Inform Decision Makers Research Articles

Understanding Hernia's Repair, Techniques, Mesh Options, and Recurrence Rates in Abdominal Wall Surgery

Introduction: Hernia repair surgery is a common procedure with significant variations in techniques, mesh options, and recurrence rates. Understanding these factors is essential for optimizing patient outcomes. Objective: This study aims to investigate hernia repair techniques, mesh options, and recurrence rates in abdominal wall surgery, providing insights to optimize patient outcomes and inform clinical decision-making. Methodology: A retrospective cohort study was conducted at two renowned hospitals in Peshawar, Pakistan, with a sample size of 102, from April 2023 to March 2024. Data on surgical techniques, mesh options, postoperative complications, and hernia recurrence rates were collected from medical records. Chi-square tests were used for statistical analysis. Results: A total of 102 patients were included in the study, with inguinal hernias being the most common (56.9%). Open tension-free repair was the predominant surgical approach (62.7%), and polypropylene mesh was the most commonly used (70.6%). Postoperative complications were observed in 19.6% of patients, with surgical site infection being the most frequent (11.8%). Hernia recurrence occurred in 13.7% of cases, with no significant association found between surgical approach and recurrence rates (p=0.632). Conclusion: This study provides insights into hernia repair outcomes highlighting the prevalence of inguinal hernias, the predominance of open tension-free repair, and the challenges posed by postoperative complications and hernia recurrence. By addressing these challenges and embracing tailored surgical approaches, we can enhance patient care and improve surgical outcomes.

Delivering and Evaluating Climate Services: The North Central U.S. Climate and Drought Webinar Series

Abstract Evaluation of near-term (sub)seasonal climate services’ impact is challenging but necessary for ensuring that society’s needs for actionable information are met. We use a descriptive study of the monthly North Central U.S. Climate and Drought Webinar Series at two time points (2014 and 2021) to examine societal impacts on capacity-building, sensemaking, fact-establishing, communication, decision-making, and social–ecological systems. The North Central U.S. Climate and Drought Webinar Series arose following a 2011 climate disaster and established itself over the next 10 years as a monthly resource for climate and impact information translation and interaction. Survey respondents indicated early benefits related to understanding how to find and use climate information and improved conceptual understanding of climate issues and problems. Many used webinar information to compare with other sources of data or to incorporate into their own communications, uses which can increase overall societal trust in climate information over time. Attendees’ self-reported capacity for using climate information in decision-making and actual use of information in specific decisions or management contexts increased as the webinar series approached the 10-yr mark. Most participants did not note financial or other social–ecological outcomes of their use of the webinars. We conclude by recommending that climate services be evaluated over sufficiently long time periods to capture evolving impacts and that evaluations incorporate impact rubrics that measure subtle yet important societal capacities and decision-making processes related to climate risk management.

Additional Procedures at the Time of Total Ankle Replacement Do Not Increase Risk of Short-term Complications: A Matched Cohort Analysis.

This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), alone or with concomitant procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using Current Procedural Terminology (CPT) codes to identify patients who underwent TAA (27702) between 2010 to 2021. Patients were divided into cohorts based on the presence or absence of ancillary procedures. Propensity score matching was employed to account for demographic differences, and statistical analyses were performed to compare short-term complication rates between matched cohorts. A total of 2225 patients were identified, with 1432 (64.4%) receiving TAA alone and 793 (35.6%) with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times (P < .001) and length of hospital stay (LOS) (P < 0.001). Rates for extended LOS were significantly higher in the ancillary cohort than in the simple cohort (P = .01). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). American Society of Anesthesiologists classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, P = .04). Matched subgroup analysis excluding tendon lengthening as a concomitant procedure found that the ancillary cohort still had longer operative time (P < .001) and LOS (P < .05) than patients undergoing simple TAA. Without significant difference in rates of AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring additional corrective procedures at the time of TAA. Level III, retrospective comparative study.

