Development Of Scoring System Research Articles

Impact of COVID-19 on antimicrobial stewardship activities in Italy: a region-wide assessment

BackgroundIn the region of Piedmont, in Northern Italy, formal monitoring of antimicrobial stewardship (AMS) programs has been in place since 2012. The objective of our study was to provide an updated assessment of AMS programs operating in our region, and to assess the impact of the COVID-19 pandemic on stewardship activities.MethodsA retrospective observational study was conducted to investigate AMS programs implemented in acute-care trusts participating in a broader healthcare-associated infections and antimicrobial resistance (AMR) prevention and control program, promoted by the regional health department. Within this program, structure, process, and outcome indicators of AMS programs were investigated, using a previously developed scoring system. Differences between scores prior to (2019) and during the pandemic (2021) were assessed. Linear regression was used to assess whether the 5-year trends (2017–2021) in outcome measures in relation to structure and process scores were statistically significant. Compound annual growth rates (CAGR) for each outcome were calculated to illustrate changes in outcome rates over time.ResultsAll public trusts in the Region (20) and a small number of private institutions (3) provided data for this study. A modest, non-significant improvement was found for 2021 structure, process, and total scores compared to respective 2019 scores. A significant improvement was found concerning the definition of a formal mission statement, whereas significantly less trusts included monitoring adherence to antimicrobial policy or treatment guidelines in their programs. Overall consumption of antibiotics for systemic use saw an increase in 2021, with 2021 recording the highest median overall consumption compared to all previous years considered in this study. Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) rates decreased over the 5-year period. Significant downwards trends in MRSA rates were identified for high-outlier structure and process groups.ConclusionsResults of this study suggest AMS programs in Piedmont were not set back following the pandemic. This outcome was possible thanks to well-established programs, coordinated within a regional framework. Continued efforts should be dedicated to supporting AMS programs and contrasting AMR, even when the focus is shifted towards other public health emergencies.

Ergonomic Assessment of Robotic versus Thoracoscopic Thymectomy.

Introduction: Robotic and thoracoscopic surgery are being increasingly adopted as minimally invasive alternatives to open sternotomy for complete thymectomy. The superior maneuverability range and three-dimensional magnified vision are potential ergonomical advantages of robotic surgery. To compare the ergonomic characteristics of robotic versus thoracoscopic thymectomy, a previously developed scoring system based on impartial findings was employed. The relationship between ergonomic scores and perioperative endpoints was also analyzed. Methods: Perioperative data of patients undergoing robotic or thoracoscopic complete thymectomy between January 2014 and December 2022 at three institutions were retrospectively retrieved. Surgical procedures were divided into four standardized surgical steps: lower-horns, upper-horns, thymic veins and peri-thymic fat dissection. Three ergonomic domains including maneuverability, exposure and instrumentation were scored as excellent(score-3), satisfactory(score-2) and unsatisfactory(score-1) by three independent reviewers. Propensity score matching (2:1) was performed, including anterior mediastinal tumors only. The primary endpoint was the total maneuverability score. Secondary endpoints included the other ergonomic domain scores, intraoperative adverse events, conversion to sternotomy, operative time, post-operative complications and residual disease. Results: A total of 68 robotic and 34 thoracoscopic thymectomies were included after propensity score matching. The robotic group had a higher total maneuverability score (p = 0.039), particularly in the peri-thymic fat dissection (p = 0.003) and peri-thymic fat exposure score (p = 0.027). Moreover, the robotic group had lower intraoperative adverse events (p = 0.02). No differences were found in residual disease. Conclusions: Robotic thymectomy has shown better ergonomic maneuverability compared to thoracoscopy, leading to fewer intraoperative adverse events and comparable early oncological results.

