Foot and Ankle Patient Education Materials and Artificial Intelligence Chatbots: A Comparative Analysis.

BACKGROUND: The purpose of this study was to perform a comparative analysis of foot and ankle patient education material generated by the AI chatbots, as they compare to the American Orthopaedic Foot and Ankle Society (AOFAS)-recommended patient education website, FootCareMD.org. METHODS: ChatGPT, Google Bard, and Bing AI were used to generate patient educational materials on 10 of the most common foot and ankle conditions. The content from these AI language model platforms was analyzed and compared with that in FootCareMD.org for accuracy of included information. Accuracy was determined for each of the 10 conditions on a basis of included information regarding background, symptoms, causes, diagnosis, treatments, surgical options, recovery procedures, and risks or preventions. RESULTS: When compared to the reference standard of the AOFAS website FootCareMD.org, the AI language model platforms consistently scored below 60% in accuracy rates in all categories of the articles analyzed. ChatGPT was found to contain an average of 46.2% of key content across all included conditions when compared to FootCareMD.org. Comparatively, Google Bard and Bing AI contained 36.5% and 28.0% of information included on FootCareMD.org, respectively (P < .005). CONCLUSION: Patient education regarding common foot and ankle conditions generated by AI language models provides limited content accuracy across all 3 AI chatbot platforms. LEVEL OF EVIDENCE: Level IV.

Surprise Billing in Elective Shoulder Surgery and Its Effect on Patient Satisfaction.

Patients often receive multiple bills following surgery, which may come as a surprise to them if they are not appropriately informed or educated prior to surgery. The purpose of this study was to identify whether surprise billing occurs following shoulder rotator cuff repair and its effect on patient satisfaction. The study surveyed adult patients who underwent elective rotator cuff repair from January 2020 to October 2021. Patients were asked if they received unexpected bills after their surgery, as well as about details regarding those bills. Additionally, patients were asked about their medical insurance carrier, knowledge of the billing process prior to surgery, and how they felt the process could be improved. Finally, patients were asked how these bills and the overall billing process affected their surgical satisfaction. Of the 158 responses, 25% of the patients stated they received at least one surprise bill following their rotator cuff surgery, with 57% of these bills being greater than $1000. Patients who received surprise bills reported being significantly less satisfied with their surgery (P<.001) and felt their billing experience affected their surgical satisfaction (64% vs 9%, P<.001). One in 4 patients undergoing elective rotator cuff repair received a surprise bill following surgery. These bills were monetarily substantial and significantly affected surgical satisfaction. Although surgeons may be unable to limit the amount of bills patients receive postoperatively, increased communication and education regarding the perioperative billing process may prove to be beneficial for both patient satisfaction and the physician-patient relationship. [Orthopedics. 2024;47(2):123-127.].

Subscapularis tear classification implications regarding treatment and outcomes: consensus decision-making.

Background: Several classifications have been proposed for subscapularis tendon tearing (SCTs); however, there remains a poor agreement between orthopedic surgeons regarding the diagnosis and management of these lesions. Distinguishing the various tear patterns and classifying them with some prognostic significance may aid the operating surgeon in planning appropriate treatment. Purpose: The purpose of this study was to outline the current literature regarding SCT classification and treatment and conduct a survey among shoulder and elbow surgeons to identify the approaches regarding surgical decision-making for these injuries. Methods: In this systematic review, we analyzed 12 articles regarding the subscapularis tendon tear classification and implications regarding treatment plans and outcomes. In addition, 4 international experts in subscapularis repair surgery participated in the development of a questionnaire form that was distributed to 1161 ASES members. One hundred sixty five surgeons participated and chose whether they agree, disagree, or abstain for each of the 32 statements in 4 parts including indications/contraindications, treatment plan, and the factors affecting outcomes in the survey. Results: Classification criteria were extremely variable with differing recommendations and descriptions of tear morphology; most were based on tear size, associated shoulder pathology, or lesser tuberosity footprint exposure. Considering the multiple classification systems and the overall poor agreement regarding SCT management, our study found that the most widely agreed upon (more than 80%) statements included early surgery is advised for traumatic SCT, chronic degenerative SCT (without fatty infiltration) associated with acute supraspinatus tear is a candidate for repair, and rotator cuff arthropathy is a contraindication for SCT repair. Conclusion: Our study was able to identify both patient and tear characteristics that are well agreed upon among surgeons in the treatment of these injuries. Lafosse classification is generally widely accepted; however, it needs to be improved by some additions. Continued collaboration among surgeons is needed to establish an acceptable and broadly applicable classification system for the management of these injuries.

