Medical Research Articles

Medical Students' Knowledge, Perceptions, and Expectations Regarding Telemedicine Education

Aim: This study aims to determine the knowledge levels and perceptions of medical faculty students about telemedicine, as well as their willingness to be prepared for telemedicine before graduation from their own perspectives. In line with this aim, the current situation was comprehensively analyzed to develop solution proposals. Method: In this study, which employs a cross-sectional survey design, data were collected using both qualitative and quantitative questions. Participants were asked direct questions (e.g., yes/partially, undecided/no; very low=1 to very high=5), followed by follow-up questions (direct or open-ended) related to these questions, aiming to gain in-depth information about their perspectives. The data obtained from open-ended questions, which were designed to allow participants to express their thoughts freely and in detail, were analyzed using content analysis techniques, including categorical and frequency analysis. Results: The study results indicated that although the number of students taking courses related to telemedicine or telemedicine applications in their current medical education processes is quite low, nearly half of the students stated that they have at least a low level of knowledge about this subject. Specifically, 48.2% of the students reported having no knowledge of the telemedicine concept, while 33.4% indicated partial knowledge. Despite this, 67.8% of the students expressed that telemedicine should be included in the curriculum. Moreover, students who had taken a course related to telemedicine reported significantly more knowledge (M=3.74) compared to those who have not taken such a course but claim to have some knowledge (M=2.29) (F(1, 268) = 291.841, p < 0.01). These findings emphasize the necessity of including telemedicine education in the curriculum. Discussion: As medicine continues to incorporate telemedicine technologies into patient care, it is important for medical faculties to introduce students to the care methods they will use in the future, allowing them to analyze the advantages and disadvantages. The results of this study also showed that the majority of students are aware of the importance of telemedicine and its education. While the majority of students expressed positive views about the inclusion of telemedicine courses in the medical faculty curriculum, a significant portion also stated that it should be integrated into other courses. This indicates that students are interested in telemedicine and believe that it should be taught either as a separate course or integrated into other courses within the curriculum. Therefore, the curriculum should be updated to accommodate digitalization and telemedicine technologies. It is important to provide necessary education before graduation so that medical students, who will play a key role among future health professionals, are prepared for the digitalized health system. To achieve this, the curriculum should be updated to include courses that contribute to their digital competencies or integrate relevant achievements into other courses. Additionally, efforts should be increased and education provided to protect against risks associated with the use of telemedicine and its processes.

Breaking the Silence: The Role of Health Professionals in the Gaza Crisis

Having the opportunity to write something in this moment, I would use it to raise my voice on behalf of the health professional community for the people of Gaza. As mentioned by Sualeha Shekhani and Dr. Aamir Jafarey, doctors represent the moral voice of their era. However, in light of the events of October 7, 2023, and the subsequent armed assault by Israeli forces on Gaza, which has led to a significant humanitarian crisis, the response from the global bioethics community seems muted (Shekhani & Jafarey, 2024). This silence can be partly explained by editorial restraints that may prevent a more robust response from the health community towards the Gaza crisis. Health professionals are uniquely positioned to influence policy decisions and advocate for equitable healthcare. They possess specialized knowledge of medical ethics and healthcare structures, enabling them to champion the causes of the vulnerable and reduce disparities across society. Physicians, trained in evidence-based medicine, can ensure that policy decisions are grounded in scientific research rather than political expediency (Fernandes, 2024). The medical community's silence regarding the Gaza crisis is troubling. Healthcare workers in Gaza are targeted, and doctors work without essential medicines and resources, risking their lives for the population they serve. The current health sector in Gaza is at a breaking point, exacerbating the public health crisis and psychological trauma experienced by the residents (Fernandes, 2024).

