Patient Information Research Articles

Clinical presentation, acute care management and discharge information of patients with thoracic trauma in South Africa and Sweden: a prospective multicenter observational study

Abstract Purpose Thoracic trauma causes pain and hospitalisation. Middle- and high-income countries have different trauma contexts and populations. To report patients’ clinical presentation (pain and shortness of breath) and its influence on hospital length of stay (LOS), acute care management, and discharge destinations in South Africa (SA) and Sweden. Methods Prospective observational multicenter study by means of clinical record review. Two centers in SA and four centers in Sweden participated. One thousand nine hundred and eighteen adults with thoracic trauma were screened over the 20 months period. Study objectives guided information retrieved from clinical records. Statistical analysis was done with significance at p-value < 0.05. Results Three-hundred-sixty-four participants were recruited with most being male (n = 170/179 (95%) SA; n = 125/185 (68%) Sweden). Type and mechanism of injury differed (SA penetrating (82%) versus Sweden blunt (95%); SA assaults (90%) versus Sweden falls (44%)). Unilateral haemopneumothorax was common (SA 68%, Sweden 35%) and managed with intercostal drainage. Rib cage injuries were common in the Swedish cohort with rib fixation surgery for 17%. Physiotherapy treatment frequency was mostly daily. Blunt injury resulted in higher pain levels during deep breathing (day 1: p = 0.014; day 2: p < 0.001; day 3: p < 0.001) and shortness of breath during activity (day 1: p = 0.036; day 2: p = 0.003; day 3: p < 0.001). LOS was shorter for SA cohort (5 (± 4) versus 7 (± 5) days; p = 0.024). Age influenced LOS in the blunt injury group. Discharge destination was mostly home (99% SA, 56% Sweden). Conclusion Priority care is indicated for those who are older and have blunt thoracic injury to prevent pulmonary complications and prolonged hospitalisation.

Reproductive cancer cryopreservation services: Patient information, clinical advice, and support.

Fertility preservation services must offer information to patients, prior to their visit, so that they have time to read and digest the information, and also have the opportunity to write down any questions they wish to ask at the oncofertility consultation appointment. Appointments must be offered immediately, based on a specifically designed referral form. Each fertility service providing oncology cryopreservation should have a robust map of the patient's journey to include referral, counseling session, medical consultation, informed consent, treatment plan, and follow-up. Consent for fertility preservation should only be obtained after thorough assessment and discussion with the patient. It must contain basic aspects such as duration of storage, right to dispose or choose alternatives, wishes about stored material if death occurs, and need for patient contact on an annual basis. Appropriate legal advice should be sought in the process of establishing oncology cryopreservation services, most importantly related to patient consent. Ethical and legal aspects of fertility cryopreservation must be considered in the provision of care for cancer patients. Cancer patients attending for cryopreservation have significant concerns in relation to the success of the process, time frame to return for cancer treatment, and safety. Two major nonmedical aspects, coping ability and mortality, are best addressed by counselors and highlight the need to offer this type of psychological support to all cancer patients attending for fertility preservation. The role of genetic counseling is to discuss any potential risks of transmission of the disease to the resulting offspring and offer genetic testing when appropriate. A service based on availability of comprehensive information coupled with in-house implications counseling will have a positive impact and improve the overall care of patients attending for fertility cryopreservation and this should be standard care.

Age did not affect the rate of subsequent hysterectomy following hysteroscopic surgery: A population-based retrospective cohort study from 2000 to 2020.

Previous studies found younger age was associated with an increased risk of hysterectomy after hysteroscopic surgeries (HS) due to abnormal uterine bleeding (AUB). The present study aimed to evaluate the effect of age on the incidence of hysterectomy after HS for treating AUB in Taiwan. This was a nationwide population-based retrospective cohort study which utilized the Taiwan National Health Insurance Database. The present study involved 4150 participants who underwent HS due to AUB. The study focused on females aged ≥40 years diagnosed with AUB who underwent HS between 2000 and 2020. Hysterectomy outcomes were analyzed using the Cox proportional hazards model, and age was categorized into three groups (40-44, 45-49, and 50-55 years). Statistical significance was set at P < 0.05. This study involved 4150 participants with an average age of 46.1 years, categorized into the following age groups: 40-44 years (39.6%), 45-49 years (38.8%), and 50-55 years (21.6%). Approximately 8.1% of participants required hysterectomy treatment; the highest incidence was observed in the 40-44-year age group (8.6%). The median time from HS to hysterectomy varied across age groups, ranging from 0.25-2.78 years. The presence of uterine myoma (adjusted hazard ration [aHR]: 2.11; 95% CI: 1.70-2.64; P < 0.0001) and adenomyosis (aHR: 10.24; 95% CI: 8.17-12.85; P < 0.0001) significantly increased the risk of hysterectomy. Kaplan-Meier survival curves demonstrated a comparable likelihood of hysterectomy across age groups within 5 years post-HS, with most occurrences occurring in the initial 5 years. Our study found no age effect on subsequent hysterectomy after HS. This study contributes to a significant understanding of HS outcomes, aiding information for patients seeking AUB surgical options.

