bluuebunny/crossref_metadata_2025 huggingface dataset:
318 Impact of dedicated teaching on frailty and comprehensive geriatric assessment at undergraduate level
Authors: Ward L , Kelly D , Gorey S , Kyne L
Published: September 2023

Background

Undergraduate exposure to geriatric medicine is essential to equip future physicians with knowledge, skills, and attitudes to provide care to older persons. Since 2009, all UCD final year medical students complete a 6-week core community medicine module run by geriatric medicine and general practice. In recent years we have further aligned our curriculum with the 2014 European undergraduate curriculum in Geriatric Medicine and have refined a simulated Comprehensive Geriatric Assessment (CGA) workshop with includes assessment of mood, cognition, ADLs and medications. We have added an interactive session on frailty.

Methods

A cross-sectional prospective study of students participating in a dedicated frailty/CGA teaching session was performed. Students were invited to complete an electronic survey using PollEV software at the beginning and end of the teaching session. Questions were a mixture of multiple-choice and open-ended.

Results

Of a potential 135 students, we received responses from 70. The data was anonymised at point of entry, and each question was recorded as an individual datapoint; exact numbers of students who answered are not possible. Quantitative results on inevitability of frailty went from 58% of students recognising that frailty is not an inevitable result of ageing; to 100%. Qualitative results showed that 29% of students did not know what frailty was to 92% demonstrating an understanding of vulnerability and poor reserve associated with frailty. With regards to CGA, 22% of students were unclear on what was involved with another 52% choosing a single modality. Following dedicated teaching, this improved to 82% showing their understanding of the interdisciplinary approach to CGA.

Conclusion

Frailty is a common, complex condition which all future clinicians will encounter. Recognition of frailty and implementation of a management plan is part of Comprehensive Geriatric Assessment. We have shown that a dedicated teaching session improves medical students understanding of this important topic.
328 From delirium detection to correction: enhancing peri-operative care for older patients
Authors: McManus C , Murphy E , O'Regan N , Doyle P
Published: September 2023

Background

Delirium is a common peri-operative complications in older adults. It is associated with poorer outcomes including functional decline, increased length of hospital stays, increased admissions to long term care and higher mortality. Therefore, this project aimed to assess the peri-operative care of older patients admitted under the surgical service in accordance with the standards set by the Collaborative for Peri-operative Optimisation of People (CPOP) and British Geriatrics Society (BGS) Peri-operative Care for People Living with Frailty undergoing Elective and Emergency Surgery Guidelines.

Methods

The study examined four key aspects of the guidelines: (1) surgical staff training on delirium; (2) proactive screening in for delirium in surgical patients; (3) proactively documenting delirium and implementing delirium guidelines; and (4) documentation of delirium diagnosis in discharge summaries.

Results

Data were collected from 72 surgical admissions over a fourteen-day period, of which 26 patients were aged >65. Results indicated suboptimal adherence to the guidelines, with only 4/26 older patients (15.4%) being screened for delirium. Three of 4 of these patients screened positive for delirium using the 4AT. No patients had delirium mentioned in their discharge summaries. Additionally, a survey of surgical non-consultant hospital doctors revealed that only 4/16 (25%) had received formal training on delirium.

Conclusion

In response to these findings, interventions were implemented, including teaching at surgical grand rounds, hospital-wide education for World Delirium Awareness Day, introduction of delirium care bundles, and an updated discharge summary template for surgical patients to include a delirium diagnosis. A reaudit is underway to evaluate the impact of these interventions on guideline adherence and the peri-operative care quality for older patients. These initial findings underscore the need for improved staff education and adherence to CPOP and BGS guidelines. The reaudit will provide valuable insights into the effectiveness of the implemented interventions in enhancing the perioperative care experience for the older patient cohort.
335 A service evaluation of a new dedicated clinic for older adults living with HIV: the Platinum clinic
Authors: Gallagher E , Stapleton C , Drought J , Robinson D
Published: September 2023

Background

The number of older adults living with HIV is increasing. Incorporation of the Comprehensive Geriatric Assessment (CGA) into their ongoing review will be a key consideration in the future care of this population. The Platinum clinic was established to provide a CGA for the patients with HIV attending the GUIDE clinic. A clinic proforma was designed with a particular focus on general health, falls history and medication review, bone health, cognition and social history.

Methods

We performed a retrospective review of the clinic proformas completed for the patients who had been assessed in the Platinum clinic. Data were collected on background medical history, frailty status, medications and social history. There was also a specific focus on falls history, bone health, cognition and psychiatric illnesses. Data were then collected on the health issues identified and planned interventions.

Results

24 patients’ charts have been reviewed to date. The average age of patients referred was 72 and 75% of patients were male. The average Rockwood Clinical Frailty Score was 2. Common co-morbidities included cardiovascular disease (29%), cerebrovascular disease (21%) and chronic respiratory disease (12%). 29% had a mood disorder. The average number of non-HIV medications was 5.9. The average MMSE was 26/30. 92% of patients had a planned intervention as a result of their assessment and there was an average of 2 interventions per patient. 24-hour blood pressure monitors were arranged for 25%, 17% were referred to the dedicated memory clinic for assessment, 50% of patients had bone health interventions. Opportunities for medication optimisation was observed in 17%. 17 patients were discharged from clinic following their first review, 9 of whom were referred to other specialist services as a result of their assessment.

