Automation of literature screening using machine learning in medical evidence synthesis: a diagnostic test accuracy systematic review protocol

Background Systematic review is an indispensable tool for optimal evidence collection and evaluation in evidence-based medicine. However, the explosive increase of the original literatures makes it difficult to accomplish critical appraisal and regular update. Artificial intelligence (AI) algorithms have been applied to automate the literature screening procedure in medical systematic reviews. In these studies, different algorithms were used and results with great variance were reported. It is therefore imperative to systematically review and analyse the developed automatic methods for literature screening and their effectiveness reported in current studies. Methods An electronic search will be conducted using PubMed, Embase, ACM Digital Library, and IEEE Xplore Digital Library databases, as well as literatures found through supplementary search in Google scholar, on automatic methods for literature screening in systematic reviews. Two reviewers will independently conduct the primary screening of the articles and data extraction, in which nonconformities will be solved by discussion with a methodologist. Data will be extracted from eligible studies, including the basic characteristics of study, the information of training set and validation set, and the function and performance of AI algorithms, and summarised in a table. The risk of bias and applicability of the eligible studies will be assessed by the two reviewers independently based on Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Quantitative analyses, if appropriate, will also be performed. Discussion Automating systematic review process is of great help in reducing workload in evidence-based practice. Results from this systematic review will provide essential summary of the current development of AI algorithms for automatic literature screening in medical evidence synthesis and help to inspire further studies in this field. Systematic review registration PROSPERO CRD42020170815 (28 April 2020).

Critique of the Royal Australian and New Zealand College of Psychiatrists Psychedelic Therapy Clinical Memorandum, Dated May 2020

Objective: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has positioned itself against medically controlled patient access (at this current time) to 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin-assisted therapies in its Therapeutic Use of Psychedelic Substances Clinical Memorandum, May 2020. The main reason given by the RANZCP for its stance is safety concerns. Methods: Every reference in the clinical memorandum (CM) was checked against the original publications used by RANZCP to justify its position. In addition, the search engines Google Scholar, PubMed, ScienceDirect, the Multidisciplinary Association for Psychedelic Therapies (MAPS) website, the Therapeutic Goods Administration (TGA) website, relevant Australian and New Zealand legislation were searched for pertinent and up-to-date- information. Results: There is no scientific or medical evidence from the last 70 years to suggest that either psilocybin or MDMA, when administered as an adjutant to therapy in a controlled clinical setting, are linked to either mental illness or negative health outcomes. On the contrary, MDMA and psilocybin have been shown to be safe, non-toxic, non-addictive, and efficacious when administered in a medically-controlled clinical environment. All associated risks are apparent in an uncontrolled setting. Conclusion: The RANZCP’s position is based on outdated, irrelevant, misinterpreted, and misinformed evidence. With the recent positive media coverage of the efficacy of these medicines when used as an adjunct to therapy, there is an intrinsic risk of self-medication or underground therapy. This means that any medical discussion must also purvey the ethical responsibilities and social duties associated with these substances.

Bases of Forensic Pathology Expert Testimony With Emphasis on Iowa v Tyler

Judicial scrutiny of the forensic sciences is increasing. This scrutiny targets the bases for expert opinions. Forensic pathologists must understand that when they express an opinion it must have an articulable underlying basis. Iowa v Tyler provides a cautionary tale where testimony from a forensic pathologist on the cause and manner of death based exclusively on police reports and audio and video recordings of police interviews of the suspect rather than on medical evidence were held to be inadmissible. Tyler has an odd and distinguishable set of facts, but has been widely cited as an example of problematic forensic pathology testimony.

Fetal Pain in the First Trimester

Fetal pain perception has important implications for fetal surgery, as well as for abortion. Current neuroscientific evidence indicates the possibility of fetal pain perception during the first trimester (<14 weeks gestation). Evidence for this conclusion is based on the following findings: (1) the neural pathways for pain perception via the cortical subplate are present as early as 12 weeks gestation, and via the thalamus as early as 7–8 weeks gestation; (2) the cortex is not necessary for pain to be experienced; (3) consciousness is mediated by subcortical structures, such as the thalamus and brainstem, which begin to develop during the first trimester; (4) the neurochemicals in utero do not cause fetal unconsciousness; and (5) the use of fetal analgesia suppresses the hormonal, physiologic, and behavioral responses to pain, avoiding the potential for both short- and long-term sequelae. As the medical evidence has shifted in acknowledging fetal pain perception prior to viability, there has been a gradual change in the fetal pain debate, from disputing the existence of fetal pain to debating the significance of fetal pain. The presence of fetal pain creates tension in the practice of medicine with respect to beneficence and nonmaleficence.

