Value In Patients Research Articles

Timing of neuroprognostication in the ICU.

Neuroprognostication after acute brain injury (ABI) is complex. In this review, we examine the threats to accurate neuroprognostication, discuss strategies to mitigate the self-fulfilling prophecy, and how to approach the indeterminate prognosis. The goal of neuroprognostication is to provide a timely and accurate prediction of a patient's neurologic outcome so treatment can proceed in accordance with a patient's values and preferences. Neuroprognostication should be delayed until at least 72 h after injury and/or only when the necessary prognostic data is available to avoid early withdraw life-sustaining treatment on patients who may otherwise survive with a good outcome. Clinicians should be aware of the limitations of available predictors and prognostic models, the role of flawed heuristics and the self-fulfilling prophecy, and the influence of surrogate decision-maker bias on end-of-life decisions. The approach to neuroprognostication after ABI should be systematic, use highly reliable multimodal data, and involve experts to minimize the risk of erroneous prediction and perpetuating the self-fulfilling prophecy. Even when such standards are rigorously upheld, the prognosis may be indeterminate. In such cases, clinicians should engage in shared decision-making with surrogates and consider the use of a time-limited trial.

Perceived challenges in treatment decision-making for endometriosis: healthcare professional perspectives

ABSTRACT Background: Endometriosis, a systemic chronic inflammatory condition which has no cure, has a high symptom burden that can negatively impact every facet of life. Given the absence of a gold-standard treatment, the best symptom management regimen in endometriosis is heavily reliant on a patient's values and preferences, making shared decision-making (SDM) vital. However, a comprehensive patient decision aid (PtDA) intervention that could facilitate patient decision-making and promote SDM is lacking in endometriosis, and there is little research on the decisional support needs of individuals with this condition. This qualitative study aimed to explore healthcare professional (HP) perspectives of their clients’ decisional support needs when choosing treatments to manage endometriosis symptoms, with a view to evaluating the need for a PtDA. Methods: Australian HPs identified as specialising in endometriosis care (N = 13) were invited to participate in a short interview over the Internet by phone. Questions focussed on perceived facilitators and challenges of decision-making when choosing treatments for endometriosis. Transcribed qualitative data were thematically analysed and verified by multiple coders, using the template approach. Results: Four themes were identified: (1) Identifying and setting priorities; (2) HPs’ lack of time and perceived lack of knowledge; (3) Patient-centred care and SDM, including patient capacity; and (4) Decision-making blinded by hope. This is the first known study to explore HPs’ perspectives on patient decision-making challenges in endometriosis. Discussion: Findings draw attention to the difficulties people with endometriosis experience when assessing and choosing treatments, highlighting the need for a comprehensive PtDA intervention to support this decision-making.

Navigating the straits of deprescribing: Psychiatrist's personal account of fears and hopes.

Deprescribing is a long-overdue concept for psychiatrists and therapists, presenting potentially more sophisticated approaches to psychiatric care. This approach is fueled by both scientific pursuits and contemporary social ideologies that underscore the pivotal role of a patient's values and their freedom of choice. Indeed, deprescribing is well woven with modern liberal and progressive values. Yet, amidst the emphasis on these aspects, it is crucial not to lose sight of the "conservative" perspective within this discourse-one that emphasizes the potential consequences of failure. While constantly addressing relapse as a looming cloud may not yield benefits for patients, overlooking these potential pitfalls could tip the balance too far, resulting in unintended harm rather than good. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Unbefriended Patient, Their Professional Guardians, and Clinical Liaison Psychiatry: The Challenging Ethics of Changing Goals of Care.

AbstractUnbefriended patients are those with decisional impairments who lack family or friends to serve as healthcare surrogates. When such patients cannot make decisions, the court typically appoints a professional guardian to make choices aligned with the patient's values and preferences. However, this case report illustrates ethical challenges that can arise when professional guardians disregard the patient's authentic wishes. In this case study, the 38-year-old unbefriended African American male patient expressed fears about traumatic resuscitation efforts and ultimately desired de-escalation of care, which the guardian was hesitant to honor despite confirmed decision-making capacity. The guardian quickly reversed a new do-not-resuscitate order when the patient later changed his mind. Decisions about aggressive interventions like a colostomy were significantly delayed while awaiting final judgments involving the guardian's supervisors and the judicial system. The case highlights pitfalls with guardians defaulting to treatment escalation without sufficiently engaging with ethical standards or eliciting the patient's narrative identity, leading to inconsistent surrogate decisions. We propose that more robust reforms are needed, including enhanced training of guardians in ethical decision-making, and we present other means to facilitate best practices in proxy decision-making.