Determinants of behavior towards hemp-based products: an application of the theory of planned behavior

PurposeThis paper examines how U.S. consumer intentions to adopt hemp vary across product types using the theory of planned behavior (TPB).Design/methodology/approachData were collected via an online survey of U.S. residents in 2022 (n = 1,948). Two-step structural equation modeling is used to examine how TPB constructs and background factors influence intent to use five different hemp-based products: cannabidiol (CBD), clothing, food, personal care products, and pet products. Data are analyzed using R.FindingsPositive attitudes towards all categories of hemp-based products increase the probability of adoption, while subjective norm and perceived behavioral control have limited and varied significant influence across product models. Age has a consistent significant and negative influence on adoption.Research limitations/implicationsFindings highlight consumer segmentation and marketing opportunities, inform hemp stakeholder decision-making, and provide directions for future research. Given the absence of explanatory power of SN and PBC on most product models and the diversity of products and nuanced U.S. hemp policy, future research could investigate expanded iterations of TPB. Using revealed behavior could also highlight potential intention-behavior gaps and offer more robust insights for hemp stakeholders.Originality/valueFindings contribute to a limited body of information on markets and consumer demand for hemp in the U.S.

End-of-life care needs in cancer patients: a qualitative study of patient and family experiences

BackgroundCancer is a disease that transcends what is purely medical, profoundly affecting the day-to-day life of both patients and family members. Previous research has shown that the consequences of cancer are greatly aggravated in patients at the end of life, at a time when they must also grapple with numerous unmet needs. The main objective of this study was to obtain more in-depth insight into these needs, primarily in patients with end-stage cancer nearing death.MethodsSemi-structured interviews were conducted in Spain with cancer patients at the end of life (n = 3) and their family members (n = 12). The findings from the interviews were analyzed using qualitative thematic analysis and a grounded theory approach.ResultsFour major themes emerged from the interviews that explored the needs and concerns of patients with cancer at the end of life: (1) physical well-being (2) emotional well-being (3) social well-being and (4), needs relating to information and autonomous decision-making. The interviews also shed light on the specific needs of family members during this period, namely the difficulties of managing increased caregiver burden and maintaining a healthy work-life balance.ConclusionsA lack of support, information and transparency during a period of immense vulnerability makes the end-of-life experience even more difficult for patients with cancer. Our findings highlight the importance of developing a more in-depth understanding of the needs of this population, so that informed efforts can be made to improve palliative healthcare and implement more comprehensive care and support at the end of life.

Features of databases that supported searching for rapid evidence synthesis during COVID-19: implications for future public health emergencies

BackgroundAs evidence related to the COVID-19 pandemic surged, databases, platforms, and repositories evolved with features and functions to assist users in promptly finding the most relevant evidence. In response, research synthesis teams adopted novel searching strategies to sift through the vast amount of evidence to synthesize and disseminate the most up-to-date evidence. This paper explores the key database features that facilitated systematic searching for rapid evidence synthesis during the COVID-19 pandemic to inform knowledge management infrastructure during future global health emergencies.MethodsThis paper outlines the features and functions of previously existing and newly created evidence sources routinely searched as part of the NCCMT’s Rapid Evidence Service methods, including databases, platforms, and repositories. Specific functions of each evidence source were assessed as they pertain to searching in the context of a public health emergency, including the topics of indexed citations, the level of evidence of indexed citations, and specific usability features of each evidence source.ResultsThirteen evidence sources were assessed, of which four were newly created and nine were either pre-existing or adapted from previously existing resources. Evidence sources varied in topics indexed, level of evidence indexed, and specific searching functions.ConclusionThis paper offers insights into which features enabled systematic searching for the completion of rapid reviews to inform decision makers within 5–10 days. These findings provide guidance for knowledge management strategies and evidence infrastructures during future public health emergencies.

Efficacy and safety of robotic vs. laparoscopic gastrectomy for patients with gastric cancer: systematic review and meta-analysis.

