Artificial intelligence (AI) has demonstrated remarkable capabilities across diverse medical applications, potentially revolutionizing healthcare delivery systems. This systematic review and meta-analysis investigated the comparative effectiveness of generative artificial intelligence (GAI)-based teaching methodologies versus conventional pedagogical approaches on educational outcomes among medical students. We conducted a comprehensive literature search across multiple electronic databases, including PubMed, Cochrane Library, EMBASE, and Web of Science, encompassing studies published from January 2014 through January 2025. The review focused on randomized controlled trials (RCTs) that compared GAI-based teaching interventions with traditional instructional teaching methods in medical students. The meta-analysis incorporated 11 eligible RCTs, comprising 786 medical students. Pooled analysis revealed no statistically significant difference in knowledge acquisition scores between GAI-based and traditional teaching approaches (standardized mean difference [SMD] 0.27, 95% confidence interval [CI] -0.31 to 0.85; p = 0.36). However, subgroup analysis indicated enhanced knowledge performance in the GAI group specifically for extended learning periods (exceeding one week) and practice-oriented courses. GAI-based instruction demonstrated superior outcomes in practical skill development compared to conventional methods (SMD 0.63, 95% CI 0.10–1.16; p = 0.02). Students in the GAI group reported significantly higher satisfaction scores with their learning experience. While theoretical knowledge acquisition remains comparable between teaching modalities, the distinctive advantages of GAI-based approaches in practical skill development warrant their integration into medical curricula. Future research should focus on optimizing the integration of GAI-based teaching methods, standardizing implementation protocols, and evaluating long-term educational outcomes. This protocol was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) with the registration number INPLASY202510006. Registered on 2 January 2025.

Background: The integration of ChatGPT with educational settings is happening at an unprecedented rate, and there is a growing trend for students to use ChatGPT for various academic work. Although numerous studies have evaluated the knowledge, attitudes, and practices related to ChatGPT among students in diverse medical fields, there remains a notable absence of such research within the Chinese context. Methods: The questionnaire survey was conducted to a sample of 1,133 medical students from various medical colleges across Sichuan Province, China, between May 2024 and November 2024 to explore the awareness and attitudes of medical students towards ChatGPT. Descriptive statistics were used to tabulate the frequency of each variable. A chi-square test and multiple regression analysis were employed to investigate the factors influencing participants’ positive attitudes toward the prospective use of ChatGPT. Results: The findings revealed that 62.9% of participants had employed ChatGPT in their medical studies, with 16.5% having utilized the tool in a published article. Participants primarily used ChatGPT for searching information (84.4%) and completing academic assignments (60.4%). However, concerns were expressed regarding the potential for ChatGPT to disseminate misinformation (76.9%) and facilitate plagiarism or complicate its detection (65.4%). Despite these concerns, 64.4% of respondents indicated a willingness to use ChatGPT to seek assistance with learning problems. Overall, a majority of participants (60.7%) maintained a positive attitude on the future use of ChatGPT in the medical field. Conclusion: Our research showed that while most medical students perceived ChatGPT as a valuable tool for academic study and research, they remained cautious about its potential risks, particularly regarding misinformation and plagiarism concerns. Despite these reservations, a majority participants indicated a willingness to incorporate ChatGPT into their academic workflow, specifically for problem-solving tasks, and maintained optimistic perspectives regarding its potential integration into medical education and clinical practice. It is therefore essential to improve student literacy about AI, develop clear guidelines for its acceptable use, and implement support systems to ensure that medical students are fully prepared for the upcoming integration of AI into medical education. Trial registration: Not applicable.

Perioperative cognitive impairment (CI) following surgeries is prevalent in geriatric surgical population aged 60 and older. This meta-analysis was designed to investigate whether the Mini-Mental State Examination (MMSE) has prognostic value on adverse outcomes in aged surgical patients. PubMed, Cochrane, Embase and Medline through the Ovid were searched. Meta-analyses were carried out for CI versus non-cognitive impairment (NCI). Quality of evidence was assessed by the GRADE approach. One randomized controlled trial, two retrospective cohort trials, and 18 prospective cohort trials were included in the meta-analysis. Perioperative diagnosis of CI by the MMSE had higher rates of patients suffering from postoperative delirium (POD) [odd ratio (OR) 5.02, 95% confidence interval (CI) 3.27, 7.71, P < 0.00001], in-hospital mortality (OR 7.51, 95% CI 2.17, 26.02, P = 0.001), mortality within 1 year (OR 2.53, 95% CI 1.95,3.29, P < 0.00001). Postoperative CI patients had no extended length of stay in orthopedic [standardized mean difference (SMD) -0.10, 95% CI -0.20, 0.17, P = 0.91)] nor rehabilitation wards ((SMD, 0.04; 95% CI, − 0.23 to 0.31; P = 0.78). Older patients with perioperative CI were more likely to suffer from POD and mortality. The MMSE showed certain value on risk stratification and prognosis evaluation in geriatric surgical population. PROSPERO CRD42018108739 .

