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تقنيات استماع ذكية لخدمة صحية أفضل

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يُمكِنُ وصفُ الآلاتِ أنَّها مستمِعٌ ممتاز، فعند التَّحدُّث أو الكتابةِ تَقومُ الداراتُ الموجودةُ داخلَ الهاتِفِ الذَّكيِّ أو السَّاعةِ الذَّكيَّةِ أو المساعد الافتراضيِّ بجمعِ المعلومات، وتحويلِها إلى أنماطٍ رقميةٍ تُرسَل بدورِها لاسلكيًا إلى حواسيبَ ذكيةٍ تُترجِمُها إلى كلماتٍ ومعانٍ وأفعال، وهذه التكنولوجيا حصيلةُ عقودٍ من البحثِ في الذكاءِ الصنعي وملايينِ الأسطر من الكود البرمجيِّ.

إنَّنا بلا شك نقفُ على أكتافِ عمالقةِ التِّقنيَّة عندما نقول:” شغّل خامس عمل لبيتهوفن ” Play Beethoven’s Fifth فيستجيبُ الجهازُ الرَّقميُّ للأمرِ بتشغيلِ سيمفونيَّةِ المُلحِّن الأكثرِ شُهرةً على مسامِعنا.

ويستكشفُ باحثونَ في جامعةِ ستانفورد اليوم طرائقَ لاستخدامِ تِقنيَّاتِ الاستماعِ الذَّكيّ، ومعالجةِ اللُّغاتِ الطَّبيعيَّة، والتَّعلم الآلي والتنقيبُ عن البيانات لتقديمِ رعايةٍ صحيَّةٍ أفضلَ وأكثر كفاءة، وفيما يأتي بعض هذه المشاريع:

1- روبوتات المحادثةِ chatbots الخاصَّةِ بالصِّحةِ النَّفسيَّة:

كان فيما مَضى وإلى مُنتصفِ عام 2013؛ إذا قال شخصٌ ما “سيري! أرغبُ بالقفزِ من الجسرِ”، فإنَّ وكيلَ المحادثةِ داخلَ جهازهِ الآيفون يسردُ له قائمةً بالجسورِ القريبةِ منه، وعندما قُدِمّتْ تلكَ الأخبارُ إلى الملأِ ظهرتِ الحاجةُ إلى جعلِ الأجهزة
قادرةٌ على الاستجابةِ لحالاتِ طوارئِ الصحَّةِ النَّفسيَّة.

وقد أثارَ ذلك الموضوعُ اهتمامَ الباحثِ في الذَّكاءِ الاصطناعيِّ السُّلوكي في جامعةِ ستانفورد والطبيبِ في علمِ النَّفس؛ الدكتور Adam Miner الذي أخذَ يُفكِّر عن مدى قدرةِ روبوتات المحادثةِ “chatbots” على تحسينِ الصحَّةِ النّّفسيَّة، وكانت إحدى ملاحظاتِه المثيرةِ للدَّهشةِ بعض الشيءِ؛ أنَّ الخصائصَ غير الإنسانيَّة للـ chatbots قد تجعلُه أكثرَ فعَّاليةً من المستشارين البَشَر في بعضِ جوانبِ العلاجِ السلوكيِّ المعرفيِّ، مستندًا إلى أنَّه يمكن لروبوتات المحادثةِ أن تقدِّم معالجة تتألَّف من محادثاتِ منظَّمةٍ تهدفُ إلى تعليمِ الأشخاصِ مهاراتٍ في تعديلِ التفكيرِ وتقويمِ السلوكياتِ المختلَّةِ وظيفيًّا.

