Future Medical Practice Research Articles

Virtual Care and Virtual Medical Education: A Canadian Medical Student Perspective


 Background: The COVID-19 pandemic had accelerated the adoption of virtual care as an extension of routine clinical practice. In addition, pre-clinical undergraduate medical education was affected by the transition to both synchronous and asynchronous online learning. The objective of this study was to assess the current experience and knowledge of medical students with regards to virtual care. A secondary objective was to identify opportunities for improvement in the undergraduate medical curriculum.
 Methods: An electronic survey was distributed to undergraduate medical students in Canadian medical schools. Main sections of the survey addressed experience with virtual care encounters and perceived impact of virtual learning on medical education.
 Result: Out of our 53 respondents, the majority (80%) of medical students perceived high educational importance of virtual care encounters. 91% of the students recognized the developing role of virtual care in current and future medical practices. 55% of the surveyed showed readiness to conduct virtual care in the current curriculum. 94% of the responses stated the preferred feedback method for clinical learning was immediate faculty assessment following the encounter.
 Discussion: The results from this study provided insight on the medical learner’s experience while navigating virtual care and identified areas of improvements at an institutional level. Effective medical training that integrates the advantages of virtual care is crucial.

Perception of medical student about community medicine as subject in Government Medical College Bhavnagar, Western India

The primary goal of teaching community medicine (CM) to medical students is to educate them to practice as community and first-level physicians. Correct attitude and interest toward subject are necessary to gain knowledge and skill for future medical practice. Objectives were to explore the perception of medical students regarding knowledge of subject and willingness to take subjects as future carrier. The study was conducted during the march 2022 involving final year student and interns of government medical college Bhavnagar. Ten in depth interviews of study subjects were taken. Saturation of responses was achieved after eight interviews additional 2 interviews taken to confirm the saturation. All interviews were audio-recorded after obtaining written informed consent, transcribed and analyzed in form of codes and categories. Student perceive health promotion, Research, Health education, early detection of disease were main domains. They refuse to take CM subjects as their carrier. With a dream to become a famous and earning doctor, they do not want CM subject. There is need of clinical exposure and awareness regarding future scope of subjects among students. Future study can evaluate impact of such interventions on medial students.

Depressive symptomatology in medical students in Chiapas, Mexico

Depression is a common mental disorder that can significantly affect medical education students. Intense academic load, high expectations and stress associated with medical training can contribute to the development of depression, which has an impact on the emotional and mental well-being of students, fundamental for their academic success and future medical practice. Objective: To determine the prevalence of depressive symptoms in medical students of Campus II of the Autonomous University of Chiapas. Method: The type of study was descriptive, cross-sectional and prospective, the sample of 231 students in the period January - June 2020. After informed consent, the Beck Depression Inventory was applied for depressive diagnosis. It was classified according to symptomatology as mild, moderate and severe. Results: It was determined that 8.23% in the fourth semester presented moderate symptomatology and 5.19% in the eighth semester had severe symptomatology. In the fourth semester 8.23% and 9.09% of the eighth semester have had suicidal thoughts. Also 67.96% of both semesters referred lack of concentration, which affects students' academic performance. Conclusions: With the results obtained it is evident that almost one third of the population studied presents some depressive symptom and one fifth, suicidal ideation, so it is necessary to address depression, to promote a healthy learning environment and support the general welfare of students.

Obesogenic Environment in the medical field: First year findings from a five-year cohort study.

Background: Doctors with a normal BMI and healthy living habits have shown to be more confident and effective in providing realistic guidance and obesity management to their patients. This study investigated obesogenic tendencies of medical students as they progress in their medical studies. Methods: A cohort of forty-nine medical students enrolled in a five-year cohort study and was followed up after one year. At the initiation of the cohort, socio-demography and information on anthropometry, accommodation, eating behavior, stress and sleeping habits of the students had been recorded. Follow-up data was collected using a standardized self-administered questionnaire. Results: Thirty-seven percent of the students in the cohort are either obese or overweight in the one-year period.. A year of follow-up suggests that there is an increase in BMI among the male students (P=0.008) and the changes are associated with changes in accommodation (P=0.016), stress levels (P=0.021), and sleeping habits (P=0.011). Conclusion: Medical education system should seriously consider evaluating this aspect in the curriculum development to help our future medical practitioners practice a healthy lifestyle and be the initiator of change in the worsening prevalence of obesity worldwide.

