Background
Primary myelofibrosis (PMF), essential thrombocythemia (ET), and polycythemia vera (PV) are BCR ABL‐negative myeloproliferative neoplasms (MPN). Published epidemiology data are scarce, and ...multiple sources are needed to assess the disease burden.
Methods
We assembled the most recent information available on the incidence and prevalence of myelofibrosis (MF), ET, and PV by conducting a structured and exhaustive literature review of the published peer‐reviewed literature in EMBASE and by reviewing online documentation from disease registries and relevant health registries in European countries. The search was restricted to human studies written in English or French and published between January 1, 2000, and December 6, 2012.
Results
Eleven articles identified from EMBASE, three online hematology or oncology registries, and two Web‐based databases or reports were used to summarize epidemiological estimates for MF, PV, and ET. The incidence rate of MF ranged from 0.1 per 100 000 per year to 1 per 100 000 per year. Among the various registries, the incidence of PV ranged from 0.4 per 100 000 per year to 2.8 per 100 000 per year, while the literature estimated the range of PV incidence to be 0.68 per 100 000 to 2.6 per 100 000 per year. The estimated incidence of ET was between 0.38 per 100 000 per year and 1.7 per 100 000 per year. While a few studies reported on the MPNs' prevalences, it is difficult to compare them as various types of prevalence were calculated (point prevalence vs. period prevalence) and standardization was made according to different populations (e.g., the world population and the European population).
Conclusion
There is a wide variation in both prevalence and incidence estimates observed across European data sources. Carefully designed studies, with standardized definitions of MPNs and complete ascertainment of patients including both primary and secondary MFs, should be conducted so that estimates of the population aimed to receive novel treatments for these neoplasms are better understood assist public health planning and provide valuable information about the burden of illness to policy makers, funding agencies, resource planners, healthcare insurers, and pharmaceutical manufacturers.
The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower ...rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid prescribing rates in patients without cancer, across 5 centers in 4 countries. In addition, we evaluated differences in the type, strength, and starting dose of medication and whether these characteristics changed over time.
We conducted a retrospective multicenter cohort study of adults who are new users of opioids without prior cancer. Electronic health records and administrative health records from Boston (United States), Quebec and Alberta (Canada), United Kingdom, and Taiwan were used to identify patients between 2006 and 2015. Standard dosages in morphine milligram equivalents (MMEs) were calculated according to The Centers for Disease Control and Prevention. Age- and sex-standardized opioid prescribing rates were calculated for each jurisdiction. Of the 2,542,890 patients included, 44,690 were from Boston (US), 1,420,136 Alberta, 26,871 Quebec (Canada), 1,012,939 UK, and 38,254 Taiwan. The highest standardized opioid prescribing rates in 2014 were observed in Alberta at 66/1,000 persons compared to 52, 51, and 18/1,000 in the UK, US, and Quebec, respectively. The median MME/day (IQR) at initiation was highest in Boston at 38 (20 to 45); followed by Quebec, 27 (18 to 43); Alberta, 23 (9 to 38); UK, 12 (7 to 20); and Taiwan, 8 (4 to 11). Oxycodone was the first prescribed opioid in 65% of patients in the US cohort compared to 14% in Quebec, 4% in Alberta, 0.1% in the UK, and none in Taiwan. One of the limitations was that data were not available from all centers for the entirety of the 10-year period.
In this study, we observed substantial differences in opioid prescribing practices for non-cancer pain between jurisdictions. The preference to start patients on higher MME/day and more potent opioids in North America may be a contributing cause to the opioid epidemic.
Benzodiazepines are a widely used medication in developed countries, particularly among elderly patients. However, benzodiazepines are known to affect memory and cognition and might thus enhance the ...risk of dementia. The objective of this review is to synthesize evidence from observational studies that evaluated the association between benzodiazepines use and dementia risk.
We performed a systematic review and meta-analysis of controlled observational studies to evaluate the risk of benzodiazepines use on dementia outcome. All control observational studies that compared dementia outcome in patients with benzodiazepine use with a control group were included. We calculated pooled ORs using a random-effects model. Ten studies (of 3,696 studies identified) were included in the systematic review, of which 8 studies were included in random-effects meta-analysis and sensitivity analyses. Odds of dementia were 78% higher in those who used benzodiazepines compared with those who did not use benzodiazepines (OR 1.78; 95% CI 1.33-2.38). In subgroup analysis, the higher association was still found in the studies from Asia (OR 2.40; 95% CI 1.66-3.47) whereas a moderate association was observed in the studies from North America and Europe (OR 1.49; 95% CI 1.34-1.65 and OR 1.43; 95% CI 1.16-1.75). Also, diabetics, hypertension, cardiac disease, and statin drugs were associated with increased risk of dementia but negative association was observed in the case of body mass index. There was significant statistical and clinical heterogeneity among studies for the main analysis and most of the sensitivity analyses. There was significant statistical and clinical heterogeneity among the studies for the main analysis and most of the sensitivity analyses. Key Messages: Our results suggest that benzodiazepine use is significantly associated with dementia risk. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or the result of some unmeasured confounding variable. Therefore, more research is needed.
