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Integrating AI with healthcare expertise: Introducing the Health Care Professional-In-The-Loop Framework: Part 1
No full text‘Artificial intelligence (AI) is a tool, the choiceof how it gets deployed is ours.’1The rapid evolution of AI is reshapingvarious industries, with healthcare standingat the forefront of this transformation.2 AI’spotential to enhance diagnostic accuracy,streamline treatment planning, and improvepatient outcomes holds immense promisein fields like medicine and dentistry.2,3 AsAI systems grow increasingly capable, theethical considerations surrounding theiruse in clinical practice, particularly inmaintaining patient autonomy and humanoversight, become critical areas of focus.4In healthcare, where patient-centred careand individualised decision-making areparamount, the unrestrained application ofAI may lead to unintended consequences,risking the replacement of nuanced humanjudgment with rigid algorithms.4,5,6The Human-In-The-Loop (HITL) model,7widely used in sectors such as finance andautonomous systems, has traditionallyaddressed the critical need for humanoversight. By embedding human intervention within automated processes, HITL ensuresthat technology remains a tool guided byhuman reasoning.However, this model requires adaptationfor healthcare, where decisions frequentlydemand empathy, contextual understanding,and clinical expertise beyond whatalgorithms can offer. This paper is structuredin two parts. Part 1 introduces the envisionedHealth Care Professional-In-The-Loop (HCPITL) framework, explaining its fundamentalprinciples and how it adapts the HITL modelto meet the unique challenges of healthcare.In Part 2, we explore the application of theHCP-ITL framework across diverse medicaland dental specialties, outlining the potentialroles AI could play within this model toenhance clinical care while ensuring ethicaland professional oversight
Outcomes of specialist physiotherapy for functional motor disorder: the Physio4FMD RCT
Get PDFBackground: Functional motor disorder often causes persistent disabling symptoms that are associated with high healthcare costs. In recent years, specialist physiotherapy, informed by an understanding of functional motor disorder, has emerged as a promising treatment, but there is an absence of evidence of its effectiveness from large randomised controlled trials. Methods: We conducted a pragmatic, multicentre, randomised controlled trial, comparing specialist physiotherapy for functional motor disorder to treatment as usual, which was defined as community neurological physiotherapy. The primary outcome was the Short Form questionnaire-36 items Physical Functioning domain at 12 months (scale range 0–100, with 100 indicating optimum health). The trial was powered to detect a 9-point difference in the primary outcome with 90% power at the 5% level of significance. Secondary domains of measurement included a patient perception of improvement, health-related quality of life, mobility, anxiety, depression and illness perception. We also completed a health economic analysis with the primary aim of calculating the mean incremental cost per qualityadjusted life-year over 12 months. In prespecified analysis plans, we excluded participants from the primary analysis if they were unable to receive their trial-allocated treatment due to COVID-19 lockdown restrictions. Sensitivity analysis explored the impact of this decision. Results: Between 19 October 2018 and 31 January 2022, 355 adults with functional motor disorder were randomised (1: 1) to specialist physiotherapy (n = 179) and treatment as usual (n = 176). Eighty-nine participants were excluded due to COVID-19 disruptions. Retention for the primary analysis was 90% for both groups, leaving 241 participants in the primary analysis. At 12 months, there was no between-group difference in the primary outcome (adjusted mean difference 3.5, 95% confidence interval −2.3 to 9.3). However, several secondary outcomes favoured specialist physiotherapy, including the participant perception of improvement, Short Form questionnaire-36 items Mental Health domain, confidence in the diagnosis and two subscales (Personal Control and Illness Coherence) of the Revised Illness Perception Questionnaire. There were no differences in the remaining outcomes. At 6 months, the following outcome measures were significantly different, in favour of specialist physiotherapy: participant perception of improvement, the Short Form questionnaire-36 items Physical Role Limitations, Short Form questionnaire-36 items Social Functioning, Short Form questionnaire-36 items Mental Health, EuroQol-5 Dimensions five-level version utility score, confidence in the diagnosis and three subscales (Timeline Cyclical, Personal Control and Treatment Control) of the Revised Illness Perception Questionnaire. No outcomes significantly favoured treatment as usual. In the health economic analysis, the incremental cost per quality-adjusted life-year gained from a health and social care cost perspective was £4133 with an 86% probability that specialist physiotherapy is cost-effective compared to treatment as