Problems Experienced by Patients in the Clinic and at Home after Orthopedic Surgery and Their Level of Care Dependency

Background: The care needs of patients who underwent orthopedic surgery are not limited to the hospital but continue at home after discharge. Objectives: The aim of this study is to determine the problems and care dependency levels of patients who has orthopedic surgery in the clinic after the surgery and at home in the first month of discharge. Methods: Between March 1, 2021 and April 18, 2022, 113 patients (aged 18 and over), who were hospitalized in the orthopedics and traumatology clinic of public hospital due to orthopedic surgery, were included in study. Data were collected using the “Patient Information Form (Part I), Follow-up Form (Part II),” and “Care Dependency Scale.” Data were evaluated using mean, standard deviation, median, minimum-maximum, number and percentage, McNemar, McNemarBrowker, eta squared (η2), Cohen’s d, Kruskal Wallis-H test, Dunn’s test for multiple comparisons and Linear regression analysis. Results: It has determined that patients who had orthopedic surgery mostly had difficulties in fulfill their self care needs and physical mobility limitations. With the relief of patients’ pain and anxiety, an increase in their belief in recovery and a decrease in their dependency levels were observed. In the linear regression model, only 17% of the changes in care dependency could be explained by independent variables, but the independent variables were not statistically significant. Conclusion: Orthopedic patients experience high levels of mobility limitation and care dependency. There was a decrease in care dependency in the first month after discharge compared to the third day in the clinic.

Comparison of clinicopathological characteristics and prognosis between primary squamous cell carcinoma of the thyroid and squamous cell carcinoma combined with papillary thyroid carcinoma

BackgroundPrimary squamous cell carcinoma of the thyroid (PSCCT) has recently been reclassified as a morphologic pattern of anaplastic thyroid carcinoma (ATC). Consequently, PSCCT and squamous cell carcinoma with papillary thyroid carcinoma (SCC-PTC) were categorized as ATC. However, in terms of clinical characteristics and overall prognosis, whether PSCCT is similar to SCC-PTC has yet to be sufficiently investigated. Therefore, this study aimed to elucidate the differences and similarities between PSCCT and SCC-PTC regarding clinicopathological characteristics and prognosis.MethodsWe retrospectively reviewed the medical records of patients with squamous cell carcinoma of the thyroid in our institution from December 2009 to December 2020. In addition, the publications in CNKI, Wanfang, VIP, PubMed, Embase, Web of Science, and ProQuest databases were systematically searched to collect patient information. According to pathological diagnosis, patients were divided into the PSCCT and SCC-PTC groups, and compared their clinical characteristics, treatment, and prognosis, respectively.Results308 patients in the PSCCT group and 60 patients in the SCC-PTC group were enrolled in the study. There were significant differences in gender, age, T stage, N stage, M stage, symptoms at diagnosis, and TTF-1 expression between the two groups. Patients in the SCC-PTC group with more frequent radioactive iodine therapy, surgery, and less frequent radiotherapy than PSCCT. In addition, PSCCT and SCC-PTC also demonstrated similarities in tracheal invasion, esophageal invasion, CK5/6 expression, TG expression, P53 expression, and chemotherapy frequency. The 3-year overall survival rate of PSCCT (19.1%) was lower than that of SCC-PTC (34.6%). The prognostic factors were different between the two groups. Multivariable analysis shows that the N stage, M stage, radiotherapy, and tracheal invasion were related to the prognosis of PSCCT, while only the T stage was associated with the prognosis in SCC-PTC.ConclusionsClinicopathological characteristics and prognosis were not identical in patients with SCC-PTC and PSCCT. These findings indicated that different clinical treatment and management plans are required for patients with these two types of thyroid cancer.

