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Tanos P, Yiangou I, Prokopiou G, Kakas A, Tanos V. Gynaecological Artificial Intelligence Diagnostics (GAID) GAID and Its Performance as a Tool for the Specialist Doctor. Healthcare (Basel) 2024; 12:223. [PMID: 38255110 PMCID: PMC10815463 DOI: 10.3390/healthcare12020223] [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: 11/14/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Human-centric artificial intelligence (HCAI) aims to provide support systems that can act as peer companions to an expert in a specific domain, by simulating their way of thinking and decision-making in solving real-life problems. The gynaecological artificial intelligence diagnostics (GAID) assistant is such a system. Based on artificial intelligence (AI) argumentation technology, it was developed to incorporate, as much as possible, a complete representation of the medical knowledge in gynaecology and to become a real-life tool that will practically enhance the quality of healthcare services and reduce stress for the clinician. Our study aimed to evaluate GAIDS' efficacy and accuracy in assisting the working expert gynaecologist during day-to-day clinical practice. METHODS Knowledge-based systems utilize a knowledge base (theory) which holds evidence-based rules ("IF-THEN" statements) that are used to prove whether a conclusion (such as a disease, medication or treatment) is possible or not, given a set of input data. This approach uses argumentation frameworks, where rules act as claims that support a specific decision (arguments) and argue for its dominance over others. The result is a set of admissible arguments which support the final decision and explain its cause. RESULTS Based on seven different subcategories of gynaecological presentations-bleeding, endocrinology, cancer, pelvic pain, urogynaecology, sexually transmitted infections and vulva pathology in fifty patients-GAID demonstrates an average overall closeness accuracy of zero point eighty-seven. Since the system provides explanations for supporting a diagnosis against other possible diseases, this evaluation process further allowed for a learning process of modular improvement in the system of the diagnostic discrepancies between the system and the specialist. CONCLUSIONS GAID successfully demonstrates an average accuracy of zero point eighty-seven when measuring the closeness of the system's diagnosis to that of the senior consultant. The system further provides meaningful and helpful explanations for its diagnoses that can help clinicians to develop an increasing level of trust towards the system. It also provides a practical database, which can be used as a structured history-taking assistant and a friendly, patient record-keeper, while improving precision by providing a full list of differential diagnoses. Importantly, the design and implementation of the system facilitates its continuous development with a set methodology that allows minimal revision of the system in the face of new information. Further large-scale studies are required to evaluate GAID more thoroughly and to identify its limiting boundaries.
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Affiliation(s)
- Panayiotis Tanos
- Institute of Applied Health Sciences, University of Aberdeen, NHS Grampian, Aberdeen AB24 3FX, UK
| | - Ioannis Yiangou
- Department of Computer Science, University of Cyprus, Nicosia 1678, Cyprus
| | - Giorgos Prokopiou
- Department of Computer Science, University of Cyprus, Nicosia 1678, Cyprus
| | - Antonis Kakas
- Department of Computer Science, University of Cyprus, Nicosia 1678, Cyprus
| | - Vasilios Tanos
- Medical School, Nicosia of University, Nicosia 2408, Cyprus
- Aretaeio Hospital, 55-57 Andreas Avraamides, Strovolos, Nicosia 2024, Cyprus
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Suskind AM, Vaittinen T, Gibson W, Hajebrahimi S, Ostaszkiewicz J, Davis N, Dickinson T, Spencer M, Wagg A. International Continence Society white paper on ethical considerations in older adults with urinary incontinence. Neurourol Urodyn 2021; 41:14-30. [PMID: 34558106 DOI: 10.1002/nau.24795] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022]
Abstract
Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, California, USA
| | - Tiina Vaittinen
- Department of Social Sciences, Tampere University, Tampere, Finland
| | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sakineh Hajebrahimi
- Departments of Urology and Family Medicine, Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nina Davis
- Department of Urology, University of Oregon Health Sciences, Portland, Oregon, USA
| | - Tamara Dickinson
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Martha Spencer
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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GÜVEY H. 65 Yaş Üstü Kadınlarda Jinekolojik Sorunlar. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.453913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Vulvovaginal conditions are common in mature women. This reflects age-related changes in immunity and skin barrier function of vulvovaginal tissues. Vaginal atrophy is commonly complicated by dryness and inflammation, which makes postmenopausal atrophic vaginitis a virtually ubiquitous condition. The differential of vaginitis includes inflammatory, infectious, and malignant diseases, plus drug hypersensitivity. Atrophic vaginitis is treated with estrogen replacement therapy. Vulvovaginal malignant melanoma occurs predominantly in postmenopausal women and carries a poor prognosis. Similarly, the incidence of vulvovaginal malignancies, such as squamous cell carcinoma and extramammary Paget disease, rises exponentially after 65 years of age. Early diagnosis of these malignancies is of utmost importance. Lichen sclerosus et atrophicus and vulvovaginal candidosis are among the most common postmenopausal vulvovaginal conditions. Lichen sclerosus et atrophicus is associated with significant morbidity, and its management can be challenging. The incidence of vulvovaginal candidosis increases in patients on estrogen replacement therapy.
