Appraisal of ChatGPT's Aptitude for Medical Education: Comparative Analysis With Third-Year Medical Students in a Pulmonology Examination.

BACKGROUND: The rapid evolution of ChatGPT has generated substantial interest and led to extensive discussions in both public and academic domains, particularly in the context of medical education. OBJECTIVE: This study aimed to evaluate ChatGPT's performance in a pulmonology examination through a comparative analysis with that of third-year medical students. METHODS: In this cross-sectional study, we conducted a comparative analysis with 2 distinct groups. The first group comprised 244 third-year medical students who had previously taken our institution's 2020 pulmonology examination, which was conducted in French. The second group involved ChatGPT-3.5 in 2 separate sets of conversations: without contextualization (V1) and with contextualization (V2). In both V1 and V2, ChatGPT received the same set of questions administered to the students. RESULTS: V1 demonstrated exceptional proficiency in radiology, microbiology, and thoracic surgery, surpassing the majority of medical students in these domains. However, it faced challenges in pathology, pharmacology, and clinical pneumology. In contrast, V2 consistently delivered more accurate responses across various question categories, regardless of the specialization. ChatGPT exhibited suboptimal performance in multiple choice questions compared to medical students. V2 excelled in responding to structured open-ended questions. Both ChatGPT conversations, particularly V2, outperformed students in addressing questions of low and intermediate difficulty. Interestingly, students showcased enhanced proficiency when confronted with highly challenging questions. V1 fell short of passing the examination. Conversely, V2 successfully achieved examination success, outperforming 139 (62.1%) medical students. CONCLUSIONS: While ChatGPT has access to a comprehensive web-based data set, its performance closely mirrors that of an average medical student. Outcomes are influenced by question format, item complexity, and contextual nuances. The model faces challenges in medical contexts requiring information synthesis, advanced analytical aptitude, and clinical judgment, as well as in non-English language assessments and when confronted with data outside mainstream internet sources.

Cost analysis of a medical procedure using the full cost method: The example of a trans-thoracic scan-guided biopsy.

INTRODUCTION: Trans-thoracic scan-guided biopsy (TTB) is a crucial examination for exploring thoracic lesions, particularly in the case of tumor pathologies. To make informed decisions in cost-effectiveness analyses, it is important to understand the actual costs of this procedure. AIM: To quantify the cost of performing TTB using a microeconomic approach. METHODS: We used the full cost method, which is the reference method in cost accounting. This method subdivides costs into direct and indirect costs. Direct costs are divided into variable and fixed components. Variable costs include consumables and wages of personnel involved in the "labor" act. Fixed direct costs are those that do not vary during the study period; they include the costs of purchasing, depreciation, maintenance, and repair of the scanner room equipment. Indirect costs include overhead costs that cannot be directly attributed to the TTB procedure. RESULTS: The total direct cost of the TTB procedure amounts to 310.191 TND when using a coaxial and 256.390 TND in the absence of a coaxial, including fixed and variable costs. Indirect costs were not included in this study due to the absence of cost accounting at the hospital. CONCLUSION: Accurate knowledge of the costs of any medical procedure is essential for making informed decisions in cost-effectiveness analyses. This study provides a precise estimate of the direct costs of TTB and can help improve the efficiency of resource allocation for performing this procedure.

Brain metastases of non-small cell lung cancer: prognostic factors and management.

BACKGROUND: The prognosis of patients with non-small cell lung cancer (NSCLC) with brain metastasis (BM) is dark. The aim of our study was to analyze the prognostic factors after the onset of BM and to evaluate the current management of BM. METHODS: We conducted a retrospective study that included 100 patients diagnosed with primary NSCLC with BM. Survival was analysed using Kaplan Meier curve.Univariate survival analysis was performed to assess the prognostic value of sex, age, gender, performance status, histologic type, tumor size, BM features and treatment modality of primary lung tumor and BM. RESULTS: The median age was 57 years; 94% of the patients were male. Most patients (85%) had a PS of (0-1). BM were unique in 54% of cases, symptomatic in 40% of cases and synchronous in 72% of cases. Chemotherapy was administered to 78% of patients; pulmonary tumor surgery was performed in 5% of patients. BM surgery and panencephalic irradiation were performed in 13% and 86% of patients, respectively. The median overall survival after NSCLC diagnosis was 13.33 months. The median overall survival after BM was 10.6 months. The Control of the primary tumor was the only factor associated with better overall survival (64.95 months Vs 10.6 months (p=0.02)). CONCLUSION: Pulmonary tumor control with complete surgical excision is predictive of better overall survival in patients with NSCLC and BM.

