatment, health-related quality of life, compliance, adverse events and treatment-related death in patients with MM.Methods and analysisWe have performed a systematic review and meta-analysis and will include both randomised and non-randomised controlled studies where the effect of bortezomib was compared in similar or dissimilar background therapies in each arm. General and adaptive search strategies have been created for the following electronic health databases: Embase, Medline, LILACS and CENTRAL. Two reviewers have independently selected eligible studies, will assess the risk of bias, and will extract data from the included studies. Similar outcomes will be plotted in the meta-analysis using the Stata Statistical Software V.17. The relative risk will be calculated with a 95% CI as the effect size of bortezomib. For the OS and progression-free survival, we calculate the overall OR from the HRs of each included study. Peto’s one-step OR will be calculated for event rates below 1%. We will use the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the certainty of evidence.Ethics and disseminationAs no primary data collection will be undertaken, formal ethical assessment is not required. We plan to present the results of this systematic review in a peer-reviewed scientific journal, conferences and popular press.PROSPERO registration numberCRD42020151142.
Objective performance of emergency medical technicians in the use of mechanical cardiopulmonary resuscitation compared with subjective self-evaluation: a cross-sectional, simulation-based study
Authors: Yang Wen-Shuo , Yen Ping , Wang Yao-Cheng , Chien Yu-Chun , Chie Wei-Chu , Ma Matthew Huei-Ming , Chiang Wen-Chu 
Published: June 2022

ObjectiveTo evaluate the subjective and objective resuscitation performance of emergency medical technicians (EMTs) using mechanical cardiopulmonary resuscitation (MCPR) devices.Design and settingThis was a cross-sectional simulation-based study where participants installed the MCPR device on a training manikin.ParticipantsWe assessed EMT-Intermediates (EMT-Is) and EMT-Paramedics (EMT-Ps) of the Emergency Medical Services (Ambulance) Division of the Taipei City Fire Department.Primary and secondary outcome measuresThe primary outcome was the gap between self-perceived (subjective) and actual (objective) no-flow time during resuscitation, which we hypothesised as statistically insignificant. The secondary outcome was the association between resuscitation performance and personal attributes like knowledge, attitude and self-confidence.ResultsAmong 210 participants between 21 and 45 years old, only six were female. There were 144 EMT-Is and 66 EMT-Ps. During a simulated resuscitation lasting between four and a half and 5 min, EMTs had longer actual no-flow time compared with self-perceived no-flow time (subjective, 38 s; objective, 57.5 s; p value<0.001). This discrepancy could cause a 6.5% drop of the chest compression fraction in a resuscitation period of 5 min. Among the EMT personal factors, self-confidence was negatively associated with objective MCPR deployment performance (adjusted OR (aOR) 0.66, 95% CI 0.45 to 0.97, p=0.033) and objective teamwork performance (aOR 0.57, 95% CI 0.34 to 0.97, p=0.037) for EMT-Ps, whereas knowledge was positively associated with objective MCPR deployment performance (aOR 2.15, 95% CI 1.31 to 3.52, p=0.002) and objective teamwork performance (aOR 1.77, 95% CI 1.02 to 3.08, p=0.043) for EMT-Is. Moreover, regarding the self-evaluation of no-flow time, both self-satisfaction and self-abasement were associated with objectively poor teamwork performance.ConclusionsEMTs’ subjective and objective performance was inconsistent during the MCPR simulation. Self-confidence and knowledge were personal factors associated with MCPR deployment and teamwork performance. Both self-satisfaction and self-abasement were detrimental to teamwork during resuscitation.
Improving mealtimes for patients and staff within an eating disorder unit: the next chapter
Authors: Gardner Lucy , Tillier Kirstie , Marshall-Tyson Kayda , Trueman Hayley , Hunt David Francis 
Published: June 2022

