High Rate Of Agreement Research Articles

The effect of injection time on rates of epileptogenic zone localization using SISCOM and STATISCOM

BackgroundThe identification of hyperperfusion on ictal single-photon emission computed tomography (SPECT) scan is a technique for the localization of the epileptogenic zone (EZ) in patients with focal epilepsy undergoing presurgical evaluation. The accuracy of this technique has been improved by subtraction from an interictal image and coregistration with magnetic resonance imaging (MRI) (subtraction ictal SPECT coregistered to MRI (SISCOM)), and subsequently by the development of Statistical Ictal SPECT Co-registered to MRI (STATISCOM) which is reported to further improve localization accuracy by statistically accounting for random variation between images. However, the use of ictal SPECT is limited by the necessity for rapid injection of the radiotracer. The purpose of this study was to investigate the effect of tracer injection time on EZ localization rates using both STATISCOM and SISCOM. MethodsConsecutive patients with drug-resistant focal epilepsy who had an ictal SPECT scan while admitted to the video-electroencephalography (EEG) monitoring unit at the Royal Melbourne Hospital, Victoria, Australia, and a subsequent interictal scan, between 2009 and 2017 were included. The information collected included age, sex, seizure type, epilepsy diagnosis, and injection time. Statistical Ictal SPECT Co-registered to MRI and SISCOM images were generated and reviewed by two blinded reviewers. The rates of potential localization of the EZ, and the agreement with the EEG, were determined for each scan. Localization rates were compared between ictal scans with different radiotracer injection time windows (<30 s, 30–45 s, 45–60 s, 60–90 s, 90–120 s, >120 s). ResultsSeventy patients (male = 32, 16–67 years) were included in the study. Overall agreement between the primary raters was moderate for STATISCOM (k = 0.44) and SISCOM (k = 0.57). The ability of SPECT to localize the potential EZ was 69% (48/70) for STATISCOM and 59% (41/70) for SISCOM. Injection time was not associated with the rate of localizing the potential EZ for STATISCOM (p = 0.64), whereas for SISCOM there was a trend that shorter injection times were associated with better ability to localize the potential EZ (p = 0.06).Agreement between SPECT and video-EEG data was 54% (38/70) for STATISCOM and 39% (27/70) for SISCOM. Statistical Ictal SPECT Co-registered to MRI did not show any difference of agreement across injection time groups (p = 0.42) whereas SISCOM showed better agreement with video-EEG data in the earlier injection time groups (p = 0.02). No differences in agreement between SPECT and video-EEG data were seen between patients with and without MRI lesions for either STATISCOM or SISCOM. Statistical Ictal SPECT Co-registered to MRI showed significantly better agreement for temporal than extratemporal seizures, with no difference of agreement between early (<45 s) and late (>45 s) injections. ConclusionStatistical Ictal SPECT Co-registered to MRI showed overall higher agreement rates with EZ localization by video-EEG than SISCOM, which was not affected by the injection times. Statistical Ictal SPECT Co-registered to MRI may provide localizing information for “late” injections where visual reads and SISCOM are inconclusive.

Diffusion-Convection Hybrid Microfluidic Platform for Rapid Antibiotic Susceptibility Testing.

Conventional antibiotic susceptibility testing (AST) assays such as broth microdilution and Kirby-Bauer disk diffusion are time-consuming (e.g., 24-72 h) and labor-intensive. Here, we present a microfluidic platform to perform AST assays with a broad range of antibiotic concentrations and controls. A culture medium stream was serially enriched with antibiotics along the length of the platform via diffusion and flow-directing mass convection mechanisms, generating a concentration gradient captured in a series of microchamber duplicates. We observed an agreement between the simulated and experimental concentration gradients and applicability to a variety of different molecules by changing the loading time according to a simple linear equation. The AST assay in our platform is based on bacterial metabolism, indicated by resazurin fluorescence. The small reaction volume enabled a minimum inhibitory concentration (MIC) to be determined in 4-5 h. Proof-of-concept functionality testing, using human isolates and clinically important antibiotics from different classes, indicated a high rate of agreement (94%: MIC within ±1 two-fold dilution of the reference method) of on-chip MICs and conventional broth microdilution. Overall, our results showed that this microfluidic platform is capable of determining antibiotic susceptibility in a rapid and reliable manner.

Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure.

Summary Textbook outcome for esophageal cancer surgery is a composite quality measure including 10 short-term surgical outcomes reflecting an uneventful perioperative course. Achieved textbook outcome is associated with improved long-term survival. This study aimed to update the original textbook outcome based on international consensus. Forty-five international expert esophageal cancer surgeons received a personal invitation to evaluate the 10 items in the original textbook outcome for esophageal cancer surgery and to rate 18 additional items divided over seven subcategories for their importance in the updated textbook outcome. Items were included in the updated textbook outcome if ≥80% of the respondents agreed on inclusion. In case multiple items within one subcategory reached ≥80% agreement, only the most inclusive item with the highest agreement rate was included. With a response rate of 80%, 36 expert esophageal cancer surgeons, from 34 hospitals, 16 countries, and 4 continents responded to this international survey. Based on the inclusion criteria, the updated quality indicator ‘textbook outcome for esophageal cancer surgery’ should consist of: tumor-negative resection margins, ≥20 lymph nodes retrieved and examined, no intraoperative complication, no complications Clavien–Dindo ≥III, no ICU/MCU readmission, no readmission related to the surgical procedure, no anastomotic leakage, no hospital stay ≥14 days, and no in-hospital mortality. This study resulted in an international consensus-based update of a quality measure, textbook outcome for esophageal cancer surgery. This updated textbook outcome should be implemented in quality assurance programs for centers performing esophageal cancer surgery, and could standardize quality measures used internationally.

Who Reports What? A Comparison of Child and Caregivers\xb4 Reports of Child Trauma Exposure and Associations to Post-Traumatic Stress Symptoms and Functional Impairment in Child and Adolescent Mental Health Clinics

Identifying trauma-related symptoms is important for treatment planning at child and adolescent mental health services (CAMHS), and routine trauma screening may be a first step to ensure appropriate treatment. Studies with community samples have found modest agreement between children’s and caregivers´ report of exposure to potentially traumatizing events (PTEs). However, studies from clinical populations are scarce and the evidence base for screening recommendations is insufficient. The current study explores child and caregiver agreement on the child’s exposure to PTEs and its relationship with the child’s post-traumatic stress symptoms (PTSS) and functional impairment. The sample consist of 6653 caregiver-child dyads referred to Norwegian CAMHS between 2012–2017. The children were 6 to 18 years of age (M = 12.03, SD = 3.14) and 47% were boys and 45% were girls (8% missing). Children reported significantly more exposure to accidents or illness, community violence, and sexual abuse than their caregiver, but there were no differences for reports of domestic violence. Kappa results were fair to moderate, with the highest agreement rate for reports of sexual abuse, followed by domestic violence, community violence, and lowest agreement for accidents or illnesses. There were higher agreement rates among caregivers and older children, and caregivers and girls. In general, the child had higher PTSS and functional impairment scores when child exposure to PTEs were reported by both the caregiver and the child. Both children and caregivers should be included in trauma screening procedures at CAMHS to collect a more complete picture of the child’s experiences and treatment needs.

Supporting Acute Advance Care Planning with Precise, Timely Mortality Risk Predictions

Summary Patients with serious, life-limiting disease benefit from end-of-life conversations, goal setting, and palliative care. Hospitalized patients at high risk of near-term death are likely to benefit from such interventions. As NYU Langone Health expanded its institutional initiatives promoting patient-centered end-of-life care, leaders developed an artificial intelligence–based system that identifies patients at high risk of dying within 2 months. Upon opening a high-risk patient’s chart, attending physicians receive an interruptive alert stating the risk. If they agree, they are encouraged to conduct and document an advance care planning discussion. In the first year of operation running live across the health system, this platform has precisely identified high-risk patients within days of admission, producing high rates of provider agreement with risk and increased adoption of advance care planning. We are continuing to refine the system and to investigate how physicians interpret the risk estimates and integrate them into their decision-making.

Correlations Between Retinal Optical Coherence Tomography and Histopathology in Preclinical Safety Assessment of Ocular Therapies.

