Medical Recommendations Research Articles

Analysis of the quality of surgical care for patients with consequences of gunshot combat wounds of the maxillofacial area

One of the most pressing problems of maxillofacial surgery (MFS) is the provision of specialized medical care to the wounded and injured in combat conditions. Even more complex tasks are reconstructive surgical treatment at the stages of evacuation and the most complete rehabilitation of patients with the consequences of combat injuries to the maxillofacial area (MFA). Gunshot combat wounds of the MFA are characterized by severe anatomical and functional disorders, they can manifest themselves as significant defects and severe deformations, which in turn leads to an increase in sanitary losses of army personnel, disability of young and middle (working) age patients, a decrease in the quality of their life, long-term and expensive treatment that requires special knowledge and manual skills from specialists. All this determines not only the medical, but also the socio-economic significance of the topic of this study.Objective. Present an analysis of the quality of surgical care provided to patients with consequences of gunshot combat wounds of the MFA.Methods. The study was carried out by specialists from the State Budgetary Healthcare Institution «Maxillofacial Hospital for War Veterans» of the Moscow Department of Health, under the guidance of the chief, PhD, professor, main specialist in MFS – V.A. Belchenko, for the period from October 2022 to July 2023. Diagnosis, planning and surgical treatment of adult patients with the consequences of gunshot combat wounds of the MFA were carried out at the stages of treatment and evacuation measures. A sample of medical documentation was made, the data obtained was processed by the generally accepted statistical method. The results were analyzed and compared with data from similar studies.Results. The study group included 55 males, aged from 23 to 56 years, the average age of the patients was 36.16±7.79 years. We divided the studied patients into subgroups according to the conditional zones of damage to the MFA: 1st – upper zone of the face (n=3, 5.45%), 2nd – middle zone of the face (n=28; 50.91%), 3rd – lower zone of the face ( n=32; 58.18%). The number of patients with isolated injuries is 18.18% (n=10); with multiple – 81.81% (n=45); with combined – 72.72% (n=40). The article presents the characteristics of patients with the pathology under study, discusses some features of diagnosis and planning, discusses tactics and problems associated with the surgical stage of treatment, as well as further rehabilitation measures.Conclusion. Despite the emergence of new medical equipment, equipment for diagnostics, planning and solving complex problems of surgical intervention, there is a clear need for training specialists, developing and improving the applied medical recommendations, with a clear indication of the method of choosing tactics and methods of surgical treatment. Medical care for adult patients with the consequences of gunshot combat wounds of the MFA must be comprehensive and carried out on the basis of specialized centers, and must include both surgical and orthopedic components, which will minimize the number of errors and complications, increase the effectiveness of treatment and, as a result, make rehabilitation as complete as possible.

Assessment of Patients’ Information towards Diabetic Self-Management in Mosul City

Background: Diabetes self-management which includes a holistic lifestyle, medication adherence, and self-monitoring glucose levels, allows individuals with diabetes to maintain optimal, tailored glycemic control. The aims of the study to assess the patient’s information about diabetic self-management. Methodology: A study design that was descriptive was used in Al-Wafaa primary health care center for diabetes and endocrinology in Mosul city. Purposive sampling technique used to select (383) male and female patients with diabetic type II who aged 20 years or more. Data were collected through a face-to-face interview from period 20 November 2023 until February 15, 2024. The study used developed diabetic self-management scale to assess patients’ information. Results: the study found the patient’s information about diabetic self-management were good except the information about blood glucose monitoring was inadequate It appeared that most of the answers were mean rank (I don’t know), (9.25), followed by the correct answers (7.75) and finally the incorrect answers (2.5). Conclusion & recommendation: The researcher concluded that the patient’s information about diabetic self-management were good except the information about blood glucose monitoring was inadequate. Diabetic patients should be encouraged to understand diabetes self-management and adhere to all medical recommendations and guidelines from the doctor and health educator, especially adherence to treatment and self-monitoring of blood sugar.

THE FIGHT AGAINST BREAST CANCER

This article reports the experience of a 60-year-old woman, living in a low-income community, who faced a battle with breast cancer. Initially, the disease was neglected and treated with home remedies, but when she sought medical help, she was diagnosed with advanced breast cancer. Despite medical recommendations, the patient chose not to undergo conventional treatment, following only palliative care. Family support played a crucial role in her decisions, influencing her choice to refuse surgery. However, the patient eventually withdrew from medical care, highlighting the need for a holistic approach and ongoing support for patients in similar situations. This report highlights the importance of raising awareness about breast cancer, early detection and adequate medical monitoring, as well as the need for emotional and psychological support for patients and their families throughout the treatment process.

