RPFT study - Registered Pulmonary Function Technologist Updated: 2023
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Registered Pulmonary Function Technologist
In setting up a CO analyzer, a pulmonary function technologist notices that the analyzer reads -0.03 while sampling
air. The technologist should
A. Accept the reading because it is within -¦ 3%.
B. Adjust the reading to +0.03.
C. Adjust the reading to 0.00.
D. Reverse the trial flow.
A patient's vital capacity is slightly reduced, the FEWFVC is normal, and the uncorrected DLco is increased.
Which of the following is the most likely diagnosis?
A. diffuse pulmonary fibrosis
B. diaphragmatic hemiparesis
D. polycythemia vera
The following results are obtained from an adult male:
The corrected DLco value -
A. is unchanged.
B. is higher.
C. is lower.
D. cannot be calculated.
To check the reliability of a pulse oximeter reading, a pulmonary function technologist should
A. Calculate the SaO2 from pH and PaO2
B. Perform hemoximetry
C. Measure the hematocrit
D. Have the patient hyperventilate
A 54-year-old male who smokes presents to the pulmonary laboratory for chronic cough and dyspnea on exertion.
PFT and blood gas results show the following:
Which of the following should the pulmonary function technologist recommend?
A. DLco measurement
B. Oxygen therapy with exercise
C. Trial of varenicline (Chantix)
D. Lung volume measurement
Which of the following is a suitable policy for following Standard Precautions in a pulmonary function laboratory?
A. Eye protection is required when obtaining ABGs from patients with hepatitis.
B. Reusable mouthpieces should be disposed when a patient has a history of tuberculosis.
C. Gloves are optional when obtaining arterial blood samples using a kit
D. Reusable mouthpieces should be disinfected between each patient.
While assessing a patient's expired gases at rest prior to exercise, a pulmonary function technologist calculates the
RER as 0.6. Which of the following is the most likely explanation?
A. B. gas analyzer is malfunctioning
B. A gas analyzer is malfunctioning
C. The expired gas is contaminated with air
D. The patient is hyperventilating
Which of the following is an appropriate reason to perform a multiple-breath nitrogen washout test?
A. Measure anatomical dead space.
B. Differentiate obstruction from restriction.
C. Detect early small airway disease.
D. Measure oxygen consumption.
During daily quality control procedures on an infrared CO2 analyzer, a pulmonary function technologist is unable
to adjust the gain to the calibration gas concentration. Which of the following is the most likely explanation?
A. Water droplets in the trial cell
B. Saturation of the soda lime
C. Presence of high levels of oxygen
D. Increased gas sampling rate
A patient who is about to begin pulmonary function testing is visibly upset and complains to a pulmonary function
technologist that she felt a receptionist was rude to her. Which of the following should the technologist do?
A. Try to get the patient to calm down by telling her that the receptionist is probably just having a bad day.
B. deliver the patient time to calm down and ask the laboratory manager to become involved.
C. Ignore the complaint because it is not going to affect the testing about to begin.
D. Accompany the patient back to the reception area and try to determine who was at fault.
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Chatbots are increasingly becoming a part of health care around the world, but do they encourage bias? That's what University of Colorado School of Medicine researchers are asking as they dig into patients' experiences with the artificial intelligence (AI) programs that simulate conversation.
"Sometimes overlooked is what a chatbot looks like â€“ its avatar," the researchers write in a new paper published in Annals of Internal Medicine. "Current chatbot avatars vary from faceless health system logos to cartoon characters or human-like caricatures. Chatbots could one day be digitized versions of a patient's physician, with that physician's likeness and voice. Far from an innocuous design decision, chatbot avatars raise novel ethical questions about nudging and bias."
The paper, titled "More than just a pretty face? Nudging and bias in chatbots", challenges researchers and health care professionals to closely examine chatbots through a health equity lens and investigate whether the technology truly improves patient outcomes.
In 2021, the Greenwall Foundation granted CU Division of General Internal Medicine Associate Professor Matthew DeCamp, MD, PhD, and his team of researchers in the CU School of Medicine funds to investigate ethical questions surrounding chatbots. The research team also included Internal medicine professor Annie Moore, MD, MBA, the Joyce and Dick Brown Endowed Professor in Compassion in the Patient Experience, incoming medical student Marlee Akerson, and UCHealth Experience and Innovation Manager Matt Andazola.
So far, the team has surveyed more than 300 people and interviewed 30 others about their interactions with health care-related chatbots. For Akerson, who led the survey efforts, it's been her first experience with bioethics research.
"I am thrilled that I had the chance to work at the Center for Bioethics and Humanities, and even more thrilled that I can continue this while a medical student here at CU," she says.
