Exploring the Efficacy of Large Language Models in Summarizing Mental Health Counseling Sessions: Benchmark Study.

BACKGROUND: Comprehensive session summaries enable effective continuity in mental health counseling, facilitating informed therapy planning. However, manual summarization presents a significant challenge, diverting experts' attention from the core counseling process. Leveraging advances in automatic summarization to streamline the summarization process addresses this issue because this enables mental health professionals to access concise summaries of lengthy therapy sessions, thereby increasing their efficiency. However, existing approaches often overlook the nuanced intricacies inherent in counseling interactions. OBJECTIVE: This study evaluates the effectiveness of state-of-the-art large language models (LLMs) in selectively summarizing various components of therapy sessions through aspect-based summarization, aiming to benchmark their performance. METHODS: We first created Mental Health Counseling-Component-Guided Dialogue Summaries, a benchmarking data set that consists of 191 counseling sessions with summaries focused on 3 distinct counseling components (also known as counseling aspects). Next, we assessed the capabilities of 11 state-of-the-art LLMs in addressing the task of counseling-component-guided summarization. The generated summaries were evaluated quantitatively using standard summarization metrics and verified qualitatively by mental health professionals. RESULTS: Our findings demonstrated the superior performance of task-specific LLMs such as MentalLlama, Mistral, and MentalBART evaluated using standard quantitative metrics such as Recall-Oriented Understudy for Gisting Evaluation (ROUGE)-1, ROUGE-2, ROUGE-L, and Bidirectional Encoder Representations from Transformers Score across all aspects of the counseling components. Furthermore, expert evaluation revealed that Mistral superseded both MentalLlama and MentalBART across 6 parameters: affective attitude, burden, ethicality, coherence, opportunity costs, and perceived effectiveness. However, these models exhibit a common weakness in terms of room for improvement in the opportunity costs and perceived effectiveness metrics. CONCLUSIONS: While LLMs fine-tuned specifically on mental health domain data display better performance based on automatic evaluation scores, expert assessments indicate that these models are not yet reliable for clinical application. Further refinement and validation are necessary before their implementation in practice.

Congenital giant right coronary artery.

Giant coronary artery aneurysms are exceptionally uncommon with an incidence of 0.02%. The natural history and prognosis of giant coronary artery aneurysm are still not well known.

An intriguing case of post-operative respiratory failure from an occult diaphragmatic hernia- be aware of the masquerader.

Though respiratory complications after cardiac surgery for congenital heart disease are common, and malformations of the diaphragm can be expected in these patients, the presence of an occult diaphragmatic defect unrecognisible preoperatively and complicating the post operative course is very rare and need a high index of suspicion for diagnosis in the setting of post operative respiratory failure. We present here a case of post operative respiratory failure from a delayed presenting diaphragmatic hernia in a 2-month-old boy who underwent corrective surgery for Taussig bing anomaly and hypoplastic aortic arch. Surgical repair of the diaphragmatic defect and reduction of the bowel loops to the abdomen resulted in rapid weaning from ventilation and recovery with subsequent discharge from hospital.

Bronchial compression as adverse effect of right pulmonary artery stenting in a patient with truncus arteriosus communis and interrupted aortic arch.

Aortic arch obstruction and bronchial compression are possible postoperative complications in patients with truncus arteriosus communis (TAC) with interrupted aortic arch (IAA). We present a case of bronchial compression as adverse effect of right pulmonary artery (PA) stenting in an infant with TAC (Type 4A)-IAA (Type B) repair. Due to growth potential, self-expandable metal stent was applied for postoperative proximal right PA stenosis, which caused bronchial compression. Later, we found patient having bronchomalacia. Surgical removal was needed. Stent insertion might be an option for postoperative PA stenosis, but bronchial compression might be a potential risk, particularly in patients with bronchomalacia.

External Plication of the Atrialized Right Ventricle in the Repair of Ebstein's Anomaly.

We describe a change in our technique for plication of the atrialized right ventricle during a Cone repair. The plication was performed from the "Outside"-on a beating heart. Advantages expected from this change are-all major coronaries are better seen when full of blood and can be avoided, if a major vessel is compromised-electrocardiography changes should point it out immediately, there is a small but significant saving in terms of arrest time and if the plication needs to be taken down because of an adverse coronary event-this can be done without the need of another cardioplegia.

Robot-Assisted Partial Atrioventricular Canal Defect Repair and Cryo-Maze Procedure.

