Artificial Intelligence in Malnutrition: A systematic literature review.

Malnutrition among the population of the world is a frequent yet underdiagnosed problem in both children and adults. Development of malnutrition screening and diagnostic tools for early detection of malnutrition is necessary to prevent long-term complications to patients' health and well-being. Most of these tools are based on predefined questionnaires and consensus guidelines. The use of artificial intelligence (AI) allows for automated tools to detect malnutrition in an earlier stage to prevent long-term consequences. In this study, a systematic literature review was carried out with the goal of providing detailed information on what patient groups, screening tools, machine learning algorithms, data types, and variables are being used as well as the current limitations and implementation stage of these AI based tools. The results showed that a staggering majority exceeding 90 percent of all AI models go unused in day-to-day clinical practice. Furthermore, supervised learning models seemed to be the most popular type of learning. Alongside this, disease-related malnutrition was the most common category of malnutrition found in the analysis of all primary studies. The current research provides a resource for researchers to identify directions for their research on the use of AI in in Malnutrition.

Barriers and facilitators to effective electronic health record-based sepsis screening in the pediatric intensive care unit.

Introduction: The Pediatric Surviving Sepsis Campaign supports the implementation of automated tools for early sepsis recognition. In 2019 the C.S. Mott Children's Hospital Pediatric Intensive Care Unit deployed an electronic medical record (EMR)-based screening for early recognition and treatment of sepsis. Materials and Methods: We analyzed all automated primary sepsis alerts, secondary screens, and bedside huddles from November 2019 to January 2020 (Cohort 1) and from November 2020 to January 2021 (Cohort 2) to identify barriers and facilitators for the use of this tool. We distributed surveys to frontline providers to gather feedback on end-user experience. Results: In Cohort 1, 895 primary alerts were triggered, yielding 503 completed secondary screens and 40 bedside huddles. In Cohort 2, 925 primary alerts were triggered, yielding 532 completed secondary screens and 12 bedside huddles. Surveys assessing end-user experience identified the following facilitators: (1) 73% of nurses endorsed the bedside huddle as value added; (2) 74% of medical providers agreed the bedside huddle increased the likelihood of interventions. The greatest barriers to successful implementation included the (1) overall large number of primary alerts from the automated tool and (2) rate of false alerts, many due to routine respiratory therapy interventions. Discussion: Our data suggests that the successful implementation of EMR-based sepsis screening tools requires countermeasures focusing on 3 key drivers for change: education, technology, and patient safety. Conclusion: While both medical providers and bedside nurses found merit in our EMR-based sepsis early recognition system, continued refinement is necessary to avoid sepsis alert fatigue.

The Accuracy of Height Prediction Equations in Greek Patients: A Cross-Sectional Study.

In clinical settings, standing height measurement is often difficult to perform due to patients' inability to stand upright. Height prediction equations derived from measurements of the length of other body segments have been published; however, they are not readily applicable to all populations since ethnic differences affect the relationship between standing height and body segment length. This cross-sectional study aimed to examine the accuracy of height prediction using the Malnutrition Universal Screening Tool (MUST) height predictive equations among Greek patients and to develop new, nationally representative equations. The study population consisted of 1198 Greek adult outpatients able to stand upright without assistance and without medical conditions that affected their height. Standing height, ulna length, knee height and demi-span measurements were obtained from 599 males and 599 females. Patients were stratified into age groups of <55 and ≥55 years, <60 and ≥60 years and <65 and ≥65 years according to the categories indicated by the MUST for height prediction from alternative measurements. There were positive correlations between standing height and ulna length and knee height and demi-span length (p < 0.001) in both sexes and all age categories. A strong correlation was observed between the measured and predicted standing height using ulna length (rho = 0.870, p < 0.001), knee height (rho = 0.923, p < 0.001) and demi-span length (rho = 0.906, p < 0.001). The average difference between the MUST indicative equations' height predictions from alternative measurements and actual height was -3.04 (-3.32, -2.76), -1.21 (-1.43, -0.988) and 2.16 (1.92, 2.41), respectively. New height prediction equations for Greek patients were identified, with the predicted values closer to the measured standing heights than those predicted with the MUST indicative equations for height prediction from alternative measurements.

