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Mishkin K, Flax C. Evaluation of Implicit Bias Training in Continuing Medical and Nursing Education to Address Racial Bias in Maternity Health Care Settings. Public Health Rep 2024; 139:37S-43S. [PMID: 38646821 PMCID: PMC11339674 DOI: 10.1177/00333549241245271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVES Implicit bias can affect clinical decisions that influence the care received by patients whose ancestors had been subjected to unfair medical and social practices. However, literature describing the effects of implicit bias training as part of continuing medical and nursing education is scarce. We conducted a longitudinal evaluation of a training for maternal health care clinical and nonclinical staff. METHODS A total of 80 staff members at 2 clinical sites in Cleveland, Ohio, participated in the training and evaluation in 2020 and 2021. We used a mixed-methods evaluation to capture changes in knowledge, awareness of bias, and application of strategies to reduce biased behavior by conducting pre- and posttraining surveys immediately after training and interviews at 3 and 6 months posttraining. We conducted univariate and bivariate analyses of the surveys and recorded, transcribed, and analyzed interviews for themes. RESULTS Using a threshold of answering 3 of 5 knowledge questions correctly, 50 of 80 (62.5%) trainees who engaged in the evaluation passed the pretraining knowledge questions and 67 (83.8%) passed the posttraining knowledge questions. Of the 80 participants, 75 (93.8%) were women. Interviewees (n = 11) said that low staff-to-patient ratios, lack of racial and ethnic diversity in leadership, inadequate training on implicit bias, and lack of institutional consequences for poor behavior exacerbated bias in maternity care. Interviewees reported having heightened awareness of bias and feeling more empowered after the training to advocate for themselves and patients to prevent and mitigate bias in the hospital. CONCLUSION Additional study describing the effect of implicit bias training as part of continuing medical education should be conducted, and administrative and management changes should also be made to prevent bias and improve quality of care.
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Affiliation(s)
- Kathryn Mishkin
- Data Science and Mission Strategy Office, March of Dimes, Arlington, VA, USA
| | - Chasmine Flax
- Data Science and Mission Strategy Office, March of Dimes, Arlington, VA, USA
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202
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Zgardau A, Hathi K, Fowler J, Mullowney T, Price A, Husein M, Graham ME, Dzioba A, Madou E, Strychowsky JE. Carbon Footprint Reduction Associated With Multidisciplinary Pediatric Airway Clinics: A Program Evaluation Study. OTO Open 2024; 8:e167. [PMID: 38974174 PMCID: PMC11222738 DOI: 10.1002/oto2.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Health care is a significant contributor to the climate crisis. Multidisciplinary clinics (MDC) may reduce carbon emissions by combining multiple appointments into one. This is the first program evaluation study to quantify the carbon footprint associated with multidisciplinary pediatric airway clinics. Study Design Retrospective. Setting Children's Hospital at London Health Sciences Center, London, Canada. Methods Pediatric airway MDC allows patients to see otolaryngology and respirology in one appointment. The carbon and financial savings (Canadian Dollars) of all patients attending the MDC from January 1, 2018 to December 31, 2022 were calculated. Patient postal codes and institutional parking rates were inputted into the CASCADES carbon accounting tool. Total distance was divided into unsustainable (vehicles) and sustainable (transit, walking, cycling) transportation to calculate carbon emissions. Travel costs included cost/kilometer for vehicles (maintenance, license/registration, insurance, fuel) and costs/ride for transit. Results A total of 560 MDC appointments for 300 patients saved 77,785 km. Total carbon emissions saved from travel averted was 16.21 tonnes. The total carbon emissions saved, minus public transit, was 15.60 tonnes. Using the Natural Resources Canada Greenhouse Gas Equivalencies Calculator, 16.21 tonnes are approximately equivalent to 5 passenger vehicles, 6906 L of gasoline, 3.8 homes' energy, and 10.8 homes' electricity use for one year, 36.6 barrels of oil consumed, and 675 propane cylinders. Travel costs of $28,891.83 (no parking), $30,519.40 ($4 minimum parking fee), or $33,774.55 ($12 maximum parking fee) were saved. Conclusion MDC effectively reduced carbon emissions and offered patients financial savings. Similar models can be adapted across institutions to help mitigate climate change.
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Affiliation(s)
- Alina Zgardau
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Kalpesh Hathi
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - James Fowler
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Tara Mullowney
- Department of Pediatrics, Division of RespirologyWestern UniversityLondonOntarioCanada
| | - April Price
- Department of Pediatrics, Division of RespirologyWestern UniversityLondonOntarioCanada
| | - Murad Husein
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - M. Elise Graham
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Agnieszka Dzioba
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Edward Madou
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Julie E. Strychowsky
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
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203
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Isleem UN, Zaidat B, Ren R, Geng EA, Burapachaisri A, Tang JE, Kim JS, Cho SK. Can generative artificial intelligence pass the orthopaedic board examination? J Orthop 2024; 53:27-33. [PMID: 38450060 PMCID: PMC10912220 DOI: 10.1016/j.jor.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 03/08/2024] Open
Abstract
Background Resident training programs in the US use the Orthopaedic In-Training Examination (OITE) developed by the American Academy of Orthopaedic Surgeons (AAOS) to assess the current knowledge of their residents and to identify the residents at risk of failing the Amerian Board of Orthopaedic Surgery (ABOS) examination. Optimal strategies for OITE preparation are constantly being explored. There may be a role for Large Language Models (LLMs) in orthopaedic resident education. ChatGPT, an LLM launched in late 2022 has demonstrated the ability to produce accurate, detailed answers, potentially enabling it to aid in medical education and clinical decision-making. The purpose of this study is to evaluate the performance of ChatGPT on Orthopaedic In-Training Examinations using Self-Assessment Exams from the AAOS database and approved literature as a proxy for the Orthopaedic Board Examination. Methods 301 SAE questions from the AAOS database and associated AAOS literature were input into ChatGPT's interface in a question and multiple-choice format and the answers were then analyzed to determine which answer choice was selected. A new chat was used for every question. All answers were recorded, categorized, and compared to the answer given by the OITE and SAE exams, noting whether the answer was right or wrong. Results Of the 301 questions asked, ChatGPT was able to correctly answer 183 (60.8%) of them. The subjects with the highest percentage of correct questions were basic science (81%), oncology (72.7%, shoulder and elbow (71.9%), and sports (71.4%). The questions were further subdivided into 3 groups: those about management, diagnosis, or knowledge recall. There were 86 management questions and 47 were correct (54.7%), 45 diagnosis questions with 32 correct (71.7%), and 168 knowledge recall questions with 102 correct (60.7%). Conclusions ChatGPT has the potential to provide orthopedic educators and trainees with accurate clinical conclusions for the majority of board-style questions, although its reasoning should be carefully analyzed for accuracy and clinical validity. As such, its usefulness in a clinical educational context is currently limited but rapidly evolving. Clinical relevance ChatGPT can access a multitude of medical data and may help provide accurate answers to clinical questions.
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Affiliation(s)
- Ula N. Isleem
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bashar Zaidat
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Renee Ren
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric A. Geng
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aonnicha Burapachaisri
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin E. Tang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S. Kim
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Jones A, Clark H, Girdler J. Climate-conscious sedation: how can we sustainably manage dental anxiety using inhalation sedation? Br Dent J 2024; 237:87-92. [PMID: 39060586 DOI: 10.1038/s41415-024-7573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 07/28/2024]
Abstract
Climate change represents an urgent global threat. Without action, rising temperatures resulting from human activity will increasingly affect our health and wellbeing through changing patterns of disease, extreme weather events and availability of resources. Expedient decarbonisation of the UK economy is an ambitious goal to which we must all contribute.The NHS aims to be the world's first net-zero health service and reach carbon-neutral status by 2040. Dental services are particularly resource-intensive. Some dental anxiety management techniques have a disproportionately high impact on the environment relative to their usage. Inhalation sedation with nitrous oxide is one such example.Nitrous oxide is a greenhouse gas almost 300 times more potent than carbon dioxide, but its utility to facilitate dental treatment for anxious and vulnerable patients is well-documented. This paper balances the health utility with environmental and social harm of continuing to use nitrous oxide and suggests evidence-based methods we can apply to limit the environmental impact of sedation services.
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Affiliation(s)
- Adam Jones
- School of Dentisty, University of Leeds, Leeds, UK.
| | - Helen Clark
- School of Dentisty, University of Leeds, Leeds, UK
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205
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Rieger C, Dean JA, Hall L, Vasquez P, Merlo G. Barriers and Enablers Affecting the Uptake of Biosimilar Medicines Viewed Through the Lens of Actor Network Theory: A Systematic Review. BioDrugs 2024; 38:541-555. [PMID: 38879730 PMCID: PMC11247062 DOI: 10.1007/s40259-024-00659-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND OBJECTIVE Biosimilars represent an opportunity to realise savings against the costs of innovative medicines. Despite efforts made by stakeholders, there are numerous barriers to the uptake of biosimilars. To realise the promise of biosimilars reducing costs, barriers must be identified, understood, and overcome, and enablers magnified. The aim of this systematic review is to summarise the enablers and barriers affecting uptake of biosimilars through the application of a classification system to organise them into healthcare professional (HCP), patient, or systemic categories. METHODS A systematic literature search was performed in PubMed, Scopus, CINAHL, eConlit, and Embase. Included were primary research studies published in English between Jan 2017 through June 2023 focused on enablers and barriers affecting uptake of biosimilars. Excluded studies comprised comparisons of biosimilar efficacy and safety versus the reference biologic. One reviewer extracted data that included classification of barriers or enablers, the sub-classification, and the identification of the degree of agency associated with the actor through their role and associations as a mediator within their network, through the application of Actor Network Theory. The data were validated by a second reviewer (PV). RESULTS Of the 94 studies included, 59 were cross-sectional, 20 were qualitative research, 12 were cohort studies, and three were economic evaluations. Within the review, 51 of the studies included HCP populations and 35 included patients. Policies and guidelines were the most cited group of enablers, overall. Systemic enablers were addressed in 29 studies. For patients, the most frequently cited enabler was positive framing of a biosimilar, while for HCPs, cost benefit was the most frequently noted enabler. The most frequently discussed systemic barrier to biosimilar acceptance was lack of effective policies or guidelines, followed by lack of financial incentives, while the most significant barriers for HCPs and patients, respectively, were their lack of general knowledge about biosimilars and concerns about safety and efficacy. Systemic actors and HCPs most frequently acted with broad degree of agency as mediators, while patient most frequently acted with a narrow degree of agency as mediators within their networks. CONCLUSIONS Barriers and enablers affecting uptake of biosimilars are interconnected within networks, and can be divided into systemic, HCP, and patient categories. Understanding the agency of actors within networks may allow for more comprehensive and effective approaches. Systemic enablers in the form of policies appear to be the most effective overall levers in affecting uptake of biosimilars, with policy makers advised to give careful consideration to appropriately educating HCPs and positively framing biosimilars for patients.
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Affiliation(s)
- Chad Rieger
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Judith A Dean
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
| | - Lisa Hall
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
| | - Paola Vasquez
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Gregory Merlo
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
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206
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Hussan A, Satheeskaran M, Dho H, Basu A, Fazaldin Y, Tariq S, Farkas M. GP perceptions of informal peer support in primary care: a qualitative study. BJGP Open 2024; 8:BJGPO.2023.0151. [PMID: 38228333 PMCID: PMC11300985 DOI: 10.3399/bjgpo.2023.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/20/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Burnout is on the rise among GPs in the UK. One approach to mitigating burnout in GPs is through informal peer support (IPS). This refers to GPs informally supporting each other on an informational (advice) and emotional (venting and reflection) basis. AIM To explore GPs' perceptions of how IPS manifests in the primary care setting and what factors influence effective GP engagement with IPS. DESIGN & SETTING A qualitative study utilising semi-structured interviews to develop an in-depth understanding of GPs' perceptions of IPS, based on their experiences in practices across England. METHOD Fifteen GPs were purposively sampled to include the views of locum, salaried, and trainee GPs and GP partners. Semi-structured interviews were conducted, recorded, and transcribed verbatim. Transcripts were analysed using inductive thematic analysis. RESULTS Four types of IPS were identified relating to emotional support, professional advice, sharing of workload, and mentorship, which reflect existing literature. The frequency and efficacy of IPS was found to be influenced by several factors categorised into individual traits, practice culture, and occupation. CONCLUSION The results highlight where efforts should be directed to improve GP engagement with IPS. Specifically, GP leaders have an important role in shaping practice culture and fostering an environment for IPS to occur. Practices may also benefit from introducing professional development measures targeted at training GPs to better support each other based on their individual traits.
