Hybrid XGBoost model with hyperparameter tuning for prediction of liver disease with better accuracy.

BACKGROUND: Liver disease indicates any pathology that can harm or destroy the liver or prevent it from normal functioning. The global community has recently witnessed an increase in the mortality rate due to liver disease. This could be attributed to many factors, among which are human habits, awareness issues, poor healthcare, and late detection. To curb the growing threats from liver disease, early detection is critical to help reduce the risks and improve treatment outcome. Emerging technologies such as machine learning, as shown in this study, could be deployed to assist in enhancing its prediction and treatment. AIM: To present a more efficient system for timely prediction of liver disease using a hybrid eXtreme Gradient Boosting model with hyperparameter tuning with a view to assist in early detection, diagnosis, and reduction of risks and mortality associated with the disease. METHODS: The dataset used in this study consisted of 416 people with liver problems and 167 with no such history. The data were collected from the state of Andhra Pradesh, India, through https://www.kaggle.com/datasets/uciml/indian-liver-patient-records. The population was divided into two sets depending on the disease state of the patient. This binary information was recorded in the attribute "is_patient". RESULTS: The results indicated that the chi-square automated interaction detection and classification and regression trees models achieved an accuracy level of 71.36% and 73.24%, respectively, which was much better than the conventional method. The proposed solution would assist patients and physicians in tackling the problem of liver disease and ensuring that cases are detected early to prevent it from developing into cirrhosis (scarring) and to enhance the survival of patients. The study showed the potential of machine learning in health care, especially as it concerns disease prediction and monitoring. CONCLUSION: This study contributed to the knowledge of machine learning application to health and to the efforts toward combating the problem of liver disease. However, relevant authorities have to invest more into machine learning research and other health technologies to maximize their potential.

Depression and suicidality among psychiatric residents - results from a multi-country study.

BACKGROUND: Previous studies have highlighted risks for depression and suicide in medical cohorts, but evidence regarding psychiatric residents is missing. This study aimed to determine rates of depression, suicide ideation and suicide attempt among psychiatric residents and to identify associated individual, educational and work-related risk factors. METHODS: A total of 1980 residents from 22 countries completed the online survey which collected data on depression (PHQ-9), suicidality (SIBQ), socio-demographic profiles, training, and education. Generalized linear modeling and logistic regression analysis were used to predict depression and suicide ideation, respectively. RESULTS: The vast majority of residents did not report depression, suicide ideation or attempting suicide during psychiatric training. Approximately 15% (n = 280) of residents met criteria for depression, 12.3% (n = 225) reported active suicide ideation, and 0.7% (n = 12) attempted suicide during the training. Long working hours and no clinical supervision were associated with depression, while more completed years of training and lack of other postgraduate education (e.g. PhD or psychotherapy training) were associated with increased risk for suicide ideation during psychiatric training. Being single and female was associated with worse mental health during training. LIMITATIONS: Due to the cross-sectional nature of the study, results should be confirmed by longitudinal studies. Response rate was variable but the outcome variables did not statistically significantly differ between countries with response rates of more or less than 50%. CONCLUSION: Depression rates among psychiatric residents in this study were lower than previously reported data, while suicide ideation rates were similar to previous reports. Poor working and training conditions were associated with worse outcomes. Training programmes should include effective help for residents experiencing mental health problems so that they could progress through their career to the benefit of their patients and wider society.

Evaluation of Leg Wrapping for the Prevention of Postspinal Hypotension in Cesarean Section under Spinal Anesthesia.

BACKGROUND: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. MATERIALS AND METHODS: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups. Patients in Group W had their legs wrapped with elastic crepe bandage and in the other Group N, leg wrapping was not done. All the patients were preloaded with Ringer lactate at 10 ml/kg before the spinal anesthesia. The hemodynamic parameters were monitored every 3 min until the delivery of the baby and every 5 min until the end of surgery. If hypotension occurred, then along with crystalloid loading a bolus dose of mephentermine 6 mg was given intravenously. STATISTICAL ANALYSIS: Statistical software "Numbers version 3.6.1 (2566)" was used for statistical calculations. RESULTS: Frequency of hypotension in Group W (10%) was significantly less compared to Group N (60%). Vasopressor requirement was significantly less in Group W (P = 0.009), which was highly significant. CONCLUSION: Wrapping of lower extremities was a simple, easy, and an effective method of decreasing episodes of hypotension and vasopressor requirement after spinal anesthesia in cesarean patients and needs to be practiced routinely.

Percutaneous reconstruction of chronic total occlusion of brachiocephalic vein using transseptal needle in dialysis-dependent patient.