A Glycemic Status Classification Model Using a Radiofrequency Noninvasive Blood Glucose Monitor.

Despite significant efforts in the development of noninvasive blood glucose (BG) monitoring solutions, delivering an accurate, real-time BG measurement remains challenging. We sought to address this by using a novel radiofrequency (RF) glucose sensor to noninvasively classify glycemic status. The study included 31 participants aged 18-65 with prediabetes or type 2 diabetes and no other significant medical history. During control sessions and oral glucose tolerance test sessions, data were collected from both a RF sensor that rapidly scans thousands of frequencies and concurrently from a venous blood draw measured with an US Food and Drug Administration (FDA)-cleared glucose hospital meter system to create paired observations. We trained a time series forest machine learning model on 80% of the paired observations and reported results from applying the model to the remaining 20%. Our findings show that the model correctly classified glycemic status 93.37% of the time as high, normal, or low.

Development and validation of the BMQ-AIR©: a screening tool for assessing patients' treatment beliefs about switching to anti-inflammatory reliever (AIR) therapy.

Introduction: Despite anti-inflammatory reliever (AIR) therapy now being the preferred treatment choice across all severities of asthma, many patients are still "attached" to their short-acting beta2-agonist (SABA) reliever, believing this to be the best way to control their asthma. To encourage individuals to switch to AIR, it is important to first identify the beliefs that patients hold about AIR. Objective: The aim of this paper was to describe the initial development and validation of the BMQ-AIR©, a six-item screening tool which assesses and identifies patients' treatment beliefs about switching to AIR therapy. Methods: Statements were identified from the primary literature that assessed patients' perceptions of AIR therapy and adapted from the Beliefs about Medicines Questionnaire (BMQ). Internal reliability was examined using Cronbach's alpha coefficient. Construct validity was evaluated by comparing scores on BMQ-AIR© with a validated measure of medication adherence and SABA beliefs. Results: A total of 446 participants completed the online survey. The BMQ-AIR© contained two subscales with three items each. Both the Necessity and Concerns subscales demonstrated good internal reliability, with Cronbach's α-values of 0.70 and 0.69, respectively. Both subscales were negatively correlated with self-report inhaled corticosteroid adherence (Necessity: r = -0.28, p < 0.0001; Concerns: r = -0.28, p < 0.0001) and positively correlated with SRQ scores (Necessity: r = 0.51, p < 0.0001; Concerns: r = 0.44, p < 0.0001). Conclusion: Preliminary findings indicate that BMQ-AIR© demonstrates satisfactory reliability and validity. BMQ-AIR© is a promising tool that may help tailor interventions to an individual's specific beliefs and barriers to switching to better support individuals in stopping SABA and initiating AIR therapy.

The risk of under-nutrition in hospitalised Malaysian children: Use of 3-minute nutrition screening-paediatrics (Paediatric 3-MinNS).

Objectives: To evaluate the under-nutrition risk of children admitted to hospitals using a validated tool. METHODS: The cross-sectional study was conducted from September 2017 to June 2018 in the paediatrics wards of a tertiary referral paediatric government hospital, a tertiary teaching hospital and a government district hospital in Malaysia. The sample comprised paediatric patients aged 2-12 years within 24-72 hours of hospital admission. Data was collected using the 3-Minute Nutrition Screening-Paediatrics tool. Data was analysed using SPSS 20. RESULTS: Of the 341 patients screened, 284(83.3%) were included; 170(59.9%) boys and 114(40.1%) girls. The overall median age was 4.85 years (interquartile range: 4.33 years). The median length of hospital stay was 3 days (interquartile range: 3 days). There were 72(25.4%) participants at high under-nutrition risk, with the highest proportion being at the district government hospital 31(33%). Among those with high risk, 5.4% subjects had severe acute malnutrition, 9.7% had severe chronic malnutrition, and 11.1% had severe thinness. Conclusion: The 3-Minute Nutrition Screening-Paediatrics scale was found to be effective as a nutrition screening tool for hospitalised children in Malaysia.

Malnutrition risk and associated factors in hospitalized older adult patients with neurological diseases: a retrospective cohort study.

