Medical Research Articles

Fuzheng-Buyi formula for treating castration-resistant prostate cancer: A systematic review and meta-analysis.

The study was designed to systematically evaluate the efficacy and safety of Fuzheng-Buyi formula in treating castration-resistant prostate cancer (CRPC). A computer-based search were conducted in the databases, including CNKI, WanFang Data, VIP, CBM, PubMed, EMbase, and the Cochrane database to identify all randomized controlled trials. The studies investigating the efficacy and safety of Fuzheng-Buyi formula combined with Western medicine for the treatment of CRPC were included from January 1st, 2010 to December 31st, 2023. The quality of the included studies was evaluated according to the Cochrane Handbook manual, and meta-analysis was performed using Review Manager 5.3 and R Studio 4.2.3 software. In this study, a total of 18 trials were included, encompassing a population of 1093 patients diagnosed with CRPC. The results of the meta-analysis showed that the combination of Fuzheng-Buyi formula and Western drugs was more effective in increasing the overall efficacy rate (risk ratio = 1.31, 95% confidence interval [CI] [1.17, 1.46], P < .00001), decreasing Traditional Chinese Medicine syndrome score (mean difference [MD] = -4.40, 95% CI [-6.10, -2.70], P < .00001), and quality of life scale (physiological condition MD = -2.31, 95% CI [-3.13, -1.48], P < .00001; social well-being MD = 1.26, 95% CI [0. 59, 1.94], P = .0002; emotional well-being MD = -2.04, 95% CI [-2.96, -1.12], P < .00001; functional well-being MD = -3.18, 95% CI [2.11, 4.26], P < .00001; others should be paid to MD = -3.15, 95% CI [-4.93, -1.37], P = .0005) compared with the Western medicine alone. And the incidence of adverse events was significantly lower in the combination treatment group compared with Western medicine group (risk ratio = 0.58, 95% CI [0.46, 0.73], P < .00001). The combination of Fuzheng-Buyi formula and Western medicine was more effective in improving the clinical efficacy and quality of life of CRPC patients, with lower incidence of adverse events compared with Western medicine alone.

Enhancement of the Performance of Large Language Models in Diabetes Education through Retrieval-Augmented Generation: Comparative Study.

Large language models (LLMs) demonstrated advanced performance in processing clinical information. However, commercially available LLMs lack specialized medical knowledge and remain susceptible to generating inaccurate information. Given the need for self-management in diabetes, patients commonly seek information online. We introduce the Retrieval-augmented Information System for Enhancement (RISE) framework and evaluate its performance in enhancing LLMs to provide accurate responses to diabetes-related inquiries. This study aimed to evaluate the potential of the RISE framework, an information retrieval and augmentation tool, to improve the LLM's performance to accurately and safely respond to diabetes-related inquiries. The RISE, an innovative retrieval augmentation framework, comprises 4 steps: rewriting query, information retrieval, summarization, and execution. Using a set of 43 common diabetes-related questions, we evaluated 3 base LLMs (GPT-4, Anthropic Claude 2, Google Bard) and their RISE-enhanced versions respectively. Assessments were conducted by clinicians for accuracy and comprehensiveness and by patients for understandability. The integration of RISE significantly improved the accuracy and comprehensiveness of responses from all 3 base LLMs. On average, the percentage of accurate responses increased by 12% (15/129) with RISE. Specifically, the rates of accurate responses increased by 7% (3/43) for GPT-4, 19% (8/43) for Claude 2, and 9% (4/43) for Google Bard. The framework also enhanced response comprehensiveness, with mean scores improving by 0.44 (SD 0.10). Understandability was also enhanced by 0.19 (SD 0.13) on average. Data collection was conducted from September 30, 2023 to February 5, 2024. The RISE significantly improves LLMs' performance in responding to diabetes-related inquiries, enhancing accuracy, comprehensiveness, and understandability. These improvements have crucial implications for RISE's future role in patient education and chronic illness self-management, which contributes to relieving medical resource pressures and raising public awareness of medical knowledge.