Conclusion

The Platinum Clinic provides the opportunity to complete a CGA and ensure the ongoing health optimisation of the older adult living with HIV.
352 Integrated care programme for older persons—community specialist teams: evaluating the patient experiences
Authors: Geoghegan J , McCleane F , Costello M , Canavan M , Munnelly P , Gavin C , Cosgrove J , Cleary A , Donohue M , Shiel E , Mannion K , Sestak K , McDonnell C , Neachtain M Ní , Rogan M , Walsh L , Fitzmaurice C
Published: September 2023

Background

Following a successful Slaintecare pilot project (2019–2021) two teams were established in Community Healthcare Networks (CHN) 4&5 and CHN 6&7. The aim of our service is to provide a Comprehensive Geriatric Assessment (CGA) to older people. Service user experience/feedback are critically important to ensure that we are meeting their needs. We also looked to compare the results against previous patient experience survey undertaken in 2021.

Methods

The survey was designed by the multidisciplinary team, consisting of 15 closed/3 open questions. A Likert scale was utilised for closed questions and thematic analysis for open questions. 208 service users who attended our teams and have received a CGA from January 2023 to April 2023 were invited to participate in a postal survey. All participants received a covering letter, questionnaire and a stamped address envelope to return their completed surveys.

Results

There was a 35% response rate (73/208). 89% were aged ≥75. 49% of participants completed the survey themselves, 51% required assistance. 66% have had 2 or more interactions with the teams. Vast majority or those who responded highlighted the importance of having their care at home or at centres close to home. 97% agreed/strongly agreed that they were satisfied with the service. 99% felt they were treated with dignity/respect and had confidence in the service. 96% felt that when they had an important question they got an answer that they could understand. 94% reported their carers had the opportunity to discuss concerns.

Conclusion

Service users had an overwhelmingly positive experience when they engaged with both our teams. CGA assessment and team interventions in the home and local healthcare settings was seen as been beneficial The importance of having time to engage with members of the team, not feeling rushed was also a recurring theme.
10 Interdisciplinarity and joint working in cultural gerontology
Authors: Waldron E , Wakefield K , O'Neill D
Published: September 2023

Background

Cultural gerontology—understanding ageing through the lens of arts and humanities—is an important element of epistemology of ageing. As a boundary area between geriatric medicine/gerontology and arts/humanities disciplines, joint-working/interdisciplinarity is desirable. This project aims to assess the degree of joint-working manifested in cultural gerontology by authorship and acknowledgements in papers dedicated to cultural gerontology in five journals.

Methods

Observational survey of authorship in 5 journals from the founding of the specific sections on cultural gerontology or specific dedicated journals, assessing number of authors, disciplinary identities, and evidence of joint working within cultural gerontology.

Results

Of 591 papers, 481 (81%) were single authors. There was a spread of disciplinary affiliations, 247 (41.8%) gerontology/age-studies, 169 arts/humanities/social sciences (28.6%) and 133 of uncertain affiliation (22.5%): only 38 papers had a clear indication of joint working across the disciplines (6.4%). In the two geriatric medicine journals, European Geriatric Medicine and Journal of the American Geriatrics Society, authorship was almost exclusively from geriatric medicine/gerontology. There was extremely limited use of acknowledgements.

Conclusion

Our study indicates that single authorship is the most frequent mode of peer-reviewed publishing in cultural gerontology, while acknowledging that some authors may have scholarly training in multiple fields but are listed as uni-disciplinary. Leaders in the field and editors of relevant journals/section need to consider ways of encouraging and recognising joint working, through fuller descriptions of multiple affiliations, brief author biographies, fuller use of acknowledgements and consideration of brief accompanying discussant responses from complementary disciplines.
99 Pathfinder: a retrospective review of the first sixty patients
Authors: Meagher B , Griffin A , O'Donoghue B , Burke D , O'Shea T , Cox T , Allen T
Published: September 2023

Background

Pathfinder is designed to safely keep older adults who phone 999 at home by utilising alternative care pathways rather than taking them to a hospital Emergency Department (ED). Pathfinder began as a pilot initiative from a collaboration with Beaumont Hospital and the National Ambulance Service (NAS) in 2018. Due to its success a permanent team was set up in March 2020. The NAS began to roll Pathfinder out nationally and this team went live in the first quarter of 2023.

Methods

The first 60 patients who were seen by this Pathfinder service were included in a retrospective review. Data was collected using a Microsoft Excel® worksheet. The data recorded included: age, gender, Clinical Frailty Scale (CFS), the presenting complaint and the outcome of the assessment.

Results

Of the first 60 patients the mean age was 79 years, 48% (n = 29) were male and 52% (n = 31) were female. The median CFS was 6 indicating a moderately frail cohort. A total of 58% (n = 35) of patients remained at home after initial assessment, 74% (n = 26) received follow-up from the Pathfinder team, and 26% (n = 9) were treated and discharged at the scene. A total of 94% (n = 33) remained at home within 24 hours after initial review, and 80% (n = 28) remained at home after 7 days. A remaining 42% (n = 25) of patients were conveyed to ED at initial assessment. Of these patients, 76% (n = 19) were admitted and six patients were discharged home from the ED, of which four (67%) received follow-up from the Pathfinder team.

