Monitor Patient Progress Research Articles

Enhancing Activity Recognition After Stroke: Generative Adversarial Networks for Kinematic Data Augmentation

The generalizability of machine learning (ML) models for wearable monitoring in stroke rehabilitation is often constrained by the limited scale and heterogeneity of available data. Data augmentation addresses this challenge by adding computationally derived data to real data to enrich the variability represented in the training set. Traditional augmentation methods, such as rotation, permutation, and time-warping, have shown some benefits in improving classifier performance, but often fail to produce realistic training examples. This study employs Conditional Generative Adversarial Networks (cGANs) to create synthetic kinematic data from a publicly available dataset, closely mimicking the experimentally measured reaching movements of stroke survivors. This approach not only captures the complex temporal dynamics and common movement patterns after stroke, but also significantly enhances the training dataset. By training deep learning models on both synthetic and experimental data, we enhanced task classification accuracy: models incorporating synthetic data attained an overall accuracy of 80.0%, significantly higher than the 66.1% seen in models trained solely with real data. These improvements allow for more precise task classification, offering clinicians the potential to monitor patient progress more accurately and tailor rehabilitation interventions more effectively.

Development and validation of survival prediction models for patients with hepatocellular carcinoma treated with transcatheter arterial chemoembolization plus tyrosine kinase inhibitors.

Due to heterogeneity of molecular biology and microenvironment, therapeutic efficacy varies among hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitors (TKIs). We examined combined models using clinicoradiological characteristics, mutational burden of signaling pathways, and radiomics features to predict survival prognosis. Two cohorts comprising 111 patients with HCC were used to build prognostic models. The training and test cohorts included 78 and 33 individuals, respectively. Mutational burden was calculated based on 17 cancer-associated signaling pathways. Radiomic features were extracted and selected from computed tomography images using a pyradiomics system. Models based on clinicoradiological indicators, mutational burden, and radiomics score (rad-score) were built to predict overall survival (OS) and progression-free survival (PFS). Eastern Cooperative Oncology Group performance status, Child-Pugh class, peritumoral enhancement, PI3K_AKT and hypoxia mutational burden, and rad-score were used to create a combined model predicting OS. C-indices were 0.805 (training cohort) and 0.768 (test cohort). The areas under the curve (AUCs) were 0.889, 0.900, and 0.917 for 1-year, 2-year, and 3-year OS, respectively. To predict PFS, alpha-fetoprotein level, tumor enhancement pattern, hypoxia and receptor tyrosine kinase mutational burden, and rad-score were used. C-indices were 0.782 (training cohort) and 0.766 (test cohort). AUCs were 0.885 and 0.925 for 6-month and 12-month PFS, respectively. Calibration and decision curve analyses supported the model's accuracy and clinical potential. The nomogram models are hopeful to predict OS and PFS in patients with intermediate-advanced HCC treated with TACE plus TKIs, offering a promising tool for treatment decisions and monitoring patient progress.

Recommendations for implementing digital alcohol interventions in primary care: lessons learned from a Norwegian feasibility study.

