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Theopilus Y, Al Mahmud A, Davis H, Octavia JR. Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives. JMIR Pediatr Parent 2024; 7:e55364. [PMID: 38669672 PMCID: PMC11087864 DOI: 10.2196/55364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/05/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. OBJECTIVE This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. METHODS This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. RESULTS Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps' functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. CONCLUSIONS The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children's competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children's internet use, providing tailored or personalized content to suit users' characteristics, and considering the provision of training and information about the use of interventions and privacy agreements.
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Affiliation(s)
- Yansen Theopilus
- Centre for Design Innovation, Swinburne University of Technology, Melbourne, Australia
- Centre for Ergonomics, Parahyangan Catholic University, Bandung, Indonesia
| | - Abdullah Al Mahmud
- Centre for Design Innovation, Swinburne University of Technology, Melbourne, Australia
| | - Hilary Davis
- Centre for Social Impact, Swinburne University of Technology, Melbourne, Australia
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Fulceri F, Gila L, Caruso A, Micai M, Romano G, Scattoni ML. Building Bricks of Integrated Care Pathway for Autism Spectrum Disorder: A Systematic Review. Int J Mol Sci 2023; 24:ijms24076222. [PMID: 37047213 PMCID: PMC10094376 DOI: 10.3390/ijms24076222] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
An integrated plan within a defined care pathway for the diagnosis, continuative interventions, and periodic redefinition of care of autistic people is essential for better outcomes. Challenges include delivering services across all domains or life stages and effective coordination between health/social care providers and services. Further, in the ‘real world’, service provision varies greatly, and in many settings is significantly weighted towards diagnosis and children’s services rather than treatment and support or adult care. This study aims to identify existing care pathways for Autism Spectrum Disorder (ASD) from referral to care management after diagnosis. The study reviewed the international literature in PubMed and PsycInfo databases and collected information on care for autistic individuals from the Autism Spectrum Disorders in Europe (ASDEU) project partners. The study found that published data mainly focused on specific components of care pathways rather than an integrated and coordinated plan of care and legislative indications. They should be aimed at facilitating access to the services for support and the inclusiveness of autistic individuals. Given the need for care addressing the complex and heterogeneous nature of ASD, effective coordination between different health/social care providers and services is essential. It is also suggested that research priority should be given to the identification of an integrated care pathway ‘model’ centered around case management, individualization, facilitation, support, continuous training and updating, and quality management.
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van Venrooij LT, Rusu V, Vermeiren RRJM, Koposov RA, Skokauskas N, Crone MR. Clinical decision support methods for children and youths with mental health disorders in primary care. Fam Pract 2022; 39:1135-1143. [PMID: 35656854 PMCID: PMC9680662 DOI: 10.1093/fampra/cmac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mental health disorders among children and youths are common and often have negative consequences for children, youths, and families if unrecognized and untreated. With the goal of early recognition, primary care physicians (PCPs) play a significant role in the detection and referral of mental disorders. However, PCPs report several barriers related to confidence, knowledge, and interdisciplinary collaboration. Therefore, initiatives have been taken to assist PCPs in their clinical decision-making through clinical decision support methods (CDSMs). OBJECTIVES This review aimed to identify CDSMs in the literature and describe their functionalities and quality. METHODS In this review, a search strategy was performed to access all available studies in PubMed, PsychINFO, Embase, Web of Science, and COCHRANE using keywords. Studies that involved CDSMs for PCP clinical decision-making regarding psychosocial or psychiatric problems among children and youths (0-24 years old) were included. The search was conducted according to PRISMA-Protocols. RESULTS Of 1,294 studies identified, 25 were eligible for inclusion and varied in quality. Eighteen CDSMs were described. Fourteen studies described computer-based methods with decision support, focusing on self-help, probable diagnosis, and treatment suggestions. Nine studies described telecommunication methods, which offered support through interdisciplinary (video) calls. Two studies described CDSMs with a combination of components related to the two CDSM categories. CONCLUSION Easy-to-use CDSMs of good quality are valuable for advising PCPs on the detection and referral of children and youths with mental health disorders. However, valid multicentre research on a combination of computer-based methods and telecommunication is still needed.
