bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicopathological factors affecting the effect of neoadjuvant chemotherapy in patients with gastric cancer
Authors: Jiang Lin , Ma Zhiqiang , Ye Xin , Kang Weiming , Yu Jianchun
Published: January 2021

Background: Neoadjuvant chemotherapy is an important part of the comprehensive treatment of advanced gastric cancer (GC). The effect of neoadjuvant chemotherapy plays a key role in the prognosis of GC patients. Pathological response can represent the effect of neoadjuvant chemotherapy. However, evidence focused on pathological response and associated clinicopathological factors in GC patients is quite little. In this retrospective study, the clinicopathological factors affecting the effect of neoadjuvant chemotherapy in GC patients were investigated, and suggestions were proposed to improve the effect of neoadjuvant chemotherapy on GC.Methods: Retrospective analysis was performed on GC patients who received radical surgery after neoadjuvant chemotherapy from February 2016 to December 2019 at Peking Union Medical College Hospital. Relevant clinicopathological data was collected to analyze the factors influencing the effect of neoadjuvant chemotherapy. Chi-square test was used for univariate analysis. Logistic regression was used for multivariate analysis. Receiver operating characteristic curve (ROC) was used to determine the cut-off value of variables which significantly influenced the effect of neoadjuvant chemotherapy.Results: A total of 203 GC patients were included in the study. Analyses showed that patients <60 years old (OR=1.840[1.016-3.332], P=0.044), histological type of poor differentiation or signet-ring cell carcinoma (OR=2.606[1.321-5.140], P=0.006), and weight loss during neoadjuvant chemotherapy (OR=2.110[1.161-3.834], P=0.014) were independent risk factors for neoadjuvant chemotherapy effect. In ROC analysis of weight change and neoadjuvant chemotherapy effect, area under the curve (AUC) was 0.593(P=0.024) and cut-off value of weight change was -2.95%. Chi-square test showed patients without weight loss during neoadjuvant chemotherapy had a higher rate of oral nutritional supplement (ONS) than patients with weight loss (P=0.039).Conclusions: Patients <60 years old, histological type of poor differentiation or signet-ring cell carcinoma, and weight loss during neoadjuvant chemotherapy were independent risk factors for neoadjuvant chemotherapy effect in GC patients. Patients with weight loss >2.95% during neoadjuvant may have a worse chemotherapy effect. Timely nutritional support such as ONS to maintain patients’ body weight is crucial for improving the effect of neoadjuvant chemotherapy.
Association of vitamin D receptor gene polymorphisms with gestational diabetes mellitus-a case control study in Wuhan, China
Authors: Liu jianqiong , Dai Qiong , Li Wei , Guo Yan , Dai Anna , Wang Yanqing , Deng Mengyao , Tang Zhao , She Lu , Chen Xiaohong , Yang Mei
Published: January 2021

Background: Gestational diabetes mellitus (GDM) increased risk for perinatal complications to both the women and the fetuses. The association between the vitamin D receptor (VDR) gene and GDM has not been thoroughly investigated in Chinese pregnant women. Therefore, we aimed to determine whether VDR gene single nucleotide polymorphisms (SNPs) rs154410, rs7975232, rs731236, rs2228570 and rs739837 contribute to GDM risk in Wuhan, China. In addition, we aimed to explore their combined effect on the risk of GDM. Methods: Pregnant women who had prenatal examination at 24 to 28 weeks’ gestation in our hospital from January 15, 2018 to March 31, 2019 were included in this case-control study. After exclusion, a total of 1684 pregnant women (826 GDM patients and 858 non-diabetic controls) were recruited. The clinical information and blood sample were collected by trained interviewers and nurses. Genotyping of candidate SNPs was conducted by the Sequenom MassARRAY platform. Statistical analyses including t-test, ANOVA, chi-square test and logistic regression were performed to the data with SPSS Software to evaluate diﬀerences in genotype distribution and association of genotypes with GDM risk. Multifactor dimensionality reduction method was used to explore the gene-gene interactions on the risk of GDM. Results: Differences in age, pre-pregnancy BMI, family history of diabetes and previous history of GDM between the case and control groups were statistically significant (P<0.05), whereas no significant differences were found in height, gravidity, parity, and age of menarche (P>0.05). There were no significant differences at genotype distributions of the examined VDR gene SNPs (P>0.05). After adjusting by age, pre-pregnancy BMI, family history of diabetes, the results of logistic regression analysis showed no associations of the five SNPs with GDM in all the four genotype models(P>0.05). Furthermore, there were no gene-gene interactions on the GDM risk among the five examined VDR gene SNPs. Conclusion: The VDR gene SNPs rs154410, rs7975232, rs731236, rs2228570 and rs739837 showed neither significant associations nor gene-gene interactions with GDM in Wuhan, China.
Effect of Probiotic Supplementation along with Calorie Restriction on Metabolic Endotoxemia, and Inflammation Markers in Coronary Artery Disease Patients: A Double Blind Placebo Controlled Randomized Clinical Trial
Authors: moludi jalal , Kafil Hossein Samadi , Qaisar Shaimaa A. , Gholizadeh Pourya , Alizadeh Mohammad , Vayghyan Hamed Jafari
Published: January 2021

