Medical Explanation Research Articles

Quality improvement project provides unexpected insights into hospitalized pain management

Patient education and multidisciplinary treatment plans are key best practices for pain management in hospitalized patients. In a routine compliance review, stakeholders at Baylor Scott & White Medical Center – Temple identified pain management patient education as an area needing improvement. A dual-sided medication explanation card was developed, including functional expectations and a QR code linking a companion website with additional pain management educational materials. This short communication details the results from a small quality improvement pilot study using QR code technology to deliver pain management education materials to hospitalized patients. Patients were surveyed the morning after admission and survey results are reported using standard descriptive statistics. Of 46 patients who received the education card, 44 reported well-controlled or moderately-controlled pain and 36 asked for as-needed pain medications. Fourteen patients said that the card was straightforward or made the medication options easy to understand. Per analytics, the companion website had at least 37 unique visitors during the survey period, with at least 8 visitors clicking additional links from the homepage. Though 30 % of patients reported that the education card was helpful and/or straightforward regarding medication options (as intended), five patients with moderately controlled pain who asked for as-needed medications reported they were delayed or ineffective, which revealed that timely administration and adjustments to regimens per patient feedback is also essential. Website analytics suggested that patients utilize and engage with available resources at differing rates. Limitations of this pilot study include small patient population, no pre-intervention comparator group, and disruption in analytics data gathering capabilities during the pilot. Despite limited qualitative data, the quality improvement objectively demonstrated regulatory compliance with pain management education standards and it was adopted throughout all the hospitals of the Baylor Scott & White Healthcare system.

Information on HIV and Narration of U=U: a mixed method analysis on social media in Italy

Abstract Background Media play a pivotal role in disseminating accurate information, particularly regarding U=U (Undetectable = Untransmittable), to increase awareness and reduce stigma. This study analyses HIV Italian communication on Facebook and Instagram, with a focus on U=U evidence. Methods A mixed-method analysis examined posts on HIV, with linked articles, from Italian news sources from 01/2009 to 04/2023. News sources were categorised as “reliable” or “unreliable” using independent third-party classification. Topic analysis identified the main topics in the posts, while an inductive content analysis was conducted on linked articles regarding U=U. The language and the accuracy in explaining U=U was evaluated through a checklist. Results A total of 10,539 Facebook and 749 Instagram posts were analysed, with 716(7%) and 18(2%) from unreliable sources respectively. Reliable and unreliable content surged around World AIDS Day(WAD) on both platforms. On Facebook, the frequency of unreliable content increased over time, whereas on Instagram it was rare and recent. On Facebook, topics varied between reliable and unreliable sources. The 3 most frequent topics from reliable sources were WAD, voluntary HIV spread, and public figures with HIV; those from unreliable sources were Death and Migrant People; Luc Montagnier and COVID-19 Conspiracies; Public Figures with HIV. On Instagram, the first 3 topics were the Italian National Institute of Health and Prevention, WAD, and public figures with HIV. A total of 68 articles nominating U=U were found and analysed, revealing 4 main areas: U=U definition, Prevention, Impact on people living with HIV, and Stigma. The accuracy in explaining U=U was generally low, with 6 articles(8.8%) providing only a definition. Conclusions HIV communication in Italy is limited and centered around WAD, with persisting bias. The dissemination of the U=U evidence is lacking. Urgent action is needed to shift the narrative and emphasize this evidence Key messages • HIV communication in Italy is limited and concentrated around World AIDS day. • The U=U evidence is poorly disseminated, often providing only a definition and medical explanation.

Impact of 3D-Printed Anatomical Models on Doctor-Patient Communication in Orthopedic Consultations: A Randomized Clinical Trial.

