Unsupervised deep learning of electrocardiograms enables scalable human disease profiling.

The 12-lead electrocardiogram (ECG) is inexpensive and widely available. Whether conditions across the human disease landscape can be detected using the ECG is unclear. We developed a deep learning denoising autoencoder and systematically evaluated associations between ECG encodings and ~1,600 Phecode-based diseases in three datasets separate from model development, and meta-analyzed the results.

Reliability of an "At-Home" Method for Monitoring Resting and Reactive Autonomic Nervous System Activity in Children: A Pilot Study.

Background: Heart rate variability (HRV), an index of the functional status of the autonomic nervous system (ANS), provides an opportunity for early detection of ANS dysfunction. Lower resting, vagally related HRV parameters are associated with increased risk of physical and mental illness. External factors influencing the ANS, such as the testing environment, may impact the interpretation of HRV.

Characteristics and Attitudes of Wearable Device Users and Nonusers in a Large Health Care System.

Background: Consumer wearable devices with health and wellness features are increasingly common and may enhance disease detection and management. Yet studies informing relationships between wearable device use, attitudes toward device data, and comprehensive clinical profiles are lacking.

Methods And Results: WATCH-IT (Wearable Activity Tracking for Comprehensive Healthcare-Integrated Technology) studied adults receiving longitudinal primary or ambulatory cardiovascular care in the Mass General Brigham health care system from January 2010 to July 2021.

Feasibility of an electronic fluid balance chart to detect and understand the significance of oliguric acute kidney injury in a general ward setting: a prospective observational cohort study.

Background: Outside critical care environments, few studies have assessed the significance of oliguric acute kidney injury (AKI). This study investigated the feasibility of an electronic fluid balance chart to diagnose oliguric AKI. Data were used to determine if oliguric AKI was met earlier than creatinine AKI and to establish outcomes of those who developed AKI.

The Hospital to Home study (H2H): smartwatch technology-enabled rehabilitation following hip fracture in older adults, a feasibility non-randomised trial.

Introduction: Hip fractures are associated with significant morbidity and mortality. This study assessed the feasibility of smartwatches supporting rehabilitation post-surgical fixation.

Methods: This UK-based non-randomised intervention study recruited patients who had sustained a hip fracture (age ≥65 and Abbreviated Mental Test Score ≥8/10), following surgical fixation, at one hospital to the intervention group, and at a second hospital to a usual care group.

1-year outcomes of patients admitted to critical care with treatment limitations: A dual-centre observational study.

Intensivists are increasingly involved in the care of frail patients as our population ages. Careful person-orientated, individualised decision-making, weighing benefits and harms of critical care are required in such situations. Few studies have reported outcomes of patients with treatment limitations.

[Initial results of the evaluation of a digital rollator].

Background: Rollators are preferred to compensate physiological limitations and to maintain mobility in old age; however, environmental obstacles or limited perception of fall hazards can lead to fall events.

Objective: The present study evaluates an electronic box that is used to supplement conventional rollators with various technical assistance systems (e.g.

Responding to the deteriorating patient: The rationale for treatment escalation plans.

A Treatment Escalation Plan (TEP) is a communication tool designed to improve quality of care in hospital, particularly if patients deteriorate. The aims are to reduce variation caused by discontinuity of care; avoid harms caused by inappropriate treatment and promote patients' priorities and preferences. The TEP is based on the goals of treatment - 'What are we trying to achieve?' The goals take account of the context of acute illness, the consequences of interventions and discussion with the patient.

Wearable accelerometer-derived physical activity and incident disease.

Physical activity is regarded as favorable to health but effects across the spectrum of human disease are poorly quantified. In contrast to self-reported measures, wearable accelerometers can provide more precise and reproducible activity quantification. Using wrist-worn accelerometry data from the UK Biobank prospective cohort study, we test associations between moderate-to-vigorous physical activity (MVPA) - both total MVPA minutes and whether MVPA is above a guideline-based threshold of ≥150 min/week-and incidence of 697 diseases using Cox proportional hazards models adjusted for age, sex, body mass index, smoking, Townsend Deprivation Index, educational attainment, diet quality, alcohol use, blood pressure, anti-hypertensive use.

Surviving severe COVID-19: Interviews with patients, informal carers and health professionals.

Background: The COVID-19 pandemic has been associated with an unprecedented number of critical care survivors. Their experiences through illness and recovery are likely to be complex, but little is known about how best to support them.

