Medical Issues Research Articles

Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation.

Postpartum haemorrhage is a leading cause of maternal mortality. A multicountry, cluster-randomised trial (E-MOTIVE) demonstrated a 60% reduction in adverse postpartum haemorrhage outcomes. The E-MOTIVE intervention included early postpartum haemorrhage detection using calibrated blood-collection drapes, followed by a postpartum haemorrhage treatment bundle (ie, uterine massage, oxytocics, tranexamic acid, intravenous fluids, examination and escalation [MOTIVE]), supported by implementation strategies. We report a mixed-methods process evaluation assessing the implementation of the E-MOTIVE intervention in Kenya, Nigeria, South Africa, and Tanzania. In this mixed-methods process evaluation, data sources were observations of health workers providing clinical care to pregnant women and pregnant people during vaginal birth and postpartum haemorrhage at intervention sites, and surveys and qualitative interviews with health workers at intervention and control sites. Intervention sites received the calibrated drapes, MOTIVE bundle, and implementation strategies and control sites used uncalibrated drapes. Primary implementation outcomes included fidelity, adoption, adaptation, acceptability, feasibility, and contamination to the calibrated drape, MOTIVE bundle, and implementation strategies. Between June 1, 2022, and Jan 31, 2023, 2578 births were observed, 295 pregnant women and people had postpartum haemorrhage, 47 qualitative interviews were done, and 889 surveys were completed. Fidelity to calibrated drape use was high (birth observations 2578 [100%] of 2578; survey 451 [98·3%] of 459). Among health workers, calibrated drape acceptability was high; however, they reported barriers to pregnant women's and people's acceptability. Fidelity to postpartum haemorrhage treatment bundle delivery was high (birth observations 286 [96·9%] of 295), with moderate to high fidelity in median time from postpartum haemorrhage diagnosis to final treatment initiation (≤15 min initiation time in 191 [66·8%] of 295 birth observations, 16-20 min in 42 [14·7%] birth observations), and high acceptability and feasibility. Research midwives participated in clinical assessments after birth and bundle delivery in some sites (mixed fidelity). This process evaluation shows generally high levels of fidelity, feasibility, and acceptability of the calibrated drape and treatment bundle across evaluation methods and countries. The E-MOTIVE intervention should be included in national policies, with consideration for health workforce, supplies, and medication issues, which might need addressing for successful implementation. The Bill and Melinda Gates Foundation and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, a co-sponsored programme of WHO. For the Swahili translation of the abstract see Supplementary Materials section.

Antimetastatic Drug, Pharmacologic Challenge and Opportunity

: Cancer is a complex and high-mortality disease in the clinic. Cancer metastasis leads to most cancer deaths. The therapeutics for cancer metastasis are greatly unsatisfactory now. Despite different types of antimetastatic agents and drugs have been reported, 90% of patients die in 5 years after metastatic nodules at secondary sites have been found. : Many pharmacologic challenges and opportunities for current metastasis therapies are presented. To overcome the dilemma and shortcomings of antimetastatic treatment, medical, chemical, pharmaceutical, methodological and technical issues are integrated and highlighted. To introduce up-to-date knowledge and insights into drug targeting and pharmaceutical features and clinical paradigms, relevant drug design insights are discussed—including different pathological modes, diagnosis advances, metastatic cascade, tumor plasticity, variety of animal models, therapeutic biomarkers, computational tools and cancer genomics. Integrated knowledge, systems and therapeutics are focused. : In summary, medicinal comparison, pharmaceutical innovation and clinical strategies should be increasingly investigated.

P-424. Challenges in Developing a Non Ventilator Hospital-Acquired Pneumonia Surveillance System

