A Beta-Prototype Chatbot for Increasing Health Literacy of Patients With Decompensated Cirrhosis: Usability Study.

BACKGROUND: Health literacy is low among patients with chronic liver disease (CLD) and associated with poor health outcomes and increased health care use. Lucy LiverBot, an artificial intelligence chatbot was created by a multidisciplinary team at Monash Health, Australia, to improve health literacy and self-efficacy in patients with decompensated CLD. OBJECTIVE: The aim of this study was to explore users' experience with Lucy LiverBot using an unmoderated, in-person, qualitative test. METHODS: Lucy LiverBot is a simple, low cost, and scalable digital intervention, which was at the beta prototype development phase at the time of usability testing. The concept and prototype development was realized in 2 phases: concept development and usability testing. We conducted a mixed methods study to assess usability of Lucy LiverBot as a tool for health literacy education among ambulatory and hospitalized patients with decompensated CLD at Monash Health. Patients were provided with free reign to interact with Lucy LiverBot on an iPad device under moderator observation. A 3-part survey (preuser, user, and postuser) was developed using the Unified Acceptance Theory Framework to capture the user experience. RESULTS: There were 20 participants with a median age of 55.5 (IQR 46.0-60.5) years, 55% (n=11) of them were female, and 85% (n=17) of them were White. In total, 35% (n=7) of them reported having difficulty reading and understanding written medical information. Alcohol was the predominant etiology in 70% (n=14) of users. Participants actively engaged with Lucy LiverBot and identified it as a potential educational tool and device that could act as a social companion to improve well-being. In total, 25% (n=5) of them reported finding it difficult to learn about their health problems and 20% (n=4) of them found it difficult to find medical information they could trust. Qualitative interviews revealed the conversational nature of Lucy LiverBot was considered highly appealing with improvement in mental health and well-being reported as an unintended benefit of Lucy LiverBot. Patients who had been managing their liver cirrhosis for several years identified that they would be less likely to use Lucy LiverBot, but that it would have been more useful at the time of their diagnosis. Overall, Lucy LiverBot was perceived as a reliable and trustworthy source of information. CONCLUSIONS: Lucy LiverBot was well received and may be used to improve health literacy and address barriers to health care provision in patients with decompensated CLD. The study revealed important feedback that has been used to further optimize Lucy LiverBot. Further acceptability and validation studies are being undertaken to investigate whether Lucy LiverBot can improve clinical outcomes and health related quality of life in patients with decompensated CLD.

Weekend effect in emergency laparotomy: a propensity score-matched analysis.

BACKGROUND: The 'weekend effect' is the term given to the observed discrepancy regarding patient care and outcomes on weekends compared to weekdays. This study aimed to determine whether the weekend effect exists within Aotearoa New Zealand (AoNZ) for patients undergoing emergency laparotomy (EL), given recent advances in management of EL patients. METHODS: A cohort study was conducted across five hospitals, comparing the outcomes of weekend and weekday acute EL. A propensity-score matched analysis was used to remove potential confounding patient characteristics. RESULTS: Of the 487 patients included, 132 received EL over the weekend. There was no statistically significant difference between patients undergoing EL over the weekend compared to weekdays. Mortality rates were comparable between the weekday and weekend cohorts (P = 0.464). CONCLUSIONS: These results suggest that modern perioperative care practice in New Zealand obviates the 'weekend' effect.

Germline modifiers of the tumor immune microenvironment implicate drivers of cancer risk and immunotherapy response.

With the continued promise of immunotherapy for treating cancer, understanding how host genetics contributes to the tumor immune microenvironment (TIME) is essential to tailoring cancer screening and treatment strategies. Here, we study 1084 eQTLs affecting the TIME found through analysis of The Cancer Genome Atlas and literature curation. These TIME eQTLs are enriched in areas of active transcription, and associate with gene expression in specific immune cell subsets, such as macrophages and dendritic cells. Polygenic score models built with TIME eQTLs reproducibly stratify cancer risk, survival and immune checkpoint blockade (ICB) response across independent cohorts. To assess whether an eQTL-informed approach could reveal potential cancer immunotherapy targets, we inhibit CTSS, a gene implicated by cancer risk and ICB response-associated polygenic models; CTSS inhibition results in slowed tumor growth and extended survival in vivo. These results validate the potential of integrating germline variation and TIME characteristics for uncovering potential targets for immunotherapy.