Aim: This study aimed to explore experiences of illness and recovery from the perspective of survivors, their relatives and professionals involved in their care.

Hyperechoic kidneys in a patient with bronchiectasis.

Introduction: Hyperechoic renal cortex in a normal-sized kidney has a range of causes, some of which irreparably damage the kidney and should initiate further investigations.

Case Report: We present a 72-year-old woman with longstanding bronchiectasis, noticed to have worsening renal function. Renal tract ultrasonography showed hyperechoic normal-sized kidneys.

Clinical decision-making in older adults following emergency admission to hospital. Derivation and validation of a risk stratification score: OPERA.

Objectives Of The Study: Demographic changes alongside medical advances have resulted in older adults accounting for an increasing proportion of emergency hospital admissions. Current measures of illness severity, limited to physiological parameters, have shortcomings in this cohort, partly due to patient complexity. This study aimed to derive and validate a risk score for acutely unwell older adults which may enhance risk stratification and support clinical decision-making.

Unraveling the Role of Empathy and Critical Life Events as Triggers for Social Entrepreneurship.

Social entrepreneurs are generally believed to have started their venture to improve societal needs and create social value. Yet, in order to achieve continuity of their organization, they need to generate economic value as well. These seemingly opposite objectives of social and economic value creation can cause tensions in social enterprises.

COVID-19 recognition and digital risk stratification.

In the acute hospital setting the COVID-19 pandemic presents some unique challenges to acute patient care. These include accurate recognition of cases, confirmation of both testing requests and results, establishing patient acuity and alerting to deterioration. We report our experience introducing a digital COVID-19 assessment tool with an associated live dashboard at two acute NHS hospitals, enabling accurate hospital-level reporting alongside risk stratification.

Respiratory failure in a cancer patient: pulmonary thrombotic microangiopathy.

The hypoxic patient with a normal chest X-ray can be a diagnostic challenge. This case illustrates the rational diagnostic process and describes a relatively rare but important complication of cancer metastasis. Thrombotic microangiopathy, like lymphangitis carcinomatosa, may cause respiratory failure and is a poor prognostic finding.

Persistently elevated early warning scores and lactate identifies patients at high risk of mortality in suspected sepsis.

Objective: In the UK, the National Early Warning Score (NEWS) is recommended as part of screening for suspicion of sepsis. Is a change in NEWS a better predictor of mortality than an isolated score when screening for suspicion of sepsis?.

Methods: A prospectively gathered cohort of 1233 adults brought in by ambulance to two UK nonspecialist hospitals, with suspicion of sepsis at emergency department (ED) triage (2015-2017) was analysed.

Surgical timing in infective endocarditis complicated by intracranial hemorrhage.

Given the growing incidence of infective endocarditis (IE), understanding the risks and benefits of valvular surgery is critical. This decision is particularly complex for the 1 in 10 cases complicated by intracranial hemorrhage (ICH). While guideline recommendations currently favor early surgery in general, delayed intervention of at least 4 weeks is still recommended for patients with ICH.

The PreOp Program: Intensive Preclinical Surgical Exposure is Associated With Increased Medical Student Surgical Interest and Competency.

Objective: As medical students' interest in surgical fields wanes, we investigated the impact of a preclinical surgical exposure program on students' attitudes toward pursuing surgical careers.

Design: This is a prospective longitudinal study of PreOp, a preclinical rotation-based surgical exposure program for first-year medical students, from 2013 to 2017. Surveys assessed PreOp rotation quality, students' surgical interest, and students' self-reported preparedness for the surgical clerkship.

NEWS 2 - too little evidence to implement?

The Royal College of Physicians (RCP) recently published the National Early Warning Score 2 (NEWS2), aiming to improve safety for patients with hypercapnic respiratory failure by suggesting a separate oxygen saturation (SpO) parameter scoring system for such patients. A previously published study of patients (n=2,361 admissions) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) demonstrated alternative scoring systems at admission did not outperform the original NEWS. Applying NEWS2 SpO parameters to this previously described cohort would have resulted in 44% (n=27/62) of patients who scored ≥7 points on the original NEWS and subsequently died being placed in a lower call-out threshold.

Correction: The ICE-AKI study: Impact analysis of a Clinical prediction rule and Electronic AKI alert in general medical patients.

[This corrects the article DOI: 10.1371/journal.pone.