Generating Quality Assurance Constraints From Natural Language With LLMs

Evaluating gpt-4 for zero-shot classification of bleeding and clotting events: Can large language models serve as second reviewers?

Aim/Purpose: The study investigates the factors influencing the acceptance and utilisation of large language models (LLMs) (predictor variables of LLM usage), such as ChatGPT, in Learning design by instructional designers and university-teaching academics from various countries. Background: Large language models (LLMs) have exploded onto the scene, transforming the landscape of learning design. Instructional designers and university teaching academics have been overburdened with content creation for their teaching programmes, and the arrival of LLM models will help in this regard by developing more interactive content that drives student engagement and, in turn, contributes to student success. Since LLMs are a relatively new phenomenon, little is known about the factors influencing their acceptance in learning design; therefore, this research is needed, as learning design principles are the bedrock of student engagement and success. Methodology: A cross-sectional correlational quantitative study was employed. Data was collected using an online questionnaire posted on social media, including LinkedIn, from 203 instructional designers and university teaching academics. Purposive and snowball sampling methods were used to target instructional designers and university teaching academics at colleges and universities worldwide. Participants were asked to share the survey link with fellow instructional designers and university-teaching academics in their communities. The factor structure of the data was determined using exploratory factor analysis. Nonetheless, the factor structure derived from the LLMs did not entirely reflect the original configuration of the Unified Theory of Acceptance and Use of Technology (UTAUT3), as certain predictors appeared to coalesce, indicating LLMs’ unique nature in learning design. Confirmatory factor analysis was used to verify the fit of the data on the measurement model. First-order and second-order structural modelling were used to identify the structural relationships among the variables. Contribution: The study determines significant factors for the acceptance of LLMs by instructional designers and academic teaching staff in learning design, enabling possible opportunities for best practices in the field through interventions to optimize LLM usage. The study applies the technology acceptance model to the emerging LLM technology and extends the technology acceptance model by adding the trust construct as a predictor variable. Findings: The structural analysis results indicated that the ingrained LLM practices, LLM peer-driven expectations, innovative propensity towards LLM adoption, reliability and provider trust in LLMs, and ease of use and support influenced perceived LLM benefits and usage, but community standards and infrastructure had no influence. The second-order structural equation modelling indicated that perceived LLM benefits and usage and ingrained LLM habits contributed most to the learning design. Recommendations for Practitioners: Teaching academics and instructional designers must use LLMs in designing content, assessments, and interactive learning activities, and attend LLM training workshops on prompting and best practices in integrating LLMs into learning and teaching to see their benefits; hence, regular use of LLMs will then lead to trust and innovation in LLMs usage, enhancing learning design and improving student learning outcomes. Recommendation for Researchers: Researchers must use mixed methods approaches to have a deeper understanding of the factors influencing LLMs. Since habit and perceived LLM benefits and usage contributed the most variance to learning design, researchers must investigate strategies that optimise these factors in learning design, such as effective intervention strategies that can help form positive LLM habits. In addition, the findings provide researchers with a starting point for future research. Further researchers must investigate interventions that optimise the influence of personal innovativeness and trust that contributed the least variance to learning design, hence unlocking the potential of LLMs in learning design through innovation, responsible, and ethical use. Impact on Society: The use of LLMs in learning design has a high possibility of transforming education, specifically the learning design landscape. Using LLMs will free up more time for teaching academics and instructional designers so that they spend more time on higher-order thinking skill demands. Consequently, the students will be exposed to more engaging and interactive content, resulting in improved learning outcomes. Future Research: Future research must include context-derived external variables in technology acceptance models, such as levels of prompting competencies, to provide a deeper understanding of LLMs. In addition, future research must be based on the application and impact of LLMs on student engagement and success, and their attainment of 21st-century skills.

