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2021 ◽  
Isabel Martinez-Tejada ◽  
Casper Schwartz Riedel ◽  
Marianne Juhler ◽  
Morten Andresen ◽  
Jens E. Wilhjelm

Abstract Background: Intracranial pressure (ICP) monitoring is a core component of neurosurgical diagnostics. With the introduction of telemetric monitoring devices in the last years, ICP monitoring has become feasible in a broader clinical setting including monitoring during full mobilization and at home, where a greater diversity of ICP waveforms are present. The need for identification of these variations, the so-called macro-patterns lasting seconds to minutes - emerges as a potential tool for better understanding the physiological underpinnings of patient symptoms. Methods: We introduce a new methodology that serves as a foundation for future automatic macro-pattern identification in the ICP signal to comprehensively understand the appearance and distribution of these macro-patterns in the ICP signal and their clinical significance. Specifically, we describe an algorithm based on k-Shape clustering to build a standard library of such macro-patterns. Results: In total, seven macro-patterns were extracted from the ICP signals. This macro-pattern library may be used as a basis for the classification of new ICP variation distributions based on clinical disease entities.Conclusions: We provide the starting point for future researchers to use a computational approach to characterize ICP recordings from a wide cohort of disorders.

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257453
Chiun-Ho Hou ◽  
Jiahn-Shing Lee ◽  
Ken-Kuo Lin ◽  
Laura Liu ◽  
Yung-Sung Lee ◽  

Objective To determine whether patients attending the ophthalmology department underestimate their glaucoma risks. Method We conducted a cross-sectional survey with a final study population of 1203 individuals from two medical centers in Taiwan during January 1–June 30, 2019. The “High concern” group was defined as the set of patients who rated themselves as having low risk but who had been rated by physicians as having medium or high risk of developing glaucoma over the next year. Results Approximately 12% of the respondents belonged to the “High concern” group. For those with education at the college level or higher, the interaction term was estimated to be 0.294 (95% CI = 0.136–0.634). Marginal effect calculations revealed significant sex-based differences in the effect of knowledge at specific age intervals. Conclusions A considerable proportion of patients attending the ophthalmology department underestimate their glaucoma risks. Misjudgment of glaucoma risks can lead to delays in seeking of medical attention. Glaucoma education should be designed according to each patient’s education level and sex, as its effect is not consistent across different education and sex clusters.

2021 ◽  
Vol 21 (1) ◽  
Tzu-Hung Liu ◽  
Amy M. Sullivan

Abstract Background Medical educators have promoted self-directed learning (SDL) as an important means of enabling students to take responsibility for their own learning throughout their training and practice. While SDL has been well-studied in classroom settings, it remains a story half told: barriers to and facilitators of SDL in the clinical setting are not yet well described. The goals of this study were to explicate student experiences of SDL in their clinical training and to identify the roles that local social and cultural contexts play in shaping their experiences of SDL. Methods To understand students’ conceptualization and experiences of SDL in the clinical setting, we carried out a qualitative study with 15 medical students at Harvard Medical School. The semi-structured interviews were recorded and transcribed. Using an interpretivist approach, data were analyzed both deductively and inductively using the Framework method of content analysis. Results Participants described patient care activities as primary motivators for engagement in SDL in the clinical setting. Participants’ descriptions of SDL aligned with Knowles’ steps in SDL, with an additional step of consolidation of learning related to their patients’ diagnosis and management. Participants described using a range of cognitive, social-emotional, and peer learning strategies to enhance their SDL. Participants who described a growth mindset appeared to engage in SDL more easily. Learning environments that fostered SDL were those in which faculty and residents demonstrated an educational orientation, promoted psychological safety, and invited student engagement. Teams with perceived excessive work demands were perceived to be less supportive of SDL. Conclusions Our study enhances previous classroom-based models of SDL by providing specific, practical implications for both students and faculty in the clinical training setting. Participants described SDL in the clinical setting as patient-centered, and when effectively implemented, SDL appears to support a mastery rather than performance orientation. Our study paves the way for improving medical students’ clinical SDL and helping them become lifelong learners in the field of medicine.

Prosthesis ◽  
2021 ◽  
Vol 3 (3) ◽  
pp. 261-266
Man Ting Kwong ◽  
David Stell ◽  
Emmanuel Akinluyi

Unfamiliarity with medical device regulations can sometimes be a barrier to deploying technology in a clinical setting for researchers and innovators. Health service providers recognise that innovation can happen within smaller organisations, where regulatory support may be limited. This article sets out to increase transparency and outline key considerations on medical device regulations from a UK healthcare provider’s perspective. The framework used by Guy’s and St Thomas’ NHS Foundation Trust (GSTFT) for assessing research devices is presented to give an overview of the routes that R&D medical devices take to enter a clinical setting. Furthermore, current trends on research studies involving medical devices were extracted from the GSTFT internal R&D database and presented as the following categories (i) commercial vs. non-commercial, (ii) assessment type and (iii) software vs. non-software. New medical devices legislation will be introduced within the UK in July 2023. It is anticipated regulating software as a medical device may become more challenging for healthcare providers and device manufacturers alike. It is therefore important for different stakeholders involved to work together to ensure this does not become a barrier to innovation.

