Would doctors dream of electric blood bankers? Large language model-based artificial intelligence performs well in many aspects of transfusion medicine.

BACKGROUND: Large language models (LLMs) excel at answering knowledge-based questions. Many aspects of blood banking and transfusion medicine involve no direct patient care and require only knowledge and judgment. We hypothesized that public LLMs could perform such tasks with accuracy and precision. STUDY DESIGN AND METHODS: We presented three sets of tasks to three publicly-available LLMs (Bard, GPT-3.5, and GPT-4). The first was to review short case presentations and then decide if a red blood cell transfusion was indicated. The second task was to answer a set of consultation questions common in clinical transfusion practice. The third task was to take a multiple-choice test experimentally validated to assess internal medicine postgraduate knowledge of transfusion practice (the BEST-TEST). RESULTS: In the first task, the area under the receiver operating characteristic curve for correct transfusion decisions was 0.65, 0.90, and 0.92, respectively for Bard, GPT-3.5 and GPT-4. All three models had a modest rate of acceptable responses to the consultation questions. Average scores on the BEST-TEST were 55%, 40%, and 87%, respectively. CONCLUSION: When presented with transfusion medicine tasks in natural language, publicly available LLMs demonstrated a range of ability, but GPT-4 consistently scored very well in all tasks. Research is needed to assess the utility of LLMs in transfusion medicine practice. Transfusion Medicine physicians should consider their role alongside such technologies, and how they might be used for the benefit and safety of patients.

Neuraxial Anesthesia Is Associated With Decreased Pain Scores and Post-Anesthesia Care Unit Opioid Requirement Compared With General Anesthesia in Hip Arthroscopy.

PURPOSE: We sought to identify the immediate postoperative differences in opioid use, pain scores, and post-anesthesia care unit (PACU) length of stay (LOS) after hip arthroscopy related to the type of anesthesia used for the surgical procedure. METHODS: Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome with labral tears by a single surgeon at an academic center between October 2017 and July 2019 were reviewed retrospectively. The primary outcome was PACU opioid administration, measured by morphine equivalents. Secondary parameters included total LOS, postincision LOS, PACU LOS, and PACU arrival/discharge pain scores. Analyses conducted were t tests, Wilcoxon rank sum tests, or χ2 tests. RESULTS: A total of 129 patients met inclusion criteria for this study; 54 male and 75 female, with an average age of 28 (±10.1) years. In total, 52 (40.3%) had general anesthesia and 77 (59.7%) had neuraxial anesthesia, including spinal, epidural, and combined spinal-epidural anesthesia, which were intermixed throughout the study period. Intraoperative and PACU opioid administration demonstrated a significant difference in medians. Neuraxial methods required a lower morphine equivalents in both the operating room (30.0 vs 53.9, P = .001) and PACU (18.2 vs 31.2, P = 0.002). Neuraxial anesthesia had lower median PACU arrival and discharge pain scores (0.0 vs. 5.0, P = .001, 3.0 vs. 4.0, P = .013). There was no statistically significant difference in postincision LOS or traction time. General anesthesia was associated with a longer PACU phase 1 time (1.0 vs 1.3 hours, P = .005). No major adverse events such as death, disability, or prolonged hospitalization occurred in either group. CONCLUSIONS: Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared with general anesthesia. LEVEL OF EVIDENCE: III, Retrospective Comparative Study.

Comparison of Hyperangulated and Standard Geometry Video Laryngoscopy Tracheal Intubation for Prehospital Care in a Manikin: A Randomized Controlled Crossover Trial.

