Board-certified Physicians Research Articles

An osteopathic assessment of lower extremity somatic dysfunctions in runners.

Runners often experience acute/chronic pain due to pre-existing structural somatic dysfunction and/or acquired various overuse injuries of the lower extremity, specifically affecting the ligaments, tendons, muscles, and bones. Common structural and function dysfunctions include but are not limited to patellofemoral pain syndrome (PFPS), Achilles tendonitis, iliotibial band syndrome (ITBS), ligamentous and muscle tears, muscle sprains/strains, stress fractures, pes planus, plantar fasciitis, and shin splints. The purpose of this study is to assess the correlation between acute and chronic pain, overuse injuries, and observational and palpatory findings upon evaluation to establish common trends of somatic dysfunctions and determine possible etiology of the pain/injury. A total of 103 individuals were recruited (54.4% female, 45.6% male) aged 23-67 years old who consistently run at least 1 mile each week. They were categorized based on their weekly mileage- Novice (1-5 miles per week), Moderate (6-15), Advanced (15+)- with the intention to have a diversity of running types and to assess the data at various levels of commitment to running. The average was 7.8 miles/week with the range at 1 to 28 miles per week. The subjects included Touro students and individuals in the community. A history was collected through an anonymous survey on the individual's running habits, chronic/acute injuries, and any other relevant medical information. Data analyzing investigators were blinded to subjects' identifying information. Additionally, an osteopathic assessment was performed by two student investigators for reliability purposes and conducted under supervision by a board-certified osteopathic physician. Analysis of the data suggested an existing correlation between the number of somatic dysfunctions and years of running. A slight correlation was found between somatic dysfunctions and miles per week, sports injuries, time per week, and lower extremity pain. Finally, statistical correlations were also identified between the presence of pes planus and limb length discrepancy with three distinct muscular hypertonicities. Runners' pains and injuries of the lower extremity are complex, and injury treatment and prevention is equally multifaceted. An association was found between both pes planus and limb length discrepancy with lower extremity muscle hypertonicity, suggesting the interrelated nature of these somatic dysfunctions. The survey concluded that many runners continue to run in pain and/or after significant injury but do not necessarily capitalize on existing support such as fitted shoes, custom arches, and osteopathic treatment that may help to minimize their risk of or treat injury. The intention of the research is to bring awareness to practitioners to the most common somatic dysfunctions such that they can recommend runners to obtain gait analyses and/or osteopathic treatments, which may not only alleviate injuries faster but also prevent future injury.

Diagnostic performance of ChatGPT in tibial plateau fracture in knee X-ray.

Tibial plateau fractures are relatively common and require accurate diagnosis. Chat Generative Pre-Trained Transformer (ChatGPT) has emerged as a tool to improve medical diagnosis. This study aims to investigate the accuracy of this tool in diagnosing tibial plateau fractures. A secondary analysis was performed on 111 knee radiographs from emergency department patients, with 29 confirmed fractures by computed tomography (CT) imaging. The X-rays were reviewed by a board-certified emergency physician (EP) and radiologist and then analyzed by ChatGPT-4 and ChatGPT-4o. The diagnostic performances were compared using the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and likelihood ratios were also calculated. The results indicated a sensitivity and negative likelihood ratio of 58.6% (95% CI: 38.9 - 76.4%) and 0.4 (95% CI: 0.3-0.7) for the EP, 72.4% (95% CI: 52.7 - 87.2%) and 0.3 (95% CI: 0.2-0.6) for the radiologist, 27.5% (95% CI: 12.7 - 47.2%) and 0.7 (95% CI: 0.6-0.9) for ChatGPT-4, and 55.1% (95% CI: 35.6 - 73.5%) and 0.4 (95% CI: 0.3-0.7) for ChatGPT4o. The specificity and positive likelihood ratio were 85.3% (95% CI: 75.8 - 92.2%) and 4.0 (95% CI: 2.1-7.3) for the EP, 76.8% (95% CI: 66.2 - 85.4%) and 3.1 (95% CI: 1.9-4.9) for the radiologist, 95.1% (95% CI: 87.9 - 98.6%) and 5.6 (95% CI: 1.8-17.3) for ChatGPT-4, and 93.9% (95% CI: 86.3 - 97.9%) and 9.0 (95% CI: 3.6-22.4) for ChatGPT4o. The area under the receiver operating characteristic curve (AUC) was 0.72 (95% CI: 0.6-0.8) for the EP, 0.75 (95% CI: 0.6-0.8) for the radiologist, 0.61 (95% CI: 0.4-0.7) for ChatGPT-4, and 0.74 (95% CI: 0.6-0.8) for ChatGPT4-o. The EP and radiologist significantly outperformed ChatGPT-4 (P value = 0.02 and 0.01, respectively), whereas there was no significant difference between the EP, ChatGPT-4o, and radiologist. ChatGPT-4o matched the physicians' performance and also had the highest specificity. Similar to the physicians, ChatGPT chatbots were not suitable for ruling out the fracture.

