Medical Research Articles

The performance of AI in medical examinations: an exploration of ChatGPT in ultrasound medical education

ObjectiveThis study aims to evaluate the accuracy of ChatGPT in the context of China’s Intermediate Professional Technical Qualification Examination for Ultrasound Medicine, exploring its potential role in ultrasound medical education.MethodsA total of 100 questions, comprising 70 single-choice and 30 multiple-choice questions, were selected from the examination’s question bank. These questions were categorized into four groups: basic knowledge, relevant clinical knowledge, professional knowledge, and professional practice. ChatGPT versions 3.5 and 4.0 were tested, and accuracy was measured based on the proportion of correct answers for each version.ResultsChatGPT 3.5 achieved an accuracy of 35.7% for single-choice and 30.0% for multiple-choice questions, while version 4.0 improved to 61.4 and 50.0%, respectively. Both versions performed better in basic knowledge questions but showed limitations in professional practice-related questions. Version 4.0 demonstrated significant improvements across all categories compared to version 3.5, but it still underperformed when compared to resident doctors in certain areas.ConclusionWhile ChatGPT did not meet the passing criteria for the Intermediate Professional Technical Qualification Examination in Ultrasound Medicine, its strong performance in basic medical knowledge suggests potential as a supplementary tool in medical education. However, its limitations in addressing professional practice tasks need to be addressed.

The addition of cannabis to prescription drug monitoring programs and medication fills in Medicaid.

To date, there is considerable evidence of the medical applications of cannabis, however concerns regarding the safety of cannabis are also mounting. To improve the safety of cannabis, nine states have added medical cannabis to their state PDMPs, helping providers to take patient cannabis use into consideration when making prescribing decisions. Across a variety of models using Medicaid State Drug Utilization claims data, I find statistically significant reductions in severely and moderately contraindicated medication fills across two outcomes. In my main specification, adding cannabis to a state PDMP is associated with a 14.4% (p<0.01) and 7.74% (p<0.001) decrease in the units per prescription, for severely and moderately contraindicated medications, respectively, as compared to states with legal medical cannabis dispensaries open. An interesting spillover effect of adding cannabis to PDMPs is an apparent decrease in the prescribing of scheduled narcotics, with Schedule II medications seeing a moderately significant decrease and Schedule IV medications seeing a 11.4% decrease (p<0.01) in the prescribing rate and a 16.2% decrease (p<0.001) in the units per prescription. The main analysis was conducted using the Borusyak etal. (2023) Imputation Estimator with a robustness check using the Callaway and Sant'Anna (2021) difference-in-difference. This work presents evidence that adding cannabis to a state PDMP impacts provider prescribing decisions involving medications that are contraindicated for use with cannabis as well as controlled substances. This paper demonstrates that adding cannabis to PDMPs influences prescribing and thus has the potential to make medical cannabis use safer. Conversely, this work indicates providers may have bias against patients who use cannabis and deny them life-improving medications (like controlled ADHD medication or opioids) on the basis of medical cannabis use. This paper also contributes to the literature comparing DD outcomes estimated using Borusyak, Jaravel, and Spiess' (2023) Imputation Estimator and Callaway and Sant'Anna's (2021) DD Estimator.

The perspectives of clinical level medical students on animal-assisted therapy: a study in Ghana

