Deep learning and minimally invasive inflammatory activity assessment: a proof-of-concept study for development and score correlation of a panendoscopy convolutional network.

Background: Capsule endoscopy (CE) is a valuable tool for assessing inflammation in patients with Crohn's disease (CD). The current standard for evaluating inflammation are validated scores (and clinical laboratory values) like Lewis score (LS), Capsule Endoscopy Crohn's Disease Activity Index (CECDAI), and ELIAKIM. Recent advances in artificial intelligence (AI) have made it possible to automatically select the most relevant frames in CE. Objectives: In this proof-of-concept study, our objective was to develop an automated scoring system using CE images to objectively grade inflammation. Design: Pan-enteric CE videos (PillCam Crohn's) performed in CD patients between 09/2020 and 01/2023 were retrospectively reviewed and LS, CECDAI, and ELIAKIM scores were calculated. Methods: We developed a convolutional neural network-based automated score consisting of the percentage of positive frames selected by the algorithm (for small bowel and colon separately). We correlated clinical data and the validated scores with the artificial intelligence-generated score (AIS). Results: A total of 61 patients were included. The median LS was 225 (0-6006), CECDAI was 6 (0-33), ELIAKIM was 4 (0-38), and SB_AIS was 0.5659 (0-29.45). We found a strong correlation between SB_AIS and LS, CECDAI, and ELIAKIM scores (Spearman's r = 0.751, r = 0.707, r = 0.655, p = 0.001). We found a strong correlation between LS and ELIAKIM (r = 0.768, p = 0.001) and a very strong correlation between CECDAI and LS (r = 0.854, p = 0.001) and CECDAI and ELIAKIM scores (r = 0.827, p = 0.001). Conclusion: Our study showed that the AI-generated score had a strong correlation with validated scores indicating that it could serve as an objective and efficient method for evaluating inflammation in CD patients. As a preliminary study, our findings provide a promising basis for future refining of a CE score that may accurately correlate with prognostic factors and aid in the management and treatment of CD patients.

Artificial intelligence in Crohn's disease: the development of an automated score for disease activity evaluation This study introduces an innovative AI-based approach to evaluate Crohn's Disease. The AI system automatically analyzes images from capsule endoscopy, focusing on finding ulcers and erosions to measure disease activity. The research reveals a robust correlation between the AI-generated score assessing inflammation in the small bowel and traditional clinical scores. This suggests that the AI solution could be a quicker and more consistent way to evaluate Crohn's Disease, speeding up the evaluation process and reducing manual scoring variability. While promising, the study acknowledges limitations and emphasizes the need for further validation with larger groups of patients. Overall, it represents a crucial step toward integrating AI into gastroenterology, offering a glimpse into a future of more objective and personalized Crohn's Disease evaluation.

Patients with complete clinical response after neoadjuvant chemoradiotherapy for locally advanced esophageal cancer: A Markov decision analysis of esophagectomy versus active surveillance.

OBJECTIVE: Chemoradiation followed by esophagectomy is a standard treatment option for patients with locally advanced esophageal cancer (LAEC). Esophagectomy is a high-risk procedure, and recent evidence suggests select patients may benefit from omitting or delaying surgery. This study aims to compare surgery versus active surveillance for LAEC patients with complete clinical response (cCR) after neoadjuvant chemoradiotherapy (nCRT). METHODS: Decision analysis with Markov modeling was used. The base case was a 60-year-old man with T3N0M0 esophageal cancer with cCR after nCRT. The decision was modeled for a 5-year time horizon. Primary outcomes were life-years and quality-adjusted life-years (QALY). Probabilities and utilities were derived through the literature. Deterministic sensitivity analyses were performed using ranges from the literature with consideration for clinical plausibility. RESULTS: Surgery was favored for survival with an expected life-years of 2.89 versus 2.64. After incorporating quality of life, active surveillance was favored, with an expected QALY of 1.70 versus 1.56. The model was sensitive to probability of recurrence on active surveillance (threshold value 0.598), probability of recurrence being resectable (0.318), and disutility of previous esophagectomy (-0.091). The model was not sensitive to perioperative morbidity and mortality. CONCLUSIONS: Our study finds that surgery increases life expectancy but decreases QALY. Although the incremental change in QALY for either modality is insufficient to make broad clinical recommendations, our study demonstrates that either approach is acceptable. As probabilities of key factors are further defined in the literature, treatment decisions for patients with LAEC and a cCR after nCRT should consider histology, patient values, and quality of life.

Integration of the social determinants of health into quality indicators for colorectal cancer surgery: a scoping review protocol.

