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Adolescent Health, Medicine and... 2023Eating disorders (EDs) are serious psychiatric illnesses that typically develop during adolescence and emerging adulthood. Early intervention is important for improved... (Review)
Review
Eating disorders (EDs) are serious psychiatric illnesses that typically develop during adolescence and emerging adulthood. Early intervention is important for improved outcomes for young people with EDs, yet help-seeking is low and individuals often have a significantly protracted start to treatment, suggesting that early intervention is not well established in the ED field. Previous reviews on facilitators and barriers to early intervention for EDs largely cover perceived barriers related to patient variables and perspectives, whereas clinician-, service-, and healthcare system-related facilitators and barriers are less frequently reviewed. The aim of this review is to synthesize the literature on barriers to and facilitators of early intervention for EDs, regarding patient-, clinician-, service-, and healthcare system-related factors. A narrative review was conducted by searching for relevant peer-reviewed, English-language articles published up until July 2023 on PubMed and PsychINFO. The search was conducted in two steps. First, key search terms were used to identify existing reviews and meta-analyses on facilitators and barriers to early intervention for EDs. Then, additional search terms were added to search for primary and secondary research on patient/family, clinician, service, and healthcare system-related barriers and facilitators. The identified literature shows that, after overcoming intrinsic, motivational barriers (such as self-stigma, denial, and ambivalence), help-seeking individuals may be met with long service waiting lists and limited treatment options. Despite these barriers, there is ongoing research into early intervention in practice, which aims to reach underserved populations and facilitate early intervention despite high service demands and shortages of trained healthcare professionals. Funding for ED research and services has historically been low, and there is also a research-practice gap. This highlights the need for increased consideration of, and funding for early intervention for EDs, to remove barriers as well as facilitate discussions around how to make early intervention programs scalable and sustainable.
PubMed: 38074446
DOI: 10.2147/AHMT.S415698 -
Medicine May 2024This paper examines the legal challenges associated with medical robots, including their legal status, liability in cases of malpractice, and concerns over patient data... (Review)
Review
This paper examines the legal challenges associated with medical robots, including their legal status, liability in cases of malpractice, and concerns over patient data privacy and security. And this paper scrutinizes China's nuanced response to these dilemmas. An analysis of Chinese judicial practices and legislative actions reveals that current denial of legal personality to AI at this stage is commendable. To effectively control the financial risks associated with medical robots, there is an urgent need for clear guidelines on responsibility allocation for medical accidents involving medical robots, the implementation of strict data protection laws, and the strengthening of industry standards and regulations.
Topics: Humans; Liability, Legal; China; Robotics; Malpractice; Computer Security; Confidentiality
PubMed: 38788002
DOI: 10.1097/MD.0000000000038330 -
The Journal of Allergy and Clinical... Aug 2023Hereditary angioedema (HAE) is a rare and potentially fatal genetic disease associated with recurrent and unpredictable episodes of angioedema. Although modern therapies...
BACKGROUND
Hereditary angioedema (HAE) is a rare and potentially fatal genetic disease associated with recurrent and unpredictable episodes of angioedema. Although modern therapies have dramatically increased quality of life, insurance changes, delays, and denials are becoming more common.
OBJECTIVE
To examine the impact of insurance delays and denials on patient health and well-being.
METHODS
A total of 20 patients with HAE (type 1 and 2) who recently experienced insurance delays or denials completed an online survey, and 19 participated in a follow-up focus group. The survey and focus group addressed the impact of insurance challenges on the use of health care services, work/school attendance, and anxiety. Three independent reviewers coded each focus group transcript using a thematic saturation approach.
RESULTS
A total of 70% of participants reported an increased frequency of angioedema attacks resulting from insurance delays or denials. More than 50% missed work/school days because of increased attacks, and 90% reported greater anxiety. Twenty-five percent of respondents reported more urgent care or emergency department visits. In focus groups, participants identified specific ways that losing access to medication had a negative impact on their health, family, and work/school life. Insufficient notification of health insurance policy changes and the time and effort required to regain access to medications compounded patients' frustration and anxiety.
