Clinical Items Research Articles

Association of disease activity with depression and anxiety in systemic lupus erythematosus: A comparison of SLEDAI-2K and SLE-DAS.

To explore the association of disease activity, as evaluated by both the Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS) and the Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K), with depression and anxiety in patients with systemic lupus erythematosus (SLE). A cross-sectional study was conducted among 85 Chinese patients with SLE. Disease activity was measured using SLEDAI-2K and SLE-DAS scoring systems. Depression and anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7), respectively. Multivariate logistic regression analysis was performed to evaluate the association of disease activity scores, as well as specific clinical and laboratory items, with depression and anxiety. There was a robust correlation between SLEDAI-2K and SLE-DAS scores in overall patients (Spearman's r = 0.764, 95% confidence interval (CI) 0.655-0.842; p< 0.001) and those with moderate-to-high disease activity (Spearman's r = 0.792, 95%CI 0.616-0.892; p< 0.0001). However, the correlation weakened for patients with mild disease activity or remission (Spearman's r = 0.450, 95%CI 0.188-0.652; p= 0.001). Multivariate logistic regression analysis did not show a significant correlation between SLEDAI-2K and SLE-DAS scores and depression/anxiety. The presence of mucosal ulcer/serositis significantly increased the risk of depression (OR = 4.472, 95%CI 1.035-19.328, p= 0.045) and anxiety (OR = 3.978, 95%CI 1.051-15.049, p= 0.042). The SLE-DAS scoring system demonstrated a comparable ability to assess disease activity in SLE compared with SLEDAI-2K. Though neither scoring system showed significant associations with depression and anxiety, the presence of mucosal ulcer/serositis markedly heightened the risk of both among SLE patients.

Sex Differences in Prehospital Identification of Large Vessel Occlusion in Patients With Suspected Stroke.

Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 prehospital scales to detect aLVO. We analyzed pooled individual patient data from 2 prospective cohort studies (LPSS [Leiden Prehospital Stroke Study] and PRESTO [Prehospital Triage of Patients With Suspected Stroke Study]) conducted in the Netherlands between 2018 and 2019, including consecutive patients ≥18 years suspected of acute stroke who presented within 6 hours after symptom onset. Ambulance paramedics assessed clinical items from 8 prehospital aLVO detection scales: Los Angeles Motor Scale, Rapid Arterial Occlusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Cincinnati Prehospital Stroke Scale, Prehospital Acute Stroke Severity, gaze-face-arm-speech-time, Conveniently Grasped Field Assessment Stroke Triage, and Face-Arm-Speech-Time Plus Severe Arm or Leg Motor Deficit. We assessed the diagnostic performance of these scales for identifying aLVO at prespecified cut points for men and women. Of 2358 patients with suspected stroke (median age, 73 years; 47% women), 231 (10%) had aLVO (100/1114 [9%] women and 131/1244 [11%] men). The area under the curve of the scales ranged from 0.70 (95% CI, 0.65-0.75) to 0.77 (95% CI, 0.73-0.82) in women versus 0.69 (95% CI, 0.64-0.73) to 0.75 (95% CI, 0.71-0.79) in men. Positive predictive values ranged from 0.23 (95% CI, 0.20-0.27) to 0.29 (95% CI, 0.26-0.31) in women versus 0.29 (95% CI, 0.24-0.33) to 0.37 (95% CI, 0.32-0.43) in men. Negative predictive values were similar (0.95 [95% CI, 0.94-0.96] to 0.98 [95% CI, 0.97-0.98] in women versus 0.94 [95% CI, 0.93-0.95] to 0.96 [95% CI, 0.94-0.97] in men). Sensitivity of the scales was slightly higher in women than in men (0.53 [95% CI, 0.43-0.63] to 0.76 [95% CI, 0.68-0.84] versus 0.49 [95% CI, 0.40-0.57] to 0.63 [95% CI, 0.55-0.73]), whereas specificity was lower (0.79 [95% CI, 0.76-0.81] to 0.87 [95% CI, 0.84-0.89] versus 0.82 [95% CI, 0.79-0.84] to 0.90 [95% CI, 0.88-0.91]). Rapid arterial occlusion evaluation showed the highest positive predictive values in both sexes (0.29 in women and 0.37 in men), reflecting the different event rates. aLVO scales show similar diagnostic performance in both sexes. The rapid arterial occlusion evaluation scale may help optimize prehospital transport decision-making in men as well as in women with suspected stroke.

