Communication training for pharmacy students with standard patients using artificial intelligence.

INTRODUCTION: The objective structured clinical examination (OSCE) is among validated approaches used to assess clinical competence through structured and practical evaluation. Most studies of OSCE have used standardized patients (SPs). However, to our knowledge, there is limited information regarding the specific communication skills enhanced by providing communication training (CT) with SPs. Recently, an artificial intelligence (AI) technology was developed. The aim of this study was to evaluate the experience and outcomes of CT with SPs and impact of using AI for this training. METHODS: This study targeted fourth-year students participating in a pre-learning course for pharmacy practice experience offered at a Japanese university in 2020. The ENcode, Decode, Control, and REgulate model, which evaluates 24 communication skills, was utilized as a questionnaire-based survey. The survey was conducted prior to CT, following CT, and after a second CT session six weeks later with AI. RESULTS: Seven skills, namely "desire suppression," "expectation acceptance," "facial expression," "emotional communication," "dominance," "maintaining relationships," and "dealing with disagreements," were enhanced by the CT with SPs. These skills were included in the broad categories of "management" and "expression" skills. They were not significantly enhanced by following AI training. However, differences observed between the students who underwent AI training and those who did not demonstrated a positive effect in almost all skills, suggesting that AI training can enhance certain skills. CONCLUSIONS: CT with SPs enhances students' "management" and "expression" skills. Additionally, AI shows potential for improving the effect of CT.

Antiproteinuric effects of renin-angiotensin inhibitors in lung cancer patients receiving bevacizumab.

PURPOSE: The objective of this study was to investigate the effect of renin-angiotensin system inhibitors (RASIs) on bevacizumab (BV)-induced proteinuria in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of NSCLC patients receiving BV between 2008 and 2014 at 11 hospitals. The patients were categorized into three groups according to their antihypertensive drug use: RASI user, non-RASI user, and non-user groups. The primary outcome was a proteinuria event of any grade during the first 6 cycles of BV treatment. RESULTS: A total of 211 patients were included, 89 of whom received antihypertensive drugs. Of these 89 patients, 49 were in the RASI user group, and 40 were in the non-RASI user group. The non-user group comprised 122 patients. The occurrence of proteinuria in the RASI user group was significantly lower than that in the non-RASI user group (P = 0.037) but was not significantly lower than that in the non-user group (P = 0.287). Patients using RASIs had a lower rate of proteinuria than those who did not use RASIs according to multivariate analysis (odds ratio 0.32; 95% confidence interval 0.12-0.86; P = 0.024). CONCLUSION: Our study suggests that RASI administration reduces the risk of proteinuria in patients receiving BV.

[A multicenter trial of regional medical cooperation for cancer chemotherapy after the great East Japan earthquake].

The Great East Japan Earthquake was the first disaster we experienced after the administration of oncology care had mostly shifted from hospitals to outpatient departments in Japan. Disaster medical assistance teams(DMATs)were deployed immediately after the disaster, and actively assisted during the acute phase of the catastrophe. After experiencing the earthquake, we realized the necessity of medical support teams, even for chronic disease. Here we report a multicenter trial of regional medical cooperation for cancer chemotherapy. First, soon after the earthquake, representatives from the regional hospitals discussed the proper roles for each institution. As agreed to in the discussion, cancer patients were redistributed from a disaster base hospital to a local general hospital, and oncologists supported the other regional hospitals on a regular basis. This broad regional network functioned well and patients resumed their treatment as soon as the situation allowed. Second, we performed a survey of the patients and found that the most important problem was patients' lack of understanding of their own illnesses. Third, we conducted an opinion survey of medical professionals on regional medical cooperation. Based on the trial, we found it important in disasters to establish regional cooperation and solid communication systems, and to promote patient education.

Preparation of neocarzinostatin apoprotein mutants and the randomized library on the chromophore-binding cavity.

W39F, F52Y, S98G, S98A, and S98C mutants of the neocarzinostatin apoprotein (apo-NCS) were newly prepared and investigated their physicochemical properties. The circular dichroism (CD) spectra of F78W, F52Y, S98A, S98G, S98C were superimposable with that of wild type 1R49 protein although the minor spectral change seemed to be in the ellipticity of W39F. The results suggest that position 52, 78, and 98 involving natural chromophore binding do not play a major role in the inducing overall structural changes of the protein. Conversely, the position 39 would be affected slightly. Ethidium bromide (EtdBr) binding to mutants was also evaluated by the monitoring of total fluorescence intensity and fluorescence polarization (FP). The observed dissociation constant in the FP study was 4.4 microM for wild type, 2.2 microM for S98A, 1.3 microM for S98G, 9.7 microM for S98C, respectively. When S98G and F52Y, the calculated maximum change of the total fluorescence intensity was increased, suggesting that the EtdBr binding to S98G or F52Y were slightly improved compared with the wild type. Then, a total of 14 amino acids randomly substituted phage displayed library of apo-NCS was successfully prepared, because substitution of the amino acid structured the chromophore-binding cavity were not change the overall structural features. The phages which bound glycyrrhetic acid conjugated bovine serum albumin were enriched from this library using phage display technique as the pilot experiments. Although more precision investigation still needs, it should be possible to select variants that have new functions not found in nature.