Abstract Background Pneumonia has been identified as the leading cause of hospital-acquired infections (HAI) with Non Ventilator Hospital-Acquired Pneumonia (NVHAP) making up the majority of cases. The ambiguity of definitions and subjective diagnostic criteria make defining and tracking NVHAP cases a challenge. We attempted to duplicate a previously validated electronic medical record (EMR) based NVHAP surveillance systems at a Midwest Academic Medical Institution. Defining NV HAP Inclusion criteria for NVHAP. Methods Using previously established criteria a surveillance system was designed to determine possible cases of NVHAP using data from our institution’s EMR (Table 1). Institutional review board approval was obtained, and the surveillance system was retrospectively applied to adult patients hospitalized throughout 2023 at two Midwest academic hospitals. A validation study was conducted to compare ten percent of cases reported by the NVHAP surveillance system to that of a single physician reviewer. Interim analysis was conducted in instances of inclusion criteria failure to allow for refinement of the NVHAP surveillance system. Results The NVHAP surveillance system generated a list of 425 possible NVHAP events in 2023. Single reviewer analysis of 20 patients revealed 12 patients who did not meet CDC pneumonia criteria and three that did not meet all inclusion criteria: two for lack of chest imaging within 48 hours of recorded oxygen deterioration event and two with no documentation of new antibiotic administration. Additional lists of 338, 322, and 76 NVHAP episodes were generated after coding changes were implemented with repeat interim analysis demonstrating further issues with adherence to inclusion criteria and errors with reproducibility of data extraction. Conclusion The development of a NVHAP surveillance system would allow an objective way to track this significant HAI. Potential models exist for creating such a system. However, multiple challenges are still present from determining EMR specific coding for complex medical issues, such as oxygen deterioration events, to reproducibility of electronic extracted data. Our efforts show that even when attempting to replicate validated methodologies site specific challenges will pose significant barriers to the development of EMR based NVHAP surveillance systems. Disclosures Kelly Cawcutt, MD, MS, BD: Advisor/Consultant|BMJ: Honoraria

Understanding Health-Related Discussions on Reddit: Development of a Topic Assignment Method and Exploratory Analysis.

Social media has become a widely used way for people to share opinions about health care and medical topics. Social media data can be leveraged to understand patient concerns and provide insight into why patients may turn to the internet instead of the health care system for health advice. This study aimed to develop a method to investigate Reddit posts discussing health-related conditions. Our goal was to characterize these topics and identify trends in these social media-based medical discussions. Using an initial query, we collected 1 year of Reddit posts containing the phrases "get tested" and "get checked." These posts were manually reviewed, and subreddits containing irrelevant posts were excluded from analysis. This selection of posts was manually read by the investigators to categorize posts into topics. A script was developed to automatically assign topics to additional posts based on keywords. Topic and keyword selections were refined based on manual review for more accurate topic assignment. Topic assignment was then performed on the entire 1-year Reddit dataset containing 347,130 posts. Related topics were grouped into broader medical disciplines. Analysis of the topic assignments was then conducted to assess condition and medical topic frequencies in medical condition-focused subreddits and general subreddits. We created an automated algorithm to assign medical topics to Reddit posts. By iterating through multiple rounds of topic assignment, we improved the accuracy of the algorithm. Ultimately, this algorithm created 82 topics sorted into 17 broader medical disciplines. Of all topics, sexually transmitted infections (STIs), eye disorders, anxiety, and pregnancy had the highest post frequency overall. STIs comprised 7.44% (5876/78,980) of posts, and anxiety comprised 5.43% (4289/78,980) of posts. A total of 34% (28/82) of the topics comprised 80% (63,184/78,980) of all posts. Of the medical disciplines, those with the most posts werepsychiatry and mental health;genitourinary and reproductive health; infectious diseases;and endocrinology, nutrition, and metabolism. Psychiatry and mental health comprised 26.6% (21,009/78,980) of posts, and genitourinary and reproductive health comprised 13.6% (10,741/78,980) of posts. Overall, most posts were also classified under these 4 medical disciplines. During analysis, subreddits were also classified as general if they did not focus on a specific health issue and topic-specific if they discussed a specific medical issue. Topics that appeared most frequently in the top 5 in general subreddits included addiction and drug anxiety, attention-deficit/hyperactivity disorder, abuse, and STIs. In topic-specific subreddits, most posts were found to discuss the topic of that subreddit. Certain health topics and medical disciplines are predominant on Reddit. These include topics such as STIs, eye disorders, anxiety, and pregnancy. Most posts were classified under the medical disciplines of psychiatry and mental health, as well as genitourinary and reproductive health.