Conclusion

This new Pathfinder service to the area provides a safe alternative pathway to older adults who contact emergency services, with 58% of patients remaining at home post Pathfinder intervention. Further research is required to investigate the patient experience of the service.
103 Impact of dedicated consultant geriatrician involvement on direct discharge of frail patients from the emergency department (ED): a pilot study
Authors: Marks E , Lyons C , Thomas N , Dockery F , Brewer L
Published: September 2023

Background

Timely assessment and tailored intervention by a dedicated multi-disciplinary Frailty Intervention Therapy Team (FITT) in ED helps facilitate direct discharge from ED of frail older people who may otherwise be admitted. We assessed the impact of additional consultant geriatrician involvement on safe admission avoidance in suitable older patients.

Methods

A consultant geriatrician, registrar and an ANP worked in conjunction with FITT, ED colleagues, and teams on call. This pilot service ran 9 am-5 pm Tuesdays to Thursdays. All patients >75y in the ED were recorded and discussed at regular huddles. Frail patients at high risk for admission had consultant geriatrician review, to facilitate discharge where possible.

Results

We completed 27 days over a 9-week period, with both registrar and ANP present on 17/27 (63%) days. 315 patients were discussed. Commonest reasons for presentation included falls (57%), generally unwell (15%) and abdominal pain (12%). Of those actively reviewed (165), 116 were discharged (70.3%; 4.3 patients daily). Mean age was 76y (75–101), 44% were > 80y and 71% were female. CFS was 5–8 in 64%. Most came from home (68%) or nursing home (29%). Rapid follow-up was arranged for outpatient/day hospital (38;33%), NH outreach (18;16%), ICPOP (8; 7%), falls/fracture clinics (6;5%), community allied professionals (4;3%) and Palliative services (2;1.7%). Of those discharged, 11 returned to ED within four weeks (9.5% return rate).

Conclusion

Geriatrician input with FITT and ANP services in ED efficiently facilitated additional daily discharges of frail patients who were at high risk for unnecessary admission. With a mean of 4.3 discharges a day, a five day service should achieve 1,118 discharges a year. Allowing for a return rate of 9.5% and a mean length of stay of 14 days, such annual discharges would result in 14,168 bed days saved annually, well in excess of the annual bed-days activity on a 35 bed ward.
207 What is the association between psychotropic medication use and orthostatic hypotension in community-dwelling older people: data from TILDA
Authors: O’Donnell D , Moriarty F , Lavan A , Kenny R A , Briggs R
Published: September 2023

Background

Psychotropic medications increase the risk of falls among older people. The aim of this study is to examine the link between psychotropic medication use and Orthostatic Hypotension (OH), a frequent cause of falls in later life.

Methods: Participants ≥65 years at TILDA Wave 1 had an active stand to assess orthostatic blood pressure. OH was defined as a blood pressure (BP) drop ≥20 mmHg systolic and/or ≥ 10 mm Hg diastolic beyond 30 seconds post-standing. Medication lists were examined for the following anatomic therapeutic chemical classification codes: N06A (Antidepressants); N05BA, N05CD, N03AE (Benzodiazepines); ‘N05CF (‘Z’ Drugs); N05A (Antipsychotics) and medications with ‘definite’ anticholinergic effects on the Anticholinergic Cognitive Burden Scale. Logistic regression models, reporting odds ratios (OR), assessed the association between psychotropic medication use and OH. Analyses were adjusted for age, sex, educational attainment, alcohol excess, depression, cognitive impairment, chronic disease burden, heart disease and sleep quality.

Results

Of the 1,875 participants (mean age 71 years, 52% female), 12% were prescribed ≥1 psychotropic medication (234/1,875), while 4% (78/1,875) were prescribed ≥2. Psychotropic medication use was associated with a larger drop in systolic BP at 30 seconds (7.81 (95% CI 5.61–10.02) vs 3.46 (95% CI 2.61–4.32) mm Hg; p < 0.001) and 60 seconds (4.02 (95% CI 1.82–6.21) vs 1.28 (0.44–2.13); p = 0.025) post standing. In fully adjusted models, psychotropic medication use was associated with a higher likelihood of OH (OR 1.50 (95% CI 1.10–2.08; p = 0 0.013), with a stronger association noted for those taking ≥2 psychotropics (OR 2.19 (95% CI 1.34–3.57); p = 0.002).

Conclusion

Psychotropic medication use is independently associated with delayed BP recovery after standing. Older people prescribed psychotropics have a 50% higher likelihood Of OH related to their use, highlighting the importance of reviewing these medications as part of a comprehensive geriatric assessment, particularly in older people with falls.
260 Using participatory action research to examine attitudes and awareness of adult safeguarding practices in the acute hospital context
Authors: Donnelly S , Casey A , Lynch C , Deaveney S , Scanlon T , McKenzie L
Published: September 2023

Background

The investigation of, and interventions on, the alleged abuse of vulnerable adults has become an important feature of social work and other professional practices in Ireland. This implies important organisational challenges in ensuring that adult safeguarding responsibilities are delivered in ways that ensure positive outcomes for all stakeholders. Many factors can influence staff responses to concerns in acute care contexts. This can relate to awareness of the many forms of abuse and reporting obligations, attitudes to adult safeguarding and understanding the impact of abuse. Acute hospitals offer unique opportunities to intervene in abusive situations and to offer support to those at risk. This study set out to explore the awareness, understanding and attitudes towards safeguarding practices of staff in a large Dublin teaching hospital using a Participatory Action Research Approach (PAR).

