Long-term survival following off-pump coronary artery bypass grafting (OPCAB) compared with conventional on-pump coronary artery bypass grafting (ONCAB) remains uncertain. Randomised trials and meta-analyses up to 5–10 years after procedures have demonstrated either no significant differences or modest disadvantages of OPCAB, particularly regarding completeness of revascularisation and late mortality. However, comparative data extending up to 20 years after procedure are scarce. Thus, very-long-term outcomes after ONCAB versus OPCAB in a propensity score-matched cohort were evaluated. Consecutive adults undergoing isolated primary coronary artery bypass grafting between 1999 and 2016 at a single cardiac surgery centre were retrospectively identified. Patients undergoing isolated OPCAB or ONCAB procedures were included and matched in a 1:2 ratio using clinically relevant preoperative variables. The primary outcome was overall survival in the matched cohort analysed using Cox proportional hazards regression. During the study period, 2,935 patients underwent isolated primary coronary artery bypass grafting (CABG), of whom 2,496 (85.0
Commercial high-sensitivity cardiac troponin T (hs-cTnT) assays measure both intact and degraded cTnT forms (i.e. total cTnT) and values are often elevated in chronic kidney disease (CKD) patients. The measurement of long cTnT forms has recently shown improved specificity for acute myocardial infarction compared to total cTnT. However, the associations between long cTnT and adverse long-term outcomes in CKD are unknown. Altogether, 136 CKD stage 4–5 patients not on dialysis were included in this prospective cohort study. Long cTnT and total cTnT levels before dialysis initiation were measured using investigational in-house immunoassays. The associations between cTnT measurements and all-cause mortality, incident major adverse cardiovascular or cerebrovascular events (MACCE), new-onset atrial fibrillation (NOAF) and a composite adverse outcome (all-cause mortality or MACCE) were assessed. Mean age was 61 (±13) years, 47 (34.6
ObjectivesEarly palliative care (PC) is recommended in pancreatic cancer but remains underutilized. This study assessed whether the timing of the PC decision affected the hospital resource use and access to specialized PC services. The implementation of an integrated PC (IPC) was also evaluated.MethodsThis retrospective single-center cohort study included 440 deceased pancreatic cancer patients treated at the Comprehensive Cancer Center, Helsinki University Hospital (2017-2018). Patients were categorized by timing of the PC decision-defined as withholding or termination of life-prolonging treatment and transition to PC-into early (>30 days before death) or late/no (≤30 days before death) groups. Hospital resource utilization was obtained from electronic medical records.ResultsA PC decision was made for 87% of patients, median of 1.5 months before death. Chemotherapy was given to 8% during the last month. Compared to early decisions, late/no PC decisions were associated with anticancer treatment closer to death (43 days vs 115 days, p < 0.001), higher acute healthcare use, including double the emergency department visits (61% vs 27%, p < 0.001) and triple the hospitalizations (59% vs 20%, p < 0.001) in the final month. Early PC decision was associated with earlier and more frequent use of the outpatient PC unit (3.6 vs 1 month before death, p < 0.001; 84% vs 61%, p < 0.001). Only 36% received PC integrated with oncologic treatment.ConclusionsLate or absent PC decisions were associated with increased end-of-life hospital interventions and reduced access to specialized PC services; both linked to impaired quality of EOL care and increased healthcare costs.