Generative large language models (LLMs) are a subset of transformers-based neural network architecture models. LLMs have successfully leveraged a combination of an increased number of parameters, improvements in computational efficiency, and large pre-training datasets to perform a wide spectrum of natural language processing (NLP) tasks. Using a few examples (few-shot) or no examples (zero-shot) for prompt-tuning has enabled LLMs to achieve state-of-the-art performance in a broad range of NLP applications. This article by the American Medical Informatics Association (AMIA) NLP Working Group characterizes the opportunities, challenges, and best practices for our community to leverage and advance the integration of LLMs in downstream NLP applications effectively. This can be accomplished through a variety of approaches, including augmented prompting, instruction prompt tuning, and reinforcement learning from human feedback (RLHF). Our focus is on making LLMs accessible to the broader biomedical informatics community, including clinicians and researchers who may be unfamiliar with NLP. Additionally, NLP practitioners may gain insight from the described best practices. We focus on 3 broad categories of NLP tasks, namely natural language understanding, natural language inferencing, and natural language generation. We review the emerging trends in prompt tuning, instruction fine-tuning, and evaluation metrics used for LLMs while drawing attention to several issues that impact biomedical NLP applications, including falsehoods in generated text (confabulation/hallucinations), toxicity, and dataset contamination leading to overfitting. We also review potential approaches to address some of these current challenges in LLMs, such as chain of thought prompting, and the phenomena of emergent capabilities observed in LLMs that can be leveraged to address complex NLP challenge in biomedical applications.

Purpose This study aims to explore the integration of large language models (LLMs) and vision-language models (VLMs) in robotics, highlighting their potential benefits and the safety challenges they introduce, including robustness issues, adversarial vulnerabilities, privacy concerns and ethical implications. Design/methodology/approach This survey conducts a comprehensive analysis of the safety risks associated with LLM- and VLM-powered robotic systems. The authors review existing literature, analyze key challenges, evaluate current mitigation strategies and propose future research directions. Findings The study identifies that ensuring the safety of LLM-/VLM-driven robots requires a multi-faceted approach. While current mitigation strategies address certain risks, gaps remain in real-time monitoring, adversarial robustness and ethical safeguards. Originality/value This study offers a structured and comprehensive overview of the safety challenges in LLM-/VLM-driven robotics. It contributes to ongoing discussions by integrating technical, ethical and regulatory perspectives to guide future advancements in safe and responsible artificial intelligence-driven robotics.

Large language models (LLMs) are increasingly adopted in educational contexts to provide personalized support to students and teachers. The unprecedented capacity of LLM‐based applications to understand and generate natural language can potentially improve instructional effectiveness and learning outcomes, but the integration of LLMs in education technology has renewed concerns over algorithmic bias, which may exacerbate educational inequalities. Building on prior work that mapped the traditional machine learning life cycle, we provide a framework of the LLM life cycle from the initial development of LLMs to customizing pre‐trained models for various applications in educational settings. We explain each step in the LLM life cycle and identify potential sources of bias that may arise in the context of education. We discuss why current measures of bias from traditional machine learning fail to transfer to LLM‐generated text (eg, tutoring conversations) because text encodings are high‐dimensional, there can be multiple correct responses, and tailoring responses may be pedagogically desirable rather than unfair. The proposed framework clarifies the complex nature of bias in LLM applications and provides practical guidance for their evaluation to promote educational equity. Practitioner notes What is already known about this topic The life cycle of traditional machine learning (ML) applications which focus on predicting labels is well understood. Biases are known to enter in traditional ML applications at various points in the life cycle, and methods to measure and mitigate these biases have been developed and tested. Large language models (LLMs) and other forms of generative artificial intelligence (GenAI) are increasingly adopted in education technologies (EdTech), but current evaluation approaches are not specific to the domain of education. What this paper adds A holistic perspective of the LLM life cycle with domain‐specific examples in education to highlight opportunities and challenges for incorporating natural language understanding (NLU) and natural language generation (NLG) into EdTech. Potential sources of bias are identified in each step of the LLM life cycle and discussed in the context of education. A framework for understanding where to expect potential harms of LLMs for students, teachers, and other users of GenAI technology in education, which can guide approaches to bias measurement and mitigation. Implications for practice and/or policy Education practitioners and policymakers should be aware that biases can originate from a multitude of steps in the LLM life cycle, and the life cycle perspective offers them a heuristic for asking technology developers to explain each step to assess the risk of bias. Measuring the biases of systems that use LLMs in education is more complex than with traditional ML, in large part because the evaluation of natural language generation is highly context‐dependent (eg, what counts as good feedback on an assignment varies). EdTech developers can play an important role in collecting and curating datasets for the evaluation and benchmarking of LLM applications moving forward.