Excessive alcohol consumption is a leading global risk factor for ill-health and premature death. Digital alcohol interventions can be effective at reducing alcohol consumption, but their widespread adoption is lagging behind. This study aimed to identify factors promoting or inhibiting the implementation of a digital alcohol intervention in Norwegian primary care, by using Normalization Process Theory (NPT). A mixed methods feasibility study combining quantitative and qualitative methods. A digital alcohol intervention called "Endre" was implemented across four GP practices in Stavanger and Oslo. Usage of the intervention was logged on the digital platform. General practitioners (GPs) reported their perceived uptake of the intervention via a web-based survey. The Normalization MeAsure Development (NoMAD) survey was used to measure support staff's perceived normalization of the intervention. Qualitative data were analyzed using the NPT framework, with quantitative data analyzed descriptively and using χ 2 and Wilcoxon signed-rank test for differences in current and future normalization. Thirty-seven GPs worked in the clinics and could recruit patients for the digital intervention. Thirty-six patients registered for the intervention. Nine patients dropped out early and 25 completed the intervention as intended. Low normalization scores at follow-up (n = 27) indicated that Endre did not become fully embedded in and across practices. Nonetheless, staff felt somewhat confident about their use of Endre and thought it may become a more integral part of their work in the future. Findings from six semi-structured group interviews suggested that limited implementation success may have been due to a lack of tailored implementation support, staff's lack of involvement, their diminished trust in Endre, and a lack of feedback on intervention usage. The outbreak of the Covid-19 pandemic further limited opportunities for GPs to use Endre. This study investigated the real-world challenges of implementing a digital alcohol intervention in routine clinical practice. Future research should involve support staff in both the development and implementation of digital solutions to maximize compatibility with professional workflows and needs. Integration of digital solutions may further be improved by including features such as dashboards that enable clinicians to access and monitor patient progress and self-reported outcomes.

Evaluating cervical spine mobility and Fitt's law compliance: The DidRen laser test adapted for virtual reality with age and sex effects

Cervical spine mobility assessment is crucial in rehabilitation to monitor patient progress. This study introduces the DidRen VR test, a virtual reality (VR) adaptation of the conventional DidRen laser test, aimed at evaluating cervical spine mobility.We conducted a cross-sectional study involving fifty healthy participants that underwent the DidRen VR test. The satisfaction of Fitts' law within this VR adaptation was examined and we analyzed the effects of age and sex on the sensorimotor performance metrics.Our findings confirm that Fitts' law is satisfied, demonstrating a predictable relationship between movement time and the index of difficulty, which suggest that the DidRen VR test can simulate real-world conditions. A clear influence of age and sex on performance was observed, highlighting significant differences in movement efficiency and accuracy across demographics, which may necessitate personalized assessment strategies in clinical rehabilitation practices.The DidRen VR test presents an effective tool for assessing cervical spine mobility, validated by Fitts' law. It offers a viable alternative to real-world method, providing precise control over test conditions and enhanced engagement for participants. Since age and sex significantly affect sensorimotor performance, personalized assessments are essential. Further research is recommended to explore the applicability of the DidRen VR test in clinical settings and among patients with neck pain.

A home-based hand rehabilitation platform for hemiplegic patients after stroke: A feasibility study

BackgroundPatients with stroke often experience weakened upper limbs, making daily tasks difficult to perform. Although rehabilitation devices are available, patients often relapse post-discharge due to insufficient practice. We present a home-based hand telerehabilitation intervention using the iManus™ platform comprising a sensorized glove, a mobile app for the patients, and a therapist portal for monitoring patient progress. ObjectivesThis research aimed to examine the feasibility, safety, and effectiveness of a home-based telerehabilitation intervention in improving hand function for individuals with mild stroke. A qualitative approach was also used to explore users' experiences, perceived benefits, and challenges associated with using the platform in a home setting. MethodsIn this single-case study, we delivered a hand telerehabilitation intervention to a chronic stroke patient with impaired hand function using the iManus™ platform. The intervention consisted of 40 home sessions over eight weeks. We assessed feasibility through user adherence and feedback obtained using a System Usability Scale (SUS) and a semi-structured interview with the participant and their informal caregiver. Safety was evaluated by monitoring pain levels using the Visual Analog Scale (VAS), and efficacy was determined by observing the changes in the fingers’ range of motion using the iManus™ platform and clinical outcomes measures, namely the Fugl-Meyer Assessment (FMA) and Jebsen Taylor Hand Function Test (JTHFT). ResultsOur participant completed all the assigned sessions, with each averaging 20 min. Usability scored 77.5 out of 100 on the SUS. User feedback from the interviews revealed improved mobility and control over therapy as benefits, indicating room for improvement in the intervention's adaptability and functionality. During the intervention, the participant noted no pain increase, and the telerehabilitation platform recorded range of motion improvements for all finger and wrist joints, excluding wrist extension. The FMA scores were 43 at T0, 53 at T1, and 56 at T2, while the JTHFT scores were 223 at T0, 188 at T1, and 240 at T2. ConclusionsThis single case study demonstrated the preliminary feasibility, safety, and efficacy of a novel home-based hand intervention for stroke survivors. The participant showed improved hand functions, good adherence to the program, and reported satisfaction with the intervention. However, these results are based on a single-case study, and further large-scale studies are needed before any generalization is recommended.

