Background The use of artificial intelligence (AI) is not a recent phenomenon, but the latest advancements in this technology are making a significant impact across various fields of human knowledge. In medicine, this trend is no different, although it has developed at a slower pace. ChatGPT is an example of an AI-based algorithm capable of answering questions, interpreting phrases, and synthesizing complex information, potentially aiding and even replacing humans in various areas of social interest. Some studies have compared its performance in solving medical knowledge exams with medical students and professionals to verify AI accuracy. This study aimed to measure the performance of ChatGPT in answering questions from the Progress Test from 2021 to 2023. Methodology An observational study was conducted in which questions from the 2021 Progress Test and the regional tests (Southern Institutional Pedagogical Support Center II) of 2022 and 2023 were presented to ChatGPT 3.5. The results obtained were compared with the scores of first- to sixth-year medical students from over 120 Brazilian universities. All questions were presented sequentially, without any modification to their structure. After each question was presented, the platform\'s history was cleared, and the site was restarted. Results The platform achieved an average accuracy rate in 2021, 2022, and 2023 of 69.7%, 68.3%, and 67.2%, respectively, surpassing students from all medical years in the three tests evaluated, reinforcing findings in the current literature. The subject with the best score for the AI was Public Health, with a mean grade of 77.8%. Conclusions ChatGPT demonstrated the ability to answer medical questions with higher accuracy than humans, including students from the last year of medical school.

The accelerated adoption of digital health technologies in the last decades has raised important ethical and safety concerns. Despite the potency and usefulness of digital health technologies, addressing safety, and ethical considerations needs to take greater prominence. This review paper focuses on ethical and safety facets, including health technology-related risks, users\' safety and well-being risks, security and privacy concerns, and risks to transparency and diminished accountability associated with the utilization of digital health technologies. In order to maximize the potential of health technology benefits, awareness of safety risks, and ethical concerns should be increased, and the use of appropriate strategies and measures should be considered.

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Artificial intelligence (AI) health technologies are increasingly available for use in real-world care. This emerging opportunity is accompanied by a need for decision makers and practitioners across healthcare systems to evaluate the safety and effectiveness of these interventions against the needs of their own setting. To meet this need, high-quality evidence regarding AI-enabled interventions must be made available, and decision makers in varying roles and settings must be empowered to evaluate that evidence within the context in which they work. This article summarizes good practices across four stages of evidence generation for AI health technologies: study design, study conduct, study reporting, and study appraisal.

BACKGROUND: The objective of this study was to compare the anastomotic leak rates between powered and manual circular staplers in elective left-sided colorectal resections.
METHODS: A retrospective cohort study of elective left-sided colorectal resections before and after implementation of a powered circular stapler at a tertiary care center was conducted. The manual stapler group consisted of consecutive resections performed between January 2016 to December 2016 and the powered stapler group, between September 2021 and December 2022. Primary outcome was 30-day anastomotic leak rate. A chi-squared analysis was performed to compare anastomotic leak rates. Factors associated with anastomotic leak were examined.
RESULTS: Two-hundred forty-seven patients were included: 154 in the manual stapler group and 93 in the powered stapler group. Mean (SD) age was 60 (15) years old, 37.7% were female and 72.9% of resections were performed for malignancy. Both groups had similar patient characteristics and surgical technique. Overall leak rate was 2.0% in the manual stapler group and 10.8% in the powered stapler group. The powered staplers were found to have 6.06 times the odds of leak compared to manual staplers (95% CI, 1.62-22.65; p = 0.01). None of the other factors were found to be associated with anastomotic leak.
CONCLUSIONS: Patients who had left-sided colorectal anastomosis had higher anastomotic leak rates with powered compared to manual circular staplers. This finding is contrary to previous retrospective studies that found lower leak rates with powered staplers.

BACKGROUND: The rapid advancement of technology-focused strategies in neurorehabilitation has brought optimism to individuals with neurological disorders, caregivers, and physicians while reshaping medical practice and training.
OBJECTIVE: We critically examine the implications of technology in neurorehabilitation, drawing on discussions from the 2021 and 2024 World Congress for NeuroRehabilitation. While acknowledging the value of technology, it highlights inherent limitations and ethical concerns, particularly regarding the potential overshadowing of humanistic approaches. The integration of technologies such as robotics, artificial intelligence, neuromodulation, and brain-computer interfaces enriches neurorehabilitation by offering interdisciplinary solutions. However, ethical considerations arise regarding the balance between compensation for deficits, accessibility of technologies, and their alignment with fundamental principles of care. Additionally, the pitfalls of relying solely on neuroimaging data are discussed, stressing the necessity for a more comprehensive understanding of individual variability and clinical skills in rehabilitation.
RESULTS: From a clinical perspective, the article advocates for realistic solutions that prioritize individual needs, quality of life, and social inclusion over technological allure. It underscores the importance of modesty and honesty in responding to expectations while emphasizing the uniqueness of each individual\'s experience. Moreover, it argues for the preservation of human-centric approaches alongside technological advancements, recognizing the invaluable role of clinical observation and human interaction in rehabilitation.
CONCLUSIONS: Ultimately, the article calls for a balanced attitude that integrates both scientific and humanistic perspectives in neurorehabilitation. It highlights the symbiotic relationship between the sciences and humanities, advocating for philosophical questioning to guide the ethical implementation of new technologies and foster interdisciplinary dialogue.

