All Publications

  • Large Language Models in Medicine: The Potentials and Pitfalls : A Narrative Review. Annals of internal medicine Omiye, J. A., Gui, H., Rezaei, S. J., Zou, J., Daneshjou, R. 2024


    Large language models (LLMs) are artificial intelligence models trained on vast text data to generate humanlike outputs. They have been applied to various tasks in health care, ranging from answering medical examination questions to generating clinical reports. With increasing institutional partnerships between companies producing LLMs and health systems, the real-world clinical application of these models is nearing realization. As these models gain traction, health care practitioners must understand what LLMs are, their development, their current and potential applications, and the associated pitfalls in a medical setting. This review, coupled with a tutorial, provides a comprehensive yet accessible overview of these areas with the aim of familiarizing health care professionals with the rapidly changing landscape of LLMs in medicine. Furthermore, the authors highlight active research areas in the field that promise to improve LLMs' usability in health care contexts.

    View details for DOI 10.7326/M23-2772

    View details for PubMedID 38285984

  • E=mc2 : Education (E), Medication (m), and Conditional Cash (c2 ) to Improve Uptake of Antiseizure Medications in a Low-Resource Population: Protocol for Randomized Trial. Epilepsia open Rezaei, S. J., Cissé, F. A., Touré, M. L., Duan, R., Rice, D. R., Ham, A. S., de Walque, D., Mateen, F. J. 2023


    Most people with epilepsy (PWE) could live seizure free if treated with one or more antiseizure medications (ASMs). The World Health Organization (WHO) estimates that 75% of PWE in low-resource settings lack adequate antiseizure treatment. Limited education surrounding epilepsy and the out-of-pocket costs of ASMs in particular pose barriers to managing epilepsy in resource-poor, low-income settings. The aim of this study is to implement and test a novel strategy to improve outcomes across the epilepsy care cascade marked by (1) retention in epilepsy care; (2) adherence to ASMs; and (3) seizure reduction, with the measured goal of seizure freedom.A randomized, double-blinded clinical trial will be performed, centered at the Ignace Deen Hospital in Conakry, Republic of Guinea, in Western Sub-Saharan Africa. Two hundred people with clinically diagnosed epilepsy, ages 18 years and above, will receive education on epilepsy and then be randomized to: (i) free ASMs versus (ii) conditional cash, conditioned upon return to epilepsy clinic. Participants will be followed for 360 days with study visits every 90 days following enrollment.We design a randomized trial for PWE in Guinea, a low-resource setting with a high proportion of untreated PWE and a nearly completely privatized healthcare system. The trial includes a conditional cash transfer intervention, which has yet to be tested as a targeted means to improve outcomes for people with a chronic neurological disorder. The trial aims to provide an evidence base for the treatment of epilepsy in such settings.

    View details for DOI 10.1002/epi4.12889

    View details for PubMedID 38131270

  • Perceptions of US-Based Muslim Patients of Their Dermatology Care. JAMA dermatology El-Banna, G., Rezaei, S. J., Chang, M., Merrell, S. B., Bailey, E. E., Kibbi, N. 2023


    Cultural humility training is of growing interest, yet the religious and cultural accommodations of Muslim patients in dermatology have not been studied.To explore the perceptions of Muslim patients of their dermatology care.This qualitative mixed-methods study, consisting of surveys and semistructured interviews, recruited participants from 2 clinical sites within a large academic health care system in California. Participants were adult, English-speaking, Muslim patients who were evaluated at least once by a medical or surgical dermatologist between January 2022 and January 2023.A survey obtained the following data: demographics, religious practices pertinent to dermatology care, and experiences of bias outside and inside the dermatology clinic. Semistructured interviews covered topics related to positive and negative experiences in the dermatology clinic, accommodation of cultural and religious needs in dermatology, and future interventions.A total of 21 patients (mean [SD] age, 36.4 [11.6] years; range, 26-71 years) participated in the study: 5 male individuals (24%) and 16 female individuals (76%), including 10 female individuals who wore hijab. Eleven participants identified as Middle Eastern (52%), 8 as South Asian (38%), 1 as North African (5%), and 1 as Pacific Islander (5%). Survey results showed variations in the impact of Islamic practices on dermatology care. Interviews showed that Muslim participants did not perceive dermatology care as a priority and expressed interest in community events focused on general dermatology education. They also experienced stigmatization of their skin disease and cosmetic care. Prior experiences with Islamophobia and colorism hindered the Muslim patient-dermatologist relationship and disclosure of the need for accommodations. There were instances when participants experienced bias and poor cultural humility from dermatologists. Finally, Muslim participants had unique religious and cultural needs pertinent to their care, including clinician gender concordance, medication timing adjustment while fasting, and halal medication ingredients.This qualitative mixed-methods study explored the experiences of Muslim patients in dermatology in the US. Recommendations supported by this study include incorporating religion into cultural humility training, increasing diversity in the dermatology workforce, implementing policies for clearer medication labeling, supporting dermatology research in subpopulations of Muslim individuals in the US, and partnering with community organizations for dermatology education.