Impact of medication nonadherence and drug-drug interaction testing on the management of primary care patients with polypharmacy: a randomized controlled trial

BackgroundClinical management of patients with chronic cardiometabolic disease is complicated by polypharmacy. Consequently, when patients clinically deteriorate, physicians are challenged to distinguish both medication nonadherence and drug-drug interactions (DDI) from chronic disease progression.MethodsIn this randomized controlled trial, we enrolled U.S. board-certified Primary Care Physicians (PCPs) serving patients with cardiometabolic disease. PCPs were randomized and managed their patients with (intervention), or without (control), a novel chronic disease management test (CDMT) that can detect medication nonadherence and DDIs. Patients’ medical records were abstracted at baseline and 3-month follow-up. Primary outcomes were the CDMT’s impact on both the PCPs’ detection of medication nonadherence and DDI, and the frequency of performing medication nonadherence- and DDI-related clinical actions. Secondary outcomes examined the types of clinical actions performed. Primary and secondary outcomes were analyzed by logistic regression using single variable and clustered multivariable modeling to adjust for similarities in patient characteristics, by PCP practice.ResultsSixteen intervention and 20 control PCPs shared de-identified records for 126 and 207 patients, respectively. There were no significant demographic differences between the two study arms, among PCPs or patients. At baseline, there was no significant difference between the intervention and control PCPs in the percentage of clinical actions performed for medication nonadherence (P = 0.98) and DDI (P = 0.41). At 3-month follow-up (after CDMT), 69.1% of intervention compared to 20.3% of control patients with medication nonadherence had a related clinical action performed (P < 0.001). Regarding DDI, 37.3% of intervention compared to 0.5% of control patients had a relevant clinical action performed in follow-up (P < 0.001). Across the range of medication nonadherence- and DDI-related actions, the intervention compared to the control PCPs were more likely to adjust the medication regimen (24.1% vs. 9.5%) and document medication nonadherence in the patient chart (31.0% vs. 14.3%) at follow-up (P = 0.04).ConclusionsAlthough intervention and control PCPs similarly detected and acted upon medication nonadherence and DDI at baseline, intervention PCPs’ detection increased significantly after using the CDMT. Also, the clinical actions performed with CDMT support were more clinically rigorous. These outcomes support the clinical utility of CDMT in the management of symptomatic patients with cardiometabolic disease and polypharmacy.Trial registrationhttps://clinicaltrials.gov/study/NCT05910684.

Implementing a Multidisciplinary Lifestyle Medicine Clinic for Cancer Survivorship.

Lifestyle medicine (LM) is increasingly recognized in cancer survivorship guidelines. The 6 LM pillars are physical activity, a predominantly plant diet, restorative sleep, stress management, avoiding risky substance use, and social connections. Through a multidisciplinary LM clinic in oncology, we describe 2 illustrative cases and the implications for broader implementation and dissemination of this clinic model. In the multidisciplinary LM clinic in oncology, patients meet with an American College of Lifestyle Medicine (ACLM) board-certified physician or nurse practitioner, a registered dietitian, and, as needed, a clinical psychologist, a psychiatrist, an obesity medicine physician, a physical therapist, and/or a rehabilitation medicine physician. Patient 1 met with the physician, the registered dietitian, the psychologist, and an affiliated cancer center psychiatrist. Patient 2 met with the nurse practitioner and the registered dietitian. The 2 cases presented illustrate the diversity of LM pillars and strategies to increase health and well-being post cancer treatment. This paper details the model of implementation of a novel oncology-focused multidisciplinary LM clinic and the clinical focuses of 2 diverse patients. The LM needs of cancer survivors seeking lifestyle consultation are growing, and awareness of the benefits of LM for this population can enhance the quality of life for patients who are survivors of cancer.

Chasing sleep physicians: ChatGPT-4o on the interpretation of polysomnographic results.