usual at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained. There were no adverse events related to physiotherapy. Conclusion: Specialist physiotherapy was not superior to treatment as usual for the primary outcome, the Short Form questionnaire-36 items Physical Functioning domain at 12 months. However, a number of secondary outcome measures favoured specialist physiotherapy at 6 and 12 months. There is a high probability that specialist physiotherapy is cost-effective. Limitations: Participants in treatment as usual waited longer to start physiotherapy, which resulted in a shorter time between concluding treatment and completing the primary outcome. Most outcome measures, including the primary outcome, were participant reported, which may have been biased by perceptions of the randomised treatment allocation. Future work: Future work should identify or develop more suitable outcome measures for functional motor disorder research, explore who is most likely to benefit from specialist physiotherapy and identify alternative interventions for those unlikely to benefit from this treatment. Additional work is needed to adapt treatment to meet the needs of minority groups and young people. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/31/63
Exploration of radiotherapy-related insufficiency fractures and risk factors of patients diagnosed with gynaecological cancer treated with radiotherapy: a service evaluation
Get PDF#400WORDS: CHIEF NURSING OFFICER’S RESEARCH FELLOWS EVIDENCE IMPLEMENTATION PROJECT
Effectiveness of hypnosis for pain management in colorectal surgery: project proposal for a systematic review
Get PDF#400WORDS: CHIEF NURSING OFFICER’S RESEARCH FELLOWS EVIDENCE IMPLEMENTATION PROJECT
Factors affecting metabolism and metabolic control in phenylketonuria
Get PDFPhenylketonuria (PKU) is an inherited metabolic disorder treated by a phenylalanine restricted diet in order to avoid neurocognitive impairment. Blood phenylalanine is the main outcome marker which is modulated by many dietary factors. Traditionally, L-amino acid-based protein substitutes are the main nitrogen source but more recently glycomacropeptide-based protein substitutes (GMP) have been introduced and are associated with several health benefits. The following aspects were studied in this thesis: 1) metabolic control achieved in patients with PKU compared with the European PKU guidelines; 2) life-long change in natural protein tolerance; 3) impact on metabolic control of different natural protein sources (animal vs. plant); 4) effect of unmeasured amounts of fruit and vegetables containing phenylalanine 76-100mg/100g on metabolic control; and 5) health benefits of GMP.The results of these studies showed that blood phenylalanine increased with age especially in patients with classical PKU (cPKU) and a higher frequency of blood phenylalanine monitoring was associated with better metabolic control. Natural protein (NP) intake was at its highest in patients aged 19-30y and patients with cPKU tolerated less than 50% of NP compared with patients with mild PKU (mPKU). Over restriction of NP was observed in mPKU patients. Sixty five percent (n=26/40) were able to increase NP by a median of 12g/day without loss of metabolic control. Animal protein sources had a higher impact on blood phenylalanine control compared with plant sources. However, some patients were unable to tolerate fruit and vegetables containing phenylalanine 76-100 mg/100g when given in uncontrolled amounts. Furthermore, exchange-free foods in the current dietary system added an extra 40% NP to the prescribed amount without any negative impact on blood phenylalanine control. Although GMP improvedgastrointestinal symptoms, it had a negative impact on blood phenylalanine control when providing 100% of the protein equivalent requirements from protein substitute.Overall, this research program described novel data that will impact future PKU guidelines and will help influence and improve the daily care of patients with PKU
The added value of narrow band imaging in Sinonasal tumour resection and surveillance: Our experience
Get PDFBACKGROUND & PURPOSE: Narrow Band Imaging (NBI), developed by Olympus Medical Systems, has played a role in diagnosing digestive tract lesions and cancers, diagnosing and characterizing bladder cancers during cystoscopy and in the diagnosis and management of Head and Neck cancers. We aim to explore the potential use of NBI in the diagnosis, management, and follow-up of sinonasal tumours.
METHODS: We present a series of cases treated at our institution, where NBI played a crucial role in the diagnosis, surgical management, intraoperative decision-making, and follow-up. The cases include a patient with sinonasal lymphoma, 2 patients with sinonosal malignant melanoma and a patient with olfactory neuroblastoma.
RESULTS: In our experience, NBI proved beneficial not only in detecting otherwise unseen nasal lesions but also in targeted biopsies and intraoperative planning, on some occasions altering the course of treatment. NBI may also be a simple, inexpensive surveillance method for detecting sinonasal tumours recurrence after excision.
