Medical Research Articles

A Comprehensive Systematic Review of Etiology and Risk Factors of Surgical Site Infections

Introduction: Surgical wound infections (SWIs) remain a significant risk to patients due to their high morbidity and mortality rates. Moreover, they pose substantial economic challenges for both developing and developed countries. The global impact of these infections is staggering, with the World Health Organization (WHO) reporting that millions of patients worldwide are affected by hospital-acquired infections annually, with many succumbing to these infections. This study aims to analyze the incidence of surgical site infections (SSIs) based on the type of surgical intervention, identify the most frequent causes of these infections, and explore effective management strategies. The findings of this study will provide valuable insights into the prevention and management of SSIs, thereby enlightening the medical community and empowering them to improve patient outcomes. Material and Methods: This study, conducted with meticulous attention to detail, focuses on patients operated on in our clinic from January to October 2024. It will reflect the incidence of SSI according to the type of surgical intervention, the most frequent causes of these infections, and the way of their treatment. Results: From January 2023 to June 2024, 788 patients were hospitalized, and 408 were operated on in the Surgery Department of the Clinical Hospital of Tetovo. Three hundred fifty were male, and 438 were female. The ages of the patients included in the study ranged from 21 to 81. Most of the patients were operated on because of cholecystolithiasis, inguinal, ventral, and umbilical hernias, breast cancer, acute appendicitis, and neoplasia of the colon and ileus. From the total number of operated patients (408), the infection of operative wounds was recorded in 49, representing an incidence of 11.76 %. Conclusion: The findings of this study underscore the serious global implications of SSIs, including increased morbidity and mortality rates and the strain on healthcare budgets. Therefore, the prevention and reduction of these infections should be a priority for all countries, irrespective of their economic status.

Implementation of Alcohol Use Disorder Training Curriculum Improves Perceived Confidence in Treating Alcohol-Related Liver Disorder Amongst Gastroenterology Fellows.

Alcohol use disorder and alcohol-associated liver disease is increasing in the US, with subsequent and expected increases in morbidity and mortality due to these conditions. To determine the impact of an educational intervention regarding alcohol use disorder on gastroenterology fellows. A before-after survey study was carried out. Subjects were gastroenterology fellows at an urban tertiary care facility, who completed a pre-questionnaire and then attended a one-hour educational lecture on alcohol use disorder, alcohol-related liver disease, and treatment/resources available for patients. Immediately after the 1-h lecture, fellows were asked to complete a post-questionnaire and then a delayed questionnaire three months later. Pre- and post-answers were averaged out of a scale of 5 and analyzed using t-tests. The study included eight fellows. Post-intervention, 12% of fellows felt more confident in having adequate training to provide alcohol use disorder counseling to their patients, 25% felt more confident in who they should refer their patients to for alcohol use disorder, and 16% felt more comfortable in being able to speak with their patients regarding alcohol use disorder and help effectively reduce their patients' consumption of alcohol (p value < 0.05). A 1-h presentation discussing the complexities associated with diagnosing and treating alcohol use disorder, and the methods of helping destigmatize the disease in the medical community, can increase trainees' confidence and knowledge base to help treat patients with alcohol use disorder in the clinic setting and reducing liver morbidity.

Therapeutic potential and pharmacological mechanisms of Traditional Chinese Medicine in gout treatment.

Gout is a systemic metabolic disorder caused by elevated uric acid (UA) levels, affecting over 1% of the population. The most common complication of gout is gouty arthritis (GA), characterized by swelling, pain or tenderness in peripheral joints or bursae, which can lead to the formation of tophi. At present, western medicines like colchicine, febuxostat and allopurinol are the primary treatment strategy to alleviate pain and prevent flare-ups in patients with GA, but they have significant side effects and increased mortality risks. Traditional Chinese medicine (TCM) has been utilized for thousands of years for the prevention and treatment of GA, demonstrating effective control over serum UA (SUA) levels with fewer side effects. Herein we summarized a total of 541 studies published from 2000 to 2023 in sources including PubMed, Web of Science, the Cochrane Library and Embase, highlighting the therapeutic potential of TCM in treating gout and GA, particularly in combination with modern medical strategies. This review focuses on TCM formulas, Chinese herbal extracts, and active compounds derived from TCM, providing an overview of recent clinical application and the pharmacological research based on animal models and cellular systems. Particularly, the current review categorized the clinical and experimental evidence into the strategies for improving hyperuricemia, decreasing the sudden onset of acute GA and retarding chronic GA progression, supplied further coherent reference and enlightenment for clinicians, investigators of natural product chemistry, researchers in TCM and pharmacology. We hope this article will inspire the development of novel formulas and molecular entities for the treatment of gout and GA.

