Impact Patient Care Research Articles

The role of large language models in the peer-review process: opportunities and challenges for medical journal reviewers and editors

The peer review process ensures the integrity of scientific research. This is particularly important in the medical field, where research findings directly impact patient care. However, the rapid growth of publications has strained reviewers, causing delays and potential declines in quality. Generative artificial intelligence, especially large language models (LLMs) such as ChatGPT, may assist researchers with efficient, high-quality reviews. This review explores the integration of LLMs into peer review, highlighting their strengths in linguistic tasks and challenges in assessing scientific validity, particularly in clinical medicine. Key points for integration include initial screening, reviewer matching, feedback support, and language review. However, implementing LLMs for these purposes will necessitate addressing biases, privacy concerns, and data confidentiality. We recommend using LLMs as complementary tools under clear guidelines to support, not replace, human expertise in maintaining rigorous peer review standards.

Investigating the Impacts of Perianal Skin Cancer on Patient Quality of Life

Perianal skin cancer, while rare, can have severe consequences on patient quality of life. This study sought to address this question by examining patient lived experience, social impact, psychological symptoms, and perceived informational needs following a diagnosis of perianal skin cancer. Mixed methods enabled contextualization, exploration, and illumination of pertinent patient issues. Results indicated that stigma, communication, psychological and physical effects, and concern for survival may impact patient care. Psychometric data support these findings. Patient informational needs suggest a reduction in the perceived frequency of all needs and a strong preference for digital over face-to-face information provision. As a truly patient-centered study, this paper provides an important starting point for the consideration of psychosocial support for perianal skin cancer patients. The outcomes are disseminated across clinical policy, offering highlighted points of consideration. Perianal skin cancers are rare. They are rare enough that, in general, the evidence base lacks the larger studies and data that could enable more consistent practice worldwide. This is the first patient-centered investigation of the impacts of perianal skin cancer on quality of life and patient well-being, and it is the first patient study to cascade into policy amendment within the United Kingdom, notably within the clinical unit. This study provides concrete, specific outcomes related to patient experience and clinical need, and suggests both the generic nature of the support available to assist these patients and the lack of productive practice that could be molded and strengthened from it.

Exploring perceptions of what increased gender diversity might bring to the nursing profession.

To explore university nursing students and academic staff's perceptions of what increased gender diversity might bring to the nursing profession. An exploratory study with students and academic staff from two university nursing schools. Students and staff in two university nursing schools were invited to participate in an anonymous online survey (October-November 2022). The survey focused on gender diversity within nursing and patient care, asking respondents about existing barriers to gender diversity and inviting ideas on increasing gender diversity within nursing. The survey findings helped inform questions, which were used to further explore views and thoughts of gender diversity within nursing through semi-structured one-to-one interviews (January-February 2023). Nearly, two-thirds (64%, n = 69) of survey respondents strongly agreed/agreed that the lack of gender diversity in nursing negatively impacted delivering care to a gender-diverse society. Most (84%, n = 90) strongly agreed/agreed that increased gender diversity within the nursing workforce would positively contribute to nursing. Three-quarters (75%, n = 74) strongly agreed/agreed that working with a more gender-diverse nursing workforce would enrich their experience as a nurse. Three themes emerged from the interview data: shared stereotypes; improved care through knowledge, better relations and the presence of a gender-diverse workforce; a culture of welcome: suggested changes for the future. Most of those who participated in the study believe there are benefits to be gained from greater gender diversity within nursing. This study provides insight into the lack of gender diversity in the nursing environment, highlights how this might impact patient care and suggests actions to make nursing a more inclusive profession. Practical solutions were suggested, including the greater visibility of trans and non-binary persons in advertisement and recruitment campaigns to ensure nursing is viewed as a career choice for "all". Including a space for considered pronouns on university application forms, hospital documentation and name badges. Gender-neutral titles and uniforms should be considered for all nursing staff, and more gender-neutral toilets should be made available for staff and patients in university and hospital settings. This study addressed the lack of gender diversity in nursing and explored what an increase in gender diversity might bring to the nursing profession. The main findings were: (i) Less than a tenth (9%, n = 12) of respondents described their team of colleagues as being "extremely gender diverse". (ii) Most (84%, n = 90) strongly agreed/agreed that increased gender diversity within the nursing workforce would be a positive attribute to nursing. (iii) Three-quarters 75% (n = 74) strongly agreed/agreed that working with a more gender-diverse nursing workforce would enrich their experience as a nurse. (iv) Many stereotypes still exist in nursing and tackling them is important to make the profession more inclusive. (v) A nurse's gender can impact the care they provide. (vi) A more gender-diverse workforce would better reflect the population it serves. (vii) This research will have an impact on the nursing profession globally. The consolidated criteria for reporting qualitative studies (COREQ) was used as a guide throughout data collection and analysis. Every step of the study, including the survey and interview schedule, was co-constructed using an iterative approach with service users, students and staff who had personal experience of gender diversity and were a core part of the study team.

