bluuebunny/crossref_metadata_2025_split huggingface dataset:
Students’ perceptions on their use of an EHR: pilot questionnaire study
Authors: Ellis Beverley S , Quayle Susan , Bailey Ian , Tishkovskaya Svetlana , Spencer Joseph , Richardson Robin 
Published: October 2020

IntroductionMany clinical education programmes have not incorporated the use of the electronic health record (EHR) into their curriculum. It is important to incorporate technologies that will be used in real-world settings to better prepare students for clinical practice.ObjectivesTo undertake a review of literature to identify a training evaluation framework; to conduct a self-completion survey, pretraining and post-training, to determine students’ perceptions on the benefit of using EHR training system.SettingNursing School, University, North West England, UK; University Ethic Committee Approval Received.ParticipantsRegistered nurses undertaking a validated return to practice course; 24 participants for the first cohort who completed pretraining questionnaire and 23 for the second post-training cohort.ResultsThe statistical results show that the students perceived that the training improved their capability in employing digital systems with statistically significant difference in the assessed preproficiency and post proficiency in the use of digital clinical systems (premedians and post medians are 2 and 5 on 10-point Likert scale, p=0.041). There was also an indication of an improvement in the knowledge of EHR systems although not statistically significant. Most students perceived it increased their knowledge on digital systems.ConclusionStudents perceived an increase in proficiency with the EHR. There was evidence of improvement in confidence in the use of the EHR, but this confidence would be enhanced by additional use of the system. Some desire to increase confidence further and to develop knowledge of digital systems was expressed.
Atrial fibrillation dashboard evaluation using the think aloud protocol
Authors: de Lusignan Simon , Liyanage Harshana , Sherlock Julian , Ferreira Filipa , Munro Neil , Feher Michael , Hobbs Richard 
Published: October 2020

BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia which is a major risk factor for stroke, transient ischaemic attacks and increased mortality. Primary care management of AF can significantly reduce these risks. We carried out an evaluation to asses the usability of an AF dashboard developed to improve data quality and the quality of care.MethodWe developed an online dashboard about the quality of AF management for general practices of the Oxford Royal College of General Practitioners Research and Surveillance Centre network. The dashboard displays (1) case ascertainment, (2) a calculation of stroke and haemorrhage risk to assess whether the benefits of anticogulants outweigh their risk, (3) prescriptions of different types of anticoagulant and (4) if prescribed anticoagulant is at the correct dose. We conducted the think aloud evaluation, involving 24 dashboard users to improve its usability.ResultsAnalysis of 24 transcripts received produced 120 individual feedback items (ie, verbalised tasks) that were mapped across five usability problem classes. We enhanced the dashboard based on evaluation feedback to encourage adoption by general practices participating in the sentinel network.ConclusionsThe think aloud evaluation provided useful insights into important usability issues that require further development. Our enhanced AF dashboard was acceptable to clinicians and its impact on data quality and care should be assessed in a formal study.
Effectiveness of virtual reality-based gait education in enhancing the rehabilitation outcomes of injured military personnel
Authors: Houston Andrew David , Coppack R J , Bennett A N 
Published: October 2020

IntroductionCorrecting adverse biomechanics is key in rehabilitating musculoskeletal injuries. Verbal instruction remains the primary method for correcting biomechanics and therefore a patient’s understanding of these instructions is believed to directly influence treatment outcomes. The aim of this study was to establish the patients’ perceptions of virtual reality-based gait education (VR-GEd) and to assess its influence on the standard military rehabilitation outcomes.MethodsA retrospective analysis using routinely collected data was performed. Twenty patients with lower-limb musculoskeletal injuries undertook a VR-GEd session on the commencement of a 3-week, multidisciplinary, inpatient course of rehabilitation. Patient outcomes were compared with a group of matched controls, completing the same standardised course of inpatient treatment.ResultsThe VR-GEd group exhibited greater reductions the interference pain had on their mood (p=0.022). Improvements in generalised anxiety (p=0.029) were greater in the VR-GEd group but were not large enough to be clinically meaningful. VR-GEd did not influence functional outcomes. Patients rated the sessions highly in terms of enjoyment and perceived value. Patient feedback highlighted that they understood their injury better and felt the session could positively influence their recovery.ConclusionVR-GEd was proven to be an enjoyable and valued means of educating military inpatients about their injury mechanics. This study found no contraindications for the inclusion of VR-GEd in current rehabilitation programmes. However, current evidence suggests a single VR-GEd session cannot act as a replacement for biofeedback interventions, due to the lack of enhanced improvement across rehabilitation outcomes.
Simulation-based education programme for upskilling non-critical care nurses for COVID-19 deployment
Authors: Almomani Emad , Sullivan Jacqueline , Hajjieh Majed , Leighton Kim 
Published: October 2020