Development of clinical items to identify dysphagia in patients with dementia-An e-Delphi study.

To identify clinical observable items that can be used to identify dysphagia while observing a typical eating situation. A three-round e-Delphi survey. An expert panel consisting of five nurses, eight speech language therapists and five physicians participated in this three-round e-Delphi survey from November 2022 to January 2023. Round 1 presented the results of a literature research conducted in September 2022 and an open question to the participants. The answers were analysed using the content analysis method. In the following rounds, the results were presented back to the participants with a request to rate them for usefulness. Means, standard deviations, ANOVA and Fisher's exact test were used to demonstrate the panel's opinion, level of agreement, demographic characteristics of the participants as well as differences between the professional groups in regard of the rating of the items. Methods and results are reported in accordance with the 'Guidance on Conducting and Reporting Delphi Studies' (CREDES). The content analysis initially generated 36 items suggested by the expert panel. Seven additional items were incorporated from the literature review. In rounds 2 and 3, a 4-point Likert scale was used to rate each item and to calculate the level of agreement. The predetermined level of agreement exceeded 70% for 23 items. Based on the expert opinions, it is possible for nurses to identify dysphagia in patients with dementia by using the determined 23 items while observing a typical eating situation. The expert panel contributed to the creation of this study by participating in the Delphi rounds. The 23 items determined in this e-Delphi study enable nurses to make dietary adjustments or consult other members of the multidisciplinary team based on available evidence, enabling complications to be avoided. What problem did the study address? This study provides evidence regarding the identification of dysphagia in patients with dementia by nurses. What were the main findings? Twenty-three items were determined by an expert panel that can be used by nurses to identify dysphagia in patients with dementia while observing a typical eating situation. Where and on whom will the research have an impact? This research will have an impact on patients with dementia and the nurses caring for them. Methods and results are reported in accordance with the 'Guidance on Conducting and Reporting Delphi Studies' (CREDES) (Jünger etal., 2017), which promotes consistency and quality in conducting Delphi studies.

Factor analysis for construct validity of a trunk impairment scale in Parkinson's disease: a cross-sectional study.

To investigate the construct validity of the Trunk Impairment Scale (TIS), which was developed to assess trunk impairment in patients with stroke, in patients with Parkinson's disease (PD). This retrospective, cross-sectional study enrolled consecutive PD inpatients. Correlation analysis was performed to clarify whether the TIS assessment was related to other balance functions, lower extremity muscle strength, or walking ability. Factor analysis was performed to see how the background factors of TIS differ from balance function, lower limb muscle strength, and walking ability. Examining the data of 471 patients with PD, there were relationships between TIS and the Mini-Balance Evaluation Systems Test (r = 0.67), Barthel Index (r = 0.57), general lower limb extension torque (r = 0.51), two-minute walk test (r = 0.54), Hoehn and Yahr stage (r = -0.61), and Movement Disorder Society Unified Parkinson's Disease Rating Scale part III total points (r = -0.59). Factor analysis showed that TIS items were divided into three factors (an abdominal muscles and righting reflex component; a perception and verticality component; and a rotational component), differing from other scales that included clinical assessment items. The TIS can be useful for assessing the underlying trunk impairment as a basis for activities of daily living, gait function, and balance ability in patients with PD.

Developing veterinary basic clinical skill items based on Korean Veterinary Entrustable Professional Activity.

