1
|
Park H, Kim J, Kang EJ, Kim Y, Jo H, Heo JH, Yang W, Yoon Y. Feasibility of new patient dose management tool in digital radiography: Using clinical exposure index data of mobile chest radiography in a large university hospital. Heliyon 2023; 9:e20760. [PMID: 37860502 PMCID: PMC10582475 DOI: 10.1016/j.heliyon.2023.e20760] [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: 03/29/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
The clinical anteroposterior (AP) chest images taken with a mobile radiography system were analyzed in this study to utilize the clinical exposure index (EI) as a patient dose-monitoring tool. The digital imaging and communications in medicine header of 6048 data points exposed under the 90 kVp and 2.5 mAs were extracted using Python for identifying the distribution of clinical EI. Even under the same exposure conditions, the clinical EI distribution was 137.82-4924.38. To determine the cause, the effect of a patient's body shape on EI was confirmed using actual clinical chest AP image data binarized into 0 and 255-pixel values using Python. As a result, the relationship between the direct X-ray area of the chest AP image, the higher the clinical EI, the larger the rate of the direct X-ray area. A conversion equation was also derived to infer entrance surface dose through clinical EI based on the patient thickness. This confirmed the possibility of directly monitoring patient dose through EI without a dosimeter in real-time. Therefore, to use the clinical EI of the mobile radiography system as a patient dose-monitoring tool, the derivation method of clinical EI considers several factors, such as the relationship between patient factors.
Collapse
Affiliation(s)
- Hyemin Park
- Department of Radiology, Masan University, Changwon, Republic of Korea
| | - Jungsu Kim
- Department of Radiologic Technology, Daegu Health College, Daegu, Republic of Korea
| | - Eun-Ju Kang
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Yeji Kim
- Department of Multidisciplinary Radiological Science, The Graduate School of Dongseo University, Busan, Republic of Korea
| | - Hyejin Jo
- Department of Multidisciplinary Radiological Science, The Graduate School of Dongseo University, Busan, Republic of Korea
| | - Jin-Haeng Heo
- Department of Multidisciplinary Radiological Science, The Graduate School of Dongseo University, Busan, Republic of Korea
- Forensic Medicine Division, Busan Institute, National Forensic Service, Yangsan, Republic of Korea
| | - Wonseok Yang
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Yongsu Yoon
- Department of Multidisciplinary Radiological Science, The Graduate School of Dongseo University, Busan, Republic of Korea
| |
Collapse
|
2
|
Carroll R, Bice AA, Roberto A, Prentice CR. Examining Mental Health Disorders in Overweight and Obese Pediatric Patients. J Pediatr Health Care 2022; 36:507-519. [PMID: 35760667 DOI: 10.1016/j.pedhc.2022.05.017] [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: 04/12/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We investigated the frequency and variation in three mental health diagnoses among obese or overweight children and adolescents. METHOD Logistic regression was used to examine the association between the outcome variables-anxiety, depression, and adjustment disorders-with the following covariates: overweight/obesity status, sex, age, and race. RESULTS Findings show anxiety, depressive, and adjustment disorder diagnoses were significantly higher for overweight or obese youth in our sample. In addition, diagnosis rates for one or more of these disorders increase as children grow into adolescence. Furthermore, we found significantly higher rates of depression and significantly lower rates of anxiety among youth who live in places with higher rates of poverty. DISCUSSION Findings indicate a target age for providers to focus on mental health screening among overweight/obese patients: (1) early adolescence (aged 11-14 years) for depressive and adjustment disorders and (2) early childhood (aged 2-4 years) for anxiety disorder.
Collapse
|
3
|
Courtney KL. Digital health systems-let's talk about sex (and gender). Healthc Manage Forum 2022; 35:370-373. [PMID: 36123821 DOI: 10.1177/08404704221120865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Historically, within digital health information systems, sex and gender have been conflated as a single concept and often have been limited to a binary answer. This has led to inappropriate care, erosion of client trust and avoidance of the healthcare system. Health leaders can improve care for all clients with technical and clinical information practice initiatives. While procurement processes could require digital health systems that utilize modern Gender, Sex, and Sexual Orientation (GSSO) terminology, for most health leaders, technical initiatives will focus on modernizing existing systems to the maximum extent possible. Terminology updates may not be immediately visible to clients, but providing the correct information to clinicians will support respectful client encounters. Simultaneously, clinical information practice initiatives can directly affect clinical encounters. Change management strategies need to include all levels of employees and redesign tools and workflows to support modernized information handling practices.