Benchmarking the medication efficiency and technological progress of diabetes drugs

BackgroundDiabetes poses a serious global challenge, given its increasing prevalence, detrimental effects on public health, and substantial economic burden. Since 1950s, tens of drugs have been approved by the United States (US) Food and Drug Administration (FDA). In the past decade, the medical community and regulatory agencies have moved away from the glucose-centric paradigm and increasingly call for a holistic approach to assess different treatments’ benefits and harms.ObjectiveThis study aimed to assess the medication efficiency and technological progress of Type 2 Diabetes (T2D) drugs, by considering their physiological outcomes, including both benefits (i.e., glucose lowering and weight loss) and adverse effects (mortality), relative to dosing frequency.MethodsTo derive medication efficiency, this study utilized data from the US FDA and prominent meta-analyses. Given that both the benefits and adverse effects of medications are multidimensional, this study employed a nonparametric frontier method, the data envelopment analysis (DEA) model, to integrate these factors into a measure of medication efficiency. Physiological outcomes could assume both positive and negative values. Adverse effects were regarded undesirable outputs. The DEA model was built under the framework of directional distance function and was able to handle negative and undesirable values which naturally arose in the case of T2D medications.ResultsThe paper presented a ranking of 20 T2D drugs in terms of medication efficiency. Three of them were able to attain the highest medication efficiency, all of which were in the GLP-1 class, including oral Semaglutide, subcutaneous Semaglutide and Dulaglutide. However, the other two GLP-1 drugs, Lixisenatide and Liraglutide, were less efficient. The average medication efficiency of drugs approved post-2010 was significantly higher than pre-2010 drugs. High dose frequency, low HbA1c reduction and insignificant weight loss were the main driving factors behind inefficiencies. Overall, medication efficiency provided an alternative perspective on treatment effectiveness other than conventional measures such as cost-effectiveness.

Unraveling the impact of host genetics and factors on the urinary microbiome in a young population.

The urinary microbiome, essential to human health, reveals its unique qualities in our study of 1,579 Chinese individuals. We identified distinctive microbial profiles, or "urotypes," and uncovered strong gender-related influences, particularly from sex hormones, on these microbial communities. Our research highlights significant genetic associations affecting specific urinary bacteria, indicating a deep interaction between our genetics and our microbiome. These insights not only enhance our understanding of the urinary microbiome's role in health and disease but also open new pathways for personalized medical strategies, making our findings crucial for future diagnostic and therapeutic innovations. This work underscores the intricate relationship between our body's biological processes and the microorganisms within, providing valuable knowledge for both scientific and medical communities.

Diagnóstico por imagem na medicina veterinária: avanços, aplicações e perspectivas futuras

Abstract. Imaging diagnostics in veterinary medicine have seen significant advancements over the years due to technological evolution, which has also driven procedures and examinations in human medicine. The objective of this article is to discuss these advancements and future prospects in veterinary imaging, as well as to assess their impacts on the clinical routine of small animals. It is concluded that ||elastography and microbubble contrast are among the most promising available imaging methods, capable of aiding in more accurate and early diagnoses, as well as monitoring various treatments and procedures, thereby contributing to the advancement of veterinary sciences.

