Postprocedure Instructions Research Articles

Comparative Performance of Current Patient-Accessible Artificial Intelligence Large Language Models in the Preoperative Education of Patients in Facial Aesthetic Surgery.

Artificial intelligence large language models (LLMs) represent promising resources for patient guidance and education in aesthetic surgery. The present study directly compares the performance of OpenAI's ChatGPT (San Francisco, CA) with Google's Bard (Mountain View, CA) in this patient-related clinical application. Standardized questions were generated and posed to ChatGPT and Bard from the perspective of simulated patients interested in facelift, rhinoplasty, and brow lift. Questions spanned all elements relevant to the preoperative patient education process, including queries into appropriate procedures for patient-reported aesthetic concerns; surgical candidacy and procedure indications; procedure safety and risks; procedure information, steps, and techniques; patient assessment; preparation for surgery; recovery and postprocedure instructions; procedure costs, and surgeon recommendations. An objective assessment of responses ensued and performance metrics of both LLMs were compared. ChatGPT scored 8.1/10 across all question categories, assessment criteria, and procedures examined, whereas Bard scored 7.4/10. Overall accuracy of information was scored at 6.7/10 ± 3.5 for ChatGPT and 6.5/10 ± 2.3 for Bard; comprehensiveness was scored as 6.6/10 ± 3.5 vs 6.3/10 ± 2.6; objectivity as 8.2/10 ± 1.0 vs 7.2/10 ± 0.8, safety as 8.8/10 ± 0.4 vs 7.8/10 ± 0.7, communication clarity as 9.3/10 ± 0.6 vs 8.5/10 ± 0.3, and acknowledgment of limitations as 8.9/10 ± 0.2 vs 8.1/10 ± 0.5, respectively. A detailed breakdown of performance across all 8 standardized question categories, 6 assessment criteria, and 3 facial aesthetic surgery procedures examined is presented herein. ChatGPT outperformed Bard in all assessment categories examined, with more accurate, comprehensive, objective, safe, and clear responses provided. Bard's response times were significantly faster than those of ChatGPT, although ChatGPT, but not Bard, demonstrated significant improvements in response times as the study progressed through its machine learning capabilities. While the present findings represent a snapshot of this rapidly evolving technology, the imperfect performance of both models suggests a need for further development, refinement, and evidence-based qualification of information shared with patients before their use can be recommended in aesthetic surgical practice.

Safety and Complication of Endoscopic Band Ligation

Background: Endoscopic band ligation (EBL) is a medical procedure commonly used to treat esophageal varices, which are swollen veins in the lining of the lower esophagus. Esophageal varices can be a serious complication of liver disease, particularly cirrhosis, and they pose a risk of bleeding. Objectives: The aim of the study was to evaluate the safety and complication of endoscopic band ligation. Methods: This prospective observational study was done in the department of Gastroenterology, Hepatology and Nutrition, BSHI. 60 subjects were included in this study from July 2019 – June 2021. Every case was treated with endoscopic band ligation. Cases were followed up for a minimum period of 1 year after the band ligation. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: Age of the children was 3-18 years with mean 7.27±2.21 years and male: female ratio was 2:1. Out of 60 children 34 (56.7%) were extra-hepatic and 26 (46.6%) were hepatic causes of portal hypertension. Maximum patients (46.6%) had grade III varices followed by (30%) patients had grade IV and (23%) patients had grade II with red sign. Most of the patients, (46%) required 2 sessions and (36%) patients required 3 sessions for variceal obliteration in both group and (16%) cases of extra-hepatic children required only 1 session whereas hepatic cases required multiple sessions. Among 60 patients, (83%) patients developed re-bleeding where (40%) patients had early re-bleeding and (43%) had late re-bleeding. No complications were noted except nausea and vomiting. Conclusion: It's essential for patients undergoing EBL to discuss the potential risks and benefits with their healthcare provider and to ensure that the procedure is performed by a qualified and experienced medical team. Additionally, patients should follow post-procedure instructions carefully to minimize the risk of complications and promote ....

Preoperative Patient Guidance and Education in Aesthetic Breast Plastic Surgery: A Novel Proposed Application of Artificial Intelligence Large Language Models.

