Patient Information Research Articles

280 Validating Artificial Intelligence Generated Patient Information Leaflets: A Patient Survey

Abstract Aim Artificial Intelligence (AI) is a ground-breaking technological advancement known for its prowess in processing extensive datasets, gaining recognition among clinicians for its potential in improving patient care. While AI is successfully employed in analysing medical imaging, its use in developing patient information literature (PIL) is limited. Patient access to information aligns with modern healthcare values, emphasizing shared decision-making, a priority in the NHS. This study, conducted under single-blinded conditions, explores the acceptability of AI-generated patient documentation. Method Four PIL examples related to common ENT procedures and conditions were identified. ChatGPT 3.5 modified existing PILs, adjusting for a UK reading age of 14. AI-generated PILs were formatted to match trust documents. Participants were blinded to leaflet sources. Results In 59 responses from ENT outpatients over six weeks, both AI and Trust leaflets had comparable appearance scores (AI 6.82, Trust 6.85). Although a slight preference for Trust leaflets existed, it wasn't statistically significant (p=0.47). In overall presentation preference, most participants had no preference (N=27), with one-third favoring Trust leaflets and 13 preferring AI-generated ones. In explaining conditions, over half had no preference (N=36), while 16 favored human-generated and 7 AI-generated leaflets. Readability and understanding were similar, with 25 participants finding both equally easy to read. Overall satisfaction was comparable, with 26 equally satisfied, 18 preferring human-generated, and 15 AI-generated leaflets. Conclusions AI technology integrated into clinical practice holds potential to transform PIL quality and quantity. As AI accessibility increases, healthcare services must guide the public to safeguard the standard of provided information.

Hybrid Summarization of Medical Records for Predicting Length of Stay in the Intensive Care Unit

Electronic health records (EHRs) are a critical tool in healthcare and capture a wide array of patient information that can inform clinical decision-making. However, the sheer volume and complexity of EHR data present challenges for healthcare providers, particularly in fast-paced environments such as intensive care units (ICUs). To address this problem, the automatic summarization of the main problems of patients from daily progress notes can be extremely helpful. Furthermore, by accurately predicting ICU patients’ lengths of stay (LOSs), resource allocation and management can be optimized, allowing for a more efficient flow of patients within the healthcare system. This work proposes a hybrid method to summarize EHR notes and studies the potential of these summaries together with structured data for the prediction of LOSs of ICU patients. Our investigation demonstrates the effectiveness of combining extractive and abstractive summarization techniques with a concept-based method combined with a text-to-text transfer transformer (T5), which shows the most promising results. By integrating the generated summaries and diagnoses with other features, our study contributes to the accurate prediction of LOSs, with a support vector machine emerging as our best-performing classifier with an accuracy of 77.5%, surpassing existing systems and highlighting the potential for optimal allocation of resources within ICUs.

O-069 The first mitotic spindle instability impacts nucleation, fragmentation, and development in human embryos

