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Large Language Models (LLMs) have the potential to improve education by personalizing learning. However, ChatGPT-generated content has been criticized for sometimes producing false, biased, and/or hallucinatory information. To evaluate AI's ability to return clear and accurate anatomy information, this study generated a custom interactive and intelligent chatbot (Anatbuddy) through an Open AI Application Programming Interface (API) that enables seamless AI-driven interactions within a secured cloud infrastructure. Anatbuddy was programmed through a Retrieval Augmented Generation (RAG) method to provide context-aware responses to user queries based on a predetermined knowledge base. To compare their outputs, various queries (i.e., prompts) on thoracic anatomy (n = 18) were fed into Anatbuddy and ChatGPT 3.5. A panel comprising three experienced anatomists evaluated both tools' responses for factual accuracy, relevance, completeness, coherence, and fluency on a 5-point Likert scale. These ratings were reviewed by a third party blinded to the study, who revised and finalized scores as needed. Anatbuddy's factual accuracy (mean ± SD = 4.78/5.00 ± 0.43; median = 5.00) was rated significantly higher (U = 84, p = 0.01) than ChatGPT's accuracy (4.11 ± 0.83; median = 4.00). No statistically significant differences were detected between the chatbots for the other variables. Given ChatGPT's current content knowledge limitations, we strongly recommend the anatomy profession develop a custom AI chatbot for anatomy education utilizing a carefully curated knowledge base to ensure accuracy. Further research is needed to determine students' acceptance of custom chatbots for anatomy education and their influence on learning experiences and outcomes.

BackgroundAtrial Fibrillation (AF) has been associated with various behavioral risk factors such as tobacco, alcohol, and/or substances abuse.ObjectiveThe main objective is to describe the national trends and burden of tobacco and substance abuse in AF hospitalizations. Also, this study identifies potential population who are more vulnerable to these substance abuse among AF hospitalizations.MethodsThe National Inpatient Sample database from 2007 to 2015 was utilized and the hospitalizations with AF were identified using the international classification of disease, Ninth Revision, Clinical Modification code. They were stratified into without abuse, tobacco use disorder (TUD), substance use disorder (SUD), alcohol use disorder (AUD) and drug use disorder (DUD).ResultsOf 3,631,507 AF hospitalizations, 852,110 (23.46%) had TUD, 1,851,170 (5.1%) had SUD, 155,681 (4.29%) had AUD and 42,667 (1.17%) had DUD. The prevalence of TUD, SUD, AUD, and DUD was substantially increased across all age groups, races, and gender during the study period. Female sex was associated with lower odds TUD, SUD, AUD, and DUD. Among AF hospitalizations, the black race was associated with higher odds of SUD, and DUD. The younger age group (18-35 years), male, Medicare/Medicaid as primary insurance, and lower socioeconomic status were associated with increased risk of both TUD and SUDs.ConclusionTUD and SUD among AF hospitalizations in the United States mainly affects males, younger individuals, white more than black, and those of lower socioeconomic status which demands for the development of preventive strategies to address multilevel influences.

The retrograde approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly contributed to the success rates of CTO PCI. It is usually performed in complex CTO lesions, in which the antegrade approach is not feasible or fails. In this article we discuss the steps to perform retrograde CTO PCI and its complications and success rates. Considering the moderate to high success rates of the retrograde approach in the hands of experienced operators and higher complication rates than antegrade only procedures, optimizing the safety of retrograde CTO PCI is of paramount importance. [ABSTRACT FROM AUTHOR]

Dual training in Interventional Cardiology (IC) with other cardiac subspecialties such as Advanced Heart Failure and Transplant Cardiology (AHFTC) and Critical Care Cardiology (CCC) is becoming a pathway for trainees to acquire a needed skill set to deliver comprehensive care for increasingly complex patients in the intensive care unit and catheterization laboratory settings. The makeup of these training pathways varies depending on several factors, with the resultant role of the specialist reflecting this reality. Herein, we review the merits to combined fellowship training for the Interventional Cardiologist, the ideal structure of programs to facilitate this, and how the faculty position for such a unique specialist can enhance a program. [ABSTRACT FROM AUTHOR]

