Search Results (46)

Background: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke (IS) and adverse long-term outcomes. The impact of pre-existing versus newly diagnosed AF on prognosis after endovascular thrombectomy (EVT) is uncertain. Methods: We conducted a retrospective analysis of patients with IS admitted to Mersey and West Lancashire Teaching Hospitals NHS Trust between January 2016 and November 2023 who underwent EVT. Data were extracted from the Sentinel Stroke National Audit Programme and cross-referenced with hospital medical records. Patients were categorised into three groups based on AF status: no-AF, pre-existing AF, and new-AF. Outcomes included prolonged hospital length of stay (LOS) [≥75th percentile], poor functional outcome (modified Rankin Scale [mRS] ≥ 3 at discharge), and all-cause mortality (in-hospital, at 30-day, and at 6-month mortality). Logistic regression and Cox proportional hazards models were used for analysis. Results: A total of 138 patients were included (mean ± SD for age: 67.9 ± 13.9 years; 45.7% female). Hospital LOS was longest in the new-AF group (median 35.0 days [IQR: 6.0–53.0]) compared with the pre-existing AF group (18.0 days [6.0–42.0]), and the no-AF group (7.0 days [3.0–28.0]), p = 0.024. In adjusted logistic regression, new-AF was significantly associated with prolonged LOS (OR = 2.55, 95%CI: 1.01–6.45, p = 0.048) but showed no association with poor functional prognosis (p = 0.851). Cox regression analysis showed that AF status was not associated with mortality (p = 0.325). Conclusions: Newly diagnosed AF after stroke is associated with prolonged hospitalisation despite comparable rates of successful EVT results but had no effect on functional prognosis or risk of death. Full article

Background: Medication adherence is essential for treatment effectiveness and safety, but pharmacy students may find it difficult to assess adherence comprehensively during medication reviews (MRs). This study examined how pharmacy students assess medication adherence in real-world MRs and explored whether complementary adherence frameworks could support broader evaluation. Methods: This observational exploratory study was conducted in the integrated MSc (Master of Science) Pharmacy program at the University of Tartu, Estonia. During the internship, 21 pharmacy students performed a Brown Bag MR with patients aged 65 years or older who used at least 5 prescription medications. Data included patient interviews, e-prescription records, and a validated MR documentation form. An expert panel applied the World Health Organization Medication Adherence Model (WHO-MAM) and the Perceptions and Practicalities Approach (PAPA) to identify adherence determinants not captured by the student-used MR tool. Descriptive statistics and qualitative content analysis were used. Results: Students mainly documented therapy- and patient-related issues, such as incorrect dosing, side effects, and interactions, while socioeconomic and healthcare system factors were rarely identified. Students identified potential adherence-related issues in 19% of cases, whereas experts identified such issues in 57% of cases. Additional gaps included limited recognition of financial barriers, access difficulties, and social support factors. Conclusions: In this exploratory study, pharmacy students identified medication-use-related problems during MRs, but broader adherence-related determinants were less consistently documented. These preliminary findings suggest that structured frameworks such as WHO-MAM and PAPA may be useful for broadening adherence assessment in experiential pharmacy education. Full article

