const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Laparoscopy in Perforation Peritonitis – JR1 Journal Club";

// ─── THEME ───────────────────────────────────────────────────────────────────
const C = {
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  teal:    "1A7A6E",
  tealLt:  "25B59E",
  gold:    "E8A020",
  white:   "FFFFFF",
  offWhite:"F4F7F9",
  grey:    "8C9BAB",
  greyLt:  "D6DFE8",
  dark:    "111B24",
  red:     "C0392B",
  green:   "1E8B60",
  orange:  "D4750F",
};

// helper: horizontal rule
function addRule(slide, y) {
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y, w: 9, h: 0.03, fill: { color: C.tealLt }, line: { color: C.tealLt } });
}

// helper: section badge
function addBadge(slide, label, x, y, w) {
  slide.addShape(pres.ShapeType.rect, { x, y, w: w || 2.2, h: 0.32, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.05 });
  slide.addText(label, { x, y, w: w || 2.2, h: 0.32, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle" });
}

// helper: stat box
function statBox(slide, label, value, unit, x, y, w, h, accent) {
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  slide.addText(value, { x, y: y + 0.08, w, h: h * 0.55, fontSize: 26, bold: true, color: accent || C.teal, align: "center", valign: "middle" });
  slide.addText(unit, { x, y: y + h * 0.52, w, h: h * 0.22, fontSize: 9, color: C.grey, align: "center", valign: "top" });
  slide.addText(label, { x, y: y + h * 0.72, w, h: h * 0.28, fontSize: 9.5, bold: true, color: C.navy, align: "center", valign: "middle" });
}

// helper: dark section divider slide
function dividerSlide(label) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 2.4, w: 10, h: 0.06, fill: { color: C.tealLt }, line: { color: C.tealLt } });
  s.addText(label, { x: 0.5, y: 1.7, w: 9, h: 1.2, fontSize: 36, bold: true, color: C.white, align: "center", valign: "middle", charSpacing: 2 });
  return s;
}

// helper: slide with standard header
function contentSlide(title, badge) {
  const s = pres.addSlide();
  // left accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.06, h: 5.625, fill: { color: C.teal }, line: { color: C.teal } });
  // header background
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.95, fill: { color: C.navy }, line: { color: C.navy } });
  // slide title
  s.addText(title, { x: 0.25, y: 0, w: 9.5, h: 0.95, fontSize: 20, bold: true, color: C.white, valign: "middle", margin: 8 });
  // background
  s.addShape(pres.ShapeType.rect, { x: 0.06, y: 0.95, w: 9.94, h: 4.675, fill: { color: C.offWhite }, line: { color: C.offWhite } });
  if (badge) addBadge(s, badge, 7.5, 0.65, 2.3);
  return s;
}

// =============================================================================
// SLIDE 1 – TITLE
// =============================================================================
{
  const s = pres.addSlide();
  // full dark background
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { color: C.navy } });
  // teal accent stripe
  s.addShape(pres.ShapeType.rect, { x: 0, y: 3.6, w: 10, h: 0.08, fill: { color: C.tealLt }, line: { color: C.tealLt } });
  // gold top stripe
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.08, fill: { color: C.gold }, line: { color: C.gold } });

  s.addText("JR1 Journal Club", { x: 0.6, y: 0.25, w: 8.8, h: 0.45, fontSize: 13, bold: true, color: C.gold, charSpacing: 3 });
  s.addText("Feasibility and Outcomes of Laparoscopic Management in Perforation Peritonitis", {
    x: 0.6, y: 0.75, w: 8.8, h: 1.8, fontSize: 28, bold: true, color: C.white, valign: "middle", align: "left"
  });
  s.addText("A Prospective Cohort Study with Propensity Score Matching", {
    x: 0.6, y: 2.45, w: 8.8, h: 0.5, fontSize: 14, italic: true, color: C.tealLt
  });
  addRule(s, 3.1);
  s.addText("Soni S, Parihar YK, Chaudhary R, et al.  |  Journal of Minimal Access Surgery 2026; 22(2):180–186", {
    x: 0.6, y: 3.25, w: 8.8, h: 0.38, fontSize: 10.5, color: C.greyLt
  });
  s.addText("AIIMS Jodhpur  |  Prospective Cohort  |  Jan 2022 – May 2023", {
    x: 0.6, y: 3.62, w: 8.8, h: 0.32, fontSize: 10.5, color: C.grey
  });
  s.addText("Presented by: JR1  |  Date: " + new Date().toLocaleDateString("en-GB", { day:"2-digit", month:"short", year:"numeric" }), {
    x: 0.6, y: 4.9, w: 8.8, h: 0.38, fontSize: 10.5, color: C.grey, italic: true
  });
}

// =============================================================================
// SLIDE 2 – OUTLINE
// =============================================================================
{
  const s = contentSlide("Presentation Outline", "Overview");
  const items = [
    ["01", "Background & Introduction", "Why is perforation peritonitis a challenge?"],
    ["02", "Study Design & Methods",    "Prospective cohort, PSM, inclusion/exclusion"],
    ["03", "Key Results",               "Operative time, hospital stay, pain, morbidity"],
    ["04", "Discussion",                "Conversion rate, learning curve, context"],
    ["05", "Conclusion & Appraisal",    "Strengths, limitations, take-home message"],
  ];
  items.forEach(([num, title, sub], i) => {
    const y = 1.1 + i * 0.83;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.52, h: 0.52, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.05 });
    s.addText(num, { x: 0.35, y, w: 0.52, h: 0.52, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(title, { x: 1.05, y: y + 0.02, w: 8.5, h: 0.28, fontSize: 13.5, bold: true, color: C.navy });
    s.addText(sub,   { x: 1.05, y: y + 0.28, w: 8.5, h: 0.22, fontSize: 10.5, color: C.grey });
  });
}

// =============================================================================
// SLIDE 3 – BACKGROUND
// =============================================================================
{
  const s = contentSlide("Background", "Introduction");
  s.addText("Perforation Peritonitis: The Problem", { x: 0.35, y: 1.05, w: 9.3, h: 0.38, fontSize: 15, bold: true, color: C.navy });

  const pts = [
    "Common emergency surgical admission — significant cause of worldwide morbidity and mortality",
    "Caused by gastrointestinal perforation → severe intra-abdominal infection",
    "Most patients present haemodynamically unstable, requiring urgent surgery",
    "Most common cause: peptic ulcer disease (PUD), followed by ileal and appendicular perforation",
    "Traditional standard of care: open laparotomy (e.g., Graham's patch repair for PUD)",
  ];
  s.addText(pts.map(p => ({ text: p, options: { bullet: { code: "2022" }, breakLine: true, paraSpaceAfter: 6 } })),
    { x: 0.5, y: 1.52, w: 5.7, h: 2.6, fontSize: 11.5, color: C.dark, valign: "top" });

  // right panel: challenges of open surgery
  s.addShape(pres.ShapeType.rect, { x: 6.45, y: 1.05, w: 3.2, h: 3.1, fill: { color: C.navy }, line: { color: C.teal, pt: 2 }, rectRadius: 0.1 });
  s.addText("Limitations of Open\nLaparotomy", { x: 6.55, y: 1.1, w: 3.0, h: 0.6, fontSize: 11.5, bold: true, color: C.gold, align: "center" });
  const openlims = ["Large midline incision", "Higher post-op pain", "Longer hospital stay", "More wound complications", "Slower recovery"];
  openlims.forEach((item, i) => {
    s.addShape(pres.ShapeType.rect, { x: 6.6, y: 1.75 + i * 0.44, w: 3.0, h: 0.35, fill: { color: C.dark }, line: { color: C.dark }, rectRadius: 0.05 });
    s.addText("✗  " + item, { x: 6.6, y: 1.75 + i * 0.44, w: 3.0, h: 0.35, fontSize: 10.5, color: C.white, valign: "middle" });
  });

  s.addText("Laparoscopy first described for PUD perforation in 1990 (Mouret et al.)", {
    x: 0.35, y: 4.25, w: 9.3, h: 0.38, fontSize: 10.5, italic: true, color: C.teal
  });
}

