Hasil untuk "Medicine (General)"

J. Nolan, C. Sandroni, B. Böttiger et al.

The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.

C. Senaratna, J. Perret, C. Lodge et al.

J. Kanaley, S. Colberg, Matthew H. Corcoran et al.

Supplemental digital content is available in the text. ABSTRACT This consensus statement is an update of the 2010 American College of Sports Medicine position stand on exercise and type 2 diabetes. Since then, a substantial amount of research on select topics in exercise in individuals of various ages with type 2 diabetes has been published while diabetes prevalence has continued to expand worldwide. This consensus statement provides a brief summary of the current evidence and extends and updates the prior recommendations. The document has been expanded to include physical activity, a broader, more comprehensive definition of human movement than planned exercise, and reducing sedentary time. Various types of physical activity enhance health and glycemic management in people with type 2 diabetes, including flexibility and balance exercise, and the importance of each recommended type or mode are discussed. In general, the 2018 Physical Activity Guidelines for Americans apply to all individuals with type 2 diabetes, with a few exceptions and modifications. People with type 2 diabetes should engage in physical activity regularly and be encouraged to reduce sedentary time and break up sitting time with frequent activity breaks. Any activities undertaken with acute and chronic health complications related to diabetes may require accommodations to ensure safe and effective participation. Other topics addressed are exercise timing to maximize its glucose-lowering effects and barriers to and inequities in physical activity adoption and maintenance.

S. Grover, R. Grewal

Joschka Haltaufderheide, R. Ranisch

With the introduction of ChatGPT, Large Language Models (LLMs) have received enormous attention in healthcare. Despite potential benefits, researchers have underscored various ethical implications. While individual instances have garnered attention, a systematic and comprehensive overview of practical applications currently researched and ethical issues connected to them is lacking. Against this background, this work maps the ethical landscape surrounding the current deployment of LLMs in medicine and healthcare through a systematic review. Electronic databases and preprint servers were queried using a comprehensive search strategy which generated 796 records. Studies were screened and extracted following a modified rapid review approach. Methodological quality was assessed using a hybrid approach. For 53 records, a meta-aggregative synthesis was performed. Four general fields of applications emerged showcasing a dynamic exploration phase. Advantages of using LLMs are attributed to their capacity in data analysis, information provisioning, support in decision-making or mitigating information loss and enhancing information accessibility. However, our study also identifies recurrent ethical concerns connected to fairness, bias, non-maleficence, transparency, and privacy. A distinctive concern is the tendency to produce harmful or convincing but inaccurate content. Calls for ethical guidance and human oversight are recurrent. We suggest that the ethical guidance debate should be reframed to focus on defining what constitutes acceptable human oversight across the spectrum of applications. This involves considering the diversity of settings, varying potentials for harm, and different acceptable thresholds for performance and certainty in healthcare. Additionally, critical inquiry is needed to evaluate the necessity and justification of LLMs’ current experimental use.

Andrew D. Auerbach, S. Kripalani, E. Vasilevskis et al.

K. Crane, E. Chu

Ching-Yun Wang, Shiuan-Chen Lin, Kao-Jung Chang et al.

Acute myeloid leukemia (AML) establishes an immunosuppressive microenvironment that favors leukemic proliferation. The immune-suppressive cytokines altered antigen processing, and presentation collectively assist AML cells in escaping cytotoxic T-cell surveillance. These CD8+ T cell dysfunction features are emerging therapeutic targets in relapsed/refractory AML patients. Besides, CD8+ T cell exhaustion is a hotspot in recent clinical oncology studies, but its pathophysiology has yet to be elucidated in AML. In this review, we summarize high-quality original studies encompassing the phenotypic and genomic characteristics of T cell exhaustion events in the leukemia progression, emphasize the surface immuno-peptidome that dynamically tunes the fate of T cells to function or dysfunction states, and revisit the biochemical and biophysical properties of type 1 MHC antigen processing mechanism (APM) that pivots in the phenomenon of leukemia antigen dampening.

Armin D. Tavakkoli, BA, Megan A. Clark, BE, Alireza Kheirollah, PhD et al.

