Viewpoint Article Research Articles

The Potential of Artificial Intelligence Tools for Reducing Uncertainty in Medicine and Directions for Medical Education.

In the field of medicine, uncertainty is inherent. Physicians are asked to make decisions on a daily basis without complete certainty, whether it is in understanding the patient's problem, performing the physical examination, interpreting the findings of diagnostic tests, or proposing a management plan. The reasons for this uncertainty are widespread, including the lack of knowledge about the patient, individual physician limitations, and the limited predictive power of objective diagnostic tools. This uncertainty poses significant problems in providing competent patient care. Research efforts and teaching are attempts to reduce uncertainty that have now become inherent to medicine. Despite this, uncertainty is rampant. Artificial intelligence (AI) tools, which are being rapidly developed and integrated into practice, may change the way we navigate uncertainty. In their strongest forms, AI tools may have the ability to improve data collection on diseases, patient beliefs, values, and preferences, thereby allowing more time for physician-patient communication. By using methods not previously considered, these tools hold the potential to reduce the uncertainty in medicine, such as those arising due to the lack of clinical information and provider skill and bias. Despite this possibility, there has been considerable resistance to the implementation of AI tools in medical practice. In this viewpoint article, we discuss the impact of AI on medical uncertainty and discuss practical approaches to teaching the use of AI tools in medical schools and residency training programs, including AI ethics, real-world skills, and technological aptitude.

Could Snacks Based on Lupin Be a Nutritious Treat? A Point of View.

This viewpoint article presents an opinion about snacks made with lupin species. The nutritional quality of cereal-based snacks increased significantly when lupin was added. For instance, the protein and fibre content of lupin snacks could be as high as 55.7% and 8.3% respectively, soluble fibre as high as 61.2% of total fibre, and protein digestibility close to that of casein. As for sensory evaluation, some lupin snacks were ranked even better than controls. Moreover, some lupin snacks had similar or improved rheological behaviour with respect to controls. For instance, expansion indices of 11 versus 3 for controls. In summary, by adjusting formula and processing conditions, it is possible to obtain, at the same time, a healthy and tasty snack with very good machinability and rheological behaviour. This could improve the image and concept of snacks by providing an excellent opportunity for improving the diet quality of habitual consumers of snacks. This point of view also provides suggestions for improving the nutritional, rheological, and sensory evaluation of lupin snacks.

The utility of high-dosage experiments in everyday life to test theories in clinical science.

This viewpoint article discusses the utility of high-dosage experiments (HDEs) in everyday life to test theories in clinical science. HDEs involve experimental manipulations and assessments that occur over much longer periods of time than traditional experiments-generally days or even weeks. By nature, they also occur outside the lab, in the everyday environments of participants. Additionally, as with other experiments, the purpose of the study is concealed from participants. Experimental design is one of the most distinguishable characteristics of psychology that separates it from other behavioral sciences. Studies that rely on experiments are essential for theory testing and establishing the potential causal role of mechanisms that underlie psychopathology. Yet despite the value of experimental research, experimental studies are not currently given special prominence in clinical psychological science. For example, in the Journal of Psychopathology and Clinical Science, of all the empirical studies in the most recent year (2023), only three of 77 incorporated an experimental manipulation. Experimental research appears to be less popular in clinical psychology than in other fields, such as social psychology. What might account for this discrepancy? First, clinical samples are more difficult to recruit. This is important because experimental manipulations may produce small effects that require large samples for detection. Additionally, mechanisms hypothesized to underlie psychopathology are often chronic and intransigent. For example, cognitive factors (e.g., perfectionistic beliefs) could require an especially strong manipulation to modify in isolation. Researchers have argued that psychology has been experiencing a crisis in theory development. Eronen and Bringmann (2021) stated that one major reason for this crisis is the difficulty in establishing causal relationships between psychological constructs. The replication crisis has garnered even more attention (Open Science Collaboration, 2015). HDEs would help address these two crises and provide stronger and more replicable tests of theory. This could allow us to more precisely identify important mechanisms underlying psychopathology, potentially enhancing treatment efficacy, and enabling us to move the field forward. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Data-informed psychological therapy, measurement-based care, and precision mental health.

