Future Medical Treatment Research Articles

Current and future medical treatment for endometriosis

Endometriosis is a chronic, progressive inflammatory disease that occurs in approximately 10% of women of reproductive age, resulting in a decreased quality of life due to dysmenorrhea, chronic pain, and other problems. The primary treatment is pain control and fertility preservation, and while preserving ovarian function through drug therapy and surgery, assisted reproductive technology (ART), including in vitro fertilization (IVF), is also utilized. Hormonal therapies such as low-dose estrogen/progestin (LEP), progestins, and GnRH analogs are often the drug of choice. We presented that IAP (inhibitor of apoptotic protein) inhibitors can potentially be novel agents for treating endometriosis. Our studies using cultured cells derived from human endometriotic lesions and mouse models have revealed that inflammatory cytokines and antiapoptotic factors (IAPs) produced by peritoneal macrophages or endometriosis cells are crucial and that NF-κB (nuclear factor-kappa B) plays a central role in the pathogenesis of endometriosis. The high expression of IAPs in human endometriotic tissues, its facilitative role in ectopic survival, and the effect of IAPs on drug-resistant apoptosis of human endometriotic cells indicate its potential as a novel drug for IAP inhibitors. We found that the medicinal herb parthenolide and selective estrogen receptor modulators (SERM) can reduce lesions through NF-κB inhibition. Recently, new findings were obtained by non-invasive observation of early lesions using bioluminescence technology and by applying knockout mouse models. We will show the possibility of new therapeutic agents for endometriosis.

Distal versus conventional transradial access for coronary angiography: a pooled analysis from the randomized RAPID trial

Abstract Background Transradial access (TRA) is the recommended approach for coronary procedures considering safety benefits over femoral access with radial artery occlusion (RAO) being the most frequent complication. Although usually not clinically significant, the presence of RAO affects potential future procedures and medical treatments. Distal TRA (dTRA) has been suggested to reduce the risk of postprocedural RAO compared to conventional TRA (cTRA) with, however, inconsistent results in clinical trials. Purpose This study aimed to compare the efficacy and safety of dTRA versus cTRA in patients undergoing diagnostic coronary angiography. Methods The RAPID trial is a single-center, open-label, 2x2 factorial, randomized study of patients undergoing coronary angiography through a 6-F radial access. The trial was stopped early by the data and safety monitoring board after the second pre-planned interim analysis and inclusion of 600 participants. Patients were randomized to dTRA or cTRA with further stratification according to periprocedural heparin use and preexisting oral anticoagulation. The primary endpoints were the incidence of RAO assessed by vascular ultrasound and puncture-site related bleedings. Results The final study population consisted of 298 patients randomized to dTRA and 302 patients to cTRA. Periprocedural heparin was administered in 382 patients (63.7%) and percutaneous coronary intervention was performed in 161 cases (26.8%) without differences between the study groups (p=0.700 and p=0.465; respectively). Distal TRA was associated with a significantly increased number of puncture attempts (2.4 ± 2.0 versus 1.5 ± 1.2; p<0.001) and failed punctures leading to access site crossover (11.7% versus 5.0%; p=0.003). Consequently, the total procedure time was longer in the dTRA group (30 min versus 25 min; p=0.004) without increasing fluoroscopy time (p=0.320), dose area product (p=0.245), or contrast volume (p=0.884). Patent hemostasis was achieved in 91.7% of patients with cTRA. The rates of RAO (16.1% versus 15.6%, p=0.855) and puncture-site related bleedings (6.7% versus 8.3%; p=0.466) were similar in both groups. Conclusions According to this study, dTRA does not reduce the risk of RAO or bleeding events compared to cTRA.

Review of Current and Future Medical Treatments in Head and Neck Squamous Cell Carcinoma.

