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    Deprescribing in cognitively vulnerable older people: development and validation of STOPPCog criteria
    (Oxford University Press, 2025-02-04) McGettigan, Siobhan; Curtin, Denis; O’Mahony, Denis
    Objective: To validate STOPPCog, a list of explicit criteria for potentially inappropriate medication use in cognitively vulnerable older adults. Design: A Delphi consensus survey of an expert panel comprising academic geriatricians, old age psychiatrists, general practitioners, and clinical pharmacists.Setting: Ireland. Subjects: Nine panellists. Methods: STOPPCog criteria were initially created by the authors based on clinical experience and literature appraisal. Criteria were organised according to drug/drug class. Using Delphi consensus methodology, panellists ranked their agreement with each criterion on a 5-point Likert scale and provided written feedback. Criteria with a median value of 1 or 2 (strongly agree/agree) and a 25th centile value of ≤2 were included in the final list. Results: All panellists completed two Delphi consensus validation rounds. Twenty-five criteria were proposed initially, twenty were accepted. One criterion was rejected (multi-vitamin supplements), and four criteria were rephrased (two of these were combined to one criterion for greater clarity). The final list comprised 23 criteria that are arranged in six subgroups i.e. (i) drugs with anticholinergic properties taken daily; (ii) drugs with sedative properties taken daily; (iii) drugs that may exacerbate psychotic symptoms in patients with alpha-synuclein pathology; (iv) drugs used for chronic pain; (v) drugs without proven efficacy for dementia taken daily; (vi) drugs that are of no proven benefit in advanced stage dementia i.e. clinical dementia rating of 3.0 where palliation may be appropriate. Conclusion: STOPPCog comprises 23 criteria relating to medications that are potentially inappropriate in cognitively vulnerable older adults. STOPPCog may assist physicians in deprescribing medications in this patient population.
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    Cardiovascular health effects of vaping e-cigarettes: a systematic review and meta-analysis
    (BMJ Publishing Group, 2025-01-24) Kundu, Anasua; Feore, Anna; Sanchez, Sherald; Abu- Zarour, Nada; Sutton, Megan; Sachdeva, Kyran; Seth, Siddharth; Schwartz, Robert; Chaiton, Michael; Centre for Addiction and Mental Health, Toronto, Canada
    Background There is substantial interest in the cardiovascular effects of e-cigarette use, highlighting the need to update our knowledge on the subject. We conducted this review to analyse whether e-cigarette use increases cardiovascular health risks and how these risks vary among different populations. Methods We searched six databases and included peer- reviewed human, animal, cell/in vitro original studies but excluded qualitative studies, which were published between July 2021 and December 2023. Three types of e-cigarette exposure were examined: acute, short-to-medium term and long term. Different risk of bias tools were used for assessing the quality of the included human studies and we conducted meta- analysis when possible. Results We included 63 studies in the main analysis, 12 studies in the meta-analysis and 32 studies in the sociodemographic factor- based subgroup analysis. Over half of the human studies had low risk of bias. Acute exposure to e-cigarette was associated with increased heart rate (HR) (mean difference (MD) 11.329, p<0.01) and blood pressure (BP) (MD 12.856, p<0.01 for systolic; MD 7.676, p<0.01 for diastolic) compared with non- use. While HR was lower after acute exposure to e- cigarettes compared with cigarettes (MD −5.415, p<0.01), no significant difference in systolic or diastolic BP was observed. Non- smoker current vapers had no significant differences in resting HR and BP compared with non- users but lower resting HR (MD −2.608, p<0.01) and diastolic BP (MD −3.226, p<0.01) compared with non-vaper current smokers. Despite some association between e- cigarette and endothelial dysfunction, short- to- medium- term transition from cigarettes to e-cigarettes may improve blood flow and BP, particularly among females and younger individuals. There is lack of evidence supporting any association of e-cigarette use with cardiovascular diseases and cardiac dysfunction or remodelling. Conclusions This review highlighted several important cardiovascular impacts of e-cigarette use compared with non-use and cigarette smoking. However, the evidence is still limited and requires future research.
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    Evaluation of ChatGPT performance on emergency medicine board examination questions: observational study
    (JMIR Publications, 2025) Pastrak, Mila; Kajitani, Sten; Goodings, Anthony James; Drewek, Austin; LaFree, Andrew; Murphy, Adrian
    Background: The ever-evolving field of medicine has highlighted the potential for ChatGPT as an assistive platform. However, its use in medical board examination preparation and completion remains unclear. Objective: This study aimed to evaluate the performance of a custom-modified version of ChatGPT-4, tailored with emergency medicine board examination preparatory materials (Anki flashcard deck), compared to its default version and previous iteration (3.5). The goal was to assess the accuracy of ChatGPT-4 answering board-style questions and its suitability as a tool to aid students and trainees in standardized examination preparation. Methods: A comparative analysis was conducted using a random selection of 598 questions from the Rosh In-Training Examination Question Bank. The subjects of the study included three versions of ChatGPT: the Default, a Custom, and ChatGPT-3.5. The accuracy, response length, medical discipline subgroups, and underlying causes of error were analyzed. Results: The Custom version did not demonstrate a significant improvement in accuracy over the Default version (P=.61), although both significantly outperformed ChatGPT-3.5 (P<.001). The Default version produced significantly longer responses than the Custom version, with the mean (SD) values being 1371 (444) and 929 (408), respectively (P<.001). Subgroup analysis revealed no significant difference in the performance across different medical subdisciplines between the versions (P>.05 in all cases). Both the versions of ChatGPT-4 had similar underlying error types (P>.05 in all cases) and had a 99% predicted probability of passing while ChatGPT-3.5 had an 85% probability. Conclusions: The findings suggest that while newer versions of ChatGPT exhibit improved performance in emergency medicine board examination preparation, specific enhancement with a comprehensive Anki flashcard deck on the topic does not significantly impact accuracy. The study highlights the potential of ChatGPT-4 as a tool for medical education, capable of providing accurate support across a wide range of topics in emergency medicine in its default form.