Effective communication between doctors and patients is essential for treatment adherence and better clinical outcomes. Although 3D printing has advanced in medicine, its impact on doctor-patient communication still requires further investigation. This randomized clinical trial evaluated the effectiveness of 3D anatomical models as a tool to facilitate communication in orthopedic consultations. This randomized clinical trial was conducted between May 2024 and September 2024, with 46 patients randomized into two groups: 21 patients received medical explanations with the aid of 3D models, and 25 without. Patients' knowledge was assessed before and after the consultation, and the quality of communication was measured using the Communication Assessment Tool (CAT). In the group using 3D models, 76.19% of patients reported improved knowledge of their conditions, while in the group without models, the increase was 52.00%. Additionally, 14 out of 15 CAT parameters showed statistically significant differences between the groups, with p-values ranging from 0.001 to 0.021. The use of 3D models significantly improved patients' understanding and facilitated communication with doctors, proving to be an effective tool for explaining complex medical conditions.

Experiences of people with unexplained hearing concerns seeking hearing healthcare in the United States.

Up to 10% of adults seeking hearing healthcare for significant hearing concerns have diagnostic test results that indicate normal hearing. Knowledge of the interactions between patients with unexplained hearing concerns and hearing healthcare providers is minimal. In this study, we explored what themes emerged when individuals with unexplained hearing concerns discuss their experiences seeking hearing healthcare. We employed a prospective, cross-sectional qualitative design with semi-structured interviews. Fifteen adults who had sought professional hearing evaluations in the United States due to hearing concerns but had audiological testing that indicated hearing within normal limits, and no other medical explanation for their hearing concerns participated in the study. Saturation of themes was reached by Interview #2, suggesting sufficient sampling. Thematic analysis revealed 3 themes from the interviews: (1) dismissive healthcare providers, (2) misalignment of patient concerns and assessment protocols, and (3) doctor shopping. These findings highlight the need for improved care for patients with unexplained hearing concerns. Clinicians could help improve care provision for patients with unexplained hearing concerns, despite a lack of professional guidance on diagnostic tests or treatment recommendations, by soliciting, listening to, and trusting patient experiences as they seek support for their hearing concerns.

Recovered or Not Recovered? A First Person Narrative Case for Non-Abstinent Recovery.

The purpose of this paper was to explore interlocking questions relating to how we deal with drugs and medication in crisis residential mental health settings. In particular, it examines issues related to overly medical and simplistic explanations of the relationship between cannabis and psychosis, the positive effects of drugs, the effects of having standard rules for diverse groups of people and the concept of non-abstinent recovery. I have used mental health and addiction services for 25 years and I have 6 years' experience as a peer worker, working with many people who use drugs. This is an opinion piece built around a first-person narrative. Drugs can have positive effects and an appreciation and understanding of these effects is essential to understanding persistent drug use. How can we integrate non-abstinent recovery as a valid and positive choice of recovery pathway?

Exploring Patients' Perceptions of One-step Surgery for Primary Cutaneous Melanoma: A Qualitative Study.

High-frequency ultrasonography (> 20 MHz) has allowed for preoperative measurement of melanoma thickness and thus a one-step surgery strategy. The potential benefits of one-step surgery to patients remain unexplored. From June 2022 to August 2023, 2 dermatologists conducted semi-structured individual interviews with patients who had undergone HFUS examination allowing the choice for one-step surgery (group A) and with patients who had had standard two-step surgery (group B). Analysis of interviews with 21 patients (age range 31-81 years) revealed 5 main themes: (a) understanding the diagnosis, highlighting the significance of clear and comprehensive medical explanations; (b) personal factors considered in treatment decisions, including preferences for minimizing surgical procedures; (c) making choices, bearing responsibility, thus showcasing different levels of patient involvement in decision-making; (d) high- frequency ultrasonography reassurance emphasizing the role of medical reassurance, and (e) patient satisfaction, discussing surgical outcomes and the decision-making process. The majority of participants expressed a clear preference for one-step surgery, perceived as a pragmatic and fast surgical strategy while minimizing interventions. In conclusion, the results emphasize the importance of patient-centred care. These insights can guide improved preoperative consultations and enhance shared decision-making between healthcare professionals and patients regarding melanoma treatment strategies.