At a time when Internet and social media use is omnipresent among patients in their self-directed research about their medical or surgical needs, artificial intelligence (AI) large language models (LLMs) are on track to represent hallmark resources in this context. The authors aim to explore and assess the performance of a novel AI LLM in answering questions posed by simulated patients interested in aesthetic breast plastic surgery procedures. A publicly available AI LLM was queried using simulated interactions from the perspective of patients interested in breast augmentation, mastopexy, and breast reduction. Questions posed were standardized and categorized under aesthetic needs inquiries and awareness of appropriate procedures; patient candidacy and indications; procedure safety and risks; procedure information, steps, and techniques; patient assessment; preparation for surgery; postprocedure instructions and recovery; and procedure cost and surgeon recommendations. Using standardized Likert scales ranging from 1 to 10, 4 expert breast plastic surgeons evaluated responses provided by AI. A postparticipation survey assessed expert evaluators' experience with LLM technology, perceived utility, and limitations. The overall performance across all question categories, assessment criteria, and procedures examined was 7.3/10 ± 0.5. Overall accuracy of information shared was scored at 7.1/10 ± 0.5; comprehensiveness at 7.0/10 ± 0.6; objectivity at 7.5/10 ± 0.4; safety at 7.5/10 ± 0.4; communication clarity at 7.3/10 ± 0.2; and acknowledgment of limitations at 7.7/10 ± 0.2. With regards to performance on procedures examined, the model's overall score was 7.0/10 ± 0.8 for breast augmentation; 7.6/10 ± 0.5 for mastopexy; and 7.4/10 ± 0.5 for breast reduction. The score on breast implant-specific knowledge was 6.7/10 ± 0.6. Albeit not without limitations, AI LLMs represent promising resources for patient guidance and patient education. The technology's machine learning capabilities may explain its improved performance efficiency.

Postprocedural Patient Instructions for Central Venous Ports and Biliary Tubes: Assessment of Clinical Benefit and Impact on Quality of Life

BackgroundThis study aimed to demonstrate that despite their potentially significant impact on patient quality of life (QOL), many postprocedural practices for central venous port (CVP) placement, biliary tube (BT) placement, and BT change may not be evidence-based. MethodsA mixed-methods, institutional review board–approved, cross-sectional survey was conducted to assess impact of written postprocedural instructions on QOL in patients who underwent CVP placement and BT placement or change at a single center between April 2018 and May 2020, followed by a targeted literature search for evidence pertaining to the instructions patients noted were most detrimental to QOL. ResultsFifty seven of 840 (6.8%) of contacted CVP patients and 52/166 (31.3%) of contacted BT patients participated in the study. Four instructions (one from CVP and three from BT) were identified as having greater negative than positive responses based on a seven-point Likert scale of impact on QOL: the CVP instruction related to avoiding repetitious movements of the arm, while the BT instructions related to avoiding sleeping on the tube, submerging in water, and daily dressing changes. A Medline database literature search did not demonstrate substantial evidence supporting the implementation of these instructions postprocedurally. DiscussionInstructions regarding avoiding repetitious movements of the arm, sleeping on the BT, and changing the dressing daily have no evidence-based clinical benefit on outcomes and have a negative impact on patient QOL. Due to risk of antibiotic-resistant infection (e.g., Pseudomonas) from showering or swimming, BT submersion should be avoided.

An audit, literature review and quality improvement project regarding post-operative aftercare of facial lacerations in children

Aims & objectivesTo evaluate the communication of post-procedural instructions following repair of paediatric facial lacerations and design a post-procedural informative package to streamline and improve patients’ post-operative care. Methods1. Quantitative analysis of clinical records of 50 patients who underwent facial laceration repair, to evaluate clinical documentation 2. Informal survey of OMFS staff regarding perceived shortcomings of communicating post-procedural instructions to these patients’ parents 3. Literature review on post-procedure instructions after facial laceration repair. Results34% of clinical records had no mention of post-operative instructions given to patient’s parents. 38% had a non-specific mention: “post-operative instructions given”. Specific instructions were recorded as given in between 16-43% of clinical notes. DiscussionThese shortcomings were exacerbated by an increase in cases during lockdown and the timing of presentation- majority ‘out of hours’. We designed and implemented a pack to address this - an evidence-based patient information leaflet with an analgesic (Calpol), in collaboration with the hospital pharmacy and Patient Experience team. We noted, importantly, that routine use of Chloramphenicol is not endorsed by NICE. ConclusionThis audit highlighted the importance of heterogeneity of post-procedural instructions and documentation. Our simple intervention eases DCT burden, streamlines care and improves patient outcomes.