CONCLUSION
Insurance delays and denials have significant impacts on individuals with HAE including (1) increased urgent care and emergency department visits, (2) missed work/school days, (3) higher levels of anxiety, and (4) a negative impact on family life.
Topics: Humans; Angioedemas, Hereditary; Quality of Life; Angioedema; Insurance, Health; Insurance Coverage
PubMed: 37558360
DOI: 10.1016/j.jaip.2023.03.006 -
International Journal For Equity in... Aug 2023Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely...
BACKGROUND
Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely reported mistreatment in healthcare settings. Mistreatment is enacted by individuals within society who hold stigmatizing beliefs. However, the relationship between healthcare mistreatment and societal stigma (i.e., the degree to which society disapproves of GM people) is unclear and not measured consistently.
METHODS
We analyzed data from 2,031 GM participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study's 2019 Annual Questionnaire to determine whether societal stigma was associated with participants' past-year reports of mistreatment (defined as denial of healthcare services and/or lower quality care) in medical or mental healthcare settings. We created a proxy measure of societal stigma by incorporating variables validated in existing literature. Participants reported whether they had experienced mistreatment in medical and mental health settings independently.
RESULTS
Healthcare denial and/or lower quality care during the past year was reported by 18.8% of our sample for medical settings and 12.5% for mental health settings. We found no associations between the societal stigma variables and past-year reports of healthcare denial and/or lower quality care in medical or mental healthcare settings.
CONCLUSIONS
Although a high proportion of GM people reported past-year healthcare mistreatment in both medical and mental health settings, mistreatment had no relationship with societal stigma. Factors other than societal stigma may be more important predictors of healthcare mistreatment, such as healthcare workers' knowledge of and attitudes toward GM people. However, other measures of societal stigma, or different types of mistreatment, may show stronger associations. Identifying key factors that contribute to mistreatment can serve as targets for intervention in communities and healthcare settings.
Topics: Infant, Newborn; Humans; Cross-Sectional Studies; Health Facilities; Social Stigma; Sexual and Gender Minorities; Delivery of Health Care
PubMed: 37620832
DOI: 10.1186/s12939-023-01975-7 -
JAMA Network Open Oct 2023Prior authorization (PA) requires clinicians and patients to navigate a complex approval pathway. Resultant delays and denials can be particularly problematic for...
IMPORTANCE
Prior authorization (PA) requires clinicians and patients to navigate a complex approval pathway. Resultant delays and denials can be particularly problematic for patients with cancer, who often need urgent treatment or symptom management.
OBJECTIVE
To investigate the patient perspective of PA for cancer-related care, including perceptions about the process, outcomes (including delays and denials), and patient administrative burden.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional, anonymous survey used a convenience sample of patients with PA experience. Participants were recruited using social media and email lists of US-based cancer advocacy organizations from July 1 to October 6, 2022.
EXPOSURE
Prior authorization for any cancer-related service.
MAIN OUTCOMES AND MEASURES
Delays to care, outcome of PA, communication, and changes in anxiety (measured on a scale of 0-100, with 0 indicating no anxiety and higher scores indicating higher levels of anxiety) and trust.
RESULTS
Of 178 respondents (158 women [88%], 151 non-Hispanic White respondents [84%], 164 respondents [92%] <65 years), 112 (63%) reported that their cancer care was approved and given as recommended, and 39 (22%) did not receive recommended care due to delays or denials. Most respondents (123 [69%]) reported a PA-related delay in care; of those with delayed care, 90 (73%) reported a delay of 2 or more weeks. Most respondents (119 [67%]) had to personally become involved in the PA process; 35 (20%) spent 11 or more hours dealing with PA issues. Overall, the PA experience was rated as bad (70 [40%]) or horrible (55 of 174 [32%]); ratings were associated with the length of delay (ρ = 0.36; P < .001) and the time spent on PA (ρ = 0.42; P < .001). Self-reported PA-related anxiety was higher than usual anxiety (mean [SD] score, 74.7 [20.2] vs 37.5 [22.6]; P < .001) and was correlated with delay length (ρ = 0.16; P = .04), time spent on PA (ρ = 0.27; P < .001), and overall PA experience (ρ = 0.34; P < .001). After PA, 159 respondents (89%) trusted their insurance company less, and 148 respondents (83%) trusted the health care system less. Patient involvement in the PA process was associated with increased odds of distrusting their insurance company (β = 6.0; 95% CI, 1.9-19.2) and the health care system (β = 3.3; 95% CI, 1.4-8.1) and of having a negative experience (β = 6.6; 95% CI, 3.1-14.3).