Purpose: Ultra High Dose-Rate (UHDR) radiation has been reported to spare normal tissue, compared with Conventional Dose-Rate (CDR) radiation. However, important work remains to be done to improve the reproducibility of the FLASH effect. A better understanding of the biologic factors that modulate the FLASH effect may shed light on the mechanism of FLASH sparing. Here, we evaluated whether sex and/or the use of 100% oxygen as a carrier gas during irradiation contribute to the variability of the FLASH effect. Methods and Materials: C57BL/6 mice (24 male, 24 female) were anesthetized using isoflurane mixed with either room air or 100% oxygen. Subsequently, the mice received 27 Gy of either 9 MeV electron UHDR or CDR to a 1.6 cm2 diameter area of the right leg skin using the Mobetron linear accelerator. The primary postradiation endpoint was time to full thickness skin ulceration. In a separate cohort of mice (4 male, 4 female), skin oxygenation was measured using PdG4 Oxyphor under identical anesthesia conditions. Results: Neither supplemental oxygen nor sex affected time to ulceration in CDR irradiated mice. In the UHDR group, skin damage occured earlier in male and female mice that received 100% oxygen compared room air and female mice ulcerated sooner than male mice. However, there was no significant difference in time to ulceration between male and female UHDR mice that received room air. Oxygen measurements showed that tissue oxygenation was significantly higher when using 100% oxygen as the anesthesia carrier gas than when using room air, and female mice showed higher levels of tissue oxygenation than male mice under 100% oxygen. Conclusions: The skin FLASH sparing effect is significantly reduced when using oxygen during anesthesia rather than room air. FLASH sparing was also reduced in female mice compared to male mice. Both tissue oxygenation and sex are likely sources of variability in UHDR studies. These results suggest an oxygen-based mechanism for FLASH, as well as a key role for sex in the FLASH skin sparing effect.

Liya Popova, Valerie J. Carabetta

The revolutionary progress in development of next-generation sequencing (NGS) technologies has made it possible to deliver accurate genomic information in a timely manner. Over the past several years, NGS has transformed biomedical and clinical research and found its application in the field of personalized medicine. Here we discuss the rise of personalized medicine and the history of NGS. We discuss current applications and uses of NGS in medicine, including infectious diseases, oncology, genomic medicine, and dermatology. We provide a brief discussion of selected studies where NGS was used to respond to wide variety of questions in biomedical research and clinical medicine. Finally, we discuss the challenges of implementing NGS into routine clinical use.

Divya Shanmugam, Monica Agrawal, Rajiv Movva et al.

The increased capabilities of generative AI have dramatically expanded its possible use cases in medicine. We provide a comprehensive overview of generative AI use cases for clinicians, patients, clinical trial organizers, researchers, and trainees. We then discuss the many challenges -- including maintaining privacy and security, improving transparency and interpretability, upholding equity, and rigorously evaluating models -- which must be overcome to realize this potential, and the open research directions they give rise to.

Emmanouil Nikolakakis, Joann Ching, Emmanouil Karystinaios et al.

Music therapy has been shown in recent years to provide multiple health benefits related to emotional wellness. In turn, maintaining a healthy emotional state has proven to be effective for patients undergoing treatment, such as Parkinson's patients or patients suffering from stress and anxiety. We propose fine-tuning MusicGen, a music-generating transformer model, to create short musical clips that assist patients in transitioning from negative to desired emotional states. Using low-rank decomposition fine-tuning on the MTG-Jamendo Dataset with emotion tags, we generate 30-second clips that adhere to the iso principle, guiding patients through intermediate states in the valence-arousal circumplex. The generated music is evaluated using a music emotion recognition model to ensure alignment with intended emotions. By concatenating these clips, we produce a 15-minute "music medicine" resembling a music therapy session. Our approach is the first model to leverage Language Models to generate music medicine. Ultimately, the output is intended to be used as a temporary relief between music therapy sessions with a board-certified therapist.

Rui Yang, Yilin Ning, Emilia Keppo et al.

Generative artificial intelligence (AI) has brought revolutionary innovations in various fields, including medicine. However, it also exhibits limitations. In response, retrieval-augmented generation (RAG) provides a potential solution, enabling models to generate more accurate contents by leveraging the retrieval of external knowledge. With the rapid advancement of generative AI, RAG can pave the way for connecting this transformative technology with medical applications and is expected to bring innovations in equity, reliability, and personalization to health care.

