Medicine Experts Research Articles

'A Rose By Any Other Name': would re-branding help general practice?

Primary care is a challenging and evolving specialty. We are increasingly dealing with patients who present with complex multi-morbidities and varied constellations of symptoms that we need to masterly unravel with limited time and resources. Yet, how many times have we said or heard 'just a GP.' This study investigated the attitudes and opinions of primary care professionals towards a change in title to reflect our evolving role. We conducted a cross-sectional survey from 15 to 22 March 2022. A PubMed literature search was undertaken to formulate a questionnaire that was distributed through an online link to medical students and primary care health professionals. There were 401 medical professionals and students who participated in the survey. Overwhelmingly, 95% felt that the public perceives the professional status and qualifications of GPs as inferior to that of hospital consultants. 94% felt hospital colleagues and other health professionals perceived the professional status and qualifications of GPs as inferior to consultants. 90% would support a change in title from GP to consultant in primary care or family medicine consultant (or similar). Many felt this would reflect the evolving role of GPs. 72% felt strongly that the title change would help improve the current GP recruitment crisis. General practice is on a knife edge. Real, meaningful changes are needed to avoid a mass exodus of GPs for pastures new. Perhaps changing our title to reflect our expertise in family medicine could be one of many essential measures to improve public and professional perceptions.

Integrative Therapies in Cancer Care: An Update on the Guidelines.

ASCO and the Society for Integrative Oncology have collaborated to develop guidelines for the application of integrative approaches in the management of anxiety, depression, fatigue and use of cannabinoids and cannabis in patients with cancer. These guidelines provide evidence-based recommendations to improve outcomes and quality of life by enhancing conventional cancer treatment with integrative modalities. All studies that informed the guideline recommendations were reviewed by an Expert Panel which was made up of a patient advocate, an ASCO methodologist, oncology providers, and integrative medicine experts. Panel members reviewed each trial for quality of evidence, determined a grade quality assessment label, and concluded strength of recommendations. Strong recommendations for management of cancer fatigue during treatment were given to both in-person or web-based mindfulness-based stress reduction, mindfulness-based cognitive therapy, and tai chi or qigong. Strong recommendations for management of cancer fatigue after cancer treatment were given to mindfulness-based programs. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. The recommended modalities for managing anxiety included Mindfulness-Based Interventions (MBIs), yoga, hypnosis, relaxation therapies, music therapy, reflexology, acupuncture, tai chi, and lavender essential oils. The strongest recommendation in the guideline is that MBIs should be offered to people with cancer, both during active treatment and post-treatment, to address depression. The evidence for integrative interventions in cancer care is growing, with research now supporting benefits of integrative interventions across the cancer care continuum.

Reliability and readability analysis of ChatGPT-4 and Google Bard as a patient information source for the most commonly applied radionuclide treatments in cancer patients

