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Fuller J, Chin-Yee B, Upshur REG. The argument framework is a flexible approach to evidence in healthcare. Nat Med 2024:10.1038/s41591-024-02930-x. [PMID: 38671239 DOI: 10.1038/s41591-024-02930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Jonathan Fuller
- Department of History and Philosophy of Science, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Benjamin Chin-Yee
- Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK
| | - Ross E G Upshur
- Dalla Lana School of Public Health and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Mortuza S, Chin-Yee B, James TE, Chin-Yee IH, Hedley BD, Ho JM, Saini L, Lazo-Langner A, Schenkel L, Bhai P, Sadikovic B, Keow J, Sangle N, Hsia CC. Myelodysplastic Neoplasms (MDS) with Ring Sideroblasts or SF3B1 Mutations: The Improved Clinical Utility of World Health Organization and International Consensus Classification 2022 Definitions, a Single-Centre Retrospective Chart Review. Curr Oncol 2024; 31:1762-1773. [PMID: 38668037 PMCID: PMC11049163 DOI: 10.3390/curroncol31040134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Myelodysplastic neoplasms (MDS) with ring sideroblasts (RS) are diagnosed via bone marrow aspiration in the presence of either (i) ≥15% RS or (ii) 5-14% RS and an SF3B1 mutation. In the MEDALIST trial and in an interim analysis of the COMMANDS trial, lower-risk MDS-RS patients had decreased transfusion dependency with luspatercept treatment. A total of 6817 patients with suspected hematologic malignancies underwent molecular testing using a next-generation-sequencing-based genetic assay and 395 MDS patients, seen at our centre from 1 January 2018 to 31 May 2023, were reviewed. Of these, we identified 39 evaluable patients as having lower-risk MDS with SF3B1 mutations: there were 20 (51.3%) males and 19 (48.7%) females, with a median age of 77 years (range of 57 to 92). Nineteen (48.7%) patients had an isolated SF3B1 mutation with a mean variant allele frequency of 35.2% +/- 8.1%, ranging from 7.4% to 46.0%. There were 29 (74.4%) patients with ≥15% RS, 6 (15.4%) with 5 to 14% RS, one (2.6%) with 1% RS, and 3 (7.7%) with no RS. Our study suggests that a quarter of patients would be missed based on the morphologic criterion of only using RS greater than 15% and supports the revised 2022 definitions of the World Health Organization (WHO) and International Consensus Classification (ICC), which shift toward molecularly defined subtypes of MDS and appropriate testing.
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Affiliation(s)
- Shamim Mortuza
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Benjamin Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Tyler E. James
- Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - Ian H. Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Benjamin D. Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Jenny M. Ho
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Lalit Saini
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Laila Schenkel
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Pratibha Bhai
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Jonathan Keow
- Edmonton Base Lab, Alberta Precision Laboratories, Edmonton, AB T2N 1M7, Canada;
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Cyrus C. Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
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Menz BD, Kuderer NM, Bacchi S, Modi ND, Chin-Yee B, Hu T, Rickard C, Haseloff M, Vitry A, McKinnon RA, Kichenadasse G, Rowland A, Sorich MJ, Hopkins AM. Current safeguards, risk mitigation, and transparency measures of large language models against the generation of health disinformation: repeated cross sectional analysis. BMJ 2024; 384:e078538. [PMID: 38508682 PMCID: PMC10961718 DOI: 10.1136/bmj-2023-078538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of safeguards to prevent large language models (LLMs) from being misused to generate health disinformation, and to evaluate the transparency of artificial intelligence (AI) developers regarding their risk mitigation processes against observed vulnerabilities. DESIGN Repeated cross sectional analysis. SETTING Publicly accessible LLMs. METHODS In a repeated cross sectional analysis, four LLMs (via chatbots/assistant interfaces) were evaluated: OpenAI's GPT-4 (via ChatGPT and Microsoft's Copilot), Google's PaLM 2 and newly released Gemini Pro (via Bard), Anthropic's Claude 2 (via Poe), and Meta's Llama 2 (via HuggingChat). In September 2023, these LLMs were prompted to generate health disinformation on two topics: sunscreen as a cause of skin cancer and the alkaline diet as a cancer cure. Jailbreaking techniques (ie, attempts to bypass safeguards) were evaluated if required. For LLMs with observed safeguarding vulnerabilities, the processes for reporting outputs of concern were audited. 12 weeks after initial investigations, the disinformation generation capabilities of the LLMs were re-evaluated to assess any subsequent improvements in safeguards. MAIN OUTCOME MEASURES The main outcome measures were whether safeguards prevented the generation of health disinformation, and the transparency of risk mitigation processes against health disinformation. RESULTS Claude 2 (via Poe) declined 130 prompts submitted across the two study timepoints requesting the generation of content claiming that sunscreen causes skin cancer or that the alkaline diet is a cure for cancer, even with jailbreaking attempts. GPT-4 (via Copilot) initially refused to generate health disinformation, even with jailbreaking attempts-although this was not the case at 12 weeks. In contrast, GPT-4 (via ChatGPT), PaLM 2/Gemini Pro (via Bard), and Llama 2 (via HuggingChat) consistently generated health disinformation blogs. In September 2023 evaluations, these LLMs facilitated the generation of 113 unique cancer disinformation blogs, totalling more than 40 000 words, without requiring jailbreaking attempts. The refusal rate across the evaluation timepoints for these LLMs was only 5% (7 of 150), and as prompted the LLM generated blogs incorporated attention grabbing titles, authentic looking (fake or fictional) references, fabricated testimonials from patients and clinicians, and they targeted diverse demographic groups. Although each LLM evaluated had mechanisms to report observed outputs of concern, the developers did not respond when observations of vulnerabilities were reported. CONCLUSIONS This study found that although effective safeguards are feasible to prevent LLMs from being misused to generate health disinformation, they were inconsistently implemented. Furthermore, effective processes for reporting safeguard problems were lacking. Enhanced regulation, transparency, and routine auditing are required to help prevent LLMs from contributing to the mass generation of health disinformation.
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Affiliation(s)
- Bradley D Menz
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | | | - Stephen Bacchi
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
- Northern Adelaide Local Health Network, Lyell McEwin Hospital, Adelaide, Australia
| | - Natansh D Modi
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Benjamin Chin-Yee
- Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK
| | - Tiancheng Hu
- Language Technology Lab, University of Cambridge, Cambridge, UK
| | - Ceara Rickard
- Consumer Advisory Group, Clinical Cancer Epidemiology Group, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Mark Haseloff
- Consumer Advisory Group, Clinical Cancer Epidemiology Group, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Agnes Vitry
- Consumer Advisory Group, Clinical Cancer Epidemiology Group, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- University of South Australia, Clinical and Health Sciences, Adelaide, Australia
| | - Ross A McKinnon
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Ganessan Kichenadasse
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
- Flinders Centre for Innovation in Cancer, Department of Medical Oncology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Andrew Rowland
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Ashley M Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
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Keow J, Kwan KF, Hedley BD, Hsia CC, Xenocostas A, Chin-Yee B. Merkel cell carcinoma mimicking acute leukemia. Int J Lab Hematol 2024. [PMID: 38477102 DOI: 10.1111/ijlh.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
Bone marrow aspirate showed diffuse infiltration by a population of monomorphic cells with scant cytoplasm, markedly increased nuclear-to-cytoplasmic ratio, and numerous indistinct nucleoli. Bone marrow biopsy confirmed extensive marrow infiltration by a malignant neoplasm with strong and diffuse expression of synaptophysin by immunohistochemistry, consistent with metastases from Merkel Cell carcinoma.
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Affiliation(s)
| | - Keith F Kwan
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Ben D Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Cyrus C Hsia
- Department of Medicine, Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Anargyros Xenocostas
- Department of Medicine, Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Benjamin Chin-Yee
- Department of Medicine, Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Almanaseer A, Chin-Yee B, Ho J, Lazo-Langner A, Schenkel L, Bhai P, Sadikovic B, Chin-Yee IH, Hsia CC. An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis. Adv Hematol 2024; 2024:3056216. [PMID: 38375212 PMCID: PMC10876298 DOI: 10.1155/2024/3056216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
Background Thrombocytosis is a common reason for referral to Hematology. Differentiating between secondary causes of thrombocytosis and essential thrombocythemia (ET) is often clinically challenging. A practical diagnostic approach to identify secondary thrombocytosis could reduce overinvestigation such as next generation sequencing (NGS) panel. Methods and Results All adult patients with thrombocytosis (≥450 × 109/L) who underwent molecular testing at a single tertiary care centre between January 1, 2018 and May 31, 2021 were evaluated. Clinical and laboratory variables were compared between patients with secondary thrombocytosis vs. ET. Clinical variables included smoking, thrombosis, splenectomy, active malignancy, chronic inflammatory disease, and iron deficiency anemia. Laboratory variables included complete blood count (CBC), ferritin, and myeloid mutations detected by NGS. The overall yield of molecular testing was 52.4%; 92.1% of which were mutations in JAK2, CALR, and/or MPL. Clinical factors predictive of ET included history of arterial thrombosis (p < 0.05); active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency were associated with secondary thrombocytosis (p < 0.05). A diagnosis of ET was associated with higher hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), and mean platelet volume (MPV), while secondary thrombocytosis was associated with higher body mass index, white blood cells, and neutrophils (p < 0.01). Conclusion A practical approach to investigating patients with persistent thrombocytosis based on clinical characteristics such as active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency may assist in accurately identifying patients more likely to have secondary causes of thrombocytosis and reduce overinvestigation, particularly costly molecular testing.
