Kwaku Marfo, Danielle Garcia, Saira Khalique, Karen Berger, Amy LuMontefiore Medical Center, Bronx, NY, USABackground: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering system. Our (...) objective was to quantify medication error type and frequency in an inpatient renal transplant unit.Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences, error type and associated medication class.Results: A total of 103 clinically significant medication errors were detected during the 10-day and 28-day audit time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ordering errors reached the patient.Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.Keywords: medication errors, CPOE, inpatient, renal transplant patients. (shrink)

Human decisions are increasingly supported by decision support systems (DSS). Humans are required to remain “on the loop,” by monitoring and approving/rejecting machine recommendations. However, use of DSS can lead to overreliance on machines, reducing human oversight. This paper proposes “reflection machines” (RM) to increase meaningful human control. An RM provides a medical expert not with suggestions for a decision, but with questions that stimulate reflection about decisions. It can refer to data points or suggest counterarguments that are (...) less compatible with the planned decision. RMs think against the proposed decision in order to increase human resistance against automation complacency. Building on preliminary research, this paper will (1) make a case for deriving a set of design requirements for RMs from EU regulations, (2) suggest a way how RMs could support decision-making, (3) describe the possibility of how a prototype of an RM could apply to the medical domain of chronic low back pain, and (4) highlight the importance of exploring an RM’s functionality and the experiences of users working with it. (shrink)

There is much to learn from Durán and Jongsma’s paper.1 One particularly important insight concerns the relationship between epistemology and ethics in medical artificial intelligence. In clinical environments, the task of AI systems is to provide risk estimates or diagnostic decisions, which then need to be weighed by physicians. Hence, while the implementation of AI systems might give rise to ethical issues—for example, overtreatment, defensive medicine or paternalism2—the issue that lies at the heart is an epistemic problem: (...) how can physicians know whether to trust decisions made by AI systems? In this manner, various studies examining the interaction of AI systems and physicians have shown that without being able to evaluate their trustworthiness, especially novice physicians become over-reliant on algorithmic support—and ultimately are led astray by incorrect decisions.3–5 This leads to a second insight from the paper, namely that even if some AI system happens to be opaque, it is still not built on the moon. To assess its trustworthiness, AI developers or physicians have different sorts of higher order evidence at hand. Most importantly, …. (shrink)

Medical classification systems aim to provide a manageable taxonomy for sorting diagnoses into their proper classes. The question, this paper wants to critically examine, is how to correctly systematise diseases within classification systems that are applied in a variety of different settings. ICD and DSM , the two major classification systems in medicine and psychiatry, will be the main subjects of this paper; however, the arguments are not restricted to these classification systems but point out (...) general methodological and epistemological challenges of classifying diseases for differing purposes. Deciding what qualifies as a disease to be included into a classification system as well as choosing a specific validator for correctly systematising diseases is complicated because the broad applicability of medical classification systems simultaneously appears as aim and challenge. Drawing upon the case study of classifying Alzheimer’s disease, this paper will address three dilemmas in designing ‘good’ medical classification systems. They are due to general epistemological problems of medicine, such as the relationship between individual manifestations of diseases and the necessity of building groups in order to scientifically elucidate causes of diseases. Moreover, they involve pragmatic issues of designing usable classifications that allow for easily discriminating between classes of diseases, restricting, however, the completeness of disease representations. This paper wants to trace how the choice of certain validators is unavoidably value-laden and deeply intertwined with epistemological assumptions of how different uses relate to each other, resulting either in a prioritisation of (constrained) coherence or of (vague) pluralistic connectibility. (shrink)

A reliable medical image management must provide proper security for patient information. Protecting the medical information of the patients is a major concern in all hospitals. Digital watermarking is a procedure prevalently used to secure the confidentiality of medical information and maintain them, which upgrades patient health awareness. To protect the medical information, the robust and lossless patient medical information sharing system using crypto-watermarking method is proposed. The proposed system consists of two phases: (i) embedding (...) and (ii) extraction. In this paper, we securely share three types of patient information, medical image, electronic health record (EHR), and face image from one hospital to another hospital. Initially, all the three inputs are encrypted and the information is concordant. In order to enhance the robustness of the crypto-watermarking system, the obtained bit stream is compressed, and the compressed bit streams are embedded into the cover image. The same process is repeated for the extraction process. The experimentation result is carried out using different medical images with EHR, and the effectiveness of the proposed algorithm is analyzed with the help of peak signal to noise ratio. (shrink)

This paper concerns the double standard debate in the ethics of AI literature. This debate essentially revolves around the question of whether we should subject AI systems to different normative standards than humans. So far, the debate has centered around the desideratum of transparency. That is, the debate has focused on whether AI systems must be more transparent than humans in their decision-making processes in order for it to be morally permissible to use such systems. Some (...) have argued that the same standards of transparency should be applied across the board, for AI systems and humans alike. Others have argued that we should hold AI systems to higher standards than humans in terms of transparency. In this paper, we first point out that there are structurally similar double standard debates to be had about other desiderata besides transparency, such as predictive accuracy. Second, we argue that when we focus on predictive accuracy, there are at least two reasons for holding AI systems to a lower standard than humans. (shrink)

