bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the performance of large language models (LLMs) in answering medical questions regarding breast cancer in the Chinese context
Authors: Piao Ying , Chen Hongtao , Wu Shihai , Li Xianming , Li Zihuang , Yang Dong 
Published: October 2024

Purpose Large language models (LLMs) are deep learning models designed to comprehend and generate meaningful responses, which have gained public attention in recent years. The purpose of this study is to evaluate and compare the performance of LLMs in answering questions regarding breast cancer in the Chinese context. Material and Methods ChatGPT, ERNIE Bot, and ChatGLM were chosen to answer 60 questions related to breast cancer posed by two oncologists. Responses were scored as comprehensive, correct but inadequate, mixed with correct and incorrect data, completely incorrect, or unanswered. The accuracy, length, and readability among answers from different models were evaluated using statistical software. Results ChatGPT answered 60 questions, with 40 (66.7%) comprehensive answers and six (10.0%) correct but inadequate answers. ERNIE Bot answered 60 questions, with 34 (56.7%) comprehensive answers and seven (11.7%) correct but inadequate answers. ChatGLM generated 60 answers, with 35 (58.3%) comprehensive answers and six (10.0%) correct but inadequate answers. The differences for chosen accuracy metrics among the three LLMs did not reach statistical significance, but only ChatGPT demonstrated a sense of human compassion. The accuracy of the three models in answering questions regarding breast cancer treatment was the lowest, with an average of 44.4%. ERNIE Bot's responses were significantly shorter compared to ChatGPT and ChatGLM ( p < .001 for both). The readability scores of the three models showed no statistical significance. Conclusions In the Chinese context, the capabilities of ChatGPT, ERNIE Bot, and ChatGLM are similar in answering breast cancer-related questions at present. These three LLMs may serve as adjunct informational tools for breast cancer patients in the Chinese context, offering guidance for general inquiries. However, for highly specialized issues, particularly in the realm of breast cancer treatment, LLMs cannot deliver reliable performance. It is necessary to utilize them under the supervision of healthcare professionals.
Acceptability of the power over pain portal among patients awaiting tertiary care consultation: A qualitative study of patients’ perceptions
Authors: King Alesha C , Zahrai Amin , Bisson Etienne , Shergill Yaadwinder , Andreev Pavel , Bosma Rachael , MacNeil Alexandra O , Radhakrishnan Arun , Rash Joshua A , Wilson Rosemary , Poulin Patricia 
Published: October 2024

Objective Chronic pain affects approximately 7.6 million Canadians and access to care remains an issue. The Power Over Pain (POP) Portal offers immediate access to evidence-based resources ranging from low- (e.g. education, self-management), to high- (e.g. individual counseling) intensity. We explored the POP Portal's acceptability, usability, and perceived usefulness among patients newly referred to a tertiary care pain clinic. Methods We used a descriptive, qualitative approach with a prospective cohort of 60 adult patients recently referred to The Ottawa Hospital Pain Clinic. Patients were offered an orientation session and asked to participate in a seven-week follow-up interview. Data were thematically analyzed in an iterative process, whereby responses were reviewed and coded by two members of the research team. Results Of the 60 patients referred to the POP Portal by clinic clerks, 45 participated in the orientation session, and 40 completed a four-week follow-up. All 40 patients had used the POP Portal and recommended that we continue to offer the POP Portal to patients awaiting care. We identified overarching themes of acceptability (five subthemes), usability (ten subthemes), accessibility (three subthemes), and patient value of the POP Portal (three subthemes). This includes (1) the POP Portal provides easy access to chronic pain resources; (2) the POP Portal is helpful in developing an understanding of chronic pain; and (3) improvements to the POP Portal are needed to increase usability and foster a user-friendly experience. Conclusions The POP Portal offers accessible and diverse resources for people living with pain awaiting a tertiary care consultation; however, patients would like to see resources specific to diagnosis. Improvements are suggested to allow greater increase the POP Portal usability.
Patient and Community Health Worker (CHW) Perspectives on a CHW-delivered Nutrition Intervention for Low-Income Adults with Hypertension: A Qualitative Study
Authors: Gu Kristine D. , Cheng Jessica , Malone Ashlie , Faulkner Katherine C. , Bejarano Oldy , Gelsomin Emily , Thorndike Anne N. 
Published: October 2024