Initiative to deprescribe high-risk drugs for older adults presenting to the emergency department after falls.

Over 35 million falls occur in older adults annually and are associated with increased emergency department (ED) revisits and 1-year mortality. Despite associations between medications and falls, the prevalence of fall risk-increasing drugs remains high. Our objective was to implement an ED-based medication reconciliation for patients presenting after falls and determine whether an intervention targeting high-risk medications was related to decreased future falls. This was an observational prospective cohort study at a single site in the United States. Adults 65 years and older presenting to the ED after falls had a pharmacist review their medicines. Pharmacists made recommendations to taper, stop, or discuss medications with the primary clinician. At 3, 6, and 12 months, we recorded the number of fall-related return ED visits and determined if recommended medication changes had been implemented. We compared the rate of return visits of patients who had followed the medication change recommendations and those who received recommendations but had no change in their medications using chi-square tests. A total of 577 patients (mean age 81 years, 63.6% female) were enrolled of 1509 potentially eligible patients. High-risk medications were identified in 310 patients (53.7%) who received medication recommendations. High-risk medications were associated with repeat fall-related visits at 12 months (risk difference 8.1% [95% confidence interval 0.97-15.0]). A total of 134 (43%) patients on high-risk medications had evidence of medication modification. At 12 months, there was no statistically significant difference in return fall visits between patients who had modifications to medications compared with those who had not implemented changes (p = 0.551). Our findings identified opportunities for medication optimization in over half of emergency visits for falls and demonstrated that medication counseling in the ED is feasible. However, evaluation of the effect on future falls was limited.

Patients' Preferences Regarding Modes of Systemic Psoriasis Treatment - A Qualitative Study.

Treatment with pathogenesis-directed biologics and oral systemic drugs have made complete clearance of psoriasis a realistic expectation for many patients with psoriasis. Patients' preferences among these treatments varies. To understand factors impacting psoriasis patients'preferences for injection vs oral medication. Psoriasis patients who receive systemic psoriasis treatment were asked to participate in a semi-structured interview. Sample size was based on achieving saturation with equal number of patients preferring oral vs injectable medications to ensure equal representation of both groups. Qualitative analysis was performed to interpret the results. Twenty-two patients participated in the study, 12 males and 10 females. Ten patients were receiving oral medication (apremilast or methotrexate) and 12 patients were receiving injectables (guselkumab, adalimumab, risankizumab, secukinumab, ixekizumab, or tildrakizumab) due to self-reported preference. Five themes resulted from the analysis: patients receiving injectables more frequently discussed the positive impact of the medication on quality of life compared to patients on oral medication; fear of side effects, particularly fear of immunosuppression, is associated with injection medications; avoidance of needles drives patients away from injection medication and towards oral systemic medication; patients prioritize convenience when selecting systemic therapy, though the definition of convenience is subject to perception; and patients value the medication recommendation of the physician, regardless of the route of administration. Improving medication adherence and disease outcomes through individualized treatment plans, with an emphasis on patients' preferences using a shared decision-making approach, may be helpful.

Chinese expert consensus on treatment of osteoporotic fractures with teriparatide (2024 edition)

Osteoporotic fracture is the most serious complication of osteoporosis, which is a special type of pathologic fracture of the skeleton that occurs because of osteoporosis. It is characterized by delayed fracture healing, high risk of re-fracture, high rate of disability and death, difficulty in treatment and long treatment time, and re-fracture has a"cascade effect". Guidelines in different countries recommend that patients with osteoporotic fractures and those at very high risk of fracture should consider anabolic agents as first treatment choice. Teriparatide is the only anabolic agent approved by National Medical Products Administration (NMPA), and it has the clinical efficacy of improving fracture healing, reducing the risk of re-fracture, and improving bone microstructure in the treatment of osteoporotic fracture. Due to deficiencies in the current standardization of clinical use of teriparatide, Committee of Accelerated Rehabilitation After Osteoporotic Fractures of China Association of Rehabilitation Technology Transformation and Promotion, Bone and Joint Group of Chinese Society of Osteoporosis and Bone Mineral Research and Osteoporosis Working Committee of Chinese Association of Orthopedic Surgeons developed this consensus. The development of this consensus follows the modified Delphi method and forms 8 evidence-based medical recommendations, aiming to propose methods and precautions for standardizing the application of teriparatide, and to emphasize the importance of teriparatide application for the treatment of patients with osteoporotic fracture.

