bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of the bow-tie analysis to improve patient safety – a lesson learned from clinical practice
Authors: Dimova Rositsa , Raycheva Ralitsa , Pavlova Pavlina 
Published: September 2024

Aim: This study aimed to assess the risk management of drug safety in an operating theater setting within a hospital-based treatment facility.
Materials and methods: This is a case study detailing a single patient. The bow-tie model was modified for analyzing medication errors in anesthesiology practice and implemented in the operating room of the university hospital. The diagram was created using well-established methods. The data was gathered using an online portal (www.rsps.bg) designed to evaluate hospital safety culture and report incidents.
Results: The Striped Bow Tie® methodology-built model illustrated the primary reasons for the medication error. The risk score was estimated to be 12 based on the specified parameters. The severity is rated on a 4-point scale ranging from catastrophic (4), critical (3), marginal (2), to negligible (1). The likelihood is assessed on a 5-point scale from frequent (5), probable (4), occasional (3), moderate (2), to unlikely (1). Preventive methods were suggested to minimize the risk, avert the incident, and manage the process.
Conclusion: The bow-tie approach is suitable and simple to apply in hospital anesthesia practice and serves as an essential instrument for analyzing medication safety risks. The analysis demonstrated systemic errors that led to the incident, including unrealized potential for continuing medical education and transforming the hospital into a place where clinicians can constantly learn by reporting adverse events and medical errors.
Low Contrast Acuity Outcomes After SMILE and LASIK
Authors: Sia Rose K. , Eaddy Isabel , Beydoun Hind , Eaddy Jennifer B. , Hogan Alexis , Skurski Zachary P. 
Published: September 2024

Purpose:
To compare early visual quality of small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK) in terms of low contrast acuity.

Methods:
A secondary analysis was performed using a harmonized dataset derived from two completed prospective cohort studies on active-duty military service members undergoing either SMILE (n = 37), wavefront-guided (WFG) LASIK (n = 51), or wavefront-optimized (WFO) LASIK (n = 56). Night vision and photopic and mesopic low contrast visual acuity (LCVA) up to 3 months postoperatively were compared between groups.

Results:

Compared to SMILE-treated eyes, WFG LASIK–treated eyes had significantly better night vision and photopic LCVA at 1 month postoperatively (beta = −0.039,
P
= .016; beta = −0.043,
P
= .007, respectively). WFO LASIK–treated eyes had significantly better photopic LCVA at 1 month postoperatively (beta = −0.039,
P
= .012) but had worse mesopic LCVA at 3 months postoperatively (beta = 0.033,
P
= .015) versus SMILE-treated eyes.

Conclusions:
SMILE and LASIK, on either a WFG or WFO laser platform, yielded excellent outcomes, but LCVA seemed to recover quicker following LASIK compared to SMILE.

[
J Refract Surg
. 2024;40(9):e667–e671.]
Long-term Visual Outcomes in Patients With Idiopathic Macular Hole Surgery
Authors: Steinkerchner Megan S. , Sharma Neha , Russell Matthew W. , Maatouk Christopher , Talcott Katherine E. , Singh Rishi P. 
Published: September 2024

Background and Objective
This study assesses long-term outcomes following surgical repair of idiopathic full-thickness macular holes (FTMHs) in patients with at least 5 years of postoperative follow-up.

Patients and Methods
A retrospective study evaluated patients diagnosed with idiopathic FTMH who received surgical repair at a single tertiary center with at least 5 years of postoperative follow-up. Data collection included demographic and preoperative characteristics along with macular hole structural integrity as determined by spectral-domain optical coherence tomography (OCT). Functional and structural improvement were assessed by collection of visual acuity and findings on OCT at determined time points until 9 years of follow-up.

Results

The study comprised 90 eyes of 80 patients with a mean age of 67.2 ± 6.8 years, with an average postoperative follow-up of 80.8 ± 17.4 months (range 54 to 130 months). The mean macular hole diameter was 239.7 µm ± 92.2. Macular hole reoperation occurred in four eyes (4%) at a mean duration of 5.5 ± 6 months (range 0.3 to 13 months). Over the study duration, ellipsoid zone (EZ) integrity was maintained in 67.8% of eyes, with an absence of intraretinal fluid (IRF) in 96% on final OCT. The preoperative mean Early Treatment Diabetic Retinopathy Study (ETDRS) best visual acuity (BVA) of 51 improved to a mean BVA of 76 at 5 years postoperatively, with an average gain of 24 letters at one year that remained stable over 5 years (
P
< 0.05). Eight years after surgical repair, more than 80% of patients achieved a BVA > 65.

