bluuebunny/crossref_metadata_2025_split huggingface dataset:
A qualitative approach to identify clinical uncertainty in practicing physicians and clinical residents
Authors: Bigdeli Shoaleh , Baradaran Hamid Reza , Ghanavati Shirin , Soltani Arabshahi Seyed Kamran 
Published: August 2022

BACKGROUND:
Clinical decision-making is not only stressful to physicians, but also to patients and even their companions. Thus, managing uncertainty in clinical decision-making is essential which requires knowing its origins. Therefore, this study aimed to understand determinants of uncertainty in clinical decision-making from the perspective of clinical physicians.

MATERIALS AND METHODS:
This is a qualitative study which is done during October to November 2020. An in-depth interview is performed with 24 specialists of clinical groups including obstetrics, surgery, internal medicine, and pediatrics, working in teaching hospitals affiliated to Iran University of Medical Sciences. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The interviews were analyzed through comparative method. Then, the interviewer created initial codes, categories, and key concepts and sent them to fourteen physicians for member check.

RESULTS:
According to the participants’ view, determinants of uncertainty in clinical decision-making consisted of three themes: individual determinants, dynamics of medical sciences, and diagnostic and instrumental constraint. Individual determinants can be related to the physician or patient. The dynamics of medical sciences could be explained in two categories: variation of medical science and complexity. Diagnostic and instrumental constraint category could be also explained in subcategories such as lack of efficient diagnostic tests and unknown etiology.

CONCLUSION:
To curb uncertainty, the more accessible way is considering interventional programs with a focus on individual determinants related to physicians, such as strengthening doctor–patient relationships, and considering related mandatory retraining courses to reduce insufficient knowledge of physicians.
Mini clinical evaluation exercise (Mini-CEX)
Authors: Batra Pooja , Batra Ravi , Verma Niket , Bokariya Pradeep , Garg Shreyak , Yadav Sneha 
Published: August 2022

BACKGROUND:
The mini-clinical evaluation exercise (mini-CEX) is a formative assessment tool designed to provide feedback on skills essential to good medical care by observing an actual clinical encounter. However, the bigger advantage of mini-CEX is the structured feedback that it provides to the students as well as the faculty, thus helping them to make better decisions.

MATERIALS AND METHODS:
This study was a cross-sectional observational study. Sixteen surgery residents volunteered for participation and five professors conducted sessions; hence, 80 mini-CEX encounters. Seven core clinical skill assessments were done, and the performance was rated on a 9-point scale (grouped into unsatisfactory, satisfactory, and superior). Immediate feedback to the residents was given by the faculty. Delayed feedback from faculty and residents regarding the perception of mini-CEX was taken. Statistical analysis was done using SPSS version 20 and analysis of variance (ANOVA) for inferential statistics.

RESULTS:
As planned, 80 (100%) mini-CEX encounters were conducted. Surgery residents showed improvement that was statistically significant in the competencies of medical interviewing skills, physical examination skills, humanistic qualities/professionalism, and counseling skills. Most of the faculty (80%) were able to identify the gaps in the knowledge of students and areas of improvement for their teaching. However, 60% of the faculty felt that it required more effort than traditional methods. The mean time taken by the assessor for observation and feedback to residents was 12.51 min and 5.68 min, respectively. The mean scores of evaluator satisfaction and resident satisfaction with mini-CEX sessions were 6.04 and 7.49, respectively.

CONCLUSIONS:
Mini-CEX improves the learning environment in residency and also leads to improvement in medical interviewing skills, physical examination skills, humanistic qualities/professionalism, and counseling skills. It is done in the actual patient encounter and hence prepares the resident better for dealing with patients in the future.
The impact of lifestyle stressors, menstrual pattern, and cardiometabolic risk factors on young females with cholelithiasis
Authors: Balakrishnan Grrishma , Iqbal Tubah , Uppinakudru Gurunandan , Fernandes Ryan , Bangera Shobith , Dutt R. Aswini 
Published: August 2022

BACKGROUND:
Lifestyle and nutritional transitions in the society driven by globalization have led to the rising burden of cholelithiasis. The present study was done to assess the impact of lifestyle, stress, menstrual pattern, and cardiometabolic risk factors on young females with cholelithiasis.