Hidden blood loss and risk factors after percutaneous endoscopic transforaminal lumbar interbody fusion

PurposeIn this study, we aimed to assess the occurrence of hidden blood loss (HBL) and its associated risk factors in patients with lumbar degenerative diseases who underwent percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF).MethodsSex, age, height, weight, body mass index, and medical history including hypertension, diabetes, and osteoporosis were recorded. The duration of symptoms, preoperative lumbar subcutaneous fat tissue thickness (measured using midsagittal T2-weighted magnetic resonance imaging), lumbar disc degeneration grade, and other basic patient information were also documented. The levels of fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, and platelet count as well as the pre- and postoperative hematocrit and hemoglobin levels were collected. In addition, the number of fusion levels, surgical time, and intraoperative blood loss were recorded. Total blood loss (TBL) was calculated using the gross formula, and HBL was calculated based on the TBL and visible blood loss. The risk factors were analyzed using single-factor correlation and multivariate linear regression analyses.ResultsOf the 83 patients, there were 42 males and 41 females. Hypertension (P = 0.003), fusion level (P &amp;lt; 0.001), and surgery time (P &amp;lt; 0.001) were significantly correlated with HBL via a single-factor correlation analysis. Multiple linear regression analysis showed that the fusion level (P &amp;lt; 0.001) and surgery time (P &amp;lt; 0.001) were independent risk factors for HBL.ConclusionIn patients with lumbar degenerative diseases treated with Endo-TLIF, HBL accounts for a large proportion of TBL. A large number of fusion segments and prolonged operation time are risk factors for increased perioperative HBL during Endo-TLIF. Increased attention should be paid to the presence of HBL to ensure the safety of perioperative patients.

Surgeons’ Perspectives on Liability for the Use of Artificial Intelligence Technologies in the United States and European Union: Results From a Focus Group Study

Objective: To examine surgeons’ perspectives on liability for using artificial intelligence (AI)-driven technologies in surgery in the United States and the European Union. Background: The introduction of AI-driven technologies in surgery can improve surgical performance and patient outcomes. However, liability risks might inhibit their implementation in the operating room. We report here the results of a focus group study that explored surgeons’ perspectives on liability for using AI-driven technologies in surgery in the United States and the European Union. Methods: Participants were identified through a call for participation disseminated through personal and professional networks. Inclusion criteria were: (1) adults (at least 18 years of age); (2) surgeons based in either the United States or in one of the European Union’s Member States, with a preference for those specializing in gastrointestinal surgery to facilitate better discussions about the vignettes that involved a colorectal surgical procedure; (3) ability to comfortably read and communicate in English; (4) willingness to consent to participation, and (5) willingness to consent to keeping the focus group meeting content, participants, and discussions confidential. Results: We conducted 6 focus groups via Zoom with a total of 18 participants (11 EU surgeons and 7 US surgeons). The following main themes emerged: (1) acknowledgment of the potential benefits of using AI-driven technology in surgery, (2) acceptance of surgeon responsibility, (3) recognition that AI may impact the standard of care, (4) skepticism about potential liability for AI manufacturers, and (5) the importance of patient information and consent. Conclusions: Despite the potential future benefits of integrating AI into surgical practice, surgeons will benefit from (1) an increased understanding of how AI-driven technologies will deliver these benefits and (2) increased clarity surrounding how AI-driven technologies will be governed by both regulators and the surgical community. While our study focused on surgeons’ perspectives, it could also provide valuable insights for other healthcare providers using AI to treat patients.

A Study to Quantify the Exercise Stress in Terms of Oxygen Consumption and Anaerobic Threshold in Patients of Suspected Coronary Artery Disease during Conventional Treadmill Testing

ABSTRACT Background: Coronary artery disease (CAD) is one of the leading causes of mortality worldwide, and early detection is crucial for effective management. Exercise stress testing, particularly treadmill testing, is widely used to assess cardiovascular function, with oxygen consumption (VO2) and anaerobic threshold (AT) serving as key indicators of cardiovascular fitness and exertional capacity. The aim of this study is to quantify exercise stress using VO2 and AT in patients with suspected CAD during conventional treadmill testing. These parameters may provide additional insight into the severity of coronary artery blockages and help in predicting cardiovascular events. Objective: The objective of this study is to quantify the exercise stress in terms of oxygen consumption (VO2) and AT in patients with suspected CAD using conventional treadmill testing. Material and Method: The present study was conducted in the Department of Physiology at Jawaharlal Nehru Medical College Sawangi Meghe Wardha Maharashtra. The study included 100 patients with suspected CAD, aged 40 to 70 years. These patients presented with symptoms such as chest pain, breathlessness, or a family history of cardiovascular disease, prompting the need for exercise stress testing. A control group of 50 healthy individuals matched by age and sex was also included for comparison. Result: The study demonstrated that VO2 and AT levels significantly correlated with the presence and severity of CAD in patients. Patients with CAD exhibited lower VO2 levels and earlier onset of anaerobic threshold compared to the healthy control group. The results suggest that these parameters could be used as effective indicators in the early detection of CAD. Conclusion: The study highlights that measuring oxygen consumption and AT during treadmill testing can enhance the assessment of cardiovascular stress and provide valuable prognostic information in patients with suspected CAD.

