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Perspectives on Medical Education 2023The increasing use of Artificial Intelligence (AI) in medicine has raised ethical concerns, such as patient autonomy, bias, and transparency. Recent studies suggest a... (Review)
Review
INTRODUCTION
The increasing use of Artificial Intelligence (AI) in medicine has raised ethical concerns, such as patient autonomy, bias, and transparency. Recent studies suggest a need for teaching AI ethics as part of medical curricula. This scoping review aimed to represent and synthesize the literature on teaching AI ethics as part of medical education.
METHODS
The PRISMA-SCR guidelines and JBI methodology guided a literature search in four databases (PubMed, Embase, Scopus, and Web of Science) for the past 22 years (2000-2022). To account for the release of AI-based chat applications, such as ChatGPT, the literature search was updated to include publications until the end of June 2023.
RESULTS
1384 publications were originally identified and, after screening titles and abstracts, the full text of 87 publications was assessed. Following the assessment of the full text, 10 publications were included for further analysis. The updated literature search identified two additional relevant publications from 2023 were identified and included in the analysis. All 12 publications recommended teaching AI ethics in medical curricula due to the potential implications of AI in medicine. Anticipated ethical challenges such as bias were identified as the recommended basis for teaching content in addition to basic principles of medical ethics. Case-based teaching using real-world examples in interactive seminars and small groups was recommended as a teaching modality.
CONCLUSION
This scoping review reveals a scarcity of literature on teaching AI ethics in medical education, with most of the available literature being recent and theoretical. These findings emphasize the importance of more empirical studies and foundational definitions of AI ethics to guide the development of teaching content and modalities. Recognizing AI's significant impact of AI on medicine, additional research on the teaching of AI ethics in medical education is needed to best prepare medical students for future ethical challenges.
Topics: Humans; Artificial Intelligence; Education, Medical; Medicine; Curriculum; Ethics, Medical
PubMed: 37868075
DOI: 10.5334/pme.954 -
Journal of Cardiothoracic and Vascular... Feb 2022No systematic studies on retractions in cardiothoracic and vascular anesthesia exist. The aim of this analysis was to identify characteristics and trends of retractions...
OBJECTIVES
No systematic studies on retractions in cardiothoracic and vascular anesthesia exist. The aim of this analysis was to identify characteristics and trends of retractions in this field over the past three decades.
DESIGN
A search of the Retraction Watch Database for retracted articles published between 1990 and 2020 in the field of cardiothoracic and vascular anesthesia was performed.
SETTING
A bibliometric study.
PARTICIPANTS
Five thousand three hundred forty-four retractions with the term "medicine" in the subject code were selected. Retractions of full-length English articles reporting findings in cardiothoracic and vascular anesthesia were included.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
A total of 63 articles published in 31 journals from January 1990 to August 2020 were retracted. The majority were original articles (n = 60, 95.2%) and retracted for scientific misconduct (n = 50, 79.4%). The percentage of retractions due to misconduct increased from 2010, with a spike in 2011 (n = 26/50, 52.0%), and reached a plateau in 2014. The three most common reasons for retraction were misconduct by the author (n = 31, 49.2%), duplication (n = 12, 19.0%), and errors within the manuscript (n = 11, 17.5%). The median time from publication to retraction was 4.3 years (IQR: 1.7-9.4) and decreased significantly over time (p < 0.001). The median impact factor (IF) of the journals that published retracted articles was 3.5 (IQR 2.0-4.5) and decreased significantly over the study period (p < 0.001).
CONCLUSION
Scientific misconduct represents the most common reason for retraction in cardiothoracic and vascular anesthesia. The median time to retraction and journal IF decreased significantly over time. While this is promising, future efforts should be made to screen for falsified data and standardize the processes after retraction to highlight problematic manuscripts.
