scholarly journals Robots are Coming

2019 ◽  
Vol 6 (3) ◽  
pp. 707-730
Author(s):  
Megan Cloud
Keyword(s):  
Legal Status ◽  
New Technology ◽  
Surgical Techniques ◽  
Surgical Care ◽  
Choice Of Law ◽  
Early Adopters ◽  
Practice Of Medicine ◽  
Care Field ◽  
Rural Access ◽  
Improve Access

New technology frequently emerges that challenges the legal status quo. Early adopters must then grapple with uncertainty over how the law will apply to novel legal quandaries. There is no better example of this than in medicine; however, the health care field is notoriously risk averse. Despite this, the practice of medicine stands to gain tremendously from these technological advancements. One such advancement is the relatively new ability to perform robotic surgery in which the surgeon is remote from the patient. Widespread use of this technology would improve rural access to surgical care, as well as improve access to more advanced surgical techniques. But problems may arise concerning choice-of-law when the laws of jurisdictions that the patient and surgeon are located in conflict. This Comment will explore the choice-of-law dilemma using Texas as a point of reference to discuss the likely choice-of-law analysis that would take place in a telesurgical malpractice case.

scholarly journals Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the COVID-19 pandemic: a review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nolan J. Brown ◽  
Bayard Wilson ◽  
Stephen Szabadi ◽  
Cameron Quon ◽  
Vera Ong ◽  
...  
Keyword(s):  
Medical Ethics ◽  
Health Care Access ◽  
Elective Surgery ◽  
Surgical Techniques ◽  
Surgical Care ◽  
Health Crisis ◽  
Surgical Safety ◽  
Care Access ◽  
Urgent Surgery ◽  
Starting Point

AbstractAt the time of writing of this article, there have been over 110 million cases and 2.4 million deaths worldwide since the start of the Coronavirus Disease 2019 (COVID-19) pandemic, postponing millions of non-urgent surgeries. Existing literature explores the complexities of rationing medical care. However, implications of non-urgent surgery postponement during the COVID-19 pandemic have not yet been analyzed within the context of the four pillars of medical ethics. The objective of this review is to discuss the ethics of elective surgery cancellation during the COVID-19 pandemic in relation to beneficence, non-maleficence, justice, and autonomy. This review hypothesizes that a more equitable decision-making algorithm can be formulated by analyzing the ethical dilemmas of elective surgical care during the pandemic through the lens of these four pillars. This paper’s analysis shows that non-urgent surgeries treat conditions that can become urgent if left untreated. Postponement of these surgeries can cause cumulative harm downstream. An improved algorithm can address these issues of beneficence by weighing local pandemic stressors within predictive algorithms to appropriately increase surgeries. Additionally, the potential harms of performing non-urgent surgeries extend beyond the patient. Non-maleficence is maintained through using enhanced screening protocols and modifying surgical techniques to reduce risks to patients and clinicians. This model proposes a system to transfer patients from areas of high to low burden, addressing the challenge of justice by considering facility burden rather than value judgments concerning the nature of a particular surgery, such as cosmetic surgeries. Autonomy can be respected by giving patients the option to cancel or postpone non-urgent surgeries. However, in the context of limited resources in a global pandemic, autonomy is not absolute. Non-urgent surgeries can ethically be postponed in opposition to the patient’s preference. The proposed algorithm attempts to uphold the four principles of medical ethics in rationing non-urgent surgical care by building upon existing decision models, using additional measures of resource burden and surgical safety to increase health care access and decrease long-term harm as much as possible. The next global health crisis will undoubtedly present its own unique challenges. This model may serve as a comprehensive starting point in determining future guidelines for non-urgent surgical care.

scholarly journals Before and beyond trust: reliance in medical AI

2021 ◽  
pp. medethics-2020-107095
Author(s):  
Charalampia (Xaroula) Kerasidou ◽  
Angeliki Kerasidou ◽  
Monika Buscher ◽  
Stephen Wilkinson
Keyword(s):  
Artificial Intelligence ◽  
Machine Learning ◽  
New Technology ◽  
Public Trust ◽  
Learning Technologies ◽  
Data Driven ◽  
Policy Makers ◽  
The Public ◽  
Regulatory Frameworks ◽  
Practice Of Medicine

