Standardized Scoring System Research Articles

Effectiveness of the Eyesi Surgical Simulator for ophthalmology trainees: systematic review and meta-analysis

ObjectifLe simulateur chirurgical Eyesi (VRmagic, Mannheim, Allemagne) est le simulateur de réalité virtuelle le plus souvent utilisé en chirurgie ophtalmologique. Si des études ont révélé que des outils de formation fondés sur la simulation améliorent l'acquisition des compétences, aucune revue de synthèse systématique avec méta-analyse n'a encore été réalisée à l’égard du simulateur chirurgical Eyesi. Notre étude visait donc à effectuer une méta-analyse des études qui comparaient le simulateur chirurgical Eyesi à d'autres méthodes d'enseignement des compétences techniques auprès d’étudiants. MéthodesNotre recherche a porté sur 3 bases de données (MEDLINE, Embase et CENTRAL). Les articles inclus comparaient le simulateur chirurgical Eyesi à d'autres formes d'enseignement des compétences techniques auprès d’étudiants et de résidents dans des facultés de médecine. On a réalisé une méta-analyse par paire qui reposait sur l'inverse de la variance à effets aléatoires. Les différences moyennes standardisées (DMS) ont servi de principal paramètre de mesure afin de tenir compte des différences entre les outils d’évaluation des compétences chirurgicales. RésultatsDes 207 citations évaluées, on a retenu 8 études, totalisant 108 étudiants qui ont eu recours au simulateur chirurgical Eyesi et de 123 étudiants qui ont utilisé une autre forme d'apprentissage. L'amélioration des scores de compétences techniques était significativement supérieure dans le groupe Eyesi (3 études; DMS = 2,02; intervalle de confiance [IC] à 95 % : 1,47–2,57; p < 0,001; I2 = 0 %). On a noté une baisse significative du nombre d’étudiants du groupe Eyesi qui ont fait des erreurs techniques après leur formation (5 études : rapport de cotes = 0,43; IC à 95 % : 0,20–0,90; p = 0,03; I2 = 30 %). Aucune différence significative n'a été enregistrée entre les groupes en ce qui a trait au temps consacré pour exécuter une tâche après la formation (3 études; DMS = 1,96; IC à 95 % : –1,96–5,88; p = 0,33; I2 = 97 %). ConclusionsLe simulateur chirurgical Eyesi pourrait améliorer l'acquisition des compétences techniques (faible degré de certitude des données probantes) et réduire le nombre d'erreurs techniques (très faible degré de certitude des données probantes) lors de l'apprentissage de la chirurgie de la cataracte chez des étudiants. Il y a donc lieu de réaliser d'autres études prospectives sur le module Eyesi qui comporteraient un système de notation standardisée.

How Would You Manage This Patient With Benign Prostatic Hyperplasia? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are common in older patients assigned male sex at birth, regardless of gender identity, and treatment of these symptoms is therefore common in primary care practice. In 2021, the American Urological Association published guidelines for management of BPH. They recommend using a standardized scoring system such as the International Prostate Symptom Score to help establish a diagnosis and to monitor the efficacy of interventions, α-blockers as the first-choice pharmacotherapy option, and 5α-reductase inhibitors for patients with prostate size estimated to be at least 30 cc. Tadalafil is another option regardless of erectile dysfunction. Combination therapies with α-blockers and 5α-reductase inhibitors, anticholinergic agents, or β3-agonists are effective options. A surgical referral is warranted if the BPH results in chronic kidney disease, refractory urinary retention, or recurrent urinary tract infections; if there is concern for bladder or prostate cancer; or if symptoms do not respond to medical therapy. In this article, a general internal medicine physician and a urologist discuss the treatment options and how they would apply their recommendations to a patient who wishes to learn more about his options.

