Cytoreductive surgery plus hyperthermic intraoperative peritoneal chemotherapy for people with peritoneal metastases from colorectal, ovarian or gastric origin: A systematic review of randomized controlled trials.

BACKGROUND: There is uncertainty in the relative benefits and harms of hyperthermic intraoperative peritoneal chemotherapy (HIPEC) when added to cytoreductive surgery (CRS) +/- systemic chemotherapy or systemic chemotherapy alone in people with peritoneal metastases from colorectal, gastric, or ovarian cancers. METHODS: We searched randomized controlled trials (RCTs) in the medical literature until April 14, 2022 and applied methods used for high-quality systematic reviews. FINDINGS: We included a total of eight RCTs (seven RCTs included in quantitative analysis as one RCT did not provide data in an analyzable format). All comparisons other than ovarian cancer contained only one trial. For gastric cancer, there is high uncertainty about the effect of CRS + HIPEC + systemic chemotherapy. For stage III or greater epithelial ovarian cancer undergoing interval cytoreductive surgery, CRS + HIPEC + systemic chemotherapy probably decreases all-cause mortality compared to CRS + systemic chemotherapy. For colorectal cancer, CRS + HIPEC + systemic chemotherapy probably results in little to no difference in all-cause mortality and may increase the serious adverse events proportions compared to CRS +/- systemic chemotherapy, but probably decreases all-cause mortality compared to fluorouracil-based systemic chemotherapy alone. INTERPRETATION: The role of CRS + HIPEC in gastric peritoneal metastases is uncertain. CRS + HIPEC should be standard of care in women with stage III or greater epithelial ovarian cancer undergoing interval CRS. CRS + systemic chemotherapy should be standard of care for people with colorectal peritoneal metastases, with HIPEC given only as part of a RCT focusing on subgroups and regimes. PROSPERO REGISTRATION: CRD42019130504.

Comparing code-free and bespoke deep learning approaches in ophthalmology.

AIM: Code-free deep learning (CFDL) allows clinicians without coding expertise to build high-quality artificial intelligence (AI) models without writing code. In this review, we comprehensively review the advantages that CFDL offers over bespoke expert-designed deep learning (DL). As exemplars, we use the following tasks: (1) diabetic retinopathy screening, (2) retinal multi-disease classification, (3) surgical video classification, (4) oculomics and (5) resource management. METHODS: We performed a search for studies reporting CFDL applications in ophthalmology in MEDLINE (through PubMed) from inception to June 25, 2023, using the keywords 'autoML' AND 'ophthalmology'. After identifying 5 CFDL studies looking at our target tasks, we performed a subsequent search to find corresponding bespoke DL studies focused on the same tasks. Only English-written articles with full text available were included. Reviews, editorials, protocols and case reports or case series were excluded. We identified ten relevant studies for this review. RESULTS: Overall, studies were optimistic towards CFDL's advantages over bespoke DL in the five ophthalmological tasks. However, much of such discussions were identified to be mono-dimensional and had wide applicability gaps. High-quality assessment of better CFDL applicability over bespoke DL warrants a context-specific, weighted assessment of clinician intent, patient acceptance and cost-effectiveness. We conclude that CFDL and bespoke DL are unique in their own assets and are irreplaceable with each other. Their benefits are differentially valued on a case-to-case basis. Future studies are warranted to perform a multidimensional analysis of both techniques and to improve limitations of suboptimal dataset quality, poor applicability implications and non-regulated study designs. CONCLUSION: For clinicians without DL expertise and easy access to AI experts, CFDL allows the prototyping of novel clinical AI systems. CFDL models concert with bespoke models, depending on the task at hand. A multidimensional, weighted evaluation of the factors involved in the implementation of those models for a designated task is warranted.

Do we need a co-pilot in the operating theatre? A cross-sectional study on surgeons' perceptions.

OBJECTIVE: The aim of this original study was to investigate general surgeons' perceptions on the role of dual surgeon operating for high-risk, elective complex surgical procedures. MATERIAL AND METHODS: A 21-part cross-sectional online survey was self-completed by 85 general surgeons across hospitals in the UK. The survey assessed the perception of dual surgeon operating on patient morbidity and mortality, surgeons' burnout rates, complaints, patient waiting times and overall trainee experience. Statistical analysis was performed using R version 3.6.1. RESULTS: Overall 78.8% believed that dual surgeon operating could help to overcome these human factors. Sub-analysis includes improve surgeon fatigue (89.4%), improve confidence (83.5%), improve decision-making (76.5%), minimise technical error (69.4%), improve communication, team work and leadership skills (65.9%). 65.9% believed it would reduce surgeons' burnout. There was a statistically significant relationship between the participants believing it would reduce surgeons' burnout and those who felt it would reduce complaints, Chi-squared(4) = [30.8], p = [0.00000342]. A statistically significant relationship was noted between participants believing it would reduce surgeons' burnout and those who felt it would reduce patient mortality/morbidity, Chi-squared(4) = [19.9], p = [0.000517]. CONCLUSION: The survey has highlighted positive surgeons' perceptions regarding dual surgeon operating.

AI as a Medical Device for Ophthalmic Imaging in Europe, Australia, and the United States: Protocol for a Systematic Scoping Review of Regulated Devices.

