Bhagvat Maheta

Background: Despite the promising potential of AI in the perioperative context, the rapid pace of development and diverse implementation warrant a thorough review to consolidate existing knowledge, identify gaps, and assess the use of trustworthiness principles in AI integration into the perioperative period for patients with serious illness. Objective: The purpose of this study was to address deficiencies in the perioperative AI literature by elucidating the extent to which discussions of equity, ethics, and safety are incorporated, thereby establishing a foundation for the development of robust ethical guidelines for the safe and effective integration of AI in health care. Methods: We searched PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus for studies published from 2010 to July 2024. We included studies that reported patient functional outcomes, occurred in the perioperative period (30 d before and up to 90 d after surgery), incorporated AI integration, and included patients with serious illness (defined as malignancy, advanced organ failure, frailty, dementia or neurodegenerative disease, or stroke). To ensure reliability and minimize bias, 2 independent reviewers screened all studies at the title or abstract and full-text stages; conflicts were resolved through team consensus. The abstraction form was developed iteratively and was tested through pilot abstractions. Any discrepancies identified during data extraction were resolved through discussion and consensus among the reviewers. The ROBINS-I (Risk of Bias Tool in Nonrandomized Studies of Interventions) tool was used to assess quality. Abstraction and risk assessment were conducted through a blinded, independent dual-review process. A narrative review was compiled from the identified studies. Results: Of the 10,980 papers identified through the database searches, this review yielded 81 papers that met the inclusion criteria. Analysis of AI implementation strategies revealed foundational efforts toward equitable access, with 6 studies providing open-access tools and several more designing models with simple inputs suitable for low-resource settings (17 studies). Seven studies mentioned their commitment to transparency (eg, publishing code) to enhance safety and trust. However, significant ethical deficiencies persist, particularly regarding input data, as only 2 studies explicitly addressed racial or ethnic disparities, and concerns about lack of sample diversity (16 studies) and the omission of socially relevant features (5 studies) were frequently noted as limitations. Conclusions: Machine learning for predictive analytics and other types of AI tools for surgical outcomes offer significant potential but require adherence to trustworthiness and safety principles to be clinically viable. Future research should prioritize adherence to guidelines for equity, ethics, and safety, conduct prospective studies, incorporate more external validation of AI models, and facilitate transparent monitoring and reporting of model performance to build clinician and patient trust and encourage broader health care system adoption.

Background: Virtual reality (VR) has promise as an innovative nonpharmacologic treatment for improving a patient’s quality of life. VR can be used as an adjunct or treatment for many acute and chronic conditions, including serious illnesses. Objective: This systematic review aims to assess the current state of the literature of randomized controlled trials that use VR in patients with serious illnesses. Two secondary aims include assessing intervention components associated with improved quality of life and functional outcomes among older adults, as well as evaluating how well the randomized controlled trials adhere to consensus standards for VR research. Methods: We searched PubMed, Embase, and CINAHL for randomized controlled studies published at any time. We screened and accepted studies that reported outcomes related to patients’ quality of life, provided an immersive VR intervention, and included patients with serious illness. We narratively summarized key attributes of publications that shed light on study efficacy, generalizability, replicability, and clinical utility. All studies were assessed for study quality with the Cochrane Risk of Bias tool and for concordance with 8 recent consensus standards for VR research. Results: From the 12,621 articles searched in May 2024, a total of 24 (0.19%) studies met the inclusion criteria, and of these, 88% (21/24) reported an improvement in at least 1 patient quality of life outcome and 67% (16/24) had a high risk of bias. In 7 (n=24, 29%) studies, VR was used to provide distraction therapy to reduce pain. In total, 5 (n=24, 21%) studies included training, supervision, and assistance in VR use, which demonstrated improvements in patient quality of life–related outcomes. Of 24 studies, 9 (38%) included patients with stroke, 9 (38%) included patients with cancer, 4 (17%) included patients with cardiovascular disease, 1 (4%) included patients with chronic obstructive pulmonary disease, and 1 (4%) included patients who reported pain in hospital. In all 9 studies that included patients with stroke, the main purpose of VR was to improve mobility and strength; these studies had higher frequency and longer durations of VR use, ranging from 2 to 9 weeks, as compared to a VR use duration of <2 weeks for studies aiming to reduce pain or anxiety. Regarding consensus standards for VR research, 29% (7/24) of the studies adhered to all 8 criteria, and all studies (24/24, 100%) adhered to ≥5 criteria. Conclusions: Nascent evidence suggests VR’s potential in mitigating pain, anxiety, and depression and improving mobility among persons with serious illnesses. Most studies did not provide detailed information about unassisted or assisted use, suggesting that VR for older adults is currently most appropriate for observed settings with assistance available. Trial Registration: PROSPERO CRD42022346178; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346178

BACKGROUND On average, competitive specialties have significantly lower match rates, and the competitiveness continues to rise each year. Besides test scores, applicants need to demonstrate interest in research, leadership, and clinical experience—opportunities often more accessible at schools with a home residency program. OBJECTIVE This study assesses how home programs impact residency match rate for competitive specialties, aiming to enhance program directors’ assessment of applicants, guide medical school advisors, and aid students in strengthening their residency candidacy. METHODS 12,489 US MD medical school graduates from 2019 to 2023 were assessed retrospectively. Match lists published on each institution’s official website and the Office of Student Affairs provided data for 152 US MD programs. Characteristics examined included Alpha Omega Alpha and Gold Humanism Honor Society chapter status, home residency program, and number of specialty faculty. An odds ratio (OR) analysis was conducted to determine the likelihood medical students with a home program matched into a competitive specialty compared to those without. RESULTS 984 competitive residency programs had school affiliations and 660 lacked affiliations. Of the matched applicants in a competitive specialty, 10,541 attended an institution affiliated with a residency program resulting in a statistically significant 2.0% match rate for students with a home program versus 1.1% match rate for students without a home program (OR: 1.73) (p<0.01). Applicants with and without a home program matched 58.3% and 52.7% into academic (OR: 1.25), emphasizing the advantageous impact of a home program. CONCLUSIONS US MD graduates with a home program were nearly twice as likely to match into their competitive specialty of choice, possibly attributed to more clinical exposure, strong faculty relationships, and application support. This study demonstrates lack of a home program disadvantages applicants and may contribute to disparities in acceptances in competitive specialties.

Background: As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. Objective: This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. Methods: In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. Results: Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies. Conclusions: Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. Trial Registration: PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698