Twelve studies that involved intravitreal or subretinal test article administration in multiple laboratory animal species and employed both OCT and histopathologic assessment were identified. These data were compared to determine the degree of correlation for each identified abnormality. Severity of observed OCT and histopathological changes ranged from minimal to severe, with moderate and severe changes having a higher rate of agreement between the 2 techniques. Changes to well-defined structures, including the retinal blood vessels, optic nerve, and retinal pigment epithelium, also showed a strong correlation. There was a strong correlation between OCT and histopathology in both intravitreal and subretinal injection studies, demonstrating the value of collaboration between the study ophthalmologist and pathologist and offering translatable means to monitor pharmacological or toxicological effects in preclinical toxicological studies.

Stability of the Communication Function Classification System among Children with Cerebral Palsy in South Korea.

Interest in the prognosis of skill levels has been an important issue among children with cerebral palsy (CP). This study aimed to verify the stability of the Communication Function Classification System (CFCS) in 2- to 18-year-old children with CP. Data collected from 171 children with CP who received rehabilitation therapy in hospitals or attended special elementary schools in South Korea were reviewed. They were divided into two groups, children <4 years and children ≥4 years. Participants were evaluated over 1-year and 2-year intervals from the first rating. Agreement between the three measurements and the weighted kappa were analyzed. At the 1-year interval, results demonstrated a high agreement rate of the CFCS in children ≥4 years old, and during the 2-year interval the study revealed a low agreement rate in children aged 2–4 years. The results indicated the stability of the CFCS in children ≥4 years old but some change of the CFCS in 2- to 4-year-old children. Moreover, the findings suggested that the change of the CFCS varied with time and age. Based on these results, it is recommended that the CFCS assessments be performed periodically, especially among 2- to 4-year-old children with CP.

Aromatic L-amino Acid Decarboxylase (AADC) deficiency: results from an Italian modified Delphi consensus

BackgroundAromatic L-amino acid decarboxylase (AADC) deficiency is a rare and underdiagnosed neurometabolic disorder resulting in a complex neurological and non-neurological phenotype, posing diagnostic challenges resulting in diagnostic delay. Due to the low number of patients, gathering high-quality scientific evidence on diagnosis and treatment is difficult. Additionally, based on the estimated prevalence, the number of undiagnosed patients is likely to be high.MethodsItalian experts in AADC deficiency formed a steering committee to engage clinicians in a modified Delphi consensus to promote discussion, and support research, dissemination and awareness on this disorder. Five experts in the field elaborated six main topics, each subdivided into 4 statements and invited 13 clinicians to give their anonymous feedback.Results100% of the statements were answered and a consensus was reached at the first round. This enabled the steering committee to acknowledge high rates of agreement between experts on clinical presentation, phenotypes, diagnostic work-up and treatment strategies. A research gap was identified in the lack of standardized cognitive and motor outcome data. The need for setting up an Italian working group and a patients’ association, together with the dissemination of knowledge inside and outside scientific societies in multiple medical disciplines were recognized as critical lines of intervention.ConclusionsThe panel expressed consensus with high rates of agreement on a series of statements paving the way to disseminate clear messages concerning disease presentation, diagnosis and treatment and strategic interventions to disseminate knowledge at different levels. Future lines of research were also identified.

Modern bioethical issues: Euthanasia, physician assisted suicide and abortion. Comparative study of attitudes between physicians and law professionals.

We aimed to examine and compare the attitudes of physicians and law professionals on modern bioethical issues. Euthanasia, physician assisted suicide and abortion were selected for this study, as they underline the conflict between human life as a fundamental value, and the individual's right to self-determination. The demand of euthanasia and physician assisted suicide services reflects each person's right to decide on the way their life will end, while the legalization of abortion determines the individual's right to self-determination. These are complex issues with moral, religious and social implications, and as such tend to divide public opinion. In order to investigate their attitudes, physicians of all specialties, as well as law professionals from all over Greece, were invited to participate in the study. In total, 220 professionals responded to the call and participated in the survey. The professionals involved showed fairly high rates of agreement in all the issues studied, but a significant difference in results was found when the occupation of participants was set as a criterion, with physicians being more negative to euthanasia, physician assisted suicide and abortion than lawyers. Religiousness, age and male sex were negatively correlated with "positive" attitudes towards euthanasia, physician assisted suicide and abortion. Moreover, participants' attitudes towards euthanasia and physician assisted suicide were found to predict their attitudes towards abortion, indicating a single ideological direction of agreement or disagreement, accordingly. Individuals' attitudes and opinions are complicated issues, not easy to be categorized. However, it is of scientific interest to shape a legislative framework that is close to the social consensus, ideological evolution and moral needs. This study tried to pave the way for a modern approach to the issues of euthanasia, physician assisted suicide and abortion.