MATERIALS AND METHODS:
A hospital-based case–control study was conducted on young females of 18–45 years. Cases and age-matched controls were compared on their lifestyle parameters like demography, marital status, occupation, educational status, family income, stress along with menstrual pattern, cardiometabolic parameters like anthropometric measures, blood pressure (BP), fasting blood sugar (FBS), and lipid profile. Chi-square test and unpaired t-test were used for the analysis of data using SPSS software, and P < 0.05 was considered statistically significant.

RESULTS:
The majority of the cases were from rural areas, married, homemakers leading a comparatively sedentary lifestyle consuming more red meat, less literate, and belonged to a lower economic group with significantly more stress compared to controls. The age of menarche, neither the regularity nor irregularity of the menstrual cycle (regular cycle 21–35 days), showed any difference, but cases had significantly more pregnancies and usage of oral contraceptives compared to controls. Waist–height ratio, systolic BP, FBS, triglyceride, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) were significantly higher in cases. Cases had a 14.4 times more risk of developing metabolic syndrome when compared with controls.

CONCLUSION:
Married, rural, less literate Indian women leading a sedentary lifestyle, consuming more of red meat, and soft drinks with increased psychosomatic stress are more prone to develop cholelithiasis. Women who use hormonal contraceptives have increased occurrence of cholelithiasis and they were more prone to develop metabolic syndrome. The need for the hour is health education, to implement simple lifestyle changes, thereby decreasing the incidence of cholelithiasis in young females.
The correlation between nursing students’ healthy lifestyle behaviors, cardiovascular disease risk factors’ knowledge level, and obsession symptoms
Authors: Baykal Dilek , Kutlu Leman , Demir Burcu D. 
Published: August 2022

BACKGROUND:
Nursing students have a role in the awareness of risk factors in the development of healthy lifestyle behaviors. Nursing students’ awareness of disease risk factors plays a role in developing healthy lifestyle behaviors. Therefore, it was aimed to determine the relationship between the effect of nursing students’ healthy lifestyle behaviors and cardiovascular disease risk factors’ knowledge levels and obsessive–compulsive symptoms.

MATERIALS AND METHODS:
This was a descriptive cross-sectional study. Two hundred and twenty-four students studying in the nursing departments of two foundation universities participated in the study between April and October 2020. Sociodemographic information form, Health Promoting Lifestyle Profile II (HPLP-II), Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL), and Maudsley Obsessive–Compulsive Inventory (MOCI) were applied to the students.

RESULTS:
It was found that the nursing students’ healthy lifestyle behaviors (123.53 ± 25.78) and cardiovascular risk factors’ knowledge level (21.08 ±± 2.70) were high. Obsessive–compulsive symptoms (16.12 ± 6.22) were moderate. In the correlation of sociodemographic characteristics, it was found that age correlated with the nutrition subdimension of CARRF-KL and HPLP-II, income level correlated with HPLP-II, place of residence correlated with HPLP-II, CARRF-KL, and MOCI, and having a health problem correlated with health responsibility. Income status, place of residence, and presence of health problems were found to be correlated with HPLP-II in all subdimensions in the regression analysis. In the regression analysis of HPLP-II with CARRF-KL and MOCI scales, it was found that it was significantly related to interpersonal relations, spiritual growth, stress management, and total score dimensions.

CONCLUSION:
Healthy lifestyle behaviors of nursing students are related to cardiovascular risk factors’ knowledge level and obsession symptoms. In addition, some demographic characteristics affect healthy lifestyle behaviors.
A Hybrid Approach to Multimodal Biometric Recognition Based on Feature-level Fusion of Face, Two Irises, and Both Thumbprints
Authors: Safavipour Mohammad H. , Doostari Mohammad A. , Sadjedi Hamed 
Published: August 2022

Background:
The most significant motivations for designing multi-biometric systems are high-accuracy recognition, high-security assurances as well as overcoming the limitations like non-universality, noisy sensor data, and large intra-user variations. Therefore, choosing data for fusion is of high significance for the design of a multimodal biometric system. The feature vectors contain richer information than the scores, decisions and even raw data, thereby making feature-level fusion more effective than other levels.