BackgroundThe exponential growth of medical knowledge presents a paradox for modern medical education. While access to information is immediate, applying it in a clinically meaningful way remains a challenge. Large language models (LLMs), such as ChatGPT, are widely used for information retrieval, yet their role in dynamic, high-pressure clinical learning remains poorly understood. ObjectiveThis study aims to evaluate whether unstructured access to an LLM improves decision-making, teamwork, and confidence in trauma education for medical students. MethodsThis randomized controlled pilot study involved 41 final-year medical students participating in a trauma simulation session. Students self-selected into teams of 4 to 6 and were randomized to either an LLM-assisted group (ChatGPT-4o mini) or a control group without LLM access. All teams completed 18 video-based trauma scenarios requiring time-sensitive clinical decisions. Prompting was unrestricted. Confidence and trauma exposure were assessed using pre- or postquestionnaires. Facilitators rated teamwork (1-5), decision accuracy, and response times. Knowledge retention was measured 4 weeks later via an online quiz. ResultsConfidence in trauma management improved in both groups (P<.001), with larger gains in the non-LLM group (P=.02). LLM support did not enhance the decision accuracy or speed and was associated with longer response times in some complex cases. Teams without LLMs demonstrated more active discussion and scored higher in teamwork ratings (median 5.0 [IQR 5.0-5.0] vs median 3.5 [IQR 3.0-4.5]; P=.08). Students primarily used the LLM for fact-checking but reported vague or overly general responses. Knowledge retention was high across both groups and did not differ significantly (P=.33). ConclusionsWhile students appreciated the inclusion of artificial intelligence (AI), unstructured LLM use did not improve performance and may have disrupted the group reasoning. The use of non-English prompting likely contributed to lower AI performance, underscoring the importance of language alignment in LLM applications. This pilot study highlights the need for structured AI integration and targeted instruction in AI literacy. Simulation-based trauma education proved effective and well received, but optimizing the educational value of LLMs will require thoughtful curricular design. Further studies with more students are needed to define best practices for LLM use in clinical education.
Background:Lung cancer screening with low-dose computed tomography (LDCT) among heavy smokers can decrease lung cancer mortality. Smoking cessation intervention is recommended within the screening program; however, the methods for smoking cessation in the LDCT screening context are not well established. We have previously shown that a novel smartphone app can increase the chance for smoking cessation along with lung cancer screening. The effects of lung cancer screening, smoking cessation, and the use of smartphone apps on health-related quality of life (HRQoL) are widely unknown. Objective:This study aims to investigate the effect of lung cancer screening, smoking cessation, and the use of smoking cessation app on HRQoL, an exploratory end point of the low-dose computed tomography screening for lung cancer combined to different smoking cessation methods in Finland (LDCT-SC-FI) study. Methods:This study was conducted as a part of the LDCT-SC-FI (NCT05630950), which was a randomized controlled trial investigating different smoking cessation methods in participants undergoing lung cancer screening with LDCT. The main inclusion criteria included an age of 50-74 years, a marked smoking history (smoked ≥15 cigarettes per day for ≥25 years or smoked ≥10 cigarettes per day for ≥30 years), an active smoking status, and access to a smartphone. The recruitment was carried out by newspaper and internet advertisements and informing relevant health care units at hospital districts. The study participants (n=200), all at Oulu University Hospital, were randomized in 1:1 fashion to a yearly LDCT with standard smoking cessation (written material) or a stand-alone smartphone app-based cessation. HRQoL, an exploratory study end point, was assessed at baseline and at 1 year with Quality of Life Questionnaire Core 30 (QLQ-C30) and EQ-5D. Results:In total, 199 and 186 individuals had both questionnaires completed at baseline and at 1 year, respectively. We did not detect a change in HRQoL between the time points using QLQ-C30 global health status score or EQ-5D index score. Smoking cessation at 1-year time did not affect QLQ-C30 global health status or EQ-5D. We observed improved quality of life scores by EQ-5D at 1 year (control: mean 0.720, SD 0.197 vs app: mean 0.799, SD 0.197; improved in 17/93, 18% of controls vs 29/93, 31% in app arm), while there was no difference in means at baseline. Smartphone app arm reported reduced pain (EQ-5D effect size [ES] 0.049, 95% CI 0.006-0.12; P=.01; adjusted ES 0.026; P=.007; QLQ-C30 ES 0.076, 95% CI 0.02-0.16; P<.001; adjusted ES 0.05; P=.02) and increased mobility (EQ-5D ES 0.031, 95% CI 0.01-0.09; P=.02; adjusted ES 0.037; P=.008) at 1 year. The number of completed questionnaires in the app was associated with improved HRQoL by EQ-5D (ES 0.073, 95% CI 0.00-0.180; P=.04; adjusted ES 0.071; P=.04). Conclusions:This is the first study to test a smoking cessation smartphone app in the context of lung cancer screening. The use of the developed app correlated with improved HRQoL, mainly by decreased pain and fatigue. To conclude, the studied app provides a feasible and effective cessation intervention that is readily implementable in population-based lung cancer screening programs, with enhanced health benefits beyond smoking cessation.