Cardiac Critical Care of the Cardio-Obstetric Patient.

Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States, with an incidence that has increased from 7.2 to 32.9 fatalities per 100,000 live births in the last 3 decades. This trend underscores the potential for an increase in the volume of admissions to cardiac intensive care units (CICUs) in the peripartum period. While congestive heart failure remains at the forefront of maternal morbidity, other life-threatening conditions include myocardial infarction (MI), hypertensive emergencies, fatal arrhythmias such as ventricular fibrillation, venous thromboembolism, aortopathies, valvular dysfunction, cardiac arrest, and cardiogenic shock. The lack of standardized guidelines to facilitate management of these conditions highlights the significant gap in medical knowledge while caring for acutely ill pregnant women. Through this comprehensive review, we highlight the most common cardiac pathologies encountered in the obstetric population and their diagnosis and contemporary management in the cardiac intensive care unit.

Effect and Safety of Fuzheng Huazhuo Decoction against Prolonged SARS-CoV-2 Clearance: A Retrospective Cohort Study.

To evaluate the effect and safety of Chinese medicine (CM) Fuzheng Huazhuo Decoction (FHD) in treating patients with coronavirus disease 2019 (COVID-19) who persistently tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This retrospective cohort study was conducted at Shanghai New International Expo Center shelter hospital in China between April 1 and May 30, 2022. Patients diagnosed as COVID-19 with persistently positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results for ⩾8 days after diagnosis were enrolled. Patients in the control group received conventional Western medicine (WM) treatment, while those in the FHD group received conventional WM plus FHD for at least 3 days. The primary outcome was viral clearance time. Secondary outcomes included negative conversion rate within 14 days, length of hospital stay, cycle threshold (Ct) values of the open reading frame 1ab (ORF1ab) and nucleocapsid protein (N) genes, and incidence of new-onset symptoms during hospitalization. Adverse events (AEs) that occurred during the study period were recorded. A total of 1,765 eligible patients were enrolled in this study (546 in the FHD group and 1,219 in the control group). Compared with the control group, patients receiving FHD treatment showed shorter viral clearance time for nucleic acids [hazard ratio (HR): 1.500, 95% confidence interval (CI): 1.353-1.664, P<0.001] and hospital stays (HR: 1.371, 95% CI: 1.238-1.519, P<0.001), and a higher negative conversion rate within 14 days (96.2% vs. 82.6%, P<0.001). The incidence of new-onset symptoms was 59.5% in the FHD group, similar to 57.8% in the control group (P>0.05). The Ct values of ORF1ab and N genes increased more rapidly over time in the FHD group than those in the control group post-randomization (ORF1ab gene: β =0.436±0.053, P<0.001; N gene: β =0.415 ±0.053, P<0.001). The incidence of AEs in the FHD group was lower than that in the control group (24.2% vs. 35.4%, P<0.001). No serious AEs were observed. FHD was effective and safe for patients with persistently positive SARS-CoV-2 PCR tests. (Registration No. ChiCTR2200063956).