// =============================================================================
// SLIDE 4 – CLINICAL QUESTION
// =============================================================================
{
  const s = contentSlide("Clinical Question & Rationale", "PICO");
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.1, w: 9.3, h: 1.5, fill: { color: C.navy }, line: { color: C.tealLt, pt: 2 }, rectRadius: 0.1 });
  s.addText("Research Question", { x: 0.5, y: 1.15, w: 9.0, h: 0.35, fontSize: 12, bold: true, color: C.gold });
  s.addText("In adult patients presenting with perforation peritonitis, is laparoscopic management feasible and does it offer comparable or improved perioperative outcomes compared to open laparotomy?",
    { x: 0.5, y: 1.5, w: 9.0, h: 0.95, fontSize: 13, color: C.white, italic: true, valign: "middle" });

  const pico = [
    ["P", "Population",    "Adults ≥18 yrs with GI perforation peritonitis (haemodynamically stable)"],
    ["I", "Intervention",  "Laparoscopic management (repair/appendectomy)"],
    ["C", "Comparator",    "Open laparotomy"],
    ["O", "Outcomes",      "Operative time, hospital stay, VAS pain, 30-day morbidity & mortality"],
  ];
  pico.forEach(([letter, label, desc], i) => {
    const y = 2.85 + i * 0.54;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.38, h: 0.38, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.05 });
    s.addText(letter, { x: 0.35, y, w: 0.38, h: 0.38, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(label + ":", { x: 0.82, y: y + 0.04, w: 1.5, h: 0.3, fontSize: 11, bold: true, color: C.navy });
    s.addText(desc, { x: 2.4, y: y + 0.04, w: 7.2, h: 0.3, fontSize: 11, color: C.dark });
  });
}

// =============================================================================
// SLIDE 5 – STUDY DESIGN
// =============================================================================
{
  const s = contentSlide("Study Design & Setting", "Methods");
  // flow boxes
  const boxes = [
    { x: 0.3,  label: "Setting",   val: "AIIMS Jodhpur\nTertiary referral centre" },
    { x: 2.85, label: "Design",    val: "Prospective\nobservational cohort" },
    { x: 5.4,  label: "Period",    val: "Jan 2022 –\nMay 2023 (17 months)" },
    { x: 7.95, label: "Ethics",    val: "IEC approved\n(AIIMS/IEC/2021/3611)" },
  ];
  boxes.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: 1.1, w: 2.3, h: 1.25, fill: { color: C.navy }, line: { color: C.teal, pt: 2 }, rectRadius: 0.1 });
    s.addText(b.label, { x: b.x, y: 1.12, w: 2.3, h: 0.36, fontSize: 10, bold: true, color: C.gold, align: "center" });
    s.addText(b.val,   { x: b.x, y: 1.48, w: 2.3, h: 0.8, fontSize: 11.5, color: C.white, align: "center", valign: "middle" });
  });
  // arrows between boxes
  for (let i = 0; i < 3; i++) {
    s.addText("▶", { x: 2.55 + i * 2.55, y: 1.55, w: 0.35, h: 0.35, fontSize: 14, color: C.tealLt, align: "center" });
  }

  s.addText("Patient Flow", { x: 0.35, y: 2.6, w: 9.3, h: 0.35, fontSize: 13, bold: true, color: C.navy });
  addRule(s, 2.95);

  // Flow diagram
  const flowY = 3.1;
  const flowBoxes = [
    { x: 0.3,  label: "140 patients enrolled\n(perforation peritonitis)" },
    { x: 3.5,  label: "64 planned for\nlaparoscopic management" },
    { x: 6.8,  label: "30 laparoscopy\ncompleted" },
  ];
  flowBoxes.forEach((b, i) => {
    const col = i === 0 ? C.teal : (i === 1 ? C.navy : C.green);
    s.addShape(pres.ShapeType.rect, { x: b.x, y: flowY, w: 2.9, h: 0.9, fill: { color: col }, line: { color: col }, rectRadius: 0.08 });
    s.addText(b.label, { x: b.x, y: flowY, w: 2.9, h: 0.9, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    if (i < 2) s.addText("▶", { x: b.x + 2.95, y: flowY + 0.25, w: 0.4, h: 0.4, fontSize: 16, color: C.tealLt, align: "center" });
  });
  // branch arrow down
  s.addText("▼", { x: 5.85, y: flowY + 0.88, w: 0.4, h: 0.35, fontSize: 16, color: C.red, align: "center" });
  s.addShape(pres.ShapeType.rect, { x: 5.4, y: flowY + 1.2, w: 2.9, h: 0.75, fill: { color: C.red }, line: { color: C.red }, rectRadius: 0.08 });
  s.addText("34 converted to\nlaparotomy (53.1%)", { x: 5.4, y: flowY + 1.2, w: 2.9, h: 0.75, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  // PSM note
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: flowY + 1.2, w: 4.7, h: 0.75, fill: { color: C.greyLt }, line: { color: C.teal, pt: 1.5 }, rectRadius: 0.08 });
  s.addText("After 1:1 Propensity Score Matching → 28 patients per group (n = 56 matched)", {
    x: 0.4, y: flowY + 1.2, w: 4.5, h: 0.75, fontSize: 11, bold: true, color: C.navy, align: "center", valign: "middle"
  });
}

// =============================================================================
// SLIDE 6 – INCLUSION / EXCLUSION
// =============================================================================
{
  const s = contentSlide("Inclusion & Exclusion Criteria", "Methods");
  // inclusion
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.1, w: 4.5, h: 3.6, fill: { color: C.offWhite }, line: { color: C.green, pt: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.1, w: 4.5, h: 0.48, fill: { color: C.green }, line: { color: C.green }, rectRadius: 0.1 });
  s.addText("✔  Inclusion Criteria", { x: 0.3, y: 1.1, w: 4.5, h: 0.48, fontSize: 12.5, bold: true, color: C.white, valign: "middle", margin: 8 });
  const inc = [
    "Age ≥ 18 years",
    "Radiological or intraoperative confirmation of GI perforation",
    "Haemodynamically stable at presentation\n(SBP ≥90 mmHg after resuscitation)",
    "Written informed consent obtained",
  ];
  s.addText(inc.map(t => ({ text: t, options: { bullet: { code: "2714" }, breakLine: true, paraSpaceAfter: 8 } })),
    { x: 0.45, y: 1.7, w: 4.25, h: 2.9, fontSize: 11.5, color: C.dark, valign: "top" });

  // exclusion
  s.addShape(pres.ShapeType.rect, { x: 5.25, y: 1.1, w: 4.5, h: 3.6, fill: { color: C.offWhite }, line: { color: C.red, pt: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 5.25, y: 1.1, w: 4.5, h: 0.48, fill: { color: C.red }, line: { color: C.red }, rectRadius: 0.1 });
  s.addText("✗  Exclusion Criteria", { x: 5.25, y: 1.1, w: 4.5, h: 0.48, fontSize: 12.5, bold: true, color: C.white, valign: "middle", margin: 8 });
  const exc = [
    "Haemodynamic instability / septic shock requiring vasopressors",
    "Previous major abdominal surgery (anticipated adhesions)",
    "Perforation secondary to malignancy",
    "Non-consenting patients",
  ];
  s.addText(exc.map(t => ({ text: t, options: { bullet: { code: "2718" }, breakLine: true, paraSpaceAfter: 8 } })),
    { x: 5.4, y: 1.7, w: 4.25, h: 2.9, fontSize: 11.5, color: C.dark, valign: "top" });
}

// =============================================================================
// SLIDE 7 – BASELINE CHARACTERISTICS
// =============================================================================
{
  const s = contentSlide("Baseline Characteristics (After PSM)", "Results");
  s.addText("1:1 Propensity score matching balanced confounders — 28 patients per group", {
    x: 0.35, y: 1.02, w: 9.3, h: 0.35, fontSize: 11, italic: true, color: C.teal
  });

  // Table header
  const cols = [2.5, 1.8, 2.0, 1.2];
  const headers = ["Variable", "Laparotomy (n=28)", "Laparoscopy (n=28)", "P-value"];
  const hx = [0.32, 2.9, 4.78, 6.88];
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: hx[i], y: 1.45, w: cols[i], h: 0.38, fill: { color: C.navy }, line: { color: C.navy } });
    s.addText(h, { x: hx[i], y: 1.45, w: cols[i], h: 0.38, fontSize: 10.5, bold: true, color: C.white, align: "center", valign: "middle" });
  });

  const rows = [
    ["Age (mean ± SD, yrs)",        "39.35 ± 17.13",    "37.57 ± 15.56",    "0.686"],
    ["Sex (M/F)",                   "19 / 9",           "20 / 8",           "0.085"],
    ["Duration of symptoms (days)", "3.14 ± 1.5",       "3.07 ± 1.62",      "0.867"],
    ["Comorbidities (n)",            "3 / 28",           "2 / 28",           "0.639"],
    ["Peptic perforation",          "13",               "12",               "—"],
    ["Appendicular perforation",    "13",               "14",               "—"],
    ["Small bowel perforation",     "2",                "2",                "—"],
  ];
  rows.forEach((row, i) => {
    const rowY = 1.86 + i * 0.42;
    const bg = i % 2 === 0 ? C.white : C.offWhite;
    row.forEach((cell, j) => {
      s.addShape(pres.ShapeType.rect, { x: hx[j], y: rowY, w: cols[j], h: 0.38, fill: { color: bg }, line: { color: C.greyLt } });
      const isp = cell === "0.686" || cell === "0.085" || cell === "0.867" || cell === "0.639";
      s.addText(cell, { x: hx[j], y: rowY, w: cols[j], h: 0.38, fontSize: 10.5, color: isp ? C.green : C.dark, align: "center", valign: "middle", bold: isp });
    });
  });

  s.addText("Groups were well-balanced after PSM — no statistically significant differences in baseline characteristics", {
    x: 0.35, y: 4.75, w: 9.3, h: 0.35, fontSize: 10, italic: true, color: C.grey
  });
}