Collapse
|
4
|
Albert K, Delano M. Sex trouble: Sex/gender slippage, sex confusion, and sex obsession in machine learning using electronic health records. PATTERNS (NEW YORK, N.Y.) 2022; 3:100534. [PMID: 36033589 PMCID: PMC9403398 DOI: 10.1016/j.patter.2022.100534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
False assumptions that sex and gender are binary, static, and concordant are deeply embedded in the medical system. As machine learning researchers use medical data to build tools to solve novel problems, understanding how existing systems represent sex/gender incorrectly is necessary to avoid perpetuating harm. In this perspective, we identify and discuss three factors to consider when working with sex/gender in research: "sex/gender slippage," the frequent substitution of sex and sex-related terms for gender and vice versa; "sex confusion," the fact that any given sex variable holds many different potential meanings; and "sex obsession," the idea that the relevant variable for most inquiries related to sex/gender is sex assigned at birth. We then explore how these phenomena show up in medical machine learning research using electronic health records, with a specific focus on HIV risk prediction. Finally, we offer recommendations about how machine learning researchers can engage more carefully with questions of sex/gender.
Collapse
Affiliation(s)
- Kendra Albert
- Cyberlaw Clinic, Harvard Law School, Cambridge, MA 02138, USA
| | - Maggie Delano
- Engineering Department, Swarthmore College, Swarthmore, PA 19146, USA
| |
Collapse
|
5
|
Marney HL, Vawdrey DK, Warsame L, Tavares S, Shapiro A, Breese A, Brayford A, Chittalia AZ. Overcoming technical and cultural challenges to delivering equitable care for LGBTQ+ individuals in a rural, underserved area. J Am Med Inform Assoc 2021; 29:372-378. [PMID: 34791308 DOI: 10.1093/jamia/ocab227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
The lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) community is vulnerable to health-care disparities. Many health-care organizations are working to collect sexual orientation and gender identity in their electronic health records (EHRs), with the goal of providing more inclusive care to their LGBTQ+ patients. There are significant human and technical barriers to making these efforts successful. Based on our 5-year experience at Geisinger (an integrated health system located in a rural, generally conservative area), this case report provides insights to overcome challenges in 4 critical areas: (1) enabling the EHR to collect and use information to support the health-care needs of LGBTQ+ patients, (2) building a culture of awareness and caring, empowering members of the health-care team to break down barriers of misunderstanding and mistrust, (3) developing services to support the needs of LGBTQ+ patients, and (4) partnering with local communities to become a trusted health-care provider.
Collapse
Affiliation(s)
- Heather L Marney
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA
| | - David K Vawdrey
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA.,Biomedical Informatics, Columbia University, New York, New York, USA
| | - Leyla Warsame
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA
| | - Spencer Tavares
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA
| | - Andrea Shapiro
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA
| | - Arthur Breese
- Human Resources, Geisinger, Pittston, Pennsylvania, USA
| | - Amy Brayford
- Human Resources, Geisinger, Pittston, Pennsylvania, USA
| | | |
Collapse
|
6
|
Kundu A, Chaiton M, Billington R, Grace D, Fu R, Logie C, Baskerville B, Yager C, Mitsakakis N, Schwartz R. Machine Learning Applications in Mental Health and Substance Use Research Among the LGBTQ2S+ Population: Scoping Review. JMIR Med Inform 2021; 9:e28962. [PMID: 34762059 PMCID: PMC8663464 DOI: 10.2196/28962] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/02/2021] [Accepted: 10/03/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A high risk of mental health or substance addiction issues among sexual and gender minority populations may have more nuanced characteristics that may not be easily discovered by traditional statistical methods. OBJECTIVE This review aims to identify literature studies that used machine learning (ML) to investigate mental health or substance use concerns among the lesbian, gay, bisexual, transgender, queer or questioning, and two-spirit (LGBTQ2S+) population and direct future research in this field. METHODS The MEDLINE, Embase, PubMed, CINAHL Plus, PsycINFO, IEEE Xplore, and Summon databases were searched from November to December 2020. We included original studies that used ML to explore mental health or substance use among the LGBTQ2S+ population and excluded studies of genomics and pharmacokinetics. Two independent reviewers reviewed all papers and extracted data on general study findings, model development, and discussion of the study findings. RESULTS We included 11 studies in this review, of which 81% (9/11) were on mental health and 18% (2/11) were on substance use concerns. All studies were published within the last 2 years, and most were conducted in the United States. Among mutually nonexclusive population categories, sexual minority men were the most commonly studied subgroup (5/11, 45%), whereas sexual minority women were studied the least (2/11, 18%). Studies were categorized into 3 major domains: web content analysis (6/11, 54%), prediction modeling (4/11, 36%), and imaging studies (1/11, 9%). CONCLUSIONS ML is a promising tool for capturing and analyzing hidden data on mental health and substance use concerns among the LGBTQ2S+ population. In addition to conducting more research on sexual minority women, different mental health and substance use problems, as well as outcomes and future research should explore newer environments, data sources, and intersections with various social determinants of health.
