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Comment: Democratisation without compromising care

The necessity of experts for equitable healthcare, by Blanca Lesmes, CEO of BB Imaging and TeleScan

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The large-scale adoption of telemedicine and the advent of artificial intelligence in healthcare have some of us very excited. These recent developments may be the very keys we’ve been searching for to unlock that holy grail of healthcare: democratisation.

What’s going right

Let’s check off some of the keys we’re holding. Today’s technologies:

  • Offer patients and providers greater access to information while keeping it secure, despite the efforts of some bad actors.
  • Enable the use of data in an intelligent way, enhancing our decision-making capabilities and enabling prediction and prevention.
  • Extend and expand care, making it more available and accessible to underserved communities.
  • Build engagement and empowerment in patients and increasingly make them our primary focus.

I don’t want to downplay this: there is so much to be gained by continuing down the path of healthcare innovation and democratization.

Likewise, I don’t want to downplay the very real possibility of these keys being misused to open a veritable Pandora’s box.

What could go wrong

Innovation has the potential to make the healthcare system more positive and effective for patients, but it could also lead to the compromise of high-quality data and compassionate care.

Let’s look again at our keys to see what we know so far:

  • Sharing information inherently leads to less personal privacy, and while healthcare organizations try their hardest to keep data secure, bad actors are occasionally successful in stealing, selling, and misusing information. This leads to less trust in the system and its data.
  • Artificial intelligence and machine learning don’t doubt their conclusions. We know that an AI fed enough of its own outputs may return nonsense. Mischaracterized and wrong information isn’t useful for decision-making, and again, erodes trust in the system.
  • The technologies that extend care can also introduce more barriers to care. Digital illiteracy, a lack of Internet access, and resistance to change could exacerbate disparities instead of minimizing them.
  • Compromising data and care quality diminishes trust and pushes patients further away from the care they need.

The master key

So, where do we go from here? How do we continue to democratize healthcare while refusing to compromise on the quality of that care?

We have one more key, and it’s the master key: We empower healthcare experts to lead the way.

No one is better positioned than our doctors, nurses, allied health professionals, etc. to effectively introduce and employ these technologies in their communities—and no one is better suited to their critique.

One example

I am the founder of TeleScan. Our software is the piece of the prenatal care puzzle that connects local providers with sonographers who are the best of the best. (I mean this literally. Our sonographers are among the most highly credentialed in the nation for the OB/GYN modality.)

When we first introduced TeleScan to the sonography community, there was a lot of resistance. Of all the misgivings I confronted, most were centered on patient care. Critics were worried about poor-quality images, missed anomalies, poor diagnostics, and a lack of compassion. These concerns are consistent with the risks we acknowledge above.

What turned this conversation around?

We showed skeptics that sonographers are involved at every step of care. They guide, provide feedback, and make requests of the local healthcare provider at the ultrasound machine during the exam. Humans skilled in ultrasound are still at the center of reviewing patient images and utilizing their experience and expertise to develop a report. More than 50 sonographers assisted in the initial product design, and several continue to provide our development team with constructive feedback. The result is a high level of quality that often surprises providers and patients.

This is only one example. I know many others have similar stories.

Unlocking healthcare equity

So, where do we go from here? My answer is we move forward—with one eye on our innovations and one eye on this important truth:

Keeping true expertise at the centre of innovation is what will keep patients at the centre of our healthcare system.

Written by Blanca Lesmes, CEO of BB Imaging and TeleScan.

Insight

Topical HRT protects bone density in women with period loss – study

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Transdermal HRT best protects bone density in women with functional hypothalamic amenorrhoea, a condition that stops periods, a review of trials has found.

The meta-analysis pooled randomised clinical trials involving 692 participants and found transdermal hormone replacement therapy and teriparatide increased bone mineral density by between 2 and 13 per cent.

Functional hypothalamic amenorrhoea can follow anorexia or intense exercise. Bone mineral density measures bone strength and the amount of mineral in bone.

Around half of women with the condition have low bone mineral density, compared with about 1 per cent of healthy women, and their fracture risk is up to seven times higher.

The research was conducted by scientists at Imperial College London and Imperial College Healthcare NHS Trust.

Professor Alexander Comninos, senior author of the study and consultant endocrinologist at the trust, said: “Bone density is lost very rapidly in FHA and so addressing bone health early is very important to reduce the lifelong risk of fractures.

“Our study provides much needed comparisons of all the available treatments from all available studies.

“Clearly the best treatment is to restore normal menstrual cycles and therefore oestrogen levels through various psychological, nutritional or exercise interventions – but that is not always possible.