Brain wounds and their treatment in VII Corps during Operation Desert Storm, February 20 to April 15, 1991.

OBJECTIVE: To evaluate field neurosurgery supporting VII Corps during combat in Operation Desert Storm. RESULTS: (1) Only 1 of 22 patients who had a head wound died. (2) The one computed tomography unit in a forward hospital worked well, aiding diagnosis and surgical management. The occurrence of hematoma at a distance from the missile track has been worrisome to past field neurosurgeons, but none of 9 patients who had predebridement scans had a distant clot. (3) The number of brain wounds was fewer than expected for Americans, and the wounds were basilar in location. Iraqis, by contrast, had wounds that were randomly distributed about the head. CONCLUSIONS: (1) Although computed tomography is a useful diagnostic adjunct, its availability should not be a sine qua non for forward neurosurgery. (2) The current Kevlar helmet design appears successful.

Perceptions and attitudes toward organ procurement and transplantation: a medical community survey analysis.

The practitioner who recognizes and facilitates donor referral plays a pivotal role in the donor process. Mechanisms that help to identify and resolve issues for these practitioners are crucial. To identify barriers and issues that the community perceives as important, a survey to elicit the perceptions, attitudes, and ethical values of its respondents-specifically with regard to the donor process-was commissioned. The main components of the instrument included perceived problems, attitudes and ethical values, knowledge of consent process, medical and legal knowledge of brain death, organ procurement organization problems and suggestions for improvement, future education recommendations, and socio-demographic characteristics of the respondent. The survey confirmed issues of concern and brought to surface issues that have an underlying negative influence on the donor process.

Louisiana neurosurgeons and the organ procurement shortage: a comparative analysis of perceptions, attitudes, and ethical values.

The supply of transplantable organs continues to fall behind demand. Knowledge of the perceptions, attitudes, and ethical values held by health care workers involved in the process is critical. This is particularly true of neurosurgeons because of their pivotal role in the procurement process. Survey data are used to compare neurosurgeons (n = 59) with emergency physicians (n = 125), critical care nurses (n = 267), and other physicians (n = 445). Analysis revealed that attitudes among those health care workers regularly involved with organ procurement and transplantation--neurosurgeons, emergency physicians and critical care nurses--tend to be similar. While there is general satisfaction and confidence in Louisiana's organ procurement and transplantation system, there are concerns. Perceived problems cited were: lack of support by the medical and lay community, high costs, potential profiteering, and conflict of interest. Other contentious issues include: organ request strategies, incentives for organ donations, racial bias, and presumed consent legislation. Debate and professional education in these areas are indicated.

Pathophysiology and management of noncardiac chest pain.

Noncardiac chest pain is a common but important clinical challenge with respect to diagnostic strategy as well as therapeutic intervention. The most common esophageal disorder associated with chest pain syndrome is gastroesophageal reflux; 24-hour ambulatory monitoring of esophageal pH and the determination of the symptom index are useful in patient evaluation. A high frequency of abnormal esophageal motility has been reported in noncardiac chest pain, but its clinical significance remains controversial. Patients with chest pain and normal coronary angiogram may have microvascular angina. Musculoskeletal conditions account for at least 10% of the cases of noncardiac chest pain. The potential effects of stress and altered psychological states in this phenomenon must be considered. The role of panic attacks in the production of pain needs to be clarified. Investigations to elucidate the exact cause of chest pain as well as its treatment should be individualized to the patient.

Development of a high level of resistance to Bacillus sphaericus in a field population of Culex quinquefasciatus from Kochi, India.

Field resistance to Bacillus sphaericus was observed in a population of Culex quinquefasciatus in Kochi, India, exposed to 35 rounds of spraying with a formulation of B. sphaericus 1593 M over a 2-year period. Larvae from the sprayed area gave LC50 and LC90 values that were 146 and 180 times greater than corresponding values for a susceptible strain from an unsprayed locality. When the resistant strain was colonized in the laboratory and subjected to moderate selection pressure at each generation, resistance rapidly increased and by the 18th generation it was 6,223 and 31,325 times greater at the LC50 and LC90 levels in comparison with the susceptible strain. There were no significant differences among 6 susceptible strains tested. Tests were repeated and validated using the standard primary powder SPH88, B. sphaericus 2362. No cross resistance was observed against B. thuringiensis H-14.

