bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Scientific Knowledge of Bard and ChatGPT in Endocrinology, Diabetes, and Diabetes Technology: Multiple-Choice Questions Examination-Based Performance
Authors: Meo Sultan Ayoub , Al-Khlaiwi Thamir , AbuKhalaf Abdulelah Adnan , Meo Anusha Sultan , Klonoff David C. 
Published: October 2023

Background:The present study aimed to investigate the knowledge level of Bard and ChatGPT in the areas of endocrinology, diabetes, and diabetes technology through a multiple-choice question (MCQ) examination format.Methods:Initially, a 100-MCQ bank was established based on MCQs in endocrinology, diabetes, and diabetes technology. The MCQs were created from physiology, medical textbooks, and academic examination pools in the areas of endocrinology, diabetes, and diabetes technology and academic examination pools. The study team members analyzed the MCQ contents to ensure that they were related to the endocrinology, diabetes, and diabetes technology. The number of MCQs from endocrinology was 50, and that from diabetes and science technology was also 50. The knowledge level of Google’s Bard and ChatGPT was assessed with an MCQ-based examination.Results:In the endocrinology examination section, ChatGPT obtained 29 marks (correct responses) of 50 (58%), and Bard obtained a similar score of 29 of 50 (58%). However, in the diabetes technology examination section, ChatGPT obtained 23 marks of 50 (46%), and Bard obtained 20 marks of 50 (40%). Overall, in the entire three-part examination, ChatGPT obtained 52 marks of 100 (52%), and Bard obtained 49 marks of 100 (49%). ChatGPT obtained slightly more marks than Bard. However, both ChatGPT and Bard did not achieve satisfactory scores in endocrinology or diabetes/technology of at least 60%.Conclusions:The overall MCQ-based performance of ChatGPT was slightly better than that of Google’s Bard. However, both ChatGPT and Bard did not achieve appropriate scores in endocrinology and diabetes/diabetes technology. The study indicates that Bard and ChatGPT have the potential to facilitate medical students and faculty in academic medical education settings, but both artificial intelligence tools need more updated information in the fields of endocrinology, diabetes, and diabetes technology.
Evaluation of Medication Exposure on Exacerbation of Disease in Patients With Myasthenia Gravis
Authors: Petrucelli Nick , Barra Megan E. , Koehl Jennifer L. 
Published: October 2023

Background and Purpose In patients with myasthenia gravis (MG), worsening of symptoms poses a risk of respiratory failure which can be precipitated by medication use. Although purported, the risks associated with administration of certain medications are not fully elucidated. Thus, clinical decision support involving a best practice alert was executed to caution providers of drug-disease interactions when ordering a potentially harmful medication. We performed an analysis of the alert overrides with subsequent medication exposure to determine the incidence of MG exacerbations. Methods This retrospective chart-review evaluated adult patients with MG at 2 large academic medical centers via electronic health records between November-2019 and November-2021 who received a medication following override of the clinical decision support tool. The primary outcome was proportion of patient encounters complicated by myasthenic exacerbations after potentially harmful medication administration. Secondary outcomes included changes in motor strength, length of stay, discharge disposition, unplanned level-of-care escalations, and changes to immunosuppressant therapy following medication administration. Results A total of 70 orders were assessed in 38 patients across 55 encounters. Medications administered during these encounters included macrolides, fluoroquinolones, β-blockers, calcium channel blockers, and magnesium sulfate. Exacerbation of disease occurred in 7 patient encounters (12.7%) and occurred after intravenous magnesium or intravenous labetalol. In 5/7 events, at least 1 other risk factor associated with a myasthenic exacerbation was present. Conclusions Of the medications reported to potentially worsen MG, intravenous labetalol and intravenous magnesium were the 2 agents associated with myasthenic exacerbations with a higher incidence in patients harboring additional risk factors.
Prevalence of myopia in school-age children in Ethiopia: A systematic review and meta-analysis
Authors: Lorato Merkineh Markos , Yimer Ali , Kebede Bizueneh Fassikaw 
Published: October 2023