Artificial intelligence (AI) is changing healthcare and the practice of medicine as data-driven science and machine-learning technologies, in particular, are contributing to a variety of medical and clinical tasks. Such advancements have also raised many questions, especially about public trust. As a response to these concerns there has been a concentrated effort from public bodies, policy-makers and technology companies leading the way in AI to address what is identified as a "public trust deficit". This paper argues that a focus on trust as the basis upon which a relationship between this new technology and the public is built is, at best, ineffective, at worst, inappropriate or even dangerous, as it diverts attention from what is actually needed to actively warrant trust. Instead of agonising about how to facilitate trust, a type of relationship which can leave those trusting vulnerable and exposed, we argue that efforts should be focused on the difficult and dynamic process of ensuring reliance underwritten by strong legal and regulatory frameworks. From there, trust could emerge but not merely as a means to an end. Instead, as something to work in practice towards; that is, the deserved result of an ongoing ethical relationship where there is the appropriate, enforceable and reliable regulatory infrastructure in place for problems, challenges and power asymmetries to be continuously accounted for and appropriately redressed.

scholarly journals Femto Laser-Assisted Cataract Surgery

2020 ◽  
Author(s):  
Clemence Bonnet ◽  
Saba Al-Hashimi ◽  
Antoine P. Brézin ◽  
Dominique Monnet
Keyword(s):  
Femtosecond Laser ◽  
Cataract Surgery ◽  
New Technology ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Current Method ◽  
Cataract Extraction ◽  
Scientific Data ◽  
Conventional Surgery ◽  
Lens Fragmentation

Cataract is a leading cause of blindness in the world, and cataract extraction is one of the most commonly performed surgeries. Preferred surgical techniques have changed over the past decades with associated improvements in outcomes and safety. Phacoemulsification is a highly successful technique first introduced over 40 years ago. It is the current method of cataract surgery, with a very low reported rate of major complications and a frequency of overall intraoperative complications of less than 2%. Application of the femtosecond laser evolved to now assist in cataract surgery and has been termed FLACS (femtosecond laser-assisted cataract surgery) and occurs in three steps: corneal incisions (including optional limbal relaxing incisions to reduce astigmatism), anterior capsulotomy, and lens fragmentation. The remaining surgical steps still require the surgeon’s hands. The FLACS technique may have some advantages compared with conventional phacoemulsification. It remains however unclear whether FLACS is globally more efficient and safer than conventional surgery. The popularity of FLACS may also be limited by its higher cost compared with conventional surgery. The potential advantages of laser-assisted surgery are yet to be determined as FLACS technology is relatively new and in continuous evolution. This chapter reports scientific data as well as our own experience with this new technology. All the platforms currently available are described.

Evidence-Based Surgery

2017 ◽  
Author(s):  
Karl Y. Bilimoria ◽  
Benjamin S Brooke
Keyword(s):  
Scientific Evidence ◽  
Surgical Techniques ◽  
Internal Validity ◽  
Surgical Care ◽  
Evidence Based ◽  
Services Research ◽  
Surgical Decision ◽  
Evidence Based Surgery ◽  
Quality Of Research

The practice of surgery has undergone a dramatic evolution over the last century with the availability of new scientific evidence supporting different surgical techniques and management.  Evidence-based surgery is defined as the judicious and systematic application of scientific evidence to surgical decision making and the establishment of standards of surgical care. This includes efforts to appraise the strength of scientific evidence and evaluate the quality of research studies or evidence, as well as efforts to interpret and apply evidence to clinical practice. In this review, we discuss important methodology and approaches in surgical health services research to accomplish these goals and improve the quality of care in surgery. By providing this overview, we hope readers will be able to navigate the surgical literature and apply evidence-based science to their own surgical practice. This review contains 1 figure, 3 tables, and 43 references. Key words: bias, comparative effectiveness, confounding, evidence, external validity, implementation science, internal validity, pragmatic trials, quality, risk adjustment, surgery

Incorporating New Technology Into a Surgical Technique: The Learning Curve of a Single Surgeon's Stereo-Electroencephalography Experience