Trends in initial pharmacological COPD treatment in primary care (2010–2021): a population-based study using the PHARMO Data Network

Abstract Background Pharmacological treatment is a cornerstone of chronic obstructive pulmonary disease (COPD) management, with general practitioners providing the most care. However, the lack of data on prescribing trends in initial pharmacotherapy in primary care hinders the understanding of how scientific and technical developments impact patient care and may also perpetuate suboptimal practices. Hence, this study aims to analyze trends in the initial pharmacological treatment of newly diagnosed COPD patients in Dutch primary care from 2010 to 2021. Methods A repeated cross-sectional study was conducted via the PHARMO GP Database. Data were extracted from the electronic health records of individuals managed by general practitioners in the Netherlands within the PHARMO Data Network. Individuals aged ≥ 40 years at diagnosis with an International Classification of Primary Care code for COPD (R95) were included. Initial pharmacological treatment was identified based on the first prescription issued within 90 days postdiagnosis. The annual proportions of individuals receiving a specific treatment among those diagnosed were calculated and directly standardized by age and sex according to the 2021 Dutch population structure. Trend analysis was performed via joinpoint regression. Results A total of 54,628 COPD patients were included (median [IQR] age: 65 [57–73]; 53.7% male), with 36.4% not receiving respiratory medication within 90 days of diagnosis, and 4.2% on other treatments. Trend analysis revealed that LAMA monotherapy increased from 13.4% in 2010 to 15.1% in 2015 and then declined to 11.0% by 2021. Moreover, LABA-ICS decreased from 17.6% to 8.5% between 2010 and 2018, after which it plateaued. In contrast, LABA-LAMA sharply increased, from 0.6% in 2010 to 9.6% in 2021. LABA monotherapy increased from 2.6% in 2010 to 5.7% in 2021. Triple therapy has remained constant. For reliever-only therapies, SABA increased from 8.5% in 2010 to 14.3% in 2018 and then stabilized, whereas SAMA and SABA-SAMA remained low throughout. Conclusions Shifts in initial pharmacological COPD treatment from 2010 to 2021 likely reflect the introduction of new inhalers and updated management strategies. However, a significant proportion of patients remain without GP prescriptions, which warrants further investigation.

The Impact Of Implementing Work Culture (Concise, Neat, Clean, Care, Diligent) And Nurse Competence On Nurse Productivity

Background: Nurse productivity is crucial in determining the quality of healthcare services in hospitals. It directly impacts patient care and hospital operations. The implementation of Work Culture (Concise, Neat, Clean, Caring, Diligent) and nurses' competencies are factors that can significantly influence the productivity of nurses. The primary objective of this study is to determine the impact of Work Culture (Concise, Neat, Clean, Caring, Diligent) and nurses' competencies on nurses' productivity at Mojowarno Christian Hospital, Jombang, in 2024. The study assesses how applying these factors enhances nurse performance and hospital service efficiency. Methods: This research uses a quantitative approach with a cross-sectional design to examine the relationship between variables at a particular moment. The sample comprises 100 nurses from Mojowarno Christian Hospital, chosen through random sampling. The independent variables include the implementation of Work Culture (Concise, Neat, Clean, Care, Diligent) and nurse competencies, while the dependent variable is nurse productivity. Data collection was conducted using observation sheets tested for validity and reliability. Ordinal regression analysis was employed to analyze the data. Results: The results of the ordinal regression analysis showed a P-value of 0.000, which is less than 0.05, leading to the rejection of H0 and the acceptance of H1. This indicates a significant collective influence of the implementation of Work Culture (Concise, Neat, Clean, Caring, Diligent) and nurses' competencies on nurses' productivity. In the partial analysis, the P-value for the Work Culture (Concise, Neat, Clean, Care, Diligent) variable was 0.024, less than 0.05, suggesting a significant influence on nurses' productivity. The P-value for nurses' competencies was 0.000, indicating a significant partial effect on productivity. Conclusion: The study concludes that both the implementation of Work Culture (Concise, Neat, Clean, Caring, Diligent) and nurses' competencies have a significant impact on nurses' productivity at Mojowarno Christian Hospital. The results underline the importance of fostering a strong work culture and continuously improving nurses' competencies to enhance productivity and the overall quality of healthcare services. Hospitals should prioritize these factors to ensure efficient and effective care delivery, improving organizational outcomes. Keywords: Work Culture (Concise, Neat, Clean, Care, Diligent), competency, productivity.