From a healthcare professional's perspective, the use of ChatGPT (Open AI), a large language model (LLM), offers huge potential as a practical and economic digital assistant. However, ChatGPT has not yet been evaluated for the interpretation of polysomnographic results in patients with suspected obstructive sleep apnea (OSA). To evaluate the agreement of polysomnographic result interpretation between ChatGPT-4o and a board-certified sleep physician and to shed light into the role of ChatGPT-4o in the field of medical decision-making in sleep medicine. For this proof-of-concept study, 40 comprehensive patient profiles were designed, which represent a broad and typical spectrum of cases, ensuring a balanced distribution of demographics and clinical characteristics. After various prompts were tested, one prompt was used for initial diagnosis of OSA anda further for patients with positive airway pressure (PAP) therapy intolerance. Each polysomnographic result was independently evaluated by ChatGPT-4o and a board-certified sleep physician. Diagnosis and therapy suggestions were analyzed for agreement. ChatGPT-4o and the sleep physician showed 97% (29/30) concordance in the diagnosis of the simple cases. For the same cases the two assessment instances unveiled 100% (30/30) concordance regarding therapy suggestions. For cases with intolerance of treatment with positive airway pressure (PAP) ChatGPT-4o and the sleep physician revealed 70% (7/10) concordance in the diagnosis and 44% (22/50) concordance for therapy suggestions. Precise prompting improves the output of ChatGPT-4o and provides sleep physician-like polysomnographic result interpretation. Although ChatGPT shows some shortcomings in offering treatment advice, our results provide evidence for AI assisted automation and economization of polysomnographic interpretation by LLMs. Further research should explore data protection issues and demonstrate reproducibility with real patient data on a larger scale.

Medical misinformation in social media: Representations of gastrointestinal disorders on a short video platform

Background and Objectives: Short video platforms have become one of the most common methods for disseminating medical information on social media. We analysed gastrointestinal (GI)-related content on TikTok, focusing on the creators’ background, patterns of content utilisation and overall content quality and understandability, using validated metrics to quantify the degree of misinformation. Methods: Twelve hashtags related to common GI conditions on TikTok and the 20 most engaging posts associated with each hashtag were selected for review. The ‘most engaging’ status was determined by the application’s internal algorithm. Six GI board-certified physicians evaluated the videos using two validated instruments: DISCERN quality criteria and Patient Education Materials Assessment Tool (PEMAT-A/V) survey. Results: In total, 253 videos were reviewed with 18.6 billion likes, 191,000 comments, 935,000 saves and 927,000 shares. IBS hashtag had the greatest number of views (2.2 billion), while videos on haemorrhoids had the most likes (4.3 million), comments (59,000) and shares (288,000). Most videos 177/253 (70%) were created by non-healthcare workers. The median video quality was 2/5 on DISCERN Likert-type scale with 23/75 DISCERN score. Of 186 videos, 114 (61.3%) were rated ‘very poor’; 58/186 (31.2%) ‘poor’, 13/186 (7%) ‘fair’ and only one video (0.5%) was rated ‘excellent’ on DISCERN grading system. The median PEMAT-A/V scores were 7/12 (73.9%) for understandability and 1/3 (33.3%) for actionability. Conclusion: Our study highlights significant public interest in common GI disorders. However, most posts lacked substantive information and did not have verifiable sources.

8076 Advancing Career Development of Physician-Scientists Engaged in Diabetes Research: Insights into the National K12 DiabDocs Program

Abstract Disclosure: K.D. Dasani: None. F.K. Bishop: None. S.H. Golden: None. L.M. Laffel: None. R.G. Mirmira: None. A.K. Steck: None. S.M. Willi: None. D.M. Maahs: None. L.A. DiMeglio: None. Background: In July 2022 the NIH established a multi-center National K12 “Diabetes-Docs: Physician-Scientist Career Development Program” (DiabDocs) to support mentored research experiences and tailored career development training for cohorts of physician scientists focused on diabetes research. DiabDocs scholars are board-certified or board-eligible physicians with training in pediatric or adult endocrinology or in another area tied to diabetes research and care. The program addresses the shortage of physicians engaged in diabetes research and is open to scholars at any eligible institution in the United States. Methods: The DiabDocs program was implemented by two multi-center Program Directors (MPD), in collaboration with an Executive Leadership Committee (ELC) comprised of experienced basic science and clinical/translational physician-scientists. Additional faculty from 19 different institutions have engaged in advisory and reviewer roles. The program solicits Letters of Intent (LOIs) annually from interested candidates followed by invitations for full applications; a program retreat features educational workshops and diversity training; and a Study Section selects Scholars. Currently, the program is in its third recruitment cycle for additional scholars to start Summer 2024. Additional career development programming is available through a series of interactive webinars. The program also has a strong commitment to diversity, equity, and inclusion, including a “DiabDiversity” program to support in-person engagement in DiabDocs experiences by under-represented in medicine trainees. Results: After two successful recruitment cycles in 2022-2023 that reviewed 24 LOIs, 11 scholars were selected. The funded scholars (6 Adult and 5 Pediatric Endocrinologists) include 3 individuals self-identifying as underrepresented in medicine and 7 females. For the 2023 application cycle, 24 LOIs were received (11 from Adult and 9 from Pediatric Endocrinology, 2 in combined Pediatric/Adult Endocrinology, and 2 from other specialties). Conclusions: The DiabDocs program aims to identify, recruit, and support outstanding early career physician scientists. The program provides a national network with resources for protected research time, career development programs, and national mentorship to develop cohorts of skilled professionals contributing to the advancement of diabetes research. Presentation: 6/2/2024