OBJECTIVE: The purpose of this study was to investigate the efficacy of hyperangulated video laryngoscopy (HAVL) versus standard geometry video laryngoscopy (SGVL) in the simulated prehospital environment using a manikin. There is consensus that video laryngoscopy (VL) can be very useful in the emergency department when difficult intubations are predicted. Emergency medical service (EMS) providers are also often faced with difficult, rapidly deteriorating airway management situations that not only involve patient and operator factors but also include challenging unique environmental factors, such as nonoptimized positions in transport vehicles (eg, helicopters and ambulances) or at ground level or entrapped positions. To our knowledge, there has never been a study purposefully investigating the efficacy of hyperangulated geometry versus standard geometry VL techniques in the prehospital environment. METHODS: A single-center, randomized controlled crossover trial was performed using attending physician helicopter EMS providers. Physicians were randomized to perform 5 HAVL or SGVL intubations followed by the subsequent technique. Intubations were performed on ground level and then repeated in the helicopter with the first location also randomized. A manikin airway management trainer was used to simulate intubation in each environment. The time to intubation (primary outcome) as well as first-pass success and the Cormack-Lehane view were recorded for each attempt. Qualitative data were also obtained for physician preference and perceived difficulty. RESULTS: There was no statistically significant difference in the time to intubation with HAVL versus SGVL (ground: 15.02 vs. 14.88 seconds, P = .86; helicopter: 16.11 vs. 16.14 seconds, P = .93). First-pass success was 100% for both techniques in both scenarios. More Grade 1 views were obtained with HAVL (147/150 vs. 134/150). Moreover, most physicians preferred HAVL overall and felt that HAVL required less force (9/15 grounded manikin and 10/15 helicopter manikin) and led to the best chance for first-pass success (11/15 grounded manikin and 10/15 helicopter manikin). CONCLUSION: The results of this study are limited because of the static and highly favorable anatomy of a manikin versus the variability and often difficult anatomy of individual patients. Our results suggest that both techniques are efficacious when the patient is both on the ground or in the helicopter, although provider preference does seem to vary.

Ultrasound-guided rectus sheath block: an anatomic study in dog cadavers.

OBJECTIVES: To describe the ultrasound-guided rectus sheath block technique and the anatomical spread of two volumes of methylene blue injection in dog cadavers. STUDY DESIGN: Blinded, prospective, experimental cadaveric study. ANIMALS: A total of eight dog cadavers weighing 8.9 ± 1.6 kg. METHODS: Ultrasound-guided rectus sheath injections were performed bilaterally 1 cm cranial to the umbilicus using 0.25 mL kg-1 (low volume; LV) and 0.50 mL kg-1 (high volume; HV) of 0.5% methylene blue dye. A total of 16 hemiabdomens were injected. The ultrasound image quality of the muscular and fascial plane landmarks and needle visualization were scored using a standardized scale. Cadavers were dissected to determine the distribution of the dye and to assess staining of ventral branches of the spinal nerves. RESULTS: Fewer ventral spinal nerve branches were stained in the LV group than in the HV group, at 2.00 ± 0 and 2.90 ± 0.83, respectively (p < 0.01). Ventral branches of thoracic (T) and lumbar (L) spinal nerves (T10, T11, T12, T13 and L1) were stained 25%, 100%, 75%, 25% and 0% of the time in LV group and 12.5%, 87.5%, 100.0%, 75.0% and 13.0% in HV group. A lesser extent of cranial-caudal dye distribution was observed in the LV group than in the HV group (7.1 ± 1.8 cm and 9.2 ± 1.8 cm, respectively; p = 0.03). There was no significant difference in medial-lateral spread of dye, number of test doses or ultrasound image quality scores between groups. CONCLUSIONS AND CLINICAL RELEVANCE: The results of this study suggest that, on an anatomical basis, this easily performed block has the potential to provide effective abdominal wall analgesia for the ventral midline. This study supports the potential of the rectus sheath block for abdominal procedures, and further investigations on its clinical efficacy are warranted.

Description of an ultrasound-guided erector spinae plane block and the spread of dye in dog cadavers.