Rural schoolteachers' knowledge about oral health and perceived roles in oral health education.

To explore schoolteachers' knowledge about oral health, their perception of their role as oral health educators, and their preparedness to teach oral health in rural public schools. We conducted a survey of 119 schoolteachers in four public elementary and middle schools in rural Minnesota during spring semester of 2019. We used descriptive statistics to analyze the data. Sixty percent of 119 teachers participated. Schoolteachers have knowledge about basic oral health hygiene but have limited awareness about fluoride and periodontal disease. Correct agreements to the fluoride statements ranged from 23 percent to 87 percent and 23 percent to 70 percent agreed correctly to statements about periodontal disease. They prefer passive roles in oral health education. There was a high rate of agreement (51-83 percent) to integrate oral health topics with subjects taught in classrooms. Schoolteachers see themselves as integrating oral health topics in the subjects they currently teach but will need further training to augment their limited knowledge of oral health.

Comparison of Two Otolith Processing Methods for Estimating Age of Three Catfish Species

AbstractWhen performing studies that require fish age estimation, biologists must achieve a high level of accuracy and precision, as age, growth, and survival data are often used in models that inform management decisions. Otolith processing techniques vary, and no studies have assessed which methodology is more precise and cost effective. Our goal was to assess the precision, effort, and resources needed to perform the ground otolith and cut otolith methods in estimating ages of Blue Catfish Ictalurus furcatus, Channel Catfish I. punctatus, and Flathead Catfish Pylodictis olivaris. Readers exhibited high initial agreement rates for both aging methods with Blue Catfish (93.3–97.8%) and Flathead Catfish (88.9–96.3%). However, readers were more confident in their age estimates with the cut otolith method, and age–bias plots revealed significant bias between the techniques. The ground otolith method yielded lower age estimates compared to the cut otolith method by roughly 1 year for Flathead Catfish from age 6 through age 10 and yielded lower age estimates by about 1 year for Blue Catfish at ages 4 and 5. Conversely, for Channel Catfish, reader agreement and confidence were lower with the cut otolith method compared to the ground otolith method (66.7% and 95.7%), but no significant bias was detected between the processing techniques. The ground otolith method required lower startup costs and less effort than the cut otolith method for Blue Catfish and Channel Catfish, whereas the cut otolith method required less effort for Flathead Catfish. The cut otolith method required higher startup costs and was more expensive to perform than the ground otolith method. This study presents advantages and disadvantages of both methods, and we recommend that fishery professionals weigh the costs and benefits of each method when developing a program for applying a method to their study systems.

Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus

Background: Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome. Objectives: The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain. Methods: A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life. Results: A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics. Conclusions: The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver’s quality of life.

Concordance in detecting amyloid positivity between 18F-florbetaben and 18F-flutemetamol amyloid PET using quantitative and qualitative assessments

We aimed to quantitatively and qualitatively assess whether there is a discrepancy in detecting amyloid beta (Aβ) positivity between 18F-florbetaben (FBB) and 18F-flutemetamol (FMM) positron emission tomography (PET). We obtained paired FBB and FMM PET images from 107 participants. Three experts visually quantified the Aβ deposition as positive or negative. Quantitative assessment was performed using global cortical standardized uptake value ratio (SUVR) with the whole cerebellum as the reference region. Inter-rater agreement was excellent for FBB and FMM. The concordance rates between FBB and FMM were 94.4% (101/107) for visual assessment and 98.1% (105/107) for SUVR cut-off categorization. Both FBB and FMM showed high agreement rates between visual assessment and SUVR positive or negative categorization (93.5% in FBB and 91.2% in FMM). When the two ligands were compared based on SUVR cut-off categorization as standard of truth, although not statistically significant, the false-positive rate was higher in FMM (9.1%) than in FBB (1.8%) (p = 0.13). Our findings suggested that both FBB and FMM had excellent agreement when used to quantitatively and qualitatively evaluate Aβ deposits, thus, combining amyloid PET data associated with the use of different ligands from multi-centers is feasible.

