In the modern era, patients often resort to the internet for answers to their health-related concerns, and clinics face challenges to providing timely response to patient concerns. This has led to a need to investigate the capabilities of AI chatbots for ophthalmic diagnosis and triage. In this in silico study, 80 simulated patient complaints in ophthalmology with varying urgency levels and clinical descriptors were entered into both ChatGPT and Bard in a systematic 3-step submission process asking chatbots to triage, diagnose, and evaluate urgency. Three ophthalmologists graded chatbot responses. Chatbots were significantly better at ophthalmic triage than diagnosis (90.0% appropriate triage vs. 48.8% correct leading diagnosis; p < 0.001), and GPT-4 performed better than Bard for appropriate triage recommendations (96.3% vs. 83.8%; p = 0.008), grader satisfaction for patient use (81.3% vs. 55.0%; p < 0.001), and lower potential harm rates (6.3% vs. 20.0%; p = 0.010). More descriptors improved the accuracy of diagnosis for both GPT-4 and Bard. These results indicate that chatbots may not need to recognize the correct diagnosis to provide appropriate ophthalmic triage, and there is a potential utility of these tools in aiding patients or triage staff; however, they are not a replacement for professional ophthalmic evaluation or advice.

Background: Spinal muscular atrophy (SMA) has a remarkable impact on function and participation. Subsequently, the caregivers of individuals with SMA are impacted as well. Providers and the SMA community should be aware of the presence of and likely expectations for the existence of caregiver burden. Methods: The Assessment of Caregiver Experience with Neuromuscular Disease (ACEND) quantifies caregivers’ perceptions of function and quality of life pertaining to time, finance and emotion. Analyses were conducted among SMA types and ambulatory and ventilatory status. Participants with SMA had varying ranges of function and were on pharmaceutical treatment. Total ACEND score, longitudinal change in total ACEND score, total quality of life (QOL) score, change in total QOL score and subdomains for QOL, including time, emotion and finance, were all explored. Results: Overall, the ACEND demonstrated discriminant validity and some observed trends. Total ACEND scores improved for caregivers of those with SMA 2, remained stable longitudinally for caregivers of those with SMA 1 and 3 and were not influenced by ventilation status. The caregivers of individuals with SMA 1 had the lowest total quality of life (QOL) score, as did the caregivers of non-ambulatory individuals and those requiring assisted ventilation. Longitudinally, there were no changes in total QOL between caregivers of individuals with different SMA types or ambulatory or ventilation status. There were some differences in emotional needs, but no differences in financial impact between the caregivers of individuals with different types of SMA or ambulatory and ventilatory status. Conclusions: With this information enlightening the presence of caregiver burden and expected changes in burden with pharmaceutical treatment, providers, third party payors and the SMA community at large can better assist, equip and empower those providing the necessary assistance to enable the lives of those with SMA.

To evaluate the association between embryo transfer techniques and pregnancy outcomes. This is a prospective observational study with a retrospective cohort. University Clinic. Patients underwent embryo transfers between 2015 and 2020. Fourteen physicians performed 25 mock embryo transfers on the embryo transfer simulator and completed a questionnaire assessing preferred embryo transfer techniques. Quantitative performance metrics on the embryo transfer simulator were measured. Individual physician embryo transfer success rates were retrospectively collected from all fresh and cryopreserved embryo transfers between January 1, 2015, and January 1, 2020. Associations between embryo transfer techniques (preferred technique and simulator performance metrics) and each physician’s historical patient pregnancy outcomes were assessed. Associations between embryo transfer techniques and live births were assessed. There were significant differences in embryo transfer techniques between physicians, including touches to the fundus, distance to the fundus, duration of embryo transfer, duration of the complete procedure, time spent navigating the cervical canal, velocity of embryo expulsion, time waited after embryo expulsion, and total score on the embryo transfer simulator. After controlling for confounders and multiple transfers per physician, the duration of embryo transfer was significantly associated with live birth, with longer durations associated with decreased live birth rates. Shorter placement distance to the fundus and higher velocity of embryo expulsion were both significantly associated with higher rates of ectopic pregnancy. This study revealed significant differences in transfer techniques among physicians. The use of the embryo transfer simulator for physicians in practice can elucidate differences and create opportunities for data-driven improvement in embryo transfer success rates.

