Mining Twitter data to #educate the public about #sepsis

Introduction Sepsis is not well known. Only 58% of Americans know the word sepsis, less than 1% can identify its symptoms and one-third wrongly believe the disease is contagious (1). What if social media educated users about sepsis? There are at least 500 million tweets worldwide per day on Twitter. Objectives and Approach Early detection of sepsis with early treatment is associated with a decrease in mortality (2). The current study aims to use Twitter to share sepsis patients’ experiences. The approach consisted of using text data mining techniques by randomly extracting tweets (N =150) with the hashtag #sepsissurvivor (3) using R software (4). The study retrieved and quantified sepsis patients’ tweets into word frequency distributions using documentation summarization and word cloud techniques (5) for visual representation of Twitter data. Sepsis patients used images symptoms cards (6) to raise awareness. The study used the R package "tesseract" to extract text from images (6). Results Patients sharing their experiences frequently used the word “sepsis.” Cardiorespiratory compromise (septic shock—the highest mortality risk) was illustrated in the words "my heart stops” or elevated "heart" rate or “low blood pressure.” Several studies have reported increased mortality associated with delays in antibiotic administration (7). Many sepsis survivors had antibiotics exposure, both in a timely manner or delayed in use. Sepsis patients experienced long stays in the hospital. Tweets mentioned "infection" 39 times (8), which supports patients’ diagnoses in addition to high rates of "fever." The clustering technique using word association indicated infection was highly correlated with sepsis (9). Sepsis survivors shared the "pain" they went through. Conclusion/Implications Twitter presents an opportunity for patients to disseminate information about sepsis raising awareness about important symptoms. The information tweeted explores the impact of this diagnosis, and the need for early treatment. The current study demonstrates the opportunity to raise awareness through the learned experiences of patients in a novel medium

An exploration of the perceptions developing educational psychologists have of their role supporting mental health in schools, and the implications for the profession.

The training of educational psychologists has extensively changed in recent years, culminating in the development of doctoral courses and the removal of the teaching requirement for applicants. These changes have enabled applicants with a wide variety of relevant experience and background to join the profession. There has also been a renewed governmental focus on mental health in schools, and proactive supports for mental health and wellbeing for children and young people, as demonstrated in the Government’s’ Future in Mind publication. This thesis presents exploratory psychological research that examines the views trainee educational psychologists (TEPs) and recently qualified educational psychologists (RQEPs) have of their role supporting mental health in schools, the training they have received, and their profession title. The findings were that both TEPs and RQEPs viewed supporting social and emotional wellbeing was a core aspect of their role, although they were reluctant to use the term ‘mental health’ to describe the type of support they provided

Recommendations for observational studies of comorbidity in multiple sclerosis

Objective: To reach consensus about the most relevant comorbidities to study in multiple sclerosis (MS) with respect to incidence, prevalence, and effect on outcomes; review datasets that may support studies of comorbidity in MS; and identify MS outcomes that should be prioritized in such studies. Methods: We held an international workshop to meet these objectives, informed by a systematic review of the incidence and prevalence of comorbidity in MS, and an international survey regarding research priorities for comorbidity. Results: We recommend establishing age- and sex-specific incidence and prevalence estimates for 5 comorbidities (depression, anxiety, hypertension, hyperlipidemia, and diabetes); evaluating the effect of 7 comorbidities (depression, anxiety, hypertension, diabetes, hyperlipidemia, chronic lung disease, and autoimmune diseases) on disability, quality of life, brain atrophy and other imaging parameters, health care utilization, employment, and mortality, including age, sex, race/ethnicity, socioeconomic status, and disease duration as potential confounders; harmonizing study designs across jurisdictions; and conducting such studies worldwide. Ultimately, clinical trials of treating comorbidity in MS are needed. Conclusion: Our recommendations will help address knowledge gaps regarding the incidence, prevalence, and effect of comorbidity on outcomes in MS

Advancing specificity in delirium: The delirium subtyping initiative

BACKGROUND: Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long-term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology and identification of targeted treatments. Current delirium subtyping methods reflect clinically evident features but likely do not account for underlying biology. METHODS: The Delirium Subtyping Initiative (DSI) held three sessions with an international panel of 25 experts. RESULTS: Meeting participants suggest further characterization of delirium features to complement the existing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision diagnostic criteria. These should span the range of delirium-spectrum syndromes and be measured consistently across studies. Clinical features should be recorded in conjunction with biospecimen collection, where feasible, in a standardized way, to determine temporal associations of biology coincident with clinical fluctuations. DISCUSSION: The DSI made recommendations spanning the breadth of delirium research including clinical features, study planning, data collection, and data analysis for characterization of candidate delirium subtypes. HIGHLIGHTS: Delirium features must be clearly defined, standardized, and operationalized. Large datasets incorporating both clinical and biomarker variables should be analyzed together. Delirium screening should incorporate communication and reasoning

Coronavirus disease 2019 (COVID-19) excess mortality outcomes associated with pandemic effects study (COPES): A systematic review and meta-analysis

