bluuebunny/crossref_metadata_2025_split huggingface dataset:
Virtual reality informative aids increase residents’ atrial fibrillation ablation procedures-related knowledge and patients’ satisfaction
Authors: Chang Shih-Lin , Kuo Ming-Jen , Lin Yenn-Jiang , Chen Shih-Ann , Yang Ying-Ying , Cheng Hao-Min , Yang Ling-Yu , Kao Shou-Yen , Lee Fa-Yauh 
Published: November 2020

Background:
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and increasing numbers of patients receive AF ablation nowadays. Therefore, in the cardiology division, residents need to be familiar with the AF ablation procedure-related knowledge for primary care. This study evaluated the baseline residents and patients' self-efficacy to the AF ablation procedure-related knowledge, developed the specific virtual reality (VR) informative aids, and evaluated the effects of VR training and resident-led VR aids-based patient education on their self-efficacy, in the aspects of familiarity, confidence and anxiety, and satisfaction.

Methods:
From 2019, April to 2020, April, this 1-year prospective prestudy and poststudy was undergone in the cardiology division. Between 2019, April and 2019, December, the experienced physicians were invited to develop VR informative aids for AF ablation procedure-related knowledge. Between January 2020 and April 2020, newly developed VR informative aids were implemented in the educational program of training rotated residents for giving patient education.

Result:
A total of 20 residents and 32 patients were enrolled. The baseline self-reported self-efficacy and knowledge scores were relatively low among rotated residents and their patients. In addition to the high level of satisfaction, self-efficacy and knowledge scores of residents and their patients were increased after VR aids-based training and resident-led patient education. Higher degree of improvement in self-efficacy was noted among patients with depression/anxiety history than those without history. The follow-up assessments among residents showed that the positive effects of VR aids were sustained until 2 weeks later.

Conclusion:
Overall, residents and patients reported that the VR aids increase the effectiveness of patient education, achieve the purpose of a paperless environment, and motivate them to recommend it to others. The implementation of resident-to-patient education has a positive impact on trainees and patients understanding about AF ablation procedures-related knowledge.
Quality Changes Among Primary Care Clinicians Participating in the Transforming Clinical Practice Initiative
Authors: Dai Mingliang , Peterson Lars E. , Phillips Robert L. 
Published: November 2020

ABSTRACT
The Transforming Clinical Practice Initiative (TCPI) was designed to provide technical assistance to clinicians and prepare practices to participate in value-based payment arrangements. In this longitudinal cohort study, we assessed whether clinician's participation in TCPI practice transformation networks (PTNs) was associated with changes in quality of care from 2016 to 2018. We extracted quarterly measure performance data from 2016 to 2018 on two NQF-endorsed measures, one for outcome (Controlling High Blood Pressure) and one for process (Use of Imaging Studies for Low Back Pain), from 1,981 primary care clinicians enrolled in the PRIME Registry. Clinicians participating in PTNs were identified and compared with their counterparts who did not participate in PTNs. We found that the performance of PTN clinicians on controlling high blood pressure and use of imaging studies for low back pain was equivalent to that of non-PTN clinicians during the first 3 years of the TCPI. Although PTNs provided assistance to help practices achieve their clinical outcomes, these findings suggest that the changes in quality of care, for the measures studied, among PTN clinicians in the first 3 years of the TCPI were attributable to temporal trends rather than participation in PTNs.
Using Focus Groups and Interviews to Inform the Design of a Workplace Exercise Programme
Authors: Burn Naomi L. , Weston Matthew , Atkinson Greg , Weston Kathryn L. 
Published: November 2020

Objective:
Using a formative evaluation of a high-intensity interval training (HIIT) intervention, we illustrate how qualitative data can inform the development of workplace exercise interventions.

Method:
Eight focus groups and four interviews were conducted with employees (n = 38) and management (n = 4) from six office-based organisations before intervention implementation.

Results:
Some participants thought workplace-based HIIT would be practical, given the limited time required. Others perceived it may not be acceptable for all individuals, given the exercise intensity. With consideration of identified barriers (workload/family commitments effecting time availability) and facilitators (flexible working conditions) participants’ perspectives were incorporated into the intervention protocol. A short-term group-based intervention was preferred, with a choice of exercise modes (based on stair climbing, stepping or boxing).

