Medical Evidence Research Articles

What You May Have Missed in 2023: Keeping Up With the Constant Flow of New Medical Evidence.

What You May Have Missed in 2023: Keeping Up With the Constant Flow of New Medical Evidence.

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

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

Image Processing in MATLAB Enhancement, Encryption and Decryption

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

Leveraging generative AI for clinical evidence synthesis needs to ensure trustworthiness

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

Exploring delusional parasitosis – a case series of three patients

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

The clinical use of cannabinoids for pain

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

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

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

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

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

The Subjective Interpretation of the Medical Evidence

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

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

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

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

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

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

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

‘A System Only to Be Defended on the Principle of Positive and Ascertained Necessity’: Quarantine and Thomas Maitland’s Contribution to the Medical Debates of 1819 and 1824

Summary This article focusses on the ‘plague debates’ which took place in the British parliament in 1819 and 1824, where the opinions of non-medical experts were also taken into account; particularly those of officials who had acquired relevant practical experience. Such opinions were crucial in politicising the medical debate from one of the nature of plagues, towards an evaluation of the impact of quarantine more broadly. Paying closer attention at the correspondence between the colonial governor of Malta and the Ionian Islands, and the colonial secretary, it reveals a different aspect of the contagion inquiry in Britain—one considering medical knowledge about plagues that was highly speculative. While most historical works illuminate the establishment of what was considered to be medical evidence, there is less work about the political, economic or even personal motives which underlined interventions in these debates.

Men after the sexual assault: The journey from medical service to court

BackgroundThere may be significant physical and psychological consequences and impacts for males who experience sexual assault as adults, however, published literature in this context is sparse, specifically for the investigative outcomes in the criminal legal process. MethodThis clinical audit tracked 138 adult males who presented for forensic and medical sexual assault care from initial presentation to ACT Police investigation and court outcome from 2004 to 2022. ResultsThere were 103/138 (74.6%) males who attended for medical and forensic care within 72 h of the reported assault. Pre-existing mental health conditions were self-reported in 59/138 (42.7%) males.Nearly half of males 67/138 (48.5%) had a medical evidence kit collected. Males presenting for medical care 44/138 (31.2%) went on to report to ACT Policing, 36/44 (81.2%) of cases did not proceed to court. The most common clearance type was inadequate evidence to proceed (17/44, 38.6%).In 8/44 (18.2%) of adult male cases who subsequently reported to ACT Police, the investigation resulted in entry to the judicial process with a suspect charged with a sexual offence. Five of those cases resulting in a conviction. ConclusionsMany adult male patients presented within timeframes that enabled the provision of time critical medical care and provided an opportunity for forensic medical evidence collection. Many adult males 59 (42.7%) self-reported pre-existing mental health conditions upon initial presentation.Attrition occurred throughout the patient journey with many males not reporting to police and thus not presenting in the legal process. This further emphasises the need for independent sexual violence patient advisors to support adult male victims through the medical and criminal justice process.

[Guidelines for clinical application of micronutrients in Chinese adult patients (2024 edition)].

Micronutrients, including trace elements and vitamins, are essential nutrients in human metabolism. The majority of patients who need nutritional therapy have different levels of micronutrient deficiency for various reasons, which can lead to disease progression and affect clinical outcomes. In order to further standardize the application of micronutrients in medical nutrition therapy, nearly 100 experts in related fields were organized by the Chinese Society of Parenteral and Enteral Nutrition (CSPEN) to elaborate on the role and dosage of micronutrients based on the existing evidence-based medical evidence in common clinical conditions such as severe illness, surgery, burns, inflammatory bowel disease, short bowel disease, malignant tumors, chronic liver and kidney disease, elderly comorbidity, weight loss and chronic infection. Finally, 13 questions and 30 recommendations were put forward to provide reference for clinical standard application of parenteral and enteral nutrition in adult patients.

