Ethicists in medicine

Most US studies of national trends in medical and nonmedical use of prescription opioids have focused on adults. Given the limited understanding in these trends among adolescents, we examine national trends in the medical and nonmedical use of prescription opioids among high school seniors between 1976 and 2015. The data used for the study come from the Monitoring the Future study of adolescents. Forty cohorts of nationally representative samples of high school seniors (modal age 18) were used to examine self-reported medical and nonmedical use of prescription opioids. Lifetime prevalence of medical use of prescription opioids peaked in both 1989 and 2002 and remained stable until a recent decline from 2013 through 2015. Lifetime nonmedical use of prescription opioids was less prevalent and highly correlated with medical use of prescription opioids over this 40-year period. Adolescents who reported both medical and nonmedical use of prescription opioids were more likely to indicate medical use of prescription opioids before initiating nonmedical use. Prescription opioid exposure is common among US adolescents. Long-term trends indicate that one-fourth of high school seniors self-reported medical or nonmedical use of prescription opioids. Medical and nonmedical use of prescription opioids has declined recently and remained highly correlated over the past 4 decades. Sociodemographic differences and risky patterns involving medical and nonmedical use of prescription opioids should be taken into consideration in clinical practice to improve opioid analgesic prescribing and reduce adverse consequences associated with prescription opioid use among adolescents.

Objectives: To investigate the characteristics of patients diagnosed with dementia or mild cognitive impairment who are treated by means of a blend between Western and Korean medicine. Methods: We searched for outpatients with dementia or mild cognitive impairment by means of a collaboration between Western and Korean medicine from August 1, 2015, to July 31, 2017, through electronic medical records in Wonkwang Hospital. The records were retrospectively analyzed according to the patients’ demographic and clinical characteristics, pathway of medical care, diagnostic tests, treatment, and medical expenses. Results: Thirteen patients were included in the analysis. Among them, six patients were diagnosed with mild cognitive impairment, five with dementia, Alzheimer''s type, one patient with frontotemporal dementia, and one patient with unspecified dementia. Twelve of the thirteen patients were over 60 years of age. The number of pathways from the Dept. of Neurology to the Dept. of Neuropsychiatry of Korean Medicine was almost the same as the opposite pathway. The most used diagnostic test in Korean medicine was a neuropsychological test such as SNSB, MMSE and GDS. In Western medicine, hematology and neuroimaging were frequently used for patients. Acupuncture in Korean medicine and medication in Western medicine were the most frequently used. In Korean medicine, uncovered service costs were much higher than covered service costs,. whereas, in Western medicine, covered service costs were higher than uncovered service costs. Conclusions: This study describes the basic characteristics of dementia and mild cognitive impairment patients treated by a collaboration between Western and Korean medicine. Based on these results, a clinical pathway of the collaborative practice system between Western and Korean medicine for dementia patients needs to be developed.

Background: Understanding the role that medical use of prescription drugs plays in nonmedical use of prescription drugs can inform prevention efforts. In order to understand fully the potential risk that medical use of prescription drugs conveys for nonmedical use of prescription drugs, the current study explored (a) the simultaneous associations between the medical use of several classes of prescription drugs with current nonmedical use of the same and other prescription drug classes, and (b) whether the associations depended upon past or current medical use. Methods: Data came from a cross-sectional survey of 1686 college students, which assessed past and current medical use and current nonmedical use of stimulants, sedatives/anxiolytics, and opioid analgesics. Results: Logistic regression analyses revealed that both past and current medical use of sedatives/anxiolytics and opioid analgesics predicted the current nonmedical use of the same drug class, whereas past medical use of stimulants predicted the current nonmedical use of stimulants. In addition, current medical use of stimulants predicted current nonmedical use of sedatives/anxiolytics and past medical use of sedatives/anxiolytics predicted current nonmedical use of opioid analgesics. Conclusions: This study provides a broader examination than past research of simultaneous same-drug class and cross-drug class associations between medical and nonmedical prescription drug use, as well as the role of past and current medical use in these associations. Overall, the results suggest that efforts to prevent nonmedical use of a prescription drug class should move beyond targeting only those who have or who are using the same drug class medically.

