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Journal of Medical Internet Research Mar 2022Mental health disorders are a leading cause of medical disabilities across an individual's lifespan. This burden is particularly substantial in children and adolescents... (Review)
Review
BACKGROUND
Mental health disorders are a leading cause of medical disabilities across an individual's lifespan. This burden is particularly substantial in children and adolescents because of challenges in diagnosis and the lack of precision medicine approaches. However, the widespread adoption of wearable devices (eg, smart watches) that are conducive for artificial intelligence applications to remotely diagnose and manage psychiatric disorders in children and adolescents is promising.
OBJECTIVE
This study aims to conduct a scoping review to study, characterize, and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of psychiatric disorders in child and adolescent psychiatry.
METHODS
This scoping review used information from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of several databases from 2011 to June 25, 2021, limited to the English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; Web of Science; and Scopus.
RESULTS
The initial search yielded 344 articles, from which 19 (5.5%) articles were left on the final source list for this scoping review. Articles were divided into three main groups as follows: studies with the main focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, and internalizing disorders such as anxiety disorders. Most of the studies used either cardio-fitness chest straps with electrocardiogram sensors or wrist-worn biosensors, such as watches by Fitbit. Both allowed passive data collection of the physiological signals.
CONCLUSIONS
Our scoping review found a large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials.
Topics: Adolescent; Adolescent Psychiatry; Artificial Intelligence; Autism Spectrum Disorder; Child Psychiatry; Humans; Wearable Electronic Devices
PubMed: 35285812
DOI: 10.2196/33560 -
Annals of Medicine Dec 2023The aim of this systematic review and meta-analysis was to identify, evaluate, and synthesize the evidence from studies that have investigated the treatment effect... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review and meta-analysis was to identify, evaluate, and synthesize the evidence from studies that have investigated the treatment effect telemedicine interventions on depressive symptoms, quality of life, and work and social functioning in patients with depression. Six electronic databases (MEDLINE [1916-2021], PubMED [1950-2021], PsycINFO [1971-2021], Scopus [2004-2021], Embase [1972-2021], and CINAHL [1937-2021]) were systematically searched in March 2021. Reference lists of identified articles were hand searched. Randomized controlled trials were included if they investigated the treatment effects telemedicine interventions in patients who had a depression diagnosis. Quality assessment was evaluated using the critical appraisal checklists developed by the Joanna Briggs Institute. Seventeen (17) trials ( = 2,394) met eligibility criteria and were included in the analysis. Eleven (11) randomized controlled trials shared common outcome measures, allowing meta-analysis. The results provided evidence that treatment telemedicine interventions were beneficial for depressive symptoms (standardized mean difference= -0.44; 95% CI= -0.64 to -0.25; < .001) and quality of life (standardized mean difference= 0.25, 95% CI -0.01 to 0.49, = .04) in patients of depression. There were insufficient data for meta-analysis of work and social functioning. This study showed the positive effects of treatment telemedicine interventions on depressive symptoms and quality of life in patients with depression and supported the idea for clinical practice to establish a well-organized telepsychiatry system.KEY MESSAGESTelemedicine is effective at reducing symptoms of depression.Telemedicine can improve quality of life in persons with depression.
Topics: Humans; Depression; Quality of Life; Psychiatry; Telemedicine
PubMed: 36920229
DOI: 10.1080/07853890.2023.2187078 -
Systematic Reviews Aug 2023More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most... (Review)
Review
BACKGROUND
More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographical areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization's current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropical diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/or care has been little explored to inform the country's NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia.
METHODS
A systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively.
RESULTS
The search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country.
CONCLUSIONS
The scoping review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.