Purpose: Alterations in the gut microbiome (dysbiosis) has been associated with increased microbial translocation, leading to chronic inflammation in coronary artery disease (CAD). It has been proposed that modulation of gut microbiota by probiotic might modify metabolic endotoxemia. Therefore, the purpose of this study was to examine the effects of Lactobacillus rhamnosus GG (LGG) on endotoxin level, and biomarkers of inflammation in CAD participants. Methods: This study was a 12-weeks randomized, double-blind, and intervention on 44 patients with CAD. Patients were randomly allocated to receive either one LGG capsule 1.6 ×109 colony-forming unit (CFU) or the placebo capsules for 12 weeks. In addition, all the participants were also prescribed a calorie-restricted diet. Serum levels of interleukin-1β (IL-1β), Toll-like receptor 4 (TLR4), interleukin-10 (IL-10), and lipopolysaccharide (LPS), were assessed before and after the intervention. Results: A significant decrease in IL1-Beta concentration (-1.88 ± 2.25, vs. 0.56 ± 1.58 mmol/L, P=0.027), and LPS levels (-5.20 ±2.70 vs. 2.96+ 5.27 mg/L, P=0.016), was observed after the probiotic supplementation compared with the placebo. Participants who had ≥2.5 kg weight loss showed signiﬁcantly improved cardiovascular-related factors, compared to patients with <2.5 kg weight reduction, regardless of the supplement they took.Conclusion: These data provide preliminary evidence that probiotic supplementation has beneficial effects on metabolic endotoxemia, and mega inflammation in participants with CAD.
The Hermeneutic of the Malay Comic: Unveiling the Symbolism of Love in Selendang Siti Rugayah
Authors: Ismail@Kamal Julina , Yaapar Md. Salleh
Published: January 2021

A comic is a form of sequential art that incorporates the integrated textual and visual aspects to reveal the desired meaning. It involves storytelling techniques with narrative elements as found in conventional literary works. Nowadays, comic art is flourishing in Malaysia with the advent of abundant comics from various old and new local authors. The uniqueness of Rejabhad, who was widely known as the King of Malaysian Cartoon, allows the researcher to analyse his comic works in the aspects of textual and visual designs. Prior studies have only discussed the outer layer of Malay comics. In fact, Malay comics especially Rejabhad’s works need to be examined more deeply to unravel their outer and inner layers of meaning. It is essential to fully understand the overall meaning of the work as well as to appreciate the author’s identity. This study focuses on one of Rejabhad’s particular comic work entitled Selendang Siti Rugayah (1997). The study uses a spiritual hermeneutic reading or exegesis (takwil) method is applied to obtain the inner or spiritual meaning of Selendang Siti Rugayah comic work. The results of this study allow the public to understand the inner meaning of the comic work and to appreciate the identity or personality of the author in his or her comic works. This study which based on the spiritual hermeneutic reading is very significant. It is a new exploration that may change the views on the creativity and wisdom of a Malay comic artist, Rejabhad, who had been appreciated and understood only based on the outer layer of reading.
Inclusão da criança autista na rede regular de ensino: desafios e possibilidades
Authors: Silva Cynara da Costa , Mendes Abraão Cabral
Published: January 2021

This article aims to investigate how teaching practice occurs based on an observation made during the period of Supervised Internship I. Additionally, it aims to analyze questions on the theme “Special and inclusive education”, realizing how autistic children are included in the regular education network. The action of the teacher involved in the process of special and inclusive education of the autistic child was observed and the work proposals to be carried out in order to favor the child development process were analyzed. It is important to understand the reality of the child with specific needs and how the pedagogical and dynamic teaching practice of the teacher is important for this inclusion and integration in regular schools. Methodologically, it was used the tool "questionnaire", with the teaching professional, to understand the challenges and possibilities of this inclusion, we conclude that, when there is commitment and interaction, and the development of both (teacher and student) happens more and more with ease and strength.
Anita Leocádia Benário Prestes: filha da revolução (parte 2)
Authors: Lima Higo
Published: January 2021