Soetomo COVID-19 Prognostic Score: A Multi-Parametric Model for Early Prediction of Disease Severity of COVID-19 in Tertiery -Resource Hospital

Objective: Coronavirus disease 2019 (COVID-19) became a global pandemic, with high mortality in severely ill patients. This study aimed to develop a novel scoring system to prognosticate disease severity in COVID-19 patients that is effective and widely available in tertiary medical resource settings.Material and Methods: Laboratory-confirmed COVID-19 patients were enrolled in this retrospective cohort, divided into severe and non-severe groups. We randomly assigned 70% of the subjects to establish a novel scoring system, while the remaining 30% was used for internal validation. The model was constructed by multivariate logistic regression using the first clinical, laboratory, and radiological finding of statistically analysis of group patients. receiver operating characteristic (ROC) and cross-tabulation were used to evaluate the performance of our score and compare it with other models.Results: A total of 599 patients were included. The Soetomo COVID-19 prognostic score predictors included age, fever, specific comorbidities (diabetes, hypertension, cardiac disease, lung tuberculosis), respiratory rate, heart rate, SF ratio, whole blood cell (WBC) count, neutrophil lympocyte ratio (NLR), blood urea nitrogen (BUN), and a RALE score. The area under the ROC of the model indicated an excellent discriminatory ability (training datasets 0.715 [95% CI 0.664-0.767, p-value<0.001]; testing datasets 0.720 [95% CI 0.638-0.802, p-value<0.001]). Our scoring system was superior to both qSOFA and MEWS regarding predictive value. The sensitivity and specificity were 60.6% and 82.5%, respectively.Conclusion: The developed scoring system accurately predicted a significant proportion of severe disease in COVID-19 patients.

Evaluation of a scoring system to predict treatment success with single-dose methotrexate in ectopic pregnancy.

This study sought to assess the efficacy of a newly developed scoring system in predicting treatment outcomes for ectopic pregnancy among patients undergoing single-dose methotrexate therapy. The primary research question centered on the reliability and predictive accuracy of objective parameters in determining methotrexate therapy success. Conducted as a retrospective single-center cohort study, data from 172 ectopic pregnancy patients treated with methotrexate between January 2021 and January 2023 were analyzed. Parameters including adnexal mass size, peritoneal fluid presence, yolk sac identification, endometrial thickness, ectopic pregnancy location, and initial B-hCG levels were meticulously evaluated for their association with treatment outcomes. Following the exclusion of 21 emergency surgery cases, the final analysis comprised 151 patients. Notable associations were observed between specific parameters (fetal cardiac activity, adnexal mass size > 3.5cm, peritoneal fluid presence, yolk sac identification, endometrial thickness > 10mm, and initial B-hCG levels) and treatment outcomes (p < 0.001). Additionally, the novel scoring system demonstrated promising predictive performance. At a cutoff of 2.50, it achieved a sensitivity of 91.7% and a specificity of 59.7%. Increasing the cutoff to 3.50 resulted in a sensitivity of 94.0%, with a specificity of 46.3%. Objective parameters, particularly those integrated into the developed scoring system, exhibited substantial associations with methotrexate therapy outcomes in ectopic pregnancy. These findings underscore the potential of an objective scoring model to significantly influence clinical decision-making in therapy, offering avenues for enhanced prognostication and patient care in treatment outcomes.

Complicated anorectal sepsis: Validation of scoring system for predicting anorectal sepsis severity.

Anorectal sepsis is a common and potentially serious medical condition characterized by infection and inflammation of the anal canal and surrounding tissues. However, the lack of standardized and comprehensive scoring systems specifically tailored for predicting the severity of anorectal sepsis poses challenges in clinical practice. This study aimed to develop and validate a scoring system for predicting the severity of anorectal sepsis by incorporating relevant patient factors. A retrospective cohort study was conducted at Mansoura University Hospital, a tertiary care center, over a period of 5 years. The study population consisted of 330 patients diagnosed with anorectal sepsis during the study period. A scoring system was developed using multiple variables, with each variable assigned a specific score based on its clinical significance and weight in predicting disease severity. The developed scoring system's predictive performance was evaluated using receiver operating characteristic (ROC) analysis, calculating the area under the ROC curve to assess discriminative ability. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study population. Chi-square tests or t tests were performed to assess differences between non-severe and severe anal sepsis groups. The scoring system consisted of 12 variables, with a maximum total score of 18. The logistic regression analysis revealed significant associations between localized swelling, presentation within 72 hours, multiple drainage sessions, and severe anorectal sepsis. The ROC analysis showed an area under the curve of 0.85, indicating good discriminative ability of the scoring system. The scoring system was developed and validated in a single center, which may limit its generalizability to other settings. The scoring system demonstrated good predictive performance and can be a valuable tool for clinicians in assessing disease severity, guiding treatment decisions, and identifying high-risk patients.