BackgroundThe role of animal-assisted therapy (AAT) in complementary and alternative medicine is well acknowledged. AAT is widely patronized, in developed countries such as USA, Canada, and many European countries, but less so in developing countries in Africa including Ghana. For persons in developing African countries and elsewhere to benefit from AAT, healthcare professionals must be acquainted with it recommend it to their patients when necessary. This study therefore assessed the perspectives of clinical-level medical students on AAT.MethodA semi-structured questionnaire was used to collect data in a cross-sectional study from 206 randomly selected clinical-level medical students of the University for Development Studies, Tamale, Ghana. The data was analyzed using Microsoft Excel and SPSS (Version 26) and the results were presented in Tables and charts. The association between demographic variables and the knowledge and attitude of the students were determined using ANOVA, while bivariate Pearson’s correlation was used to measure the relationships between continuous variables. Associations were considered significant when p-value < 0.05.ResultsThe knowledge about AAT among the medical students was very poor (0.971 ± 2.407 over 10; 9.7%); almost all of them (≈ 99.0%) had very little or no exposure to AAT in school or at home. The attitude of the students was however averagely positive (3.845 ± 0.748 over 7; 54.9%), with a perceived health benefit of ATT score of 4.768 ± 1.002 (68.1%). The motivation of the students to acquire more knowledge and skills about AAT mostly through lectures and practical sessions (70.9%) was good (4.809 ± 1.221; 68.7%). Female students were significantly more knowledgeable about AAT than their male counterparts (1.5 versus 0.6; p-value = 0.006). No other sociodemographic characteristics had any significant association with knowledge, attitude, and perception of benefit variables. However, a significant positive relationship was found to exist between the students’ knowledge, attitude and perception of animal-assisted therapy (r ≥ 0.236; p-value ≤ 0.001).ConclusionWe conclude that the knowledge about AAT among medical students is inadequate and this is worrying given the beneficial complementary role of AAT in achieving SDG 3. Medical schools and their regulators in Ghana should incorporate complementary and alternative medicine (CAM) lessons in their training curricula. For practising medical doctors, topics on CAM should be discussed during their Continuous Professional Development sessions. With better knowledge, physicians would possibly be more willing and confident in recommending this useful complementary and alternative medicine to patients who may seek other forms of therapy besides conventional medicine or which will augment the orthodox medication the patients may have been using to treat their conditions.

Practicing health equity in kidney care by establishing improved access to timely disease management and kidney replacement therapy options: from providers to patients.

The aim of this article is to review the current understanding of disparities in healthcare experienced by people living with kidney disease and emerging approaches to address root causes. Health equity for any disease state is an aspirational goal commonly sought out by the medical community, but all too often lacking the understanding and support required to improve the outcomes of people with complex conditions such as chronic kidney disease (CKD). The main themes of the literature covered in this article include a review of the structural drivers of healthcare outcomes, a description of research in the fields of health literacy and patient activation for patients with CKD, and an analysis of the examples of healthcare disparities in CKD patients that include involuntary discharges from dialysis facilities as well as the toll taken from dialysis populations during natural disasters. The National Forum of the ESRD Networks is a coalition of 18 congressionally mandated ESRD network organizations committed to equitable access to home and in-center dialysis modalities and preemptive kidney transplantation. We conclude with the patient-centered story of a patient living with end-stage kidney disease for over 40 years and how her journey has helped shape her view on what she believes should encompass a 'call to action' to provide more equitable healthcare to people living with kidney disease. The overarching implications of this article focus on improving the understanding of present-day healthcare inequality within the community of people living with kidney disease and providing a roadmap of resources and ideas that will help achieve more equitable outcomes. The National Forum of the ESRD Networks is committed to the effective implementation of 'Practicing Health Equity in Kidney Care' and improving access to dialysis modalities including home dialysis as well as kidney transplantation including preemptive transplant options.

Semiautomatic volumetry of the temporal lobes of the brain and correlation with electroencephalography results in dogs with assumed idiopathic epilepsy.

