Bariatric Evaluation Through AI: a Survey of Expert Opinions Versus ChatGPT-4 (BETA-SEOV).

BACKGROUND: Recent advancements in artificial intelligence, such as OpenAI's ChatGPT-4, are revolutionizing various sectors, including healthcare. This study investigates the use of ChatGPT-4 in identifying suitable candidates for bariatric surgery and providing surgical recommendations to improve decision-making in obesity treatment amid the global obesity epidemic. METHODS: We devised ten patient scenarios, thoughtfully encompassing a spectrum that spans from uncomplicated cases to more complex ones. Our objective was to delve into the decision-making process regarding the recommendation of bariatric surgery. From July 29th to August 10th, 2023, we conducted a voluntary online survey involving thirty prominent bariatric surgeons, ensuring that there was no predetermined bias in the selection of a specific type of bariatric surgery. This survey was designed to collect their insights on these scenarios and gain a deeper understanding of their professional experience and background in the field of bariatric surgery. Additionally, we consulted ChatGPT-4 in two separate conversations to evaluate its alignment with expert opinions on bariatric surgery options. RESULTS: In 40% of the scenarios, disparities were identified between the two conversations with ChatGPT-4. It matched expert opinions in 30% of cases. Differences were noted in cases like gastrointestinal metaplasia and gastric adenocarcinoma, but there was alignment with conditions like endometriosis and GERD. CONCLUSION: The evaluation of ChatGPT-4's role in determining bariatric surgery suitability uncovered both potential and shortcomings. Its alignment with experts was inconsistent, and it often overlooked key factors, emphasizing human expertise's value. Its current use requires caution, and further refinement is needed for clinical application.

Keeping the service running: Examining working relationships and workload of London bus network iBus controllers.

Bus controllers are an essential part of the London bus network. Although the bus driver is the individual directly in control of the vehicle, inputs from both the controller and driver influence operations. Currently, little research has focused on the dynamic between these parties, and how it works in the day-to-day operation of a bus. In the current study, data was collected across focus groups with controllers to understand the controller-driver relationship from the controller perspective. The objectives of the research were to: investigate interactions and working relationships between bus controllers and drivers in London and to explore the effect of controller/driver relationships on workload, stress and fatigue. It is clear that the working relationship between controllers and drivers is a challenging one, with both parties often misunderstanding the role of the other. This is made worse by the nature of communication via radio including poor quality audio leading to difficult interactions. All of the participating controllers expressed being overloaded with work, leading to feelings of stress and fatigue, with shift work and irregular hours being discussed as a cause of controller fatigue. Any steps taken to improve the difficult working relationship between drivers and controllers can be seen as beneficial because they could improve efficiency, worker wellbeing, and possibly safety.

5-Year Results of Banded One-Anastomosis Gastric Bypass: a Pilot Study in Super-Obese Patients.

BACKGROUND: The novel banded one-anastomosis gastric bypass (B-OAGB) procedure has not previously been reported in super-obese patients over the long term. In this pilot study, outcomes in patients with a mean baseline body mass index (BMI, kg/m2) of ≥ 50 who underwent B-OAGB were evaluated through 5-year follow-up. PATIENTS AND METHODS: Total weight loss (TWL), excess weight loss (EWL), BMI evolution, and changes in type 2 diabetes biomarkers were analyzed prospectively in super-obese patients who underwent B-OAGB. Paired samples t tests were used to assess weight outcome change from baseline through 5-year follow-up and 95% CIs were calculated. The Bariatric Outcomes and Reporting System (BAROS) was used to assess surgical success at 3 time points. RESULTS: Between October 2013 and February 2014, a 12-patient pilot cohort (mean baseline BMI 57.5 ± 6.3) underwent B-OAGB. No perioperative complications were observed within 30 days. Five-year mean BMI was 31.2 ± 5.4, a BMI loss of 25.9 (TWL 45.3 ± 7.5%; EWL 72.2 ± 12.8%). Between 11 and 24 months following surgery, 3 patients required band removal; each had one complication (1 stasis esophagitis and recurrent vomiting; 1 hypoalbuminemia; 1 anemia). There was no mortality. Long-term B-OAGB BAROS subscale and composite scores were comparable to other major bariatric procedures. CONCLUSIONS: In a pilot study of super-obese patients who underwent B-OAGB, excellent durable BMI loss of 25.9 kg/m2 (EWL 72.2%) at 5 years was achieved with an acceptable level of reoperation. More B-OAGB long-term follow-up studies are necessary to provide definitive conclusions regarding this combination bariatric procedure.

The 'Saw but Forgot' error: A role for short-term memory failures in understanding junction crashes?