Evaluation of the Rennes Universal Measurement Method (RUMM), an artificial intelligence application for hand joint angle assessment.

Although goniometric measurement is considered the gold standard for the measurement of digital range of motion, visual estimation is often employed due to its simplicity despite being inconsistent with recommended guidelines. We evaluated the Rennes Universal Measurement Method, an innovative tool employing artificial intelligence to concurrently analyse hand joint angles based on a single photograph. We found a strong correlation between the goniometric method and the photograph-based approach (Spearman correlation coefficient 0.7). The mean standard error of measurement was -1° (SD 17°). Regarding reproducibility with different photographic angles, an excellent intraclass correlation coefficient of 0.9 was noted. The tool had a processing time of less than 0.1 s per hand, while traditional goniometric methods took 20-30 s per finger. Combining simplicity, high reproducibility and good inter-rater reliability, this is a potentially useful tool that can be used to monitor patient progress in place of traditional goniometry.

SAMI: an M-Health application to telemonitor intelligibility and speech disorder severity in head and neck cancers.

Perceptual measures, such as intelligibility and speech disorder severity, are widely used in the clinical assessment of speech disorders in patients treated for oral or oropharyngeal cancer. Despite their widespread usage, these measures are known to be subjective and hard to reproduce. Therefore, an M-Health assessment based on an automatic prediction has been seen as a more robust and reliable alternative. Despite recent progress, these automatic approaches still remain somewhat theoretical, and a need to implement them in real clinical practice rises. Hence, in the present work we introduce SAMI, a clinical mobile application used to predict speech intelligibility and disorder severity as well as to monitor patient progress on these measures over time. The first part of this work illustrates the design and development of the systems supported by SAMI. Here, we show how deep neural speaker embeddings are used to automatically regress speech disorder measurements (intelligibility and severity), as well as the training and validation of the system on a French corpus of head and neck cancer. Furthermore, we also test our model on a secondary corpus recorded in real clinical conditions. The second part details the results obtained from the deployment of our system in a real clinical environment, over the course of several weeks. In this section, the results obtained with SAMI are compared to an a posteriori perceptual evaluation, conducted by a set of experts on the new recorded data. The comparison suggests a high correlation and a low error between the perceptual and automatic evaluations, validating the clinical usage of the proposed application.

Interns' Perceived Level of Proficiency After General Surgery Rotation: A Cross-Sectional Study From Saudi Arabia.

