Medical Research Articles

Applications and Concerns of ChatGPT and Other Conversational Large Language Models in Health Care: Systematic Review

Background The launch of ChatGPT (OpenAI) in November 2022 attracted public attention and academic interest to large language models (LLMs), facilitating the emergence of many other innovative LLMs. These LLMs have been applied in various fields, including health care. Numerous studies have since been conducted regarding how to use state-of-the-art LLMs in health-related scenarios. Objective This review aims to summarize applications of and concerns regarding conversational LLMs in health care and provide an agenda for future research in this field. Methods We used PubMed, ACM, and the IEEE digital libraries as primary sources for this review. We followed the guidance of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) to screen and select peer-reviewed research articles that (1) were related to health care applications and conversational LLMs and (2) were published before September 1, 2023, the date when we started paper collection. We investigated these papers and classified them according to their applications and concerns. Results Our search initially identified 820 papers according to targeted keywords, out of which 65 (7.9%) papers met our criteria and were included in the review. The most popular conversational LLM was ChatGPT (60/65, 92% of papers), followed by Bard (Google LLC; 1/65, 2% of papers), LLaMA (Meta; 1/65, 2% of papers), and other LLMs (6/65, 9% papers). These papers were classified into four categories of applications: (1) summarization, (2) medical knowledge inquiry, (3) prediction (eg, diagnosis, treatment recommendation, and drug synergy), and (4) administration (eg, documentation and information collection), and four categories of concerns: (1) reliability (eg, training data quality, accuracy, interpretability, and consistency in responses), (2) bias, (3) privacy, and (4) public acceptability. There were 49 (75%) papers using LLMs for either summarization or medical knowledge inquiry, or both, and there are 58 (89%) papers expressing concerns about either reliability or bias, or both. We found that conversational LLMs exhibited promising results in summarization and providing general medical knowledge to patients with a relatively high accuracy. However, conversational LLMs such as ChatGPT are not always able to provide reliable answers to complex health-related tasks (eg, diagnosis) that require specialized domain expertise. While bias or privacy issues are often noted as concerns, no experiments in our reviewed papers thoughtfully examined how conversational LLMs lead to these issues in health care research. Conclusions Future studies should focus on improving the reliability of LLM applications in complex health-related tasks, as well as investigating the mechanisms of how LLM applications bring bias and privacy issues. Considering the vast accessibility of LLMs, legal, social, and technical efforts are all needed to address concerns about LLMs to promote, improve, and regularize the application of LLMs in health care.

Addressing diagnostic delays in inflammatory bowel diseases in Germany

Inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis, are chronic inflammatory conditions of the gastrointestinal tract that necessitate timely diagnosis to prevent complications and improve patient outcomes. Despite advancements in medical knowledge and diagnostic techniques, significant diagnostic delays persist, particularly in CD. The study by Blüthner et al , published in the World Journal of Gastroenterology , elucidates the diagnostic delays experienced by German patients with IBD and identifies key risk factors contributing to these delays.

A Comparative, Individual Values-Based Scoring Approach to the Secure Flourish Index Among Clinical Health Professions Students

Abstract Purpose The purpose of this study was to investigate flourishing among medical (MD), physician assistant (PA), and nurse practitioner (NP) students, using the novel Secure Flourish Index (SFI). Method MD, PA, and NP students from two institutions completed the traditional SFI (tSFI), then applied a percentage weight to each of the six domains (maximum total 100%) based on perceived relative importance to their overall flourishing, creating a novel self-weighted SFI score (swSFI). The Bland–Altman (BA) plot was used to assess the magnitude of agreement between scores. Results The BA plot (n = 281) revealed a mean bias of .07(95% CI -.50,.63). Eighteen participants (6.4%) fell outside of the calculated BA limits of agreement [-9.31 [95% CI - 10.27,-8.45] and 9.45 [95% CI 8.49,10.41]]. Linear regression revealed the mean BA score is predictive of the mean difference between scores [R2 = 0.07, F(1,280) = 21.1, p < .001] indicating bias in agreement between the scoring systems as mean flourishing score changes. Conclusion Accounting for individual values is important when measuring student flourishing but is missing from current operant definitions. The overall mean difference (bias) in tSFI and swSFI scores is minimal (.07, possible range 0–120). However, the bias becomes larger as individual mean flourishing scores move towards both the high and low ends of the flourishing spectrum. This indicates that the influence of weighting flourishing domains is larger for individuals with high or low flourishing than those with moderate flourishing.

Conjugation mediates large-scale chromosomal transfer in Streptomyces driving diversification of antibiotic biosynthetic gene clusters.

