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Daneshvar N, Pandita D, Erickson S, Snyder Sulmasy L, DeCamp M. Artificial Intelligence in the Provision of Health Care: An American College of Physicians Policy Position Paper. Ann Intern Med 2024; 177:964-967. [PMID: 38830215 DOI: 10.7326/m24-0146] [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: 06/05/2024] Open
Abstract
Internal medicine physicians are increasingly interacting with systems that implement artificial intelligence (AI) and machine learning (ML) technologies. Some physicians and health care systems are even developing their own AI models, both within and outside of electronic health record (EHR) systems. These technologies have various applications throughout the provision of health care, such as clinical documentation, diagnostic image processing, and clinical decision support. With the growing availability of vast amounts of patient data and unprecedented levels of clinician burnout, the proliferation of these technologies is cautiously welcomed by some physicians. Others think it presents challenges to the patient-physician relationship and the professional integrity of physicians. These dispositions are understandable, given the "black box" nature of some AI models, for which specifications and development methods can be closely guarded or proprietary, along with the relative lagging or absence of appropriate regulatory scrutiny and validation. This American College of Physicians (ACP) position paper describes the College's foundational positions and recommendations regarding the use of AI- and ML-enabled tools and systems in the provision of health care. Many of the College's positions and recommendations, such as those related to patient-centeredness, privacy, and transparency, are founded on principles in the ACP Ethics Manual. They are also derived from considerations for the clinical safety and effectiveness of the tools as well as their potential consequences regarding health disparities. The College calls for more research on the clinical and ethical implications of these technologies and their effects on patient health and well-being.
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Affiliation(s)
| | - Deepti Pandita
- University of California Irvine Health, Laguna Niguel, California (D.P.)
| | - Shari Erickson
- American College of Physicians, Washington, DC (N.D., S.E.)
| | | | - Matthew DeCamp
- University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.D.)
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Hofmann B, Wiesing U. Kairos in diagnostics. THEORETICAL MEDICINE AND BIOETHICS 2024; 45:99-108. [PMID: 38324112 PMCID: PMC10959829 DOI: 10.1007/s11017-023-09657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
Kairos has been a key concept in medicine for millennia and is frequently understood as "the right time" in relation to treatment. In this study we scrutinize kairos in the context of diagnostics. This has become highly topical as technological developments have caused diagnostics to be performed ever earlier in the disease development. Detecting risk factors, precursors, and predictors of disease (in biomarkers, pre-disease, and pre-pre-disease) has resulted in too early diagnoses, i.e., overdiagnoses. Nonetheless, despite vast advances in science and technology, diagnoses also come too late. Accordingly, timing diagnostics right is crucial. In this article we start with giving a brief overview of the etymology and general use of the concepts of kairos and diagnosis. Then we delimit kairos in diagnostics by analysing "too early" and "too late" diagnosis and by scrutinizing various phases of diagnostics. This leads us to define kairos of diagnostics as the time when there is potential for sufficient information for making a diagnosis that is most helpful for the person. It allows us to conclude that kairos is as important in diagnostics as in therapeutics.
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Affiliation(s)
- Bjørn Hofmann
- Centre of Medical Ethics, Faculty of Medicine, University of Oslo, PO Box 1130, Oslo, N-0318, Norway.
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
| | - Urban Wiesing
- Institute for Ethics and History of Medicine, University of Tübingen, Tübingen, Germany
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Castillo-Bustamante M, Pauna HF, da Costa Monsanto R, Gutierrez VA, Madrigal J. Insights Into Vestibulo-Ocular Reflex Artifacts: A Narrative Review of the Video Head Impulse Test (vHIT). Cureus 2024; 16:e55982. [PMID: 38476505 PMCID: PMC10927385 DOI: 10.7759/cureus.55982] [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: 03/11/2024] [Indexed: 03/14/2024] Open
Abstract
Video head impulse test (vHIT) artifacts are defined as spurious elements or disturbances in the recorded data that deviate from the true vestibulo-ocular reflex response. These artifacts can arise from various sources, encompassing technological limitations, patient-specific factors, or environmental influences, introducing inaccuracies in vHIT outcomes. The absence of standardized criteria for artifact identification leads to methodological heterogeneity. This narrative review aims to comprehensively examine the challenges posed by artifacts in the vHIT. By surveying existing literature, the review seeks to elucidate the multifaceted nature of artifacts arising from technological, patient-related, evaluator-related, and environmental factors.