Current status of postoperative care for elderly osteoporotic fracture patients in Jiangsu Province, China: A multicenter cross-sectional study

BackgroundThe postoperative care behavior of elderly osteoporotic fracture patients has a significant impact on their prognosis and rehabilitation; thus, it is critical to completely comprehend their current state of care before optimizing postoperative care strategies. AimsTo determine the current status of postoperative care for elderly osteoporotic fracture patients in Jiangsu Province. MethodsFrom October to December 2023, 669 elderly postoperative patients with osteoporotic fractures were recruited for a cross-sectional study via convenience sampling and a self-designed questionnaire from 21 hospitals in seven urban areas in Jiangsu Province. ResultsA total of 800 questionnaires were distributed, and 709 questionnaires were recovered, for a return rate of 88.6%. The postoperative support and care received by the patients were mostly by their children and spouses, and the postoperative health education knowledge received by the patients was mostly about fracture-related knowledge and precautions for the use of medications. Health education methods were mainly conducted by medical staff explanations and health brochures; only 45.3% of the patients were treated with anti-osteoporosis therapy. ConclusionsThe current status of postoperative care for osteoporotic fracture patients in Jiangsu Province varies somewhat according to geographic location, hospital level and other factors, with tertiary hospitals and more economically developed areas having relatively better care outcomes. For in-hospital care, it is necessary to improve the content and methods of in-hospital education. For out-of-hospital care, it is necessary to raise the level of awareness of anti-osteoporosis treatment and the prevention and treatment of re-fractures, and to improve hospital-community referral services.

Medically unexplained symptoms and experiences with healthcare among emerging adults exposed to multiple types of potentially traumatic events.

Experiencing multiple types of traumatic events can increase the risk of developing somatic and posttraumatic stress symptoms (PTSS). Medically unexplained symptoms (MUS), or somatic symptoms that lack a distinct medical explanation, often coexist with PTSS in emerging adults and may be due to common underlying mechanisms. Coping strategies have been associated with PTSS, but have not been studied in trauma-exposed individuals with MUS. The current study examined the relationship between the number of types of potentially traumatic events experienced and MUS among emerging adults, considering the influence of PTSS and engagement and disengagement coping. A sample of 363 emerging adults (Mean = 18.91) completed self-report measures of trauma history, PTSS, MUS, experiences with healthcare providers, and coping strategies. Dissatisfaction with healthcare providers was reported by 11.3% of participants reporting MUS, with over half (52.8%) feeling their concerns were dismissed. Hierarchical linear regression showed that the number of types of traumatic events experienced did not predict MUS after accounting for PTSS. Moderation hypotheses linking traumatic events and coping strategies were not supported. Results suggest that PTSS explains the relationship between exposure to different traumatic events and MUS. Findings may have diagnostic and treatment implications for healthcare providers working with emerging adults who have experienced trauma.

MedExpQA: Multilingual benchmarking of Large Language Models for Medical Question Answering

Large Language Models (LLMs) have the potential of facilitating the development of Artificial Intelligence technology to assist medical experts for interactive decision support. This potential has been illustrated by the state-of-the-art performance obtained by LLMs in Medical Question Answering, with striking results such as passing marks in licensing medical exams. However, while impressive, the required quality bar for medical applications remains far from being achieved. Currently, LLMs remain challenged by outdated knowledge and by their tendency to generate hallucinated content. Furthermore, most benchmarks to assess medical knowledge lack reference gold explanations which means that it is not possible to evaluate the reasoning of LLMs predictions. Finally, the situation is particularly grim if we consider benchmarking LLMs for languages other than English which remains, as far as we know, a totally neglected topic. In order to address these shortcomings, in this paper we present MedExpQA, the first multilingual benchmark based on medical exams to evaluate LLMs in Medical Question Answering. To the best of our knowledge, MedExpQA includes for the first time reference gold explanations, written by medical doctors, of the correct and incorrect options in the exams. Comprehensive multilingual experimentation using both the gold reference explanations and Retrieval Augmented Generation (RAG) approaches show that performance of LLMs, with best results around 75 accuracy for English, still has large room for improvement, especially for languages other than English, for which accuracy drops 10 points. Therefore, despite using state-of-the-art RAG methods, our results also demonstrate the difficulty of obtaining and integrating readily available medical knowledge that may positively impact results on downstream evaluations for Medical Question Answering. Data, code, and fine-tuned models will be made publicly available.11https://huggingface.co/datasets/HiTZ/MedExpQA.

