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Preiksaitis C, Ashenburg N, Bunney G, Chu A, Kabeer R, Riley F, Ribeira R, Rose C. The Role of Large Language Models in Transforming Emergency Medicine: Scoping Review. JMIR Med Inform 2024; 12:e53787. [PMID: 38728687 PMCID: PMC11127144 DOI: 10.2196/53787] [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: 10/19/2023] [Revised: 12/20/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI), more specifically large language models (LLMs), holds significant potential in revolutionizing emergency care delivery by optimizing clinical workflows and enhancing the quality of decision-making. Although enthusiasm for integrating LLMs into emergency medicine (EM) is growing, the existing literature is characterized by a disparate collection of individual studies, conceptual analyses, and preliminary implementations. Given these complexities and gaps in understanding, a cohesive framework is needed to comprehend the existing body of knowledge on the application of LLMs in EM. OBJECTIVE Given the absence of a comprehensive framework for exploring the roles of LLMs in EM, this scoping review aims to systematically map the existing literature on LLMs' potential applications within EM and identify directions for future research. Addressing this gap will allow for informed advancements in the field. METHODS Using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) criteria, we searched Ovid MEDLINE, Embase, Web of Science, and Google Scholar for papers published between January 2018 and August 2023 that discussed LLMs' use in EM. We excluded other forms of AI. A total of 1994 unique titles and abstracts were screened, and each full-text paper was independently reviewed by 2 authors. Data were abstracted independently, and 5 authors performed a collaborative quantitative and qualitative synthesis of the data. RESULTS A total of 43 papers were included. Studies were predominantly from 2022 to 2023 and conducted in the United States and China. We uncovered four major themes: (1) clinical decision-making and support was highlighted as a pivotal area, with LLMs playing a substantial role in enhancing patient care, notably through their application in real-time triage, allowing early recognition of patient urgency; (2) efficiency, workflow, and information management demonstrated the capacity of LLMs to significantly boost operational efficiency, particularly through the automation of patient record synthesis, which could reduce administrative burden and enhance patient-centric care; (3) risks, ethics, and transparency were identified as areas of concern, especially regarding the reliability of LLMs' outputs, and specific studies highlighted the challenges of ensuring unbiased decision-making amidst potentially flawed training data sets, stressing the importance of thorough validation and ethical oversight; and (4) education and communication possibilities included LLMs' capacity to enrich medical training, such as through using simulated patient interactions that enhance communication skills. CONCLUSIONS LLMs have the potential to fundamentally transform EM, enhancing clinical decision-making, optimizing workflows, and improving patient outcomes. This review sets the stage for future advancements by identifying key research areas: prospective validation of LLM applications, establishing standards for responsible use, understanding provider and patient perceptions, and improving physicians' AI literacy. Effective integration of LLMs into EM will require collaborative efforts and thorough evaluation to ensure these technologies can be safely and effectively applied.
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Affiliation(s)
- Carl Preiksaitis
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Nicholas Ashenburg
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gabrielle Bunney
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Andrew Chu
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Rana Kabeer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Fran Riley
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Ryan Ribeira
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christian Rose
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Salvo F, Micallef J, Lahouegue A, Chouchana L, Létinier L, Faillie JL, Pariente A. Will the future of pharmacovigilance be more automated? Expert Opin Drug Saf 2023; 22:541-548. [PMID: 37435796 DOI: 10.1080/14740338.2023.2227091] [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: 04/13/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) based tools offer new opportunities for pharmacovigilance (PV) activities. Nevertheless, their contribution to PV needs to be tailored to preserve and strengthen medical and pharmacological expertise in drug safety. AREAS COVERED This work aims to describe PV tasks in which the contribution of AI and intelligent automation (IA) tools is required, in the context of a continuous increase of spontaneous reporting cases and regulatory tasks. A narrative review with expert selection of pertinent references was performed through Medline. Two areas were covered, management of spontaneous reporting cases and signal detection. PERSPECTIVE The use of AI and IA tools will assist a large spectrum of PV activities, both in public and private PV systems, in particular for tasks of low added value (e.g. initial quality check, verification of essential regulatory information, search for duplicates). Testing, validating, and integrating these tools in the PV routine are the actual challenges for modern PV systems, to guarantee high-quality standards in terms of case management and signal detection.