Motorcyclists are involved in an exceptionally high number of crashes for the distance they travel, with one of the most common incidents being where another road user pulls out into the path of an oncoming motorcycle frequently resulting in a fatal collision. These instances have previously been interpreted as failures of visual attention, sometimes termed 'Look but Fail to See' (LBFTS) crashes, and interventions have focused on improving drivers' visual scanning and motorcycles' visibility. Here we show from a series of three experiments in a high-fidelity driving simulator, that when drivers' visual attention towards and memory for approaching vehicles is experimentally tested, drivers fail to report approaching motorcycles on between 13% and 18% of occasions. This happens even when the driver is pulling out into a safety-critical gap in front of the motorcycle, and often happens despite the driver having directly fixated on the oncoming vehicle. These failures in reporting a critical vehicle were not associated with how long the driver looked at the vehicle for, but were associated with drivers' subsequent visual search and the time that elapsed between fixating on the oncoming vehicle and pulling out of the junction. Here, we raise the possibility that interference in short-term memory might prevent drivers holding important visual information during these complex manoeuvres. This explanation suggests that some junction crashes on real roads that have been attributed to LBFTS errors may have been misclassified and might instead be the result of 'Saw but Forgot' (SBF) errors. We provide a framework for understanding the role of short-term memory in such situations, the Perceive Retain Choose (PRC) model, as well as novel predictions and proposals for practical interventions that may prevent this type of crash in the future.

International multicenter study of safety and effectiveness of Swedish Adjustable Gastric Band in 1-, 3-, and 5-year follow-up cohorts.

BACKGROUND: No long-term, international, multicenter studies of the effectiveness and safety of the SAGB in morbid obesity have been previously published. The objective of this study was to assess the effectiveness and safety of the Swedish Adjustable Gastric Band (SAGB) at 6 bariatric centers in Australia, Europe, and Brazil, with < or =5 years of follow-up; the effect on patient covariates; and changes in co-morbidity. METHODS: A 2-phase study design was used, involving both retrospective and prospective data. SAGB was implanted by way of the pars flaccida 1, 3, and 5 years previously. The retrospective phase entailed a review of the records. The prospective phase included a subset of eligible patients who agreed to undergo additional clinical assessments. The percentage of excess weight loss (%EWL), patient level predictors, change in co-morbidities, and complications were analyzed. RESULTS: A total of 481 patients in 3 mutually exclusive follow-up cohorts (1 yr, n = 200; 3 yr, n = 184; 5 yr, n = 97) participated in the present study. Of these 481 patients, 339 (1 yr, n = 139; 3 yr, n = 131; 5 yr, n = 69) underwent prospective evaluations. The mean %EWL was 43.5% + or - 21.8%, 57.7% + or - 25.9%, and 49.8% + or - 27.6% and the mean change in body mass index was -7.64, -10.75, and -9.52 in the 1-, 3-, and 5-year cohorts, respectively (P <.001). Gender and age did not predict the %EWL; however, a greater preoperative body mass index was inversely related to the %EWL. Longer postimplantation times were associated with greater improvement in co-morbidities and with greater frequencies of reoperation. Fewer than 15% of the patients in the 5-year cohort had undergone band removal and 10% required band revisions. No fatal or life-threatening complications occurred. CONCLUSION: SAGB is safe and effective in inducing weight loss and improvement of co-morbidities in morbidly obese patients at international bariatric centers at 1, 3, and 5 years postoperatively.

Evolution of gastric band implantation and port fixation techniques.

BACKGROUND: Laparoscopic adjustable banding (LAGB) has been shown to be an effective bariatric procedure with low postoperative morbidity and mortality. Long-term complications of the operation, including gastric and esophageal dilation, gastric prolapse, erosion, and port and tubing problems, may be, in part, the result of LAGB implantation technique and the long-term follow-up program. Band technology and implantation technique are in ongoing development to improve the long-term safety and efficacy of gastric banding. The evolution of gastric band implantation technique has included the perigastric and pars flaccida dissections and the so-called "2-step," a combination of the procedures. For the majority of anatomic circumstances, the pars flaccida approach has been shown to be most efficient and reduces the incidence and severity of long-term LAGB complications, while the 2-step is a valuable option in patients with excessive perigastric and visceral fat. Recently, mechanical port fixation, an alternative to suture fixation, has been introduced with good early results. METHODS: The perigastric and 2-step techniques are summarized, and detailed descriptions of the essential steps and caveats of the pars flaccida approach and mechanical port fixation are provided. CONCLUSION: LAGB has been associated with complications that are lessened in incidence and severity by use of the pars flaccida technique and mechanical port fixation.