The face of health care
The researchers observed that chatbots were becoming especially common around the COVID-19 pandemic.
"Many health systems created chatbots as symptom-checkers," DeCamp explains. "You can go online and type in symptoms such as cough and fever and it would tell you what to do. As a result, we became interested in the ethics around the broader use of this technology."
Oftentimes, DeCamp says, chatbot avatars are thought of as a marketing tool, but their appearance can have a much deeper meaning.
"One of the things we noticed early on was this question of how people perceive the race or ethnicity of the chatbot and what effect that might have on their experience," he says. "It could be that you share more with the chatbot if you perceive the chatbot to be the same race as you."
For DeCamp and the team of researchers, it prompted many ethical questions, like how health care systems should be designing chatbots and whether a design decision could unintentionally manipulate patients.
There does seem to be evidence that people may share more information with chatbots than they do with humans, and that's where the ethics tension comes in: We can manipulate avatars to make the chatbot more effective, but should we? Does it cross a line around overly influencing a person's health decisions?" DeCamp says.
A chatbot's avatar might also reinforce social stereotypes. Chatbots that exhibit feminine features, for example, may reinforce biases on women's roles in health care.
On the other hand, an avatar may also increase trust among some patient groups, especially those that have been historically underserved and underrepresented in health care, if those patients are able to choose the avatar they interact with.
"That's more demonstrative of respect," DeCamp explains. "And that's good because it creates more trust and more engagement. That person now feels like the health system cared more about them."
Marketing or nudging?
While there's little evidence currently, there is a hypothesis emerging that a chatbot's perceived race or ethnicity can impact patient disclosure, experience, and willingness to follow health care recommendations.
"This is not surprising," the CU researchers write in the Annals paper. "Decades of research highlight how patient-physician concordance according to gender, race, or ethnicity in traditional, face-to-face care supports health care quality, patient trust, and satisfaction. Patient-chatbot concordance may be next."
That's enough reason to scrutinize the avatars as "nudges," they say. Nudges are typically defined as low-cost changes in a design that influence behavior without limiting choice. Just as a cafeteria putting fruit near the entrance might "nudge" patrons to pick up a healthier option first, a chatbot could have a similar effect.
"A patient's choice can't actually be restricted," DeCamp emphasizes. "And the information presented must be accurate. It wouldn't be a nudge if you presented misleading information."
In that way, the avatar can make a difference in the health care setting, even if the nudges aren't harmful.
DeCamp and his team urge the medical community to use chatbots to promote health equity and recognize the implications they may have so that the artificial intelligence tools can best serve patients.
"Addressing biases in chatbots will do more than help their performance," the researchers write. "If and when chatbots become a first touch for many patients' health care, intentional design can promote greater trust in clinicians and health systems broadly."
Akerson, M., et al. (2023) Â More Than Just a Pretty Face? Nudging and Bias in Chatbots. Annals of Internal Medicine. doi.org/10.7326/M23-0877.
The growing and widespread use of algorithms to make health care decisions for patients could be adding to racial bias against minorities, a new study has found.
Algorithms are the mathematical rules that tell a health care providerâ€™s computer program how to solve problems affecting a patientâ€™s access to medical treatment, quality of care and health outcomes. Doctors increasingly rely on their analysis of a patientâ€™s medical and insurance history to recommend appropriate treatment.Â
According to a study that seven public health researchers published Friday in JAMA Health Forum, 18 commonly used algorithms flag ethnicity and race in haphazard ways that may reinforce unequal treatment of dark-skinned patients due to a lack of oversight and knowledge of their functions.
The researchers posed 11 questions about the algorithms to the representatives of 42 clinical professional societies, universities, government agencies, health insurance payers and health technology organizations.
â€śFindings suggest that standardized and rigorous approaches for algorithm development and implementation are needed to mitigate racial and ethnic biases from algorithms and reduce health inequities,â€ť the researchers wrote in the study.
Survey respondents recommended â€śguidance and standardization from government and othersâ€ť to purge any bias and prevent the use of race as a â€śproxy for clinical variables,â€ť the study stated.
â€śOnly 20% of health outcomes are determined by the provision of health care services, and an individualâ€™s ZIP code has more influence on their health than their own genetic code,â€ť an anonymous clinician wrote in the survey, noting that racial data favors patients from better neighborhoods.
Some health care professionals echoed the studyâ€™s conclusions, noting that algorithms often pull data from older medical tests that treat skin color as a biological difference.
â€śMany tests in medicine are based on race, from renal function to lung strength,â€ť said Dr. Panagis Galiatsatos, a faculty health equity leader at the Johns Hopkins School of Medicine. â€śRight now, we are attempting to change pulse oximeter readings, which are known to cause false reports in dark-skinned individuals, often missing key hypoxemia that would impact medical management.â€ť
Another problem could be the algorithms themselves, said Katy Talento, a former top health adviser at the White House Domestic Policy Council under former President Donald Trump.