Background and aimWith the Coronavirus Disease 2019 (COVID-19) pandemic continuing to impact healthcare systems around the world, healthcare providers are attempting to balance resources devoted to COVID-19 patients while minimizing excess mortality overall (both COVID-19 and non-COVID-19 patients). To this end, we conducted a systematic review (SR) to describe the effect of the COVID-19 pandemic on all-cause excess mortality (COVID-19 and non-COVID-19) during the pandemic timeframe compared to non-pandemic times.MethodsWe searched EMBASE, Cochrane Database of SRs, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Controlled Trials Register (CENTRAL), from inception (1948) to December 31, 2020. We used a two-stage review process to screen/extract data. We assessed risk of bias using Newcastle-Ottawa Scale (NOS). We used Critical Appraisal and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.ResultsOf 11,581 citations, 194 studies met eligibility. Of these studies, 31 had mortality comparisons (n = 433,196,345 participants). Compared to pre-pandemic times, during the COVID-19 pandemic, our meta-analysis demonstrated that COVID-19 mortality had an increased risk difference (RD) of 0.06% (95% CI: 0.06–0.06% p < 0.00001). All-cause mortality also increased [relative risk (RR): 1.53, 95% confidence interval (CI): 1.38–1.70, p < 0.00001] alongside non-COVID-19 mortality (RR: 1.18, 1.07–1.30, p < 0.00001). There was “very low” certainty of evidence through GRADE assessment for all outcomes studied, demonstrating the evidence as uncertain.InterpretationThe COVID-19 pandemic may have caused significant increases in all-cause excess mortality, greater than those accounted for by increases due to COVID-19 mortality alone, although the evidence is uncertain.Systematic review registration[https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42020201256]

Advancing specificity in delirium: The delirium subtyping initiative

BACKGROUND: Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long-term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology and identification of targeted treatments. Current delirium subtyping methods reflect clinically evident features but likely do not account for underlying biology. METHODS: The Delirium Subtyping Initiative (DSI) held three sessions with an international panel of 25 experts. RESULTS: Meeting participants suggest further characterization of delirium features to complement the existing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision diagnostic criteria. These should span the range of delirium-spectrum syndromes and be measured consistently across studies. Clinical features should be recorded in conjunction with biospecimen collection, where feasible, in a standardized way, to determine temporal associations of biology coincident with clinical fluctuations. DISCUSSION: The DSI made recommendations spanning the breadth of delirium research including clinical features, study planning, data collection, and data analysis for characterization of candidate delirium subtypes. HIGHLIGHTS: Delirium features must be clearly defined, standardized, and operationalized. Large datasets incorporating both clinical and biomarker variables should be analyzed together. Delirium screening should incorporate communication and reasoning

ICU Delirium Search Strategy

This is a search strategy for a systematic review. It has been peer reviewed by two research librarians, but has not been published. It will be linked to the PROSPERO registration.Ye

Depression in Epilepsy

A relationship between depression and epilepsy has been consistently reported in the literature. Most of this research has estimated the proportion of people with depression in epilepsy. More recently, research has focused on determining fast and accurate methods of diagnosing depression in clinical samples. In contrast, there is a relative dearth of research into the treatment of depression in epilepsy using both pharmacological and non-pharmacological methods. Despite this research, there are still gaps in the knowledge base of this association. The literature on depression in epilepsy has not been reviewed and summarized. Screening tools for identifying depression in epilepsy have either not been validated, or have not been validated with a gold standard tool. Finally, patterns of pharmacological and non-pharmacological treatment of depression in epilepsy have not been well characterized. The work reported in this dissertation addresses each of these three knowledge gaps. Based on a systematic review, the overall pooled prevalence of active depression in persons with epilepsy was found to be 23.1% (95% Confidence Interval (CI): 20.6%-28.3%), and the overall odds ratio of active depression in those with epilepsy, relative to those without, was 2.77 (95% CI: 2.09-3.67). Three depression screening tools, one of which was previously not validated, and new cut-points for scoring were explored in a group of 185 persons with epilepsy. Compared to a gold-standard diagnostic interview, the tools with the best overall balance of sensitivity and specificity were the Hospital Anxiety and Depression Scale at a cut-point of seven and the Patient Health Questionnaire with a cut-point of nine. Newly suggested cut-points for scoring performed better than those cut-points recommended for use in the general population. Considering both pharmacological and non- pharmacological treatments for depression in persons with epilepsy, the majority of persons (70.3%) with current depression were not receiving depression-related therapy. Of those treated, ii most were receiving non-pharmacological treatments for depression. More persons with a past history of depression (37.2%) were receiving treatment, of which the majority was by pharmacological management. The results of these studies characterize the identification and management of depression, addressing knowledge gaps and providing direction for future research

Deidentified dataset from Time spent formatting research manuscripts for submission annually

Deidentified dataset for publicationData from journals studied to determine how long it takes to complete the formatting and submission process. No patient data is in this dataset. Data was generated by two research assistants who timed how long it took them to format and submit papers for publication to the top 10 general internal medicine journals. Other data came from publicly available websites