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Temporal trends and practice variation of paediatric diagnostic tests in primary care:retrospective analysis of 14 million tests

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Family Medicine and Community Health 2024年第4期12卷 1-8页

作者： Elizabeth T Thomas Diana R Withrow Cynthia Wright Drakesmith Peter J Gill Rafael Perera-Salazar Carl Heneghan Centre for Evidence-Based Medicine Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK Nuffield department of primary care Health Sciences University of OxfordOxfordUK department of Pediatrics University of TorontoTorontoOntarioCanada Hospital for Sick Children TorontoOntarioCanada

Objective The primary objective was to investigate temporal trends and between-practice variability of paediatric test use in primary *** and analysis This was a descriptive study of population-based data from Clinical Practice Research Datalink Aurum primary care consultation records from 1 January 2007 to 31 December *** aged 0–15 who were registered to one of the eligible 1464 general practices and had a diagnostic test code in their clinical record were *** primary outcome measures were(1)temporal changes in test rates measured by the average annual percent change,stratified by test type,gender,age group and deprivation level and(2)practice variability in test use,measured by the coefficient of *** 14299598 diagnostic tests were requested over 27.8 million child-years of observation for 2542101 *** test use increased by 3.6%/year(95%CI 3.4 to 3.8%)from 399/1000 child-years to 608/1000 child-years,driven by increases in blood tests(8.0%/year,95%CI 7.7 to 8.4),females aged 11–15(4.0%/year,95%CI 3.7 to 4.3),and children from the most socioeconomically deprived group(4.4%/year,95%CI 4.1 to 4.8).Tests subject to the greatest temporal increases were faecal calprotectin,fractional exhaled nitric oxide and vitamin *** classified as high-use and high-practice variability were iron studies,coeliac testing,vitamin B12,folate,and vitamin *** In this first nationwide study of paediatric test use in primary care,we observed significant temporal increases and practice variability in *** reflects inconsistency in practice and diagnosis rates and a scarcity of evidence-based *** test use generates more clinical activity with significant resource implications but conversely may improve clinical *** research should evaluate whether increased test use and variability are warranted by exploring test indications and test results and directly examine how increased test use impacts

关键词： vitamin nationwide stratified

Pregnancy stressors and postpartum symptoms of depression and anxiety:the moderating role of a cognitivebehavioural therapy(CBT)intervention

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General Psychiatry 2024年第1期37卷 112-121页

作者： Yunxiang Sun Soim Park Abid Malik Najia Atif Ahmed Zaidi Atif Rahman Pamela J Surkan department of International Health Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA department of Public Mental Health Health Services AcademyIslamabadPakistan Human Development Research Foundation RawalpindiPakistan department of primary care and Mental Health Institute of Population HealthUniversity of LiverpoolLiverpoolUK

Background Little is known about the association between stressors(especially positive stressors)during pregnancy and postpartum depression and *** We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive behavioural therapy(CBT)had a regulatory *** Participants were 621 pregnant Pakistani women with mild *** the Pregnancy Experience Scale-Brief Version,six scores were created to assess positive and negative *** performed a multivariate linear regression to examine whether these six scores,measured both at baseline and in the third trimester,were associated with postpartum anxiety and depressive *** effect of the intervention on this relationship was examined by adding an interaction term to the regression *** Hassles frequency measured in the third trimester was positively associated with depression(B=0.22,95%confidence interval(Cl):0.09 to 0.36)and anxiety(B=0.19,95%Cl:0.08to 0.30).At the same timepoint,uplifts intensity was negatively associated with symptoms of depression(B=-0.82,95%Cl:1.46 to-0.18)and anxiety(B=-0.70,95%Cl:-1.25 to-0.15),whereas hassles intensity was positively related to symptoms of depression(B=1.02,95%Cl:0.36 to 1.67)and anxiety(B=0.90,95%Cl:0.34 to 1.47).The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression(B=1.40,95%Cl:0.59 to 2.20)and anxiety(B=1.26,95%Cl:0.57 to 1.96).The intervention strengthened the overall positive effects of uplfts and the negative effects of *** experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health *** Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms

关键词： postpartum stress behaviour

Metabolic disorders and hepatitis: Insights from a Mendelian randomization study

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1775-1790页

作者： Ling-Bo Liang Xiang-Ping Liu Ting-Rui Mao Qiao-Li Su General Practice Ward General Practice Medical CenterWest China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina department of primary Health care The Fourth People’s Hospital of Dazhu CountyDazhou 635100Sichuan ProvinceChina

BACKGROUND Hepatitis is a systemic disease that often results in various ***-bolic disorders,the most common comorbidities in clinical practice,were selected for this *** To investigate the causal relationship between comorbidities and hepatitis trea-tment *** A total of 23583378 single nucleotide polymorphisms from 1248743 cases and related summaries of genome-wide association studies were obtained from online public databases.A two-sample Mendelian randomization(MR)was performed to investigate causality between exposure[type 2 diabetes mellitus(T2D),hyperlipidemia,and hypertension]and outcome(chronic hepatitis B or C in-fections).RESULTS The data supported the causal relationship between comorbidities and hepatitis infections,which will affect the severity of hepatitis progression and will also provide a reference for clinical *** three exposures showed a link with progression of both hepatitis B(T2D,P=0.851;hyperlipidemia,P=0.596;and hypertension,P=0.346)and hepatitis C(T2D,P=0.298;hyperlipidemia,P=0.141;and hypertension,P=0.035).CONCLUSION The results of MR support a possible causal relationship between different ex-posures(T2D,hyperlipidemia,and hypertension)and chronic hepatitis progression;however,the potential mechanisms still need to be elucidated.