// =============================================================================
// SLIDE 8 – PRIMARY OUTCOMES
// =============================================================================
{
  const s = contentSlide("Primary Outcomes (Post-PSM, n=28 per group)", "Results");

  // Big stat boxes
  statBox(s, "Operative Time", "217 vs 182", "min  (P = 0.049)", 0.32, 1.1, 2.8, 1.5, C.orange);
  statBox(s, "Hospital Stay", "4.4 vs 8.7", "days  (P < 0.001)", 3.6, 1.1, 2.8, 1.5, C.teal);
  statBox(s, "30-day Mortality", "0% vs 3.6%", "laparoscopy vs laparotomy", 6.88, 1.1, 2.8, 1.5, C.green);

  // callout bars
  const barData = [
    { label: "Laparoscopy", val: 217, max: 260, color: C.orange },
    { label: "Laparotomy",  val: 182, max: 260, color: C.greyLt },
  ];
  const barData2 = [
    { label: "Laparoscopy", val: 4.4,  max: 12, color: C.teal },
    { label: "Laparotomy",  val: 8.7,  max: 12, color: C.greyLt },
  ];

  // operative time bars
  s.addText("Operative Time (min)", { x: 0.32, y: 2.85, w: 2.8, h: 0.3, fontSize: 10.5, bold: true, color: C.navy, align: "center" });
  barData.forEach((b, i) => {
    const bw = (b.val / b.max) * 2.5;
    s.addText(b.label, { x: 0.32, y: 3.2 + i * 0.52, w: 1.2, h: 0.38, fontSize: 9.5, color: C.dark, valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: 1.55, y: 3.23 + i * 0.52, w: bw, h: 0.28, fill: { color: b.color }, line: { color: b.color } });
    s.addText(b.val + "", { x: 1.6 + bw, y: 3.23 + i * 0.52, w: 0.45, h: 0.28, fontSize: 9.5, color: C.dark, valign: "middle" });
  });

  // hospital stay bars
  s.addText("Hospital Stay (days)", { x: 3.6, y: 2.85, w: 2.8, h: 0.3, fontSize: 10.5, bold: true, color: C.navy, align: "center" });
  barData2.forEach((b, i) => {
    const bw = (b.val / b.max) * 2.5;
    s.addText(b.label, { x: 3.6, y: 3.2 + i * 0.52, w: 1.2, h: 0.38, fontSize: 9.5, color: C.dark, valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: 4.83, y: 3.23 + i * 0.52, w: bw, h: 0.28, fill: { color: b.color }, line: { color: b.color } });
    s.addText(b.val + "", { x: 4.88 + bw, y: 3.23 + i * 0.52, w: 0.4, h: 0.28, fontSize: 9.5, color: C.dark, valign: "middle" });
  });

  // morbidity callout
  s.addShape(pres.ShapeType.rect, { x: 6.88, y: 2.85, w: 2.8, h: 1.65, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.08 });
  s.addText("30-day Morbidity", { x: 6.88, y: 2.9, w: 2.8, h: 0.32, fontSize: 10.5, bold: true, color: C.gold, align: "center" });
  s.addText([
    { text: "Laparoscopy: ", options: { bold: true, color: C.tealLt } },
    { text: "10%  (3/28)\n", options: { color: C.white } },
    { text: "Laparotomy:  ", options: { bold: true, color: C.greyLt } },
    { text: "32%  (9/28)", options: { color: C.white } },
  ], { x: 6.95, y: 3.28, w: 2.65, h: 0.75, fontSize: 11, valign: "middle" });
  s.addText("SSI: 1 vs 6  |  Reoperation: 0 vs 2", {
    x: 6.88, y: 4.08, w: 2.8, h: 0.3, fontSize: 9.5, color: C.grey, align: "center"
  });

  s.addText("★ Significantly shorter hospital stay and lower morbidity with laparoscopy", {
    x: 0.35, y: 4.88, w: 9.3, h: 0.35, fontSize: 10.5, bold: true, italic: true, color: C.teal
  });
}

// =============================================================================
// SLIDE 9 – VAS PAIN SCORES
// =============================================================================
{
  const s = contentSlide("Post-operative Pain (VAS Scores)", "Results");
  s.addText("Visual Analogue Scale (0–10) recorded at POD 1, 3, 7 and 30", {
    x: 0.35, y: 1.02, w: 9.3, h: 0.35, fontSize: 11, italic: true, color: C.grey
  });

  // Manual bar chart
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    { day: "POD 1", lap_open: 4.56, lap_lap: 3.63, p: "0.012" },
    { day: "POD 3", lap_open: 3.96, lap_lap: 2.39, p: "<0.001" },
    { day: "POD 7", lap_open: 2.54, lap_lap: 1.46, p: "<0.001" },
    { day: "POD 30",lap_open: 1.36, lap_lap: 1.07, p: "0.005" },
  ];
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  const chartX = 0.5;
  const chartBottom = 4.6;
  const chartH = 2.8;
  const barW = 0.55;
  const groupW = 2.0;

  // y-axis gridlines & labels
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    s.addText(v + "", { x: chartX, y: yPos - 0.15, w: 0.38, h: 0.3, fontSize: 9, color: C.grey, align: "right" });
  });
  s.addText("VAS Score", { x: 0.08, y: 2.8, w: 0.5, h: 1.0, fontSize: 9.5, color: C.grey, rotate: 270, align: "center" });

  chartData.forEach((d, i) => {
    const groupX = chartX + 0.6 + i * groupW;
    const h1 = (d.lap_open / maxVAS) * chartH;
    const h2 = (d.lap_lap  / maxVAS) * chartH;

    // laparotomy bar
    s.addShape(pres.ShapeType.rect, { x: groupX, y: chartBottom - h1, w: barW, h: h1, fill: { color: C.greyLt }, line: { color: C.grey } });
    s.addText(d.lap_open.toFixed(2), { x: groupX, y: chartBottom - h1 - 0.22, w: barW, h: 0.22, fontSize: 8.5, color: C.dark, align: "center" });

    // laparoscopy bar
    s.addShape(pres.ShapeType.rect, { x: groupX + barW + 0.12, y: chartBottom - h2, w: barW, h: h2, fill: { color: C.teal }, line: { color: C.teal } });
    s.addText(d.lap_lap.toFixed(2), { x: groupX + barW + 0.12, y: chartBottom - h2 - 0.22, w: barW, h: 0.22, fontSize: 8.5, color: C.teal, align: "center", bold: true });

    // P-value
    s.addText("P=" + d.p, { x: groupX, y: chartBottom + 0.08, w: barW * 2 + 0.12, h: 0.28, fontSize: 9, color: C.red, align: "center", bold: true });
    // day label
    s.addText(d.day, { x: groupX, y: chartBottom + 0.36, w: barW * 2 + 0.12, h: 0.25, fontSize: 10.5, color: C.dark, align: "center", bold: true });
  });

  // Legend
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  s.addText("Laparotomy", { x: 6.85, y: 1.45, w: 1.8, h: 0.2, fontSize: 10, color: C.dark });
  s.addShape(pres.ShapeType.rect, { x: 6.5, y: 1.72, w: 0.28, h: 0.2, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("Laparoscopy", { x: 6.85, y: 1.72, w: 1.8, h: 0.2, fontSize: 10, color: C.teal, bold: true });

  s.addText("Laparoscopy had significantly lower pain at ALL time points (all P < 0.05)", {
    x: 0.35, y: 5.22, w: 9.3, h: 0.3, fontSize: 10.5, bold: true, italic: true, color: C.teal
  });
}

// =============================================================================
// SLIDE 10 – CONVERSION & OPERATIVE DETAILS
// =============================================================================
{
  const s = contentSlide("Conversion to Laparotomy & Surgical Technique", "Results");

