The impact and opportunities of large language models like ChatGPT in oral and maxillofacial surgery: a narrative review.

Since its release at the end of 2022, the social response to ChatGPT, a large language model (LLM), has been huge, as it has revolutionized the way we communicate with computers. This review was performed to describe the technical background of LLMs and to provide a review of the current literature on LLMs in the field of oral and maxillofacial surgery (OMS). The PubMed, Scopus, and Web of Science databases were searched for LLMs and OMS. Adjacent surgical disciplines were included to cover the entire literature, and records from Google Scholar and medRxiv were added. Out of the 57 records identified, 37 were included; 31 (84%) were related to GPT-3.5, four (11%) to GPT-4, and two (5%) to both. Current research on LLMs is mainly limited to research and scientific writing, patient information/communication, and medical education. Classic OMS diseases are underrepresented. The current literature related to LLMs in OMS has a limited evidence level. There is a need to investigate the use of LLMs scientifically and systematically in the core areas of OMS. Although LLMs are likely to add value outside the operating room, the use of LLMs raises ethical and medical regulatory issues that must first be addressed.

[AKTIN - The German Emergency Department Data Registry - real-time data from emergency medicine : Implementation and first results from 15 emergency departments with focus on Federal Joint Committee's guidelines on acuity assessment]. / Das AKTIN-Notaufnahmeregister ­ kontinuierlich aktuelle Daten aus der Akutmedizin : Ergebnisse des Registeraufbaus und erste Datenauswertungen aus 15 Notaufnahmen unter besonderer Berücksichtigung der Vorgaben des Gemeinsamen Bundesausschusses zur Ersteinschätzung.

BACKGROUND: Emergency care in Germany is in transition. Emergency departments (EDs) treat their patients based on symptoms and acuity. However, this perspective is not reflected in claims data. The aim of the AKTIN project was to establish an Emergency Department Data Registry as a data privacy-compliant infrastructure for the use of routine medical data. METHODS: Data from the respective documentation systems are continuously transmitted to local data warehouses using a standardized interface. They are available for several applications such as internal reports but also multicentre studies, in compliance with data privacy regulations. Based on a 12-months period we evaluate the population with focus on acuity assessment (triage) and vital parameters in combination with presenting complaints. RESULTS: For the period April 2018 to March 2019, 436,149 cases from 15 EDs were available. A triage level is documented in 86.0% of cases, and 70.5% were triaged within 10 min of arrival. Ten EDs collected a presenting complaint regularly (82.3%). The respective documentation of vital signs shows plausible patterns. CONCLUSIONS: The AKTIN registry provides an almost real-time insight into German EDs, regardless of the primary documentation system and health insurance claims data. The Federal Joint Committee's requirements are largely met. Standardized presenting complaints allow for symptom-based analyses as well as health surveillance.

[Skill retention using extraglottic airways in out-of-hospital emergencies: efficacy and long-term results of simulator-based medical education : A prospective follow-up study]. / Routineerhalt beim Umgang mit extraglottischen Atemwegen im Rettungsdienst: Effektivität und Nachhaltigkeit einer simulatorbasierten Ausbildung : Eine prospektive 2­zeitige Simulatorstudie.

OBJECTIVE: For emergency medicine personnel (EMP), there is little evidence concerning the adequate timing for refresher courses to maintain routine in the application of extraglottic airways. The aim of this study was to evaluate the efficacy and long-term results of a simulator-based education concept teaching the basic airway management skills with extraglottic airways for EMP and also to draw conclusions concerning the adequate time interval for refresher courses. METHODS: By use of an explorative, prospective simulator-study with nonphysician EMP, airway management skills using the Larynxmaske Supreme® (LMA­S) after an introduction lecture were examined. The application of an endotracheal tube (ETT) served as control. Time for preparation of the airway devices, insertion success, and resulting apnea time were assessed immediately after the first introduction lecture (t1) and unannounced 9-12 months thereafter (t2). RESULTS: Comparison of the times for preparation of the LMA­S at t1 and t2 demonstrated similar results. After the introduction lecture, all paramedics were able to insert the LMA­S successfully after maximal 2 attempts; 9-12 months later success rates with the LMA­S were unchanged. Apnea time during airway management was shorter with the LMA­S compared to the ETT (p < 0.01). Times needed for preparation of the airway devices were similar. CONCLUSION: The results of this simulator study indicate that a standardized introduction lecture is appropriate to ensure long-lasting procedural skills up to 12 months, so that subsequent refresher courses in basic airway management with the LMA­S once a year may be adequate. A simulator-based education in basic airway management skills with extraglottic airways is recommended for facilitation of further clinical education according to the current guidelines.