She now serves as executive director of the Alliance of Health Care Sharing Ministries, a Washington-based association of Christians who work to â€śrehumanizeâ€ť medicine by sharing medical costs.
â€śThe study rightly points out that race is a bad proxy for what matters: health history, genetics and social determinants of health such as income,â€ť Ms. Talento said in an email. â€śOur broken system requires clinicians to use bots, checklists and rapid-fire office visits driven by insurance payment models instead of doctor-patient relationships.â€ť
According to diversity experts, itâ€™s easy to see how mathematical calculations might cause minorities to receive inferior medical treatment.
â€śAlgorithms are scientific tools to analyze data, but the variables are input by humans who of course can have biases toward racial and ethnic groups,â€ť said Tyrone Howard, a Black education professor at the University of California, Los Angeles who specializes in racial equity.
Some conservatives cautioned against reading too much into the algorithms. The potential for bias does not prove racist calculations are to blame for unequal health outcomes, they said.
â€śCertain people are prone to certain diseases based on race, culture, economic status and learned behaviors,â€ť said Gregory Quinlan, a former registered nurse who leads the conservative Center for Garden State Families in New Jersey. â€śGay men are at higher risk of HIV-AIDS and monkeypox. That is not bigotry to say that. Itâ€™s a statistical, medical fact.â€ťÂ
WASHINGTON â€“ Thousands would die, and hundreds of thousands would require emergency medical care if a blackout hit Phoenix at the same time as a multiday heat wave, according to a accurate study.
The study published last month in the journal Environmental Science & Technology predicted what might happen if the five-day Phoenix heatwave of July 2006 repeated itself and the electrical grid failed at the same time.
It estimates that about 1% of the population, or 13,250 people, would die, and half the city, or 816,570 people, would be put in emergency rooms if power was completely out for two days, then slowly restored throughout the region over the next three.
â€śWeâ€™re really not prepared for this on the federal state or local level,â€ť said Brian Stone Jr., lead author of the study.
Emergency management and power company officials said the chances of a crippling heat wave coinciding with a massive power grid failure are remote, and that the desert city â€śis very well prepared.â€ť
â€śWe plan for 117-degree temperatures,â€ť said Justin Joiner, vice president of resource management for Arizona Public Service. â€śAnd we acquire another 15% additional resources on top of what we feel weâ€™re going to need for 117-degree temperatures.â€ť
Stone acknowledged that itâ€™s unlikely that extreme weather will coincide with a massive power failure, but he also noted that unlikely power and weather problems have coincided in other cities and Phoenix should be forewarned.
â€śWe know that the grid around Phoenix and Arizona is pretty resilient because it is so important that this be a low-probability event. But we have seen really low probability, extensive blackouts,â€ť said Stone, a professor in the School of City and Regional Planning at the Georgia Institute of Technology.
â€śWe didnâ€™t choose Phoenix (for the study) because we thought it was the most likely place,â€ť he said. â€śWe think itâ€™s the most dangerous place.â€ť
The study looked at heatwaves of historical intensity in Detroit, Atlanta and Phoenix and simulated what would happen if there was a power outage at the same time. It predicted that death rates would more than double if power was out during a heatwave in Detroit and Atlanta, but that it would rise around 700% in Phoenix.
The study attributes Phoenixâ€™s higher death rate to the regionâ€™s sharply higher temperatures, combined with its reliance on air conditioning â€“ more than 90% of the cityâ€™s residences have air conditioning, it said.
Stone said the people â€śwho are most vulnerable are those that are acclimated to have air conditioning all the time.â€ť
Stoneâ€™s study cites the cityâ€™s unhoused residents â€“ who year-round have little or no access to air conditioning â€“ noting that 1.6% of them died due to heat in 2021. It estimates that about 1% of all Phoenix residents would succumb if a heatwave and blackout coincided.
Heat-related deaths and illnesses will likely double by 2085 as climate change increases the likelihood of more extreme heatwaves and more frequent blackouts, Stone said.
The report comes as the Valley faces what could be hotter-than-normal summer: The National Oceanic and Atmospheric Administrationâ€™s three-month outlook forecast said there is a 40% to 70% chance that temperatures in Arizona will be higher than normal.
But Brian Lee, director of Phoenixâ€™s Office of Emergency Management, said the city is ready.
â€śWe have emergency operation plans in place to be able to respond to virtually any type of an incident that may arise within the city of Phoenix,â€ť Lee said
A separate report released earlier last month by the North American Electric Reliability Corp. warns that two-thirds of North America, including the western U.S., is at risk of energy supply shortages during temperature spikes this summer.
