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Iio M, Sato M, Narita M, Yamamoto-Hanada K, Oishi T, Kishino A, Kawaguchi T, Nishi R, Nagata M, Ohya Y. Development and Feasibility of a Mobile Asthma App for Children and Their Caregivers: Mixed Methods Study. JMIR Form Res 2022; 6:e34509. [PMID: 35594073 PMCID: PMC9166665 DOI: 10.2196/34509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mobile health apps can support the self-management of pediatric asthma. Previous studies on mobile apps for children aged >7 years with asthma are limited, and most reports on asthma apps do not consider interactions between the children and their caregivers. Therefore, we developed an asthma app for children aged 0-12 years and their caregivers based on the results of our previous study regarding user needs. Objective The aim of this study was to evaluate the feasibility of a developed mobile app for children with asthma and their caregivers and to modify and complete the app according to the feasibility results. Methods We recruited children diagnosed with persistent asthma by an allergy specialist at 2 children’s hospitals, 1 university hospital, 2 general hospitals, and 1 pediatric clinic. Thereafter, the app usage was assessed, and questionnaires were administered. This study used convergent mixed methods, including providing user feedback about the pediatric asthma app, completing questionnaire surveys regarding preferences, and obtaining quantitative data about app usage. Quantitative data were analyzed based on the ratings provided for the app features used by the participants, and the usage of the app features was analyzed using descriptive statistics. Qualitative data were analyzed via a descriptive qualitative research analysis and were used to identify codes from the content-characteristic words. Results In total, 30 pairs of children aged 2-12 years and their caregivers responded to the 3-month survey, and 20 pairs of children aged 4-12 years and their caregivers responded to the 6-month survey. In the 3- and 6-month surveys, “record” was the most commonly used feature by both caregivers and children. The average access logs per month among the 20 pairs ranged from 50 to 79 in the 6-month survey. The number of access logs decreased over time. In the qualitative results, app utilization difficulties were identified for 6 categories: record, preparing, alert settings, change settings, mobile phone owner, and display and motivation. Regarding app feasibility, 60% (12/20) of the caregivers strongly agreed or agreed for all evaluation items, while 63% (7/11) of the children strongly agreed or agreed for 6 items, excluding satisfaction. In the qualitative results, feasibility evaluation of the app was classified into 3 categories: high feasibility of the app, improvement points for the app, and personal factors preventing app utilization. Based on the results of the feasibility analysis, the final version of the app was modified and completed. Conclusions The app feasibility among children with asthma and their caregivers was generally good. Children aged 7-12 years used elements such as record, quiz, and manga. This app can support the continuous self-management of pediatric asthma. However, efforts must be taken to maintain and improve the app quality. Trial Registration UMIN Clinical Trials Registry UMIN000039058; https://tinyurl.com/3na9zyf8
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Affiliation(s)
- Misa Iio
- College of Nursing, Kanto Gakuin University, Yokohama, Japan
| | - Miori Sato
- Allergy Center, National Center for Child Health and Development, Setagaya, Japan
| | - Masami Narita
- Department of Pediatrics, Kyorin University School of Medicine, Kyorin University, Mitaka, Japan
| | | | - Taku Oishi
- Department of Pediatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Ai Kishino
- Division of Pediatrics, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | | | - Rin Nishi
- Division of Pediatrics, Yutenji Family Clinic, Meguro, Japan
| | - Mayumi Nagata
- College of Nursing, Kanto Gakuin University, Yokohama, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Setagaya, Japan
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202
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Li D, Hu Y, Liu S, Lu C, Zhang Y, Zhou J, Li J, Zhang Z. Developing an Integrated Evaluation Model for Physician Comprehensive Workload Tethered to Outpatient Practice: An Empirical Study From China. Front Public Health 2022; 10:847613. [PMID: 35664107 PMCID: PMC9162480 DOI: 10.3389/fpubh.2022.847613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies, often simply using either objective workload or mental workload as a measure of physician workload in various healthcare settings might have failed to comprehensively reflect the real workload among physicians. Despite this, there is little research that further explores a comprehensive workload evaluation framework with the integration of objective workload and mental workload to describe their comprehensive workload. Methods A comprehensive evaluation framework for physician workload was proposed based on the combination of objective workload and task-level mental workload also with the consideration of quality of provided medical services and served patient complexity; and accordingly, an integrated evaluation model for physician comprehensive workload (PCW) tethered to outpatient practice was developed and further applied to perform a PCW analysis using cross-sectional data on outpatient workload of 1,934 physicians mainly from 24 hospitals in 6 provinces in Eastern, Central, and Western China. Multiple linear regression and multinomial logistic regression analyses were established to identify significant factors influencing the PCW. Results Overall, the average score of PCW tethered to outpatient practice Chinese physicians experienced was 811.30 (SD=494.98) with concentrating on between 200 and 1,200. Physicians who were female, from Eastern or Western China, and those who worked >60 h per week and longer outpatient hours per week were more likely to experience a higher PCW. 11.2% of participating physicians were identified as very high PCW physicians, compared with 11.6% as low PCW physicians, 45.5% as medium PCW physicians and 30.7% as high PCW physicians. Those who were female, older, from Western China, those who had lower educational levels, lower professional titles and longer working years in the current institution, and those who worked in tertiary A hospitals and Internal or Surgical, and worked >60 h per week and longer outpatient hours per week were more likely to be very high PCW physicians. Conclusions Our work has a potential application for comprehensively assessing physician workload tethered to outpatient practice and could provide a solid foundation for hospital managers to further accurately determine and identify physicians with high workload, who would otherwise be missed in either objective workload or mental workload.
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Affiliation(s)
- Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yinhuan Hu
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuntao Lu
- Jingmen No. 2 People's Hospital, Jingmen, China
| | - Yeyan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinghan Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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203
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Li D, Hu Y, Liu S, Lu C, Li J, Zhou J, Zhang Y, Lu S. A Latent Profile Analysis of Chinese Physicians' Workload Tethered to Paperwork During Outpatient Encounters. Front Public Health 2022; 10:854772. [PMID: 35548081 PMCID: PMC9082025 DOI: 10.3389/fpubh.2022.854772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Physician dissatisfaction with more time spent on related paperwork but less time available for direct interaction with patients is increasing internationally. Increased physician workload resulting from paperwork might negatively affect their interaction with patients and increase the risk for burnout. This study aimed to investigate the level of physician workload tethered to paperwork during outpatient encounters and explore its latent workload subgroups among Chinese physicians. Methods A cross-sectional survey was conducted via online questionnaire primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China from November 2020 to February 2021. The Chinese physician mental workload scale developed by our research team was used for assessment of physician workload tethered to paperwork. Physicians were categorized into different subgroups of workload via latent profile analysis. Multinomial logistic regression was subsequently performed to examine how demographic variables differ among physicians belonging to different subgroups. Results A total of 1,934 valid questionnaires were received. Chinese physicians reported medium levels of workload while performing non-physician-patient communication work tasks characterized by paperwork during outpatient encounters. Four latent workload subgroups were identified: "low workload group" (8.8%), "medium workload group" (34.0%), "high workload group" (42.1%) and "very high workload group" (15.1%). Compared with the other latent workload subgroups, physicians belonging to the "very high workload group" were more likely to be younger, married, those who had worse health status, lower educational levels and lower average monthly incomes, those who worked more years in the current institution, more hours per week and longer outpatient hours per week, and those who worked in public general hospitals, tertiary B hospitals and Obstetrics and Gynecology, and saw more than 50 outpatients per day, with more time spent on per patient. Conclusions There exit four latent workload subgroups among Chinese physicians tethered to paperwork during outpatient encounters along with great individual variations among these subgroups. The characteristics of the latent "very high workload group" can help permit more targeted guidance for developing interventions with optimized human resource allocation to, in turn, increase the time available for direct interaction with patients, thereby resulting in improved quality of physician-patient interactions and decreased risk for physician burnout.
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Affiliation(s)
- Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuntao Lu
- Jingmen No. 2 People's Hospital, Jingmen, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinghan Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yeyan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoyu Lu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Pinnock H, Murphie P, Vogiatzis I, Poberezhets V. Telemedicine and virtual respiratory care in the era of COVID-19. ERJ Open Res 2022; 8:00111-2022. [PMID: 35891622 PMCID: PMC9131135 DOI: 10.1183/23120541.00111-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
The World Health Organization defines telemedicine as “an interaction between a health care provider and a patient when the two are separated by distance”. The COVID-19 pandemic has forced a dramatic shift to telephone and video consulting for follow up and routine ambulatory care for reasons of infection control. Short Message Service (“text”) messaging has proved a useful adjunct to remote consulting allowing transfer of photographs and documents. Maintaining non-communicable diseases care is a core component of pandemic preparedness and telemedicine has developed to enable (for example) remote monitoring of sleep apnoea, telemonitoring of chronic obstructive pulmonary disease, digital support for asthma self-management, remote delivery of pulmonary rehabilitation. There are multiple exemplars of telehealth instigated rapidly to provide care for people with COVID-19, to manage the spread of the pandemic, or to maintain safe routine diagnostic or treatment services.Despite many positive examples of equivalent functionality and safety, there remain questions about the impact of remote delivery of care on rapport and the longer-term impact on patient/professional relationships. Although telehealth has the potential to contribute to universal health coverage by providing cost-effective accessible care, there is a risk of increasing social health inequalities if the “digital divide” excludes those most in need of care. As we emerge from the pandemic, the balance of remote versus face-to-face consulting, and the specific role of digital health in different clinical and healthcare contexts will evolve. What is clear is that telemedicine in one form or another will be part of the “new norm”.
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Assiri GA, Alanazi BM, AlRuthia Y. The Prevalence of High-Risk Prescribing of Oral Non-Steroidal Anti-Inflammatory Drugs in Primary Healthcare: A Single-Centre Retrospective Chart Review Study. Healthcare (Basel) 2022; 10:healthcare10050867. [PMID: 35628004 PMCID: PMC9142064 DOI: 10.3390/healthcare10050867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
The quality and safety of prescribed drugs can be assessed using prescribing safety indicators (PSIs). This study aimed to estimate the prevalence of PSIs of oral non-steroidal anti-inflammatory drugs (NSAIDs) at primary care clinics of a tertiary care hospital in Saudi Arabia and to identify the risk factors associated with positive PSIs for patients. In this retrospective chart review study, data from the medical records of 450 patients aged ≥18 years, who were prescribed oral NSAIDs, were reviewed and collected manually. Seven PSIs were chosen and defined as follows: prescription of an oral NSAID to any patient with a peptic ulcer; aged ≥75 years; aged ≥65 years with a glomerular filtration rate <60; heart failure; co-prescribed warfarin; co-prescribed aspirin or clopidogrel; or co-prescribed angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker and a diuretic. Patients with positive indicators are at risk of harm from high-risk prescribing. The overall period prevalence of PSIs is 153/450 (34%; 95% CI 29.60−38.39). The overall proportion of PSIs is 202/431 (46.9%; 95% CI 42.12−51.61). The most common safety indicators were for NSAIDs prescribed to patients with heart failure and patients aged ≥65 years with a glomerular filtration rate <60. The elderly and patients using polypharmacy are at increased risk of having at least one positive PSI (OR 5.22; 95% CI 3.32−8.21, p-value < 0.001 and OR 2.97; 95% CI 1.17−7.55, p-value 0.022, respectively). Patients at risk of harm from high-risk NSAID prescriptions are common in primary care. The elderly and patients on polypharmacy are at increased risk of having at least one positive PSI. Therefore, when NSAIDs are prescribed, it is recommended to weigh the benefits versus the risks for high-risk patients, such as the elderly and those with multiple-drug therapy.
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206
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Public and Private Information Sharing under "New Normal" of COVID-19: Understanding the Roles of Habit and Outcome Expectation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095552. [PMID: 35564950 PMCID: PMC9105274 DOI: 10.3390/ijerph19095552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023]
Abstract
Information sharing is critical in risk communication and management during the COVID-19 epidemic, and information sharing has been a part of individual prevention and particular lifestyles under the "New Normal" of COVID-19. Thus, the purpose of this study was to explore influencing factors and mechanisms in public and private information sharing intention among people under the regular risk situation. This study investigated an information sharing mechanism based on a cross-sectional design. We collected 780 valid responses through a sample database of an online questionnaire platform and utilized partial least squares structural equation modeling (PLS-SEM) to further analyze the data. To explore the difference caused by news frames, we divided respondents into two groups according to the news frame (action frame vs. reassurance frame) and proceeded with the multi-group analysis. The results showed that four types of outcome expectations (information seeking, emotion regulation, altruism and public engagement) and habit had impacts on public and private information sharing intention. Two paths influencing information sharing proposed in this study were supported. The results showed that outcome expectations were positively related to habit, which implies that the cognitive mechanism was positively relevant to the formation of habit. The results proved that habit played a mediating role between outcome expectations and information sharing. This research found that emotion regulation and public engagement outcome expectations only affected two types of information sharing intention mediated by habit. Regarding the role of the news frame, this study found no significant difference between the group exposed to action-framed news and the group exposed to reassurance-framed news. By exploring influencing factors and the mechanism of information sharing under the "New Normal", these findings contribute to understanding of information sharing and have implications on risk management. The proposed mechanism classifying public and private information sharing complements risk information flowing by considering online risk incubation.
