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Pawelczyk J, Kraus M, Eckl L, Nehrer S, Aurich M, Izadpanah K, Siebenlist S, Rupp MC. Attitude of aspiring orthopaedic surgeons towards artificial intelligence: a multinational cross-sectional survey study. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05408-0. [PMID: 39127806 DOI: 10.1007/s00402-024-05408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/17/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION The purpose of this study was to evaluate the perspectives of aspiring orthopaedic surgeons on artificial intelligence (AI), analysing how gender, AI knowledge, and technical inclination influence views on AI. Additionally, the extent to which recent AI advancements sway career decisions was assessed. MATERIALS AND METHODS A digital survey was distributed to student members of orthopaedic societies across Germany, Switzerland, and Austria. Subgroup analyses explored how gender, AI knowledge, and technical inclination shape attitudes towards AI. RESULTS Of 174 total respondents, 86.2% (n = 150) intended to pursue a career in orthopaedic surgery and were included in the analysis. The majority (74.5%) reported 'basic' or 'no' knowledge about AI. Approximately 29.3% believed AI would significantly impact orthopaedics within 5 years, with another 35.3% projecting 5-10 years. AI was predominantly seen as an assistive tool (77.8%), without significant fear of job displacement. The most valued AI applications were identified as preoperative implant planning (85.3%), administrative tasks (84%), and image analysis (81.3%). Concerns arose regarding skill atrophy due to overreliance (69.3%), liability (68%), and diminished patient interaction (56%). The majority maintained a 'neutral' view on AI (53%), though 32.9% were 'enthusiastic'. A stronger focus on AI in medical education was requested by 81.9%. Most participants (72.8%) felt recent AI advancements did not alter their career decisions towards or away from the orthopaedic specialty. Statistical analysis revealed a significant association between AI literacy (p = 0.015) and technical inclination (p = 0.003). AI literacy did not increase significantly during medical education (p = 0.091). CONCLUSIONS Future orthopaedic surgeons exhibit a favourable outlook on AI, foreseeing its significant influence in the near future. AI literacy remains relatively low and showed no improvement during medical school. There is notable demand for improved AI-related education. The choice of orthopaedics as a specialty appears to be robust against the sway of recent AI advancements. LEVEL OF EVIDENCE Cross-sectional survey study; level IV.
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Affiliation(s)
- Johannes Pawelczyk
- Klinikum rechts der Isar, Sektion Sportorthopädie, Technische Universität München, Haus 524, Ismaninger Str. 22, 81675, Munich, Germany
| | - Moritz Kraus
- Schulthess Klinik, Abteilung für Schulter- und Ellenbogenchirurgie, Zurich, Switzerland
| | - Larissa Eckl
- Schulthess Klinik, Abteilung für Schulter- und Ellenbogenchirurgie, Zurich, Switzerland
| | - Stefan Nehrer
- Klinische Abteilung für Orthopädie und Traumatologie, Universitätsklinikum Krems, Krems an der Donau, Austria
- Zentrum für Regenerative Medizin, Universität für Weiterbildung Krems, Krems an der Donau, Austria
- Fakultät für Gesundheit und Medizin, Universität für Weiterbildung Krems, Krems an der Donau, Austria
| | - Matthias Aurich
- Universitätsklinikum Halle (Saale), Halle, Germany
- BG Klinikum Bergmannstrost, Halle, Germany
| | - Kaywan Izadpanah
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Sebastian Siebenlist
- Klinikum rechts der Isar, Sektion Sportorthopädie, Technische Universität München, Haus 524, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Marco-Christopher Rupp
- Klinikum rechts der Isar, Sektion Sportorthopädie, Technische Universität München, Haus 524, Ismaninger Str. 22, 81675, Munich, Germany
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Cheng R, Aggarwal A, Chakraborty A, Harish V, McGowan M, Roy A, Szulewski A, Nolan B. Implementation considerations for the adoption of artificial intelligence in the emergency department. Am J Emerg Med 2024; 82:75-81. [PMID: 38820809 DOI: 10.1016/j.ajem.2024.05.020] [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: 03/19/2024] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE Artificial intelligence (AI) has emerged as a potentially transformative force, particularly in the realm of emergency medicine (EM). The implementation of AI in emergency departments (ED) has the potential to improve patient care through various modalities. However, the implementation of AI in the ED presents unique challenges that influence its clinical adoption. This scoping review summarizes the current literature exploring the barriers and facilitators of the clinical implementation of AI in the ED. METHODS We systematically searched Embase (Ovid), MEDLINE (Ovid), Web of Science, and Engineering Village. All articles were published in English through November 20th, 2023. Two reviewers screened the search results, with disagreements resolved through third-party adjudication. RESULTS A total of 8172 studies were included in the preliminary search, with 22 selected for the final data extraction. 