Topics: Anesthesia; Anesthesiology; Bibliometrics; Biomedical Research; Databases, Factual; Humans; Scientific Misconduct
PubMed: 34600831
DOI: 10.1053/j.jvca.2021.09.005 -
Stem Cell Research & Therapy Aug 2023Recent advances in methods to culture pluripotent stem cells to model human development have resulted in entities that increasingly have recapitulated advanced stages of... (Review)
Review
Recent advances in methods to culture pluripotent stem cells to model human development have resulted in entities that increasingly have recapitulated advanced stages of early embryo development. These entities, referred to by numerous terms such as embryoids, are becoming more sophisticated and could resemble human embryos ever more closely as research progresses. This paper reports a systematic review of the ethical, legal, regulatory, and policy questions and concerns found in the literature concerning human embryoid research published from 2016 to 2022. We identified 56 papers that use 53 distinct names or terms to refer to embryoids and four broad categories of ethical, legal, regulatory, or policy considerations in the literature: research justifications/benefits, ethical significance or moral status, permissible use, and regulatory and oversight challenges. Analyzing the full range of issues is a critical step toward fostering more robust ethical, legal, and social implications research in this emerging area and toward developing appropriate oversight.
Topics: Humans; Embryo, Mammalian; Embryonic Development; Pluripotent Stem Cells; Policy
PubMed: 37605210
DOI: 10.1186/s13287-023-03448-8 -
Indian Journal of Critical Care... Aug 2022This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV).
AIM
This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV).
BACKGROUND
NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation.
METHODS
Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done.
REVIEW RESULTS
Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile.
CONCLUSION
Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations.
HOW TO CITE THIS ARTICLE
Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022;26(8):938-948.
PubMed: 36042773
DOI: 10.5005/jp-journals-10071-23950 -
Philosophy, Ethics, and Humanities in... Apr 2022Human brain organoids are a valuable research tool for studying brain development, physiology, and pathology. Yet, a host of potential ethical concerns are inherent in...
BACKGROUND
Human brain organoids are a valuable research tool for studying brain development, physiology, and pathology. Yet, a host of potential ethical concerns are inherent in their creation. There is a growing group of bioethicists who acknowledge the moral imperative to develop brain organoid technologies and call for caution in this research. Although a relatively new technology, brain organoids and their uses are already being discussed in media literature. Media literature informs the public and policymakers but has the potential for utopian or dystopian distortions. Thus, it is important to understand how this technology is portrayed to the public.
METHODS
To investigate how brain organoids are displayed to the public, we conducted a systematic review of media literature indexed in the Nexis Uni database from 2013-2019. News and media source articles passing exclusion criteria (n = 93) were scored to evaluate tone and relevant themes. Themes were validated with a pilot sample before being applied to the dataset. Thematic analysis assessed article tone, reported potential for the technology, and the scientific, social, and ethical contexts surrounding brain organoids research.
RESULTS
Brain organoid publications became more frequent from 2013 to 2019. We observed increases in positively and negatively toned articles, suggesting growing polarization. While many sources discuss realistic applications of brain organoids, others suggest treatment and cures beyond the scope of the current technology. This could work to overhype the technology and disillusion patients and families by offering false hope. In the ethical narrative we observe a preoccupation with issues such as development of artificial consciousness and "humanization" of organoid-animal chimeras. Issues of regulation, ownership, and accuracy of the organoid models are rarely discussed.
CONCLUSIONS
Given the power that media have to inform or misinform the public, it is important this literature provides an accurate and balanced reflection of the therapeutic potential and associated ethical issues regarding brain organoid research. Our study suggests increasing polarization, coupled with misplaced and unfounded ethical concern. Given the inhibitory effects of public fear or disillusion on research funding, it is important media literature provides an accurate reflection of brain organoids.
Topics: Animals; Brain; Chimera; Consciousness; Ethics, Research; Humans; Organoids
PubMed: 35414094
DOI: 10.1186/s13010-022-00119-z -
Psychiatry Investigation Dec 2023To find the safety of long-acting injectable antipsychotics (LAIs) compared to each other, and/or placebo in the treatment of schizophrenia (SCZ) and/or schizoaffective...
OBJECTIVE
To find the safety of long-acting injectable antipsychotics (LAIs) compared to each other, and/or placebo in the treatment of schizophrenia (SCZ) and/or schizoaffective disorder (SZA).
METHODS
We performed a systematic review and a network meta-analysis of randomized controlled trials (RCTs) comparing the safety of LAIs versus other LAIs or placebo in adults diagnosed with SCZ or SZA. The primary outcomes were treatment emergent adverse events (TEAEs), serious treatment emergent adverse events (STEAEs), and deaths. The secondary outcomes included treatment discontinuations due to adverse events and all-cause discontinuations.
