Richmond University Medical Center is a hospital in West New Brighton, Staten Island, New York City. The hospital occupies the buildings that were formerly St. Vincent's Medical Center, which closed in 2006. It is affiliated with the Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System.
Background/Objective Although the internet has broadened access to medical resources, concerns persist regarding the quality and accuracy of available content. ChatGPT, a general-purpose large language model, may help bridge this gap. This study evaluates its safety and user perception in addressing pediatric healthcare queries.Methods Nine experts independently evaluated 41 questions, with three experts assigned to each of the following topics: vitamin D (15 questions), food allergies (16 questions), and sleep problems (10 questions). Each question was answered separately by ChatGPT3.5 and ChatGPT4. Ratings were determined by expert consensus or, in cases of disagreement, the lowest rating. Additionally, 27 parents evaluated ChatGPT's responses.Results Experts rated 73.2% of responses from ChatGPT3.5 as "completely correct" or "correct but not comprehensive," while 26.8% were rated as "partially incorrect" or "completely incorrect." For ChatGPT4, these figures were 68.3% and 31.7%, respectively. The difference in accuracy ratings between the two versions was not statistically significant (chi-square test, p = .819). Over 80% of parents rated the responses as "completely clear with no further doubts" or "very clear with few doubts," with no significant difference found between versions (generalized mixed-effects model, p = .617). A total of 73.1% of parents expressed trust in ChatGPT's medical information, and 88.0% indicated a likelihood of continued use. Rating trends between parents and clinicians were consistent for both ChatGPT3.5 and ChatGPT4 responses (McNemar's test, ChatGPT3.5: p = .481; ChatGPT4: p = .143).Conclusion As over a quarter of responses contained expert-identified inaccuracies, the current performance of ChatGPT is insufficient for safe and reliable use in clinical decision-making. Nevertheless, it has potential to expand health information access for parents. However, these findings should be interpreted with caution given the small sample size and potential selection bias regarding parents' educational backgrounds. Future improvements should enhance accuracy, clarity, and integration between parents and healthcare professionals.
PURPOSE:We previously reported short-term (2 months) efficacy results of an advanced pneumatic compression device (APCD) versus usual care (UC) for the treatment of head and neck cancer survivors with symptomatic treatment-naive lymphedema (HNLEF). Herein we report the long-term (4 and 6 months) outcomes of that trial. METHODS AND MATERIALS:This multisite, prospective randomized clinical trial was conducted at academic and community-based sites. Eligibility criteria included: head and neck cancer survivors without evidence of cancer, previously untreated HNLEF evaluable on exam or imaging, and ≥1 associated symptom with severity of ≥4 out of 10. Participants were randomly assigned 1:1 to either daily use of an APCD for 6 months or UC per institutional standards. Measurement tools included: patient-reported outcome measures, Clinician-reported outcome (CRO) measures, digital photographs, and computed tomography (CT). Measures were at baseline, 2, 4 (no CT), and 6 months. RESULTS:A total of 236 participants were enrolled (119 APCD, 117 UC). Tumor distribution by group was as follows: APCD = larynx 29.4%, salivary glands 1.7%, oral cavity 37.8%, paranasal sinuses 1.7%, pharynx 25.2%, unknown primary 4.2%; UC = larynx 16.2%, salivary glands 5.1%, oral cavity 48.7%, paranasal sinuses 1.7%, pharynx 21.4%, unknown primary 6.8%. Of the UC group, 17.1% (n = 20) underwent bilateral neck dissection, as did 12.6% (n = 15) of the APCD group. Symptom improvement garnered during initial treatment was maintained over time in both groups with no significant difference between groups. CRO measures demonstrated improvement in internal HNLEF (Modified Patterson Scale, P < .01 both groups) and external HNLEF (grading criteria, APCD P < .01; UC P = .06) in the APCD group. Statistically significant differences at 2 of 19 anatomic subsites favored the APCD group. At 6 months, the digital photography showed improvement with no between-group difference. CT findings at 6 months verified significant improvement in soft tissue swelling in both groups (P < .01 for both groups) that was not present at 2 months, with no between-group difference. CONCLUSIONS:At 6 months, the analysis indicated that APCD and UC resulted in improved symptom control of similar magnitude. CROs, imaging, and digital photography demonstrated improvement in anatomic lymphedema in both groups over time. Select CRO outcome measures demonstrated marginal differences between groups that favored the APCD. Both interventions provided long-term benefit to patients with treatment-naive lymphedema.
