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Lumbar Disc Herniation with Radiculopathy: A Comparison of NASS Guidelines and ChatGPT
Get PDFBackground:
ChatGPT is an advanced language AI able to generate responses to clinical questions regarding lumbar disc herniation with radiculopathy. Artificial intelligence (AI) tools are increasingly being considered to assist clinicians in decision-making. This study compared ChatGPT-3.5 and ChatGPT-4.0 responses to established NASS clinical guidelines and evaluated concordance.
Methods:
ChatGPT-3.5 and ChatGPT-4.0 were prompted with fifteen questions from The 2012 NASS Clinical Guidelines for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Clinical questions organized into categories were directly entered as unmodified queries into ChatGPT. Language output was assessed by two independent authors on September 26, 2023 based on operationally-defined parameters of accuracy, over-conclusiveness, supplementary, and incompleteness. ChatGPT-3.5 and ChatGPT-4.0 performance was compared via chi-square analyses.
Results:
Among the fifteen responses produced by ChatGPT-3.5, 7 (47%) were accurate, 7 (47%) were over-conclusive, fifteen (100%) were supplementary, and 6 (40%) were incomplete. For ChatGPT-4.0, ten (67%) were accurate, 5 (33%) were over-conclusive, 10 (67%) were supplementary, and 6 (40%) were incomplete. There was a statistically significant difference in supplementary information (100% vs. 67%; p=.014) between ChatGPT-3.5 and ChatGPT-4.0. Accuracy (47% vs. 67%; p=.269), over-conclusiveness (47% vs. 33%; p=.456), and incompleteness (40% vs. 40%; p=1.000) did not show significant differences between ChatGPT-3.5 and ChatGPT-4.0. ChatGPT-3.5 and ChatGPT-4.0 both yielded 100% accuracy for definition and history and physical examination categories. Diagnostic testing yielded 0% accuracy for ChatGPT-3.5 and 100% accuracy for ChatGPT-4.0. Nonsurgical interventions had 50% accuracy for ChatGPT-3.5 and 63% accuracy for ChatGPT-4.0. Surgical interventions resulted in 0% accuracy for ChatGPT-3.5 and 33% accuracy for ChatGPT-4.0.
Conclusions:
ChatGPT-4.0 provided less supplementary information and overall higher accuracy in question categories than ChatGPT-3.5. ChatGPT showed reasonable concordance to NASS guidelines, but clinicians should caution use of ChatGPT in its current state as it fails to safeguard against misinformation
Impact of the 2022 National Formula Shortage on Clinical Decision-Making of Healthcare Providers in Switching Amino Acid Formulas for Infants With Cow’s Milk Protein Allergy: A Survey-Based Study
No full textBackground: In 2022, the United States experienced a national shortage of infant formula due to a global supply chain crisis and a large-scale domestic formula recall. The existing literature on healthcare providers\u27 (HCPs) clinical decision-making during formula shortages is limited. This study aims to analyze the factors influencing pediatric HCP clinical decision-making when switching between amino acid formulas (AAF) for managing cow\u27s milk protein allergy (CMPA) in infants under 24 months of age during an unprecedented national formula shortage.
Methods: The study included pediatric HCPs with experience managing CMPA in infants and toddlers under 24 months during the formula shortage from January 2022 to November 2022. A de-identified survey comprising 26 questions examining driving factors used in clinical decision-making was administered to pediatric HCPs using a real-time mobile data collection tool.
Results: Among the surveyed pediatric HCPs (n = 75), the factors most frequently considered as “extremely important” when switching to another AAF included safety (85%), tolerability (73%), and efficacy (83%). No statistically significant differences were found in HCP ratings among the listed examined factors of the four AAFs. The availability of specific formulas was the only factor that exhibited a statistically significant difference in perceived performance among pediatric HCPs when comparing the four AAFs (p \u3c 0.05).