• Patients in the cardiac intensive care unit have become increasingly complex and require multidisciplinary care. • There are limited and heterogeneous data on the role of multidisciplinary teams in acute cardiovascular care. • Further data on optimal leadership structure, training paradigms, staffing ratios, system-based logistics, and outcomes are needed. As cardiovascular care continues to advance and with an aging population with higher comorbidities, the epidemiology of the cardiac intensive care unit has undergone a paradigm shift. There has been increasing emphasis on the development of multidisciplinary teams (MDTs) for providing holistic care to complex critically ill patients, analogous to heart teams for chronic cardiovascular care. Outside of cardiovascular medicine, MDTs in critical care medicine focus on implementation of guideline-directed care, prevention of iatrogenic harm, communication with patients and families, point-of-care decision-making, and the development of care plans. MDTs in acute cardiovascular care include physicians from cardiovascular medicine, critical care medicine, interventional cardiology, cardiac surgery, and advanced heart failure, in addition to nonphysician team members. In this document, we seek to describe the changes in patients in the cardiac intensive care unit, health care delivery, composition, logistics, outcomes, training, and future directions for MDTs involved in acute cardiovascular care. As a part of the comprehensive review, we performed a scoping of concepts of MDTs, acute hospital care, and cardiovascular conditions and procedures. [ABSTRACT FROM AUTHOR]

• In patients receiving temporary MCS, anticoagulation is recommended to prevent device-related thromboembolism. • There are limited data on optimal anticoagulation strategies that balance the risk of bleeding and thrombosis. • The ideal anticoagulant should have short duration of action, reliability in monitoring and titration, and easy reversibility. Cardiogenic shock (CS) is a syndrome of low cardiac output resulting in critical end-organ hypoperfusion and hypoxia. The mainstay of management involves optimizing preload, afterload and contractility. In medically refractory cases, temporary percutaneous mechanical support (MCS) is used as a bridge to recovery, surgical ventricular assist device, or transplant. Anticoagulation is recommended to prevent device-related thromboembolism. However, MCS can be fraught with hemorrhagic complications, compounded by incident multisystem organ failure often complicating CS. Currently, there are limited data on optimal anticoagulation strategies that balance the risk of bleeding and thrombosis, with most centers adopting local antithrombotic stewardship practices. In this review, we detail anticoagulation protocols, including anticoagulation agents, therapeutic monitoring, and complication mitigation in CS requiring MCS. This review is intended to provide an evidence-based framework in this population at high risk for in-hospital bleeding and mortality. [Display omitted] [ABSTRACT FROM AUTHOR]