Diego Martínez-Urbistondo ◽  
Rafael Suarez del Suarez del Villar ◽  
Omar Ramos-Lopez ◽  
María Agud Fernández ◽  
Ramón Costa Segovia ◽  

The objective of this study was to examine the interactions between comorbidity and five lifestyle single habits concerning different subscales of quality of life (QoL). For the study, 302 patients were consecutively recruited at the internal medicine department of a tertiary teaching hospital. Lifestyle habits, comorbidities and QoL were recorded according to validated questionnaires. Five single unhealthy habits, such as tobacco consumption, dietary intake of ultra-processed pastries, raw nuts or carbonated drinks, sleep time and physical activity patterns were selected according to previously published data. The main outcomes of the study were the scores of the eight subscales of the SF-36 QoL survey. The aggregate of unhealthy habits showed statistically significant association to every category in the SF-36 questionnaire, both in the univariate and the multivariate analysis when adjusting by age, sex and comorbidity. An interaction was found between comorbidity and unhealthy habits in both physical and mental summaries of SF-36. In conclusion, the lifestyle assessment according to five unhealthy habits is associated with a worse QoL. The interaction between comorbidity and unhealthy habits is especially clear in diseased patients due to the interplay between illness and lifestyle in the prediction of QoL.

2021 ◽  
Yunyou Huang ◽  
Nana Wang ◽  
Suqin Tang ◽  
Li Ma ◽  
Tianshu Hao ◽  

This paper quantitatively reveals the state-of-the-art and state-of-the-practice AI systems only achieve acceptable performance on the stringent conditions that all categories of subjects are known, which we call closed clinical settings, but fail to work in real-world clinical settings. Compared to the diagnosis task in the closed setting, real-world clinical settings pose severe challenges, and we must treat them differently. We build a clinical AI benchmark named Clinical AIBench to set up real-world clinical settings to facilitate researches. We propose an open, dynamic machine learning framework and develop an AI system named OpenClinicalAI to diagnose diseases in real-world clinical settings. The first versions of Clinical AIBench and OpenClinicalAI target Alzheimer's disease. In the real-world clinical setting, OpenClinicalAI significantly outperforms the state-of-the-art AI system. In addition, OpenClinicalAI develops personalized diagnosis strategies to avoid unnecessary testing and seamlessly collaborates with clinicians. It is promising to be embedded in the current medical systems to improve medical services.

2021 ◽  
John H. Huber ◽  
Margaret Elliott ◽  
Cristian Koepfli ◽  
T. Alex Perkins

ABSTRACTBackgroundThe five Plasmodium spp. that cause human malaria appear similar under light microscopy, which raises the possibility that misdiagnosis could routinely occur in clinical settings. Assessing the extent of misdiagnosis is of particular importance for monitoring P. knowlesi, which co-circulates with the other Plasmodium spp.MethodsWe performed a systematic review and meta-analysis of studies comparing the performance of microscopy and PCR for diagnosing malaria in settings with co-circulation of the five Plasmodium spp. We assessed the extent to which co-circulation of Plasmodium parasites affects diagnostic outcomes. We fit a Bayesian hierarchical latent class model to estimate variation in microscopy sensitivity and specificity.ResultsMean sensitivity of microscopy was low, yet highly variable across Plasmodium spp., ranging from 41.7% (95% CI: 22.8 – 64.1%) for P. falciparum and 40.3% (22.0 – 61.5%) for P. vivax to 0.119% (0.0121 – 0.640%) for P. knowlesi, 7.57% (2.66 – 22.0%) for P. malariae, and 0.180% (0.00491 – 1.21%) for P. ovale. Observed PCR prevalence was positively correlated with estimated microscopic sensitivity and negatively correlated with estimated microscopic specificity, though the strength of the associations varied by species.ConclusionsOur analysis suggests that co-circulation of Plasmodium spp. undermines the accuracy of microscopy. Sensitivity was considerably lower for P. knowlesi, P. malariae, and P. ovale. The negative association between specificity and PCR prevalence imply that less frequently encountered species may be misdiagnosed as more frequently encountered species. Together, these results suggest that the burden of P. knowlesi, P. malariae, and P. ovale may be underappreciated in a clinical setting.SummaryCo-circulation of Plasmodium species parasites may limit the accuracy of malaria diagnosis by light microscopy. Variation in performance of light microscopy is highly correlated with the prevalence of the parasites in the epidemiological setting.

