Surgeons vs ChatGPT: Assessment and Feedback Performance Based on Real Surgical Scenarios.

INTRODUCTION: Artificial intelligence tools are being progressively integrated into medicine and surgical education. Large language models, such as ChatGPT, could provide relevant feedback aimed at improving surgical skills. The purpose of this study is to assess ChatGPT´s ability to provide feedback based on surgical scenarios. METHODS: Surgical situations were transformed into texts using a neutral narrative. Texts were evaluated by ChatGPT 4.0 and 3 surgeons (A, B, C) after a brief instruction was delivered: identify errors and provide feedback accordingly. Surgical residents were provided with each of the situations and feedback obtained during the first stage, as written by each surgeon and ChatGPT, and were asked to assess the utility of feedback (FCUR) and its quality (FQ). As control measurement, an Education-Expert (EE) and a Clinical-Expert (CE) were asked to assess FCUR and FQ. RESULTS: Regarding residents' evaluations, 96.43% of times, outputs provided by ChatGPT were considered useful, comparable to what surgeons' B and C obtained. Assessing FQ, ChatGPT and all surgeons received similar scores. Regarding EE's assessment, ChatGPT obtained a significantly higher FQ score when compared to surgeons A and B (p = 0.019; p = 0.033) with a median score of 8 vs. 7 and 7.5, respectively; and no difference respect surgeon C (score of 8; p = 0.2). Regarding CE´s assessment, surgeon B obtained the highest FQ score while ChatGPT received scores comparable to that of surgeons A and C. When participants were asked to identify the source of the feedback, residents, CE, and EE perceived ChatGPT's outputs as human-provided in 33.9%, 28.5%, and 14.3% of cases, respectively. CONCLUSION: When given brief written surgical situations, ChatGPT was able to identify errors with a detection rate comparable to that of experienced surgeons and to generate feedback that was considered useful for skill improvement in a surgical context performing as well as surgical instructors across assessments made by general surgery residents, an experienced surgeon, and a nonsurgeon feedback expert.

Cuidados enfermeros en el duelo perinatal. Una revisión sistemática y crítica de las actitudes y los conocimientos en la práctica clínica / Nursing care in perinatal grief. A systematic and critical review of attitudes and knowledge in clinical practice

Objetivo: Revisar y sintetizar la evidencia disponible sobre las actitudes y conocimientos de las enfermeras ante el duelo perinatal de los progenitores. Método: Se realizó una revisión sistemática de artículos originales publicados desde enero del 2016 hasta febrero del 2023, sin límite de idioma, en las bases de datos Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect y Web Of Science. Se utilizó el marco metodológico de la Declaración Preferred Reporting Items for Systematic reviews and Meta-Analyse (PRISMA) para revisiones sistemáticas y metaanálisis. Todo el proceso se efectuó por pares, siendo solventadas las discrepancias por un tercer revisor. Se evaluó la calidad de los artículos siguiendo los criterios Critical Appraisal Skills Programme Español (CASPe). Resultados: Se obtuvieron 12 artículos en esta revisión tras aplicar los criterios de inclusión, de los cuales, salvo un estudio cuantitativo transversal (8,33%), los demás eran análisis cualitativos realizados mediante entrevistas (75%) o grupos de discusión (16,66%). Se destaca que existen diferentes problemas biopsicosociales relacionados con las necesidades de cuidado que demanda la familia y que, por escasa formación o cultura del profesional sanitario, no se abordan de una manera adecuada. Los estudios encontrados muestran diversos recursos para atender adecuadamente el duelo perinatal, existiendo discrepancias en relación con permitir o no que se muestre y/o coja el cuerpo del bebé fallecido; existen también desacuerdos respecto a si el equipo asistencial debe fundamentar su práctica en protocolos o teorías como la del duelo de Kübler-Ross. La mayoría de los estudios (75%) consideran necesarias más formación y sensibilización contemplando la naturaleza biopsicosocial del usuario.(AU)