Joiner said if an extreme blackout were to expand across the large geographic footprint of Phoenix, APS would be able to â€śimport power from hundreds of miles away.â€ť The utility provides power for more than 1.3 million homes and businesses in 11 of Arizonaâ€™s 15 counties.
Stoneâ€™s study suggests long-term solutions, including tree-shading canopies across the cityâ€™s streets would reduce heat mortality by 27% and reflective cooling roofs on all city buildings, which would reduce deaths by 66%.
Lee encourages all residents to have a plan of action in case the city faces either a heat wave or a blackout â€“ or both at the same time. Plan for transportation, know where cooling centers may be located and wear protective clothing and sunscreen.
â€śWe would also encourage that the public have a plan as well,â€ť Lee said.
Jasmine Kabiri jaz-min kah-bee-ree (she/hers)News Reporter, Washington, D.C.
Jasmine Kabiri expects to graduate in May 2024 with a bachelorâ€™s degree in journalism, a minor in political science and a certificate in international studies. She is a managing editor at ASUâ€™s student-led newspaper, The State Press, and has interned for The Daily Camera in Boulder, Colorado.
When a patient asks about the risk of dying after swallowing a toothpick, two answers are given. The first points out that between two or six hours after ingestion, it is likely that it has already passed to the intestines, explaining that many people swallow toothpicks without anything happening them. But it also advises the patient to go to the emergency room if they are experiencing a â€śstomach ache.â€ť The second answer is in a similar vein. It replies that, although itâ€™s normal to worry, serious harm is unlikely to occur after swallowing a toothpick as itâ€™s small and made of wood, which is not toxic or poisonous. However, if the patient has â€śabdominal pain, difficulty swallowing or vomiting,â€ť they should see a doctor. â€śItâ€™s understandable that you may be feeling paranoid, but try not to worry too much. It is highly unlikely that the toothpick will cause you any serious harm,â€ť it adds.
The two answers say basically the same thing, but the way they do so is slightly different. The first one is more aseptic and concise; while the second is more empathetic and detailed. The first was written by a doctor, and the second was from ChatGPT, the artificial intelligence (AI) generative tool that has revolutionized the planet. This experiment â€” part of a study published in the journal Jama Internal Medicine â€” was aimed at exploring the role AI assistants could play in medicine. It compared how real doctors and the chatbot responded to patient questions in an internet forum. The conclusions â€” based on an analysis from an external panel of health professionals who did not know who had answered what â€” found that ChatGPTâ€™s responses were more emphathetic and high quality than the real doctorâ€™s in 79% of cases.
The explosion of new AI tools has opened debate about their potential use in the field of health. ChatGPT, for example, is seeking to become a resource for health workers by helping them avoid bureaucratic tasks and develop medical procedures. On the street, it is already planning to replace the imprecise and often foolish Dr Google. Experts who spoke to EL PAĂŤS say that the technology has great potential, but that it is still in its infancy. Regulation on how it is applied in real medical practice still needs to be fine-tuned to address any ethical doubts, they say. The experts also point out that it is fallible, and can make mistakes. For this reason, everything that comes out of the chatbot will require the final review of a health professional.
Paradoxically, the machine â€”not the human â€” is the most empathetic voice in the Jama Internal Medicine study. At least, in the written response. Josep Munuera, head of the Diagnostic Imaging Service at Hospital Sant Pau in Barcelona, Spain, and an expert in digital technologies applied to health, warns that the concept of empathy is broader than what the study can analyze. Written communication is not the same as face-to-face communication, nor is raising a question on an online forum the same as doing so during a medical consultation. â€śWhen we talk about empathy, we are talking about many issues. At the moment, it is difficult to replace non-verbal language, which is very important when a doctor has to talk to a patient or their family,â€ť he pointed out. But Munuera does admit these generative tools have great potential when it comes to simplifying medical jargon. â€śIn written communication, technical medical language can be complex and we may have difficulty translating it into understandable language. Probably, these algorithms find the equivalence between the technical word and another and adapt it to the receiver.â€ť
Joan Gibert, a bioinformatician and leading figure in the development of AI models at the Hospital del Mar in Barcelona, points out another variable when it comes to comparing the empathy of the doctor and the chatbox. â€śIn the study, two concepts that enter into the equation are mixed: ChatGPT itself, which can be useful in certain scenarios and that has the ability to concatenate words that deliver us the feeling that it is more empathetic, and burnout among doctors, the emotional exhaustion when it comes to caring for patients that leaves clinicians unable to be more empathetic,â€ť he explained.