Abstract Study question How multinucleation and fragmentation occur in the first mitosis in human embryos? Summary answer The first mitotic spindles had heterogeneity, and the shapes and movements of the spindles were strongly associated with multinucleation and fragmentation. What is known already Studies have shown that many problems occur during the first mitosis, such as fragmentation and multinucleation. However, the cell biologic mechanisms whereby these errors occur during the first mitosis in human embryos remain unknown. To clarify this aspect, it is necessary to analysis the dynamics of DNA and cytoskeleton using live human embryos. Although microinjections of DNA or mRNA into mammalian embryos were widely used for live imaging during early mitosis, the method into human poses the risk of ethical issues. Therefore, we established a method used for real-time imaging in human embryos using chemical fluorescent labeling. Study design, size, duration Frozen human two-pronuclear stage embryos were donated for research by couples who had completed fertility treatment. We obtained written informed consent from patients who donated human embryos. The mean age of patients at embryo freezing was 32.00 ± 3.03 (SD) years. We imaged thirty-one living human embryos using chemical fluorescent labeling and confocal microscopy to visualize DNA and tubulin. Participants/materials, setting, methods Thirty-one human embryos were cultured in medium containing the live-cell stain probes SPY555-DNA and SPY650-Tubulin. The Embryos were imaged using an LSM980 laser scanning confocal microscope every 10–20 min for a period of eight hours. Three-dimensional (3D) visualizations of human embryos were performed using the Imaris software. The first spindle shapes were quantified by image analysis and calculated the aspect ratio of the spindles using ImageJ. Main results and the role of chance We discovered that over 81% of two-pronuclear zygotes became multinucleated 2-cell stage embryos. We demonstrated that there was variation in the first mitotic spindles. There was a significant difference between the aspect ratio (AR) of the spindles leading to the mononuclear and multinuclear types at the 2-cell stage (p < 0.005). In addition, the low-AR spindles were unstable and often had more defocused poles than the high-AR spindles, which lead to multinucleation at the 2-cell stage (55 % vs. 0%, p < 0.05). More embryo having high-aspect ratio spindles tend to develop blastocysts than those having low aspect-ratio spindles (p < 0.05). Moreover, the movement of the central spindles varied after chromosome segregation. The embryos with more fragments at two cell stage had a significantly longer period for the central spindles to transform into midbodies compared to those with fewer fragments. The central spindles of embryos with more fragments moved a longer distance from the beginning of furrow ingression to the completion of the first division (p < 0.05). These results suggest that the first mitotic spindle instability and heterogeneity cause many errors such as multinucleation, fragmentation, and embryonic development. Limitations, reasons for caution Imaged human embryos were donated from a fertility clinic, and detailed patient information, such as underlying disease and method of ovarian stimulation, was not available. It is possible that the human zygotes used in this study had a bias in patient characteristics. Wider implications of the findings Our study showed that there were instability and heterogeneity in the first mitotic spindle, which was strongly associated with multinucleation, fragmentation, and embryonic development. Revealing the mechanism underlying spindle formation in cleavage-stage embryos will contribute to improving the success rate of assisted reproduction technologies in humans. Trial registration number not applicable

Improved security of medical images using DWT–SVD watermarking mechanisms based on firefly Photinus search algorithm

Security is the primary concern in the transmission of medical images, as it involves sensitive patient information. This study introduces an optimized watermarking approach, constructed using discrete wavelet transform and singular value decomposition. The Low- level frequency bands (LL3) sub-band singular values of the host image were embedded with the singular values of a binary watermark using multiple scaling factors. These MSFs were optimized using a recently proposed firefly Photinus algorithm to balance robustness and imperceptibility. The proposed method was applied to various images, including computed tomography images, where the visual quality of the signed and attacked images was evaluated by peak signal-to-noise ratio (PSNR) and normalized cross-correlation. The performance of the proposed algorithm demonstrates significant improvements in the embedding and extraction processes, showing an enhancement in the balance between robustness and imperceptibility, with a PSNR above 79.28 dB, compared to other related works.

Integrity and Privacy Assurance Framework for Remote Healthcare Monitoring Based on IoT

Remote healthcare monitoring (RHM) has become a pivotal component of modern healthcare, offering a crucial lifeline to numerous patients. Ensuring the integrity and privacy of the data generated and transmitted by IoT devices is of paramount importance. The integration of blockchain technology and smart contracts has emerged as a pioneering solution to fortify the security of internet of things (IoT) data transmissions within the realm of healthcare monitoring. In today’s healthcare landscape, the IoT plays a pivotal role in remotely monitoring and managing patients’ well-being. Furthermore, blockchain’s decentralized and immutable ledger ensures that all IoT data transactions are securely recorded, timestamped, and resistant to unauthorized modifications. This heightened level of data security is critical in healthcare, where the integrity and privacy of patient information are nonnegotiable. This research endeavors to harness the power of blockchain and smart contracts to establish a robust and tamper-proof framework for healthcare IoT data. Employing smart contracts, which are self-executing agreements programmed with predefined rules, enables us to automate and validate data transactions within the IoT ecosystem. These contracts execute automatically when specific conditions are met, eliminating the need for manual intervention and oversight. This automation not only streamlines the process of data processing but also enhances its accuracy and reliability by reducing the risk of human error. Additionally, smart contracts provide a transparent and tamper-proof mechanism for verifying the validity of transactions, thereby mitigating the risk of fraudulent activities. By leveraging smart contracts, organizations can ensure the integrity and efficiency of data transactions within the IoT ecosystem, leading to improved trust, transparency, and security. Our experiments demonstrate the application of a blockchain approach to secure transmissions in IoT for RHM, as will be illustrated in the paper. This showcases the practical applicability of blockchain technology in real-world scenarios.