Introduction/Objectives: Adults with food insecurity (FI) face barriers to hypertension management, including difficulty adhering to diet recommendations. Few community health worker (CHW) interventions focus on diet to improve blood pressure. This qualitative study elicited patient and CHW perspectives on healthy eating and a future CHW nutrition intervention for patients with hypertension. Methods: Twenty-five patients with hypertension and FI and 5 CHWs participating in a hypertension health coaching program from 5 Boston-area health centers participated in semi-structured interviews from July to September 2023. Interviews were audio recorded, transcribed, and analyzed using the Framework Method. Results: Themes included: 1) Variable patient knowledge about dietary patterns for hypertension management and low confidence in interpreting nutrition labels; 2) Culture influenced healthy food perception; and 3) Barriers to healthy eating included cost, limited cooking abilities/supplies, and competing demands. Patients and CHWs favored simple nutrition education materials (e.g., traffic light nutrition ranking, healthy meals on a budget). Patients had mixed opinions about CHW-accompanied supermarket visits. Conclusions: This study identified culture, knowledge gaps, and budget constraints as factors influencing diet among patients with hypertension and FI. A CHW-delivered intervention could include simplified nutrition education, strategies for healthy eating on a budget, and linkage to community-based food programs.
Secondary Displacement was Common in Healing Distal Femur Fractures in a Cohort of Elderly Patients
Authors: Paulsson Martin , Ekholm Carl , Rolfson Ola , Tranberg Roy , Geijer Mats 
Published: October 2024

Introduction Surgical treatment of distal femoral fractures (DFFs) in osteoporotic bone is challenging despite improvements in hardware and surgical techniques. The occurrence and degree of secondary displacement during healing after bridging plate fixation are still unknown. This study aimed to assess the occurrence and degree of secondary displacement in healing DFFs in elderly patients and correlate the secondary displacement to body mass index, bone density, and weight-bearing regimen. Patients and Methods The study involved 32 patients, 65 years or older, with a DFF of AO/OTA types 33 A2-3, B1-2, C1-2, and 32(c) A-C,1-3, including peri-prosthetic fractures with stable implants. Twenty-seven patients had at least 8 weeks of follow-up, and 21 patients had a complete 1-year follow-up. Minimally invasive surgery was performed using a distal anatomical femoral plate as a long bridge-plating construct. Secondary displacement was assessed with computed tomography of the entire femur postoperatively and at 8, 16, and 52 weeks. Femoral length, coronal angulation (varus/valgus), and subsidence as the change in distance between the distal joint surface and a specified locking screw were measured. Results There was a statistically significant mean femoral shortening at 52 weeks of 4.7 mm (SD 3.9, (95% CI 2.9–6.5), P < 0.001) mainly by subsidence of the distal fragment. Most patients experienced limited coronal angulation. There was no correlation between body mass index or bone density and secondary displacement. At the 1-year follow-up, no patient needed revision surgery for non-union or plate breakage. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or adverse events such as cut-outs. Conclusion Modern dynamic plate osteosynthesis could not prevent commonly occurring fracture subsidence in DFF in an elderly cohort. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or mechanical adverse events.
Trends in Anterior Cruciate Ligament Reconstruction Techniques and Postoperative Care Among Leaders in the Field: A Survey of the Herodicus Society
Authors: Engler Ian D. , Fox Michael A. , Curley Andrew J. , Mohr Damaris S. , Dadoo Sahil , Arner Justin W. , Musahl Volker , Bradley James P. 
Published: October 2024