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Affiliation(s)
- Aminah Hussan
- Imperial College Business School, Imperial College London, London, UK
| | - Maya Satheeskaran
- Imperial College Business School, Imperial College London, London, UK
| | - Hajin Dho
- Imperial College Business School, Imperial College London, London, UK
| | - Avishek Basu
- Imperial College Business School, Imperial College London, London, UK
| | - Yunis Fazaldin
- Imperial College Business School, Imperial College London, London, UK
| | - Samir Tariq
- Imperial College Business School, Imperial College London, London, UK
| | - Maria Farkas
- Imperial College Business School, Imperial College London, London, UK
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207
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Sisk BA, Antes AL, Bereitschaft C, Bourgeois F, DuBois JM. Providing Adolescents with Access to Online Patient Portals: Interviews with Parent-Adolescent Dyads. J Pediatr 2024; 270:114015. [PMID: 38492914 DOI: 10.1016/j.jpeds.2024.114015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To identify perceived benefits, problems, facilitators, and barriers to adolescent online patient portal use. STUDY DESIGN Qualitative, semi-structured interviews with dyads of parents and adolescents with or without chronic illness. The study team purposively sampled for racial and ethnic minorities and fathers. Three team members then performed thematic analysis of the transcripts, with subsequent dyadic analysis of themes represented by related parents and adolescents. RESULTS We performed 102 interviews with 51 dyads of parents and adolescents (26 with chronic illness, 25 without chronic illness). Nearly all participants believed that adolescents should be permitted portal access. We identified 4 themes related to portal benefits: improves adolescent's knowledge of health; supports medical self-management and autonomy; strengthens communication and relationships; and supports parental influence. We identified 4 themes related to portal problems: misunderstanding or confusion; emotional distress; strain on relationships; and irresponsible use of portal. Facilitators of portal use included severity of illness, adolescent's curiosity, and ease of technology use. Barriers included lack of awareness or interest, complexity of information, and access difficulties. Twenty adolescents (39%) did not know they could access the portal, and 23 (45%) lacked interest in portals. Parents and adolescents seldom used the portal as a collaborative tool, and instead were engaging with the portal independently. CONCLUSION Parents and adolescents perceive several benefits and problems with portal use, but many adolescents lack interest in using portals. Adolescent portals represent an underutilized resource to engage adolescents in their care.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
| | - Alison L Antes
- Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Christine Bereitschaft
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Fabienne Bourgeois
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - James M DuBois
- Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Anik E, Hurlow A, Azizoddin D, West R, Muehlensiepen F, Clarke G, Mitchell S, Allsop M. Characterising trends in the initiation, timing, and completion of recommended summary plan for emergency care and treatment (ReSPECT) plans: Retrospective analysis of routine data from a large UK hospital trust. Resuscitation 2024; 200:110168. [PMID: 38458416 DOI: 10.1016/j.resuscitation.2024.110168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
AIM To assess patient socio-demographic and disease characteristics associated with the initiation, timing, and completion of emergency care and treatment planning in a large UK-based hospital trust. METHODS Secondary retrospective analysis of data across 32 months extracted from digitally stored Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans within the electronic health record system of an acute hospital trust in England, UK. RESULTS Data analysed from ReSPECT plans (n = 23,729), indicate an increase in the proportion of admissions having a plan created from 4.2% in January 2019 to 6.9% in August 2021 (mean = 8.1%). Forms were completed a median of 41 days before death (a median of 58 days for patients with capacity, and 21 days for patients without capacity). Do not attempt cardiopulmonary resuscitation was more likely to be recorded for patients lacking capacity, with increasing age (notably for patients aged over 74 years), being female and the presence of multiple disease groups. 'Do not attempt cardiopulmonary resuscitation' was less likely to be recorded for patients having ethnicity recorded as Asian or Asian British and Black or Black British compared to White. Having a preferred place of death recorded as 'hospital' led to a five-fold increase in the likelihood of dying in hospital. CONCLUSION Variation in the initiation, timing, and completion of ReSPECT plans was identified by applying an evaluation framework. Digital storage of ReSPECT plan data presents opportunities for assessing trends and completion of the ReSPECT planning process and benchmarking across sites. Further research is required to monitor and understand any inequity in the implementation of the ReSPECT process in routine care.
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Affiliation(s)
- Evrim Anik
- Leeds Institute of Health Sciences, University of Leeds, UK; Leeds Dental Institute, University of Leeds, UK.
| | - Adam Hurlow
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, UK.
| | - Felix Muehlensiepen
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Germany.
| | - Gemma Clarke
- Leeds Institute of Health Sciences, University of Leeds, UK.
| | - Sarah Mitchell
- Leeds Institute of Health Sciences, University of Leeds, UK.
| | - Matthew Allsop
- Leeds Institute of Health Sciences, University of Leeds, UK.
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209
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Pfeil A, Klemm P, Hueber AJ, Hoffmann T, Weise T, Oelzner P, Knop S, Müller-Ladner U, Lange U, Wolf G, Schett G, Simon D, Kleyer A. Enhancing student understanding of rheumatic disease pathologies through augmented reality: findings from a multicentre trial. Rheumatology (Oxford) 2024; 63:1949-1956. [PMID: 37740288 DOI: 10.1093/rheumatology/kead508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 09/02/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The possibility of combining real and virtual environments is driving the increased use of augmented reality (AR) in education, including medical training. The aim of this multicentre study was to evaluate the students' perspective on the AR-based Rheumality GO!® app as a new teaching concept, presenting six real anonymized patient cases with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). METHODS The study encompassed 347 undergraduate medical students (232 women and 115 men) from four medical universities in Germany (Jena, Bad Nauheim/Gießen, Nuremberg, Erlangen). The course was divided into a theoretical refresher lecture followed by six AR-based cases in each of the three indications presented in the Rheumality GO! app. All participants evaluated the course after completion, assessing the benefit of the app from a student's perspective using a questionnaire with 16 questions covering six subject areas. RESULTS The use of the AR-based app Rheumality GO! improved the understanding of pathologies in RA, PsA and axSpA for 99% of the participants. For 98% of respondents, the concept of AR with real patient data has made a positive impact on the teaching environment. On the other hand, 82% were in favour of the use of virtual tools (e.g. AR) in addition to this conventional approach. CONCLUSION The results of our survey showed that from the medical students' perspective, an AR-based concept like the Rheumality GO! app can complement rheumatology teaching in medical school as an effective and attractive tool though not replace bedside teaching.
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Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig University Gießen, Bad Nauheim, Germany
| | - Axel J Hueber
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Tobias Hoffmann
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | | | - Peter Oelzner
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Stefan Knop
- Department Internal Medicine 5, Hemato-Oncology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Ulf Müller-Ladner
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Uwe Lange
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
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Vens C, van Luijk P, Vogelius RI, El Naqa I, Humbert-Vidan L, von Neubeck C, Gomez-Roman N, Bahn E, Brualla L, Böhlen TT, Ecker S, Koch R, Handeland A, Pereira S, Possenti L, Rancati T, Todor D, Vanderstraeten B, Van Heerden M, Ullrich W, Jackson M, Alber M, Marignol L. A joint physics and radiobiology DREAM team vision - Towards better response prediction models to advance radiotherapy. Radiother Oncol 2024; 196:110277. [PMID: 38670264 DOI: 10.1016/j.radonc.2024.110277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Radiotherapy developed empirically through experience balancing tumour control and normal tissue toxicities. Early simple mathematical models formalized this practical knowledge and enabled effective cancer treatment to date. Remarkable advances in technology, computing, and experimental biology now create opportunities to incorporate this knowledge into enhanced computational models. The ESTRO DREAM (Dose Response, Experiment, Analysis, Modelling) workshop brought together experts across disciplines to pursue the vision of personalized radiotherapy for optimal outcomes through advanced modelling. The ultimate vision is leveraging quantitative models dynamically during therapy to ultimately achieve truly adaptive and biologically guided radiotherapy at the population as well as individual patient-based levels. This requires the generation of models that inform response-based adaptations, individually optimized delivery and enable biological monitoring to provide decision support to clinicians. The goal is expanding to models that can drive the realization of personalized therapy for optimal outcomes. This position paper provides their propositions that describe how innovations in biology, physics, mathematics, and data science including AI could inform models and improve predictions. It consolidates the DREAM team's consensus on scientific priorities and organizational requirements. Scientifically, it stresses the need for rigorous, multifaceted model development, comprehensive validation and clinical applicability and significance. Organizationally, it reinforces the prerequisites of interdisciplinary research and collaboration between physicians, medical physicists, radiobiologists, and computational scientists throughout model development. Solely by a shared understanding of clinical needs, biological mechanisms, and computational methods, more informed models can be created. Future research environment and support must facilitate this integrative method of operation across multiple disciplines.
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Affiliation(s)
- C Vens
- School of Cancer Science, University of Glasgow, Glasgow, UK; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - P van Luijk
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - R I Vogelius
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - I El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48103, United States.
| | - L Humbert-Vidan
- University of Texas MD Anderson Cancer Centre, Houston, TX, United States; Department of MedicalPhysics, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, Comprehensive Cancer Centre, King's College London, London, UK
| | - C von Neubeck
- Department of Particle Therapy, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - N Gomez-Roman
- Strathclyde Institute of Phrmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - E Bahn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - L Brualla
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; Faculty of Medicine, University of Duisburg-Essen, Germany
| | - T T Böhlen
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - S Ecker
- Department of Radiation Oncology, Medical University of Wien, Austria
| | - R Koch
- Department of Particle Therapy, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - A Handeland
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - S Pereira
- Neolys Diagnostics, 7 Allée de l'Europe, 67960 Entzheim, France
| | - L Possenti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - T Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Todor
- Department of Radiation Oncology, Virginia Commonwealth University, United States
| | - B Vanderstraeten
- Department of Radiotherapy-Oncology, Ghent University Hospital, Gent, Belgium; Department of Human Structure and Repair, Ghent University, Gent, Belgium
| | - M Van Heerden
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | - M Jackson
- School of Cancer Science, University of Glasgow, Glasgow, UK
| | - M Alber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - L Marignol
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
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Hendriks G, Tan C, Vicknesan MJ, Chen HY, Sung SC, Ang ASY. Physician perceptions of medically unexplained symptoms in adolescent patients presenting to the emergency department. Asian J Psychiatr 2024; 97:104078. [PMID: 38810491 DOI: 10.1016/j.ajp.2024.104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Adolescents presenting with medically unexplained symptoms (MUS) in non-mental healthcare settings, particularly Emergency Departments (EDs), pose diagnostic challenges necessitating a comprehensive bio-psycho-social approach. Amid the youth mental health crisis, recognising psychological distress is imperative. This study delved into physicians' perceptions and diagnostic tendencies regarding such cases, exploring the potential overshadowing of psychosomatic presentations by medicalized diagnoses in EDs. METHODS Our study involved 74 physicians, representing 82% of eligible respondents in the Paediatric Emergency Medicine Department, and was conducted using an online questionnaire examining perceptions of case scenarios with psychosomatic presentations. RESULTS Results disclosed a prevalent inclination toward medical diagnoses, with less than 10% of physicians considering psychosomatic conditions in specific scenarios. Interestingly, psychosomatic diagnoses were more probable for symptoms like headaches, shortness of breath, and chest pain. The study uncovered a possible bias among physicians towards medical diagnoses in EDs for adolescents with MUS, possibly stemming from physicians' focus on physical care, diagnostic uncertainties, cognitive biases, and concerns about stigmatisation. CONCLUSION Adolescents with MUS seeking assistance in non-mental health settings may encounter delayed mental health diagnoses and interventions. Psychosomatic symptoms could signify stressors or underlying mental health disorders. Recognising psychosocial distress early on is crucial for optimal mental health outcomes. Consequently, the study advocates for a paradigm shift towards a holistic bio-psychosocial approach in both medical education and practice.
