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Background: Self-Directed Learning (SDL) is a subjective concept with no universally agreed definition. The aim of this project was to obtain the perspectives of Orthopaedic trainee registrars on SDL. Methods: Seven Orthopaedic trainees in the Southwest Peninsula region were recruited in person by the primary author as an Orthopaedic trainee on the same programme as the participants. A one-hour Microsoft teams video interview was arranged at a mutually convenient time exploring several topics including learning resources, experiential learning, learning strategies, training programme requirements and assessment. The interviews were audio recorded and transcribed verbatim. Transcripts were coded using Corbin's and Strauss's published coding method and analysed to develop a model of SDL in this training context. Results: Six learning stages were identified from the coded transcripts and these stages were like Knowles's stages of SDL. Participants felt less autonomous during the identification of knowledge gaps, goal setting and evaluation of learning stages. Participants perceived to have more control over the selection of strategies, and learning stages of SDL. The factors which influenced autonomy at various stages of SDL included supervisors, experiential learning opportunities, service provision competing with learning opportunities, training programme requirements and the power dynamic between trainees and supervisors. Self-advocacy by the trainees for experiential learning opportunities and for their progression was an additional action relevant to SDL that was evident. Online learning resources such as Orthobullets.com, YouTube videos, external revision courses, collaboration and webinars encouraged more autonomy with SDL. Conclusions: Although the United kingdom's Trauma and Orthopaedic curriculum is described as trainee led and SDL is encouraged, in practice Orthopaedic trainees felt limited autonomy with the various stages of SDL due to external factors including their level of experience and the training environment. Trainees' experiences around self-advocacy highlighted the importance of a collaborative and supportive learning culture emphasising dialogue, receiving high quality feedback, and openness for successful progression. [ABSTRACT FROM AUTHOR]

Objectives: Our study assesses the current knowledge and prior awareness of undergraduate medical students in Pakistan regarding palliative care. Study Design: This descriptive Cross-sectional online survey was distributed among undergraduate medical students across Pakistan, with a sample size of 246 participants. The questionnaire, adapted from the PaCKS questionnaire by Kozlov et al. (JAMA 15(5):524–34, 2017), was designed to assess the students' prior knowledge about palliative care. Results: The mean PaCKS score was 9.7 out of 13, with a standard deviation of 2.76. Having heard of palliative care before participation in the study was significantly associated with higher PaCKS scores. Key factors associated with a higher incidence of prior awareness of palliative care included attending private institutions, being in a more advanced year of study, and having a higher mean monthly family income (P < 0.001 for each factor). Conclusion: This study explores medical students' understanding of palliative care in Pakistan, finding that while many have a basic grasp of the concept, there are notable misconceptions, particularly in differentiating palliative care from hospice care and understanding its broader role. Interestingly, students' knowledge did not significantly improve as they advanced through medical school, suggesting potential shortcomings in the curriculum. The findings highlight the need for more precise education and targeted training to better equip future healthcare providers for delivering patient-centered care. [ABSTRACT FROM AUTHOR]

According to several recent studies, physicians in various medical branches have some differences in attitudes towards transgender and gender‐diverse (TGD) persons based on religious or political beliefs. Our study aims to uncover the attitudes of the general physician community in Turkey, which has a youthful profile, regarding TGD individuals. The attitudes towards transgender individuals scale (ATTI) and the general conservatism scale, along with a form that asks about socio‐demographic factors, political beliefs, and level of religion, were administered online to physicians. The ATTI score of physicians (mean = 77.8) is favourable and did not vary among branches. Being female, being close to TGD, having left‐wing views, low conservatism and low religious belief scores were associated with positive attitudes towards TGD individuals. The physician profile's moderate religious belief and left‐wing views can be interpreted as a country‐specific dynamic and did not prevent the approach from being positive. Despite physicians' positive attitude towards TGD individuals on a professional level, there is resistance to contacting them in their daily lives. The possibility of the partial contribution of socially desirable response behaviour to positive scores should not be ignored. [ABSTRACT FROM AUTHOR]

Background Ovarian cancer is among the leading causes of gynecologic cancer-related death. Past ovarian cancer screening trials using combination of cancer antigen 125 testing and transvaginal ultrasound failed to yield statistically significant mortality reduction. Estimates of ovarian cancer sojourn time—that is, the period from when the cancer is first screen detectable until clinical detection—may inform future screening programs. Methods We modeled ovarian cancer progression as a continuous time Markov chain and estimated screening modality–specific sojourn time and sensitivity using a Bayesian approach. Model inputs were derived from the screening arms (multimodal and ultrasound) of the UK Collaborative Trial of Ovarian Cancer Screening and the Prostate, Lung, Colorectal and Ovarian cancer screening trials. We assessed the quality of our estimates by using the posterior predictive P value. We derived histology-specific sojourn times by adjusting the overall sojourn time based on the corresponding histology-specific survival from the Surveillance, Epidemiology, and End Results Program. Results The overall ovarian cancer sojourn time was 2.1 years (posterior predictive P value = .469) in the Prostate, Lung, Colorectal and Ovarian studies, with 65.7% screening sensitivity. The sojourn time was 2.0 years (posterior predictive P value = .532) in the United Kingdom Collaborative Trial of Ovarian Cancer Screening's multimodal screening arm and 2.4 years (posterior predictive P value = .640) in the ultrasound screening arm, with sensitivities of 93.2% and 64.5%, respectively. Stage-specific screening sensitivities in the Prostate, Lung, Colorectal and Ovarian studies were 39.1% and 82.9% for early-stage and advanced-stage disease, respectively. The histology-specific sojourn times ranged from 0.8 to 1.8 years for type II ovarian cancer and 2.9 to 6.6 years for type I ovarian cancer. Conclusions Annual screening is not effective for all ovarian cancer subtypes. Screening sensitivity for early-stage ovarian cancers is not sufficient for substantial mortality reduction. [ABSTRACT FROM AUTHOR]

Introduction This study aimed to examine the prevalence of cold injuries and review the cold injury monitoring system in the South Korean military. Materials and Methods This study conducted a retrospective and cross-sectional analysis using data from the Defense Medical Statistic Information System (DMSIS) on cold injuries among military personnel from 2018 to 2023. It incorporated findings from the Korean Armed Forces Medical Command's cold injury surveillance system and analyzed cases from the Armed Forces Capital Hospital, covering all branches of the military by status and rank. Results An analysis of cold injury in the South Korean military over the past 5 years revealed varying numbers of cases treated, from 799 in 2018-2019 to 467 in 2022-2023. According to the surveillance system in 2023-2024, the Army experienced the majority of these cases, with 94.5% of the total. The incidence per 1,000 personnel was the highest in the Army at 0.98 compared to the Air Force and Navy/Marine Corps. Rank-based analysis indicated the most affected were private first-class soldiers. Frostbite was the most frequent condition, alongside chilblains, hypothermia, and immersion injuries, with no marked difference in the type of illness across branches. Conclusions The study underscores the need for focused prevention and treatment, particularly in the Army. By analyzing data from a newly implemented surveillance system, it revealed a higher incidence of frostbite and chilblains among lower ranks. The findings highlight the importance of targeted educational measures and enhanced response strategies to protect personnel against cold injuries. [ABSTRACT FROM AUTHOR]

Introduction A challenge confronting health care is the national physician shortage, notably impacting the DoD's recruitment of military physicians. To address this, the Health Professions Scholarship Program is annually awarded to medical students to facilitate their transition into the U.S. Armed Forces. There is a glaring absence of military medical education in civilian schools to accommodate the unique interests of these students. While medical schools have adapted with interest groups and specialty tracks, the current presence of military medicine interest groups (MMIGs) and military medicine specialty tracks (MMSTs) remains under-explored. This study aimed to (1) update the prevalence of MMIGs in U.S. medical institutions, (2) identify the presence of MMSTs, and (3) compare military medicine involvement between allopathic and osteopathic programs. Methods The study was approved for exempt status from the Kansas City University Institutional Review Board (study number 20,211,568-1). In a cross-sectional analysis, surveys were sent to 208 U.S. medical schools, with responses from student services or available public data from 200 institutions included in the final analysis. A secondary survey was sent to respondents who provided MMIG or MMST contacts. Results Results indicated that 62% (n  = 124/200) of schools currently have an established MMIG, a modest growth from 56% (n  = 70/125) in 2015 (p  = .14). MMST prevalence, however, is minimal at 2.5% (5/200). Osteopathic institutions demonstrated a significantly greater engagement in military medicine education (88.7%) compared to allopathic schools (52.4%) (p  < .001). Conclusion This research underscores the need for comprehensive military medical training in medical schools to meet the interests and career aspirations of their students. Future studies should also evaluate the efficacy of MMIGs and MMSTs in preparing students for military medical roles. [ABSTRACT FROM AUTHOR]