Perfusion CT in predicting deep pancreatic necrosis and planning early interventions for severe acute pancreatitis

Aim. To explore the potential of perfusion CT for predicting deep pancreatic necrosis and duct injury as well as for determining treatment strategy. Materials and methods. The prospective study included 74 patients hospitalized within 1–2 days of acute pancreatitis. They were exposed to perfusion CT and examination of their arterial blood flow velocity. In 37 observations, a standard CT was also performed on day 3–9 to study the depth and configuration of the necrosis. The severity of acute pancreatitis was assessed according to standard integral scoring systems, organ failure and severity of peripancreatitis. The alfa-amylase activity in fluid collections was examined. Results. Necrosis was detected in 20 patients: deep necrosis – in 11 cases, shallow – in 9. 17 patients did not reveal necrosis. Necrosis configuration of type 1 was detected in 16 patients, type 2 – in 4. Deep necrosis was preceded by a significant decrease in the arterial blood flow velocity: 39–52 ml/min/100 ml. This rate was greater in patients with shallow necrosis and without necrosis: 72–100 and 95–117 ml/min/100 ml (p &lt; 0.001). In cases of deep necrosis, advanced peripancreatitis was formed, organ failure was noted in 9 patients, 3 patients died. Internal pancreatic fistula was detected in 7 out of 9 patients with deep necrosis and in 1 out of 6 patients with shallow necrosis and type 1 configuration. In cases of necrosis type 2 configuration the pancreatic fistula was not noted. Minimally invasive interventions and transformation of the internal fistula into the external one were performed in 12 out of 20 patients: percutaneous drainage of fluid collections – in 9 observations, stenting of the pancreatic duct – in 3. Conclusion. Perfusion CT can be used to predict pancreatic necrosis on day 1–2 of the disease. A decrease in the arterial blood flow velocity in the range of 39–52 ml/min/100 ml is associated with the risk of parenchyma deep necrosis and duct injury. This parameter can be taken into account when determining indications for early minimally invasive interventions.

Pilot test of a multicomponent implementation strategy for equity in advanced heart failure allocation

Advanced heart failure (AHF) therapy allocation is vulnerable to bias related to subjective assessments and poor group dynamics. Our objective was to determine whether an implementation strategy for AHF team members could feasibly contribute to organizational and culture change supporting equity in AHF allocation. Using a pretest–posttest design, the strategy included an 8-week multicomponent training on bias reduction, standardized numerical social assessments, and enhanced group dynamics at an AHF center. Evaluations of organizational and cultural changes included pretest–posttest AHF team member surveys, transcripts of AHF meetings to assess group dynamics using a standardized scoring system, and posttest interviews guided by a framework for implementing a complex strategy. Results were analyzed with qualitative descriptive methods and Brunner-Munzel tests for relative effect (RE, RE >0.5 signals posttest improvement). The majority of survey metrics revealed potential benefit with RE >0.5. REs were >0.5 for 5 of 6 group dynamics metrics. Themes for implementation included (1) promoting equitable distribution of scarce resources, (2) requiring a change in team members’ time investment to correct bias and change the meeting structure, (3) slowing and then accelerating the allocation process, and (4) adaptable beyond AHF and reinforceable with semi-annual trainings. An implementation strategy for AHF equity demonstrated the feasibility for organizational and culture changes.

Plasminogen decreases Aβ42 and Tau deposition, and shows multi-beneficial effects on Alzheimer's disease in mice and humans

Alzheimer's disease (AD) is the most common neurodegenerative disorder in the world. The aggregation of both amyloid beta (Aβ) peptides extracellularly and Tau proteins intracellularly plays key roles in the pathological consequences of AD, which lead to cholinergic neurodegeneration and eventually death. Currently, there are no effective methods to stop the progression of AD. Using ex vivo, in vivo and clinical approaches, we investigated the functional effects of plasminogen on the widely used FAD, Aβ42 oligomer or Tau intracranial injection-induced AD mouse model and explored its therapeutic effects on patients with AD. The results show that intravenously injected plasminogen rapidly crosses the blood‒brain barrier (BBB); increases plasmin activity in the brain; colocalizes with and effectively promotes the clearance of Aβ42 peptide and Tau protein deposits ex vivo and in vivo; increases the choline acetyltransferase (ChAT) level and decreases the acetylcholinesterase (AChE) activity; and improves the memory functions. Clinically, when GMP-level plasminogen was administered to 6 AD patients for 1–2 weeks, their average scores on the Minimum Mental State Examination (MMSE), which is a standard scoring system used to measure the memory loss and cognitive deficits, were extremely significantly improved by 4.2 ± 2.23 points, e.g., an average increase from 15.5 ± 8.22 before treatment to 19.7 ± 7.09 after treatment. The preclinical study and pilot clinical study suggest that plasminogen is effective in treating AD and may be a promising drug candidate.

