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JAACAP Open Nov 2023There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage...
OBJECTIVE
There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage by supporting pediatric primary care providers (PCPs) in providing mental health services. The objective of this systematic review is to synthesize the expanding literature on CPAPs.
METHOD
A systematic literature search was conducted in PubMed, PsycInfo, Embase, and Web of Science databases to identify articles published from database inception to April 6, 2022, to identify CPAPs, defined as programs with mental health specialists providing rapid remote mental health consultation services to pediatric PCPs. Study outcomes included program adoption, provider experience, patient and caregiver experience, program cost, and patient mental health.
RESULTS
None of the 33 included studies were randomized controlled trials. Most of the studies (n = 30) focused on program adoption and provider experience (n = 18). Few studies examined patient and caregiver experience (n = 2), program cost(n = 4), or patient mental health (n = 4) outcomes. CPAPs showed year-over-year growth in adoption and were generally well-received by providers and caregivers. Health care provision costs were quite varied. No articles reported on changes in patient mental health according to validated measures. Heterogeneity in the methodological quality, study design, and outcomes used to evaluate CPAPs hindered comparison among programs.
CONCLUSION
Rigorous research on the impact of CPAPs is lacking. Findings show high provider satisfaction with CPAPs, yet few studies examine patient-level mental health outcomes. CPAPs and funding agencies should consider prioritizing and investing in research to build the evidence base for CPAPs.
DIVERSITY & INCLUSION STATEMENT
One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.
CLINICAL TRIAL REGISTRATION INFORMATION
Child Psychiatry Access Programs: A Systematic Review; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020146410; CRD42020146410.
PubMed: 38189028
DOI: 10.1016/j.jaacop.2023.07.003 -
Environmental Science and Pollution... Nov 2023Energy companies are in the spotlight regarding the environmental pressure to address the current environmental issues by initiating the sets of social responsibilities.... (Review)
Review
Energy companies are in the spotlight regarding the environmental pressure to address the current environmental issues by initiating the sets of social responsibilities. Energy sector companies are actively adopting Corporate Social Responsibility (CSR) practices to address the increased pressure and enablement to manage and prevent the risks of environmental impact at the same time concentrating on the economic growth. The current study provides a systematic literature review identifying CSR initiative measures towards sustainability and proposes a framework of CSR measurements in the energy sector. The framework combines the Search, Appraisal, Synthesis, and Analysis (SALSA) method together with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PSALSAR (Protocol, Search, Appraisal, Synthesis, Analysis and Report). Moreover, for setting the research scope, PICOC (Population, Intervention, Comparison, Outcome, and Context) is applied. As a result, eleven CSR measures for the energy sector were identified. The measurements were classified into 4 pillars: environmental pillar, stakeholder communication and external image, financial pillar, and organizational pillar. The environmental impact and GHG reduction align with the ecological modernization theories. Green energy innovations find theoretical resonance in the diffusion of innovation theories. Stakeholder engagement and branding link to the stakeholder theory, while financial performance, to the shareholder value theories. Occupational health and safety theory support the employee safety and corporate culture considerations. These measures, selected through theoretical lenses and systematic review, contribute to shaping a sustainable energy landscape. Furthermore, the research results were discussed, and the future research agenda together with policy recommendations were provided.
Topics: Occupational Health; Organizations; Social Responsibility; Organizational Culture
PubMed: 37798520
DOI: 10.1007/s11356-023-30131-5 -
PloS One 2023Smart homes represent the complement of various automation technologies that together make up a network of devices facilitating the daily tasks of residents. These...
Smart homes represent the complement of various automation technologies that together make up a network of devices facilitating the daily tasks of residents. These technologies are being studied for their application from different sectors, including the projection of their use to improve energy consumption planning and health care management. However, technology adoption depends on social awareness within the scope of cognitive advantages and innovations compared to perceived risk because although there are multiple benefits, potential users express fears related to the loss of autonomy and security. This study carries out a systematic literature review based on PRISMA in order to analyze research trends and literary evolution in the technological adoption of smart homes, considering the main theories and variables applied by the community. In proposing a research agenda in accordance with the identified gaps and the growing and emerging themes of the object of study, it is worth highlighting the growing interest in the subject, both for the present and its development in the future. Until now, adoption factors have been attributed more to the technological acceptance model and the diffusion of innovation theory, adopting components of the Theory of Planned Behavior; therefore, in several cases, the attributes of different theories are merged to adapt to the needs of each researcher, promoting the creation of empirical and extended models.