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Affiliation(s)
- Natalie Matthews
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | - Vivian Wong
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.
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Mothes AR, Lehmann T, Kwetkat A, Radosa MP, Runnebaum IB. Gynaecological Prolapse Surgery in Very Old Female Patients: A Case-Control Study on Co-Morbidity and Surgical Complications. Geburtshilfe Frauenheilkd 2016; 76:869-874. [PMID: 27582580 DOI: 10.1055/s-0042-109868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. METHOD In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Student's t, Fisher's exact and Mann-Whitney U tests. RESULTS The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p < 0.001), apical fixations were more frequent (p < 0.001), but the operating times were not different. In the very elderly patients 21 % CD II+III complications were observed, in the control group 6.6 % (p = 0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (± 1) vs. 4.1 (± 0.8; p < 0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p < 0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p < 0.001), in CIRS-G (4.1 ± 2.2 vs. 2.4 ± 1.7; p < 0.01) and in Charlson Index (1.6 ± 1.6 vs. 0.5 ± 0.7; p < 0.001). CONCLUSIONS A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities.
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Affiliation(s)
- A R Mothes
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
| | - T Lehmann
- Institut für Medizinische Statistik, Informatik und Dokumentation, Friedrich-Schiller-Universität, Jena
| | - A Kwetkat
- Klinik für Geriatrie, Universitätsklinikum, Friedrich-Schiller-Universität, Jena
| | - M P Radosa
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
| | - I B Runnebaum
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
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Functional status in older women diagnosed with pelvic organ prolapse. Am J Obstet Gynecol 2016; 214:613.e1-7. [PMID: 26704893 DOI: 10.1016/j.ajog.2015.11.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/20/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there are limited data on the prevalence of functional limitations in older women with pelvic floor disorders. OBJECTIVE The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse (POP). STUDY DESIGN This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files from 1992 through 2008. The analysis included 890 women age ≥65 years with POP. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living (ADL), and instrumental ADL (IADL) domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age. RESULTS The prevalence of functional limitations was 76.2% in strength, 44.9% in upper and 65.8% in lower body mobility, 4.5% in ADL, and 13.6% in IADL. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5% vs 69.9% in strength, 72.9% vs 33.5% in upper and 88.0% vs 56.8% in lower body mobility, 11.6% vs 0.9% in ADL, and 30.6% vs 6.7% in IADL; all P < .01. The odds of all functional limitations also increased significantly with advancing age. CONCLUSION Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with POP, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with POP.