Impacts of green credit policies and information asymmetry: From market perspective

Under green credit policies, green credit subsidies can be employed to provide differentiated credit services for manufacturers with varying eco-performance. Meanwhile, on the market side, due to the variety and complexity of associated technologies, it is difficult for customers to tell the green difference between competing products. Within this context, we investigate the effectiveness of governments’ green credit policies under this green information asymmetry. Specifically, a two-stage duopoly game model is developed to analyze the strategic interaction among government, manufacturers, and customers. We find that when making greener products incurs insignificant additional costs, green interest subsidies are not necessary for greener manufacturers to gain a competitive edge because of the market preference for greener products. In addition, we find that customers’ behavior impacts the effectiveness of market-oriented green credit policies. In particular, when customers are inclined to believe a high green difference exists, the greener manufacturer will be more likely to benefit from green interest subsidies. Based on the analysis results, the following policy recommendations are developed. When determining the level of green interest subsidies for competing products with varying greenness, the government should consider their cost differences. Moreover, to enhance the effectiveness of market-based green credit policies, a customer-oriented standard rating system can be established to facilitate ordinary customers in comparing competing green products.

Fluid Distribution Patterns in Early-Stage Upper Extremity Lymphedema.

Magnetic resonance imaging (MRI) stage 1 (early stage) upper extremity lymphedema is characterized by fluid infiltration in the subcutaneous tissues that does not exceed 50% of the extremity circumference at any level. The spatial fluid distribution in these cases has not been detailed and may be important to help determine the presence and location of compensatory lymphatic channels. The aim of this study is to determine whether there was a pattern of distribution of fluid infiltration in patients with early-stage lymphedema that could correspond to known lymphatic pathways in the upper extremity. A retrospective review identified all patients with MRI stage 1 upper extremity lymphedema who were evaluated at a single lymphatic center. Using a standardized scoring system, a radiologist graded the severity of fluid infiltration at 18 anatomical locations. A cumulative spatial histogram was then created to map out regions where fluid accumulation occurred most and least frequently. Eleven patients with MRI stage 1 upper extremity lymphedema were identified between January 2017 and January 2022. The mean age was 58 years and the mean BMI was 30 m/kg2. One patient had primary lymphedema and the remaining 10 had secondary lymphedema. The forearm was affected in nine cases, and fluid infiltration was predominantly concentrated along the ulnar aspect, followed by the volar aspect, while the radial aspect was completely spared. Within the upper arm, fluid was primarily concentrated distally and posteriorly, and occasionally medially. In patients with early-stage lymphedema, fluid infiltration is concentrated along the ulnar forearm and the posterior distal upper arm, which aligns with the tricipital lymphatic pathway. There is also sparing of fluid accumulation along the radial forearm in these patients, suggesting a more robust lymphatic drainage along this region, possibly due to a connection to the lateral upper arm pathway.

Operationalisation of a standardised scoring system to assess adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations in the UK biobank.

In 2018, The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) published ten evidence-based Cancer Prevention Recommendations designed to reduce the risk of cancer via improved lifestyle behaviours. In 2019, Shams-White and colleagues created the "2018 WCRF/AICR Score" which aimed to standardise how adherence to these recommendations is assessed. The standardised scoring system includes seven of the recommendations concerning weight, physical activity and diet, with an optional eighth recommendation on breastfeeding. To promote transparency and reproducibility, the present paper describes the methodology for operationalisation of the standardised scoring system in the UK Biobank. UK Biobank recruited >500,000 individuals aged 37-73 years, between 2006 and 2010. In 2021, we held a workshop with experts which aimed to reach consensus on how to operationalise the scoring system using data available within UK Biobank. We used data on anthropometric measurements, physical activity and diet to calculate adherence scores. 24 h dietary assessment data were used to measure adherence to the following recommendations: "Eat a diet rich in wholegrains, vegetables, fruit, and beans", "Limit consumption of "fast foods" and other processed foods high in fat, starches or sugars" and "Limit consumption of sugar-sweetened drinks"; food frequency questionnaire data were used to assess adherence to "Limit consumption of red and processed meat" and "Limit alcohol consumption". Participants were allocated points for meeting, partially meeting or not meeting each recommendation, using cut-offs defined in the standardised scoring system. At our workshop, discussions included the use of national guidelines to assess adherence to the recommendation on alcohol consumption, as well as challenges faced including defining the adapted ultra-processed food variables. A total score was calculated for 158,415 participants (mean 3.9 points, range 0-7 points). We also describe the methodology to derive a partial 5-point adherence score using data from the food frequency questionnaire in 314,616 participants. We describe the methodology used to estimate adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations for participants in the UK Biobank, including some of the challenges faced operationalising the standardised scoring system.