The Introduction of the Global Traditional, Complementary, and Integrative Healthcare (TCIH) Research Agenda on Antimicrobial Resistance and Its Added Value to the WHO and the WHO/FAO/UNEP/WOAH 2023 Research Agendas on Antimicrobial Resistance

Background/Objectives: Given the magnitude and urgency of the global antimicrobial resistance (AMR) problem and the insufficiency of strategies to reduce antimicrobial use, there is a need for novel strategies. Traditional, Complementary, and Integrative Healthcare (TCIH) provides strategies and solutions that contribute to reducing (inappropriate) antimicrobial use, preventing or treating infections in both human and veterinary medicine, and may contribute to promoting the health/resilience of humans and animals and reducing AMR. The aims of this study were to present the core results of a global TCIH research agenda for AMR and its added value to two existing global AMR research agendas published in 2023. Methods: A survey, interviews, and consensus meetings among network members, as an adapted version of the nominal group technique, were executed to develop the global TCIH research agenda. A comparison of the global TCIH research agenda with the two existing global AMR research agendas was performed. The TCIH additions to these two existing global AMR research agendas were determined. Results: The global TCIH research agenda adds to 19 of 40 research priorities of the World Health Organization (WHO) AMR research agenda 2023 and three of the five pillars of the WHO/Food and Agriculture Organization of the United Nations (FAO)/United Nations Environment Programme (UNEP)/World Organisation for Animal Health (WOAH) research agenda 2023. In addition, the TCIH research agenda adds two new research themes with four new research priorities and three new research priorities to already existing themes of the two global AMR research agendas. Conclusions: The global TCIH research agenda fits with and adds to two global AMR research agendas and can be used as an additional strategy to reduce AMR and (inappropriate) use of antibiotics.

Application of Chinese Medicine in Treatment of Ulcerative Colitis and Elucidation of Relevant Mechanisms.

Ulcerative colitis (UC) is a chronic, non-specific intestinal disease of unknown etiology, with high incidence rates worldwide. At present, Western medicine treatments have been associated with more adverse effects and poor efficacy. Chinese medicine (CM) is commonly used as an adjuvant treatment for the unique advantages in regulating immune function, repairing intestinal mucosa, and alleviating intestinal inflammation. At the same time, network pharmacology is also providing new ideas and innovations about CM and development of new drugs. This review systematically discusses the progress of research regarding UC treatment using CM, with a main focus on intestinal flora balance, intestinal mucosal barrier, CM enema, acupuncture therapy, and acupoint embedding. This study provides new ideas that clarify the therapeutic targets of UC.

Association of clinical knowledge with patient care ownership among resident physicians: a nationwide cross-sectional study in Japan

PurposeBoth clinical knowledge and patient care ownership (PCO) are crucial to the provision of quality patient care and should be acquired during training. However, the association between these two concepts is under-examined. Here, we conducted a nationwide cross-sectional study to investigate the association between clinical knowledge and PCO among resident physicians in Japan.MethodsFrom January 17 to March 31, 2024, we conducted an anonymous, online, self-administered survey for a series of PCO research projects. The survey targeted medical residents who took the General Medicine In-Training Examination (GM-ITE). The mean of the Japanese version of the PCO Scale was used as outcome variable. The primary explanatory variable was total GM-ITE score, while the secondary explanatory variables were GM-ITE category scores in medical knowledge. We conducted multivariable linear regression analysis, controlling for postgraduate years, sex, number of assigned inpatients, weekly working hours, type of hospital, and size of hospital.ResultsWe included 1836 participants in our statistical analysis. Multivariable linear regression analysis revealed that after adjustment for possible confounders, GM-ITE total scores showed a significantly negative association with PCO in the highest score quartile (adjusted mean difference − 0.20, 95% confidence interval (CI) -0.33 to -0.07, compared with the lowest score quartile). Additionally, after controlling for possible confounding factors, scores for symptomatology and clinical reasoning showed a dose-dependent negative association with PCO (adjusted mean difference − 0.17, 95% CI -0.30 to -0.03 for the highest score quartile compared with the lowest score quartile). No significant dose-dependent associations were found for the other categories.ConclusionsThese findings suggest the presence of potential challenges in the simultaneous fostering of clinical knowledge and PCO during residency training. This underscores the need for educators to actively engage in the reconsideration of current postgraduate training strategies, with the aim of effectively cultivating both clinical knowledge and PCO among medical residents.

