Ensuring useful adoption of generative artificial intelligence in healthcare.

OBJECTIVES: This article aims to examine how generative artificial intelligence (AI) can be adopted with the most value in health systems, in response to the Executive Order on AI. MATERIALS AND METHODS: We reviewed how technology has historically been deployed in healthcare, and evaluated recent examples of deployments of both traditional AI and generative AI (GenAI) with a lens on value. RESULTS: Traditional AI and GenAI are different technologies in terms of their capability and modes of current deployment, which have implications on value in health systems. DISCUSSION: Traditional AI when applied with a framework top-down can realize value in healthcare. GenAI in the short term when applied top-down has unclear value, but encouraging more bottom-up adoption has the potential to provide more benefit to health systems and patients. CONCLUSION: GenAI in healthcare can provide the most value for patients when health systems adapt culturally to grow with this new technology and its adoption patterns.

Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?

Heparin has long been a contested therapy in acute ischemic stroke (AIS). In current practice, heparin is considered on a case-by-case basis, but there is no consensus as to the appropriate timing of anticoagulation or for which ischemic stroke subtypes heparin may be beneficial. To provide better clarity on this issue, we review current research focusing on the use of heparin in AIS in each stroke subtype and subsequently make recommendations to provide readers with a systematic approach to managing complex stroke patients for which acute anticoagulation may be valuable. We conclude that there are certain subpopulations of ischemic stroke patients that may derive benefit from heparin when given acutely, including patients with symptomatic large artery stenosis >70 %, non-occlusive intraluminal thrombus, and in patients with high-risk cardiac conditions including left ventricular thrombus, left ventricular assist devices, and mechanical heart valves.

Motor deficits in homozygous and heterozygous p/q-type calcium channel mutants.

P/Q-type voltage-dependent Ca(2+) channels (VDCCs) are highly expressed in the cerebellum, and mutations of these channels are associated with disrupted motor function. Several allelic variants of the alpha1A pore-forming subunit of P/Q-type VDCCs have been described, and mice homozygous for these mutations exhibit gait ataxia, as do alpha1A knockout mice. Here we report that heterozygous alpha1A mutants also have a motor phenotype. Mice heterozygous for the leaner and alpha1A knockout mutations exhibit impaired motor learning in the vestibulo-ocular reflex (VOR), suggesting that subtle disruption of P/Q Ca(2+) currents is sufficient to disrupt motor function. Basal VOR and optokinetic reflex performance were normal in the heterozygotes but severely impaired in the leaner and alpha1A knockout homozygotes.