Key Points: Apolipoprotein L1 genetic testing did not reduce potential living donors' willingness to donate, supporting integration of testing into practice. The Apolipoprotein L1 Testing and Counseling Program did not reduce potential living donors' decisional conflict or increase preparedness to donate. The trial demonstrated the feasibility of integrating apolipoprotein L1 genetic testing and counseling into routine living donor clinical evaluation. Background: Living donors of African ancestry have the highest risk of postdonation kidney disease. Apolipoprotein L1 ( APOL1 ) risk variants may contribute to this risk. This study evaluated the effectiveness and implementation of our culturally appropriate APOL1 Testing and Counseling Program to reduce potential donors' decisional conflict for donation. Methods: This prospective, nonrandomized, pre-post two-site hybrid type 2 effectiveness-implementation study evaluated the effect of the intervention on decisional conflict about donation, preparedness for decision making about donation and for donation, willingness to donate, and satisfaction with informed consent among potential donors of African ancestry undergoing evaluation. The intervention involved donors: using a chatbot providing APOL1 information, receiving culturally competent counseling, and APOL1 genetic testing. Control arm received routine care. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to longitudinally evaluate implementation outcomes assessed through validated surveys with donors and electronic health record review using linear mixed effects models. Cross-sectional outcomes were assessed using multiple regression models. Results: We enrolled 280 potential donors (75 control arm, 205 intervention arm; 71.07% participation rate). More were female (59%) and had a mean age of 40.2 years (SD, 12.8). No significant differences emerged in most primary and secondary outcomes between the intervention and control groups (decisional conflict β [95% confidence interval (CI)], −1.05 [−4.13 to 2.03]; P = 0.50), preparation for decision making ( β [95% CI], −7.02 [−18.83 to 4.78]; P = 0.24), preparedness to donate ( β [95% CI], 0.04 [−0.48 to 0.56]; P = 0.89), willingness to donate ( β [95% CI], 0.18 [−0.29 to 0.66]; P = 0.45). The right amount of information to make a decision domain for satisfaction with informed consent was significantly lower in the intervention arm ( β [95% CI], −0.34 [−0.65 to −0.02]; P = 0.04). Conclusions: Our APOL1 Testing and Counseling Program had no effect on potential donors' willingness to donate regardless of undergoing APOL1 testing, demonstrating the feasibility of its integration into routine donor clinical evaluation. Clinical Trial registry name and registration number: NCT04910867.

Incidental findings are commonly identified on emergency department (ED) imaging, often unrelated to the reason for encounter. While system-level interventions have aimed to improve notification and follow-up, less is known about patients' experiences of receiving these unexpected results. We sought to explore ED patients' perspectives on incidental finding notification. A qualitative analysis was conducted of semi-structured interviews of 16 adult ED patients undergoing abdominal CT or ultrasound imaging at a large academic ED. Interviews were originally collected for a larger implementation trial of an electronic health record-based incidental finding notification system. Interviews explored patient preferences for communication of incidental findings including preferred communicator and desired information. The analytic team employed inductive thematic analysis, using iterative coding and team reconciliation to ultimately develop themes. Descriptive statistics were used to characterize the sample. Forty-four percent of the 16 participants were aged 35-44 (25% were aged 45-54 years; 31% were 55 years or older); 62.5% female (Table 1). Only 25% of participants reported awareness of the concept of incidental findings prior to the interview. Four themes emerged: (1) Empathetic expert communication is preferred; (2) Incidental findings trigger diverse health, emotional, and financial concerns; (3) Details of both the finding and cause are valued; and (4) Information and support are desired for next steps. Patients view incidental findings as unexpected and often stressful information requiring clear, empathetic, and actionable communication. Incorporating these preferences into ED notification processes may improve understanding, reduce distress, and support timely follow-up. Standardizing incidental finding disclosure to include plain language explanations of the finding, its cause, and detailed next steps may support ED patients as they navigate future care and the myriad concerns that arise from an unexpected result. Achieving such standardization will likely require both communication training and electronic health record integration. In ED practice, this should include a brief verbal disclosure paired with EHR-supported written instructions that identify the finding, explain urgency, name the appropriate follow-up clinician, and specify patient and clinician next steps.