Prevalence of Somatic Symptom Disorder in Students of Tertiary Educational Institutes in Pakistan and Its Correlation With Academic Performance and Sleep Quality

Objective: Somatic symptom disorder (SSD) is a disorder characterized by several somatic symptoms without medical explanation. SSD has been a burden on healthcare for ages and its awareness is not widespread among the healthcare professionals or population. This study aims to find out the prevalence of SSD among university students in Pakistan and whether it is affecting their academic performance or sleep quality. Methods: It is an observational study conducted in Pakistan in June 2023. A sample size of 381 participants was used. Patient Health Questionnaire-15 was used as SSD diagnosis, Academic Performance Scale for measuring academic performance, and Functional Outcome of Sleep Questionnaire for rating sleep quality. SPSS software 27.0 was used as a statistical tool for analysis using descriptive statistic and tests like frequency, chi-square, and crosstabs. Results: The study found a 48.8% prevalence of SSD among Pakistani students, with higher rates in females (65.6%), and no age-related correlation (p=0.341). Furthermore, the relation between academic performance of students with SSD was significant (p<0.001), whereas sleep quality was unaffected by SSD (p=0.281). Conclusion: The frequency of SSD is approximately 48.8% among the students in Pakistan. This high prevalence has been recorded to negatively affect the academic performance of the students and is more prevalent in females than males. However, it is not related to age and it does not cause any sleep disturbance. Future studies should focus on the risk factors of SSD and better treatment plans for effective control and awareness of this disorder.

Triggers, Risk Factors, and the Prevalence of Syncope Among Domestic Hajj Pilgrims, 2023: A Cross-Sectional Study.

Syncope and other transient loss of consciousness episodes in crowded and unfamiliar environments may lead to major health hazards. Despite numerous publications, data on syncope among Hajj pilgrims in Makkah is lacking. To identify the triggers, risk factors, and prevalence of syncope and other transient loss of consciousness episodes among domestic pilgrims. This cross-sectional study included a convenient sample of domestic pilgrims who performed Hajj in July 2023 using an online Google Forms questionnaire (Alphabet Inc., Mountain View, CA). Out of388 participants, 69 (18.1%) reported a history of syncope during the Hajj pilgrimage. Among these, 57 (82.6%) reported complete loss of consciousness, and 56 (81.2%) noted warning symptoms preceding the episode. The syncopal attack occurred once in 49 respondents (71%). Several triggers for syncope were identified, withsudden standing from a sitting position being the most prevalent (100%). Additional co-triggers were crowding (n=43; 62.3%), stressful conditions (n=30; 43.2%), prolonged standing (n=21; 30.4%), and walking (n=11; 15.9%). Traumatic injuries were reported in 33 (47.8%) as a result of syncope. Standing for long periods of time on the day of Arafat (Arafat standing) emerged as the most common triggering situation (n=48; 69.6%). There were multiple medical factors contributing tosyncopal episodes; the most common medical explanations were heat exhaustion (n=48; 69.6%), dehydration (n=24; 34.8%), over-exertion (n=48; 69.6%), low blood sugar (n=10; 14.5%), and low blood pressure (n=17; 24.6%). Significant predictors were the presence of cardiac disease (odd ratio (OR) 7.6, 95% confidence interval (CI) 2.71-21.45, p<0.001), anemia (OR 2.5, 95% CI 1.01-6.09, p=0.049), previous syncope (OR 2.5, 95% CI 1.02-6.27, p=0.049, and family history of syncope (OR 10.1, 95% CI 2.08-49.32, p=0.004). Syncope during the domestic Hajj pilgrimage is frequent, especially on the day of Arafat, and carries the risk of traumatic injury. People with previous episodes of syncope and comorbidities, especially cardiac patients and those who have a family history of syncope, are particularly prone to this risk. Healthcare should focus on at-riskpatients, particularly on critical pilgrimage days, and increase pilgrims' awareness about triggers of syncope including sudden and prolonged standing, exertion, and heat exposure.