OBJECTIVES: To describe a technique to perform an ultrasound-guided erector spinae plane (ESP) block and determine the distribution and potential complications after injection of two volumes of methylene blue in dog cadavers. STUDY DESIGN: Prospective experimental cadaveric study. ANIMALS: A total of eight dog cadavers weighing 9.3 ± 1.9 kg. METHODS: Ultrasound-guided injections dorsal to the transverse process and ventral to the erector spinae muscles aimed at the fifth thoracic transverse process were performed bilaterally in each dog using 0.5 and 1.0 mL kg-1 dye solution [low volume (LV) and high volume (HV) treatments, respectively]. Treatments were randomly assigned to the right or left side of each dog, resulting in a total of 16 injections. Anatomical dissections determined dye spread characteristics, including epaxial muscles spread, staining of spinal nerves, dorsal rami, ventral rami (intercostal nerves) and sympathetic trunk spread. Staining indicating potential complications (epidural, mediastinal and intrapleural spread) was recorded. RESULTS: There was complete staining of at least one dorsal ramus following all injections. A more extensive spread was observed along the muscles in the HV compared with LV (p = 0.036). No significant difference between multisegmental dorsal rami spread (six out of eight injections in each treatment) was noted. Out of 16 injections, one in LV treatment resulted in multisegmental spinal nerve staining and one in HV treatment resulted in ventral ramus (intercostal nerve) staining. Use of anatomic landmarks resulted in inaccurate identification of the fifth transverse process in at least six out of 16 injections (38%). No sympathetic trunk, epidural, mediastinal or intrapleural staining was observed. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided ESP injections resulted in extensive staining along the epaxial muscles, as well as staining of the dorsal rami in all dogs. The incidence of dorsal rami mutisegmental spread was the same in both treatments.

Description of an ultrasound-guided thoracic paravertebral block technique and the spread of dye in dog cadavers.

OBJECTIVES: To describe an ultrasound-guided thoracic paravertebral block and determine the distribution after injection of two volumes of methylene blue in dog cadavers. STUDY DESIGN: Prospective experimental cadaveric study. ANIMALS: Twelve dog cadavers weighing 11 ± 3 kg. METHODS: Ultrasound-guided injections aimed at the fifth thoracic (T5) paravertebral space were performed in randomized order using 0.1 or 0.3 mL kg-1 dye solution (six dogs for each volume). Anatomic dissections determined dye spread characteristics, including the presence and degree of staining of spinal nerves, and the presence of intercostal and sympathetic trunk spread. Staining of mediastinum, epidural, intrapleural and contralateral thoracic paravertebral space was recorded. RESULTS: There was no significant difference in dye distribution between groups. The use of anatomic landmarks resulted in the inaccurate identification of the T5 paravertebral space. The T4, T5 and T6 paravertebral spaces were injected in four, five and three of 12 dogs, respectively. Complete staining of the spinal nerve of the thoracic paravertebral space injected was observed in 11 of 12 dogs, and partial staining in one dog in the low-volume group. Multisegmental distribution was demonstrated with staining of contiguous spinal nerves in one dog in the high-volume group, and multiple segments of intercostal (three dogs) and sympathetic trunk (four dogs) spread in both groups. No mediastinal, epidural, intrapleural or contralateral thoracic paravertebral space staining was observed. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided injection at the thoracic paravertebral space resulted in staining of the spinal nerve in all dogs. However, T5 paravertebral space was not accurately identified using anatomic landmarks. Dye distribution was not significantly different between the two groups; therefore, the use of the lower-volume and multiple-site injections would be potentially necessary in clinical cases to achieve ipsilateral blockade of the thoracic wall.

A Comparison of Single Shot Adductor Canal Block Versus Femoral Nerve Catheter for Total Knee Arthroplasty.

The aim of this study was to compare perioperative analgesia provided by single-injection adductor canal block (ACB) to continuous femoral nerve catheter (FNC) when used in a multimodal pain protocol for total knee arthroplasty (TKA). A retrospective cohort study compared outcome data for 148 patients receiving a single-injection ACB to 149 patients receiving an FNC. The mean length of stay (LOS) in the ACB group was 2.67 (±0.56) and 3.01 days (±0.57) in the FNC group (P<0.0001). The median ambulatory distances for the adductor group were further than the femoral group for postoperative days 1 (P<0.0001) and 2 (P=0.01). Single-injection ACB offered similar pain control and earlier discharge compared to continuous FNC in patients undergoing TKA.

