Medication Scores Research Articles

Semi-quantitative CT score reflecting the degree of pulmonary infection as a risk factor of hypokalemia in COVID-19 patients: a cross-sectional study

BackgroundHypokalemia is a common electrolyte disorder observed in patients afflicted with coronavirus disease 2019 (COVID-19). When COVID-19 is accompanied by pulmonary infection, chest computed tomography (CT) is the preferred diagnostic modality. This study aimed to explore the relationship between CT semi-quantitative score reflecting the degree of pulmonary infection and hypokalemia from COVID-19 patients.MethodsA single-center, cross-sectional study was conducted to investigate patients diagnosed with COVID-19 between December 2022 and January 2023 who underwent chest CT scans upon admission revealing typical signs. These patients were categorized into two groups based on their blood potassium levels: the normokalemia group and the hypokalemia group. Medical history, symptoms, vital signs, laboratory data, and CT severity score were compared. Binary regression analysis was employed to identify risk factors associated with hypokalemia in COVID-19 patients with pulmonary infection.ResultsA total of 288 COVID-19 patients with pulmonary infection were enrolled in the study, of which 68 (23.6%) patients had hypokalemia. The CT severity score was found to be higher in the hypokalemia group compared to the normokalemia group [4.0 (3.0–5.0) vs. 3.0 (2.0–4.0), p = 0.001]. The result of binary logistic regression analysis revealed that after adjusting for sex, vomiting, sodium, and using potassium-excretion diuretics, higher CT severity score was identified as an independent risk factor for hypokalemia (OR = 1.229, 95% CI = 1.077–1.403, p = 0.002).ConclusionIn this cohort of patients, semi-quantitative CT score reflecting the degree of pulmonary infection may serve as a risk factor of hypokalemia in COVID-19 patients.

The Effect of Patient-Specific Variables on the Need for Dental Treatment Under General Anesthesia in Children: A Retrospective Study

Aim: For pediatric dentists, meeting the dental treatment needs of young children is often a challenge. Behavioral management techniques may be ineffective in underage children or children with special needs. Therefore, general anesthesia (GA) is required for dental rehabilitation of uncooperative children. The aim of this study was to examine the patient population treated under General Anesthesia (GA) in terms of age, gender, ASA Score (American Society of Anesthesiologists Physical Status Classification System), duration of anesthesia, duration of operation and the presence of systemic diseases of the patients. Material and Methods: In this study, 238 patients aged 2-15 years who underwent dental treatment in the General Anesthesia Operating Room of Selçuk University Faculty of Dentistry were included. Patients were divided into 2 groups according to indications for general anesthesia. Medical health status and ASA scores were analysed. Patients were also evaluated according to age, gender, duration of anesthesia and duration of dental treatment. Results: According to results, the mean age (years) and weight (kg) of the patients were 5,4 and 19,7, respectively. The gender distribution of the patients was 125 female (52,55%) and 113 male (47,5%). The number of ASA I patients was 213 (89,6%) and ASA II patients was 25 (10,5%). In terms of duration of anesthesia, 24 patients were treated in less than 60 minutes (min), 132 patients in 60-120 min and 82 patients in 120-180 min. Conclusion: Dental treatment operating rooms with inpatient services can serve more different patient groups.

The LIVERAID (LIVER And Infectious Diseases)-ICU score predicts in-hospital mortality in liver cirrhosis patients with infections in the intensive care unit

ObjectivesThe admission of patients with liver cirrhosis to the intensive care unit (ICU) due to infections is a frequent occurrence, often leading to complications such as hepatic encephalopathy, renal failure...

Hospital Heart Failure Medical Therapy Score and Associated Clinical Outcomes and Costs.