Topics: Humans; Ethiopia; Quality of Life; Tropical Medicine; Global Health; Neglected Diseases; Health Services Accessibility
PubMed: 37580784
DOI: 10.1186/s13643-023-02302-5 -
The Lancet. Global Health Feb 2023Snakebite clinical trials have often used heterogeneous outcome measures and there is an urgent need for standardisation. A globally representative group of key... (Review)
Review
Snakebite clinical trials have often used heterogeneous outcome measures and there is an urgent need for standardisation. A globally representative group of key stakeholders came together to reach consensus on a globally relevant set of core outcome measurements. Outcome domains and outcome measurement instruments were identified through searching the literature and a systematic review of snakebite clinical trials. Outcome domains were shortlisted by use of a questionnaire and consensus was reached among stakeholders and the patient group through facilitated discussions and voting. Five universal core outcome measures should be included in all future snakebite clinical trials-mortality, WHO disability assessment scale, patient-specific functional scale, acute allergic reaction by Brown criteria, and serum sickness by formal criteria. Additional syndrome-specific core outcome measures should be used depending on the biting species. This core outcome measurement set provides global standardisation, supports the priorities of patients and clinicians, enables meta-analysis, and is appropriate for use in low-income and middle-income settings.
Topics: Humans; Consensus; Outcome Assessment, Health Care; Snake Bites; Surveys and Questionnaires; Treatment Outcome; Clinical Trials as Topic; Global Health
PubMed: 36669810
DOI: 10.1016/S2214-109X(22)00479-X -
PloS One 2017Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical... (Review)
Review
INTRODUCTION
Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence.
METHODS
Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies.
RESULTS
A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent.
CONCLUSIONS
Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality standards.
Topics: Emergency Medicine; Evidence-Based Medicine; Humans; Policy; Practice Guidelines as Topic; Research
PubMed: 28628660
DOI: 10.1371/journal.pone.0178456 -
BMC Public Health Nov 2022Global public health action to address noncommunicable diseases (NCDs) requires new approaches. NCDs are primarily prevented and managed in the community where there is... (Review)
Review
BACKGROUND
Global public health action to address noncommunicable diseases (NCDs) requires new approaches. NCDs are primarily prevented and managed in the community where there is little investment in digital health systems and analytics; this has created a data chasm and relatively silent burden of disease. The nascent but rapidly emerging area of precision public health offers exciting new opportunities to transform our approach to NCD prevention. Precision public health uses routinely collected real-world data on determinants of health (social, environmental, behavioural, biomedical and commercial) to inform precision decision-making, interventions and policy based on social position, equity and disease risk, and continuously monitors outcomes - the right intervention for the right population at the right time. This scoping review aims to identify global exemplars of precision public health and the data sources and methods of their aggregation/application to NCD prevention.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) was followed. Six databases were systematically searched for articles published until February 2021. Articles were included if they described digital aggregation of real-world data and 'traditional' data for applied community, population or public health management of NCDs. Real-world data was defined as routinely collected (1) Clinical, Medication and Family History (2) Claims/Billing (3) Mobile Health (4) Environmental (5) Social media (6) Molecular profiling (7) Patient-centred (e.g., personal health record). Results were analysed descriptively and mapped according to the three horizons framework for digital health transformation.
RESULTS
Six studies were included. Studies developed population health surveillance methods and tools using diverse real-world data (e.g., electronic health records and health insurance providers) and traditional data (e.g., Census and administrative databases) for precision surveillance of 28 NCDs. Population health analytics were applied consistently with descriptive, geospatial and temporal functions. Evidence of using surveillance tools to create precision public health models of care or improve policy and practice decisions was unclear.
CONCLUSIONS
Applications of real-world data and designed data to address NCDs are emerging with greater precision. Digital transformation of the public health sector must be accelerated to create an efficient and sustainable predict-prevent healthcare system.
