Accuracy of surgeon prediction of appendicitis severity in pediatric patients

PurposeClinical prediction of disease severity is important as one considers nonoperative management of simple appendicitis. This study assesses the accuracy of surgeons' prediction of appendicitis severity.MethodsFrom February to August 2016, pediatric surgeons at a single institution were asked to predict whether patients had simple or complex appendicitis preoperatively based on clinical data, imaging, and general assessment. Receiver operating characteristic curves were generated to determine area under the curve (AUC) and optimal cutoff points of clinical findings for diagnosing simple appendicitis. Outcomes included sensitivity and specificity of variables to identify simple appendicitis. Predictions were compared to operative findings using χ². A p-value < 0.05 was considered statistically significant.ResultsOf 125 cases (median age 9 years [IQR 7–13], 58% male), simple appendicitis was predicted in 77 (62%) and complex appendicitis in 48 (38%). Predictions were accurate in 59 (77%) simple cases and 45 (94%) complex cases. Although surgeon prediction was more accurate than individual imaging or clinical findings and was highly sensitive (95%) for diagnosing simple appendicitis, specificity was only 71%.Lower WBC (< 15.5 × 10³/μL, AUC 0.61, p = 0.05), afebrile (< 100.4 °F, AUC 0.86, p < 0.01), and shorter symptom duration (≤ 1.5 days, AUC 0.71, p < 0.001) were associated with simple appendicitis. Of 18 complex cases (14%) inaccurately predicted as simple, 17 (94%) lacked diffuse tenderness, 15 (83%) were well-appearing, 11 (61%) had ultrasound findings of simple appendicitis, 11 (61%) had ≤ 2 days of symptoms, and 8 (44%) were afebrile (< 100.4 °F).ConclusionWhile surgeon prediction of simple appendicitis is more accurate than ultrasound or clinical data alone, diagnostic accuracy is still limited.Type of studyProspective survey.Level of evidenceII     

Effectiveness of Acceptance and Commitment Therapy (ACT) on aggression of patients with psychosis due to methamphetamine use: A pilot study

Background and purpose: The aim of the current study was to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) on aggression and general health of patients with a diagnosis of psychosis due to methamphetamine use.

Materials and Methods: This pilot study is an experimental controlled study with repeat measurements. Thirty patients were randomly assigned to study and control groups. The study group, received six weekly sessions of ACT, in addition to the usual treatment, while the control group received only the usual treatment. Both groups were tested using the General Health Questionnaire (GHQ-28) and Buss Perry Aggression Questionnaire (BPAQ) at three cross sections of time.

Results: General health was improved significantly in study group comparing with control group (P < 0.0001). There were significant differences between the three time points of therapy (p = 0.0001; F(2,56) = 41/456). Additionally, there were significant differences between the means of the three time points of therapy in aggressiveness variable (p = 0.0001; F(2,56) = 190/845).

Findings: ACT improved general health and decreased aggressiveness in the study group compared to the control group and may be a good therapy for methamphetamine dependents who suffer from psychosis.     

Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in adult respiratory distress syndrome patients hospitalized in an intensive care unit

PurposeThe purpose of this study was to evaluate the effect of ginger extract on delayed gastric emptying, developing ventilator-associated pneumonia, and clinical outcomes in adult respiratory distress syndrome (ARDS).Materials and MethodsThirty-two ARDS patients who were dependent on mechanical ventilation and fed via nasogastric tube were studied. After enrolment, patients were randomized to 2 groups. The control group received 1 g of coconut oil as placebo, and the study group received 120 mg of ginger extract. The amount of feeding tolerated at the first 48 hours of feeding, amount of feeding tolerated during the entire study period, nosocomial pneumonia, number of intensive care unit (ICU)–free days, number of ventilator-free days, and mortality were evaluated during 21 days of intervention.ResultsThere was a significant difference between the ginger group and the control group in the amount of feeding tolerated at the first 48 hours of enteral feeding (51% vs 57%, P < .005). There was a trend toward a decrease in pneumonia in the ginger group (P = .07). The overall in-ICU mortality was 15.6%, with no significant difference in the 2 groups. The number of ventilator-free days and that of ICU-free days were lower in the control group compared with the ginger group (P = .04 and P = .02).ConclusionThis study showed that gastric feed supplementation with ginger extract might reduce delayed gastric emptying and help reduce the incidence of ventilator-associated pneumonia in ARDS.     

Globalized and bounded Nelder‐Mead algorithm with deterministic restarts for tuning controller parameters: Method and application

This paper develops and examines an optimization algorithm for simulation‐based tuning of controller parameters. The proposed algorithm globalizes the Guin augmented variant of Nelder–Mead's nonlinear downhill simplex by deterministic restarts, linearly growing memory vector, and moving initial simplex. First, the effectiveness of the algorithm is tested using 10 complex and multimodal optimization benchmarks. The algorithm achieves global minima of all benchmarks and compares favorably against the evolutionary, swarm, and other globalized local‐search multimodal optimization algorithms in probability of finding global minimum and numerical cost. Next, the proposed algorithm is applied for tuning sliding mode controller parameters for a servo pneumatic position control application. The experimental results reveal that the system with sliding mode controller parameters tuned using the proposed algorithm targeting smooth position control with maximum possible accuracy, performs as desired and eliminates the need of manual online tuning for desired performance. The results are also compared with the performance of the same servo pneumatic system with parameters tuned using manual online tuning in an earlier published work. The system with controller parameters tuned using the proposed algorithm shows improvement in accuracy by 28.9% in sinusoidal and 42.2% in multiple step polynomials tracking.