PurposeSearching for online health information is a popular approach employed by patients to enhance their knowledge for their diseases. Recently developed AI chatbots are probably the easiest way in this regard. The purpose of the study is to analyze the reliability and readability of AI chatbot responses in terms of the most commonly applied radionuclide treatments in cancer patients. MethodsBasic patient questions, thirty about RAI, PRRT and TARE treatments and twenty-nine about PSMA-TRT, were asked one by one to GPT-4 and Bard on January 2024. The reliability and readability of the responses were assessed by using DISCERN scale, Flesch Reading Ease(FRE) and Flesch-Kincaid Reading Grade Level(FKRGL). ResultsThe mean (SD) FKRGL scores for the responses of GPT-4 and Google Bard about RAI, PSMA-TRT, PRRT and TARE treatmens were 14.57 (1.19), 14.65 (1.38), 14.25 (1.10), 14.38 (1.2) and 11.49 (1.59), 12.42 (1.71), 11.35 (1.80), 13.01 (1.97), respectively. In terms of readability the FRKGL scores of the responses of GPT-4 and Google Bard about RAI, PSMA-TRT, PRRT and TARE treatments were above the general public reading grade level. The mean (SD) DISCERN scores assesses by nuclear medicine phsician for the responses of GPT-4 and Bard about RAI, PSMA-TRT, PRRT and TARE treatments were 47.86 (5.09), 48.48 (4.22), 46.76 (4.09), 48.33 (5.15) and 51.50 (5.64), 53.44 (5.42), 53 (6.36), 49.43 (5.32), respectively. Based on mean DISCERN scores, the reliability of the responses of GPT-4 and Google Bard about RAI, PSMA-TRT, PRRT, and TARE treatments ranged from fair to good. The inter-rater reliability correlation coefficient of DISCERN scores assessed by GPT-4, Bard and nuclear medicine physician for the responses of GPT-4 about RAI, PSMA-TRT, PRRT and TARE treatments were 0.512(95% CI 0.296: 0.704), 0.695(95% CI 0.518: 0.829), 0.687(95% CI 0.511: 0.823) and 0.649 (95% CI 0.462: 0.798), respectively (p < 0.01). The inter-rater reliability correlation coefficient of DISCERN scores assessed by GPT-4, Bard and nuclear medicine physician for the responses of Bard about RAI, PSMA-TRT, PRRT and TARE treatments were 0.753(95% CI 0.602: 0.863), 0.812(95% CI 0.686: 0.899), 0.804(95% CI 0.677: 0.894) and 0.671 (95% CI 0.489: 0.812), respectively (p < 0.01). The inter-rater reliability for the responses of Bard and GPT-4 about RAİ, PSMA-TRT, PRRT and TARE treatments were moderate to good. Further, consulting to the nuclear medicine physician was rarely emphasized both in GPT-4 and Google Bard and references were included in some responses of Google Bard, but there were no references in GPT-4. ConclusionAlthough the information provided by AI chatbots may be acceptable in medical terms, it can not be easy to read for the general public, which may prevent it from being understandable. Effective prompts using 'prompt engineering' may refine the responses in a more comprehensible manner. Since radionuclide treatments are specific to nuclear medicine expertise, nuclear medicine physician need to be stated as a consultant in responses in order to guide patients and caregivers to obtain accurate medical advice. Referencing is significant in terms of confidence and satisfaction of patients and caregivers seeking information.

Juridical Analysis Of Doctors' Responsibilities For Malpractic Action

This study aims to describe the criminal liability of doctors who commit malpractice acts and to analyze the legal protection for patients who are victims of malpractice in positive law studies in Indonesia. This study uses normative legal research using three types of legal materials related to the responsibility of doctors for malpractice actions, namely primary legal materials, secondary legal materials and tertiary legal materials, with the nature of qualitative descriptive research, types of normative juridical research, statutory and conceptual approaches. The results of the study stated that malpractice is included in the realm of criminal law other than civil and administrative. Doctors can be prosecuted criminally, although the criminal law does not clearly stipulate criminal penalties for malpractice. However, several conventional articles in the Criminal Code implicitly mention provisions regarding malpractice that can be used as a basis for criminal charges. In the Criminal Code, criminal liability for malpractice is contained in Article 90, Article 359, Article 360 ??paragraphs (1) and (2) and Article 361. Those subject to this article include doctors, midwives, medicine experts, who are experts in their work. each. If they ignore the regulations or requirements in their work, causing death (Article 359) or serious injury (Article 360), they will be punished more severely. Legal protection for victims of medical malpractice is regulated in Law no. 29 of 2009 concerning Medical Practice, granting rights to victims to submit complaints to the Chairman of the Indonesian Medical Discipline Honorary Council, as well as simultaneously taking criminal and civil law remedies to court.

Mechanism of Cnidii Fructus in the Treatment of Infertility Based on Network Pharmacology and Molecular Docking Analysis Technology.

