Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review.

BACKGROUND: Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review. OBJECTIVE: With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations. METHODS: PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts. RESULTS: Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality's convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use. CONCLUSIONS: For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits.

Exploring the Need for Medical Futures Studies: Insights From a Scoping Review of Health Care Foresight.

BACKGROUND: The historical development and contemporary instances of futures studies, an interdisciplinary field that focuses on exploring and formulating alternative futures, exemplify the increasing significance of using futures methods in shaping the health care domain. Despite the wide array of these methodologies, there have been limited endeavors to employ them within the medical community thus far. OBJECTIVE: We undertook the first scoping review to date about the application of futures methodologies and published foresight projects in health care. METHODS: Through the use of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) method, we identified 59 studies that were subsequently categorized into the following 5 distinct themes: national strategies (n=19), strategic health care foresight (n=15), health care policy and workforce dynamics (n=6), pandemic preparedness and response (n=7), and specialized medical domains (n=12). RESULTS: Our scoping review revealed that the application of futures methods and foresight has been successfully demonstrated in a wide range of fields, including national strategies, policy formulation, global threat preparedness, and technological advancements. The results of our review indicate that a total of 8 futures methods have already been used in medicine and health care, while there are more than 50 futures methods available. It may underscore the notion that the field is unexploited. Furthermore, the absence of structured methodologies and principles for employing foresight and futures techniques in the health care domain warrants the creation of medical futures studies as a separate scientific subfield within the broad domains of health care, medicine, and life sciences. This subfield would focus on the analysis of emerging technological trends, the evaluation of policy implications, and the proactive anticipation and mitigation of potential challenges. CONCLUSIONS: Futures studies can significantly enhance medical science by addressing a crucial deficiency in the promotion of democratic participation, facilitating interdisciplinary dialogue, and shaping alternative futures. To further contribute to the development of a new research community in medical futures studies, it is recommended to establish a specialized scientific journal. Additionally, appointing dedicated futurists in decision-making and national strategy, and incorporating futures methods into the medical curriculum could be beneficial.

Prompt Engineering as an Important Emerging Skill for Medical Professionals: Tutorial.

Prompt engineering is a relatively new field of research that refers to the practice of designing, refining, and implementing prompts or instructions that guide the output of large language models (LLMs) to help in various tasks. With the emergence of LLMs, the most popular one being ChatGPT that has attracted the attention of over a 100 million users in only 2 months, artificial intelligence (AI), especially generative AI, has become accessible for the masses. This is an unprecedented paradigm shift not only because of the use of AI becoming more widespread but also due to the possible implications of LLMs in health care. As more patients and medical professionals use AI-based tools, LLMs being the most popular representatives of that group, it seems inevitable to address the challenge to improve this skill. This paper summarizes the current state of research about prompt engineering and, at the same time, aims at providing practical recommendations for the wide range of health care professionals to improve their interactions with LLMs.

The Impact of Multimodal Large Language Models on Health Care's Future.

When large language models (LLMs) were introduced to the public at large in late 2022 with ChatGPT (OpenAI), the interest was unprecedented, with more than 1 billion unique users within 90 days. Until the introduction of Generative Pre-trained Transformer 4 (GPT-4) in March 2023, these LLMs only contained a single mode-text. As medicine is a multimodal discipline, the potential future versions of LLMs that can handle multimodality-meaning that they could interpret and generate not only text but also images, videos, sound, and even comprehensive documents-can be conceptualized as a significant evolution in the field of artificial intelligence (AI). This paper zooms in on the new potential of generative AI, a new form of AI that also includes tools such as LLMs, through the achievement of multimodal inputs of text, images, and speech on health care's future. We present several futuristic scenarios to illustrate the potential path forward as multimodal LLMs (M-LLMs) could represent the gateway between health care professionals and using AI for medical purposes. It is important to point out, though, that despite the unprecedented potential of generative AI in the form of M-LLMs, the human touch in medicine remains irreplaceable. AI should be seen as a tool that can augment health care professionals rather than replace them. It is also important to consider the human aspects of health care-empathy, understanding, and the doctor-patient relationship-when deploying AI.

The ChatGPT (Generative Artificial Intelligence) Revolution Has Made Artificial Intelligence Approachable for Medical Professionals.

In November 2022, OpenAI publicly launched its large language model (LLM), ChatGPT, and reached the milestone of having over 100 million users in only 2 months. LLMs have been shown to be useful in a myriad of health care-related tasks and processes. In this paper, I argue that attention to, public access to, and debate about LLMs have initiated a wave of products and services using generative artificial intelligence (AI), which had previously found it hard to attract physicians. This paper describes what AI tools have become available since the beginning of the ChatGPT revolution and contemplates how it they might change physicians' perceptions about this breakthrough technology.

Patient Design: The Importance of Including Patients in Designing Health Care.

