Challenging ChatGPT 3.5 in Senology-An Assessment of Concordance with Breast Cancer Tumor Board Decision Making.

With the recent diffusion of access to publicly available large language models (LLMs), common interest in generative artificial-intelligence-based applications for medical purposes has skyrocketed. The increased use of these models by tech-savvy patients for personal health issues calls for a scientific evaluation of whether LLMs provide a satisfactory level of accuracy for treatment decisions. This observational study compares the concordance of treatment recommendations from the popular LLM ChatGPT 3.5 with those of a multidisciplinary tumor board for breast cancer (MTB). The study design builds on previous findings by combining an extended input model with patient profiles reflecting patho- and immunomorphological diversity of primary breast cancer, including primary metastasis and precancerous tumor stages. Overall concordance between the LLM and MTB is reached for half of the patient profiles, including precancerous lesions. In the assessment of invasive breast cancer profiles, the concordance amounts to 58.8%. Nevertheless, as the LLM makes considerably fraudulent decisions at times, we do not identify the current development status of publicly available LLMs to be adequate as a support tool for tumor boards. Gynecological oncologists should familiarize themselves with the capabilities of LLMs in order to understand and utilize their potential while keeping in mind potential risks and limitations.

Resilience of Gynecological and Obstetric Inpatient Care in Central Germany in Times of Repetitive Socioeconomic Shocks-An Epidemiological Study Assessing Standardized Health Services Indicators and Economic Status According to the aG-DRG Catalog.

Sequential socioeconomic shocks, including the COVID-19 pandemic, economic recession, or energy and refugee crises in the face of violent conflicts, have led to the failure of healthcare systems in Europe. Against this background, the aim of this study was to evaluate the resilience of regional gynecological and obstetric inpatient care using the example of a regional core medical provider in central Germany. Base data were retrieved from Marburg University Hospital and underwent standardized calculation and descriptive statistical assessment pursuant to the aG-DRG catalog. The data illustrate a decline in the average length of patient stays and average case complexity in combination with increasing patient turnover for the six-year observation period of 2017-2022. Core profitability of the departments of gynecology and obstetrics deteriorated in the year of 2022. The results suggest weakened resilience of gynecological and obstetrics inpatient care in the setting of a regional core medical provider in central Germany and indicate how it may have failed in core economic profitability. This is consistent with predictions about the lack of resilience of health systems and the critical economic situation of German hospitals in the face of ongoing socioeconomic shocks that collaterally endanger women's health care.

Chronological development of in-patient oncology in times of COVID-19: a retrospective analysis of hospitalized oncology and COVID-19 patients of a German University Hospital.

PURPOSE: The goal of this study is to examine the chronological development of hospitalized oncology and COVID-19 patients, and compare effects on oncology sub-disciplines for pre-pandemic (2017-19) and pandemic (2020-21) years in the setting of a German university maximum care provider. METHODS: Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with oncological main (nOnco) and COVID-19 secondary diagnosis (nCOVID-19). Data analysis is based on descriptive statistical assessment. RESULTS: The oncology patient collective (nOnco = 27,919) shows a decrease of hospitalized patients for the whole pandemic (- 4% for 2020 and - 2,5% for 2021 to 2019). The number of hospitalized COVID-19 patients increases from first to second pandemic year by + 106.71% (nCOVID-19 = 868). Maximum decline in monthly hospitalized oncology patients amounts to - 19% (May 2020) during the first and - 21% (December 2020) during the second lockdown. Relative monthly hospitalization levels of oncology patients reverted to pre-pandemic levels from February 2021 onwards. CONCLUSION: The results confirm a decline in hospitalized oncology patients for the entire pandemic in the setting of a maximum care provider. Imposed lockdown and contact restrictions, rising COVID-19 case numbers, as well as discovery of new virus variants have a negative impact on hospitalized treated oncological patients.

Impact of the COVID-19 Pandemic on Gyne-Oncological Treatment-A Retrospective Single-Center Analysis of a German University Hospital with 30,525 Patients.

