Evaluation of the International Society on Thrombosis and Haemostasis definition of major bleeding in Arizona rattlesnake bites.

INTRODUCTION: In 2023, a group of experts proposed that a definition of major bleeding in pharmaceutically anticoagulated patients be used in all snakebite trials. This includes bleeding that results in death, is life-threatening, causes chronic sequelae, or consumes major healthcare resources, including bleeding into a major area or hemoglobin concentration decrease ≥20 g/L. We hypothesized that a decline in hemoglobin concentration ≥20 g/L is common but rarely clinically significant in our population of Arizona rattlesnake bite patients. METHODS: Poison center records of rattlesnake bites in humans from 2018 through 2022 were retrospectively reviewed and assessed for major bleeding by the above criteria. RESULTS: Four hundred and eighty-one patients met the inclusion criteria, of whom 265 (55.1%) had a hemoglobin concentration decrease ≥20 g/L. No patients died, and there was no evidence of bleeding into a critical organ. Three patients (1.1%) received blood transfusions. A decrease in hemoglobin concentration ≥20 g/L was 100% sensitive for identifying the major bleeding-associated outcomes; however, specificity was only 45.2%. Measures of healthcare utilization and chronic sequelae were somewhat higher in patients with a decrease in hemoglobin concentration ≥20 g/L. DISCUSSION: Laboratory manifestations of hemotoxicity were common in this population, but hemorrhage was rare. While over half of patients met the major bleeding criterion of a decline in hemoglobin concentration ≥20 g/L, only 1.1% had bleeding that was potentially life-threatening as measured by receipt of a red blood cell transfusion. None died or had bleeding into a critical area. While nonspecific for major bleeding, a drop in hemoglobin concentration correlated with worse envenomation severity: these patients received more vials of antivenom, had a higher medical bill, a longer hospital stay, and were less likely to report full recovery at 90 days. CONCLUSIONS: A decrease in hemoglobin concentration ≥20 g/L should not be used as evidence of major bleeding for Arizona rattlesnake envenomation studies, but it may have a role as an indirect marker of envenomation severity.

From asylums to deinstitutionalization and after: an analytic review.

BACKGROUND: After a period of institution-based mental health care, in which the asylum system was the way in which the mental patients were treated, deinstitutionalization brought a set of significant changes and transformations in the conceptualization of mental illness and, by extension, the traditional therapeutic settings in which those in most need were assisted. However, this shift in the psychiatric domain was not only accompanied by valued achievements, but also by difficulties and challenges, as has been evidenced today. AIM/OBJECTIVE: The aim of this paper is thus to examine the pros and cons of the closure of asylums, and the subsequent implementation of deinstitutionalization over the 60 years or so of such important transformations in the field of psychiatry. METHODS: In considering this question, I examine in detail recent works of literature based on scholarly knowledge. In addition, I identify various issues involved, as well as ways of confronting these so as to attempt to overcome the difficulties they present. RESULTS AND CONCLUSIONS: As I show here, the changes in the treatment and care of the mentally ill after asylum and deinstitutionalization brought a new air of hope to patients and their families, but also had undesirable effects. The paper also considers how mental health professionals today try to solve these effects on behalf of patients and society as a whole.

Skin mechanical properties measured with skin elasticity measurement device in patients with lymphedema: Scoping review.

BACKGROUND: Skin conditions in patients with lymphedema have been identified according to changes in skin mechanical properties. The skin elasticity meter is a non-invasive tool for measuring the mechanical properties of the skin; however, its potential use in patients with lymphedema has received little attention. This review aimed to provide an overview of studies measuring the skin mechanical properties of patients with lymphedema using a skin elasticity meter. MATERIALS AND METHODS: Search terms and synonyms related to lymphedema and skin mechanical property measurement using a skin elasticity meter were identified, and electronic databases containing articles in English were searched. RESULTS: A total of 621 articles were retrieved, and four articles were analyzed after screening. Despite this research subject receiving increasing attention, no consensus has been reached regarding the best methods. CONCLUSION: Measurement methods are expected to be standardized in the future to elucidate the skin mechanical properties of patients with lymphedema.

How to mitigate the risks of deployment of artificial intelligence in medicine?

The aim of this study is to examine the risks associated with the use of artificial intelligence (AI) in medicine and to offer policy suggestions to reduce these risks and optimize the benefits of AI technology. AI is a multifaceted technology. If harnessed effectively, it has the capacity to significantly impact the future of humanity in the field of health, as well as in several other areas. However, the rapid spread of this technology also raises significant ethical, legal, and social issues. This study examines the potential dangers of AI integration in medicine by reviewing current scientific work and exploring strategies to mitigate these risks. Biases in data sets for AI systems can lead to inequities in health care. Educational data that is narrowly represented based on a demographic group can lead to biased results from AI systems for those who do not belong to that group. In addition, the concepts of explainability and accountability in AI systems could create challenges for healthcare professionals in understanding and evaluating AI-generated diagnoses or treatment recommendations. This could jeopardize patient safety and lead to the selection of inappropriate treatments. Ensuring the security of personal health information will be critical as AI systems become more widespread. Therefore, improving patient privacy and security protocols for AI systems is imperative. The report offers suggestions for reducing the risks associated with the increasing use of AI systems in the medical sector. These include increasing AI literacy, implementing a participatory society-in-the-loop management strategy, and creating ongoing education and auditing systems. Integrating ethical principles and cultural values into the design of AI systems can help reduce healthcare disparities and improve patient care. Implementing these recommendations will ensure the efficient and equitable use of AI systems in medicine, improve the quality of healthcare services, and ensure patient safety.