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    Upper limb strength and performance deficits after glenohumeral joint stabilization surgery in contact and collision athletes
    (2023) Fanning, Edel; Daniels, Katherine; Cools, Ann; Mullett, Hannan; Delaney, Ruth; Mcfadden, Ciaran; Falvey, Éanna
    Purpose: The primary aim was to identify and quantify differences in interlimb asymmetry magnitudes across a battery of upper extremity strength and performance tests at 4 and 6 months after glenohumeral joint stabilization surgery shoulder stabilization in contact and collision athletes compared with an un-injured group. A secondary aim was to investigate if identified asymmetry magnitudes changed from 4 to 6 months after glenohumeral joint stabilization surgery. The third aim was to explore associations within the different performance and strength variables. Methods: Fifty-six male contact and collision sport athletes who had had undergone unilateral glenohumeral joint stabilization were tested at 4 and 6 months after surgery. An un-injured control group (n = 39 for upper extremity performance tests, n = 47 for isokinetic dynamometry) were tested on a single occasion. Three upper extremity force platform-based performance tests and angle-specific concentric internal and external isokinetic shoulder rotational strength were assessed, and interlimb asymmetries were compared between the two groups. Results: At 4 months after surgery, the glenohumeral joint stabilization group demonstrated significantly higher absolute interlimb asymmetry values than the un-injured group for almost all the performance test variables. In the ballistic upper-body performance tests, the glenohumeral joint stabilization group achieved only half the body elevation reached by the un-injured (counter-movement push-up jump height (η2 = 0.50) and press-jump jump height (η2 = 0.39)). At 6 months after surgery, absolute interlimb asymmetries reduced for the performance test variables, but some asymmetry persisted. The glenohumeral joint stabilization group had significantly greater absolute interlimb asymmetries for five out the eight isokinetic variables. Conclusions: Contact and collision athletes who may be cleared to return to sport at 4 to 6 months after glenohumeral joint stabilization surgery shoulder stabilization continue to demonstrate upper limb strength and performance deficits when compared with their un-injured limb and their un-injured counterparts.
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    Accuracy of interpretation of nasogastric tube position on chest radiographs by diagnostic radiographers: A multi-case, multi-reader study
    (Elsevier Ltd., 2024-11-14) Creeden, A.; McFadden, S.; Rainey, Clare; Campbell, S.; Ather, S.; Hajilou, A.; Bond, R.; McAllister, P.; Woznitza, N.
    Introduction: Feeding via a misplaced nasogastric tube (NGT) is a common but preventable cause of patient harm. The aim of this study was to determine the accuracy of diagnostic radiographers’ assessment of NGT position on chest radiographs (CXRs) and safe-to-feed decisions. Methods: A multi-case, multi-reader study was conducted using an online image interpretation platform. A test bank consisting of 15 CXRs with an NGT in-situ was created. Diagnostic radiographers without formal qualifications in CXR interpretation were recruited via two international conferences. Participants placed an electronic marker on each CXR to identify the location of the tip of the NGT and indicated whether or not they believed that the tube was safely positioned. Results: 68 participants were recruited. Each participant reviewed 15 CXRs, providing 1020 unique image assessments. 76 % (n = 778/1020) image assessments were completely correct (both the position of the tip of the NGT was accurately located and an appropriate safe-to-use decision made). In 5 % (n = 56/1020) of cases the NGT was safely positioned and the location of the tip was correctly identified by the participant but the tube was erroneously determined to be unsafe for feeding. In a further 6 % (n = 59/1020) of cases the participant correctly located the tip of an NGT in an unsafe position but indicated that the tube was safe to use. Participants failed to correctly identify the tip of the NGT in the remaining 12 % (n = 127/1020) of cases. Conclusion: Consistent with previous studies involving other staff groups, diagnostic radiographers without formal qualification in CXR interpretation can assess NGT positioning on radiographs with moderate accuracy but require further training, including strategies for the identification of poorly-visualised tube tips, to achieve the 100 % accuracy necessary for this safety-critical task. Implications for practice: A bespoke training programme which includes teaching on image quality, tube tip identification and assessment of tube positioning using the National Patient Safety Agency (NPSA) four criteria, should be delivered prior to implementation of a radiographer-led NGT CXR evaluation service.