Clinical Conference Research Articles

P-953. Infection prevention certificate exam performance: ChatGPT 4 vs ChatGPT 3.5

Abstract Background In recent times, AI models were utilized to evaluate competitive examinations such as the US medical licensing examination and clinical case conferences. However, there was limited data on their evaluation in infection control certificate examinations, known for their inclusion of complex questions. In this study, we aimed to assess the performances of ChatGPT-4 and ChatGPT-3.5 models in handling infection control certification examinations, providing insights into their efficacy in infection prevention. Methods This cross-sectional study, conducted by an infectious disease (ID) physician, involved an ENT resident, an ID physician assistant, and a Pharm D student. Questions were sourced from the International infection control certification examination and underwent complexity validation and answer approval by international infection prevention professionals. Each model, ChatGPT-4 and ChatGPT-3.5, received questions separately, and their answers were cross-checked with validated responses by the team. Statistical analysis employed the Chi-square test to assess performance differences. Data were collected in an excel sheet for subsequent analysis. Results In the evaluation of 96 infection control examination questions, ChatGPT-4 outperformed ChatGPT-3.5, achieving an accuracy of 82.3% (79 out of 96 questions answered correctly) compared to ChatGPT-3.5's accuracy of 65.6% (63 out of 96) as shown in table -1 below. Statistical analysis using a Chi-square test confirmed a significant difference between the two models (p < 0.05), highlighting the advancements in ChatGPT-4's capabilities. ChatGPT-4 excelled in contextual comprehension, while ChatGPT-3.5 struggled with adaptability in managing complex queries. Conclusion In this study, ChatGPT-4's accuracy of 82.3% exceeded that of ChatGPT-3.5, which achieved 65.6%. Future research should compare other AI models and analyse each question for contextual understanding to enhance AI models performance in infection prevention. Disclosures All Authors: No reported disclosures

Clinical Neuropathology Conference: "Liquid Assets".

Clinical Neuropathology Conference: "Liquid Assets".

Virologic failure and emergent integrase strand transfer inhibitor drug resistance with long acting cabotegravir for HIV treatment: A meta-analysis.

The long-acting injectable regimen of cabotegravir plus rilpivirine (CAB/RPV) emerged as an alternative to oral standard of care integrase strand transfer inhibitor (INSTI)-based regimens for individuals with adherence challenges or preference for reduced dosing schedules. Although oral INSTI regimens have a high barrier to emergent resistance, less is known about the potency and durability of CAB/RPV. We reviewed clinical trial registries, PubMed, EMBASE, and conference abstract databases to identify published reports of CAB/RPV for HIV therapy. We abstracted data on virologic failure (VF) and treatment-emergent INSTI resistance at 48 weeks (range 24-52 weeks). We used single-proportion meta-analysis to summarize outcomes in three populations: 1) antiretroviral (ART)-naïve individuals initiating CAB/RPV following suppression on oral ART, 2) ART-experienced individuals switched to CAB/RPV with virologic suppression, and 3) ART-experienced individuals switched to CAB/RPV with detectable viremia. Cochrane's RoB2.0 and ROBINS-1 tools assessed risk of bias. PROSPERO registration CRD42024543919. Thirty-three studies (N=9224) reported VF prevalence. Nineteen studies (N=5662) reported resistance data. VF prevalence was 1% (95% confidence intervals [CI] 1-3%) in induction-maintenance studies, 1% (CI 1-2%) in switch-suppressed studies, and 5% (CI 3-10%) in switch-viraemic studies. INSTI resistance prevalence among successfully genotyped participants at failure was 71% (CI 25-95%), 61% (CI 44-75%), and 41% (CI 20-65%) respectively. Dolutegravir cross-resistance was common (64% of those with emergent resistance). Although VF rates with CAB/RPV were low, INSTI resistance emerged in approximately 40-70% of individuals experiencing VF. These rates are significantly higher than those for oral INSTI-based regimens. Both individual-level and broader resistance surveillance may be warranted in individuals and populations with expanding CAB/RPV use.

Case conference and a para case conference: asking different questions about disability and structural ableism

What might it mean to change the questions we ask during clinical case conferences and to ask different kinds of questions, both in case conferences and more broadly in our...

Effectiveness of tofacitinib in patients with ulcerative colitis: an updated systematic review and meta-analysis of real-world studies

ObjectivesThis study aimed to evaluate the real-world effectiveness of tofacitinib for treating moderate-to-severe ulcerative colitis (UC).DesignSystematic review and meta-analysis.Data sourcesPubMed, EMBASE and Cochrane CENTRAL databases were searched from inception up...

