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Journal of Medical Internet Research Mar 2024The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician... (Review)
Review
BACKGROUND
The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience.
OBJECTIVE
This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals.
METHODS
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes.
RESULTS
A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores.
CONCLUSIONS
Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.
Topics: Adult; Humans; Hospitals; Delivery of Health Care; Qualitative Research
PubMed: 38466978
DOI: 10.2196/47715 -
Cancer Imaging : the Official... Mar 2024This review aimed to assess the predictive value of background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) as an imaging biomarker for... (Review)
Review
Predictive value of background parenchymal enhancement on breast magnetic resonance imaging for pathological tumor response to neoadjuvant chemotherapy in breast cancers: a systematic review.
OBJECTIVES
This review aimed to assess the predictive value of background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) as an imaging biomarker for pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT).
METHODS
Two reviewers independently performed a systemic literature search using the PubMed, MEDLINE, and Embase databases for studies published up to 11 June 2022. Data from relevant articles were extracted to assess the relationship between BPE and pCR.
RESULTS
This systematic review included 13 studies with extensive heterogeneity in population characteristics, MRI follow-up points, MRI protocol, NACT protocol, pCR definition, and BPE assessment. Baseline BPE levels were not associated with pCR, except in 1 study that reported higher baseline BPE of the younger participants (< 55 years) in the pCR group than the non-pCR group. A total of 5 studies qualitatively assessed BPE levels and indicated a correlation between reduced BPE after NACT and pCR; however, among the studies that quantitatively measured BPE, the same association was observed only in the subgroup analysis of 2 articles that assessed the status of hormone receptor and human epidermal growth factor receptor 2. In addition, the predictive ability of early BPE changes for pCR was reported in several articles and remains controversial.
CONCLUSIONS
Changes in BPE may be a promising imaging biomarker for predicting pCR in breast cancer. Because current studies remain insufficient, particularly those that quantitatively measure BPE, prospective and multicenter large-sample studies are needed to confirm this relationship.
Topics: Humans; Female; Prospective Studies; Neoadjuvant Therapy; Breast; Breast Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Multicenter Studies as Topic
PubMed: 38462607
DOI: 10.1186/s40644-024-00672-0 -
Frontiers in Neuroscience 2024Tinnitus is strongly associated with an increased risk of cognitive disabilities. The findings of this research will provide valuable support for future investigations...
BACKGROUND
Tinnitus is strongly associated with an increased risk of cognitive disabilities. The findings of this research will provide valuable support for future investigations aimed at determining the correlation between tinnitus and the risk of cognitive impairments.
OBJECTIVES
We investigated the potential correlation between tinnitus and the risk of various cognitive impairments, such as dementia, compromised learning attention, anxiety, depression, and insomnia. The study examined this relationship collectively and by categorizing the data based on different age groups.
METHODS
We compiled data from case-control studies and cohort studies obtained from reputable databases such as PubMed, Cochrane Library, and Embase. To minimize potential bias, two reviewers independently assessed the selected articles. After extracting the data, we calculated the pooled odds ratios (ORs) using a random-effects model.
RESULTS
Seventeen relevant studies, comprising an adult population, were included in this analysis. Pooled estimated outcomes revealed a strong association between tinnitus and an elevated risk of dementia-compromised learning, auditory attention, anxiety, depression, and poor sleep quality (P<0.05). Furthermore, the pooled analysis stratified by age demonstrated that patients aged above 60 years, in comparison to those aged 18 to 60 years, exhibited more significant outcomes in relation to the progression of cognitive impairments.
CONCLUSION
Tinnitus has the potential to increase the risk of cognitive impairments. Moreover, geriatric patients aged above 60 shows a higher susceptibility to developing cognitive disabilities compared to their younger counterparts.