RESULTS
Seventeen RCTs were included (n=7,908). There were no significant differences between LAIs and placebo in the risk of presenting TEAEs. LAIs had a significant lower risk of presenting STEAEs except for aripiprazole. No significant differences in deaths were found. LAIs showed a significant protective effect against all-cause discontinuation, except for haloperidol. Only aripiprazole had a significantly lower risk of treatment discontinuation due to adverse events.
CONCLUSION
We found no significant differences in the risk of presenting TEAEs between LAIs and placebo. The majority of LAIs had a significantly lower risk of presenting STEAEs than placebo. Development of international guidelines for the report of safety outcomes related to antipsychotics especially for LAIs in clinical trials could minimize report and interpretation biases and improve the accuracy of posterior meta-analysis.
PubMed: 38163650
DOI: 10.30773/pi.2022.0216 -
Healthcare (Basel, Switzerland) Dec 2023There is a growing body of evidence on the effects of subjective aging on health, well-being and quality of life. This review aims to synthesize findings about the link... (Review)
Review
There is a growing body of evidence on the effects of subjective aging on health, well-being and quality of life. This review aims to synthesize findings about the link between subjective aging and cognition and cognitive decline. Furthermore, it provides an examination of variation sources such as subjective aging construct, cognitive domains, measures employed, age and moderator variables. A systematic search was performed in PubMed, PsychInfo and Web of Science, as well as grey literature searches in Google Scholar, OpenGrey, WorldCat and NDLTD, which resulted in 59 reports being included. Subjective aging is a relevant construct in the explanation and prediction of cognitive aging and cognitive decline in elderly adults. More positive views about own aging and self-perceptions of aging, as well as a younger subjective age, were consistently related to better cognition and lower risk of cognitive decline. However, there were differences due to subjective aging subdimensions and cognitive domains, as well as an effect of age. Additionally, there were concerns about the content validity of some measures employed, such as the Philadelphia Geriatric Center Morale Scale for subjective aging and the Mini Mental State Examination for global cognition. Further studies should employ longitudinal designs with a process-based approach to cognition and precise subjective aging measures.
PubMed: 38132005
DOI: 10.3390/healthcare11243115 -
Orphanet Journal of Rare Diseases Jun 2021The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients... (Review)
Review
BACKGROUND
The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients suffering from rare diseases, they are usually very expensive. The growing number of approved OMPs increases their budget impact despite their low prevalence, making it pressing to find solutions to ethical challenges on how to fairly allocate scarce healthcare resources under this context. One potential solution could be to grant OMPs special status when considering them for reimbursement, meaning that they are subject to different, and less stringent criteria than other drugs. This study aims to provide a systematic analysis of moral reasons for and against such a special status for the reimbursement of OMPs in publicly funded healthcare systems from a multidisciplinary perspective.
RESULTS
With a systematic review of reasons, we identified 39 reasons represented in 243 articles (scientific and grey literature) for and against special status for the reimbursement of OMPs, then categorized them into nine topics. Taking a multidisciplinary perspective, we found that most articles came from health policy (n = 103) and health economics (n = 49). More articles took the position for a special status of OMPs (n = 97) than those against it (n = 31) and there was a larger number of reasons identified in favour (29 reasons) than against (10 reasons) this special status.
CONCLUSION
Results suggest that OMP reimbursement issues should be assessed and analysed from a multidisciplinary perspective. Despite the higher occurrence of reasons and articles in favour of a special status, there is no clear-cut solution for this ethical challenge. The binary perspective of whether or not OMPs should be granted special status oversimplifies the issue: both OMPs and rare diseases are too heterogeneous in their characteristics for such a binary perspective. Thus, the scientific debate should focus less on the question of disease prevalence but rather on how the important variability of different OMPs concerning e.g. target population, cost-effectiveness, level of evidence or mechanism of action could be meaningfully addressed and implemented in Health Technology Assessments.
Topics: Budgets; Humans; Morals; Orphan Drug Production; Rare Diseases; Technology Assessment, Biomedical
PubMed: 34193232
DOI: 10.1186/s13023-021-01925-y -
World Journal of Pediatrics : WJP Aug 2023Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However, radiation therapy is associated with significant long-term neurocognitive morbidity. The present systematic review and meta-analysis aimed to compare the neurocognitive outcomes of children and adolescents with brain tumors treated with photon radiation (XRT) or proton therapy (PBRT).