In 2014, Indonesia\'s Ministry of Health established the Indonesian Health Technology Assessment Committee (InaHTAC) to prioritize evidence-based health care technology for inclusion in the national health insurance benefits package. This commentary provides an overview of the current state of the health care technology supply landscape in Indonesia, as well as the impact of HTA studies on priority-setting decisions. Indonesia\'s decision-making process for health care technology approval and patient access involves multiple stakeholders and follows several evaluation principles. The licensing, inclusion, and evaluation of health care technology is complex and time consuming, however, requiring input from stakeholders with different roles and interests. Although efforts have been made to establish an HTA ecosystem by, for example, engaging in capacity-building activities and issuing guidelines, challenges remain, including a lack of infrastructure, financial resources, and technical capacity and inadequate stakeholder involvement. Additionally, the current position of the HTA unit, which is connected to the Ministry of Health (MOH), and political pressures from the pharmaceutical industry can result in delayed or ignored HTA recommendations. Therefore, the establishment of an independent and robust HTA body that can inform policy makers about health technology development, licensing, dissemination, and use, along with strong regulations to ensure harmonization and coordination among stakeholders, is necessary. This requires a step-by-step approach to address inadequate overall HTA resources.

BACKGROUND: Health care professionals receive little training on the digital technologies that their patients rely on. Consequently, practitioners may face significant barriers when providing care to patients experiencing digitally mediated harms (eg, medical device failures and cybersecurity exploits). Here, we explore the impact of technological failures in clinical terms.
OBJECTIVE: Our study explored the key challenges faced by frontline health care workers during digital events, identified gaps in clinical training and guidance, and proposes a set of recommendations for improving digital clinical practice.
METHODS: A qualitative study involving a 1-day workshop of 52 participants, internationally attended, with multistakeholder participation. Participants engaged in table-top exercises and group discussions focused on medical scenarios complicated by technology (eg, malfunctioning ventilators and malicious hacks on health care apps). Extensive notes from 5 scribes were retrospectively analyzed and a thematic analysis was performed to extract and synthesize data.
RESULTS: Clinicians reported novel forms of harm related to technology (eg, geofencing in domestic violence and errors related to interconnected fetal monitoring systems) and barriers impeding adverse event reporting (eg, time constraints and postmortem device disposal). Challenges to providing effective patient care included a lack of clinical suspicion of device failures, unfamiliarity with equipment, and an absence of digitally tailored clinical protocols. Participants agreed that cyberattacks should be classified as major incidents, with the repurposing of existing crisis resources. Treatment of patients was determined by the role technology played in clinical management, such that those reliant on potentially compromised laboratory or radiological facilities were prioritized.
CONCLUSIONS: Here, we have framed digital events through a clinical lens, described in terms of their end-point impact on the patient. In doing so, we have developed a series of recommendations for ensuring responses to digital events are tailored to clinical needs and center patient care.

Digital health technologies hold promises for reducing health care costs, enhancing access to care, and addressing labor shortages. However, they risk exacerbating inequalities by disproportionately benefitting a subset of the population. Use of digital technologies accelerated during the Covid-19 pandemic. Our scoping review aimed to describe how inequalities related to their use were conceptually assessed during and after the pandemic and understand how digital strategies and policies might support digital equity. We used the PRISMA Extension for scoping reviews, identifying 2055 papers through an initial search of 3 databases in 2021 and complementary search in 2022, of which 41 were retained. Analysis was guided by the eHealth equity framework. Results showed that digital inequalities were reported in the U.S. and other high-income countries and were mainly assessed through differences in access and use according to individual sociodemographic characteristics. Health disparities related to technology use and the interaction between context and technology implementation were more rarely documented. Policy recommendations stressed the adoption of an equity lens in strategy development and multilayered and intersectoral collaboration to align interventions with the needs of specific subgroups. Finally, findings suggested that evaluations of health and wellbeing distribution related to the use of digital technologies should inform digital strategies and health policies.

Public Health Emergencies (PHE) have had repercussions on health systems on a global scale, and timely access to new health technologies is a challenge for health policy. The national regulatory authorities (NRA) play a key role in the evaluation and regulation of these technologies. The present study aims to analyze the main strategies and regulatory instruments used to deal with the challenges of regulating new technologies necessary for the health system\'s effective response during a PHE. This research, based on WHO and Brazilian NRA norms and documents, considered dimensions related to strategies for strengthening regulatory activities and regulatory instruments used to accelerate access to technologies, especially during PHEs. International cooperation between the NRA and the WHO were important strategies for strengthening the NRA, with emphasis on the use of reliance, regionalization, accelerated assessments, and work/information sharing, as well as the processes of regulatory harmonization and convergence. In addition to the use of existing regulatory instruments, efforts were also identified in order to implement new ones.
As Emergências em Saúde Pública (ESP) têm repercutido nos sistemas de saúde em escala global. O acesso às novas tecnologias em saúde em tempo oportuno é um desafio para a política de saúde. As autoridades reguladoras nacionais (ARN) têm papel fundamental na avaliação e regulação dessas tecnologias. O estudo objetiva analisar as principais estratégias e instrumentos regulatórios utilizados para lidar com os desafios da regulação de novas tecnologias necessárias à resposta do sistema de saúde durante as ESP. Trata-se de uma pesquisa normativa e documental, tendo como fonte a OMS e a ARN brasileira. Foram consideradas as dimensões relacionadas às estratégias para o fortalecimento das atividades regulatórias e os instrumentos regulatórios utilizados para acelerar o acesso às tecnologias, especialmente durante as ESP. A cooperação e a colaboração internacional entre as ARN e com a OMS foram importantes estratégias para o fortalecimento das ARN, com destaque para o uso de confiança, regionalização, avaliações aceleradas e compartilhamento de trabalho/informações, bem como os processos de harmonização e convergência regulatória. Identificou-se, além da utilização de instrumentos regulatórios já existentes, esforços na implementação de novos, com destaque para Autorização de Uso Emergencial.