Assessment Score Research Articles

Volatilome: A Novel Tool for Risk Scoring in Ischemic Heart Disease.

Developing a novel risk score for accurate assessment of cardiovascular disease (CVD) morbidity and mortality is an urgent need in terms of early prevention and diagnosis and, thereafter, management, particularly of ischemic heart disease. The currently used scores for the evaluation of cardiovascular disease based on the classical risk factors suffer from severe limitations, including inaccurate predictive values. Therefore, we suggest adding a novel non-classical risk factor, including the level of specific exhaled volatile organic compounds that are associated with ischemic heart disease, to the SCORE2 and SCORE2-OP algorithms. Adding these nonclassical risk factors can be used together with the classical risk factors (gender, smoking, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes mellitus, arterial hypertension, ethnicity, etc.) to develop a new algorithm and further program to be used widely.

Effect of Upper Robot-Assisted Training on Upper Limb Motor, Daily Life Activities, and Muscular Tone in Patients With Stroke: A Systematic Review and Meta-Analysis.

Upper limb rehabilitation robot is a relatively new technology, but its effectiveness remains debatable due to the inconsistent results of clinical trials. This article intends to assess how upper limb rehabilitation robots help the functional recovery of stroke patients. PubMed, Embase, Cochrane Library, and Web of Science databases were searched for eligible studies to explore the effect of upper limb rehabilitation robots on upper limb motor function, muscle tone, and daily living activities. Eighteen trials with 573 stroke patients met the inclusion criteria. The results showed that compared to conventional rehabilitation training, patients who received upper limb robotic therapy (RT) had significantly improved Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE) scores (weighted mean differences [WMD]: 5.27, 95% confidence intervals [CI]: 3.36, 7.17), Action Research Arm Test (ARAT) scores (WMD: 4.07, 95% CI: -4.14, 12.28), Modified Barthel Index (MBI) scores (WMD: 9.55, 95% CI: 6.37, 12.73), and modified Ashworth Scale (MAS) scores (WMD: -0.28, 95% CI: -0.50, 0.06), with no significant heterogeneity. Upper limb robot-assisted training is superior to conventional training in terms of improving upper limb motor impairment, ability to perform daily living activities, and muscle tone recovery, which supports the application of robots in clinical practice.

Predicting mortality of elderly patients undergoing open heart surgery with delirium using sequential organ failure assessment (SOFA), multi-organ dysfunction (MODS), and logistic organ dysfunction system (LODS) scores

PurposeThis study aims to assess the predictive accuracy of SOFA, MODS, and LODS scores in determining the mortality of elderly undergoing open heart surgery with delirium. MethodsA prospective study involved 111 elderly patients who met the inclusion criteria. Data were collected using scoring systems: SOFA, MODS, and LODS. ResultsUpon final follow-up, 86.5 % of the patients had recovered, 13.5 % had died. Sensitivity, specificity, negative, and positive predictive values for predicting mortality in elderly patients were calculated for the SOFA score as 99 %, 73 %, 98 %, and 76 %, respectively. For the MODS score, these values were 95 %, 60 %, 95 %, and 67 %; for the LODS score, they were 92 %, 73 %, 92 %, and 75 %, respectively. The overall accuracy of the three scores—SOFA, MODS, and LODS—was 84 %, 76 %, and 82 %, respectively. ConclusionThe results indicated that the SOFA score exhibited the highest sensitivity and specificity in predicting mortality among elderly individuals

Development of teaching materials with agricultural insight to introduce of agriculture in primary school students

Agriculture is one of the supports for national food needs, so it must continue to be preserved. Unfortunately, nowadays, the sustainability of agriculture is increasingly worrying. Many young people are no longer interested in becoming farmers or working in the agricultural sector. A solution like this must be immediately sought so that regeneration is maintained. This research aimed to develop teaching materials with agricultural insight to introduce of agriculture in primary school students in Indonesia. The research used the research and development (RD) method. Development was carried out using the Borg and Gall model, including: research and informing collecting, planning, preliminary development, and preliminary field testing and main product revision. The research results indicated that: i) the teaching material that was successfully developed was in the form of a textbook entitled “I love agriculture”. This book contains ten materials on agricultural, and ii) the test results showed that the agriculturaloriented teaching materials are of good quality. From the product eligibility test involving material experts and media experts, the average assessment score was 86.25%, while the average assessment score from students reached 85.25%. This research implied that students could get to know and love agriculture through learning activities at school.