Interacting with Large Language Models (LLMs) via declarative queries is increasingly popular for tasks like question answering and data extraction, thanks to their ability to process vast unstructured data. However, LLMs often struggle with answering complex factual questions, exhibiting low precision and recall in the returned data. This challenge highlights that executing queries on LLMs remains a largely unexplored domain, where traditional data processing assumptions often fall short. Conventional query optimization, typically cost-driven, overlooks LLM-specific quality challenges such as contextual understanding. Just as new physical operators are designed to address the unique characteristics of LLMs, optimization must consider these quality challenges. Our results highlight that adhering strictly to conventional query optimization principles fails to generate the best plans in terms of result quality. To tackle this challenge, we present a novel approach to enhance SQL results by applying query optimization techniques specifically adapted for LLMs. We introduce a database system, GALOIS, that sits between the query and the LLM, effectively using the latter as a storage layer. We design alternative physical operators tailored for LLM-based query execution and adapt traditional optimization strategies to this novel context. For example, while pushing down operators in the query plan reduces execution cost (fewer calls to the model), it might complicate the call to the LLM and deteriorate result quality. Additionally, these models lack a traditional catalog for optimization, leading us to develop methods to dynamically gather such metadata during query execution. Our solution is compatible with any LLM and balances the trade-off between query result quality and execution cost. Experiments show up to 144% quality improvement over questions in Natural Language and 29% over direct SQL execution, highlighting the advantages of integrating database solutions with LLMs.

Background and Aims Large language models (LLMs) have gained significant attention in the field of natural language processing (NLP), marking a shift from traditional techniques like Term Frequency-Inverse Document Frequency (TF-IDF). We developed a traditional NLP model to predict arteriovenous fistula (AVF) failure within next 30 days using clinical notes. The goal of this analysis was to investigate whether LLMs would outperform traditional NLP techniques, specifically in the context of predicting AVF failure within the next 30 days using clinical notes. Method We defined AVF failure as the change in status from active to permanently unusable status or temporarily unusable status. We used data from a large kidney care network from January 2021 to December 2021. Two models were created using LLMs and traditional TF-IDF technique. We used “distilbert-base-uncased”, a distilled version of BERT base model [1], and compared its performance with traditional TF-IDF-based NLP techniques. The dataset was randomly divided into 60% training, 20% validation and 20% test dataset. The test data, comprising of unseen patients’ data was used to evaluate the performance of the model. Both models were evaluated using metrics such as area under the receiver operating curve (AUROC), accuracy, sensitivity, and specificity. Results The incidence of 30 days AVF failure rate was 2.3% in the population. Both LLMs and traditional showed similar overall performance as summarized in Table 1. Notably, LLMs showed marginally better performance in certain evaluation metrics. Both models had same AUROC of 0.64 on test data. The accuracy and balanced accuracy for LLMs were 72.9% and 59.7%, respectively, compared to 70.9% and 59.6% for the traditional TF-IDF approach. In terms of specificity, LLMs scored 73.2%, slightly higher than the 71.2% observed for traditional NLP methods. However, LLMs had a lower sensitivity of 46.1% compared to 48% for traditional NLP. However, it is worth noting that training on LLMs took considerably longer than TF-IDF. Moreover, it also used higher computational resources such as utilization of graphics processing units (GPU) instances in cloud-based services, leading to higher cost. Conclusion In our study, we discovered that advanced LLMs perform comparably to traditional TF-IDF modeling techniques in predicting the failure of AVF. Both models demonstrated identical AUROC. While specificity was higher in LLMs compared to traditional NLP, sensitivity was higher in traditional NLP compared to LLMs. LLM was fine-tuned with a limited dataset, which could have influenced its performance to be similar to that of traditional NLP methods. This finding suggests that while LLMs may excel in certain scenarios, such as performing in-depth sentiment analysis of patient data for complex tasks, their effectiveness is highly dependent on the specific use case. It is crucial to weigh the benefits against the resources required for LLMs, as they can be significantly more resource-intensive and costly compared to traditional TF-IDF methods. This highlights the importance of a use-case-driven approach in selecting the appropriate NLP technique for healthcare applications.

