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Integrated use of autosomal dominant polycystic kidney disease prediction tools for risk prognostication
No full textBackground: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of kidney failure. Specific treatment is indicated upon observed or predicted rapid progression. For the latter, risk stratification tools have been developed independently based on either total kidney volume or genotyping as well as clinical variables. This study aimed to improve risk prediction by combining both imaging and clinical-genetic scores.Methods: We conducted a retrospective multi-center cohort study of 468 patients diagnosed with ADPKD. Clinical, imaging, and genetic data were analyzed for risk prediction. We defined rapid disease progression as an estimated glomerular filtration rate (eGFR) slope ≥3 ml/min/1.73m2/year over two years, Mayo imaging classification (MIC) 1D-1E, or a Predicting Renal Outcome in Polycystic Kidney Disease (PROPKD) score of ≥7 points. Using MIC, PROPKD, and Rare Exome Variant Ensemble Learner (REVEL) scores, several combined models were designed to develop a new classification with improved risk stratification. Primary endpoints were the development of advanced chronic kidney disease (aCKD) stages G4-G5, longitudinal changes in eGFR, and clinical variables such as hypertension or urological events. Statistically, logistic regression, survival, Receiver Operating Characteristic (ROC) analyses, linear mixed models, and Cox proportional hazards models were used.Results: PKD1-genotype (p Conclusions: The combined use of both risk scores was associated with higher ability to identify rapid progressors and resulted in a better stratification, notably among intermediate risk patients.</p
Enhancing the understanding of safety and the quality of patient care among medical and health sciences students in interprofessional climate: an interventional study
No full textBackground: Interprofessional education (IPE) plays an essential role in improving healthcare outcomes through achieving shared understanding. Unfortunately, most healthcare professionals have not received training for patient safety (PS) in an interprofessional setting, which can meet the societal medical needs. This study aimed to foster the understanding of senior medical, dental, pharmacy and health sciences students about PS and quality of care at the University of Sharjah (UoS) in UAE.Methods: Using a convenience sampling technique, we recruited students from the College of Medicine (CoM), College of Pharmacy (CoP), College of Dental Medicine (CDM), and College of Health Sciences (CHS) of UoS. The study was conducted in spring 2023, and an ethical approval was obtained from the UoS Research Ethics Committee (REC-21-12-12). After a thorough literature search, a bespoke English language questionnaire was developed covering three domains-medical professionalism, leadership in healthcare, and precision medicine. To ensure its validity across different settings, cultural adaptation was ensured with reiterative revision among the panel of experts. The online synchronous real-time workshop included interactive resource sessions, breakout room discussions using real clinical cases, and pre-post surveys using the questionnaire.Results: A total of 248 students and 20 facilitators participated in the workshop. CoM had the highest representation (47.5%), followed by CoP (36.5%), CHS (13.3%), and CDM (2.7%). There was a statistically improved understanding of the participants, as reflected by significantly high scores of post-test survey in all domains of PS across all colleges (p Conclusion: This study highlights the positive impact of an IPE-based interventional workshop on students' attitudes, perceptions, and insights about PS and quality of care. Students' understanding and insights of PS and quality of care underscore the paramount role of IPE in improving perceptions and approaches towards PS in the context of healthcare education.</p
Early plasma ferritin concentrations are not associated with time to red cell transfusions in extremely and very preterm neonates: a prospective single-site observational study
No full textObjective: To assess the relationship between plasma ferritin concentrations and (1) antenatal factors and (2) requirement for red cell transfusionStudy design: This single-site prospective study recruited infants in the first week of life who were born Results: Plasma ferritin concentrations were not significantly associated with birth weight or gestational age in this cohort of extremely/very preterm neonates (n=114: n=26, Conclusions: Plasma ferritin concentrations in very/extremely preterm neonates are variable and associated with the intrauterine environment. Ferritin concentration was not predictive of time to transfusion in this cohort and was not significantly different at smaller birth weight or earlier gestation. This is important for considerations of iron storage in very preterm neonates and its developmental consequences.</p
