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Application of generative language models to orthopaedic practice

Por: Caterson · J. · Ambler · O. · Cereceda-Monteoliva · N. · Horner · M. · Jones · A. · Poacher · A. T.
Objective

To explore whether large language models (LLMs) Generated Pre-trained Transformer (GPT)-3 and ChatGPT can write clinical letters and predict management plans for common orthopaedic scenarios.

Design

Fifteen scenarios were generated and ChatGPT and GPT-3 prompted to write clinical letters and separately generate management plans for identical scenarios with plans removed.

Main outcome measures

Letters were assessed for readability using the Readable Tool. Accuracy of letters and management plans were assessed by three independent orthopaedic surgery clinicians.

Results

Both models generated complete letters for all scenarios after single prompting. Readability was compared using Flesch-Kincade Grade Level (ChatGPT: 8.77 (SD 0.918); GPT-3: 8.47 (SD 0.982)), Flesch Readability Ease (ChatGPT: 58.2 (SD 4.00); GPT-3: 59.3 (SD 6.98)), Simple Measure of Gobbledygook (SMOG) Index (ChatGPT: 11.6 (SD 0.755); GPT-3: 11.4 (SD 1.01)), and reach (ChatGPT: 81.2%; GPT-3: 80.3%). ChatGPT produced more accurate letters (8.7/10 (SD 0.60) vs 7.3/10 (SD 1.41), p=0.024) and management plans (7.9/10 (SD 0.63) vs 6.8/10 (SD 1.06), p

Conclusions

This study shows that LLMs are effective for generation of clinical letters. With little prompting, they are readable and mostly accurate. However, they are not consistent, and include inappropriate omissions or insertions. Furthermore, management plans produced by LLMs are generic but often accurate. In the future, a healthcare specific language model trained on accurate and secure data could provide an excellent tool for increasing the efficiency of clinicians through summarisation of large volumes of data into a single clinical letter.

Nursing practice in modern healthcare environments: A systematic review of attributes, characteristics, and demonstrations

Abstract

Aim

To identify Attributes, Characteristics and Demonstrations of nursing practice from both nurses' and people perspectives in today's healthcare environments. A secondary aim was to identify relevant differences between female and male nurses in the context of ACDs.

Design

This systematic review was informed by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews.

Methods

The search included articles ranging from the years 2000 to 2023 across 10 electronic databases and multiple grey literature outlets. McMaster critical review forms and the Mixed Methods Appraisal Tool were used to appraise article quality. The Convergent Integrated Approach to Mixed Study Systematic Reviews was used to guide data synthesis.

Results

Twenty articles were included in this review, 13 qualitative, five quantitative and two mixed-methods studies. Three themes emerged, including knowledge, practice skills and interpersonal relationships. Differences in Attributes, Characteristics and Demonstrations of professional practice between women and men in nursing were also explored.

Conclusion

Findings suggest that evolving healthcare environments challenge nurses to remain focused on patient-centred and compassionate care. The review also supports nurses caring in a manner that empowers people, increases well-being, and reduces suffering.

Impact

Identified characteristics and attributes of nursing practice, including emphasis on continuous learning, interpersonal relationships and compassion, have a profound impact on nursing. Nurses should remain adaptable, compassionate and patient-focused in an ever-evolving healthcare environment. These foundational care principles are necessary for improving patient outcomes, enhancing trust between people and healthcare providers, and increasing inclusivity and diversity in the nursing workforce.

Wider Global Community

Nurses worldwide should strive to embody these attributes to provide high-quality, patient-centred care in an inclusive environment in today's demanding healthcare environment. Gender-specific differences in the perception and expression of professional Attributes, Characteristics and Demonstrations can inform inclusion and diversity efforts in the workplace.

Reporting Method

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Patient or Public Contribution

No Patient or Public Contribution.

Protection against Incidences of Serious Cardiovascular Events Study with daily fish oil supplementation in dialysis patients (PISCES): protocol for a randomised controlled trial

Por: Lok · C. E. · Hemmelgarn · B. R. · Moist · L. M. · Polkinghorne · K. · Tomlinson · G. · Tonelli · M.
Introduction

Patients with kidney failure with replacement therapy (KFRT) suffer premature cardiovascular (CV) mortality and events with few proven pharmacological interventions. Omega-3 polyunsaturated essential fatty acids (n-3 PUFAs) are associated with a reduced risk of CV events and death in non-dialysis patients and in patients with established CV disease but n-3 PUFAs have not been evaluated in the high risk KFRT patient population.