Undergraduate Students' Awareness of and Beliefs About Unusual End-of-Life Phenomena.

One hundred and forty undergraduate students responded to an online survey investigating their awareness of and beliefs about 12 unusual end-of-life phenomena (EOLP). Three quarters or more of the students had heard about the following EOLP: deathbed visions (75%), after-death communications (84%), near-death experiences (86%), and dying people choosing their time of death (88%). Students were least aware of the phenomena of shapes leaving the body after death (30%) and clocks or watches stopping when someone dies (26%). The two most common sources of students' knowledge about EOLP were from watching TV/movies (52-79%) and the internet (38-71%); the least common source was personal/direct experience with the EOLP (2-36%). Fifty-three percent of the students strongly agreed/agreed that EOLP are spiritual events, while 41% strongly agreed/agreed that there are medical explanations for EOLP. Suggestions for future research are offered.

A Delphi Approach to Define Lucid Episodes in People Living With Dementia.

Lucid episodes (LEs: unexpected episodes of spontaneous, meaningful, and relevant communication or behavior) in Alzheimer disease and related dementias are a new area of scientific inquiry that lacks clinical consensus and require more conceptual attention. We aimed to measure consensus from an expert group on: (1) potential medical or clinical explanations for LEs; (2) necessary medical and clinical context to LEs; and (3) interpretation of LEs. We convened 13 experts from different disciplines (neurology, psychiatry, psychology, pharmacy, palliative care, hospice, nursing, social work, primary care, geriatrics, and professional home caregivers) to identify elements of LEs. Experts provided a range of opinions on medical and clinical explanations and questions to understand LEs. Consensus on LEs when presented with clinical vignettes was not reached. Panelists highlighted key medical and contextual factors needed to make a definitive judgement about LEs. There is variability in how LEs are interpreted by clinical experts, which complicates the identification of LEs in Alzheimer disease and related dementias.

Anonymizing medical case-based explanations through disentanglement

Case-based explanations are an intuitive method to gain insight into the decision-making process of deep learning models in clinical contexts. However, medical images cannot be shared as explanations due to privacy concerns. To address this problem, we propose a novel method for disentangling identity and medical characteristics of images and apply it to anonymize medical images. The disentanglement mechanism replaces some feature vectors in an image while ensuring that the remaining features are preserved, obtaining independent feature vectors that encode the images’ identity and medical characteristics. We also propose a model to manufacture synthetic privacy-preserving identities to replace the original image’s identity and achieve anonymization. The models are applied to medical and biometric datasets, demonstrating their capacity to generate realistic-looking anonymized images that preserve their original medical content. Additionally, the experiments show the network’s inherent capacity to generate counterfactual images through the replacement of medical features.

Development of a Scoring Rubric Assessing Medical Students' Explanations of Pathology Reports.