Neurosurgery ◽  
2019 ◽  
Vol 86 (3) ◽  
pp. E281-E289 ◽  
Author(s):  
Robert A McGovern ◽  
Robert S Butler ◽  
James Bena ◽  
Jorge Gonzalez-Martinez
Keyword(s):  
Surgical Technique ◽  
Learning Curve ◽  
Clinical Experience ◽  
Imaging Modality ◽  
Imaging Techniques ◽  
New Technology ◽  
Surgical Techniques ◽  
Vascular Imaging ◽  
New Paradigm ◽  
Cusum Analysis

Abstract BACKGROUND Technological improvements frequently outpace the publication of randomized, controlled trials in surgical patients. This makes the application of new surgical techniques difficult as surgeons solely use clinical experience to guide changes in their practice. OBJECTIVE To quantitatively examine the learning curve of incorporating new technology into a surgical technique and discuss the clinical significance of incorporating this new technology into daily practice. To identify areas of improvement for operative efficiency and safety. METHODS A retrospective observational study examining quantitative measures of operative efficiency and safety from 2009 to 2017 in 454 consecutive patients undergoing stereo-electroencephalography depth electrode implantations. RESULTS The transition to a new robotic technique significantly improved operative times (196 min [95% CI 173-219] vs 115 min [95% CI 111-118], P < .0001). Cumulative sum (CUSUM) analysis demonstrated that mastery of the robotic technique took much longer than the frame-based technique (operative time peak at case 75 vs case 25, plateau of 150 vs 10 cases). Although hemorrhage rates using different vascular imaging techniques did not appear to differ using traditional statistical analysis (magnetic resonance imaging, MRI 22.3%, computed tomography angiography, CTA 17.9%, angiogram 18.1%, likelihood ratio χ2 = 4.84, P = .30), CUSUM analysis suggested MRI as the vascular imaging modality leading to higher hemorrhage and symptomatic hemorrhage rates at our center. CONCLUSION This experience demonstrates an improvement in operative efficiency through a series of changes made using clinical experience and intuition while transitioning to a completely new paradigm. CUSUM analysis identified potential areas for improvement in both operative efficiency and safety if used in a prospective manner.

Realizing the Promise of RFID

2007 ◽  
pp. 306-318
Author(s):  
V. Thillairajah ◽  
S. Gosain ◽  
D. Clarke
Keyword(s):  
Business Process ◽  
Service Providers ◽  
New Technology ◽  
Supply Network ◽  
Early Adopters ◽  
Technological Adoption ◽  
Emerging Trends ◽  
Technology Standard ◽  
Business Opportunities ◽  
Technological Barriers

This chapter touches on some basics on RFID and covers business opportunities as well as some of the relevant challenges to be faced. Although it is a new technology, standard obstacles of organizational and technological barriers still have to be overcome and mediums crossed that were previously not traversed as on warehouse and distribution center floors yield for challenging environments from a business process as well as a technological adoption perspective. It provides a combined outlook sprinkled with key lessons from early adopters and service providers close to some of the emerging trends and implementations happening in the field. A range of benefits will evolve with the adoption of RFID within an organization and especially across the entire supply network.

Same-Sex Relationships and Anglo-Canadian Choice of Law: An Argument for Universal Validity

1997 ◽  
Vol 34 ◽  
pp. 103-136
Author(s):  
Wendy A. Adams
Keyword(s):  
Supreme Court ◽  
International Law ◽  
Legal Status ◽  
Supreme Court Of Canada ◽  
Private International Law ◽  
Same Sex ◽  
Choice Of Law ◽  
The Supreme Court ◽  
The Face

SummaryThe distinction between formal and essential validity in Anglo-Canadian choice of law regarding marriage is an illogical bifurcation that unnecessarily invalidates same-sex relationships contracted in foreign jurisdictions. The Supreme Court of Canada has recently reformulated certain rules of private international law, taking into account both the constitutional and sub-constitutional imperatives inherent in a federal setting and the need for order and fairness when co-ordinating diversity in the face of increasing globalization. Reform of the choice of law rules regarding the validity of foreign marriages should proceed accordingly with the result being that a marriage valid where celebrated is valid everywhere. No principled reason exists to deny recognition to same-sex relationships validly contracted in other jurisdictions, nor to differentiate between the rights and obligations arising from the legal status of same-sex and different-sex relationships.

Sign in / Sign up

Export Citation Format

Share Document