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207
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Nabergoj Makovec U, Goetzinger C, Ribaut J, Barnestein-Fonseca P, Haupenthal F, Herdeiro MT, Grant SP, Jácome C, Roque F, Smits D, Tadic I, Dima AL. Developing a medication adherence technologies repository: proposed structure and protocol for an online real-time Delphi study. BMJ Open 2022; 12:e059674. [PMID: 35459677 PMCID: PMC9074304 DOI: 10.1136/bmjopen-2021-059674] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION An online interactive repository of available medication adherence technologies may facilitate their selection and adoption by different stakeholders. Developing a repository is among the main objectives of the European Network to Advance Best practices and technoLogy on medication adherencE (ENABLE) COST Action (CA19132). However, meeting the needs of diverse stakeholders requires careful consideration of the repository structure. METHODS AND ANALYSIS A real-time online Delphi study by stakeholders from 39 countries with research, practice, policy, patient representation and technology development backgrounds will be conducted. Eleven ENABLE members from 9 European countries formed an interdisciplinary steering committee to develop the repository structure, prepare study protocol and perform it. Definitions of medication adherence technologies and their attributes were developed iteratively through literature review, discussions within the steering committee and ENABLE Action members, following ontology development recommendations. Three domains (product and provider information (D1), medication adherence descriptors (D2) and evaluation and implementation (D3)) branching in 13 attribute groups are proposed: product and provider information, target use scenarios, target health conditions, medication regimen, medication adherence management components, monitoring/measurement methods and targets, intervention modes of delivery, target behaviour determinants, behaviour change techniques, intervention providers, intervention settings, quality indicators and implementation indicators. Stakeholders will evaluate the proposed definition and attributes' relevance, clarity and completeness and have multiple opportunities to reconsider their evaluations based on aggregated feedback in real-time. Data collection will stop when the predetermined response rate will be achieved. We will quantify agreement and perform analyses of process indicators on the whole sample and per stakeholder group. ETHICS AND DISSEMINATION Ethical approval for the COST ENABLE activities was granted by the Malaga Regional Research Ethics Committee. The Delphi protocol was considered compliant regarding data protection and security by the Data Protection Officer from University of Basel. Findings from the Delphi study will form the basis for the ENABLE repository structure and related activities.
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Affiliation(s)
| | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
- University of Luxembourg, Faculty of Science, Technology and Medicine, Esch-sur-Alzette, Luxembourg
| | - Janette Ribaut
- Institute of Nursing Science, Department Public Health, University of Basel Faculty of Medicine, Basel, Switzerland
- Department of Theragnostic, Hematology, University Hospital Basel, Basel, Switzerland
| | - Pilar Barnestein-Fonseca
- CUDECA Institute for Training and Research in Palliative Care, CUDECA Hospice Foundation, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA Group C08: Pharma economy: Clinical and economic evaluation of medication and Palliative Care, Malaga, Spain
| | - Frederik Haupenthal
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED), Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Sean Patrick Grant
- Department of Social & Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Cristina Jácome
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto Faculty of Medicine, Porto, Portugal
| | - Fatima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda Research Unit for Inland Development, Guarda, Portugal
| | - Dins Smits
- Faculty of Public Health and Social Welfare, Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia
| | - Ivana Tadic
- Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade, Faculty of Pharmacy, Belgrade, Serbia
| | - Alexandra L Dima
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Spain
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208
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Johns G, Whistance B, Khalil S, Whistance M, Thomas B, Ogonovsky M, Ahuja A. Digital NHS Wales: a coding reliability analysis based on the voices of 22 978 patients and clinicians on the benefits, challenges and sustainability of video consulting. BMJ Open 2022; 12:e057874. [PMID: 35443959 PMCID: PMC9021454 DOI: 10.1136/bmjopen-2021-057874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The use of video consulting (VC) in Wales UK has expanded rapidly. Previous VC evidence has been the subject of small-scale projects and evaluations. Technology Enabled Care Cymru is an all-Wales digital service and rolls out digital interventions and evaluates on large scales, thus capturing representative data sets across Wales, and therefore a wide range of National Health Service (NHS) specialties. OBJECTIVE To extract and analyse narrative feedback from patients and clinicians using the NHS Wales VC Service for 6 months (September 2020 to March 2021). DESIGN A coding reliability approach of a cross-sectional study was conducted. SETTING From all health boards across Wales. PARTICIPANTS NHS patients and clinicians across primary, secondary and community care settings in Wales. RESULTS Data were captured on benefits, challenges and sustainability of VC. A coding reliability analysis was used with six domain summaries materialising to include: 'The Ease of VC'; 'The Personal Touches'; 'The Benefits of VC'; 'The Challenges of VC'; 'Technical Quality'; and 'Recommendations & Future Use'. An additional 17 subdomains are included. Direct quotations from patients and clinicians are provided for context. CONCLUSIONS A total of 22 978 participants were included. These data help demonstrate that NHS remote service delivery, via the method of VC, can be highly satisfactory, well accepted and clinically suitable yielding many benefits. Despite this, the data are not without its challenges surrounding engagement and suitability for VC. The NHS Wales VC Service rolled out and evaluated at scale and demonstrates that VC has potential for long-term sustainability. For the future, use a 'blended approach' for NHS appointments that are clinically judged and centred on patient choice.
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Affiliation(s)
- Gemma Johns
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | | | - Sara Khalil
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | - Megan Whistance
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | - Bronwen Thomas
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | - Mike Ogonovsky
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | - Alka Ahuja
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
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van Laar SA, Gombert-Handoko KB, Groenwold RHH, van der Hulle T, Visser LE, Houtsma D, Guchelaar HJ, Zwaveling J. Real-World Metastatic Renal Cell Carcinoma Treatment Patterns and Clinical Outcomes in The Netherlands. Front Pharmacol 2022; 13:803935. [PMID: 35401238 PMCID: PMC8983834 DOI: 10.3389/fphar.2022.803935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/18/2022] [Indexed: 12/28/2022] Open
Abstract
The number of treatment options for patients with metastatic renal cell carcinoma (mRCC) has significantly grown in the last 15 years. Although randomized controlled trials are fundamental in investigating mRCC treatment efficacy, their external validity can be limited. Therefore, the efficacy of the different treatment options should also be evaluated in clinical practice. We performed a chart review of electronic health records using text mining software to study the current treatment patterns and outcomes. mRCC patients from two large hospitals in the Netherlands, starting treatment between January 2015 and May 2020, were included. Data were collected from electronic health records using a validated text mining tool. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method. Most frequent first-line treatments were pazopanib (n = 70), sunitinib (n = 34), and nivolumab with ipilimumab (n = 28). The overall median PFS values for first-line treatment were 15.7 months (95% confidence interval [95%CI], 8.8-20.7), 16.3 months (95%CI, 9.3-not estimable [NE]) for pazopanib, and 6.9 months (95% CI, 4.4-NE) for sunitinib. The overall median OS values were 33.4 months (95%CI, 28.1-50.9 months), 39.3 months (95%CI, 29.5-NE) for pazopanib, and 28.1 months (95%CI, 7.0-NE) for sunitinib. For nivolumab with ipilimumab, median PFS and median OS were not reached. Of the patients who finished first- and second-line treatments, 64 and 62% received follow-up treatments, respectively. With most patients starting on pazopanib and sunitinib, these real-world treatment outcomes were most likely better than in pivotal trials, which may be due to extensive follow-up treatments.
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Affiliation(s)
- S A van Laar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - K B Gombert-Handoko
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - R H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - T van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - L E Visser
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands.,Department of Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | - D Houtsma
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, Netherlands
| | - H J Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - J Zwaveling
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
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Li M, Liu Y, Yan T, Xue C, Zhu X, Yuan D, Hu R, Liu L, Wang Z, Liu Y, Wang B. Epidemiological characteristics of mumps from 2004 to 2020 in Jiangsu, China: a flexible spatial and spatiotemporal analysis. Epidemiol Infect 2022; 150:1-26. [PMID: 35393005 PMCID: PMC9074115 DOI: 10.1017/s095026882200067x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/22/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
The mumps resurgence has frequently been reported around the world in recent years, especially in many counties mumps vaccines have been widely used. This study aimed to describe the spatial epidemiological characteristics of mumps in Jiangsu, and provide a scientific basis for the implementation and adjustment of strategies to prevent and control mumps. The epidemiological characteristics were described with ratio or proportion. Spatial autocorrelation, Tango's flexible spatial scan statistics, and Kulldorff's elliptic spatiotemporal scan statistics were applied to identify the spatial autocorrelation, detect hot and cold spots of mumps incidence, and aggregation areas. A total of 172 775 cases were reported from 2004 to 2020 in Jiangsu. The general trend of mumps incidence is declining with a bimodal seasonal distribution identified mainly in summer and winter, respectively. Children aged 5–10 years old are the main risk group. A migration trend of hot spots from southeast to northwest over time was found. Similar high-risk aggregations were detected in the northwestern parts through spatial-temporal analysis with the most likely cluster time frame around 2019. Local medical and health administrations should formulate and implement targeted health care policies and allocate health resources more appropriately corresponding to the epidemiological characteristics of mumps.
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Affiliation(s)
- Mingma Li
- Key Laboratory of Environment Medicine Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, Southeast University School of Public Health, Nanjing 210009, Jiangsu, China
| | - Yuxiang Liu
- Key Laboratory of Environment Medicine Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, Southeast University School of Public Health, Nanjing 210009, Jiangsu, China
| | - Tao Yan
- Key Laboratory of Environment Medicine Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, Southeast University School of Public Health, Nanjing 210009, Jiangsu, China
| | - Chenghao Xue
- Key Laboratory of Environment Medicine Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, Southeast University School of Public Health, Nanjing 210009, Jiangsu, China
| | - Xiaoyue Zhu
- Key Laboratory of Environment Medicine Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, Southeast University School of Public Health, Nanjing 210009, Jiangsu, China
| | - Defu Yuan
- Key Laboratory of Environment Medicine Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, Southeast University School of Public Health, Nanjing 210009, Jiangsu, China
| | - Ran Hu
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China
| | - Li Liu
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China
| | - Zhiguo Wang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China
| | - Yuanbao Liu
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China
| | - Bei Wang
- Key Laboratory of Environment Medicine Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, Southeast University School of Public Health, Nanjing 210009, Jiangsu, China
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Stokes K, Oronti B, Cappuccio FP, Pecchia L. Use of technology to prevent, detect, manage and control hypertension in sub-Saharan Africa: a systematic review. BMJ Open 2022; 12:e058840. [PMID: 35383086 PMCID: PMC8984054 DOI: 10.1136/bmjopen-2021-058840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify and assess the use of technologies, including mobile health technology, internet of things (IoT) devices and artificial intelligence (AI) in hypertension healthcare in sub-Saharan Africa (SSA). DESIGN Systematic review. DATA SOURCES Medline, Embase, Scopus and Web of Science. ELIGIBILITY CRITERIA Studies addressing outcomes related to the use of technologies for hypertension healthcare (all points in the healthcare cascade) in SSA. METHODS Databases were searched from inception to 2 August 2021. Screening, data extraction and risk of bias assessment were done in duplicate. Data were extracted on study design, setting, technology(s) employed and outcomes. Blood pressure (BP) reduction due to intervention was extracted from a subset of randomised controlled trials. Methodological quality was assessed using the Mixed Methods Appraisal Tool. RESULTS 1717 hits were retrieved, 1206 deduplicated studies were screened and 67 full texts were assessed for eligibility. 22 studies were included, all reported on clinical investigations. Two studies were observational, and 20 evaluated technology-based interventions. Outcomes included BP reduction/control, treatment adherence, retention in care, awareness/knowledge of hypertension and completeness of medical records. All studies used mobile technology, three linked with IoT devices. Short Message Service (SMS) was the most popular method of targeting patients (n=6). Moderate BP reduction was achieved in three randomised controlled trials. Patients and healthcare providers reported positive perceptions towards the technologies. No studies using AI were identified. CONCLUSIONS There are a range of successful applications of key enabling technologies in SSA, including BP reduction, increased health knowledge and treatment adherence following targeted mobile technology interventions. There is evidence to support use of mobile technology for hypertension management in SSA. However, current application of technologies is highly heterogeneous and key barriers exist, limiting efficacy and uptake in SSA. More research is needed, addressing objective measures such as BP reduction in robust randomised studies. PROSPERO REGISTRATION NUMBER CRD42020223043.
