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Background/Aims: The COVID-19 pandemic accelerated the implementation of telehealth and virtual care services. Clinicians must be comfortable using this technology in order for it to be developed effectively and implemented consistently. This study evaluated the influence of various factors, including those theorised in the technology acceptance model, on physicians' intention to use teleconsultations in their clinical practice in Chennai, India. Methods: A snowball sampling method was used to distribute an online survey to physicians in Chennai, India. The survey measured respondents' intention to use teleconsultations (dependent variable), along seven independent variables relating to this technology (perceived usefulness, perceived ease of use, physicians' attitudes, social influences, facilitating conditions, perceived compatibility with the clinical area and trust). A total of 165 responses were collected. Results were analysed using descriptive and correlational statistics, along with multiple linear regression. Results: All seven independent variables were found to be significantly associated with the dependent variable (P<0.01). Multiple linear regression analysis indicated that the independent variables accounted for 67.8% of the variance in respondents' intention to use teleconsultations. Conclusions: Physicians' intention to use teleconsultations is complex and multi-faceted. Although the factors theorised by the technology acceptance model were significantly associated with intention to use telemedicine, other factors were also found to be important, including social influences, external facilitating factors, perceived compatibility with the clinical area and personal trust in technology. [ABSTRACT FROM AUTHOR]

Background and purposeNeurohospitalist neurology is a fast-growing subspecialty with a variety of practice settings featuring neurohospitalist models of care. Since inception, the subspecialty has responded to new challenges in resident training, hospital reimbursement, practice, and burnout.MethodsTo characterize neurohospitalists' current practice and perspectives, we surveyed the neurohospitalists and trainees affiliated with the Neurohospitalist Society using an electronic survey distributed through the society listserv.ResultsOf 501 individuals surveyed by e-mail, 119 began the survey (23.8% response rate), with 88.2% self-identifying as neurohospitalists. Most neurohospitalists (63%) are 10 years or less out of training, devoting 70% of their professional time to inpatient clinical activities while also performing administrative or teaching activities. Only 38% are employed by an academic department. Call schedules are common, with 75% of neurohospitalists participating in a hospital or emergency call schedule, while 55% provide telemedicine services. The majority (97%) of neurohospitalists primarily care for adults, most commonly treating patients with cerebrovascular disease, seizures, and delirium/encephalopathy. The majority (87%) are overall pleased with their work, but 36% report having experienced burnout.ConclusionsNeurohospitalists are a diverse group of neurologists primarily practicing in the inpatient setting while performing a variety of additional activities. They provide a wide array of clinical expertise for acute neurological diseases and neurological emergencies that require hospitalization, including stroke, seizure, and encephalopathy. Neurohospitalists in general are very pleased with their work, while burnout, as in neurology and other areas of medicine, remains a concern.

Introduction: The o bstructed h emi v agina and i psilateral r enal a nomaly (OHVIRA) syndrome is characterized by the triad uterus didelphys, obstructed hemivagina, and ipsilateral renal dysplasia. To make a radiological diagnosis, knowledge of this syndrome is of paramount importance. Early recognition may prevent complications such as unnecessary surgical procedures, endometriosis, and infections, which could adversely affect fertility. Case report: A 1-day-old female newborn in whom a right-sided cystic kidney abnormality was seen on antenatal ultrasound was admitted with anuria and intralabial mass. Besides the multicystic dysplastic right kidney, ultrasound revealed a uterus didelphys with right-sided uterus dysplasia, an obstructed right hemivagina, and an ectopic ureteric insertion. The diagnosis of obstructed hemivagina and ipsilateral renal anomaly syndrome with hydrocolpos was made and the hymen was incised. Later, ultrasound helped in diagnosing a pyelonephritis in the afunctional right kidney that was not draining into the bladder (hence no culture could be obtained), requiring intravenous antibiotics and a nephrectomy. Discussion: Obstructed hemivagina and ipsilateral renal anomaly syndrome is an anomaly of the Müllerian and Wolffian ducts of unknown cause. Patients typically present after menarche with (progressive) abdominal pain, dysmenorrhea, or urogenital malformations. In contrast, prepubertal patients can present with urinary incontinence or an (external) vaginal mass. The diagnosis is confirmed by an ultrasound or magnetic resonance imaging. Follow-up includes repeated ultrasounds and monitoring of kidney function. Treatment consists of drainage of the hydrocolpos/hematocolpos; in some cases, further surgery is indicated. Conclusion: Consider obstructed hemivagina and ipsilateral renal anomaly syndrome in girls with genitourinary abnormalities: early recognition prevents complications later in life. [ABSTRACT FROM AUTHOR]