Teacher as role model in developing professional behavior of medical students: a qualitative study.

This study aimed to explore students' perspectives on the attributes of medical teachers as role models to students' professional behaviour in the educational process. A phenomenological study was conducted to obtain participants' perceptions concerning the professional attributes of medical teachers. The participants were 21 final-year medical students in the School of Medicine, Universitas Gadjah Mada, who had completed and passed the national examination. The participants were recruited purposively to represent genders and performance (i.e., high-performing and average-performing students). The participants were divided into two focus groups based on their performance, each facilitated by non-teaching faculty members to avoid bias. Thematic analysis was conducted to analyze focus group transcripts by two independent coders. Codes were synthesized into themes related to the study aims. Seven themes were identified related to observed role model attributes, for instance, passionate lecturers, caring and empathetic, supportive and involving, objectivity, incompetence and compromising, poor communication and conflict, and time management. Subsequently, five themes were identified in participants' responses towards the observed role model, for instance, exemplary models, respect and motivating, confusion and inconvenience, avoiding and hate, and value collision and harmonization. This study revealed a range of role model attributes and responded positively and negatively during learning encounters. As negative attributes are also prominent and observed by students, there is a need for medical schools to perform faculty development for the professional enhancement of medical teachers. Further study should be conducted to investigate the impact of role modelling on learning achievement and future medical practice.

β-Tricalcium Phosphate-Modified Aerogel Containing PVA/Chitosan Hybrid Nanospun Scaffolds for Bone Regeneration.

Electrospinning has recently been recognized as a potential method for use in biomedical applications such as nanofiber-based drug delivery or tissue engineering scaffolds. The present study aimed to demonstrate the electrospinning preparation and suitability of β-tricalcium phosphate-modified aerogel containing polyvinyl alcohol/chitosan fibrous meshes (BTCP-AE-FMs) for bone regeneration under in vitro and in vivo conditions. The mesh physicochemical properties included a 147 ± 50 nm fibrous structure, in aqueous media the contact angles were 64.1 ± 1.7°, and it released Ca, P, and Si. The viability of dental pulp stem cells on the BTCP-AE-FM was proven by an alamarBlue assay and with a scanning electron microscope. Critical-size calvarial defects in rats were performed as in vivo experiments to investigate the influence of meshes on bone regeneration. PET imaging using 18F-sodium fluoride standardized uptake values (SUVs) detected 7.40 ± 1.03 using polyvinyl alcohol/chitosan fibrous meshes (FMs) while 10.72 ± 1.11 with BTCP-AE-FMs after 6 months. New bone formations were confirmed by histological analysis. Despite a slight change in the morphology of the mesh because of cross-linking, the BTCP-AE-FM basically retained its fibrous, porous structure and hydrophilic and biocompatible character. Our experiments proved that hybrid nanospun scaffold composite mesh could be a new experimental bone substitute bioactive material in future medical practice.

Grounded in reality: artificial intelligence in medical education.

In a recent survey, medical students expressed eagerness to acquire competencies in the use of artificial intelligence (AI) in medicine. It is time that undergraduate medical education takes the lead in helping students develop these competencies. We propose a solution that integrates competency-driven AI instruction in medical school curriculum. We applied constructivist and backwards design principles to design online learning assignments simulating the real-world work done in the healthcare industry. Our innovative approach assumed no technical background for students, yet addressed the need for training clinicians to be ready to practice in the new digital patient care environment. This modular 4-week AI course was implemented in 2019, integrating AI with evidence-based medicine, pathology, pharmacology, tele-monitoring, quality improvement, value-based care, and patient safety. This educational innovation was tested in 2 cohorts of fourth year medical students who demonstrated an improvement in knowledge with an average quiz score of 97% and in skills with an average application assignment score of 89%. Weekly reflections revealed how students learned to transition from theory to practice of AI and how these concepts might apply to their upcoming residency training programs and future medical practice. We present an innovative product that achieves the objective of competency-based education of students regarding the role of AI in medicine. This course can be integrated in the preclinical years with a focus on foundational knowledge, vocabulary, and concepts, and in clinical years with a focus on application of core knowledge to real-world scenarios.

