Doctors and medical trainees need to be fully informed about pros and cons of these tools

A fifth of family doctors (GPs) seem to have readily incorporated AI into their clinical practice, despite a lack of any formal guidance or clear work policies on the use of these tools, suggest the findings of an online UK-wide snapshot survey, published in the open access journal BMJ Health & Care Informatics.

Doctors and medical trainees need to be fully informed about the pros and cons of AI, especially because of the inherent risks of inaccuracies (‘hallucinations’), algorithmic biases, and the potential to compromise patient privacy, conclude the researchers.

Following the launch of ChatGPT at the end of 2022, interest in large language model-powered chatbots has soared, and attention has increasingly focused on the clinical potential of these tools, say the researchers.

To gauge current use of chatbots to assist with any aspect of clinical practice in the UK, in February 2024 the researchers distributed an online survey to a randomly chosen sample of GPs registered with the clinician marketing service Doctors.net.uk. The survey had a predetermined sample size of 1000.

The doctors were asked if they had ever used any of the following in any aspect of their clinical practice: ChatGPT; Bing AI; Google’s Bard; or ‘Other’. And they were subsequently asked what they used these tools for.

Some 1006 GPs completed the survey: just over half the responses came from men (531; 53%) and a similar proportion of respondents (544;54%) were aged 46 or older.

One in five (205; 20%) respondents reported using generative AI tools in their clinical practice. Of these, more than 1 in 4 (29%; 47) reported using these tools to generate documentation after patient appointments and a similar proportion (28%; 45) said they used them to suggest a differential diagnosis. One in four (25%; 40) said they used the tools to suggest treatment options.

The researchers acknowledge that the survey respondents may not be representative of all UK GPs, and that those who responded may have been particularly interested in AI—for good or bad—potentially introducing a level of bias into the findings. 

Further research is needed to find out more about how doctors are using generative AI and how best to implement these tools safely and securely into clinical practice, they add.

“These findings signal that GPs may derive value from these tools, particularly with administrative tasks and to support clinical reasoning. However, we caution that these tools have limitations since they can embed subtle errors and biases,” they say.

And they point out: “[These tools] may also risk harm and undermine patient privacy since it is not clear how the internet companies behind generative AI use the information they gather. 

“While these chatbots are increasingly the target of regulatory efforts, it remains unclear how the legislation will intersect in a practical way with these tools in clinical practice.” 

And they conclude: “The medical community will need to find ways to both educate physicians and trainees about the potential benefits of these tools in summarising information but also the risks in terms of hallucinations [perception of non-existent patterns or objects], algorithmic biases, and the potential to compromise patient privacy.”

18/09/2024

Notes for editors
Short report: Generative artificial intelligence in primary care: an online survey of UK general practitioners Doi 10.1136/bmjhci-2024-101102
Journal: BMJ Health & Care informatics

External funding: The Research Council on Health, Working Life and Welfare

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational; survey data
Subjects: People

The post Fifth of GPs using AI despite lack of guidance or clear work policies, UK survey suggests first appeared on BMJ Group.

Liz Salmi and Dr Charlotte Blease are breaking new ground as co-authors of The Step-by-Step Guide to Peer Review for Patients and Novice Researchers, published in BMJ Health & Care Informatics. With this publication, they addressed the need for clear guidelines, tackled the challenges of measuring impact, and emphasised the importance of making resources accessible for educational purposes. Patients are increasingly recognised for their critical role as peer reviewers, and their input is becoming steadily more possible thanks to the support of journals and funding agencies. 

Ms Salmi created the Guide to Peer Review as a template for herself to assist with peer reviews. Recognising its value, she shared it with others, thus providing a practical tool for those new to the process. The guide has been valuable in helping new reviewers—including patients—understand their roles and the importance of reporting on the impact of research. The guide has been cited in various contexts, including educational materials and handbooks, such as the monograph Applying Metascientific Principles to Autism Research, which offers practical ideas for academics to improve the quality of their research on the autism spectrum. The guide also plays a significant role in improving research environments through patient collaboration. 

“The utility of the peer review template—which I draw from for every peer review—and its anecdotal recognition from its users is an example of how journal editors and authors have appreciated the template.” Liz Salmi, Communications & Patient Initiatives Director for OpenNotes at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

As an educator at Uppsala University in Sweden, Dr Blease finds the guide particularly useful for PhD students and early-career researchers. It is an educational tool that helps familiarise them with the peer review process, enhancing their academic training.

“This document is a good example of patient collaboration improving research environments. Such advice must be properly articulated and accessible, as it can significantly enhance research practices.” Dr Charlotte Blease, Ph.D. Associate Professor, Participatory eHealth & Health Data Research Group, Department of Women’s and Children’s Health, Uppsala Universitet; and Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Both Ms Salmi and Dr Blease believe that the guide may have inspired the development of similar resources and increased the involvement of patient advocates in peer review, thereby broadening the scope and diversity of reviewers. BMJ Group’s support through the BMJ Patient Advisory Board also significantly contributed to the guide’s visibility and success.

