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Healthcare
Clinical AI, diagnostic bias, patient safety and medical-device regulation — the healthcare front of AI ethics, daily.
Digital Mental Health for Young People: A Scoping Review of Ethical Promises and Challenges
Mental health disorders are complex disorders of the nervous system characterized by a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Mental illness is of particular concern for younger people. The WHO estimates that around 20% of the world's children and adolescents have a mental health condition, a rate that is almost double compared to the general population. One approach toward mitigating the medical and socio-economic effects of mental h
Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study
BACKGROUND: COVID-19 vaccines show excellent efficacy in clinical trials and effectiveness in real-world data, but some people still become infected with SARS-CoV-2 after vaccination. This study aimed to identify risk factors for post-vaccination SARS-CoV-2 infection and describe the characteristics of post-vaccination illness. METHODS: This prospective, community-based, nested, case-control study used self-reported data (eg, on demographics, geographical location, health risk factors, and COVID
Connected healthcare: Improving patient care using digital health technologies
Telehealth Interventions and Outcomes Across Rural Communities in the United States: Narrative Review
BACKGROUND: In rural communities, there are gaps in describing the design and effectiveness of technology interventions for treating diseases and addressing determinants of health. OBJECTIVE: The aim of this study is to evaluate literature on current applications, therapeutic areas, and outcomes of telehealth interventions in rural communities in the United States. METHODS: A narrative review of studies published on PubMed from January 2017 to December 2020 was conducted. Key search terms includ
Mitigating bias in machine learning for medicine
Several sources of bias can affect the performance of machine learning systems used in medicine and potentially impact clinical care. Here, we discuss solutions to mitigate bias across the different development steps of machine learning-based systems for medical applications. Vokinger et al. discuss potential sources of bias in machine learning systems used in medicine. The authors propose solutions to mitigate bias across the different stages of model development, from data collection and prepa
Automatic detection of 39 fundus diseases and conditions in retinal photographs using deep neural networks
Retinal fundus diseases can lead to irreversible visual impairment without timely diagnoses and appropriate treatments. Single disease-based deep learning algorithms had been developed for the detection of diabetic retinopathy, age-related macular degeneration, and glaucoma. Here, we developed a deep learning platform (DLP) capable of detecting multiple common referable fundus diseases and conditions (39 classes) by using 249,620 fundus images marked with 275,543 labels from heterogenous sources
Artificial Intelligence in Undergraduate Medical Education: A Scoping Review
PURPOSE: Artificial intelligence (AI) is a rapidly growing phenomenon poised to instigate large-scale changes in medicine. However, medical education has not kept pace with the rapid advancements of AI. Despite several calls to action, the adoption of teaching on AI in undergraduate medical education (UME) has been limited. This scoping review aims to identify gaps and key themes in the peer-reviewed literature on AI training in UME. METHOD: The scoping review was informed by Arksey and O'Malley
Protocol for development of a reporting guideline (TRIPOD-AI) and risk of bias tool (PROBAST-AI) for diagnostic and prognostic prediction model studies based on artificial intelligence
INTRODUCTION: The Transparent Reporting of a multivariable prediction model of Individual Prognosis Or Diagnosis (TRIPOD) statement and the Prediction model Risk Of Bias ASsessment Tool (PROBAST) were both published to improve the reporting and critical appraisal of prediction model studies for diagnosis and prognosis. This paper describes the processes and methods that will be used to develop an extension to the TRIPOD statement (TRIPOD-artificial intelligence, AI) and the PROBAST (PROBAST-AI)
Understanding, explaining, and utilizing medical artificial intelligence
Medical artificial intelligence is cost-effective and scalable and often outperforms human providers, yet people are reluctant to use it. We show that resistance to the utilization of medical artificial intelligence is driven by both the subjective difficulty of understanding algorithms (the perception that they are a 'black box') and by an illusory subjective understanding of human medical decision-making. In five pre-registered experiments (1-3B: N = 2,699), we find that people exhibit an illu
Synthetic data in machine learning for medicine and healthcare
Impact of COVID-19 on the mental health of US college students
