bluuebunny/crossref_metadata_2025_split huggingface dataset:
A systematic review and meta-analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research
Authors: Widmark-Jensen Emmelie , Bernhardsson Susanne , Eriksson Maud , Hallberg Håkan , Jepsen Christian , Jivegård Lennart , Liljegren Ann , Petzold Max , Svensson Mikael , Wärnberg Fredrik , Hansson Emma 
Published: September 2021

Abstract
Background
There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction.

Methods
A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible.

Results
Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%.

Conclusion
There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified.

Pre-registration
The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.
The comparison of albumin and 6% hydroxyethyl starches (130/0.4) in cardiac surgery: a meta-analysis of randomized controlled clinical trials
Authors: Wei Ling , Li Dongping , Sun Lin 
Published: September 2021

Abstract
Background
Fluid administration is a key tool in the maintenance of normovolemia in patients with cardiac surgery. The trials that evaluated the safety of 6% hydroxyethyl starch (HES) 130/0.4 in cardiac surgical patients were inconsistent. It is necessary to compare the efficacy and safety of albumin and 6% HES (130/0.4).

Method
We searched for the randomized controlled clinical trials that compared human albumin with 6% HES (130/0.4) in cardiac surgery in PubMed, Cochrane, and Embase.

Results
Ten studies involved a total of 1567 patients were included in our meta-analysis. For the efficiency, there was no difference in total volume of infusion between compared groups [P = 0.64, Fixed Effect Model (FEM): standardized mean difference (SMD) = 0.04, 95% confidence interval (CI) (− 0.12, 0.20)]. As for safety, the albumin show more risk than hydroxyethyl starch 130/0.4 in blood loss [P = 0.02, FEM: SMD: 0.22, 95% CI (0.03, 0.41)]. There was no difference in the frequency of transfusions (P = 0.20, RR = 1.11; 95% CI (0.95, 1.27)) between the two groups. No difference was observed for the days in intensive care unit [P = 0.05, FEM: SMD = − 0.18, 95% CI (− 0.36, 0.00)], and the days in hospital [P = 0.32, FEM: SMD = − 0.11, 95% CI (− 0.32, 0.10)]. Furthermore, both the incidence of AKI, RRT, and mortality were comparable in the two groups.

Conclusion
This study provided evidence that the 6% HES (130/0.4) might be the substitute for HA, which reduced the economic burden for patients with cardiac surgery. However, the effect of 6% HES (130/0.4) and HA on AKI still needs to be further studied.
A randomised clinical study investigating efficacy of a stannous fluoride toothpaste in improving gingival health after 3 weeks’ use
Authors: Acherkouk Amina , Patel Nisha , Butler Andrew , Amini Pejmon 
Published: September 2021

AbstractBackgroundThis examiner-blind, stratified, parallel study aimed to evaluate the anti-gingivitis efficacy of a non-aqueous (anhydrous) 0.454% w/w stannous fluoride toothpaste (‘Test’) versus a sodium monofluorophosphate toothpaste (‘Control’) in people with clinically-confirmed mild-moderate gingivitis. Plaque-induced gingivitis can progress to irreversible periodontitis if left untreated. This can be controlled by an effective oral hygiene regimen such as one including toothbrushing with a toothpaste containing the chemotherapeutic agent stannous fluoride. Long-term studies over 4–12 weeks have shown the efficacy of stannous fluoride; however, shorter term studies are needed to examine if the effects on measures of gingivitis and plaque control occur sooner.MethodsEligible participants were randomised to 3 weeks’ twice-daily brushing (for 1 min) with Test or Control toothpastes. The primary efficacy variable was between-treatment difference in Bleeding Index (BI) at 3 weeks; secondary variables were between-treatment differences in number of bleeding sites, modified Gingival Index (MGI), and Turesky modification of the Quigley–Hein Plaque Index (TPI) at Weeks 2 and 3.ResultsA statistically significant (p < 0.0001) lower BI score was reported for Test (n = 65) versus Control (n = 65) groups at Week 2 (mean difference: − 0.07 [95% CI − 0.9, − 0.05]; 32.7% difference) and Week 3 (mean difference: − 0.06 [95% CI − 0.8, − 0.04]; 29.2% difference). The Test group also demonstrated statistically significant lower (allp < 0.0001 versus Control) number of bleeding sites (Weeks 2/3 mean difference [95% CI]: − 10.04 [− 12.3, − 7.5]/ − 8.2 [− 11.1, − 5.3] sites; 33.0%/29.3% difference); MGI score (Weeks 2/3 mean difference [95% CI]: − 0.09 [− 0.13, − 0.06]/ − 0.10 [− 0.14, − 0.06]; 4.3%/4.7% difference); overall TPI score (Weeks 2/3 mean difference [95% CI]: − 0.45 [− 0.55, − 0.35/ − 0.42 [− 0.53, − 0.30] difference; 16.0%/15.1% difference) and interproximal TPI score (Weeks 2/3 mean difference [95% CI]: − 0.42 [− 0.52, − 0.30]/ − 0.41 [− 0.52, − 0.29]; 14.6%/14.1% difference). Both toothpastes were generally well tolerated.ConclusionThree weeks’ twice-daily brushing with the 0.454% w/w stannous fluoride Test toothpaste compared to the Control toothpaste led to statistically significant lower gingival bleeding, gingival inflammation and plaque levels in adults with mild-moderate gingivitis. These results indicate that plaque and gingivitis-reducing benefits of 0.454% w/w stannous fluoride may be seen from 2 weeks’ use.Trial registrationClinicalTrials.gov Identifier: NCT04050722; 08/08/2019.
Impacts of a gross anatomy laboratory course on medical students’ emotional reactions in Taiwan: the role of high-level emotions
Authors: Chiou Ruei-Jen , Tsai Po-Fang , Han Der-Yan 
Published: September 2021

