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The field of Urology is no stranger to artificial intelligence (AI) and machine learning, with prior applications in urological cancer management [1,2]. Smart conversational agents ('chatbots') are one such example of AI technology and have been shown to be a convenient and powerful tool for providing patients with medical information [3], and addressing their concerns postoperatively [4,5].

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Fundamento: A síndrome de Wolff-Parkinson-White (WPW) é uma condição pró-arrítmica que pode exigir restrição de atividades extenuantes e é caracterizada por sinais de ECG, incluindo ondas delta. Observamos casos de padrões intermitentes de WPW apresentando-se como QRS alternante ('WPW alternante') em uma grande coorte de triagem de ECG pré-participação de homens jovens que se candidataram ao recrutamento militar. Objetivos: Nosso objetivo foi determinar o padrão de WPW alternante, as características do caso e a prevalência de outros diagnósticos diferenciais relevantes apresentando-se como alternância de QRS em um ambiente de pré-participação. Métodos: Cento e vinte e cinco mil cento e cinquenta e oito recrutas militares do sexo masculino prospectivos foram revisados de janeiro de 2016 a dezembro de 2019. Uma revisão de prontuários médicos eletrônicos identificou casos de WPW alternante e padrões ou síndrome de WPW. A revisão de prontuários médicos eletrônicos identificou casos de diagnósticos diferenciais relevantes que podem causar alternância de QRS. Resultados: Quatro indivíduos (2,2%) apresentaram WPW alternante em 184 indivíduos com diagnóstico final de padrão ou síndrome de WPW. Dois desses indivíduos manifestaram sintomas ou achados eletrocardiográficos compatíveis com taquicardia supraventricular. A prevalência geral de WPW alternante foi de 0,003%, e a prevalência de WPW foi de 0,147%. As WPW alternantes representaram 8,7% dos indivíduos com QRS alternantes, e QRS alternantes tiveram prevalência de 0,037% em toda a população. Conclusões: A WPW alternante é uma variante da WPW intermitente, que compreendeu 2,2% dos casos de WPW em nossa coorte de triagem pré-participação. Não indica necessariamente um baixo risco de taquicardia supraventricular. Deve ser reconhecido na triagem de ECG e distinguido de outras patologias que também apresentam QRS alternantes. Palavras-chave: Síndrome de Wolf-Parkinson-White; Síndrome do Complexo PR curto-QRS normal; Pré-Excitação Tipo Mahaim; Eletrocardiografia/métodos; Eletrocardiografia/diagnóstico.

Burnout comprises three interrelated dimensions: emotional exhaustion (EE), depersonalisation (DP) and low personal accomplishment (PA). (2) The Maslach Burnout Inventory (MBI) is the most frequently used questionnaire and includes 22 items that measure all three burnout dimensions (seven-item EE subscale, eight-item PA subscale and seven-item DP subscale). Although several studies focus on the presence of high levels of EE or DP alone, other burnout studies have also included all three components in their measurement of burnout. (3,4) Furthermore, even if burnout prevalence is defined as high EE or DP in our study instead of the current definition of high EE, high DP or low PA, the difference is small (354/446, 79.4% vs. 360/446, 80.7%, respectively) and does not change the conclusion of our paper. At the time of writing, our study was the first in Singapore to evaluate empathy and burnout among residents. (5) We acknowledge that burnout studies have been performed in other medical cohorts, such as nurses and medical students. The other local burnout study by See et al, (6) which involved 64 trainees, was published in October 2016 and our manuscript was submitted prior to that. While there are 34 different residency programmes in our institution, numbers of residents within each programme vary greatly, from as low as one (hand surgery) to as high as 153 (internal medicine). Without grouping similar programmes together, a meaningful comparison would not have been possible and may have revealed the identity of the programmes and participants. The Jefferson Scale of Physician Empathy for students (JSPE-S) and JSPE for physicians and health professionals are similar in content, differing only in the wording of the questions, which address the population they are targeted at. The website for the Jefferson Center for Research in Medical Education and Health Care states, "Both are similar in content with minor modifications in wording to avoid confusion. For example, an item beginning 'Physicians' understanding…' in the medical student version may begin 'Health care providers' understanding…' in the health professions student version". (7) Testing for internal consistency in our sample revealed a Cronbach's alpha of 0.87, which indicates good internal consistency and is indeed similar to what some of our authors have previously reported for the JSPE-S (0.83). (8) The statement that "Medical students in Singapore have been shown to be less empathetic than their counterparts from the US, although they were relatively more empathetic compared to counterparts from East Asia" is also attributable to the same cited paper. (8) We agree that more data could have been reported in that paper. Student's t-test comparing mean scores from a Japanese study (9) with those reported in Singapore students showed that Singapore students had a significantly higher mean JSPE-S score (112.18 vs. 104.30, p < 0.001). Similarly, a significant difference in mean scores between a cohort of US students (10) and Singapore students was also observe...

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