Second and last part of the interview with Anita Prestes, granted during her stay in Mossoró / RN, in September 2018, and initially published by Revista Informação e Cultura - RIC in the previous edition, when we highlight her interaction with her mother's memory, the German Olga Benário Prestes. In this excerpt of the conversation, she reveals to us the circumstances that were reflected in the biography of her father, Luís Carlos Prestes, the discipline of training at Colégio Militar and the persistent dream of a communist revolution. Researcher in History, Anita Prestes offers us a detailed trajectory of Brazilian militarism, highlighting the times when she assumed a “progressive” and “reactionary” role. Finally, Anita is hopeful with the emergence of a revolutionary popular movement that, although difficult, points out to be the only path of change.
Association between Emergency Department Overcrowding and Mortality at a Teaching Hospital in Saudi Arabia
Authors: Khubrani Fatimah Yahyia , Al-Qahtani Mona Faisal
Published: January 2021

Introduction:

Emergency Departments (ED) are highly important in hospital settings because they offer 24-hour professional assistance to patients in need of healthcare. However, ED overcrowding has started to become a global healthcare crisis, such that the patient capacity of EDs is no longer sufficient to meet patient demand.

Aim:

Thus, this study aimed to determine the relationship between ED overcrowding and the mortality rate of patients to draw the attention of decision makers in Saudi Arabia toward this issue, with the hope of ultimately attaining a solution to this problem.

Methods:

Using patients’ electronic health records that were stored in the Quadra Med system in 2018, we calculated the occupancy rates of the ED of a target teaching hospital at different quarters and associated those figures with the mortality rates for the same quarters.

Results:

Our results showed that there was no significant association between mortality rate and crowding status in the ED. Nonetheless, we recommend increasing public awareness and bed capacity at EDs in Saudi Arabia because overcrowded EDs can lead to adverse patient outcomes.

Conclusion:

The present study showed that the highest percentage (38%) of deaths that occurred during the overcrowded period were mostly of patients between 30 and 44 years of age, while patients between 60 and 74 years of age accounted for 36% of deaths.

The current study also assessed patient triaging, revealing that the highest number of patients was associated with level four (62.7% of the total patients in the overcrowded ED) and level five (33.1% in the overcrowded ED) triaging.

We also discovered higher levels of admission in the critical care unit during the ED overcrowding period compared with other periods.
A carreira de Especialistas em Políticas Públicas e Gestão Governamental de Minas Gerais e os desafios de retenção: análise comparativa de 2009 e 2019
Authors: Oliveira Kamila Pagel , Ckagnazaroff Ivan Beck , Da Silveira Mauro César
Published: January 2021

Este artigo analisa os principais motivos que levavam à evasão dos Especialistas em Políticas Públicase Gestão Governamental do Estado de Minas Gerais até o ano de 2009, bem como as mudançasintroduzidas a partir da Lei nº 18.974/2010 e seu reflexo na retenção desses profissionais. Trata-sede um estudo de caso que contou com coleta de dados em dois momentos distintos, 2009 e 2019.Para análise da evasão, foram aplicados questionários aos EPPGG, membros e exonerados, além da realização de entrevistas com os EPPGG e com os gestores da carreira, realizadas em 2009.Em 2019, foi realizada pesquisa documental que possibilitou a atualização dos dados referentesà evasão, remuneração e alocação dos profissionais. Os resultados indicam que as mudançasintroduzidas desde 2010, a partir da referida lei, influenciaram a retenção dos EPPGG, tendo emvista que trouxeram significativas mudanças nos dois principais motivos que levavam à evasão dosocupantes deste cargo, sendo eles, falhas na estrutura da carreira e inadequação no que tange àremuneração desses profissionais.
Reformas administrativas do Estado: o caso da reestruturação promovida na Secretaria de Desenvolvimento Social de Minas Gerais
Authors: Nascimento Matheus Fernandes , Silva Henrique Tangari
Published: January 2021

Este estudo aborda a reforma administrativa em curso no Estado de Minas Gerais no ano de 2019, a partir da reestruturação administrativa promovida na Secretaria de Estado de Desenvolvimento Social (Sedese). O objetivo do trabalho é, a partir da compreensão das principais mudanças promovidas, analisar o impacto institucional da absorção de algumas temáticas no escopo de atuação da secretaria. Além do arcabouço teórico relacionado às reformas administrativas, buscou-se também apropriar a pesquisa das relações existentes na temática das mudanças organizacionais, considerando aspectos relacionados à gestão da mudança e resistência à mudança. Ao abordar as dimensões legal, estratégica e gerencial, o estudo avalia de forma positiva as alterações realizadas, sendo possível observar a capacidade gerencial de absorver as diferentes temáticas. Ressalvam-se, entretanto, alguns impactos negativos nos processos e, principalmente, a dificuldade de adequação orgânica, bem como a ausência de mecanismos de transição para a promoção da gestão da mudança.
Uma governança orientada por diretrizes de governo aberto aprimora o valor público de programas governamentais?
Authors: Mariani Cristina Borges , Lassance Antônio
Published: January 2021