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Affiliation(s)
- Melissa Castillo-Bustamante
- Otoneurology, Centro de Vértigo y Mareo, Mexico City, MEX
- Otolaryngology, School of Health Sciences and Medicine, Universidad Pontificia Bolivariana, Medellín, COL
| | | | | | | | - Jorge Madrigal
- Otoneurology, Centro de Vértigo y Mareo, Mexico City, MEX
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Paranjape PR, Thai-Paquette V, Miamidian JL, Parr J, Kazin EA, McLaren A, Toler K, Deirmengian C. Achieving High Accuracy in Predicting the Probability of Periprosthetic Joint Infection From Synovial Fluid in Patients Undergoing Hip or Knee Arthroplasty: The Development and Validation of a Multivariable Machine Learning Algorithm. Cureus 2023; 15:e51036. [PMID: 38143730 PMCID: PMC10749183 DOI: 10.7759/cureus.51036] [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: 12/22/2023] [Indexed: 12/26/2023] Open
Abstract
Background and objective The current periprosthetic joint infection (PJI) diagnostic guidelines require clinicians to interpret and integrate multiple criteria into a complex scoring system. Also, PJI classifications are often inconclusive, failing to provide a clinical diagnosis. Machine learning (ML) models could be leveraged to reduce reliance on these complex systems and thereby reduce diagnostic uncertainty. This study aimed to develop an ML algorithm using synovial fluid (SF) test results to establish a PJI probability score. Methods We used a large clinical laboratory's dataset of SF samples, aspirated from patients with hip or knee arthroplasty as part of a PJI evaluation. Patient age and SF biomarkers [white blood cell count, neutrophil percentage (%PMN), red blood cell count, absorbance at 280 nm wavelength, C-reactive protein (CRP), alpha-defensin (AD), neutrophil elastase, and microbial antigen (MID) tests] were used for model development. Data preprocessing, principal component analysis, and unsupervised clustering (K-means) revealed four clusters of samples that naturally aggregated based on biomarker results. Analysis of the characteristics of each of these four clusters revealed three clusters (n=13,133) with samples having biomarker results typical of a PJI-negative classification and one cluster (n=4,032) with samples having biomarker results typical of a PJI-positive classification. A decision tree model, trained and tested independently of external diagnostic rules, was then developed to match the classification determined by the unsupervised clustering. The performance of the model was assessed versus a modified 2018 International Consensus Meeting (ICM) criteria, in both the test cohort and an independent unlabeled validation set of 5,601 samples. The SHAP (SHapley Additive exPlanations) method was used to explore feature importance. Results The ML model showed an area under the curve of 0.993, with a sensitivity of 98.8%, specificity of 97.3%, positive predictive value (PPV) of 92.9%, and negative predictive value (NPV) of 99.8% in predicting the modified 2018 ICM diagnosis among test set samples. The model maintained its diagnostic accuracy in the validation cohort, yielding 99.1% sensitivity, 97.1% specificity, 91.9% PPV, and 99.9% NPV. The model's inconclusive rate (diagnostic probability between 20-80%) in the validation cohort was only 1.3%, lower than that observed with the modified 2018 ICM PJI classification (7.4%; p<0.001). The SHAP analysis found that AD was the most important feature in the model, exhibiting dominance among >95% of "infected" and "not infected" diagnoses. Other important features were the sum of the MID test panel, %PMN, and SF-CRP. Conclusions Although defined methods and tools for diagnosis of PJI using multiple biomarker criteria are available, they are not consistently applied or widely implemented. There is a need for algorithmic interpretation of these biomarkers to enable consistent interpretation of the results to drive treatment decisions. The new model, using clinical parameters measured from a patient's SF sample, renders a preoperative probability score for PJI which performs well compared to a modified 2018 ICM definition. Taken together with other clinical signs, this model has the potential to increase the accuracy of clinical evaluations and reduce the rate of inconclusive classification, thereby enabling more appropriate and expedited downstream treatment decisions.