Measurement-based care, that is, incorporating data-informed decision support for therapists into psychological therapy, has undergone significant advancements over the past 2 decades. Technological innovations such as computerized data assessment and feedback tools have facilitated its widespread adoption across various settings. For instance, clinicians can utilize psychometric data to personalize therapeutic approaches, strategies, or modules and track a patient's response to therapy in real time (e.g., Lutz, Schwartz, & Delgadillo, 2022). Furthermore, new algorithm-based clinical support tools used within measurement-based care can optimize treatment for such patients at risk for treatment failure. Consequently, measurement-based care is evolving into a data-informed and precision psychological therapy concept that can be viewed as a low-intensity transtheoretical adjunct to evidence-based treatments. It can be integrated at multiple care points into clinical practice regardless of the clinical modality, manual, or program used in a given health care system. Therefore, it emerges as an important component of clinical competence, practice, and training, akin to continuous monitoring of physical health indicators (e.g., insulin, fever, or blood pressure). In this viewpoint article, we summarize the core concepts of data-informed psychological therapy that customizes individual psychological interventions to meet specific patient needs. We also explore implications and future steps to integrate this approach into clinical practice and further advance precision mental health care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Moving Beyond Rapport: The Importance of Active Facilitation of Therapeutic Alliance in Adult Acquired Brain Injury Rehabilitation.

Therapeutic alliance (TA) is critical to rehabilitation outcomes for adults with acquired brain injuries (ABIs). The purpose of this viewpoint article is to review factors that contribute to TA and to suggest ways speech-language pathologists (SLPs) can integrate these factors into their ABI rehabilitation practice. We evaluated literature describing client and clinician factors shown to affect-or not affect-TA in ABI rehabilitation and mapped findings onto suggested practices that SLPs may use to actively promote TA with their clients. Informed by our findings and TA frameworks, we integrated findings into a novel clinician self-reflection tool: the Therapeutic Alliance Reflection Checklist. TA is a key ingredient in ABI rehabilitation. We contend that SLPs can, and should, actively facilitate TA with clients; the self-reflection checklist can assist. We advocate for continued TA research and improved measurement across rehabilitation settings. We further contend that training in active TA-promoting skills is a critical component of speech-language pathology education.

Stop antibiotics when you feel better? Opportunities, challenges and research directions.

Shortening standard antibiotic courses and stopping antibiotics when patients feel better are two ways to reduce exposure to antibiotics in the community, and decrease the risks of antimicrobial resistance and antibiotic side effects. While evidence shows that shorter antibiotic treatments are non-inferior to longer ones for infections that benefit from antibiotics, shorter courses still represent average treatment durations that might be suboptimal for some. In contrast, stopping antibiotics based on improvement or resolution of symptoms might help personalize antibiotic treatment to individual patients and help reduce unnecessary exposure. Yet, many challenges need addressing before we can consider this approach evidence-based and implement it in practice. In this viewpoint article, we set out the main evidence gaps and avenues for future research.

The Intersection of Ultra-Processed Foods, Neuropsychiatric Disorders, and Neurolaw: Implications for Criminal Justice.

Over the last decade there has been increasing interest in the links between the consumption of ultra-processed foods and various neuropsychiatric disorders, aggression, and antisocial behavior. Neurolaw is an interdisciplinary field that seeks to translate the rapid and voluminous advances in brain science into legal decisions and policy. An enhanced understanding of biophysiological mechanisms by which ultra-processed foods influence brain and behavior allows for a historical reexamination of one of forensic neuropsychiatry's most famous cases-The People v. White and its associated 'Twinkie Defense'. Here in this Viewpoint article, we pair original court transcripts with emergent research in neurolaw, including nutritional neuroscience, microbiome sciences (legalome), pre-clinical mechanistic research, and clinical intervention trials. Advances in neuroscience, and related fields such as the microbiome, are challenging basic assumptions in the criminal justice system, including notions of universal free will. Recent dismissals of criminal charges related to auto-brewery syndrome demonstrate that courts are open to advances at the intersection of neuromicrobiology and nutritional neuroscience, including those that relate to criminal intent and diminished capacity. As such, it is our contention that experts in the neurosciences will play an increasing role in shaping research that underpins 21st-century courtroom discourse, policy, and decision-making.