Cultivating patient-centered care competence through a telemedicine-based course: An explorative study of undergraduate medical students' self-reflective writing.

The COVID-19 pandemic has encouraged adaptations of learning methods in clinical clerkship. There have been limited reports on the merits of involving medical students in telemedicine. This study, therefore, aims to investigate students' reflection on what they learned and identify the challenges and benefits of doctor-patient interaction through their experience in a telemedicine-based course. A 4 week telemedicine-based course for medical students to participate in telemonitoring of COVID-19 patients undergoing self-isolation was conducted. This is a qualitative study using an interpretive phenomenology design to investigate students' self-reflection on their experiences in monitoring COVID-19 patients. Students were asked to reflect on their experience upon completion of the course through 750-1,000 words essays. A thematic analysis which considers units of meaning based on students' experiences was completed. Our study identified four main themes gathered from students' experiences related to the telemedicine-based course: communication and education, professionalism and professional identity formation, system-based practice, and patient-centered care. The course was part of an integrative effort involving multiple parties to tackle the burden on the nation's healthcare system during the pandemic. Telemedicine is part of future medical practice which supports the medical curriculum adaptability along with attempts to develop future-proof medical doctors through various clinical learning experiences.

Paediatric endocrinology curriculum content uniformity across medical schools in Southern Nigeria - Lecturers' report

The Medical and Dental Council of Nigeria (MDCN), the regulatory body for medical practice in Nigeria, provides the benchmark for minimum academic standards (BMAS). While it is expected that there will be differences across schools, the extent of this is unknown and the effect/impact it will have on future medical practice in Nigeria is unknown. This study aimed to evaluate the differences in undergraduate paediatric endocrinology contents across medical schools in southern Nigeria and to understand the factors that influence these differences. Seven paediatric endocrinology lecturers were interviewed, and they filled a questionnaire generated from the themes of the discussion. The themes included the contents of diabetes mellitus lectures, the level of participation lecturers allowed students in emergency room management of DKA, and the assessment methods. Lecture notes on diabetes mellitus (DM) were scored using ISPAD guidelines and the differences were analysed using Student’s T test. The extent to which competence was assessed for students was also provided by the lecturers. Two lecturers had reduced contents in their DM lectures, compared to others, $p = 0.003$. Most lecturers did not consult the MDCN BMAS while preparing their lecture notes. This study highlights the differences in curriculum contents in Southern Nigeria medical schools for endocrinology training in paediatrics, and significant differences methods of training. These differences will hamper the core objectives of human capital development should the trend continue. It is recommended that uniform curriculum template that is acceptable to many to streamline training and medical practice.

Clinical conference as an educational technology for training residents in therapeutic specialties

The article discusses the concept and educational role of the clinical conference in the preparation of residents of therapeutic specialties at the Department of Hospital Therapy. The purpose of holding a clinical conference of residents is to improve professional and universal competencies and develop clinical thinking in future therapists in the process of teaching hospital therapy. The authors consider the clinical conference as an effective form of educational process that combines students' independent activities, interaction with the teacher, and the formation of basic skills for future medical practice.

Understanding Prospective Physicians' Intention to Use Artificial Intelligence in Their Future Medical Practice: Configurational Analysis.