МЕТОДИКА БАЛЛЬНО-ФАКТОРНОЙ ОЦЕНКИ ЧАСТОТЫ ИНИЦИИРУЮЩИХ ПОЖАРООПАСНЫЕ СИТУАЦИИ СОБЫТИЙ ДЛЯ ПОДЗЕМНЫХ ЕМКОСТЕЙ АВТОМОБИЛЬНОЙ ГАЗОЗАПРАВОЧНОЙ СТАНЦИИ

The purpose of the article is to develop a system for scoring the contributions of various technical and organizational measures to the magnitude of the risk of an accident based on existing approaches to the fire risk assessment at hazardous production facilities. To achieve the goal of the study and the formation of a score in cooperation with the organization operating the storage tanks of substances under pressure, a number of influencing factors were obtained. The following methods were applied in the work: analysis of hierarchies, comparison, analogy, study of documents and results of activities. The result of the work is the developed scoring system with groups of factors influencing the probability of an emergency and the resulting weight coefficients of the groups and the factors themselves. A method for point-factor estimation of the frequency of events initiating fire hazardous situations for underground liquefied petroleum gas tanks operated at gas filling stations is proposed. The results obtained can be used in assessing the fire risk for facilities where accidents can occur associated with the formation of an explosive and fire hazardous situation.

Predictive score for identifying intrahepatic cholangiocarcinoma patients without lymph node metastasis: a basis for omitting lymph node dissection

BackgroundThis study aimed to develop a predictive score for intrahepatic cholangiocarcinoma (ICC) in patients without lymph node metastasis (LNM) using preoperative factors. MethodsA retrospective analysis of 113 ICC patients who underwent liver resection with systemic lymph node dissection between 2002 and 2021 was conducted. A multivariate logistic regression analysis was used as a predictive scoring system for node-negative patients based on the β coefficients of preoperatively available factors. ResultsLNM was observed in 36 patients (31.9%). Four factors were associated with LNM: suspicion of LNM on MDCT (odds ratio [OR] 13.40, p < 0.001), low-vascularity tumor (OR 6.28, p = 0.005), CA19-9 ≥500 U/mL (OR 5.90, p = 0.010), and tumor location in the left lobe (OR 3.67, p = 0.057). The predictive scoring system was created using these factors (assigning 3 points for suspected LNM on MDCT, 2 points for CA19-9 ≥500 U/mL, 2 points for low vascularity tumor, and 1 point for tumor location in the left lobe). A score cutoff value of 4 resulted in 0.861 sensitivity and a negative predictive value of 0.922 for detecting LNM. Notably, no patients with peripheral tumors and a score of ≤3 had LNM. ConclusionThe developed scoring system may effectively help identify ICC patients without LNM.

Diagnostic evaluation of viral versus bacterial tonsillopharyngitis using an artificial intelligence mobile application and symptom questionnaire

Objective: In this study, it was aimed to distinguish bacterial/viral tonsillopharyngitis (TP) by scoring the symptom and throat images of pediatric patients with artificial intelligence-based mobile application. &#x0D; &#x0D; Method: Fifty-one patients who applied to Sakarya University Training and Research Hospital, Department of Pediatrics and Diseases with acute tonsillopharyngitis were included. Samples were taken from patients and mouth/throat pictures were taken so that the tonsils and pharynx were clearly visible. In the microbiology laboratory, identification with culture/MALDI-TOF MS (Biomerieux, France) from the first samples, and nucleic acid isolation from the other for molecular tests were performed. Symptoms such as fatigue, sore throat, muscle pain, cough, sneezing, and runny nose were questioned from each patient on a scale of 1 to 5. By uploading the symptom results and throat pictures to the artificial intelligence application, it was aimed to distinguish bacterial/viral tonsillopharyngitis with the developed scoring system. &#x0D; &#x0D; Results: Of the 51 samples included in the study, 21 were culture positive and 30 were negative. The artificial intelligence application was defined as 20 out of 21 culture-positive samples, 3 out of 30 culture-negative samples as bacterial tonsillopharyngitis (Sensitivity: 95.2%, specificity: 90%). &#x0D; &#x0D; Conclusion: This study is one of the first to bring together the artificial intelligence application and microbiology. AI/scoring system may have a role to play in the diagnosis of bacterial vs viral TP, and in doing so may enable more appropriate antibiotic usage targeted to only bacterial TP infections. It is important to distinguish between bacterial and viral tonsillopharyngitis in the COVID-19 pandemic.