Background: Ischemic stroke remains a leading cause of mortality and long-term disability worldwide. Reperfusion therapies, such as intravenous thrombolysis and mechanical thrombectomy, are crucial for restoring cerebral blood flow but may also trigger ischemia–reperfusion injury and systemic inflammatory activation, associated with poorer clinical outcomes. Methods: We retrospectively analyzed medical records of 8833 patients hospitalized for acute ischemic stroke between January 2014 and May 2025. Of these, 2242 (25.38%) underwent reperfusion therapy (mechanical thrombectomy ± intravenous thrombolysis), and 6591 (74.62%) were treated conservatively. Laboratory parameters, including leukocyte count, C-reactive protein (CRP), and albumin, and composite inflammatory indices (e.g., neutrophil-to-lymphocyte ratio (NLR), systemic immune–inflammation index (SII), systemic-inflammation response index (SIRI), and neutrophil percentage-to-albumin ratio (NPAR)), were assessed at admission. Clinical outcomes included in-hospital mortality and functional scale results (e.g., National Institutes of Health Stroke Scale, modified Rankin score (mRS), Barthel scale, and Glasgow Coma Scale (GCS)). Results: Patients treated with reperfusion therapy had higher inflammatory indices (white blood cells, CRP, NLR, SII, and NPAR) compared to patients treated conservatively. In multiple regression analysis, these indices were significantly determined only by GCS and mRS scores, but age, gender, comorbidities, biochemical determinations, and type of ischemic stroke treatment (reperfusion or conservative) remained non-statistically significant. Conclusions: Patients with acute ischemic stroke undergoing reperfusion therapy exhibited a stronger inflammatory response and higher in-hospital mortality than those treated conservatively. However, multivariate analysis showed that a stronger inflammatory response following reperfusion therapy results more from the severity of the patients’ state than the kind of therapy. Full article

Background/Objectives: In clinical informatics, the term ‘information overload’ is increasingly used to describe the operational impediments of excessive documentation. While electronic health records (EHRs) are growing in abundance, many medical records (MRs) remain in legacy formats that impede efficient, systematic processing, contributing to the extenuating challenges of care fragmentation. Thus, there is a growing interest in using generative AI (genAI) for automated MR summarization and characterization. Methods: MRs for a set of 78 individuals were digitized. Some were known systemic lupus erythematosus (SLE) cases, while others were under evaluation for possible SLE classification. A two-pass genAI assessment strategy was implemented using the Claude 3.5 large language model (LLM) to mine MRs for information relevant to classifying SLE vs. undifferentiated connective tissue disorder (UCTD) vs. neither via the 22-criteria EULAR 2019 model. Results: Compared to clinical determination, the antinuclear antibody (ANA) criterion (whose results are crucial for classifying SLE-negative cases) exhibited favorable sensitivity 0.78 ± 0.09 (95% confidence interval) and a positive predictive value 0.85 ± 0.08 but a marginal performance for specificity 0.60 ± 0.11 and uncertain predictivity for the negative predictive value 0.48 ± 0.11. Averaged over the remaining 21 criteria, these four performance metrics were 0.69 ± 0.11, 0.87 ± 0.04, 0.54 ± 0.10, and 0.93 ± 0.03. Conclusions: ANA performance statistics imply that genAI yields confident assessments of SLE negativity (per high sensitivity) but weaker positivity. The remaining genAI criterial determinations support (per specificity) confident assertions of SLE-positivity but tend to misclassify a significant fraction of clinical positives as UCTD. Full article

Background: It is unclear whether sex or age impacts the prognostic value of a zero coronary artery calcium (CAC) score. Methods: We searched our electronic medical record (eMR) database for primary prevention patients who underwent positron emission tomography/computed tomography (PET/CT) stress testing. We assessed coronary prognosis and all-cause death during 2.2 (SD 1.9) years of follow-up in women vs. men and in those ≥65 vs. <65 years old by CAC = 0 vs. CAC > 0 scores. Results: We identified 40,018 qualifying patients, of which 48.7% were women and 58.9% were ≥65. CAC = 0 was present in 7967 (19.9%), of which 67.8% were women, and 34.9% were aged ≥65. In CAC = 0 patients, 13 coronary events occurred: 7 (0.13%) in women and 6 (0.24%) in men (p = 0.28); and 6 (0.12%) in <65 and 7 (0.25%) in ≥65 years old (p = 0.15). All-cause death rates comparing CAC = 0 to CAC > 0 subjects were 3.1% vs. 9.8% overall: 3.1% vs. 9.5% in women and 3.3% vs. 10.2% in men, 2.4% vs. 6.9% for ages <65, and 4.7% vs. 11.5% for ≥65 years old; all p < 0.001. Conclusions: A zero CAC score predicts an excellent prognosis for not only coronary events but also all-cause mortality, both overall and in women and the elderly. Full article