Emergency physicians perspectives of state continuing medical education requirements for medical licensure.

This study aims to better understand the perspectives of emergency medicine physicians' on the role that state-mandated, topic-specific continuing medical education (CME) plays in addressing knowledge gaps, its relevance to current emergency practice, its reported burden and costs of CME activities to emergency physicians, and its perceived improvement in patient care. A cross-sectional survey was designed by the Coalition of Board-Certified Emergency Physicians (COBCEP) and distributed in February 2023 to all American Board of Emergency Medicine (ABEM)-certified physicians. Statistical tests of significance (Pearson's chi-square and Fisher's exact test) assessed the cost and time spent on CME as well as the perceived value placed on CME by ABEM-certified physicians to improve patient care. Data were summarized using descriptive statistics. There were 5562 (13.0%) responses from the 43656 physicians who received the survey-5506 responses were included for analysis. Over half of the physicians (53.0%) had more than 15 years of post-residency practice experience. Most physicians (57.3%) spent less than $5,000 per year on obtaining CME. Most physicians practicing in states with state-mandated, topic-specific CME requirements believed that participation in ABEM continuing certification could be used to reduce the need for state-mandated, topic-specific CME requirements (83.6%) and state-mandated, topic-specific requirements were believed to be unlikely to improve patient care (70.8%). Although well-intended, state CME requirements may lack relevancy and can, at times, place an undue burden on emergency physicians. Tailoring CME requirements to increase relevance to their patient populations and reduce barriers to completing CME could enhance knowledge translation and improve patient outcomes.

Performance of Publicly Available Large Language Models on Internal Medicine Board-style Questions.

Ongoing research attempts to benchmark large language models (LLM) against physicians' fund of knowledge by assessing LLM performance on medical examinations. No prior study has assessed LLM performance on internal medicine (IM) board examination questions. Limited data exists on how knowledge supplied to the models, derived from medical texts improves LLM performance. The performance of GPT-3.5, GPT-4.0, LaMDA and Llama 2, with and without additional model input augmentation, was assessed on 240 randomly selected IM board-style questions. Questions were sourced from the Medical Knowledge Self-Assessment Program released by the American College of Physicians with each question serving as part of the LLM prompt. When available, LLMs were accessed both through their application programming interface (API) and their corresponding chatbot. Mode inputs were augmented with Harrison's Principles of Internal Medicine using the method of Retrieval Augmented Generation. LLM-generated explanations to 25 correctly answered questions were presented in a blinded fashion alongside the MKSAP explanation to an IM board-certified physician tasked with selecting the human generated response. GPT-4.0, accessed either through Bing Chat or its API, scored 77.5-80.7% outperforming GPT-3.5, human respondents, LaMDA and Llama 2 in that order. GPT-4.0 outperformed human MKSAP users on every tested IM subject with its highest and lowest percentile scores in Infectious Disease (80th) and Rheumatology (99.7th), respectively. There is a 3.2-5.3% decrease in performance of both GPT-3.5 and GPT-4.0 when accessing the LLM through its API instead of its online chatbot. There is 4.5-7.5% increase in performance of both GPT-3.5 and GPT-4.0 accessed through their APIs after additional input augmentation. The blinded reviewer correctly identified the human generated MKSAP response in 72% of the 25-question sample set. GPT-4.0 performed best on IM board-style questions outperforming human respondents. Augmenting with domain-specific information improved performance rendering Retrieval Augmented Generation a possible technique for improving accuracy in medical examination LLM responses.

