Real Clinical Cases Research Articles

PECULIARITIES OF TEACHING THE DISCIPLINE "ORTHOPEDIC DENTISTRY, INCL. IMPLANTATION" SPP DENTISTRY AT MILITARY CONDITION

In the conditions of rapid development of modern dentistry, the providing of high-quality dental services is extremely important and requires the presence of qualified specialists. Therefore, their acquisition of professional competences should take place starting from the student ranks. Educational discipline "Orthopedic dentistry, incl. implantation" OPP Dentistry is studied by students during 3-5 courses and ensures that students acquire integral, general and professional competencies for the future provision of high-quality dental consultations and services with the use and application of modern aesthetic orthopedic structures for the replacement of partial and complete defects of the dentition, as well as elimination of pathology, which contributes to the occurrence of defects in the hard tissues of the teeth. In addition, the process of examining patients in order to establish a diagnosis and draw up a treatment plan is important. Therefore, the application of the latest teaching methods includes a combination of both theoretical knowledge and practice and consolidation of acquired and properly mastered practical skills. The education of foreign students is of great importance, which, in connection with military actions and constant air alerts caused by the danger caused by the activity of enemy strategic aviation taking place in our country, is conducted in a mixed format (online for students who are at home (by border) and offline for foreign students living and studying in Ukraine) using innovative multimedia teaching methods. The constant and continuous development of modern technologies in the field of stomatology also requires the introduction of the latest training tools and methods associated with the use of modern methods and technological support. All these challenges today are combined with student education, which takes place under martial law and requires a special approach. Therefore, it is important to provide education seekers with proper professional and safe learning conditions, which will make it possible to fully and comprehensively provide a comprehensive complex of both theoretical and practical training of future dental specialists. Thanks to the Armed Forces of Ukraine and the clear consolidation and mutual cooperation of teachers and students, the learning process not only does not stop, but also continues to develop productively, making it possible to provide and provide a sufficient amount of professional competences under the condition of simultaneous and parallel objective control of the acquisition and consolidation of appropriate level of knowledge of students of all courses and areas of dentistry. The purpose of the study is directed to the organization and implementation of the latest teaching methods with the maximum use of modern equipment and methods while respecting life safety. Materials and methods. The Department of Orthopedic Dentistry of the Ivano-Frankivsk National Medical University implements the educational program "Orthopedic Dentistry, incl. implantation" SPP Dentistry in military time conditions, aimed at students' acquisition of integral, general and professional competencies for the future provision of high-quality dental services. Research results. They indicate the need to introduce the latest actions and methods of training in connection with the constant development of modern technologies in the branch of dentistry. The conclusions of this study indicate the presence of feedback from students who is interested and stimulated by a new approach in studying, combined with real clinical cases and modern methods of their treatment and orthopedic treatment.

Application of clinical case-guided, task-driven escape room teaching in nursing education: a quasi-experimental study

BackgroundIn the new era, the professional ability requirements for nursing personnel are no longer limited to traditional nursing knowledge and skills, but pay more attention to the cultivation and enhancement of their diversified abilities, such as humanistic caring ability, creative thinking, and so on. As a new type of education model that integrates gamification, flipped learning, and problem-based learning, escape room teaching plays an important role in effectively developing and stimulating students' humanistic care ability and creative thinking. PurposeTo investigate the effectiveness of an Escape Room teaching approach, clinical cases (C) as guide (G) and task (T) as driver (D) , within the CGTD model in the undergraduate Adult Nursing course. MethodUsing purposive sampling, 108 undergraduate nursing students in the class of 2020 were selected as the study subjects, and 11 innovative escape room teaching activities were conducted. Real clinical cases were selected, so that the student teams were immersed in clinical scenarios to complete the escape room game focusing on circulatory care, and the humanistic caring and creative thinking of the students in the two groups were compared before and after the intervention. ResultsNursing students' humanistic care and creative thinking scores at the end of the instruction were significantly better than those before the escape room instruction (P<0.05). ConclusionThe use of the CGTD-based escape room teaching method applied to adult nursing practice courses is an innovative teaching strategy that integrates theoretical knowledge into the game, which can significantly improve undergraduate nursing students' humanistic caring ability and creative thinking.

Educational needs for virtual reality-based simulation training in the nursing care of adult respiratory patients: an explanatory sequential mixed-methods study.