A self-image profile analysis of spina bifida adolescents in Louisiana.

With the growing number of spina bifida children reaching adolescence and adulthood and the national thrust toward "mainstreaming" disabled children, there is increasing need for research on the problems of social and psychological adaptation. The goal of this study was to obtain a normed, psychosocial self-image profile of Louisiana's adolescent spina bifida population. Offer's self-image scale was administered to a sample of 50 Louisiana spina bifida adolescents, ranging from 11 to 21 years of age. The sample's self-image profile was statistically compared to a normal profile, as a group, by age, by gender, and by level of vertebral disability. With the exception of the sexuality dimension, which was significantly below normal, especially in females, 10 of the 11 dimensions were statistically within normal limits. Correlations of self-image subscales with gender, age, and disability revealed several curious and potentially important findings.

Multisource drugs: implications and concerns in the geriatric population.

The demand for high-quality, cost-effective pharmaceuticals has increased. Much of this demand has evolved as a result of rising healthcare costs, state and federal entitlement programs, and third-party drug benefit restrictions. Patent expirations and changing patient demographics, as well as recent contributory forces, have fueled the need for multisource drugs and led to their greater availability. Legislative attention focused on the Food and Drug Administration and Abbreviated New Drug Application approval has had a positive effect on the multisource industry. The public is assured an era of vigilance, continual quality assessment, and greater integrity in the multisource drug approval process. The elderly are a rapidly growing population of prescription drug users who can benefit from cost-effective pharmaceuticals, such as those offered by multisource drugs. However, concerns and issues have arisen regarding the use of multisource drugs in the elderly. This article reviews these concerns and places into perspective the role of multisource pharmaceuticals in this population.

The right to die: public perceptions and attitudes in metropolitan Baton Rouge.

The right to die movement is gaining momentum. Forty states, including Louisiana, have passed living will statues. Survey results indicate that relatively few people have accurate knowledge of the living will concept, and less than 4% have actually executed a living will. When informed of their rights, nearly two thirds of the sample would consider executing a living will or appointing a health care agent. Specific kinds of medical procedures desired in hypothetical terminal care situations vary considerably, and vary also according to certain socioeconomic characteristics. situations vary considerably, and vary also according to certain socioeconomic characteristics.

Space-spraying with malathion as a supplementary measure for operational malaria control.

Entomological studies showed that due to outdoor resting by the vector Anopheles culicifacies as well as poor spray coverage, indoor residual spraying with malathion was ineffective in malarious villages of the Thenpennai riverine tract in Tamil Nadu. Over a 4 yr period during which residual spraying was supplemented with ground applications of malathion space spraying, the slide positivity among patients with fever fell from 21.04 to 1.1 per cent. In mass blood surveys 0.7 per cent persons surveyed at the beginning of the study were positive for the malarial parasite, but no positives were detected in the last survey, in 1984. There was a rising trend in malaria incidence in riverine villages outside the programme.

Use of trapezius muscle for closure of complicated upper spinal defects.

Dehiscence of cervicothoracic incisional wounds is an occasional complication of laminectomy. Subsequent healing can be further compromised by associated immunodeficiency, malignancy, infection, previous radiotherapy, and cerebrospinal fluid fistula. Two such cases that responded dramatically to the use of a lower trapezius muscle flap are described. Pertinent anatomical and surgical considerations are reviewed.

Natural history of smouldering leukaemia.

The natural history of 45 cases of smouldering leukaemia has been studied. Males and females were equally represented, with a median age of 60.5. The median survival of the whole group was only 20 months, but rare cases lived 10 years or longer. 38% developed acute leukaemia; the remainder usually died of the results of marrow failure. Although it was possible to divide these marrow dysplasias morphologically into 3 major subgroups (refractory anaemia with excess of myeloblasts, chronic myelomonocytic leukaemia and chronic erythraemic myelosis), several displayed transitional features. Many showed refractory macrocytosis at diagnosis. The survival of the 3 groups was similar, though patients with high monocyte counts tended to present with less anaemia and fared rather better than the others. Statistical analysis suggests that increasing age, severe anaemia, thrombocytopenia and hepatomegaly are associated with a poor prognosis. Chemotherapy, when attempted, was usually unsuccessful.