Background: Despite a growing body of literature regarding anterior cruciate ligament reconstruction (ACLR), there remains a wide diversity in surgical technique and clinical practice across providers. Purpose: To (1) describe current ACLR practice preferences among members of the Herodicus society and (2) determine whether these preferences are influenced by years in practice and overall surgical volume. Study Design: Cross-sectional study. Methods: A 24-question survey investigating surgeons’ practices and preferred ACLR surgical techniques was sent via email to all active Herodicus Society members. Survey responses were subdivided by years of experience and overall ACLR annual case volume. Descriptive statistics were compiled and chi-square testing was utilized to determine the significance of experience and case volume on survey responses. Results: Of the 113 invited Herodicus Society members who perform ACLR, 69 (61%) completed the survey. Respondents had a mean ± SD of 30.9 ± 9.8 years of experience in clinical practice and performed a mean of 96.0 ± 50.7 primary and 21.6 ± 16.9 revision ACLR annually. Of revision cases, 72.1% were performed using a single-stage technique. Mean frequency of graft usage by surgeon was bone–patellar tendon–bone autograft (58.6%), quadriceps autograft (14.6%), hamstring tendon autograft (14.0%), and allograft (11.8%). The plurality of surgeons responded that they used anterolateral augmentation “rarely” in primary ACLR (39.1%) and “sometimes” in revision ACLR (31.9%), with the majority performing lateral extra-articular tenodesis (66.7%) rather than anterolateral ligament reconstruction (14.5%). Most surgeons would not allow a 20-year-old football player to return before 7 months after ACLR (71.0%) but highly valued return-to-sports testing to determine readiness (94.2%). Higher volume surgeons performed single-stage revision ACLR at a significantly higher rate (79.8% vs 62.9%, P = .02) and significantly differed in return-to-sports criteria, with a greater proportion relying primarily on biometric testing ( P = .01). Conclusion: The survey demonstrated that, in the Herodicus Society, a wide range of preferences exist regarding ACLR surgical technique. Bone–patellar tendon–bone autograft is the most frequent primary ACLR graft choice. Most participants have not embraced newer techniques such as anterolateral or suture tape augmentation. Return to sports is generally not allowed before 7 months and heavily factors-in return-to-sports testing metrics, suggesting that purely time-based criteria for return to sports is not modern practice among elite sports medicine surgeons.
Exploring Lived Experiences of Vulnerability in Nursing Management during the Coronavirus Disease 2019 Pandemic: A Phenomenological Study of Nurse Managers and Nurses
Authors: Heydarikhayat Nastaran , Ghanbarzehi Nezar , Darban Fatemeh , Kashani Zahra Atarodi , Rohani Camelia 
Published: October 2024

Introduction The Coronavirus Disease 2019 (COVID-19) pandemic placed enormous pressure on healthcare systems around the world, but it also provided valuable insights for healthcare organizations during this challenging period. Objective This study aimed to explore nurses’ lived experiences of vulnerability in hospital nursing management during the COVID-19 pandemic, and reflect on the lessons learned. Methods In this phenomenological study, 14 participants, including nurse managers at different levels and staff nurses, were selected by purposive sampling from one center university hospital. Data collection was done through in-depth individual semistructured interviews with participants and a review of weekly reports of crisis management meetings at the university hospital. Interviews were analyzed using Colaizzi's method in seven phases by MAXQDA software Version 10. Results One overarching theme, four themes, and 15 subthemes were obtained from analyses of interviews. Four themes of “nurses’ attrition,” “distrust of society to the organization,” “fragility in the organization's performance,” and “intensified inequalities” were extracted as threats to nursing management at the hospital. Subsequently, the weekly reports of crisis management meetings at the university hospital were analyzed to extract the solutions and lessons. Conclusion The unpreparedness of the healthcare system against a crisis can led to the loss of organizational assets, including medical staff and the credibility of the healthcare system. Limitations of the infrastructure at hospital became more obvious during the pandemic and caused serious threats to the healthcare system. Despite severe challenges along with the pandemic, it offered four valuable lessons in nursing management.
“I Just Had to Do What I Had to Do”: Characterizing Direct and Indirect Prostate Cancer Treatment Costs for Black Survivors and Their Caregivers
Authors: Rice Hannah E. , L’Hotta Allison J. , Siječić Amela , Drake Bettina F. , Chang Su-Hsin , Kim Eric H. , Wright-Jones Robin , Shahid Mellve , Neal Camille , Housten Ashley J. 
Published: October 2024