Предикторы госпитальной летальности при экстренном хирургическом лечении острейшего расслоения аорты типа А по Стенфорду в условиях искусственного кровообращения: ретроспективное когортное исследование

INTRODUCTION: Acute Stanford type A aortic dissection is one of the most severe cardiovascular diseases with high in-hospital mortality. OBJECTIVE: To establish predictors of in-hospital mortality in the treatment of patients with acute Stanford type A aortic dissection under conditions of artificial circulation and to determine their threshold values. MATERIALS AND METHODS: Study design: retrospective, cohort, single-center. Inclusion criteria: surgical intervention with cardiopulmonary bypass, confirmed diagnosis of acute Stanford type A aortic dissection, age > 18 years. The study included 51 patients: 42 men and 9 women aged from 35 to 77 years, median 59 years [47; 65]. All patients (n = 51) were treated in 2022 and were divided into 2 groups depending on the outcome: group 1 (n = 27) included those who died in the intensive care unit within 30 days, group 2 (n = 24) included survived and discharged patients. The endpoint of trial was 30-day in-hospital mortality. RESULTS: Postoperative Sequential Organ Failure Assessment (SOFA) score > 7, Acute Physiology And Chronic Health Evaluation (APACHE) II score > 19, and Vasoactive-inotropic score (VIS) > 10, cardiopulmonary bypass time > 177 minutes, and total hypothermic circulatory arrest time > 30 minutes were associated with an increased risk of 30-day in-hospital mortality. CONCLUSIONS: Statistically significant predictors of hospital mortality in the treatment of patients with acute Stanford type A aortic dissection under cardiopulmonary bypass are the SOFA index, the APACHE II index and the VIS index after the end of surgery, as well as the time of cardiopulmonary bypass and the time of total hypothermic circulatory arrest.

Clinical Course and Outcomes of Brain Tumor Patients Admitted to Medical Intensive Care Unit: A Descriptive Analysis

Background: There is a shortage of data on brain tumor patients admitted in to intensive care unit (ICU) from developing countries. We aimed to assess the clinical course and 30-day mortality with factors affecting the mortality of brain tumor patients who were admitted to medical ICU.Methods: This study was a single-centre retrospective observational cohort study and was conducted in a medical ICU of a tertiary care center in India. We included 42 patients admitted in to the medical oncology ICU over 3 years. Data regarding demographics, baseline characteristics, clinical and laboratory data, need for organ support, and 30-day mortality were collected. Factors associated with increased mortality in these patients were determined.Results: Overall 30-day mortality was 30.95%. The most common indication for ICU admission was altered sensorium (57.1%) followed by sepsis (23.8%). Age [odds ratio, OR: 0.843 (95% confidence interval, CI: 0.721–0.986)], and need for invasive mechanical ventilator (IMV) support [OR: 484.62 (95% CI: 2.707–8676.02)] or vasopressor support [OR: 523.83 (95% CI: 2.12– 3,023.13)] were directly associated with 30-day mortality. Severity indices such as Sequential Organ Failure Assessment (SOFA) score, SAPS II (Simplified Acute Physiology Score II), and Acute physiology and chronic health evaluation II (APACHE II), APACHE III and APACHE IV scores were higher in non-survivors than survivors.Conclusion: Advancing age and need for IMV or vasopressor support may be associated with worse prognosis in brain tumor patients admitted in to ICU. A scoring system could be used along with clinical judgement to triage brain tumor patients for ICU admission.