Head and neck squamous cell carcinoma (HNSCC) is a complex cancer requiring a multidisciplinary approach. For patients with locally or regionally advanced disease, surgery and/or radiation are the cornerstones of definitive treatment. Medical therapy plays an important adjunct role in this setting, typically consisting of a platinum-based regimen given as induction, concurrent, or adjuvant treatment. While relapsed/metastatic HNSCC has historically been a difficult-to-treat disease with poor outcomes, options have considerably improved with the incorporation of biologics and immune checkpoint inhibitors. Clinical trials are ongoing to investigate novel approaches, including new and combination immunotherapies, targeted therapies, therapeutic vaccines, antibody-drug conjugates, and cellular therapies. The results thus far have been mixed, highlighting the knowledge gaps that continue to challenge the medical oncologist treating HNSCC. Here, we present the most updated and broad review of the current treatment landscape in both locoregional and metastatic HNSCC and discuss the expansive future medical therapies under investigation.

A Mixed Methods Systematic Review of the Effectiveness, Acceptability, and Feasibility of Advanced Care Plans for Older Adults Without Life-Limiting Conditions

Context: Advance care planning (ACP) is a comprehensive procedure aimed at helping individuals understand and articulate their values, life goals, and preferences concerning future medical treatment. Despite extensive research on ACP in populations with terminal illnesses, dementia, and those in long-term care, there is a lack of focus on its impact among older adults without life-limiting conditions. Objectives: To investigate the effectiveness, acceptability, and feasibility of ACP for older adults without life-limiting conditions. Methods: We searched 11 electronic databases, spanning from inception to November 2023, complemented by extensive grey literature and reference searches. Rigorous quality assessments were conducted using the Mixed Methods Appraisal Tool (MMAT). Our approach adopted a dynamic convergent mixed-methods design, incorporating thematic and narrative synthesis. Findings: From over 12,600 citations, a total of 16 studies, comprising four randomised controlled trials (RCTs), nine qualitative studies, and three mixed methods studies met the inclusion criteria. Limited findings indicate that ACP interventions are generally effective in improving document completion rates and reducing hospital readmissions. Acceptability and feasibility of these interventions were high, although significantly influenced by cultural and religious factors. Limitations: Evidence supporting the effectiveness, acceptability, and feasibility of ACP in reducing unplanned hospital admissions in older adults without life-limiting conditions was limited. We excluded observations based on unwell older people, though some material with unclear distinctions may have been included. Quality assessments revealed that one of four RCTs had a high risk of bias, three had unclear risks; all nine qualitative studies had low risk; and one of three mixed methods studies had low risk while two had unclear risks. Implications: Further targeted research is necessary to assess the intervention’s value for this population. Rigorous real-world evidence studies involving older adults without life-limiting conditions and their proxies is crucial to enabling providers to tailor ACPs to diverse populations, whilst respecting individuals’ religious and cultural beliefs.

Advance Care Planning: A Retrospective Audit in a National Referral Center for Interstitial Lung Diseases.

Idiopathic and progressive pulmonary fibrosis (IPF/PPF) of known cause are relatively rare lung diseases with a limited survival time after diagnosis. Conscious attention for palliative care is recommended. Optimal care requires collaboration to define goals and preferences for future medical treatment and care with the patient and their families, to inform (or enable) Advance Care Planning (ACP). To get insight into the frequency of key elements of ACP described after dialogues with patients with IPF/PPF. A retrospective audit included charts of patients with IPF/PPF who died between December 2017 and December 2020. A data extraction model was developed based on a guideline for patient federation and wider literature and finally consisted of fourteen key elements. Subsequently content analysis was performed. The medical charts of 60 patients showed that an element of ACP was recorded in 57(95%) of cases. No medical chart contained all fourteen key elements of ACP. Most frequently recorded ACP elements were: knowledge of illness, goals of treatment and care and fears and concerns. The lack of structural implementation of ACP in the care for patients with interstitial lung disease, results in only some elements of ACP being dialogued by health care professionals (HCP). These notes recorded are often superficial and reflect the view of the HCP. Implementation of ACP conversations and structured documentation is needed to gain better insight into the wishes and preferences of the patient.