Aim: To review and synthesize the available evidence on the attitudes and knowledge of nurses regarding the perinatal grief of the parents. Methods: A systematic review of original articles published from January 2016 to February 2023 without language limit in the Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect and Web Of Science databases was carried out. The PRISMA Statement methodological framework was used for systematic reviews and meta-analyses. The entire process was carried out in pairs, with discrepancies being resolved by a third reviewer. The quality of the articles was evaluated following the Critical Appraisal Skills Program Spanish (CASPe criteria). Results: Twelve articles were obtained in this review after applying the inclusion criteria, of which. Except for one cross-sectional quantitative study (8.33%), the rest were qualitative studies carried out through interviews (75%) or discussion groups (16.66%). It is highlighted that there are different biopsychosocial problems related to the care needs demanded by the family and that, due to poor training or culture of the health professional, are not adequately addressed. The studies found show various resources to adequately attend to perinatal grief, there being discrepancies in relation to allowing or not allowing the body of the deceased baby to be shown and/or taken; There are also disagreements regarding whether the healthcare team should base its practice on protocols or theories such as the Kübler-Ross theory of grief. Most of the studies (75%) consider that more training and awareness is necessary, contemplating the biopsychosocial nature of the user.(AU)

Comparative study of video recordings of non-medical devices in laparoscopic surgery: a cross-sectional study.

INTRODUCTION: Laparoscopic surgery is the approach of choice for multiple procedures, being laparoscopic cholecystectomy one of the most frequently performed surgeries. Likewise, video recording of these surgeries has become widespread. Currently, the market offers medical recording devices (MRD) with an approximate cost of 2000 USD, and alternative non-medical recording devices (NMRD) with a cost ranging from 120 to 200 USD. To our knowledge, no comparative studies between the available recording devices have been done. We aim to compare the perception of the quality of videos recorded by MRD and NMRD in a group of surgeons and surgical residents. METHODS: A cross-sectional study was conducted using an online survey to compare recordings from three NMRDs (Elgato 30 fps, AverMedia 60 fps, Hauppauge 30 fps) and one MRD (MediCap 20 fps) during a laparoscopic cholecystectomy. The survey assessed: definition of anatomical structures (DA), fluidity of movements (FM), similarity with the operating room screen (ORsim), and overall quality (OQ). Descriptive and nonparametric analytical statistics tests were applied. Results were analyzed using JMP-15 software. RESULTS: Forty surveys were collected (80% surgeons, 20% residents). NMRDs scored significantly higher than MRD in DA (p = 0.003), FM (p < 0.001), ORsim (p < 0.001), and OQ (p < 0.001). One NMRD was chosen as the highest quality device (70%), and MRD as the poorest (78%). No significant differences were found when analyzing by surgical experience. CONCLUSIONS: In terms of recording laparoscopic procedures, non-medical video recording devices (NMRDs) outperformed medical-grade recording device (MRD) with a higher overall score. This suggests that NMRDs could serve as a cost-effective alternative with superior video quality for recording laparoscopic surgeries.

Nursing care in perinatal grief. A systematic and critical review of attitudes and knowledge in clinical practice.

AIM: To review and synthesize the available evidence on the attitudes and knowledge of nurses regarding the perinatal grief of the parents. METHODS: A systematic review of original articles published from January 2016 to February 2023 without language limit in the Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect and Web Of Science databases was carried out. The Prisma Statement methodological framework was used for systematic reviews and meta-analyses. The entire process was carried out in pairs, with discrepancies being resolved by a third reviewer. The quality of the articles was evaluated following the CASPe criteria (Critical Appraisal Skills Program Spanish). RESULTS: Twelve articles were obtained in this review after applying the inclusion criteria, of which. Except for one cross-sectional quantitative study (8.33%), the rest were qualitative studies carried out through interviews (75%) or discussion groups (16.66%). It is highlighted that there are different biopsychosocial problems related to the care needs demanded by the family and that, due to poor training or culture of the health professional, are not adequately addressed. DISCUSSION: The studies found show various resources to adequately attend to perinatal grief, there being discrepancies in relation to allowing or not allowing the body of the deceased baby to be shown and/or taken; There are also disagreements regarding whether the healthcare team should base its practice on protocols or theories such as the Kubler-Ross theory of grief. Most of the studies (75%) consider that more training and awareness is necessary, contemplating the biopsychosocial nature of the user.

Five-Year Experience Training Surgeons with a Laparoscopic Simulation Training Program for Bariatric Surgery: a Quasi-experimental Design.