Correlation of Clinical and Pathological Diagnosis and Inflammatory Markers for Patients Undergoing Laryngeal Microsurgery

The purpose of this study was to investigate the rate of concordance between indirect- and direct laryngoscopy and final pathology in patients undergoing laryngeal microsurgery. Retrospective case study. This study was conducted in the Otolaryngology clinic of a tertiary center between January 2017 and June 2020. Archives records of 432 patients, who underwent laryngeal microsurgery because of benign and premalignant lesions or malignancy, were examined. The patients were divided into three subgroups according to pathology results: benign lesions, premalignant lesions, and malignancies. There were 400 laryngeal lesions from 385 patients, that met the inclusion and exclusion criteria, 307 (79.7%) were male and 78 were (20.3%) female. The average age of patients was 52.88 ± 13.21 years. The most common diagnosis was polyp (34.25%) followed by squamous cell carcinoma (27.75%) and Reinke's edema (8.25%) according to final pathology. For the benign laryngeal lesions, a high correlation level was observed regarding the compatibility of the indirect- and direct laryngoscopy diagnosis, and final pathology (P < 0.001). The laryngeal premalignant lesions and malignancies were significantly more common in older age and male gender (P <0.001). Similarly, smoking usage was more frequent in patients with premalignant lesions and malignancy (P <0.001). The neutrophil count, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, neutrophil to platelet ratio as well as CRP value were significantly higher in malignancy group (P <0.05). On the other hand, lymphocyte ratio was smaller in the malignancy group compared with the benign and premalignant lesions, and this difference was significant (P = 0.016). Our study demonstrated a high rate of agreement between the clinical diagnosis and pathology results in patients with benign laryngeal lesions, in contrast to premalignant lesions and malignancies. Also, the neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, neutrophil to platelet ratio as well as CRP were shown to be increased in patients with laryngeal malignancies.

Flexural Behavior of Composite GFRP Pultruded I-Section Beams under Static and Impact Loading

In this study, the effect of glass fiber reinforced polymer (GFRP) section and compressive strength of concrete in composite beams under static and low velocity impact loads was examined. Modeling was performed and the obtained results were compared with the test results and their compatibility was evaluated.‎ Experimental tests of four composite beams were carried out, where two of them are control specimen with 20 MPa compressive strength of concrete deck slab and 50 MPa for other. Bending characteristics were affected by the strength of concrete under impact loading case, as it increased maximum impact force and damping time at a ratio of 59% and reduced the damping ratio by 47% compared to the reference hybrid beam. Under static loading, there was an increase in all the parameters, including the maximum load, ductility, and stiffness. Mid-span deflection was reduced by 25% under static and impact loads. A finite element analysis was performed by using the ABAQUS software. The midspan deflection value was greater than the experimental values by 6% and 3% for impact and static loads, respectively, and all other results showed a high rate of agreement with the obtained test results. The agreement between the numerical and experimental results indicates that the developed numerical model is capable of analyzing the impact and static behavior of such hybrid GFRP-concrete system. Doi: 10.28991/cej-2020-03091608 Full Text: PDF

