[Experimental] List of manuscripts available for review volunteers
Over the last decades, clinical decision support systems have been gaining importance. They help clinicians to make effective use of the overload of available information to obtain correct diagnoses and appropriate treatments. However, their power often comes at the cost of a black box model which cannot be interpreted easily. This interpretability is of paramount importance in a medical setting with regard to trust and (legal) responsibility. In contrast, existing medical scoring systems are easy to understand and use, but they are often a simplified rule-of-thumb summary of previous medical experience rather than a well-founded system based on available data.
Interval Coded Scoring (ICS) connects these two approaches, exploiting the power of sparse optimization to derive scoring systems from training data. The presented toolbox interface makes this theory easily applicable to both small and large datasets. It contains two possible problem formulations based on linear programming or elastic net. Both allow to construct a model for a (binary) classification problem and establish risk profiles that can be used for future diagnosis. All of this requires only a few lines of code.
ICS differs from standard machine learning through its model consisting of interpretable main effects and interactions. Furthermore, insertion of expert knowledge is possible because the training can be semi-automatic. This allows end users to make a trade-off between complexity and performance based on cross-validation results and expert knowledge.
Additionally, the toolbox offers an accessible way to assess classification performance via accuracy and the ROC curve, whereas the calibration of the risk profile can be evaluated via a calibration curve. Finally, the colour-coded model visualization has particular appeal if one wants to apply ICS manually on new observations, as well as for validation by experts in the specific application domains.
The validity and applicability of the toolbox is demonstrated by comparing it to standard Machine Learning approaches such as Naive Bayes and Support Vector Machines for several real-life datasets. These case studies on medical problems show its applicability as a decision support system. ICS performs similarly in terms of classification and calibration. Its slightly lower performance is countered by its model simplicity which makes it the method of choice if interpretability is a key issue.
Background. Work related accidents are common and may lead to permanent physical disability or death. Besides specific injury related challenges these workers face numerous socioeconomic stresses. These stresses are associated with cortical reorganization that may result in cognitive problems. The purpose of this study was to evaluate the stress level and attention in adults with work related physical disabilities.
Methods. Morning salivary cortisol was used as a stress marker while the event-related potential during the performance of the auditory oddball paradigm was conducted to investigate the attentive ability to sound stimuli. Eighteen injured workers (IW) and ten unaffected healthy workers (CW) were recruited for this study with half being men and the other half women (aged 21 to 55). Behavioral performance measures including reaction time (RT), accuracy rate, and commission error as well as the latency and amplitude of P300 wave over the central (Cz), centroparietal (CPz), and parietal (Pz) electrode sites were used to compare the two groups.
Results. This study demonstrated significantly higher salivary cortisol levels, longer RT, less accuracy to respond to the target during the auditory oddball paradigm in the IW group as compared to CW group. In addition, a significant prolongation of the peak latency of auditory P300 wave over Cz, CPz, and Pz electrodes was also detected in IW group.
Discussion. The increased cortisol levels found in the IW group reflect the alteration of the basal hypothalamic-pituitary-adrenal axis as a result of the stresses of living with a physical disability. Delayed RT and the decreased in accuracy together with changing in peak latencies of auditory P300 wave indicate the impairment of attention networks in IW.
Conclusion. Our study revealed that the workers with permanent physical disabilities exhibit the higher level of stress and attention deficits as compared to their uninjuried peers.
Background and Aim: To compare the impact of neoadjuvant radiotherapy and adjuvant radiotherapy on survival for patients with hepatocellular carcinoma.
Methods: Patients with hepatocellular carcinoma were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method and multivariate Cox regression analysis were used to compare the impact of neoadjuvant radiotherapy on survival with adjuvant radiotherapy. Subsequently, a propensity score matched analysis was performed to confirm the result.