PURPOSE: Nearly 200,000 laparoscopic Roux-en-Y gastric bypass (LRYGB) are performed yearly. Reported learning curves range between 50 and 150, even 500 cases to decrease the operative risk. Simulation programs could accelerate this learning curve safely; however, trainings for LRYGB are scarce. This study aims to describe and share our 5-year experience of a simulated program designed to achieve proficiency in LRYGB technical skills. MATERIALS AND METHODS: A quasi-experimental design was used. All recruited participants were previously trained with basic and advanced laparoscopic simulation curriculum completing over 50 h of practical training. Ex vivo animal models were used to practice manual and stapled gastrojejunostomy (GJ) and stapled jejunojejunostomy (JJO) in 10, 3, and 4 sessions, respectively. The main outcome was to assess the manual GJ skill acquisition. Pre- and post-training assessments using a Global Rating Scale (GRS; max 25 pts), Specific Rating Scale (SRS; max 20 pts), performance time, permeability, and leakage rates were analyzed. For the stapled GJ and JJO, execution time was registered. Data analysis was performed using parametric tests. RESULTS: In 5 years, 68 trainees completed the program. For the manual GJ's pre- vs post-training assessment, GRS and SRS scores increased significantly (from 17 to 24 and from 13 to 19 points respectively, p-value < 0.001). Permeability rate increased while leakage rate and procedural time decreased significantly. CONCLUSION: This simulated training program showed effectiveness in improving laparoscopic skills for manual GJ and JJO in a simulated scenario. This new training program could optimize the clinical learning curve. Further studies are needed to assess the transfer of skills to the operating room.

Reversión del bypass gástrico: indicaciones y resultados quirúrgicos / Gastric bypass reversal: surgical indications and results

Resumen Introducción: Debido a su eficacia en el tratamiento de la obesidad mórbida, el bypass gástrico (BPG) sigue siendo una intervención realizada frecuentemente. Sin embargo, un grupo reducido de pacientes puede desarrollar complicaciones nutricionales y metabólicas que no logran controlarse con un tratamiento médico óptimo. En estos casos, puede ser necesario reestablecer la continuidad del tracto gastrointestinal por medio de la reversión del BPG (R-BPG). Objetivo: Presentar las indicaciones y resultados obtenidos en una serie de pacientes sometidos a una R-BPG. Materiales y Método: Identificación y evaluación retrospectiva de todos los pacientes sometidos a una R-BPG en nuestra institución de manera consecutiva. Se registraron las características demográficas y antropométricas de la cirugía original y al momento de la reversión. Las complicaciones se registraron de acuerdo con la clasificación de Clavien-Dindo. Resultados: Se identificaron 7 pacientes en los cuales se realizó una R-BPG. En 2 casos la reversión fue por síndrome de intestino corto, en 3 casos por hipoglicemias severas refractarias a manejo médico y en 2 casos por diarrea crónica. La mediana de edad al momento de la reversión fue de 55 años. La mediana de tiempo desde la cirugía original hasta el momento de la reversión fue de 77 meses. La mediana de estadía hospitalaria fue de 6 días. No hubo complicaciones Clavien-Dindo ≥ III. La R-BPG logró revertir en todos los casos las complicaciones nutricionales y metabólicas. Conclusión: La restauración de la continuidad del tracto gastrointestinal permite el control de las complicaciones nutricionales y metabólicas.

Introduction: Due to its efficacy in the treatment of morbid obesity, roux-en-y gastric bypass (RYGB) continues to be a frequently performed intervention. However, a small group of patients may develop nutritional and metabolic complications that cannot be controlled with optimal medical treatment. In these cases, it may be necessary to reestablish the continuity of the gastrointestinal tract by reversing the RYGB (R-RYGB). Aim: To present the indications and results obtained in a series of patients who underwent to R-RYGB. Materials and Method: Identification and retrospective evaluation of all patients who underwent consecutive R-RYGB in our institution. Demographic and anthropometric characteristics of the original surgery and at the time of the reversal were recorded. Complications were classified according to Clavien-Dindo classification. Results: Seven patients were identified in whom an R-RYGB was performed. In 2 cases the reversal was due to short bowel syndrome, in 3 cases due to severe hypoglycemia refractory to medical treatment and in 2 cases due to chronic diarrhea. The median age at the time of the reversal was 55 years. The median time from primary surgery to reversal was 77 months. The median hospital stay was 6 days. There were no Clavien-Dindo complications ≥ III. The R-RYGB was able to reverse nutritional and metabolic complications in all cases. Conclusion: Restoring the continuity of the gastrointestinal tract allows control of nutritional and metabolic complications.

Probiotic Lactobacilli Isolated from Kefir Promote Down-Regulation of Inflammatory Lamina Propria T Cells from Patients with Active IBD.