The paper studies the problem of software code migration during the transition from the old version of the SAP ERP 6.0 system to modern ERP platforms, in particular SAP S/4HANA. The necessity of automation of the migration process using artificial intelligence methods and tools is substantiated. A comprehensive analysis of existing academic and industrial case studies confirmed the feasibility of using large language models for code migration. A number of advantages of the approach based on large language models are revealed, in particular, the ability to handle various migration scenarios. The key risks and limitations common in the enterprise environment are highlighted, including data security, privacy, high cost of API calls and limited knowledge of models regarding the subject area. A method is developed for selecting a large open source language model that can be safely used in the enterprise landscape, thereby mitigating the risks associated with cloud solutions. The method is based on the developed system of criteria, including: model size, context window size, license type, support for fine-tuning training, focus on code quality (measured using a reference dataset), support for model quantization and community support. The hybrid AHP-TOPSIS method is proposed for systematic ranking of candidate models. The AHP method was used to check the weights of the criteria, while TOPSIS was used to rank the models based on their proximity to the ideal solution. Based on the developed method, three large language models were selected: Qwen 2.5 Coder 14B, DeepSeek-Coder-V2 16B and Llama 3.1 8B. A comprehensive testing plan for the selected models was developed for further experimental studies. The scientific novelty of the work lies in the development of a method for selecting large language models for custom code migration tasks, which differs from the existing system of model selection criteria and the use of a hybrid AHP-TOPSIS approach for ranking candidate models. The practical value of the work is that the developed method allows you to select a model taking into account the constraints of the corporate environment and information security requirements, which will increase the level of automation in the migration of AVAP when switching to new versions of ERP systems from SAP SE. The developed method can be applied to the selection of large language models when upgrading any large computer systems developed in both open source and proprietary programming languages.

Readability & quality of large language model responses in CAR-T patient education

Introduction Game theory has long served as a foundational tool in cybersecurity to test, predict, and design strategic interactions between attackers and defenders. The recent advent of Large Language Models (LLMs) offers new tools and challenges for the security of computer systems. In this work, we investigate whether classical game-theoretic frameworks can effectively capture the behaviors of LLM-driven actors and bots. Methods Using a reproducible framework for game-theoretic LLM agents, we investigate two canonical scenarios—the one-shot zero-sum game and the dynamic Prisoner's Dilemma—and we test whether LLMs converge to expected outcomes or exhibit deviations due to embedded biases. We experiments on four state-of-the-art LLMs and five natural languages (English, French, Arabic, Vietnamese, and Mandarin Chinese) to assess linguistic sensitivity. Results For both games, we observe that the final payoffs are influenced by agents characteristics such as personality traits or knowledge of repeated rounds. We also uncover an unexpected sensitivity of the final payoffs to the choice of languages, which should warn against indiscriminate application of LLMs in cybersecurity applications and call for in-depth studies, as LLMs may behave differently when deployed in different countries. We also employ quantitative metrics to evaluate the internal consistency and cross-language stability of LLM agents. Discussion In addition to uncovering unexpected behaviors requiring attention by scholars and practitioners, our work can help guide the selection of the most stable LLMs and optimizing models for secure applications.