关键词： Hepatitis Comorbidity Type 2 diabetes mellitus Hyperlipidemia Hypertension

Origin and age group of the fastest amateur triathletes competing in ‘Ironman Hawaii’ between 2003 and 2019

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Sports Medicine and Health Science 2024年第1期6卷 70-75页

作者： Paulo Puccinelli Arthur Narloch Sacchelli Aldo Seffrin Beat Knechtle Katja Weiss Marilia Santos Andrade department of Physiology Federal University of Sao PauloBrazil Federal University of Santa Catarina Brazil Medbase St.Gallen Am Vadianplatz St.GallenSwitzerland Institute of primary care University of ZurichZurichSwitzerland

Little is known about the prevalent nationalities among the best-placed athletes participating in“Ironman Hawaii.”Moreover,the age at which athletes achieve their best performances remains *** present study aimed to compare the prevalent nationalities among the athletes,their respective placement among the top five,and the performance difference between the different age groups in‘Ironman Hawaii’from 2003 to 2019.A total of 30354 amateur triathletes were selected from the Obsessed Triathlete(OBSTRI)website.A“TOP 5”division filter was applied for further analysis,resulting in 1851 athletes being included in this *** the male runners,Americans participated the most in Ironman events(39%),followed by Germans(10%).Among female runners,Americans participated the most(54%),followed by Australian runners(8%).Male Americans also featured most among the top five(30%),followed by Germans(16%).Female Americans were the most prevalent among the top five(47%),followed by Australian Americans(10%).There were no significant performance differences(p>0.05)between the 25–29 and 40–44 age groups for either *** 45–49 age group presented significantly worse performance than the 35–39 age group for both sexes(p<0.001).North Americans were the most performant and frequent participants in“Ironman Hawaii.”The expected performance decline due to aging was observed after 45 years in both sexes.

关键词： Aging Cycling Endurance Performance Running Swimming Triathlon

Extracorporeal membrane oxygenation as a bridging therapy for patients with thiamine deficiency-induced pulmonary arterial hypertension

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World Journal of Emergency Medicine 2024年第2期15卷 147-149页

作者： Fangfang Qiu Weixing Dai Tengyue Huang Min Li department of Intensive care Unit the Fourth Affiliated Hospital of Zhejiang University School of MedicineYiwu 322000China department of Intensive care Unit the Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou 310009China

Thiamine deficiency is characterized by a deficiency of thiamine(vitamin B1),lactic acidosis,pulmonary arterial hypertension(PAH),right-sided heart failure,and peripheral nerve *** deficiency is easily misdiagnosed and missed during clinical practice and is associated with death in severe cases.[1,2]Here we reported a patient who was admitted to the hospital with severe metabolic acidosis and pulmonary hypertension and finally diagnosed with thiamine deficiency by detecting plasma vitamin B1 *** clinically obvious thiamine deficiency is rare,and cases of thiamine deficiency requiring extracorporeal membrane oxygenation(ECMO)treatment are rarer,we believe that our case will be helpful for emergency clinicians.

关键词： vitamin hypertension arterial

Nasogastric tube syndrome:A Meta-summary of case reports

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World Journal of Clinical Cases 2024年第1期12卷 119-129页

作者： Deven Juneja Prashant Nasa Gunjan Chanchalani Ravi Jain department of Critical care Medicine Max Super Speciality HospitalNew Delhi 110017India department of Critical care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates department of Critical care Medicine Karamshibhai Jethabhai Somaiya Hospital and Research CentreMumbai 400022India department of Critical care Medicine Mahatma Gandhi Medical College and HospitalJaipur 302022RajasthanIndia

BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral ***,the risks associated with its placement are often *** airway obstruction with a NGT is an uncommon but potentially life-threatening *** syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually *** is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway ***,fewer cases may have been reported than might have occurred,primarily due to the clinicians'*** lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite *** To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway *** We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://***/)and Google scholar,from all the past studies till August *** search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further *** Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our *** was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 *** patients had diabetes mellitus(37.04%),and nine were hyperte

关键词： Nasogastric tube Nasogastric tube syndrome Ryle’s tube Sofferman syndrome Vocal cord paralysis

GLI1 and PTTG1 expression in colorectal carcinoma patients undergoing radical surgery and their correlation with lymph node metastasis

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1328-1335页

作者： Feng Cao Yang-Yan Chen Hong-Cheng Wang department of care Section Beijing Geriatric HospitalBeijing 100095China Research department Shanghai Zhangjiang Institute of Medical InnovationShanghai 200000China care department Beijing Geriatric HospitalBeijing 100095China