Conclusion:
This study provides a framework to incorporate stakeholders’ perspectives into the development of workplace exercise interventions.
Impacts of Working From Home During COVID-19 Pandemic on Physical and Mental Well-Being of Office Workstation Users
Authors: Xiao Yijing , Becerik-Gerber Burcin , Lucas Gale , Roll Shawn C. 
Published: November 2020

Objective:
To understand impacts of social, behavioral and physical factors on well-being of office workstation users during COVID-19 work from home (WFH).

Methods:
A questionnaire was deployed from April 24 to June 11, 2020 and 988 responses were valid. Linear regression, multinomial logistic regression and chi-square tests were used to understand factors associated with overall physical and mental health statuses and number of new physical and mental health issues.

Results:
Decreased overall physical and mental well-being after WFH were associated with physical exercise, food intake, communication with coworkers, children at home, distractions while working, adjusted work hours, workstation set-up and satisfaction with workspace indoor environmental factors.

Conclusion:
This study highlights factors that impact workers’ physical and mental health well-being while WFH and provides a foundation for considering how to best support a positive WFH experience.
Clinical Resources for Assessing Mobility of People with Lower-Limb Amputation: Interviews with Rehabilitation Clinicians
Authors: Morgan Sara J. , Balkman Geoffrey S. , Gaunaurd Ignacio A. , Kristal Anat , Amtmann Dagmar , Hafner Brian J. 
Published: November 2020

ABSTRACT

Introduction
Mobility tests are increasingly used in prosthetic rehabilitation to evaluate patient outcomes. Knowledge of the space, equipment, and time resources available to clinicians who work in different settings can guide recommendations for which tests are most clinically feasible and promote coordination of mobility testing among members of the rehabilitation team. The primary aim of this study was to characterize the different resources available to clinicians for measuring mobility of people with lower-limb amputation. A secondary aim was to identify performance tasks that clinicians use to evaluate prosthetic mobility.

Materials and Methods
Semistructured interviews were conducted with prosthetists, physical therapists, and physiatrists who treat people with lower-limb amputation. Researchers used convenience and snowball sampling to identify participants. Interviews included questions about the resources available for conducting mobility tests, as well as questions about which tasks clinicians deemed valuable to assessing mobility of patients with lower-limb amputation. Interviews were audio recorded and transcribed. Summary and frequency statistics were calculated for quantitative data; explanatory comments were summarized.

Results
Interviews were conducted with 25 clinicians (eight prosthetists, nine physical therapists, and eight physiatrists). Participants had access to multiple spaces and basic measurement equipment. The maximum time participants were willing to spend on performance tests varied. Physiatrists reported less time available (median, 10 minutes; range, 5–30 minutes) than prosthetists and physical therapists (median, 30 minutes; range, 5–60 minutes for both professions). Mobility tasks commonly used to evaluate patients with lower-limb amputation included sit-to-stand, standing balance, walking, and varying speed. Participant comments suggested that mobility tests need to be quick, simple, and add value; existing mobility tests are beneficial but challenging to incorporate into practice; mobility tests should reflect real-world activities; and technological advancements could improve mobility testing.

Conclusions
Clinicians generally had small-to-medium spaces, basic measurement equipment, and sufficient training to administer mobility tests in their clinics. A limiting factor was time, which can be addressed through selection of efficient measures and collaboration within the rehabilitation team.
Surgical Affirmation for Gender-Diverse Youth
Authors: Oles Norah , Ganor Oren , Aquino Nelson J. , Boskey Elizabeth R. 
Published: November 2020

Abstract
Gender affirmation surgeries have become increasingly accessible over the past decade, and more youth and young adults are seeking surgical solutions to align their physical characteristics with their gender identity. This article describes several major types of gender affirming surgeries, reviews the guidelines outlined by the World Professional Association for Transgender Health, and covers practical surgical care concerns. It is addressed to the healthcare provider taking care of gender-diverse youth with emphasis on best practice guidelines, informed consent, and ethical issues in transgender medicine.
Pharmacological Prevention of Noise-induced Hearing Loss: A Systematic Review
Authors: Gupta Avigeet , Koochakzadeh Sina , Nguyen Shaun A. , Brennan Emily A. , Meyer Ted A. , Lambert Paul R. 
Published: November 2020

Objective:
This study aims to explore and determine the effectiveness of current pharmacologic agents for the prevention of noise-induced hearing loss (NIHL) via a systematic review.