CONCLUSIONS AND RELEVANCE
This survey-based cross-sectional study of the patient experience with PA highlights an adverse outcome of PA: 22% of patients did not receive the care recommended by their treatment team because of PA. Most respondents experienced a delay in recommended oncology care, and delays were associated with increased anxiety, a negative perception of the PA process, and patient administrative burden.
Topics: Humans; Female; Prior Authorization; Cross-Sectional Studies; Surveys and Questionnaires; Neoplasms; Patient Outcome Assessment
PubMed: 37851442
DOI: 10.1001/jamanetworkopen.2023.38182 -
Mathematical Biosciences and... Sep 2023In conventional message communication systems, the practice of multi-message multi-receiver signcryption communication encounters several challenges, including the...
In conventional message communication systems, the practice of multi-message multi-receiver signcryption communication encounters several challenges, including the vulnerability to Key Generation Center (KGC) attacks, privacy breaches and excessive communication data volume. The KGC necessitates a secure channel to transmit partial private keys, thereby rendering the security of these partial private keys reliant on the integrity of the interaction channel. This dependence introduces concerns regarding the confidentiality of the private keys. Our proposal advocates for the substitution of the KGC in traditional certificateless schemes with blockchain and smart contract technology. Parameters are publicly disclosed on the blockchain, leveraging its tamper-proof property to ensure security. Furthermore, this scheme introduces conventional encryption techniques to achieve user identity privacy in the absence of a secure channel, effectively resolving the issue of user identity disclosure inherent in blockchain-based schemes and enhancing communication privacy. Moreover, users utilize smart contract algorithms to generate a portion of the encrypted private key, thereby minimizing the possibility of third-party attacks. In this paper, the scheme exhibits resilience against various attacks, including KGC leakage attacks, internal privilege attacks, replay attacks, distributed denial of service attacks and Man-in-the-Middle (MITM) attacks. Additionally, it possesses desirable security attributes such as key escrow security and non-repudiation. The proposed scheme has been theoretically and experimentally analyzed under the random oracle model, based on the computational Diffie-Hellman problem and the discrete logarithm problem. It has been proven to possess confidentiality and unforgeability. Compared with similar schemes, our scheme has lower computational cost and shorter ciphertext length. It has obvious advantages in communication and time overhead.
PubMed: 38052552
DOI: 10.3934/mbe.2023806 -
Critical Care Explorations Sep 2023Competing definitions of sepsis have significant clinical implications and impact both medical coding and hospital payment. Although clinicians may prefer Sepsis-2,...
Competing definitions of sepsis have significant clinical implications and impact both medical coding and hospital payment. Although clinicians may prefer Sepsis-2, payer use of Sepsis-3 to validate clinical diagnoses may result in denial of payment or requests to recoup previously paid funds from healthcare providers. The Sepsis-2.5 project was a cooperative effort between a hospital system and a private payer to develop a community-based, literature-supported consensus definition for sepsis characterized by the presence of clinical illness, a source of infection, and evidence of organ dysfunction. This new definition ("Sepsis-2.5") has been instrumental in resolving provider-payer conflicts in defining clinical sepsis and reimbursing care.
PubMed: 37644973
DOI: 10.1097/CCE.0000000000000970 -
HealthcarePapers Jul 2023Despite notions of colour-blindness and denials of widespread systemic racism, anti-Black racism remains inherent in the political, economic, educational and healthcare...
Despite notions of colour-blindness and denials of widespread systemic racism, anti-Black racism remains inherent in the political, economic, educational and healthcare systems in Europe. We use the Netherlands as a case study to explore some of these mechanisms. Here, we discuss how a focus on cultural deficiency and the denial of racism allows the bearers of inequality and inequity to be blamed for their own disenfranchisement. Nonetheless, scholars in the Netherlands continue to show how everyday racism is negatively impacting marginalized people's lives and their access to the social determinants of health and well-being in society.
