bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Adaptive Conjoint Analysis–Based Values Clarification in a Patient Decision Aid Is Not Associated with Better Perceived Values Clarity or Reduced Decisional Conflict but Enhances Values Congruence
Authors: Yılmaz Nida Gizem , Pieterse Arwen H. , Timmermans Danielle R. M. , Becker Annemarie , Witte-Lissenberg Birgit , Damman Olga C. 
Published: November 2024

Background Evidence is lacking on the most effective values clarification methods (VCMs) in patient decision aids (PtDAs). We tested the effects of an adaptive conjoint analysis (ACA)–based VCM compared with a ranking-based VCM and no VCM on several decision-related outcomes, with the decisional conflict and its subscale “perceived values clarity” as primary outcomes. Design Online experimental study with 3 conditions: no VCM versus ranking-based VCM versus ACA-based VCM ( N = 282; Mage = 63.11 y, s = 12.12), with the latter 2 conditions including attributes important for a lung cancer treatment decision. We assessed 1) decisional conflict, 2) perceived values clarity (decisional conflict subscale), 3) perceived cognitive load, 4) anticipated regret, 5) ambivalence, 6) preparedness for decision making, 7) hypothetical treatment preference, and 8) values congruence (proxy). We performed analysis of covariance and linear regression. Age and level of deliberation were included as potential moderators, and we controlled for subjective numeracy (covariate). We exploratively tested the moderating effects of subjective numeracy and health literacy (without covariates). Results We found no significant effect of type of VCM on overall decisional conflict or perceived values clarity. Age had a moderating effect: in younger participants, no VCM (v. ranking-based VCM) led to more values clarity, while in older participants, a ranking-based VCM (v. no VCM) led to more values clarity. Completing the ACA-based VCM, compared with no VCM, resulted in more values congruence. Limitations The hypothetical choice situation might have induced lower levels of cognitive/affective involvement in the decision. Conclusions This study found mixed effects of an ACA-based VCM. It did not decrease decisional conflict or increase perceived values clarity, yet it did improve values congruence. Implications Completion of an ACA-based VCM in a PtDA may increase values congruence. Highlights An adaptive conjoint analysis or a ranking-based values clarification method did not decrease analog patients’ decisional conflict nor did it increase their perceived values clarity. In younger participants, no VCM (v. ranking-based VCM) led to more values clarity, while in older participants, a ranking-based VCM (v. no VCM) led to more values clarity. An adaptive conjoint analysis task for values clarification resulted in more values congruence.
Can machine learning models improve the prediction of surgical site infection in abdominal surgery than traditional statistical models?
Authors: Piebpien Pongsathorn , Tansawet Amarit , Pattanaprateep Oraluck , Pattanateepapon Anuchate , Wilasrusmee Chumpon , Mckay Gareth J. , Attia John , Thakkinstian Ammarin 
Published: November 2024

Objective To externally validate by revision and update the study on the efficacy of nosocomial infection control (SENIC) model of surgical site infection (SSI) using logistic regression (LR) and machine learning (ML) approaches. Methods A retrospective analysis of hospital database-derived data from patients that had undergone gastrointestinal, colorectal and hernia surgeries (identified by ICD-9-CM). The SENIC index was calculated and fitted in an LR. MLs were developed using decision-tree (DT), random forest (RF), extreme-gradient-boosting (XGBoost) and Naïve Bayes (NB). Results The prevalence of an SSI was 3.21% (404 of 12 596 surgeries; 95% confidence interval [CI] 2.91%, 3.53%). The C-statistic for the original SENIC model was 0.668 (95% CI 0.648, 0.688) with an observed/expected (O/E) ratio of 0.998 (interquartile range [IQR] 0.750, 1.047). An updated-SENIC-LR model with six predictors had a C-statistic of 0.768 (95% CI 0.745, 0.790) and O/E ratio of 0.999 (IQR 0.976, 1.004). The performance of MLs considering 14 predictors was poorer than the updated-SENIC-LR with C-statistics of 0.679, 0.675, 0.656 and 0.651 for NB, XGBoost, RF and DT, respectively. Overfitting was detected for ML approaches, particularly for DT, RF and XGBoost. Conclusion The updated-SENIC-LR model and NB may be useful for monitoring SSI risk following abdominal surgery.
The Effect of Breastfeeding Education to Immigrant Mothers in the Neonatal Intensive Care Unit on Breastfeeding Success: A Randomized Control Study
Authors: Ceylan Sibel Serap , Güner Elmas , Keskin Züleyha , Ceylan Selim 
Published: November 2024