    View details for DOI 10.1001/jamadermatol.2023.4439

    View details for PubMedID 37966806

    View details for PubMedCentralID PMC10652213

  • The Current State of Transgender Health Curricula in Graduate Surgical Education: A Systematic Review of Survey Data. Journal of surgical education Rezaei, S. J., Miranda, N., Bene, N. C., Ganor, O. 2023


    Transgender and gender diverse (TGD) individuals in the U.S. face significant healthcare disparities, which can be further exacerbated by providers' unfamiliarity with this population's specific needs. ACGME currently does not have requirements for gender-affirming surgery (GAS) in the residency programs of surgical specialties that are responsible for providing this care. This systematic review evaluates gender-affirming care (GAC) and GAS training in surgical residency programs in the U.S. through the analysis of survey respondent data.Six databases (PubMed, Embase, Web of Science and Scopus, Cochrane Library and Google Scholar) were searched in December 2022 and May 2023. The search process ultimately yielded 22 survey-based studies, published between 2015 and 2023, with responses from 3020 respondents (2582 trainees and/or attending physicians, 438 program directors).Six different surgical specialties were the focus of included studies, and common questions revolved around GAS training availability, comfort in treating TGD patients, and the importance of GAS in graduate surgical education (GSE). Less than half of trainees indicated that they received some form of previous GAC or GAS training, and less than half of program directors indicated that their residency or fellowship program offered such training.While comfort levels around treating TGD patients ranged, the studies indicated an overall perceived importance of GAS training. These findings highlight the need to incorporate GAS training into graduate surgical education to improve access to and quality of care for TGD patients.

    View details for DOI 10.1016/j.jsurg.2023.08.007

    View details for PubMedID 37658003

  • Health literacy and transmasculine procedures: A readability analysis of patient-centered online resources. Journal of plastic, reconstructive & aesthetic surgery : JPRAS Rezaei, S. J., Miller, A. S., Ganor, O. 2023; 85: 92-94

    View details for DOI 10.1016/j.bjps.2023.06.064

    View details for PubMedID 37473645

  • Body mass index and benign breast surgeries: A survey of plastic surgeons' knowledge and attitudes. JPRAS open Rezaei, S. J., Boskey, E. R., Ganor, O. 2023; 36: 46-54


    Background: The academic literature has not arrived at a consensus on the importance of body mass index (BMI) as an indicator of surgical feasibility and risk. This study evaluates board-certified plastic surgeons' and trainees' knowledge, experiences, and concerns around performing benign breast surgeries in high-BMI patients.Methods: An online survey instrument was developed and shared with plastic surgeons and plastic surgery trainees from December 2021 to January 2022.Results: There were 30 respondents (18 from Israel, 11 from the United States, and 1 from Turkey). For respondents who had BMI guidelines for performing benign breast surgeries, the median maximum BMI was 35 for all procedures. Most respondents supported or strongly supported their BMI guidelines.The majority of respondents indicated that they tended to have less training and experience in performing benign breast surgeries on high-BMI patients compared to those with BMI <30. Most respondents indicated that they were less satisfied with the results of these procedures on high-BMI patients compared to those with BMI <30. The median post-operation recovery time was indicated to be similar for high-BMI patients compared to those with BMI <30 across all procedures; however, the postoperative complication rate was indicated as higher.Conclusions: Respondents indicated that the risks of complication, more frequent need for surgical revisions, and unsatisfactory outcomes were their greatest concerns when conducting chest surgeries among high-BMI patients. Given that most surgeons practice in settings where high-BMI patients are excluded from procedure access, further research is needed to assess the extent to which these concerns reflect actual outcome differences.

