Three Epochs of Artificial Intelligence in Health Care.

Importance: Interest in artificial intelligence (AI) has reached an all-time high, and health care leaders across the ecosystem are faced with questions about where, when, and how to deploy AI and how to understand its risks, problems, and possibilities. Observations: While AI as a concept has existed since the 1950s, all AI is not the same. Capabilities and risks of various kinds of AI differ markedly, and on examination 3 epochs of AI emerge. AI 1.0 includes symbolic AI, which attempts to encode human knowledge into computational rules, as well as probabilistic models. The era of AI 2.0 began with deep learning, in which models learn from examples labeled with ground truth. This era brought about many advances both in people's daily lives and in health care. Deep learning models are task-specific, meaning they do one thing at a time, and they primarily focus on classification and prediction. AI 3.0 is the era of foundation models and generative AI. Models in AI 3.0 have fundamentally new (and potentially transformative) capabilities, as well as new kinds of risks, such as hallucinations. These models can do many different kinds of tasks without being retrained on a new dataset. For example, a simple text instruction will change the model's behavior. Prompts such as "Write this note for a specialist consultant" and "Write this note for the patient's mother" will produce markedly different content. Conclusions and Relevance: Foundation models and generative AI represent a major revolution in AI's capabilities, ffering tremendous potential to improve care. Health care leaders are making decisions about AI today. While any heuristic omits details and loses nuance, the framework of AI 1.0, 2.0, and 3.0 may be helpful to decision-makers because each epoch has fundamentally different capabilities and risks.

The Great Migration and Healthcare to Black America.

The Great Migration, the movement of 6,000,000 black Americans from the South to the great urban centers of the eastern seaboard, the industrial Midwest, and West Coast port cities from roughly 1915-1970, was one of the defining demographic events in American history. It dwarfed the 100,000 49ers who swarmed westward in search of gold, the incarceration of 110,000 Japanese to concentration camps in the American interior during World War II, and the 300,000 Okies who escaped the Dust Bowl to California. In the words of writer Isabel Wilkerson, "[It] swept a good portion of all the black people alive in the United States at the time into a river that carried them to all points north and west."Blacks crammed into urban districts rife with crime and communicable disease, subjecting them to risks of death far higher than their proportion of the population. Without access to adequate inpatient hospital facilities, they received care in public hospitals run by hospital staffs that excluded black physicians from their membership and medical schools that refused admission to black students. The untenable health station of Black America was one of the leading causes of the civil rights movement of the 1950s and 1960s, activism that succeeded in integrating the hospitals and medical schools by federal acts passed in 1964 and 1965 that transformed American medicine.

Scoping review of African health histories: a protocol.

INTRODUCTION: The history of African health is closely entwined with the history of the continent itself-from precolonial times to the present day. A study of African health histories is critical to understanding the complex interplay between social, economic, environmental and political factors that have shaped health outcomes on the continent. Furthermore, it can shed light on the successes and failures of past health interventions, inform current healthcare policies and practices, and guide future efforts to address the persistent health challenges faced by African populations. This scoping review aims to identify existing literature on African health histories. METHODS AND ANALYSIS: The Arksey and O'Malley's framework for conducting scoping reviews will be utilised for the proposed review, which will be reported in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The main review question is 'What literature exists on the history of health practices and healthcare delivery systems in Africa from the precolonial era through to the sustainable development goal era?' Keywords such as Africa, health and histories will be used to develop a search strategy to interrogate selected databases and grey literature repositories such as PubMed, Scopus, Web of Science and WHOLIS. Two authors will independently screen titles and abstracts of retrieved records. One author will extract data from articles that meet the inclusion criteria using a purposively designed data charting. The data would be coded and analysed thematically, and the findings presented narratively. ETHICS AND DISSEMINATION: The scoping review is part of a larger project which has approval from the WHO AFRO Ethics Research Committee (Protocol ID: AFR/ERC/2022/11.3). The protocol and subsequent review will be submitted to the integrated African Health Observatory and published in a peer-reviewed journal. REGISTRATION DETAILS: https://osf.io/xsaez/.

From hospital unit to intestinal failure center: Twenty years of history.