Efficacy of a nurse-led sexual rehabilitation intervention for women with gynaecological cancers receiving radiotherapy: results of a randomised trial.

The multicentre randomised SPARC trial evaluated the efficacy of a nurse-led sexual rehabilitation intervention on sexual functioning, distress, dilator use, and vaginal symptoms after radiotherapy for gynaecological cancers. Eligible women were randomised to the rehabilitation intervention or care-as-usual. Four intervention sessions were scheduled over 12 months, with concurrent validated questionnaires and clinical assessments. Primary outcome was the Female Sexual Function Index (FSFI). A generalised-mixed-effects model compared groups over time. In total, 229 women were included (n = 112 intervention; n = 117 care-as-usual). No differences in FSFI total scores were found between groups at any timepoint (P = 0.37), with 12-month scores of 22.57 (intervention) versus 21.76 (care-as-usual). The intervention did not significantly improve dilator use, reduce sexual distress or vaginal symptoms compared to care-as-usual. At 12 months, both groups had minimal physician-reported vaginal stenosis; 70% of women were sexually active and reported no or mild vaginal symptoms. After radiotherapy and brachytherapy, 85% (intervention) versus 75% (care-as-usual)of participants reported dilation twice weekly. Sexual rehabilitation for women treated with combined (chemo)radiotherapy and brachytherapy improved before and during the SPARC trial, which likely contributed to comparable study groups. Best practice involves a sexual rehabilitation appointment 1 month post-radiotherapy, including patient information, with dilator guidance, preferably by a trained nurse, and follow-up during the first year after treatment. NCT03611517.

Consensus for Operating Room Multimodal Data Management: Identifying Research Priorities for Data-Driven Surgery

Introduction: This study aimed to identify research areas that demand attention in multimodal data-driven surgery for improving data management in minimally invasive surgery. Background: New surgical procedures, high-tech equipment, and digital tools are increasingly being introduced, potentially benefiting patients and surgical teams. These innovations have resulted in operating rooms evolving into data-rich environments, which, in turn, requires a thorough understanding of the data pipeline for improved and more intelligent real-time data usage. As this new domain is vast, it is necessary to identify where efforts should be focused on developing seamless and practical data usage. Methods: A modified electronic Delphi approach was used; 53 investigators were divided into the following groups: a research group (n=9) for problem identification and a narrative literature review, a medical and technical expert group (n=14) for validation, and an invited panel (n=30) for two electronic survey rounds. Round 1 focused on a consensus regarding bottlenecks in surgical data science areas and research gaps, while round 2 prioritized the statements from round 1, and a roadmap was created based on the identified essential and very important research gaps. Results: Consensus panelists have identified key research areas, including digitizing operating room (OR) activities, improving data streaming through advanced technologies, uniform protocols for handling multimodal data, and integrating AI for efficiency and safety. The roadmap prioritizes standardizing OR data formats, integrating OR data with patient information, ensuring regulatory compliance, standardizing surgical AI models, and securing data transfers in the next generation of wireless networks. Conclusions: This work is an international expert consensus regarding the current issues and key research targets in the promising field of data-driven surgery, highlighting the research needs of many operating room stakeholders with the aim of facilitating the implementation of novel patient care strategies in minimally invasive surgery.

The Effect of Bowel Anastomosis on Outcomes in Complex Abdominal Wall Reconstruction: A 10-Year Retrospective Cohort Study.

In patients who require complex abdominal wall reconstruction (CAWR), the need for a bowel anastomosis could impact procedure choice and outcome. In this retrospective cohort study, we examine the effect of bowel anastomosis on complications and hernia recurrence. All patients who underwent CAWR between 2011 and 2021 by the senior author were reviewed in a retrospective cohort analysis. Patients were included if they met the above criteria. Patients were excluded if they did not undergo the above procedure or if they underwent a different procedure simultaneously. Univariate analysis was performed for patients who underwent bowel anastomosis, and multiple variable logistic regression analysis was performed with respect to overall complications. A total of 264 patients underwent CAWR over a 10-year interval. A total of 41 patients underwent bowel anastomosis (16%), and 223 patients (84%) underwent CAWR without bowel anastomosis. Mean patient age was 55.50 ± 11.55 years. Mean patient body mass index was 32.36 ± 7.31 kg/m2. Mean follow-up time was 10.20 months. There was a significant difference in hernia repair etiology, with higher rates of recurrent hernia repair among patients receiving bowel anastomosis (odds ratio, 2.98; 95% confidence interval, 1.49-5.95; P = 0.0018). Acellular dermal matrix was used more frequently in patients who required a bowel anastomosis (odds ratio, 3.74; 95% confidence interval, 1.75-8.00; P = 0.0018). Major and minor complications were also significantly higher in this cohort. Regression analysis for overall complications revealed the presence of bowel anastomosis, fascial repair technique, and follow-up time as independent predictors of overall complications. Bowel anastomosis performed at the time of CAWR significantly increased the rate of overall and major complications but did not predict hernia recurrence. Plastic surgeons should utilize this information in counseling patients and in deciding the most appropriate hernia repair technique.

