Determinants of 30-day mortality in elderly patients admitted to a cardiovascular surgery intensive care unit.

BACKGROUND: This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery. METHODS: Data from 360 patients who underwent cardiac surgery between January 2012 and August 2021 in the Cardiovascular Surgery Intensive Care Unit (CVS ICU) were analyzed. Patients were categorized into two groups: "mortality+" (33 patients) and "mortality-" (327 patients). Factors influencing mortality, including preoperative, intraoperative, and postoperative risk factors, complications, and outcomes, were assessed. RESULTS: Significant differences were observed between the two groups in factors affecting mortality, including extubation time, ICU stay duration, blood transfusion, surgical reexploration, aortic clamp duration, glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine, hemoglobin A1c (HbA1c) levels, and the lowest systolic blood pressure during the first 24 hours in the ICU (p<0.05). The "mortality+" group had longer extubation times and ICU stays, required more blood transfusions, and had higher BUN-creatinine ratios, but lower systolic blood pressures, GFR, and HbA1c levels. Mortality was also higher in patients needing noradrenaline infusions and those who underwent reoperation for bleeding (p<0.05). CONCLUSION: By optimizing preoperative renal function, minimizing extubation time, shortening ICU stays, and carefully managing blood transfusions, surgical reexplorations, aortic clamp duration, and HbA1c levels, we believe that the mortality rate can be reduced in elderly patients. Key strategies include shortening aortic clamp times, reducing perioperative blood transfusions, and ensuring effective bleeding control.

Evaluating the accuracy of ChatGPT-4 in predicting ASA scores: A prospective multicentric study ChatGPT-4 in ASA score prediction.

BACKGROUND: This study investigates the potential of ChatGPT-4, developed by OpenAI, in enhancing medical decision-making processes, particularly in preoperative assessments using the American Society of Anesthesiologists (ASA) scoring system. The ASA score, a critical tool in evaluating patients' health status and anesthesia risks before surgery, categorizes patients from I to VI based on their overall health and risk factors. Despite its widespread use, determining accurate ASA scores remains a subjective process that may benefit from AI-supported assessments. This research aims to evaluate ChatGPT-4's capability to predict ASA scores accurately compared to expert anesthesiologists' assessments. METHODS: In this prospective multicentric study, ethical board approval was obtained, and the study was registered with clinicaltrials.gov (NCT06321445). We included 2851 patients from anesthesiology outpatient clinics, spanning neonates to all age groups and genders, with ASA scores between I-IV. Exclusion criteria were set for ASA V and VI scores, emergency operations, and insufficient information for ASA score determination. Data on patients' demographics, health conditions, and ASA scores by anesthesiologists were collected and anonymized. ChatGPT-4 was then tasked with assigning ASA scores based on the standardized patient data. RESULTS: Our results indicate a high level of concordance between ChatGPT-4 predictions and anesthesiologists' evaluations, with Cohen's kappa analysis showing a kappa value of 0.858 (p = 0.000). While the model demonstrated over 90% accuracy in predicting ASA scores I to III, it showed a notable variance in ASA IV scores, suggesting a potential limitation in assessing patients with more complex health conditions. DISCUSSION: The findings suggest that ChatGPT-4 can significantly contribute to the medical field by supporting anesthesiologists in preoperative assessments. This study not only demonstrates ChatGPT-4's efficacy in medical data analysis and decision-making but also opens new avenues for AI applications in healthcare, particularly in enhancing patient safety and optimizing surgical outcomes. Further research is needed to refine AI models for complex case assessments and integrate them seamlessly into clinical workflows.

Using the Perfusion Index for Block Success in Pediatric Patients: A Retrospective Study.

STUDY OBJECTIVE: To investigate the efficacy of the perfusion index in assessing block success in pediatric patients undergoing elective supracondylar fracture repair surgery. METHODS: It was a retrospective study in a tertiary-care center. Twenty-eight pediatric supracondylar humerus fracture patients who underwent elective surgery for fracture repair were evaluated. Perfusion index, pulse rate, pleth variability index (PVi), and oxygen saturation were measured at different time intervals before and after the coracoid infraclavicular block procedure. MAIN RESULTS:  The changes in perfusion index (PI) values were found to be statistically significant (p˂0.05). The Bonferroni analysis revealed that the results obtained at three separate measurement times differed significantly (p˂0.05). On the other hand, changes in other variables were not statistically significant (p˃0.05). CONCLUSIONS:  The perfusion index can be used as an indicator of block success in elective surgeries of the upper extremities in pediatric patients.

Brain vascularization in deep brain stimulation surgeries: epilepsy, Parkinson's disease, and obsessive-compulsive disorder.