A composite score for guideline-directed medical therapy (GDMT) for patients with heart failure (HF) is associated with increased survival. Whether hospital performance according to a GDMT score is associated with a broader array of clinical outcomes at lower costs is unknown. To evaluate hospital variability in GDMT score at discharge, 90-day risk-standardized clinical outcomes and costs, and associations between hospital GDMT score and clinical outcomes and costs. This was a retrospective cohort study conducted from January 2015 to September 2019. Included for analysis were patients hospitalized for HF with reduced ejection fraction (HFrEF) in the Get With the Guidelines-Heart Failure Registry, a national hospital-based quality improvement registry. Study data were analyzed from July 2022 to April 2023. GDMT score at discharge. Hospital variability in GDMT score, a weighted index from 0 to 1 of GDMT prescribed divided by the number of medications eligible, at discharge was evaluated using a generalized linear mixed model using the hospital as a random effect and quantified with the adjusted median odds ratio (AMOR). Parallel analyses centering on 90-day mortality, HF rehospitalization, mortality or HF rehospitalization, home time, and costs were performed. Costs were assessed from the perspective of the Centers of Medicare & Medicaid Services. Associations between hospital GDMT score and clinical outcomes and costs were evaluated using Spearman coefficients. Among 41 161 patients (median [IQR] age, 78 [71-85] years; 25 546 male [62.1%]) across 360 hospitals, there was significant hospital variability in GDMT score at discharge (AMOR, 1.23; 95% CI, 1.21-1.26), clinical outcomes (mortality AMOR, 1.17; 95% CI, 1.14-1.24; HF rehospitalization AMOR, 1.22; 95% CI, 1.18-1.27; mortality or HF rehospitalization AMOR, 1.21; 95% CI, 1.18-1.26; home time AMOR, 1.07; 95% CI, 1.06-1.10) and costs (AMOR, 1.23; 95% CI, 1.21-1.26). Higher hospital GDMT score was associated with lower hospital mortality (Spearman ρ, -0.22; 95% CI, -0.32 to -0.12; P < .001), lower mortality or HF rehospitalization (Spearman ρ, -0.17; 95% CI, -0.26 to -0.06; P = .002), more home time (Spearman ρ, 0.14; 95% CI, 0.03-0.24; P = .01), and lower cost (Spearman ρ, -0.11; 95% CI, -0.21 to 0; P = .047) but not with HF rehospitalization (Spearman ρ, -0.10; 95% CI, -0.20 to 0; P = .06). Results of this cohort study reveal that hospital variability in GDMT score, clinical outcomes, and costs was significant. Higher GDMT score at discharge was associated with lower mortality, lower mortality or hospitalization, more home time, and lower cost. Efforts to increase health care value should include GDMT optimization.

Study on psychological resilience and associated influencing factors in lung cancer patients with bone metastases

BACKGROUND Evaluating the psychological resilience of lung cancer (LC) patients helps understand their mental state and guides future treatment. However, there is limited research on the psychological resilience of LC patients with bone metastases. AIM To explore the psychological resilience of LC patients with bone metastases and identify factors that may influence psychological resilience. METHODS LC patients with bone metastases who met the inclusion criteria were screened from those admitted to the Third Affiliated Hospital of Wenzhou Medical University. The psychological scores of the enrolled patients were collected. They were then grouped based on the mean psychological score: Those with scores lower than the mean value were placed in the low-score group and those with scores equal to or greater than the mean value was placed in the high-score group. The baseline data (age, gender, education level, marital status, residence, monthly income, and religious beliefs), along with self-efficacy and medical coping mode scores, were compared. RESULTS This study included 142 LC patients with bone metastases admitted to our hospital from June 2022 to December 2023, with an average psychological resilience score of 63.24 ± 9.96 points. After grouping, the low-score group consisted of 69 patients, including 42 males and 27 females, with an average age of 67.38 ± 9.55 years. The high-score group consisted of 73 patients, including 49 males and 24 females, with a mean age of 61.97 ± 5.00 years. χ 2 analysis revealed significant differences between the two groups in education level (χ 2 = 6.604, P = 0.037), residence (χ 2 = 12.950, P = 0.002), monthly income (χ 2 = 9.375, P = 0.009), and medical coping modes (χ 2 = 19.150, P = 0.000). Independent sample t -test showed that the high-score group had significantly higher self-efficacy scores (t = 3.383, P = 0.001) and lower age than the low-score group (t = 4.256, P &lt; 0.001). Furthermore, multivariate logistic regression hazard analysis confirmed that self-efficacy is an independent protective factor for psychological resilience [odds ratio (OR) = 0.926, P = 0.035, 95% confidence interval (CI): 0.862-0.995], while age (OR = 1.099, P = 0.003, 95%CI: 1.034-1.169) and medical coping modes (avoidance vs confrontation: OR = 3.767, P = 0.012, 95%CI: 1.342-10.570; resignation vs confrontation: OR = 5.687, P = 0.001, 95%CI: 1.974-16.385) were identified as independent risk factors. A predictive model based on self-efficacy, age, and medical coping modes was developed. The receiver operating characteristic analysis showed an area under the curve value of 0.778 (95%CI: 0.701-0.856, P &lt; 0.001), indicating that the model has good predictive performance. CONCLUSION LC patients with bone metastases are less psychologically resilient than the general population. Factors such as self-efficacy, age, and medical coping modes influence their psychological resilience. Patients with low self-efficacy, old age, and avoidance/resignation coping modes should be closely observed.