Background: Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. Objective: This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Methods: Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health & Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. Results: After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81%) and MHAS (n=12,560, 52.19%) were included. Of these, 96.78% (n=11,135) participants in CHARLS and 70.02% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95% CI 0.40-0.59; P<.001) in MHAS. Conclusions: A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations.

This review comprehensively assesses the epidemiology, interaction, and impact on patient outcomes of perioperative sleep disorders (SD) and perioperative neurocognitive disorders (PND) in the elderly. The incidence of SD and PND during the perioperative period in older adults is alarmingly high, with SD significantly contributing to the occurrence of postoperative delirium. However, the clinical evidence linking SD to PND remains insufficient, despite substantial preclinical data. Therefore, this study focuses on the underlying mechanisms between SD and PND, underscoring that potential mechanisms driving SD‐induced PND include uncontrolled central nervous inflammation, blood–brain barrier disruption, circadian rhythm disturbances, glial cell dysfunction, neuronal and synaptic abnormalities, impaired central metabolic waste clearance, gut microbiome dysbiosis, hippocampal oxidative stress, and altered brain network connectivity. Additionally, the review also evaluates the effectiveness of various sleep interventions, both pharmacological and nonpharmacological, in mitigating PND. Strategies such as earplugs, eye masks, restoring circadian rhythms, physical exercise, noninvasive brain stimulation, dexmedetomidine, and melatonin receptor agonists have shown efficacy in reducing PND incidence. The impact of other sleep‐improvement drugs (e.g., orexin receptor antagonists) and methods (e.g., cognitive‐behavioral therapy for insomnia) on PND is still unclear. However, certain drugs used for treating SD (e.g., antidepressants and first‐generation antihistamines) may potentially aggravate PND. By providing valuable insights and references, this review aimed to enhance the understanding and management of PND in older adults based on SD.

Purpose: To investigate the effects of ciprofol on postoperative cognitive function in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Patients and Methods: A total of 138 patients who underwent cardiac surgery with cardiopulmonary bypass were included in this prospective, randomized, controlled study. Patients were randomized into two groups: the Ciprofol group (Group C) and the Propofol group (Group P). During anesthesia induction and maintenance, the patients in Group C received ciprofol, whereas those in Group P received propofol. The primary outcome measure was the incidence of postoperative delirium (POD), which was assessed twice daily for 7 days after surgery via either the Confusion Assessment Method (CAM) or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Statistical analyses included chi-square tests for categorical outcomes and relative risk calculations for POD. Additionally, delirium subtypes were recorded. The incidence of postoperative cognitive dysfunction (POCD) was evaluated at 1 and 3 months after surgery using the Telephone Montreal Cognitive Assessment (T-MoCA). Furthermore, the occurrence of postinduction adverse events, including hypotension, bradycardia, and tachycardia, as well as the incidence of postoperative complications, were also documented. Results: POD occurred in 19/64 (29.69%) patients in the Ciprofol group and 34/65 (52.31%) patients in the Propofol group (RR = 0.57; 95% confidence interval = 0.37 to 0.88; p = 0.009). There was no significant difference in the incidence of POCD at 1 month (22.03% vs 26.62%, p = 0.547) or 3 months (16.25% vs 16.00%; p = 0.771) after surgery between the two groups. Conclusion: Ciprofol was found to decrease the incidence of POD in patients who underwent cardiac surgery with cardiopulmonary bypass. Nevertheless, no significant effect of this intervention on the incidence of POCD was demonstrated at either 1 or 3 months after surgery. A reduction in the incidence of delirium may be associated with improved postoperative recovery, shortened hospital stays, and a decrease in long-term cognitive impairments. Registration: The study had been registered in the Chinese Clinical Trials Registry (www.chictr.org.cn; Trial Identifier: ChiCTR2200061712).