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Affiliation(s)
- Katy Stokes
- School of Engineering, University of Warwick, Coventry, UK
| | - Busola Oronti
- School of Engineering, University of Warwick, Coventry, UK
| | - Francesco P Cappuccio
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, UK
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Shukuya T, Takamochi K, Sakurai H, Yoh K, Hishida T, Tsuboi M, Goto Y, Kudo Y, Ohde Y, Okumura S, Taguri M, Kunitoh H. Efficacy of adjuvant chemotherapy with tegafur/uracil in patients with completely resected, node-negative non-small cell lung cancer – real-world data in the era of molecularly targeted agents and immunotherapy. JTO Clin Res Rep 2022; 3:100320. [PMID: 35601927 PMCID: PMC9117917 DOI: 10.1016/j.jtocrr.2022.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction In Japan, adjuvant tegafur-uracil (UFT) chemotherapy is recommended for patients with completely resected, stage I NSCLC. This treatment requires real-world re-evaluation because of recent advances in target-based and immuno-oncological treatments and refinement of lung cancer staging. Methods The Japan Clinical Oncology Group (JCOG) 0707, a phase 3 trial comparing the benefits of UFT and S-1 (tegafur-gimeracil-oteracil) in patients with completely resected stage I NSCLC (T1 >2 cm and T2 in the TNM sixth edition), was conducted in Japan. A multicenter observational cohort study (Comprehensive Support Project for Oncology Research [CSPOR]-LC03) was also conducted for those patients excluded from JCOG 0707 during the study enrollment period. Physicians from institutions that participated in JCOG 0707 retrospectively assessed the medical records of each patient. The efficacy of UFT was evaluated in the CSPOR-LC03 cohort. Results In the entire study population (n = 5005), patients treated with UFT (n = 1549) had significantly longer overall survival (OS) than those without any adjuvant chemotherapy (n = 3338). There was no significant difference in OS between the patients treated with UFT (n = 1061) and those without adjuvant chemotherapy (n = 1484) in the JCOG 0707-eligible population (logrank p = 0.755). For tumors without ground-glass attenuation and size greater than 3 cm, patients treated with UFT had significantly longer survival than those without adjuvant chemotherapy, on univariate but not on multivariate analysis. Conclusions There was no significant difference in OS between the patients treated with UFT and those without adjuvant chemotherapy in the clinical trial-eligible population. Adjuvant UFT for patients with completely resected NSCLC may be recommended only in patients with a tumor without ground-glass attenuation and size greater than 3 cm. In patients with node-negative early NSCLC, further study is needed to select patients who will benefit from adjuvant chemotherapy.
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Affiliation(s)
- Takehito Shukuya
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
- Corresponding author. Address for correspondence: Takehito Shukuya, MD, PhD, Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421 Japan.
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Division of Respiratory Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kiyotaka Yoh
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery & Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yujin Kudo
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Masataka Taguri
- Yokohama City University School of Data Science, Yokohama, Japan
- Department of Health Data Science, Tokyo Medical University, Tokyo, Japan
| | - Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
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Walthall H, Schutz S, Snowball J, Vagner R, Fernandez N, Bartram E. Patients' and clinicians' experiences of remote consultation? A narrative synthesis. J Adv Nurs 2022; 78:1954-1967. [PMID: 35362191 PMCID: PMC9321562 DOI: 10.1111/jan.15230] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Aims To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in‐person consultations. Design Narrative synthesis. Data sources Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020. Review Methods Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute. Results Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non‐face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges. Conclusion This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non‐face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self‐manage with support from clinicians who are not in‐person. More high‐quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post‐SARS‐CoV‐2 pandemic to identify any learning and education opportunities. Impact Health care staff can provide high‐quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.
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Affiliation(s)
- Helen Walthall
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Sue Schutz
- Oxford Brookes University and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanne Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
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Collins C, Petek D, Diaz E, Muñoz MA. General Practice/Family Medicine Research During the Pandemic: Showing The Links to the EGPRN Research Strategy. EURASIAN JOURNAL OF FAMILY MEDICINE 2022. [DOI: 10.33880/ejfm.2022110101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
General Practice/Family Medicine is at the forefront of the clinical response to the COVID-19 crisis just as it is known to be a critical component of healthcare systems globally.
A large number of COVID-19 related papers have been published and dedicated funding calls were available in many countries and across the European Union. However, General Practice/Family Medicine does not feature as strongly as it should in COVID-19 high impact publications or successful funding applications.
In this paper, we take a look at the findings on which the recommendations of the “European General Practice Research Network (EGPRN) Research Strategy for General Practice in Europe 2021” are based and highlight how these align with the COVID-19 experience of General Practice/Family research.
To elaborate on this, the issues identified and the recommendations of the EGPRN Research Strategy are grouped into three broad areas on which we need to focus – capacity, collaboration, and complexity (3-Cs).
Apparent or presumed deficiencies in these 3-Cs are possibly why the General Practice/Family research impact during COVID-19 does not match its position on the ground in fighting the pandemic and supporting patients. The EGPRN Research Strategy identifies how we might work to position ourselves better in the future and gain the recognition deserved, in terms of publications, research funding, and prominence.
Keywords: general practice, research, pandemics, publications, financing
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Affiliation(s)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana
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Esmaeilzadeh P. Benefits and concerns associated with blockchain-based health information exchange (HIE): a qualitative study from physicians' perspectives. BMC Med Inform Decis Mak 2022; 22:80. [PMID: 35346176 PMCID: PMC8962111 DOI: 10.1186/s12911-022-01815-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Blockchain technology has the potential to revolutionize information sharing in companies. Many studies suggest using blockchain-powered platforms to replace existing mechanisms for health information exchange (HIE) across healthcare organizations. However, very few blockchain-based projects have been implemented in the healthcare sector. This study takes a qualitative approach to explore benefits, concerns, and barriers to the rollout of blockchain in HIE projects from physicians' perspectives. METHODS The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to help us better understand root causes, existing problems, perceived risks, perceived benefits, and suggestions. In-depth interviews have been conducted with 38 physicians in six months. The data were analyzed and coded using NVIVO to classify conceptually similar themes mentioned by the interviewees. RESULTS In total, seven themes have been identified. The key benefits are categorized into three themes: innovative technological features, collaborative ecosystem, and system performance. The main concerns and risks are categorized into four themes: individual, organizational, technological, and market-related issues. The findings can contribute to knowledge by highlighting key values expected from blockchain technology in HIEs. The results also explore obstacles to leveraging the blockchain in healthcare from the perspectives of an important stakeholder (physicians). CONCLUSIONS The results show that although blockchain technology may create several benefits (e.g., innovative technological features, collaborative ecosystem, and system performance), its applications in healthcare are still in their early stages. The perceptions of the individual issues (e.g., lack of knowledge), organizational issues (e.g., implementation issues), technological issues (e.g., blockchain model types), and market-related issues (e.g., regulatory concerns) indicate that blockchain-based applications in healthcare continue to be an emerging field. This study has practical implications as understanding these concerns can help developers and healthcare managers identify potential issues in the planning, developing, and implementing blockchain-based HIE systems. Addressing these barriers would support the widespread use of blockchain-based HIEs in different healthcare settings and facilitate interoperability and connectivity in regional and community health information networks.
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Affiliation(s)
- Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, College of Business, Florida International University (FIU), Modesto A. Maidique Campus, 11200 S.W. 8th St, RB 261B, Miami, FL, 33199, USA.
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Carmona-Pírez J, Ioakeim-Skoufa I, Gimeno-Miguel A, Poblador-Plou B, González-Rubio F, Muñoyerro-Muñiz D, Rodríguez-Herrera J, Goicoechea-Salazar JA, Prados-Torres A, Villegas-Portero R. Multimorbidity Profiles and Infection Severity in COVID-19 Population Using Network Analysis in the Andalusian Health Population Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073808. [PMID: 35409489 PMCID: PMC8997853 DOI: 10.3390/ijerph19073808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023]
Abstract
Identifying the population at risk of COVID-19 infection severity is a priority for clinicians and health systems. Most studies to date have only focused on the effect of specific disorders on infection severity, without considering that patients usually present multiple chronic diseases and that these conditions tend to group together in the form of multimorbidity patterns. In this large-scale epidemiological study, including primary and hospital care information of 166,242 patients with confirmed COVID-19 infection from the Spanish region of Andalusia, we applied network analysis to identify multimorbidity profiles and analyze their impact on the risk of hospitalization and mortality. Our results showed that multimorbidity was a risk factor for COVID-19 severity and that this risk increased with the morbidity burden. Individuals with advanced cardio-metabolic profiles frequently presented the highest infection severity risk in both sexes. The pattern with the highest severity associated in men was present in almost 28.7% of those aged ≥ 80 years and included associations between cardiovascular, respiratory, and metabolic diseases; age-adjusted odds ratio (OR) 95% confidence interval (1.71 (1.44–2.02)). In women, similar patterns were also associated the most with infection severity, in 7% of 65–79-year-olds (1.44 (1.34–1.54)) and in 29% of ≥80-year-olds (1.35 (1.18–1.53)). Patients with mental health patterns also showed one of the highest risks of COVID-19 severity, especially in women. These findings strongly recommend the implementation of personalized approaches to patients with multimorbidity and SARS-CoV-2 infection, especially in the population with high morbidity burden.
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Affiliation(s)
- Jonás Carmona-Pírez
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Delicias-Sur Primary Care Health Centre, Aragon Health Service (SALUD), 50009 Zaragoza, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-976-765-500 (ext. 5371/5375)
| | - Ignatios Ioakeim-Skoufa
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health, NO-0213 Oslo, Norway
- Department of Drug Statistics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, NO-0213 Oslo, Norway
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (SEMFYC), 08009 Barcelona, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Francisca González-Rubio
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (SEMFYC), 08009 Barcelona, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud (SAS), 41071 Seville, Spain; (D.M.-M.); (J.R.-H.); (J.A.G.-S.); (R.V.-P.)
| | - Juliana Rodríguez-Herrera
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud (SAS), 41071 Seville, Spain; (D.M.-M.); (J.R.-H.); (J.A.G.-S.); (R.V.-P.)
| | - Juan Antonio Goicoechea-Salazar
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud (SAS), 41071 Seville, Spain; (D.M.-M.); (J.R.-H.); (J.A.G.-S.); (R.V.-P.)
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Román Villegas-Portero
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud (SAS), 41071 Seville, Spain; (D.M.-M.); (J.R.-H.); (J.A.G.-S.); (R.V.-P.)
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Najjar A, Amro B, Macedo M. islEHR, a model for electronic health records interoperability. BIO-ALGORITHMS AND MED-SYSTEMS 2022. [DOI: 10.1515/bams-2021-0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Due to the diversity, volume, and distribution of ingested data, the majority of current healthcare entities operate independently, increasing the problem of data processing and interchange. The goal of this research is to design, implement, and evaluate an electronic health record (EHR) interoperability solution – prototype – among healthcare organizations, whether these organizations do not have systems that are prepared for data sharing, or organizations that have such systems.
Methods
We established an EHR interoperability prototype model named interoperability smart lane for electronic health record (islEHR), which comprises of three modules: 1) a data fetching APIs for external sharing of patients’ information from participant hospitals; 2) a data integration service, which is the heart of the islEHR that is responsible for extracting, standardizing, and normalizing EHRs data leveraging the fast healthcare interoperability resources (FHIR) and artificial intelligence techniques; 3) a RESTful API that represents the gateway sits between clients and the data integration services.
Results
The prototype of the islEHR was evaluated on a set of unstructured discharge reports. The performance achieved a total time of execution ranging from 0.04 to 84.49 s. While the accuracy reached an F-Score ranging from 1.0 to 0.89.
Conclusions
According to the results achieved, the islEHR prototype can be implemented among different heterogeneous systems regardless of their ability to share data. The prototype was built based on international standards and machine learning techniques that are adopted worldwide. Performance and correctness results showed that islEHR outperforms existing models in its diversity as well as correctness and performance.