Correlations among hope, fertility quality of life and negative emotions for couples undergoing their first in vitro fertilization–embryo transfer: a cross-sectional analysis

BackgroundThe global incidence of infertility is increasing, and infertility has become an important medical and social issue. With the widespread application of in vitro fertilization-embryo transfer (IVF-ET) technology, the mental health problems of patients undergoing this treatment have gradually attracted widespread attention. The purpose of this study was to explore the relationships among the level of hope, the fertility quality of life and negative emotions of patients who underwent IVF-ET treatment for the first time to provide a scientific basis for subsequent psychological support interventions.MethodsThis study was a cross-sectional survey conducted at the Reproductive Medicine Center of Renmin Hospital of Wuhan University. From February 2023 to October 2023, 1425 patients who received IVF-ET treatment for the first time participated in the questionnaire survey. The survey content included the General Information Questionnaire, the Fertility Quality of Life (FertiQoL) Questionnaire, and the Herth Hope Index (HHI). Pearson correlation analysis was used to examine the relationships among the level of hope, fertility quality of life, and negative emotions.ResultsThe survey included 805 women and 620 men representing 603 couples. The level of hope in patients undergoing IVF-ET treatment for the first time was positively correlated with fertility quality of life (r = 0.247, P < 0.01), and the level of hope was negatively correlated with negative emotions (stress: r = − 0.135, P < 0.01; anxiety: r = − 0.105, P < 0.01; depression: r = − 0.189, P < 0.01). Fertility quality of life was negatively correlated with negative emotions (stress: r = − 0.609, P < 0.01; anxiety: r = − 0.533, P < 0.01; depression: r = − 0.591, P < 0.01). Among couples undergoing IVF-ET treatment for the first time, the husband’s level of hope (r = 0.131, P < 0.01), fertility quality of life (r = 0.372, P < 0.01), and negative emotions (stress: r = 0.181, P < 0.01; anxiety: r = 0.163, P < 0.01; depression: r = 0.210, P < 0.01) were positively correlated with those of his wife.ConclusionsIn patients undergoing their first IVF-ET treatment, there is a significant correlation among hope, fertility quality of life, and negative emotions. Moreover, within couples, the levels of hope, fertility quality of life, and negative emotions of husbands and wives mutually influence each other. Enhancing the level of hope in this population is conducive to alleviating negative emotions and improving their fertility quality of life. The mutual influence of spouses should not be overlooked in clinical practice, and psychological support for both partners should be emphasized.

Prospects for the Use of Machine Learning for Mood Disorders

Relevance. Mental disorders are one of the key medical and social issues. Over the last years artificial intelligence (AI) methods including machine and deep learning have been actively developing. This narrative review aimed to identify current and promising areas for the development and application of AI into clinical practice using the example of patients with depression and bipolar disorder. Methods. The search of publications was performed in January ─ February 2024 in PubMed, Google Scholar, elibrary databases using the combination of keywords: psychiatry, mental health, psychiatric disorder, depression, depressive episode, major depressive disorder, bipolar disorder, machine learning, deep learning, artificial intelligence. The review included original articles on the use of AI methods in patients with depression and bipolar disorder, and review articles devoted to the problems of applying AI methods in psychiatry and published in Russian or English in the last 10 years. Results. Most often, neuroimaging (mainly MRI and EEG), text, audio and video data, electronic device data, molecular genetics, clinical data and its combination, are used for machine learning (ML) models in patients with mood disorders. Despite the potential benefits of AI application in psychiatry, its implementation into clinical practice is currently challenging due to number of difficulties, such as small sample sizes, low representativeness, lack of standardization, inclusion of “noise” and correlated variables into models, lack of model testing on independent samples. Conclusion. Studies of ML methods have shown promising results for the early diagnosis of affective episodes and predicting response to therapy. However, the use of ML methods into clinical practice has a number of limitations, primarily due to insufficient validation. There is a need for well-designed prospective cohort studies, as well as the development of extensive and high-quality databases and models capable of identifying new relationships between variables in order to overcome these limitations.

Medical insurance-related professionals’ identification of the benefits of the medical insurance system in Northeast China: a cross-sectional study