Introduction Health disparities in the Military Health System (MHS) have been consistently documented despite the system ensuring equal access to care for its beneficiaries. Research has shown that social, economic, and political factors (i.e. Social Determinants of Health) and health care-specific factors like provider bias and systemic discrimination are key drivers of health disparities in the general population. Medical education focused on introducing these concepts using case-based learning has led to effective learning of health equity terminology. However, a significant gap exists in identifying optimal teaching approaches to develop skills to recognize these factors in actual clinical cases. This begs the million-dollar question: can case-based learning help trainees acquire the skills needed to identify the main factors contributing to health disparities in the MHS? Materials and Methods A longitudinal case-based curriculum was developed in which clinical cases from the Internal Medicine Wards, Medical Intensive Care Unit, or General Internal Medicine Clinic at the National Capital Consortium were solicited from trainees and analyzed for evidence of health care provider bias and systemic forms of discrimination using small groups. The National Capital Consortium Internal Medicine Residency Program implemented this pilot study in November 2021. A retrospective pretest-posttest survey assessing trainee reactions to the curriculum and changes in self-reported confidence in skills was used for curriculum assessment. Survey data were analyzed using a paired samples t -test. Results The survey was administered during the last session of the 2022-2023 academic year, with 14 of the 23 available trainees completing it: a 60.8% response rate. Overall, 93% reported that the cases selected that academic year were engaging; the skills they were taught were practice-changing, and the educational value of the curriculum was good, very good, or excellent. Confidence ratings, assessed via a 5-point Likert Scale, demonstrated a statistically significant increase in self-reported confidence in the following skill domains with large effect sizes: identification of bias and systemic discrimination in clinical cases—change in mean: 1.07 (Pre: 3.29, Post: 4.36), P  < .001, g = 1.38; recognizing and mitigating personal biases—change in mean: 0.71 (Pre: 3.50, Post: 4.21), P <.001, g = 1.10; participating in a discussion about health care provider bias and systemic discrimination—change in mean: 0.79 (Pre: 3.57, Post: 4.36), P  = .001, g = 1.06; and leading a discussion about bias and systemic discrimination—change in mean: 1.00 (Pre: 2.93, Post: 3.93), P =.002, g = 0.98. Conclusions As the need to address health disparities in the United States becomes more pressing, so does the need for military physicians to recognize the drivers of these disparities within the MHS. Results from this pilot study of Health Equity Rounds suggest that case-based learning may be an optimal teaching approach to improve the skills of military Internal Medicine trainees in identifying and recognizing the impact of health care provider bias and systemic discrimination on clinical cases from the MHS. [ABSTRACT FROM AUTHOR]

Introduction Mentorship programs have well-documented benefits to both mentees and mentors. Military medical students face unique challenges in medical school given their service-specific requirements and separate military match process. We therefore aimed to determine whether military medical students' participation in a mentorship program impacts their confidence in applying to obstetrics and gynecology (OB/GYN) residency. Materials and Methods First, a needs assessment survey regarding the use of a mentorship program was sent to medical students, residents, fellows, and attendings. A structured mentorship program was then developed for military medical students applying to OB/GYN residency based on the survey results. Mentors were randomly paired with mentees and asked to appraise curriculum vitaes, review personal statements, and perform mock interviews. Following completion of these activities, participants were sent a post-intervention questionnaire. This project was exempt by our institution's Institutional Review Board. Results Our program had 56 participants, with 29 individuals completing our post-intervention survey (response rate 51.8%). After participating in the program, 92.3% of mentors stated they plan to continue a relationship with their mentee. All the mentee respondents stated they would participate in this program again. Before participating in the program, 16.7% of mentees felt "prepared" or "extremely prepared" for the match, compared to 87.6% post-intervention. Most mentee respondents (75%) reported that this program made them a more competitive applicant. Following the mentorship program, 66.7% of participants successfully matched into OB/GYN residency. Conclusions This reproducible, well-received intervention can be implemented to facilitate mentoring connections regardless of geographic location. As the OB/GYN specialty develops its own application process, civilian medical schools should consider adopting similar programs to aid their students in navigating the match process. [ABSTRACT FROM AUTHOR]

Introduction Disease and non-battle injuries (DNBIs) cause substantial losses among military personnel. NATO has monitored DNBIs among its personnel since 1996 using multiple versions of a tool now called EpiNATO-2, but the surveillance system has never been systematically evaluated. Following a request from NATO to the CDC, the objective of this study was to assess surveillance system attributes of EpiNATO-2 using CDC's updated guidelines for evaluating public health surveillance systems. Materials and Methods Between June and October 2022, a literature review and key informant interviews were conducted to assess the following attributes: usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness, timeliness, stability, informatics system quality, informatics service quality, and informatics interoperability. Key informant interviews were conducted in Kosovo, Germany, and remotely with EpiNATO-2 users spanning three levels: clinical and data entry personnel (tactical level); regional medical and public health officers (operational level); and senior commanders and other governmental entities (strategic level). Results Fourteen EpiNATO-2 users participated in interviews, representing 3 of the 5 major NATO missions, 3 partner entities, and 7 nationalities. All users (100%) reported that the system did not meet their needs, with most users noting the following challenges: lack of clearly defined system objectives; poor data quality due to ambiguous case definitions and frequently unsubmitted reports (37% missing during January to June 2022); long delay between the occurrence of health events and the availability of corresponding data (≥2 weeks); and an antiquated and inflexible data management system. Overall, performance was deemed unsatisfactory on 11 of the 13 attributes. Conclusions This multinational sample of EpiNATO-2 users at all military levels reported that the system is currently not useful with respect to its stated objectives. Opportunities exist to improve the performance and usefulness of EpiNATO-2: improve case definitions, modernize data infrastructure, and regularly evaluate the surveillance system. [ABSTRACT FROM AUTHOR]

Introduction Ventral hernia repair cost the U.S. healthcare system nearly 3 billion dollars annually. Surgical repair is a critical competency for residents yet hernia recurrence rates following mesh-based repair range from 0.8% to 24%. Improving surgical techniques using cadavers is often cost-prohibited for many education programs and limited research exists using simulation models with a corresponding hernia repair curriculum in the graduate medical education setting. This pilot project aimed to develop a low cost, easily reproducible novel abdominal wall reconstruction model and pilot-test the ventral hernia repair curriculum to inform further refinement prior to formal evaluation. Material and Methods This descriptive study pilot-tested the newly refined Abdominal Wall Surgical Skills Operative Model (AWSSOM) simulator for ventral hernia repair with mesh and its corresponding 2-h training curriculum for use at all levels of general surgery graduate medical education. The AWSSOM is a 3D printed synthetic anatomically realistic abdominal wall model consisting of silicone cured layers of skin, fat, rectus abdominis and a posterior rectus sheath fascia, and silicone tubules to simulate lateral neurovascular bundles. The curriculum incorporated didactic content reflecting surgical practice guidelines, hands-on practice, and faculty guidance promoting interactive critical thinking development during task performance. A pre-/post-assessment included a 10-item knowledge test, a 19-item psychomotor assessment, and 4-items confidence survey to examine changes in performance, knowledge, and confidence in competently completing the ventral hernia repair technique. Descriptive statistics were used to report the limited results of six military surgical resident participants and inform further model and curriculum refinement prior to formal evaluation. Results The five-layer AWSSOM model was manufactured in 65 h at a material cost of $87 per model frame, is reusable model, and secure base. Six surgical residents were recruited; only four completed both pre- and post-tests due to resident schedule conflicts. The average increase in knowledge was 25%, although variable changes in confidence were observed over the four program year participants. A larger sample size and a control group are needed to demonstrate curriculum effectiveness at improving knowledge, performance, and confidence in ventral hernia repair with mesh and better delineate if high scores translate to better operative skills. A key improvement requested by residents was a more secure model base for dissection and performance of the hernia repair. Conclusions The novel abdominal wall surgical skills operative model fills an important proof of concept gap in simulation training. It is low cost with the potential to improve cognitive and psychomotor skills, as well as confidence to competently complete ventral hernia repair with mesh in the graduate medical education setting. Prior to formal effectiveness testing, our lessons learned should be addressed in both the model and curriculum. Future studies must include an adequately powered statistical evaluation with a larger sample across all levels of training. [ABSTRACT FROM AUTHOR]

Background The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI). Methods Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI. Results Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P  < 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P  = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P  < 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P  < 0.001]. Conclusion We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality. [ABSTRACT FROM AUTHOR]

