bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiology intensive care unit nurse in italy: definition of advanced competences. IN-CORE study
Authors: Cruciani F , Barisone M , Cacciavillani L , D'alessandro G , Valente S , Rosati M , Marenzi G , Mazza M , Gasparetto N , Casonato C , Bernardo P , Piccinini C , Luchetti S , Marini M
Published: July 2024

Background/Introduction

Since the establishment of the Cardiology Intensive Care Units to date, there have been many scientific and technological progresses that have involved not only the pathways of diagnosis and treatment of patients in this specialist area, but also the specialist competencies that nurses must acquire in order to work in these settings.

The epidemiological picture and incidence of comorbidities suggest the care of patients requiring intensive and specialised care, with the use of high technology and circulatory support systems, changing the usual setting of a cardiology intensive care unit to a high-intensity cardiology intensive care unit.

To date, a few studies have been described in the literature that have mapped the competences of the cardiology intensive care unit nurse, but the heterogeneity of training education at a European level has not yet made a reference framework for this specialist area generalisable. (Endacott R., et al. 2022). In Italy, there are no specific postgraduate courses focused on specialist cardiac intensive care skills development for nurses. To develop such courses, content incorporating appropriate competencies is required and this study was designed to meet this.

Purpose

To identify the core competencies of nurses working in High-intensity cardiology intensive care units (ICUs) in Italy to develop national competence framework.

Methods

A three-round e-Delphi study was conducted with a group of 30 experienced cardiac intensive care unit nurses; 28 completed all three rounds. The first round asked each participant to write down five competences, which they were asked to prioritize in the second round. In the third round, they were asked to prioritize again, considering the scores made in the second round. The final list of competencies was the one that achieved a greater than 70% agreement among the participants.

Results

We identified 12 core competencies that include a few competence areas, including high-tech care, emergency management, teamwork, and critical decision-making. Only slight differences emerged among the panel of experts regarding the priority given to certain core competencies, such as ECG reading, emergency management and technical and practical skills in the intensive care area.

Conclusions

This is the first study in Italy to identify the core and advanced competencies of nurses working in high level cardiac intensive care units. This study provides an important basis for the development of postgraduate educational programme and a framework for the definition of national standards to be implemented in clinical practice.
Determining what matters most to Marfan syndrome (MFS) patients: a convergent mixed method study of the health-related quality of life and psychosocial effects of MFS aortovascular manifestations
Authors: Magboo R , Oo A , Cooper J , Gibbs D , Owens G , Sanders J
Published: July 2024

Background

Marfan Syndrome (MFS) affects multiple organ systems but the aortovascular manifestations are the most serious and life-threatening. However, there is no available evidence on the effect of the aortovascular manifestations on health-related quality of life (HRQoL) and psychosocial wellbeing of MFS patients.

Purpose

This study aims to determine the HRQoL and the psychosocial effects of the aortovascular manifestation of MFS.

Methods

A convergent mixed-method design was used in this single site study. Specifically, the quantitative study (S1) is an observational exploratory study using seven validated questionnaires relating to HRQoL (SF36, EQ-5D-5L) and psychosocial health (depression [CESD], illness perception [IPQ], fatigue [FSS], self-esteem [RSES], stigma [PSQ]), previously used in MFS research. The qualitative study (S2) is an exploratory study using semi-structured interviews. Analysis consisted of descriptive and inferential statistics and Framework method1 for S1 and S2, respectively. Joint display was used for data integration.

Results

A total of 75 participants completed the questionnaires (S1) and 20 were interviewed (S2). The mean age was 43 years (S1) and 40 years (S2) and the majority (S1: 54 (72%); S2: 17 (85%)) were white British. S1 found the majority of MFS participants experienced depression, anxiety, pain and fatigue. These areas were confirmed in S2. A positive self-esteem was generally reported in S1, but this is not supported by S2, which highlighted patients experience a loss of self-esteem due to perceived body image disturbance. Finally, S2 generated new areas not identified in S1 including health anxiety, loss of personal efficacy, self-stigma and ‘invisible disability’ affecting work and socio-economic condition. Overall, the joint display generated three confirmed, seven expanded and one discordant finding.

Conclusion

MFS patients with aortovascular manifestations experienced several HRQoL and psychosocial issues related to their condition. Collaborative efforts are needed to develop multifaceted interventions and programs to address their needs and provide a holistic and comprehensive service for MFS patients. Finally, four new areas were identified in S2, which added important new evidence in this body of knowledge.
The lived experience of loneliness and social isolation in patients with pulmonary arterial hypertension: A phenomenological study
Authors: Cedrone N C , Lommi M L , Gangemi I G , Iovino P I , Vellone E V
Published: July 2024

Background

Pulmonary arterial hypertension (PAH) is a rare, complex and chronic disease, characterised by a mean pulmonary arterial pressure at rest above 20 mmHg, determined through right heart catheterisation. As the disease progresses, symptoms (e.g., chest pain, syncope, respiratory distress) occur, which negatively impact quality of life. Moreover, symptoms of PAH can impair activities of daily living and social functions, leading to social isolation and loneliness. So far the experience of social isolation and loneliness in PAH patients.