Atrial septal defect is one of the most common congenital heart anomalies in adults. Patients with partial atrioventricular canal defects, previously known as ostium primum atrial septal defect, usually present at an early age, and only a few reach adulthood without surgical correction. Herein, we describe a young woman who presented with an ostium primum defect and severe symptomatic mitral and tricuspid regurgitation with paroxysmal atrial fibrillation. A complex repair was successfully done through a left atrial approach using robot-assistance.

Is a tricuspid annuloplasty ring significantly better than a De Vega's annuloplasty stitch when repairing severe tricuspid regurgitation?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether tricuspid valve (TV) repair with an annuloplasty ring leads to an improved outcome over a conventional suture annuloplasty for patients with severe tricuspid incompetence. Altogether, 306 papers were found using the reported search, of which 14 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We found seven studies supporting the use of ring annuloplasty over De Vega's suture annuloplasty. Five studies found no significant difference in outcome between the two techniques. We found only two studies supporting the use of De Vega's suture annuloplasty over ring annuloplasty. Therefore, most of the tabulated studies show good evidence in support of ring annuloplasty compared with De Vega's suture repair for treatment of moderate to severe TV regurgitation. One cohort study identified a 20.4% postoperative failure rate for tricuspid regurgitation (TR) repair and concluded non-application of ring as a predictor for reoperation. One cohort study with a mean follow-up of 17 months reported success rates as high as 97% with ring annuloplasty for TV regurgitation. One large cohort study of 2277 patients with TR who had undergone repair reported a sustained reduction in TR and the rate of recurrence in a 5-year echocardiographic follow-up. One cohort study of 129 patients concluded that ring annuloplasty has the lowest rate of recurrence compared with De Vega's suture repair. An old randomized controlled trial (RCT) on the subject also reported a similar result to the mentioned studies. In contrast, we reviewed one recent study and four older studies and found no significant difference between the two techniques. We reviewed one study that reported De Vega's suture repair as a superior technique to ring annuloplasty. We conclude that there is good evidence supporting ring annuloplasty over conventional De Vega's suture annuloplasty.

A comprehensive approach to fast tracking in cardiac surgery: ambulatory low-risk open-heart surgery.

OBJECTIVE: Ambulatory surgery, where the processes of admission, surgery and discharge are completed within 24h, is an increasingly important part of many surgical specialties. The aim of this study was to evaluate suitability of ambulatory approach for low-risk open-heart procedures. METHODS: A retrospective analysis of 48 patients who had undergone atrial septal defect (ASD) closure at our centre (from October 2005 through November 2006) suggested that this open-heart procedure was optimally suited for treatment with ambulatory approach. Based on this, 15 patients with ostium secundum ASD underwent surgical closure as ambulatory patients, with targeted discharge within 24h of admission. Twenty patients receiving conventional surgery in the other two units of the department served as the control group. RESULTS: Fourteen of the 15 patients were successfully discharged within 24h of admission. One patient remained in the hospital for excess incision site pain and was discharged on the 2nd postoperative day. Mean hospital stay for the entire cohort of 15 patients was 1583+/-669 min, whereas the mean hospital stay in the control group was 9.8 days. Follow-up was 100% complete at 30 days. There were no in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from the procedure. CONCLUSIONS: This study suggests that sufficient advancement in cardiac surgery has occurred to permit low-risk open-heart procedures (with an expected uneventful postoperative course) to be performed on an ambulatory basis. Once such a practice is firmly established, expanding its horizon may provide considerable improvement in patient satisfaction, more patient turnover per bed, and significant financial savings.

Does hemodilution by the crystalloid priming solution derange the efficacy of anticoagulation during cardiopulmonary bypass?

