bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applications of interpretability in deep learning models for ophthalmology
Authors: Hanif Adam M. , Beqiri Sara , Keane Pearse A. , Campbell J. Peter 
Published: July 2021

Purpose of review
In this article, we introduce the concept of model interpretability, review its applications in deep learning models for clinical ophthalmology, and discuss its role in the integration of artificial intelligence in healthcare.

Recent findings
The advent of deep learning in medicine has introduced models with remarkable accuracy. However, the inherent complexity of these models undermines its users’ ability to understand, debug and ultimately trust them in clinical practice. Novel methods are being increasingly explored to improve models’ ’interpretability’ and draw clearer associations between their outputs and features in the input dataset. In the field of ophthalmology, interpretability methods have enabled users to make informed adjustments, identify clinically relevant imaging patterns, and predict outcomes in deep learning models.

Summary
Interpretability methods support the transparency necessary to implement, operate and modify complex deep learning models. These benefits are becoming increasingly demonstrated in models for clinical ophthalmology. As quality standards for deep learning models used in healthcare continue to evolve, interpretability methods may prove influential in their path to regulatory approval and acceptance in clinical practice.
A review of the impact of exercise on fall rates among community-dwelling older adults
Authors: Pierson Kirsten , Maloney Meghan , Bavuso Alyssa , Dowling Kathryn , Kunsang Tenzin , Wong Michelle E. 
Published: July 2021

ABSTRACT

Background:
The physical decrements of aging predispose older adults to falls and fall-related injuries. Consequences of falling place financial and logistical burdens on the health care system. With an aging population, mitigation of risk and reduction of harm are important objectives. Studies show that exercise can improve balance and build muscle mass. The challenge is prescribing safe and evidence-based exercise regimens to older adults.

Objectives:
The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community.

Data sources:
This review included 14 randomized control trials and one quasi-experimental interventional study, all published between 2014 and 2020.

Conclusions:
The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults.

Implications for practice:
The evidence suggests that a home- or community-based exercise program may be an effective fall-prevention strategy for older adults living independently in the community. Health care providers should educate these patients about the benefits of exercise as a fall-prevention measure and assist patients in increasing participation in exercise programs by making referrals and promoting engagement in evidence-based exercise programs.
Perioperative omega-3 fatty acids for liver surgery
Authors: Xiao Fubin , Han Wei , Yue Qing , Ke Jianji , Jia Baoxing , Fu Xiaojuan 
Published: July 2021

Abstract

Introduction:
The effect of perioperative omega-3 fatty acids for liver surgery remained controversial. We conducted a systematic review and meta-analysis to explore the influence of omega-3 fatty acids versus placebo in patients undergoing liver surgery.

Methods:
We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020, and included randomized controlled trials (RCTs) assessing the effect of omega-3 fatty acids versus placebo for liver surgery. This meta-analysis was performed using the random-effect model.

Results:
Five RCTs were included in the meta-analysis. Overall, compared with control group for liver surgery, omega-3 fatty acids were associated with substantially reduced incidence of infection (odd ratio [OR]=0.56; 95% confidence interval [CI] =0.34–0.91; P = .02), but revealed no remarkable influence on complications (OR = 0.60; 95% CI = 0.29–1.24; P = .17), mortality (OR = 0.76; 95% CI = 0.06–9.37; P = .83), liver failure (OR = 0.72; 95% CI = 0.10 to 5.00; P = 0.74), biliary leakage (OR=1.24; 95% CI = 0.41 to 3.76; P = .70), bleeding (OR = 1.76; 95% CI = 0.63–4.95; P = .28), or ileus (OR = 0.39; 95% CI = 0.07–2.05; P = .27).

