Do young people get the mental healthcare they need? Trajectories of depressive symptoms, correlates and care pathways in a clinical sample of young people reaching the upper age limit of their CAMHS.

Identifying young service users whose depressive symptoms persist into adulthood is crucial to avert potential difficulties they may face when transitioning from Child and Adolescent Mental Healthcare Services (CAMHS) to Adult Mental Healthcare Services (AMHS). As depressive symptoms are diverse in severity and stability, it is important to objectively identify those who require continued support. A clinical cohort of 763 young people from eight European countries, reaching the upper age limit of their CAMHS, was studied to identify trajectories of self-reported depressive problems (ASEBA Youth Self-Report and Adult Self-Report) over a 24-month follow-up period, as well as associated risk factors for persistent depression and service use, using growth mixture modeling.

Fetal and Infant Growth and the Cardiovascular Stress Response in Adolescence: A Cardiovascular Magnetic Resonance Imaging Study in a Pediatric Population-Based Cohort.

Background: Abnormal birth weight and infant weight gain are recognized as risk factors for cardiovascular diseases. Underlying mechanisms remain unclear. Exercise testing can detect subtle differences in cardiovascular function not present at rest.

Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trial.

Unlabelled: Clinical decision support systems (CDSSs) have been developed to give guidance for referring physicians to make appropriate decisions at the point of care. The MIDAS study, a multicenter cluster randomized trial at four German university hospitals, was designed to evaluate the effectiveness of a CDSS for imaging referral (ESR iGuide) in routine clinical care. Based on our experience within the MIDAS study, we aim to describe the hurdles and difficulties, as well as the various insights gained, in the process of implementing a CDSS in a clinical and research setting.

Hair Cortisone Levels and the Metabolic Syndrome: Stronger Links in Younger Compared to Older Adults.

Background: The striking link between Cushing's syndrome, the metabolic syndrome (MetS), and cardiovascular disease suggests that long-term exposure to high glucocorticoid levels catalyzes cardiometabolic deterioration. However, the relation of subtle variations in long-term glucocorticoid levels with MetS remains poorly understood. Specifically, little is known about potential moderating roles of age, sex and mental health status in this association.

Personalized Biopsy Schedules Using an Interval-Censored Cause-Specific Joint Model.

Active surveillance (AS), where biopsies are conducted to detect cancer progression, has been acknowledged as an efficient way to reduce the overtreatment of prostate cancer. Most AS cohorts use fixed biopsy schedules for all patients. However, the ideal test frequency remains unknown, and the routine use of such invasive tests burdens the patients.

Risk-Profile Based Monitoring Intervals for Multivariate Longitudinal Biomarker Measurements and Competing Events With Applications in Stable Heart Failure.

Patient monitoring is routinely used to detect disease aggravation in many chronic conditions. We propose an adaptive scheduling strategy based on dynamic individual risk predictions that can improve the efficiency of monitoring programs that incorporate multiple longitudinal measurements and competing events. It is motivated by stable chronic heart failure (CHF) patients who are periodically seen to assess the risk of disease aggravation based on multiple patient characteristics and circulating marker protein levels such as NT-proBNP and troponin.

A Joint Model for (Un)Bounded Longitudinal Markers, Competing Risks, and Recurrent Events Using Patient Registry Data.

Joint models for longitudinal and survival data have become a popular framework for studying the association between repeatedly measured biomarkers and clinical events. Nevertheless, addressing complex survival data structures, especially handling both recurrent and competing event times within a single model, remains a challenge. This causes important information to be disregarded.

Low-Strip Dorsal Preservation Rhinoplasty Opens the Internal Nasal Valve in Tension Nose Deformity.

Background: Dorsal preservation is a recently popularized technique to lower the nasal dorsum without opening the cartilaginous vault. Improved nasal breathing has been reported after lowering an intact dorsum using preservation techniques, suggesting that septal deprojection opens the internal nasal valves. The goal of this study was to evaluate the effect of dorsal preservation on internal nasal valve dimensions in noses with an overprojected cartilaginous septum.

Evaluation of a Clinical Decision Support System for Imaging Requests: A Cluster Randomized Clinical Trial.

Importance: Given the widespread use of medical imaging, evaluating the effectiveness of interventions to improve appropriateness is crucial for optimizing health care resources and patient outcomes.

Objective: To assess the effects of implementing a clinical decision support system (CDSS), the European Society of Radiology iGuide, on the appropriateness of the medical imaging ordering behavior of physicians.

Design And Setting: A cluster randomized clinical trial with 26 departments at 3 German university hospitals acting as clusters, incorporating a before and after discontinued design.

Extremely asymmetric ectasia: Tomographically unilateral keratoconus.

Purpose: To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC).

Methods: In this retrospective case-control study, strict unilaterality criteria were applied to select tomographically unilateral cases with ≥3 years of follow-up. For comparison, a healthy cohort and two bilateral KC cohorts were matched to the tomographically unilateral cases.

Opt-In versus opt-out for the secondary use of routinely recorded health data: A randomized controlled trial.

