1
|
Panico A, Gatta G, Salvia A, Grezia GD, Fico N, Cuccurullo V. Radiomics in Breast Imaging: Future Development. J Pers Med 2023; 13:jpm13050862. [PMID: 37241032 DOI: 10.3390/jpm13050862] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Breast cancer is the most common and most commonly diagnosed non-skin cancer in women. There are several risk factors related to habits and heredity, and screening is essential to reduce the incidence of mortality. Thanks to screening and increased awareness among women, most breast cancers are diagnosed at an early stage, increasing the chances of cure and survival. Regular screening is essential. Mammography is currently the gold standard for breast cancer diagnosis. In mammography, we can encounter problems with the sensitivity of the instrument; in fact, in the case of a high density of glands, the ability to detect small masses is reduced. In fact, in some cases, the lesion may not be particularly evident, it may be hidden, and it is possible to incur false negatives as partial details that may escape the radiologist's eye. The problem is, therefore, substantial, and it makes sense to look for techniques that can increase the quality of diagnosis. In recent years, innovative techniques based on artificial intelligence have been used in this regard, which are able to see where the human eye cannot reach. In this paper, we can see the application of radiomics in mammography.
Collapse
Affiliation(s)
- Alessandra Panico
- Radiology Division, Department of Precision Medicine, Università della Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Gianluca Gatta
- Radiology Division, Department of Precision Medicine, Università della Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Antonio Salvia
- Radiology Division, Department of Precision Medicine, Università della Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | | | - Noemi Fico
- Department of Physics "Ettore Pancini", Università di Napoli Federico II, 80126 Naples, Italy
| | - Vincenzo Cuccurullo
- Nuclear Medicine Unit, Department of Precision Medicine, Università della Campania "Luigi Vanvitelli", 80138 Naples, Italy
| |
Collapse
|
2
|
Gunnarson M. Disclosing the person in renal care coordination: why unpredictability, uncertainty, and irreversibility are inherent in person-centred care. MEDICINE, HEALTH CARE AND PHILOSOPHY 2022; 25:641-654. [PMID: 36125646 PMCID: PMC9613738 DOI: 10.1007/s11019-022-10113-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
This article explores an example of person-centred care: the work of so-called renal care coordinators. The empirical basis of the article consists of qualitative interviews with renal care coordinators, alongside participant observations of their patient interactions. During the analyses of the empirical material, I found that that one of the coordinators’ most fundamental ambitions is to get to know who the patient is. This is also a central tenet of person-centred care. The aim of the article is not only to argue for the plausibility of this tenet, but also, and more importantly, to highlight and explore its implications in the context of healthcare, through the example of renal care coordination. By drawing on the philosophy of Hannah Arendt, the article shows that the disclosure of who the patient is that takes place in person-centred care requires speech and action, which are modes of human activity that initiate processes characterized by unpredictability, uncertainty, and irreversibility. This unpredictability, uncertainty, and irreversibility, found to be inherent in person-centred care, is then discussed in relation to the pursuit of certainty characterizing contemporary evidence-based medicine. At the end of the article the conclusion is drawn that, if healthcare is to be person-centred, it must find ways of accommodating the contradictory pursuits of certainty and uncertainty found in evidence-based medicine and person-centred care respectively.
Collapse
|
3
|
Thomas A, Chin-Yee B, Mercuri M. Thirty years of teaching evidence-based medicine: have we been getting it all wrong? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:263-276. [PMID: 34559327 DOI: 10.1007/s10459-021-10077-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
Evidence based medicine (EBM) has been synonymous to delivery of quality care for almost thirty years. Since the movement's inception, the assumption has been that decisions based on high quality evidence would translate to better care for patients. Despite EBM's many attractive features and the substantive attention it has received in the contemporary clinical and medical education literature, how it is defined and operationalized as a component of training is often unclear and problematic. How to practice EBM is not well articulated in the literature; therefore, it becomes difficult to teach and equally challenging to assess. In this paper, we put forward a call for deeper consideration of how EBM is taught, and for clarification on how it is defined and operationalized in medical education. In preparing this paper, we considered questions such as what it means to practice EBM, the role that medical education plays in helping realize EBM, how the teaching of EBM can change to reflect recent developments in clinical practice and education, and whether transformations in the practice of medicine necessitate a change in how we teach EBM. We end with four avenues that may be pursued to advance the teaching of EBM in medical education: (1) consensus on what we mean by EBM; (2) clear articulation of EBM-associated competencies; (3) empirically and theoretically supported means of promoting EBM competencies; (4) ways to assess both skill acquisition and use of EBM. We discuss implications for educators of EBM.
Collapse
Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy and Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University and Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3654 Promenade Sir William Osler, Montreal, QC, H3G-1Y5, Canada.