Collapse
Affiliation(s)
- Anasua Kundu
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Michael Chaiton
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rebecca Billington
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rui Fu
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
| | - Bruce Baskerville
- Canadian Institutes of Health Research, Government of Canada, Ottawa, ON, Canada
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | | | - Nicholas Mitsakakis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Robert Schwartz
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
McClure RC, Macumber CL, Kronk C, Grasso C, Horn RJ, Queen R, Posnack S, Davison K. Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation. J Am Med Inform Assoc 2021; 29:354-363. [PMID: 34613410 PMCID: PMC8757317 DOI: 10.1093/jamia/ocab196] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/04/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Accurate representation of clinical sex and gender identity in interoperable clinical
systems is a major challenge for organizations intent on improving outcomes for sex- and
gender-marginalized people. Improved data collection has been hindered by the historical
approach that presumed a single, often binary, datum was sufficient. We describe the
Health Level Seven International (HL7) Gender Harmony logical model that proposes an
improved approach. Materials and Methods The proposed solution was developed via an American National Standards Institute
(ANSI)-certified collaborative balloted process. As an HL7 Informative Document, it is
an HL7 International-balloted consensus on the subject of representing sex and
representing gender in clinical systems based on work of the gender harmony project led
by the HL7 Vocabulary Work Group. Results The Gender Harmony Model is a logical model that provides a standardized approach that
is both backwards-compatible and an improvement to the meaningful capture of gender
identity, recorded sex or recorded gender, a sex for clinical use, the name to use, and
pronouns that are affirmative and inclusive of gender-marginalized people. Conclusion Most clinical systems and current standards in health care do not meaningfully address,
nor do they consistently represent, sex and gender diversity, which has impeded
interoperability and led to suboptimal health care. The Gender Harmony Project was
formed to create more inclusive health information exchange standards to enable a safer,
higher-quality, and embracing healthcare experience. The Gender Harmony Model provides
the informative guidance for standards developers to implement a more thorough technical
design that improves the narrow binary design used in many legacy clinical systems.
Collapse
Affiliation(s)
| | | | - Clair Kronk
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Steven Posnack
- US Department of Health and Human Services, Office of the National Coordinator for Health IT, Washington, District of Columbia, USA
| | - Kelly Davison
- Canada Health Infoway, Toronto, ON, Canada.,School of Health Information Science, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
8
|
Antonio M, Lau F, Davison K, Devor A, Queen R, Courtney K. Toward an inclusive digital health system for sexual and gender minorities in Canada. J Am Med Inform Assoc 2021; 29:379-384. [PMID: 34605910 PMCID: PMC8757318 DOI: 10.1093/jamia/ocab183] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/25/2021] [Accepted: 08/23/2021] [Indexed: 01/01/2023] Open
Abstract
Most digital health systems (DHS) are unable to capture gender, sex, and sexual orientation (GSSO) data beyond a single binary attribute with female and male options. This binary system discourages access to preventative screening and gender-affirming care for sexual and gender minority (SGM) people. We conducted this 1-year multi-method project and cocreated an action plan to modernize GSSO information practices in Canadian DHS. The proposed actions are to: (1) Envisage an equity- and SGM-oriented health system; (2) Engage communities and organizations to modernize GSSO information practices in DHS; (3) Establish an inclusive GSSO terminology; (4) Enable DHS to collect, use, exchange, and reuse standardized GSSO data; (5) Integrate GSSO data collection and use within organizations; (6) Educate staff to provide culturally competent care and inform patients on the need for GSSO data; and (7) Establish a central hub to coordinate efforts.