Association of Serum Blood Urea Nitrogen to Albumin Ratio with in-Hospital Mortality in Patients with Acute Ischemic Stroke: A Retrospective Cohort Study of the eICU Database

Albumin (ALB) and blood urea nitrogen (BUN) are both associated with the prognosis of acute ischemic stroke (AIS). A recent prognostic marker, the BUN/ALB ratio (BAR), has been suggested as a simple and sensitive method to predict certain acute diseases. To determine the predictive value of BAR in relation to the risk of in-hospital mortality among AIS patients. Retrospective cohort study. Cox regression analysis was employed to assess the relationship between in-hospital mortality and BAR, with hazard ratios (HRs) and 95% confidence intervals. Subgroup analysis of acute pulmonary embolism, acute myocardial infarction (AMI), thrombolysis, thrombectomy, and septic shock was performed to further examine this relationship. The predictive value of BAR and BAR multivariate models for in-hospital mortality was evaluated and compared to BUN, ALB, the Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score, and the Sequential Organ Failure Assessment Score (SOFA). Among the 1,635 eligible patients, 226 (13.81%) died during hospitalization. An elevated serum BAR level was associated with an increased in-hospital mortality risk (HR: 1.3) after covariates were adjusted. Additionally, this positive association was observed in patients without AP, AMI, thrombolysis, history of thrombectomy, or septic shock (all; p < 0.05). The efficacy of the BAR multivariate model in predicting in-hospital mortality among AIS patients was superior to that of both APACHE IV and SOFA, with an area under the curve of 0.87. Serum BAR exhibits the potential to identify AIS patients with high mortality risk, which may contribute to enhanced disease surveillance and risk stratification.

A novel digital health approach to improving global pediatric sepsis care in Bangladesh using wearable technology and machine learning.

Sepsis is the leading cause of child death globally with low- and middle-income countries (LMICs) bearing a disproportionate burden of pediatric sepsis deaths. Limited diagnostic and critical care capacity and health worker shortages contribute to delayed recognition of advanced sepsis (severe sepsis, septic shock, and/or multiple organ dysfunction) in LMICs. The aims of this study were to 1) assess the feasibility of a wearable device for physiologic monitoring of septic children in a LMIC setting and 2) develop machine learning models that utilize readily available wearable and clinical data to predict advanced sepsis in children. This was a prospective observational study of children with sepsis admitted to an intensive care unit in Dhaka, Bangladesh. A wireless, wearable device linked to a smartphone was used to collect continuous recordings of physiologic data for the duration of each patient's admission. The correlation between wearable device-collected vital signs (heart rate [HR], respiratory rate [RR], temperature [T]) and manually collected vital signs was assessed using Pearson's correlation coefficients and agreement was assessed using Bland-Altman plots. Clinical and laboratory data were used to calculate twice daily pediatric Sequential Organ Failure Assessment (pSOFA) scores. Ridge regression was used to develop three candidate models for advanced sepsis (pSOFA > 8) using combinations of clinical and wearable device data. In addition, the lead time between the models' detection of advanced sepsis and physicians' documentation was compared. 100 children were enrolled of whom 41% were female with a mean age of 15.4 (SD 29.6) months. In-hospital mortality rate was 24%. Patients were monitored for an average of 2.2 days, with > 99% data capture from the wearable device during this period. Pearson's r was 0.93 and 0.94 for HR and RR, respectively) with r = 0.72 for core T). Mean difference (limits of agreement) was 0.04 (-14.26, 14.34) for HR, 0.29 (-5.91, 6.48) for RR, and -0.0004 (-1.48, 1.47) for core T. Model B, which included two manually measured variables (mean arterial pressure and SpO2:FiO2) and wearable device data had excellent discrimination, with an area under the Receiver-Operating Curve (AUC) of 0.86. Model C, which consisted of only wearable device features, also performed well, with an AUC of 0.78. Model B was able to predict the development of advanced sepsis more than 2.5 hours earlier compared to clinical documentation. A wireless, wearable device was feasible for continuous, remote physiologic monitoring among children with sepsis in a LMIC setting. Additionally, machine-learning models using wearable device data could discriminate cases of advanced sepsis without any laboratory tests and minimal or no clinician inputs. Future research will develop this technology into a smartphone-based system which can serve as both a low-cost telemetry monitor and an early warning clinical alert system, providing the potential for high-quality critical care capacity for pediatric sepsis in resource-limited settings.