Clinicians’ perspectives on race-specific guidelines for hypertensive treatment

Despite the general consensus that there is no biological basis to race, racial categorization is still used by clinicians to guide diagnosis and treatment plans for certain diseases. In medicine, race is commonly used as a rough proxy for unmeasured social, environmental, and genetic factors. The American College of Cardiology's Eighth Joint National Committee's (JNC 8) guidelines for the treatment of hypertension provide race-specific medication recommendations for Black versus non-Black patients, without strong evidence for race-specific physiological differences in drug response. Clinicians practicing family or geriatric medicine (n = 21) were shown a video of a mock hypertensive patient with genetic ancestry test results that could be viewed as discordant with their phenotype and self-identified race. After viewing the videos, we conducted in-depth interviews to examine how clinicians value and prioritize different cues about race -- namely genetic ancestry data, phenotypic appearance, and self-identified racial classifications – when making treatment decisions in the context of race-specific guidelines, particularly in situations when patients claim mixed-race or complex racial identities. Results indicate that clinicians inconsistently follow the race-specific guidelines for patients whose genetic ancestry test results do not match neatly with their self-identified race or phenotypic features. However, many clinicians also emphasized the importance of clinical experience, side effects, and other factors in their decision making. Clinicians' definitions of race, categorization of the patient's race, and prioritization of racial cues greatly varied. The existence of the race-specific guidelines clearly influences treatment decisions, even as clinicians' express uncertainty about how to incorporate consideration of a patient's genetic ancestry. In light of widespread debate about removal of race from medical diagnostics, researchers should revisit the clinical justification for maintaining these race-specific guidelines. Based on our findings and prior studies indicating a lack of convincing evidence for biological differences by race in medication response, we suggest removing race from the JNC 8 guidelines to avoid risk of perpetuating or exacerbating health disparities in hypertension.

A multidisciplinary approach to improve adherence to medical recommendations in older adults at hospital discharge: The APPROACH study protocol.

Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. This randomized controlled trial aims to evaluate the effectiveness of an integrated approach in improving older individuals' adherence to medical recommendations after hospital discharge. Data from an expected sample of 360 older inpatients (and their caregivers) will be collected. Medical recommendations' understanding will be tested before and after the routine explanation received by in-charge physicians. Participants will be randomized in the control (usual care) and intervention group. The intervention consists of educational training by a multidisciplinary team (occupational therapist, dietician, and physician, in consultation with a pharmacologist) at hospital discharge and, after hospital discharge, receiving a phone recall checking for therapy adherence and having the possibility to contact the study team for potential related concerns. After 7 days, medication adherence will be assessed through structured phone interviews comparing ongoing and prescribed medications and by administering the 4-item validated Morisky, Green, Levine scale and the Medication adherence report scale (MARS-5). At 30 and 90 days from discharge, data on medication adherence, falls, rehospitalizations, and vital status will be collected through phone interviews and hospital records. Registration: NCT05719870 (clinicaltrial.gov). https://classic.clinicaltrials.gov/ct2/show/NCT05719870.

Does small talk with a medical provider affect ChatGPT's medical counsel? Performance of ChatGPT on USMLE with and without distractions.