Association Between Baseline and Changes in Early Neutrophil-to-Lymphocyte Ratio on Survival in Patients with Metastatic Bladder Carcinoma Treated with Immunotherapy.

Background and Objectives: A high baseline neutrophil-to-lymphocyte ratio (NLR) is a poor prognostic factor in various cancers. However, its predictive role in metastatic bladder cancer (mBC) treated with immunotherapy is unclear. In this study, we aimed to investigate the relationship between the baseline and change in NLR and overall survival in mBC patients treated with immunotherapy, with the potential to significantly impact patient care. Materials and Methods: A retrospective analysis was conducted on 56 mBC patients who received second-line immunotherapy after progressing on platinum-based chemotherapy. Patients were classified into high and low NLR groups using a cutoff value of 3.3. A further division was made based on NLR changes after two cycles of immunotherapy: whether NLR increased (≥10%) or decreased (≥10%). The endpoint was to estimate the association between clinicopathological features and survival outcomes. Results: The study included 56 patients, with a median age of 66.6 years and a male-to-female ratio of 2.3:1. A low baseline NLR was associated with better OS than a high baseline NLR (p = 0.005). After two immunotherapy cycles, patients with a decreased NLR (≥10%) had significantly longer OS than those with an increased NLR (≥10%), regardless of the baseline NLR (p = 0.003). The overall median survival was 15 months, with 10 months for the NLR-increased group and not reached for the NLR-decreased group. Conclusions: Our study highlights the potential of baseline NLR and early changes in NLR as valuable prognostic markers for mBC patients receiving immunotherapy. Elevated neutrophils and lymphopenia negatively impact prognosis and treatment effectiveness, and NLR shows promise as a prognostic marker, inspiring further research and potential improvements in patient care.

[89Zr]Zr-DFO-TOC: a novel radiopharmaceutical for PET imaging of somatostatin receptor positive neuroendocrine tumors

BackgroundNeuroendocrine tumors (NETs) are clinically diverse types of tumors that can arise anywhere in the body. Previous studies have shown that somatostatin receptors (SSTRs) are overexpressed on NET cell membranes relative to healthy tissue, allowing for tumor targeting through radiolabeled somatostatin analogs (SSAs). This work aims to develop a novel 89Zr-labeled tracer incorporating the SSA, octreotide (TOC), for positron emission tomography (PET) imaging of SSTR + NETs and predictive dosimetry calculations, leveraging the excellent nuclear (t½ = 3.27 days, β+ = 22.3%, β+avg = 395.5 keV) and chemical characteristics (+ 4 oxidation state, preferential coordination number of 7/8, favorable aqueous chemistry) of 89Zr. In combination with 89Zr, the known radiochemistry with the chelator deferoxamine (DFO) gives reason to believe that this radiopharmaceutical incorporating an octreotide conjugate will be successful in studying the suitability of detecting SSTR + NETs.ResultsRadiochemical tracer assessment indicated that amounts as low as 0.1 nmol DFO-TOC can be effectively radiolabeled with 89Zr, while maintaining ≥ 95% radiochemical yield. The stability of the compound was found to maintain radiochemical yields of 89.6% and 88.7% on the benchtop and in mouse serum, respectively, after 9 days. Receptor binding and competitive receptor blocking assays compared AR42J (high SSTR expression), PC-3 (moderate SSTR expression), and PANC-1 (minimal SSTR expression) cell lines at time points up to 6 days. In vitro studies demonstrated highest uptake in AR42J cells, and statistically significant differences in tracer uptake were seen after 1 h. Internalization assays showed maximum internalization after 3 h for all cell lines.ConclusionsIn this work, [89Zr]Zr-DFO-TOC was synthesized with radiochemical yields ≥ 95% and was found to remain stable in vitro at extended time points. In vitro cell studies demonstrated a statistically significant difference between receptor binding and blocking experiments. The development of this work shows potential to positively impact patient care through the predictive dosimetry calculations for the FDA-approved therapeutic agent [177Lu]Lu-DOTA-TATE, while allowing for imaging at extended timepoints and should be studied further.