Lesions causing refractory epilepsy, often associated with temporal lobe epilepsy (TLE), can be undetectable on standard magnetic resonance imaging (MRI) in dogs. Automated brain volumetry, widely used in human medicine, can now be applied in veterinary medicine because of the availability of brain atlases. This study aimed to develop an automatic volumetry method, translate the outcomes into the assessment of temporal lobe volumes in dogs with idiopathic epilepsy, and correlate the results with the electroencephalography (EEG) data of epileptiform discharges (EDs). Thirty-one dogs of various breeds with dominant temporal lobe discharge. Retrospective, observational study. The MRI and EEG examination results of dogs referred for neurological diagnosis data between 2016 and 2021 were retrospectively analyzed. An automated volumetry method was developed, which allowed the evaluation of temporal lobe volumes of the dogs. The asymmetric ratio (AR) was then estimated, and the results were correlated with the EEG EDs. 12/31 (38%; 95% CI: 21.8%-57.8%) dogs had an asymmetric ratio >6%. Among them, reduction in temporal lobe volumes correlated with the side of the EEG EDs in 7 cases. There was no statistical correlation between temporal lobe volume changes and ED location. Preliminary volumetric analysis of the temporal lobes indicates the presence of volume differences between the lobes in some dogs with idiopathic epilepsy. Diagnosis of TLE in dogs based on MRI volumetry in correlation with EEG examination, especially for dogs with drug-resistant epilepsy, can influence the development of new therapeutic options, such as surgery.

The use of complementary and alternative medicine (CAM) during pregnancy.

Approximately one-third of the global population uses complementary medicine, as yoga and meditation, not endorsed by evidence-based conventional medicine and, with more difficulties in case of pregnancy. Our study investigates the prevalence of Complementary and Alternative Medicine (CAM) usage in Novara (Italy) and its province through a survey to pregnant women at 36 gestational weeks. The sample consisted of 70 women, average age of 33 years, most Caucasian, highly educated, mostly employed, under private gynecological care, with a prevalence of CAM use of 24.3 % [95 % CI 14.83; 36.01]. Six women (35.3 %) did not inform their healthcare provider of using these medicines, 15 women (88.2 %) express willingness to use complementary medicine in their next pregnancy, while 2 (11.8 %) are uncertain. The study found a significant association between higher education and CAM usage among pregnant women. Other factors, including nationality, occupation, choice of private practice, parity, physical activity, diet, smoking, pregnancy complications, and vaccination status, did not show significant relationships with CAM usage. Our objective is to delineate the characteristics of CAM users, explore the methodologies and motivations of their usage, and ascertain any correlations with the rejection of conventional vaccination practices. The analyzed population consists of 70 women aged 32.9 years in mean, mostly Caucasian, with a high level of education. Most women are under private gynecological care (84.3 %), half of the participants are experiencing their first pregnancy. Physical activity levels vary, with 34.3 % reporting high activity levels. Regarding diet, 77.1 % consider their eating habits moderately healthy, with a notable portion of smokers women (24.3 %); 20.0 % have experienced pregnancy complications. 17 participants utilized non-conventional or alternative medicine, with a prevalence of 24.3 [95 % CI 14.83; 36.01]. Six women (35.3 %) did not inform their healthcare provider about using CAM. Seven women (46.7 %) claim significant beneficial effects in most cases, while 8 (53.3 %) state this occasionally. Based on their experiences, 15 women (88.2 %) express willingness to use complementary alternative medicine in their subsequent pregnancy, while 2 (11.8 %) are uncertain. Only one person (11.1 %) used this type of therapy as a substitute for conventional treatment, but they informed their attending physician. The study seeks to enhance our understanding of CAM utilization in pregnancy, informing more comprehensive and evidence-based healthcare practices for expectant mothers.

