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Xiao W, Liu Y, Tang H, Xie Q, Luo Y, Mei T. Knowledge, Attitude and Practice Toward Intracerebral Hemorrhage Prevention Among Patients Taking Oral Anticoagulants. Int J Gen Med 2024; 17:3137-3146. [PMID: 39049832 PMCID: PMC11268559 DOI: 10.2147/ijgm.s454039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 07/06/2024] [Indexed: 07/27/2024] Open
Abstract
Background Intracerebral hemorrhage (ICH) affects up to 1% of chronic oral anticoagulation (OAC) users per year. This study explored the knowledge, attitude and practice (KAP) towards ICH prevention among patients taking OACs. Methods This multicenter cross-sectional survey was conducted at 4 hospitals from February to May 2023, and a self-administered questionnaire was developed to assess KAP toward ICH prevention among patients taking OACs. Structural equation modeling was used to assess the relationship between KAP. Results A total of 536 valid questionnaires (67.25%) were analyzed, from 43.8% participants on Warfarin, 40.5% on Rivaroxaban and 15.7% on Dabigatran. The average knowledge, attitudes and practice scores were 9.22, 24.11, and 28.01 out of 16, 35 and 40, respectively. Participants who received Rivaroxaban had lower knowledge scores but higher attitude and practice store compared to those who received Warfarin or Dabigatran (all p < 0.001). According to Structure Equation Modeling, attitude had direct positive effect on practice (β = 0.694 [0.603-0.804], p = 0.012), while knowledge had direct negative effect on attitude (β = -2.077 [-2.507-1.651], p = 0.013), as well as negative effect on practice, both direct (β = -0.450[-0.689-2.03], p=0.012), and indirect (β = -1.441 [-1.928-1.192], p = 0.004). Conclusion Patients taking OACs showed insufficient knowledge, negative attitude and proactive practice regarding ICH; practice scores were affected by age, type of anticoagulation medication, and attitude rather than knowledge.
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Affiliation(s)
- Wei Xiao
- Department of Neurosurgical Care Unit, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, 415003, People’s Republic of China
| | - Yanqiong Liu
- Cardiovascular Medicine Department, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, 415003, People’s Republic of China
| | - Hua Tang
- Neurosurgery Department, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, 415003, People’s Republic of China
| | - Qin Xie
- Cardiovascular Medicine Department, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, 415003, People’s Republic of China
| | - Yanlan Luo
- Cardiovascular Medicine Department, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, 415003, People’s Republic of China
| | - Tao Mei
- Department of Neurosurgical Care Unit, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, 415003, People’s Republic of China
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Salam B, Kravchenko D, Nowak S, Sprinkart AM, Weinhold L, Odenthal A, Mesropyan N, Bischoff LM, Attenberger U, Kuetting DL, Luetkens JA, Isaak A. Generative Pre-trained Transformer 4 makes cardiovascular magnetic resonance reports easy to understand. J Cardiovasc Magn Reson 2024; 26:101035. [PMID: 38460841 PMCID: PMC10981113 DOI: 10.1016/j.jocmr.2024.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Patients are increasingly using Generative Pre-trained Transformer 4 (GPT-4) to better understand their own radiology findings. PURPOSE To evaluate the performance of GPT-4 in transforming cardiovascular magnetic resonance (CMR) reports into text that is comprehensible to medical laypersons. METHODS ChatGPT with GPT-4 architecture was used to generate three different explained versions of 20 various CMR reports (n = 60) using the same prompt: "Explain the radiology report in a language understandable to a medical layperson". Two cardiovascular radiologists evaluated understandability, factual correctness, completeness of relevant findings, and lack of potential harm, while 13 medical laypersons evaluated the understandability of the original and the GPT-4 reports on a Likert scale (1 "strongly disagree", 5 "strongly agree"). Readability was measured using the Automated Readability Index (ARI). Linear mixed-effects models (values given as median [interquartile range]) and intraclass correlation coefficient (ICC) were used for statistical analysis. RESULTS GPT-4 reports were generated on average in 52 s ± 13. GPT-4 reports achieved a lower ARI score (10 [9-12] vs 5 [4-6]; p < 0.001) and were subjectively easier to understand for laypersons than original reports (1 [1] vs 4 [4,5]; p < 0.001). Eighteen out of 20 (90%) standard CMR reports and 2/60 (3%) GPT-generated reports had an ARI score corresponding to the 8th grade level or higher. Radiologists' ratings of the GPT-4 reports reached high levels for correctness (5 [4, 5]), completeness (5 [5]), and lack of potential harm (5 [5]); with "strong agreement" for factual correctness in 94% (113/120) and completeness of relevant findings in 81% (97/120) of reports. Test-retest agreement for layperson understandability ratings between the three simplified reports generated from the same original report was substantial (ICC: 0.62; p < 0.001). Interrater agreement between radiologists was almost perfect for lack of potential harm (ICC: 0.93, p < 0.001) and moderate to substantial for completeness (ICC: 0.76, p < 0.001) and factual correctness (ICC: 0.55, p < 0.001). CONCLUSION GPT-4 can reliably transform complex CMR reports into more understandable, layperson-friendly language while largely maintaining factual correctness and completeness, and can thus help convey patient-relevant radiology information in an easy-to-understand manner.
