Assessing the Utility of Multimodal Large Language Models (GPT-4 Vision and Large Language and Vision Assistant) in Identifying Melanoma Across Different Skin Tones.

The large language models GPT-4 Vision and Large Language and Vision Assistant are capable of understanding and accurately differentiating between benign lesions and melanoma, indicating potential incorporation into dermatologic care, medical research, and education.

Frequency of catheter related infections in haemodialysed uraemic patients.

OBJECTIVE: To investigate the incidence of bacteraemia and bacterial colonization related to the use of dual-lumen catheters in ESRD patients on haemodialysis. METHODS: Sixty patients with ESRD of varied etiologies, both males and females falling in the age range (16-74 years) were randomly selected. Non-cuffed, non-tunneled polyurethane double lumen catheters were inserted under aseptic technique. Patients on twice a week schedule of haemodialysis were followed up for a period of 5 months. After every haemodialysis session, catheters were examined for any local infection or signs of bacteraemia. In case of suspicion, distal 5 cm segment of the catheter, and local pus swab and two blood culture samples were sent to the pathology laboratory. RESULT: Thirty one catheters (51.6%) sent for culture and sensitivity showed colonization (> 15 CFU). Bacteraemia was positive in 15 (25%) patients. Thirteen (41.9%) catheter tips were found to be colonized by staphylococcus epidermidis, eleven (35.4%) by staphylococcus aureus, three (0.96%) by Candida albicans species, two (6.45%) by E coli, one (3.2%) by P Aeruginosa and one (3.2%) by mixed Pseudomonas and E coli respectively. CONCLUSION: Non cuffed non tunneled double lumen catheters are designed for short-term emergency use and should be used in the same context. Although pathogenesis of catheter related infection is multifactorial the transcutaneous migration of organisms colonizing the skin remains the most important route.

Continuum of medical education: objectivity in instructional method, learning and assessment.

OBJECTIVE: To find the effect of objectivity practiced during instruction and assessment on learning. METHOD: Fifty first year BDS students of Islamic International dental college, Islamabad were selected for a descriptive case series study extending from January to mid February 2007. Before starting the haematology module, specific learning objectives were defined. Interactive student centered instructional method was adopted in the form of interactive lectures and small group discussions. Assessment tool selected for measuring predefined objectives were to choose one best and the correct statement MCQS. Students were informed of the assessment pattern and practiced. Out of 65 test items 58 required a correct choice while 7 MCQS were objectively structured with "choose one best answer," mixed in the main test pool and marked with an asterisk. RESULT: Evaluation survey showed dissatisfaction regarding the traditional lecture system. Although students were satisfied with the learning environment but majority disagreed with the reliability and validity of the current assessment method. After introducing the reforms in the instructional method and assessment pattern, the level of student satisfaction became high and their feedback was positive regarding the learning experience. The qualifying criteria for the 50 students was achieving 50% in both type of MCQS. In objectively structured choose one best type, 80% of the students scored more than 50% marks (i.e. 4 out of 7). In choose the correct statement, 96% of the students scored more than 50% marks (i.e., 29 out of 58). Final scoring for 65 test items showed that 96% of the students scored more than 50% marks. CONCLUSION: Introducing objectivity in instruction, learning and assessment gives good outcome in medical education. Learners groomed in such an environment are critical thinkers as evidenced by test results of, objectively structured choose one best type.