Regional, rural and remote medicine attracts students with a similar approach to learning in both the Northern and Southern hemisphere

ABSTRACT Doctors who work in areas of workforce shortage, such as regional, rural and remote areas or areas of low socioeconomic means need to be more self-motivated, adaptable and self-directed than their metropolitan counterparts. This study aimed to examine the goal orientation and learning characteristics of students recruited into two medical programmes, one from the Northern hemisphere and one from the Southern hemisphere; both with a commitment to producing doctors to practice medicine in rural locations. Three survey tools were administered to 263 medical students: 1. achievement goal orientation survey; 2. learning characteristics survey and 3. the study process questionnaire. Medical students from both cohorts showed a learning goal orientation, which significantly increased with age (P0.007). In terms of learning characteristics, the students from the south had significantly higher scores for curiosity (P0.003), while the northern students had significantly higher scores for methodical (p < 0.001). Both cohorts were similar for adaptability and consciousness. Across the entire student cohort, three of the four learning disposition characteristics were also seen to correlate with learning goal orientation. In both cohorts of medical students deep learning scores exceeded surface learning scores. Selection of students with a learning goal orientation and learning characteristics of curiosity, adaptability and conscientiousness could potentially help students to flourish in rural placement environments.

First-Generation Low-Income Individuals in Medicine: A Scoping Review.

This comprehensive scoping review of the medical literature on first-generation low-income (FGLI) individuals in medicine aimed to synthesize the highest levels of evidence to inform medical education stakeholders. Database searches were conducted in Academic Search Premier, Education Research Premier, ERIC, Ovid MEDLINE, Ovid Embase, Professional Development Collection, PubMed, Scopus, Google Scholar, and Web of Science Core Collection from database inception through March 15, 2023. English-language articles on first-generation or low-income individuals in medicine from U.S. medical schools were included. Articles were evaluated for level of evidence and themes chosen. Database searches resulted in 27,075 citations, 247 of which qualified for data extraction. The articles were classified by evidence level: level I (n = 2), level II (n = 17), level III (n = 90), level IV (n = 78), and level V (n = 60). Publications reported on 9 major outcomes: exam performance (n = 108), medical school performance (n = 63), residency and fellowship performance (n = 7), honor society status (n = 12), leave of absence (n = 9), withdrawal, dismissal, and attrition (n = 20), medical education graduation (n = 37), career choice (n = 109), and intent to practice in disadvantaged and rural communities (n = 60). Compared with their peers, FGLI individuals had lower medical school and standardized exam scores, enrollment in national medical honor societies and multiple degree programs, and graduate medical education performance and higher rates of leaves of absence, incompletion of medical education, pursuing primary care and family medicine specialties, and intent to practice in underserved communities. Despite an increase in the number of FGLI individuals in medicine, there remains significant opportunity to improve their inclusion and support. Multi-institutional, prospective, risk-adjusted, observational studies are required to determine how to best support FGLI individuals through all medical career stages.

Dupilumab and House Dust Mite Immunotherapy in Patients with Atopic Dermatitis: A Preliminary Study.

Severe atopic dermatitis (AD) is a complex disease requiring systemic treatment. This study aimed to assess the effectiveness of combined therapy consisting of dupilumab and sublingual dust mite allergen immunotherapy (SLIT-HDM) in patients with severe AD and HDM allergies. Patients diagnosed with severe AD were included in this randomised, placebo-controlled, double-blind 12-month trial; they received SLIT for HDMs and/or dupilumab for 12 months and were compared with patients on cyclosporine. The primary outcomes for the treatment arms were changes in the Eczema Area and Severity Index (EASI), body surface area (%BSA), and Investigator Global Assessment (IsGA) over 12 months. The secondary outcomes were the proportion of patients who achieved IsGA success and reduced medication scores. Significant improvements were observed in all analysed groups after 12 months of therapy based on the EASI, %BSA, and IsGA. However, the most substantial changes were observed in the groups treated with dupilumab or a combination of SLIT-HDM and dupilumab. Additionally, the proportion of patients who achieved an IsGA reduction was significantly greater in the group receiving combination therapy than in the other groups (9/14 [64% of the group receiving SLIT-HDM] vs. 11/14 [73% of the group receiving dupilumab] vs. 15/17 [88% of the group receiving dupilumab and SLIT-HDM] vs. 7/13 [53% of the group receiving cyclosporine]) (p < 0.05). In patients with severe AD and HDM allergies, combination treatment with dupilumab and allergen immunotherapy for HDMs may increase the therapeutic benefit over treatment with these methods separately.

