1
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Collins GS, Moons KGM, Dhiman P, Riley RD, Beam AL, Van Calster B, Ghassemi M, Liu X, Reitsma JB, van Smeden M, Boulesteix AL, Camaradou JC, Celi LA, Denaxas S, Denniston AK, Glocker B, Golub RM, Harvey H, Heinze G, Hoffman MM, Kengne AP, Lam E, Lee N, Loder EW, Maier-Hein L, Mateen BA, McCradden MD, Oakden-Rayner L, Ordish J, Parnell R, Rose S, Singh K, Wynants L, Logullo P. TRIPOD+AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods. BMJ 2024; 385:e078378. [PMID: 38626948 PMCID: PMC11019967 DOI: 10.1136/bmj-2023-078378] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Gary S Collins
- Centre for Statistics in Medicine, UK EQUATOR Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Karel G M Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Paula Dhiman
- Centre for Statistics in Medicine, UK EQUATOR Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Richard D Riley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Andrew L Beam
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Science, Leiden University Medical Centre, Leiden, Netherlands
| | - Marzyeh Ghassemi
- Department of Electrical Engineering and Computer Science, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Johannes B Reitsma
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten van Smeden
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Anne-Laure Boulesteix
- Department of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jennifer Catherine Camaradou
- Patient representative, Health Data Research UK patient and public involvement and engagement group
- Patient representative, University of East Anglia, Faculty of Health Sciences, Norwich Research Park, Norwich, UK
| | - Leo Anthony Celi
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | - Alastair K Denniston
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Robert M Golub
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Georg Heinze
- Section for Clinical Biometrics, Centre for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Michael M Hoffman
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | | | - Emily Lam
- Patient representative, Health Data Research UK patient and public involvement and engagement group
| | - Naomi Lee
- National Institute for Health and Care Excellence, London, UK
| | - Elizabeth W Loder
- The BMJ, London, UK
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lena Maier-Hein
- Department of Intelligent Medical Systems, German Cancer Research Centre, Heidelberg, Germany
| | - Bilal A Mateen
- Institute of Health Informatics, University College London, London, UK
- Wellcome Trust, London, UK
- Alan Turing Institute, London, UK
| | - Melissa D McCradden
- Department of Bioethics, Hospital for Sick Children Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
| | - Lauren Oakden-Rayner
- Australian Institute for Machine Learning, University of Adelaide, Adelaide, SA, Australia
| | - Johan Ordish
- Medicines and Healthcare products Regulatory Agency, London, UK
| | - Richard Parnell
- Patient representative, Health Data Research UK patient and public involvement and engagement group
| | - Sherri Rose
- Department of Health Policy and Center for Health Policy, Stanford University, Stanford, CA, USA
| | - Karandeep Singh
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Laure Wynants
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Patricia Logullo
- Centre for Statistics in Medicine, UK EQUATOR Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
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2
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Ferretti A, Adjei KK, Ali J, Atuire C, Ayuk BT, Banougnin BH, Cengiz N, Gichoya J, Jjingo D, Juma DO, Kotze W, Krubiner C, Littler K, McCradden MD, Moodley K, Naidoo M, Nair G, Obeng-Kyereh K, Oliver K, Ralefala D, Toska E, Wekesah FM, Wright J, Vayena E. Digital tools for youth health promotion: principles, policies and practices in sub-Saharan Africa. Health Promot Int 2024; 39:daae030. [PMID: 38558241 PMCID: PMC10983781 DOI: 10.1093/heapro/daae030] [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] [Indexed: 04/04/2024] Open
Abstract
Although digital health promotion (DHP) technologies for young people are increasingly available in low- and middle-income countries (LMICs), there has been insufficient research investigating whether existing ethical and policy frameworks are adequate to address the challenges and promote the technological opportunities in these settings. In an effort to fill this gap and as part of a larger research project, in November 2022, we conducted a workshop in Cape Town, South Africa, entitled 'Unlocking the Potential of Digital Health Promotion for Young People in Low- and Middle-Income Countries'. The workshop brought together 25 experts from the areas of digital health ethics, youth health and engagement, health policy and promotion and technology development, predominantly from sub-Saharan Africa (SSA), to explore their views on the ethics and governance and potential policy pathways of DHP for young people in LMICs. Using the World Café method, participants contributed their views on (i) the advantages and barriers associated with DHP for youth in LMICs, (ii) the availability and relevance of ethical and regulatory frameworks for DHP and (iii) the translation of ethical principles into policies and implementation practices required by these policies, within the context of SSA. Our thematic analysis of the ensuing discussion revealed a willingness to foster such technologies if they prove safe, do not exacerbate inequalities, put youth at the center and are subject to appropriate oversight. In addition, our work has led to the potential translation of fundamental ethical principles into the form of a policy roadmap for ethically aligned DHP for youth in SSA.
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Affiliation(s)
- Agata Ferretti
- Health Ethics and Policy Lab, ETH Zurich, Hottingerstrasse 10, 8092 Zurich, Switzerland
| | - Kwame K Adjei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Ghana
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD 21205, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Caesar Atuire
- Department of Philosophy and Classics, University of Ghana, MR26+9PV, W.E.B. Dubois Road, Accra, Ghana
- Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7BN, UK
| | - Betrand Tambe Ayuk
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, 574W+49W, Buea, Cameroon
| | - Boladé Hamed Banougnin
- United Nations Population Fund, West and Central Africa Regional Office, PFQM+RVF, Route des Almadies, Dakar, Senegal
- Centre for Social Science Research, University of Cape Town, 12 University Avenue South, Rondebosch, Cape Town 7700, South Africa
| | - Nezerith Cengiz
- Department of Medicine, Faculty of Medicine and Health Sciences, Division for Medical Ethics and Law, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Judy Gichoya
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322, USA
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University, 8HMC+PF5, Kampala, Uganda
| | | | - Wiaan Kotze
- Faculty of Medicine and Health Science, Stellenbosch University, Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa
| | | | - Katherine Littler
- Health Ethics & Governance Unit, Research for Health Department, Science Division, WHO, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Melissa D McCradden
- Department of Bioethics, Genetics & Genome Biology, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Keymanthri Moodley
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, 574W+49W, Buea, Cameroon
| | - Meshandren Naidoo
- Howard College, School of Law, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa
| | - Gonasagrie Nair
- Desmond Tutu Health Foundation, 3 Woodlands Road, Woodstock, Cape Town 7915, South Africa
| | - Kingsley Obeng-Kyereh
- Children and Youth in Broadcasting—Curious Minds, 3 Damba Close, Chaban-Sakaman, Accra, Ghana
| | - Kedebone Oliver
- Genesis Analytics, Health Practice Area, 50 6th Road, Hyde Park, Johannesburg 2196, South Africa
| | - Dimpho Ralefala
- Office of Research and Development, University of Botswana, 4775 Notwane Road, Gaborone, Botswana
| | - Elona Toska
- Faculty of Humanities, Centre for Social Science Research, University of Cape Town, 12 University Avenue, Rondebosch, Cape Town 7700, South Africa
| | - Frederick M Wekesah
- African Population and Health Research Center, APHRC Headquarters, Kitisuru, Nairobi, Kenya
| | - Jonty Wright
- Faculty of Medicine and Health Science, Stellenbosch University, Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa
| | - Effy Vayena
- Health Ethics and Policy Lab, ETH Zurich, Hottingerstrasse 10, 8092 Zurich, Switzerland
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Martindale APL, Ng B, Ngai V, Kale AU, Ferrante di Ruffano L, Golub RM, Collins GS, Moher D, McCradden MD, Oakden-Rayner L, Rivera SC, Calvert M, Kelly CJ, Lee CS, Yau C, Chan AW, Keane PA, Beam AL, Denniston AK, Liu X. Concordance of randomised controlled trials for artificial intelligence interventions with the CONSORT-AI reporting guidelines. Nat Commun 2024; 15:1619. [PMID: 38388497 PMCID: PMC10883966 DOI: 10.1038/s41467-024-45355-3] [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: 07/27/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
The Consolidated Standards of Reporting Trials extension for Artificial Intelligence interventions (CONSORT-AI) was published in September 2020. Since its publication, several randomised controlled trials (RCTs) of AI interventions have been published but their completeness and transparency of reporting is unknown. This systematic review assesses the completeness of reporting of AI RCTs following publication of CONSORT-AI and provides a comprehensive summary of RCTs published in recent years. 65 RCTs were identified, mostly conducted in China (37%) and USA (18%). Median concordance with CONSORT-AI reporting was 90% (IQR 77-94%), although only 10 RCTs explicitly reported its use. Several items were consistently under-reported, including algorithm version, accessibility of the AI intervention or code, and references to a study protocol. Only 3 of 52 included journals explicitly endorsed or mandated CONSORT-AI. Despite a generally high concordance amongst recent AI RCTs, some AI-specific considerations remain systematically poorly reported. Further encouragement of CONSORT-AI adoption by journals and funders may enable more complete adoption of the full CONSORT-AI guidelines.