Prospective physicians are expected to find artificial intelligence (AI) to be a key technology in their future practice. This transformative change has caught the attention of scientists, educators, and policy makers alike, with substantive efforts dedicated to the selection and delivery of AI topics and competencies in the medical curriculum. Less is known about the behavioral perspective or the necessary and sufficient preconditions for medical students' intention to use AI in the first place. Our study focused on medical students' knowledge, experience, attitude, and beliefs related to AI and aimed to understand whether they are necessary conditions and form sufficient configurations of conditions associated with behavioral intentions to use AI in their future medical practice. We administered a 2-staged questionnaire operationalizing the variables of interest (ie, knowledge, experience, attitude, and beliefs related to AI, as well as intention to use AI) and recorded 184 responses at t0 (February 2020, before the COVID-19 pandemic) and 138 responses at t1 (January 2021, during the COVID-19 pandemic). Following established guidelines, we applied necessary condition analysis and fuzzy-set qualitative comparative analysis to analyze the data. Findings from the fuzzy-set qualitative comparative analysis show that the intention to use AI is only observed when students have a strong belief in the role of AI (individually necessary condition); certain AI profiles, that is, combinations of knowledge and experience, attitudes and beliefs, and academic level and gender, are always associated with high intentions to use AI (equifinal and sufficient configurations); and profiles associated with nonhigh intentions cannot be inferred from profiles associated with high intentions (causal asymmetry). Our work contributes to prior knowledge by showing that a strong belief in the role of AI in the future of medical professions is a necessary condition for behavioral intentions to use AI. Moreover, we suggest that the preparation of medical students should go beyond teaching AI competencies and that educators need to account for the different AI profiles associated with high or nonhigh intentions to adopt AI.

The Validity and Reliability of the Patient-Physician Interview Skill Evaluation Form in Five Steps

Objective: Developing basic and clinical communication and clinical reasoning skills is crucial in facilitating medical school students' future medical practice. The path to these skills` development goes through conducting patient-physician interviews. This research aims to conducted to determine the validity and reliability of the Patient-Physician Interview Skill Evaluation Form(P-PISEF) to be used in performance-based tests in the evaluation of patient-physician interview skills. Methods: This study has a descriptive and methodological design and was carried out in June-December 2021. The data were collected from the performance of 197 students with the evaluation of 18 faculty members using the developed form. Explanatory and confirmatory factor analyses, Cronbach's alpha and item the total score was analyzed. Results: The distribution of the eighteen lecturers (38.88%) was associate professors. P-PISEF, comprising 46 articles, five main sections, and seven components. Lecturers were evaluated in a certain order with over 70% compliance. Over 90% of evaluators evaluated P-PISEF similarly. The Cronbach's Alpha (α) was found at 0.793. The KMO value in this study is 0.733, and the data is moderately adequate for analysis. The result of the Bartlett's test was 5983.586 (p<0.05). This measurement shows that the variable we are measuring is multivariate in the sample parameter (specialty, career step, etc.). The total variance explained in this study was 57.577. Conclusion: P-PISEF is an evaluation tool that can be used in patient-physician interview simulations of medical students. The results help curriculum planners to arrange programs that address the development of medical interview skills more effectively.

Prevalence of depressive symptoms and its predictive factors among male medical students in University of Bisha, Saudi Arabia

Background: Identifying the potential factors of depression among medical students is the first step towards academic excellence and future safe medical practice. Methods: A cross-sectional study was conducted during a period from December 2019 to February 2020 at the University of Bisha, College of Medicine (UBCOM), Bisha province, Saudi Arabia. Male medical students from year one to year six were involved. A self-administered questionnaire was used to collect data about the socio-demographic and academic characteristics of students. The Arabic version of the PHQ-9 scale with a score of 10 was used to diagnose depression. Logistic regression analysis was used to assess the prevalence and risk of depression. Results: Of the 190 male students enrolled, 26.8% had depressive symptoms, of whom 45.1% were having moderate to severe symptoms. The significantly highest depression rate was found among the second-year students, at 43.8% (OR=2.544; 95% CI 1.178-5.714; p =0.018), and the lowest rate was foundamong year one students, at 8.9% (OR=0.203; 95% CI 0.075-0.560; p=0.002). Univariate regression revealed a significant correlation between depression and dissatisfaction of family income, loss of family members, having psychological illness, difficulties in personal relationships, regretted studying medicine, failure in an academic year, a lower grade than expected, conflict with tutors, lack of college facilities and heavy academic load. In multivariate analysis, loss of family members (AOR=0.077; 95% CI 0.013-0.451), difficulties in personal relationships (AOR=2.371; 95% CI 1.009-5.575), regret study medicine (AOR=3.764; 95% CI 1.657-8.550), failed in an academic year (AOR=2.559; 95% CI 1.112-5.887) were independently correlated with depression. Conclusion: The study concluded that medical students at UBCOM also experience depressive symptoms associated with various risk indicators. Optimizing the educational and social environment coupled with infrastructure facilities at UBCOM might promote students’ mental health and well-being. Keywords: Depression, predictive factors, medical students, Saudi Arabia

Mental Health of Healthcare Workers in Indonesia, Philippines, and Taiwan During COVID-19 Pandemic: a Cross-Sectional Survey.