Efforts are being made to improve the time effectiveness of healthcare providers. Artificial intelligence tools can help transcript and summarize physician-patient encounters and produce medical notes and medical recommendations. However, in addition to medical information, discussion between healthcare and patients includes small talk and other information irrelevant to medical concerns. As Large Language Models (LLMs) are predictive models building their response based on the words in the prompts, there is a risk that small talk and irrelevant information may alter the response and the suggestion given. Therefore, this study aims to investigate the impact of medical data mixed with small talk on the accuracy of medical advice provided by ChatGPT. USMLE step 3 questions were used as a model for relevant medical data. We use both multiple-choice and open-ended questions. First, we gathered small talk sentences from human participants using the Mechanical Turk platform. Second, both sets of USLME questions were arranged in a pattern where each sentence from the original questions was followed by a small talk sentence. ChatGPT 3.5 and 4 were asked to answer both sets of questions with and without the small talk sentences. Finally, a board-certified physician analyzed the answers by ChatGPT and compared them to the formal correct answer. The analysis results demonstrate that the ability of ChatGPT-3.5 to answer correctly was impaired when small talk was added to medical data (66.8% vs. 56.6%; p = 0.025). Specifically, for multiple-choice questions (72.1% vs. 68.9%; p = 0.67) and for the open questions (61.5% vs. 44.3%; p = 0.01), respectively. In contrast, small talk phrases did not impair ChatGPT-4 ability in both types of questions (83.6% and 66.2%, respectively). According to these results, ChatGPT-4 seems more accurate than the earlier 3.5 version, and it appears that small talk does not impair its capability to provide medical recommendations. Our results are an important first step in understanding the potential and limitations of utilizing ChatGPT and other LLMs for physician-patient interactions, which include casual conversations.

Public perception of psychiatry, psychology and mental health professionals: a 15-year analysis.

X (previously known as "Twitter") serves as a platform for open discussions on mental health, providing an avenue for scrutinizing public perspectives regarding psychiatry, psychology and their associated professionals. To analyze the conversations happening on X about psychiatrists, psychologists, and their respective disciplines to understand how the public perception of these professionals and specialties has evolved over the last 15 years. We collected and analyzed all tweets posted in English or Spanish between 2007 and 2023 referring to psychiatry, psychology, neurology, mental health, psychiatrist, psychologist, or neurologist using advance topic modelling and sentiment analysis. A total of 403,767 tweets were analyzed, 155,217 (38%) were in English and 248,550 (62%) in Spanish. Tweets about mental health and mental health professionals and disciplines showed a consistent volume between 2011 and 2016, followed by a gradual increase from 2016 through 2022. The proportion of tweets discussing mental health doubled from 2016 to 2022, increasing from 20% to 67% in Spanish and from 15% to 45% in English. Several differences were observed on the volume of tweets overtime depending on the language they were written. Users associated each term with varied topics, such as seeking for help and recommendation for therapy, self-help resources, medication and side effects, suicide prevention, mental health in times of crisis, among others. The number of tweets mentioning these topics increased by 5-10% from 2016 to 2022, indicating a growing interest among the population. Emotional analysis showed most of the topics were associated with fear and anger. The increasing trend in discussions about mental health and the related professionals and disciplines over time may signify an elevated collective awareness of mental health. Gaining insights into the topics around these matters and user's corresponding emotions towards them presents an opportunity to combat the stigma surrounding mental health more effectively.

Harnessing big data for tailored health communication: A systematic review of impact and techniques

In recent years, the convergence of healthcare and big data analytics has opened new avenues for tailored health communication, enabling personalized interventions and improving healthcare outcomes. This systematic review investigates the impact and techniques of harnessing big data for tailored health communication. The review synthesizes findings from diverse studies spanning healthcare sectors, including public health campaigns, clinical interventions, and patient engagement initiatives. It examines the effectiveness of tailored communication strategies in addressing various health challenges, such as chronic diseases, infectious outbreaks, and mental health disorders. Key findings highlight the significant positive impact of personalized health communication on health behavior change, treatment adherence, and patient empowerment. Big data analytics enable the segmentation of diverse populations based on socio-demographic, behavioral, and clinical characteristics, facilitating the delivery of targeted messages tailored to individual preferences and needs. Personalization enhances engagement, fosters trust, and motivates individuals to adopt healthier lifestyles and adhere to medical recommendations. Furthermore, the review explores the diverse techniques and technologies employed in harnessing big data for tailored health communication. Machine learning algorithms, natural language processing, and predictive modeling are leveraged to analyze vast datasets, predict health outcomes, and tailor communication messages in real-time. Mobile health applications, social media platforms, and wearable devices serve as channels for delivering personalized interventions and collecting real-time health data. However, the review also identifies challenges and limitations, including privacy concerns, data security risks, and the digital divide. Ethical considerations regarding data collection, consent, and transparency are paramount in ensuring the responsible use of big data in health communication. This systematic review underscores the transformative potential of harnessing big data for tailored health communication. By leveraging advanced analytics and technology, healthcare stakeholders can deliver personalized interventions that resonate with individuals, ultimately driving positive health behavior change and improving healthcare outcomes on a population scale.