Cannabis use disorder risk among midlife adults reporting medical and nonmedical cannabis use, 2019-2024.

Background: Stable angina is a common condition with high morbidity and mortality rates. It has been reported that combining oral Chinese patent medicines (OCPMs) and Western medicine (WM) could potentially achieve a better effect than WM alone. However, the optimal OCPMs for stable angina remain controversial and merit further empirical research.Methods: PubMed, Embase, Web of Science, Cochrane Library, Ovid-Medline, Clinical Trials.gov, China National Knowledge Infrastructure, Wanfang Database, Weipu Journal Database, and Chinese Biomedical Literature Database were all searched from inception to 13 March 2022. We employed Version 2 of the Cochrane risk-of-bias tool (ROB2) to assess the overall quality of the selected studies. We also used R 4.1.2 and STATA 14.0 software applications to perform network meta-analysis, followed by sensitivity and subgroup analysis.Results: A total of 179 randomized controlled trials with 16,789 patients were included. The selected trials were all assessed as some concerns. OCPMs combined with WM had a better treatment effect than WM alone. In terms of the effective clinical rate, a significant increase was detected for Qishen Yiqi dripping pill (QSYQ)+WM as compared with Shensong Yangxin capsule (SSYX)+WM, Shexiang Baoxin pill (SXBX)+WM, Tongxinluo capsule (TXL)+WM, Xuefu Zhuyu capsule (XFZY)+WM, Qiliqiangxin capsule (QLQX)+WM, Naoxintong capsule (NXT)+WM, Fufang Danshen dripping pill (FFDS)+WM, and Danlou tablet (DL)+WM. QSYQ + WM had the highest-ranking probability (98.12%). Regarding the effective rate in ECG, QSYQ + WM was superior to SXBX + WM, TXL + WM, DL + WM, FFDS + WM, and NXT + WM. QSYQ + WM ranked first (94.21%). In terms of weekly frequency of angina, QLQX + WM obtained a better effect than FFDS + WM, Kuanxiong aerosol (KXQW)+WM, NXT + WM, QLQX + WM, SSYX + WM, SXBX + WM, and TXL + WM. QLQX + WM ranked first (100.00%). Regarding the duration of an angina attack, KXQW + WM was superior to SSYX + WM; KXQW + WM ranked first (95.71%). Adverting to weekly nitroglycerin usage, TXL + WM had the highest-ranking probability (82.12%). Referring to cardiovascular event rate, DL + WM had the highest effect (73.94%). Additionally, SSYX + WM had the lowest rate of adverse drug reactions (1.14%).Conclusion: OCPMs combined with WM had a higher efficacy. QSYQ + WM, QLQX + WM, KXQW + WM, TXL + WM, DL + WM, SSYX + WM, and SXBX + WM merit further investigation. SXBX + WM is presumably the optimal treatment prescription for both clinically effective and cardiovascular event rates. Further high-quality empirical research is needed to confirm the current results.Systematic Review Registration: URL = https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=316534, CRD 42022316534

BackgroundStroke is a major cause of death or long-term disability worldwide. Many patients with stroke receive integrative therapy consisting of Western medicine (WM) and routine rehabilitation in conjunction with Chinese...

