Gulseren Akyuz

Background: Lipedema is a frequently misdiagnosed chronic condition that significantly impacts patients’ quality of life. As artificial intelligence (AI)-based large language models (LLMs) become increasingly integrated into healthcare communication, their accuracy and consistency in providing patient-centered information require thorough evaluation, especially in rare diseases like lipedema. Therefore, this study aimed to evaluate the accuracy and reproducibility of responses generated by ChatGPT, DeepSeek, and Gemini to questions frequently asked by patients with lipedema. Methods: This cross-sectional study assessed the accuracy and reproducibility of responses generated by ChatGPT, DeepSeek, and Gemini to 25 commonly asked lipedema-related questions. Each model was queried twice in separate sessions, and answers were evaluated by three independent experts using a four-point rating scale. To ensure the objectivity and consistency of expert evaluations, inter-rater agreement was assessed using Cohen’s kappa coefficient. Results: DeepSeek achieved the highest proportion of comprehensive and correct responses (72%), followed by Gemini (64%) and ChatGPT (56%). Accuracy varied across content categories, with notable limitations particularly in treatment, follow-up, and maintenance questions. Reproducibility analysis revealed that DeepSeek produced the most consistent responses across sessions, while ChatGPT and Gemini showed more variability, particularly in treatment and quality-of-life questions. Cohen’s kappa values indicated high inter-rater agreement overall, with perfect agreement in some categories for ChatGPT and DeepSeek. Conclusions: LLMs can provide generally accurate and consistent responses to patient-centered questions about lipedema, particularly in areas related to general information and diagnosis. However, reduced accuracy and reproducibility in complex clinical domains suggest that expert oversight is essential when using these tools for patient education.

Cancer and its treatments are well-established contributors to the deterioration of skeletal health, primarily through reductions in bone mineral density (BMD), ultimately resulting in osteoporosis and an elevated risk of fractures. This complication extends far beyond the musculoskeletal system, constituting a significant systemic issue that adversely affects patients' quality of life, level of independence, physical functionality, and long-term outcomes. In oncology, the preservation of bone integrity is particularly critical in patient populations with prolonged survival expectations, such as women with early-stage breast cancer and men with non-metastatic prostate cancer. In these groups, the burden of skeletal complications becomes increasingly relevant as overall cancer survival improves. Androgen deprivation therapy (ADT), a cornerstone of treatment in prostate cancer, has been widely associated with a spectrum of adverse metabolic and skeletal effects, including obesity, insulin resistance, metabolic syndrome, osteoporosis, sarcopenia, cardiovascular disease, gynecomastia, and hypogonadism. Similarly, the use of aromatase inhibitors in hormone-sensitive breast cancer significantly accelerates bone loss, particularly in postmenopausal women. Collectively, these treatment-related effects create a high-risk profile for fracture development, emphasizing the importance of early and proactive bone health management in cancer survivors. According to current ASCO guidelines, all patients with non-metastatic cancer should undergo a comprehensive assessment of clinical risk factors for osteoporotic fractures at the time of cancer diagnosis. In individuals at elevated risk, BMD should be measured promptly using dual-energy X-ray absorptiometry (DXA), and fracture probability should be further evaluated through validated tools such as the FRAX score. Risk stratification should guide clinical decision-making and allow for timely intervention.

Hip fracture is one of the most common fractures among the elderly population with high rates of mortality and morbidity. The annual incidence of hip fractures is predicted to be increased by around 16 times by the year 2050. Due to the high cost of traditional rehabilitation after hip fracture surgery and the effect of pandemics, telerehabilitation after hip fracture is gaining more importance in recent years. This review is designed to examine the importance and progress of telerehabilitation after hip fracture surgery. PubMed/MEDLINE, Scopus, and Web of Science for English-language sources were searched from their inception using the keywords telerehabilitation and hip fracture between January 2014 and January 2023. The literature search resulted in 29 non-duplicate records and 8 of them were eligible and were included in this review. Telerehabilitation is a feasible, safe, and effective rehabilitation method after hip fracture surgery. However, the ability of elderly patients and their caregivers to use technology and apply what they see seems to be a big disadvantage. The literature lacks long-term studies with larger patient groups.