Abstract
Background
Gross anatomy laboratory course at medical school is usually an important learning subject for medical students; however, seeing a cadaver often makes them feel uncomfortable. According to the broaden-and-build theory, positive emotions broaden our inventory of thoughts and actions, and build physical, mental, and social resources. Research on positive psychology found that through direct thanks and positive reframing, people who feel gratitude show fewer depressive symptoms. The present study tried to reduce students’ negative emotions towards cadavers by sequential activities, such as family interviews and an initiation ceremony, which induced gratitude and other positive emotions.

Methods
The Emotional Reactions Towards Cadavers Scale (ERTCS) was used to evaluate medical students’ emotional reactions after they see a cadaver. Third year medical students (n = 105) at Taipei Medical University in northern Taiwan completed ERTCS on three occasions within a single semester during academic year 2016. Repeated-measures ANOVA and hierarchical regression analyses were then conducted to identify any changes in the emotional reactions of these students.

Results
The ERTCS showed satisfactory internal consistency and a three-factor structure, i.e., negative emotions, high-level emotions, and excited emotions. High-level emotions were the highest, and negative emotions were the lowest among the three in our sample. Three-wave data showed that participants’ high-level emotions increased, negative emotions decreased, and the former simultaneously predicted the latter after controlling for the influence of gender, religious beliefs, experience of the death of a family member or friend, and burnout level.

Conclusions
While past research usually focused on coping strategies to reduce medical students’ negative emotions, our study supported the broaden-and-build theory, which emphasizes positive emotions, and demonstrated that elevating medical students’ gratitude to ‘silent mentors’ is an effective way. It is suggested that combining dissection courses with medical humanities can help students successfully handle negative emotions during a gross anatomy laboratory course.
Automatic detection of actionable radiology reports using bidirectional encoder representations from transformers
Authors: Nakamura Yuta , Hanaoka Shouhei , Nomura Yukihiro , Nakao Takahiro , Miki Soichiro , Watadani Takeyuki , Yoshikawa Takeharu , Hayashi Naoto , Abe Osamu 
Published: September 2021

Abstract
Background
It is essential for radiologists to communicate actionable findings to the referring clinicians reliably. Natural language processing (NLP) has been shown to help identify free-text radiology reports including actionable findings. However, the application of recent deep learning techniques to radiology reports, which can improve the detection performance, has not been thoroughly examined. Moreover, free-text that clinicians input in the ordering form (order information) has seldom been used to identify actionable reports. This study aims to evaluate the benefits of two new approaches: (1) bidirectional encoder representations from transformers (BERT), a recent deep learning architecture in NLP, and (2) using order information in addition to radiology reports.

Methods
We performed a binary classification to distinguish actionable reports (i.e., radiology reports tagged as actionable in actual radiological practice) from non-actionable ones (those without an actionable tag). 90,923 Japanese radiology reports in our hospital were used, of which 788 (0.87%) were actionable. We evaluated four methods, statistical machine learning with logistic regression (LR) and with gradient boosting decision tree (GBDT), and deep learning with a bidirectional long short-term memory (LSTM) model and a publicly available Japanese BERT model. Each method was used with two different inputs, radiology reports alone and pairs of order information and radiology reports. Thus, eight experiments were conducted to examine the performance.

