Clinical Decision Support Systems Used in Transplantation: Are They Tools for Success or an Unnecessary Gadget? A Systematic Review.

Although clinical decision support systems (CDSSs) have been used since the 1970s for a wide variety of clinical tasks including optimization of medication orders, improved documentation, and improved patient adherence, to date, no systematic reviews have been carried out to assess their utilization and efficacy in transplant medicine. The aim of this study is to systematically review studies that utilized a CDSS and assess impact on patient outcomes. A total of 48 articles were identified as meeting the author-derived inclusion criteria, including tools for posttransplant monitoring, pretransplant risk assessment, waiting list management, immunosuppressant management, and interpretation of histopathology. Studies included 15 984 transplant recipients. Tools aimed at helping with transplant patient immunosuppressant management were the most common (19 studies). Thirty-four studies (85%) found an overall clinical benefit following the implementation of a CDSS in clinical practice. Although there are limitations to the existing literature, current evidence suggests that implementing CDSS in transplant clinical settings may improve outcomes for patients. Limited evidence was found using more advanced technologies such as artificial intelligence in transplantation, and future studies should investigate the role of these emerging technologies.

Using Artificial Intelligence for Predicting Survival of Individual Grafts in Liver Transplantation: A Systematic Review.

The demand for liver transplantation far outstrips the supply of deceased donor organs, and so, listing and allocation decisions aim to maximize utility. Most existing methods for predicting transplant outcomes use basic methods, such as regression modeling, but newer artificial intelligence (AI) techniques have the potential to improve predictive accuracy. The aim was to perform a systematic review of studies predicting graft outcomes following deceased donor liver transplantation using AI techniques and to compare these findings to linear regression and standard predictive modeling: donor risk index (DRI), Model for End-Stage Liver Disease (MELD), and Survival Outcome Following Liver Transplantation (SOFT). After reviewing available article databases, a total of 52 articles were reviewed for inclusion. Of these articles, 9 met the inclusion criteria, which reported outcomes from 18,771 liver transplants. Artificial neural networks (ANNs) were the most commonly used methodology, being reported in 7 studies. Only 2 studies directly compared machine learning (ML) techniques to liver scoring modalities (i.e., DRI, SOFT, and balance of risk [BAR]). Both studies showed better prediction of individual organ survival with the optimal ANN model, reporting an area under the receiver operating characteristic curve (AUROC) 0.82 compared with BAR (0.62) and SOFT (0.57), and the other ANN model gave an AUC ROC of 0.84 compared with a DRI (0.68) and SOFT (0.64). AI techniques can provide high accuracy in predicting graft survival based on donors and recipient variables. When compared with the standard techniques, AI methods are dynamic and are able to be trained and validated within every population. However, the high accuracy of AI may come at a cost of losing explainability (to patients and clinicians) on how the technology works.

A pilot study of primary care physicians' attitude to weight loss surgery in England: are the young more prejudiced?

BACKGROUND: Primary care practitioners (PCP) are the "gate-keepers" for publicly funded weight loss surgery (WLS) in the United Kingdom, but their attitude toward WLS has not been studied to date. OBJECTIVE: This pilot study aimed to investigate opinions and experience of PCPs regarding WLS in the United Kingdom. SETTING: PCPs from 3 publicly funded primary care consortiums from distinct geographic areas within the United Kingdom were surveyed. METHODS: A cross-sectional survey approach was used to assess PCP attitude to WLS surgery. A questionnaire was sent electronically to PCPs, designed to assess PCP demographic, experience, knowledge, and attitude regarding obesity and WLS. For the purposes of analysis, PCPs were divided into junior and senior based on duration of practice. RESULTS: Of PCPs, 35 completed and returned the questionnaire. Although PCPs stated that approximately 30% of their patients were obese, 17 (49%) had made not a single referral for WLS in the previous 12 months. PCPs overestimated early WLS mortality rate more than 10-fold and 23 (66%) did not feel confident providing care to patients post-WLS. Junior PCPs were significantly more likely to feel that WLS should not be publicly funded (P = .01). CONCLUSIONS: These findings suggest a prejudice against WLS amongst PCPs in England, particularly among junior doctors.

Does a PBL-based medical curriculum predispose training in specific career paths? A systematic review of the literature.

BACKGROUND: North American medical schools have used problem-based learning (PBL) structured medical education for more than 60 years. However, it has only recently been introduced in other medical schools outside of North America. Since its inception, there has been the debate on whether the PBL learning process predisposes students to select certain career paths. OBJECTIVES: To review available evidence to determine the predisposition of specific career paths when undertaking a PBL-based medical curriculum. The career path trajectory was determined as measured by official Matching Programs, self-reported questionnaires and surveys, and formally defined career development milestones. METHODS: A systematic literature review was performed. PubMed, Medline, Cochrane and ERIC databases were analysed in addition to reference lists for appropriate inclusion. RESULTS: Eleven studies fitting the inclusion criteria were identified. The majority of studies showed that PBL did not predispose a student to a career in a specific speciality (n = 7 out of 11 studies, 64%). However, three studies reported a significantly increased number of PBL graduates working in primary care compared to those from a non-PBL curriculum. CONCLUSIONS: PBL has been shown not to predispose medical students to a career in General Practice or any other speciality. Furthermore, a greater number of similar studies are required before a definitive conclusion can be made in the future.

Change in Sexual Dysfunction Following Bariatric Surgery.

Obesity is associated with multiple comorbidities and psychosocial burdens, but often sexual dysfunction (SD) is overlooked. Bariatric surgery is the most effective treatment for morbid obesity, and its role in reversing SD is reviewed. A literature search of MEDLINE, PubMed Central, and Cochrane databases was conducted. Fifty-six articles were identified and 32 selected for inclusion. SD was measured via hormonal studies, questionnaires, and a combination of both (n = 14 males SD studies, n = 13 female SD studies, 5 = both sexes). There is an exponential rise in patients reporting post-surgical improvements in SD in both genders. The emerging use of quality of life indices to measure sexual function as part of a more global enjoyment of life may be a helpful adjunct to existing hormonal and sex-specific measures.

Cognitive Task Analysis: Bringing Olympic Athlete Style Training to Surgical Education.

BACKGROUND: Surgical training is changing and evolving as time, pressure, and legislative demands continue to mount on trainee surgeons. A paradigm change in the focus of training has resulted in experts examining the cognitive steps needed to perform complex and often highly pressurized surgical procedures. OBJECTIVE: To provide an overview of the collective evidence on cognitive task analysis (CTA) as a surgical training method, and determine if CTA improves a surgeon's performance as measured by technical and nontechnical skills assessment, including precision, accuracy, and operative errors. METHODS: A systematic literature review was performed. PubMed, Cochrane, and reference lists were analyzed for appropriate inclusion. RESULTS: A total of 595 surgical participants were identified through the literature review and a total of 13 articles were included. Of these articles, 6 studies focused on general surgery, 2 focused on practical procedures relevant to surgery (central venous catheterization placement), 2 studies focused on head and neck surgical procedures (cricothyroidotomy and percutaneous tracheostomy placement), 2 studies highlighted vascular procedures (endovascular aortic aneurysm repair and carotid artery stenting), and 1 detailed endovascular repair (abdominal aorta and thoracic aorta). Overall, 92.3% of studies showed that CTA improves surgical outcome parameters, including time, precision, accuracy, and error reduction in both simulated and real-world environments. CONCLUSION: CTA has been shown to be a more effective training tool when compared with traditional methods of surgical training. There is a need for the introduction of CTA into surgical curriculums as this can improve surgical skill and ultimately create better patient outcomes.