Multi-stakeholder preferences for the use of artificial intelligence in healthcare: A systematic review and thematic analysis.

INTRODUCTION: Despite the proliferation of Artificial Intelligence (AI) technology over the last decade, clinician, patient, and public perceptions of its use in healthcare raise a number of ethical, legal and social questions. We systematically review the literature on attitudes towards the use of AI in healthcare from patients, the general public and health professionals' perspectives to understand these issues from multiple perspectives. METHODOLOGY: A search for original research articles using qualitative, quantitative, and mixed methods published between 1 Jan 2001 to 24 Aug 2021 was conducted on six bibliographic databases. Data were extracted and classified into different themes representing views on: (i) knowledge and familiarity of AI, (ii) AI benefits, risks, and challenges, (iii) AI acceptability, (iv) AI development, (v) AI implementation, (vi) AI regulations, and (vii) Human - AI relationship. RESULTS: The final search identified 7,490 different records of which 105 publications were selected based on predefined inclusion/exclusion criteria. While the majority of patients, the general public and health professionals generally had a positive attitude towards the use of AI in healthcare, all groups indicated some perceived risks and challenges. Commonly perceived risks included data privacy; reduced professional autonomy; algorithmic bias; healthcare inequities; and greater burnout to acquire AI-related skills. While patients had mixed opinions on whether healthcare workers suffer from job loss due to the use of AI, health professionals strongly indicated that AI would not be able to completely replace them in their professions. Both groups shared similar doubts about AI's ability to deliver empathic care. The need for AI validation, transparency, explainability, and patient and clinical involvement in the development of AI was emphasised. To help successfully implement AI in health care, most participants envisioned that an investment in training and education campaigns was necessary, especially for health professionals. Lack of familiarity, lack of trust, and regulatory uncertainties were identified as factors hindering AI implementation. Regarding AI regulations, key themes included data access and data privacy. While the general public and patients exhibited a willingness to share anonymised data for AI development, there remained concerns about sharing data with insurance or technology companies. One key domain under this theme was the question of who should be held accountable in the case of adverse events arising from using AI. CONCLUSIONS: While overall positivity persists in attitudes and preferences toward AI use in healthcare, some prevalent problems require more attention. There is a need to go beyond addressing algorithm-related issues to look at the translation of legislation and guidelines into practice to ensure fairness, accountability, transparency, and ethics in AI.

Effect of Time to Minimally Invasive Esophagectomy After Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma.

BACKGROUND: Neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil/capecitabine (DCF/DCX) followed by esophagectomy has been the recommended treatment for esophageal squamous cell carcinoma (ESCC). However, the optimal interval from NAC to surgery has not yet been established. This study evaluated the impact of time to surgery (TTS) in the treatment of ESCC. METHODS: Between August 2018 and September 2021, 97 patients who underwent radical esophagectomy following 3-6 cycles of NAC with DCF/DCX for ESCC at a single hospital were analyzed. TTS was categorized into three groups: 16-41 days (group 1; 33 patients), 42-55 days (group 2; 29 patients), and 56-135 days (group 3; 35 patients). Survival outcomes included overall survival (OS) and progression-free survival (PFS). RESULTS: Mean age was 59.6 ± 6.8 years, and 95 patients were male. One patient had grade-III anemia, 12 had grade-II anemia, and four had grade-II neutropenia; all other NAC-related toxicities were as grade I. Regarding pathologic tumor response, 18.6% achieved complete response, 71.1% achieved partial response, and 10.3% had stable disease. Forty-eight patients (49.5%) had a postoperative complication, but only six (6.2%) with grade IIIa and two (2.1%) with grade IVa according to the Clavien-Dindo classification. Median follow-up time was 24 months. Groups 1 and 3 had worse OS (HR [95% CI]: 3.36 [1.16-11.7] and 1.83 [0.55-6.10]) and worse PFS (HR [95% CI]: 3.27 [1.25-8.53] and 1.61 [0.58-4.45]) compared to group 2. CONCLUSION: We suggest the optimal TTS after NAC is 6-8 weeks. However, this finding must be confirmed by prospective trials.

The Effect of Price Changes and Teaspoon Labelling on Intention to Purchase Sugar-Sweetened Beverages: A Discrete Choice Experiment.

