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Academic Medicine : Journal of the... Apr 2022To identify features of instruments, test procedures, study design, and validity evidence in published studies of electrocardiogram (ECG) skill assessments.
PURPOSE
To identify features of instruments, test procedures, study design, and validity evidence in published studies of electrocardiogram (ECG) skill assessments.
METHOD
The authors conducted a systematic review, searching MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, ERIC, and Web of Science databases in February 2020 for studies that assessed the ECG interpretation skill of physicians or medical students. Two authors independently screened articles for inclusion and extracted information on test features, study design, risk of bias, and validity evidence.
RESULTS
The authors found 85 eligible studies. Participants included medical students (42 studies), postgraduate physicians (48 studies), and practicing physicians (13 studies). ECG selection criteria were infrequently reported: 25 studies (29%) selected single-diagnosis or straightforward ECGs; 5 (6%) selected complex cases. ECGs were selected by generalists (15 studies [18%]), cardiologists (10 studies [12%]), or unspecified experts (4 studies [5%]). The median number of ECGs per test was 10. The scoring rubric was defined by 2 or more experts in 32 studies (38%), by 1 expert in 5 (6%), and using clinical data in 5 (6%). Scoring was performed by a human rater in 34 studies (40%) and by computer in 7 (8%). Study methods were appraised as low risk of selection bias in 16 studies (19%), participant flow bias in 59 (69%), instrument conduct and scoring bias in 20 (24%), and applicability problems in 56 (66%). Evidence of test score validity was reported infrequently, namely evidence of content (39 studies [46%]), internal structure (11 [13%]), relations with other variables (10 [12%]), response process (2 [2%]), and consequences (3 [4%]).
CONCLUSIONS
ECG interpretation skill assessments consist of idiosyncratic instruments that are too short, composed of items of obscure provenance, with incompletely specified answers, graded by individuals with underreported credentials, yielding scores with limited interpretability. The authors suggest several best practices.
Topics: Delivery of Health Care; Electrocardiography; Humans; Physicians; Research Personnel; Students, Medical
PubMed: 33913438
DOI: 10.1097/ACM.0000000000004140 -
Journal of Medical Internet Research May 2021Digital health technologies (DHTs) generate a large volume of information used in health care for administrative, educational, research, and clinical purposes. The... (Review)
Review
BACKGROUND
Digital health technologies (DHTs) generate a large volume of information used in health care for administrative, educational, research, and clinical purposes. The clinical use of digital information for diagnostic, therapeutic, and prognostic purposes has multiple patient safety problems, some of which result from poor information quality (IQ).
OBJECTIVE
This systematic review aims to synthesize an IQ framework that could be used to evaluate the extent to which digital health information is fit for clinical purposes.
METHODS
The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We searched Embase, MEDLINE, PubMed, CINAHL, Maternity and Infant Care, PsycINFO, Global Health, ProQuest Dissertations and Theses Global, Scopus, and HMIC (the Health Management Information Consortium) from inception until October 2019. Multidimensional IQ frameworks for assessing DHTs used in the clinical context by health care professionals were included. A thematic synthesis approach was used to synthesize the Clinical Information Quality (CLIQ) framework for digital health.
RESULTS
We identified 10 existing IQ frameworks from which we developed the CLIQ framework for digital health with 13 unique dimensions: accessibility, completeness, portability, security, timeliness, accuracy, interpretability, plausibility, provenance, relevance, conformance, consistency, and maintainability, which were categorized into 3 meaningful categories: availability, informativeness, and usability.
CONCLUSIONS
This systematic review highlights the importance of the IQ of DHTs and its relevance to patient safety. The CLIQ framework for digital health will be useful in evaluating and conceptualizing IQ issues associated with digital health, thus forestalling potential patient safety problems.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42018097142; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=97142.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1136/bmjopen-2018-024722.
Topics: Delivery of Health Care; Female; Humans; Pregnancy
PubMed: 33835034
DOI: 10.2196/23479 -
Clinical Kidney Journal Feb 2021Respiratory tract infections (RTIs) are a common reason for people to seek medical care. RTIs are associated with high short-term mortality. Inconsistent evidence exists...