PubMed: 38389785
DOI: 10.3389/fnins.2024.1275560 -
Addictive Behaviors Jun 2024Previous epidemiological studies examining the prospective association between maternal prenatal tobacco smoking and offspring academic achievement have reported... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous epidemiological studies examining the prospective association between maternal prenatal tobacco smoking and offspring academic achievement have reported conflicting results. Therefore, this systematic review and meta-analysis was conducted to examine the magnitude and consistency of association reported by those studies.
METHODS
This systematic review and meta-analysis was guided by the PRISMA protocol. Relevant epidemiological studies on the topic were extracted from four main databases (PubMed/Medline, Embase, PsycINFO, and Scopus). The Newcastle-Ottawa Scale (NOS) was used to appraise the methodological quality of the included studies. We conducted a narrative assessment of the studies that did not report effect estimates. Inverse variance-weighted random effect meta-analysis was used to combine studies reporting effect sizes to estimate pooled adjusted odds ratio with 95% confidence intervals (95% CI). The review was prospectively registered in PROSPERO (CRD42022350901).
RESULTS
Nineteen observational studies, published between 1973 and 2021 with a total of 1.25 million study participants were included in the final review. Of these, fifteen studies (79 %) reported reduced academic achievement in offspring exposed to maternal prenatal tobacco smoking. The eight primary studies (sample size = 723,877) included in the meta-analysis together suggested a 49 % higher risk of reduced academic achievement in offspring exposed to maternal prenatal tobacco smoking when compared to non-exposed offspring (Pooled odds ratio = 1.49, 95 % CI:1.17-1.91).
CONCLUSION
Our review found a positive association between maternal prenatal tobacco smoking and offspring reduced academic achievement. However, variation in the adjustment of potential confounders and significant heterogeneity across included studies limited more conclusive inference. Mechanistic studies to identify causal pathways and specific academic impacts are needed to inform targeted developmental programs to assist child learning and academic performance.
Topics: Pregnancy; Female; Child; Humans; Academic Success; Prenatal Exposure Delayed Effects; Smoking; Tobacco Smoking; Educational Status
PubMed: 38367506
DOI: 10.1016/j.addbeh.2024.107985 -
JAMA Network Open Feb 2024Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services...
IMPORTANCE
Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services research. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are 2 of the most commonly used measures. There is also early interest in incorporating area-level measures to create more equitable alternative payment models.
OBJECTIVE
To review the evidence on the association of ADI and SVI with health care spending, including claims-based spending and patient-reported barriers to care due to cost.
EVIDENCE REVIEW
A systematic search for English-language articles and abstracts was performed in the PubMed, Web of Science, Embase, and Cochrane databases (from inception to March 1, 2023). Peer-reviewed articles and abstracts using a cross-sectional, case-control, or cohort study design and based in the US were identified. Data analysis was performed in March 2023.
FINDINGS
This review included 24 articles and abstracts that used a cross-sectional, case-control, or cohort study design. In 20 of 24 studies (83%), ADI and SVI were associated with increased health care spending. No association was observed in the 4 remaining studies, mostly with smaller sample sizes from single centers. In adjusted models, the increase in spending associated with higher ADI or SVI residence was $574 to $1811 for index surgical hospitalizations, $3003 to $24 075 for 30- and 90-day episodes of care, and $3519 for total annual spending for Medicare beneficiaries. In the studies that explored mechanisms, postoperative complications, readmission risk, and poor primary care access emerged as health care system-related drivers of increased spending.
CONCLUSIONS AND RELEVANCE
The findings of this systematic review suggest that both ADI and SVI can play important roles in efforts to understand drivers of health care spending and in the design of payment and care delivery programs that capture aspects of social risk. At the health care system level, higher health care spending and poor care access associated with ADI or SVI may represent opportunities to codesign interventions with patients from high ADI or SVI areas to improve access to high-value health care and health promotion more broadly.
Topics: United States; Humans; Aged; Cohort Studies; Cross-Sectional Studies; Health Expenditures; Medicare; Socioeconomic Disparities in Health
PubMed: 38358740
DOI: 10.1001/jamanetworkopen.2023.56121 -
Briefings in Bioinformatics Jan 2024Despite a standardized diagnostic examination, cancer of unknown primary (CUP) is a rare metastatic malignancy with an unidentified tissue of origin (TOO). Patients...