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Affiliation(s)
- Ala Almanaseer
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jenny Ho
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Laila Schenkel
- Molecular Diagnostic Division, Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H. Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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Chin-Yee B, Ho J, Sadikovic B, Chin-Yee I. Finding Goldilocks: Choosing Wisely Together in Hematology/Oncology. JCO Oncol Pract 2024; 20:300-302. [PMID: 38193724 DOI: 10.1200/op.23.00604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Benjamin Chin-Yee
- Benjamin Chin-Yee, MD, MA, FRCPC, Jenny Ho, MD, MSc, FRCPC, Bekim Sadikovic, PhD, DABMG, FACMG, and Ian Chin-Yee, MD, FRCPC, Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jenny Ho
- Benjamin Chin-Yee, MD, MA, FRCPC, Jenny Ho, MD, MSc, FRCPC, Bekim Sadikovic, PhD, DABMG, FACMG, and Ian Chin-Yee, MD, FRCPC, Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Benjamin Chin-Yee, MD, MA, FRCPC, Jenny Ho, MD, MSc, FRCPC, Bekim Sadikovic, PhD, DABMG, FACMG, and Ian Chin-Yee, MD, FRCPC, Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian Chin-Yee
- Benjamin Chin-Yee, MD, MA, FRCPC, Jenny Ho, MD, MSc, FRCPC, Bekim Sadikovic, PhD, DABMG, FACMG, and Ian Chin-Yee, MD, FRCPC, Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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Liu J, Chin-Yee B, Chin-Yee IH, Ho J, Sadikovic B, Hsia CC. Sodium-glucose cotransporter-2 inhibitor-associated erythrocytosis: A retrospective cohort study. J Intern Med 2024; 295:103-105. [PMID: 37729395 DOI: 10.1111/joim.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Jessica Liu
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jenny Ho
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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Pradeu T, Daignan-Fornier B, Ewald A, Germain PL, Okasha S, Plutynski A, Benzekry S, Bertolaso M, Bissell M, Brown JS, Chin-Yee B, Chin-Yee I, Clevers H, Cognet L, Darrason M, Farge E, Feunteun J, Galon J, Giroux E, Green S, Gross F, Jaulin F, Knight R, Laconi E, Larmonier N, Maley C, Mantovani A, Moreau V, Nassoy P, Rondeau E, Santamaria D, Sawai CM, Seluanov A, Sepich-Poore GD, Sisirak V, Solary E, Yvonnet S, Laplane L. Reuniting philosophy and science to advance cancer research. Biol Rev Camb Philos Soc 2023; 98:1668-1686. [PMID: 37157910 PMCID: PMC10869205 DOI: 10.1111/brv.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
Cancers rely on multiple, heterogeneous processes at different scales, pertaining to many biomedical fields. Therefore, understanding cancer is necessarily an interdisciplinary task that requires placing specialised experimental and clinical research into a broader conceptual, theoretical, and methodological framework. Without such a framework, oncology will collect piecemeal results, with scant dialogue between the different scientific communities studying cancer. We argue that one important way forward in service of a more successful dialogue is through greater integration of applied sciences (experimental and clinical) with conceptual and theoretical approaches, informed by philosophical methods. By way of illustration, we explore six central themes: (i) the role of mutations in cancer; (ii) the clonal evolution of cancer cells; (iii) the relationship between cancer and multicellularity; (iv) the tumour microenvironment; (v) the immune system; and (vi) stem cells. In each case, we examine open questions in the scientific literature through a philosophical methodology and show the benefit of such a synergy for the scientific and medical understanding of cancer.
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Affiliation(s)
- Thomas Pradeu
- CNRS UMR5164 ImmunoConcEpT, University of Bordeaux, 146 rue Leo Saignat, Bordeaux 33076, France
- CNRS UMR8590, Institut d’Histoire et Philosophie des Sciences et des Technique, University Paris I Panthéon-Sorbonne, 13 rue du Four, Paris 75006, France
| | - Bertrand Daignan-Fornier
- CNRS UMR 5095 Institut de Biochimie et Génétique Cellulaires, University of Bordeaux, 1 rue Camille St Saens, Bordeaux 33077, France
| | - Andrew Ewald
- Departments of Cell Biology and Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Pierre-Luc Germain
- Department of Health Sciences and Technology, Institute for Neurosciences, Eidgenössische Technische Hochschule (ETH) Zürich, Universitätstrasse 2, Zürich 8092, Switzerland
- Department of Molecular Life Sciences, Laboratory of Statistical Bioinformatics, Universität Zürich, Winterthurerstrasse 190, Zurich 8057, Switzerland
| | - Samir Okasha
- Department of Philosophy, University of Bristol, Cotham House, Bristol, BS6 6JL, UK
| | - Anya Plutynski
- Department of Philosophy, Washington University in St. Louis, and Associate with Division of Biology and Biomedical Sciences, St. Louis, MO 63105, USA
| | - Sébastien Benzekry
- Computational Pharmacology and Clinical Oncology (COMPO) Unit, Inria Sophia Antipolis-Méditerranée, Cancer Research Center of Marseille, Inserm UMR1068, CNRS UMR7258, Aix Marseille University UM105, 27, bd Jean Moulin, Marseille 13005, France
| | - Marta Bertolaso
- Research Unit of Philosophy of Science and Human Development, Università Campus Bio-Medico di Roma, Via Àlvaro del Portillo, 21-00128, Rome, Italy
- Centre for Cancer Biomarkers, University of Bergen, Bergen 5007, Norway
| | - Mina Bissell
- Biological Systems & Engineering Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Rd, Berkeley, CA 94720, USA
| | - Joel S. Brown
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 800 Commissioners Rd E, London, ON, Canada
- Rotman Institute of Philosophy, Western University, 1151 Richmond Street North, London, ON, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, 800 Commissioners Rd E, London, ON, Canada
| | - Hans Clevers
- Pharma, Research and Early Development (pRED) of F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel 4070, Switzerland
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences and University Medical Center, Uppsalalaan 8, Utrecht 3584 CT, The Netherlands
| | - Laurent Cognet
- CNRS UMR 5298, Laboratoire Photonique Numérique et Nanosciences, University of Bordeaux, Rue François Mitterrand, Talence 33400, France
| | - Marie Darrason
- Department of Pneumology and Thoracic Oncology, University Hospital of Lyon, 165 Chem. du Grand Revoyet, 69310 Pierre Bénite, Lyon, France
- Lyon Institute of Philosophical Research, Lyon 3 Jean Moulin University, 1 Av. des Frères Lumière, Lyon 69007, France
| | - Emmanuel Farge
- Mechanics and Genetics of Embryonic and Tumor Development group, Institut Curie, CNRS, UMR168, Inserm, Centre Origines et conditions d’apparition de la vie (OCAV) Paris Sciences Lettres Research University, Sorbonne University, Institut Curie, 11 rue Pierre et Marie Curie, Paris 75005, France
| | - Jean Feunteun
- INSERM U981, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - Jérôme Galon
- INSERM UMRS1138, Integrative Cancer Immunology, Cordelier Research Center, Sorbonne Université, Université Paris Cité, 15 rue de l’École de Médecine, Paris 75006, France
| | - Elodie Giroux
- Lyon Institute of Philosophical Research, Lyon 3 Jean Moulin University, 1 Av. des Frères Lumière, Lyon 69007, France
| | - Sara Green
- Section for History and Philosophy of Science, Department of Science Education, University of Copenhagen, Rådmandsgade 64, Copenhagen 2200, Denmark
| | - Fridolin Gross
- CNRS UMR5164 ImmunoConcEpT, University of Bordeaux, 146 rue Leo Saignat, Bordeaux 33076, France
| | - Fanny Jaulin
- INSERM U1279, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - Rob Knight
- Department of Bioengineering, University of California San Diego, 3223 Voigt Dr, La Jolla, CA 92093, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Ezio Laconi
- Department of Biomedical Sciences, School of Medicine, University of Cagliari, Via Università 40, Cagliari 09124, Italy
| | - Nicolas Larmonier
- CNRS UMR5164 ImmunoConcEpT, University of Bordeaux, 146 rue Leo Saignat, Bordeaux 33076, France
| | - Carlo Maley
- Arizona Cancer Evolution Center, Arizona State University, 427 East Tyler Mall, Tempe, AZ 85287, USA
- School of Life Sciences, Arizona State University, 427 East Tyler Mall, Tempe, AZ 85287, USA
- Biodesign Center for Biocomputing, Security and Society, Arizona State University, 1001 S McAllister Ave, Tempe, AZ 85287, USA
- Biodesign Center for Mechanisms of Evolution, Arizona State University, 1001 S McAllister Ave, Tempe, AZ 85287, USA
- Center for Evolution and Medicine, Arizona State University, 427 East Tyler Mall, Tempe, AZ 85287, USA
| | - Alberto Mantovani
- Department of Biomedical Sciences, Humanitas University, 4 Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy
- Department of Immunology and Inflammation, Istituto Clinico Humanitas Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy
- The William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Violaine Moreau