Today, energy harvesting has developed into a technique from which various aspects are still hidden. By extracting energies from the environment and even the human body, and converting them into electrical energy, we can supply power to low‐consumption electronic devices. Energy harvesting works by inhibiting small amounts of ambient energies; otherwise, it is wasted in other forms such as heat, vibration, and light. In this paper, we aim to eliminate or minimize the dependence of portable electronic devices to the batteries, which have limited life times, service costs, handling, and environmental problems. This is accomplished via incorporating the hybrid energy‐harvesting techniques and designed to power (bio)medical devices in order to measure vital signs. In this circuit, by simultaneously harvesting RF, light, thermal, and solar (natural and artificial) energies, we were able to increase the reliability of continuous supply of electrical energy in energy‐harvesting systems by generating and storing maximum power from the environment. Supercapacitors are used as the energy storage elements so that there is no energy waste, and each system is constantly storing the electrical energy with the aid of a diode block. In addition, with the help of supercapacitors, this device is able to transmit a maximum of 420 mW to the load and the total efficiency is equal to 74%. [ABSTRACT FROM AUTHOR]

The rate of unplanned hospital readmissions following total hip arthroplasty (THA) varies from 3 to 10%, representing a major economic burden. However, it is unknown if specific factors are associated with different types of complications (ie, medical or orthopaedic-related) that lead to readmissions. Therefore, this study aimed to: (1) determine the overall, medical-related, and orthopaedic-related 90-day readmission rate; and (2) develop a predictive model for risk factors affecting overall, medical-related, and orthopaedic-related 90-day readmissions following THA. A prospective cohort of primary unilateral THAs performed at a large tertiary academic center in the United States from 2016 to 2020 was included (n = 8,893 patients) using a validated institutional data collection system. Orthopaedic-related readmissions were specific complications affecting the prosthesis, joint, and surgical wound. Medical readmissions were due to any other cause requiring medical management. Multivariable logistic regression models were used to investigate associations between prespecified risk factors and 90-day readmissions, as well as medical and orthopaedic-related readmissions independently. Overall, the rate of 90-day readmissions was 5.6%. Medical readmissions (4.2%) were found to be more prevalent than orthopaedic-related readmissions (1.4%). The area under the curve for the 90-day readmission model was 0.71 (95% confidence interval: 0.69 to 0.74). Factors significantly associated with medical-related readmissions were advanced age, Black race, education, Charlson Comorbidity Index, surgical approach, opioid overdose risk score, and nonhome discharge. In contrast, risk factors linked to orthopaedic-related readmissions encompassed body mass index, patient-reported outcome measure phenotype, nonosteoarthritis indication, opioid overdose risk, and nonhome discharge. Of the overall 90-day readmissions following primary THA, 75% were due to medical-related complications. Our successful predictive model for complication-specific 90-day readmissions highlights how different risk factors may disproportionately influence medical versus orthopaedic-related readmissions, suggesting that patient-specific, tailored preventive measures could reduce postoperative readmissions in the current value-based health care setting. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to summarize studies that compared the performance of health-care institutions led by leaders with medical background versus those with no medical background. Design/methodology/approach: A systematic search was conducted on three databases: PubMed, Ovid Medline and Google Scholar to identify relevant peer-reviewed studies using the keywords "performance," "impact," "physician," "medical," "doctor," "leader," "healthcare institutions" and "hospital." Only quantitative studies that compared the performance of health-care institutions led by leaders with medical background versus non-medical background were included. Articles were screened and assessed for eligibility before the relevant data were extracted to summarize, appraise and make a narrative account of the findings. Findings: A total of eight studies were included, four were based in the USA, two in the UK and one from Germany and one from the Arab World. Half of the studies (n = 4) reported overall better health-care institutional performance in terms of hospital quality ranking such as clinical effectiveness and patient safety under leaders with medical background, whereas one study showed poorer performance. The remaining studies reported mixed results among the different performance indicators, especially financial performance. Practical implications: While medical background leaders may have an edge in clinical competence to manage health-care institutions, it will be beneficial to equip them with essential management skills to optimize leadership competence and enhance organizational performance. Originality/value: The exclusive inclusion of quantitative empirical studies that compared health-care institutional performance medical and non-medical leaders provides a clearer link between the relationship between health-care institutional performance and the leaders' background. [ABSTRACT FROM AUTHOR]

Hyper spectral imaging (HSI) has emerged as a powerful technique for accurate disease diagnosis in medical environments. It provides high-resolution images with detailed spectral information, making it possible to identify subtle differences between healthy and diseased tissues. However, current HSI systems face challenges in terms of accuracy and efficiency, limiting their widespread application in sustainable medical environments. To overcome these challenges, our team has developed an improved HSI system that utilizes state-of-the-art spectral imaging technology and machine learning algorithms. This system is capable of capturing and analyzing a wider range of spectral data, enabling more precise identification of disease-specific spectral signatures. Furthermore, our system has been optimized to operate with minimal power consumption, making it environmentally friendly and suitable for sustainable medical environments. The improved HSI system has been successfully tested in clinical settings and has shown promising results in accurately diagnosing various diseases such as cancer, dermatitis, and cardiovascular conditions. Its high accuracy and fast processing time make it a valuable tool for early disease detection and treatment planning. Moreover, the ability to operate with low energy consumption makes it a sustainable solution for medical facilities in resourcelimited areas. In addition to its accuracy and efficiency, our improved HSI system is also user-friendly and can be easily integrated into existing medical imaging systems. [ABSTRACT FROM AUTHOR]

This paper explores the telemedicine possibilities available to astronauts during spaceflight, focusing on the possible utilization of medical avatars for continuous health monitoring. Various types and sources of telemedicine are examined, along with their applications in deep space travel to address the challenges faced by astronauts and facilitate timely intervention in case of injuries and illnesses. The use of medical avatars presents a promising solution to mitigate risks and ensure effective healthcare delivery in the absence of immediate physical medical support. Furthermore, potential terrestrial applications of telemedicine and virtual medical avatars are discussed, highlighting the wider implications and benefits beyond space exploration. By leveraging advanced technologies and innovative approaches, telemedicine in conjunction with medical avatars offers a compelling avenue for enhancing healthcare practices both in space and on Earth. [ABSTRACT FROM AUTHOR]

Introduction: The impact of medical student involvement in anesthetic procedures on operating room (OR) efficiency and patient outcomes remains understudied, despite its importance in medical education. This study aimed to quantify the effects of fifth-year medical students' participation in anesthetic procedures on key time metrics, perceived difficulty, procedural success, and postoperative complications and to compare these effects with those of anesthetic residents and student nurse anesthetists. Methods: This prospective observational study was conducted between April and July 2022 in the OR of a tertiary university hospital in southern Thailand. We analyzed 111 elective obstetric-gynecologic and general surgery procedures under subarachnoid block or general anesthesia, equally distributed among three groups: fifth-year medical students, anesthetic residents, and student nurse anesthetists. Key time intervals, perceived difficulty, number of attempts, success rates, and postoperative complications were recorded and compared across groups. Results: Fifth-year medical students exhibited significantly prolonged anesthesia release time, anesthesia-controlled time, anesthetic preparation time, and anesthetic procedure time compared to anesthetic residents and student nurse anesthetists (p < 0.05). Medical students perceived case inductions as more challenging than the other groups did (p < 0.001), but procedural success rates were comparable across groups. Immediate postoperative airway complications were more frequent among medical students than anesthetic residents, but no significant differences were found in intraoperative or 24-h postoperative complications. Discussion: While the involvement of medical students in anesthetic procedures extends specific time metrics, it does not significantly impact overall case duration or major patient outcomes. These findings support the continued integration of medical student training in the OR, with appropriate supervision to manage the slightly increased risk of immediate postoperative complications. Further research is needed to optimize the balance between educational opportunities and OR efficiency. [ABSTRACT FROM AUTHOR]