Gastric linitis plastica is an aggressive malignancy with poor prognosis. Timely diagnosis is important for effective management. However, the conventional endoscopic biopsies are often inconclusive ...leading to delay in diagnosis and subsequent management. We present a case of a 55-year old female with high suspicion of gastric linitis plastica on gastroscopy with repeated negative endoscopic biopsies. She underwent an endoscopic ultrasound fine needle aspiration (EUS-FNA) at our center with establishment of diagnosis of gastric malignancy. There are no established guidelines about the role of EUS-FNA as a sequential diagnostic modality for this tumour. However, EUS-FNA is a highly sensitive modality to establish diagnosis in challenging cases where routine endoscopy remains inconclusive.
Imagine having a knowledge graph that can extract medical health knowledge related to patient diagnosis solutions and treatments from thousands of research papers, distilled using machine learning ...techniques in healthcare applications. Medical doctors can quickly determine treatments and medications for urgent patients, while researchers can discover innovative treatments for existing and unknown diseases. This would be incredible! Our approach serves as an all-in-one solution, enabling users to employ a unified design methodology for creating their own knowledge graphs. Our rigorous validation process involves multiple stages of refinement, ensuring that the resulting answers are of the utmost professionalism and solidity, surpassing the capabilities of other solutions. However, building a high-quality knowledge graph from scratch, with complete triplets consisting of subject entities, relations, and object entities, is a complex and important task that requires a systematic approach. To address this, we have developed a comprehensive design flow for knowledge graph development and a high-quality entities database. We also developed knowledge distillation schemes that allow you to input a keyword (entity) and display all related entities and relations. Our proprietary methodology, multiple levels refinement (MLR), is a novel approach to constructing knowledge graphs and refining entities level-by-level. This ensures the generation of high-quality triplets and a readable knowledge graph through keyword searching. We have generated multiple knowledge graphs and developed a scheme to find the corresponding inputs and outputs of entity linking. Entities with multiple inputs and outputs are referred to as joints, and we have created a joint-version knowledge graph based on this. Additionally, we developed an interactive knowledge graph, providing a user-friendly environment for medical professionals to explore entities related to existing or unknown treatments/diseases. Finally, we have advanced knowledge distillation techniques.
A novel pulse integration has been put forward in which the radar receiver, before combining envelope detector outputs in all pulses, first clips them to a suitable level to suppress excessive energy ...inflicted by a jammer. Mathematical expressions for various decision metrics relevant to this scheme are derived. Using these metrics it is shown that the proposed scheme, when combined with frequency agility, yields healthy performance gain over similar detection schemes when operating against pulse jamming.
•The study systematically examines the role of AI in enhancing CDS, highlighting its impact on patient outcomes and healthcare efficiency.•32 recent studies were analysed, and six domains were ...identified; data-driven insights and Analytics, diagnostic and predictive Modelling, treatment optimisation and personalised Medicine, patient monitoring and telehealth Integration, workflow and administrative Efficiency, and knowledge management and decision support.•Despite all benefits, AI faces challenges like data privacy concerns, ethical issues, and difficulties integrating with existing healthcare systems, necessitating multi-disciplinary collaboration.•AI's role in healthcare is transformative, enhancing CDS to provide more effective, efficient, and patient-focused care.•The future of AI in healthcare involves ethical development, ongoing training for healthcare professionals, and collaborative problem-solving, ensuring a balanced integration of AI and human expertise.
Artificial Intelligence (AI) is a transformative force in clinical decision support (CDS) systems within healthcare. Its emergence, fuelled by the growing volume and diversity of healthcare data, offers significant potential in patient care, diagnosis, treatment, and health management. This study systematically reviews AI's role in enhancing CDS across six domains, underscoring its impact on patient outcomes and healthcare efficiency.
A four-step systematic review was conducted, involving a comprehensive literature search, application of inclusion and exclusion criteria, data extraction and synthesis, and analysis. Sources included PubMed, Embase, and Google Scholar, with papers published in English since 2019. Selected studies focused on AI's application in CDS, with 32 papers ultimately reviewed.