P178 Evaluation of the Ulcerative Colitis Intestinal Ultrasound (UC-IUS) Index in Pediatric patients with newly diagnosed ulcerative colitis

Abstract Background Transabdominal bowel ultrasound (TABUS) is a non-invasive tool that can be used to assess bowel inflammation in ulcerative colitis (UC). It is particularly attractive for use in children, given the need for general anesthesia when undergoing endoscopic assessment of bowel inflammation. A standardized TABUS scoring system in UC has only been developed in adults (the UC Intestinal Ultrasound (UC-IUS) Index). Our aim was to evaluate the UC-IUS Index in Pediatric patients. Methods Pediatric patients (&amp;lt;18 years old) with suspected UC were prospectively enrolled. TABUS was performed for the right side colon, transverse, descending, and sigmoid colons. UC-IUS Index scores were calculated: bowel wall thickness (BWT) (&amp;gt;2mm=1, &amp;gt;3mm=2, &amp;gt;4mm=3), Doppler signal (spots=1, stretches=2), haustrations (abnormal=1), and fat wrapping (present=1). Mayo endoscopic subscore (for each segment), Pediatric Ulcerative Colitis Activity Index (PUCAI), and inflammatory biomarkers were collected. Non-parametric tests were used to correlate UC-IUS and BWT with Mayo endoscopic subscores. Receiver operating characteristic (ROC) analyses evaluated the UC-IUS Index BWT cut-offs. Results Fifty-two patients (56% male) were included (Table 1). Data for 206 colonic segments were analyzed (2 segments missing due to 1 incomplete colonoscopy). Total UC-IUS scores significantly correlated with CRP (rho=0.61), albumin (rho=-0.49), PUCAI (rho=0.54), FCP (rho=0.41). UC-IUS Index scores and mean BWT for each segment showed significant moderate correlations with Mayo sub-scores of that segment (rho=0.60 and rho=0.58, respectively) (p&amp;lt;0.001) (Fig 1). These correlations were strong in the right colon (rho=0.77, rho=0.69), and moderate in the transverse (rho=0.52, rho=0.56), descending (rho=0.43, rho=0.50), and sigmoid (rho=0.50, rho=0.46) colons (p&amp;lt;0.01). The adult UC-IUS 2mm cut-off (Mayo 0 vs. Mayo 1-3) performed similarly in our Pediatric patients (sensitivity 80%, specificity 96%, area under the curve (AUC) 0.92). The 3mm (Mayo 0-1 vs. Mayo 2-3) and 4mm (Mayo 0-2 vs. Mayo 3) cut-offs had lower sensitivity (sensitivity 44%, specificity 98%, AUC 0.87; sensitivity 59%, specificity 92%, AUC 0.80) (Fig 2). Thinner BWT cut-offs performed better: 2.5mm (sensitivity 65%; specificity 89%) and 3.5mm (sensitivity 71%; specificity 86%). Fig 1: Fig 2: Conclusion In Pediatric patients with newly diagnosed UC, TABUS was a useful tool, with the UC-IUS and BWT correlating well with their endoscopic, clinical, and biochemical disease activity. Compared to the adult UC-IUS Index, Pediatric patients need a thinner BWT cut-off to better discriminate between mild vs. moderate/severe disease (2.5mm instead of 3mm) and mild/moderate vs. severe disease (3.5mm instead of 4mm).

Assessing Symmetry and Accuracy of SpaceOAR Insertion Prior to Radical Radiotherapy to the Prostate: a Single UK Centre Experience

Purpose: SpaceOAR is an absorbable hydrogel inserted into the prerectal space of men undergoing radical radiotherapy to the prostate with the intention of reducing radiation-induced rectal toxicity. The benefit of SpaceOAR insertion in reducing rectal toxicity is related to the degree of prostate–rectum separation and symmetry of spacer placement [1,2]. Assessment of SpaceOAR insertion symmetry using a standardised scoring system can facilitate positional optimisation of future SpaceOAR insertion.

