bluuebunny/crossref_metadata_2025_split huggingface dataset:
In vitro glistening formation in IOLs: automated method for assessing the volumetric density and depth distribution of microvacuoles
Authors: Borghesi Simone , Colciago Sara , Zeri Fabrizio , Scialdone Antonio , Tavazzi Silvia 
Published: June 2020

Purpose:
To develop a method to measure the depth profile of microvacuoles (MVs) in intraocular lenses (IOLs) and to characterize, after accelerated aging, the glistening of an acrylic hydrophobic IOL.

Setting:
University of Milano-Bicocca, Milan, Italy.

Design:
In vitro study.

Methods:
A heat treatment was applied in vitro to Basis V IOLs exposed to deionized water (24 hours at 45 ± 1°C, rapid cooling, and 24 hours at 24 ± 1°C). Thirty images (area 1.2 mm2) of each IOL were acquired by a microscope, focusing on sequential planes every 23 ± 2 μm. By tracking the traces of each MV in consecutive images, the coordinates of the MV centroids along the IOL thickness were construed by an automated procedure, and in the generated single-focus stacked image, MVs were counted by an automated method.

Results:
MV density was found normally distributed along the IOL depth profile (Jarque-Bera test). In focus-stacked images, the MV automated counting was found accurate within 5% vs manual counting, and MV volume density of the order of 103 mm−3 was estimated. It was observed that stacks of 15 images provided a 4% lower MV volume density compared with the stacking of 30 images.

Conclusions:
The assessment of the number of MVs by the acquisition of a single image of an IOL was influenced by the distance of the selected plane from the IOL surface. The decrease in MV density approaching the IOL edges can be explained as a consequence of the diffusion of water toward the external environment after accelerated aging.
Effectiveness of a Home-Based Telehealth Exercise Training Program for Patients With Cardiometabolic Multimorbidity
Authors: Chiang Shang-Lin , Shen Chien-Lung , Chen Liang-Cheng , Lo Yi-Pang , Lin Chueh-Ho , Lin Chia-Huei 
Published: June 2020

Background
Exercise training has positive effects on the management of cardiometabolic conditions. Little is known about the effectiveness of home-based telehealth exercise training programs among patients with cardiometabolic multimorbidity, which is associated with functional decline and decreased health-related quality of life.

Objective
The aim of this study was to determine the effectiveness of a 12-week home-based telehealth exercise training program designed to increase physical activity and exercise capacity and improve health-related quality of life in patients with cardiometabolic multimorbidity.

Methods
A randomized controlled trial was conducted. Fifty eligible patients with 2 or more cardiometabolic conditions from outpatient clinics of a medical center in Northern Taiwan were randomized to either an experimental group (EG; received a 12-week home-based telehealth exercise training program) or a control group (CG; maintained usual lifestyles). The home-based telehealth exercise training program consisted of 36 individualized home-based exercise training sessions and a weekly reminder for maintenance of exercise and providing patient support. Amounts of physical activity, exercise capacity, and health-related quality of life were assessed at baseline and 12 weeks. Generalized estimating equations were used to examine the intervention effects via the interaction of time and group.

Results
The EG had higher amounts of physical activity (β = 1333, P = .004) and moderate-intensity physical activity (β = 330, P = .04) than the CG after the intervention. The EG had increased exercise capacity (VO2peak, β = 4.43, P = .04), as well as improved health-related quality of life (physical function, β = 7.55, P = .03; and physical component summary, β = 4.42, P = .03) compared with those in the CG.

Conclusions
A 12-week home-based telehealth exercise training program is feasible and effective in increasing amounts of physical activity, elevating exercise capacity, and improving health-related quality of life in patients with cardiometabolic multimorbidity.
Psychometric Characteristics of the Caregiver Contribution to Self-care of Heart Failure Index in a South American Population
Authors: Ávila Christiane Wahast , De Maria Maddalena , Vellone Ercole , Riegel Barbara , Bernardes Daniela , Silveira Luana Jacoby , Rabelo-Silva Eneida Rejane 
Published: June 2020

Background
Caregivers can contribute enormously to the self-care of patients with heart failure (HF). The Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI) measures these contributions across 3 scales: self-care maintenance, which evaluates caregiver contributions to symptom monitoring and treatment adherence; self-care management, which evaluates caregiver contributions in dealing with symptoms; and caregiver confidence, which assesses caregiver self-efficacy in managing all contributions to self-care. Although the CC-SCHFI has been used in several investigations, only 1 study has evaluated its psychometric characteristics.