Conclusion:
Perioperative omega-3 fatty acids may be beneficial to reduce the incidence of infection after liver surgery.
The efficacy of sodium glucose co-transport-2 inhibitors on glycemic control for patients with type 1 diabetes mellitus
Authors: Zhang Yajie , Gan Ping , Huo Yanan 
Published: July 2021

Abstract

Background:
Currently, there are a number of sodium glucose co-transport-2 (SGLT2) inhibitors that are under development or in clinical trials. Prior meta-analyses had established the safety and efficacy of SGLT2 inhibitors in type 1 diabetes mellitus (T1DM), but with low level of evidences and inconsistent conclusions. However, recently many new randomized clinical trials (RCTs) have been published, we hence try to design a study protocol to assess the effect of SGLT2 inhibitors on cardiovascular events via a comprehensive meta-analysis of data from much more RCTs, including sensitivity and subgroup analyses.

Methods:
We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines to conduct this meta-analysis. Two investigators will perform a systematic search of scientific literature in the databases (from conception through June 12, 2021), including PubMed, Embase, and Cochrane Central Register of Controlled Trials. This meta-analysis will be conducted using RevMan statistical software. The risk of bias for each included study will be assessed using the Cochrane Risk of Bias Assessment Tool.

Results:
Our protocol is conceived to test the hypothesis that SGLT2 inhibitors could lead to better outcomes in patients presenting with T1DM.

Registration number:
10.17605/OSF.IO/ZD8WX.
Clinical therapeutic effects of eradication of Helicobacter pylori in treating patients with type 2 diabetes mellitus
Authors: Shi Zhi-Guo , Chen Li-Hui 
Published: July 2021

Abstract

Background:
Previous studies have demonstrated that Helicobacter pylori is a critical factor in the development of gastrointestinal diseases. However, only limited studies have reported results on the relationship between H pylori infection and patients with type 2 diabetes mellitus (T2DM). Moreover, the conclusions from these past studies are variable. Because there are contradictory results on this issue, the present study aims to examine the clinical therapeutic impacts of H pylori eradication to treat patients experiencing T2DM.

Methods:
The present protocol is drafted according to the provisions of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols guidelines. PubMed, Cochrane Central Register of Controlled Trials databases, EMBASE, Web of Science, China National Knowledge Infrastructure, and Chinese BioMedical Literature Database will be searched up to May 2021 to obtain randomized controlled trials evaluating the clinical therapeutic effects of H pylori eradication to treat patients experiencing T2DM. We will use 2 investigators independently to carry out study selection, data extraction, and employ the Cochrane Collaboration criteria to evaluate their risks of bias. Furthermore, we will apply Stata 16.0 software to perform data analysis.

Results:
We intend to evaluate the clinical therapeutic impacts of H pylori eradication to treat patients suffering from T2DM.

Conclusions:
Our findings may support existing evidence on the clinical therapeutic impacts of H pylori eradication to treat patients with T2DM.

Ethics and dissemination:
Since all data will be extracted from the published literature, the study does not require an ethical approval.

OSF registration number:
May 31, 2021.osf.io/qtexu. (https://osf.io/qtexu/)
Detection of Chlamydia psittaci in both blood and bronchoalveolar lavage fluid using metagenomic next-generation sequencing
Authors: Yuan Yingpu , Zhang Xiaobo , Gui Chunmei 
Published: July 2021

Abstract

Rationale:

Chlamydia psittaci (C psittaci) is a gram-negative obligate intracellular parasite, with birds as main hosts. The main route of infection in humans is inhalation of aerosols from contaminated animal excreta through the respiratory tract. The main manifestation of C psittaci infection is pneumonia. Patients suffering from severe infection are prone to sepsis and multiple organ failure. We report a case of simultaneous detection of C psittaci in blood and bronchoalveolar lavage fluid using metagenomic next-generation sequencing (mNGS) technology.

Patient concerns:
The 71-year-old male patient was a farmer with a long history of raising poultry and initial symptoms of fever and muscle pain accompanied by limb weakness and paroxysmal cough.

Diagnoses:
The patient was diagnosed with sepsis, severe pneumonia, and multiple organ failure.

Interventions:
Anti-infective therapy with doxycycline and meropenem was applied.

Outcomes:
The patient's body temperature and infection indicators improved and the chest X-ray findings showed the amelioration of lesions after 18 days of treatment. The patient was discharged without treatment on hospital day 19 due to financial constraints and subsequently died after 7 days.