ObjectivesMealtimes are an integral part of treatment for patients in an eating disorder inpatient unit. However, they are often distressing and anxiety provoking for both patients and staff. A consequence of patients’ distress is an increase in eating disorder behaviours specific to mealtimes. This is the second paper detailing a quality improvement project following on from an initial paper outlining the first test of change. The aim of this quality improvement project was to decrease the number of eating disorder behaviours at mealtimes in the dining room through the implementation of interventions identified through diagnostic work.Methods/designThe Model for Improvement was used as the systematic approach for this project. Baseline assessment included observations in the dining room, gathering of qualitative feedback from staff and patients and the development of a form which identifies eating disorder behaviours completed by staff. Interventions in the form of three change ideas have so far been introduced including (1) a host role in the dining room, (2) a guide to the dining room for new staff along with competencies and (3) a dining goals group. The impact of the three interventions is assessed.ResultsThe introduction of the interventions has overall reduced the average number of eating disorder behaviours per patient in the dining room by 33%.ConclusionsThis paper reports the challenges and successes of continuing a QI project through the COVID-19 pandemic and the need for multiple tests of change to improve a complex problem. The results demonstrate a consistent reduction in eating disorder behaviours over a period of nearly 2 years.
Predictors of liver cirrhosis and hepatocellular carcinoma among perioperative survivors of the Fontan operation
Authors: Inuzuka Ryo , Nii Masaki , Inai Kei , Shimada Eriko , Shinohara Tokuko , Kogiso Tomomi , Ono Hiroshi , Otsuki Shin-ichi , Kurita Yoshihiko , Takeda Atsuhito , Hirono Keiichi , Takei Kota , Yasukohchi Satoshi , Yoshikawa Tadahiro , Furutani Yoshiyuki , Shinozaki Tomohiro , Matsuyama Yutaka , Senzaki Hideaki , Tokushige Katsutoshi , Nakanishi Toshio 
Published: June 2022

ObjectiveFontan-associated liver disease (FALD) is widely recognised as a common complication in patients long after the Fontan operation. However, data on the predictors of FALD that can guide its screening and management are lacking. The present study aimed to identify the predictors of liver cirrhosis (LC) and hepatocellular carcinoma (HCC) in post-Fontan patients.MethodsThis was a multi-institutional retrospective cohort study. Clinical data of all perioperative survivors of Fontan operation before 2011 who underwent postoperative catheterisation were collected through a retrospective chart review.ResultsA total of 1117 patients (538 women, 48.2%) underwent their first Fontan operation at a median age of 3.4 years. Postoperative cardiac catheterisation was conducted at a median of 1.0 year. During a median follow-up period of 10.3 years, 67 patients (6.0%) died; 181 (16.2%) were diagnosed with liver fibrosis, 67 (6.0%) with LC, 54 (4.8%) with focal nodular hyperplasia and 7 (0.6%) with HCC. On multivariable analysis, high central venous pressure (CVP) (HR, 1.28 (95% CI 1.01 to 1.63) per 3 mm Hg; p=0.042) and severe atrioventricular valve regurgitation (HR, 6.02 (95% CI 1.53 to 23.77); p=0.010) at the postoperative catheterisation were identified as independent predictors of LC/HCC.ConclusionsPatients with high CVP and/or severe atrioventricular valve regurgitation approximately 1 year after the Fontan operation are at increased risk of developing advanced liver disease in the long term. Whether therapeutic interventions to reduce CVP and atrioventricular valve regurgitation decrease the incidence of advanced liver disease requires further elucidation.
Mortality and cancer incidence among female Australian firefighters
Authors: Glass Deborah Catherine , Del Monaco Anthony , Pircher Sabine , Vander Hoorn Stephen , Sim Malcolm Ross 
Published: June 2022

ObjectivesTo investigate the mortality and cancer incidence of female firefighters, a group where there are limited published findings.MethodsParticipating fire agencies supplied records of individual firefighters including the number and type of incidents attended. The cohort was linked to the Australian National Death Index and Australian Cancer Database. Standardised mortality ratios and standardised cancer incidence ratios were calculated separately for paid and volunteer firefighters. Volunteer firefighters were grouped into tertiles by the duration of service and by a number of incidents attended and relative mortality ratios and relative incidence ratios calculated.ResultsFor volunteer firefighters (n=37 962), the overall risk of mortality and risk from all major causes of death were reduced when compared with the general population whether or not they had ever attended incidents. Volunteer firefighters had a similar cancer incidence when compared with the general population for most major cancer categories. Female volunteer firefighters have usually attended few fires. Of those who had turned out to incidents, only one-third had attended more than 12 fires about half the number for male volunteers. Mortality and cancer incidence for paid female firefighters (n=1682) were similar to the general population but the numbers were small and so power was limited.ConclusionsFemale volunteer firefighters have a cancer incidence similar to the general population but a reduced risk of mortality which is likely to be a result of a ‘healthy volunteer’ effect.Most of the paid female firefighters were relatively recent recruits and it will be important to monitor the health of this group as more women are recruited to front-line firefighting roles.
Changes in common mental disorders and diagnosis-specific sickness absence: a register-linkage follow-up study among Finnish municipal employees
Authors: Mauramo Elina , Lahti Jouni , Lallukka Tea , Lahelma Eero , Pietiläinen Olli , Rahkonen Ossi 
Published: June 2022