Background and Purpose: High quality clinical documentation is a fundamental skill for practicing physicians and important for quality improvement. However, documentation and coding are rarely integrated into medical education curricula and there is a lack of standard neurology curriculum on this topic. We developed and evaluated a teaching session on clinical documentation for neurology resident physicians., Methods: The education consisted of a didactic session designed by a neurologist with content about risk-adjusted mortality, clinical documentation integrity (CDI), impact of documentation on patients, and neurology-specific documentation guidance. A pre-post survey design was used to compare baseline and post-intervention self-reported knowledge and attitudes., Results: 61 responses were collected (37 pre- and 24 post-intervention). Residents had increased understanding of the impact of documentation on quality metrics ( P = 0.004), risk-adjusted mortality ( P < 0.0001), and impact on patients ( P = 0.02). Attitude towards CDI education improved significantly ( P = 0.0016), as well as agreement that CDI is important to resident physicians ( P = 0.003). The portion of residents who agreed training on CDI is useful and valuable increased significantly ( P = 0.004). 92% agreed this curriculum was useful, and 96% agreed they understood the role of CDI better after the session., Conclusions: In this study of a teaching session for neurology residents on clinical documentation, we found this format of teaching was well-received and highly effective in improving resident attitudes and self-reported knowledge., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

IntroductionReducing unplanned hospital readmissions has become a national focus due to the Centers for Medicare and Medicaid Services' (CMS) penalties for hospitals with high rates. A first step in reducing unplanned readmission is to understand which patients are at high risk for readmission, which readmissions are planned, and how well planned readmissions are currently captured in comparison to patient-level chart review.MethodsWe examined all 5455 inpatient neurology admissions over a 2-year period to University of California San Francisco Medical Center and Johns Hopkins Hospital via chart review. We collected information such as patient age, procedure codes, diagnosis codes, all-payer diagnosis-related group, observed length of stay (oLOS), and expected length of stay. We performed multivariate logistic modeling to determine predictors of readmission. Discharge summaries were reviewed for evidence that a subsequent readmission was planned.ResultsA total of 353 (6.5%) discharges were readmitted within 30 days. Fifty-five (15.6%) of the 353 readmissions were planned, most often for a neurosurgical procedure (41.8%) or immunotherapy (23.6%). Only 8 of these readmissions would have been classified as planned using current CMS methodology. Patient age (odds ratio [OR] = 1.01 for each 10-year increase, P < .001) and estimated length of stay (OR = 1.04, P = .002) were associated with a greater likelihood of readmission, whereas index admission oLOS was not.ConclusionsMany neurologic readmissions are planned; however, these are often classified by current CMS methodology as unplanned and penalized accordingly. Modifications of the CMS lists for potentially planned neurological and neurosurgical procedures and for acute discharge neurologic diagnoses should be considered.

Abstract Background Controlled vocabularies are fundamental resources for information extraction from clinical texts using natural language processing (NLP). Standard language resources available in the healthcare domain such as the UMLS metathesaurus or SNOMED CT are widely used for this purpose, but with limitations such as lexical ambiguity of clinical terms. However, most of them are unambiguous within text limited to a given clinical specialty. This is one rationale besides others to classify clinical text by the clinical specialty to which they belong. Results This paper addresses this limitation by proposing and applying a method that automatically extracts Spanish medical terms classified and weighted per sub-domain, using Spanish MEDLINE titles and abstracts as input. The hypothesis is biomedical NLP tasks benefit from collections of domain terms that are specific to clinical subdomains. We use PubMed queries that generate sub-domain specific corpora from Spanish titles and abstracts, from which token n-grams are collected and metrics of relevance, discriminatory power, and broadness per sub-domain are computed. The generated term set, called Spanish core vocabulary about clinical specialties (SCOVACLIS), was made available to the scientific community and used in a text classification problem obtaining improvements of 6 percentage points in the F-measure compared to the baseline using Multilayer Perceptron, thus demonstrating the hypothesis that a specialized term set improves NLP tasks. Conclusion The creation and validation of SCOVACLIS support the hypothesis that specific term sets reduce the level of ambiguity when compared to a specialty-independent and broad-scope vocabulary.