Evolution of stickleback spines through independent cis-regulatory changes at HOXDB.

Understanding the mechanisms leading to new traits or additional features in organisms is a fundamental goal of evolutionary biology. We show that HOXDB regulatory changes have been used repeatedly in different fish genera to alter the length and number of the prominent dorsal spines used to classify stickleback species. In Gasterosteus aculeatus (typically 'three-spine sticklebacks'), a variant HOXDB allele is genetically linked to shortening an existing spine and adding an additional spine. In Apeltes quadracus (typically 'four-spine sticklebacks'), a variant HOXDB allele is associated with lengthening a spine and adding an additional spine in natural populations. The variant alleles alter the same non-coding enhancer region in the HOXDB locus but do so by diverse mechanisms, including single-nucleotide polymorphisms, deletions and transposable element insertions. The independent regulatory changes are linked to anterior expansion or contraction of HOXDB expression. We propose that associated changes in spine lengths and numbers are partial identity transformations in a repeating skeletal series that forms major defensive structures in fish. Our findings support the long-standing hypothesis that natural Hox gene variation underlies key patterning changes in wild populations and illustrate how different mutational mechanisms affecting the same region may produce opposite gene expression changes with similar phenotypic outcomes.

Rehabilitation Needs of the Elderly Patient with Cancer.

Physiatrist taking care of the geriatric patient with cancer should be able to manage an array of conditions that might present from diagnosis throughout completion of treatments and beyond. The elderly cancer population is at greater risk of functional impairments. The physician should anticipate changes in clinical status and must adjust rehabilitation goals accordingly. Treatment options and rehabilitation goals should be tailored to help maximize quality of life in these patients.

A comparison of two balance measures to predict discharge performance from inpatient stroke rehabilitation.

OBJECTIVE: To compare the admission Berg Balance Scale (BBS) and Postural Assessment Scale for Stroke (PASS) in predicting outcomes at discharge from an inpatient rehabilitation unit (IRU). We hypothesized that discharge outcomes would be better predicted by (1) the PASS compared with the BBS, and (2) by the PASS changing position subscore compared with the PASS maintain posture subscore. DESIGN: A retrospective study. SETTING: An IRU in an academic medical center. PARTICIPANTS: Fifty-five subjects with stroke and mean (standard deviation [SD]) age of 71.5 ± 13.8 years, admission functional independence measures (FIM) of 57.2 ± 17.2 points, and IRU length of stay of 17.3 ± 9.7 days. METHODOLOGY/MAIN OUTCOME MEASUREMENTS: Admission and discharge BBS and PASS scores, gait velocity (GV) at discharge, and selected FIM items at discharge were measured. GV was analyzed both as a continuous and categorical variable. RESULTS: The Spearman rank correlation coefficient (r) was strong between admission BBS and PASS (r = 0.90, P < .0001). Correlations between admission BBS and PASS and discharge GV were 0.32 (P = .03) and 0.28 (P = .06), respectively. Analysis of variance was significant for both balance measures when grouped by the discharge gait speed category (P < .0001). Pairwise comparisons were significant between GV-A and the other 2 categories but not between GV-B and GV-C. The magnitude of the observed correlation with discharge GV was greater for PASS maintain posture subscore (r = 0.35, P = .02) than for PASS changing position subscore (r = 0.23, P = .13). Both subscores were significantly associated with both toileting and transfers (r = 0.43-0.56, all at least P ≤ .001). CONCLUSIONS: Contrary to our hypotheses, the BBS and PASS performed equally well in our study sample and were best at predicting patients discharged in the slowest GV category. There were few differences between the PASS subscores. Further research should compare how well admission BBS and PASS predict gait velocity, falls, and other functional parameters in the community after IRU discharge.