The purpose of this study was to: 1) investigate the differences in the needs of end-stage cancer who can move independently, using mobility aids (MA), or are bedridden; and 2) determine the effects of these different mobility levels on the patients’ current quality of life (QoL), fatigue, and mental conditions. The study employed an exploratory prospective cross-sectional study design, which was carried out in two hospitals. The study included 99 end-stage cancer. The mobility levels of the patients were evaluated in three groups: Group 1: bedridden; Group 2: mobile with MA; and Group 3: ambulatory (under supervision or fully independent). A core cancer-specific questionnaire-integrating system for assessing health-related QOL (EORTC-QLQ-C15-PAL), the Piper Fatigue Scale (PFS), and the Hospital Anxiety-Depression scale were utilized. The median age was 60years (31–83). Cancer types were as follows: gastrointestinal (45.5%), lung (38.4%), breast (4%), genitourinary system (4%), and others (8%). Forty-two percent of the patients were completely bedridden, 42.2% used MA, and 15.2% were independently ambulatory. The EORTC QLQ-C15-PAL physical (=.000) and emotional function values (=.029) differed among mobilization statuses. There was a significant difference among mobilization groups, in terms of behavioral values, in the PFS (=.006). The depression rate in the independent ambulatory group was lower than in the bedridden and MA groups (=0.011; =0.004). p p p p1  p2  Health-related QoL, fatigue level, and emotional state vary in end-stage cancer who undergo evaluations according to their mobility levels. These patients should be assessed comprehensively, and treatment plans should be organized carefully, with a multidisciplinary approach.

Background Searching for information on the Internet, especially YouTube^TM, is gaining popularity for cancer survivors. Based on the topic of online health information, the importance of studies using YouTube data for various cancer types and treatment methods has increased. This study aims to investigate the quality, reliability, and accuracy of YouTube videos on cancer rehabilitation (CR). Methods YouTube search was performed on February 26th, 2021, with two keyword sets: “cancer rehabilitation” and “oncology rehabilitation.” The modified DISCERN, the Journal of the American Medical Association (JAMA) scoring system, and the Global Quality Score (GQS) were used to evaluate the quality and reliability of the videos. The features of each video such as the number of likes, dislikes, and views, upload date, duration, like ratio, and the uploader profile were also collected. Results Fifty-three of the first 200 videos shown in the search results met the criteria. Most of the videos were low quality. The most common uploader profile was academic institute/university hospital. The three most common subjects in the videos were CR definition, physical therapy and occupational therapy, and patient experiences. The mean modified DISCERN, JAMA, and GQS scores were 2.14, 2.03, and 2.78, respectively. Higher quality videos had longer duration, greater number of views, and better reliability scores. Conclusion The results showed that most of the rated videos were of low-quality and didn’t provide sufficient information on the topic discussed. Higher-quality and more accurate YouTube videos are needed to increase awareness of CR. Implications for Cancer Survivors For cancer survivors, CR-related YouTube video content often provides information of low reliability. In this context, it is necessary to focus on the production of video content that includes clinical guides, references, and are based on clinical-based practices.

This study aims to evaluate pain, quality of life, and patient satisfaction in parenterally treated patients with postmenopausal osteoporosis (OP). Between May 2016 and January 2018, a total of 138 patients (mean age 63.78 years; range, 50 to 70 years) with postmenopausal OP were retrospectively analyzed. All patients were previously treated with denosumab (DEN) and parenteral forms of bisphosphonates such as zoledronic acid (ZOL) and ibandronate (IBN). The pain severity was evaluated using the Visual Analog Scale (VAS) and Brief Pain Inventory-Short Form (BPI-SF). The quality of life was evaluated using the Quality of Life Questionnaire of the European Foundation for Osteoporosis (Qualeffo-41). For the evaluation of patient satisfaction, a three-item questionnaire including satisfaction with the medication, route, and frequency of administration was applied. Of the patients, 50 received DEN, 48 received ZOL, and 40 received IBN treatment. There was no significant difference in any of the pain parameters. All domains of the Qualeffo-41 were similar among the three groups. The patients in the DEN group were more satisfied with their medication (DEN: 88%, ZOL: 43.75%, and IBN: 52.5%), its administration route (DEN: 84%, ZOL: 43.8%, and IBN: 57.5%), and the frequency of its administration (DEN: 84%, ZOL: 56.25%, and IBN: 52.5%) (p=0.0001). Neither of the medication showed a superior effect on quality of life. However, patients were more satisfied with medications used in a six-month interval and applied subcutaneously. Of these three treatment options, DEN seems to be a step ahead in terms of patient satisfaction.