Tele-rehabilitation for Type II diabetics with heart failure with preserved ejection fraction

ObjectiveThis study aims to determine whether tele-rehabilitation has similar effects to conventional face-to-face physical rehabilitation for diabetic patients with heart failure with preserved ejection fraction (HFpEF).Materials and methodsDemographic, laboratory, diagnostic and rehabilitation information for patients with type 2 diabetes with HFpEF were extracted from disease-specific databases. Outcome measures, including the Short Physical Performance Battery (SPPB), 6-minute walk distance, frailty status, European Quality of Life 5-Dimension 5-Level questionnaire (EQ-5D-5L) and reduction in HbA1c from admission, patients who received tele-rehabilitation therapy were compared to those received face-to-face rehabilitation.ResultsIn this study, 90 patients with type 2 diabetes and HFpEF using tele-rehabilitation were matched with 90 patients with type 2 diabetes and HFpEF using face-to-face physical rehabilitation. Improvements in the results of the SPPB scores, 6-min walk distance and gait speed and EQ-5D-5L were noted from the follow-up time point 3 months to 6 months in both two groups. There were no significant differences in functional tests and quality of life between the two groups.ConclusionOur study proved that mobile-based tele-rehabilitation programs are non-inferior to face-to-face physical rehabilitation for diabetes patients after HFpEF. In addition, adherence to the telerehabilitation program showed that the novel technology was accepted well and could be an alternative to the conventional face-to-face rehabilitation program.

Risk of anti-TNF therapy on pregnancy, breastfeeding, live vaccines and related information in patients with inflammatory bowel disease: Real-world data from a nationwide study

BackgroundAnti-TNF are usually maintained during pregnancy in patients with inflammatory bowel disease (IBD) but safety is still a concern for them. AimsTo provide data on management of anti-TNF agents during pregnancy, safety of live vaccines (BCG-MMR-rotavirus) and breastfeeding in newborns and dedicated information delivered to IBD women. MethodsWe performed an observational study in 25 centers from 2016 to 2018. We administered questionnaires to women with IBD receiving anti-TNF during pregnancy with newborn follow-up ≥ one year. ResultsOf 153 patients, 52 % maintained anti-TNF during the third trimester. Anti-TNF was shortly resumed in 79 % (58/73) after delivery. The rate of breastfeeding was 44 % (68/153) without any complication; 38 % of the mothers denied to breastfeed based on physician's advice. 26 % (34/129) of the newborns received live vaccines before 6 months-old (BCG:30 %; MMR:63 %; Rotavirus:8 %) and only 3 complications occurred (local BCGitis=1, fever=2). Information concerning anti-TNF during pregnancy/post-partum was delivered to 92 % of the patients, mainly by a gastroenterologist (97 %) who discussed with the obstetrician or the paediatrician in only 48 % and 25 %. ConclusionIn IBD patients, maintaining anti-TNF during pregnancy and breastfeeding is safe. Accidental live vaccines before 6 months did not lead to significant adverse events. The communication about these questions remains to improve.

Evaluación de la adecuación de los estudios de casos clínicos enfermeros a través de la lista de comprobación Case Report

Case report is a narrative description of the problem of one or several patients. The CARE checklist (Case Report) is the consensus document for reporting clinical case reports and through adaptations to the different CARE disciplines is used to define standards for authors in scientific journals; however, the specificity of the nursing process makes it difficult to adjust nursing case reports to CARE. The aim was to analyze the publications of clinical cases with a nursing perspective in scientific journals, as well as the quality standards and evaluation systems used. Few journals reviewed agreed to publish nursing case reports or stated standards for authors to adjust to CARE. Preliminary results indicated average or poor adherence to CARE, with the most reported elements being: Keywords, patient information and introduction. Adherence was lower for the elements: Timeline, therapeutic intervention, follow-up and outcomes, and patient perspective. The characteristics of the nursing process implies a low adherence to CARE, so it is necessary to unify criteria to guide researchers, authors, reviewers and editors of scientific journals, as well as to improve the rigor and quality of the reports. Currently, there are no specific guidelines for reporting clinical case reports with a nursing perspective available. These normative gaps could be solved by developing a CARE extension adapted to the methodological characteristics of the nursing process.