Infertility is a condition characterized by a low fertility rate, which significantly affects the physical and mental health of women of reproductive age. Typically, the treatment duration is prolonged, and the therapeutic outcomes are often unsatisfactory. Professor Cheng-yao He, a renowned expert in traditional Chinese medicine, commonly uses the herb Cnidii Fructus (SCZ) for the treatment of infertility. However, the exact mechanism remains unclear, and there is limited research available on this topic. The active ingredients of SCZ were obtained from the traditional chinese medicine system pharmacology (TCMSP) database and screened for pharmacokinetics (PK), involving absorption, distribution, metabolism, and excretion (ADME). Target prediction was performed by SwissTargetPrediction database, and infertility-related disease targets were searched in GeneCards, TTD, DrugBank, and OMIM database. The protein-protein interaction (PPI) network was constructed using the STRING database (Version 11.5) and analyzed by Cytoscape software (Version 3.9.1). Additionally, the target genes were subjected to biological enrichment analysis in the Metascape database, including gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis, and the "Disease-Ingredient-pathway-target" network was constructed using Cytoscape software. With the assistance of AutoDockVina, Ligplot, and PyMOL software, a validation of Molecular docking results and a visualization of the results were performed. This study identified 11 retained active ingredients of SCZ, 447 drug targets, 233 of which were related to infertility, and 5393 disease targets. GO enrichment analysis mainly involved 221 biological processes such as cellular response to chemical stress and gland development. KEGG enrichment analysis mainly involved 68 pathways such as thyroid hormone signaling pathway, estrogen signaling pathway, FOXO signaling pathway, and PI3K/Akt signaling pathway. Molecular docking showed that the core active ingredients of SCZ, including Ammidin, Diosmetin, Xanthoxylin N, and Prangenidin, had strong binding abilities with core targets such as MDM2, MTOR, CCND1, EGFR, and AKT1. This study preliminarily demonstrated that SCZ may act on the PI3K/Akt signaling pathway, exerting its therapeutic effects on infertility by improving energy metabolism disorders and endometrial receptivity, inducing primordial follicle activation, regulating oocyte proliferation, differentiation, and apoptosis, and promoting the release of dominant follicles.

Incorporating Synthetic Accessibility in Drug Design: Predicting Reaction Yields of Suzuki Cross-Couplings by Leveraging AbbVie's 15-Year Parallel Library Data Set.

Despite the increased use of computational tools to supplement medicinal chemists' expertise and intuition in drug design, predicting synthetic yields in medicinal chemistry endeavors remains an unsolved challenge. Existing design workflows could profoundly benefit from reaction yield prediction, as precious material waste could be reduced, and a greater number of relevant compounds could be delivered to advance the design, make, test, analyze (DMTA) cycle. In this work, we detail the evaluation of AbbVie's medicinal chemistry library data set to build machine learning models for the prediction of Suzuki coupling reaction yields. The combination of density functional theory (DFT)-derived features and Morgan fingerprints was identified to perform better than one-hot encoded baseline modeling, furnishing encouraging results. Overall, we observe modest generalization to unseen reactant structures within the 15-year retrospective library data set. Additionally, we compare predictions made by the model to those made by expert medicinal chemists, finding that the model can often predict both reaction success and reaction yields with greater accuracy. Finally, we demonstrate the application of this approach to suggest structurally and electronically similar building blocks to replace those predicted or observed to be unsuccessful prior to or after synthesis, respectively. The yield prediction model was used to select similar monomers predicted to have higher yields, resulting in greater synthesis efficiency of relevant drug-like molecules.

Trust in the Food and Drug Administration: ANational Survey Study.

Building trust in public health agencies like the US Food and Drug Administration (FDA) has become a key government priority. Understanding the roots of FDA mistrust is important if the agency is to develop targeted messaging and reforms aimed at building confidence in the agency. We conducted a survey of 2,021 respondents in the US probing attitudes toward the FDA. The primary outcome was FDA trust, defined as the mean score that each respondent assigned to the FDA across four prespecified axes: (1) competence and effectiveness; (2) commitment to acting in the best interests of the American public; (3) abiding by the rules and regulations set forth by policy or law; and (4) expertise in health, science, and medicine. On multivariableordinal logistic regression, FDA mistrust was associated with female gender (odds ratio [OR] = 0.74, 95% confidence interval [CI] 0.62-0.88), rural community (OR 0.85, 95% CI 0.75-0.96), conservative political views (OR 0.77, 95% CI 0.74-0.81), worse self-reported health (OR 0.89, 95% CI 0.80-0.98), lower satisfaction with health care received (OR 0.63, 95% CI 0.56-0.71), less attention to health and science news (OR 0.72, 95% CI 0.64-0.80), and not having children under the age of 18 (OR 0.72, 95% CI 0.60-0.86). These findings underscore the challenges faced by US political leaders in convincing a heterogeneous American public to trust the FDA. The FDA should develop and deploy targeted outreach strategies to populations with lower levels of trust and strengthen internal processes that minimize biases and ensure sound decision-making.