American Geriatrics Society position statement: Making medical treatment decisions for unrepresented older adults

AbstractThis paper is an official position statement of the American Geriatrics Society (AGS) and updates the 2017 AGS position statement, Making Medical Treatment Decisions for Unbefriended Older Adults. In this updated position statement, the term “unbefriended” is replaced by “unrepresented” as a term that is more value‐neutral, more accurately describes the circumstance in which a person without medical decision‐making capacity does not have recognized surrogate representation, and better aligns with increasingly preferred terminology as reflected in recent medical literature. We define unrepresented older adults as those who (1) lack decisional capacity to provide informed consent for a particular medical treatment, (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so, and (3) lack representation from a surrogate decision‐maker (i.e., family, friend, or legally authorized surrogate). Making medical decisions on behalf of unrepresented older adults is exceptionally challenging and, given demographic trends, is likely to become increasingly common in the years ahead. The process of arriving at treatment decisions for this population should follow standards of procedural fairness and include capacity assessment, search for potential surrogates, team‐based efforts to determine the patient's values and preferences, and steps to guard against bias. Proactive measures are needed to identify older adults at risk for becoming unrepresented. This position statement also calls for national efforts to reduce state‐to‐state variability in legal approaches for unrepresented patients.

Patient-centered endometriosis care implementation at tertiary and secondary care hospitals in Indonesia

BackgroundEndometriosis has a high recurrence rate within five years (40–50 %). High recurrence remarkably reduces Health-Related Quality of Life (HRQOL). Patient-centered endometriosis care (PCEC) is a range of care that respects the patient's preferences and needs while being guided by the patient's values and may provide better treatment for patients. Our study is the first to evaluate the implementation of PCEC in Indonesia. Materials and methodsWe evaluated PCEC at Dr. Cipto Mangunkusumo Hospital in Jakarta (Center-1), Raden Mattaher Hospital in Jambi, and dr. Zainoel Abidin Hospital in Aceh (Center-2) from October 2021 to May 2022. Center-1 represented tertiary care, and center-2 represented secondary care. This study used the ENDOCARE Questionnaire (ECQ) instrument, which produced mean important score (MIS), percentage of negative performance (PNP), and patient-centeredness score (PCS) as outcomes. Higher PCS reflects greater patient-centered care of the center. ResultsA total of 73 patients were recruited and divided into two groups of centers. Patients from Center-1 had significantly higher patient-centeredness scores vs. patients in centers without the training and guideline: dimension "Respect for patients' values, preferences, and needs" (Center-1 7.33, 6–10, Center-2 6, 6–6; p < 0.001), dimension "Coordination and integration of care" (Center-1 6, 4.44–8.67, Center-2 5.5, 4–6; p = 0.006), dimension "Information, communication, and education" (Center-1 7.14, 6–8.29, Center-2 5.14, 5.14–6; p < 0.001), dimension "Physical comfort" (Center-1 6, 6–8, Center-2 6, 6–6; p = 0.033), dimension "Endometriosis clinical staff" (Center-1 6, 6–9, Center-2 6, 6–6, p = 0.049). Subjects with higher education and experienced endometriosis recurrences statistically had higher patient-centeredness scores. ConclusionOur findings suggest that endometriosis training and having endometriosis clinical guidelines could improve patients' experience in receiving PCEC. Information for patients should be made simple so they can understand the purpose of the treatment.

Are we crossing a line with extensive dental implant treatments? The problem of overtreatment and potential solutions.

In this opinion article, the problem of overtreatment is discussed, and some examples of potential overtreatment with dental implants are presented. The concept of GRADE (Grading of Recommendations Assessment, Development, and Evaluation) is also presented as a system to help clinicians (and patients) make the most appropriate decisions about treatments with dental implants. In this concept, elements other than the quality of evidence are weighed, such as the balance between benefits and harm, and between a patient's values and good use of resources, to make an appropriate clinical decision. GRADE can be tailored/modified and then used by both clinicians and patients to reduce cases of overtreatment with dental implants.

A Smart Water Bottle and Companion App (HidrateSpark 3) to Improve Bladder-Filling Compliance in Patients With Prostate Cancer Receiving Radiotherapy: Nonrandomized Trial of Feasibility and Acceptability.