ObjectiveThis study examined the associations between changes in common mental disorders (CMD) and subsequent diagnosis-specific sickness absence (SA) among midlife and ageing municipal employees.MethodsData from the Helsinki Health Study phase I (2000–2002) and phase II (2007) surveys among employees of the City of Helsinki, Finland, were linked with prospective register data from the Social Insurance Institution of Finland on diagnosis-specific (mental, musculoskeletal, other causes) SA (n=3890). Associations between change in CMD (General Health Questionnaire 12) from phase I to phase II and the first SA event in 2007–2014 were analysed using Cox regression modelling. Sociodemographic, work and health-related covariates from phase I, and SA from the year preceding phase I were controlled for.ResultsHaving CMD at one or two time points, that is, favourable and unfavourable change in CMD and repeated CMD, were all associated with a higher risk of SA due to mental, musculoskeletal and other diagnoses compared with women and men with no CMD. Favourable change in CMD reduced the risk of SA when compared with repeated CMD. The strongest associations were observed for repeated CMD (HR range: 1.44 to 5.05), and for SA due to mental diagnoses (HR range: 1.15 to 5.05). The associations remained after adjusting for the covariates.ConclusionsChanging and repeated CMD increased the risk of SA due to mental, musculoskeletal and other diagnoses. CMD should be tackled to prevent SA and promote work-ability among ageing employees.
Rawlsian reasoning about fairness at the end of life
Authors: Lynøe Niels , Engström Ingemar , Juth Niklas 
Published: June 2022

ObjectivesThe aim of this study was to discuss end-of-life care in the context of Rawls’ and Daniels’ philosophy of justice. The study is based on an empirical survey of Swedish physicians who were asked whether they would want the option of physician-assisted suicide (PAS) for themselves (hereafter called own preferences), what are their attitudes towards PAS in general and whether they were prepared to prescribe PAS drugs to eligible patients. The question is to what extent the physicians’ answers are impartial and consistent in a Rawlsian sense.MethodsThe underlying indicator was the physicians’ own preferences. Kappa score inter-rater agreement was measured between that response and that same physician’s general attitude towards allowing PAS and preparedness to prescribe PAS drugs. The coherence of provided comments and arguments were analysed using content analysis.ResultsPalliative care physicians are the least willing to offer PAS, and surgeons and psychiatrist the most willing. There is a discrepancy between physicians’ general attitudes about allowing PAS, their own wishes to be offered PAS at the end of life and the concrete action of prescribing PAS drugs. Arguments given for not prescribing PAS by those in favour of PAS are seemingly but not truly inconsistent.ConclusionsThose supporting PAS provided impartial and consistent arguments for their stances in a Rawlsian sense, while those against PAS provided partial arguments. Two specialties, psychiatrists and palliative care physicians, were coherent in their reasoning about PAS for themselves and their willingness to prescribe the needed drugs.
Assisted dying request assessments by trained consultants: changes in practice and quality - Repeated cross-sectional surveys (2008–2019)
Authors: Vissers Stijn , Dierickx Sigrid , Chambaere Kenneth , Deliens Luc , Mortier Freddy , Cohen Joachim 
Published: June 2022

ObjectivesTo study changes in the peer consultation practice of assessing assisted dying requests and its quality among trained ‘Life End Information Forum’ (LEIF) consultants in Belgium between 2008 and 2019.MethodsCross-sectional surveys conducted in 2008 (N=132) and 2019 (N=527) among all registered LEIF consultants.ResultsThe response rate was 75% in 2008 and 57% in 2019. In 2019 compared with 2008, more LEIF consultants were significantly less than 40 years old (25%/10%, p=0.006) and at least 60 years old (34%/20%, p=0.006). In their activities regarding assessments of assisted dying requests over 12 months, we found a significant increase in the number of patients who did not meet the substantive requirements for assisted dying in 2019 compared with 2008 (1–4 patients: 41.1 %/58.8%, p=0.020). In their most recent assessments of an assisted dying request, LEIF consultants in 2019 made significantly more assessments of patients aged 80 years or older than in 2008 (31%/9%, p<0.001), and significantly fewer assessments for patients with cancer (53%/70%, p=0.034). Regarding adherence to quality criteria for consultation, LEIF consultants discussed unbearable suffering (87%/65%, p=0.003) and alternative treatments (palliative: 48 %/13%, p<0.001; curative: 28%/5%, p=0.002) significantly more often with the attending physician.ConclusionsChanges in peer consultation practice and its quality among LEIF consultants likely reflect changes in assisted dying practice in general, as well as changes in LEIF consultations on more complex cases for which LEIF consultants’ expertise is required.