An international Delphi consensus on patient preparation for metabolic and bariatric surgery.

Global obesity rates have risen dramatically, now exceeding deaths from starvation. Metabolic and bariatric surgery (MBS), initially for severe obesity (BMI ≥35 kg/m2), is performed globally over 500 000 times annually, offering significant metabolic benefits beyond weight loss. However, varying eligibility criteria globally impact patient care and healthcare resources. Updated in 2022, ASMBS and IFSO guidelines aim to standardise MBS indications, reflecting current understanding and emphasising comprehensive preoperative assessments. Yet, clinical variability persists, necessitating consensus-based recommendations. This modified Delphi study engaged 45 global experts to establish consensus on perioperative management in MBS. Experts selected from bariatric societies possessed expertise in MBS and participated in a two-round Delphi protocol. Consensus was achieved on 90 of 169 statements (53.3%), encompassing multidisciplinary team composition, patient selection criteria, preoperative testing, and referral pathways. The agreement highlighted the critical role of comprehensive preoperative assessments and the integration of healthcare professionals in MBS. These findings offer essential insights to standardise perioperative practices and advocate for evidence-based guidelines in MBS globally. The study underscores the need for unified protocols to optimise outcomes and guide future research in MBS.

Generative Artificial Intelligence and Cybersecurity Risks: Implications for Healthcare Security Based on Real-life Incidents

Background: The potential of generative artificial intelligence (genAI) tools, such as ChatGPT, is being increasingly explored in healthcare settings. However, the same tools also introduce significant cybersecurity risks that could compromise patient safety, data integrity, and institutional trust. This study aimed to examine real-world security breaches involving genAI and extrapolate their potential implications for healthcare settings. Methods: Using a systematic Google News search and a consensus-based approach among the authors, five high-profile genAI breaches were identified and analyzed. These cases included: (1) Data exposure in ChatGPT (OpenAI) due to an open-source library bug (March 2023); (2) Unauthorized data disclosure via Samsung’s (Samsung Group) use of ChatGPT (2023); (3) Logical vulnerabilities in Chevrolet (General Motors) AI-powered chatbot resulting in pricing errors (December 2023); (4) Prompt injection vulnerability in Vanna AI (Vanna AI, Inc.) which enabled remote code execution (2024); and (5) the deepfake technology used in a scam targeting the engineering firm Arup (Arup Group Limited), leading to fraudulent transactions (February 2024). Hypothetical healthcare scenarios were constructed based on the five cases, mapping their mechanisms to vulnerabilities in electronic health records (EHRs), clinical decision support systems (CDSS), and patient engagement platforms. Each case was analyzed using the Confidentiality, Integrity, and Availability (CIA) triad of information security to systematically identify vulnerabilities and propose actionable safeguards. Results: The analyzed cases of AI security breaches revealed significant risks to healthcare systems. Confidentiality violations included the potential exposure of sensitive patient records and billing information, extrapolated from incidents such as the ChatGPT data exposure and Samsung’s cases. These identified security breaches raised concerns about privacy violations, identity theft, and non-compliance with regulations such as Health Insurance Portability and Accountability Act (HIPAA). Integrity vulnerabilities were highlighted in Vanna AI's prompt injection flaw incident, with risks of altering patient records, compromising diagnostic algorithms, and misleading CDSS with erroneous recommendations. Similarly, logic errors identified in the Chevrolet case exposed potential risks of inaccurate billing, double-booked appointments, and flawed treatment plans within healthcare contexts. Availability disruptions, observed through system outages and operational suspensions following breaches like the ChatGPT and deepfake cases, can delay access to EHR systems or AI-driven CDSS. Such interruptions would directly impact patient care and create inefficiencies in administrative workflows. Conclusions: Generative AI presents a double-edged sword in healthcare, with transformative potential accompanied by substantial risks. Extrapolation of security breach cases in this study highlighted the urgent need for robust safeguards if genAI is implemented in healthcare settings. To address these vulnerabilities, healthcare institutions must implement strong security protocols, enforce strict data governance, and create AI-specific incident response plans. The balance between genAI-enabled innovation and protection of patient safety and data integrity trust requires proactive safety measures.

