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Current Allergy and Asthma Reports Jul 2024Artificial intelligence (AI), be it neuronal networks, machine learning or deep learning, has numerous beneficial effects on healthcare systems; however, its potential... (Review)
Review
PURPOSE OF REVIEW
Artificial intelligence (AI), be it neuronal networks, machine learning or deep learning, has numerous beneficial effects on healthcare systems; however, its potential applications and diagnostic capabilities for immunologic diseases have yet to be explored. Understanding AI systems can help healthcare workers better assimilate artificial intelligence into their practice and unravel its potential in diagnostics, clinical research, and disease management.
RECENT FINDINGS
We reviewed recent advancements in AI systems and their integration in healthcare systems, along with their potential benefits in the diagnosis and management of diseases. We explored machine learning as employed in allergy diagnosis and its learning patterns from patient datasets, as well as the possible advantages of using AI in the field of research related to allergic reactions and even remote monitoring. Considering the ethical challenges and privacy concerns raised by clinicians and patients with regard to integrating AI in healthcare, we explored the new guidelines adapted by regulatory bodies. Despite these challenges, AI appears to have been successfully incorporated into various healthcare systems and is providing patient-centered solutions while simultaneously assisting healthcare workers. Artificial intelligence offers new hope in the field of immunologic disease diagnosis, monitoring, and management and thus has the potential to revolutionize healthcare systems.
PubMed: 38954325
DOI: 10.1007/s11882-024-01152-y -
AIDS and Behavior Jul 2024Long Acting Injectable (LAI) therapy to treat HIV is an alternative to daily oral medications. The success of early roll-out of LAI to eligible patients requires a...
Long Acting Injectable (LAI) therapy to treat HIV is an alternative to daily oral medications. The success of early roll-out of LAI to eligible patients requires a better understanding of patients' awareness and interest in this novel therapy. We administered an electronic survey to patients attending an urban HIV clinic in the US South. Eligible participants were 18 + years old with a most recent HIV-1 viral load < 200 copies/ml, without any evidence of genotypic resistance to LAI components or chronic hepatitis B. Survey recipients were asked about current treatment, engagement in care, and knowledge of LAI. Between January-April 2023, 480 patients were screened; 319 were eligible, and 155 (49%) completed the survey. The majority (119, 77%) were aware of, and 87 (56%) were interested in LAI. In regression analysis, only age was associated with interest in LAI (OR 0.95, 95% CI 0.92,0.99). Among proposed benefits of injectables, ease of travel without pills, lack of daily pill-taking, and fewer medication interactions were most appealing. Among proposed concerns with injectables, higher cost and insurance coverage of the new medicine were most worrisome. A large majority of people with HIV (PWH) are aware of the newest treatment available, and just over half of our sample expressed interest in LAI. Older age was associated with lower interest in LAI. LAI is appealing for its convenience, privacy, and avoidance of drug interactions, while the increased costs associated with LAI need to be addressed.
PubMed: 38954172
DOI: 10.1007/s10461-024-04423-x -
Journal of Advanced Nursing Jul 2024To describe key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in...
AIM
To describe key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in rural Australian general practice.
DESIGN
Co-design methodology informed by the Experience-Based Co-Design Framework.
METHODS
Consumers, nurses, physicians and key women's health stakeholders participated in a co-design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six-step process for thematic analysis.
RESULTS
Fifty-two participants took part in the co-design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient-approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications.
CONCLUSION
Our approach to experience-based co-design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse-led model of care.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
The co-designed nurse-led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice.
IMPACT
Nurse-led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse-led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025.
REPORTING METHOD
Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.
PATIENT OR PUBLIC CONTRIBUTION
Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.
PubMed: 38953531
DOI: 10.1111/jan.16299 -
Research in Nursing & Health Jul 2024Adolescent health research with biomarker data collection is limited due to difficulties in recruiting and engaging this age group. Thus, successful recruitment,...
