[ChatGPT and the German board examination for ophthalmology: an evaluation]. / ChatGPT und die deutsche Facharztprüfung für Augenheilkunde: eine Evaluierung.

PURPOSE: In recent years artificial intelligence (AI), as a new segment of computer science, has also become increasingly more important in medicine. The aim of this project was to investigate whether the current version of ChatGPT (ChatGPT 4.0) is able to answer open questions that could be asked in the context of a German board examination in ophthalmology. METHODS: After excluding image-based questions, 10 questions from 15 different chapters/topics were selected from the textbook 1000 questions in ophthalmology (1000 Fragen Augenheilkunde 2nd edition, 2014). ChatGPT was instructed by means of a so-called prompt to assume the role of a board certified ophthalmologist and to concentrate on the essentials when answering. A human expert with considerable expertise in the respective topic, evaluated the answers regarding their correctness, relevance and internal coherence. Additionally, the overall performance was rated by school grades and assessed whether the answers would have been sufficient to pass the ophthalmology board examination. RESULTS: The ChatGPT would have passed the board examination in 12 out of 15 topics. The overall performance, however, was limited with only 53.3% completely correct answers. While the correctness of the results in the different topics was highly variable (uveitis and lens/cataract 100%; optics and refraction 20%), the answers always had a high thematic fit (70%) and internal coherence (71%). CONCLUSION: The fact that ChatGPT 4.0 would have passed the specialist examination in 12 out of 15 topics is remarkable considering the fact that this AI was not specifically trained for medical questions; however, there is a considerable performance variability between the topics, with some serious shortcomings that currently rule out its safe use in clinical practice.

Are residents' work schedules related to their in-training examination scores?

OBJECTIVE: To study the relationship between residents' pre-test available study time and subsequent examination performance. METHODS: We compiled rotation schedules and in-training examination performances for all residents enrolled in the two University of Texas Medical School-Houston obstetrics and gynecology residencies between 1993 and 1995. Services on which the residents had rotated were ranked by surveying all enrolled residents as to their perceived available study time while on those services. A mean available study time rating was computed for each service, which was used to describe each resident's schedule. Pearson correlations between available preparation-time preceding the in-training examination and examination performance were calculated. "Tough" and "easy" rotation subgroups were defined; two-tailed t tests were performed to compare the in-training examination performance of these subgroups. RESULTS: No significant correlation was found between available study time and subsequent examination scores beyond that which could be accounted for by year of training. Scores of residents in the "tough" subgroup were not significantly different from those in the "easy" subgroup on any examination performance measure. For correlations at the one-tailed .05 level, statistical power to detect relationships predicting 16% of variance ranges from approximately 85% for samples of 42 to 68% for samples of 27. CONCLUSION: Residents' in-training examination performance was not significantly affected by their service obligations. Altering resident monthly schedules is not likely to improve in-training examination performance.

Randomized crossover comparison of high-dose intravenous metoclopramide versus a five-drug antiemetic regimen.

In a randomized open crossover study, the antiemetic efficacy of a five-drug antiemetic regimen consisting of metoclopramide, dexamethasone, diazepam, diphenhydramine, and thiethylperazine was compared to that of high-dose metoclopramide. Thirteen patients treated with cisplatin combination chemotherapy regimens were evaluated. The study was terminated prior to accrual of the planned number of patients because of the statistically significant difference in efficacy between treatments found at interim analysis. The duration of nausea and number of vomiting episodes on the day of chemotherapy were significantly less (p less than 0.01) after receiving the five-drug combination. After receiving the five-drug regimen, 77% of the patients did not experience any episodes of vomiting on day 1, and 8% of patients had only one episode. In contrast, only 31% of patients treated with high-dose metoclopramide did not have any episodes of vomiting on day 1, and 61% of the patients had five or more episodes. None of the patients treated with the five-drug regimen required additional antiemetic administration. Although both regimens were, in general, well tolerated, when given the choice of continuing antiemetic therapies, 92% of the patients preferred the five-drug antiemetic combination.

Prenatal, intrapartum, and postpartum support of the lactating mother.

Physicians must continue to improve their knowledge regarding lactation. Improved education will allow for alterations in standard practices that may deter breastfeeding. Presently known influences on successful breastfeeding should direct changes in clinic and hospital practices. Continued research into various aspects of care in and out of the hospital must be pursued to improve maternal-infant care and breastfeeding.

Ovarian abscess 15 months after vaginal hysterectomy. A case report.

BACKGROUND: Ovarian abscess is a primary infection of ovarian parenchyma. Since 1869, only 44 cases after vaginal hysterectomy have been reported in the medical literature. The pathophysiology of bacterial infection in these cases is different from the traditional ascending mechanism. CASE: A 28-year-old woman presented with complaints of lower abdominal pain and fever 15 months after transvaginal hysterectomy. Her white blood cell count was 22,700/mm3, with 90% neutrophils. Bimanual examination revealed a tender mass in the cul-de-sac, and computed tomography showed a large, multiloculated pelvic mass. Laparotomy, pathologic examination and microbiologic study confirmed the diagnosis of ovarian abscess. CONCLUSION: Our case represents another rare posthysterectomy ovarian abscess. Most of these cases were managed by surgery and antibiotic treatment.

Liquid-chromatographic assay of dexamethasone in plasma.

We report a simple, efficient method for removing dexamethasone from plasma by use of solid-phase extraction columns. The dexamethasone is then quantified by "high-performance" liquid chromatography with ultraviolet detection at 254 nm. Dexamethasone concentrations and peak-height ratios were linearly related over the range 5 to 200 micrograms/L. The lower limit of sensitivity was 5 micrograms/L. The average recoveries of dexamethasone and methylprednisolone (internal standard) were 72 and 71%, respectively. This procedure offers improved efficiency over that of previously described methods by decreasing analytical time and improving sample clean-up. Sensitive, specific, and relatively inexpensive, this method is suitable for most clinical applications.

Structure and dynamics of ion transport through gramicidin A.

Molecular dynamics calculations in which all atoms were allowed to move were performed on a water-filled ion channel of the polypeptide dimer gramicidin A (approximately 600 atoms total) in the head-to-head Urry model conformation. Comparisons were made among nine simulations in which four different ions (lithium, sodium, potassium, and cesium) were each placed at two different locations in the channel as well as a reference simulation with only water present. Each simulation lasted for 5 ps and was carried out at approximately 300 K. The structure and dynamics of the peptide and interior waters were found to depend strongly on the ion tested and upon its location along the pore. Speculations on the solution and diffusion of ions in gramicidin are offered based on the observations in our model that smaller ions tended to lie off axis and to distort the positions of the carbonyl oxygens more to achieve proper solvation and that the monomer-monomer junction was more distortable than the center of the monomer. With the potential energy surface used, the unique properties of the linear chain of interior water molecules were found to be important for optimal solvation of the various ions. Strongly correlated motions persisting over 25 A among the waters in the interior single-file column were observed.