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Context: Whether venous catheterization at the femoral site is associated with an increased risk of complications compared with that at the subclavian site is debated.Objective: To compare mechanical, infectious, and thrombotic complications of femoral and subclavian venous catheterization.Design and Setting: Concealed, randomized controlled clinical trial conducted between December 1997 and July 2000 at 8 intensive care units (ICUs) in France.Patients: Two hundred eighty-nine adult patients receiving a first central venous catheter.Interventions: Patients were randomly assigned to undergo central venous catheterization at the femoral site (n = 145) or subclavian site (n = 144).Main Outcome Measures: Rate and severity of mechanical, infectious, and thrombotic complications, compared by catheterization site in 289, 270, and 223 patients, respectively.Results: Femoral catheterization was associated with a higher incidence rate of overall infectious complications (19.8% vs 4.5%; P<.001; incidence density of 20 vs 3.7 per 1000 catheter-days) and of major infectious complications (clinical sepsis with or without bloodstream infection, 4.4% vs 1.5%; P =.07; incidence density of 4.5 vs 1.2 per 1000 catheter-days), as well as of overall thrombotic complications (21.5% vs 1.9%; P<.001) and complete thrombosis of the vessel (6% vs 0%; P =.01); rates of overall and major mechanical complications were similar between the 2 groups (17.3% vs 18.8 %; P =.74 and 1.4% vs 2.8%; P =.44, respectively). Risk factors for mechanical complications were duration of insertion (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.08 per additional minute; P<.001); insertion in 2 of the centers (OR, 4.52; 95% CI, 1.81-11.23; P =.001); and insertion during the night (OR, 2.06; 95% CI, 1.04-4.08; P =.03). The only factor associated with infectious complications was femoral catheterization (hazard ratio [HR], 4.83; 95% CI, 1.96-11.93; P<.001); antibiotic administration via the catheter decreased risk of infectious complications (HR, 0.41; 95% CI, 0.18-0.93; P =.03). Femoral catheterization was the only risk factor for thrombotic complications (OR, 14.42; 95% CI, 3.33-62.57; P<.001).Conclusion: Femoral venous catheterization is associated with a greater risk of infectious and thrombotic complications than subclavian catheterization in ICU patients. [ABSTRACT FROM AUTHOR]

Objective: This study explores radiology program directors' perspectives on the impact of large language model (LLM) use among residency applicants to craft personal statements., Methods: Eight program directors from the Radiology Residency Education Research Alliance (RRERA) participated in a mixed-methods study, which included a survey regarding impressions of AI-generated personal statements and focus group discussions (July 2023). Each director reviewed four personal statement variations for five applicants, blinded to author type: the original and three ChatGPT-4.0 versions generated with varying prompts, aggregated for analysis. A 5-point Likert scale surveyed the writing quality, including voice, clarity, engagement, organization, and the perceived origin of each statement. An experienced qualitative researcher facilitated focus group discussions. Data analysis was performed using a rapid analytic approach with a coding template capturing key areas related to residency applications., Results: GPT-generated statement (GPT) ratings were more often average or worse in quality (56%, 268/475) than ratings of human-authored statements (Hu) (29% [45/160]). Although reviewers were not confident in their ability to distinguish the origin of personal statements, they did so reliably and consistently, identifying the human-authored personal statements at 95% (38/40) as probably or definitely original. Focus group discussions highlighted the inevitable use of AI in crafting personal statements and concerns about its impact on the authenticity and the value of the personal statement in residency selections. Program directors were divided on the appropriate use and regulation of AI., Discussion: Radiology residency program directors rated LLM-generated personal statements as lower in quality and expressed concern about the loss of the applicant's voice but acknowledged the inevitability of increased AI use in the generation of application statements., (Copyright © 2024. Published by Elsevier Inc.)