Medical Evidence Research Articles

Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment.

Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies. During 2020-22, we conducted thirty-one semistructured interviews with forty policy officials and treatment providers in nine states identified through a legal analysis. Of these states, three states required treatment organizations to offer MOUD, and two prohibited organizations from denying admission to people receiving MOUD. Qualitative findings revealed that licensure policies were part of a broader effort to transition the specialty treatment system to a model of care more consistent with medical evidence; states perceived tension between raising quality standards and maintaining adequate treatment capacity; aligning other state policies with MOUD access goals facilitated implementation of the licensure requirement; and measuring compliance was challenging. Licensure may offer states an opportunity to take a more active role in ensuring access to effective treatment.

Candidate selection for lung transplantation - considerations beyond the medical evidence.

The scarcity of organs available for lung transplantation makes it necessary to develop consistent practices for candidate selection and organ allocation. Such policies are mainly built on prognostic estimations, which are again built on medical evidence. In addition, however, other factors also guide these practices. These factors are not always explicit. The purpose of this review is to discuss some of these factors. While one candidate may be considered to be in need of a transplant, the extent to which this need is weighed up against other patients at need varies, depending on how societal responsibility is conceived at the transplant center. Individual survival benefit may be in conflict with the concept of a just distribution of life years ('fair innings'). Furthermore, the need to expand medical knowledge, and the perceived patient autonomy and right to choose may affect the selection and allocation practices. Finally, financial considerations and nationality may have great influence. Although well trained in medical judgment, the clinicians' candidate selection for lung transplantation is often influenced by factors beyond the medical evidence. These factors should be discussed just as transparently and accountably as the medical judgments.

Chinese expert consensus on the whole-course standardized management of biliary tract cancer(2023)

The early detection of biliary tract cancer remains challenging,with the majority of patients often presenting at an advanced stage,characterized by a low rate of radical surgery,limited comprehensive treatment options,and poor prognosis. Currently,the specialized diagnosis and treatment of biliary system diseases,as well as the establishment of multi-disciplinary collaboration strategy,are still developing in China. Given the increasing complexity of biliary tract cancer diagnosis and treatment,the Study Group of Biliary Surgery in Chinese Society of Surgery of Chinese Medical Association and the Biliary Surgeon Working Group of the Surgical Branch of the Chinese Medical Doctor Association have developed this "Chinese expert consensus on the whole-course standardized management of biliary tract cancer(2023)". This consensus has been based on current medical evidence and was reached through expert discussions. It comprehensively covers screening,diagnosis,treatment,and follow-up,providing clinicians with guidance on standardized and holistic management of biliary tract cancer.

Consensus on the rational implementation of laparoscopic surgery after conversion therapy in far-advanced gastric cancer (first edition)

Far-advanced gastric cancer has always been a challenging problem in clinical treatment and a key direction for breakthrough research. Non-surgical treatments are primarily managed in patients with far-advanced gastric cancer. However, with the advancement of therapeutic methods in recent years, tumor foci can be significantly regressed after effective preoperative treatment, in prospect ofregaining the opportunity of radical gastrectomy. In the surgical field, laparoscopic surgery, as one of the routine methods for gastric cancer, has proven effective in the treatment of initially resectable gastric cancer. However, its application in far-advanced gastric cancer still lacks high-level medical evidence. Nevertheless, global clinicians have widely participated in research exploration, achieving certain progress. This consensus, formulated based on the latest research developments and adopting through the international Delphi method with multiple expert votes and amendments, divides the perioperative period after conversion therapy for far-advanced gastric cancer into three parts, i.e., preoperative assessment, rational implementation of laparoscopic surgery, and postoperative assessment and treatment. It forms a preliminary consensus of 18 items, aiming to provide a basic reference and guidance for clinicians.

Interdisciplinary care for gender diverse adolescents. The example of the Centre hospitalier universitaire vaudois (CHUV)

This article outlines the management of transgender and non-binary adolescents at CHUV. The current rise in visibility of this topic is associated with an increased demand for intervention and at the same time with an increased generation of continuously expanding medical evidence to guide interventions. The close collaboration among various specialized adolescent health services enables an interdisciplinary evaluation of diagnostic elements and indications for potential psychological, social or medical interventions. This article underscores the significance of an interdisciplinary and individualized approach to transgender and non-binary adolescents, respecting the diversity of the human being.

Livestreaming clinical experience to remotely located learners: A critical narrative review.