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Affiliation(s)
- Pearl R Paranjape
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - Van Thai-Paquette
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - John L Miamidian
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - Jim Parr
- Department of Data Science and Machine Learning, Zimmer Biomet, Swindon, GBR
| | - Eyal A Kazin
- Department of Data Science and Machine Learning, Zimmer Biomet, Swindon, GBR
| | - Alex McLaren
- Department of Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Krista Toler
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - Carl Deirmengian
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Philadelphia, USA
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, USA
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Wilson NA. CORR Insights®: Can a Deep Learning Algorithm Improve Detection of Occult Scaphoid Fractures in Plain Radiographs? A Clinical Validation Study. Clin Orthop Relat Res 2023; 481:1836-1838. [PMID: 37039785 PMCID: PMC10427042 DOI: 10.1097/corr.0000000000002663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Nicole A Wilson
- Assistant Professor of Surgery, Pediatrics, and Biomedical Engineering, Division of Pediatric Surgery, University of Rochester, Rochester, NY, USA
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Lee SH, Hwang HH, Kim S, Hwang J, Park J, Park S. Clinical Implication of Maumgyeol Basic Service-the 2 Channel Electroencephalography and a Photoplethysmogram-based Mental Health Evaluation Software. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:583-593. [PMID: 37424425 PMCID: PMC10335898 DOI: 10.9758/cpn.23.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 07/11/2023]
Abstract
Objective Maumgyeol Basic service is a mental health evaluation and grade scoring software using the 2 channels EEG and photoplethysmogram (PPG). This service is supposed to assess potential at-risk groups with mental illness more easily, rapidly, and reliably. This study aimed to evaluate the clinical implication of the Maumgyeol Basic service. Methods One hundred one healthy controls and 103 patients with a psychiatric disorder were recruited. Psychological evaluation (Mental Health Screening for Depressive Disorders [MHS-D], Mental Health Screening for Anxiety Disorders [MHS-A], cognitive stress response scale [CSRS], 12-item General Health Questionnaire [GHQ-12], Clinical Global Impression [CGI]) and digit symbol substitution test (DSST) were applied to all participants. Maumgyeol brain health score and Maumgyeol mind health score were calculated from 2 channel frontal EEG and PPG, respectively. Results Participants were divided into three groups: Maumgyeol Risky, Maumgyeol Good, and Maumgyeol Usual. The Maumgyeol mind health scores, but not brain health scores, were significantly lower in the patients group compared to healthy controls. Maumgyeol Risky group showed significantly lower psychological and cognitive ability evaluation scores than Maumgyeol Usual and Good groups. Maumgyel brain health score showed significant correlations with CSRS and DSST. Maumgyeol mind health score showed significant correlations with CGI and DSST. About 20.6% of individuals were classified as the No Insight group, who had mental health problems but were unaware of their illnesses. Conclusion This study suggests that the Maumgyeol Basic service can provide important clinical information about mental health and be used as a meaningful digital mental healthcare monitoring solution to prevent symptom aggravation.