  // conversion stats
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  s.addText("Conversion Rate", { x: 0.32, y: 1.12, w: 4.3, h: 0.4, fontSize: 12.5, bold: true, color: C.gold, align: "center" });
  s.addText("34 / 64  =  53.1%", { x: 0.32, y: 1.55, w: 4.3, h: 0.55, fontSize: 22, bold: true, color: C.white, align: "center" });
  s.addText("of patients planned for laparoscopy\nrequired conversion to open", {
    x: 0.32, y: 2.1, w: 4.3, h: 0.5, fontSize: 10.5, color: C.grey, align: "center"
  });
  // reasons
  const reasons = [
    ["Poor visibility (purulent contamination)", "15 (44%)"],
    ["Dense adhesions",                          "11 (32%)"],
    ["Inadequate peritoneal lavage",             " 8 (24%)"],
  ];
  reasons.forEach(([r, n], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: 2.68 + i * 0.5, w: 4.1, h: 0.4, fill: { color: C.dark }, line: { color: C.dark }, rectRadius: 0.05 });
    s.addText(r, { x: 0.5, y: 2.68 + i * 0.5, w: 3.0, h: 0.4, fontSize: 10, color: C.white, valign: "middle" });
    s.addText(n, { x: 3.55, y: 2.68 + i * 0.5, w: 0.9, h: 0.4, fontSize: 10, color: C.gold, valign: "middle", bold: true, align: "right" });
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  // technique bullets
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  s.addText("Laparoscopic Technique", { x: 4.95, y: 1.12, w: 4.6, h: 0.3, fontSize: 11, bold: true, color: C.teal });
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  s.addText(laptech.map(t => ({ text: t, options: { bullet: { code: "25B8" }, breakLine: true, paraSpaceAfter: 3 } })),
    { x: 5.0, y: 1.45, w: 4.55, h: 0.68, fontSize: 9.5, color: C.dark });

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  s.addText("Open Technique", { x: 4.95, y: 2.32, w: 4.6, h: 0.3, fontSize: 11, bold: true, color: C.navy });
  const opentech = ["Midline laparotomy under GA", "Suction of contaminated peritoneal fluid", "Site repair ± omental (Graham's) patch ± stoma", "Thorough peritoneal lavage + drain placement", "Abdominal closure in layers"];
  s.addText(opentech.map(t => ({ text: t, options: { bullet: { code: "25B8" }, breakLine: true, paraSpaceAfter: 3 } })),
    { x: 5.0, y: 2.65, w: 4.55, h: 0.68, fontSize: 9.5, color: C.dark });

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  s.addText("📌  Comparator: Agresta et al. 2006 reported only 23.2% conversion rate — our higher rate likely reflects delayed patient presentation and greater intra-abdominal contamination", {
    x: 4.95, y: 3.6, w: 4.6, h: 0.72, fontSize: 9.5, color: C.navy, valign: "middle"
  });
}

// =============================================================================
// SLIDE 11 – DISCUSSION
// =============================================================================
{
  const s = contentSlide("Discussion", "Critical Appraisal");

  const points = [
    {
      icon: "⏱", color: C.orange,
      title: "Longer operative time in laparoscopy",
      body: "217 vs 182 min (P=0.049) — attributable to learning curve for intracorporeal suturing in emergency setting. Surgeons with advanced skills may close this gap."
    },
    {
      icon: "🏥", color: C.teal,
      title: "Shorter hospital stay: major clinical advantage",
      body: "4.4 vs 8.7 days — significant implication for resource-limited settings; improved bed turnover and cost savings."
    },
    {
      icon: "🩹", color: C.green,
      title: "Reduced wound complications",
      body: "SSI 3.6% vs 21.4%. Smaller incisions with laparoscopy substantially reduce wound morbidity."
    },
    {
      icon: "🔄", color: C.red,
      title: "High conversion rate (53%) — key limitation",
      body: "Delayed presentation → widespread contamination, adhesions. Careful patient selection is paramount."
    },
    {
      icon: "📊", color: C.navy,
      title: "PSM reduces confounding — but study is not randomised",
      body: "PSM balanced age, sex, duration of symptoms, comorbidities. However residual unmeasured confounders cannot be excluded."
    },
  ];
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    s.addText(p.body,  { x: 0.95, y: y + 0.3,  w: 8.7, h: 0.4,  fontSize: 10.5, color: C.dark });
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}

// =============================================================================
// SLIDE 12 – STRENGTHS & LIMITATIONS
// =============================================================================
{
  const s = contentSlide("Strengths & Limitations", "Critical Appraisal");

  // Strengths
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    "Prospective study design — reduces recall bias",
    "Propensity score matching — controls for major confounders",
    "Objective outcome measures (VAS, LOS, operative time)",
    "All procedures performed by consultant-level laparoscopic surgeons",
    "Consecutive recruitment from a high-volume tertiary centre",
    "Comprehensive follow-up to 30 days",
  ];
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  // Limitations
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    "Small sample size (n=56 after PSM) — underpowered for mortality analysis",
    "Single-centre study at a tertiary institution — limited generalisability",
    "Pain management not standardised (analgesia ladder, not fixed protocol)",
    "High conversion rate (53%) may reflect local expertise rather than global applicability",
    "No long-term outcomes beyond 30 days",
  ];
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}

// =============================================================================
// SLIDE 13 – TAKE-HOME MESSAGE / CONCLUSION
// =============================================================================
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    { icon: "📉", text: "Significant advantages: shorter hospital stay (4.4 vs 8.7 days), less pain, fewer SSIs, lower 30-day morbidity (10% vs 32%)" },
    { icon: "⏱", text: "Trade-off: longer operative time (217 vs 182 min) — acceptable with experienced teams" },
    { icon: "⚠️", text: "High conversion rate (53%) — patient selection is critical; delayed presentations should favour open approach" },
    { icon: "🎓", text: "Surgical training in emergency laparoscopy is essential; learning curve impacts outcomes" },
    { icon: "🔬", text: "Future work: larger multicentre RCTs, standardised analgesia protocols, longer-term follow-up" },
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  s.addText("Soni S et al. J Min Access Surg 2026;22(2):180–186  |  DOI: 10.4103/jmas.jmas_135_25", {
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// =============================================================================
// SLIDE 14 – REFERENCES
// =============================================================================
{
  const s = contentSlide("References", "Appendix");
  const refs = [
    "1. Soni S, Parihar YK, Chaudhary R, et al. Feasibility and outcomes of laparoscopic management in perforation peritonitis: a prospective cohort study with propensity score matching. J Min Access Surg 2026;22(2):180-186.",
    "2. Mouret P, François Y, Vignal J, et al. Laparoscopic treatment of perforated peptic ulcer. Br J Surg 1990;77:1006.",
    "3. Agresta F, Ciardo LF, Mazzarolo G, et al. Peritonitis: laparoscopic approach. World J Emerg Surg 2006;1:9.",
    "4. Ge B, Wu M, Chen Q, et al. A prospective randomized controlled trial of laparoscopic repair versus open repair for perforated peptic ulcers. Surgery 2016;159:451–8.",
    "5. Tan S, Wu G, Zhuang Q, et al. Laparoscopic versus open repair for perforated peptic ulcer: a meta-analysis of randomized controlled trials. Int J Surg 2016;33:124–32.",
    "6. Vakayil V, Bauman B, Joppru K, et al. Surgical repair of perforated peptic ulcers: laparoscopic versus open approach. Surg Endosc 2019;33:281–92.",
    "7. Sermonesi G, Tian BW, Vallicelli C, et al. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies. World J Emerg Surg 2023;18:57.",
  ];
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}

// =============================================================================
// WRITE
// =============================================================================
const outPath = "/home/daytona/workspace/jc-presentation/JR1_JC_Laparoscopy_Perforation_Peritonitis.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("✅ Saved: " + outPath);
}).catch(err => {
  console.error("❌ Error:", err);
});

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Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/jc-presentation/create_pptx.js'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/jc-presentation/create_pptx.js'

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Prophylactic Ureteral Stent Placement by General Surgeons - JR1 Journal Club";

// ─── THEME ───────────────────────────────────────────────────────────────────
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// =============================================================================
// SLIDE 1 – TITLE
// =============================================================================
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  s.addText("Prophylactic Ureteral Stent Placement by General Surgeons is Safe and Feasible", {
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  s.addText("UCSF Fresno  |  Retrospective Review  |  July 2017 – July 2024  |  SWSC 2025 Special Issue", {
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// =============================================================================
// SLIDE 2 – OUTLINE
// =============================================================================
{
  const s = contentSlide("Presentation Outline", "Overview");
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    ["01", "Background & Rationale", "Ureteral injury risk, prophylactic stenting, ICG use"],
    ["02", "Study Objective & Design", "Retrospective review, training/credentialing program"],
    ["03", "Methods & Cohort", "Inclusion, variables recorded, statistical analysis"],
    ["04", "Key Results", "Complication rate, cannulation success, subgroup analysis"],
    ["05", "Discussion & Appraisal", "Comparison to urologist outcomes, strengths, limitations"],
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// =============================================================================
// SLIDE 3 – BACKGROUND
// =============================================================================
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    "Associated with significant short- and long-term morbidity",
    "Strategies to mitigate injury: prophylactic ureteral stenting + intraureteral indocyanine green (ICG) injection",
    "Aids intraoperative ureter identification and immediate injury recognition/repair",
    "Traditionally performed via rigid cystoscopy by a urologist prior to abdominal incision",
  ];
  s.addText(pts.map(p => ({ text: p, options: { bullet: { code: "2022" }, breakLine: true, paraSpaceAfter: 7 } })),
    { x: 0.5, y: 1.45, w: 5.7, h: 2.9, fontSize: 11.5, color: C.dark, valign: "top" });

  s.addShape(pres.ShapeType.rect, { x: 6.45, y: 1.05, w: 3.2, h: 3.25, fill: { color: C.navy }, line: { color: C.burg, pt: 2 }, rectRadius: 0.1 });
  s.addText("The Care Gap", { x: 6.55, y: 1.1, w: 3.0, h: 0.4, fontSize: 12.5, bold: true, color: C.gold, align: "center" });
  const gaps = ["Urology coverage not\nalways available", "Requires coordination\nbetween 2 teams", "Can delay or reschedule\ncases", "OR scheduling\ninefficiency"];
  gaps.forEach((item, i) => {
    s.addShape(pres.ShapeType.rect, { x: 6.6, y: 1.62 + i * 0.65, w: 3.0, h: 0.58, fill: { color: C.dark }, line: { color: C.dark }, rectRadius: 0.05 });
    s.addText("⚠  " + item, { x: 6.65, y: 1.62 + i * 0.65, w: 2.9, h: 0.58, fontSize: 9.5, color: C.white, valign: "middle" });
  });

  s.addText("Solution: Train non-urologic surgeons (general surgery, colorectal, OB/GYN) to independently perform cystoscopy and prophylactic stent/ICG placement", {
    x: 0.35, y: 4.4, w: 9.3, h: 0.55, fontSize: 11, italic: true, bold: true, color: C.teal
  });
}