We aimed to ascertain the current state of and needs for virtual reality (VR)-based simulation training in the care of adult respiratory patients. Learning to care for patients with infectious respiratory disease is crucial in nurses' practical education. Thus, studies on the state of VR-based simulation-training are required. We used an explanatory sequential mixed-methods design. The sample included 122 new nurses at two advanced general hospitals and five educators at a nursing college. The educational needs of virtual reality-based simulation education were measured by the tool developed in this study. Research data were collected from August 31 to September 26, 2022. Quantitative data were subjected to a descriptive analysis, while qualitative data were subjected to content analysis. The new nurses in this study had a mean age of 24.51 years and total clinical experience of 11.18 months; 82.8% of the participants had experience in adult respiratory patient care, and 94.3% were aware of the need for this training. In the qualitative data analysis of six new nurses, all participants had experience with simulation training and were aware of its need. Moreover, all participants wanted repeated VR-based simulation training using real clinical cases. Regarding the qualitative data analysis of five nursing college educators, most of them had experience providing and receiving simulation training, and they were aware of its need in caring for respiratory patients. They reported the need for VR learning spaces that reflect the clinical environment, alongside sufficient duration and frequency of learning. Our findings could help develop simulation training programs for nursing students to assist adult respiratory patients. We provide a basis for developing VR-based simulation training for respiratory care by studying the current state of and demand for nurses' VR-based simulation training. The results can contribute to improving the quality of nursing for adult respiratory patients.

Peripheral nerve traction injury modeling in an experiment

Background. Peripheral nerve (PN) injuries can lead to significant functional impairment and reduced quality of life. Functional recovery of PN is a complex process dependent on many factors, some of which can be controlled to improve outcomes. The number of wounded people with damage to the peripheral nerves of the limbs can be up to 25 % in war conditions. The degree of disability of patients is 65–70 %, so the issue of restoring peripheral nerves is extremely relevant, especially during wartime. The purpose was to develop a model of PN traction injury in an experiment resulting from longitudinal stretching of the sciatic nerve using a tool modified based on a standard self-retaining retractor, which provides the possibility of reproducing traumatic conditions that most accurately imitate real clinical cases. Materials and methods. The study was conducted on 20 outbreed male rats (average weight of 225 ± 55 g) kept in standard conditions of the vivarium of the State Institution “Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine” in compliance with current norms of bioethics. The animals were divided into two groups: the first one (n = 10) — traction injury of the nerve, withdrawal from the experiment after 15 days with further examination of the damaged area with the light and electron microscopy. The second group of animals (n = 10) — traction injury of the nerve, withdrawal from the experiment after 30 days with further examination of the damaged part of the nerve with the help of light and electron microscopy. Before surgery, on the 15th and 30th day after simulating injury (before the nerve harvesting for morphological analysis), the sciatic functional index (SFI) was determined using the walking track test in groups I and II of animals, respectively. Rats were maintained on a standard 12-h light/dark cycle with free access to food and water. The experiment ended by removing the animals from the experiment by injecting a lethal dose of thiopental sodium. For a more detailed analysis, on the 15th and 30th day after the start of the experiment, repeated surgical interventions were performed to collect the appropriate sections of the nerve for morphological examination. For accurate identification of the proximal end of the nerve, the method of applying a ligature to the epineurium was used, which allowed to clearly demarcate the studied areas for further analysis. Structural changes in the nerve tissue were analyzed using light and electron microscopy, which provided high detail of morphological characteristics. Results. At the beginning of the experiment, before traction injury, the SFI in the first group was 2.26 ± 0.27, and in the second group — 3.14 ± 0.53. Fifteen days after injury simulation, the SFI in the first group was 68.90 ± ± 1.61, and in the second group — 70.31 ± 1.75, the difference between the indicators was statistically insignificant (p ≥ 0.05). When comparing the SFI before and after injury, the difference was statistically significant (p &lt; 0.0014 and p &lt; 0.0032, respectively). Thirty days after injury simulation, the SFI in the second group was 32.27 ± 1.13 and, compared to the indicator on the 15th day after the injury, it differed statistically significantly in favor of the indicator after 30 days (p &lt; 0.0026). From the biomechanical point of view, three main types of injuries can be distinguished, when traction is the main traumatic mechanism: elastic stretching, inelastic (plastic) stretching and rupture. Elastic stretching is characterized by the return of the nerve to its original length after removal of traction. With a further increase in the stretching force, the nerve enters the phase of plastic deformation, during which irreversible changes in its structure occur, such as the rupture of axons, endoneural and perineural sheaths. When a certain threshold of stretching is exceeded (in particular, when the hook was moved along racks at position of 9, 10, 11 teeth), nerve rupture occurred. The results of morphological studies are planned to be described in detail in future scientific publications. Conclusions. 1. The model of the peripheral nerve traction injury is objective as evidenced by the sciatic nerve functional index. This technique is easily reproducible and does not require expensive and complex equipment. 2. The use of a model of peripheral nerve traction injury in an experiment, with the aim of studying the therapeutic effects in this type of trauma, will allow to expand the understanding of its patho- and morphogenesis and to improve treatment strategy. 3. Extrapolation of this model to clinical practice will allow to improve the treatment of victims with the consequences of combat injuries to peripheral nerves, where a similar mechanism of trauma often occurs.

