ObjectiveTo explore whether large language models (LLMs) Generated Pre-trained Transformer (GPT)-3 and ChatGPT can write clinical letters and predict management plans for common orthopaedic ...scenarios.DesignFifteen scenarios were generated and ChatGPT and GPT-3 prompted to write clinical letters and separately generate management plans for identical scenarios with plans removed.Main outcome measuresLetters were assessed for readability using the Readable Tool. Accuracy of letters and management plans were assessed by three independent orthopaedic surgery clinicians.ResultsBoth models generated complete letters for all scenarios after single prompting. Readability was compared using Flesch-Kincade Grade Level (ChatGPT: 8.77 (SD 0.918); GPT-3: 8.47 (SD 0.982)), Flesch Readability Ease (ChatGPT: 58.2 (SD 4.00); GPT-3: 59.3 (SD 6.98)), Simple Measure of Gobbledygook (SMOG) Index (ChatGPT: 11.6 (SD 0.755); GPT-3: 11.4 (SD 1.01)), and reach (ChatGPT: 81.2%; GPT-3: 80.3%). ChatGPT produced more accurate letters (8.7/10 (SD 0.60) vs 7.3/10 (SD 1.41), p=0.024) and management plans (7.9/10 (SD 0.63) vs 6.8/10 (SD 1.06), p<0.001) than GPT-3. However, both LLMs sometimes omitted key information or added additional guidance which was at worst inaccurate.ConclusionsThis study shows that LLMs are effective for generation of clinical letters. With little prompting, they are readable and mostly accurate. However, they are not consistent, and include inappropriate omissions or insertions. Furthermore, management plans produced by LLMs are generic but often accurate. In the future, a healthcare specific language model trained on accurate and secure data could provide an excellent tool for increasing the efficiency of clinicians through summarisation of large volumes of data into a single clinical letter.
Abstract
Background
Surgical coaching programmes are a means of improving surgeon performance. Embedded audiovisual technology has the potential to further enhance participant benefit and scalability ...of coaching. The objective of this systematic review was to evaluate how audiovisual technology has augmented coaching in the acute-care hospital setting and to characterize its impact on outcomes.
Methods
A systematic review was conducted, searching PubMed, Ovid MEDLINE, Embase, PsycInfo, and CINAHL databases using PRISMA. Eligible studies described a coaching programme that utilized audiovisual technology, involved at least one coach–coachee interaction, and included healthcare professionals from the acute-care hospital environment. The risk of bias 2 tool and grading of recommendations, assessment, development, and evaluations (GRADE) framework were used to evaluate studies. Synthesis without meta-analysis was performed, creating harvest plots of three coaching outcomes: technical skills, self-assessment/feedback, and non-technical skills.
Results
Of 10 458 abstracts screened, 135 full texts were reviewed, and 21 studies identified for inclusion. Seventeen studies were conducted within surgical specialties and six classes of audiovisual technology were utilized. An overall positive direction of effect was demonstrated for studies measuring improvement of either technical skills or non-technical skills. Direction of effect for self-assessment/feedback was weakly positive.
Conclusion
Audiovisual technology has been used successfully in coaching programmes within acute-care hospital settings to facilitate or assess coaching, with a positive impact on outcome measures. Future studies may address the additive benefits of video over in-person observation and enhance the certainty of evidence that coaching impacts on surgeon performance, surgeon well-being, and patient outcomes.
Surgical coaching programmes have become a feasible means of improving surgeon performance. Embedding audiovisual technology into such programmes has the potential to further enhance participant benefit. This systematic review evaluates how audiovisual technology has been utilized within coaching programmes for healthcare professionals in acute-care hospital settings.
To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance.
Surgeons ...need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons.
A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included "Assessment," "Surgeons," and "Technology". Eligible studies included a digital assessment of nontechnical skills for surgeons, residents, and/or medical students within an operative context.
From 19,229 articles screened, 81 articles met the inclusion criteria. The studies varied in surgical specialties, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least 1 category of surgical nontechnical skill using a single (n=54) or multiple objective measures (n=27). The majority of studies utilized simulation (n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load (n=57), situation awareness (n=24), communication (n=3), teamwork (n=13), and leadership (n=2). No studies measured intraoperative decision-making.