The attitudes and knowledge of family physicians regarding malnutrition in the elderly: a call for action

BackgroundMalnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly.MethodsBased on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years.ResultsSurveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients.ConclusionWe recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention.

Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System.

Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers. This study was a mixed-methods, retrospective review of quality assurance data collected prior to and after implementation of a telemedicine program targeting patients with chest pain. We compared quantitative data from the 12-month pre-implementation phase to data from 15 months post-implementation. Patients were included if they had a chief complaint of chest pain or a 12-lead electrocardiogram had been obtained. The primary outcome was the rate of ALS transport before and after program implementation. Secondary outcomes included EMS call response times and EMS agency performance on quality improvement benchmarks. Qualitative data were also collected after each telemedicine encounter to evaluate paramedic/EMT and EMS physician perception of call quality. The telemedicine pilot project was implemented in September 2020. Overall, there were 58 successful encounters. For this analysis, we included 38 patients in both the pre-implementation period (September 9, 2019-September 10, 2020) and the post-implementation period (September 11, 2020-December 5, 2021). Among this population, the ALS transport rate was 42% before and 45% after implementation (odds ratio 1.11; 95% confidence interval 0.45-2.76). The EMS median out-of-service times were 47 minutes before, and 33 minutes after (P = 0.07). Overall, 64% of paramedics/EMTs and 89% of EMS physicians rated the telemedicine call quality as "good." In this rural EMS system, a telehealth platform was successfully used to connect paramedics/EMTs to board-certified EMS physicians over a 15-month period. Telemedicine use did not alter rates of ALS transports and did not increase on-scene time. The majority of paramedics/EMTs and EMS physicians rated the quality of the telemedicine connection as "good."

Family Presence During Resuscitation: Perspectives of Saudi Emergency Medicine Providers.

Background Family presence during resuscitation (FPDR) has been a long-debated topic in medical circles in the last 40 years. Studies usually concentrate on the opinions and responses of the family members of the patients being resuscitated. Only a handful of studies have focussed on the medical practitioner's opinions and beliefs on the topic. Hence, this study aimed to investigate opinions and beliefs regarding FPDR among emergency medicine practitioners (EMPs) in the Kingdom of Saudi Arabia. Methodology This was a self-filled, questionnaire-based study conducted among 450 EMPs across the Kingdom of Saudi Arabia. Proportions and subgroup analyses were conducted with respect to gender, experience, and seniority. EMPs were asked about the number of family members they would allow to attend the resuscitation of a patient under their care in different clinical scenarios. Results A total of 392 (87.1%) EMPs participated in this study. Overall, 64% (n = 250) of EMPs reported that they would not allow FPDR in cases that involved trauma, or if the patient being revived was female. This percentage dropped to about 33% (n = 129) when the patient being resuscitated was a child or in out-of-hospital arrest. The majority of EMPs believed that the decision to allow FPDR was the physician's decision (n = 251, 64.8%) and not the right of the family (n = 133, 34.7%). Moreover, emergency medicine board-certified physicians were more likely to allow FPDR in different cases with 19 (18.5%) in adult arrest cases, 18 (18%) in pediatric cases, and 16 (15.1%) in trauma cases, than non-board-certified practitioners (p = 0.001, 0.007, and 0.031, respectively). Female EMPs were more likely to refuse FPDR than their male counterparts (p < 0.001). Conclusions Approximately, 60-70% of EMPs allowed a member of the family to attend the resuscitation of their loved one. However, this percentage dropped in cases where the patient was a female, or the case was a trauma case instead of a medical case. Most Saudi EMPs believed that FPDR hurts the resuscitating team and might hinder the resuscitation efforts.

Assessing the readability and quality of online patient information for laser tattoo removal

Just as tattoos continue to increase in popularity, many people with tattoos also seek removal, often due to career concerns. Prospective clients interested in laser tattoo removal may do research about the procedure online, as the internet increasingly becomes a resource to get preliminary health information. However, it is important that the online health information on the topic be of high quality and be accessible to all patients. We analyzed 77 websites from a Google search query using the terms “Laser tattoo removal patient Information” and “Laser tattoo removal patient Instructions” to assess this. The websites were evaluated for their readability using multiple validated indices and comprehensiveness. We found that websites had a broad readability range, from elementary to college, though most were above the recommended eighth-grade reading level. Less than half of the websites adequately discussed the increased risk of pigmentary complications in the skin of color clients or emphasized the importance of consulting with a board-certified dermatologist/plastic surgeon before the procedure. Over 90% of the websites noted that multiple laser treatments are likely needed for complete clearance of tattoos. The findings from our study underscore a significant gap in the accessibility and quality of online information for patients considering laser tattoo removal, particularly in addressing specific risks for patients with darker skin tones and emphasizing the need for consulting a board-certified physician before undergoing the procedure. It is important that online resources for laser tattoo removal be appropriately written to allow better decision-making, expectations, and future satisfaction for potential clients interested in the procedure.