China’s national continuing medical education program for general practitioners: a cross-sectional survey (2016–2023)

BackgroundPursuing excellence in healthcare delivery systems is an ongoing process. In this process, continuing medical education (CME) is essential for medical professionals to maintain high standards of patient care. In China, where the healthcare sector is undergoing considerable reforms and faces challenges owing to socioeconomic development and demographic shifts, an effective CME system is vital for general practitioners (GPs).MethodsA cross-sectional survey of CME programs was conducted between 2016 and 2023. The external characteristics of the programs were systematically gathered and statistically analyzed. The programs were subsequently subjected to a competency-based assessment by using the six core competencies outlined by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education as a framework. Furthermore, keywords were extracted for the CME program names based on the International Classification of Primary Care. Visual analysis was performed via VOSviewer software, facilitating a content-based evaluation of the programs.ResultsA total of 6,607 items were obtained. A total of 3,815 CME programs were subjected to statistical analysis, and 2,895 CME programs were comprehensively evaluated for content and capability. A diverse range of CME providers were identified, with hospitals and publishing/education companies being the primary providers. Since 2019, a significant increase in online CME offerings has been noted. However, the regional distribution of the CME programs was uneven, with Shanghai, Zhejiang, and Beijing leading but western China lagging. Furthermore, most programs focused on patient care and medical knowledge in competency-based CME evaluations, with less emphasis on interpersonal and communication skills. Content-based CME evaluations revealed that the teaching focus is the diagnosis, treatment, and primary care management of elderly patients and chronic diseases such as diabetes and hypertension.ConclusionsOur findings underscore the essential role of CME in equipping GPs with the competencies required to navigate the evolving landscape of medical knowledge and practice, suggesting a more systematic, relevant, and individualized approach to training GPs. Therefore, there is an opportunity to increase the quality of primary care and contribute to the Healthy China 2030 Plan.

The case of Wellness Valley: promoting physical activity and exercise medicine for a sustainable health care system

ABSTRACT Today’s health care systems primarily focus on treating noncommunicable diseases (NCDs) rather than preventing them. Currently, this approach is not sustainable and requires innovative transformations to face the challenges posed by the aging population, the increasing NCD prevalence, widespread physical inactivity, and growing obesity rates. Regular physical activity and exercise improve quality of life and are effective for the prevention and treatment of numerous NCDs and to reduce health care costs. Physical activity promotion and exercise medicine thus represent cost-effective solutions for a sustainable model of health. The Wellness Valley initiative in Emilia-Romagna, Italy, exemplifies this model by fostering active, healthy lifestyles. In Wellness Valley, physical activity is promoted through multi-stakeholder initiatives of education and engagement, and exercise medicine is supported in the medical community through continuous education and dedicated infrastructure, such as certified health-promoting gyms. With these initiatives in place, the population of Wellness Valley is more physically active compared to the Italian national average. Overall, shifting health models toward preventative strategies centered on healthy active lifestyles and exercise can increase physical activity levels and contribute to alleviating the growing burden of NCDs on health care systems.

Pharmacodynamic Profiling of Amoxicillin: Targeting Multidrug-Resistant Gram-Positive Pathogens Staphylococcus aureus and Staphylococcus pseudintermedius in Canine Clinical Isolates

The rising threat of antimicrobial resistance (AMR) is a global concern in both human and veterinary medicine, with multidrug-resistant (MDR) pathogens such as Staphylococcus aureus and Staphylococcus pseudintermedius presenting significant challenges. Background/Objectives: This study evaluates the effectiveness of amoxicillin against these MDR pathogens in canine isolates using pharmacokinetic and pharmacodynamic parameters. Methods: Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and mutation prevention concentration (MPC) were assessed. Additionally, time-kill assays and post-antibiotic effect (PAE) assessments were performed. Epidemiological cutoff (ECOFF) values were established for both species to guide therapy. Results: S. aureus had a higher resistance rate (35.89%) than S. pseudintermedius (15.27%), with MIC50 values of 0.50 μg/mL and 0.25 μg/mL, respectively. The MPC analysis revealed that S. pseudintermedius required higher antibiotic concentrations (16.11 μg/mL) to prevent mutations compared to S. aureus (2.20 μg/mL). Time-kill assays indicated that higher amoxicillin dosages caused faster bacterial reduction. The PAE analysis showed extended post-treatment bacterial suppression at elevated doses, particularly against S. aureus. Conclusions: Species-specific amoxicillin dosing strategies are necessary due to differing resistance and susceptibility profiles between S. aureus and S. pseudintermedius. High-dose amoxicillin therapy is recommended to achieve optimal therapeutic outcomes for resistant SA, while slightly adjusted dosing can manage S. pseudintermedius infections. These findings provide essential insights for veterinary antimicrobial stewardship, underscoring the need for tailored therapeutic approaches to minimize AMR development while ensuring effective infection control.