Placement of a dialysis catheter substantially increases the risk of central vein stenosis. 52-year-old female with end-stage renal disease and a right brachial-cephalic hemodialysis access presented with right arm swelling. The chronic total occlusion of right brachiocephalic vein was refractory to wire traversal. Sharp recanalization of the central venous occlusion was done with transseptal needle retrogradely. The track was balloon dilated and stented. When the conventional catheters and guide wires options fail, sharp recanalization technique may be used to salvage a precious dialysis access.

Why medical students choose psychiatry - a 20 country cross-sectional survey.

BACKGROUND: Recruitment to psychiatry is insufficient to meet projected mental health service needs world-wide. We report on the career plans of final year medical students from 20 countries, investigating factors identified from the literature which influence psychiatric career choice. METHODS: Cross sectional electronic or paper survey. Subjects were final year medical students at 46 medical schools in participating countries. We assessed students' career intentions, motivations, medical school teaching and exposure to psychiatry. We assessed students' attitudes and personality factors. The main outcome measure was likelihood of specializing in psychiatry. Multilevel logistic regression was used to examine the joint effect of factors upon the main outcome. RESULTS: 2198 of 9135 (24%) of students responded (range 4 to 91%) across the countries. Internationally 4.5% of students definitely considered psychiatry as a career (range 1 to 12%). 19% of students (range 0 to 33%) were "quite likely", and 25% were "definitely not" considering psychiatry. Female gender, experience of mental/physical illness, media portrayal of doctors, and positive attitudes to psychiatry, but not personality factors, were associated with choosing psychiatry. Quality of psychiatric placement (correlation coefficient = 0.22, p < 0.001) and number of placements (correlation coefficient =0.21, p < 0.001) were associated with higher ATP scores. During medical school, experience of psychiatric enrichment activities (special studies modules and university psychiatry clubs), experience of acutely unwell patients and perceived clinical responsibility were all associated with choice of psychiatry.Multilevel logistic regression revealed six factors associated with students choosing psychiatry: importance of own vocation, odds ratio (OR) 3.01, 95% CI 1.61 to 5.91, p < 0.001); interest in psychiatry before medical school, OR 10.8 (5.38 to 21.8, p < 0.001); undertaking a psychiatry special study module, OR 1.45 (1.05 to 2.01, p = 0.03) or elective OR 4.28 (2.87- 6.38, p < 0.001); membership of a university psychiatry club, OR 3.25 (2.87 to 6.38, p < 0.001); and exposure to didactic teaching, OR 0.54 (0.40 to 0.72, p < 0.001). CONCLUSIONS: We report factors relevant to medical student selection and psychiatry teaching which affect career choice. Addressing these factors may improve recruitment to psychiatry internationally.

Challenges for trainees in psychiatry and early career psychiatrists.

Psychiatry as a discipline will undergo major changes in the coming years. Although changes can be particularly stimulating and challenging from an intellectual, scientific and social viewpoint, the new generations of psychiatrists must be prepared to face these changes and deal with them appropriately. Paradigms which have represented the foundations of psychiatry in the last century now need a major revision. In particular, both trainees in psychiatry and early career psychiatrists need to (1) (re)discover psychopathology, (2) improve mental healthcare through integrated treatments, (3) identify and treat new syndromes, (4) promote an image of psychiatry with patients at the heart of care and as advocates for each other by fighting stigma and promoting the recruitment in psychiatry by medical students. These can be achieved by increasing involvement in institutions and organizations to influence the agenda. In this paper the possible contribution of trainees and early career psychiatrists is discussed and recommendations are made in order to set a new agenda for early career psychiatrists who will still be practising 2-3 decades from now.

Student career choice in psychiatry: findings from 18 UK medical schools.

Psychiatry recruitment continues to be a problem in the UK and large-scale studies are required to understand the factors surrounding this. A quantitative, cross-sectional online survey, incorporating demographics, career choices, teaching exposure, attitudes to psychiatry and personality factors, was administered to final-year UK medical students. A total of 484 students from 18 medical schools responded (66% women). Sixteen (16%) had chosen psychiatry at medical school entry. By final year, 15 respondents (3%) had decided to pursue a career in psychiatry, while another 78 (17%) were seriously considering it. There was little difference in the quality ratings of lectures and small group teaching between those interested in psychiatry and those not. Experience of 'enrichment activities' (psychiatry special study modules or components, psychiatric research, university psychiatry clubs, and psychiatry electives) were significantly more likely to take up psychiatry. Causality cannot, however, be determined in this study. The study identified several distinct groups of UK students: those deciding on psychiatry before medical school and maintaining that career choice, those deciding on psychiatry during medical school, and those interested in other fields. Addressing psychiatry teaching and exposure may improve recruitment into the speciality.

Encouraging French medical students to choose a career in psychiatry: how and why?