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Affiliation(s)
- Gillian Hendriks
- KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore.
| | - Chunzhen Tan
- KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | | | - Helen Yu Chen
- KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
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Pugliese M, Connell L, Turco J, Trivedi A, Foster A, Kumarasinghe APW. Implementation of a geriatric in-reach service improves acute surgical unit outcomes; a retrospective before-and-after study. ANZ J Surg 2024; 94:1349-1355. [PMID: 38727023 DOI: 10.1111/ans.19026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Australia's ageing population is challenging for surgical units and there is a paucity of evidence for geriatric co-management in acute general surgery. We aimed to assess if initiating a Geriatric Medicine in-reach service improved outcomes for older adults in our Acute Surgical Unit (ASU). METHODS The Older Adult Surgical Inpatient Service (OASIS) was integrated into ASU in 2021. We retrospectively reviewed all patients over age 65 admitted to ASU over a 12-month period before and after service integration with a length of stay (LOS) greater than 24 h. There was no subsequent truncation or selection. Primary outcomes were 30-day mortality, LOS, and 28-day readmissions. Secondary outcomes were discharge disposition, in-hospital mortality, and hospital-acquired complications (HACs). RESULTS 1339 consecutive patients were included in each group, with no differences in baseline characteristics. There was a significant decrease in 28-day readmissions from 20.2% to 16.0% (P < 0.05), greatest in patients undergoing non-EL operative procedures (21.9% pre-OASIS vs. 12.6% post-OASIS; P < 0.05). Trends towards reduced 30-day mortality (7.17% vs. 5.90%; P = 0.211), in-hospital mortality (3.88% vs. 2.91%; P = 0.201), permanent care placement (7.77% vs. 7.09%; P = 0.843) and HACs (8.14% vs. 7.62%; P = 0.667) were seen, although statistical significance was not demonstrated. LOS remained unchanged at 4 days (P = 0.653). CONCLUSION The addition of a geriatric in-reach service to a tertiary ASU led to a significant reduction in 28-day readmissions. Downtrends were seen in mortality, permanent care placement, and HAC rates, while LOS remained unchanged.
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Affiliation(s)
- Matthew Pugliese
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Louis Connell
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jennifer Turco
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Anand Trivedi
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Amanda Foster
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Anuttara Panchali W Kumarasinghe
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, Curtin University, Bentley, Western Australia, Australia
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Schoenhof R, Schoenhof R, Blumenstock G, Lethaus B, Hoefert S. Synthetic, non-person related panoramic radiographs created by generative adversarial networks in research, clinical, and teaching applications. J Dent 2024; 146:105042. [PMID: 38710314 DOI: 10.1016/j.jdent.2024.105042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES Generative Adversarial Networks (GANs) can produce synthetic images free from personal data. They hold significant value in medical research, where data protection is increasingly regulated. Panoramic radiographs (PRs) are a well-suited modality due to their significant level of standardization while simultaneously displaying a high degree of personally identifiable data. METHODS We produced synthetic PRs (syPRs) out of real PRs (rePRs) using StyleGAN2-ADA by NVIDIA©. A survey was performed on 54 medical professionals and 33 dentistry students. They assessed 45 radiological images (20 rePRs, 20 syPRs, and 5 syPRcontrols) as real or synthetic and interpreted a single-image syPR according to the image quality (0-10) and 14 different items (agreement/disagreement). They also rated the importance for the profession (0-10). A follow-up was performed for test-retest reliability with >10 % of all participants. RESULTS Overall, the sensitivity was 78.2 % and the specificity was 82.5 %. For professionals, the sensitivity was 79.9 % and the specificity was 82.3 %. For students, the sensitivity was 75.5 % and the specificity was 82.7 %. In the single syPR-interpretation image quality was rated at a median of 6 and 11 items were considered as agreement. The importance for the profession was rated at a median score of 7. The Test-retest reliability yielded a value of 0.23 (Cohen's kappa). CONCLUSIONS The study marks a comprehensive testing to demonstrate that GANs can produce synthetic radiological images that even health professionals can sometimes not differentiate from real radiological images, thereby being genuinely considered authentic. This enables their utilization and/or modification free from personally identifiable information. CLINICAL SIGNIFICANCE Synthetic images can be used for university teaching and patient education without relying on patient-related data. They can also be utilized to upscale existing training datasets to improve the accuracy of AI-based diagnostic systems. The study thereby supports clinical teaching as well as diagnostic and therapeutic decision-making.
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Affiliation(s)
- Rouven Schoenhof
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. B. Lethaus), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany.
| | - Raoul Schoenhof
- Fraunhofer Society for the Advancement of Applied Research, Hansastraße 27c, 80686 München, Germany
| | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry (Head: Prof. Dr. rer. nat. P. Martus), University Hospital Tuebingen, Silcherstrasse 5, 72076 Tuebingen, Germany
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. B. Lethaus), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany
| | - Sebastian Hoefert
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. B. Lethaus), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany
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Oettl FC, Pareek A, Winkler PW, Zsidai B, Pruneski JA, Senorski EH, Kopf S, Ley C, Herbst E, Oeding JF, Grassi A, Hirschmann MT, Musahl V, Samuelsson K, Tischer T, Feldt R. A practical guide to the implementation of AI in orthopaedic research, Part 6: How to evaluate the performance of AI research? J Exp Orthop 2024; 11:e12039. [PMID: 38826500 PMCID: PMC11141501 DOI: 10.1002/jeo2.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/13/2024] [Accepted: 04/19/2024] [Indexed: 06/04/2024] Open
Abstract
Artificial intelligence's (AI) accelerating progress demands rigorous evaluation standards to ensure safe, effective integration into healthcare's high-stakes decisions. As AI increasingly enables prediction, analysis and judgement capabilities relevant to medicine, proper evaluation and interpretation are indispensable. Erroneous AI could endanger patients; thus, developing, validating and deploying medical AI demands adhering to strict, transparent standards centred on safety, ethics and responsible oversight. Core considerations include assessing performance on diverse real-world data, collaborating with domain experts, confirming model reliability and limitations, and advancing interpretability. Thoughtful selection of evaluation metrics suited to the clinical context along with testing on diverse data sets representing different populations improves generalisability. Partnering software engineers, data scientists and medical practitioners ground assessment in real needs. Journals must uphold reporting standards matching AI's societal impacts. With rigorous, holistic evaluation frameworks, AI can progress towards expanding healthcare access and quality. Level of Evidence Level V.
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Affiliation(s)
- Felix C. Oettl
- Hospital for Special SurgeryNew YorkNew YorkUSA
- Schulthess KlinikZurichSwitzerland
| | - Ayoosh Pareek
- Sports Medicine and Shoulder Institute, Hospital for Special SurgeryNew YorkNew YorkUSA
| | - Philipp W. Winkler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Sahlgrenska Sports Medicine CenterGöteborgSweden
| | - Bálint Zsidai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Sahlgrenska Sports Medicine CenterGöteborgSweden
| | - James A. Pruneski
- Department of Orthopaedic SurgeryTripler Army Medical CenterHonoluluHawaiiUSA
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine CenterGöteborgSweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sebastian Kopf
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneGermany
| | - Christophe Ley
- Department of MathematicsUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
| | - Jacob F. Oeding
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Mayo Clinic Alix School of Medicine, Mayo ClinicRochesterMinnesotaUSA
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and TraumatologyKantonsspital BasellandBruderholzSwitzerland
- University of BaselBaselSwitzerland
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Sahlgrenska Sports Medicine CenterGöteborgSweden
- Department of OrthopaedicsSahlgrenska University HospitalMölndalSweden
| | - Thomas Tischer
- Department of Orthopaedic SurgeryUniversitymedicine RostockRostockGermany
- Department of Orthopaedic and Trauma SurgeryMalteser Waldkrankenhaus ErlangenErlangenGermany
| | - Robert Feldt
- Department of Computer Science and EngineeringChalmers University of TechnologyGothenburgSweden
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Kwok WH, Zhang Y, Wang G. Artificial intelligence in perinatal mental health research: A scoping review. Comput Biol Med 2024; 177:108685. [PMID: 38838557 DOI: 10.1016/j.compbiomed.2024.108685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 04/28/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
The intersection of Artificial Intelligence (AI) and perinatal mental health research presents promising avenues, yet uncovers significant challenges for innovation. This review explicitly focuses on this multidisciplinary field and undertakes a comprehensive exploration of existing research therein. Through a scoping review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we searched relevant literature spanning a decade (2013-2023) and selected fourteen studies for our analysis. We first provide an overview of the main AI techniques and their development, including traditional methods across different categories, as well as recent emerging methods in the field. Then, through our analysis of the literature, we summarize the predominant AI and ML techniques adopted and their applications in perinatal mental health studies, such as identifying risk factors, predicting perinatal mental health disorders, voice assistants, and Q&A chatbots. We also discuss existing limitations and potential challenges that hinder AI technologies from improving perinatal mental health outcomes, and suggest several promising directions for future research to meet real needs in the field and facilitate the translation of research into clinical settings.
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Affiliation(s)
- Wai Hang Kwok
- School of Nursing and Midwifery, Edith Cowan University, WA, Australia
| | - Yuanpeng Zhang
- Department of Medical Informatics, Nantong University, Nantong, 226001, China
| | - Guanjin Wang
- School of Information Technology, Murdoch University, Murdoch, WA, Australia.
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216
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Jernigan DA. Adjunctive Testing Using Biospectral Emission Sequencing: Bioregulatory Intelligence Technology in Parallel With the Goals of Artificial Intelligence in Medicine. Cureus 2024; 16:e65739. [PMID: 39082049 PMCID: PMC11288169 DOI: 10.7759/cureus.65739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 08/02/2024] Open
Abstract
The many advancements in medical technology of the last century have continually sought to improve the sensitivity of testing and the specificity of treatment of human maladies. Conventional physical and pharmaceutical treatment is largely an imprecise process, stimulating the impetus for the advancement of machine learning-enhanced artificial intelligence (AI) medical technologies. Biospectral Emission Sequencing (BES) is a bioregulatory intelligence (BI) technology already in use as an adjunct to conventional testing. Biospectral Emission Sequencing provides a functional system of dynamic real-time adjunctive testing and treatment selection. This paper discusses the parallel technologies of present and future AI and BI technologies in medicine.
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Affiliation(s)
- David A Jernigan
- Complementary Medicine, Biologix Center for Optimum Health, Franklin, USA
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217
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Bhandoria GP, Jayraj AS, Tiwari S, Migliorelli F, Nelson G, van Ramshorst GH, Kacperczyk-Bartnik J, Angeles MA, Nair N, El Hajj H, Bizzarri N. Use of social media for academic and professional purposes by gynecologic oncologists. Int J Gynecol Cancer 2024:ijgc-2024-005573. [PMID: 38955373 DOI: 10.1136/ijgc-2024-005573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To investigate the prevalence and patterns of social media use among gynecologic oncologists for professional and academic purposes. METHODS A prospective online survey between November and December 2022 targeted gynecologic oncology practitioners (gynecologic oncologists, surgical oncologists, medical oncologists, radiation/clinical oncologists, and onco-pathologists/pathologists). The survey, distributed via various social media platforms, included 40 questions to capture qualitative and quantitative data on social media use. RESULTS Of 131 respondents from 32 countries, 106 (80.9%) were gynecologic oncologists and affiliated with academic institutions (84.7%). Facebook (n=110, 83.9%), Twitter (n= 108, 82.4%), and Instagram (n=100, 76.3%) were the most used platforms. Respondents used social media to stay updated (n=101, 77.1%), network (n=97, 74%), learn about conferences and webinars (n=97, 74%), and engage in academic discussions (n=84, 64.1%). Following the COVID-19 pandemic, 100/129 (77.5%) reported increased social media use. However, only 32 (24.4%) used it to connect with patients, and concerns were raised about privacy and the need for separate professional and personal accounts. A quarter of respondents hesitated to share their opinions on social media due to the fear of controversy, with 26 (20%) experiencing cyberbullying, yet 120/130 (92.3%) believed it enabled junior professionals to express their views. Concerns about differentiating valid content, information reliability, and the professional perception of sourcing knowledge from social media were noted. Gender, age, specialty, and income level influenced patterns of social media use, with variations in preferences for platforms, content engagement, and purposes, highlighting a complex landscape of social media interaction among gynecologic oncologists. CONCLUSION While the use of social media among gynecologic oncologists is prevalent, particularly for academic and professional development, challenges such as cyberbullying, privacy concerns, and the need for formal training in social media navigation persist. Tailored training programs and guidelines could enhance social media's effective and ethical use in this field, promoting a safe environment for professional expression and engagement.
