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Human-centred AI for emergency cardiac care:Evaluating RAPIDx AI with PROLIFERATE_AI
No full textBackground: Chest pain diagnosis in emergency care is hindered by overlapping cardiac and non-cardiac symptoms, causing diagnostic uncertainty. Artificial Intelligence, such as RAPIDx AI, aims to enhance accuracy through clinical and biochemical data integration, but its adoption relies on addressing usability, explainability, and seamless workflow integration without disrupting care. Objective: Evaluate RAPIDx AI's integration into clinical workflows, address usability barriers, and optimise its adoption in emergencies. Methods: The PROLIFERATE_AI framework was implemented across 12 EDs (July 2022–January 2024) with 39 participants: 15 experts co-designed a survey via Expert Knowledge Elicitation (EKE), applied to 24 ED clinicians to assess RAPIDx AI usability and adoption. Bayesian inference, using priors, estimated comprehension, emotional engagement, usage, and preference, while Monte Carlo simulations quantified uncertainty and variability, generating posterior means and 95% bootstrapped confidence intervals. Qualitative thematic analysis identified barriers and optimisation needs, with data triangulated through the PROLIFERATE_AI scoring system to rate RAPIDx AI's performance by user roles and demographics. Results: Registrars exhibited the highest comprehension (median: 0.466, 95 % CI: 0.41–0.51) and preference (median: 0.458, 95 % CI: 0.41–0.48), while residents/interns scored the lowest in comprehension (median: 0.198, 95 % CI: 0.17–0.26) and emotional engagement (median: 0.112, 95 % CI: 0.09–0.14). Registered nurses showed strong emotional engagement (median: 0.379, 95 % CI: 0.35–0.45). Novice users faced usability and workflow integration barriers, while experienced clinicians suggested automation and streamlined workflows. RAPIDx AI scored “Good Impact,” excelling with trained users but requiring targeted refinements for novices. Conclusion: RAPIDx AI enhances diagnostic accuracy and efficiency for experienced users, but usability challenges for novices highlight the need for targeted training and interface refinements. The PROLIFERATE_AI framework offers a robust methodology for evaluating and scaling AI solutions, addressing the evolving needs of sociotechnical systems
Developing a Systematic Approach for the Implementation of Medical Extended Reality Learning Modules in Cardiothoracic Health Care:Recommendations From an International Expert Group
No full textExtended reality (XR) modalities in health care are quickly evolving. There is a lack of systematically described developmental process and the “how to” execute a business-case guidance. This article formulates a systematic approach on the technical developmental steps and generation of business-case to guide the iterative development of an XR tool. An international expert group was established and several available frameworks related to entrepreneurship and business-case development were used to generate recommendations. Our ongoing experience with the development life cycle of an XR tool for cardiopulmonary resuscitation training is provided as a real-life case illustration. Market demand, value proposition, stakeholder analyses, and profitability scenarios are captured with a business model canvas. Developmental process is divided into 4 aspects: Desirability, Feasibility, Viability, and Scalability. Technical- and Investment Readiness Level models are used in defining the technical feasibility and the business viability and scalability, respectively. Best practice recommendations including examples are provided. Health care professionals, health care financers, and health care policymakers are urged to consider the provided systematic approach and recommendations prior to starting a venture with XR
Ultrasensitive ctDNA detection for preoperative disease stratification in early-stage lung adenocarcinoma
No full textCirculating tumor DNA (ctDNA) detection can predict clinical risk in early-stage tumors. However, clinical applications are constrained by the sensitivity of clinically validated ctDNA detection approaches. NeXT Personal is a whole-genome-based, tumor-informed platform that has been analytically validated for ultrasensitive ctDNA detection at 1–3 ppm of ctDNA with 99.9% specificity. Through an analysis of 171 patients with early-stage lung cancer from the TRACERx study, we detected ctDNA pre-operatively within 81% of patients with lung adenocarcinoma (LUAD), including 53% of those with pathological TNM (pTNM) stage I disease. ctDNA predicted worse clinical outcome, and patients with LUAD with <80 ppm preoperative ctDNA levels (the 95% limit of detection of a ctDNA detection approach previously published in TRACERx) experienced reduced overall survival compared with ctDNA-negative patients with LUAD. Although prospective studies are needed to confirm the clinical utility of the assay, these data show that our approach has the potential to improve disease stratification in early-stage LUADs
Trial-based economic evaluation of a multicomponent positive psychology intervention for euthymic patients with bipolar disorder