Objective
The aim of this study was to evaluate the psychometric properties of the CC-SCHFI in Brazil.

Methods
A cross-sectional design was used in this study. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability.

Results
The sample comprised 99 caregivers of patients with HF. Most were women (73%), with a mean age of 48 ± 14 years; 57% were patients' spouses. Confirmatory factor analysis confirmed the original factor structure of the instrument, with supportive fit indices for all 3 scales (comparative fit index, 0.95–1.00; root-mean-square error of approximation, 0.00–0.057). Reliability estimates were adequate for each CC-SCHFI scale (0.77–0.96).

Conclusions
The CC-SCHFI is a valid and reliable scale to measure caregiver contributions to self-care maintenance, caregiver contributions to self-care management, and caregiver confidence in HF.
Assessing Motor Function in Congenital Muscular Dystrophy Patients Using Accelerometry
Authors: Lawal Tokunbor A. , Todd Joshua J. , Elliott Jeffrey S. , Linton Melody M. , Andres Megan , Witherspoon Jessica W. , Collins John P. , Chrismer Irene C. , Tounkara Fatoumata , Waite Melissa R. , Nichols Carmel , Bönnemann Carsten G. , Vuillerot Carole , Bendixen Roxanna , Jain Minal S. , Meilleur Katherine G. 
Published: June 2020

ABSTRACT

BACKGROUND
When tested in a controlled clinic environment, individuals with neuromuscular-related symptoms may complete motor tasks within normal predicted ranges. However, measuring activity at home may better reflect typical motor performance. The accuracy of accelerometry measurements in individuals with congenital muscular dystrophy (CMD) is unknown. We aimed to compare accelerometry and manual step counts and assess free-living physical activity intensity in individuals with CMD using accelerometry.

METHODS
Ambulatory pediatric CMD participants (n = 9) performed the 6-minute walk test in clinic while wearing ActiGraph GT3X accelerometer devices. During the test, manual step counting was conducted to assess concurrent validity of the ActiGraph step count in this population using Bland-Altman analysis. In addition, activity intensity of 6 pediatric CMD participants was monitored at home with accelerometer devices for an average of 7 days. Cut-point values previously validated for neuromuscular disorders were used for data analysis.

RESULTS
Bland-Altman and intraclass correlation analyses showed no concurrent validity between manual and ActiGraph-recorded step counts. Fewer steps were recorded by ActiGraph step counts compared with manual step counts (411 ± 74 vs 699 ± 43, respectively; P = .004). Although improved, results were in the same direction with the application of low-frequency extension filters (587 ± 40 vs 699 ± 43, P = .03). ActiGraph step-count data did not correlate with manual step count (Spearman ρ = 0.32, P = .41; with low-frequency extension: Spearman ρ = 0.45, P = .22). Seven-day physical activity monitoring showed that participants spent more than 80% of their time in the sedentary activity level.

CONCLUSIONS
In a controlled clinic setting, step count was significantly lower by ActiGraph GT3X than by manual step counting, possibly because of the abnormal gait in this population. Additional studies using triaxial assessment are needed to validate accelerometry measurement of activity intensity in individuals with CMD. Accelerometry outcomes may provide valuable measures and complement the 6-minute walk test in the assessment of treatment efficacy in CMD.
Initial User Testing of Decision Aids for Multiple Sclerosis Disease-Modifying Therapies
Authors: Hakim Hasna , Newland Pamela , Oliver Brant J. 
Published: June 2020

ABSTRACT

BACKGROUND
Disease-modifying therapies (DMTs) are the cornerstone of multiple sclerosis (MS) treatment. DMT treatment is a preference-sensitive decision in which shared decision making is indicated.