Method:
In the proposed method, kernel is used for fusion in feature space. First, the face features are extracted using kernel-based methods, the features of both right and left irises are extracted using Hough Transform and Daugman algorithm methods, and the features of both thumb prints are extracted using the Gabor filter bank. Second, after normalization operations, we use kernel methods to map the feature vectors to a kernel Hilbert space where non-linear relations are shown as linear for the purpose of compatibility of feature spaces. Then, dimensionality reduction algorithms are used to the fusion of the feature vectors extracted from fingerprints, irises and the face. since the proposed system uses face, both right 7and left irises and right and left thumbprints, it is hybrid multi-biometric system. We c8arried out the tests on seven databases.

Results:
Our results show that the hybrid multimodal template, while being secure against spoof attacks and making the system robust, can use the dimensionality of only 15 features to increase the accuracy of a hybrid multimodal biometric system to 100%, which shows a significant improvement compared with uni-biometric and other multimodal systems.

Conclusion:
The proposed method can be used to search large databases. Consequently, a large database of a secure multimodal template could be correctly differentiated based on the corresponding class of a test sample without any consistency error.
Brain Tumor Segmentation using Hierarchical Combination of Fuzzy Logic and Cellular Automata
Authors: Kalantari Roqaie , Moqadam Roqaie , Loghmani Nazila , Allahverdy Armin , Shiran Mohammad Bagher , Zare-Sadeghi Arash 
Published: August 2022

Background:
Magnetic resonance (MR) image is one of the most important diagnostic tools for brain tumor detection. Segmentation of glioma tumor region in brain MR images is challenging in medical image processing problems. Precise and reliable segmentation algorithms can be significantly helpful in the diagnosis and treatment planning.

Methods:
In this article, a novel brain tumor segmentation method is introduced as a postsegmentation module, which uses the primary segmentation method's output as input and makes the segmentation performance values better. This approach is a combination of fuzzy logic and cellular automata (CA).

Results:
The BraTS online dataset has been used for implementing the proposed method. In the first step, the intensity of each pixel is fed to a fuzzy system to label each pixel, and at the second step, the label of each pixel is fed to a fuzzy CA to make the performance of segmentation better. This step repeated while the performance saturated. The accuracy of the first step was 85.8%, but the accuracy of segmentation after using fuzzy CA was obtained to 99.8%.

Conclusion:
The practical results have shown that our proposed method could improve the brain tumor segmentation in MR images significantly in comparison with other approaches.
Comparison of Two Different Contrast Sensitivity Testing Methods in Patients with Low Vision
Authors: Altinbay Deniz , Sahli Esra , Idil Aysun 
Published: August 2022

Purpose:
To assess the agreement between two different contrast testing modalities using the index of contrast sensitivity (ICS) in patients with low vision.

Methods:
Thirty-eight patients with low vision were included in the study. Contrast sensitivity (CS) was measured binocularly with both the Vector vision-standardized CS test (CSV-1000E, Vector Vision Co, Greenville, Ohio, USA) and the MonPack 3 (Metrovision, France) after refractive correction for each participant. Based on the data from the two tests, the ICS was calculated. The Bland–Altman technique was used to evaluate the agreement between ICSs obtained from different test methods.

Results:
Range of best corrected visual acuity was 0.50–1.00 logMAR. According to the median logCS values, CS values were highest at 3 cycles per degree (cpd) for the CSV-1000E test and at 1.5 cpd for the Metrovision MonPack 3 test. The median ICS for CSV-1000E was −0.22 (95th percentile 4.75), and the median ICS for Metrovision MonPack 3 was 0.08 (95th percentile 1.65). The mean difference was 0.655 (between −3.82 and 5.13) within limits of agreement (LoA). The difference and mean values between the two CS test measurements were found to be within LoA range.

