Medical Journals Research Articles

Infectious pulmonary artery pseudoaneurysms in 3 children and literatures review

Objective: To summarize the clinical characteristics and prognosis of infectious pulmonary artery pseudoaneurysm (IPAP) in pediatric patients. Methods: This case series study summarizes the clinical data of 3 children diagnosed with IPAP at the Children's Hospital of Chongqing Medical University from January 2015 to December 2024.A comprehensive literature review was conducted by searching Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China VIP Database and Chinese Medical Journals Full Text Database) and the PubMed database through December 2024, using the keywords"infect""pseudoaneurysm""pulmonary artery". The clinical characteristics and prognosis of IPAP were synthesized by combining the reviewed literature. Results: The 3 cases included a 2-month-old male infant, a 6-year-3-month-old male child, and a 12-year-old female child, all of whom presented with fever and various respiratory symptoms. Case 1 was complicated by a retro-orbital abscess, Case 2 had a history of chronic granulomatous disease and psoriasis, and Case 3 was diagnosed with patent ductus arteriosus. Enhanced CT imaging in all 3 cases revealed multiple IPAP, with 2 cases associated with pulmonary infection foci and 1 case linked to infective endocarditis. Accompanying complications included pleural effusion in all 3 cases, necrotizing pneumonia in 2 cases, and pulmonary embolism in 1 case. Of the 3 cases, 2 cases showed improvement after anti-infective treatment, while 1 case resulted in death. A total of 9 English-language studies were identified, while no suitable Chinese-language studies were found. Including these 3 cases, a total of 12 pediatric IPAP cases were analyzed. The predominant clinical manifestations included fever in 10 cases, cough in 6 cases and hemoptysis in 5 cases. The most frequently identified pathogen was methicillin-resistant Staphylococcus aureus (MRSA) found in 3 cases. Additionally, 6 cases were complicated by extra-pulmonary infections, 4 cases had a history of congenital heart disease and surgical intervention, 1 case underwent rectovestibular fistula repair and 4 cases exhibited immune dysfunction. Imaging characteristics revealed that 9 of the 12 cases were associated with pulmonary infection foci, while 1 case was related to infective endocarditis, and 2 cases had insufficient imaging data for accurate classification. A total of 7 cases presented with a single IPAP, predominantly located in the right lower lobe in 3 cases, while the remaining 5 cases had multiple IPAP. IPAP was complicated by pleural effusion in 8 cases, by necrotizing pneumonia in 8 cases (1 of which was suspected), and by lung abscess and pulmonary embolism in 3 cases each. Among the 12 cases, 5 cases received anti-infective therapy without lobectomy or embolization, of which 3 cases improved, 1 case showed no response, and 1 case died. Additionally, 6 cases underwent endovascular embolization, with 4 cases showing improvement and 2 cases resulting in death. Only 1 case underwent lobectomy and was discharged in stable condition. Conclusions: IPAP in children manifests with a broad spectrum of clinical signs, frequently accompanied by extra-pulmonary infections and immune dysfunction. Enhanced CT plays a crucial role in the diagnosis of IPAP. The prognosis of IPAP is closely linked to the treatment approach, and timely diagnosis along with personalized treatment are essential for improving survival rates.

Working under the influence of cannabis amongst medical cannabis patients with chronic pain.

Cannabis use is increasing in the United States, and, on average, those consuming medical cannabis report more frequent cannabis use than those who use recreationally. The present analyses focus on the prevalence and correlates of working under the influence of cannabis (WUIC) amongst individuals with chronic pain who use cannabis medically. Adults were recruited from medical cannabis certification clinics in Michigan and individuals who were employed in the past 6 months were included in the analytic sample (N = 362). Unadjusted and adjusted logistic regressions were estimated to examine factors associated with WUIC. Descriptive analyses examined WUIC by types of employment. WUIC was reported by 34% (n = 123) of employed medical cannabis patients. After adjusting for other factors, older age and having episodes of 6+ drinks were significantly associated with lower odds of WUIC. History of driving under the influence of cannabis, reporting three+ hours high on cannabis per day, and using 0.5 oz+ of cannabis per week were all significantly associated with higher odds of WUIC. Amongst individuals who use cannabis for pain and are in the workforce, WUIC is relatively common. This may be particularly concerning in jobs that are safety-sensitive. Prevention efforts for WUIC might focus on those who use cannabis several times per day and might consider how to balance the needs for pain management with workplace-related roles. The current study extends knowledge around the prevalence and characteristics of individuals using medical cannabis who engage in WUIC.