Objective: This study aims to apply different deep learning convolutional neural network algorithms to assess the grading of cervical spinal stenosis and to evaluate their consistency with clinician grading results as well as clinical manifestations of patients. Methods: We retrospectively enrolled 954 patients with cervical spine magnetic resonance imaging (MRI) data and medical records from the Fifth Affiliated Hospital of Sun-Yat Sen University. The Kang grading method for sagittal MR images of the cervical spine and the spinal cord compression ratio for horizontal MR images of the cervical spine were adopted for cervical spinal canal stenosis grading. The collected data were randomly divided into training/validation and test sets. The training/validation sets were processed by various image preprocessing and annotation methods, in which deep learning convolutional networks, including classification, target detection, and key point localization models, were applied. The predictive grading of the test set by the model was finally contrasted with the grading results of the clinicians, and correlation analysis was performed with the clinical manifestations of the patients. Result: The EfficientNet_B5 model achieved a five-fold cross-validated accuracy of 79.45% and near-perfect agreement with clinician grading on the test set (κ= 0.848, 0.822), surpassing resident–clinician consistency (κ = 0.732, 0.702). The model-derived compression ratio (0.45 ± 0.07) did not differ significantly from manual measurements (0.46 ± 0.07). Correlation analysis showed moderate associations between model outputs and clinical symptoms: EfficientNet_B5 grades (r = 0.526) were comparable to clinician assessments (r = 0.517, 0.503) and higher than those of residents (r = 0.457, 0.448). Conclusion: CNN models demonstrate strong performance in the objective, consistent, and efficient grading of cervical spinal stenosis severity, offering potential clinical value in automated diagnostic support. Full article

Background/Objectives: Mitral regurgitation (MR) is the most common left heart valve disease, but its exact prevalence remains uncertain. To estimate the prevalence of MR we conducted a systematic review and meta-analysis of population-based studies. Methods: We searched the Medline/PubMed, Embase, and Scopus databases, in January 2023, for studies reporting or allowing for the calculation of the prevalence of moderate-to-severe MR in the general population. Eligible studies included those using echocardiography or primary care databases from countries with universal healthcare. Studies where echocardiography was performed for medical indications were excluded. Random-effects meta-analysis was used to calculate the pooled estimates. Subgroup and meta-regression analyses were employed to investigate the reasons for heterogeneity. Mixed-model multivariable meta-regression was used to estimate age- and sex-specific prevalence. Results: After screening 13,847 records, we identified 20 eligible studies (22 study populations) including 6,036,691 individuals. The global prevalence of moderate-to-severe MR was 0.67% (95% CI, 0.33−1.11). Prevalence increased greatly with age, and it was estimated to be approximately 0.63% (0.25–1.16) at age 50, 2.85% (1.96–3.90) at 70, and 6.45% (4.17–9.16) by 90 years. North America showed the largest crude prevalence (1.11%; 0.52−1.88), followed by Europe (0.60%; 0.34−0.92), Asia (0.24%; 0.00−0.92), and Africa (0.16%; 0.03−0.37). Differences in prevalence by geographic region and ethnic group were primarily attributable to population age. Prevalence did not differ by sex, study year, or diagnostic criteria. Conclusions: Moderate-to-severe MR is a prevalent condition, particularly among elderly people. With rising life expectancy worldwide, ensuring universal access to interventions will be vital to reduce morbidity and mortality. Full article