A Comprehensive Survey for Hiding Medical Data Based DNA Lossless Technique

The health information data includes reports on the patient’s condition, including addresses, names, tests, treatments, diagnoses, and medical history. It is sensitive information for patients, and all means of protection must be provided to prevent third parties from manipulation or fraudulent use. The goal of this paper presents studies of safeguard the transfer of sensitive data over an unsecured network using DNA techniques to enhance security. A comparison analysis is used to show the security issues of the various DNA-based data (ciphering, concealing, and compression) techniques that are studied and investigated. Also, in our study is to provide future researchers with the necessary knowledge to conduct data security research to develop or improve DNA-based data- ciphering, compression-hiding strategies that are more reliable, secure, and efficient. Thus, future researchers need to propose a trustworthy DNA-based data (ciphering, hiding, and compression) techniques. The result of our study appears the perceived vulnerability of medical data and health insurance to concerns of security as well as common security issues, also the nature of these common security concerns, for reducing medical data security risks.

Analysis of Clinical and Radiologic Parameters in Children Diagnosed with COVID-19 Infection at Admission and Discharge

Background: Recognizing risk factors for poor prognosis among COVID-19 patients is crucial, especially given the absence of standardized treatments and medications. Objectives: In the present study, our aim was to survey changes in clinical parameters in children diagnosed with COVID-19 infection from admission to discharge. Methods: The present retrospective cross-sectional study focused on children with COVID-19 infection. All demographic data and clinical information of patients were extracted upon admission and at discharge from the hospital. Data analysis utilized the Mann-Whitney U test and Fisher exact test. Multivariable regression modeling was employed to identify factors predicting the probability and duration of hospitalization in ICUs for children with COVID-19. Results: Elevated levels of ESR, CRP, creatinine, and ferritin were found in 51.7%, 67.4%, 69.3%, and 53.6% of patients upon admission. Moreover, 98.2% and 38.3% of patients had high levels of ALP and AST. Platelet (PLT) and neutrophil levels were higher at discharge compared to admission (P < 0.001), while creatinine levels were lower at admission than at discharge (P < 0.001). Patients admitted to ICUs exhibited significantly higher levels of pulse rate (P < 0.001), respiratory rate (P < 0.001), mean corpuscular volume (MCV) (P = 0.01), red cell distribution width (RDW) (P = 0.002), prothrombin time (PT) (P = 0.006), and ESR (P = 0.04). Conclusions: Pulse rate, respiratory rate, MCV, RDW, PT, ESR, and oxygen saturation (SPO2) percentage can be used to predict the severity of COVID-19 disease. However, further studies are needed to determine the prognosis and severity of COVID-19 infection in children.

Improving Treatment Literacy of Antibiotic Use in Newly Defined WHO 6 Months and 9 Months All-oral Regimens for Drug-resistant Tuberculosis – Comparison of the Readability of Patient Information Leaflets from High Tuberculosis Burden Countries to 10 Antibiotics Used in the Treatment of Drug-resistant Tuberculosis

Improving Treatment Literacy of Antibiotic Use in Newly Defined WHO 6 Months and 9 Months All-oral Regimens for Drug-resistant Tuberculosis – Comparison of the Readability of Patient Information Leaflets from High Tuberculosis Burden Countries to 10 Antibiotics Used in the Treatment of Drug-resistant Tuberculosis

Recommendations for Recovery of the COVID-19 Pandemic-related Diagnostic, Screening, and Procedure Backlog in Ontario: A Survey of Healthcare Leaders.