A prospective study on prognostic value of hypocholestrolemia in sepsis

Background: Sepsis is a major cause of mortality in adult, non-coronary intensive care units (ICUs) and holds significant clinical importance. Multicentre prospective surveys have shown that 1% of hospitalized patients experience bacteraemia, with 0.3% suffering from bacteraemia with severe sepsis. These rates increase eightfold and thirtyfold, respectively, when ICU admissions are considered. Approximately 10% of ICU patients have sepsis, 6% have severe sepsis, and 2-3% experience septic shock. Aim: This study aimed to assess the dynamic changes in serum cholesterol levels in sepsis patients and evaluate whether these cholesterol levels correlate with prognosis using the Sequential Organ Failure Assessment (SOFA) score. Materials and methods: A comprehensive analysis was conducted over 18 months on 115 patients with sepsis. SOFA scores and lipid profiles were collected at ICU admission (day 0) and day 3. Patients were categorized into two groups based on their total cholesterol: Group A (&lt;160 mg/dl) and Group B (&gt;160 mg/dl). Statistical analysis was performed to examine differences. Results: The study found that 56.5% of patients had cholesterol &lt;160 mg/dl (Group A) and 43.5% had &gt;160 mg/dl (Group B). Significant differences in cholesterol and SOFA scores between groups were observed on days 0 and 3 (p &lt; 0.001). Mortality was higher in Group B, indicating that hypocholesterolaemia is associated with increased mortality risk. Conclusion: This study suggests that monitoring cholesterol levels can serve as a prognostic tool in sepsis. An increasing cholesterol trend may indicate a better disease outcome.

Autologous platelet rich plasma injection can be effective in the management of osteoarthritis of the knee: impact on IL-1 β, TNF-α, hs-CRP

ObjectiveTo analyze the clinical efficacy of autologous platelet rich plasma (PRP) injection in the treatment of knee osteoarthritis (KOA) and its influence on related biomarkers such as interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP).Method150 study subjects are randomly selected from KOA patients received treatment in the Third Hospital of Bethune Hospital from January 2022 to January 2023. After enrollment, patients are randomly numbered 1–100. 75 patients with odd and even numbers are included in the control group and the observation group, respectively. The former is cured with etocoxib, while the latter is treated with autologous PRP injection based on this. The clinical efficacy, relevant biomarkers (IL-1β, TNF-α, hs-CRP), and Lysholm knee score scale and Fugl Meyer assessment (FMA) scores are compared and analyzed.ResultsThe total effective rate of 94.67% (71/75) in the observation group was higher than 84.00% (63/75) in the other one group (P < 0.05). Before treatment, the comparison in IL-1β, TNF-α, hs-CRP, Lysholm knee joint score, and FMA scale score are with P > 0.05. When the treatment period is at 1 and 2 months, the IL-1β, TNF-α, hs-CRP levels within the group were lower than before treatment, while the Lysholm knee joint score and FMA scale score were higher than before treatment (P < 0.05). When the treatment period is at 1 and 2 months, the IL-1β, TNF-α, hs-CRP levels and the Lysholm knee joint and FMA scale scores in the observation group were lower and higher than those in the other one group, respectively (P < 0.05).ConclusionThe application of autologous PRP injection therapy in KOA patients can significantly improve their levels of related biomarkers, effectively improve knee joint function and motor function, and have good clinical efficacy.

A Systematic Investigation of Assessment Scores, Self-Efficacy, and Clinical Practice: Are They Related?