BACKGROUND/AIM: In the beginning of 2020, the novel Coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus, became a public health emergency in the U.S. and rapidly escalated into a global pandemic. Because the SARS-CoV-2 virus is highly contagious, physical distancing was enforced and indoor public spaces, including schools and educational institutions, were abruptly closed and evacuated to ensure civilian safety. Accordingly, educational institutions rapidly transitioned to remote learn
Considering the possibilities and pitfalls of Generative Pre-trained Transformer 3 (GPT-3) in healthcare delivery
Natural language computer applications are becoming increasingly sophisticated and, with the recent release of Generative Pre-trained Transformer 3, they could be deployed in healthcare-related contexts that have historically comprised human-to-human interaction. However, for GPT-3 and similar applications to be considered for use in health-related contexts, possibilities and pitfalls need thoughtful exploration. In this article, we briefly introduce some opportunities and cautions that would ac
Federated Learning in a Medical Context: A Systematic Literature Review
Data privacy is a very important issue. Especially in fields like medicine, it is paramount to abide by the existing privacy regulations to preserve patients’ anonymity. However, data is required for research and training machine learning models that could help gain insight into complex correlations or personalised treatments that may otherwise stay undiscovered. Those models generally scale with the amount of data available, but the current situation often prohibits building large databases acr
Developing a reporting guideline for artificial intelligence-centred diagnostic test accuracy studies: the STARD-AI protocol
INTRODUCTION: Standards for Reporting of Diagnostic Accuracy Study (STARD) was developed to improve the completeness and transparency of reporting in studies investigating diagnostic test accuracy. However, its current form, STARD 2015 does not address the issues and challenges raised by artificial intelligence (AI)-centred interventions. As such, we propose an AI-specific version of the STARD checklist (STARD-AI), which focuses on the reporting of AI diagnostic test accuracy studies. This paper
Current Challenges and Future Opportunities for XAI in Machine Learning-Based Clinical Decision Support Systems: A Systematic Review
Machine Learning and Artificial Intelligence (AI) more broadly have great immediate and future potential for transforming almost all aspects of medicine. However, in many applications, even outside medicine, a lack of transparency in AI applications has become increasingly problematic. This is particularly pronounced where users need to interpret the output of AI systems. Explainable AI (XAI) provides a rationale that allows users to understand why a system has produced a given output. The outpu
Kvasir-Capsule, a video capsule endoscopy dataset
Artificial intelligence (AI) is predicted to have profound effects on the future of video capsule endoscopy (VCE) technology. The potential lies in improving anomaly detection while reducing manual labour. Existing work demonstrates the promising benefits of AI-based computer-assisted diagnosis systems for VCE. They also show great potential for improvements to achieve even better results. Also, medical data is often sparse and unavailable to the research community, and qualified medical personn
Swarm Learning for decentralized and confidential clinical machine learning
Abstract Fast and reliable detection of patients with severe and heterogeneous illnesses is a major goal of precision medicine 1,2 . Patients with leukaemia can be identified using machine learning on the basis of their blood transcriptomes 3 . However, there is an increasing divide between what is technically possible and what is allowed, because of privacy legislation 4,5 . Here, to facilitate the integration of any medical data from any data owner worldwide without violating privacy laws, we
End-to-end privacy preserving deep learning on multi-institutional medical imaging
Clinical applications of artificial intelligence and machine learning in cancer diagnosis: looking into the future
Artificial intelligence (AI) is the use of mathematical algorithms to mimic human cognitive abilities and to address difficult healthcare challenges including complex biological abnormalities like cancer. The exponential growth of AI in the last decade is evidenced to be the potential platform for optimal decision-making by super-intelligence, where the human mind is limited to process huge data in a narrow time range. Cancer is a complex and multifaced disorder with thousands of genetic and epi
Artificial intelligence in nursing: Priorities and opportunities from an international invitational think‐tank of the Nursing and Artificial Intelligence Leadership Collaborative
AIM: To develop a consensus paper on the central points of an international invitational think-tank on nursing and artificial intelligence (AI). METHODS: We established the Nursing and Artificial Intelligence Leadership (NAIL) Collaborative, comprising interdisciplinary experts in AI development, biomedical ethics, AI in primary care, AI legal aspects, philosophy of AI in health, nursing practice, implementation science, leaders in health informatics practice and international health informatics
Health information technology and digital innovation for national learning health and care systems