The role of interns during general surgical rotation is crucial in shaping their future careers as surgeons. Surgical rotation offers a unique opportunity to gain valuable hands-on experience in fast-paced and challenging environments. However, interns often face significant challenges in obtaining the necessary practical training to develop proficiency in surgical techniques. This article aims to analyze some aspects of the accumulated competency of interns during their general surgery rotation, focusing on the range of skills and knowledge gained, in addition to the challenges faced. We conducted a cross-sectional study using an anonymous web-based self-assessment questionnaire. The target population of the study included all Jazan University medical interns enrolled in the academic year 2022-2023. Most participants showed low-to-average levels of proficiency in monitoring clinical evolution and treatment plans, ranging from fundamental awareness (n = 17, 17.5%) to working knowledge (n = 51, 52.6%), with only three participants (3.1%) reporting an expert level of proficiency. The same pattern was observed in the documentation of patient records (range: 7.2%, n = 7 for fundamental awareness to 42.3%, n = 41 for working knowledge). However, a significant proportion saw themselves as either proficient (n = 23, 23.7%) or experts (n = 15, 15.5%) in this aspect. Regarding bedside procedures, such as venipuncture, proctoscopy, nasogastric tube insertion, and urethral catheterization, the participants showed different proficiency levels, with the lowest in proctoscopy, where 66 (68.0%) of the participants reported only fundamental awareness. The results also revealed low perceived proficiency in performing surgical skin incisions, wound suturing, knot tying, application of surgical skin clips, and abscess drainage, with the lowest proficiency observed in the excision of superficial lumps as more than half of the participants reported only fundamental awareness (n = 51, 52.6%). The results of this study indicate that documentation and monitoring of patient progress are the competencies mastered most by the majority of interns during their rotations in general surgery. However, the interns' overall level of proficiency in bedside procedures and basic surgical skills acquired during their rotation was low to average. Additionally, interns were dissatisfied with their training and the opportunities provided for them to actively engage in performing procedures in the operating room. This low proficiency is unrelated to pre-internship academic achievement, sex, or interest in future surgical careers. This suggests that efforts are needed to develop strategies to enhance interns' satisfaction and engagement, ultimately improving their overall experience during internships.

Perceptiveness and Attitude on the use of Artificial Intelligence (AI) in Dentistry among Dentists and Non-Dentists - A Regional Survey

ABSTRACT Artificial intelligence (AI) is an emerging tool in modern medicine and the digital world. AI can help dentists diagnose oral diseases, design treatment plans, monitor patient progress and automate administrative tasks. The aim of this study is to evaluate the perception and attitude on use of artificial intelligence in dentistry for diagnosis and treatment planning among dentists and non-dentists’ population of south Tamil Nadu region in India. Materials and Methods: A cross sectional online survey conducted using 20 close ended questionnaire google forms which were circulated among the dentists and non -dentists population of south Tamil Nadu region in India. The data collected from 264 participants (dentists -158, non-dentists -106) within a limited time frame were subjected to descriptive statistical analysis. Results: 70.9% of dentists are aware of artificial intelligence in dentistry. 40.5% participants were not aware of AI in caries detection but aware of its use in interpretation of radiographs (43.9%) and in planning of orthognathic surgery (42.4%) which are statistically significant P < 0.05.44.7% support clinical experience of a human doctor better than AI diagnosis. Dentists of 54.4% agree to support AI use in dentistry. Conclusion: The study concluded AI use in dentistry knowledge is more with dentists and perception of AI in dentistry is optimistic among dentists than non -dentists, majority of participants support AI in dentistry as an adjunct tool to diagnosis and treatment planning.

The “Get Moving Trial”: A phase I/II RCT of home-based (P)rehabilitation ((P)REHAB) with ExerciseRx in muscle-invasive bladder cancer (MIBC)—Study protocol for a randomized controlled trial.