Patients with prostate cancer undergoing radiation therapy (RT) need comfortably full bladders to reduce toxicities during treatment. Poor compliance is common with standard of care written or verbal instructions, leading to wasted patient value (PV) and clinic resources via poor throughput efficiency (TE). Herein, we assessed the feasibility and acceptability of a smartphone-based behavioral intervention (SBI) to improve bladder-filling compliance and methods for quantifying PV and TE. In total, 36 patients with prostate cancer were enrolled in a single-institution, closed-access, nonrandomized feasibility trial. The SBI consists of a fully automated smart water bottle and smartphone app. Both pieces alert the patient to empty his bladder and drink a personalized volume goal, based on simulation bladder volume, 1.25 hours before his scheduled RT. Patients were trained to adjust their volume goal and notification times to achieve comfortably full bladders. The primary end point was met if qualitative (QLC) and quantitative compliance (QNC) were >80%. For QLC, patients were asked if they prepared their bladders before daily RT. QNC was met if bladder volumes on daily cone-beam tomography were >75% of the simulation's volume. The Service User Technology Acceptability Questionnaire (SUTAQ) was given in person pre- and post-SBI. Additional acceptability and engagement end points were met if >3 out of 5 across 4 domains on the SUTAQ and >80% (15/18) of patients used the device >50% of the time, respectively. Finally, the impact of SBI on PV and TE was measured by time spent in a clinic and on the linear accelerator (linac), respectively, and contrasted with matched controls. QLC was 100% in 375 out of 398 (94.2%) total treatments, while QNC was 88.9% in 341 out of 398 (85.7%) total treatments. Of a total score of 5, patients scored 4.33 on privacy concerns, 4 on belief in benefits, 4.56 on satisfaction, and 4.24 on usability via SUTAQ. Further, 83% (15/18) of patients used the SBI on >50% of treatments. Patients in the intervention arm spent less time in a clinic (53.24, SEM 1.71 minutes) compared to the control (75.01, SEM 2.26 minutes) group (P<.001). Similarly, the intervention arm spent less time on the linac (10.67, SEM 0.40 minutes) compared to the control (14.19, SEM 0.32 minutes) group (P<.001). This digital intervention trial showed high rates of bladder-filling compliance and engagement. High patient value and TE were feasibly quantified by shortened clinic times and linac usage, respectively. Future studies are needed to evaluate clinical outcomes, patient experience, and cost-benefit. ClinicalTrials.gov NCT04946214; https://www.clinicaltrials.gov/study/NCT04946214.

Medical tattooing as a complementary cosmetic intervention to reduce body-image distress and mental health symptoms in U.S. breast cancer survivors.

A review of the literature revealed a high incidence of body-image distress among breast cancer survivors who had surgery. This cross-sectional study examined the relationship between medical tattooing as a complementary cosmetic intervention and body-image distress and mental health outcomes among breast cancer survivors following surgery. We examined 330 post-surgical breast cancer survivors collected through a nationwide online survey in the U.S., pursuing two main objectives. First, we investigated body-image distress, depression and anxiety symptoms, and perceived stress in survivors who underwent breast cancer surgery, comparing those with medical tattooing (n = 89) and those without (n = 226). Second, we assessed the influence of the participant's surgery type on body-image distress, depression and anxiety symptoms, and perceived stress. Additionally, we evaluated whether individual factors, such as appearance investment, satisfaction with decision, and cosmetic expectation discrepancy, predicted the participant's body-image distress. Findings suggest that participants with medical tattoos reported significantly lower body-image distress, depression and anxiety symptoms, and perceived stress compared to those without medical tattoos. The participant's surgery type did not significantly predict body-image distress, depression or anxiety symptoms, or perceived stress. However, participants who reported greater appearance investment endorsed higher body-image distress. Participants who reported higher satisfaction with their treatment decisions and lower cosmetic expectation discrepancy endorsed lower body-image distress. Medical tattooing may be a valuable tool in improving body-image distress and mental health for those who wish to pursue it, but more research is needed. Empirical studies supporting the mental health benefits of medical tattooing among survivors are crucial to standardize insurance coverage and promote its inclusion as a complementary intervention across insurance providers nationwide. This complementary intervention should be considered using a patient-centered approach that aligns with the patient's values and preferences.

Implantable cardioverter defibrillator explantation upon patient request: Clinical and ethical considerations.

Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues. The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance. Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health. The paper debates the issues related to establishing a patient-physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non-maleficence, and the conflicts that sometimes arise between them. If a paternalistic approach in the patient-physician relationship evolves into a patient-centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals. The shared decision making (SDM) process and the use of pathology-specific decision aids are able to transform the informed consent tool, usually related to medical-legal issues, into an aid for true partnership between the patient and the medical care team.

Students' clinical management decisions: use of a tool to increase awareness of cost

Background: The overuse of medical resources is a global issue, often resulting in more harm than good. Within the United States, almost one-third of medical spending is unnecessary, with physicians being responsible for an estimated 10% of this waste, primarily through lack of care coordination and overtreatment. Identifying opportunities for cost savings while delivering quality care is a core competency requirement for all medical specialties. We took a pragmatic approach to improve medical students' decision-making in different contexts to assist them in understanding contextual factors when ordering care. Methods: This study retrospectively reviewed 193 high-value care prescriptions. Prescriptions were completed by 4th-year medical students completing a rotation in an outpatient, inpatient, or emergency room settingduring the 2020 and 2021 academic years. Indicators of interest included underlying reasons for testing, whether non-clinical effects of tests were considered, who the students discussed costs with, and whether students believed the course changed the management of the patient. Results: A majority of students described downstream effects on the healthcare system and effects related to patients, such as cost, time, transportation, stress or anxiety, missed work, and childcare. The financial cost was one of the primary considerations for patients, yet it was not routinely discussed with patients. Most students felt that the prescription tool did not change the management of the current patient. However, they did feel that the tool changed their approach to future patients with the same problem, which was the goal of this project. Conclusion: There is a need to consider the valuefor patients and the cost to the health care system when ordering tests and procedures. More workmust be done to encourage consideration and conversations about finances and socialdeterminants of health amongst all team members, including patients.

Discordant Care and Decision Quality: Patients' Reasons for Not Receiving Their Initial Test of Choice in Colorectal Cancer Screening.

Concordance between a person's values and the test or treatment they ultimately receive is widely considered to be an essential outcome for good decision quality. There is little research, however, on why patients receive "discordant" care. A large, randomized trial of decision aids for colorectal cancer (CRC) screening provided an opportunity to assess why some patients received a different test than the one they preferred at an earlier time point. Of 688 patients who participated in the trial, 43 received a different CRC screening test than the one they selected after viewing a decision aid 6 mo prior. These patients answered 2 brief, open-ended questions about the reasons for this discordance. The research team analyzed their answers using qualitative description. Patient responses reflected 6 major categories: barriers or risks of initially favored test, benefits of alternative test, costs or health insurance coverage, discussion with family or friends, provider factors or recommendation, and health issues. Some of the patients' explanations fit well with the informed concordance approach, which infers poor decision quality from the existence of discordant care, since in these cases it appears that the patient's values and preferences were not adequately respected. Other statements suggest that the patient had an informed rationale for changing their mind about which test to undergo. These cases may reflect high-quality decision making, despite the existence of discordance as measured in the trial. This analysis highlights a major challenge to a popular approach for assessing decision quality, the difficulty of normatively assessing the quality of decision making when apparent discordant care has been provided, and the need to assess patient values and preference over time. Value-choice concordance is an accepted measure for assessing decision quality in decision aid trials, but greater exploration of apparently discordant care challenges key assumptions of this method; this study provides evidence that discordance as typically measured may not always reflect low-quality patient decision making.Researchers evaluating decision aids and assessing decision quality should consider the use of qualitative methods to supplement measures of decision quality and consider assessing patient preferences at multiple time points.

Premature ovarian insufficiency

Key content: Premature ovarian insufficiency (POI) is a clinical syndrome involving ovarian follicle depletion and defined by loss of ovarian function before 40 years of age. The diagnostic workup in women with suspected POI is in two steps: confirming the diagnosis and establishing its cause; it is important to understand the rationale for performing each diagnostic test, how to interpret results and appropriate multidisciplinary team involvement. Treatment options include various regimens and preparations of hormone replacement therapy (HRT), monitoring and surveillance, induction of puberty in those with very early POI, complimentary treatment and fertility treatment. Management of POI requires a comprehensive and personalised strategy that addresses not only the physical symptoms and disease risks, but also the psychosocial and reproductive health aspects, and it is important that women receive adequate counselling. Learning objectives: To raise awareness of early diagnosis of POI. To be able to discuss the implications of POI for the health of women affected and their families, as well as for different hormonal and non‐hormonal treatment options. To understand various fertility treatment options for POI. Ethical issues: It is important to consider the reproductive and diagnostic implications for women with chromosomal or genetic problems (e.g. Turner syndrome, Fragile X mutation carriers) and for their family members. A diagnosis of POI may have differing implications based on social and cultural factors, and healthcare providers should consider a patient's values, beliefs, cultural background and preferences.