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Affiliation(s)
| | - Benjamin Ng
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Christ Church, University of Oxford, Oxford, UK
| | - Victoria Ngai
- University College London Medical School, London, UK
| | - Aditya U Kale
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | | | - Robert M Golub
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gary S Collins
- Centre for Statistics in Medicine//UK EQUATOR Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottowa, ON, Canada
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
- Genetics & Genome Biology Research Program, Peter Gilgan Centre for Research & Learning, Toronto, ON, Canada
- Division of Clinical and Public Health, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Lauren Oakden-Rayner
- Australian Institute for Machine Learning, University of Adelaide, Adelaide, SA, Australia
| | - Samantha Cruz Rivera
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | | | | | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Health Data Research UK, London, UK
| | - An-Wen Chan
- Department of Medicine, Women's College Hospital. University of Toronto, Toronto, ON, Canada
| | - Pearse A Keane
- NIHR Biomedical Research Centre at Moorfields, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Andrew L Beam
- Department of Epidemiology, Harvard. T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre at Moorfields, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
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4
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Herington J, McCradden MD, Creel K, Boellaard R, Jones EC, Jha AK, Rahmim A, Scott PJH, Sunderland JJ, Wahl RL, Zuehlsdorff S, Saboury B. Ethical Considerations for Artificial Intelligence in Medical Imaging: Data Collection, Development, and Evaluation. J Nucl Med 2023; 64:1848-1854. [PMID: 37827839 PMCID: PMC10690124 DOI: 10.2967/jnumed.123.266080] [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: 11/28/2022] [Revised: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
The development of artificial intelligence (AI) within nuclear imaging involves several ethically fraught components at different stages of the machine learning pipeline, including during data collection, model training and validation, and clinical use. Drawing on the traditional principles of medical and research ethics, and highlighting the need to ensure health justice, the AI task force of the Society of Nuclear Medicine and Molecular Imaging has identified 4 major ethical risks: privacy of data subjects, data quality and model efficacy, fairness toward marginalized populations, and transparency of clinical performance. We provide preliminary recommendations to developers of AI-driven medical devices for mitigating the impact of these risks on patients and populations.
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Affiliation(s)
- Jonathan Herington
- Department of Health Humanities and Bioethics and Department of Philosophy, University of Rochester, Rochester, New York
| | - Melissa D McCradden
- Department of Bioethics, Hospital for Sick Children, Toronto and Dana Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Creel
- Department of Philosophy and Religion and Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Elizabeth C Jones
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Abhinav K Jha
- Department of Biomedical Engineering and Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Arman Rahmim
- Departments of Radiology and Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J H Scott
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - John J Sunderland
- Departments of Radiology and Physics, University of Iowa, Iowa City, Iowa
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri; and
| | | | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland;
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5
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McCradden MD, Joshi S, Anderson JA, London AJ. A normative framework for artificial intelligence as a sociotechnical system in healthcare. Patterns (N Y) 2023; 4:100864. [PMID: 38035190 PMCID: PMC10682751 DOI: 10.1016/j.patter.2023.100864] [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] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Artificial intelligence (AI) tools are of great interest to healthcare organizations for their potential to improve patient care, yet their translation into clinical settings remains inconsistent. One of the reasons for this gap is that good technical performance does not inevitably result in patient benefit. We advocate for a conceptual shift wherein AI tools are seen as components of an intervention ensemble. The intervention ensemble describes the constellation of practices that, together, bring about benefit to patients or health systems. Shifting from a narrow focus on the tool itself toward the intervention ensemble prioritizes a "sociotechnical" vision for translation of AI that values all components of use that support beneficial patient outcomes. The intervention ensemble approach can be used for regulation, institutional oversight, and for AI adopters to responsibly and ethically appraise, evaluate, and use AI tools.
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Affiliation(s)
- Melissa D. McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
- Genetics & Genome Biology Research Program, Peter Gilgan Center for Research & Learning, Toronto, ON, Canada
- Division of Clinical & Public Health, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Shalmali Joshi
- Department of Biomedical Informatics, Department of Computer Science (Affliate), Data Science Institute, Columbia University, New York, NY, USA
| | - James A. Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Alex John London
- Department of Philosophy and Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, PA, USA
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6
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Arora A, Alderman JE, Palmer J, Ganapathi S, Laws E, McCradden MD, Oakden-Rayner L, Pfohl SR, Ghassemi M, McKay F, Treanor D, Rostamzadeh N, Mateen B, Gath J, Adebajo AO, Kuku S, Matin R, Heller K, Sapey E, Sebire NJ, Cole-Lewis H, Calvert M, Denniston A, Liu X. The value of standards for health datasets in artificial intelligence-based applications. Nat Med 2023; 29:2929-2938. [PMID: 37884627 PMCID: PMC10667100 DOI: 10.1038/s41591-023-02608-w] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023]
Abstract
Artificial intelligence as a medical device is increasingly being applied to healthcare for diagnosis, risk stratification and resource allocation. However, a growing body of evidence has highlighted the risk of algorithmic bias, which may perpetuate existing health inequity. This problem arises in part because of systemic inequalities in dataset curation, unequal opportunity to participate in research and inequalities of access. This study aims to explore existing standards, frameworks and best practices for ensuring adequate data diversity in health datasets. Exploring the body of existing literature and expert views is an important step towards the development of consensus-based guidelines. The study comprises two parts: a systematic review of existing standards, frameworks and best practices for healthcare datasets; and a survey and thematic analysis of stakeholder views of bias, health equity and best practices for artificial intelligence as a medical device. We found that the need for dataset diversity was well described in literature, and experts generally favored the development of a robust set of guidelines, but there were mixed views about how these could be implemented practically. The outputs of this study will be used to inform the development of standards for transparency of data diversity in health datasets (the STANDING Together initiative).
