Use of modern forensic methods for post-mortem diagnosis of blood loss

In forensic medical practice, when diagnosing the cause of death from blood loss, it is often necessary to solve questions related to the etiology of loss of circulating blood volume (CBV), the degree and severity of the injury, as well as its role in thanatogenesis and the duration of the terminal (agonal) period. When investigating the cases of death from acute blood loss, the authorities often ask forensic experts to solve issues related to the possibility of performing active targeted actions by the dying person, as well as to assess the timeliness of medical care and the actions of medical personnel. The solution of these issues is often difficult for experts, and it is associated with both objective and subjective reasons. For example, in cases where the circumstances of death are unknown, or there are no medical documents, or they do not contain sufficient information, without which it is impossible to conduct a retrospective clinical and anatomical analysis for the purpose of differential diagnosis between hemolytic shock and post-hemorrhagic anemia. The article deals with the use of new methodological approaches in postmortem morphological diagnostics of blood loss by the rate of its development and its role in thanatogenesis, in forensic medical practice. For example, a particular forensic expertise (case study) shows that the application of two new methods allowed to solve the issues for the investigator related to the cause of death and duration of dying from blood loss. Experts knowledge of new methodological approaches to the forensic diagnosis of acute blood loss will help law enforcement authorities to counteract crimes against the life of citizens, as well as to development the measures to improve the methods for prevention and reduction of mortality from traumatic injuries with blood loss.

Internet System Supporting the Work of Nurses in Long-Term Geriatric Care

The development of health sciences along with the continuous technological progress contribute to the emergence of web applications. There exist many applications supporting the work of doctors, whereas the market definitely lacks solutions supporting the work of nurses. This is particularly evident in long-term geriatric home care, in which the nursing specialization is developing rapidly. Care of elderly patients requires the nurse to collect medical documents from each visit. Considering the large number of diseases affecting elderly people and the number of required visits – which should exceed 4 a week – a decision was made to develop an Internet application supporting the work of nurses in long-term geriatric care. The application facilitates the process of geriatric patient description in order to eliminate the need for filling in paper medical records. This study presents the method of developing an Internet application supporting the work of nurses in long-term geriatric care. The software was developed based on an analysis of conclusions from a social study carried out in a group of 42 nurses providing geriatric long-term home medical care services in the district of Białystok, Poland. The aim of the study was to determine the features, functionality, and declarative interest in using the software. Conclusions from the analysis indicated that the attempt to develop the application had been justified. Moreover, conclusions from the social survey formed the basis for formulating the design assumptions. The web application was developed in the following technologies: HTML 5, CSS3, JavaScript, PHP 7, and MySQL. First, a prototype of the solution was tested in a XAMPP environment. After successful tests, the app was tested in a nursing practice. The obtained test results raise high hopes for potential commercialization of the application.

A Smart Mobile Application to Simplify Medical Documents and Improve Health Literacy: System Design and Feasibility Validation (Preprint)

BACKGROUND People with low health literacy experience more challenges in understanding instructions given by their health providers, following prescriptions, and understanding their healthcare system well enough to get the maximum benefits. People with insufficient health literacy have a higher risk of making medical mistakes, more chances of experiencing adverse drug effects, and inferior control of chronic diseases. OBJECTIVE This study aimed to design, develop, and evaluate a mHealth application, MediReader, to help individuals better understand complex medical materials and improve their health literacy. METHODS MediReader is designed and implemented through several steps: (1) Measure and understand an individual’s health literacy level. (2) Identify medical terminologies the individual may not understand based on his/her health literacy. (3) Annotate and interpret the identified medical terminologies tailored to the individual’s reading skill levels with meanings defined in the appropriate external knowledge sources. (4) Evaluate MediReader with task-based user study and satisfaction surveys. RESULTS Based on the comparison with a control group, user study results demonstrate that MediReader can improve users’ understanding of medical documents. The improvement is especially significant for users with lower health literacy levels. The satisfaction survey shows that users are satisfied with the tool in general. CONCLUSIONS MediReader provides an easy-to-use interface for users to read and understand medical documents. It can effectively identify medical terms a user may not understand, and then annotate and interpret them with appropriate meanings with languages that the user can understand. Experimental results demonstrate the feasibility of using this tool to improve an individual’s understanding of medical materials.