Adolescent health research with biomarker data collection is limited due to difficulties in recruiting and engaging this age group. Thus, successful recruitment, engagement, and retention of adolescents in translational research are necessary to elucidate factors influencing mental and physical health conditions, uncover novel biomarkers, and expand prevention and treatment options. This paper describes strategies for effective recruitment and retention of adolescents in a research study, using a project examining depressive symptoms and the microbiome to illustrate these approaches. This cross-sectional study collected electronic self-reported survey data and self-collected biospecimens (stool and salivary samples) from adolescents 13-19 years old. All but two participants completed the questionnaires, with few missing responses. 94% provided at least one salivary sample and 89% supplied a stool sample. Participants were able to adhere to the study instructions. Using a participant-centered approach, our study successfully recruited and engaged the targeted 90 participants in self-collection of electronic survey data and biospecimens. Successful strategies of recruitment and retention included: 1) on-site clinic recruitment by research team, 2) active involvement of parents as appropriate, 3) use of electronic surveys and self-collection of biospecimens to foster control and ease of participation while addressing privacy concerns, 4) noninvasive collection of data on biospecimen, 5) frequent texting to communicate with participants, 6) flexibility in the pickup and transferring of biospecimens to accommodate adolescent schedules, 7) developmentally appropriate research, 8) participant reimbursement, and 9) sensitivity toward discussing stool sample materials. As a result of these strategies, adolescent participation in the research proved feasible.
PubMed: 38953164
DOI: 10.1002/nur.22412 -
Harm Reduction Journal Jul 2024Deaths due to drug overdose are an international issue, causing an estimated 128,000 global deaths in 2019. Scotland has the highest rate of drug-related deaths in...
BACKGROUND
Deaths due to drug overdose are an international issue, causing an estimated 128,000 global deaths in 2019. Scotland has the highest rate of drug-related deaths in Europe, with those in the most deprived areas at greater risk than those in affluent areas. There is a paucity of research on digital solutions, particularly from the perspective of those who use drugs who additionally access harm reduction and homelessness support services. The Digital Lifelines Scotland programme (DLS) provides vulnerable people who use/d drugs with digital devices to connect with services.
METHODS
This paper reports on the evaluation of the DLS from the perspective of service users who accessed services for those at risk of drug-related harms. A mixed methods approach was used including an online-survey (n = 19) and semi-structured interviews (n = 21). Survey data were analysed descriptively and interview data through inductive coding, informed by the Technology, People, Organisations and Macroenvironmental factors (TPOM) framework, to investigate the use, access, and availability of devices, and people's experiences and perceptions of them.
RESULTS
Most participants lived in social/council housing (63.2%, n = 12), many lived alone (68.4%, n = 13). They were mainly over 40 years old and lived in a city. Participants described a desire for data privacy, knowledge, and education, and placed a nascent social and personal value on digital devices. Participants pointed to the person-centred individuality of the service provision as one of the reasons to routinely engage with services. Service users experienced an increased sense of value and there was a palpable sense of community, connection and belonging developed through the programme, including interaction with services and devices.
CONCLUSIONS
This paper presents a unique perspective which documents the experiences of service users on the DLS. Participants illustrated a desire for life improvement and a collective and individual feeling of responsibility towards themselves and digital devices. Digital inclusion has the potential to provide avenues by which service users can safely and constructively access services and society to improve outcomes. This paper provides a foundation to further cultivate the insight of service users on digital solutions in this emerging area.
Topics: Humans; Scotland; Harm Reduction; Female; Male; Adult; Digital Technology; Middle Aged; Drug Overdose; Drug Users; Young Adult; Ill-Housed Persons; Substance-Related Disorders; Surveys and Questionnaires
PubMed: 38951880
DOI: 10.1186/s12954-024-01012-y -
BMC Public Health Jun 2024Many women in low- and middle-income countries, including Kenya, access antenatal care (ANC) late in pregnancy. Home pregnancy testing can enable women to detect...
BACKGROUND
Many women in low- and middle-income countries, including Kenya, access antenatal care (ANC) late in pregnancy. Home pregnancy testing can enable women to detect pregnancy early, but it is not widely available. Our study explored the acceptability and potential of home pregnancy testing delivered by community health volunteers (CHV) on antenatal care initiation in rural Kenya.
METHODS
This study was part of a public health intervention to improve uptake and quality of ANC. Between November and December 2020, we conducted 37 in-depth interviews involving women who tested positive or negative for a urine pregnancy test provided by CHVs; CHVs and their supervisors involved in the delivery of the pregnancy tests; facility healthcare workers; and key informants. Using Sekhon et al.'s framework of acceptability, the interviews explored participants' perceptions and experiences of home pregnancy testing, including acceptability, challenges, and perceived effects on early ANC uptake. Data were analysed thematically in NVivo12 software.