Streptomyces are ubiquitous soil dwelling bacteria with large, linear genomes that are of special importance as a source of metabolites used in human and veterinary medicine, agronomy and industry. Conjugative elements (Actinomycetes Integrative and Conjugative Elements, AICEs) are the main drivers of Streptomyces Horizontal Gene Transfer. AICE transfer has long been known to be accompanied by mobilization of chromosomal DNA. However, the magnitude of DNA transfer, or the localization of acquired DNA across their linear chromosome, has remained undetermined. We here show that conjugative crossings in sympatric strains of Streptomyces result in the large-scale, genome-wide distributed replacement of up to one third of the recipient chromosome, a phenomenon for which we propose the name 'Streptomyces Chromosomal Transfer' (SCT). Such chromosome blending results in the acquisition, loss and hybridization of Specialized Metabolite Biosynthetic Gene Clusters, leading to a novel metabolic arsenal in exconjugant offspring. Harnessing conjugation-mediated SMBGC diversification holds great promise in the discovery of new bioactive compounds including antibiotics.

Voice or text? The role of physician media choice on patient experience in online medical communities

AbstractOnline medical communities (OMCs) are a type of online healthcare, in which physician‐patient interaction can be comprised of a variety of media options such as pictures, text, and voice. These media formats are often used to create a personalized patient experience in AI‐driven conversational healthcare platforms. To explore how physician media usage affects patient experience, we propose a counterfactual causal inference model using AI‐driven data mining methods on 131,083 online consultation records and 7,666,111 messages sent by physicians from one of the largest OMCs in China. Our study reveals the negative impact of physician use of voice on patient experience, compared to text. Drawing upon social support theory, we identify the mechanism by which physician media usage for voice produces a negative effect. The findings indicate that the negative effect of physicians' voice‐media usage occurs mainly in low‐risk disease conditions, by weakening the role of professional and emotional support. In contrast, in high‐risk disease conditions, voice‐media usage strengthens the role of professional and emotional support in improving the patient's experience. Our study is one of the first to focus on the social support attributes of the different media formats used in OMCs. We use advanced AI text‐analysis algorithms to extract features related to social support in physician‐patient conversations, and thus contribute to the use of AI in feature extraction for research.

Conflicting interpretations and FDA reputation: the case of post-market surveillance of breast implants

Conflicting interpretations regarding the severity of the adverse effects associated with FDA-approved drugs and therapies are common among the United States Food and Drug Administration (FDA), the medical community, patients, and the general public. However, scholars have paid little attention to how these conflicting interpretations may affect the FDA’s reputation for facilitating inclusive dialogue between competing policy actors. Focusing on breast implants, a medical device characterized by a stormy regulatory past, we observe that the design properties of post-market surveillance are adjusted to low-quality information. Such information-gathering mechanisms likely lead to underreporting by medical practitioners and patients, thus resulting in low-quality data. Given that the FDA cannot rely on congressional appropriations to ensure a stable flow of funding, the confusion and uncertainty created by conflicting interpretations enhance the FDA’s ability to appeal to different audiences simultaneously and thereby secure funding from industry-based user fees. This strategy may persist until the FDA’s reputation is challenged by critical information regarding adverse effects and the ensuing potentially negative media coverage. A stable appropriation-based funding model will likely encourage stronger post-market surveillance of medical devices.

Chemical analysis and concentrations of cannabidiol substances used for refractory epilepsy in Chilean patients. An underestimated worldwide risk.

The purpose of this study is to analyze composition of HMS (homemade CBD), NLS (non-licensed commercial products), and bioequivalent CBD (BES) collected from Chilean patients that voluntary accepted to analyze the "CBD-substance." Samples were collected through an open invitation for different patients to anonymously and free of charge participate in the analysis of CBD oil. The analysis of the active principle was performed using High-Resolution Liquid Chromatography (HPLC). A total of 35 samples were collected between March 2020 and September 2021, including two BES, six NLS, and 27 HMS products. The BES had an average CBD concentration of 89.15 mg/mL and an average THC concentration of 0.015 mg/mL, which complied with the maximum THC levels required by regulatory authorities (<0.2% THC.). The NLS (six samples) exhibited significant variability in CBD concentrations, ranging from a maximum of 78.5 mg/mL to a minimum of 0.1 mg/mL, with an average of 25.41 mg/mL. The THC concentrations ranged from 0 mg/mL to 2.43 mg/mL with an average of 0.62 mg/mL. The HMS products exhibited even higher variations of CBD concentrations, ranging from 0 to a maximum of 6.6 mg/mL. THC concentrations were even more variable, ranging from 0 mg/mL to 388 mg/mL. The medical community and patients involved should be aware that Hemp products are not pure and/or innocuous. HMS are likely to have high levels of THC and very low CBD, far away from therapeutic doses of CBD. CBD used in epilepsy should be restricted to licensed products, especially in children where THC toxicity is much more harmful. The study analyzed three types of CBD (cannabidiol) oils: homemade, non-licensed, and bioequivalent. Homemade and non-licensed products showed nonacceptable variance of CBD and THC concentration (tetrahydrocannabinol), in some cases with 0 mgs of CBD and many beyond THC maximum accepted. The THC is another component found in cannabis and is responsible for the neurotoxic effects. Only bioequivalent products showed concentrations of CBD and THC acceptable for epilepsy treatment, therefore are the only products recommended for such purpose.