Purpose

To explore the lived experience of social isolation and loneliness in patients with PAH.

Methods

A multicentre descriptive phenomenological study was conducted with semi-structured interviews driven by the Middle Range Theory of Social Isolation. This study followed the COREQ guidelines, and data analysis was conducted using the Elo and Kyngäs method.

Results

Seventeen patients (mean age 55,3 years; range 21-83 years; n=3 male) recruited from specialized clinics or patient associations across different Italian regions, participated in the interviews. The results show that patients with a marked symptomatology experience daily moments of loneliness and social isolation that inevitably impact the quality of life. While, patients with a mild symptomatology or with drug support can lead a life similar to that before diagnosis. Three main categories emerged. First, within the main category of loneliness emerged generic categories including emotions associated with loneliness (anger, depression, frustration, guilt, fear)as well as the influence of loneliness on the disease and the various strategies to limit it. Second, for the main category of social isolation were also identified other generic categories including networks of support of the person with PAH (family, social and work), emotions related to social isolation (dismissal and pretend to be well) and the influence of social isolation on the path of illness. Finally, generic categories related to well-being, autonomy, health, self-care activity or health promotion performed by the patient emerged for the main quality of life category.

Conclusion

The findings of this study contribute to a more in depth understanding of the factors influencing the quality of life of patients with PAH and enlighten the design of interventions aimed at improving their condition. Integration of these results with quantitative data regarding the extent of the influence of loneliness and social isolation is warranted.
Incidence of heart disease and stroke among patients with bipolar disorder
Authors: Szczepanowski R , Krzyzanowski D , Kulinska J , Palej-Cieplinska M , Ferdinan T , Hernandez Ibarburu G
Published: July 2024

Background

Increased vulnerability to cardiovascular diseases (CVD) and stroke has been observed among people with mental disorders, such as bipolar disorder (BP). Yet, the evidence for the association between severe mental disorders and CVD and stroke events remains inconclusive.

Purpose

By running a cohort study based on large retrospective data, we aimed to establish the relative risk of CVD problems and stroke in patients admitted to the hospital and diagnosed with BP.

Methods

The study was conducted on electronic health records provided by 113 healthcare organizations worldwide from the TriNetX Global Collaborative Network, containing at least 690,946 patients with BP symptoms. The assessment was focused on the first incidence of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction among patients after BP diagnosis. After propensity score matching age, gender, race and comorbidities, the rates were compared against a cohort of patients with no mental, behavioral, or neurodevelopmental disorders who also suffered from similar CVD and stroke events. In addition, Kaplan-Meier Analysis was performed to compare their survivability to CVD, taking into account patient censoring.

Results

Patient count after applying the score matching yielded 532,082 per cohort. The odds ratio (OR) of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction on BP compared to people without any mental disorder was equal to 2.349, indicating a significantly elevated risk for such events. The Kaplan-Meier analysis showed that patients with BP diagnosis had 9.88% less survival probability to having CVD problems after 20 years since the diagnosis than patients without any mental disorder. With a hazard ratio of 1.970 (95%CI 1.935-2.005), the risk of developing a CVD problem on the former (patients with BP diagnosis) was almost twice greater than for patients suffering without mental health disorders.

Conclusion

There is an increased risk of developing cardiovascular problems and stroke among patients with bipolar disorder compared to patients affected by such symptoms without mental disorders. The robust results were ensured by limiting the potential confounders with the propensity score matching procedure, such as demographics, comorbidity, and medication. The study implies that monitoring and prevention approaches for cardiovascular and cerebral vascular diseases must be tailored to symptoms of mental disorders.
Comprehensive assessment of the results of zorba dance-based rehabilitation in patients after myocardial infarction
Authors: Rzepka-Cholasinska A , Ratajczak J , Nowaczyk A , Grzelakowska K , Kubica A
Published: July 2024

Introduction

Dance movement engages global muscle sequences of the human body, improves physical performance, and helps reduce stress and excessive muscle tension. Dance exercises allow you to better control your movement and muscles. Zorba Greek dancing as a form of physical activity brings benefits in the form of improved mental health, well-being and quality of life. Rehabilitation may contribute to improving cardiorespiratory fitness and mental condition in the group of patients after myocardial infarction.

Aim of the study

The aim of the study was to evaluate a rehabilitation program based on Zorba dance on selected clinical parameters in patients after myocardial infarction.

Materials and methods

The study included 99 patients after myocardial infarction who were rehabilitated for 5 weeks. Patients were enrolled into two groups. Group I (50 patients) performed cycle ergometer training and the Greek dance Zorba. Group II (49 patients) performed cycle ergometer training and rehabilitation exercises. At the beginning and after rehabilitation, patients' BMI, balance (scales: Tinetti, Berg, 30CST), gait (6MWT), psychophysical status (SF-36, WHO-5, FCIS), and breathlessness (mMRC scale) were assessed.