LLMs application to clinical practice is growing fast. However, LLMs are less studied in geriatrics practice but are urgently needed. This symposium will address whether LLMs allocation to geriatric practice can be trusted via five approaches. 1) LLMs generated gender and race-biased outputs. We will demonstrate whether LLMs generated age-biased output by assessing their geriatric attitude evaluated by social workers. 2). LLMs passed USMLE and other examinations. We will demonstrate whether LLMs can pass geriatrics knowledge competence tests evaluated by geriatricians 3). LLMs performed well on clinical vignettes from different clinical disciplines. We will demonstrate whether LLMs can perform well on geriatrics 5M-based vignettes of older adults evaluated by clinical providers and trainees 4) LLMs reviewed and summarized clinical charts. We will demonstrate whether LLMs can review geriatrics and general medicine notes to extract Mobility (one of Geriatrics 5Ms) documentation evaluated by geriatricians 5). LLMs can generate deprescribing recommendations, tapering schedules, and patient education materials. We will demonstrate their accuracy, safety, and appropriateness compared to recommendations from a multidisciplinary team of pharmacists, geriatricians, and nurses. Specifically, this symposium will address the following topics: 1) Geriatric Attitude of ChatGPT4.o and Its Evaluation by Social Workers. 2) ChatGPT4.o Geriatrics Knowledge Competency and Its Evaluation by Geriatricians. 3) LLMs application to geriatrics 5Ms evaluated by clinical providers and trainees. 4) Using LLMs to Extract and Assess Mobility Documentation for Age-Friendly Health System evaluated by geriatricians. 5) Using LLMs to generate medication deprescribing recommendations compared to clinician-led deprescribing recommendations.

Introduction Advances in large language models (LLMs) have opened new avenues for healthcare applications. Recently, ChatGPT-4 successfully achieved the pass mark >80% in 5 of 10 sleep medicine examination domains, indicating a strong foundational knowledge of sleep medicine. However, the ability to answer USMLE-type multiple-choice questions may not equate to the capacity to offer accurate and comprehensive answers to clinical queries or real-world case scenarios. Current literature exhibits a significant gap in validation research examining the clinical utility of LLMs in evidence-based medicine practice. This investigation aims to evaluate the potential usefulness and reliability of LLMs as adjunctive clinical decision-support tools (namely, “curbside consultants”) in sleep medicine. Methods Six clinical sleep queries and six case scenarios were presented to 6 LLMs including 3 general-purpose LLMs (ChatGPT-4o, Gemini-1.5-Pro, and Llama-3.1-405B) and 3 medical-specialized LLMs (OpenEvidence, Clara AI, and MediGPT). Performance assessment was conducted independently utilizing two independently developed 5-point Likert scales evaluating two primary domains: answer content (accuracy, relevance, comprehensiveness/depth, clarity/coherence, and unique insightfulness) and reference quality (accuracy, relevance, currentness, comprehensiveness/depth, and searchability). Benchmark answers were established through consensus among four sleep medicine specialists. Analysis of variance was used to compare the performance of the LLMs. Results The medical LLMs demonstrated superior overall performance compared to the general LLMs (P< 0.001). The primary distinction was observed in reference quality metrics, where medical LLMs significantly outperformed general LLMs across all parameters: accuracy, relevance, and searchability (p< 0.001), currentness (p=0.001), and comprehensiveness/depth (p=0.010). Notably, Open Evidence achieved the highest reference quality (p< 0.001). In contrast, the answer content analysis revealed no significant overall differences between medical and general LLMs (p=0.659). Most answer content-related metrics, including accuracy, relevance, or unique insightfulness, did not differ significantly (p>0.050). An exception was clarify/coherence, where medical LLMs were superior to general LLMs (p=0.030). Furthermore, MediGPT and ChatGPT-4o displayed better content comprehensiveness/depth relative to other LLMs (p< 0.001). These two LLMs exhibited comparable performance in overall metrics (p=0.615), answer contents (p=0.922), and reference quality (p=0.621). Conclusion Both medical-specialized and general-purpose LLMs show promise as adjunctive decision-support tools in clinical practice. However, substantial improvements in reference quality are critically needed across most LLM platforms. Support (if any)