Introduction. Financial hardship is prevalent among Black prostate cancer survivors and exacerbates health disparities. Characterizing and sharing cost information with patients can facilitate well-informed treatment decision making. Our research explored the direct and indirect costs associated with prostate cancer treatment among Black men and their caregivers. Direct costs included out-of-pocket and insurance-related fees, and indirect costs included the unforeseen costs of care, including patient time, caregiver time, lost wages, and transportation. Methods. We conducted semi-structured interviews with Black prostate cancer survivors and their caregivers to learn about the experience of direct and indirect costs. The interview guide and data analysis were informed by the Measures of Financial Wellbeing framework to gain a better understanding of the material, behavioral, and psychosocial aspects of care-related costs. Guided by a qualitative descriptive approach, we used inductive and deductive coding for our thematic analysis. Results. Eleven prostate cancer survivors with a median age of 68 y (interquartile range [IQR] 62.0–71.5 y) and 11 caregivers with a median age of 64 y (IQR 58.5–70.5 y) participated. We grouped themes into 3 domains and their intersections (i.e., material, behavioral, psychosocial). Participants reported their work and insurance had a significant influence on their finances, treatment costs required rearranging of household budgets, and the weight of indirect costs varied. Ultimately, participants emphasized the significant impact of care costs and the adjustments needed to adapt to them. Discussion. The complexities of material, behavioral, and psychosocial domains of direct and indirect costs of prostate cancer are critical to address when supporting those diagnosed with prostate cancer when making preference-sensitive treatment decisions. The interconnectedness between indirect costs highlights the wide-ranging impact financial well-being has on prostate cancer survivors and caregivers. Highlights Direct and indirect costs have a wide-ranging impact on the material, behavioral, and psychosocial aspects of financial well-being of Black prostate cancer survivors and their caregivers. These results emphasize the need for sharing cost information to support medical decision making. Future research should focus on the design of cost-sharing interventions that target the complexities of direct and indirect costs collectively, rather than separately.
Large ischemic core defined by visually assessed ASPECTS predicts functional outcomes comparably accurate to automated CT perfusion in the 6–24 h window
Authors: Dittrich Tolga D , Nguyen Anh , Sporns Peter B , Toebak Anna M , Kriemler Lilian F , Rudin Salome , Zietz Annaelle , Wagner Benjamin , Barinka Filip , Hänsel Martin , Gensicke Henrik , Sutter Raoul , Nickel Christian H , Katan Mira , Peters Nils , Michels Lars , Kulcsár Zsolt , Karwacki Grzegorz M , Pileggi Marco , Cereda Carlo , Wegener Susanne , Bonati Leo H , Psychogios Marios , De Marchis Gian Marco 
Published: October 2024

Introduction: Automated CT perfusion (aCTP) is commonly used to select patients with anterior circulation large vessel occlusion (aLVO) for endovascular treatment (EVT). The equivalence of visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) and aCTP based selection in predicting favorable functional outcomes remains uncertain. Patients and methods: Retrospective multicenter study of adult aLVO patients from the Swiss Stroke Registry (2014–2021) treated with EVT or best medical treatment 6–24 h after stroke onset. We assessed ASPECTS on non-contrast CT visually and ischemic core volumes on aCTP, defining ASPECTS 0–5 and aCTP CBF < 30% volumes ⩾50 mL as large ischemic cores. We used logistic regression to explore the association between CT modalities and favorable functional outcomes (modified Rankin Scale [mRS] score shift toward lower categories) at 3 months. Receiver operating characteristic (ROC) curve analysis compared the predictive accuracy of visually assessed ASPECTS and aCTP ischemic core for favorable outcomes (mRS 0–2) at 3 months. Results: Of 210 patients, 11.4% had ASPECTS 0–5, and 12.9% aCTP core volumes ⩾50 mL. Within the same model, ASPECTS but not aCTP core volumes were associated with favorable outcomes (ASPECTS: acOR 1.85, 95%CI 1.27–2.70, p = 0.001). The ROC curve analyses showed comparable diagnostic accuracy in predicting favorable functional outcomes (mRS 0–2) at 3 months (ROC areas: ASPECTS 0.80 [95%CI 0.74–0.86] vs aCTP core 0.79 [95%CI 0.72–0.85]). Discussion and conclusion: In patients with aLVO, visually assessed ASPECTS showed at least comparable accuracy to automatically generated CTP core volumes in predicting functional outcomes at 3 months.
The Role of Genetic Variations in the FAAH rs324420 Polymorphism and its Interaction with CRHR1 rs110402 and CNR1 rs2180619 in Anxiety and- Trauma Related Symptoms After Military Deployment
Authors: Leen Nadia , de Weijer Antoin , Boks Marco , Baas Johanna , Vermetten Eric , Geuze Elbert 
Published: October 2024