Evaluation of the quality of information provided by ChatGPT on pelvic and acetabular surgery
No full textBackground: Pelvic and Acetabular fractures are complex injuries commonly caused by both high-energy mechanisms in young patients and low velocity trauma in older patients, which can result in significant morbidity and mortality for both. This study aimed to assess the information provided by ChatGPT on pelvic and acetabular surgery using standard scoring systems to assess the quality, reliability, and readability of the content. We hypothesized that while ChatGPT would generate information of high quality, its readability would be low.Methods: An open AI model (ChatGPT) was used to answer 20 commonly asked questions from patients about Pelvic and Acetabular surgery. These answers were evaluated for medical accuracy, quality, and readability using the JAMA Benchmark criteria, DISCERN score, Flesch-Kincaid Reading Ease Score (FRES), and Grade Level (FKGL).Results: The JAMA Benchmark criteria score was 0, the lowest score, indicating no reliable resources cited. The DISCERN score was 42.5, which scores information of fair quality. The area the open AI model scored lowest was the reliability portion of the DISCERN score due to a lack of resources. The FRES was 52.9, and the FKGL was at a 10th-12th grade reading level.Conclusion: A 10th to 12th grade reading level was required to comprehend the information provided by ChatGPT with regards to Pelvic and acetabular surgery, and the evidence supplied was of fair quality. With no citations provided, it remains unclear where these answers originate and how scientifically valid they are with respect to the latest literature. In spite of this, ChatGPT did safety-net patients by encouraging the importance of further discussion with a surgeon.</p
Informing implementation of a national integrated clinical pathway for low back pain in Ireland: a pre-implementation qualitative study with general practitioners
No full textIntroduction: Ireland's Health Service Executive is developing a new national integrated low back pain (LBP) pathway spanning primary and secondary care to improve LBP healthcare. Clinical pathways are frequently employed to optimise clinical outcomes and resource use but are challenging to implement. Context-specific implementation planning, leveraging implementation science and its conceptual frameworks, should inform successful implementation.Aim: To explore General Practitioner (GP) perceptions of the new LBP pathway, using their on-the-ground knowledge to assess barriers and facilitators to implementation with the goal of developing tailored implementation strategies.Methods: Qualitative data will be collected through semi-structured one-to-one interviews with a purposive sample of GPs. Data analysis will be guided by Framework Analysis with initial open coding followed by mapping to the domains and constructs of the Consolidated Framework for Implementation Science and Proctor's implementation outcomes of acceptability, appropriateness and feasibility. Potential implementation strategies will be devised from the identified determinants of implementation.Conclusion: System-wide changes and improvements in healthcare are difficult to accomplish. The rationale and design of a pre-implementation study with key stakeholders is outlined with the view of informing optimal implementation of Ireland's new national integrated LBP pathway in primary care settings.</p
The influence of electronic health record design on usability and medication safety: systematic review
No full textBackground: The advantages of electronic health records (EHRs) are well-documented regarding the process of care, enhanced data accessibility and cost savings. However, EHR design can also contribute to usability challenges, with poorly designed EHRs being implicated in user errors including patient overdoses. Our study seeks to evaluate how EHR design influences both usability and medication safety.Methods: A systematic review was conducted of PubMed, EMBASE, CINAHL and the ACM library from 1 January 2009 to 8 October 2024. Eligible studies reported on the impact of specific EHR design elements on usability and/or medication safety, involved healthcare providers and took place in a secondary, tertiary or quaternary care setting. Usability was defined as the extent to which an EHR can be used to achieve specified goals with effectiveness, efficiency and satisfaction, while medication safety related to the risk of drug-related problems, including adverse drug events and medication errors. Design features identified within studies were validated, by cross-referencing these elements with ISO standards regarding design recommendations. A narrative synthesis was conducted, with studies tabulated based on whether they assessed usability and/or medication safety. Patterns were identified and common