Autonomy and Its Limits

Photo ID 277640924© Dizain777 | Dreamstime.com INTRODUCTION Medicine is intertwined with promotion of positive health while prioritizing a patient’s diagnosis, prognosis, and treatment. The prioritization of a patient’s needs stems from a branch of morality called biomedical ethics, which focuses on moral principles that arise in healthcare, medical research.[1] Biomedical ethics serves to provide a framework for addressing complex medical questions while safeguarding the rights, dignity, and well-being of individuals.1 Often times in healthcare, decisions made by physicians and patients result in beneficence and/or maleficence. Beneficence implies that healthcare professionals and institutions have a moral duty to act in a patient’s best interest by providing positive health outcomes while minimizing harm (maleficence).1 As a result of biomedical ethics’ emphasis on beneficence and maleficence, healthcare is designed to respect a patient’s needs, beliefs, and decisions. The practice of allowing patients to make their own medical decisions is called autonomy, and it is vital to biomedical ethics because it emphasizes the concerns of the patient.[2] However, it is difficult to ensure that a person has autonomy over their medical decision-making if they are not fully informed about the circumstances of their health or treatment options. ANALYSIS Thus, an important aspect of biomedical ethics is informed consent. Informed consent is a practice in healthcare and research where individuals must voluntarily agree to or decline medical care after being educated about their medical condition.[3] Informed consent protects an individual’s right to express their beliefs and make educated decisions about their health. Furthermore, there is an important distinction to be made between voluntary consent and informed consent. While informed consent emphasizes that individuals are fully educated and comprehend information about a procedure, voluntary consent maintains that a person must freely and willingly make decisions without any form of pressure or coercion.3 While a patient might be educated or informed about their health, they might not have the power to voluntarily make medical choices. Thus, consent must be both informed and voluntary to ensure that a patient is fully educated while preserving the right to make medical decisions. Without autonomy and (voluntary) informed consent, individuals would be deprived of their freedom to make educated medical choices, leading to interventions that do not align with their wishes or desires. However, autonomy and informed consent also have severe limitations and barriers, specifically when it comes to the informedness gap, cognitive capacity, and underestimation or overestimation of treatment risks. According to author Onora O’Neill, the informedness gap occurs when patients may not fully understand the complex medical information provided to them by their physician.[4] The informedness gap is especially prevalent when medical professionals discuss complex procedures or treatments, as the patients may feel overwhelmed by the information and not make truly informed decisions. In addition to the informedness gap, limited cognitive capacity and mental health can hinder effective communication and informed consent.[5] When patients are unable to provide informed consent due to factors like dementia, mental illness, or unconsciousness, ensuring thorough communication and education becomes extremely challenging.4 Additionally, it is important to consider how informed consent is limited by underestimation or overestimation of treatment risks. Patients may be overly optimistic about the success of a treatment or procedure, thereby underestimating the likelihood of complications or adverse outcomes. On the other hand, patients may possess fear and anxiety, causing them to overestimate the effects of treatment. Anxiety can cause a heightened perception of risk, which can lead to refusal of beneficial treatments, despite the presence of objective medical evidence.[6] Overall, these limitations of informed consent demonstrate that even when a patient is educated about their health, they still might not be fully knowledgeable when making medical decisions. In fact, while patients have the power of autonomy to make medical choices, the limitations of informed consent can have fatal effects. This becomes abundantly clear when looking at the case study of the world-famous musician, Michael Jackson. Michael Jackson’s death was the result of acute propofol and benzodiazepine intoxication. Propofol and benzodiazepine are extremely powerful medications commonly used for ICU sedation.[7] Dr. Conrad Murray, Michael Jackson's personal physician, was involved in Jackson’s care leading up to his death and played a central role in the events surrounding it. To briefly summarize the case, Michael Jackson was experiencing chronic insomnia and sought medical treatment after struggling to sleep for months.