Developing clinical skills is an essential element of veterinary education to ensure the competency of veterinary graduates. Although the Korean Veterinary Education Graduation Competencies were established in 2016, reflecting domestic needs and international trends in competency-based veterinary education, they have yet to be implemented in Korean veterinary education. This study aimed to establish the basic veterinary clinical skills required to ensure graduates of Korean veterinary universities have the day-one competency to independently perform their professional duties. The Education Committee of the Korean Association of Veterinary Medical Colleges, composed of veterinary school professors and an experienced veterinarian in the clinic, reviewed domestic and international veterinary education-related materials to define basic clinical skills. The Korean Veterinarian Entrustable Professional Activities (KVEPA) was introduced, followed by the subsequent development of 54 essential clinical skills based on the KVEPA. The veterinary basic clinical skills established through this study can be used as a specific guide for clinical education in Korean veterinary school, and is expected to play an important role in meeting the needs of the educational sector of the veterinary education accreditation standards.

Radiography students' viewpoints of the clinical learning environment: A cross-sectional study

IntroductionThe quality of clinical learning environments (CLEs) impact learners' experience and competence development. Objective instruments have been developed to evaluate CLEs from the perspective of medical and nursing students. No such instruments have been used in Radiography. MethodsRadiography students' perspectives of CLEs were investigated using the validated Undergraduate Clinical Education Environment Measure (UCEEM). Undergraduate (UG) (n = 365) and graduate entry (GE) radiography students (n = 45) from an Irish university were invited to participate. CLEs consisted of 25 public and 10 private hospitals. The UCEEM contains 25 items under two overarching dimensions, experiential learning and social participation, with four subscales: opportunities to learn in and through work and quality of supervision; preparedness for student entry; workplace interaction patterns and student inclusion; and equal treatment. ResultsTwo hundred and fifteen students participated (response rate 52.4%; n = 185 UG, n = 30 GE), most of whom were based in public hospitals (87.4%). The mean UCEEM score was 107.5 ± 17.7 (optimal range: 90–125). Experiential learning and social participation were scored 74.2 ± 12.5 (optimal range: 60–85) and 33.37 ± 6.29 (optimal range: 30–40), respectively. Private hospitals ranked slightly higher than public hospitals for ‘opportunities to learn in and through work and quality of supervision’ (p = 0.018). Items ranked highest related to ‘equal treatment’ and ‘opportunity to put theory into practice’. Clinical supervision-related items were scored highest by first-year students. ConclusionHigh UCEEM scores indicate radiography students' positive perceptions of their CLEs, particularly regarding equality and experiential learning. Findings support the expansion of radiography placement to include public and private hospitals. Implications for practiceThe UCEEM is a theoretically robust, validated tool which appears suitable for evaluating radiography CLEs. This study provides valuable baseline data for comparison of Radiography CLEs.

Development and validation of a clinical prediction model for the diagnostic management of acute pulmonary embolism: an individual participant data meta-analysis

Abstract Background/Introduction Risk stratification is used for decisions about imaging in patients with clinically suspected acute pulmonary embolism (PE). Purpose To develop a clinical prediction model that provides an individualized, accurate probability estimate for acute pulmonary embolism (PE) based on readily available clinical items and D-dimer concentrations. Methods An individual participant data meta-analysis was performed based on sixteen studies with data from 28,305 adult patients with clinically suspected PE from various clinical settings. A multilevel logistic regression model was built and validated including ten a priori defined objective candidate predictors to predict PE at baseline or during follow-up of 30-90 days. Multiple imputation was used for missing data. Backward elimination was performed with a P-value &amp;lt; 0.10. Discrimination (c-statistic with 95% CI and prediction intervals [PI]) and calibration (outcome:expected [O:E] ratio and calibration plot) were evaluated based on internal-external cross-validation. The accuracy of the model was compared to algorithms based on the Wells score and D-dimer testing. Results The final model included age (in years), sex, previous VTE, recent surgery/immobilization, hemoptysis, cancer, clinical signs of DVT, inpatient status, D-dimer (in μg/L), and an interaction term between age and D-dimer. The pooled c-statistic was 0.87 (95%-CI, 0.85-0.89; 95%-PI, 0.77-0.93) and overall calibration was very good (pooled O:E ratio, 0.99; 95% CI, 0.87-1.14; 95% PI, 0.55-1.79). In the lower range of probabilities, the model slightly overestimated VTE probability. Discrimination of the current model in the validation data sets was better than that of the Wells score combined with a D-dimer threshold based on age (c- statistic 0.73; 95%-CI, 0.70-0.75) or structured clinical pretest probability (c-statistic 0.79; 95%-CI, 0.76- 0.81). Conclusion(s) The present model provides an absolute, individualized probability of PE presence in a broad population of patients with suspected PE, with very good discrimination and calibration. Its clinical utility needs to be evaluated in a prospective management or impact study.Calibration plot of the new model