10 studies were reviews and the remaining 12 were primary quantitative, qualitative, and mixed-methods studies. Out of the 22, 13 studies investigated a specific AI tool or application. Common barriers to implementation included a lack of model interpretability and explainability, encroachment on physician autonomy, and medicolegal considerations. Common facilitators to implementation included educating staff on the model, efficient integration into existing workflows, and sound external validation. CONCLUSION There is increasing literature on AI implementation in the ED. Our research suggests that the most common barrier facing AI implementation in the ED is model interpretability and explainability. More primary research investigating the implementation of specific AI tools should be undertaken to help facilitate their successful clinical adoption in the ED.
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Affiliation(s)
- R Cheng
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - A Aggarwal
- School of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Chakraborty
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - V Harish
- School of Medicine, University of Toronto, Toronto, ON, Canada
| | - M McGowan
- Department of Emergency Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - A Roy
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | - A Szulewski
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - B Nolan
- Department of Emergency Medicine, St Michael's Hospital, Toronto, ON, Canada..
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Bianchi V, Giambusso M, De Iacob A, Chiarello MM, Brisinda G. Artificial intelligence in the diagnosis and treatment of acute appendicitis: a narrative review. Updates Surg 2024; 76:783-792. [PMID: 38472633 PMCID: PMC11129994 DOI: 10.1007/s13304-024-01801-x] [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: 02/06/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024]
Abstract
Artificial intelligence is transforming healthcare. Artificial intelligence can improve patient care by analyzing large amounts of data to help make more informed decisions regarding treatments and enhance medical research through analyzing and interpreting data from clinical trials and research projects to identify subtle but meaningful trends beyond ordinary perception. Artificial intelligence refers to the simulation of human intelligence in computers, where systems of artificial intelligence can perform tasks that require human-like intelligence like speech recognition, visual perception, pattern-recognition, decision-making, and language processing. Artificial intelligence has several subdivisions, including machine learning, natural language processing, computer vision, and robotics. By automating specific routine tasks, artificial intelligence can improve healthcare efficiency. By leveraging machine learning algorithms, the systems of artificial intelligence can offer new opportunities for enhancing both the efficiency and effectiveness of surgical procedures, particularly regarding training of minimally invasive surgery. As artificial intelligence continues to advance, it is likely to play an increasingly significant role in the field of surgical learning. Physicians have assisted to a spreading role of artificial intelligence in the last decade. This involved different medical specialties such as ophthalmology, cardiology, urology, but also abdominal surgery. In addition to improvements in diagnosis, ascertainment of efficacy of treatment and autonomous actions, artificial intelligence has the potential to improve surgeons' ability to better decide if acute surgery is indicated or not. The role of artificial intelligence in the emergency departments has also been investigated. We considered one of the most common condition the emergency surgeons have to face, acute appendicitis, to assess the state of the art of artificial intelligence in this frequent acute disease. The role of artificial intelligence in diagnosis and treatment of acute appendicitis will be discussed in this narrative review.