BACKGROUND
Respiratory tract infections (RTIs) are a common reason for people to seek medical care. RTIs are associated with high short-term mortality. Inconsistent evidence exists in the association between the presence of kidney disease and the risk of death in patient with RTIs.
METHODS
We searched the PubMed, Cochrane Library and Embase databases from inception through April 2019 for cohort and case-control studies investigating the presence of kidney disease (defined as medical diagnosis of kidney disease, reduced estimated glomerular filtration rate or creatinine clearance, elevated serum creatinine and proteinuria) on mortality in adults with RTIs in different settings including community, inpatient and intensive care units. We assessed the quality of the included studies using Cochrane Collaboration's tool and conducted a meta-analysis on the relative risk (RR) of death.
RESULTS
Of 5362 records identified, 18 studies involving 16 676 participants met the inclusion criteria, with 15 studies investigating pneumonia and 3 studies exploring influenza. The risk of bias in the available evidence was moderate. Most [17/18 (94.5%)] of studies reported positive associations of underlying chronic kidney disease with mortality. The pooled adjusted risk for all-cause mortality in patients with RTIs almost doubled [RR 1.96 (95% confidence interval 1.48-2.59)] in patients with kidney disease. Associations were consistent across different timings of kidney disease assessment and provenances of RTIs (community-acquired or healthcare-associated).
CONCLUSIONS
The presence of kidney disease is associated with higher mortality among people with RTIs, especially in those with pneumonia. The presence of kidney disease might be taken into account when considering admission for patients who present with RTIs.
PubMed: 33623685
DOI: 10.1093/ckj/sfz188 -
European Respiratory Review : An... Dec 2020Lung volume reduction (LVR) treatment in patients with severe emphysema has been shown to have a positive effect on hyperinflation, expiratory flow, exercise capacity... (Review)
Review
Lung volume reduction (LVR) treatment in patients with severe emphysema has been shown to have a positive effect on hyperinflation, expiratory flow, exercise capacity and quality of life. However, the effects on diffusing capacity of the lungs and gas exchange are less clear. In this review, the possible mechanisms by which LVR treatment can affect diffusing capacity of the lung for carbon monoxide ( ) and arterial gas parameters are discussed, the use of in LVR treatment is evaluated and other diagnostic techniques reflecting diffusing capacity and regional ventilation (')/perfusion (') mismatch are considered.A systematic review of the literature was performed for studies reporting on and arterial blood gas parameters before and after LVR surgery or endoscopic LVR with endobronchial valves (EBV). after these LVR treatments improved (40 studies, n=1855) and the mean absolute change from baseline in % predicted was +5.7% (range -4.6% to +29%), with no real change in blood gas parameters. Improvement in ' inhomogeneity and '/' mismatch are plausible explanations for the improvement in after LVR treatment.
Topics: Humans; Lung; Pneumonectomy; Pulmonary Emphysema; Quality of Life; Total Lung Capacity
PubMed: 33115787
DOI: 10.1183/16000617.0171-2019 -
JMIR Medical Informatics Mar 2020Clinical narratives represent the main form of communication within health care, providing a personalized account of patient history and assessments, and offering rich... (Review)
Review
BACKGROUND
Clinical narratives represent the main form of communication within health care, providing a personalized account of patient history and assessments, and offering rich information for clinical decision making. Natural language processing (NLP) has repeatedly demonstrated its feasibility to unlock evidence buried in clinical narratives. Machine learning can facilitate rapid development of NLP tools by leveraging large amounts of text data.
OBJECTIVE
The main aim of this study was to provide systematic evidence on the properties of text data used to train machine learning approaches to clinical NLP. We also investigated the types of NLP tasks that have been supported by machine learning and how they can be applied in clinical practice.
METHODS
Our methodology was based on the guidelines for performing systematic reviews. In August 2018, we used PubMed, a multifaceted interface, to perform a literature search against MEDLINE. We identified 110 relevant studies and extracted information about text data used to support machine learning, NLP tasks supported, and their clinical applications. The data properties considered included their size, provenance, collection methods, annotation, and any relevant statistics.