RESULTS
Home pregnancy testing was well-received by women who trusted test results and appreciated the convenience and autonomy it offered. Adolescents cherished the privacy, preferring home testing to facility testing which could be a stigmatising experience. Testing enabled earlier pregnancy recognition and linkage to ANC as well as reproductive decision-making for those with undesired pregnancies. Community delivery of the test enhanced the reputation and visibility of the CHVs as credible primary care providers. CHVs in turn were motivated and confident to deliver home pregnancy testing and did not find it as an unnecessary burden; instead, they perceived it as a complement to their work in providing ANC in the community. Challenges identified included test shortages, confidentiality and safeguarding risks, and difficulties accessing facility-based care post-referral. Newly identified pregnant adolescents hesitated to seek ANC due to stigma, fear of reprimand, unwanted parental notification, and perceived pressure from healthcare workers to keep the pregnancy.
CONCLUSION
Home pregnancy testing by CHVs can improve early ANC initiation in resource-poor settings. Mitigating privacy, confidentiality, and safeguarding concerns is imperative. Additional support for women transitioning from pregnancy identification to ANC is essential to ensure appropriate care. Future research should focus on integrating home pregnancy testing into routine community health services.
Topics: Humans; Female; Kenya; Pregnancy; Prenatal Care; Adult; Patient Acceptance of Health Care; Adolescent; Young Adult; Rural Population; Pregnancy Tests; Community Health Workers; Qualitative Research; Interviews as Topic; Home Care Services
PubMed: 38951787
DOI: 10.1186/s12889-024-19254-7 -
JCO Clinical Cancer Informatics Jun 2024There has been growing interest in the use of real-world data (RWD) to address clinically and policy-relevant (research) questions that cannot be answered with data from... (Review)
Review
There has been growing interest in the use of real-world data (RWD) to address clinically and policy-relevant (research) questions that cannot be answered with data from randomized controlled trials (RCTs) alone. This is, for example, the case in rare malignancies such as sarcomas as limited patient numbers pose challenges in conducting RCTs within feasible timeliness, a manageable number of collaborators, and statistical power. This narrative review explores the potential of RWD to generate real-world evidence (RWE) in sarcoma research, elucidating its application across different phases of the patient journey, from prediagnosis to the follow-up/survivorship phase. For instance, examining electronic health records (EHRs) from general practitioners (GPs) enables the exploration of consultation frequency and presenting symptoms in primary care before a sarcoma diagnosis. In addition, alternative study designs that integrate RWD with well-designed observational RCTs may offer relevant information on the effectiveness of clinical treatments. As, especially in cases of ultrarare sarcomas, it can be an extreme challenge to perform well-powered randomized prospective studies. Therefore, it is crucial to support the adaptation of novel study designs. Regarding the follow-up/survivorship phase, examining EHR from primary and secondary care can provide valuable insights into identifying the short- and long-term effects of treatment over an extended follow-up period. The utilization of RWD also comes with several challenges, including issues related to data quality and privacy, as described in this study. Notwithstanding these challenges, this study underscores the potential of RWD to bridge, at least partially, gaps between evidence and practice and holds promise in contributing to the improvement of sarcoma care.
Topics: Humans; Sarcoma; Electronic Health Records; General Practitioners; Data Collection; Clinical Trials as Topic; Prospective Studies
PubMed: 38950319
DOI: 10.1200/CCI.24.00054 -
African Journal of Primary Health Care... Jun 2024Transgender women - individuals assigned male at birth but who identify as female - are disproportionately affected by, among others, human immunodeficiency virus...
BACKGROUND
Transgender women - individuals assigned male at birth but who identify as female - are disproportionately affected by, among others, human immunodeficiency virus (HIV), other sexually transmitted diseases (STIs) and mental health issues. Studies show that transgender women often encounter discrimination and stigma when seeking healthcare from health facilities.
AIM
This study assessed the healthcare needs of transgender women, their experiences of the mainstream healthcare system and alternative strategies for navigating the healthcare system.