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Affiliation(s)
- Francesco Salvo
- University of Bordeaux, Inserm, BPH, Team AHeaD, Bordeaux, France
- CHU de Bordeaux, Service de Pharmacologie Medicale, Bordeaux, France
| | - Joelle Micallef
- Pharmacovigilance Centre, Department of Clinical Pharmacology and Pharmacovigilance, University of Aix Marseille, INSERM UMR 1106 Institut de Neurosciences des Systèmes, Marseille, France
| | - Amir Lahouegue
- Department of Pharmacovigilance and Medical Information, Astrazeneca, Courbevoie, France
| | - Laurent Chouchana
- Regional Center of Pharmacovigilance, Pharmacology Department, Cochin Port Royal University Hospital, Paris, France
| | - Louis Létinier
- University of Bordeaux, Inserm, BPH, Team AHeaD, Bordeaux, France
- CHU de Bordeaux, Service de Pharmacologie Medicale, Bordeaux, France
- Synapse Medicine, Bordeaux, France
| | - Jean-Luc Faillie
- Inserm, Departement de Pharmacologie Medicale Et Toxicologie, Centre Regional de PV, Institut Desbrest D'epidemiologie Et de Sante Publique, CHU de Montpellier, Universite Montpellier, Montpellier, France
| | - Antoine Pariente
- University of Bordeaux, Inserm, BPH, Team AHeaD, Bordeaux, France
- CHU de Bordeaux, Service de Pharmacologie Medicale, Bordeaux, France
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Plat R, Vasile M, Roubille F, Mercier G. Relationships between the COVID-19 lockdown, socioeconomic factors and acute coronary syndrome hospitalisations in France. PLoS One 2023; 18:e0286700. [PMID: 37285371 DOI: 10.1371/journal.pone.0286700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Worldwide, the COVID-19 pandemic has been associated with an overall drop in acute coronary syndrome (ACS) hospitalizations. Additionally, there is a well-known association between ACS and socioeconomic status. This study aims to assess the COVID-19 effect on ACS admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity. MATERIALS AND METHODS In this retrospective study, we used the French hospital discharge database (PMSI) to estimate ACS admission rates in all public and private hospitals in 2019 and 2020. A negative binomial regression explored the nationwide change in ACS admissions during lockdown compared with 2019. A multivariate analysis explored the factors associated with the ACS admission incidence rate ratio (IRR, 2020 incidence rate/2019 incidence rate) variation at the county level. RESULTS We found a significant but geographically heterogeneous nationwide reduction in ACS admissions during lockdown (IRR 0·70 [0·64-0·76]). After adjustment for cumulative COVID-19 admissions and the ageing index, a higher share of people on short-term working arrangements during lockdown at the county level was associated with a lower IRR, while a higher share of individuals with a high school degree and a higher density of acute care beds were associated with a higher ratio. CONCLUSIONS During the first national lockdown, there was an overall decrease in ACS admissions. Local provision of inpatient care and socioeconomic determinants linked to occupation were independently associated with the variation in hospitalizations.
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Affiliation(s)
- Rodney Plat
- Data Science Unit, Montpellier University Hospital, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Maria Vasile
- Data Science Unit, Montpellier University Hospital, Montpellier, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Grégoire Mercier
- Data Science Unit, Montpellier University Hospital, Montpellier, France
- UMR UA11 IDESP CNRS, University of Montpellier, Montpellier, France
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Steeg S, John A, Gunnell DJ, Kapur N, Dekel D, Schmidt L, Knipe D, Arensman E, Hawton K, Higgins JPT, Eyles E, Macleod-Hall C, McGuiness LA, Webb RT. The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. Br J Psychiatry 2022; 221:603-612. [PMID: 35816104 DOI: 10.1192/bjp.2022.79] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. AIMS To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. METHOD A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool. RESULTS Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17-56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls. CONCLUSIONS Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK
| | - Ann John
- Medical School, Swansea University, UK; and Public Health Wales NHS Trust, UK
| | - David J Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, UK;NIHR Greater Manchester Patient Safety Translational Research Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Dana Dekel
- Department of Population Psychiatry, Suicide and Informatics, Swansea University, UK
| | - Lena Schmidt
- Sciome LLC, North Carolina, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, UK
| | - Julian P T Higgins
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK; National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Luke A McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Roger T Webb
- Division of Psychology and Mental Health, University of Manchester, UK; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK
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Di Stefano R, Di Pietro A, Talevi D, Rossi A, Socci V, Pacitti F, Rossi R. Personality disorders (PD) and interpersonal violence (IV) during COVID-19 pandemic: a systematic review. Ann Gen Psychiatry 2022; 21:11. [PMID: 35397587 PMCID: PMC8994418 DOI: 10.1186/s12991-022-00388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
Not only did the ongoing CoronaVIrus Disease-19 (COVID-19) pandemic cause a massive number of casualties, but also there is growing concern that the burden of its psychological aftermaths will only show up years down the road. This systematic review summarises the existing literature reporting the impact of COVID-19 on personality disorders (PDs)-related violence. MEDLINE and APA PsycINFO were independently searched for relevant studies by two authors. Eligible studies had to be identifiable through database searching, published and fully accessible. This systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. An initial pool of 241 studies were found, out of which 69 met the selection criteria and were, therefore, included. The majority reported a worse Mental Health Outcome (MHO) during the pandemic as related to dysfunctional personality and positive personality traits predicting a better outcome. Furthermore, increased levels of interpersonal violence (IV) and self-directed violence were reported. Further research should be conducted on the reciprocal interaction of PDs and IV during the time of pandemic. Nevertheless, the dramatic impact of restrictive measures on PDs has still to be appropriately addressed.
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Affiliation(s)
- Ramona Di Stefano
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito, 67100, L'Aquila, Italy.
| | - Angelica Di Pietro
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Dalila Talevi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
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Barberis N, Cannavò M, Cuzzocrea F, Verrastro V. Suicidal Behaviours During Covid-19 Pandemic: A Review. CLINICAL NEUROPSYCHIATRY 2022; 19:84-96. [PMID: 35601250 PMCID: PMC9112993 DOI: 10.36131/cnfioritieditore20220202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective Novel COVID-19 disease has become a major concern worldwide, and a recent line of research warned that the context of the COVID-19 pandemic may be a major risk factor for developing severe suicidal behaviors. A broad systematic review is needed to cover the studies that have already assessed the potential underlying factors for suicidal behaviors in the context of the COVID-19 outbreak. Method A total of 52 studies met the inclusion criteria, and data were then described according to the subsequent categories: (1) countries where the studies were carried out; (2) factors impacting suicidal behaviors during the COVID-19 outbreak; and (3) examination of the observed populations. Results Findings of the current systematic review suggest that there is a certain amount of heterogeneity in factors impacting suicidal behaviors during the COVID-19 outbreak, with economic downturn, psychiatric vulnerability, isolation and quarantine, health concerns, and relational difficulties being the most prominent reasons for developing suicidal behaviors during the COVID-19 outbreak. Conclusions Timely interventions are needed to prevent suicidal behaviors in both the clinical and general populations, and in this regard, the creation of standard procedures may speed up the process.
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