INTRODUCTION: Quality monitoring is a critical component of high-performing cancer care systems. Quality indicators (QIs) are standardised, evidence-based measures of healthcare quality that allow healthcare systems to track performance, identify gaps in healthcare delivery and inform areas of priority for strategic planning. Social structures and economic systems that allow for unequal access to power and resources that shape health and health inequities can be described through the social determinants of health (SDoH) framework. Therefore, granular analysis of healthcare quality through SDoH frameworks is required to identify patient subgroups who may experience health inequity. Given the high burden of disease of colorectal cancer (CRC) and well-defined cancer care pathways, CRC is often the first disease site targeted by health systems for quality improvement. The objective of this review is to examine how SDoH have been integrated into QIs for CRC surgery. This review aims to address three primary questions: (1) Have SDoH been integrated into the development, reporting and assessment of CRC surgery QIs? (2) When integrated, what measures and statistical methods have been applied? (3) In which direction do individual SDoH influence QIs outputs? METHODS: This review will follow Arksey and O'Malley frameworks for scoping reviews. We will search MEDLINE, EMBASE, HealthSTAR databases for papers that examine QIs for CRC surgery applicable to healthcare systems from database inception until January 2023. Interventional trials, prospective and retrospective observational studies, reviews, case series and qualitative study designs will be included. Two authors will independently review all titles, abstracts and full texts to determine which studies meet the inclusion criteria. ETHICS & DISSEMINATION: No ethics approval is required for this review. Results will be disseminated through scientific presentation and relevant conferences targeted for researchers examining healthcare quality and equity in cancer care. REGISTRATION DETAILS: osf.io/vfzd3-Open Science Framework.

Integrating equity frameworks into surgical quality improvement and health administrative databases: A narrative review.

Ensuring safe, timely, and effective surgery is critical for high-quality healthcare and is the goal of surgical quality monitoring systems. At the heart of these systems are health administrative databases which house patient clinico-demographic information, healthcare processes and outcomes. Through analysis of monitoring systems outputs, we can identify gaps within healthcare delivery, patient experience, and surgical outcomes. However, gaps in our healthcare can only be measured by the variables we collect. Equity stratifiers are sociodemographic descriptors that can identify patient populations who experience differences in health and healthcare that may be considered unjust or unfair. They include age, education, gender, geographic location, income, Indigenous identity, racialized group, and sex at birth. These equity stratifiers represent measurable components of the social determinants of health housed within health administrative databases and allow for standardized analysis and reporting of health inequity. However, not all databases collect these stratifiers - making granular analysis of patient subgroups who may experience health inequity impossible to measure. Moreover, in databases that do collect this information, a wide range in the classification systems used makes for comparisons across jurisdictions challenging. The focus of this narrative review will be to apply the principles of the equity stratifier framework to examine what measures are collected in surgical quality improvement databases, cancer monitoring systems and provincial/state health administrative databases in the United States of America and Canada. The goal of this narrative review is to 1) inform researchers, surgeons, and policymakers of the current landscape of social variables collected within common health administrative databases. 2) Outline the pros and cons of the current collection system. 3) Issue a call to action for policymakers to incorporate health equity frameworks into the collection and reporting of data.

Avaliação da cobertura vacinal em crianças de 2 meses a 5 anos na estratégia saúde da família / Assessment of vaccination coverage among children aged 2 months to 5 years in the family health strategy

A vacinação é uma ação rotineira dos serviços de saúde etem como objetivo erradicar doenças imunopreveníveis.O objetivo deste estudo foi avaliar a cobertura vacinal emcrianças de 2 meses a 5 anos em quatro Unidades da Saú-de da Família em Volta Redonda ? RJ. Estudo transversale descritivo, utilizando o método de amostragem por conveniênciacom os lactentes e pré-escolares que compareceramàs unidades de saúde no período de 30 de julho a 30de agosto de 2012. O critério de inclusão foi a idade entredois meses a cinco anos e o de exclusão foi a ausênciado Cartão de Vacinação no momento da entrevista. Paracada criança avaliada, foi aplicado um questionário à mãe.11% das crianças estavam em atraso com a vacinação. Sobrea idade materna, constatou-se que a maioria das mãesdas crianças com cartões atrasados encontrava-se na faixaetária entre 26 e 30 anos. Quanto à escolaridade materna,64% das mães das crianças com cartões atrasados estudaramentre 4 e 7 anos. Em relação à renda familiar, 91%das mães de crianças com cartões atrasados informaramrenda entre 1 a 2 salários. Observando-se a faixa etária dascrianças com os cartões atrasados, notou-se que o maiornúmero de atrasos ocorreu em menores de um ano. Paraobtermos maior êxito na cobertura vacinal, cabe aos profissionaisde saúde a participação mais ativa na busca decrianças em falta com a vacinação, por meio da revisãosistemática dos cartões, de palestras ministradas à populaçãoe de uma maior efetividade nas visitas domiciliares.

Vaccination is a routine action in health services and aimsto eradicate preventable diseases. The aim of this study wasto assess vaccination coverage in children from 2 monthsto 5 years of age in four Family Health Care Units in VoltaRedonda, RJ, Brazil. It is a cross-sectional and descriptivestudy, using convenience sampling method, with infantsand preschoolers who were attended at health facilities inthe period from July 30 to August 30, 2012. The inclusioncriterion was the age from two months to five yearsold, and for exclusion, the absence of the VaccinationCard at the time of the interview. For each child beingassessed, a questionnaire was administered to the mother.Eleven percent (11%) of the children were not currentwith their vaccinations. As to maternal age, it was foundthat most mothers of children with delayed vaccinationswere aged between 26 and 30 years. Regarding their levelof schooling, 64% of mothers of children with cardsout of date went to school for 4 to 7 years. Regardingfamily income, 91% of mothers of children with delayedvaccinations reported income between 1 and 2 minimumwages. Observing the ages of the children with delayedvaccinations, it was noted that the greatest number ofdelays occurred with children less than one year old.To obtain greater success in immunization coverage,health professionals have to participate more actively inthe search for children who have missed vaccinations,through a systematic review of vaccination cards, publicpresentations, and better effectiveness in home visits.