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Fischer T, Brothers KB, Erdmann P, Langanke M. Clinical decision-making and secondary findings in systems medicine. BMC Med Ethics 2016; 17:32. [PMID: 27209083 PMCID: PMC4875611 DOI: 10.1186/s12910-016-0113-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/10/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Systems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology (especially systems biology); "big data" statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems medicine knowledge and clinicians working to apply it. DISCUSSION This article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through "big data" approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the "death computer," to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their "quantified self." This paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care.
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Wolf D, Fischer T, Fazelnia C, Schilcher A, Wertaschnigg D. Misodel – erste Erfahrung einer neuen Geburtseinleitungsmethode. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1582200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hösel S, Fazelnia C, Stierle C, Fischer T, Wertaschnigg D. Postpartales akutes Nierenversagen mit thrombotischer Mikroangiopathie bei St.p. Präeklampsie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1582187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Klaassen Federspiel F, Peintinger F, Sir A, Fischer T, Reitsamer R. Technische und kosmetische Ergebnisse sowie Komplikationsraten nach Nipple sparing mastectomy (NSM) und Sofortrekonstruktion der Brust mittels Implantatabdeckung durch porcine azelluläre dermale Matrix. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1579597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hutter J, Sir A, Fischer T, Reitsamer R. Portmetastase im Bereich der Brust nach thorakoskopischer Resektion einer Lungenmetastase bei Analkarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1579596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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81
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Gouy C, Fazelnia C, Wolfrum-Ristau P, Koch H, Mlineritsch B, Schönlieb C, Kronberger C, Bogner G, Fischer T. Primäres diffus großzelliges B-Zell-Lymphom der Zervix in der Schwangerschaft – ein Fallbericht. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1579591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Fischer T, Thomas P. Zentrale Sonografieabteilung unter Leitung der Radiologie: How to do. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fischer T, Thomas P. Von Navigation über Fusion bis zur Intervention: Ultraschall schießt aus allen Rohren. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fischer T. Sonografie basics. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fischer T. Pankreastumoren: CEUS oder doch gleich CT? Pro CEUS. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fischer T, Martínez-Pinedo G, Hempel M, Huther L, Röpke G, Typel S, Lohs A. Expected impact from weak reactions with light nuclei in corecollapse supernova simulations. EPJ WEB OF CONFERENCES 2016. [DOI: 10.1051/epjconf/201610906002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bolten K, Thomas A, Löschmann YYN, Diederichs G, Fischer T. Die Sectionarbe in der Bildfusion. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bogner G, Wallner V, Resenberger K, Fischer T. Welchen Einfluss hat die Lage des II. Zwillings auf das perinatale Outcome? Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bogner G, Fazelnia C, Strobl M, Fischer T, Jacobs V. Breech delivery of the second twin in all fours position of the mother. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gharehbaghi D, Fischer T, Bogner G. Effect of corticosteroid therapy in HELLP syndrome. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schäfer G, Dobos G, Lünnemann L, Blume-Peytavi U, Fischer T, Kottner J. Using ultrasound elastography to monitor human soft tissue behaviour during prolonged loading: A clinical explorative study. J Tissue Viability 2015; 24:165-72. [DOI: 10.1016/j.jtv.2015.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/14/2015] [Accepted: 06/18/2015] [Indexed: 01/25/2023]
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Arreba-Tutusaus P, Mack TS, Bullinger L, Schnöder TM, Polanetzki A, Weinert S, Ballaschk A, Wang Z, Deshpande AJ, Armstrong SA, Döhner K, Fischer T, Heidel FH. Impact of FLT3-ITD location on sensitivity to TKI-therapy in vitro and in vivo. Leukemia 2015; 30:1220-1225. [PMID: 26487272 DOI: 10.1038/leu.2015.292] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Emami K, Sandel N, Tedaldi E, Fischer T, Minniti N. DIVERSITYA-02Word Reading Ability is a Better Predictor of Global Neuropsychological Performance in an Urban HIV+ Cohort. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sandel N, Emami K, Tedaldi E, Fischer T, Minniti N. NEUROPSYCHOLOGICAL DOMAINS: EXECUTIVE FUNCTIONSC-35Construct Validity of NAB Mazes and Relationship with CD4+ T-cell Nadirs in an Urban HIV+ Cohort. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jayavelu AK, Müller JP, Bauer R, Böhmer SA, Lässig J, Cerny-Reiterer S, Sperr WR, Valent P, Maurer B, Moriggl R, Schröder K, Shah AM, Fischer M, Scholl S, Barth J, Oellerich T, Berg T, Serve H, Frey S, Fischer T, Heidel FH, Böhmer FD. NOX4-driven ROS formation mediates PTP inactivation and cell transformation in FLT3ITD-positive AML cells. Leukemia 2015; 30:473-83. [DOI: 10.1038/leu.2015.234] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 08/04/2015] [Accepted: 08/14/2015] [Indexed: 12/21/2022]
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Fischer T, Kamps U. Power Maps in Goodness-of-fit Testing Based on Censored Samples. COMMUN STAT-SIMUL C 2015. [DOI: 10.1080/03610918.2013.839034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sirsch E, Gnass I, Fischer T. [Diagnostics of pain in old age. Perspectives on a multidimensional phenomenon]. Schmerz 2015; 29:339-48. [PMID: 26238374 DOI: 10.1007/s00482-015-0026-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Old people's experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.
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Fischer T, Anke T. Optimierung und Integration neuer Ultraschallmodalitäten in ein interdisziplinäres Ultraschall-Zentrum. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Baur A, Wagner M, Kilic E, Fischer T, Durmus T. Multiparametrische MRT der Prostata zur Tumordetektion bei 3 Tesla mit und ohne endorektaler Spule: Ein intraindividueller Vergleich von Bildqualität und diagnostischer Genauigkeit. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fischer T, Thomas A. Fusion zur Interventionsplanung bei Prostata-CA. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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