Toward a Frontierless Collaboration in Neurosurgery: A Systematic Review of Remote Augmented and Virtual Reality Technologies.

OBJECTIVE: Augmented reality (AR) and virtual reality (VR) technologies have been introduced to neurosurgery with the goal of improving the experience of human visualization. In recent years, the application of remote AR and VR has opened new horizons for neurosurgical collaboration across diverse domains of education and patient treatment. Herein, we aimed to systematically review the literature about the feasibility of this technology and discuss the technical aspects, current limitations, and future perspectives. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 4 databases (PubMed, Embase, Scopus, and Cochrane Library) were queried for articles discussing the use of remote AR and VR technologies in neurosurgery. Data were collected in various fields, including surgery type, application type, subspecialty, software and hardware descriptions, haptic device utilization, visualization technology, internet connection, remote site descriptions, technical outcomes, and limitations. Data were summarized as counts and proportions and analyzed using IBM SPSS software. RESULTS: Our search strategy generated 466 records, out of which 9 studies satisfied the inclusion criteria. The majority of AR and VR applications were used in cranial procedures (77.8%), mainly in education (63.6%), followed by telesurgical assistance (18.2%), patient monitoring (9.1%), and surgical planning (9.1%). Local collaborations were established in 55.6% of the studies, while national and international partnerships were formed in 44.4% of the studies. AR was the main visualization technology, and 3G internet connection was predominantly used (27.5%). All studies subjectively reported the utility of remote AR and VR for real-time interaction. The major technical challenges and limitations included audiovisual latency, the requirement for higher-fidelity and resolution image reconstructions, and the level of proficiency of the patient with the software. CONCLUSIONS: The results from this systematic review suggest that AR and VR technologies are dynamically advancing to offer remote collaboration in neurosurgery. Although still incipient in development and with an imperative need for technical improvement, remote AR and VR hold a frontierless potential for patient monitoring, neurosurgical education, and long-distance surgical assistance.

Performance of ChatGPT, Bard, Claude, and Bing on the Peruvian National Licensing Medical Examination: a cross-sectional study.

PURPOSE: We aimed to describe the performance and evaluate the educational value of justifications provided by artificial intelligence chatbots, including GPT-3.5, GPT-4, Bard, Claude, and Bing, on the Peruvian National Medical Licensing Examination (P-NLME). METHODS: This was a cross-sectional analytical study. On July 25, 2023, each multiple-choice question (MCQ) from the P-NLME was entered into each chatbot (GPT-3, GPT-4, Bing, Bard, and Claude) 3 times. Then, 4 medical educators categorized the MCQs in terms of medical area, item type, and whether the MCQ required Peru-specific knowledge. They assessed the educational value of the justifications from the 2 top performers (GPT-4 and Bing). RESULTS: GPT-4 scored 86.7% and Bing scored 82.2%, followed by Bard and Claude, and the historical performance of Peruvian examinees was 55%. Among the factors associated with correct answers, only MCQs that required Peru-specific knowledge had lower odds (odds ratio, 0.23; 95% confidence interval, 0.09-0.61), whereas the remaining factors showed no associations. In assessing the educational value of justifications provided by GPT-4 and Bing, neither showed any significant differences in certainty, usefulness, or potential use in the classroom. CONCLUSION: Among chatbots, GPT-4 and Bing were the top performers, with Bing performing better at Peru-specific MCQs. Moreover, the educational value of justifications provided by the GPT-4 and Bing could be deemed appropriate. However, it is essential to start addressing the educational value of these chatbots, rather than merely their performance on examinations.

Factors associated with the non-use of health services in LGBTI people from Peru. / Factores asociados a la no utilización de servicios de salud en personas LGBTI de Perú.

OBJECTIVE: To determine the factors associated with the non-use of health services in a sample of the lesbian, gay, bisexual, transgender, and intersex population of Peru. MATERIALS AND METHODS: Analytical cross-sectional study, analysis of secondary data from the First LGBTI Survey of Peru. Those who suffered from a medical condition during the last twelve months and had to receive medical attention were considered a variable of interest. Crude prevalence ratios (PRc) and adjusted (PRa), with 95% confidence intervals (95% CI) were calculated using Poisson regressions with robust variance. Three models were developed, adjusted to variables grouped according to sexual orientation, gender identity, and intersexuality. RESULTS: 55.4% were male at birth, the median age was 25 years (IR: 21-30). 16% stated that they had not sought medical attention. The three models presented a negative association in having suffered a chronic disease, infectious, contagious diseases, and mental illness and those who expressed their orientation openly. Not being respected for the gender they identified with was related to not using the services in model 3. Models 1 and 3 included a positive association with not being respected with the gender identified. CONCLUSION: Suffering from a mental illness, an infectious contagious disease, a chronic disease, and not being treated with respect according to their gender identity are factors associated with the non-use of health services.