Societal Preferences in Health Technology Assessments for Rare Diseases and Orphan Drugs: A Systematic Literature Review of New Analytic Approaches.

OBJECTIVES: This systematic literature review aimed to explore experiences worldwide of societal preferences integration into health technology assessments (HTAs) for rare diseases (RDs) and orphan drugs (ODs) through the implementation of multicriteria decision analysis (MCDA), discrete choice experiments (DCEs), and person trade-off (PTO) methods, among others. METHODS: A systematic search of the literature was conducted in April 2021 using PubMed, Cochrane, Embase, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used for the review phases. Finally, the Promoting Action on Research Implementation in Health Services framework was used to discuss the implementation of these instruments in the RD context. RESULTS: A total of 33 articles met the inclusion criteria. The studies measured societal preferences for RD and OD as part of HTA using MCDA (n = 17), DCE (n = 8), and PTO (n = 4), among other methods (n = 4). These found that patients and clinicians do not prioritize funding based on rarity. The public is willing to allocate funds only if the OD demonstrates effectiveness and improves the quality of life, considering as relevant factors disease severity, unmet health needs, and quality of life. Conversely, HTA agency experts preferred their current approach, placing more weight on cost-effectiveness and evidence quality, even though they expressed concern about the fairness of the drug review process. CONCLUSIONS: MCDA, PTO, and DCE are helpful and transparent methods for assessing societal preferences in HTA for RD and OD. However, their methodological limitations, such as arbitrary criteria selection, subjective scoring methods, framing effects, weighting adaptation, and value measurement models, could make implementation challenging.

Elevating Residency Match Success: The Potential Impact of a Home Program on the Surgical Match Rate.

INTRODUCTION: Home residency programs can provide medical students with opportunities for networking, mentorship, research, and exposure to surgeries. The goal of this project was to understand the potential impact of home surgical residencies on student match rates into specific surgical specialties. METHODS: This 5-year retrospective study (2019-2023) analyzed 12,916 matched applicants from 155 United States MD programs through publicly available match lists. Odds ratios (ORs) were used to determine the likelihood of students from institutions with home surgical residency programs (home programs) matching into desired surgical specialties compared to students from institutions without home programs. Additional variables included the Alpha Omega Alpha and the Gold Humanism Honor Society statuses of the medical school, the number of faculty, and the type of residency program. RESULTS: Of the matched applicants, 11,442 had home programs resulting in a 39.1% match rate into surgical specialties compared to a 22.3% match rate for students without a home program (OR: 1.76) (P < 0.001). Of the applicants with a home program compared to those without a home program, 69.2% matched into an academic residency (OR: 1.06), 7.7% matched into a community residency (OR: 0.90), 13.6% matched into a combined residency (OR: 0.95), and 2.5% matched into a military residency (OR: 1.31). CONCLUSIONS: Medical students graduating from institutions with home programs were 1.76 times more likely to match into a surgical residency program compared to those graduating from institutions without a home program. Future studies should look at how access to certain resources may influence a student's match rate.

Determinants of job continuity among older workers: a mixed-methods research in Japan.

This study aims to determine the factors that encourage older workers to continue working. This study had an exploratory sequential design using a mixed-methods approach, including interviews and questionnaire surveys. In the interview survey, we targeted 30 workers aged between 60-65 across three manufacturing companies. After using the results of the content analysis in the interviews, we conducted an online questionnaire survey with 1,500 workers aged between 60-89 across the country. We analyzed whether the 15 factors were related to intention to continue working using logistic regression analysis. We identified factors affecting job continuity from three perspectives: individual, company, and life. We determined several factors: health condition, job performance, self-esteem, conservatism, employment system, workload, medical insurance and welfare programs, monetary and non-monetary rewards, relationships, attachment to the organization, distance between living and work, social support, economic situation, and employment policy. In the questionnaire survey, some factors had no relationship with job continuity, including conservatism, employment systems, monetary rewards, and the distance between living and work. Employers and policymakers can use the findings to consider appropriate ways of supporting older workers.

Overview of the 88th Annual Scientific Meeting of the Japanese Circulation Society (JCS2024)　- The Future of Cardiology - Challenges in Overcoming Cardiovascular Disease.

The 88thAnnual Scientific Meeting of the Japanese Circulation Society (JCS2024) was held from Friday, March 8thto Sunday, March 10thin Kobe, Japan. The main theme of this 3-day meeting was "The Future of Cardiology: Challenges in Overcoming Cardiovascular Disease". As COVID-19 has been finally conquered, with revision of its categorization under the Infectious Disease Control Law and relaxation of infection prevention measures, it was once again possible to have face-to-face presentations and lively discussion. JCS2024 was a major success, with 19,209 participants and attendees, thanks to the greatly appreciated cooperation and support from all affiliates.