A pilot study: handgrip as a predictor in the disease progression of SCA3

BackgroundSpinocerebellar ataxia type 3 (SCA3) is an inherited, autosomal, and rare neurodegenerative disease. Serum/plasma biomarkers or functional magnetic resonance imaging used to assess progression, except for neurological examinations, is either inconvenient or expensive. Handgrip strength (HGS) may be considered as a biomarker to predict the progress of SCA3 and align with the alteration of plasma neurofilament light chain (NfL) and Scale for the Assessment and Rating of Ataxia (SARA).MethodsPatients with SCA3 and healthy subjects were recruited from Changhua Christian Hospital. SARA, body mass index (BMI), and NfL were obtained for both groups. HGS was measured using a Jamar Plus + hand dynamometer.ResultsThis study recruited 31 patients and 36 controls. HGS in the SCA3 group revealed a profound decrease (P < 0.001) compared with normal subjects. HGS also had a negative correlation with SARA (r = − 0.548, P = 0.001), NfL (r = − 0.359, P = 0.048), and a positive correlation with BMI (r = 0.680, P < 0.001). Moreover, HGS/BMI ratio correlated with SARA (r = − 0.441, P = 0.013). Controlling for gender and age, HGS still correlated with the above clinical items. The initial hypothesis was also proved in SCA3 84Q transgenic mice, showing grip strength weakness compared to normal mice.ConclusionsHGS can be an alternative tool to assess the clinical severity of SCA3. Further research is needed to investigate the underlying mechanisms.

Closing the Loop: Toward Sustainable 3D Print Recycling in the Clinic

THREE-DIMENSIONAL (: 3D) printing is becoming ubiquitous in Radiation Therapy resulting in large amounts of plastic waste generated. We report on the feasibility, workflows, material properties and cost effectiveness of 3D print recycling to increase sustainability of 3D printing in clinics. Polylactic acid (PLA) prints were recycled using a consumer-grade recycling system consisting of i) plastic shredder to granulate used prints ii) heated extruder to melt material into filament iii) fan-cooled path for rapid cooling iv) spooling rig and v) pelletizer to cut filament into more regularized pellets as input material for step ii). The recovery percentage of material was characterized after each step by weighing inputs/outputs; timing and workloads were also recorded. Resulting recycled filaments were characterized in diameter and tensile strength and were compared between two different extruder nozzle configurations and with vs without pelletization to find an optimal recycling process. Recycled filament was finally used to create clinical items and evaluated. Lastly, a cost analysis over the past 1 year of recycling use was performed to determine the cost effectiveness of the recycling system. PLA prints were recycled with an overall efficiency of 79.3 ± 12.2% (standard deviation) between color batch runs. The best recycled filament quality was produced using the pelletization process and wider 3.25mm extruder nozzle. Relative to new filament, tensile strength testing showed recycled filament strength was 79% vs 70% (pelletized vs unpelletized) and 86% vs 60% (3.25mm vs 2.85mm nozzle). Extrusion and spooling procedures proved difficult to optimize, requiring lots of operator supervision (∼45 minutes per spool, mean 475g) and achieved a best filament diameter of 2.85 ± 0.09mm. A cost analysis shows that without accounting for operator time, it would require over 25 years to recoup the cost of the recycling system. Over the past 1-year, clinical 3D printing at our site consisted of 40 patient boluses and 25 electron cutouts, consuming about 6.5kg of PLA. Due to infection control concerns only 35% of this material was eligible for recycling, however 3.5 times that amount was collected from other printing activities. Recycling reduced new filament use by 56% ($470). Recycling workflows proved difficult to streamline and resulted in filament diameter that was marginally outside common industry standards and about 20% less strong but deemed adequate for clinical printing. Although the cost savings analysis indicates a poor return on investment, increasing the scale of the operation would be beneficial. To achieve this, we plan to recycle PLA boluses after disinfection and solicit other clinics in our hospital network and local 3D printing hobbyist community to recycle their prints.