Introduction Pectus carinatum (PC) is a congenital chest wall deformity which is characterized by the protrusion of the sternum and costal cartilages. Although orthotic and exercise therapies are commonly offered by physicians for PC treatment, there is a lack of evidence on the benefits of exercises and how long the orthosis should be worn. The aim of this study is to investigate the effects and feasibility of custom-made compression orthosis and exercises in the treatment of PC. Materials and Methods Patients with PC aged 7 to 17 years old were randomized into three groups: compression orthosis 23 hours, compression orthosis 8 hours, and control group. All groups received exercises for 1 hour a day for 3 weeks. Additionally, compression orthosis 23 hours group wore the orthosis for 23 hours a day, while compression orthosis 8 hours group wore the orthosis for 8 hours a day. PC protrusion, pressure of correction, thorax lateral and anteroposterior parameters, external chest wall measurements, and Nuss Questionnaire were evaluated before and after the treatment. Also, adverse effects, retention, and compliance were assessed. Feasibility was evaluated by calculating the percentages of recruitment, retention, and safety. Results The compression orthosis 23 hours group showed greater improvements than the other groups. After treatment, all groups showed significant changes in protrusion, pressure of correction, and external chest wall measurements. Adverse events occurred with similar frequency across groups. Retention percentages did not differ among groups. Conclusion Compression orthosis use for 23 hours can be recommended rather than its use for 8 hours because 23 hours of orthosis use has better correction and similar adverse effects.

The aim the study is to assess relationships between caregiver burden, quality of life, arm disability, grip strength, and lymphedema symptoms in women with postmastectomy lymphedema. Fifty-two patients with postmastectomy lymphedema were recruited. Burden Interview, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-30 and EORTC QLQ BRE-23) were used for the assessments of caregiver burden, arm disability, and quality of life. Lymphedema symptoms were questioned by Visual Analogue Scale (VAS) for pain, heaviness, and tension. Grip strength and arm volumes of the affected and unaffected sides were measured. Statistically significant positive correlations were detected between Burden Interview scores and DASH scores, VAS for pain and EORTC QLO-30 symptom scores. There were statistically negative correlations between Burden Interview and grip strength of affected side and unaffected side and lymphedema duration. Multiple linear regression was calculated to predict Burden Interview and EORTC QLO-30 functional and symptom scores based on age, DASH, stage, and duration of lymphedema. DASH score was significant predictors of Burden Interview while DASH score and Burden Interview scores were significant predictors of quality of life. Arm disability indicates caregiver burden and quality of life in patients with postmastectomy lymphedema while caregiver burden predicts the quality of life. These findings have implications for the management of lymphedema. We suggest that arm disability should be diagnosed and treated to improve caregiver burden and quality of life.

Neuromodulation techniques work by modulating pain perception by inducing changes in polarity of the neuronal membrane and thereby cortical excitability. The aim of this review is to evaluate the efficiency and safety of noninvasive neuromodulation techniques for phantom limb pain (PLP). A systematic literature search in the PubMed, Scopus, Web of Science, and Cochrane Library databases was performed to identify studies investigating the effects of noninvasive neuromodulation for PLP. The included journal articles were assessed with Furlan et al.’s method for examining the risk of bias to assess methodologic quality, and evidence was graded using the GRADE approach. The literature search identified 239 studies. Of these 239, four studies fulfilled the inclusion criteria and were included for data extraction. Two of the studies focused on repetitive transcranial magnetic stimulation (rTMS) whereas two other concentrated on transcranial direct current stimulation (tDCS). The present review showed that there is conflicting evidence to support the use of tDCS in short term and moderate evidence to support the use of rTMS in immediate and short term. It is important to recognize that this evidence comes from a very small sample size. No serious adverse effects were reported. Further information from randomized controlled trials with larger sample size investigating immediate and short-term and long-term effects are needed to clarify the best effective stimulation parameters and number of sessions of tDCS and rTMS for PLP.