Real-World Study of Ragweed Sublingual Immunotherapy in Hungary.

Ragweed (Ambrosia elatior) has become invasive in Europe, causing significant respiratory issues. Subcutaneous allergen immunotherapy (SCIT) has long been used to manage pollen allergies, but sublingual immunotherapy (SLIT) has gained interest. This study aimed to evaluate the clinical benefits of ragweed SLIT under real-world in a cohort of Hungarian patients allergic to ragweed pollen. We retrospectively reviewed the clinical records of 57 patients during the 2015 and 2016 ragweed pollen seasons. Patients were divided into two groups: Group 1 (n = 29), who had not received immunotherapy, and Group 2 (n = 28), who had previously undergone immunotherapy with another sublingual preparation. All patients were treated with Oraltek® ragweed for 4-6 months, initiating 2-4 months before the pollen season and rest of the period was 2 months of the 2016 pollen season. Symptom score (SS), medication score (MS), and combined symptom and medication score (CSMS) were evaluated intra- and intergroup. Pollen counts were consistent between 2015 and 2016. All patients showed significant improvement in SS, MS, and CSMS, with a large effect size (>0.8). Group 2 had significantly lower SS and CSMS in 2015 because of prior immunotherapy. By 2016, both groups exhibited marked improvements, with Group 1 showing a 75% improvement in CSMS. No local or systemic reactions were recorded, indicating a high safety profile. Ragweed SLIT significantly improved symptoms and reduced use of medication in patients allergic to ragweed pollen. The treatment was effective even in patients with previous immunotherapy, with a high benefit-risk ratio demonstrated by the absence of adverse reactions. These findings support the use of Oraltek SLIT for managing ragweed pollen allergy.

Hepatitis A vaccination in a racially and sexually diverse population of gay, bisexual, and other men who have sex with men: Findings from the QVax study.

Previous studies found vaccination uptake of vaccine-preventable diseases (VPD) to be associated with race/ethnicity and medical mistrust among key populations, however, few studies examine Hepatitis A vaccination uptake. This cross-sectional study used online survey data collected from NJ and NY residents identifying as lesbian, gay, bisexual, transgender, queer (LGBTQ+) from October 2021 through November 2022. This study used a subsample of 222 gay, bisexual, and other cisgender men, 66.7% White, with mean age 41.22years (SD = 15.23), and 60% fully vaccinated for Hepatitis A. Overall, average group-based medical mistrust scores did not differ among non-vaccinated participants compared to fully or partially vaccinated participants. However, higher group-based medical mistrust scores were associated with non-White identifying participants, and were highest among Hispanic/Latinx (2.68, sd = 0.43) and Black non-Hispanic (2.58, sd = 0.50) participants (p < .001). Vaccination patterns did not differ among fear or vaccine confidence-based items. Our results contribute to the limited knowledge of differences in Hepatitis A vaccination uptake among men who have sex with men, and support the need for targeted intervention programs that acknowledge the diverse population of LGBTQ + identifying individuals and their associated health behaviors.