OBJETIVO: Determinar los factores asociados a la no utilización de servicios de salud en una muestra de la población de lesbianas, gais, bisexuales, transgénero e intersexuales (LGBTI) de Perú. MATERIALES Y MÉTODOS: Estudio transversal analítico, análisis de datos secundarios de la Primera Encuesta LGBTI de Perú. Se tomó como variable de interés a las personas que tuvieron alguna enfermedad durante los últimos doce meses y que tuvieron que recibir atención médica. Se calcularon razones de prevalencias crudas (RPc) y ajustadas (RPa), con intervalos de confianza al 95% (IC   95%), usando regresiones de Poisson con varianza robusta. Se desarrollaron tres modelos, ajustados a variables agrupadas en correspondencia con la orientación sexual, identidad de género e intersexualidad, respectivamente. RESULTADOS: El 55,4% fueron registrados como varones al nacer, la mediana de la edad fue 25 años (Rango intercuartil: 21-30). El 16% manifestó no haber buscado atención médica. Los tres modelos presentaron una asociación negativa respecto de padecer una enfermedad crónica, enfermedad infectocontagiosa, enfermedad mental y en quienes expresaban su orientación abiertamente. El no ser respetados por el género con el que se identificaban estuvo relacionado a no usar los servicios en el modelo 3. Los modelos 1 y 3, incluyeron una asociación positiva con no ser respetados con el género que se identifica. CONCLUSIÓN: Padecer de alguna enfermedad mental, una enfermedad infectocontagiosa y una enfermedad crónica además de no ser tratado con respeto según el género con el que se identifica son factores asociados a la no utilización de los servicios de salud.

Factores asociados a la no utilización de servicios de salud en personas LGBTI de Perú

Objetivo: Determinar los factores asociados a la no utilización de servicios de salud en una muestra de la población de lesbianas, gais, bisexuales, transgénero e intersexuales (LGBTI) de Perú. Materiales y métodos: Estudio transversal analítico, análisis de datos secundarios de la Primera Encuesta LGBTI de Perú. Se tomó como variable de interés a las personas que tuvieron alguna enfermedad durante los últimos doce meses y que tuvieron que recibir atención médica. Se calcularon razones de prevalencias crudas (RPc) y ajustadas (RPa), con intervalos de confianza al 95% (IC 95%), usando regresiones de Poisson con varianza robusta. Se desarrollaron tres modelos, ajustados a variables agrupadas en correspondencia con la orientación sexual, identidad de género e intersexualidad, respectivamente. Resultados: El 55,4% fueron registrados como varones al nacer, la mediana de la edad fue 25 años (Rango intercuartil: 21-30). El 16% manifestó no haber buscado atención médica. Los tres modelos presentaron una asociación negativa respecto de padecer una enfermedad crónica, enfermedad infectocontagiosa, enfermedad mental y en quienes expresaban su orientación abiertamente. El no ser respetados por el género con el que se identificaban estuvo relacionado a no usar los servicios en el modelo 3. Los modelos 1 y 3, incluyeron una asociación positiva con no ser respetados con el género que se identifica. Conclusión: Padecer de alguna enfermedad mental, una enfermedad infectocontagiosa y una enfermedad crónica además de no ser tratado con respeto según el género con el que se identifica son factores asociados a la no utilización de los servicios de salud.

Objective: To determine the factors associated with the non-use of health services in a sample of the lesbian, gay, bisexual, transgender, and intersex population of Peru. Materials and methods: Analytical cross-sectional study, analysis of secondary data from the First LGBTI Survey of Peru. Those who suffered from a medical condition during the last twelve months and had to receive medical attention were considered a variable of interest. Crude prevalence ratios (PRc) and adjusted (PRa), with 95% confidence intervals (95% CI) were calculated using Poisson regressions with robust variance. Three models were developed, adjusted to variables grouped according to sexual orientation, gender identity, and intersexuality. Results: 55.4% were male at birth, the median age was 25 years (IR: 21-30). 16% stated that they had not sought medical attention. The three models presented a negative association in having suffered a chronic disease, infectious, contagious diseases, and mental illness and those who expressed their orientation openly. Not being respected for the gender they identified with was related to not using the services in model 3. Models 1 and 3 included a positive association with not being respected with the gender identified. Conclusion: Suffering from a mental illness, an infectious contagious disease, a chronic disease, and not being treated with respect according to their gender identity are factors associated with the non-use of health services.