Designing preference elicitation (PE) methodologies that can quickly ascertain a user’s top item preferences in a cold-start setting is a key challenge for building effective and personalized conversational recommendation (ConvRec) systems. While large language models (LLMs) enable fully natural language (NL) PE dialogues, we hypothesize that monolithic LLM NL-PE approaches lack the multi-turn, decision-theoretic reasoning required to effectively balance the exploration and exploitation of user preferences towards an arbitrary item set. In contrast, traditional Bayesian optimization PE methods define theoretically optimal PE strategies, but cannot generate arbitrary NL queries or reason over content in NL item descriptions – requiring users to express preferences via ratings or comparisons of unfamiliar items. To overcome the limitations of both approaches, we formulate NL-PE in a Bayesian Optimization (BO) framework that seeks to actively elicit NL feedback to identify the best recommendation. Key challenges in generalizing BO to deal with natural language feedback include determining: (a) how to leverage LLMs to model the likelihood of NL preference feedback as a function of item utilities, and (b) how to design an acquisition function for NL BO that can elicit preferences in the infinite space of language. We demonstrate our framework in a novel NL-PE algorithm, PEBOL, which uses: 1) Natural Language Inference (NLI) between user preference utterances and NL item descriptions to maintain Bayesian preference beliefs, and 2) BO strategies such as Thompson Sampling (TS) and Upper Confidence Bound (UCB) to guide LLM query generation. We numerically evaluate our methods in controlled simulations, finding that after 10 turns of dialogue, PEBOL can achieve an MRR@10 of up to 0.27 compared to the best monolithic LLM baseline’s MRR@10 of 0.17, despite relying on earlier and smaller LLMs.1