- INSERM UMR1312, Bordeaux Institute of Oncology (BRIC), University of Bordeaux, 146 Rue Léo Saignat, Bordeaux 33076, France
| | - Pierre Nassoy
- CNRS UMR 5298, Laboratoire Photonique Numérique et Nanosciences, University of Bordeaux, Rue François Mitterrand, Talence 33400, France
| | - Elena Rondeau
- INSERM U1111, ENS Lyon and Centre International de Recherche en Infectionlogie (CIRI), 46 Allée d’Italie, Lyon 69007, France
| | - David Santamaria
- Molecular Mechanisms of Cancer Program, Centro de Investigación del Cáncer, Consejo Superior de Investigaciones Científicas (CSIC)-University of Salamanca, Salamanca 37007, Spain
| | - Catherine M. Sawai
- INSERM UMR1312, Bordeaux Institute of Oncology (BRIC), University of Bordeaux, 146 Rue Léo Saignat, Bordeaux 33076, France
| | - Andrei Seluanov
- Department of Biology and Medicine, University of Rochester, Rochester, NY 14627, USA
| | | | - Vanja Sisirak
- CNRS UMR5164 ImmunoConcEpT, University of Bordeaux, 146 rue Leo Saignat, Bordeaux 33076, France
| | - Eric Solary
- INSERM U1287, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif 94800, France
- Département d’hématologie, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif 94800, France
- Université Paris-Saclay, Faculté de Médecine, 63 Rue Gabriel Péri, Le Kremlin-Bicêtre 94270, France
| | - Sarah Yvonnet
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Copenhagen DK-2200, Denmark
| | - Lucie Laplane
- CNRS UMR8590, Institut d’Histoire et Philosophie des Sciences et des Technique, University Paris I Panthéon-Sorbonne, 13 rue du Four, Paris 75006, France
- INSERM U1287, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif 94800, France
- Center for Biology and Society, College of Liberal Arts and Sciences, Arizona State University, 1100 S McAllister Ave, Tempe, AZ 85281, USA
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9
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Chin-Yee B, Bhai P, Cheong I, Matyashin M, Hsia CC, Kawata E, Ho JM, Levy MA, Stuart A, Lin H, Chin-Yee I, Kadour M, Sadikovic B, Lazo-Langner A. A Rational Approach to JAK2 Mutation Testing in Patients with Elevated Hemoglobin: Results from the JAK2 Prediction Cohort (JAKPOT) Study. J Gen Intern Med 2023; 38:1828-1833. [PMID: 36451015 PMCID: PMC10271984 DOI: 10.1007/s11606-022-07963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Erythrocytosis, most often measured as an increase in hemoglobin and/or hematocrit, is a common reason for referral to internal medicine and hematology clinics and a rational approach is required to effectively identify patients with polycythemia vera while avoiding over-investigation. AIM We aimed to develop and validate a simple rule to predict JAK2 mutation positivity based on complete blood count parameters to aid in the diagnostic approach to patients referred for elevated hemoglobin. SETTING Internal medicine and hematology clinics at an academic tertiary referral center. PARTICIPANTS The JAK2 Prediction Cohort (JAKPOT), a large retrospective cohort (n = 901) of patients evaluated by internal medicine and hematology specialists for elevated hemoglobin. DESIGN JAK2 mutation analysis was performed in all patients and clinical and laboratory variables were collected. Patients were randomly divided into derivation and validation cohorts. A prediction rule was developed using data from the derivation cohort and tested in the validation cohort. KEY RESULTS The JAKPOT prediction rule included three variables: (i) red blood cell count >6.45×1012/L, (ii) platelets >350×109/L, and (iii) neutrophils >6.2×109/L; absence of all criteria was effective at ruling out JAK2-positivity with sensitivities 94.7% and 100%, and negative predictive values of 98.8% and 100% in the derivation and validation cohorts, respectively, with an overall low false negative rate of 0.4%. The rule was validated for three different methods of JAK2 testing. Applying this rule to our entire cohort would have resulted in over 50% fewer tests. CONCLUSION In patients with elevated hemoglobin, the use of a simple prediction rule helps to accurately identify patients with a low likelihood of having a JAK2 mutation, potentially limiting costly over-investigation in this common referral population.
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Affiliation(s)
- Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Ian Cheong
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Maxim Matyashin
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Eri Kawata
- Division of Hematology, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Jenny M Ho
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael A Levy
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Alan Stuart
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Hanxin Lin
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mike Kadour
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bekim Sadikovic
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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10
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Chin-Yee B, Nimmon L, Veen M. Technical Difficulties: Teaching Critical Philosophical Orientations toward Technology. Teach Learn Med 2023; 35:240-249. [PMID: 36286229 DOI: 10.1080/10401334.2022.2130334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Issue: Technological innovation is accelerating, creating less time to reflect on the impact new technologies will have on the medical profession. Modern technologies are becoming increasingly embedded in routine medical practice with far-reaching impacts on the patient-physician relationship and the very essence of the health professions. These impacts are often difficult to predict and can create unintended consequences for medical education. This article is driven by a main question: How do we prepare trainees to critically assess technologies that we cannot foresee and effectively use technology to support equitable and compassionate care? Evidence: We translate insights from the philosophy of technology into a proposal for integrating critical technical consciousness in medical curricula. We identify three areas required to develop critical consciousness with regard to emerging technologies. The first area is technical literacy, which involves not just knowing how to use technology, but also understanding its limitations and appropriate contexts for use. The second area is the ability to assess the social impact of technology. This practice requires understanding that while technification creates new possibilities it can also have adverse, unintended consequences. The third area is critical reflection on the relationship between 'the human' and 'the technical' as it relates to the values of the medical profession and professional identity formation. Human and technology are two sides of the same coin; therefore, thinking critically about technology also forces us to think about what we consider 'the human side of medicine'. Implications: Critical technical consciousness can be fostered through an educational program underpinned by the recognition that, although technological innovation can create new possibilities for healing, technology is never neutral. Rather, it is imperative to emphasize that technology is interwoven with the social fabric that is essential to healing. Like medication, technology can be both potion and poison.
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Affiliation(s)
- Benjamin Chin-Yee
- Schulich School of Medicine and Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mario Veen
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
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11
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Ahmad M, Chin-Yee B, Sangle N, Rizkalla K, Chin-Yee I, Hsia CC. Pericardial Extramedullary Hematopoiesis Associated with Metastatic Adenocarcinoma of Gastrointestinal or Pancreaticobiliary Origin: A Case Report. Case Rep Oncol 2023; 16:96-101. [PMID: 36820213 PMCID: PMC9938399 DOI: 10.1159/000529123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/19/2022] [Indexed: 02/19/2023] Open
Abstract
Extramedullary hematopoiesis (EMH) is a rare complication of solid tumor malignancies. We describe the first case of a patient who developed EMH in the pericardium secondary to metastatic gastrointestinal or pancreaticobiliary cancer. A 58-year-old man presented with recurrent episodes of fatigue and shortness of breath and was treated with thoracocentesis and pericardiocentesis for pleural and pericardial effusions, respectively. Owing to a markedly elevated alkaline phosphatase, a bone scan was performed and demonstrated diffuse sclerotic lesions. Evaluation of pleural effusion diagnosed metastatic adenocarcinoma, and cytospin morphology of the pericardial fluid demonstrated EMH. While EMH secondary to solid tumors is commonly suggested to be due to cytokine signaling, we propose the mechanism of EMH in this patient was due to extensive disruption of bone marrow hematopoiesis, similar to what is seen in myeloproliferative neoplasms.