RESULTS
The majority of datasets used to train machine learning models included only hundreds or thousands of documents. Only 10 studies used tens of thousands of documents, with a handful of studies utilizing more. Relatively small datasets were utilized for training even when much larger datasets were available. The main reason for such poor data utilization is the annotation bottleneck faced by supervised machine learning algorithms. Active learning was explored to iteratively sample a subset of data for manual annotation as a strategy for minimizing the annotation effort while maximizing the predictive performance of the model. Supervised learning was successfully used where clinical codes integrated with free-text notes into electronic health records were utilized as class labels. Similarly, distant supervision was used to utilize an existing knowledge base to automatically annotate raw text. Where manual annotation was unavoidable, crowdsourcing was explored, but it remains unsuitable because of the sensitive nature of data considered. Besides the small volume, training data were typically sourced from a small number of institutions, thus offering no hard evidence about the transferability of machine learning models. The majority of studies focused on text classification. Most commonly, the classification results were used to support phenotyping, prognosis, care improvement, resource management, and surveillance.
CONCLUSIONS
We identified the data annotation bottleneck as one of the key obstacles to machine learning approaches in clinical NLP. Active learning and distant supervision were explored as a way of saving the annotation efforts. Future research in this field would benefit from alternatives such as data augmentation and transfer learning, or unsupervised learning, which do not require data annotation.
PubMed: 32229465
DOI: 10.2196/17984 -
Health Expectations : An International... Aug 2019Numerous frameworks for supporting, evaluating and reporting patient and public involvement in research exist. The literature is diverse and theoretically heterogeneous.
BACKGROUND
Numerous frameworks for supporting, evaluating and reporting patient and public involvement in research exist. The literature is diverse and theoretically heterogeneous.
OBJECTIVES
To identify and synthesize published frameworks, consider whether and how these have been used, and apply design principles to improve usability.
SEARCH STRATEGY
Keyword search of six databases; hand search of eight journals; ancestry and snowball search; requests to experts.
INCLUSION CRITERIA
Published, systematic approaches (frameworks) designed to support, evaluate or report on patient or public involvement in health-related research.
DATA EXTRACTION AND SYNTHESIS
Data were extracted on provenance; collaborators and sponsors; theoretical basis; lay input; intended user(s) and use(s); topics covered; examples of use; critiques; and updates. We used the Canadian Centre for Excellence on Partnerships with Patients and Public (CEPPP) evaluation tool and hermeneutic methodology to grade and synthesize the frameworks. In five co-design workshops, we tested evidence-based resources based on the review findings.
RESULTS
Our final data set consisted of 65 frameworks, most of which scored highly on the CEPPP tool. They had different provenances, intended purposes, strengths and limitations. We grouped them into five categories: power-focused; priority-setting; study-focused; report-focused; and partnership-focused. Frameworks were used mainly by the groups who developed them. The empirical component of our study generated a structured format and evidence-based facilitator notes for a "build your own framework" co-design workshop.
CONCLUSION
The plethora of frameworks combined with evidence of limited transferability suggests that a single, off-the-shelf framework may be less useful than a menu of evidence-based resources which stakeholders can use to co-design their own frameworks.
Topics: Community Participation; Empowerment; Group Processes; Humans; Patient Participation; Research
PubMed: 31012259
DOI: 10.1111/hex.12888 -
Medicine Dec 2018We performed the network meta-analysis (NMA) and systematic review involved all evidence from relevant trials to compare the efficiency and safety of various types of... (Comparative Study)
Comparative Study Meta-Analysis
Comparative efficacy and safety of phosphodiesterase-5 inhibitors with selective serotonin reuptake inhibitors in men with premature ejaculation: A systematic review and Bayesian network meta-analysis.
BACKGROUND
We performed the network meta-analysis (NMA) and systematic review involved all evidence from relevant trials to compare the efficiency and safety of various types of selective serotonin reuptake inhibitors (SSRI) and phosphodiesterase-5 inhibitors (PDE5i) in patients with premature ejaculation (PE).
METHODS
We conducted comprehensive searches of peer-reviewed and grey literature. PubMed, the Cochrane Library Central Register of Controlled Trials, Embase were searched for randomized controlled trials published up to June 1, 2017. The primary outcome was intravaginal ejaculation latency time (IVELT) and adverse effects (AEs). We performed pairwise meta-analyses by random effects model and network meta-analysis by Bayesian model. We used the GRADE framework to assess the quality of evidence contributing to each network estimate.