Profile of HER2/neu Expression in Surface Epithelial Ovarian Tumours: A Clinicomorphological Study

Introduction: Surface Epithelial Ovarian Tumours (SEOT) are most prevalent tumours and account for about two third of all ovarian cancers. Survival of ovarian carcinoma is poor despite optimal surgical and chemotherapeutic management. Evaluation of new diagnostic and prognostic Immunohistochemical (IHC) markers will be essential in this aspect. Aim: To evaluate quantitatively the profile of Human Epidermal growth factor Receptor 2 (HER2)/neu IHC expression with standard scoring system in SEOTs and their association with various clinicpathologic variables (age, laterality, CA 125 levels, histological subtype and FIGO staging). Materials and Methods: The present ambispective study was done in the Department of Pathology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India, from August 2020 to August 2022 with a sample size of 166 cases. All the histopathological samples of SEOT during the study period from August 2020 to August 2022 (prospective) and all borderline, malignant and few benign cases from June 2016 to August 2020 (retrospective) were also included in the study. Cases for which slides and blocks were not available and patient treated with neo adjuvant chemotherapy or radiotherapy were excluded in the study. For prospective cases after getting clinical history and Cancer Antigen 125 (CA 125) level, specimens were fixed, processed and Haematoxylin and Eosin (H&amp;E), IHC staining was done as per standard lab protocol, for retrospective cases clinical history, CA 125 levels, pathological diagnosis and tissue blocks were retrieved, IHC performed and finally both prospective and retrospective cases HER2/neu IHC expression association was studied related to clinicopathological parameters. Results: Out of total sample, SEOT was the most common (n=184, 76.98%) tumour cases, followed by germ cell tumours (n=42, 17.57%) cases and least common was sex cord stromal tumour (n=13, 5.43%). HER2/neu had higher IHC expression in malignant tumours and showed statistically significant positive association with age (p-value=0.001), CA 125 level (p-value0.001), and histological diagnosis (p-value &lt;0.001), but there is no significant association with size of tumour (p-value=0.786), parity (p-value=0.717), laterality (p-value=0.514) and the International Federation of Gynecology and Obstetrics (FIGO) grading (p-value=0.274). Conclusion: Malignant tumours had high HER2/neu IHC expression, thus emphasising its carcinogenic role and helps in the diagnostic differentiation of benign and borderline tumours with malignant potential from actual malignant tumours and can be a therapeutic target in future.

Defining hip cartilage repair: a modified delphi study to establish the Magnetic Resonance Evaluation of the Repair of Cartilage in the Hip (MERCH) score

PurposeTo develop a standardized scoring system to evaluate pre- to post-operative repair or reconstruction of hip cartilage using magnetic resonance imaging (MRI).MethodsA two-phase modified Delphi study was conducted. Phase 1 involved a survey with suggested criteria and diagrams to define various stages of articular cartilage repair and phase 2 involved an expert consensus meeting that discussed the survey responses and voted on final scoring criteria. The survey was emailed to members of the Canadian Hip Preservation Research Collaborative (CHIPR) and respondents included both board certified orthopedic surgeons as well as musculoskeletal radiologists.ResultsOverall, there were 17 survey respondents from Canada and most (47%, 8/17) participants agreed that the minimum MRI protocol needed to evaluate cartilage repair was a 3.0 T MRI and 94% (17/18) agreed that the minimum time post-operatively that they felt they would be able to accurately evaluate cartilage repair on an MRI was 12 months. Following phases 1 and 2, the final Magnetic Resonance Evaluation of the Repair of Cartilage in the Hip (MERCH) score was developed with 7 domains, 3 criteria per domain: 1) volume fill of cartilage defect, 2) integration into adjacent cartilage, 3) surface of the repair tissue, 4) structure of the repair tissue, 5) bony overgrowth, 6) subchondral changes, and 7) delamination. The score ranges from 60 (optimal) to -20 points (worst/none).ConclusionsThis consensus project established a new MRI scoring system to evaluate post-operative cartilage restoration of the hip. The implementation of the MERCH score is essential in our ability to guide patient management and expectations in a rapidly evolving field and will help with standardizing our evaluation of cartilage repair in future research trials.Level of EvidenceLevel II Diagnostic.

