Developing an AI-Assisted Educational Chatbot for Radiotherapy Using the IBM Watson Assistant Platform.

Objectives: This study aims to make radiotherapy knowledge regarding healthcare accessible to the general public by developing an AI-powered chatbot. The interactive nature of the chatbot is expected to facilitate better understanding of information on radiotherapy through communication with users. Methods: Using the IBM Watson Assistant platform on IBM Cloud, the chatbot was constructed following a pre-designed flowchart that outlines the conversation flow. This approach ensured the development of the chatbot with a clear mindset and allowed for effective tracking of the conversation. The chatbot is equipped to furnish users with information and quizzes on radiotherapy to assess their understanding of the subject. Results: By adopting a question-and-answer approach, the chatbot can engage in human-like communication with users seeking information about radiotherapy. As some users may feel anxious and struggle to articulate their queries, the chatbot is designed to be user-friendly and reassuring, providing a list of questions for the user to choose from. Feedback on the chatbot's content was mostly positive, despite a few limitations. The chatbot performed well and successfully conveyed knowledge as intended. Conclusions: There is a need to enhance the chatbot's conversation approach to improve user interaction. Including translation capabilities to cater to individuals with different first languages would also be advantageous. Lastly, the newly launched ChatGPT could potentially be developed into a medical chatbot to facilitate knowledge transfer.

Learning the Treatment Process in Radiotherapy Using an Artificial Intelligence-Assisted Chatbot: Development Study.

BACKGROUND: In knowledge transfer for educational purposes, most cancer hospital or center websites have existing information on cancer health. However, such information is usually a list of topics that are neither interactive nor customized to offer any personal touches to people facing dire health crisis and to attempt to understand the concerns of the users. Patients with cancer, their families, and the general public accessing the information are often in challenging, stressful situations, wanting to access accurate information as efficiently as possible. In addition, there is seldom any comprehensive information specifically on radiotherapy, despite the large number of older patients with cancer, to go through the treatment process. Therefore, having someone with professional knowledge who can listen to them and provide the medical information with good will and encouragement would help patients and families struggling with critical illness, particularly during the lingering pandemic. OBJECTIVE: This study created a novel virtual assistant, a chatbot that can explain the radiation treatment process to stakeholders comprehensively and accurately, in the absence of any similar software. This chatbot was created using the IBM Watson Assistant with artificial intelligence and machine learning features. The chatbot or bot was incorporated into a resource that can be easily accessed by the general public. METHODS: The radiation treatment process in a cancer hospital or center was described by the radiotherapy process: patient diagnosis, consultation, and prescription; patient positioning, immobilization, and simulation; 3D-imaging for treatment planning; target and organ contouring; radiation treatment planning; patient setup and plan verification; and treatment delivery. The bot was created using IBM Watson (IBM Corp) assistant. The natural language processing feature in the Watson platform allowed the bot to flow through a given conversation structure and recognize how the user responds based on recognition of similar given examples, referred to as intents during development. Therefore, the bot can be trained using the responses received, by recognizing similar responses from the user and analyzing using Watson natural language processing. RESULTS: The bot is hosted on a website by the Watson application programming interface. It is capable of guiding the user through the conversation structure and can respond to simple questions and provide resources for requests for information that was not directly programmed into the bot. The bot was tested by potential users, and the overall averages of the identified metrics are excellent. The bot can also acquire users' feedback for further improvements in the routine update. CONCLUSIONS: An artificial intelligence-assisted chatbot was created for knowledge transfer regarding radiation treatment process to the patients with cancer, their families, and the general public. The bot that is supported by machine learning was tested, and it was found that the bot can provide information about radiotherapy effectively.

Chatbot for Health Care and Oncology Applications Using Artificial Intelligence and Machine Learning: Systematic Review.