Conclusions
Vitreoretinal surgery for idiopathic FTMH resulted in successful hole closure and sustained visual acuity improvement over long-term follow-up.

[
Ophthalmic Surg Lasers Imaging Retina
2025;56:15–22.]
Is God evolving? Totems in contemporary art
Authors: Yan Zhilong , Zhang Aixin 
Published: September 2024

This article explores the evolution of totemic symbolism in contemporary visual art and its profound link with religious concepts, particularly the image of God. It examines how artists reinterpret sacred themes through totems, reflecting both historical religious traditions and modern societal transformations. Through a review of totemic representations from ancient to contemporary artworks, this study illuminates the evolving portrayal of divine figures – from traditional religious icons to more personalised spiritual symbols. This evolution not only signifies changes in artistic expression but also suggests a deepening societal understanding of divinity. The analysis highlights the totem’s role as a mediator between the human and the divine, offering insights into the spiritual connections that transcend conventional religious frameworks. This research not only enriches the discourse on the relationship between art and religion but also underscores the dynamic interaction between cultural heritage and contemporary artistic exploration.Contribution: This study enriches the field of art history and religious studies by tracing the transformative representation of totems in art from ancient symbolism to modern reinterpretations. It underscores the totem’s role as a dynamic symbol in contemporary visual culture, facilitating deeper spiritual connections and dialogues across various cultural and religious landscapes. The findings of this study provide a nuanced understanding of how contemporary art mediates complex theological concepts, thus offering new perspectives on the intersection of art, religion and spirituality.
Histopathological evaluation and grading for prostate cancer: current issues and crucial aspects
Authors: Agosti Vittorio , Munari Enrico 
Published: September 2024

Abstract
A crucial aspect of prostate cancer grading, especially in low- and intermediate-risk cancer, is the accurate identification of Gleason pattern 4 glands, which includes ill-formed or fused glands. However, there is notable inconsistency among pathologists in recognizing these glands, especially when mixed with pattern 3 glands. This inconsistency has significant implications for patient management and treatment decisions. Conversely, the recognition of glomeruloid and cribriform architecture has shown higher reproducibility. Cribriform architecture, in particular, has been linked to the worst prognosis among pattern 4 subtypes. Intraductal carcinoma of the prostate (IDC-P) is also associated with high-grade cancer and poor prognosis. Accurate identification, classification, and tumor size evaluation by pathologists are vital for determining patient treatment. This review emphasizes the importance of prostate cancer grading, highlighting challenges like distinguishing between pattern 3 and pattern 4 and the prognostic implications of cribriform architecture and intraductal proliferations. It also addresses the inherent grading limitations due to interobserver variability and explores the potential of computational pathology to enhance pathologist accuracy and consistency.
Serum Progesterone Levels on the Day of Human Chorionic Gonadotrophin Trigger, and its effects on the Outcome of In Vitro Fertilization, and Embryo Transfer: A Two-Center Study
Authors: Onuh Monday Augustine , Ameh Nkeiruka , Ejenobo Tolulope Ejiroghene David , Afolabi Adeniyi stephen , Wada Ibrahim 
Published: September 2024

Abstract

Introduction:
Gonadotrophin-releasing hormone analogs were expected to make preovulatory progesterone (P4) elevation rare during in vitro fertilization (IVF) cycles, but despite its widespread use, subtle rise in P4 levels on the day of ovulation trigger has a documented prevalence of 5%–38%. The effect of preovulatory progesterone levels on IVF outcomes is still controversial and published data from West Africa is sparse.

Materials and Methods:
This was a prospective observational study of 107 women who underwent IVF in both Garki and Nisa hospitals in Abuja, Nigeria. A serum sample was obtained from participants on the day of human chorionic gonadotrophin administration for a single determination of progesterone level. Oocytes retrieved, biochemical pregnancy, and clinical pregnancy were the primary outcomes.