BACKGROUND: Artificial intelligence as a medical device (AIaMD) has the potential to transform many aspects of ophthalmic care, such as improving accuracy and speed of diagnosis, addressing capacity issues in high-volume areas such as screening, and detecting novel biomarkers of systemic disease in the eye (oculomics). In order to ensure that such tools are safe for the target population and achieve their intended purpose, it is important that these AIaMD have adequate clinical evaluation to support any regulatory decision. Currently, the evidential requirements for regulatory approval are less clear for AIaMD compared to more established interventions such as drugs or medical devices. There is therefore value in understanding the level of evidence that underpins AIaMD currently on the market, as a step toward identifying what the best practices might be in this area. In this systematic scoping review, we will focus on AIaMD that contributes to clinical decision-making (relating to screening, diagnosis, prognosis, and treatment) in the context of ophthalmic imaging. OBJECTIVE: This study aims to identify regulator-approved AIaMD for ophthalmic imaging in Europe, Australia, and the United States; report the characteristics of these devices and their regulatory approvals; and report the available evidence underpinning these AIaMD. METHODS: The Food and Drug Administration (United States), the Australian Register of Therapeutic Goods (Australia), the Medicines and Healthcare products Regulatory Agency (United Kingdom), and the European Database on Medical Devices (European Union) regulatory databases will be searched for ophthalmic imaging AIaMD through a snowballing approach. PubMed and clinical trial registries will be systematically searched, and manufacturers will be directly contacted for studies investigating the effectiveness of eligible AIaMD. Preliminary regulatory database searches, evidence searches, screening, data extraction, and methodological quality assessment will be undertaken by 2 independent review authors and arbitrated by a third at each stage of the process. RESULTS: Preliminary searches were conducted in February 2023. Data extraction, data synthesis, and assessment of methodological quality commenced in October 2023. The review is on track to be completed and submitted for peer review by April 2024. CONCLUSIONS: This systematic review will provide greater clarity on ophthalmic imaging AIaMD that have achieved regulatory approval as well as the evidence that underpins them. This should help adopters understand the range of tools available and whether they can be safely incorporated into their clinical workflow, and it should also support developers in navigating regulatory approval more efficiently. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52602.

Glaucoma Health Coaching: A Survey of Eye Drop Instillation Education.

PRCIS: Health coaching is an effective strategy in supporting glaucoma patients to become champions of their own health. A personalized program should be implemented at the point of diagnosis. PURPOSE: Glaucoma is the leading cause of irreversible blindness worldwide. Its mainstay of treatment is intraocular pressure-lowering eye drops. Yet, many patients do not receive education regarding their condition, the importance of their eye drops, and how to instil them. The purpose of this audit was to assess what proportion of glaucoma patients had received any education regarding eye drop usage and whether a health coaching intervention would be beneficial. MATERIALS AND METHODS: This prospective audit was conducted during World Glaucoma Week at Moorfields Eye Hospital. Patients diagnosed with glaucoma were given a 6-part questionnaire. Subsequently, they received a coaching session with a pharmacy team member, focusing on eye drop instillation. Patient feedback was recorded. RESULTS: The sample size was 262. Overall, 92% of patients who had received teaching found it useful. Approximately half the patients had never been shown how to use eye drops before. In all, 79% of those who had never received a demonstration thought that further coaching would be helpful. When experiencing difficulties with eye drop instillation; 29% of patients felt comfortable asking a relative; 26% would not ask for help, and 16% would consult their glaucoma doctor. Almost 30% of patients had poked themselves in the eye at least once, during self-administration. CONCLUSIONS: Experienced and inexperienced patients found glaucoma health coaching beneficial. Health coaching empowers patients with long-term conditions to be champions of their own health condition, and it is important for patients to receive this training from the onset of their treatment.

'Long COVID' syndrome.

SARS-CoV-2 has resulted in a global pandemic and an unprecedented public health crisis. Recent literature suggests the emergence of a novel syndrome known as 'long COVID', a term used to describe a diverse set of symptoms that persist after a minimum of 4 weeks from the onset of a diagnosed COVID-19 infection. Common symptoms include persistent breathlessness, fatigue and cough. Other symptoms reported include chest pain, palpitations, neurological and cognitive deficits, rashes, and gastrointestinal dysfunction. We present a complex case of a previously well 28-year-old woman who was diagnosed with COVID-19. After resolution of her acute symptoms, she continued to experience retrosternal discomfort, shortness of breath, poor memory and severe myalgia. Investigations yielded no significant findings. Given no alternative diagnosis, she was diagnosed with 'long COVID'.

Idiopathic intracranial hypertension presenting as iron deficiency anemia: a case report.

BACKGROUND: The presentation of idiopathic intracranial hypertension (IIH) in association with iron deficiency anemia (IDA) is rare. CASE PRESENTATION: This case report depicts the unusual case of a 31-year-old woman of mixed Jamaican and English heritage with IIH who presented initially as IDA in the context of menorrhagia. Subsequent ophthalmic review, lumbar puncture, cerebrospinal fluid analysis and neuroimaging studies revealed severe bilateral optic disc swelling and raised intracranial pressure in keeping with IIH. Prompt treatment of IDA with blood transfusion and orally administered iron supplements, in addition to medical treatment for IIH, contributed to significant improvement of symptoms and prevented long-term visual deficits. CONCLUSION: The possibility of IDA, albeit rare, should always be considered and investigated appropriately in all patients with IIH, as the treatment of the anemia alone may be sight-saving.