Lessons:
mNGS is an excellent diagnostic tool when specific pathogens are undetected by traditional assays.
Smartphone based alerting of first responders during the corona virus disease-19 pandemic
Authors: Ganter Julian , Damjanovic Domagoj , Trummer Georg , Busch Hans-Jörg , Baldas Klemens , Hänsel Mike , Müller Michael Patrick 
Published: July 2021

Abstract
Smartphone alerting systems (SAS) for first responders potentially shorten the resuscitation-free interval of patients with acute cardiac arrest. During the corona virus disease-19 (COVID-19) pandemic, many systems are suspended due to potential risks for the responders.
Objective of the study was to establish a concept for SAS during the COVID-19 pandemic and to evaluate whether a SAS can safely be operated in pandemic conditions.
A SAS had been implemented in Freiburg (Germany) in 2018 alerting nearby registered first responders in case of emergencies with suspected cardiac arrest. Due to the pandemic, SAS was stopped in March 2020. A concept for a safe restart was elaborated with provision of a set with ventilation bag/mask, airway filter, and personal protective equipment (PPE) for every volunteer. A standard operating procedure was elaborated following the COVID-19 guidelines of the European Resuscitation Council.
Willingness of the participants to respond alarms during the pandemic was investigated using an online survey. The response rates of first responders were monitored before and after deactivation, and during the second wave of the pandemic.
The system was restarted in May 2020. The willingness to respond to alarms was lower during the pandemic without PPE. It remained lower than before the pandemic when the volunteers had been equipped with PPE, but the alarm response rate remained at approximately 50% during the second wave of the pandemic.
When volunteers are equipped with PPE, the operation of a SAS does not need to be paused, and the willingness to respond remains high among first responders.
Time-saving effects using helicopter transportation: comparison to a ground transportation time predicted using a social navigation software
Authors: Jang Ji Young , Kwon Woo-Keun , Roh Haewon , Moon Jong Ha , Hwang Jun Seong , Kim Yoon Jic , Kim Jang Hun 
Published: July 2021

Abstract
Previous comparison studies regarding 2 types of transportation, helicopter (HEMS) versus ground emergency medical services (GEMS), have shown underlying heterogeneity as these options have completely different routes and consequent times with reference to one patient. To compare the 2 types of transportation on a case-by-case basis, we analyzed the retrospectively reviewed HEMS and predicted GEMS data using an open-source navigation software.
Patients transferred by military HEMS from 2016 to 2019 were retrospectively enrolled. The HEMS records on the time of notification, injury point and destination address, and time required were reviewed. The GEMS data on distance and the predicted time required were acquired using open-source social navigation systems. Comparison analyses between the two types of transportation were conducted. Furthermore, linear logistic regression analyses were performed on the distance and time of the two options.
A total of 183 patients were enrolled. There was no statistical difference (P = .3021) in the distance between the 2 types of transportation, and the HEMS time was significantly shorter than that of GEMS (61.31 vs 116.92 minutes, P < .001). The simple linear curves for HEMS and GEMS were separately secured, and two graphs presented the statistical significance (P) as well as reasonable goodness-of-fit (R
2). In general, the HEMS graph demonstrates a more gradual slope and narrow distribution compared to that of GEMS.
Ideally, HEMS is identified as a better transportation modality because it has a shorter transportation time (56 minutes saved) and a low possibility of potential time delays (larger R
2). With a strict patient selection, HEMS can rescue injured or emergent patients who are “out of the golden hour.”
Analysis of pediatric emergency department patient volume trends during the COVID-19 pandemic
Authors: Pepper Matthew Philip , Leva Ernest , Trivedy Prerna , Luckey James , Baker Mark Douglas 
Published: July 2021