BACKGROUND: In our experience, we encountered more blood vessels during deep brain stimulation (DBS) surgeries in epilepsy. In this study, we have quantified and compared the cerebral vascularization in epilepsy, Parkinson's disease (PD) and obsessive-compulsive disorder (OCD). METHODS: A retrospective observational study in 15 epilepsy and 15 PD patients was performed. The amount, location, and size of blood vessels within 5 millimeters (mm) of all DBS electrode trajectories (N.=120) for both targets (anterior nucleus of the thalamus: ANT and subthalamic nucleus: STN) in both patient groups were quantified and compared on a Medtronic workstation (Dublin, Ireland). Additionally, blood vessels in the trajectories (N.=120) of another group of 15 PD (STN) and 15 OCD (ventral capsule-ventral striatum [VC-VS]) patients were quantified and compared (trajectories N.=120), also to the first group. Statistical analyses were performed with SPSS version 27.0 (descriptive statistics, independent samples t-tests, Mann Whitney U Test, ANOVA Test and post-hoc Tukey Test). A P value <0.05 was considered statistically significant. RESULTS: Our results showed a significant greater amount of cerebral blood vessels in epilepsy patients (10 SD±4) compared to PD (PD1 6 SD±1 and PD2 5 SD±3) and OCD (5 SD±1) with P<0.0001. Also, all other subanalyses showed more vascularization in the epilepsy group. CONCLUSIONS: Our results show that the brain of epilepsy patients seems to be more vascularized compared to PD and OCD patients. This can make the surgical planning for DBS more challenging, and the use of multiple trajectories limited.

Does Type 1 Diabetic Adolescents' Fear of Stigmatization Predict a Negative Perception Insulin Treatment?

The purpose of this study was to investigate stigmatization, sociodemographic/diabetes-related characteristics and parents-related characteristics as predictors of a negative perception of insulin treatment in adolescents with type 1 diabetes in Turkey. The study was carried out using a cross-sectional correlation design. The research sample included 80 adolescents with type 1 diabetes who volunteered to take part. A positive perception of insulin treatment (ß = -.38, p < .001), stigmatization (ß = -.24, p = .013), informing others about one's type 1 diabetes (ß = .24, p = .017) and only using insulin when alone in public places (ß = .19, p = .042) were significant predictors of a negative perception of insulin treatment, and these variables explained 35% of the common variance. Diabetes' nurses should take stigmatization into account during their training and plan appropriate measures. Entrepreneurial, randomized, and controlled studies should be conducted to decrease the negative influence of stigmatization on the perception of insulin treatment in individuals with type 1 diabetes.

Assessment of the Accuracy of Cardiopulmonary Resuscitation Videos in English on YouTube according to the 2015 AHA Resuscitation Guidelines.

Over the last decade, YouTube has become one of the largest online resources for medical information. However, uploaded videos are published without any peer review or quality control, so incorrect and incomplete information can be easily disseminated via the virtual platform and can be perceived as correct. The YouTube website was searched for videos in English uploaded between 15 October 2015 and 21 October 2016 using the following keywords: "CPR," "cardiopulmonary resuscitation," and "basic life support." This study had a cross-sectional analytical design. In the first evaluation, the accuracy of the videos was checked according to the information contained in the basic cardiac life support algorithm. In the second evaluation, we assessed whether advanced-level, innovative medical information was included in these videos; when included, the accuracy of such information was checked. Of 774 videos evaluated, 92 videos were included in the study after application of the exclusion criteria. The videos were scored on a scale ranging from 0 to 20 points. The mean total score, based on all criteria, was 4.79 ± 2.88. The highest mean total score was achieved by videos uploaded by official medical organizations (6.43 ± 3.57), followed by those uploaded by health professionals and organizations (4.25 ± 2.49), and those uploaded by unidentified sources. YouTube videos are insufficient in providing information about the basic life support algorithm and advanced-level information according to the 2015 AHA resuscitation guidelines for health professionals. The educational material published by health institutions that are constantly working in the area is a more reliable source of information on subjects that directly affect human life, such as cardiopulmonary resuscitation.

[Discrepancy Between Subjective Memory Complaints and Objective Memory Deficits in Elderly Patients with Depression Compared to Mild Cognitive Impairment]. / Yaslilik Çagi Depresyonu ve Hafif Bilissel Bozuklugu Olan Hastalarda Öznel Bellek Yakinmalari ile Nesnel Bellek Bozukluklarinin Karsilastirilmasi.