This study aims to determine factors associated with hesitation and motivation to work among healthcare workers (HCWs) in Indonesia, Philippines, and Taiwan during the COVID-19 pandemic. HCWs aged ≥20 years working in five hospitals in Indonesia, Philippines, and Taiwan were invited to participate in a self-administered mental health survey between 30 January 2021 and 31 August 2021. The 33-item questionnaire measured HCWs' perceived stress, level of motivation and hesitation to work, attitude and confidence regarding work, attitude on the policies by the hospital and government, and discrimination against the occupation. Each item was rated in a 4-point Likert scale from 0 (never) to 3 (always). Sociodemographic and occupational factors were also considered in data analysis. Of 1349 participants, 671 (49.7%) were from Indonesia, 365 (27.1%) from Philippines, and 313 (23.2%) from Taiwan. Overall, 20.8% of participants showed motivation to work and only 4.7% showed hesitation to work. Compared with HCWs in their 20s, HCWs in their 30s, 40s, and 50s had significantly lower hesitation to work (adjusted odds ratio [AOR] = 0.42, 0.33, and 0.11, respectively; p = 0.01, 0.02, and 0.03, respectively). Similarly, compared with HCWs in their 20s, HCWs in their 30, 40s, 50s, 60s, and 70s had significantly higher motivation to work (AOR = 1.71, 2.98, 5.92, 5.40, and 7.15, respectively; p = 0.01, <0.001, <0.001, <0.001, and 0.02, respectively). Clinical staff had lower motivation to work than non-clinical staff (AOR = 0.60, p = 0.01). Those who worked in high-risk areas had lower hesitation to work than those who worked in low-risk areas (AOR = 0.51, p = 0.03). Overall, higher hesitation to work was associated with 'wanting to leave job/study' (AOR = 4.54, p = 0.03) and 'feeling isolated' (AOR = 4.84, p = 0.01), whereas lower hesitation to work was associated with 'being confident about the future of medical practice' (AOR = 0.33, p = 0.02) and 'burden of child care including lack of nursery' (AOR = 0.30, p = 0.04). Higher motivation to work was associated with 'feeling of being protected by hospital' (AOR = 2.23, p = 0.001), 'confident in my country's pandemic prevention policy' (AOR = 2.19, p = 0.001), 'feeling of elevated mood' (AOR = 4.14, p = 0.004), and 'being confident about the future of medical practice' (AOR = 2.56, p < 0.001), whereas lower motivation to work was associated with 'exhausted mentally' (AOR = 0.35, p = 0.03). Various stress-related factors contribute to hesitation and motivation to work among HCWs in Indonesia, Philippines, and Taiwan during the COVID-19 pandemic. Proactive and practical strategies should be implemented to protect HCWs from the negative behavioural and emotional effects of the COVID-19 pandemic.

Perception of Medical Humanities among Polish Medical Students: Qualitative Analysis.

Medical humanities (MH) courses are a critical element of the medical curriculum influencing the establishment of a physician in the medical profession. However, the opinion about MH among medical students remains unknown. Interviews from seven focus groups were analysed. The students attended one of three Polish medical schools in Gdansk, Krakow, and Warsaw and were recruited to the discussion focused on the impact of drug manufacturers' presence at medical universities on socialization in the medical profession. Thematic analysis was conducted using the theoretical framework of social constructivism. The students' opinions about the MH classes arose during the analysis. In six groups, students thought that MH courses would be helpful in their future medical practice. However, in four groups, different opinion was expressed that MH courses were unnecessary or even "a waste of time". Factors discouraging students from the MH classes included poorly taught courses (monotonous, uninteresting, unrelated to medical practice, taught by unsuitable lecturers). Secondly, students thought that the time investment in the MH was too extensive. Furthermore, curriculum problems were identified, reflecting the incompatibility between the content of MH courses and teaching semesters. Lastly, some students stated that participation in MH courses should be elective and based on individual interests. Addressing problems recognized in this work could improve the training of future Polish physicians.