An in vitro evaluation of the effect of antimicrobial treatment on bovine mammary microbiota

Antimicrobial-resistant bacteria have been an increasing problem in human medicine and animal husbandry since the introduction of antimicrobials on the market in the 1940s. Over the last decades, efforts to reduce antimicrobial usage in animal husbandry have been shown to limit the development of resistant bacteria. Despite this, antimicrobial-resistant bacteria are still commonly detected and isolated worldwide. In this study, we investigated the presence of antimicrobial-resistant bacteria in bovine milk samples using a multiple approach based on culturing and amplicon sequencing. We first enriched milk samples obtained aseptically from bovine udders in the presence of two antimicrobials commonly used to treat mastitis and then described the resistant microbiota by amplicon sequencing and isolate characterization. Our results show that several commensal species and mastitis pathogens harbor antimicrobial resistance and dominate the enriched microbiota in milk in presence of antimicrobial agents. The use of the two different antimicrobials selected for different bacterial taxa and affected the overall microbial composition. These results provide new information on how different antimicrobials can shape the microbiota which is able to survive and reestablish in the udder and point to the fact that antimicrobial resistance is widely spread also in commensal species.

Quaternary Ammonium Salts-Based Materials: A Review on Environmental Toxicity, Anti-Fouling Mechanisms and Applications in Marine and Water Treatment Industries.

The adherence of pathogenic microorganisms to surfaces and their association to form antibiotic-resistant biofilms threatens public health and affects several industrial sectors with significant economic losses. For this reason, the medical, pharmaceutical and materials science communities are exploring more effective anti-fouling approaches. This review focuses on the anti-fouling properties, structure-activity relationships and environmental toxicity of quaternary ammonium salts (QAS) and, as a subclass, ionic liquid compounds. Greener alternatives such as QAS-based antimicrobial polymers with biocide release, non-fouling (i.e., PEG, zwitterions), fouling release (i.e., poly(dimethylsiloxanes), fluorocarbon) and contact killing properties are highlighted. We also report on dual-functional polymers and stimuli-responsive materials. Given the economic and environmental impacts of biofilms in submerged surfaces, we emphasize the importance of less explored QAS-based anti-fouling approaches in the marine industry and in developing efficient membranes for water treatment systems.

Perceptions, prevalence, and patterns of cannabis use among cancer patients treated at 12 NCI-Designated Cancer Centers.

The legal climate for cannabis use has dramatically changed with an increasing number of states passing legislation legalizing access for medical and recreational use. Among cancer patients, cannabis is often used to ameliorate adverse effects of cancer treatment. Data are limited on the extent and type of use among cancer patients during treatment and the perceived benefits and harms. This multicenter survey was conducted to assess the use of cannabis among cancer patients residing in states with varied legal access to cannabis. A total of 12 NCI-Designated Cancer Centers, across states with varied cannabis-access legal status, conducted surveys with a core questionnaire to assess cannabis use among recently diagnosed cancer patients. Data were collected between September 2021 and August 2023 and pooled across 12 cancer centers. Frequencies and 95% confidence intervals for core survey measures were calculated, and weighted estimates are presented for the 10 sites that drew probability samples. Overall reported cannabis use since cancer diagnosis among survey respondents was 32.9% (weighted), which varied slightly by state legalization status. The most common perceived benefits of use were for pain, sleep, stress and anxiety, and treatment side effects. Reported perceived risks were less common and included inability to drive, difficulty concentrating, lung damage, addiction, and impact on employment. A majority reported feeling comfortable speaking to health-care providers though, overall, only 21.5% reported having done so. Among those who used cannabis since diagnosis, the most common modes were eating in food, smoking, and pills or tinctures, and the most common reasons were for sleep disturbance, followed by pain and stress and anxiety with 60%-68% reporting improved symptoms with use. This geographically diverse survey demonstrates that patients use cannabis regardless of its legal status. Addressing knowledge gaps concerning benefits and harms of cannabis use during cancer treatment is critical to enhance patient-provider communication.

A survey of patients with cancer and oncology health-care professionals about cannabis use during treatment.

