Reliability, Accuracy, and Comprehensibility of AI-Based Responses to Common Patient Questions Regarding Spinal Cord Stimulation

Background: Although spinal cord stimulation (SCS) is an effective treatment for managing chronic pain, many patients have understandable questions and concerns regarding this therapy. Artificial intelligence (AI) has shown promise in delivering patient education in healthcare. This study evaluates the reliability, accuracy, and comprehensibility of ChatGPT's responses to common patient inquiries about SCS. Methods: Thirteen commonly asked questions regarding SCS were selected based on the authors' clinical experience managing chronic pain patients and a targeted review of patient education materials and relevant medical literature. The questions were prioritized based on their frequency in patient consultations, relevance to decision-making about SCS, and the complexity of the information typically required to comprehensively address the questions. These questions spanned three domains: pre-procedural, intra-procedural, and post-procedural concerns. Responses were generated using GPT-4.0 with the prompt "If you were a physician, how would you answer a patient asking…". Responses were independently assessed by 10 pain physicians and two non-healthcare professionals using a Likert scale for reliability (1-6 points), accuracy (1-3 points), and comprehensibility (1-3 points). Results: ChatGPT's responses demonstrated strong reliability (5.1 ± 0.7) and comprehensibility (2.8 ± 0.2), with 92% and 98% of responses, respectively, meeting or exceeding our predefined thresholds. Accuracy was 2.7 ± 0.3, with 95% of responses rated sufficiently accurate. General queries, such as "What is spinal cord stimulation?" and "What are the risks and benefits?", received higher scores compared to technical questions like "What are the different types of waveforms used in SCS?". Conclusions: ChatGPT can be implemented as a supplementary tool for patient education, particularly in addressing general and procedural queries about SCS. However, the AI's performance was less robust in addressing highly technical or nuanced questions.

Maladaptive personality traits are associated with burnout risk in Italian anesthesiologists and intensivists: a secondary analysis from a cross-sectional study

BACKGROUND

Burnout is a maladaptive response to chronic stress, particularly prevalent among clinicians. Anesthesiologists are at risk of burnout, but the role of maladaptive traits in their vulnerability to burnout remains understudied.

METHODS

A secondary analysis was performed on data from the Italian Association of Hospital Anesthesiologists, Pain Medicine Specialists, Critical Care, and Emergency (AAROI-EMAC) physicians. The survey included demographic data, burnout assessment using the Maslach Burnout Inventory (MBI) and subscales (emotional exhaustion, MBI-EE; depersonalization, MBI-DP; personal accomplishment, MBI-PA), and evaluation of personality disorders (PDs) based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition) criteria using the assessment of DSM-IV PDs (ADP-IV). We investigated the aggregated scores of maladaptive personality traits as predictor variables of burnout. Subsequently, the components of personality traits were individually assessed.

RESULTS

Out of 310 respondents, 300 (96.77%) provided complete information. The maladaptive personality traits global score was associated with the MBI-EE and MBI-DP components. There was a significant negative correlation with the MBI-PA component. Significant positive correlations were found between the MBI-EE subscale and the paranoid (r = 0.42), borderline (r = 0.39), and dependent (r = 0.39) maladaptive personality traits. MBI-DP was significantly associated with the passive-aggressive (r = 0.35), borderline (r = 0.33), and avoidant (r = 0.32) traits. Moreover, MBI-PA was negatively associated with dependent (r =  - 0.26) and avoidant (r =  - 0.25) maladaptive personality features.

CONCLUSIONS

There is a significant association between different maladaptive personality traits and the risk of experiencing burnout among anesthesiologists. This underscores the importance of understanding and addressing personality traits in healthcare professionals to promote their well-being and prevent this serious emotional, mental, and physical exhaustion state.

Recent Advances and Perspectives in Anesthesiology: Towards Artificial Intelligence-Based Applications

In recent years, the field of anesthesiology has seen remarkable advancements in patient safety, comfort, and outcomes [...].

Advanced statistical approaches for predicting pain after pediatric thoracotomy: a cross-sectional study using zero-inflated and Poisson models

BACKGROUND

Thoracotomy is one of the surgical procedures most burdened by chronic post-operative pain. There is poor evidence regarding the possibility that even in pediatric patients, thoracotomy can be followed by post-operative pain. The primary objective of this analysis is to identify associations with home pain therapy, pain intensity, and possible protective factors acting on chronic pain in this population.

METHODS

A retrospective cross-sectional study was conducted at Ospedale Pediatrico Bambino Gesù IRCCS. The study included pediatric patients undergoing thoracotomy. For statistical analyses, a logistic model and a zero-inflated strategy were implemented to explore associations and predict factors related to home-based analgesic therapy and pain intensity.

RESULTS

Gender and age were identified as significant factors in the assignment of home therapy, with males having over seven times the risk compared to females (OR = 7.06, 95% CI = [2.11, 29.7]). At the last measurement, pain intensity was positively associated with age and the number of pain events during the week.

CONCLUSIONS

The study highlights significant factors influencing post-thoracotomy pain management in pediatric patients. These findings underscore the importance of tailored pain management strategies that consider gender and age to improve post-operative care and outcomes in pediatric thoracotomy patients.

Last-Minute Cancellations in Pediatric Ambulatory and Day Surgeries in Italy: Prevalence and Risk Factors

BACKGROUND

Cancellation of pediatric day and ambulatory surgeries on the day of the procedure poses a significant challenge, impacting hospital resources and patient care. In Italy, ambulatory surgery is defined as a surgical/diagnostic procedure without hospitalization, and day surgery is defined as a surgical/diagnostic procedure with daytime hospitalization.