Medical education relies on real patient learning (RPL) to provide medical students with essential clinical experience. However, growing demand for clinical placements continues to be a challenge in providing sufficient RPL opportunities. The COVID-19 pandemic forced academic institutions to rethink the delivery of traditional clinical training and innovations in online clinical learning experiences, specifically livestreamed clinical experiences, have emerged which show promise in addressing the capacity limitations of traditional placements. Although previous reviews have explored the use of livestreamed clinical experiences during the pandemic, there is a lack of rigorous theoretical framing to support these innovations. The aim of this review is two-fold: to examine the effectiveness of livestreamed clinical experiences through an experience-based learning (ExBL) theory perspective and to provide practical recommendations to optimise and implement these innovations. A review of literature was conducted to identify journal articles published between September 2019 and January 2023 reporting on innovations relating to livestreamed clinical experiences. The search focused on undergraduate and postgraduate medical education but relevant evidence from other healthcare professions were also included due to a limited evidence base. Strengths and weaknesses were derived from the literature and analysed in relation to ExBL components. Principal strengths of livestreamed clinical experiences included expanded access to RPL opportunities and medical specialties, enhanced standardisation of learning experiences and positive perceptions from students regarding convenience. Clinical educators found these innovations enabled teaching at scale. Patients did not perceive such innovations to negatively impact their standard of care. Limitations included the inability to practice physical examination skills, challenges in ensuring learner engagement and connectivity issues. Livestreamed clinical experiences have the potential to effectively expand placement capacity and provide high-quality educational experiences for medical students. Although certain limitations exist, technological and pedagogical adaptations can help overcome these challenges. The application of theoretical frameworks to future online innovations will be fundamental to ensure effective clinical learning.

Ankylosing spondylitis prediction using fuzzy K-nearest neighbor classifier assisted by modified JAYA optimizer

The diagnosis of ankylosing spondylitis (AS) can be complex, necessitating a comprehensive assessment of medical history, clinical symptoms, and radiological evidence. This multidimensional approach can exacerbate the clinical burden and increase the likelihood of diagnostic inaccuracies, which may result in delayed or overlooked cases. Consequently, supplementary diagnostic techniques for AS have become a focal point in clinical research. This study introduces an enhanced optimization algorithm, SCJAYA, which incorporates salp swarm foraging behavior with cooperative predation strategies into the JAYA algorithm framework, noted for its robust optimization capabilities that emulate the evolutionary dynamics of biological organisms. The integration of salp swarm behavior is aimed at accelerating the convergence speed and enhancing the quality of solutions of the classical JAYA algorithm while the cooperative predation strategy is incorporated to mitigate the risk of convergence on local optima. SCJAYA has been evaluated across 30 benchmark functions from the CEC2014 suite against 9 conventional meta-heuristic algorithms as well as 9 state-of-the-art meta-heuristic counterparts. The comparative analyses indicate that SCJAYA surpasses these algorithms in terms of convergence speed and solution precision. Furthermore, we proposed the bSCJAYA-FKNN classifier: an advanced model applying the binary version of SCJAYA for feature selection, with the aim of improving the accuracy in diagnosing and prognosticating AS. The efficacy of the bSCJAYA-FKNN model was substantiated through validation on 11 UCI public datasets in addition to an AS-specific dataset. The model exhibited superior performance metrics—achieving an accuracy rate, specificity, Matthews correlation coefficient (MCC), F-measure, and computational time of 99.23 %, 99.52 %, 0.9906, 99.41 %, and 7.2800 s, respectively. These results not only underscore its profound capability in classification but also its substantial promise for the efficient diagnosis and prognosis of AS.

Leveraging generative AI for clinical evidence synthesis needs to ensure trustworthiness

Evidence-based medicine promises to improve the quality of healthcare by empowering medical decisions and practices with the best available evidence. The rapid growth of medical evidence, which can be obtained from various sources, poses a challenge in collecting, appraising, and synthesizing the evidential information. Recent advancements in generative AI, exemplified by large language models, hold promise in facilitating the arduous task. However, developing accountable, fair, and inclusive models remains a complicated undertaking. In this perspective, we discuss the trustworthiness of generative AI in the context of automated summarization of medical evidence.