BackgroundThe coronavirus disease 2019 (COVID-19) crisis created pressure on healthcare institutions to be prepared with maximum workforce and bed capacity. Clinical education during COVID-19 has high risk of disease transmission to learners due to contamination of equipment, supplies and surfaces, in addition to increased clinical-related stress and fear. Simulation-based education (SBE) has potential to help manage the pandemic by rapidly upskilling nurses’ clinical responsibilities.MethodsUpskilling of 445 non-critical care nurses was conducted using SBE between 14th March and 30 May 2020. Training consisted of completing a mandatory online critical care awareness module, followed by 3 hours of critical care simulation-based scenarios using demonstration and return-demonstration approach.ResultsAll 445 non-critical care nurses completed required modules and simulation experiences. The critical care simulation-based upskilling programme was evaluated as an effective way to learn how to manage critically ill patients. The majority of evaluation items were rated over 95% for effectiveness of the education; four items were less than 95% (88–94%). Lower rated items considered training and practice time, improved competency and commitment to apply learning.ConclusionRapidly developed and implemented upskilling of critical care nurses was effectively accomplished with SBE. However, learners noted the need for longer learning times and increased practice opportunity to improve competency. Lack of intent to apply the patient care techniques requires further study. SBE has potential as an effective educational method for rapid preparedness in future crisis.
Total knee arthroplasty under quadruple nerve block with ropivacaine 0.32%: effect of addition of intravenous dexmedetomidine to intravenous dexamethasone on analgesic duration
Authors: Chassery Clement , Marty Philippe , Rontes Olivier , Chaubard Martine , Vuillaume Corine , Basset Bertrand , Merouani Mehdi , Marquis Constance , De Lussy Anne , Delbos Marie-Claude , Casalprim Julie , Bataille Benoit , Naudin Cecile , Ferre Fabrice , Delbos Alain 
Published: October 2020

Background and objectivesPeripheral nerve blocks reduce postoperative pain and enhance recovery after total knee arthroplasty (TKA). This study aims to assess the benefits of addition of intravenous dexmedetomidine (DexM) to intravenous dexamethasone on the analgesic duration of quadruple nerve blocks.MethodsThis double-blind, randomized, controlled trial prospectively enrolled 90 patients scheduled for TKA under quadruple nerve blocks (sciatic, femoral, obturator, and lateral femoral cutaneous nerves blocks) with 70 mL, 0.32% ropivacaine. All patients received systemic dexamethasone 10 mg. Patients were randomized to receive DexM (2 µg/kg, intravenous) or placebo (1:1 ratio). The primary endpoint was the duration of analgesia defined as the time to first request for rescue analgesia (oxycodone).ResultsKaplan-Meier curves for the first analgesic request were similar between groups (log-rank test; p=0.27). Median (IQR) duration of analgesia was similar between placebo (1575 min (1211–1952)) and DexM (1470 min (1263–1700)) groups (p=0.56). Cumulative consumption of oxycodone at the 48th hour was 20 mg (10–30) and 30 mg (20–40) in placebo and DexM groups, respectively (p=0.14). The day after surgery, 93% and 89% of patients were able to walk in placebo and DexM groups, respectively (p=0.46). Intravenous DexM was associated with bradycardia, hypotension and longer recovery room stay (p<0.05 for all comparisons).ConclusionsIn a multimodal analgesic regimen, addition of systemic DexM (2 µg/kg) to systemic dexamethasone does not prolong the analgesic duration of quadruple nerve block with ropivacaine 0.32% after TKA.Trial registration numberNCT03834129.
Emerging insights in weight management and prevention: implications for practice and research
Authors: Doucet Eric , Hall Kevin , Miller Andrea , Taylor Valerie H. , Ricupero Maria , Haines Jess , Brauer Paula , Gudzune Kimberly A. , House James D. , Dhaliwal Rupinder 
Published: October 2020