The emergence of robotic surgical systems compensated for the technological shortcomings of laparoscopic approaches. However, whether robotic gastrectomy (RG) has better perioperative outcomes and survival than laparoscopic gastrectomy (LG) for gastric cancer is still unclear but increasingly drawing attention. In this systematic review and meta-analysis, we searched the PubMed, EMBASE, Web of Science, and Cochrane Library as of January 20, 2024 and referenced list of eligible articles for all published studies comparing RG and LG for patients with gastric cancer, Data on study characteristics, individual characteristics, and outcome parameters were extracted. The quality of studies was assessed using the Revised Cochrane risk-of-bias 2 tool and the risk of bias in non-randomized studies of interventions tool. The main outcome measures were overall survival (OS) and disease-free survival (DFS). We identified 3641 articles, of which 72 studies (30081 patients) were included in the meta-analysis. Compared with LG, RG was associated with higher OS [hazard ratio (HR)=0.89, 95% CI=0.83 to 0.96), lower rate of overall postoperative complications [odds ratio (OR)=0.77, 95% CI=0.71 to 0.84], longer operating time [mean difference (MD)=35.53, 95% CI=29.23 to 41.83], less estimated blood loss (MD=-37.45, 95% CI=-46.24 to -28.67), a higher number of retrieved lymph nodes (MD=1.88, 95% CI=0.77 to 3.00), faster postoperative recovery, and lower rate of conversion (OR=0.44, 95% CI=0.36 to 0.55). Mortality and DFS were not significantly different between the two groups. The subgroup of meta-analysis results also showed the advantages of robotic surgery over laparoscopic surgery in intracorporeal reconstruction, total gastrectomy, Ⅰ/Ⅱ stage, and BMI≥25, especially for patients with stage Ⅰ/Ⅱ, there is better overall survival and disease-free survival. Our findings point to robotic surgery having great benefits compared with laparoscopic surgery in gastric cancer. Our study may help inform decision-making in applying robotic surgical systems to clinical treatment.

Growing pains with kratom: experiences discussed in subreddits contrast with satisfaction expressed in surveys.

"Kratom" refers to an array of bioactive products derived from Mitragyna speciosa, a tree indigenous to Southeast Asia. Most kratom consumers report analgesic and stimulatory effects, and common reasons for use are to address mental and physical health needs, manage pain, and to reduce use of other substances. Natural-history studies and survey studies suggest that many kratom consumers perceive benefits from those uses, but such studies are unlikely to capture the full range of kratom-use experiences. We collected text data from Reddit posts from 2020-2022 to qualitatively examine conceptualizations, motivations, effects, and consequences associated with kratom use among people posting to social media. Reddit posts mentioning kratom were studied using template thematic analysis, which included collecting descriptions of kratom product types and use practices. Network analyses of coded themes was performed to examine independent relationships among themes, and between themes and product types. Codes were applied to 329 of the 370 posts that comprised the final sample; 134 posts contained kratom product descriptions. As Reddit accounts were functionally anonymous, demographic estimates were untenable. Themes included kratom physical dependence (tolerance, withdrawal, or use to avoid withdrawal), perceived addiction (net detrimental effects on functioning), and quitting. Extract products were positively associated with reports of perceived addiction, dependence, and experiences of quitting kratom. Many used kratom for energy and self-treatment of pain, fatigue, and problems associated with opioid and alcohol; they perceived these uses as effective. Consumers expressed frustrations about product inconsistencies and lack of product information. As in previous studies, kratom was deemed helpful for some and a hindrance to others, but we also found evidence of notable negative experiences with kratom products that have not been well documented in surveys. Daily kratom use may produce mild-moderate physical dependence, with greater severity being possibly more common with concentrated extracts; however, there are currently no human laboratory studies of concentrated kratom extracts. Such studies, and detailed kratom product information, are needed to help inform consumer decision-making.

Functional Outcomes After Transanal Total Mesorectal Excision (taTME) for Rectal Cancer: Results From the Phase II North American Multicenter Prospective Observational Trial.