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Background : Evaluating patients with ascending sensorimotor deficits has a broad differential diagnosis at initial presentation which can be further narrowed upon neurologic examination but may represent a diagnostic and therapeutic dilemma in light of findings raising suspicion for multiple possible etiologies. Data Collection : In this case, a 29-year-old patient presented with ascending bilateral lower extremity sensory loss, paresthesias, and weakness which progressed to the inability to ambulate. Conclusions : This case highlights the diagnostic approach to patients with bilateral lower extremity sensorimotor deficits, discusses the development of a comprehensive differential diagnosis, and further evaluates the most likely etiologies. Furthermore, this case reviews complexities related to clinical reasoning in the setting of diagnostic uncertainty, particularly when the neurologic structures affected portend high risk for severe disability and early treatment may improve outcome., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: and Purpose: Episodes of unresponsiveness are one of several criteria used to diagnose dementia with Lewy bodies and are also seen in people with Parkinson's disease dementia. Patients examined during episodes of coma, whose evaluations found no other explanation than the neurological disorder, have not been described. This paper describes four cases, seen in the past two years. The objective is to bring this uncommon phenomenon to the attention of hospital based neurologists and to demonstrate that this may not be due to autonomic dysfunction., Methods: These are brief case descriptions by medical personnel observing affected patients supplemented by family reports of similar episodes described on the internet., Results: Four cases are described, all older men with either dementia with Lewy bodies or Parkinson's disease dementia, who had single, or multiple episodes of otherwise unexplained coma and were examined during a spell. IRB approval waived., Conclusions: Episodic coma may occur in demented patients with an alpha-synucleinopathy and is the likely explanation when evaluations have found no other cause. This information will reassure the family and patient that this is the likely explanation but that spells may recur., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Data from randomized clinical trials have supported the safety and efficacy of intravenous tissue-type plasminogen activator (IV tPA) for acute ischemic stroke when administered within 3 hours of symptom onset, and regulatory approvals for this indication have been in place for almost 20 years. However, recent clinical trials have provided evidence that IV tPA may be safe and effective in selected patients up to 4.5 hours after symptom onset, thereby increasing the proportion of patients that may be eligible for treatment. Although professional organizations in the United States and many regulatory agencies internationally have supported this expanded time window for IV tPA, the US Food and Drug Administration has declined to approve this expanded indication and so this use of IV tPA has remained off-label in the United States. Here we review the current evidence for IV tPA in the standard and the expanded time windows and the data on current clinical practice in the United States as it relates to IV tPA treatment for acute stroke within 3 to 4.5 hours of symptom onset.

Background: Controlled vocabularies are fundamental resources for information extraction from clinical texts using natural language processing (NLP). Standard language resources available in the healthcare domain such as the UMLS metathesaurus or SNOMED CT are widely used for this purpose, but with limitations such as lexical ambiguity of clinical terms. However, most of them are unambiguous within text limited to a given clinical specialty. This is one rationale besides others to classify clinical text by the clinical specialty to which they belong.Results: This paper addresses this limitation by proposing and applying a method that automatically extracts Spanish medical terms classified and weighted per sub-domain, using Spanish MEDLINE titles and abstracts as input. The hypothesis is biomedical NLP tasks benefit from collections of domain terms that are specific to clinical subdomains. We use PubMed queries that generate sub-domain specific corpora from Spanish titles and abstracts, from which token n-grams are collected and metrics of relevance, discriminatory power, and broadness per sub-domain are computed. The generated term set, called Spanish core vocabulary about clinical specialties (SCOVACLIS), was made available to the scientific community and used in a text classification problem obtaining improvements of 6 percentage points in the F-measure compared to the baseline using Multilayer Perceptron, thus demonstrating the hypothesis that a specialized term set improves NLP tasks.Conclusion: The creation and validation of SCOVACLIS support the hypothesis that specific term sets reduce the level of ambiguity when compared to a specialty-independent and broad-scope vocabulary. [ABSTRACT FROM AUTHOR]

Glucocorticoids (GCs) are widely used for inflammatory and autoimmune diseases. Their mechanism of action is most commonly rooted in genomic effects that have both beneficial and adverse consequences. The purpose of this review is to discuss the potential complications and side effects that may occur with GC use. Many of these complications are related to the dose and duration of therapy used. Evidence-based preventative strategies are discussed. Many recommendations are based on expert opinion and not on strong evidence. A 54-year-old man presents with proximal upper and lower extremity weakness. There are no rashes. The antinuclear antibody is negative; the erythrocyte sedimentation rate and C reactive protein are 24 mm/h and 3 mg/dL, respectively. An electromyography displays myopathic motor unit potentials with fibrillation and a muscle biopsy confirms polymyositis. Prednisone of 60 mg/d is initiated. What are the risks associated with GC use? What other studies and interventions should occur in this patient starting long-term GC therapy?