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Joseph E Alderman
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Joanne Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | | | - Elinor Laws
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics and Genome Biology, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lauren Oakden-Rayner
- The Australian Institute for Machine Learning, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Marzyeh Ghassemi
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Vector Institute, Toronto, Ontario, Canada
| | - Francis McKay
- The Ethox Centre and the Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Darren Treanor
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
- Department of Clinical Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | | | - Bilal Mateen
- Institute for Health Informatics, University College London, London, UK
- Wellcome Trust, London, UK
| | - Jacqui Gath
- Patient and Public Involvement and Engagement (PPIE) Group, STANDING Together, Birmingham, UK
| | - Adewole O Adebajo
- Patient and Public Involvement and Engagement (PPIE) Group, STANDING Together, Birmingham, UK
| | | | - Rubeta Matin
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Elizabeth Sapey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- PIONEER, HDR UK Hub in Acute Care, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Neil J Sebire
- National Institute for Health and Care Research, Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Great Ormond Street Institute of Child Health, University Hospital London, London, UK
| | | | - Melanie Calvert
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Birmingham-Oxford Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- UK SPINE, University of Birmingham, Birmingham, UK
| | - Alastair Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital/University College London, London, UK
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
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7
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Herington J, McCradden MD, Creel K, Boellaard R, Jones EC, Jha AK, Rahmim A, Scott PJH, Sunderland JJ, Wahl RL, Zuehlsdorff S, Saboury B. Ethical Considerations for Artificial Intelligence in Medical Imaging: Deployment and Governance. J Nucl Med 2023; 64:1509-1515. [PMID: 37620051 DOI: 10.2967/jnumed.123.266110] [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: 11/28/2022] [Revised: 07/11/2023] [Indexed: 08/26/2023] Open
Abstract
The deployment of artificial intelligence (AI) has the potential to make nuclear medicine and medical imaging faster, cheaper, and both more effective and more accessible. This is possible, however, only if clinicians and patients feel that these AI medical devices (AIMDs) are trustworthy. Highlighting the need to ensure health justice by fairly distributing benefits and burdens while respecting individual patients' rights, the AI Task Force of the Society of Nuclear Medicine and Molecular Imaging has identified 4 major ethical risks that arise during the deployment of AIMD: autonomy of patients and clinicians, transparency of clinical performance and limitations, fairness toward marginalized populations, and accountability of physicians and developers. We provide preliminary recommendations for governing these ethical risks to realize the promise of AIMD for patients and populations.
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Affiliation(s)
- Jonathan Herington
- Department of Health Humanities and Bioethics and Department of Philosophy, University of Rochester, Rochester, New York
| | - Melissa D McCradden
- Department of Bioethics, Hospital for Sick Children, and Dana Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Creel
- Department of Philosophy and Religion and Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Elizabeth C Jones
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Abhinav K Jha
- Department of Biomedical Engineering and Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Arman Rahmim
- Departments of Radiology and Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J H Scott
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - John J Sunderland
- Departments of Radiology and Physics, University of Iowa, Iowa City, Iowa
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri; and
| | | | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland;
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Kwong JCC, Khondker A, Lajkosz K, McDermott MBA, Frigola XB, McCradden MD, Mamdani M, Kulkarni GS, Johnson AEW. APPRAISE-AI Tool for Quantitative Evaluation of AI Studies for Clinical Decision Support. JAMA Netw Open 2023; 6:e2335377. [PMID: 37747733 PMCID: PMC10520738 DOI: 10.1001/jamanetworkopen.2023.35377] [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: 06/09/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Importance Artificial intelligence (AI) has gained considerable attention in health care, yet concerns have been raised around appropriate methods and fairness. Current AI reporting guidelines do not provide a means of quantifying overall quality of AI research, limiting their ability to compare models addressing the same clinical question. Objective To develop a tool (APPRAISE-AI) to evaluate the methodological and reporting quality of AI prediction models for clinical decision support. Design, Setting, and Participants This quality improvement study evaluated AI studies in the model development, silent, and clinical trial phases using the APPRAISE-AI tool, a quantitative method for evaluating quality of AI studies across 6 domains: clinical relevance, data quality, methodological conduct, robustness of results, reporting quality, and reproducibility. These domains included 24 items with a maximum overall score of 100 points. Points were assigned to each item, with higher points indicating stronger methodological or reporting quality. The tool was applied to a systematic review on machine learning to estimate sepsis that included articles published until September 13, 2019. Data analysis was performed from September to December 2022. Main Outcomes and Measures The primary outcomes were interrater and intrarater reliability and the correlation between APPRAISE-AI scores and expert scores, 3-year citation rate, number of Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) low risk-of-bias domains, and overall adherence to the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement. Results A total of 28 studies were included. Overall APPRAISE-AI scores ranged from 33 (low quality) to 67 (high quality). Most studies were moderate quality. The 5 lowest scoring items included source of data, sample size calculation, bias assessment, error analysis, and transparency. Overall APPRAISE-AI scores were associated with expert scores (Spearman ρ, 0.82; 95% CI, 0.64-0.91; P < .001), 3-year citation rate (Spearman ρ, 0.69; 95% CI, 0.43-0.85; P < .001), number of QUADAS-2 low risk-of-bias domains (Spearman ρ, 0.56; 95% CI, 0.24-0.77; P = .002), and adherence to the TRIPOD statement (Spearman ρ, 0.87; 95% CI, 0.73-0.94; P < .001). Intraclass correlation coefficient ranges for interrater and intrarater reliability were 0.74 to 1.00 for individual items, 0.81 to 0.99 for individual domains, and 0.91 to 0.98 for overall scores. Conclusions and Relevance In this quality improvement study, APPRAISE-AI demonstrated strong interrater and intrarater reliability and correlated well with several study quality measures. This tool may provide a quantitative approach for investigators, reviewers, editors, and funding organizations to compare the research quality across AI studies for clinical decision support.