A knowledge-transfer-based approach for combining ordinal regression and medical scoring system in the early prediction of sepsis with electronic health records

Objective:The prediction of sepsis, especially early diagnosis, has received a significant attention in biomedical research. In order to improve current medical scoring system and overcome the limitations of class imbalance and sample size of local EHR (electronic health records), we propose a novel knowledge-transfer-based approach, which combines a medical scoring system and an ordinal logistic regression model. Materials and Methods:Medical scoring systems (i.e. NEWS, SIRS and QSOFA) are generally robust and useful for sepsis diagnosis. With local EHR, machine-learning-based methods have been widely used for building prediction models/methods, but they are often impacted by class imbalance and sample size. Knowledge distillation and knowledge transfer have recently been proposed as a combination approach for improving the prediction performance and model generalization. In this study, we developed a novel knowledge-transfer-based method for combining a medical scoring system (after a proposed score transformation) and an ordinal logistic regression model. We mathematically confirmed that it was equivalent to a specific form of the weighted regression. Furthermore, we theoretically explored its effectiveness in the scenario of class imbalance. Results:For the local dataset and the MIMIC-IV dataset, the VUS (the volume under the multi-dimensional ROC surface, a generalization measure of AUC-ROC for ordinal categories) of the knowledge-transfer-based model (ORNEWS) based on the NEWS scoring system were 0.384 and 0.339, respectively, while the VUS of the traditional ordinal regression model (OR) were 0.352 and 0.322, respectively. Consistent analysis results were also observed for the knowledge-transfer-based models based on the SIRS/QSOFA scoring systems in the ordinal scenarios. Additionally, the predicted probabilities and the binary classification ROC curves of the knowledge-transfer-based models indicated that this approach enhanced the predicted probabilities for the minority classes while reducing the predicted probabilities for the majority classes, which improved AUCs/VUSs on imbalanced data. Discussion:Knowledge transfer, which combines a medical scoring system and a machine-learning-based model, improves the prediction performance for early diagnosis of sepsis, especially in the scenarios of class imbalance and limited sample size.

Study of Patients' Privacy during the COVID-19 Pandemic in Iranian Health Care Settings.

Patient's privacy protection is a challenging ethical issue. The complex situation of the COVID-19 pandemic was a probable predictor of breaching confidentiality. This study aimed to assess the viewpoints of COVID-19-confirmed patients, who were hospitalized, and their healthcare providers about the compliance of different aspects of patient's privacy. This cross-sectional study included 3433 COVID-19-confirmed patients who were hospitalized in Kerman, between 2020 and 2021, and about 1228 related physicians, nurses, and paraclinical staff. Two separate validated researcher-made questionnaires were developed, each including subscales for physical, informational, and spatial privacy, as well as a satisfaction rate of privacy protection. The data were analyzed using SPSS software version 26, with independent samples t test, Mann-Whitney-U, Kruskal Wallis, and Multiple Linear Regression tests at a 95% confidence interval. The mean percentages of the patients' privacy scores in physical, spatial, and informational areas were significantly lower (P<0.001) than the average of the medical staff's scores in all three areas (Difference: 10.27%, 14.83%, and 4.91%, respectively). Physical and spatial privacy scores could be predicted based on the participants' classification, patients or medical staff, and sex. The mean patients' satisfaction score was 9.25% lower than the medical staff's (P<0.001). Moreover, only academic hospitals showed a statistically significant difference between the patient's satisfaction with privacy protection and medical staff's viewpoints (P<0.001). Although this study indicated the benefits of protecting patients' privacy in the healthcare setting, patients' privacy scores and satisfaction were lower than their healthcare providers. The pandemic conditions might have been an obstacle to preserving patients' rights. These findings demonstrated the importance of sensitizing healthcare providers to manage these ethical challenges in a complicated critical state such as the COVID-19 pandemic.

Staff-Perceived Barriers to Patient Mobilization Vary by Hospital, Discipline, and Experience: A Multisite Cross-Sectional Survey

ObjectiveTo describe staff-perceived barriers to progressive patient mobilization. DesignCross-sectional staff survey. SettingTen internal medicine wards in 4 hospitals in a large health service. ParticipantsNursing, medical, and allied health staff (n=208). InterventionsNot applicable. Main Outcome MeasuresPatient Mobilization Attitudes and Beliefs Survey. An overall barriers score and subscale scores for knowledge, attitudes, and behaviors were calculated and compared between hospitals, discipline, and years of clinical experience. ResultsThe survey was completed by 208 participants (123 nurses, 27 medical, 58 allied health), of whom 104 (50%) had <5 years of experience. The greatest perceived barriers included nursing workload, medical orders not being in place, and patient and family resistance to mobilization. Overall barrier scores differed between hospitals, discipline (mean nursing score ± SD 50±7; mean medical score ± SD, 51±7; mean allied health score ± SD, 43±7), and years of clinical experience (<5y mean score ± SD, 50±7; 5-9y mean score ± SD, 47±7; ≥10y mean score ± SD, 46±8); significant differences by hospital and discipline persisted in multivariate analysis. The behavior subscale had the highest barriers score and knowledge the lowest across all subgroups. ConclusionsStaff-perceived nursing workload, lack of medical orders, and patient and family resistance to be the greatest barriers to patient mobilization. Barrier scores differed between disciplines, experience levels, and across hospitals within a single health service. Lower scores on the knowledge subscale highlight the need for multicomponent strategies beyond education that address culture and systems; education may particularly benefit medical staff.

