The De Ritis ratio, defined as the serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio, is a widely recognized biochemical marker with significant applications in diagnosing and managing various diseases, particularly liver disorders. This comprehensive review synthesizes current knowledge surrounding the clinical relevance of the De Ritis ratio, examining its historical development, diagnostic utility, and prognostic significance across various medical conditions, including liver diseases, cardiovascular disorders, and muscular pathologies. Through an in-depth analysis of literature spanning several decades, this review highlights the role of the De Ritis ratio not only in differential diagnosis but also as a prognostic indicator for disease progression and patient outcomes. The ratio\'s ability to distinguish between different types of liver pathology, aid in early disease detection, and its potential use in monitoring treatment response are discussed. Additionally, the review addresses the methodological considerations, such as confounding factors and interpretation challenges, that impact the clinical utility of the De Ritis ratio. Given the evolving landscape of clinical diagnostics and the push toward more personalized medicine, the review concludes with recommendations for further research. These include longitudinal studies to explore the ratio\'s changes over time, comparative research across diverse populations, and technological integration to enhance diagnostic accuracy and patient care. This review aims to reaffirm the importance of the De Ritis ratio in modern clinical practice and encourages continued exploration into its potential applications and benefits in healthcare.

The fusion of mythology and ancient Indian medicine, particularly Ayurveda, is a fascinating synthesis of cultural heritage and scientific endeavor. Ayurveda encompasses a wide range of practices, including pharmacology, anatomy, physiology, surgery, and obstetrics, and integrates the rich tapestry of Hindu mythology, providing a comprehensive understanding of health and disease. The inclusion of mythological figures and narratives in the discourse of ancient Indian medicine offers a unique perspective on the integration of spiritual and empirical knowledge, highlighting the role of mythology in shaping the foundational principles of clinical medicine. The discourse explores the profound impact of Ayurveda and its mythological underpinnings on contemporary clinical practices, underscoring the timeless wisdom embedded in ancient narratives. These stories represent the bedrock of holistic medical practices, emphasizing the parity between mind, body, and spirit that is increasingly validated in modern therapeutic paradigms. The philosophy and methods detailed in the age-old texts of Sushruta and Charaka, coupled with the allegorical tales of Dhanvantari and Bharadwaja, contribute significantly to the foundational principles underpinning today\'s holistic medical approaches. The enduring legacy of Ayurveda and its mythological narratives continues to influence and inspire a holistic approach to health care, underscoring the indelible connection between ancient wisdom and modern medical practices.

BACKGROUND: As large language models receive greater attention in medical research, the investigation of ethical considerations is warranted. This review aims to explore surgery literature to identify ethical concerns surrounding these artificial intelligence models and evaluate how autonomy, beneficence, nonmaleficence, and justice are represented within these ethical discussions to provide insights in order to guide further research and practice.
METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched in October 2023. Eligible studies included surgery-related articles that focused on large language models and contained adequate ethical discussion. Study details, including specialty and ethical concerns, were collected.
RESULTS: The literature search yielded 1179 articles, with 53 meeting the inclusion criteria. Plastic surgery, orthopedic surgery, and neurosurgery were the most represented surgical specialties. Autonomy was the most explicitly cited ethical principle. The most frequently discussed ethical concern was accuracy (n = 45, 84.9%), followed by bias, patient confidentiality, and responsibility.
CONCLUSIONS: The ethical implications of using large language models in surgery are complex and evolving. The integration of these models into surgery necessitates continuous ethical discourse to ensure responsible and ethical use, balancing technological advancement with human dignity and safety.

Blockchain is topical in many areas of science. The impact on clinical care of physicians is not known. We undertook a rapid review of the literature to identify areas of interest for clinicians in active practice focusing on evidence relevant to clinical care. We found limited evidence for use blockchain in clinical practice with most studies focusing on technical aspects of prototypes and implementation with no evidence of standardised metric to measure impact for patients, clinicians, and organisations. Personal Health Records for use across organisational and geographic boundaries emerged as the strongest clinical use-case. Defined metrics by professional bodies might aid research, development, and future impact.

This narrative review discusses how the safe and effective use of clinical artificial intelligence (AI) prediction tools requires recognition of the importance of human intelligence. Human intelligence, creativity, situational awareness, and professional knowledge, are required for successful implementation. The implementation of clinical AI prediction tools may change the workflow in medical practice resulting in new challenges and safety implications. Human understanding of how a clinical AI prediction tool performs in routine and exceptional situations is fundamental to successful implementation. Physicians must be involved in all aspects of the selection, implementation, and ongoing product monitoring of clinical AI prediction tools.

There are numerous, often single centre discussions of assorted medication-related problems after hospital discharge in patients who survive critical illness. However, there has been little synthesis of the incidence of medication-related problems, the classes of medications most often studied, the factors that are associated with greater patient risk of such problems or interventions that can prevent them.
We undertook a systematic review to understand medication management and medication problems in critical care survivors in the hospital discharge period. We searched OVID Medline, Embase, PsychINFO, CINAHL and the Cochrane database (2001-2022). Two reviewers independently screened publications to identify studies that examined medication management at hospital discharge or thereafter in critical care survivors. We included randomised and non-randomised studies. We extracted data independently and in duplicate. Data extracted included medication type, medication-related problems and frequency of medication issues, alongside demographics such as study setting. Cohort study quality was assessed using the Newcastle Ottowa Score checklist. Data were analysed across medication categories.
The database search initially retrieved 1180 studies; following the removal of duplicates and studies which did not fit the inclusion criteria, 47 papers were included. The quality of studies included varied. The outcomes measured and the timepoints at which data were captured also varied, which impacted the quality of data synthesis. Across the studies included, we found that as many as 80% of critically ill patients experienced medication-related problems in the posthospital discharge period. These issues included inappropriate continuation of newly prescribed drugs such as antipsychotics, gastrointestinal prophylaxis and analgesic medications, as well as inappropriate discontinuation of chronic disease medications, such as secondary prevention cardiac drugs.
Following critical illness, a high proportion of patients experience problems with their medications. These changes were present across multiple health systems. Further research is required to understand optimal medicine management across the full recovery trajectory of critical illness.
CRD42021255975.