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Affiliation(s)
- Arwa Najjar
- Information Technology College, Hebron University , Hebron , Palestine
| | - Belal Amro
- Information Technology College, Hebron University , Hebron , Palestine
| | - Mário Macedo
- Sciences and Technologies of Information and Communication College, Atlântica University , Lisbon , Portugal
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218
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Wagner SK, Hughes F, Cortina-Borja M, Pontikos N, Struyven R, Liu X, Montgomery H, Alexander DC, Topol E, Petersen SE, Balaskas K, Hindley J, Petzold A, Rahi JS, Denniston AK, Keane PA. AlzEye: longitudinal record-level linkage of ophthalmic imaging and hospital admissions of 353 157 patients in London, UK. BMJ Open 2022; 12:e058552. [PMID: 35296488 PMCID: PMC8928293 DOI: 10.1136/bmjopen-2021-058552] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Retinal signatures of systemic disease ('oculomics') are increasingly being revealed through a combination of high-resolution ophthalmic imaging and sophisticated modelling strategies. Progress is currently limited not mainly by technical issues, but by the lack of large labelled datasets, a sine qua non for deep learning. Such data are derived from prospective epidemiological studies, in which retinal imaging is typically unimodal, cross-sectional, of modest number and relates to cohorts, which are not enriched with subpopulations of interest, such as those with systemic disease. We thus linked longitudinal multimodal retinal imaging from routinely collected National Health Service (NHS) data with systemic disease data from hospital admissions using a privacy-by-design third-party linkage approach. PARTICIPANTS Between 1 January 2008 and 1 April 2018, 353 157 participants aged 40 years or older, who attended Moorfields Eye Hospital NHS Foundation Trust, a tertiary ophthalmic institution incorporating a principal central site, four district hubs and five satellite clinics in and around London, UK serving a catchment population of approximately six million people. FINDINGS TO DATE Among the 353 157 individuals, 186 651 had a total of 1 337 711 Hospital Episode Statistics admitted patient care episodes. Systemic diagnoses recorded at these episodes include 12 022 patients with myocardial infarction, 11 735 with all-cause stroke and 13 363 with all-cause dementia. A total of 6 261 931 retinal images of seven different modalities and across three manufacturers were acquired from 1 54 830 patients. The majority of retinal images were retinal photographs (n=1 874 175) followed by optical coherence tomography (n=1 567 358). FUTURE PLANS AlzEye combines the world's largest single institution retinal imaging database with nationally collected systemic data to create an exceptional large-scale, enriched cohort that reflects the diversity of the population served. First analyses will address cardiovascular diseases and dementia, with a view to identifying hidden retinal signatures that may lead to earlier detection and risk management of these life-threatening conditions.
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Affiliation(s)
- Siegfried Karl Wagner
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Fintan Hughes
- Department of Anaesthesiology, Duke University Hospital, Durham, North Carolina, USA
| | | | - Nikolas Pontikos
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Robbert Struyven
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Eric Topol
- Scripps Research Institute, La Jolla, California, USA
| | - Steffen Erhard Petersen
- William Harvey Research Institute, Queen Mary University of London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Konstantinos Balaskas
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Jack Hindley
- Department of Information Governance, University College London, London, UK
| | - Axel Petzold
- Institute of Ophthalmology, University College London, London, UK
- Institute of Neurology, University College London, London, UK
- Department of Neurophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Jugnoo S Rahi
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Ulverscroft Vision Research Group, University College London, London, UK
| | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
| | - Pearse A Keane
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Igumbor JO, Bosire EN, Vicente-Crespo M, Igumbor EU, Olalekan UA, Chirwa TF, Kinyanjui SM, Kyobutungi C, Fonn S. Considerations for an integrated population health databank in Africa: lessons from global best practices. Wellcome Open Res 2022; 6:214. [PMID: 35224211 PMCID: PMC8844538 DOI: 10.12688/wellcomeopenres.17000.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The rising digitisation and proliferation of data sources and repositories cannot be ignored. This trend expands opportunities to integrate and share population health data. Such platforms have many benefits, including the potential to efficiently translate information arising from such data to evidence needed to address complex global health challenges. There are pockets of quality data on the continent that may benefit from greater integration. Integration of data sources is however under-explored in Africa. The aim of this article is to identify the requirements and provide practical recommendations for developing a multi-consortia public and population health data-sharing framework for Africa. Methods: We conducted a narrative review of global best practices and policies on data sharing and its optimisation. We searched eight databases for publications and undertook an iterative snowballing search of articles cited in the identified publications. The Leximancer software
© enabled content analysis and selection of a sample of the most relevant articles for detailed review. Themes were developed through immersion in the extracts of selected articles using inductive thematic analysis. We also performed interviews with public and population health stakeholders in Africa to gather their experiences, perceptions, and expectations of data sharing. Results: Our findings described global stakeholder experiences on research data sharing. We identified some challenges and measures to harness available resources and incentivise data sharing. We further highlight progress made by the different groups in Africa and identified the infrastructural requirements and considerations when implementing data sharing platforms. Furthermore, the review suggests key reforms required, particularly in the areas of consenting, privacy protection, data ownership, governance, and data access. Conclusions: The findings underscore the critical role of inclusion, social justice, public good, data security, accountability, legislation, reciprocity, and mutual respect in developing a responsive, ethical, durable, and integrated research data sharing ecosystem.
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Affiliation(s)
- Jude O Igumbor
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
| | - Edna N Bosire
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
| | - Marta Vicente-Crespo
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa.,African Population and Health Research Centre, Nairobi, Kenya
| | - Ehimario U Igumbor
- Nigeria Centre for Disease Control, Abuja, Nigeria.,School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Uthman A Olalekan
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tobias F Chirwa
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
| | | | | | - Sharon Fonn
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
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Baral S, Silwal SR, Shrestha UM, Lamichhane D. Evaluation of Quality Indicators of Breast Cancer Management at a Tertiary Cancer Center in Nepal. JCO Glob Oncol 2022; 8:e2100303. [PMID: 35298295 PMCID: PMC8955076 DOI: 10.1200/go.21.00303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Breast cancer is the second commonest cancer among female in Nepal. This is our first attempt to audit breast cancer management in our institute and compare with standard quality indicators (QIs) available. METHODS The retrospective study included 104 female patients with breast cancer who had taken treatment at Bhaktapur Cancer Hospital in 1 year. Participants were selected on the basis of convenience sampling. Of 33 QIs in breast cancer management according to European Society of Breast Cancer Specialists guidelines, 19 QIs were chosen relevant to our setup. These QIs were calculated for all patients and compared with the European Society of Breast Cancer Specialists standard target. Frequencies and percentages were calculated and presented in tables. Binomial 95% of the rates for QI adherence were also calculated for each QI. RESULTS One hundred four patients had a median age of 47.5 years (range 24-70 years). Applicable QIs were in the range of 5-15 with a mean of 9.66 per patient. Of 19 evaluable QIs, very high adherence rates were observed in six QIs, high adherence in three Qis, and low adherences in 10 QIs. High adherence rates were for QI 5 and QI 10a, which were 88.46% and 94.73%, respectively. The low compliance was for QI 1, QI 4a, QI 8, QI 9d, QI 10b, QI 11a, QI 11b, QI 13b, QI 13e, and 14b, which were 53.84%, 78.21%, 0%, 83.16%, 76.92%, 36.0%, 33.33%, 4.76%, 30.55%, and 10.81%, respectively. CONCLUSION There are several QIs that have low levels of adherence in our setting and suggest that there is significant room for improvement. We will be continuing auditing these QIs regularly to improve our quality of care.
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Affiliation(s)
- Shweta Baral
- Clinical Oncologist, Bhaktapur Cancer Hospital, Bhaktapur, Nepal
| | | | | | - Deep Lamichhane
- Surgical Oncologist, Bhaktapur Cancer Hospital, Bhaktapur, Nepal
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Griffiths E, Joseph RM, Tilston G, Thew S, Kapacee Z, Dixon W, Peek N. Findability of UK health datasets available for research: a mixed methods study. BMJ Health Care Inform 2022; 29:bmjhci-2021-100325. [PMID: 35193857 PMCID: PMC8867248 DOI: 10.1136/bmjhci-2021-100325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE How health researchers find secondary data to analyse is unclear. We sought to describe the approaches that UK organisations take to help researchers find data and to assess the findability of health data that are available for research. METHODS We surveyed established organisations about how they make data findable. We derived measures of findability based on the first element of the FAIR principles (Findable, Accessible, Interoperable, Reproducible). We applied these to 13 UK health datasets and measured their findability via two major internet search engines in 2018 and repeated in 2021. RESULTS Among 12 survey respondents, 11 indicated that they made metadata publicly available. Respondents said internet presence was important for findability, but that this needed improvement. In 2018, 8 out of 13 datasets were listed in the top 100 search results of 10 searches repeated on both search engines, while the remaining 5 were found one click away from those search results. In 2021, this had reduced to seven datasets directly listed and one dataset one click away. In 2021, Google Dataset Search had become available, which listed 3 of the 13 datasets within the top 100 search results. DISCUSSION Measuring findability via online search engines is one method for evaluating efforts to improve findability. Findability could perhaps be improved with catalogues that have greater inclusion of datasets, field-level metadata and persistent identifiers. CONCLUSION UK organisations recognised the importance of the internet for finding data for research. However, health datasets available for research were no more findable in 2021 than in 2018.
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Affiliation(s)
- Emily Griffiths
- Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, UK
| | | | - George Tilston
- Informatics, Imaging, and Data Sciences, The University of Manchester, Manchester, Greater Manchester, UK
| | - Sarah Thew
- Manchester Academic Health Science Centre, Manchester, UK
| | - Zoher Kapacee
- Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, UK
| | - William Dixon
- Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Niels Peek
- Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, UK .,NIHR Manchester Biomedical Research Centre, Manchester, UK
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Cesare N, Were LPO. A multi-step approach to managing missing data in time and patient variant electronic health records. BMC Res Notes 2022; 15:64. [PMID: 35177096 PMCID: PMC8851714 DOI: 10.1186/s13104-022-05911-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Electronic health records (EHR) hold promise for conducting large-scale analyses linking individual characteristics to health outcomes. However, these data often contain a large number of missing values at both the patient and visit level due to variation in data collection across facilities, providers, and clinical need. This study proposes a stepwise framework for imputing missing values within a visit-level EHR dataset that combines informative missingness and conditional imputation in a scalable manner that may be parallelized for efficiency. RESULTS For this study we use a subset of data from AMPATH representing information from 530,812 clinic visits from 16,316 Human Immunodeficiency Virus (HIV) positive women across Western Kenya who have given birth. We apply this process to a set of 84 clinical, social and economic variables and are able to impute values for 84.6% of variables with missing data with an average reduction in missing data of approximately 35.6%. We validate the use of this imputed dataset by predicting National Hospital Insurance Fund (NHIF) enrollment with 94.8% accuracy.
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Affiliation(s)
- Nina Cesare
- Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston, MA, USA.
| | - Lawrence P O Were
- Department of Health Sciences & School of Public Health, Department of Global Health, Boston University Sargent College, Boston, MA, USA
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Sezgin MG, Bektas H. The effect of decision support systems on pain in patients with cancer: A systematic review and meta-analysis of randomized controlled trials. J Nurs Scholarsh 2022; 54:578-588. [PMID: 35166032 DOI: 10.1111/jnu.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE This study was conducted to systematically examine the effect of decision support systems (DSSs) applied to patients with cancer on pain severity. REVIEW METHODS Systematic review and meta-analysis. A search was done on Web of Science, Science Direct, PubMed, ProQuest, EBSCOhost/CINAHL Complete, Scopus, Springer Link, Cochrane Library, and Ovid databases, which covered a period until September 2021. Meta-analysis of the data was conducted on the CMA 3 software package. Comprehensive reviews were conducted by two independent researchers in line with the PICOS criteria. The study was conducted according to the PRISMA checklist. FINDINGS Five randomized controlled trials with 1.880 participants were included in this systematic review and meta-analysis. In the study, visits, consultations, simulation of patient outcomes, telephone support, and email applications were employed for periods ranging from 6 weeks to 6 months. The evaluation of the meta-analysis results indicated that DSSs had positive effects on pain severity in patients with cancer (Hedge's g = 0.22; p < 0.001). CONCLUSION The findings of this systematic review and meta-analysis show that DSSs can be used as an effective and comfortable technological application in reducing the severity of pain in patients with cancer. CLINICAL RELEVANCE The use of DSSs for pain severity in patients with cancer is an effective method. In line with the findings of this systematic review and meta-analysis, awareness and knowledge levels of all health disciplines about DSSs will increase. It is believed that the use of DSSs to improve patient-centered care will be guiding.