Ulcerative colitis and Crohn's disease, the two main forms of inflammatory bowel disease (IBD), are immunologically mediated disorders. Several therapies are focused on activated T cells as key targets. Although Lactobacillus kefiri has shown anti-inflammatory effects in animal models, few studies were done using human mucosal T cells. The aim of this work was to investigate the immunomodulatory effects of this bacterium on intestinal T cells from patients with active IBD. Mucosal biopsies and surgical samples from IBD adult patients (n = 19) or healthy donors (HC; n = 5) were used. Lamina propria mononuclear cells were isolated by enzymatic tissue digestion, and entero-adhesive Escherichia coli-specific lamina propria T cells (LPTC) were expanded. The immunomodulatory properties of L. kefiri CIDCA 8348 strain were evaluated on biopsies and on anti-CD3/CD28-activated LPTC. Secreted cytokines were quantified by ELISA, and cell proliferation and viability were assessed by flow cytometry. We found that L. kefiri reduced spontaneous release of IL-6 and IL-8 from inflamed biopsies ex vivo. Activated LPTC from IBD patients showed low proliferative rates and reduced secretion of TNF-α, IL-6, IFN-γ and IL-13 in the presence of L. kefiri. In addition, L. kefiri induced an increased frequency of CD4+FOXP3+ LPTC along with high levels of IL-10. This is the first report showing an immunomodulatory effect of L. kefiri CIDCA 8348 on human intestinal cells from IBD patients. Understanding the mechanisms of interaction between probiotics and immune mucosal cells may open new avenues for treatment and prevention of IBD.

Different Crises, Different Patterns of Trauma. The Impact of a Social Crisis and the COVID-19 Health Pandemic on a High Violence Area.

BACKGOUND: Santiago, Chile underwent two separate periods of crisis over the past year. The first period, the 'social crisis,' extended over thirteen weeks in late 2019 into early 2020 due to protests over income inequality and the government response to social unrest. The second period, the 'health crisis,' began in March 2020 with Chile's first case of COVID-19 and escalated rapidly to include 'stay at home orders,' traffic restrictions, and the shuttering of most businesses. We wished to evaluate the impact of these crisis periods on trauma epidemiology. METHODS: We performed a retrospective review of the South-East Metropolitan Health Service Trauma Registry. Trauma admissions, operative volume, and in-hospital mortality were evaluated during the crisis period and the year prior. RESULTS: The social crisis saw increased levels of trauma, both blunt and penetrating, relative to the time period immediately preceding. The health crisis saw an increase in penetrating trauma with a concomitant decline in blunt trauma. Both crisis periods had decreased levels of trauma, overall, compared to the year prior. There were no statistically significant differences in in-hospital trauma mortality. CONCLUSION: Different crises may have different patterns of trauma. Crisis periods that include extended periods of lockdown and curfew may lead to increasing penetrating trauma volume. Governments and health officials should anticipate the aggregate impact of these measures on public health and develop strategies to actively mitigate them. LEVEL OF EVIDENCE: III.

El fenómeno de las caídas en residencias e instituciones: revisión del Grupo de Trabajo de Osteoporosis, Caídas y Fracturas de la Sociedad Española de Geriatría y Gerontología (GCOF-SEGG) / Falls in nursing homes and institutions: Update by the Osteoporosis, Falls and Fractures Working Group of the Spanish Society of Geriatrics and Gerontology (GCOF-SEGG)

Desde el Grupo de Trabajo de Osteoporosis, Caídas y Fracturas (GOCF) de la Sociedad Española de Geriatría y Gerontología (SEGG), se creó una comisión de trabajo con vistas a realizar una revisión de la evidencia en cuanto a la detección, los factores de riesgo y las herramientas de valoración de caídas, así como las pautas de actuación frente a las mismas en residencias e instituciones. Igualmente, se definen los distintos perfiles de usuarios de estas instituciones para efectuar una aproximación exhaustiva respecto a un fenómeno y a una subpoblación tan heterogéneos, ofreciendo una clasificación de riesgo y unas recomendaciones específicas de acuerdo a dicha clasificación(AU)

The Workshop on Osteoporosis, Falls and Fractures (GCOF) of The Spanish Geriatrics and Gerontology Society (SEGG) formed a committee in order to review the state of the art on the detection, risk factors and assessment tools for falls, and intervention protocols when falls occurs in nursing homes, long-term hospitals or medium-stay units. The different patient profiles are described in order to make a comprehensive approach to this heterogeneous topic and population, offering a risk classification and specific advice according to these categories(AU)

[Falls in nursing homes and institutions: update by the Osteoporosis, Falls and Fractures Working Group of the Spanish Society of Geriatrics and Gerontology (GCOF-SEGG)]. / El fenómeno de las caídas en residencias e instituciones: revisión del Grupo de Trabajo de Osteoporosis, Caídas y Fracturas de la Sociedad Española de Geriatría y Gerontología (GCOF-SEGG).