Principles for Defining Estimands in Clinical Trials-A Proposal.

The ICH E9(R1) guideline outlines the estimand framework, which aligns planning, design, conduct, analysis, and interpretation of a clinical trial. The benefits and value of using this framework in clinical trials have been outlined in the literature, and guidance has been provided on how to choose the estimand and define the estimand attributes. Although progress has been made in the implementation of estimands in clinical trials, to the best of our knowledge, there is no published discussion on the basic principles that estimands in clinical trials should fulfill to be well defined and consistent with the ideas presented in the ICH E9(R1) guideline. Therefore, in this Viewpoint article, we propose four key principles for defining an estimand. These principles form a basis for well-defined treatment effects that reflect the estimand thinking process. We hope that this Viewpoint will complement ICH E9(R1) and stimulate a discussion on which fundamental properties an estimand in a clinical trial should have and that such discussions will eventually lead to an improved clarity and precision for defining estimands in clinical trials.

Opportunities and challenges of hybrid meat products: a viewpoint article

SummaryHybrid foods are made by blending animal‐based and plant‐based ingredients to make food products that are similar to the 100% animal‐based ones. Examples include hybrid meat products such as burgers or minced meat with vegetables or more recently hybrid dairy products such as cheddar cheese with oats. While hybrid meat products have been launched in several countries by both retailers and foodservice outlets, there are very few examples of hybrid meat products still available in the market, such as hybrid nuggets targeting children and hybrid minced meat products. This short viewpoint article covers some of the possible reasons this might be happening, presents examples of successful hybrid food products, discusses the importance of sustainability claims and the potential of hybrid meals.

Ethical Considerations and Fundamental Principles of Large Language Models in Medical Education: Viewpoint.

This viewpoint article first explores the ethical challenges associated with the future application of large language models (LLMs) in the context of medical education. These challenges include not only ethical concerns related to the development of LLMs, such as artificial intelligence (AI) hallucinations, information bias, privacy and data risks, and deficiencies in terms of transparency and interpretability but also issues concerning the application of LLMs, including deficiencies in emotional intelligence, educational inequities, problems with academic integrity, and questions of responsibility and copyright ownership. This paper then analyzes existing AI-related legal and ethical frameworks and highlights their limitations with regard to the application of LLMs in the context of medical education. To ensure that LLMs are integrated in a responsible and safe manner, the authors recommend the development of a unified ethical framework that is specifically tailored for LLMs in this field. This framework should be based on 8 fundamental principles: quality control and supervision mechanisms; privacy and data protection; transparency and interpretability; fairness and equal treatment; academic integrity and moral norms; accountability and traceability; protection and respect for intellectual property; and the promotion of educational research and innovation. The authors further discuss specific measures that can be taken to implement these principles, thereby laying a solid foundation for the development of a comprehensive and actionable ethical framework. Such a unified ethical framework based on these 8 fundamental principles can provide clear guidance and support for the application of LLMs in the context of medical education. This approach can help establish a balance between technological advancement and ethical safeguards, thereby ensuring that medical education can progress without compromising the principles of fairness, justice, or patient safety and establishing a more equitable, safer, and more efficient environment for medical education.

National dairy research programs: what is their role in animal health and sustainability research?