Results:
The mean P4 on human chorionic gonadotrophin (hCG) trigger day was 2.07 ± 0.24 ng/mL and 48 (44.9%) had P4 > 1.5 ng/mL. There was no relationship between P4, and the number of oocytes retrieved but implantation, biochemical pregnancy, and clinical pregnancy were significantly diminished when P4 >1.5 and <1 ng/mL: biochemical pregnancy (27.3% vs. 61.5% vs. 14.6%, χ2 = 17.896; P < 0.0001), clinical pregnancy (24.2% vs. 50.0% vs. 14.6%, χ2 = 11.041; P = 0.004).

Conclusion:
Pregnancy rates are diminished when P4 on hCG trigger day is elevated.
Parliamentarily speaking: A thematic analysis of Kerala Legislative Assembly questions relating to health from 2016 to 2021
Authors: Kochuvilayil Arsha , Sankar Hari , Joseph Jaison , Nair Arun B. , Nambiar Devaki 
Published: September 2024

ABSTRACT

Introduction:
Legislative assemblies often provide a platform for legislators to question the government during question hours, which are crucial for governance However, question hours remain understudied, especially when addressing health policy and systems related issues in lower- and middle-income countries. This study assesses the 14th Kerala Legislative Assembly questions, focusing on health-related areas to provide insights for health policy formulation and decision-making processes.

Materials and Methods:
We sourced and transcribed all starred questions (346) related to health that were answered by the health minister in the 14th Legislative Assembly between 2016 and 2021 from the archives of the assembly website. We conducted a thematic analysis of these questions and mapped them into various themes, guided by the World Health Organization building blocks framework.

Results:
About 7.8% of all questions (N = 4404) were related to health (N = 346). Of these questions, the majority were directly related to service delivery (43.4%), followed by health information (16.5%). Health financing, food safety, and human resources were the least discussed topics throughout the assessed period within the state. The legislators primarily focussed on health services and health information, with less attention given to health financing, food safety, and human resources regardless of constituency or political affiliation.

Discussion:
This study underscores the need for a balanced approach to public health issues, highlighting the importance of legislators to priortizing health services and information, while also addressing health financing, food safety, and human resources. This would enable a robust and resilient public health system to effectively address diverse health concerns.
“Am I really fat/thin?!” Self-perceived body image and correlation with nutritional status among medical students in Central Gujarat
Authors: Sheth Margi B. , Damor Raman D. , Shringarpure Kalpita S. , Patel Darsh T. , Manikam Logan 
Published: September 2024

ABSTRACT

Introduction:
Adolescence is a crucial part of life characterised by rapid body changes that can be influenced by perceptions and misinformation regarding their body image. Body image is usually associated with self-esteem and self-worth. Therefore, it is important to address this issue at this transitional time. This study aims to understand the perception of body image and its correlation with nutritional status among first-year medical students.

Methods:
A cross-sectional study was conducted among first-year medical students enrolled in the MBBS curriculum. Data related to perception of body image were collected through a self-administered, pre-tested questionnaire. Height and weight were taken by the principal investigator at the time of data collection and body mass index (BMI) was calculated according to Asian criteria for BMI. Kappa statistics were used for the agreement between self-perceived body image and BMI.

Results:
A total of 234 out of the 250 students enrolled in the first year gave consent for the study. The median (interquartile range [IQR]) age of the students was 18 (17–19) years and 72% were male students. One-fourth of the students were dissatisfied with their weight (26.9%) followed by height (25%). The Kappa statistics for agreement between BMI and self-perception about body weight was 0.373 (95% confidence interval [CI], standard error (SE) of Kappa = 0.048), showing poor agreement.

Conclusion:
One-fourth of the students were dissatisfied with their physical appearance. The agreement between perceived body weight and nutritional status was poor (64.53%).
Glaucoma burden and its profile in a tertiary care centre of North-East India: A retrospective hospital-based study
Authors: Nongrum Benjamin , Thangkhiew Lanalyn , Natung Tanie , Pandey Ishita , Shullai Wakaru , Wahlang Julie B. , Sundaram Shanthosh Priyan 
Published: September 2024

ABSTRACT

Purpose:
To estimate the proportion and pattern distribution of glaucoma disease in a teaching hospital of North-East India.