Is ChatGPT a Reliable Source of Patient Information on Asthma?

ChatGPT (OpenAI, San Francisco, CA, USA) is a novel artificial intelligence (AI) application that is used by millions of people, and the numbers are growing by the day. Because it has the potential to be a source of patient information, the study aimed to evaluate the ability of ChatGPT to answer frequently asked questions (FAQs) about asthma with consistent reliability, acceptability, and easy readability. We collected 30 FAQs about asthma from the Global Initiative for Asthma website. ChatGPT was asked each question twice, by two different users, to assess for consistency. The responses were evaluated by five board-certified internal medicine physicians for reliability and acceptability. The consistency of responses was determined by the differences in evaluation between the two answers to the same question. The readability of all responses was measured using the Flesch Reading Ease Scale (FRES), the Flesch-Kincaid Grade Level (FKGL), and the Simple Measure of Gobbledygook (SMOG). Sixty responses were collected for evaluation. Fifty-six (93.33%) of the responses were of good reliability. The average rating of the responses was 3.65 out of 4 total points. 78.3% (n=47) of the responses were found acceptable by the evaluators to be the only answer for an asthmatic patient. Only two (6.67%) of the 30 questions had inconsistent answers. The average readability of all responses was determined to be 33.50±14.37 on the FRES, 12.79±2.89 on the FKGL, and 13.47±2.38 on the SMOG. Compared to online websites, we found that ChatGPT can be a reliable and acceptable source of information for asthma patients in terms of information quality. However, all responses were of difficult readability, and none followed the recommended readability levels. Therefore, the readability of this AI application requires improvement to be more suitable for patients.

Sexual Misconduct by Board Certified Family Physicians.

Sexual misconduct by physicians is a consequential violation of patient trust. The purpose of this study was to determine the frequency and patterns of sexual misconduct by physicians certified by the American Board of Family Medicine (ABFM). We described a cohort of current or formerly ABFM certified physicians ("Diplomates") disciplined for sexual misconduct in 2016 to 2022. Ninety-four physicians, representing only 0.1% of ABFM Diplomates, were identified as having received disciplinary action(s) for reported sexual misconduct. These constituted 8.9% of the 1122 cases that resulted in a physician losing board certification or eligibility for any cause in 2016 to 2022. Ninety-three of the 94 physicians identified as male, with an average age of 56 (range 22 to 88 years). Eighty-nine percent of victims were female, and 90% were patients of the physician. Unwanted sexual behavior/assault occurred in more than half of the cases, whereas one third described an ongoing sexual relationship between patient and physician. Nearly 1 in 5 cases also included controlled substance prescribing. Seven cases involved minors. Noncontact ("grooming") behaviors were described in 34 cases, 28 of which included subsequent physical sexual behavior. A clinical setting was the site of misconduct in 84% of cases. Reports of sexual misconduct among board-certified family physicians are infrequent. However, any sexual misconduct by physicians is harmful to patients and the profession. The specialty should work to enhance education and change professional culture to mitigate this important problem.

Inter-rater agreement of CAUTI (catheter-associated urinary tract infections) diagnosis among Infectious disease physicians

