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Physical Therapy Feb 2024Technology-based interventions offer many opportunities to enhance neurorehabilitation, with associated research activity gathering pace. Despite this fact, translation...
OBJECTIVE
Technology-based interventions offer many opportunities to enhance neurorehabilitation, with associated research activity gathering pace. Despite this fact, translation for use in clinical practice has lagged research innovation. An overview of the current "state of play" regarding the extent of clinical uptake and factors that might influence use of technologies is required. This scoping review explored the uptake of technologies as neurorehabilitation interventions in clinical practice and factors that are reported to influence their uptake.
METHODS
This systematic scoping review was conducted with narrative synthesis and evidence mapping. Studies of any design reporting uptake or implementation of technology (wearable devices, virtual reality, robotics, and exergaming) for movement neurorehabilitation after stroke and other neurological conditions were sought via a formal search strategy in MEDLINE (Ovid), CINAHL, AMED, and Embase. Full-text screening and data extraction were completed independently by 2 reviewers.
RESULTS
Of 609 studies returned, 25 studies were included after title, abstract, and full-text screening. Studies investigated a range of technologies at various stages of development. Only 4 of the included studies explored the sustained use of technology in practice. The following 5 themes representing experiences of technology use emerged: perceived usefulness, technology design, social interaction, integration with services, and suggested improvements to enhance uptake.
CONCLUSION
Reporting of uptake and use of neurorehabilitation technologies in clinical practice is limited. The synthesis provided comprehensive knowledge of barriers to and facilitators of uptake to be considered in future protocols, including a steep learning curve required to engage with technology, a need for a supportive organizational culture, and a need for user involvement in both design and development.
IMPACT
This scoping review has provided indicators from current evidence of important factors to consider in the planning of research into and clinical implementation of technologies for neurorehabilitation. It serves to support an evidence-based, user-centered platform for improved research on and translation of technologies in neurorehabilitation clinical practice.
Topics: Humans; Neurological Rehabilitation; Health Personnel; Virtual Reality
PubMed: 37856528
DOI: 10.1093/ptj/pzad140 -
Neurosurgical Review Apr 2022The COVID-19 pandemic has disrupted neurosurgical training worldwide, with the shutdown of academic institutions and the reduction of elective surgical procedures. This... (Review)
Review
The COVID-19 pandemic has disrupted neurosurgical training worldwide, with the shutdown of academic institutions and the reduction of elective surgical procedures. This impact has disproportionately affected LMICs (lower- and/or middle-income countries), already burdened by a lack of neurosurgical resources. Thus, a systematic review was conducted to examine these challenges and innovations developed to adapt effective teaching and learning for medical students and neurosurgical trainees. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and The Cochrane Handbook of Systematic Reviews of Interventions. MEDLINE, PubMed, Embase and Cochrane databases were accessed, searching and screening literature from December 2019 to 5th December 2020 with set inclusion and exclusion criteria. Screening identified 1254 articles of which 26 were included, providing data from 96 countries. Twenty-three studies reported transition to online learning, with 8 studies also mentioned redeployment into COVID wards with 2 studies mentioning missed surgical exposure as a consequence. Of 7 studies conducted in LMICs, 3 reported residents suffering financial insecurities from reduced surgical caseload and recession. Significant global disruption in neurosurgical teaching and training has arisen from the COVID-19 pandemic. Decreased surgical exposure has negatively impacted educational provision. However, advancements in virtual technology have allowed for more affordable, accessible training especially in LMICs. Using this, initiatives to reduce physical and mental stress experienced by trainees should be paramount.
Topics: COVID-19; Humans; Neurosurgery; Pandemics
PubMed: 34623526
DOI: 10.1007/s10143-021-01664-5 -
BMC Medical Education Apr 2022Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the...
BACKGROUND
Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs.
METHODS
Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions.
RESULTS
The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs.
CONCLUSION
Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.
Topics: Attitude; Humans; Medicine; Physicians; Reproducibility of Results
PubMed: 35443679
DOI: 10.1186/s12909-022-03278-x -
International Journal of Environmental... Nov 2022The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The... (Review)
Review
The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The evolution of telemedicine poses a series of clinical and medicolegal considerations. However, only a few articles have dealt with telemedicine and orthopedics. This review assesses the ethical and medicolegal issues related to tele-orthopedics. A systematic review was performed including papers published between 2017 and 2021 focusing on the main medicolegal and clinical-governance aspects of tele-orthopedics. Most of the articles were published during the COVID-19 pandemic, confirming the impetus that the pandemic has also given to the spread of telemedicine in the orthopedic field. The areas of interest dealt with in the scientific evidence, almost exclusively produced in the USA, Europe, the UK, and Canada, are quality, patient satisfaction, and safety. The impact of telemedicine in orthopedics has not yet been fully evaluated and studied in terms of the potential medicolegal concerns. Most of the authors performed qualitative studies with poor consistency. Authorizations and accreditations, protection of patient confidentiality, and professional responsibility are issues that will certainly soon emerge.
