Comparison of artificial intelligence large language model chatbots in answering frequently asked questions in anaesthesia.

Background: Patients are increasingly using artificial intelligence (AI) chatbots to seek answers to medical queries. Methods: Ten frequently asked questions in anaesthesia were posed to three AI chatbots: ChatGPT4 (OpenAI), Bard (Google), and Bing Chat (Microsoft). Each chatbot's answers were evaluated in a randomised, blinded order by five residency programme directors from 15 medical institutions in the USA. Three medical content quality categories (accuracy, comprehensiveness, safety) and three communication quality categories (understandability, empathy/respect, and ethics) were scored between 1 and 5 (1 representing worst, 5 representing best). Results: ChatGPT4 and Bard outperformed Bing Chat (median [inter-quartile range] scores: 4 [3-4], 4 [3-4], and 3 [2-4], respectively; P<0.001 with all metrics combined). All AI chatbots performed poorly in accuracy (score of ≥4 by 58%, 48%, and 36% of experts for ChatGPT4, Bard, and Bing Chat, respectively), comprehensiveness (score ≥4 by 42%, 30%, and 12% of experts for ChatGPT4, Bard, and Bing Chat, respectively), and safety (score ≥4 by 50%, 40%, and 28% of experts for ChatGPT4, Bard, and Bing Chat, respectively). Notably, answers from ChatGPT4, Bard, and Bing Chat differed statistically in comprehensiveness (ChatGPT4, 3 [2-4] vs Bing Chat, 2 [2-3], P<0.001; and Bard 3 [2-4] vs Bing Chat, 2 [2-3], P=0.002). All large language model chatbots performed well with no statistical difference for understandability (P=0.24), empathy (P=0.032), and ethics (P=0.465). Conclusions: In answering anaesthesia patient frequently asked questions, the chatbots perform well on communication metrics but are suboptimal for medical content metrics. Overall, ChatGPT4 and Bard were comparable to each other, both outperforming Bing Chat.

EEG response of dexmedetomidine during drug induced sleep endoscopy.

Introduction: Dexmedetomidine is one of the anesthetics of choice for drug induced sleep endoscopy (DISE), with advantages including limited respiratory depression, analgesia, and decreased incidence of emergence delirium. However, challenges with determining sedation levels and prolonged recovery have limited its usage. An improved understanding of the effect of dexmedetomidine on the level of sedation and the corresponding electroencephalographic (EEG) changes could help overcome these barriers. Methods: Fifty-one patients received dexmedetomidine sedation with Richmond Agitation-Sedation Scale (RASS) score assessment and continuous EEG monitoring via SedLine for DISE. We constructed a pharmacokinetic model to determine continuous dexmedetomidine blood concentration. From the SedLine, we extracted the patient state index (PSI), and from the EEG we calculated the spectral edge frequency 95% (SEF95) and the correlation dimension (CD), a type of fractal dimension used to assess the complexity of a system. These metrics were subsequently compared against one another and with the dexmedetomidine concentration. Results: Our pharmacokinetic model yielded a two-compartment model with volumes of 51.8 L and 106.2 L, with clearances of 69.5 and 168.9 L/h, respectively, and a time to effect of 9 min, similar to prior studies. Based on this model, decreasing RASS score, SEF95, CD, and PSI were all significantly associated with increasing dexmedetomidine concentration (p < 0.001, p = 0.006, p < 0.001 respectively). The CD, SEF95, and PSI better captured the effects of increasing dexmedetomidine concentration as compared to the RASS score. Simulating dexmedetomidine concentration based on titration to target levels derived from CD and PSI confirmed commonly used dexmedetomidine infusion dosages. Conclusion: Dexmedetomidine use for DISE confirmed previous pharmacokinetic models seen with dexmedetomidine. Complex EEG metrics such as PSI and CD, as compared to RASS score and SEF95, better captured changes in brain state from dexmedetomidine and have potential to improve the monitoring of dexmedetomidine sedation.

Evaluation of patient state index, bispectral index, and entropy during drug induced sleep endoscopy with dexmedetomidine.

Multiple electroencephalographic (EEG) monitors and their associated EEG markers have been developed to aid in assessing the level of sedation in the operating room. While many studies have assessed the response of these markers to propofol sedation and anesthetic gases, few studies have compared these markers when using dexmedetomidine, an alpha-2 agonist. Fifty-one patients underwent drug induced sleep endoscopy with dexmedetomidine sedation. Continuous EEG was captured using SedLine (Masimo, Inc), and a playback system was used to extract the bispectral index (BIS) (Medtronic Inc), the patient state index (PSI) (Masimo, Inc), the state and response Entropy (GE Healthcare), and calculate the spectral edge frequency 95% (SEF95). Richmond Agitation-Sedation Scale (RASS) scores were assessed continually throughout the procedure and in recovery. We assessed the correlation between EEG markers and constructed ordinal logistic regression models to predict the RASS score and compare EEG markers. All three commercial EEG metrics were significantly associated with the RASS score (p < 0.001 for all metrics) whereas SEF95 alone was insufficient at characterizing dexmedetomidine sedation. PSI and Entropy achieved higher accuracy at predicing deeper levels of sedation as compared to BIS (PSI: 58.3%, Entropy: 58.3%, BIS: 44.4%). Lightening secondary to RASS score assessment is significantly captured by all three commercial EEG metrics (p < 0.001). Commercial EEG monitors can capture changes in the brain state associated with the RASS score during dexmedetomidine sedation. PSI and Entropy were highly correlated and may be better suited for assessing deeper levels of sedation.