There is an increasing demand for psychiatrists in France. This paper reviews the reasons for French medical students choosing psychiatry and the rationale and mechanisms for encouraging them towards this medical speciality. The main factors associated with choosing psychiatry as a career are the quantity and quality of undergraduate training and placements in psychiatry, better attitudes towards psychiatry and more emphasis on a positive life/work balance. The quality of postgraduate training can also influence students' decisions. Medical students should be encouraged to choose psychiatry first to counterbalance the existing stigma towards mental illness within the society, but also towards psychiatry within the medical profession, and second because of the current decline in French medical demography. Ways to improve recruitment are a selection process that favours a large number of psychiatric trainees, and an increase in the quality and quantity of training. Providing medical students with relevant information about training in psychiatry, notably through a national trainees' association, will not only improve the quality of care by increasing recruitment in psychiatry, but also ensure that all future doctors are familiar with and develop positive attitudes towards mental health issues.

Recruitment to psychiatry in the Czech Republic: 'waiting for resuscitation'?

Recruitment to psychiatry is becoming a serious obstacle in providing first-class mental health treatment in many countries worldwide. We attempt to address this burning issue by examining medical student's attitudes towards psychiatry and factors influencing their career choice in the Czech Republic. In 2010, 71 students in their last year of medical school at the First Faculty of Medicine, Charles University, Prague were recruited in this quantitative cross-sectional online study. From the sample, 16% (n = 11) of students were considering psychiatry as a career path. An important factor in choosing psychiatry as a career path was personal/family presence of mental illness. Longer experience with psychiatry placement also contributed to the choice of psychiatry, as well as participation in elective courses or psychiatric research projects. Students considering psychiatry were less systematic compared to the group not considering psychiatry. Low reported levels of recruitment to psychiatry present a problematic issue in the Czech Republic. To make psychiatry more appealing to medical students, proactive steps by the relevant stakeholders need to be implemented. These strategies should include steps such as allocating more time for psychiatry in the medical curriculum, better quality of lectures, and the inclusion of additional elective courses.

Are there future psychiatrists among medical students in Croatia? The role of premedical and medical factors on career choice in psychiatry.

Despite the high prevalence of mental disorders, a worldwide shortage of psychiatrists exists. Moreover, the number of students interested in choosing psychiatry as their future profession is low and psychiatry is frequently regarded as one of the least wanted medical specializations. We report the findings of a cross-sectional quantitative survey of final year Croatian medical students as part of the International Survey of Student Career Choice in Psychiatry (ISoSCCiP). The questionnaire consisted of three sections: socio-demographic factors, psychiatric education during medical school, and attitudes and personality characteristics. Out of 200 students, 122 completed the questionnaire (response rate 61%). The overall student evaluation of the compulsory psychiatry curriculum was 'average'. Significantly higher ratings were reported by students who attended special psychiatry teaching modules, or felt more involved in the teaching of the subject. Poor evaluation of medical school psychiatric education significantly increased the likelihood of not choosing psychiatry as a future career. The choice of psychiatry was also predicted by attitudes towards psychiatry and by personal characteristics. In conclusion, student ratings of medical school psychiatric education and involvement in teaching appear to influence choice towards psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice.

Experience of psychiatry teaching at medical school influences Croatian medical students' attitudes towards choosing psychiatry as a career.

BACKGROUND: Reports indicate that the number of students interested in choosing psychiatry as their future profession is constantly decreasing in the last decades. Our aim was to determine the proportion of medical students intending to pursue a career in psychiatry and to define undergraduate education-related factors influencing that choice. SUBJECTS AND METHODS: We report the preliminary findings of a cross sectional quantitative survey of final year Croatian medical students as part of the International Survey Of Student Career Choice In Psychiatry (ISOSCCIP). We surveyed medical students attending their final year at Zagreb School of Medicine in the academic year 2009/2010, using a structured questionnaire examining demographics, students' preferences on future career choice and their evaluations of undergraduate psychiatry teaching. RESULTS: The overall student evaluation of the compulsory psychiatry curriculum was "average". Significantly higher ratings were reported by students who felt more involved in the teaching of the subject. The possibility of psychiatry as a career choice correlated significantly with better evaluation grades of psychiatry lectures. Furthermore, poor evaluation grades predicted a higher likelihood that medical students completely ruled out choosing a career in psychiatry. CONCLUSION: This is the first survey of this kind in Croatia. Student ratings of medical school psychiatric education and perceived involvement in teaching appears to influence the likelihood of a stated career in psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice.

Workplace-based assessments in psychiatry: evaluation of a whole assessment system.