Medical Problems of Chronic Hypoxia in Highlanders Living on the Tibetan Plateau.

Ri-Li Ge. Medical problems of chronic hypoxia in highlanders living on the tibetan plateau. High Alt Med Biol. 00:00-00, 2024.-Health issues at high altitudes arise due to the lower atmospheric pressure and subsequent reduction in the partial pressure of oxygen in ambient air. While much research has been published on health problems of lowlanders who move to high altitudes, less is known about the medical challenges faced by long-term and permanent high-altitude residents, especially in the Qinghai-Tibetan plateau. In this review, we briefly summarized the chronic hypoxia-related health issues in highlanders, focusing on the specific population of the Qinghai-Tibetan plateau. It deals with important health problems for highlanders, including the main disease categories, from chronic mountain sicknesses and pulmonary hypertension (PH) to kidney, neurocognitive impairments, perinatal problems, and congenital heart defect. However, the most hallmark of disorders is excessive erythrocytosis associated with specific symptoms and signs, and high-altitude heart disease is characterized by excessive PH, right ventricular hypertrophy, and right heart failure. We also provide information on potential treatment strategies, including some traditional Tibetan medical practices and also a combination of Western medicine and traditional Chinese medicine to prevent and treat these conditions effectively. This mini-review is heavily based on a couple of decades of research carried out by Chinese high-altitude medical research groups at the Qinghai-Tibetan Plateau. We believe that this review will provide valuable perspective to researchers whose study interest and base lie in high altitude.

Online resources for ankle sprains : AGerman language web analysis

With the Internet as the main source of information for health content, the quality of websites with medical information is of high importance. This study analysed 250 websites on acute ankle sprain (ASD), one of the most common musculoskeletal disorders, for their quality and readability. Based on the results, aguide for patients was created. The quality of the websites was assessed using a25-item content score and the EQIP36 score for medical information material. The reading level could be determined using the Flesch-Kincaid index and the calculated readability. The best three websites were evaluated in auser survey. Of the 250 websites recorded 77 were included in the study. The quality of these varied significantly, with none achieving the maximum score. Sources in the healthcare system showed higher quality, while commercially influenced sites were below average in terms of completeness of content. Only 14% of the websites reached the recommended reading level. Asignificant negative correlation was found between completeness of content and readability. The user survey showed amixed level of satisfaction and participants with previous medical knowledge were more critical than laypersons. Online resources about ASD are suboptimal and differ considerably. Deficiencies in content, readability and structure were identified, which limit the effective use by patients. Health information publishers should work harder to improve the comprehensibility and quality of the information provided.

The 6th Year of the Study of Human Medicine is Mainly Orientated to Practice: a Pilot Study with a Digital Logbook

Digital learning resources are in increasing demand, especially in the light of the planned reform of the medical licensing regulations for 2028. In a pilot project, we digitised and evaluated a logbook for students in their practical year (PJ).The aim of this study is to evaluate the digital and non-digital PJ logbooks.Based on a printed PJ logbook, a digital PJ logbook was developed as a web app. The implementation was performed using the commercial enterprise knowledge management system Confluence (Atlassian Corporation, Sydney, Australia), which allows responsive design, integration with the university's user directory, and incorporation of corporate design. Student satisfaction (n=34) was assessed using questionnaires and a 5-level Likert scale. Additionally, students self-assessed their skills at the beginning and end of the rotation before (n=49) and after (n=34) the introduction of the digital logbook by grade points.The majority of students found the digital logbook to be an intuitive and a valuable addition. In the stationary setting, the introduction of the digital logbook led to a significant improvement in self-assessed skills by 0.73 grade points at the beginning (p<0.001) and 0.78 grade points at the end of the rotation (p<0.001). In the operating theatre, there was only a significant improvement of 0.47 grade points at the beginning of the rotation (p=0.027).The evaluation demonstrates that the digital PJ logbook is well-received by students and significantly improves their self-assessed skills. The observed increase in self-assessed skills could be attributed to the introduction of the digital logbook and its contents, although other factors, such as the engagement of the instructors, cannot be excluded. Future modifications are planned to make the logbook more appealing.