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Affiliation(s)
- Geetu Prakash Bhandoria
- Department of Obstetrics and Gynecology, Command Hospital Kolkata, Kolkata, West Bengal, India
| | - Aarthi S Jayraj
- South Tees NHS Foundation Trust, James Cook University, Middlesbrough, UK
| | - Shyamji Tiwari
- Department of Obstetrics and Gynaecology, Military Hospital Patiala, Patiala, Punjab, India
| | - Federico Migliorelli
- Maternal-Fetal Medicine Department, Hospital Clinic Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Gabriëlle H van Ramshorst
- Department of Gastrointestinal Surgery, University Hospital Ghent, Ghent, Belgium
- Human Structure and Repair, Ghent University, Ghent, Belgium
| | | | - Martina Aida Angeles
- Department of Gynecologic Oncology, Centro Sociosanitario y Residencial de la Vall d'Hebron de Barcelona, Barcelona, Spain
| | - Navya Nair
- Division of Gynecologic Oncology, Dept of Obstetrics and Gynecology, University of Miami Sylvester Cancer Center, Miami, Florida, USA
| | - Houssein El Hajj
- Department of Gynecologic Oncology, Institute Curie, Paris, France
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
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Lemak CH, Pena D, Jones DA, Kim DH, Guptill J. Leadership to Accelerate Healthcare's Digital Transformation: Evidence From 33 Health Systems. J Healthc Manag 2024; 69:267-279. [PMID: 38976787 DOI: 10.1097/jhm-d-23-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
GOAL The COVID-19 pandemic, healthcare market disruptors, and new digital healthcare technologies have made a substantial impact on the delivery of healthcare services, highlighting the critical roles of leaders in hospitals and health systems. This study sought to understand the evolving roles of CEOs, CIOs, and other executive leaders in the postpandemic era and highlight the adaptability and strategic vision of executives in shaping the future of healthcare delivery. METHODS Between October 2022 and May 2023, 51 interviews were conducted with CEOs, CIOs, and other executives responsible for delivering technology solutions for 33 nonprofit health systems in the United States. They were asked to describe their backgrounds; how information solutions and technologies were viewed within their organizations' strategy, operations, and governance; and the key characteristics of executive leaders. PRINCIPAL FINDINGS The study has found that effective CEOs have an authentic belief in technology's role in achieving their organization's mission and that contemporary CIOs are strategic executive partners who align strategy with culture to improve care. This study examines how healthcare systems are creating digitally savvy executive leadership teams that operate in a new, integrated model that unites previously siloed functions. PRACTICAL APPLICATIONS Some healthcare CIOs are unprepared for current and future business challenges, and some CEOs are unsure how to leverage digital technologies and C-suite expertise to transform their organizations. This research provides insights into how the nation's health systems are building and sustaining leadership teams capable of adapting to the healthcare environment and accelerating organizational transformation.
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Affiliation(s)
| | | | - Douglas A Jones
- Department of Health Services Administration, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Dae Hyun Kim
- Department of Health Management and Policy, Georgetown University, Washington, District of Columbia; and
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Bouhouita-Guermech S, Haidar H. Scoping Review Shows the Dynamics and Complexities Inherent to the Notion of "Responsibility" in Artificial Intelligence within the Healthcare Context. Asian Bioeth Rev 2024; 16:315-344. [PMID: 39022380 PMCID: PMC11250714 DOI: 10.1007/s41649-024-00292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 07/20/2024] Open
Abstract
The increasing integration of artificial intelligence (AI) in healthcare presents a host of ethical, legal, social, and political challenges involving various stakeholders. These challenges prompt various studies proposing frameworks and guidelines to tackle these issues, emphasizing distinct phases of AI development, deployment, and oversight. As a result, the notion of responsible AI has become widespread, incorporating ethical principles such as transparency, fairness, responsibility, and privacy. This paper explores the existing literature on AI use in healthcare to examine how it addresses, defines, and discusses the concept of responsibility. We conducted a scoping review of literature related to AI responsibility in healthcare, searching databases and reference lists between January 2017 and January 2022 for terms related to "responsibility" and "AI in healthcare", and their derivatives. Following screening, 136 articles were included. Data were grouped into four thematic categories: (1) the variety of terminology used to describe and address responsibility; (2) principles and concepts associated with responsibility; (3) stakeholders' responsibilities in AI clinical development, use, and deployment; and (4) recommendations for addressing responsibility concerns. The results show the lack of a clear definition of AI responsibility in healthcare and highlight the importance of ensuring responsible development and implementation of AI in healthcare. Further research is necessary to clarify this notion to contribute to developing frameworks regarding the type of responsibility (ethical/moral/professional, legal, and causal) of various stakeholders involved in the AI lifecycle.
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Affiliation(s)
| | - Hazar Haidar
- Ethics Programs, Department of Letters and Humanities, University of Quebec at Rimouski, Rimouski, Québec Canada
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220
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Weber B, Zineh I, Lalonde R, Visser SAG. How debunking biases in research and development decisions could lead to more equitable healthcare? Clin Transl Sci 2024; 17:e13880. [PMID: 39016187 PMCID: PMC11252826 DOI: 10.1111/cts.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/18/2024] Open
Abstract
Decades of research have demonstrated that a variety of cognitive biases can affect our judgment and ability to make rational decisions in personal and professional environments. The lengthy, risky, and costly nature of pharmaceutical research and development (R&D) makes it vulnerable to biased decision-making. Moreover, cognitive biases can play a role in regulatory and clinical decision-making, the latter impacting diagnostic and treatment decisions in the therapeutic use of medicines. These inherent and/or institutionalized biases (e.g., in assumptions, data, or decision-making practices) could conceivably contribute to health inequities. In this mini-review, we provide a broad perspective on how cognitive biases can affect pharmaceutical R&D, regulatory evaluation, and therapeutic decision-making. Example approaches to mitigate the effect of common biases in the development, approval, and use of new therapeutics, such as quantitative decision criteria, multidisciplinary reviews, regulatory and treatment guidelines, and evidence-based clinical decision support systems are illustrated. Mitigating the impact of cognitive biases could increase pharma R&D efficiency, change the perspective and prioritization of unmet medical needs, increase representativeness and quality of evidence generated through clinical trials and real-world research, leading to higher quality insights and more effective medication use, and as such could eventually contribute to more equitable healthcare.
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Affiliation(s)
| | - Issam Zineh
- Office of Clinical Pharmacology, US Food and Drug AdministrationSilverspringMassachusettsUSA
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Sammut-Powell C, Sisk R, Vazquez-Mendez E, Vasnawala H, Goncalves S, Edge M, Cameron R. Global Validation of a Model to Predict Reduced Estimated GFR in People With Type 2 Diabetes Without Diagnosis of CKD. Kidney Int Rep 2024; 9:2047-2055. [PMID: 39081746 PMCID: PMC11284396 DOI: 10.1016/j.ekir.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction A minimal-resource model for predicting reduced kidney function among people with type 2 diabetes and no diagnosis of chronic kidney disease (CKD) stages 3 to 5 was previously developed in a UK population to pre-screen for undiagnosed CKD. This study aims to evaluate the performance of the model on a global population and assess its adequacy with and without regional adjustment. Methods A retrospective observational study was performed using data collected from the iCaReMe global registry (NCT03549754) and the DISCOVER study (NCT02322762 and NCT02226822). Patients were grouped by their World Health Organization classified region. An estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2 was the marker of reduced kidney function. A regional-intercept recalibration was applied to adjust for regional variation. Discrimination and calibration were evaluated for the UK-developed and recalibrated models. Results A total of 14,180 patients (46 countries, 6 regions) were identified with type 2 diabetes, no previous diagnosis of CKD stages 3 to 5, and had a serum creatinine measurement or eGFR recorded. The UK model underestimated risk when applied globally and was deemed inadequate. The model with regional adjustment achieved the target sensitivity (80.5%; 95% confidence interval [CI]: 78.8%-82.3%) and demonstrated a relative improvement of 51.5% (95% CI: 48.1%-55.1%) in the positive predictive value (PPV), compared to a screen-all approach. Conclusion The regional-adjusted model demonstrated adequate performance globally. Incorporating the model within practice could help clinicians to risk-stratify and prioritize patients at high risk. This could enable improved efficiency via risk-tailored screening, particularly in lower-middle-income countries (LMICs).
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Dilek Turan F, İşler A, Duman Ö. Effect of virtual reality-based seizure management education program for parents (VR-ESMEPP) on seizure management: A randomized controlled trial. Epilepsy Behav 2024; 156:109824. [PMID: 38788661 DOI: 10.1016/j.yebeh.2024.109824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE This study evaluated the efficacy of Virtual Reality-Based Seizure Management Education Program for Parents (VR-ESMEPP) that was designed to improve parents' knowledge-skill percentage about epileptic seizure, and motivation levels about educational material. METHODS The study was conducted at a university hospital's pediatric neurology clinic in Turkey and involved both a VR-trained group and a control group. The parents' knowledge-skill percentage about epileptic seizure, and motivation levels about educational material were assessed before, after, and at 15 days after participating in VR-ESMEPP. RESULTS The parents' knowledge-skill percentage about epileptic seizure increased in the group that participated in the VR-ESMEPP. There was no such increase in the control group. Examination of the scores of the Instructional Materials Motivation Survey (IMMS) for the parents showed that while there was a significant increase between the pre-test and post-test within the group that participated in the VR-ESMEPP, there was no significant difference in the scores of the control group. However, the high IMMS scores obtained by all parents indicate the motivating nature of the education material. SIGNIFICANCE The study established the efficacy of VR-ESMEPP and demonstrated its ability to enhance parents' knowledge-skill percentage about epileptic seizure. Despite the absence of a difference in motivation levels between the groups, the high scores obtained by all participants indicate that the program was indeed motivating.
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Affiliation(s)
- Fatma Dilek Turan
- Department of Pediatric Nursing, Kumluca Faculty of Health Sciences, Akdeniz University, Kumluca, Antalya, Turkey.
| | - Ayşegül İşler
- Department of Pediatric Nursing, Faculty of Nursing, Akdeniz University, 07100 Campus, Akdeniz, Antalya, Turkey.
| | - Özgür Duman
- Department of Pediatric Neurology, Faculty of Medicine, Akdeniz University Hospital, 07100 Campus, Akdeniz, Antalya, Turkey.
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Yan L, Karamchandani K, Gaiser RR, Carr ZJ. Identifying, Understanding, and Minimizing Unconscious Cognitive Biases in Perioperative Crisis Management: A Narrative Review. Anesth Analg 2024; 139:68-77. [PMID: 37874227 DOI: 10.1213/ane.0000000000006666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Rapid clinical decision-making behavior is often based on pattern recognition and other mental shortcuts. Although such behavior is often faster than deliberative thinking, it can also lead to errors due to unconscious cognitive biases (UCBs). UCBs may contribute to inaccurate diagnoses, hamper interpersonal communication, trigger inappropriate clinical interventions, or result in management delays. The authors review the literature on UCBs and discuss their potential impact on perioperative crisis management. Using the Scale for the Assessment of Narrative Review Articles (SANRA), publications with the most relevance to UCBs in perioperative crisis management were selected for inclusion. Of the 19 UCBs that have been most investigated in the medical literature, the authors identified 9 that were judged to be clinically relevant or most frequently occurring during perioperative crisis management. Formal didactic training on concepts of deliberative thinking has had limited success in reducing the presence of UCBs during clinical decision-making. The evolution of clinical decision support tools (CDSTs) has demonstrated efficacy in improving deliberative clinical decision-making, possibly by reducing the intrusion of maladaptive UCBs and forcing reflective thinking. Anesthesiology remains a leader in perioperative crisis simulation and CDST implementation, but spearheading innovations to reduce the adverse impact of UCBs will further improve diagnostic precision and patient safety during perioperative crisis management.