// =============================================================================
// SLIDE 4 – OBJECTIVE / PICO
// =============================================================================
{
  const s = contentSlide("Study Objective", "PICO");
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.1, w: 9.3, h: 1.4, fill: { color: C.navy }, line: { color: C.burgLt, pt: 2 }, rectRadius: 0.1 });
  s.addText("Research Question", { x: 0.5, y: 1.15, w: 9.0, h: 0.35, fontSize: 12, bold: true, color: C.gold });
  s.addText("Can non-urologic surgeons safely and feasibly perform cystoscopy with prophylactic ureteral stent placement and/or ICG injection, after completing a structured training and credentialing program?",
    { x: 0.5, y: 1.48, w: 9.0, h: 0.9, fontSize: 13, color: C.white, italic: true, valign: "middle" });

  const pico = [
    ["P", "Population",   "Adults ≥18 yrs undergoing cystoscopy + prophylactic ureteral stent/ICG placement by the primary operating surgeon"],
    ["I", "Intervention", "Cystoscopy & stent/ICG placement performed by trained, credentialed non-urologic surgeons"],
    ["C", "Comparator",   "Historical/literature benchmark of urologist-performed stenting (complication rate 2.37–12%)"],
    ["O", "Outcomes",     "Successful ureteral cannulation rate, overall complication rate, specific complications by subgroup"],
  ];
  pico.forEach(([letter, label, desc], i) => {
    const y = 2.75 + i * 0.55;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.38, h: 0.38, fill: { color: C.burg }, line: { color: C.burg }, rectRadius: 0.05 });
    s.addText(letter, { x: 0.35, y, w: 0.38, h: 0.38, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(label + ":", { x: 0.82, y: y + 0.03, w: 1.5, h: 0.32, fontSize: 11, bold: true, color: C.navy });
    s.addText(desc, { x: 2.4, y: y + 0.03, w: 7.2, h: 0.45, fontSize: 10.3, color: C.dark });
  });
}

// =============================================================================
// SLIDE 5 – METHODS
// =============================================================================
{
  const s = contentSlide("Methods", "Study Design");

  const boxes = [
    { x: 0.3,  label: "Design",   val: "Retrospective\nchart review" },
    { x: 2.85, label: "Setting",  val: "UCSF Fresno /\nCommunity Medical Centers" },
    { x: 5.4,  label: "Period",   val: "July 2017 –\nJuly 2024 (7 yrs)" },
    { x: 7.95, label: "Approval", val: "IRB approved\n(retrospective)" },
  ];
  boxes.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: 1.1, w: 2.3, h: 1.15, fill: { color: C.navy }, line: { color: C.burg, pt: 2 }, rectRadius: 0.1 });
    s.addText(b.label, { x: b.x, y: 1.12, w: 2.3, h: 0.34, fontSize: 10, bold: true, color: C.gold, align: "center" });
    s.addText(b.val,   { x: b.x, y: 1.46, w: 2.3, h: 0.75, fontSize: 11, color: C.white, align: "center", valign: "middle" });
  });

  s.addText("Population & Inclusion", { x: 0.35, y: 2.42, w: 9.3, h: 0.32, fontSize: 13, bold: true, color: C.navy });
  addRule(s, 2.72);
  s.addText("Adults (≥18 years) who underwent cystoscopy with prophylactic ureteral stent placement and/or ureteral cannulation with ICG injection, performed by the primary operating surgeon (general surgery, colorectal surgery, or OB/GYN) after completing an institutional training and credentialing program.", {
    x: 0.35, y: 2.82, w: 9.3, h: 0.75, fontSize: 11, color: C.dark
  });

  s.addText("Variables Recorded", { x: 0.35, y: 3.62, w: 9.3, h: 0.3, fontSize: 13, bold: true, color: C.navy });
  const vars = ["Patient demographics & indication for surgery", "Surgical service performing procedure", "Surgical approach: open vs. robotic vs. laparoscopic", "Laterality: unilateral vs. bilateral stent placement", "Indwelling duration: kept for procedure vs. removed after ICG", "Intra-/post-operative complications"];
  const half = 3;
  for (let i = 0; i < vars.length; i++) {
    const col = i < half ? 0 : 1;
    const row = i % half;
    s.addText("▸ " + vars[i], { x: 0.45 + col * 4.7, y: 3.95 + row * 0.32, w: 4.5, h: 0.3, fontSize: 10, color: C.dark });
  }

  s.addText("Statistics: regression analysis; significance at p<0.05; IBM SPSS v29", {
    x: 0.35, y: 5.0, w: 9.3, h: 0.3, fontSize: 9.5, italic: true, color: C.grey
  });
}

// =============================================================================
// SLIDE 6 – COHORT FLOW
// =============================================================================
{
  const s = contentSlide("Study Cohort", "Methods");

  const flowY = 1.4;
  const flowBoxes = [
    { x: 0.5,  label: "834 cases of prophylactic\nureteral cannulation with ICG\ninjection during study period", color: C.burg },
    { x: 3.75, label: "748 cases included\nafter exclusions", color: C.navy },
  ];
  flowBoxes.forEach((b, i) => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: flowY, w: 3.0, h: 1.05, fill: { color: b.color }, line: { color: b.color }, rectRadius: 0.08 });
    s.addText(b.label, { x: b.x, y: flowY, w: 3.0, h: 1.05, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    if (i < 1) s.addText("▶", { x: b.x + 3.05, y: flowY + 0.32, w: 0.45, h: 0.4, fontSize: 16, color: C.burgLt, align: "center" });
  });

  statBox(s, "Mean Age", "54.6 ± 15.7", "years", 7.05, flowY, 2.2, 1.05, C.teal);

  s.addText("Baseline Cohort Characteristics", { x: 0.35, y: 2.7, w: 9.3, h: 0.32, fontSize: 13, bold: true, color: C.navy });
  addRule(s, 3.0);

  const stats = [
    ["748", "Cases Included", C.burg],
    ["97.7%", "Female patients (majority)*", C.teal],
    ["4", "Primary services performing procedure", C.navy],
    ["7 yrs", "Study duration (2017–2024)", C.gold],
  ];
  stats.forEach((st, i) => {
    const x = 0.35 + i * 2.35;
    statBox(s, st[1], st[0], "", x, 3.15, 2.15, 1.35, st[2]);
  });

  s.addText("*Majority female reflecting predominance of gynecologic/pelvic indications (exact female count partially obscured in source scan)", {
    x: 0.35, y: 4.62, w: 9.3, h: 0.55, fontSize: 8.8, italic: true, color: C.grey
  });
}

// =============================================================================
// SLIDE 7 – PRIMARY RESULTS
// =============================================================================
{
  const s = contentSlide("Primary Outcomes", "Results");

  statBox(s, "Successful Ureteral\nCannulation Rate", "97.7%", "", 0.32, 1.1, 3.0, 1.5, C.green);
  statBox(s, "Overall Complication\nRate", "9.4%", "", 3.5, 1.1, 3.0, 1.5, C.orange);
  statBox(s, "Ureteral Injury\nRate", "0.5%", "", 6.68, 1.1, 3.0, 1.5, C.red);

  s.addText("Complication Breakdown (n = 748)", { x: 0.35, y: 2.85, w: 9.3, h: 0.32, fontSize: 12.5, bold: true, color: C.navy });

  const complications = [
    { label: "AKI", val: 4.4, color: C.orange },
    { label: "Urinary retention", val: 3.3, color: C.teal },
    { label: "UTI", val: 2.7, color: C.gold },
    { label: "Hematuria ≥3 days", val: 0.9, color: C.burg },
    { label: "Ureteral injury", val: 0.5, color: C.red },
    { label: "Urethral injury", val: 0.4, color: C.navy },
  ];
  const maxVal = 5;
  const barX = 2.0;
  const barMaxW = 6.7;
  complications.forEach((c, i) => {
    const y = 3.28 + i * 0.3;
    const bw = (c.val / maxVal) * barMaxW;
    s.addText(c.label, { x: 0.35, y, w: 1.6, h: 0.28, fontSize: 9.5, color: C.dark, valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: barX, y: y + 0.02, w: bw, h: 0.22, fill: { color: c.color }, line: { color: c.color } });
    s.addText(c.val + "%", { x: barX + bw + 0.08, y, w: 0.6, h: 0.28, fontSize: 9.5, bold: true, color: c.color, valign: "middle" });
  });

  s.addText("Complication rates comparable to published urologist-performed benchmarks (2.37–12%)", {
    x: 0.35, y: 5.15, w: 9.3, h: 0.3, fontSize: 10, bold: true, italic: true, color: C.teal
  });
}