Developmentally Based-Universal Erosion Scoring System

Dental erosion is a growing health problem that has escalated in recent years. Diagnosing these lesions, assessing extent of the disease, and drawing a comparison among clinical findings from multiple studies, often confront a critical problem. This problem stems from the lack of a universally acceptable comprehensive assessment criteria and standardized scoring system, hence the objective of this report. The proposed Universal Erosion Scoring System (UESS) is based on the developmental stages of the disease and can be used for private practices and clinical studies in populations of all ages. The numerical scores, the corresponding criteria and protocol to implement this scoring index system are described.

Quality standards and recommendations for research in music and neuroplasticity.

Research on how music influences brain plasticity has gained momentum in recent years. Considering, however, the nonuniform methodological standards implemented, the findings end up being nonreplicable and less generalizable. To address the need for a standardized baseline of research quality, we gathered all the studies in the music and neuroplasticity field in 2019 and appraised their methodological rigor systematically and critically. The aim was to provide a preliminary and, at the minimum, acceptable quality threshold-and, ipso facto, suggested recommendations-whereupon further discussion and development may take place. Quality appraisal was performed on 89 articles by three independent raters, following a standardized scoring system. The raters' scoring was cross-referenced following an inter-rater reliability measure, and further studied by performing multiple ratings comparisons and matrix analyses. The results for methodological quality were at a quite good level (quantitative articles: mean = 0.737, SD = 0.084; qualitative articles: mean = 0.677, SD = 0.144), following a moderate but statistically significant level of agreement between the raters (W = 0.44, χ2 = 117.249, p = 0.020). We conclude that the standards for implementation and reporting are of high quality; however, certain improvements are needed to reach the stringent levels presumed for such an influential interdisciplinary scientific field.

Predicting General Surgery Match Outcomes Using Standardized Ranking Metrics

IntroductionObjective measurements for applicant ranking are becoming increasingly important, not only to help address the growing number of general surgery applicants each year but also to minimize bias and ensure consistency. We assessed if our general surgery applicant scoring system was an effective tool for accurately predicting the results of the resident match. MethodsA retrospective review of applicant rank lists from 2017 to 2020 was conducted. Applicants were ranked based on the sum of preinterview and interview scores. The preinterview score is an objective metric related to the applicant's academic portfolio. The interview score is a standardized score based on interview performance. We reviewed match results from ranked candidates and categorized them as academic categorical (AC), community categorical (CC), preliminary surgical (PS), nonsurgical specialty (NS), or unmatched (UM) positions. ResultsA total of 378 applicants were interviewed. Forty-nine percent matched into AC, 22% into CC, 11% into PS, and 5% into NS positions, while 13% of the interviewees were UM. Applicants who matched into AC positions had significantly higher preinterview and interview scores than applicants in other categories. Applicants who matched into CC positions had significantly higher interview scores than those categorized as UM, but their preinterview scores did not differ significantly from the UM group. Applicants who did not match into a categorical position (PS, NS, or UM) did not have significantly different preinterview or interview scores from one another. ConclusionsOur standardized scoring system was effective in stratifying which applicants would match into categorical general surgery residency programs.

Quantitative Analysis of Mucin Expression Using Combined Alcian Blue-Periodic Acid Schiff (AB-PAS) Stain and Combined High Iron Diamine-Alcian Blue (HID-AB) Stain and the Correlation With Histomorphological Score in Chronic Calculous Cholecystitis.

Introduction Chronic calculous cholecystitis is the most common and important contributing factor for cholecystectomy across the country, with a prevalence of 2-29%. Cholesterol supersaturated bile plays a major role in stone formation. It is very essential to identify the pathogenesis of stone formation in order to prevent its formation. This study is aimed to evaluate histomorphological features of chronic calculous cholecystitis and to quantitatively evaluate alteration in mucin expression using the combined Alcian blue-periodic acid Schiff (AB-PAS) stain and the combined high iron diamine Alcian blue (HID-AB) stain, to correlate with each other and also with biochemical features of gall stones. Methods A cross-sectional study of 64 chronic calculous cholecystitis were taken for histomorphological assessment and grading using Hematoxylin and Eosin (H&E) stainand Masson's trichrome stains.Expression of the type of mucins wasanalyzed using histochemical stains by a standardized scoring system. Results A significant positive correlation was observed between an increase in grades of inflammation and fibrosis with an increase in the quantity of sialomucin and neutral mucin in the deep layers of epithelium, and a significant negative correlation was observed between an increase in grades with a decrease in acidic mucin and sulfomucin of both superficial and deep epithelium except sulfomucin in fibrosis. No significant correlation was obtained with muscle thickness, adipose tissue deposition, and epithelial hyperplasia. A higher frequency of mixed-type stones was associated with severe inflammation. Conclusion Inflammation and fibrosis were strongly correlated with quantitative alteration and reversal of mucin composition in chronic cholecystitis; hence we conclude that these features play a significant role in the pathogenesis of stone formation. Using Combined AB(2.5pH)-PAS stain and Combined HID-AB(2.5 pH) stain to detect mucin hypersecretion and composition of altered mucin is relatively accurate and cost-effective rather than performing costly immunohistochemical (IHC) markers.