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Affiliation(s)
- Luying Yan
- From the Yale University School of Medicine, New Haven, Connecticut
| | - Kunal Karamchandani
- Department of Anesthesiology
- University of Texas, Southwestern Medical School, Dallas, Texas
| | - Robert R Gaiser
- From the Yale University School of Medicine, New Haven, Connecticut
- Department of Anesthesiology
| | - Zyad J Carr
- From the Yale University School of Medicine, New Haven, Connecticut
- Department of Anesthesiology
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Hassan MZ, Shirin T, Satter SM, Rahman MZ, Bourner J, Cheyne A, Torreele E, Horby P, Olliaro P. Nipah virus disease: what can we do to improve patient care? THE LANCET. INFECTIOUS DISEASES 2024; 24:e463-e471. [PMID: 38185127 DOI: 10.1016/s1473-3099(23)00707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024]
Abstract
The year 2023 marked the 25th anniversary of the first detected outbreak of Nipah virus disease. Despite Nipah virus being a priority pathogen in the WHO Research and Development blueprint, the disease it causes still carries high mortality, unchanged since the first reported outbreaks. Although candidate vaccines for Nipah virus disease exist, developing new therapeutics has been underinvested. Nipah virus disease illustrates the typical market failure of medicine development for a high-consequence pathogen. The unpredictability of outbreaks and low number of infections affecting populations in low-income countries does not make an attractive business case for developing treatments for Nipah virus disease-a situation compounded by methodological challenges in clinical trial design. Nipah virus therapeutics development is not motivated by commercial interest. Therefore, we propose a regionally led, patient-centred, and public health-centred, end-to-end framework that articulates a public health vision and a roadmap for research, development, manufacturing, and access towards the goal of improving patient outcomes. This framework includes co-creating a regulatory-compliant, clinically meaningful, and context-specific clinical development plan and establishing quality standards in clinical care and research capabilities at sites where the disease occurs. The success of this approach will be measured by the availability and accessibility of improved Nipah virus treatments in affected communities and reduced mortality.
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Affiliation(s)
- Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh; Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK.
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Syed M Satter
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Mohammed Z Rahman
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Josephine Bourner
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Ashleigh Cheyne
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Els Torreele
- Institute for Innovation and Public Purpose, University College London, London, UK; Independent Researcher and Advisor, Geneva, Switzerland
| | - Peter Horby
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Piero Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
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225
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Wilkinson LS, Dunbar JK, Lip G. Clinical Integration of Artificial Intelligence for Breast Imaging. Radiol Clin North Am 2024; 62:703-716. [PMID: 38777544 DOI: 10.1016/j.rcl.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
This article describes an approach to planning and implementing artificial intelligence products in a breast screening service. It highlights the importance of an in-depth understanding of the end-to-end workflow and effective project planning by a multidisciplinary team. It discusses the need for monitoring to ensure that performance is stable and meets expectations, as well as focusing on the potential for inadvertantly generating inequality. New cross-discipline roles and expertise will be needed to enhance service delivery.
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Affiliation(s)
- Louise S Wilkinson
- Oxford Breast Imaging Centre, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK.
| | - J Kevin Dunbar
- Regional Head of Screening Quality Assurance Service (SQAS) - South, NHS England, England, UK
| | - Gerald Lip
- North East Scotland Breast Screening Service, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2XF, UK
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226
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Arena F, Geiser E, Auer S, Clair C, Schwarz J. Reflexivity and positionality applied to medical practice: a study on implicit gender bias with medical students in a Swiss university. Int J Equity Health 2024; 23:132. [PMID: 38951888 PMCID: PMC11218196 DOI: 10.1186/s12939-024-02222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND An array of evidence shows how the presence of implicit bias in clinical encounters can negatively impact provider-patient communication, quality of care and ultimately contribute to health inequities. Reflexive practice has been explored as an approach to identify and address implicit bias in healthcare providers, including medical students. At the Lausanne School of Medicine, a clinically integrated module was introduced in 2019 to raise students' awareness of gender bias in medical practice using a reflexivity and positionality approach. The purpose of this study is to describe the gender bias that were identified by medical students, analysing their types, places and modes of emergence during a clinical encounter. It further explores how positionality supported students' reflection on the way in which social position modulates their relationship to patients. METHODS As part of the teaching activity, medical students individually reflected on gender bias in a specific clinical encounter by answering questions in their electronic portfolio. The questionnaire included a section on positionality. We qualitatively analysed the students' assignments (n=76), applying a thematic analysis framework. RESULTS Medical students identified and described gender biases occurring at different moments of the clinical encounter (anamnesis (i.e. patient history), physical exam, differential diagnosis, final management). They causally associated these biases with wider social phenomena such as the gendered division of labour or stereotypes around sexuality and gender. Analysing students' reflections on how their position influenced their relationship with patients, we found that the suggested exercise revealed a major contradiction in the process of medical enculturation: the injunction to be neutral and objective erases the social and cultural context of patients and impedes an understanding of gender bias. CONCLUSION Gender biases are present in the different steps of a clinical consultation and are rooted in broader gendered social representations. We further conclude that the tension between a quest for objectivity and the reality of social encounters should be made explicit to students, because it is constitutive of medical practice.
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Affiliation(s)
- Francesca Arena
- Institute for Ethics, History and Humanities, Faculty of Medicine, University of Geneva, iEH2, Geneva, Switzerland
| | - Elisa Geiser
- Center for Primary Care and Public Health, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Silva Auer
- Center for Primary Care and Public Health, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Center for Primary Care and Public Health, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Joëlle Schwarz
- Center for Primary Care and Public Health, Unisanté, University of Lausanne, Lausanne, Switzerland.
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Manuel K, Crotty M, Kurrle SE, Cameron ID, Lane R, Lockwood K, Block H, Sherrington C, Pond D, Nguyen TA, Laver K. Hospital-Based Health Professionals' Perceptions of Frailty in Older People. THE GERONTOLOGIST 2024; 64:gnae041. [PMID: 38712983 PMCID: PMC11181707 DOI: 10.1093/geront/gnae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There is a high prevalence of frailty amongst older patients in hospital settings. Frailty guidelines exist but implementation to date has been challenging. Understanding health professional attitudes, knowledge, and beliefs about frailty is critical in understanding barriers and enablers to guideline implementation, and the aim of this study was to understand these in rehabilitation multidisciplinary teams in hospital settings. RESEARCH DESIGN AND METHODS Twenty-three semistructured interviews were conducted with health professionals working in multidisciplinary teams on geriatric and rehabilitation wards in Adelaide and Sydney, Australia. Interviews were audio recorded, transcribed, and coded by 2 researchers. A codebook was created and interviews were recoded and applied to the Framework Method of thematic analysis. RESULTS Three domains were developed: diagnosing frailty, communicating about frailty, and managing frailty. Within these domains, 8 themes were identified: (1) diagnosing frailty has questionable benefits, (2) clinicians don't use frailty screening tools, (3) frailty can be diagnosed on appearance and history, (4) frailty has a stigma, (5) clinicians don't use the word "frail" with patients, (6) frailty isn't always reversible, (7) there is a lack of continuity of care after acute admission, and (8) the community setting lacks resources. DISCUSSION AND IMPLICATIONS Implementation of frailty guidelines will remain challenging while staff avoid using the term "frail," don't perceive benefit of using screening tools, and focus on the individual aspects of frailty rather than the syndrome holistically. Clinical champions and education about frailty identification, reversibility, management, and communication techniques may improve the implementation of frailty guidelines in hospitals.
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Affiliation(s)
- Kisani Manuel
- Division of Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Department of Rehabilitation and Aged Care, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
| | - Ian D Cameron
- Department of Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Lane
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Keri Lockwood
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Heather Block
- Caring Futures Institute, College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Catherine Sherrington
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Dimity Pond
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Tuan A Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Kate Laver
- Division of Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
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Rafiq M, Mazzocato P, Guttmann C, Spaak J, Savage C. Predictive analytics support for complex chronic medical conditions: An experience-based co-design study of physician managers' needs and preferences. Int J Med Inform 2024; 187:105447. [PMID: 38598905 DOI: 10.1016/j.ijmedinf.2024.105447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/05/2023] [Accepted: 04/05/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The literature suggests predictive technology applications in health care would benefit from physician and manager input during design and development. The aim was to explore the needs and preferences of physician managers regarding the role of predictive analytics in decision support for patients with the highly complex yet common combination of multiple chronic conditions of cardiovascular (Heart) and kidney (Nephrology) diseases and diabetes (HND). METHODS This qualitative study employed an experience-based co-design model comprised of three data gathering phases: 1. Patient mapping through non-participant observations informed by process mining of electronic health records data, 2. Semi-structured experience-based interviews, and 3. A co-design workshop. Data collection was conducted with physician managers working at or collaborating with the HND center, Danderyd University Hospital (DSAB), in Stockholm, Sweden. HND center is an integrated practice unit offering comprehensive person-centered multidisciplinary care to stabilize disease progression, reduce visits, and develop treatment strategies that enables a transition to primary care. RESULTS Interview and workshop data described a complex challenge due to the interaction of underlying pathophysiologies and the subsequent need for multiple care givers that hindered care continuity. The HND center partly met this challenge by coordinating care through multiple interprofessional and interdisciplinary shared decision-making interfaces. The large patient datasets were difficult to operationalize in daily practice due to data entry and retrieval issues. Predictive analytics was seen as a potentially effective approach to support decision-making, calculate risks, and improve resource utilization, especially in the context of complex chronic care, and the HND center a good place for pilot testing and development. Simplicity of visual interfaces, a better understanding of the algorithms by the health care professionals, and the need to address professional concerns, were identified as key factors to increase adoption and facilitate implementation. CONCLUSIONS The HND center serves as a comprehensive integrated practice unit that integrates different medical disciplinary perspectives in a person-centered care process to address the needs of patients with multiple complex comorbidities. Therefore, piloting predictive technologies at the same time with a high potential for improving care represents an extreme, demanding, and complex case. The study findings show that health care professionals' involvement in the design of predictive technologies right from the outset can facilitate the implementation and adoption of such technologies, as well as enhance their predictive effectiveness and performance. Simplicity in the design of predictive technologies and better understanding of the concept and interpretation of the algorithms may result in implementation of predictive technologies in health care. Institutional efforts are needed to enhance collaboration among the health care professionals and IT professionals for effective development, implementation, and adoption of predictive analytics in health care.
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Affiliation(s)
- Muhammad Rafiq
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden.
| | - Pamela Mazzocato
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden; Södertälje Hospital, Research, Development, Innovation and Education unit, Rosenborgsgatan 6-10, 152 40 Södertälje, Sweden.
| | - Christian Guttmann
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden; Nordic Artificial Intelligence Institute, Garvis Carlssons Gata 4, 16941 Stockholm, Sweden.
| | - Jonas Spaak
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden; Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden.
| | - Carl Savage
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden; School of Health and Welfare, Halmstad University, Halmstad, Sweden.
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Adelstein JM, Sinkler MA, Li LT, Mistovich RJ. ChatGPT Responses to Common Questions About Slipped Capital Femoral Epiphysis: A Reliable Resource for Parents? J Pediatr Orthop 2024; 44:353-357. [PMID: 38597253 DOI: 10.1097/bpo.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND We sought to evaluate the ability of ChatGPT, an AI-powered online chatbot, to answer frequently asked questions (FAQs) regarding slipped capital femoral epiphysis (SCFE). METHODS Seven FAQs regarding SCFE were presented to ChatGPT. Initial responses were recorded and compared with evidence-based literature and reputable online resources. Responses were subjectively rated as "excellent response requiring no further clarification," "satisfactory response requiring minimal clarification," "satisfactory response requiring moderate clarification," or "unsatisfactory response requiring substantial clarification." RESULTS ChatGPT was frequently able to provide satisfactory responses that required only minimal clarification. One response received an excellent rating and required no further clarification, while only 1 response from ChatGPT was rated unsatisfactory and required substantial clarification. CONCLUSIONS ChatGPT is able to frequently provide satisfactory responses to FAQs regarding SCFE while appropriately reiterating the importance of always consulting a medical professional.