The interaction of structured data using openEHR and large Language models for clinical decision support in prostate cancer.

Multidisciplinary teams (MDTs) are essential for cancer care but are resource-intensive. Decision-making processes within MDTs, while critical, contribute to increased healthcare costs due to the need for specialist time and coordination. The recent emergence of large language models (LLMs) offers the potential to improve the efficiency and accuracy of clinical decision-making processes, potentially reducing costs associated with traditional MDT models. We conducted a retrospective study of 171 consecutively treated patients with newly diagnosed prostate cancer. Relevant structured clinical data and the European Association of Urology (EAU) pocket guidelines were provided to two LLMs (chatGPT-4, Claude-3-Opus). LLM treatment recommendations were compared to actual treatment recommendations of the MDT meeting (MDM). Both LLMs demonstrated an overall adherence of 93% with the MDT treatment recommendations. Discrepancies between LLM and MDT recommendations were observed in 15 cases (9%), primarily due to lack of clinical information that could be provided to the LLMs. In 5 cases (3%), the LLM recommendations were not in line with EAU guidelines despite having access to all relevant information. Our findings provide evidence that LLMs can provide accurate treatment recommendations for newly diagnosed prostate cancer patients. LLMs have the potential to streamline MDT workflows, enabling specialists to focus on complex cases and patient-centered discussions. In this study, we explored the potential of artificial intelligence models called large language models (LLMs) to assist in treatment decision-making for prostate cancer patients. We found that LLMs, when provided with patient information and clinical guidelines, can recommend treatments that closely match those made by a team of cancer specialists, suggesting that LLMs could help streamline the decision-making process and potentially reduce healthcare costs.

Industrial Automation using Artificial Intelligence

The pharmaceutical and consumer healthcare industries have been greatly impacted by artificial intelligence and machine learning. A subfield of computer science called artificial intelligence is able to analyze intricate medical data. The goal of artificial intelligence (AI) is to create intelligent modeling, which facilitates knowledge imagination, problem solving, and decision making. AI is becoming more and more significant in many areas of pharmacy, including drug discovery and formulation of drug delivery, process optimization, testing, and pharmacokinetics/pharmacodynamics (PK/PD) studies growth. This review focuses on the significant applications of AI in various pharmaceutical domains, including drug development and discovery, Many studies are being conducted to enhance the AI technology that is currently available in order to increase the efficiency of the pharmacy profession. Artificial intelligence and system mastery have seen a significant upsurge in recent years. It has lessened the effort required of humans to advance in their extraordinary lives. Numerous drug discovery implementations have been examined, demonstrating the technology's effectiveness in quantitative structure-property relationships (QSPR) and quantitative structure-activity relationships (QSAR). Additionally, they are employed in clinical trials to generate and interpret data gathered from patient information. The pharmaceutical industry is currently having trouble maintaining its drug development programs due to rising R&amp;D expenses and declining productivity. In addition to helping with experimental design, machine learning algorithms can forecast the toxicity and pharmacokinetics of potential drugs. This capability lessens the need for extensive and expensive animal testing by enabling the prioritization and optimization of lead compounds. Artificial intelligence (AI) algorithms that examine actual patient data can support personalized medicine strategies, improving patient adherence and treatment outcomes

Development Validation of UV Spectrophoto Meter Method for Determination of Polyherbal Powder

The pharmaceutical and consumer healthcare industries have been greatly impacted by artificial intelligence and machine learning. A subfield of computer science called artificial intelligence is able to analyze intricate medical data. The goal of artificial intelligence (AI) is to create intelligent modeling, which facilitates knowledge imagination, problem solving, and decision making. AI is becoming more and more significant in many areas of pharmacy, including drug discovery and formulation of drug delivery, process optimization, testing, and pharmacokinetics/pharmacodynamics (PK/PD) studies growth. This review focuses on the significant applications of AI in various pharmaceutical domains, including drug development and discovery, Many studies are being conducted to enhance the AI technology that is currently available in order to increase the efficiency of the pharmacy profession. Artificial intelligence and system mastery have seen a significant upsurge in recent years. It has lessened the effort required of humans to advance in their extraordinary lives. Numerous drug discovery implementations have been examined, demonstrating the technology's effectiveness in quantitative structure-property relationships (QSPR) and quantitative structure-activity relationships (QSAR). Additionally, they are employed in clinical trials to generate and interpret data gathered from patient information. The pharmaceutical industry is currently having trouble maintaining its drug development programs due to rising R&amp;D expenses and declining productivity. In addition to helping with experimental design, machine learning algorithms can forecast the toxicity and pharmacokinetics of potential drugs. This capability lessens the need for extensive and expensive animal testing by enabling the prioritization and optimization of lead compounds. Artificial intelligence (AI) algorithms that examine actual patient data can support personalized medicine strategies, improving patient adherence and treatment outcomes