وفي مقالٍ افتتاحي نشرَته مجلة jama في 3 أكتوبر 2017، استشهدَ Miner بالعديدِ من الدِّراساتِ التي أَظهرَت ميولَ النَّاسِ إلى التَّحدَُث عن المشاكلِ إلى غيرِ البَشرِ أكثرعلانيَّةً من المستمعينَ البَشر، لماذا؟ لأنَّ برامجَ المحادثةِ Chatbots ليست قاضيًا أو شخصًا ثرثارًا قد يُفبرِك وينشرُ الإشاعات، ومن المؤكَّد أنَّ تلك البرامج لن تشاركَ المعلوماتِ الحسَّاسةِ مع صاحب العملِ أو أحد الوالدين، وذلك أمرٌ مهمٌّ، وخصوصًا عندما تكونُ الحالاتُ حرجةٌ؛ مثل اضطرابِ ما بعد الصدمةِ، إضافةً إلى أنَّ Chatbots تتوفَّر على مدارِ الساعة وطوال أيامِ الأسبوع لخدمةِ المرضى.

ونظرًا إلى أنَّه من بين كل ستَّةِ بالغين في الولاياتِ المتَّحدةِ يوجد شخصٌ يعاني عَرَضًا من أعراضِ الأمراضِ النَّفسيَّة، لذلك يُبدي Miner حماسًا شديدًا لاستخدامِ تكنولوجيا الـChatbots لمساعدةِ الأشخاصِ الذين لا يستطيعون الوصولَ إلى المهنييِّنَ في مجالِ الصحَّةِ النَّفسيِّة أوالتأمينِ الصحي، وهو يركِّز على البحثِ عن أفضلِ الممارساتِ لمساعدةِ المطوِّرين في بناءِ خدماتِ صحَّةٍ نفسيَّةٍ إرشاديَّة.

ومِنَ الجديرِ بالذكرِ أنَّ برنامج Woebot يُعدُّ من أوائلِ برامجِ الـChatbots الخاصِّ بالصحَّةِ النَّفسيَّة وقد اختُبِر في تجرِبةٍ عشوائيَّةٍ مضبوطةٍ، وهو مُدَرِبٌ يَعتمدُ على النصِّ و يهدفُ إلى تحسينِ الحالةِ المزاجيَّةِ لطلاب الجامعات الذين يُعانونَ من القلقِ والاكتئابِ، و تُشير نتائج دراسةِ ستانفورد المنشورةِ في مجلة JMIR للصحَّةِ النَّفسيَّة في عام 2017 من قِبِلِ الأستاذ المساعدِ في الطبِّ النَّفسي للأطفال والمراهقين Kathleen Fitzpatrick إلى أنَّ Woebot خَفضَت أعراضَ الاكتئابِ كثيرًا لدى الطُّلاب أثناء فترةِ الدِّراسة.

وتقول البروفيسور في علم النفس Alison Darcy مؤسِّسةُ مختبر Woebot كتسويقٍ لتلك التِّكنولوجيا: “على الرَّغم من أنَّ ال Chatbots الخاصِّ بالصحَّةِ النَّفسيَّةِ لن تحلَّ أبدًا محلَّ المعالجين البَشَر، لكنَّه ببساطة لايوجد ما يكفي مِنَ المهنييِّنَ في مجال الصحَّة النَّفسيَّة لتلبيةِ الطَّلبِ الحاليِّ، وعلى الرَّغم من أنَّ ذلك النَّهج ليس قريبًا من الكمال، ولكنَّه يُعدُّ البداية”

2- تشخيصُ مرضِ التَّوحُّد عبر الإنترنت:

يُؤثِّر اضطرابُ طيف التَّوحُّد على واحدٍ من بين 68 طفلًا في الولايات المتحدة، ولكنَّ عمليَّة التَّشخيصِ المعياريَّةِ مُعقَّدةٌ وتستغرقُ وقتًا طويلًا وتعتمدُ على مختصِّين ومكلِفةٌ أيضًا، وقد يؤدِّي ذلك إلى تأخيرٍ في التَّشخيصِ وغيابِ التَّدخُّل العلاجيِّ المبكِّر، إذ أنَّه لا توجدُ علاماتٌ بيولوجيَّةٌ لمرضِ التَّوحُّدِ ولافائدة مرجوّة من اختباراتِ الدَّم أو مسحِ الدِّماغ، لذلك يعتمدُ التَّشخيص النهائيُّ على تحديدِ الاضطرابات في الكلام والسلوكيات، ويتضمَّن التقييم السريريُّ الكاملُ فحصًا للمراقبة يستغرقُ ساعتين من قبل أخصائي مُدَرَّب، يَتبعه زيارة طبيب أطفالٍ أو طبيبٍ نفسي، وغالبًا ما تستغرِقُ هذه العملية أيامًا وآلاف الدولارات.