Introduction: The study aimed to evaluate the effect of education given to immigrant mothers on breastfeeding success of mothers. Method: The randomized-controlled, single-blind study was conducted in a neonatal intensive care unit of a state hospital in Turkey. The Mother–infant information form, Nutrition monitoring form, and LATCH Assessment Tool were used to collect the study data. Results: In the study, the mean LATCH score of the mothers in the experimental group was higher than that of the control group ( P < .05). It was determined that the breastfeeding duration of the mothers in the experimental group was longer, and the number of infants fed exclusively by breastfeeding was higher in the last follow-up ( P < .05). Discussion: It was found that breastfeeding education positively affected the breastfeeding success of immigrant mothers. This study reveals the positive effects of health education programs designed for immigrants on immigrant health.
Speech Outcomes in Children with Robin Sequence Treated with a Pre-Epiglottic Baton Plate
Authors: Schmidt Gül , Engeli Nora , Matuschek Carsten , Hunn-Stohwasser Christa , Bestendonk Carolin , Heiland Max , Hirschfelder Anke , Hofmann Elena 
Published: November 2024

Objective To analyze speech outcomes and cleft shape changes in children diagnosed with Robin sequence (RS) treated with a customized pre-epiglottic baton plate (PEBP). Design Single-surgeon retrospective analysis. Setting Tertiary care institution. Patients and Participants Twenty-five patients with RS who were treated with PEBP and primary cleft palate repair between 2010 and 2019. Interventions Postnatal use of a PEBP. Main Outcome Measures Speech assessment at the age of 3.5 to 4.5 years documenting hypernasality, nasal emission, nasal turbulence, voice quality, and consonant production, and analysis of digitally scanned cast models before and after the use of PEBP to quantify changes in cleft shape and width. Results The study cohort ( N = 25) consisted of 19 patients with hard and soft cleft palates and 6 patients with soft cleft palate only and postnatal use of PEBP. The mean reduction in cleft width following PEBP treatment prior to cleft palate repair in 19 infants with hard and soft cleft palates was 41.30% (standard deviation, 13.25). Speech assessments were conducted at a mean age of 48.5 months in all 25 children treated with PEBP. Most children presented with absent or mild hypernasality (96%), a rate of 8% of nasal emission and 4% of nasal turbulence was found. The most frequent findings were articulation errors in 14 children (56%), of whom 2 presented with cleft-type characteristics. Conclusions Children with RS and cleft palate treated with PEBP demonstrated a narrowing of the cleft palate prior to a timely surgical repair, and favorable speech outcomes already at a young age during childhood.
Premaxillary Setback in the Management of Patients With Bilateral Cleft Lip: A 2 Decade Review
Authors: Jolibois Marah I. , Lasky Sasha , Stanton Eloise W. , Roohani Idean , Moshal Tayla , Foster Lacey , Husain Fatemah , Munabi Naikhoba CO , Urata Mark M. , Magee William P. , Hammoudeh Jeffrey A. 
Published: November 2024

