Real-world clinical characterization, healthcare resource utilization and productivity loss in chronic graft versus host patients exposed to extracorporeal photopheresis in Sweden.

BACKGROUND: Extracorporeal photopheresis (ECP) is frequently used to treat moderate-severe chronic graft versus host disease (cGVHD), however limited data exists describing ECP treatment effects on healthcare and societal costs. We aimed to characterize clinical and health economic outcomes and productivity loss in cGVHD patients exposed to ECP. METHODS: We identified 2708 patients aged ≥ 18 years with a record of allogeneic hematopoietic stem cell transplantation (HSCT) in the Swedish Patient Register between 2006 and 2020. Patients exposed to ECP from 3-months post HSCT (index) were included (n= 183). Data was linked to the Prescribed Drug Register, the Cause of Death Register, and the Longitudinal Integrated Database for Health Insurance and Labor Market Studies (LISA). RESULTS: The median patient age at index was 51 years (IQR1-3; 38-61). In the 3-month period before ECP initiation compared to 9-12 months post-ECP, the cumulative three-month dose per patient decreased prednisolone/prednisone (1,381 mg vs. 658 mg, p < 0.001) and cyclosporin (12,242 mg vs. 3,501 mg, p < 0.001). Infection incidence also decreased over the same period (79.2% vs 59.1%, p < 0.001). Time spent in healthcare decreased from 68.9% to 22.1% from the first and fifth follow-up year respectively, and corresponding annual healthcare cost reduced from €27,719 to €1,981. Among patients < 66 years of age, sickness-related workplace absence decreased from 73.2% to 31.9% between the first and fifth follow-up year, with median annual productivity loss decreasing from €20,358 to €7,211 per patient. CONCLUSIONS: ECP was associated with reduced use of corticosteroids, immunosuppressive agents, and fewer infections. Furthermore, cost and healthcare utilization decreased over time.

Development and evaluation of deep learning algorithms for assessment of acute burns and the need for surgery.

Assessment of burn extent and depth are critical and require very specialized diagnosis. Automated image-based algorithms could assist in performing wound detection and classification. We aimed to develop two deep-learning algorithms that respectively identify burns, and classify whether they require surgery. An additional aim assessed the performances in different Fitzpatrick skin types. Annotated burn (n = 1105) and background (n = 536) images were collected. Using a commercially available platform for deep learning algorithms, two models were trained and validated on 70% of the images and tested on the remaining 30%. Accuracy was measured for each image using the percentage of wound area correctly identified and F1 scores for the wound identifier; and area under the receiver operating characteristic (AUC) curve, sensitivity, and specificity for the wound classifier. The wound identifier algorithm detected an average of 87.2% of the wound areas accurately in the test set. For the wound classifier algorithm, the AUC was 0.885. The wound identifier algorithm was more accurate in patients with darker skin types; the wound classifier was more accurate in patients with lighter skin types. To conclude, image-based algorithms can support the assessment of acute burns with relatively good accuracy although larger and different datasets are needed.

Determinants of speeding among new generations of car drivers from the Arabian Peninsula. An investigation based among Omani drivers using the theory of planned behaviour.