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine and Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Mathew Mercuri
- Department of Medicine, McMaster University, Hamilton, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for the Future of Knowledge, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
4
|
Paradis E, De Freitas C, Heisey R, Burrell K, Fernandes L, McLeod J, Whitehead CR. Getting standardization right. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:323-325. [PMID: 33980621 DOI: 10.46747/cfp.6705323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Elise Paradis
- Sociologist and Assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto in Ontario, and Scientist at The Wilson Centre in the University Health Network
| | | | - Ruth Heisey
- Chief of Family Medicine and Medical Director of the Peter Gilgan Centre for Women's Cancers at Women's College Hospital in Toronto and Clinician Investigator and Associate Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Karen Burrell
- Clinical social worker and psychotherapist at the Women's College Hospital Family Practice Health Centre, and Adjunct Lecturer in both the Factor-Inwentash Faculty of Social Work and the Department of Family and Community Medicine at the University of Toronto
| | - Lisa Fernandes
- Clinical pharmacist at Women's College Hospital Family Practice Health Centre and Assistant Professor (status only) in the Department of Family and Community Medicine at the University of Toronto
| | - Jane McLeod
- Registered nurse at Women's College Hospital Family Practice Health Centre
| | - Cynthia R Whitehead
- Family physician at Women's College Hospital, Professor in the Department of Family and Community Medicine at the University of Toronto, and Director and Scientist at The Wilson Centre.
| |
Collapse
|
5
|
Martínez-Sellés M, Martín-Sánchez FJ. Medical associations in the 21st century. Reflections in the wake of the agreement between the Spanish Heart Foundation and the Official Physicians Association of Madrid. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:727-728. [PMID: 34172406 DOI: 10.1016/j.rec.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Facultad de Ciencias Biomédicas, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Ilustre Colegio Oficial de Médicos de Madrid, Madrid, Spain.
| | - Francisco Javier Martín-Sánchez
- Facultad de Medicina, Universidad Complutense, Madrid, Spain; Ilustre Colegio Oficial de Médicos de Madrid, Madrid, Spain; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
6
|
Martínez-Sellés M, Martín-Sánchez FJ. Los colegios de médicos en el siglo XXI. Reflexiones a raíz del acuerdo de la Fundación Española del Corazón y el Ilustre Colegio Oficial de Médicos de Madrid. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Sarker SK. Legal & ethical dilemmas in incidental findings during surgery: Review article. Int J Surg 2020; 75:107-113. [DOI: 10.1016/j.ijsu.2020.01.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 12/25/2022]
|
8
|
Artificial intelligence: Who is responsible for the diagnosis? Radiol Med 2020; 125:517-521. [PMID: 32006241 DOI: 10.1007/s11547-020-01135-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/16/2020] [Indexed: 12/15/2022]
Abstract
The aim of the paper is to find an answer to the question "Who or what is responsible for the benefits and harms of using artificial intelligence in radiology?" When human beings make decisions, the action itself is normally connected with a direct responsibility by the agent who generated the action. You have an effect on others, and therefore, you are responsible for what you do and what you decide to do. But if you do not do this yourself, but an artificial intelligence system, it becomes difficult and important to be able to ascribe responsibility when something goes wrong. The manuscript addresses the following statements: (1) using AI, the radiologist is responsible for the diagnosis; (2) radiologists must be trained on the use of AI since they are responsible for the actions of machines; (3) radiologists involved in R&D have the responsibility to guide the respect of rules for a trustworthy AI; (4) radiologist responsibility is at risk of validating the unknown (black box); (5) radiologist decision may be biased by the AI automation; (6)risk of a paradox: increasing AI tools to compensate the lack of radiologists; (7) need of informed consent and quality measures. Future legislation must outline the contours of the professional's responsibility, with respect to the provision of the service performed autonomously by AI, balancing the professional's ability to influence and therefore correct the machine, limiting the sphere of autonomy that instead technological evolution would like to recognize to robots.