Conclusions:
An agreement was found between the Metrovision MonPack 3 test and the standard CSV-1000E test results in patients with visual impairment. However, the agreement range was within very wide limits. Therefore, it was thought that they may not be used interchangeability in clinical practice.
Relationship Between Postoperative Intraocular Pressure and Refractive Outcomes in Patients after Deep Anterior Lamellar Keratoplasty
Authors: Wei Wei Dayna Yong , Shen Liang , Manotosh Ray , Wee Tien Anna Tan , Hui-Chen Charmaine Chai 
Published: August 2022

Purpose:
To study the effect of intraocular pressure (IOP) on refractive outcomes after deep anterior lamellar keratoplasty (DALK).

Methods:
This retrospective study included eyes which underwent DALK. DALK technique involved either modified Anwar big-bubble if possible or manual anterior lamellar dissection. Our main outcome measures are postoperative IOP and refractive outcomes at postoperative week and months 1, 3, 6, and 12.

Results:
Fifty-nine eyes of 59 patients were included. DALK was performed for optical (93.2%) and tectonic (6.8%) purposes. 76.3% of the patients had keratoconus. Anwar's big-bubble technique was successful in 30 cases. Linear mixed-model was used to analyze the effect of the highest postoperative IOP measured prior to measurement of postoperative cylinder. Patients with greater maximum postoperative IOP measured had worse postoperative cylinder (P = 0.015) and spherical equivalent (P = 0.012). Those with IOP more than 21 mmHg had worse postoperative cylinder (P = 0.050) and spherical equivalent (P = 0.054). The method of DALK and presence of suture removal were not shown to statistically affect postoperative cylinder.

Conclusion:
Our study shows a positive correlation between postoperative IOP and worse spherical equivalent and cylinder post-DALK, emphasizing the need for good IOP control with IOP-lowering medication(s).
Ocular Biometric Values and Prevalence of Corneal Astigmatism in Patients Candidate for Cataract Surgery
Authors: Hashemian Seyed Javad , Hashemian Seyed Mahyar , Karimian Farid , Hadavandkhani Ali , Jafari Mohammad Ebrahim , Hashemian Mahsa Sadat , Hadi Yasaman , Semnani Fatemeh Nadjafi 
Published: August 2022

Purpose:To analyze the biometric values and the prevalence of corneal astigmatism in cataract surgery candidates.Methods:This is a prospective study. Ocular biometric values and corneal keratometric astigmatism were measured by optical low-coherence reflectometry (Lenstar LS 900) before surgery in patients who were candidates for cataract extraction surgery. Descriptive measurements of biometric dimensions and keratometric cylinder data and their correlations with sex and age were evaluated.Results:Ocular biometric and keratometric values from 2084 eyes of 2084 patients (mean age 66.43, range 19–95 years) were analyzed. The mean values were as follows: corneal astigmatism 0.89 diopter (D), mean corneal keratometry 44.29 D, central corneal thickness 534 μ, internal anterior chamber depth (ACD) 3.11 mm, lens thickness 4.50 mm, and axial length 23.35 mm. Corneal astigmatism was <1.25 D in 1660 (79.5%) of eyes. Astigmatism was with-the-rule in 976 (46.8%) of eyes, against-the-rule (ATR) in 702 (33.7%), and oblique in 406 (19.5%). Analysis of corneal astigmatism revealed a change toward “ATR” with age which was not statistically significant. The ACD was correlated with age. The amount of corneal astigmatism had no correlation with age and sex.Conclusion:Corneal astigmatism was higher than 1.25 D in about 21% of cataract surgery candidates with slight differences between the various age ranges and had no correlation with age and sex.
Contralateral Autokeratoplasty, Pars Plana Vitrectomy for Luxated Cataract, and Flanged Intrascleral Intraocular Lens Fixation
Authors: Saa Francisco Lucero , Cremona Federico Andrés , Cotic Mariano , Chiaradía Pablo 
Published: August 2022

Purpose:
To describe a case of a combined procedure including autokeratoplasty, pars plana vitrectomy (PPV), and scleral intraocular lens (IOL) fixation.

Methods:
Case report.

Results:
We describe a case of an 85-year-old patient presenting a right, blind eye with a clear cornea and a left eye with acceptable visual potential but affected by bullous keratopathy, aphakia, and a posteriorly dislocated nucleus. The patient underwent a contralateral autokeratoplasty, PPV, and flanged intrascleral IOL fixation with double needle technique. After 24 months of follow-up, the graft remained clear, and the IOL was stable.