BackgroundThe identification of the benefits of the medical insurance system (IBMIS) serves as an important indicator of the effectiveness of medical insurance policy implementation and provides valuable feedback during the ongoing reform phase of the medical insurance system (MIS). This research aims to analyze the IBMIS from the perspective of medical insurance-related professionals and to identify potential associate factors with IBMIS.MethodsIn 2021, we conducted a cross-sectional questionnaire survey (n = 1829) in Heilongjiang Province, located in Northeast China, to collect data. Interviewees were selected using a multi-stage stratified cluster random sampling method. A binary logistic regression model was employed to identify the factors influencing the IBMIS.ResultsOverall, 66% (1,207) of professionals associated with medical insurance exhibited a high IBMIS. The logistic regression model indicated that a high IBMIS was positively correlated with the following dimensions: policy capacity (OR = 1.562, 95% CI: 1.375–1.775), financial burden (OR = 1.512, 95% CI: 1.347–1.699), and convenience (OR = 1.300, 95% CI: 1.171–1.442). Four significant factors (P < 0.05) contributing to a high IBMIS include: “Relief of financial burden for people with serious diseases” (OR = 2.288, 95% CI: 1.740–3.007), “Medical insurance’s ability to address major problems that people expect” (OR = 1.565, 95% CI: 1.175–2.085), “Governance capacity of the medical insurance administrative agencies and management institutions” (OR = 1.472, 95% CI: 1.111–1.951), and “Effectiveness of governance for off-site medical reimbursement issues” (OR = 1.445, 95% CI: 1.036–2.014).ConclusionThe policy capacity, financial burden, and convenience of the MIS have a positive impact on the IBMIS. Government departments can pay closer attention to these factors and formulate targeted intervention measures to improve the implementation effectiveness of medical insurance policies.

A review of the current status of biological effects of plant-derived therapeutics in breast cancer.

Phytochemicals are bioactive secondary plant metabolites found in high concentrations in fruits, grains, and vegetables. Recent studies provide evidence of usage of plant-based diets rich in phytochemicals and their corelation to reduction in cancer incidence. Several phytochemicals have demonstrated effectiveness as chemotherapeutic agents against various cancers, including breast cancer. Breast cancer (BC) is a major worldwide medical issue owing to its high incidence, especially in women. It is the most often detected malignancy and an important trigger of mortality in women. Various chemotherapeutics along with radiotherapy are being investigated as potential treatment options for breast cancer. However, multidrug resistance, toxicity to normal cells, and other adverse effects limit the usage of chemotherapeutics in breast cancer. Cancer treatment with dietary phytochemicals is a highly effective approach that is currently gaining widespread attention. This manuscript intends to describe the existing data on the anticancer effects of various phytochemicals, including their preclinical exploration against breast cancer. Phytochemicals are broadly categorized, with an explanation of their role in breast cancer prognosis through various signalling pathways, preclinical status, physicochemical property analysis using Data Warrior, and evidence on individual phototherapeutics.

Understanding cultural perceptions of sexuality in China and their influence on human papillomavirus vaccine hesitancy

IntroductionThe human papillomavirus (HPV) vaccine prevents infections that may result in precancerous lesions, cervical cancers, genital warts, and many other diseases. However, its uptake rate in China is 2.24%, and HPV vaccine hesitancy is widespread. This study aimed to identify whether cultural perceptions of sexuality in China influence HPV vaccine hesitancy and explore the correlation between sexual attitudes, sexual morality, and HPV hesitancy in Chinese.MethodsBetween January and April 2024, we adopted a qualitative approach and conducted in-depth, one-on-one, semi-structured interviews with 15 young female Chinese university students of sexual maturity.ResultsAlthough all college students exhibited vaccine hesitancy, their perceptions of vaccines and reasons for hesitation varied. This study classified hesitancy into three types: individuals hesitant owing to cultural conservatism and stigmatization, individuals with positive intentions but delayed vaccination, and overconfident individuals who disregarded vaccines. The reasons for vaccine hesitancy are linked to China’s conservative culture of sexuality, and Chinese sexual attitudes and morality have complex mechanisms that influence vaccination. Social taboos on sexual topics lead to inadequate sources of information regarding the HPV vaccine. Sexual morality is internalized into an individual’s subconscious, influencing the cognition of the vaccine. Negative associations and stigmatization of the vaccine further discourage vaccination.DiscussionVaccine hesitancy is not solely a medical or political-economic issue but also a deep-seated cultural issue. Culture significantly affects individual health behaviors, and ignoring socio-cultural factors can exacerbate public health problems. Future research should investigate the political-economic and socio-cultural factors to address geographic differences in vaccine hesitancy.