Breaking the taboo of using the nursing process: lived experiences of nursing students and faculty members

BackgroundDespite the numerous advantages of the nursing process, nursing students often struggle with utilizing this model. Therefore, studies suggest innovative teaching methods to address this issue. Teaching based on real clinical cases is considered a collaborative learning method that enhances students’ active learning for the development of critical thinking and problem-solving skills. In this method, students can acquire sufficient knowledge about patient care by accessing authentic information.ObjectiveThe aim of the present study was to investigate the experiences of nursing students and faculty members regarding the implementation of nursing process educational workshops, based on real case studies.DesignA qualitative descriptive study.Participants9 Nursing students and 7 faculty members from the Isfahan School of Nursing and Midwifery who attended the workshops.MethodsThis qualitative descriptive study was conducted from 2021 to 2023. Data was collected through semi-structured individual and focus group interviews using a qualitative content analysis approach for data analysis.ResultsAfter analyzing the data, a theme titled “Breaking Taboos in the Nursing Process” was identified. This theme consists of four categories: “Strengthening the Cognitive Infrastructure for Accepting the Nursing Process,” “Enhancing the Applicability of the Nursing Process,” “Assisting in Positive Professional Identity,” and “Facilitating a Self-Directed Learning Platform.” Additionally, thirteen subcategories were obtained.ConclusionThe data obtained from the present study showed that conducting nursing process educational workshops, where real clinical cases are discussed, analyzed, and criticized, increases critical thinking, learning motivation, and understanding of the necessity and importance of implementing the nursing process. Therefore, it is recommended that instructors utilize this innovative and effective teaching method for instructing the nursing process.

Semi-automated finite element analyses of surgically treated acetabular fractures to investigate the biomechanical behaviour of patient-specific compared to conventional implants

BackgroundIn acetabular fracture surgery, understanding the biomechanical behaviour of fractures and implants is beneficial for clinical decision-making about implant selection and postoperative (early) weightbearing protocols. This study outlines a novel approach for creating finite element models (FEA) from actual clinical cases. Our objectives were to (1) create a detailed semi-automatic three-dimensional FEA of a patient with a transverse posterior wall acetabular fracture and (2) biomechanically compare patient-specific implants with manually bent off-the-shelf implants.MethodsA computational study was performed in which we developed three finite element models. The models were derived from clinical imaging data of a 20-year-old male with a transverse posterior wall acetabular fracture treated with a patient-specific implant. This implant was designed to fit the patient's anatomy and fracture configuration, allowing for optimal placement and predetermined screw trajectories. The three FEA models included an intact hemipelvis for baseline comparison, one with a fracture fixated with a patient-specific implant, and another with a conventional implant. Two loading conditions were investigated: standing up and peak walking forces. Von Mises stress and displacement patterns in bone, implants and screws were analysed to assess the biomechanical behaviour of fracture fixation with either a patient-specific versus a conventional implant.ResultsThe finite element models demonstrated that for a transverse posterior wall type fracture, a patient-specific implant resulted in lower peak stresses in the bone (30 MPa and 56 MPa) in standing-up and peak walking scenario, respectively, compared to the conventional implant model (46 MPa and 90 MPa). The results suggested that patient-specific implant could safely withstand standing-up and walking after surgery, with maximum von Mises stresses in the implant of 156 MPa and 371 MPa, respectively. The results from the conventional implant indicate a likelihood of implant failure, with von Mises stresses in the implant (499 MPa and 1000 MPa) exceeding the yield stress of stainless steel.ConclusionThis study presents a workflow for conducting finite element analysis of real clinical cases in acetabular fracture surgery. This concept of personalized biomechanical fracture and implant assessment can eventually be applied in clinical settings to guide implant selection, compare conventional implants with innovative patient-specific ones, optimizing implant designs (including shape, size, materials, screw positions), and determine whether immediate full weight-bearing can be safely permitted.