The impact of using bee pollen in poultry systems

The use of antibiotic growth promoters in poultry production has resulted in the development of drug resistance, and destruction of the normal beneficial intestinal flora. Therefore, the task of poultry industry is to find alternative solutions to ensure safe products. The aim of this review article was to understand the potential use of bee pollen in poultry production system regarding its impact on performance, carcass traits, immunity, bacterial community, and blood parameters. Bee products such as pollen have been used in traditional medicine and have recently appeared as possible feed additives. Bee pollen is considered the most important substance in the hive, as a basic feed for bees. It consists of a mixture of proteins, amino acids, fats, carbohydrates, and multiple vitamins, minerals, and enzymes. The chemical composition of bee pollen depends mainly on the plant species, geographic region, and season of collection. Bee pollen has many uses in human medicine and livestock production. It has been used to improve general health, and may also act as an antibacterial, antifungal, antioxidant, anti-radiation, anti-carcinogenic, anti-inflammatory, hepato- and cardio-protective, and antidiabetic. Dietary supplementation of bee pollen could increase performance parameters as a growth promotor, enhancing carcass quality. In addition, bee pollen can enhance the immune response, reduce the pathogenic bacterial count, and enhance important blood parameters.

Evaluations of State Medical Cannabis Programs in the US: A Narrative Review

Background: Medical cannabis (MC) use is increasing across the US, with functional MC programs now operating in 38 states. While program policies and practices vary widely, little is known about whether and how states evaluate their programs. Better characterization of state MC program evaluation to date could inform states, program officials, and providers about best practices and provide a roadmap for future program evaluation. Summary: We conducted a narrative review of state MC program evaluations, including peer-reviewed literature and reports produced by independent state-based and non-state-based evaluators. Among 304 abstracts initially screened, seven evaluations met inclusion criteria. Within these evaluations, we report results according to three overarching themes: 1) evaluation characteristics, including comparison across evaluations; 2) program experience, including perceptions of providers and patients; and 3) assessment of cannabis use, including self-reported efficacy for qualifying medical conditions, patterns of medical and nonmedical cannabis use, and assessment of risk factors relevant to MC use. Additionally, we found that while goals and methods for state MC evaluations varied widely, evaluations that relied on independent, non-state entities tended to have more comprehensive and quantitatively rigorous results. Key Messages: Few states operating MC programs have completed a formal evaluation of their program. Among states that have completed an evaluation, approaches varied widely; however, common themes were also present, which may inform future state evaluation efforts. Evaluation through independent, non-state partners may provide an optimal strategy to ensure high-quality data and meaningful results.

Lifetime prevalence of questionable health behaviors and their psychological roots: A preregistered nationally representative survey.

A growing body of evidence suggests that questionable health behaviors- not following medical recommendations and resorting to non-evidence based treatments-are more frequent than previously thought, and that they seem to have strong psychological roots. We thus aimed to: 1) document the lifetime prevalence of intentional non-adherence to medical recommendations (iNAR) and use of traditional, complementary and alternative medicine (TCAM) in Serbia and 2) understand how they relate to 'distal' psychological factors-personality traits and thinking dispositions, and 'proximal' factors-a set of beliefs and cognitive biases under the term 'irrational mindset'. In this preregistered cross-sectional study on a nationally representative sample (N = 1003), we observed high lifetime prevalence of iNAR (91.3%) and TCAM (99.2%). Irrational beliefs, especially magical health beliefs and medical conspiracy theories, were the strongest predictors of TCAM. They also mediated the relation between Disintegration/lower cognitive reflectiveness and TCAM. High Disintegration, and low Conscientiousness predicted iNAR directly, whilst negative experiences with the healthcare system facilitated both types of questionable health practices. The established psychological profile of people prone to questionable health behaviors and the fact they can be tracked to negative experiences with the system can be used to tailor public health communications.