Personal hand gel for improved hand hygiene compliance on the regional anesthesia team.

PURPOSE: Hand hygiene reduces healthcare-associated infections, and several recent publications have examined hand hygiene in the perioperative period. Our institution's policy is to perform hand hygiene before and after patient contact. However, observation suggests poor compliance. This is a retrospective review of a quality improvement database showing the effect of personal gel dispensers on perioperative hand hygiene compliance on a regional anesthesia team. METHODS: Healthcare providers assigned to the Acute Pain Service were observed for compliance with hand hygiene policy during a quality improvement initiative. Provider type and compliance were prospectively recorded in a database. Team members were then given a personal gel dispensing device and again observed for compliance. We have retrospectively reviewed this database to determine the effects of this intervention. RESULTS: Of the 307 encounters observed, 146 were prior to implementing personal gel dispensers. Compliance was 34%. Pre- and post-patient contact compliances were 23 and 43%, respectively. For 161 encounters after individual gel dispensers were provided, compliance was 63%. Pre- and post-patient contact compliances were 53 and 72%, respectively. Improvement in overall compliance from 34 to 63% was significant. CONCLUSION: On the Acute Pain Service, compliance with hand hygiene policy improves when individual sanitation gel dispensing devices are worn on the person.

Post-dural puncture headaches following spinal drain placement during thoracoabdominal aortic aneurysm repair: incidence, associated risk factors, and treatment.

PURPOSE: Spinal drains are used as a neuroprotective measure during thoracoabdominal aortic aneurysm (TAA) repair. Unfortunately, these drains can cause post-dural puncture headaches (PDPH). While PDPH following spinal anesthesia have been thoroughly evaluated, limited data exists about the incidence and risk factors for PDPH following spinal drains. Additionally, the efficacy of treatment with conservative therapies and epidural blood patches (EBP) for PDPH secondary to spinal drains has not been well documented. METHODS: Data on 235 patients receiving spinal drains for scheduled TAA repair and surviving to discharge between January, 2005 and July, 2012 at the University of Wisconsin Hospitals and Clinics were retrospectively reviewed. The following data were extracted from the patient medical record: patient demographics, pre-existing medical conditions, spinal drain details, PDPH presentation, PDPH treatment methods, and success of treatments used. This data was then analyzed for statistical significance. RESULTS: Of 235 patients, 43 (18.3 %) developed PDPH. Younger age (p < 0.001) and history of preoperative headache (p ≤ 0.001) were found to increase the risk of PDPH. Use of EBP, either as the primary treatment, or following failed conservative therapy, was found to be a more effective treatment for PDPH than conservative therapies alone (p = 0.017). CONCLUSIONS: Spinal drain placement carries a risk of PDPH, as supported by an 18.3 % PDPH incidence in this study. Younger patients and/or patients with a history of chronic headache are at elevated risk for PDPH. Treatment using EBP, either as primary therapy or following unsuccessful conservative therapies, is a significantly more effective treatment than conservative therapies alone.

Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial.

PURPOSE: Propofol injection pain, despite various strategies, remains common and troublesome. This study aimed to test the hypothesis that pretreatment with the combination of intravenous lidocaine and magnesium would have an additive effect on reducing propofol injection pain. METHODS: After institutional review board (IRB) approval and informed consent, we performed a prospective, double-blind, placebo-controlled, randomized trial. Subjects were randomly assigned to pretreatment with either lidocaine (50 mg), magnesium sulfate (0.25 mg), lidocaine (50 mg) plus magnesium sulfate (0.25 mg), or 0.9 % sodium chloride. Following pretreatment, propofol (50 mg) was administered, and subjects were questioned regarding injection site pain and observed for behavioral signs of pain. RESULTS: Two hundred subjects were enrolled and 158 subjects (39 placebo, 38 lidocaine, 44 magnesium sulfate, and 37 lidocaine plus magnesium sulfate) received their assigned pretreatment intervention. Intergroup baseline characteristics were similar. The proportion of subjects reporting propofol injection pain was highest in those pretreated with magnesium sulfate (57 %), followed by those pretreated with placebo (46 %), lidocaine plus magnesium sulfate (41 %), and then lidocaine (29 %; p = 0.011). When adjusted for age, gender, diabetes mellitus, chronic pain, tobacco use, and selective-serotonin reuptake inhibitor use, the pain response scale scores were significantly reduced by lidocaine pretreatment compared to magnesium sulfate and placebo (p = 0.031 and p = 0.0003, respectively). CONCLUSIONS: In this double-blind, placebo-controlled, randomized trial, the combination of intravenous magnesium sulfate and lidocaine offered no additional benefit for the relief of propofol injection pain compared to intravenous lidocaine alone. An improved, receptor-based understanding of the mechanism of propofol injection pain is still needed.