Management of Fatigue in Adult Survivors of Cancer: ASCO-Society for Integrative Oncology Guideline Update.

To update the ASCO guideline on the management of cancer-related fatigue (CRF) in adult survivors of cancer. A multidisciplinary panel of medical oncology, geriatric oncology, internal medicine, psychology, psychiatry, exercise oncology, integrative medicine, behavioral oncology, nursing, and advocacy experts was convened. Guideline development involved a systematic literature review of randomized controlled trials (RCTs) published in 2013-2023. The evidence base consisted of 113 RCTs. Exercise, cognitive behavioral therapy (CBT), and mindfulness-based programs led to improvements in CRF both during and after the completion of cancer treatment. Tai chi, qigong, and American ginseng showed benefits during treatment, whereas yoga, acupressure, and moxibustion helped to manage CRF after completion of treatment. Use of other dietary supplements did not improve CRF during or after cancer treatment. In patients at the end of life, CBT and corticosteroids showed benefits. Certainty and quality of evidence were low to moderate for CRF management interventions. Clinicians should recommend exercise, CBT, mindfulness-based programs, and tai chi or qigong to reduce the severity of fatigue during cancer treatment. Psychoeducation and American ginseng may be recommended in adults undergoing cancer treatment. For survivors after completion of treatment, clinicians should recommend exercise, CBT, and mindfulness-based programs; in particular, CBT and mindfulness-based programs have shown efficacy for managing moderate to severe fatigue after treatment. Yoga, acupressure, and moxibustion may also be recommended. Patients at the end of life may be offered CBT and corticosteroids. Clinicians should not recommend L-carnitine, antidepressants, wakefulness agents, or routinely recommend psychostimulants to manage symptoms of CRF. There is insufficient evidence to make recommendations for or against other psychosocial, integrative, or pharmacological interventions for the management of fatigue.Additional information is available at www.asco.org/survivorship-guidelines.

Деятельность пятого настоятеля Агинского дацана Галсан-Жимбы Тугулдурова (1817–1872/3)

Introduction. The article examines the biography and works of the 5th abbot of Aginsky datsan (Dechen Lhundublin) Galsan Zhimba Tuguldurov. The relevance of the study is determined by importance of the personality of G.-Zh. Tuguldurov. He was one of the most significant Buryat Buddhist leaders of the 19th century. Tuguldurov was one of the bright representatives of the Buryat priesthood, expert in Buddhist philosophy, astrology, medicine and lexicology (he compiled the first Buryat Tibetan-Mongolian dictionary Despite the weight of his multifaceted personality and the presence of works reflecting his activities, the information about the details of G. Tuguldurov's biography and writings continues to remain little known. The purpose of the article is to provide historiographic overview of researches on his biography and creative heritage, introduce some new information into scientific circulation. This information was obtained from archive documents written in Old Mongolic script from the preliminary translation of not studied before biography (namthar) of G.-Zh. Tuguldurov in Tibetan language. The title of the namthar is “The biography of Galsan-Zhimba Balzangpo — the abbot of the datsan Dechen Lhundubling (bde chen lhun grub gling gi khri pa chos rje skal bzang spyin pa dpal bzang po’i rnam thar gyi sa bon bzhugs)”. Materials and methods. The research is based on the works of Russian and Mongolian authors written in different times, archival data from funds of the State Archive of the Republic of Buryatia, Center of Oriental Manuscripts and Xylographs of the Institute for Mongolian, Buddhist and Tibetan studies of the SB RAS and namthar of G.-Zh. Tuguldurov in Tibetan language (archive of Aginsky datsan). The following methods were used: collection, analysis and processing of data, historical-systematic and retrospective analysis. The results of the research helped to restore the chronology of activities of G.-Zh. Tuguldurov. For the first time the biography of G.-Zh. Tuguldurov with additional and clarifying information has been put into scientific circulation. Therefore, the restored biography of G.-Zh. Tuguldurov can make a significant contribution into academic researches, especially into reconstruction of the spread of Buddhism in the region.

A general framework for developing computable clinical phenotype algorithms.