Abstract Background Dementia, termed major neurocognitive disorder in the DSM-5-TR, and substance use disorders (SUD) are major and increasingly overlapping public health concerns in the United States. However, population-level trends examining their combined contribution to mortality remain limited. This study evaluates national mortality trends involving both conditions. Methods We conducted a retrospective analysis of the CDC WONDER Multiple Cause of Death database (2000–2023). Deaths listing both dementia and SUD as underlying or contributing causes were identified using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Trends were analyzed using Joinpoint regression, reporting annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Results A total of 283,206 deaths were identified. The overall AAMR increased significantly from 0.58 in 2000 to 7.63 in 2023 (AAPC: 13.29%; 95% CI: 10.42–16.23; p<0.001). Sex-stratified analysis showed higher mortality in males (AAMR: 0.87→9.61) than females (0.41→6.23), although females demonstrated a greater relative increase (AAPC: 14.07% vs 12.55%; both p <0.001). By race, non-Hispanic (NH) White individuals had the highest absolute rates (AAMR: 0.60→8.57), while NH Black individuals exhibited the highest long-term burden (AAPC: 12.69%; p <0.001). Hispanic individuals showed lower rates but consistent increases (AAMR: 0.22→3.33; p <0.001). Age-stratified analysis demonstrated increasing age-adjusted mortality rates among individuals aged 45–64 years (0.14→0.61; p <0.001). Among older adults (≥65 years), mortality rates initially increased substantially (2.79→41.94) through 2020 ( p <0.001), then declined sharply, reaching 0.61 in 2023 ( p <0.001). Regionally, the Midwest had the highest mortality (AAMR: 0.58→10.8; AAPC: 14.38%; p <0.001), while the Northeast had the lowest rates (0.29→4.95; p <0.001). All regions showed significant upward trends ( p <0.001). Urbanization analysis revealed increasing mortality in metropolitan (0.56→3.5) and non-metropolitan areas (0.71→3.8), with stronger growth in non-metropolitan regions (AAPC: 16.72% vs 15.82%; p <0.001). Conclusion Mortality involving both dementia and substance use disorders has increased substantially in the United States over the past two decades, with significant disparities across sex, race, geography, and urbanization. These findings highlight the growing burdens of neurodegenerative disease and substance use, emphasizing the need for integrated public health strategies targeting both conditions.
Unregulated peptide use is emerging as a digitally mediated public health concern. Although peptide-based medicines have important therapeutic roles when developed, prescribed, manufactured, and monitored through regulated pathways, online biohacking and wellness spaces increasingly promote experimental or weakly evidenced peptides for fat loss, recovery, aesthetics, cognition, performance, and longevity. This narrative review examines how digital promotion, gray-market access, self-injection, stacking, informal titration, product-quality uncertainty, regulatory ambiguity, and weak pharmacovigilance interact to normalize poorly traceable peptide products outside clinical supervision. The central concern is not legitimate peptide medicine, but consumer experimentation with products of uncertain identity, purity, potency, sterility, and safety. Improved clinician awareness, adverse-event reporting, product-quality monitoring, digital risk communication, and proportionate regulatory oversight are needed to distinguish evidence-based peptide therapy from unregulated consumer use.
Abstract Background Disease of the cardiac conduction system may arise in the atrioventricular node or distal His–Purkinje network, with important differences in mechanism, prognosis, and management. Alternating bundle branch block (ABBB) is a rare, high-risk electrocardiographic finding reflecting advanced bilateral His–Purkinje involvement, particularly when accompanied by atrioventricular block. Full serial documentation of its progression with intracardiac confirmation during the same clinical course appears exceptionally uncommon. Case summary We present an educational case of rapidly progressive His–Purkinje disease in which serial electrocardiograms documented evolution from early fascicular disease to bifascicular involvement, left bundle branch block, and ultimately ABBB with superimposed infra-Hisian Mobitz type II block over less than 8 months. Evaluation did not identify an obvious reversible or structural cause. Electrophysiology study provided intracardiac correlation of the surface electrocardiogram findings, directly capturing ABBB with superimposed infra-Hisian Mobitz type II block and confirming advanced His–Purkinje system disease. Given this high-risk conduction phenotype, cardiac resynchronization therapy pacemaker implantation was performed, with subsequent symptom resolution. Discussion The principal value of this educational case lies not simply in the presence of ABBB, but in the unusually complete chronology with which rapidly progressive His–Purkinje disease was documented and mechanistically confirmed. This case highlights the importance of recognizing ABBB as a Class I pacing indication, irrespective of symptoms, and illustrates the challenge of completing etiologic evaluation, including cardiac magnetic resonance imaging, when urgent device implantation is required.