Materials and Methods:
Retrospective hospital-based study of glaucoma cases from January 2014 to December 2022.

Results:
Out of a total of 89725 new patients, 449 patients had glaucoma with a prevalence of 0.50% (95% CI: 0.46%-0.55%) of which 361 (80.4%) were ≥40 years and 88 (19.6%) were <40 years. The commonest type was POAG (32.1%) followed by PACG (17.6%) while JOAG was 7.8%. Males (67.2%) were predominant with a male: female ratio of 2.0:1. The mean age of patients was 53.4 (17.1) years. PACG was found to be significantly higher among females (p=0.001) whereas POAG was higher among males (p=0.003). There was no association of either age or systemic conditions with the prevalence of POAG and PACG. Hypertension and diabetes were present among 139 (31.0%) and 103 (23.0%) respectively while 13 (2.9%) had chronic obstructive pulmonary disease (COPD), 5 had coronary artery disease (CAD) and 5 hypothyroidism.

Conclusion:
The prevalence of glaucoma though lower compared to other parts of the country, the number was significant, warranting screening activities owing to its silent nature. PACG was significantly higher among females while POAG was higher among males. Systemic factors like COPD, CAD and hypothyroidism require further studies for better understanding of the temporal association with glaucoma.
Virtual care is a double-edged sword: Adjusting preventive care service delivery in community health clinics during COVID-19
Authors: Papajorgji-Taylor Dea , Sheppler Christina R. , McMullen Carmit , O’Connor Patrick J. , Gold Rachel 
Published: September 2024

ABSTRACT

Purpose:
Qualitatively examine how community health clinics delivered cardiovascular disease (CVD) preventive care during COVID-19 using virtual care and related adaptations.

Methods:
Semi-structured interviews were conducted in 2021–2022 with nine clinician leaders from four clinics across the country that share an electronic health record. Interviews covered: (1) the pandemic’s impact on preventive care delivery, (2) the adaptation and role of virtual care, and (3) management of CVD risk in this context. Collected data were analyzed using a thematic analysis approach.

Results:
Staff reported substantial pros and cons to virtual care for CVD risk management. It was seen as useful for general check-ins with patients. However, without current laboratory results and vital measurements, providers found it challenging to assess patient CVD risk and direct care accordingly.

Conclusion:
Findings add to the evolving evidence base that the necessary pivot to virtual care during the pandemic spurred innovations but also created limitations and delays in delivering appropriate preventive care.
Exploring the link between leptin levels and metabolic syndrome in elderly Indian patients: Implications for family medicine and primary care practices
Authors: Singhal Arjun Kumar , Singh Gaurav , Singh Shravan Kumar , Karunanand Busi , Gunjan Gagan , Agrawal Sonu K. 
Published: September 2024

ABSTRACT

Background:
The metabolic syndrome (MetS), according to the Adult Treatment Panel III of the National Cholesterol Education Programme, is a collection of metabolic abnormalities that includes one, two, or all three of the following traits: obesity in the abdomen, dyslipidemia, hypertension, fasting blood sugar, or insulin resistance. This study’s aim was to assess the relationship between fasting serum leptin and MetS in elderly adults with T2DM in the Northern Indian population.

Material and Methods:
The following information was collected from all the participants: (1) anthropometric data, (2) biochemical data, and (3) a lifestyle questionnaire on sociodemographic data, dietary practices, smoking, and alcohol intake to identify their risk factors for diabetes mellitus, CVD, and hypertension.

Results:
A total of 36 older participants (56.30%) had a history of hypertension, while 29 elderly participants (44.61%) had diabetes mellitus. A total of 32 elderly participants (49.2%) had MetS, and this group had higher serum leptin (P 0.003), body weight (P = 0.019), BMI (P 0.001), waist circumference (P 0.001), CRP (P = 0.021), insulin (P = 0.001), and HOMA-IR (P = 0.003) values as well as higher percentages of females (P = 0.001), and those with type 2 diabetes mellitus (P = 0.002) and hypertension (P = 0.039) than those in the non-MetS group.