ABSTRACT A considerable amount of continuing professional development (CPD) for health professionals is online and voluntary. There is evidence that some CPD activities impact clinical practice outcomes from self-reported and objective, administrative data. Some studies have shown that there is a potential mediating effect of knowledge/competency and/or self-efficacy between participation in CPD activities and the outcomes of that participation, specifically clinical practice. However, because clinical practice in those studies has been self-report, little is known about how this relationship impacts real world clinical practice. The purpose of the current study is to examine the relationship between knowledge/competency, self-efficacy, and real-world clinical practice so that we can begin to understand whether our focus on knowledge/competency and self-efficacy to change real-world clinical practice is empirically supported. We employed secondary data analysis from pre-participation questionnaire and medical and pharmacy claims data originally collected in three evaluations of online CPD interventions to examine if the relationship between knowledge/competency and self-efficacy contributed to physicians’ real-world clinical practice. Results show an association between knowledge/competency scores and ratings of self-efficacy and suggest unique contributions of knowledge/competency and self-efficacy to clinical practice. Study results support the value of knowledge/competency scores and self-efficacy ratings as predictors of clinical practice. The effect size was larger for self-efficacy suggesting it may be a more practical indicator of clinical practice for CPD evaluators because its process of question development is simpler than the process for knowledge and case-based decision-making questions. However, it is important to conduct thorough need assessments which may include knowledge/competency assessments to identify topics to cover in CPD activities that are more likely to increase self-efficacy and ultimately, clinical practice.

Management of 10 Children With Inflammatory Rosacea With Topical Ivermectin.

Rosacea diagnosis and treatment in children are challenging, due to its rarity and to the lack of approved pharmacological agents for its treatment in this age group. In this case series, response to treatment with once daily applications of ivermectin (IVM) 1% cream for 12 weeks in 10 children affected by mild to severe inflammatory rosacea was evaluated clinically by Investigator Erythema Severity Assessment (IESA), Investigator Global Assessment of Severity (IGA-S), Investigator Global Assessment score of Global Efficacy (IGA-GE), and instrumentally by dermoscopy and Erythema-Directed Digital Photography (EDDP). Clinical improvement was achieved at the end of treatment compared to baseline (IESA: 2.3 vs. 0.5; IGA-S: 2.1 vs. 0.3) and confirmed by IGA-GE (0 = 55%, 1 = 33%, 3 = 11%) and instrumental monitoring (EDDP: 2.7 vs. 0.6). Once daily IVM application may be an effective therapeutic option for children with rosacea.

A nomogram based on the value of the dynamic evolution of systemic immune inflammatory index in the evaluation of severe heatstroke.

Severe heatstroke patients have a poor prognosis. There are few descriptions of the inflammatory response to heatstroke in clinical studies. Systemic immune-inflammation index(SII) is a new index to reflect the inflammatory state of disease. This retrospective observational study included patients who had severe heatstroke between 2010 and 2023. Multivariate logistic regression and nomogram were performed to determine the ability of the SII to predict the prognosis of these patients, and subgroup analysis was performed according to SII levels. Of the 177 patients included in our study, 28 (15.8%) died. There was no difference in SII values between the first day (p = 0.810) and the second day (p = 0.184) in multivariate analysis. The SII value of the third day (SII 72) was elevated in patients with heatstroke who died compared to that in those who survived (p = 0.035). In multivariable logistic regression, Sequential Organ Failure Assessment (SOFA) score (OR = 1.717, 95%CI: 1.073-2.747, p = 0.024) and SII 72 (OR = 1.001, 95%CI: 1.000-1.002, p = 0.035) were found to be independent predictors of mortality. SII 72 combined with SOFA score distinguished between patients who died and those who survived better than did the separate SOFA score. Patients with SII 72 > 1000 had poor clinical prognosis. Compared to SII results from the first and second days, third-day results more meaningfully predict poor heatstroke prognosis. SII 72 may be a good indicator, and when combined with SOFA, offers enhanced predictive value.

Dupilumab is Efficacious in Young Children with Atopic Dermatitis Regardless of Type2 Comorbidities.