Probability Assessment of Pulmonary Embolism (PE) Using Laboratory Values in Hospitalized Patients: A Single Center, Retrospective Observational Study and a Review of the Literature

Introduction: Venous thromboembolism, including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and potentially life-threatening condition in hospitals. Currently, the assessment of PE probability relies on subjective scoring systems, such as Well's and Geneva's scores, which have limitations in certain patient populations (demented, sedated, or intubated patients). This study aims to investigate the use of laboratory values for PE probability assessment, which has not been explored before. Methods: This retrospective observational study included 855 patients meeting the inclusion criteria for suspected PE (age 18 or older and the presence of signs and symptoms of suspected PE such as shortness of breath, chest pain, hemoptysis, tachypnea, tachycardia, and signs of DVT). Sixteen variables were examined, including laboratory values and clinical factors (Table 1). Logistic regression analysis, adjusting for confounding factors, was performed, and significant variables were used to develop a scoring method. Continuous variables that showed statistical significance were transformed into categorical variables using their respective maximum Youden index as the cut-off score. The receiver operating characteristic (ROC) curve was used to detect PE using the developed scoring system and determine the optimal cut-off value. A p-value of less than 0.05 was considered statistically significant. Results: The logistic regression model, incorporating several variables, achieved an 84.6% accuracy in predicting PE after accounting for confounding factors. Among the variables, hypocapnia, fever, alkaline phosphatase (ALP), D-dimer, and lactate had significant predictive values for PE (Table 1). ALP, D-dimer, and lactate were continuous variables with respective maximum Youden indices of 83.89, 952.50, and 1.614. Hypocapnia, ALP, and lactate showed negative slopes (B values), while fever and D-dimer had positive slopes in the logistic regression model. A scoring method was developed based on these variables. Fever, with an adjusted odds ratio (OR) of 1.995, received a score of 2 for values above the cut-off, while other variables with adjusted OR values at or below 1 were assigned a score of 1 above the cut-off. The mean ± SD score among all study participants was 1.84 ± 1.10, with a median (IQR) 2.0 (1.0 - 2.0). Patients without PE had a mean ± SD score of 1.80 ± 1.13, with a median (IQR) of 2 (1 - 2), while patients with PE had a mean ± SD score of 2.07 ± 0.91, with a median (IQR) of 2 (1 - 3). Patients with PE exhibited significantly higher mean ± SD scores than those without PE (P = 0.001; t = -5.813) (Table 2). The area under the ROC curve was 0.585 (95% CI: 0.563 - 0.606), indicating a statistically significant ability to detect PE (p-value = 0.001). Using a cut-off score of 1.5 based on the maximum Youden index, the scoring system achieved a sensitivity of 73.1% and specificity of 43.4% in detecting PE among the study participants. The Well's score, calculated for the study participants, demonstrated a sensitivity of 51.13% and specificity of 75.10% in detecting PE. Conclusion: This study presents a novel approach using laboratory values for PE probability assessment. The developed scoring method showed promising results, providing an alternative to the current accepted scoring systems. Further research and validation are needed to confirm the utility of laboratory-based assessment in clinical practice.

A new scoring system for predicting cut-out risk in patients with intertrochanteric femur fractures treated with proximal femoral nail anti-rotation.