“The foundation for bone health is good calcium and vitamin D intake (through diet and/or supplements) but we have additional treatments that are more effective.”

When FHA is diagnosed, clinicians first try to restore periods through lifestyle measures, including psychological and dietary support, but these can fail. Guidelines then recommend giving oestrogen, though the best form was unclear.

The team reviewed all prior randomised trials comparing therapies, including oral and transdermal oestrogen, and also assessed teriparatide, a prescription bone-building drug used for severe osteoporosis.

They found no significant benefit for oral contraceptive pills or oral hormone therapy.

A recent UK audit reported that about a quarter of women with anorexia-related FHA are prescribed the oral contraceptive pill for bone loss; the study suggests using transdermal therapy instead.

Comninos said: “Our goal is simple: to help women receive the right treatment sooner and to protect their bone health in the long-term.

“We hope this study provides clinicians with better evidence to choose transdermal oestrogen when prescribing oestrogen and so inform future practice guidelines.

“Right now, millions of women with FHA may not be receiving the best treatments for their bone health.”

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Insight

AI cuts interval breast cancers in Swedish trial

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An AI tool cut interval breast cancers by 12 per cent in a Swedish screening trial of more than 105,000 women.

The study also found 27 per cent fewer aggressive breast cancers detected at screening when AI was used.

Interval cancers are cancers found between routine screening appointments because they were missed at the original scan. They are often more dangerous and linked to higher death rates than cancers found at screening.

The MASAI trial is described as the first large randomised study to test whether AI can improve mammography screening, which uses low-dose X-rays to examine breast tissue for signs of cancer.

The AI tool, called Transpara Detection and developed by ScreenPoint Medical, supported radiologists in analysing mammography images.

Earlier results from the same trial showed that Transpara Detection increased cancers found by 29 per cent and reduced radiologist workload by 44 per cent compared with standard double-reading, where two radiologists independently review each scan.

The latest findings indicate higher accuracy with AI support. Sensitivity, the ability to detect cancer, was 6.7 percentage points higher in the AI group while specificity, the ability to rule out healthy cases, was maintained. Results were similar across age groups and breast density levels.

Women screened with AI had 16 per cent fewer invasive interval cancers and 21 per cent fewer large interval cancers than those in the standard screening group.

The system also helps doctors assess risk more precisely by subdividing suspicious findings into BI-RADS 4 categories A, B and C. BI-RADS (Breast Imaging Reporting and Data System) is a standardised scale that guides whether a patient needs closer monitoring, further tests or treatment.

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Mental health

Fear of ageing may age women faster, study suggests

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Ageing anxiety may accelerate biological ageing in women, with fears about worsening health linked to faster epigenetic ageing, according to new research.

The study found that greater anxiety about growing old was associated with accelerated epigenetic ageing, as measured by the DunedinPACE clock, based on biological markers in blood samples.

Epigenetic changes are shifts in how genes are switched on or off without altering DNA itself, which can influence how the body ages and functions.

“Our research suggests that subjective experiences may be driving objective measures of ageing,” said Mariana Rodrigues, a PhD student and the first author of the study.

“Ageing-related anxiety is not merely a psychological concern, but may leave a mark on the body with real health consequences.”

Researchers analysed data from 726 women in the Midlife in the US study.

Participants were asked how much they worried about becoming less attractive with age, having more health issues and being too old to have children.

Blood samples were used to assess ageing with two epigenetic clocks: DunedinPACE, which estimates the pace of biological ageing, and GrimAge2, which estimates cumulative biological damage.

The study was conducted by researchers at NYU School of Global Public Health.

Worrying about declining health showed the strongest links with epigenetic ageing, while anxiety about attractiveness and fertility was not significantly associated with biological markers.

The authors suggest health worries are more common and persist over time, whereas concerns about appearance and reproduction may fade with age.

“Women in midlife may also be multiple in roles, including caring for their ageing parents,” Rodrigues said.

“As they see older family members grow older and become sick, they may worry about whether the same thing will happen to them.”

The authors caution that the study offers a snapshot in time and other factors may influence these biological changes.

When analyses were adjusted for health behaviours such as smoking and alcohol use, the link between ageing anxiety and epigenetic ageing decreased and was no longer significant.

“Our research identifies ageing anxiety as a measurable and modifiable psychological determinant that seems to be shaping ageing biology,” said Adolfo Cuevas, associate professor of social and behavioural sciences and the study’s senior author.

They call for more research to clarify how this anxiety influences ageing over time, to guide support for those experiencing ageing anxiety.

“Ageing is a universal experience.” Rodrigues said.

“We need to start a discourse about how we as a society, through our norms, structural factors and interpersonal relationships, address the challenges of ageing.”

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