Patients with atopic dermatitis (AD) often have other comorbid type2 inflammatory conditions. The aim of this study was to evaluate the impact of type2 comorbidities on the response to and safety of dupilumab in young children with AD. LIBERTY AD PRESCHOOL partB was a randomized, placebo-controlled trial in children aged 6months to 5years with moderate-to-severe AD. In this posthoc analysis, patients were stratified by the presence or absence of caregiver-reported selected type2 comorbidities at baseline: asthma, allergic rhinitis (AR), and food allergies (FAs). At week16, significantly more patients receiving dupilumab versus placebo, with or without asthma and AR, achieved an Investigator's Global Assessment (IGA) score of 0/1 and a ≥ 75% improvement in Eczema Area and Severity Index (all p < 0.05). Significantly more patients receiving dupilumab versus placebo with FAs and numerically more patients without FAs achieved an IGA score of 0/1 (p = 0.0007 and p = 0.06). Numerically more patients receiving dupilumab versus placebo with asthma and significantly more patients without asthma achieved a ≥ 4-point reduction in the weekly average of daily score on the Worst Scratch/Itch Numeric Rating Scale (WSI-NRS) (p = 0.6 and p < 0.0001). Additionally, significantly more patients receiving dupilumab versus placebo with or without AR (p = 0.008 and p < 0.0001) and with or without FAs (p = 0.0002 and p = 0.004) achieved a ≥ 4-point reduction in the weekly average of daily score on the WSI-NRS. Overall safety was consistent with the known dupilumab safety profile. Dupilumab treatment improves AD signs and symptoms in children aged 6months to 5years with and without type2 comorbidities such as asthma, AR, and FAs. ClinicalTrials.gov registration number NCT03346434. Do type 2 comorbidities impact the response to dupilumab in children with atopic dermatitis? (MP4 103,451 KB).

The role of surgery in recurrent local cerebral metastases: a multi-institutional retrospective analysis.

Local recurrent brain metastases are defined as lesions that recur in the brain at the same site after a previous local therapy. In patients already submitted to surgery, a second operation may be potentially challenging due to scar formation, infiltration of cerebral vessels or eloquent brain areas and local effect of previous radiotherapy. The aim of this study is to retrospectively review the results and complications of a second surgical treatment in a series of local recurrent lesions and to review the literature on this topic. 37 patients submitted to surgery for a local, histologically confirmed, recurrent brain metastases between 2000 and 2022 were retrospectively analyzed with respect to the following parameters: age, histology, anatomic location, time to recurrence, previous radiotherapy, size of recurrent tumors, preoperative and postoperative Karnofsky Performance Status(KPS) score, recursive partitioning analysis (RPA) class and graded prognostic assessment (GPA) score, surgery-related complications and the presence of further cerebral metastases. Overall survival (OS) was calculated using the Kaplan-Meier method. A multivariate Cox proportional hazard model was developed using stepwise regression (forwards selection) with predictive variables that were significant in the univariate analyses. A significant improvement of post-operative KPS status was obtained after second surgery. At multivariate analysis better results in terms of OS were achieved in patients with a pre-operative KPS ≥ 70 and in patients who had received radiotherapy after the initial surgery. No significant postoperative complications related to previous treatments were observed. Surgical resection of local recurrent brain metastases may improve patients ́ neurologic conditions allowing more time for systemic therapies to act with a low incidence of surgery-related morbidity and mortality. However, careful patient selection with a fair pre-operative clinical status seems mandatory to achieve the best post-operative results, since uniform treatment-paradigms cannot be established yet, due to the highly heterogeneous patient cohort.

Peer editing and writing proficiency: an experimental study in South Korean higher education

ABSTRACT Peer editing enhances critical thinking, improves student writing, ultimately leading to a more productive learning environment (Kostopoulou and O’Dwyer 2021; Lundstrom and Baker 2009, “To give is better than to receive: The benefits of peer review to the reviewer’s own writing.” Journal of Second Language Writing 18:30–43; Storch 2018, “Written corrective feedback from sociocultural theoretical perspectives: A research agenda.” Language Teaching 51 (02): 262–277; Yao et al. 2021, “How university EFL writers’ beliefs in writing ability impact their perceptions of peer assessment: Perspectives from implicit theories of intelligence.” Assessment & Evaluation in Higher Education 46 (1): 151–167). However, reservations toward peer feedback in a university EFL setting persist due to the accuracy of L2 feedback (Braine, 2003; Erdel 2023, “Student feedback literacy (SFL) profiles in an L2 writing classroom and the influence of peer feedback on the SFL features.” International Journal of Education and Literacy Studies 11 (3): 112–125.). This study utilized a pretest-posttest writing assessment to analyze differences in writing outcomes in an academic research writing course at two universities in Seoul, South Korea. The researchers also examined the accuracy of the L2 peer-editing feedback. The sampling consisted of five randomized classes of university undergraduates. Two control groups received feedback via the instructor and two experimental groups received peer-editing feedback. A fifth mixed group was divided between the control and experimental groups but within the same context. The instructors used both in-class and online feedback tools for the control and experimental groups. The analysis used Sengupta’s (1998, “Peer evaluation: ‘I am not the teacher’.” ELT Journal 52 (1): 19–28) revision taxonomy to assess peer feedback accuracy. Participants completed separate pretest and posttest writing assessments. One at the start of the semester (pretest) and one at the end (posttest). The researchers used a MANOVA to compare the pretest and posttest mean average assessment scores between the control and experimental groups. The results show that peer feedback matches the effectiveness of professor feedback for pretest/posttest scores. Researchers also assessed 156 peer-editing assignments for feedback accuracy. Peer editors demonstrated statistically significant accuracy. This study recommends using peer feedback for its benefits to L2 learners and instructors.

