Combining clinical notes with structured electronic health records enhances the prediction of mental health crises.

An automatic prediction of mental health crises can improve caseload prioritization and enable preventative interventions, improving patient outcomes and reducing costs. We combine structured electronic health records (EHRs) with clinical notes from 59,750 de-identified patients to predict the risk of mental health crisis relapse within the next 28 days. The results suggest that an ensemble machine learning model that relies on structured EHRs and clinical notes when available, and relying solely on structured data when the notes are unavailable, offers superior performance over models trained with either of the two data streams alone.

Two edges of the screen: Unpacking positive and negative associations between phone use in everyday contexts and subjective well-being.

A plethora of past studies have highlighted a negative association between phone use and well-being. Recent studies claimed that there is a lack of strong evidence on the deleterious effects of smartphones on our health, and that previous systematic reviews overestimated the negative link between phone use and well-being. In a three-week long in-the-wild study with 352 participants, we captured 15,607 instances of smartphone use in tandem with rich contextual information (activity, location, company) as well as self-reported well-being measures.

for fairness in digital health apps.

Digital mental health applications promise scalable and cost-effective solutions to mitigate the gap between the demand and supply of mental healthcare services. However, very little attention is paid on differential impact and potential discrimination in digital mental health services with respect to different sensitive user groups (e.g.

A late, solitary brain metastasis of epithelial ovarian carcinoma.

Background: Brain metastasis from epithelial ovarian cancer (EOC) is very rare with a reported incidence of less than 2%. It is usually associated with a poor prognosis that is related to several factors, the most important including: single vs multiple lesions, performance status, platinum-sensitive disease, tumor grade, extracranial disease, and multimodal approach treatment. At the time of diagnosis, an extracranial disease is found in over half of patients.

Have changes in ECMO technology impacted outcomes in adult patients developing postcardiotomy cardiogenic shock?

Extracorporeal membrane oxygenation (ECMO) technology has undergone several advancements over the last decade. We sought to compare current ECMO technology to older ones to determine how these technological improvements have impacted outcomes in patients suffering from postcardiotomy cardiogenic shock (PCS). Between 2005 and 2010, 49 patients received ECMO as support for PCS following elective cardiac surgery.

The impact of hypogammaglobulinemia on infection outcome in patients undergoing ventricular assist device implantation.

Background: Infection is a major comorbidity after ventricular assist device (VAD) placement. Defects in cellular immunity have been reported after VAD placement. However, to our knowledge, quantitative immunoglobulin G (IgG) level determination and the impact of hypogammaglobulinemia (HGG) on infections after VAD implantation have not been evaluated before.

The impact of CytoGam on cardiac transplant recipients with moderate hypogammaglobulinemia: a randomized single-center study.

Background: We have previously shown that the preemptive use of cytomegalovirus (CMV) immunoglobulin (Ig) replacement (CytoGam) decreases the incidence of opportunistic infections in cardiac transplant recipients with severe hypogammaglobulinemia. However, the impact of Ig replacement in moderately hypogammaglobulinemic patients is unknown.

Methods: Periodic monitoring of the IgG levels was done in 300 heart transplant recipients.

PET abnormalities in patients with nonischemic cardiomyopathy.

Background: The abnormalities in dilated cardiomyopathy (DCM) are generally considered diffuse and to affect the left ventricle in a global manner. However, regional wall motion abnormalities and metabolic defects may also occur to varying, but unclear degrees. QRS width and metabolic defects on positron emission tomography (PET) correlate with survival.

Noninvasive assessment of cardiac mechanics and clinical outcome after partial left ventriculectomy.

Background: Partial left ventriculectomy (PLV) was developed as a therapy for end-stage heart failure, but results were variable with few a priori predictors of outcome. Little is known about its effects on myocardial mechanics and their relation to clinical outcome.

Methods: Twenty-four dilated cardiomyopathy patients underwent cardiac magnetic resonance imaging (MRI) before PLV, and 3 and 12 months after surgery.

Severe renal dysfunction complicating cardiogenic shock is not a contraindication to mechanical support as a bridge to cardiac transplantation.

Objectives: This study investigated outcomes in patients with cardiogenic shock and severe renal dysfunction treated with ventricular assist devices (VAD) as a bridge to cardiac transplantation.

Background: Previous reports have documented poor survival in patients with cardiogenic shock and severe renal dysfunction treated with VAD.

Methods: We surveyed 215 consecutive patients who received a VAD from 1992 to 2000 and selected patients who had a serum creatinine > or =3.

Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients.

Background: Insertion of an implantable left ventricular assist device (LVAD) complicated by early right ventricular (RV) failure has a poor prognosis and is largely unpredictable. Prediction of RV failure after LVAD placement would lead to more precise patient selection and optimal device selection.

Methods And Results: We reviewed data from 245 patients (mean age, 54+/-11 years; 85% male) with 189 HeartMate (77%) and 56 Novacor (23%) LVADs.

Nursing and psychosocial issues of patients on mechanical support.

Mechanical support technology continues to evolve. Ongoing research has led to more efficient devices allowing for discharge to outpatient or home settings. From December of 1991 to July 31, 2000 the Cleveland Clinic Foundation has placed 240 mechanical support devices.

Results of partial left ventriculectomy for dilated cardiomyopathy: hemodynamic, clinical and echocardiographic observations.

Objectives: The study was done to prospectively measure the echocardiographic, hemodynamic and clinical outcomes after partial left ventriculectomy (PLV).

Background: Although PLV can improve symptoms of advanced heart failure, immediate postoperative echocardiographic findings remain abnormal.

Methods: Fifty-nine patients with cardiomyopathy and advanced heart failure underwent PLV and concomitant mitral valve surgery between May 1996 and December 1997.

Cardiac exercise hemodynamics late after partial left ventriculectomy.

Background: Although some patients report favorable activity levels late after partial left ventriculectomy (PLV), their exercise physiology has not been well described.

Methods And Results: We performed upright bicycle hemodynamics in 10 patients (9 men) aged 56+/-12 years at 1.7 years after PLV.

Real-time three-dimensional echocardiographic study of left ventricular function after infarct exclusion surgery for ischemic cardiomyopathy.

Background: Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes.

Methods And Results: Thirty patients who underwent IE (mean age 61+/-8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42+/-67 days after surgery in 22 patients.

Left ventricular reduction surgery with mitral valve repair.

The echocardiographic changes and functional outcome from mitral valve repair, combined with partial left ventriculectomy (PLV), the Batista procedure, were investigated. From May 1996 to August 1997 the operation was performed on 57 patients, primarily (95%) transplant candidates with idiopathic dilated cardiomyopathy. All had been Class IV (36.

Surgical therapy for heart failure: care of the patient with partial left ventriculectomy.

Partial left ventriculectomy (PLV) surgery has gained significant attention worldwide as a possible alternative to heart transplantation or as a therapy to treat heart failure. This procedure offers an attractive choice to patients and physicians because of the lack of need for immunosuppressive medications and a decrease in the risk of rejection associated with transplantation. PLV surgery is currently under investigation in several centers worldwide, but long-term outcomes have yet to be definitively evaluated.

Early results with partial left ventriculectomy.

Objective: We sought to determine the role of partial left ventriculectomy in patients with dilated cardiomyopathy.

Methods: Since May 1996 we have performed partial left ventriculectomy in 53 patients, primarily (94%) in heart transplant candidates. The mean age of the patients was 53 years (range 17 to 72 years); 60% were in class IV and 40% in class III.