Evaluating genetic counseling session duration: A scoping review of patient care time, influencing factors, and impact onpatient outcomes.

One key element of evaluating the quality of a genetic counseling session is the measurement of its efficiency, yet limited research exists on how the genetic counseling process relates to time and which elements contribute to improved quality of care. A scoping review was undertaken to document studies that have reported genetic counseling patient care time and provide a landscape of the average patient care time, which factors impact patient care time, and how patient care time relates to experiences and outcomes. Twenty-five studies met criteria and were included. Patient care time was reported variably among the studies included. On average, genetic counseling patient care time was a mean of 60 min (53 min median) for observational studies and control groups in experimental studies and 44 min (41 min median) for intervention groups in experimental studies. Interventions impacting patient care time included pre-genetic counseling education and group genetic counseling sessions. The impact of patient care time on patient experiences and outcomes was rarely evaluated, and therefore, efficiency could not often be assessed in the studies. Studies that reported on patient care time and outcomes were able to draw conclusions such as shorter time did not negatively impact patients and some groups of patients may benefit from longer sessions. Most studies did not analyze the relationship between patient care time and patient experiences or outcomes. Future research should aim to identify factors influencing patient care time, assess the content of genetic counseling sessions, and evaluate patient care time in relation to patient experiences and outcomes. Understanding these aspects could lead to improved efficiency and patient-centered, equitable care in genetic counseling practices.

Navigating the unseen peril: safeguarding medical imaging in the age of AI

In response to the increasing significance of artificial intelligence (AI) in healthcare, there has been increased attention – including a Presidential executive order to create an AI Safety Institute – to the potential threats posed by AI. While much attention has been given to the conventional risks AI poses to cybersecurity, and critical infrastructure, here we provide an overview of some unique challenges of AI for the medical community. Above and beyond obvious concerns about vetting algorithms that impact patient care, there are additional subtle yet equally important things to consider: the potential harm AI poses to its own integrity and the broader medical information ecosystem. Recognizing the role of healthcare professionals as both consumers and contributors to AI training data, this article advocates for a proactive approach in understanding and shaping the data that underpins AI systems, emphasizing the need for informed engagement to maximize the benefits of AI while mitigating the risks.

Standardized Neonatal ICU Progress Note Template and Feedback System: A Clinical Documentation Improvement Initiative.

Introduction This quality improvement (QI) initiative aimed to improve the clinical documentation of daily progress notes in the neonatal intensive care unit (NICU) by applying a standardized documentation template and conducting regular cycles of audit and feedback to ensure compliance and improvement. Methods Firstly, to better assess documentation practices impacting patient care, members of the NICU auditing team identified seven key points in medical records. These points were then used for the audit of 30 randomly selected "progress notes" for infants admitted to the NICU between January and June 2022. We introduced a new standardized progress note template in the NICU based on the initial seven key points considered essential in NICU documentation. Subsequently, we educated the staff on the latest changes and their impact on patient care delivery. Also, we raised awareness amongthe NICU staff regarding the quality improvement project we were running and the requirement to adopt the new standard template. We also ensured that everyone had access to the new template. The QI team analyzed NICU progress notes every three months from October 2022 to July 2023; 45 notes were reviewed per cycle, a total of 135 notes. With each cycle, we took feedback from NICU team members regarding the deficiencies and opportunities for improvement in clinical documentation and encouraged adherence to key points. A template for the specific needs of the NICU was redesigned based on feedback received from all stakeholders on how to reduce the obstacles in adopting and retaining compliance with the new template. Results Compliance with the "key elements" of documentation improved dramatically after introducing a new template and feedback system. In the final cycle, the overall compliance was 81% (p<0.0001), well above our initial target of 60% compliance. Conclusion A unit that implements targeted audit-and-feedback measuresrelevant to the clinical team requirement can substantiallyand consistently improve documentation.