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Affiliation(s)
- Jethro C. C. Kwong
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Lajkosz
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Xavier Borrat Frigola
- Laboratory for Computational Physiology, Harvard–Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge
- Anesthesiology and Critical Care Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Melissa D. McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics & Genome Biology Research Program, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Division of Clinical and Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
- Data Science and Advanced Analytics, Unity Health Toronto, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alistair E. W. Johnson
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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9
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McCradden MD. Ethics, First. Am J Bioeth 2023; 23:55-56. [PMID: 37647467 DOI: 10.1080/15265161.2023.2237459] [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] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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10
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Bradshaw TJ, McCradden MD, Jha AK, Dutta J, Saboury B, Siegel EL, Rahmim A. Artificial Intelligence Algorithms Need to Be Explainable-or Do They? J Nucl Med 2023; 64:976-977. [PMID: 37116913 PMCID: PMC10885777 DOI: 10.2967/jnumed.122.264949] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/17/2023] [Indexed: 04/30/2023] Open
Affiliation(s)
| | | | - Abhinav K Jha
- Washington University in St. Louis, St. Louis, Missouri
| | - Joyita Dutta
- University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Eliot L Siegel
- University of Maryland School of Medicine, Baltimore, Maryland; and
| | - Arman Rahmim
- University of British Columbia, Vancouver, British Columbia, Canada
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11
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Thai K, Tsiandoulas KH, Stephenson EA, Menna-Dack D, Zlotnik Shaul R, Anderson JA, Shinewald AR, Ampofo A, McCradden MD. Perspectives of Youths on the Ethical Use of Artificial Intelligence in Health Care Research and Clinical Care. JAMA Netw Open 2023; 6:e2310659. [PMID: 37126349 PMCID: PMC10152306 DOI: 10.1001/jamanetworkopen.2023.10659] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Importance Understanding the views and values of patients is of substantial importance to developing the ethical parameters of artificial intelligence (AI) use in medicine. Thus far, there is limited study on the views of children and youths. Their perspectives contribute meaningfully to the integration of AI in medicine. Objective To explore the moral attitudes and views of children and youths regarding research and clinical care involving health AI at the point of care. Design, Setting, and Participants This qualitative study recruited participants younger than 18 years during a 1-year period (October 2021 to March 2022) at a large urban pediatric hospital. A total of 44 individuals who were receiving or had previously received care at a hospital or rehabilitation clinic contacted the research team, but 15 were found to be ineligible. Of the 29 who consented to participate, 1 was lost to follow-up, resulting in 28 participants who completed the interview. Exposures Participants were interviewed using vignettes on 3 main themes: (1) health data research, (2) clinical AI trials, and (3) clinical use of AI. Main Outcomes and Measures Thematic description of values surrounding health data research, interventional AI research, and clinical use of AI. Results The 28 participants included 6 children (ages, 10-12 years) and 22 youths (ages, 13-17 years) (16 female, 10 male, and 3 trans/nonbinary/gender diverse). Mean (SD) age was 15 (2) years. Participants were highly engaged and quite knowledgeable about AI. They expressed a positive view of research intended to help others and had strong feelings about the uses of their health data for AI. Participants expressed appreciation for the vulnerability of potential participants in interventional AI trials and reinforced the importance of respect for their preferences regardless of their decisional capacity. A strong theme for the prospective use of clinical AI was the desire to maintain bedside interaction between the patient and their physician. Conclusions and Relevance In this study, children and youths reported generally positive views of AI, expressing strong interest and advocacy for their involvement in AI research and inclusion of their voices for shared decision-making with AI in clinical care. These findings suggest the need for more engagement of children and youths in health care AI research and integration.
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Affiliation(s)
- Kelly Thai
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, Ontario, Canada
| | - Kate H Tsiandoulas
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth A Stephenson
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dolly Menna-Dack
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Randi Zlotnik Shaul
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - James A Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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12
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Katzman DK, McCradden MD. Capacity for Preferences: Adolescents With AN-PLUS. J Adolesc Health 2023; 72:827-828. [PMID: 37032212 DOI: 10.1016/j.jadohealth.2023.02.020] [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] [Received: 12/12/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, Ontario, Canada
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13
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Affiliation(s)
- Melissa D McCradden
- Bioethics Department, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Genetics & Genome Biology, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Division of Clinical and Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Roxanne E Kirsch
- Bioethics Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Critical Care Medicine Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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14
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Taheri-Shirazi M, Namdar K, Ling K, Karmali K, McCradden MD, Lee W, Khalvati F. Exploring potential barriers in equitable access to pediatric diagnostic imaging using machine learning. Front Public Health 2023; 11:968319. [PMID: 36908403 PMCID: PMC9998668 DOI: 10.3389/fpubh.2023.968319] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/30/2023] [Indexed: 03/14/2023] Open
Abstract
In this work, we examine magnetic resonance imaging (MRI) and ultrasound (US) appointments at the Diagnostic Imaging (DI) department of a pediatric hospital to discover possible relationships between selected patient features and no-show or long waiting room time endpoints. The chosen features include age, sex, income, distance from the hospital, percentage of non-English speakers in a postal code, percentage of single caregivers in a postal code, appointment time slot (morning, afternoon, evening), and day of the week (Monday to Sunday). We trained univariate Logistic Regression (LR) models using the training sets and identified predictive (significant) features that remained significant in the test sets. We also implemented multivariate Random Forest (RF) models to predict the endpoints. We achieved Area Under the Receiver Operating Characteristic Curve (AUC) of 0.82 and 0.73 for predicting no-show and long waiting room time endpoints, respectively. The univariate LR analysis on DI appointments uncovered the effect of the time of appointment during the day/week, and patients' demographics such as income and the number of caregivers on the no-shows and long waiting room time endpoints. For predicting no-show, we found age, time slot, and percentage of single caregiver to be the most critical contributors. Age, distance, and percentage of non-English speakers were the most important features for our long waiting room time prediction models. We found no sex discrimination among the scheduled pediatric DI appointments. Nonetheless, inequities based on patient features such as low income and language barrier did exist.
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Affiliation(s)
- Maryam Taheri-Shirazi
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Khashayar Namdar
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Vector Institute, Toronto, ON, Canada.,NVIDIA Deep Learning Institute, Austin, TX, United States
| | - Kelvin Ling
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Karima Karmali
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,Peter Giligan Centre for Research and Learning - Genetics and Genome Biology Program, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wayne Lee
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Farzad Khalvati
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Vector Institute, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.,Department of Computer Science, University of Toronto, Toronto, ON, Canada
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15
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Tsiandoulas K, McSheffrey G, Fleming L, Rawal V, Fadel MP, Katzman DK, McCradden MD. Ethical tensions in the treatment of youth with severe anorexia nervosa. Lancet Child Adolesc Health 2023; 7:69-76. [PMID: 36206789 DOI: 10.1016/s2352-4642(22)00236-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022]
Abstract
Treatment of anorexia nervosa poses a moral quandary for clinicians, particularly in paediatrics. The challenges of appropriately individualising treatment while balancing prospective benefits against concomitant harms are best highlighted through exploration and discussion of the ethical issues. The purpose of this Viewpoint is to explore the ethical tensions in treating young patients (around ages 10-18 years) with severe anorexia nervosa who are not capable of making treatment-based decisions and describe how harm reduction can reasonably be applied. We propose the term AN-PLUS to refer to the subset of patients with a particularly concerning clinical presentation-poor quality of life, lack of treatment response, medically severe and unstable, and severe symptomatology-who might benefit from a harm reduction approach. From ethics literature, qualitative studies, and our clinical experience, we identify three core ethical themes in making treatment decisions for young people with AN-PLUS: capacity and autonomy, best interests, and person-centred care. Finally, we consider how a harm reduction approach can provide direction for developing a personalised treatment plan that retains a focus on best interests while attempting to mitigate the harms of involuntary treatment. We conclude with recommendations to operationalise a harm reduction approach in young people with AN-PLUS.
