Revolutionizing Healthcare with ChatGPT: An Early Exploration of an AI Language Model's Impact on Medicine at Large and its Role in Pediatric Surgery.

BACKGROUND: ChatGPT, a natural language processing model, has shown great promise in revolutionizing the field of medicine. This paper presents a comprehensive evaluation of the transformative potential of OpenAI's ChatGPT on healthcare and scientific research, with an exploration on its prospective capacity to impact the field of pediatric surgery. METHODS: Through an extensive review of the literature, we illuminate ChatGPT's applications in clinical healthcare and medical research while presenting the ethical considerations surrounding its use. RESULTS: Our review reveals the exciting work done so far evaluating the numerous potential uses of ChatGPT in clinical medicine and medical research, but it also shows that significant research and advancements in natural language processing models are still needed. CONCLUSION: ChatGPT has immense promise in transforming how we provide healthcare and how we conduct research. Currently, further robust research on the safety, effectiveness, and ethical considerations of ChatGPT is greatly needed. LEVEL OF STUDY: V.

Site-selection criteria for the Einstein Telescope.

The Einstein Telescope (ET) is a proposed next-generation, underground gravitational-wave detector to be based in Europe. It will provide about an order of magnitude sensitivity increase with respect to the currently operating detectors and, also extend the observation band targeting frequencies as low as 3 Hz. One of the first decisions that needs to be made is about the future ET site following an in-depth site characterization. Site evaluation and selection is a complicated process, which takes into account science, financial, political, and socio-economic criteria. In this paper, we provide an overview of the site-selection criteria for ET, provide a formalism to evaluate the direct impact of environmental noise on ET sensitivity, and outline the necessary elements of a site-characterization campaign.

Increased Healthcare Utilization for Medical Comorbidities Prior to Surgery Improves Postoperative Outcomes.

OBJECTIVE: The purpose of this study was to evaluate the impact of optimization of preoperative comorbidities by nonsurgical clinicians on short-term postoperative outcomes. SUMMARY BACKGROUND DATA: Preoperative comorbidities can have substantial effects on operative risk and outcomes. The modifiability of these comorbidity-associated surgical risks remains poorly understood. METHODS: We identified patients with a major comorbidity (eg, diabetes, heart failure) undergoing an elective colectomy in a multipayer national administrative database (2010-2014). Patients were included if they could be matched to a preoperative surgical clinic visit within 90 days of an operative intervention by the same surgeon. The explanatory variable of interest ("preoperative optimization") was defined by whether the patient was seen by an appropriate nonsurgical clinician between surgical consultation and subsequent surgery. We assessed the impact of an optimization visit on postoperative complications with use of propensity score matching and multilevel, multivariable logistic regression. RESULTS: We identified 4531 colectomy patients with a major potentially modifiable comorbidity (propensity weighted and matched effective sample size: 6037). After matching, the group without an optimization visit had a higher rate of complications (34.6% versus 29.7%, P = 0.001). An optimization visit conferred a 31% reduction in the odds of a complication (P < 0.001) in an adjusted analysis. Median preoperative costs increased by $684 (P < 0.001) in the optimized group, and a complication increased total costs of care by $14,724 (P < 0.001). CONCLUSIONS AND RELEVANCE: We demonstrated an association between use of nonsurgical clinician visits by comorbid patients prior to surgery and a significantly lower rate of complications. These findings support the prospective study of preoperative optimization as a potential mechanism for improving postoperative outcomes.

Missed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery.

BACKGROUND: Certain behavioral traits and inadequate social support are known risk factors for complications after cancer surgery. Despite their importance, it is unclear whether conventional patient preoperative evaluation captures them. This study was conducted to assess concordance between documentation and patient survey of selected risk factors and to determine whether failure to document affected postoperative outcomes. METHODS: Adult patients at a tertiary academic medical center were surveyed before abdominal cancer surgery to assess 6 psychosocial risk factors. Risk factors were also assessed by retrospective chart review and compared with survey results through concordance measures. Thirty-day postoperative complications were abstracted by chart review. Rates of major complications for those with and without clinically missed risk factors were compared. RESULTS: Comparisons between chart review and screening survey revealed poor-to-moderate positive agreement (0%-47%) for 5 risk factors and strong negative agreement (82%-99%) among all risk factors. Kappa analysis demonstrated poor-to-fair agreement among 5 risk factors (κ = 0.112-0.423). The overall complication rate was 36%. The complication rate for patients with at least 1 clinically missed risk factor was 49% vs 24% in those without (P = .021), with a similar effect replicated for each individual risk factor. CONCLUSION: This study shows a high level of discordance between formal screening and routine clinician documentation in a preoperative setting for psychosocial risk factors. There is a significant association between missing these risk factors and worse postoperative outcomes. Future work should examine whether structured screening of psychosocial risk factors may improve preoperative risk stratification through proactive interventions.

Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients.

BACKGROUND: The specific effect of psychosocial risk factors on surgical outcomes in cancer patients remains unexplored. The purpose of this prospective observational study was to assess the association of preoperative psychosocial risk factors and 30-day complications following cancer surgery. METHODS: Psychosocial risks among elective gastrointestinal cancer surgery patients were ascertained through structured interviews using well-established screening forms. We then collected postoperative course by chart review. Multivariable analysis of short-term surgical outcomes was performed in those with a low versus high number of psychosocial risks. RESULTS: Overall, 142 patients had a median age of 65 years (interquartile range 55-71), 55.9% were male, and 23.1% were non-White. More than half (58.2%) of the study population underwent a resection for a hepato-pancreato-biliary primary tumor, and 31.9% had a colorectal primary tumor. High-risk biomedical comorbidities were present in 43.5% of patients, and three-quarters of patients (73.4%) had at least one psychosocial risk. Complication rates in patients with at least one psychosocial risk were 28.0 absolute percentage points higher than those with no psychosocial risks (54.4% vs. 26.2%, p = 0.039). Multiple psychosocial risk factors in medically comorbid patients independently conferred an increase in the odds of a complication by 3.37-fold (95% CI 1.08-10.48, p = 0.036) compared with those who had one or no psychosocial risks. CONCLUSIONS: We demonstrated a more than threefold odds of a complication in medically comorbid patients with multiple psychosocial risks. These findings support the use of psychosocial risks in preoperative assessment and consideration for inclusion in preoperative optimization efforts.

Comparison of Efficacy and Tolerance of Automatic Continuous Positive Airway Pressure Devices With the Optimum Continuous Positive Airway Pressure.

Patients diagnosed with obstructive sleep apnea syndrome were randomly placed on automatic continuous positive airway pressure (ACPAP) for 2 hours followed by manual titration for the rest of the night. One hundred sixty-one patients entered the study, with at least 50 patients titrated with each of 3 ACPAP devices. The optimum continuous positive airway pressure (CPAP) was defined as the lowest pressure with an apnea-hypoxia index of ≤5/hr, which ranged from 4 cm to 18 cm. Success with ACPAP was approximately 60%-80% when the optimum CPAP was 4-6 cm but fell to below 30% if the optimum CPAP was ≥8 cm (P = 0.001). Average ACPAP ranged from 2 to 10 cm below the optimum level if the optimum CPAP was ≥8 cm. Patients who responded to a low CPAP but deteriorated on higher pressures failed to respond to any of the automatic devices. We recommend that CPAP titration be performed manually before initiation of ACPAP in patients with obstructive sleep apnea. The basal pressure for ACPAP should be the optimum pressure obtained by manual titration. Limits on the upper level of ACPAP may be necessary for patients who deteriorate on higher positive pressures.

Efficacy and safety of intrapleural instillation of alteplase in the management of complicated pleural effusion or empyema.

We investigated the efficacy and safety of intrapleural instillation of recombinant tissue plasminogen activator (Alteplase) in 120 patients with complicated pleural effusion (CPE) or empyema. These 120 patients had failed simple chest tube placement and conventional medical treatment. The patients included 52 with empyema, 41 with CPE, 10 with hemothorax, and 17 with complicated malignant pleural effusions. A total of 345 doses of Alteplase were instilled intrapleurally in these patients, with doses ranging from 10 to 100 mg daily. Most patients required 3 to 4 doses of alteplase. After Alteplase therapy, complete resolution of CPE/empyema occurred in 102 patients (85%), partial resolution in 10 patients (8%), and failure to respond in 8 patients (7%). All patients who failed to respond to Alteplase treatment had either chronic empyema or empyema associated with lung abscesses. Adverse effects of Alteplase therapy were chest pain in 7 patients (6%) and bleeding at the chest tube site in 2 patients (2%).