Results

After undergoing rehabilitation, there was a reduction in BMI (I vs. II p<0.01), improvement in balance on the Tinetti (I vs. II p<0.01) and Berg scale (I vs. II p<0.01), improvement in the 30CS test score (I vs. II p= 0.018), improvement in WHO-5 (I vs. II p< 0.01), and reduction in dyspnea (mMRC)

(I vs. II p< 0.01) in the Zorba group.

Conclusions

Both methods of rehabilitation improve functional efficiency; However, rehabilitation with the use of Zorba dance additionally improves balance in patients after myocardial infarction.
Complications in the postoperative period of heart transplantation: a retrospective cohort
Authors: Molinari Genari P , Malaman Galhardi N , Batista Dos Santos Pedrosa R
Published: July 2024

Introduction

Primary graft dysfunction, graft rejection, renal dysfunction, and infections are frequent complications after heart transplantation (HT), and there is evidence that previous comorbidities and risk factors, such as arterial hypertension, diabetes, dyslipidemia, and smoking can predispose or even aggravate the development and evolution of these disorders.

Objectives

This study verified the association between previous comorbidities and risk factors in the development of complications after HT.

Methods

A retrospective cohort study was conducted and included 91 HT patients and followed up to 10 years postoperatively, in a Brazilian hospital between 1988 and 2020. The study was designed according to the recommendations of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Data were collected by retrospective analysis of medical records. The independent variables were the following: Demographic and clinical conditions of the subjects during the preoperative period, such as age, sex, arterial hypertension, diabetes, dyslipidemia, and smoking. The outcome variables were: Acute cellular rejection, infection, renal dysfunction, hemodialysis therapy after the HT, and death. Data were submitted to descriptive, Fisher’s Exact Test and Chi-square analyses, with p < 0.05 as the level of statistical significance. The local Ethics Committee approved the study (CAAE: 53026321.4.0000.5404).

Results

There was a predominance of women (67.0%), with a mean age of 49.4 (11.1) years. Most of them were diagnosed with hypertension (49.45%), smokers (38.46%), dyslipidemia (18.68%), and diabetes (16.48%). Regarding complications, 73.63% of the sample of this study developed acute cellular rejection, 61.54% had infections, 25.47% developed renal dysfunction, in addition to 24.18% of patients received hemodialysis treatment after HT. More than half of patients died (58.24%). Positive associations of strong magnitude were found between renal dysfunction and hypertension (p=0.0018); of moderate magnitude between acute cellular rejection and smoking (p=0.0386) and between infection and smoking (p=0.0156). Furthermore, it was observed that those who developed renal dysfunction had a high association with hemodialysis (p<0.0001).

Conclusion

This study demonstrated that hypertension may be associated with the development of renal dysfunction, and smoking may contribute to acute cellular rejection and infection after HT. These findings provide support to health professionals to implement prevention strategies and early detection of complications in the postoperative period.
Virtual reality and cardiac rehabilitation: a new middle-range theory to outline its mechanism of effectiveness
Authors: Micheluzzi V , Casu G , Sanna G D , Vellone E , Iovino P
Published: July 2024

Background

To reduce symptoms and improve outcomes in patients with cardiovascular diseases, international guidelines recommend cardiac rehabilitation. However, patients’ adherence to rehabilitation programs remains suboptimal, compromising its beneficial effects. Virtual reality has proven to be effective in enhancing adherence to rehabilitation in different fields (e.g., neurological and post-trauma). In the cardiological field, it has been proven effective in improving functional capacity and several psychological parameters (e.g., anxiety, depression, and emotional stress). Despite the increasing use of this digital technology, there is still a lack of information regarding its underlying mechanism of effectiveness.

Purpose

This middle-range theory aims to explain the mechanism of effectiveness of virtual reality in cardiac rehabilitation.

Methods

An inductive-deductive approach was used to develop this middle-range theory. Three steps were conducted including synthesis of key concepts, definition of the relationship between these concepts, and setting up of a hypothetical model.

Results

This middle-range theory proposes both proximal and distal outcomes of virtual reality. Proximal outcomes are classified as responses at the psychological (i.e., emotional stress, depression, and anxiety) and physical (i.e., exercise capacity) level, which, in turn, influence adherence to rehabilitation (i.e., distal outcome). Mediators of the relationship between virtual reality and outcomes are both at a proximal and distal level. The proximal mediators are activated at the neurological level to generate a multisensory experience of sight, hearing, and touch. This alters perception, by inducing an immersive altered state of consciousness and activating the distal mediators of attention, enjoyment, and sense of presence. The activation of the distal mediators promotes distraction from negative external stimuli related to the disease and healthcare setting and perception of positive emotions by interacting with the virtual world. Consequently, these mediators influence physical and psychological responses that enhance overall adherence to cardiac rehabilitation. Moderators of the relationship between virtual reality and rehabilitation adherence include age, gender, trust in technology, and cognitive status (Figure 1).