This study characterizes patient and health-care professional perspectives regarding medical cannabis use at a National Cancer Institute-Designated Cancer Center. Data evaluated included the prevalence and patterns of and reasons for cannabis use. Patients with cancer undergoing treatment were recruited into a cross-sectional survey as part of a national National Cancer Institute-funded effort. Participants completed a survey about cannabis use, reasons for use, and types of cannabis. A health-care professional survey was also conducted to explore perspectives regarding patients' use of cannabis. A total of 313 patients with cancer (mean [SD] age = 60.7 [12.8] years) completed the survey (43% response rate) between 2021 and 2022. Of the respondents, 58% were female; identified as White (61%) and Black (23%); and had diverse cancer diagnoses. Nearly half of respondents (43%) had previously used cannabis, one-quarter (26%) had used cannabis since their cancer diagnosis, and almost 1 in 6 (17%) were actively using cannabis at the time of survey completion. The most common modes of ingestion were gummies (33%) and smoking (30%). The most commonly reported reasons for use were insomnia (46%), pain (41%), and mood (39%). For the 164 health-care professionals who completed the survey (25% response rate), the majority agreed that cannabis use (72%) is safe and beneficial for patients (57%). Four in 10 (39%) health-care professionals felt comfortable providing guidance to patients about cannabis use; however, only 1 in 8 (13%) felt knowledgeable about the topic of cannabis. Approximately one-sixth of patients with cancer receiving treatment actively use cannabis for management of various cancer symptoms. Perceptions about cannabis use and education varied widely among health-care professionals.

Strengthening Patient Care through Training Students in Mindfulness as a Part of the Medical Curriculum

Abstract Mindfulness clinical practice refers to the deliberate efforts to stay in the present moment while dealing with patients and not being judgmental. There is an immense need for health-care professionals to deliver an objective and compassionate response to their patients by demonstrating their genuine presence, better understanding, and empathy. Mindfulness practice by health-care professionals is linked with professional development and multiple benefits in patient care, and it is quite essential that medical students are trained in the same during their undergraduate period. This will essentially require systematic planning and collaboration between teachers, as exposure of mindfulness across the curriculum will play a defining role in facilitating the comprehensive development of medical students. In conclusion, acknowledging the multiple benefits of mindfulness to health-care professionals and improvement in the quality of patient care services, it is the need of the hour that every medical college or health-care establishment should take active interventions to plan and implement the same within their settings.

Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis.

Endometriosis is a common chronic gynecological condition characterized by the presence of endometrial tissue outside the uterine cavity, leading to chronic inflammation, pelvic nodules and masses, pelvic pain, and infertility. Acupuncture has been shown to improve pain associated with endometriosis by modulating abnormal levels of prostaglandins, β-endorphins, dynorphins, electrolytes, and substance P. This review aims to evaluate the clinical efficacy of acupuncture in treating endometriosis, specifically focusing on its efficacy in relieving pain associated with endometriosis. A comprehensive search was conducted in eight databases (PubMed, EMBASE, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), the China Biology Medicine (CBM), Wanfang, and Weipu database) to identify randomized controlled trials (RCTs) published from database inception to December 16, 2022, which investigated the use of acupuncture for endometriosis-related pain. Two researchers independently screened articles, extracted data, and assessed methodological quality using the Cochrane Collaboration's risk of bias tool. Meta-analysis was performed using Stata statistical software. A total of 1991 articles were identified, and ultimately, 14 studies involving 793 patients (387 in the acupuncture group and 359 in the control group) were included. The control interventions in the included studies included placebo, traditional Chinese medicine (TCM), and Western medicine treatments. Meta-analysis results showed that compared to the control group, acupuncture treatment for pain associated with endometriosis demonstrated significant reductions in pain severity [SMD = -1.10, 95% CI (-1.45, -0.75), P < 0.001], improved response rate [RR = 1.25, 95% CI (1.09, 1.44), P = 0.02], and decreased serum CA-125 levels [SMD = -0.62, 95% CI (-1.15, -0.08), P = 0.024]. Furthermore, subgroup analysis revealed that electroacupuncture and auricular acupuncture were superior to the control group in reducing pain severity, while auricular acupuncture and warm needling showed greater clinical efficacy compared to the control group. However, there were no significant differences between electroacupuncture or fire needling and the control group in terms of pain relief. The findings suggest that acupuncture is effective in improving pain associated with endometriosis. In conclusion, acupuncture is effective in alleviating dysmenorrhea and pelvic pain associated with endometriosis, reducing serum CA-125 levels, decreasing the size of nodules, improving patients' quality of life, and lowering the recurrence rate. However, it should be noted that the current evidence is limited by the design and quality flaws of the original studies, as well as a lack of research specifically focusing on subtypes of acupuncture. Therefore, caution should be exercised when interpreting the results.