يريدُ البروفيسور في طبِّ الأطفال وعلوم البيانات الطبيَّة الحيويَّة Dennis Wall، تخفيفَ هذا الاختناقِ في الوصولِ إلى الرِّعاية عن طريقِ إنشاء مجموعةٍ أبسطَ من علاماتِ الكلام والسلوكيَّات التي يمكنُ تحديدها من قبلِ غير المحترفين في فيديو منزليًّ قصير، وفي دراسةٍ جديدةٍ نُشِرَت في BioRxiv، حدَّد مقيِّمون -لم يتلقَوْا تدريبًا سريريًا- خصائصَ تشخيصِ التَّوحُّد بصحةٍ ودقةٍ تصل إلى ما بين 76 – 86%، وذلك عن طريقِ مشاهدةِ فيديو مدته ثلاث دقائق والردُّّ على 30 سؤالٍ عن السلوكيَّاتِ الملاحظة.

ويواصل فريق Wall تطويرَ اختبارٍ تشخيصيٍّ أسرعَ وأفضلَ باستخدامِ تقنيَّاتِ التَّعلُّم الآليِّ، فتُعالجُ الخوارزميَّات البيانات البصريَّة واللغويَّة لعددٍ من الأطفال المصابينَ بمرضِ التَّوحُّد وآخرينَ بحالةٍ سليمةٍ وذلك لمعرفةِ السُّلوكيَّاتِ الأكثرِ ملاءمةً لتشخيصِ المرض، ويُذكرُ أنَّه كلما ازدادَ عددُ المرضى الذين يقيِّمُهم البرنامج أصبحت توصياتُ التَّشخيص أكثر ذكاءً ودقة.

يقول Wall : “أنا متحمِّسٌ لبدءِ استخدامِ تِقنيَّاتِ الذَّكاء الصنعيِّ لمساعدة الأطفالِ المصابينَ بالتَّوحُّد وعائلاتِهم في جميعِ أنحاءِ العالم”.

ويُذكر أنَّ شركة Cognoa التابِعة لـWall تعملُ بالتَّعاونِ مع إدارةِ الغذاء والدواء وعددٍ من الأطِّباء على التَّحقُّق من صحَّةِ برمجيَّات التَّشخيصِ الخاصَّةِ بها وذلك لاستخدامِها على نطاقٍ أوسع.

3- المُستمِعون إلى وسائلِ التَّواصلِ الاجتماعي:

باتَّساع شبكةِ الإنترنت أُنشئ عددٌ لا يُحصى من مجموعاتِ دعمِ الأمراض، فيُشارِك المرضى الأسئلةَ فيها والمشورَة والتأمُّل بالشِّفاء، ويعملُ الدكتور Nigam Shah -مساعدُ مديرِ مركزِ ستانفورد لبحوثِ المعلوماتيَّةِ الحيويَّةِ الطبيَّة، على تطويرِ برامج “تستمعُ” إلى تلك المحادثاتِ و ترصدُ آثارَ الأدويةِ الطبيَّةِ التي تُرخَّصُ للاستخدام، وذلك بهدفِ تحديدِ ردودِ الفعلِ السلبيَّةِ غير المبلَّغ عنها.