Impact of the Prepectoral Breast Reconstruction Assessment Score on Expander-Based Reconstruction Success

Background/Objectives: The rising incidence of breast cancer has led to more mastectomies and increased demand for reconstruction. While retropectoral reconstruction with expanders is common, it has complications like postoperative pain and animation deformity. Prepectoral reconstruction, aided by advancements in biological and synthetic meshes, offers a promising alternative. Methods: This study prospectively evaluated the “Prepectoral Breast Reconstruction Assessment Score” on 20 patients undergoing mastectomy at Policlinico Umberto I, Rome, from July 2022 to February 2024. Patients with scores between 5 and 8 were included. The procedure involved the use of ADM (Acellular Dermal Matrix) or titanium-coated polypropylene mesh, followed by postoperative expansions and final implant placement after six months. Results: The mean age of patients was 51.85 years, with a mean BMI of 24.145 kg/m2. ADM was used in 15 cases and synthetic mesh in 5. Complications were one exposure of the expander, one superficial skin necrosis and one seroma. Statistical analysis showed a trend toward fewer complications with higher scores, though this was not statistically significant (p-value = 0.139). Conclusions: Prepectoral reconstruction with expanders is a viable option, offering benefits such as reduced operating time, better volume control, and a more natural breast contour compared to the retropectoral approach. Although the trend suggests fewer complications with higher assessment scores, further studies with larger samples are needed for confirmation.

Serum potassium levels and in-hospital mortality in distinct phenotypes of myocardial infarction patients by machine learning clustering

Abstract Background Abnormal serum potassium levels are associated with an increased risk of mortality in patients with myocardial infarction (MI); however, it is unclear whether the impact of potassium levels on mortality risk varies depending on the characteristics of MI patients. Purpose We aimed to classify MI patients according to their clinical characteristics and explore the relationship between potassium levels and in-hospital mortality in distinct clusters of MI. Methods Using Medical Information Mart for Intensive Care (MIMIC) IV database, we identified 3,159 patients who admitted for the first time to the intensive care unit with a primary diagnosis of acute MI. Machine learning clustering was performed on this population based on available clinical and laboratory data. Results Three distinct clusters of MI patients were identified using clustering analysis: 1,455 (46%) in cluster 1, 587 (19%) in cluster 2, and 1,117 (35%) in cluster 3. Patients in cluster 2 were older, had the highest comorbidity burden, Sequential Organ Failure Assessment (SOFA) score, peak lactate, creatinine, peak troponin, N-terminal B-type natriuretic peptide (NT-proBNP) levels and the lowest hemoglobin levels among the 3 clusters. Patients in cluster 3 were younger, had the lowest comorbidity burden, SOFA score, peak lactate, creatinine, NT-proBNP levels. Patients belonging to cluster 1 had clinical characteristics intermediate to those of cluster 2 and 3, except for the lowest troponin level. In-hospital mortality was highest in cluster 2, followed by cluster 1 and then cluster 3. Patients in cluster 2 had the highest in-hospital mortality risk with hypokalemia (OR 3.71, 95% 1.81­­-7.63) and patients in cluster 3 had highest in-hospital mortality risk with hyperkalemia (OR 2.77, 95% CI 0.84-9.06). Patients in cluster 1 did not exhibit a linearly increasing mortality with hyperkalemia. Conclusions The use of clustering analysis in patients with acute MI could characterize baseline clinical data into clinically distinct clusters with different in-hospital mortality across the dyskalemia continuum. The results suggest that the optimal range of potassium levels in patients with MI may vary depending on patient characteristics.Figure - clusteringTable - K and In-hospital mortality