The efficacy of Salvia-ligustrazine and Ligustrazine in treating gestational hypertension: A systematic review and meta-analysis.

Pregnancy-induced hypertension syndrome (PIH), a prevalent and critical condition, has garnered increasing attention due to its significant impact on maternal and fetal health outcomes. The conventional treatment approaches rely on magnesium sulfate and various antihypertensive drugs; however, the clinical efficacy of these treatments is limited, highlighting the need to explore alternative avenues for improvement. Recently, a growing number of clinical studies have investigated the use of Salvia-ligustrazine or Ligustrazine in combination with conventional therapy. A comprehensive synthesis and critical analysis of these studies is necessary to evaluate the efficacy and safety of Salvia-ligustrazine or Ligustrazine in treating PIH. We sought all articles published prior to December 2, 2023, from seven databases to identify randomized controlled trials (RCTs) that involved traditional Chinese medicine Salvia-ligustrazine or Ligustrazine in combination with Western medicines for the conventional treatment of PIH, according to predefined inclusion criteria. The studies were assessed using the Cochrane Risk of Bias tool (ROB2.0), and meta-analyses were conducted using Stata 15.0 statistical software. We analyzed 47 RCTs encompassing 4,517 patients. The results demonstrated that combining Salvia-ligustrazine or Ligustrazine with Western medications was more efficacious than using Western medications alone. This combination improved the overall response rate, reduced the incidence of adverse pregnancy outcomes for mothers and infants, and decreased the occurrence of side effects associated with PIH treatment. While we evaluated the efficacy of traditional Chinese medicine injections of Salvia-ligustrazine or Ligustrazine alongside conventional Western treatments, our conclusions must be considered provisional due to potential bias and the limited availability of RCTs.

Accuracy and Completeness of Large Language Models About Antibody-Drug Conjugates and Associated Ocular Adverse Effects.

The purpose of this study was to assess the accuracy and completeness of 3 large language models (LLMs) to generate information about antibody-drug conjugate (ADC)-associated ocular toxicities. There were 22 questions about ADCs, tisotumab vedotin, and mirvetuximab soravtansine that were developed and input into ChatGPT 4.0, Bard, and LLaMa. Answers were rated by 4 ocular toxicity experts using standardized 6-point Likert scales on accuracy and completeness. ANOVA tests were conducted for comparison between the 3 subgroups, followed by pairwise t-tests. Interrater variability was assessed with Fleiss kappa tests. The mean accuracy score was 4.62 (SD 0.89) for ChatGPT, 4.77 (SD 0.90) for Bard, and 4.41 (SD 1.09) for LLaMA. Both ChatGPT (P = 0.03) and Bard (P = 0.003) scored significantly better for accuracy when compared with LLaMA. The mean completeness score was 4.43 (SD 0.91) for ChatGPT, 4.57 (SD 0.93) for Bard, and 4.42 (SD 0.99) for LLaMA. There were no significant differences in completeness scores between groups. Fleiss kappa assessment for interrater variability was good (0.74) for accuracy and fair (0.31) for completeness. All 3 LLMs had relatively high accuracy and completeness ratings, showing LLMs are able to provide sufficient answers for niche topics of ophthalmology. Our results indicate that ChatGPT and Bard may be slightly better at providing more accurate answers than LLaMA. As further research and treatment plans are developed for ADC-associated ocular toxicities, these LLMs should be reassessed to see if they provide complete and accurate answers that remain in line with current medical knowledge.

ICDXML: enhancing ICD coding with probabilistic label trees and dynamic semantic representations

Accurately assigning standardized diagnosis and procedure codes from clinical text is crucial for healthcare applications. However, this remains challenging due to the complexity of medical language. This paper proposes a novel model that incorporates extreme multi-label classification tasks to enhance International Classification of Diseases (ICD) coding. The model utilizes deformable convolutional neural networks to fuse representations from hidden layer outputs of pre-trained language models and external medical knowledge embeddings fused using a multimodal approach to provide rich semantic encodings for each code. A probabilistic label tree is constructed based on the hierarchical structure existing in ICD labels to incorporate ontological relationships between ICD codes and enable structured output prediction. Experiments on medical code prediction on the MIMIC-III database demonstrate competitive performance, highlighting the benefits of this technique for robust clinical code assignment.