Results: A total of 244 patients with hepatocellular carcinoma identified from the SEER database (2004-2014) included in this study. 151 patients received postoperative radiotherapy, 93 patients received preoperative radiotherapy. Preoperative radiotherapy had a clear superiority in terms of unadjusted overall and cancer-specific survival (p＜0.001 for log-rank test). After adjusting for confounding variables, hazard ratios for all-cause (HR, 0.33; 95% CI, 0.19-0.53, p＜0.001) and cancer cause-specific (HR, 0.32; 95% CI, 0.19-0.53, p＜0.001) mortality risk in preoperative radiotherapy group were significantly lower than that of postoperative radiotherapy group. Subsequently, a propensity score matched analysis was performed to confirm this result.
Conclusion: We found that neoadjuvant radiotherapy was associated with improved long-term survival for patients with hepatocellular carcinoma versus adjuvant radiotherapy.
Background. E-health technology applications are essential tools of modern information technology that improve quality of healthcare delivery in hospitals of both developed and developing countries. However, despite its positive benefits, studies indicate that the rate of the e-health adoption in some developing countries is either low or underutilized. This is due in part, to barriers such as resistance from healthcare professionals, poor infrastructure, and low technical expertise among others.
Objective. The aim of this study is to investigate, identify and analyze the underlying factors that affect healthcare professionals decision to adopt and use e-health technology applications in developing countries, with particular reference to hospitals in Nigeria.
Methods. The study used quantitative method in the form of close-ended questionnaire to collect data from a sample of 465 healthcare professionals randomly selected from 15 hospitals in Nigeria. We used variables of modified Technology Acceptance Model (TAM) as dependent variables and external factors as independent variables. The collected data was then analyzed using SPSS statistical analysis such as frequency test, reliability analysis, and correlation coefficient analysis.
Results. The results obtained, which correspond with findings from other researches published, indicate that perceived usefulness, belief, as well as attitude of healthcare professionals have significant influence on their willingness to adopt and use the e-health technology applications. Other strategic factors identified include low literacy level and experience in using the e-health technology applications, lack of motivation, poor organizational and management policies.
Conclusion. The study contributes to the literature by pin-pointing significant areas its findings can positively affect or be useful, such as serving as guide to healthcare policy decision makers in Nigeria and other developing countries to understand their areas of priorities and weaknesses when planning for e-health technology adoption and implementation.
Background: Kawasaki disease (KD) is an immune-mediated systemic vasculitis and infection plays an important role in the pathophysiology of KD. The susceptibility to infectious disease in patients with KD remains largely unclear. This study aimed to investigate the risk of respiratory tract infection (RTI)-related hospitalizations in children with KD.
Methods: Data from Taiwanese National Health Insurance Research Database was analyzed. Children with KD were selected as KD group and age- and sex-matched non-KD patients were selected as control group with 1:1 ratio. Both cohorts were tracked for 1 year to investigate the incidences of RTI-related hospitalizations. Cox regression hazard model was used to adjust for confounding factors and calculate the adjusted hazard ratio (aHR).
Results: Between January 1996 and December 2012, 13,760 patients with KD were identified as KD group and 13,709 patients were enrolled as control group. An obviously reduced risk of RTI-related hospitalizations was observed in KD patients (aHR: 0.53, 95% confidence interval: 0.49-0.57). The decreased risk persisted through the 1-year follow-up period with a peak protection in 3-6 months (aHR: 0.46, 95% confidence interval: 0.40-0.53).
Conclusions: KD patients had approximately half reduction of risk for RTI-related hospitalizations. The protective effects persisted for at least 1 year. Further studies are warranted to elucidate the entire mechanism and investigate the influences of intravenous immunoglobulin.
The transversus abdominus plane (TAP) block provides analgesia for abdominal wall incisions and reduces post operative opioid consumption. However, the pharmacokinetics of local anesthestics in children receiving this block remain understudied. Bupivacaine has been the local anesthetic used to perform TAP blocks in most studies published to date. The aim of this study was to establish the population pharmacokinetics of bupivacaine following single dose TAP block administration in children and to investigate the influence of patient covariates on drug disposition.