Image Processing in MATLAB Enhancement, Encryption and Decryption

Photography was invented in 1826 by French inventor Joseph Nicéphore Niépce. Since then, it has revolutionized the modern world. From medical evidence in court & drawing images of industrial machines to personal photos for memory, not a single field is left untouched by photography. Nowadays when there is so many photo editing software, not a single one ensures true privacy and provides open-source code to ensure that no data is being collected. In six months of project making, we have developed an Image processing app that not only provides enhancement tools but also displays the power of steganography, a user-friendly environment to encrypt your enhanced images before sending them forward, and a magnificent display of Fourier series epicycles which creates an image using Fourier series, an intuitive way to learn and understand the beauty of mathematics. Mathematics could be called the language of science. Our tool proves why it is said so. And what could be a better platform to make all this other than MATLAB which not only provides numerous libraries but also is a powerful debugging tool that can display all the things happening inside the code. This app is built using the Guide function in MATLAB and has the potential to influence this generation toward data security as well as mathematics. Keyword: Enhancement, Cryptography, Epicycles, and Steganography

Delusional parasitosis: the importance of a multidisciplinary approach

IntroductionDelusional parasitosis, also known as delusional infestation or Ekbom’s syndrome, is a rare psychotic disorder characterized by the false belief that a parasitic skin infestation exists, despite the absence of any medical evidence to support this claim. These patients often see many physicians, so a multidisciplinary approach among clinicians is important. Many patients refuse any treatment due to their firm belief that they suffer from an infestation, not a psychiatric condition, so it is crucial to gain the trust of these patients.ObjectivesThe comprehensive review of this clinical case aims to investigate Ekbom syndrome, from a historical, clinical and therapeutic perspective.MethodsLiterature review based on delusional parasitosis.ResultsA 65-year-old woman comes to the psychiatry consultation referred by her primary care physician concerned about being infested by insects that she perceives through scales on her skin for the last three months. She recognizes important impact on her functionality. She is also convinced that her family is being infected too. As psychiatric history she recognizes alcohol abuse in the past (no current consumption) and an episode of persecutory characteristics with a neighbor, more than ten years ago. On psychopathological examination, she shows delusional ideation of parasitosis, with high behavioral repercussions, cenesthetic and cotariform hallucinations, as well as feelings of helplessness and anger. Treatment with Pimozide was started and the patient was referred to dermatology for evaluation, a plan she accepted. Her primary care physician and dermatology specialist were informed about the case and the treatment plan. In the recent reviews, the patient is calmer, however, despite the corroboration of dermatology and in the absence of organic lesions in cranial CT, she is still unsatisfied with the results, remaining firm in her conviction of infestation. It was decided to start treatment with atypical neuroleptics (Aripiprazole), with progressive recovery of her previous functionality.ConclusionsDespite the increase in the number of studies in recent years, there are still few studies on this type of delirium. The female:male ratio varies in the bibiliography (between 2:1 and 3:1). The onset is usually insidious, generally appearing as a patient who comes to his primary care physician convinced of having parasites in different skin locations. It is usual to observe scratching lesions or even wounds in search of the parasite. In the past, the most used and studied treatment was Pimozide. Currently the treatment of choice is atypical neuroleptics due to their lower side effects. The latest reviews on the prognosis of this disorder show data with percentages of complete recovery between 51% and 70%, and partial responses between 16.5% and 20%. Finally, for a good diagnosis and therapeutic management, it is important to achieve a multidisciplinary approach.Disclosure of InterestNone Declared

“Ekbom syndrome: delirium engraved on the skin”

IntroductionEkbom syndrome also known as Morgellons syndrome or delirium of parasitosis is a psychiatric condition where the patient has the absolute conviction of being infested in spite of medical evidence. Patients may even mutilate themselves or apply toxic substances in order to get rid of these hypothetical organisms. Sometimes they bring samples of these hypothetical parasites to the office to prove their existence, which is known as the “matchbox sign”, a pathognomonic finding.ObjectivesThe aim of this clinical case is to make visible the impact that this psychiatric condition can have on the patient’s quality of lifeMethodsWe present the case of a 40-year-old woman from Peru who was admitted to the otorhinolaryngology unit for injuries compatible with necrosis of the right pinna. When the patient was examined, scars were found on the lower limbs and back. The patient justifies the scratching lesions with the presence of pathogenic organisms, with no trace of them by the physician.ResultsThe patient was evaluated by psychiatry service during her admission in otorhinolaryngology, being diagnosed with Ekbom’s delirium and starting treatment with 3 mL of Aripiprazole. Subsequently she was referred to the mental health unit where she left the follow-up until today.Conclusions Different effective treatments have been described, among them pimozide, atypical antipsychotics and some SSRIs. However, the complexity of treatment arises when dealing with the irreducible idea that the patient has of being infested, refusing in most cases to receive psychiatric treatment. This can degenerate into major organic and psychological problems that turn the patient’s life into a real hell, which often end up losing much of their daily functionality. The fact of empathizing with the patient and trying to elaborate a plan adjusted to the reality and needs of the moment, can help us to establish a good therapeutic bond that facilitates an early start of treatment and greater therapeutic adherence, enabling a significant improvement in their quality of life.Disclosure of InterestNone Declared