CONCLUSION: While there are limitations to its use, there is potential for NBI to be of significant use in rhinology practice, reducing morbidity and tumour recurrence rates and streamlining the diagnostic and surveillance process
Ontological Machines: Subjectivity and Relational Desire in Immersive and Interactive Environments
Get PDFThis practice-based artistic research focuses on two contemporary spaces; namely the pedagogical spaces of healthcare Simulation Based Education (SBE), and the exhibition spaces of installation art. These seemingly unrelated activities share a range of technological and operational similarities that render their combined study under the banner of ‘immersive and interactive environments’ both novel and necessary. The lack of broad engagement with questions of representation, aesthetics, and affect is conspicuous in an educational practice that is reliant on, and implemented through, a network of overtly visual mediums, material technologies, and sensory modalities. In healthcare SBE, clinical skills are acquired, and medical knowledge is reinforced while a biomedical worldview is quietly spatialised through the immersive and interactive environments in which healthcare simulation is performed. With the rapid adoption of SBE in healthcare training both nationally and internationally, the apparent dearth of philosophical inquiry that examines healthcare SBE outside of the performance metrics of technical skills training and competencies of patient safety warrants examination. I use the philosopher Karen Barad’s ‘diffractive methodology’ and Levi Bryant’s theory of ‘ontological machines’ to examine how the immersive techniques and interactive technologies deployed within these seemingly unrelated spaces shape specific forms of meaning, knowing, and being in the world.In response to fieldwork conducted in a simulation training facility of a South-West UK medical school, the practice component of this research is articulated through a series of what I introduce as immersive and interactive installation art Prototypes. These Prototypes explore subjectivity and relationality through wearable technology that captures real-time participant biodata to augment physical spaces with digital layers
Automated Vulnerability Scanning and Security Audit Framework for Maritime Systems
Get PDFThe maritime industry is a well-established sector, with the shipping industry dating back hundreds of years. The devices in this sector differ from those in the Information Technology (IT) sector in their usage, operations, hardware, andprotocols. Technological advancements have introduced new challenges in the sector, including the increased risk of cyber attacks. To effectively identify, respond to, and analyse these threats, it is essential to understand the cyber securityvulnerabilities in maritime systems and system-of-systems.Currently, there are no standardised methods or automated tools for conducting cyber security testing of maritime systems. This thesis presents an automated vulnerability scanning and security audit framework for maritime systems thatwill perform cyber security testing on real-world hardware systems and system-of-systems to identify and assess vulnerabilities. The proposed framework, BridgeAudit, is divided into three phases, each comprising various modules that assist in the automation of testing and security assessments. These phases– asset profiling, auditing, and reporting– feature different functionalities that work together to produce comprehensive security audit reports. The Asset Profiling phase focuses on profiling and managing devices onboard a vessel to support in automated testing while also assisting in compliance, utilising a machine learning algorithm. The Auditing phase examines the security of vessel networks to detect vulnerabilities and identify potential attack paths using optimisation techniques and heuristics. Meanwhile, the Reporting phase simplifies the presentation of results and findings, generating clear and accessible reports. To validate the effectiveness of the framework, an implementation of BridgeAudit was executed on real hardware systems and networks within a maritime cyber-physical testbed. This implementation led to the identification of vulnerabilities,including a few undocumented ones within the systems. BridgeAudit aims to assist stakeholders, maritime professionals, and testers in better understanding their devices, enabling them to implement mitigation strategies and prepare forpotential cyber attacks
Exploring university students’ reasons for not working while studying: Implications for Employability
Get PDFThe purpose of this paper is to examine the behaviours and perceptions of university students who do not work part-time while studying. A structured, online questionnaire was issued to Business Management students at a UK university. A total of 123 responses were received, of which 64 indicated that they were not working while studying. While non-working students were mindful of the importance of work to developing employability skills, greater importance was attached to their degree studies. Most work to date has focused on the motivations and behaviours of university students who undertake work while studying. Little work has been carried out on university students who do not work during their degree studies. Not working part-time will have employability implications for graduates, employers and universities, all of which are discussed in this paper
Parent\u27s Help-Seeking For, and Care Of, a Sick or Injured Child During COVID-19 Pandemic Lockdowns: A National Online Survey in Türkiye
No full textAim: This study aimed to investigate how COVID-19 lockdowns in Türkiye influenced parents\u27 actions when their child was ill or injured and how they perceived the impact of the lockdown on the severity of their child\u27s illness and the treatment received. Methods: This descriptive, and cross-sectional mixed method was conducted with 104 parents whose children experienced illness or injury during the pandemic lockdowns between July and September 2022. Data was collected through online survey using snowball sampling method. Descriptive statistics and pearson\u27s chi-square test were used for statistical analysis, while free-text data was subjected to thematic analysis. Results: Of the parents who sought medical help, 51.7% reported their child being admitted to hospital, and 29.8% noted their child had a chronic health illness. These parents were more likely to report that changes in health services affected their child\u27s treatment compared to those with children without a long-term health issue (45.1% vs. 12.3%, p \u3c 0.001). The experiences of parents seeking help for their sick or injured child during the lockdown were categorized into three main themes: the lockdown\u27s impact on the child, health service accessibility during the lockdown, and parental help-seeking behavior during lockdown. Conclusion: It is concluded in this study that during COVID-19 lockdowns, pediatric nurses should guide parents regarding when and where to seek medical assistance to mitigate potential complications resulting from reduced parental help-seeking behavior. Practice Implications: To ensure the uninterrupted monitoring and treatment of children with chronic health issues during lockdowns, it is advisable to expand telemedicine practices