Research on current issues of self-medication among young people

The aim of the work is to determine the prevalence of self-medication among young people and their attitude to it, with the further development of recommendations for pharmacists regarding the prevention of negative consequences of self-medication and the improvement of pharmaceutical assistance (educational activities) in matters of responsible self-medication. Materials and methods. The work used methods of information search, survey, critical analysis, generalization, and interpretation of results. The survey took place online from January to May 2024, using the developed questionnaire (the electronic version was created using Google Forms). A total of 207 questionnaires were received from people aged 20–25. Results. Mostly, it is difficult for young people to determine their attitude toward self-medication. During treatment, a large number of research participants use the advice of doctors and pharmacists. 75.8 % of respondents always study the instructions for the medical use of drugs before using them. Basically, young people do not increase the dose of drugs arbitrarily to speed up their recovery. Almost half of them do not change the prescribed medications by the doctor to cheaper analogs. According to the research participants, half of them consider an adequate amount of drugs in the form of two names, and this is confirmed by the fact that 83.6 % of them had cases of simultaneous administration of more than one drug. After undergoing self-treatment, 75.8 % of respondents consider it not always practical, among which 13.5 % indicate that it was necessary to consult a doctor. Conclusions. The prevalence and attitude toward self-medication among young people were studied. The main reasons for self-medication are the difficulty of getting to a doctor’s appointment and lack of time, as well as the reduction of disease symptoms after self-diagnosis and the use of drugs and preventive measures. It should be noted, that 23.2 % of young people nevertheless turned to a doctor after receiving negative manifestations of self-medication, and half of the respondents shared their experience of self-medication. The obtained information can be useful for pharmacy institutions, which can use it to create a comprehensive model of a program for the prevention of negative consequences of self-medication, especially among young people, and increase patients’ commitment to the pharmaceutical enterprise.

Knowledge Aware Automated Health Claims Processing with Medical Ontologies and Large Language Models

One of the major challenges in automating health insurance claims processing lies in the complexity involved in validating an incoming claim's medical diagnoses against its policy Underwriting (UW) exclusions. Termed UW Exclusion Detection, this process ensures claims are only paid out if their diagnoses are not medically associated with conditions excluded under the policy. Medical diagnoses in health insurance claims are typically represented by the International Classification of Disease (ICD) codes, established by the World Health Organization. For example, given a policy that excludes "all respiratory illness". A claim with the ICD code J45 (Asthma) will be subject to rejection as J45 is a respiratory-related diagnosis that falls within the scope of the policy's UW exclusion. The key challenge in automating this process lies in the wide range of available ICD codes. The ICD-10-CM coding scheme consists of over 40,000 codes, which often results in scenarios where codes encountered during inference are absent from the training data. These unseen ICD codes limit the effectiveness of data-driven approaches, which depend on the training data to discern medically relevant associations between UW exclusions and ICD codes. This underscores the need to supplement data-driven approaches with additional domain knowledge. We hypothesize that integrating implicit medical domain knowledge inherent in Large Language Models (LLMs) with explicit domain knowledge from medical ontologies, will enhance data-driven approaches for UW Exclusion Detection. Thoroughly validated on real-world health insurance claims data, our proposed approach proved effective in accurately establishing medically relevant associations between UW exclusions and ICD codes.

YouTube as a source of information in cardiopulmonary resuscitation for 2020 AHA Resuscitation Guidelines.

The Internet has transformed global information access, particularly through platforms like YouTube, which launched in 1995 and has since become the second largest search engine worldwide with over two billion monthly users. While YouTube offers extensive educational content, including health topics like cardiopulmonary resuscitation (CPR) and basic life support (BLS), it also poses risks due to potential misinformation. Our study focuses on evaluating the accuracy of CPR and BLS videos on YouTube according to the latest 2020 American Heart Association (AHA) guidelines. This research aims to highlight inconsistencies and provide insights into improving YouTube as a reliable educational resource for both lay rescuers and healthcare professionals. In this cross-sectional observational study, English YouTube videos uploaded between October 21, 2020, and May 1, 2023, were searched using keywords related to CPR and basic life support. Videos were assessed for their source, duration, views, use of human or mannequin models, and mean assessment scores by two emergency medicine physicians. A third physician's opinion was sought in cases of disagreement. The first assessment evaluated video validity based on specified information criteria, while the second assessed their ability to convey advanced medical information aligned with the 2020 AHA guidelines. In this study, 201 English YouTube videos uploaded between October 21, 2020, and May 1, 2023, were evaluated based on search terms related to CPR and BLS, resulting in 95 videos meeting inclusion criteria after excluding 106 due to various reasons. Most included videos were from healthcare professionals (49.5%), followed by anonymous sources (29.5%) and official medical organizations (21.1%). Video durations ranged widely from 43 to 6,019 seconds, with an average of 692 seconds. Videos featuring mannequins predominated (91.6%), followed by those using human subjects (5.3%) or both (3.2%). Healthcare professional and official medical organization videos scoring significantly higher than those of unknown origin (p=0.001). Video length did not correlate significantly with view counts, although shorter videos under 5 minutes tended to have higher average views. The results presented in this study demonstrated that English-language videos on YouTube related to BLS and CPR, throughout the study period, did not conform to the 2020 AHA guidelines in terms of providing basic information for lay rescuers. Furthermore, healthcare professionals cannot obtain advanced medical knowledge through these videos. We recommend a professional oversight mechanism in health-related videos that does not tolerate such misinformation.