Despite a standardized diagnostic examination, cancer of unknown primary (CUP) is a rare metastatic malignancy with an unidentified tissue of origin (TOO). Patients diagnosed with CUP are typically treated with empiric chemotherapy, although their prognosis is worse than those with metastatic cancer of a known origin. TOO identification of CUP has been employed in precision medicine, and subsequent site-specific therapy is clinically helpful. For example, molecular profiling, including genomic profiling, gene expression profiling, epigenetics and proteins, has facilitated TOO identification. Moreover, machine learning has improved identification accuracy, and non-invasive methods, such as liquid biopsy and image omics, are gaining momentum. However, the heterogeneity in prediction accuracy, sample requirements and technical fundamentals among the various techniques is noteworthy. Accordingly, we systematically reviewed the development and limitations of novel TOO identification methods, compared their pros and cons and assessed their potential clinical usefulness. Our study may help patients shift from empirical to customized care and improve their prognoses.
Topics: Humans; Neoplasms, Unknown Primary; Precision Medicine; Gene Expression Profiling; Microarray Analysis
PubMed: 38343328
DOI: 10.1093/bib/bbae028 -
BMC Medicine Feb 2024A comprehensive overview of artificial intelligence (AI) for cardiovascular disease (CVD) prediction and a screening tool of AI models (AI-Ms) for independent external...
BACKGROUND
A comprehensive overview of artificial intelligence (AI) for cardiovascular disease (CVD) prediction and a screening tool of AI models (AI-Ms) for independent external validation are lacking. This systematic review aims to identify, describe, and appraise AI-Ms of CVD prediction in the general and special populations and develop a new independent validation score (IVS) for AI-Ms replicability evaluation.
METHODS
PubMed, Web of Science, Embase, and IEEE library were searched up to July 2021. Data extraction and analysis were performed for the populations, distribution, predictors, algorithms, etc. The risk of bias was evaluated with the prediction risk of bias assessment tool (PROBAST). Subsequently, we designed IVS for model replicability evaluation with five steps in five items, including transparency of algorithms, performance of models, feasibility of reproduction, risk of reproduction, and clinical implication, respectively. The review is registered in PROSPERO (No. CRD42021271789).
RESULTS
In 20,887 screened references, 79 articles (82.5% in 2017-2021) were included, which contained 114 datasets (67 in Europe and North America, but 0 in Africa). We identified 486 AI-Ms, of which the majority were in development (n = 380), but none of them had undergone independent external validation. A total of 66 idiographic algorithms were found; however, 36.4% were used only once and only 39.4% over three times. A large number of different predictors (range 5-52,000, median 21) and large-span sample size (range 80-3,660,000, median 4466) were observed. All models were at high risk of bias according to PROBAST, primarily due to the incorrect use of statistical methods. IVS analysis confirmed only 10 models as "recommended"; however, 281 and 187 were "not recommended" and "warning," respectively.
CONCLUSION
AI has led the digital revolution in the field of CVD prediction, but is still in the early stage of development as the defects of research design, report, and evaluation systems. The IVS we developed may contribute to independent external validation and the development of this field.
Topics: Humans; Artificial Intelligence; Cardiovascular Diseases; Algorithms; Africa; Europe
PubMed: 38317226
DOI: 10.1186/s12916-024-03273-7 -
Asian Journal of Urology Jan 2024Transurethral resection of bladder tumor is one of the most common everyday urological procedures. This kind of surgery demands a set of skills that need training and... (Review)
Review
OBJECTIVE
Transurethral resection of bladder tumor is one of the most common everyday urological procedures. This kind of surgery demands a set of skills that need training and experience. In this review, we aimed to investigate the current literature to find out if simulators, phantoms, and other training models could be used as a tool for teaching urologists.
METHODS
A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews. Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.