RESULTS
Of 3046 titles and abstracts initially identified, 17 trials reporting 5739 participants were included. Considering IVELT in the NMA, paroxetine plus sildenafil and sildenafil alone are both superior to placebo (MD: 1.75, 95% CrI: 0.05 to 3.78; MD 1.43, 95% CrI 0.003 to 2.81). Sildenafil is superior to sertraline (MD: 1.63, 95% CrI: 0.10 to 2.79). Considering AEs, placebo demonstrated obviously lower risk comparing to paroxetine, sildenafil and paroxetine plus sildenafil (OR 0.20, 95% CI: 0.05 to 0.52; OR 0.23, 95% CI: 0.04 to 0.80; OR 0.45, 95% CI: 0.01 to 0.92). Compared with tadalafil plus paroxetine, dapoxetine showed significantly less AEs (OR 0.23, 95% CI 0.02 to 0.96).
CONCLUSIONS
Our study concluded that although paroxetine plus sildenafil and sildenafil alone both demonstrated significant IVELT benefit compared with placebo, significant increase of AEs risk was also observed. Furthermore, sildenafil alone was superior to sertraline in efficacy with comparable tolerability.
Topics: Bayes Theorem; Humans; Male; Phosphodiesterase 5 Inhibitors; Premature Ejaculation; Selective Serotonin Reuptake Inhibitors
PubMed: 30544399
DOI: 10.1097/MD.0000000000013342 -
Annals of Work Exposures and Health Nov 2018In epidemiological studies of work-related ill-health only current exposures can, at best, be measured. Previous exposures may be estimated using contemporaneous hygiene...
OBJECTIVES
In epidemiological studies of work-related ill-health only current exposures can, at best, be measured. Previous exposures may be estimated using contemporaneous hygiene records or published data. This study aimed to create a job exposure matrix for exposure in bakers for use in an ongoing cohort study.
METHODS
A systematic review was conducted of English language publications on exposures in bakeries. All publications that appeared to contain quantitative measures of exposure to flour dust, wheat allergen, or fungal α-amylase were read independently by two investigators and relevant data extracted. A third investigator reviewed these data and publications were retained that reported full-shift exposures to inhalable dust, wheat allergen, or α-amylase, and for which geometric means (GMs) were given or could be estimated. For each study, the number of sampling results contributing to each GM was recorded together with information on task, bakery size, product, filter type, sampling head, the country in which the study was conducted, and the estimated year of sampling. Multivariable models were elaborated for each exposure using a linear mixed effects approach. The predictive capacity of the model for inhaled particles was tested against samples collected in eight Alberta bakeries. The capacity of exposure intensity, estimated from each of the three models, to predict sensitization was tested against skin prick testing (SPT) for bakery allergens in bakers currently employed in Alberta.
RESULTS
One thousand three hundred and ninety-seven publications were identified through the systematic search, of which 27 had data used to create one or more of the predictive models. Weighted GMs were used as outcome variables. For inhalable dust, task, bakery size, type of sampling head, and year of sampling contributed to the final model. For wheat allergen and α-amylase, task, bakery size, sampling head, and year of sampling again contributed. Product (bread rather than confectionary or mixed products) was also important in these two latter measures. The model for inhalable dust was used to predict the concentration in 33 samples from Alberta bakeries. Overall, 91% of observed samples had 95% confidence intervals (CIs) overlapping the 95% CIs of the predicted values. A model including the Alberta samples found no effect attributable to Alberta provenance. Using this model for inhalable dust and the models developed solely from the literature for wheat allergen and α-amylase, a positive SPT for bakery allergens in 57 bakers recruited for this study was significantly related to log cumulative exposure for each of the three outcome variables and to log exposure intensity for wheat allergen and α-amylase.
CONCLUSIONS
The exposure models developed from the literature provide useful estimates of exposure. Calibration of the models against locally collected samples may be useful for countries poorly represented in the modeling dataset.
