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Archives of Rheumatology Jun 2024This study aimed to analyze the risk factors for mortality of idiopathic inflammatory myopathy (IIM) patients admitted with interstitial lung disease (ILD) to guide...
OBJECTIVES
This study aimed to analyze the risk factors for mortality of idiopathic inflammatory myopathy (IIM) patients admitted with interstitial lung disease (ILD) to guide rapid and accurate judgment of clinical prognosis.
PATIENTS AND METHODS
This retrospective, single-center cohort study was conducted with 135 participants (37 males, 98 females; mean age: 54.8±11.1 years; range, 24 to 85 years) between June 1, 2016, and June 30, 2021. The participants were categorized into the survival group (n=111) and nonsurvivors (n=24) according to whether they survived during the one-year follow-up. The independent risk factors for mortality in one year after discharge were analyzed. Receiver operating characteristic curve analysis was used to determine the accuracy of oxygenation index at baseline combined with pulmonary infection (PI) at follow-up to indicate death in IIM-ILD patients.
RESULTS
Compared to the survival group, nonsurvivors were older (p=0.006) and had a higher proportion of anti-MDA5 (melanoma differentiation-associated protein 5) positivity (p<0.001). The ILD duration was shorter (p=0.006), the oxygenation index was lower (p<0.001), and the intensive care unit occupancy rate (p<0.001) and ventilator utilization rate (p<0.001) were elevated in nonsurvivors compared to the survival group. Oxygenation index at baseline (odds ratio [OR]=1.021, 95% confidence interval [CI]: 1.001-1.023, p=0.040) and PI (clinical judgment) at follow-up (OR=16.471, 95% CI: 1.565-173.365, p=0.020) were found as independent risk factors for death in the year after discharge in IIM inpatients with ILD. An oxygenation index ≤279 mmHg at baseline combined with PI at follow-up exhibited a promising predictive value for all-cause death in IIM-ILD patients within one year.
CONCLUSION
Oxygenation index at baseline and PI during follow-up were independent risk factors for death of IIM-ILD patients within one year after discharge. Patients with an oxygenation index ≤279 mmHg at baseline had an increased risk of death once they developed PI during the one-year follow-up.
PubMed: 38933718
DOI: 10.46497/ArchRheumatol.2024.10418 -
International Journal of Environmental... May 2024This study aims to examine how the activation of the role of nursee and professional identification as a nurse can influence moral judgments in terms of deontological...
This study aims to examine how the activation of the role of nursee and professional identification as a nurse can influence moral judgments in terms of deontological and utilitarian inclinations. In Study 1, a priming technique was used to assess the impact of activating the nursing concept on moral reasoning. Participants were randomly assigned to either a nursing prime or neutral prime condition. By using a scrambled-sentence task, participants were prompted to think about nursing-related or neutral thoughts. Following the priming task, participants were asked to respond to 20 moral dilemmas. The process dissociation approach was employed to measure the degree of deontological and utilitarian tendencies in their moral reasoning. In Study 2, participants completed the nursing profession identification scale and the moral orientation scale before engaging in moral judgments similar to those in Study 1. The findings revealed that priming the concept of being a nursee resulted in an increase in deontological clinical inclinations while having no significant effect on utilitarian inclinations. Additionally, a positive correlation was observed between identification with the nursing profession and deontological clinical inclinations, whereas a negative correlation was found with utilitarian inclinations. Deliberation orientation acted as a complete mediator in the relationship between nursing professional identification and deontological tendencies and as a partial mediator for utilitarian tendencies.
Topics: Humans; Female; Male; Adult; Young Adult; Morals; Nurses; Judgment
PubMed: 38928958
DOI: 10.3390/ijerph21060712 -
International Journal of Environmental... May 2024Retention in care for people living with HIV (PLWH) is important for individual and population health. Preemptive identification of PLWH at high risk of lapsing in care...
Retention in care for people living with HIV (PLWH) is important for individual and population health. Preemptive identification of PLWH at high risk of lapsing in care may improve retention efforts. We surveyed providers at nine institutions throughout Chicago about their perspectives on using an electronic health record (EHR) tool to predict the risk of lapsing in care. Sixty-three percent (20/32) of providers reported currently assessing patients' risk for lapsing in care, and 91% (29/32) reported willingness to implement an EHR tool. When compared to those with other job roles, prescribers agreed (vs. neutral) that the tool would be less biased than personal judgment (OR 13.33, 95% CI 1.05, 169.56). Prescribers were also more likely to identify community health workers as persons who should deliver these interventions (OR 10.50, 95% CI 1.02, 108.58). Transportation, housing, substance use, and employment information were factors that providers wanted to be included in an EHR-based tool. Social workers were significantly more likely to indicate the inclusion of employment information as important (OR 10.50, 95% CI 1.11, 98.87) when compared to other participants. Acceptability of an EHR tool was high; future research should investigate barriers and evaluate the effectiveness of such a tool.