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Affiliation(s)
- Jeremy M Adelstein
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH
| | - Margaret A Sinkler
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH
| | - Lambert T Li
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH
| | - R Justin Mistovich
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
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Johansson JV, Engström E. 'Humans think outside the pixels' - Radiologists' perceptions of using artificial intelligence for breast cancer detection in mammography screening in a clinical setting. Health Informatics J 2024; 30:14604582241275020. [PMID: 39155239 DOI: 10.1177/14604582241275020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
OBJECTIVE This study aimed to explore radiologists' views on using an artificial intelligence (AI) tool named ScreenTrustCAD with Philips equipment) as a diagnostic decision support tool in mammography screening during a clinical trial at Capio Sankt Göran Hospital, Sweden. METHODS We conducted semi-structured interviews with seven breast imaging radiologists, evaluated using inductive thematic content analysis. RESULTS We identified three main thematic categories: AI in society, reflecting views on AI's contribution to the healthcare system; AI-human interactions, addressing the radiologists' self-perceptions when using the AI and its potential challenges to their profession; and AI as a tool among others. The radiologists were generally positive towards AI, and they felt comfortable handling its sometimes-ambiguous outputs and erroneous evaluations. While they did not feel that it would undermine their profession, they preferred using it as a complementary reader rather than an independent one. CONCLUSION The results suggested that breast radiology could become a launch pad for AI in healthcare. We recommend that this exploratory work on subjective perceptions be complemented by quantitative assessments to generalize the findings.
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Affiliation(s)
- Jennifer Viberg Johansson
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Emma Engström
- Institute for Futures Studies, Stockholm, Sweden; Department of Urban Planning and Environment, KTH Royal Institute of Technology, Stockholm, Sweden
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231
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Carson RA, Lyles JL. Cognitive Bias in an Infant with Constipation. J Pediatr 2024; 270:113996. [PMID: 38432294 DOI: 10.1016/j.jpeds.2024.113996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Rebecca A Carson
- Clinical Assistant Professor, Conway School of Nursing, The Catholic University of America, Washington, DC
| | - John L Lyles
- Assistant Professor of Pediatrics, Division of Gastroenterology/Hepatology/Nutrition, Duke University School of Medicine, Durham, NC.
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Ahn J, Choi M. Advancements and turning point of artificial intelligence in ophthalmology: A comprehensive analysis of research trends and collaborative networks. Ophthalmic Physiol Opt 2024; 44:1031-1040. [PMID: 38581209 DOI: 10.1111/opo.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
Artificial intelligence (AI) has emerged as a transformative force with great potential in various fields, including healthcare. In recent years, AI has garnered significant attention due to its potential to revolutionise ophthalmology, leading to advancements in patient care such as disease detection, diagnosis, treatment and monitoring of disease progression. This study presents a comprehensive analysis of the research trends and collaborative networks at the intersection of AI and ophthalmology. In this study, we conducted an extensive search of the Web of Science Core Collection to identify articles related to 'artificial intelligence' in ophthalmology published from 1968 to 2023. We performed co-occurrence keywords and co-authorship network analyses using VOSviewer software to explore the relationships between keywords and country collaboration. We found a remarkable surge in articles applying AI in ophthalmology after 2017, marking a turning point in the integration of AI within the medical field. The primary application of AI shifted towards the diagnosis of ocular disease, which was particularly evident through keywords such as glaucoma, diabetic retinopathy and age-related macular degeneration. Analysis of the collaboration networks of countries revealed a global expansion of ophthalmology-related AI research. This study provides valuable insights into the evolving landscape of AI integration in ophthalmology, indicating its growing potential for enhancing disease detection, diagnosis, treatment planning and monitoring of disease progression. In order to translate AI technologies into clinical practice effectively, it is imperative to comprehend the evolving research trends and advancements at the intersection of AI and ophthalmology.
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Affiliation(s)
- Jihye Ahn
- Department of Optometry, College of Energy and Biotechnology, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - Moonsung Choi
- Department of Optometry, College of Energy and Biotechnology, Seoul National University of Science and Technology, Seoul, Republic of Korea
- Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, Seoul, Republic of Korea
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Byrnes T, Pate K, Belin L, Weaver KJA, Cochran A. COVID-19 and the Impact on Delirium Care of Hospitalized Older Adults: A Qualitative Study. J Nurs Care Qual 2024; 39:266-272. [PMID: 38470855 DOI: 10.1097/ncq.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Older adult patients with COVID-19 and delirium experience higher rates of adverse outcomes. Early recognition of at-risk patients and implementation of management strategies improve outcomes, though understanding barriers to acute care nurses implementing these strategies is limited. PURPOSE This study's purpose was to understand the experiences of acute care nurses providing care to older adults with COVID-19 and delirium. Experiences explored included assessment, nursing management interventions, and barriers to care. METHODS Purposive sampling to recruit nurses for semistructured focus groups was performed, and thematic analysis was generated by 4 members of the research team. RESULTS Twenty-one nurses participated in focus groups. Thematic analysis revealed themes of increased patient social isolation, barriers to delirium assessment and prevention, increased staff demands, and stressful work environments. CONCLUSION Rich findings reveal the profound impact of the pandemic on assessment for delirium and implementation of strategies for prevention and management in older adult patients.
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Affiliation(s)
- Tru Byrnes
- Author Affiliations: Atrium Health Carolinas Medical Center, Charlotte, North Carolina (Drs Byrnes and Pate and Ms Weaver); Atrium Health Mercy, Charlotte, North Carolina (Dr Belin); and Carolinas Center for Surgical Outcomes Science, Atrium Health, and Wake Forest University School of Medicine, Charlotte, North Carolina (Dr Cochran)
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Patel P, Siraw BB, Mehadi AY, Zaher EA, Ebrahim MA, Tafesse YT. Predictors of in-hospital outcomes for diverticular bleeding patients: a retrospective analysis of National Inpatient Sample data (2016-2020). Ann Gastroenterol 2024; 37:449-457. [PMID: 38974086 PMCID: PMC11226741 DOI: 10.20524/aog.2024.0896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/04/2024] [Indexed: 07/09/2024] Open
Abstract
Background Diverticular bleeding is the leading cause of lower gastrointestinal bleeding, affecting 3-5% of patients with diverticulosis. Current management protocols include resuscitation, diagnosis via direct visualization, computed tomography imaging, endoscopic interventions, angioembolization, and surgery when needed. However, predictive factors for outcomes and optimal interventions remain ambiguous. Methods This retrospective cohort study analyzed data from the National Inpatient Sample (NIS) database (2016-2020) to determine predictors of adverse in-hospital outcomes in diverticular bleeding patients without perforation or abscess. Demographic and clinical data were extracted, and multivariate regression models were applied. Analysis was conducted using R statistical software (version 4.1.3), with significance set at P<0.05. Results A total of 28,269 patients hospitalized for diverticular bleeding were identified. Age >85 years, moderate to severe Charlson Comorbidity Index, hypovolemic shock, blood transfusion requirement, and requirement for colectomy were significantly associated with greater in-hospital mortality. Factors such as late colonoscopy timing and colon resection led to longer hospital stays, while arterial embolization was predicted by older age, Black race, hypovolemic shock, and blood transfusion. Predictors of colon resection included advanced age, presence of colon cancer, and hypovolemic shock. Conclusions Our retrospective study identified significant predictors of in-hospital outcomes among patients with diverticular bleeding, informing risk stratification and management strategies. Further research is warranted to validate these findings and refine management algorithms for improved patient care. Integrating these insights into clinical practice may enhance outcomes and guide personalized interventions in diverticular bleeding management.
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Affiliation(s)
- Parth Patel
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim)
| | - Bekure B. Siraw
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim)
| | - Abdulrahim Yusuf Mehadi
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County (Abdulrahim Yusuf Mehadi)
| | - Eli Adrian Zaher
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim)
| | - Mohamed Ayman Ebrahim
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim)
| | - Yordanos T. Tafesse
- Biological Sciences Division, University of Chicago (Yordanos T. Tafesse), USA
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Khan M, Banerjee S, Muskawad S, Maity R, Chowdhury SR, Ejaz R, Kuuzie E, Satnarine T. The Impact of Artificial Intelligence on Allergy Diagnosis and Treatment. Curr Allergy Asthma Rep 2024; 24:361-372. [PMID: 38954325 DOI: 10.1007/s11882-024-01152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Artificial intelligence (AI), be it neuronal networks, machine learning or deep learning, has numerous beneficial effects on healthcare systems; however, its potential applications and diagnostic capabilities for immunologic diseases have yet to be explored. Understanding AI systems can help healthcare workers better assimilate artificial intelligence into their practice and unravel its potential in diagnostics, clinical research, and disease management. RECENT FINDINGS We reviewed recent advancements in AI systems and their integration in healthcare systems, along with their potential benefits in the diagnosis and management of diseases. We explored machine learning as employed in allergy diagnosis and its learning patterns from patient datasets, as well as the possible advantages of using AI in the field of research related to allergic reactions and even remote monitoring. Considering the ethical challenges and privacy concerns raised by clinicians and patients with regard to integrating AI in healthcare, we explored the new guidelines adapted by regulatory bodies. Despite these challenges, AI appears to have been successfully incorporated into various healthcare systems and is providing patient-centered solutions while simultaneously assisting healthcare workers. Artificial intelligence offers new hope in the field of immunologic disease diagnosis, monitoring, and management and thus has the potential to revolutionize healthcare systems.
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Affiliation(s)
- Maham Khan
- Fatima Jinnah Medical University, Lahore, Pakistan.
| | | | | | - Rick Maity
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | | | - Rida Ejaz
- Shifa College of Medicine, Islamabad, Pakistan
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Stevenson DK, Gotlib IH, Buthmann JL, Marié I, Aghaeepour N, Gaudilliere B, Angst MS, Darmstadt GL, Druzin ML, Wong RJ, Shaw GM, Katz M. Stress and Its Consequences-Biological Strain. Am J Perinatol 2024; 41:1282-1284. [PMID: 35292943 DOI: 10.1055/a-1798-1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Understanding the role of stress in pregnancy and its consequences is important, particularly given documented associations between maternal stress and preterm birth and other pathological outcomes. Physical and psychological stressors can elicit the same biological responses, known as biological strain. Chronic stressors, like poverty and racism (race-based discriminatory treatment), may create a legacy or trajectory of biological strain that no amount of coping can relieve in the absence of larger-scale socio-behavioral or societal changes. An integrative approach that takes into consideration simultaneously social and biological determinants of stress may provide the best insights into the risk of preterm birth. The most successful computational approaches and the most predictive machine-learning models are likely to be those that combine information about the stressors and the biological strain (for example, as measured by different omics) experienced during pregnancy.
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Affiliation(s)
- David K Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ian H Gotlib
- Department of Psychology, Stanford University School of Humanities and Science, Stanford, California
| | - Jessica L Buthmann
- Department of Psychology, Stanford University School of Humanities and Science, Stanford, California
| | - Ivana Marié
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Gary L Darmstadt
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Maurice L Druzin
- Department of Obstetrics and Gynecology-Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, California
| | - Ronald J Wong
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Michael Katz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Aden D, Zaheer S, Khan S. Possible benefits, challenges, pitfalls, and future perspective of using ChatGPT in pathology. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2024; 57:198-210. [PMID: 38971620 DOI: 10.1016/j.patol.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/22/2024] [Accepted: 04/16/2024] [Indexed: 07/08/2024]
Abstract
The much-hyped artificial intelligence (AI) model called ChatGPT developed by Open AI can have great benefits for physicians, especially pathologists, by saving time so that they can use their time for more significant work. Generative AI is a special class of AI model, which uses patterns and structures learned from existing data and can create new data. Utilizing ChatGPT in Pathology offers a multitude of benefits, encompassing the summarization of patient records and its promising prospects in Digital Pathology, as well as its valuable contributions to education and research in this field. However, certain roadblocks need to be dealt like integrating ChatGPT with image analysis which will act as a revolution in the field of pathology by increasing diagnostic accuracy and precision. The challenges with the use of ChatGPT encompass biases from its training data, the need for ample input data, potential risks related to bias and transparency, and the potential adverse outcomes arising from inaccurate content generation. Generation of meaningful insights from the textual information which will be efficient in processing different types of image data, such as medical images, and pathology slides. Due consideration should be given to ethical and legal issues including bias.