Definition and recommendations of advance care planning: A Delphi study in five Asian sectors.

In Confucian-influenced Asian societies, explicit end-of-life conversations are uncommon and family involvement in decision-making is crucial, which complicates the adoption of culturally sensitive advance care planning. To develop a consensus definition of advance care planning and provide recommendations for patient-centered and family-based initiatives in Asia. A five-round Delphi study was performed. The rating of a definition and 84 recommendations developed based on systematic reviews was performed by experts with clinical or research expertise using a 7-point Likert scale. A median = 1 and an inter-quartile range = 0-1 were considered very strong agreement and very strong consensus, respectively. The Delphi study was carried out by multidisciplinary experts on advance care planning in five Asian sectors (Hong Kong/Japan/Korea/Singapore/Taiwan). Seventy-seven of 115 (67%) experts rated the statements. Advance care planning is defined as "a process that enables individuals to identify their values, to define goals and preferences for future medical treatment and care, to discuss these values, goals, and preferences with family and/or other closely related persons, and health-care providers, and to record and review these preferences if appropriate." Recommendations in the domains of considerations for a person-centered and family-based approach, as well as elements, roles and tasks, timing for initiative, policy and regulation, and evaluations received high levels of agreement and consensus. Our definition and recommendations can guide practice, education, research, and policy-making in advance care planning for Asian populations. Our findings will aid future research in crafting culturally sensitive advance care planning interventions, ensuring Asians receive value-aligned care.

Advance Care Planning Practices For Nursing Home Residents Referred To Specialist Palliative Care In An Acute Hospital Setting

Abstract Background Advance care planning (ACP) is a structured process of discussion between patients, their loved ones and health care professionals, which aims to establish and record an individual’s goals and preferences for future medical treatment and care. It is of significant relevance to nursing home residents, a comorbid and frail population at high risk of clinical deterioration. Methods This prospective, observational study included all nursing home residents referred to an inpatient specialist palliative care (SPC) service in a model four hospital over a six-month period (November 2023 to May 2024). Basic clinical and demographic information as well as data on functional status and advance care planning was anonymised and collated using Microsoft excel. Results 36 patients (mean age 79 years) were recruited. 36% (n=13) were referred within 48 hours of admission. The average Australia-modified Karnofsky Performance Scale score was 40 on admission. 94% (n=34) had a clinical frailty score of ≥7 on admission. 72% (n=26) had an advance care plan in the nursing home. However, 22% (n=8) had not recorded their wishes pertaining to hospital readmission and 3 patients were admitted despite documenting a preference to remain in the nursing home. 53% (n=19) had not documented their preferred place for end-of-life care. 69% (n=25) died in hospital. Conclusion Most nursing home residents referred to the inpatient SPC team had severe frailty and died in hospital, reflecting the prognostic implications of severe frailty. Crucial components of the advance care plan were omitted in a significant proportion of patients, which may have influenced their referral to hospital. Provision of increased support to staff caring for older, frail adults in the residential care setting should be considered to enhance ACP.

Nurse-Led Advance Care Planning in Adults in the U.S.- A Scoping Review.