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Affiliation(s)
- Maud Ahmad
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kamilia Rizkalla
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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12
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Chin-Yee B, Suthakaran A, Hedley BD, Howlett C, Stuart A, Sadikovic B, Chin-Yee IH, Hsia CC. T-cell clonality testing for the diagnosis of T-cell large granular lymphocytic leukemia: Are we identifying pathology or incidental clones? Int J Lab Hematol 2022; 44:1115-1120. [PMID: 36380468 DOI: 10.1111/ijlh.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION T-cell clonality testing by T-cell receptor (TCR) gene rearrangement is key to the diagnosis of T-cell lymphoproliferative disorders such as T-cell large granular lymphocytic (T-LGL) leukemia. Benign clonal T-cell expansions, however, are commonly found in patients without identifiable disease, a condition referred to as T-cell clones of uncertain significance (T-CUS). In practice, T-cell clonality testing is performed for a range of reasons and results are often challenging to interpret given the overlap between benign and malignant clonal T-cell proliferations and uncertainties in the management of T-CUS. METHODS We conducted a 5-year retrospective cohort study of 211 consecutive patients who underwent PCR-based T-cell clonality testing for suspected T-LGL leukemia at our institution to characterize the use of T-cell clonality testing and its impact on patient management. RESULTS Overall, 46.4% (n = 98) of individuals tested had a clonal T-cell population identified. Patients with a monoclonal T-cell population were more likely to be older, have rheumatoid arthritis and have higher lymphocyte counts compared to patients with polyclonal populations. The majority of patients eventually diagnosed and treated for T-LGL leukemia had rheumatoid arthritis and lower neutrophil counts compared to untreated patients with monoclonal T-cell populations. A diagnosis of T-LGL leukemia was made in only a minority of patients (n = 48, 22.7%), and only a small proportion were treated (n = 17, 8.1%). CONCLUSION Our study suggests that T-cell clonality testing most commonly identifies incidental T-cell clones with only a minority of patients receiving a diagnosis of T-LGL leukemia and fewer requiring active treatment. These finding indicate an opportunity to improve utilization of T-cell clonality testing in clinical practice to better target patients where the results of testing would impact clinical management.
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Affiliation(s)
- Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Abitha Suthakaran
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher Howlett
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alan Stuart
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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13
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Istasy P, Lee WS, Iansavichene A, Upshur R, Gyawali B, Burkell J, Sadikovic B, Lazo-Langner A, Chin-Yee B. The Impact of Artificial Intelligence on Health Equity in Oncology: Scoping Review. J Med Internet Res 2022; 24:e39748. [PMID: 36005841 PMCID: PMC9667381 DOI: 10.2196/39748] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The field of oncology is at the forefront of advances in artificial intelligence (AI) in health care, providing an opportunity to examine the early integration of these technologies in clinical research and patient care. Hope that AI will revolutionize health care delivery and improve clinical outcomes has been accompanied by concerns about the impact of these technologies on health equity. OBJECTIVE We aimed to conduct a scoping review of the literature to address the question, "What are the current and potential impacts of AI technologies on health equity in oncology?" METHODS Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases from January 2000 to August 2021 for records engaging with key concepts of AI, health equity, and oncology. We included all English-language articles that engaged with the 3 key concepts. Articles were analyzed qualitatively for themes pertaining to the influence of AI on health equity in oncology. RESULTS Of the 14,011 records, 133 (0.95%) identified from our review were included. We identified 3 general themes in the literature: the use of AI to reduce health care disparities (58/133, 43.6%), concerns surrounding AI technologies and bias (16/133, 12.1%), and the use of AI to examine biological and social determinants of health (55/133, 41.4%). A total of 3% (4/133) of articles focused on many of these themes. CONCLUSIONS Our scoping review revealed 3 main themes on the impact of AI on health equity in oncology, which relate to AI's ability to help address health disparities, its potential to mitigate or exacerbate bias, and its capability to help elucidate determinants of health. Gaps in the literature included a lack of discussion of ethical challenges with the application of AI technologies in low- and middle-income countries, lack of discussion of problems of bias in AI algorithms, and a lack of justification for the use of AI technologies over traditional statistical methods to address specific research questions in oncology. Our review highlights a need to address these gaps to ensure a more equitable integration of AI in cancer research and clinical practice. The limitations of our study include its exploratory nature, its focus on oncology as opposed to all health care sectors, and its analysis of solely English-language articles.
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Affiliation(s)
- Paul Istasy
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Wen Shen Lee
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine, Western University, London, ON, Canada
| | | | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jacquelyn Burkell
- Faculty of Information and Media Studies, Western University, London, ON, Canada
| | - Bekim Sadikovic
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine, Western University, London, ON, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Benjamin Chin-Yee
- Rotman Institute of Philosophy, Western University, London, ON, Canada
- Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
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14
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Chin-Yee B, Matyashin M, Cheong I, Bhai P, Lazo-Langner A, Almanaseer A, Kawata E, Levy MA, Stuart A, Lin H, Chin-Yee I, Sadikovic B, Hsia C. Secondary causes of elevated hemoglobin in patients undergoing molecular testing for suspected polycythemia vera in southwestern Ontario: a chart review. CMAJ Open 2022; 10:E988-E992. [PMID: 36347562 PMCID: PMC9648622 DOI: 10.9778/cmajo.20210322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Molecular testing for JAK2 mutations is part of the standard diagnostic workup for patients with suspected polycythemia vera. We sought to characterize evolving practice patterns in the investigation of erythrocytosis and the prevalence of secondary causes, including use of medications such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, among patients who underwent molecular testing. METHODS We reviewed charts of all consecutive patients investigated for erythrocytosis (hemoglobin > 160 g/L for women, > 165 g/L for men) with JAK2 testing between 2015 and 2021 at London Health Sciences Centre, a tertiary referral centre in Ontario, Canada, to assess changes in rates of JAK2 mutation positivity, average hemoglobin levels and the prevalence of secondary causes of erythrocytosis. RESULTS A total of 891 patients with erythrocytosis underwent JAK2 mutation testing with an increase in number of tests (particularly from 2017 to 2018), a decrease in the rate of JAK2 positivity and similar average hemoglobin levels over the study period. We observed a high proportion of patients with secondary causes of erythrocytosis, ranging from 59% to 74% over the study period, including medications associated with erythrocytosis, namely testosterone (6%-11%) and SGLT2 inhibitors (2%-19%). Stopping SGLT2 inhibitors was associated with a significant decrease in hemoglobin levels (mean -14.7 g/L, 95% confidence interval -18.9 to -10.5 g/L) compared with continuation. INTERPRETATION Use of SGLT2 inhibitors may be a common and underrecognized secondary cause of elevated hemoglobin levels in patients investigated for erythrocytosis. Our findings underscore the importance of a detailed medical history to support judicious use of molecular testing, in adherence with the current guideline on the investigation of erythrocytosis.
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Affiliation(s)
- Benjamin Chin-Yee
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Maxim Matyashin
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ian Cheong
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Pratibha Bhai
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Alejandro Lazo-Langner
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ala Almanaseer
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eri Kawata
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michael A Levy
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Alan Stuart
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hanxin Lin
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ian Chin-Yee
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Bekim Sadikovic
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Cyrus Hsia
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
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15
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Szeto VG, Chin-Yee B, Dehghani M, Rizkalla K, Licskai C, Hsia CC. Successful treatment of Kimura disease with benralizumab. Ann Hematol 2022; 101:2099-2100. [PMID: 35622096 DOI: 10.1007/s00277-022-04873-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Vivian G Szeto
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Benjamin Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada
| | - Mina Dehghani
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada
| | - Kamilia Rizkalla
- Department of Pathology, Victoria Hospital, London Health Sciences Centre and Western University, London, ON, Canada
| | - Christopher Licskai
- Department of Medicine, Division of Respirology, London Health Sciences Centre and Western University, London, ON, Canada
| | - Cyrus C Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada.
