"Brilliant AI Doctor" in Rural China: Tensions and Challenges in AI-Powered CDSS Deployment

Artificial intelligence (AI) technology has been increasingly used in the implementation of advanced Clinical Decision Support Systems (CDSS). Research demonstrated the potential usefulness of AI-powered CDSS (AI-CDSS) in clinical decision making scenarios. However, post-adoption user perception and experience remain understudied, especially in developing countries. Through observations and interviews with 22 clinicians from 6 rural clinics in China, this paper reports the various tensions between the design of an AI-CDSS system ("Brilliant Doctor") and the rural clinical context, such as the misalignment with local context and workflow, the technical limitations and usability barriers, as well as issues related to transparency and trustworthiness of AI-CDSS. Despite these tensions, all participants expressed positive attitudes toward the future of AI-CDSS, especially acting as "a doctor's AI assistant" to realize a Human-AI Collaboration future in clinical settings. Finally we draw on our findings to discuss implications for designing AI-CDSS interventions for rural clinical contexts in developing countries

Human-centered design and evaluation of AI-empowered clinical decision support systems: a systematic review

IntroductionArtificial intelligence (AI) technologies are increasingly applied to empower clinical decision support systems (CDSS), providing patient-specific recommendations to improve clinical work. Equally important to technical advancement is human, social, and contextual factors that impact the successful implementation and user adoption of AI-empowered CDSS (AI-CDSS). With the growing interest in human-centered design and evaluation of such tools, it is critical to synthesize the knowledge and experiences reported in prior work and shed light on future work.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review to gain an in-depth understanding of how AI-empowered CDSS was used, designed, and evaluated, and how clinician users perceived such systems. We performed literature search in five databases for articles published between the years 2011 and 2022. A total of 19874 articles were retrieved and screened, with 20 articles included for in-depth analysis.ResultsThe reviewed studies assessed different aspects of AI-CDSS, including effectiveness (e.g., improved patient evaluation and work efficiency), user needs (e.g., informational and technological needs), user experience (e.g., satisfaction, trust, usability, workload, and understandability), and other dimensions (e.g., the impact of AI-CDSS on workflow and patient-provider relationship). Despite the promising nature of AI-CDSS, our findings highlighted six major challenges of implementing such systems, including technical limitation, workflow misalignment, attitudinal barriers, informational barriers, usability issues, and environmental barriers. These sociotechnical challenges prevent the effective use of AI-based CDSS interventions in clinical settings.DiscussionOur study highlights the paucity of studies examining the user needs, perceptions, and experiences of AI-CDSS. Based on the findings, we discuss design implications and future research directions

The effect of overnight culture after thawing of D3 cleavage-stage embryos on clinical pregnancy outcomes: focus on embryo development to day 4

ObjectiveThis study aims to investigate the impact of day-3 (D3) cleavage-stage embryo thawing with immediate transfer versus thawing and overnight culture before transfer on clinical outcomes. It also examines the relationship between cleavage-stage embryo developmental speed after overnight culture and clinical pregnancy outcomes, as well as factors influencing clinical pregnancy in frozen embryo transfer (FET).MethodsA retrospective analysis was conducted on 1,040 patients who underwent D3 cleavage-stage frozen embryo transfer at Yulin City Maternal and Child Health Hospital between July 2022 and December 2023. Patients were divided into two groups based on embryo culture time after thawing: control (same-day transfer, 2-3 hours) and experimental (overnight culture, 18-20 hours). Clinical pregnancy rates, embryo implantation rates, early miscarriage rates, and multiple pregnancy rates were compared between groups. The experimental group was further subdivided based on the number of cleavage blastomeres increased after culture: A1 (≥4 blastomeres), A2 (1-3 blastomeres), and A3 (no increase). A binary logistic regression analysis identified independent factors affecting clinical pregnancy outcomes in FET.ResultsNo significant differences were found between the control and experimental groups in clinical pregnancy rate (37.2% vs. 40.2%), embryo implantation rate (24.9% vs. 26.4%), early miscarriage rate (13.1% vs. 18.8%), or multiple pregnancy rate (9.2% vs. 10.2%) (P > 0.05). In the experimental group, clinical pregnancy rates for A1, A2, and A3 subgroups were 44.2%, 29.8%, and 25.5%, respectively. Early miscarriage rates were 18.6%, 10.7%, and 38.5%, showing statistically significant differences (P < 0.05). Female age, endometrial thickness, embryo morphology, and the number of cleavage blastomeres were identified as independent factors influencing clinical pregnancy rate.ConclusionThis study indicates that D3 embryos with an increase in the number of blastomeres to more than four or entering the compaction stage after overnight culture have better pregnancy outcomes. Female age and endometrial thickness are important factors influencing clinical pregnancy rates. Optimizing culture conditions and ensuring optimal endometrial thickness may help improve the success rate of frozen-thawed embryo transfer