O artigo analisa em que medida a introdução de princípios de governo aberto, ao promover mudanças na governança das políticas públicas, favorece a geração de valor público em programas governamentais. A partir de estudo de caso do programa Bolsa Família, com triangulação de métodos, é feito o rastreamento das alterações na governança do programa que estiveram alinhadas a princípios de governo aberto, aferindo até que ponto houve ou não uma maior geração de valor público pelo programa. O estudo conclui que o Bolsa Família, mais do que atender a normativos e adotar uma governança orientada por padrões genéricos, construiu seu próprio modelo (ou referencial) de governança aberta. Alguns aspectos cruciais desse modelo já coincidiam com princípios e diretrizes de governo aberto que só seriam consagrados posteriormente. As evidências são de que isso ocorreu pela necessidade prática de encontrar soluções que trouxessem agilidade e facilidades operacionais à implementação e à prestação de contas do programa, materializadas na forma de algumas de suas ferramentas de política, como o Cadastro Único. A pesquisa oferece ainda uma contribuição aplicada de operacionalização do conceito de valor público por meio, entre outras, da análise do acesso e do uso de dados abertos.
Governança pública: análise da alienação de bens móveis com base nas recomendações da IFAC no IFPB
Authors: Freitas Camila Martins de , Morais José Jassuipe da silva , Vieira Gonçalves Pereira Dimmitre Morant
Published: January 2021

A administração pública brasileira busca mudanças por meio das suas reformas, tentando diminuir as práticas que inibem seu bom funcionamento. Dessa forma, o modelo de administração gerencialista vivenciado atualmente buscou trazer os instrumentos de gestão que demonstraram êxito no âmbito privado ao serem utilizados na administração pública, a saber, a governança. Neste viés, o presente artigo busca analisar o nível de aderência do processo de alienação de bens móveis às práticas de governança pública elencadas pela International Federation Accounting Committee (IFAC). Trata-se de um estudo de caso de abordagem qualitativa, utilizando-se da técnica de pesquisa de triangulação de dados a partir de fontes bibliográficas, documentais e da observação direta, realizado no âmbito do Instituto Federal da Paraíba, campus Campina Grande. Somados à observação direta, os dados foram coletados em legislações, normativas internas, relatórios internos, regulamentos e edital, nos quais se fez um estudo acerca da governança pública trazida nas recomendações da IFAC. Os resultados do estudo apontaram que o IFPB - Campus Campina Grande cumpre parcialmente as exigências da IFAC em seu processo de desfazimento, atendendo satisfatoriamente às dimensões padrões de comportamento e estruturas e processos organizacionais e necessitando de melhorias nas dimensões controle e relatórios externos. Assim, apesar de atender a alguns pontos específicos, verifica-se a necessidade de ampliar a aderência das práticas de desfazimento de tais categorias.
Adherence of Internet-Based Cancer Risk Assessment Tools to Best Practices in Risk Communication: Content Analysis (Preprint)
Authors: Waters Erika A , Foust Jeremy L , Scherer Laura D , McQueen Amy , Taber Jennifer M
Published: January 2021

BACKGROUND

Internet-based risk assessment tools offer a potential avenue for people to learn about their cancer risk and adopt risk-reducing behaviors. However, little is known about whether internet-based risk assessment tools adhere to scientific evidence for what constitutes good risk communication strategies. Furthermore, their quality may vary from a user experience perspective.

OBJECTIVE

This study aims to understand the extent to which current best practices in risk communication have been applied to internet-based cancer risk assessment tools.

METHODS

We conducted a search on August 6, 2019, to identify websites that provided personalized assessments of cancer risk or the likelihood of developing cancer. Each website (N=39) was coded according to standardized criteria and focused on 3 categories: general website characteristics, accessibility and credibility, and risk communication formats and strategies.

RESULTS

Some best practices in risk communication were more frequently adhered to by websites. First, we found that undefined medical terminology was widespread, impeding comprehension for those with limited health literacy. For example, 90% (35/39) of websites included technical language that the general public may find difficult to understand, yet only 23% (9/39) indicated that medical professionals were their intended audience. Second, websites lacked sufficient information for users to determine the credibility of the risk assessment, making it difficult to judge the scientific validity of their risk. For instance, only 59% (23/39) of websites referenced the scientific model used to calculate the user’s cancer risk. Third, practices known to foster unbiased risk comprehension, such as adding qualitative labels to quantitative numbers, were used by only 15% (6/39) of websites.