Follow Ms Salmi on X: @TheLizArmy or online: thelizarmy.com

Follow Dr Blease on X: @crblease or online: charlotteblease.com

The post The impact of patient advocacy on peer review first appeared on BMJ Group.

The post Facial thermal imaging + AI accurately predict presence of coronary artery disease first appeared on BMJ Group.

Posts by politicians and news anchors had greatest impact, analysis suggests

Data might be used to bolster public health messaging and counter misinformation

Tweets by people in the public eye likely increasingly shaped negative public opinion of the COVID-19 pandemic as it progressed in the US, suggests an analysis of sentiments expressed in social media posts, published in the open access journal BMJ Health & Care Informatics.

In particular, posts shared by politicians and news anchors seemed to exert the greatest influence, the findings indicate.

Better analysis of social media activity might help officials and policy makers to better combat mis/disinformation on these platforms and bolster prevention and control efforts, not only for COVID-19 but also future disease outbreaks, conclude the researchers.

People have increasingly turned to social media networks to share their thoughts and feelings on the impacts of the COVID-19 pandemic, note the researchers. And several studies have highlighted the persuasive nature of celebrity behaviour and messaging on public health issues.

The researchers therefore wanted to find out if there might be a link between messaging shared by athletes, politicians, news anchors and entertainers about COVID-19 and public sentiment and discourse on COVID-19 vaccines and vaccination.

They harvested around 13 million tweets posted between 1 January 2020 and 1 March 2022. The sentiment expressed was calculated for each tweet using a fine-tuned natural language processing (DistilRoBERTa) model.

This was then compared with tweets about COVID-19 that also mentioned certain US COVID-19 vaccine sceptics in the public eye, in sport, the media, and politics.

These were Joe Rogan (commentator and podcaster); Tucker Carlson (TV host); Nicki Minaj (rapper); Aaron Rodgers (footballer); Novak Djokovic (tennis player); Eric Clapton (singer-songwriter); Rand Paul (Republican senator); the late Phil Valentine (broadcaster); Donald Trump; Ted Cruz (Republican senator); Candace Owens (political commentator); and Ron DeSantis (Republican governor of Florida).

The final analysis was based on 45,255 tweets from 34,407 unique authors. The tweets contained a total of 16.32 million likes, up to a maximum of 70,228 for each one.

The findings suggest that although there were minor differences between the various groups of vaccine sceptics in the public eye, a broadly polarised negative tone emerged.

And the consistent emotional content these celebrities shared about COVID-19 vaccines and vaccination during the first 2 years of the pandemic influenced public opinion and largely stimulated online public discourse, say the researchers. 

Politicians were among the most influential people in the public eye. 

“The spread, reaction and engagement by the public to posts made by politicians online was indicative of a strong level of influence, suggesting politicians play key roles in ensuring population health and should be committed to promoting health-protective behaviours rather than sensational falsehoods,” write the researchers.

Although sentiment about COVID-19 vaccines and vaccination in relation to news anchors varied during this period, overall, it was more negative than positive. And tweets referencing these media personalities tended to be associated with anti-vaccine controversy or death  rather than news about vaccine development.

The news anchors’ posts clocked up a total of 14,017 likes between them, prompting the researchers to suggest that: “The high number of likes displayed within these tweets shows that a much higher number of users are involved in reading tweets and are therefore potentially influenced by the content.”

The researchers suggest that their findings could help to bolster currently available surveillance tools for targeted health promotion, management of the ongoing pandemic, and preparing for the next crisis. 

“As we have demonstrated, messaging shared by influential members of society can have considerable effects on the directionality of public emotion and shared health decision making,” they write. 

“Both negative and positive online social endorsement of prevention strategies such as vaccination are key in determining population-wide compliance and uptake success. 

“However, threats of the spread of misinformation and disinformation by those with influence stand to undermine programmes supporting protective measures such as vaccination.” 

Public health bodies have a role to play in countering this, including working with those in the public eye to share more positive messaging about vaccination, they suggest.

The researchers acknowledge certain limitations to their findings, including the well known difficulties of correctly interpreting the tone of written language and the relatively small number of celebrities included in the analysis.

But they conclude: “as the pandemic progressed, public sentiment shared on social networks was shaped by risk perceptions, political ideologies and health-protective behaviours shared by [people in the public eye]. 

“The risk of severe negative health outcomes increases with failure to comply with health-protective behaviour recommendations set forth by public health officials, such as vaccination, and our findings suggest that polarised messages from societal elites may downplay these risks, unduly contributing to an increase in the spread of COVID-19.”