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Affiliation(s)
- Valentina Bianchi
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, IRCCS, Fondazione Policlinico Universitario A Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Mauro Giambusso
- General Surgery Operative Unit, Vittorio Emanuele Hospital, 93012, Gela, Italy
| | - Alessandra De Iacob
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, IRCCS, Fondazione Policlinico Universitario A Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Michela Chiarello
- Department of Surgery, General Surgery Operative Unit, Azienda Sanitaria Provinciale Cosenza, 87100, Cosenza, Italy
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, IRCCS, Fondazione Policlinico Universitario A Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Catholic School of Medicine, University Department of Translational Medicine and Surgery, 00168, Rome, Italy.
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De Simone B, Abu-Zidan FM, Saeidi S, Deeken G, Biffl WL, Moore EE, Sartelli M, Coccolini F, Ansaloni L, Di Saverio S, Catena F. Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web-based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)-WSES project. Updates Surg 2024:10.1007/s13304-024-01853-z. [PMID: 38801604 DOI: 10.1007/s13304-024-01853-z] [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: 01/29/2024] [Accepted: 04/10/2024] [Indexed: 05/29/2024]
Abstract
Fluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difficult, high-risk surgical procedures. The aim of this study is to assess current knowledge, attitudes, and practices of emergency surgeons in the use of indocyanine green (ICG) in emergency settings. Between March 08, 2023 and April 10, 2023, a questionnaire composed of 27 multiple choice and open-ended questions was sent to 200 emergency surgeons who had previously joined the ARtificial Intelligence in Emergency and trauma Surgery (ARIES) project promoted by the WSES. The questionnaire was developed by an emergency surgeon with an interest in advanced technologies and artificial intelligence. The response rate was 96% (192/200). Responders affirmed that ICG fluorescence can support the performance of difficult surgical procedures in the emergency setting, particularly in the presence of severe inflammation and in evaluating bowel viability. Nevertheless, there were concerns regarding accessibility and availability of fluorescence imaging in emergency settings. Eighty-seven out of 192 (45.3%) respondents have a fluorescence imaging system of vision for both elective and emergency surgical procedures; 32.3% of respondents have this system solely for elective procedures; 21.4% of respondents do not have this system, 15% do not have experience with it, and 38% do not use this imaging in emergency surgery. Less than 1% (2/192) affirmed that ICG fluorescence changed always their intraoperative decision-making. Precision surgery effectively tailors surgical interventions to individual patient characteristics using advanced technology, data analysis and artificial intelligence. ICG fluorescence can serve as a valid and safe tool to guide emergency surgery in different scenarios, such as intestinal ischemia and severe acute cholecystitis. Due to the lack of high-level evidence within this field, a consensus of expert emergency surgeons is needed to encourage stakeholders to increase the availability of fluorescence imaging systems and to support emergency surgeons in implementing ICG fluorescence in their daily practice.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency and Digestive Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve St Georges, France.
- Department of Emergency and General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy.
- eCampus University, Novedrate, CO, Italy.
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Sara Saeidi
- Minimally Invasive Research Center, Division of Minimally Invasive and Bariatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Genevieve Deeken
- Center for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, 75004, Paris, France
- Department of Global Public Health and Global Studies, University of Virginia, Charlottesville, VA, 22904-4132, USA
| | - Walter L Biffl
- Department of Trauma and Emergency Surgery, Scripps Clinic, La Jolla, San Diego, USA
| | | | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Federico Coccolini
- Department of General and Trauma Surgery, University Hospital of Pisa, Pisa, Italy
| | - Luca Ansaloni
- Department of General Surgery, Pavia University Hospital, Pavia, Italy
| | - Salomone Di Saverio
- Department of Surgery, Santa Maria del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Fausto Catena
- Department of Emergency and General Surgery, Level I Trauma Center, Bufalini Hospital, AUSL Romagna, Cesena, Italy
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Zhang LY, Zhang HY. Torso hemorrhage: noncompressible? never say never. Eur J Med Res 2024; 29:153. [PMID: 38448977 PMCID: PMC10919054 DOI: 10.1186/s40001-024-01760-4] [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: 11/11/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH' (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.