// =============================================================================
// SLIDE 8 – SUBGROUP ANALYSIS
// =============================================================================
{
  const s = contentSlide("Subgroup Analysis: No Significant Differences", "Results");
  s.addText("Complication rates were statistically similar regardless of who performed the procedure or how it was performed", {
    x: 0.35, y: 1.0, w: 9.3, h: 0.35, fontSize: 11, italic: true, color: C.grey
  });

  const hx = [0.32, 5.2];
  const cols = [4.85, 4.0];
  const headers = ["Comparison Factor", "P-value"];
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: hx[i], y: 1.45, w: cols[i], h: 0.4, fill: { color: C.navy }, line: { color: C.navy } });
    s.addText(h, { x: hx[i], y: 1.45, w: cols[i], h: 0.4, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
  });

  const rows = [
    ["Surgical service (Gen Surg / Colorectal / OB-GYN)", "0.193"],
    ["Surgical approach (open vs. robotic vs. laparoscopic)", "0.648"],
    ["Unilateral indwelling stent", "0.768"],
    ["Bilateral indwelling stents", "0.801"],
    ["ICG injection alone (no indwelling stent)", "0.596"],
  ];
  rows.forEach((row, i) => {
    const rowY = 1.9 + i * 0.55;
    const bg = i % 2 === 0 ? C.white : C.offWhite;
    row.forEach((cell, j) => {
      s.addShape(pres.ShapeType.rect, { x: hx[j], y: rowY, w: cols[j], h: 0.5, fill: { color: bg }, line: { color: C.greyLt } });
      s.addText(cell, { x: hx[j], y: rowY, w: cols[j], h: 0.5, fontSize: 11, color: j === 1 ? C.green : C.dark, align: j === 1 ? "center" : "left", valign: "middle", bold: j === 1, margin: j===0?8:0 });
    });
  });

  s.addShape(pres.ShapeType.rect, { x: 0.32, y: 4.7, w: 9.3, h: 0.5, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.06 });
  s.addText("All P-values > 0.05 → complication risk was NOT significantly influenced by service, approach, or stenting strategy", {
    x: 0.4, y: 4.7, w: 9.1, h: 0.5, fontSize: 10.5, bold: true, color: C.white, valign: "middle", align: "center"
  });
}

// =============================================================================
// SLIDE 9 – DISCUSSION
// =============================================================================
{
  const s = contentSlide("Discussion", "Critical Appraisal");

  const points = [
    { icon: "🎯", color: C.green,  title: "Comparable to urologist-performed benchmarks", body: "9.4% overall complication rate falls within/near the published urologist range of 2.37–12% — supports non-inferiority of trained non-urologic surgeons." },
    { icon: "✅", color: C.teal,   title: "High procedural success", body: "97.7% successful ureteral cannulation rate demonstrates that the training/credentialing model translates into reliable technical competence." },
    { icon: "🗓️", color: C.gold,   title: "Solves a real operational problem", body: "Removes dependency on urology coverage — improves OR scheduling efficiency and reduces case delays at community/resource-limited centres." },
    { icon: "🔬", color: C.navy,   title: "Low ureteral/urethral injury rates", body: "Ureteral injury 0.5%, urethral injury 0.4% — reassuring safety signal despite non-urologic proceduralists." },
    { icon: "⚖️", color: C.red,    title: "No difference across approach or laterality", body: "Findings held regardless of open/robotic/laparoscopic approach or unilateral/bilateral stenting — broadly generalisable within this cohort." },
  ];
  points.forEach((p, i) => {
    const y = 1.08 + i * 0.8;
    s.addShape(pres.ShapeType.rect, { x: 0.32, y: y + 0.03, w: 0.48, h: 0.48, fill: { color: p.color }, line: { color: p.color }, rectRadius: 0.05 });
    s.addText(p.icon, { x: 0.32, y: y + 0.03, w: 0.48, h: 0.48, fontSize: 13, align: "center", valign: "middle" });
    s.addText(p.title, { x: 0.92, y: y + 0.02, w: 8.75, h: 0.26, fontSize: 11.5, bold: true, color: p.color });
    s.addText(p.body,  { x: 0.92, y: y + 0.28, w: 8.75, h: 0.42, fontSize: 10, color: C.dark });
  });
}

// =============================================================================
// SLIDE 10 – STRENGTHS & LIMITATIONS
// =============================================================================
{
  const s = contentSlide("Strengths & Limitations", "Critical Appraisal");

  s.addShape(pres.ShapeType.rect, { x: 0.32, y: 1.1, w: 4.35, h: 3.5, fill: { color: C.offWhite }, line: { color: C.green, pt: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 0.32, y: 1.1, w: 4.35, h: 0.42, fill: { color: C.green }, line: { color: C.green }, rectRadius: 0.1 });
  s.addText("✔  Strengths", { x: 0.32, y: 1.1, w: 4.35, h: 0.42, fontSize: 12.5, bold: true, color: C.white, valign: "middle", margin: 8 });
  const str = [
    "Large cohort (748 cases) over a 7-year period",
    "Structured, credentialed training program — reproducible model",
    "Multiple surgical services included (general surgery, colorectal, OB/GYN)",
    "Assessed multiple relevant subgroups (approach, laterality, ICG-only)",
    "Addresses a genuine real-world resource/access problem",
    "Statistically rigorous regression analysis (SPSS v29)",
  ];
  s.addText(str.map(t => ({ text: t, options: { bullet: { code: "2714" }, breakLine: true, paraSpaceAfter: 7 } })),
    { x: 0.45, y: 1.6, w: 4.1, h: 2.9, fontSize: 10.5, color: C.dark, valign: "top" });

  s.addShape(pres.ShapeType.rect, { x: 5.18, y: 1.1, w: 4.5, h: 3.5, fill: { color: C.offWhite }, line: { color: C.red, pt: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 5.18, y: 1.1, w: 4.5, h: 0.42, fill: { color: C.red }, line: { color: C.red }, rectRadius: 0.1 });
  s.addText("✗  Limitations", { x: 5.18, y: 1.1, w: 4.5, h: 0.42, fontSize: 12.5, bold: true, color: C.white, valign: "middle", margin: 8 });
  const lim = [
    "Retrospective design — no urologist-performed control arm within the same cohort",
    "Single institution — limited external generalisability",
    "Comparison to urologist benchmarks is indirect (literature-derived, not concurrent)",
    "Potential selection bias — surgeons chose which cases to stent",
    "No long-term renal/functional outcome data reported",
    "Learning-curve/credentialing thresholds not detailed in abstract",
  ];
  s.addText(lim.map(t => ({ text: t, options: { bullet: { code: "2718" }, breakLine: true, paraSpaceAfter: 7 } })),
    { x: 5.3, y: 1.6, w: 4.25, h: 2.9, fontSize: 10.5, color: C.dark, valign: "top" });
}

// =============================================================================
// SLIDE 11 – CONCLUSION / TAKE-HOME
// =============================================================================
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.08, h: 5.625, fill: { color: C.burgLt }, line: { color: C.burgLt } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.9, w: 10, h: 0.04, fill: { color: C.burg }, line: { color: C.burg } });

  s.addText("Conclusion & Take-Home Message", {
    x: 0.25, y: 0.1, w: 9.5, h: 0.75, fontSize: 18, bold: true, color: C.gold, valign: "middle"
  });

  const msgs = [
    { icon: "✅", text: "Cystoscopy with prophylactic ureteral stent placement CAN be safely performed by trained non-urologic surgeons" },
    { icon: "📊", text: "97.7% successful cannulation, 9.4% overall complication rate — comparable to urologist-performed benchmarks (2.37–12%)" },
    { icon: "⚖️", text: "No significant difference in complications by service, surgical approach, or stenting strategy (all P > 0.05)" },
    { icon: "🏥", text: "A credentialing program can close urology coverage gaps and improve OR scheduling efficiency" },
    { icon: "⚠️", text: "Retrospective, single-centre data — needs prospective, multi-centre validation with a concurrent comparator arm" },
    { icon: "🎓", text: "Supports wider adoption of structured training pathways for non-urologic proceduralists" },
  ];

  msgs.forEach((m, i) => {
    const y = 1.08 + i * 0.72;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y: y, w: 9.3, h: 0.6, fill: { color: C.dark }, line: { color: C.dark }, rectRadius: 0.07 });
    s.addText(m.icon, { x: 0.45, y: y, w: 0.45, h: 0.6, fontSize: 14, align: "center", valign: "middle" });
    s.addText(m.text, { x: 0.98, y: y, w: 8.55, h: 0.6, fontSize: 11, color: C.white, valign: "middle" });
  });

  s.addText("Tamashiro KK et al. Am J Surg 2025;250:116474  |  DOI: 10.1016/j.amjsurg.2025.116474  |  PMID: 40554228", {
    x: 0.35, y: 5.25, w: 9.3, h: 0.28, fontSize: 9, color: C.grey, align: "center"
  });
}