S. Roberts, Doug Leslie, Guodong Liu et al.

s from the 2020 Annual Meeting of the Society of General Internal Medicine "J OURNEY OF A THOUSAND MILES” CHALLENGES ENCOUNTERED BY INTERNATIONAL MEDICAL GRADUATES AND COMPARATIVE PROBLEMS FACED BY AMERICAN GRADUATES DURING INTERNAL MEDICINE RESIDENCY TRAINING AT A COMMUNITY HOSPITAL IN ILLINOIS. Gauri Pethe. Internal Medicine, Amita Saint Francis Hospital, Evanston, IL. (Control ID #3392714) BACKGROUND: International physicians make up 25% of the physician work force in the United States, a majority of international applicants pursue Internal Medicine. Based on their accents, religious symbolism or ethnicity, they are often perceived as being different. AmericanGraduates, although being in a familiar environment, face huddles such as student-loan debt and face challenges such as having to compete with International-Graduates who have more clinical experience. METHODS: A cross sectional study was done at Saint Francis Hospital. Questionnaires included a basic survey about questions including wellness, personal and work life balance, burnout, and discrimination at the workplace. International students had additional questions including ease of availability and access to basic necessities such as housing, cultural food, and community and learning curve. Questions also included communication barriers faced, and other perceived challenges. American Graduates were inquired about challenges and their perception regarding integration of international students. RESULTS: Total residents were 60; 39-IMGs-65%, 2-US-IMGs 3.33%, 19-AMG-31.66% with 22IMGs-56.4% and 10-AMGs-52.63% replied. Within IMGs: 12-females(54.54%) and 10-males(45.45%). AMGs: there were 5 females(50%) and 5 males(50%). 100%-IMGs applied for US residency match for: Better opportunities, 36.36%-Better pay, 90.9%Quality of life, 86.36%-Work hours. 95.45%-IMGs reported better work hours. 31.81%-IMGs stayed late for work vs 20%-AMGs. 22.73%-IMGs had difficulty finding apartment vs 0%-AMGs. 68.19%-IMGs reported difficulty in finding local food, 77.28%-reported difficulty finding home community. 90.9%-IMGs feel compensated enough for the work they do vs 60%-AMGs. 27.27%-IMGs face discrimination; 83.33%were discriminated based on race vs 30%-AMGs; 66.66% was racial and 33.33% sexual. 45.45%-IMGs reported depression vs 60% AMGs. 80% IMG and 83.33% AMGs are likely to seek help, mostly from family. Both IMGs and AMGs reported to feel burned out at least once a month, most during long-call days. 63.63%-IMGs reported ease in balancing work/personal life vs 80%AMGs. Most IMGs and AMGs interact with each other during work, and have no problems making friendsips, but rarely meet socially. 36.36%-IMGs think they are treated differently than AMGs. Biggest challenge for IMGs when adjusting to the US system was cultural change and getting used to EMRs. 81.81%IMGs and 90%AMGs stated that this is their intended specialty. Most IMGs are able to visit home 1-2 time/year, 4 cannot due to civil war. 100% IMGs do not regret their decision to pursue residency in USA. CONCLUSIONS: This study outlines different difficulties faced by IMGs and AMGs alike. IMGs reported more racial discrimination and the biggest challenge was to learn the Electronic-Medical-Records and culture. Despite these challenges, IMGs reported that 100% of them do not regret their decision to pursue residency in the United States. A MULTI-SITE FOCUS GROUP STUDY OF U.S. ADULT WOMEN’S BELIEFS AND ASSUMPTIONS ABOUT BLADDER HEALTH AND FUNCTION Beverly R. Williams; Missy D. Lavender; Kathryn L. Burgio; Yvette LaCoursiere; Diane K. Newman; Sonya S. Brady; Lisa K. Low; Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consoritum. Medicine, University of Alabama at Birmingham, Birmingham, AL; Medicine, Birmingham/Atlanta GRECC, Birmingham VA Medical Center, Birmingham, AL; Independent Researcher, Chicago, IL; Obstetrics, Gynecology, and Reproductive Health, UC San Diego Health La Jolla, La Jolla, CA; Medicine, University of Pennsylvania, Philadelphia, PA; School of Public Health, University of Minnesota, Minneapolis, MN; School of Nursing, University of Michigan, Ann Arbor, MI; NIH-NIDDK, District of Columbia, DC. (Control ID #3360438) BACKGROUND: The Study of Habits, Attitudes, Realities, and Experiences (SHARE), a qualitative study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, explored women’s knowledge experiences, perceptions, knowledge, and behaviors about bladder health/function. The purpose of this analysis was to characterize women's lay beliefs and assumptions about bladder health and function. METHODS: Forty-four focus groups were conducted across seven U.S. research centers with 360 women and adolescents, organized by six age categories. Focus groups were audio-recorded and transcribed. Following transcript and fieldnote coding, multi-level qualitative content analyses was used to classify emergent themes. A transdisciplinary lens and inductive approach guided