Topics: Air Pollutants, Occupational; Alberta; Allergens; Cohort Studies; Cooking; Dust; Environmental Monitoring; Flour; Humans; Inhalation Exposure; Occupational Exposure; Skin Tests; alpha-Amylases
PubMed: 30184166
DOI: 10.1093/annweh/wxy078 -
Breast Cancer (Dove Medical Press) 2017Stress has been extensively studied as a psychosomatic factor associated with breast cancer. This study aims to review the prevalence of post-traumatic stress disorder... (Review)
Review
A systematic literature review exploring the prevalence of post-traumatic stress disorder and the role played by stress and traumatic stress in breast cancer diagnosis and trajectory.
Stress has been extensively studied as a psychosomatic factor associated with breast cancer. This study aims to review the prevalence of post-traumatic stress disorder (PTSD), its associated risk factors, the role of predicting factors for its early diagnosis/prevention, the implications for co-treatment, and the potential links by which stress could impact cancer risk, by closely examining the literature on breast cancer survivors. The authors systematically reviewed studies published from 2002 to 2016 pertaining to PTSD, breast cancer and PTSD, and breast cancer and stress. The prevalence of PTSD varies between 0% and 32.3% mainly as regards the disease phase, the stage of disease, and the instruments adopted to detect prevalence. Higher percentages were observed when the Clinician Administered PTSD Scale was administered. In regard to PTSD-associated risk factors, no consensus has been reached to date; younger age, geographic provenance with higher prevalence in the Middle East, and the presence of previous cancer diagnosis in the family or relational background emerged as the only variables that were unanimously found to be associated with higher PTSD prevalence. Type C personality can be considered a risk factor, together with low social support. In light of the impact of PTSD on cognitive, social, work-related, and physical functioning, co-treatment of cancer and PTSD is warranted and a multidisciplinary perspective including specific training for health care professionals in communication and relational issues with PTSD patients is mandatory. However, even though a significant correlation was found between stressful life events and breast cancer incidence, an unequivocal implication of distress in breast cancer is hard to demonstrate. For the future, overcoming the methodological heterogeneity represents one main focus. Efficacy studies could help when evaluating the effect of co-treating breast cancer and post-traumatic stress symptoms, even if all the criteria for a Diagnostic and Statistical Manual of Mental Disorders diagnosis are not fulfilled.
PubMed: 28740430
DOI: 10.2147/BCTT.S111101 -
Applied Clinical Informatics Jan 2017Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The...
BACKGROUND
Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The Partnership for Health IT Patient Safety was formed to gather data, conduct analysis, educate, and disseminate safe practices for safer care using health information technology (IT).
OBJECTIVE
To characterize copy and paste events in clinical care, identify safety risks, describe existing evidence, and develop implementable practice recommendations for safe reuse of information via copy and paste.
METHODS
The Partnership 1) reviewed 12 reported safety events, 2) solicited expert input, and 3) performed a systematic literature review (2010 to January 2015) to identify publications addressing frequency, perceptions/attitudes, patient safety risks, existing guidance, and potential interventions and mitigation practices.
RESULTS
The literature review identified 51 publications that were included. Overall, 66% to 90% of clinicians routinely use copy and paste. One study of diagnostic errors found that copy and paste led to 2.6% of errors in which a missed diagnosis required patients to seek additional unplanned care. Copy and paste can promote note bloat, internal inconsistencies, error propagation, and documentation in the wrong patient chart. Existing guidance identified specific responsibilities for authors, organizations, and electronic health record (EHR) developers. Analysis of 12 reported copy and paste safety events was congruent with problems identified from the literature review.
CONCLUSION
Despite regular copy and paste use, evidence regarding direct risk to patient safety remains sparse, with significant study limitations. Drawing on existing evidence, the Partnership developed four safe practice recommendations: 1) Provide a mechanism to make copy and paste material easily identifiable; 2) Ensure the provenance of copy and paste material is readily available; 3) Ensure adequate staff training and education; 4) Ensure copy and paste practices are regularly monitored, measured, and assessed.
Topics: Cooperative Behavior; Documentation; Electronic Health Records; Humans; Medical Informatics; Patient Safety; Stakeholder Participation
PubMed: 28074211
DOI: 10.4338/ACI-2016-09-R-0150