Cerebral venous sinus thrombosis (CVST) is a rare and potentially fatal condition. It is believed to be one of the rare complications of lumbar puncture (LP), however other causes and risk factors should be considered and ruled out. Diagnosis can be challenging after an LP as it can mimic low pressure or post dural puncture. We present a 23-year-old patient diagnosed with CVST following a diagnostic lumbar puncture, in the absence of other risk factors. The patient presented with a persistent headache that was initially attributed to low CSF pressure, as well as a transient episode of right hemi-body paresthesia. Neuroimaging including contrasted MRI with venography confirmed the diagnosis. The patient had negative hypercoagulable evaluation and was placed on anticoagulation on discharge. Our report highlights the importance of considering CVST in refractory headaches after LP and the value of neuroimaging when indicated., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: 22q11.2 microdeletion is the most common microdeletion syndrome in humans with a prevalence of 13 per 100 000 live births, and it is a multisystem condition with variable phenotypic presentations., Methods: We present a case of an adult patient with Dandy-Walker syndrome who presented to our epilepsy clinic with 2 years of new-onset seizures and cognitive decline and 1 year of psychotic symptoms., Results: Patient had a non-revealing autoimmune and malignancy work-up. Continuous scalp vEEG study showed bursts of 1-2 Hz generalized fronto-centrally predominant spike or polyspike and slow wave discharges. Several myoclonic jerks were time-locked with the generalized discharges indicative of cortical myoclonus. MRI brain revealed periventricular nodular heterotopia in addition to findings suggestive of Dandy-Walker syndrome. Array-based comparative genomic hybridization demonstrated a 22q11.2 microdeletion seen in 22q11.2 deletion syndrome., Conclusion: Our case illustrates the challenges of diagnosing genetic disorders in adults especially when the initial diagnosis is dependent on a number of factors, including the patient's age, the severity of the phenotypic features, and the awareness of the physician., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Tyler E. Gaston has received a consulting fee from GW Biosciences within the last 2 years. Mike Zhang has received personal compensation as a consultant to Neurelis in 2023. The remaining authors have no conflicts of interest., (© The Author(s) 2024.)

Acute focal neurological deficits demand immediate evaluation. In this report, we present the case of a woman 20-some years of age with a history of hemolytic anemia and thrombocytopenia who presented with altered mental status and focal neurological deficits including aphasia, acute left gaze preference, right homonymous hemianopsia, right lower facial weakness, and right arm and leg weakness. Extensive neurological and hematological workup revealed that the patient suffered from focal status epilepticus associated with an extreme delta brush patten on electroencephalogram, likely secondary to thrombotic thrombocytopenic purpura. This case underscores the connection between hematological disorders and the neurological axis, emphasizing the critical role of integrating the neurological examination and neuroimaging findings to formulate an effective management plan., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Purpose: In-person prerounding has long been a routine practice for residents in the field of neurology. However, with the emergence of the COVID-19 pandemic, many institutions, including our two academic neurology centers, have shifted to computer rounding. This study aims to assess the effects of computer rounding alone compared to a combination of computer rounding and in-person prerounding from the perspective of neurology residents., Methods: A mixed-methods approach was employed, including a survey administered to 79 neurology residents and a qualitative thematic analysis of their responses., Results: The quantitative analysis revealed that residents who engaged in inperson prerounding spent significantly more time on prerounding and computer rounding compared to those who did not. The majority of residents reported a neutral effect of in-person prerounding on their relationship with patients and bedside time, but a significant impact on personal lives and other tasks. Qualitative analysis identified four key themes: accessibility to team members, learning opportunities gained and lost, inefficiency, and sleep disturbance., Conclusions: Overall, residents perceived in-person prerounding as inefficient and causing sleep disruption for both patients and themselves. While some residents valued the face-to-face interaction and improved accessibility, others felt that computer rounding allowed for thorough review of patient data, improving preparedness and efficiency. The potential elimination of in-person prerounding from residents' routines may enhance their overall wellbeing. Further research is needed to assess the advantages and drawbacks of removing this classic approach to caring for patients from the perspective of residents, attendings and patients., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective . To cotemare the current situation and propose the development plan for the clinical specialties of Shanghai Jiao Tong University School of Medicine. Methods . Based on Scopus database, English academic papers issued by 39 clinical specialties of Shanghai Jiao Tong University School of Medicine during 2011-20 f§ were analyzed by bibliomctric methods. Results . The overall performance of the clinical specialties was good. The total scholarly output was 8 957 and^showed an increasing trend year by year, the total citation count was 99 342, the total average citation count was 11.1, the total number of Top 1% of highly cited papers was 83, the total international cooperation papers accounted for 16.3%, and the total field-weighted citation impact of 22 clinical specialties was higher than the world average level. However, the development of each clinical specialty was not balanced. According to the number of the outstanding indexes, the 39 clinical specialties could be divided into five types, including leading type, advantage type, potential type, characteristic type, and disadvantaged type. Conclusion . According to the different types of clinical specialties, medical colleges should adhere to the development concept of classified management and take targeted measures to promote the overall level of clinical specialties. [ABSTRACT FROM AUTHOR]