There is no reliable evidence that providing authors with customized article templates including items from reporting guidelines improves completeness of reporting: the GoodReports randomized trial (GRReaT)

BackgroundAlthough medical journals endorse reporting guidelines, authors often struggle to find and use the right one for their study type and topic. The UK EQUATOR Centre developed the GoodReports website to direct authors to appropriate guidance. Pilot data suggested that authors did not improve their manuscripts when advised to use a particular reporting guideline by GoodReports.org at journal submission stage. User feedback suggested the checklist format of most reporting guidelines does not encourage use during manuscript writing. We tested whether providing customized reporting guidance within writing templates for use throughout the writing process resulted in clearer and more complete reporting than only giving advice on which reporting guideline to use.Design and methodsGRReaT was a two-group parallel 1:1 randomized trial with a target sample size of 206. Participants were lead authors at an early stage of writing up a health-related study. Eligible study designs were cohort, cross-sectional, or case-control study, randomized trial, and systematic review. After randomization, the intervention group received an article template including items from the appropriate reporting guideline and links to explanations and examples. The control group received a reporting guideline recommendation and general advice on reporting. Participants sent their completed manuscripts to the GRReaT team before submitting for publication, for completeness of each item in the title, methods, and results section of the corresponding reporting guideline. The primary outcome was reporting completeness against the corresponding reporting guideline. Participants were not blinded to allocation. Assessors were blind to group allocation. As a recruitment incentive, all participants received a feedback report identifying missing or inadequately reported items in these three sections.ResultsBetween 9 June 2021 and 30 June 2023, we randomized 130 participants, 65 to the intervention and 65 to the control group. We present findings from the assessment of reporting completeness for the 37 completed manuscripts we received, 18 in the intervention group and 19 in the control group. The mean (standard deviation) proportion of completely reported items from the title, methods, and results sections of the manuscripts (primary outcome) was 0.57 (0.18) in the intervention group and 0.50 (0.17) in the control group. The mean difference between the two groups was 0.069 (95% CI -0.046 to 0.184; p = 0.231). In the sensitivity analysis, when partially reported items were counted as completely reported, the mean (standard deviation) proportion of completely reported items was 0.75 (0.15) in the intervention group and 0.71 (0.11) in the control group. The mean difference between the two groups was 0.036 (95% CI -0.127 to 0.055; p = 0.423).ConclusionAs the dropout rate was higher than expected, we did not reach the recruitment target, and the difference between groups was not statistically significant. We therefore found no evidence that providing authors with customized article templates including items from reporting guidelines, increases reporting completeness. We discuss the challenges faced when conducting the trial and suggest how future research testing innovative ways of improving reporting could be designed to improve recruitment and reduce dropouts.

Deep Disease Label-guided Graph Convolutional Network for Medical Report Generation

Medical report generation which extracts pathological information within medical images and subsequently produces diagnostic text autonomously aims to alleviate the workload of medical experts and offers auxiliary support in diagnoses. Despite some preliminary progress have been made, several limitations still persist, including lack of specificity in extracted visual features, insufficient consideration of cross-modal alignment and extensive preparatory work required for prior knowledge.To address these issues, we, in this paper, propose a novel deep label-guided graph convolutional network for medical report generation which utilizes disease label to guide to extract pathological information from medical images. To be specific, we firstly construct graph convolutional network to guide the model to extract the specific visual features based on disease labels, which allowing us to selectively extract disease specificity information resided in medical images. Then, we develop cross-modal alignment module to guide the alignment across medical image, diagnose report and disease label, which enables more accurate generation with more precise description. Besides, we build pre-constructed relational matrix to guide report generation model to learn the relationship between visual features and disease types with minimal additional workload to further reduce intensive workload. Extensive experiments on three benchmark datasets, i.e., IU X-ray, MIMIC-CXR, and COV-CTR, demonstrate that the proposed method outperforms the recent state-of-the-art medical report generation methods. Ours shows a 9.2% improvement in BLEU-4 score on the IU X-ray dataset, and both BLEU-4 and CIDEr scores improve by 6.31% on the MIMIC-CXR dataset. Additionally, the results show that it can be easily to applied and extended to medical image report generation with different modalities.