Background: CAUTIs constitute forty percent of nosocomial infections, yet their direct link with mortality remains debated. In 2009, NHSN estimated the economic burden of CAUTIs in the U.S. to be over $340 million. Limited data exist on inter-physician concordance in diagnosing CAUTIs, especially in patients with abnormal genitourinary (GU) anatomy. Our study assessed inter-provider variability in diagnosing CAUTI in 50 such patients, including those meeting NHSN(National healthcare safety network) criteria. Methods: We included a random set of 50 adults (18+) with abnormal GU anatomy admitted to the University of Miami hospitals from January 2018 to November 2021 who had a urinary foley catheter and at least one positive urine culture during their hospitalization. Three Infectious disease fellows and three board-certified Infectious disease physicians independently reviewed each patient’s chart, classifying them as having or not having a CAUTI. Inter-physician reliability was assessed using kappa statistics. Results: Our findings highlight substantial variation in clinician-determined CAUTI incidence among the 50 patients with abnormal GU anatomy, ranging from 8% to 32% (Figures 2,3). Inter-rater agreement on CAUTI diagnosis was generally poor (Kappa Hollenbeak CS, et al. The attributable cost of catheter-associated urinary tract infections in the United States: A systematic review. Am J Infect Control. 2018 Jul;46(7):751-757. Trautner BW, et al. Development and validation of an algorithm to recalibrate mental models and reduce diagnostic errors associated with catheter-associated bacteriuria. BMC Med Inform Decis Mak. 2013 Apr 15;13:48. Gafary M, et al. Catheter Associated Urinary Tract Infections (CAUTI) in Bladder Cancer Patients Post Cystectomy With a Neobladder, Open Forum Infectious Diseases, Volume 2, Issue suppl_1, December 2015, 293.

Assessment of YouTube Videos in Patient Education for Coronary Artery Disease: A DISCERN-Based Cross-Sectional Analysis.

Introduction Cardiovascular disease has one of the highest mortality rates and continues to grow. Therefore, it is important for the medical community to get involved in widespread patient education efforts. As technology has steadily advanced, YouTube (Google LLC, Mountain View, California, United States) has become a popular source for patients to gather medical information. In this study, we aim to assess the quality of YouTube videos pertaining to coronary artery disease. Methods We searched the following key terms on June 20, 2023, using the view count filter: coronary artery disease, coronary artery disease treatment, cardiac catheterization, and coronary artery bypass grafting (CABG). The top twenty videos for each keyword were recorded. After videos that were over 20 minutes, non-English, procedural videos without words, and duplicates were excluded, forty-five videos remained. Each video was assessed by three viewers using the DISCERN criteria (http://www.discern.org.uk). Numerical data was averaged into composite scores. Two-sided t-tests and one-way analysis of variance (ANOVA) tests were used to compare mean ratings between groups. A Spearman correlation was done to compare each of the following terms to one another: overall quality of videos, total likes a video received, and total views. Results The mean ratings for coronary artery disease, coronary artery disease treatment, cardiac catheterization, and CABG were 2.30, 2.60, 2.05, and 2.92, respectively, with an overall mean of 2.42. The means between coronary artery disease and coronary artery disease treatment were significantly different (p adj = 0.01). The overall rating for videos with board-certified physicians was significantly higher than those without a board-certified physician (p < 0.001). There was a low correlation between likes and overall ratings (0.03) and views and overall ratings (-0.068). Conclusion The videos on coronary artery disease, coronary artery disease treatment, cardiac catheterization, and CABG had poor overall quality based on DISCERN criteria. The overall ratings from videos with board physicians are higher than those from non-physicians, suggesting that physicians should be encouraged to create content about important medical conditions. There was also a low correlation between the overall quality of a video and the likes and views, respectively, indicating a disconnect between what the public values and the actual value of a video.

The Evolution of Board-Certified Emergency Physicians and Staffing of Emergency Departments in Israel.

Emergency medicine (EM) was recognized as a specialty in Israel in 1999. Fifty-nine of the 234 (25%) attending physicians working in emergency departments (ED) nationwide in 2002 were board-certified emergency physicians (EP). A 2012 study revealed that 123/270 (45%) of ED attendings were EPs, and that there were 71 EM residents. The EPs primarily worked midweek morning shifts, leaving the EDs mostly staffed by other specialties. Our objective in this study was to re-evaluate the EP workforce in Israeli EDs and their employment status and satisfaction 10years after the last study, which was conducted in 2012. We performed a three-part, prospective cross-sectional study: 1) a survey, sent to all EDs in Israel, to assess the numbers, level of training, and specialties of physicians working in EDs; 2) an anonymous questionnaire, sent to EPs in Israel, to assess their demographics, training, employment, and work satisfaction; and 3) interviews of a convenience sample of EPs analyzed by a thematic approach. There were 266 board-certified EPs, 141 (53%) of whom were employed in EDs full-time or part-time. Sixty-two non-EPs also worked in EDs. The EPs were present in the EDs primarily during weekday morning shifts. There were 273 EM residents nationwide. A total of 101 questionnaires were completed and revealed that EPs working part-time in the ED worked fewer hours, received higher salaries, and had more years of experience compared to EPs working full time or not working in the ED. Satisfaction correlated only with working part time. Meaningful work, diversity, and rewarding relationships with patients and colleagues were major positive reasons for working in the ED. Feeling undervalued, carrying a heavy caseload, and having complicated relationships with other hospital departments were reasons against working in the ED. Our study findings showed an increase in the number of trained and in-training EPs, and a decrease in the percentage of board-certified EPs who persevere in the EDs. Emergency medicine in Israel is at a crossroads: more physicians are choosing EM than a decade ago, but retention of board-certified EPs is a major concern, as it is worldwide. We recommend taking measures to maintain trained and experienced EPs working in the ED by allowing part-time ED positions, introducing dedicated academic time, and diversifying EP roles, functioning, and work routine.

