-
Technology and Health Care : Official... May 2024The widespread use of antibiotics has led to a gradual adaptation of bacteria to these drugs, diminishing the effectiveness of treatments. (Review)
Review
BACKGROUND
The widespread use of antibiotics has led to a gradual adaptation of bacteria to these drugs, diminishing the effectiveness of treatments.
OBJECTIVE
To comprehensively assess the research progress of antibiotic resistance prediction models based on machine learning (ML) algorithms, providing the latest quantitative analysis and methodological evaluation.
METHODS
Relevant literature was systematically retrieved from databases, including PubMed, Embase and the Cochrane Library, from inception up to December 2023. Studies meeting predefined criteria were selected for inclusion. The prediction model risk of bias assessment tool was employed for methodological quality assessment, and a random-effects model was utilised for meta-analysis.
RESULTS
The systematic review included a total of 22 studies with a combined sample size of 43,628; 10 studies were ultimately included in the meta-analysis. Commonly used ML algorithms included random forest, decision trees and neural networks. Frequently utilised predictive variables encompassed demographics, drug use history and underlying diseases. The overall sensitivity was 0.57 (95% CI: 0.42-0.70; p< 0.001; I2= 99.7%), the specificity was 0.95 (95% CI: 0.79-0.99; p< 0.001; I2 = 99.9%), the positive likelihood ratio was 10.7 (95% CI: 2.9-39.5), the negative likelihood ratio was 0.46 (95% CI: 0.34-0.61), the diagnostic odds ratio was 23 (95% CI: 7-81) and the area under the receiver operating characteristic curve was 0.78 (95% CI: 0.74-0.81; p< 0.001), indicating a good discriminative ability of ML models for antibiotic resistance. However, methodological assessment and funnel plots suggested a high risk of bias and publication bias in the included studies.
CONCLUSION
This meta-analysis provides a current and comprehensive evaluation of ML models for predicting antibiotic resistance, emphasising their potential application in clinical practice. Nevertheless, stringent research design and reporting are warranted to enhance the quality and credibility of future studies. Future research should focus on methodological innovation and incorporate more high-quality studies to further advance this field.
PubMed: 38875058
DOI: 10.3233/THC-240119 -
Bioinspiration & Biomimetics Jun 2024This research presents a 10-year systematic review based on bibliometric analysis of the bio-inspired design of hard-bodied mobile robot mechatronic systems considering...
This research presents a 10-year systematic review based on bibliometric analysis of the bio-inspired design of hard-bodied mobile robot mechatronic systems considering the anatomy of arthropods. These are the most diverse group of animals whose flexible biomechanics and adaptable morphology, thus, it can inspire robot development. Papers were reviewed from two international databases (Scopus and Web of Science) and one platform (Aerospace Research Central), then they were classified according to: year of publication (January 2013 to April 2023), arthropod group, published journal, conference proceedings, editorial publisher, research teams, robot classification according to the name of arthropod, limb's locomotion support, number of legs/arms, number of legs/body segments, limb's degrees of freedom, mechanical actuation type, modular system, and environment adaptation. During the screening, more than 33000 works were analyzed. Finally, a total of 174 studies (90 journal-type, 84 conference-type) were selected for in-depth study: Insecta - hexapod (53,8%), Arachnida - octopods (20.7%), Crustacea - decapods (16,1%), and Myriapoda - centipedes and millipedes (9,2%). The study reveals that the most active editorials are the Institute of Electrical and Electronics Engineers Inc., Springer, MDPI, and Elsevier, while the most influential researchers are located in the USA, China, Singapore, and Japan. Most works pertained to spiders, crabs, caterpillars, cockroaches, and centipedes. We conclude that "arthrobotics" research, which merges arthropods and robotics, is constantly growing and includes a high number of relevant studies with findings that can inspire new methods to design biomechatronic systems.
PubMed: 38866026
DOI: 10.1088/1748-3190/ad5778 -
Disability and Rehabilitation.... Jun 2024To conduct a systematic review on the impacts of using mechanical assistive devices on function, performance in activities and participation of persons with upper... (Review)
Review
PURPOSE
To conduct a systematic review on the impacts of using mechanical assistive devices on function, performance in activities and participation of persons with upper extremity impairments, and to synthesize the strengths and limitations of these devices.
METHOD
Three independent reviewers conducted systematic searches of articles published between 2003 and 2023 in Compendex, Inspec, Embase, PubMed/Medline, IEEE Xplore, and Web of Science, as well as manual searches on the RESNA website for conference papers over the same period. The methodological quality of articles was appraised using the tool.