INTRODUCTION: Malnutrition risk (MR) in older adults with neurological disorders is high, but there is little evidence for validated screening tools in this group, as well as for the clinical and socioeconomic factors associated with a high MR. OBJECTIVES: To determine the association of MR using the Malnutrition Universal Screening Tool (MUST) with mortality and length of stay (LOS) in older adults with neurological diseases. Secondarily, the association of clinical, and socioeconomic factors with MR and clinical outcomes was sought. METHODS: A retrospective cohort study was carried out at a third-level neurological disease referral center in Mexico. All patients older than 60 years admitted from January 2017 to December 2018 were considered. MUST, clinical and socioeconomic factors were assessed at hospital admission. Outcomes were followed up to hospital discharge or a maximum of 6 months. RESULTS: A total of 765 patients were included, of whom 24.7% (n = 189) were at high risk. A high MR was independently associated with mortality (OR 3.09; 95% CI 1.60-5.98, p = .001) and LOS >14 days (OR 4.38; 95% CI 2.79-6.89, p = <.001). The only factors independently associated with high MR was economic dependence and unemployment. Patients with high MR and economic dependence (OR 4.0; 95% CI 1.34-11.99, p = .013) or unemployment (OR 3.43; 95% CI 1.17-10.06, p = .025) had the highest mortality. CONCLUSIONS: In hospitalized older adults with neurological diseases, high MR is independently associated with increased mortality and LOS. Economic dependence or unemployment are associated with worse clinical outcomes in patients with high MR.

The reliability and validity of brief cognitive screening tools used in traumatic brain injury: A systematic review.

Reliable and valid cognitive screening tools are essential in the assessment of those with traumatic brain injury (TBI). Yet, there is no consensus about which tool should be used in clinical practice. This systematic review assessed psychometric properties of cognitive screening tools for detecting cognitive impairment in TBI. Inclusion criteria were: peer-reviewed validation studies of a cognitive screening tool(s); with a sample of adults aged 18-80 diagnosed with TBI (mild-severe); and with psychometrics consistent with COSMIN guidelines. Published literature was retrieved from MEDLINE, Web of Science Core Collection, EMBASE, CINAHL, and PsycINFO on 27 January 2022. A narrative synthesis was performed. Thirty-four studies evaluated the psychometric properties of a total of 22 cognitive screening tools, in a variety of languages. Properties assessed included structural validity, internal consistency, reliability, criterion validity (or diagnostic test accuracy), convergent/divergent validity, and discriminant validity. The Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) were the most widely validated cognitive screening tools for use in TBI. The MoCA had the most promising evidence of its psychometric properties, which has implications for clinical practice. Future research should aim to follow standard criteria for psychometric studies to allow meaningful comparisons across the literature.

Development of a Screening Tool for Assessing Sexual Difficulties Among Patients with Parkinson's Disease: The PD-SDS.

Background: People with Parkinson's disease (PwPD) exhibit various sexual difficulties (SDs) that may be due to motor and/or nonmotor symptoms or the use of antiparkinsonian medication. SDs are often underreported by PwPD and underexplored by physicians. Objective: This study aimed to explore the SDs experienced by PwPD and create a scale for assessing them. Methods: A corpus of items was generated from semistructured interviews to represent the experience of PwPD as closely as possible. The number of items was reduced according to the psychometric properties, and the scale's structure was subsequently examined. The final phase consisted of measuring the scale's validity and reliability. Results: After assessment of the original corpus of 59 items by PwPD and clinicians, a 25-item version was obtained. The analysis of item properties led to the removal of fifteen items. An exploratory factor analysis of the first 10-item version with a first PwPD sample identified four components of the SDs among PwPD: "low sexual esteem," "sexual displeasure," "impact on sexual position" and "hypersexuality." With a second PwPD sample, a confirmatory factor analysis demonstrated a satisfactory fit between the model with four components and the data. The 10-item scale had good internal consistency and good temporal reliability. Conclusions: The Parkinson's Disease Sexual Difficulties Scale (PD-SDS) is a valid screening tool that facilitates the investigation of and communication about PD-related SDs. It is intended to improve the identification of vulnerable PwPD and to target the domain of sexual experience impacted by PD to better support PwPD.

The association between the 'at risk of developing undernutrition' category of the Short Nutritional Assessment Questionnaire 65+ and incident undernutrition in community-dwelling older adults.