The US dairy industry has made great strides in improving animal health over many decades, which has driven substantial improvements in economic, social, and environmental sustainability. As consumer and corporate focus on climate continues to grow, the continued need to research and improve animal health and understand its connection with the environment is integral to the success of the dairy industry. Research to address these areas can be supported by national research programs and collaboration between them. The USDA and Dairy Management Inc established a collaborative research agreement in 2007; to date, this collaboration has not explicitly focused on animal health or its intersection with the environment. It is integral to the success of animal agriculture in an ever-changing sustainability landscape that animal health is addressed as a key piece of socioeconomic and environmental sustainability. An academic-industry stakeholder committee reached a consensus that supported this idea and identified that it is equally important to communicate these research findings with consumers in a way that resonates. The purpose of this Viewpoint article is to highlight that national research programs at the USDA Agricultural Research Service's National Animal Disease Center and Dairy Management Inc can and should play an important role in supporting and facilitating research at the intersection of animal health and sustainability broadly.

Impact of Large Language Models on Medical Education and Teaching Adaptations.

This viewpoint article explores the transformative role of large language models (LLMs) in the field of medical education, highlighting their potential to enhance teaching quality, promote personalized learning paths, strengthen clinical skills training, optimize teaching assessment processes, boost the efficiency of medical research, and support continuing medical education. However, the use of LLMs entails certain challenges, such as questions regarding the accuracy of information, the risk of overreliance on technology, a lack of emotional recognition capabilities, and concerns related to ethics, privacy, and data security. This article emphasizes that to maximize the potential of LLMs and overcome these challenges, educators must exhibit leadership in medical education, adjust their teaching strategies flexibly, cultivate students' critical thinking, and emphasize the importance of practical experience, thus ensuring that students can use LLMs correctly and effectively. By adopting such a comprehensive and balanced approach, educators can train health care professionals who are proficient in the use of advanced technologies and who exhibit solid professional ethics and practical skills, thus laying a strong foundation for these professionals to overcome future challenges in the health care sector.

Towards a Sustainable Future: Challenges and Opportunities for Early‐Career Chemists

AbstractThe concepts of sustainability and sustainable chemistry have attracted increasing attention in recent years, being of great importance to the younger generation. In this Viewpoint Article, we share how early‐career chemists can contribute to the sustainable transformation of their discipline. We identify ways in which they can engage to catalyse action for change. This article does not attempt to answer questions about the most promising or pressing areas driving research and chemical innovation in the context of sustainability. Instead, we want to inspire and engage early‐career chemists in pursuing sustainable actions by showcasing opportunities in education, outreach and policymaking, research culture and publishing, while highlighting existing challenges and the complexity of the topic. We want to empower early‐career chemists by providing resources and ideas for engagement for a sustainable future globally. While the article focuses on students and early‐career chemists, it provides insights to further stimulate the engagement of scientists from diverse backgrounds.

Towards a Sustainable Future: Challenges and Opportunities for Early-Career Chemists.

The concepts of sustainability and sustainable chemistry have attracted increasing attention in recent years, being of great importance to the younger generation. In this Viewpoint Article, we share how early-career chemists can contribute to the sustainable transformation of their discipline. We identify ways in which they can engage to catalyse action for change. This article does not attempt to answer questions about the most promising or pressing areas driving research and chemical innovation in the context of sustainability. Instead, we want to inspire and engage early-career chemists in pursuing sustainable actions by showcasing opportunities in education, outreach and policymaking, research culture and publishing, while highlighting existing challenges and the complexity of the topic. We want to empower early-career chemists by providing resources and ideas for engagement for a sustainable future globally. While the article focuses on students and early-career chemists, it provides insights to further stimulate the engagement of scientists from diverse backgrounds.

Adapting lesson study for early-years practitioners

This viewpoint article considers the challenges of adapting mathematics lesson study for early-years practitioners working in pre-school settings.

Engaging With Health Consumers in Scientific Conferences-As Partners not Bystanders.