The literature detailing the intersection between surgical data science and operative nontechnical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including the need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide a holistic assessment of surgical performance.
•Cognitive Load is the finite cognitive resource volume required to meet the demands of a task.•Cognitive overload occurs when demand outstrips available resource.•Cognitive overload can have a ...negative impact on surgical training and performance.•Knowledge and application of Cognitive Load Theory can enhance surgical training and performance.
This article highlights the importance of considering Cognitive Load (CL) and Cognitive Load Theory (CLT) during surgical training, focusing on the acquisition of intra-operative skills. It describes the basis of CLT with the overarching aim of describing CLT-based techniques to enhance current training strategies and surgical performance, many of which are instinctively already employed in surgical practice. Currently, methods of feedback and assessment are imperfect - typically subjective, unsystematic, opportunistic, or retrospective, and at risk of human bias. Surgical Sabermetrics, the advanced analytics of surgical and audio-visual data, aims to enhance this feedback by providing objective, real-time, digital-based feedback. This article introduces the benefit of real-time measurement of CL to enhance feedback and its applications to surgical performance that follow the ethos of Surgical Sabermetrics.1 The 2022 theme for ICOSET was “Making it Better.” Cognitive Load and Surgical Sabermetrics principles provide tools to make Surgical training better, with the goal of higher quality care for patients.
This thesis comprises three papers; a systematic review, empirical study and critical review. The systematic review aimed to identify the factors that are associated with well-being in parents who ...care for a child with PKU. Six electronic databases were searched (Scopus, PsycINFO, Medline, Embase, EBSCO Cinahl and Web of Science) of papers published between 1965 and November 2016. The search yielded 189 articles; 15 were included in the final review. Quality ratings revealed six studies scored within the ‘moderate’ range and nine within the ‘high’ range. Demographic variables were the most widely reported factor associated with parental well-being, as identified by seven studies. Social support was the next most reproducible factor associated with well-being, as identified by six studies. The clinical implications of these findings are discussed and recommendations are made for future research. The aims of the empirical study were to identify what factors predict distress for parents who care for a child with PKU and to examine the incidence of behaviour problems in children with the condition. Thirty-eight parents of children and adolescents (up to and including 18 years old) with PKU and 32 parents in the general population participated in the study. Parents in both groups completed self-report measures of psychological resilience, child behaviour, perceived social support and psychological distress. Parents of children with PKU also completed measures of their child’s care dependency and behaviour related to developmental or intellectual disabilities. Findings from a multiple regression analysis showed that child behaviour related to anxiety and psychological resilience predicted 35% of the variance in distress scores for parents of children with PKU, whereas child behaviour and resilience predicted 19% of the variance in distress for parents in the general population. The implications of these findings are discussed with reference to further research and clinical practice.
Phenylketonuria (PKU) is an inherited metabolic condition that can lead to the onset of intellectual disabilities if not strictly managed through a low-protein diet. Parents are responsible for ...supervising their child’s treatment for PKU, which may impact on their experience of distress. This cross-sectional study aimed to identify the factors that contribute to distress in parents who care for a child with PKU, distinct from parents in the general population. Thirty-eight parents of children and adolescents with PKU and 32 parents in the general population completed the questionnaires measuring parental psychological resilience, child behaviour problems, perceived social support and distress. Parents of children with PKU also completed measures of their child’s care dependency and behaviour related to developmental and intellectual disabilities. The findings revealed no statistically significant differences in distress between the groups, but parents of children with PKU reported more child behaviour problems. Multiple regression analysis identified that parental psychological resilience and child anxious behaviour explained 35% of the variance in distress for parents of children with PKU. By comparison, parental psychological resilience and generic child behaviour only accounted for 19% of the variance in distress for parents in the general population. This has implications for developing interventions in clinical settings that aim to reduce parents’ distress by enhancing their psychological resilience and supporting them to manage child behaviour difficulties, particularly anxious behaviour. Future research should include larger, more diverse samples and use longitudinal study designs.