Cardiogenic shock (CS) is a hemodynamic syndrome that can progress to systemic metabolic derangements and end-organ dysfunction. Prior studies have reported hemodynamic parameters at the time of admission to be associated with mortality but hemodynamic trajectories in CS have not been well described. We studied the association between hemodynamic profiles and their trajectories and in-hospital mortality in patients with CS due to heart failure (HF-CS) and acute myocardial infarction (MI-CS). Using data from the large multicenter Cardiogenic Shock Working Group (CSWG) registry, we analyzed hemodynamic data obtained at the time of pulmonary artery catheter (PAC) insertion (dataset at baseline) and at PAC removal or death (dataset at final time point). Univariable regression analyses for prediction of in-hospital mortality were conducted for baseline and final hemodynamic values, as well as the interval change (delta-P). Data was further analyzed based on CS etiology and survival status. A total of 2260 patients with PAC data were included (70% male, age 61 ± 14 years, 61% HF-CS, 27% MI-CS). In-hospital mortality was higher in the MI-CS group (40.1%) compared with HF-CS (22.4%, P <.01). In the HF-CS cohort, survivors exhibited lower right atrial pressure (RAP), pulmonary artery pressure (PAP), cardiac output/index (CO/CI), lactate, and higher blood pressure (BP) than nonsurvivors at baseline. In this cohort, during hospitalization, improvement in metabolic (aspartate transaminase, lactate), BP, hemodynamic (RAP, pulmonary artery pulsatility index [PAPi], pulmonary artery compliance for right-sided profile and CO/CI for left-sided profile), had association with survival. In the MI-CS cohort, a lower systolic BP and higher PAP at baseline were associated with odds of death. Improvement in metabolic (lactate), BP, hemodynamic (RAP, PAPi for right-sided profile and CO/CI for left-sided profile) were associated with survival. In a large contemporary CS registry, hemodynamic trajectories had a strong association with short-term outcomes in both cohorts. These findings suggest the clinical importance of timing and monitoring hemodynamic trajectories to tailor management in patients with CS. • Baseline hemodynamics impact mortality in HF-CS more so than MI-CS. • Hemodynamics indicative of end-organ perfusion and congestion have distinct trajectories between survivors and non-survivors in CS. • Hemodynamic trajectories have strong association with hospital outcomes in both HF- and MI-CS • Changes in hemodynamics should be closely monitored to tailor management practices in CS [ABSTRACT FROM AUTHOR]

In the past, medical museums played a significant role in anatomy and pathology training. The attraction of medical museums has declined recently due to the emergence of information technology and innovative medical curricula. An innovative mobile learning platform has been developed using quick response (QR) codes for the museum specimens at the Lee Kong Chain School of Medicine, Singapore. High-quality images of the potted specimens were captured and combined into an album and a video using Adobe Acrobat Pro 9 and Windows Movie Maker, respectively. Subsequently, QR codes were generated linking to PDF documents with annotations, pathology, and clinical history concerning the specimens. Quick response codes were piloted in gastrointestinal teaching module for Year 2 medical students. Survey responses were obtained from students to verify the efficacy of QR as a learning tool. The majority of students either agreed or strongly agreed that it was easy to access the information about the specimen with QR codes (4.47 ± 0.84), while 96% of students agreed that they are able to correlate the specimen with the annotated images (4.56 ± 0.56). The majority of students (78%) agreed that QR codes are useful for their learning (4.22 ± 0.87), while 75% of students felt QR codes motivate them to visit Anatomy Resource Centre. Most of the students agreed that QR codes are useful for revision of materials (4.13 ± 1.07) and independent learning (4.38 ± 0.87). These findings suggest that QR codes are not only effective for students learning but also enhance their exploration experience with the museum specimens.

Previous studies have identified a moderate association between acute kidney injury (AKI) requiring renal replacement therapy (RRT) and the risk of death from cardiogenic shock (CS). The magnitude of this association may be underestimated due to immortal time bias: patients who receive RRT cannot have died prior to RRT, yet this time is often misclassified as at-risk time. We sought to re-estimate the RRT association with CS mortality using methods to account for immortal time bias. We analyzed all patients hospitalized with CS at a major referral center between 2015 and 2022 who met criteria for SCAI stage B to E CS. RRT was treated as a time-varying exposure in multivariable Cox proportional hazard models to account for immortal time bias, and these estimates were compared to the standard risk ratio and to models treating RRT as a fixed exposure. 1162 patients with CS (27% AMI; 73% ADHF) were included, of whom 379 (33%) died in-hospital, 193 (17%) required new RRT, 31% female, and 22% non-white. The median time to RRT was 10 days from admission (interquartile range 3 to 14). RRT was strongly associated with mortality in univariate models and after adjustment for age, sex, cardiac index, right atrial pressure, inotrope dose, and presence of mechanical circulatory support (adjusted hazard ratio [aHR] 2.2 (95% CI 1.5-3.1), p<0.001). By comparison, the relative risk of death was only 1.65 (95% CI 1.4-2.0), consistent with previously reported estimates, and Cox models with RRT as a fixed variable falsely showed no association with mortality (aHR 1.1 [95% CI 0.7-1.6], p=0.72). RRT is a significant risk factor for CS mortality. The magnitude of this association is even more pronounced when accounting for immortal time bias. Severe AKI requiring RRT likely indicates the convergence of prominent hemodynamic, neurohormonal, and metabolic derangements that directly impact CS mortality. [ABSTRACT FROM AUTHOR]