Garbhini Paricharya and its Clinical Importance

Ayurveda refers to prenatal care as Garbhini Paricharya, a preventive healthcare system. Pregnant women should receive care from the start of their pregnancy until the baby is born. Given that the health of the mother affects the outcome for the fetus, pregnancy and childbirth are among the most important times in a woman’s life cycle and require special care. The rising incidence of congenital malformations in infants nowadays is a major source of concern for the medical community. These flaws might be mild, large, anatomical, or physiological in character. Prenatal care known as Garbhini Paricharya suggests Ahar, or a certain nutrition plan, Vihar, or a Garbhini way of life, and behavioral changes in the psychological domain. The right Garbhini Paricharya would lead to the fetus developing normally, to a healthy delivery, and to the mother’s ability to endure the hardship of childbirth. Garbhini Paricharya consists of Garbhasthapak Dravyas (substances favorable for maintaining pregnancy), Garbhopaghatakar Bhavas (activities and substances which are damaging to fetus), and Masanumasik Pathya (mouth smart food regimen). The primary goals of advising Garbhini Paricharya are Anupaghata (simple pregnancy), Paripurnatya (ensuring the fetus and mother grow properly), and Sukhaprasava (healthy delivery). Conclusion: Prenatal care should be provided in an integrated manner, that is, in accordance with both current science and Ayurvedic literature, as the ancient Ayurvedic literature detailed in the many Samhitas is not only unique but also scientific as modern medical sciences.

Western Anthelmintics in Early Twentieth-Century China Colonial Practices and Knowledge on "Tropical Diseases" of the In/between.

Protestant (medical) missionaries were the main proponents of Western medicine in China after the Opium Wars. Several studies have highlighted how they used spectacular surgery as a means of gaining public trust. As well as surgery, they also administered anthelmintic drugs such as santonin as a tool of persuasion and conversion. Many anthelmintic drugs of the European materia medica had a colonial history. My paper analyses how coloniality materialised in medical practice and anthelmintics in China. For the late nineteenth century, I will examine the colonial practices in which the drug santonin was involved. At the time, santonin was the drug of choice for treating roundworm. In the early twentieth century, medical missionaries became involved in parasitological research on parasitic worms such as hookworm and Fasciolopsis buski. For this period, I will explore how new knowledge about anthelmintics emerged in the scattered knowledge space of China, and how it related to colonialism and imperialism.

Unveiling the efficacy and mechanism of Danggui-Shaoyao-San in treating nephrotic syndrome: A meta-analysis and network pharmacology study

Aim of the studyThe purpose of this study was to investigate the efficacy and mechanism of DSS in treating nephrotic syndrome through meta-analysis and network pharmacology methods. Materials and methodsTo conduct a comprehensive search for randomized controlled trials on the efficacy of Danggui Shaoyao San (DSS) in the treatment of nephrotic syndrome, we searched across eight electronic databases from their establishment to May 1, 2023. The Cochrane Collaboration's Risk of Bias 2 tool was used to evaluate the quality of evidence regarding bias risk and outcomes. Statistical analysis was performed using RevMan software (version 5.4). Furthermore, network pharmacology was employed to validate the underlying mechanism. ResultsThis study included 14 articles that involved 1256 patients with nephrotic syndrome. The clinical efficacy of DSS against nephrotic syndrome was significantly higher than that of Western medical treatment alone. In comparison with the control groups, which were administered Western medicines alone, the use of DSS significantly increased plasma albumin levels (mean difference [MD] = 4.32, 95 % confidence interval [CI] [2.37, 6.24], p < 0.00001) and reduced 24 h urinary protein excretion (MD = −0.92, 95 % CI [−1.11, −0.73], p < 0.00001), total cholesterol levels (MD = −1.23, 95 % CI [−1.76, −0.70], p < 0.00001), triglyceride levels (MD = −0.37, 95 % CI [−0.54, −0.20], p < 0.00001). Furthermore, the combination of DSS with Western medicines achieved better control of adverse reactions in comparison with the control groups (relative risk = 0.37, 95 % CI [0.29, 0.49], p < 0.00001). Network pharmacology analysis identified 39 important active compounds and 18 core target genes involved in the treatment of primary nephrotic syndrome by DSS. Gene Ontology enrichment analysis identified 2126 biological processes, 64 cellular components, and 115 molecular functions, while Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis identified 149 signaling pathways. Key active compounds include ginsenoside Rg5, ginsenoside Rg1, schisandrin A, berberine, gallic acid, quercetin, and β-sitosterol, while potential core target genes include IL6, AKT1, TNF, VEGFA, IL1B, and TP53. KEGG pathway analysis indicated that DSS is involved in multiple mechanisms, such as neural development, synaptic plasticity, programmed cell death, inflammation, and immunity. ConclusionsDSS has higher efficacy and safety in the treatment of nephrotic syndrome and acts on nephrotic syndrome via mechanisms that involve multiple targets, components, and pathways.

