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Frontiers in Human Neuroscience 2024This study aimed to explore the electroencephalogram (EEG) indicators and clinical factors that may lead to poor prognosis in patients with prolonged disorder of...
OBJECTIVE
This study aimed to explore the electroencephalogram (EEG) indicators and clinical factors that may lead to poor prognosis in patients with prolonged disorder of consciousness (pDOC), and establish and verify a clinical predictive model based on these factors.
METHODS
This study included 134 patients suffering from prolonged disorder of consciousness enrolled in our department of neurosurgery. We collected the data of sex, age, etiology, coma recovery scales (CRS-R) score, complications, blood routine, liver function, coagulation and other laboratory tests, resting EEG data and follow-up after discharge. These patients were divided into two groups: training set ( = 107) and verification set ( = 27). These patients were divided into a training set of 107 and a validation set of 27 for this study. Univariate and multivariate regression analysis were used to determine the factors affecting the poor prognosis of pDOC and to establish nomogram model. We use the receiver operating characteristic (ROC) and calibration curves to quantitatively test the effectiveness of the training set and the verification set. In order to further verify the clinical practical value of the model, we use decision curve analysis (DCA) to evaluate the model.
RESULT
The results from univariate and multivariate logistic regression analyses suggested that an increased frequency of occurrence microstate A, reduced CRS-R scores at the time of admission, the presence of episodes associated with paroxysmal sympathetic hyperactivity (PSH), and decreased fibrinogen levels all function as independent prognostic factors. These factors were used to construct the nomogram. The training and verification sets had areas under the curve of 0.854 and 0.920, respectively. Calibration curves and DCA demonstrated good model performance and significant clinical benefits in both sets.
CONCLUSION
This study is based on the use of clinically available and low-cost clinical indicators combined with EEG to construct a highly applicable and accurate model for predicting the adverse prognosis of patients with prolonged disorder of consciousness. It provides an objective and reliable tool for clinicians to evaluate the prognosis of prolonged disorder of consciousness, and helps clinicians to provide personalized clinical care and decision-making for patients with prolonged disorder of consciousness and their families.
PubMed: 38952644
DOI: 10.3389/fnhum.2024.1387471 -
Frontiers in Oncology 2024To construct and validate a computed tomography (CT) radiomics model for differentiating lung neuroendocrine neoplasm (LNEN) from lung adenocarcinoma (LADC) manifesting...
PURPOSE
To construct and validate a computed tomography (CT) radiomics model for differentiating lung neuroendocrine neoplasm (LNEN) from lung adenocarcinoma (LADC) manifesting as a peripheral solid nodule (PSN) to aid in early clinical decision-making.
METHODS
A total of 445 patients with pathologically confirmed LNEN and LADC from June 2016 to July 2023 were retrospectively included from five medical centers. Those patients were split into the training set (n = 316; 158 LNEN) and external test set (n = 129; 43 LNEN), the former including the cross-validation (CV) training set and CV test set using ten-fold CV. The support vector machine (SVM) classifier was used to develop the semantic, radiomics and merged models. The diagnostic performances were evaluated by the area under the receiver operating characteristic curve (AUC) and compared by Delong test. Preoperative neuron-specific enolase (NSE) levels were collected as a clinical predictor.
RESULTS
In the training set, the AUCs of the radiomics model (0.878 [95% CI: 0.836, 0.915]) and merged model (0.884 [95% CI: 0.844, 0.919]) significantly outperformed the semantic model (0.718 [95% CI: 0.663, 0.769], both<.001). In the external test set, the AUCs of the radiomics model (0.787 [95% CI: 0.696, 0.871]), merged model (0.807 [95%CI: 0.720, 0.889]) and semantic model (0.729 [95% CI: 0.631, 0.811]) did not exhibit statistical differences. The radiomics model outperformed NSE in sensitivity in the training set (85.3% vs 20.0%; <.001) and external test set (88.9% vs 40.7%; = .002).
CONCLUSION
The CT radiomics model could non-invasively, effectively and sensitively predict LNEN and LADC presenting as a PSN to assist in treatment strategy selection.
PubMed: 38952551
DOI: 10.3389/fonc.2024.1420213 -
Heliyon Jun 2024Decision-makers have consistently developed a range of classification models, each possessing unique features within the domain of intelligent models. These endeavors...