A 36-year-old pregnant woman with a prior history of depression and recent gunshot wounds presented with sudden deterioration in her mental status. Clinical examination revealed psychosis, hallucinations, and lack of orientation, with an otherwise normal neurological and cardiorespiratory examination. Computed tomographic scan of her head was normal, and she was diagnosed with acute psychosis and excited delirium. She did not respond to supraphysiologic dosages of antipsychotic therapy and needed physical restraints for combativeness and agitation. Her cerebrospinal fluid analysis was negative for an infectious etiology, but was positive for anti-N-methyl-D-aspartate receptor encephalitis antibodies. Abdominal imaging revealed a right-sided ovarian cyst. Subsequently she underwent right-sided oophorectomy. Postoperatively the patient continued to have intermittent episodes of agitation requiring antipsychotic medications. Later, she was safely transitioned to home care with family support. [ABSTRACT FROM AUTHOR]

Cardiogenic shock (CS) is associated with high morbidity and mortality. In recent times, there is increasing interest in the role of angiotensin II in CS. We sought to systematically review the current literature on the use of angiotensin II in CS. PubMed, EMBASE, Medline, Web of Science, PubMed Central, and CINAHL databases were systematically searched for studies that evaluated the efficacy of angiotensin II in patients with CS during 01/01/2010–07/07/2022. Outcomes of interest included change in mean arterial pressure (MAP), vasoactive medication requirements (percent change in norepinephrine equivalent [NEE] dose), all-cause mortality, and adverse events. Of the total 2,402 search results, 15 studies comprising 195 patients were included of which 156 (80%) received angiotensin II. Eleven patients (84.6%) in case reports and case series with reported MAP data at hour 12 noted an increase in MAP. Two studies noted a positive hemodynamic response (defined a priori) in eight (88.9%) and five (35.7%) patients. Eight studies reported a reduction in NEE dose at hour 12 after angiotensin II administration and one study noted a 100% reduction in NEE dose. Out of 47 patients with documented information, 13 patients had adverse outcomes which included hepatic injury (2), digital ischemia (1), ischemic optic neuropathy (1), ischemic colitis (2), agitated delirium (1), and thrombotic events (2). In this first systematic review of angiotensin II in CS, we note the early clinical experience. Angiotensin II was associated with improvements in MAP, decrease in vasopressor requirements, and minimal reported adverse events. • Angiotensin II is used infrequently in cardiogenic shock and mixed shock. • Use of angiotensin II in mixed shock is associated with hemodynamic improvement. • Early experience demonstrated minimal side-effects to angiotensin II use. [ABSTRACT FROM AUTHOR]

Cardiac catheterization laboratory (CCL) morbidity and mortality conferences (MMCs) are a critical component of CCL quality improvement programs and are important for the education of cardiology trainees and the lifelong learning of CCL physicians and team members. Despite their fundamental role in the functioning of the CCL, no consensus exists on how CCL MMCs should identify and select cases for review, how they should be conducted, and how results should be used to improve CCL quality. In addition, medicolegal ramifications of CCL MMCs are not well understood. This document from the American College of Cardiology's Interventional Section attempts to clarify current issues and options in the conduct of CCL MMCs and to recommend best practices for their conduct. [Display omitted] • Most cardiac cath labs hold MMCs, but standards for their conduct have not been established. • This paper suggests best practices for MMCs to meet the needs of different types of cath labs. • Cath lab directors should review their morbidity and mortality processes to ensure protection from legal discovery. [ABSTRACT FROM AUTHOR]