BACKGROUND: Health care policy and practice-level enthusiasm around social screening has emerged in the absence of a clear appreciation for how patients feel about these activities. Yet patient and caregiver perspectives should be used to establish the rationale and inform the design and implementation of social screening initiatives.
METHODS: We conducted a systematic scoping review to better understand patient and patient caregiver perspectives regarding multidomain social screening in US health care settings.
RESULTS: We identified 16 articles. Thirteen studies assessed the perspectives of patients; a partially overlapping 9 studies assessed the perspectives of adult patient caregivers. Most articles assessing the acceptability of social screening reported that patients and patient caregivers generally found it to be acceptable. Notably, there was some variation by screening approach and prior experiences in health care settings, as well as mixed findings by race/ethnicity and gender. Participants from several articles raised concerns regarding data documentation and sharing, highlighting the potential for social data to contribute to provider bias.
CONCLUSIONS: The themes emerging in this diverse set of largely descriptive studies warrant deeper and more rigorous exploration as social screening initiatives expand in health care settings across the United States.

The review analyzes the fundamental work of V. I. Borodulin about the history of Internal Disease Clinic in the USSR, based on the biographies of more than fifty prominent Soviet therapeutists; the research is devoted to development of main Soviet therapeutic scientific schools and formation of new scientific and educational clinical disciplines in this field in 1920s-1970s, as well as difficulties and dynamic life of therapeutic elite in the USSR in that period.
Представлен анализ фундаментального труда В. И. Бородулина по истории клиники внутренних болезней в СССР, в котором освещены деятельность более чем 50 выдающихся советских терапевтов, история развития основных отечественных терапевтических школ и выделение новых самостоятельных научно-учебных клинических дисциплин в период 1920-х - 1970-х годов. Отражена сложная и динамичная жизнь терапевтической элиты СССР этого периода.

The proliferation and growing demands of genetic testing are anticipated to revolutionise medical practice. As gatekeepers of healthcare systems, general practitioners (GPs) are expected to play a critical role in the provision of clinical genetic services. This paper aims to review existing literature on GPs\' experience, attitudes and needs towards clinical genetic services.
A systematic mixed studies review of papers published between 2010 and 2022.
The inclusion criterion was peer-reviewed articles in English and related to GPs\' experience, views and needs on any genetic testing.
The PubMed, PsycINFO, Cochrane, EMBASE databases were searched using Mesh terms, Boolean and wildcards combinations to identify peer-reviewed articles published from 2010 to 2022. Study quality was assessed using Mixed Methods Appraisal Tool. Only articles that fulfilled the inclusion criteria were selected. A thematic meta-synthesis was conducted on the final sample of selected articles to identify key themes.
A total of 62 articles were included in the review. Uncertainty over GPs\' role in providing genetic services were attributed by the lack of confidence and time constraints and rarity of cases may further exacerbate their reluctance to shoulder an expanded role in clinical genetics. Although educational interventions were found to increasing GPs\' knowledge and confidence to carry out genetic tasks, varied interest on genetic testing and preference for a shared care model with other genetic health professionals have resulted in minimal translation to clinical adoption.
This review highlights the need for deeper exploration of GPs\' varied experience and attitudes towards clinical genetic services to better facilitate targeted intervention in the adoption of clinical genetics.

BACKGROUND: Updated European Committee on Antimicrobial Susceptibility Testing (EUCAST) amikacin breakpoints for Enterobacterales and Pseudomonas aeruginosa included revised dosing recommendations of 25-30 mg/kg to achieve key pharmacokinetic/pharmacodynamic parameters, higher than recommended in the British National Formulary. The objectives of this review were to identify clinical evidence for high-dose amikacin regimens and to determine drug exposures that are related to adverse events and toxicity.
METHODS: The literature search was conducted in October 2021 and updated in May 2022 using electronic databases for any study reporting adult participants treated with amikacin at doses ≥20 mg/kg/day. Reference lists of included papers were also screened for potential papers. Data were extracted for pharmacokinetic parameters and clinical outcomes, presented in a summary table and consolidated narratively. Meta-analysis was not possible. Each study was assessed for bias before, during and after the intervention using the ROBINS-I tool.
RESULTS: Nine studies (total 501 participants in 10 reports) were identified and included, eight of which were observational studies. Assessment of bias showed substantial flaws. Dosing regimens ranged from 25 to 30 mg/kg/day. Six studies adjusted the dose in obesity when participants had a body mass index of ≥30 kg/m2. Target peak serum concentrations ranged from 60 mg/L to 80 mg/L and 59.6-81.8% of patients achieved these targets, but there was no information on clinical outcomes. Two studies reported the impact of high-dose amikacin on renal function. No studies reporting auditory or vestibular toxicity were identified.
CONCLUSIONS: All included papers were limited by a significant risk of bias, while methodological and reporting heterogeneity made drawing conclusions challenging. Lack of information on the impact on renal function or ototoxicity means high-dose regimens should be used cautiously in older people. There is a need for a consensus guideline for high-dose amikacin to be written.
BACKGROUND: PROSPERO (CRD42021250022).