TPS706 Background: Patients with MIBC often have a high burden of frailty, sarcopenia, mobility impairment, and multimorbidity, each of which is associated with reduced treatment tolerability. Prehabilitation programs are designed to improve functional capability prior to treatment to mitigate functional decline and optimize outcomes. Barriers to widespread adoption include cost, time, intensity of in-person interventions, and overly restrictive inclusion criteria which would exclude most patients with MIBC. Here, we describe a randomized controlled trial to evaluate the feasibility, usability, and impact of a pragmatic (P)REHAB exercise intervention delivered via the ExerciseRx app in participants with MIBC undergoing neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). The primary objectives are to evaluate the (P)REHAB intervention vs. standard care (SC) to quantify the efficacy of the intervention to 1) improve or maintain physical function in patients with MIBC undergoing NAC followed by RC, and 2) globally characterize the impact of the (P)REHAB intervention with respect to patient-reported feasibility and acceptability, health-related quality of life, body-composition, frailty, treatment-associated and clinical outcomes. Methods: We will recruit and randomize 102 patients in a 1:1 ratio to the (P)REHAB or SC arms. The (P)REHAB arm will be prescribed a personalized, home exercise program (~20-minutes, 4x weekly) via the ExerciseRx app, during NAC, prior to RC and for 90-days post-RC as well as graded progression in step count. SC participants will receive printed guideline-based recommendations for physical activity during standard perioperative care. ExerciseRx comprises of 1) a provider dashboard integrated into the electronic health record for prescribing exercises and monitoring patient progress, and 2) a patient app, that administers exercise plans and tracks exercise repetitions using sensors in commodity smart devices. Step count in the (P)REHAB and SC arm will be tracked with Fitbit trackers. In the (P)REHAB arm, step count data from the Fitbit will be reviewable in the ExerciseRx provider dashboard and patient app. Eligibility criteria: English-speaking adults (>18 years) with AJCC pT2-4 N0-1 M0 MIBC planning to undergo NAC followed by RC who are willing and able to participate in the trial. Primary outcome: Change in the Short Physical Performance Battery. Secondary outcomes: FitBit-assessed step count and sedentary time, ExerciseRx adherence and usability, patient-reported quality of life (EORTC-QLQ-C30, -BLM30), change in body composition (fat-mass, fat-free mass), frailty (Cancer and Aging Resilience Evaluation), treatment-associated adverse events between baseline and following NAC, and 3 months following RC. Trial enrollment will commence 10/2023. Clinical trial information: NCT06040762 .

Leveraging ICT for improved quality services in secondary healthcare facilities in Nigeria: Evidence from Kogi State

This study focused on investigating the relationship between Information and Communication Technology (ICT) and the provision of high-quality healthcare services. The research employed a survey research design and concentrated on secondary healthcare facilities within the state. A total of 273 healthcare personnel were randomly selected from these facilities using a simple random sampling technique. Data was collected through a well-structured questionnaire. The secondary information was provided through the Kogi State Strategic Health Development Plan, textbooks, journal articles, conference papers, theses, and the internet. The gathered information was analysed using descriptive statistics and linear regression. Data on respondents’ demographic characteristics and ICT utilisation were presented using simple percentages in tables. The findings of the study demonstrated that the adoption of ICT significantly influences the delivery of quality healthcare services in secondary healthcare facilities. Specifically, the utilisation of ICT can enhance patient safety by facilitating comprehension of medical information, enabling online treatment evaluations, monitoring patient progress, and predicting potential medical complications. Based on the results, it can be concluded that improving ICT adoption is crucial for enhancing and sustaining the provision of quality healthcare services. Therefore, the study recommends that the management of secondary healthcare facilities should prioritise efforts to enhance ICT adoption within their operations. The practical implication of the study is that incorporating ICT in healthcare practices can contribute to more informed decision-making and proactive measures, ultimately fostering a safer and more effective healthcare environment in secondary healthcare facilities.

Syndrome of the Trephined, a Rare Complication of Decompression Craniotomy: A Case Report

Post-traumatic brain injury can lead to intracranial hypertension, which is a serious neurological emergency that may require decompressive craniotomy (DC). However, decompressive craniotomies can give rise to complications in some patients during their recovery phase, in particular the "trephine" syndrome, which adversely affects patients' functional rehabilitation. The main symptoms are severe orthostatic headaches, motor deficits, cognitive decline and convulsions. Imaging, particularly CT scans, is essential for making a positive diagnosis and monitoring patient progress. In this study, we describe a case of skin flap syndrome secondary to post-traumatic decompression.

Asynchronous assessment with the PCL-5: Practice considerations and recommendations.