Advanced Detection of Chronic Atrophic Gastritis Using High-Resolution Endoscopy and Semantic Web

Chronic atrophic gastritis is a precancerous lesion that can progress to gastric cancer. Existing deep-learning methods often downsample high-resolution images during diagnosis, leading to a loss of texture details and a reduced ability to identify pathological features of chronic atrophic gastritis. To address this limitation, we propose a novel approach for intelligently identifying chronic atrophic gastritis directly from high-resolution endoscopic images. Specifically, we design a two-stage network that emulates the diagnostic workflow of clinical experts, which first localizes the lesion area to downscale the high-resolution image and then applies a patch-based magnification technique to detect finer pathological features. On a real clinical cases dataset, our method achieves a diagnostic accuracy of 94.08%, with specificity and precision of 96.86% and 96.28%, respectively. These performance metrics outperform many state-of-the-art methods and closely match those of senior endoscopists, providing clinicians with a more objective and reliable tool for lesion assessment.

Challenges in treating radioiodine-refractory thyroid cancer: a global perspective with a focus on developing nations in Latin America.

This article aims to comprehensively analyze the unique challenges in managing patients with metastatic Differentiated Thyroid Cancer (DTC) that develop radioiodine-refractory disease, especially in developing countries in Latin America. We discuss key contentious aspects of their treatment, such as the optimal timing for initiating systemic therapy, the choice of first-line medications, the appropriate timing for requesting molecular interrogation, and the challenges associated with accessing these drugs and molecular panels. To illustrate these challenges and enhance understanding, we present five real clinical cases from the authors' experiences. Patients with Differentiated Thyroid Cancer (DTC) generally have an excellent prognosis, with an overall 10-year survival rate exceeding 97%. However, approximately 5% of DTC patients, especially those with distant metastases, may develop radioiodine-refractory disease, reducing survival rates. Access to medications remains difficult and time-consuming, particularly for patients within the public healthcare system. Urgent discussions on drug pricing involving all stakeholders are imperative. To break free from complacency, stakeholders must prioritize patient well-being by advocating for evidence-based drug pricing, increased participation in clinical trials, and streamlined regulatory processes. Beyond the recognized need for prospective randomized clinical trials to determine the optimal first-line drug and the timing of molecular testing, this type of manuscript plays a pivotal role in stimulating discussions and disseminating comprehensive knowledge about the challenges associated with treating and monitoring patients with radioiodine-refractory thyroid carcinoma, especially in developing countries.

Modeling cardiac microcirculation for the simulation of coronary flow and 3D myocardial perfusion.

Accurate modeling of blood dynamics in the coronary microcirculation is a crucial step toward the clinical application of in silico methods for the diagnosis of coronary artery disease. In this work, we present a new mathematical model of microcirculatory hemodynamics accounting for microvasculature compliance and cardiac contraction; we also present its application to a full simulation of hyperemic coronary blood flow and 3D myocardial perfusion in real clinical cases. Microvasculature hemodynamics is modeled with a compliant multi-compartment Darcy formulation, with the new compliance terms depending on the local intramyocardial pressure generated by cardiac contraction. Nonlinear analytical relationships for vessels distensibility are included based on experimental data, and all the parameters of the model are reformulated based on histologically relevant quantities, allowing a deeper model personalization. Phasic flow patterns of high arterial inflow in diastole and venous outflow in systole are obtained, with flow waveforms morphology and pressure distribution along the microcirculation reproduced in accordance with experimental and in vivo measures. Phasic diameter change for arterioles and capillaries is also obtained with relevant differences depending on the depth location. Coronary blood dynamics exhibits a disturbed flow at the systolic onset, while the obtained 3D perfusion maps reproduce the systolic impediment effect and show relevant regional and transmural heterogeneities in myocardial blood flow (MBF). The proposed model successfully reproduces microvasculature hemodynamics over the whole heartbeat and along the entire intramural vessels. Quantification of phasic flow patterns, diameter changes, regional and transmural heterogeneities in MBF represent key steps ahead in the direction of the predictive simulation of cardiac perfusion.