Outcome's Classification in Mobile Applications Tailored to Parents of Premature Infants: A Systematic Review.

Integration of healthcare services for preterm neonates at home and hospital by mobile technology is an economical and convenient intervention, which is being increasingly applied worldwide. We aimed to classify the outcomes of mobile applications tailored to parents of premature infants. This systematic review was conducted by searching the six main databases until May 2021. Mobile applications tailored to parents of premature infants and the reported outcomes of this technology were identified and classified. Quality of screened articles checked by MMAT tool. Overall, 10703 articles were retrieved, and after eliminating the duplicated articles, 9 articles were reviewed ultimately. Identified outcomes were categorized into three groups parental, application, and neonatal outcomes. In the parental outcomes, maternal stress/stress coping, parenting self-efficacy, satisfaction, anxiety, partnership advocacy/improved parent-infant relationship, feeling of being safe, reassurance and confidence, increase awareness, as well as discharge preparedness, were identified. In the application outcomes, application usage, ease of use/user-friendly, and usability of the designed application were placed. Finally, the neonatal outcomes include health and clinical items. Mobile applications can be useful in prematurity for educating pregnant mothers, managing stress and anxiety, supporting families, and preparing for discharge. Moreover, due to the coronavirus condition, providing remote services for parents is an appropriate solution to reduce the in-person visits to neonatal care centers. Development of tailored apps can promote the neonates' health and reduce their parents' stress.

Family History of Developmental Dysplasia of the Hip is a Risk Factor for the Progression of Hip Osteoarthritis

BackgroundDevelopmental dysplasia of the hip (DDH) is considered to have genetic predisposition and presents many intrafamilial occurrences. However, there is no report that evaluates the effect of DDH family history on the progression after the onset of hip osteoarthritis (OA). MethodsMedical interviews about detailed clinical information including family history were conducted on 298 consecutive patients who had undergone surgery for OA due to DDH. Clinical or radiographic items that are associated with the severity of DDH (total hip arthroplasty [THA], involvement of bilateral DDH, onset age of hip pain, and three radiological indices of DDH: center-edge angle, sharp angle, and acetabular roof obliquity) were collected and evaluated in multivariate analyses for their associations with DDH family history in a qualitative or quantitative manner. Survival time analyses for THA as the endpoint was also performed to evaluate the effects of DDH family history on the progression of OA. ResultsThe DDH family history showed significant associations with bilateral involvement of DDH (odds ratio = 2.09 [95% confidence interval {CI} 1.05 to 4.16]; P = .037), early onset of hip pain (P = .0065), and radiological severity of DDH (P = .016). The DDH family history showed a significant association with undergoing THA (odds ratio = 2.25 [95% CI 1.09 to 4.66]; P = .029), further supported by the Cox regression analyses (hazards ratio = 1.56 [95% CI 1.15 to 2.11]; P = .0044). ConclusionA DDH family history is a risk factor for the progression of hip OA. Stronger genetic predisposition to DDH leads to faster onset and progression of hip OA.

Development of a clinical questionnaire to support contraception decisions in an adolescent reproductive health clinic in Colorado.