METHODS
We used qualitative methods to explore usability of MS decision aids in people aged 18 to 70 years diagnosed with MS. Semistructured interviews aimed to assess patients' overall reaction to using the decision aids. This included specific aspects of the user experience to improve readability, format, content, and patient opinions about whether the integration of the decision aids into visits with MS clinicians would be feasible and assist with making better DMT selections.

RESULTS
Twenty-three interviews were completed with eligible patients with MS aged 18 to 70 years to improve readability. Using thematic analysis, 5 themes emerged from the analysis including decision aids are easy and understandable, include cost, prioritize side effects and tests, increase font size, and have a simpler injectable grid. We also identified areas for improvement including formatting, side effects of DMT options, transparency of data sources, research, and development.

CONCLUSION
Overall findings suggest that the decision aids are usable, easy to understand, and helpful to facilitate shared decision making for DMT selection. This work will help guide further modifications to the prototype MS decision aids before publication and can inform the growing body of knowledge regarding the development of high-quality decision aids.
Psychosocial Sequelae of Stroke in Working-Age Adults: A Pilot Study
Authors: Rhudy Lori M. , Wells-Pittman Jennifer , Flemming Kelly D. 
Published: June 2020

ABSTRACT

OBJECTIVE
Few prospective studies have examined psychosocial symptoms in young adult stroke survivors. The purpose of this pilot study was to examine the feasibility of methods to assess and describe the presence of symptoms and their characteristics in young adult stroke survivors.

METHODS
A prospective descriptive design using PROMIS and NeuroQoL patient-reported outcomes was used. Stroke survivors aged 18 to 65 years admitted for acute ischemic stroke completed baseline measures before hospital discharge; the same measures were collected by telephone interview 6 months later.

RESULTS
Thirty patients were recruited, and 18 (60%) completed follow-up measures. There was wide variability in scores across patients for each patient-reported outcome that persisted at 6 months. NeuroQoL cognitive function was the only patient-reported outcome to have a statistically significant change from baseline to 6 months (P = .045).

CONCLUSIONS
It is feasible to recruit and retain young adult stroke survivors in a prospective study. Wide variability in scores across patients suggests different trajectories of recovery in the first 6 months after stroke. Neuroscience nurses can assess for these symptoms and provide individualized interventions to aid in self-management of burdensome symptoms.
Death Self-efficacy, Attitudes Toward Death and Burnout Among Oncology Nurses
Authors: Zheng Ruishuang , Guo Qiaohong , Dong Fengqi , Gao Li 
Published: June 2020

Background
To effectively care for dying patients, nurses need to possess death self-efficacy—the state of having both a range of skills and capabilities to provide care to dying patients and confidence in one’s ability to do so. A paucity of death self-efficacy may lead to burnout.

Objectives
The aims of this study are to clarify oncology nurses’ death self-efficacy and to explore its relationships with attitudes toward death and burnout.

Methods
A cross-sectional study was performed in 7 cancer hospitals across mainland China between June and July 2019. Oncology nurses completed an online survey consisting of the Death Self-efficacy Scale, Death Attitude Profile–Revised Scale, and Maslach Burnout Inventory.

Results
The 755 oncology nurses completing the survey reported low death self-efficacy and high levels of burnout. Those who had more years of clinical experience, had the highest professional rank, talked death quite often, and have received palliative care trainings, doing no shift work, scored higher on death self-efficacy. Death self-efficacy was positively correlated with positive attitudes toward death and negatively correlated with levels of burnout. The multiple regression analysis showed that death self-efficacy and attitudes toward death were independent, significant predictors of oncology nurses’ burnout.

Conclusions
Chinese oncology nurses are not well prepared to care for dying cancer patients and cope with death-related issues.

Implications for Practice
Improvement in death self-efficacy among oncology nurses is necessary, especially for those who are young, are unmarried, are doing shift work, and never received palliative care training. Enhanced death self-efficacy may be realized through self-reflective practice and palliative care education.
Virtual Reality Intervention Targeting Pain and Anxiety Among Pediatric Cancer Patients Undergoing Peripheral Intravenous Cannulation
Authors: Wong Cho Lee , Li Chi Kong , Chan Carmen W. H. , Choi Kai Chow , Chen Jieling , Yeung Man Ting , Chan On Na 
Published: June 2020

Background
Peripheral intravenous cannulation (PIC) is commonly performed in cancer treatment and causes pain and anxiety to children with cancer.