Objective: This study aimed to estimate the pooled prevalence of myopia among school-age children in Ethiopia. Methods: Eligible articles were searched from PubMed, Embase, and Web of Science databases. In addition, Google Scholar and reference lists of the retrieved articles were searched from 30 July 2022 to 02 January 2023. The preferred reporting of items for systematic reviews and meta-analysis was used to report the search results. Microsoft Excel was used to keep the data. The qualities of eligible studies were checked using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Analysis was held using STATA Version 11. The degree of heterogeneity was checked using I² statistics. The possible sources of heterogeneity were examined using meta-regression and subgroup analyses. The funnel plot and Egger’s test were used to assess the potential publication bias. A correction was made for publication bias using Duval and Twee Die’s trim-and-fill analysis. The systematic review registration number is PROSPERO (#CRD42022330541). Results: We identified 21 eligible articles including 20,757 subjects. Of those participants, 10,601 (51.1%) and 10,156 (48.9%) were males and females, respectively. A total of 15,152 (73%) participants were urban residents. The estimated prevalence of myopia among school-age children in Ethiopia was found to be 5.26% (95% confidence interval: 4.09–6.42). Conclusions: The prevalence of myopia among school-age children in Ethiopia is considerable, affecting one in 20 school-age children. Therefore, the authors recommend the stakeholders take extra steps to speed up the implementation of the school vision screening program and its integration plan into the existing school nutrition program.
A feasibility study on the efficacy of a patient-owned wound surveillance system for diabetic foot ulcer care (ePOWS study)
Authors: Lo Zhiwen J , Harish Keerthi B , Tan Elaine , Zhu Julia , Chan Shaun , Liew Huiling , Hoi Wai H , Liang Shanying , Cho Yuan T , Koo Hui Y , Wu Kyle , Car Josip 
Published: October 2023

Objective Wound image analysis tools hold promise in helping patients to monitor their wounds. We aim to perform a novel feasibility study on the efficacy of a patient-owned wound surveillance system for diabetic foot ulcer (DFU) care. Methods This two-institutional, prospective, single-arm pilot study examined patients with DFU. An artificial intelligence-enabled image analysis app calculating the wound surface area was installed and patients or caregivers were instructed to take pictures of wounds during dressing changes. Patients were followed until wound deterioration, wound healing, or wound stability at 6 months occurred and the outcomes of interest included study adherence, algorithm performance, and user experience. Results Between January 2021 and December 2021, 39 patients were enrolled in the study, with a mean age of 61.6 ± 8.6 years, and 69% ( n = 27) of subjects were male. All patients had documented diabetes and 85% ( n = 33) of them had peripheral arterial disease. A mean follow-up for those completing the study was 12.0 ± 8.5 weeks. At the conclusion of the study, 80% of patients ( n = 20) had primary wound healing whilst 20% ( n = 5) had wound deterioration. The study completion rate was 64% ( n = 25). Usage of the app for surveillance of DFU healing, as compared to physician evaluation, yielded a sensitivity of 100%, specificity of 20%, positive predictive value of 83%, and negative predictive value of 100%. Of those who provided user experience feedback, 59% ( n = 10) felt the app was easy to use, 47% ( n = 8) would recommend the wound analysis app to others but only 6% would pay for the app out of pocket ( n = 1). Conclusion Implementation of a patient-owned wound surveillance system is feasible. Most patients were able to effectively monitor wounds using a smartphone app-based solution. The image analysis algorithm demonstrates strong performance in identifying wound healing and is capable of detecting deterioration prior to interval evaluation by a physician. Patients generally found the app easy to use but were reluctant to pay for the use of the solution out of pocket.
Sociocultural and Economic Barriers to Land Ownership Among Widows in Rural Western Kenya
Authors: Otieno Beatrice Adhiambo , Muga Geoffrey Otieno 
Published: October 2023