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Affiliation(s)
- Lennard T van Venrooij
- Corresponding author: Department of Research and Education, Academic Center for Child and Youth Psychiatry, Curium-LUMC, Endegeesterstraatweg 27, Oegstgeest, 2342 AK, the Netherlands.
| | | | - Robert R J M Vermeiren
- Department of Research and Education, Academic Center for Child and Youth Psychiatry, Curium-LUMC, Oegstgeest, the Netherlands
- Youz, Parnassia Psychiatric Institute, the Hague, the Netherlands
| | - Roman A Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, Northern Norway, UiT, The Arctic University of Norway, Tromsø, Norway
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare, IPH, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Matty R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Meimei L, Zenghui M. A systematic review of telehealth screening, assessment, and diagnosis of autism spectrum disorder. Child Adolesc Psychiatry Ment Health 2022; 16:79. [PMID: 36209100 PMCID: PMC9547568 DOI: 10.1186/s13034-022-00514-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
There is a significant delay between parents having concerns and receiving a formal assessment and Autism Spectrum Disorder (ASD) diagnosis. Telemedicine could be an effective alternative that shortens the waiting time for parents and primary health providers in ASD screening and diagnosis. We conducted a systematic review examining the uses of telemedicine technology for ASD screening, assessment, or diagnostic purposes and to what extent sample characteristics and psychometric properties were reported. This study searched four databases from 2000 to 2022 and obtained 26 studies that met the inclusion criteria. The 17 applications used in these 26 studies were divided into three categories based on their purpose: screening, diagnostic, and assessment. The results described the data extracted, including study characteristics, applied methods, indicators seen, and psychometric properties. Among the 15 applications with psychometric properties reported, the sensitivity ranged from 0.70 to 1, and the specificity ranged from 0.38 to 1. The present study highlights the strengths and weaknesses of current telemedicine approaches and provides a basis for future research. More rigorous empirical studies with larger sample sizes are needed to understand the feasibility, strengths, and limitations of telehealth technologies for screening, assessing, and diagnosing ASD.
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Affiliation(s)
- Liu Meimei
- grid.12380.380000 0004 1754 9227Vrije University Amsterdam, Amsterdam, The Netherlands
| | - Ma Zenghui
- Beijing ALSOABA Technology Co. LTD, ALSOLIFE, Beijing, China
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5
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Wallis M, Craswell A, Marsden E, Taylor A. Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model. BMC Health Serv Res 2022; 22:692. [PMID: 35606808 PMCID: PMC9128293 DOI: 10.1186/s12913-022-08081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 05/13/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Frail older adults require specific, targeted care and expedited shared decision making in the emergency department (ED) to prevent poor outcomes and minimise time spent in this chaotic environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to help limit these undesirable consequences. This qualitative study aimed to explore the ways in which two hospital implementation sites implemented the structures and processes of the GEDI model and to examine the ways in which the i-PARIHS (innovation-Promoting Action on Research Implementation in Health Services) framework influenced the implementation. METHODS Using the i-PARIHS approach to implementation, the GEDI model was disseminated into two hospitals using a detailed implementation toolkit, external and internal facilitators and a structured program of support. Following implementation, interviews were conducted with a range of staff involved in the implementation at both sites to explore the implementation process used. Transcribed interviews were analysed for themes and sub-themes. RESULTS There were 31 interviews with clinicians involved in the implementation, conducted across two hospitals, including interviews with the two external facilitators. Major themes identified included: (i) elements of the GEDI model adopted or (ii) adapted by implementation sites and (iii) factors that affected the implementation of the GEDI model. Both sites adopted the model of care and there was general support for the GEDI approach to the management of frail older people in the ED. Both sites adapted the structure of the GEDI team and the expertise of the team members to suit their needs and resources. Elements such as service focus, funding, staff development and service evaluation were initially adopted but adaptation occurred over time. Resourcing and cost shifting issues at the implementation sites and at the site providing the external facilitators negatively impacted the facilitation process. CONCLUSIONS The i-PARIHS framework provided a pragmatic approach to the implementation of the evidenced-based GEDI model. Passionate, driven clinicians ensured that successful implementation occurred despite unanticipated changes in context at both the implementation and host facilitator sites as well as the absence of sustained facilitation support.