Why Is Hospice One of the Few Health Care Environments Structured for Peace?

Historically, Western medicine has recognized health care environments as vital to patient well-being and enhanced clinical outcomes. Yet most modern Western hospitals are primarily designed and regulated to promote safety and minimize risk rather than to enhance comfort or serve as therapeutic environments in and of themselves. Hospice stands out as one of the few places within the Western health care service delivery system in which the structures and spaces of caregiving are viewed as key to patient-centered practice. This commentary on a case suggests the importance of designing health care environments that center patient experiences of well-being throughout the lifespan, not just at the end of life.

Alternative therapy for lymphoma with febrile neutropenia using traditional Chinese medicine: A case report

IntroductionFebrile neutropenia is a common complication in patients undergoing chemotherapy for hematologic malignancies and is associated with significant morbidity and mortality. Primary granulocyte colony-stimulating factor (G-CSF) prophylaxis is consistently associated with a notable reduction in the risk of febrile neutropenia. However, the use of G-CSF in patients who are already neutropenic from chemotherapy remains controversial. Studies have shown that 12.9% of cancer patients incorporate traditional Chinese medicine (TCM) to alleviate chemotherapy side effects in Taiwan; thereby providing an alternative management strategy for neutropenic fever in cancer patients. Case presentationThis is an 18-year-old female with newly diagnosed precursor T-lymphoblastic lymphoma. After chemotherapy, the patient developed febrile neutropenia. Despite the use of antibiotics and G-CSF, the febrile neutropenia persisted for two months. Approximately ten days after the initiation of traditional Chinese medicine decoction with the strategy of tonifying the spleen and stomach, clearing yin fire, and uplifting yang, her absolute neutrophil count (ANC) had gradually increased. Additionally, after two weeks of treatment, her fever subsided. The patient continued with chemotherapy and was discharged in stable condition. DiscussionAntibiotic use aligns with the TCM perspective of an “attack” approach. Conversely, our TCM decoction was designed to raise the ANC by tonifying the spleen and stomach, clearing Yin Fire, and uplifting Yang. Li Dongyuan, one of the four great masters of the Jin Yuan Dynasty, created the formula: Bupiwei Shengyang Sanhuo Decoction that is notable in this regard. The herbs in our decoction have shown hematopoietic and myelosuppression-alleviating effect. For many patients who do not respond adequately to G-CSF alone, integrative treatments involving both TCM and Western medicine can offer additional therapeutic benefits by increasing blood cell counts.

Discerning the Multi-dimensional Role of Salicin: Bioactive Glycoside Beyond Analgesic: Different Perspectives

: Salicin is a glycoside that can be found in several Salix and Populus species. Salicin is also connected to the glycoside populin, commonly known as benzoyl Salicin, in the Salicaceae tree barks. D-glucose is a component of the alcoholic glycoside Salicin (C13H18O7). The willow tree, as well as other trees like poplar and aspen, contains the natural chemical Salicin, which is a member of the salicylate family. Salicin is an anti-inflammatory and analgesic used in conventional medicine, and it served as the inspiration for the creation of aspirin. This molecule may have important human pharmacological actions that need to be considered in determining the efficacy and safety of willow herbal medicines. The extracts obtained from the bark of the tree, belonging to the Saliceae family in different solvents have been known for possessing many important medicinal values by potent pharmacological actions. The current effort deals with exquisite detailed aspects and concerns related to Salicin, which will be fruitful for the futuristic approaches to Salicin.