Background Widows still face immense barriers in owning land and get inferior reliable rights to land than males across most Kenyan communities. The objective of this study, therefore, was to establish the sociocultural and economic factors that continue to bar widows from owning land in rural Western Kenya. Methods A cross-sectional study employing qualitative data collection methods was adopted in this study where six widows participated in Case Narratives (CN), and two Focus Group Discussions (FGDs) each with five widows and one FGD comprising eight men were conducted. In addition, six widows were identified from the FGD participants for in-depth interviews (IDIs) and 10 key informant interviews with stakeholders were carried out. Data from the qualitative interviews were transcribed for coding and analysis. The thematic content analysis method was used to identify themes related to sociocultural and economic factors hindering women from land ownership. Results Economic marginalisation, traditional land ownership structures, and practices such as the skewed land inheritance that disfavour women due to the deep-rooted patriarchy, low level of education and lack of awareness of existing land laws were found to be the major hindrances to land ownership by widows. In addition, the tedious process of accessing land documents and widow inheritance is also to blame. Conclusion The study concludes that the existence of a legal regime that accords women and widows the right to own land may not be sufficient in realising the intended gains for women if it is not backed up with an effective implementation and awareness creation on the laws as well as economic empowerment of the widows through targeted social protection schemes.
Tibial Tuberosity Rotation in Patients With Patellar Instability Versus Age- and Sex-Matched Controls
Authors: Polat Metin , Tandogan Reha Nevzat , Solak Evsen Polattas , Bekiroglu Gulnaz Nural , Beyzadeoglu Tahsin , Kayaalp Asim 
Published: October 2023

Background: Several methods have been described to measure external rotation of the tibial tuberosity; all use femoral landmarks. Purpose: To develop reproducible tibial-based methods to measure external rotation of the tibial tuberosity in patients with patellar instability. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were magnetic resonance images of 61 patients with patellar instability and 61 age- and sex-matched healthy controls. Three novel methods using tibial landmarks to measure the rotation of the tibial tuberosity (plateau axis-tuberosity axis [PA-TA] angle, tibial geometric center-tuberosity axis [GC-TA] angle, and plateau axis-midtuberosity point [PA-MT] angle) as well as a femoral-based rotational measurement (surgical transepicondylar axis-tuberosity axis [sTEA-TA] angle) and the tibial tuberosity-trochlear groove (TT-TG) distance were measured and compared in instability patients and controls using unpaired t tests, and the cutoff values for predicting instability were calculated using receiver operating characteristic curves. The correlations between the angle measurements and the TT-TG distance were analyzed. Results: Instability patients had significantly higher external rotation of the tibial tuberosity compared with controls with regard to the PA-TA angle (18.2° ± 9.6° versus 13.1° ± 6.8°; P = .001), GC-TA angle (8.4° ± 4.5° versus 11.5° ± 3.9°; P = .0001) and sTEA-TA angle (122° ± 8.5° versus 113.6° ± 6.3°; P = .0001). The mean TT-TG distance was also significantly higher in the instability group (18.2 ± 5.4 versus 11.5 ± 2.7 mm; P = .001). The cutoff values were 17.5° (area under the receiver operating characteristic curve [AUC] = 0.66) for PA-TA angle, 8.5° (AUC = 0.705) for GC-TA angle, 118.8° (AUC = 0.79) for sTEA-TA angle, and 15.2 mm for TT-TG distance (AUC = 0.863). PA-TA angle was significantly correlated with all other measurements ( r = 0.35-0.71; P ≤ .006 for all), whereas sTEA-TA angle had the strongest correlation with TT-TG distance ( r = 0.78; P = .001). Conclusion: The tibial tuberosity was externally rotated in patellar instability patients compared with age- and sex-matched controls, and this intrinsic malalignment of the proximal tibia was demonstrated in the tibial-based measurements.
Quality of Life among Ethiopian Cancer Patients: A Systematic Review of Literatures
Authors: Muhamed Ahmed Nuru , Chekole Bogale , Tafesse Fikremariam Endeshaw , Dessie Getnet , Bantie Berihun , Habtu Bisrat Fikadu , Shemsu Abdumejid Mustefa 
Published: October 2023