To present a general framework providing high-level guidance to developers of computable algorithms for identifying patients with specific clinical conditions (phenotypes) through a variety of approaches, including but not limited to machine learning and natural language processing methods to incorporate rich electronic health record data. Drawing on extensive prior phenotyping experiences and insights derived from 3 algorithm development projects conducted specifically for this purpose, our team with expertise in clinical medicine, statistics, informatics, pharmacoepidemiology, and healthcare data science methods conceptualized stages of development and corresponding sets of principles, strategies, and practical guidelines for improving the algorithm development process. We propose 5 stages of algorithm development and corresponding principles, strategies, and guidelines: (1) assessing fitness-for-purpose, (2) creating gold standard data, (3) feature engineering, (4) model development, and (5) model evaluation. This framework is intended to provide practical guidance and serve as a basis for future elaboration and extension.

The Necessary Components for Evaluating Return-to-Work in Depressive Workers: A Modified Delphi Technique

Background: Mental health issues in the workplace can have adverse effects on productivity. Among the various mental disorders, depression is the most observed problem. That being stated, the return to work (RTW) rates for depressive workers are lower than other disabling conditions. The present study was due to the absence of guidelines regarding RTW assessments for depressive workers in occupational medicine. Objective: To determine the necessary components for evaluating RTW in depressive workers. Materials and Methods: Twenty-two occupational medicine and psychiatry experts deployed a modified Delphi study. The study was conducted in four steps, expert selection, comprehensive literature review, and administration of a two-round questionnaire to assess the level of agreement among participants. A second-round questionnaire was used to determine the degree of consensus. Results: Twenty experts responded to the first-round questionnaire, agreed on 15 components, and suggested four additional components. In the second-round questionnaire, 14 components consisted of distress, depress mood, anxiety, suicidal ideation, executive function, attention, social awareness, learning and memory, language, health-risk behavior, self-efficacy, psychiatric medication, communication with supervisor, and job stress. Twenty tools met the consensus criteria. A depressed mood and suicidal ideation were the most consensus components from experts. Conclusion: The assessment of RTW in workers with depression requires considering 14 components; however, developing guidelines and appropriate tools for evaluating these components requires further investigation and study.

Are Internet Information Sources Helpful for Adult Crohn's Disease Patients Regarding Nutritional Advice?

Background: Adult patients suffering from Crohn's disease (CD) are often dissatisfied with the information they receive from their physicians about nutrition and its impact on CD inflammation activity. Only a few publications are available about patients' internet research on nutrition in CD. The study aim is to elucidate the internet information sources of adult CD patients regarding nutritional advice via a questionnaire. Methods: A questionnaire with 28 (general and specific) questions for outpatients at our tertiary center with CD was created and used for an analysis of their information sources about nutrition in CD. Four CD and/or nutritional medicine experts examined the 21 most relevant websites referring to nutritional advice for CD patients. Results: One hundred and fifty CD patients reported their Internet research behavior for nutritional advice and their dietary habits. Many CD patients prefer to consult the Internet instead of asking their general practitioner (GP) for nutritional recommendations. Most of the websites providing nutritional advice for CD patients are of very poor quality and cannot be recommended. We found significant correlations between (a) nutritional habits of CD patients, (b) their information sources and several demographic or CD-related factors. There is a lack of websites which provide high-quality, good nutritional advice to CD patients. Conclusions: The majority of the examined websites did not provide sufficient information according to the CD guidelines and nutritional medicine guidelines. A higher quality level of website content (e.g., on social media or on university/center websites) provided by experienced physicians is required to secure trustworthy and reliable nutritional information in CD.

Exploring a definition of healthy longevity in Chinese population based on Delphi method