Methods

A PAR methodology was utilised involving a social work academic and six members of the Medical Social Work team as co-researchers in the study design, data collection and data analysis. A quantitative, descriptive study design was adopted, which utilised a cross-sectional online survey of hospital staff which generated 100 responses from a variety of hospital staff including nurses, doctors and health and social care professionals.

Results

Findings indicate that acute care staff have varying levels of awareness of different categories of abuse. 59% of respondents reported being ‘somewhat confident’ in recognising and reporting suspected harm, neglect or abuse of a patient they were treating. 66% of respondents reported being aware of their mandated reporting requirements under the Criminal Justice (Withholding of Information on Offences against Children and Vulnerable Persons) Act 2012.

Conclusion

Many staff in acute care contexts lack confidence and knowledge in detecting and reporting the abuse of adults at risk, including their mandated reporting obligations with 90% of respondents stating that they need further training in this area.
300 Older persons in early supported discharge: an exploration of their experiences
Authors: Duddy S , Breen C , Chawke M , Burke C , Cosgrove C , Corry M , Waldron E , Walsh T , Deery M
Published: September 2023

Background

Early Supported Discharge (ESD) for Stroke is a complex intervention which enables people with new onset stroke to realise an accelerated discharge with rehabilitation in their home setting. ESD is supported with a robust evidence base, yet less is known about the specific experience of older adults. This paper aims to explore the experience and outcomes of patients over 65 years old in 2022 in a single stroke ESD site.

Methods

A password-encrypted database is held onsite, on which data for all ESD patients is inputted and updated during the time the patient is in the ESD service or shortly thereafter. The database was retrospectively reviewed to look at pertinent characteristics of the subgroup of ESD patients over 65 in 2022. Descriptive statistics were used to describe demographic details, functional outcomes, and predicted Length of Stay (LoS) saving in the acute hospital and LoS on the programme.

Results

Of 75 patients availing of ESD in the period, 47 were over 65 (62.6%). 63.8% of the over 65 cohort were female in contrast to 48% of the under 65 s. The Functional Independence Measure/Functional Assessment Measure (FIM/FAM) and Extended Activities of Daily Living (EADL) tools were used on admission and discharge. The FIM/FAM produced improvement score median of 6.08% and EADL, median score 12% among those over 65. The estimated LOS saving was the same across both groups (9.4 days). Average time on ESD programme was 29 days for this population, while those under 65 averaged at 46.6 days.

Conclusion

Older adults demonstrated functional gains in this ESD service, as measured by FIM/FAM and EADL measures, and they required less time in ESD than those under 65. Age did not influence acute LOS saving in this cohort. A larger review is indicated to determine trends over time and across ESD sites.
323 A service evaluation of a new initiative; the Mercers Acute Medical Assessment Unit for Older Adults (MASU)
Authors: Gallagher E , O'Donnell D , Doyle K , McCormick J , Finnegan E , Ryan M , Khan P , Briggs R , Keane B , Cunningham C , Lavan A
Published: September 2023

Background

Mercers Acute Medical Assessment Unit for Older Adults (MASU), a new service, was developed to expedite diagnosis, reduce delays in treatment and avoid unnecessary admissions in older adults presenting to hospital.

Methods

This was a retrospective review of the MASU service which included a dedicated registrar and consultant geriatrician assessing adults > = 70 years with geriatric needs in the emergency department. Adults reviewed by the MASU team over a 16-week period (June 20th–Oct 9th 2022) were reviewed. MASU operated between 9.00–17.00 (Monday–Thursday) and 9.00–16.00 (Friday). The usual on-call service operated outside these hours.

Results

Over 16-weeks, 348 patients were admitted; 166 (47.7%) by MASU, 182 (52.3%) by out of hours (OOH). Patients’ average age was 83.1 years, 57.8% were female and median length of stay was 11 days (9.3 MASU vs 14.4 OOH). Twenty-four hour discharge rates were 13.2% for MASU vs 3.7% for OOH, 48-hour discharge rates were 18% MASU vs 9.8% OOH and 72-hour discharge rates 23.4% MASU vs 17.7% OOH. Four-week data for (July 2022) were compared to the same 4-week period in 2019; Day time admissions were higher in 2022 (70% vs 50.3%). Of those admitted by MASU, 14.3% were accepted directly from triage avoiding ED review and delays in specialist input. Despite admissions in 2022 being on average 3.6 years older (85.7 years vs 82.1 years) and frailer (85.7% > =5CFS vs 54% > =5CFS), more were discharged ≤24 hours after presentation (14.3% vs 8.1%) with 30-day readmission rates (26.2% vs 29.7%) and 30-day mortality (7.1% vs 8.1%) remaining static.

Conclusion

Having a dedicated consultant geriatrician and registrar allocated to review older adults with geriatric needs attending the emergency department lead to earlier discharges, thus potentially avoiding hospital associated morbidity.
340 Dementia knowledge and attitudes among undergraduate medical students- a cross-sectional study
Authors: Loughlin E , Lynch A , Murphy R , Costello M
Published: September 2023

Background

With our ageing population, medical students should expect to encounter and treat growing numbers of patients with dementia throughout their careers. This must be reflected during their preclinical and clinical training. This study aimed to assess knowledge and attitudes towards patients with Alzheimer’s Disease (ad) and dementia among undergraduate medical students in Ireland.