A paradigm shift is underway in the patient-clinician relationship, driven by irreversible changes in information access, yet the model under which clinicians are trained, care is conducted, and care delivery is designed has not changed significantly even though we call it "patient centered." Humanity endured centuries in which even doctors had little idea what the patient's problem really was. Science slowly solved that, and for a century, only doctors could know what was worth knowing. Today, the rise of the internet and digital health has led to the end of that era. We are already witnessing early signs of the era of participatory health: genuinely empowered people living their lives and managing their health according to their own priorities, in partnership and consultation with physicians as needed. This may feel like a threat to the physician's sacred role, but it is no more so than when physicians adopted informed consent and then shared decision-making. In the 2010s, many pharmaceutical, medical, and health care companies started to use patient centricity as a mantra. We argue that to drive this paradigm change fully into existence, we need to shift "patient centricity" from a relatively passive process, driven by industry needs, into a far more active, collaborative process driven by both parties' needs and preferences. To build this new world of practice and workflow, we simply must engage with patients as true partners. To achieve medicine's new potential, it must be optimized around the wants and priorities of the ultimate stakeholder-the party that has the most at stake in how it all plays out: the patient. Patient design is the approach that can make it happen.

A Revised Hippocratic Oath for the Era of Digital Health.

Physicians have been taking the Hippocratic Oath for centuries. The Oath contains a set of ethical rules designed to guide physicians through their profession; it articulates a set of true north principles that govern the practice of medicine. The Hippocratic Oath has undergone several revisions, most notably in 1948 by the World Medical Association. However, in an era of rapid change in medicine, we believe it is time to update the Oath with modest but meaningful additions so that it optimally reflects 21st century health care. The rise of digital health has dramatically changed the practice of medicine in a way that could not have been easily predicted at the time Hippocrates outlined his ethical principles of medicine. Digital health is a broad term that encompasses use of digital devices and platforms, including electronic health records, patient-provider portals, mobile health apps, wearable biosensors, artificial intelligence, social media platforms, and medical extended reality, to improve the process and outcomes of health care delivery. These technologies have driven a cultural transformation in the delivery of care. We offer modest suggestions to help prompt discussion and contemplation about the current Oath and its relevancy to our changing times. Our suggestions are not meant to be a definitive set of final recommendations. Rather, we propose new text that bodies such as the World Medical Association might consider integrating into an updated Oath, just as previous changes were adopted to ensure the Oath remains relevant and impactful for all physicians and their patients.

The Real Era of the Art of Medicine Begins with Artificial Intelligence.

Physicians have been performing the art of medicine for hundreds of years, and since the ancient era, patients have turned to physicians for help, advice, and cures. When the fathers of medicine started writing down their experience, knowledge, and observations, treating medical conditions became a structured process, with textbooks and professors sharing their methods over generations. After evidence-based medicine was established as the new form of medical science, the art and science of medicine had to be connected. As a result, by the end of the 20th century, health care had become highly dependent on technology. From electronic medical records, telemedicine, three-dimensional printing, algorithms, and sensors, technology has started to influence medical decisions and the lives of patients. While digital health technologies might be considered a threat to the art of medicine, I argue that advanced technologies, such as artificial intelligence, will initiate the real era of the art of medicine. Through the use of reinforcement learning, artificial intelligence could become the stethoscope of the 21st century. If we embrace these tools, the real art of medicine will begin now with the era of artificial intelligence.

The Rise of the Empowered Physician in the Digital Health Era: Viewpoint.

Being a 21st-century health care provider is extremely demanding. The growing number of chronic diseases, lack of medical workforce, increasing amounts of administrative tasks, the cost of medical treatment, and rising life expectancy result in an immense challenge for medical professionals. This transformation has been triggered by the growing presence of digital health. Digital health does not only refer to technological transformation; it also fundamentally reshapes the physician-patient relationship and treatment circumstances. We argue that patient empowerment, the spread of digital health, the biopsychosocial-digital approach, and the disappearance of the ivory tower of medicine lead to a new role for physicians. Digital health allows the job of being a medical professional to become more rewarding and creative. The characteristics of a physician-as-idol could shift from self-confident to curious, from rule follower to creative, and from lone hero to team worker. Empowered physicians (e-physicians) can be described as "electronic," where they use digital technologies in their practice with ease; "enabled," where they are enabled by regulations and guidelines; and "empowered," where they are empowered by technologies that support their job and their empowered patients (e-patients). They can be described as "experts" in the use of technologies in their practice or in knowing the best, most reliable, and trustworthy digital health sources and technologies. They can also be described as "engaged," when understanding the feelings and points of view of their patients, giving relevant feedback, and involving them throughout the whole healing process. The skills and approaches that characterize this era of e-physicians, such as face-to-face communication skills, digital literacy, interdisciplinarity, knowing where to find information, translating large amounts of data into insights for patients, among others, should always have been at the core of practicing medicine. However, the economical, technological, and administrative burden of the profession has not made it possible for most physicians to enjoy the benefits of their training, individual capabilities, and creativity. By understanding how digital health technologies can support or augment their capabilities, physicians would have the chance to practice the art of medicine like never before.