Background: The use of electronic medical record (EMR) is anticipated to bring benefits for patients, physicians, and organizations. But limited physicians' acceptance of EMR presents a serious threat to its effective implementation.Objectives: The current study incorporates technology acceptance model (TAM) with two antecedents, gender, and clinical specialty and one context-specific factor, financial incentives, to identify the factors that influence physicians' intention to use EMR in Taiwan.Methods: The survey methodology was used to collect data from the physicians, working in the regional hospital that had implemented EMR system. A total of 119 out of 213 questionnaires returned in a response rate of 56%. But four responses were considered ineffective due to missing values. The structural equation modeling (SEM) technique was employed to analyze the research framework.Results: The partial least squares (PLS) regression indicated that three factors perceived usefulness, financial incentives, and attitude toward using EMR significantly affect physicians' intention. But concerning perceived ease of use (PEOU), an insignificant path coefficient was reported. Additionally, regression analysis showed gender, and clinical specialty positively influenced physicians' intention to use EMR.Discussion and Conclusions: The proposed research framework contributes to the conclusive explanation for interpreting physicians' intention to use EMR. Physicians generally have a higher level of computer literacy. Therefore, the factor of PEOU could not be critical regarding adopting new health information technology (HIT). This study also brings perspectives from the gender, and clinical differences have primarily been missing in the literature of the physicians' intention to use HIT. In doing so, it infers how gender, and clinical specialty, may complement (and in some instances, reinforce) the influence of technological and attitudinal factors of HIT use. Thus, health care providers must take these factors into consideration in the development and validation of the theories regarding the intention to use EMR. [ABSTRACT FROM AUTHOR]

Background: Distribution of available manpower in healthcare sector is an important issue to maintain the optimum health status of the community. The study of aspirations of the undergraduate medical students might help to know the future availability of the medical fraternity in various fields and to understand the necessities in the medical education field in Rajasthan State. Methods: A cross-sectional study was conducted among 500 undergraduate medical students of JLN Medical College, Ajmer (Rajasthan) in November 2015, using a self-administered questionnaire. Results: There were 65% males and 35% females. About 41.88% students were from rural and 58.12% were from urban background. Average age of students was 21.23 years (±1.89). Majority (87.92%) of MBBS students aspired to do postgraduation. Only 14.17% were interested in a government job in rural and 28.54% in urban areas. Very few (2.7%) students were interested in the research field. Approximately, 8% students wanted to study abroad. Overall specialty preference was internal medicine (31.45%), surgery (15.95%), and Pediatrics (12.07%). Branch preference in females was the same. Nonclinical branches were not the preferred choice among our study participants. The most influencing factors for undergraduate students to choose specialty were job satisfaction and job security (>90%). Unnecessary burden of complicated clerical work instead of clinical job (80.83%) was an important influencing factor for less interest in a government job. Conclusions: Our study shows majority of students desiring to do postgraduation in clinical specialties and most of them want to join urban, socially respectful clinically oriented hospitals instead of a primary health center at the rural area or a nonclinical research oriented specialty. It might lead to shortage of doctors in non- and para-clinical branches and also in rural areas of Rajasthan in future.