To investigate fecal incontinence and defecatory, urinary, and sexual functional outcomes after transanal total mesorectal excision (taTME). Proctectomy for rectal cancer may result in alterations in defecatory, urinary, and sexual function that persist beyond 12 months. The recent multicenter phase II taTME trial demonstrated the safety of taTME in patients with stage I to III tumors. Prospectively registered self-reported questionnaires were collected from 100 taTME patients. Fecal continence [Fecal Incontinence Quality of Life (FIQL), Wexner], defecatory function [Colorectal Functional Outcome (COREFO)], urinary function (International Prostate Symptom Score), and sexual function (Female Sexual Function Index-female, International Index of Erectile Function-male) were assessed preoperatively (PQ), 3 to 4 months postileostomy closure (FQ1), and 12 to 18 months post-taTME [postoperative questionnaire 2 (FQ2)]. Among 83 patients who responded at all 3 time points, FIQL, Wexner, and COREFO significantly worsened postileostomy closure. Between FQ1 and FQ2, FIQL lifestyle and coping, Wexner, and COREFO incontinence, social impact, frequency, and need for medication significantly improved, while FIQL depression and embarrassment did not change. International Prostate Symptom Score did not change relative to preoperative scores. For females, Female Sexual Function Index declined for desire, orgasm, and satisfaction between PQ and FQ1, and did not improve between FQ1 and FQ2. In males, International Index of Erectile Function declined with no change between FQ1 and FQ2. Although taTME resulted in initial decline in defecatory function and fecal continence, most functional domains improved by 12 months after ileostomy closure, without returning to preoperative status. Urinary function was preserved while sexual function declined without improvement by 18 months post-taTME. Our results address patient expectations and inform shared decision-making regarding taTME.

Information search and decision-making in credit acquisition

Information search and decision-making in credit acquisition

Life Cycle Sustainability Assessment of Waste to Energy Systems in the Developing World: A Review

The global move towards a circular economy, as well as that of achieving the United Nations Sustainable Development Goals (SDGs), has necessitated the search for several sustainable solutions in various sectors. Given this, the provision of sustainable waste management and electricity systems constitute a significant part of the SDGs, and the waste-to-energy (WtE) concept has recently become a key topic given that it can potentially help reduce the dependence on fossil fuels for energy generation, as well as minimizing the need to dispose of waste in landfill. However, to date, the sustainability assessments of WtE generation technologies have been limited in scope concerning the three-dimensional sustainability framework (economic, environmental, and social). Life Cycle Sustainability Assessment (LCSA) has been proposed as a potential approach that could comprehensively address these three pillars of sustainability simultaneously based on life cycle thinking. LCSA, as a holistic method, could also potentially deal with the complexity associated with decision-making by allowing for the consideration of a full range of possible sustainability consequences. LCSA is an analytical tool that integrates the Life Cycle Assessment (LCA), Life Cycle Costing (LCC), and Social Life Cycle Assessment (sLCA) methodologies, which already exist and continue to be developed. Individually, these life-cycle approaches tend to be used to point out particular ‘hotspots’ in product or service systems, and hence focus on direct impacts in a given sustainability domain, neglecting the indirect ones. LCSA aims for a more holistic sustainability perspective and seeks to address the associated challenge of integrating these three pillars of sustainability into an overall and more comprehensive sustainability assessment. This need for harmonization within the LCSA methodology is a major challenge in its operationalization. In recent years there has been steady progress towards developing and applying LCSA, including for WtE. The aim of this paper is to review the most recent trends and perspectives in developing countries, especially regarding how LCSA could help inform decision-making. The paper also analyses the LCSA literature to set out the theoretical and practical challenges behind integrating the three methods (LCA, LCC, and sLCA). The review was conducted via a search of keywords such as LCSA, waste, and energy in the Web of Science databases, resulting in the selection of 187 publications written in English. Of those, 13 articles operationalized LCSA in specific waste and WtE related case studies. The review provides a review of the application of LCSA for researchers, technological experts, and policymakers through published findings and identifies perspectives on new research. These include uncertainty, subjectivity in weighting, double-counting, the low maturity of sLCA, and the integration of the interconnection between the three dimensions (environmental, economic, and social dimensions) of LCSA results in decision-making. In addition, gaps (such as the integration of the interconnection between the three dimensions) that need to be addressed via further research are highlighted to allow for a better understanding of methodological trade-offs that come from using the LCSA analytical approach to assess the sustainability of WtE generation technologies, especially in developing countries. It is hoped that this study will be a positive contribution to environmental and energy policy decisions in developing countries faced with the dual problems of waste management and electricity supply along with their sustainable development goals.