Harm reduction for perinatal cannabis use: protocol for a scoping review of clinical practices

IntroductionThe American College of Obstetricians and Gynaecologists recommends against cannabis use during pregnancy and lactation (‘perinatal cannabis use’) given its association with negative parent–child health outcomes. However, cannabis is becoming...

Meeting abstracts of the clinical epigenetics international conference 2024

Meeting abstracts of the clinical epigenetics international conference 2024

Clinical coordination in cancer diagnosis: healthcare stakeholders’ viewpoints in Latin America

Abstract Background Delays in diagnosis contribute to increasing cancer mortality rates in Latin American countries due to, among others, highly fragmented healthcare systems. The objective of this study, part of a larger research project (EquityCancer-LA), was to analyze cross-level coordination during cancer diagnosis and factors influencing it from healthcare stakeholders’ perspectives in Chile, Colombia, and Ecuador. Methods This descriptive-interpretative qualitative study was based on 114 semi-structured individual interviews in 2022-23 using a criterion sample of health professionals from primary care (PC) (n = 40) and secondary care (SC) (n = 44) as well as managers and policy makers (n = 30) from two public healthcare networks in each country. Sample reached saturation. A thematic analysis was conducted first by country and then comparatively, guided by the theoretical framework of clinical coordination. Results In all countries, informants highlighted limited cross-level exchange of information and limited coordination of clinical management, delays in referral, and long waiting times after referral, leading to diagnostic delays. Factors hindering coordination differed across countries: structural (insufficient personnel, access to diagnostic tests in PC); organizational (limited/inadequate coordination mechanisms, e.g. shared clinical records; poor working conditions); and health professional characteristics (limited knowledge and skills among PC doctors). Direct feedback was emphasized to facilitate coordination of cancer diagnosis: virtual joint clinical conferences in Chile, co-location of PC and SC in Colombia, and informal networks (based on personal contacts) in Ecuador. Conclusions The findings underscore the critical coordination problems contributing to delays in cancer diagnosis. Addressing these challenges requires strategic interventions aimed at strengthening primary care and fostering cross-level coordination. Key messages • Cancer diagnosis in Latin America suffers from coordination deficits due to structural, organizational, and professional factors. • Strengthening primary care and cross-level coordination is needed.

CLINICAL CONFERENCE ON PRACTICAL CLASSES IN DENTAL THERAPY

The modern education reform in Ukraine aims to provide high-quality subject training for specialists while reducing classroom load and increasing access to information. One of the ways to solve this problem is to introduce new, more effective methods and technologies of learning. An essential stage in training of doctors from the first years of study is the formation of clinical thinking, the ability to analyze and synthesize data, determine the criteria for making a diagnosis, and draw up a rational treatment plan. Developing this ability requires knowledge and practical experience, starting in educational institutions and continuing in clinical settings. Technologies and techniques of learning and teaching clinical disciplines are gaining particular relevance and determining importance. The training of dentists at the Department of Dental Therapy of I. Horbachevsky Ternopil National Medical University always meets the requirements of the times. Special attention is paid not only to the high-quality teaching of the discipline but also to the diversification of the organization of practical classes. The early years of medical specialists' training are crucial for developing clinical thinking. This process hones the ability to analyze and systematize data, define criteria for establishing a diagnosis, and compile a plan of effective treatment. At I. Horbachevsky Ternopil National Medical University, special attention is given to the qualitative teaching of the discipline and the diversification of the pedagogical process, with the clinical conference playing a pivotal role in this development. At the Dental Therapy Department, the study of the 'Dental Therapy' discipline concludes with a student clinical conference, a good tradition. This conference, held for the 5th-year students in the X semester, involves three groups of students who are currently completing their study of the subject. In each group, a student-curator who represents a specific clinical case is selected. Students present reports with a visual presentation of the patient's clinical condition, the results of the primary and additional methods of examination, differential diagnosis of the disease, the treatment scheme of the patient and its effectiveness. An important stage at the conference is the performance of prepared opponents, who are appointed from among the students of another group. On the eve of the meeting, the opponents directly familiarize themselves with the work of the student-curator, analyze the sequence of the patient's examinations, the correctness of the diagnosis, the preparation of medical documentation, the differential diagnosis of the disease, evaluate the treatment scheme, ask questions and express observations. The lecturers play a crucial role in this process, providing guidance and doing summaries of the clinical conference, ensuring that the learning objectives are met and the student's progress is acknowledged. Clinical conferences, are not just about deepening and systematizing theoretical knowledge or developing clinical thinking. They also provide a unique and invaluable opportunity for students to gain experience in public speaking. This experience, coupled with the development of personal qualities such as communication and cooperation, prepares students for the challenges they will face in their future careers. This holistic approach to medical education is a key part of the learning process, instilling confidence and readiness in the students.