N10 “I probably am being a naughty boy, but…” Exploring reasons for non-adherence to prescribed medication, as perceived by people living with Inflammatory Bowel Disease: A Qualitative Study

Abstract Background Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take treatments as prescribed. Identifying and understanding reasons behind medication adherence and non-adherence in IBD is critical. Methods In-depth, semi-structured interviews were audio or video-recorded and transcribed verbatim. Braun and Clarke’s (Braun &amp; Clarke, 2006) principles of thematic data analysis were followed to analyse data. Results Twenty people living with IBD were purposively selected and interviewed. Four main themes were identified (Table1) with related sub-themes; 1) The Context within which adherence needs to happen 2) Battles throughout the IBD “journey” 3) Multiple medical treatment issues and 4) Knowledge, learning, understanding and experience of IBD as a condition and its treatment. From diagnosis and throughout their IBD “journey,” medication adherence in many participants was variable. Adherence was impacted by the context of healthcare received by individuals, their daily activities, physical and emotional well-being and relationships with others. Participants regularly described themselves as experiencing a battle using intense terms such as battling with their IBD, their healthcare professionals (HCPs) and/or their IBD medication. Treatment type (including drug category, for example steroids or immunosuppressants, associated risks and side effects), treatment effectiveness and requirements for taking it, all influenced adherence, as did an individual’s treatment values and beliefs. Gaining knowledge, developing understanding regarding medication and its necessity from the start of diagnosis was critical for adherence. This had strong potential to impact adherence positively and/or negatively, based upon what participants were told, when, and by whom. Yet, treatment information was frequently not offered by HCPs, leading individuals to self-educate and develop a personal understanding of their condition and medication. This, combined with the experiencing of living with IBD, influenced their adherence. Conclusion Medication adherence is a journey, affected by multiple determinants. Determinants may be patient-centred, influenced by HCPs and/or determined by an individual’s knowledge and experience level. Diagnosis is a critical stage where individuals require compassionate care from their personal networks and multidisciplinary HCPs. Clear medical treatment information should also be provided by HCPs, with self-education encouraged via trusted resources. To promote adherence and establish treatment routines, patients must feel fully informed, supported, confident and comfortable in their shared decision-making about treatment, that will suit their lifestyle. References -Braun, V. &amp; Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2), 77-101

P0409 Clinical and serological characteristic of Crohn’s Disease patients with gastrointestinal strictures

Abstract Background Processes of inflammation and fibrogenesis in Crohn’s Disease (CD) contribute to development of strictures and subsequent complications, constituting a significant medical issue. The primary objective of the study was to identify clinical parameters associated with the occurrence of gastrointestinal stenosis, as well as to determine the clinical utility of promising biomarkers of fibrosis in a cohort of patients with CD. Methods A single-center cohort study was performed on 78 adults diagnosed with different phenotypes of CD. The study cohort included 36 subjects (46.2%) with gastrointestinal strictures identified by endoscopic or radiological methods, while the control group comprised 42 individuals (53.8%) without stenosis. The assessment of clinical factors, like gender, age of disease onset, disease duration, comorbidities, disease location, extra-intestinal symptoms was undertaken to explore potential associations with the presence of gastrointestinal strictures. Serum levels of candidate biomarkers of fibrosis, including granulocyte-macrophage colony stimulating factor antibodies (GM-CSF Ab), hepatocyte growth factor activator (HGFA), fibronectin isoform ED-A and cartilage oligomeric matrix protein (COMP) were measured using ELISA test. Results The overall cohort consisted of 47.44% females (n=37) and 52.56% males (n=41). The median age of disease onset was similar between the stenosis group (25.00 years, IQR: 19.00–37.00) and the non-stenosis group (26.00 years, IQR: 21.00–33.00). A proportion of 44.44% of the stenosis group required surgical or endoscopic treatment due to strictures. The most common sites of stenosis comprised the large intestine (52.78%) and the ileocecal valve region (50%), ranking ileocecal valve involvement as a significant predictor for stricture formation, with OR=3.65 (95% CI: 1.11–13.43, p=0.039). Fibronectin ED-A, with a cut-off of ≤14.52 ng/mL, was significantly associated with strictures occurrence, with OR=0.96 (95% CI: 0.92–1.00, p=0.036). Some trends in GM-CSF Ab levels were observed in patients with ileocecal involvement (median 1.75 ng/mL) compared to those without (median 1.37 ng/mL), nearing statistical significance (p=0.061). Conclusion The performed study provided some significant data about stricturing course of CD, with ileocecal valve involvement as a marker of stricture formation among CD patients. Evaluated serum biomarkers, especially fibronectin isoform ED-A, seem to be a promising diagnostic tool, however obtained data are inconsistent and demand further trials.