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Affiliation(s)
- Durre Aden
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - Sabina Khan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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238
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Edgar AK, Chong LX, Wood-Bradley R, Armitage JA, Narayanan A, Macfarlane S. The role of extended reality in optometry education: a narrative review. Clin Exp Optom 2024:1-10. [PMID: 38944747 DOI: 10.1080/08164622.2024.2366366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/05/2024] [Indexed: 07/01/2024] Open
Abstract
The evolution of digitally based pedagogies, such as extended reality (XR) - a group of simulated learning environments that include virtual simulation, virtual reality, and augmented reality - has prompted optometry educators to seek evidence to guide the implementation of these teaching and learning activities within their curricula. Looking more broadly across the medical and allied health fields, there is a wealth of evidence to guide the incorporation of XR, as it is increasingly being integrated into the curricula of other select health professions disciplines. Educators from these disciplines continue to explore and embed XR in practice. This narrative review summarises the findings and appraises the literature on the use of XR in optometry education. It identifies the learning domains in which XR has been implemented in optometry education and proposes areas for further investigation. The review questions the technology-focused approach that has driven the literature within the review and calls for richer pedagogical foundations with suggestions for future research agendas. As such, this narrative review provides optometry educators with new ways of understanding XR and its relationship with the curriculum.
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Affiliation(s)
- Amanda K Edgar
- Deakin Learning Futures, Deakin University, Geelong, Australia
| | - Luke X Chong
- School of Medicine, Deakin University, Geelong, Australia
| | | | | | - Anuradha Narayanan
- Unit of Medical Research Foundation, Elite School of Optometry, Chennai, India
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239
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Glaudemans AW. Heliyon medical imaging: Shaping the future of health. Heliyon 2024; 10:e32395. [PMID: 39183843 PMCID: PMC11341280 DOI: 10.1016/j.heliyon.2024.e32395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 08/27/2024] Open
Affiliation(s)
- Andor W.J.M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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240
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Pessoa-Amorim G, Goldacre R, Crichton C, Stevens W, Nunn M, King A, Murray D, Welsh R, Pinches H, Rees A, Morris EJA, Landray MJ, Haynes R, Horby P, Wallendszus K, Peto L, Campbell M, Harper C, Mafham M. Clinical trial results in context: comparison of baseline characteristics and outcomes of 38,510 RECOVERY trial participants versus a reference population of 346,271 people hospitalised with COVID-19 in England. Trials 2024; 25:429. [PMID: 38951929 PMCID: PMC11218071 DOI: 10.1186/s13063-024-08273-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Randomised trials are essential to reliably assess medical interventions. Nevertheless, interpretation of such studies, particularly when considering absolute effects, is enhanced by understanding how the trial population may differ from the populations it aims to represent. METHODS We compared baseline characteristics and mortality of RECOVERY participants recruited in England (n = 38,510) with a reference population hospitalised with COVID-19 in England (n = 346,271) from March 2020 to November 2021. We used linked hospitalisation and mortality data for both cohorts to extract demographics, comorbidity/frailty scores, and crude and age- and sex-adjusted 28-day all-cause mortality. RESULTS Demographics of RECOVERY participants were broadly similar to the reference population, but RECOVERY participants were younger (mean age [standard deviation]: RECOVERY 62.6 [15.3] vs reference 65.7 [18.5] years) and less frequently female (37% vs 45%). Comorbidity and frailty scores were lower in RECOVERY, but differences were attenuated after age stratification. Age- and sex-adjusted 28-day mortality declined over time but was similar between cohorts across the study period (RECOVERY 23.7% [95% confidence interval: 23.3-24.1%]; vs reference 24.8% [24.6-25.0%]), except during the first pandemic wave in the UK (March-May 2020) when adjusted mortality was lower in RECOVERY. CONCLUSIONS Adjusted 28-day mortality in RECOVERY was similar to a nationwide reference population of patients admitted with COVID-19 in England during the same period but varied substantially over time in both cohorts. Therefore, the absolute effect estimates from RECOVERY were broadly applicable to the target population at the time but should be interpreted in the light of current mortality estimates. TRIAL REGISTRATION ISRCTN50189673- Feb. 04, 2020, NCT04381936- May 11, 2020.
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Affiliation(s)
- Guilherme Pessoa-Amorim
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK.
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK.
| | - Raphael Goldacre
- Big Data Institute, Oxford Population Health, University of Oxford, Oxford, UK
| | - Charles Crichton
- Big Data Institute, Oxford Population Health, University of Oxford, Oxford, UK
| | - Will Stevens
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Michelle Nunn
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Andy King
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Dave Murray
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Richard Welsh
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | | | | | - Eva J A Morris
- Big Data Institute, Oxford Population Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Martin J Landray
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
- Big Data Institute, Oxford Population Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Haynes
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), University of Oxford, Oxford, UK
- Pandemic Sciences Centre, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karl Wallendszus
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Leon Peto
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark Campbell
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charlie Harper
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Marion Mafham
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX37LF, UK
- Medical Research Council Population Health Research Unit, Oxford Population Health, University of Oxford, Oxford, UK
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Leung R, Wang B, Gottbrecht M, Doerr A, Marya N, Soni A, McManus DD, Lin H. Association between deep neural network-derived electrocardiographic-age and incident stroke. Front Cardiovasc Med 2024; 11:1368094. [PMID: 39006167 PMCID: PMC11239432 DOI: 10.3389/fcvm.2024.1368094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Background Stroke continues to be a leading cause of death and disability worldwide despite improvements in prevention and treatment. Traditional stroke risk calculators are biased and imprecise. Novel stroke predictors need to be identified. Recently, deep neural networks (DNNs) have been used to determine age from ECGs, otherwise known as the electrocardiographic-age (ECG-age), which predicts clinical outcomes. However, the relationship between ECG-age and stroke has not been well studied. We hypothesized that ECG-age is associated with incident stroke. Methods In this study, UK Biobank participants with available ECGs (from 2014 or later). ECG-age was estimated using a deep neural network (DNN) applied to raw ECG waveforms. We calculated the Δage (ECG-age minus chronological age) and classified individuals as having normal, accelerated, or decelerated aging if Δage was within, higher, or lower than the mean absolute error of the model, respectively. Multivariable Cox proportional hazards regression models adjusted for age, sex, and clinical factors were used to assess the association between Δage and incident stroke. Results The study population included 67,757 UK Biobank participants (mean age 65 ± 8 years; 48.3% male). Every 10-year increase in Δage was associated with a 22% increase in incident stroke [HR, 1.22 (95% CI, 1.00-1.49)] in the multivariable-adjusted model. Accelerated aging was associated with a 42% increase in incident stroke [HR, 1.42 (95% CI, 1.12-1.80)] compared to normal aging. In addition, Δage was associated with prevalent stroke [OR, 1.28 (95% CI, 1.11-1.49)]. Conclusions DNN-estimated ECG-age was associated with incident and prevalent stroke in the UK Biobank. Further investigation is required to determine if ECG-age can be used as a reliable biomarker of stroke risk.
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Affiliation(s)
- Robert Leung
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Biqi Wang
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Matthew Gottbrecht
- Division of Cardiology, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Adam Doerr
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Neil Marya
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
- Division of Gastroenterology, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - David D. McManus
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
- Division of Cardiology, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
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Doshi S, Vuppula S, Jaggi P. Healthcare Sustainability to Address Climate Change: Call for Action to the Infectious Diseases Community. J Pediatric Infect Dis Soc 2024; 13:306-312. [PMID: 38758197 DOI: 10.1093/jpids/piae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/05/2024] [Indexed: 05/18/2024]
Abstract
The US healthcare system's contribution to greenhouse gas emissions and climate change is disproportionately high and harms the public. Several medical specialties are now reassessing how they can mitigate healthcare's harmful environmental impact. Healthcare sustainability is broadly defined as measures to decrease greenhouse gas emissions, waste, and other pollutants generated during the healthcare delivery process. Prior efforts and programs by infectious diseases (ID) professionals, such as antimicrobial stewardship and infection prevention and control can form a framework for ID professionals to help apply this expertise to healthcare environmental sustainability more broadly. This call to action proposes strategies for ID societies and professionals to incorporate climate change education for trainees, increase research and funding opportunities in healthcare sustainability, and calls for action by ID societies to champion system changes to decrease greenhouse gas emissions.
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Affiliation(s)
- Shreya Doshi
- Division of Infectious Diseases, Children's National Medical Center, Washington, DC, USA
| | - Sharon Vuppula
- Division of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Preeti Jaggi
- Division of Infectious Diseases and Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, GA, USA
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Gregory A, Ender J, Shaw AD, Denault A, Ibekwe S, Stoppe C, Alli A, Manning MW, Brodt JL, Galhardo C, Sander M, Zarbock A, Fletcher N, Ghadimi K, Grant MC. ERAS/STS 2024 Expert Consensus Statement on Perioperative Care in Cardiac Surgery: Continuing the Evolution of Optimized Patient Care and Recovery. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00399-9. [PMID: 39004570 DOI: 10.1053/j.jvca.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Alexander Gregory
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Joerg Ender
- Department of Anesthesiology and Intensive Care Medicine, Heartcenter Leipzig GmbH, Leipzig, Germany
| | - Andrew D Shaw
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH
| | - André Denault
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Stephanie Ibekwe
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX
| | - Christian Stoppe
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Ahmad Alli
- Department of Anesthesiology & Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Jessica L Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto CA
| | - Carlos Galhardo
- Department of Anesthesia, McMaster University, Ontario, Canada
| | - Michael Sander
- Anesthesiology and Intensive Care Medicine, Justus Liebig University Giessen, University Hospital Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Nick Fletcher
- Institute of Anaesthesia and Critical Care, Cleveland Clinic London, London, UK
| | | | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Johnston M, O'Mahony M, O'Brien N, Connolly M, Iohom G, Kamal M, Shehata A, Shorten G. The feasibility and usability of mixed reality teaching in a hospital setting based on self-reported perceptions of medical students. BMC MEDICAL EDUCATION 2024; 24:701. [PMID: 38937764 PMCID: PMC11212163 DOI: 10.1186/s12909-024-05591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 05/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Clinical teaching during encounters with real patients lies at the heart of medical education. Mixed reality (MR) using a Microsoft HoloLens 2 (HL2) offers the potential to address several challenges: including enabling remote learning; decreasing infection control risks; facilitating greater access to medical specialties; and enhancing learning by vertical integration of basic principles to clinical application. We aimed to assess the feasibility and usability of MR using the HL2 for teaching in a busy, tertiary referral university hospital. METHODS This prospective observational study examined the use of the HL2 to facilitate a live two-way broadcast of a clinician-patient encounter, to remotely situated third and fourth year medical students. System Usability Scale (SUS) Scores were elicited from participating medical students, clinician, and technician. Feedback was also elicited from participating patients. A modified Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions Questionnaire (mETELM) was completed by medical students and patients. RESULTS This was a mixed methods prospective, observational study, undertaken in the Day of Surgery Assessment Unit. Forty-seven medical students participated. The mean SUS score for medical students was 71.4 (SD 15.4), clinician (SUS = 75) and technician (SUS = 70) indicating good usability. The mETELM Questionnaire using a 7-point Likert Scale demonstrated MR was perceived to be more beneficial than a PowerPoint presentation (Median = 7, Range 6-7). Opinion amongst the student cohort was divided as to whether the MR tutorial was as beneficial for learning as a live patient encounter would have been (Median = 5, Range 3-6). Students were positive about the prospect of incorporating of MR in future tutorials (Median = 7, Range 5-7). The patients' mETELM results indicate the HL2 did not affect communication with the clinician (Median = 7, Range 7-7). The MR tutorial was preferred to a format based on small group teaching at the bedside (Median = 6, Range 4-7). CONCLUSIONS Our study findings indicate that MR teaching using the HL2 demonstrates good usability characteristics for providing education to medical students at least in a clinical setting and under conditions similar to those of our study. Also, it is feasible to deliver to remotely located students, although certain practical constraints apply including Wi-Fi and audio quality.