Evaluation of Rehabilitation Techniques for Traumatic Ulnar Nerve Injuries After Surgical Repair: A Systematic Review.

Traumatic ulnar nerve injuries often result in significant loss of motor and sensory function, negatively impacting patients' quality of life. Physical rehabilitation is crucial for recovery, but standardized treatment protocols are lacking. This study aims to systematically review rehabilitation techniques to identify future research direction and improve existing protocols for ulnar nerve injury patients. PubMed, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and Scopus were queried from inception until July 31, 2023. Articles containing axonotmesis or neurotmesis injuries of the ulnar nerve were included. Reviews, opinions, editorials, technical reports without clinical outcomes, conference abstracts, non-English text, nonhuman studies, and studies without adult patients were excluded. Three independent reviewers performed screening and data extraction using Covidence, and risk of bias assessments utilizing Cochrane and JBI tools. Because of article heterogeneity, a narrative review was conducted. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number CRD42023442016. This systematic review included one randomized controlled trial and four observational studies (103 patients), which exhibited differences in study quality. Overall, motor and sensory outcomes improved after rehabilitation. Rehabilitation techniques varied widely, and early sensory reeducation appeared to improve sensory function. Only two studies included patient-reported outcomes. Diverse rehabilitation techniques are used to address ulnar nerve injuries. The low number of included studies, differences in study quality, and small sample size underscore the need for larger and more inclusive studies to improve functional recovery after ulnar nerve injuries. Future research should consider the impact of patient and injury characteristics to develop comprehensive treatment guidelines for these patients.

Moving Toward Anti-Ableist Practices in Aphasia Rehabilitation and Research: A Viewpoint.

Ableism is a pervasive set of beliefs that regard nondisabled bodies and minds as ideal and necessary to live a full life. Ableism manifests for people with aphasia as stigma and discrimination based on their language ability. We assert that ableism contributes to decreased quality of life for people with aphasia and should be actively challenged and disrupted by clinicians and researchers in the field. We applied the Health Stigma and Discrimination Framework (HSDF) to outline how stigma and discrimination are perpetuated against people with aphasia on the basis of language ability and their downstream health and social consequences. We presented this framework at the Clinical Aphasiology Conference in 2023 and share themes and challenges that arose from this discussion and from our ongoing learning. Applying the HSDF to aphasia outlined potential sequelae of ableism. We identified preliminary foci of future initiatives aimed at challenging ableist beliefs and practices and means to monitor the effectiveness of such interventions. Furthermore, we draw attention to the seeming tension between anti-ableist practices and traditional language rehabilitation goals. We assert that this tension may be a catalyst for fruitful discourse on how clinicians and researchers can resist ableism while honoring the lived experiences of people with aphasia and their goals for language rehabilitation. These discussions may be facilitated by existing models in disability studies (e.g., the political/relational model). Clinicians and researchers are well positioned to challenge ableism and minimize the resultant health and social impacts for people living with aphasia. Anti-ableist practices are not antithetical to aphasia rehabilitation and can be thoughtfully integrated into rehabilitation practices and discourse.

Utility of Biomarker-Informed Drug Interaction Evaluation in Drug Development and Regulatory Decision Making.

The measurement of endogenous biomarkers in plasma and urine before and after administration of an investigational drug in a clinical study may provide an early indication of its drug-drug interaction (DDI) potential via a specific pathway. In the first international harmonized guideline on drug interaction studies, the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) M12, endogenous biomarkers have been recognized as an emerging approach in the transporter- and enzyme-based DDI risk assessment. Clinical Pharmacology Roundtable Conference 2024 held at Pharmaceuticals and Medical Devices Agency (PMDA) brought together experts from regulatory agencies, academia, and industries to discuss potential advantages and challenges of the biomarkers approach in drug development and regulatory decision making. This meeting report facilitates stakeholders involved in drug development in better understanding the utility of biomarker approaches and promotes early implementation of biomarker-informed DDI evaluation in regulatory use.

The Use of 3D Printing in Fetal Surgery for Surgical Planning: A Scoping Review.