No full textBACKGROUND: To date, no study has evaluated the cost-effectiveness of positive psychology interventions (PPI) for people with bipolar disorder (BD). This study evaluates the cost-effectiveness of the multicomponent PPI "Living well with bipolar disorder" for people with BD in the euthymic phase, compared to treatment as usual (TAU) alone. METHODS: 96 participants were included in the study, with 53 randomized to the intervention group. Utility scores (EQ-5D-5L), well-being (MHC-SF), healthcare costs, productivity losses, and patient and family costs were assessed at baseline, 6 months and 12 months. Incremental cost-utility (quality-adjusted life-years (QALYs)) and cost-effectiveness ratios (costs per additional responder to treatment using MHC-SF scores) were estimated. Non-parametric bootstrapping (5000 repetitions) was used to assess uncertainty. Sensitivity analyses were conducted to test robustness. RESULTS: The intervention led to an estimated incremental cost difference of €691 (95 % CI: -€2128; €3458) and 0.04 (95 % CI: -0.01; 0.08) incremental QALYs, which results in an ICUR of €19,669 per QALY gained. The probability of cost-effectiveness was ~70 % considering a willingness-to-pay of €50,000 per QALY. Incremental treatment response was estimated at 0.12 (CI: -0.06; 0.30), resulting in an ICER of €5624 per additional responder. Sensitivity analyses indicated similar results. CONCLUSION: Results indicate that the PPI "Living well with bipolar disorder" for patients with BD in the euthymic phase is likely to be cost-effective, introducing small but improved health outcomes against additional costs. Despite study limitations and the need for further research, results support the inclusion of this PPI in the spectrum of available treatments for BD. PRéCIS: Positive Psychology interventions in addition to treatment as usual for patients with Bipolar Disorder are more effective and more costly than treatment as usual alone
Breathlessness in the general population
No full textPURPOSE OF THE REVIEW: Breathlessness is a prevalent symptom that significantly affects physical and mental health. While commonly associated with respiratory and cardiovascular diseases, breathlessness is increasingly recognised as a concern in the general population. This review summarises recent research on the prevalence, risk factors, assessment methods, and clinical and societal impact, with a focus on findings from the past 18 months. RECENT FINDINGS: Recent studies indicate that breathlessness affects a substantial proportion of adults worldwide, with prevalence varying across populations and regions. Identified risk factors include older age, female sex, high body mass index, smoking, and comorbidities such as respiratory and cardiovascular diseases. Novel approaches in assessing breathlessness are looking beyond unidimensional scales to improve diagnostic accuracy. However, breathlessness remains underdiagnosed in clinical practice. Recent publications also show that breathlessness has a substantial impact on health outcomes of the affected person, but also imposes a burden on their informal caregivers, health care systems and the economy. SUMMARY: Despite progress in understanding chronic breathlessness, knowledge gaps persist, particularly regarding its assessment in large-population samples. Longitudinal studies are needed to understand risk factors for breathlessness and its impact on health outcomes and society
Systemic pro-inflammatory response following bronchoscopic lung volume reduction using endobronchial valves
No full textRATIONALE: Bronchoscopic lung volume reduction treatment using endobronchial valves (EBV) is an effective treatment for severe COPD patients by improving lung function and quality of life. However, little is known about its effects on systemic inflammation. Therefore, the aim of our study was to investigate whether EBV treatment impacts the inflammatory cytokine profile. METHODS: This study was a predefined sub-study of the SoLVE trial (NCT03474471) that investigated the combination of EBV treatment with pulmonary rehabilitation (PR). The sub-study included the collection of blood samples with assessment of 10 inflammatory markers prior to EBV treatment and 6 months after EBV or EBV+PR treatment. RESULTS: In 66 patients, 6 months after treatment a pro-inflammatory cytokine profile was observed, with an increase in all pro-inflammatory markers and a decrease in the anti-inflammatory cytokine interleukin-10. The changes in plasma cytokine profile were not associated with changes in clinical outcomes such as lung function or exercise capacity. DISCUSSION: In conclusion, our study demonstrated an elevation in systemic pro-inflammatory cytokine levels following successful EBV treatment, which was not associated with adverse clinical outcomes. It would be interesting to further explore whether this increase is attributed to a foreign body response or if other factors contribute to this phenomenon
Triadic shared decision making in emergency psychiatry:an explorative study