BACKGROUND & AIMS: Screening tools like the Short Nutritional Assessment Questionnaire 65+ (SNAQ65+) have been developed for the early recognition of undernutrition in older adults. The SNAQ65+ screens for being undernourished (red), being 'at risk of developing undernutrition' (i.e. 'at risk', orange), or 'not at risk' (green). This study investigated whether community-dwelling older adults 'at risk' (orange) are more likely to develop undernutrition during a 3-year follow-up compared to those 'not at risk' (green). METHODS: Prospective data from a Longitudinal Aging Study were used. A total of 5461 observations, using multiple 3-year waves of participants aged ≥65 years with an orange or green baseline score were included. Logistic mixed models were used to assess the association with four indicators of incident undernutrition at 3-year follow-up: (1) red SNAQ65+ score (mid upper arm circumference (MUAC) < 25 cm and/or ≥4 kg self-reported unintended weight loss in 6 months); (2) MUAC <25 cm; (3) ≥4 kg self-reported unintended weight loss in 6 months; and (4) ≥10% objectively measured weight loss in 3 years. RESULTS: There were 53.1% female participants across waves, with a mean age of 74.2 (SD 6.1) years. Overall, 6.2% were 'at risk of developing undernutrition' (orange) at baseline. The incidence rates of undernutrition based on a red SNAQ65+ score, MUAC <25 cm, ≥4 kg self-reported unintended weight loss, and ≥10% measured weight loss were 10.4%, 2.9%, 6.4%, and 5.4%, respectively. Those 'at risk' (orange) had a higher odds ratio of incident undernutrition based on these four indicators than those 'not at risk' (green) (respective odds ratio's: 2.51 (95%CI 1.74-3.62); 2.16 (95%CI 1.11-4.20); 2.43 (95%CI 1.61-3.65); and 2.08 (95%CI 1.28-3.37)). CONCLUSION: Community-dwelling older adults screened to be 'at risk of developing undernutrition' (orange) with the SNAQ65+ have a more than two-fold higher odds ratio of developing undernutrition during a 3-year follow-up compared to those 'not at risk' (green).

Risk factors for postoperative urinary retention in fragility hip fracture patients: a prospective study.

BACKGROUND: Postoperative urinary retention (POUR) among older patients with hip fractures is common and may result in delayed ambulation, prolonged hospital stays, and urinary tract infections. Although preoperative urinary catheter indwelling and early postoperative removal can prevent perioperative urinary retention, this condition may occur in some patients after catheter removal, which requires urinary catheter re-indwelling or intermittent catheterization. Therefore, this study aims to identify risk factors and develop a screening tool for postoperative urinary retention in patients who have undergone operative treatment for fragility hip fractures subsequent to urinary catheter removal. METHODS: A prospective cohort study of 145 fragility hip fracture in older patients who were operatively treated between September 2020 and May 2022 was conducted. All patients were evaluated for urine retention after urinary catheter removal using a bladder scan. In addition, factors related to urinary retention were collected and utilized for screening tool development. RESULTS: Of the included patients, 22 (15.2%) were diagnosed with POUR. A multivariable logistic regression model using a stepwise backward elimination algorithm identified the current use of drugs with anticholinergic effect (OR = 11.9, p = 0.012), international prostate symptom score (IPSS) ≥ 8 (OR = 9.3, p < 0.001), and inability to independently get out of bed within 24 h postoperatively (OR = 6.5, p = 0.051) as risk factors of POUR. The screening tool that has been developed revealed an excellent performance (AuROC = 0.85, 95%CI 0.75 to 0.91) with good calibration and minimal optimism. CONCLUSIONS: Current use of drugs with anticholinergic effects, IPSS ≥ 8, and inability to independently get out of bed within 24 h postoperatively are significant variables of POUR. For additional external validation, a proposed scoring system for POUR screening was developed. TRIAL REGISTRATION: The study protocol was retrospectively registered in The Thai Clinical Trials Registry (TCTR20220502001: 2 May 2022).

OIT-BRAVE Questionnaire: Development and clinical implementation of a screening instrument for patient-reported difficulties during oral immunotherapy.

The OIT-BRAVE questionnaire was developed to serve as a clinical screening tool to identify patients who may be experiencing adverse effects with oral immunotherapy.

