Prediction of vitreomacular traction syndrome outcomes with deep learning: A pilot study.

PURPOSE: To investigate the potential of an Optical Coherence Tomography (OCT) based Deep-Learning (DL) model in the prediction of Vitreomacular Traction (VMT) syndrome outcomes. DESIGN: A single-centre retrospective review. METHODS: Records of consecutive adult patients attending the Royal Adelaide Hospital vitreoretinal clinic with evidence of spontaneous VMT were reviewed from January 2019 until May 2022. All patients with evidence of causes of cystoid macular oedema or secondary causes of VMT were excluded. OCT scans and outcome data obtained from patient records was used to train, test and then validate the models. RESULTS: For the deep learning model, ninety-five patient files were identified from the OCT (SPECTRALIS system; Heidelberg Engineering, Heidelberg, Germany) records. 25% of the patients spontaneously improved, 48% remained stable and 27% had progression of their disease, approximately. The final longitudinal model was able to predict 'improved' or 'stable' disease with a positive predictive value of 0.72 and 0.79, respectively. The accuracy of the model was greater than 50%. CONCLUSIONS: Deep-learning models may be utilised in real-world settings to predict outcomes of VMT. This approach requires further investigation as it may improve patient outcomes by aiding ophthalmologists in cross-checking management decisions and reduce the need for unnecessary interventions or delays.

Quality of life during usual epilepsy care for anxiety or depression symptoms: Secondary patient-reported outcomes in a randomized trial of remote assessment methods.

BACKGROUND AND OBJECTIVES: Anxiety and depression are highly prevalent and impactful in epilepsy. American Academy of Neurology quality measures emphasize anxiety and depression screening and quality of life (QOL) measurement, yet usual epilepsy care QOL and anxiety/depression outcomes are poorly characterized. The main objective was to assess 6-month QOL, anxiety and depression during routine care among adults with epilepsy and baseline anxiety or depression symptoms; these were prespecified secondary outcomes within a pragmatic randomized trial of remote assessment methods. METHODS: Adults with anxiety or depression symptoms and no suicidal ideation were recruited from a tertiary epilepsy clinic via an electronic health record (EHR)-embedded process. Participants were randomized 1:1 to 6 month outcome collection via patient portal EHR questionnaires vs. telephone interview. This report focuses on an a priori secondary outcomes of the overall trial, focused on patient-reported health outcomes in the full sample. Quality of life, (primary health outcome), anxiety, and depression measures were collected at 3 and 6 months (Quality of Life in Epilepsy-10, QOLIE-10, Generalized Anxiety Disorder-7, Neurological Disorders Depression Inventory-Epilepsy). Change values and 95 % confidence intervals were calculated. In post-hoc exploratory analyses, patient-reported anxiety/depression management plans at baseline clinic visit and healthcare utilization were compared with EHR-documentation, and agreement was calculated using the kappa statistic. RESULTS: Overall, 30 participants (15 per group) were recruited and analyzed, of mean age 42.5 years, with 60 % women. Mean 6-month change in QOLIE-10 overall was 2.0(95 % CI -6.8, 10.9), and there were no significant differences in outcomes between the EHR and telephone groups. Mean anxiety and depression scores were stable across follow-up (all 95 % CI included zero). Outcomes were similar regardless of whether an anxiety or depression action plan was documented. During the baseline interview, most participants with clinic visit EHR documentation indicating action to address anxiety and/or depression reported not being offered a treatment(7 of 12 with action plan, 58 %), and there was poor agreement between patient report and EHR documentation (kappa=0.22). Healthcare utilization was high: 40 % had at least one hospitalization or emergency/urgent care visit reported and/or identified via EHR, but a third (4/12) failed to self-report an EHR-identified hospitalization/urgent visit. DISCUSSION: Over 6 months of usual care among adults with epilepsy and anxiety or depression symptoms, there was no significant average improvement in quality of life or anxiety/depression, suggesting a need for interventions to enhance routine neurology care and achieve quality of life improvement for this group.

Prevalence and Management Outcomes of Burns in a Teaching Hospital in Ekiti State, Nigeria: A Five-Year Review.

Burn injuries are significant sources of morbidity and mortality globally. Despite the advances in the management of burn injuries, a great number of victims still develop complications. This study aimed at determining the prevalence and management outcomes of burn injuries in a Teaching Hospital in Ekiti State, Nigeria. The study was retrospective in nature. A total of 203 hospital records of burn patients seen between January 2015 and December 2019 were collected and analyzed, using descriptive and inferential statistics. Findings from the study revealed that half (51.7%) of the respondents were within ages 0-10 years and more than half (63.1%) were males. The study findings also revealed a relative decline in the prevalence of burn injury as the average prevalence in the years under review. Some of the reported complications were wound infection (4.9%), delayed healing (4.4%), residual wound (4.4%) and death (9.4%). In addition, the study revealed that there was no relationship between gender, age, socioeconomic factors and prevalence and management outcomes of burn in the study setting. The study recommends that efforts should be made by health workers to equip themselves with knowledge of the complex needs of burn victims and also to keep abreast with the advances in critical care.

Les brûlures sont une cause significative de morbidité et de mortalité. Malgré les progrès dans leur prise en charge, de nombreux patients souffrent de complications. Cette étude a pour but de déterminer la prévalence et l'évolution des patients hospitalisés dans un CHU de l'état d'Etiki. Il s'agit d'une étude rétrospective ayant revu les dossiers de 203 patients hospitalisés entre janvier 2015 et décembre 2019 pour réaliser une étude descriptive et inférentielle. Plus de la moitié (51,7%) des patients avaient moins de 10 ans et quasiment les 2/3 étaient de sexe masculin. La prévalence semble diminuer mais est encore en cours d'évaluation. La mortalité était de 9,4% et les principales complications étaient l'infection de brûlure (4,9%), le retard ou l'absence de cicatrisation (4,4% pour les 2). Il n'y avait pas de relation entre l'âge, le sexe, les conditions socio-économiques et la prévalence ni la prise en charge. Nous recommandons que les soignants développent et mettent à jour leur connaissances sur le prise en charge des brûlés et leur réanimation.