Introduction: Musculoskeletal ultrasound (MSUS) is integral to routine clinical diagnostics for musculoskeletal and joint disorders. This study aims to establish and validate a sonography course tailored to undergraduate medical students acquiring MSUS-specific skills at a German university. Methods: A blended learning training concept, comprising 24 instruction sessions of 45 min each, was designed based on the current national guidelines of the German Society for Ultrasound in Medicine (DEGUM). This program was integrated into the clinical phase of the undergraduate students' medical education. The self-perceived improvement in competency and the effectiveness of the course design were evaluated using a a 7-point Likert scale questionnaire. Objective learning success was evaluated via a written test and a "Direct Observation of Practical Skills" practical exam. Control groups included medical students without MSUS training (control group 1) and doctors who had completed DEGUM-certified basic MSUS courses (control group 2). Both control groups completed the written test, while control group 2 also took the practical final exam. The study involved 146 participants: 56 were allocated to the study group, 44 to control group 1, and 46 to control group 2. Results: The study group rated their skills significantly higher after the course (p < 0.01). Participants expressed high satisfaction with the course design, the teaching materials, and the teachers. The study group's performance on the final written test was comparable to those of control group 2 (p = 0.06) and significantly superior to control group 1 (p < 0.001). Additionally, the study group's performance on the practical final exam was not significantly different from control group 2 (p = 0.28), with both groups achieving scores exceeding 80%. Conclusion: Both subjective and objective measures of learning suggest that an MSUS course designed for postgraduates can be effectively adapted for undergraduate medical students. Incorporating MSUS training into the clinical curriculum is recommended to enhance future medical professionals' educational experience and practical skills. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to evaluate the effectiveness of a novel e-learning module in teaching the physical exam of the temporomandibular joint (TMJ) in Juvenile idiopathic arthritis (JIA.). Methods: An e-learning module was developed to convey the TMJ physical examination maneuvers that are considered to be best practice in JIA. Pediatric rheumatology fellows were randomized to two groups. One group received an article describing the physical examination skills while the second group received both the article and module. All participants completed a written pre-test, an in-person objective structured clinical examination (OSCE), a written post-test, and a follow-up survey. Results: Twenty-two pediatric rheumatology fellows enrolled, with 11 per group. Written test: The two groups improved equally, although there was a trend toward improved defining of maximal incisal opening (MIO) in the module group. OSCE: The mean OSCE score was 11.1 (SD 3.3) in the article group and 13.5 (SD 1.9) in the module group (p = 0.06); significant differences were seen in measuring MIO (p = 0.01), calculating maximal unassisted mouth opening (MUMO; p = 0.01), and assessment of facial symmetry (p = 0.03), all favoring the module. Enjoyment scores in the module group were higher than in the article group (mean 7.7/10 vs. 5.9/10, p = 0.02). The two groups self-reported performing TMJ examinations at comparable rates three months following the intervention. Conclusions: The study demonstrated that a formalized educational program improved knowledge of the physical exam of the TMJ in JIA. Learners viewing the module were more adept at obtaining quantitative TMJ measurements. [ABSTRACT FROM AUTHOR]

Introduction: The impact of medical student involvement in anesthetic procedures on operating room (OR) efficiency and patient outcomes remains understudied, despite its importance in medical education. This study aimed to quantify the effects of fifth-year medical students' participation in anesthetic procedures on key time metrics, perceived difficulty, procedural success, and postoperative complications and to compare these effects with those of anesthetic residents and student nurse anesthetists. Methods: This prospective observational study was conducted between April and July 2022 in the OR of a tertiary university hospital in southern Thailand. We analyzed 111 elective obstetric-gynecologic and general surgery procedures under subarachnoid block or general anesthesia, equally distributed among three groups: fifth-year medical students, anesthetic residents, and student nurse anesthetists. Key time intervals, perceived difficulty, number of attempts, success rates, and postoperative complications were recorded and compared across groups. Results: Fifth-year medical students exhibited significantly prolonged anesthesia release time, anesthesia-controlled time, anesthetic preparation time, and anesthetic procedure time compared to anesthetic residents and student nurse anesthetists (p<0.05). Medical students perceived case inductions as more challenging than the other groups did (p< 0.001), but procedural success rates were comparable across groups. Immediate postoperative airway complications were more frequent among medical students than anesthetic residents, but no significant differences were found in intraoperative or 24-h postoperative complications. Discussion: While the involvement of medical students in anesthetic procedures extends specific time metrics, it does not significantly impact overall case duration or major patient outcomes. These findings support the continued integration of medical student training in the OR, with appropriate supervision to manage the slightly increased risk of immediate postoperative complications. Further research is needed to optimize the balance between educational opportunities and OR efficiency. Clinical trial registration: https://www.thaiclinicaltrials.org/show/ TCTR20220418006, identifier TCTR20220418006. [ABSTRACT FROM AUTHOR]

The identification of malaria infection using microscope images of blood smears is considered as a 'gold standard'. The diagnosis of malaria needs expert microscopists which are scarce in remote areas where malaria is endemic. Therefore, it is desirable to automate the repetitive task of pathogen detection in the blood samples received as microscope images. This study provides an easy to use and deploy method for implementing a malaria pathogen detection software- the Intelligent Suite. The Intelligent Suite features a graphical user interface (GUI) implemented using 'cvui' library to interact with the OpenVINO's inference engine for model optimisation and deployment across several inference devices. The intelligent Suite uses a custom YOLO-mp-3l model trained on Darknet framework for detection of malaria pathogen in thick smear microscope images. Moreover, the Intelligent Suite provides user interface for inference device/mode selection, alter model parameters, and generate detection reports along with the model performance metrics. The Intelligent Suite was executed on a CPU computer with model inference running on a plug-and-play Neural Compute Stick (NCS2) and performance reported. [ABSTRACT FROM AUTHOR]

A modified Vesikari severity score (MVSS) is a useful research tool for assessing severity of acute gastroenteritis. We present a MVSS for studies in which a follow-up assessment of symptoms cannot be obtained. The MVSS significantly correlated with other markers of severity, including illness duration and work and school absenteeism. [ABSTRACT FROM AUTHOR]

Post-artesunate delayed hemolysis (PADH) occurred in 6 of 24 children treated with artesunate for severe malaria in the United States; however, severe hemolysis requiring hospitalization or transfusion was rare. In children in the United States treated with artesunate, counseling, and symptom monitoring may be preferred to weekly laboratory surveillance for PADH. [ABSTRACT FROM AUTHOR]

Youth and families impacted by legal systems now resoundingly attest to the systems' lasting harm, echoed by interdisciplinary research. Lawyering thus requires a vastly renewed outlook, boldness, and honest inquiry about the limits of what the law and public systems can (and should) attempt as purported problem‐solving amidst broader socioeconomic forces and injustice. This report synthesizes recommendations from a groundswell of diverse, dedicated voices following an October 2023 convening hosted by the American Bar Association Commission on Youth at Risk, the ABA Center on Children and the Law, and Hofstra University's Maurice A. Deane School of Law. Entitled "Renewal and Revolution: Recommitting the Legal Profession to Serving Children and Youth, Their Families, and Communities," the convening engaged various professionals—many with firsthand experience in foster and justice systems— and other advocates. Since the 2006 ABA Youth At Risk Initiative Planning Conference, the ABA Commission on Youth At Risk has elevated the representation and voice of youth through ethical practice standards, expanded access, and national initiatives. This report recounts findings of the 2023 convening's four working groups which met for two‐days of (often tense) discussions to chart a path for the legal profession, law, and policy for the next decade and beyond. Priorities include: transcending conceptions of youth "at risk" towards recognition of harms done, a strengths‐based lens, and lived experience leadership and expertise; cultivating next generation attorneys; prioritizing early family defense and diversion; divesting from systems and re‐investing directly with youth and families; and further eliminating racial disparities. Key points for the family court community: Attorneys and advocates representing youth and families require a bold paradigm shift towards legal strategies that minimize harm and trauma, divert from courts and facilities, and empower those directly impacted by systems.Lived experience expertise on the part of youth and families should be better compensated and leveraged, towards the advocacy goals of improved legal representation and divestment from public systems which cause harm.Constitutional and civil rights protections for youth and parents in family courts, and other systems like the immigration system, need to be strengthened and formalized.Judges, attorneys and advocates require more extensive training on eliminating racial and ethnic disparities. Jurisdictions should prioritize this as a matter of professional ethics (and/or continue doing so). Additional measures are often needed to counter inevitable resistance to change, and retrenchment of biases.While the next generation of attorneys representing youth and families may benefit from being further mentored and supported, it is also an honor and an asset for the legal profession to have and mentor emerging attorneys with firsthand experience in youth‐serving systems themselves. [ABSTRACT FROM AUTHOR]