Pro-Con Debate: Air or Saline for Loss-of-Resistance Technique of Interlaminar Epidural Access with Fluoroscopy-Guided Pain Medicine Procedures

In this Pro-Con commentary article, the Pro side advocates that using the loss of resistance (LOR) to air technique for interlaminar epidural access is safe as the risk of pneumocephalus is exceptionally low. They note that case reports detailing complications typically utilize at least 1 mL of air, frequently exceeding this amount. Even a 1-mL dosage surpasses the requirement, particularly when fluoroscopy is applied in the context of chronic pain management. The proponents also suggest a modified technique, where a syringe containing a drop of saline or contrast acts as a visual cue, minimizing air injection into the epidural space to a negligible quantity. Moreover, they emphasize that air facilitates the identification of any fluid as an indicator of unintended intrathecal access. The Con perspective argues against the utilization of air for epidural access and advocates for the use of LOR with saline instead. This stance is supported by evidence pointing to a greater occurrence of adverse events, such as postdural puncture headache (PDPH) and pneumocephalus, associated with LOR to air compared to LOR with saline. They also argue that saline’s physical properties enhance tactile feedback, potentially contributing to its increased safety. Both saline and air have been used for many years for epidural access via the interlaminar approach. Although both are generally accepted in practice, neither has been formally established as the standard of care. It would benefit the medical community to further delineate the pros and cons of each medium, enabling practitioners to make more informed decisions. This Pro-Con debate will provide 2 perspectives (Table) on the evidence and rationales for the use of air or saline for the LOR technique in interlaminar epidural access with fluoroscopy.

Medicines shortages in the UK: review of the causes and analysis of serious shortage protocols – a mixed methods study