INTRODUCTION: Childhood obesity is a major public health concern and sugar-sweetened beverages (SSBs) are a known contributor. SSB taxation and food labelling have been proposed as policies to reduce consumption by changing purchasing behaviours. The study aimed to analyse caregivers' preferences on commonly purchased SSBs in Australia and to determine the effect of price increases and teaspoon labelling on their purchasing intentions. METHODS: We used a discrete choice experiment (DCE) to obtain data about choices between SSB and non-SSB alternatives. 563 caregivers, who had young children aged 3-7 years, completed the experiment online. 286 were randomly allocated to receive choice sets with plain labelling while 277 were assigned to teaspoon labelling. Each participant completed nine choice scenarios where they chose between six SSB and non-SSB beverage options or a no-beverage option, with beverage prices varying between scenarios. While hypothetical, price and teaspoon labelling for sugar content for each beverage was obtained from an informal market survey. Responses from the DCE were modelled using random parameters logit within a random utility theory framework. Household income and children's consumption volumes of soft drink were used to explore preference heterogeneity. RESULTS: Using mixed logit as the final model, we found that higher reduction in intended purchases was observed for soft drink and fruit drink in teaspoon labelling than it was in plain labelling. Participants exposed to teaspoon labelling intended to purchase less of flavoured milk and fruit juice compared to those exposed to plain labelling. Compared to baseline prices, a hypothetical 20% increase in SSB prices and the presentation of 'teaspoons of sugar' labelling were predicted to reduce intentional SSB purchases and increase intentional non-SSB purchases. Within each labelling group, there were no significant differences of intentional purchases between the highest and the lowest income quintile, high and low consumers of soft drinks. However, compared to plain labelling, teaspoon labelling was predicted to strongly influence intentional purchases of SSBs and non-SSBs. CONCLUSION: This study suggests that a policy to increase SSB price and include teaspoon labelling would lead to a reduced consumption of SSBs and increased consumption of non-SSBs.

Dynamic entrepreneurship, planned innovation, and firm profitability: evidence from a Southeast Asian country.

This study applies the theory of planned behaviors to evaluate economic outcomes resulting from planned innovation and dynamic entrepreneurship of Vietnamese firms. The analysis uses data on Vietnamese small and medium manufacturing firms from surveys conducted by United Nations University World Institute for Development Economics Research (UNU-WIDER) during 2005-2015. Employing various estimation techniques including normal standard one-side regressions (fixed effect models, panel robust model, and Pds-lasso) and two-side structural two-stage models (extended regression model, treatment effect model, and IV-Lasso), we analyze the impacts of innovation activities on firm profitability in connection to the role of dynamic entrepreneurship and planned innovation. We measure planned innovation by the interaction between intention to innovate and firm innovation activities. The study shows that planned innovation is associated with higher profitability for firms. This holds true for all three innovation activities including introduction of a new product, introduction of a new production process and improvements to existing products/processes. In light of the theory of planned behaviors, entrepreneurial intentions embedded in planned innovation can underlie a comprehensive plan and action that drives the innovation process. The findings suggest that for small and medium enterprises (SMEs) to thrive, willingness to pursue innovation by the firm owners is key to success as the intention to innovate will enable firms to gain a planning advantage. This advantage leads to a better resource allocation within the firms, shaping more effective strategies to implement a planned innovation. Overall, the study provides an important implication for the introduction of support schemes that promote innovation for SMEs in Vietnam. Any support schemes, introduced either by the public or private sector to target SMEs, should be engaged with the group of dynamic entrepreneurs who have intentions to innovate to warrant a higher chance of success.

Risk and clinical outcomes of acute myocardial infarction and acute ischemic stroke following gram-negative bloodstream infection.