Steps parameters of elderly patients hospitalised for an acute medical illness in a Swiss University Hospital: an observational pilot study

Objective mobility goals for elderly hospitalised medical patients remain debated. We therefore studied steps parameters of elderly patients hospitalised for an acute illness, to determine goals for future interventional trials and medical practice. Observational study conducted from February to November 2018 in a medical ward of the Lausanne University Hospital, Switzerland. We measured the step parameters of consecutive medical patients aged ≥65 years admitted for an acute medical illness using a wrist accelerometer (Geneactiv). We also collected demographic, somatic and functional factors. Overall, 187 inpatients had their step parameters (daily step count, walking cadence and bout duration) measured with accelerometers worn for a mean of 3.6 days (standard deviation [SD] 3.2). Elderly inpatients (81.5 years, SD 8.5) walked a median of 603 steps daily (interquartile range [IQR] 456-809), at a median cadence of 100 steps/minute (IQR 99-101) with median walking bouts of 33 seconds (IQR 27-37) and with 70% of the walking bouts lasting less than 30 seconds. Patients walking ≥600 steps were younger (80.4 years, SD 8.9 vs 82.8 years,SD 7.9, p = 0.050) and had a longer length of stay (7.8 days, SD 5.1 vs 6.1 days, SD 4.1, p = 0.011) than those walking <600 steps. Patients at high risk of bed sores walked less (564 steps, IQR 394-814 vs 626, IQR 526-840) than those with a lower risk of sores. During a hospitalisation for an acute medical illness, patients aged ≥65 years walk a mere 603 steps daily and most of the time for periods of less than 30 seconds. This information should be used to build up future interventional trials or to set mobility goals for patients hospitalised in Swiss hospitals.

Survey of knowledge and attitude regarding induced abortion among nurses in a tertiary hospital in Thailand after amendment of the abortion act: a cross-sectional study

BackgroundThe abortion act in Thailand is approximately 60 years old. However, because of increasing problems due to unsafe abortions, the act was recently amended to accord a legal status for abortions. In the southernmost provinces of Thailand, most people follow the Islamic faith, according to which induced abortion is a sin for both the providers and the pregnant women. This may affect the attitude of the medical staff, such as registered nurses, who play an important role in abortion services. Our study aims to evaluate the knowledge of the amended abortion act, attitude toward abortions and the intentions behind them, and willingness to perform abortions among registered nurses.MethodsA cross-sectional study was conducted from January 2022 to February 2022 wherein a self-administrated questionnaire was electronically distributed to 450 registered nurses practicing at a tertiary hospital in the southernmost province of Thailand. Linear regression analysis and Fisher’s exact test were conducted to evaluate the association between basic characteristics, knowledge scores, and attitudes toward induced abortion.ResultsA total of 375 nurses (83.3%) completed the survey. Most participants were Muslim (58.9%), and 18.7% of them correctly answered > 80% of the knowledge questions. Among all the participants, 41.4% had a favorable attitude toward induced abortion, of which 21.3% were willing to provide safe abortion services. Knowledge scores were independently associated with practicing in obstetrics-gynecology departments and a lower age. Participants practicing Buddhism and having good knowledge scores tended to have favorable attitudes toward abortion.ConclusionsNurses in the southernmost province of Thailand lack knowledge regarding the amended abortion act and do not have a favorable moral attitude toward abortion. Favorable attitudes toward abortions, support toward intentions behind abortions, and a willingness to provide abortion services were all lesser among the Muslim participants than among the Buddhist participants. Compared with participants who scored lower, those with higher knowledge scores had a better moral attitude toward abortion and, in turn, demonstrated a greater intention to provide abortion services. Encouraging nurses to gain better knowledge may improve their attitude toward abortion, which may positively influence future medical practices.