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Affiliation(s)
- Kate Tsiandoulas
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Health Science Research Program, University of Toronto, Toronto, ON, Canada
| | - Gordon McSheffrey
- Department of Pediatrics, Scarborough Health Network, Toronto, ON, Canada; Child, Youth, Family Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lindsay Fleming
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Vandana Rawal
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Marc P Fadel
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Division of Child and Youth Mental Health, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, ON, Canada.
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16
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Anderson JA, McCradden MD, Stephenson EA. Response to Open Peer Commentaries: On Social Harms, Big Tech, and Institutional Accountability. Am J Bioeth 2022; 22:W6-W8. [PMID: 35593914 DOI: 10.1080/15265161.2022.2075977] [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: 06/15/2023]
Affiliation(s)
| | - Melissa D McCradden
- The Hospital for Sick Children
- Peter Gilgan Centre for Research and Learning
- Dalla Lana School of Public Health
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Vasey B, Nagendran M, Campbell B, Clifton DA, Collins GS, Denaxas S, Denniston AK, Faes L, Geerts B, Ibrahim M, Liu X, Mateen BA, Mathur P, McCradden MD, Morgan L, Ordish J, Rogers C, Saria S, Ting DSW, Watkinson P, Weber W, Wheatstone P, McCulloch P. Publisher Correction: Reporting guideline for the early-stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI. Nat Med 2022; 28:2218. [PMID: 35962208 DOI: 10.1038/s41591-022-01951-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Baptiste Vasey
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. .,Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK. .,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Myura Nagendran
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, UK
| | - Bruce Campbell
- University of Exeter Medical School, Exeter, UK.,Royal Devon and Exeter Hospital, Exeter, UK
| | - David A Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK.,British Heart Foundation Data Science Centre, London, UK.,Health Data Research UK, London, UK.,UCL Hospitals Biomedical Research Centre, London, UK
| | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Livia Faes
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Bart Geerts
- Healthplus.ai-R&D BV, Amsterdam, The Netherlands
| | - Mudathir Ibrahim
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bilal A Mateen
- Institute of Health Informatics, University College London, London, UK.,The Wellcome Trust, London, UK.,The Alan Turing Institute, London, UK
| | - Piyush Mathur
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa D McCradden
- The Hospital for Sick Children, Toronto ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
| | | | - Johan Ordish
- Medicines and Healthcare products Regulatory Agency, London, UK
| | | | - Suchi Saria
- Departments of Computer Science, Statistics, and Health Policy, and Division of Informatics, Johns Hopkins University, Baltimore, MD, USA.,Bayesian Health, New York, NY, USA
| | - Daniel S W Ting
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,NIHR Biomedical Research Centre Oxford, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | | | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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18
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Kwong JCC, Erdman L, Khondker A, Skreta M, Goldenberg A, McCradden MD, Lorenzo AJ, Rickard M. The silent trial - the bridge between bench-to-bedside clinical AI applications. Front Digit Health 2022; 4:929508. [PMID: 36052317 PMCID: PMC9424628 DOI: 10.3389/fdgth.2022.929508] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
As more artificial intelligence (AI) applications are integrated into healthcare, there is an urgent need for standardization and quality-control measures to ensure a safe and successful transition of these novel tools into clinical practice. We describe the role of the silent trial, which evaluates an AI model on prospective patients in real-time, while the end-users (i.e., clinicians) are blinded to predictions such that they do not influence clinical decision-making. We present our experience in evaluating a previously developed AI model to predict obstructive hydronephrosis in infants using the silent trial. Although the initial model performed poorly on the silent trial dataset (AUC 0.90 to 0.50), the model was refined by exploring issues related to dataset drift, bias, feasibility, and stakeholder attitudes. Specifically, we found a shift in distribution of age, laterality of obstructed kidneys, and change in imaging format. After correction of these issues, model performance improved and remained robust across two independent silent trial datasets (AUC 0.85–0.91). Furthermore, a gap in patient knowledge on how the AI model would be used to augment their care was identified. These concerns helped inform the patient-centered design for the user-interface of the final AI model. Overall, the silent trial serves as an essential bridge between initial model development and clinical trials assessment to evaluate the safety, reliability, and feasibility of the AI model in a minimal risk environment. Future clinical AI applications should make efforts to incorporate this important step prior to embarking on a full-scale clinical trial.
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Affiliation(s)
- Jethro C. C. Kwong
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
| | - Lauren Erdman
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marta Skreta
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anna Goldenberg
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Melissa D. McCradden
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Clinical and Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Genetics & Genome Biology, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Armando J. Lorenzo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Correspondence: Mandy Rickard,
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Vasey B, Nagendran M, Campbell B, Clifton DA, Collins GS, Denaxas S, Denniston AK, Faes L, Geerts B, Ibrahim M, Liu X, Mateen BA, Mathur P, McCradden MD, Morgan L, Ordish J, Rogers C, Saria S, Ting DSW, Watkinson P, Weber W, Wheatstone P, McCulloch P. Reporting guideline for the early stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI. BMJ 2022; 377:e070904. [PMID: 35584845 PMCID: PMC9116198 DOI: 10.1136/bmj-2022-070904] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Baptiste Vasey
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Myura Nagendran
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, UK
| | - Bruce Campbell
- University of Exeter Medical School, Exeter, UK
- Royal Devon and Exeter Hospital, Exeter, UK
| | - David A Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- British Heart Foundation Data Science Centre, London, UK
- Health Data Research UK, London, UK
- UCL Hospitals Biomedical Research Centre, London, UK
| | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Livia Faes
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Mudathir Ibrahim
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Surgery, Maimonides Medical Center, New York, NY, USA
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bilal A Mateen
- Institute of Health Informatics, University College London, London, UK
- Wellcome Trust, London, UK
- Alan Turing Institute, London, UK
| | - Piyush Mathur
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa D McCradden
- Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Johan Ordish
- The Medicines and Healthcare products Regulatory Agency, London, UK
| | | | - Suchi Saria
- Departments of Computer Science, Statistics, and Health Policy, and Division of Informatics, Johns Hopkins University, Baltimore, MD, USA
- Bayesian Health, New York, NY, USA
| | - Daniel S W Ting
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre Oxford, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | | | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Vasey B, Nagendran M, Campbell B, Clifton DA, Collins GS, Denaxas S, Denniston AK, Faes L, Geerts B, Ibrahim M, Liu X, Mateen BA, Mathur P, McCradden MD, Morgan L, Ordish J, Rogers C, Saria S, Ting DSW, Watkinson P, Weber W, Wheatstone P, McCulloch P. Reporting guideline for the early-stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI. Nat Med 2022; 28:924-933. [PMID: 35585198 DOI: 10.1038/s41591-022-01772-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/03/2022] [Indexed: 12/31/2022]
Abstract
A growing number of artificial intelligence (AI)-based clinical decision support systems are showing promising performance in preclinical, in silico evaluation, but few have yet demonstrated real benefit to patient care. Early-stage clinical evaluation is important to assess an AI system's actual clinical performance at small scale, ensure its safety, evaluate the human factors surrounding its use and pave the way to further large-scale trials. However, the reporting of these early studies remains inadequate. The present statement provides a multi-stakeholder, consensus-based reporting guideline for the Developmental and Exploratory Clinical Investigations of DEcision support systems driven by Artificial Intelligence (DECIDE-AI). We conducted a two-round, modified Delphi process to collect and analyze expert opinion on the reporting of early clinical evaluation of AI systems. Experts were recruited from 20 pre-defined stakeholder categories. The final composition and wording of the guideline was determined at a virtual consensus meeting. The checklist and the Explanation & Elaboration (E&E) sections were refined based on feedback from a qualitative evaluation process. In total, 123 experts participated in the first round of Delphi, 138 in the second round, 16 in the consensus meeting and 16 in the qualitative evaluation. The DECIDE-AI reporting guideline comprises 17 AI-specific reporting items (made of 28 subitems) and ten generic reporting items, with an E&E paragraph provided for each. Through consultation and consensus with a range of stakeholders, we developed a guideline comprising key items that should be reported in early-stage clinical studies of AI-based decision support systems in healthcare. By providing an actionable checklist of minimal reporting items, the DECIDE-AI guideline will facilitate the appraisal of these studies and replicability of their findings.