Work injury compensation and pensions are often determined according to medical disability rating scales attributing a percentage to each impaired body part or function. Incorporated into central medical–administrative networks of committees and examinations, these produce disability as a calculable space. This article examines the specific case of the Israeli National Insurance regulations regarding work injuries of 1956 and analyzes the shifted order they set. Looking at this system in the specific historical context of transition from the British (...) Mandate workmen’s compensation system to the “disability percentages” system, provides insight into the process of structuring and stabilizing durable numerical forms and the production of centralized government. Drawing on conceptualizations regarding the sociotechnical role of classification systems, I contend that through encoding and calculating classifications of disability, heterogeneity is eliminated and an ordering based on physiology is “black boxed,” illustrating the importance of technoscientific formations in structuring the “medical model of disability.”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 65.4 (2004) 603-625 [Access article in PDF] Noting the Mind: Commonplace Books and the Pursuit of the Self in Eighteenth-Century Britain Lucia Dacome University College London Ae for "Adversariorum methodus." Be for "Beauty, Beneficience, Bread, Bleeding, Blemishes."1 By associating the first letter with the initial vowel of a word, generations of eighteenth-century readers, students, and observers diligently regulated access to information they reputed (...) worth retaining. Following this rule, they organized the notes they took on a certain subject, the thoughts and observations they believed were worth remembering, and the exemplary words of their favorite authors. The rule was devised by John Locke for his "new method of making commonplace-books," a method characterized by a particular system for indexing the entries of a notebook that became popular in the eighteenth century. Before Locke developed his new method readers had already familiarized themselves with the practice of keeping an account of their readings, excerpting passages of texts, and copying them in their notebooks under a relevant heading. Throughout the early modern period commonplace books provided repositories for arranging notes, excerpts, drawings, and objects.2 Regarded as aids to memory and storehouses of knowledge, they were part of a pedagogic tradition related to rhetoric and the art of memory that dated back to the classical period. Reducing vast amounts of knowledge to a [End Page 603] manageable form, they instantiated a special relationship between the accumulation of knowledge and the organization of space. At the turn of the eighteenth century Locke's new method promised to facilitate compilers' task by providing a new way of accumulating multum in parvo at a time of increasing concern for the uncontrollable growth of the "Stock of Knowledge."3 It did so by seeking to increase the amount of information one could annotate in the notebook, while also speeding up its retrieval. Many eighteenth-century compilers relied on it in order to reduce the volume of their notebooks and save time. Some were lured by the promise that this technique could also help them to order their minds and thus turn them into better people.Although commonplace books have dropped out of usage today, they were still mentioned in nineteenth-century educational manuals. As tools that lay at the intersection between practices of collecting, reading, classifying, learning, and the arts of rhetoric, they have come to the fore of historical discussion.4 In some cases, commonplace books have been regarded as capable of providing insights into compilers' reading patterns and as biographical sources casting light on compilers' personal idiosyncrasies and cataloguing manias.5 The intellectual and cultural significance of Locke's own new method of compiling has [End Page 604] accordingly been discussed in relation to Locke's own intellectual biography (and in particular his medical interests), in the context of shifting patterns of systematization of knowledge and in light of the dissemination of eighteenth-century encyclopedic projects.6 However, still little is known about the uses and the popularity of the Lockean method in the eighteenth century.What follows considers the spreading of Lockean commonplacing in the context of eighteenth-century discussions on the nature of the self. Locke himself contributed to these discussions when, in the second edition of his Essay concerning Human Understanding (1694), he famously suggested that self-identity lay in the mind and resided in the continuity of memory and consciousness.7 Now a widely shared assumption of Western modernity, the view that self lies in the mind has long been dated back to the Age of Enlightenment. Yet early in this period Locke's proposal to make self-identity coextensive with memory and self-knowledge proved controversial. The debate that followed is now part of the canon of the history of philosophy and of the philosophical literature as a whole.8 In the course of the debate some of Locke's critics doubted that it was possible to found the self in conscious memory: they wondered about the destiny of the self during intervals... (shrink)

Se realizó una propuesta metodológica en el Hospital Militar Clínico Quirúrgico Docente Doctor Octavio de la Concepción y la Pedraja de Camagüey durante el año 2014 con el objetivo de argumentar el valor ético que tiene para el estudiante de Medicina ser insertado al sistema de garantía de la calidad hospitalaria. Se emplearon métodos de nivel teórico como análisis y síntesis, histórico-lógico, inducción-deducción. La vinculación del estudiante universitario al sistema de garantía de calidad en un centro asistencial docente permite elevar (...) la utilización correcta del método clínico y provee al discente de conocimiento para que al egresar desempeñe un servicio de excelencia y alcance a reducir los errores e insatisfacciones de la población y con ello los costos innecesarios. In order to increase the ethical value integrating medical students into a hospital quality guarantee system has, a methodological proposal was put forward in the Doctor Octavio de la Concepcion y la Pedraja Teaching Clinical-Surgical Military Hospital of Camaguey during 2014. Theoretical methods such as analysis and synthesis, historical-logical methods and induction-deduction were used. Linking college students to the quality guarantee system allows increasing the proper use of the clinician and it provides the learner with the knowledge he needs to carry out an excellent service and to reduce errors making and people dissatisfactions, therefore cutting on unnecessary costs. (shrink)

Health information technology in hospitals can be approached as a tool to reduce health care costs and improve hospital efficiency and profitability, increase the quality of healthcare services, and make the transition to patient-centered healthcare. A hospital’s efficiency and profitability depends on linking IT with the knowledge and motivation of medical personnel. It is important to design and execute a knowledge management strategy as a part of the implementation of IT in hospital management. A Diagnosis-Related Groups system was introduced (...) in Poland in 2008 as a basis for settlements between hospitals and the National Health Fund. The importance and role of a DRG system in management of healthcare entities was emphasized based on a survey of medical professionals from two hospitals in the Lubelskie province. The goal of a survey is to assess the knowledge of medical professionals about the DRG system and how the medical personnel uses the DRG system in order to achieve the strategic goals of the organization. A newly developed survey was used to assess the medical personnel’s knowledge of DRG, using 12 closed and 5 open questions. The survey was conducted on 160 medical employees from two hospitals in the Lubelskie province. In conclusion, medical personnel’s DRG knowledge unambiguously contributes to reducing hospital costs and increasing profitability. The DRG related knowledge enables personnel to obtain value from data by applying DRG data-driven decisions. (shrink)