Topics: Humans; Racism; Antiracism; Delivery of Health Care
PubMed: 37887166
DOI: 10.12927/hcpap.2023.27195 -
Family Medicine and Community Health Jul 2023General practice receptionists provide an essential function in the healthcare system but routinely encounter acts of incivility and aggression from patients, including...
OBJECTIVE
General practice receptionists provide an essential function in the healthcare system but routinely encounter acts of incivility and aggression from patients, including hostility, abuse and violence. This study was conducted to summarise what is known about patient-initiated aggression towards general practice receptionists, including impacts on reception staff and existing mitigation strategies.
DESIGN
Systematic review with convergent integrated synthesis.
ELIGIBILITY CRITERIA
Studies published at any time in English that examine patient aggression experiences of reception staff in primary care settings.
INFORMATION SOURCES
Searches of five major databases were performed (CINAHL Complete, Scopus, PubMed, Healthcare Administration Database and Google Scholar) to August 2022.
RESULTS
Twenty studies of various designs were included, ranging from the late 1970s to 2022 and originating from five OECD countries. Twelve were assessed as high quality using a validated checklist. Reviewed articles represented 4107 participants; 21.5% were general practice receptionists. All studies reported that displays of aggression towards receptionists by patients were a frequent and routine occurrence in general practice, particularly verbal abuse such as shouting, cursing, accusations of malicious behaviour and use of racist, ablest and sexist insults. Although infrequent, physical violence was widely reported. Inefficient appointment scheduling systems, delayed access to doctors and prescription denial appeared common precipitators. Receptionists adapted their behaviour and demeanour to placate and please patients to avoid escalation of patient frustrations at the cost of their own well-being and clinic productivity. Training in patient aggression management increased receptionist confidence and appeared to decrease negative sequalae. Coordinated support for general practice reception staff who had experienced patient aggression was generally lacking, with a small proportion receiving professional counselling.
CONCLUSIONS
Patient aggression towards reception staff is a serious workplace safety concern for general practices and negatively affects healthcare sector function more broadly. Receptionists in general practice deserve evidence-based measures to improve their working conditions and well-being for their own benefit and that of the community.
REGISTRATION
Pre-registered in Open Science Framework (osf.io/42p85).
Topics: Humans; Aggression; Family Practice; General Practice; Violence; Physicians
PubMed: 37414572
DOI: 10.1136/fmch-2023-002171 -
Sensors (Basel, Switzerland) Oct 2023Current vehicles include electronic features that provide ease and convenience to drivers. These electronic features or nodes rely on in-vehicle communication protocols...
Current vehicles include electronic features that provide ease and convenience to drivers. These electronic features or nodes rely on in-vehicle communication protocols to ensure functionality. One of the most-widely adopted in-vehicle protocols on the market today is the Controller Area Network, popularly referred to as the CAN bus. The CAN bus is utilized in various modern, sophisticated vehicles. However, as the sophistication levels of vehicles continue to increase, we now see a high rise in attacks against them. These attacks range from simple to more-complex variants, which could have detrimental effects when carried out successfully. Therefore, there is a need to carry out an assessment of the security vulnerabilities that could be exploited within the CAN bus. In this research, we conducted a security vulnerability analysis on the CAN bus protocol by proposing an attack scenario on a CAN bus simulation that exploits the arbitration feature extensively. This feature determines which message is sent via the bus in the event that two or more nodes attempt to send a message at the same time. It achieves this by prioritizing messages with lower identifiers. Our analysis revealed that an attacker can spoof a message ID to gain high priority, continuously injecting messages with the spoofed ID. As a result, this prevents the transmission of legitimate messages, impacting the vehicle's operations. We identified significant risks in the CAN protocol, including spoofing, injection, and Denial of Service. Furthermore, we examined the latency of the CAN-enabled system under attack, finding that the compromised node (the attacker's device) consistently achieved the lowest latency due to message arbitration. This demonstrates the potential for an attacker to take control of the bus, injecting messages without contention, thereby disrupting the normal operations of the vehicle, which could potentially compromise safety.
PubMed: 37837053
DOI: 10.3390/s23198223