The virtual family conference in stroke rehabilitation: Education, preparation, and transition planning.

OBJECTIVE: To examine the virtual family conference as an educational, preparatory, and transition planning intervention in stroke rehabilitation. DESIGN: Observational-cross-sectional study. SETTING: Inpatient stroke rehabilitation. SUBJECTS: Eighty-seven carers, participating in 48 conferences, were evaluated. INTERVENTIONS: The virtual family conference, involving the patient, carer(s), and interdisciplinary rehabilitation team, completed prior to community transition. The conference protocol and framework, consisting of nine primary themes and additional sub-themes, are outlined. Teleconferencing was the utilized virtual modality. MAIN MEASURES: Carers were assessed via questionnaires regarding pre- and post-conference rated: (1) stroke-related knowledge, (2) satisfaction with information provision, and (3) confidence, preparedness, and stress associated with community transition; by use of the Stroke Knowledge and Community Transition Preparedness Questionnaire, Mant et al. Information Satisfaction Questionnaire, and Kingston Caregiver Stress Scale. RESULTS: Significant improvement in post-conference carer-rating was noted for knowledge, pertaining to stroke nature/impairments, stroke management/prevention, functional status, and community services. Significant gains were demonstrated in post-conference satisfaction with information provided regarding stroke and discharge planning, across all assessed topics. There was also a significant increase in carer-reported confidence and preparedness for the community transition as well as a significant reduction in self-perceived stress for elements of the caregiving role. Organization of community follow-up care was consistently enabled within the proposed framework. CONCLUSIONS: The virtual family conference intervention demonstrated efficacy in facilitating carer education and preparation, along with discharge planning prior to community transition from stroke rehabilitation. Thus, illustrating potential benefits of family conferences and feasibility of their virtual application in stroke rehabilitative care.

Exploration of exposure to artificial intelligence in undergraduate medical education: a Canadian cross-sectional mixed-methods study.

BACKGROUND: Emerging artificial intelligence (AI) technologies have diverse applications in medicine. As AI tools advance towards clinical implementation, skills in how to use and interpret AI in a healthcare setting could become integral for physicians. This study examines undergraduate medical students' perceptions of AI, educational opportunities about of AI in medicine, and the desired medium for AI curriculum delivery. METHODS: A 32 question survey for undergraduate medical students was distributed from May-October 2021 to students to all 17 Canadian medical schools. The survey assessed the currently available learning opportunities about AI, the perceived need for learning opportunities about AI, and barriers to educating about AI in medicine. Interviews were conducted with participants to provide narrative context to survey responses. Likert scale survey questions were scored from 1 (disagree) to 5 (agree). Interview transcripts were analyzed using qualitative thematic analysis. RESULTS: We received 486 responses from 17 of 17 medical schools (roughly 5% of Canadian undergraduate medical students). The mean age of respondents was 25.34, with 45% being in their first year of medical school, 27% in their 2nd year, 15% in their 3rd year, and 10% in their 4th year. Respondents agreed that AI applications in medicine would become common in the future (94% agree) and would improve medicine (84% agree Further, respondents agreed that they would need to use and understand AI during their medical careers (73% agree; 68% agree), and that AI should be formally taught in medical education (67% agree). In contrast, a significant number of participants indicated that they did not have any formal educational opportunities about AI (85% disagree) and that AI-related learning opportunities were inadequate (74% disagree). Interviews with 18 students were conducted. Emerging themes from the interviews were a lack of formal education opportunities and non-AI content taking priority in the curriculum. CONCLUSION: A lack of educational opportunities about AI in medicine were identified across Canada in the participating students. As AI tools are currently progressing towards clinical implementation and there is currently a lack of educational opportunities about AI in medicine, AI should be considered for inclusion in formal medical curriculum.