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Affiliation(s)
- Merve Gozde Sezgin
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
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224
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Macbeth AE, Holmes S, Harries M, Chiu WS, Tziotzios C, de Lusignan S, Messenger AG, Thompson AR. The associated burden of mental health conditions in alopecia areata: A population-based study in UK primary care. Br J Dermatol 2022; 187:73-81. [PMID: 35157313 PMCID: PMC9542942 DOI: 10.1111/bjd.21055] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/24/2021] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
Background Alopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact. Objectives To assess the co‐occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment. Methods In total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre‐existing mental health conditions, rates of mental health‐related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521). Results Depression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new‐onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA. Conclusions People with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence‐based mental health treatment programmes are needed for people with AA.
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Affiliation(s)
- Abby E Macbeth
- Department of Dermatology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Susan Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Matthew Harries
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, UK; Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Wing Sin Chiu
- Pfizer Ltd, Walton Oaks, Walton on the Hill, Tadworth, Surrey, KT20 7NS, UK
| | - Christos Tziotzios
- St. John's Institute of Dermatology, King's College London, London, Guy's Hospital, London, SE1 9RT, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care health Sciences, University of Oxford, UK; Royal College of General Practitioners, Research and Surveillance Centre, London, UK
| | - Andrew G Messenger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Department of Psychology, Cardiff University, 11th Floor, Tower Building, 70 Park Place Cardiff, CF10 3AT, Wales
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Stevenson DJ, Avery AJ, Coupland C, Hobbs FDR, Kendrick D, Moore MV, Morris C, Rubin GP, Smith MD, Hawkey CJ, Dumbleton JS. Recruitment to a large scale randomised controlled clinical trial in primary care: the Helicobacter Eradication Aspirin Trial (HEAT). Trials 2022; 23:140. [PMID: 35164864 PMCID: PMC8842965 DOI: 10.1186/s13063-022-06054-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Helicobacter Eradication Aspirin Trial (HEAT) is a multicentre, double blind, randomised controlled trial investigating whether Helicobacter (H.) pylori eradication reduces hospitalisation for peptic ulcer bleeding. Recruited participants were aged 60 and over and taking aspirin (≤325 mg daily) for at least four months prior to consent. Based on results of a pilot study, a sample size calculation predicted 6600 H. pylori-positive randomised participants would be required, from 33,000 volunteers, recruited from 170,000 invited patients. Methodology was therefore designed for recruitment of large numbers of patients from primary care using a novel electronic search tool, automated mail-out and electronic follow-up. Recruitment started in 2012 and completed in 2017. Methods All participants were recruited from GP practices, with assistance from the UK Clinical Research Network (UKCRN). H. pylori-positive participants were randomised to one week of eradication treatment or placebo. Recruitment was managed using a bespoke web-based database that communicated directly with a programmed search tool downloaded at participating practices. The primary endpoint is hospitalisation due to peptic ulcer bleeding. The trial will end when 87 adjudicated events have occurred, identified from searches of GP databases, review of secondary care admission data and mortality data, and reported events from randomised participants and GPs. Results HEAT has recruited participants from 1208 GP practices across the UK. Of the 188,875 invitation letters sent, 38,771 returned expressions of interest. Of these, 30,166 patients were consented to the trial, of whom 5355 H. pylori-positive participants (17.8% of those consented) were randomised. Mean age at consent was 73.1 ± 6.9 (SD) years and 72.2% of participants were male. Of the randomised (H. pylori-positive) participants, 531 have died (as of 17 Sep 2020); none of the deaths was due to trial treatment. Conclusion The HEAT trial methodology has demonstrated that recruitment of large numbers of patients from primary care is attainable, with the assistance of the UKCRN, and could be applied to other clinical outcomes studies. Trial registration ClinicalTrials.gov; registration number NCT01506986. Registered on 10 Jan 2012. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06054-w.
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Vasileiou E, Shi T, Kerr S, Robertson C, Joy M, Tsang R, McGagh D, Williams J, Hobbs R, de Lusignan S, Bradley D, OReilly D, Murphy S, Chuter A, Beggs J, Ford D, Orton C, Akbari A, Bedston S, Davies G, Griffiths LJ, Griffiths R, Lowthian E, Lyons J, Lyons RA, North L, Perry M, Torabi F, Pickett J, McMenamin J, McCowan C, Agrawal U, Wood R, Stock SJ, Moore E, Henery P, Simpson CR, Sheikh A. Investigating the uptake, effectiveness and safety of COVID-19 vaccines: protocol for an observational study using linked UK national data. BMJ Open 2022; 12:e050062. [PMID: 35165107 PMCID: PMC8844955 DOI: 10.1136/bmjopen-2021-050062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The novel coronavirus SARS-CoV-2, which emerged in December 2019, has caused millions of deaths and severe illness worldwide. Numerous vaccines are currently under development of which a few have now been authorised for population-level administration by several countries. As of 20 September 2021, over 48 million people have received their first vaccine dose and over 44 million people have received their second vaccine dose across the UK. We aim to assess the uptake rates, effectiveness, and safety of all currently approved COVID-19 vaccines in the UK. METHODS AND ANALYSIS We will use prospective cohort study designs to assess vaccine uptake, effectiveness and safety against clinical outcomes and deaths. Test-negative case-control study design will be used to assess vaccine effectiveness (VE) against laboratory confirmed SARS-CoV-2 infection. Self-controlled case series and retrospective cohort study designs will be carried out to assess vaccine safety against mild-to-moderate and severe adverse events, respectively. Individual-level pseudonymised data from primary care, secondary care, laboratory test and death records will be linked and analysed in secure research environments in each UK nation. Univariate and multivariate logistic regression models will be carried out to estimate vaccine uptake levels in relation to various population characteristics. VE estimates against laboratory confirmed SARS-CoV-2 infection will be generated using a generalised additive logistic model. Time-dependent Cox models will be used to estimate the VE against clinical outcomes and deaths. The safety of the vaccines will be assessed using logistic regression models with an offset for the length of the risk period. Where possible, data will be meta-analysed across the UK nations. ETHICS AND DISSEMINATION We obtained approvals from the National Research Ethics Service Committee, Southeast Scotland 02 (12/SS/0201), the Secure Anonymised Information Linkage independent Information Governance Review Panel project number 0911. Concerning English data, University of Oxford is compliant with the General Data Protection Regulation and the National Health Service (NHS) Digital Data Security and Protection Policy. This is an approved study (Integrated Research Application ID 301740, Health Research Authority (HRA) Research Ethics Committee 21/HRA/2786). The Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub meets NHS Digital's Data Security and Protection Toolkit requirements. In Northern Ireland, the project was approved by the Honest Broker Governance Board, project number 0064. Findings will be made available to national policy-makers, presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
| | - Ting Shi
- The University of Edinburgh, Usher Institute, Edinburgh, UK
| | - Steven Kerr
- The University of Edinburgh, Usher Institute, Edinburgh, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dylan McGagh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Declan Bradley
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Dermot OReilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Siobhan Murphy
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Antony Chuter
- BREATHE - The Health Data Research Hub for Respiratory Health, London, UK
| | - Jillian Beggs
- BREATHE - The Health Data Research Hub for Respiratory Health, London, UK
| | - David Ford
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Chris Orton
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Gareth Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Lucy J Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Emily Lowthian
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Laura North
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Malorie Perry
- Vaccine Preventable Disease Programme, Public Health Wales, Cardiff, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Rachael Wood
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Public Health Scotland, Edinburgh, UK
| | - Sarah Jane Stock
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Public Health Scotland, Edinburgh, UK
| | | | - Paul Henery
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Colin R Simpson
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Wellington School of Health, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Aziz Sheikh
- The University of Edinburgh, Usher Institute, Edinburgh, UK
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A Privacy-Preserving and Standard-Based Architecture for Secondary Use of Clinical Data. INFORMATION 2022. [DOI: 10.3390/info13020087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The heterogeneity of the formats and standards of clinical data, which includes both structured, semi-structured, and unstructured data, in addition to the sensitive information contained in them, require the definition of specific approaches that are able to implement methodologies that can permit the extraction of valuable information buried under such data. Although many challenges and issues that have not been fully addressed still exist when this information must be processed and used for further purposes, the most recent techniques based on machine learning and big data analytics can support the information extraction process for the secondary use of clinical data. In particular, these techniques can facilitate the transformation of heterogeneous data into a common standard format. Moreover, they can also be exploited to define anonymization or pseudonymization approaches, respecting the privacy requirements stated in the General Data Protection Regulation, Health Insurance Portability and Accountability Act and other national and regional laws. In fact, compliance with these laws requires that only de-identified clinical and personal data can be processed for secondary analyses, in particular when data is shared or exchanged across different institutions. This work proposes a modular architecture capable of collecting clinical data from heterogeneous sources and transforming them into useful data for secondary uses, such as research, governance, and medical education purposes. The proposed architecture is able to exploit appropriate modules and algorithms, carry out transformations (pseudonymization and standardization) required to use data for the second purposes, as well as provide efficient tools to facilitate the retrieval and analysis processes. Preliminary experimental tests show good accuracy in terms of quantitative evaluations.
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228
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Harries M, Macbeth A, Holmes S, Chiu W, Gallardo W, Nijher M, de Lusignan S, Tziotzios C, Messenger A. The epidemiology of alopecia areata: a population-based cohort study in UK primary care. Br J Dermatol 2022; 186:257-265. [PMID: 34227101 PMCID: PMC9298423 DOI: 10.1111/bjd.20628] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a lack of population-based information on the disease burden and management of alopecia areata (AA). OBJECTIVES To describe the epidemiology of AA, focusing on incidence, demographics and patterns of healthcare utilization. METHODS Population-based cohort study of 4·16 million adults and children, using UK electronic primary care records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database, 2009-2018. The incidence and point prevalence of AA were estimated. Variation in AA incidence by age, sex, deprivation, geographical distribution and ethnicity was examined. Patterns of healthcare utilization were evaluated in people with incident AA. RESULTS The AA incidence rate was 0·26 per 1000 person-years. AA point prevalence in 2018 was 0·58% in adults. AA onset peaked at age 25-29 years for both sexes, although the peak was broader in females. People of nonwhite ethnicity were more likely to present with AA, especially those of Asian ethnicity [incidence rate ratio (IRR) 3·32 (95% confidence interval 3·11-3·55)]. Higher AA incidence was associated with social deprivation [IRR most vs. least deprived quintile 1·47 (1·37-1·59)] and urban living [IRR 1·23 (1·14-1·32)]. People of higher social deprivation were less likely to be referred for specialist dermatology review. CONCLUSIONS By providing the first large-scale estimates of the incidence and point prevalence of AA, our study helps to understand the burden of AA on the population. Understanding the variation in AA onset between different population groups may give insight into the pathogenesis of AA and its management.
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Affiliation(s)
- M. Harries
- The Dermatology CentreSalford Royal NHS Foundation Trust, Salford, Greater Manchester, M6 8HD UK; Centre for Dermatology ResearchUniversity of ManchesterMAHSC and NIHR Manchester Biomedical Research CentreManchesterM13 9PLUK
| | - A.E. Macbeth
- Department of DermatologyNorfolk & Norwich University Hospitals NHS Foundation TrustNorwichNR4 7UYUK
| | - S. Holmes
- Alan Lyell Centre for DermatologyQueen Elizabeth University HospitalGlasgowG51 4TFUK
| | - W.S. Chiu
- Pfizer LtdWalton Oaks, Walton on the HillTadworthSurreyKT20 7NSUK
| | - W.R. Gallardo
- Pfizer LtdWalton Oaks, Walton on the HillTadworthSurreyKT20 7NSUK
| | - M. Nijher
- Pfizer LtdWalton Oaks, Walton on the HillTadworthSurreyKT20 7NSUK
| | - S. de Lusignan
- Department of Primary Care Health SciencesUniversity of Oxford, OX2 6GG, UK; Oxford‐Royal College of General Practitioners, Research and Surveillance CentreLondonNW1 2FBUK
| | - C. Tziotzios
- St John’s Institute of DermatologyGuy’s and St Thomas’ Hospitals & King’s College LondonLondonSE1 9RTUK
| | - A.G. Messenger
- Department of DermatologyRoyal Hallamshire HospitalSheffieldS10 2JFUK
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Teleorthodontics: Where Are We Going? From Skepticism to the Clinical Applications of a New Medical Communication and Management System. Int J Dent 2022; 2022:7301576. [PMID: 35154324 PMCID: PMC8825573 DOI: 10.1155/2022/7301576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Teleorthodontics represents the orthodontic care system involving remote management of orthodontic treatment. Despite skepticism, there are several advantages of including teleorthodontics in the clinical orthodontic practice. In the present review, we discuss the lights and shadows of this new communication healthcare system and its applications in the field of orthodontics that is destined to change the future of our clinical practice. For this purpose, we have provided a point-to-point analysis based on data from the most valuable scientific evidence on this topic. The information and data discussed in the present paper were obtained from the most relevant studies evaluating the performance of teleorthodontics and remote monitoring systems in clinical practice.