Uncovering Reflections of Preclinical Medical Students from Clinical Shadowing: A Thematic Analysis

Purpose Clinical shadowing(CS) offers preclinical medical students the opportunity to observe certified physicians in practice. Analyzing the content of students’ reflective writings(RWs) to understand core competencies they perceived during CS, as well as stages of their reflections, can offer valuable insights for course design and instructor guidance. This study aimed to address this matter by employing a thematic analysis of students’ RWs to explore the learning outcomes derived from CS. Materials and methods The dataset of the thematic analysis comprised de-identified RWs from preclinical medical students who participated in the clinical shadowing program during the first semester of the 2019 academic year at National Taiwan University College of Medicine. Two researchers independently extracted and categorized pertinent content from the texts of RWs, aligning them with the six core competencies of ACGME and mapping them to the stages of Kolb’s learning cycle. Additionally, correlation with shadowing specialties and fields was investigated. Results In total, 155 RWs were analyzed. Patient care emerged as the most frequently reflected competency(30%), followed by systems-based practice(23%), and medical knowledge(21%). The shadowing specialties and fields had an impact on the core competencies students perceived. In terms of Kolb’s learning stages, concrete experience(66%) predominated in RWs, while abstract conceptualization(19%) and reflective observation(14%) were less prevalent. For each competency, concrete experience was the prevailing stage, with active experimentation being the least dominant one. Students exhibited varying proportions of reflections at different stages for each core competency. Conclusions Clinical shadowing experiences enable preclinical medical students to explore required clinical core competencies, with emphases depending on the shadowing specialties and fields. Currently, most reflections are concentrated at Kolb’s concrete experience stage. This study offers valuable insights for designing future CS programs and improving faculty development, aimed at helping students achieve deeper and more comprehensive reflective learning in relation to core competencies, and even professional identity.

Enhancing early detection of cognitive decline in the elderly: a comparative study utilizing large language models in clinical notes

BackgroundLarge language models (LLMs) have shown promising performance in various healthcare domains, but their effectiveness in identifying specific clinical conditions in real medical records is less explored. This study evaluates LLMs for detecting signs of cognitive decline in real electronic health record (EHR) clinical notes, comparing their error profiles with traditional models. The insights gained will inform strategies for performance enhancement. MethodsThis study, conducted at Mass General Brigham in Boston, MA, analysed clinical notes from the four years prior to a 2019 diagnosis of mild cognitive impairment in patients aged 50 and older. We developed prompts for two LLMs, Llama 2 and GPT-4, on Health Insurance Portability and Accountability Act (HIPAA)-compliant cloud-computing platforms using multiple approaches (e.g., hard prompting, retrieval augmented generation, and error analysis-based instructions) to select the optimal LLM-based method. Baseline models included a hierarchical attention-based neural network and XGBoost. Subsequently, we constructed an ensemble of the three models using a majority vote approach. Confusion-matrix-based scores were used for model evaluation. FindingsWe used a randomly annotated sample of 4,949 note sections from 1,969 patients (women: 1,046 [53.1%]; age: mean, 76.0 [SD, 13.3] years), filtered with keywords related to cognitive functions, for model development. For testing, a random annotated sample of 1,996 note sections from 1,161 patients (women: 619 [53.3%]; age: mean, 76.5 [SD, 10.2] years) without keyword filtering was utilised. GPT-4 demonstrated superior accuracy and efficiency compared to Llama 2, but did not outperform traditional models. The ensemble model outperformed the individual models in terms of all evaluation metrics with statistical significance (p<0.01), achieving a precision of 90.2% [95% CI: 81.9%-96.8%], a recall of 94.2% [95% CI: 87.9%-98.7%], and an F1-score of 92.1% [95% CI: 86.8%-96.4%]. Notably, the ensemble model showed a significant improvement in precision, increasing from a range of 70%-79% to above 90%, compared to the best-performing single model. Error analysis revealed that 63 samples were incorrectly predicted by at least one model; however, only 2 cases (3.2%) were mutual errors across all models, indicating diverse error profiles among them. InterpretationLLMs and traditional machine learning models trained using local EHR data exhibited diverse error profiles. The ensemble of these models was found to be complementary, enhancing diagnostic performance. Future research should investigate integrating LLMs with smaller, localised models and incorporating medical data and domain knowledge to enhance performance on specific tasks.