CONCLUSIONS

Limitations in risk communication strategies used by internet-based cancer risk assessment tools were common. By observing best practices, these tools could limit confusion and cultivate understanding to help people make informed decisions and motivate people to engage in risk-reducing behaviors.
Serious Games for Improving Technical Skills in Medicine: Scoping Review (Preprint)
Authors: Olgers Tycho Joan , bij de Weg Anne Akke , ter Maaten Jan Cornelis
Published: January 2021

BACKGROUND

Serious games are being used to train specific technical skills in medicine, and most research has been done for surgical skills. It is not known if these games improve technical skills in real life as most games have not been completely validated.

OBJECTIVE

This scoping review aimed to evaluate the current use of serious games for improving technical skills in medicine and to determine their current validation state using a validation framework specifically designed for serious games.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A multidatabase search strategy was adopted, after which a total of 17 publications were included in this review.

RESULTS

These 17 publications described five different serious games for improving technical skills. We discuss these games in detail and report about their current validation status. Only one game was almost fully validated. We also discuss the different frameworks that can be used for validation of serious games.

CONCLUSIONS

Serious games are not extensively used for improving technical skills in medicine, although they may represent an attractive alternative way of learning. The validation of these games is mostly incomplete. Additionally, several frameworks for validation exist, but it is unknown which one is the best. This review may assist game developers or educators in validating serious games.
Exploring the Role of Persuasive Design in Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Adults: Systematic Review, Meta-analysis, and Meta-regression (Preprint)
Authors: McCall Hugh C , Hadjistavropoulos Heather D , Sundström Christopher Richard Francis
Published: January 2021

BACKGROUND

Internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. Various research groups have suggested that unguided ICBT (ie, ICBT without therapist support) and other eHealth interventions can be designed to enhance user engagement and thus outcomes. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT.

OBJECTIVE

This study aims to provide an updated meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety, describe the frequency with which various persuasive design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety.

METHODS

We conducted a systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety. We conducted separate random effects meta-analyses and separate meta-regressions for depression and anxiety interventions. Each meta-regression included 2 steps. The first step included, as a predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition. The number of persuasive design principles identified for each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design.

RESULTS

Of the 4471 articles we identified in our search, 46 (1.03%) were eligible for inclusion in our analyses. Our meta-analyses showed effect sizes (Hedges g) ranging from 0.22 to 0.31 for depression interventions, depending on the measures taken to account for bias in the results. We found a mean effect size of 0.45 (95% CI 0.33-0.56) for anxiety interventions, with no evidence that the results were inflated by bias. Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4.95 (SD 2.85). The meta-regressions showed that a greater number of persuasive design principles predicted greater efficacy in ICBT for depression (R2 change=0.27; B=0.04; P=.02) but not anxiety (R2 change=0.05; B=0.03; P=.17).

CONCLUSIONS

These findings show wide variability in the use of persuasive design in unguided ICBT for depression and anxiety and provide preliminary support for the proposition that more persuasively designed interventions are more efficacious, at least in the treatment of depression. Further research is needed to clarify the role of persuasive design in ICBT.

CLINICALTRIAL
Taking a Leap of Faith: A Study of Abruptly Transitioning an Undergraduate Medical Education Program to Distance-Learning Owing to the COVID-19 Pandemic (Preprint)
Authors: Du Plessis Stefan S , Otaki Farah , Zaher Shroque , Zary Nabil , Inuwa Ibrahim , Lakhtakia Ritu
Published: January 2021

UNSTRUCTURED

The COVID-19 pandemic has forced universities worldwide to immediately transition to distance-learning. Although numerous studies have investigated the effect of the COVID-19 pandemic on universities in the Middle East, none have reflected on the process through which medical education programs for health professions underwent this transition. This study aimed to elucidate the rapid transition to distance-learning of an undergraduate medical program at the College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences (Dubai, United Arab Emirates), owing to the COVID-19 pandemic. An action research approach constituted the foundation of this collaborative effort that involved investigations, reflections, and improvements of practice, through ongoing cycles of planning, acting, observing, and reflecting. Efforts of transitioning to distance-learning were grouped into four interrelated aspects: supporting faculty members in delivering the program content, managing curriculum changes, engaging with the students to facilitate distance-learning experiences, and conducting web-based assessments. Challenges included the high perceived uncertainty, need for making ad hoc decisions, lack of experiential learning and testing of clinical skills, and blurring of work-life boundaries. Our preliminary findings show the successful generation of a strong existing digital base, future prospects for innovation, and a cohesive team that was key to agility, rapid decision-making, and program implementation.
Innovative Virtual Role Play Simulations for Managing Substance Use Conversations: Pilot Study Results and Relevance During and After COVID-19 (Preprint)
Authors: Albright Glenn , Khalid Nikita , Shockley Kristen , Robinson Kelsey , Hughes Kevin , Pace-Danley Bethany
Published: January 2021

BACKGROUND

Substance use places a substantial burden on our communities, both economically and socially. In light of COVID-19, it is predicted that as many as 75,000 more people will die from alcohol and other substance use and suicide as a result of isolation, new mental health concerns, and various other stressors related to the pandemic. Public awareness campaigns that aim to destigmatize substance use and help individuals have meaningful conversations with friends, coworkers, or family members to address substance use concerns are a timely and cost-effective means of augmenting existing behavioral health efforts related to substance use. These types of interventions can supplement the work being done by existing public health initiatives.