The danger of "hallucinations"
Nevertheless, as is the case with the famous Dr Google, itâ€™s important to be careful with ChatGPTâ€™s responses, regardless of how sensitive or kind they may seem. Experts highlight that the chatbot is not a doctor and can deliver incorrect answers. Unlike other algorithms, ChatGPT is generative. In other words, it creates information according to the databases that it has been trained on, but it can still invent some responses. â€śYou always have to keep in mind that it is not an independent entity and cannot serve as a diagnostic tool without supervision,â€ť Gibert insisted.
These chatboxes can suffer from what experts call â€śhallucinations,â€ť explained Gibert. â€śDepending on the situation, it could tell you something that is not true. The chatbot puts words together in a coherent way and because it has a lot of information, it can be valuable. But it has to be reviewed since, if not, it can fuel fake news,â€ť he said. Munuera also highlighted the importance of â€śknowing the database that has trained the algorithm because if the databases are poor, the response will also be poor.â€ť
Outside of the doctorâ€™s office, the potential uses of ChatGPT in health are limited, since the information they provide can lead to errors. Jose Ibeas, a nephrologist at the Parc TaulĂ Hospital in Sabadel, Spain, and secretary of the Big Data and Artificial Intelligence Group of the Spanish Society of Nephrology, pointed out that it is â€śuseful for the first layers of information because it synthesizes information and help, but when you enter a more specific area, in more complex pathologies, its usefulness is minimal or itâ€™s wrong.â€ť
â€śIt is not an algorithm that helps resolve doubts,â€ť added Munuera. â€śYou have to understand that when you ask it to deliver you a differential diagnosis, it may invent a disease.â€ť Similiarly, the AI system can tell a patient that nothing is wrong, when something is. This can lead to missed opportunities to see a doctor, because the patient follows the advice of the chatbot and does not speak to a real professional.
Where experts see more room for possibilies for AI is as a support tool for health professionals. For example, it could help doctors answer patient messages, albeit under supervision. The Jama Internal Medicine study suggests that it would help â€śimprove workflowâ€ť and patient outcomes: â€śIf more patientsâ€™ questions are answered quickly, with empathy, and to a high standard, it might reduce unnecessary clinical visits, freeing up resources for those who need them,â€ť the researchers said. â€śMoreover, messaging is a critical resource for fostering patient equity, where individuals who have mobility limitations, work irregular hours, or fear medical bills, are potentially more likely to turn to messaging.â€ť
The scientific community is also studying the use of these tools for other repetitive tasks, such as filling out forms and reports. â€śBased on the premise that everything will always, always, always need to be reviewed by the doctor,â€ť AI could help medical professionals complete repetitive but important bureaucratic tasks, said Gibert. This, in turn, would allow doctors to spend more time on other issues, such as patient care. An article published in The Lancet, for example, suggests that AI technology could help streamline discharge summaries. Researchers say automating this process could east the work burden of doctors and even Improve the quality of reports, but they are aware of the difficulties involved with training algorithms, which requires large amounts of data, and the risk of â€śdepersonalization of care,â€ť which could lead to resistance to the technology.
Ibeas insists that, for any medical use, these tools must be â€ścheckedâ€ť and the division of responsibilities must be well established. â€śThe systems will never decide. It must be the doctor who has the final sign-off,â€ť he argued.
Gibert also pointed out some ethical considerations that must be taken into account when including these tools in clinical practice: â€śYou need this type of technology to be under a legal umbrella, for there to be integrated solutions within the hospital structure and to ensure that patient data is not used to retrain the model. And if someone wants to do the latter, they should do it within a project, with anonymized data, following all the controls and regulations. Sensitive patient information cannot be shared recklessly.â€ť
The bioinformatician also argued that AI solutions, such as ChatGPT or models that help with diagnosis, introduce â€śbiasesâ€ť that can affect how doctors relate to patients. For example, these tools could condition a doctorâ€™s decision, one way or another. â€śThe fact that the professional has the result of an AI model changes the very professional. Their way of relating [to patients] may be very good, but it can introduce problems, especially in professionals who have less experience. That is why the process has to be done in parallel: until the professional gives the diagnosis, they cannot see what the AI says.â€ť
A group of researchers from Stanford University also examined how AI tools can help to further humanize health care in an article in Jama Internal Medicine. â€śThe practice of medicine is much more than just processing information and associating words with concepts; it is ascribing meaning to those concepts while connecting with patients as a trusted partner to build healthier lives,â€ť they concluded. â€śWe can hope that emerging AI systems may help tame laborious tasks that overwhelm modern medicine and empower physicians to return our focus to treating human patients.â€ť
As we wait to see how this incipient technology grows and what repercussions it has for the public, Munuera argued: â€śYou have to understand that [ChatGPT] is not a medical tool and there is no health professional who can confirm the veracity of the answer [the chatbot gives]. You have to be prudent and understand what the limits are.â€ť In summary, Ibeas said: â€śThe system is good, robust, positive and it is the future, but like any tool, you have to know how to use it so that it does not become a weapon.â€ť
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Artificial intelligence is already in wide use in health care: medical workers use it to record patient interactions and add notes to medical records; some hospitals use it to read radiology images, or to predict how long a patient may need to be in intensive care.