AIMS

To measure the rate and causes of cancellations on the day of the procedure in a tertiary pediatric hospital in Italy.

METHODS

We collected the data retrospectively from the electronic health record between January 2020 and March 2022 at Ospedale Pediatrico Bambino Gesù in Rome, Italy. The number of case cancellations were captured. The reasons for cancellation were categorized into three different buckets: anesthetic reasons, surgical reasons, and non-adherence to protocol. The reasons under each of these categories were further explored. We analyzed the difference in the rate of last-minute cancellations between ambulatory surgery and day surgeries to examine if different pathways produce different results.

RESULTS

A total of 4,600 procedures were scheduled and 183 were canceled (3.9% of total procedures). Surgical reasons contributed to most cancellations (49%), followed by anesthesia reasons (42%) and non-adherence to protocols (9%). Surgical reasons, including the need for post-operative hospitalization, were the primary causes for cancellation, often due to mismatches between pre-operative evaluations and the final decision-making process. Younger patients, particularly those prone to respiratory tract infections, were more likely to experience cancellations. Anesthetic reasons were also a significant factor but less prevalent than surgical ones.

CONCLUSIONS

Using standardized treatment and diagnosis pathways can reduce the number of canceled procedures and optimize resources. A telephone re-assessment before the procedure and telemedicine can be useful strategies to further reduce the cancellation rate.

CLINICAL IMPLICATIONS

The use of pediatric day surgery has significant advantages: minimizing last-minute canceled procedures means increasing patient comfort and reducing healthcare costs. Identifying the causes of cancellations on the day of the procedure allows one to improve the organizational system of the operating room.

Discogenic Low Back Pain: Anatomic and Pathophysiologic Characterization, Clinical Evaluation, Biomarkers, AI, and Treatment Options

Discogenic low back pain (LBP) is a significant clinical condition arising from degeneration of the intervertebral disc, a common yet complex cause of chronic pain, defined by fissuring in the annulus fibrosus resulting in vascularization of growing granulation tissue and growth of nociceptive nerve fibers along the laceration area. This paper delves into the anatomical and pathophysiological underpinnings of discogenic LBP, emphasizing the role of intervertebral disc degeneration in the onset of pain. The pathogenesis is multifactorial, involving processes like mitochondrial dysfunction, accumulation of advanced glycation end products, and pyroptosis, all contributing to disc degeneration and subsequent pain. Despite its prevalence, diagnosing discogenic LBP is challenging due to the overlapping symptoms with other forms of LBP and the absence of definitive diagnostic criteria. Current diagnostic approaches include clinical evaluations, imaging techniques, and the exploration of potential biomarkers. Treatment strategies range from conservative management, such as physical therapy and pharmacological interventions, to more invasive procedures such as spinal injections and surgery. Emerging therapies targeting molecular pathways involved in disc degeneration are under investigation and hold potential for future clinical application. This paper highlights the necessity of a multidisciplinary approach combining clinical, imaging, and molecular data to enhance the accuracy of diagnosis and the effectiveness of treatment for discogenic LBP, ultimately aiming to improve patient outcomes.

Non-invasive Mechanical Ventilation in Lung Cancer: Physiological Principles and Clinical Utilization in Surgical and Non-surgical Settings

Non-invasive mechanical ventilation (NIMV) has emerged as a pivotal intervention for the care of individuals with lung cancer. NIMV offers substantial advantages in enhancing oxygenation, optimizing respiratory function, elevating pulmonary capacities, and facilitating patient comfort. NIMV's utility extends to enhancing clinical conditions that range from chronic obstructive pulmonary disease and emphysematous lung ailments to aiding patients with lung cancer facing acute respiratory failure. Furthermore, NIVM includes perioperative pulmonary rehabilitation. This approach is particularly relevant for individuals with limited lung capacity. Since both non-invasive positive pressure ventilation modes, including BiLevel positive airway pressure and continuous positive airway pressure, address the underlying pathophysiological mechanisms that contribute to postoperative respiratory failure, the proactive and early integration of NIMV has the potential to significantly enhance gas exchange and overall respiratory performance in meticulously chosen patients within the perioperative phase. Although non-intubated video-assisted thoracic surgery represents an interesting field of application for NIMV strategies, further studies are needed to optimize operative modalities. Lastly, NIMV has a pivotal role in the settings of intensive care and palliative care units, thereby cementing its versatile utility across various medical contexts.

Assessing the Efficacy and Safety of Extubation Protocols in the Intensive Care Unit Following Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome: A Retrospective Cohort Study

Background: There is a notable lack of protocols addressing extubation techniques in transoral robotic surgery (TORS) for obstructive sleep apnea (OSA). Methods: This retrospective cohort study enrolled patients who underwent TORS for OSA between March 2015 and December 2021 and were managed with different extubation approaches. The patients were divided into two groups: high-flow nasal cannula (HFNC) therapy and conventional oxygen therapy. The use of an airway exchange catheter (AEC) was investigated. Results: The application of HFNC use versus conventional oxygen therapy led only to a statistical reduction in extubation time (p = 0.024); length of stay in the intensive care unit (ICU) and the episodes of desaturation below 95% were reduced, but data are non-statistically significant. Similarly, the application of an AEC led to a reduction in extubation time in hours (p = 0.008) and length of stay in the ICU (p = 0.024). Conclusions: In patients with OSA who underwent TORS, the use of an HFNC, with or without an AEC, resulted in a significant reduction in extubation time without major adverse events. Additionally, HFNC utilization may decrease desaturation episodes during extubation. Despite limitations, based on the findings of this preliminary investigation, the combination of an HFNC and an AEC emerges as a promising strategy for enhancing the safety and efficacy of extubation protocols in this patient population.