Shared Lightweight Autonomous Vehicles for Urban Food Deliveries: A Simulation Study

In recent years, the rapid growth of on-demand delivery services, especially in food deliveries, has spurred the exploration of innovative mobility solutions. In this context, lightweight autonomous vehicles have emerged as a potential alternative. However, their fleet-level behavior remains largely unexplored. To address this gap, we have developed an agent-based model and an environmental impact study assessing the fleet performance of lightweight autonomous food delivery vehicles. This model explores critical factors such as fleet sizing, service level, operational strategies, and environmental impacts. We have applied this model to a case study in Cambridge, MA, USA, where results indicate that there could be significant environmental benefits in replacing traditional car-based deliveries with shared lightweight autonomous vehicle fleets. Lastly, we introduce an interactive platform that offers a user-friendly means of comprehending the model’s performance and potential trade-offs, which can help inform decision-makers in the evolving landscape of food delivery innovation.

Stratifying risk of failure to achieve textbook outcomes among patients undergoing hepatectomy for hepatocellular carcinoma: A multicenter score validation study

Background and aimsThe concept of textbook outcomes (TOs) has gained increased attention as a critical metric to assess the quality and success of outcomes following complex surgery. A simple yet effective scoring system was developed and validated to predict risk of not achieving textbook outcomes (non-TOs) following hepatectomy for hepatocellular carcinoma (HCC). MethodsUsing a multicenter prospectively collected database, risk factors associated with non-TO among patients who underwent hepatectomy for HCC were identified. A predictive scoring system based on factors identified from multivariate regression analysis was used to risk stratify patients relative to non-TO. The score was developed using 70 % of the overall cohort and validated in the remaining 30 %. ResultsAmong 3681 patients, 1458 (39.6 %) failied to experience a TO. Based on the derivation cohort, obesity, American Society of Anaesthesiologists score(ASA score), Child-Pugh grade, tumor size, and extent of hepatectomy were identified as independent predictors of non-TO. The scoring system ranged from 0 to 10 points. Patients were categorized into low (0–3 points), intermediate (4–6 points), and high risk (7–10 points) of non-TO. In the validation cohort, the predicted risk of developing non-TOs was 39.0 %, which closely matched the observed risk of 39.9 %. There were no differences among the predicted and observed risks within the different risk categories. ConclusionsA novel scoring system was able to predict risk of non-TO accurately following hepatectomy for HCC. The score may enable early identification of individuals at risk of adverse outcomes and inform surgical decision-making, and quality improvement initiatives.

Long-Term Outcomes of Cricothyroidotomy Versus Endotracheal Intubation in Military Personnel: A Retrospective Comparative Analysis Cohort Study

