Using ChatGPT for Clinical Practice and Medical Education: Cross-Sectional Survey of Medical Students' and Physicians' Perceptions.

BACKGROUND: ChatGPT is a well-known large language model-based chatbot. It could be used in the medical field in many aspects. However, some physicians are still unfamiliar with ChatGPT and are concerned about its benefits and risks. OBJECTIVE: We aim to evaluate the perception of physicians and medical students toward using ChatGPT in the medical field. METHODS: A web-based questionnaire was sent to medical students, interns, residents, and attending staff with questions regarding their perception toward using ChatGPT in clinical practice and medical education. Participants were also asked to rate their perception of ChatGPT's generated response about knee osteoarthritis. RESULTS: Participants included 124 medical students, 46 interns, 37 residents, and 32 attending staff. After reading ChatGPT's response, 132 of the 239 (55.2%) participants had a positive rating about using ChatGPT for clinical practice. The proportion of positive answers was significantly lower in graduated physicians (48/115, 42%) compared with medical students (84/124, 68%; P<.001). Participants listed a lack of a patient-specific treatment plan, updated evidence, and a language barrier as ChatGPT's pitfalls. Regarding using ChatGPT for medical education, the proportion of positive responses was also significantly lower in graduate physicians (71/115, 62%) compared to medical students (103/124, 83.1%; P<.001). Participants were concerned that ChatGPT's response was too superficial, might lack scientific evidence, and might need expert verification. CONCLUSIONS: Medical students generally had a positive perception of using ChatGPT for guiding treatment and medical education, whereas graduated doctors were more cautious in this regard. Nonetheless, both medical students and graduated doctors positively perceived using ChatGPT for creating patient educational materials.

Is subclassification of Gartland extension-type pediatric supracondylar fracture into types IIA and IIB necessary for treatment decision? A result of pediatric orthopedist's survey and review of literature.

Extension-type pediatric supracondylar humeral fractures are very common. The Gartland classification is typically used to guide treatment. However, there is still no consensus on what factors should be used to subclassify the type II fractures and whether subclassification is needed to guide treatment. Therefore, we aim to explore the opinions of pediatric orthopedists on the treatment method of the Gartland type II supracondylar fracture. Specifically, we ask what factors are considered for their treatment decisions and whether subclassification is needed to guide treatment. An online questionnaire was developed and sent to the Thai Paediatric Orthopedics Society and Asia-Pacific Paediatric Orthopaedic Society members. The results were analyzed to explore the relationship between respondents' demographic factors and treatment decisions. Out of 113 participants reached, 57 (50.4%) responded to the questionnaire. Factors chosen by respondents are stability testing intraoperatively (73.7%), the relationship of the anterior humeral line and capitellum (66.7%), the presence of rotation (50.9%), the presence of translation (47.4%), the presence of medial comminution 42.1%), soft tissue condition(38.6%), the shaft - condylar angle (31.6%), and the Bauman angle (21.1%). Thirty-three of 57 respondents (57.9%) deemed subclassification for Gartland type II necessary for guiding treatment. About half of respondents in our study deemed the current Gartland type II subclassification necessary to guide treatment, which may indicate that the subclassification might not be sufficiently comprehensive and reliable. Therefore, better criteria for a subclassification and a prospective evaluating study might be needed.

A Preliminary Report on Augmented Reality Assisted Carpal Tunnel Release.

Augmented reality (AR) refers to the use of technology to enhance a real-world environment by computer generated visual, auditory, haptic, somatosensory and/or olfactory stimuli. We developed an augmented reality-assisted surgery (ARAS) for carpal tunnel syndrome (CTS). It generates a virtual image of the operative field that the surgeon can view. This enhances the operative experience. We report the use of ARAS in performing limited open carpal tunnel release. Level of Evidence: Level V (Therapeutic).

Comparative effectiveness of treatment modalities in severe Legg­Calvé­Perthes disease: Systematic review and network meta­analysis of observational studies.