Results
Without order information, BERT achieved the highest area under the precision-recall curve (AUPRC) of 0.5138, which showed a statistically significant improvement over LR, GBDT, and LSTM, and the highest area under the receiver operating characteristic curve (AUROC) of 0.9516. Simply coupling the order information with the radiology reports slightly increased the AUPRC of BERT but did not lead to a statistically significant improvement. This may be due to the complexity of clinical decisions made by radiologists.

Conclusions
BERT was assumed to be useful to detect actionable reports. More sophisticated methods are required to use order information effectively.
Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study
Authors: Ji Yoonjung , Lee Hyeonkyeong , Lee Taewha , Choi Mona , Lee Hyejung , Kim Sanghee , Do Hyunok Kim , Kim Sunah , Chu Sang Hui , Park Jeongok , Kim Young Man , Park Soyoon 
Published: September 2021

Abstract
Background
Nursing students’ practical training should begin when students can apply core knowledge, skills, and attitudes related to patient safety. This necessitates an integrated curriculum in nursing education that links practice to the theory concerning patient safety to enhance patient safety competencies and quality in nursing care. This study aimed to develop an integrated curriculum that incorporates patient safety factors in the existing curriculum to increase patient safety competencies in nursing students.

Method
A case study approach was adopted to explain the development processes of a new curriculum integrating patient safety in the existing outcome-based curriculum of a nursing college. Based on the existing outcome-based curriculum of a nursing college, a four-step process was performed to integrate patient safety component, including quality improvement, into the curriculum: 1) literature review, 2) analysis of course syllabus, 3) selection of courses related to patient safety topics, and 4) development of evaluation tool.

Results
The integrated patient safety curriculum was based on six topics: patient safety principles, teamwork, communication, patient engagement, risk management and, quality improvement, and International Patient Safety Goals. Based on the characteristics of the course according to the level of students in each year, the curriculum was integrated to address patient safety topics in seven courses (four theoretical and three practical). A Patient safety Competency self-assessment checklist was developed for students to naturally acquire patient safety competencies in clinical settings.

Conclusions
This study demonstrated that patient safety topics should be addressed in both theoretical and practical settings across the entire nursing curriculum per the continuity and sequence of education principles.
Predictive accuracy of enhanced versions of the on-admission National Early Warning Score in estimating the risk of COVID-19 for unplanned admission to hospital: a retrospective development and validation study
Authors: Faisal Muhammad , Mohammed Mohammed Amin , Richardson Donald , Steyerberg Ewout W. , Fiori Massimo , Beatson Kevin 
Published: September 2021

Abstract
Background
The novel coronavirus SARS-19 produces ‘COVID-19’ in patients with symptoms. COVID-19 patients admitted to the hospital require early assessment and care including isolation. The National Early Warning Score (NEWS) and its updated version NEWS2 is a simple physiological scoring system used in hospitals, which may be useful in the early identification of COVID-19 patients. We investigate the performance of multiple enhanced NEWS2 models in predicting the risk of COVID-19.

Methods
Our cohort included unplanned adult medical admissions discharged over 3 months (11 March 2020 to 13 June 2020 ) from two hospitals (YH for model development; SH for external model validation). We used logistic regression to build multiple prediction models for the risk of COVID-19 using the first electronically recorded NEWS2 within ± 24 hours of admission. Model M0’ included NEWS2; model M1’ included NEWS2 + age + sex, and model M2’ extends model M1’ with subcomponents of NEWS2 (including diastolic blood pressure + oxygen flow rate + oxygen scale). Model performance was evaluated according to discrimination (c statistic), calibration (graphically), and clinical usefulness at NEWS2 ≥ 5.

Results
The prevalence of COVID-19 was higher in SH (11.0 %=277/2520) than YH (8.7 %=343/3924) with a higher first NEWS2 scores ( SH 3.2 vs YH 2.8) but similar in-hospital mortality (SH 8.4 % vs YH 8.2 %). The c-statistics for predicting the risk of COVID-19 for models M0’,M1’,M2’ in the development dataset were: M0’: 0.71 (95 %CI 0.68–0.74); M1’: 0.67 (95 %CI 0.64–0.70) and M2’: 0.78 (95 %CI 0.75–0.80)). For the validation datasets the c-statistics were: M0’ 0.65 (95 %CI 0.61–0.68); M1’: 0.67 (95 %CI 0.64–0.70) and M2’: 0.72 (95 %CI 0.69–0.75) ). The calibration slope was similar across all models but Model M2’ had the highest sensitivity (M0’ 44 % (95 %CI 38-50 %); M1’ 53 % (95 %CI 47-59 %) and M2’: 57 % (95 %CI 51-63 %)) and specificity (M0’ 75 % (95 %CI 73-77 %); M1’ 72 % (95 %CI 70-74 %) and M2’: 76 % (95 %CI 74-78 %)) for the validation dataset at NEWS2 ≥ 5.