AIM: Home parenteral nutrition (HPN) is one of the most demanding medical therapies as it is the only option for patients for intestinal failure (IF). No unequivocal policy on how to start and progress with HPN has ever been presented. The IF Center at the Stanley Dudrick's Memorial Hospital in Skawina is one of the biggest centers in Poland, celebrating its twentieth birthday last year. It offered the unique chance to present how to create and grow the IF center, increasing the quality of care. The above became the aim of this study. METHODS: A retrospective analysis of all medical records of HPN patients from the University Hospital and Stanley Dudrick's Memorial Hospital in Skawina. Patient profile, clinical course and treatment outcomes were assessed. The evolution of all aspects of HPN is presented. A brief historical perspective has been added to better illustrate the center's growth and transformation. RESULTS: 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. The most frequent indication for HPN was mechanical obstruction (277, 45.7%), followed by short bowel syndrome (SBS, 208, 34.3%) and intestinal fistula (46, 7.59%). The most common primary disease was cancer (n = 267), followed by mesenteric ischemia (n = 104), and surgical complications (n = 62). 314 patients (51.8%) died. 73 (12.04%) were successfully weaned off PN. The catheter infection rate reached 0.39/1000 catheter days. CONCLUSIONS: the founding of the HPN center and its further development is possible provided that there is team of dedicated people, supported by hospital base. The real growth opportunity is guaranteed by the reimbursement. It is necessary to adapt to the changing circumstances.

One year of the pandemic - how European endocrinologists responded to the crisis: a statement from the European Society of Endocrinology.

Changes that COVID-19 induced in endocrine daily practice as well as the role of endocrine and metabolic comorbidities in COVID-19 outcomes were among the striking features of this last year. The aim of this statement is to illustrate the major characteristics of the response of European endocrinologists to the pandemic including the disclosure of the endocrine phenotype of COVID-19 with diabetes, obesity and hypovitaminosis D playing a key role in this clinical setting with its huge implication for the prevention and management of the disease. The role of the European Society of Endocrinology (ESE) as a reference point of the endocrine community during the pandemic will also be highlighted, including the refocusing of its educational and advocacy activities.

Understanding failings in patient safety: lessons from the case of surgeon Ian Paterson.

While rare, incidents of inappropriate and/or unnecessary surgery do occur, so effective surveillance of surgical practice is required to ensure patient safety. This article explores the case of Ian Paterson, a consultant surgeon who was sentenced to 20 years in prison in 2017 for wounding with intent and unlawful wounding, primarily by undertaking inappropriate or unnecessary mastectomies. The article details the main points of the Paterson case, with reference to the subsequent government-commissioned inquiry and its recommendations. It also outlines various strategies for enhancing patient safety, including applying human factors theory, improving auditing, and rationalising NHS and private healthcare. The author concludes that nurses have a crucial role in the surveillance of surgical practice and that combined reporting of surgeons' practice across NHS and private healthcare organisations is required.

[Between Alma-Ata and the Brazilian sanitary reform: the National Basic Health Services Program (Prev-saúde), 1979-1983]. / Entre Alma-Ata e a reforma sanitária brasileira: o Programa Nacional de Serviços Básicos de Saúde (Prev-saúde), 1979-1983.

The history of the National Basic Health Services Program (Prev-saúde) begins in 1979 with a joint effort involving the Ministries of Health, Social Security and Assistance, Interior, and Economy, as well as the Pan-American Health Organization. The objective was to reorganize basic health services in their connections with other levels of care. Internationally, it was part of the movement sparked by the International Conference on Primary Health Care in Alma-Ata in September 1978. Domestically, the program represented an accumulation of knowledge about the organization of services as well as a movement that was partially adapted to Brazilian health reform agenda. Prev-saúde was a set of health proposals that represented a technical consensus between bureaucracies and leaders of health reform.

A história do Programa Nacional de Serviços Básicos de Saúde (Prev-saúde) se inicia em 1979, na articulação entre os Ministérios da Saúde, da Previdência e Assistência Social, do Interior e da Economia e a Organização Pan-americana da Saúde. Teve como objetivo reorganizar os serviços básicos de saúde em suas conexões com os demais níveis assistenciais. Internacionalmente, inscrevia-se no movimento deflagrado pela Conferência de Alma-Ata, de setembro de 1978. Em termos nacionais, representava tanto um acúmulo de conhecimento sobre organização dos serviços quanto um movimento que se adequava, em parte, à agenda da reforma sanitária brasileira. O Prev-saúde representou um conjunto de proposições para a reorganização da saúde que, naquele contexto, era consenso técnico entre burocracias e lideranças da reforma da saúde.