Perceived Stress in Medical Education: Relationship with Empathy and Stigmatisation

Objective: Medical students have been shown to report high levels of perceived stress. Perceived stress leads to a loss of empathy and negatively affects attitudes and behaviours towards patients. This study aimed to investigate the perceived stress levels and empathy skills of medical students and their relationship with their attitudes to mental illness. Material and Method: A cross-sectional study was conducted in Türkiye between March 2024 and April 2024 using an online survey. A total of 544 medical students attending university in the academic year 2023-2024 completed the questionnaire, which included the sociodemographic data form, the perceived medical school stress scale, the empathy scale, and the beliefs towards mental illness scale. Participants were asked whether they had received psychiatry training, whether they had been diagnosed with a mental illness, and whether they would disclose if they were diagnosed with a mental illness. Results: By gender, the mean Perceived Medical School Stress Scale score of females was statistically significantly higher than that of males (p=0.035). Perceived Medical School Stress Scale scores did not differ by training year, whereas Beliefs Towards Mental Illness Scale Weak Social and Interpersonal Skills sub-dimension scores did (p=0.643; and p=0.027, respectively). The Empathy Scale score of students who received psychiatry training was statistically significantly higher than that of students who did not receive a placement (p=0.003). A low significant negative correlation was found between the Perceived Medical School Stress and Empathy Scale scores (rho=-0.098; p=0.005). Conclusion: In our study, the perceived stress of medical students during their training differs according to gender, and its relationship with empathy skills is demonstrated. Individualised interventions to prevent and alleviate stress should be developed for students who need support coping with difficulties during their training.

The Evaluation Value of the Modified Lund-Kennedy Nasal Endoscopy Score on the Efficacy of Sublingual Immunotherapy for Allergic Rhinitis.

Allergic rhinitis (AR) is a growing public health problem worldwide. Respecting the significance of the modified Lund-Kennedy (MLK) score in rhinitis assessment, we delved into its evaluation value on the sublingual immunotherapy (SLIT) efficacy in AR patients. Totally 100 AR patients were enrolled, with pre- and post-SLIT MLK score, total nasal symptoms score (TNSS), total medication score (TMS), visual analogue scale (VAS), inflammatory cytokines, and immune function-related parameters compared. The correlations of MLK score with TNSS/TMS/VAS, as well as with IL-4/INF-γ/eosinophil (EOS)/percentage/specific immunoglobulin (sIgE)/sIgG were assessed by Spearman correlation analysis. The value of MLK score on assessing SLIT efficacy in AR patients was analyzed. SLIT treatment reduced MLK/TNSS/TMS/VAS scores, abated IL-4 level/EOS percentage/sIgE, and elevated INF-γ/sIgG levels. MLK score was positively correlated with pre- and post-SLIT TNSS score (rpre-treatment = 0.592, rpost-treatment = 0.756), TMS score (rpre-treatment = 0.385, rpost-treatment = 0.718), VAS score (rpre-treatment = 0.369, rpost-treatment = 0.704), IL-4 (rpre-treatment = 0.553, rpost-treatment = 0.639), EOS percentage (rpre-treatment = 0.511, rpost-treatment = 0.632), and sIgE (rpre-treatment = 0.472, rpost-treatment = 0.524), and negatively with INF-γ (rpre-treatment = -0.418, rpost-treatment = -0.578) and sIgG4 (rpre-treatment = -0.460, rpost-treatment = -0.613). The MLK score had an area under curve of 0.846 (77.01% sensitivity, 76.92% specificity, 4 cut-off value) and 0.944 (91.67% sensitivity, 92.11% specificity, 2 cut-off value) for assessing SLIT treatment as effective and markedly effective for the patients, respectively. The MLK score had good evaluation value on the efficacy of SLIT treatment in AR patients.