The impact of regular physical activity on vertebral fractures: Korean nationwide population-based cohort study

BackgroundVertebral fractures are a common medical issue. Physical activity helps improve bone health and manage the risk of fractures. However, much controversy exists about the association between physical activity and vertebral fractures. Therefore, we aimed to investigate the association between changes in regular physical activity (RPA) and vertebral fractures.MethodsThis study was a nationwide, observational cohort study based on claim data from the Korean National Health Insurance Service. Physical activity level was obtained from self-reported questionnaires from 2009 to 2012. Participants were divided depending on their levels of physical activity and the occurrence of vertebral fractures from 2013 to 2016 was recorded.ResultsThe group with sufficient RPA, compared to the Insufficient group (incidence rate showed a decrease of 1.93/1,000 PY; adjusted HR (aHR): 0.83; 95% CI: 0.81–0.84), had a reduced risk of vertebral fracture. From the perspective of RPA changes, the Continuous Sufficient group had an aHR of 0.74, 95% CI 0.72–0.76, and the Increased group had an aHR of 0.87, 95% CI 0.85–0.88. The Decreased group had an aHR of 0.94, 95% CI 0.92–0.95.ConclusionThe degree of RPA could reduce the risk of vertebral fracture. Continuous sufficient RPA helped lower the risk of vertebral fracture.

Addressing challenges in pediatric thrombosis: a comprehensive guideline development

BackgroundPediatric thrombosis is a relatively rare but severe condition in the field of pediatrics, with far-reaching consequences. Recent studies have indicated a rising incidence of this disease in children over the years. Additionally, the pharmacological treatment of thrombotic diseases in children faces numerous challenges. Due to significant physiological differences between children and adults, guidelines for the prevention and treatment of thrombotic diseases in adults cannot be directly applied to pediatric patients.PurposeA systematic review of the existing evidence-based medical literature should be conducted to propose pharmacological prevention and treatment recommendations for pediatric thrombotic diseases. Developing a comprehensive and practical pharmacotherapy guideline for the prevention and treatment of pediatric thrombotic diseases is essential to enhancing the rational use of medications in managing these conditions in children.MethodsThe guideline development followed the World Health Organization's (WHO) Handbook for Guideline Development. This involves systematically searching and extensively collecting data on common medication issues in the prevention and treatment of pediatric thrombosis nationwide. The Delphi method was used to survey experts and identify the clinical issues to be included. Subsequently, a systematic literature review was conducted to evaluate existing primary studies, systematic reviews, and guidelines or consensus statements from professional organizations. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The Delphi method was employed again to reach a consensus on the recommendations and evidence levels. This process was culminated in the development of the Guideline for Pharmacological Management of Thrombotic Diseases in Children.ResultsDuring the guideline development process, a total of 29 clinical issues were collected and evaluated by 78 experts in clinical pharmacy and clinical medicine. Through two rounds of surveys, 13 clinical issues were selected. Under the supervision of two methodologists, 13 clinical pharmacotherapy recommendations were formulated.ConclusionBy conducting a comprehensive assessment of the feasibility and safety of clinical practices, the guideline provides specific anticoagulant medication recommendations for pediatric healthcare professionals. This will help enhance the prevention and treatment of pediatric thrombosis, promoting more standardized and effective medical practices.

Current applications and challenges in large language models for patient care: a systematic review

BackgroundThe introduction of large language models (LLMs) into clinical practice promises to improve patient education and empowerment, thereby personalizing medical care and broadening access to medical knowledge. Despite the popularity of LLMs, there is a significant gap in systematized information on their use in patient care. Therefore, this systematic review aims to synthesize current applications and limitations of LLMs in patient care.MethodsWe systematically searched 5 databases for qualitative, quantitative, and mixed methods articles on LLMs in patient care published between 2022 and 2023. From 4349 initial records, 89 studies across 29 medical specialties were included. Quality assessment was performed using the Mixed Methods Appraisal Tool 2018. A data-driven convergent synthesis approach was applied for thematic syntheses of LLM applications and limitations using free line-by-line coding in Dedoose.ResultsWe show that most studies investigate Generative Pre-trained Transformers (GPT)-3.5 (53.2%, n = 66 of 124 different LLMs examined) and GPT-4 (26.6%, n = 33/124) in answering medical questions, followed by patient information generation, including medical text summarization or translation, and clinical documentation. Our analysis delineates two primary domains of LLM limitations: design and output. Design limitations include 6 second-order and 12 third-order codes, such as lack of medical domain optimization, data transparency, and accessibility issues, while output limitations include 9 second-order and 32 third-order codes, for example, non-reproducibility, non-comprehensiveness, incorrectness, unsafety, and bias.ConclusionsThis review systematically maps LLM applications and limitations in patient care, providing a foundational framework and taxonomy for their implementation and evaluation in healthcare settings.