The impact of real life treatment strategies for Candida peritonitis-A retrospective analysis.

Candida species are commonly detected isolates from abdominal foci. The question remains as to who would benefit from early empiric treatment in cases of Candida peritonitis. This study collected real-life data on critically ill patients with Candida peritonitis to estimate the relevance of the chosen treatment strategy on the outcome of these patients. One hundred and thirty-seven surgical intensive care unit (ICU) patients with intra-abdominal invasive Candidiasis were included in the study. Fifty-six patients did not get any antifungal agent. Twenty-nine patients were empirically treated, and 52 patients were specifically treated. In the group without, with empiric and with specific antifungal treatment, the 30-day mortality rate was 33.9, 48.3 and 44.2 respectively. Candida albicans was the most frequently found species. Seven patients in the specific treatment group and one patient in the empiric treatment group emerged with candidaemia. Age, leucocyte count, APACHE II Score and acute liver failure were independent predictors of 30-day mortality in patients with Candida peritonitis. Not all patients with Candida peritonitis received antifungal treatment in real clinical practice. Patients with higher morbidity more often got antifungals. Early empirical therapy has not been associated with a better 30-day mortality.

Secure Electronical Communications and Data Transfers in a Clinical Environment.

As part of the German Project AKTIN, data security arises as an important issue. The context of this issue was detailed and the requirements were determined, with special focus on the hospital's point of view. The solution is illustrated in this poster. Further use cases in other medical or study context are also discussed.

[Outpatient care in emergency departments and primary care services : A descriptive analysis of secondary data in a rural hospital]. / Ambulante Versorgung in ZNA und Bereitschaftsdienstpraxis : Eine deskriptive Sekundärdatenanalyse in einer ländlichen Klinik.

BACKGROUND: The use of emergency departments in German hospitals has been increasing in recent years. Emergency care provided by primary care services ("Bereitschaftsdienstpraxis") or a hospital emergency departments (EDs) is the subject of current discussions. AIMS: The purpose of this study was to determine the reasons that outpatients with lower treatment urgency consult the ED. Further, the effects of the cooperation between primary care services and the ED will be examined. METHODS: The study was an exploratory secondary data analysis of data from the hospital information system and a quality management survey of a basic and standard care clinic in a rural area. All patients classified as 4 and 5 according to the emergency severity index (ESI), both four weeks before and after the primary care services and ED visit, were included in the study. RESULTS: During the two survey periods, a total of 1565 outpatient cases were treated, of which 962 cases (61%) were triaged ESI 4 or 5. Of these patients, 324 were surveyed (34%). Overall, 276 cases (85%) visited the ED without contacting a physician beforehand, 161 of the cases (50%) reported an emergency as the reason. In 126 cases (39%) the symptoms lasted more than one day. One-third of all outpatient admissions (537 cases, 34%) visited the ED during the opening hours of the general practitioner. DISCUSSION: More than 80% of the surviving cases visited the ED without physician contact beforehand. The most common reason for attending the ED was, "It is an emergency." The targeted control of the patients by integrating the primary care service into the ED does not lead to an increased number of cases in the primary care service, but to a subjective relief of the ED staff.

Methods for Addressing Technology-induced Errors: The Current State.

OBJECTIVES: The objectives of this paper are to review and discuss the methods that are being used internationally to report on, mitigate, and eliminate technology-induced errors. METHODS: The IMIA Working Group for Health Informatics for Patient Safety worked together to review and synthesize some of the main methods and approaches associated with technology- induced error reporting, reduction, and mitigation. The work involved a review of the evidence-based literature as well as guideline publications specific to health informatics. RESULTS: The paper presents a rich overview of current approaches, issues, and methods associated with: (1) safe HIT design, (2) safe HIT implementation, (3) reporting on technology-induced errors, (4) technology-induced error analysis, and (5) health information technology (HIT) risk management. The work is based on research from around the world. CONCLUSIONS: Internationally, researchers have been developing methods that can be used to identify, report on, mitigate, and eliminate technology-induced errors. Although there remain issues and challenges associated with the methodologies, they have been shown to improve the quality and safety of HIT. Since the first publications documenting technology-induced errors in healthcare in 2005, we have seen in a short 10 years researchers develop ways of identifying and addressing these types of errors. We have also seen organizations begin to use these approaches. Knowledge has been translated into practice in a short ten years whereas the norm for other research areas is of 20 years.

The Rising Frequency of IT Blackouts Indicates the Increasing Relevance of IT Emergency Concepts to Ensure Patient Safety.