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Affiliation(s)
- Marianne Wallis
- Faculty of Health, Southern Cross University, Southern Cross Drive, Bilinga, Queensland Australia
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
| | - Elizabeth Marsden
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
| | - Andrea Taylor
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 278] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Koscielniak NJ, Dharod A, Moses A, Bundy R, Feiereisel KB, Albertini LW, Palakshappa D. Feasibility of computerized clinical decision support for pediatric to adult care transitions for patients with special healthcare needs. JAMIA Open 2021; 4:ooab088. [PMID: 34738078 PMCID: PMC8564708 DOI: 10.1093/jamiaopen/ooab088] [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: 05/30/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to determine the feasibility of a computerized clinical decision support (cCDS) tool to facilitate referral to adult healthcare services for children with special healthcare needs. A transition-specific cCDS was implemented as part of standard care in a general pediatrics clinic at a tertiary care academic medical center. The cCDS alerts providers to patients 17-26 years old with 1 or more of 15 diagnoses that may be candidates for referral to an internal medicine adult transition clinic (ATC). Provider responses to the cCDS and referral outcomes (e.g. scheduled and completed visits) were retrospectively analyzed using descriptive statistics. One hundred and fifty-two patients were seen during the 20-month observation period. Providers referred 87 patients to the ATC using cCDS and 77% of patients ≥18 years old scheduled a visit in the ATC. Transition-specific cCDS tools are feasible options to facilitate adult care transitions for children with special healthcare needs.
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Affiliation(s)
- Nikolas J Koscielniak
- Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam Moses
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Richa Bundy
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kirsten B Feiereisel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Laurie W Albertini
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Pierce K, Gazestani V, Bacon E, Courchesne E, Cheng A, Barnes CC, Nalabolu S, Cha D, Arias S, Lopez L, Pham C, Gaines K, Gyurjyan G, Cook-Clark T, Karins K. Get SET Early to Identify and Treatment Refer Autism Spectrum Disorder at 1 Year and Discover Factors That Influence Early Diagnosis. J Pediatr 2021; 236:179-188. [PMID: 33915154 DOI: 10.1016/j.jpeds.2021.04.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the impact of a new approach, Get SET Early, on the rates of early autism spectrum disorder (ASD) detection and factors that influence the screen-evaluate-treat chain. STUDY DESIGN After attending Get SET Early training, 203 pediatricians administered 57 603 total screens using the Communication and Symbolic Behavior Scales Infant-Toddler Checklist at 12-, 18-, and 24-month well-baby examinations, and parents designated presence or absence of concern. For screen-positive toddlers, pediatricians specified if the child was being referred for evaluation, and if not, why not. RESULTS Collapsed across ages, toddlers were evaluated and referred for treatment at a median age of 19 months, and those screened at 12 months (59.4% of sample) by 15 months. Pediatricians referred one-third of screen-positive toddlers for evaluation, citing lack of confidence in the accuracy of screen-positive results as the primary reason for nonreferral. If a parent expressed concerns, referral probability doubled, and the rate of an ASD diagnosis increased by 37%. Of 897 toddlers evaluated, almost one-half were diagnosed as ASD, translating into an ASD prevalence of 1%. CONCLUSIONS The Get SET Early model was effective at detecting ASD and initiating very early treatment. Results also underscored the need for change in early identification approaches to formally operationalize and incorporate pediatrician judgment and level of parent concern into the process.
