The Effect of AI-Enhanced Breast Imaging on the Caring Radiologist-Patient Relationship.

AI has shown radiologist-level performance at diagnosis and detection of breast cancer from breast imaging such as ultrasound and mammography. Integration of AI-enhanced breast imaging into a radiologist's workflow through the use of computer-aided diagnosis systems, may affect the relationship they maintain with their patient. This raises ethical questions about the maintenance of the radiologist-patient relationship and the achievement of the ethical ideal of shared decision-making (SDM) in breast imaging. In this paper we propose a caring radiologist-patient relationship characterized by adherence to four care-ethical qualities: attentiveness, competency, responsiveness, and responsibility. We examine the effect of AI-enhanced imaging on the caring radiologist-patient relationship, using breast imaging to illustrate potential ethical pitfalls.Drawing on the work of care ethicists we establish an ethical framework for radiologist-patient contact. Joan Tronto's four-phase model offers corresponding elements that outline a caring relationship. In conjunction with other care ethicists, we propose an ethical framework applicable to the radiologist-patient relationship. Among the elements that support a caring relationship, attentiveness is achieved after AI-integration through emphasizing radiologist interaction with their patient. Patients perceive radiologist competency by effective communication and medical interpretation of CAD results from the radiologist. Radiologists are able to administer competent care when their personal perception of their competency is unaffected by AI-integration and they effectively identify AI errors. Responsive care is reciprocal care wherein the radiologist responds to the reactions of the patient in performing comprehensive ethical framing of AI recommendations. Lastly, responsibility is established when the radiologist demonstrates goodwill and earns patient trust by acting as a mediator between their patient and the AI system.

Toxic epidermal necrolysis in adult patients: Experience from the West Australian Collaboration.

Toxic epidermal necrolysis (TEN) is a rare and life-threatening mucocutaneous disease triggered by a reaction to a drug. Despite reported mortality of 30%, management differs between healthcare settings. Our hospital was established in February 2015 becoming the new state burns centre in Western Australia (WA). Following this, we collaborated on comprehensive multidisciplinary guidelines for the management of TEN. These guidelines are updated annually to reflect the weight of emerging evidence in managing TEN. Our aim was to review the management and outcomes of TEN patients presenting to our hospital between February 2015 and May 2021 (inclusive). We collected data for 10 patients on year, age, ethnicity, gender, medical history, culprit drug and exposure, SCORTEN, length of stay, maximum percentage of skin detachment, mucosal surface involvement, ophthalmic amniotic membrane transplant, burns unit input/admission, intensive care unit admission, weight, systemic treatment(s), complications and outcome. We excluded 7 out of 17 flagged patients who did not strictly meet the definition of TEN as greater than 30% epidermal detachment, with epidermal detachment defined as bullae, erosions, and/or positive Nikolsky. We found that the mortality rate in WA from TEN is improving compared with two previous WA studies, with a mortality rate in our study of 20% (2 deaths). Though limited by small sample size and retrospective design, our study suggests a shift towards at least one systemic therapy per patient (most commonly cyclosporine), the growing use of etanercept and the ophthalmic use of amniotic membrane transplants. It demonstrates the importance of burns unit input and the utility of comprehensive multidisciplinary guidelines. While the management and outcomes of TEN patients in WA are continuing to improve, we support calls for large registry data to facilitate evidence growth and collaboration for this rare life-threatening condition.

A community intervention by firefighters to increase 911 calls and aspirin use for chest pain.