The posttraumatic stress disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5 (PCL-5; Weathers et al., 2013) is a well-validated self-report instrument intended to assess provisional diagnostic status and symptom severity of PTSD. With the recent release of the Department of Veterans Affairs measurement-based care initiative, the PCL-5 is now required to be used by VA-based PTSD Specialty Clinics to track and monitor patient progress in treatment. With the rise of telehealth modalities in response to the COVID pandemic, clinicians have turned to remote, asynchronous assessment (i.e., assessments completed without the provider present through remote platforms) as a means to provide best care to virtual patients and reduce time burden on providers. We review the psychometric properties of the PCL-5 along with relevant criticisms of the measure to provide recommendations for its optimal use through remote, asynchronous means. We also explore considerations for using remote, asynchronous assessment to assist with measurement-based care more broadly. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Clinical Audit of Orthopaedic Clinical Documentation of Acute Ankle Fractures: A Quality Improvement Project.

Background Orthopaedic ankle fractures are common injuries that require careful assessment, management, and documentation to ensure optimal patient outcomes. Proper documentation plays a critical role in facilitating communication among healthcare professionals, ensuring accurate diagnosis, treatment planning, and monitoring patient progress. Moreover, it is essential for medico-legal purposes and quality improvement initiatives. This article presents a comprehensive clinical audit aimed at evaluating the quality of orthopaedic ankle fracture documentation within a healthcare setting. The aim of this project was to assess the quality and accuracy of ankle fracture documentation within a single centreagainst the audit standards set by the British Orthopaedic Association (BOA) and the National Institute for Health and Care Excellence (NICE). Methods The study was a closed-loop audit utilising both retrospective and prospective analysis of ankle fracture clerking documentation performed by members of the trauma and orthopaedics team. Two audit cycles were completed in total; the first cycle was carried out in January 2020 where data were collected retrospectively from all orthopaedic admissions of ankle fractures. This was then re-audited against the BOA and NICE guidelines and presented to the local clinical governance meeting. A targeted educational intervention was then implemented with the goal of educating and reinforcing to key team members the documentation standards and the importance of accurate clerking documentation. The second cycle was carried out during July 2020 prospectively. All data were collected and collated with a total of nine data parameters analysed. Patients were included if they were skeletally mature and presented with closed malleolar and syndesmotic ankle injuries. Excluded patients were those who presented with open fractures, pilon fractures, and/or were skeletally immature. Data were then re-presented at the clinical governance meeting. Results A total of 23 patients were identified in the initial audit cycle and 22 patients in re-audit. On admission, it was found that 86% of patients presenting with ankle fractures had adequate documentation of their injury mechanism, which subsequently improved to 100% following the intervention. Similarly, there was a 71% improvement in precise documentation of clinical findings of ankle fractures. There was a marked improvement in the consistency of examination findings as well, with over 30% improvement in the rate of documentation for sensation status, skin integrity, circulation, and motor function. Results also revealed a 71% improvement in the documentation rates of vascular examinations where a Doppler ultrasound was used or pulses named in the documentation. Conclusion Through a targeted educational scheme focussing on the proposed documentation guidelines, we noted a significant improvement in documentation standards and accuracy of ankle fractures in the trauma and orthopaedic department. With ongoing educational input and reinforcement, team members can be supported to maintain a high level of documentation that meets all available standards, which will ultimately lead to improved patient care.

Alcohol use disorder treatment via video conferencing compared with in-person therapy during COVID-19 social distancing : A non-inferiority comparison of three cohorts.