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Affiliation(s)
- Seung-Hwan Lee
- Bwave Inc., Goyang, Korea
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
- Clinical Emotion and Cognition Research Laboratory, Department of Psychiatry, Inje University, Goyang, Korea
| | - Hyeon-Ho Hwang
- Clinical Emotion and Cognition Research Laboratory, Department of Psychiatry, Inje University, Goyang, Korea
- Department of Human-Computer Interaction, Hanyang University, Ansan, Korea
| | - Sungkean Kim
- Department of Human-Computer Interaction, Hanyang University, Ansan, Korea
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Lobig F, Subramanian D, Blankenburg M, Sharma A, Variyar A, Butler O. To pay or not to pay for artificial intelligence applications in radiology. NPJ Digit Med 2023; 6:117. [PMID: 37353531 DOI: 10.1038/s41746-023-00861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
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Castner J, Stanislo K, Castner M, Monsen KA. Public health nursing workforce and learning needs: A national sample survey analysis. Public Health Nurs 2023; 40:339-352. [PMID: 36683284 PMCID: PMC10328423 DOI: 10.1111/phn.13171] [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: 08/03/2022] [Revised: 12/12/2022] [Accepted: 12/26/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States. DESIGN Secondary data analysis of the 2018 National Sample Survey of Registered Nurses. SAMPLE Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce. MEASUREMENTS Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed. RESULTS Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting. CONCLUSIONS Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice.
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Affiliation(s)
- Jessica Castner
- Administration, Castner Incorporated, Grand Island, New York
| | | | - Martin Castner
- Administration, Castner Incorporated, Grand Island, New York
- David B. Falk College of Sport and Human Dynamics, College of Arts and Sciences, Castner Incorporated, Syracuse University, Syracuse, New York
| | - Karen A Monsen
- University of Minnesota School of Nursing, Minneapolis, Minnesota
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Cagliero D, Deuitch N, Shah N, Feudtner C, Char D. A framework to identify ethical concerns with ML-guided care workflows: a case study of mortality prediction to guide advance care planning. J Am Med Inform Assoc 2023; 30:819-827. [PMID: 36826400 PMCID: PMC10114055 DOI: 10.1093/jamia/ocad022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Identifying ethical concerns with ML applications to healthcare (ML-HCA) before problems arise is now a stated goal of ML design oversight groups and regulatory agencies. Lack of accepted standard methodology for ethical analysis, however, presents challenges. In this case study, we evaluate use of a stakeholder "values-collision" approach to identify consequential ethical challenges associated with an ML-HCA for advanced care planning (ACP). Identification of ethical challenges could guide revision and improvement of the ML-HCA. MATERIALS AND METHODS We conducted semistructured interviews of the designers, clinician-users, affiliated administrators, and patients, and inductive qualitative analysis of transcribed interviews using modified grounded theory. RESULTS Seventeen stakeholders were interviewed. Five "values-collisions"-where stakeholders disagreed about decisions with ethical implications-were identified: (1) end-of-life workflow and how model output is introduced; (2) which stakeholders receive predictions; (3) benefit-harm trade-offs; (4) whether the ML design team has a fiduciary relationship to patients and clinicians; and, (5) how and if to protect early deployment research from external pressures, like news scrutiny, before research is completed. DISCUSSION From these findings, the ML design team prioritized: (1) alternative workflow implementation strategies; (2) clarification that prediction was only evaluated for ACP need, not other mortality-related ends; and (3) shielding research from scrutiny until endpoint driven studies were completed. CONCLUSION In this case study, our ethical analysis of this ML-HCA for ACP was able to identify multiple sites of intrastakeholder disagreement that mark areas of ethical and value tension. These findings provided a useful initial ethical screening.
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Affiliation(s)
- Diana Cagliero
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Deuitch
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
- National Institutes of Health, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Nigam Shah
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - Chris Feudtner
- The Department of Medical Ethics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Pediatrics, Medical Ethics and Healthcare Policy, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danton Char
- Division of Pediatric Cardiac Anesthesia, Department of Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
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National Council of State Boards of Nursing. The NCSBN 2023 Environmental Scan: Nursing at a Crossroads—An Opportunity for Action. JOURNAL OF NURSING REGULATION 2023. [DOI: 10.1016/s2155-8256(23)00006-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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