With increasing availability of immediate patient access to pathology reports, it is imperative that all physicians be equipped to discuss pathology reports with their patients. No validated measures exist to assess how pathology report findings are communicated during patient encounters. To pilot a scoring rubric evaluating medical students' communication of pathology reports to standardized patients. The rubric was iteratively developed using the Pathology Competencies for Medical Education and Accreditation Council for Graduate Medical Education pathology residency milestones. After a brief training, third- and fourth-year medical students completed 2 standardized patient encounters, presenting simulated benign and malignant pathology reports. Encounters were video recorded and scored by 2 pathologists to calculate overall and item-specific interrater reliability. All students recognized the need for pathology report teaching, which was lacking in their medical curriculum. Interrater agreement was high for malignant report scores (intraclass correlation coefficient, 0.65) but negligible for benign reports (intraclass correlation coefficient, 0). On malignant reports, most items demonstrated good interrater agreement, except for discussing the block (cassette) summary, explaining the purpose of the pathology report, and acknowledging uncertainty. Participating students (N = 9) felt the training was valuable given their limited prior exposure to pathology reports. This pilot study demonstrates the feasibility of using a structured rubric to assess the communication of pathology reports to patients. Our findings also provide a scalable example of training on pathology report communication, which can be incorporated in the undergraduate medical curriculum to equip more physicians to facilitate patients' understanding of their pathology reports.

OA17 An unusual cause of unilateral retroperitoneal fibrosis

Abstract Background/Aims Retroperitoneal fibrosis (RPF) is a rare condition, with an incidence of around 1 per 200,000 to 500,000 per year. It is distinguished by fibro-inflammatory changes in the retroperitoneum, which typically surrounds the abdominal aorta. Idiopathic RPF is common, whilst secondary causes can result from drug therapies, infection, malignancy, or surgery. Early symptoms include dull, poorly-localised back or flank pain, and lower limb swelling. The classical focal mass of primary retroperitoneal fibrosis is typically situated over the distal aorta, anterior to the L4 and L5 vertebra. External compression of the ureter can result in hydronephrosis due to prevention of normal ureteric urinary peristalsis. Management options are limited, generally involving immunosuppression and urological surgery, often necessitating cross-specialty, multidisciplinary input. Methods We report the case of a young gentleman with no past medical or family history who presented with abdominal pain, vomiting, septic shock and metabolic acidosis. To exclude acute abdominal pathology, computed tomography (CT) abdomen and pelvis was performed. Incidentally, this found chronic inflammatory changes in the descending colon and right retroperitoneal soft tissue thickening causing severe right hydroureteronephrosis. This incidental finding of retroperitoneal fibrosis on CT scan prompted an exploration into infective, inflammatory, and malignant aetiological causes of retroperitoneal fibrosis. Results Following initial stabilisation, urological opinion was sought, which concluded that surgical intervention for ureteric stenting was unnecessary. This decision was supported by the absence of obstruction from fibrosis and the lack of signs indicating infection. No medical explanation was found for the initial presentation in extremis. Rheumatological advice was sought for consideration of biopsy and immunosuppressive therapy for this suspected primary retroperitoneal fibrosis. Upon inquiry, the patient divulged a historical occurrence of retroperitoneal fluid accumulation secondary to a paravertebral mass that mandated laparoscopic drainage four years ago overseas. Histopathological analysis of the mass confirmed the presence of tuberculosis (TB), which was treated. His recovery was complicated at that time by right-sided hydronephrosis and fibrosis necessitating decompression. This sequence of events was deemed by a radiologist to also account for the observed bowel findings in the right flank. Conclusion This case report is the first of its kind to document TB, or any infective aetiology, as being the primary cause of unilateral retroperitoneal fibrosis. Unilateral retroperitoneal fibrosis is incredibly rare, and there are only four English language case reports in the literature. Idiopathic RPF typically presents as bilateral concentric tissue around the abdominal aorta, whilst secondary causes can lead to unconventional imaging patterns, as seen in this case. It was only upon direct inquiry that the patient disclosed a prior diagnosis of TB affecting the lumbar spine. This case highlights the importance of meticulous history taking and systematic exclusion of secondary causes of RPF, prior to contemplating invasive biopsies and steroid therapy. Disclosure D. Li: None. M. Renju: None.