OBJECTIVE

This pilot study examines the impact of the One Degree: Shift the Influence role play simulation, designed to teach family, friends, and coworkers to effectively manage problem-solving conversations with individuals that they are concerned about regarding substance use.

METHODS

Participants recruited for this mixed methods study completed a presurvey, the simulation, and a postsurvey, and were sent a 6-week follow-up survey. The simulation involves practicing a role play conversation with a virtual human coded with emotions, a memory, and a personality. A virtual coach provides feedback in using evidence-based communication strategies such as motivational interviewing.

RESULTS

A matched sample analysis of variance revealed significant increases at follow-up in composite attitudinal constructs of preparedness (P<.001) and self-efficacy (P=.01), including starting a conversation with someone regarding substance use, avoiding upsetting someone while bringing up concerns, focusing on observable facts, and problem solving. Qualitative data provided further evidence of the simulation’s positive impact on the ability to have meaningful conversations about substance use.

CONCLUSIONS

This study provides preliminary evidence that conversation-based simulations like One Degree: Shift the Influence that use role play practice can teach individuals to use evidence-based communication strategies and can cost-effectively reach geographically dispersed populations to support public health initiatives for primary prevention.
Assessment of the Quality Management System for Clinical Nutrition in Jiangsu: Survey Study (Preprint)
Authors: Wang Jin , Pan Chen , Ma Xianghua
Published: January 2021

BACKGROUND

An electronic system that automatically collects medical information can realize timely monitoring of patient health and improve the effectiveness and accuracy of medical treatment. To our knowledge, the application of artificial intelligence (AI) in medical service quality assessment has been minimally evaluated, especially for clinical nutrition departments in China. From the perspective of medical ethics, patient safety comes before any other factors within health science, and this responsibility belongs to the quality management system (QMS) within medical institutions.

OBJECTIVE

This study aims to evaluate the QMS for clinical nutrition in Jiangsu, monitor its performance in quality assessment and human resource management from a nutrition aspect, and investigate the application and development of AI in medical quality control.

METHODS

The participants for this study were the staff of 70 clinical nutrition departments of the tertiary hospitals in Jiangsu Province, China. These departments are all members of the Quality Management System of Clinical Nutrition in Jiangsu (QMSNJ). An online survey was conducted on all 341 employees within all clinical nutrition departments based on the staff information from the surveyed medical institutions. The questionnaire contains five sections, and the data analysis and AI evaluation were focused on human resource information.

RESULTS

A total of 330 questionnaires were collected, with a response rate of 96.77% (330/341). A QMS for clinical nutrition was built for clinical nutrition departments in Jiangsu and achieved its target of human resource improvements, especially among dietitians. The growing number of participating departments (an increase of 42.8% from 2018 to 2020) and the significant growth of dietitians (t93.4=–0.42; P=.02) both show the advancements of the QMSNJ.

CONCLUSIONS

As the first innovation of an online platform for quality management in Jiangsu, the Jiangsu Province Clinical Nutrition Management Platform was successfully implemented as a QMS for this study. This multidimensional electronic system can help the QMSNJ and clinical nutrition departments achieve quality assessment from various aspects so as to realize the continuous improvement of clinical nutrition. The use of an online platform and AI technology for quality assessment is worth recommending and promoting in the future.
A Didactic Escape Game for Emergency Medicine Aimed at Learning to Work as a Team and Making Diagnoses: Methodology for Game Development (Preprint)
Authors: Abensur Vuillaume Laure , Laudren Garry , Bosio Alexandre , Thévenot Pauline , Pelaccia Thierry , Chauvin Anthony
Published: January 2021

BACKGROUND

In the health care environment, teamwork is paramount, especially when referring to patient safety. We are interested in recent and innovative solutions such as escape games, which is a type of adventure game that may be highly useful as an educational tool, potentially combining good communication skills with successful gamification. They involve teams of 5 to 10 individuals who are “locked” in the same room and must collaborate to solve puzzles while under pressure from a timer.

OBJECTIVE

The purpose of this paper was to describe the steps involved in creating and implementing an educational escape game. This tool can then be put into service or further developed by trainers who wish to use it for learning interprofessional collaboration. Therefore, we started with an experience of creating an educational escape game for emergency medicine teams.