Conclusions

This middle-range theory aims to clarify the mechanism by which virtual reality enhances adherence to cardiac rehabilitation. Further qualitative and quantitative studies are warranted to test its hypothetical model.
Early heart rate recovery after a 6-min walking test in patients after percutaneous aortic valve implantation coresponds with clinical benefits
Authors: Aleksandrowicz K
Published: July 2024

Background

Time-appropriate return to a resting heart rate (HR) after cessation of exercise is a marker for predicting outcomes in patients with heart failure (HF). We aimed to evaluate the prognostic value of HR recovery in functional improvement in patients with severe aortic stenosis after percutaneous aortic valve implantation (TAVI).

Methods

6 min walk test (6MWT) was performed in 93 individuals before TAVI and in 3 months follow up. The change in walking distance was measured. We analyzed also the differences between baseline HR, HR at the end of the test, and HR at the 1st, 2nd and 3rd minute of recovery.

Results

After 3 months the distance of 6MWT in TAVI patients improved by 39±63 m and reached a total of 322±117 m. The differences between HR after 2 min of recovery and baseline HR in pre-TAVI after a 6MWT was the only significant predictor of waking distance improvement during follow-up in multiple linear regression model.

Conclusions

Our study showes that changes of HR recovery after a 6MWT may be a helpful and easy parameter to assess improvement in exercise capacity after TAVI. This simple method can also help to identify patients in whom no significant benefit in functional improvement can be expected despite successful valve implantation.Demographics
A pan-Europe comparative review of allied profession roles in cardiac science
Authors: Stain N , Bayne S , Bruce D , Malcolmson J
Published: July 2024

Introduction

Over the last 75 years, Cardiac Science (CS) has evolved into a widely practised Allied Profession (AP) throughout Europe. Despite this prominence, there are limited comparative works on AP titles, regulation, scope of practice (SoP) and training routes. The recognition of CS as a profession in the United Kingdom dates from 1948 when the Society for Cardiac Science and Technology (SCST) was established. In the UK, the AP role has evolved into Cardiac Physiologists with education at bachelor’s degree level and Clinical Scientists at master’s level. The SoP has also developed over time, leading to more advanced training and practice. Similar progression in professional titles, SoP, education and training routes also occurred in other European countries.

Purpose

To compare Allied Professions in Cardiac Science (APCS) including professional nomenclature, regulation, education, SoP, and pan-European identity.

Methods

Data were collected from November 2023 to January 2024. European and country databases were scrutinised to determine nomenclature, professional status, regulation, and educational requirements. Online translation was used when information was not available in English.

Results

The analysis of databases revealed 15 APCS roles (Table 1). In 60% of the countries, the role is officially recognised by a professional body that provides advocacy, education, training, and defines SoP (Figure 1). Moreover, 47% of countries operate a mandatory licensing or registration scheme. In 33% of countries, APCS roles are incorporated within the Biomedical Science profession. In the remaining countries, nine alternate titles are used to describe the discipline. In most cases (66%), education is at bachelor’s level, while in others, particularly where recognition is more limited, it is at a vocational level. In four countries (Austria, Ireland, Iceland, and The Netherlands), SoP is broadly in line with the UK, covering electrocardiography, echocardiography, haemodynamics for invasive procedures, implantable devices, and electrophysiology. Conversely, in other countries SoP varies and can include nuclear medicine (Sweden and Denmark) or perfusion and respiratory (Italy and Portugal). Some countries restrict SoP to defined roles such as pacemaker or echo technicians (Spain, Luxembourg, and Switzerland). Notably, Finland, France, and Norway, as well as most Eastern European countries do not recognise APCS roles.

Conclusion

While APCS roles are widely acknowledged in Europe, they lack visibility compared to other health professions. The variability in professional titles, education, and SoP constrain the development of a unified identity. Collaborative works connecting APCS roles across Europe may enhance identity, improve quality of care and raise the profile of this discipline.
Physical and mental components after cardiac rehabilitation intervention: a systematic review and meta-analysis
Authors: Delgado B R U N O , Boto P A U L O , Moreira J O S E
Published: July 2024

Background

Cardiovascular disease is a major public health problem associated with high mortality and morbidity, reduced exercise capacity, and Health-related quality of life (HRQol). Interventions in Cardiac Rehabilitation (CR) programmes have gained ground in optimising these indicators, using patient-reported outcome measures (PROMs) to assess the HRQol of patients participating in these programmes, allowing them to show their state of health and make more informed clinical decisions.

Purpose

To analyse, using PROMs, the effect of CR programmes on the HRQoL of patients after a cardiac event, depending on the time of assessment.

Methods

The search was carried out in the MEDLINE, CINAHL, CENTRAL and Web of Science databases after registering the protocol in PROSPERO. We included all randomized controlled trials (RCTs) that compared interventions in CR programmes with usual care after a cardiac event and that used PROMs to assess HRQoL over time. The risk of bias was assessed using the Cochrane tool (RoB2) and the quality of evidence using the GRADE system. A meta-analysis was carried out with studies that assessed HRQoL in patients with coronary pathology using the SF-12 PROM at 6 months after a CR programme.