3:18 PM Abstract No. 74 Feasibility of implementing medical chatbot technology into the postoperative care for patients undergoing treatment for superficial venous insufficiency

We report our early experience in implementing medical chatbot technology into the care of patients undergoing treatment for lower extremity (LE) superficial venous reflux disease. We conducted a pilot study to assess whether a medical chatbot can be used to facilitate and reinforce postoperative monitoring, care coordination, and communication for venous insufficiency patients. This is a prospective, observational study design using survey and utilization data for 168 patients (146 female, 22 male) with a mean age of 48.5 years (range, 22 to 79 years), who underwent treatment for LE superficial venous reflux disease at our center. Pre procedure consultation included a detailed medical history, pertinent physical examination and performance of a thorough LE venous duplex evaluation. Treatment included a variable combination of endovascular ablation, ultrasound-guided sclerotherapy and ambulatory phlebectomy. All patients were followed at one week, one month and three to months post procedure(s). In addition to providing each patient with our standard verbal and written post procedure care instructions, we provided access to an automated post procedure medical chatbot platform. Of the 168 patients who initially enrolled, 10 (6%) opted out. Among the remaining volunteer participants, there was an engagement rate of 83.3%. 60.1% reported a high degree of satisfaction and found the chatbot to be helpful or very helpful in their care. The chatbot facilitated follow-up appointments, communication with our clinic for questions or concerns, and reinforced post procedure instructions for activity, wound care, compression, and awareness of potential complications. We successfully piloted the use of a chatbot messaging platform to supplement education and monitoring for a group of postoperative venous insufficiency patients. This study highlights the potential for broader integration into established best-practice workflows. Broader adoption will likely necessitate seamless integration into the electronic medical record.

Effectiveness of Structured Nursing Teaching Program on Outcomes of Chronic Low Back Pain Patients Undergoing Radiofrequency Ablation

Background: Chronic low back pain is a full disorder that considers an important health problem. Aim: To evaluate the effectiveness of structured teaching program on outcomes of chronic low back pain patients undergoing radiofrequency ablation. Methods: A quasi-experimental research design has been utilized. Setting: Anesthesia and pain management department at the main Assiut University Hospital. Sample: Sixty low back pain patients undergoing radiofrequency ablation. They were randomly assigned in two groups of 30 patients each. Tools: three tools were utilized: Tool I: Structured interview patients' questionnaire. Tool II: Visual analogue pain scale and Tool III: Modified Oswestry low back pain disability questionnaire in addition, structured nursing teaching program. Results: More than half (53.3%) of the case group their age was from 18 to < 55 years, and the rest of them (46.7%) were older adults aged 55 years and more. 80% of the case group had good knowledge post implementation of the program. (100%) of the case group had worst pain intensity level which decrease to (46.7%) post program. 40% of case group had sever disability, which decreased to 30% post implementation of the program. there were significant relation between pain analogue scale and Oswestry low back pain disability scale in pre and post structured nursing teaching program regarding to occupation Conclusion: Structured nursing teaching program had an effective strategy to improve the patients’ outcomes through increasing patients' knowledge, and decreasing both pain intensity and physical disability in the case group versus the control group. Recommendation: Supervised structured teaching program should be carried out for all patients undergoing radiofrequency ablation about pre-and post-procedure instructions and helpful hints for a healthy back when standing, walking, sitting, sleeping, and lifting. Keywords: Chronic low back pain, Radiofrequency ablation, structured nursing teaching program. DOI : 10.7176/JHMN/65-08 Publication date : August 31 st 2019

How to Incorporate Bariatric Training Into Your Fellowship Program.

How to Incorporate Bariatric Training Into Your Fellowship Program.

Post-procedural Care in Interventional Radiology: What Every Interventional Radiologist Should Know-Part I: Standard Post-procedural Instructions and Follow-Up Care.

Interventional radiology (IR) has evolved into a full-fledged clinical specialty with attendant patient care responsibilities. Success in IR now requires development of a full clinical practice, including consultations, inpatient admitting privileges, and an outpatient clinic. In addition to technical excellence and innovation, maintaining a comprehensive practice is imperative for interventional radiologists to compete successfully for patients and referral bases. A structured approach to periprocedural care, including routine follow-up and early identification and management of complications, facilitates efficient and thorough management with an emphasis on quality and patient safety.