Hyperbolic vision language representation learning on chest radiology images.

Given the visual-semantic hierarchy between images and texts, hyperbolic embeddings have been employed for visual-semantic representation learning, leveraging the advantages of hierarchy modeling in hyperbolic space. This approach demonstrates notable advantages in zero-shot learning tasks. However, unlike general image-text alignment tasks, textual data in the medical domain often comprises complex sentences describing various conditions or diseases, posing challenges for vision language models to comprehend free-text medical reports. Consequently, we propose a novel pretraining method specifically for medical image-text data in hyperbolic space. This method uses structured radiology reports, which consist of a set of triplets, and then converts these triplets into sentences through prompt engineering. To address the challenge that diseases or symptoms generally occur in local regions, we introduce a global + local image feature extraction module. By leveraging the hierarchy modeling advantages of hyperbolic space, we employ entailment loss to model the partial order relationship between images and texts. Experimental results show that our method exhibits better generalization and superior performance compared to baseline methods in various zero-shot tasks and different datasets.

Effect of Monetary Incentives on Peer Review Acceptance and Completion: A Quasi-Randomized Interventional Trial.

Peer review typically relies on experts volunteering their time to review research. This process presents challenges for journals that may face a shortage of qualified referees, resulting in either delay in handling papers or less thorough review than is optimal. We experimentally tested the impact of providing cash incentives to complete peer review assignments at Critical Care Medicine. Quasi-randomized, blinded, interventional study with an alternating treatment design. Critical Care Medicine (CCM), a peer-reviewed specialty journal. All reviewers receiving requests from CCM to review research articles during a 6-month period from September 2023 to March 2024 (excluding a 2-wk holiday window). In alternating 2-week blocks, reviewer invitation letters were sent out, including either an offer of $250 for accepting the peer review request (treatment) or the standard letter with no cash offer (control). Reviewers who fulfilled incentivized invitations received a $250 check from the journal. Our primary outcome was the rate of invitation-to-completed-review conversion, defined as the number of reviews submitted divided by the number of reviewer invitations sent out. Secondary outcomes included the "on-time" conversion rate, invitation acceptance rate, time to invitation acceptance, time to review submission, and review quality. Seven hundred fifteen reviewer invitations were sent out, 414 of which (57.9%) included an incentive offer. Two hundred eighteen (52.7%) of the incentivized invitations were accepted, compared with 144 (47.8%) in the control group. A greater proportion of reviewer invitations led to submitted peer review reports in the incentive group than in the control group (49.8% [206/414] vs. 42.2% [127/301]; p = 0.04). In a "survival analysis," invitations sent with an incentive offer were fulfilled faster on average (Cox proportional hazard ratio, 1.30 [1.04-1.62]; p = 0.02), corresponding to quicker review times of approximately 1 day (11 vs. 12 d). Of the 333 reviewer reports submitted, 205 (61.6%) were assessed by editors, with no difference in review quality noted between study arms. Providing cash incentive for completing peer review reports resulted in a modest increase in the share of invited reviewers who complete reviews for a specialty medical journal.

Web references are not eternal: time-trend and qualitative impact of the loss of access to online resources cited in peer-reviewed medical journals.

Web resources can contain high-quality data relevant to peer-reviewed medical publications. However, their online location may change or disappear with time. As medical publication professionals, we are concerned with the ephemeral nature of web resources and the associated qualitative impact on publication integrity of referencing such resources. Time-dependence of the phenomenon was probed using a dataset of reference lists from open and free access articles published in 2018. Each reference list was manually screened to tally the number of web pages no longer accessible. The analysis was repeated yearly from 2021 to 2023. Additionally, a set of proofs was analyzed to investigate the proportion of cited web references already inaccessible at publication. A third dataset, consisting of modeling articles published in 2018-2023, was used to quantify -at a single timepoint- the share of web resources cited as model inputs that were inaccessible. The proportion of inaccessible web resources increased on average from 27.2% to 41.9% three to five years post publication (n = 992 articles), respectively. One out of four analyzed proofs cited at least one inaccessible web resource (n = 50). Five years after publication, 26.1% of web resources used as model inputs were no longer accessible, with one in three modeling articles being impacted (n = 61). The issue of inaccessible web resources cited in peer-reviewed medical publications is of great concern due to the fast pace and potential impact on research reproducibility. These findings call for the definition of best practices involving all stakeholders and the deployment of robust archiving solutions.