IntroductionEmergency airway management is critical in trauma care. Cricothyroidotomy (CRIC) is a salvage procedure commonly used in failed endotracheal intubation (ETI) or difficult airway cases. However, more data is needed regarding the short and long-term complications associated with CRIC. This study aimed to evaluate the Israel Defense Forces experience with CRIC over the past 2 decades and compare the short-term and long-term sequelae of prehospital CRIC and ETI. MethodsData on patients undergoing either CRIC or ETI in the prehospital setting between 1997 and 2021 were extracted from the Israel Defense Forces trauma registry. Patient data was then cross-referenced with the Israel national trauma registry, documenting in-hospital care, and the Israel Ministry of Defense rehabilitation department registry, containing long-term disability files of military personnel. ResultsOf the 122 patients with short-term follow-up through initial hospitalization, 81% underwent prehospital ETI, while 19% underwent CRIC. There was a higher prevalence of military-related and explosion injuries among the CRIC patients (96% versus 65%, P = 0.02). Patients who underwent CRIC more frequently exhibited oxygen saturations below 90% (52% versus 29%, P = 0.002). Injury Severity Score was comparable between groups.No significant difference was found in intensive care unit length of stay and need for tracheostomy. Regarding long-term complications, with a median follow-up time of 15 y, CRIC patients had more upper airway impairment, with most suffering from hoarseness alone. One patient in the CRIC group suffered from esophageal stricture. ConclusionsThis retrospective comparative analysis did not reveal significant short or long-term sequelae among military personnel who underwent prehospital CRIC. The long-term follow-up did not indicate severe aerodigestive impairments, thus suggesting that this technique is safe. Along with the high success rates attributed to this procedure, we recommend that CRIC remains in the armamentarium of trauma care providers. The findings of this study could provide valuable insights into managing difficult airway in trauma care and inform clinical decision-making in emergency settings.

Research on Critical Factors Influencing Organizational Resilience of Major Transportation Infrastructure Projects: A Hybrid Fuzzy DEMATEL-ISM-MICMAC Approach

To strengthen major transportation infrastructure projects’ (MTIPs’) organizational resilience and fortify their capacity for crisis management and project risk prevention. In this paper, based on the resilience theory development process, the connotation of organizational resilience of MTIPs is defined, and 20 influencing factors of organizational resilience of MTIPs are extracted from four categories of stability, redundancy, adaptability, and rapidity according to the literature analysis and case study method. The significance, causality, and multilevel recursive order structure of the influencing factors were investigated by the fuzzy DEMATEL-ISM approach, and their driving and dependent characteristics were analyzed through MICMAC. The results indicate that risk warning and prediction, human resources management, inter-organizational synergies, resource reserve situations, organizational leadership, and organizational learning are the crucial factors of organizational resilience in MTIPs. There are three levels and five ranks in the multilevel recursive rank structure of the factors affecting MTIPs’ organizational resilience. Among them, risk warning and prediction, equipment condition and performance, human resources management, and organizational leadership have the deepest impact on organizational resilience in MTIPs. The findings can clarify ideas for subsequent research on organizational resilience in this area and inform project decision-makers in developing strategies for optimizing organizational resilience.

Comparative patient-reported tolerability (PRT): A multiplicity-controlled analysis of LIBRETTO-531, a randomized controlled trial (RCT) in medullary thyroid cancer (MTC).

