Rationale: Global Lung Function Initiative (GLI) Global spirometry reference equations were recently derived to offer a “race-neutral” interpretation option. The impact of transitioning from the race-specific GLI-2012 to the GLI Global reference equations is unknown. Objectives: Describe the direction and magnitude of changes in predicted lung function measurements in a population of diverse race and ethnicity using GLI Global in place of GLI-2012 reference equations. Methods: In this multicenter cross-sectional study using a large pulmonary function laboratory database, 109,447 spirometry tests were reanalyzed using GLI Global reference equations and compared with the existing GLI-2012 standard, stratified by self-reported race and ethnicity. Measurements and Main Results: Mean FEV1 and FVC percent predicted increased in the White and Northeast Asian groups and decreased in the Black, Southeast Asian, and mixed/other race groups. The prevalence of obstruction increased by 9.7% in the White group, and prevalences of possible restriction increased by 51.1% and 37.1% in the Black and Southeast Asian groups, respectively. Using GLI Global in a population with equal representation of all five race and ethnicity groups altered the interpretation category for 10.2% of spirometry tests. Subjects who self-identified as Black were the only group with a relative increase in the frequency of abnormal spirometry test results (32.9%). Conclusions: The use of GLI Global reference equations will significantly impact spirometry interpretation. Although GLI Global offers an innovative approach to transition from race-specific reference equations, it is important to recognize the continued need to place these data within an appropriate clinical context.

Limited critical care subspecialty training and experience is available in many low- and middle-income countries, creating barriers to the delivery of evidence-based critical care. We hypothesized that a structured tele-education critical care program using case-based learning and ICU management principles is an efficient method for knowledge translation and quality improvement in this setting. Weekly 45-min case-based tele-education rounds were conducted in the recently established medical intensive care unit (MICU) in Banja Luka, Bosnia and Herzegovina. The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) was used as a platform for structured evaluation of critically ill cases. Two practicing US intensivists fluent in the local language served as preceptors using a secure two-way video communication platform. Intensive care unit structure, processes, and outcomes were evaluated before and after the introduction of the tele-education intervention. Patient demographics and acuity were similar before (2015) and 2 years after (2016 and 2017) the intervention. Sixteen providers (10 physicians, 4 nurses, and 2 physical therapists) evaluated changes in the ICU structure and processes after the intervention. Structural changes prompted by the intervention included standardized admission and rounding practices, incorporation of a pharmacist and physical therapist into the interprofessional ICU team, development of ICU antibiogram and hand hygiene programs, and ready access to point of care ultrasound. Process changes included daily sedation interruption, protocolized mechanical ventilation management and liberation, documentation of daily fluid balance with restrictive fluid and transfusion strategies, daily device assessment, and increased family presence and participation in care decisions. Less effective (dopamine, thiopental, aminophylline) or expensive (low molecular weight heparin, proton pump inhibitor) medications were replaced with more effective (norepinephrine, propofol) or cheaper (unfractionated heparin, H2 blocker) alternatives. The intervention was associated with reduction in ICU (43% vs 27%) and hospital (51% vs 44%) mortality, length of stay (8.3 vs 3.6 days), cost savings ($400,000 over 2 years), and a high level of staff satisfaction and engagement with the tele-education program. Weekly, structured case-based tele-education offers an attractive option for knowledge translation and quality improvement in the emerging ICUs in low- and middle-income countries.

Background: ChatGPT is a large language model-based chatbot developed by OpenAI. ChatGPT has many potential applications to health care, including enhanced diagnostic accuracy and efficiency, improved treatment planning, and better patient outcomes. However, health care professionals’ perceptions of ChatGPT and similar artificial intelligence tools are not well known. Understanding these attitudes is important to inform the best approaches to exploring their use in medicine. Objective: Our aim was to evaluate the health care professionals’ awareness and perceptions regarding potential applications of ChatGPT in the medical field, including potential benefits and challenges of adoption. Methods: We designed a 33-question online survey that was distributed among health care professionals via targeted emails and professional Twitter and LinkedIn accounts. The survey included a range of questions to define respondents’ demographic characteristics, familiarity with ChatGPT, perceptions of this tool’s usefulness and reliability, and opinions on its potential to improve patient care, research, and education efforts. Results: One hundred and fifteen health care professionals from 21 countries responded to the survey, including physicians, nurses, researchers, and educators. Of these, 101 (87.8%) had heard of ChatGPT, mainly from peers, social media, and news, and 77 (76.2%) had used ChatGPT at least once. Participants found ChatGPT to be helpful for writing manuscripts (n=31, 45.6%), emails (n=25, 36.8%), and grants (n=12, 17.6%); accessing the latest research and evidence-based guidelines (n=21, 30.9%); providing suggestions on diagnosis or treatment (n=15, 22.1%); and improving patient communication (n=12, 17.6%). Respondents also felt that the ability of ChatGPT to access and summarize research articles (n=22, 46.8%), provide quick answers to clinical questions (n=15, 31.9%), and generate patient education materials (n=10, 21.3%) was helpful. However, there are concerns regarding the use of ChatGPT, for example, the accuracy of responses (n=14, 29.8%), limited applicability in specific practices (n=18, 38.3%), and legal and ethical considerations (n=6, 12.8%), mainly related to plagiarism or copyright violations. Participants stated that safety protocols such as data encryption (n=63, 62.4%) and access control (n=52, 51.5%) could assist in ensuring patient privacy and data security. Conclusions: Our findings show that ChatGPT use is widespread among health care professionals in daily clinical, research, and educational activities. The majority of our participants found ChatGPT to be useful; however, there are concerns about patient privacy, data security, and its legal and ethical issues as well as the accuracy of its information. Further studies are required to understand the impact of ChatGPT and other large language models on clinical, educational, and research outcomes, and the concerns regarding its use must be addressed systematically and through appropriate methods.