How to Prevent Technical Issues in Large Multiparty Medical Videoconferencing

Introduction: Videoconferencing (VC) is useful for physicians who need to learn about many cases without moving from one institution to another. However, this advantage can be hampered by technical issues. This study aims to analyse the factors relating technical support that cause technical issues in regular multiparty medical VC to provide high-quality VC to meet participants’ demands. Methods: The study includes large multiparty VC between the Kyushu University Hospital Department of Paediatric Surgery and different institutions within Japan that were held from September 2014 to January 2017. Technical tests, a “previous-week test” and a “last-hour test,” were conducted for checking conditions prior to the VC. The chi-square test was used for factors: participation for previous-week and last-hour test, and attendance by an engineer VCs in each participating institution. A questionnaire survey was distributed among the participants to collect feedback on the quality of VC, ease of preparation and necessity of previous-week testing. Results: Participation in the last-hour test (P=0.002) and the presence of an engineer (P=0.049) significantly decreased overall technical issues. The last-hour tests significantly decreased disconnection (P=0.015) and audio (P=0.019) issues. The engineer’s attendance decreased content-sharing issues (P=0.027). Participants reporting “very good” and “good” audio and visual quality were 92% (109/118) and 96% (105/110). Eighty-three percent of participants (82/99) found the preparation “very easy” or “easy”; while 61% (63/103) found the previous-week test, “unnecessary.” Conclusions: Based on our study, “engineers’ attendance” and “last-hour” technical testing significantly reduced technical problems; these factors help provide high-quality output VC and meet the needs of the participants

A Train-the-Trainers (TtT) Program for Engineers for Hosting Multiparty International Clinical Teleconferences

Background: International clinical teleconferencing connecting hospitals contributes to the standardisation of medical care. Introduction: The perception that participating in international teleconferences is easy while hosting and coordinating them is difficult has limited the expansion of these kinds of programmes. We evaluated the effectiveness of a Train-the-Trainer (TtT) programme on hosting international multiparty teleconferences targeted at hospital engineers. Methods: From 2015 to 2017, 20 engineers and physicians from 17 institutions in 10 countries participated in Kyushu University Hospital’s TtT programme. Hands-on training and hosting a Training Report Conference (TRC) were conducted. The impact of the programme was assessed using questionnaires about the participants’ confidence, perception of barriers, and teleconference activity before and one year after the training period. Results: The mean training period was 16.7 days (median, 19 days). Twelve TRCs were hosted by trainees connecting 56 institutions in 11 countries. All participants gave positive evaluations of the overall programme, 19 (95%) "very good" and 1 (5%) "good", and the trainers 9 (90%) "very good" and 1 (10%) "good"). Following the TtT programme, the mean number of trainee-hosted events increased significantly (0.8 to 1.3, p<0.001), and more respondents (12/17, 71%) reported barriers to hosting a programme than participating in one (5/17, 29%, p<0.001). Trainee confidence in both hosting and participating in international teleconferences was significantly higher after TtT. Conclusion: There are more barriers to hosting than participating in international clinical teleconferences. This TtT programmes for engineers could contribute to more active hosting engagement

Event style preferences in medical education and research meetings in Japan

Purpose: With the spread of COVID-19, medical education and research events have either been cancelled or shifted to online or hybrid mode. However, there are no accurate records containing the exact number of these events in new modes. This study explores trends in event modes of medical education and research in Japan using registered event data from a web service. Methods: We collected event data from January 2019 to December 2021. Text mining was used to extract and classify data into categories such as on-site and online events. Then, the annual and monthly numbers of categories were counted. Results: The total number of events in March 2020 was drastically reduced, but it recovered in November 2021 to a level equivalent to that of the peak month in 2019. The majority of the events were online by December 2020, increasing in number from March 2020. Hybrid events that integrate on-site and online modes later outnumbered online events and accounted for approximately 20% of the total in June, October, and November 2021. Conclusions: The online and hybrid modes ensured the continuation of medical education and research events during the pandemic. Though online events may reduce after COVID-19, the hybrid mode could become a popular mode that offers diversity

Five-Year Technological Changes of Distant Medical Education in Asia

All physicians would benefit from more comprehensive distance learning. However, the technology is often difficult to use because technological infrastructure is limited in many hospitals in Asia. Since 2003, we have worked to advance international distant medical education implemented through the Internet in Asia. This paper presents an analysis of our activities over the past five years to evaluate the technical transition and its effects on modes of distant medical education. Methods: We analysed distant medical education programmes that we conducted from 2011 to 2015. We used a Digital Video Transport System (DVTS), H.323 and Vidyo, along with commercial and research and education networks (REN) installed in the subject hospitals. Questionnaires were randomly distributed to the audience to evaluate image resolution, image movement, sound quality, and programme content. Results: The number of programmes increased to over 90 per year in 2014–2015. The main system gradually changed from DVTS (58%, 30/52 in 2011) to Vidyo (64%, 67/104 in 2015). The number of new institutions increased to 149 in 2014–2015. Over 92% of the ratings for image resolution and movement were positive. Sound quality was somewhat lower at 83%. Ultimately, 98% of respondents rated the programmes “very good” or “good.” Conclusions: Continuous technical development was observed with increasing numbers of sites for each programme. This resulted in expansion of activity involving non-university hospitals. Practical distant medical education, satisfies physicians’ need for quality and inclusiveness could be expanded to normal hospitals in Asia and beyond

Topically applied tissue factor pathway inhibitor reduced intimal thickness of small arterial autografts in rabbits