Background: The main data basis for the Diagnosis-Related Group (DRG) payment methodology is the disease diagnosis and clinical codes in the Medical Record (MR). Problems such as up-coding have arisen during implementation in many countries, and problems with MR quality and solutions have been studied mostly from the physician’s perspective. We investigated and analyzed the main influences on clinical coding from the perspectives of directors and coders in Medical Records Section (MRS) to provide recommendations for improvements in data quality. Methods: The questionnaire was developed, revised and improved using literature research and expert consultation methods. From 13 to 19 June 2024, the electronic questionnaire survey was conducted among the directors and coders of medical records department in healthcare organization. A total of 484 directors and coders were included in this study. And relevant statistics were computed and analyzed by non-parametric tests. Results: Coders should possess strong job responsibilities (92.36%), coding skills (91.33%), knowledge of clinical medicine (90.70%), and other comprehensive qualities and abilities. When encountering difficult problems, the clinical coders should first communicate with clinical doctors (91.95%). The two main factors affecting the quality of MR and clinical coding are the individual factors of doctors (88.84%) and the individual factors of coders (85.54%). Conclusions: Doctors and coders are the primary factors influencing the quality of clinical coding. It is recommended to establish a systematic training program for doctors to enhance the connotative quality of MR, for coders to solidify professional coding skills, strengthen communication and exchange, adopt reasonable behaviors, avoid moral hazards, and effectively improve the quality of clinical coding. Full article

Purpose: Lymphomas are generally radiosensitive; therefore, disease volume tends to shrink during radiotherapy courses. As MRI-linac provides excellent soft tissue definition and allows daily re-contouring of gross tumor volume and clinical target volume, its adoption could be beneficial for the treatment of lymphomas. Nonetheless, at this time there is a lack of literature regarding the use of MR-linac in this context. Methods: A prospective observational study was conducted on patients affected by non-Hodgkin lymphoma (NHL) involving head and neck (H&N) sites and treated with Elekta Unity^® MR-Linac. The clinical and dosimetric data of the first eight patients were collected and integrated with relevant data from medical records. Results: Seven patients had B-cell lymphoma (three DLBCL, two MALT, one follicular, and one mantle-cell) and one T-cell/NK lymphoma. The intent of RT was radical for four patients, salvage treatment for three, and CAR-T bridging for one. Two patients presented orbital localizations and six cervical lymphonodal sites. Median GTV was 5.74 cc, median CTV 127.01 cc, and median PTV 210.37 cc. The prescribed dose was 24–50 Gy in 2 Gy fractions for seven patients and 24 Gy in 3 Gy fractions for one patient. All the patients experienced acute toxicity, the maximum grade was G1 for five patients and G2 for three at the end of RT. One month after radiotherapy seven patients still experienced G1 toxicity, but no toxicity grade ≥ 2 was reported. First radiological assessment was performed for all the patients after a median of 101.5 days, reporting complete response in all the cases. After a median follow up of 330 days, no patient experienced local disease progression, while one patient developed distant progression. Conclusions: radiotherapy for NHL with H&N localization using a 1.5 T MR-linac was feasible, with no >G2 toxicity and optimal response rate and disease control. Full article

Introduction: This study presents long-term data of pediatric AIS patients with a favorable initial clinical presentation who were followed by a tertiary pediatric neurology clinic with a well-organized stroke team. Method: Patients who were diagnosed with AIS at pediatric age (28 days–18 years) and followed for at least 5 years by the same clinic were included in this study. The clinical and demographical characteristics of the patients were retrospectively collected from their medical records. At their last visit, the modified Rankin scale (mRS) and Pediatric Stroke Outcome Measure Short Neuro Exam (PSOM-SNE) were administered, and a neurological examination was performed. Results: A total of 32 patients (20 of whom were male, 62.5%) were included in this study. Their mean age at the time of the study was 162.62 ± 64.4 (62–300) months. The mean age at first ischemic stroke was 77.39 ± 61.93 (0.5–180) months, and the mean follow-up duration was 85.44 ± 20.52 (60–121) months. Seventeen patients (53.3%) reported normal daily functions at the last visit. A younger presentation age (≤60 months) was related to a longer hospital admission duration (24 h vs. 9 h) and worse long-term functional outcomes (p = 0.023). The affected vascular territory did not have any significant effect on long-term clinical outcomes (p = 0.550). Anticoagulant treatment alone was consistent with a worse prognosis compared to antithrombotic treatment alone or the combination of both (p = 0.026). PSOM-SNE scores were helpful in detecting some mild cognitive and language dysfunctions in patients with favorable mRS scores and subtle neurological sequelae. Conclusions: Pediatric AIS with a mild presentation has some degree of long-term morbidity, even when handled at well-organized stroke centers. A younger presentation age has the highest risk of long-term neurological sequelae. Full article

