Perceptions and concerns of emergency medicine practitioners about artificial intelligence in emergency triage management during the pandemic: a national survey-based study.

Objective: There have been continuous discussions over the ethics of using AI in healthcare. We sought to identify the ethical issues and viewpoints of Turkish emergency care doctors about the use of AI during epidemic triage. Materials and methods: Ten emergency specialists were initially enlisted for this project, and their responses to open-ended questions about the ethical issues surrounding AI in the emergency room provided valuable information. A 15-question survey was created based on their input and was refined through a pilot test with 15 emergency specialty doctors. Following that, the updated survey was sent to emergency specialists via email, social media, and private email distribution. Results: 167 emergency medicine specialists participated in the study, with an average age of 38.22 years and 6.79 years of professional experience. The majority agreed that AI could benefit patients (54.50%) and healthcare professionals (70.06%) in emergency department triage during pandemics. Regarding responsibility, 63.47% believed in shared responsibility between emergency medicine specialists and AI manufacturers/programmers for complications. Additionally, 79.04% of participants agreed that the responsibility for complications in AI applications varies depending on the nature of the complication. Concerns about privacy were expressed by 20.36% regarding deep learning-based applications, while 61.68% believed that anonymity protected privacy. Additionally, 70.66% of participants believed that AI systems would be as sensitive as humans in terms of non-discrimination. Conclusion: The potential advantages of deploying AI programs in emergency department triage during pandemics for patients and healthcare providers were acknowledged by emergency medicine doctors in Turkey. Nevertheless, they expressed notable ethical concerns related to the responsibility and accountability aspects of utilizing AI systems in this context.

Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study.

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.

Anesthesiologists' Perspective on the Use of Artificial Intelligence in Ultrasound-Guided Regional Anaesthesia in Terms of Medical Ethics and Medical Education: A Survey Study.

OBJECTIVE: Controversy exists around the world as experts disagree on what artificial intelligence will imply for humanity in the future. Medical experts are starting to share perspectives on artificial intelligence with ethical and legal concerns appearing to prevail. The purpose of this study was to determine how anesthesiology and reanimation specialists in Turkey perceive the use of artificial intelligence in ultrasound-guided regional anesthetic applications in terms of medical ethics and education, as well as their perspectives on potential ethical issues. MATERIALS AND METHODS: This descriptive and cross-sectional survey was conducted across Turkey between July 1 and August 31. Data were collected through an online questionnaire distributed by national associations and social media platforms. The questionnaire included questions about the descriptive features of the participants and the possible ethical problems that may be encountered in the use of artificial intelligence in regional anesthesia and 20 statements that were requested to be evaluated. RESULTS: The average age of the 285 anesthesiologists who took part in the study was 42.00 ± 7.51, 144 of them were male, the average years spent in the field was 10.95 ± 7.15 years, 59.3% were involved in resident training, and 74.7% habitually used ultrasound guidance regional anesthetic applications. Of the participants, 80% thought artificial intelligence would benefit patients, 86.7% thought it would benefit resident training, 81.4% thought it would benefit post-graduate medical education, and 80.7% thought it would decrease complications in practice. There will be no ethical issues if sonographic data are captured anonymously, according to 78.25%, while 67% are concerned about who will be held accountable for inaccuracies. CONCLUSION: The majority of anesthetists believe that using artificial intelligence in regional anesthetic applications will decrease complications. Although ethical concerns about privacy and data governance are low, participants do have ethical worries about "accountability for errors."

Quadrant and Dermatomal Analysis of Sensorial Block in Ultrasound- Guided Erector Spinae Plane Block.

OBJECTIVE: As a novel procedure now gaining popularity, erector spinae plane block has been the subject of many studies. However, dermatomal coverage of the sensory block caused by erector spinae plane block has been rarely studied. The goal of this study is to evaluate the sensory block resulting from erector spinae plane block applied at the T9 vertebral level. MATERIALS AND METHODS: This observational, prospective, blinded study was conducted on 50 adult patients undergoing laparoscopic abdominal surgery. All patients underwent bilateral erector spinae plane block at the T9 level after completion of the surgery while under general anesthesia. In order to further evaluate the sensory blockade, we divided the hemiabdomen-hemithorax region into 4 quadrants: dorsal-medial, dorsal- laterel, ventral-lateral, and ventral-medial. The sensorial evaluation was performed using the pinprick test, 2 hours following the application of erector spinae plane block. RESULTS: A total of 28 female and 22 male patients were examined in this study. Complete failure of the block was recorded in 7 patients, with no thoracic/lumbar segmental or quadrant involvement. Successful sensory block was achieved in 67% of the dorsolateral quadrants, 58% of the dorsomedial quadrants, 69% of the ventrolateral quadrants, and 55% of the ventromedial quadrants. CONCLUSION: Cutaneous sensory block of erector spinae plane block at T9 vertebral level revealed variable results and low failure rates. Administration of erector spinae plane block for postoperative analgesia in thoracoab- dominal surgeries requires further randomized controlled trials to confirm its effectiveness and convenience.