Entre Alma-Ata e a reforma sanitária brasileira: o Programa Nacional de Serviços Básicos de Saúde (Prev-saúde), 1979-1983 / Between Alma-Ata and the Brazilian sanitary reform: the National Basic Health Services Program (Prev-saúde), 1979-1983

Resumo A história do Programa Nacional de Serviços Básicos de Saúde (Prev-saúde) se inicia em 1979, na articulação entre os Ministérios da Saúde, da Previdência e Assistência Social, do Interior e da Economia e a Organização Pan-americana da Saúde. Teve como objetivo reorganizar os serviços básicos de saúde em suas conexões com os demais níveis assistenciais. Internacionalmente, inscrevia-se no movimento deflagrado pela Conferência de Alma-Ata, de setembro de 1978. Em termos nacionais, representava tanto um acúmulo de conhecimento sobre organização dos serviços quanto um movimento que se adequava, em parte, à agenda da reforma sanitária brasileira. O Prev-saúde representou um conjunto de proposições para a reorganização da saúde que, naquele contexto, era consenso técnico entre burocracias e lideranças da reforma da saúde.

Abstract The history of the National Basic Health Services Program (Prev-saúde) begins in 1979 with a joint effort involving the Ministries of Health, Social Security and Assistance, Interior, and Economy, as well as the Pan-American Health Organization. The objective was to reorganize basic health services in their connections with other levels of care. Internationally, it was part of the movement sparked by the International Conference on Primary Health Care in Alma-Ata in September 1978. Domestically, the program represented an accumulation of knowledge about the organization of services as well as a movement that was partially adapted to Brazilian health reform agenda. Prev-saúde was a set of health proposals that represented a technical consensus between bureaucracies and leaders of health reform.

Broken Promises to the People of Newark: A Historical Review of the Newark Uprising, the Newark Agreements, and Rutgers New Jersey Medical School's Commitments to Newark.

Many have referred to the coronavirus disease 2019 crisis and intertwined issues of structural racism as "twin pandemics". As healthcare workers in Newark, New Jersey, a city heavily affected by the twin pandemics, we recognize that health workforce changes must be grounded in our community's recent history. The objective of this essay is to briefly describe the relationship between organized medicine, state and local leaders, and the people of Newark. We begin with a discussion of Newark in the 1950s and 1960s: its people experienced poor socioeconomic conditions, terrible medical care, and the many sequelae of abhorrent racism. Plans to establish a New Jersey Medical School in Newark's Central Ward also threatened to displace many residents from their homes. We then describe the Newark Agreements of 1968, which formalized a social contract between the state, business leaders, and people of Newark. In part, the Medical School committed to indefinitely promoting public health in Newark. We share progress towards this goal. Finally, we document key healthcare administrative decisions facing our community today. Stakeholder opinions are shared. We conclude that the Newark Agreements set an important standard for communities across the country. Creative solutions to healthcare policy may be realized through extensive community collaboration.

"HEALTH FOR ALL". THE MEDICAL SYSTEM IN WALLACHIA UNDER PROTOMEDICUS NICOLAE GUSSI 1848-1859.

The main objective of this study is to provide an overview of the evolution of the medical system in Wallachia between 1840 and 1860 and the very important role of physician Nicolae Gussi (1802-1869), protomedicus of Wallachia between 1840 and 1859, to transform medicine into a modern public service, accessible to the entire population. Particularly, we will refer to the medical reform project of 1853, which Gussi implemented during the time he headed the medical-sanitary administration. We will insist on the details of the project because it was designed to create a network of county hospitals that would improve the health of the population and, in the medium and long term, would reduce mortality and increase life expectancy. Another dimension of the study aims at the tenure of physicians in county hospitals and describes the medical services they provided to patients, particularly from the poor population.

The Economic Rationality of Religious-Based Medical Abstinence in the Early Twentieth Century: The Case of Philadelphia's Faith Tabernacle Congregation.

At the turn of the twentieth century, Faith Tabernacle Congregation's commitment to medical abstinence was an economically rational practice. To the working poor of Philadelphia, who constituted the earliest members, Faith Tabernacle's therapy was financially attainable, psychologically supportive, and physically rejuvenating. Orthodox medicine was deficient in these three areas based on the patient narratives (i.e., testimonies) published in the church's monthly periodical Sword of the Spirit and testimony book Words of Healing. First, some early members spent all their money on orthodox medical care without relief causing significant financial hardship, while others found medical care prohibitive. Second, many early members experienced a great loss of hope because orthodox physicians ended treatment due to chronic or critical illness, both of which were interpreted as psychologically harmful. Third, early members of the church perceived getting physically worse by physicians because of low quality care, which was compounded by low access to orthodox medicine. Faith Tabernacle alternatively provided care that - in the patient narratives of the earliest members - helped them improve and get back to work faster.

