Advancements in endoscopic ultrasound-guided tissue acquisition (EUS-TA) for solid pancreatic masses have prompted updates in society guideline recommendations. However, the extent to which these recommendations have been adopted in clinical practice remains unclear. Thus, we sought to characterize current practice patterns and beliefs regarding EUS-TA for solid pancreatic masses in a large, international cohort of endosonographers. We developed and distributed an electronic survey to 1,281 endosonographers worldwide between September and November 2024. The survey aimed to evaluate EUS-TA practices across six domains: A) needle selection, B) sampling technique, C) method guiding the number of passes, D) specimen handling, E) quality indicator (QI) monitoring, and F) factors influencing decision-making. The response rate was 30
BACKGROUND AND AIMS:Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is increasingly used; however, clinical application remains unstandardized. We assessed real-world practice among international users. METHODS:A cross-sectional 70-item survey was conducted. Results are presented descriptively (numbers, percentages). RESULTS:Overall, 91 of 175 invited physicians from Europe (74.4%), North America (13.3%), and Asia (12.2%) completed the survey. EUS-RFA was performed by 94.1% of respondents for insulinoma, with heterogeneous responses for other indications. Most physicians (96.3%) performed EUS-RFA under deep sedation or general anesthesia; marked variability was reported on antibiotic prophylaxis (57.5%), aggressive hydration (52.5%), generator power settings, ablation strategy, or probe selection. Lesions involving or located ≤ 1 mm from the main pancreatic duct were considered high risk by 97.5% and 85.0%, respectively, yet no standardized preventive strategy was identified. Post-procedural management and follow-up were heterogeneous, with a high proportion of responses for definitions of technical success (88.8%), clinical success in insulinoma (92.3%), and disease recurrence (97.5%), with high variability for definitions of partial ablation and post-RFA pancreatitis. CONCLUSIONS:Despite the global expansion of EUS-RFA, clinical practice remains highly heterogeneous and geographically skewed. The lack of standardized methodology and terminology poses significant barriers to generating high-quality evidence.
Background: Malnutrition and muscle wasting are common in critically ill patients and contribute to functional decline. Multidisciplinary nutrition support teams (NSTs) are recommended to improve nutritional delivery; however, data from Indian intensive care units (ICUs) using functional endpoints are limited. Objectives: To evaluate the effect of NST implementation on handgrip strength (HGS) (primary endpoint) and nutritional outcomes in critically ill adults. Materials and Methods: Single-center pre–post observational study including 100 adult ICU patients (>18 years; ICU stay >48 h). Phase 1 (n = 50) received standard nutrition care and Phase 2 (n = 50) received structured NST-led care (intensivist, dietitian, nurse, pharmacist, and respiratory therapist). Nutrition targets were prescribed based on body mass index and measured resting energy expenditure (indirect calorimetry). Dominant HGS and weight were recorded on day 1, at discharge, and at day 28 postdischarge. Results: Baseline age, sex distribution, and acute physiology and chronic health evaluation II (APACHE II) were similar between groups; Nutrition risk in critically ill (NUTRIC) score was higher in Phase 1. Calorie and protein delivery improved in Phase 2 with lower deficits (all P < 0.01). The primary endpoint change in dominant HGS from Day 1 to Day 28 was − 1.02 ± 1.48 kg in Phase 1 versus + 1.99 ± 2.88 kg in Phase 2 (mean difference 3.01 kg; 95% confidence interval [CI] 2.11 to 3.91; P < 0.001). Effect size was large (Cohen’s d = 1.31). In an adjusted linear model (age, sex, APACHE II, and NUTRIC), NST remained independently associated with improved grip change (adjusted mean difference 3.01 kg; 95% CI 2.02 to 3.99; P < 0.001). Conclusion: Implementation of a multidisciplinary NST improved nutritional adequacy and was associated with clinically meaningful improvement in muscle strength recovery. Structured team-based nutritional care may improve the functional outcomes in critically ill patients in Indian tertiary care settings.
Use of Artificial Intelligence tools such as ChatGPT and Google Gemini enables understanding the disease perspective for the patients with underlying pathogenesis and aids in management. The present study aims to compare ChatGPT and Google Gemini responses for writing patient information guides on Autism, Attention Deficit Hyperactivity Disorder (ADHD) and Post-Traumatic Stress Disorder (PTSD) among pediatric age groups. This cross-sectional study was conducted by generating patient education guides for three psychiatric disorders using ChatGPT and Google Gemini. The responses generated were compared for parameters such as grade level, ease score, word count and sentence count. Tools such as the Flesch–Kincaid calculator, Quillbot and modified DISCERN score were used to assess the ease, similarity and reliability of the responses, respectively. Analysis was done using RStudio v4.3.2. Responses generated by ChatGPT and Google Gemini show no significant difference in the word count (P = 0.1022), sentence count (P = 0.1289) and average word per sentence (P = 0.7629). A higher ease score was observed for Google Gemini (34.70) compared to ChatGPT (17.27), with no statistical significance. Grade level scores calculated for ChatGPT were 13.07 and 10.05 for Google Gemini. Modified DISCERN score predicted a higher reliability score for Google Gemini (4.67/5) versus ChatGPT (4.33/5). Data collected using ChatGPT and Google Gemini reveals a higher ease score for Google Gemini, which signifies easy understanding of the text for the general population. The Modified DISCERN score was also higher for Google Gemini which indicates reliability of the data collected. The study has its own limitations as a greater variety of AI tools needs to be explored to enhance knowledge and understanding for further study and patient’s perspective.