Collapse
Affiliation(s)
- Marcy Antonio
- School of Health Information Science, University of Victoria, Victoria, Canada
- Corresponding Author: Marcy Antonio, MPH, BSc, School of Health Information Science, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada ()
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Kelly Davison
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Aaron Devor
- Chair in Transgender Studies, University of Victoria, Victoria, Canada
| | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Karen Courtney
- School of Health Information Science, University of Victoria, Victoria, Canada
| |
Collapse
|
9
|
Lau F. A brief communication on the action plan to improve gender, sex and sexual orientation documentation practices in Canadian electronic health records. Can Oncol Nurs J 2021; 31:350-351. [PMID: 34395842 PMCID: PMC8320803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Affiliation(s)
- Francis Lau
- Professor, School of Health Information Science, University of Victoria, Victoria, British Columbia,
| |
Collapse
|
10
|
Davison K, Queen R, Lau F, Antonio M. Culturally Competent Gender, Sex, and Sexual Orientation Information Practices and Electronic Health Records: Rapid Review. JMIR Med Inform 2021; 9:e25467. [PMID: 33455901 PMCID: PMC7906831 DOI: 10.2196/25467] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/01/2021] [Accepted: 01/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Outdated gender, sex, and sexual orientation (GSSO) information practices in health care contribute to health inequities for sexual and gender minorities (SGMs). Governments, statistics agencies, and health care organizations are developing and implementing modernized practices that support health equity for SGMs. Extending our work, we conducted a rapid review of grey literature to explore information practices that support quality health care for SGMs. OBJECTIVE The aim of this rapid review of grey literature was to elucidate modern GSSO information practices from leading agencies for adaptation, adoption, and application by health care providers and organizations seeking to modernize outdated GSSO information practices that contribute to health inequities among SGMs. METHODS We searched MEDLINE and Google from 2015 to 2020 with terms related to gender, sex, sexual orientation, and electronic health/medical records for English-language grey literature resources including government and nongovernment organization publications, whitepapers, data standards, toolkits, health care organization and health quality practice and policy guides, conference proceedings, unpublished academic work, and statistical papers. Peer-reviewed journal articles were excluded, as were resources irrelevant to information practices. We also screened the reference sections of included articles for additional resources, and canvassed a working group of international topic experts for additional relevant resources. Duplicates were eliminated. ATLAS.ti was used to support analysis. Themes and codes were developed through an iterative process of writing and discussion with the research team. RESULTS Twenty-six grey literature resources met the inclusion criteria. The overarching themes that emerged from the literature were the interrelated behaviors, attitudes, and policies that constitute SGM cultural competence as follows: shared language with unambiguous definitions of GSSO concepts; welcoming and inclusive care environments and affirming practices to reduce barriers to access; health care policy that supports competent health care; and adoption of modernized GSSO information practices and electronic health record design requirements that address invisibility in health data. CONCLUSIONS Health equity for SGMs requires systemic change. Binary representation of sex and gender in electronic health records (EHRs) obfuscates natural and cultural diversity and, in the context of health care, places SGM patients at risk of clinical harm because it leads to clinical assumptions. Agencies and agents in health care need to be equipped with the knowledge and tools needed to cultivate modern attitudes, policies, and practices that enable health equity for SGMs. Adopting small but important changes in the language and terminology used in technical and social health care systems is essential for institutionalizing SGM competency. Modern GSSO information practices depend on and reinforce SGM competency in health care.
Collapse
Affiliation(s)
- Kelly Davison
- University of Victoria, Victoria, BC, Canada
- Canada Health Infoway, Toronto, ON, Canada
| | - Roz Queen
- University of Victoria, Victoria, BC, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | | |
Collapse
|