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that poses serious long-term patient burdens. (1) Background: SLE patient classification and care are often complicated by case heterogeneity (diverse variations in symptoms and severity). Large language models (LLMs) and generative artificial intelligence (genAI) may mitigate this challenge by profiling medical records to assess key medical criteria. (2) Methods: To demonstrate genAI-based profiling, ACR (American College of Rheumatology) 1997 SLE classification criteria were used to define medically relevant LLM prompts. Records from 78 previously studied patients (45 classified as having SLE; 33 indeterminate or negative) were computationally profiled, via five genAI replicate runs. (3) Results: GenAI determinations of the “Discoid Rash” and “Pleuritis or Pericarditis” classification criteria yielded perfect concurrence with clinical classification, while some factors such as “Immunologic Disorder” (56% accuracy) were statistically unreliable. Compared to clinical classification, our genAI approach achieved a 72% predictive success rate. (4) Conclusions: GenAI classifications may prove sufficiently predictive to aid medical professionals in evaluating SLE patients and structuring care strategies. For individual criteria, accuracy seems to correlate inversely with complexities in clinical determination, implying that improvements in AI patient profiling tools may emerge from continued advances in clinical classification efficacy. Full article

Background: Hepatic encephalopathy (HE) may arise as a possible consequence of cirrhosis. Magnetic resonance imaging (MRI) may reveal a T1-weighted hyperintensity in the globi pallidi, indicating the deposition of paramagnetic substances. The objective of this research was to implement a machine learning-based radiomic model to predict the diagnosis and severity of chronic hepatic encephalopathy in adult patients with cirrhosis. Methods: Between October 2018 and February 2020, brain magnetic resonance imaging (MRI) was conducted on adult patients, both with and without cirrhosis. The control population consisted of individuals who did not have a previous medical record of chronic liver disease. The grade of hepatic encephalopathy (HE) was determined by considering factors such as the presence of underlying liver disease, the severity of clinical symptoms, and the frequency of encephalopathic episodes. Radiomic texture analysis based on five machine learning algorithms was applied to axial T1-weighted MR images of bilateral lentiform nuclei. Using the area under the receiver operating characteristics curve, we determined the accuracy of the five machine learning-based algorithms in predicting the presence of HE and the HE grading. Results: The ultimate research cohort included 124 individuals, with 70 being cirrhotic patients and 54 being non-cirrhotic controls. Of the total number of patients, 38 had a previous occurrence of HE and, among them, 22 had a grade of HE greater than 1. The multilayer perceptron algorithm classified patients versus controls with an accuracy of 100%. The k-nearest neighbor (KNN) algorithm classified patients with or without HE with an accuracy of 76.5%. The multilayer perceptron algorithm classified HE grade (HE grade 1, HE grade ≥ 2) with an accuracy of 94.1%. Conclusions: The machine learning algorithms implemented provide a robust modeling technique for deriving valuable insights from brain MR images in cirrhotic patients and this can serve as an imaging tool valuable for the assessment of the burden of hepatic encephalopathy. Full article

