RUSK Insights on Rehabilitation Medicine

The discussion included the following topics: how treatment for knee pain has advanced in the past 5-10 years, challenges involved in aligning treatment of orthopedic knee problems with other comorbidities, extent to which telemedicine is used at NYU in treating patients with knee problems, and the status of evidence-based guidelines on physical activities that should be either promoted or restricted involving patients with knee pain. Jennifer Gallinaro has her Doctorate in Physical Therapy and is a Board Certified Orthopedic Clinical Specialist. She is a Program Manager for Physical Therapy and Sports Performance at the NYU Langone Orthopedic Center. William Oswald has a Doctorate in Physical Therapy. He is the Director of Ambulatory Service Line Operations and is a Clinical Instructor for the Department of Rehabilitation Medicine. Daniel Peredo has a Doctorate in Physical Therapy and is a dual Board-Certified Orthopedic and Sports Clinical Specialist. He also is a Physical Therapy Supervisor at the NYU Langone Orthopedic Center.

The discussion included the following topics: how the decision originated to offer this webinar course, kinds of educational modalities the course will include, common gaps in knowledge regarding treatments for knee pain that characterize individuals for whom this course is intended to address, patient-related actions that can compromise the quality of care provided, and helping learners deal with various forms of patient dissatisfaction. Jennifer Gallinaro has her Doctorate in Physical Therapy and is a Board Certified Orthopedic Clinical Specialist. She is a Program Manager for Physical Therapy and Sports Performance at the NYU Langone Orthopedic Center. William Oswald has a Doctorate in Physical Therapy. He is the Director of Ambulatory Service Line Operations and is a Clinical Instructor for the Department of Rehabilitation Medicine. Daniel Peredo has a Doctorate in Physical Therapy and is a dual Board-Certified Orthopedic and Sports Clinical Specialist. He also is a Physical Therapy Supervisor at the NYU Langone Orthopedic Center.

Dr. Kellie Owens, is an assistant professor in the section of medical ethics at NYU Grossman School of Medicine. She's a sociologist and empirical bioethicist studying how digital technologies are woven into the fabric of healthcare and society and how governance structures can better support those affected by technological change. She also leads the responsible AI review process for the Division of Applied AI Technologies and with the IRB. PART 2 In medicine, we do know that examples of bias and harm from that bias have happened. The most famous case was brought to our attention from Ziad Obermeyer and his colleagues in Science in 2019. It was examining racial discrimination resulting from a commercial algorithm that was widely used by health systems to identify patients with complex health needs that might need extra support. Instead, we found that the algorithm was prioritizing white patients over black patients and was reducing the number of black patients who should have been enrolled in those care management programs by more than half. In some ways, there are pretty easy ways to fix these kinds of biases and problems if we're attuned to them. So once we see them, we can usually fix them. In this case, training the model using active chronic conditions rather than total costs would have significantly reduced bias.  The point is that understanding the social context in which an algorithm is developed and is operating in is really important. Otherwise, it can be pretty easy to make mistakes like this if you're not paying attention to disparate impacts in the ways that our choices in algorithm development can have impacts on fairness and outcomes for different groups. Another major ethics consideration touched upon in her presentation is mostly about data privacy.

Dr. Kellie Owens, is an assistant professor in the section of medical ethics at NYU Grossman School of Medicine. She's a sociologist and empirical bioethicist studying how digital technologies are woven into the fabric of healthcare and society and how governance structures can better support those affected by technological change. She also leads the responsible AI review process for the Division of Applied AI Technologies and with the IRB. Part 1 Dr. Owens began by indicating that by AI, she means any computer system that's designed to perform tasks that typically require human intelligence, which could be things like recognizing patterns, interpreting data, making predictions, or even making decisions. In the health care context, that means AI systems that analyze complex. medical data that assist with diagnosis or risk prediction that can help automate some routine processes.  She wants to talk mostly about the less fun side, the sort of limitations and potential harms that we have to be aware of to make sure that we're using this technology responsibly. Her focus today is on the people and process side of AI integration and not the technical side. Examples raised today focus specifically on health care implementation. She indicated that there are increasing calls from AI developers and users and regulators and folks in ethics to increase evidence standards for implementing new AI systems. The majority fall outside of FDA regulation, which means they really haven't undergone any formal review for safety and efficacy. The stated goals of ambient documentation, ambient scribes, are to give doctors more time with their patients or more time with their families. We are going to have to vigorously defend that time savings. Otherwise, that free time will be used in plenty of ways that don't touch the problem of physician burnout at all. She wants to be really intentional about how we think about time savings and efficiency regarding AI.

Dr. Capozzi is a board-certified orthopedic surgeon with specialty training in joint replacement surgery. After receiving his bachelor's degree from Columbia University, he obtained his medical degree from Mount Sinai School of Medicine. He completed his orthopedic training at Mount Sinai and the Otto Alfrank Adult Joint Reconstructive Fellowship at the New England Baptist Hospital in Boston. In addition to performing hip and knee replacements, Dr. Capozzi specializes in difficult revision surgery, utilizing the newest techniques in joint reconstructive surgery.   Part 2   Figuring out what happened took them less than a day because the cause of the crash was fuel exhaustion. The plane ran out of gas. Why it happened took about 15 months to figure out all that took place, how a plane runs out of fuel on its approach. So, what transpired? The crash analysis in the NTSB report indicates that there were significant communication errors. Keep this in mind when dealing with matters in the hospital. When there's really an urgent situation, you're very mindful of how you're conveying that urgency. To air traffic control, saying that we're running out of fuel doesn't mean anything significant. It's like if I'm in the operating room and I say that a patient's blood pressure is a little low. Well, pressure is always a little low. There's blood loss, there's anesthesia, there's pain medication, we're operating. The pressure is expected to be low. But if the patient's crashing, I would assume there'd be more sense of urgency in that statement. It is called mitigated speech when it downplays or sugarcoats or when wanting to be polite or the speaker is ashamed, embarrassed or trying to be deferential to authority. So doing away with mitigated speech, doing away with ambiguous terminology, and really being clear when there's a patient safety concern that needs to be brought up. Again, this is classic for an operating room.