Daily Archives: 10 August 2024

NIH research illuminates the pros and cons of incorporating AI into healthcare decision processes

National Institutes of Health (NIH) researchers have discovered that an artificial intelligence (AI) model can accurately solve medical quiz questions designed to evaluate health professionals’ diagnostic skills using clinical images and concise text summaries. Despite this, physician evaluators noted errors in the AI’s image descriptions and explanations of its decision-making processes. These insights were detailed in a study published in npj Digital Medicine, led by the NIH’s National Library of Medicine (NLM) and Weill Cornell Medicine in New York City.

NLM’s Acting Director, Stephen Sherry, PhD, commented on the findings, stating, “The integration of AI into healthcare shows immense potential to aid medical professionals in diagnosing patients more swiftly, thus hastening the onset of treatment.” However, he also cautioned that “AI has not yet evolved sufficiently to supplant the nuanced expertise of human clinicians, which remains vital for precise diagnostics.”

The study involved the AI model and medical doctors responding to diagnostic queries from the New England Journal of Medicine (NEJM)’s Image Challenge. This online quiz presents actual clinical images and brief descriptions detailing patient symptoms and asks for the correct diagnosis from a set of options. The AI model was tasked with answering 207 such questions and providing detailed justifications for each answer, including image descriptions, relevant medical knowledge, and the reasoning process behind its choices.

Nine physicians from various specialities participated in the study to assess the AI’s performance. They answered questions first without any external resources (closed-book) and then with access to external information (open-book). After completing their answers, the physicians were presented with the correct diagnoses and the AI’s responses and rationales, which they were then asked to evaluate.

The findings indicated that the AI model and the physicians performed well in identifying the correct diagnoses. Intriguingly, the AI often outperformed the physicians in the closed-book setting, while the doctors excelled with access to external resources, particularly with the more challenging questions. However, the physicians consistently found faults in the AI’s image descriptions and explanatory reasoning, even in cases where the AI accurately identified the diagnosis. For example, the AI failed to recognize that two differently angled lesions on a patient’s arm were manifestations of the same condition, mistaking them for distinct issues due to their differing appearances.

These results underscore the need for further evaluation of multi-modal AI technologies before clinical deployment. Zhiyong Lu, PhD, NLM Senior Investigator and the study’s corresponding author, emphasized, “This technology could significantly enhance clinicians’ abilities by providing data-driven insights for better clinical decisions. Nevertheless, understanding its risks and limitations is crucial for effectively leveraging its potential in medical practice.”

The study utilized an AI model known as GPT-4V (Generative Pre-trained Transformer 4 with Vision), a multimodal AI capable of processing diverse data types, including text and images. Although the research scope was limited, it highlighted the potential benefits and challenges of using multimodal AI in enhancing medical decision-making. The researchers advocate for more extensive studies to better understand how these AI models compare with human physicians in diagnostic accuracy.

More information: Qiao Jin et al, Hidden flaws behind expert-level accuracy of multimodal GPT-4 vision in medicine, npj Digital Medicine. DOI: 10.1038/s41746-024-01185-7

Journal information: npj Digital Medicine Provided by NIH / National Library of Medicine

Recent research identifies the incidence and risk factors for hepatitis C virus reinfection among men with HIV, providing fresh perspectives on transmission

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This study provides new insights into the transmission of the hepatitis C virus (HCV), which predominantly affects the liver and is often contracted through the injection of drugs. However, this research explicitly addresses the transmission among men who have sex with men (MSM). Researchers undertook a prospective cohort study in New York City involving MSM with HIV who had previously cleared an initial HCV infection. The purpose was to explore the incidence and risk factors for HCV reinfection over nearly two decades. The study revisited two risk behaviours identified in earlier research: the receipt of semen in the rectum and sexualised methamphetamine use, including instances where methamphetamine was injected. The analysis used a multivariable approach with a Cox proportional hazards model.