Topics: Humans; HIV Infections; Electronic Health Records; Male; Female; Chicago; Feasibility Studies; Adult; Health Personnel; Middle Aged; Retention in Care; Attitude of Health Personnel
PubMed: 38928919
DOI: 10.3390/ijerph21060671 -
Foods (Basel, Switzerland) Jun 2024Against the backdrop of continuous socio-economic development, there is a growing concern among people about food quality and safety. Individuals are increasingly...
Against the backdrop of continuous socio-economic development, there is a growing concern among people about food quality and safety. Individuals are increasingly realizing the critical importance of healthy eating for bodily health; hence the continuous rise in demand for detecting food pollution. Simultaneously, the rapid expansion of global food trade has made people's pursuit of high-quality food more urgent. However, traditional methods of food analysis have certain limitations, mainly manifested in the high degree of reliance on personal subjective judgment for assessing food quality. In this context, the emergence of artificial intelligence and biosensors has provided new possibilities for the evaluation of food quality. This paper proposes a comprehensive approach that involves aggregating data relevant to food quality indices and developing corresponding evaluation models to highlight the effectiveness and comprehensiveness of artificial intelligence and biosensors in food quality evaluation. The potential prospects and challenges of this method in the field of food safety are comprehensively discussed, aiming to provide valuable references for future research and practice.
PubMed: 38928877
DOI: 10.3390/foods13121936 -
Diagnostics (Basel, Switzerland) Jun 2024Lung cancer is a prevalent malignancy associated with a high mortality rate, with a 5-year relative survival rate of 23%. Traditional survival analysis methods, reliant...
Lung cancer is a prevalent malignancy associated with a high mortality rate, with a 5-year relative survival rate of 23%. Traditional survival analysis methods, reliant on clinician judgment, may lack accuracy due to their subjective nature. Consequently, there is growing interest in leveraging AI-based systems for survival analysis using clinical data and medical imaging. The purpose of this study is to improve survival classification for lung cancer patients by utilizing a 3D-CNN architecture (ResNet-34) applied to CT images from the dataset. Through comprehensive ablation studies, we evaluate the effectiveness of different features and methodologies in classification performance. Key contributions include the introduction of a novel feature (), the proposal of a novel loss function () accounting for false negatives and false positives, and the showcasing of their efficacy in classification. Experimental work demonstrates results surpassing those of the existing literature, achieving a classification accuracy of 0.7434 and an ROC-AUC of 0.7768. The conclusions of this research indicate that the AI-driven approach significantly improves survival prediction for lung cancer patients, highlighting its potential for enhancing personalized treatment strategies and prognostic modeling.
PubMed: 38928724
DOI: 10.3390/diagnostics14121309 -
Brain Sciences Jun 2024Intracerebral hemorrhage (ICH) is a critical condition characterized by a high prevalence, substantial mortality rates, and unpredictable clinical outcomes, which...
Intracerebral hemorrhage (ICH) is a critical condition characterized by a high prevalence, substantial mortality rates, and unpredictable clinical outcomes, which results in a serious threat to human health. Improving the timeliness and accuracy of prognosis assessment is crucial to minimizing mortality and long-term disability associated with ICH. Due to the complexity of ICH, the diagnosis of ICH in clinical practice heavily relies on the professional expertise and clinical experience of physicians. Traditional prognostic methods largely depend on the specialized knowledge and subjective judgment of healthcare professionals. Meanwhile, existing artificial intelligence (AI) methodologies, which predominantly utilize features derived from computed tomography (CT) scans, fall short of capturing the multifaceted nature of ICH. Although existing methods are capable of integrating clinical information and CT images for prognosis, the effectiveness of this fusion process still requires improvement. To surmount these limitations, the present study introduces a novel AI framework, termed the ICH Network (ICH-Net), which employs a joint-attention cross-modal network to synergize clinical textual data with CT imaging features. The architecture of ICH-Net consists of three integral components: the Feature Extraction Module, which processes and abstracts salient characteristics from the clinical and imaging data, the Feature Fusion Module, which amalgamates the diverse data streams, and the Classification Module, which interprets the fused features to deliver prognostic predictions. Our evaluation, conducted through a rigorous five-fold cross-validation process, demonstrates that ICH-Net achieves a commendable accuracy of up to 87.77%, outperforming other state-of-the-art methods detailed within our research. This evidence underscores the potential of ICH-Net as a formidable tool in prognosticating ICH, promising a significant advancement in clinical decision-making and patient care.