Ocular Cystinosis Experience in Southwestern Ontario

Purpose To evaluate ocular treatment adherence and its impact on clinical outcomes in patients with cystinosis in southwestern Ontario, where the disease incidence is higher due to a founder effect in the Old Order Amish population. Methods This was a retrospective case series of patients with ocular cystinosis seen at Victoria Hospital and the Ivey Eye Institute at St Joseph's Health Care in London, Ontario, Canada, from 2008 to 2023. The authors investigated the demographics, ocular manifestations, and visual outcomes and characteristics in pediatric patients with ocular cystinosis. They also conducted qualitative analysis to characterize medication compliance and identify treatment barriers to compliance. Results This study included 14 patients with ocular cystinosis. In southwestern Ontario, the incidence of cystinosis is approximately 1 in 4,700 live births. Most patients were Old Order Amish, with a family history of cystinosis and consanguineous parents. During treatment, patients were typically asymptomatic, but photophobia was the most reported symptom. Slit-lamp examination revealed cystine crystals in the cornea of all patients; however, best corrected visual acuity and intraocular pressure were unremarkable in every case. A Fisher's exact test revealed a trend toward lower compliance in Amish patients compared to non-Amish patients (odds ratio: 0.067, P = .103). Significant treatment barriers for patients with ocular cystinosis were identified, including compliance issues with frequent eye drop regimens, educational and financial burdens, and geographical and cultural challenges, all impacting patient care and follow-up. Conclusions This study highlights the need for improved strategies to improve treatment compliance and overcome barriers to care for patients with ocular cystinosis, particularly within the Old Order Amish population in southwestern Ontario, to ensure better clinical outcomes and quality of life. [ J Pediatr Ophthalmol Strabismus . 20XX;XX(X):XXX–XXX.]

Psychometric properties of Farsi version of Demoralization Scale-II (DS-II) in Iranian cancer patients.

Demoralization, a prevalent form of psychological distress, significantly impacts patient care, particularly in terminally ill individuals, notably those diagnosed with cancer. This study aimed to assess psychometric properties of Farsi version of Demoralization Scale-II (DS-II) in Iranian cancer patients. This study was descriptive-analytical cross-sectional research. The statistical population was cancer patients who sought treatment at Imam Khomeini Hospital in Tehran throughout the 2021-2022. In the initial phase of the study, a preliminary sample comprising 200 patients was carefully selected through convenience sampling. After applying these criteria, 160 patients satisfactorily completed the questionnaires, forming the final study sample. They completed series of questionnaires that included sociodemographic information, DS-II, Scale of Happiness of the Memorial University of Newfoundland, and Beck Depression Inventory (BDI-II). The evaluation included exploratory factor analysis, confirmatory factor analysis (CFA), assessments of convergent validity, and internal consistency reliability. The CFA revealed a 2-factor model consistent with the original structure. The specific fit indices, including the Comparative Fit Index, Root Mean Square Error of Approximation, and Goodness-of-Fit Index, were 0.99, 0.051, and 0.86, respectively. Significant correlation coefficients (p < 0.05) were found between the DS-II and the Beck Depression and MUNSH Happiness scales. The internal consistency of the DS-II, as measured by Cronbach's alpha, yielded values of 0.91 for the meaning and purpose factor, 0.89 for the coping ability factor, and 0.92 for the total score. The Farsi version of DS-II has demonstrated reliability and validity in evaluating demoralization among cancer patients in Iran. This tool can offer valuable insights into the psychological problems of terminally ill patients. Further research opportunities may include conducting longitudinal studies to track demoralization over time and exploring the impact of demoralization on the overall well-being and care of terminally ill patients in Iranian society.

Panel estimated Glomerular Filtration Rate (GFR): Statistical considerations for maximizing accuracy in diverse clinical populations.