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Affiliation(s)
- Baptiste Vasey
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Myura Nagendran
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, UK
| | - Bruce Campbell
- University of Exeter Medical School, Exeter, UK
- Royal Devon and Exeter Hospital, Exeter, UK
| | - David A Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- British Heart Foundation Data Science Centre, London, UK
- Health Data Research UK, London, UK
- UCL Hospitals Biomedical Research Centre, London, UK
| | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Livia Faes
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Bart Geerts
- Healthplus.ai-R&D BV, Amsterdam, The Netherlands
| | - Mudathir Ibrahim
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bilal A Mateen
- Institute of Health Informatics, University College London, London, UK
- The Wellcome Trust, London, UK
- The Alan Turing Institute, London, UK
| | - Piyush Mathur
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa D McCradden
- The Hospital for Sick Children, Toronto ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
| | | | - Johan Ordish
- Medicines and Healthcare products Regulatory Agency, London, UK
| | | | - Suchi Saria
- Departments of Computer Science, Statistics, and Health Policy, and Division of Informatics, Johns Hopkins University, Baltimore, MD, USA
- Bayesian Health, New York, NY, USA
| | - Daniel S W Ting
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre Oxford, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | | | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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McCradden MD, Anderson JA, A Stephenson E, Drysdale E, Erdman L, Goldenberg A, Zlotnik Shaul R. A Research Ethics Framework for the Clinical Translation of Healthcare Machine Learning. Am J Bioeth 2022; 22:8-22. [PMID: 35048782 DOI: 10.1080/15265161.2021.2013977] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The application of artificial intelligence and machine learning (ML) technologies in healthcare have immense potential to improve the care of patients. While there are some emerging practices surrounding responsible ML as well as regulatory frameworks, the traditional role of research ethics oversight has been relatively unexplored regarding its relevance for clinical ML. In this paper, we provide a comprehensive research ethics framework that can apply to the systematic inquiry of ML research across its development cycle. The pathway consists of three stages: (1) exploratory, hypothesis-generating data access; (2) silent period evaluation; (3) prospective clinical evaluation. We connect each stage to its literature and ethical justification and suggest adaptations to traditional paradigms to suit ML while maintaining ethical rigor and the protection of individuals. This pathway can accommodate a multitude of research designs from observational to controlled trials, and the stages can apply individually to a variety of ML applications.
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Affiliation(s)
- Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children
- Genetics and Genome Biology, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning
- Division of Clinical & Public Health, Dalla Lana School of Public Health
| | - James A Anderson
- Department of Bioethics, The Hospital for Sick Children
- Institute for Health Management Policy, & Evaluation, University of Toronto
| | - Elizabeth A Stephenson
- Labatt Family Heart Centre, The Hospital for Sick Children
- Department of Pediatrics, The Hospital for Sick Children
| | - Erik Drysdale
- Genetics and Genome Biology, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning
| | - Lauren Erdman
- Genetics and Genome Biology, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning
- Vector Institute
- Department of Computer Science, University of Toronto
| | - Anna Goldenberg
- Department of Bioethics, The Hospital for Sick Children
- Vector Institute
- Department of Computer Science, University of Toronto
- CIFAR
| | - Randi Zlotnik Shaul
- Department of Bioethics, The Hospital for Sick Children
- Department of Pediatrics, The Hospital for Sick Children
- Child Health Evaluative Sciences, The Hospital for Sick Children
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22
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McCradden MD, Chad L. Screening for facial differences worldwide: equity and ethics. Lancet Digit Health 2021; 3:e615-e616. [PMID: 34481766 DOI: 10.1016/s2589-7500(21)00179-5] [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] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Division of Clinical & Public Health, Dalla Lana School of Public Health, Toronto, ON, Canada; Genetics & Genome Biology, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.
| | - Lauren Chad
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, ON, Canada
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Affiliation(s)
- Melissa D. McCradden
- grid.42327.300000 0004 0473 9646Bioethics Department, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Division of Clinical & Public Health, Dalla Lana School of Public Health, Toronto, ON Canada
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Baba A, Saha A, McCradden MD, Boparai K, Zhang S, Pirouzmand F, Edelstein K, Zadeh G, Cusimano MD. Development and validation of a patient-centered, meningioma-specific quality-of-life questionnaire. J Neurosurg 2021:1-10. [PMID: 33990085 DOI: 10.3171/2020.11.jns201761] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningiomas can have significant impact on health-related quality of life (HRQOL). Patient-centered, disease-specific instruments for assessing HRQOL in these patients are lacking. To this end, the authors sought to develop and validate a meningioma-specific HRQOL questionnaire through a standardized, patient-centered questionnaire development methodology. METHODS The development of the questionnaire involved three main phases: item generation, item reduction, and validation. Item generation consisted of semistructured interviews with patients (n = 30), informal caregivers (n = 12), and healthcare providers (n = 8) to create a preliminary list of items. Item reduction with 60 patients was guided by the clinical impact method, multiple correspondence analysis, and hierarchical cluster analysis. The validation phase involved 162 patients and collected evidence on extreme-groups validity; concurrent validity with the SF-36, FACT-Br, and EQ-5D; and test-retest reliability. The questionnaire takes on average 11 minutes to complete. RESULTS The meningioma-specific quality-of-life questionnaire (MQOL) consists of 70 items representing 9 domains. Cronbach's alpha for each domain ranged from 0.61 to 0.91. Concurrent validity testing demonstrated construct validity, while extreme-groups testing (p = 1.45E-11) confirmed the MQOL's ability to distinguish between different groups of patients. CONCLUSIONS The MQOL is a validated, reliable, and feasible questionnaire designed specifically for evaluating QOL in meningioma patients. This disease-specific questionnaire will be fundamentally helpful in better understanding and capturing HRQOL in the meningioma patient population and can be used in both clinical and research settings.