The results revealed that the rate of HCV reinfection was ten times higher than the rate of primary infection in New York City, highlighting that sexual transmission of the virus is neither inefficient nor unusual. Moreover, the introduction of highly effective, direct-acting antiviral treatments did not reduce the reinfection rate, indicating that these treatments do not mitigate the spread of HCV among MSM in the city. Notably, the sole risk factor linked to reinfection was the receipt of semen into the rectum, whereas sexualised methamphetamine use did not pose a significant risk.

This finding underscores a broader implication: only a limited number of sexual networks exhibit a high prevalence of HCV, and sexualised methamphetamine use is more of an indicator of membership in these high-prevalence networks than a direct mediator of transmission. This distinction challenges the traditional understanding of HCV transmission dynamics within this community.

The significance of this research stems from the historical perspective that HCV was predominantly transmitted parenterally, not sexually, and that MSM was not considered at high risk for HCV infection. Initial reports of HCV outbreaks among MSM around twenty years ago showed low infection rates, reinforcing the belief that HCV transmission among this group was rare and atypical. The methods of transmission have been a point of contention, with most evidence pointing to sexual transmission. Yet, many experts continued to attribute these cases to conventional risk factors such as drug use and blood exposure. This study, however, affirms that sexual transmission through semen is a viable and standard route among MSM, independent of drug use.

Dr. Fierer commented on the research, noting, “This study enhances our previous work on HCV among MSM in New York City, offering the most definitive evidence to date that the primary mode of HCV transmission among MSM in the city is sexual, which is distinct from the traditional transmission route via blood contact during drug injection. Given that neither condoms nor current treatments have proven effective at preventing HCV, there is a pressing need for innovative prevention strategies. We are immensely grateful to the hundreds of men who initially came to us as patients and subsequently engaged as study participants, helping us to investigate this newly recognised transmission route. We are committed to continuing our collaborative efforts to develop effective interventions to curb this ongoing epidemic.” This statement highlights the ongoing challenges and the critical need for new approaches to address the spread of HCV within these communities.

More information: Daniel S Fierer et al, Hepatitis C Virus Reinfection Among Men Who Have Sex With Men With HIV in New York City, Clinical Infectious Diseases. DOI: 10.1093/cid/ciae297

Journal information: Clinical Infectious Diseases Provided by The Mount Sinai Hospital / Mount Sinai School of Medicine

Studies Provide Optimism and Comfort for Adults Struggling with Eating Disorders

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Research conducted at Curtin University has identified that an inpatient treatment methodology can substantially aid adults with eating disorders, not only in enhancing their physical health but also their psychological well-being. This method, known as ‘High-energy refeeding,’ which is typically employed to rehabilitate malnourished adolescents with anorexia nervosa, involves a rapid escalation of caloric intake over a short period to bolster nutritional health quickly. There was initial scepticism regarding applying this approach to adults with the same condition, but the recent findings suggest that such concerns may be unwarranted.

In a study spearheaded by the School of Population Health at Curtin, 97 voluntary hospital inpatients, split between 55 adults and 42 adolescents, all suffering from eating disorders, predominantly anorexia nervosa, underwent treatment using the high-energy refeeding protocol. The outcome was encouraging, showing that adults and adolescents exhibited similar positive responses, marked by notable weight gain and improved psychological health assessments. Fiona Salter, a Master’s student and lead researcher, had highlighted concerns that adult patients might be more susceptible to refeeding syndrome — a potentially fatal condition arising from a sudden reintroduction of nutrition to severely malnourished individuals, causing drastic shifts in body fluids and electrolytes.

Despite worries about the greater frequency of mental health issues in adults potentially complicating their medical care, the study recorded just one adult unable to tolerate the high-energy regimen due to oedema, where excess fluid accumulates in body tissues. Dr Emily Jeffery, a co-author of the study, elaborated that these findings affirm that high-energy refeeding can be safely administered to adults who are mild to moderately malnourished, delivering substantial nutritional and psychological benefits. However, she cautioned that the approach might need to be adjusted for severely malnourished adults to prevent complications.