OBJECTIVE: Work Place-Based Assessments (WPBAs) were introduced into psychiatry along with the new curriculum in 2005. The Royal College of Psychiatrists decided to pilot several WPBAs to ascertain their suitability. METHOD: Eight types of assessments (Case-Based Discussion, Assessment of Clinical Expertise, Mini-Assessed Clinical Encounter, Mini-Peer Assessment Tool, Direct Observations of Procedural Skills, Patient Satisfaction Questionnaires, Case Conference, and Journal Club Presentation) were piloted, either singly or in combination, on 16 sites, with 600 psychiatric trainees. RESULTS: Consultant psychiatrists carried out most of the assessments. Case-Based Discussion was the most popular, and high levels of correlation were obtained across several assessment tools. CONCLUSION: There is evidence that with suitable training of assessors and trainees, WPBAs can be introduced and are feasible in assessing some competencies.

Factors influencing French medical students towards a career in psychiatry.

BACKGROUND: There is a need to increase the recruitment to psychiatry in France. Our aim in this study was to compare factors influencing career choice between French medical students considering and not considering psychiatry as a specialty. SUBJECTS AND METHODS: Quantitative cross-sectional online survey on 145 French students in their last year of medical school. RESULTS: 22.7% of our sample considered choosing a career in psychiatry. A preference for a career in psychiatry was associated with more frequent history of personal/familial mental illness, higher ratings of psychiatric teaching, more weeks of compulsory psychiatry teaching and placement, during which students had more often met patients in recovery and been asked their opinion on patients. Students considering psychiatry as a career also emphasized more the need for a good work-life balance, and presented better attitudes toward psychiatry. CONCLUSIONS: Improving opportunities of interactions between students and psychiatrists or psychiatric patients might help to improve recruitment in psychiatry.

Successful ablation of sinus node reentrant tachycardia using remote magnetic navigation system.

Ablation of sinus node reentrant tachycardia (SNRT) may be difficult with risk of sinus node injury by using conventional catheters. We report successful ablation of SNRT by using remote magnetic navigation system (Stereotaxis).

Mental health reforms in Europe: challenges of postgraduate psychiatric training in Europe: a trainee perspective.

The European Federation of Psychiatric Trainees (EFPT) is an umbrella organization for trainee associations in 31 countries. A survey asked member countries about the three most important issues facing postgraduate training. Qualitative analysis grouped responses in five categories: implementation of new postgraduate curricula, poor working conditions, low recruitment of psychiatric trainees, insufficient training opportunities, and inadequate psychotherapy training. Disparities between countries lead to trainee migration, which worsens conditions in their home countries. The EFPT is in a unique position to obtain feedback and work with partner organizations to improve the standards of psychiatric training for European trainees.

The psychiatric profession: an expertise under siege?

BACKGROUND: Psychiatry along with other medical disciplines has been under siege in the UK and the USA for a number of years and for a number of reasons. These have varied from various medical scandals and funding changes to political imperatives and public expectations. Changes in the knowledge base have added yet another dimension to this debate. MATERIAL: The subject is explored using historical figures and their writings and an overview of historic views on the psychiatry profession. DISCUSSION: The demise of the psychiatrist as an expert and the profession of psychiatry as an expertise can be related to both real and perceived factors. Unlike, for instance, the language used by cardio-thoracic surgeons, the language used in and for professional communications in psychiatry has become very similar to that used in lay discourses on psychological and relationship matters in the general population--partly as a result of the Freudian project successfully insinuating itself into 'common knowledge' and partly as the influence of media grows across the globe. This language has been misappropriated by a wide variety of non-experts, who then speak and interpret it as if they are specialists and any challenge from professionals is seen as self-protection and heresy. As psychiatrists, we do not use technology in a persuasive way as other branches of medicine tend to and this takes away a powerful symbolic conveying 'expertise'. Increased consumerism adds yet another dimension to this discourse. CONCLUSIONS: The patient is definitely the expert on how their illness affects their life, but it is the psychiatrist who is the expert on the illness rather than simply focusing on disease. It is time for the profession loudly to proclaim itself for what it is and what it can and cannot do.

Dose-dependent galactorrhea with quetiapine.

Quetiapine is an atypical antipsychotic agent with minimal propensity to induce hyperprolactinemia in standard therapeutic dosages. Despite that quetiapine is considered to be a prolactin-sparing atypical antipsychotic, hyperprolactinemia with related side effects may rarely be encountered in susceptible individuals. We report a case of quetiapine-induced hyperprolactinemia and galactorrhea in an adult female, which was dose-dependent.

Percutaneous retrieval of a fully expanded maldeployed left subclavian artery stent: nightmares in cath lab.

A self expendable Nitinol stent was accidently maldeployed when precise positioning was being done in a pre dilated 100% occluded left subclavian artery. A significant part of stent was hanging into the arch of aorta necessitating removal of stent either surgically or percutaneously. The fully expanded stent was successfully retrieved with the help of Acu-snare and long 8F sheath without any injury or dissection of aorta or iliac artery. After retrieval of stent, the culprit lesion was stented with another self expendable stent in the same sitting with good end result.