Objective: To explore a definition of healthy longevity in the Chinese population based on the Delphi method. Methods: Through a comprehensive literature review and expert consultation, the dimensions in the definition of healthy longevity were identified, and a preliminary list of questions was created. Experts in clinical medicine, public health, basic research, and the elderly care service industry, who had been working in the field of geriatric health for at least 5 years, were invited to participate in the Delphi survey from August to December 2022. The survey questionnaires were administered via email in two rounds, and experts were asked to select the optimal options from the provided questions. The active coefficients were expressed by the response rate, and a consensus was reached when the largest number of experts agreed for single-choice questions and more than 70% agreed for multiple-choice questions. Results: In the two rounds, the active coefficients were 96.00% (24/25) and 79.17% (19/24), respectively, and a consensus was finally reached on nine items, including age, physical health, common metabolic indicators, mental health, cognitive function, functional ability, social activity, self-rated health, and subjective well-being. Following discussions among the research team and experts, a final definition of healthy longevity was determined. Healthy longevity could refer to a state of good physical, psychological, cognitive function and social adaptation, as well as subjective well-being, in individuals aged 90 and above. Specifically, individuals with healthy longevity should be free from diseases associated with high disability rates and mortality, such as stroke, cancer, and Parkinson's disease. They should also maintain reasonable levels of common non-communicable disease indicators, such as blood pressure and blood glucose, and exhibit favorable mental health and cognitive function using validated measurement tools. In addition, individuals with healthy longevity should engage in social interactions with friends and relatives, care for family members, and go out to do things. Meanwhile, with the ability to complete the visual and hearing functions of daily life and communication, and the ability to complete basic activities such as walking, eating, bathing, toileting, dressing, continence of urination, and bowel movement independently, they could rate themselves to be in good health and experience a relatively high level of life satisfaction. Conclusion: A definition of healthy longevity in the Chinese population is established through the two-round Delphi consultation.

Views of Hong Kong Chinese medicine practitioners on the application of the “Chinese Medicine Anti-epidemic Plans” prepared by the Chinese medicine expert group of central authorities: a focus group study

BackgroundDrawing on the extensive utilization of traditional Chinese medicine (TCM) to combat COVID-19 in Mainland China, experts designed a series of TCM anti-epidemic strategies. This study aims to understand Hong Kong CM practitioners’ application of and opinions on the “Chinese Medicine Anti-epidemic Plans.”MethodsOnline focus group interviews were conducted, and purposive sampling was employed to invite 22 CM practitioners to voluntarily participate in three interview sessions. The interviews were audio recorded, then transcribed verbatim. The transcripts were analyzed using template analysis.ResultsThree themes were derived: (1) facilitators of the “Chinese Medicine Anti-epidemic Plans,” (2) barriers of the “Chinese Medicine Anti-epidemic Plans,” and (3) expectations on improving the “Chinese Medicine Anti-epidemic Plans.” The participants could obtain relevant information from various sources, which highlights the value of the plans for TCM medicinal cuisine and non-pharmacologic therapies and guiding junior CM practitioners, supplementing Western medicine interventions, and managing Chinese herb reserves in clinics. However, the barriers included the lack of a specialized platform for timely information release, defective plan content, limited reference value to experienced CM practitioners, and lack of applicability to Hong Kong. The expectations of the CM practitioners for improving the plans were identified based on the barriers.ConclusionsTo enhance the implementation of the anti-epidemic plans, CM practitioners in Hong Kong expect to utilize a specific CM platform and refine the plans to ensure that they are realistic, focused, comprehensive, and tailored to the local context.

3DFRINet: A Framework for the Detection and Diagnosis of Fracture Related Infection in Low Extremities Based on 18F-FDG PET/CT 3D Images

Fracture related infection (FRI) is one of the most devastating complications after fracture surgery in the lower extremities, which can lead to extremely high morbidity and medical costs. Therefore, early comprehensive evaluation and accurate diagnosis of patients are critical for appropriate treatment, prevention of complications, and good prognosis. 18Fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is one of the most commonly used medical imaging modalities for diagnosing FRI. With the development of deep learning, more neural networks have been proposed and become powerful computer-aided diagnosis tools in medical imaging. Therefore, a fully automated two-stage framework for FRI detection and diagnosis, 3DFRINet (Three Dimension FRI Network), is proposed for 18F-FDG PET/CT 3D imaging. The first stage can effectively extract and fuse the features of both modalities to accurately locate the lesion by the dual-branch design and attention module. The second stage reduces the dimensionality of the image by using the maximum intensity projection, which retains the effective features while reducing the computational effort and achieving excellent diagnostic performance. The diagnostic performance of lesions reached 91.55% accuracy, 0.9331 AUC, and 0.9250 F1 score. 3DFRINet has an advantage over six nuclear medicine experts in each classification metric. The statistical analysis shows that 3DFRINet is equivalent or superior to the primary nuclear medicine physicians and comparable to the senior nuclear medicine physicians. In conclusion, this study first proposed a method based on 18F-FDG PET/CT three-dimensional imaging for FRI location and diagnosis. This method shows superior lesion detection rate and diagnostic efficiency and therefore has good prospects for clinical application.