data interpretation of the” bladder beliefs and assumptions code”. A team of investigators articulated interpretive insights, which were validated by a community engagement panel. RESULTS: Women exhibited limited understanding of bladder health and function, with assumptions and beliefs shaped by personal experience and hearsay. Except for the rare occasion when women had input from a medical professional, notions about bladder health and function were characterized by uncertainty, tentativeness, and unconfirmed impressions. Women speculated on (1)the function of the urinary tract system in cleansing or flushing the bodily system of impurities and toxins, (2) the functional relationship between and among the kidneys, bladder, urethra, vagina, pelvic floor and (3)the impact on bladder function of medications for chronic conditions. Women’s assumptions and beliefs about bladder healthwere framedwithin a “cause and effect” perspective, covering a wide array of habits/behaviors while conjecturing about the physiological mechanisms through such practices promote or deter bladder health. Finally, there was agreement on the importance of bladder friendly habits and the inadvisability of potentially harmful practices. This was acompanied by an assumption that bladder problems could be prevented by developing communitybased programs for educating women about bladder health and function, encouraging women to practice healthy bladder habits, eliminating taboos about discussing bladder health, and empowering women to speak out about their bladder-related experiences and concerns. S1 DOI: 10.1007/s11606-020-05890-3 © Society of General Internal Medicine 2020 J Gen Intern Med 35 :S1–S779 (Suppl 1) 8 Published online July 2 , 2020 CONCLUSIONS: Community-engaged public health messaging can inform women’s assumptions and beliefs about bladder health/function, educating women about the promotion of bladder health and the prevention of LUTS. BEHAVIORAL INCENTIVES TO IMPROVE MOBILITY AND DECREASE OPIOID USE IN VETERANS WITH CHRONIC PAIN Manik Chhabra; Krisda Chaiyachati; Peggy Compton. School of Nursing, University of Pennsylvania, Philadelphia, PA; Corporal Michael Crescenz VA Medical Center, Philadelphia, PA; University of Pennsylvania, Philadelphia, PA. (Control ID #3389698) BACKGROUND: An estimated 88.5 million adults suffer from daily pain, resulting in an estimated cost of $635 billion in lost productivity and $300 billion in health care expenditures. To manage their chronic pain, 5 to 8 million Americans take an opioid medication daily. However, the risks associated with ongoing opioid use (overdose, abuse, diversion) temper their analgesic effects. Appreciating the gains in health outcomes that behavioral incentives produce, we tested the hypothesis that loss-framed financial incentives combined with technology enabled care (TEC) can improve patient mobility, reduce pain, and decrease opioid use in patients with chronic pain. METHODS: We conducted a randomized controlled trial, allocating 40 patients 1:1 to a lottery-based behavioral incentive program combined with TEC vs. TEC alone (e.g., text-message communication and activity trackers). Patients were eligible if they received care from a VA pain-focused primary care program, on opioid therapy, and had a cell phone with text messaging capabilities. Patients were excluded if they had cancer-related pain, sensory impairments precluding the use of TEC, or had mobility limitations precluding them from walking. The primary outcome was the change in mobility (number of steps taken), and secondarily, pain severity, physical function, and opioid use using self-reported questionnaires over 12-weeks. Data were collected weekly using activity trackers, and text-messaged questionnaires. We measured baseline mobility using a two-week pre-study period observation before randomization. For the lottery + TEC arm, participants were eligible for a weekly regret lottery if their steps increased by 5% from the prior week. Once the subject reached 150% of baseline, they were always entered into the lottery. The eligible lottery participants could win either $30 or $100; those not meeting the walking goals were told what they would have won had they met their goal. RESULTS: Forty subjects have been enrolled and 38 have completed the study. The remaining two subjects will complete the trial by January 31, 2020. The results of the full sample will be available for presentation. Based on interim data analyses on the first 20 subjects, the lottery + TEC arm increased weekly average by 2004 steps, whereas the TEC only arm decreased by 1239 steps. For secondary outcomes, the lottery + TEC arm had improvements in pain severity and physical function but not chronic pain. CONCLUSIONS: Combining a regret lottery incentive with TEC improved mobility in patients with chronic pain, as well as increased participation in exercise and decreased pain severity and interference. While additional interventions o