Databases Reviewed:
The PubMed, Scopus, ClinicalTrials.gov, and Cochrane Library databases were searched from inception through February 6, 2020.

Methods:
Full-text, English-language articles detailing prospective randomized and nonrandomized clinical trials with pharmacological interventions administered to prevent NIHL were included in accordance with PRISMA guidelines. The detailed search terms are included in the Appendix, http://links.lww.com/MAO/B67.

Results:
Eleven articles were included in this review with 701 patients receiving a pharmacologic prevention for various noise exposures. Various regimens included administration of alpha-lipoic acid, ambient oxygen, beta-carotene, carbogen, ebselen, Mg-aspartate, N-acetylcysteine, and vitamins C, E, and B12. A number of studies demonstrated statistically significant amelioration of NIHL with pharmacologic intervention. Two studies demonstrated significantly better hearing outcomes for pharmacological prophylaxis with carbogen or ebselen as compared with placebo for the 4 kHz frequency, where the noise-notch is most likely to be encountered. Given the considerable heterogeneity in agents and methodologies, however, it was not possible to conduct a meta-analysis.

Conclusions:
While several heterogenous articles demonstrated promising results for Mg-aspartate, carbogen, vitamin B12, and alpha-lipoic acid, the clinical significance of these pharmaceuticals remains unclear. Initial data from this study alongside future clinical trials might potentially contribute to the generation of clinical practice guidelines to prevent NIHL.
Level of Evidence: 2
A Comparison of Dizziness Handicap Inventory Scores by Categories of Vestibular Diagnoses
Authors: Graham Madison K. , Staab Jeffrey P. , Lohse Christine M. , McCaslin Devin L. 
Published: November 2020

Objective:
The Dizziness Handicap Inventory (DHI) is a 25-item self-report quantifying dizziness-related physical and emotional symptoms and restrictions in daily activities. DHI scores do not correlate with severity of structural vestibular deficits; thus, high DHI scores may reflect other causes of morbidity. This study investigated the relationship between total DHI scores and the presence of structural, functional, and psychiatric disorders in tertiary neurotology patients.

Study Design:
Retrospective.

Setting:
Tertiary center.

Patients:
Eighty-five patients who underwent multidisciplinary neurotologic evaluations.

Intervention:
Diagnostic.

Main Outcome Measure(s):
Active illnesses identified by a multidisciplinary neurotology team were abstracted from medical records, cataloged as structural, functional, or psychiatric disorders, and used to group patients into diagnostic categories: structural (structural disorders only), functional (functional disorders with/without structural disorders), and psychiatric (psychiatric disorders with/without other conditions). DHI scores were compared across diagnostic categories. Sensitivities and specificities of DHI scores for identifying structural versus functional or psychiatric disorders were calculated.

Results:
Mean DHI scores differed significantly by diagnostic category (structural 35 ± 18, functional 64 ± 15, and psychiatric 65 ± 19), before and after adjusting for age and sex (p < 0.001, Hedges’ g>1.62 for structural versus functional and psychiatric categories). DHI≤30 (mild handicap) had specificity = 0.98 for structural disorders alone, whereas DHI>60 (severe handicap) had specificity = 0.88 for functional or psychiatric disorders.

Conclusions:
In this tertiary cohort, categories of illnesses had large effects on total DHI scores. Patients with scores ≤30 were likely to have structural disorders alone, whereas those with scores >60 were likely to have functional or psychiatric disorders, with or without coexisting structural conditions.
Prevalence of aberrant blood pressure readings across two automated intraoperative blood pressure monitoring systems among patients undergoing caesarean delivery
Authors: Schonberger Robert B. , Gonzalez-Fiol Antonio , Fardelmann Kristen L. , Bardia Amit , Michel George , Dai Feng , Banack Trevor , Alian Aymen 
Published: November 2020

Objectives
Aberrant automated blood pressure (BP) readings during caesarean delivery may lead to disruptions in monitoring. The present study compared the frequency of aberrant BP readings across two types of commercially available BP monitoring systems in use during caesarean delivery.