INTRODUCTION: As many medical workflows depend vastly on IT support, great demands are placed on the availability and accuracy of the applications involved. The cases of IT failure through ransomware at the beginning of 2016 are impressive examples of the dependence of clinical processes on IT. Although IT risk management attempts to reduce the risk of IT blackouts, the probability of partial/total data loss, or even worse, data falsification, is not zero. The objective of this paper is to present the state of the art with respect to strategies, processes, and governance to deal with the failure of IT systems. METHODS: This article is conducted as a narrative review. RESULTS: Worst case scenarios are needed, dealing with methods as to how to survive the downtime of clinical systems, for example through alternative workflows. These workflows have to be trained regularly. We categorize the most important types of IT system failure, assess the usefulness of classic counter measures, and state that most risk management approaches fall short on exactly this matter. CONCLUSION: To ensure that continuous, evidence-based improvements to the recommendations for IT emergency concepts are made, it is essential that IT blackouts and IT disasters are reported, analyzed, and critically discussed. This requires changing from a culture of shame and blame to one of error and safety in healthcare IT. This change is finding its way into other disciplines in medicine. In addition, systematically planned and analyzed simulations of IT disaster may assist in IT emergency concept development.

A Consensus German Reporting Standard for Secondary Data Analyses, Version 2 (STROSA-STandardisierte BerichtsROutine für SekundärdatenAnalysen).

Although secondary data analyses have been established in recent years in health research, explicit recommendations for standardized, transparent and complete reporting of secondary data analyses do not exist as yet. Therefore, between 2009 and 2014, a first proposal for a specific reporting standard for secondary data analysis was developed (STROSA 1). Parallel to this national process in Germany, an international reporting standard for routine data analysis was initiated in 2013 (RECORD). Nevertheless, because of the specific characteristics of the German health care system as well as specific data protection requirements, the need for a specific German reporting standard for secondary data analyses became evident. Therefore, STROSA was revised and tested by a task force of 15 experts from the working group Collection and Use of Secondary Data (AGENS) of the German Society for Social Medicine and Prevention (DGSMP) and the German Society for Epidemiology (DGEpi) as well as from the working group Validation and Linkage of Secondary Data of the German Network for Health Services Research (DNVF). The consensus STROSA-2 checklist includes 27 criteria, which should be met in the reporting of secondary data analysis from Germany. The criteria have been illustrated and clarified with specific explanations and examples of good practice. The STROSA reporting standard aims at stimulating a wider scientific discussion on the practicability and completeness of the checklist. After further discussions and possibly resulting modifications, STROSA shall be implemented as a reporting standard for secondary data analyses from Germany. This will guarantee standardized and complete information on secondary data analyses enabling assessment of their internal and external validity.

[Identification and economic evaluation of anesthesiologic secondary diagnoses on the basis of intraoperative medication]. / Identifikation und ökonomische Bewertung von anästhesiologischen Nebendiagnosen auf Basis von intraoperativen Medikamentengaben.

BACKGROUND: Complications and comorbidities are encodable in the German diagnosis related groups (G-DRG) system and can improve revenues. In this study, secondary diagnoses were identified through drug administrations during anaesthesia and were economically evaluated by regrouping these cases. METHODS: All intraoperative drug administrations from 2008 were extracted from a database. After exclusion of synonyms and procedure-specific drug administrations, all remaining drugs were matched to explicit secondary diagnoses. All cases were regrouped with their newly defined secondary diagnoses by G­DRG grouper software, and changes in cost weight were evaluated. RESULTS: A total of 29 drugs could be assigned to 18 secondary diagnoses. From 22,440 anaesthesia the § 21 data record could be extracted in 1,929 cases and was regrouped with 2,976 secondary diagnoses, according to additional proceeds of 125,330.25 € in 2008 and 103,542.35 € in 2014. Intraoperative secondary diagnoses influence cost weight only in small parts. The average increase in revenue in this study could have been about 50 € per case. From 2008 to 2014 secondary diagnoses were continuously devaluated, although some of them, e. g. afibrinogenemia, have were revaluated. DISCUSSION: Our retrospective method of making a diagnosis and assuming a correct indication of drug administration is inapplicable to daily routine. The anaesthesiologic documentation has to make drug administration and thereby the secondary diagnosis plausible.

[Patient safety in anesthesiology : Multimodal strategies for perioperative care]. / Patientensicherheit in der Anästhesie : Multimodale Strategien für die perioperative Versorgung.