// =============================================================================
// SLIDE 12 – REFERENCES
// =============================================================================
{
  const s = contentSlide("References", "Appendix");
  const refs = [
    "1. Tamashiro KK, Wilkins CJ, Maron A, Kwok AM, Vue Y, Gallegos J, Tom C, Livingston-Rosanoff D, Emeny P, Disbrow D. Prophylactic ureteral stent placement by general surgeons is safe and Feasible: Implementation of a training and credentialing program for non-urologic surgeons. Am J Surg 2025;250:116474. PMID: 40554228.",
    "2. da Silva G, Boutros M, Wexner SD. Role of prophylactic ureteric stents in colorectal surgery. Asian J Endosc Surg 2012.",
    "3. Merola J, Arnold B, Luks V, et al. Prophylactic Ureteral Stent Placement vs No Ureteral Stent Placement During Open Colectomy. JAMA Surg 2018.",
    "4. Rizvi SAA, Leung A, Pretorius CF, et al. Role of general surgeons in acute urinary obstruction. ANZ J Surg 2016.",
  ];
  s.addText(refs.map(r => ({ text: r, options: { breakLine: true, paraSpaceAfter: 14 } })),
    { x: 0.35, y: 1.15, w: 9.3, h: 4.0, fontSize: 10.5, color: C.dark, valign: "top" });

  s.addText("Note: This summary is based on the article's title page/abstract (from provided scan) plus supplementary abstract data retrieved via PubMed (PMID: 40554228) and the publisher listing, as the full-text methods/discussion/results sections were partially cropped in the source image.", {
    x: 0.35, y: 4.85, w: 9.3, h: 0.6, fontSize: 8.5, italic: true, color: C.grey
  });
}

// =============================================================================
// WRITE
// =============================================================================
const outPath = "/tmp/workspace/jc-ureteral-stent/JR1_JC_Ureteral_Stent_Placement.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("Saved: " + outPath);
}).catch(err => {
  console.error("Error:", err);
});

from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.chart.data import CategoryChartData
from pptx.enum.chart import XL_CHART_TYPE, XL_LEGEND_POSITION
from pptx.enum.dml import MSO_THEME_COLOR