PURPOSE: There are several treatment modalities for Legg-Calvé-Perthes disease (LCPD), self-limiting, avascular osteonecrosis of the femoral head in children. Most treatments focus on containment of the weakened femoral head, but there is no consensus on the best modality for severe LCPD. Therefore, we compared the effectiveness of all treatment modalities for severe LCPD. MATERIALS AND METHODS: We searched the PubMed, Embase, and Scopus up until July 2021 for studies that investigated LCPD treatment effectiveness. A network meta-analysis was performed to examine the comparative effectiveness in terms of the ability to achieve radiographic spherical congruity of the hip joint after skeletal maturity. The risk ratio (RR) and 95% confidence interval (CI) of each treatment modality were estimated from both direct and indirect evidence. Treatment ranking was based on Surface Under the Cumulative Ranking curve (SUCRA). RESULTS: A total of 857 studies were identified and 34 comparative studies with 3718 affected hips comparing seven different LCPD treatment modalities were included. Compared with symptomatic treatment, combined osteotomy was the most effective modality (RR = 1.47, 95% CI 0.90 to 2.42, SUCRA = 0.8), followed by femoral varus osteotomy (RR = 1.31, 95% CI 1.06 to 1.60, SUCRA = 0.7), and Salter innominate osteotomy (RR = 1.25, 95% CI 0.95 to 1.65, SUCRA = 0.6). CONCLUSIONS: Combined osteotomy is the most effective procedure in terms of improving the spherical congruity of the hip joint in severe LCPD patients. However, the superiority of operative treatments seems to be limited to patients older than eight years old.

Tuberculosis Septic Arthritis of the Elbow: A Case Report and Literature Review.

Tuberculosis (TB) infections of the musculoskeletal system are rare. A 77-year-old female with chronic left elbow pain for five months was treated by irrigation and debridement of the elbow for a presumed diagnosis of septic arthritis. Her pain and wound condition did not improve, and she was referred to our institution. Plain radiograph and magnetic resonance imaging (MRI) revealed an osteolytic lesion with joint effusion and severe destruction of the elbow joint. We suspected an atypical infection of the elbow due to the chronicity, negative culture results and severe osteoarticular destruction. An open arthrotomy with irrigation and debridement was performed, and the joint was stabilized with a pin and immobilized. A tissue acid-fast bacillus (AFB) stain was positive and Mycobacterium tuberculosis culture and polymerase chain reaction (PCR) were also positive. Anti-TB drugs were started for a planned 12-month course, but she developed an adverse drug reaction from the standard regimen and had to be switched to a second-line regimen. The stitches were removed at two weeks and the wound eventually healed. The elbow was immobilized in a posterior slab for six weeks then the pin was removed. At the last follow-up visit seven months after the initial surgery, she had improved, with only mild pain on elbow motion. Her range of motion was 110 degrees of flexion and extension lag of 30 degrees. TB of the elbow is a rare condition. The presentation is insidious and varies, and can be confused with other elbow conditions. Delayed diagnosis can lead to severe joint destruction and poor outcome. The physician should always suspect a TB elbow in cases of chronic elbow pain with synovitis, especially in areas endemic for TB. Joint fluid aspiration and MRI are the most reliable investigations for diagnosis. Anti-TB drugs are the mainstay of treatment. Appropriate surgical interventions such as drainage, synovectomy and reconstructive procedures will often be required. Collaboration between the orthopedist and an infectious specialist is essential for optimal treatment planning.

Factors for Blood Transfusions Following Hemi Hip Arthroplasty for Patients With Femoral Neck Fracture.

BACKGROUND: Hemi hip arthroplasty is one treatment option for femoral neck fractures; however, there has been limited evidence on factors associated with blood transfusions following hemi hip arthroplasty. Hence, the aim of this study was to identify the predictors of blood transfusion after hemi hip arthroplasty, which could lead to the establishment of proper guidelines for management protocols. MATERIALS AND METHODS: This study was a retrospective cohort study, conducted in a single center of 323 femoral neck fracture patients having undergone hemi hip arthroplasty. Peri-operative factors and demographic data were extracted from the electronic medical records, from 2007 to 2019. A predictive model was developed by logistic regression (LR), and adjusted by multivariate logistic regression. RESULT: One hundred and twenty-six (39%) patients received blood transfusions. On multivariate analysis, those of a female gender (odds ratio (OR) 2.00, p = 0.037), having a body mass index lower than 18.5 kg/m2 (OR 2.40, p = 0.028), lower preoperative hemoglobin levels (OR 0.52, p < 0.001) and given general anesthesia (OR 2.07, p = 0.028) were shown to be significantly associated with a higher risk of requiring a blood transfusion. CONCLUSION: The authors recommend that preparation of blood components coupled with the utilization of blood conserving methods for high risk patients, as studies have stated, in addition to the consideration of spinal anesthesia; if patients have no contraindication, should be implemented.