Topics: Humans; Noncommunicable Diseases; Public Health; Delivery of Health Care; Telemedicine; Social Media
PubMed: 36434553
DOI: 10.1186/s12889-022-14452-7 -
Perspectives on Medical Education 2023The increasing use of Artificial Intelligence (AI) in medicine has raised ethical concerns, such as patient autonomy, bias, and transparency. Recent studies suggest a... (Review)
Review
INTRODUCTION
The increasing use of Artificial Intelligence (AI) in medicine has raised ethical concerns, such as patient autonomy, bias, and transparency. Recent studies suggest a need for teaching AI ethics as part of medical curricula. This scoping review aimed to represent and synthesize the literature on teaching AI ethics as part of medical education.
METHODS
The PRISMA-SCR guidelines and JBI methodology guided a literature search in four databases (PubMed, Embase, Scopus, and Web of Science) for the past 22 years (2000-2022). To account for the release of AI-based chat applications, such as ChatGPT, the literature search was updated to include publications until the end of June 2023.
RESULTS
1384 publications were originally identified and, after screening titles and abstracts, the full text of 87 publications was assessed. Following the assessment of the full text, 10 publications were included for further analysis. The updated literature search identified two additional relevant publications from 2023 were identified and included in the analysis. All 12 publications recommended teaching AI ethics in medical curricula due to the potential implications of AI in medicine. Anticipated ethical challenges such as bias were identified as the recommended basis for teaching content in addition to basic principles of medical ethics. Case-based teaching using real-world examples in interactive seminars and small groups was recommended as a teaching modality.
CONCLUSION
This scoping review reveals a scarcity of literature on teaching AI ethics in medical education, with most of the available literature being recent and theoretical. These findings emphasize the importance of more empirical studies and foundational definitions of AI ethics to guide the development of teaching content and modalities. Recognizing AI's significant impact of AI on medicine, additional research on the teaching of AI ethics in medical education is needed to best prepare medical students for future ethical challenges.
Topics: Humans; Artificial Intelligence; Education, Medical; Medicine; Curriculum; Ethics, Medical
PubMed: 37868075
DOI: 10.5334/pme.954 -
PloS One 2017Our objective was to evaluate quality of conduct and reporting of published systematic reviews and meta-analyses in paediatric surgery. We also aimed to identify... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Our objective was to evaluate quality of conduct and reporting of published systematic reviews and meta-analyses in paediatric surgery. We also aimed to identify characteristics predictive of review quality.
BACKGROUND
Systematic reviews summarise evidence by combining sources, but are potentially prone to bias. To counter this, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was published to aid in reporting. Similarly, the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) measurement tool was designed to appraise methodology. The paediatric surgical literature has seen an increasing number of reviews over the past decade, but quality has not been evaluated.
METHODS
Adhering to PRISMA guidelines, we performed a systematic review with a priori design to identify systematic reviews and meta-analyses of interventions in paediatric surgery. From 01/2010 to 06/2016, we searched: MEDLINE, EMBASE, Cochrane, Centre for Reviews and Dissemination, Web of Science, Google Scholar, reference lists and journals. Two reviewers independently selected studies and extracted data. We assessed conduct and reporting using AMSTAR and PRISMA. Scores were calculated as the sum of reported items. We also extracted author, journal and article characteristics, and used them in exploratory analysis to determine which variables predict quality.
RESULTS
112 articles fulfilled eligibility criteria (53 systematic reviews; 59 meta-analyses). Overall, 68% AMSTAR and 56.8% PRISMA items were reported adequately. Poorest scores were identified with regards a priori design, inclusion of structured summaries, including the grey literature, citing excluded articles and evaluating bias. 13 reviews were pre-registered and 6 in PRISMA-endorsing journals. The following predicted quality in univariate analysis:, word count, Cochrane review, journal h-index, impact factor, journal endorses PRISMA, PRISMA adherence suggested in author guidance, article mentions PRISMA, review includes comparison of interventions and review registration. The latter three variables were significant in multivariate regression.
CONCLUSIONS
There are gaps in the conduct and reporting of systematic reviews in paediatric surgery. More endorsement by journals of the PRISMA guideline may improve review quality, and the dissemination of reliable evidence to paediatric clinicians.