We describe a case of a 41-year-old male with a history of end-stage renal disease, hypertension, epilepsy, ischemic stroke, and traumatic brain injury transferred to our tertiary care center for subacute, progressive cognitive impairment. He was found to have disproportionate brain atrophy, focal seizures, and refractory hypertension. Given suspicion for an underlying genetic etiology, a genetic panel for progressive renal disease was sent, revealing two known pathogenic variants in a gene for a cobalamin metabolism disorder, Cobalamin C deficiency. He was started on targeted metabolic supplementation with subsequent improvement in his cognition. Our case highlights the crucial need to expand diagnostic workup to include genetic and metabolic causes in patients with neurologic disease, atypical features, relevant family history and multi-organ dysfunction., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

We report a case highlighting key clinical, CSF, and imaging findings of recurrent pleomorphic xanthoastrocytoma with leptomeningeal spread., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Doctors rate clinical relevance and applicability as the most important determinants of continuing professional development (CPD) course selection. This study examined patterns of current CPD practice and perceived CPD needs among hospital doctors in Ireland across various clinical specialties. A cross-sectional survey was administered to doctors, focusing on the areas of training needs analysis, CPD course content and preferred course format. In total, 547 doctors identified doctor-patient communication as the skill ranked highest for importance and level of current performance. Workload/time organisation and stress management were areas where a skills deficiency was identified. Non-clinical CPD topics, including resilience training, management and communication skills, were preferred areas for future CPD offerings. All respondents favoured interactive, hands-on sessions. CPD course completion and preference patterns differed significantly across clinical specialties. These results highlight the importance of considering the individual needs and preferences of clinicians across clinical specialties to facilitate more effective CPD programmes. [ABSTRACT FROM AUTHOR]

Background: Automated methods for identifying clinically relevant new versus redundant information in electronic health record (EHR) clinical notes is useful for clinicians and researchers involved in patient care and clinical research, respectively. We evaluated methods to automatically identify clinically relevant new information in clinical notes, and compared the quantity of redundant information across specialties and clinical settings.Methods: Statistical language models augmented with semantic similarity measures were evaluated as a means to detect and quantify clinically relevant new and redundant information over longitudinal clinical notes for a given patient. A corpus of 591 progress notes over 40 inpatient admissions was annotated for new information longitudinally by physicians to generate a reference standard. Note redundancy between various specialties was evaluated on 71,021 outpatient notes and 64,695 inpatient notes from 500 solid organ transplant patients (April 2015 through August 2015).Results: Our best method achieved at best performance of 0.87 recall, 0.62 precision, and 0.72 F-measure. Addition of semantic similarity metrics compared to baseline improved recall but otherwise resulted in similar performance. While outpatient and inpatient notes had relatively similar levels of high redundancy (61% and 68%, respectively), redundancy differed by author specialty with mean redundancy of 75%, 66%, 57%, and 55% observed in pediatric, internal medicine, psychiatry and surgical notes, respectively.Conclusions: Automated techniques with statistical language models for detecting redundant versus clinically relevant new information in clinical notes do not improve with the addition of semantic similarity measures. While levels of redundancy seem relatively similar in the inpatient and ambulatory settings in the Fairview Health Services, clinical note redundancy appears to vary significantly with different medical specialties. [ABSTRACT FROM AUTHOR]

Background: One of the reasons of uncertainty in choosing a specific clinical specialty is wrong decision-making. This study was conducted to train professional decision-making skills to medical students at internship and externship course levels in the form of a workshop. We also reviewed the impacts of the workshop on reducing indecisiveness in selecting a clinical specialty. Methods: This was a quasi-experimental study on 43 medical students at internship and externship course levels at Isfahan University of Medical Sciences, Isfahan, Iran. Before holding the workshop, students completed the hesitation and indecision scales. The participants were taught about decision-making skills for 15 hours. Immediately after the course and a month later, the students completed the same questionnaires again. The information and scores related to the pre-test, post-test, and one-month follow-up were analyzed using t-tests in SPSS. Findings: There was a significant difference in scores of hesitation scale at pre-test, post-test, and follow-up (P = 0.033). However, there was no significant difference in the scores of indecision scale (P = 0.151). There was no significant correlation between scores of students and different educational levels, sex, and marital status (P > 0.05). Therefore, training on professional decision-making skills reduced hesitation in selecting clinical specialty among medical students. However, it had no significant impact on their indecision. Conclusion: The professional decision-making skills training course reduced uncertainty in selecting clinical specialty among medical students. They were thus satisfied with participation in the course. They were also willing to attend complementary programs on selecting clinical specialty. Therefore, such an educational course is recommended to be held for all students who like to continue specialized studies in medicine during their medical course, especially in the first year of university.