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Affiliation(s)
- Lian-Yang Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Hua-Yu Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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6
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Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
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Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
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Salimi M, Parry JA, Shahrokhi R, Mosalamiaghili S. Application of artificial intelligence in trauma orthopedics: Limitation and prospects. World J Clin Cases 2023; 11:4231-4240. [PMID: 37449222 PMCID: PMC10337008 DOI: 10.12998/wjcc.v11.i18.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 06/26/2023] Open
Abstract
The varieties and capabilities of artificial intelligence and machine learning in orthopedic surgery are extensively expanding. One promising method is neural networks, emphasizing big data and computer-based learning systems to develop a statistical fracture-detecting model. It derives patterns and rules from outstanding amounts of data to analyze the probabilities of different outcomes using new sets of similar data. The sensitivity and specificity of machine learning in detecting fractures vary from previous studies. AI may be most promising in the diagnosis of less-obvious fractures that are more commonly missed. Future studies are necessary to develop more accurate and effective detection models that can be used clinically.
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Affiliation(s)
- Maryam Salimi
- Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, CO 80215, United States
| | - Joshua A Parry
- Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, CO 80215, United States
| | - Raha Shahrokhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7138433608, Iran
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Kamal AH, Zakaria OM, Majzoub RA, Nasir EWF. Artificial intelligence in orthopedics: A qualitative exploration of the surgeon perspective. Medicine (Baltimore) 2023; 102:e34071. [PMID: 37327255 PMCID: PMC10270518 DOI: 10.1097/md.0000000000034071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023] Open
Abstract
Artificial intelligence (AI) is currently integrated into many medical services. AI is utilized in many aspects of orthopedic surgery. The scope ranges from diagnosis to complex surgery. To evaluate the perceptions, attitudes, and interests of Sudanese orthopedic surgeons regarding the different applications of AI in orthopedic surgery. This qualitative questionnaire-based study was conducted through an anonymous electronic survey using Google Forms distributed among Sudanese orthopedic surgeons. The questionnaire entailed 4 sections. The first section included the participants' demographic data. The remaining 3 sections included questions for the assessment of the perception, attitude, and interest of surgeons toward (AI). The validity and reliability of the questionnaire were tested and piloted before the final dissemination. One hundred twenty-nine surgeons responded to the questionnaires. Most respondents needed to be more aware of the basic concepts of AI. However, most respondents were aware of its use in spinal and joint replacement surgeries. Most respondents had doubts regarding the safety of (AI). However, they were highly interested in utilizing (AI) in many orthopedic surgical aspects. Orthopedic surgery is a rapidly evolving branch of surgery that involves adoption of new technologies. Therefore, orthopedic surgeons should be encouraged to enroll in research activities to generate more studies and reviews to assess the usefulness and safety of emerging technologies.
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Affiliation(s)
- Ahmed Hassan Kamal
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | | | - Rabab Abbas Majzoub
- Department of Pediatrics, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - El Walid Fadul Nasir
- Department of Public Health & Biostatics, College of Dentistry, King Faisal University, Al-Ahsa, Saudi Arabia
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Cobianchi L, Piccolo D, Dal Mas F, Agnoletti V, Ansaloni L, Balch J, Biffl W, Butturini G, Catena F, Coccolini F, Denicolai S, De Simone B, Frigerio I, Fugazzola P, Marseglia G, Marseglia GR, Martellucci J, Modenese M, Previtali P, Ruta F, Venturi A, Kaafarani HM, Loftus TJ. Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey. World J Emerg Surg 2023; 18:1. [PMID: 36597105 PMCID: PMC9811693 DOI: 10.1186/s13017-022-00467-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes. METHODS An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile. RESULTS 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. DISCUSSION The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.