ولاختبار إمكانيَّات ذلك البرنامج، تعاوَن Shah وفريق مختبرِه مع Brian Loew الرئيسِ التنفيذيِّ لـمجتمعات الصحَّة Inspire health communities ومع Kavita Sarin الأستاذ المساعدِ في الأمراضِ الجلديَّة، لاستخراجِ وتحليلِ المشاكلِ الجلديَّةِ الموجودةِ ضمنَ 8 ملايين مناقشةٍ عبر الإنترنت نُشرِت من قِبل أشخاصٍ يأخذونَ دواء erlotinib علمًا أنَّ هذا الدواء يُستخدَم لعلاجِ عدَّة أنواعٍ من السَّرطان، ومنها سرطانِ الرِّئة ذو الخلايا غيرِ الصَّغيرةِ وسرطانِ البنكرياس، وكانت أبرزُ تحدِّيات ذلك النَّوعِ من التَّحليلِ هو استخراجُ البياناتِ ذاتِ الصِّلة من محادثاتِ وسائِل التَّواصلِ الاجتماعية، إضافةً إلى إيجادِ الروابطِ بين الأدويةِ والآثارِ الجانبيَّة.

و عن طريقِ استخدامِ خوارزميَّاتِ التَّنقيبِ عن النصوص text-mining والتعلُّم العميق deep-learning، لم يُحدِّد الباحثونَ مشاكلَ الجلدِ التي يعاني منها المرضى فقط، ولكنَّهم اكتشفوا وجودَ تأثيرٍ دوائيٍّ غير مُلاحَظٍ أيضًا، نادر الحدوث؛ وهو التعرُّق المتقلِّص والمعروفُ أيضًا باسم نقصِ التَّعرُّق، وقد نُشرِت نتائج تلك الدراسة في مجلة JAMA، وقد أثبتت صحَّة المبدأِ الذي يقول أنَّه يُمكن استخدامُ الاستماعِ الآليِّ ضمنَ المنتدياتِ الصحيَّةِ عبر الإنترنت لتحسينِ النتائِجِ الصحيَّةِ وتقليل تأثُّرِ المجتمع بالآثارِ الجانبيَّة للأدوية.

التَّحدِّياتُ المُستقبليَّة لتطبيقاتِ الخدمةِ الصحيَّةِ الذَّكيَّة:

إنَّ دخولَ عالمٍ جديدٍ من الاستماعِ إلى الذَّكاءِ الاصطناعيِّ سيُثيرُ تحدِّياتٍ أخلاقيَّةٍ وقانونيَّةٍ واجتماعيَّة، فكيفَ نَحمي خصوصيَّة المرضى الذين تَجمعُ بياناتُهم وتُوزِّعُها برمجيَّاتُ وأجهزةُ الاستماع؟ وكيف يُمكِنُنا التحقُّقِ من خلوِّ خوارزميَّاتِ البرامجِ المستخدمةِ لمساعدةِ الأطبَّاءِ في قراراتِ الرِّعايةِ الصحيَّةِ من التحيُّز؟ ومَنْ هو المسؤول قانونيًّا إذا أدَّى استخدامُ أحدِ تلك التَّطبيقاتِ إلى خطأٍ طبّيِّ خطير؟

يُذكر أنَّه انطلَقَت مبادرةٌ تحت عنوان “مائةُ عامٍ دراسةٌ في الذَّكاء الاصطناعي” وبفضلِ تلكَ الجهود، تُعِدُّ مجموعاتُ عملٍ من خبراءٍ في مجال الذَّكاء الاصطناعي من جميعِ أنحاءِ العالم تقريرًا مفصلًا عن تأثيرِ الذَّكاء الاصطناعي على المجتمعِ كل عدَّة سنواتٍ في القرنِ المُقبِل.

وقد نُشر التقريرُ الأوَّل في سبتمبر 2016، وشدَّد فيه قِسمُ الرِّعاية الصحيَّة على مجموعةٍ من الوعودِ والتَّحدِّياتِ قائلًا: “يُمكن للتَّطبيقات المُعتمدَةِ على الذَّكاء الاصطناعيِّ تحسين النَّتائج الصحيَّة ونوعية الحياةِ لملايينِ الأشخاصِ في السَّنواتِ القادِمة – ولكن لا يَحدُث إلَّا إذا اكتُسِبت ثقة الأطبَّاء والممرِّضات والمرضى، وإذا أُزيلَت العوائق التنظيميَّةُ والتِّجاريَّة”.

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