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Affiliation(s)
- Michael Johnston
- Peripheral Nerve Block Fellow, Cork University Hospital, Cork, Ireland.
| | | | - Niall O'Brien
- Department of Anaesthesia, University College Cork, Cork, Ireland
| | - Murray Connolly
- Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Gabriella Iohom
- Anaesthesiologist Cork University Hospital, University College Cork, Cork, Ireland
| | - Mohsin Kamal
- Peripheral Nerve Block Fellow, Cork University Hospital, Cork, Ireland
| | - Ahmed Shehata
- Peripheral Nerve Block Fellow, Cork University Hospital, Cork, Ireland
| | - George Shorten
- Anaesthesiologist Cork University Hospital, University College Cork, Cork, Ireland
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Bellal M, Lelandais J, Chabin T, Heudron A, Gourmelon T, Bauduin P, Cuchet P, Daubin C, De Carvalho Ribeiro C, Delcampe A, Goursaud S, Joret A, Mombrun M, Valette X, Cerasuolo D, Morello R, Mordel P, Chaillot F, Dutheil JJ, Vivien D, Du Cheyron D. Calibration trial of an innovative medical device ( NEVVA© ) for the evaluation of pain in non-communicating patients in the intensive care unit. Front Med (Lausanne) 2024; 11:1309720. [PMID: 38994344 PMCID: PMC11236545 DOI: 10.3389/fmed.2024.1309720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/05/2024] [Indexed: 07/13/2024] Open
Abstract
Background Pain management is an essential and complex issue for non-communicative patients undergoing sedation in the intensive care unit (ICU). The Behavioral Pain Scale (BPS), although not perfect for assessing behavioral pain, is the gold standard based partly on clinical facial expression. NEVVA© , an automatic pain assessment tool based on facial expressions in critically ill patients, is a much-needed innovative medical device. Methods In this prospective pilot study, we recorded the facial expressions of critically ill patients in the medical ICU of Caen University Hospital using the iPhone and Smart Motion Tracking System (SMTS) software with the Facial Action Coding System (FACS) to measure human facial expressions metrically during sedation weaning. Analyses were recorded continuously, and BPS scores were collected hourly over two 8 h periods per day for 3 consecutive days. For this first stage, calibration of the innovative NEVVA© medical device algorithm was obtained by comparison with the reference pain scale (BPS). Results Thirty participants were enrolled between March and July 2022. To assess the acute severity of illness, the Sequential Organ Failure Assessment (SOFA) and the Simplified Acute Physiology Score (SAPS II) were recorded on ICU admission and were 9 and 47, respectively. All participants had deep sedation, assessed by a Richmond Agitation and Sedation scale (RASS) score of less than or equal to -4 at the time of inclusion. One thousand and six BPS recordings were obtained, and 130 recordings were retained for final calibration: 108 BPS recordings corresponding to the absence of pain and 22 BPS recordings corresponding to the presence of pain. Due to the small size of the dataset, a leave-one-subject-out cross-validation (LOSO-CV) strategy was performed, and the training results obtained the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.792. This model has a sensitivity of 81.8% and a specificity of 72.2%. Conclusion This pilot study calibrated the NEVVA© medical device and showed the feasibility of continuous facial expression analysis for pain monitoring in ICU patients. The next step will be to correlate this device with the BPS scale.
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Affiliation(s)
- Mathieu Bellal
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
- Normandie Univ., UNICAEN, INSERM UMRS U1237 PhIND, Caen, France
| | - Julien Lelandais
- Normandie Univ., UNICAEN, INSERM UMRS U1237 PhIND, Caen, France
- Samdoc Medical Technologies Company, Caen, France
| | | | | | | | - Pierrick Bauduin
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
| | - Pierre Cuchet
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
| | - Cédric Daubin
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
| | | | - Augustin Delcampe
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
| | - Suzanne Goursaud
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
- Normandie Univ., UNICAEN, INSERM UMRS U1237 PhIND, Caen, France
| | - Aurélie Joret
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
| | - Martin Mombrun
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
| | - Xavier Valette
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
| | - Damiano Cerasuolo
- Department of Methodology and Statistics, Caen University Hospital, Caen, France
| | - Rémy Morello
- Department of Methodology and Statistics, Caen University Hospital, Caen, France
| | - Patrick Mordel
- Department of Clinical Research, Caen University Hospital, Caen, France
| | - Fabien Chaillot
- Department of Clinical Research, Caen University Hospital, Caen, France
| | | | - Denis Vivien
- Normandie Univ., UNICAEN, INSERM UMRS U1237 PhIND, Caen, France
- Department of Clinical Research, Caen University Hospital, Caen, France
- Department of Biological Resources Center, Caen University Hospital, Caen, France
| | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
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Rai A, Shukla S, Mehtani N, Acharya V, Tolley N. Does a junior doctor focused 'Bootcamp' improve the confidence and preparedness of newly appointed ENT registrars to perform their job roles? BMC MEDICAL EDUCATION 2024; 24:702. [PMID: 38937721 PMCID: PMC11212423 DOI: 10.1186/s12909-024-05691-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND To assess changes in confidence and preparedness after conducting a 2-day induction bootcamp for novice Ear Nose and Throat (ENT) first year specialty trainee registrars (ST3s) in the United Kingdom (UK). The bootcamp covered common ENT presentations on the ward, and in the elective and emergency settings. METHODS A total of 32 trainees (ST3 or research fellow) voluntarily registered via an online application form to the Southern ST3 accelerated learning course bootcamp through ENT UK. ENT UK is a membership body that supports ENT trainees throughout their careers. They completed a two-day bootcamp that was hosted at St Mary's Hospital, London and 10 skills sessions were delivered by either a senior ENT registrar or an ENT consultant. A pre-session questionnaire was distributed to all participants and a post-session questionnaire was provided that assessed the changes in confidence and preparedness of the participants, if any. The responses were scored by a 10-point Likert scale. Only participants who fully completed the pre and post questionnaire were included, which was 29 in total. RESULTS Participants self-reported a significant increase in confidence (p < 0.001) and preparedness (p < 0.001) following the bootcamp course. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station. CONCLUSION The use of a two-day bootcamp improved confidence and preparedness of managing common ENT presentations in the ward, elective and emergency settings for ENT ST3s. It provides a useful adjunct in the acquisition of technical and non-technical skills alongside the traditional surgical apprenticeship. In the future, more work is required to assess the impact of bootcamps on patient outcomes and long-term benefits on trainees' skill retention and clinical proficiency.
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Affiliation(s)
- Amar Rai
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Shivani Shukla
- The School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nikita Mehtani
- Department of ENT Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Vikas Acharya
- Department of ENT Surgery, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Neil Tolley
- Department of ENT Surgery, Imperial College Healthcare NHS Trust, London, UK
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Murphy C. Increasing multimorbidity and the evolving peri-operative model of care. Anaesthesia 2024. [PMID: 38924039 DOI: 10.1111/anae.16367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
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Abbasi H, Gillespie B, Samhat M, White K, Jeffrey D. Should physician-assisted suicide (PAS) be legalised in the UK? An innovative workshop exploring medical students' perspectives. EDUCATION FOR PRIMARY CARE 2024:1-4. [PMID: 38924552 DOI: 10.1080/14739879.2024.2364874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
This workshop aimed to investigate students' perspectives on physician-assisted suicide (PAS) and its potential legalisation. A two-pronged strategy was used - a goldfish bowl roleplay simulation and a facilitated group discussion. The roleplay enabled students to engage with practical and emotional challenges related to responding to a PAS request, while the discussion encouraged open dialogue on the ethical complexities of legalising PAS. Students showed nuanced changes in perspectives on PAS by actively participating in roleplay and discussions, demonstrating the potential for these approaches to promote deeper understanding.
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Affiliation(s)
- Habiba Abbasi
- Three Counties Medical School, University of Worcester, Worcester, UK
| | - Bethan Gillespie
- Three Counties Medical School, University of Worcester, Worcester, UK
| | - Mohamad Samhat
- Three Counties Medical School, University of Worcester, Worcester, UK
| | - Katherine White
- Three Counties Medical School, University of Worcester, Worcester, UK
| | - David Jeffrey
- Three Counties Medical School, University of Worcester, Worcester, UK
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Kerins J, Ralston K, Stirling SA, Simpson N, Tallentire VR. Training as imagined? A critical realist analysis of Scotland's internal medicine simulation programme. Adv Simul (Lond) 2024; 9:27. [PMID: 38926742 PMCID: PMC11210083 DOI: 10.1186/s41077-024-00299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Evaluating the impact of simulation-based education (SBE) has prioritised demonstrating a causal link to improved patient outcomes. Recent calls herald a move away from looking for causation to understanding 'what else happened'. Inspired by Shorrock's varieties of human work from patient safety literature, this study draws on the concept of work-as-done versus work-as-imagined. Applying this to SBE recognises that some training impacts will be unexpected, and the realities of training will never be quite as imagined. This study takes a critical realist stance to explore the experience and consequences, intended and unintended, of the internal medicine training (IMT) simulation programme in Scotland, to better understand 'training-as-done'. METHODS Critical realism accepts that there is a reality to uncover but acknowledges that our knowledge of reality is inevitably our construction and cannot be truly objective. The IMT simulation programme involves three courses over a 3-year period: a 3-day boot camp, a skills day and a 2-day registrar-ready course. Following ethical approval, interviews were conducted with trainees who had completed all courses, as well as faculty and stakeholders both immersed in and distant from course delivery. Interviews were audio-recorded, transcribed verbatim and analysed using critical realist analysis, influenced by Shorrock's proxies for work-as-done. RESULTS Between July and December 2023, 24 interviews were conducted with ten trainees, eight faculty members and six stakeholders. Data described proxies for training-as-done within three broad categories: design, experience and impact. Proxies for training design included training-as-prescribed, training-as-desired and training-as-prioritised which compete to produce training-as-standardised. Experience included training-as-anticipated with pre-simulation anxiety and training-as-unintended with the valued opportunity for social comparison as well as a sense of identity and social cohesion. The impact reached beyond the individual trainee with faculty development and inspiration for other training ventures. CONCLUSION Our findings highlight unintended consequences of SBE such as social comparison and feeling 'valued as a trainee, valued as a person'. It sheds light on the fear of simulation, reinforcing the importance of psychological safety. A critical realist approach illuminated the 'bigger picture', revealing insights and underlying mechanisms that allow this study to present a new framework for conceptualising training evaluation.
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Affiliation(s)
- Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK.
- NHS Education for Scotland, Glasgow, UK.
| | | | | | - Nicholas Simpson
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
- Medical Education Directorate, NHS Lothian, Edinburgh, UK
- NHS Education for Scotland, Glasgow, UK
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Al Khatib I, Chembakath JJ, Ndiaye M. Benchmarking Sweden's Digitalization Transformation Strategy-Is It a Good Fit for the UAE? Telemed J E Health 2024. [PMID: 38916743 DOI: 10.1089/tmj.2024.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background: The ongoing revolution in health care, driven by wearable technology, virtual reality, and the Internet of Things, is reshaping both health care operations and our daily lives. This digital transformation ensures broader access to health care options, fosters patient-centered care and affects both health care institutions and individuals. In Sweden, health care is undergoing a digital shift, with initiatives like personal health management, remote monitoring, and virtual care enhancing patient involvement. This article reviews Sweden's health care digital transformation and compares it with the United Arab Emirates (UAE's) initiatives to assess viability. Methods: Using systematic literature review methods, databases from 2011 to 2023 were searched, supplemented by reference lists. Results: Database searches identified 761 records. A total of 480 articles were screened on basis of title and abstract, yielding 184 that were assessed for eligibility, leading to 40 academic studies to be included and 12 grey literature. Conclusions: The findings highlight Sweden's success in empowering patients through enhanced connectivity with clinical teams, knowledge sharing, and care management. However, due to contextual differences, the UAE should not blindly replicate Sweden's strategy. In conclusion, Sweden's efforts have positively engaged patients in health care, but challenges such as emerging technologies, demographic shifts, and budget constraints persist. Proactive planning and adaptation are crucial, with lessons applicable to the UAE market. Establishing a clear regulatory framework for digital care is imperative for future resilience.
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Affiliation(s)
- Inas Al Khatib
- College of Industrial Engineering, American University of Sharjah, Sharjah, United Arab Emirates
| | - Junu Jahana Chembakath
- College of Industrial Engineering, American University of Sharjah, Sharjah, United Arab Emirates
| | - Malick Ndiaye
- College of Industrial Engineering, American University of Sharjah, Sharjah, United Arab Emirates
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