How Would You Treat Tricuspid Valve Infective Endocarditis in a Patient Who Uses Injection Drugs? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Infective endocarditis is a common and morbid condition involving prolonged hospital stays, significant disability, and a high mortality rate. The current crises of injection drug use and opioid use disorder have contributed to high rates of infective endocarditis in the United States. Endocarditis in patients who inject drugs involves additional management complexity for multiple reasons.

From Tool to Teammate: A Randomized Controlled Trial of Clinician-AI Collaborative Workflows for Diagnosis.

Early studies of large language models (LLMs) in clinical settings have largely treated artificial intelligence (AI) as a tool rather than an active collaborator. As LLMs now demonstrate expert-level diagnostic performance, the focus shifts from whether AI can offer valuable suggestions to how it can be effectively integrated into physicians' diagnostic workflows. We conducted a randomized controlled trial (n=70 clinicians) to evaluate the value of employing a custom GPT system designed to engage collaboratively with clinicians on diagnostic reasoning challenges.

What Would You Recommend for This Patient Interested in a Total Knee Joint Arthroplasty? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Fourteen million people in the United States have symptomatic knee osteoarthritis (OA), a number that is expected to rise with an aging population. Patients with OA can benefit from nonoperative treatment. However, none of these treatments are disease modifying, and many patients eventually require total joint arthroplasty (TJA).

GPT-4 assistance for improvement of physician performance on patient care tasks: a randomized controlled trial.

While large language models (LLMs) have shown promise in diagnostic reasoning, their impact on management reasoning, which involves balancing treatment decisions and testing strategies while managing risk, is unknown. This prospective, randomized, controlled trial assessed whether LLM assistance improves physician performance on open-ended management reasoning tasks compared to conventional resources. From November 2023 to April 2024, 92 practicing physicians were randomized to use either GPT-4 plus conventional resources or conventional resources alone to answer five expert-developed clinical vignettes in a simulated setting.

Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial.

Importance: Large language models (LLMs) have shown promise in their performance on both multiple-choice and open-ended medical reasoning examinations, but it remains unknown whether the use of such tools improves physician diagnostic reasoning.

Objective: To assess the effect of an LLM on physicians' diagnostic reasoning compared with conventional resources.

Design, Setting, And Participants: A single-blind randomized clinical trial was conducted from November 29 to December 29, 2023.

Large Language Model Influence on Management Reasoning: A Randomized Controlled Trial.

Importance: Large language model (LLM) artificial intelligence (AI) systems have shown promise in diagnostic reasoning, but their utility in management reasoning with no clear right answers is unknown.

Objective: To determine whether LLM assistance improves physician performance on open-ended management reasoning tasks compared to conventional resources.

Design: Prospective, randomized controlled trial conducted from 30 November 2023 to 21 April 2024.

How Would You Treat This Inpatient With Type 2 Diabetes Mellitus? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Management of hospitalized patients with type 2 diabetes mellitus (T2DM) presents unique challenges. Two recently released guidelines, one from the American Diabetes Association and the other from the Endocrine Society, provide useful recommendations and evidence review to inform the care of medical inpatients with T2DM. These guidelines mostly agree, although there are slight differences in their recommendations.

How Would You Prevent Subsequent Strokes in This Patient? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Stroke is a major cause of morbidity, mortality, and disability. The American Heart Association/American Stroke Association recently published updated guidelines on secondary stroke prevention. In these rounds, 2 vascular neurologists use the case of Mr.

"Two Years Later I'm Still Just as Angry": A Focus Group Study of Emergency and Internal Medicine Physicians on Disrespectful Communication.

: Disrespectful behavior between physicians across departments can contribute to burnout, poor learning environments, and adverse patient outcomes. : In this focus group study, we aimed to describe the nature and context of perceived disrespectful communication between emergency and internal medicine physicians (residents and faculty) at patient handoff. We used a constructivist approach and framework method of content analysis to conduct and analyze focus group data from 24 residents and 11 faculty members from May to December 2019 at a large academic medical center.

Would You Screen This Patient for Cognitive Impairment? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Dementia, according to the American Psychiatric Association's , is defined by a significant decline in 1 or more cognitive domains that interferes with a person's independence in daily activities. Mild cognitive impairment (MCI) differs from dementia in that the impairment is not sufficient to interfere with independence. For the purposes of this discussion, cognitive impairment (CI) includes both dementia and MCI.

How Would You Manage This Patient With Infection? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

The Infectious Diseases Society of America/Society for Healthcare Epidemiology of America and the American College of Gastroenterology recently released updated guidelines on management of patients with infection. Although these 2 guidelines generally agree, there are a few important differences in their advice to clinicians. In these rounds, 2 experts, an infectious diseases specialist and a gastroenterologist, discuss antibiotic treatment options for nonsevere disease, the role of fecal microbiota transplantation for fulminant disease, and the use of bezlotoxumab to prevent recurrence in the context of Ms.

How Would You Resuscitate This Patient With Septic Shock? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Sepsis is a potentially life-threatening systemic dysregulatory response to infection, and septic shock occurs when sepsis leads to systemic vasodilation and subsequent tissue hypoperfusion. The Surviving Sepsis Campaign published updated guidelines in 2021 on the management of sepsis and septic shock. Here, in the context of a patient with septic shock, 2 critical care specialists discuss and debate conditional guideline recommendations on using lactate to guide resuscitation, the use of balanced crystalloids versus normal saline, and the use of corticosteroids.

How Would You Screen This Patient for Colorectal Cancer? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Colorectal cancer (CRC) is the third leading cause of cancer death for men and women in the United States, with an estimated 52 580 people expected to die in 2022. Most frequently, CRC is diagnosed among persons aged 65 to 74 years. However, among persons younger than 50 years, incidence rates have been increasing since the mid-1990s.

How Would You Treat This Patient With Pulmonary Embolism? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Pulmonary embolism can be acutely life-threatening and is associated with long-term consequences such as recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension. In 2020, the American Society of Hematology published updated guidelines on the management of patients with venous thromboembolism. Here, a hematologist and a cardiology and vascular medicine specialist discuss these guidelines in the context of the care of a patient with pulmonary embolism.