AbstractMedical students are highly susceptible to distress and burnout, raising concern about how this can carry over into their careers, impacting wellness, professionalism, and patient care. The aims of this study are to assess the mental health and wellness status of medical students in Ontario. This study electronically surveyed medical students across M1-M4 attending a medical school in Ontario, Canada, using the Brief COPE, DASS21, and Copenhagen Burnout Inventory (CBI) to examine their coping mechanisms, levels of stress, anxiety, and depression, the prevalence of personal, work-related, and patient-related burnout, and perceived support. Participants were recruited through mass email containing a survey link. BriefCOPE results show that students tend to rely on self-distraction, emotional support, instrumental support, and acceptance as coping mechanisms. DASS21 demonstrates that M4 students report severe stress and anxiety and mild depression. Results of CBI show moderate personal and work-related burnout, and low patient-related burnout. Qualitative analysis of students’ opinion on how the institution can enhance their wellness resulted in three themes: enhanced student scheduling, more communication from the administration, and more elective wellness sessions and social events. The data presented in this study will provide insight into the overall mental health and wellness of medical students studying in Ontario and may have important implications for medical education, healthcare institutions, and health policymaking. [ABSTRACT FROM AUTHOR]

Background Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. Reliability and validity of adherence to NPIs in accordance with normalization process theory (NPT) in coherent and convenient social subgroups using reflective measurement model assessment has not been evaluated. Methods In February 2021, a sample of medical students and people with substance use disorders in treatment as coherent (based on continuous probability distribution) vs. convenient groups (based on convenience, not equal probability) composed of travellers and COVID-19 suspected persons from Split-Dalmatia County (SDC) (n  = 656) in the Mediterranean completed self-administered surveys. Partial least squares structural equation modelling (PLS-SEM) was used to measure reflective model assessment of adherence to NPIs according to NPT. Results PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined adherence to NPIs with excellent goodness-of-fit [ χ 2 = 1.292, df = 1; P  = 0.297, CFI = 1, TLI = 0.997, RMSEA = 0.011 (90% CI 0–0.105), RMSEA P  = 0.604, SRMR = 0.008, Hoelter CN (α = 0.05) = 2322.757]. Significant negative factors covariance estimate (−0.716) revealed an inverse relationship between first (adherence to NPIs and internal locus of control (LoC) (0.640)) and second factor; young adulthood age (≤25) and highest level of education (1362). As the first factor increased the second tended to decrease. LoC is expected potential mechanism by which sex (MLsex = −0.017, SE = 0.007, P  < 0.016) and belonging to coherent subgroups (MLgroup = −0.008, SE = 0.003, P  = 0.015) can produce indirect effect of adherence to NPIs. Conclusions Coherent subgroups had a more pronounced tendency toward integration of NPIs in everyday life. Group factors that facilitate the normalization were higher educated younger adults with a tendency toward external LoC. [ABSTRACT FROM AUTHOR]

Objective: Global variations in women's health outcomes, increased international migration, and an increase in the number of medical schools underpin the need for global standardization in obstetrics and gynecology curricula for medical students. However, there are currently no recommendations regarding the content of a common curriculum. The aim of this project was to agree the objectives for a common curriculum in obstetrics and gynecology for medical students globally. Methods: The curriculum was developed and agreed by an international taskforce of obstetricians and gynecologists. Published curricula for medical students in a variety of regions globally were reviewed and discussed, and the objectives for a common curriculum in obstetrics and gynecology for medical students were agreed by consensus. Results: The content of the proposed curriculum is classified into three domains: clinical skills, professional behaviors, and knowledge. The recommended curriculum covers health conditions that affect women globally in different social and cultural contexts, and addresses important global health issues of relevance to obstetrics and gynecology. Conclusion: The methods and outcomes of a project by an international taskforce of obstetricians and gynecologists to develop a common curriculum in obstetrics and gynecology for medical students globally are presented. More work is required to identify ways in which the curriculum may be adapted to a minimum essential required curriculum in times of man‐made or natural disasters. Achieving these will facilitate the intended long‐term aims of this curriculum, to improve women's health outcomes globally. Synopsis: This article describes the methods and outcomes of a project by an international taskforce to develop a common curriculum in O&G for medical students globally. [ABSTRACT FROM AUTHOR]

Objective: The state of Illinois' Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019. Methods: A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used. Results: A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users. Conclusions: Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Multidisciplinary tumour boards (MDTs) play a vital role in providing high-quality cancer care. In Pakistan's compromised healthcare system, there is a lack of tumour board establishment. To bridge this gap, we aimed to enhance medical education by exposing medical students to the processes and advantages of MDTs early in their careers through conducting a mock tumour board. This approach seeks to provide students with a practical understanding of cancer care and the collaborative decisionmaking involved in managing cancer patients. Methodology: A session took place at Jinnah Postgraduate Medical Centre in May, 2023, with participants voluntarily agreeing to attend. This session comprised six components: a Pretest questionnaire, a didactic lecture on the concept of tumour boards, an interactive group discussion following the lecture, a simulated tumour case presentation, a workshop simulating a tumour board scenario and a Posttest questionnaire. Results: A total of 80 participants were included in the study. The mean age of study participants was 22. Among these, 36 (45%) were in their final year, 34 (42.5%) in their fourth year and 10 (12.5%) in their third year. While the majority of students possessed a fundamental understanding of tumour boards, they lacked awareness regarding their importance, implementation and procedural aspects involved. Before the mock tumour board, 53 (66.3%) students were unfamiliar with tumour board procedures; post-workshop, all 80 (100%) gained awareness of the process. Additionally, the study showed a positive shift in perceptions regarding the cost-effectiveness of tumour boards. Initially, 44(55%) students responded with 'maybe' regarding tumour board's cost-effectiveness, but after training, 64 (80%) perceived it as cost-effective from patient's perspective. Moreover, students' overall pretest score was 66.5%, and posttest was 94.62%., showing an overall difference in knowledge of 28%. Conclusion: The mock tumour board workshop successfully heightened students' understanding of tumour board procedures, positively shaped their views on cost-effectiveness, and resulted in a noteworthy enhancement of their knowledge scores. Organising similar workshops for undergraduates offers a practical approach to bridging the current gap in the establishment of tumour boards in the future in Pakistan. [ABSTRACT FROM AUTHOR]

Background Inflammatory bowel disease increases the risk of colorectal neoplasia. A particular problem arises in patients who have undergone subtotal colectomy leaving a rectal remnant. The risk of future rectal cancer must be accurately estimated and weighed against the risks of further surgery or surveillance. The aim of this study was to estimate the 10-year cumulative incidence of rectal cancer in such patients. Methods A nationwide study using England's hospital administrative data was performed. A cohort of patients undergoing subtotal colectomy between April 2002 and March 2014 was identified. A competing risks survival analysis was performed to calculate the cumulative incidence of rectal cancer. The effect of the COVID-19 pandemic on endoscopic surveillance was investigated using time-trend analysis. Results A total of 8120 patients were included and 61 patients (0.8%) were diagnosed with cancer. The cumulative incidence of rectal cancer was 0.26% (95% c.i. 0.17% to 0.39%), 0.49% (95% c.i. 0.36% to 0.68%), and 0.77% (95% c.i. 0.57% to 1.02%) at 5, 10, and 15 years respectively. A previous diagnosis of colonic dysplasia (HR 3.34, 95% c.i. 1.01 to 10.97; P = 0.047), primary sclerosing cholangitis (HR 5.42, 95% c.i. 1.34 to 21.85; P = 0.018), and elective colectomy (HR 1.83, 95% c.i. 1.11 to 3.02; P = 0.018) was associated with an increased incidence of rectal cancer. Regarding endoscopic surveillance, there was a 43% decline in endoscopic procedures performed in 2020 (333 procedures) compared with 2019 (585 procedures). Conclusion The incidence of rectal cancer after subtotal colectomy is low. Asymptomatic patients without evidence of rectal dysplasia should be carefully counselled on the possible benefits and risks of prophylactic proctectomy. [ABSTRACT FROM AUTHOR]

Background Recent therapeutic advances have improved survival among lung cancer (LC) patients, who are now at high risk of second primary lung cancer (SPLC). Hispanics comprise the largest minority in the United States, who have shown a lower LC incidence and mortality than other races, and yet their SPLC risk is poorly understood. We quantified the SPLC incidence patterns among Hispanics vs other races. Methods We used data from the Multiethnic Cohort, a population-based cohort of 5 races (African American, Japanese American, Hispanic, Native Hawaiian, and White), recruited between 1993 and 1996 and followed through 2017. We identified patients diagnosed with initial primary lung cancer (IPLC) and SPLC via linkage to Surveillance, Epidemiology, and End Results registries. We estimated the 10-year cumulative incidence of IPLC (in the entire cohort) and SPLC (among IPLC patients). A standardized incidence ratio (SIR) was calculated as the ratio of SPLC-to-IPLC incidence by race and ethnicity. Results Among 202 692 participants, 6788 (3.3%) developed IPLC over 3 871  417 person-years. The 10-year cumulative IPLC incidence was lower among Hispanics (0.80%, 0.72 to 0.88) vs Whites (1.67%, 1.56 to 1.78) or Blacks (2.44%, 2.28 to 2.60). However, the 10-year SPLC incidence following IPLC was higher among Hispanics (3.11%, 1.62 to 4.61) vs Whites (2.80%, 1.94 to 3.66) or Blacks (2.29%, 1.48 to 3.10), resulting in a significantly higher SIR for Hispanics (SIR = 8.27, 5.05 to 12.78) vs Whites (SIR = 5.60, 4.11 to 7.45) or Blacks (SIR = 3.48, 2.42 to 4.84; P  < .001). Conclusion Hispanics have a higher SPLC incidence following IPLC than other races, which may be potentially due to better survival after IPLC and extended duration for SPLC development. Continuing surveillance is warranted to reduce racial disparities among LC survivors. [ABSTRACT FROM AUTHOR]

