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Shoval DH, Gigi K, Haber Y, Itzhaki A, Asraf K, Piterman D, Elyoseph Z. A controlled trial examining large Language model conformity in psychiatric assessment using the Asch paradigm. BMC Psychiatry 2025; 25:478. [PMID: 40355854 PMCID: PMC12070653 DOI: 10.1186/s12888-025-06912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Accepted: 04/25/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Despite significant advances in AI-driven medical diagnostics, the integration of large language models (LLMs) into psychiatric practice presents unique challenges. While LLMs demonstrate high accuracy in controlled settings, their performance in collaborative clinical environments remains unclear. This study examined whether LLMs exhibit conformity behavior under social pressure across different diagnostic certainty levels, with a particular focus on psychiatric assessment. METHODS Using an adapted Asch paradigm, we conducted a controlled trial examining GPT-4o's performance across three domains representing increasing levels of diagnostic uncertainty: circle similarity judgments (high certainty), brain tumor identification (intermediate certainty), and psychiatric assessment using children's drawings (high uncertainty). The study employed a 3 × 3 factorial design with three pressure conditions: no pressure, full pressure (five consecutive incorrect peer responses), and partial pressure (mixed correct and incorrect peer responses). We conducted 10 trials per condition combination (90 total observations), using standardized prompts and multiple-choice responses. The binomial test and chi-square analyses assessed performance differences across conditions. RESULTS Under no pressure, GPT-4o achieved 100% accuracy across all domains. Under full pressure, accuracy declined systematically with increasing diagnostic uncertainty: 50% in circle recognition, 40% in tumor identification, and 0% in psychiatric assessment. Partial pressure showed a similar pattern, with maintained accuracy in basic tasks (80% in circle recognition, 100% in tumor identification) but complete failure in psychiatric assessment (0%). All differences between no pressure and pressure conditions were statistically significant (P <.05), with the most severe effects observed in psychiatric assessment (χ²₁=16.20, P <.001). CONCLUSIONS This study reveals that LLMs exhibit conformity patterns that intensify with diagnostic uncertainty, culminating in complete performance failure in psychiatric assessment under social pressure. These findings suggest that successful implementation of AI in psychiatry requires careful consideration of social dynamics and the inherent uncertainty in psychiatric diagnosis. Future research should validate these findings across different AI systems and diagnostic tools while developing strategies to maintain AI independence in clinical settings. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Dorit Hadar Shoval
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, Max Stern Yezreel Valley College, Yezreel Valley, Israel.
- The Institute for Research and Development, The Artificial Third, Tel Aviv, Israel.
| | - Karny Gigi
- The Institute for Research and Development, The Artificial Third, Tel Aviv, Israel
| | - Yuval Haber
- The Institute for Research and Development, The Artificial Third, Tel Aviv, Israel
- The PhD Program of Hermeneutics & Cultural Studies, Interdisciplinary Unit, Bar-Ilan University, Ramat Gan, Israel
| | - Amir Itzhaki
- The Institute for Research and Development, The Artificial Third, Tel Aviv, Israel
- At time of research: Senior at Hakfar Hayarok High School, Ramat HaSharon, Israel
| | - Kfir Asraf
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - David Piterman
- Faculty of Education, School of Therapy, Counseling, and Human Development, University of Haifa, Haifa, Israel
| | - Zohar Elyoseph
- The Institute for Research and Development, The Artificial Third, Tel Aviv, Israel
- Faculty of Education, School of Therapy, Counseling, and Human Development, University of Haifa, Haifa, Israel
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Vosoughi F, Menbari Oskouie I, Rahimdoost N, Pesantez R. Decoding tibial plateau fracture classifications: a century of individualized insights in a systematic review. EFORT Open Rev 2025; 10:316-326. [PMID: 40326555 PMCID: PMC12061015 DOI: 10.1530/eor-2024-0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2025] Open
Abstract
Purpose We conducted a systematic review of all proposed classifications of tibial plateau fractures (TPFs) to facilitate comparison and identify the most effective reduction methods. Methods PubMed, Scopus, Embase, Web of Science and Cochrane Library databases were searched for all the articles involving the suggestion of a new method of TPF classification. The descriptions of classifications, along with their suggested management strategies, were recorded. Results Out of the 2,712 identified records, 69 were included in the study. Schatzker's and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications were the most frequently mentioned in the literature. The concept of a 'column' and posterior column fractures were introduced in 2010. Following this, posterior plateau fractures were further divided into posteromedial and posterolateral fractures. Proposed treatment approaches in most studies were based on the involved region and degree of displacement, while others considered fracture plane, deformity direction and type of fracture. The latest developments include the subclassification of the posterolateral column and consideration of associated injuries to the fibular head, eminentia, extensor mechanism and mechanical derangements along with the concept of the main deformity direction. Conclusion The understanding of TPF patterns, associated injuries, surgical approaches and fixation methods has evolved in a compelling stepwise manner. Currently, there is no gold standard classification that addresses fracture configuration, soft-tissue injuries, principal direction of deformity, central eminence avulsions, extensor mechanism disruptions and mechanical derangements, while maintaining a simple and reliable categorization. Therefore, employing individualized classification systems remains the most logical approach at present. This study offers invaluable assistance in this regard.