Objective This study analyzes indications and outcomes of premaxillary setback (PS) and presents an algorithm for its use in patients with bilateral cleft lip and/or palate (BCL ± P). Design Retrospective review. Setting Children's Hospital Los Angeles. A retrospective review was conducted evaluating patients with BCL ± P undergoing lip repair from 2003–2023. Patients were categorized as undergoing repair with (BCL + PS) or without (BCL-PS) simultaneous PS. Presurgical nasoalveolar molding (NAM), indications for PS, timing of surgery, and complications were collected. Interventions BCL with PS, BCL + PS. Main Outcome Measures(s) Primary outcomes included rates of postoperative complications and revision surgeries. Secondary outcome was the need for orthognathic surgery to correct midface hypoplasia in patients at least 14 years old at their most recent follow-up. Results Of 1193 patients, 262 met inclusion criteria. One hundred forty-nine patients (56.9%) were referred for NAM. Fifty-one patients (19.5%) underwent PS during primary BCL repair. Patients who failed repositioning of the premaxilla following presurgical NAM (n = 12) were not candidates for NAM (n = 31) or presented late with a protruding premaxilla (n = 8, 12.977 ± 8.196 months) underwent PS. Median age at surgery was 4.29 months. Complications included wound dehiscence (n = 3) and abscess formation (n = 2). No premaxillary necrosis occurred. Overall revision rates were 9.9%. Of 41 patients over 14 years old, 53.6% needed orthognathic surgery. BCL + PS had comparable rates of wound dehiscence (2.0% vs 4.0%; P = .790), lip revisions (7.8% vs 10.4%; P = .770), and orthognathic surgery (50.0% vs 56.3%; P > .999). Conclusion PS is a safe and effective method to facilitate BCL repair in patients who are not candidates for NAM.
Artificial Intelligence can Facilitate Application of Risk Stratification Algorithms to Bladder Cancer Patient Case Scenarios
Authors: Yudovich Max S , Alzubaidi Ahmad N , Raman Jay D 
Published: November 2024

Background: Chat Generative Pre-Trained Transformer (ChatGPT) has previously been shown to accurately predict colon cancer screening intervals when provided with clinical data and context in the form of guidelines. The National Comprehensive Cancer Network® (NCCN®) guideline on non-muscle invasive bladder cancer (NMIBC) includes criteria for risk stratification into low-, intermediate-, and high-risk groups based on patient and disease characteristics. The aim of this study is to evaluate the ability of ChatGPT to apply the NCCN Guidelines to risk stratify theoretical patient scenarios related to NMIBC. Methods: Thirty-six hypothetical patient scenarios related to NMIBC were created and submitted to GPT-3.5 and GPT-4 at two separate time points. First, both models were prompted to risk stratify patients without any additional context provided. Custom instructions were then provided as textual context using the written versions of the NMIBC NCCN® Guidelines, followed by repeat risk stratification. Finally, GPT-4 was provided with an image of the NMIBC risk groups table, and the risk stratification was again performed. Results: GPT-3.5 correctly risk stratified 68% (24.5 of 36) of scenarios without context, slightly increasing to 74% (26.5 of 36) with textual context. Using GPT-4, the model had accuracy of 83% (30 of 36) without context, reaching 100% (36 of 36) with textual context ( P = .025). GPT-4 with image context maintained similar accuracy to GPT-4 without context, with accuracy 81% (29 of 36). ChatGPT generally performed poorly when stratifying intermediate risk NMIBC (33%-63%). When risk stratification was incorrect, most responses were overestimations of risk. Conclusions: GPT-4 can accurately risk stratify patients with respect to NMIBC when provided with context containing guidelines. Overestimation of risk is more common than underestimation, and intermediate risk NMIBC is most likely to be incorrectly stratified. With further validation, GPT-4 can become a tool for risk stratification of NMIBC in clinical practice.
MLAU-Net: Deep supervised attention and hybrid loss strategies for enhanced segmentation of low-resolution kidney ultrasound
Authors: Khan Rashid , Zaman Asim , Chen Chao , Xiao Chuda , Zhong Wen , Liu Yang , Hassan Haseeb , Su Liyilei , Xie Weiguo , Kang Yan , Huang Bingding 
Published: November 2024