Abstract Introduction Causes of medicines shortages are multifactorial. In February 2019, the Human Medicines Regulations 2012 introduced Serious Shortage Protocols (SSPs) to address medicines shortages. SSPs are issued by the Department of Health and Social Care and enable pharmacists to supply alternative medicines without amended prescriptions1. Aim This review aimed to explore contemporary reasons attributed to medicines shortages in the United Kingdom (UK) and analyse expired SSP records. Methods A rapid scoping literature review was conducted using National Library of Medicine (PubMed®) and Elsevier (ScienceDirect). Grey literatures were collated from the Pharmaceutical Journal, Google, and Public Health England’s grey literature index. Searches were limited to publications written in English, published since 2014, which met the inclusion criteria (medicines OR drugs AND shortages AND causes). Data extraction and analysis was performed using Microsoft Excel. Expired SSPs were extracted to Microsoft Excel and analysed using descriptive and inferential statistics on R software (v.4.3.2). SSP data is publicly available; therefore, no ethical approval was required. Results Causes of Medication Shortages A total of 11 papers were selected, in which 77 medicines shortage causes were discussed. Narrative analysis identified 10 shortage-drivers. The most frequent were Manufacturing and Quality Challenges (30%,23/77), Business and Commercial Issues (21%,16/77), and Regulatory Changes and Challenges (10%,8/77). Content analysis found that supply-driven issues were more frequently cited than demand-driven issues. SSP Analysis Between October 2019 and June 2024, 59 SSPs had expired2. Menopausal Hormonal Treatments (MHTs) were the most common medication class in shortage (41%,24/59), followed by antibiotics (17%,10/59), and antidepressants (12%,7/59). The mean shortage length was 129.2 days (IQR=51–196), the longest lasting 359 days (oestradiol 0.5mg/1mg gel sachets). Oestradiol transdermal medications accounted for 19 of 24 MHT SSPs. The mean MHT shortage length was 152.6 days (IQR=51.0–216.0). Phenoxymethylpenicillin accounted for 8 of 10 antibiotic shortages. All 8 phenoxymethylpenicillin SSPs were active from 15 December 2022 to 12 May 2023; 7 of 8 were oral solution formulations. The mean antibiotic shortage length was 168.8 days, which is significantly longer than the whole sample average (p&amp;lt;0.05, IQR=147.0–148.0). All antidepressant SSPs were fluoxetine capsules. The mean shortage length was 99 days (IQR= 35.5–122.0). Discussion Existing literature suggests supply-driven rather than demand-driven causes of medication shortages are more pertinent; however, most expired SSPs were issued in response to demand-driven factors, such as disease outbreaks and changing prescribing demand. This suggests the extent of demand-driven shortages is not reflected in current literature. Future research should explore how demand-driven causes of shortages can be mitigated. As a rapid scoping review was conducted, the full breadth of literature may not be presented. Additionally, the grey literature findings are limited by potential inaccuracies. Finally, the use of narrative analysis may limit the generalisability of identified shortage drivers. As of 05 June 2024, there are 5 active SSPs. With medicines shortages becoming normalised within the UK health system3, there is an urgent need to mitigate supply- and demand-driven causes. Additionally, further research should explore why certain medication classes are more frequently in shortage than others.

Addressing diagnostic delays in inflammatory bowel diseases in Germany.

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

Understanding the role of induction, intensions and extensions in pragmatic clinical research and practice

BackgroundPragmatic clinical research methods are poorly understood, but essential to practice outcome-based medical or surgical care. Pragmatic research aims to verify the connections between medical knowledge and the reality of practice. Its methods can be understood by reviewing the problems of induction, as well as the related linguistic and mathematical notions of intensions and extensions. MethodsWe briefly review the source of problems with using inductive methods to gain knowledge, and the relationships between language, mathematics and reality. We discuss linguistic 'sense’ and ‘reference’, and the set-theory terms ‘intensions’ and ‘extensions’, which define the relationship between individuals and whichever pertinent collection these individuals comprise. Both concepts are essential to understand pragmatic medical research and evidence-based practice. ResultsPragmatic clinical research can be explained in terms of testing (in reality) the repeatability of various inductive referential and inferential steps used in clinical practice - from reliability, diagnostic accuracy, and prognostic studies to pragmatic trials. All pragmatic studies aim to verify the relationship between the extensions of the notions of symptoms, diagnoses, prognoses, treatments, and outcomes. The concepts of intensions and extensions also serve to understand ‘statistical significance’ in analyzing trial results, as well as problems related to eligibility criteria and subgroup analyses. The results of clinical studies can be generalized to the extent that they have been tested in numerous and widely different individuals. ConclusionThe notions of sense and reference, and of intensions and extensions, help explain the role pragmatic clinical research methods can play in optimizing care.