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Affiliation(s)
- Babak Salam
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Nowak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Leonie Weinhold
- University Hospital Bonn, Department of Medical Biometry, Informatics, and Epidemiology, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Anna Odenthal
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Leon M Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel L Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
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Duranteau O, Hamriti A, Ickx B, Tuna T. Influence of compliance to antithrombotic agents on perioperative morbidity and mortality. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:38. [PMID: 37853478 PMCID: PMC10583434 DOI: 10.1186/s44158-023-00123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
For patients on antithrombotic medication, the outcome of a planned surgery depends on the adjustment of their daily treatment. This study aimed to assess the impact of non-compliance to published recommendations about antithrombotic agents, specifically those provided by the Groupement d'Intérêt pour l'hémostase Peri-opératoire (GIHP), on patient morbidity and mortality.A prospective cohort observational monocentric study was conducted over a 7-month period in 2019 in an academic hospital. The study included patients on antithrombotic agents scheduled for elective surgery, excluding cardiac surgery. The primary endpoints were morbidity and mortality at 1 month according to GIHP guidelines compliance. Blood loss during surgery and length of hospital stay were secondary endpoints.Among the 589 patients included in the study, 87 complications were recorded, resulting in a morbidity rate of 14.8%. Thirty-six patients experienced hemorrhagic events, leading to 8 deaths, while 33 patients suffered from ischemic events, resulting in 3 deaths. Additionally, 18 patients died from causes unrelated to hemorrhage or ischemia. Compliance with GIHP guidelines was observed in 62% of patients. Statistical analysis did not reveal a significant association between adherence to guidelines and morbidity (p value = 0.923), nor between adherence and 1-month survival (p value = 0.698). Similarly, no statistically significant relationships were found between compliance and intraoperative bleeding volume (p value = 0.087), postoperative bleeding (p value = 0.460), or length of hospital stay (p value = 0.339).This study did not identify any substantial associations between non-strict adherence to GIHP recommendations and patient outcomes, including morbidity, mortality, and bleeding. However, it is important to interpret these findings with caution, considering the study's limitations and the need for further research in this area.
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Affiliation(s)
- Olivier Duranteau
- Anesthesiology Service, CUB-ULB Hôpital Erasme, Brussels, Belgium.
- Intensive Care Unit, HIA Percy, Clamart, France.
| | - Ayoub Hamriti
- Anesthesiology Service, CUB-ULB Hôpital Erasme, Brussels, Belgium
| | - Brigitte Ickx
- Anesthesiology Service, CUB-ULB Hôpital Erasme, Brussels, Belgium
| | - Turgay Tuna
- Anesthesiology Service, CUB-ULB Hôpital Erasme, Brussels, Belgium
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Praxedes MFDS, da Silva JLP, da Cruz AJA, Viana CC, Barbosa HC, Guimarães NS, Martins MAP. Assessment of the relationship between the level of patient knowledge on warfarin therapy and the quality of oral anticoagulation: A systematic review and meta-analysis. PLoS One 2023; 18:e0289836. [PMID: 37561771 PMCID: PMC10414645 DOI: 10.1371/journal.pone.0289836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
The present study aimed to investigate the relationship between the level of patient knowledge on warfarin therapy and the quality of oral anticoagulation. This is a systematic review and meta-analysis written on the basis of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Searches at MEDLINE, EMBASE, Scopus and LILACS electronic databases were carried out on February 13, 2023, using the descriptors "Patient Medication Knowledge", "Patient Education as Topic", "Health Education", "Patient Education" and Warfarin. The steps of selection, data extraction and quality analysis of articles were performed independently by two reviewers. The analysis was performed considering patient knowledge as a possible modifier of time in therapeutic range (TTR). The meta-analysis included studies that reported the correlation coefficient (Pearson or Spearman) between patient knowledge and TTR. A subgroup analysis was performed according to questionnaires employed to measure patient knowledge. Twelve studies were selected with an overall sample size of 7634 participants and mean age 58.2 (standard deviation (SD)±12,8) years. Eleven (92.0%) cross-sectional studies. The mean TTR was 57.8% (SD±11,3%) and the average level of knowledge was 60.4%. The meta-analysis indicated that patient level of knowledge on warfarin therapy was moderately associated with TTR (rs = 0.435; 95% confidence interval (CI) = 0.163-0.645; I2 = 96%). Subgroup analysis indicated association between knowledge level and TTR in studies employing the OAK test (rs = 0.617; 95% CI = 0.192-0.847; I2 = 97%) and the AKA (rs = 0.269; 95% CI = 0.002 to 0.501; I2 = 94%). However, the subgroup analysis presented no significant difference between them (p = 0.14). The meta-regression showed a non-significant negative effect of age on the correlation (estimate = -0.028, 95% CI = -0.073 to 0.016, p = 0.207). No publication bias was noted (p = 0.881). To our knowledge, this is the first systematic review and meta-analysis gathering evidence about the relationship between the level of patient knowledge on oral anticoagulation with warfarin and TTR. The implementation of structured and patient-centered educational interventions is essential to effectively increase the level of patient knowledge and, thus, to improve the quality and safety of warfarin therapy. Systematic review registration number: PROSPERO CRD42023398030.
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Affiliation(s)
| | | | | | - Catiane Costa Viana
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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