Decision-makers have consistently developed a range of classification models, each possessing unique features within the domain of intelligent models. These endeavors are all directed toward achieving the highest levels of accuracy. In recent developments, two notable methodologies-reliable modeling and jumping modeling approaches-offer specific advantages in formulating cost functions and have been recognized for their role in enhancing classifier accuracy. Specifically, the jumping methodology is based on aligning the learning process with the discrete nature of the classification goal, while the reliable methodology integrates the reliability factor into the learning paradigm. However, their innovative combination, leveraging both accuracy and reliability factors in guiding learning processes, leads to the creation of a high-performing classifier. This addresses a research gap in tackling classification challenges, which remains the core focus of the present study. To evaluate the performance of the proposed reliable jumping-based intelligent classifier in environmental decision-making, we considered ten benchmark datasets spanning various application domains. The numerical results demonstrate that the proposed Reliable Jumping-based intelligent classifier consistently outperforms traditional intelligent classifiers across all studied cases. As a result, the proposed approach proves to be a viable and effective alternative to other intelligent methods in environmental applications.
PubMed: 38952378
DOI: 10.1016/j.heliyon.2024.e32541 -
Heliyon Jun 2024Thermal spraying (TS) is one of the main processes for obtaining surfaces with the desired protective properties in various industrial applications. TS is an...
Thermal spraying (TS) is one of the main processes for obtaining surfaces with the desired protective properties in various industrial applications. TS is an energy-intensive treatment required to heat the application material and consumes different resources. To assess the environmental impact of TS, it becomes necessary to integrate an approach that jointly analyses and evaluates the economic and environmental variables influencing the system. The concept of eco-efficiency (EE) added to the TS process allows for assessing the environmental and economic condition through the survey and application of eco-indicators. The lack of an EE evaluation model for TS processes was identified based on literature searches. Thus, the overall objective of this work is to propose a conceptual model to evaluate the EE of TS treatment, selecting environmental and economic indicators considered more impactful in the process. The model developed consists of three main steps: (i) the input and output indicators (environmental and economic) are identified by applying the Analytic Hierarchy Process (AHP) method; (ii) the structure to be employed in the model is defined; and (iii) the Data Envelopment Analysis (DEA) model is applied to define the EE evaluation form. The proposed model consists of clear and easy-to-follow steps for evaluating the EE of spraying processes, filling the gap found in the literature. The use of DEA allowed the integration of the environmental and economic indicators obtained from the TS processes to generate important insights for evaluating EE. The results prove the model's effectiveness in identifying the EE results for each analysed unit of the TS process. The model has provided an evaluation consistent with the existing studies, and the EE scores were assessed according to twenty-one decision-making units (DMUs) allowing the identification of the most eco-efficient DMUs concerning TS processes.
PubMed: 38952377
DOI: 10.1016/j.heliyon.2024.e32414 -
Heliyon Jun 2024To investigate the physical properties of commercially available multipurpose soft contact lens solutions in Ghana.
PURPOSE
To investigate the physical properties of commercially available multipurpose soft contact lens solutions in Ghana.
METHODS
pH (Kelilong ICL-099 pH meter, China), osmolality (OSMOMAT 3000, GONOTEC, Germany), surface tension (Sigma 700 Tensiometer, Sweden), and viscosity (CFOC-200 Viscometer, Cannon Company, USA) of various soft contact lens multipurpose solutions (MPS) were measured in triplicates at room temperature. Viscosity measurements were also taken at 34 °C ocular surface temperature. The solutions examined were Opti-Free Replenish (OFR), Trufresh (TF), Avizor (AV), Freshlook (FL), and Refresh (RF).
RESULTS
Several solutions were largely hypo-osmotic in the range of 108-231 mOsm/kg, the exception being Avizor, which had osmolality values that were closer to human tears (301 ± 0.58 mOsm/kg). The range of pH values of the solutions (6.33-8.24, mean (SD) = 7.53 ± 0.18) fell within the reported tolerable range for the ocular surface (6.20-9.00). Surface tension values ranged from 35.86 to 42.27 mNm with a mean of 38.49 ± 2.32 mNm. The average viscosity of most solutions at room temperature (25 °C) was 1.44 ± 0.49 cP with a range of 1.04-2.15 cP. Significantly lower values ranging from 0.79 to 1.58 cP were obtained at ocular surface temperature (34 °C), = 0.0001).