Prevalence, spermatozoa, hormonal, and genetic evaluation of rare mosaic klinefelter syndrome patients in southern China

BackgroundKlinefelter syndrome (KS) is the most common genetic cause of male infertility in humans. Mosaic KS is a subtype of KS. Due to its low prevalence, the lack of typical clinical signs, and the limited professional awareness of the syndrome, many cases of mosaic KS remain undiagnosed.ObjectiveTo investigate the prevalence of rare mosaic KS, karyotype characteristics, reproductive hormone levels, and sperm quality in southern China, and to enrich our knowledge of patients with mosaic KS.MethodsThe chromosome results of 8,110 cases of infertile male patients attending the Reproductive Center of Yulin Maternal and Child Health Hospital from January 2018 to July 2024 were retrospectively analyzed. Semen, sex hormone tests, and Y chromosome microdeletions were analyzed in fourteen selected patients with a diagnosis of mosaic KS.ResultsAmong the 8,110 male infertility patients, a total of 0.703% (57/8,110) were diagnosed with KS. Of these, 0.530% (43/8,110) had the typical non-mosaic chromosomal karyotype of 47, XXY, while 0.172% (14/8,110) demonstrated mosaicism. Non-mosaic KS accounted for 75.44% (43/57), whereas mosaic KS accounted for 24.56% (14/57). Among the fourteen patients diagnosed with mosaic KS, the predominant chromosomal karyotype was 47,XXY/46,XY, observed in eleven patients, accounting for 78.57% of the cases. Additionally, one patient exhibited a chromosomal karyotype of 47,XXY [29]/46,XX [78]. Another patient had 47,XXY [92]/48,XXXY [3]/46,XY [5], and a third patient presented with 47,XXY [87]/46,XX [3]/46,XY [2]. The semen analysis of individuals with mosaic KS revealed two cases of azoospermia, one case of cryptozoospermia, one case of severe oligospermia, one case of oligospermia, and ten cases of normal sperm. The results of the sex hormone analysis revealed abnormal increases in serum follicle-stimulating hormone (FSH) levels in four patients diagnosed with mosaic KS. Additionally, two patients with mosaic KS exhibited higher luteinizing hormone (LH) and testosterone (TT) levels compared to the normal range, while four patients had lower estradiol (E2) levels than the normal range. Among the fourteen patients with mosaic KS, four couples underwent assisted reproductive technology at our hospital for fertility assistance. Of these four couples, two successfully gave birth to a healthy child.ConclusionThe prevalence of mosaic KS among male infertility patients in southern China is 0.172% (14/8,110), with the predominant chromosomal karyotype being 47,XXY/46,XY, accounting for 78.57% (11/14) of the cases. Patients with mosaic KS may present with various sperm conditions, including azoospermia, cryptozoospermia, severe oligozoospermia, oligozoospermia, and normal sperm. There is a notable correlation between sperm count and the number of abnormal cell karyotypes in these patients; specifically, a higher number of abnormal chromosomal mosaic cells is associated with a lower sperm count. In comparison to non-mosaic KS patients, those with mosaic KS exhibit a lower rate of azoospermia. In summary, patients with rare mosaic KS in southern China demonstrate significant heterogeneity in sperm production, hormonal levels, and genetics. These patients can achieve biological fatherhood through assisted reproductive techniques, and mosaic KS does not appear to impact the success rate of these techniques. However, due to the low prevalence and limited sample size, more data is necessary to confirm these findings