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Affiliation(s)
- Ami Baba
- 1Division of Neurosurgery, Department of Surgery and
| | | | | | | | - Shudong Zhang
- 1Division of Neurosurgery, Department of Surgery and
| | - Farhad Pirouzmand
- 3Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto
| | - Kim Edelstein
- 4Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto.,5Department of Psychiatry, Faculty of Medicine, University of Toronto
| | - Gelareh Zadeh
- 6Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Michael D Cusimano
- 1Division of Neurosurgery, Department of Surgery and.,2Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, University of Toronto.,7Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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25
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McCradden MD, Joshi S, Mazwi M, Anderson JA. Ethical limitations of algorithmic fairness solutions in health care machine learning. Lancet Digit Health 2021; 2:e221-e223. [PMID: 33328054 DOI: 10.1016/s2589-7500(20)30065-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Shalmali Joshi
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Mjaye Mazwi
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - James A Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
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McCradden MD, Joshi S, Anderson JA, Mazwi M, Goldenberg A, Zlotnik Shaul R. Patient safety and quality improvement: Ethical principles for a regulatory approach to bias in healthcare machine learning. J Am Med Inform Assoc 2020; 27:2024-2027. [PMID: 32585698 PMCID: PMC7727331 DOI: 10.1093/jamia/ocaa085] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 12/27/2022] Open
Abstract
Accumulating evidence demonstrates the impact of bias that reflects social inequality on the performance of machine learning (ML) models in health care. Given their intended placement within healthcare decision making more broadly, ML tools require attention to adequately quantify the impact of bias and reduce its potential to exacerbate inequalities. We suggest that taking a patient safety and quality improvement approach to bias can support the quantification of bias-related effects on ML. Drawing from the ethical principles underpinning these approaches, we argue that patient safety and quality improvement lenses support the quantification of relevant performance metrics, in order to minimize harm while promoting accountability, justice, and transparency. We identify specific methods for operationalizing these principles with the goal of attending to bias to support better decision making in light of controllable and uncontrollable factors.
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Affiliation(s)
- Melissa D McCradden
- Bioethics Department, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - James A Anderson
- Bioethics Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Mjaye Mazwi
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anna Goldenberg
- Vector Institute, Toronto, Ontario, Canada
- Genetics and Genome Biology, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- CIFAR, Toronto, Ontario, Canada
| | - Randi Zlotnik Shaul
- Bioethics Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research, Toronto, Ontario, Canada
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27
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McCradden MD, Patel E, Chad L. The point-of-care use of a facial phenotyping tool in the genetics clinic: An ethics tête-a-tête. Am J Med Genet A 2020; 185:658-660. [PMID: 33244863 DOI: 10.1002/ajmg.a.61985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/16/2020] [Accepted: 11/05/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Evani Patel
- University of Toronto, Toronto, Ontario, Canada
| | - Lauren Chad
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
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McCradden MD, Anderson JA, Zlotnik Shaul R. Accountability in the Machine Learning Pipeline: The Critical Role of Research Ethics Oversight. Am J Bioeth 2020; 20:40-42. [PMID: 33103980 DOI: 10.1080/15265161.2020.1820111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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McCradden MD, Sarker T, Paprica PA. Conditionally positive: a qualitative study of public perceptions about using health data for artificial intelligence research. BMJ Open 2020; 10:e039798. [PMID: 33115901 PMCID: PMC7594363 DOI: 10.1136/bmjopen-2020-039798] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/05/2020] [Accepted: 10/08/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Given widespread interest in applying artificial intelligence (AI) to health data to improve patient care and health system efficiency, there is a need to understand the perspectives of the general public regarding the use of health data in AI research. DESIGN A qualitative study involving six focus groups with members of the public. Participants discussed their views about AI in general, then were asked to share their thoughts about three realistic health AI research scenarios. Data were analysed using qualitative description thematic analysis. SETTINGS Two cities in Ontario, Canada: Sudbury (400 km north of Toronto) and Mississauga (part of the Greater Toronto Area). PARTICIPANTS Forty-one purposively sampled members of the public (21M:20F, 25-65 years, median age 40). RESULTS Participants had low levels of prior knowledge of AI and mixed, mostly negative, perceptions of AI in general. Most endorsed using data for health AI research when there is strong potential for public benefit, providing that concerns about privacy, commercial motives and other risks were addressed. Inductive thematic analysis identified AI-specific hopes (eg, potential for faster and more accurate analyses, ability to use more data), fears (eg, loss of human touch, skill depreciation from over-reliance on machines) and conditions (eg, human verification of computer-aided decisions, transparency). There were mixed views about whether data subject consent is required for health AI research, with most participants wanting to know if, how and by whom their data were used. Though it was not an objective of the study, realistic health AI scenarios were found to have an educational effect. CONCLUSIONS Notwithstanding concerns and limited knowledge about AI in general, most members of the general public in six focus groups in Ontario, Canada perceived benefits from health AI and conditionally supported the use of health data for AI research.
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Affiliation(s)
- Melissa D McCradden
- Department of Bioethics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tasmie Sarker
- Health Team, Vector Institute, Toronto, Ontario, Canada
| | - P Alison Paprica
- Health Team, Vector Institute, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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30
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Affiliation(s)
| | | | - James A Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, Canada
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31
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McCradden MD, Baba A, Saha A, Ahmad S, Boparai K, Fadaiefard P, Cusimano MD. Ethical concerns around use of artificial intelligence in health care research from the perspective of patients with meningioma, caregivers and health care providers: a qualitative study. CMAJ Open 2020; 8:E90-E95. [PMID: 32071143 PMCID: PMC7028163 DOI: 10.9778/cmajo.20190151] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 11/22/2022] Open
Abstract
BACKGROUND As artificial intelligence (AI) approaches in research increase and AI becomes more integrated into medicine, there is a need to understand perspectives from members of the Canadian public and medical community. The aim of this project was to investigate current perspectives on ethical issues surrounding AI in health care. METHODS In this qualitative study, adult patients with meningioma and their caregivers were recruited consecutively (August 2018-February 2019) from a neurosurgical clinic in Toronto. Health care providers caring for these patients were recruited through snowball sampling. Based on a nonsystematic literature search, we constructed 3 vignettes that sought participants' views on hypothetical issues surrounding potential AI applications in health care. The vignettes were presented to participants in interviews, which lasted 15-45 minutes. Responses were transcribed and coded for concepts, frequency of response types and larger concepts emerging from the interview. RESULTS We interviewed 30 participants: 18 patients, 7 caregivers and 5 health care providers. For each question, a variable number of responses were recorded. The majority of participants endorsed nonconsented use of health data but advocated for disclosure and transparency. Few patients and caregivers felt that allocation of health resources should be done via computerized output, and a majority stated that it was inappropriate to delegate such decisions to a computer. Almost all participants felt that selling health data should be prohibited, and a minority stated that less privacy is acceptable for the goal of improving health. Certain caveats were identified, including the desire for deidentification of data and use within trusted institutions. INTERPRETATION In this preliminary study, patients and caregivers reported a mixture of hopefulness and concern around the use of AI in health care research, whereas providers were generally more skeptical. These findings provide a point of departure for institutions adopting health AI solutions to consider the ethical implications of this work by understanding stakeholders' perspectives.