An assessment of the consumption and disposal of medications home use

In the current scenario, the market society, an economic model consolidated in many parts of the world, faces some social and environmental challenges, such as the solid waste disposal and treatment of different residues generated daily, especially in big cities. In Brazil, 4,540 municipalities provided medical waste collection services, and more than a third (36.2%) sent the MS to landfills, dumps, and septic ditches. This issue faced by municipalities is challenging as they try to promote less damaging management that impacts the environment due to urban demography and fragile socio-environmental conditions. Action as reverse logistics is a strategy that enables the return of after-sales and post-consumption waste to the business environment and the productive sector, promoting the circular economy, the recovery of waste, the life cycle of products, decrease in the use of materials, reduction of environmental impacts, compliance with current regulations and non-contamination of the environment. The assessment of unusual medications and population knowledge allows drawing an overview of the disposal of uncommon medications for home use by an electronic questionnaire addressing different questions, referring to the identification of the user's profile, various forms of consumption, storage, and disposal of medication waste, and knowledge about the local regulation. Most medications consumed by the population are antibiotics, analgesics, fever reducers, and pain relief without medical recommendations, not used to seeing the expiration date, and not reading the drug leaflet. The assessment population could only pay a little for the additional tax for final medication waste disposal. Most of the participants disposed of the unusual medications in the household garbage. Finally, the reverse logistics implementation of medication waste in Brazil will be a significant challenge for decreasing the environmental impacts and pollution because of the culture of the local population.

PROMISE: A pre-trained knowledge-infused multimodal representation learning framework for medication recommendation

Electronic Health Records (EHRs) significantly enhance clinical decision-making, particularly in safe and effective medication recommendation based on complex patient data. Current methods, while encoding each medical event individually with domain-specific knowledge, inadequately harness multi-source domain knowledge and neglect the interrelations among various medical codes, the influence of historical patient visits, and the relevance of similar patient trajectories. To address these limitations, we present PROMISE, a multimodal medication recommendation framework that progressively learns patient representations from specific health states to a comprehensive view. PROMISE integrates domain knowledge into modality-specific encoders to improve local and global patient representations, facilitating enhanced medication recommendations through the interaction of patient representations from various modalities. Specifically, within the code modality, PROMISE utilizes encoding of EHR hypergraphs to learn patient representations featuring structured information. Simultaneously, in the text modality, it acquires patient representations with semantic information by encoding clinical texts obtained from tables. Our framework surpasses state-of-the-art baselines with up to 2.06% and 1.97% improvements on key metrics within the MIMIC-III and IV datasets, respectively, confirming its effectiveness and superiority.

The use of complementary and alternative medicine for functional gastrointestinal disorders among the saudi population

Background and objectiveComplementary and alternative medicine (CAM) is a common practice among patients, who experience functional gastrointestinal disorders (FGID). Among the Saudi population, less is known about CAM use for FGID. Therefore, this study aimed to determine the prevalence of CAM utilization for FGID amongst the Saudi population and determine the types of CAM used for treatment. MethodA cross-sectional study was carried out in Riyadh, Saudi Arabia during February 2023 through social media platforms using questionnaires adopted from the literature. There were three sections in the questionnaire including demographic information, questions to determine the prevalence of CAM use for FGID, the types of FGID, and the types of CAM utilization, and questions on the sources of information about CAM. Multivariable logistic regression was applied to find factors associated with CAM use. All statistical analyses were performed using SPSS version 26. ResultsA total of 828 people participated in this study. The overall prevalence of CAM use for FGID problems was 87.2 %. There were no significant differences in CAM use for FGID problems between men (87.5 %) and women (86.3 %) (P = 0.727). The most commonly used types of CAM for FGID were ginger (73.4 %), chamomile (66.6 %), mint (61.6 %), turmeric (59.0 %), anise (55.5 %), fennel (43.1 %), and Activia yogurt©️ (42.7 %). The most common FGID disorders for utilizing CAM were IBS (29.9 %), followed by constipation (29.8 %), dyspepsia (22.7 %), and bloating (17.0 %). In the multivariable regression, age, gender and employment status did not have an impact on the odds of using CAM. The subjects who had high school, university, and postgraduate education had significant odds ratios of CAM use (OR = 2.73; 95 % CI: 1.22–6.13), (OR = 4.18; 95 % CI: 2.03–8.58), and (OR = 20.85; 95 % CI: 5.51–78.80), respectively, compared to subjects who did not complete high school. Participants who had private insurance had a significant odds ratio (OR = 0.27; 95 % CI: 0.14–0.55) compared to governmental insurance. ConclusionThe use of CAM among the Saudi population is alarmingly high; however, the lack of standardized medical recommendations and treatment options may be the cause. Although there were no significant gender differences, participants with higher educational levels and private insurance coverage were more likely to use CAM for FGID. Patients suffering from FGID and limited access to medical advice and treatment options are vulnerable to being exposed to dubious and incredible information sources. Expanding access to preventative medical services, funding governmental medical websites to provide credible information, educating healthcare professionals about FGID, and conducting more research in safe and effective treatments for FGID is recommended.