Advance care planning involves discussing individuals' future medical treatment and care preferences. Nurses, due to their close relationships with patients and families, may be well-positioned to lead these discussions. Exploring the components and characteristics of nurse-led ACP interventions is essential for enhancing their implementation, effectiveness, and sustainability. This scoping review aimed to explore the characteristics of nurse-led ACP interventions in adult patients, identify the populations and settings where these interventions have been utilized, and the outcomes of these interventions in the U.S. A scoping review was conducted following Arksey and O'Malley's five-stage framework. Using keywords related to nurse-led ACP interventions, a comprehensive search was performed across PubMed, Web of Science, CINAHL, EMBASE, and PsycINFO databases. Twelve studies met the inclusion criteria. These studies were conducted in varied settings. Registered nurses, oncology nurse navigators, and other specialized nurses primarily delivered nurse-led ACP interventions. The interventions ranged from one to two sessions and utilized various models and resources such as the Five Wishes and Respecting Choices. Nurse-led ACP interventions have shown significant positive outcomes, including increased engagement in ACP, improved attitudes towards ADs, higher completion rates of ADs, and enhanced patient-surrogate congruence. These interventions are well-received by patients and can be implemented in diverse settings. However, a general guideline regarding nurse-led ACP interventions is needed to address the specific duration, sessions, and mode of delivery required for their optimal effectiveness.

Implantable cardioverter defibrillator explantation upon patient request: Clinical and ethical considerations.

Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues. The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance. Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health. The paper debates the issues related to establishing a patient-physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non-maleficence, and the conflicts that sometimes arise between them. If a paternalistic approach in the patient-physician relationship evolves into a patient-centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals. The shared decision making (SDM) process and the use of pathology-specific decision aids are able to transform the informed consent tool, usually related to medical-legal issues, into an aid for true partnership between the patient and the medical care team.

Evaluation on PCOS in Hypothyroidism among Young Females in the Age Group of 18-25 Years: A Study from Tamilnadu, India

A multifactorial ailment, polycystic ovary syndrome, is typified by persistent anovulation along with indications of excess androgen without the presence of other particular diseases of the pituitary, thyroid, or adrenal glands that might cause comparable symptoms. Because polycystic ovarian syndrome is frequently accompanied by obesity, elevated insulin resistance and increased metabolic and cardiovascular risk factors are commonly linked to the condition. In Kulasekharam, Tamil Nadu, India, at the Sree Ramakrishna Medical College of Naturopathy and Yogic Sciences and Hospital, the study was conducted. Women who are between the ages of 18 and 25 are taking part in the research. After outlining the purpose of the study, verbal consent was obtained. This survey received 30 responses. There are thirty questions in the survey. The following subjects were included in the questionnaire's parameters: food, menstruation disorders, anxiety, hair care, and digestive problems. The study excluded female subjects who were unwilling or uncooperative. Most women are affected by polycystic ovarian syndrome. Their food is not well- balanced and healthy. Women also need to be better informed on the importance of maintaining good hygiene, eating a balanced diet, drinking enough water, and the dangers of junk food. They also need to learn more about gut dysbiosis and how to prevent exposure to environmental pollutants. Future medical treatments should concentrate on these areas in order to improve young women's general health and wellness.

Experiences with a national team-based learning program for advance care planning in pediatric palliative care

BackgroundAdvance Care Planning (ACP) enables patients and relatives to define and share values, goals and preferences for future medical treatment and care. The IMplementing Pediatric Advance Care Planning Toolkit (IMPACT), developed in the Netherlands, is a method for conducting ACP in pediatric palliative care. Healthcare professionals who were trained to use IMPACT, indicated their need for ongoing support to practice ACP communication skills optimally over time. Therefore, we developed a team-based learning program aimed at teaching participants how to transfer knowledge on ACP, continue practicing ACP communication skills and reflect on ACP conversations within their own team context. The aim of this study was to evaluate the program’s transfer of knowledge as well as the professionals’ experience and team reflection on ACP.MethodsA one-day IMPACT train-the-trainer course was developed and a selection of healthcare professionals (facilitators) from pediatric palliative care teams (PPCTs) from all seven Dutch university hospitals and the specialized Center for Pediatric Oncology were invited to participate. Hereafter, facilitators were asked to transfer their course-acquired knowledge to their team members (learners) by organizing two coaching-on-the-job sessions. A mixed-methods design, combining questionnaires and field notes, was used to evaluate the level of knowledge transfer and team reflection achieved.ResultsEighteen healthcare professionals in the role of facilitator participated in the train-the-trainer course. In seven PPCTs one (n = 3) or two (n = 4) coaching-on-the-job session(s) took place, attended by 29 and 17 learners, respectively. In the questionnaires, 11 facilitators indicated that they had to some extent transferred acquired knowledge to their team members as intended. Sixteen out of 21 learners who participated in at least one coaching-on-the-job session, reported (somewhat) increased self-confidence for conducting ACP conversations. The reported main strength of the program was practicing with/learning from colleagues whereas dealing with workload and variation in existing ACP skills within PPCTs need more attention.ConclusionsThe newly developed team-based learning program resulted in intended transfer of knowledge and methodical reflection on ACP in coaching-on-the-job sessions in most participating PPCTs. Planning coaching-on-the-job sessions regarding ACP in pediatric palliative care with multiple healthcare professionals is challenging and needs more emphasis in the training.