PubMed: 38928618
DOI: 10.3390/brainsci14060618 -
Brain Sciences May 2024: People with Down syndrome (DS) are deficient in verbal memory but relatively preserved in visuospatial perception. Verbal memories are related to semantic knowledge....
: People with Down syndrome (DS) are deficient in verbal memory but relatively preserved in visuospatial perception. Verbal memories are related to semantic knowledge. Receptive ability is better than expressive ability in people with DS but still seriously lags behind their age-matched controls. This lag may result in the weak semantic integration of people with DS. : This study aimed to examine the ability of semantic integration of people with DS by using false-memory tasks. Possible differences in the number of false memories induced by nouns and verbs were of focus. Two phases were involved in the false-memory task. In the study phase, ten-word lists with semantically related associates were presented. In the recognition phase, judgments were to be made about whether the words presented had been heard before. Three types of words were tested: previously presented associates, semantically related lures, and semantically unrelated new words. : People with DS overall showed the lowest accuracy among groups in response to tested word types. In the processing of lures, people with DS were worse in recognition than MA controls. In processing unrelated words, people with DS responded least accurately to all types of words compared to control groups. In the processing of associates, people with DS showed similar recognition rates as the MA controls but were less accurate than the CA controls. No difference was observed between nouns and verbs in recognizing word types among groups, though faster responses to nouns than to verbs emerged in college students. Further analyses on topic-wised comparisons of errors across syntactic categories revealed differences in specific concepts among groups, suggesting people with DS were atypical in semantic organization. : People with DS showed mixed patterns in semantic integration by false-memory tasks with delay to associates and deviance to lures together with unrelated words. People with DS showed distinct patterns in processing nouns and verbs while conducting topic-wise comparisons, suggesting that they formed false memories differently based on distinct syntactic categories. We concluded that people with DS develop a deviant semantic structure, hence showing problems in language and social cognition. Category-based rehabilitation is suggested to be implemented for people with DS to improve their semantic knowledge through lexical connections.
PubMed: 38928536
DOI: 10.3390/brainsci14060538 -
Zhongguo Shi Yan Xue Ye Xue Za Zhi Jun 2024To investigate the value of serum free light chain (sFLC) and serum calcium ion in the diagnosis and prognosis of multiple myeloma (MM).
OBJECTIVE
To investigate the value of serum free light chain (sFLC) and serum calcium ion in the diagnosis and prognosis of multiple myeloma (MM).
METHODS
Forty patients with MM treated in Henan Provincial People's Hospital from January 2018 to January 2022 were selected as the observation group, and 40 healthy volunteers were selected as the control group. The differences of sFLC-κ、sFLC-λ、sFLC-κ/λ, serum calcium ions, etc between the two groups were compared. Meanwhile, the differences of sFLC-κ、sFLC-λ、sFLC-κ/λ, serum calcium ions, etc in different international staging systems (ISS), chemotherapy efficacy and prognosis patients were analyzed.
RESULTS
The levels of sFLC-κ[(98.39±21.19) (12.01±4.45) mg/L], sFLC-λ[(210.20±45.54) (14.10±5.11) mg/L] and proportions of hypocalcemia (65% 0) in the observation group were significantly higher than those in the control group ( < 0.05), while sFLC-κ/ λ ratio[(0.44±0.10) (0.87±0.12)] and serum calcium ions [(1.98±0.46) (2.42±0.40)mmol/L] were significantly lower than those in the control group ( < 0.05). The sFLC-κ, sFLC-λ, the proportion of hypocalcemia and the course of hypocalcemia in ISS stage III patients in the observation group were significantly higher than those in stage I and II patients ( < 0.05), while sFLC-κ/λ ratio, and serum calcium ions were significantly lower than those in stage I and II patients ( < 0.05). The levels of sFLC-κ [(107.76±21.22) (94.67±20.11)mg/L], sFLC- λ[(245.54±41.12) (205.54±50.22)mg/L] of patients with hypocalcemia in the observation group was significantly higher than those without hypocalcemia ( < 0.05), while the sFLC-κ/λ ratio was significantly lower than those without hypocalcemia [(0.42±0.04) (0.47±0.06); < 0.05]. The levels of sFLC-κ [(107.29±20.14) ( 91.11±18.92)mg/L], sFLC-λ[(247.98±42.26) (179.29±39.32)mg/L] in patients with ineffective chemotherapy were significantly higher than those in patients with effective chemotherapy ( < 0.05), while the sFLC-κ/λ ratio was significantly lower than those in patients with effective chemotherapy [(0.43±0.10) (0.50±0.09); < 0.05)]. The area under the ROC curve for sFLC-κ, sFLC-λ, sFLC-κ/λ predicting ineffective chemotherapy was 0.803, 0.793 and 0.699 respectively, < 0.05. There was no significant difference in sFLC-κ, sFLC-λ, sFLC-κ/λ ratio, serum calcium ion, hypocalcemia ratio and hypocalcemia course between survival and death patients ( >0.05).