Finite element analysis of endoscopic cross-overtop decompression for single-segment lumbar spinal stenosis based on real clinical cases.

Introduction: For severe degenerative lumbar spinal stenosis (DLSS), the conventional percutaneous endoscopic translaminar decompression (PEID) has some limitations. The modified PEID, Cross-Overtop decompression, ensures sufficient decompression without excessive damage to the facet joints and posterior complex integrity. Objectives: To evaluate the biomechanical properties of Cross-Overtop and provide practical case validation for final decision-making in severe DLSS treatment. Methods: A finite element (FE) model of L4-L5 (M0) was established, and the validity was verified against prior studies. Endo-ULBD (M1), Endo-LOVE (M2), and Cross-Overtop (M3) models were derived from M0 using the experimental protocol. L4-L5 segments in each model were evaluated for the range of motion (ROM) and disc Von Mises stress extremum. The real clinical Cross-Overtop model was constructed based on clinical CT images, disregarding paraspinal muscle influence. Subsequent validation using actual FE analysis results enhances the credibility of the preceding virtual FE analysis. Results: Compared with M0, ROM in surgical models were less than 10°, and the growth rate of ROM ranged from 0.10% to 11.56%, while those of disc stress ranged from 0% to 15.75%. Compared with preoperative, the growth rate of ROM and disc stress were 2.66%-11.38% and 1.38%-9.51%, respectively. The ROM values in both virtual and actual models were less than 10°, verifying the affected segment stability after Cross-Overtop decompression. Conclusion: Cross-Overtop, designed for fully expanding the central canal and contralateral recess, maximizing the integrity of the facet joints and posterior complex, does no significant effect on the affected segmental biomechanics and can be recommended as an effective endoscopic treatment for severe DLSS.

Applications of ChatGPT in Otolaryngology-Head Neck Surgery: A State of the Art Review.

To review the current literature on the application, accuracy, and performance of Chatbot Generative Pre-Trained Transformer (ChatGPT) in Otolaryngology-Head and Neck Surgery. PubMED, Cochrane Library, and Scopus. A comprehensive review of the literature on the applications of ChatGPT in otolaryngology was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. ChatGPT provides imperfect patient information or general knowledge related to diseases found in Otolaryngology-Head and Neck Surgery. In clinical practice, despite suboptimal performance, studies reported that the model is more accurate in providing diagnoses, than in suggesting the most adequate additional examinations and treatments related to clinical vignettes or real clinical cases. ChatGPT has been used as an adjunct tool to improve scientific reports (referencing, spelling correction), to elaborate study protocols, or to take student or resident exams reporting several levels of accuracy. The stability of ChatGPT responses throughout repeated questions appeared high but many studies reported some hallucination events, particularly in providing scientific references. To date, most applications of ChatGPT are limited in generating disease or treatment information, and in the improvement of the management of clinical cases. The lack of comparison of ChatGPT performance with other large language models is the main limitation of the current research. Its ability to analyze clinical images has not yet been investigated in otolaryngology although upper airway tract or ear images are an important step in the diagnosis of most common ear, nose, and throat conditions. This review may help otolaryngologists to conceive new applications in further research.

Abstract 2315: AI-enabled precision oncology era: Advanced and interactive interpretation of next-gneneration sequencing (NGS) reports

Abstract Background: Next-generation sequencing (NGS) has been widely adopted in clinical practice, but there are still unmet needs among physicians regarding the interpretation and application of NGS reports. These needs include selecting multi-targeted and combination therapies, keeping up with evolving treatment options and clinical trial results, and incorporating personalized medicine based on real clinical cases. Methods: To address these challenges, we propose using large language model (LLM) to analyze and interpret clinical questions, perform semantic searches in a high-quality database, and provide customized prompts and logical outputs. Our knowledge base includes diagnostic and treatment details for 600+ tumor subtypes, 620,000+ entries, 2,000+ drug details, and 440,000+ clinical trials. The database is updated automatically using a fact engine and medical literature sources. Personalized gene interpretation is incorporated using pretraining, cosine similarity, and context learning prompts. Results: Our tool, named "SmartMTB", enables personalized interpretation of genomic testing reports for precision oncology. Users input the latest clinical features using a selection-based or question-and-answer approach. The tool identifies the treatment stage and genomic variations, provides information on mutation frequencies, sensitivity and resistance of targeted and immunotherapies, and priority selection strategies for multi-gene mutations. It matches similar clinical cases and provides real-time updates on treatment options and clinical trial literature. It also facilitates patient matching for clinical trials and considers economic factors. Conclusion: We present a groundbreaking artificial intelligence (AI) tool in cancer care that revolutionizes precision oncology. This AI system, trained on extensive datasets, swiftly and accurately analyzes and interprets complex genomic and clinical data. It enables clinicians to make informed decisions about personalized treatment strategies, significantly improving patient outcomes in cancer therapy. Citation Format: Hui Chen, Zanmei Xu, Lijuan Chen, Mingmin Wang, Peng Zhang, Fei Pang, Kai Wang. AI-enabled precision oncology era: Advanced and interactive interpretation of next-gneneration sequencing (NGS) reports [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2315.