Exploring delusional parasitosis – a case series of three patients

Delusional parasitosis is a psychiatric condition where individuals believe they are infested with parasites despite lacking medical evidence. This often leads to underestimation within psychiatric settings. Three patients with delusional parasitosis, aged above and below 50, presented with symptoms lasting from 1 to 6 months. Two had consulted specialists before, and one had primary delusional parasitosis while two had secondary due to schizophrenia and depression. Tablet Olanzapine showed partial response in one patient before admission. Tablet Risperidone resulted in complete symptom resolution within 10 days in two patients and within 1 month in one patient. Randomized controlled trials on antipsychotics for delusional parasitosis treatment are lacking. Further research is needed to assess treatment recommendations. Psychiatrists should report cases to provide clinical evidence supporting treatment decisions.

The clinical use of cannabinoids for pain

Cannabis has been used for medicinal purposes more than millennia., further research concerning the potential applications of medicinal cannabis has gained considerable momentum in the medical community. Among the several cannabinoids produced by cannabis leaves, the most notable compounds include Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), which act on the endocannabinoid system and play significant physiological roles, such as pain regulation. This manuscript reviews the current knowledge and provides medical evidence about the analgesic potential of medicinal cannabis for chronic pain management. The following databases were searched: MEDLINE, COCHRANE, SCIELO and LILACS. Only randomized controlled trials published within six years were selected. Nine articles met the inclusion criteria for the present review. All nine RCTs reported a significant difference in the reduction in pain intensity; however, only five of the studies reported a significant reduction in pain. The presence of mild-to-moderate adverse events was greater in the intervention groups than in the control group, but these adverse events were well tolerated. The difference in opioid use and other analgesic drugs between the intervention group and the placebo group was not statistically significant. Cannabis-derived compounds promote beneficial effects when administered into patients with chronic pain.

From Mind-Reading to Health-Reading Machines: Towards Contactless Health Diagnosis using Generative Artificial Intelligence

Generative Artificial Intelligence (AI) has recently shown impressive results across a wide spectrum of tasks. Inspired by the emerging notion of mind-reading machines and by the medical evidences indicating that some diseases and brain disorders produce facial abnormalities and interrupt normal facial expression formation, we are (1) establishing, in close interaction with medical practitioners, the basic understanding of the correlations between visual patterns and health conditions, and (2) developing novel computational models, based on Generative AI, to learn the identified correlations. Devising computational models for detecting abnormalities reflective of internal diseases based only on visual information is a highly intriguing research problem. The goal is to achieve ground-breaking results in unobtrusive health diagnosis and to gain insight into the correlation between face, body, and mind. This work has the potential to open new research directions in several fields and to bridge the gap between the research activities conducted in several disciplines like engineering and medicine. This article explains the main idea behind contactless health reading using generative artificial intelligence.

Accuracy of Maternal Self-Report of Recent Preeclampsia Among Healthy Women.

Background: Preeclampsia history signals a higher risk for cardiovascular disease, but its value as a risk marker relies primarily on self-report. To identify the accuracy of maternal self-reports of recent preeclampsia, we conducted a validation study among women recruited to a web-based trial. Methods: Women with preeclampsia in the past 5 years were recruited to Heart Health 4 Moms. Preeclampsia was self-reported through an online recruitment questionnaire and affirmed via phone screen. Accuracy of maternal self-report was quantified using positive predictive value (PPV) versus medical record evidence of preeclampsia using three definitions: (1) documentation of clinician diagnosis, (2) American College of Obstetricians and Gynecologists (ACOG) 2002 diagnostic criteria (gestational hypertension and proteinuria), and (3) ACOG 2013 diagnostic criteria (gestational hypertension and proteinuria or systemic symptoms). Results: Complete medical records were received for 290 women who delivered from 2011 to 2016 and were predominantly non-Hispanic White (81.7%) with a mean age of 31.2 ± 4.8 years. Mean length of recall was 13.6 ± 14.7 months. The majority of women (92.1%) had medical record evidence of preeclampsia using ≥1 of the definitions. Maternal self-report of preeclampsia was validated for 88.3% based on clinician diagnosis, 59.0% with ACOG 2002, and 65.2% with ACOG 2013. Conclusions: In this validation study of U.S. women, the majority accurately self-reported their preeclampsia diagnosis based on medical record review. A higher proportion of self-reports validated by clinician diagnosis than ACOG criteria, suggesting women remember the diagnosis given by their provider and providers may not always follow or document criteria when making a diagnosis.