Topics: Humans; Technology; Automation; Research Personnel
PubMed: 37862296
DOI: 10.1371/journal.pone.0292558 -
Medicina (Kaunas, Lithuania) Sep 2023: The most common sites of implantation of endometriotic tissue are the ovaries. Endometriomas are present in most cases of endometriosis (up to 45%). Although... (Meta-Analysis)
Meta-Analysis Review
: The most common sites of implantation of endometriotic tissue are the ovaries. Endometriomas are present in most cases of endometriosis (up to 45%). Although laparoscopic cystectomy is the standard of care in endometrioma, new strategies have been set up to minimize iatrogenic injuries to ovarian tissue. Sclerotherapy consists of injecting alcohol into the endometrioma to denature the amino acidic components of its pseudocapsule. The aim of this systematic review and meta-analysis is to compare clinical and pregnancy outcomes in surgery and sclerotherapy. : Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched PubMed, EMBASE, Scopus, Google Scholar, Clinical-trials.gov, and the Cochrane Central Register of Controlled Trials databases in January 2023, adopting the string "Endometriosis and sclerotherapy". We made no limitations on the country and year of publication. We included the studies containing Success Rate (SR), Recurrence Rate (RR), Pregnancy Rate (PR) before and after the procedure. We used comparative studies for meta-analysis. : A total of 29 studies fulfilled inclusion criteria, 7 retrospective observational studies and 22 prospective studies. Eight comparative studies were enrolled in meta-analysis. Patients were analyzed concerning the number of recurrences and pregnancies in surgery, and compared with sclerotherapy. Four studies showed SR > 80.0%, and only two had SR < 80.0%, of which one consisted of tetracycline instillation. Only 1 study had 100% PR, the other 14 reported PR > 30.0%, whereas six had PR < 30.0%, of which one showed 0.0% PR with ethanol injection at two-thirds of the cyst fluid volume. Meta-analysis highlighted a non-significant lower incidence of recurrence in the surgery group compared to the sclerotherapy group ( = 0.87). In parallel, the surgery group showed a non-significant better PR than the sclerotherapy group ( = 0.08). : Despite sclerotherapy having a minor incidence of postoperative complications compared to surgery, the latter is associated with a lower RR and better PR. However, those data assert the importance of a targeted therapy according to preoperative conditions and reproductive potential.
Topics: Female; Pregnancy; Humans; Sclerotherapy; Endometriosis; Prospective Studies; Retrospective Studies; Fertility
PubMed: 37763762
DOI: 10.3390/medicina59091643 -
Endocrine Practice : Official Journal... Oct 2023The coronavirus disease 2019 pandemic highlighted a pre-existing need for alternatives to traditional in-person diabetes device trainings. Barriers to care, which... (Review)
Review
OBJECTIVE
The coronavirus disease 2019 pandemic highlighted a pre-existing need for alternatives to traditional in-person diabetes device trainings. Barriers to care, which include the heavy burden of training, pose a threat to optimal adoption and utilization of these devices. We searched the literature for alternative methods of training, evaluated user satisfaction, and compared short-term clinical outcomes with guideline-based glucometric targets and historical training results.
METHODS
A scoping review of Embase articles from 2019 to 2021 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines using key words relevant to diabetes technologies. Original full-text articles investigating training of new users on devices were included. Titles and abstracts were screened for eligibility by 2 independent reviewers, and results were summarized.
RESULTS
Of 25 articles retrieved from the database, 11 met the criteria. Alternative training strategies included video conferencing, phone calls, mobile applications, and hybrids with traditional trainings. Overall, there was a high degree of user satisfaction with virtual visits, with a preference for hybrid approaches (6 articles). Although glucometrics varied between articles, short-term glucometrics were satisfactory overall (8 articles), including improved glycated hemoglobin measurements and time in range. Two articles compared time in range over various time points after traditional and remote training. One found equivalency, and the other identified a 5% improvement with remote training.
CONCLUSION
Alternative training approaches are a viable option to reduce the barriers to care and to alleviate training burden. Intentional implementation of alternatives should be considered a solution to address current barriers.