RESULTS
The UroTrainer (Karl Storz GmbH, Tuttlingen, Germany), a virtual reality training simulator, achieved positive feedback and an excellent face and construct validity by the participants. The inspection of bladder mucosa, blood loss, tumor resection, and procedural time was improved after the training, especially for inexperienced urologists and medical students. The construct validity of UroSim® (VirtaMed, Zurich, Switzerland) was established. SIMBLA simulator (Samed GmbH, Dresden, Germany) was found to be a realistic and useful tool by experts and urologists with intermediate experience. The test objective competency model based on SIMBLA simulator could be used for evaluating urologists. The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it. The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity, and 60% of participants would like to use the simulators in the future. The 5-day multimodal training curriculum "Boot Camp" in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.
CONCLUSION
Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon, and there is no doubt that they should be a part of every urologist's technical education.
PubMed: 38312823
DOI: 10.1016/j.ajur.2022.08.005 -
PLOS Global Public Health 2024Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing...
Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing aids do not receive them, in part due to challenges in accessing hearing aids and related services, which are most salient in low- and middle-income countries (LMIC) and other resource-limited settings. Innovative approaches for hearing aid service delivery can overcome many of the challenges related to access, including that of limited human resources trained to provide ear and hearing care. The purpose of this systematic scoping review is to synthesize evidence on service delivery approaches for hearing aid provision in LMIC and resource-limited settings. We searched 3 databases (PubMed, Scopus, Ovid MEDLINE) for peer-reviewed articles from 2000 to 2022 that focused on service delivery approaches related to hearing aids in LMIC or resource-limited settings. Fifteen peer-reviewed articles were included, which described hospital-based (3 studies), large-scale donation program (1 studies), community-based (7 studies), and remote (telehealth; 4 studies) service delivery approaches. Key findings are that hearing aid services can be successfully delivered in hospital- and community-based settings, and remotely, and that both qualified hearing care providers and trained non-specialists can provide quality hearing aid services. Service delivery approaches focused on community-based and remote care, and task sharing among qualified hearing care providers and trained non-specialists can likely improve access to hearing aids worldwide, thereby reducing the burden of untreated hearing loss.
PubMed: 38266001
DOI: 10.1371/journal.pgph.0002823 -
Spine Deformity May 2024The purpose of this review was to evaluate the effectiveness of patient-specific rods for adult spinal deformity. (Review)
Review
PURPOSE
The purpose of this review was to evaluate the effectiveness of patient-specific rods for adult spinal deformity.
METHODS
A systematic review of the literature was performed through an electronic search of the PubMed, Scopus, and Web of Science databases. Human studies between 2012 and 2023 were included. Sample size, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), pelvic tilt (PT), operation time, blood loss, follow-up duration, and complications were recorded for each study when available.
RESULTS
Seven studies with a total of 304 adult spinal deformity patients of various etiologies were included. All studies reported SVA, and PT; two studies did not report PI-LL. Four studies reported planned radiographic outcomes. Two found a significant association between preoperative plan and postoperative outcome in all three outcomes. One found a significant association for PI-LL alone. The fourth found no significant associations. SVA improved in six of seven studies, PI-LL improved in all five, and three of seven studies found improved postoperative PT. Significance of these results varied greatly by study.
CONCLUSION
Preliminary evidence suggests potential benefits of PSRs in achieving optimal spino-pelvic parameters in ASD surgery. Nevertheless, conclusions regarding the superiority of PSRs over traditional rods must be judiciously drawn, given the heterogeneity of patients and study methodologies, potential confounding variables, and the absence of robust randomized controlled trials. Future investigations should concentrate on enhancing preoperative planning, standardizing surgical methodologies, isolating specific patient subgroups, and head-to-head comparisons with traditional rods to fully elucidate the impact of PSRs in ASD surgery.
Topics: Humans; Adult; Lordosis; Treatment Outcome; Spinal Curvatures; Spine; Spinal Fusion
PubMed: 38265734
DOI: 10.1007/s43390-023-00805-8