Integrating Palliative Care Into the Management of Genitourinary Malignancies.

Palliative care (PC) plays a critical role in managing the difficulties associated with genitourinary malignancies. Its primary aim is to improve the overall health of patients, provide support to both patients and their caregivers, and help individuals to navigate the complex decisions about treatment and end-of-life care. PC takes a holistic approach to patient care, recognizing that genitourinary malignancies affect multiple aspects of a person's life. By addressing physical, emotional, social, and spiritual needs, PC aims to provide comprehensive support that is consistent with the patient's values and preferences. The goal is to optimize comfort, minimize distress, and enhance the patient's quality of life throughout the course of the illness. PC is not a one-off intervention, but an ongoing source of support. This article aims to provide a thorough overview of the critical elements involved in addressing the challenges posed by genitourinary cancers, emphasizing the importance of palliative interventions. We will highlight the multifaceted aspects of care and explore strategies to optimize the overall well-being of patients throughout the course of treatment for genitourinary malignancies.

Common mistakes and evidence-based approaches in goals-of-care conversations for seriously ill older adults in cardiac care unit.

For older adults with serious, life-limiting illnesses near the end of life, clinicians frequently face difficult decisions about the medical care they provide because of clinical uncertainty. This difficulty is further complicated by unique challenges and medical advancements for patients with advanced heart diseases. In this article, we describe common mistakes encountered by clinicians when having goals-of-care conversations (e.g. conversations between clinicians and seriously ill patients/surrogates to discuss patient's values and goals for clinical care near the end of life.). Then, we delineate an evidence-based approach in goals-of-care conversations and highlight the unique challenges around decision-making in the cardiac intensive care unit.

Pan American League of Associations for Rheumatology Recommendations for the Treatment of Psoriatic Arthritis.

Psoriatic arthritis (PsA) is chronic disease that compromises multiple domains and might be associated with progressive joint damage, increased mortality, functional limitation, and considerably impaired quality of life. Our objective was to generate evidence-based recommendations on the management of PsA in Pan American League of Associations for Rheumatology (PANLAR) countries. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to adapt the 2019 recommendations of the European Alliance of Associations for Rheumatology. A working group consisting of rheumatologists from various countries in Latin America identified relevant topics for the treatment of PsA in the region. The methodology team updated the evidence and synthesized the information used to generate the final recommendations. These were then discussed and defined by a panel of 31 rheumatologists from 15 countries. Theses guidelines report 15 recommendations addressing therapeutic targets, use of antiinflammatory agents and corticosteroids, treatment with disease-modifying antirheumatic drugs (conventional synthetic, biologic, and targeted synthetic), therapeutic failure, optimization of biologic therapy, nonpharmacological interventions, assessment tools, and follow-up of patients with PsA. Here we present a set of recommendations to guide decision making in the treatment of PsA in Latin America, based on the best evidence available, considering resources, medical expertise, and the patient's values and preferences. The successful implementation of these recommendations should be based on clinical practice conditions, healthcare settings in each country, and a tailored evaluation of patients.

Ethical and moral principles for oncology healthcare workers: A brief report from a Bioethics consortium emphasizing on need for education.

The medical sub-specialty of Oncology presents diverse ethical dilemmas, often challenging cancer healthcare workers with difficult-to-handle clinical scenarios that are tough from a personal and professional perspective. Making decisions on patient care in various circumstances is a defining obligation of an oncologist and those duty-based judgments entail more than just selecting the best treatment or solution. Ethics is an essential and inseparable aspect of clinical medicine and the oncologists as well as the allied health care workers are ethically committed to helping the patient, avoiding or minimizing harm, and respecting the patient's values and choices. This review provides an overview of ethics and clinical ethics and the four main ethical principles of autonomy, beneficence, non-maleficence, and justice are stated and explained. At times there are frequently contradictions between ethical principles in patient care scenarios, especially between beneficence and autonomy. In addition, truth-telling, professionalism, empathy, and cultural competence; which are recently considered important in cancer care, are also addressed from an Indian perspective.