Artificial intelligence and regional anesthesiology education curriculum development: navigating the digital noise.

Artificial intelligence (AI) has demonstrated a disruptive ability to enhance and transform clinical medicine. While the dexterous nature of anesthesiology work offers some protections from AI clinical assimilation, this technology will ultimately impact the practice and augment the ability to provide an enhanced level of safe and data-driven care. Whether predicting difficulties with airway management, providing perioperative or critical care risk assessments, clinical-decision enhancement, or image interpretation, the indications for AI technologies will continue to grow and are limited only by our collective imagination on how best to deploy this technology.An essential mission of academia is education, and challenges are frequently encountered when working to develop and implement comprehensive and effectively targeted curriculum appropriate for the diverse set of learners assigned to teaching faculty. Curriculum development in this context frequently requires substantial efforts to identify baseline knowledge, learning needs, content requirement, and education strategies. Large language models offer the promise of targeted and nimble curriculum and content development that can be individualized to a variety of learners at various stages of training. This technology has not yet been widely evaluated in the context of education deployment, but it is imperative that consideration be given to the role of AI in curriculum development and how best to deploy and monitor this technology to ensure optimal implementation.

Danger, Danger, Gaston Labat! Does zero-shot artificial intelligence correlate with anticoagulation guidelines recommendations for neuraxial anesthesia?

INTRODUCTION: Artificial intelligence and large language models (LLMs) have emerged as potentially disruptive technologies in healthcare. In this study GPT-3.5, an accessible LLM, was assessed for its accuracy and reliability in performing guideline-based evaluation of neuraxial bleeding risk in hypothetical patients on anticoagulation medication. The study also explored the impact of structured prompt guidance on the LLM's performance. METHODS: A dataset of 10 hypothetical patient stems and 26 anticoagulation profiles (260 unique combinations) was developed based on American Society of Regional Anesthesia and Pain Medicine guidelines. Five prompts were created for the LLM, ranging from minimal guidance to explicit instructions. The model's responses were compared with a "truth table" based on the guidelines. Performance metrics, including accuracy and area under the receiver operating curve (AUC), were used. RESULTS: Baseline performance of GPT-3.5 was slightly above chance. With detailed prompts and explicit guidelines, performance improved significantly (AUC 0.70, 95% CI (0.64 to 0.77)). Performance varied among medication classes. DISCUSSION: LLMs show potential for assisting in clinical decision making but rely on accurate and relevant prompts. Integration of LLMs should consider safety and privacy concerns. Further research is needed to optimize LLM performance and address complex scenarios. The tested LLM demonstrates potential in assessing neuraxial bleeding risk but relies on precise prompts. LLM integration should be approached cautiously, considering limitations. Future research should focus on optimization and understanding LLM capabilities and limitations in healthcare.

Use of a chlorhexidine-impregnated patch does not decrease the incidence of bacterial colonization of femoral nerve catheters: a randomized trial.