Proactive advance care planning conversations in general practice: a quality improvement project

Advance care planning (ACP) is a process of discussion, reflection and communication, enabling planning for future medical treatment. Despite evidence of benefits of ACP to patients, families and the healthcare...

Unveiling the Evolution of Virtual Reality in Medicine: A Bibliometric Analysis of Research Hotspots and Trends over the Past 12 Years.

Virtual reality (VR), widely used in the medical field, may affect future medical training and treatment. Therefore, this study examined VR's potential uses and research directions in medicine. Citation data were downloaded from the Web of Science Core Collection database (WoSCC) to evaluate VR in medicine in articles published between 1 January 2012 and 31 December 2023. These data were analyzed using CiteSpace 6.2. R2 software. Present limitations and future opportunities were summarized based on the data. A total of 2143 related publications from 86 countries and regions were analyzed. The country with the highest number of publications is the USA, with 461 articles. The University of London has the most publications among institutions, with 43 articles. The burst keywords represent the research frontier from 2020 to 2023, such as "task analysis", "deep learning", and "machine learning". The number of publications on VR applications in the medical field has been steadily increasing year by year. The USA is the leading country in this area, while the University of London stands out as the most published, and most influential institution. Currently, there is a strong focus on integrating VR and AI to address complex issues such as medical education and training, rehabilitation, and surgical navigation. Looking ahead, the future trend involves integrating VR, augmented reality (AR), and mixed reality (MR) with the Internet of Things (IoT), wireless sensor networks (WSNs), big data analysis (BDA), and cloud computing (CC) technologies to develop intelligent healthcare systems within hospitals or medical centers.

The application and significance of 3D printing technology in biomedicine

3D printing technology, also known as rapid prototyping technology, is an emerging production and manufacturing method. Medical researchers can create various medical devices for patients' bodies with greater accuracy by converting 3D digital graphics from computer-aided design into physical entities and printing 3D objects layer by layer. Thriving as medicine is, 3D printing, being a widely used and promising technology, will make significant contributions to the progress of biomedical science in multiple directions. The fundamental principle of this technology is akin to building blocks, where small parts are assembled into a comprehensive structure, utilizing materials such as plastic, metal, ceramics, etc. In the production of medical equipment under traditional manufacturing methods, a significant amount of manual debugging is sometimes necessary, which often results in the waste of considerable time and resources. Nonetheless, the manufacturing technique of 3D printing can rapidly and precisely create intricate instruments, as well as produce implants or tissue models. The main focus of this article is to analyze recent progress, applications and restriction prospects of 3D printing in medical applications. The advancement that 3D technology gains across different domains and levels is poised to significantly influence future medical treatment. The significance is to clarify the application and significance of 3D printing technology in the biomedical field. Through the review and analysis of relevant literature, a comprehensive understanding of the research progress and existing problems on 3D printing in the biomedical domain be gained, providing references and inspiration for future research.