Topics: Child; Humans; Pediatrics; Surgical Procedures, Operative
PubMed: 28384296
DOI: 10.1371/journal.pone.0175213 -
The Western Journal of Emergency... Apr 2022Trauma exposure is a highly prevalent experience for patients and clinicians in emergency medicine (EM). Trauma-informed care (TIC) is an effective framework to mitigate... (Review)
Review
INTRODUCTION
Trauma exposure is a highly prevalent experience for patients and clinicians in emergency medicine (EM). Trauma-informed care (TIC) is an effective framework to mitigate the negative health impacts of trauma. This systematic review synthesizes the range of TIC interventions in EM, with a focus on patient and clinician outcomes, and identifies gaps in the current research on implementing TIC.
METHODS
The study was registered with PROSPERO (CRD42020205182). We systematically searched peer-reviewed journals and abstracts in the PubMed, EMBASE (Elsevier), PsycINFO (EBSCO), Social Services Abstract (ProQuest), and CINAHL (EBSCO) databases from 1990 onward on August 12, 2020. We analyzed studies describing explicit TIC interventions in the ED setting using inductive qualitative content analysis to identify recurrent themes and identify unique trauma-informed interventions in each study. Studies not explicitly citing TIC were excluded. Studies were assessed for bias using the Newcastle-Ottawa criteria and Critical Appraisal Skills Programme (CASP) Checklist.
RESULTS
We identified a total of 1,372 studies and abstracts, with 10 meeting inclusion criteria for final analysis. Themes within TIC interventions that emerged included educational interventions, collaborations with allied health professionals and community organizations, and patient and clinician safety interventions. Educational interventions included lectures, online modules, and standardized patient exercises. Collaborations with community organizations focused on addressing social determinants of health. All interventions suggested a positive impact from TIC on either clinicians or patients, but outcomes data remain limited.
CONCLUSION
Trauma-informed care is a nascent field in EM with limited operationalization of TIC approaches. Future studies with patient and clinician outcomes analyzing universal TIC precautions and systems-level interventions are needed.
Topics: Emergency Medicine; Humans
PubMed: 35679503
DOI: 10.5811/westjem.2022.1.53674 -
BMJ Open Jan 2022Defensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a...
OBJECTIVES
Defensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a no-fault malpractice system. The objectives of this systematic review were to explore the definition of the term 'defensive medicine' in European original medical literature and to identify the motives stated therein.
DESIGN
Systematic review.
DATA SOURCES
PubMed, Embase and Cochrane, 3 February 2020, with an updated search on 6 March 2021.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we reviewed all European original peer-reviewed studies fully or partially investigating 'defensive medicine'.
RESULTS
We identified a total of 50 studies. First, we divided these into two categories: the first category consisting of studies defining defensive medicine by using a narrow definition and the second category comprising studies in which defensive medicine was defined using a broad definition. In 23 of the studies(46%), defensive medicine was defined narrowly as: health professionals' deviation from sound medical practice motivated by a wish to reduce exposure to malpractice litigation. In 27 studies (54%), a broad definition was applied adding … or other self-protective motives. These self-protective motives, different from fear of malpractice litigation, were grouped into four categories: fear of patient dissatisfaction, fear of overlooking a severe diagnosis, fear of negative publicity and unconscious defensive medicine. Studies applying the narrow and broad definitions of defensive medicine did not differ regarding publication year, country, medical specialty, research quality or number of citations.
CONCLUSIONS
In European research, the narrow definition of defensive medicine as exclusively motivated by fear of litigation is often broadened to include other self-protective motives. In order to compare results pertaining to defensive medicine across countries, future studies are recommended to specify whether they are using the narrow or broad definition of defensive medicine.
PROSPERO REGISTRATION NUMBER
CRD42020167215.
Topics: Defensive Medicine; Europe; Humans; Malpractice; Medicine
PubMed: 35058268
DOI: 10.1136/bmjopen-2021-057169