Evaluation of ultrasound-guided bilateral low thoracic erector spinae plane block for postoperative analgesia in cesarean delivery patients: a prospective, randomized, controlled clinical trial.

BACKGROUND: Erector spinae plane block (ESPB) is a recently described block. In many reports, ESPB has been reported to provide effective postoperative analgesia in patients undergoing cesarean delivery (CD). Herein, we compared the effectiveness of ESPB and control group in postoperative analgesia in patients undergoing CD under spinal anesthesia. METHODS: This assessor-blinded, prospective, randomized, efficiency study was conducted in the postoperative recovery room and ward at a tertiary university hospital. Eighty-six patients ASA II-III were recruited. Following exclusion, 80 patients were randomized into two equal groups (block and control group). Standard multimodal analgesia was performed in the control group while ESPB block was performed in the intervention (ESPB) group. Opioid consumption was measured and pain intensity between groups was compared using Numeric Rating Scores (NRS). RESULTS: NRS was lower in Group ESPB at 3rd and 6th hours. There was no difference between NRS scores at other hours. Opioid consumption was lower in Group ESPB. CONCLUSION: When added to multimodal analgesia, bilateral ultrasound guided low thoracic ESPB leads to improve the quality of analgesia in the first 24 hours in patients undergoing CD.

Is a Combination of the Serratus Intercostal Plane Block and Rectus Sheath Block Superior to the Bilateral Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy?

OBJECTIVE: The serratus intercostal plane block (SIPB) is a recently defined interfascial plane block. The oblique subcostal transversus abdominis plane block (OSTAP) is another type of interfascial plane block, and it is also used as a part of multimodal analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this retrospective study, we evaluated the effects of the bilateral OSTAP and a combination of the right SIPB and bilateral rectus sheath block (RSB) on the postoperative pain and analgesia requirement in patients undergoing LC. MATERIALS AND METHODS: Data of the patients who underwent LC between May 2018 and November 2018 were evaluated retrospectively. Postoperative pain was evaluated using the numeric rating scale (NRS), and 24-hour tramadol consumption and rescue analgesia requirements were compared. RESULTS: Bilateral OSTAP was applied to 47 patients, and SIPB+RSB was applied to 25 patients. Postoperative pain scores were similar between the two groups. In the first 24 hours, tramadol requirement in the SIPB+RSB group was significantly lower than in the OSTAP block group (p<0.001). There was no statistically significant difference between the NRS averages at different time frames between the two block groups. CONCLUSION: We found that when SIPB is used as a part of multimodal analgesia in a combination with RSB in LS, it improves the quality of analgesia and decreases the analgesic requirement compared to patients undergoing a bilateral OSTAP block. Randomized controlled trials are necessary to compare the effects of SIPB alone and in a combination with other blocks in LC.

Comparison of ultrasound guided Erector Spinae Plane Block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study.

STUDY OBJECTIVE: Erector Spinae Plane Block (ESPB) is a recently described block. Both ESPB and Quadratus Lumborum block type II (QLB-II) have been reported to provide effective postoperative analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this study, we compared the postoperative analgesic effects of ESPB and QLB-II in patients undergoing LC. DESIGN: Assessor Blinded, prospective, randomized, controlled study. SETTING: Tertiary hospital, postoperative recovery room & ward. PATIENTS: 80 patients (ASA I-II) were recruited. Patients were allocated in to two equal groups (ESB and QLB-II). All patients were included in analysis. INTERVENTIONS: Standard multimodal analgesia was performed in all groups. ESPB and QLB-II were performed under ultrasound guidance. MEASUREMENTS: Mean opioid consumptions and Numeric Rating Scores was measured during the first 24 postoperative hours. MAIN RESULTS: Demographic data was similar between groups. There was no difference between NRS scores and opioid consumption at any hour between the groups. CONCLUSION: While ESPB and QLB-II are not significantly different, they improve analgesia quality in patients undergoing LC.