OBJECTIVES: To test the effectiveness of an intervention, delivered face-to-face by local firefighters, designed to increase utilization of 911 and self-administration of aspirin for seniors experiencing chest pain. METHODS: King County, Washington was divided into 126 geographically distinct areas that were randomized to intervention and control areas. A mailing list identified households of seniors within these areas. More than 20,000 homes in the intervention areas were contacted by local firefighters. Data on all 911 calls for chest pain and self-administration of aspirin were collected from the medical incident report form (MIRF). The unit of analysis was the area. Firefighters delivered a heart attack survival kit (that included an aspirin) and counseled participants on the importance of aspirin and 911 use for chest pain. Main outcome measures were 911 calls for chest pain and aspirin ingestion for a chest pain event, obtained from the MIRFs that are collected by emergency medical services personnel for 2 years after the intervention. RESULTS: There were significantly more calls (16%) among seniors on the mailing list in the intervention than control areas in the first year after the intervention. Among the seniors who were not on the mailing list, there was little difference in the intervention and control areas. The results were somewhat sensitive to the analytical model used and to an outlier in the treatment group. CONCLUSIONS: A community-based firefighter intervention can be effective in increasing appropriate response to symptoms of a heart attack among elders.

Do older adults use the Internet for information on heart attacks? Results from a survey of seniors in King County, Washington.

BACKGROUND: Early treatment can reduce mortality from heart attacks. However, patient delay, especially among the elderly, has slowed progress in this area. One of the reasons for delay may be because of a lack of knowledge about symptoms of acute myocardial infarction (AMI) and treatment benefits. The Internet is a new and promising source of heart health information, but we know little about how elderly people use this medium. METHODS: This study investigates the demographic and psychosocial variables that are related to Internet access, health information seeking, and information seeking about heart attacks from the Internet among seniors. We interviewed seniors (N = 323) aged more than 65 years and asked them questions about Internet access, health information seeking, and information seeking on heart attacks, as well as demographic information, risk perceptions for AMI, and personal experience with AMI. RESULTS: The results showed that several demographic variables were related to access to the Internet. Only 7% of the seniors who reported access to the Internet had sought information on heart attacks from the Internet. Age, history of AMI, and family history of AMI were significant predictors of information seeking on heart attacks. This suggests that to date only a very small, high-risk group of seniors actually seeks information on heart attack emergencies from the Internet.

Evaluation of a public education program delivered by firefighters on early recognition of a heart attack.

The Heart Attack Survival Kit (HASK) project is a prospective, randomized trial, testing the effectiveness of an intervention delivered door-to-door by firefighters to increase use of 911 and ingestion of aspirin for symptoms of acute myocardial infarction (AMI) among seniors in King County, Washington. Firefighters visited 24,582 seniors in King County, Washington and delivered a Heart Attack Survival Kit. Another 24,191 senior households served as the control group. Outcomes of the program were measured by tracking 911 calls as well as survey data. This study reports on the results of the telephone survey with a random sample of seniors (N = 323) to assess their knowledge of and intentions to act during a heart emergency. Results of a logistic regression analysis showed that being female, being younger, and remembering the kit was significantly related to intentions to act appropriately to AMI symptoms. The results are discussed in terms of public education around AMI.

Intentions to use an automated external defibrillator during a cardiac emergency among a group of seniors trained in its operation.

OBJECTIVE: By decreasing the time to defibrillation, automated external defibrillators (AEDs) provide an opportunity for lay people to improve survival in out-of-hospital sudden cardiac arrest. We examined how beliefs, expectations, and actual performance are related to intentions to use an AED during a future heart emergency among a group of seniors. DESIGN AND OUTCOME MEASURES: One hundred fifty-nine seniors who had been previously trained in the operation of an AED were tested on their AED skills and asked about their perceptions regarding their AED skills; their expectations that an AED would save the life of a cardiac arrest victim; and their intentions to use an AED during a future cardiac event. RESULTS: Logistic regression analyses showed that greater self-perceived ability to use an AED better actual performance on skills assessment but not expectations regarding the efficacy of AED treatment were independently associated with positive intentions to use an AED in a future heart emergency. CONCLUSIONS: The likelihood that an elderly lay bystander will actually use an AED during a cardiac event may be closely tied to perceptions of his or her ability to operate an AED.