OBJECTIVE: Since depression in the elderly usually presents with memory complaints and may impair memory functions, differential diagnosis of cognitive impairment is quite difficult. This study aimed to investigate the discrepancy between subjective memory complaints (SMC) and objective memory deficits in elderly patients with major depressive disorder (MDD) and mild cognitive impairment (MCI). METHOD: The study sample consisted of 30 elderly patients with a diagnosis of MCI (according to Petersen- Mayo criteria) and 29 with a diagnosis of DSM-IV-TR MDD who were admitted to the outpatient geriatric psychiatry clinic. The control group (HC) consisted of 30 healthy elderly volunteers. Turkish versions of the Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), ADAS-Cog, Subjective Memory Complaints Questionnaire (SMCQ) and Geriatric Depression Scale (GDS) were administered to all participants. RESULTS: The SMCQ scores of both MDD and MCI patients were higher than HC. However, there was no difference between HC and MDD groups in terms of the MMSE, the CDT and the ADAS-Cog scores. CONCLUSION: In elderly patients, subjective memory complaints do not seem to differentiate between depression and cognitive impairment. However, the discrepancy between SMC and cognitive performances suggest depression rather than a cognitive impairment. Further longitudinal studies should investigate the role of SMC in future cognitive impairment for elderly patients with depression.

[Dimensions of Agitation Based on the Cohen-Mansfield Agitation Inventory in Patients with Dementia]. / Demans Hastalarinda Cohen-Mansfield Ajitasyon Envanteri ile Degerlendirilen Ajitasyon Boyutlarinin Arastirilmasi.

OBJECTIVE: The aim of this study was to investigate the dimensions of agitation in dementia patients using the Turkish version of the Cohen-Mansfield Agitation Inventory (CMAI-T). MATERIALS AND METHODS: The study included 100 patients diagnosed as dementia, according to the DSM-IV-TR. The CMAI-T was administered to the patients' caregivers via face-to-face interviews. The Standardized Mini Mental State Examination (SMMSE) was used to assess cognitive functions. The severity of depression and the functional state of the patients were assessed using the Cornell Scale for Depression in Dementia (CSDD) and the Functional Activities Questionnaire (FAQ). Principal component analysis and varimax rotation were used to determine the factor structure of the CMAI-T. RESULTS: Factor analysis of the CMAI-T indicated a 3-factor structure: physically aggressive agitation, verbal agitation, and physically non-aggressive agitation. In 92% of the patients there was ≥1 agitation behavior during the previous 2 weeks. The CMAI-T total and factor scores were negatively correlated with the SMMSE scores, and positively correlated with the CSDD and the FAQ scores. CONCLUSIONS: The CMAI-T yielded 3 factors (physically aggressive agitation, verbal agitation, and physically non-aggressive agitation), which indicated the scale had construct validity. Agitation behaviors were associated with cognitive dysfunction, symptoms of depression and general level of functioning. Additional research is necessary to identify the predictors of these dimensions in different dementia samples, and to determine the efficacy of therapeutic interventions.

Discriminant validity and reliability of the Turkish version of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-T).

The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) has been used as a measure of cognitive decline in different cultures. The purpose of the study was to establish the validity and reliability of the Turkish version of IQCODE (IQCODE-T) and the ability of the questionnaire to distinguish between older adults with DSM-IV-TR dementia (n = 100) and healthy control participants (n = 60). In addition, the power of the IQCODE-T to distinguish between patients with depression and dementia was investigated. The Mini-Mental State Examination (MMSE) was performed on all participants and the IQCODE-T was administered to their informants. The IQCODE-T, which was not associated with age or education of the patients, significantly differentiated patients with dementia and controls. The IQCODE-T also correctly classified 73% of depressed patients as "non-demented". Because it is easy to administer, not associated with age/education and yields fewer false-positive results than the MMSE in depression, the IQCODE-T can be used in the detection of dementia.

Predictors of burnout in the family caregivers of Alzheimer's disease: evidence from Turkey.

OBJECTIVE: The aim of this study was to investigate the factors related to burnout in the family caregivers of Alzheimer's disease. METHODS: Subjects included in the study were 44 Alzheimer's disease patients and their primary caregivers. Patients were evaluated with Mini Mental State Examination, Brief Psychiatric Rating Scale, Physical Self-Maintenance Scale and Geriatric Depression Scale, and carers were administered Maslach Burnout Inventory, Ways of Coping Scale, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale. RESULTS: The emotional exhaustion of caregivers revealed a significant relationship with the caregivers' anxiety, submissive approach for coping and the patient's self-maintenance. Depersonalisation was found to be related to the depression score of the patient. DISCUSSION: This study may serve to increase clinicians' awareness of burnout in relatives of dementia patients. It points to the fact that research for determining the causes and consequences of burnout in the family caregivers is warranted.