SETTING
The study was carried out in the City of Ekurhuleni Metropolitan Council in South Africa's Gauteng province.
METHODS
A case study design was followed. Participants were purposively selected and included 10 transgender women aged 26-50. Individual semi-structured interviews were conducted over 2 months.
RESULTS
Participants expressed a need for hormone replacement therapy, HIV treatment and prevention and treatment for STIs. Experiences of participants within the healthcare system were predominantly negative, with instances of discrimination, stigma and privacy violations being commonplace. Alternative strategies to meet their healthcare needs included the use of self-medication, consulting traditional healers and utilising non-governmental organisations.
CONCLUSION
There is an urgent need for equitable and inclusive health management of transgender women in South Africa.Contribution: This study provided a first look in a South African context into how and to what extent transwomen employ alternative healthcare strategies such as self-medication and utilising non-governmental organisations when faced with mainstream healthcare access barriers. The use of traditional doctors was identified as a novel, alternative strategy used by transwomen to access healthcare and treatment.
Topics: Humans; Female; Transgender Persons; Adult; South Africa; Social Stigma; Middle Aged; HIV Infections; Health Services Accessibility; Male; Sexually Transmitted Diseases; Qualitative Research; Health Services Needs and Demand; Interviews as Topic; Hormone Replacement Therapy; Patient Acceptance of Health Care
PubMed: 38949443
DOI: 10.4102/phcfm.v16i1.4598 -
Data in Brief Aug 2024Data sharing has facilitated the digitisation of society. We can access our bank accounts or make an appointment with our doctor anytime and anywhere. To achieve this,...
Data sharing has facilitated the digitisation of society. We can access our bank accounts or make an appointment with our doctor anytime and anywhere. To achieve this, we have to share certain information, whether personal, professional, etc. This may seem like a minor cost for an individual user, but actually the data economy as the backbone of a digital transformation that is reshaping all aspects of human life. However, one of the major concerns arises regarding what happens to such individual data; once shared, control over it is often lost. For that reason, users and companies are reluctant to share their data. The European Union, through its European Strategy for Data, is establishing a policy and legal framework for establishing a single market for data in Europe by improving the trust and fairness of the data economy. Data spaces are a commitment to sharing data in a reliable and secure way, but this endeavour should, of course, not be at the expense of privacy rights. In recent years, Privacy-Enhancing Technologies (PETs) have emerged to achieve data sharing and privacy preservation that can address the requirements of data spaces around sensitive citizen and business data. In this work, we review existing PETs and assess their relevance, technological maturity, and applicability in the context of common European data spaces. Finally, we illustrate the benefits of secure data sharing via Federated Learning in a healthcare use case, where the preservation of privacy is a primer requirement and is therefore to be guaranteed.
PubMed: 38948408
DOI: 10.1016/j.dib.2024.110560 -
PNAS Nexus Jun 2024Large language models (LLMs) demonstrate increasingly human-like abilities across a wide variety of tasks. In this paper, we investigate whether LLMs like ChatGPT can...
Large language models (LLMs) demonstrate increasingly human-like abilities across a wide variety of tasks. In this paper, we investigate whether LLMs like ChatGPT can accurately infer the psychological dispositions of social media users and whether their ability to do so varies across socio-demographic groups. Specifically, we test whether GPT-3.5 and GPT-4 can derive the Big Five personality traits from users' Facebook status updates in a zero-shot learning scenario. Our results show an average correlation of ( ) between LLM-inferred and self-reported trait scores-a level of accuracy that is similar to that of supervised machine learning models specifically trained to infer personality. Our findings also highlight heterogeneity in the accuracy of personality inferences across different age groups and gender categories: predictions were found to be more accurate for women and younger individuals on several traits, suggesting a potential bias stemming from the underlying training data or differences in online self-expression. The ability of LLMs to infer psychological dispositions from user-generated text has the potential to democratize access to cheap and scalable psychometric assessments for both researchers and practitioners. On the one hand, this democratization might facilitate large-scale research of high ecological validity and spark innovation in personalized services. On the other hand, it also raises ethical concerns regarding user privacy and self-determination, highlighting the need for stringent ethical frameworks and regulation.
PubMed: 38948324
DOI: 10.1093/pnasnexus/pgae231