Electronic health records have become more prevalent worldwide, and with this, the opportunity for more accurate and automated prediction of health events has grown. Such predictions are crucial for providing preventive and proactive healthcare to patients. Although various advanced methods have been explored, they often fail to fully leverage medical domain knowledge, understand interrelations between diseases and patients comprehensively, and efficiently integrate unstructured clinical notes into predictive models. To address these challenges, we propose the Medical Domain Knowledge Collaborative Graph Learning (MED‐CGL) model. MED‐CGL incorporates external medical knowledge bases to enhance the predictive power of unstructured clinical notes and extracts learnable features from the MIMIC‐III health record dataset using medical domain knowledge and collaborative graph learning. We introduce the Enhanced Medical Knowledge Integration (EMKI) module, which employs a novel attention mechanism to connect clinical notes with disease descriptions precisely. It also enhances the system's performance by integrating medical knowledge from the semantically labelled knowledge‐enhanced (SLAKE) dataset during the training phase. Furthermore, our model considers the complexities of unstructured clinical notes, providing a nuanced perspective on the interplay between diseases and patient profiles. Our experiments show that the MED‐CGL model exhibited outstanding performance in diagnosis prediction, achieving an F1 score of 27.32%, and in heart failure prediction, where it attained an accuracy of 91.39%. This significant improvement demonstrates the robustness and effectiveness of our model, which is further supported by our in‐depth ablation study.

ObjectiveTo explore women's and maternity care providers’ experiences of birth, and the roles of (bio)medical and experiential knowledge therein. Research design/settingIn-depth qualitative interviews were undertaken with pregnant women and new mothers (n = 14) as well as with a range of maternity care providers working for the National Health Service (n = 6) and privately (n = 7). FindingsTrust emerged as a key concept in women's and maternity care providers' narratives. It was found that women and maternity care providers placed trust in two key areas: trust in past experiences and trust in women's innate abilities and embodied knowledge of birth. Key conclusionsWomen and maternity care providers trust and utilise both (bio)medical and experiential forms of knowledge of birth in complex ways and the value an individual ascribes to (bio)medical and/or experiential knowledge is highly subjective, and not necessarily mutually exclusive. This destabilises the notion that (bio)medical knowledge is associated with experts and experiential knowledge is associated with ‘lay’ people, and that these two bodies of knowledge are distinct. Implications for practiceTrust is a key concept in maternity care. The predominance of biomedical models of birth risk reducing trust in the value of experiential based birth knowledges – both embodied and empathetic. Trust in experiential knowledge could help to facilitate woman-centred care by recognising women as valuable ‘knowers’ with unique insight to contribute, and not just receivers of medical knowledge. It may also help providers ‘tune-in’ with the women in their care if they allow their experiential knowledge to complement their (bio)medical knowledge.

Chinese and Western medicine have different origins and have developed in different ways and with different contents. This paper focuses on a comparative study of the history of Chinese and Western medicine, tracing the development of ancient Greek medicine, the rescue and treatment of the Black Death in medieval Europe, and the medical treatment and public health represented by the prevention and treatment of smallpox in the Qing Dynasty. Chinese and Western medicine offered different paths to the rescue and treatment of disease from different perspectives. At the same time, the paper focus on the formation and development of the systematization of Chinese and Western medicine in modern times and the transformation of modern Chinese medicine under the influence of Western learning in the east. By discussing the changes in the modern Chinese medical education system - from ecclesiastical medicine to an integrated institutional training model, the further training of medical talents and finally the government's promulgation of the University Decree to provide modern By discussing the changes in the modern Chinese medical education system - from ecclesiastical medicine to an integrated institutional training model for medical personnel and finally the government’s promulgation of the University Decree to provide institutional guarantees for modern medical education, the significance of the convergence of Western and Chinese medicine for the development of modern Chinese medicine will be discussed in this paper.