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Affiliation(s)
- Melissa D McCradden
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont.
| | - Ami Baba
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Ashirbani Saha
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Sidra Ahmad
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Kanwar Boparai
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Pantea Fadaiefard
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Michael D Cusimano
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
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Baba A, McCradden MD, Rabski J, Cusimano MD. Determining the unmet needs of patients with intracranial meningioma-a qualitative assessment. Neurooncol Pract 2019; 7:228-238. [PMID: 32626591 DOI: 10.1093/nop/npz054] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Meningiomas are the most common primary benign brain neoplasms, but despite their commonality, the supportive needs of this patient population have been overlooked. The aim of this study is to identify unmet needs of meningioma patients, caregivers, and health care providers. Methods We adopted a patient-centered approach by using qualitative interviewing with patients diagnosed with a meningioma who have undergone treatment in the last 10 years since the date of their interview. Informal caregivers (family and/or friends) of the patient population and health care providers who are normally involved in the management and care of meningioma patients were also interviewed. Interview transcripts were subjected to thematic analysis. Results Of the 50 participants interviewed, there were 30 patients, 12 caregivers, and 8 health care professionals. Thematic analysis revealed 4 overarching themes: (1) access to targeted postoperative care, (2) financial struggles for patients and their families, (3) lack of information specific to meningiomas and postsurgical management, and (4) lack of psychosocial support. Conclusion This study identified supportive needs specific to the meningioma patient population, which predominantly falls within the postoperative phase. The postoperative journey of this patient population could potentially extend to the rest of the patient's life, which necessitates resources and information directed to support postoperative recovery and management. The development of directly relevant supportive resources that support meningioma patients in their postoperative recovery is necessary to improve the health-related quality of life in this patient population.
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Affiliation(s)
- Ami Baba
- Injury Prevention Research Office, St. Michael's Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Melissa D McCradden
- Injury Prevention Research Office, St. Michael's Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Jessica Rabski
- Injury Prevention Research Office, St. Michael's Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Injury Prevention Research Office, St. Michael's Hospital, Division of Neurosurgery, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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McCradden MD, Anderson JA. The Last Refuge of Privacy. AJOB Neurosci 2019; 10:25-28. [PMID: 31070559 DOI: 10.1080/21507740.2019.1595786] [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: 10/26/2022]
Affiliation(s)
- Melissa D McCradden
- a The Hospital for Sick Children and Vector Institute for Artificial Intelligence
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Affiliation(s)
- Melissa D McCradden
- St Michael's Hospital, Neurosurgery, Toronto, Ontario, Canada.,Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - James A Anderson
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Bioethics, Toronto, Ontario, Canada
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McCradden MD, Cusimano MD. Staying true to Rowan's Law: how changing sport culture can realize the goal of the legislation. Can J Public Health 2019; 110:165-168. [PMID: 30694447 DOI: 10.17269/s41997-019-00174-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022]
Abstract
Rowan's Law was recently introduced into Ontario legislation following the death of Rowan Stringer, a young rugby player for whom a string of head injuries culminated in her death. The law mandates the removal from play of any youth athlete suspected to have a concussion and makes concussion education mandatory for certain individuals involved with youth sport. This commentary addresses the larger issues within sport culture that may limit the effectiveness of the law, and describes how awareness alone is not sufficient to generate change. The law can sometimes lead to a false sense of security, as well as retaliatory actions for those who are motivated to hide concussion. We describe the role of all persons involved with youth sport in facilitating a cultural shift to honour the intent behind Rowan's Law.
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Affiliation(s)
- Melissa D McCradden
- St. Michael's Hospital - Neurosurgery, 30 Bond St, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Michael D Cusimano
- St. Michael's Hospital - Neurosurgery, 30 Bond St, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- Melissa D McCradden
- Department of Neurosurgery, St. Michael's Hospital, Injury Prevention Research Office, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Department of Neurosurgery, St. Michael's Hospital, Injury Prevention Research Office, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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McCradden MD, Cusimano MD. Concussions in Sledding Sports and the Unrecognized "Sled Head": A Systematic Review. Front Neurol 2018; 9:772. [PMID: 30279676 PMCID: PMC6153360 DOI: 10.3389/fneur.2018.00772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/31/2018] [Accepted: 08/24/2018] [Indexed: 12/04/2022] Open
Abstract
Background: Sport-related concussion is a significant public health concern. Little research has been conducted on sport-related concussion and injury prevention strategies in competitive sledding sports like bobsleigh, luge, and skeleton. Athletes have identified “sled head” as a key concern due to its symptom burden. Purpose: To summarize our knowledge of the prevalence of concussion and related symptoms in sledding sports; to utilize Haddon's Matrix to inform and define strategies for injury prevention. Methods: An independent information specialist conducted a search for the known literature on injuries in non-recreational sledding sports, and specifically for concussion via OVID Medline, CINAHL, the Cochrane Database, EMBASE, PsycInfo, PubMed, Scopus, and the Web of Sciences from 1946 to December 2017. After iterative searches of reference sections, a total of 844 articles were assessed for inclusion. Results: Nine articles were included for review. Concussions are a common occurrence in elite sledding sport athletes, affecting 13-18% of all sledding athletes. Significant variance exists between events, indicating a potential effect of the ice track in injury risk. The condition known as “sled head” is discussed and identified as a key point of further investigation. A number of potential injury prevention strategies are discussed. Interpretation: Head injuries and concussions are an important injury for elite sledding sports and a number of avenues exist for prevention. More work is required to delineate the mechanisms, characteristics, natural history and management of “sled head.”
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Affiliation(s)
- Melissa D McCradden
- Department of Neurosurgery, St. Michael's Hospital, Injury Prevention Research Office, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael D Cusimano
- Department of Neurosurgery, St. Michael's Hospital, Injury Prevention Research Office, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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McCradden MD, Cusimano MD. Optimized or Hijacked? The Moral Boundaries of Natural Athletic Performance. Am J Bioeth 2018; 18:26-28. [PMID: 29852116 DOI: 10.1080/15265161.2018.1459947] [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: 06/08/2023]
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