Predicting High-Flow Nasal Cannula Oxygen Therapy Failure in Patients With Acute Hypoxaemic Respiratory Failure Using Machine Learning: Model Development and External Validation.

To develop and validate a prediction model for high-flow nasal cannula (HFNC) failure in patients with acute hypoxaemic respiratory failure (AHRF). AHRF accounts for a major proportion of intensive care unit (ICU) admissions and is associated with high mortality. HFNC is a non-invasive respiratory support technique that can improve patient oxygenation. However, HFNC failure, defined as the need for escalation to invasive mechanical ventilation, can lead to delayed intubation, prolonged mechanical ventilation and increased risk of mortality. Timely and accurate prediction of HFNC failure has important clinical implications. Machine learning (ML) can improve clinical prediction. Multicentre observational study. This study analysed 581 patients from an academic medical centre in Boston and 180 patients from Guangzhou, China treated with HFNC for AHRF. The Boston dataset was randomly divided into a training set (90%, n = 522) and an internal validation set (10%, n = 59), and the model was externally validated using the Guangzhou dataset (n = 180). A random forest (RF)-based feature selection method was used to identify predictive factors. Nine machine learning algorithms were selected to build the predictive model. The area under the receiver operating characteristic curve (AUC) and performance evaluation parameters were used to evaluate the models. The final model included 38 features selected using the RF method, with additional input from clinical specialists. Models based on ensemble learning outperformed other models (internal validation AUC: 0.83; external validation AUC: 0.75). Important predictors of HFNC failure include Glasgow Coma Scale scores and Sequential Organ Failure Assessment scores, albumin levels measured during HFNC treatment, ROX index at ICU admission and sepsis. This study developed an interpretable ML model that accurately predicts the risk of HFNC failure in patients with AHRF. Clinicians and nurses can use ML models for early risk assessment and decision support in AHRF patients receiving HFNC. TRIPOD checklist for prediction model studies was followed in this study. Patients were involved in the sample of the study.

A two-point strategy to clarify prognosis in &amp;gt;80 year olds experiencing out of hospital cardiac arrest

Abstract Background The global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group. Purpose To assess predictors of survival to discharge in ≥80 year old people experiencing OHCA. Methods The Victorian Ambulance Cardiac Arrest Registry was utilised to identify OHCAs in patients aged ≥80 years between 2002-2021. Predictors of survival to discharge were defined and a prognostic score derived from this cohort. Results 77,628 patients experienced OHCA of whom 25,269 (32.6%) were ≥80 years (80-90 years=18,956; 90-100 years=6,148; &amp;gt;100 years=209). The number of patients ≥80 years increased over time both absolutely (p=0.002) and proportionally (p=0.028). 619 (2.4%) patients survived to discharge without change over time. Older ages had no difference in witnessed OHCA status but were less likely to have shockable rhythm (OR 0.50 (95% CI 0.44-0.57) for 90-100-year-olds, OR 0.28 (95% CI 0.12-0.63) for 90-100-year-olds). If OHCA was witnessed and there was a shockable rhythm then survival was 14%; if one factor was present survival was 5-6% and if neither factor was present, survival was 0.09%. These survival rates enabled derivation of a simplified prognostic assessment score – the ‘15/5/0’ score - highly comparable to a previously-published American cohort. Conclusions Elderly OHCA rates have increased to one-third of caseload. The most important factors predicting survival were whether the OHCA was witnessed and there was a shockable rhythm. We present a simple two-point ‘15/5/0’ prognostic score defining which patients will gain most from advanced resuscitative measures.