METHODS

We chose to develop an educational escape game by using 6 successive steps. First, we built a team. Second, we chose the pedagogical objectives. Third, we gamified (switched from objectives to scenario). Next, we found the human and material resources needed. Thereafter, we designed briefing and debriefing. Lastly, we tested the game.

RESULTS

By following these 6 steps, we created the first ambulant educational escape game that teaches people, or nurses, doctors, and paramedics, working in emergency medicine to work as a team.

CONCLUSIONS

From a pedagogic point of view, this game may be a good tool for helping people in multidisciplinary fields (medical and paramedical teams) to learn how to work collaboratively and to communicate as a group. Above all, it seems to be an innovative tool that complements medical simulation–based learning and thus consolidates traditional education.
Using Machine Learning Techniques to Predict Factors Contributing to the Incidence of Metabolic Syndrome in Tehran: Cohort Study (Preprint)
Authors: Hosseini-Esfahani Firoozeh , Alafchi Behnaz , Cheraghi Zahra , Doosti-Irani Amin , Mirmiran Parvin , Khalili Davood , Azizi Fereidoun
Published: January 2021

BACKGROUND

Metabolic syndrome (MetS), a major contributor to cardiovascular disease and diabetes, is considered to be among the most common public health problems worldwide.

OBJECTIVE

We aimed to identify and rank the most important nutritional and nonnutritional factors contributing to the development of MetS using a data-mining method.

METHODS

This prospective study was performed on 3048 adults (aged ≥20 years) who participated in the fifth follow-up examination of the Tehran Lipid and Glucose Study, who were followed for 3 years. MetS was defined according to the modified definition of the National Cholesterol Education Program/Adult Treatment Panel III. The importance of variables was obtained by the training set using the random forest model for determining factors with the greatest contribution to developing MetS.

RESULTS

Among the 3048 participants, 701 (22.9%) developed MetS during the study period. The mean age of the participants was 44.3 years (SD 11.8). The total incidence rate of MetS was 229.9 (95% CI 278.6-322.9) per 1000 person-years and the mean follow-up time was 40.5 months (SD 7.3). The incidence of MetS was significantly (P<.001) higher in men than in women (27% vs 20%). Those affected by MetS were older, married, had diabetes, with lower levels of education, and had a higher BMI (P<.001). The percentage of hospitalized patients was higher among those with MetS than among healthy people, although this difference was only statistically significant in women (P=.02). Based on the variable importance and multiple logistic regression analyses, the most important determinants of MetS were identified as history of diabetes (odds ratio [OR] 6.3, 95% CI 3.9-10.2, P<.001), BMI (OR 1.2, 95% CI 1.0-1.2, P<.001), age (OR 1.0, 95% CI 1.0-1.03, P<.001), female gender (OR 0.5, 95% CI 0.38-0.63, P<.001), and dietary monounsaturated fatty acid (OR 0.97, 95% CI 0.94-0.99, P=.04).

CONCLUSIONS

Based on our findings, the incidence rate of MetS was significantly higher in men than in women in Tehran. The most important determinants of MetS were history of diabetes, high BMI, older age, male gender, and low dietary monounsaturated fatty acid intake.
Infodemiological Examination of Personal and Commercial Tweets About Cannabidiol: Term and Sentiment Analysis (Preprint)
Authors: Turner Jason , Kantardzic Mehmed , Vickers-Smith Rachel
Published: January 2021

BACKGROUND

In the absence of official clinical trial information, data from social networks can be used by public health and medical researchers to assess public claims about loosely regulated substances such as cannabidiol (CBD). For example, this can be achieved by comparing the medical conditions targeted by those selling CBD against the medical conditions patients commonly treat with CBD.

OBJECTIVE

The objective of this study was to provide a framework for public health and medical researchers to use for identifying and analyzing the consumption and marketing of unregulated substances. Specifically, we examined CBD, which is a substance that is often presented to the public as medication despite complete evidence of efficacy and safety.

METHODS

We collected 567,850 tweets by searching Twitter with the Tweepy Python package using the terms “CBD” and “cannabidiol.” We trained two binary text classifiers to create two corpora of 167,755 personal use and 143,322 commercial/sales tweets. Using medical, standard, and slang dictionaries, we identified and compared the most frequently occurring medical conditions, symptoms, side effects, body parts, and other substances referenced in both corpora. In addition, to assess popular claims about the efficacy of CBD as a medical treatment circulating on Twitter, we performed sentiment analysis via the VADER (Valence Aware Dictionary for Sentiment Reasoning) model on the personal CBD tweets.