Will artificial intelligence solve the human resource crisis in healthcare?

Artificial intelligence (AI) has the potential to ease the human resources crisis in healthcare by facilitating diagnostics, decision-making, big data analytics and administration, among others. For this we must first tackle the technological, ethical and legal obstacles.The human resource crisis is widening worldwide, and it is obvious that it is not possible to provide care without workforce. How can disruptive technologies in healthcare help solve the variety of human resource problems? Will technology empower physicians or replace them? How can the medical curriculum, including post-graduate education prepare professionals for the meaningful use of technology? These questions have been growing for decades, and the promise of disruptive technologies filling them is imminent with digital health becoming widespread. Authors of this essay argue that AI might not only fill the human resources gap, but also raises ethical questions we need to deal with today.While there are even more questions to address, our stand is that AI is not meant to replace caregivers, but those who use AI will probably replace those who don't. And it is possible to prepare for that.

[An objective scoring system to evaluate the credibility of health related websites]. / Rendszer az egészségügyi weboldalak hitelesítésére.

INTRODUCTION AND AIM: The unreliable quality of online health contents poses a serious challenge to the medical profession. Evaluating websites on the basis of their credibility increases the chance for readers to access professional content of better quality. Hungary still lags behind in taking practical steps to improve the quality and reliability of online patient education. METHOD: EgészségKommandó (HealthCommando) is a new Hungarian objective scoring system established to evaluate the credibility of health related websites. It uses four types of indicators: transparency, content, recommendations, references. RESULTS: We evaluated 122 websites with EgészségKommandó. Out of this, 22.1% qualified as credible. The same assessment using JAMA benchmarks yielded only one credible website (0.8%). The most frequent deficiencies were the absence of reference to source, the omission of the quote that "the website information does not replace the doctor-patient discussion", and the identity of the author. In 45.9% of the cases, however, the content was written by medical professionals with contact information. CONCLUSION: By applying different types of credibility and quality indicators in a scoring system, EgészségKommandó can efficiently assess the websites on health-awareness. In cases where the recognized indicators are absent multiple times from a website, it will not pass the credibility test. Thus, EgészégKommandó can act as a filter. At the same time, EgészségKommandó is also capable of assessing webpages of different sorts systemically, and can recommend a proportionately large amount of reliable Hungarian medical web resources to those interested. Orv Hetil. 2018; 159(13): 511-519.

A review of technology giants' healthcare collaborations.

Healthcare in the 21st century has become more dependent on technologies than ever before). The cultural transformation called digital health has brought a range of advanced technologies into the practice of medicine and the delivery of healthcare. This has led to a rise of consumerism, an approach that would put the interests of the patients on top of those of healthcare or medical professionals in general. Companies that have traditionally been involved with developing medications, medical technologies and biotech inventions, have started to turn to developing digital health-related solutions and products. This is the change in healthcare that has started to attract companies that have never been involved with this industry. Companies like Amazon, Google (and their parent company, Alphabet), Microsoft, NVIDIA, IBM, Apple and Samsung would primarily fall into this category. Technology giants have clear incentives to enter the healthcare market as patients and medical professionals turn more to technological products to obtain, access and analyze health and medical data. However, without precious healthcare data, tech giants face a challenge in developing relevant technologies that could be implemented in the clinical practice, therefore they started to collaborate with healthcare institutions that traditionally own and store such health data. We reviewed those collaborations between tech giants and healthcare institutions that have been made public to provide a picture about the nature of these collaborations and their purposes. Our goal was to shed light on the potential privacy consequences as well as the technological advantages of tech giants' collaborating with healthcare institutions. To our knowledge, this is the first review of such collaborations in the medical literature.

The imperative for regulatory oversight of large language models (or generative AI) in healthcare.

The rapid advancements in artificial intelligence (AI) have led to the development of sophisticated large language models (LLMs) such as GPT-4 and Bard. The potential implementation of LLMs in healthcare settings has already garnered considerable attention because of their diverse applications that include facilitating clinical documentation, obtaining insurance pre-authorization, summarizing research papers, or working as a chatbot to answer questions for patients about their specific data and concerns. While offering transformative potential, LLMs warrant a very cautious approach since these models are trained differently from AI-based medical technologies that are regulated already, especially within the critical context of caring for patients. The newest version, GPT-4, that was released in March, 2023, brings the potentials of this technology to support multiple medical tasks; and risks from mishandling results it provides to varying reliability to a new level. Besides being an advanced LLM, it will be able to read texts on images and analyze the context of those images. The regulation of GPT-4 and generative AI in medicine and healthcare without damaging their exciting and transformative potential is a timely and critical challenge to ensure safety, maintain ethical standards, and protect patient privacy. We argue that regulatory oversight should assure medical professionals and patients can use LLMs without causing harm or compromising their data or privacy. This paper summarizes our practical recommendations for what we can expect from regulators to bring this vision to reality.

