Allan Mun Fai Kwok

Aim: Artificial intelligence (AI) chatbots such as Chat Generative Pretrained Transformer‐4 (ChatGPT‐4) have made significant strides in generating human‐like responses. Trained on an extensive corpus of medical literature, ChatGPT‐4 has the potential to augment patient education materials. These chatbots may be beneficial to populations considering a diagnosis of colorectal cancer (CRC). However, the accuracy and quality of patient education materials are crucial for informed decision‐making. Given workforce demands impacting holistic care, AI chatbots can bridge gaps in CRC information, reaching wider demographics and crossing language barriers. However, rigorous evaluation is essential to ensure accuracy, quality and readability. Therefore, this study aims to evaluate the efficacy, quality and readability of answers generated by ChatGPT‐4 on CRC, utilizing patient‐style question prompts.Method: To evaluate ChatGPT‐4, eight CRC‐related questions were derived using peer‐reviewed literature and Google Trends. Eight colorectal surgeons evaluated AI responses for accuracy, safety, appropriateness, actionability and effectiveness. Quality was assessed using validated tools: the Patient Education Materials Assessment Tool (PEMAT‐AI), modified DISCERN (DISCERN‐AI) and Global Quality Score (GQS). A number of readability assessments were measured including Flesch Reading Ease (FRE) and the Gunning Fog Index (GFI).Results: The responses were generally accurate (median 4.00), safe (4.25), appropriate (4.00), actionable (4.00) and effective (4.00). Quality assessments rated PEMAT‐AI as ‘very good’ (71.43), DISCERN‐AI as ‘fair’ (12.00) and GQS as ‘high’ (4.00). Readability scores indicated difficulty (FRE 47.00, GFI 12.40), suggesting a higher educational level was required.Conclusion: This study concludes that ChatGPT‐4 is capable of providing safe but nonspecific medical information, suggesting its potential as a patient education aid. However, enhancements in readability through contextual prompting and fine‐tuning techniques are required before considering implementation into clinical practice.

Background: There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work–life balance globally. Methods: A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career. Results: Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work–life balance. Conclusion: Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.

Aim Fistulae‐in‐ano are associated with high treatment costs and impact deleteriously on quality of life. A wide range of healing, incontinence and recurrence rates have been reported.This study aimed to identify operative, patient and disease factors that influence these outcomes after surgery for fistula‐in‐ano. Method An observational cohort study of consecutive patients who were managed for fistulae‐in‐ano at a tertiary colorectal practice (1999‐2019) was performed. Outcome measures included healing, impaired continence and need to re‐operate. Clinico‐pathological variables, including patient comorbidities, fistula anatomy, and operative approach, were assessed for their association with these outcomes. Results Some 411 procedures were performed on 263 patients (median age 41.8 years [range 17.8–79.7], 184 [70.0%] male). 77.9% of patients achieved complete healing. experienced some deterioration in continence post‐operatively. 37.6% of patients required re‐operation at a median time of 19.0 weeks. Poorer healing was associated with Crohn’s disease, high trans‐sphincteric fistulae, extrasphincteric fistulae and steroid usage. Poorer continence was associated with female sex, age >40 years, posterior location, suprasphincteric fistulae, seton insertion and having >3 subsequent procedures. Need to re‐operate was associated with female sex, high trans‐sphincteric fistulae, supra‐sphincteric fistulae, inflammatory bowel disease and previous operations for fistula‐in‐ano. Conclusion Minimising fistula‐in‐ano recurrence and preservation of continence can be competing management goals. Over one‐in‐three patients require re‐operation, one‐in‐five fail to heal completely, and one‐in‐ten suffer worsened continence following surgery. Awareness of the factors that contribute to these outcomes is important to the process of informed consent and managing patient expectations before surgery.

Background: Diverticula of the appendix (DA) are infrequent and their clinical implications are often overlooked. Several studies have found a significantly increased prevalence of neoplasms in appendiceal specimens with diverticula. Despite the potential clinical implications, there is a paucity of literature. A systematic review and meta‐analysis was performed to evaluate the prevalence of DA and its association with neoplasia.Methods: A systematic search of literature (Cochrane, EMBASE, PubMed and Medline) reporting the prevalence of DA and association with neoplasia was performed in November 2019. Relevant articles were assessed in accordance with the PRISMA guidelines. Risk of bias assessment was carried out using modified Newcastle–Ottawa scale. Meta‐analysis with risk ratio and random‐effects model was performed using RevMan.Results: The initial search identified 1122 potential articles of which 11 were appropriate for quantitative analysis. The prevalence rate of DA was 1.74%. The mean age of patients with DA and those without DA was 41.2 and 33.9 years, respectively. The ratio of male to female was 1.8:1. The prevalence of neoplasia in specimens without DA versus those with DA was 1.28% and 26.94%, respectively. Only four studies addressed the prevalence of locoregional neoplasia in the setting of DA compared to control. Meta‐analysis with random‐effects model demonstrated that pooled risk ratio was 25.46 (95% confidence interval 12.77–50.75, P < 0.00001).Conclusion: The strong association with neoplasia in this meta‐analysis reinforces the clinical significance of DA. Surgeons, pathologists and radiologists should be mindful of this uncommon pathology and consider individualized patient management, until further evidence can direct clinical guidelines for the management of patients with DA.

Primary extragenital mixed malignant Mullerian tumour presenting as a painful splenic mass: A case report and review of the literature