OUT='/tmp/workspace/jc-scanned-article/JR1_JC_LLM_Surgical_Exams_Meta_Analysis.pptx'
prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5)
blank=prs.slide_layouts[6]
NAVY='102A43'; TEAL='007C83'; GOLD='E6A93D'; OFF='F5F8FA'; INK='172B3A'; MUTED='587080'; RED='B6413B'; GREEN='16836B'; WHITE='FFFFFF'; PALE='DDEBF0'
def rgb(h): return RGBColor.from_string(h)
def rect(s,x,y,w,h,color, radius=False, line=None):
    sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h))
    sh.fill.solid(); sh.fill.fore_color.rgb=rgb(color); sh.line.color.rgb=rgb(line or color)
    return sh
def text(s,tx,x,y,w,h,size=18,color=INK,bold=False,align=PP_ALIGN.LEFT, valign=MSO_ANCHOR.TOP, font='Aptos', margin=.06):
    sh=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=sh.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin); tf.vertical_anchor=valign
    lines=tx if isinstance(tx,list) else [tx]
    for i,line in enumerate(lines):
        p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line; p.alignment=align; p.space_after=Pt(4)
        for r in p.runs: r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=rgb(color)
    return sh
def title(s,kicker,heading,subtitle=''):
    rect(s,0,0,13.333,.24,TEAL); text(s,kicker.upper(),.55,.45,12,.26,10,TEAL,True); text(s,heading,.55,.73,12.1,.58,26,NAVY,True)
    if subtitle:text(s,subtitle,.55,1.31,12,.37,12,MUTED)
    rect(s,.55,1.78,12.22,.025,PALE)
def foot(s,n):
    rect(s,.55,7.12,12.22,.018,PALE); text(s,'JR1 JOURNAL CLUB',.55,7.18,2.3,.18,8,MUTED,True); text(s,str(n).zfill(2),12.22,7.16,.55,.2,9,TEAL,True,PP_ALIGN.RIGHT)
def card(s,x,y,w,h,hd,body,accent=TEAL):
    rect(s,x,y,w,h,WHITE,True,PALE); rect(s,x,y,.09,h,accent); text(s,hd,x+.22,y+.15,w-.35,.32,14,NAVY,True); text(s,body,x+.22,y+.58,w-.35,h-.68,12,INK)
def bullet(s,items,x,y,w,h,size=15):
    sh=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=sh.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=Inches(.05); tf.margin_right=Inches(.05)
    for i,item in enumerate(items):
        p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=item; p.level=0; p.font.size=Pt(size); p.font.name='Aptos'; p.font.color.rgb=rgb(INK); p.space_after=Pt(10); p.bullet=True
    return sh
def new(bg=OFF):
    s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,bg); return s
#1
s=new(NAVY); rect(s,.65,.72,.12,5.9,TEAL); text(s,'JR1 JOURNAL CLUB',1.0,.78,5,.3,12,'7BE5DD',True); text(s,'Can large language models\npass surgical examinations?',1.0,1.34,10.8,1.45,33,WHITE,True); text(s,'Performance of ChatGPT versus Google Bard on Answering Postgraduate-Level Surgical Examination Questions: A Meta-Analysis',1.03,3.0,10.5,.75,17,'DDEBF0'); rect(s,1.03,4.12,3.0,.38,GOLD,True); text(s,'Indian Journal of Surgery • 2025',1.12,4.18,2.8,.2,10,NAVY,True,PP_ALIGN.CENTER); text(s,'Albert Andrew & Sunny Zhao\nPresented by: JR1 | Department of Surgery | Date: __________',1.03,5.12,8.5,.6,13,'DDEBF0'); text(s,'ARTICLE APPRAISAL',10.0,6.37,2.2,.2,10,'7BE5DD',True,PP_ALIGN.RIGHT)
#2
s=new(); title(s,'ROADMAP','Journal Club outline','A systematic review and meta-analysis of ChatGPT-3.5, ChatGPT-4.0 and Google Bard (Gemini).')
items=[('01','Why this matters'),('02','Research question & methods'),('03','Study selection'),('04','Results'),('05','Critical appraisal'),('06','Take-home message')]
for i,(a,b) in enumerate(items):
 x=.8+(i%3)*4.1; y=2.25+(i//3)*1.75; rect(s,x,y,3.55,1.22,WHITE,True,PALE); text(s,a,x+.2,y+.21,.48,.26,13,TEAL,True); text(s,b,x+.82,y+.2,2.4,.34,16,NAVY,True); text(s,['Clinical relevance','Design and conduct','Evidence base','Effect estimates','Bias and applicability','Practice implication'][i],x+.82,y+.62,2.45,.24,11,MUTED)
foot(s,2)
#3
s=new(); title(s,'BACKGROUND','Why assess LLMs in surgical education?')
card(s,.7,2.2,3.85,3.65,'The opportunity','LLMs can generate human-like answers to complex prompts and could support revision, formative feedback and knowledge retrieval.',TEAL)
card(s,4.75,2.2,3.85,3.65,'The risk','A correct answer does not prove sound clinical reasoning. Hallucination, opaque reasoning and outdated knowledge can mislead trainees.',GOLD)
card(s,8.8,2.2,3.85,3.65,'The gap','Individual benchmark studies report variable performance across surgical domains. A pooled estimate helps define the current evidence.',RED)
foot(s,3)
#4
s=new(); title(s,'QUESTION','Objective and review question')
rect(s,.75,2.2,11.8,1.15,NAVY,True); text(s,'Objective: compare the accuracy of publicly available ChatGPT (3.5 / 4.0) and Google Bard in postgraduate-level surgical multiple-choice examination questions.',1.05,2.52,11.15,.4,17,WHITE,True,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE)
for i,(hd,bd,col) in enumerate([('Population / material','Postgraduate-level surgical MCQ question sets',TEAL),('Index tests','ChatGPT-3.5, ChatGPT-4.0 and Google Bard',GOLD),('Outcome','Proportion of questions answered correctly',RED),('Design','Systematic review and random-effects meta-analysis',GREEN)]): card(s,.85+(i%2)*6.05,3.75+(i//2)*1.35,5.55,1.05,hd,bd,col)
foot(s,4)
#5
s=new(); title(s,'METHODS','How was the review conducted?')
card(s,.72,2.12,3.85,3.92,'Search & eligibility','• PubMed/MEDLINE and Cochrane Library\n• Comparative studies of ChatGPT and Google Bard\n• Postgraduate-level surgical MCQs\n• Studies from 2023-2024',TEAL)
card(s,4.75,2.12,3.85,3.92,'Analysis','• Full texts reviewed\n• Random-effects models\n• Pooled accuracy with 95% CI\n• Odds ratios for head-to-head comparisons\n• I² for heterogeneity',GOLD)
card(s,8.78,2.12,3.85,3.92,'Bias assessment','• Funnel plots\n• Egger test for asymmetry\n• Statistical significance: P < 0.05\n• Evidence is based on benchmark datasets, not clinical care',RED)
foot(s,5)
#6
s=new(); title(s,'EVIDENCE BASE','Study selection and included evidence')
# PRISMA
steps=[('Database records','60'),('Title/abstract screened','60'),('Full texts assessed','25'),('Included studies','12')]
for i,(a,b) in enumerate(steps):
 x=.75+i*3.1; rect(s,x,2.45,2.45,1.25,WHITE,True,PALE); text(s,b,x,2.65,2.45,.38,25,TEAL,True,PP_ALIGN.CENTER); text(s,a,x+.12,3.14,2.2,.28,11,NAVY,True,PP_ALIGN.CENTER)
 if i<3: text(s,'→',x+2.52,2.86,.45,.25,22,GOLD,True,PP_ALIGN.CENTER)
text(s,'Full-text review: 12 studies were included. The article reports question sets spanning postgraduate surgical science examinations and subspecialties including ENT, urology, plastic surgery and urogynecology.',.95,4.35,11.4,.7,16,INK,False,PP_ALIGN.CENTER)
rect(s,1.4,5.45,10.55,.62,'E7F5F4',True); text(s,'Important: the 12 studies are benchmark comparisons. Their question banks, prompts, scoring and versions were not uniform.',1.65,5.63,10.05,.22,13,TEAL,True,PP_ALIGN.CENTER)
foot(s,6)
#7
s=new(); title(s,'RESULTS','Pooled accuracy by model')
chart_data=CategoryChartData(); chart_data.categories=['ChatGPT-4.0','ChatGPT-3.5','Google Bard']; chart_data.add_series('Pooled accuracy (%)',(73,56,55))
chart=s.shapes.add_chart(XL_CHART_TYPE.COLUMN_CLUSTERED,Inches(.75),Inches(2.15),Inches(6.1),Inches(3.9),chart_data).chart
chart.has_legend=False; chart.value_axis.maximum_scale=100; chart.value_axis.minimum_scale=0; chart.value_axis.major_unit=20; chart.category_axis.tick_labels.font.size=Pt(12); chart.value_axis.tick_labels.font.size=Pt(10); chart.series[0].format.fill.solid(); chart.series[0].format.fill.fore_color.rgb=rgb(TEAL)
card(s,7.25,2.2,5.25,1.05,'ChatGPT-4.0','73% pooled accuracy (95% CI 65%-80%); P < 0.01; I² = 94%',TEAL)
card(s,7.25,3.5,5.25,1.05,'ChatGPT-3.5','56% pooled accuracy (95% CI 52%-61%); P < 0.01; I² = 78%',GOLD)
card(s,7.25,4.8,5.25,1.05,'Google Bard','55% pooled accuracy (95% CI 50%-61%); P < 0.01; I² = 89%',RED)
foot(s,7)
#8
s=new(); title(s,'RESULTS','Head-to-head comparisons')
rect(s,.8,2.15,5.85,3.7,WHITE,True,PALE); text(s,'ChatGPT-3.5 vs Google Bard',1.15,2.52,5.15,.32,19,NAVY,True,PP_ALIGN.CENTER); text(s,'OR 0.98',1.25,3.15,4.95,.58,34,TEAL,True,PP_ALIGN.CENTER); text(s,'95% CI 0.80-1.21 | P = 0.88 | I² = 67%',1.25,3.87,4.95,.3,14,MUTED,False,PP_ALIGN.CENTER); text(s,'No statistically significant difference.',1.25,4.68,4.95,.3,15,INK,True,PP_ALIGN.CENTER)
rect(s,6.72,2.15,5.85,3.7,WHITE,True,PALE); text(s,'ChatGPT-4.0 vs Google Bard',7.05,2.52,5.15,.32,19,NAVY,True,PP_ALIGN.CENTER); text(s,'OR 2.25',7.15,3.15,4.95,.58,34,GOLD,True,PP_ALIGN.CENTER); text(s,'95% CI 1.73-2.91 | P < 0.01 | I² = 78%',7.15,3.87,4.95,.3,14,MUTED,False,PP_ALIGN.CENTER); text(s,'ChatGPT-4.0 was significantly more accurate.',7.15,4.68,4.95,.3,15,INK,True,PP_ALIGN.CENTER)
foot(s,8)
#9
s=new(); title(s,'INTERPRETATION','What do these results mean?')
for i,(hd,bd,col) in enumerate([('Capability','GPT-4.0 achieved the best pooled exam accuracy, but performance was not near-perfect.',TEAL),('Consistency','Marked heterogeneity (I² 78%-94%) indicates performance varies substantially by study and question set.',GOLD),('Safety','Exam performance is not a substitute for supervised clinical judgment, guideline use or local protocols.',RED),('Education','Potential role: adjunctive revision and feedback tool, with transparent verification by educators.',GREEN)]): card(s,.75+(i%2)*6.05,2.15+(i//2)*1.8,5.55,1.45,hd,bd,col)
foot(s,9)
#10
s=new(); title(s,'CRITICAL APPRAISAL','Strengths and limitations')
card(s,.75,2.12,5.8,3.98,'Strengths','• Timely question in surgical education\n• Systematic search of two major databases\n• Meta-analytic comparison rather than relying on one benchmark\n• Reports uncertainty (95% CI), heterogeneity and publication-bias checks\n• Direct comparison of three widely used models',GREEN)
card(s,6.78,2.12,5.8,3.98,'Limitations','• Only 12 studies, mostly 2023-2024\n• Very high heterogeneity limits a single pooled interpretation\n• Likely different question sources, prompts and scoring methods\n• Model versions are rapidly outdated\n• MCQ accuracy may not test reasoning, calibration, citation accuracy or clinical safety\n• No patient-level or educational-outcome evidence',RED)
foot(s,10)
#11
s=new(); title(s,'APPLICABILITY','Implications for a JR1 surgical trainee')
for i,(n,hd,bd) in enumerate([('1','Use it to learn','Ask for explanations, differential diagnoses and quiz questions.'),('2','Verify it','Check every answer against standard textbooks, guidelines and a senior.'),('3','Protect patients','Never use an LLM as an independent source for a clinical decision.'),('4','Know its limits','Errors are often plausible. Confidence in wording is not evidence of correctness.')]):
 x=.8+(i%2)*6.0;y=2.15+(i//2)*1.75; rect(s,x,y,5.55,1.35,WHITE,True,PALE); rect(s,x+.2,y+.2,.55,.55,TEAL,True); text(s,n,x+.2,y+.34,.55,.16,14,WHITE,True,PP_ALIGN.CENTER); text(s,hd,x+.95,y+.21,4.3,.28,15,NAVY,True); text(s,bd,x+.95,y+.63,4.25,.43,12,INK)
foot(s,11)
#12
s=new(NAVY); text(s,'TAKE-HOME MESSAGE',.8,.85,11.6,.3,13,'7BE5DD',True,PP_ALIGN.CENTER); text(s,'GPT-4.0 outperformed Google Bard\non surgical examination questions.',1.0,1.5,11.3,1.08,31,WHITE,True,PP_ALIGN.CENTER); rect(s,4.0,3.0,5.33,.05,GOLD); text(s,'But pooled accuracy was 73% and heterogeneity was high.\nLLMs are promising educational adjuncts, not independent clinical decision-makers.',1.3,3.55,10.7,.75,18,'DDEBF0',False,PP_ALIGN.CENTER); text(s,'Critical appraisal: benchmark accuracy ≠ clinical competence.',1.4,5.25,10.5,.36,17,'7BE5DD',True,PP_ALIGN.CENTER); text(s,'Reference: Andrew A, Zhao S. Indian J Surg. 2025;88(1):22-31. doi:10.1007/s12262-025-04296-X',.9,6.72,11.55,.22,9,'AFC4D2',False,PP_ALIGN.CENTER)
prs.save(OUT); print(OUT)