Mechanical versus suture fixation of the port in adjustable gastric banding procedures: a prospective randomized blinded study.

BACKGROUND: Laparoscopic adjustable gastric band port placement can require 9-25% of total implantation time. Prolonged port fixation combined with extended wound manipulation results in an elevated incidence of port-related complications (infection, port tension, pain, rotation). This study compared port fixation using a novel applier to traditional fixation using nonresorbable sutures. METHODS: From Dec 2005 to March 2006, 50 patients were enrolled into a prospective randomized study. Intra- and postoperative outcomes of placing the Swedish Adjustable Gastric Band((R)) (SAGB) Realize with Velocity port and fixation device (group A) were compared to those of the SAGB with its titanium suture-fixation port (group B). Patient characteristics, port implantation duration, incision length, postoperative port-site pain [via visual analogue scale (VAS)], pain medication, and complications were recorded. Minimum follow-up was 12 months (three visits). Postoperative evaluation was performed by an investigator not involved in the surgery. RESULTS: Patient groups were comparable in age, sex, and body mass index. In group A versus group B, mean port implantation time was lower (53.5 +/- 13.1 versus 451.3 +/- 84.9 s, p < 0.0001), port-site skin incision was longer (mean 4.1 +/- 0.2 versus 3.1 +/- 0.2 cm, p < 0.0001), and postoperative opioid consumption was less (mean 1.3 versus 3.0 units, p < 0.01). Group A reported less mean pain on the VAS (3.2 versus 3.8, p < 0.01); 0/25 group A versus 3/25 group B patients required hypnotics. There were no discernible differences between groups in hospitalization (mean 2.9 days), nursing requirements, or pain at 3, 6, and 12 months. In group A, no patient required reoperation for a port complication; two port rotations occurred in group B (NS). CONCLUSION: Velocity mechanical port applier fixation is superior in efficiency to port suture fixation, safely increasing the speed to port implant from nearly 8 min to under 1 min and decreasing total operative time by 19%. Port applier fixation trends to reduction of major complications and statistically significantly lessens the minor complication of port-site pain.

Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial.

BACKGROUND: Staple line failure, although uncommon, can result in significant morbidity and, even, mortality. Staple line buttressing has been developed to improve staple line strength, decrease bleeding, and minimize the risk of leak. Many different products are currently available. However, most have not been proved in clinical trials for their clinical relevance. METHODS: From April 2004 to March 2005, 48 morbidly obese patients who had undergone laparoscopic Roux-en-Y gastric bypass were enrolled in this study. The patients were randomly allocated to 2 groups according to whether polyglycolide acid and trimethylene carbonate (Seamguard) was (group 1, n = 24) or was not (group 2, n = 24) used in an investigator-initiated study. All patients underwent barium radiography at 3 and 12 months postoperatively. RESULTS: Peri- and postoperative mortality were absent. The intraoperative methylene blue test was positive in 1 patient in group 2. No conversion to laparotomy was needed. No patient required reoperation or transfusion for extraluminal bleeding, and no anastomotic leaks were detected in either group postoperatively. The mean number of clip instruments used was significantly lower in group 1 patients (2 versus 22, P <.0001, odds ratio 121.0, 95% confidence interval 12.5-1491). The operative time was significantly less in group 1 (115 +/- 30.0 min, range 85-210) compared with that in group 2 (150 +/- 51.7 min, range 90-240; P <.05). The postoperative hemoglobin level was significantly greater in group 1 (12.47 +/- 1.7 mg/dL, range 9.2-14.8) compared with that in group 2 (11.1 +/- 1.9 mg/dL, range 8.1-14.6; P <.05). Gastrogastric fistula formation was detected in 3 patients (12.5%) in group 2, with no statistically significant difference (P = .2). CONCLUSION: The results of our study have shown that synthetic reinforcement material minimizes staple line bleeding and reduces the operative time, with no animal source contamination. No adverse events related to the resorbable buttressing material were observed.

Implantable electrical gastric stimulation to treat morbid obesity in the human: operative technique.

BACKGROUND: The surgery to place the implantable gastric stimulator (IGS) is described. METHODS: There are two implantable components to the IGS. One is the electrical stimulator itself, which is placed in the anterior abdominal wall. It is connected to a bipolar lead that is positioned in the muscle wall of the stomach. We describe the procedure that is necessary to safely place the components. RESULTS: 4 patients have been implanted using techniques that were developed and refined around the world. There were no operative deaths. All procedures were successfully completed laparoscopically. Two (2/4) connections required revision because the leads were not fully inserted into the header of the generator. CONCLUSIONS: The operation to implant the IGS is safe and simple to perform. Attention to technical details is essential.