//www.igerbera.com/journals/jamainternalmedicine en - us 星期五,2023年4月28日格林尼治时间就是 Fri, 28 Apr 2023 11:43:47 GMT Silverchair jamams@jamanetwork.org support@www.igerbera.com //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804310 星期五,2023年4月28日格林尼治时间就是 In an era of clinicians being burnt out by electronic medical records and documentation burdens, we might all dream of having a personal scribe to draft progress notes, translate patient instructions, summarize the literature, complete insurance authorization paperwork, and respond to unending in-basket messages, as described in the Perspective in this issue of JAMA Internal Medicine. This would have sounded like a fantasy just a few years ago, but the release of rapidly developing chatbots now demonstrates the potential of large language model artificial intelligence (AI) systems with surprisingly adept language manipulation and knowledge processing capabilities. The underlying foundation model technology rides atop the peak of inflated expectations, reflecting a disruptive technology likely to change the way we work and live, even as we must be aware of substantial limitations. Good or bad, ready or not, Pandora’s box has already been opened. One such large language model, ChatGPT, is the fastest-growing internet application in history with more than 100 million users. This has shifted access to sophisticated AI capabilities away from concentrated pockets of technical experts to the masses, where all types of otherwise unimaginable (and unintended) use cases are being discovered. To ensure that the adoption of such tools into health care practice is done effectively and responsibly, physicians must lean in to understand and drive this conversation. 10.1001/jamainternmed.2023.1835 2804310 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804309 星期五,2023年4月28日格林尼治时间就是 This cross-sectional study evaluates the ability of an artificial intelligent chatbot to provide quality and empathetic responses to patient questions. 10.1001/jamainternmed.2023.1838 2804309 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804308 星期五,2023年4月28日格林尼治时间就是 This Perspective envisions a world where artificial intelligence is integrated into health care. 10.1001/jamainternmed.2023.1832 2804308 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804307 Mon, 24 Apr 2023 00:00:00 GMT This case report presents the electrocardiogram findings of a patient in their 90s with end-stage dementia, pressure ulcers, extrapyramidal syndrome, paroxysmal atrial fibrillation, and hypothyroidism who experienced a massive aspiration of gastric content. 10.1001/jamainternmed.2023.0298 2804307 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804306 Mon, 24 Apr 2023 00:00:00 GMT Ulyte和科尔eagues describe Medicare costs associated with the COVID-19–related public health emergency policies, specifically that waiving the requirement that use of the skilled nursing facility (SNF) benefit generally requires a 3-day prior hospital stay. They found substantial increases in use of the SNF benefit that were primarily associated with long-stay residents and largely during the early and worst of the pandemic. After large-scale COVID-19 vaccinations during the winter and spring of 2021, SNF benefit episodes not preceded by a 3-day hospital stay stabilized at low levels for new admissions and long-term care residents. 10.1001/jamainternmed.2023.0744 2804306 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804305 Mon, 24 Apr 2023 00:00:00 GMT This survey study describes the perceived implications of virtual-only recruitment and the preferred application process for residents and fellows. 10.1001/jamainternmed.2023.0281 2804305 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804304 Mon, 24 Apr 2023 00:00:00 GMT 给编辑博朗博士和他的同事们an interesting and well-documented case report of ST elevation in leads aVR and V1 with diffuse ST depression in inferior and lateral leads (II, III, aVF, V4 to V6). The case report is excellent; however, we would like to discuss the electrocardiogram (ECG) abnormality regarding its exclusion from the ST-segment elevation myocardial infarction (STEMI) equivalent category. 10.1001/jamainternmed.2023.1048 2804304 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804303 Mon, 24 Apr 2023 00:00:00 GMT To the Editor We read with interest the case report by Dr Brouner and colleagues. The authors described the case of a patient in their 50s who presented to the emergency department afebrile with signs of hemodynamic shock; results of an initial electrocardiogram (ECG) showed tachycardia with ST depression in inferior and lateral leads (II, III, aVF, V4 to V6) and ST elevation of 2 mm in leads aVR and V1. 10.1001/jamainternmed.2023.1051 2804303 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804302 Mon, 24 Apr 2023 00:00:00 GMT In Reply We would like to thank Dr Alsagaff and colleagues and Dr Di Pietro and colleagues for their thoughtful comments on our case report. We agree with Dr Alsagaff and colleagues that patients who present with ST elevation in lead aVR coupled with diffuse ST depression must have acute coronary syndrome (ACS) included in their differential diagnosis. In patients who present with symptoms consistent with coronary ischemia—regardless of the initial electrocardiogram (ECG) findings—one must be vigilant in determining appropriate next steps in management, including further investigation with coronary angiography in select patients. Given the association of this ECG pattern with an underlying ACS, it must be taken seriously in any circumstance, especially in patients with ischemic signs and symptoms. However, in patients whose clinical status may indicate a different underlying cause, one must consider the entire clinical context to determine how best to expedite care on an individualized level. 10.1001/jamainternmed.2023.1045 2804302 //www.igerbera.com/journals/jamainternalmedicine/fullarticle/2804301 Mon, 24 Apr 2023 00:00:00 GMT This cohort study examines whether skilled nursing facility (SNF) episode volume and Medicare spending on SNF care changed after introduction of the public health emergency waiver during the COVID-19 pandemic among long-term care residents and other Medicare beneficiaries. 10.1001/jamainternmed.2023.0770 2804301

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