Background: Chronic subdural hematoma (CSDH) is increasingly common due to the aging population and widespread use of anticoagulant and antiplatelet medications. The objective of this study is to examine the internal composition of CSDH and explore potential risk factors associated with its recurrence. Methods: This retrospective study analyzed data from 189 patients who underwent surgery in our department between 2014 and 2018. Recorded data included demographics, clinical information, details of surgical interventions, computer tomography (CT) scans, neurological assessments, and follow-up data. The outcome was evaluated clinically and through CT follow-up conducted 4–12 weeks post-surgery. CT scans measured various parameters, including hematoma thickness, hyperdense regions, chronic components, and membrane presence. Results: Patients after the evacuation of CSDH were significantly more common males (66.1%, p > 0.001) had a significantly higher BMI (p < 0.001, 61.6%), arterial hypertension (p < 0.001, 68.3%), and the intake of anticoagulant therapy (p < 0.001, 58%). The recurrence rate was 18.6% after 4 weeks and 2.1% after 8–12 weeks. After uni- and multivariable analysis, the initial hemispheric type (p = 0.019, HR: 3.191; p = 0.012, HR: 3.810) and the increasing preoperative midline shift in CT (p = 0.028, HR: 1.114; p = 0.041, HR: 1.107) were found as independent predictors for recurrence. Overall, outcomes were favorable with a modified Rankin scale (mRS) of 0–2 at discharge (72%), after 4 (89.7%) and 12 (87%) weeks. Conclusion: According to our data, increasing midline shift before surgery and initial hemispheric type of hematoma were independent predictors of recurrence. Most patients achieved an excellent outcome with a low-risk profile. Full article

Background/Objectives: Post-polio syndrome (PPS) affects former polio patients, manifesting decades after initial infection with progressive symptoms like pain, fatigue, and muscle weakness. Diagnosis relies on the clinical criteria and exclusion of other probable causes. The purpose of this study is to determine the scope and new diagnostic value of magnetic resonance imaging (MRI) in identifying muscle involvement in PPS and distinguishing it from prior poliomyelitis (PPM). Methods: This study was approved by the Koç University Ethics Committee with Approval No. 2023.409.IRB2.090. Electronic medical archives from two academic institutions were searched for records tagged with ICD code B-91 for poliomyelitis sequalae. The resulting search query of 291 records was manually sorted for PPS and PPM, medical history, clinical examination findings, and lumbar MR images down to 32 patients. Two independent radiologists evaluated the paraspinal musculature in the MRIs using the Mercuri scale. Inter-rater agreement, comparison of the paraspinal musculatures between groups, and their relationship to leg involvement were assessed with the resulting data. Results: Inter-rater agreement was found to be almost perfect across all muscles, except for the multifidus muscle. When clinical examination findings were included for these muscles, quadratus lumborum (QL) degradation was found in both right-side (p = 0.017) and left-side (p = 0.002) leg involvement. Conclusions: QL muscle deterioration may serve as a diagnostic marker for PPS, potentially guiding lumbar pain treatment through rehabilitation. Full article

Background and Objectives: The aim of the report is to report the outcomes of the medial rectus (MR) disinsertion procedure for the management of large-angle esotropia (ET) patients. Materials and Methods: This is a retrospective case series of patients with large-angle ET who underwent an MR disinsertion procedure between March 2012 to April 2022. The procedure happened accidentally during muscle surgery. The demographic and clinical data, including sex, age, visual acuity, pre- and postoperative angle of strabismus, duction limitations, results of intraoperative forced duction tests, and follow-up duration were collected from medical records. Results: Five patients were enrolled in this study. The mean age was 62.2 ± 9.8 years, and the mean follow-up was 24.8 ± 8.7 months. The ET at the primary position of gaze was 92.0 ± 17.9 prism diopters (PD) before MR disinsertion and 38.0 ± 29.5 PD after MR disinsertion only. Abduction deficiency was −4 before after MR disinsertion, which improved to −1 at the last follow-up. Conclusions: The results of MR disinsertion were not as frustrating as anticipated. MR disinsertion may be considered in patients with large-angle sensory ET who refuse surgery on the opposite eye. Full article