Clinical Friction in Dual-Healthcare Systems: Institutional Barriers to Integrative Traditional Medicine

2026-09-29T05:42:46+00:00

Vietnam operates a unique, state-mandated healthcare system that structurally integrates Traditional Vietnamese Medicine (TVM) within conventional hospitals. However, the operational success of this dual model relies heavily on the clinical behaviors and collaborative practices of Western-trained conventional physicians. This multi-center, cross-sectional study investigated the levels of objective knowledge, professional attitudes, and cross-departmental referral workflows regarding TVM among conventional physicians practicing in major urban medical hubs in Vietnam. A validated, 28-item structured questionnaire was distributed to licensed modern medicine physicians across tertiary (Tier-1) and secondary (Tier-2) hospitals in Hanoi and Ho Chi Minh City. Data from 412 completed surveys were analyzed using descriptive statistics and binary logistic regression to identify independent predictors of active referral workflows. The data revealed a critical “Attitude-Knowledge Paradox.” While a majority of conventional physicians exhibited highly positive cultural attitudes toward TVM (Mean Likert Score: 3.8  0.6), objective pharmacological knowledge was critically low (Mean Score: 4.2 1.8 out of 10). Specifically, 78.4% of respondents failed to identify verified herb-drug interactions. Consequently, active outbound referrals were low (24.3%) and heavily restricted to chronic musculoskeletal pain (82.0%) and neurological rehabilitation (68.0%). The leading institutional bottlenecks were a lack of randomized controlled trial (RCT) data on native Vietnamese flora (86.5%) and fears of unpredictable drug-herb toxicities (79.2%). Formal TVM exposure during medical school was a powerful independent predictor of active clinical referral practice (aOR = 2.45; 95% CI: 1.32 - 4.56; p < 0.01). Structural integration in Vietnamese hospitals has not achieved functional clinical synthesis. Conventional physicians default to defensive prescribing habits due to an educational vacuum and a lack of evidence-based pharmacological parameters. To bridge this divide, the Ministry of Health must prioritize pharmacology-focused curriculum reforms, automated electronic drug-herb interaction screening, and state-funded clinical trials for indigenous phytotherapeutics.

Spectral Subtraction Denoising (SSD) Improves Factor-3 GRAPPA 3T Lumbar MRI for Disc Herniation

2026-09-29T05:42:44+00:00

Parallel imaging shortens lumbar MRI examinations but factor-3 GRAPPA produces spatially varying noise that can obscure clinically important structures. Evidence for a simple, reproducible spectral subtraction denoising approach in clinically acquired 3T lumbar examinations remains limited. This paired pretest-posttest study evaluated MATLAB-based spectral subtraction denoising (SSD) in 16 patients with clinically diagnosed lumbar disc herniation. Sagittal T2-weighted TSE-GRAPPA images acquired at acceleration factor 3 were processed by estimating the background-noise spectrum, directly subtracting it from the image spectrum, retaining the original phase, and applying an inverse Fourier transform. Signal-to-noise ratio (SNR) was measured in five anatomical regions, and two radiologists with more than five years of experience independently performed blinded five-point visual grading. Paired differences were assessed with the Wilcoxon signed-rank test; acceleration-factor comparisons used the Friedman test, and interobserver agreement used Cohen’s kappa. SSD increased SNR in every evaluated structure, with the largest absolute gains in the vertebral body (+1.81) and degenerated nucleus pulposus (+0.41). Overall visual information improved (p < 0.001); four of five structures improved significantly, whereas the vertebral body showed a ceiling effect (p = 0.236). Interobserver agreement increased from κ = 0.60 to κ = 0.72. The findings support SSD as a low-complexity post-processing option for preserving diagnostic visibility in accelerated lumbar MRI. Larger multicenter studies should compare SSD with modern learning-based denoisers and evaluate diagnostic accuracy.

International Journal of Clinical Inventions and Medical Sciences (IJCIMS)

Clinical Friction in Dual-Healthcare Systems: Institutional Barriers to Integrative Traditional Medicine

Spectral Subtraction Denoising (SSD) Improves Factor-3 GRAPPA 3T Lumbar MRI for Disc Herniation