Topics: Humans; Pandemics; COVID-19; Telemedicine; Delivery of Health Care; Orthopedics
PubMed: 36497728
DOI: 10.3390/ijerph192315653 -
Journal of Cutaneous Medicine and... 2024Telemedicine use has been increasing especially during the COVID-19 pandemic. Various studies have outlined benefits of telemedicine including improving health equity,... (Meta-Analysis)
Meta-Analysis Review
Telemedicine use has been increasing especially during the COVID-19 pandemic. Various studies have outlined benefits of telemedicine including improving health equity, reducing wait times, and cost-effectiveness. Skin diseases such as atopic dermatitis (AD) may potentially be managed via telemedicine. However, there are no evidence-based recommendations for best practices in telemedicine for assessing AD patients. The objective of this review is to assess and summarize current evidence on telemedicine modalities for AD. This review will assess patient outcomes from various telemedicine models for AD. A review protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Two reviewers independently screened potential studies and extracted data. Studies were included if they evaluated any telemedicine assessment for AD. Of 2719 identified records, 5 reports were included. Two reports used the direct-access online model, 1 used web-based consultation, 1 used e-health through a personal eczema portal, and 1 used an online platform and mobile application. All models were variations of the asynchronous, store and forward model. In all the included reports, teledermatology for the follow-up of patients with AD was effective and equivalent when compared to in-person appointments or standard treatment for their respective key outcome measures. However, it is unclear what the most effective teledermatology model is due to significant heterogeneity between studies. Teledermatology may serve as an important tool for triaging and follow-up of patients with AD. More studies are needed to determine which teledermatology models are most effective for virtual assessment of AD.
Topics: Humans; Dermatology; Dermatitis, Atopic; Pandemics; Skin Diseases; Telemedicine
PubMed: 38205736
DOI: 10.1177/12034754231223694 -
Reviews in Endocrine & Metabolic... Feb 2024In the last years growing evidences on the role of radiomics and machine learning (ML) applied to different nuclear medicine imaging modalities for the assessment of... (Review)
Review
BACKGROUND
In the last years growing evidences on the role of radiomics and machine learning (ML) applied to different nuclear medicine imaging modalities for the assessment of thyroid diseases are starting to emerge. The aim of this systematic review was therefore to analyze the diagnostic performances of these technologies in this setting.
METHODS
A wide literature search of the PubMed/MEDLINE, Scopus and Web of Science databases was made in order to find relevant published articles about the role of radiomics or ML on nuclear medicine imaging for the evaluation of different thyroid diseases.
RESULTS
Seventeen studies were included in the systematic review. Radiomics and ML were applied for assessment of thyroid incidentalomas at F-FDG PET, evaluation of cytologically indeterminate thyroid nodules, assessment of thyroid cancer and classification of thyroid diseases using nuclear medicine techniques.
CONCLUSION
Despite some intrinsic limitations of radiomics and ML may have affect the results of this review, these technologies seem to have a promising role in the assessment of thyroid diseases. Validation of preliminary findings in multicentric studies is needed to translate radiomics and ML approaches in the clinical setting.
Topics: Humans; Fluorodeoxyglucose F18; Machine Learning; Nuclear Medicine; Radiomics; Thyroid Neoplasms; Thyroid Nodule; Thyroid Diseases
PubMed: 37434097
DOI: 10.1007/s11154-023-09822-4 -
Nursing Open May 2022This review aimed to elucidate research trends in global nursing in international literature. (Review)
Review
AIM
This review aimed to elucidate research trends in global nursing in international literature.
DESIGN
A scoping literature review of the PRISMA was used to guide the review.
METHODS
PubMed was used to search for English articles published in academic journals between 2016-2018. The search keywords were "global/international/world nursing." We used thematic synthesis to analyse and interpret the data and generated topics for global nursing literature.
RESULTS
In total, 133 articles were analysed. Six topics emerged: (a) conceptualization of global nursing, (b) environmental health, (c) infectious diseases, (d) security efforts, (e) global shortage of nursing personnel and (f) diversification of study abroad programmes. The results of this review reflect today's serious international health, labour and global environmental issues. Based on these latest global nursing topics, it is necessary to develop new strategies, nursing models and environment-related theories to create and maintain a healthy environment.
Topics: Environmental Health; Global Health; Publications
PubMed: 34021729
DOI: 10.1002/nop2.938 -
JMIR MHealth and UHealth Sep 2022The popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and... (Review)
Review
BACKGROUND
The popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and chronic condition management.