[8] Initially, Dr. Murray prescribed conventional anti-anxiety medications to help the artist sleep, but he was unsuccessful in resolving Jackson’s symptoms.7 Without coercing the artist, Dr. Murray offered to administer the powerful anesthetics, propofol and benzodiazepine. After Dr. Murray’s brief description of the effects of propofol and benzodiazepine, Jackson voluntarily agreed to this treatment.7 Initially, the treatment was a success, but Jackson was unaware of the significant toll these sedatives had on his health. On June 25th, 2009, after 2 and a half months of treatment, Jackson experienced severe propofol intoxication, causing him to die from cardiac arrest.[9] Clearly, this case highlights how limitations of informed consent, specifically the informedness gap and underestimation of treatment risks, can have fatal consequences. Michael Jackson was granted the autonomy to make medical decisions about treatments for his insomnia, and he was briefly informed that propofol and benzodiazepine are potent sedatives.7 However, according to the artist’s family, Jackson wasn’t fully educated about the level of addictivity and long-term ramifications of the drugs he was administered.8 The Jackson family cited that while the artist voluntarily agreed to treatment, his chronic sleep deprivation caused him to underestimate the effects of his medication. The family explained that Jackson lacked the mental capacity to make informed decisions about his health.8 Perhaps the outcome of this case may have been different if Dr. Murray had fully explored alternatives for treatment or made a thorough effort to fully educate Jackson about the effects of propofol. Additionally, it is difficult to discredit how sleep deprivation hindered Jackson’s ability to make rational decisions about his health.8 While it is true that Dr. Murray informed Michael Jackson about the strength of the sedatives he was administered, that doesn’t mean Jackson fully understood the treatment’s consequences or the weight of his decision. Furthermore, Michael Jackson didn’t suffer from the limitations of informed consent because of his unique status as a celebrity; Jackson is not an exception from the norm. Research suggests that factors such as limited interaction time between patients and physicians causes an informedness gap in about 1 out of every 3 people.[10] Michael Jackson had the wealth and resources to be informed about his health; he could have employed any doctor to provide his treatment. Yet, the average person does not have the resources to employ their own doctor or be thoroughly educated about their health.10 If Michael Jackson wasn’t fully informed about his medical condition or treatment, it is likely that the average person is uninformed as well. CONCLUSION To put it simply, autonomy and informed consent ensure that individuals can express their personal beliefs while making educated decisions about their health. However, it is crucial to consider the limitations of informed consent such as the informedness gap, cognitive capacity, and misjudgment of treatment risks. How useful is autonomy and informed consent if patients lack the ability to think clearly, logically, and holistically about their health?[11] The tragic case of Michael Jackson exemplifies how limitations of informed consent have profound consequences. Although Jackson was informed about the risks associated with propofol and voluntarily agreed to his treatment, he was not fully aware of the drug’s long-term ramifications. If healthcare seeks to achieve positive health outcomes, there is an ongoing need for effective communication and patient education to address the limitations of autonomy and informed consent. - [1]Tom L. Beaucham, Standing on Principles: Collected Essay p, European Journal of Health Law 19, no. 5 (2012): 544–51. [2] Daniel Callahan, “Autonomy: A Moral Good, Not a Moral Obsession,” The Hastings Center Report 14, no. 5 (1984): 40–42, https://doi.org/10.2307/3561098. [3] Onora O’Neill, “Between Consenting Adults,” Philosophy & Public Affairs 14, no. 3 (1985): 252–77. [4] Onora O’Neill, “Some Limits of Informed Consent,” Journal of Medical Ethics 29, no. 1 (February 1, 2003): 4–7, https://doi.org/10.1136/jme.29.1.4. [5] Antoine Aoun, Sibelle Al Hayek, and Flora El Jabbour, “The Need for a New Model of the Physician–Patient Relationship: A Challenge for Modern Medical Practice,” Family Medicine & Primary Care Review 20, no. 4 (2018): 379–84, https://doi.org/10.5114/fmpcr.2018.79351. [6] Rebecca Dresser. "Sunday Dialogue: Conversations Between Doctor and Patient,” The New York Times, August 25, 2012, sec. Opinion, https://www.nytimes.com/2012/08/26/opinion/sunday/sunday-dialogue-conversations-between-doctor-and-patient.html. [7] Katherine Harmon, “What Is Propofol--and How Could It Have Killed Michael Jackson?” Scientific American, accessed October 15, 2023, https://www.scientificamerican.com/article/propofol-michael-jackson-doctor/. [8] “Doctor Is Guilty in Michael Jackson’s Death - The New York Times,” accessed October 15, 2023, https://www.nytimes.com/2011/11/08/us/doctor-found-guilty-in-michael-jacksons-death.html. [9] B. Lyons, “Medical Manslaughter,” Irish Medical Journal 106, no. 1 (January 2013): 26–27. [10] D. R. Hansberry et al., “Are We Effectively Informing Patients? A Quantitative Analysis of On-Line Patient Education Resources from the American Society of Neuroradiology,” American Journal of Neuroradiology 35, no. 7 (July 1, 2014): 1270–75, https://doi.org/10.3174/ajnr.A3854. [11] Rebecca Kukla, “How Do Patients Know?,” Hastings Center Report 37, no. 5 (2007): 27–35.

[Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation].

With the significant increase in the use of extracorporeal membrane oxygenation in patients with severe respiratory failure, cardiogenic shock, and cardiopulmonary resuscitation, complications related to extracorporeal membrane oxygenation are increasingly being taken seriously. Cerebral injury is one of the most serious complications during extracorporeal membrane oxygenation treatment, and is an important factor affecting the hospital mortality rate and long-term quality of life. Due to the use of analgesics, sedatives, and muscle relaxants interfering with neurological physical examination results, cerebral injury that occurs during extracorporeal membrane oxygenation therapy is not easily detected in a timely manner. Therefore, bedside cerebral monitoring has important value in quickly detecting cerebral injury in patients with extracorporeal membrane oxygenation and providing early intervention guidance. Therefore, Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association organized relevant experts across the country to develop the"Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation", this expert consensus is based on the pathological and physiological mechanisms of cerebral injury in patients with extracorporeal membrane oxygenation. It is based on the current application status of cerebral monitoring technologies such as neurological physical examination, plasma brain injury biomarkers, brain imaging, intracranial pressure, cerebral blood flow, brain oxygen, electroencephalogram, and somatosensory evoked potential. Combining the special clinical application scenarios of extracorporeal membrane oxygenation and integrating the latest evidence-based medical evidence, we have formed 15 consensus recommendations which can be referenced by professionals in critical care medicine, neurology, cardiovascular disease, respiratory and critical care, emergency medicine, and other fields. Given the particularity, complexity, and individual differences of critically ill patients, the recommendations formed by this expert consensus need to implement personalized strategies.

[Expert consensus on the application of ω-3 fatty acid prescription drugs in aging-related diseases (2024 edition)].

With the severe rapid aging in China, the health management system of elderly-related diseases is facing great challenges. Because of its various effects such as lipid-lowering, anti-inflammatory, and primary and sencondary prevension of atherosclerotic cardiovascular disease, etc, ω-3 fatty acids are increasingly being valued in the field of geriatric medicine. To further standardize the application of ω-3 fatty acid drugs in the field of geriatrics, initiated by the Chinese Medical Association Geriatrics Branch, based on the existing medical evidence and combined with the clinical practice of geriatrics in China, 12 recommendations were proposed, including the application of ω-3 fatty acids on cardiovascular diseases, chronic kidney disease, nervous system disease, respiratory system disease, sarcopenia, frailty, osteoporosis, tumor and autoimmune diseases, aiming to provide guidance for clinical decision-making in geriatric diseases.

The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes.

The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's "no presumption of advantage" principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of "meaningful competition" is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.

How Does ChatGPT Use Source Information Compared With Google? A Text Network Analysis of Online Health Information.

