Physical Features and Vital Signs Predict Serum Albumin and Globulin Concentrations Using Machine Learning.

OBJECTIVE: Serum protein concentrations are diagnostically and prognostically valuable in cancer and other diseases, but their measurement via blood test is uncomfortable, inconvenient, and costly. This study investigates the possibility of predicting albumin, globulin, and albumin-globulin ratio from easily accessible physical characteristics (height, weight, Body Mass Index, age, gender) and vital signs (systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, pulse) using advanced machine learning techniques. METHODS: We obtained albumin concentration, globulin concentration, albumin-globulin ratio and predictor information (physical characteristics, vital signs) from physical exam records of 46,951 healthy adult participants in Hangzhou, China. We trained a computational model to predict each serum protein concentration from the predictors and then evaluated the predictive accuracy of each model on an independent portion of the dataset that was not used in model training. We also determined the relative importance of each feature within the model. RESULTS: Prediction accuracies were r=0.540 (95% CI: 0.539-0.540; Pearson r) for albumin, r=0.250 (95% CI: 0.249-0.251) for globulin, and r=0.373 (95% CI: 0.372-0.374) for albumin-globulin ratio. The most important predictive features were age (100% ± 0.0%; mean ± 95% CI of normalized importance), gender (34.4% ± 0.7%), pulse (25.6% ± 1.3%) and Body Mass Index (24.4% ± 2.3%) for albumin, pulse (83.7% ± 3.8%) for globulin, and age (99.2% ± 1.0%), gender (59.2% ± 1.7%), Body Mass Index (46.1% ± 4.2%) and height (40.0% ± 3.8%) for albumin-globulin ratio. CONCLUSIONS: Our models predicted serum protein concentrations with appreciable accuracy showing the promise of this approach. Such models could serve to augment existing tools for identifying "at-risk" individuals for follow-up with a blood test.

Stress Determined through Heart Rate Variability Predicts Immune Function.

BACKGROUND: Stress is a prevalent health problem in modern society. If experienced for long periods of time it can lead to immune dysfunctions. Thus, public health management practices must include the assessment of stress. In health management settings, electrocardiography (ECG) is routinely used to assess cardiovascular health and make inferences about stress using information from heart rate variability (HRV). However, it is unclear whether stress assessment based on HRV can also be used to index immune function. OBJECTIVES: To compare stress that was determined by a measure of HRV (pNN50) from ECG with immune function indices (neutrophil, monocyte, and lymphocyte percentages) obtained from blood samples. METHODS: A total of 184 healthy adults participated in the study, which took place in an examination room at the Health Management Center of The Affiliated Hospital of Hangzhou Normal University, China. Participants viewed a relaxing video while having a 2-min ECG recorded. They were then taken to have their blood drawn as part of their physical examination. Measures of stress (pNN50) were extracted from ECG, while measures of immune function (percentages of neutrophils, monocytes, and lymphocytes) were extracted from blood samples. RESULTS: Stress correlated positively with neutrophil percentages (r = 0.21) and negatively with monocyte (r = -0.16) and lymphocyte percentages (r = -0.18). CONCLUSIONS: These findings show HRV analysis to be a potentially viable noninvasive and inexpensive method not only for indexing stress, but also predicting immune function, thus managing the health risks associated with stress.

Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

BACKGROUND: Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. OBJECTIVE: Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. MATERIALS AND METHODS: We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. RESULTS: We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. CONCLUSION: Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed.

Good clinical practice in dubious head trauma - the problem of retained intracranial foreign bodies.

OBJECTIVE: In young people, traumatic head and brain injuries are the leading cause of morbidity and mortality. In some cases, no neurological deficits are present, even after penetrating trauma. These patients have a greater risk of suffering from secondary injuries due to secondary infections, brain edema, and hematomas. We present a case report which illustrates that brain injuries that do not induce neurological deficits can still result in a fatal clinical course and death, with medicolegal consequences. CLINICAL PRESENTATION: A 19-year-old patient was admitted to hospital suffering from a head injury due to an assault. He reported that he was attacked from behind. Medical examination showed no neurological deficits, and only a small occipital wound. Neuroimaging of the cranium revealed that a knife blade was penetrating the cranial bone and touching the superior sagittal sinus. INTERVENTION: After removing the foreign body, magnetic resonance imaging showed that the superior sagittal sinus remained open. CONCLUSION: We want to stress that possible problems can arise due to the retention of objects in the cranium, while also highlighting the risk of superficial clinical examination.

Assessing operational effectiveness in healthcare organizations: a systematic approach.

PURPOSE: The purpose of this paper is to propose a systematic approach to measuring, tracking, monitoring and continuously improving efficiency, availability and quality in healthcare operational settings. DESIGN/METHODOLOGY/APPROACH: The proposed measure of healthcare operational effectiveness (HOE) consists of three indicators. They include an availability indicator, an quality indicator, and an efficiency indicator. The proposed approach tends to facilitate the systematic improvement at the different facets of operational effectiveness. FINDINGS: The proposed operational performance approach based on the HOE is consistent with the themes of performance measures and measurement reported in the literature. RESEARCH LIMITATIONS/IMPLICATIONS: The proposed healthcare operational effectiveness approach represents a serious attempt at quantifying the key facets of service effectiveness in healthcare operational settings. The validation of this performance assessment and measurement approach is worthy of future research. PRACTICAL IMPLICATIONS: The approach advocated by the HOE has operational and strategic relevance to decision makers of healthcare organizations. ORIGINALITY/VALUE: This paper presents a practical, systematic approach toward enhancing operational effectiveness in healthcare organizations. Relevant implementation issues associated with the proposed approach are also addressed.

The utility of the StarClose arterial closure device in patients with peripheral arterial disease.

The StarClose (Abbott Vascular, Redwood City, CA) arterial closure device utilizes an extraluminal nitinol clip to establish hemostasis. The purpose of this study was to determine the safety and efficacy of StarClose from a prospective peripheral arterial disease (PAD) registry. Over an 18-month time interval, 500 StarClose devices were used in 378 consecutive patients with symptomatic PAD after diagnostic and/or therapeutic endovascular cases. Patient demographics along with objective criteria including duplex ultrasound images, common femoral artery flow velocities, and ankle-brachial indexes (ABIs) were analyzed before and after StarClose placement. All outpatients received prophylactic antibiotic (one dose), periprocedural heparin (without protamine reversal), and antiplatelet therapy. Aspirin and clopidogrel (Plavix) was used for all patients undergoing therapeutic intervention. There were 378 patients who underwent procedures for aortoiliac or infrainguinal PAD, 99 of which were bilateral. Of the 500 arteriotomy closures, 296 were therapeutic interventions with sheath sizes of 6-8 F in the common femoral artery. The diagnostic studies (n = 204 arteriotomies) were performed with a 5F sheath. The technical success in achieving hemostasis was 97.2%; only 14 devices had a deployment problem requiring prolonged manual compression. Median length of stay was 157 min for patients done on an outpatient basis. Eleven of 260 (4.2%) on duplex follow-up had a doubling of the peak systolic velocity, only one of which was symptomatic. Late follow-up showed 42 of 360 (11.7%) with a drop in ABI >0.10. Nine major complications (2.0%) were identified in follow-up. The StarClose closure device has a low major complication rate and is safe and efficacious in patients with PAD, although stenosis at the arteriotomy site may occur. The device has achieved rapid hemostasis without need for anticoagulant reversal and requires significantly less time to ambulation than manual compression.