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16
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Thomas A, Chin-Yee B, Mercuri M. Thirty years of teaching evidence-based medicine: have we been getting it all wrong? Adv Health Sci Educ Theory Pract 2022; 27:263-276. [PMID: 34559327 DOI: 10.1007/s10459-021-10077-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
Evidence based medicine (EBM) has been synonymous to delivery of quality care for almost thirty years. Since the movement's inception, the assumption has been that decisions based on high quality evidence would translate to better care for patients. Despite EBM's many attractive features and the substantive attention it has received in the contemporary clinical and medical education literature, how it is defined and operationalized as a component of training is often unclear and problematic. How to practice EBM is not well articulated in the literature; therefore, it becomes difficult to teach and equally challenging to assess. In this paper, we put forward a call for deeper consideration of how EBM is taught, and for clarification on how it is defined and operationalized in medical education. In preparing this paper, we considered questions such as what it means to practice EBM, the role that medical education plays in helping realize EBM, how the teaching of EBM can change to reflect recent developments in clinical practice and education, and whether transformations in the practice of medicine necessitate a change in how we teach EBM. We end with four avenues that may be pursued to advance the teaching of EBM in medical education: (1) consensus on what we mean by EBM; (2) clear articulation of EBM-associated competencies; (3) empirically and theoretically supported means of promoting EBM competencies; (4) ways to assess both skill acquisition and use of EBM. We discuss implications for educators of EBM.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy and Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University and Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3654 Promenade Sir William Osler, Montreal, QC, H3G-1Y5, Canada.
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine and Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Mathew Mercuri
- Department of Medicine, McMaster University, Hamilton, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for the Future of Knowledge, University of Johannesburg, Johannesburg, South Africa
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17
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Kawata E, Hedley BD, Chin-Yee B, Xenocostas A, Lazo-Langner A, Hsia CC, Howson-Jan K, Yang P, Levy MA, Santos S, Bhai P, Howlett C, Lin H, Kadour M, Sadikovic B, Chin-Yee I. Reducing cytogenetic testing in the era of next generation sequencing: Are we choosing wisely? Int J Lab Hematol 2021; 44:333-341. [PMID: 34713980 DOI: 10.1111/ijlh.13747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION In most laboratories, next generation sequencing (NGS) has been added without consideration for redundancy compared to conventional cytogenetics (CG). We tested a streamlined approach to genomic testing in patients with suspected myeloid and plasma cell neoplasms using next generation sequencing ("NGS first") as the primary testing modality and limiting cytogenetics (CG) to samples with morphologic abnormalities in the marrow aspirate. METHODS Based on morphologic interpretation of bone marrow aspirate and flow cytometry, samples were triaged into four groups: (a) Samples with dysplasia or excess blasts had both NGS and karyotyping; (b) Samples without excess blasts or dysplasia had NGS only; (c) Repeat samples with previous NGS and/or CG studies were not retested; (d) Samples for suspected myeloma with less than 5% plasma cell had CG testing cancelled. RESULTS Seven hundred eleven adult bone marrow (BM) samples met the study criteria. The NGS first algorithm eliminated CG testing in 229/303 (75.6%) of patients, primarily by reducing repeat testing. Potential cost avoided was approximately $124 000 per annum. Hematologists overruled the triage comment in only 11/303 (3.6%) cases requesting CG testing for a specific indication. CONCLUSIONS Utilizing NGS as the primary genomic testing modality NGS was feasible and well accepted, reducing over three quarters of all CG requests and improving the financial case for adoption of NGS. Key factors for the success of this study were collaboration of clinical and genomic diagnostic teams in developing the algorithm, rapid turnaround time for BM interpretation for triage, and communication between laboratories.
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Affiliation(s)
- Eri Kawata
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Hematology, Panasonic Health Insurance Organization Matsushita Memorial Hospital, Moriguchi, Japan.,Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anargyros Xenocostas
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada
| | - Kang Howson-Jan
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ping Yang
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Cytogenetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Michael A Levy
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Santos
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher Howlett
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Mike Kadour
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada
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18
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Voss C, Esmail S, Liu X, Knauer MJ, Ackloo S, Kaneko T, Lowes L, Stogios P, Seitova A, Hutchinson A, Yusifov F, Skarina T, Evdokimova E, Loppnau P, Ghiabi P, Haijan T, Zhong S, Abdoh H, Hedley BD, Bhayana V, Martin CM, Slessarev M, Chin-Yee B, Fraser DD, Chin-Yee I, Li SS. Epitope-specific antibody responses differentiate COVID-19 outcomes and variants of concern. JCI Insight 2021; 6:148855. [PMID: 34081630 PMCID: PMC8410046 DOI: 10.1172/jci.insight.148855] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/02/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUNDThe role of humoral immunity in COVID-19 is not fully understood, owing, in large part, to the complexity of antibodies produced in response to the SARS-CoV-2 infection. There is a pressing need for serology tests to assess patient-specific antibody response and predict clinical outcome.METHODSUsing SARS-CoV-2 proteome and peptide microarrays, we screened 146 COVID-19 patients' plasma samples to identify antigens and epitopes. This enabled us to develop a master epitope array and an epitope-specific agglutination assay to gauge antibody responses systematically and with high resolution.RESULTSWe identified linear epitopes from the spike (S) and nucleocapsid (N) proteins and showed that the epitopes enabled higher resolution antibody profiling than the S or N protein antigen. Specifically, we found that antibody responses to the S-811-825, S-881-895, and N-156-170 epitopes negatively or positively correlated with clinical severity or patient survival. Moreover, we found that the P681H and S235F mutations associated with the coronavirus variant of concern B.1.1.7 altered the specificity of the corresponding epitopes.CONCLUSIONEpitope-resolved antibody testing not only affords a high-resolution alternative to conventional immunoassays to delineate the complex humoral immunity to SARS-CoV-2 and differentiate between neutralizing and non-neutralizing antibodies, but it also may potentially be used to predict clinical outcome. The epitope peptides can be readily modified to detect antibodies against variants of concern in both the peptide array and latex agglutination formats.FUNDINGOntario Research Fund (ORF) COVID-19 Rapid Research Fund, Toronto COVID-19 Action Fund, Western University, Lawson Health Research Institute, London Health Sciences Foundation, and Academic Medical Organization of Southwestern Ontario (AMOSO) Innovation Fund.
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MESH Headings
- Agglutination Tests/methods
- Amino Acid Sequence
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Antibody Formation/immunology
- Antibody Specificity/immunology
- COVID-19/blood
- COVID-19/immunology
- COVID-19/mortality
- COVID-19 Serological Testing/methods
- Epitopes/immunology
- Epitopes, B-Lymphocyte/chemistry
- Epitopes, B-Lymphocyte/genetics
- Epitopes, B-Lymphocyte/immunology
- Humans
- Immunity, Humoral
- Microarray Analysis/methods
- Nucleocapsid/chemistry
- Nucleocapsid/genetics
- Nucleocapsid/immunology
- Peptides/immunology
- SARS-CoV-2/genetics
- SARS-CoV-2/immunology
- Severity of Illness Index
- Spike Glycoprotein, Coronavirus/chemistry
- Spike Glycoprotein, Coronavirus/genetics
- Spike Glycoprotein, Coronavirus/immunology
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Affiliation(s)
| | | | | | - Michael J. Knauer
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | | | - Lori Lowes
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Peter Stogios
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Tatiana Skarina
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Elena Evdokimova
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Loppnau
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Pegah Ghiabi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Taraneh Haijan
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | | | - Husam Abdoh
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Benjamin D. Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Claudio M. Martin
- Department of Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Douglas D. Fraser
- Department of Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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19
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Esmail S, Knauer MJ, Abdoh H, Voss C, Chin-Yee B, Stogios P, Seitova A, Hutchinson A, Yusifov F, Skarina T, Evdokimova E, Ackloo S, Lowes L, Hedley BD, Bhayana V, Chin-Yee I, Li SSC. Rapid and accurate agglutination-based testing for SARS-CoV-2 antibodies. Cell Rep Methods 2021; 1:100011. [PMID: 34235498 PMCID: PMC8114573 DOI: 10.1016/j.crmeth.2021.100011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/23/2021] [Accepted: 04/21/2021] [Indexed: 12/23/2022]
Abstract
We have developed a rapid, accurate, and cost-effective serologic test for SARS-CoV-2 virus, which caused the COVID-19 pandemic, on the basis of antibody-dependent agglutination of antigen-coated latex particles. When validated using plasma samples that are positive or negative for SARS-CoV-2, the agglutination assay detected antibodies against the receptor-binding domain of the spike (S-RBD) or the nucleocapsid protein of SARS-CoV-2 with 100% specificity and ∼98% sensitivity. Furthermore, we found that the strength of the S-RBD antibody response measured by the agglutination assay correlated with the efficiency of the plasma in blocking RBD binding to the angiotensin-converting enzyme 2 in a surrogate neutralization assay, suggesting that the agglutination assay might be used to identify individuals with virus-neutralizing antibodies. Intriguingly, we found that >92% of patients had detectable antibodies on the day of a positive viral RNA test, suggesting that the agglutination antibody test might complement RNA testing for the diagnosis of SARS-CoV-2 infection.