OBJECTIVES: This retrospective cohort study examines incidence, risk factors, and clinical outcomes of acute myocardial infarction (AMI) and acute ischemic stroke (AIS) within one year of gram-negative bloodstream infection (GN-BSI) based on predefined clinical criteria. METHODS: Hospitalized adults with GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from 2010 through 2015 were identified. Kaplan-Meier analysis was used to determine incidence of AMI and AIS within one year after GN-BSI. Multivariate Cox proportional hazards regression models were used to examine risk factors for AMI or AIS and impact on 1-year mortality. RESULTS: Among 1292 patients with GN-BSI, 263 and 17 developed AMI and AIS within 1-year with incidences of 23.4% and 1.9%, respectively. Majority of AMI were type 2 (164; 62%); 99 patients had type 1 AMI with incidence of 8.9%. Age >65 years (hazard ratio [HR] 1.52, 95% CI: 1.17-1.99), prior coronary artery disease or stroke (HR 1.74, 95% CI: 1.34-2.25), hypertension (HR 1.55, 95% CI: 1.13-2.15), end-stage renal disease (HR 1.52, 95% CI: 1.09-2.08), and quick Pitt bacteremia score (HR 1.55 per point, 95% CI: 1.40-1.72) were predictors of AMI/AIS. Development of type 1 AMI or AIS after GN-BSI was independently associated with increased 1-year mortality (HR 1.47, 95% CI: 1.03-2.07). CONCLUSIONS: AMI and AIS occur frequently within one year of GN-BSI and have negative impact on 1-year survival. Future randomized clinical trials are needed to determine the most effective clinical interventions for prevention of AMI/AIS following BSI in high risk patients and improve survival after these events.

Laparoscopic Proximal Gastrectomy with Jejunal Interposition for Early Proximal Gastric Cancer.

PURPOSE: Proximal gastrectomy has been more advantageous than total gastrectomy in early cancer in the upper third of the stomach. Jejunal interposition is a novel reconstruction technique to prevent reflux esophagitis and anastomotic stricture in proximal gastrectomy. The combination of these two procedures via laparoscopic approach is not yet widespread. Therefore, this study is to evaluate the feasibility and safety of this surgery. METHODS: This is a retrospective study on eight patients with laparoscopic proximal gastrectomy and jejunal interposition for early proximal gastric cancer. Patients were followed up at 1, 3, and 6 months and then at 6-month intervals to investigate complications, recurrence, metastasis, and survival. RESULTS: All cases were adenocarcinoma in the early stage (cT1N0M0). The median (range) operating time and postoperative hospital stay were 145 min (120-210) and 7 days (6-9), respectively. No complication (including reflux esophagitis and anastomotic stricture) occurred. All patients were alive without any recurrence or metastasis during the median follow-up of 28 months (ranged 6-40 months). CONCLUSION: Laparoscopic proximal gastrectomy with jejunal interposition for early gastric cancer is safe and feasible with good long-term outcomes. Further large studies are required to evaluate the safety and efficacy of this procedure.

The incidence and aetiology of hospitalised community-acquired pneumonia among Vietnamese adults: a prospective surveillance in Central Vietnam.

BACKGROUND: Lower respiratory tract infection (LRTI) including Community-acquired pneumonia (CAP) is a common infectious disease that is associated with significant morbidity and mortality. The patterns of aetiological pathogens differ by region and country. Special attention must be paid to CAP in Southeast Asia (SEA), a region facing rapid demographic transition. Estimates burden and aetiological patterns of CAP are essential for the clinical and public health management. The purposes of the study are to determine the incidence, aetiological pathogens, clinical pictures and risk factors of community-acquired pneumonia (CAP) in the Vietnamese adult population. METHODS: A prospective surveillance for hospitalised adult CAP was conducted in Khanh Hoa Province, Central Vietnam. All adults aged ≥15 years with lower respiratory tract infections (LRTI) admitted to a provincial hospital from September 2009 to August 2010 were enrolled in the study. Patients were classified into CAP and non-pneumonic LRTI (NPLRTI) according to the radiological findings. Bacterial pathogens were identified from sputum samples by the conventional culture and polymerase chain reaction (PCR) for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; 13 respiratory viruses were identified from nasopharyngeal specimens by PCR. RESULTS: Of all 367 LRTI episodes examined, 174 (47%) were CAP. Older age, the presence of underlying respiratory conditions, and higher index score of smoking were associated with CAP. The one-year estimated incidence of hospitalised adult CAP in our study population was 0.81 per 1,000 person years. The incidence increased considerably with age and was highest among the elderly. The case fatality proportion of hospitalised CAP patients was 9.8%. Among 286 sputum samples tested for bacterial PCR, 79 (28%) were positive for H. influenzae, and 65 (23%) were positive for S. pneumoniae. Among 357 samples tested for viral PCR, 73 (21%) were positive for respiratory viruses; influenza A (n = 32, 9%) was the most common. CONCLUSIONS: The current adult CAP incidence in Vietnam was relatively low; this result was mainly attributed to the young age of our study population.