Chapitre 6. The challenges and effects of digital medical devices on the doctor-patient relationship, as seen through the lens of treating sleep apnoea.

Tablets, smartphones, digital platforms, connected objects with or without Artificial Intelligence (AI) are invading our daily lives and transforming our relationships with others. Having already entered the field of wellness, in recent years we have seen the expectations and hopes raised by these new devices turn towards the field of health. In 2019, the European Parliament passed a resolution on a comprehensive European industrial policy on artificial intelligence and robotics 55, calling for caution in the use of algorithmic processes in the medical field and stressing that “the current system of approval of Digital Medical Devices may not be suitable for AI technologies”. Drawing on the framework of the treatment of sleep apnoea by continuous positive airway pressure (CPAP), our reflection highlights the fact that the increase in the amount of data, the acceleration of information, the disparity in the attractiveness and skills in IT and AI between the actors involved (doctors and patients), as well as the subjective effects of these changes lead to a redefinition of the doctor-patient relationship and a transformation of medical practice more generally.

Antidepressant therapy in patients undergoing coronary artery bypass grafting: the MOTIV-CABG trial.

BACKGROUND: The efficacy of antidepressant therapy in patients undergoing coronary artery bypass grafting (CABG) is not clearly established. METHODS: This double-blind trial was conducted at University Hospital, Besançon, France. Adult CABG patients were randomized (1:1) to receive escitalopram (10 mg daily) or placebo from 2 to 3 weeks before to 6 months after surgery, including 12 months post-surgery follow-up. The primary composite endpoint was the occurrence of mortality or predefined morbidity events. Secondary endpoints included measures of depression, mental and physical health using Beck Depression Inventory Short Form (BDI), and quality of life 36-Item Short Form (SF-36) self assessments. RESULTS: The treated cohort contained 361 patients with mean age 67 years. At 12 months, the proportions of patients with the composite morbidity and mortality endpoint were not different between escitalopram and placebo (110 of 182 [60.4%] vs 108 of 179 [60.3%], p = 0.984). However, over the 6 months postoperative period, the BDI and SF-36 Mental Component Summary scores were better overall in the escitalopram group than in the placebo group for all patients (p = 0.015 and p = 0.014, respectively) and preoperatively depressed (BDI > 3) patients (p = 0.002 and p = 0.005, respectively). Moreover, the SF-36 Pain score was better overall in the escitalopram group than in the placebo group in the preoperatively-depressed subset (p = 0.026). CONCLUSIONS: Antidepressant therapy had no effect on morbidity and mortality events up to 1 year after CABG. However, antidepressant therapy may provide faster improvements to mental health aspects of quality of life and reduce postoperative pain in patients with preoperative depression. Subject to contra-indications, we recommend antidepressant therapy in coronary revascularization patients who are preoperatively depressed.