But some hospitals have begun to contemplate using a new phase of AI that is much more advanced and could have a profound effect on their operations, and possibly even clinical care.
Indeed, never one for modesty, ChatGPT, one form of the new AI technology that can render answers to queries in astonishing depth (if dubious accuracy), called its own role in the future of medicine a â€śgroundbreaking development poised to reshape the medical landscape.â€ť
What that medical landscape will look like is just starting to come into focus. Hospitals, doctors, and medical companies are experimenting with different facets of its application, and even hiring staff dedicated to using state-of-the art AI language technology in what could become a pivotal moment in medicine.
â€śThereâ€™s been many times that we have a potentially disruptive technology that hasnâ€™t made it,â€ť said Dr. Isaac Kohane, professor of biomedical informatics at Harvard Medical School, and editor-in-chief of a new journal the publisher of the New England Journal of Medicine started to cover just AI. Large language models like ChatGPT may be different, he said, because the rapid adoption of the technology is pressuring the health care system to follow along.
At its foundation, â€ślarge language modelâ€ť AI uses powerful analytics to convincingly generate human-like text. The latest versions of the technology behind platforms such as ChatGPT, GPT-4, and Googleâ€™s Bard have produced some astonishing results because they have been trained on enormous data sets and are run by more powerful computers.
While there have been some dire warnings issued about the threat the technology poses, hospitals see it as a useful tool to streamline administrative tasks and, perhaps one day, Improve patient care. But they are moving slowly and methodically, testing the platform mostly with administrative tasks.
Boston Childrenâ€™s Hospital recently posted an opening for an AI prompt engineer, to help integrate large language technology into the hospitalâ€™s operations.
Like other hospitals, Boston Childrenâ€™s already makes broad use of older types of artificial intelligence, such as to read radiology and pathology scans and to make predictions about patientsâ€™ length of stay in the ICU and emergency departments.
John Brownstein, the hospitalâ€™s chief innovation officer, said the new role will build on that foundation. In the short term, the hospital hopes to implement such tools on the administrative and financial sides and is soliciting feedback from staff on where AI tools might help people. Brownstein envisions using the technology to manage licensing requirements for providers, or to cull resumes of job candidates. On the research side, such technology can be used to read and summarize scientific literature.
â€śFrom my perspective, it will be as fundamental a tool as a search engine and mobile phone, and we have to prepare people for that world,â€ť Brownstein said. â€śItâ€™s going to be hard in the future to be effective at your job without taking advantage of these technologies.â€ť
However, he said, medical professionals are being thoughtful and deliberate about bringing the tools to patient care. There are concerns about patient privacy, consent, and bias. He said the technology also has a tendency to â€śhallucinate,â€ť or say things that are not true.
Given those concerns, experts are considering guardrails for large language models. But one day, the technology could be used to navigate a personâ€™s electronic medical record, summarize a medical history, and even potentially generate clinical and discharge notes. Writing e-mails, which clinicians have to do on a daily basis, may become more efficient with the use of AI.
â€śThe holy grail is using these tools to optimize and provide the best possible clinical support to our patients,â€ť Brownstein said. â€śBut itâ€™s also the place we have to take the most time because we have to be the most thoughtful.â€ť
Elsewhere, Microsoft and electronic medical record software maker Epic are working to integrate large language model technology into electronic medical records. For example, UC San Diego Health, UW Health in Madison, Wisconsin, and Stanford Health Care have begun using it to draft messages to patients.
Dr. Sahil Mehta, a physician in Boston specializing in vascular and interventional radiology, uses ChatGPT with the administrative functions of his job. He just used it to help write an appeal of an insurance denial.
â€śWhile it needed some minor editing, this type of document easily could take 20-30 minutes to write, yet ChatGPT wrote it in a few seconds and required just minor changes,â€ť Mehta said. â€śAs this technology evolves, and is better integrated into workflows, it has the ability to significantly Improve physician morale, documentation, and patient care because we will spend more time with patients, less with paperwork.â€ť
According to a survey of 500 health care professionals conducted in April by digital health platform Tebra, more than 10 percent were using AI. Another 50 percent expressed an interest in using the technology in the future.
