Assessing the Economic Value of Clinical Artificial Intelligence: Challenges and Opportunities

ObjectivesClinical artificial intelligence (AI) is a novel technology, and few economic evaluations have focused on it to date. Before its wider implementation, it is important to highlight the aspects of AI that challenge traditional health technology assessment methods.MethodsWe used an existing broad value framework to assess potential ways AI can provide good value for money. We also developed a rubric of how economic evaluations of AI should vary depending on the case of its use.ResultsWe found that the measurement of core elements of value—health outcomes and cost—are complicated by AI because its generalizability across different populations is often unclear and because its use may necessitate reconfigured clinical processes. Clinicians’ productivity may improve when AI is used. If poorly implemented though, AI may also cause clinicians’ workload to increase. Some AI has been found to exacerbate health disparities. Nevertheless, AI may promote equity by expanding access to medical care and, when properly trained, providing unbiased diagnoses and prognoses. The approach to assessment of AI should vary based on its use case: AI that creates new clinical possibilities can improve outcomes, but regulation and evidence collection may be difficult; AI that extends clinical expertise can reduce disparities and lower costs but may result in overuse; and AI that automates clinicians’ work can improve productivity but may reduce skills.ConclusionsThe potential uses of clinical AI create challenges for health technology assessment methods originally developed for pharmaceuticals and medical devices. Health economists should be prepared to examine data collection and methods used to train AI, as these may impact its future value.     

Chronic Intake of Energy Drinks and Their Sugar Free Substitution Similarly Promotes Metabolic Syndrome

Energy drinks containing significant quantities of caffeine, taurine and sugar are increasingly consumed, particularly by adolescents and young adults. The putative effects of chronic ingestion of either standard energy drink, Mother^TM (ED), or its sugar-free formulation (sfED) on metabolic syndrome were determined in wild-type C57BL/6J mice, in comparison to a soft drink, Coca-Cola (SD), a Western-styled diet enriched in saturated fatty acids (SFA), and a combination of SFA + ED. Following 13 weeks of intervention, mice treated with ED were hyperglycaemic and hypertriglyceridaemic, indicating higher triglyceride glucose index, which was similar to the mice maintained on SD. Surprisingly, the mice maintained on sfED also showed signs of insulin resistance with hyperglycaemia, hypertriglyceridaemia, and greater triglyceride glucose index, comparable to the ED group mice. In addition, the ED mice had greater adiposity primarily due to the increase in white adipose tissue, although the body weight was comparable to the control mice receiving only water. The mice maintained on SFA diet exhibited significantly greater weight gain, body fat, cholesterol and insulin, whilst blood glucose and triglyceride concentrations remained comparable to the control mice. Collectively, these data suggest that the consumption of both standard and sugar-free forms of energy drinks induces metabolic syndrome, particularly insulin resistance.     

体外膈肌起搏器在治疗面神经麻痹中的临床应用

目的 :探讨体外膈肌起搏器配合药物治疗特发性面神经麻痹的疗效。方法 :治疗组在常规使用激素、血管扩张剂和神经营养药等治疗的基础上配合应用体外膈肌起搏器 ,治疗面神经麻痹 ,对照组单纯使用药物治疗 ,对照两组的治愈率、好转率和平均治疗时间和好转时间。结果 :治疗组 73例 ,治愈 6 2例 ,好转 5例 ,总有效率 92 % ;对照组 32例 ,治愈 2 3例 ,好转 5例 ,总有效率 81% ,两组差异有显著性。 (P <0 0 5)。结论 :应用体外膈肌起搏器配合药物治疗面神经麻痹治愈率高 ,疗程缩短     

血浆置换联合胎肝细胞悬液治疗重型肝炎

目的 :评价中间型人工肝支持系统治疗重型肝炎的疗效。方法 :对 138例重型肝炎患者进行血浆置换联合胎肝细胞悬液治疗 ,5 6例重型肝炎患者采用血浆置换治疗 ,另 48例重型肝炎患者采用胎肝细胞悬液治疗。观察血浆置换联合胎肝细胞悬液治疗患者治疗前后肝功能、氨基酸谱及心肌酶学变化。比较血浆置换联合胎肝细胞悬液治疗与单用血浆置换或胎肝细胞悬液治疗的疗效。结果 :血浆置换联合胎肝细胞悬液治疗较单用血浆置换或胎肝细胞悬液治疗能更有效提高重型肝炎患者好转存活率 ,改善肝功能 ,提高支链氨基酸 (BCAA) /芳香氨基酸 (AAA)比值 ,改善心肌酶学。结论 :血浆置换联合胎肝细胞悬液可有效治疗重型肝炎。     

The use of artificial intelligence and robotics in regional anaesthesia

The current fourth industrial revolution is a distinct technological era characterised by the blurring of physics, computing and biology. The driver of change is data, powered by artificial intelligence. The UK National Health Service Topol Report embraced this digital revolution and emphasised the importance of artificial intelligence to the health service. Application of artificial intelligence within regional anaesthesia, however, remains limited. An example of the use of a convoluted neural network applied to visual detection of nerves on ultrasound images is described. New technologies that may impact on regional anaesthesia include robotics and artificial sensing. Robotics in anaesthesia falls into three categories. The first, used commonly, is pharmaceutical, typified by target-controlled anaesthesia using electroencephalography within a feedback loop. Other types include mechanical robots that provide precision and dexterity better than humans, and cognitive robots that act as decision support systems. It is likely that the latter technology will expand considerably over the next decades and provide an autopilot for anaesthesia. Technical robotics will focus on the development of accurate sensors for training that incorporate visual and motion metrics. These will be incorporated into augmented reality and visual reality environments that will provide training at home or the office on life-like simulators. Real-time feedback will be offered that stimulates and rewards performance. In discussing the scope, applications, limitations and barriers to adoption of these technologies, we aimed to stimulate discussion towards a framework for the optimal application of current and emerging technologies in regional anaesthesia.     