Does small talk with a medical provider affect ChatGPT's medical counsel? Performance of ChatGPT on USMLE with and without distractions.

Efforts are being made to improve the time effectiveness of healthcare providers. Artificial intelligence tools can help transcript and summarize physician-patient encounters and produce medical notes and medical recommendations. However, in addition to medical information, discussion between healthcare and patients includes small talk and other information irrelevant to medical concerns. As Large Language Models (LLMs) are predictive models building their response based on the words in the prompts, there is a risk that small talk and irrelevant information may alter the response and the suggestion given. Therefore, this study aims to investigate the impact of medical data mixed with small talk on the accuracy of medical advice provided by ChatGPT. USMLE step 3 questions were used as a model for relevant medical data. We use both multiple-choice and open-ended questions. First, we gathered small talk sentences from human participants using the Mechanical Turk platform. Second, both sets of USLME questions were arranged in a pattern where each sentence from the original questions was followed by a small talk sentence. ChatGPT 3.5 and 4 were asked to answer both sets of questions with and without the small talk sentences. Finally, a board-certified physician analyzed the answers by ChatGPT and compared them to the formal correct answer. The analysis results demonstrate that the ability of ChatGPT-3.5 to answer correctly was impaired when small talk was added to medical data (66.8% vs. 56.6%; p = 0.025). Specifically, for multiple-choice questions (72.1% vs. 68.9%; p = 0.67) and for the open questions (61.5% vs. 44.3%; p = 0.01), respectively. In contrast, small talk phrases did not impair ChatGPT-4 ability in both types of questions (83.6% and 66.2%, respectively). According to these results, ChatGPT-4 seems more accurate than the earlier 3.5 version, and it appears that small talk does not impair its capability to provide medical recommendations. Our results are an important first step in understanding the potential and limitations of utilizing ChatGPT and other LLMs for physician-patient interactions, which include casual conversations.

Knowledge and competences in hematological malignancies amongst radiation oncology residents in Germany-results from anational survey.

Radiation oncology is apivotal modality in the treatment of hematologic malignancies. To enable state-of-the-art patient care, structured education during residency is essential. However, given the lack of detailed data, the scope of educational opportunities available to trainees remains elusive. This prompted our group to perform anational survey amongst radiation oncology residents in Germany assessing the status quo of competences in the treatment of lymphoma and leukemia patients. Furthermore, areas of potential improvement were identified to further the goal of competence-based education for residents. Asurvey-based analysis was conducted to assess the knowledge and competence of radiation oncology residents in Germany regarding hematological malignancies. Adecisive questionnaire covering demographics, self-assessment of competences, and areas for improvement was developed in adaption of asurvey by the Association of Residents in Radiation Oncology and distributed amongst 1439 members of the German Society of Radiation Oncology. Responses were collected anonymously via an online survey tool and analyzed using descriptive statistics and chi-square tests. Atotal of 59complete and 22partial responses were collected, yielding a5.6% response rate. Participants' competence varied, with notable experience gaps in pediatric cases, proton therapy, and large-field techniques like total-skin irradiation or pediatric total body irradiation. While participants felt confident in treatment planning and patient counseling, they showed deficiencies in the definition of the planning target volume for modern involved site radiotherapy. Resources for education included national and international guidelines, scientific reviews, and textbooks. Board-certified radiation oncologists and physicians from specialized lymphoma centers demonstrated higher overall competence levels. This survey highlights the diversity of resident education regarding hematological malignancies in German radiation oncology programs. Knowledge gaps exist in key areas, including pediatric cases and specialized techniques. Competence-based education, interactive teaching formats, and rotations to specialized centers are potential strategies to address these gaps. The study contributes to the understanding of the federal educational landscape, underscoring the need for standardized and comprehensive training to ensure optimal patient care in hematological malignancies within the context of radiation oncology. Further research and collaborations are warranted to enhance training and expertise in this critical domain.