Assessing ChatGPT's Capability in Addressing Thyroid Cancer Patient Queries: A Comprehensive Mixed-Methods Evaluation

Abstract Context Literature suggests patients with thyroid cancer have unmet informational needs in many aspects of care. Patients often turn to online resources for their health-related information, and generative artificial intelligence programs such as ChatGPT are an emerging and attractive resource for patients. Objective To assess the quality of ChatGPT’s responses to thyroid cancer-related questions. Methods Four endocrinologists and four endocrine surgeons, all with expertise in thyroid cancer, evaluated the responses to 20 thyroid cancer-related questions. Responses were scored on a 7-point Likert scale in areas of accuracy, completeness, and overall satisfaction. Comments from the evaluators were aggregated and a qualitative analysis was performed. Results Overall, only 57%, 56%, and 52% of the responses “agreed” or “strongly agreed” that ChatGPT’s responses were accurate, complete, and satisfactory, respectively. One hundred ninety-eight free-text comments were included in the qualitative analysis. The majority of comments were critical in nature. Several themes emerged, which included overemphasis of diet and iodine intake and its role in thyroid cancer, and incomplete or inaccurate information on risks of both thyroid surgery and radioactive iodine therapy. Conclusion Our study suggests that ChatGPT is not accurate or reliable enough at this time for unsupervised use as a patient information tool for thyroid cancer.

Safety and efficacy of dapagliflozin versus empagliflozin as add-on therapy in type 2 diabetes mellitus management

Objectives: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are drugs used as the oral hypoglycaemic that have a significant effect in lowering blood glucose, glycated haemoglobin (HbA1c), weight and blood pressure in patients of type 2 diabetes mellitus (T2DM). SGLT-2 inhibitors, such as empagliflozin and dapagliflozin, are used in addition to diet and exercise to help persons with T2DM improve their glucose control. The drugs are combined with other antidiabetic medications or used as monotherapy. Materials and Methods: The aim of this study was to evaluate the efficacy and the safety of the drug dapagliflozin against empagliflozin in individuals with T2DM as an add-on treatment. The study is carried out in a Tertiary Care Hospital in Coimbatore using a prospective observational research design. T2DM patients with a HbA1c level of &gt;7% are included in the study. Patient information was collected by patient interviews and from the patient file. Participants in the study are categorised into two groups: one group consists of patients taking oral dapagliflozin in doses of 5 mg or 10 mg alongside other oral hypoglycemic agents (OHAs), while the other group comprises patients taking oral empagliflozin in doses of 10 mg or 20 mg alongside other OHAs. The endpoints were to assess the safety and effectiveness of each SGLT-2 inhibitor by monitoring changes in the diabetic profile, body weight, body mass index (BMI), blood pressure and cardiovascular risk. Results: The study included 100 patients, with 56 males and 44 females. Most participants were aged 51–60 years. In both treatment groups, A and B, significant reductions in body weight Group A: 3.14 kg and Group B: 2.29 kg and BMI Group A: 0.65 kg/m2 and Group B: 0.84 kg/m2 were observed after 6 months of treatment follow-up. Both groups experienced decreases in HbA1c levels from baseline to 6 months of treatment. The mean differences in HbA1c were 0.36% in Group A and 0.55% in Group B; empagliflozin led to a more significant reduction in HbA1c (0.19%) compared to dapagliflozin. Significant reductions were noted in fasting blood sugar (FBS) and postprandial blood sugar (PPBS) levels in both groups. Both dapagliflozin and empagliflozin were associated with reductions in systolic blood pressure (SBP) after 6 months of therapy. Dapagliflozin showed a greater reduction in SBP of 10.26 mmHg compared to 4.2 mmHg with empagliflozin. In addition, dapagliflozin increases diastolic blood pressure (DBP) by 2.25 mmHg, while empagliflozin reduces DBP by 3.61 mmHg. While both groups experienced reductions in SBP, only the group using empagliflozin showed a significant reduction in DBP. The Framingham risk score showed significant reductions in mean differences observed in both groups after 6 months of treatment, with a mean difference of 1.08% in Group A and 2.17% in Group B. However, the score is not statistically different between the groups. Both drugs exhibited equal effects on the prevention of cardiovascular risk. Both drugs exhibited a similar safety profile, with mild-to-moderate adverse events reported, including urinary tract infections (Group A: 18% and Group B: 12%) and hypoglycaemia (Group A: 24% and Group B: 20%) during the study period. Conclusion: SGLT-2 inhibitors dapagliflozin and empagliflozin have favourable efficacy and safety in the management of T2DM; both drugs show equal effects on HbA1c, FBS, PPBS, body weight and BMI. Empagliflozin led to a more significant reduction in HbA1c compared to dapagliflozin. In both hypertensive and non-hypertensive patients, dapagliflozin exhibited greater systolic blood pressure reduction compared to empagliflozin, whereas empagliflozin exhibited greater reduction in diastolic blood pressure compared to dapagliflozin; in contrast, dapagliflozin has shown to increase DBP. Further investigation is required to explore the blood pressure effects of SGLT-2 inhibitors in a large population. In addition, these drugs decreased cardiovascular risk. Both medications exhibited fewer instances of hypoglycaemic episodes and urinary tract infections.