A clinical comparison of indices of pulmonary gas exchange with changes in the inspired oxygen concentration

Several indices have been introduced as convenient alternatives to calculation of the physiological shunt fraction (Qs/QT) for the assessment of pulmonary gas exchange. These include: the arterial-alveolar oxygen tension ratio (a/APO2), the arterial oxygen tension-inspired oxygen concentration ratio (PaO2/FIO2), the respiratory index (RI), [A-a)DO2/PaO2) and the alveolar-arterial oxygen tension difference [A-a)Do2). These indices are in use clinically despite the fact that they may not accurately predict gas exchange in situations where FIO2, Qs/QT or arterial-venous oxygen content is changing. The clinical stability of each of these indices, relative to the behaviour of the physiological shunt, was therefore investigated prospectively in ten mechanically ventilated postoperative adults as FIO2 was varied from 0.30 to 1.00. None of the indices studied reliably reflected the behaviour of the physiological shunt. As FIO2 was increased incrementally from 0.30 to 1.00, 42 to 55 per cent of the measured changes in these indices were opposite in direction to the corresponding changes in the physiological shunt. The maximum magnitudes of the opposite changes were substantial; 24 and 22 per cent for the a/APO2 and PaO2/FIO2 ratio respectively, 67 per cent for the RI and 101 per cent for the (A-a)DO2. We conclude that the use of any of these indices for clinical assessment of a patient's gas exchange defect when FIO2 is varying can be substantially misleading.     

宫内胎肝细胞移植形成血小板GPⅡb Bak a/b嵌合体的研究

目的　探讨宫内胎肝细胞移植是否形成人工血小板杂合子嵌合体 ,评估其在治疗血小板无力症的临床应用前景。方法　选择血小板膜GPⅡbBaka/b(GPⅡb异亮氨酸 84 3丝氨酸多态性 )作为遗传标记 ,采用等位基因特异引物PCR和FOKⅠ限制性内切酶消化技术从 4 2名引产妇筛选一例纯合子GPⅡbBaka/a作为供者 ,一例纯合子GPⅡbBakb/b作为受者 ,制备供者胎肝细胞 ,取 4ml(2 2× 10 5细胞 )在B超引导下通过脐静脉穿刺输给受者。结果　移植后 2 1天 ,用PCR FOKⅠ消化技术检测引产后受者外周血DNA和血小板RNA ,发现已形成Baka/b嵌合体。结论　我们认为宫内胎肝细胞移植可能提供一种治疗血小板无力症和其他遗传性疾病的方法。     

胸部创伤并发急性呼吸窘迫综合征的治疗

目的：总结胸部创伤并发急性呼吸窘迫综合征（ARDS）的临床特点。方法：对22例胸部创伤并发ARDS的患者进行分析;其中,肺叶切除术后6例,食管贲门癌术后10例,胸部严重外伤6例。救治方法主要包括去除病因,给予呼吸支持及循环支持等。结果：抢救成功18例,死亡4例。死亡原因主要是多器官功能衰竭及严重的肺部感染。结论：ARDS确诊后,应尽早应用机械通气治疗,其中包括使用呼气未正压通气、间歇正压通气等方法。     

外伤性白内障人工晶状体植入术临床观察

目的 评价外伤性白内障人工晶体植入的疗效及问题。方法 对56例外伤性白内障人工晶体植入术后进行回顾性研究。结果 术后矫正视力≥0.5者48眼,占85.7%;0.1-0.4者6眼,占10.7%;0.1以下者2眼,占3.6%。结论 利用显微手术方法,使用粘弹剂,控制眼内炎症,选择好手术时机,可使手术效果满意。     

阴道内放置PGE_2用于足月妊娠引产351例疗效观察

目的　比较 PGE2 阴道栓剂及催产素静滴引产的效果。方法　将 5 85例同样条件孕妇 ,随机分两组 ,分别给PGE2 阴道栓剂和催产素静脉滴注引产。结果　前列腺素组及催产素组引产成功率分别为 96 .3%和 79.92 % ;临产发动时间及总产程分别为 (2 .70± 0 .6 3) h,(3.0 1± 3.41) h和 (3.91± 0 .71) h,(6 .0 3± 3.5 0 ) h;剖宫产率分别为6 .8%和 18.18% (P<0 .0 1) ,有显著差异。结论　 PGE2 栓剂用于足月妊娠引产效果显著、安全、方便 ,对促宫颈成熟意义重要 ,可缩短住院天数 ,减少住院费用。