Publications by authors named "David Xiao"

Introduction: The National Trauma Research Action Plan convened 11 topic area panels to complete consensus-driven Delphi surveys to identify high priority trauma research questions. The Neurotrauma Panel identified questions relating to interventional and comparative effectiveness trials in severe traumatic brain injury (sTBI) critical care as highest priority. This qualitative secondary analysis aims to translate results across several Delphi panels into potential studies in sTBI critical care.

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Purpose To evaluate the performance of eight lung cancer prediction models on patient cohorts with screening-detected, incidentally detected, and bronchoscopically biopsied pulmonary nodules. Materials and Methods This study retrospectively evaluated promising predictive models for lung cancer prediction in three clinical settings: lung cancer screening with low-dose CT, incidentally detected pulmonary nodules, and nodules deemed suspicious enough to warrant a biopsy. The area under the receiver operating characteristic curve of eight validated models, including logistic regressions on clinical variables and radiologist nodule characterizations, artificial intelligence (AI) on chest CT scans, longitudinal imaging AI, and multimodal approaches for prediction of lung cancer risk was assessed in nine cohorts ( = 898, 896, 882, 219, 364, 117, 131, 115, 373) from multiple institutions.

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Intradialytic hypotension (IDH) is a common occurrence in hemodialysis. IDH occurs when there is a drop in blood pressure along with hypotensive symptoms. There are various causes of IDH, and it is important to consider proper management of this condition.

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Article Synopsis
  • Rural hospitals in the US, particularly in Tennessee, are closing at alarming rates, resulting in reduced healthcare access for rural populations.
  • Interviews with stakeholders from five diverse rural communities in Tennessee revealed key strategies that have helped some hospitals survive despite these closures.
  • The analysis identified six main themes related to preventing closures, including government policies, commercial factors, internal business strategies, community engagement, ongoing challenges, and the impact of behavioral health and substance abuse issues.
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Background: Radiomics has shown promise in improving malignancy risk stratification of indeterminate pulmonary nodules (IPNs) with many platforms available, but with no head-to-head comparisons. This study aimed to evaluate transportability of radiomic models across platforms by comparing performances of a commercial radiomic feature extractor (HealthMyne) with an open-source extractor (PyRadiomics) on diagnosis of lung cancer in IPNs.

Methods: A commercial radiomic feature extractor was used to segment IPNs from computed tomography (CT) scans, and a previously validated radiomic model based on commercial features was used as baseline (ComRad).

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Article Synopsis
  • Pulmonary nodules can be challenging to assess, leading to delays in diagnosing cancer and unnecessary tests for non-cancerous conditions.
  • This study evaluated the effectiveness of prediction models for assessing the likelihood of malignancy in nodules referred for biopsy, specifically using a cohort of 322 cases.
  • The results indicated that commonly used models (Brock, Mayo Clinic, and VA) had limited accuracy, while the Herder model showed better performance when PET-CT scans were included, suggesting a need for improved diagnostic tools in this area.
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Article Synopsis
  • * It highlights the current applications of ChatGPT in clinical settings and medical research, while also addressing the necessary ethical considerations regarding its use.
  • * The conclusion suggests that while ChatGPT shows great promise, more research is needed to ensure its safety, effectiveness, and ethical implications in healthcare.
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Background: Patients who are symptomatic from diaphragmatic dysfunction may benefit from diaphragmatic plication. We recently modified our plication approach from open thoracotomy to robotic transthoracic. We report our short-term outcomes.

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Article Synopsis
  • A study evaluated a deep learning model (LCP CNN) for assessing indeterminate pulmonary nodules (IPNs), finding it outperformed traditional clinical models but only used data from a single timepoint.
  • Researchers analyzed changes in LCP CNN scores over time to see if they differed between benign and malignant nodules, using a specific study design that involved multiple CT scans and blinded assessments.
  • Results showed that while benign nodules had stable LCP CNN scores, malignant nodules exhibited increasing scores over time, indicating that longitudinal analysis may enhance predictions of lung cancer risk.
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Background: The Affordable Care Act Medicaid expansion demonstrated inconsistent effects on cancer surgery utilization rates among racial and ethnic minorities and low-income Americans. This quasi-experimental study examines whether Medicaid expansion differentially increased the utilization of surgical cancer care for low-income groups and racial minorities in states that expanded their Medicaid programs.

Methods: A cohort of more than 81,000 patients 18 to 64 years of age who underwent cancer surgery were examined in Medicaid expansion versus nonexpansion states.

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Background: The Affordable Care Act (ACA)'s Medicaid expansion has increased access to surgical care overall. Whether it was associated with reduced disparities in use of regionalized surgery at high-volume hospitals (HVH) remains unknown. Quasi-experimental evaluations of this expansion were performed to examine the use of regionalized surgery at HVH among racial/ethnic minorities and low-income populations.

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Background: While pre-Affordable Care Act expansions in Medicaid eligibility led to increased utilization of elective inpatient procedures, the impact of the Affordable Care Act on such preference-sensitive procedures (also known as discretionary procedures) versus time-sensitive non-discretionary procedures remains unknown. As such, we performed a hospital-level quasi-experimental evaluation to measure the differential effects of the Affordable Care Act's Medicaid expansion on utilization of discretionary procedures versus non-discretionary procedures.

Methods: The State Inpatient Database (2012-2014) yielded 476 hospitals providing selected discretionary procedures or non-discretionary procedures performed on 288,446 non-elderly, adult patients across 3 expansion states and 2 non-expansion control states.

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Background: The Affordable Care Act's Medicaid expansion has been heavily debated due to skepticism about Medicaid's ability to provide high-quality care. Particularly, little is known about whether Medicaid expansion improves access to surgical cancer care at high-quality hospitals. To address this question, we examined the effects of the 2001 New York Medicaid expansion, the largest in the pre-Affordable Care Act era, on this disparity measure.

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Background: Although the Affordable Care Act (ACA) expanded Medicaid access, it is unknown whether this has led to greater access to complex surgical care. Evidence on the effect of Medicaid expansion on access to surgical cancer care, a proxy for complex care, is sparse. Using New York's 2001 statewide Medicaid expansion as a natural experiment, we investigated how expansion affected use of surgical cancer care among beneficiaries overall and among racial minorities.

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