Social distancing measures during the COVID-19 pandemic forced an abrupt transformation of treatment delivery for mental health care. In mid-March 2020, nearly all in-person contact was replaced with video conferencing. The pandemic thus offered a natural experiment and a unique opportunity to conduct an observational study of whether alcohol use disorder treatment through video conferencing is non-inferior to in-person treatment. In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pre-test and post-test data on alcohol use (Measurements in the Addictions for Triage and Evaluation), psychopathology (Depression Anxiety Stress Scales), and quality of life (Manchester Short Assessment of Quality of Life) were used to compare outcomes of cognitive behavioral therapy treatment for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to (n = 628), partially during (n = 557), and entirely during (n = 653) the COVID-19 lockdown. Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments that started in-person, but were continued through video conferencing, compared to in-person treatments that were conducted prior to COVID-19. The number of drop-outs were also similar between cohorts. However, there was a difference in average treatment intensity between cohorts, with treatment partially or fully conducted during the COVID-19 pandemic lasting longer. Treatment for a primary alcohol use disorder, provided partially or predominantly through video conferencing during the COVID-19 pandemic resulted in abstinence rates and secondary outcomes similar to traditional in-person care, in spite of the potentially negative effects of the COVID-related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta-analyses in which video conferencing appeared non-inferior to in-person care in clinical effectiveness.

Exploring the Potential of Chatbots in Critical Care Nephrology.

The exponential growth of artificial intelligence (AI) has allowed for its integration into multiple sectors, including, notably, healthcare. Chatbots have emerged as a pivotal resource for improving patient outcomes and assisting healthcare practitioners through various AI-based technologies. In critical care, kidney-related conditions play a significant role in determining patient outcomes. This article examines the potential for integrating chatbots into the workflows of critical care nephrology to optimize patient care. We detail their specific applications in critical care nephrology, such as managing acute kidney injury, alert systems, and continuous renal replacement therapy (CRRT); facilitating discussions around palliative care; and bolstering collaboration within a multidisciplinary team. Chatbots have the potential to augment real-time data availability, evaluate renal health, identify potential risk factors, build predictive models, and monitor patient progress. Moreover, they provide a platform for enhancing communication and education for both patients and healthcare providers, paving the way for enriched knowledge and honed professional skills. However, it is vital to recognize the inherent challenges and limitations when using chatbots in this domain. Here, we provide an in-depth exploration of the concerns tied to chatbots' accuracy, dependability, data protection and security, transparency, potential algorithmic biases, and ethical implications in critical care nephrology. While human discernment and intervention are indispensable, especially in complex medical scenarios or intricate situations, the sustained advancements in AI signal that the integration of precision-engineered chatbot algorithms within critical care nephrology has considerable potential to elevate patient care and pivotal outcome metrics in the future.

A functional Hidden Markov Model to incorporate dynamics into Bayesian optimal stopping problems: Helping physicians manage traumatic brain injuries

This paper describes a decision support system for neurosurgeons to determine the release schedule for polytrauma patients with concurrent traumatic brain injuries (TBIs). We present a novel functional Hidden Markov Model (fHMM) designed to mitigate the computational burden caused by ever-growing historical data. Our fHMM is nested into a Bayesian optimal stopping problem, effectively representing emergency physicians' crucial decisions during the discharge process. Our model is unique in its ability to adapt to different physician decision-making styles while continuously monitoring patient progress. We validate our approach using simulated and real data from a major hospital in Tampa Bay. The analysis reveals that dynamic prognostic measures can help balance the competing needs of rapid patient release and neurologic stability. Additionally, our results show variability in physicians' expectations regarding neurological recovery. Counterfactual analyses suggest that implementing this decision model could potentially save up to $27,500 per TBI patient under certain conditions.

The first aphasia screening test in Hungarian: A preliminary study on validity and diagnostic accuracy.