Electronics ◽  
2021 ◽  
Vol 10 (18) ◽  
pp. 2230
Maria Filomena Santarelli ◽  
Anna Mori ◽  
Michelangelo Bertasi ◽  
Vincenzo Positano ◽  
Alessia Gimelli ◽  

A technical comparison is described between two SPECT systems, one dedicated to cardiovascular studies and one general-purpose, to evaluate the advantages and disadvantages of their use in an organ-specific clinical setting. The comparison was made between a dedicated cardiac SPECT (Alcyone, Discovery NM 530c, GE Healthcare) scanner and a general-purpose one (Discovery NM/CT 670 CZT, GE Healthcare). The two scanners differ in terms of hardware, mainly in the arrangement of the detectors and collimators, which are the main components of SPECT. A standard NEMA phantom was used to characterize the energy resolution, spatial resolution, and sensitivity for the two systems. Then, using a custom-made cardiac phantom, more specific indices were computed to evaluate the quality of cardiac images, such as signal-to-background noise ratio (SBNR), tissue-background contrast-to-noise ratio (TBCNR), and uniformity. Finally, the same indices were computed for clinical images acquired with the two systems from 11 subjects. Alcyone showed superior performance for dedicated cardiac imaging; however, its excellent qualities are aimed only at the study of the heart and only at patients with a low body-mass index, unlike Discovery NM/CT 670 CZT, which can be used for every anatomic district area and for every type of patient.

2021 ◽  
Vol 4 (1) ◽  
Lucy J. Bock ◽  
Philip M. Ferguson ◽  
Maria Clarke ◽  
Vichayanee Pumpitakkul ◽  
Matthew E. Wand ◽  

AbstractPseudomonas aeruginosa is an opportunistic pathogen capable of stably adapting to the antiseptic octenidine by an unknown mechanism. Here we characterise this adaptation, both in the laboratory and a simulated clinical setting, and identify a novel antiseptic resistance mechanism. In both settings, 2 to 4-fold increase in octenidine tolerance was associated with stable mutations and a specific 12 base pair deletion in a putative Tet-repressor family gene (smvR), associated with a constitutive increase in expression of the Major Facilitator Superfamily (MFS) efflux pump SmvA. Adaptation to higher octenidine concentrations led to additional stable mutations, most frequently in phosphatidylserine synthase pssA and occasionally in phosphatidylglycerophosphate synthase pgsA genes, resulting in octenidine tolerance 16- to 256-fold higher than parental strains. Metabolic changes were consistent with mitigation of oxidative stress and altered plasma membrane composition and order. Mutations in SmvAR and phospholipid synthases enable higher level, synergistic tolerance of octenidine.

2021 ◽  
pp. 1-23
Zhubin Lun ◽  
Ziling Mai ◽  
Liwei Liu ◽  
Guanzhong Chen ◽  
Huanqiang Li ◽  

<b><i>Objective:</i></b> Previous studies have shown that the relationship between hypertension (HT) and contrast-associated acute kidney injury (CA-AKI) is not clear. We apply a systematic review and meta-analysis to assess the association between HT and CA-AKI. <b><i>Methods:</i></b> We searched for articles on the study of risk factors for CA-AKI in the Embase, Medline, and Cochrane Database of Systematic Reviews (by March 25, 2021). Two authors independently performed quality assessment and extracted data such as the studies’ clinical setting, the definition of CA-AKI, and the number of patients. The CA-AKI was defined as a serum creatinine (SCr) increase ≥25% or ≥0.5 mg/dL from baseline within 72 h. We used fixed or random models to pool adjusted OR (aOR) by STATA. <b><i>Results:</i></b> A total of 45 studies (2,830,338 patients) were identified, and the average incidence of CA-AKI was 6.48%. There was an increased risk of CA-AKI associated with HT (aOR: 1.378, 95% CI: 1.211–1.567, <i>I</i><sup>2</sup> = 67.9%). In CA-AKI with a SCr increase ≥50% or ≥0.3 mg/dL from baseline within 72 h, an increased risk of CA-AKI was associated with HT (aOR: 1.414, 95% CI: 1.152–1.736, <i>I</i><sup><i>2</i></sup> = 0%). In CA-AKI with a Scr increase ≥50% or ≥0.3 mg/dL from baseline within 7 days, HT increases the risk of CA-AKI (aOR: 1.317, 95% CI: 1.049–1.654, <i>I</i><sup><i>2</i></sup> = 51.5%). <b><i>Conclusion:</i></b> Our meta-analysis confirmed that HT is an independent risk factor for CA-AKI and can be used to identify risk stratification. Physicians should pay more attention toward prevention and treatment of patients with HT in clinical practice.

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