The objectives of this study were to: (1) determine all the potential risk factors defined in the literature for cut-out after proximal femoral nail anti-rotation in managing intertrochanteric fractures and (2) make a reliable prediction about the likelihood of cut-out by developing a quantitative scoring system. Four hundred eighty patients who were operated on for an intertrochanteric femur fracture were included in the study. The patients were evaluated retrospectively. Radiological parameters known to affect cut-out, including tip apex distance (TAD), calcarreferenced TAD (CalTAD), and reduction quality, were also used to evaluate the patients. Additionally, the classification of the fracture according to the cortical thickness index for osteoporosis, the Charlson comorbidity index for additional comorbidities, and the Arbeitsgemeinschaft Für Osteosynthesefragen classification were evaluated. The cut-out rate among all patients was 7.2%. Cut-out risk could be predicted by gender, TAD, CalTAD, and reduction quality. Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality significantly increased the cut-out risk. Based on the chi-square analysis, it was determined that there was a significant relationship between the cut-out risk and the variables of TAD, CalTAD, reduction quality, gender, and fracture type (P=.000, P=.000, P=.000, P=.008, P=.016, respectively). Logistic regression analysis showed a strong correlation between the newly developed scoring system and the risk of cut-out. The risk of cut-out increased 8.1 times in individuals with a score of more than 2 (P < .001). Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality are the parameters found to be significant in determining the cut-out risk. With the newly developed scoring system, risks can be calculated for all situations that may occur according to the scores obtained by the patients. The cut-out risk increases significantly in patients with a score above 2 points. Level III, Diagnostic Study.

Association of Single Nucleotide Polymorphisms in Transforming Growth Factor-β1 Pathway and Risk of Radiation Pneumonitis in Lung Cancer Patients Treated with Thoracic Radiation Therapy

Several clinical and dosimetric parameters are known to be associated with radiation-induced lung toxicity, including radiation pneumonitis (RP). Also, single nucleotide polymorphisms (SNPs) of genes in TGF-β1 pathway have a notable association with the RP. However, studies on the predictive value of SNPs for RP are still limited. Herein, we tried to develop a novel integrated predictive model for severe RP in lung cancer patients. A total of 59 patients who were treated with definitive or preoperative radiotherapy for primary lung cancer and had DNA samples were included. Potentially functional and tagging SNPs of TGF-β1 (rs1800469, rs1800471, rs1982073, and rs11466345), BMP2 (rs235768, rs3178250, rs1979855, and rs170986), and BMP4 (rs17563, rs4898820, and rs762642) were genotyped. Logistic regression was performed to build severe (grade ≥2) RP prediction models, and best subset selection algorithm with L0 and L2 regulations was used for variable selection. Only clinical/dosimetric variables were evaluated in model 1, and those variables as well as SNPs were included in model 2. Using beta coefficient obtained by the logistic regression, a scoring system was also developed. With median follow-up of 39.7 months, severe RP occurred in 20.3% of patients. In model 1, age (>66) and PTV volume (≥300 cc) were significant factors (p = 0.016, OR 8.820 [95% CI, 1.730-63.800]; and p = 0.024, OR 7.440 [95% CI, 1.460-52.100], respectively). In model 2, the above two factors (p = 0.010, OR 16.200 [95% CI, 2.440-187.000] and p = 0.025, OR 10.100 [95% CI, 1.610-105.000]) and the AG/GG genotype in BMP2 rs1979855 were significant factors (p = 0.031, OR 7.260 [95% CI, 1.380-59.100]). The AUC was significantly higher in model 2 than in model 1 (0.822 vs. 0.741, p = 0.029). According to developed scoring system, patients with a score >2.8 are more likely to experience severe RP (AUC 0.829). BMP2 rs1979855 could serve as a reliable biomarker for predicting RP while significantly improving predictive power compared to when only clinical factors were used.

DEPRIVATION, COMPLEXITY, AND MORTALITY IN KNEE ARTHROPLASTY

AbstractIntroductionKnee replacement surgery can greatly improve pain, disability, quality of life and ability to work. Socioeconomic deprivation is associated with multiple poor health outcomes, partly due to reduced access to services, including surgery. We investigated whether deprivation was associated with characteristics at presentation, and outcomes following knee arthroplasty.MethodologyWe linked data from 2358 knee arthroplasty cases with the Index of Multiple Deprivation, and mortality data after mean 7.6 years follow up. A locally developed scoring system was used prospectively to categorise case complexity.ResultsMost patients were from more affluent areas. Deprivation was associated with younger age, and increasing case complexity. There was a significant association between case complexity and mortality, while an independent association between deprivation and mortality could not be confirmed.ConclusionHealth inequalities may impact presentations and outcomes in knee arthroplasty. Patients from areas of socioeconomic deprivation present more complex cases, which may be a result of associated comorbidity and delayed presentation due to impaired access. As knee arthroplasty can improve disability and ability to work, its availability in deprived areas can play a role in the alleviation of health inequality.