Perhaps the most immediate implementation of the technology has been in medical school education. Mehta, who founded MedSchoolCoach, an educational technology company focused on pre-med and medical students, said students can use the technology as a brainstorming tool for medical school essays. MedSchoolCoach is also creating study aids using large language model technology that has been trained on medical textbooks and other expert-written texts.
Meanwhile, patients have already begun turning to AI. The Tebra survey, which also asked 1,000 Americans about the use of the technology, found that more than 5 percent of those surveyed had used ChatGPT to help diagnose a problem and had followed its advice. Additionally, a quarter of those surveyed would not visit a health care provider who refused to embrace AI technology.
Early evidence shows ChatGPT can accurately answer some medical questions. A accurate study by physicians at Massachusetts General Hospital and Taipei Medical University Shuang Ho Hospital, in Taiwan showed that the free version of the technology successfully answered common questions about colonoscopy prep. Most trained physicians couldnâ€™t tell which responses were from the bot and which were taken from hospital websites.
Whether the technology can accurately answer more complicated questions is unclear, and will be the focus of future research, said Dr. Braden Kuo, a neurogastroenterologist and director of the Center for Neurointestinal Health at MGH, who worked on the study. Some research has already shown the chatbot is more empathetic than physicians when answering medical questions.
For his part, Kohane said he will be disappointed if hospitals donâ€™t figure out how to use the technology to Improve care, a vision that includes alleviating administrative burdens and allowing physicians to spend more time with patients.
While the larger existential risks are worth considering, he said, the more immediate concern is making sure health systems use AI to Improve patient care and not simply to boost margins.
With the wrong goals, the technology could be problematic, squeezing ever more patient visits with every provider. Patients might be confronted with an empathetic robot when reaching out with questions or concerns, further fracturing the relationship patients have with their physicians.
The fact that the technology has been found to makes things up means it is concerning for use in patient clinical data.
â€śWe need a public discussion about what we are going to do with this technology,â€ť Kohane said. â€śIt can be used to Improve not just the doctor experience but the patient one, and reestablish the relationship that has been incredibly frayed over the last couple of decades. The technology is giving us the opportunity.â€ť
Patients with heart disease could benefit from less extensive interventions thanks to cutting-edge technology that creates 3D computer models of blood flow through the heart's arteries, according to research presented at the British Cardiovascular Society in Manchester.
When the research team trialled the VIRTUHeartTM technology with doctors treating heart attack patients, they found that using it would have changed the treatment of more than 20 per cent of patients. In many cases, it would have led to fewer patients undergoing an invasive procedure such as having a stent fitted.
By giving doctors a clearer picture of a patient's arteries, the research funded by the British Heart Foundation (BHF) showed that VIRTUHeartTM could help more heart patients to get the right treatment for them, free up doctors' time and better meet demand on heart care services.
The researchers are currently investigating the impact this technology could have if it was used widely in the NHS, including the effect it might have on waiting lists. They hope that it could be in use in as little as three years.
Dr Hazel Arfah Haley, Interventional Cardiologist at Sheffield Teaching Hospitals NHS Foundation Trust, led the study. She said:
"By giving doctors a better understanding of what is happening inside their patient's blood vessels, we've shown that this technology has the potential to help Improve how we assess and treat heart disease, ensuring patients have the treatment that best meets their needs.
"Our team are also investigating whether VIRTUHeartTM could Improve treatment for people with another common heart condition called angina, helping to make sure that even more patients get the treatment they need first time around."
There are up to 250,000 coronary angiograms performed in the UK every year - a test which allows doctors to look inside a patient's coronary arteries (which supply the heart muscle with blood) and check for blockages. This is one of the first tests that patients admitted to hospital with a heart attack will undergo and helps doctors plan treatment to restore blood supply to the heart muscle.
But angiograms can be hard to interpret when an artery is only partly blocked, and this can make it challenging for treatment decisions to be made, particularly when doctors are managing patients with complex heart disease.
The innovative technology, developed by researchers at the University of Sheffield, re-creates another invasive but underused test called a Fractional Flow Reserve (FFR) in which doctors insert a special wire into arteries to calculate how well blood is flowing. FFR is underused for several reasons including time pressure, availability, complex anatomy, and operator's familiarity.
Using only the images from a patient's angiogram, VIRTUHeartTM works as a "virtual FFR" and creates computer models of their blood vessels, allowing doctors to calculate blood flow and find out more about the extent of blockages.
The study involved 208 patients who were admitted to hospital with an NSTEMI â€“ a type of heart attack where the affected coronary artery isn't completely blocked. All of the patients had their coronary arteries reconstructed using VIRTUHeartTM.