Objective
The aim of this study was to determine whether virtual reality distraction intervention can alleviate pain and anxiety and reduce length of procedure among pediatric cancer patients undergoing PIC.

Methods
One hundred eight pediatric cancer patients aged 6 to 17 years were recruited from a regional public hospital in Hong Kong to participate in this randomized controlled trial. The intervention group received virtual reality distraction intervention, and the control group received standard care. The primary outcome was child-reported pain. Secondary outcomes included child-reported anxiety, pulse rate, and length of procedure. Outcome measurements were conducted at 5 minutes before, during, and immediately after the procedure.

Results
Pediatric cancer patients in the intervention group demonstrated a significantly greater reduction in pain (estimated mean difference = −1.69, P = .007) and anxiety levels (estimated mean difference = −3.50, P < .001) compared with the control group. The mean duration (in minutes) for the PIC procedure was significantly shorter among participants receiving virtual reality intervention compared with the control counterparts (estimated mean difference = −0.75, P = .017). However, no significant difference was observed in pulse rate during and after the procedure between groups.

Conclusions
Findings indicate that virtual reality is safe and effective to alleviate pain and anxiety among pediatric cancer patients undergoing PIC procedure.

Implications for Practice
Virtual reality can be considered as an adjunctive treatment to manage pain and anxiety in pediatric cancer patients before and during PIC procedure.
Implementing a New Capstone Leadership Clinical Course
Authors: Novotny Nancy L. , Jarvill Melissa , Nielsen Sandra D. , Morris Kathleen A. 
Published: June 2020

Background
Nurse educators are challenged to ensure clinical education meets the changing health care environments and needs.

Problem
New nurses remain unprepared for practice, have insufficient foundational leadership capacities, and lack systems-thinking awareness.

Approach
Responding to educational gaps, increased enrollment, and scarce clinical placements, faculty used an eclectic education model to develop a new capstone leadership clinical course that included 5 types of experiences. The total acute care clinical hours were reduced, while adding leadership-focused experiences and simulated learning.

Outcomes
Stakeholders' evaluations indicate the pilot provided opportunities to strengthen students' leadership capacity, systems thinking, and professional identity while still providing sufficient practice managing care of multiple patients, engaging in teamwork, and applying evidence.

Conclusion
The new clinical course addressed students' transition into practice needs and enrollment capacity issues. Thoughtful planning by invested stakeholders, communication among faculty, and clear expectations are necessary to implement eclectic clinical models.
A Vital Sign-Based Model to Predict Clinical Deterioration in Hospitalized Children*
Authors: Mayampurath Anoop , Jani Priti , Dai Yangyang , Gibbons Robert , Edelson Dana , Churpek Matthew M. 
Published: June 2020

Objectives:
Clinical deterioration in hospitalized children is associated with increased risk of mortality and morbidity. A prediction model capable of accurate and early identification of pediatric patients at risk of deterioration can facilitate timely assessment and intervention, potentially improving survival and long-term outcomes. The objective of this study was to develop a model utilizing vital signs from electronic health record data for predicting clinical deterioration in pediatric ward patients.

Design:
Observational cohort study.

Setting:
An urban, tertiary-care medical center.

Patients:
Patients less than 18 years admitted to the general ward during years 2009–2018.

Interventions:
None.

Measurements and Main Results:
The primary outcome of clinical deterioration was defined as a direct ward-to-ICU transfer. A discrete-time logistic regression model utilizing six vital signs along with patient characteristics was developed to predict ICU transfers several hours in advance. Among 31,899 pediatric admissions, 1,375 (3.7%) experienced the outcome. Data were split into independent derivation (yr 2009–2014) and prospective validation (yr 2015–2018) cohorts. In the prospective validation cohort, the vital sign model significantly outperformed a modified version of the Bedside Pediatric Early Warning System score in predicting ICU transfers 12 hours prior to the event (C-statistic 0.78 vs 0.72; p < 0.01).

