Effect of multimodal comprehensive communication skills training with video analysis by artificial intelligence for physicians on acute geriatric care: a mixed-methods study.

OBJECTIVES: To quantitatively analyse by artificial intelligence (AI) the communication skills of physicians in an acute care hospital for geriatric care following a multimodal comprehensive care communication skills training programme and to qualitatively explore the educational benefits of this training programme. DESIGN: A convergent mixed-methods study, including an intervention trial with a quasi-experimental design, was conducted to quantitatively analyse the communication skills of physicians. Qualitative data were collected via physicians' responses to an open-ended questionnaire administered after the training. SETTING: An acute care hospital. PARTICIPANTS: A total of 23 physicians. INTERVENTIONS: In a 4-week multimodal comprehensive care communication skills training programme, including video lectures and bedside instruction, from May to October 2021, all the participants examined a simulated patient in the same scenario before and after their training. These examinations were video recorded by an eye-tracking camera and two fixed cameras. Then, the videos were analysed for communication skills by AI. MAIN OUTCOME MEASURES: The primary outcomes were the physicians' eye contact, verbal expression, physical touch and multimodal communication skills with a simulated patient. The secondary outcomes were the physicians' empathy and burnout scores. RESULTS: The proportion of the duration of the participants' single and multimodal types of communication significantly increased (p<0.001). The mean empathy scores and the personal accomplishment burnout scores also significantly increased after training. We developed a learning cycle model based on the six categories that changed after training from the physicians' perspective: multimodal comprehensive care communication skills training; increasing awareness of and sensitivity to changes to geriatric patients' condition; changes in clinical management; professionalism; team building and personal accomplishments. CONCLUSIONS: Our study showed that multimodal comprehensive care communication skills training for physicians increased the proportions of time spent performing single and multimodal communication skills by video analysis through AI. TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry (UMIN000044288; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050586).

Non-Necrotizing Soft Tissue Infection and Streptococcal Toxic Shock Syndrome Caused by a Novel Streptococcus pyogenes Subtype (emm76.10).

We report a case of non-necrotizing soft tissue infection and streptococcal toxic shock syndrome (STSS) caused by a novel emm subtype (emm76.10) of group A Streptococcus pyogenes (GAS). A 54-year-old Japanese woman suffering from fever, fatigue, and lower abdominal pain along with erythema for 3 days was admitted to our hospital. Additionally, she presented with hypotension and multiple organ failure. Exploratory incision was performed due to the presence of STSS and for an examination of the necrotizing soft tissue infection from her lower abdomen to the left thigh. Tissue cultures from the exudates and fascia yielded positive results for GAS growth, although blood cultures returned as negative. After 15 days of antimicrobial therapy, she recovered fully without any complications. Genotyping of the isolate indicated a novel emm subtype (emm76.10), with 5 amino acid substitutions in the emm76.0 subtype sequence and the full-length sequence of 780 bp. This isolate was resistant to tetracyclines, macrolides-lincosamides, and fluoroquinolones, owing to the presence of antibiotic resistance determinants, tet(M) and erm(B), and point mutations, Ser79Phe/Ser81Phe, in the quinolone resistance-determining regions of parC/gyrA. In conclusion, our observations suggest the importance of early-stage exploratory incision and drainage from the infected region for the isolation and characterization of causative bacteria to facilitate selection of appropriate antibiotics for treatment.