Post-COVID Syndrome as a Defect of a Transaction Through the Example of a Mortgage Agreement

Introduction: currently, society is faced with a very important and urgent task: formatting the established foundations of civil circulation with the participation of individuals in connection with the manifestation of the negative consequences of a new coronavirus infection. Representatives from the medical community have stated that the emergence of a new disease can have negative consequences for a person’s mental health. The concern of law enforcement officers is caused by the fact that over the past 3–5 years, the cases of court proceedings for invalidation of a transaction on the grounds of Article 177 of the Civil Code of the Russian Federation have become more frequent, as committed at the time of ignorance and misunderstanding of the consequences of the transaction not related to the indicators of the individual’s legal capacity as a whole. Undermining the stability of civil circulation, especially in terms of concluding and executing transactions, increases when one of the parties is a capable citizen who, due to a previous coronavirus infection, has deviations from a normal mental state (post-COVID syndrome). The potential for nullifying such transactions and, subsequently, disrupting the dynamics of civil circulation highlights the necessity for the development and implementation of a set of methods and mechanisms that are not primarily legislative in nature but rather focus on flexible enforcement. These methods and mechanisms should be designed to address the negative manifestations, including those caused by the deterioration of an individual’s mental health following a SARS-CoV-2 infection, in the context of significant structural changes in social, environmental, and economic activities. In light of the above, one of the challenges for civilists is the humane and fair application of the provisions on invalidation of the transaction due to the inability of a person to realize and bear responsibility for decisions made due to deviations from the norm of mental health as a result of a coronavirus infection. Of particular importance in the light of the issue under study is the analysis of judicial practice, which allows studying the specifics of law enforcement on this issue and identifying blocks of perspectives in the judicial review of such disputes, taking into account the opinions of representatives of medicine focused on identifying negative consequences in human mental health. Thus, to a greater extent in the practice of civil law than in science, there is a need to formulate the problems of the legal regulation of invalidation of a transaction on the grounds of Article 177 of the Civil Code of the Russian Federation and propose fair, wise, and objective ways to resolve judicial conflicts, which is the purpose of the study. Methods: the methodological framework for the study is a set of methods of scientific cognition, among which the main ones are analysis, synthesis, generalization, and comparative jurisprudence. Results: the author has studied the judicial practice of modern times on the issue of invalidation of transactions through the example of a mortgage agreement. The analysis has made it possible to recognize that the consequences of a coronavirus infection can affect the psychiatric and mental state of a legally capable person in such a way that the person is unable to realize and understand the consequences of the actions performed. The main result is the conclusion that within the framework of resolving the issue of invalidation of the transaction due to the inability of a person to realize the consequences of his actions, it is necessary to consider in detail the arguments of the person who has applied for judicial protection, including taking into account those medical indicators that normally do not affect the legal capacity of an individual but have a negative effect on mental health.

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

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

SAMCT: Segment Any CT Allowing Labor-Free Task-Indicator Prompts.

Segment anything model (SAM), a foundation model with superior versatility and generalization across diverse segmentation tasks, has attracted widespread attention in medical imaging. However, it has been proved that SAM would encounter severe performance degradation due to the lack of medical knowledge in training and local feature encoding. Though several SAM-based models have been proposed for tuning SAM in medical imaging, they still suffer from insufficient feature extraction and highly rely on high-quality prompts. In this paper, we propose a powerful foundation model SAMCT allowing labor-free prompts and train it on a collected large CT dataset consisting of 1.1M CT images and 5M masks from public datasets. Specifically, based on SAM, SAMCT is further equipped with a U-shaped CNN image encoder, a cross-branch interaction module, and a task-indicator prompt encoder. The U-shaped CNN image encoder works in parallel with the ViT image encoder in SAM to supplement local features. Cross-branch interaction enhances the feature expression capability of the CNN image encoder and the ViT image encoder by exchanging global perception and local features from one to the other. The task-indicator prompt encoder is a plug-and-play component to effortlessly encode task-related indicators into prompt embeddings. In this way, SAMCT can work in an automatic manner in addition to the semi-automatic interactive strategy in SAM. Extensive experiments demonstrate the superiority of SAMCT against the state-of-the-art task-specific and SAM-based medical foundation models on various tasks. The code, data, and model checkpoints are available at https://github.com/xianlin7/SAMCT.

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

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

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

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

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

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

The impact of using bee pollen in poultry systems

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

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

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