The Subjective Interpretation of the Medical Evidence

This Viewpoint discusses whether commonly occuring, sometimes divergent interpretations of new evidence’s validity and usefulness should be explained when experts and guideline committees provide recommendations for screening or treatment.

Efficacy and safety of biologic agents for IgA nephropathy: A protocol for systematic review and meta-analysis.

IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis worldwide and a leading cause of chronic kidney failure. There are currently no definitive therapeutic regimens to treat or prevent the progression of IgAN. However, biologic agents offer novel therapeutic approaches that target immunological mechanisms to slow or halt disease progression. The objective of this study is to evaluate the efficacy and safety of biologic agents in patients with IgA nephropathy. We will systematically search PubMed, EMbase, Web of Science, Cochrane Library, and www.clinicaltrials.gov for randomized controlled trials of biologic agents for the treatment of IgA nephropathy. The search period will span from the establishment of each database until October 2023. The quality assessment of included studies will be performed individually using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2), and meta-analysis will be conducted using Revman 5.4.1 software. The results of this study will provide evidence-based medical evidence for the clinical application of biologic agents in patients with IgA nephropathy. CRD42023400450.

Impact of Stent Size Selection and Vessel Evaluation on Skull Base Cerebrovascular Diseases Treated With Willis Covered Stents: A Multicenter Retrospective Analysis.

This study aimed to evaluate the impact of the diverse stent size selection on the clinical and angiographic outcomes of Willis covered stent (WCS) for the treatment of skull base cerebrovascular diseases. A total of 147 patients with 151 skull base cerebrovascular diseases treated with WCS in 3 centers between January 2015 and July 2022 were included in this study. Several parameters depicting stent size and parent artery condition were incorporated into the analysis of the outcomes. Complete occlusion was found in 106 cases (68.2%) immediately after deployment and 126 cases (83.4%) after technical adjustment. In the multivariate logistics analysis, the difference between stent diameter and parent artery diameter (DD) was significantly associated with immediate endoleak without adjustment (odds ratio [OR]=0.410; p=0.005) and late endoleak (OR=0.275; p=0.028). In addition, differences between stent diameter and parent artery diameter at wide landing point (DSW) and differences between stent diameter and parent artery diameter at narrow landing point (DSN) was also was significant associated with immediate endoleak without adjustment and balloon re-dilation respectively. This study demonstrated that the diameter selection of the WCS was associated with the occurrence of endoleak during the treatment of skull base cerebrovascular diseases. Precise selection and evaluation of stent size and vessel condition were significant factors for skull base cerebrovascular diseases treated by WCS. This study demonstrates a significant association between the diameter selection of the Willis covered stent (WCS) and the occurrence of endoleak in the management of skull base cerebrovascular diseases. The results offer valuable medical evidence that can inform stent selection for WCS. The study emphasizes the significance of precise evaluation of stent size and vessel condition as crucial factors in WCS procedures. These findings underscore the importance of meticulous consideration and individualized approaches to stent selection, ultimately improving treatment outcomes in clinical practice.

Expert recommendation on clinical diagnosis and treatment pathway of hydrochloric ear disease

In order to improve the awareness and understanding of hydropic ear disease, the Vertigo Committee of the Chinese Medical Education Association established an expert group and formed the expert recommendation on clinical diagnosis and treatment pathway of hydrochloric ear disease after repeated discussions, based on the existing medical evidence and clinical experience of experts. The article included the understanding process, characteristics, medical history collection and physical examination, diagnosis and clinical pathway of various treatment and rehabilitation methods in hydrochloric ear disease, aiming to promote standardized clinical work and research on hydropic ear disease.

The utility of trace DNA within forensic science for investigative and intelligence purposes

AbstractForensic science not only provides evidence to support criminal investigations, but also contributes to knowledge surrounding criminal phenomena. Forensic scientists are in the unique position to strategically combine information gained from traces to create intelligence that can assist the security space in keeping our communities safe. Research into the use of traces for more than just criminal investigations, with a focus on the greater “utility” of a trace, has pointed to the broader problem‐solving potential of traces when more fully exploited. Alongside this, there has continued to be an exponential increase of the use of biological traces for criminal investigations, in particular the collection of trace DNA specimens. The potential for identification, among other information, trace DNA can provide is vast, however much of the previous research has predominately focused on recovery rates which does not provide a holistic view of the value of trace DNA. This paper summarizes the current knowledge on the utility of trace DNA, as well as makes suggestions toward the creation of a decision‐making model that can inform scene of crime officers in regards to trace selection and decisions about trace analysis.This article is categorized under: Forensic Biology > DNA Databases and Biometrics Crime Scene Investigation > From Traces to Intelligence and Evidence