Methods and analysis

This multicentre randomised, placebo controlled, parallel pragmatic clinical trial tests the hypothesis that oral supplementation with n-3 PUFA, when added to usual care, leads to a reduction in the rate of serious CV events in haemodialysis patients when compared with usual care plus matching placebo. A target sample size of 1100 KFRT patients will be recruited from 26 dialysis units in Canada and Australia and randomised to n-3 PUFA or matched placebo in a 1:1 ratio with an expected intervention period of at least 3.5 years. The primary outcome to be analysed and compared between intervention groups is the rate of all, not just the first, serious CV events which include sudden and non-sudden cardiac death, fatal and non-fatal myocardial infarction, stroke, and peripheral vascular disease events.

Ethics and dissemination

This study has been approved by all institutional ethics review boards involved in the study. Participants could only be enrolled following informed written consent. Results will be published in peer-reviewed journals and presented at scientific and clinical conferences.

Trial registration number

ISRCTN00691795

Understanding the uptake of virtual care for first and return outpatient appointments in child and adolescent mental health services: a mixed-methods study

Por: Campbell · L. A. · Clark · S. E. · Chorney · J. · Emberly · D. · Carrey · N. · Bagnell · A. · Blenus · J. · Daneff · M. · Campbell · J. C.
Objective

To describe patterns of virtual and in-person outpatient mental health service use and factors that may influence the choice of modality in a child and adolescent service.

Design

A pragmatic mixed-methods approach using routinely collected administrative data between 1 April 2020 and 31 March 2022 and semi-structured interviews with clients, caregivers, clinicians and staff. Interview data were coded according to the Consolidated Framework for Implementation Research (CFIR) and examined for patterns of similarity or divergence across data sources, respondents or other relevant characteristics.

Setting

Child and adolescent outpatient mental health service, Nova Scotia, Canada.

Participants

IWK Health clinicians and staff who had participated in virtual mental healthcare following its implementation in March 2020 and clients (aged 12–18 years) and caregivers of clients (aged 3–18 years) who had received treatment from an IWK outpatient clinic between 1 April 2020 and 31 March 2022 (n=1300). Participants (n=48) in semi-structured interviews included nine clients aged 13–18 years (mean 15.7 years), 10 caregivers of clients aged 5–17 years (mean 12.7 years), eight Community Mental Health and Addictions booking and registration or administrative staff and 21 clinicians.

Results

During peak pandemic activity, upwards of 90% of visits (first or return) were conducted virtually. Between waves, return appointments were more likely to be virtual than first appointments. Interview participants (n=48) reported facilitators and barriers to virtual care within the CFIR domains of ‘outer setting’ (eg, external policies, client needs and resources), ‘inner setting’ (eg, communications within the service), ‘individual characteristics’ (eg, personal attributes, knowledge and beliefs about virtual care) and ‘intervention characteristics’ (eg, relative advantage of virtual or in-person care).

Conclusions

Shared decision-making regarding treatment modality (virtual vs in-person) requires consideration of client, caregiver, clinician, appointment, health system and public health factors across episodes of care to ensure accessible, safe and high-quality mental healthcare.

Investigating the associations of age of initiation and other psychosocial factors of singular alcohol, tobacco and marijuana usage on polysubstance use: analysis of a population-based survey in Jamaica

Por: Lalwani · K. · Whitehorne-Smith · P. · McLeary · J.-G. · Albarus · N. · Abel · W.
Objectives

This study aimed to examine concurrent polysubstance use of alcohol, tobacco and marijuana and determine correlations with access to marijuana, friend and familial drug use habits, risk perception and the age of initiation associated with the singular use of these substances.

Design

A secondary data analysis.

Setting

Used the Jamaica National Drug Prevalence Survey 2016 dataset.

Participants

Involved the entire dataset comprising 4623 randomly selected respondents between 12 and 65 years old.

Outcome measures

Primary outcome: concurrent polysubstance use recorded as using two or more of alcohol, tobacco and marijuana. Predictor variables include risk perception and age of initiation of singular alcohol, tobacco and marijuana use, ease of marijuana access and family and friend alcohol and illegal drug use.

Results

Approximately 58%–66% of respondents commenced singular alcohol, tobacco or marijuana use under 17. Participants commencing marijuana use at 11 years and under and between 12 and 17 were 3.346 and 4.560 times more likely to report past month concurrent polysubstance use (p=0.030 and p

Conclusions

Decreased perceived risk, childhood and adolescent age of initiation and easy access to marijuana were significantly associated with polysubstance use among Jamaicans. The influence of friends and family members’ drug and alcohol use behaviours on individuals developing polysubstance use habits further endorses the need for interventions.

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