The study pursues the objective of drawing a comparison between the data of gyne-oncology, gynecology, and obstetrics patient collectives of a German university hospital regarding the progression of patient number and corresponding treatment data during the five-year period of 2017-2021 to assess the impact of the COVID-19 pandemic on gyne-oncological treatment. Descriptive assessment is based on data extracted from the database of the hospital controlling system QlikView® for patients hospitalized at the Department of Gynecology and Obstetrics of Marburg University Hospital. Gynecology and gyne-oncology experience a maintained decline in patient number (nGynecology: -6% 2019 to 2020, -5% 2019 to 2021; nGyne-Oncology: -6% 2019 to 2020, -2% 2019 to 2021) with varying effects on the specific gyne-oncological main diagnoses. Treatment parameters remain unchanged in relative assessment, but as gyne-oncology constitutes the dominating revenue contributor in gynecology (35.1% of patients, 52.9% of revenue, 2021), the extent of the decrease in total revenue (-18%, 2019 to 2020, -14%, 2019 to 2021) surpasses the decline in patient number. The study displays a negative impact on the gynecology care situation of a German university hospital for the entire pandemic, with an even greater extent on gyne-oncology. This development not only endangers the quality of medical service provision but collaterally pressurizes gynecology service providers.

Use Case Evaluation and Digital Workflow of Breast Cancer Care by Artificial Intelligence and Blockchain Technology Application.

This study aims at evaluating the use case potential of breast cancer care for artificial intelligence and blockchain technology application based on the patient data analysis at Marburg University Hospital and, thereupon, developing a digital workflow for breast cancer care. It is based on a retrospective descriptive data analysis of all in-patient breast and ovarian cancer patients admitted at the Department of Gynecology of Marburg University Hospital within the five-year observation period of 2017 to 2021. According to the German breast cancer guideline, the care workflow was visualized and, thereon, the digital concept was developed, premised on the literature foundation provided by a Boolean combination open search. Breast cancer cases display a lower average patient case complexity, fewer secondary diagnoses, and performed procedures than ovarian cancer. Moreover, 96% of all breast cancer patients originate from a city with direct geographical proximity. Estimated circumference and total catchment area of ovarian present 28.6% and 40% larger, respectively, than for breast cancer. The data support invasive breast cancer as a preferred use case for digitization. The digital workflow based on combined application of artificial intelligence as well as blockchain or distributed ledger technology demonstrates potential in tackling senological care pain points and leveraging patient data safety and sovereignty.

Impact of the COVID-19 Pandemic on Delivery of Gynecology and Obstetrics Services at a Maximum Care University Hospital in Germany.

Einleitung Die COVID-19-Pandemie bedeutet einschneidende Maßnahmen für das nationale Gesundheitssystem. Dies bot den Anlass, die klinischen und ökonomischen Leistungsindikatoren der gynäkologischen und geburtshilflichen Versorgung des Universitätsklinikums Marburg als regionaler universitärer Maximalversorger zu analysieren. Hierzu wurden die Auswirkungen auf die monatlichen stationären und ambulanten Fallzahlvolumina sowie die entsprechenden ICD- und DRG-Kodierungen ausgewertet, um etwaige Versorgungsdefizite aufzudecken. Material und Methoden Die Studie basiert auf einer retrospektiven Datenanalyse therapierter stationären und ambulanten Fälle der Jahre 2016 bis 2020. Hierzu wurden über das klinikinterne Leistungscontrolling-Programm QlikView die Daten von 9487 Fällen der Klinik für Gynäkologie und 19597 Fällen der Klinik für Geburtshilfe ausgewertet. Ergebnisse Es bildet sich eine der nationalen Pandemiedynamik folgende Abnahme der gynäkologischen stationären Fallzahlen um -6% ab, während das geburtshilfliche Fallzahlvolumen um +11% im Jahr 2020 steigt. Insgesamt fallen die Effekte für die ambulante Versorgung geringer aus. Zudem lässt sich eine standortbezogene Abnahme der C50 "Bösartige Neubildungen der Brustdrüse" und C56 "Bösartige Ovarialtumoren" Diagnosen um -7,4% bzw. -14% feststellen. Eine Rückkehr zu dem Leistungsniveau des Vorjahres konnte im ambulanten in 3 und im stationären Sektor in 5 Monaten erreicht werden. Schlussfolgerung Die negativen Auswirkungen der COVID-19-Pandemie treffen vorwiegend die Klinik für Gynäkologie. Durch das Vertrauen in die Sicherheit der universitären Versorgung und das Serviceangebot, werdende Väter nach Schnelltestung am Geburtsprozess teilhaben zu lassen, konnte eine Fallzunahme in der Geburtshilfe erreicht werden. Die Rückkehr zu präpandemischen Leistungsniveaus gestaltet sich weiterhin schleppend, während sich der ohnehin weniger betroffene ambulante Sektor zügiger erholt. Der standortbezogene Rückgang der Diagnosen C50 und C56 ist besorgniserregend und bedarf epidemiologischer Aufarbeitung. Die fallzahlbezogenen Auswirkungen der Pandemie bilden sich gleichsam in den ökonomischen Leistungskennzahlen ab.