Prevalence of Staphylococcus aureus and Enterococcus sp. Among Pregnant Women Attending General Hospitals in Delta Central Senatorial District, Nigeria

This study aimed to assess the prevalence of Staphylococcus aureus and Enterococcus sp. among pregnant women who visit the General Hospital in Delta Central Senatorial District, Nigeria. Samples were collected from the vaginal and rectum areas of pregnant women attending the General Hospitals of Abraka, Oghara, Udu, Ughelli North and Ughelli South. Bacteriological and biochemical analyses were conducted to isolate, characterize, and identify the bacteria. Two types of bacteria were found; Enterococcus sp. and Staphylococcus sp. The study result showed that Staphylococcus aureus (13.7%) was more prevalent than other isolates and was found in samples obtained from Udu General Hospital. In comparison, Ughelli South General Hospital had the lowest prevalence for S. aureus (7.9%). Samples from Oghara General Hospital had the highest prevalence for Enterococcus sp. (3.7%) while the lowest prevalence for Enterococcus sp. (1.1%) was obtained from Ughelli South General Hospital. S. aureus (51.6%) was found to be the most prevalent bacterium, while Enterococcus sp. (11.1%) was the least prevalent. The bacterial load from the vaginal swab samples was higher than that of rectum swab samples, which suggests that pregnant women attending these hospitals may have infections. The total bacterial count among pregnant women was highest in samples obtained from Udu General Hospital (5.4±0.5), followed by Abraka (5.0±0.6), Oghara (4.8±0.2), and Ughelli North (4.5±0.15), and while the least count was recorded from samples obtained from Ughelli South General Hospital (3.0±0.2). This study helps manage and plan future medical treatments. Pregnant women should be screened early in their pregnancies, between the 12th and 16th weeks, which is the second trimester, and treated appropriately to avoid complications that arise from untreated infections. 
 Keywords: Prevalence, vaginal, pregnancy, women, infection

Rights of the Child or Parental Authority in Children’s Medical Treatment Cases?

Recent cases concerned with the future medical treatment of a child with a life-limiting condition have presented, on appeal, the argument that the threshold for intervention in a parental decision about the child’s medical treatment should be significant harm rather than best interests. The basis of the claim is that parents know their child best and, consequently, should have the right or authority to make decisions about their child’s future. Although unsuccessful before the courts, these legal arguments have inspired the inclusion of provisions in Bills before Parliament aimed at enhancing parental authority in such cases. This article examines this modern reincarnation of the claim to parental authority, in the context of the medical treatment of a seriously ill child. It argues that reform of the law to re-assert parental authority would be a seriously retrograde development—a contemporary conservative reformulation of the child as object—which would significantly erode the rights of the child. Rather, it is argued that the child should be at the centre of the shared care of parents and professionals focused upon the individual child’s needs, interests and rights. This article concludes with a fictional account of an attempt to reform the law to place the interests, rights and voice of the child at the centre of determination of their future medical treatment. Keywords: children’s interests, rights and voice; parental authority; children’s medical treatment; best interests or significant harm threshold.

The trajectory of prognostic cognition in patients with advanced cancer: is the traditional advance care planning approach desirable for patients?

Most patients with advanced cancer initially express a desire to be informed of their prognosis, and prognostic discussions between patients and their oncologists can trigger the subsequent trajectory of prognostic cognitions. On the continuum of prognostic cognition, including inaccurate/accurate prognostic awareness (awareness of incurability of cancer, terminal nature of illness or life expectancy) and prognostic acceptance (accepting one's prognosis), patients' perceptions of being informed of their prognosis by oncologists and patients' coping strategy for serious medical conditions regulate prognostic cognitions. However, nearly half of the patients with advanced cancer have poor prognostic awareness, and few patients achieve prognostic acceptance. These phenomena partly act as barriers to participation in advance care planning. When oncologists engage in advance care planning conversations, they must assess the patient's prognostic cognition and readiness for advance care planning. Considering the inaccurate prognostic awareness in a non-negligible proportion of patients and that astatic patients' preferences for future treatment and care are influenced by prognostic cognition, more research on decision-making support processes for high-quality and goal-concordant end-of-life care is needed along with research of advance care planning. In addition to making decisions regarding future medical treatment and care, oncologists must engage in continuous and dynamic goal-of-care conversations with empathic communication skills and compassion from diagnosis to end-of-life care.