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Affiliation(s)
- Karen Pierce
- Department of Neurosciences, University of California, San Diego, La Jolla, CA.
| | - Vahid Gazestani
- Department of Neurosciences, University of California, San Diego, La Jolla, CA; Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Elizabeth Bacon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Eric Courchesne
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Amanda Cheng
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | | | - Srinivasa Nalabolu
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Debra Cha
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Steven Arias
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Linda Lopez
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Christie Pham
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Kim Gaines
- San Diego Regional Center, San Diego, CA
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Pandina G. The role of digital medicine in autism spectrum disorder. Eur Neuropsychopharmacol 2021; 48:42-44. [PMID: 33736943 DOI: 10.1016/j.euroneuro.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 11/16/2022]
Abstract
The field of digital medicine is concerned with the use of technologies as tools for measurement and intervention in the service of human health (Coravos et al, 2019), and may facilitate development of improved therapies for ASD. The use of established and emerging technologies to diagnose, assess, treat, and coordinate care expanded widely over the past ten years. Technologic advances promise to foster earlier and more accurate diagnosis, improved disposition, treatment access and planning, and provide better outcomes and quality of life for individuals with ASD. Two main areas are reviewed below: 1) assessment diagnosis, and outcome, and; 2) digital therapeutics.
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Li X, Cui L, Zhang GQ, Lhatoo SD. Can Big Data guide prognosis and clinical decisions in epilepsy? Epilepsia 2021; 62 Suppl 2:S106-S115. [PMID: 33529363 PMCID: PMC8011949 DOI: 10.1111/epi.16786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 01/16/2023]
Abstract
Big Data is no longer a novel concept in health care. Its promise of positive impact is not only undiminished, but daily enhanced by seemingly endless possibilities. Epilepsy is a disorder with wide heterogeneity in both clinical and research domains, and thus lends itself to Big Data concepts and techniques. It is therefore inevitable that Big Data will enable multimodal research, integrating various aspects of "-omics" domains, such as phenome, genome, microbiome, metabolome, and proteome. This scope and granularity have the potential to change our understanding of prognosis and mortality in epilepsy. The scale of new discovery is unprecedented due to the possibilities promised by advances in machine learning, in particular deep learning. The subsequent possibilities of personalized patient care through clinical decision support systems that are evidence-based, adaptive, and iterative seem to be within reach. A major objective is not only to inform decision-making, but also to reduce uncertainty in outcomes. Although the adoption of electronic health record (EHR) systems is near universal in the United States, for example, advanced clinical decision support in or ancillary to EHRs remains sporadic. In this review, we discuss the role of Big Data in the development of clinical decision support systems for epilepsy care, prognostication, and discovery.
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Affiliation(s)
- Xiaojin Li
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Licong Cui
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Guo-Qiang Zhang
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Samden D. Lhatoo
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Campbell K, Carbone PS, Liu D, Stipelman CH. Improving Autism Screening and Referrals With Electronic Support and Evaluations in Primary Care. Pediatrics 2021; 147:e20201609. [PMID: 33568493 PMCID: PMC7919108 DOI: 10.1542/peds.2020-1609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Universal screening for autism promotes early evidence-based treatment. However, many children are not screened, and screened children are often not referred for autism evaluation. METHODS We implemented process changes in 3 phases: phase 1, changing the screening instrument and adding decision support; phase 2, adding automatic reminders; and phase 3, adding a referral option for autism evaluations in primary care. We analyzed the proportion of visits with autism screening at 2 intervention clinics before and after implementation of process changes versus 27 community clinics (which received only automatic reminders in phase 2) with χ2 test and interrupted time series. We evaluated changes in referral for autism evaluation by calculating the rate ratio for referral. RESULTS In 12 233 visits over 2 years (baseline and phased improvements), autism screening increased by 52% in intervention clinics (58.6%-88.8%; P < .001) and 21% in community clinics (43.4%-52.4%; P < .001). In phase 1, interrupted time series trend for screening in intervention clinics increased by 2% per week (95% confidence interval [CI]: 1.1% to 2.9%) and did not increase in community clinics. In phase 2, screening in the community clinics increased by 0.46% per week (95% CI: 0.03% to 0.89%). In phase 3, the intervention clinic providers referred patients for diagnostic evaluation 3.4 times more frequently (95% CI: 2.0 to 5.8) than at baseline. CONCLUSIONS We improved autism screening and referrals by changing the screening instrument, adding decision support, using automatic reminders, and offering autism evaluation in primary care in intervention clinics. Automatic reminders alone improved screening in community clinics.