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Affiliation(s)
- Sally Esmail
- Departments of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON N6G 2V4, Canada
| | - Michael J. Knauer
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Husam Abdoh
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Courtney Voss
- Departments of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON N6G 2V4, Canada
| | - Benjamin Chin-Yee
- Divison of Hematology, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Peter Stogios
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
| | - Almagul Seitova
- Structural Genomics Consortium, University of Toronto, 101 College Street, MaRS South Tower, Suite 700, Toronto, ON M5G 1L7, Canada
| | - Ashley Hutchinson
- Structural Genomics Consortium, University of Toronto, 101 College Street, MaRS South Tower, Suite 700, Toronto, ON M5G 1L7, Canada
| | - Farhad Yusifov
- Structural Genomics Consortium, University of Toronto, 101 College Street, MaRS South Tower, Suite 700, Toronto, ON M5G 1L7, Canada
| | - Tatiana Skarina
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
| | - Elena Evdokimova
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
| | - Suzanne Ackloo
- Structural Genomics Consortium, University of Toronto, 101 College Street, MaRS South Tower, Suite 700, Toronto, ON M5G 1L7, Canada
| | - Lori Lowes
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Benjamin D. Hedley
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Shawn S.-C. Li
- Departments of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON N6G 2V4, Canada
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20
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Chin-Yee B, Diaz P, Bryden P, Soklaridis S, Kuper A. From hermeneutics to heteroglossia: 'The Patient's View' revisited. Med Humanit 2020; 46:464-473. [PMID: 31831593 DOI: 10.1136/medhum-2019-011724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
This article explores conceptual and methodological challenges surrounding the recovery of patients' voices in the history of medicine. We examine the debate that followed Roy Porter's seminal article, 'The Patient's View: Doing Medical History from Below' (1985). Porter argued that patients should be given a central role in medical history, aiming to restore to patients a voice and agency that is often lost in 'physician-centered' historical narratives. His work carried significant influence but also sparked an ongoing debate about the possibility of conducting 'patient-centered' history of medicine. The growth of the medical humanities has afforded renewed attention to patient narratives, supporting the need to recognise patients' voices in contemporary healthcare and medical education. However, several barriers complicate and problematise the expansion of a patient-centred epistemology across historical periods. Postmodern critics have expressed scepticism that 'the patient's view' can be recovered from history, with some claiming that 'the patient' is a construct of the 'medical gaze' whose subjectivity cannot be reconstituted outside of sociohistorical discourses of knowledge and power. Psychiatry in the mid-20th century presents a particular challenge for patient-centred history. We discuss the influence of postmodern theorists, especially Michel Foucault, whose work is seen as undermining the possibility of a patient-centred epistemology. We argue against Foucault's erasure of the patient, and instead explore alternate constructivist epistemologies, focusing on the hermeneutics of Hans-Georg Gadamer and dialogism of Mikhail Bakhtin, to help address historiographical challenges in recovering 'the patient's view'. To illustrate the value of Gadamerian and Bakhtinian approaches, we apply them to a case study from the Verdun Protestant Hospital (Québec, Canada) from 1941 to 1956, which sheds light on the introduction of the first antipsychotic, chlorpromazine, into clinical practice. We highlight how Gadamer's hermeneutics and Bakhtin's dialogism together offer insights into patient perspectives during this liminal period in the history of psychiatry.
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Affiliation(s)
- Benjamin Chin-Yee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Diaz
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Pier Bryden
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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21
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Affiliation(s)
- Benjamin Chin-Yee
- Clinical fellow, Division of Hematology, Department of Medicine, Western University, London, Ont
| | - Ziad Solh
- Assistant professor, Pathology and Laboratory Medicine, Western University, London, Ont
| | - Cyrus Hsia
- Associate professor, Division of Hematology, Department of Medicine, Western University, London, Ont
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Thomas A, Kuper A, Chin-Yee B, Park M. What is "shared" in shared decision-making? Philosophical perspectives, epistemic justice, and implications for health professions education. J Eval Clin Pract 2020; 26:409-418. [PMID: 32032468 DOI: 10.1111/jep.13370] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/12/2019] [Accepted: 01/25/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Drawing from the philosophical work of Hans-Georg Gadamer and the perspectives of theorists Mikhail Bakhtin and Kenneth Burke, the aim of this paper is to critically reflect on the meaning of the word "shared." METHOD The authors draw on the concept of epistemic justice, which they argue permeates the clinical encounter, to discuss how various forms of, and claims to, knowledge may influence the attainement of shared decision-making in health care contexts. The specific objectives are twofold: first, the authors draw key concepts from key Gadamerian, Burkean, and Bakhtinian philosophical perspectives to consider shared decision-making in relation to two types of epistemic injustice: testimonial and hermeneutic epistemic injustice. Second, building on philosopher Paulo Freire's critical pedagogy, the authors emphasize that major changes in educational structures and systems are required to promote the critical reflexivity required to address issues of epistemic justice, in the broader pursuit of authentic shared decision-making. RESULTS They propose three main areas of focus for helath professions education: (a) changes in content (moving from a focus on biomedical knowledge to more content on social sciences) and methods of teaching (more dialogue and the creation of moments of dissonance); (b) a re-examination of teachers' role in promoting epistemic justice; and (c) inclusion of patients as partners. CONCLUSIONS Without major transformation in what, how, and with whom we teach, future clinicians may be unprepared to enact shared decision-making in a manner that does justice to the various ways of knowing.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada.,Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Ayelet Kuper
- Sunnybrook Health Sciences Centre, Toronto, Canada.,The Wilson Centre, University Health Network/University of Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Ontario, Canada
| | | | - Melissa Park
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
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Abstract
There is now broad agreement that ideas like person-centred care, patient expertise and shared decision-making are no longer peripheral to health discourse, fine ideals or merely desirable additions to sound, scientific clinical practice. Rather, their incorporation into our thinking and planning of health and social care is essential if we are to respond adequately to the problems that confront us: they need to be seen not as "ethical add-ons" but core components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. This, the tenth philosophy thematic edition of the journal, presents papers conducting urgent research into the social context of scientific knowledge and the significance of viewing clinical knowledge not as something that "sits within the minds" of researchers and practitioners, but as a relational concept, the product of social interactions. It includes papers on the nature of reasoning and evidence, the on-going problems of how to 'integrate' different forms of scientific knowledge with broader, humanistic understandings of reasoning and judgement, patient and community perspectives. Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under-developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on shared decision-making, analysing its proper meaning, its role in policy, methods for realising it and its limitations in real-world contexts.
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Affiliation(s)
- Michael Loughlin
- European Institute for Person-Centred Health and Social Care, University of West London, London, UK
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Michael Cournoyea
- Institute for the History and Philosophy of Science, University of Toronto, Toronto, Canada
| | - Samantha Marie Copeland
- Ethics and Philosophy of Technology Section, Department of Values, Technology and Innovation, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
| | | | - K W M Fulford
- Collaborating Centre for Values Based Practice, University of Oxford, Oxford, UK
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24
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Taran S, Chin-Yee B, Detsky AS. Night Call in a Teaching Hospital: 1979 and 2019. J Hosp Med 2019; 14:782-784. [PMID: 31433766 DOI: 10.12788/jhm.3284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
No matter the era, few aspects of residency are more
defining or memorable than overnight call. Nights
can be a time of growth and learning but also of
fear and uncertainty, as residents take on the responsibility
of managing sick patients on their own. One of
us (ASD) started his residency in 1978 at the Massachusetts
General Hospital in Boston; the other two (ST and BCY) started
theirs in 2016 and 2017, respectively, at the University of
Toronto. In this essay, we reflect on our experiences of night
call separated by 40 years, highlighting what has changed and
what has stayed the same.