Preventive use of glycoprotein IIb/IIIa inhibitors in patients with ST-segment elevation myocardial infarction and a high risk of no-reflow phenomenon

Aim: To evaluate the efficacy and safety of the preventive use of glycoprotein (GP) IIb/IIIa inhibitors in patients with ST-elevation myocardial infarction (STEMI) and a high risk of «no-reflow» phenomenon.Material and Methods. A total of 100 patients were included in the study. For all patients, the risk of no-reflow was calculated using a previously developed scoring system. In case of high risk, GP IIb/IIIa inhibitors were administered according to the decision of the interventional cardiologist. The rate of no-reflow as well as the rates of death, recurrent myocardial infarction and stent thrombosis were analyzed.Results. High risk of no-reflow was determined in 37 patients, low risk of no-reflow – in 63 patients. In the high-risk group 22 patients (59.5%) GP IIb/IIIa inhibitors were preventively used. In these patients, the frequency of no-reflow was lower compared with high-risk patients who did not receive preventive GP IIb/IIIa inhibitors (9.1 vs. 46.7%, p = 0.017). With the preventive use of GP IIb/IIIa inhibitors in high-risk patients, the rates of no-reflow (9.1 vs. 11.1%, p = 1.000) and angiographic success of percutaneous coronary intervention (72.7 vs. 84.1%, p = 0.341) were comparable with low-risk patients.Conclusion. The preventive use of GP IIb/IIIa inhibitors in patients with STEMI and a high risk was associated with reduction of «no-reflow». In the prophylactic use of GP IIb/IIIa inhibitors in patients with STEMI and a high risk of no-reflow, the results of their treatment were comparable to patients with a low risk of no-reflow.

Analysis of in-person general practice respiratory consultations: assessing translatability to telehealth.

The COVID-19 pandemic saw many GPs adopt telehealth as a consultation modality to minimise disease transmission. Patients presenting with respiratory ailments were particularly affected by this transition, given the overlap of general respiratory symptoms with those of COVID-19. It is unclear if the rapid transition to telehealth has compromised the ability to conduct certain tasks that were possible during in-person consultations. To investigate the extent to which tasks observed during in-person GP consultations are replicable in telehealth, focusing on patients with respiratory concerns. Twenty-six respiratory consultations were extracted from a database of 281 consultations collated from various general practices in the UK. Interactions between GPs and respiratory patients were assessed through in-depth transcript review and de-identified video analysis. Then, tasks performed and physical artefacts used during the consultations were identified and ranked in terms of their translatability to telehealth, using a newly developed scoring system. Overall, the translatability to telehealth score for these respiratory consultations was 6.7/10, suggesting that many tasks can be replicated over telehealth, but that they might require additional physical artefacts to support this. However, some tasks are not currently amenable to telehealth (for example, auscultation). While many aspects of respiratory consultations are replicable over telehealth, some tasks cannot be replicated at this stage.

Development and validation of common data model-based fracture prediction model using machine learning algorithm.