The COVID-19 pandemic has resulted in a significant diagnostic, screening, and procedure backlog in Ontario. Engagement of key stakeholders in healthcare leadership positions is urgently needed to inform a comprehensive provincial recovery strategy. A list of 20 policy recommendations addressing the diagnostic, screening and procedure backlog in Ontario were transformed into a national online survey. Policy recommendations were rated on a 7-point Likert scale (strongly agree to strongly disagree) and organized into those retained (≥75% strongly agree to somewhat agree), discarded (≥80% somewhat disagree to strongly disagree), and no consensus reached. Survey participants included a diverse sample of healthcare leaders with the potential to impact policy reform. Of 56 healthcare leaders invited to participate, there were 34 unique responses (61% response rate). Participants were from diverse clinical backgrounds, including surgical subspecialties, medicine, nursing, and healthcare administration and held institutional or provincial leadership positions. A total of 11 of 20 policy recommendations reached the threshold for consensus agreement with the remaining 9 having no consensus reached. Consensus agreement was reached among Canadian healthcare leaders on 11 policy recommendations to address the diagnostic, screening, and procedure backlog in Ontario. Recommendations included strategies to address patient information needs on expected wait times, expand health and human resource capacity, and streamline efficiencies to increase operating room output. No consensus was reached on the optimal funding strategy within the public system in Ontario or the appropriateness of implementing private funding models.

The effect on back pain, anxiety, and comfort levels of an elevated supine position and back support applied to patients undergoing coronary angiography: A randomized controlled experimental study.

To determine the effect of elevated supine position with back support on back pain, anxiety and comfort in patients undergoing coronary angiography. This randomized-controlled, experimental study was conducted in the Coronary Intensive Care Unit between September 2021 and January 2022, with an intervention group of 51 patients and a control group of 53 patients. Data were collected using a patient information form, a visual analog scale, the anxiety state inventory and the immobilization comfort questionnaire. Following angiography, the intervention group received pillow support to the back and the bedhead was elevated to 30 degrees. Routine nursing care was applied to the control group. In both groups, the severity of back pain was measured at 0, 2, and 4 hours, and anxiety and comfort at 0 and 4 hours. The pain severity at 2 and 4 hours after the procedure was determined to be significantly lower in the intervention group than in the control group (p<0.001, p<0.001). At 4 hours, the anxiety levels were similar in both groups (p<0.05), and the comfort level was higher in the intervention group (p<0.001). The mean pain value was 6.003 points lower and the comfort level was 20.499 points higher in the intervention group than in the control group. The elevated supine position with back support was seen to reduce back pain, increase comfort, and did not change anxiety levels.Clinical Trials No: NCT05546216.

The Effect of Video Streaming With Virtual Reality Glasses on on Pain Anxiety and Satisfaction Applied in Peripheral Intravenous Catheter Process

Peripheral intravenous catheter (PIC) implementation is among the most frequent and highly invasive nursing initiatives. PIC leads to anxiety with procedural pain, causing individuals to reject these procedures or negatively affecting the process's success. The study was conducted to determine the effect of virtual reality glasses (VRG) on pain, anxiety, and patient satisfaction during the peripheral intravenous catheter (PIC) process in adults. An experimental study. An emergency department of a university hospital. Individuals who were admitted to the emergency unit of the university hospital were recruited between the data collection dates. Data from individuals' "Patient Information Form," "Visual Pain Scale," "Visual Anxiety Scale," and "Visual Satisfaction Scale" were collected. "VR-Box 3D Glasses" was used as virtual reality glasses. In our study, when the pain point averages with VAS were compared during the PIC process, the pain score average of the patients in the control group was 5.78 ± 1.23 visual anxiety scale 5.89 ± 1.23 and patient satisfaction scale 3.86 ± 2.48, The visual pain score average of patients in the VRG group is 4.12 ± 2.16, visual anxiety scale 3.14 ± 1.76 and visual patient satisfaction scale 7.64 ± 3.26. In short, it has been detected that the pain, anxiety, and patient satisfaction score averages of patients in the VRG group are statistically significant compared to the pain score averages of patients in the control group (p < .005). Our study unearthed a statistically significant relationship at an average level of negative direction between PIC post-treatment pain, anxiety, and patient satisfaction (r = - 0.476). Utilization of VRG has been detected to reduce pain and anxiety felt during the PIC process in adult patients and increase process satisfaction. VRG, a non-pharmacological, non-invasive, inexpensive, and feasible nursing initiative, may be recommended for use in pain and anxiety control in patients undergoing PIC treatment.