Recent advances in foundational research on energy balance and weight loss shed new light on earlier findings. Emerging evidence and insights around mental illness and client-centred, weight-inclusive approaches have implications for practitioners. This paper provides an overview of opinions from invited experts who presented at the Canadian Nutrition Society Thematic Conference in January 2019. Novelty: Weight loss involves an interplay of multiple factors, not diet alone. There is no “best diet” or treatment approach for weight loss. Future research should involve minimizing weight loss countermeasures and new health system-based approaches aimed at improving health.
A biocompatible technique for magnetic field sensing at (sub)cellular scale using Nitrogen-Vacancy centers
Authors: Bernardi Ettore , Moreva Ekaterina , Traina Paolo , Petrini Giulia , Ditalia Tchernij Sviatoslav , Forneris Jacopo , Pastuović Željko , Degiovanni Ivo Pietro , Olivero Paolo , Genovese Marco 
Published: October 2020

AbstractWe present an innovative experimental set-up that uses Nitrogen-Vacancy centres in diamonds to measure magnetic fields with the sensitivity of $\eta =68\pm 3~\mathrm{nT}/\sqrt{\mathrm{Hz}}$
η
=
68
±
3

nT
/

Hz

at demonstrated (sub)cellular scale. The presented method of magnetic sensing, utilizing a lock-in based ODMR technique for the optical detection of microwave-driven spin resonances induced in NV centers, is characterized by the excellent magnetic sensitivity at such small scale and the full biocompatibility. The cellular scale is obtained using a NV-rich sensing layer of 15 nm thickness along z axis and a focused laser spot of $(10 \times 10)~\mu\mathrm{m}^{2}$
(
10
×
10
)

μ

m
2

in x-y plane. The biocompatibility derives from an accurate choice of the applied optical power. For this regard, we also report how the magnetic sensitivity changes for different applied laser power and discuss the limits of the sensitivity sustainable with biosystem at such small volume scale. As such, this method offers a whole range of research possibilities for biosciences.
Effect of Empagliflozin on the Clinical Stability of Patients With Heart Failure and a Reduced Ejection Fraction
Authors: Packer Milton , Anker Stefan D. , Butler Javed , Filippatos Gerasimos , Ferreira João Pedro , Pocock Stuart J. , Carson Peter , Anand Inder , Doehner Wolfram , Haass Markus , Komajda Michel , Miller Alan , Pehrson Steen , Teerlink John R. , Brueckmann Martina , Jamal Waheed , Zeller Cordula , Schnaidt Sven , Zannad Faiez ,   For the EMPEROR-Reduced Trial Committees and Investigators
Published: October 2020

Background:
Empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, with or without diabetes, but additional data are needed about the effect of the drug on inpatient and outpatient events that reflect worsening heart failure.

Methods:
We randomly assigned 3730 patients with class II to IV heart failure with an ejection fraction of ≤40% to double-blind treatment with placebo or empagliflozin (10 mg once daily), in addition to recommended treatments for heart failure, for a median of 16 months. We prospectively collected information on inpatient and outpatient events reflecting worsening heart failure and prespecified their analysis in individual and composite end points.

Results:

Empagliflozin reduced the combined risk of death, hospitalization for heart failure or an emergent/urgent heart failure visit requiring intravenous treatment (415 versus 519 patients; empagliflozin versus placebo, respectively; hazard ratio [HR], 0.76; 95% CI, 0.67–0.87;
P
<0.0001). This benefit reached statistical significance at 12 days after randomization. Empagliflozin reduced the total number of heart failure hospitalizations that required intensive care (HR, 0.67; 95% CI, 0.50–0.90;
P
=0.008) and that required a vasopressor or positive inotropic drug or mechanical or surgical intervention (HR, 0.64; 95% CI, 0.47–0.87;
P
=0.005). As compared with placebo, fewer patients in the empagliflozin group reported intensification of diuretics (297 versus 414 [HR, 0.67; 95% CI, 0.56–0.78;
P
<0.0001]). Additionally, patients assigned to empagliflozin were 20% to 40% more likely to experience an improvement in New York Heart Association functional class and were 20% to 40% less likely to experience worsening of New York Heart Association functional class, with statistically significant effects that were apparent 28 days after randomization and maintained during long-term follow-up. The risk of any inpatient or outpatient worsening heart failure event in the placebo group was high (48.1 per 100 patient-years of follow-up), and it was reduced by empagliflozin (HR, 0.70; 95% CI, 0.63–0.78;
P
<0.0001).