Background Assessment of quality of life (QoL) in cancer patients can provide an overall picture of the patient's adaptation to the disease and maintain long-term health and well-being. Determining the QoL in cancer patients could help with better care and could be as prognostic as medical factors and the survival benefit that pharmacological treatment could provide. The main objective of this review was to determine the prevalence of QoL among Ethiopian adult cancer patients. Methods A systematic review was conducted using the “Preferred Reporting Results of Systematic Reviews and Meta-Analyses” guidelines. Databases such as PubMed/Medline, CINAHL, AMED, Embase, the Cochrane Library, ScienceDirect, World Health Organization's Hinari portal, and African Journals Online databases were searched from January 2022 to June 2022. Google, Google Scholar, and university repositories were used to access unpublished studies. Two reviewers independently screened the data using a standardized data extraction format and appraised their quality using the Newcastle–Ottawa Scale. Results In this review, 10 studies were included. The prevalence of poor QoL ranged from 52 to 89.6. The physical, role, social, and emotional functioning were the most affected domains of QoL and have been significantly associated with QoL. Financial difficulty was the most important predictor of QoL among Ethiopian cancer patients. Pain, dyspnea, nausea, vomiting, and poor appetite were also reported as predictors of QoL. Low income, lower educational status, unmarried status, underweight, anxiety, and depression, advanced stage of cancer, patients with ≤2 cycles of chemotherapy, and the presence of comorbid diseases were significantly correlated with QoL. Conclusions The QoL of an Ethiopian cancer patient was low. Quality of life assessments, appropriate symptom management, integration of psycho-oncology care, and providing economic support shall be considered to improve their QoL.
Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis
Authors: Dragonas Christos G. , Mamarelis Georgios , Dott Cameron , Waseem Saima , Bajracharya Abhijit , Leivadiotou Dimitra 
Published: October 2023

This systematic review and meta-analysis compared the revision rates, complications, and outcomes in anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) performed for primary glenohumeral osteoarthritis in patients aged over 70 years without a full-thickness rotator cuff tear. We performed a systematic literature search identifying comparative studies meeting the above patient criteria and published from January 2010 to May 2022 from 3 databases: MEDLINE, EMBASE, and Cochrane Library. We performed the systematic review in accordance with PRISMA guidelines and the study was prospectively registered on PROSPERO. From the 1798 studies identified from the initial literature search, 4 met our inclusion criteria. Two thousand seven hundred thirty-one shoulder arthroplasties (1472 aTSA and 1259 rTSA) were evaluated with a minimum follow up of 2 years. A statistically significant lower revision rate was observed in rTSA compared to aTSA (odds ratio [OR] 0.50, 95% confidence interval [CI]: 0.30, 0.84, p < .05). No significant difference was noted between aTSA and rTSA in overall complication rate (OR 0.98, 95% CI 0.34, 2.86, p = .97) while aTSA displayed a statistically significant improved postoperative Constant-Murley score [aTSA: 80(75; 82), rTSA: 68(66; 76.5), p < .001]. Higher revision rates were identified following aTSA in our study population, although admittedly this is within retrospective studies. aTSA displayed equal functional results and postoperative complications compared to rTSA in patients over 70 without a full-thickness rotator cuff tear. Given these similar results a shoulder surgeon must carefully consider each patient individually prior to deciding the optimal form of arthroplasty to offer.
Influence of provider openness and leadership behaviors on adherence to motivational interviewing training implementation strategies: Considerations for evidence-based practice delivery
Authors: Budhwani Henna , Alley Zoe M. , Chapman Jason E. , Aarons Gregory A. , Pooler-Burgess Meardith , Coyle Karin , Carcone April Idalski , MacDonnell Karen , Naar Sylvie 
Published: October 2023