The review identified six AI CDS domains: Data-Driven Insights and Analytics, Diagnostic and Predictive Modelling, Treatment Optimisation and Personalised Medicine, Patient Monitoring and Telehealth Integration, Workflow and Administrative Efficiency, and Knowledge Management and Decision Support. Each domain is crucial in improving various aspects of CDS, from enhancing diagnostic accuracy to optimising resource management. AI's capabilities in EHR analysis, predictive analytics, personalised treatment, and telehealth demonstrate its critical role in advancing healthcare.
AI significantly enhances healthcare by improving diagnostic precision, predictive capabilities, and administrative efficiency. It facilitates personalised medicine, remote monitoring, and evidence-based decision-making. However, challenges such as data privacy, ethical considerations, and integration with existing systems persist. This requires collaboration among technologists, healthcare professionals, and policymakers.
AI is revolutionising healthcare by enhancing CDS in several domains, contributing to more efficient, effective, and patient-centric care. However, it should complement, not replace, human expertise. Future directions include ethical AI development, continuous professional development for healthcare personnel, and collaborative efforts to address challenges. This approach ensures AI's potential is fully harnessed, leading to a synergistic blend of technology and human care.
AIM To describe the efficacy and safety of endoscopic papillary large balloon dilatation(EPLBD) in the management of bile duct stones in a Western population. METHODS Data was collected from the ...endoscopic retrograde cholangiopancreatography(ERCP) and Radiology electronic database along with a review of case notes over a period of six years from 1 st August 2009 to 31 st July 2015 and incorporated into Microsoft excel. Statistical analyses were performed using Med Calc for Windows,version 12.5(Med Calc Software,Ostend,Belgium). Simple statistical applications were applied in order to determine whether significant differences exist in comparison groups. We initially used simple proportions to describe the study populations. Furthermore,we used chi-square test to compare proportions and categorical variables. Non-parametric Mann-Whitney U-test was applied in order to compare continuous variables. All comparisons were deemed to be statistically significant if P values were less than 0.05.RESULTS EPLBD was performed in 229 patients(46 females) with mean age of 68 ± 14.3 years. 115/229(50%) patients had failed duct clearance at previous ERCP referred from elsewhere with standard techniques. Duct clearance at the Index* ERCP(1 st ERCP at our centre) was 72.5%. Final duct clearance rate was 98%. EPLBD after fresh sphincterotomy was performed in 81(35.4%). Median balloon size was 13.5 mm(10-18). In addition to EPLBD,per-oral cholangioscopy(POC) and electrohydraulic lithotripsy(EHL) was performed in 35(15%) patients at index* ERCP. 63(27.5%) required repeat ERCP for stone clearance. 28(44.5%) required POC and EHL and 11(17.4%) had repeat EPLBD for complete duct clearance. Larger stone size(12.4 mm vs 17.4 mm,P < 0.000001),multiple stones(2,range(1-13) vs 3,range(1-12),P < 0.006) and dilated common bile duct(CBD)(12.4 mm vs 18.3 mm,P < 0.001) were significant predictors of failed duct clearance at index ERCP. 47 patients(20%) had ampullary or peri-ampullary diverticula. Procedure related adverse events included 2 cases of bleeding and pancreatitis(0.87%) each.CONCLUSION EPLBD is a safe and effective technique for CBDS removal. There is no difference in outcomes whether it is performed at the time of sphincterotomy or at a later procedure or whether there is a full or limited sphincterotomy.
Groundwater plays a major role in addressing the worldwide problem of water scarcity and food security. With a growing population and increasing urbanization, there is a rising demand for groundwater ...to meet agricultural and domestic water needs. A variety of advanced approaches are necessary to sustain groundwater management. This study investigated the age and origin of groundwater, as well as its relationship with anthropogenic and climatic factors. Stable isotopes were used, namely oxygen-18 (18O) and deuterium (2H) for the estimation of groundwater origin and radioactive isotopes of Tritium (3H) for the estimation of its age. The investigation of stable isotopes revealed that the aquifer is predominantly influenced by river water, with a minor contribution from rainwater. Furthermore, the analysis of radioactive isotopes revealed that the groundwater age ranges from 5 to 50 years old in most areas. Older groundwater is predominantly found in urban areas, while younger groundwater is present in agricultural and woodland regions. However, the presence of “old” water in the upper groundwater layers in urban areas is attributed to over-abstraction and limited natural recharge. The primary climatic factor that governs the age and origin of groundwater is rainfall upstream of the study area, which directly contributes to the river flows. The rainfall is high in the east but, due to urbanization, recharge is decreased. Consequently, old and river recharge groundwater is found in this area. These observations underscore the unsustainable and alarming use of groundwater in urban areas.
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