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Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy.
- General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
- ITIR - Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy.
| | - Daniele Piccolo
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- Department of Neurosurgery, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | | | - Luca Ansaloni
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Jeremy Balch
- Department of Surgery, University of Florida Health, Gainesville, FL, USA
| | - Walter Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Giovanni Butturini
- Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital Pisa, Pisa, Italy
| | - Stefano Denicolai
- ITIR - Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
- Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Belinda De Simone
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Isabella Frigerio
- Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Paola Fugazzola
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Gianluigi Marseglia
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- IRCCS Policlinico San Matteo Foundation, Pediatric Clinic., Pavia, Italy
| | | | | | | | - Pietro Previtali
- ITIR - Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
- Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Federico Ruta
- General Direction, ASL BAT (Health Agency), Andria, Italy
| | - Alessandro Venturi
- ITIR - Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
- Bureau of the Presidency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Haytham M Kaafarani
- Harvard Medical School, Boston, MA, USA
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL, USA
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Schwendicke F, Chaurasia A, Wiegand T, Uribe SE, Fontana M, Akota I, Tryfonos O, Krois J. Artificial intelligence for oral and dental healthcare: Core education curriculum. J Dent 2023; 128:104363. [PMID: 36410581 DOI: 10.1016/j.jdent.2022.104363] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Artificial intelligence (AI) is swiftly entering oral health services and dentistry, while most providers show limited knowledge and skills to appraise dental AI applications. We aimed to define a core curriculum for both undergraduate and postgraduate education, establishing a minimum set of outcomes learners should acquire when taught about oral and dental AI. METHODS Existing curricula and other documents focusing on literacy of medical professionals around AI were screened and relevant items extracted. Items were scoped and adapted using expert interviews with members of the IADR's e-oral health group, the ITU/WHO's Focus Group AI for Health and the Association for Dental Education in Europe. Learning outcome levels were defined and each item assigned to a level. Items were systematized into domains and a curricular structure defined. The resulting curriculum was consented using an online Delphi process. RESULTS Four domains of learning outcomes emerged, with most outcomes being on the "knowledge" level: (1) Basic definitions and terms, the reasoning behind AI and the principle of machine learning, the idea of training, validating and testing models, the definition of reference tests, the contrast between dynamic and static AI, and the problem of AI being a black box and requiring explainability should be known. (2) Use cases, the required types of AI to address them, and the typical setup of AI software for dental purposes should be taught. (3) Evaluation metrics, their interpretation, the relevant impact of AI on patient or societal health outcomes and associated examples should be considered. (4) Issues around generalizability and representativeness, explainability, autonomy and accountability and the need for governance should be highlighted. CONCLUSION Both educators and learners should consider this core curriculum during planning, conducting and evaluating oral and dental AI education. CLINICAL SIGNIFICANCE A core curriculum on oral and dental AI may help to increase oral and dental healthcare providers' literacy around AI, allowing them to critically appraise AI applications and to use them consciously and on an informed basis.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany; ITU/WHO Focus Group AI on Health, Topic Group Dentistry, Switzerland.