[The Role of Organizational Indicators within the Implementation of Cross-Sectoral Mental Health Care and Home Treatment in Germany - A Literature and Theory Review]. / Zur Rolle organisationaler Variablen bei der Implementierung sektorenübergreifender psychiatrischer Versorgung und stationsäquivalenter Behandlung in Deutschland.

OBJECTIVE: To elucidate organizational and human resource management-related drivers of community mental health services and home treatment in Germany. METHODS: Systematic review of psychiatric and organizational science literature, additional manual search. RESULTS: Relevant driver variables in community mental health services and home treatment have mostly been addressed. However, only a few have been evaluated and complex cause-and-effect models are missing so far. CONCLUSIONS: The proposed drivers, moderators, and throughputs should be integrated into an evaluation system that should be able to estimate effects of organizational and human resources on care-related and economic outcomes.

Primary prevention of childhood obesity: an interdisciplinary analysis.

The primary prevention of childhood obesity requires combined efforts by stakeholders at various societal levels, based on the knowledge from multiple disciplines. The goal of the present study was therefore to analyze current preventive approaches and delineate implications for future prevention research and practice by integrating knowledge from genetics, law, economics, psychology, and social ethics. Inconclusive evidence on the etiology of obesity, a complex, multifactorial condition, likely complicates prevention, leading to a lack of specificity regarding target groups, focus, and techniques. It is recommended to increase the specificity of prevention by explicitly considering risk factor evidence, including evidence on genetic factors. Because the institutional and legal framework of primary obesity prevention in children is insufficient in many countries, considering the risk factors for childhood obesity is also crucial for establishing a basis for legal regulations. Companies from sectors concerned with food intake and physical activity may be involved in preventive action, e.g., for initiating self-defeating sanctions. Long-term behavior change may be enhanced through the systematic application of behavior modification techniques within primary prevention programs. Overall, an interdisciplinary perspective furthers understanding of the complexity of this condition and can inform public health strategies on the primary prevention of childhood obesity.

[Primary prevention of adult obesity. an interdisciplinary analysis]. / Primäre Prävention der Adipositas bei Erwachsenen : Eine interdisziplinäre Analyse.

The primary prevention of adult obesity requires combined efforts by stakeholders at various societal levels, based on the knowledge from multiple disciplines. The goal of the present study was, therefore, to analyze current preventive approaches and delineate implications for future prevention research and practice by integrating knowledge from genetics, law, economics, psychology, and social ethics (Figure 1). Inconclusive evidence on the etiology of obesity, a complex, multifactorial condition, likely complicates prevention, contributing to a lack of specificity regarding target groups, focus, and techniques of prevention. Given the urgency and significance of the "obesity problem" that requires immediate and effective solutions, it is recommended that the various existing and developing prevention programs are evaluated to ensure orientation at current risk factor research. Results from genetic risk factor research can be used as a rationale to increase specificity of preventive measures regarding identification of high-risk groups, timing, and goals of prevention. Further, it is important to evaluate prevention programs for systematic application of behavior modification techniques and consideration of individual risk factors and resources to ensure promotion of long-term behavior change that leads to weight maintenance and a reduction of incidence rates of obesity in adults (Figure 3). Although the primary prevention of childhood obesity may lead to a reduction of incidence rates of obesity in adults, high rates of adult-onset obesity and the related medical and psychosocial sequelae in adulthood underscore the necessity of preventive efforts for adults. Concerning the environmental basis of obesity prevention, in many countries, the institutional and legal framework of preventive approaches requires further examination in order to improve funding, coordination between multiple stakeholders, and implementation of prevention in the health-care system. Evidence on risk factors for obesity is also crucial to inform network approaches and to justify restrictive legal options for the purpose of prevention. Here, self-defeating sanctions of the relevant industries may be a viable first step toward obesity prevention. As taxes or subsidies are limited in feasibility (Figure 2), relevant industries could be involved in the design and promotion of "healthy" products, stimulating greater request of such products. Network approaches appear suited to involve companies and other relevant stakeholders of prevention efforts on adult obesity. Yet these approaches require greater societal conscience about the severity of the obesity problem in adults and its multifactorial etiology. Recognizing the multifactorial etiology of obesity and acknowledging that weight regulation is only somewhat within personal responsibility may therefore lead to destigmatize obese individuals as the focus is shifted away from blaming them toward a more realistic understanding of this condition. Responsibility for the development of obesity and the prevention of weight gain is in multiple areas: law, policy, industry, health-care institutions, medical professions, and the individual - all should contribute to obesity prevention. Overall, the current analysis shows that an interdisciplinary perspective furthers understanding of the complexity of this condition and can inform public-health strategies on the prevention of adult obesity.