Application of European Society of Cardiology guidelines for evaluating acute coronary syndrome risk in low-risk patients with cocaine-associated chest pain: Findings from the RISK study - An observational analysis.

Background: Cocaine was the drug of choice in 4.7 % of all recreational drug-related emergency department visits. Of these patients, 40 % present with cocaine-associated chest pain, of whom 4.7 % develop an acute coronary syndrome. The American Heart Association recommends a 12-hour observation period for these patients. Objective: This study primarily aimed to ascertain whether the European Society of Cardiology non-ST-elevation myocardial infarction guidelines can be safely applied to rule-out acute coronary syndrome in low-risk patients with cocaine-associated chest pain. Methods: For this prospective observational cohort study, patients, aged 18-45 years old, who presented with cocaine-associated chest pain and were risk stratified as low risk according to the European Society of Cardiology non-ST-elevation myocardial infarction guidelines and therefore discharged home without prolonged observation period, were included. They were followed to assess major adverse cardiac events four weeks after presentation to the emergency department or chest pain unit. Cocaine use was confirmed with urine toxicology screening. Results: A total of 107 patients were included and analysed. The accuracy of the self-reported history of recent cocaine use was 94 %. Post-discharge cocaine use persisted among 32 % of patients. None of the included 107 patients died and major adverse cardiac event within four weeks did not occur among 97 patients with available data regarding MACE. Conclusion: Ruling out an acute coronary syndrome using the European Society of Cardiology non-ST-elevation myocardial infarction guidelines is likely to be safe for patients with cocaine-associated chest pain, however this study was underpowered to reach definitive conclusions.

"This was never about a virus": Perceptions of Vaccination Hazards and Pandemic Risk in #Covid19NZ Tweets.

In this paper, we draw on qualitative methods from the medical humanities and quantitative approaches from corpus linguistics to assess the different mappings of pandemic risks by Twitter (X) users employing the #Covid19nz hashtag. We look specifically at their responses to government measures around vaccines between August and November 2021. Risk, we reveal, was a major discursive thread in tweets during this period, but within our tweets, it was the vaccine rather than the virus around which hazard perception and response were grouped. We find that the discursive stance of those opposed to the vaccine evoked entangled medical and political hazards, untrustworthy experts, obscure information, restrictions on sovereignty, threats to children, and uncertain future dangers, all of which positioned them within what Ulrich Beck termed the world risk society. We also found that these narratives of risk manifested in specific Twitter styles, which employed a consistently larger number of hashtags. The lack of conjunctions between the hashtags, we argue, encouraged a disordered reading of doubt and precaution, as the hashtags presented triggering phrases whose interconnections were hinted at rather than specified. By contrast, those who tweeted in support of government measures were rhetorically led by solutions rather than risks, with one exception: their perception of those who were vaccine opposed. We use scholarship on risk and precautionary logic to map out the contrasting positions in tweets addressing Aotearoa New Zealand's pandemic experience during the closing months of 2021.

Barriers to mental health service utilization among Arab society in Israel: Perspectives from service providers.

This study attempted to identify the barriers to the utilization of mental health services among the Arab society in Israel, as perceived by professionals working with this population. Twenty-seven therapists from community mental health services participated in structured in-depth interviews with at least 5 years of experience. Five main types of barriers to the utilization of mental health services were discovered: barriers related to attitudes and perceptions regarding mental disorders and their treatment, low literacy in the field of mental health, exposure and stigma, family characteristics and cultural values, and instrumental barriers. Flexibility and sensitivity to the socio-cultural context of the target population while allocating resources to create equality in access to mental health care may increase the utilization of mental health services in a traditional society such as the Arab society in Israel.

The Society of Black Academic Surgeons membership survey: Insights on demographics, engagement, and opportunities for improvement.

BACKGROUND: The Society of Black Academic Surgeons (SBAS) sought to understand who constitutes its membership and obtain feedback to improve the organization. METHODS: SBAS conducted a 25-question survey amongst members. RESULTS: The response rate was 19 â€‹% (n â€‹= â€‹132/685) with an even gender breakdown (male n â€‹= â€‹64, female n â€‹= â€‹68). The majority identified as Black or African American (85 â€‹%), followed by White (12 â€‹%). Fifty-two percent identified as trainees, while the rest were practicing surgeons specializing in burn/trauma/critical care (19 â€‹%), oncology (19 â€‹%), and general surgery (13 â€‹%). Half joined SBAS within the last 3 years. Satisfaction was reported at a mean of 3.7/5. Lack of awareness (41 â€‹%), time (13 â€‹%), or interest (5 â€‹%) limited committee participation. Networking (83 â€‹%), mentorship/sponsorship/allyship (71 â€‹%), and leadership development (46 â€‹%) were most valued benefits with job boards, webinars, and grants least valuable. CONCLUSION: SBAS is a unique organization uniting both new and lifetime members and opportunities exist to enhance current membership and improve participation.