In Islamic thought, the accumulation regarding Tafsir appears in various ways. One of them is the type of work called Anmudhaj that contains chapters about Tafsīr. In the An-mudhaj type of works, the determination of the sciences to investigate may occur according to different criteria. These criteria may occur as a classification of science and they also can be limited to a few sciences. In this article, we will examine the Tafsīr chapter from the work of Sipāhīzādah who took charge (...) as a teacher and judge in the Ottoman Empire. That part cons-titutes the first chapter of the work called Anmūdhaju’l-Funūn which he symbolically limited the investigated sciences to seven. The other investigated sciences in the work are Ḥadīth, Kalām, the methodology of Islamic Law, Fiqh, Bayân, and Medical Science. In the Tafsīr chap-ter of the work of Sipāhīzādah called Anmūdhaju’l-Funūn, seven different issues are investi-gated in total. Those questions are “Does Bismillah count as a vow?” and “What is the order of the creation of the earth and the heavens in the light of the verse al-Baqarah 2/29?” and “Do the names of the numbers imply limitation (hasr)?” and “What is the reason behind the borrowing of Israelites the jewels of the Egyptians in the light of the verse al-Baqarah 2/50?” and “The entry order to the city was given to Israelites in the verses al-Baqara 2/58-59, was this order given to them before or after their deviation?” and “Where is the prostrated door which is mentioned in the verse?” and “How can we assess Fakhr al-Dīn al-Rāzī’s questions and answers regarding the narrative differences between the verses al-Baqarah (2/58-59) and al-A‘râf (7/161-162)?” Sipāhīzādah examined the issues of Tafsīr through a historical which makes him the participant of the debate and allows him to the continue the present discourse through a critical reading. This makes the subject of work quite important. Because thanks to the work, it will be possible to catch some clues about the progress of the accumu-lation regarding Tafsīr in the era the author lived.Summary: In Islamic thought, the accumulation regarding Tafsīr appears in various ways. One of them is the type of work called Anmudhaj that contains chapters about Tafsīr. In Anmudhaj type of works, the determination of the sciences to investigate may occur according to diffe-rent criteria. These criteria may occur as a classification of science and they also can be limi-ted to a few sciences. In this article, we will examine the Tafsīr chapter from the work of Sipāhīzādah who took charge as a teacher and judge in the Ottoman Empire. That part cons-titutes the first chapter of the work called Anmūdhaju’l-Funūn which he symbolically limited the investigated sciences to seven. The other investigated sciences in the work are Ḥadīth, Kalām, the methodology of Islamic Law, Fiqh, Bayân, and Medical Science.The work of Sipāhīzādah, Anmūdhaju’l-Funūn consists of seven chapters and also seven is-sues are investigated in the Tafsīr part of the work. The first investigated issue in the Tafsīr part is the issue of Basmalah and in our opinion, it would not be surprising to accept that in one dimension it is a conscious choice aimed at the beginning of the work. His general attitude is presenting the issues firstly. He constituted all of the issues through the trio of al-Zamakhs-harī, al-Rāzī, and al-Bayḍāwī either one or two of them. Another remarkable point in the de-velopment of the issues is Sipāhīzādah begins with Basmalah according to the Mushaf com-position and proceeds to al-Baqarah verse 59 in a particular order. According to this, the aut-hor takes the problems he detected in the relevant parts as a subject.The issues that are investigated in the Tafsīr chapter can be listed as follows:1. Can Bismillah be used as a vow? According to Sipāhīzādah, al-Bayḍāwī, al-Jurjānī and Mollā Khusraw claim that there is a difference between vowing in the name of God and starting something with Bismillah and this difference should be rejected through the work of al-Mergīnānī that is called Hidâye and Ibn al-Humām’s Sharh. Thus, according to him one of the differences between Billah and Bismillah is not that they count as a vow.2. What is the order of the creation of the earth and the heavens in the light of the verse al-Baqarah 2/29? Sipāhīzādah mentions that the creation and the arrangement of the earth did not happen at the same time.3. Do the names of the numbers imply limitation (hasr)? Regarding this issue, Sipāhīzādah took the verse that says “…and made them seven heavens” as the focal point and claimed that the mentioned number in this verse indicated limitation and gave examples from verses, hadith, linguists and scholars of the methodology.4. What is the reason behind the borrowing of Israelites the jewels of the Egyptians in the light of the verse al-Baqarah 2/50? Sipāhīzādah criticized the two arguments of Fakhr al-Dīn al-Rāzī. Sipāhīzādah criticized the assessments that Ancient Egyptians pursued those properties which they lent before and Israelites kept those jewels and he rejected them.5. The entry order to the city was given to Israelites in the verses al-Baqara 2/58-59, was this order given to them before or after their deviation? He criticized the argu-ments of al-Zamakhsharī and al-Bayḍāwī which they have given to prove that this order was given to them after their deviation. He offered arguments and emphasi-zed that the entry order to the city was given before their deviation.6. Where is the prostrated door which is mentioned in the verse al-Baqara 2/58? It is controversial if it is Jerusalem or the door of the Mosque in which they were perfor-ming the prayer. al-Zamakhsharī and al-Bayḍāwī claim that it is Jerusalem. Was this order given before or after the death of the prophet Moses? Sipāhīzādah thinks that it has to be the door of Jerusalem.7. How can we assess Fakhr al-Dīn al-Rāzī’s questions and answers regarding the nar-rative differences between the verses al-Baqarah (2/58-59) and al-A‘râf (7/161-162)? Sipāhīzādah criticized the responses which are given by al-Rāzī and gives contrary responses.It is obvious that the author is Hanafi in the matters of Islamic Law. Besides this, we can say that Sipāhīzādah did not examine the issues of Tafsīr through a sense of belonging, he emp-hasized the opinions of people which he found compatible with his beliefs. Hence, He someti-mes comes to an agreement with al-Bayḍāwī who is a Shaffi in the matters of Islamic Law and from time to time he affirms al-Zamakhsharī who is a Mutazilite in the matters of faith. Sipāhīzādah examined the issues of Tafsīr through a historical depth and this both makes him a participant of the debate and allows the continuation of the present discourse through a critical reading. Thus, an attitude of critical consistency is prominent in his works. In our opi-nion, this attitude of critical consistency is an action of consolidation for the maintenance of the power of the relevant text-centered linguistic system. In this regard, we can say that Tafsīr remained its liveliness in the geography in which the author lived. So, the founders of the system which we can list as al-Zamakhsharī, Fakhr al-Dīn al-Rāzī, and al-Bayḍāwī and the ones who caused it to continue which we can list as Sayyid Sharif al-Jurjānī, Mollā Khusraw, and Ibn Kamāl Pasha have been read critically by the author. This makes the subject of work quite important. Because thanks to the work, it will be possible to catch some clues about the progress of the accumulation regarding Tafsir in the era the author lived. Even though it was negative in the issues that are investigated by the author, the fact that the Fakhr al-Dīn al-Rāzī is a prominent figure is an indicator of the maintenance of the dominance of Rāzī. It would be more appropriate to link this with his effectiveness rather than the Kalāmī power of his Tafsir. For Rāzī is not taken as the focal point by Sipāhīzādah only in issues of Kalām. Besides that, he renders Rāzī as a participant of the subject in linguistic issues too such as whether if the name of the numbers implies limitation or not and the usage of varied phrases in verses. (shrink)