Osteoporotic fractures are substantial health and economic burden. Therefore, the need for an accurate real-world-based fracture prediction model is increasing. We aimed to develop and validate an accurate and user-friendly model to predict major osteoporotic and hip fractures using a common data model database. The study included 20,107 and 13,353 participants aged ≥ 50years with data on bone mineral density using dual-energy X-ray absorptiometry from the CDM database between 2008 and 2011 from the discovery and validation cohort, respectively. The main outcomes were major osteoporotic and hip fracture events.DeepHit and Cox proportional hazard models were used to identify predictors of fractures and to build scoring systems, respectively. The mean age was 64.5years, and 84.3% were women. During a mean of 7.6years of follow-up, 1990 major osteoporotic and 309 hip fracture events were observed. In the final scoring model, history of fracture, age, lumbar spine T-score, total hip T-score, and cardiovascular disease were selected as predictors for major osteoporotic fractures. For hip fractures, history of fracture, age, total hip T-score, cerebrovascular disease, and diabetes mellitus were selected. Harrell's C-index for osteoporotic and hip fractures were 0.789 and 0.860 in the discovery cohort and 0.762 and 0.773 in the validation cohort, respectively. The estimated 10-year risks of major osteoporotic and hip fractures were 2.0%, 0.2% at score 0 and 68.8%, 18.8% at their maximum scores, respectively. We developed scoring systems for osteoporotic fractures from hospital-based cohorts and validated them in an independent cohort. These simple scoring models may help predict fracture risks in real-world practice.

Development and validation of a scoring system for the prediction of HIV drug resistance in Hubei province, China.

The present study aimed to build and validate a new nomogram-based scoring system for the prediction of HIV drug resistance (HIVDR). Totally 618 patients with HIV/AIDS were included. The predictive model was created using a retrospective set (N = 427) and internally validated with the remaining cases (N = 191). Multivariable logistic regression analysis was carried out to fit a model using candidate variables selected by Least absolute shrinkage and selection operator (LASSO) regression. The predictive model was first presented as a nomogram, then transformed into a simple and convenient scoring system and tested in the internal validation set. The developed scoring system consisted of age (2 points), duration of ART (5 points), treatment adherence (4 points), CD4 T cells (1 point) and HIV viral load (1 point). With a cutoff value of 7.5 points, the AUC, sensitivity, specificity, PLR and NLR values were 0.812, 82.13%, 64.55%, 2.32 and 0.28, respectively, in the training set. The novel scoring system exhibited a favorable diagnostic performance in both the training and validation sets. The novel scoring system can be used for individualized prediction of HIVDR patients. It has satisfactory accuracy and good calibration, which is beneficial for clinical practice.

The Influence of Ultra-Low Tidal Volume Ventilation during Cardiopulmonary Resuscitation on Renal and Hepatic End-Organ Damage in a Porcine Model

The optimal ventilation strategy during cardiopulmonary resuscitation (CPR) has eluded scientists for years. This porcine study aims to validate the hypothesis that ultra-low tidal volume ventilation (tidal volume 2-3 mL kg-1; ULTVV) minimizes renal and hepatic end-organ damage when compared to standard intermittent positive pressure ventilation (tidal volume 8-10 mL kg-1; IPPV) during CPR. After induced ventricular fibrillation, the animals were ventilated using an established CPR protocol. Upon return of spontaneous circulation (ROSC), the follow-up was 20 h. After sacrifice, kidney and liver samples were harvested and analyzed histopathologically using an Endothelial, Glomerular, Tubular, and Interstitial (EGTI) scoring system for the kidney and a newly developed scoring system for the liver. Of 69 animals, 5 in the IPPV group and 6 in the ULTVV group achieved sustained ROSC and were enlisted, while 4 served as the sham group. Creatinine clearance was significantly lower in the IPPV-group than in the sham group (p < 0.001). The total EGTI score was significantly higher for ULTVV than for the sham group (p = 0.038). Aminotransferase levels and liver score showed no significant difference between the intervention groups. ULTVV may be advantageous when compared to standard ventilation during CPR in the short-term ROSC follow-up period.

Linear Regression Modeling Based Scoring System to Reduce Benign Breast Biopsies Using Multi-parametric US with Color Doppler and SWE