In high-income countries of the Arabian Peninsula, including the Sultanate of Oman, motorization has been extremely rapid. As a result, road traffic crashes are by far the highest cause of premature mortality, and speeding is an acknowledged key risk factor. Theory-based interventions are needed to target prevention of this unsafe practice. This study sheds light on determinants of speeding among new generations of Omani drivers applying the Theory of Planned Behaviour (TPB). A questionnaire covering all five main constructs of the TPB was first contextualized and administered to two target groups: male drivers of all ages (n = 1107) approached in person when renewing their driving license and university students drivers (men and women) reached through internet contact (n = 655). Multiple, stepwise linear regression analyses were used to explore factors associated with speeding. Results indicate that driving fast and not respecting the posted speed limits was common in both groups of drivers, although rates were higher among students; 41.8% reported driving a bit faster than other drivers and 24.1% faster than the posted speed limit compared with 31.4% and 14.2% in male drivers of all ages. In both groups the TPB model predicted to a limited extent the determinants of speeding behaviour. However, the intention to speed was associated with a negative attitude towards the respect of rules for men of all ages (ß = -0.30 (p<0.001)) and for students (ß = -0.26 (p<0.001)); a positive view regarding subjective norms (ß = 0.25 (p<0.001) and ß = 0.28 (p<0.001) respectively), and behavioural control (ß = 0.15 (p<0.001) and ß = 0.20 (p<0.001) respectively). Intention was the only significant predictor of speeding behaviour (ß = 0.48 (p<0.001); and ß = 0.64 (p<0.001)). To conclude, speeding is widespread among Omani drivers of all ages and the intention to respect posted speed limits meets a range of barriers that need greater consideration in order to achieve a better safety culture in the country.

Image-based teleconsultation using smartphones or tablets: qualitative assessment of medical experts.

BACKGROUND: Mobile health has promising potential in improving healthcare delivery by facilitating access to expert advice. Enabling experts to review images on their smartphone or tablet may save valuable time. This study aims at assessing whether images viewed by medical specialists on handheld devices such as smartphones and tablets are perceived to be of comparable quality as when viewed on a computer screen. METHODS: This was a prospective study comparing the perceived quality of 18 images on three different display devices (smartphone, tablet and computer) by 27 participants (4 burn surgeons and 23 emergency medicine specialists). The images, presented in random order, covered clinical (dermatological conditions, burns, ECGs and X-rays) and non-clinical subjects and their perceived quality was assessed using a 7-point Likert scale. Differences in devices' quality ratings were analysed using linear regression models for clustered data adjusting for image type and participants' characteristics (age, gender and medical specialty). RESULTS: Overall, the images were rated good or very good in most instances and more so for the smartphone (83.1%, mean score 5.7) and tablet (78.2%, mean 5.5) than for a standard computer (70.6%, mean 5.2). Both handheld devices had significantly higher ratings than the computer screen, even after controlling for image type and participants' characteristics. Nearly all experts expressed that they would be comfortable using smartphones (n=25) or tablets (n=26) for image-based teleconsultation. CONCLUSION: This study suggests that handheld devices could be a substitute for computer screens for teleconsultation by physicians working in emergency settings.

Can We Trust the Use of Smartphone Cameras in Clinical Practice? Laypeople Assessment of Their Image Quality.

BACKGROUND: Smartphone cameras are rapidly being introduced in medical practice, among other devices for image-based teleconsultation. Little is known, however, about the actual quality of the images taken, which is the object of this study. MATERIALS AND METHODS: A series of nonclinical objects (from three broad categories) were photographed by a professional photographer using three smartphones (iPhone(®) 4 [Apple, Cupertino, CA], Samsung [Suwon, Korea] Galaxy S2, and BlackBerry(®) 9800 [BlackBerry Ltd., Waterloo, ON, Canada]) and a digital camera (Canon [Tokyo, Japan] Mark II). In a Web survey a convenience sample of 60 laypeople "blind" to the types of camera assessed the quality of the photographs, individually and best overall. We then measured how each camera scored by object category and as a whole and whether a camera ranked best using a Mann-Whitney U test for 2×2 comparisons. RESULTS: There were wide variations between and within categories in the quality assessments for all four cameras. The iPhone had the highest proportion of images individually evaluated as good, and it also ranked best for more objects compared with other cameras, including the digital one. The ratings of the Samsung or the BlackBerry smartphone did not significantly differ from those of the digital camera. CONCLUSIONS: Whereas one smartphone camera ranked best more often, all three smartphones obtained results at least as good as those of the digital camera. Smartphone cameras can be a substitute for digital cameras for the purposes of medical teleconsulation.