The lay public is increasingly using ChatGPT (a large language model) as a source of medical information. Traditional search engines such as Google provide several distinct responses to each search query and indicate the source for each response, but ChatGPT provides responses in paragraph form in prose without providing the sources used, which makes it difficult or impossible to ascertain whether those sources are reliable. One practical method to infer the sources used by ChatGPT is text network analysis. By understanding how ChatGPT uses source information in relation to traditional search engines, physicians and physician organizations can better counsel patients on the use of this new tool. (1) In terms of key content words, how similar are ChatGPT and Google Search responses for queries related to topics in orthopaedic surgery? (2) Does the source distribution (academic, governmental, commercial, or form of a scientific manuscript) differ for Google Search responses based on the topic's level of medical consensus, and how is this reflected in the text similarity between ChatGPT and Google Search responses? (3) Do these results vary between different versions of ChatGPT? We evaluated three search queries relating to orthopaedic conditions: "What is the cause of carpal tunnel syndrome?," "What is the cause of tennis elbow?," and "Platelet-rich plasma for thumb arthritis?" These were selected because of their relatively high, medium, and low consensus in the medical evidence, respectively. Each question was posed to ChatGPT version 3.5 and version 4.0 20 times for a total of 120 responses. Text network analysis using term frequency-inverse document frequency (TF-IDF) was used to compare text similarity between responses from ChatGPT and Google Search. In the field of information retrieval, TF-IDF is a weighted statistical measure of the importance of a key word to a document in a collection of documents. Higher TF-IDF scores indicate greater similarity between two sources. TF-IDF scores are most often used to compare and rank the text similarity of documents. Using this type of text network analysis, text similarity between ChatGPT and Google Search can be determined by calculating and summing the TF-IDF for all keywords in a ChatGPT response and comparing it with each Google search result to assess their text similarity to each other. In this way, text similarity can be used to infer relative content similarity. To answer our first question, we characterized the text similarity between ChatGPT and Google Search responses by finding the TF-IDF scores of the ChatGPT response and each of the 20 Google Search results for each question. Using these scores, we could compare the similarity of each ChatGPT response to the Google Search results. To provide a reference point for interpreting TF-IDF values, we generated randomized text samples with the same term distribution as the Google Search results. By comparing ChatGPT TF-IDF to the random text sample, we could assess whether TF-IDF values were statistically significant from TF-IDF values obtained by random chance, and it allowed us to test whether text similarity was an appropriate quantitative statistical measure of relative content similarity. To answer our second question, we classified the Google Search results to better understand sourcing. Google Search provides 20 or more distinct sources of information, but ChatGPT gives only a single prose paragraph in response to each query. So, to answer this question, we used TF-IDF to ascertain whether the ChatGPT response was principally driven by one of four source categories: academic, government, commercial, or material that took the form of a scientific manuscript but was not peer-reviewed or indexed on a government site (such as PubMed). We then compared the TF-IDF similarity between ChatGPT responses and the source category. To answer our third research question, we repeated both analyses and compared the results when using ChatGPT 3.5 versus ChatGPT 4.0. The ChatGPT response was dominated by the top Google Search result. For example, for carpal tunnel syndrome, the top result was an academic website with a mean TF-IDF of 7.2. A similar result was observed for the other search topics. To provide a reference point for interpreting TF-IDF values, a randomly generated sample of text compared with Google Search would have a mean TF-IDF of 2.7 ± 1.9, controlling for text length and keyword distribution. The observed TF-IDF distribution was higher for ChatGPT responses than for random text samples, supporting the claim that keyword text similarity is a measure of relative content similarity. When comparing source distribution, the ChatGPT response was most similar to the most common source category from Google Search. For the subject where there was strong consensus (carpal tunnel syndrome), the ChatGPT response was most similar to high-quality academic sources rather than lower-quality commercial sources (TF-IDF 8.6 versus 2.2). For topics with low consensus, the ChatGPT response paralleled lower-quality commercial websites compared with higher-quality academic websites (TF-IDF 14.6 versus 0.2). ChatGPT 4.0 had higher text similarity to Google Search results than ChatGPT 3.5 (mean increase in TF-IDF similarity of 0.80 to 0.91; p < 0.001). The ChatGPT 4.0 response was still dominated by the top Google Search result and reflected the most common search category for all search topics. ChatGPT responses are similar to individual Google Search results for queries related to orthopaedic surgery, but the distribution of source information can vary substantially based on the relative level of consensus on a topic. For example, for carpal tunnel syndrome, where there is widely accepted medical consensus, ChatGPT responses had higher similarity to academic sources and therefore used those sources more. When fewer academic or government sources are available, especially in our search related to platelet-rich plasma, ChatGPT appears to have relied more heavily on a small number of nonacademic sources. These findings persisted even as ChatGPT was updated from version 3.5 to version 4.0. Physicians should be aware that ChatGPT and Google likely use the same sources for a specific question. The main difference is that ChatGPT can draw upon multiple sources to create one aggregate response, while Google maintains its distinctness by providing multiple results. For topics with a low consensus and therefore a low number of quality sources, there is a much higher chance that ChatGPT will use less-reliable sources, in which case physicians should take the time to educate patients on the topic or provide resources that give more reliable information. Physician organizations should make it clear when the evidence is limited so that ChatGPT can reflect the lack of quality information or evidence.