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Berghmans B, Nieman F, Leue C, Weemhoff M, Breukink S, van Koeveringe G. Prevalence and triage of first-contact complaints on pelvic floor dysfunctions in female patients at a Pelvic Care Centre. Neurourol Urodyn 2015; 35:503-8. [DOI: 10.1002/nau.22739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/08/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Bary Berghmans
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Fred Nieman
- Department of Clinical Epidemiology & Medical Technology Assessment; Maastricht University Medical Centre; Maastricht The Netherlands
| | - C. Leue
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - M. Weemhoff
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - S. Breukink
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - G. van Koeveringe
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
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Berghmans B, Nieman F, Leue C, Weemhoff M, Breukink S, van Koeveringe G. Prevalence and triage of first contact pelvic floor dysfunction complaints in male patients referred to a Pelvic Care Centre. Neurourol Urodyn 2015; 35:487-91. [DOI: 10.1002/nau.22733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/15/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Bary Berghmans
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Fred Nieman
- Department of Clinical Epidemiology & Medical Technology Assessment; Maastricht University Medical Centre; Maastricht The Netherlands
| | - C. Leue
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - M. Weemhoff
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - S. Breukink
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - G. van Koeveringe
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
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Raglan G, Lawrence H, Schulkin J. Obstetrician/Gynecologist Care Considerations: Practice Changes in Disease Management with an Aging Patient Population. WOMENS HEALTH 2014; 10:155-60. [DOI: 10.2217/whe.14.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Demographic changes across the country are leading to an increased proportion of older Americans. This shift will likely lead to changes in the patient population seen by obstetrician/gynecologists, and practices may need to adapt to the needs of older women. This article looks at mental health, sexual health, bone loss, cardiovascular disease and cancer as areas in which obstetrician/gynecologists may experience changes with the increasing age of patients. While this is by no means a comprehensive list of changing areas of practice, it offers a guide for reflecting on the future of obstetrician/gynecologists training, and the importance of considering the needs of older patients in practice.
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Affiliation(s)
- Greta Raglan
- American College of Obstetricians & Gynecologists, Research Department, 409 12th Street Southwest, Washington, DC 20024, USA
| | - Hal Lawrence
- American College of Obstetricians & Gynecologists, Research Department, 409 12th Street Southwest, Washington, DC 20024, USA
| | - Jay Schulkin
- American College of Obstetricians & Gynecologists, Research Department, 409 12th Street Southwest, Washington, DC 20024, USA
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Geirsson RT. Leadership, organization and teamwork for obstetrics and gynecology. Acta Obstet Gynecol Scand 2013; 92:1237-8. [DOI: 10.1111/aogs.12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Urogenital consequences in ageing women. Best Pract Res Clin Obstet Gynaecol 2013; 27:699-714. [PMID: 23764480 DOI: 10.1016/j.bpobgyn.2013.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 02/20/2013] [Accepted: 03/22/2013] [Indexed: 12/18/2022]
Abstract
Various anatomical, physiological, genetic, lifestyle and reproductive factors interact throughout a woman's life span and contribute to pelvic floor disorders. Ageing affects pelvic floor anatomy and function, which can result in a variety of disorders, such as pelvic organ prolapse, lower urinary tract symptoms, dysfunctional bowel and bladder evacuation, and sexual dysfunction. The exact mechanisms and pathophysiological processes by which ageing affects pelvic floor and lower urinary and gastrointestinal tract anatomy and function are not always clear. In most cases, it is difficult to ascertain the exact role of ageing per se as an aetiological, predisposing or contributing factor. Other conditions associated with ageing that may co-exist, such as changes in mental status, can result in different types of pelvic floor dysfunction (e.g. functional incontinence). Pelvic organ dysfunction may be associated with significant morbidity and affect quality of life. These groups of patients often pose difficult diagnostic and therapeutic dilemmas owing to complex medical conditions and concurrent morbidities. In this chapter, we summarise the current evidence on the management of pelvic floor disorders, with emphasis on elderly women and the associations between the ageing process and these disorders. Clinicians with an understanding of the affect of ageing on the pelvic floor and lower urinary and gastrointestinal tract anatomy and function, and the complex interplay of other comorbidities, will be able to investigate, diagnose and treat appropriately there women. A holistic approach may result in substantial improvements in their quality of life.
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