Conclusions:
In patients with heart failure and a reduced ejection fraction, empagliflozin reduced the risk and total number of inpatient and outpatient worsening heart failure events, with benefits seen early after initiation of treatment and sustained for the duration of double-blind therapy.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03057977.
A Model of Online Temporal-Spatial Integration for Immediacy and Overrule in Discourse Comprehension
Authors: Uchida Takahisa , Lair Nicolas , Ishiguro Hiroshi , Dominey Peter Ford 
Published: October 2020

AbstractDuring discourse comprehension, information from prior processing is integrated and appears to be immediately accessible. This was remarkably demonstrated by an N400 for “salted” and not “in love” in response to “The peanut was salted/in love.” Discourse overrule was induced by prior discourse featuring the peanut as an animate agent. Immediate discourse overrule requires a model that integrates information at two timescales. One is over the lifetime and includes event knowledge and word semantics. The second is over the discourse in an event context. We propose a model where both are accounted for by temporal-to-spatial integration of experience into distributed spatial representations, providing immediate access to experience accumulated over different timescales. For lexical semantics, this is modeled by a word embedding system trained by sequential exposure to the entire Wikipedia corpus. For discourse, this is modeled by a recurrent reservoir network trained to generate a discourse vector for input sequences of words. The N400 is modeled as the difference between the instantaneous discourse vector and the target word. We predict this model can account for semantic immediacy and discourse overrule. The model simulates lexical priming and discourse overrule in the “Peanut in love” discourse, and it demonstrates that an unexpected word elicits reduced N400 if it is generally related to the event described in prior discourse, and that this effect disappears when the discourse context is removed. This neurocomputational model is the first to simulate immediacy and overrule in discourse-modulated N400, and contributes to characterization of online integration processes in discourse.
At the Nexus of Refugee and Labour Migration: US Refugee Policy Formulation after the Second World War
Authors: Wasem Ruth Ellen 
Published: October 2020

Abstract
After the Second World War, liberal reformers in the US Congress pushed refugee legislation and included refugee provisions in their immigration reform bills. Presidents Harry Truman and Dwight Eisenhower were among those who urged Congress to enact refugee legislation. Without a statutory pathway for persons entering as refugees or asylees to become lawful permanent residents (lprs), refugee admissions were reactive. Some presidents would draw on other executive authorities to bring refugees into the United States, relying on Congress to subsequently enact laws providing lpr status. In other instances, Congress would enact refugee legislation aimed at specific populations and limited numbers. As a result, refugee policy was handled in a piecemeal and incremental fashion during this period. It is within this context that this article explores the nexus of refugee and labour migration policies and the role the nativist right-wing political leaders played in shaping US policy in this period.
Two Different Tracts and Origin of Pyriform Sinus Fistula
Authors: Sakakura Koichi , Yasuoka Yoshihito , Shino Masato , Toyoda Minoru , Obi Kisho , Chikamatsu Kazuaki 
Published: October 2020

Objective: Suppurative acute thyroiditis is caused by pyriform sinus fistula (PSF), and PSF frequently elicits deep neck abscess. However, complete fistulectomy is the ideal management of PSF, and studies on surgical findings of PSF are exceedingly rare. This study aimed to reveal the origins of PSF, each route, and clinical presentation. Methods: This is a multicenter study. We have conducted 19 complete fistulectomies of PSF in Japan, analyzed routes of the fistulas, estimated the origins, and investigated their histological and clinical findings. Results: No recurrence was observed in all cases. Five of 12 cases showed thymic and/or parathyroid tissues around the fistulas, passing inside the inferior horn of thyroid cartilage, were regarded as having 3rd pouch origin, and tended to have low frequency of severe deep neck abscess. The remaining 7 cases originated from the 4th pouch running outside of the horn and showed frequent severe infection. Conclusion: PSF have 2 different routes depending on their generation and may present different clinical manifestations.
A Prospective Multicenter Clinical Performance Evaluation of the C-CGM System
Authors: Rebec Mihailo , Cai Kevin , Dutt-Ballerstadt Ralph , Anderson Ellen 
Published: October 2020