Development of a Subjective Visual Vertical Test System Using a Smartphone With Virtual Reality Goggles for Screening of Otolithic Dysfunction: Observational Study.

BACKGROUND: The subjective visual vertical (SVV) test can evaluate otolith function and spatial awareness and is performed in dedicated vertigo centers using specialized equipment; however, it is not otherwise widely used because of the specific equipment and space requirements. An SVV test smartphone app was developed to easily perform assessments in outpatient facilities. OBJECTIVE: This study aimed to verify whether the SVV test smartphone app with commercially available virtual reality goggles can be used in a clinical setting. METHODS: The reference range was calculated for 15 healthy participants. We included 14 adult patients with unilateral vestibular neuritis, sudden sensorineural hearing loss with vertigo, and Meniere disease and investigated the correlation between the SVV test results and vestibular evoked myogenic potential (VEMP) results. RESULTS: The SVV reference range of healthy participants for the sitting front-facing position was small, ranging from -2.6º to 2.3º. Among the 14 patients, 6 (43%) exceeded the reference range for healthy participants. The SVV of patients with vestibular neuritis and sudden sensorineural hearing loss tended to deviate to the affected side. A total of 9 (64%) had abnormal cervical VEMP (cVEMP) values and 6 (43%) had abnormal ocular VEMP (oVEMP) values. No significant difference was found between the presence or absence of abnormal SVV values and the presence or absence of abnormal cVEMP and oVEMP values; however, the odds ratios (ORs) suggested a higher likelihood of abnormal SVV values among those with abnormal cVEMP and oVEMP responses (OR 2.40, 95% CI 0.18-32.88; P>.99; and OR 2, 95% CI 0.90-4.45; P=.46, respectively). CONCLUSIONS: The SVV app can be used anywhere and in a short period while reducing directional bias by using virtual reality goggles, thus making it highly versatile and useful as a practical otolith dysfunction screening tool.

Detection of Cervical Foraminal Stenosis from Oblique Radiograph Using Convolutional Neural Network Algorithm.

PURPOSE: This study was conducted to develop a convolutional neural network (CNN) algorithm that can diagnose cervical foraminal stenosis using oblique radiographs and evaluate its accuracy. MATERIALS AND METHODS: A total of 997 patients who underwent cervical MRI and cervical oblique radiographs within a 3-month interval were included. Oblique radiographs were labeled as "foraminal stenosis" or "no foraminal stenosis" according to whether foraminal stenosis was present in the C2-T1 levels based on MRI evaluation as ground truth. The CNN model involved data augmentation, image preprocessing, and transfer learning using DenseNet161. Visualization of the location of the CNN model was performed using gradient-weight class activation mapping (Grad-CAM). RESULTS: The area under the curve (AUC) of the receiver operating characteristic curve based on DenseNet161 was 0.889 (95% confidence interval, 0.851-0.927). The F1 score, accuracy, precision, and recall were 88.5%, 84.6%, 88.1%, and 88.5%, respectively. The accuracy of the proposed CNN model was significantly higher than that of two orthopedic surgeons (64.0%, p<0.001; 58.0%, p<0.001). Grad-CAM analysis demonstrated that the CNN model most frequently focused on the foramen location for the determination of foraminal stenosis, although disc space was also frequently taken into consideration. CONCLUSION: A CNN algorithm that can detect neural foraminal stenosis in cervical oblique radiographs was developed. The AUC, F1 score, and accuracy were 0.889, 88.5%, and 84.6%, respectively. With the current CNN model, cervical oblique radiography could be a more effective screening tool for neural foraminal stenosis.

Short functional geriatric evaluation: Confirmatory factor analysis to assess the multidimensionality of frailty in community-dwelling older adults.

This paper explores the ageing population in Italy, where older adults account for more than 14 million individuals (in January 2023) and constitute 24.1 % of the total population. Frailty, a condition encompassing biological, psychological, social, and economic challenges, is recognised as a significant public health issue. The study introduces the Short Functional Geriatric Evaluation (SFGE) as a large-scale screening tool for frailty in community-dwelling older individuals. A Confirmatory Factor Analysis (CFA) was conducted on the SFGE. The CFA scrutinises the construct validity of SFGE using a sample population from the "Long Live the Elderly!" program in Italy. Initial results indicate an acceptable fit, prompting the incorporation of Modification Indices to enhance model performance. The refined CFA demonstrates that the SFGE model effectively captures the multidimensional nature of frailty. The text underscores the timeliness of identifying frailty, emphasising the need for simple, fast, and predictive tools to screen large populations efficiently.