Evaluation of the antibacterial properties of four bioactive biomaterials for chronic wound management.

Chronic wound infections present a prevalent medical issue and a multifaceted problem that significantly impacts healthcare systems worldwide. Biofilms formed by pathogenic bacteria are fundamental virulence factors implicated in the complexity and persistence of bacterial-associated wound infections, leading to prolonged recovery times and increased risk of infection. This study aims to investigate the antibacterial effectiveness of commonly employed bioactive wound healing compositions with a particular emphasis on their effectiveness against common bacterial pathogens encountered in chronic wounds - Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa to identify optimal wound product composition for managing chronic wound infections. This study tested the antibacterial and antibiofilm effectiveness of four bioactive wound healing materials by performing in vitro antibacterial assays and measuring ion release profiles. The anti-biofilm effectiveness differed extensively among the biomaterials tested and slightly among the bacterial species. Particularly, copper and zinc-doped borate bioactive glass wound healing compositions inhibited the three clinically relevant bacteria in both planktonic and biofilm forms, which were found to be ascribed to the copper and zinc gradual release. The findings suggest that copper and zinc-doped bioactive glasses hold great promise for improving chronic wound management by providing strong antibacterial action and promoting faster healing.

Social issues in general practice – a survey assessing the interprofessional perspective of general practitioners and social workers regarding frequency, challenges, and needs

BackgroundHealth or illness and social issues cannot be viewed in isolation. Social problems can influence well-being and disease. General Practitioners (GPs) are requested to offer counselling opportunities to respond to the social issues of their patients adequately. Counselling on non-medical issues in general practice increases GPs’ workload. The study aimed to analyse the occurrence of social problems as well as the strengths and weaknesses of existing working agreements between social services and GPs in primary care.MethodsWe carried out a cross-sectional online survey between December 2022 and January 2023 among a sample of Swiss GPs from the Sentinella-Network, the uniham-bb-Network and social workers from the SAGES-Network.ResultsFindings come from a sample of 143 GPs (mean age 54 years, 37.8% female) and 41 social workers (mean age 43 years, 75.6% female). GPs face a median of 3 patients with social problems per week (IQR 5.2). They reported encountering patients facing “Finance” issues most frequently, with 78.8% encountering such cases between “more than 3 patients per week” and “1–3 patients per month”. “Work” (76.4%) and “Loneliness” (73.7%) were also among the most commonly encountered social problems. When suspecting the problem, GPs more often addressed the issue if it was about “Addiction” (83.2%), “Loneliness” (72.3%), or “Protection” (71.4%). More than half of GPs (56.0%) reported having contact with social workers less than once a month, while approximately half of the social workers reported having contact with GPs 1 to 3 times a month (48.7%). GPs (69.3%) and social workers (76.3%) would like more contact. The most frequently mentioned benefits of an increased collaboration from the GPs’ perspective were “improved quality of care (more time for medical issues)” (64.8%) and “improved mental health of patients” (55.6%).ConclusionsSocial problems in general practice are common, but the interprofessional cooperation between GPs and social workers is scarce. However, both parties appear to be in favour of closer interprofessional collaboration and seem to be willing to attempt to improve joint patient care in the future. The integration of social workers into general practice is promising for a comprehensive, interprofessional, and preventative patient approach to providing the best healthcare.

Assessing Theoretical Considerations of Effects Within a Behavioural Obesity Treatment in Women: Implications for Medical Professional Referral.

Obesity is an increasing medical issue not responding well to behavioural treatments beyond their initial weeks/months. Before suggesting surgical or pharmacological interventions, medical professionals might consider referrals to cost-effective, community-based behavioural treatments if stronger theoretical/empirical bases were demonstrated. Thus, evaluation of such is warranted. Women with obesity were randomly assigned to 6-month treatments emphasizing either behavioural theory-based methods focused on exercise-associated psychological changes generalizing to dietary changes (n = 101), or typical instruction in weight-control methods (n = 53). Theory-driven psychosocial, behavioural and weight changes were assessed over 12 months. Improvements in all measured variables were significantly greater in the behavioural theory group. In the evaluation of hypothesized theory-based relationships-which have overarching bases in social cognitive theory-(1) self-efficacy theory was supported by self-regulation-associated increases in self-efficacy predicting later positive changes in exercise and the diet; (2) coaction theory was reinforced by the identified transfer of changes in self-regulation of exercise to self-regulation of eating; (3) the mood-behaviour model was sustained by improved mood predicting exercise and dietary improvements through (mediated by) self-regulation changes; (4) self-regulation theory was bolstered through early improvements in self-regulation supporting its longer-term increase, especially under conditions of self-regulatory skills practice and (5) operant conditioning theory was supported through results indicating a reinforcing effect from exercise-associated mood improvement to reduced emotional eating. Across the theories, relationships among tested variables were generally stronger in the behavioural theory group. Improvements in exercise and dietary behaviours were significant independent predictors of reduced weight. Findings support the addressed behavioural theories within a community-based obesity treatment model that emphasized exercise for its psychosocial impacts on dietary behaviours and sustained weight loss. Based on the present empirical supports, medical professionals should consider referral to such approaches before (or in combination with) surgical or pharmacological methods.