Results

17 studies with 4,993 patients participating in CR programmes were included. The PROMs used in these studies to assess HRQoL were SF-12 (n=7), SF-36 (n=2), EQ5D (n=5), KCCQ (n=3), MacNewHRQL (n=3) and HeartQol (n=1). In the 3 RCTs of the meta-analysis, and after applying the SF-12 PROM at 6 months after a CR programme in patients with coronary pathology, the effect of participation was positive on HRQoL only in the physical component (MD 7.02; 95%CI [0.41,13.62]; p=0.04). The results of our meta-analysis indicate a moderate overall quality of evidence, using the GRADE approach, when assessing HRQoL at 6 and 12 month after intervention in a CR program.

Conclusions

This study develops knowledge on CR by showing the different PROMs applied after a programme, demonstrating a positive effect of CR on HRQoL after evaluation by the same PROM. The importance of time for assessing HRQoL was demonstrated by applying the SF-12 after the CR programme in patients with coronary pathology, with statistically significant results in the physical domain at 6 months. Given the importance of these results in improving HRQoL, it will be important for healthcare organisations to implement PROMs, investing more time and resources in a utilisation strategy.
Nurses' perceptions of virtual consultations and home-monitoring in patients with cardiac disease: a qualitative meta-synthesis
Authors: Rosenstroem S
Published: July 2024

Objective

This study aims to investigate the facilitators and barriers perceived by nurses in utilizing video-consultations supported by home-monitoring for patients with cardiac disease.

Methodology

A systematic search was conducted in PubMed, CINAHL, Scopus, and Web of Science for qualitative data published in English, Norwegian, Swedish, or Danish between 2013-2023. Ten studies were included in the qualitative synthesis using Braun and Clarke's methodology.

Findings

From the qualitative meta-synthesis, a main theme emerged: Nurses’ uncertainty toward telemedicine is a risk toward the use of video-consultations and home-monitoring The findings spans from nurses' positive encounters to their frustrations with the implementation process and the inadequate technical support for both clinicians and patients. Nurses frequently experienced frustration and uncertainty regarding the quality of care delivered through virtual consultations.

Conclusion

The successful implementation of video-consultations and home-monitoring necessitates a focus on the specific context in which they are applied, considering the perspectives of both patients and nurses. Additionally, active involvement of nurses, leveraging their clinical expertise, is crucial for the effective integration of these technologies.
Cultural Differences in Daily Coupling of Subjective Views of Aging and Negative Affect
Authors: Shenkman Geva , Shrira Amit , Kornadt Anna E , Neupert Shevaun D , Tse Dwight C K , Can Reyyan , Palgi Yuval
Published: July 2024

Objectives

The established link between subjective views of aging (VoA) and well-being shows variations across different cultures. Although VoA show daily fluctuations, little is known about cultural differences in such fluctuations and the daily coupling of VoA and well-being. We compared Israeli Arabs to Israeli Jews in the daily coupling of VoA and negative affect (NA).

Methods

Community-dwelling older adults (N = 76, Mage = 66.71) completed measures of subjective age, subjective accelerated aging, ageist attitudes, and NA over 14 consecutive days.

Results

Respondents reported higher daily NA when they felt older, reported to be aging faster, or had more ageist attitudes. The daily coupling between subjective age/subjective accelerated aging and NA was stronger among Israeli Arabs compared to Israeli Jews. There was no such interaction with ageist attitudes.

Discussion

It is important to adopt a cultural perspective when investigating daily fluctuations in VoA and their correlates. In applied contexts, this might help to identify cultural groups that are particularly sensitive to the effects of VoA.
Sequence-to-expression approach to identify etiological non-coding DNA variations in P53 and cMYC-driven diseases
Authors: Kin Katherine , Bhogale Shounak , Zhu Lisha , Thomas Derrick , Bertol Jessica , Zheng W Jim , Sinha Saurabh , Fakhouri Walid D
Published: July 2024

Disease risk prediction based on genomic sequence and transcriptional profile can improve disease screening and prevention. Despite identifying many disease-associated DNA variants, distinguishing deleterious non-coding DNA variations remains poor for most common diseases. In this study, we designed in vitro experiments to uncover the significance of occupancy and competitive binding between P53 and cMYC on common target genes. Analyzing publicly available ChIP-seq data for P53 and cMYC in embryonic stem cells showed that ~344–366 regions are co-occupied, and on average, two cis-overlapping motifs (CisOMs) per region were identified, suggesting that co-occupancy is evolutionarily conserved. Using U2OS and Raji cells untreated and treated with doxorubicin to increase P53 protein level while potentially reducing cMYC level, ChIP-seq analysis illustrated that around 16 to 922 genomic regions were co-occupied by P53 and cMYC, and substitutions of cMYC signals by P53 were detected post doxorubicin treatment. Around 187 expressed genes near co-occupied regions were altered at mRNA level according to RNA-seq data analysis. We utilized a computational motif-matching approach to illustrate that changes in predicted P53 binding affinity in CisOMs of co-occupied elements significantly correlate with alterations in reporter gene expression. We performed a similar analysis using SNPs mapped in CisOMs for P53 and cMYC from ChIP-seq data, and expression of target genes from GTEx portal. We found significant correlation between change in cMYC-motif binding affinity in CisOMs and altered expression. Our study brings us closer to developing a generally applicable approach to filter etiological non-coding variations associated with common diseases.
The potential and pitfalls of using a large language model such as ChatGPT, GPT-4, or LLaMA as a clinical assistant
Authors: Zhang Jingqing , Sun Kai , Jagadeesh Akshay , Falakaflaki Parastoo , Kayayan Elena , Tao Guanyu , Haghighat Ghahfarokhi Mahta , Gupta Deepa , Gupta Ashok , Gupta Vibhor , Guo Yike
Published: July 2024