Imaging-based representation and stratification of intra-tumor heterogeneity via tree-edit distance

Personalized medicine is the future of medical practice. In oncology, tumor heterogeneity assessment represents a pivotal step for effective treatment planning and prognosis prediction. Despite new procedures for DNA sequencing and analysis, non-invasive methods for tumor characterization are needed to impact on daily routine. On purpose, imaging texture analysis is rapidly scaling, holding the promise to surrogate histopathological assessment of tumor lesions. In this work, we propose a tree-based representation strategy for describing intra-tumor heterogeneity of patients affected by metastatic cancer. We leverage radiomics information extracted from PET/CT imaging and we provide an exhaustive and easily readable summary of the disease spreading. We exploit this novel patient representation to perform cancer subtyping according to hierarchical clustering technique. To this purpose, a new heterogeneity-based distance between trees is defined and applied to a case study of prostate cancer. Clusters interpretation is explored in terms of concordance with severity status, tumor burden and biological characteristics. Results are promising, as the proposed method outperforms current literature approaches. Ultimately, the proposed method draws a general analysis framework that would allow to extract knowledge from daily acquired imaging data of patients and provide insights for effective treatment planning.

Systematic bibliometric and visualized analysis of research hotspots and trends on the application of artificial intelligence in diabetic retinopathy.

Artificial intelligence (AI), which has been used to diagnose diabetic retinopathy (DR), may impact future medical and ophthalmic practices. Therefore, this study explored AI's general applications and research frontiers in the detection and gradation of DR. Citation data were obtained from the Web of Science Core Collection database (WoSCC) to assess the application of AI in diagnosing DR in the literature published from January 1, 2012, to June 30, 2022. These data were processed by CiteSpace 6.1.R3 software. Overall, 858 publications from 77 countries and regions were examined, with the United States considered the leading country in this domain. The largest cluster labeled "automated detection" was employed in the generating stage from 2007 to 2014. The burst keywords from 2020 to 2022 were artificial intelligence and transfer learning. Initial research focused on the study of intelligent algorithms used to localize or recognize lesions on fundus images to assist in diagnosing DR. Presently, the focus of research has changed from upgrading the accuracy and efficiency of DR lesion detection and classification to research on DR diagnostic systems. However, further studies on DR and computer engineering are required.

Hyperprogressive disease in patients suffering from solid malignancies treated by immune checkpoint inhibitors: A systematic review and meta-analysis

IntroductionHyperprogressive disease (HPD) is a paradoxically rapid disease progression during or shortly after antitumor treatment, especially immune checkpoint inhibitors (ICIs). Various diagnosis criteria of HPD cause heterogeneous incidence rates in different clinical research, and there is no consensus on potential risk factors associated with HPD occurrence. Hence, we aimed to summarize incidence of HPD in ICI treatment for solid tumors. Clinicopathological factors associated with HPD are also analyzed.MethodsClinical studies about HPD during/after ICI treatment of solid malignancies are included. Pubmed, Embase, and Cochrane library were searched for eligible studies published before October 7. The Newcastle–Ottawa scale was used to assess the quality of the included studies. Random effect and fixed effect models were, respectively, used for pooling incidence of HPD and analysis of risk factors for HPD. Heterogeneity, subgroup analysis, and publication bias were also analyzed. All meta-analysis was performed via R software (y -40v4.0.2).ResultsForty-one studies with 6009 patients were included. The pooled incidence of HPD was 13.2% (95% CI, 11.2%–15.4%). Head and neck cancer (HNC) had the highest incidence of HPD (18.06%), and melanoma had the lowest (9.9%). Tumor types (P = .0248) and gender ratio (P = .0116) are sources of heterogeneity of pooled incidence of HPD. For five clinicopathological factors associated with HPD, only programmed cell death protein 1 ligand 1 (PD-L1) positivity was a preventive factor (odds ratio = 0.61, P <.05). High lactate dehydrogenase (LDH) level (OR = 1.51, P = .01), metastatic sites >2 (OR = 2.38, P <.0001), Eastern Cooperative Oncology Group Performance Score ≥2 (OR = 1.47, P = .02), and liver metastasis (OR = 3.06, P <.0001) indicate higher risk of HPD.ConclusionsThe pooled incidence of HPD was less than 15%, and HNC had the highest incidence of HPD. LDH and PD-L1 are remarkable biomarkers for prediction of HPD in future medical practice.