Hasil untuk "Medicine"

J. Richards

R. Fuller

D. Mader

B. Halliwell

W. Hazzard

J. Bensing

C. L. Otis, B. Drinkwater, M. Johnson et al.

James C. Martin, R. Avant, M. Bowman et al.

BACKGROUND Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. METHODS A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here. RESULTS The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine’s basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies. Family medicine education must continue to include training in maternity care, the care of hospitalized patients, community and population health, and culturally effective and proficient care. A comprehensive lifelong learning program for each family physician will support continuous personal, professional, and clinical practice assessment and improvement. Ultimately, systemwide changes will be needed to ensure high-quality health care for all Americans. Such changes include taking steps to ensure that every American has a personal medical home, promoting the use and reporting of quality measures to improve performance and service, advocating that every American have health care coverage for basic services and protection against extraordinary health care costs, advancing research that supports the clinical decision making of family physicians and other primary care clinicians, and developing reimbursement models to sustain family medicine and primary care practices. CONCLUSIONS The leadership of US family medicine organizations is committed to a transformative process. In partnership with others, this process has the potential to integrate health care to improve the health of all Americans.

Jihoon Jeong

AI models of equivalent capability can exhibit fundamentally different behavioral patterns, yet no standardized instrument exists to measure these dispositional differences. Existing approaches either borrow human personality dimensions and rely on self-report (which diverges from actual behavior in LLMs) or treat behavioral variation as a defect rather than a trait. We introduce the Model Temperament Index (MTI), a behavior-based profiling system that measures AI agent temperament across four axes: Reactivity (environmental sensitivity), Compliance (instruction-behavior alignment), Sociality (relational resource allocation), and Resilience (stress resistance). Grounded in the Four Shell Model from Model Medicine, MTI measures what agents do, not what they say about themselves, using structured examination protocols with a two-stage design that separates capability from disposition. We profile 10 small language models (1.7B-9B parameters, 6 organizations, 3 training paradigms) and report five principal findings: (1) the four axes are largely independent among instruction-tuned models (all |r| < 0.42); (2) within-axis facet dissociations are empirically confirmed -- Compliance decomposes into fully independent formal and stance facets (r = 0.002), while Resilience decomposes into inversely related cognitive and adversarial facets; (3) a Compliance-Resilience paradox reveals that opinion-yielding and fact-vulnerability operate through independent channels; (4) RLHF reshapes temperament not only by shifting axis scores but by creating within-axis facet differentiation absent in the unaligned base model; and (5) temperament is independent of model size (1.7B-9B), confirming that MTI measures disposition rather than capability.

M. Laroussi

Susheel Kumar Nethi, Venugopal Gunda, Nagabhishek Sirpu Natesh et al.

Summary: Pancreatic cancer (PC) exhibits profound metabolic adaptations that support tumor progression, survival, and therapy resistance. Hypoxia-inducible factor-1α (HIF-1α) is a key regulator of these processes, promoting metabolic reprogramming and chemoresistance. Given that mitochondrial metabolites modulate HIF-1α stability, targeting mitochondrial metabolism offers a promising therapeutic strategy. Niclosamide (Nic), a clinically approved anthelmintic, disrupts mitochondrial function but is limited by poor bioavailability. To overcome this, we developed polyanhydride-based Nic nanoparticles (NicNps) to enhance bioavailability and efficacy. NicNps impaired mitochondrial function, suppressed metabolism, downregulated HIF-1α, and inhibited growth of PC cells and orthotopic gemcitabine (Gem)-resistant mouse tumor models. Notably, NicNps combined with Gem overcame therapy resistance by synergistically reducing tumor hypoxia and HIF-1α-driven metabolic reprogramming. These findings highlight NicNps as a mitochondria-targeted, nanoparticle-based therapy that enhances Nic’s bioavailability while suppressing HIF-1α-driven adaptations. NicNps in combination with Gem offer a promising strategy to overcome therapy resistance and improve treatment outcomes in patients with pancreatic cancer.

Joana Marques‐Antunes, Egon Rodrigues, Marta Guimarães et al.

PurposeRepairing complex abdominal wall hernias is challenging, often requiring component separation techniques (CST) for tension-free closure. Adjuvant therapies, such as botulinum toxin type A (BTA), preoperative progressive pneumoperitoneum (PPP), and intraoperative fascial traction (IFT), may reduce the need for CST by improving abdominal wall compliance and reduce the complexity of the hernia. There is limited knowledge about the effects of their combined use. Our aim is to evaluate the rate of CST in abdominal wall reconstruction for complex midline hernias after adjuvant therapies.MethodsA cross-sectional study was conducted on patients who underwent surgery for correction of midline complex abdominal hernias between June 2020 and June 2024. Patients submitted to BTA, PPP, or/and IFT were included. Exclusion criteria were non-midline hernias, non eletive surgeries and less than 3 months of follow-up.ResultsAmong the 44 patients studied, 61.4% underwent abdominal wall reconstruction without requiring CST. Traditional predictors like component separation index and rectus/defect ratio were not associated with a higher rate of CST after adjuvant therapies. 45.5% of patients underwent a combination of adjuvant techniques (BTA + PPP or BTA + IFT). The early and late complication rates were 20.5% and 9.1%. A recurrence rate of 4.5% was reported after a median follow-up of 13 months.ConclusionThis study suggests that adjuvant therapies may influence the surgical approach to abdominal wall reconstruction. The synchronous application of adjuvant therapies, both preoperatively and intraoperatively, could enhance their effect and contribute to the use of less disruptive techniques.