Chinese Expert Consensus for Assessment of Vocal Function (2024): Guidelines of the Subspecialty Group of Voice, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association; Subspecialty Group of Laryngopharyngology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery.

The assessment of vocal function plays an important role in the diagnosis of voice disorders. With the continuous development of voice medicine in China, the evaluation, diagnosis, and treatment of voice disorders are gradually professionalized and standardized. Experts of the Subspecialty Group of Voice, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association; Subspecialty Group of Laryngopharyngology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery reached the expert consensus through clinical research, literature search, and quality evaluation, as well as two meetings and two rounds of questionnaire voting. It includes the baseline information of patients, subjective and objective assessment of voice quality, voice-related quality of life assessment, laryngoscopy and vocal fold vibration evaluation, aerodynamic analysis, laryngeal neuromuscular electrophysiological function evaluation, and many other aspects. This is the first expert consensus on vocal function assessment in China and provides appropriate guidance recommendations to voice specialists, otolaryngologists, and primary care practitioners in China.

Efgartigimod efficacy and safety in refractory myasthenia gravis: UK’s first real-world experience

BackgroundWe report our experience of patients with generalised myasthenia gravis (gMG) treated with efgartigimod, an neonatal Fc receptor antagonist, under the Early Access to Medicine Scheme (EAMS) in the UK.MethodsData...

Comparative Efficacy and Safety of Oral Semaglutide in Asians and Non-Asians Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

More than half of diabetes patients are Asians, and their tolerance to antidiabetic drugs may differ from that of non-Asians. Oral semaglutide has recently gained attention for its advantages in glycemic and body weight control. However, its effects across different ethnic groups remain unknown. All available databases of randomized controlled trials (RCTs) on oral semaglutide in patients with type 2 diabetes mellitus were included. These databases provided detailed patient information, including HbA1c levels, body weight, and adverse events (AEs and serious adverse events [SAEs]). Ten randomized controlled trials involving 7817 patients were included: six conducted in European and American populations and four in East Asian populations. In both the Asian and non-Asian patients' subgroups, oral semaglutide 3, 7, and 14mg was more effective in reducing HbA1c than placebo, and between-subgroups analysis showed that semaglutide 3, 7, and 14mg was more effective in reducing HbA1c in the Asian patients' subgroup than in the non-Asian patients' subgroup. There were no significant differences between subgroups in the number of patients achieving HbA1c < 5%. Non-Asian patients with type 2 diabetes showed significant weight reduction with 7mg and 14mg oral semaglutide, and Asian patients reduced body weight only with 14mg oral semaglutide. Between-subgroups analysis showed that 7mg oral semaglutide was more effective for weight reduction in non-Asian patients than in Asian patients. In the analysis of the efficacy of oral semaglutide at weeks 26 and 52 in Asian and non-Asian patients, in Asian patients, the hypoglycemic efficacy of oral semaglutide at 3-, 7-, and 14-mg doses at week 52 was significantly lower than that at week 26. In non-Asian patients, there was no significant difference in the reducing HbA1c efficacy of these doses of oral semaglutide at weeks 26 and 52. The weight-reduction efficacy of all doses of oral semaglutide did not change significantly with treatment duration in either Asian or non-Asian patients. Compared with sitagliptin, oral semaglutide was more effective in HbA1c reduction and weight reduction in both Asian and non-Asian patients. Subgroup analysis showed that compared with sitagliptin, Asian patients received oral semaglutide to achieve greater efficacy (HbA1c and weight reduction) than non-Asian patients. In the analysis of adverse events, oral semaglutide, as compared with placebo, was not associated with serious adverse events in either subgroup. The incidence of other (not including series) adverse events was significantly higher in non-Asian patients receiving 7mg and 14mg oral semaglutide. Oral semaglutide demonstrates superior efficacy in reducing HbA1c levels and a rapid onset of action in Asian patients. However, its efficacy appears to diminish with prolonged treatment in this population. Medium (7mg)-dose oral semaglutide was associated with greater weight reduction in non-Asian patients than in Asian patients, but this difference was eliminated with higher doses. Additionally, doses of 7mg or more of oral semaglutide are associated with a higher incidence of side effects in non-Asian patients.