PURPOSE: Femoral nerve catheter (FNC) insertion is commonly performed for postoperative analgesia following total knee arthroplasty (TKA). A wide range of rates has been reported relating to the bacterial colonization of catheters complicating FNC insertion. The BIOPATCH® is a chlorhexidine (CHG) impregnated patch designed to inhibit bacterial growth for days. The BIOPATCH has proven to be effective at decreasing bacterial colonization in epidural and vascular catheters. We hypothesized that the BIOPATCH would be effective at decreasing the rates of FNC bacterial colonization. METHODS: Following Institutional Review Board approval and written informed consent, 100 patients scheduled for TKA were prospectively enrolled in the study. Patients at elevated risk for infection were excluded from analysis. Femoral nerve catheters were inserted and tunneled under sterile conditions using ultrasound guidance following CHG skin cleansing. Participants were then randomized either to have the BIOPATCH applied to the catheter exit site or not to have the patch applied. All patients received pre/postoperative antibiotic therapy. The FNC tip and catheter exit site were cultured for bacterial growth at the conclusion of therapy. RESULTS: No differences were observed between groups in regards to catheter exit site. Catheter colonization was observed in three of 48 (6.3%) BIOPATCH patients and two of 47 (4.3%) non-BIOPATCH patients (risk ratio [RR] = 1.5; 95% confidence interval [CI] 0.3 to 8.4; P = 1.0). Colonization of the catheter exit site was observed in 12 BIOPATCH and 14 non-BIOPATCH patients (RR = 0.8; 95% CI 0.4 to 1.6; P = 0.65). Local skin inflammation (non-BIOPATCH 10.6% vs BIOPATCH 2.1%) and colonization of the FNC exit site by more than one type of bacteria trended towards increased values in the non-BIOPATCH group. CONCLUSIONS: The baseline rate of bacterial colonization of FNCs is quite low in the setting of short-term use, CHG skin decontamination, ultrasound guidance, subcutaneous tunneling, and perioperative antibiotic therapy. No benefit was shown by using the BIOPATCH in this patient population. (ClinicalTrials.gov number: NCT01411891).

Weight-based volume of injection influences cranial to caudal spread of local anesthetic solution in ultrasound-guided transversus abdominis plane blocks in canine cadavers.

OBJECTIVE: To determine if the volume of injected local anesthetic solution affects cranial to caudal spread when performing ultrasound-guided transversus abdominis plane (TAP) blocks in dogs. STUDY DESIGN: Prospective experimental study. ANIMALS: Adult Beagle cadavers (n = 20) METHODS: Bilateral TAP blocks using ultrasound guidance was performed in 20 Beagle cadavers (mean ± SD weight, 9.3 ± 1.4 kg) using a 1:1 solution of methylene blue/bupivacaine injected at volumes of 0.25, 0.5, 0.75, and 1.0 mL/kg. Cadavers were dissected to determine injectate spread within the transversus abdominis fascial plane. RESULTS: The transversus abdominis fascial plane was adequately identified by ultrasonography, injected, and dissected in 38 beagle hemi-abdominal walls; injectate was not identified in 2 hemi-abdominal walls. Dermatomal spread (number of ventral nerve roots saturated by injected solution) was volume dependent (P = .026, Kruskal Wallis): 2.9 ± 0.74 nerve roots for 0.25 mL/kg; 3.4 ± 1.1 for 0.5 mL/kg; 4.0 ± 0.67 for 0.75 mL/kg; and 4.2 ± 1.2 for 1 mL/kg. CONCLUSION: In Beagle cadavers, the volume of injected local anesthetic solution significantly affects cranial to caudal spread within the TAP during ultrasound-guided TAP blocks. The volume of local anesthetic injected could potentially be used to augment the spread of analgesic coverage for a given surgical procedure in dogs.

Evaluation of language analysis to summarize the literature: a comparison to traditional meta-analysis in primary hip and knee surgery.