الأدوار المستقبلية لمعلم التربية الفنية في ضوء مهارات القرن الحادي والعشرون

يهدف البحث الحالي تحديد أدوار معلم التربية الفنية في ضوء التوجهات المعاصرة لمعلم المستقبل والتي فرضتها مهارات القرن الحادي والعشرون . وقد تمحورت مشکلة الدراسة في الإجابة على الأسئلة التالية: ما العلاقة بين مقومات معلم التربية الفنية وبين تحقيق مؤشرات مرتبطة بمهارات القرن الحادي والعشرون؟ ، ما مدى تضمين الأدوار المتعددة لمعلم التربية الفنية لمؤشرات ترتبط باداؤه کمعلم فعال ومؤشرات الاستجابة المتوقعة من الطلبة؟ وقد اتبع الباحث إجراءات المنهج الوصفي خلال تصميم نموذج يتضح خلاله تحديد العمليات والمؤشرات المتوقعة للأدوار الجديدة لمعلم المستقبل ، بالتزامن واستشراف مؤشرات الاستجابة المتوقعة من الطلبة. وقد تم تصنيف ادوار المعلم الى معايير ومؤشرات على هيئة نموذج للاستبيان على صلاحيته تم توزيعه على لجنة من الخبراء في الميدان . أظهرت نتائج البحث ارتفاع نسب الاتفاق على المعايير والمؤشرات الخاصة بمواصفات معلم التربية الفنية المستقبلي . قدم البحث عددا من التوصيات أهمها العمل على الأخذ بالمعايير المقترحة عند تطوير نظم اعتماد برامج التربية الفنية في المؤسسات الجامعية . الکلمات المفتاحية: معلم التربية الفنية ، معلم المستقبل ، مهارات القرن الحادي والعشرون. Abstract The current research aims to define the roles of the art education teacher in light of the contemporary trends of the future teacher imposed by the skills of the twenty first century. The study problem centered in answering the following questions: What is the relationship between the components of the art education teacher and the achievement of indicators related to the skills of the twenty first century? To what extent do the various roles of the art education teacher include indicators related to his performance as an effective teacher and the response indicators expected from students? The researcher followed the descriptive approach procedures during designing a model in which it is clear to define the expected processes and indicators for the new roles of the future teacher, in conjunction with exploring the expected response indicators from the students. The teacher's roles were classified into criteria and indicators in the form of a questionnaire on its validity, which was distributed to a committee of experts in the field. The results of the research showed high rates of agreement on the criteria and indicators for the specifications of the future art education teacher. The research presented a number of recommendations, the most important of which is to work on adopting the proposed standards when developing systems for accrediting art education programs in university institutions. Key words: art education teacher, future teacher, twenty-first century skills.

Digital morphology analyzers in hematology: a French survey

questionnaire sent by e-mail in 2018 to French public and private laboratories. out of 118 responses (56 private, 62 public), 117 participants had a CellaVision® microscope, 1 had a West Medica®. Practices were sometimes different, especially in the choice of smears to be digitized or for quality controls (16.1% had internal quality controls, 48.3% external quality controls); 62.1% never used the red blood cell (RBC) characterization tool; the number of cells counted varied from 100 to 400. The study reported a high rate of agreement for these benefits: traceability (95.7%), staff training (94.1%), eye strain (91.4%), risk of error (87.2%), time saving (83.6%). Among the disadvantages, apart from the inadequate search for platelets clumps (93.2%), the agreement rates were often lower: adaptation to digital images (61.2%), difficult assessment of atypical morphologies (49.6%) or RBC morphology (49.6%). despite well-established benefits, standardization of practices and technical improvement are still needed.

Development of BDMS Utilization Review Technology (BURT): An Artificial Intelligence Tool Using Thai Natural Language Processing to Assess Appropriateness of Hospitalization