Assessing glomerular filtration rate (GFR) is critical for diagnosis, staging, and management of kidney disease. However, accuracy of estimated GFR (eGFR) is limited by large errors (>30% error present in >10-50% of patients), adversely impacting patient care. Errors often result from variation across populations of non-GFR determinants affecting the filtration markers used to estimate GFR. We hypothesized that combining multiple filtration markers with non-overlapping non-GFR determinants into a panel GFR could improve eGFR accuracy, extending current recognition that adding cystatin C to serum creatinine improves accuracy. Non-GFR determinants of markers can affect the accuracy of eGFR in two ways: first, increased variability in the non-GFR determinants of some filtration markers among application populations compared to the development population may result in outlying values for those markers. Second, systematic differences in the non-GFR determinants of some markers between application and development populations can lead to biased estimates in the application populations. Here, we propose and evaluate methods for estimating GFR based on multiple markers in applications with potentially higher rates of outlying predictors than in development data. We apply transfer learning to address systematic differences between application and development populations. We evaluated a panel of 8 markers (5 metabolites and 3 low molecular weight proteins) in 3,554 participants from 9 studies. Results show that contamination in two strongly predictive markers can increase imprecision by more than two-fold, but outlier identification with robust estimation can restore precision nearly fully to uncontaminated data. Furthermore, transfer learning can yield similar results with even modest training set sample size. Combining both approaches addresses both sources of error in GFR estimates. Once the laboratory challenge of developing a validated targeted assay for additional metabolites is overcome, these methods can inform the use of a panel eGFR across diverse clinical settings, ensuring accuracy despite differing non-GFR determinants.

Understanding the Burden of Lennox-Gastaut Syndrome: Implications for Patients, Caregivers, and Society in High and Low Resource Settings: A Narrative Review.

Lennox-Gastaut syndrome (LGS) poses significant challenges in diagnosis, management, and treatment due to its rare nature, diverse presentation, and drug-resistant seizures. While classical features aid diagnosis, challenges persist, impacting patient care and outcomes. Understanding the syndrome's burden is essential for improving healthcare policies and interventions. This literature review aimed to comprehensively analyze clinical symptom burden, comorbidities, care requirements, quality of life (QoL), economic burden, caregiver burden, and treatment burden to pinpoint knowledge gaps for future research and intervention development, ultimately aiming to enhance the well-being of patients and caregivers. A comprehensive literature review was conducted using electronic databases and manual searches to analyze clinical symptom burden, comorbidities, care requirements, QoL, economic burden, caregiver burden, and treatment burden associated with LGS. LGS significantly impacts the QoL for patients, with seizures, cognitive impairment, and social challenges affecting various aspects of daily living. Caregivers, particularly mothers, face significant stress and exhaustion, impacting their own health and well-being. Healthcare resource utilization is substantial, with elevated costs for LGS patients compared to controls. Cognitive impairment is prevalent and worsens over time, influencing educational and social outcomes. Prognosis varies based on factors like age of onset, underlying cause, and genetic factors, with limited treatment options available. Managing LGS requires tailored approaches addressing seizures, comorbidities, and caregiver needs. While advancements in treatments and surgical techniques offer hope, challenges persist in achieving optimal outcomes and reducing the societal burden. The management of LGS involves a combination of pharmacological and nonpharmacological therapies, tailored to the individual patient's needs and response to treatment. Regular follow-up with a neurologist specialized in epilepsy is crucial for ongoing management, including annual reassessment of the diagnosis and treatment plan. The primary focus should always be on optimizing the patient's QoL, including learning and behavioral management, as complete seizure remission is rare.

Impact of Demographic Modifiers on Readability of Myopia Education Materials Generated by Large Language Models.

The rise of large language models (LLM) promises to widely impact healthcare providers and patients alike. As these tools reflect the biases of currently available data on the internet, there is a risk that increasing LLM use will proliferate these biases and affect information quality. This study aims to characterize the effects of different race, ethnicity, and gender modifiers in question prompts presented to three large language models (LLM) on the length and readability of patient education materials about myopia. ChatGPT, Gemini, and Copilot were provided a standardized prompt incorporating demographic modifiers to inquire about myopia. The races and ethnicities evaluated were Asian, Black, Hispanic, Native American, and White. Gender was limited to male or female. The prompt was inserted five times into new chat windows. Responses were analyzed for readability by word count, Simple Measure of Gobbledygook (SMOG) index, Flesch-Kincaid Grade Level, and Flesch Reading Ease score. Significant differences were analyzed using two-way ANOVA on SPSS. A total of 150 responses were analyzed. There were no differences in SMOG index, Flesch-Kincaid Grade Level, or Flesch Reading Ease scores between responses generated with prompts containing different gender, race, or ethnicity modifiers using ChatGPT or Copilot. Gemini-generated responses differed significantly in their SMOG Index, Flesch-Kincaid Grade Level, and Flesch Reading Ease based on the race mentioned in the prompt (p<0.05). Patient demographic information impacts the reading level of educational material generated by Gemini but not by ChatGPT or Copilot. As patients use LLMs to understand ophthalmologic diagnoses like myopia, clinicians and users should be aware of demographic influences on readability. Patient gender, race, and ethnicity may be overlooked variables affecting the readability of LLM-generated education materials, which can impact patient care. Future research could focus on the accuracy of generated information to identify potential risks of misinformation.