Collapse
|
9
|
van Veenendaal H, van der Weijden T, Ubbink DT, Stiggelbout AM, van Mierlo LA, Hilders CGJM. Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation. PATIENT EDUCATION AND COUNSELING 2018; 101:2097-2104. [PMID: 30006242 DOI: 10.1016/j.pec.2018.06.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/25/2018] [Accepted: 06/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To prioritize strategies to implement shared decision-making (SDM) in daily practice, resulting in an agenda for a nationwide approach. METHODS This was a qualitative, exploratory investigation involving: Interviews (N = 43) to elicit perceived barriers to and facilitators of change, focus group discussions (N = 51) to develop an implementation strategy, and re-affirmation through written feedback (n = 19). Professionals, patients, researchers and policymakers from different healthcare sectors participated. Determinants for change were addressed at four implementation levels: (1) the concept of SDM, (2) clinician and/or patient, (3) organizational context and (4) socio-political context. RESULTS Following the identification of perceived barriers, four strategies were proposed to scale up SDM: 1) stimulating intrinsic motivation among clinicians via an integrated programmatic approach, 2) training and implementation in routine practice, 3) stimulating the empowerment of patients, 4) creating an enabling socio-political context. CONCLUSION Clinicians mentioned that applying SDM makes their job more rewarding and indicated that implementation in daily practice needs ground-up redesign. The challenge is to effectively influence the behavior of clinicians and patients alike, and adapt clinical pathways to facilitate the exploration of patient values. PRACTICE IMPLICATIONS Stakeholders should connect nationwide initiatives to pool information, and make the healthcare system supportive of implementing SDM.
Collapse
Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI, Maastricht University Medical Centre, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Dirk T Ubbink
- Department of Surgery, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Post zone J10-S, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Linda A van Mierlo
- Department of Innovation, CZ Healthcare Insurance, Postbus 90152, 5000 LD, Tilburg, The Netherlands.
| | - Carina G J M Hilders
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands; Board of directors, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands.
| |
Collapse
|
10
|
Salloch S, Otte I, Reinacher-Schick A, Vollmann J. What does physicians' clinical expertise contribute to oncologic decision-making? A qualitative interview study. J Eval Clin Pract 2018; 24:180-186. [PMID: 29076629 DOI: 10.1111/jep.12840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/10/2017] [Accepted: 09/26/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Physicians' clinical expertise forms an exclusive body of competences, which helps them to find the appropriate diagnostics and treatment for each individual patient. Empirical evidence, however, suggests that there is an inverse relationship between the number of years in practice and the quality of care provided by a physician. Knowledge and adherence to professional standards (such as clinical guidelines) are often used as indicators in previous research. METHODS Semistructured interviews and the Q method were used for an explorative study on oncologists' views on the interplay between their own clinical expertise, intuition, and the external evidence incorporated in clinical guidelines. The interviews were audio recorded, transcribed ad verbatim, and analysed using qualitative content analysis. RESULTS Data analysis shows the complex character of clinical expertise with respect to experience, professional development, and intuition. An irreplaceable role is attributed to personal and bodily experience during the providing of care for a patient. Professional experience becomes important, particularly in those situations that lie out of the focus of "guideline medicine." Intuition is regarded as having a strong emotional component and helps for deciding which therapeutic option the patient can deal with. CONCLUSIONS Using measurable knowledge and adherence to standards as indicators does not account for the complexity of clinical expertise. Other factors, such as the importance of bodily experience and physicians' intuitive knowledge, must be considered, also with respect to the occurrence of treatment biases.
Collapse
Affiliation(s)
- Sabine Salloch
- Institute for Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ina Otte
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Anke Reinacher-Schick
- Department for Hematology, Oncology and Palliative Care, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
11
|
Song S, Budden A, Short A, Nesbitt-Hawes E, Deans R, Abbott J. The evidence for laser treatments to the vulvo-vagina: Making sure we do not repeat past mistakes. Aust N Z J Obstet Gynaecol 2017; 58:148-162. [PMID: 29067688 DOI: 10.1111/ajo.12735] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/27/2017] [Indexed: 12/26/2022]
Abstract
Following menopause, up to 49% of women will experience genitourinary symptoms such as vaginal itching, dryness, dyspareunia and incontinence as a result of oestrogen deficiency. Treatments such as vaginal lubricants and moisturisers only temporarily relieve symptoms, while local oestrogen treatments are often unacceptable or unsafe for many women. Recently, a novel laser treatment has been proposed as a non-invasive, long-term solution to vulvo-vaginal and urinary symptoms. While preliminary histological results have been promising, its therapeutic, clinical effect has yet to be determined. However, despite the scarcity of evidence for its safety and long-term benefit, laser treatments are widely marketed for a range of genitourinary symptoms, with high uptake by both clinicians and women alike. This review aims to examine the evidence for laser treatments to the vulvo-vagina and to evaluate its safety and efficacy. Our results include 17 studies investigating the effect of laser therapy for vulvo-vaginal symptoms, seven for its effects on urinary incontinence and four for histology. These are limited to non-randomised, observational data with small sample sizes between 15 to 175 women and follow-up duration from none to two years. As such, strong evidence for laser efficacy and safety is limited and warrants more robust, placebo-controlled, randomised trials before widespread implementation.
Collapse
Affiliation(s)
- Sophia Song
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Aaron Budden
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Asha Short
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Jason Abbott
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| |
Collapse
|