Retrospective trial of long acting analogues detemir and degludec usage in children and adolescents to overcome glucose variability caused by dawn phenomenon and reverse dawn phenomenon

Backgraund: Children with type 1 diabetes mellitus (T1DM) need more insulin late in the evening (reverse dawn phenomenon (RDP)), and adolescents need more insulin yearly in the morning (dawn phenomenon (DP)); these cause blood glucose variability. Modern long acting insulin analogues allow to achieve satisfactory glycemic control.Aims: To study the characteristics of insulin therapy in children and adolescents with T1DM using insulin analogues detemir and degludec to overcome blood glucose variability caused by DP and RDP in different age periods.Materials and methods: We analyzed medical documents of 200 patients using detemir, admitted to pediatric endocrinology department in 2013–2019, at mean age 9.0 years (5.4; 13.0), with T1DM for 1.3 years (0.5; 3.0); and medical documents of 50 patients switched to degludec in 2018–2019 at mean age 12.0 years (10.5; 14.5) with T1DM for 3.0 years (1.5; 6.0). Before degludec they were on intensive insulin therapy with glargine (22), detemir (26), or insulin pump (2); 16 patients (32%) presented with clinical characteristics of DP, and 5 (10%) — RDP.Results: 67 children of 108 (62%) aged 1–9 years had redistribution of detemir doses to daytime; 58 adolescents of 92 (63%) aged 10–17 лет — to nighttime. Patients switched to degludec demonstrated decrease in HbA1с from 8.7% (7.8; 9.9) to 8.0% (7.4; 9.0) (р<0.001); fasting blood glucose from 9.8 mmol/l (7.4; 11.7) to 7.7 mmol/l (6.4; 8.6) (р<0.001); within-day variability from 35.2% (31.6; 40.9) to 23.5% (19.7; 28.6) (р<0.001); daily insulin dose from 0.98 U/kg/day (0.82; 1.14) to 0.87 U/kg/day (0.75; 1.07) (р=0.002). Sub-groups of patients with DP and RDP demonstrated decrease in fasting blood glucose (from 11.5 mmol/l (9.8; 13.8) to 7.5 mmol/l (6.6; 9.1) (р<0.001)), and late evening blood glucose (from 11.0 mmol/l (10.2; 11.2) to 8.0 mmol/l (6.7; 9.5) (р= 0.03)) correspondently. Achieved levels of glycemic control did not differ between sub-groups of patients initially using glargine or detemir.Conclusions: Compensation of T1DM may be complicated due to DP and RDP. Switching to degludec allowed to achieve better glycemic control and lowering of blood glucose variability caused by DP and DRP.

Cancer Registry of Population in the City Ozyorsk: Structure of Malignant Neoplasms First Diagnosed in Period From 1948 to 2016

Purpose: The analysis of the structure of malignant neoplasms (MN) incidence among the population in the city Ozyorsk, located near Mayak Production Association, based on the information from the territorial cancer registry. Materials and methods: There were 14681 first diagnosed cases of malignant neoplasms at the period from 1948 to 2016 in the territorial cancer registry of Ozyorsk. The diagnoses were verified by all available medical documents. The structure of MN incidence, vital status of diseased people, age in a year of diagnostics, rank distribution of the basic localizations were studied. Results: For 70 years period of follow-up there were 7676 cases from 14681 of MN incidence cases during the last 17 years (from 2000 to 2017) – as much as for the previous 51 years of follow-up from 1948 to 1999 (7005 cases). In the MN structure solid cancer constitutes 94.5 %, hemoblastoses – 5.5 %. As at December 31, 2016 23.3 % of the diseased people were alive, 75.2 % died from all causes, 1.5 % lost to follow-up. The cause of 80,6 % deaths was MN. Age in the year of diagnostics constitutes 61,7 years. 75.8 % diagnoses have morphological confirmation. During the entire period of follow-up first three places belong to lung cancer, gastric cancer and prostate cancer for males; breast cancer, gastric cancer and colon cancer for females in the MN structure. Conclusions: During the period from 1948 to 2016 the growth of the first diagnosed MN cases among the population of Ozyorsk was a result of the population doubling and a fourfold increase of the citizens over the age of 50. Developed and supported cancer registry allows to analyze and partially control oncological situation in the closed cities of Rosatom.

Determination of the accuracy of osteoporotic fractures risk assessment in patients with rheumatoid arthritis using the prognostic model, developed at V.A. Nasonova Research Institute of Rheumatology, and the FRAX algorithm

Objective: comparison of the accuracy of risk assessment of low-energy fractures in patients with rheumatoid arthritis (RA) using the prognostic model developed at V.A. Nasonova Research Institute of Rheumatology, and the Russian model of the FRAX algorithm.Patients and methods. A prospective long-term observational non-interventional study included 70 women aged 40–80 years with a definite diagnosis of RA (ACR, 1987). All patients underwent dual-energy X-ray absorptiometry at baseline and over time; clinical and anamnestic data were analyzed, including information on fractures that occurred during the observation period, confirmed by medical documents.Results and discussion. The sensitivity and specificity of the FRAX algorithm were 67 and 56%, the sensitivity and specificity of the prognostic model of V.A. Nasonova Research Institute of Rheumatology – 78 and 56%, respectively. The diagnostic accuracy of the FRAX algorithm and the predictive model was 58 and 61%, respectively.Conclusion. The predictive model developed at V.A. Nasonova Research Institute of Rheumatology, showed higher diagnostic accuracy and sensitivity, as well as comparable specificity with the FRAX algorithm in assessing fractures in RA patients.