Methods

A cross-sectional study was carried out of medical students undergoing hospital-based clinical attachments using the Alzheimer’s Disease Knowledge Scale (ADKS) and Dementia Attitudes Scale (DAS). These were distributed electronically. The ADKS is a 30-point true/false questionnaire covering 7 areas of knowledge of ad. The DAS is a 20-item scale using a 7-point Likert scale assessing attitudes towards patients with dementia across two domains: ‘dementia knowledge’ and ‘social comfort’. Demographics were collected including age, gender, academic year, student type (undergraduate or postgraduate) and desired field of future study. Data was collected and analysed via Qualtrics.

Results

The survey was distributed to 415 students, with a 21.7% respondent rate (n = 90). 64.7% (n = 54) were female, mean age of 23.3 years. 68.6% of students were in their first phase of clinical attachment (n = 59), undergraduate students represented 95.4% of respondents (n = 82). Mean percentage of correct answers on the ADKS was 83.7%. The domain with the highest correct scores was ‘Assessment and Diagnosis’ at 93.6%. The mean score on the DAS was 7.4% (108.4/140); when analysed by subgroup, mean score on ‘comfort’ was 68.1% (47.7/70) and mean score on ‘knowledge’ was 88.2% (61.7/70).

Conclusion

Participating medical students demonstrated high levels of ad knowledge and high positive attitudes scores towards patients with dementia. Scores were higher for ‘knowledge’ than ‘comfort’. Limitations included volunteer bias and social-desirability bias. This study identifies areas of deficits in students’ experience and attitudes and provides useful insights to inform training requirements for medical students to ensure they are adequately trained for these major demographic changes.
Smooth vs Textured Expanders: Patient Factors and Anatomic Plane Are Greater Factors in Determining First-Stage Breast Reconstruction Outcomes
Authors: Dahmus Emma S , Ruffino Amanda E , Madera Joshua D , Long Alexandra , Wang Shengxuan , Kauffman Christian A , Devitt Sean , Sanders Christopher , DeSantis Joseph
Published: September 2023

Background

Textured implants and expanders are associated with an increased risk of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). As a result, plastic surgeons are utilizing smooth expanders, but many perceive these produce undesirable outcomes including infection, seroma, and lateral displacement.

Objectives

The aim of this study was to compare clinical outcomes of smooth and textured expanders.

Methods

Breast reconstruction patients from January 2018 to May 2021 were retrospectively reviewed. Included patients underwent placement of tissue expanders at the time of mastectomy. Primary outcomes included postoperative seroma, infection, malposition, days to final reconstruction, explantation, and the need for capsulorrhaphy.

Results

In total, 233 patients were reviewed, of whom 167 met both inclusion and exclusion criteria. There was no statistically significant difference in poor outcomes comparing smooth and textured expanders. Days to final reconstruction was lower with smooth expanders per breast (P = .0424). The subpectoral group was associated with an increased likelihood of undergoing capsulorrhaphy (P = .004). Prepectoral placement was associated with more seromas (P = .0176) and infections (P = .0245). Demographic factors included older age as a protective factor for undergoing capsulorrhaphy (odds ratio [OR] = 0.962, P = .038), obesity increased the risk of infection (OR = 5.683, P = .0279) and malposition (OR = 6.208, P = .0222), and radiation was associated with malposition (OR = 3.408, P = .0246).

Conclusions

There was no significant difference in poor outcomes between smooth and textured expanders. Patient demographics and anatomical plane placement had greater effects on infection, seroma, and the need for capsulorrhaphy compared with tissue expander texturing.

Level of Evidence: 3
Comparing the Efficacy of Large Language Models ChatGPT, BARD, and Bing AI in Providing Information on Rhinoplasty: An Observational Study
Authors: Seth Ishith , Lim Bryan , Xie Yi , Cevik Jevan , Rozen Warren M , Ross Richard J , Lee Mathew
Published: September 2023

Background

Large language models (LLMs) are emerging artificial intelligence (AI) technologies refining research and healthcare. However, the impact of these models on presurgical planning and education remains under-explored.

Objectives

This study aims to assess 3 prominent LLMs—Google's AI BARD (Mountain View, CA), Bing AI (Microsoft, Redmond, WA), and ChatGPT-3.5 (Open AI, San Francisco, CA) in providing safe medical information for rhinoplasty.

Methods

Six questions regarding rhinoplasty were prompted to ChatGPT, BARD, and Bing AI. A Likert scale was used to evaluate these responses by a panel of Specialist Plastic and Reconstructive Surgeons with extensive experience in rhinoplasty. To measure reliability, the Flesch Reading Ease Score, the Flesch–Kincaid Grade Level, and the Coleman–Liau Index were used. The modified DISCERN score was chosen as the criterion for assessing suitability and reliability. A t test was performed to calculate the difference between the LLMs, and a double-sided P-value <.05 was considered statistically significant.

Results

In terms of reliability, BARD and ChatGPT demonstrated a significantly (P < .05) greater Flesch Reading Ease Score of 47.47 (±15.32) and 37.68 (±12.96), Flesch–Kincaid Grade Level of 9.7 (±3.12) and 10.15 (±1.84), and a Coleman–Liau Index of 10.83 (±2.14) and 12.17 (±1.17) than Bing AI. In terms of suitability, BARD (46.3 ± 2.8) demonstrated a significantly greater DISCERN score than ChatGPT and Bing AI. In terms of Likert score, ChatGPT and BARD demonstrated similar scores and were greater than Bing AI.