Medical Lysenkoism.

Medicine is a compound field composed of science and art. The (necessary) degree to which the latter is involved opens medicine, in particular, to the introduction of ideas which do not, by their very nature, submit to confirmation or confutation as do the various methods of traditional science. This paper explores several ways in which a Lysenkoistic ideology can be interjected into medicine changing the manner in which it interacts with both patients and society. Simply, when ideology supersedes evidence the edifice of Western Medicine comes under direct threat. The exploration of this emerging ideological transition in medicine, and science more broadly, is of critical importance to determine the most salutary path forward.

Nutri-Score : what can we tell patients about this current scientific topic?

Issues such as the Nutri-score is regularly in the media spotlight like those of PFAS and 5G which are discussed in a second article. The model of the physician possessing all medical knowledge is evolving. Patients now come to consultations with information from a variety of sources, some of which are exhaustive, some of which are not. How can we keep our knowledge up to date on recent scientific topics that are regularly in the spotlight and evolving? Where can we, as a healthcare professionals, find reliable, up-to-date information to discuss the subject during the consultation? This article summarizes information from a variety of solid sources, which we hope will serve as a knowledge base for your discussions.

PFAS and 5G: what can we tell patients about these two current scientific topics?

Issues such as PFAS and 5G are regularly in the media spotlight like this of Nutri-Score which is discussed in a second article. The model of the physician possessing all medical knowledge is evolving. Patients now come to consultations with information from a variety of sources, some of which are exhaustive, some of which are not. How can we keep our knowledge up to date on recent scientific topics that are regularly in the spotlight and evolving? Where can we, as a healthcare professionals, find reliable, up-to-date information to discuss the subject during the consultation? This article summarizes information from a variety of solid sources, which we hope will serve as a knowledge base for your discussions.

Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis.

Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals' cultural, social, and personal backgrounds, further complicating efforts to combat its spread. This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Over 35.61% (1740/4959) of respondents reported encountering "a lot" of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing "some" amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ≥75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions.

Atrial fibrillation – a comparative review of one of the most common arrhythmias in dogs and humans

Atrial fibrillation is the most prevalent arrythmia in dogs and humans and is characterised by chaotic depolarisation of the atria, resulting in damage to the atrial myocardium. It can lead to heart failure or worsen an existing condition and cause sudden death. Electrocardiographically, atrial fibrillation is characterised by the absence of P waves and an irregularly irregular rhythm, with narrow QRS complexes. Treatment of atrial fibrillation requires knowledge of pathophysiology and the pharmacology of antiarrhythmic drugs. In contrast to human medicine, the treatment of dogs revolves mainly around rate control strategies, although new studies propose the consideration of several rhythm strategies. Considering the complexity of atrial fibrillation, there is strong need for a consensus on classification, diagnosis and treatment in dogs.

Herbal medicine use in patients seeking treatment in emergency departments

To ascertain the extent of toxicological profiles around their medical use, herbal medicine use problems need to be consistently traced for consumer safety. Medical information regarding botanical use in various diseases or disorders, as well as adverse/toxicological effects of the botanicals, was sourced from scientific databases. Patients who request medical care at hospitals may be using at least one formulation of botanicals at the time of the visit, and some of the used medicinal plant products possess the potential to be the cause of toxicity as well as herb–conventional drug interactions. Emergency healthcare providers must be aware of some potential adverse events that may be seen in admitted emergency department patients when the herbal medicine is used alone or concomitantly with conventional medicine. Moreover, emergency healthcare providers must be knowledgeable of herbal medicine practices to ensure that optimal treatments will be selected for these patients.

CRISPR Technology Acts as a Dual-Purpose Tool in Pig Breeding: Enhancing Both Agricultural Productivity and Biomedical Applications

