Following the rapid advancement of artificial intelligence technologies, especially the development of large language models like ChatGPT, the field of medical clinical practice is undergoing an unprecedented technological revolution. These advanced technologies, through efficient processing and analysis of large datasets, not only provide medical professionals with auxiliary diagnoses and treatment suggestions but also significantly enhance the quality and efficiency of medical education. This study conducts a comprehensive analysis and review of the applications of large language models in various aspects, including clinical inquiry, history collection, medical literature writing, clinical decision support, optimization of medical portal websites, patient health management, medical education, academic research, and scientific writing. However, the application of these technologies is not without flaws and presents several limitations and ethical challenges. This paper focuses on challenges related to technological errors, academic dishonesty, abuse risks, over-reliance, possibilities of misdiagnosis and treatment errors, and issues of accountability. In conclusion, large language models demonstrate tremendous potential in the integration and advancement of medical practices. Nevertheless, while fully harnessing the benefits brought by ChatGPT, it is essential to acknowledge and address these ethical challenges to ensure that the application of ChatGPT in the medical field is responsible and effective.
Based on peer-reviewed systematic reviews and randomized controlled trials published between January 2000 and June 2019 with regards to the management of glenohumeral joint osteoarthritis (GJO), the American Academy of Orthopaedic Surgeons (AAOS) established the clinical practice guidelines for the treatment of GJO. The guidelines provided practice recommendations including risk factors, non-surgical treatment, surgical treatment, prosthesis selection, and perioperative management for GJO. The recommendations were graded according to different evidence strength. This paper interprets the guidline in order to provide reference for domestic medical workers.
In the context of collaboration between healthcare and education systems, in order to promote competency-oriented medical education reform and improve the clinical capabilities of medical students at all levels, it is urgent to enhance the organizational guarantee to establish a stable teaching team in university-affiliated hospitals. As the National Clinical Teaching and Training Demonstration Center, West China School of Medicine / West China Hospital of Sichuan University has taken the lead to explore the building of a full-time teaching team for clinical practice teaching, innovating and implementing the system of “Full-time Practice Teaching Post”. This innovative measure ensures the whole-process management, teaching, and assessment of medical students, strengthens teacher training and top-level design of teaching and research, improves the incentive mechanism for teachers, applies multiple teaching resources and novel teaching methods, and finally improves the quality and culture of clinical practice teaching.
Objective By means of evidence-based clinical practice, to find more effective treatment for a hepatitis B related nephritis patient with renal failure. Methods The following databases as Up to Date (May 2011), The Cochrane Library (Issue 5, 2011), PubMed (1978 to 2011) and CNKI (1978 to 2011) were searched to identify systematic reviews and randomized controlled trials (RCTs) of treating hepatitis B related nephritis with glucocorticoid, immunosuppressor or antiviral therapies, and the quality of collected clinical evidence was evaluated by using GRADEpro software. Results The glucocorticoid or combined immunosuppressors was not recommended for existing adverse effects and not acting on the remission of hepatitis B related nephritis and reduction of proteinuria. However, the antiviral therapy used alone was recommended for acting on the remission of hepatitis B related nephritis and the reduction of proteinuria. In view of adverse effects and expensive price of interferon, the nucleoside analogue antiviral agent was suggested. Considering the renal toxicity of adefovir and tenofovir, and possible drug-resistance of lamivudine, the entecavir (0.5 mg qd) was finally selected with patient’s agreement, and the supporting therapies such as lowering blood pressure, and protecting the kidney and liver were adopted continually. After one month treatment, 24-hour urinary protein got reduced, serum albumin got increased, kidney function got stable, and hepatitis B virus DNA quantity got reduced. Conclusion For treating hepatitis B related nephritis with kidney failure, entacavir can reduce 24-hour urinary protein, raise serum albumin, stabilize kidney function and reduce hepatitis B virus DNA in a short term, but its long-term efficacy still requires further studies.
Based-on retrieval and reviewing information of evidence-based clinical practice guidelines from the literature, this paper introduced the key components of assessment guideline quality, including the process of development and reporting of guideline.
Objective To compare the postoperative outcomes of elderly and non-elderly patients undergoing inguinal hernia repair in same-day surgery mode, and explore the utility and safety of same-day surgery mode in inguinal hernia repair. Methods Patients who underwent inguinal hernia repair in Day Surgery Center, West China Hospital of Sichuan University between January 1st 2021 and October 31st 2021 were prospectively included. The patients were divided into elderly group (≥60 years old) and non-elderly group (18-59 years old). The preoperative conditions, postoperative outcomes, discharge readiness and social support of the two groups were analyzed. Results A total of 451 patients were enrolled, including 111 elderly patients and 340 non-elderly patients. The male proportion, prevalence rates of preoperative comorbidities, and bilateral inguinal hernia proportion in the elderly group were significantly higher than those in the non-elderly group (P<0.05), and the body mass index in the elderly group were significantly lower than that in the non-elderly group (P<0.05). There was no significant difference in anesthesia method, analgesic method, bleeding volume, or surgery time between the two groups (P>0.05). The postoperative pain score of the non-elderly group was higher than that in the elderly group (Z=–2.226, P=0.026), but there was no statistically significant difference in the rate of postoperative unplanned analgesia, rate of discharge delay, pain score on the third day after discharge, re-consultation within one month after discharge, complications within one month after discharge, or post-discharge satisfaction (P>0.05). The total score of social support was higher in the elderly group than that in the non-elderly group (31.77±3.04 vs. 29.75±4.78; t=4.182, P<0.001). Conclusion The same-day surgery mode for inguinal hernia repair is feasible and safe in elderly patients and worthy of implementation.
The incidence of primary malignant bone tumors is low, and clinical cognition is insufficient. The establishment of diagnostic criteria is of great significance for prognosis of tumors. National Comprehensive Cancer Network (NCCN) regularly publishes “Clinical Practice Guidelines for Bone Tumors” to summarize the latest treatment progress of bone tumors. In the latest version of the guidelines released in November 2020, surgery is the main treatment for chondrosarcoma, chordoma, and giant cell tumor of bone, which can be combined with radiotherapy or targeted therapy. Ewing’s sarcoma and osteosarcoma are treated by surgery combined with chemotherapy. Immunotherapy can be used to treat high-grade undifferentiated pleomorphic sarcoma. For recurrent tumors, surgery combined with radiotherapy, chemotherapy, and/or targeted therapy can be used for control. The guidelines provide a reference for the standard treatment of bone tumors.
Mechanoresponsive microRNAs are a type of miRNAs which are sensitive or responsive to mechanical strain applied to them, their expression levels were changed after mechanical loading, thus affecting the expression levels of mRNA and proteins they regulated. Up to now, some mechanoresponsive miRNAs have been discovered in physiological or pathological tissues or organs. However, these discoveries are usually limited, and they are not able to guide clinical practice well. According to this situation, this paper summarizes research findings of mechanoresponsive miRNAs, and provides directions for clinical practice and further researches.