Intramuscular vs. Subcutaneous: Rethinking Influenza Vaccination Strategy in Japan.

In Japan, inactivated vaccines, including the influenza vaccine, are administered subcutaneously, which is contrary to global recommendations for intramuscular injections. This practice is attributed to historical medical incidents and unchallenged conventions. However, this outdated method, which differs from that of international standards and is linked with less immunogenicity and more adverse reactions, may contribute to vaccination hesitancy. Therefore, with the adoption of intramuscular vaccination administration, which was widely adopted in the coronavirus disease 2019 vaccination, a shift in the Japanese health policy to conform to international standards potentially improves vaccine acceptance and effectiveness.

Artificial Intelligence in Childcare: Assessing the Performance and Acceptance of ChatGPT Responses.

Purpose This study aimed to evaluate the performance and acceptance of responses generated by ChatGPT-3.5 and GPT-4 to Japanese childcare-related questions to assess their potential applicability and limitations in the childcare field, specifically focusing on the accuracy, usefulness, and empathy of the generated answers. Methods We evaluated answers in Japanese generated by GPT-3.5 and GPT-4 for two types of childcare-related questions. ① For the written examination questions of Japan's childcare worker national examination for 2023's fiscal year, we calculated the correct answer rates using official answers. ② We selected one question from each of the seven categories from the child-rearing questions posted on the Japanese National Childcare Workers Association's website and had GPT-3.5 and GPT-4 generate answers. These were evaluated alongside existing childcare worker answers by human professionals. Five childcare workers then blindly selected what they considered the best answer among the three and rated them on a five-point scale for 'accuracy,' 'usefulness,' and 'empathy.' Results In the examination consisting of 160 written questions, both GPT-3.5 and GPT-4 produced responses to all 155 questions, excluding four questions omitted due to copyright concerns and one question deemed invalid due to inherent flaws in the question itself, with correct answer rates of 30.3% for GPT-3.5 and 47.7% for GPT-4 (p<0.01). For the child-rearing Q&A questions, childcare worker answers by human professionals were chosen as the best answer most frequently (45.7%), followed by GPT-3.5 (31.4%) and GPT-4 (22.9%). While GPT-3.5 received the highest average rating for accuracy (3.69 points), childcare worker answers by human professionals received the highest average ratings for usefulness and empathy (both 3.57 points). Conclusions Both GPT-3.5 and GPT-4 failed to meet the passing criteria in Japan's childcare worker national examination, and for the child-rearing questions, GPT-3.5 was rated higher in accuracy despite lower correct answer rates. Over half of the childcare workers considered the ChatGPT-generated answers to be the best ones, yet concerns about accuracy were observed, highlighting the potential risk of incorrect information in the Japanese context.

Safety of Sublingual Immunotherapy: A Secondary Analysis of Post-marketing Adverse Events Reports Using a Japanese Public Database.

Purpose Allergic rhinitis impacts a significant portion of the Japanese population, leading to the rise of sublingual immunotherapy (SLIT) as an alternative treatment. Despite its growing popularity, there is limited safety information. Therefore, this study aimed to consolidate data on its adverse effects in an academic context. Methods We conducted a secondary analysis of adverse events reported in the Pharmaceutical Adverse Events Information Database for three SLIT drugs (Actair®, Cedarcure®, and Miticure®) approved in Japan. A descriptive analysis concerning age, gender, underlying diseases, symptoms, time of onset, and outcomes was performed. Results We identified 98 cases of adverse reactions reported for the SLIT drugs. These cases were mainly from the pediatric to adolescent group (73.7%). Males made up 59.5% of reports. Recovery or improvement was noted in 97.7% of reports. Anaphylactic reactions were the most common adverse event (42.6%), followed by respiratory distress (12.2%). Reactions typically occurred within one week of starting treatment (54.1%). Conclusions Our research illuminated the safety of SLIT drugs in Japan, revealing a favorable profile. It underscores the need for vigilance, particularly among younger patients and during initial doses, emphasizing the importance of proper patient selection and further research to enhance the treatment's efficacy.

Assessing the Performance of GPT-3.5 and GPT-4 on the 2023 Japanese Nursing Examination.

Purpose The purpose of this study was to evaluate the changes in capabilities between the Generative Pre-trained Transformer (GPT)-3.5 and GPT-4 versions of the large-scale language model ChatGPT within a Japanese medical context. Methods The study involved ChatGPT versions 3.5 and 4 responding to questions from the 112th Japanese National Nursing Examination (JNNE). The study comprised three analyses: correct answer rate and score rate calculations, comparisons between GPT-3.5 and GPT-4, and comparisons of correct answer rates for conversation questions. Results ChatGPT versions 3.5 and 4 responded to 237 out of 238 Japanese questions from the 112th JNNE. While GPT-3.5 achieved an overall accuracy rate of 59.9%, failing to meet the passing standards in compulsory and general/scenario-based questions, scoring 58.0% and 58.3%, respectively, GPT-4 had an accuracy rate of 79.7%, satisfying the passing standards by scoring 90.0% and 77.7%, respectively. For each problem type, GPT-4 showed a higher accuracy rate than GPT-3.5. Specifically, the accuracy rates for compulsory questions improved from 58.0% with GPT-3.5 to 90.0% with GPT-4. For general questions, the rates went from 64.6% with GPT-3.5 to 75.6% with GPT-4. In scenario-based questions, the accuracy rates improved substantially from 51.7% with GPT-3.5 to 80.0% with GPT-4. For conversation questions, GPT-3.5 had an accuracy rate of 73.3% and GPT-4 had an accuracy rate of 93.3%. Conclusions The GPT-4 version of ChatGPT displayed performance sufficient to pass the JNNE, significantly improving from GPT-3.5. This suggests specialized medical training could make such models beneficial in Japanese clinical settings, aiding decision-making. However, user awareness and training are crucial, given potential inaccuracies in ChatGPT's responses. Hence, responsible usage with an understanding of its capabilities and limitations is vital to best support healthcare professionals and patients.

Guillain-Barre Syndrome After COVID-19 Vaccination: A Secondary Analysis of Domestic Safety Data by the Japanese Government.

Purpose The purpose of this study was to figure out the risk of Guillain-Barre syndrome (GBS) after coronavirus disease 2019 (COVID-19) vaccination, which has been reported as a rare adverse reaction. Methods Elucidating the characteristics, we performed a secondary analysis of the cases from February 2020 through January 2022, based on the publicly available spontaneous adverse reaction reports in Japan. Results We identified 115 cases, and all were after messenger RNA (mRNA) vaccination. Of all the cases, 69 (60.0%) were female and 44 (38.2%) were older than 65 years old. Severe GBS was reported by 38 males (median age 61.5 years) and 51 females (median age 55 years). The median interval from vaccination to the onset of symptoms was eight days for males and four days for females. Sequelae were reported in 18 patients (7 males, median age 81 years; 11 females, median age 51 years), 11 of whom were older than 65 years old. The estimated incidence was about 0.0001% (0.000058% for the Pfizer vaccine and about 0.000046% for the Moderna vaccine, respectively). Conclusions Spontaneous reports would have various biases, the incidence of GBS after mRNA vaccination was as low as in other existing vaccination programs, and it is important not to interpret that risk expansively.