Background: Due to challenges in therapies, researchers have developed significant interest in herbal medicines during drug discovery and development programs. This study evaluates the knowledge of community pharmacists on interactions between herbal and orthodox medicines in some communities in Anambra State, Nigeria. Method: Descriptive cross–sectional study was adopted using structured questionnaires that were distributed randomly. Results: Male/female ratio was 1:1.2. Ages of respondents were between 21-60 years old and above. 49(31.6%) had practiced between 16 and 30 years and they were mainly fifirst degree holders. 96(61.9%) of the respondents claimed that patients had used both orthodox and herbal medicines concomitantly. 23(14.8%) and 101(65.2%) of them agreed that patients used herbal medicine before visiting the pharmacy and they were low income earners respectively. Most patients sourced their herbal medicines from hawkers and herbalists and open markets. Few stocked in Pharmacy shops. The preparations were mainly administered orally. 78(50.3%) of the respondents agreed that there could be herb-drug interactions. The common ailments that herbal medicines were mostly used were malaria and diabetes. Frequently reported adverse effffects in the use of herbal medicines were rashes, nausea and vomiting. There were significant differences in the claim of enhancing and inhibitory effect between orthodox and herbal medicines when used together (P<0.05). 38(34.5%) of the respondents advised their clients that herbal and orthodox medicine should not be used concomitantly. Pharmacists preferred orthodox medicines because of clearer dose, better efficacy and approval by regulatory authorities. Conclusion: The study revealed the extent of knowledge of drug-herbal interaction and utilization among community pharmacists, and further improvement in their perception will enhance pharmaceutical care practice.

BackgroundSince 2001, Canadians have been able to obtain cannabis for medical purposes, initially through the Access to Cannabis for Medical Purposes Regulations (ACMPR). The Cannabis Act (Bill C-45) came into force on October 17, 2018, replacing the ACMPR. The Cannabis Act enables Canadians to possess cannabis purchased from a licensed retailer without authorization for either medical or nonmedical purposes. The Cannabis Act is currently the guiding legislation which governs both medical and nonmedical access. The Cannabis Act contains some improvements for patients but is essentially the same as its previous legislation. Beginning in October 2022, the federal government is conducting a review of the Cannabis Act and is questioning whether a distinct medical cannabis stream is still required, given the ease of access to cannabis and cannabis products. Although there is overlap in the reasons for medical and recreational cannabis use, the distinct legislation of medical versus recreational use of cannabis in Canada may be under threat.Main bodyA large segment of the medical, academic, research, and lay communities agree that there is a need for distinct medical and recreational cannabis streams. Perhaps most importantly, separation of these streams is necessary to ensure that both medical cannabis patients and healthcare providers receive the required support needed to optimize benefits while minimizing risks associated with medical cannabis use. Preservation of distinct medical and recreational streams can help to ensure that needs of different stakeholders are met. For example, patients require guidance in the form of assessing the appropriateness of cannabis use, selection of appropriate products and dosage forms, dosing titration, screening for drug interactions, and safety monitoring. Healthcare providers require access to undergraduate and continuing health education as well as support from their professional organizations to ensure medical cannabis is appropriately prescribed. Although there are challenges in conducing research, as motives for cannabis use frequently straddle boundaries between medical versus recreational cannabis use, maintenance of a distinct medical stream is also necessary to ensure adequate supply of cannabis products appropriate for medical use, to reduce stigma associated with cannabis in both patients and providers, to help enable reimbursement for patients, to facilitate removal of taxation on cannabis used for medical purposes, and to promote research on all aspects of medical cannabis.ConclusionCannabis products for medical and recreational purposes have different objectives and needs, requiring different methods of distribution, access, and monitoring. HCPs, patients, and the commercial cannabis industry would serve Canadians well to continue to advocate to policy makers to ensure the continued existence of two distinct streams and must strive to make ongoing improvements to the current programs.

Medical and non-medical marijuana use in depression: Longitudinal associations with suicidal ideation, everyday functioning, and psychiatry service utilization

Past-year medical and non-medical opioid use by HIV status in a nationally representative US sample: Implications for HIV and substance use service integration

Perspectives on advancing preventative medicine through vaccinology at the comparative veterinary, human and conservation medicine interface: Not missing the opportunities

How do medical and non-medical use of z-drugs relate to psychological distress and the use of other depressant drugs?