OBJECTIVES: To develop an effective artificial intelligence (AI) driven platform to optimize the process of assessing appropriateness of hospitalization. MATERIALS AND METHODS: Anonymized data of 22,020 insured-patient admissions in a BDMS network hospital were included to build a prediction model based on a comprehensive guideline for appropriate hospitalization. To develop Thai Natural Language Processing (NLP) model, 77,707 sentences from medical records were used and separated into two datasets, 80% for training and 20% for testing. A combined NLP and rule-based algorithms formed an AI engine and outputs were displayed using a web-based application. An expert panel of five Utilization Management (UM) physicians had several collaborative discussions to fine tune the NLP model, application of clinical criteria, and classification engine. Eventually, NLP model in the latest version (BURT1.1), had satisfactory features with overall higher than 99% accuracy, precision, recall, and F1.&nbsp; RESULTS: Performance of BURT1.1 was assessed using 300 cases randomly selected from the main dataset, against other methods, including concurrent review by UM nurses at the participating hospital, and UM nurses at Bangkok Hospital Headquarters (BHQ). Agreement upon UM Physician Panel consensus was set as one of the performance indicators, and BURT1.1 showed a favorable outcome with the highest rate of agreement (86%) among all the methods. The precision rate was 99% as compared to insurance claim approval status. Additionally, dramatic time savings were achieved with 0.59 second of processing time as compared to 10-15 minutes per case by conventional manual review. CONCLUSION: BURT1.1 should be effectively implemented as an automatic daily tool to screen inappropriate hospitalization. It can immediately identify patients at high risk of inappropriate hospitalization that require further assessment by UM nurse, thus providing feedback to attending physicians on the completeness and quality of documentation, with parallel notification to UM physicians. Ultimately, BURT1.1 can contribute to increase UM efficiency, speeding up the claim process, reducing health care costs due to unnecessary hospitalization, and reduction of claim denials.

Italian young doctors’ knowledge, attitudes and practices on antibiotic use and resistance: A national cross-sectional survey

ObjectivesAntimicrobial resistance (AMR) is one of the major health issues worldwide. Clinicians should play a central role to fight AMR, and medical training is a pivotal issue to combat it; therefore, assessing levels of knowledge, attitudes and practices among young doctors is essential for future antimicrobial stewardship (AMS) programmes. MethodsA nationwide, cross-sectional, multicentre survey was conducted in Italy. A descriptive analysis of knowledge and attitudes was performed, along with a univariate and multivariate analysis of their determinants. ResultsOverall, 1179 young doctors accessed the survey and 1055 (89.5%) completed all sections. Regarding the knowledge section of the questionnaire, almost all participants declared to know the different species of bacteria proposed, however the percentage of participants who correctly responded to clinical quizzes was 23% for the question on vancomycin-resistant enterococci (VRE), 42% on carbapenem-resistant Enterobacteriaceae (CRE), 32% on extended-spectrum β-lactamase-producing enterobacteria (ESBL) and 27% on methicillin-resistantStaphylococcus aureus (MRSA). Similarly, 81% of participants disagreed in stating that AMR was adequately addressed during their medical training and 71% disagreed that they received the right example from their tutors. Finally, a high rate of agreement with the proposed actions to combat AMR was documented; in particular, the percentage agreement was 76% for respondents who agreed to be part of an active surveillance system or AMS programme. ConclusionsTackling AMR should be a priority for politicians and for all health workers. Inclusion of competencies in antibiotic use in all specialty curricula is urgently needed.

RNA in situ hybridization for human papillomavirus testing in oropharyngeal squamous cell carcinoma on a routine clinical diagnostic platform.

The current diagnostic standard for detection of high-risk human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is via a two-stage algorithm, namely p16 immunohistochemistry followed by HPV DNA in situ hybridization in p16 positive cases. This study evaluated the feasibility of automated RNA in situ hybridization on a clinical platform as a single-step alternative to the two-stage algorithm within a routine diagnostic histopathology setting. Thirty-eight cases positive for both p16 and DNA in situ hybridization, 42 p16 negative cases and 20 cases positive for p16 but negative for DNA in situ hybridization were randomly selected. High-risk HPV RNA in situ hybridization was undertaken on all cases on an automated clinical platform. Manufacturer-recommended and on-slide additional p16/HPV positive and negative controls were used. Test quality assurance and diagnostic RNA in situ hybridization were independently assessed by two observers. A consensus diagnosis was reached in the presence of a third observer on discordant cases. All RNA in situ hybridization results were then correlated against p16 and DNA ISH status. Inter-slide RNA in situ hybridization staining variation was observed in control sections. RNA in situ hybridization demonstrated a high inter-observer agreement rate (κ=.897, P<.001). Following consensus review, there was full concordance between RNA in situ hybridization and the current standard. Human papillomavirus testing by standalone automated RNA in situ hybridization on a clinical diagnostic platform currently available in routine diagnostic histopathology laboratories is a feasible alternative to the two-step algorithm of p16 and DNA in situ hybridization. Control tissue staining procedures need to be adapted to achieve the most accurate results.