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Affiliation(s)
- Kathleen Campbell
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Paul S Carbone
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Diane Liu
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
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12
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Desideri L, Pérez-Fuster P, Herrera G. Information and Communication Technologies to Support Early Screening of Autism Spectrum Disorder: A Systematic Review. CHILDREN-BASEL 2021; 8:children8020093. [PMID: 33535513 PMCID: PMC7912726 DOI: 10.3390/children8020093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
The aim of this systematic review is to identify recent digital technologies used to detect early signs of autism spectrum disorder (ASD) in preschool children (i.e., up to six years of age). A systematic literature search was performed for English language articles and conference papers indexed in Pubmed, PsycInfo, ERIC, CINAHL, WoS, IEEE, and ACM digital libraries up until January 2020. A follow-up search was conducted to cover the literature published until December 2020 for the usefulness and interest in this area of research during the Covid-19 emergency. In total, 2427 articles were initially retrieved from databases search. Additional 481 articles were retrieved from follow-up search. Finally, 28 articles met the inclusion criteria and were included in the review. The studies included involved four main interface modalities: Natural User Interface (e.g., eye trackers), PC or mobile, Wearable, and Robotics. Most of the papers included (n = 20) involved the use of Level 1 screening tools. Notwithstanding the variability of the solutions identified, psychometric information points to considering available technologies as promising supports in clinical practice to detect early sign of ASD in young children. Further research is needed to understand the acceptability and increase use rates of technology-based screenings in clinical settings. .
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Affiliation(s)
| | - Patricia Pérez-Fuster
- Autism and Technologies Laboratory, University Research Institute on Robotics and Information and Communication Technologies (IRTIC), Universitat de València, 46010 València, Spain; (P.P.-F.); (G.H.)
| | - Gerardo Herrera
- Autism and Technologies Laboratory, University Research Institute on Robotics and Information and Communication Technologies (IRTIC), Universitat de València, 46010 València, Spain; (P.P.-F.); (G.H.)
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Proteomics and Metabolomics Approaches towards a Functional Insight onto AUTISM Spectrum Disorders: Phenotype Stratification and Biomarker Discovery. Int J Mol Sci 2020; 21:ijms21176274. [PMID: 32872562 PMCID: PMC7504551 DOI: 10.3390/ijms21176274] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022] Open
Abstract
Autism spectrum disorders (ASDs) are neurodevelopmental disorders characterized by behavioral alterations and currently affect about 1% of children. Significant genetic factors and mechanisms underline the causation of ASD. Indeed, many affected individuals are diagnosed with chromosomal abnormalities, submicroscopic deletions or duplications, single-gene disorders or variants. However, a range of metabolic abnormalities has been highlighted in many patients, by identifying biofluid metabolome and proteome profiles potentially usable as ASD biomarkers. Indeed, next-generation sequencing and other omics platforms, including proteomics and metabolomics, have uncovered early age disease biomarkers which may lead to novel diagnostic tools and treatment targets that may vary from patient to patient depending on the specific genomic and other omics findings. The progressive identification of new proteins and metabolites acting as biomarker candidates, combined with patient genetic and clinical data and environmental factors, including microbiota, would bring us towards advanced clinical decision support systems (CDSSs) assisted by machine learning models for advanced ASD-personalized medicine. Herein, we will discuss novel computational solutions to evaluate new proteome and metabolome ASD biomarker candidates, in terms of their recurrence in the reviewed literature and laboratory medicine feasibility. Moreover, the way to exploit CDSS, performed by artificial intelligence, is presented as an effective tool to integrate omics data to electronic health/medical records (EHR/EMR), hopefully acting as added value in the near future for the clinical management of ASD.
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