Conclusions

BARD delivered the most succinct and comprehensible information, followed by ChatGPT and Bing AI. Although these models demonstrate potential, challenges regarding their depth and specificity remain. Therefore, future research should aim to augment LLM performance through the integration of specialized databases and expert knowledge, while also refining their algorithms.

Level of Evidence: 5
Single-cell insights into development of the bovine placenta
Authors: Davenport Kimberly M , O’Neil Eleanore V , Ortega M Sofia , Patterson Amanda , Kelleher Andrew M , Warren Wesley C , Spencer Thomas E
Published: September 2023

A central determinant of pregnancy success is proper development of the conceptus (embryo/fetus and associated extraembryonic membranes including the placenta). Although the gross morphology and histology of the bovine placenta have been well studied, the cellular and molecular mechanisms regulating placenta development and trophoblast differentiation and function remain essentially undefined. Here, single-cell transcriptome (scRNA-seq) analysis was performed on the day 17 bovine conceptus and chorion of day 24, 30, and 50 conceptuses (n = 3–4 samples per day) using the 10X Genomics platform. Bioinformatic analyses identified cell types and their ontogeny including trophoblast, mesenchyme, and immune cells. Loss of interferon tau–expressing trophoblast uninucleate cells occurred between days 17 and 30, whereas binucleate cells, identified based on expression of placental lactogen (CSH2) and specific pregnancy-associated glycoprotein genes (PAGs), first appeared on day 24. Several different types of uninucleate cells were present in day 24, 30, and 50 samples, but only one (day 24) or two types of binucleate cells (days 30 and 50). Cell trajectory analyses provided a conceptual framework for uninucleate cell development and binucleate cell differentiation, and bioinformatic analyses identified candidate transcription factors governing differentiation and function of the trophoblasts. The digital atlas of cell types in the developing bovine conceptus reported here serves as a resource to discover key genes and biological pathways regulating its development during the critical periods of implantation and placentation.
Retrospective causal inference with multiple effect variables
Authors: Li Wei , Lu Zitong , Jia Jinzhu , Xie Min , Geng Zhi
Published: September 2023

As highlighted in Dawid (2000) and Pearl & Mackenzie (2018), deducing the causes of given effects is a more challenging problem than evaluating the effects of causes in causal inference. Lu et al. (2023) proposed an approach for deducing causes of a single effect variable based on posterior causal effects. In many applications, there are multiple effect variables, and they can be used simultaneously to more accurately deduce the causes. To retrospectively deduce causes from multiple effects, we propose multivariate posterior total, intervention and direct causal effects conditional on the observed evidence. We describe the assumptions of no confounding and monotonicity, under which we prove identifiability of the multivariate posterior causal effects and provide their identification equations. The proposed approach can be applied for causal attributions, medical diagnosis, blame and responsibility in various studies with multiple effect or outcome variables. Two examples are used to illustrate the proposed approach.
Repeat expansions in NOP56 are a cause of spinocerebellar ataxia Type 36 in the British population
Authors: Lam Tanya , Rocca Clarissa , Ibanez Kristina , Dalmia Anupriya , Tallman Samuel , Hadjivassiliou Marios , Hensiek Anke , Nemeth Andrea , Facchini Stefano ,   Genomics England Research Consortium, Ambrose J C , Arumugam P , Bevers R , Bleda M , Boardman-Pretty F , Boustred C R , Brittain H , Brown M A , Caulfield M J , Chan G C , Giess A , Griffin J N , Hamblin A , Henderson S , Hubbard T J P , Jackson R , Jones L J , Kasperaviciute D , Kayikci M , Kousathanas A , Lahnstein L , Lakey A , Leigh S E A , Leong I U S , Lopez F J , Maleady-Crowe F , McEntagart M , Minneci F , Mitchell J , Moutsianas L , Mueller M , Murugaesu N , Need A C , O’Donovan P , Odhams C A , Patch C , Perez-Gil D , Pereira M B , Pullinger J , Rahim T , Rendon A , Rogers T , Savage K , Sawant K , Scott R H , Siddiq A , Sieghart A , Smith S C , Sosinsky A , Stuckey A , Tanguy M , Taylor Tavares A L , Thomas E R A , Thompson S R , Tucci A , Welland M J , Williams E , Witkowska K , Wood S M , Zarowiecki M , Wood Nicholas , Cortese Andrea , Houlden Henry , Tucci Arianna
Published: September 2023