Objectives: We sought to identify in which clinical scenarios 3D printed models are used to plan for fetal surgeries as well as the main purpose and the imaging method utilized for the models. In addition, we describe benefits and shortcomings of the models, as well as potential future improvements. Methods: In this scoping review, data were collected retrospectively from scientific databases (PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, and the Web of Science platform) and screened by title, abstract, and full text against strict criteria. The inclusion criteria required the study be performed on a live fetus and involve 3D models used for fetal surgery. The models must have been designed from diagnostic imaging modalities such as CT, MRI, or ultrasound. The articles considered include clinical trials, review articles, cohort studies, case series, case reports, and conference abstracts. Results: Of the initial 742 articles collected, six met the inclusion criteria. Spina bifida and EXIT procedures were the most frequent use cases that inspired surgeons to print models for surgical planning. The ability to view patient-specific anatomy in a 3D handheld model was often touted as providing a great benefit to the surgical team's ability to anticipate intraoperative challenges. Conclusions: Three-dimensional printing models have been applied to plan for fetal surgeries, more specifically, for EXIT procedures and fetoscopic surgical repair of spina bifida. The potential benefits of 3D printing in fetal surgery are enormous.

Has cross-level clinical coordination changed in the context of the pandemic? The case of the Catalan health system

BackgroundThe COVID-19 pandemic triggered numerous changes in health services organisation, whose effects on clinical coordination are unknown. The aim is to analyse changes in the experience and perception of cross-level clinical coordination and related factors of primary (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022.MethodsComparison of two cross-sectional studies based on online surveys by means of the self-administration of the COORDENA-CAT (2017) and COORDENA-TICs (2022) questionnaires to PC and SC doctors. Final sample n = 3308 in 2017 and n = 2277 in 2022. Outcome variables: experience of cross-level information and clinical management coordination and perception of cross-level clinical coordination in the healthcare area and related factors. Stratification variables: level of care and year. Adjusting variables: sex, years of experience, type of specialty, type of hospital, type of management of PC/SC. Descriptive bivariate and multivariate analysis using Poisson regressions models to detect changes between years in total and by levels of care.ResultsCompared with 2017, while cross-level clinical information coordination remained relatively high, with a slight improvement, doctors of both care levels reported a worse experience of cross-level clinical management coordination, particularly of care consistency (repetition of test) and accessibility to PC and, of general perception, which was worse in SC doctors. There was also a worsening in organisational (institutional support, set objectives, time available for coordination), attitudinal (job satisfaction) and interactional factors (knowledge between doctors). The use of ICT-based coordination mechanisms such as shared electronic medical records and electronic consultations between PC and SC increased, while the participation in virtual joint clinical conferences was limited.ConclusionsResults show a slight improvement in clinical information but also less expected setbacks in some dimensions of clinical management coordination and in the perception of clinical coordination, suggesting that the increased use of some ICT-based coordination mechanisms did not counteract the effect of the worsened organisational, interactional, and attitudinal factors during the pandemic. Strategies are needed to facilitate direct communication, to improve conditions for the effective use of mechanisms and policies to protect healthcare professionals and services in order to better cope with new crises.

Anesthesia management for cesarean section in a woman with chronic renal failure and heart failure: a case report

IntroductionPregnancy in a woman with heart and chronic renal failure can lead to life-threatening complications for both mother and child. Although such cases are often delivered by cesarean section, few reports have described anesthesia methods.Case presentationWe encountered a case in which cesarean section was performed using combined spinal and epidural anesthesia for a pregnant woman with chronic renal and heart failure. The 35-year-old Japanese woman had been undergoing hemodialysis for several years. Heart failure symptoms that appeared during pregnancy initially improved with treatments such as increasing hemodialysis, but recurred. She was admitted to the intensive care unit. The initial plan was to deliver the baby after a few weeks, but further progression of heart failure became a concern. After a clinical conference among staff, a cesarean section with combined spinal and epidural anesthesia was scheduled for 24 weeks, 0 days of gestation. The anticoagulant for dialysis was also changed from heparin to nafamostat in preparation for cesarean section. Monitoring was started with central venous and radial artery pressures before induction of anesthesia. Combined spinal and epidural anesthesia was induced and the cesarean section was completed without complications. Surgery was initiated under continuous administration of phenylephrine, which was intended to avoid hypotension due to anesthesia. The hemodynamic and respiratory status of the patient remained stable postoperatively. After the cesarean section, morphine was administered epidurally and the epidural catheter was removed.ConclusionCesarean section was safely performed for a pregnant woman with renal and heart failure using combined spinal and epidural anesthesia.