Background: Continuous glucose monitors (CGMs) have had a significant impact on the management of diabetes mellitus. We present the results of a multinational evaluation of the Cascade CGM (“C-CGM”) over 14 days of in-clinic and home use. Method: Each of the 57 enrolled type 1 diabetes mellitus and type 2 diabetes mellitus subjects wore 2 C-CGMs on the abdomen for 14 days. One part of the evaluation was the performance versus reference glucose values generated for 12 -hour in-clinic sessions on days 1, 4, 7, 10, and 14. Glucose blood samples were drawn every 15 minutes and analyzed with the Yellow Spring Instruments (YSI) 2300 glucose analyzer. The performance assessment on in-clinic days was based on paired YSI/CGM data points and on home-use days was based on paired fingerstick BGM (blood glucose monitoring)/CGM data points. Results: A total of 17 823 CGM/YSI data points during in-clinic use was analyzed. The mean absolute relative difference for glucose values between 100 and 400 mg/dL (MARD) and mean absolute difference for values between 40 and 100 mg/dL (MAD) were 11.5% and 15.1 mg/dL, respectively. The system accuracy during home use was 12.7% and 15 mg/dL for MARD and MAD, respectively. There were no serious adverse events or infectious complications reported. A modified algorithm “Hybrid Algorithm” was used in a prospective analysis of the in-clinic data, resulting in a MARD of 9.9% and MAD of 14.5 mg/dL. Conclusions: The performance of the C-CGM device over 14 days meets the safety and efficacy standards of CGM systems for managing blood glucose levels in people with diabetes. This was further confirmed when the C-CGM system was given approval for CE Mark in October 2019.
Doxorubicin and subsequent risk of cardiovascular diseases among survivors of diffuse large B-cell lymphoma in Hong Kong
Authors: Lee Shing Fung , Luque-Fernandez Miguel Angel , Chen Yu Hui , Catalano Paul J. , Chiang Chi Leung , Wan Eric Yuk-Fai , Wong Ian Chi-Kei , Chen Ming Hui , Ng Andrea K. 
Published: October 2020

Abstract
Evidence regarding the dose-related impact of doxorubicin on subsequent cardiovascular diseases (CVDs) in Asian patients with diffuse large B-cell lymphoma (DLBCL) without preexisting CVDs is lacking. From a territory-wide electronic database in Hong Kong, we identified adults who were diagnosed with DLBCL and treated with chemotherapy between 2000 and 2018. We evaluated the patients for incident CVDs (including ischemic heart disease, heart failure, and cardiomyopathy). We evaluated the cause-specific cumulative incidence (csCI) of CVD with levels of doxorubicin exposure by using flexible parametric competing risk analysis and adjusting for demographics, comorbidities, therapeutic exposure, cardiovascular risk factors, and lifestyle factors. Controls were age- and sex-matched to DLBCL patients. We analyzed 2600 patients and 13 000 controls. The adjusted cause-specific hazard ratio (HR) for CVD in patients treated with &gt;500 mg doxorubicin compared with non-doxorubicin regimens was 2.65 (95% confidence interval [CI], 1.23-5.74; P = .013). The 5-, 10-, and 15-year csCIs were 8.2%, 11.3%, and 12.8% in patients vs 3.1%, 4.4%, and 5.2% in controls, respectively. Hypertension (HR, 6.20; 95% CI, 0.79-48.44; P = .082) and use of aspirin/angiotensin-converting enzyme inhibitor/beta-blocker at baseline (HR, 2.13-4.63; P &lt; .001 to .002) might confer a higher risk of subsequent CVDs. In this Hong Kong population-based study, doxorubicin exposure (absolute dose &gt;500 mg), together with hypertension or baseline use of medication for cardiovascular risk factors, was found to be associated with an increase in csCIs of CVDs. Tailoring therapeutic strategies to underlying CVD risk factors and risk-adapted monitoring and follow-up of susceptible DLBCL patients are advisable.