To develop a simple ultrasound (US) based scoring system to reduce benign breast biopsies. Women with BI-RADS 4 or 5 breast lesions underwent shear-wave elastography (SWE) imaging before biopsy. Standard US and color Doppler US (CDUS) parameters were recorded, and the size ratio (SzR=longest/shortest diameter) was calculated. Measured/calculated SWE parameters were minimum (SWVMin) and maximum (SWVMax) shear velocity, velocity heterogeneity (SWVH=SWVMax-SWVMin), velocity ratio (SWVR=SWVMin/SWVMax), and normalized SWVR (SWVRn=(SWVMax-SWVMin)/SWVMin). Linear regression analysis was performed by converting continuous parameters into categorical corresponding equivalents using decision tree analyses. Linear regression models were fitted using stepwise regression analysis and optimal coefficients for the predictors in the models were determined. A scoring model was devised from the results and validated using a different data set from another center consisting of 187 cases with BI-RADS 3, 4, and 5 lesions. A total of 418 lesions (238 benign, 180 malignant) were analyzed. US and CDUS parameters exhibited poor (AUC=0.592-0.696), SWE parameters exhibited poor-good (AUC=0.607-0.816) diagnostic performance in benign/malignant discrimination. Linear regression models of US+CDUS and US+SWE parameters revealed an AUC of 0.819 and 0.882, respectively. The developed scoring system could have avoided biopsy in 37.8% of benign lesions while missing 1.1% of malignant lesions. The scoring system was validated with a 100% NPV rate with a specificity of 74.6%. The linear regression model using US+SWE parameters performed better than any single parameter alone. The developed scoring method could lead to a significant decrease in benign biopsies.

General anesthesia does not induce ultrasonographic changes in the pleura of healthy adult horses anesthetized for elective magnetic resonance imaging.

To compare thoracic ultrasonographic findings in healthy horses before and after general anesthesia for elective MRI utilizing a recently developed ultrasonographic scoring system to aid clinicians in the early identification of pneumonia following anesthesia. 13 adult horses > 3 years of age. Prior to anesthesia, horses underwent a thorough physical examination, CBC, thoracic radiography, and thoracic ultrasonography. Horses were then anesthetized for elective MRI, and thoracic ultrasonography was repeated within 3 hours after recovery. Thoracic ultrasonographic findings were scored utilizing a recently developed scoring system, and scores were compared before and after anesthesia. There was no significant difference identified in total thoracic ultrasonography score before and after anesthesia, and there was no correlation between thoracic ultrasonography score following anesthesia and the body weight of the horse, the time recumbent, and the dependent side. In healthy horses undergoing anesthesia for elective imaging, there was no significant change in thoracic ultrasonographic findings 3 hours after recovery from anesthesia. These data can aid clinicians in determining the clinical significance of ultrasonographic changes in the lung in the immediate postanesthetic period.

A Systematic Review of Heart Rate Variability as a Measure of Stress in Medical Professionals.

Understanding the physiological effects of responding to crises is a critical component in understanding how to manage and prepare medical professionals to be crisis responders. Heart rate variability (HRV) is the variation in rate between a succession of R-R intervals. This variation is not only affected by physiological processes such as respiration or metabolic rate but is also directly controlledby the autonomic nervous system. As such, heart rate variability has been proposed as a noninvasive tool to measure the physiological stress response. The aim of this systematic review is to consolidate heart rate variability literature in the context of medical emergencies to determine if heart rate variability changes predictably from baseline when responding to medical crises. This may demonstrate utility as an objective, noninvasive measure of stress response. A systematic literature review of six databases yielded 413 articles, 17 of which met our inclusion criteria of being written in English, measuring HRV in healthcare providers, and measuring HRV in real or simulated medical resuscitations or procedures. Articles were then analyzed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. Out of the 17 articles reviewed, 11 demonstrated statistically significant results showing heart rate variability responding in a predictable manner to stress. Three articles utilized a medical simulation as the stressor, six used medical procedures, and eight used medical emergencies encountered during clinical work. Overall, a predictable trend in heart rate variability metrics of standard deviation from the mean value of normal-to-normal(N-N) intervals (SDNN), root mean square of the successive differences (RMSSD),mean number of times per time interval in which the change in successive normal sinus (N-N) intervals exceeds 50 ms (PNN50), low frequency % (LF%), and low-frequency-to-high-frequency ratio (LF/HF) was observed when responding to stress. This systematic literature review showed that heart rate variability among healthcare providers responding to stressful scenarios follows a predictable pattern of change and expands our understanding of the physiology of stress in healthcare providers. This review supports the use of HRV to monitor stress during high-fidelity simulation to ensure that appropriate physiological arousal is achieved during the training of medical personnel.