User-acceptability of an automated telephone call for post-operative follow-up after uncomplicated cataract surgery.

BACKGROUND: Innovative technology is recommended to address the current capacity challenges facing the NHS. This study evaluates the patient acceptability of automated telephone follow-up after routine cataract surgery using Dora (Ufonia Limited, Oxford, United Kingdom), which to our knowledge is the first AI-powered clinical assistant to be used in the NHS. Dora has a natural-language, phone conversation with patients about their symptoms after cataract surgery. METHODS: This is a prospective mixed-methods cohort study that was conducted at Buckinghamshire Healthcare NHS Foundation Trust. All patients who were followed up using Dora were asked to give a Net Promoter Score (NPS), and 24 patients were randomly selected to complete the validated Telephone Usability Questionnaire (TUQ) as well as extended semi-structured interviews that underwent thematic analysis. RESULTS: A total of 170 autonomous calls were completed. The median NPS score was 9 out of 10. The TUQ (scored out of 5) showed high rates of acceptability, with an overall mean score of 4.0. Simplicity, time saving, and ease of use scored the highest with a median of 5, whilst 'speaking to Dora feels the same as speaking to a clinician' scored a median of 3. The main themes extracted from the qualitative data were 'I can see why you're doing it', 'It went quite well actually', 'I just trust human beings I suppose'. CONCLUSION: We found high levels of patient acceptability when using Dora across three acceptability measures. Dora provides a potential solution to reduce pressure on hospital capacity whilst also providing a convenient service for patients.

Safety and Acceptability of a Natural Language Artificial Intelligence Assistant to Deliver Clinical Follow-up to Cataract Surgery Patients: Proposal.

BACKGROUND: Due to an aging population, the demand for many services is exceeding the capacity of the clinical workforce. As a result, staff are facing a crisis of burnout from being pressured to deliver high-volume workloads, driving increasing costs for providers. Artificial intelligence (AI), in the form of conversational agents, presents a possible opportunity to enable efficiency in the delivery of care. OBJECTIVE: This study aims to evaluate the effectiveness, usability, and acceptability of Dora agent: Ufonia's autonomous voice conversational agent, an AI-enabled autonomous telemedicine call for the detection of postoperative cataract surgery patients who require further assessment. The objectives of this study are to establish Dora's efficacy in comparison with an expert clinician, determine baseline sensitivity and specificity for the detection of true complications, evaluate patient acceptability, collect evidence for cost-effectiveness, and capture data to support further development and evaluation. METHODS: Using an implementation science construct, the interdisciplinary study will be a mixed methods phase 1 pilot establishing interobserver reliability of the system, usability, and acceptability. This will be done using the following scales and frameworks: the system usability scale; assessment of Health Information Technology Interventions in Evidence-Based Medicine Evaluation Framework; the telehealth usability questionnaire; and the Non-Adoption, Abandonment, and Challenges to the Scale-up, Spread and Suitability framework. RESULTS: The evaluation is expected to show that conversational technology can be used to conduct an accurate assessment and that it is acceptable to different populations with different backgrounds. In addition, the results will demonstrate how successfully the system can be delivered in organizations with different clinical pathways and how it can be integrated with their existing platforms. CONCLUSIONS: The project's key contributions will be evidence of the effectiveness of AI voice conversational agents and their associated usability and acceptability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/27227.

The Effectiveness of Artificial Intelligence Conversational Agents in Health Care: Systematic Review.

BACKGROUND: The high demand for health care services and the growing capability of artificial intelligence have led to the development of conversational agents designed to support a variety of health-related activities, including behavior change, treatment support, health monitoring, training, triage, and screening support. Automation of these tasks could free clinicians to focus on more complex work and increase the accessibility to health care services for the public. An overarching assessment of the acceptability, usability, and effectiveness of these agents in health care is needed to collate the evidence so that future development can target areas for improvement and potential for sustainable adoption. OBJECTIVE: This systematic review aims to assess the effectiveness and usability of conversational agents in health care and identify the elements that users like and dislike to inform future research and development of these agents. METHODS: PubMed, Medline (Ovid), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and the Association for Computing Machinery Digital Library were systematically searched for articles published since 2008 that evaluated unconstrained natural language processing conversational agents used in health care. EndNote (version X9, Clarivate Analytics) reference management software was used for initial screening, and full-text screening was conducted by 1 reviewer. Data were extracted, and the risk of bias was assessed by one reviewer and validated by another. RESULTS: A total of 31 studies were selected and included a variety of conversational agents, including 14 chatbots (2 of which were voice chatbots), 6 embodied conversational agents (3 of which were interactive voice response calls, virtual patients, and speech recognition screening systems), 1 contextual question-answering agent, and 1 voice recognition triage system. Overall, the evidence reported was mostly positive or mixed. Usability and satisfaction performed well (27/30 and 26/31), and positive or mixed effectiveness was found in three-quarters of the studies (23/30). However, there were several limitations of the agents highlighted in specific qualitative feedback. CONCLUSIONS: The studies generally reported positive or mixed evidence for the effectiveness, usability, and satisfactoriness of the conversational agents investigated, but qualitative user perceptions were more mixed. The quality of many of the studies was limited, and improved study design and reporting are necessary to more accurately evaluate the usefulness of the agents in health care and identify key areas for improvement. Further research should also analyze the cost-effectiveness, privacy, and security of the agents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/16934.

A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery.

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.

A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery.

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.

Those who can, teach. Assessing medical students' perception of a finals revision programme delivered by foundation and core trainees: a cross-sectional study.

OBJECTIVE: To determine whether medical students perceive a foundation and core trainee finals revision programme as useful. DESIGN: Questionnaires were used to assess students' perception of the teaching programme. SETTING: A medical school in the South of England. PARTICIPANTS: There were 106 final year medical students in the cohort. RESULTS: The teaching scored well in all facets analysed and scored best on enthusiasm, interactivity and communication. CONCLUSIONS: We provide a framework for how foundation and core trainees could provide a very well received teaching programme benefiting medical students, the doctors and the medical school.

Repeat percutaneous coronary revascularization: indications and outcomes in a "real world" cohort.

OBJECTIVES: To investigate rates of and reasons for second and subsequent stent procedures in an unselected, "real-world" population. BACKGROUND: Repeat stenting is the primary difference reported in clinical trials of alternative revascularization strategies. The incidence, indication, and outcome for repeat stenting in contemporary practice outside the more selective populations of trials and registries has not been described. METHOD: All patients undergoing a first percutaneous coronary intervention (PCI) procedure with stenting from January 2001 to August 2009 (10,509) from a large UK tertiary referral and district general hospital were identified. Mortality and the incidence, timing, and indication for repeat revascularization in this population were investigated from patient records. RESULTS: Of 10,509 patients undergoing a first PCI and stent implant 23.5% underwent repeat angiography of which 11.2% required repeat PCI and 2% coronary artery bypass grafting (median follow-up of 3.8 years). A total of 1.3% went on to a third PCI. The commonest indication for repeat stenting was disease progression remote from the original stent (46%) and planned staged PCI (23%); 21% had a stent-related indication. Functional assessment before repeat stenting was used in one-third of stable patients. Mortality was 2.5% per annum. CONCLUSIONS: In contemporary practice, patients undergoing a first stenting procedure have a low subsequent mortality, and the substantial majority (86.4%) requires no further revascularization over a median 3.8 year follow-up. For those who do require repeat stenting, this is most commonly at a site remote from the first stent.