Background Adherence to intervention training implementation strategies is at the foundation of fidelity; however, few studies have linked training adherence to trainee attitudes and leadership behaviors to identify what practically matters for the adoption and dissemination of evidence-based practices. Through the conduct of this hybrid type 3 effectiveness-implementation cluster randomized controlled trial, we collected Exploration, Preparation, Implementation, and Sustainment (EPIS) data and merged it with tailored motivational interviewing training adherence data, to elucidate the relationship between provider attitudes toward evidence-based practices, leadership behaviors, and training implementation strategy (e.g., workshop attendance and participation in one-on-one coaching) adherence. Method Our sample included data from providers who completed baseline (pre-intervention) surveys that captured inner and outer contexts affecting implementation and participated in tailored motivational interviewing training, producing a dataset that included training implementation strategies adherence and barriers and facilitators to implementation ( N = 77). Leadership was assessed by two scales: the director leadership scale and implementation leadership scale. Attitudes were measured with the evidence-based practice attitude scale (EBPAS-50). Adherence to training implementation strategies was modeled as a continuous outcome with a Gaussian distribution. Analyses were conducted in SPSS. Results Of the nine general attitudes toward evidence-based practice, openness was associated with training adherence (estimate [EST] = 0.096, p < .001; 95% CI = [0.040, 0.151]). Provider general (EST = 0.054, 95% CI = [0.007, 0.102]) and motivational interviewing-specific (EST = 0.044, 95% CI = [0.002, 0.086]) leadership behaviors were positively associated with training adherence ( p < .05). Of the four motivational interviewing-specific leadership domains, knowledge and perseverant were associated with training adherence ( p < .05). As these leadership behaviors increased, knowledge (EST = 0.042, 95% CI = [0.001, 0.083]) and perseverant (EST = 0.039, 95% CI = [0.004, 0.075]), so did provider adherence to training implementation strategies. Conclusions As implementation science places more emphasis on assessing readiness prior to delivering evidence-based practices by evaluating organizational climate, funding streams, and change culture, consideration should also be given to metrics of leadership. A potential mechanism to overcome resistance is via the implementation of training strategies focused on addressing leadership prior to conducting training for the evidence-based practice of interest.
Healthcare Utilization, Costs and Other Outcomes of Peroral Endoscopic Myotomy (POEM) Versus Heller Myotomy in the Inpatient Management of Achalasia in The United States: A 2016 to 2020 Nationwide Study
Authors: Kilani Yassine , Aldiabat Mohammad , Mubashir Maryam , Alsakarneh Saqr , Vohra Ammar Arif , Aljabiri Yazan , Hamo Falak , Vikash Fnu , Kumar Vikash , Samo Salih 
Published: October 2023

Introduction: Per-Oral Endoscopic Myotomy (POEM) is the recommended first-line treatment for all achalasia subtypes due to its minimally invasive nature. We aim to evaluate the trends of utilization, costs, and outcomes (mortality and complications) of POEM versus Heller Myotomy (HM) in U.S. hospitals. Methods: This is a retrospective study of individuals admitted with a primary diagnosis of achalasia. Data was obtained from Nationwide Inpatient Sample databases from the years 2016 to 2020 using ICD-10 codes. We assessed the therapeutic procedures employed, the trends and outcomes associated with POEM versus HM in terms of hospital utilization, mortality, morbidity, and the baseline characteristics of our study population. Results: A total of 26 880 adult individuals were diagnosed with achalasia. Of these, 11% underwent POEM, while 59% underwent HM. POEM rates increased from 6% to 10% of achalasia admissions, while HM decreased from 49% to 41% during the study period. No significant differences in total hospital charges or length of stay were observed between the 2 procedures. Regarding procedural complications, HM was associated with significantly reduced odds of pneumonia (adjusted Odds Ratio [aOR] = 0.09, 95% CI: 0.02-0.41), pneumoperitoneum (aOR = 0.11, 95% CI: 0.03-0.36), and pneumomediastinum (aOR = 0.21, 95% CI: 0.06-0.68), with no difference in the odds of esophageal perforation (aOR = 1.33, 95% CI: 0.27-6.48) and sepsis (aOR = 2.04, 95% CI: 0.22-18.40). Conclusion: While HM rates are currently declining in the U.S., POEM usage appears to be increasing. Despite being a less invasive measure than HM, POEM remains underutilized in the U.S.