The Hungarian Aphasia Screening Test (HAST) is a newly developed diagnostic tool for detecting post-stroke aphasia in clinical settings, and for differentiating between stroke patients with and without aphasia. The HAST was developed by our team and has not been published in English yet. In Hungarian, to date, there is no aphasia screening test with reported psychometric properties available. This study aims to present the main characteristics of the HAST and to evaluate its validity, internal consistency, and diagnostic accuracy. The HAST comprises five subtests (maximum score: 20) and takes 5-10 minutes to administer. We administered the HAST to 40 stroke patients with aphasia, 26 stroke patients without aphasia, and 51 healthy control participants to evaluate the test's construct validity, convergent validity, and internal consistency, as well as its sensitivity and specificity. We used the Western Aphasia Battery (WAB) as a reference test. With a cut-off score of 17, the HAST showed high diagnostic accuracy (sensitivity: 92.5%, specificity: 88.5%). Its construct validity was good; we identified one component in the test, and moderate-to-strong positive correlations across most of its subtests (mean Spearman r = 0.56). Convergent validity of the HAST was satisfying, reflected by the moderate-to-strong positive correlations between subtests of the HAST and subtests of the WAB (Spearman r = 0.50-0.86). The correlation between the HAST total score and the WAB aphasia quotient was high (Spearman r = 0.86). Despite the small number of items within tasks, all subtests showed acceptable internal consistency (mean Cronbach's α = 0.74). Our preliminary results suggest that the HAST is a valid, accurate, and clinically feasible test to detect post-stroke aphasia and to identify patients who require a more detailed assessment of their language skills. In addition, it reliably identifies not only the presence but also the severity of aphasia, thus, it might be a good candidate for monitoring patient progress.

Challenges in rehabilitation and continuum of care provision after knee replacement: a mixed-methods study from a low- and middle-income country

Purpose Continuum-of-care is crucial following knee replacement. This is an understudied area in the context of low- and middle-income countries. We report findings of a mixed-methods study conducted to understand patient’s postoperative experiences in following unsupervised home-based physiotherapy protocols and healthcare provider’s experiences in providing rehabilitation care. Methods Consecutive adults (n = 79) scheduled or had undergone knee replacement, attending an urban tertiary care hospital in India completed a 22-item questionnaire to gauge attitude towards physical rehabilitation. We conducted in-depth interviews with nine patients, ten physiotherapists, and three surgeons using a phenomenology approach. Data were interpreted using the capability, opportunity, and motivation-behaviour (COM-B) framework. Results Patients were motivated to do exercises and valued family support during the recovery period. However, they desired physiotherapy support, especially during the early recovery period due to post-operative pain. Healthcare providers reported poor adherence with the exercise regimen and desired a mechanism to monitor patient progress after discharge. Patients and health care providers identified accessibility to rehabilitation centre as a major barrier in availing affordable and reliable physiotherapy services. Conclusion There is a need for a continuum of care to improve patient experience during recovery and for health care providers to monitor progress and provide personalised progressive exercise therapy.

Advancements in portable instruments based on affinity-capture-migration and affinity-capture-separation for use in clinical testing and life science applications

The shift from testing at centralized diagnostic laboratories to remote locations is being driven by the development of point-of-care (POC) instruments and represents a transformative moment in medicine. POC instruments address the need for rapid results that can inform faster therapeutic decisions and interventions. These instruments are especially valuable in the field, such as in an ambulance, or in remote and rural locations. The development of telehealth, enabled by advancements in digital technologies like smartphones and cloud computing, is also aiding in this evolution, allowing medical professionals to provide care remotely, potentially reducing healthcare costs and improving patient longevity. One notable POC device is the lateral flow immunoassay (LFIA), which played a major role in addressing the COVID-19 pandemic due to its ease of use, rapid analysis time, and low cost. However, LFIA tests exhibit relatively low analytical sensitivity and provide semi-quantitative information, indicating either a positive, negative, or inconclusive result, which can be attributed to its one-dimensional format. Immunoaffinity capillary electrophoresis (IACE), on the other hand, offers a two-dimensional format that includes an affinity-capture step of one or more matrix constituents followed by release and electrophoretic separation. The method provides greater analytical sensitivity, and quantitative information, thereby reducing the rate of false positives, false negatives, and inconclusive results. Combining LFIA and IACE technologies can thus provide an effective and economical solution for screening, confirming results, and monitoring patient progress, representing a key strategy in advancing diagnostics in healthcare.