Objectives

This study aims to evaluate the utility of large language models (LLMs) in healthcare, focusing on their applications in enhancing patient care through improved diagnostic, decision-making processes, and as ancillary tools for healthcare professionals.

Materials and Methods

We evaluated ChatGPT, GPT-4, and LLaMA in identifying patients with specific diseases using gold-labeled Electronic Health Records (EHRs) from the MIMIC-III database, covering three prevalent diseases—Chronic Obstructive Pulmonary Disease (COPD), Chronic Kidney Disease (CKD)—along with the rare condition, Primary Biliary Cirrhosis (PBC), and the hard-to-diagnose condition Cancer Cachexia.

Results

In patient identification, GPT-4 had near similar or better performance compared to the corresponding disease-specific Machine Learning models (F1-score ≥ 85%) on COPD, CKD, and PBC. GPT-4 excelled in the PBC use case, achieving a 4.23% higher F1-score compared to disease-specific “Traditional Machine Learning” models. ChatGPT and LLaMA3 demonstrated lower performance than GPT-4 across all diseases and almost all metrics. Few-shot prompts also help ChatGPT, GPT-4, and LLaMA3 achieve higher precision and specificity but lower sensitivity and Negative Predictive Value.

Discussion

The study highlights the potential and limitations of LLMs in healthcare. Issues with errors, explanatory limitations and ethical concerns like data privacy and model transparency suggest that these models would be supplementary tools in clinical settings. Future studies should improve training datasets and model designs for LLMs to gain better utility in healthcare.

Conclusion

The study shows that LLMs have the potential to assist clinicians for tasks such as patient identification but false positives and false negatives must be mitigated before LLMs are adequate for real-world clinical assistance.
Accounting for taste: preferences mediate the relationship between documentation time and ambulatory physician burnout
Authors: Apathy Nate C , Hartman-Hall Heather , Tran Alberta , Kim Dae Hyun , Ratwani Raj M , Marchalik Daniel
Published: July 2024

Objectives

Physician burnout in the US has reached crisis levels, with one source identified as extensive after-hours documentation work in the electronic health record (EHR). Evidence has illustrated that physician preferences for after-hours work vary, such that after-hours work may not be universally burdensome. Our objectives were to analyze variation in preferences for after-hours documentation and assess if preferences mediate the relationship between after-hours documentation time and burnout.

Materials and Methods

We combined EHR active use data capturing physicians’ hourly documentation work with survey data capturing documentation preferences and burnout. Our sample included 318 ambulatory physicians at MedStar Health. We conducted a mediation analysis to estimate if and how preferences mediated the relationship between after-hours documentation time and burnout. Our primary outcome was physician-reported burnout. We measured preferences for after-hours documentation work via a novel survey instrument (Burden Scenarios Assessment). We measured after-hours documentation time in the EHR as the total active time respondents spent documenting between 7 pm and 3 am.

Results

Physician preferences varied, with completing clinical documentation after clinic hours while at home the scenario rated most burdensome (52.8% of physicians), followed by dealing with prior authorization (49.5% of physicians). In mediation analyses, preferences partially mediated the relationship between after-hours documentation time and burnout.

Discussion

Physician preferences regarding EHR-based work play an important role in the relationship between after-hours documentation time and burnout.

Conclusion

Studies of EHR work and burnout should incorporate preferences, and operational leaders should assess preferences to better target interventions aimed at EHR-based contributors to burnout.
The incremental design of a machine learning framework for medical records processing
Authors: Streiffer Christopher , Saini Divya , Whitehead Gideon , Daniel Jency , Garzon-Mrad Carolina , Kavanaugh Laura , Anyanwu Emeka
Published: July 2024

Objectives

This work presents the development and evaluation of coordn8, a web-based application that streamlines fax processing in outpatient clinics using a “human-in-the-loop” machine learning framework. We demonstrate the effectiveness of the platform at reducing fax processing time and producing accurate machine learning inferences across the tasks of patient identification, document classification, spam classification, and duplicate document detection.

Methods

We deployed coordn8 in 11 outpatient clinics and conducted a time savings analysis by observing users and measuring fax processing event logs. We used statistical methods to evaluate the machine learning components across different datasets to show generalizability. We conducted a time series analysis to show variations in model performance as new clinics were onboarded and to demonstrate our approach to mitigating model drift.