Abstract
During the early period of the COVID-19 pandemic there was a substantial decrease in pediatric emergency department (PED) visitation. The intent of this study is to report PED utilization during the COVID-19 pandemic in an urban pediatric referral center located close to the epicenter in the northeastern US.
A retrospective analysis of medical records of patients visiting the PED at Robert Wood Johnson University Hospital (RWJUH) was performed. Data included: daily census, admission rate, Emergency Severity Index, and ICD-10 diagnosis codes for the period of February through July, 2018 to 2020.
By the week of March 26th, visits had decreased by 70% compared to the average of the previous 2 years. This census nadir lasted for 6 weeks. At 5 weeks postnadir the average daily census recovered to levels 40% lower than prior year norms and remained at that level during subsequent months. The greatest decreases were seen in low-acuity visits. Visits for behavioral health and fractures decreased by approximately 50% and 70%, respectively, but recovered to prior year norms by June and July of 2020. Visits for asthma exacerbation decreased by as much as 87% and remained at record lows for the remainder of the study period.
A substantial and persistent decrease in PED visitation was experienced during the COVID-19 pandemic. Whereas visits for behavioral health and fractures have recovered to prior year norms, visits for asthma exacerbation remain at record lows. Further research is needed to ascertain the causes of these changes, including patient perceptions of the PED.
The prevalence and associated factors of burnout among undergraduates in a university
Authors: Li You , Cao Liang , Liu Jianyuan , Zhang Tai , Yang Yixing , Shi Wuxiang , Wei Yingjue 
Published: July 2021

Abstract
The study aimed to evaluate the prevalence and possible factors associated with burnout (BO) among undergraduates in a university setting in Dali.
This cross-sectional study involved students enrolled in different specialties. The method of stratified random sampling was used to conduct the investigation. The questionnaire included Maslach Burnout Inventory and the influencing factors. The data were analyzed using SPSS 16.0 (SPSS Inc., Chicago, IL). The quantitative data were compared using t tests or ANOVA. Multiple linear regression was used to assess the relationship between BO risk and relevant influencing factors.
The prevalence of study BO was 38.1%. Significant differences of the mean scores on BO and low personal efficacy were observed between men and women, with women obtaining a higher score (t = –2.588, P = .010; t = –2.929, P = .003; respectively). The scores of overall BO, emotional exhaustion (EE), and cynicism were low, whereas that of professional efficacy was higher for students with excellent marks (P = .000). Students majoring in liberal arts obtained low scores of overall BO, EE, and cynicism. Nevertheless, their score for professional efficacy was higher than those from other specializations (P < .05). Total BO, as the dependent variable, revealed that 3 predictors (social factors, school factors, and interpersonal communication) accounted for 30.8% of the variance (R
2 = 0.308). A regression analysis of EE as the dependent variable identified that 2 variables (social and school factors) explained 45.8% of the variance (R
2 = 0.458).
BO among undergraduates is present in a university setting in Dali. A variety of factors including social factors, school factors, and interpersonal communication can influence the prevalence of BO. Therefore, society should strengthen employment and further understand psychology; schools and families must pay attention to the psychological development of college students.
Fracture of a covered stent–graft due to heterotopic ossification of residual hematoma after endovascular treatment of superficial femoral artery pseudoaneurysm
Authors: Ge Jinting , Wang Tiehao , Zhao Jichun , Lu Susu , Wang Jiarong , Yuan Ding 
Published: July 2021

Abstract

Rationale:
Endovascular treatment (EVT) is considered a preferred procedure of superficial femoral artery (SFA) pseudoaneurysm in recent years. However, heterotopic ossification (HO) after SFA pseudoaneurysm is a rare occurrence, that may cause late stent–graft fracture.

Patient concerns:
A 58-year-old male who underwent EVT for SFA pseudoaneurysm 8 years ago presented with a progressive mass at the right thigh and claudication. Computed tomography angiography (CTA) showed fracture and occlusion of stent–graft, which was compressed by the deep femoral artery (DFA) pseudoaneurysm and a bone-like body.

Diagnosis:
According to the CTA images, the stent–graft was fractured and occluded, accompanied by DFA pseudoaneurysm.

Interventions and outcomes:
Debridement and arterial reconstruction were performed. Pathological analysis showed that the bone-like body was derived from HO. CTA at one-year follow-up showed that the prosthetic vessel was patent and previous hematoma disappeared.