Objective The precise segmentation of kidneys from a 2D ultrasound (US) image is crucial for diagnosing and monitoring kidney diseases. However, achieving detailed segmentation is difficult due to US images’ low signal-to-noise ratio and low-contrast object boundaries. Methods This paper presents an approach called deep supervised attention with multi-loss functions (MLAU-Net) for US segmentation. The MLAU-Net model combines the benefits of attention mechanisms and deep supervision to improve segmentation accuracy. The attention mechanism allows the model to selectively focus on relevant regions of the kidney and ignore irrelevant background information, while the deep supervision captures the high-dimensional structure of the kidney in US images. Results We conducted experiments on two datasets to evaluate the MLAU-Net model's performance. The Wuerzburg Dynamic Kidney Ultrasound (WD-KUS) dataset with annotation contained kidney US images from 176 patients split into training and testing sets totaling 44,880. The Open Kidney Dataset’s second dataset has over 500 B-mode abdominal US images. The proposed approach achieved the highest dice, accuracy, specificity, Hausdorff distance (HD95), recall, and Average Symmetric Surface Distance (ASSD) scores of 90.2%, 98.26%, 98.93%, 8.90 mm, 91.78%, and 2.87 mm, respectively, upon testing and comparison with state-of-the-art U-Net series segmentation frameworks, which demonstrates the potential clinical value of our work. Conclusion The proposed MLAU-Net model has the potential to be applied to other medical image segmentation tasks that face similar challenges of low signal-to-noise ratios and low-contrast object boundaries.
ChatGPT utilization within the building blocks of the healthcare services: A mixed-methods study
Authors: Shojaei Payam , Khosravi Mohsen , Jafari Yalda , Mahmoudi Amir Hossein , Hassanipourmahani Hadis 
Published: November 2024

Introduction ChatGPT, as an AI tool, has been introduced in healthcare for various purposes. The objective of the study was to investigate the principal benefits of ChatGPT utilization in healthcare services and to identify potential domains for its expansion within the building blocks of the healthcare industry. Methods A comprehensive three-phase study was conducted employing mixed methods. The initial phase comprised a systematic review and thematic analysis of the data. In the subsequent phases, a questionnaire, developed based on the findings from the first phase, was distributed to a sample of eight experts. The objective was to prioritize the benefits and potential expansion domains of ChatGPT in healthcare building blocks, utilizing gray SWARA (Stepwise Weight Assessment Ratio Analysis) and gray MABAC (Multi-Attributive Border Approximation Area Comparison), respectively. Results The systematic review yielded 74 studies. A thematic analysis of the data from these studies identified 11 unique themes. In the second phase, employing the gray SWARA method, clinical decision-making (weight: 0.135), medical diagnosis (weight: 0.098), medical procedures (weight: 0.070), and patient-centered care (weight: 0.053) emerged as the most significant benefit of ChatGPT in the healthcare sector. Subsequently, it was determined that ChatGPT demonstrated the highest level of usefulness in the information and infrastructure, information and communication technologies blocks. Conclusion The study concluded that, despite the significant benefits of ChatGPT in the clinical domains of healthcare, it exhibits a more pronounced potential for growth within the informational domains of the healthcare industry's building blocks, rather than within the domains of intervention and clinical services.
Translation and Cross-cultural Adaptation of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score Into Japanese and Comparison of Visual Analog Scale and 10-Point Scale Formats
Authors: Ishigaki Tomonobu , Yokota Hirotake , Akuzawa Hiroshi , Akiho-Toyoda Noriko , Ushiro Keisuke , Ebihara Yuki , Tanaka Shigeharu , Wada Tadashi , Jigami Hirofumi , Matsumoto Hisashi , Ito Yu , Kikumoto Takanori , Matsuura Yuiko , Hirabayashi Ryo , Sekine Chie , Yamamoto Noriaki , Omori Go , Edama Mutsuaki 
Published: November 2024

Background: The Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score (KJOC) is sensitive enough to detect subtle changes in the functional level of the shoulder or elbow in overhead athletes. However, a Japanese version of the KJOC is not yet available. Moreover, the original KJOC uses a visual analog scale (VAS) assessment format that requires a print version so that users can add a check mark along a horizontal line. The KJOC can be completed using online tools such as Google Forms if a 10-point scale format can be used with comparable results. Purposes: To (1) translate and cross-culturally adapt the KJOC into Japanese (KJOC-J) and assess its validity and (2) evaluate the correlation between a standard VAS format and a 10-point scale format (KJOC-J10). Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: In total, 318 athletes participated in the validation study, 255 in the test-retest reliability study for the KJOC-J, and 273 in the validation study for the KJOC-J10. Internal consistency was evaluated using the Cronbach alpha. Validity was evaluated by calculating the correlation between the KJOC-J and the Disability of the Arm, Shoulder and Hand (DASH). Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). The validity of the KJOC-J10 was evaluated by calculating the correlation between the KJOC-J10 and KJOC-J. Results: The Cronbach alpha was 0.914, indicating good internal consistency. The KJOC-J was moderately correlated with the DASH ( r = −0.581; P < .001) and had good test-retest reliability (ICC, 0.874). A strong correlation was found between the KJOC-J and KJOC-J10 ( r = 0.846; P < .001). Conclusion: The study results demonstrated good internal consistency, validity, and reliability for the KJOC-J, indicating that it is a valid assessment tool for shoulder and elbow functions in Japanese overhead athletes. Moreover, a strong correlation was found between the VAS and 10-point formats of the KJOC-J.
Effects of Booking Horizon Reduction on Cancellation Rates: An Experimental Analysis in Pediatric Outpatient Care
Authors: Ravenscroft Benjamin , Abouee Mehrizi Hossein , Wylie-Toal Brendan 
Published: November 2024