COVID-19's Impact on Digital Health Adoption: The Growing Gap Between a Technological and a Cultural Transformation.

Health care in the 21st century has started undergoing major changes due to the rising number of patients with chronic conditions; increased access to new technologies, medical information, and peer support via the internet; and the ivory tower of medicine breaking down. This marks the beginning of a cultural transformation called digital health. This has also led to a shift in the roles of patients and medical professionals, resulting in a new, equal partnership. When COVID-19 hit, the adoption of digital health technologies skyrocketed. The technological revolution we had been aiming for in health care took place in just months due to the pandemic, but the cultural transition is lagging. This creates a dangerous gap between what is possible technologically through remote care, at-home lab tests, or health sensors and what patients and physicians are actually longing for. If we do it well enough now, we can spare a decade of technological transformations and bring that long-term vision of patients becoming the point of care to the practical reality of today. This is a historic opportunity we might not want to waste.

Chronic obstructive pulmonary disease-specific gene expression signatures of alveolar macrophages as well as peripheral blood monocytes overlap and correlate with lung function.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease characterized by progressive airflow limitation and significant extrapulmonary (systemic) effects that lead to co-morbid conditions, though the pathomechanism of COPD is largely undetermined. Alveolar macrophages (AM) derived from peripheral monocytes (MO) appear to play a key role in initiating and/or sustaining disease progression. OBJECTIVES: To identify disease- and cell type-specific gene expression profiles and potential overlaps in those in order to diagnose COPD, characterize its progression and determine the effect of drug treatment. METHOD: Global gene expression analysis was used for primary screening in order to obtain expression signatures of AMs and circulating MOs of COPD patients and healthy controls. The results of microarray analyses of AMs (20 controls and 26 COPD patients) and MOs (16 controls and 22 COPD patients) were confirmed and validated by real-time quantitative polymerase chain reaction. RESULTS: We have identified gene sets specifically associated with COPD in AMs and MOs. There were overlapping genes between the two cell types. Our data also show that COPD-specific gene expression signatures in AMs and MOs correlate with percent of predicted FEV(1). CONCLUSION: Disease-specific and overlapping gene expression signatures can be defined in lung-derived macrophages and also in circulating monocytes. Some of the validated expression changes in both cell types correlate with lung function and therefore could serve as biomarkers of disease progression.

Wikipedia: a key tool for global public health promotion.

The Internet has become an important health information resource for patients and the general public. Wikipedia, a collaboratively written Web-based encyclopedia, has become the dominant online reference work. It is usually among the top results of search engine queries, including when medical information is sought. Since April 2004, editors have formed a group called WikiProject Medicine to coordinate and discuss the English-language Wikipedia's medical content. This paper, written by members of the WikiProject Medicine, discusses the intricacies, strengths, and weaknesses of Wikipedia as a source of health information and compares it with other medical wikis. Medical professionals, their societies, patient groups, and institutions can help improve Wikipedia's health-related entries. Several examples of partnerships already show that there is enthusiasm to strengthen Wikipedia's biomedical content. Given its unique global reach, we believe its possibilities for use as a tool for worldwide health promotion are underestimated. We invite the medical community to join in editing Wikipedia, with the goal of providing people with free access to reliable, understandable, and up-to-date health information.

The Medical Futurist Institute: A vision about the technological future of healthcare.

As digital health technologies make patients the point of care, The Medical Futurist and its accompanying Institute are designed to help individual patients and medical professionals prepare for changes in the near future.

A short guide for medical professionals in the era of artificial intelligence.

Artificial intelligence (A.I.) is expected to significantly influence the practice of medicine and the delivery of healthcare in the near future. While there are only a handful of practical examples for its medical use with enough evidence, hype and attention around the topic are significant. There are so many papers, conference talks, misleading news headlines and study interpretations that a short and visual guide any medical professional can refer back to in their professional life might be useful. For this, it is critical that physicians understand the basics of the technology so they can see beyond the hype, evaluate A.I.-based studies and clinical validation; as well as acknowledge the limitations and opportunities of A.I. This paper aims to serve as a short, visual and digestible repository of information and details every physician might need to know in the age of A.I. We describe the simple definition of A.I., its levels, its methods, the differences between the methods with medical examples, the potential benefits, dangers, challenges of A.I., as well as attempt to provide a futuristic vision about using it in an everyday medical practice.