Prognostic factors for second-line chemotherapy of metastatic non-small-cell lung cancer.

BACKGROUND: Few studies have been conduct¬ed to determine prognostic factors of second-line chemotherapy. The aim of this study was to determine the prognostic factors for survival in patients receiving second-line treatment for advanced NSCLC. METHODS: We retrospectively reviewed the records of 71 patients with metastatic NSCLC who received second-line chemotherapy from January 2006 to January 2013. RESULTS: The mean age was 57 years. All patients were male. The performance status was 0 or 1 in 90.1% of cases. Sixty-four patients received a first line platinum-based chemotherapy. The second line chemotherapy regimen was docetaxel in 31 cases and pemetrexed in 18 cases. Fourteen patients (19.71%) had received third-line chemotherapy. The median overall survival was 13.5 months. Age older than 65 years (p=0.025), advanced T stage (T4 versus T3 and T2; p=0.01), advanced N stage (N3 versus N2 and N1; p=0.001), lower level hemoglobin (p=0.05) and non-responders who showed progression with first-line chemotherapy (p=0.04) were significant negative predictors in univariate analysis for overall survival (OS). The multivariate analysis showed that age≥ 65 years (HR=2.15; 95% CI[1.26-2.44]), advanced N stage (HR=2.273; 95% CI [1.26-2.44]) were independent prognostic factors for OS. CONCLUSION: Age and advanced N stage were important factors in predicting the outcome of advanced NSCLC patients who were undergoing second-line chemotherapy.

Descemet membrane detachment after Nd: YAG laser capsulotomy in a patient with fuchs dystrophy.

PURPOSE: Descemet membrane detachment (DMD) is uncommon. It most frequently occurs as a complication of intraocular surgery. The aim of this study was to report a case of DMD after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy in a patient with Fuchs dystrophy. METHODS: We describe the case of an 89-year-old man suffering from Fuchs dystrophy, who underwent cataract surgery on his left eye. Three years later, the patient presented with posterior capsule opacification, which was treated using Nd:YAG laser capsulotomy. The day after the procedure, the patient came back for emergency treatment because of an acute reduction in his vision caused by a DMD. RESULTS: Fifteen days after an initial treatment involving the injection of air into the anterior chamber coupled with ocular paracentesis, clinical examination revealed a significant improvement in visual acuity, reduction in corneal edema, and reattachment of Descemet membrane. These findings were confirmed using anterior segment optical coherence tomography. CONCLUSIONS: To our knowledge, this is the first reported case of DMD after Nd:YAG laser capsulotomy.

[Lung cancer with venous thrombo-embolism: clinical characteristics]. / Maladie veineuse thromboembolique en cas de cancer bronchopulmonaire : approche clinique.

BACKGROUND: Lung cancer is the most common malignancy diagnosed in patients with venous thrombo-embolism (VTE). AIM: To investigate clinical, biological, radiological features and survival of lung cancer patients with VTE. METHODS: Retrospective case-control study investigating biologic, clinical course and survival of 25 patients lung cancers with VTE (Group M) and 50 lung cancers without VTE (group T). RESULTS: The frequency of the VTE was 5.88% with 2.58% pulmonary embolism (PE). The mean age was 58 years ± 9.8 in group M and 57.9 years ± 9.6 in group T. No significant difference concerning medical or surgical history for both groups was found. The dyspnea and chest pain were at equal frequency (63.6%). Regarding the clinical probability of the PE, it was no significant differences between the two groups. A rate of D-dimer > 0.7µg/l was more frequent among group M (75% vs 20%; p = 0.054). The most common histological type was nonsmall cell lung cancer (88%). A stage IV was significantly more frequent in group M (86.4% vs. 52.3%; p = 0.007). The mean period of survival in Group M was 10.6 ± 1.2 month and 20.2 + 1.8 month in group T; p = 0.38. CONCLUSION: The VTE associated to lung cancer is under diagnosed. Prospective studies are needed to establish more adapted scores.