A study protocol for individualized prognostic counselling in the palliative phase

BackgroundHead and neck squamous cell cancer (HNSCC) has a poor prognosis, with approximately 25–30% of patients transitioning into the palliative phase at some point. The length of this phase is relatively short, with a median duration of five months. Patients in this stage often have increased prognostic information needs. Unfortunately, predicting individual life expectancy in this phase is particularly challenging, as physicians and patients tend to overestimate survival. To address this issue, we developed the prognostic model OncologIQ Palliative based on user preferences. In this study, we now aim to assess the clinical impact of utilizing this model during counselling.MethodsThis study will employ both quantitative and qualitative approaches. The primary outcome is decisional conflict and satisfaction with the decision-making process after counselling without (cohort 1) and with (cohort 2) OncologIQ Palliative. Therefore, a prospective sequential cohort study will be conducted. Secondary outcomes include the amount of palliative treatment, overall survival rates, and quality of life. These measurements will be collected after the intervention. Additionally, patients’ perspectives on the decision-making process and proactive care planning, including end-of-life discussions, will be explored through interviews.DiscussionBy offering more personalized prognostic information for HNSCC patients in the palliative phase, we anticipate a shift towards more patient-centred counselling. This approach can facilitate enhanced end-of-life discussions and better proactive care planning. Patients may experience reduced decisional conflict, feel better prepared for what’s coming, and find assistance in their decision-making process. This could potentially lead to fewer palliative treatments. Overall, these aspects can contribute to a better quality of life and quality of care for HNSCC patients in the last phase of their lives.Trial RegistrationThis study was registered November 18, 2024, on ClinicalTrials.gov: NCT06699316.

Assessment of decision-making with locally run and web-based large language models versus human board recommendations in otorhinolaryngology, head and neck surgery.

Tumor boards are a cornerstone of modern cancer treatment. Given their advanced capabilities, the role of Large Language Models (LLMs) in generating tumor board decisions for otorhinolaryngology (ORL) head and neck surgery is gaining increasing attention. However, concerns over data protection and the use of confidential patient information in web-based LLMs have restricted their widespread adoption and hindered the exploration of their full potential. In this first study of its kind we compared standard human multidisciplinary tumor board recommendations (MDT) against a web-based LLM (ChatGPT-4o) and a locally run LLM (Llama 3) addressing data protection concerns. Twenty-five simulated tumor board cases were presented to an MDT composed of specialists from otorhinolaryngology, craniomaxillofacial surgery, medical oncology, radiology, radiation oncology, and pathology. This multidisciplinary team provided a comprehensive analysis of the cases. The same cases were input into ChatGPT-4o and Llama3 using structured prompts, and the concordance between the LLMs' and MDT's recommendations was assessed. Four MDT members evaluated the LLMs' recommendations in terms of medical adequacy (using a six-point Likert scale) and whether the information provided could have influenced the MDT's original recommendations. ChatGPT-4o showed 84% concordance (21 out of 25 cases) and Llama 3 demonstrated 92% concordance (23 out of 25 cases) with the MDT in distinguishing between curative and palliative treatment strategies. In 64% of cases (16/25) ChatGPT-4o and in 60% of cases (15/25) Llama, identified all first-line therapy options considered by the MDT, though with varying priority. ChatGPT-4o presented all the MDT's first-line therapies in 52% of cases (13/25), while Llama 3 offered a homologous treatment strategy in 48% of cases (12/25). Additionally, both models proposed at least one of the MDT's first-line therapies as their top recommendation in 28% of cases (7/25). The ratings for medical adequacy yielded a mean score of 4.7 (IQR: 4-6) for ChatGPT-4o and 4.3 (IQR: 3-5) for Llama 3. In 17% of the assessments (33/200), MDT members indicated that the LLM recommendations could potentially enhance the MDT's decisions. This study demonstrates the capability of both LLMs to provide viable therapeutic recommendations in ORL head and neck surgery. Llama 3, operating locally, bypasses many data protection issues and shows promise as a clinical tool to support MDT decisions. However at present, LLMs should augment rather than replace human decision-making.