| | - Akhilanand Chaurasia
- ITU/WHO Focus Group AI on Health, Topic Group Dentistry, Switzerland; Department of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | - Thomas Wiegand
- ITU/WHO Focus Group AI on Health, Topic Group Dentistry, Switzerland; Technical University Berlin, Berlin, Germany
| | - Sergio E Uribe
- ITU/WHO Focus Group AI on Health, Topic Group Dentistry, Switzerland; Bioinformatics Lab & Dept of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia; School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - Margherita Fontana
- Cariology, Restorative Sciences & Endodontics, University of Michigan, Ann Arbor, United States
| | - Ilze Akota
- Department of Oral and Maxillofacial surgery, Riga Stradins University, Riga, Latvia
| | - Olga Tryfonos
- ITU/WHO Focus Group AI on Health, Topic Group Dentistry, Switzerland; Department of Periodontology and Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherland
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany; ITU/WHO Focus Group AI on Health, Topic Group Dentistry, Switzerland
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De Simone B, Chouillard E, Gumbs AA, Loftus TJ, Kaafarani H, Catena F. Artificial intelligence in surgery: the emergency surgeon's perspective (the ARIES project). DISCOVER HEALTH SYSTEMS 2022; 1:9. [PMID: 37521114 PMCID: PMC9734362 DOI: 10.1007/s44250-022-00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
Artificial Intelligence (AI) has been developed and implemented in healthcare with the valuable potential to reduce health, social, and economic inequities, help actualize universal health coverage, and improve health outcomes on a global scale. The application of AI in emergency surgery settings could improve clinical practice and operating rooms management by promoting consistent, high-quality decision making while preserving the importance of bedside assessment and human intuition as well as respect for human rights and equitable surgical care, but ethical and legal issues are slowing down surgeons' enthusiasm. Emergency surgeons are aware that prioritizing education, increasing the availability of high AI technologies for emergency and trauma surgery, and funding to support research projects that use AI to provide decision support in the operating room are crucial to create an emergency "intelligent" surgery.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and St Germain en Laye Hospitals, Poissy, France
| | - Elie Chouillard
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and St Germain en Laye Hospitals, Poissy, France
| | - Andrew A. Gumbs
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and St Germain en Laye Hospitals, Poissy, France
| | - Tyler J. Loftus
- Department of Surgery, University of Florida Health, Gainesville, USA
| | - Haytham Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, USA
| | - Fausto Catena
- Department of Emergency and General Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
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Alsobhi M, Sachdev HS, Chevidikunnan MF, Basuodan R, K U DK, Khan F. Facilitators and Barriers of Artificial Intelligence Applications in Rehabilitation: A Mixed-Method Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15919. [PMID: 36497993 PMCID: PMC9737928 DOI: 10.3390/ijerph192315919] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Artificial intelligence (AI) has been used in physical therapy diagnosis and management for various impairments. Physical therapists (PTs) need to be able to utilize the latest innovative treatment techniques to improve the quality of care. The study aimed to describe PTs' views on AI and investigate multiple factors as indicators of AI knowledge, attitude, and adoption among PTs. Moreover, the study aimed to identify the barriers to using AI in rehabilitation. Two hundred and thirty-six PTs participated voluntarily in the study. A concurrent mixed-method design was used to document PTs' opinions regarding AI deployment in rehabilitation. A self-administered survey consisting of several aspects, including demographic, knowledge, uses, advantages, impacts, and barriers limiting AI utilization in rehabilitation, was used. A total of 63.3% of PTs reported that they had not experienced any kind of AI applications at work. The major factors predicting a higher level of AI knowledge among PTs were being a non-academic worker (OR = 1.77 [95% CI; 1.01 to 3.12], p = 0.04), being a senior PT (OR = 2.44, [95%CI: 1.40 to 4.22], p = 0.002), and having a Master/Doctorate degree (OR = 1.97, [95%CI: 1.11 to 3.50], p = 0.02). However, the cost and resources of AI were the major reported barriers to adopting AI-based technologies. The study highlighted a remarkable dearth of AI knowledge among PTs. AI and advanced knowledge in technology need to be urgently transferred to PTs.
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Affiliation(s)
- Mashael Alsobhi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Harpreet Singh Sachdev
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Reem Basuodan
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Dhanesh Kumar K U
- Nitte Institute of Physiotherapy, Nitte University, Deralaktte, Mangalore 575022, India
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
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De Simone B, Di Saverio S. Invited Commentary: Artificial Intelligence in Surgical Care: We Must Overcome Ethical Boundaries. J Am Coll Surg 2022; 235:275-277. [PMID: 35839402 DOI: 10.1097/xcs.0000000000000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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