Scaling new heights: a prospective survey of rock climbing's impact on mental health

BackgroundSport climbing, officially added to the 2020 Summer Olympics, has grown rapidly, with U.S. climbing gyms increasing from 310 in 2013 to 591 in 2021. Over the past decade, European research has identified bouldering as a potential psychotherapeutic treatment for anxiety and depression. Randomized controlled trials have compared bouldering psychotherapy (BPT) to cognitive behavioral therapy (CBT), showing that BPT produces comparable results and positively impacts mental health.PurposeThere have been very few studies dedicated to the use of rock climbing as a therapy in the United States; further, there are few surveys that investigate whether American climbers would even consider climbing as beneficial towards mental health or not. With the ever-growing prevalence of mental health disorders and as climbing gains more traction, it is important to explore the potential of climbing as a therapeutic modality. It is hypothesized that rock climbing will be viewed as beneficial towards mental health amongst the population surveyed.MethodsA prospective survey was conducted to assess rock climbing’s impact on mental health, focusing on participants' climbing habits and perceptions of its therapeutic benefits. The protocol was approved by the Rowan-Virtua IRB (Reference #: PRO-2022–353) in accordance with the latest guidelines of the International Committee of Medical Journal Editors. Participants were recruited using flyers and posters at climbing gyms, an online climbing forum, and social media. The survey included individuals aged 18 years and older who engage in rock climbing at least once per week. No specific exclusion criteria was set in place, though participants were given the option to omit the mental health portion. The survey included questions on climbing frequency, mental health impact, and demographics. The survey was distributed online via Qualtrics Forms between February 2023 to June 2023, with informed consent obtained from participants, explaining both risks and data safeguards in place. Univariate graphs and bivariate analyses via chi square analysis were done using R Studio.ResultsA total of 748 survey responses were received, with 50.4% of participants aged 26–40 years. Most were White Non-Hispanic (59.7%) and resided in the Mid-Atlantic/Tri-State Area. Climbing preferences showed indoor bouldering (24.9%) as the most popular, followed by indoor top rope (16.4%) and indoor lead climbing (12.4%). Outdoor climbing activities were less common, with traditional climbing at 10.1% and speed climbing at 0.2%. Significant associations were found between climbing frequency and age (p = 0.0045), session length and age (p = 8.2e-10), and climbing frequency by gender (p = 0.0024). Regarding social behavior, 46.8% identified as introverts and 37.1% as ambiverts. Mental health data revealed that 73.1% of climbers felt rock climbing positively impacted their mental health. Depression and anxiety were the most reported conditions. When compared to therapy and medications, 73.3% of participants found rock climbing more beneficial than medications, and 64.8% found it more beneficial than therapy. Gender and race were significantly associated with perceptions of climbing's mental health benefits (p = 0.0448 and p = 0.0422, respectively).ConclusionSurvey results offered future focal points of interest and affirmed that BPT would be received well as a therapeutic modality in the United States. Further, survey participation of 748 completed responses illustrates the community’s support and open communication regarding mental health, creating a promising field to continue exploring. Overall, rock climbing holds potential as a treatment modality for mental health disorders, further bridging the gap between physical and mental health.

Partnerships to Overcome the Peacetime Effect: Excelsior Surgical Society Panel Session.

The Military Health System (MHS) in the United States currently faces a crisis: maintaining medical readiness during a time of relative peace in the face of an increasingly hostile and unstable geopolitical environment. Collaboration through partnerships-with civilian academic medical centers, with academic medical societies and scientific journals, and with advocates for improved policy and supporting legislation-represents one important strategy to stave off the peacetime effect that threatens to erode our combat casualty care skills. This panel session held during the 2022 Excelsior Surgical Society Symposium at the American College of Surgeons Clinical Congress explored the way forward for the MHS amidst these historic challenges with important action items and take-home points for civilian and military surgeons alike.