Abstract PO5-05-13: Clinical utility of whole body low dose computed tomography for detecting bone metastasis in breast cancer patients: A cross sectional study

Abstract Clinical utility of Whole Body Low Dose CT scan for detecting bone metastasis in Breast cancer patients: A cross sectional study Background: Skeletal scintigraphy (Bone scan) is the imaging of choice to detect bone metastasis in locally advanced and metastatic breast cancer patients. Nuclear medicine facilities are however limited in their availability. As an alternative diagnostic modality to bone scan, we studied the diagnostic capability of Whole-Body Low Dose CT (WBLDCT) scan for detection of bone metastasis in these patients. Materials and Method: This cross-sectional study was conducted from November 2021 to May 2023 at a tertiary healthcare center in India with an aim to study the clinical applicability of whole-body low dose computed tomography scan for detecting bone metastasis in patients with breast cancer. Breast cancer patients with primary tumor measuring 5cm or more, pathologically proven axillary lymph node metastasis, Stage III/IV disease, symptoms attributable to metastasis and suspected disease recurrence were included. All patients underwent WBLDCT and Bone scan within a period of about 2 weeks. WBLDCT was done during the same time as conventional dose CT scan was being done as part of metastatic workup. WBLDCT acquisition protocol was set in CT scan machine by modulating the technical parameters like Care dose 4D-automated, Care kV semi, rotation time &amp; noise index. The image analysis was performed by Radiologist and Nuclear medicine experts in a blinded fashion. Data was recorded in MS Excel sheet. Sensitivity, specificity, positive and negative predicative value, and concordance rates were calculated using SPSS software ver 25.0. Agreement amongst WBLDCT and Bone scan was calculated using Inter-rater agreement. p value &amp;lt; 0.05 was taken as significant. Results: 110 patients were enrolled in this study. The mean age of participants was 48.5 years and three fourth had stage III disease at presentation. Estrogen receptor positive disease was seen in 43.64% participants while 30% were triple negative. Her2neu positive disease was seen in 27.27% patients. Bone scan couldn’t be done in 03 patients who deferred treatment (these had no bone metastasis on WBLDCT). Both bone scan and WBLDCT detected bone metastasis in 19 patients. Bone scan picked up additional metastasis in three patients which were missed on WBLDCT. WBLDCT detected bone metastasis additionally in three patients which were not detected on Bone scan. Multiple lesions were most seen in vertebrae in 38.5% and 28.6% on bone scan and WBLDCT respectively. The sensitivity and specificity of WBLDCT for detection of bone metastasis was 86.36% and 96.47% respectively. The concordance rate between Bone scan and WBLDCT scan was 94.39% with an Inter-rater Kappa(k) quotient for agreement of 0.828 (p&amp;lt; 0.0001). Conclusion: WBLDCT scan has comparable diagnostic capability to skeletal scintigraphy in detecting bone metastasis in breast cancer and may be a useful alternative specially in resource limited settings. Table 1: Sensitivity, specificity, positive predictive value and negative predictive value of WBLDCT for detection of metastasis Variables Values Sensitivity (95% CI) 86.36% Specificity (95% CI) 96.47% AUC (95% CI) 0.91 Positive Predictive Value (95% CI) 86.36% Negative Predictive Value (95% CI) 96.47% Diagnostic accuracy 94.39% Inter-rater agreement (kappa) 0.828 Citation Format: Lipton Mitra, Suhani Suhani, Ankur Goyal, Rakesh Kumar, Mohit Joshi, Hemanga Bhattacharjee, Haresh KP, Raju Sharma, Rajinder Parshad. Clinical utility of whole body low dose computed tomography for detecting bone metastasis in breast cancer patients: A cross sectional study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-13.

Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department.