Personalized Pressure Conditions and Calibration for a Predictive Computational Model of Coronary and Myocardial Blood Flow

Predictive modeling of hyperemic coronary and myocardial blood flow (MBF) greatly supports diagnosis and prognostic stratification of patients suffering from coronary artery disease (CAD). In this work, we propose a novel strategy, using only readily available clinical data, to build personalized inlet conditions for coronary and MBF models and to achieve an effective calibration for their predictive application to real clinical cases. Experimental data are used to build personalized pressure waveforms at the aortic root, representative of the hyperemic state and adapted to surrogate the systolic contraction, to be used in computational fluid-dynamics analyses. Model calibration to simulate hyperemic flow is performed in a “blinded” way, not requiring any additional exam. Coronary and myocardial flow simulations are performed in eight patients with different clinical conditions to predict FFR and MBF. Realistic pressure waveforms are recovered for all the patients. Consistent pressure distribution, blood velocities in the large arteries, and distribution of MBF in the healthy myocardium are obtained. FFR results show great accuracy with a per-vessel sensitivity and specificity of 100% according to clinical threshold values. Mean MBF shows good agreement with values from stress-CTP, with lower values in patients with diagnosed perfusion defects. The proposed methodology allows us to quantitatively predict FFR and MBF, by the exclusive use of standard measures easily obtainable in a clinical context. This represents a fundamental step to avoid catheter-based exams and stress tests in CAD diagnosis.

The effects of hospice care education on first-year undergraduate nursing students in mainland China: A mixed-methods study

BackgroundWith the rising number of people with end-stage chronic diseases, the demand for hospice care has increased dramatically. As the future health professionals for the implementation of hospice care, undergraduate nursing students in mainland China still lack knowledge and skills of hospice care, thus hospice care education plays a vital role in its development. ObjectivesTo understand the effects of hospice care education on nursing students' death attitudes, end-of-life attitudes, humanistic care qualities, and their learning experiences. DesignThis study used a mixed-methods design. SettingA University of Chinese Medicine in mainland China. ParticipantsThe first-year undergraduate nursing students (n = 65). MethodsA mixed-methods study was conducted to evaluate the impact of a hospice care course from March to June 2021. The quantitative part included a quasi-experimental study designed with pre- and post-intervention measurements and the qualitative part included a descriptive qualitative study with semi-structured individual interviews. ResultsThe quantitative data revealed that after the course, nursing students experienced improvements in their death attitudes, end-of-life attitudes, and humanistic care qualities. Two categories were identified from the qualitative data. The category of “Gain from learning” included 4 themes (Confronting death and thinking about life; Understanding and agreeing with the idea of hospice care; Perceiving the humanistic spirit of medicine; Enhancing of the nursing discipline cognition and professional identity) and the category of “Course feedback” included 2 themes (Expressing recognition for the course arrangement; Making suggestions on the course optimization). ConclusionsHospice care education had a positive influence on nursing students. Students expressed satisfaction with the course arrangement. However, future hospice care courses should further optimize the curriculum designs by increasing the discussion of death-related topics, sharing more real clinical cases, recruiting students from different majors, and providing clinical practice, to provide high-quality nursing education for the development of hospice care.