Health information technology can support the development of national learning health and care systems, which can be defined as health and care systems that continuously use data-enabled infrastructure to support policy and planning, public health, and personalisation of care. The COVID-19 pandemic has offered an opportunity to assess how well equipped the UK is to leverage health information technology and apply the principles of a national learning health and care system in response to a major
Digital Twins for Multiple Sclerosis
An individualized innovative disease management is of great importance for people with multiple sclerosis (pwMS) to cope with the complexity of this chronic, multidimensional disease. However, an individual state of the art strategy, with precise adjustment to the patient's characteristics, is still far from being part of the everyday care of pwMS. The development of digital twins could decisively advance the necessary implementation of an individualized innovative management of MS. Through arti
A Review on Virtual Reality Skill Training Applications
This study aimed to discuss the research efforts in developing virtual reality (VR) technology for different training applications. To begin with, we describe how VR training experiences are typically created and delivered using the current software and hardware. We then discuss the challenges and solutions of applying VR training to different application domains, such as first responder training, medical training, military training, workforce training, and education. Furthermore, we discuss the
Addressing Fairness, Bias, and Appropriate Use of Artificial Intelligence and Machine Learning in Global Health
In Low- and Middle- Income Countries (LMICs), machine learning (ML) and artificial intelligence (AI) offer attractive solutions to address the shortage of health care resources and improve the capacity of the local health care infrastructure. However, AI and ML should also be used cautiously, due to potential issues of fairness and algorithmic bias that may arise if not applied properly. Furthermore, populations in LMICs can be particularly vulnerable to bias and fairness in AI algorithms, due t
Wearable Sensor-Based Real-Time Gait Detection: A Systematic Review
Gait analysis has traditionally been carried out in a laboratory environment using expensive equipment, but, recently, reliable, affordable, and wearable sensors have enabled integration into clinical applications as well as use during activities of daily living. Real-time gait analysis is key to the development of gait rehabilitation techniques and assistive devices such as neuroprostheses. This article presents a systematic review of wearable sensors and techniques used in real-time gait analy
Social Media Use for Health Purposes: Systematic Review
BACKGROUND: Social media has been widely used for health-related purposes, especially during the COVID-19 pandemic. Previous reviews have summarized social media uses for a specific health purpose such as health interventions, health campaigns, medical education, and disease outbreak surveillance. The most recent comprehensive review of social media uses for health purposes, however, was conducted in 2013. A systematic review that covers various health purposes is needed to reveal the new usages
The role of artificial intelligence in healthcare: a structured literature review
BACKGROUND/INTRODUCTION: Artificial intelligence (AI) in the healthcare sector is receiving attention from researchers and health professionals. Few previous studies have investigated this topic from a multi-disciplinary perspective, including accounting, business and management, decision sciences and health professions. METHODS: The structured literature review with its reliable and replicable research protocol allowed the researchers to extract 288 peer-reviewed papers from Scopus. The authors
Diagnostic accuracy of deep learning in medical imaging: a systematic review and meta-analysis
Deep learning (DL) has the potential to transform medical diagnostics. However, the diagnostic accuracy of DL is uncertain. Our aim was to evaluate the diagnostic accuracy of DL algorithms to identify pathology in medical imaging. Searches were conducted in Medline and EMBASE up to January 2020. We identified 11,921 studies, of which 503 were included in the systematic review. Eighty-two studies in ophthalmology, 82 in breast disease and 115 in respiratory disease were included for meta-analysis
Federated deep learning for detecting COVID-19 lung abnormalities in CT: a privacy-preserving multinational validation study
Data privacy mechanisms are essential for rapidly scaling medical training databases to capture the heterogeneity of patient data distributions toward robust and generalizable machine learning systems. In the current COVID-19 pandemic, a major focus of artificial intelligence (AI) is interpreting chest CT, which can be readily used in the assessment and management of the disease. This paper demonstrates the feasibility of a federated learning method for detecting COVID-19 related CT abnormalitie
Deep learning-based artificial intelligence model to assist thyroid nodule diagnosis and management: a multicentre diagnostic study