CONCLUSIONS
The physical properties of many of the solutions used as MPS in Ghana are markedly variable. Nevertheless, pH, surface tension, and viscosity fall within the acceptable limits of ocular physiological tolerance; except for osmolality, which majority were outside the reported tolerable range for the ocular surface. This information may partly explain the reason some patients exhibit strong preferences for certain care systems and should aid clinical decision-making when prescribing eye care systems to patients.
PubMed: 38952357
DOI: 10.1016/j.heliyon.2024.e32491 -
Journal of Korean Medical Science Jul 2024Despite medical advancements in neonatal survival rates, many children have poor neurological outcomes. Because the law in Korea restricts the withdrawal of...
BACKGROUND
Despite medical advancements in neonatal survival rates, many children have poor neurological outcomes. Because the law in Korea restricts the withdrawal of life-sustaining treatment to only cases of imminent death, treatment discontinuation may not be an option, even in patients with poor neurological prognosis. This study investigated the opinions of the general population and clinicians regarding life-sustaining treatment withdrawal in such cases using hypothetical scenarios.
METHODS
We conducted a cross-sectional study on the general population and clinicians using a web-based questionnaire. The sample of the general population from an online panel comprised 500 individuals aged 20-69 years selected by quota sampling. The clinician sample comprised 200 clinicians from a tertiary university hospital. We created hypothetical vignettes and questionnaire items to assess attitudes regarding mechanical ventilation withdrawal for an infant at risk of poor neurological prognosis due to birth asphyxia at 2 months and 3 years after the incidence.
RESULTS
Overall, 73% of the general population and 74% of clinicians had positive attitudes toward mechanical ventilator withdrawal at 2 months after birth asphyxia. The proportion of positive attitudes toward mechanical ventilator withdrawal was increased in the general population (84%, < 0.001) and clinicians (80.5%, = 0.02) at 3 years after birth asphyxia. Religion, spirituality, the presence of a person with a disability in the household, and household income were associated with the attitudes of the general population. In the multivariable logistic regression analysis of the general population, respondents living with a person with a disability or having a disability were more likely to find the withdrawal of the ventilator at 2 months and 3 years after birth asphyxia not permissible. Regarding religion, respondents who identified as Christians were more likely to find the ventilator withdrawal at 2 months after birth asphyxia unacceptable.
CONCLUSION
The general population and clinicians shared the perspective that the decision to withdraw life-sustaining treatment in infants with a poor neurological prognosis should be considered before the end of life. A societal discussion about making decisions centered around the best interest of pediatric patients is warranted.
Topics: Humans; Male; Female; Adult; Prognosis; Surveys and Questionnaires; Withholding Treatment; Middle Aged; Cross-Sectional Studies; Respiration, Artificial; Infant; Aged; Young Adult; Infant, Newborn; Asphyxia Neonatorum; Republic of Korea; Attitude of Health Personnel
PubMed: 38952347
DOI: 10.3346/jkms.2024.39.e196 -
Health Services Research Jul 2024To assess differences in hospitals' collection and use of data on patients' health-related social needs (HRSN) by availability of programs or strategies in place to...
OBJECTIVE
To assess differences in hospitals' collection and use of data on patients' health-related social needs (HRSN) by availability of programs or strategies in place to address patients' HRSN and social determinants of health (SDOH) of communities.
DATA SOURCES
The 2021 American Hospital Association Annual Survey and 2022 Information Technology (IT) Supplement.
STUDY DESIGN
This cross-sectional study described hospitals' engagement in screening and the availability of programs or strategies to address nine different HRSN. We assessed differences in screening rates and uses of data collected through screening among hospitals with and without programs or strategies in place to address HRSN or SDOH using Chi-squared tests of independence.
DATA COLLECTION/EXTRACTION METHODS
Analyses were restricted to IT Supplement respondents with complete data for social needs questions asked in the Annual Survey (N = 1997).
PRINCIPAL FINDINGS
In 2022, hospitals used social needs data collected through screening for various purposes including discharge planning and clinical decision-making at their hospital as well as to refer patients to needed resources and assess community-level needs. Hospitals with a program or strategy in place had higher rates of screening across all domains and higher rates of using of data collected through screening for uses involving exchange or coordination with external entities.
CONCLUSIONS
Collection of social needs data may help inform the development of programs or strategies to address HRSN and SDOH, which in turn can enable providers to screen for these needs and use the data in the near term for care delivery and in the long term to address community and population needs.