Development and perception of surgery-specific goals of care discussions in the preoperative setting: A learning pilot.

Goals of care discussions are infrequently documented in the preoperative period. Furthermore, documentation does not consistently address what matters most to patients, although patient values (PV) are central to person-centered care. A multidisciplinary working group was formed. An electronic note comprised of (1) topics of discussion, (2) PV, and (3) advance care planning (ACP), was created and embedded into existing note templates for Gynecologic Surgical Oncology. Surgeons and advanced practice providers (APPs) were educated to conduct and document these conversations in preoperative clinic for patients undergoing cancer surgery for a pilot period. Data were collected regarding usage of the template. Focus groups with surgeons, APPs, and patients were conducted. Qualitative analysis was performed on transcripts. During the pilot, 7 surgeon/APP teams utilized the template on a total of 55 notes. Average number of notes completed per surgeon was 7.8 (SD 8.5). Forty-six notes (84%) included topics of discussion, 15 (27%) included PV, 4 (7%) included ACP. Qualitative analysis of focus group transcripts revealed that clinicians and patients perceived the initiative to be useful and important, although implementation barriers were identified. Creating a surgery-specific GOC template is feasible. Iterative revisions are needed to increase utility in clinic workflows.

Use of induction therapy post-heart transplantation: Clinical practice recommendations based on systematic review and network meta-analysis of evidence.

The use of induction therapy (IT) agents in the early post-heart transplant period remains controversial. The following recommendations aim to provide guidance on the use of IT agents, including Basiliximab and Thymoglobulin, as part of routine care in heart transplantation (HTx). We recruited an international, multidisciplinary panel of 15 stakeholders, including patient partners, transplant cardiologists and surgeons, nurse practitioners, pharmacists, and methodologists. We commissioned a systematic review on benefits and harms of IT on patient-important outcomes, and another on patients' values and preferences to inform our recommendations. We used the GRADE framework to summarize our findings, rate certainty in the evidence, and develop recommendations. The panel considered the balance between benefits and harms, certainty in the evidence, and patient's values and preferences, to make recommendations for or against the routine post-operative use of Thymoglobulin or Basiliximab. The panel made recommendations on three major clinical problems in HTx: (1) We suggest against the routine post-operative use of Basiliximab compared to no IT, (2) we suggest against the routine use of Thymoglobulin compared to no IT, and (3) for those patients for whom IT is deemed desirable, we suggest for the use of Thymoglobulin as compared to Basiliximab. This report highlights gaps in current knowledge and provides directions for clinical research in the future to better understand the clinical utility of IT agents in the early post heart transplant period, leading to improved management and care.

A Review of Machine Learning Techniques for Early Detection of Alzheimer's disease

This review aims to discuss the use of AI and ML in diagnosing and managing neurodegenerative diseases, with particular emphasis on AD and MCI. Emerging innovations present in depth the effectiveness of using ML models such as SVM, random forests, CNNs, and new frameworks such as quantum-classical neural networks on data obtained from MRI imaging, EEG signals, genetic makers and sociodemographic data. Widely used research findings demonstrate that these tools offer seemingly higher detection rates, sensitivity, and specificity than traditional diagnostic techniques for identifying and diagnosing early-stage illnesses. Some of them are techniques based on analyzing EEG time-frequency bands, combining MRI and PET data integration approaches, and creating telemedicine services to overcome geographical barriers. Furthermore, interpretable AI models improve clinical relevance by providing decision and trust support among practitioners. While these achievements are notable, the following limitations need to be noted, thus making it easier to establish the generalizability of the results and ways of using datasets that are free from bias and difficulties associated with applying AI in clinical settings. There are pressing questions regarding patients' rights and privacy, the issue of homogenization and standardization of data, and the distribution and accessibility of AI tools across industries as well as within the same region. More studies should be conducted to expand AI applications, use a more diverse dataset, and promote cooperation between representatives of various fields of science to ensure that technological advancement meets clinical demands. It also includes new methods like Vision Transformers and Quantum Computing Enhanced Deep Learning to overcome diagnostic issues in time-consuming and multi-parametric data analysis. These gaps can be closed with the help of AI and ML to enhance diagnostic accuracy, select the right treatment strategy, and risk assessment for the long-term management of NDs. In conclusion, this review similarly reaffirms how stunning AI's role is in improving future neurodegenerative disease care. For this reason, the deployment process must be done sensibly to enhance the patient's value most appropriately.