OBJECTIVE
This review aimed to identify behavior change techniques (BCTs) commonly used in mHealth, assess their effectiveness based on the evidence reported in interventions and reviews to highlight the most appropriate techniques to design an optimal strategy to improve adherence to data reporting, and provide recommendations for future interventions and research.
METHODS
We performed a systematic review of studies published between 2010 and 2021 in relevant scientific databases to identify and analyze mHealth interventions using BCTs that evaluated their effectiveness in terms of user adherence. Search terms included a mix of general (eg, data, information, and adherence), computer science (eg, mHealth and BCTs), and medicine (eg, personalized medicine) terms.
RESULTS
This systematic review included 24 studies and revealed that the most frequently used BCTs in the studies were feedback and monitoring (n=20), goals and planning (n=14), associations (n=14), shaping knowledge (n=12), and personalization (n=7). However, we found mixed effectiveness of the techniques in mHealth outcomes, having more effective than ineffective outcomes in the evaluation of apps implementing techniques from the feedback and monitoring, goals and planning, associations, and personalization categories, but we could not infer causality with the results and suggest that there is still a need to improve the use of these and many common BCTs for better outcomes.
CONCLUSIONS
Personalization, associations, and goals and planning techniques were the most used BCTs in effective trials regarding adherence to mHealth apps. However, they are not necessarily the most effective since there are studies that use these techniques and do not report significant results in the proposed objectives; there is a notable overlap of BCTs within implemented app components, suggesting a need to better understand best practices for applying (a combination of) such techniques and to obtain details on the specific BCTs used in mHealth interventions. Future research should focus on studies with longer follow-up periods to determine the effectiveness of mHealth interventions on behavior change to overcome the limited evidence in the current literature, which has mostly small-sized and single-arm experiments with a short follow-up period.
Topics: Behavior Therapy; Humans; Mobile Applications; Precision Medicine; Self Report; Telemedicine
PubMed: 36083606
DOI: 10.2196/33247 -
Systematic Reviews Apr 2020The importance of teaching the skills and practice of evidence-based medicine (EBM) for medical professionals has steadily grown in recent years. Alongside this growth...
BACKGROUND
The importance of teaching the skills and practice of evidence-based medicine (EBM) for medical professionals has steadily grown in recent years. Alongside this growth is a need to evaluate the effectiveness of EBM curriculum as assessed by competency in the five 'A's': asking, acquiring, appraising, applying and assessing (impact and performance). EBM educators in medical education will benefit from a compendium of existing assessment tools for assessing EBM competencies in their settings. The purpose of this review is to provide a systematic review and taxonomy of validated tools that evaluate EBM teaching in medical education.
METHODS
We searched MEDLINE, EMBASE, Cochrane library, Educational Resources Information Centre (ERIC), Best Evidence Medical Education (BEME) databases and references of retrieved articles published between January 2005 and March 2019. We have presented the identified tools along with their psychometric properties including validity, reliability and relevance to the five domains of EBM practice and dimensions of EBM learning. We also assessed the quality of the tools to identify high quality tools as those supported by established interrater reliability (if applicable), objective (non-self-reported) outcome measures and achieved ≥ 3 types of established validity evidence. We have reported our study in accordance with the PRISMA guidelines.
RESULTS
We identified 1719 potentially relevant articles of which 63 full text articles were assessed for eligibility against inclusion and exclusion criteria. Twelve articles each with a unique and newly identified tool were included in the final analysis. Of the twelve tools, all of them assessed the third step of EBM practice (appraise) and four assessed just that one step. None of the twelve tools assessed the last step of EBM practice (assess). Of the seven domains of EBM learning, ten tools assessed knowledge gain, nine assessed skills and-one assessed attitude. None addressed reaction to EBM teaching, self-efficacy, behaviours or patient benefit. Of the twelve tools identified, six were high quality. We have also provided a taxonomy of tools using the CREATE framework, for EBM teachers in medical education.
CONCLUSIONS
Six tools of reasonable validity are available for evaluating most steps of EBM and some domains of EBM learning. Further development and validation of tools that evaluate all the steps in EBM and all educational outcome domains are needed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42018116203.
Topics: Clinical Competence; Curriculum; Education, Medical; Evidence-Based Medicine; Humans; Learning; Reproducibility of Results; Teaching
PubMed: 32331530
DOI: 10.1186/s13643-020-01311-y -
European Journal of Surgical Oncology :... May 2022Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and... (Review)
Review
BACKGROUND AND PURPOSE
Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews.
MATERIAL AND METHODS
A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models.
RESULTS
Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy.
CONCLUSION
A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.
Topics: Fee-for-Service Plans; Humans; Neoplasms; Radiation Oncology; Reimbursement Mechanisms; Surgical Oncology
PubMed: 34479744
DOI: 10.1016/j.ejso.2021.08.018