Hubert Baniecki, Bartlomiej Sobieski, Patryk Szatkowski et al.

Time-to-event prediction, e.g. cancer survival analysis or hospital length of stay, is a highly prominent machine learning task in medical and healthcare applications. However, only a few interpretable machine learning methods comply with its challenges. To facilitate a comprehensive explanatory analysis of survival models, we formally introduce time-dependent feature effects and global feature importance explanations. We show how post-hoc interpretation methods allow for finding biases in AI systems predicting length of stay using a novel multi-modal dataset created from 1235 X-ray images with textual radiology reports annotated by human experts. Moreover, we evaluate cancer survival models beyond predictive performance to include the importance of multi-omics feature groups based on a large-scale benchmark comprising 11 datasets from The Cancer Genome Atlas (TCGA). Model developers can use the proposed methods to debug and improve machine learning algorithms, while physicians can discover disease biomarkers and assess their significance. We hope the contributed open data and code resources facilitate future work in the emerging research direction of explainable survival analysis.

Kathrin Krieger, Jan Egger, Jens Kleesiek et al.

3D data from high-resolution volumetric imaging is a central resource for diagnosis and treatment in modern medicine. While the fast development of AI enhances imaging and analysis, commonly used visualization methods lag far behind. Recent research used extended reality (XR) for perceiving 3D images with visual depth perception and touch but used restrictive haptic devices. While unrestricted touch benefits volumetric data examination, implementing natural haptic interaction with XR is challenging. The research question is whether a multisensory XR application with intuitive haptic interaction adds value and should be pursued. In a study, 24 experts for biomedical images in research and medicine explored 3D medical shapes with 3 applications: a multisensory virtual reality (VR) prototype using haptic gloves, a simple VR prototype using controllers, and a standard PC application. Results of standardized questionnaires showed no significant differences between all application types regarding usability and no significant difference between both VR applications regarding presence. Participants agreed to statements that VR visualizations provide better depth information, using the hands instead of controllers simplifies data exploration, the multisensory VR prototype allows intuitive data exploration, and it is beneficial over traditional data examination methods. While most participants mentioned manual interaction as best aspect, they also found it the most improvable. We conclude that a multisensory XR application with improved manual interaction adds value for volumetric biomedical data examination. We will proceed with our open-source research project ISH3DE (Intuitive Stereoptic Haptic 3D Data Exploration) to serve medical education, therapeutic decisions, surgery preparations, or research data analysis.

M. Linzer, S. Poplau, S. Babbott et al.

Selwa Y Abdeldafie, Sameera O Alaajmi

Background: In this study, we look at the role of nurses in dealing with sickle cell disease (SCD) patients in Jazan city. Objectives: The aim of this study was to determine the knowledge of nurses and their attitudes toward SCD patients in Jazan hospitals, Saudi Arabia. Materials and Methods: In this cross-sectional, hospital-based study, based on the inclusion and exclusion criteria, we recruited 240 nurses from Prince Mohammed bin Nasser and Jazan general hospitals in Jazan city, Saudi Arabia. We depend on the validity and reliability of the instrument that were done by the author who prepared the tool of the primary research, and data management processing was incorporated. Statistical analysis was performed with the obtained data. Results: In this study, 24.2% of males and 75.8% of females were included. Of these, 40.4% of nurses between 35 and 40 years of age. About 50.4% has 10–15 years of working experience. 5% of the study participants' salary is equal to 5000 SR which is the lower salary in the group of the participants. Also, 54.6% of nurses had a bachelor's degree, 32.9% had a diploma, and only 12.5% had a master's degree. Approximately 65% of nurses were married. Around 52% of nurses knew that SCD patients should have daily intake of 3 l of liquid and 44% of them recommended pop, juice, and broth. Among the sociodemographic variables, gender and income source were associated with attitude and knowledge scales, whereas among nurses' groups, only marital status was associated (P < 0.05). Also, among the sociodemographic variables of nurses, There is statistically significant relation between the nurses' knowledge and attitude and the demographic characteristics such as income levels, marital status and experiences as revealed by P.vale <0.05. In this study, 72.5% of nurses had poor knowledge score levels and 27.5% had good knowledge. Conclusion: This study concludes that the average total knowledge score was 8.41 and only 27.5% of nurses had good knowledge about SCD in Jazan region. This study also suggests increasing educational interventions, which could aid in improving nurses' knowledge and attitudes toward SCD. It is recommended to conduct a similar study with a large number of professionals in order to generalize the findings.