Spinocerebellar ataxias form a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by progressive cerebellar ataxia. Their prevalence varies among populations and ethnicities. Spinocerebellar ataxia 36 is caused by a GGCCTG repeat expansion in the first intron of the NOP56 gene and is characterized by late-onset ataxia, sensorineural hearing loss and upper and lower motor neuron signs, including tongue fasciculations. Spinocerebellar ataxia 36 has been described mainly in East Asian and Western European patients and was thought to be absent in the British population. Leveraging novel bioinformatic tools to detect repeat expansions from whole-genome sequencing, we analyse the NOP56 repeat in 1257 British patients with hereditary ataxia and in 7506 unrelated controls. We identify pathogenic repeat expansions in five families (seven patients), representing the first cohort of White British descent patients with spinocerebellar ataxia 36. Employing in silico approaches using whole-genome sequencing data, we found an 87 kb shared haplotype in among the affected individuals from five families around the NOP56 repeat region, although this block was also shared between several controls, suggesting that the repeat arises on a permissive haplotype. Clinically, the patients presented with slowly progressive cerebellar ataxia with a low rate of hearing loss and variable rates of motor neuron impairment. Our findings show that the NOP56 expansion causes ataxia in the British population and that spinocerebellar ataxia 36 can be suspected in patients with a late-onset, slowly progressive ataxia, even without the findings of hearing loss and tongue fasciculation.
Targeted DNA Methylation Analysis Facilitates Leukocyte Counts in Dried Blood Samples
Authors: Hubens Wouter H G , Maié Tiago , Schnitker Matthis , Bocova Ledio , Puri Deepika , Wessiepe Martina , Kramer Jan , Rink Lothar , Koschmieder Steffen , Costa Ivan G , Wagner Wolfgang
Published: September 2023

Background

Cell-type specific DNA methylation (DNAm) can be employed to determine the numbers of leukocyte subsets in blood. In contrast to conventional methods for leukocyte counts, which are based on cellular morphology or surface marker protein expression, the cellular deconvolution based on DNAm levels is applicable for frozen or dried blood. Here, we further enhanced targeted DNAm assays for leukocyte counts in clinical application.

Methods

DNAm profiles of 40 different studies were compiled to identify CG dinucleotides (CpGs) with cell-type specific DNAm using a computational framework, CimpleG. DNAm levels at these CpGs were then measured with digital droplet PCR in venous blood from 160 healthy donors and 150 patients with various hematological disorders. Deconvolution was further validated with venous blood (n = 75) and capillary blood (n = 31) that was dried on Whatman paper or on Mitra microsampling devices.

Results

In venous blood, automated cell counting or flow cytometry correlated well with epigenetic estimates of relative leukocyte counts for granulocytes (r = 0.95), lymphocytes (r = 0.97), monocytes (r = 0.82), CD4 T cells (r = 0.84), CD8 T cells (r = 0.94), B cells (r = 0.96), and NK cells (r = 0.72). Similar correlations and precisions were achieved for dried blood samples. Spike-in with a reference plasmid enabled accurate epigenetic estimation of absolute leukocyte counts from dried blood samples, correlating with conventional venous (r = 0.86) and capillary (r = 0.80) blood measurements.

Conclusions

The advanced selection of cell-type specific CpGs and utilization of digital droplet PCR analysis provided accurate epigenetic blood counts. Analysis of dried blood facilitates self-sampling with a finger prick, thereby enabling easier accessibility to testing.
Metabolic targeting of platelets to combat thrombosis: dawn of a new paradigm?
Authors: Flora Gagan D , Nayak Manasa K , Ghatge Madankumar , Chauhan Anil K
Published: September 2023

Current antithrombotic therapies used in clinical settings target either the coagulation pathways or platelet activation receptors (P2Y12 or GPIIb/IIIa), as well as the cyclooxygenase (COX) enzyme through aspirin. However, they are associated with bleeding risk and are not suitable for long-term use. Thus, novel strategies which provide broad protection against platelet activation with minimal bleeding risks are required. Regardless of the nature of agonist stimulation, platelet activation is an energy-intensive and ATP-driven process characterized by metabolic switching toward a high rate of aerobic glycolysis, relative to oxidative phosphorylation (OXPHOS). Consequently, there has been considerable interest in recent years in investigating whether targeting metabolic pathways in platelets, especially aerobic glycolysis and OXPHOS, can modulate their activation, thereby preventing thrombosis. This review briefly discusses the choices of metabolic substrates available to platelets that drive their metabolic flexibility. We have comprehensively elucidated the relevance of aerobic glycolysis in facilitating platelet activation and the underlying molecular mechanisms that trigger this switch from OXPHOS. We have provided a detailed account of the antiplatelet effects of targeting vital metabolic checkpoints such as pyruvate dehydrogenase kinases (PDKs) and pyruvate kinase M2 (PKM2) that preferentially drive the pyruvate flux to aerobic glycolysis. Furthermore, we discuss the role of fatty acids and glutamine oxidation in mitochondria and their subsequent role in driving OXPHOS and platelet activation. While the approach of targeting metabolic regulatory mechanisms in platelets to prevent their activation is still in a nascent stage, accumulating evidence highlights its beneficial effects as a potentially novel antithrombotic strategy.
Determinants of left atrial stiffness by reservoir strain using 2D speckle tracking echocardiography in structurally normal heart
Authors: Elsayegh Aya Tarek , Mohamed Asous Osama Mohameden , El misiri Ahmed Mohamed
Published: September 2023

Introduction

The left atrium (LA)’s essential function is modulating left ventricular (LV) filling via its different reservoir, conduit, and contractile functions. This could be accurately achieved now by dedicated speckle-tracking echocardiography software.

Methodology

We included in this prospective cohort study 200 subjects with structurally normal hearts, who present for elective echocardiography, routine echocardiography was performed in addition to left atrial strain analysis by 2D speckle tracking echocardiography.

Aim of work

To study the effect of different variables on left atrial reservoir strain.