After the patients had been treated, the researchers revealed the virtual blood vessel models to their doctors. They found that using the technology would have changed how doctors treated 46 patients (22 per cent). Of these, 21 patients who had an invasive procedure such as a stent would have instead been treated with medication only if the technology had been used to plan their treatment.
Overall, using VIRTUHeartTM to plan treatment would have led to 42 fewer stents being fitted â€“ a decrease of 18 per cent.
The VIRTUHeartTM system was developed by the Mathematical Modelling in Medicine research group in the department of Infection, Immunity and Cardiovascular Disease at the University of Sheffield, in partnership with the Insigneo Institute and Sheffield Teaching Hospitals NHS Foundation Trust.
CAMBRIDGE, MASS. (WHDH) - A new Massachusetts Institute of Technology study on sleep is finding that as youâ€™re nodding off you could be at your most creative.
Research from MIT and Harvard Medical School found that the sweet spot is when youâ€™re between sleeping and waking.
Researchers at MIT found that sleep and creativity are connected and that people are inventive as they drift off but the tricky part is timing.
The study also found that people can be guided to dream about a given subject and that those targeted dreams can make them more creative in the waking hours.
The researchers are also working to find out what information about dreams in the later stage of the sleeping process will yield with regards to creativity.
(Copyright (c) 2022 Sunbeam Television. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)
Estimated read time: 4-5 minutes
Editor's note: This is part of a series looking at the rise of artificial intelligence technology tools such as ChatGPT, the opportunities and risks they pose and what impacts they could have on various aspects of our daily lives.
SALT LAKE CITY â€” ChatGPT is not always great at providing accurate answers, but there's at least one realm in which it far surpasses social media: common cancer myths.
Dr. Skyler Johnson worked on a study with the Huntsman Cancer Institute days after the artificial intelligence chatbot was made available to see whether ChatGPT has accurate answers for common myths and misconceptions about cancer.
Johnson said the questions they fact-checked through the chatbot were commonly asked questions from a list created by the National Cancer Institute. ChatGPT's answers were pretty accurate, and 97% of the answers matched the answers from the National Cancer Institute.
On social media, about one-third of all articles or sources contain misinformation, according to Johnson.
He said sometimes patients' decisions, like refusing a prescribed or tested treatment in favor of something they read online or heard about from a friend, can lead to poor health outcomes. In a 2018 study, Johnson found patients who make the decision to go with unproven treatments have worse chances for survival; there is almost a sixfold increase in the risk for death.
For a while, it has been clear that social media is a source for much of this misinformation about cancer treatment, Johnson said, adding that "the vast majority of those contain the potential to hurt cancer patients."
He said the amount of misinformation is scary, and it is not uncommon to see patients make decisions to go with an alternative treatment and then come back later with cancer that has spread further.
"That's always disheartening, and I lose a lot of sleep over those situations," Johnson said.
Consequently, it's clear why Johnson was also interested in studying ChatGTP's accuracy. And after seeing the results of this most accurate study, he and other researchers noted answers the chatbot came up with, while accurate, were more vague than the answers provided by the National Cancer Institute.
That had them concerned about whether patients could interpret the answers as being less definitive than they are. Because of this, Johnson said they would not recommend using ChatGPT as a resource.
He also said it's likely ChatGPT would not be as accurate when asked about less-common cancer myths.
"I do think that we have to continually monitor this new information environment that includes these AI chatbots â€¦ because there's a potential risk that it starts producing misinformation at some point," Johnson said.
He said things could change, too. The study was completed when ChatGPT was only a few days old, and there have since been multiple updates.
"I have concerns, where things are evolving so quickly in this space, that although it looks accurate right now, it may not be accurate in the future," Johnson said.
He said cancer patients look for alternative treatments because they want to have control, have autonomy over their medical care, actively participate in their care, and because of fear of side effects from treatment.
"There's no guarantees in cancer care, and some people want certainty. â€¦ They will often choose false certainties in the face of known uncertainties," Johnson said.
He said doctors can work to Improve trust to help with this, spending more time with patients and communicating better. He said if doctors establish common goals with their patients, often to cure the cancer and reduce pain, then they can build trust.
Johnson splits his time between research and caring for patients directly. He said research allows for population-based changes, but as a physician he makes positive changes for individuals.
He encouraged patients to talk with their physicians about their questions and go to well-established websites for information, like the website for the Huntsman Cancer Institute or the National Cancer Institute.
"I think, a lot of times, patients have some fear that they might be judged by their physician or that their questions might be stupid, but that's rarely the case. Most physicians are very interested to know what patients are thinking about, and they want to help patients make the best decisions possible," he said.
Johnson said he is optimistic that AI could provide a way for cancer communication experts, doctors and organizations to help answer patients' questions accurately.
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