11111 Background: In cancers with longer natural histories, progression free survival (PFS) alone may not adequately capture the impact of treatment side effects (SE) and may, therefore, be complemented by robust measures of patient-reported tolerability (PRT) to quantify overall SE burden. Here, we pioneer the use of a novel, scalable, quantitative PRT metric as a key secondary endpoint to support the regulatory review and inform clinical decision-making of selpercatinib use in LIBRETTO-531 (NCT04211337), an RCT that demonstrated the PFS benefit (HR=0.28) of selpercatinib over vandetanib/cabozantinib (control) in RET-mutant MTC. Methods: We first assessed PRT using the single Functional Assessment of Cancer Therapy (FACT) item GP5, asking patients to rate “bothered by treatment side effects” from 0 to 4. Patients who reported “3=quite a bit” or “4=very much” on GP5 were classified as “high SE bother,” a validated meaningful cutoff for treatment SE burden. In a second pre-specified step, PRT was defined as the proportion of time on treatment (PTOT) with “high SE bother” and was compared between selpercatinib vs. control arms in the tolerability evaluable population. PRT was tested at a 1-sided significance level of 0.025, conditional on achieving statistical significance for PFS and treatment failure-free survival by BICR. To complement PRT, other patient-reported outcomes including health-related quality of life (HRQoL, using EORTC QLQ-C30) and symptomatic adverse events (AEs; using PRO-CTCAE) were evaluated. We calculated the PTOT that patients reported clinically meaningful impairment of HRQoL (using pre-specified cutoff scores) and highly symptomatic AEs (scores of 3 or 4). Results: Patients on selpercatinib (n=161) had a significantly better PRT (lower PTOT with high SE bother) than control (n=81) (8% vs. 24%, p&lt;.0001). Sensitivity analyses using different cutoffs for high SE bother showed consistent results (p&lt;.0001). On QLQ-C30, patients on selpercatinib reported significantly less PTOT with HRQoL impairment across physical (36% vs. 52%), role (2% vs. 11%), cognitive (4% vs. 8%), emotional (6% vs. 11%), and social (2% vs. 8%) functions (all p&lt;0.01) vs. control. On PRO-CTCAE, patients on selpercatinib reported significantly less PTOT with diarrhea (5% vs. 38%), fatigue (6% vs. 21%), taste change (3% vs. 15%), decreased appetite (2% vs. 15%), hand/foot syndrome (2% vs. 9%) (all p&lt;.001) vs. control. Conclusions: Through the incorporation of a novel, single question and quantifiable metric that measured time on treatment under high SE bother into the LIBRETTO-531 study, we demonstrated superior PRT and improved PFS for selpercatinib in patients with RET-mutant MTC versus vandetanib/cabozantinib. This simplified PRT metric deserves further adoption as a quantitative endpoint to complement PFS in future RCTs.

Self Identifying Mental Health Status and Get Guidance For Support Using AI

In recent years, an awareness has emerged about the importance of the individual in mental health and treatment. Mental health problems are common among college students around the world; Therefore, identifying at-risk groups will help provide services. Self-diagnosis of mental illness is an important step in recognizing and addressing personal health. Our goal is to develop a screening tool to identify students at risk for mental illness. Students are taught to use assessment tools to distinguish between those at reduced and increased risk of mental illness. Psychological services should be provided to students at risk. Despite the prevalence of psychological problems, problems such as fear of decision-making and lack of information often make it difficult for people to define themselves. The person may deny or ignore symptoms, which may delay the person's intervention and make the situation worse. Empowering people with mental health knowledge and resources can enable them to take part in their own health. As well as personal benefits, self-expression can promote understanding and acceptance and contribute to a culture of empathy and support. Artificial Intelligence (AI) technology holds both great promise and potential pitfalls in transforming mental health. This article discusses the current limitations of artificial intelligence, areas where further research is needed, and how it can improve healthcare by considering the ethical fairness of intellectual technology. As AI technology continues to evolve and improve, it may be able to help psychiatrists reclassify mental disorders beyond what is currently specified in the DSM-5, identifying these problems in their early or prodromal stages so that interventions can be implemented. . Quality and personalized treatment based on individual characteristics. However, caution must be exercised to avoid overinterpretation of preliminary results, and more studies must be conducted to close the gap in scientific expertise on mental health and treatment.

Deep Learning Models for Predicting Malignancy Risk in CT-Detected Pulmonary Nodules: A Systematic Review and Meta-analysis