Shaping competencies for culturally safe practice among medical students.

Limited evidence exists around authentic activities that can positively influence students' knowledge of and appreciation for the First Nations peoples' culture, impacts of colonisation and other determinants of health. A renewed Indigenous Health curriculum provided us with an opportunity to implement a cultural immersion for medical students to enhance their cultural awareness and competency. Our approach towards the design and evaluation of cultural immersion was guided by three key frameworks-a strengths-based approach towards curriculum design, Indigenous ways of knowing and being and immersions as transformative pedagogy. Pre- and post-immersion surveys were sent to 260 first-year medical students in 2020 and 323 students in 2021 who were the participants. Response rates were 37% (2020) and 47% (2021). The data indicated significant improvements in students' knowledge of Indigenous cultural beliefs and history as well as confidence in working with Indigenous populations. Students' comments indicated their experiences varied on a continuum of four ways of 'knowing': reluctant, receiving, relating and reconstructing their beliefs. Their ways of 'being' varied across four levels: privileged, feeling discomforted, being humbled and agentic. The study extends the limited evidence of theoretically informed interventions that have the potential to positively influence medical students' knowledge and appreciation of Indigenous history, culture and its impact of health outcomes. Cultural immersion experiences, when co-designed with the community and in consideration with students' prior beliefs, are powerful tools to promote capabilities for working with Indigenous patients in culturally safe ways.

Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey.

Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown. This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care. In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan. The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected. Our nationwide surveys provided insights into the current status of online medical care in Japan and simultaneously identified several problems and issues related to it, which will be useful in promoting its wider adoption.

Application of Sini Decoction at acupoint on gastrointestinal dysfunction in patients with sepsis: A clinical study.

The occurrence of gastrointestinal dysfunction is widely recognized as a prevalent complication in patients with sepsis. To investigate clinical effect of Sini Decoction at acupoint on gastrointestinal dysfunction in sepsis patients. Seventy-five patients with gastrointestinal dysfunction caused by sepsis were randomly divided into 2 groups. Treatment group received routine Western medicine treatment combined with Sini Decoction at acupoint, while control group treated with talcum powder at acupoint. Treatments in both groups lasted 7 days. Changes in the acute physiology and chronic health evaluation II score, sequential organ failure assessment score, mechanical ventilation duration, the length of Intensive Care Unit (ICU) stay, enteral nutrition tolerance scores, abdominal circumference, gastric residual volume, bowel sounds, and serum index were observed. After treatment, the enteral nutrition tolerance score, abdominal circumference, gastric residual volume, and levels of lactate and interleukin-6 were significantly lower in the treatment group compared to the control group. Bowel sounds were more active and motilin levels were higher in the treatment group. Additionally, the length of ICU stay was significantly shorter in the treatment group than in the control group. Our findings demonstrated that the application of Sini Decoction at acupoints in sepsis patients with gastrointestinal dysfunction can effectively enhance gastrointestinal function, leading to a reduction in ICU stay duration and an improvement in patients' prognosis.