Methods
This was a retrospective observational study using two comparable patient cohorts that resulted from simultaneous introduction of two types of monitors into a single obstetric surgical center in which similar patients were treated for the same surgical procedure by the same set of clinicians during the same year. Our primary hypothesis was that aberrant readings were significantly associated with the type of monitor being used for BP measurement, controlling for a variety of relevant covariates as specified in the analytic plan

Results
A total of 1418 cesarean delivery patients met inclusion criteria. Gaps of at least 6 min in machine-captured BP readings occurred in 159 (21.1%) of cases done in the operating room using a Datex-Ohmeda monitor vs. 183 (27.5%) of cases in the operating rooms using Phillips monitors (P = 0.005). In multivariable logistic regression analysis, the relative odds of the occurrence of monitoring gaps was 35% higher in rooms with the Phillips BP monitors as compared to the Datex-Ohmeda monitor while controlling for pre-specified covariates (odds ratio = 1.35, 95% confidence interval = 1.04–1.74, P = 0.02).

Conclusion
The present analysis suggests that aberrant BP readings for parturients undergoing caesarean delivery are significantly different between the two types of automated BP monitoring systems used in the operating rooms at our institution.
Association of vitamin D deficiency with arterial stiffness in newly diagnosed hypertension
Authors: Cakal Sinem , Çakal Beytullah , Karaca Oguz 
Published: November 2020

Objective
Vitamin D has beneficial effects on vascular endothelial function, blood pressure (BP) and arterial stiffness. Arterial stiffness increases in early-stage hypertensive patients and it is a strong predictor of cardiovascular morbidity and mortality. The purpose of this study was to assess the association between serum 25-hydroxyvitamin D (25-OH D) levels and arterial stiffness in patients with newly diagnosed hypertension.

Method
Our study included 100 newly diagnosed hypertensive patients (63 male, 37 female and mean age: 51.7 ± 10.3 years) without cardiovascular disease, malignancy, chronic kidney disease and diabetes mellitus. Patients were divided into two groups: vitamin D deficiency group (<20 ng/ml) and normal vitamin D group (≥20 ng/ml). Twenty-four-hour, daytime and nighttime ambulatory BP readings were recorded. Mobil-O-Graph ARC solver algorithm was used to evaluate arterial stiffness parameters of pulse wave velocity (PWV) (m/s), augmentation index normalized with 75/min heart rate (Alx@75).

Results
Patients with vitamin D deficency had higher values of Alx@75 and PWV values (20.9 ± 9 vs. 16.8 ± 6.9, P = 0.018 and 8.37 ± 1.16 vs. 6.9 ± 0.9, P = 0.001, respectively) despite similar 24-hour ambulatory BP monitoring in both groups. Level of serum calcium was significantly higher in vitamin D deficiency group (9.5 ± 0.23 vs. 9.3 ± 0.12, P = 0.007). Nighttime SBP was higher in vitamin D deficiency group (133.2 ± 14.3 mmHg vs. 126.3 ± 17.2 mmHg; P = 0.03) and also, vitamin D deficiency group had non-dipping SBP pattern compared to normal Vitamin D group (P = 0.013).

Conclusion
Vitamin D deficiency is associated with increased arterial stiffness in newly diagnosed hypertensive patients in terms of increased PWV and Alx@75 values.
Could aortic arch calcification help in detection of hypertensive retinopathy?
Authors: Adar Adem , Onalan Orhan , Sevik Ozge , Turgut Yeliz , Cakan Fahri 
Published: November 2020

Objective
Hypertension-induced end-organ damage is one of the important determinants of morbidity and mortality in patients with hypertension. All types of hypertension-induced end-organ damages start with vascular damage. Vascular calcification is a marker of vascular damage and aortic arch calcification (AAC) is one of the easily identifiable types of vascular calcification. We hypothesized that AAC predicts retinopathy in hypertensive patients.

Methods
Consecutive hypertensive patients without diabetes mellitus were included. Chest radiography in the posterior-anterior was used to assess the presence of AAC. All patients underwent ophthalmologic examination for retinopathy.