BackgroundThere has been growing interest in using artificial intelligence/deep learning (DL) to help diagnose prevalent diseases earlier. In this study we sought to survey the landscape of externally validated DL-based computer-aided diagnostic (CADx) models, and assess their diagnostic performance for predicting the risk of malignancy in computed tomography (CT)-detected pulmonary nodules.MethodsAn electronic search was performed in four databases (from inception to 10 August 2023). Studies were eligible if they were peer-reviewed experimental or observational articles comparing the diagnostic performance of externally validated DL-based CADx models with models widely used in clinical practice to predict the risk of malignancy. A bivariate random-effect approach for the meta-analysis on the included studies was used.ResultsSeventeen studies were included, comprising 8553 participants and 9884 nodules. Pooled analyses showed DL-based CADx models were 11.6% more sensitive than physician judgement alone, and 14.5% more than clinical risk models alone. They had a similar pooled specificity to physician judgement alone [0.77 (95% CI 0.68–0.84) v 0.81 (95% CI 0.71–0.88)], and were 7.4% more specific than clinical risk models alone. They had superior pooled areas under the receiver operating curve (AUC), with relative pooled AUCs of 1.03 (95% CI 1.00–1.07) and 1.10 (95% CI 1.07–1.13) versus physician judgement and clinical risk models alone, respectively.ConclusionDL-based models are already used in clinical practice in certain settings for nodule management. Our results show their diagnostic performance potentially justifies wider, more routine deployment alongside experienced physician readers to help inform multidisciplinary team decision-making.

Non-invasive prenatal screening: Testing motivations and decision making in the low-risk population.

Non-invasive prenatal screening provides a risk assessment for aneuploidies by utilizing cell-free DNA (cfDNA). It is recommended that cell-free DNA screening (cfDNA screening) be offered to all pregnant people regardless of a priori risk for aneuploidy. In the absence of an increased risk, alternative motives for electing cfDNA screening and different levels of informed decision making may arise. Therefore, our study aimed to characterize low-risk patients' motivations for cfDNA screening election, determine how often informed decisions are being made, and compare motivations between informed and uninformed decision makers. A survey that included a modified, validated measure of informed choice (MMIC) and questions to assess patients' motivations for cfDNA screening was offered at four MFM clinics following genetic counseling. It was found that 44% of participants (n = 100) made an uninformed decision about testing. Participants with private insurers were 4.25 times more likely to make an informed decision (95% CI = 1.10-16.37). Informed decision makers scored avoiding invasive procedures higher (p = 0.007) and ranked doing what family/friends desire lower (p = 0.005) than uninformed decision makers. While most participants scored receiving information about genetic conditions highest, 12% of participants reported fetal sex disclosure as a priority. However, this was not found to be associated with uninformed decision making. This study ultimately established that following genetic counseling, a low-risk population shared motivations with high-risk populations which highlights the importance of complete pre-test counseling for all. Future research should investigate the effect of modifying variables, such as socioeconomic status, on the performance of informed choice measures and critically evaluate the parameters that determine informed choice.

Palliative care for chronic heart failure: non-pharmacological methods of relieving the main symptoms

Chronic heart failure is one of the main causes of the increase in mortality and disability of the population around the world. In the final stages of chronic heart failure, when the debilitating symptoms of patients no longer respond to treatment, the issue of palliative care arises. To date, current clinical recommendations and guidelines do not contain data on palliative measures for this category of patients – in such conditions, doctors often do not understand what tactics of patient management they need to choose. Therefore, the importance of integrating palliative care into the treatment of chronic heart failure is increasing. Many symptoms associated with the terminal stages of chronic heart failure have a negative impact on the general condition and quality of life of patients. The main ones are shortness of breath, pain, manifestations of asthenia, as well as anxiety-depressive disorders. In order to maximize the possible improvement in the quality of life of such patients, palliative care should be comprehensive: regular pharmacotherapy prescribed in accordance with current clinical recommendations, combined with various non-drug methods for relieving the main symptoms. As such methods, the main cardiac rehabilitation measures can be considered, including regular physical training, training in compliance with the treatment regimen, stress management techniques, and psychological support. The relationship of patients and caregivers with medical professionals is important in the organization of palliative care. Adequate and timely communication is necessary to improve self-control and compliance with medication, prevent unplanned hospitalization, inform decision-making and, ultimately, ensure a safe death. The article discusses the basic concepts of organizing and providing palliative care to patients with chronic heart failure, as well as non-pharmacological palliative measures proposed by European, American, and Russian specialists.