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Brossard PY, Minvielle E, Sicotte C. The path from big data analytics capabilities to value in hospitals: a scoping review. BMC Health Serv Res 2022; 22:134. [PMID: 35101026 PMCID: PMC8805378 DOI: 10.1186/s12913-021-07332-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/23/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As the uptake of health information technologies increased, most healthcare organizations have become producers of big data. A growing number of hospitals are investing in the development of big data analytics (BDA) capabilities. If the promises associated with these capabilities are high, how hospitals create value from it remains unclear. The present study undertakes a scoping review of existing research on BDA use in hospitals to describe the path from BDA capabilities (BDAC) to value and its associated challenges. METHODS This scoping review was conducted following Arksey and O'Malley's 5 stages framework. A systematic search strategy was adopted to identify relevant articles in Scopus and Web of Science. Data charting and extraction were performed following an analytical framework that builds on the resource-based view of the firm to describe the path from BDA capabilities to value in hospitals. RESULTS Of 1,478 articles identified, 94 were included. Most of them are experimental research (n=69) published in medical (n=66) or computer science journals (n=28). The main value targets associated with the use of BDA are improving the quality of decision-making (n=56) and driving innovation (n=52) which apply mainly to care (n=67) and administrative (n=48) activities. To reach these targets, hospitals need to adequately combine BDA capabilities and value creation mechanisms (VCM) to enable knowledge generation and drive its assimilation. Benefits are endpoints of the value creation process. They are expected in all articles but realized in a few instances only (n=19). CONCLUSIONS This review confirms the value creation potential of BDA solutions in hospitals. It also shows the organizational challenges that prevent hospitals from generating actual benefits from BDAC-building efforts. The configuring of strategies, technologies and organizational capabilities underlying the development of value-creating BDA solutions should become a priority area for research, with focus on the mechanisms that can drive the alignment of BDA and organizational strategies, and the development of organizational capabilities to support knowledge generation and assimilation.
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Affiliation(s)
- Pierre-Yves Brossard
- Arènes (CNRS UMR 6051), Institut du Management, Chaire Prospective en Santé, École des Hautes Études en Santé Publique, Rennes, France
| | - Etienne Minvielle
- i3-Centre de Recherche en Gestion, Institut Interdisciplinaire de l’Innovation (UMR 9217), École polytechnique, Palaiseau, France
- Institut Gustave Roussy, Patient Pathway Department, Villejuif, France
| | - Claude Sicotte
- Arènes (CNRS UMR 6051), Institut du Management, Chaire Prospective en Santé, École des Hautes Études en Santé Publique, Rennes, France
- Department of Health Management, Evaluation and Policy, University of Montreal, Quebec, Canada
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231
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Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study. BMC Pregnancy Childbirth 2022; 22:73. [PMID: 35086478 PMCID: PMC8793222 DOI: 10.1186/s12884-021-04351-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Valproate is a teratogenic drug that should be avoided during the preconception period and pregnancy. The aim was to explore general practitioners’ (GPs) prescription patterns over time, describe trends, and explore inter-practice variation within primary care. Methods We identified women of childbearing age (12–46 years old) in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network. We performed repeated cross-sectional analyses from 2004 to 2018 to determine rates of prescription and a retrospective cohort estimated the prevalence of use of valproate during pregnancy. Results In 2004, 0.31% (95% Confidence Interval (95%CI):0.18 to 0.44%) women were prescribed valproate, decreasing to 0.16% (95%CI:0.07 to 0.24%) by 2018. Among women with epilepsy, the rate fell from 15.2% (95%CI:14.4 to 16.0%) to 8.8% (95% CI:8.2 to 9.7%) over the same period. In 2018, almost two thirds (62.2%) of women who were prescribed valproate had epilepsy only, whereas bipolar disorder and migraine accounted for 15.8% and 7.4% respectively. Contraceptive prescriptions did not increase over time, and only in 2018 was there greater odds of being prescribed contraception (OR 1.41, 95%CI:1.08 to 1.45). Just under a fifth (19.7%) of women were prescribed valproate during their pregnancy; two out of three of these pregnancies were preceded by folic acid prescription (5 mg). While some practices reduced their rate of valproate prescription, others did not. Conclusions Regulatory guidelines have changed GPs' prescription patterns in women of childbearing potential for valproate but not for contraception. Further research is needed to identify the barriers of GPs and women of childbearing potential to undertaking contraception. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04351-x.
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Martini N, Broadbent E, Koo J, Lam L, Verches D, Zeng S, Montgomery-Walsh R, Sutherland C. Investigating the Usability, Efficacy and Accuracy of a Medication Entering Software System for a Healthcare Robot. Front Robot AI 2022; 9:814268. [PMID: 35146001 PMCID: PMC8821944 DOI: 10.3389/frobt.2022.814268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: This research aimed to evaluate medication software for a healthcare robot. Study I compared two software versions (RoboGen and RoboGen2) for system usability, speed and accuracy of medication entry; Study II evaluated system usability and community pharmacists’ views of RoboGen2. Methods: Study I had a within-subjects experimental design and recruited 40 Health Sciences students to enter different, comparable sets of prescriptions into the two systems, in randomized order, within a limit of 15 min. Screen activity was recorded to observe prescription errors. Study II had a cross-sectional observational design and recruited 20 community pharmacists using convenience sampling. Pharmacists entered three prescriptions using RoboGen2. Participants in both studies completed the System Usability Scale (SUS) following each task. Study I participants completed a questionnaire on system preference, and Study II participants a semi-structured interview. Results: Study I participants preferred Robogen2 (p < 0.001) due to its sleek and modern layout, good flow, ease of use, and intuitive design. SUS scores [t (40) = −3.40, p = 0.002] and speed of medication entry favored Robogen2 (t = 3.65, p < 0.001). No significance was found in accuracy (t = 1.12, p = 0.27). In study 2, pharmacists rated the usability of RoboGen2 below average. Themes from interviews were navigation and streamlining the system, ease of use, and integration with pharmacy software systems. Conclusion: Adding safety features and better aesthetics can improve the usability and safety of a medication prescription system. Streamlining workflow and pre-populating data can increase speed of prescription entry without compromising patient safety. However, a better approach is integration with pre-existing pharmacy systems to reduce workload while incorporating safety features built into existing dispensing systems.
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Affiliation(s)
- Nataly Martini
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- *Correspondence: Nataly Martini,
| | - Elizabeth Broadbent
- School of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jasmine Koo
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Laurence Lam
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Diane Verches
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sophie Zeng
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rhea Montgomery-Walsh
- School of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Craig Sutherland
- Department of Electrical, Computer and Software Engineering, Faculty of Engineering, University of Auckland, Auckland, New Zealand
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O'Sullivan B, Couch D, Naik I. Using Mobile Phone Apps to Deliver Rural General Practitioner Services: Critical Review Using the Walkthrough Method. JMIR Form Res 2022; 6:e30387. [PMID: 35076401 PMCID: PMC8826308 DOI: 10.2196/30387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/31/2021] [Accepted: 12/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background The widespread use of mobile phones represents new frontiers for improving access to health care. This includes using mobile apps to deliver general practitioner (GP) services in rural areas. However, the wider adoption of apps for increasing access to rural GP services relies on understanding how they might intersect with the rural health system context. Objective This research aims to critically review mobile apps for delivering GP services in a rural health service context using the walkthrough method. Methods The sample comprised 3 GP service apps under the top 100 list in the medical category in the Apple App Store (also available via the Google Play Store) in Australia as of June 2020. The walkthrough method was applied to extract data and critique the explicit factors, such as the app interface elements, and implicit factors, such as the embedded cultural features related to use for people in rural settings. Data analysis was undertaken between 3 researchers over 6 months applying the walkthrough method and using critical reflection. Results There were 3 main themes: improving rural access, addressing rural health care needs, and providing quality of care. App-based GP services may improve rural GP service availability. However, this may be at a relatively superficial level that does not encompass the scope and intensity of the services needed in rural areas (including relevant chronic and emergency care) at a cost that rural patients can afford. The apps showed signs of limited tailoring to the cultural dimensions of rural health care as a barrier to rural use. Patients generally self-selected to use GP service apps with limited support, potentially leading to inappropriate uptake especially by disadvantaged groups with lower health literacy. Although the apps claimed to avail most GP services (70%-80% in some cases), it emerged after enrollment that emergency, complex, and serious conditions might be excluded, potentially imposing more complex caseloads on in-person rural GPs. Apps provided limited information about continuity and coordination of care and sharing information with rural GPs, potentially leading to fragmented and low-quality care. There was commonly no assurance of rural skills and experience of physicians staffing apps despite the wider scope of skills needed to be effective in rural general practice. Conclusions GP apps may increase the availability of GP services, but they may require clearer exclusions, appropriate use through decision-making tools, more rural-tailored interfaces, and capacity to align appointment times and costs with patients with complex needs to engage and be useful in a rural context. It is also important to consider how these app-based services could share information with local health care staff for safety and continuity of rural primary care. Finally, information about the physicians’ rural training and experience is critical for quality.
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Affiliation(s)
- Belinda O'Sullivan
- The Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba, Australia.,General Practice Supervisors Australia, Bendigo, Australia.,Monash University School of Rural Health, Bendigo, Australia
| | - Danielle Couch
- Monash University School of Rural Health, Bendigo, Australia.,Bendigo District Aboriginal Cooperative, North Bendigo, Australia
| | - Ishani Naik
- University of Queensland Medical School, Brisbane, Australia
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Fiedler J, Pruskil S, Wiessner C, Zimmermann T, Scherer M. Remote interpreting in primary care settings: a feasibility trial in Germany. BMC Health Serv Res 2022; 22:99. [PMID: 35073890 PMCID: PMC8785004 DOI: 10.1186/s12913-021-07372-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global migration trends have led to a more diverse population in health care services everywhere, which in turn has set off a paradigm shift away from medical paternalism toward more patient autonomy. Consequently, physicians need to provide a more precise patient-centred healthcare. Professional interpreting appears to play a crucial part in tackling the challenges of language barriers adequately. The aim of this study was to conduct process evaluation through the implementing of video remote interpreting (VR) and telephone remote interpreting (TR) within primary care facilities in the northern German metropolis of Hamburg. METHODS We conducted a three-armed exploratory pilot trial, which compared VR to TR and to a control group (CG) in different primary care settings. We assessed feasibility of implementation, as well as the acceptance of interpreting tools among their users. In addition, we compared the quality of communication as perceived by patients and physicians, as well as the enabling of patient-centred medicine over all three study groups using quantitative questionnaires. RESULTS 13 practices (7 GPs, 3 Gynaecologists, 3 Paediatricians) took part in this trial. 183 interpreting calls were documented, 178 physicians as well as 127 patients answered their respective questionnaires. The implementation of the VR- und TR-tools went smoothly and they were broadly accepted by their users. However, the tools were used significantly less often than we had anticipated. With regards to quantitative questionnaires, VR scored significantly better than the control group in terms of the perceived quality of communication by both, patients and physicians and enabled of patient-centred medicine. CONCLUSION Our main findings were the discrepancy between the assumed high demand of professional interpreting solutions on the one hand and the low willingness of practices to participate on the other. The rather low utilisation rates were also noteworthy. This discrepancy indicates a lack of awareness concerning the adverse effects of using informal or no interpreter in medical settings, which needs to be rectified. Due to the small sample size, all statistical results must be viewed with caution. However, our results show that remote interpreting represents a promising approach to tackling language barriers in primary care settings.
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Affiliation(s)
- Jonas Fiedler
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Pruskil
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Public health department, Altona, Hamburg, Germany.
| | - Christian Wiessner
- Centre for Experimental Medicine, Department of Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Recommendations for the Development of Telemedicine in Poland Based on the Analysis of Barriers and Selected Telemedicine Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031221. [PMID: 35162248 PMCID: PMC8835106 DOI: 10.3390/ijerph19031221] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/04/2023]
Abstract
Technological development around the world has led to the digitalisation of the health system. Along with the digitalisation of the health sector, financial, legal, awareness-related, technological and IT barriers appeared. The aim of the article is to present recommendations for the development of telemedicine services in Poland on the basis of a list of implementation barriers and ways of resolving them in the USA and selected European countries. A literature review was conducted in accordance with the PRISMA-ScR, using the PubMed and Google Scholar databases, Scopus and the OECD iLibrary. A total of 59 literature positions were used, which constituted the references. The article presented the implemented and effective solutions in selected countries. Based on these solutions, recommendations for the development of telemedicine in Poland were presented, as well as successes in the form of telemedicine startups, which can inspire other countries. The analysis of the publications discussed in the article shows that the implementation of telemedicine services should begin with the elimination of barriers limiting the development of telemedicine systems. An important issue in their elimination is to analyse their interconnections and implement such solutions which would have a multi-area coverage.