No full textBACKGROUND: This study aims to understand the complex triadic shared decision-making process in psychiatric emergency services, focusing on the choice between inpatient and outpatient care post-triage. It also identify scenarios where patient or significant others' preferences override clinical judgment. METHODS: Conducted in the greater Rotterdam area, Netherlands, this explorative study surveyed patient and significant others' preferences for voluntary or involuntary admission versus outpatient treatment, alongside professionals' clinical indications. Descriptive statistics were used to profile participants, and preference data were used to categorize groups, revealing patterns of agreement. RESULTS: Among 5680 assessments involving significant others, four groups emerged: agreement among the triad on in- or outpatient care (48.2%), patient disagrees (38.5%), significant others disagree (11.0%), and professionals disagree (2.3%). Professionals' recommendations were followed more frequently (57.0%) than patient (9.4%) or significant others' preferences (11.0%). CONCLUSIONS: We observed that consensus could often be reached among the members of the triad on inpatient or outpatient care following triage. Disagreements typically occurred when patients preferred outpatient care while others favoured inpatient care, or when significant others advocated for inpatient care while others preferred outpatient care. While professionals' recommendations held the most influence, they could be overridden in cases where valid criteria mandated involuntary care
REM sleep quality is associated with balanced tonic activity of the locus coeruleus during wakefulness
No full textBACKGROUND: Animal studies established that the locus coeruleus (LC) plays important roles in sleep and wakefulness regulation. Whether it contributes to sleep variability in humans is not yet established. Here, we investigated if the in vivo activity of the LC is related to the variability in the quality of Rapid Eye Movement (REM) sleep. METHODS: We assessed the LC activity of 34 healthy younger (~ 22y) and 18 older (~ 61y) individuals engaged in bottom-up and top-down cognitive tasks using 7-Tesla functional Magnetic Resonance Imaging (fMRI). We further recorded their sleep electroencephalogram (EEG) to evaluate associations between LC fMRI measures and REM sleep EEG metrics. RESULTS: Theta oscillation energy during REM sleep was positively associated with LC response in the top-down task. In contrast, REM sleep theta energy was negatively associated with LC activity in older individuals during the bottom-up task. Importantly, sigma oscillations power immediately preceding a REM sleep episode was positively associated with LC activity in the top-down task. CONCLUSIONS: LC activity during wakefulness was related to REM sleep intensity and to a transient EEG change preceding REM sleep, a feature causally related to LC activity in animal studies. The associations depend on the cognitive task, suggesting that a balanced level of LC tonic activity during wakefulness is required for optimal expression of REM sleep. The findings may have implications for the high prevalence of sleep complaints reported in aging and for disorders such as insomnia, Alzheimer's, and Parkinson's disease, for which the LC may play pivotal roles through sleep
Critical dialogue:recent advancements toward omission of axillary lymph node dissection in clinically node positive breast cancer patients treated with neoadjuvant chemo-immuno therapy
No full textPrioritizing orthopaedic evidence uncertainties:expert consensus based on a modified DELPHI study and a focus group
No full textAIMS: To develop a multidisciplinary health research agenda (HRA) utilizing expertise from various disciplines to identify and prioritize evidence uncertainties in orthopaedics, thereby reducing research waste. METHODS: We employed a novel, structured framework to develop a HRA. We started by systematically collecting all evidence uncertainties from stakeholders with an interest in orthopaedic care, categorizing them into 13 sub-themes defined by the Dutch Orthopaedic Association (NOV). Subsequently, a modified two-phased Delphi study (two rounds per phase), adhering to the Conducting and REporting DElphi Studies (CREDES) guideline, was conducted. In Phase 1, board members assessed the collected evidence uncertainties on a three-point Likert scale to confirm knowledge gaps. In Phase 2, diverse stakeholders, including orthopaedic surgeons, rated the confirmed knowledge gaps on a seven-point Likert scale. Panel members rated one self-selected sub-theme and two randomly assigned sub-themes. The results from Phase 2 were ranked based on the overall average score for each uncertainty. Finally, a focus group discussion with patient associations' representatives identified their top-ranked uncertainty from a predefined consensus process, leading to the final HRA. An advisory board, the Federation of Medical Specialists, and the NOV research coordinator oversaw the process. RESULTS: Of the 687 collected evidence uncertainties, 160 (zero to 33 per theme) were confirmed by 41 panel members (three to five per theme). In Phase 2, 124 panel members prioritized 41 evidence uncertainties (zero to five per theme). The focus group members identified 12 key evidence uncertainties leading to the final HRA. The remaining 29 evidence uncertainties will be addressed after research on the HRA's prioritized evidence uncertainty is completed. CONCLUSION: Our framework resulted in a multidisciplinary HRA, enabling an inclusive approach to consensus-building among healthcare professionals and patients on future research priorities within orthopaedic care. We anticipate this innovative framework will enhance inclusivity and transparency, leading to broader acceptance and optimized resource allocation, ultimately reducing research waste