Expert consensus on Prospective Precision Diagnosis and Treatment Strategies for Osteoporotic Fractures.

Osteoporotic fractures are the most severe complications of osteoporosis, characterized by poor bone quality, difficult realignment and fixation, slow fracture healing, and a high risk of recurrence. Clinically managing these fractures is relatively challenging, and in the context of rapid aging, they pose significant social hazards. The rapid advancement of disciplines such as biophysics and biochemistry brings new opportunities for future medical diagnosis and treatment. However, there has been limited attention to precision diagnosis and treatment strategies for osteoporotic fractures both domestically and internationally. In response to this, the Chinese Medical Association Orthopaedic Branch Youth Osteoporosis Group, Chinese Geriatrics Society Geriatric Orthopaedics Committee, Chinese Medical Doctor Association Orthopaedic Physicians Branch Youth Committee Osteoporosis Group, and Shanghai Association of Integrated Traditional Chinese and Western Medicine Osteoporosis Professional Committee have collaborated to develop this consensus. It aims to elucidate emerging technologies that may play a pivotal role in both diagnosis and treatment, advocating for clinicians to embrace interdisciplinary approaches and incorporate these new technologies into their practice. Ultimately, the goal is to improve the prognosis and quality of life for elderly patients with osteoporotic fractures.

의료관광만족도 확대를 위한 시설입지 요인 분석

As the competition for survival of medical institutions is rapidly changing due to the expansion and expansion of large medical institutions and the entry of foreign medical institutions into Korea, it is urgently needed to strategically respond to the importance of medical management to secure differentiated competitiveness. Therefore, as a management strategy in medical services, domestic medical institutions have been carrying out activities in various ways in order to measure physical service factors, medical service factors and patient satisfaction.
 In this study, the following conclusions were drawn based on the results of the patients who had been hospitalized using a medical institution. First, the design, cleanliness, convenience, provision and use of medical institutions were analyzed to improve patient satisfaction. Second, medical services were analyzed to increase patient satisfaction. Third, it was analyzed that the patient 's satisfaction is higher due to the physical service and medical service of the medical institution. As a result, we have focused on the physical service factors of medical institutions as a marketing strategy to increase patient satisfaction of medical institutions. However, recent patients can be found to be more satisfied with patients' services than physical services. It is expected that the satisfaction of the patients will be higher if the service of the medical personnel is increased during the future medical treatment.

Impact of Paternal Age on Reproduction

The increase in the age of life, the delay in the age of marriage and the increase in income, the increase in living standards lead to the delay in the time of childbearing age, and therefore, the long-term impact of male age on the children born to the development is affected by certain molecular biochemical diagnostic tools trapped by the authoritative information at the front end with the advancement of science and technology, so that we understand the impact of aging on men from deep fascial cells and mutations in chromosomal genes caused by mental maturation. The offspring affected by the long-term genetic diseases, such as the Y chromosome, epigenetic or genetic de-novo mutation can lead to changes after pregnancy, such as premature birth, miscarriage, stillbirth, and underweight children, as well as genetic diseases such as bone underdevelopment and blood disorders such as acute leukemia because of the father’s age. As for the development of the central nervous system, as for the behaviour, it may lead to an increase in the proportion of schizophrenia, affective psychosis, and an increase in the proportion of autism, which may be that we will do large-scale research in the future, and use animal experiments or molecular biology and chemistry to confirm his rapid turn and understand the cause of his actual illness, as a future medical policy and male infertility treatment, as well as some important theoretical basis and basis for consultation in our infertility clinic.