Focusing a Bioethics Lens on the Development and Use of Artificial Intelligence in Medicine and Neurosurgery.

The rapid pace of development and application of digital technology and data science, including artificial intelligence (AI), is transforming our world. In this chapter, we address the question: "Is bioethics relevant to how we should develop, govern, and use AI in healthcare, specifically in neurosurgery?" We recognize that medical decision-making involves uncertainty and is complex, and predicting potential outcomes is difficult. We conclude that the use of AI in neurosurgery is not inherently unethical.

Effects of a comprehensive brain computed tomography deep learning model on radiologist detection accuracy.

Objectives: Non-contrast computed tomography of the brain (NCCTB) is commonly used to detect intracranial pathology but is subject to interpretation errors. Machine learning can augment clinical decision-making and improve NCCTB scan interpretation. This retrospective detection accuracy study assessed the performance of radiologists assisted by a deep learning model and compared the standalone performance of the model with that of unassisted radiologists.

Predictors of improvement in quality of life at 12-month follow-up in patients undergoing anterior endoscopic skull base surgery.

Background: Patients with pituitary lesions experience decrements in quality of life (QoL) and treatment aims to arrest or improve QoL decline.

Objective: To detect associations with QoL in trans-nasal endoscopic skull base surgery patients and train supervised learning classifiers to predict QoL improvement at 12 months.

Methods: A supervised learning analysis of a prospective multi-institutional dataset (451 patients) was conducted.

Natural Language Processing Applications in the Clinical Neurosciences: A Machine Learning Augmented Systematic Review.

Natural language processing (NLP), a domain of artificial intelligence (AI) that models human language, has been used in medicine to automate diagnostics, detect adverse events, support decision making and predict clinical outcomes. However, applications to the clinical neurosciences appear to be limited. NLP has matured with the implementation of deep transformer models (e.

Effect of a comprehensive deep-learning model on the accuracy of chest x-ray interpretation by radiologists: a retrospective, multireader multicase study.

Background: Chest x-rays are widely used in clinical practice; however, interpretation can be hindered by human error and a lack of experienced thoracic radiologists. Deep learning has the potential to improve the accuracy of chest x-ray interpretation. We therefore aimed to assess the accuracy of radiologists with and without the assistance of a deep-learning model.

Machine learning applications to neuroimaging for glioma detection and classification: An artificial intelligence augmented systematic review.

Glioma is the most common primary intraparenchymal tumor of the brain and the 5-year survival rate of high-grade glioma is poor. Magnetic resonance imaging (MRI) is essential for detecting, characterizing and monitoring brain tumors but definitive diagnosis still relies on surgical pathology. Machine learning has been applied to the analysis of MRI data in glioma research and has the potential to change clinical practice and improve patient outcomes.

Investigating Risk Factors and Predicting Complications in Deep Brain Stimulation Surgery with Machine Learning Algorithms.

Background: Deep brain stimulation (DBS) surgery is an option for patients experiencing medically resistant neurologic symptoms. DBS complications are rare; finding significant predictors requires a large number of surgeries. Machine learning algorithms may be used to effectively predict these outcomes.

Machine learning applications to clinical decision support in neurosurgery: an artificial intelligence augmented systematic review.

Machine learning (ML) involves algorithms learning patterns in large, complex datasets to predict and classify. Algorithms include neural networks (NN), logistic regression (LR), and support vector machines (SVM). ML may generate substantial improvements in neurosurgery.

Biceps Tenotomy Versus Tenodesis in Active Patients Younger Than 55 Years: Is There a Difference in Strength and Outcomes?

Background: Proximal biceps pathology is a significant factor in shoulder pain. Surgical treatment options include biceps tenotomy and subpectoral biceps tenodesis. Tenotomy is a simple procedure, but it may produce visible deformity, subjective cramping, or loss of supination strength.

The administration of rescue medication to children with prolonged acute convulsive seizures in a non-hospital setting: an exploratory survey of healthcare professionals' perspectives.

Unlabelled: Timely administration of rescue medication for prolonged convulsive seizures lasting more than 5 min is necessary to prevent progression to status epilepticus in children. The Practices in Emergency and Rescue Medication for Epilepsy Managed with Community Administered Therapy (PERFECT™) initiative was set up to gain a better understanding of how prolonged convulsive seizures in children are managed when they occur outside of the hospital. We present the findings from an exploratory telephone survey of 128 healthcare professionals (HCPs) (85 pediatric neurologists and neurologists, 28 community pediatricians, and 15 epilepsy nurses) from six EU countries, conducted as part of the PERFECT™ initiative.

Are we there yet? A journey of health reform in Australia.