Background: Liquid rhinoplasty, a non-surgical procedure using hyaluronic acid (HA) to reshape and refine the nose, has gained in popularity as an alternative to traditional surgical rhinoplasty although its results are not definitive. However, the lack of standardized injection protocols has raised concerns about treatment consistency and patient safety. Objectives: In this article, the authors propose a systematic protocol for the most common indications of liquid rhinoplasty. Methods: By adopting a standardized methodology, healthcare professionals can enhance patient safety, improve treatment consistency, and optimize patient satisfaction. Results: The protocol includes standardized injection sites categorized as dorsal, paramedian, tip and endonasal injections. Specific injection areas are recommended for different nasal shapes such as droopy noses, dorsal humps, nasal saddle deformity, inverted V deformity, tip shape abnormalities, twisted noses, revision cases with dorsal irregularities, and internal nasal valve dysfunction. While variations in filler dosages may be necessary based on individual patient needs, a conservative approach is recommended to maintain natural-looking results and reduce the risk of complications. Conclusions: The increase in non-surgical techniques for nasal refinement offers patients more options, and systematized injection protocols based on different nasal types provide a structured framework for liquid rhinoplasty. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background and aim: Alexithymia is defined as emotional response inhibition. As well, empathy refers to the ability to put oneself in someone's position and resilience is the capacity to recover from a series of negative emotional experiences. Considering the psychological distress induced by the coronavirus disease 2019 (COVID-19) pandemic together with academic stress and the role of empathy in physician–patient relationships, the present study was to investigate alexithymia, empathy, and resilience in Iranian medical interns and residents. Materials and methods: This cross-sectional study was fulfilled in northern Iran in 2021–2022. In total, 394 medical interns and residents were initially recruited for this purpose. Then, an online sociodemographic survey form (SDSF), the Jefferson Scale of Empathy (JSE), the Toronto Alexithymia Scale (TAS-20), and the Connor–Davidson Resilience Scale (CD-RISC) were completed. The data analysis was performed using the IBM SPSS Statistics (ver.26) software in regard to the p < 0.05 significance level. Results: The mean age of the study participants was 28.8 ± 5.00. As well, 38.1% of these individuals were male, 62.2% of the cases were single, and 54.6% of them were medical interns. The mean value of empathy, resilience and alexithymia was 89.90 ± 14.00, 49.75 ± 10.56, and 46.40 ± 16.40, respectively. No significant relationship was found between empathy and educational level (p = 0.532). As well, medical interns empathy and resilience than residents (p = 0.000 & p = 0.000, respectively). Besides, male participants had more empathy and resilience (p = 0.000 & p = 0.007). Conclusion: Low empathy and resilience in medical interns and residents, especially in women who make up the majority of them, can be a warning for health care in Iran. [ABSTRACT FROM AUTHOR]

Medical named entity recognition (NER) focuses on extracting and classifying key entities from medical texts. Through automated medical information extraction, NER can effectively improve the efficiency of electronic medical record analysis, medical literature retrieval, and intelligent medical question–answering systems, enabling doctors and researchers to obtain the required medical information more quickly and thereby helping to improve the accuracy of diagnosis and treatment decisions. The current methods have certain limitations in dealing with contextual dependencies and entity memory and fail to fully consider the contextual relevance and interactivity between entities. To address these issues, this paper proposes a Chinese medical named entity recognition model that combines contextual dependency perception and a new memory unit. The model combines the BERT pre-trained model with a new memory unit (GLMU) and a recall network (RMN). The GLMU can efficiently capture long-distance dependencies, while the RMN enhances multi-level semantic information processing. The model also incorporates fully connected layers (FC) and conditional random fields (CRF) to further optimize the performance of entity classification and sequence labeling. The experimental results show that the model achieved F1 values of 91.53% and 64.92% on the Chinese medical datasets MCSCSet and CMeEE, respectively, surpassing other related models and demonstrating significant advantages in the field of medical entity recognition. [ABSTRACT FROM AUTHOR]

Purpose: Minimizing delays in delivering nursing care is paramount for enhancing the overall quality of care. Certain bottleneck variables restrict the workflow of nurses, resulting in extended shift times. This study is designed to pinpoint and analyze the principal factors contributing to bottleneck issues in nursing workflow, to direct improvement endeavors. This study seeks to provide insights into the key variables contributing to nurses' extended shift times, with the ultimate goal of prioritizing efforts for improvement. Methods: A descriptive multicenter cross-sectional study was conducted. A scale was developed for this study by the authors after conducting a literature review, subsequently validated, and its reliability was assessed. Results: Among the 31 bottleneck variables, 29 were retained under three persistent bottleneck factors: (1) Nurse staffing— This pertains to the availability of sufficient nursing staff at all times across the continuum of care; (2) Working environment and quality of care—This refers to the availability of necessary skills and resources for nurses to perform their duties effectively and; (3) Medical devices— This factor concerns the availability of fully functional medical devices required for providing care. Conclusion: Efforts aimed at enhancing the overall healthcare system should concentrate on addressing persistent bottleneck factors. This may involve the implementation of a healthcare workforce management system, the establishment of standards for a conducive and supportive working environment, and the utilization of a standardized system for the management of medical equipment. The outcomes of this study can be utilized by nurses and policymakers to devise comprehensive strategies for improvement. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Programmatic assessment approaches can be extended to the design of allied health professions training, to enhance the learning of trainees. The Australasian College of Physical Scientists and Engineers in Medicine worked with assessment specialists at the Australian Council for Educational Research and Amplexa Consulting, to revise their medical physics and radiopharmaceutical science training programs. One of the central aims of the revisions was to produce a training program that provides standardized training support to their registrars throughout the 3 years, better supporting their registrars to successfully complete the program in the time frame through providing timely and constructive feedback on the registrar's progression. METHODS: We used the principles of programmatic assessment to revise the assessment methods and progression decisions in the three training programs. RESULTS: We revised the 3-year training programs for diagnostic imaging medical physics, radiation oncology medical physics and radiopharmaceutical science in Australia and New Zealand, incorporating clear stages of training and associated progression points. CONCLUSIONS: We discuss the advantages and difficulties that have arisen with this implementation. We found 5 key elements necessary for implementing programmatic assessment in these specialized contexts: embracing blurred boundaries between assessment of and for learning, adapting the approach to each specialized context, change management, engaging subject matter experts, and clear communication to registrars/trainees. [ABSTRACT FROM AUTHOR]