design elements between studies translated into themes. The Mixed Methods Appraisal Tool was used to evaluate study quality and PRISMA guidelines were followed throughout.Results: Thirty-two studies were identified. The design features described in these studies fit within seven broad design themes: searchability, automation, customisation, data entry, workflow, user guidance and interoperability. EHR systems that prioritised these areas were associated with higher reported usability and enhanced medication safety, while the opposite was found for systems that overlooked these design aspects. Our review also highlighted the numerous ways these themes can be implemented, while identifying the contributing factors that enable their successful implementation.Conclusion: The design of EHRs can enhance or undermine usability and medication safety, depending on the searchability and customisability of these systems, how data entry processes and provider workflow are facilitated and how automation, user guidance and interoperability are implemented. Future EHR evaluations should be performed throughout the design process and consensus building is required regarding what exactly constitutes a design element, within an EHR context.</p
The psychological impact of implantable cardioverter defibrillators: a narrative review
No full textImplantable cardioverter defibrillators (ICDs) are critical to the prevention of sudden cardiac death caused by life-threatening arrhythmias such as ventricular tachycardia and fibrillation. While their clinical value is well-established, the psychological impact of living with an ICD remains underrecognized. Patients often experience anticipatory anxiety, depression, Post-Traumatic Stress Disorder (PTSD), and reduced quality of life. These challenges can begin before implantation, persist after both appropriate and inappropriate shocks, and be worsened by fears of device malfunction, recalls, or cybersecurity risks. Many patients alter postimplantation behaviors, avoiding physical activity and reporting diminished trust in medical technology. The burden is especially significant in children, alongside those who experience multiple or unnecessary shocks. Despite increased awareness, mental health care remains poorly integrated into cardiology. Cognitive Behavioural Therapy (CBT), structured patient education, and transparent communication around device updates and recalls have shown effectiveness. In conclusion, addressing this gap is essential to improving outcomes and quality of life.</p
Neuropharmacology adenosine A<sub>2A</sub> receptor and glial glutamate transporter GLT-1 are synergistic targets to reduce brain hyperexcitability after traumatic brain injury in mice
No full textTraumatic brain injury (TBI) is a leading cause of acquired epilepsy, with post-traumatic epilepsy (PTE) significantly contributing to morbidity and mortality. To date, there is no treatment capable to prevent the development of PTE, which remains an urgent unmet need. Previous studies suggest that adenosine A2A receptor (A2AR) activation and glutamate transporter 1 (GLT-1) dysregulation may contribute to epileptogenesis, however, it is unclear whether therapeutic targeting of the A2AR or GLT-1 can attenuate TBI-induced hyperexcitability, and whether there are synergistic interactions between the two. Here, we investigated the therapeutic potential of two FDA approved drugs istradefylline (A2AR inhibitor) and ceftriaxone (GLT-1 activator) in preventing long-lasting brain hyperexcitability in a clinically relevant rodent model of TBI. Adult male mice underwent controlled cortical impact (CCI)-induced TBI and were randomly assigned to istradefylline, ceftriaxone, istradefylline/ceftriaxone, or vehicle groups, receiving treatment during the first 24 hours post-injury. Susceptibility to chemoconvulsant-evoked seizures was quantified at 4-5 weeks after CCI. We show that CCI caused a reduction in GLT-1 and an increase in A2AR protein levels in the ipsilateral hippocampus. Transient acute treatment with istradefylline or ceftriaxone reduced brain hyperexcitability at 4-5 weeks post-TBI. Notably, mice treated with the combination of istradefylline and ceftriaxone exhibited increased GLT-1 levels, accompanied by further reductions in brain hyperexcitability, showing greater effects than either drug alone. Our findings identify a novel disease-modifying approach following TBI using a combination of two FDA-approved drugs which might be useful to mitigate the long-lasting brain hyperexcitability-induced by TBI.</p
Thyroid nodule size and risk of malignancy: a systematic review