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Affiliation(s)
- Shaurya Taran
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Chin-Yee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan S Detsky
- Institute for Health Policy, Management, and Evaluation, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
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25
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Chin-Yee B, Messinger A, Young LT. Three visions of doctoring: a Gadamerian dialogue. Adv Health Sci Educ Theory Pract 2019; 24:403-412. [PMID: 29663183 DOI: 10.1007/s10459-018-9824-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
Medicine in the twenty-first century faces an 'identity crisis,' as it grapples with the emergence of various 'ways of knowing,' from evidence-based and translational medicine, to narrative-based and personalized medicine. While each of these approaches has uniquely contributed to the advancement of patient care, this pluralism is not without tension. Evidence-based medicine is not necessary individualized; personalized medicine may be individualized but is not necessarily person-centered. As novel technologies and big data continue to proliferate today, the focus of medical practice is shifting away from the dialogic encounter between doctor and patient, threatening the loss of humanism that many view as integral to medicine's identity. As medical trainees, we struggle to synthesize medicine's diverse and evolving 'ways of knowing' and to create a vision of doctoring that integrates new forms of medical knowledge into the provision of person-centered care. In search of answers, we turned to twentieth-century philosopher Hans-Georg Gadamer, whose unique outlook on "health" and "healing," we believe, offers a way forward in navigating medicine's 'messy pluralism.' Drawing inspiration from Gadamer's emphasis on dialogue and 'practical wisdom' (phronesis), we initiated a dialogue with the dean of our medical school to address the question of how medical trainees and practicing clinicians alike can work to create a more harmonious pluralism in medicine today. We propose that implementing a pluralistic approach ultimately entails 'bridging' the current divide between scientific theory and the practical art of healing, and involves an iterative and dialogic process of asking questions and seeking answers.
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Affiliation(s)
| | - Atara Messinger
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Philosophy, Tel Aviv University, Tel Aviv, Israel
| | - L Trevor Young
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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26
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Wang MK, Chin-Yee B, Lo CKL, Lee S, El-Helou P, Alowami S, Gangji A, Ribic C. Crusted scabies in a renal transplant recipient treated with daily ivermectin: A case report and literature review. Transpl Infect Dis 2019; 21:e13077. [PMID: 30873722 DOI: 10.1111/tid.13077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 12/11/2022]
Abstract
Crusted scabies is a rare disease variant associated with T-cell dysregulation. Transplant patients are at risk of developing crusted scabies as a consequence of their immunosuppressive regimens. We report a case of crusted scabies presenting with recurrent septicemia in a 65-year-old renal transplant recipient, treated with daily ivermectin for 7 days after initial failure of weekly ivermectin dosing. A literature review of crusted scabies in transplant recipients consisting of 19 cases reports was summarized. Pruritus was common, and initial misdiagnosis was frequent. Most were treated with topical therapy, with one-third receiving ivermectin. Three of seven cases presenting with a concomitant infection died. Crusted scabies is commonly misdiagnosed in transplant recipients owing to its rarity, varied appearance, and different skin distributions. It should be considered in the differential diagnosis of transplant recipients presenting with rash and pruritus, given its association with secondary infection and subsequent mortality.
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Affiliation(s)
- Michael Ke Wang
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Benjamin Chin-Yee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carson Ka-Lok Lo
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephen Lee
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Philippe El-Helou
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Salem Alowami
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Azim Gangji
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christine Ribic
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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27
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Chin-Yee B, Sadikovic B, Chin-Yee IH. Genomic data in prognostic models-what is lost in translation? The case of deletion 17p and mutant TP53 in chronic lymphocytic leukaemia. Br J Haematol 2019; 188:652-660. [PMID: 30836431 DOI: 10.1111/bjh.15827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Genomic technologies are revolutionizing the practice of haematology-oncology, leading to improved disease detection, more accurate prognostication and targeted treatment decisions. These advances, however, have also introduced new clinical challenges, which include problems of prognostic underdetermination and its attendant risks of over- and undertreatment. Genomic data is generated from different technologies, from cytogenetics to next-generation sequencing, which are often interpreted interchangeably and in a binary fashion-as the presence or absence of a given chromosomal deletion or mutation-an oversimplification which may lead to mistaken prognosis. We discuss the clinical use of one such prognostic marker, represented by sequence and copy number alterations in TP53, located on chromosome 17p. Mutations in TP53 are strongly linked to poor prognosis in a variety of haematological malignancies, including chronic lymphocytic leukaemia (CLL). We review studies in CLL which utilize the 17p deletion or TP53 mutations for prognostic stratification with specific focus on the technologies used for detection, the thresholds established for clinical significance, and the clinical contexts in which these alterations are identified. The case of CLL illustrates issues arising from simplistic, binary interpretation of genetic testing and highlights the need to apply a critical lens when incorporating genomics into prognostic models.
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Affiliation(s)
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ian H Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Medicine, Division of Hematology, Western University, London, ON, Canada
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28
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Abstract
The rise of big data and artificial intelligence (AI) in health care has engendered considerable excitement, claiming to improve approaches to diagnosis, prognosis, and treatment. Amidst the enthusiasm, the philosophical assumptions that underlie the big data and AI movement in medicine are rarely examined. This essay outlines three philosophical challenges faced by this movement: (1) the epistemological-ontological problem arising from the theory-ladenness of big data and measurement; (2) the epistemological-logical problem resulting from the inherent limitations of algorithms and attendant issues of reliability and interpretability; and (3) the phenomenological problem concerning the irreducibility of human experience to quantitative data. These philosophical issues demonstrate several important challenges for these technologies that must be considered prior to their integration into clinical care. Our article aims to initiate a critical dialogue on the impact of big data and AI in health care in order to allow for more robust evaluation of these technologies and to aid in the development of approaches to clinical care that better serve clinicians and their patients.
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29
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Arya S, Ahmad T, Chin-Yee B, Mak S. 5-Fluorouracil–Induced Coronary Vasospasm. CJC Open 2019. [PMCID: PMC7063605 DOI: 10.1016/j.cjco.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Affiliation(s)
| | - Jonathan Fuller
- Toronto Philosophy of Medicine and Healthcare Network, University of Toronto, Toronto, Canada
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31
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Chin-Yee B, Upshur R. Clinical judgement in the era of big data and predictive analytics. J Eval Clin Pract 2018; 24:638-645. [PMID: 29237237 DOI: 10.1111/jep.12852] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022]
Abstract
Clinical judgement is a central and longstanding issue in the philosophy of medicine which has generated significant interest over the past few decades. In this article, we explore different approaches to clinical judgement articulated in the literature, focusing in particular on data-driven, mathematical approaches which we contrast with narrative, virtue-based approaches to clinical reasoning. We discuss the tension between these different clinical epistemologies and further explore the implications of big data and machine learning for a philosophy of clinical judgement. We argue for a pluralistic, integrative approach, and demonstrate how narrative, virtue-based clinical reasoning will remain indispensable in an era of big data and predictive analytics.
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Affiliation(s)
| | - Ross Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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32
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Chin-Yee B, Chin-Yee N. Dying at Home-Our Grandfather's Great Escape. JAMA Intern Med 2018; 178:183-184. [PMID: 29228073 DOI: 10.1001/jamainternmed.2017.7295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Benjamin Chin-Yee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Chin-Yee
- Department of Medicine, University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
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33
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Chin-Yee B, Upshur REG. Re-evaluating concepts of biological function in clinical medicine: towards a new naturalistic theory of disease. Theor Med Bioeth 2017; 38:245-264. [PMID: 28660393 DOI: 10.1007/s11017-017-9410-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Naturalistic theories of disease appeal to concepts of biological function, and use the notion of dysfunction as the basis of their definitions. Debates in the philosophy of biology demonstrate how attributing functions in organisms and establishing the function-dysfunction distinction is by no means straightforward. This problematization of functional ascription has undermined naturalistic theories and led some authors to abandon the concept of dysfunction, favoring instead definitions based in normative criteria or phenomenological approaches. Although this work has enhanced our understanding of disease and illness, we need not necessarily abandon naturalistic concepts of function and dysfunction in the disease debate. This article attempts to move towards a new naturalistic theory of disease that overcomes the limitations of previous definitions and offers advantages in the clinical setting. Our approach involves a re-evaluation of concepts of biological function employed by naturalistic theories. Drawing on recent insights from the philosophy of biology, we develop a contextual and evaluative account of function that is better suited to clinical medicine and remains consistent with contemporary naturalism. We also show how an updated naturalistic view shares important affinities with normativist and phenomenological positions, suggesting a possibility for consilience in the disease debate.