Results

The study population consisted of 134 males and 66 females, age range between 20 and 69 years of age. linear regression analysis was performed to examine the contributions of different variables as predictors in explaining the variance.

S-R (strain reservoir) was significantly affected by age in a negative correlation with P = 0.032. Body weight, height, BMI (body mass index), lipid profile and HbA1C (glycosylated hemoglobin) had no significant impact on S-R left atrial function. All echocardiographic parameters of diastolic function including E/A ratio, Septal E′, Lateral E′, E/E′ and TR jet velocity had no significant impact on S-R left atrial function.

Maximum and minimum indexed left atrial volumes, indexed LV systolic and diastolic volumes measured by Simpson’s method had no significant effect on S-R left atrial function.

Conclusion

Left atrial stiffness increases with age. Obesity, dyslipidemia, impaired glucose tolerance and diastolic dysfunction have no significant effect on the S-R of the left atrium.

Additional Content

An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.
Immediate, short-term, and long-term effects of balloon mitral valvuloplasty on the left atrial global longitudinal strain and its correlation to the outcomes in patients with severe rheumatic mitral stenosis
Authors: Setouhi Amr , Boshra Hesham , Askalany Hany , Farrag Hazem M A
Published: September 2023

Background

Global longitudinal left atrial strain (GLS) has been used as a new assessment tool for left atrial function.

Aim

To investigate the effect of balloon mitral valvuloplasty (BMV) in patients with severe rheumatic mitral stenosis on GLS and its relation to the mitral valve area achieved after the procedure.

Methods

The study included 95 patients with severe mitral stenosis who fulfilled the criteria for BMV (case group) and 80 normal healthy subjects (control group). All included participants underwent complete echocardiographic examinations. For the case group, GLS was assessed by 2D speckle-tracking Echocardiography before valvuloplasty, immediately after, within 24 h, at 6 months, and at 12 months, and the results were compared.

Results

The impaired left-atrium strain in patients with severe mitral stenosis was improved immediately after BMV, and the improvement continued at 6 and 12 months post-BMV (23.1% ± 4.2 vs. 36.0 % ± 4.9, 36.2% ± 4.5, and 40.1% ± 9.5, respectively P < 0.01). After BMV, there was a significant decrease in left atrial volume (76.3 ± 12.4 mL/m2 vs. 68.6 ± 10.4 mL/m2, P < 0.01) and a significant increase in the area occupied by the mitral valve (1.02 ± 0.18 cm2 vs. 1.60 ± 0.31 cm, P < 0.01).The immediate GLS and the mitral valve area were positively correlated (r = 0.64, P < 0.01). Furthermore, the immediate GLS was associated with significantly improved function class (P < 0.01).

Conclusion

GLS can indicate left atrial function (mainly reservoir function). The improvement observed in patients after BMV may indicate that GLS can be used to evaluate the progress after BMV.

Additional Content

An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.
Stenting the unprotected left main coronary artery- mid-term outcomes of the observational registry
Authors: Rafla Samir , Zaki Amr , Loutfi Mohamed , Sadaka Mohamed Ahmed , Shebl Moataz
Published: September 2023

Background

New imaging modalities such as IVUS had improved results of Stenting of the unprotected left main coronary artery (UPLM). The results of stenting UPLM without these new modalities but with meticulous care need to be studied more.

Methods

This prospective and retrospective study was performed in multiple local centers. The local ethics committee approved the study, and the patients signed informed consent. In addition, the local heart team, including a cardiac surgeon, was consulted for a joint decision agreement. In the last five years, one hundred twenty patients with left main disease >50% were subjected to stenting with drug- eluted stents.All patients were subjected to detailed history taking with particular emphasis on acute coronary syndrome, angina duration, class, previous coronary interventions, and medications. In addition, 12 lead ECGs were revised with an evaluation of ST/T changes and any old infarction. An echocardiographic examination was done on all patients. Relevant laboratory tests were done.Risk assessment was calculated for every patient, including Euro SCORE and Syntax score. Patient selection: Consecutive patients arriving for primary Stenting or acute coronary episode were included. Medications: All patients received clopidogrel and aspirin before the planned procedure. Anticoagulation with unfractionated heparin in a dose of 10000 IU was given at the beginning of the PCI. Post PCI, all patients received B blockers, ACE inhibitors, statins, and dual antiplatelets in the guidelines recommended doses. Calcification was assessed by angiographic imaging only. We estimated the vessel diameter as 2/3 diameter of the branches. PCI technique: A steerable guidewire was advanced in LAD, followed by PCI with pre-dilatation or direct Stenting according to the operator’s discretion. One or two stent strategy was utilized according to the situation of the lesions.

Results

92 patients (77.3%) presented with ACS, of which 65 patients (54.6%) had no Previous Intervention, and 27 patients (22.7%) had a previous PCI. Left ventricular ejection fraction significantly correlates with the complication at six months follow-up; all 16 patients with reported complications (100%) had baseline LVEF of <40% (P-value = 0.023).

Syntax score

11 patients (55%) with a high score of more than 32 had adverse events, P = 0.004. Residual syntax shows a less significant correlation with a mean value of 7.3 in the complication group vs. 4.9 in the other group (P = 0.016). Final kissing balloon inflation shows no statistically significant difference.

Conclusions

PCI in UPLM is a safe, feasible option with a high technical success rate and acceptable outcome at follow-up, even without the utilization of IVUS