Feasibility of an artificial intelligence phone call for postoperative care following cataract surgery in a diverse population: two phase prospective study protocol.

INTRODUCTION: Artificial intelligence (AI) development has led to improvements in many areas of medicine. Canada has workforce pressures in delivering cataract care. A potential solution is using AI technology that can automate care delivery, increase effectiveness and decrease burdens placed on patients and the healthcare system. This study assesses the use of 'Dora', an example of an AI assistant that is able to deliver a regulated autonomous, voice-based, natural-language consultation with patients over the telephone. Dora is used in routine practice in the UK, but this study seeks to assess the safety, usability, acceptability and cost-effectiveness of using the technology in Canada. METHODS AND ANALYSIS: This is a two-phase prospective single-centred trial. An expected 250 patients will be recruited for each phase of the study. For Phase I of the study, Dora will phone patients at postoperative week 1 and for Phase II of the study, Dora will phone patients within 24hours of their cataract surgery and again at postoperative week 1. We will evaluate the agreement between Dora and a supervising clinician regarding the need for further review based on the patients' symptoms. A random sample of patients will undergo the System Usability Scale followed by an extended semi-structured interview. The primary outcome of agreement between Dora and the supervisor will be assessed using the kappa statistic. Qualitative data from the interviews will further gauge patient opinions about Dora's usability, appropriateness and level of satisfaction. ETHICS AND DISSEMINATION: Research Ethics Board William Osler Health System (ID: 22-0044) has approved this study and will be conducted by guidelines of Declaration of Helsinki. Master-linking sheet will contain the patient chart identification (ID), full name, date of birth and study ID. Results will be shared through peer-reviewed journals and presentations at conferences.

Investigating the Impact of Automation on the Health Care Workforce Through Autonomous Telemedicine in the Cataract Pathway: Protocol for a Multicenter Study.

BACKGROUND: While digital health innovations are increasingly being adopted by health care organizations, implementation is often carried out without considering the impacts on frontline staff who will be using the technology and who will be affected by its introduction. The enthusiasm surrounding the use of artificial intelligence (AI)-enabled digital solutions in health care is tempered by uncertainty around how it will change the working lives and practices of health care professionals. Digital enablement can be viewed as facilitating enhanced effectiveness and efficiency by improving services and automating cognitive labor, yet the implementation of such AI technology comes with challenges related to changes in work practices brought by automation. This research explores staff experiences before and after care pathway automation with an autonomous clinical conversational assistant, Dora (Ufonia Ltd), that is able to automate routine clinical conversations. OBJECTIVE: The primary objective is to examine the impact of AI-enabled automation on clinicians, allied health professionals, and administrators who provide or facilitate health care to patients in high-volume, low-complexity care pathways. In the process of transforming care pathways through automation of routine tasks, staff will increasingly "work at the top of their license." The impact of this fundamental change on the professional identity, well-being, and work practices of the individual is poorly understood at present. METHODS: We will adopt a multiple case study approach, combining qualitative and quantitative data collection methods, over 2 distinct phases, namely phase A (preimplementation) and phase B (postimplementation). RESULTS: The analysis is expected to reveal the interrelationship between Dora and those affected by its introduction. This will reveal how tasks and responsibilities have changed or shifted, current tensions and contradictions, ways of working, and challenges, benefits, and opportunities as perceived by those on the frontlines of the health care system. The findings will enable a better understanding of the resistance or susceptibility of different stakeholders within the health care workforce and encourage managerial awareness of differing needs, demands, and uncertainties. CONCLUSIONS: The implementation of AI in the health care sector, as well as the body of research on this topic, remain in their infancy. The project's key contribution will be to understand the impact of AI-enabled automation on the health care workforce and their work practices. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/49374.

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.

Ectopic vortex veins and varices in Donnai Barrow syndrome.

BACKGROUND: Donnai Barrow Syndrome (DBS) is a rare, multi-system autosomal recessively inherited disorder of relevance to ophthalmologists. To aim to describe the ocular phenotype using multimodal imaging for two cases of genetically confirmed DBS and compare against the published phenotype. MATERIALS AND METHODS: Retrospective case series of two unrelated patients with DBS and review of the literature. Both cases were referred to our tertiary unit for laser prophylaxis against retinal detachment. RESULTS: There was extreme high myopia greater than 20 dioptres without rhegmatogenous retinal detachment (RRD). Anterior segment features included iris transillumination and ciliary body hypoplasia. Posterior segment changes included previously described changes of optic nerve hypoplasia and a strikingly abnormal appearance of the fundus consisting of multiple bilateral giant posterior vortex veins (PVV). The mouse model shows a similar phenotype. CONCLUSIONS: Ectopic vortex veins of the choroid expand the phenotype of DBS and can be helpful in distinguishing the differential diagnosis of high myopia in children. Posterior vortex veins have been described in adult high myopia as acquired but our cases suggest that they could be congenital. Orbital manipulation and hypotony during surgery should be avoided to minimise complications. The evidence to recommend prophylactic laser retinopexy in these cases is inconclusive, and overall we recommend that conservative management should be considered using wide-angle retinal imaging in the clinic.

Let's embed peer-support groups into the medical curriculum for all.

Even before the COVID-19 pandemic, attending to the mental wellbeing of all doctors was high on the political agenda. The quality of patient care is also known to be related to doctors' wellbeing. Now, in the midst of a global pandemic, doctors are having to cope with ever more trauma and moral injury. Group-based peer support and regular reflective practice are interventions known to reduce clinician burnout and optimise wellbeing. Junior doctors are the most likely of all medical groups to be at a high risk of burnout. The NHS Staff and Learners' Mental Wellbeing Commission report advocates establishing explicit peer support mechanisms and the use of peer support as part of the first line of psychological first aid. Peer support is not addressed in the curriculum for the majority of medical specialties. We recommend that regular peer-support reflective groups are provided during protected time for all trainees.

The BElfast Retinal Tear and detachment Score (BERT Score).

PURPOSE: To establish a scoring system to triage patients presenting with symptoms of flashes and floaters to allow safe differentiation between those with retinal tears and detachments, versus uncomplicated posterior vitreous detachments (PVDs). METHODS: Prospective and retrospective audits of 153 patients presenting to eye casualty and vitreoretinal clinics to ascertain the clinical features most likely to be associated with retinal pathology, rather than simple PVD. We then developed a scoring system, which was applied to 160 patients in a further prospective audit. RESULTS: The significant risk factors, symptoms and signs were identified then given a number related to their importance: male sex 1, myopia 1, blurred vision 2, shadow 2, vitreous haemorrhage 3, tobacco dust 4. The scores were summed and a total score > 3 was more likely to be a complicated PVD. Sensitivity of the scoring system was 90% (confidence interval (CI) 68.3-98.8%), specificity 80% (CI 73.2-86.9%), positive predictive value 40% (CI 25.7-55.7%), and negative predictive value 98.26% (CI 93.9-99.8%). CONCLUSIONS: The BElfast Retinal Tear and detachment Score is an easy to apply scoring system, which has a high sensitivity and negative predictive value i.e. nearly all retinal tears or detachments are detected by the scoring system.