Responding to human trafficking among refugees: prevalence and test accuracy of a modified version of the adult human trafficking screening tool.

BACKGROUND: Human trafficking is a human rights violation and urgent public health challenge. It involves the exploitation of a person by means of force, intimidation or deceit and causes severe health risks. Though it occurs all over the world, its true extent is still unknown. Refugees are especially vulnerable to human trafficking due to language barriers and difficult living conditions. Therefore, the purpose of this study was to estimate the prevalence and design a screening tool to identify survivors of all forms of human trafficking among refugees in a German state registration and reception centre. METHODS: In cooperation with the local authorities and the Ministry of Justice and for Migration Baden-Württemberg, we interviewed newly arrived refugees at an initial reception centre in Southern Germany to assess the prevalence of human trafficking. We used both a combination of the Adult Human Trafficking Screening Tool and a publication by Mumma et al. to assess all forms of human trafficking. RESULTS: In total, 13 of the 176 refugees had experienced trafficking, which corresponded to a prevalence of 7.3% (95%-CI = [3.5%, 11.3%]). Across all languages the questionnaire had a sensitivity of 76.9% and a specificity of 84.0% at a recommended cut-off of six positive responses. The recommended cut-off differed slightly for the Arabic, Farsi, Turkish, and English version. In an exploratory descriptive analysis on subregions, refugees from West Africa had a substantially higher prevalence (33.3%, 8 out of 24) for human trafficking within our sample, especially women. However, when we excluded this region from our analysis, we found no significant gender difference for the rest of the sample. CONCLUSIONS: The high prevalence of trafficking in most regions, regardless of gender, suggests that more effort is needed to identify and protect all trafficked persons. The designed screening tool seems to be a promising tool to detect an especially vulnerable group of refugees and provides assistance in identifying survivors of human trafficking.

Predictive validity of the Developmental Coordination Disorder Questionnaire as a screening tool to identify motor skill problems: A systematic review and meta-analysis.

BACKGROUND: The Developmental Coordination Disorder Questionnaire (DCDQ) has been used to screen children who probably have developmental coordination disorder (DCD). AIMS: We systematically reviewed studies on the predictive validity of the DCDQ and performed a meta-analysis on its diagnostic accuracy. METHODS AND PROCEDURES: Literature was searched through four electronic databases: MEDLINE, Embase, CINAHL, and PsycArticles. A total of 27 studies was selected based on the inclusion criteria. The sensitivity and specificity of the DCDQ were assessed using summary receiver operating characteristic (sROC) curves. Subgroup analyses were conducted according to the DCDQ type, reference standard, and participant type. OUTCOMES AND RESULTS: Overall, the DCDQ has a sensitivity of 0.70 and a specificity of 0.77, showing moderate diagnostic accuracy (area under the curve, 0.80). Subgroup analysis showed that the revised version of the DCDQ had higher diagnostic accuracy than the original version. When the reference standard was the Diagnostic and Statistical Manual of Mental Disorders, the sensitivity and specificity of the DCDQ were 0.87 and 0.83, respectively. The diagnostic accuracy was higher in clinical samples compared to the general population. CONCLUSIONS AND IMPLICATIONS: This study demonstrated that the DCDQ has adequate diagnostic accuracy, suggesting it can help screen children with motor skill deficits.

Validation of the brief screening of Social Network Addiction Risk.

INTRODUCTION: This study aims to develop a valid and reliable tool to evaluate social network behavior in young adults. METHODS: To validate the Brief screening for Social Network Addiction Risk (BSNA), data from 776 Italian young adults (64.3 % of women) were collected. The suitability of the instrument was statistically assessed. Experts' opinions, item reliability, exploratory and confirmatory factor analyses, and convergent validity were adopted to validate the BSNA items. Internal consistency coefficients were also calculated. RESULTS: According to the statistical analyses, a 2-factor structure was confirmed. The two scales of BSNA assess behavior and motivation frame of social networks use. The second order model proved a global score of risk of social network addiction. Fit indices highlighted the high goodness of the model. Preliminary analyses of prevalence estimated that about 18 % of participants reported problematic Social Network use, which may overtime represent a marker of addictive behavior. CONCLUSION: The final version of the BSNA, with 11 items evaluated on a 5-point Likert- scale, is a short but valid tool for measuring the risk of social network addiction. It represents a promising screening tool aimed to not overpathologize a behavior, but to furnish adequate insight into this phenomenon.