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236
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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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Aldughayfiq B, Sampalli S. Patients', pharmacists', and prescribers' attitude toward using blockchain and machine learning in a proposed ePrescription system: online survey. JAMIA Open 2022; 5:ooab115. [PMID: 35028528 PMCID: PMC8752039 DOI: 10.1093/jamiaopen/ooab115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/28/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the attitudes of the parties involved in the system toward the new features and measure the potential benefits of introducing the use of blockchain and machine learning (ML) to strengthen the in-place methods for safely prescribing medication. The proposed blockchain will strengthen the security and privacy of the patient’s prescription information shared in the network. Once the ePrescription is submitted, it is only available in read-only mode. This will ensure there is no alteration to the ePrescription information after submission. In addition, the blockchain will provide an improved tracking mechanism to ensure the originality of the ePrescription and that a prescriber can only submit an ePrescription with the patient’s authorization. Lastly, before submitting an ePrescription, an ML algorithm will be used to detect any anomalies (eg, missing fields, misplaced information, or wrong dosage) in the ePrescription to ensure the safety of the prescribed medication for the patient. Methods The survey contains questions about the features introduced in the proposed ePrescription system to evaluate the security, privacy, reliability, and availability of the ePrescription information in the system. The study population is comprised of 284 respondents in the patient group, 39 respondents in the pharmacist group, and 27 respondents in the prescriber group, all of whom met the inclusion criteria. The response rate was 80% (226/284) in the patient group, 87% (34/39) in the pharmacist group, and 96% (26/27) in the prescriber group. Key Findings The vast majority of the respondents in all groups had a positive attitude toward the proposed ePrescription system’s security and privacy using blockchain technology, with 72% (163/226) in the patient group, 70.5% (24/34) in the pharmacist group, and 73% (19/26) in the prescriber group. Moreover, the majority of the respondents in the pharmacist (70%, 24/34) and prescriber (85%, 22/26) groups had a positive attitude toward using ML algorithms to generate alerts regarding prescribed medication to enhance the safety of medication prescribing and prevent medication errors. Conclusion Our survey showed that a vast majority of respondents in all groups had positive attitudes toward using blockchain and ML algorithms to safely prescribe medications. However, a need for minor improvements regarding the proposed features was identified, and a post-implementation user study is needed to evaluate the proposed ePrescription system in depth.
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Fogg C, Fraser SDS, Roderick P, de Lusignan S, Clegg A, Brailsford S, Barkham A, Patel HP, Windle V, Harris S, Zhu S, England T, Evenden D, Lambert F, Walsh B. The dynamics of frailty development and progression in older adults in primary care in England (2006-2017): a retrospective cohort profile. BMC Geriatr 2022; 22:30. [PMID: 34991479 PMCID: PMC8740419 DOI: 10.1186/s12877-021-02684-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty is a common condition in older adults and has a major impact on patient outcomes and service use. Information on the prevalence in middle-aged adults and the patterns of progression of frailty at an individual and population level is scarce. To address this, a cohort was defined from a large primary care database in England to describe the epidemiology of frailty and understand the dynamics of frailty within individuals and across the population. This article describes the structure of the dataset, cohort characteristics and planned analyses. METHODS Retrospective cohort study using electronic health records. Participants were aged ≥50 years registered in practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre between 2006 to 2017. Data include GP practice details, patient sociodemographic and clinical characteristics, twice-yearly electronic Frailty Index (eFI), deaths, medication use and primary and secondary care health service use. Participants in each cohort year by age group, GP and patient characteristics at cohort entry are described. RESULTS The cohort includes 2,177,656 patients, contributing 15,552,946 person-years, registered at 419 primary care practices in England. The mean age was 61 years, 52.1% of the cohort was female, and 77.6% lived in urban environments. Frailty increased with age, affecting 10% of adults aged 50-64 and 43.7% of adults aged ≥65. The prevalence of long-term conditions and specific frailty deficits increased with age, as did the eFI and the severity of frailty categories. CONCLUSION A comprehensive understanding of frailty dynamics will inform predictions of current and future care needs to facilitate timely planning of appropriate interventions, service configurations and workforce requirements. Analysis of this large, nationally representative cohort including participants aged ≥50 will capture earlier transitions to frailty and enable a detailed understanding of progression and impact. These results will inform novel simulation models which predict future health and service needs of older people living with frailty. STUDY REGISTRATION Registered on www.clinicaltrials.gov October 25th 2019, NCT04139278 .
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Affiliation(s)
- Carole Fogg
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Simon D S Fraser
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Paul Roderick
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Road, Oxford, OX2 6ED, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30, Euston Square, London, NW1 2FB, UK
| | - Andrew Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Abigail Barkham
- Southern Health NHS Foundation Trust, Unit 1 Wessex Way, Colden Common, Winchester, SO21 1WP, UK
| | - Harnish P Patel
- Medicine for Older People, University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Vivienne Windle
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Scott Harris
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Shihua Zhu
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Tracey England
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Dave Evenden
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Francesca Lambert
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Bronagh Walsh
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
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Ren C, Li M, Zheng Y, Cai B, Du W, Zhang H, Wu F, Tong M, Lin F, Wang J, Quan R. Single-cell RNA-seq reveals altered NK cell subsets and reduced levels of cytotoxic molecules in patients with ankylosing spondylitis. J Cell Mol Med 2022; 26:1071-1082. [PMID: 34994057 PMCID: PMC8831943 DOI: 10.1111/jcmm.17159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 01/04/2023] Open
Abstract
Ankylosing spondylitis (AS) is an autoimmune disease with unknown aetiology. To unravel the mechanisms mediating AS pathogenesis, we profiled peripheral blood mononuclear cells (PBMCs) from AS patients and healthy subjects using 10X single-cell RNA sequencing. The frequencies of immune cell subsets were evaluated by flow cytometry. NK cells were purified from PBMCs using isolation kit and were examined for gene expression by RT-qPCR. Plasma levels of cytolytic molecules were examined by enzyme-linked immunosorbent assay. Compared to healthy controls, AS patients showed a significant decrease in total NK cells as well as CD56dim NK subset, whereas CD56bright NK cells were increased. Additionally, impaired expression of cytotoxic genes in NK cells of AS patients was observed by bioinformatics algorithm and verified by RT-qPCR and flow cytometry. Consistent with changes in transcriptomics, we found decreased plasma levels of granzymes, but not granulysin, in AS patients. Furthermore, Pearson correlation analysis revealed a negative correlation between plasma GZMB levels and disease activity (r = -0.5275, p = 0.0358). No correlation was observed between plasma cytolytic molecules and biochemical indexes (ESR and CRP). Our findings uncover altered NK cell subsets and cytotoxic profiles in peripheral circulation of AS patients at single-cell resolution.
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Affiliation(s)
- Conglin Ren
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mingshuang Li
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yang Zheng
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bingbing Cai
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Department of Orthopedics, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Weibin Du
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Department of Orthopedics, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Helou Zhang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fengqing Wu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengsha Tong
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fu Lin
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jinfu Wang
- Institute of Cell and Development Biology, College of Life Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Renfu Quan
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Department of Orthopedics, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
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Geospatial epidemiology of Toxoplasma gondii infection in livestock, pets, and humans in China, 1984-2020. Parasitol Res 2022; 121:743-750. [PMID: 34988670 DOI: 10.1007/s00436-021-07415-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/19/2021] [Indexed: 12/22/2022]
Abstract
Undercooked or raw meat containing cyst-stage bradyzoites and oocyst-contaminated pets are presumed to constitute a major source of human toxoplasmosis. As the geospatial epidemiology of Toxoplasma gondii (T. gondii) infection in livestock, pets, and humans is rarely studied in China, we undertook a geospatial analysis using GIS visualization techniques. The present study retrieved information from the PubMed, China National Knowledge Infrastructure, and Baidu Scholar databases from 1984 up to 2020. All the data about the seroprevalence of T. gondii in livestock (sheep and goats, pigs, cattle and yaks), pets (cats, dogs), and humans in China were collected. Geospatial epidemiology of T. gondii infection in these hosts was performed using GIS. Results revealed that the estimated pooled seroprevalence of T. gondii was ranged from 3.98 to 43.02% in sheep and goats in China, 0.75 to 30.34% in cattle and yaks, 10.45 to 66.47% in pigs, 2.50 to 60.00% in cats, 0.56 to 27.65% in dogs, and 0.72 to 23.41% in humans. The higher seroprevalences of T. gondii were observed in sheep and goats in the districts of Chongqing, Zhejiang, and Beijing. The infection rates of T. gondii in cattle and yaks were higher in Guizhou, Zhejiang, and Chongqing. Also, the pigs from Chongqing and Guizhou were most severely infected with T. gondii. For cats, the districts of Shanxi, Hebei, and Yunnan had higher seroprevalences of T. gondii and, the infections among dogs were higher in Yunnan and Hebei as well. Furthermore, higher infection pressure of T. gondii exists in the districts of Taiwan and Tibet in humans. The geographical and spatial distribution of toxoplasmosis indicated that infection with T. gondii was widely spread in China, with a wide range of variations among the different hosts and regions in the country. Our results suggested that livestock and pets are not only a reservoir for the parasite but also a direct source of T. gondii infection for humans. It is important to control T. gondii infections in these animals that would reduce the risk of toxoplasmosis in humans.
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Telehealth in rheumatology: the 2021 Arab League of Rheumatology Best Practice Guidelines. Rheumatol Int 2022; 42:379-390. [PMID: 34993578 PMCID: PMC8735733 DOI: 10.1007/s00296-021-05078-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
To develop Best Practice Guidelines (BPG) for the use of Telehealth in Rheumatology in the Arab region, to identify the main barriers and facilitators of telehealth, and to provide rheumatologists with a practical toolkit for the implementation of telehealth. Guidelines were drafted by a core steering committee from the Arab League of Associations for Rheumatology (ArLAR) after performing a literature search. A multidisciplinary task force (TF), including 18 rheumatologists, 2 patients, and 2 regulators from 15 Arab countries, assessed the BPG using 3 rounds of anonymous online voting by modified Delphi process. The statements were included in the final BPG without further voting if ≥ 80% of TF members indicated high agreement. The voting on barriers and facilitators was performed through one voting round. The toolkit was developed based on available literature and discussions during the Delphi rounds. Four General Principles and twelve Statements were formulated. A teleconsultation was specifically defined for the purpose of these guidelines. The concept of choice in telehealth was highlighted, emphasizing patient confidentiality, medical information security, rheumatologist's clinical judgment, and local jurisdictional regulations. The top barrier for telehealth was the concern about the quality of care. The toolkit emphasized technical aspects of teleconsultation and proposed a triage system. The ArLAR BPG provide rheumatologists with a series of strategies about the most reliable, productive, and rational approaches to apply telehealth.
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Costa SD, Barcellos MP, Falbo RDA, Conte T, Oliveira KMD. A core ontology on the Human-Computer Interaction phenomenon. DATA KNOWL ENG 2022. [DOI: 10.1016/j.datak.2021.101977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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243
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Valentine S, Cunningham AC, Klasmer B, Dabbah M, Balabanovic M, Aral M, Vahdat D, Plans D. Smartphone movement sensors for the remote monitoring of respiratory rates: Technical validation. Digit Health 2022; 8:20552076221089090. [PMID: 35493956 PMCID: PMC9052820 DOI: 10.1177/20552076221089090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mobile health (mHealth) offers potential benefits to both patients and
healthcare systems. Existing remote technologies to measure respiratory
rates have limitations such as cost, accessibility and reliability. Using
smartphone sensors to measure respiratory rates may offer a potential
solution to these issues. Objective The aim of this study was to conduct a comprehensive assessment of a novel
mHealth smartphone application designed to measure respiratory rates using
movement sensors. Methods In Study 1, 15 participants simultaneously measured their respiratory rates
with the app and a Food and Drug Administration-cleared reference device. A
novel reference analysis method to allow the app to be evaluated ‘in the
wild’ was also developed. In Study 2, 165 participants measured their
respiratory rates using the app, and these measures were compared to the
novel reference. The usability of the app was also assessed in both
studies. Results The app, when compared to the Food and Drug Administration-cleared and novel
references, respectively, showed a mean absolute error of 1.65
(SD = 1.49) and 1.14 (1.44), relative mean absolute
error of 12.2 (9.23) and 9.5 (18.70) and bias of 0.81 (limits of
agreement = –3.27 to 4.89) and 0.08 (–3.68 to 3.51). Pearson correlation
coefficients were 0.700 and 0.885. Ninety-three percent of participants
successfully operated the app on their first use. Conclusions The accuracy and usability of the app demonstrated here in individuals with a
normal respiratory rate range show promise for the use of mHealth solutions
employing smartphone sensors to remotely monitor respiratory rates. Further
research should validate the benefits that this technology may offer
patients and healthcare systems.
