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Yates posted an update 7 months, 1 week ago
The aim of the paper is to find an answer to the question “Who or what is responsible for the benefits and harms of using artificial intelligence in radiology?” When human beings make decisions, the action itself is normally connected with a direct responsibility by the agent who generated the action. You have an effect on others, and therefore, you are responsible for what you do and what you decide to do. But if you do not do this yourself, but an artificial intelligence system, it becomes difficult and important to be able to ascribe responsibility when something goes wrong. The manuscript addresses the following statements (1) using AI, the radiologist is responsible for the diagnosis; (2) radiologists must be trained on the use of AI since they are responsible for the actions of machines; (3) radiologists involved in R&D have the responsibility to guide the respect of rules for a trustworthy AI; (4) radiologist responsibility is at risk of validating the unknown (black box); (5) radiologist decision may be biased by the AI automation; (6)risk of a paradox increasing AI tools to compensate the lack of radiologists; (7) need of informed consent and quality measures. Future legislation must outline the contours of the professional’s responsibility, with respect to the provision of the service performed autonomously by AI, balancing the professional’s ability to influence and therefore correct the machine, limiting the sphere of autonomy that instead technological evolution would like to recognize to robots.BACKGROUND Studies assessing the effect of high dose tigecycline on severe infections are limited and remain controversial. OBJECTIVES To assess systematically the effectiveness and safety of high dose tigecycline in the treatment of severe infections. METHODS Pubmed, Web of Science, Embase, MEDLINE, Cochrane Library and ClinicalTrials were searched up to February 20, 2019 for studies that compared the effectiveness and safety of high dose tigecycline with standard dose tigecycline or other non-tigecycline-containing regimens in the treatment of severe infections. Rates for all-cause mortality, clinical cure, microbiological eradication and adverse events were analysed. RESULTS Ten studies with 593 patients were included. The results indicated that using high dose tigecycline resulted in better outcomes compared with controls with lower all-cause mortality (OR 0.44, 95% CI 0.30-0.66, p less then 0.0001), higher clinical cure (OR 3.43, 95% CI 2.09-5.63, p less then 0.00001), higher microbiological eradicaticrobiological eradication and comparable adverse events. However, as a result of the high risks of bias of the included studies, well-designed randomised clinical trials are warranted to establish the effectiveness and safety of high dose tigecycline compared with standard dose tigecycline and other commonly used antibiotics.INTRODUCTION A principal mechanism of action in bariatric surgery is reduction in calorie consumption due to decreased hunger and increased satiety. Patients’ ability to perceive post-operative changes to their hunger is therefore central to optimal results. This study examined factors that may impact how patients perceive post-operative hunger and how perception of hunger impacts eating and subsequent weight loss after laparoscopic adjustable gastric banding (LAGB). METHODS Patients undertaking LAGB (n = 147) provided pre-surgery and 2-year weight loss data and pre-surgery and 12-month psychological data (perception of hunger, disinhibition related to eating, emotional eating). RESULTS Path analysis demonstrated that patients with lower levels of pre-surgery cognitive restraint over eating experienced significantly greater reduction in perception of hunger at 12 months post-surgery. Perceived reduction in hunger was significantly associated with lower levels of both emotional eating and disinhibited eating. Finally, reduced emotional eating at 12 months significantly predicted 9% of the variance in percentage of total weight loss (%TWL) at 2 years after surgery. CONCLUSION These initial findings suggest that preparation for bariatric surgery may be enhanced by psychoeducation regarding cognitive restraint over eating and its effect on hunger perception. In addition, psychological treatment that focuses on identifying and responding to changes in hunger may contribute to improved outcomes for those who have difficulty adjusting to post-operative eating behaviours.BACKGROUND Post-operative pain management following laparoscopic bariatric surgery can be challenging. There are concerns regarding the use of opioids. The rate of cardiorespiratory problems following neuraxial opioids is unclear. There is little published data on their use in bariatric surgery. This study aimed to assess technique feasibility, pain outcomes, patient acceptability, and the side effects and complications of a ‘high-dose’ (1.0 mg) intrathecal diamorphine technique for patients undergoing primary laparoscopic bariatric surgery. MATERIALS AND METHODS Fifty patients were included. Eleven patients (22%) had a diagnosis of OSA. All patients had a spinal anaesthetic with 2.0 mL of 0.25% isobaric bupivacaine containing 1.0 mg diamorphine. General anaesthesia followed together with multi-modal analgesia and anti-emesis. Post-operative pain scores, complications, and side effects in the first 24 h post-operative period were documented. Patients were followed up 6 to 8 weeks after discharge. RESULTS All patients had a working spinal anaesthetic with thirty-nine insertions (78%) on the first attempt. Pain scores were similar to previously published data where they were found to be superior to a non-spinal analgesic regime. The median 24 h post-operative oral morphine equivalent consumption was 5 mg. Eight patients (16%) required urinary catheterisation. Four patients (8%) complained of pruritus. Eighteen patients (36%) had post-operative nausea or vomiting. mTOR inhibition Thirty-three patients (66%) responded to the follow-up request. Thirty of the thirty-three patients (91%) stated they would have the spinal anaesthetic again. CONCLUSION We have demonstrated that neuraxial blockade is a simple, practical, and feasible technique to adopt. Our case series demonstrated a high level of patient acceptability.