Background. The time between booking an appointment and the appointment taking place, known as lead time, has been identified as a predictor of cancellation and no-show probability in health care settings. Understanding the impact of reducing permissible lead times, that is, the booking horizon, at a policy level in an outpatient care setting is important when mitigating costly cancellation and no-show rates. Few studies have researched this in an observational or experimental setting. Methods. We leveraged longitudinal observational data from an outpatient pediatric rehabilitation organization in Ontario, Canada, consisting of 73,482 visits between June 2021 and October 2023. This organization reduced its booking horizon at the policy level from 12 to 4 wk in February 2023. Using 2 interrupted time-series approaches, we estimated the change in level, slope, and variance of the weekly combined last-minute cancellation and no-show rate associated with the policy change. Results. It is estimated that reducing the booking horizon is associated with an absolute reduction in the weekly rate of last-minute cancellations and no-shows of 1.02% to 1.85% (a relative reduction of 8.07%–15.70%). Furthermore, the variance dropped by 48.18%. Conclusion. Reducing the appointment booking horizon is associated with a significant reduction in the rate and variance of costly last-minute cancellations and no-shows. The reduced variance can also help enable effective usage of strategies such as overbooking for organizations seeking further approaches to mitigating the negative effects of no-shows. Highlights This study uses interrupted time-series approaches to assess the effects of reducing the appointment booking horizon at a policy level on last-minute cancellations and no-shows in a pediatric outpatient care setting. Reducing the permissible booking horizon from up to 3 mo to up to 4 wk is associated with a significant reduction in the rate of last-minute cancellations and no-shows. The shortened booking horizon policy is associated with a significant drop in the variance of last-minute cancellations and no-show rates, which is valuable in settings where overbooking occurs.
The Professional Guest: conceptualizing home visits in palliative care settings
Authors: Sabar Ron , Halevi Hochwald Inbal , Weiss Moran , Yakov Gila 
Published: November 2024

Background:Home-based palliative care is a growing trend, necessitating a deeper understanding of the unique challenges faced by professional staff members in this setting. The shift to home-based care has been driven by advances in technology, changing demographics, and a move toward more patient-centered approaches. As a care setting, the home environment offers distinct characteristics, presenting both advantages and drawbacks for patients and healthcare providers.Objectives:This study aims to explore the experiences and perceptions of professional staff members providing palliative care in patients’ homes.Design:A qualitative descriptive study.Methods:Qualitative study with 36 home-based hospice professionals using questionnaires and interviews. Thematic analysis identified key themes in staff experiences and challenges.Results:The central theme of “The Professional Guest” highlights the hybrid identity and boundary role professional staff members must navigate, being both medical professionals and guests in the patient’s domain. Four sub-themes emerged: (1) Observing and Applying, emphasizing the conscious scanning of the home environment to build trust and tailor care plans; (2) Asking for Permission, respecting the patient’s territory and adapting to their norms; (3) Expecting the Unexpected, maintaining flexibility and improvising in unfamiliar situations; and (4) Preparing the Ground for Your Absence, equipping patients and families with comprehensive self-care guidance during professional staff members’ absences.Conclusion:The “Professional Guest” phenomenon captures the complexities of providing care in patient’s homes, necessitating a delicate balance between professionalism and personal vulnerability. Specialized training programs and policies should be developed to support professional staff members in navigating this hybrid identity and effectively negotiating the boundaries between professional and personal spheres.