No full textBackground: There is ongoing uncertainty about the association between thyroid nodule size and likelihood of malignancy. Researchers are divided, some proposing that risk is increased with nodule size while others claim the opposite. Numerous studies have been completed but there is at present no agreed consensus. Furthermore, the diagnostic accuracy of fine needle aspiration (FNA), the standard test for investigating thyroid nodules is disputed. Reported ranges of false negatives range from 2 to 20%.Aims: The overall aims of this study were to investigate the relationship between thyroid nodule size and malignancy and to examine the association between FNA results and malignancy rates in small and large nodules.Design: Systematic review and meta-analysis of observational studies examining the association between malignancy and thyroid nodule size.Methods: A systematic review was completed using search words 'thyroid, nodule and size' in PubMed database. Criteria for inclusion were retrospective or prospective studies with nodule size and final pathology and/or FNA results that had a primary focus on adult populations.Results: In total 17 studies were deemed eligible for inclusion. 16 studies were included in the first meta-analysis looking at the relationship between nodule size and malignancy rates. Overall, nodules over 4 cm were associated with a lower incidence of malignancy, 15% compared with 37%. A Random effects model meta-analysis was undertaken, which also indicated a trend towards a lower risk of malignancy in nodules over 4 cm, with a risk difference of 0.1 (95% CI - 0.01, 0.21). However, there was significant heterogeneity with an I2 of 99%, therefore caution has to be exercised when interpreting the results. 11 studies were included in the second meta- analysis, examining the impact of nodule size on the association between FNA results and malignancy. The meta-analysis showed that there was no statistically difference between the false negative rates of nodules less than or greater than 4 cm.Conclusion: While there is a trend towards larger nodule being less likely to indicate malignancy, thyroid nodule size does not appear to have a significant influence on the accuracy of FNA in predicting cancer. Thyroid nodule size alone should not influence the decision to refer for further tests or surgery as it is an unreliable predictor of malignancy in isolation. However, taken in conjunction with clinical and radiological findings it may be a useful adjunct to guiding treatment.</p
Radiofrequency identification tag localization of nonpalpable breast lesions: a systematic review and meta-analysis
No full textObjective: Preoperative localization of nonpalpable breast lesions has traditionally been performed by wire-guided localization (WGL). Radiofrequency identification (RFID) tag localization provides a less invasive alternative. The aim of this systematic review and meta-analysis was to investigate outcomes of RFID in terms of clinical utility, efficacy, and safety, also in comparison with WGL.Materials and methods: Following PRISMA guidelines, studies reporting on outcomes post-RFID tag localization, and comparing outcomes post-RFID tag localization and WGL were included. Positive margins and re-excision rates were estimated using meta-analyses of proportions. Further meta-analyses compared positive margins and re-excision rates between RFID tag localization and WGL. Random effects models were used.Results: Nineteen studies involving 3,234 patients were included. Localization was performed for 497 benign and 2,741 malignant lesions. No study reported failure to retrieve an inserted RFID tag. Failed localization rates ranged from 0.0 to 60.7% across studies. After RFID tag localization, the pooled rate of positive margins was 12% (95% confidence interval (CI) 10-15%) and the pooled re-excision rate was 13% (95% CI 10-16%) in 14 and 16 studies, respectively; heterogeneity was high, I2 = 54.6% and 54.9, respectively. In three comparative studies, RFID tag localization was associated with significantly lower rates of positive margins than WGL, odds ratio (OR) 0.71 (95% CI 0.54-0.95), p = 0.021; however, no difference was observed in re-excision rates, OR 1.13 (95% CI 0.88-1.45), p = 0.346. Heterogeneity was low in both analyses, I2 = 0.0%. Moderate bias was reported in 16/19 studies, serious bias in 3/19.Conclusion: RFID tag localization provides an effective alternative to WGL.Relevance statement: This systematic review shows that RFID tag localization of nonpalpable breast lesions provides a less invasive, safe and effective alternative to WGL-guided localization for selected patients, considering its higher cost. Randomized trials are required to elucidate the benefit of RFID tag localization over WGL and other non-wire localization techniques.Key points: The pooled rates of positive margins and re-excision after RFID tag localization were 12% and 13%, respectively. RFID localization had significantly lower positive margin rates than wire-guided localization (WGL); however, no difference was observed in re-excision rate. RFID localization provides an effective alternative to WGL and may be of benefit in selected patients. Randomized trials are required to better elucidate the benefit of RFIS tag localization.</p