Chinese and western medicine treatment of myocardial fibrosis drugs

Myocardial fibrosis (MF) is a common pathological manifestation of many cardiovascular diseases, such as myocardial infarction, myocardial ischemia, and sudden cardiac death. It is characterized by excessive proliferation and activation of fibroblasts, transformation into myofibroblasts, and, eventually, excessive deposition of the extracellular matrix, resulting in heart damage. Currently, modern drugs such as angiotensin-converting enzyme inhibitors, diuretics, and β-blockers can improve myocardial fibrosis in clinical treatment, but their therapeutic effect on this disease is limited, with obvious side effects and high cost. Traditional Chinese medicine (TCM) has the advantages of multiple targets, low cost, and few side effects. Traditional Chinese medicines, such as Salvia miltiorrhiza, Astragalus, and Angelica extracts, and patent Chinese medicines, such as Qiliqiangxin capsules, Shenqi Yiqi dropping pills, and Tongxinluo capsules, can improve myocardial fibrosis. In this review, current Chinese and Western medicine methods for treating myocardial fibrosis are discussed. The signaling pathways and targets of Chinese and Western medicine are involved in the treatment of myocardial fibrosis. This review aimed to provide valuable insights and ideas for both clinical treatment and basic research on myocardial fibrosis.

Utilization of Cannabidiol in Post-Organ-Transplant Care

Cannabidiol (CBD) is one of the major phytochemical constituents of cannabis, Cannabis sativa, widely recognized for its therapeutic potential. While cannabis has been utilized for medicinal purposes since ancient times, its psychoactive and addictive properties led to its prohibition in 1937, with only the medical use being reauthorized in 1998. Unlike tetrahydrocannabinol (THC), CBD lacks psychoactive and addictive properties, yet the name that suggests its association with cannabis has significantly contributed to its public visibility. CBD exhibits diverse pharmacological properties, most notably anti-inflammatory effects. Additionally, it interacts with key drug-metabolizing enzyme families, including cytochrome P450 (CYP) and uridine 5′-diphospho-glucuronosyltransferase (UGT), which mediate phase I and phase II metabolism, respectively. By binding to these enzymes, CBD can inhibit the metabolism of co-administered drugs, which can potentially enhance their toxicity or therapeutic effects. Mild to moderate adverse events associated with CBD use have been reported. Advances in chemical formulation techniques have recently enabled strategies to minimize these effects. This review provides an overview of CBD, covering its historical background, recent clinical trials, adverse event profiles, and interactions with molecular targets such as receptors, channels, and enzymes. We particularly emphasize the mechanisms underlying its anti-inflammatory effects and interaction with drugs relevant to organ transplantation. Finally, we explore recent progress in the chemical formulation of CBD in order to enhance its bioavailability, which will enable decreasing the dose to use and increase its safety and efficacy.

Controversies around the treatment of peritoneal metastases of colorectal cancer.

In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology. Surgical resection for peritoneal metastases from colorectal cancer (CRC) has been gradually accepted in the medical oncology community. A randomized trial (PRODIGE 7) on cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin. Nevertheless, isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver. Another tool is required in those patients to achieve more local control of the disease. Surgical groups in peritoneal surgery continue to use HIPEC in their procedures, using other agents than oxaliplatin for peritoneal cavity infusion, such as mitomycin C. These patients present with complex surgical issues to manage, and consequently a large burden of complications has to be anticipated. Therefore, identifying patients who will benefit from CRS with or without HIPEC would be of great interest.