Following Research Ethics Board approval and parental/patient consent, 20 ASA I-III children over 3 months of age undergoing elective surgery with a scheduled TAP block were recruited into this observational study. After general anesthesia was induced, children received an ultrasound-guided TAP block with 0.25% bupivacaine with epinephrine 1:200 000. Venous blood samples were drawn at predetermined times using a population pharmacokinetic (PK) protocol following the TAP block.
20 children were included in the study. The mean serum bupivacaine level was 0.58 mcg/l occurring 30 minutes following administration of local anesthetic. There was wide inter-patient variability and age was a major covariate. There were no adverse events.
The main finding of this study is that serum bupivacaine levels were below the toxic level after single-injection TAP block in children undergoing surgical procedures. The major covariate was patient age.
Background: Patellofemoral pain is often reported as a diffuse pain at the front of the knee during knee-loading activities. A patient’s description of pain location and distribution is commonly drawn on paper by clinicians, which is difficult to quantify, report and compare within and between patients. One way of overcoming these potential limitations is to have the patient draw their pain regions using digital platforms, such as personal computer tablets.
Objective: To assess the validity of using computer tablets to acquire a patient’s knee pain drawings as compared to paper based records in patients with patellofemoral pain.
Methods: Patients (N=35) completed knee pain drawings on identical images (size and color) of the knee as displayed on paper and a computer tablet. Pain area expressed as pixel density, was calculated as a percentage of the total drawable area for paper and digital records. Bland-Altman plots, Pearson’s correlation coefficients and one-sample tests were used in data analysis.
Results: No significant difference in pain area was found between the paper and digital records of mapping pain area (mean difference (95%CI; p) = 0.002% (-0.159 to 0.157; P=0.98)). A strong linear correlation (R2=0.870) was found for pain area and the limits of agreement show less than ±1% difference between paper and digital drawings.
Conclusion: Pain drawings as acquired using paper and computer tablet are equivalent in terms of total area of reported knee pain. The advantages of digital recording platforms, such as, quantification and reporting of pain area, could be realized in both research and clinical settings.
Objective: To translate the Perceived Stress Questionnaire (PSQ) into Chinese, validate its reliability and validity in nursing students and investigate the perceived stress level of nursing students.
Method: Forward- and back-translation combined with expert assessment and cross-cultural adaptations were used to construct the Chinese version of the Perceived Stress Questionnaire (C-PSQ). This research adopted a stratified sampling method among 1519 nursing students in 30 classes of Ningbo College of Health Sciences to assess the reliability and validity of the C-PSQ.
Results: The C-PSQ retained all 30 items of the original scale. Principal component analysis extracted five factors that explained 52.136% of the total variance. The S-CVI/Ave was 0.913. The results of the confirmatory factor analysis were as follows: χ 2 /df=4.376, RMR=0.023, GFI=0.921, AGFI=0.907,CFI=0.921, PNFI=0.832, and PGFI=0.782. The scale’s Cronbach’s α was 0.922 CI (0.916, 0.928), and Cronbach’s α of each dimension was 0.899 CI (0.891, 0.907), 0.821 CI (0.807, 0.835), 0.688 CI (0.661, 0.713), 0.703 CI (0.678, 0.726) and 0.523 CI (0.472, 0.570). The correlation coefficient between the first and second test, the first and third test, and the second and third test was 0.725 CI (0.514, 0.878), 0.787 CI (0.607, 0.890), and 0.731 CI (0.506, 0.897), respectively. The average score of perceived stress in nursing students was 0.399±0.138. Different demographic factors were significantly associated with the perceived stress of nursing students.
Discussion:The C-PSQ has good reliability and validity, which means that the scale can be used as a universal tool for psychosomatic studies. The perceived stress of nursing students was relatively high. Further studies are needed.
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