Those giving birth within modern maternity systems are recognised as facing a number of barriers to person-centred care. In this paper, I argue that in order to best facilitate the conditions for positive change, work needs to be done to provide a more granular articulation of the specific barriers. I then offer a nuanced and contextually aware articulation of one key component of the overall failure to ensure person-centred care: medical authority and the expectation of conformity. Articulating (...) these barriers with increased specificity is valuable, as it creates a stronger foundation from which to challenge existing problems which serve to constrain the autonomy of birthing individuals. The analysis offered in this paper also underscores the need for change at an institutional, rather than individual, level. (shrink)

Medical expert systems (MES) are knowledge-based computer programs that are designed for advising physicians on diagnostical and therapeutical decision-making. They use heuristic methods developed by Artificial Intelligence researchers in order to retrieve from large knowledge-bases information needed in the situation. Constructing the knowledge-base of a MES embraces the problem of explicating and fixing the conceptual, causal and epistemic relations between a lot of medical objects. There is a number of preconditions which any adequate representation of such (...) knowledge must fulfil, among them the conditions of consistency, of completeness, of unequivocality, etc. Existing systems for classification and coding, like ICD and SNOMED, are not designed for the needs of constructing expert systems or, more generally, of knowledge processing and knowledge engineering. Their syntax is not sufficiently rich for expressing the more complex structures of (medical) knowledge. What is needed, is a language that can be used for expressing logical and descriptive relations between medical objects and facts, approximately at the level of the language of second order predicate logic. Simultaneously, it must be possible to process this language at the machine level. This can be achieved by using some dialects of the programming language LISP or, particularly, by using the programming language PROLOG. Thus, in order to achieve a suitable classification system, it is necessary to develop a system of medical data structures and predicates expressed in LISP or PROLOG. (shrink)

The great variousness and plurality of goodness has given comfort to general scepticism about values and a multitude of metaethical attitudes or predilections. But is this variousness and plurality really the hotch-potch it has appeared? The paper recapitulates and expands von Wright's typology of the varieties of goodness and looks to explain the order or system that underlies the phenomena by developing and extending a conjecture of Aristotle's, the so-called 'focal hypothesis', and combining there-with a suggestion of von Wright's, (...) to the effect that the central case of something good is the faring well of a being. By means of focal hypothesis, one may account fairly well for medical, technical, instrumental, beneficial and utilitarian goodness. Other varieties such as hedonic and ethical goodness complicate the picture, as also do all cases where it seems that an antecedent kind of goodness impinges upon a being. These complications mirror in part the finding that the human scale of values is not a scale exclusively of human values. (shrink)

The great variousness and plurality of goodness has given comfort to general scepticism about values and a multitude of metaethical attitudes or predilections. But is this variousness and plurality really the hotch-potch it has appeared? The paper recapitulates and expands von Wright's typology of the varieties of goodness and looks to explain the order or system that underlies the phenomena by developing and extending a conjecture of Aristotle's, the so-called ‘focal hypothesis’, and combining therewith a suggestion of von Wright's, (...) to the effect that the central case of something good is the faring well of a being. By means of focal hypothesis, one may account fairly well for medical, technical, instrumental, beneficial and utilitarian goodness. Other varieties such as hedonic and ethical goodness complicate the picture, as also do all cases where it seems that an antecedent kind of goodness impinges upon a being. These complications mirror in part the finding that the human scale of values is not a scale exclusively of human values. (shrink)

This article considers the issues of adaptation and organization of the educational process, barrier-free environment and readiness for professional activity of students with disabilities in inclusive education in conditions of inclusive education in a medical university. The relevance of this work is determined by one of the priority areas of state policy in the field of higher education – access to higher education for people with disabilities in inclusive education. Inclusive education at the university is designed to ensure not (...) only the realization of the right of students with disabilities in inclusive education to higher education, but also to solve the problems of socialization and professional demand for such people. In order to improve the process of introducing inclusive education at the Ryazan State Medical University named after Academician I.P. Pavlov, a study was conducted, the main problems and ways of solving them were identified, related to the organization of the educational process, the conditions of the barrier-free environment and the readiness for professional activity of students with disabilities in inclusive education. An increase in the proportion of university teachers who have undergone advanced training in inclusive education also contributes to solving problems. Adaptation of educational programs and educational and methodological support for persons with disabilities includes psychological, pedagogical and tutor support etc. The organization of the educational process using distance education technologies is one of the priority conditions for teaching students with disabilities and/or HIA. The use of this technology makes it possible to significant-ly expand and modify some educational standards for students with disabilities in inclusive education, namely, to create an individual way for each student with disabilities in inclusive education in a medical university. It is proposed to use training techniques such as: online consultation of teachers; VR technologies; availability of training materials 24/7; online webinars that facilitate the inclusion of such students in the educational and research activities of the university. The professionally organized educational space and educational process of the university provide not only a high level of mastery of professional competencies, but also contribute to the formation of personal qualities of students with disabilities in inclusive education, necessary for their successful socialization, life and activity in society. (shrink)

The Physician Orders for Life-Sustaining Treatment Paradigm is designed to improve end-of-life care by converting patients' treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. An observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and (...) long-term care organizations/agencies in combination with a review of relevant state law. (shrink)

The Physician Orders for Life-Sustaining Treatment Paradigm is designed to improve end-of-life care by converting patients’ treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. Accordingly, an observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services (...) and long-term care organizations/agencies in combination with a review of relevant state law. Legal analysis of survey responses and existing laws identified several potential state legal barriers to a POLST Paradigm implementation. The most potentially problematic barriers are detailed statutory specifications for out-of-hospital DNR protocols. Other potential barriers include limitations on the authority to consent to forgo life-sustaining treatments, medical preconditions, and witnessing requirements for out-of-hospital DNR protocols. (shrink)

Advancing Medical Posthumanism Through Twenty-First Century American Poetry places contemporary poetics in dialogue with posthumanism and biomedicine in order to create a framework for advancing a posthuman-affirmative ethics within the culture of medical practice. This book makes a case for a posthumanist understanding of the body—one that sees health and illness not as properties possessed by individual bodies, but as processes that connect bodies to their social and natural environment, shaping their capacity to act, think, and feel. (...) Tana Jean Welch demonstrates how contemporary American poetry is specifically poised to develop a pathway toward a posthuman intervention in biomedicine, the field of medical humanities, medical discourse, and the value systems that guide U.S. healthcare in general. (shrink)