Real-world use of the updated refractory epilepsy screening tool for Lennox-Gastaut syndrome.

OBJECTIVE: To evaluate the Refractory Epilepsy Screening Tool for Lennox-Gastaut Syndrome (REST-LGS) for real-world identification of LGS in adults and to develop a scoring system for the tool. METHODS: A retrospective chart review of adults with drug resistant epilepsy (DRE) and intellectual development disorder (IDD) was conducted by 2 primary care providers blinded to diagnosis. The REST-LGS was designed via the Modified Delphi Consensus and was previously validated. This tool consists of 8 criteria (4 major, 4 minor) considered indicative of LGS. To account for missing data in the earlier validation study and to evaluate applicability in a real-world setting, the REST-LGS was refined to include a scoring system in which major criteria were more heavily weighted than minor criteria, producing categories of "likely" (>11 points), "possible" (8-11 points), and "unlikely" (<8 points) LGS. Statistical analyses were descriptive. RESULTS: Of the 100 patients included in the analysis, data for slow spike-waves in electroencephalography and seizure onset age - both major REST-LGS criteria - were missing for 46% and 42% of patients, respectively. The majority of patients met 4 of the 8 REST-LGS criteria (cognitive impairment since childhood, 71%; persistent seizures despite a trial of ≥2 antiseizure medications, 65%; seizure onset before the age of 12 years, 57%; ≥2 seizure types, 56%). All 4 major criteria were met in 22 patients (22%). The percentages of patients considered "likely," "possible," or "unlikely" to have LGS were 26%, 30%, and 44%, respectively. Of the 74 patients without a previous LGS diagnosis, 42 (57%) were identified as "possible" or "likely" to have LGS using REST-LGS. SIGNIFICANCE: In this analysis, the validated REST-LGS was evaluated in a real-world setting. The majority of previously undiagnosed patients were identified via REST-LGS as "possible" or "likely" to have LGS. Extensive missing data highlights challenges of LGS diagnosis in adults. PLAIN LANGUAGE SUMMARY: There is a need to identify adult patients with Lennox-Gastaut syndrome (LGS) so they can receive appropriate treatment. The Refractory Epilepsy Screening Tool for LGS (REST-LGS) questionnaire was designed by experts to identify whether patients with seizures that are not controlled by medications may have LGS. In this study, 2 physicians completed the REST-LGS using charts for 100 patients who experience seizures not controlled by medications. Of the patients who were previously diagnosed as not having LGS, the majority were "likely" or "possible" to have LGS based on the REST-LGS; therefore, the REST-LGS can identify patients for further evaluation.

Understanding the Utility of Fecal Occult Blood Testing in Hospitalized Patients With Suspected GI Bleeding.

Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality worldwide. There have been increasing efforts to reduce its incidence and mortality. Screening plays a crucial role, with various tests such as the fecal occult blood test (FOBT), colonoscopy, and flexible sigmoidoscopy commonly used for investigation. FOBT is a Food and Drug Administration (FDA) approved screening tool commonly used in acute healthcare settings for early detection of CRC. We report a 50-year-old man presenting with shortness of breath, chills, and malaise with findings positive for pneumonia. Laboratory tests revealed anemia as an incidental finding. A subsequent FOBT came back positive, and the patient was admitted for further gastrointestinal testing. Esophagogastroduodenoscopy (EGD) and colonoscopy were performed, but no significant findings were observed. This case report focuses on the overuse of FOBT testing during hospital admission, despite its limited impact on patient care in acute settings. Key takeaways include being aware of the potential for false positive and false negative results from a FOBT. Using the test carefully can help reduce both direct and indirect healthcare costs for hospitalized patients, as well as minimize the use of hospital resources. The test should primarily be used for CRC screening in the outpatient setting.