Background During military deployment, stress regulation is vital to protect against the development of anxiety and trauma-related symptoms. Brain endocannabinoids play an important role in stress regulation and previous research has shown that genetic variations in the FAAH rs324420 polymorphism demonstrate protective effects during stress. In addition, this polymorphism shows interactions with the CRHR1 and CNR1 polymorphisms on anxiety. The present study examines whether genetic variations of the FAAH, CRHR1 and CNR1 polymorphisms interact with the development of anxiety and trauma related symptoms in military veterans. Methods Veterans (N = 949) who went on military deployment and experienced a stressful event were genotyped for FAAH rs324420, CRHR1 rs110402 and CNR1 rs2180619. Anxiety and trauma symptoms were measured pre-deployment and 6 months after deployment. Anxiety was measured with the anxiety subscale of the Symptom Checklist-90 (SCL-90) and trauma with the Self-Rating Inventory for PTSD (SRIP). Results Covariance Pattern Models demonstrated no significant relation of genetic variations in FAAH rs324420 on anxiety and PTSD symptoms from pre-deployment to 6 months after military deployment. Additionally, we investigated interactions between the FAAH s324420, CRHR1 rs110402 and CNR1 rs2180619 polymorphisms. This also demonstrated no significant effects on anxiety and PTSD symptoms pre- to post deployment. However, the covariate of childhood trauma that was included in the models was significant in all these models. Conclusion Genetic variations in FAAH rs324420 and its interactions with CRHR1 rs110402 and CNR1 rs2180619 are not related to the development of anxiety and trauma-related symptoms. The study however, indicates the importance of considering childhood trauma in the investigation of the effects of polymorphisms that are related to the endocannabinoid system on the development of anxiety and PTSD symptoms.
Pharmacists’ perceptions of error reporting systems
Authors: Hartt Christopher Michael , Weigand Heidi , MacDonald Ashley Jean , Barker James R , MacKinnon Neil J 
Published: October 2024

Background Healthcare-related adverse events directly impact patient safety. Effective reporting of adverse events and workplace factors affecting the quality and quantity of reporting has been a recent focus. In Nova Scotia, pharmacists have been required to report quality-related events (QREs), errors, and near misses since 2010 through the Canadian Pharmacy Incident Reporting (CPhIR) database. This study aims to better understand how healthcare professionals who use the CPhIR system feel about their experience with QREs and the QRE reporting process. Methods A total of 1000 registered pharmacists and staff were contacted through the Nova Scotia College of Pharmacists. Five focus group meetings were conducted from May to October 2018, consisting of 17 community pharmacists, pharmacy technicians, and assistants. Analysis Thematic analysis was used to identify and define emerging themes in the transcripts by multiple readers. The Actor-Network Analytical Theory helped draw a web of connections in producing a safety culture that extends beyond the roles at the dispensing counter. Results It was found that participants were committed to minimizing and reporting errors, but using the CPhIR database system is both time-consuming and onerous. Additionally, there was a lack of continuity in communicating the QRE system protocols and compliance protocols for the system. Conclusions Community-based pharmacy culture needs to shift from a compliance-based culture, where error reporting is based on completion and volume, to a just culture that embraces quality and learning from mistakes, a critical element of safe dispensing.