Artificial intelligence (AI) systems have demonstrated impressive performance across a variety of clinical tasks. However, notoriously, sometimes these systems are 'black boxes'. The initial response in the literature was a demand for 'explainable AI'. However, recently, several authors have suggested that making AI more explainable or 'interpretable' is likely to be at the cost of the accuracy of these systems and that prioritising interpretability in medical AI may constitute a 'lethal prejudice'. In this paper, we defend (...) the value of interpretability in the context of the use of AI in medicine. Clinicians may prefer interpretable systems over more accurate black boxes, which in turn is sufficient to give designers of AI reason to prefer more interpretable systems in order to ensure that AI is adopted and its benefits realised. Moreover, clinicians may be justified in this preference. Achieving the downstream benefits from AI is critically dependent on how the outputs of these systems are interpreted by physicians and patients. A preference for the use of highly accurate black box AI systems, over less accurate but more interpretable systems , may itself constitute a form of lethal prejudice that may diminish the benefits of AI to - and perhaps even harm - patients. (shrink)

The principles of medical ethics, common as they are in the world at the present time, have been formed in the context of Western secular communities; consequently, secular principles and values are inevitably manifested in all corners of medical ethics. Medical ethics is at its infancy in Iran. In order to incorporate medical ethics into the country's health system, either the same thoughts, principles, rules, and codes of Western communities should be translated and taught across (...) the country, or else, if the principles and values and consequently the prominent moral rules and codes of Western medical ethics are not consistent with the culture, customs, and religion of our country, then new principles and values should be formulated that are more in harmony with our society. According to the available literature in Iran, the four principles proposed by Beauchamp and Childress do not contradict the Islamic-Iranian culture and can thus be generally applied in the mentioned context. However, the application of these four principles and their derivatives requires careful examination and adaptation to Islamic ethics. A comparison of the ontological, anthropological and epistemological foundations of secular and Islamic attitudes shows the differences between these two attitudes to be deep-rooted. “Rationalism,” “scientism,” and “humanism” are the main foundations of secularism, whereas “Godcentrism,” “pure human servitude to God,” the belief in “returning of humans to God,” “resurrection day,” and also human's accountability to God are all fundamental beliefs and principles of religion for Muslims of all cults and sects. It can thus be concluded that the principles of secularist thought are different from and to some extent inconsistent with the principles of Islam. Instructions derived from secular thought can therefore not be implemented in an Islamic community; rather, these communities should adopt Islamic foundations as the source for the norms and standards of their medical ethics. The capacities of religious thought make possible the formation of an ethical system consistent with Islamic Ummah. (shrink)

Even a small percentage of missing data can cause serious problems with analysis, reducing the statistical power of a study and leading to wrong conclusions being drawn. In the case of monitoring a woman’s monthly cycle, missing entries can appear even in a woman experienced in fertility awareness methods. Due to the fact that in a system of controlling a woman’s fertility, it is the most important to predict the day of ovulation and, ultimately, to determine the fertile window as (...) much precisely as possible, much attention should be paid to the quality of the used data. This paper presents the results of handling missing observations as far as predicting the time during the cycle when a woman can become pregnant is concerned. Data taken from a multinational European study of daily fecundability was used to learn the quantitative part of the variety of a higher-order dynamic Bayesian network modeling a woman’s monthly cycle. The main goal of this paper is to examine whether omitting observations has an influence on the model’s reliability. The accuracy of comparison was examined based on two measures: the average percentage length of the infertile time during the monthly cycle and average percentage of days inside the fertile window classified as infertile. (shrink)

The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, (...) to date, dominated the arena. In this problematization, the paper discusses a range of understandings and uses of the term ‘medical tourism’ and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces. (shrink)

Today, Yoga has acquired global recognition and an exalted status as an ancient health-building system. It is true that Yoga is powerful and contains the solutions for all the global problems. Yoga as a complete medical science and philosophy of life and accepts its scientific reasoning and basis. Yoga is not just a physical exercise but a holistic medical science; it is a philosophy of life, a spiritual knowledge. It is a profound philosophical thought process, but it is (...) also about having a simple, easy and balanced life-style. It is the path to gain eternal wisdom, ultimate truth and to unite the inner soul with the supreme soul through self-realization. It is a tradition in which sages have attained immeasurable bliss, indescribable happiness and inexplicable peace by entering the supreme consciousness which is present beyond mind. It is the science that inhibits the agitations of the mind and takes it to its highest level. Yoga is the spiritual journey from ignorance to knowledge, mortality to immortality, obvious to hidden and peace to ultimate tranquillity. It is the inner journey from thoughtfulness to emptiness, subjective to objective concentration, determinate to indeterminate samadhi and extrovertedness to introvertedness and being firm in judgement. This book is an humble attempt in this direction. We are determined to obtain more scientific evidence and build a science perspective not only for Yoga and Ayurveda but for the entire Vedic knowledge and wisdom. We shall lead the world in finding solutions for complex problems besetting humanity through the fusion of science and spiritualism. This book is the outcome of meticulous work put in by us in order to present various scientific standards used to test and validate this ancient system of Yoga, demographic study and personal experiences of several hundred people along with sufficient supporting proofs and documents. This is our first attempt to present Yoga backed by currently available scientific evidence, the goal is far more ambitious and the task of scientific documentation and research is an ongoing process. We will continue with the research and shall present new facts as they become available. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within (...) healthcare organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

The ArgumentMedicine is only a cultural system of its own. It also performs specific roles in the broader culture of society at large. This article examines the role of medical arguments in the critique of“enthusiasm” on the eve of the Enlightenment. The enthusiasts, who claimed to prophesy and to have direct divine inspiration, were increasingly see in the seventeenth century as melancholics. With the decline of humoral medicine, however, the account of melancholic disturbances – including enthusiasm – that was (...) offered tended to be chemical, mechanistic, and clearly corpuscular. Protestant ministers, in adopting such an account of enthusiasm, also adopted a strict distinction between the realm of the mind (to which true prophecy belonged) and that of the body (in which they located the phenomena of enthusiasm). Such a distinctions served in turn to demarcate more specifically the limits between the clerical and medical professions. Yet in relegating the treatment of enthusiasts to the physicians, rather than seeing the enthusiasts as heretics, the ministers stood in danger of relying too much on a secular profession and secular arguments, thus paving the way to a more general secularization of the ideological basis of the social order. (shrink)