Conclusions:
This report demonstrates that residual hematoma can induce HO, which may result in late stent fracture, and it should thus be removed timely. Patients with SFA pseudoaneurysm who have undergone EVT should be followed up regularly.
Gwakhyangjeonggi-san for irritable bowel syndrome
Authors: Park Jongwon , Ko Seok-Jae , Han Gajin , Kim Keumji , Jun Hyejin , Park Jae-Woo 
Published: July 2021

Abstract

Background:
Irritable bowel syndrome (IBS) is a chronic functional bowel disorder characterized by abdominal pain or discomfort, stool irregularities, and bloating. Owing to its atypical symptoms and various mechanisms, there is no standard treatment for IBS. Gwakhyangjeonggi-san (GJS), a traditional Korean herbal medicine, has been used to treat lower intestinal abnormalities in Asia. We will systematically review randomized controlled trials (RCTs) to evaluate the efficacy and safety of GJS as a complementary treatment for IBS.

Methods and analysis:
Four English databases, namely, Medline (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and the Allied and Complementary Medicine Database, will be searched for entries up to May, 2021. Additional databases will include 5 Korean databases, 1 Chinese database, and 1 Japanese database. RCTs and quasi-RCTs will be searched for to assess the effectiveness and safety of GJS. The primary outcome measure will be the overall efficacy rate, and the secondary outcome will include data such as global symptom scores, IBS Quality of Life measurements, and adverse events. Data analysis will be performed using Review Manager Version 5.3, and the risk of bias will be assessed using the Cochrane Collaboration's risk-of-bias tool. The quality of the results will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Conclusion:
This systematic review will provide evidence for the efficacy and safety of GJS for IBS.

OSF registration number:
DOI 10.17605/OSF.IO/V93JN (https://osf.io/v93jn).
Systematic Review of Quality Improvement Projects Related to Intershift Nursing Handover
Authors: Cho Sumi , Lee Jung Lim , Kim Kyeong Sug , Kim Eun Man 
Published: July 2021

Background:
Nursing handover is a real-time process in which patient-specific information is passed between nurses to ensure the continuity and safety of patient care.

Purpose:
The purpose of this study was to determine the effects of quality improvement (QI) projects in improving the intershift nursing handover process.

Methods:
A computerized search was performed of electronic databases for articles published during 2009-2019 in English or Korean for which the full texts were available. The included studies involved QI projects, handover between nurses, and intershift handover. The QI-MQCS (Quality Improvement Minimum Quality Criteria Set) was used to appraise the quality of QI strategies.

Results:
The handover methods used in the 22 QI projects could be broadly divided into 2 types: (1) using a standardized communication tool; and (2) involving patient-participation bedside handover.

Conclusions:
The published research on intershift handover-related QI projects employed standardized communication tools and the patient-participation bedside handover method to reduce adverse events and handover times and increase the satisfaction of patients and nurses. Future studies should measure the changes in patient safety-related outcomes.
Systematic Debriefing for Critical Events Facilitates Team Dynamics, Education, and Process Improvement
Authors: Gabriel Paula M. , Smith Kirsten , Mullen-Fortino Margaret , Ballinghoff James , Holland Sara , Cacchione Pamela Z. 
Published: July 2021

Background:
Debriefing is used in clinical settings to support interprofessional staff, improve processes, and identify educational needs. Nurses who lead debriefing sessions are empowered to improve processes.

Problem:
Nurse leaders identified the need for debriefing outside the critical care areas due to the rising acuity levels.

Approach:
Two nurse leaders developed a debriefing initiative in one urban teaching hospital following rapid responses, codes, and stressful situations. Nurses developed a Debriefing Facilitation Guide to collect qualitative aspects of clinical emergencies to improve processes, education, and team dynamics.

Outcomes:
Following each debriefing session, we deductively purposively coded the qualitative data into 3 a priori themes: the American Heart Association's team dynamics, process improvement, and educational opportunities. We identified opportunities for improvement for these themes during our first 54 debriefing sessions.

Conclusions:
Following each debriefing session, the debriefing nurse leader intervened on all educational and process improvement opportunities identified and facilitated positive team dynamics.