The perceived legitimacy of US foreign policy plummeted in the wake of the US-led
2003 invasion of Iraq. Most commentators would agree that international law, or at
least US actions in relation to ...international law, had something to do with this
decline. But, what the recent debate as to how best to restore US legitimacy has
starkly revealed, is that we know little as to just how international law accords
legitimacy to certain foreign policy endeavours. While the legality of the action
may have much to do with it, the relationship between international law, foreign
policy and legitimacy appears to be more complex than is suggested by a
straightforward legal–illegal categorization of behaviour. A theorization
of international law as ideology can provide an overall explanation of the role of
international law in the decline in US foreign policy legitimacy following the
invasion of Iraq.
This thesis comprises three papers; a systematic review, empirical study and critical review. The systematic review aimed to identify the factors that are associated with well-being in parents who ...care for a child with PKU. Six electronic databases were searched (Scopus, PsycINFO, Medline, Embase, EBSCO Cinahl and Web of Science) of papers published between 1965 and November 2016. The search yielded 189 articles; 15 were included in the final review. Quality ratings revealed six studies scored within the ‘moderate’ range and nine within the ‘high’ range. Demographic variables were the most widely reported factor associated with parental well-being, as identified by seven studies. Social support was the next most reproducible factor associated with well-being, as identified by six studies. The clinical implications of these findings are discussed and recommendations are made for future research. The aims of the empirical study were to identify what factors predict distress for parents who care for a child with PKU and to examine the incidence of behaviour problems in children with the condition. Thirty-eight parents of children and adolescents (up to and including 18 years old) with PKU and 32 parents in the general population participated in the study. Parents in both groups completed self-report measures of psychological resilience, child behaviour, perceived social support and psychological distress. Parents of children with PKU also completed measures of their child’s care dependency and behaviour related to developmental or intellectual disabilities. Findings from a multiple regression analysis showed that child behaviour related to anxiety and psychological resilience predicted 35% of the variance in distress scores for parents of children with PKU, whereas child behaviour and resilience predicted 19% of the variance in distress for parents in the general population. The implications of these findings are discussed with reference to further research and clinical practice.
The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined.
To examine the prevalence of symptoms of ...stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission.
This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states.
Having a family member in the ICU with COVID-19.
Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6).
A total of 330 participants (mean SD age, 51.2 15.1 years; 228 69.1% women; 150 52.8% White; 92 29.8% Hispanic) were surveyed at the 3-month time point. Most individuals were the patients' child (129 40.6%) or spouse or partner (81 25.5%). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners.
In this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.
The coronavirus (COVID-19) pandemic continues to affect the NHS. The Vascular and Endovascular Research Network (VERN) COvid Vascular sERvice (COVER) study has prospectively shown the significant ...global impact of the COVID-19 pandemic on vascular surgery. The aim of this study is to investigate the way in which this second wave has affected surgeons' ability to treat patients with urgent vascular conditions, using contemporaneous snapshot data from 30 UK vascular centres.
This is a contemporary (18-28 January 2021) re-run of the Tier 1 COVER survey. This used closed and open questions, related to centres' provision of common vascular services, threshold for treatment, imaging, screening, staff and theatre availability, multidisciplinary team input, clinics, personal protective equipment, vaccination policies and case-backlogs. The survey was disseminated to clinicians via email. A service reduction score was calculated.
Forty-two complete responses were received from 30 vascular centres (England, Northern Ireland, Scotland and Wales). Overall, 56.7% of units are performing only urgent procedures. The threshold for abdominal aortic aneurysm (AAA) repair has increased in the majority of UK centres (60%). One in six AAA screening programmes have stopped all screening activity: 30% having a significantly reduced programme and only half running as normal. Waiting lists are increasing for AAA, lower limb revascularisation and venous disease.
Overall, these data suggest that vascular care in the NHS is facing unprecedented pressures due to COVID-19. Vascular stakeholders will have to urgently address these issues in the coming months.
ISRCTN 80453162 (registered prospectively).
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