Artificial intelligence (AI) systems have demonstrated impressive performance across a variety of clinical tasks. However, notoriously, sometimes these systems are “black boxes.” The initial response in the literature was a demand for “explainable AI.” However, recently, several authors have suggested that making AI more explainable or “interpretable” is likely to be at the cost of the accuracy of these systems and that prioritizing interpretability in medical AI may constitute a “lethal prejudice.” In this paper, we defend (...) the value of interpretability in the context of the use of AI in medicine. Clinicians may prefer interpretable systems over more accurate black boxes, which in turn is sufficient to give designers of AI reason to prefer more interpretable systems in order to ensure that AI is adopted and its benefits realized. Moreover, clinicians may be justified in this preference. Achieving the downstream benefits from AI is critically dependent on how the outputs of these systems are interpreted by physicians and patients. A preference for the use of highly accurate black box AI systems, over less accurate but more interpretable systems, may itself constitute a form of lethal prejudice that may diminish the benefits of AI to—and perhaps even harm—patients. (shrink)

BackgroundMedical professionalism is a core aspect of medical education and practice worldwide. Medical professionalism must be reinterpreted to adapt to different social/cultural/historical contexts. We conducted a survey to examine the current understanding and perceived value of medical professionalism among Korean physicians.MethodsThe survey was distributed to 950 physicians nationwide; 721 completed surveys were returned between 1 April and 31 July 2011.ResultsIn their practice, Korean physicians prioritized the values and virtues of medical professionalism in the following order: (...) veracity, respect for patient autonomy, integrity, responsibility, altruism, and honesty. Approximately two-thirds of physicians responded that medical professionalism is an element of their vocation. When asked to choose the most important sets of attributes or virtues of medical professionalism from a provided list, the top three sets were: “responsibility and duty,” “veracity, integrity, and honesty,” and “rapport with patients and conversational skill.”ConclusionsKorean physicians value moral duties, such as responsibility and veracity, more than they do moral virtues, such as altruism and honesty with patients. It is presumed that physicians are under pressure due to governmental regulation of the national healthcare system and have difficulty exercising their autonomy. (shrink)

BackgroundBioethics can play an important role in addressing diversity both in and outside of academia, setting precedents for meaningful contributions to public discourse, research, teaching, training, and policy development. However, in order to do so, these conversations also need to reflect on the issue of diversity within the field of bioethics across the globe. This study aims to examine current gender representation and diversity at medical ethics and humanities institutes in Germany, the German-speaking areas of Switzerland, and Austria.MethodsA (...) total of forty-nine medical ethics and humanities institutes from Germany (n=42), the German-speaking areas of Switzerland (n=5), and Austria (n=2) were included in the study. Institutes websites were reviewed in the first week of March 2021 and the details of each staff member listed on the website recorded.ResultsOverall, a total of 964 staff members were identified at the forty-nine German-speaking medical ethics and humanities institutes. Just over half (530/964; 55%) of all staff were female. There were significant differences between gender in some staff positions: 64.6 per cent (31/48) of directors were male (χ2(1)=4.1, P=.04); 62.7 per cent (84/134) of student assistants were female (χ2(1)=8.6, P=.003); and 83.7 per cent (77/92) of administrative staff were female (χ2(1)=41.8, P<.001). There were no significant differences between staff gender for researchers and lecturers, or associated researchers. In addition, 65.5 per cent (19/29) of researchers and lecturers who had a professor title were male, but the difference between genders was not found to be significant. However, significantly more of the researchers and lecturers who had completed a habilitation were male (75.8% (25/33); χ2(1)=8.8, P=.003). When comparing the institute director’s gender presentation with staff gender presentation, it was found that male-led institutes had 53.4 per cent (286/536) female staff overall but had 52.7 per cent (136/258) male researchers and lecturers. However, the difference between genders were not found to be significant. On the other hand, female-led institutes had significantly more female staff overall (59.9% (223/372); χ2(1)=14.7, P<.001) and also significantly more female researchers and lecturers (58.9% (119/202; χ2(1)=6.4, P=.01).ConclusionsThere has been a significant push to address gender diversity in German-speaking academia, and this study finds overall good gender parity in medical ethics and humanities institutes. However, there has not been a similar openness to discussing issues of systemic racism or how other forms of inequality affect academic diversity. Taking diversity seriously requires opening up conversations around intersectionality, including difficult conversations around race and cultural background that have long been taboo in German-speaking countries. (shrink)

Medical-legal partnerships (MLPs) have the potential to address racial health disparities by improving the conditions that constitute the social determinants of health. In order to live up to this potential, these partnerships must intentionally incorporate seven core racial justice principles into their design and implementation. Otherwise, they are likely to replicate the systemic barriers that lead to racialized health disparities.

BackgroundOperation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their (...) elective surgery rescheduled for non-medical reasons.MethodsIn this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ2-test.ResultsSignificantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer.ConclusionsElderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery.Trial registration DRKS00015836. Retrospectively registered. (shrink)

This brief review of the efficacy, safety, and costs of IVF demonstrates that this procedure has become accepted medical practice without adequate scientific assessment. Its rapid proliferation especially in the market-oriented USA system, has preceded the type of outcomes research that is essential in order to protect both individual patients and the health care system. In addition, concern over the psychological costs borne by the vast majority of women who unsuccessfully pursue pregnancy through these techniques should warrant a (...) level of caution which to date has not been forthcoming. The demand for pregnancy, the organisation of medical specialties surrounding these procedures, the open-ended reimbursement and incentive structure, and powerful market forces make it unlikely that IVF and a whole range of medical technologies can be regulated without some semblance of a national health system. These findings clearly reinforce the themes raised by the Radical Statistics Health Group and illustrate some of the weaknesses of a market approach to medical care. (shrink)

The healthcare systems of the United States and United Kingdom are vastly different. The former relies primarily on private sector incentives and market forces to allocate medical care services, while the latter is a centrally planned system funded almost entirely by the public sector. Therefore, each nation represents divergent views on the relative efficacy of the market or government in achieving social objectives in the area of medical care policy. Since its inception in 1948, the National Health (...) Services of the United Kingdom has consistently emphasized equity in the allocation of medical services. It has done so by creating a system whereby services are universally free of charge at the point of entry. Conversely, the United States has relied upon the evolution of a perplexing array of public and private sector insurance schemes centered more around consumer choice than equity in allocation. (shrink)