Pulmonary function in swimmers exposed to disinfection by-products: a narrative review.

Swimming produces many psychophysiological effects, including blood, hormonal, enzymatic, pulmonary, cardiovascular and energetic adaptations. However, asthma and allergies are becoming increasingly prevalent medical issues among elite endurance-trained swimmers, where exercise-induced asthma or bronchospasm is frequently reported. Heavy endurance swimming training, especially under adverse conditions, stresses the airway mucosa, leading to inflammatory changes, as observed in induced sputum in competitive swimmers. In addition, chlorine-based disinfectants (CBDs) are commonly used in indoor pools due to their effectiveness and lower relative cost. Many of these substances have carcinogenic and genotoxic properties, and exposure to DBPs have been linked to adverse respiratory effects. The association between long-term exposure to a chlorinated swimming pool and elevated serum sIgE levels suggests a link between allergens, chlorine exposure and the development of various pulmonary dysfunctions. Thus, the combination of intense and repeated physical endurance training over extended periods, along with suboptimal environmental conditions, may contribute to the development of rhinitis, asthma and bronchial hyperresponsiveness in athletes. While occasional or low-level exposure to chlorine might not be harmful, regular swimmers, especially those at competitive levels, are at a higher risk of developing respiratory disorders. Because these potential risks of exposure to CBDs must be balanced against the benefits of swimming and the risk of microbial infections in pools, we recommend better pool management and regular health checks for swimmers. Fortunately, the reduction of bronchial symptoms in swimmers who reduce training volume and intensity suggests that the negative effects on pulmonary function may be reversible. For these reasons, it is crucial to develop effective respiratory protection strategies, including medical interventions and modifications to the pool environment. Practical steps such as reducing chlorine use, ensuring proper hygiene before swimming and using swim caps can minimise risks. Research should also explore safer alternatives to CBDs, such as ozonation, and improved ventilation to reduce air pollutants.

Risk factor for difficult cases at the comprehensive consultation services about medical, welfare and legal problems.

This study aimed to identify the associations between background factors (such as medical conditions, intractable diseases, welfare problems, disabilities, economic difficulties, legal problems, elderly adults, children, and foreign persons) and difficult cases to provide more thorough consultation services. A survey was conducted on people who participated in comprehensive consultation services on medical, welfare, and legal issues related to medical care, welfare, and legal matters held from April 2021 to March 2024. We analyzed risk factors that may be difficult to resolve using multivariate logistic regression. Multivariate analysis showed that the factor of "economic difficulty" was significantly more difficult to solve. When treating patients, doctors must consider the possibility of multiple underlying issues. It is advisable for doctors to be aware of the need to consult with social workers and legal professionals when necessary.

Risk Management Considerations and Multiple Responsibilities in Medical Pharmaceutical Practice

In the health field, risk assessment of health damage is a basic component in the control and maintenance of human health. Risk management is defined as the technique of assessing and preventing accidental losses through insurance, and safety measures by making the right decisions and ensuring accountability. The responsibility of those in the medical-pharmaceutical field is permanent and multiple, on several levels, and named as follows: professional responsibility towards the patient, legal responsibility, administrative responsibility, economic responsibility, and social responsibility. Accountability in decisions is ongoing all the time and is a constant, daily, and multi-layered activity. The double responsibility of the doctor and the pharmacist is very important: to the patient and to the community. The society holds physicians accountable for the high cost of health care. Public health programs, warn that the rate of increase in medical costs is growing faster than national income. Still, patients, who are becoming more and more informed about medical issues - are also demanding more diagnostic procedures, more drugs, more medical care, and more hospitalizations.