RESULTS

We found references to medically relevant terms that were unique to either personal or commercial CBD tweet classes, as well as medically relevant terms that were common to both classes. When we calculated the average sentiment scores for both personal and commercial CBD tweets referencing at least one of 17 medical conditions/symptoms terms, an overall positive sentiment was observed in both personal and commercial CBD tweets. We observed instances of negative sentiment conveyed in personal CBD tweets referencing autism, whereas CBD was also marketed multiple times as a treatment for autism within commercial tweets.

CONCLUSIONS

Our proposed framework provides a tool for public health and medical researchers to analyze the consumption and marketing of unregulated substances on social networks. Our analysis showed that most users of CBD are satisfied with it in regard to the condition that it is being advertised for, with the exception of autism.
Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations (Preprint)
Authors: Huang Mian , Wang Jian , Nicholas Stephen , Maitland Elizabeth , Guo Ziyue
Published: January 2021

UNSTRUCTURED

By applying advanced health information technology to the health care field, health informatization helps optimize health resource allocation, improve health care services, and realize universal health coverage. COVID-19 has tested the status quo of China’s health informatization, revealing challenges to the health care system. This viewpoint evaluates the development, status quo, and practice of China’s health informatization, especially during COVID-19, and makes recommendations to address the health informatization challenges. We collected, assessed, and evaluated data on the development of China’s health informatization from five perspectives—health information infrastructure, information technology (IT) applications, financial and intellectual investment, health resource allocation, and standard system—and discussed the status quo of the internet plus health care service pattern during COVID-19. The main data sources included China’s policy documents and national plans on health informatization, commercial and public welfare sources and websites, public reports, institutional reports, and academic papers. In particular, we extracted data from the 2019 National Health Informatization Survey released by the National Health Commission in China. We found that China developed its health information infrastructure and IT applications, made significant financial and intellectual informatization investments, and improved health resource allocations. Tested during COVID-19, China’s current health informatization system, especially the internet plus health care system, has played a crucial role in monitoring and controlling the pandemic and allocating medical resources. However, an uneven distribution of health resources and insufficient financial and intellectual investment continue to challenge China’s health informatization. China’s rapid development of health informatization played a crucial role during COVID-19, providing a reference point for global pandemic prevention and control. To further promote health informatization, China’s health informatization needs to strengthen top-level design, increase investment and training, upgrade the health infrastructure and IT applications, and improve internet plus health care services.
Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study (Preprint)
Authors: Hu Lu , Trinh-Shevrin Chau , Islam Nadia , Wu Bei , Cao Shimin , Freeman Jincong , Sevick Mary Ann
Published: January 2021

BACKGROUND

Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D.

OBJECTIVE

This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D.

METHODS

In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use.

RESULTS

The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management.

CONCLUSIONS

Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group.
Diagnostic Accuracy of Artificial Intelligence and Computer-Aided Diagnosis for the Detection and Characterization of Colorectal Polyps: Systematic Review and Meta-analysis (Preprint)
Authors: Nazarian Scarlet , Glover Ben , Ashrafian Hutan , Darzi Ara , Teare Julian
Published: January 2021

BACKGROUND

Colonoscopy reduces the incidence of colorectal cancer (CRC) by allowing detection and resection of neoplastic polyps. Evidence shows that many small polyps are missed on a single colonoscopy. There has been a successful adoption of artificial intelligence (AI) technologies to tackle the issues around missed polyps and as tools to increase the adenoma detection rate (ADR).

OBJECTIVE

The aim of this review was to examine the diagnostic accuracy of AI-based technologies in assessing colorectal polyps.

METHODS

A comprehensive literature search was undertaken using the databases of Embase, MEDLINE, and the Cochrane Library. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Studies reporting the use of computer-aided diagnosis for polyp detection or characterization during colonoscopy were included. Independent proportions and their differences were calculated and pooled through DerSimonian and Laird random-effects modeling.

RESULTS

A total of 48 studies were included. The meta-analysis showed a significant increase in pooled polyp detection rate in patients with the use of AI for polyp detection during colonoscopy compared with patients who had standard colonoscopy (odds ratio [OR] 1.75, 95% CI 1.56-1.96; P<.001). When comparing patients undergoing colonoscopy with the use of AI to those without, there was also a significant increase in ADR (OR 1.53, 95% CI 1.32-1.77; P<.001).

CONCLUSIONS

With the aid of machine learning, there is potential to improve ADR and, consequently, reduce the incidence of CRC. The current generation of AI-based systems demonstrate impressive accuracy for the detection and characterization of colorectal polyps. However, this is an evolving field and before its adoption into a clinical setting, AI systems must prove worthy to patients and clinicians.

CLINICALTRIAL

PROSPERO International Prospective Register of Systematic Reviews CRD42020169786; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020169786