The ethics of using biased artificial intelligence programs in the clinic Dear Dr Dermatoethicist: I recently attended a seminar about artificial intelligence (AI) programs being used in dermatology. The lecturer praised the technology but warned that few images from patients with skin type III or greater were in the training data set. Should I use this program in the clinic? -Dr Conscientious
The practice of dermatopathology faces unique quandaries regarding ethics and professionalism. While anecdotes exist and a recent quantitative survey has been reported, 1 no qualitative research has focused on ethical and professional concerns of dermatopathologists. [2][3][4][5] To address this knowledge deficit, we performed qualitative analyses on free-text case responses about ethical/professionalism issues encountered by American Society of Dermatopathology (ASDP) members using an anonymous cross-sectional survey. | MATERIALS AND METHODSAfter IRB approval, members of ASDP were surveyed using methods described previously. 1 Participants were asked to "briefly describe (in one paragraph) a recent case or scenario you've experienced that was ethically challenging in your practice of dermatopathology," excluding all identifiers. Free-text responses were coded by three researchers (medical student, dermatology resident, and qualitative research analyst) using directed content analysis with MAXQDA software (VERBI, Berlin, Germany). A structured codebook was developed with deductive codes that included eight categories of ethical challenges presented in the quantitative survey a priori, as well as inductive codes from the qualitative data revisions. The codebook was revised iteratively to ensure reliability. The senior author reviewed the codes and resolved disagreements. Codes were organized to synthesize key themes and subthemes of challenging ethical scenarios reported by ASDP members.Frequencies of themes and subthemes were summarized. | RESULTSAcross four survey distributions, 1497 unique respondents were sent surveys, and 172 free-text responses were submitted (free-text response rate 11.5%). From this, 284 partial quotes were isolated as units of analysis containing single subthemes. Overarching themes were generated from
PURPOSE: Mandibular hypoplasia is a defining characteristic of craniofacial microsomia. In this work, we review a single institution experience of the treatment and outcomes of mandibular reconstruction. METHODS:Craniofacial microsomia patients actively treated at the UCLA Craniofacial Clinic (n = 151) between 2008-2014 were reviewed for mandibular treatment and outcomes. Patients greater than 14 years of age at the time of study initiation were included (n = 42, average age of 18.3 years). RESULTS: 83.3% of patients had mandibular hypoplasia, of which 22.9% were bilateral, 40.0% were on the right, and 37.1% were on the left. 58.1% of mandibles were Pruzansky I, 20.9% Pruzansky IIA, 7.0% Pruzansky IIB, and 14.0% Pruzansky III. Facial nerve dysfunction was normal to mild in greater than 80% of the patients. 22.9% of patients required tracheostomy or early distraction for airway compromise. 40.0% of patients underwent an average of 4.14 mandibular surgeries with the initial surgery at a mean age of 9.9 years. 31.1% of patients required distraction, 7.1% required rib graft, and 19.0% underwent orthognathic surgery. In a linear regression model, age, higher Pruzansky score, airway compromise, or simultaneous microtia reconstruction did not predict increased number of mandibular surgeries, reoperation, or relapse. Facial nerve involvement was significantly associated with a greater number of surgeries performed (p = 0.039).CONCLUSION: Mandibular reconstruction in craniofacial microsomia patients is a multi-stage procedure. Increased operations but not risk of complications were associated to the severity of the constellation of clinical presentation in craniofacial microsomia.
With increasing access to electronic health records, patients may encounter dermatopathology reports more readily. Dermatopathologists should consider their impact and interactions with transgender patients, who may face specific health and healthcare inequities. Rendering accurate diagnosis for skin diseases requires accurate information about patient's sex assigned at birth and gender identity. Understanding how sex and gender identity data flow between electronic health records, laboratory information systems, insurance billing systems, and patients will be important to avoid patient misgendering, to render accurate diagnoses, to maintain consistency in dermatopathology reports, and to avoid insurance billing denials. Dermatopathologists have important roles to build patient trust in the healthcare system and to help dermatologists diagnose, treat, and characterize skin diseases in transgender populations.
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