Results
We included 495 hypertensive patients in this study. Of these, 306 (62%) had hypertensive retinopathy. Patients with hypertensive retinopathy had significantly higher prevalence of AAC as compared to the patients without hypertensive retinopathy (88% vs. 22%, P < 0.001). We found a strong and positive correlation between hypertensive retinopathy and AAC grades (r = 639, P < 0.001). Receiver operator characteristics curve analysis yielded a strong predictive ability of AAC for the presence of hypertensive retinopathy [area under curve = 0.814, 95% confidence interval (CI): 0.775–0.853, P < 0.0001]. In multivariate logistic regression analysis, presence of AAC [odds ratio (OR) 13.128; CI: 7.894–21.832] and serum glucose levels (OR 1.020; CI: 1.003–1.037) were strongly and independently associated with hypertensive retinopathy.

Conclusion
Presence of AAC on chest radiograph is strongly and independently associated with retinopathy in nondiabetic hypertensive patients. This simple, inexpensive and widely available tool may help in early detection of retinopathy in patients with hypertension.
Evaluation of cuff deflation and inflation rates on a deep learning-based automatic blood pressure measurement method: a pilot evaluation study
Authors: Pan Fan , He Peiyu , Chen Fei , Xu Yuhang , Zhao Qijun , Sun Ping , Zheng Dingchang 
Published: November 2020

Objective
The aim of this study was to evaluate the performance of using a deep learning-based method for measuring SBPs and DBPs and the effects of cuff inflation and deflation rates on the deep learning-based blood pressure (BP) measurement (in comparison with the manual auscultatory method).

Methods
Forty healthy subjects were recruited. SBP and DBP were measured under four conditions (i.e. standard deflation, fast deflation, slow inflation and fast inflation) using both our newly developed deep learning-based method and the reference manual auscultatory method. The BPs measured under each condition were compared between the two methods. The performance of using the deep learning-based method to measure BP changes was also evaluated.

Results
There were no significant BP differences between the two methods (P > 0.05), except for the DBPs measured during the slow and fast inflation conditions. By applying the deep learning-based method, SBPs measured from fast deflation, slow inflation and fast inflation decreased significantly by 3.0, 3.5 and 4.7 mmHg (all P < 0.05), respectively, in comparison with the standard deflation condition. Whereas, corresponding DBPs measured from the slow and fast inflation conditions increased significantly by 5.0 and 6.8 mmHg, respectively (both P < 0.05). There were no significant differences in BP changes measured by the two methods in most cases (all P > 0.05, except for DBP change in the slow and fast inflation conditions).

Conclusion
This study demonstrated that the deep learning-based method can achieve accurate BP measurement under the deflation and inflation conditions with different rates.
Probiotics for the Prevention of Antibiotic-associated Diarrhea in Adults
Authors: Liao Wanqian , Chen Chongxiang , Wen Tianmeng , Zhao Qingyu 
Published: November 2020

Objective:
This meta-analysis aims to combine the latest research evidence to assess the effect of probiotics on preventing antibiotic-associated diarrhea (AAD) in adults.

Methods:
PubMed, Cochrane Library, EMBASE, and Web of Science were searched for randomized placebo-controlled trials on probiotics preventing AAD. A random or fixed effect model was used to combine the incidence of AAD (primary outcome) and the adverse event rates. The authors performed subgroup analyses to explore the effects of different participants population, probiotics species, and dosage.

Results:
Thirty-six studies were included with 9312 participants. Probiotics reduced the incidence of AAD by 38% (pooled relative risk, 0.62; 95% confidence interval, 0.51-0.74). The protective effect of probiotics was still significant when grouped by reasons for antibiotics treatment, probiotic duration, probiotic dosage, and time from antibiotic to probiotic. However, there were no statistically significant increased adverse events in the probiotics group (relative risk, 1.00; 95% confidence interval, 0.87-1.14).

Conclusions:
This updated meta-analysis suggested that using probiotics as early as possible during antibiotic therapy has a positive and safe effect on preventing AAD in adults. Further studies should focus on the optimal dosage and duration of probiotics to develop a specific recommendation.