Evaluation of Online AI-Generated Foot and Ankle Surgery Information

As a natural progression from educational pamphlets to the worldwide web, and now artificial intelligence (AI), OpenAI chatbots provide a simple way of obtaining pathology-specific patient information, however, little is known concerning the readability and quality of foot and ankle surgery information. This investigation compares such information using the commercially available OpenAI ChatGPT Chatbot and FootCareMD®. A list of common foot and ankle pathologies from FootCareMD® were queried and compared with similar results using ChatGPT. From both resources, the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) scores were calculated for each condition. Qualitative analysis of each query was performed using the JAMA Benchmark Criteria Score and the DISCERN Score.The overall ChatGPT and FootCareMD® FRES scores were 31.12±7.86 and 55.18±7.27, respectively (p<0.0001). The overall ChatGPT and FootCareMD® FKGL scores were 13.79±1.22 and 9.60±1.24 respectively (p<0.0001), except for the pilon fracture FKGL scores (p=0.09). The average JAMA Benchmark for all information obtained through ChatGPT and FootCareMD® were 0±0 and 1.95±0.15 (p < 0.001), respectively. The DISCERN Score for all information obtained through ChatGPT and FootCareMD® were 52.53±5.39 and 66.93±4.57 (p < 0.001), respectively. AI-assisted queries concerning common foot and ankle pathologies are written at a higher grade level and with less reliability and accuracy compared to similar information available on FootCareMD®. With the ease of use and increase in AI technology, consideration should be given to the nature and quality of information being shared with respect to the diagnosis and treatment of foot and ankle conditions. Level of EvidenceIV

Heart Failure Predictive Analysis Using Decision Tree Classification

With an average age of 28 compared to Western countries, India's young population accounts for half of heart attacks in South Asia, which happen to people under 52. Autopsy reports, which identify the actual cause of death, frequently concentrate on sudden deaths in young adults that have no apparent reason or warning signs. Fat accumulation in the blood vessels of the heart is the cause of abrupt, unexpected natural deaths. The heart stops beating and loses blood as a result of these arteries narrowing or blocking. The body may exhibit subtle symptoms prior to abrupt death, such as shortness of breath, palpitations, tightness in the chest, and chest discomfort. A decision tree classification is a death dataset model that generates labelled classes at leaf nodes and makes judgments at edges to predict class labels for subsequent records. The purpose of the proposed paper study is to predict abrupt natural deaths, which are frequently brought on by smoking, by using regression analysis, a statistical technique that establishes the relationship between independent and dependent variables. The experiment's outcome, which looks at how Artificial Neural Networks (ANN) may be used to forecast heart failure, shows five records out of 50,000 patients from different hospitals. Perceptron’s, both single- and multi-layer, were used to gather patient information. Keywords: Artificial Neural Network, Linear Regression Analysis, Sudden and Unexpected Natural Deaths etc.

Analysis of methylation-driven genes for predicting the prognosis of patients with oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is a highly aggressive malignancy that is characterized by early distant metastasis and poor prognosis. DNA methylation plays an important role in the etiology and pathogenesis of OSCC. This study aimed to identify methylation-driven genes through bioinformatics analysis as potential biomarkers for early diagnosis and prognostic assessment of OSCC. Methylation data, RNA sequencing (RNA-seq) data and clinical prognosis information of OSCC patients were retrieved from The Cancer Genome Atlas (TCGA) database. The R packages MethylMix were employed to analyze the correlation between methylation status and corresponding gene expression in tumor and normal tissues to obtain methylation-driven genes. Univariate Cox regression analysis was developed to further screen methylation-driven genes associated with the prognosis of OSCC patients. Subsequently, multivariate Cox regression analysis was utilized to construct a linear prognostic risk prediction model. Furthermore, a combined survival analysis integrating methylation and gene expression was performed to investigate the prognostic value. A total of 374 differentially expressed methylation-driven genes were identified. Seven methylation-driven genes (BST2, KRT15, ZNF134, NT5E, GSTA7P, NAPRT, and GOLPH3L) were found to be significantly associated with patient prognosis. Additionally, four methylation-driven genes (BST2, KRT15, ZNF134 and NAPRT) were used to construct a linear prognostic risk prediction model for OSCC patients. Furthermore, a combined Kaplan-Meier survival analysis revealed that three methylation-driven genes (ZKSCAN7, MFF, ZNF134) alone can be used as independent prognostic markers or drug targets. Our findings facilitate a better understanding of molecular mechanisms of OSCC and provide potential biomarkers of early diagnosis, precision treatment and prognosis evaluation.