Global impact of a virtual neurology morning report

The global shortage and inequitable distribution of neurologists has led to significant gaps not only in neurology care, but also in neurology education. In order to increase access to neurology education, we developed neurology virtual morning report (NVMR), a virtual, open-access, case-based clinical reasoning conference available to learners worldwide. To evaluate NVMR's impact on participants' perception of, interest in, and confidence in neurology, we conducted a survey. Respondents represented 25 different countries of various income levels. The majority of respondents reported that NVMR decreased their perception of difficulty in understanding neurology and increased confidence in various clinical reasoning domains in neurology. Additionally, the majority of medical student participants showed an increased interest in pursuing neurology as a future specialty after participating in NVMR. NVMR represents a potential model for virtual educational conferences and highlights the opportunities digital education has to improve equitable access to neurology education.

Morning clinical conference in a therapeutic hospital: is it needed today?

The article presents the experience of the staff of the Department of Hospital Therapy conducting a morning conference on the clinical basis of therapeutic departments of a multidisciplinary hospital. The role and importance of the morning conference format in the organization of hospital work in several areas of activity are considered. The role of the conference moderator, the specifics of presenting the material in the reports of the doctor on duty, the possibilities of interdisciplinary discussion of various aspects of diagnosis and treatment in this format were discussed in more detail.

Model for an Academic Medicine Interest Group: A student-led initiative

Academic physicians are responsible for the education of medical students, residents, and other practicing physicians through clinical rotations lectures, seminars, research, and conferences. Therefore, the increasing need to recruit academic physicians holds immense value within the healthcare system. Academic Medicine Interest Group (AMIG) is a collective made up of students who share an interest in the growth and advancement of academic medicine. We present a guide and model on establishing an AMIG. We found that AMIG fostered professional growth by providing leadership, research, and teaching opportunities. Strategic planning, effective leadership, and group organization were all necessary for the success of the group.

Barriers to and facilitators of paediatric medical device innovation: a scoping review protocol

IntroductionThe development of paediatric medical devices continues to lag adult medical devices and contributes to issues of inequity, safety, quality and patient outcomes. New legislation and funding mechanisms have been...

Unveiling consistency: A large-scale analysis of conference proceedings and subsequent publications in oncology clinical trials using large language models.

7568 Background: Conference abstracts serve as pivotal sources for sharing initial clinical trial findings, and influencing clinical decisions.Yet, concerns persist regarding the impact of unpublished conference abstracts on ultimate conclusions and the potential for inconsistency in result reporting. We aim to assess the feasibility of large-scale analysis, examining the consistency between initial conference results and subsequent reporting in published articles, specifically focusing on treatment efficacy and safety in oncology clinical trials using a large language model (LLM) pipeline. Methods: We collected clinical trial abstracts (2012-2023) from the American Society of Clinical Oncology conference (ASCO) conference and PubMed, encompassing both solid and hematopoietic cancer treatments. Utilizing a GPT-4-based LLM model, we extracted study details, treatment safety, and efficacy outcomes. Performance evaluation was conducted on manually annotated gold standards, including 100 multiple myelomas, 25 leukemia, 25 lymphomas, 30 breast cancer, and 35 lung cancer studies. To assess the consistency between reported outcome values in earlier conference abstracts and final published articles, we conducted a two-proportional Z-test. The test factored in cohort size and outcome values at each time point for selected efficacy outcomes, with p-values exceeding 0.05 suggesting a consistent pattern. Results: Our LLM pipeline achieved high performance with precision, recall (sensitivity), and F1 scores in the ranges of 0.958-0.986, 0.944-0.969, and 0.951-0.976, respectively, across diverse cancer types. While challenges arose in comparing outcomes between initial and final reporting in phase 1 dose-escalation studies due to variations in reported dosage groups, consistency prevailed when focusing on the recommended phase 2 dosage (RP2D) cohort in phases 1/2 and 2 studies. As part of the feasibility test, we analyzed outcomes from conference abstracts and final published data (with 1-2y differences) for the most common efficacy-safety measures in multiple myeloma studies. Results showed consistency with p-values ranging for Overall Response Rate (0.618-1), Complete Response (0.072-0.844), Very Good Partial Response (0.525), Minimal Residual Disease Negative (0.074), Neutropenia (0.212), Thrombocytopenia (0.372-0.422), Cytokine Release Syndrome (0.113-1), and Neurotoxicity (0.308-1). Conclusions: Our LLM model enables large-scale dataset analysis and facilitates effective outcome comparison among diverse sources and time points. The analysis of frequently appearing treatment outcomes showed no significant differences between earlier and final time points in the fixed dosage studies across therapies, despite variations in cohort sizes and follow-up times.