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244
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Seneviratne S, Desloge A, Haregu T, Kwasnicka D, Kasturiratne A, Mandla A, Chambers J, Oldenburg B. Characteristics and Outcomes of Community Health Worker Training to Improve the Prevention and Control of Cardiometabolic Diseases in Low and Middle-Income Countries: A Systematic Review. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221112834. [PMID: 35916447 PMCID: PMC9350494 DOI: 10.1177/00469580221112834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Community health workers (CHWs) play an important role in controlling
non-communicable diseases in low- and middle-income countries. The aim of this
review was to describe the characteristics and outcomes of CHW training programs
that focused on the prevention and control of cardiometabolic diseases in low-
and middle-income countries (LMICs). Medline, CINAHL Complete, Academic Search
Complete, Directory of Open Access Journal, ScienceDirect, ERIC, Gale Academic,
and OneFile). Studies that described the training programs used to train CHWs
for prevention and control of cardiovascular diseases and type2 diabetes
mellitus in LMICs. Only studies that evaluated the outcomes of training programs
in at least one of the 4 levels of Kirkpatrick’s training evaluation model were
included in the review. CHWs who underwent training focused on the prevention
and control of cardiovascular disease and type 2 diabetes mellitus. We
summarized the resulting evidence using qualitative synthesis through a
narrative review. Training outcomes were assessed in relation to (1) CHW
reactions to training, their degree of learning, and their behaviors following
training, and (2) changes in biochemical and anthropometric indicators in target
populations following the CHW program implementation. PROSPERO (CRD42020162116).
Thirty-two studies were included. Methods used to train CHWs included:
face-to-face lectures, interactive group activities, and blended teaching with
online support. Training focused on identifying people with elevated risk of
cardiometabolic diseases and their risk factors as well as supporting people to
adopt healthy lifestyles. Many studies that utilized trained CHWs did not
publish CHW training methods and evaluations, and therefore could not be
included in this study. Training programs resulted in an increase in knowledge
and skills among CHWs demonstrating that there are certain activities that can
be shifted to CHWs following training.
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Affiliation(s)
- Shilanthi Seneviratne
- Ministry of Health, Colombo, Sri Lanka
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Dominika Kwasnicka
- University of Melbourne, Melbourne, VIC, Australia
- SWPS University of Social Sciences and Humanities, Poland
| | | | | | - John Chambers
- Nanyang Technological University (Singapore) and Imperial College London, London, UK
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Joseph N, Lindblad I, Zaker S, Elfversson S, Albinzon M, Ødegård Ø, Hantler L, Hellström PM. Automated data extraction of electronic medical records: Validity of data mining to construct research databases for eligibility in gastroenterological clinical trials. Ups J Med Sci 2022; 127:8260. [PMID: 35173908 PMCID: PMC8809051 DOI: 10.48101/ujms.v127.8260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 10/03/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Electronic medical records (EMRs) are adopted for storing patient-related healthcare information. Using data mining techniques, it is possible to make use of and derive benefit from this massive amount of data effectively. We aimed to evaluate validity of data extracted by the Customized eXtraction Program (CXP). METHODS The CXP extracts and structures data in rapid standardised processes. The CXP was programmed to extract TNFα-native active ulcerative colitis (UC) patients from EMRs using defined International Classification of Disease-10 (ICD-10) codes. Extracted data were read in parallel with manual assessment of the EMR to compare with CXP-extracted data. RESULTS From the complete EMR set, 2,802 patients with code K51 (UC) were extracted. Then, CXP extracted 332 patients according to inclusion and exclusion criteria. Of these, 97.5% were correctly identified, resulting in a final set of 320 cases eligible for the study. When comparing CXP-extracted data against manually assessed EMRs, the recovery rate was 95.6-101.1% over the years with 96.1% weighted average sensitivity. CONCLUSION Utilisation of the CXP software can be considered as an effective way to extract relevant EMR data without significant errors. Hence, by extracting from EMRs, CXP accurately identifies patients and has the capacity to facilitate research studies and clinical trials by finding patients with the requested code as well as funnel down itemised individuals according to specified inclusion and exclusion criteria. Beyond this, medical procedures and laboratory data can rapidly be retrieved from the EMRs to create tailored databases of extracted material for immediate use in clinical trials.
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Affiliation(s)
- Nora Joseph
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University, Uppsala
| | | | - Sara Zaker
- IQVIA Sweden AB, Solna, Stockholm, Sweden
| | | | | | | | - Li Hantler
- IQVIA Sweden AB, Solna, Stockholm, Sweden
| | - Per M. Hellström
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University, Uppsala
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Iyamu I, Gómez-Ramírez O, Xu AXT, Chang HJ, Watt S, Mckee G, Gilbert M. Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review. Digit Health 2022; 8:20552076221102255. [PMID: 35656283 PMCID: PMC9152201 DOI: 10.1177/20552076221102255] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background “Digital public health” has emerged from an interest in integrating digital technologies into public health. However, significant challenges which limit the scale and extent of this digital integration in various public health domains have been described. We summarized the literature about these challenges and identified strategies to overcome them. Methods We adopted Arksey and O’Malley's framework (2005) integrating adaptations by Levac et al. (2010). OVID Medline, Embase, Google Scholar, and 14 government and intergovernmental agency websites were searched using terms related to “digital” and “public health.” We included conceptual and explicit descriptions of digital technologies in public health published in English between 2000 and June 2020. We excluded primary research articles about digital health interventions. Data were extracted using a codebook created using the European Public Health Association's conceptual framework for digital public health. Results and analysis Overall, 163 publications were included from 6953 retrieved articles with the majority (64%, n = 105) published between 2015 and June 2020. Nontechnical challenges to digital integration in public health concerned ethics, policy and governance, health equity, resource gaps, and quality of evidence. Technical challenges included fragmented and unsustainable systems, lack of clear standards, unreliability of available data, infrastructure gaps, and workforce capacity gaps. Identified strategies included securing political commitment, intersectoral collaboration, economic investments, standardized ethical, legal, and regulatory frameworks, adaptive research and evaluation, health workforce capacity building, and transparent communication and public engagement. Conclusion Developing and implementing digital public health interventions requires efforts that leverage identified strategies to overcome diverse challenges encountered in integrating digital technologies in public health.
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Affiliation(s)
- Ihoghosa Iyamu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Oralia Gómez-Ramírez
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Alice XT Xu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hsiu-Ju Chang
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Sarah Watt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Geoff Mckee
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
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Brown R, Coventry L, Sillence E, Blythe J, Stumpf S, Bird J, Durrant AC. Collecting and sharing self-generated health and lifestyle data: Understanding barriers for people living with long-term health conditions - a survey study. Digit Health 2022; 8:20552076221084458. [PMID: 35284085 PMCID: PMC8905063 DOI: 10.1177/20552076221084458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background The growing popularity of collecting self-generated health and lifestyle data presents a valuable opportunity to develop our understanding of long-term health conditions and improve care. Barriers remain to the effective sharing of health and lifestyle data by those living with long-term health conditions which include beliefs around concepts of Trust, Identity, Privacy and Security, experiences of stigma, perceptions of risk and information sensitivity. Method We surveyed 250 UK adults who reported living with a range of long-term health conditions. We recorded data to assess self-reported behaviours, experiences, attitudes and motivations relevant to sharing self-generated health and lifestyle data. We also asked participants about their beliefs about Trust, Identity, Privacy and Security, stigma, and perceptions of risk and information sensitivity regarding their health and lifestyle data. Results Three-quarters of our sample reported recording information about their health and lifestyle on a daily basis. However, two-thirds reported never or rarely sharing this information with others. Trust, Identity, Privacy and Security concerns were considered to be ‘very important’ by those with long-term health conditions when deciding whether or not to share self-generated health and lifestyle data with others, with security concerns considered most important. Of those living with a long-term health condition, 58% reported experiencing stigma associated with their condition. The greatest perceived risk from sharing with others was the potential for future harm to their social relationships. Conclusions Our findings suggest that, in order for health professionals and researchers to benefit from the increased prevalence of self-generated health and lifestyle data, more can be done to address security concerns and to understand perceived risks associated with data sharing. Digital platforms aimed at facilitating the sharing of self-generated health and lifestyle data may look to highlight security features, enable users to control the sharing of certain information types, and emphasise the practical benefits to users of sharing health and lifestyle data with others.
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Affiliation(s)
- Richard Brown
- Psychology Department, Northumbria University, Newcastle, UK
| | - Lynne Coventry
- Psychology Department, Northumbria University, Newcastle, UK
| | | | | | - Simone Stumpf
- Department of Computer Science, City University of London, UK
| | - Jon Bird
- Department of Computer Science, University of Bristol, UK
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van Pinxteren M, Colvin CJ, Cooper S. Using health information for community activism: A case study of the movement for change and social justice in South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000664. [PMID: 36962538 PMCID: PMC10022230 DOI: 10.1371/journal.pgph.0000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
The access to, use, and exchange of health information is crucial when strengthening public health services and improving access to care. However, many health system stakeholders, including community groups are perpetually excluded from accessing and using health information. This is problematic as community groups, themselves end-users of care, are well-positioned to keep the health system accountable, provide feedback on the quality of services, and identify emerging health concerns. Using qualitative, ethnographic methods, this paper investigates different strategies used by the Movement for Change and Social Justice (MCSJ)-a local health activism group-to collect, use and distribute health information to improve health care in Gugulethu, a low-income neighbourhood in Cape Town, South Africa. Through participant observation, shadowing, informal conversations and semi-structured interviews that were analysed using iterative thematic analysis, findings revealed that MCSJ effectively collected, used and exchanged health information to develop short-term health campaigns. To get access to the needed health information, they used innovative strategies, including cultivating allies in the health system, finding safe spaces, and using community brokers to effectively mobilise community members to keep the health system accountable. MCSJ's strategies highlight that stakeholders' engagement with health information is not only a technical exercise, but a complex social process that requires constant negotiation and relationship building. Therefore, to make meaningful improvements to health services and create adaptive and responsive health systems, we need to include community groups as active stakeholders in the health system, provide relevant, up-to-date and locally relevant health information, and facilitate opportunities to socially engage with health information and those who produce it.
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Affiliation(s)
- Myrna van Pinxteren
- Department of Medicine, Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Harron K. Data linkage in medical research. BMJ MEDICINE 2022; 1:e000087. [PMID: 36936588 PMCID: PMC9951373 DOI: 10.1136/bmjmed-2021-000087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Katie Harron
- UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
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250
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Pomare C, Mahmoud Z, Vedovi A, Ellis LA, Knaggs G, Smith CL, Zurynski Y, Braithwaite J. Learning health systems: A review of key topic areas and bibliometric trends. Learn Health Syst 2022; 6:e10265. [PMID: 35036549 PMCID: PMC8753300 DOI: 10.1002/lrh2.10265] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The emergent field of learning health systems (LHSs) has been rapidly evolving as the concept continues to be embraced by researchers, managers, and clinicians. This paper reports on a scoping review and bibliometric analysis of the LHS literature to identify key topic areas and examine the influence and spread of recent research. METHODS We conducted a scoping review of LHS literature published between January 2016 and May 2020. The authors extracted publication data (eg, journal, country, authors, citation count, keywords) and reviewed full-texts to identify: type of study (empirical, non-empirical, or review), degree of focus (general or specific), and the reference used when defining LHSs. RESULTS A total of 272 publications were included in this review. Almost two thirds (65.1%) of the included articles were non-empirical and over two-thirds (68.4%) were from authors in the United States. More than half of the publications focused on specific areas, for example: oncology, cardiovascular care, and genomic medicine. Other key topic areas included: ethics, research, quality improvement, and electronic health records. We identified that definitions of the LHS concept are converging; however, many papers focused on data platforms and analytical processes rather than organisational and behavioural factors to support change and learning activities. CONCLUSIONS The literature on LHSs remains largely theoretical with definitions of LHSs focusing on technical processes to reuse data collected during the clinical process and embedding analysed data back into the system. A shift in the literature to empirical LHS studies with consideration of organisational and human factors is warranted.
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Affiliation(s)
- Chiara Pomare
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Zeyad Mahmoud
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Alex Vedovi
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Louise A. Ellis
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Gilbert Knaggs
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Carolynn L. Smith
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Yvonne Zurynski
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Jeffrey Braithwaite
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
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