Imagine if doctors could determine, many years in advance, who is likely to develop dementia. Such prognostic capabilities would give patients and their families time to plan and manage treatment and care. Thanks to artificial intelligence research conducted at McGill University, this kind of predictive power could soon be available to clinicians everywhere.
Scientists from the Douglas Mental Health University Institute’s Translational Neuroimaging Laboratory at McGill used artificial intelligence techniques and big data to develop an algorithm capable of recognizing the signatures of dementia two years before its onset, using a single amyloid PET scan of the brain of patients at risk of developing Alzheimer’s disease.
Dr. Pedro Rosa-Neto, co-lead author of the study and Associate Professor in McGill’s departments of Neurology & Neurosurgery and Psychiatry, expects that this technology will change the way physicians manage patients and greatly accelerate treatment research into Alzheimer’s disease.
“By using this tool, clinical trials could focus only on individuals with a higher likelihood of progressing to dementia within the time frame of the study. This will greatly reduce the cost and the time necessary to conduct these studies,” adds Dr. Serge Gauthier, co-lead author and Professor of Neurology & Neurosurgery and Psychiatry at McGill.
Scientists have long known that a protein known as amyloid accumulates in the brain of patients with mild cognitive impairment (MCI), a condition that often leads to dementia. Though the accumulation of amyloid begins decades before the symptoms of dementia occur, this protein couldn’t be used reliably as a predictive biomarker because not all MCI patients develop Alzheimer’s disease.
To conduct their study, the McGill researchers drew on data available through the Alzheimer’s Disease Neuroimaging Initiative (ADNI), a global research effort in which participating patients agree to complete a variety of imaging and clinical assessments.
Sulantha Mathotaarachchi, a computer scientist from Rosa-Neto’s and Gauthier’s team, used hundreds of amyloid PET scans of MCI patients from the ADNI database to train the team’s algorithm to identify which patients would develop dementia, with an accuracy of 84%, before symptom onset. Research is ongoing to find other biomarkers for dementia that could be incorporated into the algorithm in order to improve the software’s prediction capabilities.
“This is an example how big data and open science brings tangible benefits to patient care,” says Dr. Rosa-Neto, who is also director of the McGill University Research Centre for Studies in Aging.
While new software has been made available online to scientists and students, physicians won’t be able to use this tool in clinical practice before certification by health authorities. To that end, the McGill team is currently conducting further testing to validate the algorithm in different patient cohorts, particularly those with concurrent conditions such as small strokes.

McGill Universityhttp://tinyurl.com/y8dd4zda

Hospital chaplains provide spiritual care that helps patients facing serious illness cope with their symptoms and prognosis, yet because mechanically ventilated patients cannot speak, spiritual care of these patients has been limited.
A study was undertaken to determine the feasibility and to measure the effects of chaplain-led picture-guided spiritual care for mechanically ventilated adults in the intensive care unit (ICU).
Researchers conducted a quasi-experimental study at a tertiary care hospital between March 2014 and July 2015. Fifty mechanically ventilated adults in medical or surgical ICUs without delirium or dementia received spiritual care by a hospital chaplain using an illustrated communication card to assess their spiritual affiliations, emotions, and needs and were followed until hospital discharge. Feasibility was assessed as the proportion of participants able to identify spiritual affiliations, emotions, and needs using the card. Among the first 25 participants, they performed semi-structured interviews with 8 ICU survivors to identify how spiritual care helped them. For the subsequent 25 participants, they measured anxiety (on 100-mm visual analogue scales [VAS]) immediately before and after the first chaplain visit, and performed semi-structured interviews with 18 ICU survivors with added measurements of pain and stress (on ±100-mm VAS).
The mean (SD) age was 59 (±16) years, median mechanical ventilation days was 19.5 (interquartile range, 7–29 d), and 15 (30%) died in hospital. Using the card, 50 (100%) identified a spiritual affiliation, 47 (94%) identified one or more emotions, 45 (90%) rated their spiritual pain, and 36 (72%) selected a chaplain intervention. Anxiety after the first visit decreased 31% (mean score change, −20; 95% confidence interval, −33 to −7). Among 28 ICU survivors, 26 (93%) remembered the intervention and underwent semi-structured interviews, of whom 81% felt more capable of dealing with their hospitalization and 0% felt worse. The 18 ICU survivors who underwent additional VAS testing during semi-structured follow-up interviews reported a 49-point reduction in stress (95% confidence interval, −72 to −24) and no significant change in physical pain that they attributed to picture-guided spiritual care.
The researchers found that chaplain-led picture-guided spiritual care is feasible among mechanically ventilated adults and shows potential for reducing anxiety during and stress after an ICU admission.