Objectives To outline the procedural implementation and optimization of rapid diagnostic test (RDT) results for bloodstream infections (BSIs) and to evaluate the combination of RDTs with real-time antimicrobial stewardship team (AST) support plus clinical surveillance platform (CSP) software on time to appropriate therapy in BSIs at a single health system. Methods Blood culture reporting and communication were reported for four time periods: (i) a pre-BCID [BioFire® FilmArray® Blood Culture Identification (BCID) Panel] implementation period that consisted of literature review and blood culture notification procedure revision; (ii) a BCID implementation period that consisted of BCID implementation, real-time results notification via CSP, and creation of a treatment algorithm; (iii) a post-BCID implementation period; and (iv) a BCID2 implementation period. Time to appropriate therapy metrics was reported for the BCID2 time period. Results The mean time from BCID2 result to administration of effective antibiotics was 1.2 h (range 0–7.9 h) and time to optimal therapy was 7.6 h (range 0–113.8 h) during the BCID2 Panel implementation period. When comparing time to optimal antibiotic administration among patients growing ceftriaxone-resistant Enterobacterales, the BCID2 Panel group (mean 2.8 h) was significantly faster than the post-BCID Panel group (17.7 h; P  = 0.0041). Conclusions Challenges exist in communicating results to the appropriate personnel on the healthcare team who have the knowledge to act on these data and prescribe targeted therapy against the pathogen(s) identified. In this report, we outline the procedures for telephonic communication and CSP support that were implemented at our health system to distribute RDT data to individuals capable of assessing results, enabling timely optimization of antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Introduction Training for mass casualty incident (MCI) response is critical to ensure that resource allocation and treatment priorities limit preventable mortality. Previous research has investigated the use of immersive virtual environments as an alternative to high fidelity MCI training, which is expensive and logistically challenging to implement. While these have demonstrated positive early results, they still require complex technology deployment, dedicated training facilities, and significant time from instructors and facilitators. This study explores the feasibility of a smartphone-based application for trauma care training and MCI triage to fill the gap between classroom learning and high-fidelity simulation. The goals of this investigation were to evaluate clinician perceptions of a virtual MCI training simulator's usability, acceptability, fidelity, functionality, and pacing. Materials and Methods This study used a smartphone-based training simulation called Extensible Field and Evacuation Care Training in a Virtual Environment (EFECTIVE), which presents virtual patient scenarios in a gamified, but visually high-fidelity environment. A total of 21 participants were recruited as a convenience sample of medical students, paramedics, nurses, and emergency medicine resident and attending physicians at University of Massachusetts Memorial Medical Center, an urban tertiary care medical center. Participants completed a brief tutorial and then performed a series of virtual patient scenarios and 1 MCI scenario on the simulator, each of which was 5 minutes in duration. Then, each participant completed a survey assessing the perceived usability, acceptability, fidelity, functionality, and pacing of the virtual training simulator. The research protocol was approved by the University of Massachusetts Chan Medical School Institutional Review Board. Results 48% of participants disagreed that a virtual simulator could completely replace live MCI training, though 71% agreed that app-based simulations could effectively supplement live MCI training and 67% felt that they could be used to learn how to order medical interventions in care under fire scenarios. 80% of participants agreed that the simulation could be used to practice MCI triage and to gain experience with coordinating movement of casualties to casualty collection points. 67% of participants believed that use of virtual simulators would increase their MCI preparedness. 76% agreed that the clinical cases depicted were medically realistic and that the clinical cases presented accurately represented the scenarios described. In addition, despite being presented on a smartphone as opposed to virtual reality, 62% of participants rated the experience immersive. Conclusions This study provides encouraging evidence that easy to deploy smartphone–based simulations may be an effective way to supplement MCI and care under fire training. Although the study is limited by a small sample size, there was strong agreement among participants from a wide variety of emergency medicine roles that such a simulation could train core topics associated with MCI triage. Because app-based simulations are easily deployable and can be executed quickly and frequently, they could be used as a more flexible training model compared to large scale live or virtual reality–based simulations. The results of this investigation also indicate that a sufficient level of medical realism can be achieved without live simulation. [ABSTRACT FROM AUTHOR]

Introduction Illnesses among Navy divers degrade readiness, decrease manpower levels, and increase costs for medical care. Prior research has shown that Navy divers have high rates of the types of illnesses that might be because of diving in contaminated water. The objectives of this study were to examine medical records of U.S. Navy Sailors from 2016 to 2022 and determine if divers have higher incidence rates of health conditions that might be associated with contaminated water diving compared to non-divers. Materials and Methods For this retrospective cohort study, we used data from the Defense Medical Epidemiology Database (DMED). The DMED is operated by the Armed Forces Health Surveillance Division and uses data from the Defense Manpower Data Center to classify occupations. The DMED provides free online access to a de-identified subset of data contained within the Defense Medical Surveillance System. The population was U.S. Navy enlisted males, aged 25 to 29 years. Divers were compared to non-divers using 8 selected diagnoses that may reasonably be associated with diving in contaminated water. Results During the study period, the database contained a total of 5,474 diver and 827,406 non-diver person-years. Of the 8 diagnoses, the ones with the largest number of cases for divers were upper respiratory infections with 128 and ear disorders with 62. The relative risks (RRs) for divers compared to non-divers were higher for otitis externa (RR = 1.44; confidence interval = 1.03, 2.01) and for ear disorders (RR = 1.15; confidence interval = 0.89, 1.47); for the other 6 diagnoses, the divers had lower rates than the non-divers. Conclusions The high RRs found for otitis externa and ear disorders support the need to devote resources to better understand the reasons for these higher risks and to develop, test, and implement targeted risk-reduction strategies. Future studies should attempt to link verified contaminated water exposures with adverse health outcomes and calculate risks based on criteria such as age and dive factors. [ABSTRACT FROM AUTHOR]

Introduction Mass screening for SARS-CoV-2 using nasopharyngeal swabs (NPS) is costly, uncomfortable for patients, and increases the chance of virus exposure to health care workers. Therefore, this study focused on determining if self-collected unpreserved saliva can be an effective alternative to NPS collection in COVID-19 surveillance. Materials and Methods In this study, patients being tested for SARS-CoV-2 using NPS were asked to provide a saliva sample to compare their results. NPS samples were evaluated for SARS-CoV-2 using BioFire® FilmArray® Torch® or Cepheid® GeneXpert® systems while saliva samples were evaluated using an in-house developed reverse transcriptase polymerase chain reaction (RT-PCR) which targeted the Envelope (E) and Nucleocapsid (N) genes. Results Detection of SARS-CoV-2 using self-collected saliva was found to be only slightly less accurate (<5%) than testing using NPS. In addition, initial saliva RT-PCR identified 27 positive subjects, 18 of which provided amplicons sufficient for confirmatory sequencing. The sequencing data showed a genetic shift in the virus within our population sometime between 22 June and July 8, 2021 from Alpha to Delta variant. Conclusions The saliva sample collection method identifies the E gene in SARS COVID-2 samples which provides an alternative specimen source to the NPS. This identifies the S gene and ORF1ab. Saliva collection is more convenient to the patient, yields comparable results to NPS collection, and potentially increases Covid-19 surveillance. [ABSTRACT FROM AUTHOR]

Introduction The U.S. Army Telemedicine and Advanced Technology Research Center Advanced Medical Technology Initiative (AMTI) demonstrate key emerging technologies related to military medicine. AMTI invites researchers to submit proposals for short-term funding opportunities that support this goal. AMTI proposal selection is guided by a time-intensive peer review process, where proposals are rated on innovation, military relevance, metrics for success, and return on investment. Utilizing machine learning (ML) could assist in proposal evaluations by learning relationships between proposal performance and proposal features. This research explores the viability of artificial intelligence/ML for predicting proposal ratings given content-based proposal features. Although not meant to replace experts, a model-based approach to evaluating proposal quality could work alongside experts to provide a fast, minimally biased estimate of proposal performance. This article presents initial stages of a project aiming to use ML to prioritize research proposals. Materials and Methods The initial steps included a literature review to identify potential features. Then, these features were extracted from a dataset consisting of past proposals submissions. The dataset includes 824 proposals submitted to the AMTI program from 2010 to 2022. The analysis will inform a discussion of anticipated next steps toward developing a ML model. The following features were created for future modeling: requested funds; word count by section; readability by section; citations and partners identified; and term frequency—inverse document frequency word vectors. Results This initial process identified the top ranked words (data, health, injury, device, treatment, technology, etc.) among the abstract, problem to be solved, military relevance, and metrics/outcomes text proposal fields. The analysis also evaluated the text fields for readability using the Flesch readability scale. Most proposals text fields were categorized as "college graduate," indicating a challenging readability level. Finally, citations and partners were reviewed as an indicator of proposal successfulness. Conclusions This research was the first stage of a larger project to explore the use of ML to predict proposal ratings for the purpose of providing automated support to proposal reviewers and to reveal the preferences and values of AMTI proposal reviewers and other decision-makers. The result of this work will provide practical insights regarding the review process for the AMTI program. This will facilitate reduction in bias for AMTI innovators and a streamlined and subjective process for AMTI administrators, which benefits the military health system overall. [ABSTRACT FROM AUTHOR]