Longitudinal variation of correlations between different components of assessment within a medical school

BackgroundAn assessment program should be inclusive and ensure that the various components of medical knowledge, clinical skills, and professionalism are assessed. The level and the variation over time in the strength of the correlation between these components of assessment is still a matter of study. Based on the meaningful learning theory and the integrated learning theory, we hypothesize that these components increase their connections during the medical school course.MethodsThis is a retrospective cohort study that analyzed data collected for a 10-year period in one medical school. We included students from the 3rd to 6th year of medical school from 2011 to 2021. Three assessment components were addressed: Knowledge, Clinical Skills, and Professionalism. For data analysis, Pearson correlation coefficients (R) and R2 were calculated to study the correlation between variables and a z-test on Fisher's r-to-z was used to determine the differences between correlation coefficients.Results949 medical students were included in the study. The correlation between Clinical Skills and Professionalism showed a medium to strong association (Pearson's R ranging from 0.485 to 0.734), while the correlation between Knowledge and Professionalism was weaker but exhibited a steady evolution with Pearson's R fluctuating between 0.075 and 0.218. The Knowledge and Clinical Skills correlation became statistically significant from 2013 onwards and peaking at Pearson's R of 0.440 for the cohort spanning 2016–2019. We also revealed a strengthening of correlations between Professionalism and Clinical Skills from the beginning to the end of clinical training, but not with the knowledge component.ConclusionsThis analysis contributes to our understanding of the dynamics of correlations of different assessment components within an institution and provides a framework for how they interact and influence each other.Trial registrationThis study was not a clinical trial, but a retrospective observational study, without health care interventions. Nevertheless, we provide herein the number of the study as submitted to the Ethics committee – CEICVS 146/2021.

Synergistic antifungal effect of thiophene derivative as an inhibitor of fluconazole-resistant Candida spp. biofilms.

Candida species resistant to fluconazole have raised concern in the scientific medical community due to high mortality in patients with invasive disease. In developing countries, such as Brazil, fluconazole is the most commonly used antifungal, and alternative treatments are expensive or not readily available. Furthermore, the occurrence of biofilms is common, coupled with their inherent resistance to antifungal therapies and the host's immune system, these microbial communities have contributed to making infections caused by these yeasts an enormous clinical challenge. Therefore, there is an urgent need to develop alternative medicines, which surpass the effectiveness of already used therapies, but which are also effective against biofilms. Therefore, the present study aimed to describe for the first time the antifungal and antibiofilm action of the derivative 2-amino-5,6,7,8-tetrahydro-4H-cyclohepta[b]thiophene-3-isopropyl carboxylate (2AT) against clinical strains of Candida spp. resistant to fluconazole (FLZ). When determining the minimum inhibitory concentrations (MIC), it was found that the compound has antifungal action at concentrations of 100 to 200µg/mL, resulting in 100% inhibition of yeast cells. Its synergistic effect with the drug FLZ was also observed. The antibiofilm action of the compound in subinhibitory concentrations was detected, alone and in association with FLZ. Moreover, using scanning electron microscopy, it was observed that the compound 2AT in isolation was capable of causing significant ultrastructural changes in Candida. Additionally, it was also demonstrated that the compound 2AT acts by inducing characteristics compatible with apoptosis in these yeasts, such as chromatin condensation, when visualized by transmission electron microscopy, indicating the possible mechanism of action of this molecule. Furthermore, the compound did not exhibit toxicity in J774 macrophage cells up to a concentration of 4000µg/mL. In this study, we identify the 2AT derivative as a future alternative for invasive candidiasis therapy, in addition, we highlighted the promise of a strategy combined with fluconazole in combating Candida infections, especially in cases of resistant isolates.