American Thoracic Society http://tinyurl.com/z4phyfr

Human rhinovirus (HRV), the culprit behind most colds, is the leading cause of hospitalization for premature babies. However, in very preterm children, exactly how HRV causes severe respiratory disease — and which patients may need more intensive observation and treatment — is less well understood.
A new study led by Children’s National Health System research clinicians showed that in children who were born severely premature, HRV infections seem to trigger an airway hyper-reactivity (AHR) type of disease, which leads to wheezing and air-trapping (hyperinflation) and more severe respiratory disease. This, in turn, increases the risk for hospitalization.
The study found that other signs of respiratory distress, such as low arterial blood oxygen or rapid shallow breathing, were no more common in severely premature children (less than 32 weeks of gestational age) than in kids born preterm or full-term. The findings have implications for administering supportive care sooner or more intensively for severely premature children than for other infants.
“When it comes to how they respond to such infections, severely premature children are quite different,” says Geovanny Perez, M.D., a specialist in pulmonary medicine at Children’s National and lead study author. “We’ve known they are more susceptible to human rhinovirus infection and have more severe disease. However, our study findings suggest that severely premature kids have an ‘asthma’ type of clinical picture and perhaps should be treated differently.”
The study team sought to identify clinical phenotypes of HRV infections in young children hospitalized for such infections. The team theorized that severely premature babies would respond differently to these infections and that their response might resemble symptoms experienced by patients with asthma.
“For a number of years, our team has studied responses to viruses and prematurity, especially HRV and asthma,” Dr. Perez says. “We know that premature babies have an immune response to HRV from the epithelial cells, similar to that seen in older patients with asthma. But we wanted to address a gap in the research to better understand which children may need closer monitoring and more supportive care during their first HRV infection.”
In a retrospective cross-sectional analysis, the study looked at 205 children aged 3 years or younger who were hospitalized at Children’s National in 2014 with confirmed HRV infections. Of these, 71 percent were born full-term (more than 37 gestational weeks), 10 percent were preterm (32 to 37 gestational weeks) and 19 percent were severely premature (less than 32 gestational weeks).
Dr. Perez and his team developed a special respiratory distress scoring system based on physical findings in the children’s electronic medical records to assess the degree of lower-airway obstruction or AHR (as occurs in asthma) and of parenchymal lung disease. The physical findings included:

• Wheezing;
• Subcostal retraction (a sign of air-trapping/hyperinflation of the lungs), as can occur in pneumonia;
• Reduced oxygen levels (hypoxemia); and
• Increased respiratory rate (tachypnea).

The research team assigned each case an overall score. The severely premature children had worse overall scores — and significantly worse scores for AHR and hyperinflated lungs relative to children born late preterm or full-term.
“What surprised us, though, in this study was that the phenotypical characterization using individual parameters for parenchymal lung disease, such as hypoxemia or tachypnea, were not different in severe preterm children and preterm or full term,” says Dr. Perez. “On the other hand, our study found that severely preterm children had a lower airway obstruction phenotype associated with retractions and wheezing. Moreover there was a ‘dose effect’ of prematurity: children who were born more premature had a higher risk of wheezing and retractions.”
Among the implications of this study, Dr. Perez sees the potential to use phenotypical (clinical markers, such as retractions and wheezing) and biological biomarkers to better personalize patients’ treatments. Dr. Perez and his team have identified biological biomarkers in nasal secretions of children with rhinovirus infection that they plan to combine with clinical biomarkers to identify which patients with viral infections will benefit from early supportive care, chronic treatments or long-term monitoring.
ScienceDailyhttps://tinyurl.com/yd3mz3eu