Physicians’ Attitudes Toward Prescribable mHealth Apps and Implications for Adoption in Germany: Mixed Methods Study

Background In October 2020, Germany became the first country, worldwide, to approve certain mobile health (mHealth) apps, referred to as DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health applications), for prescription with costs covered by standard statutory health insurance. Yet, this option has only been used to a limited extent so far. Objective The aim of this study was to investigate physicians’ and psychotherapists’ current attitudes toward mHealth apps, barriers to adoption, and potential remedies. Methods We conducted a two-stage sequential mixed methods study. In phase one, semistructured interviews were conducted with physicians and psychotherapists for questionnaire design. In phase two, an online survey was conducted among general practitioners, physicians, and psychotherapists. Results A total of 1308 survey responses by mostly outpatient-care general practitioners, physicians, and psychotherapists from across Germany who could prescribe DiGA were recorded, making this the largest study on mHealth prescriptions to date. A total of 62.1% (807/1299) of respondents supported the opportunity to prescribe DiGA. Improved adherence (997/1294, 77.0%), health literacy (842/1294, 65.1%), and disease management (783/1294, 60.5%) were most frequently seen as benefits of DiGA. However, only 30.3% (393/1299) of respondents planned to prescribe DiGA, varying greatly by medical specialty. Professionals are still facing substantial barriers, such as insufficient information (1135/1295, 87.6%), reimbursement for DiGA-related medical services (716/1299, 55.1%), medical evidence (712/1298, 54.9%), legal uncertainties (680/1299, 52.3%), and technological uncertainties (658/1299, 50.7%). To support professionals who are unsure of prescribing DiGA, extended information campaigns (1104/1297, 85.1%) as well as recommendations from medical associations (1041/1297, 80.3%) and medical colleagues (1024/1297, 79.0%) were seen as the most impactful remedies. Conclusions To realize the benefits from DiGA through increased adoption, additional information sharing about DiGA from trusted bodies, reimbursement for DiGA-related medical services, and further medical evidence are recommended.

"Get Your Gavel Out of My Pants": Replacing the Medical and Legal Scrutiny of Trans Bodies with Self-Identification as a Basis for Changing Sex Markers on Birth Certificates

<p>Section 28 of the Births, Deaths, Marriages, and Relationships Registration Act 1995 allows people to apply to the Family Court to change the sex marker on their birth certificate. This essay argues that this provision is out-dated and does not serve the needs of the trans community. It is based on the medical model of sex, and requires medical evidence that the applicant’s body conforms sufficiently to that of the “nominated sex”. This essay suggests a reform based on the self-identification model, which exists in Argentina for birth certificates, and in New Zealand for passports and drivers’ licences. Such a reform of s 28 would bring birth certificates in line with these other documents, leading to more consistency and increased respect for the human rights of trans people.</p>

"Get Your Gavel Out of My Pants": Replacing the Medical and Legal Scrutiny of Trans Bodies with Self-Identification as a Basis for Changing Sex Markers on Birth Certificates

<p>Section 28 of the Births, Deaths, Marriages, and Relationships Registration Act 1995 allows people to apply to the Family Court to change the sex marker on their birth certificate. This essay argues that this provision is out-dated and does not serve the needs of the trans community. It is based on the medical model of sex, and requires medical evidence that the applicant’s body conforms sufficiently to that of the “nominated sex”. This essay suggests a reform based on the self-identification model, which exists in Argentina for birth certificates, and in New Zealand for passports and drivers’ licences. Such a reform of s 28 would bring birth certificates in line with these other documents, leading to more consistency and increased respect for the human rights of trans people.</p>