V. Patel, E. Shortliffe, M. Stefanelli et al.

K. Lee, Lim Jeong, Y. Kang et al.

N. O’grady, P. Barie, J. Bartlett et al.

D. Rakel, L. Fortney, V. Sierpina et al.

Jiayu Peng, Jiajun Zeng, Manlin Lai et al.

Objective: Ultrasound (US) examination has unique advantages in diagnosing carpal tunnel syndrome (CTS) while identifying the median nerve (MN) and diagnosing CTS depends heavily on the expertise of examiners. To alleviate this problem, we aimed to develop a one-stop automated CTS diagnosis system (OSA-CTSD) and evaluate its effectiveness as a computer-aided diagnostic tool. Methods: We combined real-time MN delineation, accurate biometric measurements, and explainable CTS diagnosis into a unified framework, called OSA-CTSD. We collected a total of 32,301 static images from US videos of 90 normal wrists and 40 CTS wrists for evaluation using a simplified scanning protocol. Results: The proposed model showed better segmentation and measurement performance than competing methods, reporting that HD95 score of 7.21px, ASSD score of 2.64px, Dice score of 85.78%, and IoU score of 76.00%, respectively. In the reader study, it demonstrated comparable performance with the average performance of the experienced in classifying the CTS, while outperformed that of the inexperienced radiologists in terms of classification metrics (e.g., accuracy score of 3.59% higher and F1 score of 5.85% higher). Conclusion: The OSA-CTSD demonstrated promising diagnostic performance with the advantages of real-time, automation, and clinical interpretability. The application of such a tool can not only reduce reliance on the expertise of examiners, but also can help to promote the future standardization of the CTS diagnosis process, benefiting both patients and radiologists.

XU Lijun, LI Shasha, YAN Renfu et al.

This paper reviewed the concept，form，status quo of application of multicomponent exercise to promote health of the elderly，and the research progress of multicomponent exercise combined intervention with nutrition supplement，cognitive training and ADL training，in order to provide basis for the application of multicomponent exercise health intervention for the elderly.

Alice Manjate, Charlotta Nilsson, Maria Axelsson et al.

<h4>Background</h4>Mozambique is a high-prevalence country for HIV and early detection of new HIV infections is crucial for control of the epidemic. We aimed to evaluate the accuracy of the 4th-generation rapid diagnostic test (RDT) AlereTM HIV Combo in detecting acute and seroconverted HIV-infection, among sexually-active women attending three clinical health centers in Maputo, Mozambique.<h4>Methods</h4>Women aged 14-55 years (n = 920) seeking care at the Mavalane Health Area, Maputo (February 2018-January 2019) were included, and blood specimens sampled. Sociodemographic and sexual behavior data were collected. Point-of-care HIV testing was performed using Alere DetermineTM HIV-1/2 and Uni-GoldTM HIV-1/2. All samples were also tested using Enzygnost® HIV Integral 4 and Innotest® HIV Antigen mAb in laboratory. The 4th-generation RDT AlereTM HIV Combo was evaluated on serum samples in the laboratory. Finally, Innotest® HIV Antigen mAb, Enzygnost® HIV Integral 4 (Ag/Ab), and HIV RNA quantification acted as gold standard assays in the evaluation of AlereTM HIV Combo test for HIV antigen detection (in clinical samples and in three HIV-1 seroconversion panels).<h4>Results</h4>The antibody component of the 4th generation AlereTM HIV Combo RDT demonstrated a sensitivity and specificity of 100% examining clinical samples. However, the test did not detect HIV p24 antigen in any clinical samples, while Innotest® HIV Antigen mAb, verified by Enzygnost® HIV Integral 4 (Ag/Ab) and/or HIV RNA quantification, detected HIV antigen in six clinical samples. Furthermore, the AlereTM HIV Combo RDT had a low sensitivity in the detection of HIV p24 antigen in seroconversion panels. The HIV prevalence among the examined women was 17.8%.<h4>Conclusions</h4>The 4th-generation RDT AlereTM HIV Combo showed similar sensitivity to the 3rd-generation RDTs to detect seroconverted HIV-infections. However, the sensitivity for detection of HIV p24 antigen and diagnosing acute HIV infections, before seroconversion, was low. There is an urgent need to develop and evaluate simple and affordable POC tests with high sensitivity and specificity for diagnosing individuals with acute HIV infection in resource-limited settings with high HIV prevalence.