Discussion: This study elucidates the crucial aspects that influenced pediatric HCPs\u27 selection of AAFs for CMPA management during the 2022 formula shortage. The findings highlight the significance of safety, tolerability, efficacy, and availability in the pediatric HCP decision-making processes
Pregnane X Receptor Signaling Pathway and Vitamin K: Molecular Mechanisms and Clinical Relevance in Human Health
Get PDFThis review explores the likely clinical impact of Pregnane X Receptor (PXR) activation by vitamin K on human health. PXR, initially recognized as a master regulator of xenobiotic metabolism in liver, emerges as a key regulator influencing intestinal homeostasis, inflammation, oxidative stress, and autophagy. The activation of PXR by vitamin K highlights its role as a potent endogenous and local agonist with diverse clinical implications. Recent research suggests that the vitamin K-mediated activation of PXR highlights this vitamin\u27s potential in addressing pathophysiological conditions by promoting hepatic detoxification, fortifying gut barrier integrity, and controlling pro-inflammatory and apoptotic pathways. PXR activation by vitamin K provides an intricate association with cancer cell survival, particularly in colorectal and liver cancers, to provide new insights into potential novel therapeutic strategies. Understanding the clinical implications of PXR activation by vitamin K bridges molecular mechanisms with health outcomes, further offering personalized therapeutic approaches for complex diseases
Trust in Physicians Among Young Sexual Minority Men
Get PDFTrust in physicians and the medical establishment more broadly is critical for access to and provision of relevant healthcare services. This is especially true for sexual minority men (SMM) as their healthcare is negatively impacted due to stigma and discrimination which in turn affects disclosure of sexual behavior and sexual orientation. This study sought to understand trust in physicians (TIP) as it relates to anal sex position, difficulty in paying for healthcare, insurance status, and pre-exposure prophylaxis (PrEP) use. This study employs data from a cross-sectional survey conducted between February 2018 and February 2019. The final analytic sample is 179 sexual minority men who reported an human immunodeficiency virus (HIV) negative serostatus and identified as a sexual minority person (i.e., non-heterosexual). The present use of the Trust in Physicians Scale is further dichotomized for analytical purposes. The results show that slightly over half of the participants (52%, n = 93) reported trusting their physicians. Higher trust in physician scores were associated with preference of anal sex position (insertive or receptive as opposed to versatile/no preference), less difficulty in paying for health care services, people who were uninsured, and those who were currently using PrEP. In conclusion, TIP plays a critical role in disclosure of sexual orientation and sexual behaviors that allow for the delivery of necessary and appropriate healthcare services. Findings from this study can be used to develop best practices for taking patient histories that foster trust and disclosure of sensitive health information
Academic Accomplishments of Black Neurosurgeons in the United States
No full textOBJECTIVE
Neurosurgery has remained relatively homogeneous in terms of racial and gender diversity, trailing behind national demographics. Less than 5% of practicing neurosurgeons in the United States identify as Black/African American (AA). Research and academic productivity are highly emphasized within the field and are crucial for career advancement at academic institutions. They also serve as important avenues for mentorship and recruitment of diverse trainees and medical students. This study aimed to summarize the academic accomplishments of AA neurosurgeons by assessing publication quantity, h-index, and federal grant funding.
METHODS
One hundred thirteen neurosurgery residency training programs accredited by the Accreditation Council for Graduate Medical Education in 2022 were included in this study. The American Society of Black Neurosurgeons registry was reviewed to analyze the academic metrics of self-identified Black or AA academic neurosurgeons. Data on the academic rank, leadership position, publication quantity, h-index, and race of neurosurgical faculty in the US were obtained from publicly available information and program websites.
RESULTS
Fifty-five AA and 1393 non-AA neurosurgeons were identified. Sixty percent of AA neurosurgeons were fewer than 10 years out from residency training, compared to 37.4% of non-AA neurosurgeons (p = 0.001). AA neurosurgeons had a median 32 (IQR 9, 85) publications compared to 52 (IQR 22, 122) for non-AA neurosurgeons (p = 0.019). AA neurosurgeons had a median h-index of 12 (IQR 5, 24) compared to 16 (IQR 9, 31) for non-AA colleagues (p = 0.02). Following stratification by academic rank, these trends did not persist. No statistically significant differences in the median amounts of awarded National Institutes of Health funding (p = 0.194) or level of professorship attained (p = 0.07) were observed between the two cohorts.
CONCLUSIONS
Racial disparities between AA and non-AA neurosurgeons exist in publication quantity and h-index overall but not when these groups are stratified by academic rank. Given that AA neurosurgeons comprise more junior faculty, it is expected that their academic accomplishments will increase as more enter academic practice and current neurosurgeons advance into more senior positions