Introduction: Diagnosis and management of specialty choice indecision is an important part of career guidance and support for medical students. Determining causes of indecision and resolving them helps students to make an optimum decision. The aim of this study was to determine the psychometric properties of a Persian version of the specialty indecision scale as an on-line questionnaire for medical student and graduates of Isfahan University of medical sciences, and also to determine the attitude of the participants towards this questionnaire. Methods: In this cross-sectional study, using Richard's specialty indecision questionnaire, the Iranian version of the questionnaire for clinical specialty indecision was developed. Face validity and cultural validity were confirmed by educational experts, and translation, back translation method, respectively. Then, the participants completed the online version of the questionnaire. Afterward, the questionnaire's items were factor analyzed. At the end, Subjects were asked about the questionnaire (clarity of the questionnaire, attractiveness of the website, user friendliness of the questionnaire, number of personal questions). Results: Fifty eight subjects participated in this study. The reliability of the questionnaire was acceptable (0.84). Two questions were omitted and five were revised. Items were grouped in 4 factors (general indecisiveness, postponing, barriers, and lack of determination) one of which (barriers) was similar to the American version. The subjects were also satisfied with online questionnaire and 100% of them thought completion of the tool was useful. Conclusion: This study showed that conducting a web based specialty indecision questionnaire is possible. It had differences with the American version both in number of factors and the items placement. These differences are justifiable in terms of the differences in cultural backgrounds and residency admission processes in the two countries. Also, lack of attention to translating the questions and inadequacy of sample size could be other reasons for these differences. With regard to the fact that there are no career counselors in Iranian universities, operating a web based career guidance system, along with introducing a counselor, may help medical students in specialty choice decision making.

Cancer and stroke comprise two of the most common causes of death worldwide. Despite a significantly increased risk of stroke among patients with cancer, most stroke trials have excluded patients with malignancy. There is thus limited evidence to help guide management decisions in this complex population. We present the case of a 78-year-old man with recurrent strokes - both ischemic and hemorrhagic - in the setting of newly-identified metastatic prostate cancer. An atypical cause of cancer-associated stroke is reviewed and the management is discussed., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: One of the reasons of uncertainty in choosing the specialty major is wrong decisionmaking. This study conducted aimed to train decision-making job skills in the form of a workshop to the medical students at internship and externship course levels and its impact was reviewed on reducing the indecision for choosing a clinical specialty major of students. Methods: This was a quasi-experimental study on 43 medical students at internship and externship course levels of Isfahan University of Medical Sciences, Iran, using hesitation and indecision scales. Before holding the workshop, students completed the mentioned scales. The participants were taught decision-making skills for 15 hours. Immediately after the course and a month later, the students completed the mentioned questionnaires again. The information and scores related to the pre-test, post-test and one-month follow-up were analyzed through Software SPSS and t-tests. Findings: There was a significant difference in comparison of pre-test, post-test and follow up scores in hesitation scale (P = 0.033). However, there was no significant difference in comparing the scores of indecision scale (P = 0.151). There was no significant correlation between scores of students and different educational levels, sex and marital status (P > 0.05). Therefore, decision-making job skills training reduced clinical specialty hesitation of medical students; however, it had no significant impact on their indecision. Conclusion: Given to the impact of decision-making job skills training course in reducing the uncertainty clinical specialty selection of medical students and their satisfaction from participation in this course and willingness to hold complementary programs in terms of specialty major selection, it is recommended that this educational course should be held for all the students who like to continue specialized studies in medicine during medical course and specially at the first years of university. [ABSTRACT FROM AUTHOR]

Cytomegaloviral hepatitis is an infantile liver disease commonly encountered in China, which could be differentiated into 4 patterns with different clinical conditions. Along with the progress of laboratory diagnostic techniques, multiple diagnostic approaches are available for this disease, but accurate diagnosis can only be made when individual patients’ realities are taken into consideration. Clinical treatments are various, and the Western medicine used is mainly anti-viral agents such as Ganciclovir, and so far no unified therapeutic program has been formed. More and more ways of regarding Chinese medicine treatment of cytomegaloviral hepatitis have been published increasingly in recent years, though further research to seek preferable treatment programs is still expected. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosis and management of specialty choice indecision is an important part of career guidance and support for medical students. Determining causes of indecision and resolving them helps students to make an optimum decision. The aim of this study was to determine the psychometric properties of a Persian version of the specialty indecision scale as an on-line questionnaire for medical student and graduates of Isfahan University of medical sciences, and also to determine the attitude of the participants towards this questionnaire. Methods: In this cross-sectional study, using Richard's specialty indecision questionnaire, the Iranian version of the questionnaire for clinical specialty indecision was developed. Face validity and cultural validity were confirmed by educational experts, and translation, back translation method, respectively. Then, the participants completed the online version of the questionnaire. Afterward, the questionnaire's items were factor analyzed. At the end, Subjects were asked about the questionnaire (clarity of the questionnaire, attractiveness of the website, user friendliness of the questionnaire, number of personal questions). Results: Fifty eight subjects participated in this study. The reliability of the questionnaire was acceptable (0.84). Two questions were omitted and five were revised. Items were grouped in 4 factors (general indecisiveness, postponing, barriers, and lack of determination) one of which (barriers) was similar to the American version. The subjects were also satisfied with online questionnaire and 100% of them thought completion of the tool was useful. Conclusion: This study showed that conducting a web based specialty indecision questionnaire is possible. It had differences with the American version both in number of factors and the items placement. These differences are justifiable in terms of the differences in cultural backgrounds and residency admission processes in the two countries. Also, lack of attention to translating the questions and inadequacy of sample size could be other reasons for these differences. With regard to the fact that there are no career counselors in Iranian universities, operating a web based career guidance system, along with introducing a counselor, may help medical students in specialty choice decision making. [ABSTRACT FROM AUTHOR]