Individualized sublingual immunotherapy with dynamic maintenance dose ascending for house dust mite-induced allergic rhinitis

BackgroundPrecision dosing in sublingual immunotherapy (SLIT) has become a hotspot gradually, yet no standardized dose adjustment pattern for house dust mite (HDM)-SLIT. This study aims to investigate the clinical feasibility of the dynamic maintenance dose ascending regimen for individualized SLIT. MethodsA total of 258 allergic rhinitis (AR) patients treated with HDM-SLIT were included in this retrospective study. Patients were divided into the regular dose (RD) group (n = 101) and the high dose (HD) group (n = 157) according to different maintenance dosages of SLIT. In the RD group, patients received the fixed dose recommended by the manufacturer. In the HD group, patients received a maximum tolerance dose determined by dynamic dose ascending. The clinical efficacy was evaluated by combined symptom and medication score (CSMS) and visual analogue scale score (VAS) at the baseline, 0.5-year, 1-year, and 2-year. The safety was evaluated by adverse events (AEs). ResultsSignificant reductions of CSMS and VAS at 0.5-year, 1-year, and 2-year were observed in both the RD group and the HD group compared to the baseline (P < 0.05). In addition, greater improvements in these clinical parameters from 0.5- to 2-year were found in the HD group compared to the RD group (P < 0.05). For subgroup analysis in the HD group, no significant differences in CSMS and VAS were observed among subgroups of patients <14 years old and patients ≥14 years old (P > 0.05). No serious AEs in the two groups and no significant differences were observed between the AE incidence rate of the RD group and HD group during the incremental and maintenance phases. ConclusionsThe 2-year HDM-SLIT with dynamic maintenance dose ascending regimen offers an “optimal” treatment for AR patients while maintaining safety. This study introduced a pattern for individualized dose adjustment in clinical practice, offering potential benefits for AR patients.

AI-KODA score application for cleanliness assessment in video capsule endoscopy frames

Background Currently, there is no automated method for assessing cleanliness in video capsule endoscopy (VCE). Our objectives were to automate the process of evaluating and collecting medical scores of VCE frames according to the existing KOrea-CanaDA (KODA) scoring system by developing an easy-to-use mobile application called artificial intelligence-KODA (AI-KODA) score, as well as to determine the inter-rater and intra-rater reliability of the KODA score among three readers for prospective AI applications, and check the efficacy of the application. Method From the 28 patient capsule videos considered, 1539 sequential frames were selected at five-minute intervals, and 634 random frames were selected at random intervals during small bowel transit. The frames were processed and shifted to AI-KODA. Three readers (gastroenterology fellows), who had been trained in reading VCE, rated 2173 frames in duplicate four weeks apart after completing the training module on AI-KODA. The scores were saved automatically in real time. Reliability was assessed for each video using estimate of intra-class correlation coefficients (ICCs). Then, the AI dataset was developed using the frames and their respective scores, and it was subjected to automatic classification of the scores via the random forest and the k-nearest neighbors classifiers. Results For sequential frames, ICCs for inter-rater variability were ‘excellent’ to ‘good’ among the three readers, while ICCs for intra-rater variability were ‘good’ to ‘moderate’. For random frames, ICCs for inter-rater and intra-rater variability were ‘excellent’ among the three readers. The overall accuracy achieved was up to 61% for the random forest classifier and 62.38% for the k-nearest neighbors classifier. Conclusions AI-KODA automates the process of scoring VCE frames based on the existing KODA score. It saves time in cleanliness assessment and is user-friendly for research and clinical use. Comprehensive benchmarking of the AI dataset is in process.

Personalized care for complex lives: initial outcomes of a behaviorally-informed complex care intervention