Conclusions:
Complex cases comprising anterior and posterior segments pathology sometimes require combined procedures. A shortage of corneal tissue in developing countries is common. In strictly selected cases, autokeratoplasty may be an option and is associated with fewer complications than allograft corneal transplantation. Sutureless novel techniques for intrascleral fixation of IOL have shown good results and reliable lens stability.
Differences and Limits of Agreement Among Pentacam, Corvis-St, and Iol-Master 700 Optical Biometric Devices Regarding Central Corneal Thickness Measurements
Authors: Rajabi Sattar , Asharlous Amir , Riazi Abbas , Khabazkhoob Mehdi , Moalej Alireza 
Published: August 2022

Purpose:To investigate the differences and limits of agreement in measuring corneal thickness using Pentacam, Corvis, and intraocular lens (IOL)-Master 700 devices.Methods:This study was conducted on 37 right eyes of 21 males and 16 females (n= 37) with a mean age of 52.11 ± 6.30 years. The central corneal thickness was measured using three optical biometric devices, including Pentacam, Corvis, and IOL-Master 700. The inclusion criteria were normal eyes without any ophthalmological abnormalities, history of ocular pathology, or ocular surgery. The data obtained from these three devices were compared two by two. The correlation and agreement limits among them were analyzed using statistical techniques.Results:The mean standard deviation differences between Pentacam and Corvis, Pentacam and IOL-Master 700, as well as Corvis and IOL-Master 700 regarding the corneal thickness measurement, were 22.13 ± 8.05, 7.91 ± 8.02, and 14.21 ± 9.85 μm, respectively, which were statistically significant (P< 0.0001). Based on the investigation of the limits of agreement according to the Bland Altman method, the corresponding values between Pentacam and Corvis, Pentacam and IOL-Master 700, and Corvis and IOL-Master 700 were -16.2 to +15.4, -15.8 to +16.3, and -20.1 to +20.0 μm, respectively. Furthermore, the correlation coefficients of the measurements obtained by Pentacam and Corvis, Pentacam and IOL-Master 700, as well as Corvis and IOL-Master 700 were determined 0.957, 0.964, and 0.948, respectively (P< 0.0001).Conclusion:The results from this study indicate that the interchangeable use of these three devices is not appropriate due to statistically significant differences and broad limits of agreement among the three devices, especially between Corvis and IOL-Master 700.
Evaluation of Systolic Time Intervals in Patients of Ischemic Heart Disease with Clinical Heart Failure
Authors: Seetharam Smitha Pernaje , Vinutha Shankar M S , Reddy Niranjan 
Published: August 2022

Introduction:
Left ventricular (LV) systolic function evaluation is based on ejection fraction assessment. Due to the great sensitivity of the examination and the ease of measurement, systolic time intervals (STIs) are ideally appropriate for studying the effects of pharmacologic agents upon the heart. In this context, the present study aimed to estimate and compare STI in patients with ischemic heart disease (IHD) with clinical heart failure and among control subjects without clinically established LV dysfunction based on their LV ejection fraction (LVEF).

Materials and Methods:
This case–control study included 33 IHD patients as cases and 32 healthy subjects as controls. All subjects underwent pulsed-Doppler echocardiogram to estimate STIs: total electromechanical systole (QS2), preejection period (PEP), and LV ejection time (LVET).

Results:
A significant difference between PEP (145.23 ± 23.20 vs. 82.99 ± 8.63, P < 0.00001), LVET (231.34 ± 40.89 vs. 265.39 ± 31.98, P = 0.000947), and PEP/LVET ratio (0.63 ± 0.15 vs. 0.31 ± 0.08, P < 0.00001) between cases and controls was found. On subgroup analysis, a weak correlation was found in patients with LVEF ≤40% and PEP/LVET (r = −0.3677, P = 0.1958). In addition, a relatively strong correlation between LVET and heart rate (r = −0.432, P = 0.012) was found among the cases.

Conclusion:
The current study results showed that the differences in the values of STI among cases than in controls could be an indicator of LV systolic dysfunction. In addition, this method may have impending applications in the management of IHD.