Importance: Optimal data availability for secondary use is crucial for continuous improvement in healthcare. At the same time, it is imperative to uphold patients' rights to be informed, to control the use of their health data and to protect their privacy. To balance these two needs, we investigated which consent procedure (opt-in or opt-out) would be most supportive of data availability.

Projected outcomes of reduced-biopsy management of Grade Group 1 prostate cancer: implications for relabeling.

Background: Implications of relabeling Grade Group 1 prostate cancer as noncancer will depend on the recommended active surveillance strategy. Whether relabeling should prompt deintensifying, prostate-specific antigen (PSA)-based active monitoring approaches is unclear. We investigated outcomes of biopsy-based active surveillance strategies vs PSA-based active monitoring for Grade Group 1 diagnoses under different patient adherence rates.

Effectiveness of Transitional Care in Inflammatory Bowel Disease; Development, Validation, and Initial Outcomes of a Transition Success Score.

Background And Aims: The effectiveness of transition programs from pediatric to adult healthcare in adolescents with inflammatory bowel disease (IBD) is not clear, as prospective studies using validated outcome measures for transition are lacking. This study aimed to develop and validate a quantitative Transition Success Score (TSS), and to apply it in a multicenter setting to assess the effectiveness of transitional care.

Methods: The Top 10 outcome items related to a successful transition, identified through an international Delphi study with IBD stakeholders, were integrated into a generic questionnaire, the TSS.

Regional aortic wall shear stress increases over time in patients with a bicuspid aortic valve.

Background: Aortic wall shear stress (WSS) is a known predictor of ascending aortic growth in patients with a bicuspid aortic valve (BAV). The aim of this study was to study regional WSS and changes over time in BAV patients.

Methods: BAV patients and age-matched healthy controls underwent four-dimensional (4D) flow cardiovascular magnetic resonance (CMR).

Randomised clinical trial: First-line infliximab biosimilar is cost-effective compared to conventional treatment in paediatric Crohn's disease.

Background: Data on cost-effectiveness of first-line infliximab in paediatric patients with Crohn's disease are limited. Since biologics are increasingly prescribed and accompanied by high costs, this knowledge gap needs to be addressed.

Aim: To investigate the cost-effectiveness of first-line infliximab compared to conventional treatment in children with moderate-to-severe Crohn's disease.

The Rhinoplasty Rosetta Stone: Using Rasch Analysis to Create and Validate Crosswalks between the NOSE and the SCHNOS Functional Subscale.

Background: The Nasal Obstruction Symptom Evaluation (NOSE) and the Functional subscale of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS-O) are widely used patient-reported outcome measures to measure functional outcomes of rhinoplasty. However, as different instruments produce scores on different metrics, results of these instruments cannot be linked directly, thus hindering comparison and aggregating of rhinoplasty outcome data from practices using either instrument. The aim of this study was to develop and validate crosswalks between the NOSE and the SCHNOS-O.

Using joint models for longitudinal and time-to-event data to investigate the causal effect of salvage therapy after prostatectomy.

Prostate cancer patients who undergo prostatectomy are closely monitored for recurrence and metastasis using routine prostate-specific antigen measurements. When prostate-specific antigen levels rise, salvage therapies are recommended in order to decrease the risk of metastasis. However, due to the side effects of these therapies and to avoid over-treatment, it is important to understand which patients and when to initiate these salvage therapies.

Exploring the relation of active surveillance schedules and prostate cancer mortality.

Background: Active surveillance (AS), where treatment is deferred until cancer progression is detected by a biopsy, is acknowledged as a way to reduce overtreatment in prostate cancer. However, a consensus on the frequency of taking biopsies while in AS is lacking. In former studies to optimize biopsy schedules, the delay in progression detection was taken as an evaluation indicator and believed to be associated with the long-term outcome, prostate cancer mortality.

Establishing how much improvement in lung function and distance walked is clinically important for adult patients with Pompe disease.

Background And Purpose: Pompe disease is a rare, inheritable, progressive metabolic myopathy. This study aimed to estimate the minimal clinically important difference (MCID) for an improvement in forced vital capacity in the upright seated position (FVC) and the 6-min walk test (6MWT) after a year of treatment with enzyme replacement therapy.

Methods: Data were obtained from two prospective follow-up studies.

Optimizing dynamic predictions from joint models using super learning.

Joint models for longitudinal and time-to-event data are often employed to calculate dynamic individualized predictions used in numerous applications of precision medicine. Two components of joint models that influence the accuracy of these predictions are the shape of the longitudinal trajectories and the functional form linking the longitudinal outcome history to the hazard of the event. Finding a single well-specified model that produces accurate predictions for all subjects and follow-up times can be challenging, especially when considering multiple longitudinal outcomes.

Machine learning-based biomarker profile derived from 4210 serially measured proteins predicts clinical outcome of patients with heart failure.

Aims: Risk assessment tools are needed for timely identification of patients with heart failure (HF) with reduced ejection fraction (HFrEF) who are at high risk of adverse events. In this study, we aim to derive a small set out of 4210 repeatedly measured proteins, which, along with clinical characteristics and established biomarkers, carry optimal prognostic capacity for adverse events, in patients with HFrEF.

Methods And Results: In 382 patients, we performed repeated blood sampling (median follow-up: 2.