OntoMedRec: Logically-pretrained model-agnostic ontology encoders for medication recommendation

Recommending medications with electronic health records (EHRs) is a challenging task for data-driven clinical decision support systems. Most existing models learnt representations for medical concepts based on EHRs and make recommendations with the learnt representations. However, most medications appear in EHR datasets for limited times (the frequency distribution of medications follows power law distribution), resulting in insufficient learning of their representations of the medications. Medical ontologies are the hierarchical classification systems for medical terms where similar terms will be in the same class on a certain level. In this paper, we propose OntoMedRec, the logically-pretrained and model-agnostic medical Ontology Encoders for Medication Recommendation that addresses data sparsity problem with medical ontologies. We conduct comprehensive experiments on real-world EHR datasets to evaluate the effectiveness of OntoMedRec by integrating it into various existing downstream medication recommendation models. The result shows the integration of OntoMedRec improves the performance of various models in both the entire EHR datasets and the admissions with few-shot medications. We provide the GitHub repository for the source code. (https://github.com/WaicongTam/OntoMedRec)

Analisis Metode Happy When Sick (HWS) dalam Bimbingan Rohani di Rumah Sakit

Along with the times and the complexity of the problems faced by humans, especially those who are facing illness, the problems of patients in hospitals are not only physical but also psychological, such as anxiety. Therefore, spiritual guidance is considered important to support the healing process by helping patients accept their condition with sincerity, patience and trust. An effective method is needed so that the aims and objectives of achieving healing, both physical and spiritual, can be achieved. This study aims to analyze the effectiveness of the HWS (Happy When Sick) method in Islamic spiritual guidance at Muhammadiyah Hospital using qualitative descriptive methods. Data was collected through observation and in-depth interviews, then analyzed using the interactive model of Miles, Huberman, and Saldana. The results show that the application of the HWS method has a positive impact on the psychological and spiritual condition of patients from various generations, families and medical personnel. Patients show increased calm, enthusiasm for worship, and optimism regarding recovery, as well as reduced anxiety and increased compliance with medical recommendations. This research recommends the integration of holistic and adaptive spiritual guidance methods to optimally support patients' physical and spiritual health.

Potential Benefits of a Cosmetic Ingredient Combining Thermal Spring Water and Diatom Algae Extract

The development of cosmetic ingredients improving the management of skin with irritation proclivity is an actual need. However, medical recommendations in specific cases, such as sensitive skin, include the use of as few and low-reactive ingredients as possible. In this context, we here describe the development of a new ingredient consisting of a mixture of thermal water and a diatom algae extract. First, we characterized a thermal spring water (La Solia, LS-TSW). Attending to its chemical composition, LS-TSW displayed an exclusive combination of different inorganic elements, with interesting potential properties when compared with other commercial spring waters. Then, LS-TSW hydrobiome was studied, and after finding specimens of Phaeodactylum-like sp., we proposed potentiating LS-TSW benefits with its combination with an oil extract of Phaeodactylum tricornutum (PtOE). Finally, we assessed the potential of the mixture during pro-inflammatory stimulation, in the first instance using an immune cell model, and then in an in vitro system mimicking keratinocytes under skin irritation. In the last-mentioned model, the ingredient of interest effectively attenuated the induced levels of different pro-inflammatory mediators (IL-6, IL-1, TNFα, NF-κB, and CCL1), at the level of gene expression. Thus, our results highlight the potential benefits of this combination in the context of skin irritation, opening roads for its use in new skincare regimens, and addressing an important dermatological concern.

Medication recommendations for treatment of lumbosacral radiculopathy: A systematic review of clinical practice guidelines.