INTRODUCTION: Sentiment analysis, by evaluating written wording and its context, is a growing tool used in computer science that can determine the level of support expressed in a body of text using artificial intelligence methodologies. The application of sentiment analysis to biomedical literature is a growing field and offers the potential to rapidly and economically explore large amounts of published research and characterize treatment efficacy. METHODS: We compared the results of sentiment analysis of 115 article abstracts analyzed in a recently published meta-analysis of peripheral nerve block usage in primary hip and knee arthroplasty to the conclusions drawn by the authors of the original meta-analysis. RESULTS: A moderately positive outlook supporting the utilization of regional anesthesia for hip and knee arthroplasty was found in the 115 articles that were included for analysis, with 46% expressing positive sentiment, 35% expressing neutral sentiment, and 19% of abstracts expressing negative sentiment. This was well aligned with the conclusions reached by a previous meta-analysis of the same articles. DISCUSSION: Sentiment analysis applied to the medical literature can rapidly evaluate large collections of published data and generate an impression of overall findings that are aligned with the findings of a traditional meta-analysis.

Utilization of sentiment analysis to assess and compare negative finding reporting in veterinary and human literature.

Publication bias and the decreased publication of trials with negative or non-significant results is a well-recognized problem in human and veterinary medical publications. These biases may present an incomplete picture of evidence-based clinical care and negatively impact medical practices. The purpose of this study was to utilize a novel sentiment analysis tool as a quantitative measure for assessing clinical trial reporting trends in human and veterinary medical literature. Abstracts from 177,617 clinical trials in human medical journals and 8684 in veterinary medical journals published in the PubMed database from 1995 to 2020. Abstracts were analyzed using the GAN-BioBERT sentiment classifier for both general trends and percentage of neutral/negative publications. Sentiment was defined on a - 1 (highly negative) to 1 (highly positive) scale. Human-based clinical trial publications were less likely to feature positive findings (OR 0.87, P < 0.001) and more likely to include neutral findings (OR 1.18, P < 0.001) relative to veterinary clinical trials. No difference was found in reporting of negative sentiment trials (OR 1.007, P = 0.83). In both groups, the published sentiment of clinical trials increased over time. Using sentiment analysis to evaluate large publication datasets and compare publication trends within and between groups, this study is significant in its detection of significant publication differences between human and veterinary medicine clinical trials and a continued unbalanced positive sentiment in the published literature. The implications of this unbiased reporting have important clinical and research implications that require consideration.

Validating GAN-BioBERT: A Methodology for Assessing Reporting Trends in Clinical Trials.

Background: The aim of this study was to validate a three-class sentiment classification model for clinical trial abstracts combining adversarial learning and the BioBERT language processing model as a tool to assess trends in biomedical literature in a clearly reproducible manner. We then assessed the model's performance for this application and compared it to previous models used for this task. Methods: Using 108 expert-annotated clinical trial abstracts and 2,000 unlabeled abstracts this study develops a three-class sentiment classification algorithm for clinical trial abstracts. The model uses a semi-supervised model based on the Bidirectional Encoder Representation from Transformers (BERT) model, a much more advanced and accurate method compared to previously used models based upon traditional machine learning methods. The prediction performance was compared to those previous studies. Results: The algorithm was found to have a classification accuracy of 91.3%, with a macro F1-Score of 0.92, significantly outperforming previous studies used to classify sentiment in clinical trial literature, while also making the sentiment classification finer grained with greater reproducibility. Conclusion: We demonstrate an easily applied sentiment classification model for clinical trial abstracts that significantly outperforms previous models with greater reproducibility and applicability to large-scale study of reporting trends.

A multisociety organizational consensus process to define guiding principles for acute perioperative pain management.

The US Health and Human Services Pain Management Best Practices Inter-Agency Task Force initiated a public-private partnership which led to the publication of its report in 2019. The report emphasized the need for individualized, multimodal, and multidisciplinary approaches to pain management that decrease the over-reliance on opioids, increase access to care, and promote widespread education on pain and substance use disorders. The Task Force specifically called on specialty organizations to work together to develop evidence-based guidelines. In response to this report's recommendations, a consortium of 14 professional healthcare societies committed to a 2-year project to advance pain management for the surgical patient and improve opioid safety. The modified Delphi process included two rounds of electronic voting and culminated in a live virtual event in February 2021, during which seven common guiding principles were established for acute perioperative pain management. These principles should help to inform local action and future development of clinical practice recommendations.