Objective performance metrics in human robotic neuroendovascular interventions: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to review the available information on objective performance metrics used during robotic neuroendovascular intervention procedures on humans. INTRODUCTION: Robotic neuroendovascular intervention is defined as any endovascular procedure within the vasculature of the central nervous system with the assistance of a robotic system for diagnostic or therapeutic procedures. Robotic systems are described as a 2-component system consisting of a patient-side mechanical robot, and a separate operator control station. Robotic neuroendovascular intervention is a growing field and there is a need to establish objective performance metrics for furthering evidence-based reporting of the literature. INCLUSION CRITERIA: This scoping review will consider all studies involving humans that utilize robotic neuroendovascular intervention. We will consider all types of studies, reports, and reviews as well as gray literature. Studies will be included if they describe the use of an objective performance metric during robotic neuroendovascular intervention. This review is not limited to a particular country or health care system, and will consider all study designs, regardless of their rigor or language. METHODS: Utilizing a 3-step framework as a guide, we will perform a systematic search in Embase, Cochrane Library, and MEDLINE. Available literature from inception to the present will be considered. Studies will be independently screened according to the inclusion criteria by 2 reviewers based on title, abstract, and full text. Data will be extracted, sorted, and presented in both a narrative summary as well as table and diagram based on the objective of the scoping review.

Safety of Minimizing Intensity of Follow-up on Active Surveillance for Clinical Stage I Testicular Germ Cell Tumors.

Background: We have recommended active surveillance as the preferred management option for clinical stage I (CSI) testicular germ cell tumors (GCTs) since 1980. Over time, the recommended intensity of surveillance has decreased; however, the impact on relapse detection has not been investigated. Objective: To examine relapse rate, time to relapse, extent of disease, and burden of treatment at relapse across decreasing surveillance intensity over time. Design setting and participants: CSI GCT patients under active surveillance from 1981 to 2021 were included in this study. Outcome measurements and statistical analysis: Through four major iterations in both nonseminomatous (NSGCT) and seminoma surveillance schedules, visit frequency, blood testing, and imaging have been decreased successively. Low-dose, noncontrast computed tomography (CT) scans were adopted in 2011. Categorical variables and time to relapse were compared using chi-square and Fisher's exact or Kruskal-Wallis test, respectively. Results and limitations: A total of 1583 consecutive patients (942 with seminoma and 641 with NSGCT) were included. In seminoma, chest x-rays were reduced from 13 to one and CT scans were reduced from 20 to ten. Relapse rate, time to relapse, N or M category, and International Germ Cell Cancer Collaborative Group (IGCCCG) classification did not change. In NSGCT, chest x-rays were reduced from 27 to zero and CT scans were reduced from 11 to five. Relapse rate (from 46.2% to 21.2%, p = 0.002) and the median time to relapse (from 6.54 to 4.47 mo, p = 0.025) decreased. No difference in relapsed disease burden was identified by N, M, and S category or IGCCCG classification. Treatment burden at relapse and GCT cancer deaths remained similar for seminoma and NSGCT. Limitations include the retrospective design and large time period covered. Conclusions: Despite considerable reductions in surveillance intensity, we did not observe an increase in disease extent, treatment burden, or GCT cancer deaths upon relapse. These results support that our current lower-intensity active surveillance schedules are safe for managing CSI GCT. Patient summary: Our current reduced-intensity surveillance schedules for clinical stage I germ cell tumors appear to be safe.

Impact of Functional Magnetic Resonance Imaging on Clinical Outcomes in a Propensity-Matched Low Grade Glioma Cohort.

BACKGROUND: This study aims to evaluate the impact of preoperative functional magnetic resonance imaging (fMRI) on clinical outcomes in patients with low grade glioma (LGG). METHODS: In a retrospective propensity-matched cohort study, we compared patients with LGG based on whether they underwent fMRI as part of preoperative assessment. Twelve patients with LGG who underwent preoperative fMRI were selected, and a contemporaneous group of 12 control patients with LGG who did not undergo fMRI were matched to the fMRI group based on age, sex, and 1p/19q status. RESULTS: fMRI group subjects tended to have more aggressive surgeries (67% resection, 33% biopsy) than the control group (33% resection, 67% biopsy). There were no significant differences in outcomes between the 2 groups. Time between clinical assessment and surgery tended to be longer in the fMRI group (6.3 ± 4.2 weeks) than in the control group (2.7 ± 2.2 weeks). Extent of resection was similar between the 2 cohorts. fMRI group subjects had lower preoperative functional status and tended to have a greater postoperative functional status improvement than control group subjects. Mean survival was not significantly different (fMRI group 5-year survival: 88.9%, control group 5-year survival: 61.1%). CONCLUSIONS: We evaluated the impact of preoperative fMRI in patients with LGG in this propensity-matched cohort study. This study has not demonstrated any significant difference in outcomes between the fMRI and control groups; however, there were nonsignificant trends for patients who underwent fMRI to undergo more aggressive surgical interventions and have a greater postoperative functional status improvement.