Korean Prosody Phrase Boundary Prediction Model for Speech Synthesis Service in Smart Healthcare

Speech processing technology has great potential in the medical field to provide beneficial solutions for both patients and doctors. Speech interfaces, represented by speech synthesis and speech recognition, can be used to transcribe medical documents, control medical devices, correct speech and hearing impairments, and assist the visually impaired. However, it is essential to predict prosody phrase boundaries for accurate natural speech synthesis. This study proposes a method to build a reliable learning corpus to train prosody boundary prediction models based on deep learning. In addition, we offer a way to generate a rule-based model that can predict the prosody boundary from the constructed corpus and use the result to train a deep learning-based model. As a result, we have built a coherent corpus, even though many workers have participated in its development. The estimated pairwise agreement of corpus annotations is between 0.7477 and 0.7916 and kappa coefficient (K) between 0.7057 and 0.7569. In addition, the deep learning-based model based on the rules obtained from the corpus showed a prediction accuracy of 78.57% for the three-level prosody phrase boundary, 87.33% for the two-level prosody phrase boundary.

Assessing the impact of a cannabis course on pharmacy students’ understanding, beliefs and preparedness regarding medical and recreational cannabis

Background: With the legalization of cannabis in Canada in 2018, pharmacists are increasingly likely to encounter patients using this substance. The primary objective of this pre-post questionnaire study was to evaluate the impact of an accredited cannabis course on the understanding, beliefs, perceptions and knowledge of undergraduate PharmD students. Methods: A 38-question, web-based survey generated in REDCap was administered to third-year PharmD students at the University of Waterloo, prior to and right after taking an accredited cannabis course. The pre- and postsurvey data were analyzed using SPSS version 25. Pearson chi-square tests were performed on questions in which answers consisted of qualitative categorical data. Two-sided t tests were performed to test the significance of mean differences of questions measuring continuous variables. Results: In a class of 120 students, 110 completed the presurvey and 79 students completed the postsurvey. After the course, students were more likely to report being knowledgeable and prepared for patient encounters dealing with medical and recreational cannabis, understanding that medical cannabis should be prescribed for select (vs all) medical conditions, rating the quality of evidence as poor to moderate for medical use of cannabis, understanding that medical documents should be more prescriptive and understanding that cannabis should not be sold in pharmacies ( p < 0.05). Interpretation: With cannabis education a part of their curriculum, pharmacy students felt more prepared to engage patients using cannabis both medically and recreationally. Furthermore, students were more cautious regarding the potential use of cannabis therapeutically and indicated that more oversight should be in place. Can Pharm J (Ott) 2021;154:xx-xx.

Radiation Risks of Helicopter Personnel Responding to the Chernobyl Accident: Early and Long-Term Health Disorders

The objectives of the study were to analyze the radiation doses received by helicopter crew members during the work above the emergency unit and the effectiveness of some radioprotective means; to determine the most radiosensitive systems of the body, their condition in the early and distant terms after the accident and the causes of disqualification of flight personnel. Materials and research methods. The first stage of the work was performed directly in the zone of helicopter aviation flight over the Chernobyl NPP emergency power unit. We determined radiation doses received by flight personnel, their dependence on the type of helicopter and pilot's workplace. Also we evaluated the dependence of exposure dose on the radio-protective means used and the primary reaction of pilots to radiation exposure. The second stage of the work was performed on the basis of the Central Research Aviation Hospital and the State Research Test Institute of Military Medicine of the Russian Ministry of Defense. At this stage the results of laboratory, clinical and psychological examination of the pilots who performed the tasks of liquidation of the Chernobyl accident effects in 1986 - 1987 and received regulated radiation doses were assessed. The corresponding medical documents (expert decisions of medical and aviation committees, results of medical follow-up) were studied for the period from 1986 till 2000, i.e. till the time when almost all helicopter liquidators were disqualified for health reasons or discharged due to senior service. Results of the study and their analysis. The radiation doses received by the helicopter crew members during the execution of the assigned tasks over the emergency unit and the efficiency of some radio-protective means were analyzed. The most radiosensitive body systems, their condition in the early and distant terms after the accident and the diseases leading to the disqualification of flight personnel were determined.