BACKGROUND Few studies have investigated the expression of GLI1 and PTTG1 in patients undergoing radical surgery for colorectal carcinoma(CRC)and their association with lymph node metastasis(LNM).Therefore,more relevant studies and analyses need to be *** To explore GLI1 and PTTG1 expression in patients undergoing radical surgery for CRC and their correlation with *** This study selected 103 patients with CRC admitted to our hospital between April 2020 and April *** specimens of CRC and adjacent tissues were collected to determine the positive rates and expression levels of GLI1 and *** correlation of the two genes with patients’clinicopathological data(e.g.,LNM)was explored,and differences in GLI1 and PTTG1 expression between patients with LNM and those without were *** operating characteristic(ROC)curves were plotted to evaluate the predictive potential of the two genes for LNM in patients with *** Significantly higher positive rates and expression levels of GLI1 and PTTG1 wereobserved in CRC tissue samples compared with adjacent ***1 and PTTG1 were strongly linked to LNM in patients undergoing radical surgery for CRC,with higher GLI1 and PTTG1 levels found in patients with LNM than in those *** areas under the ROC curve of GLI1 and PTTG1 in assessing LNM in patients with CRC were 0.824 and 0.811,*** GLI1 and PTTG1 expression was upregulated in patients undergoing radical surgery for CRC and are significantly related to LNM in these ***,high GLI1 and PTTG1 expression can indicate LNM in patients with CRC undergoing radical *** expression of both genes has certain diagnostic and therapeutic significance.

关键词： Colorectal carcinoma GLI1 PTTG1 Radical resection Lymph node metastasis

Machine learning applications in stroke medicine:advancements,challenges,and future prospectives

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Neural Regeneration Research 2024年第4期19卷 769-773页

作者： Mario Daidone Sergio Ferrantelli Antonino Tuttolomondo Internal Medicine and Stroke care Ward Department of Health PromotionMother and Child CareInternal Medicine and Medical SpecialtiesUniversity of Palermo Molecular and Clinical Medicine PhD Program University of Palermo

Stroke is a leading cause of disability and mortality worldwide,necessitating the development of advanced technologies to improve its diagnosis,treatment,and patient *** recent years,machine learning techniques have emerged as promising tools in stroke medicine,enabling efficient analysis of large-scale datasets and facilitating personalized and precision medicine *** abstract provides a comprehensive overview of machine learning’s applications,challenges,and future directions in stroke *** introduced machine learning algorithms have been extensively employed in all the fields of stroke *** learning models have demonstrated remarkable accuracy in imaging analysis,diagnosing stroke subtypes,risk stratifications,guiding medical treatment,and predicting patient *** the tremendous potential of machine learning in stroke medicine,several challenges must be *** include the need for standardized and interoperable data collection,robust model validation and generalization,and the ethical considerations surrounding privacy and *** addition,integrating machine learning models into clinical workflows and establishing regulatory frameworks are critical for ensuring their widespread adoption and impact in routine stroke *** learning promises to revolutionize stroke medicine by enabling precise diagnosis,tailored treatment selection,and improved *** research and collaboration among clinicians,researchers,and technologists are essential for overcoming challenges and realizing the full potential of machine learning in stroke care,ultimately leading to enhanced patient outcomes and quality of *** review aims to summarize all the current implications of machine learning in stroke diagnosis,treatment,and prognostic *** the same time,another purpose of this paper is to explore all the future perspectives these techniques can provide in combating this disabling dis

关键词： cerebrovascular disease deep learning machine learning reinforcement learning stroke stroke therapy supervised learning unsupervised learning

Bibliometric study of sepsis-associated liver injury from 2000 to 2023

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World Journal of Gastroenterology 2024年第30期30卷 3609-3624页

作者： Zheng Zhang Xiao-Jiao Tan Hai-Qing Shi Huan Zhang Jian-Bo Li Xue-Lian Liao department of Critical care Medicine West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina department of Critical care Medicine West China Tianfu Hospital of Sichuan UniversityChengdu 610200Sichuan ProvinceChina

BACKGROUND Sepsis-associated liver injury(SLI)is a severe and prevalent complication of *** To explore the literature on SLI via a bibliometric *** Reviews and articles correlated with SLI published from January 1,2000 to October 28,2023 were searched from the Web of Science Core ***,the searched data were analyzed using VOSviewer,CiteSpace,and R *** There were 787 publications involved in this paper,comprising 745 articles and 42 ***,the United States,and Germany are the primary publication sources in this *** related to SLI primarily focused on mechanisms of pathogenesis,as evidenced by analyzing keywords,references,and the counting of original *** studies mainly involved tumor necrosis factor alpha,inflammation,oxidative stress,and nuclear factor-kappa *** There is significant growth in the research on *** investigations primarily involve basic experiments that aimed at uncovering pathogenic *** to the analyzed literature,the identified pathogenic mechanisms and potential therapeutic targets serve as the foundation for translating findings from basic research to clinical applications.

关键词： Sepsis Liver injury Bibliometric analysis Cite space VOS viewer