Topics: Humans; COVID-19; Diabetes Mellitus
PubMed: 37290557
DOI: 10.1016/j.eprac.2023.05.012 -
Body Image Mar 2024Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing... (Review)
Review
Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma - experienced, anticipated, and internalized - and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English-language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria. A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.
Topics: Humans; Body Image; Weight Prejudice; Feeding and Eating Disorders; Thinness; Cognition
PubMed: 38278088
DOI: 10.1016/j.bodyim.2023.101678 -
Journal of Medical Internet Research Aug 2023Digital therapeutics (DTx), a class of software-based clinical interventions, are promising new technologies that can potentially prevent, manage, or treat a spectrum of... (Review)
Review
BACKGROUND
Digital therapeutics (DTx), a class of software-based clinical interventions, are promising new technologies that can potentially prevent, manage, or treat a spectrum of medical disorders and diseases as well as deliver unprecedented portability for patients and scalability for health care providers. Their adoption and implementation were accelerated by the need for remote care during the COVID-19 pandemic, and awareness about their utility has rapidly grown among providers, payers, and regulators. Despite this, relatively little is known about the capacity of DTx to provide economic value in care.
OBJECTIVE
This study aimed to systematically review and summarize the published evidence regarding the cost-effectiveness of clinical-grade mobile app-based DTx and explore the factors affecting such evaluations.
METHODS
A systematic review of economic evaluations of clinical-grade mobile app-based DTx was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Major electronic databases, including PubMed, Cochrane Library, and Web of Science, were searched for eligible studies published from inception to October 28, 2022. Two independent reviewers evaluated the eligibility of all the retrieved articles for inclusion in the review. Methodological quality and risk of bias were assessed for each included study.
RESULTS
A total of 18 studies were included in this review. Of the 18 studies, 7 (39%) were nonrandomized study-based economic evaluations, 6 (33%) were model-based evaluations, and 5 (28%) were randomized clinical trial-based evaluations. The DTx intervention subject to assessment was found to be cost-effective in 12 (67%) studies, cost saving in 5 (28%) studies, and cost-effective in 1 (6%) study in only 1 of the 3 countries where it was being deployed in the final study. Qualitative deficiencies in methodology and substantial potential for bias, including risks of performance bias and selection bias in participant recruitment, were identified in several included studies.
CONCLUSIONS
This systematic review supports the thesis that DTx interventions offer potential economic benefits. However, DTx economic analyses conducted to date exhibit important methodological shortcomings that must be addressed in future evaluations to reduce the uncertainty surrounding the widespread adoption of DTx interventions.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42022358616; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022358616.
Topics: Humans; Cost-Benefit Analysis; COVID-19; Mobile Applications; Pandemics; Clinical Trials as Topic
PubMed: 37526973
DOI: 10.2196/47094 -
Cureus Oct 2023Robotic assistance in stereoelectroencephalography (SEEG) holds promising potential for enhancing accuracy, efficiency, and safety during electrode placement and... (Review)
Review
Robotic assistance in stereoelectroencephalography (SEEG) holds promising potential for enhancing accuracy, efficiency, and safety during electrode placement and surgical procedures. This systematic review and meta-analysis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and International Prospective Register of Systematic Reviews (PROSPERO) registration, delves into the latest advancements and implications of robotic systems in SEEG, while meticulously evaluating outcomes and safety measures. Among 855 patients suffering from medication-refractory epilepsy who underwent SEEG in 29 studies, averaging 24.6 years in age, the most prevalent robots employed were robotic surgical assistant (ROSA) (450 patients), Neuromate (207), Sinovation (140), and ISys1 (58). A total of 8,184 electrodes were successfully implanted, with an average operative time of 157.2 minutes per procedure and 15.1 minutes per electrode, resulting in an overall mean operative time of 157.7 minutes across all studies. Notably, the mean target point error (TPE) stood at 2.13 mm, the mean entry point error (EPE) at 1.48 mm, and postoperative complications occurred in 7.69% of robotically assisted (RA) SEEG cases (60), with 85% of these complications being asymptomatic. This comprehensive analysis underscores the safety and efficacy of RA-SEEG in patients with medication-refractory epilepsy, characterized by low complication rates, reduced operative time, and precise electrode placement, supporting its widespread adoption in clinical practice, with no discernible differences noted among the various robotic systems.