METHODS
A systematic search was conducted (PubMed, Embase, Cochrane, and Web of Science from inception until 02/01/2022) for studies comparing the neurocognitive outcomes of children and adolescents with brain tumors treated with XRT vs. PBRT. The pooled mean differences (expressed as Z scores) were calculated using a random effects method for those endpoints analyzed by a minimum of three studies.
RESULTS
Totally 10 studies (n = 630 patients, average age range: 1-20 years) met the inclusion criteria. Patients who had received PBRT achieved significantly higher scores (difference in Z scores ranging from 0.29-0.75, all P < 0.05 and significant in sensitivity analyses) after treatment than those who had received XRT for most analyzed neurocognitive outcomes (i.e., intelligence quotient, verbal comprehension and perceptual reasoning indices, visual motor integration, and verbal memory). No robust significant differences (P > 0.05 in main analyses or sensitivity analyses) were found for nonverbal memory, verbal working memory and working memory index, processing speed index, or focused attention.
CONCLUSIONS
Pediatric brain tumor patients who receive PBRT achieve significantly higher scores on most neurocognitive outcomes than those who receive XRT. Larger studies with long-term follow-ups are needed to confirm these results.
Topics: Child; Adolescent; Humans; Infant; Child, Preschool; Young Adult; Adult; Protons; Brain Neoplasms; Proton Therapy
PubMed: 37154861
DOI: 10.1007/s12519-023-00726-6 -
JMIR Public Health and Surveillance Jan 2023During the COVID-19 pandemic, infodemic spread even more rapidly than the pandemic itself. The COVID-19 vaccine hesitancy has been prevalent worldwide and hindered... (Review)
Review
BACKGROUND
During the COVID-19 pandemic, infodemic spread even more rapidly than the pandemic itself. The COVID-19 vaccine hesitancy has been prevalent worldwide and hindered pandemic exiting strategies. Misinformation around COVID-19 vaccines is a vital contributor to vaccine hesitancy. However, no evidence systematically summarized COVID-19 vaccine misinformation.
OBJECTIVE
This review aims to synthesize the global evidence on misinformation related to COVID-19 vaccines, including its prevalence, features, influencing factors, impacts, and solutions for combating misinformation.
METHODS
We performed a systematic review by searching 5 peer-reviewed databases (PubMed, Embase, Web of Science, Scopus, and EBSCO). We included original articles that investigated misinformation related to COVID-19 vaccines and were published in English from January 1, 2020, to August 18, 2022. We excluded publications that did not cover or focus on COVID-19 vaccine misinformation. The Appraisal tool for Cross-Sectional Studies, version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2), and Critical Appraisal Skills Programme Checklist were used to assess the study quality. The review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and registered with PROSPERO (CRD42021288929).
RESULTS
Of the 8864 studies identified, 91 observational studies and 11 interventional studies met the inclusion criteria. Misinformation around COVID-19 vaccines covered conspiracy, concerns on vaccine safety and efficacy, no need for vaccines, morality, liberty, and humor. Conspiracy and safety concerns were the most prevalent misinformation. There was a great variation in misinformation prevalence, noted among 2.5%-55.4% in the general population and 6.0%-96.7% in the antivaccine/vaccine hesitant groups from survey-based studies, and in 0.1%-41.3% on general online data and 0.5%-56% on antivaccine/vaccine hesitant data from internet-based studies. Younger age, lower education and economic status, right-wing and conservative ideology, and having psychological problems enhanced beliefs in misinformation. The content, format, and source of misinformation influenced its spread. A 5-step framework was proposed to address vaccine-related misinformation, including identifying misinformation, regulating producers and distributors, cutting production and distribution, supporting target audiences, and disseminating trustworthy information. The debunking messages/videos were found to be effective in several experimental studies.
CONCLUSIONS
Our review provides comprehensive and up-to-date evidence on COVID-19 vaccine misinformation and helps responses to vaccine infodemic in future pandemics.
TRIAL REGISTRATION
PROSPERO CRD42021288929; https://tinyurl.com/2prejtfa.
Topics: Humans; COVID-19 Vaccines; COVID-19; Cross-Sectional Studies; Pandemics; Prevalence
PubMed: 36469911
DOI: 10.2196/40201