CONCLUSION
sFLC and serum calcium are related to ISS stage of MM patients. sFLC level has a certain value to predict the curative effect of chemotherapy in MM patients. However, the prognostic values of sFLC and serum calcium are not yet confirmed for MM patients.
Topics: Humans; Multiple Myeloma; Calcium; Prognosis; Immunoglobulin kappa-Chains; Immunoglobulin Light Chains; Hypocalcemia; Case-Control Studies; Female; Immunoglobulin lambda-Chains; Male; Middle Aged
PubMed: 38926969
DOI: 10.19746/j.cnki.issn.1009-2137.2024.03.021 -
Applied Clinical Informatics May 2024While clinical practice guidelines recommend that oncologists discuss goals of care with patients who have advanced cancer, it is estimated that less than 20% of... (Comparative Study)
Comparative Study
OBJECTIVES
While clinical practice guidelines recommend that oncologists discuss goals of care with patients who have advanced cancer, it is estimated that less than 20% of individuals admitted to the hospital with high-risk cancers have end-of-life discussions with their providers. While there has been interest in developing models for mortality prediction to trigger such discussions, few studies have compared how such models compare with clinical judgment to determine a patient's mortality risk.
METHODS
This study is a prospective analysis of 1,069 solid tumor medical oncology hospital admissions ( = 911 unique patients) from February 7 to June 7, 2022, at Memorial Sloan Kettering Cancer Center. Electronic surveys were sent to hospitalists, advanced practice providers, and medical oncologists the first afternoon following a hospital admission and they were asked to estimate the probability that the patient would die within 45 days. Provider estimates of mortality were compared with those from a predictive model developed using a supervised machine learning methodology, and incorporated routine laboratory, demographic, biometric, and admission data. Area under the receiver operating characteristic curve (AUC), calibration and decision curves were compared between clinician estimates and the model predictions.
RESULTS
Within 45 days following hospital admission, 229 (25%) of 911 patients died. The model performed better than the clinician estimates (AUC 0.834 vs. 0.753, < 0.0001). Integrating clinician predictions with the model's estimates further increased the AUC to 0.853 ( < 0.0001). Clinicians overestimated risk whereas the model was extremely well-calibrated. The model demonstrated net benefit over a wide range of threshold probabilities.
CONCLUSION
The inpatient prognosis at admission model is a robust tool to assist clinical providers in evaluating mortality risk, and it has recently been implemented in the electronic medical record at our institution to improve end-of-life care planning for hospitalized cancer patients.
Topics: Humans; Neoplasms; Male; Female; Middle Aged; Patient Admission; Risk Assessment; Aged; Hospitalization
PubMed: 38925539
DOI: 10.1055/s-0044-1787185 -
Neuroscience and Biobehavioral Reviews Jun 2024The sense of agency is the experience of being the author of self-generated actions and their outcomes. Both clinical manifestations and experimental evidence suggest... (Review)
Review
The sense of agency is the experience of being the author of self-generated actions and their outcomes. Both clinical manifestations and experimental evidence suggest that the agency experience and the mechanisms underlying agency attribution may be dysfunctional in schizophrenia. Yet, studies investigating the sense of agency in these patients show seemingly conflicting results: some indicated under-attribution of self-agency (coherently with certain positive symptoms), while others suggested over-attribution of self-agency. In this review, we assess whether recent theoretical frameworks can reconcile these divergent results. We examine whether the identification of agency abnormalities in schizophrenia might depend on the measure of self-agency considered (depending on the specific task requirements) and the available agency-related cues. We conclude that all these aspects are relevant to predict and characterise the type of agency misattribution that schizophrenia patients might show. We argue that one particular model, based on the predictive coding theory, can reconcile the interpretation of the multifarious phenomenology of agency manifestations in schizophrenia, paving the way for testing agency disorders in novel ways.
PubMed: 38925210
DOI: 10.1016/j.neubiorev.2024.105781