When Descriptor is Diagnosis: An Autoethnographic Response to the Medical Treatment of Women with Vulvodynia

ABSTRACT Women with chronic vulvar pain experience symptoms that can affect their everyday functioning. These women are often diagnosed with vulvodynia, defined as vulvar pain without a medical explanation lasting at least three months. Yet while vulvodynia is presented by medical authorities as a diagnosis it is, more accurately, a descriptor of the physical condition. As such it does not have the ability to explain what causes this vulvar pain and, consequently, cannot determine an appropriate treatment pathway for all patients. As women with vulvodynia (‘V women’), we use this article to highlight the issues posed by a descriptor camouflaging as a diagnosis, including the harm it can cause. Using literature in the field and autoethnographic vignettes, our article unravels the effects of receiving this diagnosis from disappointment at what it offers women like us in explanatory terms to how it pressures us to live up to ideas of the ideal heteronormative patient (and woman). While we use our experiences to speak to how medical descriptors can be used, through diagnosis, to undermine and damage women’s bodies and voices, we also reveal possible paths for resistance through personal research, autoethnography and encouragement of the voices and agency of other ‘V women’.

Awareness of somatisation disorder among Swedish physicians at emergency departments: a cross-sectional survey

BackgroundSomatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians’ awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience.MethodsA web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 – January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi2 tests and Fisher’s exact test.ResultsOf the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness.ConclusionsAwareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally.

Extensive Review of Literature on Explainable AI (XAI) in Healthcare Applications

Abstract: Artificial Intelligence (AI) techniques are widely being used in the medical fields or various applications including diagnosis of diseases, prediction and classification of diseases, drug discovery, etc. However, these AI techniques are lacking in the transparency of the predictions or decisions made due to their black box-type operations. The explainable AI (XAI) addresses such issues faced by AI to make better interpretations or decisions by physicians. This article explores XAI techniques in the field of healthcare applications, including the Internet of Medical Things (IoMT). XAI aims to provide transparency, accountability, and traceability in AI-based systems in healthcare applications. It can help in interpreting the predictions or decisions made in medical diagnosis systems, medical decision support systems, smart wearable healthcare devices, etc. Nowadays, XAI methods have been utilized in numerous medical applications over the Internet of Things (IOT), such as medical diagnosis, prognosis, and explanations of the AI models, and hence, XAI in the context of IoMT and healthcare has the potential to enhance the reliability and trustworthiness of AI systems.

Oral Capsaicin as Treatment for Unexplained Chronic Cough and Airway Symptoms

BackgroundUnexplained Chronic Cough (UCC) is characterized by persistent coughing without evident medical explanation. Research questionDoes daily oral administration of natural capsaicin (chili) improve refractory coughing in patients with UCC? Study Design and MethodsForty-six patients (mean age, 60.5 years) with UCC participated in this crossover, randomized, double-blind study.For 4 weeks, the participants took capsules containing pure capsaicin orally, and after a washout of 2 weeks, took placebo capsules for 4 weeks.A capsaicin inhalation cough test was used to assess the capsaicin concentrations required to reach two coughs (C2) and five coughs (C5). The number of coughs in a 24-h period and the number of coughs per hour were recorded on four occasions using the Leicester Cough Monitor (LCM). Participants completed questionnaires with items on cough, cough-related symptoms, and quality of life. ResultsThe mean values for C2 and C5 increased after the capsaicin treatment period, as compared to the first visit (baseline) (P<0.05 and P<0.03, respectively), although they did not differ from the placebo recordings.Neither the capsaicin nor the placebo treatment significantly reduced the cough frequency and did not differ between the two treatment periods. When dividing the participants in Low coughers (≤400 coughs within 24-h) respective High coughers (>400 cough) the Low coughers experienced a significantly better outcome from capsaicin but not from placebo.The Visual Analog Scale (VAS) symptom scores improved following capsaicin treatment compared with baseline and placebo treatment, in terms of the frequencies of coughing (P<0.001), rhinitis (P<0.03) and throat irritation (P<0.01). The Leicester Cough Questionnaire (LCQ-S) improved after capsaicin treatment compared to baseline and compared to the placebo treatment for all the domains (P<0.01 for the total score). InterpretationCapsaicin powder taken orally is clinically effective and well-tolerated by patients with UCC. The results suggest a future treatment for UCC.