BACKGROUND: Chatbot is a timely topic applied in various fields, including medicine and health care, for human-like knowledge transfer and communication. Machine learning, a subset of artificial intelligence, has been proven particularly applicable in health care, with the ability for complex dialog management and conversational flexibility. OBJECTIVE: This review article aims to report on the recent advances and current trends in chatbot technology in medicine. A brief historical overview, along with the developmental progress and design characteristics, is first introduced. The focus will be on cancer therapy, with in-depth discussions and examples of diagnosis, treatment, monitoring, patient support, workflow efficiency, and health promotion. In addition, this paper will explore the limitations and areas of concern, highlighting ethical, moral, security, technical, and regulatory standards and evaluation issues to explain the hesitancy in implementation. METHODS: A search of the literature published in the past 20 years was conducted using the IEEE Xplore, PubMed, Web of Science, Scopus, and OVID databases. The screening of chatbots was guided by the open-access Botlist directory for health care components and further divided according to the following criteria: diagnosis, treatment, monitoring, support, workflow, and health promotion. RESULTS: Even after addressing these issues and establishing the safety or efficacy of chatbots, human elements in health care will not be replaceable. Therefore, chatbots have the potential to be integrated into clinical practice by working alongside health practitioners to reduce costs, refine workflow efficiencies, and improve patient outcomes. Other applications in pandemic support, global health, and education are yet to be fully explored. CONCLUSIONS: Further research and interdisciplinary collaboration could advance this technology to dramatically improve the quality of care for patients, rebalance the workload for clinicians, and revolutionize the practice of medicine.

Using School-Based Health Programs to Prevent Human Trafficking: The Mount Sinai Experience.

This article describes how school-based health centers can serve as human trafficking prevention sites. Setting: School-based health centers are available to all students attending a school and are often located in schools whose students have risk factors associated with human trafficking: those with a history of running away from home; unstable housing or homelessness; a history of childhood maltreatment or substance use; LGBTQ-identification; physical or developmental disabilities, including students who have Individualized Education Programs and need special education; gang involvement; and/or a history of involvement in child welfare or the juvenile justice system. The Mount Sinai Adolescent Health Center provides a model of the types of service school clinics can offer, including integrated medical, sexual, and reproductive health, health education, and behavioral and mental health. Activities: Identifying young people with risk factors and addressing those factors in our clinics in a timely way can disrupt the progression to human trafficking. In addition, if young people who are trafficked are attending schools that have a clinic, their health needs, such as care for sexually transmitted infections and mental health issues, can be addressed on-site. Lastly, some people go to school to recruit students for human trafficking. By raising awareness and addressing human trafficking in the school, students can become aware of this issue and perhaps gain the ability to ask for help if they are approached or know of other students being recruited by a trafficker. Implications: The location of easily-accessible, adolescent-friendly, trafficking-aware services in schools can prevent, identify and intervene in human trafficking.

Options for Teens with No Options: A Self-Managed Second Trimester Abortion.

BACKGROUND: Several states have deemed abortions as nonessential services, effectively calling for a halt to abortion care during the COVID-19 pandemic. In response, women might elect for self-managed abortions by obtaining abortion medications online. CASE: A 15-year-old girl presented with abdominal cramping and vaginal discharge after taking misoprostol obtained from an online retailer for a self-managed abortion in her second trimester during the COVID-19 pandemic. Her exam showed products of conception protruding from the vagina. The patient was emergently evaluated for an incomplete and possible septic abortion and underwent a dilation and evacuation procedure.

Featured counter trafficking program: Mount Sinai Adolescent Health Center.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Mount Sinai Adolescent Health Center, a US-based health system dedicated to serving adolescents, some of whom are survivors of sex trafficking or at risk for sexual exploitation.

Markers of Cardiovascular Dysfunction in Adolescents With Anorexia Nervosa.

Background. Cardiovascular complications contribute to the high morbidity and mortality rate among children with anorexia nervosa (AN). Advances in cardiac imaging permit a more comprehensive assessment of myocardial performance in children that could not be previously obtained with conventional imaging. Myocardial strain analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in children. Objective. To assess global and regional left ventricular (LV0 function in children newly diagnosed with AN with conventional and quantitative 2-dimensional speckle tracking echocardiographic (2DSTE)-derived strain imaging. Materials. In a cross-sectional study of 30 patients with AN (DSM-5) and 14 age-, sex-, and race-matched healthy children, markers of cardiovascular risk, conventional and 2DSTE measures of LV function, and structure were evaluated and compared. The AN cohort was further stratified by behavioral patterns (restrict, exercise, or purge). Results. Conventional measures and LV global strain were similar between controls and children with AN. A subgroup of AN children with purging behavior had LV remodeling characterized by significantly decreased LV mass index. Regional ventricular function at the apex, as measured by strain, was also decreased in all AN patients. Percent change from ideal body weight, body mass index Z-score, electrolyte profiles, heart rate, and blood pressure were similar. Conclusions. Subclinical regional ventricular dysfunction is present in children with AN. Ventricular remodeling exists in a subgroup of children with AN in association with purging behavior. Future studies may utilize strain imaging to identify those AN patients who are at an increased risk for developing significant cardiac dysfunction.