Results

Our observation analysis showed a mean reduction in individual fax processing time by 147.5 s, while our event log analysis of over 7000 faxes reinforced this finding. Document classification produced an accuracy of 81.6%, patient identification produced an accuracy of 83.7%, spam classification produced an accuracy of 98.4%, and duplicate document detection produced a precision of 81.0%. Retraining document classification increased accuracy by 10.2%.

Discussion

coordn8 significantly decreased fax-processing time and produced accurate machine learning inferences. Our human-in-the-loop framework facilitated the collection of high-quality data necessary for model training. Expanding to new clinics correlated with performance decline, which was mitigated through model retraining.

Conclusion

Our framework for automating clinical tasks with machine learning offers a template for health systems looking to implement similar technologies.
Development and Validation of a GC–MS Method Based on Solid-Phase Extraction and Derivatization for Analysis of Free and Glucuronide-Conjugated Bisphenol F in Biological Samples
Authors: Cao Xu-Liang , Popovic Svetlana , Gill Santokh
Published: July 2024

Background

As one of the speculated bisphenols to replace bisphenol A (BPA), bisphenol F (BPF), naturally present in mustard, is structurally similar to BPA and may have similar estrogenic activity, but information on its toxicity is very limited compared to BPA.

Objective

In order to support the toxicology study of BPF at Heath Canada, a GC–MS method based on solid-phase extraction (SPE) and derivatization was developed for analysis of BPF in liver samples.

Methods

Samples were treated with β-glucuronidase to convert BPF glucuronide to free BPF for analysis of total BPF.

Results

The method was validated for free BPF at different spiking levels, and recoveries ranged from 90–97.5% with RSDs from 0.11–5.54%. The method was also validated for glucuronide-conjugated BPF at different spiking levels of BPF mono-β-D-glucuronide: recoveries ranged from 72.3–93.3% with RSDs from 1.7–8.94%. The method was used to analyze 60 liver tissue samples from rats dosed with BPF at different levels in a toxicology study. Free and glucuronide-conjugated BPF were not detected in any of the control samples, which were not dosed with BPF (average method detection limit: 0.31 ng/g) but detected in all the other liver tissue samples with levels increasing at higher doses. The percentage of glucuronide-conjugated BPF in total BPF varied among the liver samples, from as low as 9.8% to as high as 77.9%, indicating the importance of analyzing biological samples for BPF in both free and conjugated forms for total exposure.

Conclusion

A GC–MS method based on solid-phase extraction (SPE) and derivatization was developed for analysis of both free and glucuronide-conjugated BPF in liver samples. This method was validated not only for free BPF, but also for mono-β-D-glucuronide-conjugated BPF for the first time to confirm the efficiency of the deconjugation procedure with enzyme.

Highlights

This method can be adapted and applied for analysis of free and glucuronide-conjugated BPF in other biological samples with appropriate validation in target sample matrixes.
Penalization and Color Code Technical Approaches for Method Greenness and Whiteness Appraisal in Veterinary Medication: Assay of Toltrazuril Suspension
Authors: Kamal Miranda F , Youssef Rasha M , El-Sayed Nehal W , Morshedy Samir , Elbordiny Haydi S
Published: July 2024

Background

Intestinal coccidiosis is a debilitating disease in poultry and livestock, leading to economic impact worldwide. Coccidiosis is prevented and treated in broilers by the inclusion of anticoccidials in feed. Toltrazuril is administered in potable water to treat coccidiosis.

Objective

Three robust analytical methods for the quantitation of toltrazuril in pure and pharmaceutical formulations are developed. Furthermore, ecological metrics, either penalization- or color-code-based techniques, are applied for the appraisal of assays.

Methods

First, second-derivative (Δλ; 5 nm) spectrophotometric method is used. Toltrazuril is measured from peak to peak at 244–260 nm within a linearity range of 5–25 μg/mL. The second method is an HPTLC analysis performed on an aluminum sheet of silica gel using ethyl acetate–methanol–ammonium chloride buffer–water (8:1:0.5:0.5, by volume respectively) as the elution phase. Toltrazuril, at a retardation factor of 0.66 ± 0.01, is linearly determined in the range of 1–9 μg/spot at 243 nm. The third method is reversed-phase HPLC with diode array detection, using an Agilent C18 column (5 μm, 4.6 × 150 mm) in isocratic elution mode at 1 mL/min flow rate with a mobile phase of acetonitrile and water in a ratio of 80:20 (v/v). Toltrazuril elutes at a retention time of 2.58 ± 0.1 min and is linearly determined at 243 nm in the range of 0.25–25 μg/mL.

Results

Calculated 2D-values and peak areas are highly correlated to their corresponding drug concentrations at coefficients: r > 0.999. All methods were International Council of Harmonization (ICH) validated and applied to the dosage form with satisfactory % recoveries (97–103%). Statistical comparisons versus reported one using t-test and F-test disclose insignificant variation. In examining greenness and whiteness norms, the proposed methods were evaluated and ranked alongside four different reported methods.

Conclusions

The proposed methods are green, accurate, and can be applied in routine QC for the determination of toltrazuril in pharmaceutical formulations.