PubMed: 38021558
DOI: 10.7759/cureus.47675 -
Digital Health 2023Artificial intelligence (AI) technologies are transforming medicine and healthcare. Scholars and practitioners have debated the philosophical, ethical, legal, and... (Review)
Review
BACKGROUND
Artificial intelligence (AI) technologies are transforming medicine and healthcare. Scholars and practitioners have debated the philosophical, ethical, legal, and regulatory implications of medical AI, and empirical research on stakeholders' knowledge, attitude, and practices has started to emerge. This study is a systematic review of published empirical studies of medical AI ethics with the goal of mapping the main approaches, findings, and limitations of scholarship to inform future practice considerations.
METHODS
We searched seven databases for published peer-reviewed empirical studies on medical AI ethics and evaluated them in terms of types of technologies studied, geographic locations, stakeholders involved, research methods used, ethical principles studied, and major findings.
FINDINGS
Thirty-six studies were included (published 2013-2022). They typically belonged to one of the three topics: exploratory studies of stakeholder knowledge and attitude toward medical AI, theory-building studies testing hypotheses regarding factors contributing to stakeholders' acceptance of medical AI, and studies identifying and correcting bias in medical AI.
INTERPRETATION
There is a disconnect between high-level ethical principles and guidelines developed by ethicists and empirical research on the topic and a need to embed ethicists in tandem with AI developers, clinicians, patients, and scholars of innovation and technology adoption in studying medical AI ethics.
PubMed: 37434728
DOI: 10.1177/20552076231186064 -
Journal of Medical Internet Research Dec 2023Embodied conversational agents (ECAs) are advanced human-like interfaces that engage users in natural face-to-face conversations and interactions. These traits position... (Review)
Review
BACKGROUND
Embodied conversational agents (ECAs) are advanced human-like interfaces that engage users in natural face-to-face conversations and interactions. These traits position ECAs as innovative tools for delivering interventions for promoting health-related behavior adoption. This includes motivational interviewing (MI), a therapeutic approach that combines brief interventions with motivational techniques to encourage the adoption of healthier behaviors.
OBJECTIVE
This study aims to identify the health issues addressed by ECAs delivering MI interventions, explore the key characteristics of these ECAs (eg, appearance, dialogue mechanism, emotional model), analyze the implementation of MI principles and techniques within ECAs, and examine the evaluation methods and primary outcomes of studies that use ECAs providing MI interventions.
METHODS
We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) methodology. Our systematic search covered the PubMed, Scopus, IEEE Xplore, ACM Digital, and PsycINFO databases for papers published between January 2008 and December 2022. We included papers describing ECAs developed for delivering MI interventions targeting health-related behaviors and excluded articles that did not describe ECAs with human appearances and without the necessary evaluation or MI explanation. In a multistage process, 3 independent reviewers performed screening and data extraction, and the collected data were synthesized using a narrative approach.
RESULTS
The initial search identified 404 articles, of which 3.5% (n=14) were included in the review. ECAs primarily focused on reducing alcohol use (n=5, 36%), took on female representations (n=9, 64%), and gave limited consideration to user ethnicity (n=9, 64%). Most of them used rules-driven dialogue mechanisms (n=13, 93%), include emotional behavior to convey empathy (n=8, 57%) but without an automatic recognition of user emotions (n=12, 86%). Regarding MI implementation, of 14 studies, 3 (21%) covered all MI principles, 4 (29%) included all processes, and none covered all techniques. Most studies (8/14, 57%) conducted acceptability, usability, and user experience assessments, whereas a smaller proportion (4/14, 29%) used randomized controlled trials to evaluate behavior changes. Overall, the studies reported positive results regarding acceptability, usability, and user experience and showed promising outcomes in changes in attitudes, beliefs, motivation, and behavior.
CONCLUSIONS
This study revealed significant advancements in the use of ECAs for delivering MI interventions aimed at promoting healthier behaviors over the past 15 years. However, this review emphasizes the need for a more in-depth exploration of ECA characteristics. In addition, there is a need for the enhanced integration of MI principles, processes, and techniques into ECAs. Although acceptability and usability have received considerable attention, there is a compelling argument for placing a stronger emphasis on assessing changes in attitudes, beliefs, motivation, and behavior. Consequently, inclusion of more randomized controlled trials is essential for comprehensive intervention evaluations.
Topics: Humans; Female; Motivational Interviewing; Health Behavior; Communication; Motivation; Emotions
PubMed: 38064707
DOI: 10.2196/52097