Presumed primary and secondary hepatic copper accumulation in cats.

OBJECTIVE: To determine signalments, clinical features, clinicopathologic variables, imaging findings, treatments, and survival time of cats with presumed primary copper-associated hepatopathy (PCH) and to determine quantitative measures and histologic characteristics of the accumulation and distribution of copper in liver samples of cats with presumed PCH, extrahepatic bile duct obstruction, chronic nonsuppurative cholangitis-cholangiohepatitis, and miscellaneous other hepatobiliary disorders and liver samples of cats without hepatobiliary disease. DESIGN: Retrospective cross-sectional study. ANIMALS: 100 cats with hepatobiliary disease (PCH [n = 11], extrahepatic bile duct obstruction [14], cholangitis-cholangiohepatitis [37], and miscellaneous hepatobiliary disorders [38]) and 14 cats without hepatobiliary disease. PROCEDURES: From 1980 to 2013, cats with and without hepatobiliary disease confirmed by liver biopsy and measurement of hepatic copper concentrations were identified. Clinical, clinicopathologic, and imaging data were compared between cats with and without PCH. RESULTS: Cats with PCH were typically young (median age, 2.0 years); clinicopathologic and imaging characteristics were similar to those of cats with other liver disorders. Copper-specific staining patterns and quantification of copper in liver samples confirmed PCH (on the basis of detection of > 700 µg/g of liver sample dry weight). Six cats with PCH underwent successful treatment with chelation (penicillamine; n = 5), antioxidants (5), low doses of elemental zinc (2), and feeding of hepatic support or high-protein, low-carbohydrate diets, and other hepatic support treatments. One cat that received penicillamine developed hemolytic anemia, which resolved after discontinuation of administration. Three cats with high hepatic copper concentrations developed hepatocellular neoplasia. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that copper accumulates in livers of cats as primary and secondary processes. Long-term management of cats with PCH was possible.

The Newborn Behavioral Observations system as a nursing intervention to enhance engagement in first-time mothers: feasibility and desirability.

Engagement is the social process of maternal transition that enables growth and transformation and is linked to attachment and bonding. The feasibility and desirability of the Newborn Behavioral Observations (NBO) system as a nursing intervention to enhance engagement in first-time mothers were examined. The NBO is an exploration of the newborn conducted with parents to increase their understanding of their infant's behavioral cues as well as how to respond. Perceptions of the NBO were obtained from mothers who participated in NBO sessions in the postpartum period and from unit nurses who had been given information on the NBO. Mothers (n= 10) rated the NBO high for increasing their knowledge of what their infants can do (m=3.7/4.0, SD=0.48), and how to interact with them (m=3.8/4.0, SD=0.63). Two of the activities of engagement, experiencing the infant and active participation in care, emerged as themes from the mothers' qualitative responses. Nurses (n=20) believed the NBO would be an effective intervention. Participants believed the NBO to be an effective nursing intervention for enhancing maternal engagement in the early postpartum period.

Adolescent constipation: evaluation and management.

It is important for physicians who deal with adolescents to become familiar with the multiple facets of the symptom of constipation. Constipation is not a life-threatening problem; however, affected patients may suffer a great deal of angst and have their lives disrupted, especially when it is left untreated. A thorough history and physical examination will uncover the majority of predisposing problems that may contribute to constipation. Most adolescents are adequately treated by appropriate behavioral and lifestyle changes and pharmacologic interventions. Failure of treatment despite good compliance requires reconsideration of the differential diagnosis, further evaluation, and possible referral to the subspecialist.