    View details for DOI 10.1016/j.jpra.2023.02.001

    View details for PubMedID 37102187

  • The effect of activity and face masks on exhaled particles in children. Pediatric investigation Moschovis, P. P., Lombay, J., Rooney, J., Schenkel, S. R., Singh, D., Rezaei, S. J., Salo, N., Gong, A., Yonker, L. M., Shah, J., Hayden, D., Hibberd, P. L., Demokritou, P., Kinane, T. B. 2023; 7 (2): 75-85


    Despite the high burden of respiratory infections among children, the production of exhaled particles during common activities and the efficacy of face masks in children have not been sufficiently studied.To determine the effect of type of activity and mask usage on exhaled particle production in children.Healthy children were asked to perform activities that ranged in intensity (breathing quietly, speaking, singing, coughing, and sneezing) while wearing no mask, a cloth mask, or a surgical mask. The concentration and size of exhaled particles were assessed during each activity.Twenty-three children were enrolled in the study. Average exhaled particle concentration increased by intensity of activity, with the lowest particle concentration during tidal breathing (1.285 particles/cm3 [95% CI 0.943, 1.627]) and highest particle concentration during sneezing (5.183 particles/cm3 [95% CI 1.911, 8.455]). High-intensity activities were associated with an increase primarily in the respirable size (≤ 5 µm) particle fraction. Surgical and cloth masks were associated with lower average particle concentration compared to no mask (P = 0.026 for sneezing). Surgical masks outperformed cloth masks across all activities, especially within the respirable size fraction. In a multivariable linear regression model, we observed significant effect modification of activity by age and by mask type.Similar to adults, children produce exhaled particles that vary in size and concentration across a range of activities. Production of respirable size fraction particles (≤ 5 µm), the dominant mode of transmission of many respiratory viruses, increases significantly with coughing and sneezing and is most effectively reduced by wearing surgical face masks.

    View details for DOI 10.1002/ped4.12376

    View details for PubMedID 37324601

    View details for PubMedCentralID PMC10262878

  • Streamlining Interstate Access to Gender-Affirming Surgeries. JAMA Rezaei, S. J., Ganor, O. 2023

    View details for DOI 10.1001/jama.2022.24805

    View details for PubMedID 36780199

  • Conditional cash transfers to improve health-focused outcomes: a global scoping review. Global public health Rezaei, S. J., de Walque, D., Mateen, F. J. 2022: 1-18


    This scoping review assesses the use of conditional cash transfer (CCT) interventions - direct distribution of money to individuals conditional on their compliance to certain requirements - in randomised controlled trials, quasi-experimental studies and large community-based randomised trials with health-focused outcomes. Five databases were searched to identify 68 records published 2004-2021 from 25 countries (8 low- (32%), 5 lower middle- (20%), 6 upper middle- (24%) and 6 high-income (24%), according to the World Bank Categorisation (2017). Forty-six studies were unique (after excluding multiple publications on a single study). The most common outcomes assessed were infectious diseases (30%); maternal health (24%); vaccination rates (17%); and childhood developmental measures (17%). The number of participants receiving CCT in each study ranged from 47 to 5,788, with a median of 487 individuals. The number of total participants ranged from 72 to 14,000, with a median of 1,289 individuals. Fifteen percent of studies involved mobile CCT disbursement. More than a quarter of payments were greater than 50 USD (29%), and most payments were 20 USD or less (58%). Seventy-eight percent of unique full-length studies reported statistically significant CCT effects. Although CCTs remain controversial, a growing evidence base is emerging for their potential impact in specific health conditions.

    View details for DOI 10.1080/17441692.2022.2092186

    View details for PubMedID 35727705

  • The great recession and job loss spillovers: impact of tradable employment shocks on supporting services. The Annals of regional science Nguyen, H., Rezaei, S., Agarwal, D. 1800: 1-27


    This paper explores the spillover effects of job losses via input-output linkages during the Great Recession. Exploiting exogenous variation in tradable employment shocks across US counties, the paper finds that job losses in a county's tradable industries cause further job losses in the county's supporting services. A 10% exogenous decline in tradable employment reduces supporting industries' employment by 3.1%. In addition, a county's regional supporting services are relatively less affected by its tradable job losses than its local supporting services, reinforcing the argument that the spillovers are due to input-output linkages.