Adolescents need support to make informed decisions about contraception. Few clinical questionnaires exist to help adolescents and their healthcare providers align contraception decisions with patient needs and preferences. Our mixed-methods study involved a convenience sample of English-speaking, female patients aged 13-19 seeking contraception services at an adolescent reproductive health clinic in Colorado, USA. Qualitative interviews informed development of clinical questionnaire items. The questionnaire elicited demographic characteristics, pregnancy and contraception use history, preferred contraception attributes, peer and family involvement, healthcare information and support needs, motivations for contraceptive use, and barriers to contraceptive services. We identified key decision-making factors and reduced the number of questionnaire items through principal components analysis. Using multivariable analyses, we examined the correlation between questionnaire responses and current contraceptive method. Twenty individuals participated in interviews and 373 individuals completed the preliminary questionnaire with 63 candidate items. We identified five contraceptive decision-making factors: side-effect avoidance (eight items, Cronbach's alpha = 0.84), preferred method attributes (six items, Cronbach's alpha = 0.67), parental involvement (three items, Cronbach's alpha = 0.67), life goals prior to parenting (four items, Cronbach's alpha = 0.88), and access to a contraceptive provider (two items, Cronbach's alpha = 0.92) and nine stand-alone items. In multivariable analyses, we found that questionnaire responses for decision-making factors varied among participants using different contraceptive methods. Multiple priorities may influence adolescent contraceptive decisions. This clinical questionnaire can elicit these priorities before or during a healthcare encounter. Future studies should assess generalizability of the questionnaire and examine impact on method choice, continuation, satisfaction, and reproductive health outcomes.

Vital role of clinicians in reducing the NHS carbon footprint through smarter procurement decisions

BackgroundThe NHS’ impact on the environment is significant, accounting for 5.9% of the national carbon footprint of the UK and 20 million tonnes of carbon dioxide equivalent (Mt CO2e) emissions...

Diagnostic management of acute pulmonary embolism: a prediction model based on a patient data meta-analysis.

Risk stratification is used for decisions regarding need for imaging in patients with clinically suspected acute pulmonary embolism (PE). The aim was to develop a clinical prediction model that provides an individualized, accurate probability estimate for the presence of acute PE in patients with suspected disease based on readily available clinical items and D-dimer concentrations. An individual patient data meta-analysis was performed based on sixteen cross-sectional or prospective studies with data from 28 305 adult patients with clinically suspected PE from various clinical settings, including primary care, emergency care, hospitalized and nursing home patients. A multilevel logistic regression model was built and validated including ten a priori defined objective candidate predictors to predict objectively confirmed PE at baseline or venous thromboembolism (VTE) during follow-up of 30 to 90 days. Multiple imputation was used for missing data. Backward elimination was performed with a P-value <0.10. Discrimination (c-statistic with 95% confidence intervals [CI] and prediction intervals [PI]) and calibration (outcome:expected [O:E] ratio and calibration plot) were evaluated based on internal-external cross-validation. The accuracy of the model was subsequently compared with algorithms based on the Wells score and D-dimer testing. The final model included age (in years), sex, previous VTE, recent surgery or immobilization, haemoptysis, cancer, clinical signs of deep vein thrombosis, inpatient status, D-dimer (in µg/L), and an interaction term between age and D-dimer. The pooled c-statistic was 0.87 (95% CI, 0.85-0.89; 95% PI, 0.77-0.93) and overall calibration was very good (pooled O:E ratio, 0.99; 95% CI, 0.87-1.14; 95% PI, 0.55-1.79). The model slightly overestimated VTE probability in the lower range of estimated probabilities. Discrimination of the current model in the validation data sets was better than that of the Wells score combined with a D-dimer threshold based on age (c-statistic 0.73; 95% CI, 0.70-0.75) or structured clinical pretest probability (c-statistic 0.79; 95% CI, 0.76-0.81). The present model provides an absolute, individualized probability of PE presence in a broad population of patients with suspected PE, with very good discrimination and calibration. Its clinical utility needs to be evaluated in a prospective management or impact study. PROSPERO ID 89366.

Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes

BackgroundBecause of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future – Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class.MethodA cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure.ResultsFour classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge.DiscussionDifferent risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.