AbstractPurpose: The purpose of this study was to investigate whether topically applied tissue factor pathway inhibitor (TFPI) reduces intimal thickness and increases long-term patency of small arterial autografts in rabbits. Methods: An entire 10-mm long section of the left femoral artery was harvested and immersed in saline solution (control group, n = 10), 100 IU/mL of heparin (heparin group, n = 15), or 40 μg/mL of TFPI (TFPI group, n = 15) for 15 minutes. Then the graft was interposed to the right femoral artery. Patency rates were determined by flow measurements throughout the time course of the study, and the grafts were analyzed for measurement of intimal thickness at 3 months after operation. Immunohistochemical analysis was performed to examine whether topically applied TFPI binds to endothelial cells of the grafts. Results: Three-month postoperative patency rates were 10% in the control group, 47% in the heparin group, and 73% in the TFPI group. The TFPI group had a significantly higher patency rate than that of the control group (P <.005). Compared with the heparin group, the TFPI group had a significant reduction in intimal area (0.19 ± 0.05 mm2 vs 0.30 ± 0.09 mm2, P =.0051), in percentage of stenosis (35.7% ± 7.7% vs 61.4% ± 15.8%, P <.0001), and in intimal/media areas ratio (0.64 ± 0.24 vs 1.04 ± 0.33, P =.0051). Immunohistologic analyses confirmed that topically applied TFPI bound to endothelial cells. Conclusion: These results indicate that topically applied TFPI reduces intimal thickness and increases long-term patency of small arterial autografts in rabbits. (J Vasc Surg 2001;34:151-5.

Kamishoyosan and Shakuyakukanzoto promote recovery from paclitaxel-induced neurite retraction in PC12 cells

Background: In chemotherapy, the full round of treatment must be completed as scheduled to achieve the strongest therapeutic effect. However, peripheral neuropathy, a severe side effect of the chemotherapeutic agent paclitaxel, can force the premature discontinuation of treatment. As some kampo practitioners have suggested that it may be possible to counteract such side effects, we analyzed the effects of Kamishoyosan, Shakuyakukanzoto, and Goshajinkigan in an in vitro model of paclitaxel-induced peripheral neuropathy. Methods: Paclitaxel-treated PC12 cells were assessed for neurite length and performed Western blot analysis for growth-associated protein-43 (GAP-43) and light neurofilament protein (NF-L) levels in the presence of nerve growth factor (NGF); they were re-assessed, with additional testing for acetylcholinesterase levels, after application of one of the kampo. We also compared phosphorylation of extracellular signal-regulated kinase (Erk)1/2 and Akt via Western blot analysis. About effect of kampo to anticancer efficacy, we confirmed cell cytotoxicity in A549 cells using MTT assay. Results: Addition of Kamishoyosan or Shakuyakukanzoto, but not Goshajinkigan, significantly improved neurite length and GAP-43 and NF-L levels from paclitaxel-treated PC12 cells, relative to those of only NGF-treated PC12 cells. The promoting effect of Kamishoyosan and Shakuyakukanzoto in neurite outgrowth is confirmed when NGF promoted neurite outgrowth, and it was inhibited partially when Erk1/2 and Akt were blocked by Erk1/2 inhibitor or Akt inhibitor alone. Furthermore, neurite outgrowth induced by TJ24 and TJ68 was inhibited more strongly when Erk1/2 inhibitor and Akt inhibitor were treated at the same time. NGF with Kamishoyosan or Shakuyakukanzoto promoted the proportion of phosphorylated Erk1/2 and phosphorylated Akt compare with NGF only. On the other hand, Kamishoyosan or Shakuyakukanzoto didn’t influence cytotoxicity of paclitaxel in A549 cells. Conclusions: Kamishoyosan or Shakuyakukanzoto promotes neurite outgrowth with NGF via increasing the proportion of phosphorylated Erk1/2 and phosphorylated Akt in PC12 cells. The effect applies to recovery from paclitaxel-induced axonal involvement and might promote recovery from paclitaxel-induced neuropathy without influence of anticancer effect of paclitaxel

Inverse square Levy walk emerging universally in goal-oriented tasks

The Levy walk in which the frequency of occurrence of step lengths follows a power-law distribution, can be observed in the migratory behavior of organisms at various levels. Levy walks with power exponents close to 2 are observed, and the reasons are unclear. This study aims to propose a model that universally generates inverse square Levy walks (called Cauchy walks) and to identify the conditions under which Cauchy walks appear. We demonstrate that Cauchy walks emerge universally in goal-oriented tasks. We use the term "goal-oriented" when the goal is clear, but this can be achieved in different ways, which cannot be uniquely determined. We performed a simulation in which an agent observed the data generated from a probability distribution in a two-dimensional space and successively estimated the central coordinates of that probability distribution. The agent has a model of probability distribution as a hypothesis for data-generating distribution and can modify the model such that each time a data point is observed, thereby increasing the estimated probability of occurrence of the observed data. To achieve this, the center coordinates of the model must be moved closer to those of the observed data. However, in the case of a two-dimensional space, arbitrariness arises in the direction of correction of the center; this task is goal oriented. We analyze two cases: a strategy that allocates the amount of modification randomly in the x- and y-directions, and a strategy that determines allocation such that movement is minimized. The results reveal that when a random strategy is used, the Cauchy walk appears. When the minimum strategy is used, the Brownian walk appears. The presence or absence of the constraint of minimizing the amount of movement may be a factor that causes the difference between Brownian and Levy walks