It is now widely recognised that engaging consumers in research activities can enhance the quality, equity and relevance of the research. Much of the commentary about consumer engagement in research focuses on research processes and implementation, rather than dissemination in conference settings. This article offers reflections and learnings from consumers, researchers and conference organisers on the 12th Health Services Research Conference, a biennial conference hosted by the Health Services Research Association of Australia and New Zealand (HSRAANZ). We were awarded funds via a competitive application process by Bellberry Limited, a national not-for-profit agency with a focus on improving research quality, to incorporate consumer engagement strategies in conference processes and evaluate their impact. Strategies included consumer scholarships, a buddy system, designated quiet space and consumer session co-chairs; the reflections explored in this paper were collected in the funded, independent evaluation. Our insights suggest a need for more structured consumer involvement in conference planning and design, as well as the development of specific engagement strategies. To move toward active partnership in scientific conference settings, our experience reinforces the need to engage consumers as members in designing and conducting research and in presenting research and planning conference content and processes. Consumer engagement in research dissemination at conferences is the focus of this viewpoint article. Consumers were involved in the conception of this article and have contributed to authorship at all stages of revisions and edits.

Racial and social inequities in medication use: A review of articles responding to the Journal of Managed Care + Specialty Pharmacy's Call to Action.

This article provides a summary of Viewpoint and Research articles responding to the 2020 Journal of Managed Care + Specialty Pharmacy Call to Action to address racial and social inequities in medication use. We find great heterogeneity in terms of topic, clinical condition examined, and health disparity addressed. Common recommendations across Viewpoint articles include the need to increase racial and ethnic diversity in clinical trial participants, the need to address drug affordability and health insurance literacy, and the need to incentivize providers and plans to participate in diversity initiatives, such as the better capture of information on social determinants of health (SDOH) in claims data to be able to address SDOH needs. Across research articles, we also find a large range of approaches and study designs, spanning from randomized controlled trials to surveys to observational studies. These articles identify disparities in which minoritized beneficiaries are shown to be less likely to receive medications and vaccines, as well as less likely to be adherent to medications, across a variety of conditions. Finally, we discuss Healthy People 2030 as a potential framework for future health disparity researchers.

Reflections on the opportunities and challenges of applying experience-based co-design (EBCD) to phase 1 clinical trials in oncology.

Experience-Based Co-Design (EBCD) is a multi-stage participatory action research process which was developed originally to increase patient involvement in service improvement initiatives. This viewpoint article serves as a reflection on the researchers' experiences, focusing on the application and feasibility of participatory approaches, particularly co-design, in the specific context of early-phase clinical trials. We reflect on the opportunities and challenges of applying EBCD in a new context of early-phase clinical trials in oncology where experimental treatments are increasingly perceived as a therapeutic option and, in certain instances, their efficacy may lead to accelerated approval facilitating a swifter integration into standard care. We propose that the opportunity of applying EBCD in such trials lies in improving the delivery of person-centered care, care coordination, and support during the transition from experimental to standard care. Three potential challenges when applying EBCD in early-phase clinical trials are discussed related to: the need for standardization in trial processes; planning EBCD in a context of high uncertainty; and vulnerability of patient populations. Integrating EBCD into early-phase oncology trials presents an opportunity to enhance person-centered care and can lead to simultaneous improvements in care processes and therapeutic development. This article has been developed with the collaboration of a patient partner who serves on the advisory board of our ongoing EBCD study in early clinical trials.

Reshaping essential public spaces and services: towards socio-spatial justice in a post-pandemic era

In our last viewpoint article, we illustrated the hidden stories of immigrant suburbs during the COVID-19 pandemic and challenges facing racialised communities. This article delves deeper into intensified social and spatial inequalities by interrogating: what are the ‘essential’ public spaces, places and services that must remain accessible to benefit the settlement, well-being and inclusion of marginalised, racialised, immigrant populations? What engagement approaches effectively include racialised minority groups’ voices in decisions about the future of public space and (sub)urban systems? We emphasise the utility of a socio-spatial justice framework in reimagining and reconfiguring essential public spaces and associated services in the aftermath of the COVID-19 pandemic. Using examples from the Canadian context (i.e. community land trusts, cultural district plans, cultural festivals and food systems), we unpack pillars of distributional, procedural and recognitional justice to interrogate the status quo and illuminate pathways to more inclusive, fair and accessible communities. This article was published open access under a CC BY licence: https://creativecommons.org/licenses/by/4.0/ .

Combating Barriers to the Development of a Patient-Oriented Frailty Website.

This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users' responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care.