Based on biopsy results, thousands of donated kidneys each year are discarded instead of being transplanted, but a new study from physicians at Columbia University Medical Center and NewYork-Presbyterian suggests that biopsies underestimate organ quality.
“It’s a complex issue, but our findings suggest that biopsy results should be used not to discard organs, but instead used in limited circumstances to guide recipient selection,” says the study’s lead investigator Sumit Mohan, MD, nephrologist at NewYork-Presbyterian and associate professor of medicine and epidemiology at Columbia University Medical Center.
Each year, nearly 20 percent of deceased-donor kidneys recovered with the intent to transplant are instead discarded. The most common reason cited for rejecting a kidney is a poor biopsy result. Biopsies allow physicians to look for any abnormalities in the microanatomy of the organ, Dr. Mohan says, but it’s unclear how well biopsy results predict the long-term health of a transplanted kidney.
The new study looked at nearly 1,000 kidney biopsies that were processed by pathologists at NewYork-Presbyterian/Columbia University Medical Center from 2005 through 2009 and the subsequent long-term function of the organ in the recipients.
For living-donor transplantation, biopsy results did not help predict long-term outcomes.
Our study raises serious questions about transplant centres using biopsy findings to make decisions about whether to use an available kidney for their patients. For deceased-donor kidneys, long-term outcomes did correlate with biopsy findings, but the researchers also found that 73 percent of deceased-donor kidneys with even suboptimal biopsy results were still functioning five years later.
Transplantation with even suboptimal kidneys provides a significant survival advantage compared to remaining on dialysis, Dr. Mohan says.

Columbia University Medical Centerhttp://tinyurl.com/yc4y5p8o

Having a loved one go through a critical illness is a stressful and traumatic experience that may have lasting effects months after the patient is discharged from the intensive care unit (ICU). To improve the well-being of both patients and family during this vulnerable time, a set of new guidelines has been released, providing physicians with evidence-based strategies to optimize outcomes for the critically ill and those at their bedside.
“There is increasing awareness that support for family can also improve patient outcomes,” said Judy Davidson, lead author of the guidelines and a nurse at UC San Diego Health. “Families in the ICU aren’t visitors — they are an integral part of the care and the care team.”
Based on an analysis of more than 450 qualitative and quantitative studies, a multidisciplinary, international panel of 29 health care experts developed a series of recommendations for family-centred care, defined as an approach to healthcare that is respectful of and responsive to individual families’ needs and values. The experiences and perspectives of former ICU patients and family members from UC San Diego Health, the University of Maryland (UOM) School of Medicine, patient advocacy organizations and the LGBTQ community were used to develop the new guidelines.
The 23 recommendations grouped into five categories include: space for loved ones to sleep; educational programmes to teach family how to assist with care; encouraging family members to be part of the decision-making process; implementing ICU diaries to reduce a family’s anxiety and post-traumatic stress; and involving a multi-disciplinary team, such as psychologists, social workers and spiritual advisors. UC San Diego Health is among the first hospitals in the nation to embrace the concept of implementing a family diary in the ICUs.
“Structured interventions and approaches to support family members of critically ill patients are needed both to mitigate the impact of the crisis of critical illness and to prepare family members for decisionmaking and caregiving demands,” said Davidson. “Up to half of families with a critically ill loved one experience psychological symptoms. A robust programme built around family-centred care may decrease the negative impact surrounding critical illness. It is a matter of public health.”
The guidelines suggest that clinicians and institutions need to decide which intervention or combination of interventions are likely to be the most successful in specific circumstances.
“We have developed a self-analysis tool that ICUs can use to build a customized family-centered plan that will bring change,” said Robert El-Kareh, MD, MPH, hospitalist at UC San Diego Health and associate professor at UC San Diego of Medicine, who was instrumental in building translational tools to help ICUs move recommendations into practice.

University of California – San Diego http://tinyurl.com/y732jdfk