Mayo Clinic Proceedings. Digital health最新文献

Objective

To learn more about the effect of virtual reality videos on patients’ symptoms near the end of life, including which are most effective, how long the effect lasts, and which patients benefit the most.

Patients and Methods

We conducted a prospective study of 30 patients in a regional hospice and palliative care program from March 11, 2022, through July 14, 2023. Using a head-mounted display virtual reality, all participants viewed a 15-minute video of serene nature scenes with ambient sounds. Fifteen patients also participated in a second session of viewing bucket-list video clips they selected. Symptoms were measured with the revised Edmonton Symptom Assessment Scale before, immediately after, and 2 days after each experience. Participants rated their bucket-list selections by level of previous experience, strength of connection, and overall video quality. Functional status was also recorded.

Results

Nature scenes significantly improved total symptom scores (30% decrease, P<.001), as well as scores for drowsiness, tiredness, depression, anxiety, well-being, and dyspnea. The improved scores were not sustained 2 days later. Overall, bucket-list videos did not significantly improve symptoms. Neither previous experience with an activity nor a strong connection correlated with significant improvement; however, when patients rated video quality as outstanding, scores improved (31% decrease, P=.03). Patients with lower functional status tended to have more symptoms beforehand and improve the most.

Conclusion

Serene nature head-mounted display virtual reality scenes safely reduce symptoms at the end of life. Bucket-list experiences may be effective if they are high-quality. More infirm patients may benefit the most.

The aim of this systematic review was to identify clinical decision support algorithms (CDSAs) proposed for assisted reproductive technologies (ARTs) and to evaluate their effectiveness in improving ART cycles at every stage vs traditional methods, thereby providing an evidence-based guidance for their use in ART practice. A literature search on PubMed and Embase of articles published between 1 January 2013 and 31 January 2024 was performed to identify relevant articles. Prospective and retrospective studies in English on the use of CDSA for ART were included. Out of 1746 articles screened, 116 met the inclusion criteria. The selected articles were categorized into 3 areas: prognosis and patient counseling, clinical management, and embryo assessment. After screening, 11 CDSAs were identified as potentially valuable for clinical management and laboratory practices. Our findings highlight the potential of automated decision aids to improve in vitro fertilization outcomes. However, the main limitation of this review was the lack of standardization in validation methods across studies. Further validation and clinical trials are needed to establish the effectiveness of these tools in the clinical setting.

Objective

To report the development and performance of 2 distinct deep learning models trained exclusively on retinal color fundus photographs to classify Alzheimer disease (AD).

Patients and Methods

Two independent datasets (UK Biobank and our tertiary academic institution) of good-quality retinal photographs derived from patients with AD and controls were used to build 2 deep learning models, between April 1, 2021, and January 30, 2024. ADVAS is a U-Net–based architecture that uses retinal vessel segmentation. ADRET is a bidirectional encoder representations from transformers style self-supervised learning convolutional neural network pretrained on a large data set of retinal color photographs from UK Biobank. The models’ performance to distinguish AD from non-AD was determined using mean accuracy, sensitivity, specificity, and receiving operating curves. The generated attention heatmaps were analyzed for distinctive features.

Results

The self-supervised ADRET model had superior accuracy when compared with ADVAS, in both UK Biobank (98.27% vs 77.20%; P<.001) and our institutional testing data sets (98.90% vs 94.17%; P=.04). No major differences were noted between the original and binary vessel segmentation and between both eyes vs single-eye models. Attention heatmaps obtained from patients with AD highlighted regions surrounding small vascular branches as areas of highest relevance to the model decision making.

Conclusion

A bidirectional encoder representations from transformers style self-supervised convolutional neural network pretrained on a large data set of retinal color photographs alone can screen symptomatic AD with high accuracy, better than U-Net–pretrained models. To be translated in clinical practice, this methodology requires further validation in larger and diverse populations and integrated techniques to harmonize fundus photographs and attenuate the imaging-associated noise.

Objective

To assess the feasibility and potential scalability of telemedicine-enabled ambulances for the prehospital evaluation of patients with suspected acute stroke symptoms.

Patients and Methods

A pilot study of telemedicine-enabled ambulances for evaluating patients with suspected acute stroke symptoms en route at 2 tertiary academic comprehensive stroke centers from January 1, 2018, to February 5, 2024. Charts of included patients were reviewed for demographic data, vascular risk factors, final diagnosis, time from arrival to neuroimaging, door-to–needle and door-to-puncture times in patients eligible for acute treatment, and any reported technical challenges during audio-video consultations.

Results

Forty-seven patients (mean age, 68.0 years; 62% men) were evaluated via telemedicine-enabled ambulances, of which 35 (74%) where for hospital-to-hospital transferred patients. Mean time from arrival to neuroimaging was 11.8 minutes. Twenty-nine patients (62%) were diagnosed with acute ischemic stroke, and the remainder were diagnosed with intracranial hemorrhage (n=13), seizure (n=2), brain mass (n=1), or other diagnoses (n=3). Four patients (9%) received intravenous thrombolysis with alteplase (mean door to needle, 30.3 minutes), and 15 patients (32%) underwent mechanical thrombectomy (mean door to puncture, 72 minutes). Technical challenges were reported in 15 of the 42 (36%) cases, of which 10 (67%) were related to poor internet connectivity.

Conclusion

Telemedicine-enabled ambulances in emergency medical services systems are novel, feasible, and potentially scalable options for evaluating patients with suspected acute stroke in the prehospital setting. However, optimization of infrastructure, staffing models, and internet connectivity is necessary, and larger studies evaluating the clinical and cost effectiveness of this approach are needed before widespread implementation.