Use of Thermography Method in Diagnosis of Horse Diseases

Abstract The paper is focused on the practical use of infrared thermography (IRT) in the diagnosis of clinical or subclinical forms of equine inflammation. The aim of the study was to verify the suitability of IRT for the early detection of areas with the potential existence of inflammation. The verification of findings was carried out through veterinary data (medical reports, radiographs). The study claimed the suitability of the IRT method for practical monitoring and detection of health problems, especially limb diseases – hooves, tendons, muscles (13 horses) as well as dermatological diseases (3 horses). The results showed that the most frequent occurrence of the disease, manifested by muscle and tendon overload and inflammatory processes, is on the limbs. The results claimed a significant difference between the measured temperatures and the typical temperatures of a healthy horse.

Automatic medical report generation based on deep learning: A state of the art survey.

Automatic medical report generation based on deep learning: A state of the art survey.

Essential Components of Pharmacist-Prepared Home Care Reports to Facilitate Information Sharing from the Pharmacy Pharmacist to Other Professionals

In this study, we assessed the information sharing practices between pharmacists and multidisciplinary healthcare professionals such as doctors, care managers, and nurses, and others. We evaluated the effectiveness of "home medical care management guidance reports" and "home-visit drug management guidance reports" prepared by pharmacists. We also identified factors that could enhance collaborative practices. To improve the reports, we introduced a new report form with an overview column and a reply column. We used the SOAP format in the new reports. We found that the response rate for reports from X pharmacy was significantly higher than that of Y pharmacies. A survey revealed that X's reports contained more categories (median of 3 versus 1 in Y's reports). Pharmacy X's reports had a smaller proportion of pharmacotherapy details, and a larger proportion of information regarding patients' living and health conditions, as well as environmental factors. We also found that the character count in X's assessment column was significantly greater (168.5 versus 60), and notably less in the overview sections (12 versus 22) when compared to Y's reports. Suggestions and guidance constituted a significantly larger portion of X's reports (29.8% compared to 10.8% in Y's). Questionnaire feedback from other healthcare professionals to whom the subject pharmacies send reports highlighted the importance of pharmacist-provided information on health and living conditions, based on pharmacological knowledge. Based on these results, to enhance health information sharing, pharmacists should integrate assessments of pharmacotherapy with health and living conditions and effectively communicate this information to other professionals.

Bibliometric analysis: A few suggestions (Part Two).

Bibliometric analysis: A few suggestions (Part Two).

FAMM flap in oral cavity and tongue defect reconstruction: A systematic review and meta-analysis.

The facial artery musculomucosal (FAMM) flap is a versatile flap based on the facial artery. It can be used to reconstruct the floor of the mouth, palate, tongue and alveolar ridge. The flap can be designed in various orientations and modified as an islanded or tunnelised flap. This study aimed to review the application of FAMM flap in the reconstruction of defects of the tongue and oral cavity, with specific focus on success rates and total complications. A literature search was conducted by 2 independent reviewers on PubMed, Dynamed, DARE, EMBASE, Cochrane and British Medical Journal (BMJ) electronic databases (Registry CRD42024529989). Twenty-seven studies fulfilled the search criteria and data on 407 FAMM flaps performed on 402 patients were extracted for analysis. Overall, 1.7% (n=7) of flaps failed because of total necrosis (n=3), partial necrosis requiring surgical intervention and flap abandonment (n=2), total failure (n=1) and fistula formation (n=1). Overall, 26.0% (n=106) of patients experienced non-functional complications. The most reported complications were partial necrosis (n=23, 5.7%), wound dehiscence (n=18, 4.4%) and venous congestion (n=13, 3.2%). The pooled success rate in all studies using FAMM flaps for oral cavity and tongue reconstruction was 99.47% (95% CI, 98.26 to 100.00, P = 1.00; I2 = 0%;). Pooled total complication rates were 30.18% (95% CI, 16.97 to 43.38, P < 0.01; I2 = 91%). Only 35 flaps required re-operation. With low complication and failure rates, FAMM flaps are a safe and versatile option to consider in oral cavity and tongue reconstruction.

Inadequate Reporting of Harm From Randomized Clinical Trials in Top Medical Publications.