Conclusions
Model M2’ appears to be reasonably accurate for predicting the risk of COVID-19. It may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions.
Creating person-al space for unspoken voices during diagnostic medical imaging examinations: a qualitative study
Authors: Makanjee Chandra Rekha , Bergh Anne-Marie , Xu Deon , Sarswat Drishti 
Published: September 2021

Abstract
Background
There is emerging interest in person-centred care within a short-lived yet complex medical imaging encounter. This study explored this event from the viewpoint of patients referred for an imaging examination, with a focus on the person and their person-al space.

Methods
We used convenience sampling to conduct semi-structured interviews with 21 patients in a private medical imaging practice in Australia. The first phase of data analysis was conducted deductively, using the six elements of the person-centred, patient-journey framework of the Australian Commission on Safety and Quality in Healthcare: transition in; engagement; decisions; well-being; experience; and transition out. This was followed by inductive content analysis to identify overarching themes that span a patient’s journey into, through and out of an imaging encounter.

Results
The transition-in phase began with an appointment and the first point of contact with the imaging department at reception. Engagement focused on patient-radiographer interactions and explanations to the patient on what was going to happen. Decisions related primarily to radiographers’ decisions on how to conduct a particular examination and how to get patient cooperation. Participants’ well-being related to their appreciation of gentle treatment; they also referred to past negative experiences that had made a lasting impression. Transitioning out of the imaging encounter included the sending of the results to the referring medical practitioner. Person-al vulnerabilities emerged as a cross-cutting theme. Patients’ vulnerability, for which they needed reassurance, pertained to uncertainties about the investigation and the possible results. Healthcare professionals were vulnerable because of patient expectations of a certain demeanour and of pressure to perform optimal quality investigations. Lastly, patients’ personal lives, concerns and pressures – their person-al ‘baggage’ – shaped their experience of the imaging encounter.

Conclusion
To add value to the quality of the service they deliver, radiography practitioners should endeavour to create a person-al space for clients. Creating these spaces is complex as patients are not in a position to judge the procedures required by technical imaging protocols and the quality control of equipment. A reflective tool is proposed for radiographers to use in discussions with their team and its leaders on improving person-centred care and the quality of services in their practice.
Pediatric primary care and subspecialist providers’ comfort, attitudes and practices screening and referring for social determinants of health
Authors: Lax Yonit , Bathory Eleanor , Braganza Sandra 
Published: September 2021

AbstractBackgroundEarly detection and management of poverty-related disorders is a recommended pediatric practice; however, little is known about variations of practice between pediatric primary care physicians and subspecialists. The objectives of this study were to assess (1) provider perceptions and attitudes toward caring for low-income children in an urban academic medical center, and (2) variations between primary care physicians and subspecialists in social and financial needs screening and referral practices for low-income children.Design/MethodsPrimary care providers (pediatric and family medicine) and subspecialists providing direct patient care in an urban academic medical center (response rate = 24 %, n = 85/356) completed a 24-item survey (adapted with permission from the AAP Periodic Survey of Fellows No.90) assessing feasibility and comfort screening and addressing social and financial needs, rates of screening for financial hardship, and referrals to local resources. Chi-square tests were performed.ResultsAmong respondents, 88 % (75/85) reported comfort caring for low-income children, while 28 % (24/85) reported comfort inquiring about social and financial needs and 34 % (29/85) referring to community resources. Primary care providers more commonly than subspecialists screened for childcare (80 % vs. 59 %,p = 0.04), parental: employment (84 % vs. 59 %, p = 0.01), education (40 % vs. 17 %,p = 0.02) and mental health (86 % vs. 46 %,p = 0.0001), and less commonly screened for transportation (47 % vs. 73 %,p = 0.01). Primary care providers more commonly referred for public health insurance (74 % vs. 39 %,p = 0.001), public food assistance (30 % vs. 12 %,p = 0.04), and adult mental health services (65 % vs. 44 %,p < 0.05).ConclusionsIn an urban academic institution serving a population with high poverty rates, pediatric providers feel comfortable providing medical care for low-income children but lack comfort screening and addressing SDH. Though most feel it is their job to refer to resources, less than half felt it was feasible to screen for or address financial needs. Pediatric primary care providers report higher rates of screening and referring than subspecialists. Understanding variations in practice and perceptions among primary care providers and subspecialists may aid in creating interventions to increase screening and referral rates.