Predictors of microalbuminuria in workers of locomotive crews: prospective observational study

BACKGROUND: Cardiorenal relationships are one of the key problems in cardiology and nephrology. Microalbuminuria is a symptom of kidney pathologies and cardiovascular diseases. Studying the causes of microalbuminuria will help in solving the issue of pathological cardiorenal relationships.&#x0D; AIM: To study the causes of the origin of microalbuminuria on the group of locomotive crews employees of the Trans-Baikal Railway.&#x0D; MATERIALS AND METHODS: Predictors of microalbuminuria were established using data from a 6-year prospective follow-up of 22 clinical and anamnestic items in a natural cohort group of initially healthy 7,959 men (workers of locomotive crews) aged 1866 years. A confusion matrix, multivariate regression model, and relative risk assessment were used for this purpose.&#x0D; RESULTS: Microalbuminuria was found to be caused by excessive alcohol consumption, arterial hypertension, dyslipidemia, family history of early cardiovascular disease, grade III retinopathy, and smoking. The established predictors of microalbuminuria showed statistical heterogeneity in different analyses, referring to the significance of their assessment in the models used.&#x0D; CONCLUSION: The statistical heterogeneity of microalbuminuria predictors of is probably determined by and related to their qualitative characteristics and the unique implementation of their damaging effect in the formation and progression of microalbuminuria at the cellular level. The results of the study showed the need to continue the examination of predictors of microalbuminuria using other statistical analysis tools until their unique specific characteristics are known and the effects of damage on the formation of this pathological symptom are clarified.

Automated diagnostic classification with lateral cephalograms based on deep learning network model

Objective: To establish a comprehensive diagnostic classification model of lateral cephalograms based on artificial intelligence (AI) to provide reference for orthodontic diagnosis. Methods: A total of 2 894 lateral cephalograms were collected in Department of Orthodontics, Capital Medical University School of Stomatology from January 2015 to December 2021 to construct a data set, including 1 351 males and 1 543 females with a mean age of (26.4± 7.4) years. Firstly, 2 orthodontists (with 5 and 8 years of orthodontic experience, respectively) performed manual annotation and calculated measurement for primary classification, and then 2 senior orthodontists (with more than 20 years of orthodontic experience) verified the 8 diagnostic classifications including skeletal and dental indices. The data were randomly divided into training, validation, and test sets in the ratio of 7∶2∶1. The open source DenseNet121 was used to construct the model. The performance of the model was evaluated by classification accuracy, precision rate, sensitivity, specificity and area under the curve (AUC). Visualization of model regions of interest through class activation heatmaps. Results: The automatic classification model of lateral cephalograms was successfully established. It took 0.012 s on average to make 8 diagnoses on a lateral cephalogram. The accuracy of 5 classifications was 80%-90%, including sagittal and vertical skeletal facial pattern, mandibular growth, inclination of upper incisors, and protrusion of lower incisors. The acuracy rate of 3 classifications was 70%-80%, including maxillary growth, inclination of lower incisors and protrusion of upper incisors. The average AUC of each classification was ≥0.90. The class activation heat map of successfully classified lateral cephalograms showed that the AI model activation regions were distributed in the relevant structural regions. Conclusions: In this study, an automatic classification model for lateral cephalograms was established based on the DenseNet121 to achieve rapid classification of eight commonly used clinical diagnostic items.

Cost awareness amongst irish ophthalmologists

BackgroundHealthcare systems have increasingly limited and stretched budgets. Clinicians have a key role in budget allocation. Awareness of the costs of high-use clinical items is important.AimsAssess awareness of the cost of commonly utilised clinical items amongst Irish OphthalmologistsMethodsIrish ophthalmologists were contacted and asked to fill out an anonymous survey. We assessed knowledge of hospital costs of surgical materials, medications and anti VEGF drugs as well as retail pharmacy costs of commonly prescribed medications. The cost of items to the hospital was recorded from pharmacy and ward order receipts from a single university hospital. The costs of items to the patient were calculated by taking an average of 3 prices charged by local retail pharmacies. For each estimate we calculated the absolute error from the true price. We calculated the mean absolute errors (MAE) and percentage errors (MAPE) across the different groups.ResultsWe received responses from 47 participants (15 Senior House Officers, 11 Registrars, 21 Consultant/Community Ophthalmologists). Despite 70% of respondents agreeing that the cost of an item should have a major role in its use, the average estimate was 124% inaccurate. Less than 50% of responses were within 50% of the true cost of the item. Self-perceived knowledge was acknowledged to be limited or very limited in 73% of responses.ConclusionsWe demonstrate variable and limited levels of cost awareness. Seniority and better self-perceived knowledge were not found to be associated with better estimate accuracy.