BACKGROUND: Strategies for integrating artificial intelligence (AI) into thyroid nodule management require additional development and testing. We developed a deep-learning AI model (ThyNet) to differentiate between malignant tumours and benign thyroid nodules and aimed to investigate how ThyNet could help radiologists improve diagnostic performance and avoid unnecessary fine needle aspiration. METHODS: ThyNet was developed and trained on 18 049 images of 8339 patients (training set) from two hos
Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI
The use of black box algorithms in medicine has raised scholarly concerns due to their opaqueness and lack of trustworthiness. Concerns about potential bias, accountability and responsibility, patient autonomy and compromised trust transpire with black box algorithms. These worries connect epistemic concerns with normative issues. In this paper, we outline that black box algorithms are less problematic for epistemic reasons than many scholars seem to believe. By outlining that more transparency
On Interpretability of Artificial Neural Networks: A Survey
Deep learning as represented by the artificial deep neural networks (DNNs) has achieved great success recently in many important areas that deal with text, images, videos, graphs, and so on. However, the black-box nature of DNNs has become one of the primary obstacles for their wide adoption in mission-critical applications such as medical diagnosis and therapy. Because of the huge potentials of deep learning, increasing the interpretability of deep neural networks has recently attracted much re
Role of Artificial Intelligence Applications in Real-Life Clinical Practice: Systematic Review
BACKGROUND: Artificial intelligence (AI) applications are growing at an unprecedented pace in health care, including disease diagnosis, triage or screening, risk analysis, surgical operations, and so forth. Despite a great deal of research in the development and validation of health care AI, only few applications have been actually implemented at the frontlines of clinical practice. OBJECTIVE: The objective of this study was to systematically review AI applications that have been implemented in
Health data poverty: an assailable barrier to equitable digital health care
Data-driven digital health technologies have the power to transform health care. If these tools could be sustainably delivered at scale, they might have the potential to provide everyone, everywhere, with equitable access to expert-level care, narrowing the global health and wellbeing gap. Conversely, it is highly possible that these transformative technologies could exacerbate existing health-care inequalities instead. In this Viewpoint, we describe the problem of health data poverty: the inabi
Evaluating the Quality of Machine Learning Explanations: A Survey on Methods and Metrics
The most successful Machine Learning (ML) systems remain complex black boxes to end-users, and even experts are often unable to understand the rationale behind their decisions. The lack of transparency of such systems can have severe consequences or poor uses of limited valuable resources in medical diagnosis, financial decision-making, and in other high-stake domains. Therefore, the issue of ML explanation has experienced a surge in interest from the research community to application domains. W
A survey of clinicians on the use of artificial intelligence in ophthalmology, dermatology, radiology and radiation oncology
Artificial intelligence technology has advanced rapidly in recent years and has the potential to improve healthcare outcomes. However, technology uptake will be largely driven by clinicians, and there is a paucity of data regarding the attitude that clinicians have to this new technology. In June-August 2019 we conducted an online survey of fellows and trainees of three specialty colleges (ophthalmology, radiology/radiation oncology, dermatology) in Australia and New Zealand on artificial intell
AI applications to medical images: From machine learning to deep learning
PURPOSE: Artificial intelligence (AI) models are playing an increasing role in biomedical research and healthcare services. This review focuses on challenges points to be clarified about how to develop AI applications as clinical decision support systems in the real-world context. METHODS: A narrative review has been performed including a critical assessment of articles published between 1989 and 2021 that guided challenging sections. RESULTS: We first illustrate the architectural characteristic
Implicit bias in healthcare: clinical practice, research and decision making
Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). B
COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health
How the COVID-19 pandemic will change the future of critical care
Coronavirus disease 19 (COVID-19) has posed unprecedented healthcare system challenges, some of which will lead to transformative change. It is obvious to healthcare workers and policymakers alike that an effective critical care surge response must be nested within the overall care delivery model. The COVID-19 pandemic has highlighted key elements of emergency preparedness. These include having national or regional strategic reserves of personal protective equipment, intensive care unit (ICU) de