Background: Computer anxiety can significantly impact students' academic performance and technology usage. This study examines the psychometric properties of the Persian Abbreviated Technology Anxiety Scale (ATAS). Methods: This cross-sectional study was conducted among students from five public and private universities in Hormozgan province, Iran, from October to December 2022. A total of 1158 students were selected to respond to the ATAS (having two dimensions with scores ranging from 11 to 55) and the Computer Anxiety Scale (CAS) (having six dimensions with scores ranging from 22 to 110). The CAS was used to establish concurrent validity with the ATAS. The ATAS underwent expert review, including back-translation and content validation. Structural validity was analyzed through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) using SPSS 25 and LISREL 8.8 software. Reliability was determined using split-half, test-retest, and Cronbach's alpha methods, with a significance threshold of 0.05. Results: The majority of participants were female (62.5%) and at the undergraduate level (46.5%). The ATAS demonstrated strong content validity, with all items exceeding the required Content Validity Ratio (CVR) and Content Validity Index (CVI) thresholds. A significant positive correlation with the CAS (r=0.51, P<0.001) supported its concurrent validity. Factor analysis confirmed a twofactor structure--technology change anxiety (23.26±9.15) and technology incompetence anxiety (8.78±3.61)--accounting for 60.9% of the variance. The model's fit indices were acceptable. High reliability was evident, with an overall Cronbach's alpha of 0.96 and subscale ranges from 0.90 to 0.96. Test-retest reliability was 0.88 (P<0.01), and split-half reliability scored 0.92 and 0.93 for each half. Conclusion: The ATAS, with its 11 questions and two dimensions, possesses high validity and reliability. Therefore, it can serve as a credible and dependable tool for assessing technology anxiety and its facets among Iranian students. [ABSTRACT FROM AUTHOR]

Medical education is embracing digital transformation with immersive technology and artificial intelligence. These technologies have gained acceptance in education and practice to create realistic and engaging learning experiences for students and professionals. In the recent fast-growing interventions in Artificial Intelligence (AI) research, generative AI proved as a great resource for novel and realistic content, such as images, text, music, or code, based on some input or data. Integrating generative AI in immersive technologies can offer many opportunities and challenges for medical education, as well as ethical and social implications. This article focuses on the prospects of generative AI in immersive technologies for medical education and future opportunities. It also highlights some of the potential benefits and risks of generative AI in immersive technologies for medical education. It covers the enhancement of diversity and richness of the learning experiences, fostering the creativity and innovation of the learners, ensuring the quality of content and outcomes, as well as addressing ethical and legal issues. This article also stimulates further research and debate on this emerging and promising field. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) is an immersive technology that can be a learning tool for medical students. However, VR devices are costly and need high maintenance. In addition, prior research rarely integrates VR into medical education's pedagogical and learning aspects. Questionnaires and guidelines for implementing VR are also scarce. This study analysed the need for VR implementation in medical curricula in Indonesia using qualitative descriptive methods. A non-discriminative snowball sampling technique was used, and in-depth semi-structured interviews were conducted for data collection. Data analysis was carried out using thematic analysis. This study included nine respondents from five medical schools (three state and two private). The results show that the VR implementation process must consist of several stages: needs exploration, blueprint creation, multidiscipline or multi-centre collaboration, training provision, success stories and scientific evidence, appreciation, and evaluation. Readiness factors assessed during the needs exploration stage include human resources, curriculum, infrastructure, funding, and regulations. In conclusion, VR implementation in Indonesian medical curricula must be carried out in seven steps, and five essential readiness factors must be extensively explored to ensure that the implementation is successful, has educational value, and has further potential development in the future. [ABSTRACT FROM AUTHOR]

Background: We investigated the prevalence of restless legs syndrome (RLS) among Jordanian medical students and its association with stress, anxiety, smoking, caffeine use, study habits, and academic performance. Methods: A cross-sectional study was conducted between November 2023 and January 2024 among medical students in the Jordanian public universities. Participants were selected to complete a questionnaire (based on the DSM-5 diagnostic criteria for RLS) through convenience and snowball sampling. Results: Among the 215 participants, 11 men and 13 women met the diagnostic criteria for RLS based on their questionnaire responses; the prevalence of RLS was 11.2%. Among these 24 participants, 66.7% reported worsened symptoms during examination periods; 79.1% reported worsened symptoms when experiencing daytime stress; 62.5% reported improved symptoms following physical activity; 66.7% reported that RLS symptoms affected sleep quality; and 45.8% reported having a concomitant anxiety disorder. Meeting the criteria for RLS was not associated with sex, academic stage (basic vs clinical), smoking status, or academic performance. Conclusion: RLS is not uncommon among medical students in Jordan. Greater awareness of RLS is needed for prompt diagnosis and treatment to prevent associated negative impacts. [ABSTRACT FROM AUTHOR]

Backgrounds: Research shows that medical students' knowledge and skills concerning the assessment of cognition in various neuropsychiatric conditions (e.g., Alzheimer's disease and schizophrenia) are unsatisfactory. This research aims to conduct a training needs analysis (TNA) for medical students to identify and refer patients with neuropsychiatric conditions. Methods: The study comprised two phases. First, developing a TNA toolkit to assess training needs in clinical tasks related to cognitive function assessment (by adopting the Hennessy–Hicks TNA toolkit); and second, through a self-reported survey, their training needs in cognitive function assessment were assessed. Data analysis involved calculating training gaps, importance scores, performance scores, training scores, and organization scores for various clinical tasks-stratified participants' study year; for training needs and trends, factor analysis and post-hoc analyses were conducted. Results: A total of 153 medical students from a tertiary care center participated in the survey. The participants rated their performance lower than the perceived importance of tasks, indicating a need for improvement in all competencies (P <.01). Pre–final-year students had the highest training needs, particularly in accessing literature, planning, and organizing care for patients with cognitive impairment, performing mental status examination, screening patients for cognitive deficits, and counseling them/caregivers about interventions (P <.01). Factor analysis identified a single dominant factor, suggesting a correlation among these skills. Conclusion: Pre–final-year students require targeted training, whereas students beyond this stage can benefit from special training modules and awareness of available resources for cognitive assessment. The findings also suggest the importance of a hybrid approach involving training and organizational modifications. [ABSTRACT FROM AUTHOR]

Design An observational cohort study conducted at a tertiary referral center for aortic surgery to describe the medical and surgical characteristics of patients assessed for abdominal aortic aneurysm repair and examine associations with 12-month outcome. Methods Patients with aortic aneurysms referred for discussion at the aortic multidisciplinary meeting (MDM). Data were collected via a prospectively maintained clinical database and included aneurysm characteristics, patient demographics, co-morbidities, geriatric syndromes, including frailty, management decision and 12-month mortality, both aneurysm-related and all-cause including cause of death. The operative and non-operative groups were compared statistically. Results 621 patients referred to aortic MDM; 292 patients listed for operative management, 141 patients continued on surveillance, 138 patients for non-operative management. There was a higher 12-month mortality rate in the non-operative group compared to the operative group (41% vs 7%, P = <0.001). In the non-operative group, 16 patients (29%) died of aneurysm rupture within 12 months, with 39 patients (71%) dying from other medical causes. Non-operatively managed patients were older, more likely to have cardiac and respiratory disease and more likely to be living with frailty, cognitive impairment and functional limitation, compared to the operative group. Conclusion This study shows that preoperative geriatric syndromes and increased comorbidity lead to shared decision to non-operatively manage asymptomatic aortic aneurysms. Twelve-month mortality is higher in the non-operative group with the majority of deaths occurring due to cause other than aneurysm rupture. These findings support the need for preoperative comprehensive geriatric assessment followed by multispecialty discussion and shared decision making. [ABSTRACT FROM AUTHOR]

Background MRSA is a major contributor to AMR-related deaths. The WHO's global action plan emphasizes a One Health approach, acknowledging the connection between humans and their companion animals. It is agreed on that comprehensive AMR surveillance is needed. Objectives This study provides a large-scale overview of MRSA occurrence in cats and dogs in Germany, serving as a foundation for continuous surveillance. Methods The study analysed all results of canine and feline bacterial diagnostic samples from a large laboratory, encompassing samples received from veterinary practices between January 2019 and December 2021. MRSA prevalence between host species, sample types and geographical distribution were compared. Additionally, data were contrasted with human MRSA surveillance data from Germany. Results Samples originated from 3491 German veterinary practices, representing 33.1% of practices and clinics nationally. Bacterial examination results from 175 171 samples were analysed, identifying S. aureus in 5526 of these samples (3.2% isolation rate). S. aureus in clinical samples was more prevalent in cats (5.6%) than dogs (2.0%). Methicillin resistance was found in 17.8% of S. aureus samples and was higher in dogs (20.4%, 95%CI 18.9–22.0) than cats (15.6%, 95%CI 14.3–17.0). The highest MRSA prevalence was found in canine wound samples (32%), compared to skin/soft tissue, respiratory tract and other (<23% respectively). Conclusion The study reveals a 17.8% MRSA prevalence, which is higher than the human outpatient MRSA prevalence (5.4%). Restriction and regulation of veterinary antibiotic use should be validated with AMR surveillance. Our study shows that this is feasible in companion animals with significant coverage. [ABSTRACT FROM AUTHOR]