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Affiliation(s)
- Benjamin Chin-Yee
- Department of Medicine, University of Toronto, 152 Saint Patrick St., Toronto, ON, M5T 3J9, Canada.
| | - Ross E G Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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34
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Chin-Yee B. The new medical model: why medicine needs philosophy. CMAJ 2017; 189:E896. [DOI: 10.1503/cmaj.733122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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35
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Chin-Yee B. Learning Professionalism Under Stress. Acad Med 2017; 92:307. [PMID: 28221233 DOI: 10.1097/acm.0000000000001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Benjamin Chin-Yee
- B. Chin-Yee is a fourth-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; e-mail:
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36
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Chin-Yee B, Lazo-Langner A, Butler-Foster T, Hsia C, Chin-Yee I. Blood donation and testosterone replacement therapy. Transfusion 2017; 57:578-581. [PMID: 28150363 DOI: 10.1111/trf.13970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/22/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polycythemia is the most common adverse effect of testosterone replacement therapy (TRT) and may predispose patients to adverse vascular events. Current Canadian guidelines recommend regular laboratory monitoring and discontinuing TRT or reducing the dose if the hematocrit exceeds 54% (hemoglobin ≥180 g/L). This threshold has been interpreted by some physicians and patients to indicate the need for phlebotomy or blood donation while on TRT. STUDY DESIGN AND METHODS We reviewed all male blood donors in Southwestern Ontario at Canadian Blood Services from December 2013 to March 2016 who self-identified or were found on donor screening to be on TRT. Hemoglobin concentration was measured at the time of donation or clinic visit and with each subsequent appointment in repeat donors. RESULTS We identified 39 patients on TRT who presented for blood donation over a 2-year period. The mean hemoglobin level at all clinic visits was 173 g/L (range, 134-205 g/L; n = 108). Hemoglobin concentrations of 180 g/L or more (calculated hematocrit, ≥54%) were measured at 25% of appointments. Of the 27 repeat donors, 12 (44%) had persistently elevated hemoglobin levels (≥180 g/L) at subsequent donations. CONCLUSION Hemoglobin concentrations were elevated in donors on TRT, and significant numbers had hemoglobin levels above those recommended by current guidelines. These data also suggest that repeat blood donation was insufficient to maintain a hematocrit below 54%. Our findings raise concerns about the persistent risk of vascular events in these donors, particularly when coupled with the misperception by patients and health care providers that donation has reduced or eliminated the risks of TRT-induced polycythemia.
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Affiliation(s)
- Benjamin Chin-Yee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, Schulich School of Medicine, Western University.,Department of Epidemiology, Schulich School of Medicine, Western University
| | | | - Cyrus Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine, Western University
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine, Western University.,Canadian Blood Services, London, Ontario, Canada
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37
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Chin-Yee B, Shah K, Rotstein O, Nagy A, Williams C, Leong-Poi H, Lu JC, Razak F. Bioprosthetic Valve Streptococcus bovis Endocarditis Secondary to Colon Cancer Presenting with a Lacunar Stroke. ACTA ACUST UNITED AC 2016. [DOI: 10.1089/crsi.2016.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Benjamin Chin-Yee
- Division of General Internal Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kalpa Shah
- Division of General Internal Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ori Rotstein
- Division of General Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
| | - Amro Nagy
- Division of General Internal Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cameron Williams
- Division of General Internal Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Howard Leong-Poi
- Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
- Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C. Lu
- Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahad Razak
- Division of General Internal Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
- Harvard Centre for Population and Development Studies, Harvard University, Cambridge, Massachusetts
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38
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Abstract
This essay is a reflection on the doctor-patient relationship from the perspective of two medical students, which draws on the ideas of 20th-century philosopher Martin Buber. Although Buber never wrote about medicine directly, his 'philosophy of dialogue' raises fundamental questions about how human beings relate to one another, and can thus offer valuable insights into the nature of the clinical encounter. We argue that Buber's basic word pairs, 'I-You' and 'I-It', provide a useful heuristic for understanding different modes of caring for patients, which we illustrate using examples of illness narratives from two literary works: Tolstoy's Ivan Ilych and Margaret Edson's Wit Our essay demonstrates how the humanities in general and philosophy in particular can inform a more humanistic practice for healthcare trainees and practicing clinicians alike.
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Affiliation(s)
- Atara Messinger
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Chin-Yee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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39
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Minuk L, Jackson S, Iorio A, Poon MC, Dilworth E, Brose K, Card R, Rizwan I, Chin-Yee B, Louzada M. Cardiovascular disease (CVD) in Canadians with haemophilia: Age-Related CVD in Haemophilia Epidemiological Research (ARCHER study). Haemophilia 2015. [DOI: 10.1111/hae.12768] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- L. Minuk
- Division of Hematology; Department of Medicine; Western University; London ON Canada
| | - S. Jackson
- Division of Hematology; Department of Medicine; University of British Columbia; Vancouver BC Canada
| | - A. Iorio
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - M.-C. Poon
- Department of Medicine and The Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; University of Calgary and Alberta Health Services; Calgary AB Canada
| | - E. Dilworth
- Division of Hematology; Department of Medicine; Western University; London ON Canada
| | - K. Brose
- Division of Hematology; University of Saskatchewan; Saskatoon AB Canada
| | - R. Card
- Division of Hematology; University of Saskatchewan; Saskatoon AB Canada
| | - I. Rizwan
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - B. Chin-Yee
- Division of Hematology; Department of Medicine; Western University; London ON Canada
| | - M. Louzada
- Division of Hematology; Department of Medicine; Western University; London ON Canada
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40
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Xia Y, Chu JE, Chin-Yee B, Goodale D, Croker AK, Allan AL. Abstract B10: Soluble lung-derived factors mediate breast cancer cell migration and growth via CD44 receptor-ligand interactions. Cancer Res 2013. [DOI: 10.1158/1538-7445.tim2013-b10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The majority of breast cancer deaths occur due to metastatic disease. Clinical studies have identified a specific pattern for the metastatic spread of breast cancer, where preferential secondary sites include the lymph node, lung, liver, bone, and brain. However, it is not clear whether properties of the cancer cells (the “seeds”); properties of the organ microenvironment (the “soil”), or a combination of both are responsible for this observed organ tropism of breast cancer. It has been proposed that small subsets of stem-like tumor cells are responsible for tumor initiation and progression. In breast cancer, these cells are identified by their high aldehyde dehydrogenase (ALDH) activity and/or CD44+CD24- phenotype. We have previously shown that ALDHhiCD44+ breast cancer cells exhibit key metastatic behaviors in vitro and in vivo. However, the mechanisms underlying the organ-specific metastatic capacity of these cells requires further elucidation.
Hypothesis: Breast cancer cells exhibit differential growth and migration patterns in specific organ microenvironments; and ALDHhiCD44+ breast cancer cells exhibit increased organ-specific migration and growth (1) preferentially in the lung microenvironment and (2) compared to their ALDHlowCD44- counterparts.
Methods: A novel ex vivo model system comprised of organ-conditioned media generated from athymic nude mice was used to test organotropic migration/growth of whole populations of MDA-MB-231, MDA-MB-468, SUM149, and SUM159 human breast cancer cell lines, and ALDHhiCD44+ and ALDHlowCD44- populations isolated from the MDA-MB-231 cell line. Protein arrays were used to interrogate lung-conditioned media and identify soluble factors of interest. Bead-based immunodepletion of target proteins was performed on lung-conditioned media. The migration/growth response of MDA-MB-231 breast cancer cells was then assessed following exposure to depleted vs. non-depleted lung-conditioned media.
Results: Whole populations of all 4 human breast cancer cell lines examined responded via cell line specific patterns of migration towards organ-conditioned media. Notably, all lines demonstrated increased migration towards lung-conditioned media (p<0.05). These observations closely mirror previously observed patterns of in vivo metastatic behavior, providing validation for our ex vivo model system. ALDHhiCD44+ cells responded in a chemotactic manner towards organ-conditioned media in a similar pattern to whole population results. Notably, ALDHhiCD44+ cells showed preferential migration towards lung-conditioned media relative to all other organ-conditioned media tested (p<0.05). Several CD44 ligands including osteopontin (OPN) and E-, L-, and P-selectin were identified by protein array analysis of lung-conditioned media. Immunodepletion of L-selectin or OPN from lung-conditioned media resulted in decreased migration of MDA-MB-231 cells, however only depletion of OPN also resulted in decreased growth relative to non-depleted media. These effects could be abrogated by pre-treatment with a functional CD44 receptor blocking antibody (p<0.05).
Conclusions: Our data suggest an important role for CD44 receptor-ligand interactions in mediating lung-specific breast cancer cell migration and growth. To the best of our knowledge, this is the first study to undertake ex vivo investigation of the role of the microenvironment in metastatic organ tropism in the context of the cancer stem cell hypothesis.
Citation Format: Ying Xia, Jenny E. Chu, Benjamin Chin-Yee, David Goodale, Alysha K. Croker, Alison L. Allan. Soluble lung-derived factors mediate breast cancer cell migration and growth via CD44 receptor-ligand interactions. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr B10.
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Affiliation(s)
- Ying Xia
- 1London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada,
| | | | - Benjamin Chin-Yee
- 1London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada,
| | - David Goodale
- 1London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada,
| | | | - Alison L. Allan
- 1London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada,
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