PubMed: 38952231
DOI: 10.1111/1475-6773.14341 -
Clinical Transplantation Jul 2024The decision to become a living donor requires consideration of a complex, interactive array of factors that could be targeted for clinical, policy, and educational...
INTRODUCTION
The decision to become a living donor requires consideration of a complex, interactive array of factors that could be targeted for clinical, policy, and educational interventions. Our objective was to assess how financial barriers interact with motivators, other barriers, and facilitators during this process.
METHODS
Data were obtained from a public survey assessing motivators, barriers, and facilitators of living donation. We used multivariable logistic regression and consensus k-means clustering to assess interactions between financial concerns and other considerations in the decision-making process.
RESULTS
Among 1592 respondents, the average age was 43; 74% were female and 14% and 6% identified as Hispanic and Black, respectively. Among employed respondents (72%), 40% indicated that they would not be able to donate without lost wage reimbursement. Stronger agreement with worries about expenses and dependent care challenges was associated with not being able to donate without lost wage reimbursement (OR = 1.2, 95% CI = 1.0-1.3; OR = 1.2, 95% CI = 1.1-1.3, respectively). Four respondent clusters were identified. Cluster 1 had strong motivators and facilitators with minimal barriers. Cluster 2 had barriers related to health concerns, nervousness, and dependent care. Clusters 3 and 4 had financial barriers. Cluster 3 also had anxiety related to surgery and dependent care.
CONCLUSIONS
Financial barriers interact primarily with health and dependent care concerns when considering living organ donation. Targeted interventions to reduce financial barriers and improve provider communication regarding donation-related risks are needed.
Topics: Humans; Female; Male; Decision Making; Adult; Motivation; Living Donors; Tissue and Organ Procurement; Middle Aged; Surveys and Questionnaires; Prognosis; Follow-Up Studies
PubMed: 38952192
DOI: 10.1111/ctr.15377 -
European Journal of Neurology Jul 2024A real-time biomarker in chemotherapy-induced peripheral neurotoxicity (CIPN) would be useful for clinical decision-making during treatment. Neurofilament light chain...
BACKGROUND AND PURPOSE
A real-time biomarker in chemotherapy-induced peripheral neurotoxicity (CIPN) would be useful for clinical decision-making during treatment. Neurofilament light chain (NfL) can be detected in blood in the case of neuroaxonal damage. The aim of the study was to compare the levels of plasma NfL (pNfL) according to the type of chemotherapeutic agent and the severity of CIPN.
METHODS
This single-center prospective observational longitudinal study included patients treated with paclitaxel (TX; n = 34), brentuximab vedotin (BV; n = 29), or oxaliplatin (PT; n = 19). All patients were assessed using the Total Neuropathy Score-clinical version and Common Terminology Criteria for Adverse Events before, during, and up to 6-12 months after the end of treatment. Nerve conduction studies (NCS) were performed before and after chemotherapy discontinuation. Consecutive plasma samples were analyzed for NfL levels using a Simoa analyzer. Changes in pNfL were compared between groups and were eventually correlated with clinical and NCS data. Clinically relevant (CR) CIPN was considered to be grade ≥ 2.
RESULTS
Eighty-two patients, mostly women (59.8%), were included. One third of the patients who received TX (29.4%), BV (31%), or PT (36.8%) developed CR-CIPN, respectively, without differences among them (p = 0.854). Although pNfL significantly increased during treatment and decreased throughout the recovery period in all three groups, patients receiving TX showed significantly greater and earlier changes in pNfL levels compared to the other agents (p < 0.001).
CONCLUSIONS
A variable change in pNfL is observed depending on the type of agent and mechanism of neurotoxicity with comparable CIPN severity, strongly implying the need to identify different cutoff values for each agent.
PubMed: 38952074
DOI: 10.1111/ene.16369 -
JMIR Aging Jun 2024Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance...
BACKGROUND
Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood.
OBJECTIVE
This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff's perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery.
METHODS
Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework.
RESULTS
The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families.
CONCLUSIONS
In this qualitative study exploring health care staff's experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW.
Topics: Humans; Qualitative Research; Female; Male; Personnel, Hospital; Australia; Adult; Attitude of Health Personnel; Middle Aged
PubMed: 38952009
DOI: 10.2196/54774