Evaluation of the Stanford Anesthesiology Faculty Teaching Scholars Program Using the Context, Input, Process, and Product Framework.

Background: Faculty development programs are essential to the educational mission of academic medical centers as they promote skill development and career advancement and should be regularly evaluated to determine opportunities for improvement. The context, input, process, and product (CIPP) framework evaluates all phases of a program and focuses on improvement and outcomes. The aim of this study was to use the CIPP framework to evaluate the Stanford Anesthesiology Faculty Teaching Scholars Program. Methods: Using the CIPP framework, a survey was developed for alumni (2007 to 2018) of the program, followed by structured interviews, and each interview was deductively coded to identify themes. Results: Twenty-six of the 54 (48% response rate) participants in the program completed the survey, with 23 completing their projects and 17 of those projects still part of the anesthesiology training program. Seventeen survey responders went on to educational leadership roles. Twenty-five of the 26 survey responders would recommend this program to their colleagues. Fifteen structured interviews were conducted. Using the CIPP framework, themes were identified for context (reason for participation, previous experience in medical education, and resident education impact), input (benefits/negatives of the lecture series, availability of resources, and adequacy of nonclinical time), process (resident participation, mentorship, and barriers to implementation), and product (project completion, education sustainability, positive/negative outcomes of the program, and suggestions for improvement). Conclusions: The CIPP framework was successfully used to evaluate the Teaching Scholars Program. Areas of improvement were identified, including changing the program for input (add education lectures customized to faculty interests) and process (formally designate an experienced mentor to faculty).

The significance of widely split P waves: a case report.

BACKGROUND: P wave morphology on electrocardiogram is often overlooked but indicates abnormal cardiac conduction from various etiologies. Split P waves on electrocardiogram have been reported previously but not in a perioperative setting. CASE PRESENTATION: A 69-year-old Caucasian male patient with widely split P waves on his preoperative electrocardiogram was scheduled for a reimplantation right total hip replacement under a combined spinal-general anesthetic technique. The patient was evaluated prior to surgery by a cardiologist and the preoperative anesthesia clinic without any comment on the abnormal P wave morphology on electrocardiogram. The patient was cleared to proceed with anesthesia and surgery. Following induction of general anesthesia, his cardiac rhythm changed to a Mobitz type II pattern. The surgical procedure was cancelled, and a permanent cardiac pacemaker was inserted. CONCLUSIONS: Anesthesiologists should be aware that the presence of widely split P waves on electrocardiogram indicates the presence of atrial conduction abnormalities, likely from an ischemic or infiltrative process that can lead to more serious cardiac arrhythmias. P wave morphology should be observed and noted during the perioperative period for all patients.

Development of an Objective Structured Clinical Examination Using the American Board of Anesthesiology Content Outline for the Objective Structured Clinical Examination Component of the APPLIED Certification Examination.

The goal of this study was to use the American Board of Anesthesiology Objective Structured Clinical Examination (OSCE) content outline as a blueprint to develop and administer a 9-station mock OSCE with station-specific checklists to senior residents (n = 14). The G- and Ф-coefficient reliability estimates were 0.76 and 0.61, respectively. Residents judged the scenarios as either extremely or somewhat realistic (88%). It is feasible to develop and administer a mock OSCE with rigorous psychometric characteristics.

Radiometric studies of Mycobacterium tuberculosis

A atividade metabólica do M. tuberculosis sob diversas condiçöes experimentais foi estudada utilizando um sistema radiométrico automático, capaz de quantificar o 14CO2 produzido pela oxidaçäo de substâncias marcadas com Carbono-14. As experiências realizadas incluíram: a) vias metabólicas; b) determinaçäo dos tempos de detecçäo para inoculaçöes de diversas magnitudes; c) efeito da filtraçäo sobre a reprodutibilidade dos resultados; d) influência de meio hostil; e) determinaçäo das concentraçöes inibitórias mínimas para hidrazida, estreptomicina, etambutol e rifampicina; f) tempo de duplicaçäo para o M. tuberculosis e M. bovis. Estes microorganismos metabolizaram até 14CO2 o 14C-formato, (U-14C) acetato, (u-14C) glicerol, (1-14C) ácido palmítico, (1-14C) ácido láurico, (u-14C) L-ácido málico, (U-14C) D-glicose e (1-14C) D-glicose, mas näo (1-14C) L-glicose, (u-14C) glicina ou (U-14C) piruvato. Usando 14C-formato, (1-14C) ácido palmítico ou (1-14C) ácido láurico foi possível detectar 10 bacilos/frasco em 24-48 horas e até 10 bacilos/frasco em 16-20 dias. Resultados reprodutíveis foram obtidos sem filtrar a suspensäo de bactérias, desde que cultivadas em meio 7H9 líquido com 0,05% de polissorbato 80 e homogenizadas antes da experiência. Drogas que bloqueiam a síntese protêica apresentaram concentraçäo inibitória mínima menor com o método radiométrico do que com o convencional. O tempo médio de duplicaçäo para o M. bovis e várias cepas de M. tuberculosis com diversas substâncias marcadas foi 9 + ou - 1 horas