Conclusion:
In older persons with T2DM, our study discovered a favorable correlation between serum leptin and MetS. It can act as a standalone indicator of MetS, offering a way to spot populations at risk for associated consequences and enabling early intervention.
From data to decisions: Exploring family planning services utilization in Karnataka and India through the prism of NFHS-4 and NFHS-5
Authors: Kulkarni Namratha , Kumar Saurabh , Havaldar Pavan P. 
Published: September 2024

ABSTRACT

Background:
Family planning (FP) services are pivotal in assessing a country’s healthcare efficacy. Despite India’s strides in FP promotion, disparities persist in its utilization rates. This study analyzes Karnataka’s FP trends by using National Family Health Survey (NFHS) rounds 4 and 5, comparing its indicators with national averages.

Methods:
A retrospective record review-based descriptive study design was employed. Data from NFHS-4 (2015–16) and NFHS-5 (2019–21) were analyzed using MS Excel 365. Key variables included age at marriage, total fertility rate (TFR), and various contraceptive methods.

Results:
Karnataka exhibited a stable rate of early marriages for women and a decline among men aged 25–29 years. TFR in Karnataka slightly decreased, with increased contraceptive usage and significant growth in modern contraceptive methods. However, male sterilization rates remained low. There was an improvement in health workers’ engagement with female non-users and in providing information on contraceptive side effects.

Conclusion:
While Karnataka has progressed in FP, challenges such as early marriages persist. Enhancing integration, leveraging technology, and empowering women are essential for comprehensive FP services in India.
Coverage evaluation of Iron folic acid and vitamin A supplementation among children in rural Puducherry—A Mixed method study
Authors: Mohan Reenaa , Vaishnavi B Sowbarnika , Premanandh Kandasamy 
Published: September 2024

ABSTRACT

Background:
Despite many measures taken by the government, still the problem of Vitamin A deficiency and anaemia exists among children. This study focuses on coverage of iron and folic acid and Vitamin A supplementation among children aged between 9 months and 5 years and to find out the barriers in administrating these supplements to children.

Methods:
An explanatory sequential mixed methodology was conducted in the field practice area of Thirubuvanai primary health centre. In the quantitative survey, a cross-sectional cluster sampling survey was conducted to find the coverage of IFA and Vitamin A supplementation among children (n = 215), followed by a qualitative interview (n = 14) to find out the barriers in administrating these supplements to children was conducted among the mothers.

Results:
Our study found that Vitamin A supplementation coverage was taken only by 42% of the children in the last 6 months preceding the survey. IFA supplementation was taken by 31.2% of the children in the last 7 days preceding the survey. Lack of awareness, myths and misbeliefs, fear of adverse effects and lack of family support were found as barriers in administering the supplement to the children.

Conclusion:
The study findings have highlighted the need for community health education to improve the coverage of supplement administration.
Risk and protective factors of miscarriage: Evidence from a nationally representative sample of women in India
Authors: Sonu H S , Das Sumit Kumar , Tony Roshni , Binu V S 
Published: September 2024

ABSTRACT

Context:
Miscarriage is the most distressing complication in early pregnancy, with one in every five pregnant women ending in a miscarriage, and its causes are multifactorial.

Aim:
This study aimed to find the risk and protective factors of miscarriage among women aged 15–49 years in India by using the National Family Health Survey (NFHS-5) data.

Methods and Material:
The data were taken from NFHS-5; 53,560 women aged 15–49 years who had reported either a miscarriage (n = 5104) or livebirth (n = 48,456) during the last 12 months preceding the survey were included in the study.

Statistical Analysis Used:
Various sociodemographic, lifestyle, comorbid, and fertility-related factors were considered in the Poisson regression analysis, and adjusted prevalence ratios were obtained.

Results:
Significant sociodemographic risk factors were age less than 20 years or more than 34 years, urban residence, primary and higher education levels, wealth index middle and above, and occupation as employed. Muslim religion, Scheduled Tribe, and Other Backward Class castes were statistically significant protective factors. Obesity, severe anemia, hypertension, and thyroid disorder were the significant comorbid risk factors, whereas tobacco chewing was the only significant lifestyle risk factor. A higher number of ever-born children was the fertility-related risk factor, whereas the use of intrauterine devices was a significant protective factor for miscarriage.

Conclusions:
To reduce the incidence of miscarriage in developing countries like India, the respective governments and healthcare providers should develop intervention programs targeting women in well-educated and high-income families.