Social Democratic Solidarity and the Welfare State: Health Care and Single-Tier Universality in Sweden and Canada.

Although it is not generally done, it is useful to compare the history of the evolution of universal health coverage (UHC) in Canada and Sweden. The majority of citizens in both countries have shared, and continue to share, a commitment to a strong form of single-tier universality in the design of their respective UHC systems. In the postwar era, they also share a remarkably similar timeline in the emergence and entrenchment of single-tier UHC, despite the political and social differences between the two countries. At the same time, UHC was initially designed, implemented, and managed by social democratic governments that held power for long periods of time, creating a path dependency for single-tier Medicare that was difficult for future governments of different ideological persuasions to alter.

['A case of decapitation'; calamity investigation in 1822]. / 'Het geval van onthoofting'.

A case of childbirth with a fatal outcome described in the book 'The King's Court Physician: the Adventurous Life of Franz Joseph Harbaur, 1776-1822' (De lijfarts van de koning. Het avontuurlijkeleven van Franz Joseph Harbaur, 1776-1822) puts the work of the Dutch Health and Youth Care Inspectorate into an historical context by pointing out the similarities between a calamity investigation held in 1822 and the situation today. Conflicts between medical disciplinary law and criminal law, boundary disputes between various professions (in this particular case midwives and gynaecologists) and questions of openness and transparency turn out to be nothing new. By doing case studies on how to deal with calamities, it is possible to gain insight into medical failures of the past and how they were managed. It is also possible to get a better picture of the expectations that medicine had to meet in the past, and how, and under what circumstances, these have changed. This information is of value in making choices in today's healthcare system.

[Explore the history of artificial intelligence, to better define and understand it]. / Parcourir l'histoire de l'intelligence artificielle, pour mieux la définir et la comprendre.

TITLE: Parcourir l'histoire de l'intelligence artificielle, pour mieux la définir et la comprendre. ABSTRACT: L'intelligence artificielle est une expression fourre-tout, qui suscite autant d'espoirs que de craintes. Cette locution a envahi les médias, les conférences, les conversations, mais aussi les appels à projets des institutions de recherche et de diverses associations. On ne peut quasiment plus élaborer de projet de recherche sans mentionner une interface avec l'intelligence artificielle. Dans cet article, après la présentation d'une brève vision historique, nous proposerons une définition de l'intelligence artificielle et un paysage des possibles offerts par celle-ci.

[The development of the Austrian medical system-250 years ago the "Sanitäts-Hauptnormativ", 150 years ago the "Reichs-Sanitätsgesetz"]. / Das Werden des österreichischen Sanitätswesens ­ vor 250 Jahren das "Sanitäts-Hauptnormativ", vor 150 Jahren das "Reichs-Sanitätsgesetz".

The first regulations of the healthcare system in the domains and cities of the German Empire were the infection and plague regulations issued in many places from the sixteenth century onwards; however, as early as 1348 the Venetian state formed precise state structures to combat the black death that had broken out in Europe at the time. These were taken over analogously and in part in the Austrian states. Defense measures against the plague became particularly important on the k. k. (imperial-royal) military frontier against the Ottoman Empire. Under Empress Maria Theresa's enlightened absolutism, the state felt obliged to provide the largest possible healthy population with the help of the medical police. The fight against smallpox in Austria is described as an example. Through the collaboration of Maria Theresia with her protomedicus Gerard van Swieten, a codification of the k. k. healthcare system was created. As a quasi preliminary attempt the Empress proclaimed the Main Medical Regulations for Bohemia in 1753, which were supplemented 2 years later by the General Health Regulations for the Austrian Littoral. The result was the comprehensive medical standard for all hereditary lands from 1770. This brought about a regulation of all healthcare professions and their use for public health. Maria Theresa's son and successor introduced a further development of the administration in the direction of centralization and promotion of social conditions and humanitarian institutions, such as hospitals, infirmaries, childbirth houses and madhouses as well as foundling institutions and orphanages and poor and workhouses as special institutions. He was also very interested in promoting military medicine. The last major step in the development of the Austrian public healthcare system was the Imperial Sanitary Act of 1870. This is also the basis for the current structure of healthcare administration. The sanitary tasks are (and were) regulated in the legislation and enforcement of the (k.k.) State, and the federal states (kingdoms and countries represented in the Imperial Assembly) and the municipalities in, however, still existing complex division of some affairs between federal, state and local authorities.