Two Kings: Empire, Abolition, and the University of Aberdeen’s First African Student

This article presents a biography and multi-generational microhistory of Nathaniel King (1847–1884), the University of Aberdeen’s first African-born student and a pioneering practitioner of Western medicine in colonial West Africa. Nathaniel’s father, Thomas King, rose from slavery to become a missionary and linguist in Sierra Leone and what would later become Nigeria. Nathaniel, born to survivors of the Middle Passage, graduated M.B., C.M. from Aberdeen in 1876, before returning to West Africa to become a prominent member of the educated elite in Victorian Lagos. The long-established historiography of Scottish ‘sojourners’ abroad has not yet explored the impact of colonial sojourners to Scotland, an itinerary travelled particularly by male students from within the empire, especially as Scotland’s universities became imperial centres of medical training. This article draws particular attention to the significance of Britain’s nineteenth-century campaign against the trans-Atlantic slave trade in the arrival of the first African-born students at Scottish universities, placing King’s history within a broader pattern of Africans born to people liberated from slave ships who ventured to Aberdeen, Edinburgh, and St Andrews in the middle decades of the nineteenth century for medical training.

Educational Recommendations for Medical Students Regarding Assessment and Management of Patients of Undifferentiated Criticality

Classical medical education teaches history and physical skills using scenarios wherein the criticality of a patient is predefined. This educational approach creates a gap in medical knowledge for students, who do not regularly define or establish patient criticality, and this gap is realized when it comes to the triage and management of critical patients. The purpose of this paper is to define an approach to patient assessment and management that is accessible to medical students regardless of criticality. This approach is algorithmic and defined by the use of three steps: (1) a primary survey, during which a general impression of the patient is formed, ABCDEs are assessed, and a criticality assessment is made; (2) a secondary survey, during which vitals, history, and exam data are all collected to form a working diagnosis; and (3) plan and treatment, during which supportive diagnostics, such as labs, imaging, and testing, are performed in the service of patient stabilization and intervention, consults/referrals are ordered/placed, and a final disposition is established. This model is intended to complement existing medical education and further expand it to encompass both critical and noncritical patients.

Gynecologic Pathology Journal Club: A 2-year, Worldwide Virtual Learning Experience With a Focus on Mentorship and Inclusion.

Journal clubs (JCs) are a common format used in teaching institutions to promote trainee engagement and develop skills in seeking out evidence-based medicine and critically evaluating literature. Digital technology has made JC accessible to worldwide audiences, which allows for increased inclusion of globally diverse presenters and attendees. Herein we describe the experience of the first 2 years of a virtual gynecologic pathology JC designed with the goal of providing mentorship and increasing inclusivity. JC began in a virtual format in April 2020 in response to the need for remote learning during the coronavirus disease 2019 pandemic. Each JC had 1 moderator, lasted 1 hour, featured up to 3 trainees/early-career pathologists, and covered articles on gynecologic surgical pathology/cytopathology. Trainees were recruited through direct contact with moderators and advertising through social media (eg, Twitter). A template was used for all presentations, and before presenting, live practice sessions were conducted with the moderator providing constructive feedback and evaluations were provided to presenters and attendees for feedback. Recordings of the meetings were made publicly available after the event through YouTube, a society website, and emails to registrants. Fifty-nine presenters participated, covering 71 articles. Most were trainees (53/59; 89%) from North America (33/59; 56%), with additional presenters from Asia (14/59; 24%), Australia/Oceania (5/59; 8%), Africa (4/59; 7%), and Europe (3/59; 5%). An average of 20 hours were spent per month by moderators on the selection of papers, meeting preparation, and provision of mentorship/feedback. Live events had a total of 827 attendees, and 16,138 interactions with the recordings were noted. Among those who self-identified on provided surveys, the attendees were most commonly from Europe (107/290; 37%) and were overwhelmingly practicing pathologists (275/341; 81%). The experience, including mentorship, format, and content, was positively reviewed by attendees and presenters. Virtual JC is an inclusive educational opportunity to engage trainees and early-career pathologists from around the world. The format allowed for the JC to be widely viewed by attendees from multiple countries, most being practicing pathologists. Based on feedback received, virtual JC appears to expand the medical knowledge of the attendees and empower presenters to develop their expertise and communication skills.