Exploring the correlations between six serological inflammatory markers and different stages of type 2 diabetic retinopathy

To determine the correlations between six serological inflammatory markers, namely the systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), aggregate index of systemic inflammation (AISI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), and various stages of type 2 diabetic retinopathy (T2DR). Additionally, the diagnostic value of these markers in T2DR was evaluated. Clinical data were collected from a total of 397 patients with type 2 diabetes who visited the ophthalmology department at Mian Yang Central Hospital and the Affiliated Hospital of Southwest Medical University from January 2023 to December 2023. Based on the results of fundus photography, patients were categorized into a non-diabetic retinopathy group (NDR, n = 121), a non-proliferative diabetic retinopathy group (NPDR, n = 77), and a proliferative diabetic retinopathy group (PDR, n = 199). General patient information and systemic inflammatory markers, including the SII, SIRI, AIRI, NLR, PLR, and MLR, were compared among the groups, and their correlations with T2DR were analyzed. The SII values were found to be significantly higher in the PDR group compared to the NPDR group, which in turn were higher than those in the NDR group (P < 0.05). Similarly, the AISI values were significantly elevated in the PDR group compared to both the NPDR and NDR groups (P < 0.05). The SIRI and MLR values were significantly higher in the PDR group than in the NDR group (P < 0.05). Furthermore, the NLR and PLR values were significantly higher in the NPDR and PDR groups compared to the NDR group (P < 0.05). The Mantel‒Haenszel chi-square test revealed a significant linear trend between the SII and PLR and the incidence of PDR (P < 0.001), with the incidence of PDR increasing as the quartile levels of the SII and PLR increased. Multivariate logistic regression analysis indicated that, compared with NDR, a higher SII was found to be an independent risk factor for NPDR (ORSII = 1.002, p = 0.001) and PDR (ORSII = 1.002, P < 0.001). The ROC curve analysis suggested that the combined assessment of the six inflammatory indices had the highest accuracy in the evaluation of DR, with an area under the curve (AUC) of 0.69, a sensitivity of 54%, and a specificity of 75%. The results of this study indicate that the SII is an independent risk factor for T2DR. A close correlation was observed between the SII and PLR and the occurrence and progression of T2DR. The high accuracy of the combined diagnosis of T2DR via various serological inflammatory markers underscores their potential as early biological indicators for the diagnosis of T2DR.

Integrating CT-based radiomics and clinical features to better predict the prognosis of acute pancreatitis

ObjectivesTo develop and validate the performance of CT-based radiomics models for predicting the prognosis of acute pancreatitis.MethodsAll 344 patients (51 ± 15 years, 171 men) in a first episode of acute pancreatitis (AP) were retrospectively enrolled and randomly divided into training (n = 206), validation (n = 69), and test (n = 69) sets with the ratio of 6:2:2. The patients were dichotomized into good and poor prognosis subgroups based on follow-up CT and clinical data. The radiomics features were extracted from contrast-enhanced CT. Logistic regression analysis was applied to analyze clinical-radiological features for developing clinical and radiomics-derived models. The predictive performance of each model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA).ResultsEight pancreatic and six peripancreatic radiomics features were identified after reduction and selection. In the training set, the AUCs of clinical, pancreatic, peripancreatic, radiomics, and combined models were 0.859, 0.800, 0.823, 0.852, and 0.899, respectively. In the validation set, the AUCs were 0.848, 0.720, 0.746, 0.773, and 0.877, respectively. The combined model exhibited the highest AUC among radiomics-based models (pancreatic, peripancreatic, and radiomics models) in both the training (0.899) and validation (0.877) sets (all p < 0.05). Further, the AUC of the combined model was 0.735 in the test set. The calibration curve and DCA indicated the combined model had favorable predictive performance.ConclusionsCT-based radiomics incorporating clinical features was superior to other models in predicting AP prognosis, which may offer additional information for AP patients at higher risk of developing poor prognosis.Critical relevance statementIntegrating CT radiomics-based analysis of pancreatic and peripancreatic features with clinical risk factors enhances the assessment of AP prognosis, allowing for optimal clinical decision-making in individuals at risk of severe AP.Key PointsRadiomics analysis provides help to accurately assess acute pancreatitis (AP).CT radiomics-based models are superior to the clinical model in the prediction of AP prognosis.A CT radiomics-based nomogram integrated with clinical features allows a more comprehensive assessment of AP prognosis.Graphical