In today’s rapidly evolving business landscape, Artificial Intelligence (AI), and specifically Large Language Models (LLMs), are redefining how organizations operate, make decisions, and engage with customers. AI-driven technologies have become indispensable, providing businesses with powerful tools to streamline operations, derive actionable insights from vast data, and foster more meaningful customer interactions. For business leaders, scholars, and practitioners alike, understanding the transformative potential of AI isn’t just advantageous—it’s essential to staying competitive in an increasingly data-driven world.This editorial delves into recent scholarly advancements in LLM applications within business contexts, analyzing studies that explore AI’s potential across various domains, from decision support to creative industries. By introducing a structured framework, this editorial highlights key insights and contributions from recent studies, assessing their value to academia and industry. The following comparative analysis sheds light on how these innovations shape our understanding of AI’s role in business while pointing to future research directions.Puyt and Madsen's (2024) study stands out as a foundational exploration of LLM accuracy, assessing ChatGPT-4's ability to recount the history of the SWOT analysis-a vital business strategy tool. Their findings reveal that, while ChatGPT-4 effectively conveys general concepts, it struggles with detailed historical information, often producing inaccuracies or "hallucinations." This gap underscores the need for LLMs to be trained with verified academic data, particularly for strategic business applications that demand precision. This study not only contributes to the literature by proposing methods to evaluate AI accuracy in historical contexts but also highlights the importance of rigorous information vetting in industry settings where reliability is crucial.In contrast, Raikov et al. (2024) explore a hybrid intelligence model that combines LLM capabilities with explainable AI (XAI) principles to enhance human-machine collaboration. Their approach emphasizes cognitive semantics, improving transparency and decision-making efficiency. The hybrid model's real-time adaptability addresses the needs of complex, regulated industries such as finance and healthcare, where trust in AI decisions is paramount. Academically, this study provides a valuable addition to XAI literature by demonstrating how LLMs can bridge the gap between AI autonomy and human oversight, making it a model for future human-AI interactions in complex business environments.Another significant study by Mariotti and colleagues (2024) examines the integration of LLMs with enterprise knowledge graphs to enhance data-driven decision-making. By enabling organizations to leverage knowledge graphs for more accurate and scalable data retrieval, this research provides a robust framework for businesses seeking efficient knowledge management systems. The academic contribution here lies in advancing the dialogue between LLMs and knowledge graphs, emphasizing ethical data handling and quality standards essential for industry applications. For enterprises, the study offers practical solutions to achieve streamlined data management, balancing automation with privacy and security. 2024) take a different approach, investigating LLMs' role in creative industries, specifically within fashion design. They introduce a hybrid intelligence model that supports creative processes, allowing AI to complement rather than replace human ingenuity. While LLMs in this field demonstrate potential in automating repetitive design tasks and enhancing customer personalization, the study reveals limitations in AI's ability to handle spatial and stylistic nuances. This study's academic contribution lies in promoting human-AI co-creation, inspiring further research into AI applications across diverse creative sectors, including media and marketing.Collectively, these studies not only illuminate LLMs' transformative potential in business but also highlight critical ethical and operational considerations. Ensuring accuracy, transparency, and data privacy are vital to responsibly integrating AI into business workflows. Future research should focus on enhancing LLM accuracy, refining hybrid intelligence models, and exploring creative AI applications, all while maintaining ethical standards. As LLMs evolve, interdisciplinary collaborations will be essential to harness their full potential, making AI an ethical, effective, and innovative force in the business world.

Large Language Models (LLMs) have garnered increasing attention in neurosurgery and possess significant potential to improve the field. However, the breadth and performance of LLMs across diverse neurosurgical tasks have not been systematically examined, and LLMs come with their own challenges and unique terminology. We seek to identify key models, establish reporting guidelines for replicability, and highlight progress in key application areas of LLM use in the neurosurgical literature. We searched PubMed and Google Scholar using terms related to LLMs and neurosurgery ("large language model" OR "LLM" OR "ChatGPT" OR "GPT-3" OR "GPT3" OR "GPT-3.5" OR "GPT3.5" OR "GPT-4" OR "GPT4" OR "LLAMA" OR "MISTRAL" OR "BARD") AND "neurosurgery". The final set of articles was reviewed for publication year, application area, specific LLM(s) used, control/comparison groups used to evaluate LLM performance, whether the article reported specific LLM prompts, prompting strategy types used, whether the LLM query could be reproduced in its entirety (including both the prompt used and any adjoining data), measures of hallucination, and reported performance measures. Fifty-one articles met inclusion criteria, and were categorized into six application areas, with the most common being Generation of Text for Direct Clinical Use (n = 14, 27.5%), Answering Standardized Exam Questions (n = 12, 23.5%), and Clinical Judgement and Decision-Making Support (n = 11, 21.6%). The most frequently used LLMs were GPT-3.5 (n = 30, 58.8%), GPT-4 (n = 20, 39.2%), Bard (n = 9, 17.6%), and Bing (n = 6, 11.8%). Most studies (n = 43, 84.3%) used LLMs directly out-of-the-box, while 8 studies (15.7%) conducted advanced pre-training or fine-tuning. Large language models show advanced capabilities in complex tasks and hold potential to transform neurosurgery. However, research typically addresses basic applications and overlooks enhancing LLM performance, facing reproducibility issues. Standardizing detailed reporting, considering LLM stochasticity, and using advanced methods beyond basic validation are essential for progress.