The Workshop on Osteoporosis, Falls and Fractures (GCOF) of The Spanish Geriatrics and Gerontology Society (SEGG) formed a committee in order to review the state of the art on the detection, risk factors and assessment tools for falls, and intervention protocols when falls occurs in nursing homes, long-term hospitals or medium-stay units. The different patient profiles are described in order to make a comprehensive approach to this heterogeneous topic and population, offering a risk classification and specific advice according to these categories.

Miedo a caerse / Fear of falling

El temor o miedo a caerse (MC) puede considerarse como una respuesta protectora a una amenaza real, previniendo al anciano de iniciar actividades con alto riesgo de caerse, aunque conlleve a una restricción de las actividades que resultará a largo plazo en un efecto adverso en el plano social, físico o cognitivo. Se presenta con una prevalencia del 30% en los ancianos que no tienen historia de caídas y en el doble en aquellos que han tenido el antecedente de caída. Su prevalencia es más elevada en mujeres y con la edad más avanzada. Se han desarrollado diversas escalas para medir los efectos psicológicos del MC, entre las que destacan la escala de eficacia en caídas, la escala de confianza y equilibrio en las actividades específicas y la encuesta de actividades y temor de caída en la tercera edad. Tiene unas consecuencias negativas en la funcionalidad, en la sensación subjetiva de bienestar y en la consiguiente pérdida de autonomía. El deterioro funcional, físico o de la calidad de vida está claramente relacionado con el MC, aunque no está bien establecido si estos factores son causa o efecto. Se han recomendado múltiples intervenciones con óptimos resultados, conllevando a cambios que resultan en reforzar su confianza para realizar las actividades. Las intervenciones e investigaciones deberían promover una visión real y adaptada sobre el riesgo de caídas y enseñar a los ancianos a realizar actividades seguras. Aunque la reducción del MC es un objetivo importante en sí mismo para mejorar la sensación subjetiva de bienestar, los beneficios podrían incrementarse si esta reducción también se acompañase de un incremento en una conducta segura, en una participación social y en actividades de la vida diaria(AU)

Fear of falling (FF) can be considered as a protective response to a real threat, preventing the elderly from performing activities with high risk of falling, but can also lead to a restriction of the activities that will result in a long-term adverse effect on social, physical or cognitive functions. There is a prevalence of FF in 30% in the elderly who have no history of falls, and double that in those with a history of falling. Its prevalence is increased in women and with advanced age. Several scales have been developed to measure the psychological effects of FF, among which are noted are, the Fall Efficacy Scale (FES), the Activities-specific Balance and Confidence Scale (ABC), and the survey of activities and fear of falling in the elderly (SAFE). It has negative consequences in the functionality, the subjective feeling of well-being, and in the consequent loss of independence. The functional and physical deterioration, or the quality of life is clearly related to the FF, although it has not been established if these factors are cause or effect. Multiple interventions have been recommended, bringing about changes that reinforce their confidence to carry out activities. Interventions and research should promote a realistic and appropriate approach to the risk of falls and teach the elderly to perform activities safely. The reduction in FF is an important goal in itself to improve the subjective feeling of well-being, and the benefits could be increased if this reduction was also accompanied by an increase in safe behaviour, social participation, and activities of the daily life(AU)

[Fear of falling]. / Miedo a caerse.

Fear of falling (FF) can be considered as a protective response to a real threat, preventing the elderly from performing activities with high risk of falling, but can also lead to a restriction of the activities that will result in a long-term adverse effect on social, physical or cognitive functions. There is a prevalence of FF in 30% in the elderly who have no history of falls, and double that in those with a history of falling. Its prevalence is increased in women and with advanced age. Several scales have been developed to measure the psychological effects of FF, among which are noted are, the Fall Efficacy Scale (FES), the Activities-specific Balance and Confidence Scale (ABC), and the survey of activities and fear of falling in the elderly (SAFE). It has negative consequences in the functionality, the subjective feeling of well-being, and in the consequent loss of independence. The functional and physical deterioration, or the quality of life is clearly related to the FF, although it has not been established if these factors are cause or effect. Multiple interventions have been recommended, bringing about changes that reinforce their confidence to carry out activities. Interventions and research should promote a realistic and appropriate approach to the risk of falls and teach the elderly to perform activities safely. The reduction in FF is an important goal in itself to improve the subjective feeling of well-being, and the benefits could be increased if this reduction was also accompanied by an increase in safe behaviour, social participation, and activities of the daily life.