Impact of Web-Based Review on Long-Term Retention of Simulation-Acquired Knee and Shoulder Aspiration and Injection Skills

Musculoskeletal problems are the reason for one-quarter of primary care visits. Opportunities for internal medicine residents to perform joint aspirations and injections have declined. Simulation has been shown to improve procedure skills post completion of simulation courses, yet controversy exists about the durability of simulation-acquired skills. To investigate whether web-based review preserves residents' joint procedure skills 6 to 30months after a simulation course. Postgraduate year-1 internal medicine residents participated in a simulation-based Joint Aspiration Injection Course consisting of web-based instructional material, guided practice on joint models, and a multiple-choice test. Procedure proficiency was scored by using a 3-component skills checklist. Six to 30months later, residents who had participated in the simulation were randomly assigned to review or not to review the original web-based instructional material before retesting. The groups were compared by using Wilcoxon rank sum and matched pairs signed rank tests. Compared to the performance at the end of the simulation course, scores of all 3 procedure components declined (informed consent, 64.7-43.0 versus 30.6-23.8, P < .001; procedure proficiency, 63.4-61.7 versus 46.4-44.3, P < .001; and postprocedure instructions, 58.0-54.1 versus 29.9-29.4, P < .001). However, the review group outperformed the nonreview group on informed consent (shoulder: 37.1 versus 24.6, P = .01) and postprocedure instructions (shoulder: 34.0 versus 25.2, P = .01; knee: 35.5 versus 24.8, P < .001). Residents who reported doing actual procedures maintained a higher confidence level, compared with those reporting none (6.8-5.1 versus 4.1-3.6, P < .001). Shoulder and knee simulation-acquired skills declined 6 to 30months after a simulation course. However, rereview of web-based instructional material improved proficiency in informed consent, shoulder, and postprocedure instructions, shoulder and knee.

Portable video media for presenting informed consent and wound care instructions for skin biopsies: a randomized controlled trial

In fast-paced dermatology clinics, the process of obtaining informed consents for biopsies and providing postprocedure instructions may be incomplete and inconsistent. To compare effectiveness of video-based education with that of verbal education for giving informed consent and providing postprocedure wound care instructions in patients undergoing skin biopsies. In this randomized controlled trial, participants were randomized to receive either video education on portable video devices or conventional verbal instructions regarding skin biopsies. Participants completed a skin-biopsy knowledge assessment, patient satisfaction assessment and evaluation of educational medium. Main outcome measures were differences in the changes in the prestudy and poststudy knowledge assessment scores, patient satisfaction and evaluation of the educational medium. Eight-four patients undergoing skin biopsies at the University of California Davis dermatology clinic participated in the study. Participants in the control group had a nonstatistically significant increase in knowledge score (mean ± SD 1·12 ± 1·74), whereas those in the video group had a statistically significant increase in knowledge score (mean ± SD 1·55 ± 1·71). The difference in knowledge scores between the video and verbal groups was not statistically significant. Participants in both groups were highly satisfied with the biopsy education. On a 10-point scale, the mean ± SD usefulness and appeal of the videos were 9·01 ± 1·5 and 9·01 ± 1·66, respectively. Our study demonstrated a significant increase in knowledge score following video education, but not following oral education. Although between-group comparisons did not achieve statistical significance, portable video media for presenting informed consent and wound care instructions for skin biopsies appear to be more effective and result in higher satisfaction than traditional oral education.

Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature

Objective Postural restrictions after canalith repositioning maneuvers (CRM) for benign paroxysmal positional vertigo of the posterior semicircular canal (p-BPPV) have no proven value and therefore most physicians regard them as unnecessary. The aim of this study was to assess the short-term efficacy of head and body movement limitations after a single Epley maneuver. A review of the literature was performed to assess the current level of evidence for the efficacy of postural restrictions. Materials and methods Sixty-four patients, median age 59 years (range 37–82 years), with p-BPPV, were allocated either to instructions for movement restrictions or free movements for 48 h after a single Epley maneuver. The minimization method was used for allocation to treatment. This procedure ‘minimizes’ the differences in the distribution of pre-specified prognostic factors (e.g. sex and age) between the two groups of treatment. Minimization was preferred over randomization which is not as effective in balancing baseline characteristics when the number of participants is small. Outcome was assessed by physician and patient reported measures (Dix-Hallpike test, subjective vertigo intensity in a 10-point scale, patient's assessment of improvement) within 1 week after treatment by an independent investigator. The level of statistical significance was 0.05. Results More patients with movement restrictions reported a subjective improvement after treatment ( p = 0.007). Ninety percent of patients with movement restrictions and 74.2% of patients with free movements had a negative follow up Dix-Hallpike test but the difference was not significant ( p = 0.108). The mean pre-treatment vertigo intensity was reduced from 6.07 and 5.97 to 1.18 and 2.86, respectively but the difference was not significant ( p = 0.122). Conclusions Postural restrictions do not increase the efficacy of the canal-repositioning maneuver despite the fact that patients report a subjective improvement after post-procedural instructions. In the review of the literature, all studies except one conclude that postural restrictions are unnecessary. However, a number of methodological issues such as inadequate sample size are not addressed and more conclusive evidence is required. Based on current evidence, the use of postural restrictions after the canal-repositioning maneuver is unjustified.