Medical terminology collects and organizes the many different kinds of terms employed in the biomedical domain both by practitioners and also in the course of biomedical research. In addition to serving as labels for biomedical classes, these names reflect the organizational principles of biomedical vocabularies and ontologies. Some names represent invariant features (classes, universals) of biomedical reality (i.e., they are a matter for ontology). Other names, however, convey also how this reality is perceived, measured, and understood by health professionals (...) (i.e., they belong to the domain of epistemology). We analyze terms from several biomedical vocabularies in order to throw light on the interactions between ontological and epistemological components of these terminologies. We identify four cases: 1) terms containing classification criteria, 2) terms reflecting detectability, modality, uncertainty, and vagueness, 3) terms created in order to obtain a complete partition of a given domain, and 4) terms reflecting mere fiat boundaries. We show that epistemology-loaded terms are pervasive in biomedical vocabularies, that the “classes” they name often do not comply with sound classification principles, and that they are therefore likely to cause problems in the evolution and alignment of terminologies and associated ontologies. (shrink)

The public perception of decision‐making procedures as fair processes is a central means for establishing their legitimacy to make difficult resource allocation decisions. According to the ethical framework of accountability for reasonableness (A4R, hereafter), which specifies conditions for fair healthcare resource allocation, disagreements about what constitutes relevant considerations are a central threat to its perceived fairness. This article considers how an ethical principle grounded in the public memory of past traumatic events may become the topic of such disagreements. I demonstrate (...) this through an anthropological case study of a recent public de bate concerning an Israeli healthcare allocation committee (HAC, thereafter), which determines state subsidies for new medical technologies as part of Israel’s public healthcare system. Drawing upon ethnographic fieldwork about the HAC, I show how the public memory of Adolf Eichmann’s trial constitutes a bioethical problem for the committee’s legitimacy. Based on Arendt’s and Bauman’s writings that Nazi bureaucrats’ manner of “following orders” was an ethical transgression, some patients contended that the committee has a historical responsibility to question its strict adherence to bureaucratic procedures. Since the committee did not have a direct link to the events of the Holocaust, other considerations seemed to them more relevant. I then present an offer that can settle this disagreement and maintain the HAC’s legitimacy according to A4R. I conclude by discussing the contribution of empirical data to models of bioethical legitimacy. (shrink)

Definition of the problem Few concepts in recent ethical debates have enjoyed as much popularity as the concept of discrimination. However, a comparative discussion of the concept, including its conceptual nuances and its ethical significance for health care, has so far been lacking. The aim of this paper is to develop a nuanced understanding of discrimination based on the philosophical and sociological literature against the background of ethically relevant medical and nursing scenarios. Methods Using practical examples from health care, (...) we discuss direct, indirect, and statistical discrimination; we examine the importance of intentions and the role of collective actors. In addition, we analyze which social groups may experience discrimination and the respective importance of forms of epistemic injustice. Conclusions We argue that despite its complexity, the concept offers significant added value because it allows us to highlight forms of disadvantage that go beyond the violation of individual specific rights or interests. As a knowledge-based system of great societal influence, health care exhibits some characteristics that can foster discrimination. Acknowledging this fact is essential in order to effectively address discrimination. (shrink)

Medical residency—specialty training after the completion of medical school—is an essential component of medical education and is required in order to be a licensed, independent medical practitioner in most jurisdictions. As things currently stand in the United States, the match between medical school graduates and residency programs is governed by a match between rank-order lists prepared by candidates and residencies alike. An applicant picks a number of residency programs and ranks them according to (...) order of interest. The residency program prepares a similar list, ranking the candidates it most wants in its program. A computer program compares the rankings and makes assignments according to a certain algorithm. Using these lists, the match system assigns approximately 24,000 applicants to approximately 21,000 training positions in pediatrics, obstetrics and gynecology, internal medicine, and the rest. These assignments are then announced to all parties on specific days. The system has been in place since 1952 and is overseen by the National Residency Match Program, a nonprofit organization. This system has several advantages. First of all, it standardizes the timetable for decisions, and applicants are in no position to tie up offers while waiting to hear from other institutions. Institutions are not held captive, either, in making assignments while waiting to hear from particular parties. (shrink)

The first case of COVID-19 in Iran was officially reported by the Iranian Government in February 19, 2020. In order to control and prevent the infection, the Government closed all the universities and requested the people to stay at home. Consequently, Tehran University of Medical Sciences (TUMS), like other universities, cancelled all the face-to-face classes in different Schools, and since the exact date for the resolution of this calamity could not be determined, TUMS decided to proceed the education (...) flow through the available Learning Management System (LMS). As one of the departments of the university, TUMS Department of Foreign Languages devised a plan and prepared itself for the new situation. This paper is a narrative account of the transition. Through reading this narration as a case of educational solution in the preset particular situation, language professors can adopt and implement efficient strategies and approaches in their educational settings. (shrink)

Background Denmark has implemented a comprehensive, nationwide pharmaceutical information system, and this system has been evaluated by the Danish Council of Ethics. The system can be seen as an exemplar of a comprehensive health information system for clinical use. Analysis The paper analyses 1) how informed consent can be implemented in the system and how different implementations create different impacts on autonomy and control of information, and 2) arguments directed towards justifying not seeking informed consent in this context. Results and (...) Conclusion Based on the analysis a heuristic is provided which enables a ranking and estimation of the impact on autonomy and control of information of different options for consent to entry of data into the system and use of data from the system. The danger of routinisation of consent is identified. The Danish pharmaceutical information system raises issues in relation to autonomy and control of information, issues that will also occur in relation to other similar comprehensive health information systems. Some of these issues are well understood and their impact can be judged using the heuristic which is provided. More research is, however needed in relation to routinisation of consent. (shrink)

Ethical problems are related to computer data bases, containing data on individuals and groups of persons, as well as to computer knowledge bases, containing general rules and elements of expert systems.In the present essay the following conclusions are made regarding computer data bases: privacy, security, and confidentiality of medical computer data bases should be ensured. This duty should rest with physicians in hospitals. The principle of informed consent should be applied to gathering information which is to be stored (...) and processed by computers. Information stored in computer data bases should not be used for purposes for which the subjects (patients as well as personnel) have not given their consent. In order to decrease the possibility of misuses of medical data bases containing information on individuals, these registers should not be linked to other central data bases. (shrink)