To assess the quality of harm reporting in randomized controlled trials (RCTs) published in high-impact general medical journals. Publications of RCTs involving drugs compared with placebo controls, that were published in five general medical journals with high Impact Factors were identified from January 2022 to December 2023. Data relating to the presentation and discussion of harm were extracted and analyzed based on the Consort Harm framework. We identified 175 eligible RCTs (AIM: n = 5; BMJ: n = 8; JAMA: n = 26, Lancet: n = 64, and NEJM: n = 72). None of the studies referenced the CONSORT Harms 2004 statement. Seventy-one percent of studies (n = 125) did not mention how harm data about patients' symptoms were collected and 86.3% of the analyses (n = 151) were limited to descriptive statistics. Only 45.1% of studies (n = 79) discussed the balance of benefits and harms. Common limitations included unclear methodological details, selective reporting, and inadequate analysis of results. RCTs published in five highly cited general medical journals contain deficiencies in harm reporting. The recently updated Consort Harm 2022 provides an implementable evaluation and guidance tool and should be actively promoted among researchers, reviewers, and journal editors. More attention to adequate and reasonable reporting requirements for harms in RCTs is necessary to provide a better opportunity for evidence-based decision making.

Slovenian Journal of Public Health: The Journey so Far and the Road Ahead.

The Slovenian Journal of Public Health, established 63 years ago as the official publication of the National Institute of Public Health in Slovenia, was initially aimed at tracking the development of public health in Slovenia and disseminating scientific advancements to professionals in the field. In 2000, a new editorial board took over and shifted the journal's focus towards enhancing scientific rigour and achieving international recognition. This strategic transformation led to the journal being indexed in the Social Sciences Citation Index (SSCI) in 2009, specifically within the category of Public, Environmental & Occupational Health. The indexing enabled the journal to acquire its first impact factor in 2011, which has demonstrated a consistent upward trajectory, currently standing at 1.6 (IF2023). The journal has recently ascended to the third quartile of its field and is now recognised as the second highest-ranked medical journal in Slovenia. Following over two decades of successful leadership, the journal is poised to enter a new phase under an incoming editor-in-chief. It is imperative for the journal to sustain its contributions to public health by promoting high-quality scientific publications and facilitating critical discourse among researchers.

Generating Medical Reports With a Novel Deep Learning Architecture

Generating Medical Reports With a Novel Deep Learning Architecture

What Constitutes a High-Quality Guideline: Exploring Consumers' Views.

Clinical guidelines are a cornerstone of evidence-based medicine. Little is known about clinicians' knowledge of guideline development and how they perceive guideline quality. A survey protocol was designed according to the CHERRIES (improving the quality of web surveys: the Checklist for Reporting Results of Internet E-Surveys) checklist. The survey explored three main aspects: high-quality markers of guidelines, knowledge of guideline development, and areas for improvement. The survey was conducted by contacting UEG and affiliated societies by email and via social media. All valid answers to each question were counted. A total of 585 participants responded during the 3-month period. Some 65.8% were aged between 30 and 60years, and 75.4% were doctors. The most important perceived quality indicators within a guideline were 'clear and actionable recommendations (97%)', followed by 'based on systematic literature review' (96%), and 'transparent methodology' (90%). 230 (39.3%) respondents were previously involved in clinical guideline development. However, the experience of working with a methodologist (18.8%) and using well-established guideline checklists (AGREE-II [21.0%]), RIGHT (Reporting Items for Practice guidelines in HealThcare) (9.9%) were limited. Just under half of the responders (289, 49.4%) were familiar with the GRADE methodology. Apps (78.5%), webinars (73.8%), and short videos (68.2%) were popular tools to access clinical guidelines. Over 90% of responders stated that the reputation of the journal (92%) and the name of the society involved in guideline development (91%) were important. Two-thirds of the responders preferred to see abridged versions of guidelines and 69.2% preferred freely accessible or open access guidelines. Consumers are keen to read clear and actionable guidelines that are developed transparently. There is a gap in guideline development knowledge. Initiatives by medical journals and professional societies are important to ensure the development of accessible and robust clinical guidelines.

Did you know... that 43.5% of New Zealand women report at least some urinary incontinence?

A recent publication in the New Zealand Medical Journal identified that 43.5% of New Zealand women between the ages of 16 and 74 report at least some urinary incontinence.

Generative Artificial Intelligence for the Automated Generation of Medical Reports: A Modified Poor and Rich Optimization (MPRO)-Based Approach

Generative Artificial Intelligence for the Automated Generation of Medical Reports: A Modified Poor and Rich Optimization (MPRO)-Based Approach