The ADRENAL score: A comprehensive scoring system for standardized evaluation of adrenal tumor.

To propose an original and standardized scoring system to quantify the functional and anatomical characteristics of adrenal tumor. Four groups of consecutive adrenalectomies (n = 458) with heterogeneity in tumor characteristics and surgical approaches, including 212 laparoscopic cases (Group 1) and 105 robotic cases (Group 2) from The First Affiliated Hospital of Nanchang University, 28 robotic cases from Temple University Hospital (Group 3) and 113 laparoscopic cases from The First Affiliated Hospital of Guangxi Medical University (Group 4). All patients were followed up for 4.5 to 5.5 years. Six parameters including functional status or suspicion of malignancy, tumor size, relationship to adjacent organs, intratumoral enhancement on CT, nearness of the tumor to major vessels and body mass index were assessed and scored on a 0, 1 and 2 points scale. Correlation between the sum of the 6 scores and tumor laterality (ADRENAL score) verse operative time (OT), estimated blood loss (EBL), perioperative complications, transfusion, conversion and length of hospital stay was analyzed. ADRENAL score was a strong predictor of both OT and EBL in all four groups (p < 0.05 for all tests). In Group 2 and 4, higher ADRENAL score seemed to correlate with longer hospital stay. No statistically significant correlation between ADRENAL score and complication, transfusion or conversion was noted yet. ADRENAL score appears to be a valid predictor of surgical outcomes. It may provide a common reference for adrenal surgery training program, preoperative risk assessment and stratified comparative analysis of adrenal surgeries via different techniques and approaches.

Reducing Operation Costs of Thyroid Nodules Using Machine Learning Algorithms with Thyroid Nodules Scoring Systems

Continuous advancement in the health sector is essential to reduce costs and increase efficiency and quality of service. The widespread use of ultrasonography (USG) has made it possible to detect thyroid nodules with higher success rates. Some standard scoring systems have been developed to score thyroid nodules. Thyroid scoring systems are classification systems that determine the risk of cancer in thyroid nodules according to ultrasonographic characteristics and nodule size. Different scoring results for the same thyroid nodule may occur according to these different scoring systems, which can cause some unnecessary surgical interventions. In this study, some intelligent models are developed to assist thyroid scoring systems, with the aim to determine the correct surgical intervention and reduce operation costs by preventing unnecessary interventions and surgical procedures. The integration of current thyroid scoring systems (K-TIRADS, ACR-TIRADS, EU-TIRADS, ATA, and BTA) and machine learning methods provides radiologists and clinicians a decision-support mechanism in the evaluation of thyroid nodules. Correct diagnosis will help to reduce costs by helping prevent unnecessary procedures. The present dataset was retrospectively constructed using ultrasound images of thyroid nodules between 2014 and 2018. In determining the treatment process of thyroid nodules, Random Forest, Adaboost, J48 Decision Tree (J48 DT), and Support Vector Machine (SVM) models are used for increased prediction accuracy of thyroid scoring systems. The goal is to decrease redundant Fine Needle Aspiration (FNA) biopsies and surgical interventions of suspicious thyroid nodules. As a result of the study, higher degrees of accuracy are achieved in the determination of correct or incorrect surgical interventions of thyroid nodules using the J48 DT algorithm with the EU-TIRADS scoring system, with an accuracy rate of 99.7853%, compared to other classifiers.