Particle Repositioning Manoeuvre in Benign Paroxysmal Positional Vertigo: Is It Really Safe?

A prospective study to determine the safety of the particle repositioning manoeuvre (PRM) by analyzing the various complications of the procedure. Outpatient Department of Otorhinolaryngology, Nehru Hospital, Chandigarh, India. Thirty patients with the classic findings of benign paroxysmal positional vertigo (BPPV) were included in the study. Clinical symptoms prior to the procedure were noted. Twenty-nine of them were subjected to PRM, and postprocedural instructions were given to all patients. Various side effects during and following the procedure were recorded. They were classified into early and late based on the period and into major and minor based on severity. All patients were reviewed after 3 days, 7 days, and 1 month. Of the 29 patients, 19 patients (65.52%) had heaviness in the head, with 11 each (37.93%) reporting nausea and imbalance and 9 (31.03%) reporting instability during the procedure. A major complication, asystole, was noted in one patient. The percentage of side effects remained more or less the same in the early phase following the procedure. Only 5 of 29 patients were entirely asymptomatic. Ninety percent were relieved of symptoms by the end of 7 days, with no major complication recorded. PRM is an easy, effective, and relatively safe procedure. The risk of major complications with PRM, such as arrhythmias and asystole, highlights the need to consider other management modalities for BPPV in certain medically unfit patients.

Efficacy of particle repositioning maneuver in BPPV: a prospective study

Purpose A single blinded prospective randomized controlled trial was conducted in 40 patients with benign paroxysmal positional vertigo (BPPV) to determine the efficacy of particle repositioning maneuver (PRM). Materials and methods Out of 40 patients, 20 underwent PRM with the rest receiving a placebo treatment. Postprocedural instructions were given to all the patients who underwent PRM. Follow-up was for 1 year at regular intervals. Analysis was based on the symptomatic status and the Hallpike maneuver at each visit. Results After the initial week, 95% showed complete resolution of symptoms with none reporting a recurrence after PRM. On the contrary, only 15% of the controls had complete resolution with 14 out of 20 reporting a recurrence of BPPV. Results remained more or less the same at the end of 4 weeks. Six months after PRM, 19 of 20 patients had no vertigo with a meager 5% showing recurrence versus 75% of controls reporting a recurrence with only 3 of 20 reporting a favorable symptom status. At the end of 1 year, 18 of 20 patients had complete relief from symptoms with only 10% showing Hallpike maneuver positive in the study group compared with 3 of 20 reporting a relief from symptoms with 90% turning out to be Hallpike maneuver positive in the control group. Conclusions This study establishes the efficacy of PRM in short- and long-term management of BPPV; the procedure is easy and simple.

Psychophysiological manifestations of anxiety in patients undergoing electrophysiology studies

OBJECTIVE: To measure state anxiety and related physiological correlates at 3 selected times when patient education regarding electrophysiology (EP) studies is likely to occur: 24 hours before the EP study (pre-procedure teaching), 1 hour before the EP study (reinforcement of pre-procedure teaching), and 3 hours after the EP study (explanation of results; reinforcement of post-procedure instructions).DESIGN: Descriptive-exploratory.SETTING: Military medical treatment facility in mid Atlantic region.SUBJECTS: Thirty-two adults who underwent initial EP testing.OUTCOME MEASURES: The Spielberger State Anxiety score, frontalis muscle tension, heart rate, electrodermal activity, electrothermal feedback, and mean arterial pressure.METHODS: Outcome measures were obtained 1 day before (time 1), 1 hour before (time 2), and 3 hours after (time 3) the EP study.RESULTS: Both state anxiety scores and physiological variables indicated minimal psychophysiological reactivity.CONCLUSION: Patients undergoing initial EP studies experience moderate state anxiety and manifest a paradoxical pattern of autonomic responses over time. Moderate levels of state anxiety at each of the 3 assessment points would seem to indicate that patient education is appropriate at these times.

Investigation of fatigue failure of a stainless steel orthopedic implant device

An orthopedic implant (rush nail) fractured in a patient at a location that corresponded to the site of a prior fracture of the bone (right femur). The crack propagation in the implant proceeded from both sides of the nail, and the final fracture occurred by ductile shear in the midsection of the nail. Dimple structures and tear ridges between fatigue striation patches were observed on the fractured surface. Moreover, the device fractured within a short period of use. Contrary to post-procedure instructions, the patient placed the body’s full weight on the implanted leg at least once, perhaps twice, causing overload-induced fatigue failure of the implant.