Conclusions:
We developed a model utilizing six commonly used vital signs to predict risk of deterioration in hospitalized children. Our model demonstrated greater accuracy in predicting ICU transfers than the modified Bedside Pediatric Early Warning System. Our model may promote opportunities for timelier intervention and risk mitigation, thereby decreasing preventable death and improving long-term health.
Practical Considerations for Radiologists in Implementing a Patient-friendly MRI Experience
Authors: Oztek Murat Alp , Brunnquell Christina L. , Hoff Michael N. , Boulter Daniel J. , Mossa-Basha Mahmud , Beauchamp Luke H. , Haynor David L. , Nguyen Xuan V. 
Published: June 2020

AbstractFor many patients, numerous unpleasant features of the magnetic resonance imaging (MRI) experience such as scan duration, auditory noise, spatial confinement, and motion restrictions can lead to premature termination or low diagnostic quality of imaging studies. This article discusses practical, patient-oriented considerations that are helpful for radiologists contemplating ways to improve the MRI experience for patients. Patient friendly scanner properties are discussed, with an emphasis on literature findings of effectiveness in mitigating patient claustrophobia, other anxiety, or motion and on reducing scan incompletion rates or need for sedation. As shorter scanning protocols designed to answer specific diagnostic questions may be more practical and tolerable to the patient than a full-length standard-of-care examination, a few select protocol adjustments potentially useful for specific clinical settings are discussed. In addition, adjunctive devices such as audiovisual or other sensory aides that can be useful distractive approaches to reduce patient discomfort are considered. These modifications to the MRI scanning process not only allow for a more pleasant experience for patients, but they may also increase patient compliance and decrease patient movement to allow more efficient acquisition of diagnostic-quality images.
Virtual Reality to Relieve Pain in Burn Patients Undergoing Imaging and Treatment
Authors: Bermo Mohammed S. , Patterson David , Sharar Sam R. , Hoffman Hunter , Lewis David H. 
Published: June 2020

Abstract
Pain from burn injuries is among the most excruciating encountered in clinical practice. Pharmacological methods often fail to achieve acceptable level of analgesia in these patients, especially during burn wound dressing and debridement. Virtual reality (VR) distraction is a promising analgesic technique that progressed significantly in the last decade with development of commercially available, low-cost, high-resolution, wide field-of-view, standalone VR devices that can be used in many clinical scenarios. VR has demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. The technique has proven useful also in preparing patients for magnetic resonance imaging scans, particularly in claustrophobic patients. Modulation of pain-related brain activity at cortical and subcortical levels by VR, and its correlation with subjective improvement in various laboratory and clinical pain experiences has been demonstrated using multiple functional brain imaging studies including functional magnetic resonance imaging and brain perfusion single photon emission computed tomography.
Applying Artificial Intelligence to Mitigate Effects of Patient Motion or Other Complicating Factors on Image Quality
Authors: Nguyen Xuan V. , Oztek Murat Alp , Nelakurti Devi D. , Brunnquell Christina L. , Mossa-Basha Mahmud , Haynor David R. , Prevedello Luciano M. 
Published: June 2020

AbstractArtificial intelligence, particularly deep learning, offers several possibilities to improve the quality or speed of image acquisition in magnetic resonance imaging (MRI). In this article, we briefly review basic machine learning concepts and discuss commonly used neural network architectures for image-to-image translation. Recent examples in the literature describing application of machine learning techniques to clinical MR image acquisition or postprocessing are discussed. Machine learning can contribute to better image quality by improving spatial resolution, reducing image noise, and removing undesired motion or other artifacts. As patients occasionally are unable to tolerate lengthy acquisition times or gadolinium agents, machine learning can potentially assist MRI workflow and patient comfort by facilitating faster acquisitions or reducing exogenous contrast dosage. Although artificial intelligence approaches often have limitations, such as problems with generalizability or explainability, there is potential for these techniques to improve diagnostic utility, throughput, and patient experience in clinical MRI practice.