Reducing medical cannabis use risk among Veterans: A descriptive study

BackgroundCanadian Veterans experiencing chronic pain report concerns about accessing accurate information on the risks associated with medical cannabis (MC) use. The Lower Risk Cannabis Use Guidelines (LRCUG) were developed to equip individuals who use cannabis recreationally with safer-use strategies. Many of the harm reduction recommendations for recreational cannabis use are relevant and important considerations for MC use. The primary objective of our study was to assess Canadian Veterans’ awareness of and interest in the LRCUG, and engagement in potential higher-risk MC use behaviours.MethodsCanadian Armed Forces Veterans living with chronic pain (N = 582) were recruited online and through the Chronic Pain Centre of Excellence for Canadian Veterans. Participants completed measures on: cannabis use (never, past, current use), sources of cannabis knowledge, mental health, and awareness of and interest in receiving the LRCUG. Chi-Square and post-hoc analyses characterized the sample and assessed for demographic differences based on cannabis use status and awareness of the LRCUG. Engagement in higher-risk MC use behaviours were aligned to LRCUG recommendations, and detailed descriptively.ResultsVeterans who currently use cannabis were more likely to be unemployed (z = 3.62, p < .01), released as a Non-Commissioned Officer (z = -3.83, p < .01), and unable to work due a disability (z = -3.43, p < .01) than Veterans who do not currently use. Less than 30% of Veterans were aware of the LRCUG, with greater awareness among individuals who currently use cannabis (n = 356). Engagement in higher-risk MC use behaviours that contradicted LRCUG recommendations ranged from ~ 9% to ~ 85%. Approximately 9% of Veterans experienced co-morbid mental health concerns, yet their MC use was not for mental health purposes (LRCUG recommendation #7). Additionally, almost 85% of Veterans engaged in daily MC use (LRCUG recommendation #5). The majority of Veterans who currently use cannabis engaged in two or more higher-risk MC use behaviours (60.2%; LRCUG recommendation #12). Almost half of all Veterans received their cannabis information from a healthcare provider or the internet.ConclusionsOur study suggests the importance of safer use guidelines tailored for MC use. Development of lower-risk MC use guidelines can support prescribing practitioners and Veterans with information needed for safer and better-informed MC use decisions, tailored to patients’ needs and circumstances.

Complementary and Alternative Medicine Use among Dermatology Outpatients in Southeastern Nigeria: A Tertiary Hospital Study

Background: Complementary and Alternative Medicine (CAM) is widely used globally, including among dermatology patients. CAM includes different practices not typically part of conventional medicine and is classified into five categories, including biologically based therapies and mind-body interventions. Despite its popularity, little is known about CAM usage patterns among dermatology outpatients in Southeastern Nigeria. Aim: This study aimed to assess the prevalence, the sociodemographic characteristics of dermatology outpatients using CAM and reasons for its usage. Study Design: Cross-sectional study. Place and Duration of Study: Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria, between August to November 2022. Methodology: We recruited 212 dermatology outpatients through convenient sampling. Data were collected using interviewer-administered structured questionnaires capturing sociodemographics, dermatological conditions, and CAM usage patterns.Data analysis was performed using SPSS™ Version 23.0, with chi-square tests determining associations between variables at a significance level of P &lt; 0.05. Results: Among 212 participants recruited, the prevalence of CAM use was 34.4%. The median age was 28 years, and more females (56.1%) than males (43.9%) used CAM. Acne (17.8%), psoriasis (16.4%), and mycoses (11%) were the most common conditions among CAM users. Biologically based therapies, particularly plant-based products like aloe vera, were the most frequently used CAM. Family recommendations (16%) and perceived safety (12.3%) were key reasons for CAM use. CAM usage was significantly associated with longer disease duration (P &lt; .001). Conclusion: The high prevalence of CAM use among dermatology outpatients in Southeastern Nigeria highlights the need for clinicians to recognize and consider alternative therapies in patient care. Understanding the patterns of CAM use can also guide clinicians in advising patients on safe and evidence-based alternatives. Future research on the efficacy and safety of CAM in dermatology is crucial to develop comprehensive, evidence-based treatment strategies that encompass both conventional and complementary therapies.

DOCTORS DIFFER: A PHILOSOPHICAL PERSPECTIVE

The phrase "Drs differ" acknowledges the inherent uncertainty and variability in medical practice. This paper explores the complexities of medical decision-making through two case studies, highlighting the importance of patient-centered care and the need for nuanced understanding of medical knowledge.