Engaging children and young people on the potential role of artificial intelligence in medicine

INTRODUCTION

There is increasing interest in Artificial Intelligence (AI) and its application to medicine. Perceptions of AI are less well-known, notably amongst children and young people (CYP). This workshop investigates attitudes towards AI and its future applications in medicine and healthcare at a specialised paediatric hospital using practical design scenarios.

METHOD

Twenty-one members of a Young Persons Advisory Group for research contributed to an engagement workshop to ascertain potential opportunities, apprehensions, and priorities.

RESULTS

When presented as a selection of practical design scenarios, we found that CYP were more open to some applications of AI in healthcare than others. Human-centeredness, governance and trust emerged as early themes, with empathy and safety considered as important when introducing AI to healthcare. Educational workshops with practical examples using AI to help, but not replace humans were suggested to address issues, build trust, and effectively communicate about AI.

CONCLUSION

Whilst policy guidelines acknowledge the need to include children and young people to develop AI, this requires an enabling environment for human-centred AI involving children and young people with lived experiences of healthcare. Future research should focus on building consensus on enablers for an intelligent healthcare system designed for the next generation, which fundamentally, allows co-creation.

IMPACT

Children and young people (CYP) want to be included to share their insights about the development of research on the potential role of Artificial Intelligence (AI) in medicine and healthcare and are more open to some applications of AI than others. Whilst it is acknowledged that a research gap on involving and engaging CYP in developing AI policies exists, there is little in the way of pragmatic and practical guidance for healthcare staff on this topic. This requires research on enabling environments for ongoing digital cooperation to identify and prioritise unmet needs in the application and development of AI.

Hydroxyurea and trimidox enhance the radiation effect in human pancreatic adenocarcinoma cells

BACKGROUND

Pancreatic cancer remains the most lethal of all common human malignancies with a 5-year survival rate of lower than 5%. Adjuvant and neoadjuvant preoperative and postoperative chemo-radiotherapy using 5-fluorouracil, have reduced local relapse rate and slightly increased the median survival. Testing new and more potent radiation-sensitising drugs in human pancreatic cancer cells can provide the basis for a more effective chemo-radiation regimen and may consequently improve treatment outcome.

MATERIALS & METHODS

The present study was performed to evaluate the efficacy of two potent ribonucleotide reductase (RR) inhibitors: hydroxyurea and trimidox in radio-sensitising Panc-1 human pancreatic cancer cells in an attempt to identify a more effective chemo-radiotherapy regimen with minimal side effects.

RESULTS

Treatment of Panc-1 cells with hydroxyurea or trimidox alone for 2 hours was associated with a dose-dependent decrease in their cloning efficacy to similar extent. The IC50 of trimidox, hydroxyurea or radiation alone were 2.5 + 0.3 microM, 39.0 + 0.4 microM and 3.2 + 0.2 Gy, respectively. Treatment with 39.0 microM non-cytotoxic IC50 dose of hydroxyurea for two hours before or immediately after radiation reduced the IC50 of radiation to only 1.1 + 0.14 or 1.0 + 0.1 Gy, respectively. Treatment with 2.5 microM non-cytotoxic IC50 dose of trimidox for two hours before or immediately after radiation reduced the IC50 of radiation to only 1.2 + 0.16 or 1.4 + 0.12 Gy, respectively. The mean radiation enhancement ratios were 2.9 and 3.2 for hydroxyurea before and immediately after radiation. The greater radio-sensitising effect of hydroxyurea compared to trimidox or gemcitabine could be due to its unique double action by synchronising the cancer cells into the radiosensitive G1/S border and inhibiting DNA damage repair.

CONCLUSIONS

The present study demonstrates the superiority of hydroxyurea at non-cytotoxic doses compared to the other two recent RR inhibitors: gemcitabine and trimidox in radio-sensitising human pancreatic cancer cells. Hydroxyurea combined with radiation has significantly improved progression-free survival of advanced cervical cancer and glioblastoma patients and showed clinical benefit in combination with other chemotherapy drugs in advanced pancreatic cancer. The present results suggest the clinical use of hydroxyurea as a radiosensitiser in both pre- and post-operative chemo-radiotherapy in pancreatic cancer patients. Given the demonstrated potent radio-sensitising effect of hydroxyurea at non-cytotoxic doses when administered before or immediately after radiation and its low clinical toxicity, it should be feasible to administer hydroxyurea both before and after radiation in pancreatic cancer patients.

Teaching behavioral medicine using individual coronary heart disease risk factors

Two hundred twenty-one first-year medical students participated in a voluntary coronary heart disease risk factor self-change project designed to teach the principles of behavioral change. Blood pressure, serum lipids, percentage body fat, cardiovascular fitness, and smoking status were measured prior to the project. Students designed their own programs of behavior modification and, after 8 weeks, repeat measurements were obtained in students whose projects related to coronary heart disease risk (56% of entire group). Despite generally low initial coronary heart disease risk factors, most risk factor groups successfully altered the targeted risk factors. The subgroup attempting to lower serum cholesterol (n = 49) reduced total cholesterol 15 +/- 24 mg/dl (mean +/- SD) and low-density lipoprotein cholesterol 11 +/- 20 mg/dl (P less than 0.001 for both). The blood pressure group (n = 9) decreased systolic blood pressure 8 +/- 10 mm Hg (P less than 0.05), and the weight-loss group (n = 33) lost 3.0 +/- 2.9 kg (P less than 0.001), reducing estimated percentage body fat 1.7 +/- 1.8 (P less than 0.001). The self-change project was well received by the students and appears to be a useful technique for introducing the principles of behavioral medicine to first-year medical students.