Pigs have long been integral to human society for their roles in agriculture and medicine. Consequently, there is an urgent need for genetic improvement of pigs to meet human dual needs for medicine and food. In agriculture, gene editing can improve productivity traits, such as growth rate and disease resistance, which could lower farming costs and benefit consumers through enhanced meat quality. In biomedical research, gene-edited pigs offer invaluable resources as disease models and in xenotransplantation, providing organs compatible with human physiology. Currently, with CRISPR technology, especially the CRISPR/Cas9 system emerging as a transformative force in modern genetics, pigs are not only sources of sustenance but also cornerstones of biomedical innovation. This review aims to summarize the applications of CRISPR/Cas9 technology in developing pigs that serve dual roles in agriculture and biomedical applications. Compared to ZFNs and TALENs, the CRISPR/Cas9 system offers several advantages, including higher efficiency, greater specificity, ease of design and implementation, and the capability to target multiple genes simultaneously, significantly streamlining the process of genetic modifications in complex genomes. Therefore, CRISPR technology supports the enhancement of traits beneficial for agricultural productivity and facilitates applications in medicine. Furthermore, we must acknowledge the inherent deficiencies and technical challenges of the CRISPR/Cas9 technology while also anticipating emerging technologies poised to surpass CRISPR/Cas9 as the next milestones in gene editing. We hypothesize that with the continuous advancements in gene editing technologies and successful integration of traits beneficial to both agricultural productivity and medical applications, the goal of developing dual-purpose pigs for both agricultural and medical use can ultimately be achieved.

A critical comparative study of the performance of three AI-assisted programs for bone age determination.

To date, AI-supported programs for bone age (BA) determination for medical use in Europe have almost only been validated separately, according to Greulich and Pyle (G&P). Therefore, the current study aimed to compare the performance of three programs, namely BoneXpert, PANDA, and BoneView, on a single Central European population. For this retrospective study, hand radiographs of 306 children aged 1-18 years, stratified by gender and age, were included. A subgroup consisting of the age group accounting for 90% of examinations in clinical practice was formed. The G&P BA was estimated by three human experts-as ground truth-and three AI-supported programs. The mean absolute deviation, the root mean squared error (RMSE), and dropouts by the AI were calculated. The correlation between all programs and the ground truth was prominent (R2 ≥ 0.98). In the total group, BoneXpert had a lower RMSE than BoneView and PANDA (0.62 vs. 0.65 and 0.75 years) with a dropout rate of 2.3%, 20.3% and 0%, respectively. In the subgroup, there was less difference in RMSE (0.66 vs. 0.68 and 0.65 years, max. 4% dropouts). The standard deviation between the AI readers was lower than that between the human readers (0.54 vs. 0.62 years, p < 0.01). All three AI programs predict BA after G&P in the main age range with similar high reliability. Differences arise at the boundaries of childhood. Question There is a lack of comparative, independent validation for artificial intelligence-based bone age estimation in children. Findings Three commercially available programs estimate bone age after Greulich and Pyle with similarly high reliability in a central European cohort. Clinical relevance The comparative study will help the reader choose a software for bone age estimation approved for the European market depending on the targeted age group and economic considerations.

Economic analysis of implementing Systemic Coronary Risk Estimation (SCORE2) scale and long-term consequences

Objective: to assess the demand for pharmacotherapy in risk groups on adverse cardiovascular (CV) events identified during prophylactic medical examination of the adult population according to the SCORE2 (Systemic Coronary Risk Estimation) scale, which is being introduced into clinical practice.Material and methods. To analyze the economic consequences of including diagnostic examinations to assess the risk by SCORE and SCORE2 scales, a Markov model was developed, which described the course of lipid metabolism disorders in adult patients aged 40 to 69 years without concomitant diseases identified during prophylactic medical examination. The model cycle was 2 months (the average waiting time for response to therapy); the modeling horizon was 3 years; the calculated values were estimated for the period 2024–2026. The economic analysis of long-term consequences involved calculating the cost of pharmacotherapy and the costs associated with CV events at outpatient and inpatient stages of medical care. The costs of drug therapy were determined based on dosage regimens presented in instructions for medical use in Russia, and clinical guidelines.Results. According to the modeling results, in the period 2024–2026, the administration of pharmacotherapy to reduce the risks of CV events will enable to achieve 23,224 potentially saved lives through exclusively government funding or 23,605 through mixed sources of funding (government and citizens’ own funds). The cost of the analyzed pharmacotherapy upon the introduction of the SCORE2 scale will be from 50.18 billion rubles (with government funding) to 318.14 billion rubles. Concurrently, pharmacocorrection will provide a reduction in the costs of inpatient treatment and outpatient medical services to 4.1 billion rubles due to the achieving of intended low-density lipoprotein level, and 1.6 billion rubles due to the achieving of intended triglyceride levels.Conclusion. Using new SCORE2 scale may lead to changes in the practice of prescribing lipid-lowering prophylaxis of CV diseases, as well as to a sharp increase in the number of patients who may require earlier prescription of pharmacotherapy to prevent CV events.

The Prospects for Nursing in Japan That Integrates Conventional Medicine and Chinese Medicine.

The Prospects for Nursing in Japan That Integrates Conventional Medicine and Chinese Medicine.