The purpose of this systematic review was to ascertain guideline-recommended pharmaceutical approaches to lumbosacral radicular symptoms, assess the quality of the clinical practice guidelines (CPGs) with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, and qualitatively synthesize the guideline recommendations. Literature searches were performed in PubMed, Cochrane Database of Systematic Reviews, Index to Chiropractic Literature, Allied and Complementary Medicine Database (AMED), Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro). We included guidelines published between January 1, 2017, and January 9, 2022, written in the English language, related to radiculopathy, sciatica, and/or low back pain with leg pain, and that provided recommendations on oral medication. The review was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) and the protocol was pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO). Eligibility screening, full-text review, extraction of information pertaining to pharmacological management, and synthesis of results were performed independently by two authors and a third investigator was recruited to arbitrate any disagreements. The AGREE II tool was administered by four authors to appraise CPG quality. After screening 413 citations and assessing 37 full-text articles, 11 CPGs met the inclusion criteria. They represented seven countries (Belgium, Canada, England, France, Japan, Korea, and United States) and three continents (Asia, Europe, and North America), as well as the Global Spine Care Initiative aimed at a worldwide presence. The mean overall AGREE II score was 87.1% (standard deviation [SD] 12.6%), generally reflecting high-quality CPGs. The highest domain mean score was for Clarity of Presentation (96.7%, SD 4.4%), and the lowest was Applicability (75.6%, SD 22.8%). Five classes of medications were recommended by at least one CPG: anticonvulsants, antidepressants, oral corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. The most common medication class recommended by the CPGs for lumbar radiculopathy was antidepressants. No CPGs recommended prescribing acetaminophen, benzodiazepines, muscle relaxants, or antibiotics. There was very little agreement between the CPGs, and all the medication classes had at least one CPG recommended against its use. Three guidelines reviewed did not recommend any medications due to lack of supporting literature, and instead recommended nonpharmacologic therapy.

AKA-SafeMed: A safe medication recommendation based on attention mechanism and knowledge augmentation

Medication recommendation (MR) focuses on generating a medication combination without adverse drug-drug interactions (DDIs) based on electronic health records (EHRs) in making prescriptions. However, how to capture the temporality in historical visits and concurrence in clinical events are two challenges that determine the outcomes of an MR model. To achieve effective and safe MR with imbalanced EHR data, we propose a medication recommendation model based on the attention mechanism and knowledge augmentation strategy (AKA-SafeMed). Specifically, in the patient representation module, bidirectional long short-term memory (BiLSTM) models are deployed to encode the patient's sequential visits, and a self-attention mechanism is employed to learn the weights of diagnosis and procedure vectors from a patient's historical visits; in the medication generation module, the EHR and DDI graphs are leveraged to fully explore the relationships between pairwise drugs as a knowledge augmentation strategy. Finally, extensive experiments are conducted to evaluate the performance of AKA-SafeMed on public EHR datasets. The experimental results demonstrate that the AKA-SafeMed model achieves superior performance in MR tasks compared with the state-of-the-art baseline models.

New S2k guideline "Surgical techniques for gender incongruence"

Various techniques for the surgical treatment of gender incongruence (GI) have been available for years. The spectrum is broad and covers various specialties. In recent years, there has been an increase in the number of clinics offering body-modifying procedures. This has led to aconsiderable variation in methods in some cases. Although the topic has recently found its way more and more into teaching and the relevant specialist literature, there are still no evidence-based recommendations on the various techniques. Acompendium of established surgical techniques was to be compiled, containing recommendations on indication, performance and aftercare as well as complication management and subjecting them to aconsensus-based evaluation. In accordance with "Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften" (AWMF) regulations, the guideline was developed at level S2k, i.e., it is consensus based. The guideline group was founded in February 2019 in aformal constituent meeting. Atotal of 14medical societies and 2interest groups were recruited for the guideline work. In the end, two consensus meetings were held, which was due to the large number of recommendations and background texts to be adopted. The guideline focuses on the choice and applicability of surgical techniques as well as the wishes of those seeking treatment and protection of fertility. There is awide variety of methods and treatment goals for each individual. Taking into account medical standards, recommendations, and contraindications, an optimal result that minimizes individual suffering can be achieved together with the person seeking treatment. The content of the guideline represents aunique compendium of surgical methods, recommendations for the selection of procedures, and common indications in the field of body-modifying surgery for gender incongruence.