Highlights

Intestinal coccidiosis substantially affects the chicken intestinal tract leading to reduced growth. Toltrazuril is used for the treatment and prevention of intestinal coccidiosis. Three robust, accurate, and precise analytical methods are developed for toltrazuril determination in pure and pharmaceutical formulations. All proposed methods were ecologically assessed and compared with published ones.
One-carbon metabolite supplementation increases vitamin B12, folate, and methionine cycle metabolites in beef heifers and fetuses in an energy dependent manner at day 63 of gestation
Authors: Syring Jessica G , Crouse Matthew S , Entzie Yssi L , King Layla E , Hirchert Mara R , Ward Alison K , Reynolds Lawrence P , Borowicz Pawel P , Dahlen Carl R , Caton Joel S
Published: July 2024

One-carbon metabolites (OCM) are metabolites and cofactors which include folate, vitamin B12, methionine, and choline that support methylation reactions. The objectives of this study were to investigate the effects of moderate changes in maternal body weight gain in combination with OCM supplementation during the first 63 d of gestation in beef cattle on (1) B12 and folate concentrations in maternal serum (2) folate cycle intermediates in maternal and fetal liver, allantoic fluid (ALF), and amniotic fluid (AMF) and (3) metabolites involved in one-carbon metabolism and related metabolic pathways in maternal and fetal liver. Heifers were either intake restricted (RES) and fed to lose 0.23 kg/d, or fed to gain 0.60 kg/d (CON). Supplemented (+ OCM) heifers were given B12 and folate injections weekly and fed rumen-protected methionine and choline daily, while non-supplemented (-OCM) heifers were given weekly saline injections. These two treatments were combined in a 2 × 2 factorial arrangement resulting in 4 treatments: CON-OCM, CON + OCM, RES-OCM, and RES + OCM. Samples of maternal serum, maternal and fetal liver, ALF, and AMF were collected at slaughter on day 63 of gestation. Restricted maternal nutrition most notably increased (./ ≤ 0.05) the concentration of vitamin B12 in maternal serum, 5,10-methylenetetrahydrofolate and 5,10-methenyltetrahydrofolate in maternal liver, and cystathionine in the fetal liver; conversely, maternal restriction decreased (P = 0.05) 5,10-methylenetetrahydrofolate concentration in fetal liver. Supplementing OCM increased (P ≤ 0.05) the concentrations of maternal serum B12, folate, and folate intermediates, ALF and AMF 5-methyltetrahydrofolate concentration, and altered (P ≤ 0.02) other maternal liver intermediates including S-adenosylmethionine, dimethylglycine, cystathionine Glutathione reduced, glutathione oxidized, taurine, serine, sarcosine, and pyridoxine. These data demonstrate that OCM supplementation was effective at increasing maternal OCM status. Furthermore, these data are similar to previously published literature where restricted maternal nutrition also affected maternal OCM status. Altering OCM status in both the dam and fetus could impact fetal developmental outcomes and production efficiencies. Lastly, these data demonstrate that fetal metabolite abundance is highly regulated, although the changes required to maintain homeostasis may program altered metabolism postnatally.
Piscivory by the crabs Cancer productus Randall, 1840 and Pugettia producta (Randall, 1840) (Decapoda: Brachyura: Cancridae, Epialtidae)
Authors: Jensen Gregory C
Published: July 2024

Cancer productus Randall, 1840 and Pugettia producta (Randall, 1840) have been observed in the field feeding on live teleost fishes, an unexpected behavior for the molluscivorous C. productus and the largely herbivorous P. producta. Crabs were seen employing a speculative hunting technique of pouncing on tufts of algae or open areas of sediment followed by probing with the pereopods. Such behaviors suggest that food web relationships involving crabs may be much more complex than usually assumed.
A Bipartisan Approach to Political Prosecutions
Authors: Ayres Ian , Prakash Saikrishna Bangalore
Published: July 2024

The multiple prosecutions of a former President, and the threat of reprisals should he return to the Oval Office, places the Republic on an awful precipice. There is a pervasive perception that prosecutions have been, or soon will be, weaponized against opponents. To restore confidence, an innovative check is essential. We propose the creation of a Prosecutor Jury—a mechanism that balances the requirement that politicians be held accountable for their crimes, against the need to avert weaponized prosecutions that target enemies. Before prosecuting high-level politicians, the Department of Justice should randomly select ten former prosecutors nominated by Democratic Presidents and ten former prosecutors nominated by Republican Presidents. The Department should prosecute only if at least two-thirds of these former prosecutors agree that a prosecution is warranted. Further, the Department should apply this framework to decide whether to prosecute presidential candidates, members of Congress, candidates for Congress, and federal judges. To test our procedure and provide a simulacrum, we applied our framework, and conducted surveys of former US Attorneys to assess whether former President Donald Trump should have been indicted, yielding fascinating results. The results differed substantially across the indictments, with strong bipartisan support for the Florida prosecution. We believe that Prosecutor Juries have the potential to ensure that no high officer is above the law, nor laid low because of partisan machinations.