AI-Based Aortic Stenosis Classification in MRI Scans

Aortic stenosis (AS) is a critical cardiovascular condition that necessitates precise diagnosis for effective patient care. Despite a limited dataset comprising only 202 images, our study employs transfer learning to investigate the efficacy of five convolutional neural network (CNN) models, coupled with advanced computer vision techniques, in accurately classifying AS. The VGG16 model stands out among the tested models, achieving 95% recall and F1-score. To fortify the model’s robustness and generalization, we implement various data augmentation techniques, including translation, rotation, flip, and brightness adjustment. These techniques aim to capture real-world image variations encountered in clinical settings. Validation, conducted using authentic data from Hospital Santa Maria, not only affirms the clinical applicability of our model but also highlights the potential to develop robust models with a limited number of images. The models undergo training after the images undergo a series of computer vision and data augmentation techniques, as detailed in this paper. These techniques augment the size of our dataset, contributing to improved model performance. In conclusion, our study illuminates the potential of AI-driven AS detection in MRI scans. The integration of transfer learning, CNN models, and data augmentation yields high accuracy rates, even with a small dataset, as validated in real clinical cases.

Using Risk Ratios to Quantify Potential Behavior-Environment Relations.

Behavior-environment functional relations are the units of explanation in applied behavior analysis (ABA). Whether hypothesized experimentally or descriptively, quantification of putative functional relations improves our ability to predict and influence behavior. Risk ratios are an accessible, straightforward quantitative analysis that can serve this purpose. They have been employed to great effect in other fields (e.g., medicine, public health), but are rarely used within ABA. In this tutorial, we describe risk ratios and how they are calculated, discuss why risk ratios are well suited for quantifying behavior-environment relations, and illustrate their utility and applicability across five demonstrations from real clinical cases. Recommendations for the use of risk ratios in research and practice are discussed.

Classification of nasal polyps and inverted papillomas using CT-based radiomics

ObjectivesNasal polyp (NP) and inverted papilloma (IP) are two common types of nasal masses. And their differentiation is essential for determining optimal surgical strategies and predicting outcomes. Thus, we aimed to develop several radiomic models to differentiate them based on computed tomography (CT)-extracted radiomic features.MethodsA total of 296 patients with nasal polyps or papillomas were enrolled in our study. Radiomics features were extracted from non-contrast CT images. For feature selection, three methods including Boruta, random forest, and correlation coefficient were used. We choose three models, namely SVM, naive Bayes, and XGBoost, to perform binary classification on the selected features. And the data was validated with tenfold cross-validation. Then, the performance was assessed by receiver operator characteristic (ROC) curve and related parameters.ResultsIn this study, the performance ability of the models was in the following order: XGBoost > SVM > Naive Bayes. And the XGBoost model showed excellent AUC performance at 0.922, 0.9078, 0.9184, and 0.9141 under four conditions (no feature selection, Boruta, random forest, and correlation coefficient).ConclusionsWe demonstrated that CT-based radiomics plays a crucial role in distinguishing IP from NP. It can provide added diagnostic value by distinguishing benign nasal lesions and reducing the need for invasive diagnostic procedures and may play a vital role in guiding personalized treatment strategies and developing optimal therapies.Critical relevance statementBased on the extraction of radiomic features of tumor regions from non-contrast CT, optimized by radiomics to achieve non-invasive classification of IP and NP which provide support for respective therapy of IP and NP.Key points• CT images are commonly used to diagnose IP and NP.• Radiomics excels in feature extraction and analysis.• CT-based radiomics can be applied to distinguish IP from NP.• Use multiple feature selection methods and classifier models.• Derived from real clinical cases with abundant data.Graphical

Safety verification of a novel irrigation catheter with flexible tip of laser-cut kerfs and contact force sensor.