The fourth Society for Academic Emergency Medicine (SAEM) Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4) is on the topic of the emergency department (ED) management of nonopioid use disorders and focuses on alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS). The SAEM GRACE-4 Writing Team, composed of emergency physicians and experts in addiction medicine and patients with lived experience, applied the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding six priority questions for adult ED patients with AWS, AUD, and CHS. The SAEM GRACE-4 Writing Team reached the following recommendations: (1) in adult ED patients (over the age of 18) with moderate to severe AWS who are being admitted to hospital, we suggest using phenobarbital in addition to benzodiazepines compared to using benzodiazepines alone [low to very low certainty of evidence]; (2) in adult ED patients (over the age of 18) with AUD who desire alcohol cessation, we suggest a prescription for one anticraving medication [very low certainty of evidence]; (2a) in adult ED patients (over the age of 18) with AUD, we suggest naltrexone (compared to no prescription) to prevent return to heavy drinking [low certainty of evidence]; (2b) in adult ED patients (over the age of 18) with AUD and contraindications to naltrexone, we suggest acamprosate (compared to no prescription) to prevent return to heavy drinking and/or to reduce heavy drinking [low certainty of evidence]; (2c) in adult ED patients (over the age of 18) with AUD, we suggest gabapentin (compared to no prescription) for the management of AUD to reduce heavy drinking days and improve alcohol withdrawal symptoms [very low certainty of evidence]; (3a) in adult ED patients (over the age of 18) presenting to the ED with CHS we suggest the use of haloperidol or droperidol (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence]; and (3b) in adult ED patients (over the age of 18) presenting to the ED with CHS, we also suggest offering the use of topical capsaicin (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence].

Guideline for diagnosis and treatment of recurrent spontaneous abortion with integrated traditional Chinese and western medicine

Recurrent spontaneous abortion is one of the most common pregnancy complications in obstetrics and gynecology. The normative diagnosis and treatment of recurrent spontaneous abortion has become an important problem to be solved urgently in the field of reproductive health. The integrated traditional Chinese and western medicine provides a safe and effective treatment method for recurrent spontaneous abortion, but there is no guideline for diagnosis and treatment of recurrent spontaneous abortion with integrated traditional Chinese and western medicine. The guideline is based on the requirements of World Health Organization(WHO) handbook for guideline development and follows the principles of evidence-based medicine. Through literature pre-search, expert interviews, clinical research, and conference consensus, 16 clinical problems are identified in this guideline. PICO principles are used for evidence retrieval, screening, and synthesis. The evidence quality is evaluated for the included evidence bodies. Recommendation opinions and consensus suggestions are formed through three rounds of the Delphi expert questionnaire survey. An expert meeting is held to finalize the draft. The opinions of experts in traditional Chinese medicine, western medicine, integrated traditional Chinese and western medicine, methodology and pharmacy are widely solicited. The guideline contains five parts: scope, term and definition, diagnosis, treatment, and diagnosis and treatment flow chart of integrated traditional Chinese and western medicine. There are corresponding recommendations and summaries of evidence for clinical problems related to the diagnosis and treatment of integrated traditional Chinese and western medicine. This guideline is guided by clinical problems, combining disease differentiation and syndrome differentiation and integrating pre-pregnancy regulation and treatment and post-pregnancy preservation, highlighting the therapeutic advantages of integrated traditional Chinese and western medicine, so as to further standardize the clinical diagnosis and treatment of recurrent spontaneous abortion and promote the diagnosis and treatment level of integrated traditional Chinese and western medicine for recurrent spontaneous abortion.

Quick Consult: Connecting Members to Academic Family Medicine Expertise.

Quick Consult: Connecting Members to Academic Family Medicine Expertise.

CULTURAL DYNAMICS OF THE KANIKKAR TRIBE: AN ETHNOGRAPHIC INQUIRY

This ethnographic study delved into the intricate cultural dynamics of the Kanikkar tribe, a marginalized indigenous community residing in the southern regions of Kerala. Through immersive fieldwork and qualitative analysis, the research explored the multifaceted aspects of Kanikkar culture, including their social organization, livelihood, traditional practices, belief systems, cultural identity, and interactions with the surrounding environment. The Kanikkar tribe displayed unique cultures, lifestyles, customs, traditions, religious practices, and rituals. Their lifestyles connected them to the land, forests, rivers, and natural resources. Subsistence practices such as hunting, fishing, agriculture, and gathering sustained them. Traditional clothing, music, dance, and storytelling formed integral parts of their cultural expression. They were renowned for their traditional medicinal expertise, possessing intricate knowledge of herbs and their healing properties. The findings of this inquiry shed light on the resilience of Kanikkar traditions in the face of modernization, as well as the ongoing processes of cultural adaptation and transformation within the community.