BACKGROUND AND AIM: Recent studies suggest the development of a procoagulant state with hemodilution. We conducted this study to investigate the effect of hemodilution, by the priming solution in a cardiopulmonary bypass (CPB) circuit, on "point of care" coagulation assays (activated clotting time [ACT] and thromboelastography [TEG]). METHODS: Twenty patients undergoing cardiac surgery with crystalloid priming of CPB circuit were evaluated. Confounding variables arising from contact activation were eliminated by minor modifications. Ten milliliter per kilogram body weight of priming solution (lactated Ringer's) was infused via the aortic cannula. ACT and TEG were performed, both prior to and immediately after hemodilution. In case of latter, four variables, reaction time (r), coagulation time (k), maximum amplitude (MA), and clot formation rate (angle alpha), were estimated and considered for the results. To see if these results are duplicated "in vitro," prebypass blood samples from eight heparinized patients, diluted (4:1) with priming solution from the venous reservoir, were also analyzed. RESULTS: Falls in ACT, from a mean of 659.7 (+/-260.6) seconds to 251.5 (+/-103.2) seconds (p < 0.01), r time (678.1 [+/-318.1] sec to 468.7 [+/-152.7] sec) (p < 0.01), and k time (211.7 [+/-161.7] sec to 123.8 [+/-32.1] sec) (p < 0.05) on TEG were noted upon hemodilution. Angle alpha and MA increased, but were not statistically significant. Results from the in vitro study closely matched the results from our in vivo analysis. CONCLUSION: The study suggests that hemodilution by crystalloid priming solution may impair the efficacy of anticoagulation during CPB. The mechanism for this phenomenon remains to be elucidated.

Should patients undergoing coronary artery bypass grafting with mild to moderate ischaemic mitral regurgitation also undergo mitral valve repair or replacement?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether mitral valve repair at the time of coronary artery bypass grafting (CABG) in patients with coronary artery disease and mild to moderate mitral insufficiency improves short and long-term outcome. Altogether 465 papers were found using the reported search, of which 16 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that there is good evidence to suggest that moderate mitral regurgitation in patients undergoing isolated CABG adversely affects survival and mitral regurgitation does not reliably improve after CABG alone. Unfortunately, the evidence to support mitral valve repair at the time of CABG to improve long-term survival is still weak. On balance, patients with moderate ischaemic mitral regurgitation having CABG should have mitral repair at the same time, although the evidence to support this is weaker than one might like.

Blunt abdominal injury: serum ALT-A marker of liver injury and a guide to assessment of its severity.

BACKGROUND: Elevated serum alanine aminotransferase (ALT) as a marker for diagnosis, and assessment of severity in patients with blunt hepatic injuries are hitherto un-described or casually mentioned in literature. METHODS: Prospective observational study of all patients admitted with blunt abdominal trauma accrued between May 2002 and December 2003. Upon admission, vital parameters were recorded and blood samples were drawn for haemogram and serum ALT (SGPT) levels. Patients were further evaluated with USG, CT scan or underwent a laparotomy. RESULTS: Of the 122 patients with blunt abdominal injury, 32 had raised ALT, among these 31 had liver injury. No patient with a normal ALT had hepatic injury. Five patients with a significantly raised ALT and negative USG had liver injury. Patients with modestly raised ALT, mostly resolved on non-operative treatment, whereas, patients with more marked rise had more serious hepatic injuries, more complications, greater transfusion requirement, and higher death rates. CONCLUSION: This observational cohort study strongly suggests that raised serum ALT is a sensitive diagnostic marker for blunt liver injury and its levels may assist with prognosis and guide management.

Anticoagulation for pregnant patients with mechanical heart valves.

Management of a pregnant patient with mechanical heart valve is a complex issue for all health care providers involved in the care of such patients. Complications may arise at any stage due to the increased haemodynamic load imposed by pregnancy or because of impaired cardiac performance often seen in these patients. In addition, the use of various cardiovascular drugs in pregnancy (especially anticoagulants) may lead tofoetal loss or teratogenic complications. Additionally, the risk of thrombo-embolic complications in the mother is increased by the hypercoagulable state of pregnancy. In this review, we have attempted to draw inferences to guide management of such patients based on the available literature. It seems that in pregnant women with mechanical heart valves, recent data support warfarin use throughout pregnancy, followed by a switch to heparin and planned induction of labour. However, the complexity of this situation demands a cafeteria approach where the patient herself can choose from the available options that are supported by evidence-based information. Unfortunately there is no consensus on such data. An overview of the available literature forms the basis of this review. In conclusion, a guideline comprising pragmatic considerations is preffered.

Prostate cancer: altering the natural history by dietary changes.

The importance of diet on the development and progression of prostate cancer was initially suggested by epidemiological studies. Since then, there has been a vast amount of research in this field. Compelling evidence now provides hope that evidence-based dietary alterations may markedly alter the natural history of this disease. Is there enough evidence for clinicians to be able to advise dietary modifications? The preliminary results no doubt are encouraging, but at present there seems to be no evidence to justify the widespread use of these proposed dietary interventions. However, as public awareness increases, all physicians involved with the care of patients with cancer of the prostate will need to be better armed with the current updates and advice on this issue.