The safety evaluation of TactiFlex, a novel contact-force sensing catheter with a flexible 4-mm tip irrigated through laser-cut kerfs, has been ongoing. This study aimed to verify the safety of this type of catheter. Study 1: Radiofrequency (RF) applications at a range of powers (30-50W), contact forces (10-20g), and durations (10-60 s) using perpendicular/parallel catheter orientation with half-normal (HNS) or normal saline irrigation were compared between TactiFlex (4-mm tip) and TactiCath (3.5-mm tip) with temperature-controlled mode in excised porcine hearts. Study 2: The relation between RF applications using TactiFlex and the incidence of steam-pops in the real clinical cases were examined. Study-1: 576 RF lesions were examined. TactiFlex demonstrated a significantly lower risk of steam-pops (5[1.7%] vs. 59[20.5%], p< .0001). Compared to 3.5-mm-tip catheter (TactiCath), 4-mm-tip catheter (TactiFlex) produced smaller lesion volume at perpendicular (193[98-554]mm3 vs. 263[139-436]mm3 , p< .0001), but relatively similar lesion volume at parallel contact (243[105-443]mm3 vs. 278[180-440]mm3 , p=.06). HNS-irrigation tended to increase the lesion volume in both catheters and to increase the incidence of steam-pops with TactiCath, but not with TactiFlex. The cut-off value of %impedance-drop ( =absolute impedance-drop/initial impedance) of 20% predicted steam-pops with a sensitivity=100% and specificity=89.6% in TactiFlex. Study-2: 5496 RF applications in 84 patients (51AFs/8ATs/3AVNRTs/4AVRTs/17PVCs/4VTs) using TactiFlex were analyzed. Four steam-pops (0.07%) in three patients with pericardial effusion were observed (%impedance-drop=24%/26%/29%/35%, respectively). The cut-off value of %impedance-drop=20%, derived from ex-vivo study, showed sensitivity=100% and specificity=90.1% in detecting steam-pops. TactiFlex reduced the risk of steam-pops than TactiCath. %impedance-drop≤20% may be reasonable for safely use with a sufficient safety margin. For 4-mm-tip catheter, parallel-contact may be recommended for larger lesion creation.

Usefulness of a low-cost simulation model for teaching internal manual aortic compression. A survey-based mannequin evaluation.

To evaluate the users' opinion on internal manual aortic compression (IMAC) training, using a low-cost simulation model. An educational strategy was designed to teach IMAC, which included: (1) guided reading of educational material and viewing an explanatory video of IMAC; (2) an introductory lecture with the anatomical considerations, documentation of the cessation of femoral arterial flow during IMAC, and real clinical cases in which this procedure was used; and (3) simulated practice of IMAC with a new low-cost manikin. The educational strategy was applied during three postpartum hemorrhage workshops in three Latin American countries and the opinions of the participants were measured with a survey. Almost all of the participants in the IMAC workshop, including the simulation with the low-cost mannikin, highlighted the usefulness of the strategy (scores of 4/5 and 5/5 on the Likert scale) and would recommend it to colleagues. We present a low-cost simulation model for IMAC as the basis of an educational strategy perceived as very useful by most participants. The execution of this strategy in other populations and its impact on postpartum hemorrhage management should be evaluated in further studies.

Personalized prognostic prediction tool for high-grade neuroendocrine cervical cancer: a SEER database analysis and single-center validation

PurposeCervical high-grade neuroendocrine carcinoma (CHGNEC) is a rare but highly aggressive cancer. The purpose of this study is to develop a prognostic nomogram that can accurately predict the outcomes for CHGNEC patients.MethodsWe analyzed clinical data from the Surveillance, Epidemiology, and End Results (SEER) database of CHGNEC patients, including small-cell neuroendocrine carcinoma (SCNEC) and large-cell neuroendocrine carcinoma (LCNEC). We investigated patient characteristics and prognosis, and developed a prognostic nomogram model for cancer-specific survival in CHGNEC patients. External validation was conducted using real clinical cases from our hospital.ResultsOur study included 306 patients from SEER database, with a mean age of 49.9 ± 15.5 years. Most of the patients had SCNEC (86.9%). Among them, 170 died from the disease, while 136 either survived or died from other causes. Our final predictive model identified age at diagnosis, stage 1 status, stage 4 status, T1, N0, and surgery of the primary site as independent prognostic factors for CHGNEC. We validated our model using a group of 16 CHGNEC patients who underwent surgery at our center. The external validation showed that the prognostic nomogram had excellent discriminative ability, with an area under the receiver operating characteristic curve (AUC) of 0.76 (95% CI 0.49–1.00) for the prediction of 3-year cancer-specific survival (CSS) and an AUC of 0.85 (95% CI 0.62–1.00) for the prediction of 5-years CSS. The random survival forest model achieved an AUC of 0.80 (95% CI 0.56–1.00) for 3-years CSS and 0.91 (95% CI 0.72–1.00) for 5-years CSS, indicating its adequacy in predicting outcomes for CHGNEC patients.ConclusionOur study provides an excellent nomogram for predicting the prognosis of CHGNEC patients. The prognostic nomogram can be a useful tool for clinicians in identifying high-risk patients and making personalized treatment decisions.