Las universidades de hoy enfrentan serios desafíos para cumplir su misión social debido a los cambios producidos por la globalización. El presente trabajo tiene como objetivo: describir elementos presentes en la Universidad de Ciencias Médicas de La Habana, mediante un breve recuento histórico de la enseñanza de la Medicina en Cuba, para describir las funciones, retos, los elementos favorecedores y el sistema de influencias educativas para la formación integral de los profesionales de la salud en la Universidad de Ciencias Médicas (...) de La Habana. Modern universities face serious challenges to fulfill their social mission due to the changes caused by globalization. This paper aims at: describing elements present in the Medical Sciences University of Havana, through a brief historical recountal of the teaching of medicine in Cuba, in order to describe the functions, challenges, beneficial elements and the system of educational influences towards the comprehensive training of health professionals in the Medical Sciences University of Havana. (shrink)

Both healthcare professionals and the healthcare system must defend each patient's health individually while simultaneously seeking to protect the population's health in general. Nowadays, there is an important increase in the cost of healthcare supply, mainly due to the developments of medical science, the public's expectations and the demographic ageing. Since healthcare resources are not unlimited, it is obvious that immoderate consumption of them by certain patients limits the use of the same funds by others. Therefore, we have to (...) seek an optimal distribution of the existing resources in order to manage a constriction of expenses, especially under the circumstances of the modern economic crisis. The criteria of effectiveness and efficiency should be used. Health policies focus on both the public's behaviour and the rules of medical practice. Under the modern challenges the physician's role is particularly important for the protection of the patient's health and the promotion of public health. (shrink)

Not long ago I visited the Personal Genome Project's website. The PGP describes its mission as “creating public genome, health, and trait data.” In the “Participant Profiles” section, I found several entries that disclosed the names of individuals along with their date of birth, sex, weight, height, blood type, race, health conditions, medications, allergies, medical procedures, and more. Other profiles did not feature names but provided all of the other details. I had no special access to this information. It (...) is available to absolutely anyone with Internet access. The PGP is part of a trend known as “open data.” Many government and private entities have launched initiatives to compile very large data resources and to make them available to the public. President Obama himself has endorsed open data by issuing a May 2013 executive order directing that, to the extent permitted by law, the federal government must release its data to the public in forms that make it easy to locate, access, and use. (shrink)

I analyse an argument according to which medical artificial intelligence represents a threat to patient autonomy—recently put forward by Rosalind McDougall in the Journal of Medical Ethics. The argument takes the case of IBM Watson for Oncology to argue that such technologies risk disregarding the individual values and wishes of patients. I find three problems with this argument: it confuses AI with machine learning; it misses machine learning’s potential for personalised medicine through big data; it fails to distinguish (...) between evidence-based advice and decision-making within healthcare. I conclude that how much and which tasks we should delegate to machine learning and other technologies within healthcare and beyond is indeed a crucial question of our time, but in order to answer it, we must be careful in analysing and properly distinguish between the different systems and different delegated tasks. (shrink)

When software is written and then utilized in complex computer systems, problems often occur. Sometimes these problems cause a system to malfunction, and in some instances such malfunctions cause harm. Should any of the persons involved in creating the software be blamed and punished when a computer system failure leads to persons being harmed? In order to decide whether such blame and punishment are appropriate, we need to first consider if the people are “morally responsible”. Should any of (...) the people involved in creating the software be held morally responsible, as individuals, for the harm caused by a computer system failure?This article provides one view of moral responsibility and then discusses some barriers to holding people morally responsible. Next, it provides information about the Therac-25, a computer-controlled medical linear accelerator, and its computer systems failures that led to deaths and injuries. Finally it investigates whether two key people involved in the Therac-25 case could reasonably be considered to have some degree of moral responsibility for the deaths and injuries. The conclusions about whether or not these people were morally responsible necessarily rest upon a certain amount of speculation about what they knew and what they did. These limitations, however, should not cause us to conclude that discussions of moral responsibility are fruitless. In some cases, determinations of moral responsibility may be made and in others the investigation is still worthwhile, as the article demonstrates. (shrink)

The experience of the use of applied containerized biomedical software tools in cloud environment is summarized. The reproducibility of scientific computing in relation with modern technologies of scientific calculations is discussed. The main approaches to biomedical data preprocessing and integration in the framework of the intelligent analytical system are described. At the conditions of pandemic, the success of health care system depends significantly on the regular implementation of effective research tools and population monitoring. The earlier the risks of disease can (...) be identified, the more effective process of preventive measures or treatments can be. This publication is about the creation of a prototype for such a tool within the project «Development of methods, algorithms and intelligent analytical system for processing and analysis of heterogeneous clinical and biomedical data to improve the diagnosis of complex diseases», implementted by the V.M. Glushkov Institute of Cybernetics, National Academy of Sciences of Ukraine, together with the United Institute of Informatics Problems, National Academy of Sciences of Belarus. The insurers, entering the market, can insure mostly low risks by facilitating more frequent changes of insurers by consumers and mixing the overall health insurance market. Socio-demographic variables can be risk adjusters. Since age and gender have a relatively small explanatory power, other socio-demographic variables were studied – marital status, retirement status, disability status, educational level, income level. Because insurers have an interest in beneficial diagnoses for their policyholders, they are also interested in the ability to interpret relevant information – upcoding: insurers can encourage their policyholders to consult with doctors more often to select as many diagnoses as possible. Many countries and health care systems use diagnostic information to determine the reimbursement to a service provider, revealing the necessary data. For processing and analysis of these data, software implementations of construction for classifiers, allocation of informative features, processing of heterogeneous medical and biological variables for carrying out scientific research in the field of clinical medicine are developed. The experience of the use of applied containerized biomedical software tools in cloud environment is summarized. The reproducibility of scientific computing in relation with modern technologies of scientific calculations is discussed. Particularly, attention is paid to containerization of biomedical applications, this permits to get reproducibility of the conditions in which the calculations took place, technologies of software pipelining of calculations, that allows to organize flow calculations, and technologies for parameterization of software environment, that allows to reproduce, if necessary, an identical computing environment. The main approaches to biomedical data preprocessing and integration in the framework of the intelligent analytical system are described. The experience of using the developed linear classifier, gained during its testing on artificial and real data, allows us to conclude about several advantages provided by the containerized form of the created application: it permits to provide access to real data located in cloud environment; it is possible to perform calculations to solve research problems on cloud resources both with the help of developed tools and with the help of cloud services; such a form of research organization makes numerical experiments reproducible, i.e. any other researcher can compare the results of their developments on specific data that have already been studied by others, in order to verify the conclusions and technical feasibility of new results; there exists a universal opportunity to use the developed tools on technical devices of various classes from a personal computer to powerful cluster. (shrink)