Background5% of patients account for the majority of healthcare spend, but standardized interventions for this complex population struggle to generate return on investment. The aim of this study is the development and proof of concept of an adaptive intervention to reduce cost and risk of readmission for medically high-risk individuals with any behavioral health diagnosis.MethodsA behaviorally-oriented, personalized care service was delivered using a consultative, team-based approach including a physician, counselor, dietitian and social worker in collaboration with nurse care coordinators. Iterative re-conceptualizations informed tailored treatment approaches to prevent acute decompensation while retraining behaviors that impeded recovery. This service was offered to a small set of members of the employee health plan at University Hospitals Cleveland with an existing behavioral health disorder from November of 2020 to March of 2023. 26 members receiving the service were identified and matched with 26 controls using a risk algorithm. Members and controls were then classified as high utilizers (n = 14) or standard utilizers (n = 38) based on utilization claims data.ResultsPrimary outcomes of this study included medical expenditures (delineated as planned and unplanned spend) and readmission risk scores. Compared to risk-matched controls, both planned and unplanned health care expenditures significantly decreased (p < .05) for 7 high utilizers, and unplanned spend only significantly decreased for 19 standard utilizers (p < .05). Risk scores, which predict future spend, decreased significantly for standard utilizers (p < .05), but not for high utilizers.DiscussionThe value of a behaviorally-oriented personalized care intervention for medically high-risk patients in a commercial insurance population was demonstrated through decreased spend for high utilizers and decreased risk for standard utilizers. Further expansion, refinement, evaluation and scaling are warranted.

Predicting a successful match among applicants to reproductive endocrinology and infertility fellowship

To identify independent predictors of a successful match to reproductive endocrinology and infertility (REI) fellowships, and to develop and internally validate a prediction model for REI match results. Retrospective cohort study. REI fellowship applications sent to the University of Pennsylvania from 2019 to 2023 (excluding 2020), which represented nearly all REI applicants nationally according to National Resident Matching Program (NRMP) data. Demographics, education, training, and academic achievements. Match result, confirmed through online search and communication with program administrators. Univariate analyses identified variables associated with match, which were then included in multivariable models to identify independent predictors. Bootstrapping was used to assess model discrimination and calibration. The final model was integrated into a web-based tool. Of 286 applications (99.0% of REI applications to the NRMP), 199 (69.6%) resulted in a successful match. In univariate analyses, variables associated with match were younger age, attendance at an allopathic U.S. medical school, USMLE and CREOG scores, residency rank, residency affiliation with a fellowship, research experiences, first-author publications, abstracts/articles in progress, and poster presentations. In the adjusted model, independent predictors of match included residency affiliation with an REI fellowship (aOR 5.43, 2.02-14.64), residency rank (aOR 1.77, 1.25-2.50), USMLE score (aOR 1.05, 1.02-1.08), at least one first-author publication (aOR 2.32, 1.08-4.96), projects in progress (aOR 1.26 (1.02-1.55), and poster presentations (aOR 1.07, 1.00-1.15). Attendance at an international medical school was a negative predictor (aOR 0.32, 0.11-0.88). The model achieved an area under the curve (AUC) of 0.883, with 88.5% sensitivity and 65.8% specificity. A refined model without USMLE scores maintained strong performance (C-statistic 0.85, 0.81-0.91; calibration slope 0.91, 0.72-1.24). Affiliation with an REI fellowship, residency reputation, and research output strongly predicted match success. Gender, race, and ethnicity were not major predictors, yet underrepresentation of certain racial and ethnic groups limited the power to detect potential differences. Our prediction model correctly classified >75% of candidates' match results. These findings may help candidates optimize applications and estimate chances of a successful match into REI fellowship, as well as assist programs in critically reviewing their selection criteria for fellowship match.

The Effects of Implementing Gamification in the Hepatology Curriculum for Medical Students.

Background Gamification, the incorporation of game theory into the curriculum, has been correlated with improved knowledge retention compared to standard didactics. Objective To determine the impact of gamified hepatology modules on medical student knowledge retention and exam performance. Methods We created three web-based, gamified hepatology modules with 15-question pre- and post-tests. Differences in each module's pre- and post-test scores were compared using paired t-tests. Medical school exam scores (total score and hepatology-specific score) in module users versus non-users were compared using independent two-sample t-tests. Results Module completion yielded significant increases in pre- to post-test scores for the jaundice (p=0.002) and anatomy modules (p<0.001). Module users scored 1.2 points higher on the total exam score (p=0.4) and 2 points higher on the hepatology exam score (p=0.31). Post-module survey results revealed higher knowledge retention in hepatology topics, expanded interest in hepatology, and an increased inclination to use web-based learning platforms for future learning experiences. Conclusion Module use led to improved post-test scores in the modules. Module users also had higher hepatology exam and total exam scores, yet, this difference was not statistically significant. Overall, this study suggests that gamification may be beneficial in aiding hepatology knowledge recall.