Knowledge and Awareness about Anesthesia and Perception about Anesthesiologists and their Role during the COVID-19 Pandemic among Patients at a Zonal Hospital: A Cross-sectional Survey

Abstract Background: Anesthesia forms the cornerstone of the practice of modern medicine as we know it today. The field of anesthesia has evolved beautifully since its conception in the 1800s and today the reach of the anesthesiologist goes far beyond his role in the OT. The most critical patients are managed by this fraternity, witnessed by the world during the tough times of the COVID-19 pandemic. However, even today, in the 21st century, anesthesia functions in relative obscurity, succinctly labelled as a ‘behind the screen’ specialty by the medical fraternity itself. Aims and Objectives: Conducted in the aftermath of the pandemic, the research was aimed to assess the general knowledge among patients regarding the branch of Anesthesia and understanding the public perception regarding Anesthesiologists, including their role inside and outside the OT, especially during the Covid-19 pandemic. In addition, the sources of patient information and significant association with age, gender, literacy level and employment status were explored by our study. Materials and Methods: A quantitative cross-sectional survey was conducted at a secondary-care government hospital and a total of 307 participants were enrolled in the study. After a detailed structured interview with participants, the data was tabulated in Excel form and statistical analysis was done for association with demographic variables. Results: The results, viewed against a background of previous similar national and international studies, revealed significant ignorance regarding this specialty and poor improvement as compared to previous data, despite having been in the limelight owing to the recent pandemic. Only 58% participants had heard the term ‘Anesthesia’ and 38% were aware of what it achieves in a patient. About three-fourths of them knew the anesthesiologist as a qualified doctor but only 50% considered his job equivalent to that of the surgeon. The main source of knowledge was by word of mouth followed by prior exposure to anesthesia. Furthermore, the study revealed that the level of the patient’s education controlled with the patient’s age and employment factors was the significant predictor of their knowledge, awareness and perception regarding anesthesia and role of anesthesiologists (p&lt;0.05). The patients with secondary and above level education, the younger age groups and those who were currently employed were significantly better informed. Conclusion: The results of the research, compared with previous data of Indian and International studies since the last two decades, demonstrated a clear lack of improvement in public knowledge levels. This was unexpected considering how the recent pandemic brought the entire medical community into the limelight, some of which should have been shed on Anesthesiologists as well. Additionally, there is a stark difference between the populations of developed and developing countries seen in several post pandemic studies. The ignorance continues to pervade all aspects of the anesthesiologist’s job including his purview beyond the OT. A fresh perspective was obtained through the demographic factors brought out by the study, elucidating that the anesthesia fraternity needs to focus on improving communication with certain subsets of their patients (like the elderly, the unemployed and illiterate). Several conjoint endeavors are required between the government the professional community to increase the public cognizance and appreciation that all current and future anesthesiologists, deserve.

Knowledge-tuning Large Language Models with Structured Medical Knowledge Bases for Trustworthy Response Generation in Chinese

Large Language Models (LLMs) have demonstrated remarkable success in diverse natural language processing (NLP) tasks in general domains. However, LLMs sometimes generate responses with the hallucination about medical facts due to limited domain knowledge. Such shortcomings pose potential risks in the utilization of LLMs within medical contexts. To address this challenge, we propose knowledge-tuning, which leverages structured medical knowledge bases for the LLMs to grasp domain knowledge efficiently and facilitate trustworthy response generation. We also release cMedKnowQA, a Chinese medical knowledge question-answering dataset constructed from medical knowledge bases to assess the medical knowledge proficiency of LLMs. Experimental results show that the LLMs which are knowledge-tuned with cMedKnowQA, can exhibit higher levels of accuracy in response generation compared with vanilla instruction-tuning and offer a new trustworthy way for the domain adaptation of LLMs. We release our code and data at https://github.com/SCIR-HI/Huatuo-Llama-Med-Chinese .