21/2/23

Research: Exploring celebrity influence on public attitude towards the COVID-19 pandemic: social media shared sentiment analysis doi 10.1136/bmjhci-2022-100665

Journal: BMJ Health & Care Informatics

Funding: National Cancer Institute (NCI)

Link to Academy of Medical Sciences press release labelling system

http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Data analysis
Subjects: Social media posts

The post Celebrity tweets likely shaped US negative public opinion of covid-19 pandemic first appeared on BMJ Group.

Findings independent of other types of regular physical activity

Housework is linked to sharper memory, attention span, and better leg strength, and by extension, greater protection against falls, in older adults, finds research published in the open access journal BMJ Open.

The findings were independent of other regular recreational and workplace physical activities, and active commuting.

Regular physical activity is good for maintaining optimal physical and mental health. And among older adults, it curbs the risks of long term conditions, falls, immobility, dependency and death.

Yet global monitoring data indicate that in 2016, physical activity was well below recommended weekly levels and had budged little in a decade, with people in high income countries more than twice as likely to be couch potatoes as those in low income countries.

Given that housework involves physical activity and is an indicator of the ability to live independently, the researchers wanted to explore whether doing the household chores might contribute to healthy ageing and boost physical and mental capacity among older adults in a wealthy country.

They included 489 randomly selected adults, aged between 21 and 90, with fewer than 5 underlying conditions and no cognitive issues. All were living independently in one large residential town in Singapore, and able to carry out routine daily tasks.

Participants were divided into two age bands: 21-64 year olds (249; average age 44), classified as ‘younger’; and 65-90 year olds (240; average age 75), classified as ‘older.’

Walking (gait) speed and sit-to-stand speed from a chair (indicative of leg strength and falls risk) were used to assess physical ability. Validated tests were used to assess mental agility (short and delayed memory, visuospatial ability, language and attention span) and physiological factors linked to falls.

Participants were quizzed about the intensity and frequency of household chores they regularly did, as well as how many other types of physical activity they engaged in.

Light housework included washing up, dusting, making the bed, hanging out the washing, ironing, tidying up, and cooking. Heavy housework was defined as window cleaning, changing the bed, vacuuming, washing the floor, and activities such as painting/decorating.

Housework intensity was measured in metabolic equivalent of task (METs). These are roughly equivalent to the amount of energy (calories) expended per minute of physical activity. Light housework was assigned a MET of 2.5; heavy housework was assigned a MET of 4.

Only around a third (36%; 90) of those in the younger group and only around half (48%;116) of those in the older age group, met the recommended physical activity quota from recreational physical activity alone.

But nearly two thirds (61%,152 younger; and 66%,159 older) met this target exclusively through housework.

After adjusting for other types of regular physical activity, the results showed that housework was associated with sharper mental abilities and better physical capacity.  But only among the older age group.

Cognitive scores were 8% and 5% higher, respectively, in those doing high volumes of light or heavy housework compared with those in the low volume groups.

And the intensity of housework was associated with specific cognitive domains. Specifically, heavy housework was associated with a 14% higher attention score while light housework was associated with 12% and 8% higher short and delayed memory scores, respectively.

Similarly, sit-to-stand time and balance/coordination scores were 8% and 23% faster, respectively, in the high volume group than they were in the low volume group.

Those in the younger age group had five more years of education on average than their older counterparts. And since education level is positively associated with baseline mental agility and slower cognitive decline, this might explain the observed differences in the impact of housework between the two age groups, explain the researchers.

This is an observational study, and as such, can’t establish cause, they caution, adding that the study relied on subjective reporting of physical activity levels and the volume and intensity of household chores.

But they point to previous research indicating a link between aerobic exercise and improved cognitive function, so the sharper mental agility associated with housework might occur through similar mechanisms, they suggest.

And they conclude: “These results collectively suggest that the higher cognitive, physical and sensorimotor functions related to heavy housework activities might plausibly be associated with lower physiological fall risk among community-dwelling older adults.”

They add: “Incorporating [physical activity] into daily lifestyle through domestic duties (ie, housework) has the potential to achieve higher [physical activity], which is positively associated with functional health, especially among older community-dwelling adults.”

[Ends]

22/11/21

Notes for editors
Research: Cross-sectional associations of housework with cognitive, physical and sensorimotor functions in younger and older community-dwelling adults: the Yishun Study doi: 10.1136/bmjopen-2021-052557
Journal: BMJ Open

Funding: Geriatric Education and Research Institute, Singapore

Link to AMS labelling system
https://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Cross sectional observational
Subjects: People

The post Housework linked to sharper memory and better falls protection in older adults first appeared on BMJ Group.