A decision support system for Rey–Osterrieth complex figure evaluation

Objective:The Rey Osterrieth complex figure (ROCF) is one of the most used neuropsychological tests for the assessment of mild cognitive impairment (MCI) and dementia. In the copy test, the patient has to draw a replica of a 18-pattern image and the outcome is a score based on the accuracy of the overall drawing. The standard scoring system however have limitations related to its subjective nature and its inability to evaluate other cognitive domains than constructional abilities. Previous works addressed those problems by proposing tablet-based automated evaluation systems. Even promising, such methods are still far away from clinical validation and translation. In this work, we developed a decision support system (DSS) for the evaluation of the ROCF copy test in the common practice using retrospective information from previously performed drawings. The goal of our system was to support the professionals providing a qualitative judgement for each of the 18 patterns, estimating the most probable diagnosis for the patient, and identifying the main signs associated to the obtained diagnosis. Methods:A total of 250 human evaluated ROCF copies were scanned from 57 healthy subjects, 131 individuals with MCI, and 62 individuals with dementia. The images were pre-processed and analysed using both computer vision and deep learning techniques to assign a qualitative label to the 18 patterns. Then, the 18 labels were used as features in 3 binary (healthy VS MCI, healthy VS dementia, MCI VS dementia) and a 3-class classifications with model explanation (SHAP). Results:Very good to excellent performance were obtained in all the diagnosis classification tasks. Indeed, an accuracy of about 85%, 91%, and 83% was obtained in discriminating healthy subjects from MCI, healthy subjects from dementia and MCI from dementia respectively. An accuracy of 73% was achieved in the 3-class classification. The model explanation showed which patterns are responsible for each prediction and how the importance of some patterns changes according to the severity of the cognitive decline. Significance:The proposed DSS enriches the standard evaluation and interpretation of the ROCF copy test. Being trained with retrospective knowledge, the performance of the DSS can be further enhanced by extending the dataset with existing ROCF copies.

Implementation of a COVID-19 Vaccine Emergency Department Education Program for Underserved Communities.

Background The COVID-19 pandemic has provided an opportunity for significant reflection on our public health response as providers. Throughout the past two years, we learned that administration of COVID-19 vaccines, rapidly and widely across all communities, has been key to halting the spread of the virus. One significant challenge in promoting a large-scale immunization program is the threat of vaccine hesitancy. A general mistrust in healthcare providers exists across the country, especially in underrepresented minority (URM) communities. Objective This study aims to determine reasons for vaccine hesitancy in an urban emergency department and to provide targeted education on the safety and efficacy of the COVID-19 vaccines to patients. Methods An interprofessional quality improvement team was assembled to develop an educational intervention addressing COVID-19 vaccine safety for vaccine-eligible patients receiving treatment in the emergency department at an urban community hospital where over 70% of patients identify as URM. A survey was conducted to elucidate patients' concerns surrounding the COVID-19 vaccine. Upon completion of the survey, up-to-date safety information and education targeting their surveyed concerns were provided by trained medical students. A follow-up survey was conducted to assess the impact of education on patients' attitudes toward the vaccine. Surveys were developed using standardized scoring systems from the Oxford coronavirus explanations, attitudes, and narratives survey (OCEANS) II study and the Kaiser Foundation. Hesitancy scores before and after education were tabulated to assessthe effectiveness of targeted education in improving vaccine hesitancy. Results Patients cited a variety of concerns surrounding the COVID-19 vaccine. The three most common reasons for declining vaccines were potential side effects (67.3% were concerned or extremely concerned), the belief that COVID-19 vaccines are neither effective nor safe (64.5% were concerned to extremely concerned), and the risk of developing COVID-19 infection from the vaccine itself (38.8% were concerned to extremely concerned). This information was used to address these concerns directly with patients, answer questions, clarify information, andencourage patients to get vaccinated. Through this education program, vaccine hesitancy scores improved by an average of 29% indicating an increased likelihood of patients who would get vaccinated in the future. Of patients receiving education, 38% agreed to sign up for a vaccine appointment during the intervention. Conclusion The emergency department often serves vulnerable patient populations. As such, its role in public health in these communities cannot be underestimated. This quality improvement project is a novel method that can be used to develop and implement public health education programs to address specific community needs in the emergency department. These results show that a multidisciplinary healthcare team can provide a measurable change in attitudes about vaccine safety with directed education in the emergency department that can help address vaccine hesitancy in the future.