The concept of patient safety is more of a presence in modern day medicine than ever before. All measures and processes aiming at preempting and preventing critical incidents and accidents in patient care are collectively grouped under this concept. With the Declaration of Helsinki in 2010 modern anesthesiology has undertaken a fundamental role in the clinical implementation and perioperative clinicians are confronted with a multitude of theories, models, methods and tools targeted at improving or facilitating optimized patient safety. One of the biggest challenges lies in their synergistic combination to create a functioning concept for perioperative risk management while also incorporating individual strengths and weaknesses. The aim of the present paper is to provide a structured overview of the various components presently available for increasing perioperative patient safety.

The impact of early surgical intervention in free intestinal perforation: a time-to-intervention pilot study.

PURPOSES: An abdominal inflammatory focus is the second most often source of sepsis with a high risk of death in surgical intensive care units. By establishing evidence-based bundled strategies the surviving sepsis campaign provided an optimized rapid and continuous treatment of these emergency patients. Hereby the hospital mortality decreased from 35 to 30 %. Sepsis treatment is based on three major therapeutic elements: surgical treatment (source control), antiinfective treatment, and supportive care. The international guidelines of the surviving sepsis campaign were updated recently and recommend rapid diagnosis of the infection and source control within the first 12 h after the diagnosis (grade 1c). Interestingly this recommendation is mainly based on studies on soft tissue infections. METHODS: In this retrospective analysis 76 septic patients with an intraabdominal inflammatory focus were included. All patients underwent surgery at different time-points after diagnosis. RESULTS: With 80 % patients of the early intervention group had an improved overall survival (vs. 73 % in the late intervention group). CONCLUSIONS: Literature on the time dependency of early source control is rare and in part contradicting. Results of this pilot study reveal that immediate surgical intervention might be of advantage for septic emergency patients. Further multi-center approaches will be necessary to evaluate, whether the TTI has any impact on the outcome of septic patients with intestinal perforation.

Memorandum "Open Metadata". Open Access to Documentation Forms and Item Catalogs in Healthcare.

At present, most documentation forms and item catalogs in healthcare are not accessible to the public. This applies to assessment forms of routine patient care as well as case report forms (CRFs) of clinical and epidemiological studies. On behalf of the German chairs for Medical Informatics, Biometry and Epidemiology six recommendations to developers and users of documentation forms in healthcare were developed. Open access to medical documentation forms could substantially improve information systems in healthcare and medical research networks. Therefore these forms should be made available to the scientific community, their use should not be unduly restricted, they should be published in a sustainable way using international standards and sources of documentation forms should be referenced in scientific publications.

[The effect of peridural analgesia on long-term survival after surgery in patients with colorectal cancer : A systematic meta-analysis]. / Effekt einer perioperativen Periduralanalgesie auf das Langzeitüberleben von Patienten nach Resektion eines kolorektalen Karzinoms : Eine systematische Metaanalyse.

BACKGROUND: The results of recent clinical studies suggest a potential benefit of peridural analgesia (PDA) during general anesthesia on long-term survival in patients after surgery for colorectal cancer. In order to test the hypothesis a meta-analysis was performed. OBJECTIVES: To determine the prognostic impact of perioperative PDA on long-term survival in patients with colorectal cancer who underwent surgical resection. MATERIAL AND METHODS: By searching the relevant literature (up to May 2014) a total of 5 studies were identified from a total of 608 publications and a meta-analysis was carried out. Adjusted hazard ratios (HR) with 95 % confidence intervals (CI) were used to assess the strength of associations. The random effects model was used to analyze the data and a modified forest plot was applied. Additionally, a potential publication bias was visually examined in a funnel plot. RESULTS: A positive association between PDA and improved long-term survival was observed in patients who underwent surgery for colorectal cancer without metastases (HR = 0.81, 95 % CI 0.68-0.96, p = 0.055). CONCLUSION: Despite a publication bias the use of PDA in patients who underwent surgery for colorectal cancer without metastases seemed to be advantageous. Randomized controlled trials are warranted to confirm the positive effects of additional PDA. The exact mechanisms of tumor suppressive effects of PDA have not yet been elucidated.

[Customers who have bought a comfort alarm also bought wireless cable and volleyball rackets : legal and medical aspects of so-called comfort alarms]. / Kunden, die einen Sekundäralarm gekauft haben, kauften auch W-LAN-Kabel und Volleyballschläger : Rechtliche und medizinische Problematik von "Sekundäralarmen"

The word "secondary alarm" also sometimes known as "comfort alarm" means that a system indicates a critical situation (alarm condition) but this does not happen with the safety of an alarm system. A closer inspection of the small print reveals that the comfort alarm is in reality not an alarm but only additional information. This article summarizes in compact form what consequences this has for the user and what precautions should be taken when acquiring an alarm system.