    View details for DOI 10.1007/s00168-021-01104-8

    View details for PubMedID 35068666

  • Encephalitis and meningitis in Western Africa: a scoping review of pathogens. Tropical medicine & international health : TM & IH Rezaei, S. J., Mateen, F. J. 2021; 26 (4): 388-396


    To give an overview of the recently reported literature on the aetiologies of meningitis and encephalitis in western sub-Saharan Africa.We conducted a scoping review following PRISMA guidance on published meningitis and encephalitis cases in the 16 countries of the United Nations-defined western sub-Saharan African region as identified in cohort studies, case series, and case reports, published 01/01/2000-08/01/2020, and available in four databases in August 2020 with an abstract in English, French or Italian.There were 38 distinct pathogens identified from 91 cohort studies' data and 48 case reports or case series' data. In cohort-level data, the majority of cases were caused by Neisseria meningitidis (71.5%), Streptococcus pneumoniae (17.6%) and Haemophilus influenzae (7.3%). In case report- and case series-level data, 40.5% of patients were <18 years old, 28.6% were female, and 28.6% were known to be immunocompromised. The case fatality rate was 39.3%. The most commonly reported pathogens among immunocompetent patients were Salmonella species (13 cases) and Ebola virus (9 cases), and the most commonly reported pathogen among immunocompromised patients was Cryptococcus neoformans (18 cases). Most cohort cases (52.3%) derived from Niger followed by Burkina Faso (28.6%). Most cases from single reports or series were reported from Nigeria (21.4%), Mali (20.2%) and Burkina Faso (19.0%).Given the small number of pathogens reported, our findings underscore the need to better screen, diagnose and monitor populations in western sub-Saharan Africa for additional CNS pathogens, including those posing significant outbreak risks.

    View details for DOI 10.1111/tmi.13539

    View details for PubMedID 33340211

  • Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach. Gates open research Rezaei, S., Sakadi, F., Hiew, F. L., Rodriguez-Leyva, I., Kruja, J., Wasay, M., Seidi, O. A., Abdel-Aziz, S., Nafissi, S., Mateen, F. 2021; 5: 178


    Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person's country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.

    View details for DOI 10.12688/gatesopenres.13447.2

    View details for PubMedID 35299829

    View details for PubMedCentralID PMC8901583.2

  • Impact of COVID-19 on U.S. and Canadian neurologists' therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices. Journal of neurology Mateen, F. J., Rezaei, S., Alakel, N., Gazdag, B., Kumar, A. R., Vogel, A. 2020; 267 (12): 3467-3475


    To report the understanding and decision-making of neuroimmunologists and their treatment of patients with multiple sclerosis (MS) during the early stages of the SARS-CoV-2 (COVID-19) outbreak.A survey instrument was designed and distributed online to neurologists in April 2020.There were 250 respondents (response rate 21.8%). 243 saw >  = 10 MS patients in the prior 6 months (average 197 patients) and were analyzed further (92% USA, 8% Canada; average practice duration 16 years; 5% rural, 17% small city, 38% large city, 40% highly urbanized). Patient volume dropped an average of 79% (53-11 per month). 23% were aware of patients self-discontinuing a DMT due to fear of COVID-19 with 43% estimated to be doing so against medical advice. 65% of respondents reported deferring >  = 1 doses of a DMT (49%), changing the dosing interval (34%), changing to home infusions (20%), switching a DMT (9%), and discontinuing DMTs altogether (8%) as a result of COVID-19. Changes in DMTs were most common with the high-efficacy therapies alemtuzumab, cladribine, ocrelizumab, rituximab, and natalizumab. 35% made no changes to DMT prescribing. 98% expressed worry about their patients contracting COVID-19 and 78% expressed the same degree of worry about themselves.  > 50% believed high-efficacy DMTs prolong viral shedding of SARS-CoV-2 and that B-cell therapies might prevent protective vaccine effects. Accelerated pace of telemedicine and practice model changes were identified as major shifts in practice.Reported prescribing changes and practice disruptions due to COVID-19 may be temporary but could have a lasting influence on MS care.

    View details for DOI 10.1007/s00415-020-10045-9

    View details for PubMedID 32638107

    View details for PubMedCentralID PMC7339100

  • Neuromyelitis optica practice and prescribing changes in the setting of Covid19: A survey of neurologists. Journal of neuroimmunology Rezaei, S. J., Vogel, A. C., Gazdag, B., Alakel, N., Kumar, A. R., Mateen, F. J. 2020; 346: 577320


    This study reports and analyzes the findings from the responses of 192 neurologists in the United States and Canada to a new survey instrument distributed in April 2020 to assess NMO practice and prescribing changes during the Covid19 pandemic.92% of responding neurologists considered their NMO patients to be at an elevated risk of acquiring Covid19. They also indicated sharp declines in visits, delays in treatment and related services, and several unmet needs deterring treatment.There is a need for evidence-based, comprehensive guidelines for treating NMO patients amid healthcare crises moving forward.

    View details for DOI 10.1016/j.jneuroim.2020.577320

    View details for PubMedID 32682142

    View details for PubMedCentralID PMC7351672