Point-of-Care Ultrasound Track in an Academic Family Medicine Department

Introduction: Point-of-care ultrasound (POCUS) is increasingly being employed in family medicine. Residency tracks can be an effective way to increase mastery in a specific subdiscipline for interested residents, but no studies exist on the implementation of a POCUS track in family medicine. We address this gap in the literature by assessing POCUS use by POCUS track residents compared to non-POCUS track residents and faculty in an academic family medicine department. Methods: We performed a retrospective review of all POCUS scans completed in the first year after implementation of a family medicine residency POCUS track. Scans were analyzed by two reviewers. We compared scan volume and type between POCUS track residents, non-POCUS track residents, and faculty. A blinded quality analysis was performed on each group of scans. Results: A total of 572 scans were completed on 536 patients over 1 year. POCUS track residents scanned significantly more than non-POCUS track residents (mean difference of 72.2, CI 59.1 to 85.4; P&amp;lt;.0001). The most common scan types across groups were musculoskeletal and soft tissue. POCUS track residents showed statistically improved scan quality in all scan types, while non-POCUS track residents showed statistical improvement only in soft tissue, shoulder, and abdominal aortic aneurysm scans. Conclusions: This is the first longitudinal study of a novel academic family medicine residency POCUS track. Participation in a POCUS track can increase the number, variety, and quality of scans performed. Our curriculum can be a model for family medicine residency programs that wish to provide robust POCUS training.

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A Pilot Study for the Characterization of Bacillus spp. and Analysis of Possible B. thuringiensis/Strongyloides stercoralis Correlation.

Differentiating between Bacillus species is relevant in human medicine. Bacillus thuringiensis toxins might be effective against Strongyloides stercoralis, a nematode causing relevant human morbidity. Our first objective was to evaluate genomic and MALDI-TOF identification methods for B. thuringiensis. Our secondary objective was to evaluate a possible negative selection pressure of B. thuringiensis against S. stercoralis. PCR and Sanger were compared to MALDI-TOF on a collection of 44 B. cereus group strains. B. thuringiensis toxin genes were searched on 17 stool samples from S. stercoralis-infected and uninfected dogs. Metagenomic 16S rRNA was used for microbiome composition. The inter-rate agreement between PCR, Sanger, and MALDI-TOF was 0.631 k (p-value = 6.4 × 10-10). B. thuringiensis toxins were not found in dogs' stool. Bacteroidota and Bacillota were the major phyla in the dogs' microbiome (both represented >20% of the total bacterial community). Prevotella was underrepresented in all Strongyloides-positive dogs. However, the general composition of bacterial communities was not significantly linked with S. stercoralis infection. The genomic methods allowed accurate differentiation between B. thuringiensis and B. cereus. There was no association between B. thuringiensis and S. stercoralis infection, but further studies are needed to confirm this finding. We provide the first descriptive results about bacterial fecal composition in dogs with S. stercoralis infection.

Addressing musculoskeletal curricular inadequacies within undergraduate medical education

BackgroundMusculoskeletal (MSK) injuries and diseases place a significant burden on the health care system. Despite this, research indicates that physician training in the area of MSK medicine has historically been inadequate, with a majority of medical students feeling that their training in MSK medicine is lacking. The goal of this investigation was to evaluate the efficacy of a new preclinical MSK curriculum that was implemented within a nationally accredited allopathic medical program.MethodsRetrospective analysis was completed on five consecutive years (2017–2021) of preclinical MSK curricular data for 549 medical students, including mid and end-of-course examinations and end-of-course student satisfaction surveys. Both parametric and non-parametric methods of analysis were used to examine within and between class differences (P < 0.05).ResultsThe new MSK curriculum covered 15 of 16 “core or must know” topics in MSK medicine, and academic performance was consistently high over the 5-year period of analysis (final course marks ranged from 76.6 ± 7.1 to 81.4 ± 8.1; failures/year: range from 0 to 4), being equal or above levels of student performance observed for other courses delivered during preclinical studies. Likert data from end-of-course surveys demonstrated that feedback was overwhelmingly positive (overall course satisfaction ranged from a low of 3.07/4.00 to a high of 3.56/4.00) and indicated that students felt that the new preclinical MSK curriculum did effectively support medical student learning and knowledge retention.ConclusionResults are expected to help advance the current body of knowledge that is dedicated to improving physician learning and knowledge retention in the area of MSK medicine and provides a curricular model that could be used by other nationally accredited medical programs to help enhance MSK learning at the preclinical levels of physician training.

Socio-ecological influences on access to abortion care in Costa Rica: a qualitative analysis of key perspectives from clinical and policy stakeholders

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person’s life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.