We discuss a case of a middle-aged woman with a history of urothelial carcinoma, who presented with subacute progression of double vision, right facial numbness, and back pain. Her MRI brain and spine demonstrated multifocal enhancing lesions at the skull base and throughout the spine. Since her initial serum and cerebrospinal fluid (CSF) studies were unrevealing, she underwent a biopsy of her skull base lesion, which was initially concerning for infection. However, her symptoms worsened despite appropriate antibiotic therapy, necessitating a spinal root biopsy that was consistent with leptomeningeal urothelial carcinoma. Her case illustrates the challenge of accurately diagnosing isolated leptomeningeal metastatic disease, which can be difficult to diagnose from CSF analysis and often requires multiple lumbar punctures to improve sensitivity. While genitourinary cancers rarely metastasize to the CNS, clinicians should retain high suspicion for neoplastic etiologies of leptomeningeal disease in patients with a history of cancer and new neurologic deficits., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Here we report a challenging case of a 52-year-old man presenting with subacute constipation, urinary retention, impotence, absent Achilles reflexes, and hypoesthesia in S2-S5 dermatomes. We review the clinical decision-making as the symptoms evolved and diagnostic testing changed over time. Once the diagnosis is settled, we discuss the sign and symptoms, additional diagnostic tools, treatment options and prognosis., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background and Purpose: COVID-19 is associated with systemic thromboembolism including stroke. The study evaluated the 30-days stroke incidence in SARS-CoV-2 PCR positive patients and described the outcome of such patients., Methods: This is a retrospective study of consecutive patients with a positive SARS-CoV-2 PCR test between March 1st, 2020 and August 30th, 2020. The study included COVID-19 patients who were hospitalized and had a stroke within 30 days from the positive PCR test., Results: During the study period, there were 4301 patients with a positive SARS-CoV-2 PCR test. Of those, 1786 patients (41.5%) were hospitalized and 4 patients developed a stroke within 30 days. The 30-days stroke incidence was 0.09% and 0.2% of all and hospitalized patients, respectively. The mean age of stroke patients was 78 years and 2 died during the same hospitalization. The 4 patients had comorbidities, one had pre-existing atrial fibrillation and all had ischemic stroke., Conclusion: This study showed a low 30-day incidence of stroke among COVID-19 patients., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

This article characterizes 2 cases of longitudinally extensive transverse myelitis (LETM) that did not respond to immunotherapy and were diagnosed by biopsy as primary central nervous system (CNS) malignancies. Diffuse H3 K27M-mutant glioma is a recently described entity with very few cases of isolated spinal disease described in adults. Primitive neuroectodermal tumor is similarly uncommon in the spinal cord. Malignancies should be considered in patients who fail to improve with immunomodulatory therapy. We believe the experiences of our center will raise awareness about that point, broaden the existing understanding of the diagnostic approach to LETM, and highlight the need for additional studies., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

A 67-year-old woman was admitted to our hospital for progressive weakness, dysphagia, muscle pain, and weight loss. Here we detail the clinical problem solving involved in diagnosing and treating her immune-mediated necrotizing myopathy caused by anti-HMGCoA reductase autoantibodies. Interestingly, this diagnosis coincided with discovery of a gastrointestinal stromal tumor (GIST) and positivity for anti-nuclear matrix protein (anti-NXP2), another myositis specific autoantibody., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)