• Five years on from the establishment of the National Health and Hospitals Reform Commission, it is timely to review the context for reform and some of the actions taken to date, and to highlight remaining areas of concern and priority. • The Commission's final report was released in July 2009 and presented 123 recommendations organised under four reform themes: Taking responsibility: individual and collective action to build good health and wellbeing - by people, families, communities, health professionals, employers, health funders and governments Connecting care: comprehensive care for people over their lifetime Facing inequities: recognise and tackle the causes and impacts of health inequities Driving quality performance: leadership and systems to achieve best use of people, resources and evolving knowledge. • Overall, the Australian Government's response to the Commission's report has been very positive, but challenges remain in some key areas: Financial sustainability and the vertical fiscal imbalance between the federal and state governments Getting the best value from the health dollar by reducing inefficiency and waste and using value-based purchasing across the public and private health sectors National leadership across the system as a whole Getting the right care in the right place at the right time Health is about more than health care - increasing focus on prevention and recognising and tackling the broader social determinants of health.

Are we failing to provide adequate rescue medication to children at risk of prolonged convulsive seizures in schools?

Objective: This paper explores the issues that arise from the discussion of administering rescue medication to children who experience prolonged convulsive seizures in mainstream schools in the UK.

Situation Analysis: Current guidelines recommend immediate treatment of children with such seizures (defined as seizures lasting more than 5 min) to prevent progression to status epilepticus and neurological morbidity. As children are unconscious during prolonged convulsive seizures, whether or not they receive their treatment in time depends on the presence of a teacher or other member of staff trained and able to administer rescue medication.

Metabolism and performance during extended high-intensity intermittent exercise after consumption of low- and high-glycaemic index pre-exercise meals.

The metabolic and performance benefits of prior consumption of low-glycaemic index (GI) meals v. high-GI meals were determined in extended high-intensity intermittent exercise. Participants (ten males and four females, aged 25·8 (sd 7·3) years) completed two testing days (each consisting of back-to-back 90-min intermittent high-intensity treadmill running protocols separated by 3 h) spaced by at least 7 d.

The administration of rescue medication to children with prolonged acute convulsive seizures in the community: what happens in practice?

This paper presents the findings of a review of existing clinical and non-clinical guidance on the management of children with prolonged acute convulsive seizures (PCS) and the administration of rescue medication in community settings. Findings are based on desk- and web-based research in 6 countries. Published clinical guidelines are mostly limited to the hospital setting and offer few explicit recommendations for community settings.

The impact of population-based disease management services for selected chronic conditions: the Costs to Australian Private Insurance--Coaching Health (CAPICHe) study protocol.

Background: Recent evidence from a large scale trial conducted in the United States indicates that enhancing shared decision-making and improving knowledge, self-management, and provider communication skills to at-risk patients can reduce health costs and utilisation of healthcare resources. Although this trial has provided a significant advancement in the evidence base for disease management programs it is still left for such results to be replicated and/or generalised for populations in other countries and other healthcare environments. This trial responds to the limited analyses on the effectiveness of providing chronic disease management services through telephone health coaching in Australia.

A healthier future for all Australians: an overview of the final report of the National Health and Hospitals Reform Commission.

After extensive community and health industry consultation, the final report of the National Health and Hospitals Reform Commission, A healthier future for all Australians, was presented to the Australian Government on 30 June 2009. The reform agenda aims to tackle major access and equity issues that affect health outcomes for people now; redesign our health system so that it is better positioned to respond to emerging challenges; and create an agile, responsive and self-improving health system for long-term sustainability. The 123 recommendations are grouped in four themes: Taking responsibility: supporting greater individual and collective action to build good health and wellbeing.

Beyond the blame game.

The federal government announced the establishment of the National Health and Hospitals Reform Commission (NHHRC) in February 2008 to advise on future directions of health care delivery in Australia. In late April, the NHHRC issued its first report, Beyond the blame game, giving its views on key issues for the proper function of the Australian Health Care Agreements. In this report, the NHHRC has proposed 44 benchmarks to be met by both federal and state governments, where performance should have clear consequences for the accountable party.

Contemporary (post-Wills) survey of the views of Australian medical researchers: importance of funding, infrastructure and motivators for a research career.

Objectives: To investigate the perceptions of Australian health and medical researchers 4 years after the Wills Report recommended and led to a substantial increase in health and medical research funding in Australia.

Design, Setting And Participants: A telephone poll of 501 active health and medical researchers, conducted between 28 April and 5 May, 2003.

Main Outcome Measures: Researchers' views on the adequacy of funding, infrastructure and support, salary, community recognition, the excitement of discovery and research outcomes such as publication and patenting in research.