The psychological improvements noted in adult patients were particularly significant, underscoring the critical role of psychological well-being in the treatment regime. Salter pointed out that while the physical restoration of nutritional health can be achieved relatively quickly, the psychological recovery from an eating disorder is a more extended process, often taking months or years. She emphasized the importance of maintaining these gains after discharge to support long-term psychological recovery.

Looking forward, Salter indicated that subsequent research would focus on the effectiveness of high-energy refeeding in less structured environments, such as intensive treatment day programs. The aim is to determine whether similar positive outcomes can be maintained when patient meals are only partially supervised, testing the adaptability of the high-energy protocol outside the strictly controlled hospital setting. This exploration will help in understanding how to extend best the benefits of this treatment approach to broader and potentially less controlled real-world settings.

More information: Fiona Salter et al, A prospective observational study examining weight and psychosocial change in adolescent and adult eating disorder inpatients admitted for nutritional rehabilitation using a high-energy re-feeding protocol, Journal of Eating Disorders. DOI: 10.1186/s40337-024-01015-x

Journal information: Journal of Eating Disorders Provided by Curtin University

Vegetarian Men and Women May Experience Higher Risk of Hip Fractures

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Both men and women who adopt a vegetarian lifestyle face a 50% increased risk of hip fracture compared to those who consume meat regularly, according to a comprehensive study. While it is known that vegetarian women are particularly susceptible to hip fractures, the reasons remain unclear, with previous research focusing on men being limited and inconclusive. This new research, conducted by the University of Leeds, involved analyzing data from 413,914 individuals, providing the first evidence that vegetarian men also face a higher risk compared to their meat-eating counterparts while also identifying potential risk factors for both genders.

Participants, recruited for the UK Biobank project between 2006 and 2010, provided detailed dietary information. They were classified into four categories: regular meat-eaters (consuming meat five or more times a week), occasional meat-eaters (less than five times a week), pescatarians (fish but no meat), and vegetarians (dairy but no fish or meat). The study linked these dietary profiles with hospital records to monitor hip fracture occurrences up to the year 2021. The findings, documented in a paper titled “Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants,” published in BMC Medicine and available online, reflect the thoroughness and rigour of the research.

The study revealed that among the nearly 414,000 participants, 3,503 cases of hip fractures occurred, translating to an overall incidence rate of 0.8%. Although the overall risk of hip fractures is low, vegetarians showed a significantly higher risk compared to regular meat-eaters, irrespective of gender. The risk among occasional meat-eaters was similar to that of regular meat-eaters. At the same time, pescatarians had a slightly elevated risk of 8% compared to regular meat-eaters, though this difference was not statistically significant.

In real-world terms, the researchers estimated that, on average, both regular and occasional meat-eaters would encounter 6.5 hip fractures. At the same time, pescatarians would face 7 cases, and vegetarians would see 9.5 cases. James Webster, a doctoral researcher at the School of Food Science and Nutrition who led the study, emphasized that while the risk of hip fracture among vegetarians translates to just three additional fractures per 1,000 people over a decade, the overall health benefits of a vegetarian diet, such as reduced risk of cancer and cardiovascular diseases, might outweigh the increased fracture risk, providing reassurance to those following a vegetarian diet.

Webster pointed out that a lower BMI could be a key factor in the elevated risk among vegetarians. The study also found vegetarians were about 17% less likely to meet protein intake recommendations than meat-eaters. He highlighted the importance of vegetarians ensuring a balanced protein-rich diet and maintaining a healthy BMI to support bone and muscle health.

Professor Janet Cade, who heads the Nutritional Epidemiology Group at the University of Leeds and supervised the research, underscored the significant health implications of hip fractures and the potential role of diet in mitigating risk. She reiterated that while vegetarian diets offer numerous health benefits, enhancing understanding of diet quality and the balance of essential nutrients could help reduce risks and promote better bone health in the future.

More information: James Webster et al, Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants, BMC Medicine. DOI: 10.1186/s12916-023-02993-6

Journal information: BMC Medicine Provided by University of Leeds