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Affiliation(s)
- Fardis Vosoughi
- Department of Orthopaedics and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nazanin Rahimdoost
- Department of Orthopaedics and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rodrigo Pesantez
- Department of Orthopedic Surgery, Fundación Santa Fe de Bogota, Universidad de Los Andes School of Medicine, Bogota, Colombia
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Menbari Oskouie I, Hakiminejad A, Yazdanmehr A, Mostafavi K, Mafhoumi A, Sajedi AH, Roosta A, Arvin A, Presedo A, Nabian MH, Kasaeian A. Radiological outcomes of surgical techniques for spastic hip in cerebral palsy: a systematic review and meta-analysis. J Orthop Traumatol 2025; 26:13. [DOI: https:/doi.org/10.1186/s10195-025-00827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 02/05/2025] [Indexed: 05/13/2025] Open
Abstract
Abstract
Background
In patients with cerebral palsy (CP), spastic hip is a prevalent complication. Various surgical approaches,, including pelvic osteotomy (PO), femoral osteotomy (FO), combined femoral and pelvic osteotomy (CFPO), and soft tissue surgery (STS), have been used to address this problem. This systematic review and meta-analysis was designed to compare the radiologic outcomes of these interventions for spastic hip in patients with CP.
Methods
To identify relevant studies, databases were searched using specific keywords. Initially, duplicates were removed, then the titles and abstracts were screened, followed by a comprehensive full-text review. Data extraction took place from the studies that met the inclusion criteria. Subsequently, a meta-analysis was conducted.
Results
The analysis of 6116 hips from 4546 patients across 81 studies demonstrated that PO significantly enhanced the center–edge angle (CEA), reduced the acetabular index (AI) and migration percentage (MP), and improved the Sharp and Tönnis angles. FO led to a substantial decrease in AI and MP, though CEA did not show a significant change, while CFPO resulted in significant improvements across AI, MP, neck-shaft angle (NSA), CEA, Sharp angle, and Tönnis angle. STS did not show significant changes in AI or CEA, but MP was notably reduced. Tone-decreasing procedures, such as selective dorsal rhizotomy and botulinum toxin injections, did not significantly alter MP, whereas guided growth techniques showed a significant reduction. MP improvements in FO decreased over time, with other radiologic parameters remaining relatively stable as follow-up increased. Age-specific trends indicated that children under 6 years primarily underwent tone-decreasing procedures and STS, while those around 7 years favored FO and guided growth, and older children (over 9 years) more commonly underwent PO, CFPO, or percutaneous osteotomy. Comparative analysis showed PO and percutaneous osteotomy were particularly more effective in reducing MP, with PO also being superior for AI improvement; whereas CFPO provided better outcomes for enhancing CEA. No significant differences were found among surgical methods for improving NSA.
Conclusions
This systematic review and meta-analysis underscores the superior efficacy of PO and CFPO in correcting spastic hip deformity in children with CP. Radiological outcomes demonstrate significant improvements following these procedures. The findings suggest that these approaches are particularly effective for complex cases where procedures such as FO, STS, or TDS may fall short. Future studies should focus on refining surgical protocols and exploring the long-term functional outcomes of these interventions.
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Menbari Oskouie I, Hakiminejad A, Yazdanmehr A, Mostafavi K, Mafhoumi A, Sajedi AH, Roosta A, Arvin A, Presedo A, Nabian MH, Kasaeian A. Radiological outcomes of surgical techniques for spastic hip in cerebral palsy: a systematic review and meta-analysis. J Orthop Traumatol 2025; 26:13. [PMID: 40021534 PMCID: PMC11871257 DOI: 10.1186/s10195-025-00827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 02/05/2025] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND In patients with cerebral palsy (CP), spastic hip is a prevalent complication. Various surgical approaches,, including pelvic osteotomy (PO), femoral osteotomy (FO), combined femoral and pelvic osteotomy (CFPO), and soft tissue surgery (STS), have been used to address this problem. This systematic review and meta-analysis was designed to compare the radiologic outcomes of these interventions for spastic hip in patients with CP. METHODS To identify relevant studies, databases were searched using specific keywords. Initially, duplicates were removed, then the titles and abstracts were screened, followed by a comprehensive full-text review. Data extraction took place from the studies that met the inclusion criteria. Subsequently, a meta-analysis was conducted. RESULTS The analysis of 6116 hips from 4546 patients across 81 studies demonstrated that PO significantly enhanced the center-edge angle (CEA), reduced the acetabular index (AI) and migration percentage (MP), and improved the Sharp and Tönnis angles. FO led to a substantial decrease in AI and MP, though CEA did not show a significant change, while CFPO resulted in significant improvements across AI, MP, neck-shaft angle (NSA), CEA, Sharp angle, and Tönnis angle. STS did not show significant changes in AI or CEA, but MP was notably reduced. Tone-decreasing procedures, such as selective dorsal rhizotomy and botulinum toxin injections, did not significantly alter MP, whereas guided growth techniques showed a significant reduction. MP improvements in FO decreased over time, with other radiologic parameters remaining relatively stable as follow-up increased. Age-specific trends indicated that children under 6 years primarily underwent tone-decreasing procedures and STS, while those around 7 years favored FO and guided growth, and older children (over 9 years) more commonly underwent PO, CFPO, or percutaneous osteotomy. Comparative analysis showed PO and percutaneous osteotomy were particularly more effective in reducing MP, with PO also being superior for AI improvement; whereas CFPO provided better outcomes for enhancing CEA. No significant differences were found among surgical methods for improving NSA. CONCLUSIONS This systematic review and meta-analysis underscores the superior efficacy of PO and CFPO in correcting spastic hip deformity in children with CP. Radiological outcomes demonstrate significant improvements following these procedures. The findings suggest that these approaches are particularly effective for complex cases where procedures such as FO, STS, or TDS may fall short. Future studies should focus on refining surgical protocols and exploring the long-term functional outcomes of these interventions.
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Affiliation(s)
| | - Alireza Hakiminejad
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amirali Yazdanmehr
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Keihan Mostafavi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Asma Mafhoumi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir H Sajedi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Ali Roosta
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Alireza Arvin
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ana Presedo
- Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amir Kasaeian
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Chronic Inflammatory Diseases, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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