Artificial intelligence (AI) for paediatric fracture detection: a multireader multicase (MRMC) study protocol

IntroductionPaediatric fractures are common but can be easily missed on radiography leading to potentially serious implications including long-term pain, disability and missed opportunities for safeguarding in cases of inflicted injury....

Student perspectives of equity, diversity, and inclusion in the curriculum of a UK medical school—A mixed-methods study

BACKGROUND: Equity, inclusion, and diversity in medical education are increasingly recognized as crucial for enhancing student engagement and improving health outcomes. This paper aims to analyze trends and assess student attitudes toward ethnic equity, inclusion, and diversity within campus-based modules at the University of Buckingham Medical School, UK. MATERIALS AND METHODS: A mixed-methods approach was employed, involving 97 medical students aged 18–24 years (86.6%) between 2021 and 2023. Quantitative data were gathered through a pretested questionnaire using a five-point Likert scale and analyzed using SPSS software (version 26). Qualitative insights were obtained from five focus group sessions with randomly selected medical students and analyzed thematically. RESULTS: The findings of this study indicated a significant proportion of Asian descent students (56.7%). First-year and White ethnicity students perceived the curriculum as more representative compared to second-year counterparts and peers from other ethnic backgrounds. Notably, first-year students showed a heightened understanding of social science terms, especially “ethnicity,” and 67% of female students demonstrated a deeper comprehension of sociocultural factors influencing health behaviors. Across demographics, there was consistent recognition of these factors impacting patient care. Qualitative findings underscored the importance of representation in medical education, biases in recruitment, and advocated for greater faculty diversity. Additionally, there is a need for a curriculum reflecting diverse dietary habits and including role models from various ethnic backgrounds. CONCLUSION: This study emphasizes the critical need for curricular reform in medical education to prepare students for a multicultural society. Addressing disparities in curriculum representation and promoting diversity within faculties are essential for equipping future healthcare professionals with the skills to provide culturally competent care and navigate diverse patient populations effectively.

Pharmacist Perceptions of Motivation and Well-being Using Self-Determination Theory: A Qualitative Study.

Many US hospitals and health systems have implemented well-being programs to address the clinician well-being and burnout crisis. Most community pharmacists experience at least one symptom of burnout, yet they have been overlooked for inclusion in well-being initiatives. To explore community pharmacists' perceptions of how motivation and burnout impact patient care and how fulfillment of basic psychological needs (autonomy, competence, and relatedness) impacts motivation and well-being. Focus groups were conducted with 20 community pharmacists. A semi-structured focus group guide was developed using Self-Determination Theory (SDT). Transcriptions from the focus groups were analyzed using deductive qualitative analysis with SDT as a framework and inductive analysis to code subthemes. Our findings revealed that pharmacists who feel burnout experience depersonalization toward patients which lowers the quality of patient-pharmacist interactions. Pharmacists who did not feel burnout expressed a sense of professional fulfillment, which motivated them to provide patient-centered care. Pharmacists indicated that unrealistic expectations from patients and corporate management, such as pressure from patients to fill prescriptions quickly and management expectations to meet prescription fill quotas, negatively impacted autonomy. Conversely, having access to clinical information, workflow optimization, and realistic job expectations supported autonomy. Poor relationships with patients and coworkers negatively impacted relatedness and contributed to communication barriers, workplace negativity, and emotional detachment from work. Relatedness was facilitated by building relationships and mutual respect with patients and coworkers and cultivating a positive work culture. Expectations for perfection and the need for multitasking when understaffed diminished competency. Adequate staffing and allocation of time to complete job duties served to support competency. Community pharmacists are faced with situations that undermine autonomy, relatedness, and competency, which according to SDT need to be fulfilled to facilitate well-being.