A suggestive approach for assessing item quality, usability and validity of Automatic Item Generation

Automatic Item Generation (AIG) refers to the process of using cognitive models to generate test items using computer modules. It is a new but rapidly evolving research area where cognitive and psychometric theory are combined into digital framework. However, assessment of the item quality, usability and validity of AIG relative to traditional item development methods lacks clarification. This paper takes a top-down strong theory approach to evaluate AIG in medical education. Two studies were conducted: Study I—participants with different levels of clinical knowledge and item writing experience developed medical test items both manually and through AIG. Both item types were compared in terms of quality and usability (efficiency and learnability); Study II—Automatically generated items were included in a summative exam in the content area of surgery. A psychometric analysis based on Item Response Theory inspected the validity and quality of the AIG-items. Items generated by AIG presented quality, evidences of validity and were adequate for testing student’s knowledge. The time spent developing the contents for item generation (cognitive models) and the number of items generated did not vary considering the participants' item writing experience or clinical knowledge. AIG produces numerous high-quality items in a fast, economical and easy to learn process, even for inexperienced and without clinical training item writers. Medical schools may benefit from a substantial improvement in cost-efficiency in developing test items by using AIG. Item writing flaws can be significantly reduced thanks to the application of AIG's models, thus generating test items capable of accurately gauging students' knowledge.

Outcome Predictors in Pediatric Nonfatal Drowning: Results of a Family Caregiver Survey (S2.006)

<h3>Objective:</h3> Drowning is the second cause of unintentional injury-related death in children ages 1–4. Pediatric non-fatal drowning (PnFD) is prevalent; for every child dying by drowning, eight receive emergency care and survive. Despite the high prevalence of hypoxic-ischemic encephalopathy (HIE) in PnFD, data on clinical outcomes and outcome predictors are sparse. This study addressed this gap. <h3>Background:</h3> In prior work, we used quantitative MRI to delineate an HIE lesion topography consistent with selective deefferentation. A network-based behavioral scoring instrument (NBBS) was developed (5-level Likert-scale) and agreed with MRI predictions. <h3>Design/Methods:</h3> The NBBS supplemented with additional clinical and demographic items was administered as <i>The Non-Fatal Drowning Survey</i>. Surveys were distributed online using REDCap via social media support sites for parents of children with neurological injury from PnFD. Analysis was performed using Excel and RStudio. <h3>Results:</h3> 161 responses met inclusion/exclusion criteria. Unsupervised clustering identified three groups: Group 1 (mild; n=37), Group 2 (moderate; n=75) and, Group 3 (severe; n=40). Severity of impairment ranged from near-normal to persistent vegetative state. Across the outcome spectrum (Groups 1–3), motor impairment predominated (p &lt; 0.01). Locked-in syndrome was endorsed for 99 (61%) of survivors. The most reliable predictor of good outcome was alterness at discharge (Relative Risk = 0.11), irrespective of motor status. Admission status was not predictive. Pessimistic management recommendations – terminate care (acute) or institutionalize (chronic) – were common (n = 127) but were not predictive. Furthermore, less aggressive management was associated with poorer outcome. <h3>Conclusions:</h3> The majority (112/161) of PnFD survivors were not severely impaired, contradicting current beliefs. Alertness on discharge was a reliable predictor of good outcome. Pessimistic prognoses and care recommendations, although commonly given, were not reliable and should be avoided. Pattern of injury – motor deficits predominating over perceptual and cognitive – replicated our prior work, consistent with the frequent endorsement of Locked-in Syndrome. <b>Disclosure:</b> The institution of Ms. Razaqyar has received research support from National Institutes of Health. Dr. Osta has nothing to disclose. The institution of Mr. Towne has received research support from NIH T32GM113896. Ms. Ishaque has nothing to disclose. Dr. Chiang has received research support from NIH/NICHD . Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. The institution of Dr. Fox has received research support from NIH. Dr. Fox has received intellectual property interests from a discovery or technology relating to health care. Dr. Fox has received personal compensation in the range of $500,000-$999,999 for serving as a Reviewer with NIH.