RESULTS
From the 34 retained studies, 28 mechanical devices were identified and classified into two categories: (1) mobile arm supports (MASs) designed to perform multiple activities, and (2) devices used to assist with a specific activity of daily living (ADL). Overall, MASs helped users to perform manual activities in elevation and/or against gravity. Specific ADL devices allowed users to perform unique activities requiring fine motor skills such as opening a medicine container. Some of these devices have advantages like portability, adaptability, low cost, and ease of use. Limitations most often reported included interference or mobility restraints.
CONCLUSION
This review synthesizes the impacts of mechanical devices on the three domains of the International Classification of Functioning, Disability and Health (ICF) for individuals with upper extremity impairments. Impacts regarding function and performance in activities were more often measured than participation. Future studies should include outcomes related to participation, as taking this aspect into account might favor successful continued use of assistive devices.
PubMed: 38864384
DOI: 10.1080/17483107.2024.2356833 -
Farmacia Hospitalaria : Organo Oficial... Jun 2024To identify validated questionnaires to assess medication adherence, and its associated factors, in adult patients with chronic pathologies. (Review)
Review
OBJECTIVE
To identify validated questionnaires to assess medication adherence, and its associated factors, in adult patients with chronic pathologies.
METHOD
A systematic review of scientific publications that describe validated medication adherence questionnaires in PubMed and Scopus was carried out during May 2022. The search strategy combined the MeSH heading "Medication adherence" with the keywords: "Questionnaire" and "Validation"; adding "Spanish" to rescue questionnaires in our language. Systematic reviews, meta-analyses, or scientific articles with full text available in Spanish or English were selected; published from January 2000 to April 2022; that present the application and validation of a medication adherence questionnaire in adults with chronic pathologies; and publications of the initial validation of a questionnaire, recovered through bibliographic citations of the previously identified publications, even if they are prior to the year 2000. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to represent the search process, inclusion and exclusion of the retrieved publications.
RESULTS
(97) records in PubMed and 3 adding "Spanish" were retrieved; in Scopus, 334 records were retrieved and 13 with "Spanish". 118 records were retrieved through bibliographic citations identification. From the analysis of the previous publications, 14 validated questionnaires were identified that assess medication adherence and are applied in English and/or Spanish in adult patients with chronic pathologies. For each questionnaire, the following characteristics were described: name, authors, year of publication, dimensions (barriers and facilitators factors), number and wording of the items, response scale, form of administration, language, and pathologies of the initial validation. Of the subsequent validations, only those carried out in English and/or Spanish were presented. So far, 6 questionnaires were validated in Spanish and only for certain chronic pathologies.
CONCLUSIONS
(14) validated questionnaires were identified, 6 of them were validated in Spanish. They are designed to evaluate medication adherence in a comprehensive manner, being useful to be applied in hospital and community pharmaceutical services. This review provides health professionals with tools to develop and validate their own questionnaire, adapting the wording to the local language and context of the health system.
PubMed: 38862302
DOI: 10.1016/j.farma.2024.04.019 -
Therapeutic Innovation & Regulatory... Jun 2024Although oncology has seen large scientific and clinical advances over the last decade, it also has one of the lowest success rates for novel agents across therapeutic...
INTRODUCTION
Although oncology has seen large scientific and clinical advances over the last decade, it also has one of the lowest success rates for novel agents across therapeutic areas. Adaptive clinical trial design has been a popular option for increasing clinical trial efficiency and the chances of trial success. Seamless clinical trial design are studies in which two or more clinical trial phases are combined into a single study with a pre-specified transition between stages. This integration of phases may enhance efficiency.
METHODS
To understand the precedent for the use of seamless designs, this working group was formed to conduct a comprehensive literature search on seamless clinical trials conducted with confirmatory intent in oncology. Trial design features were extracted into a database and analyzed with descriptive statistics.
RESULTS
A literature search identified 68 clinical trials meeting inclusion and exclusion criteria. The most common design feature was a gate on treatment efficacy, where the trial would only proceed to the second stage if sufficient efficacy was observed in the first. The next most common feature was a selection of a dose or treatment regimen. Inferentially and operationally seamless designs were approximately equally represented.
DISCUSSION
Key statistical considerations for seamless phase II/III designs include optimizing design choices by evaluating and comparing operating characteristics across design alternatives as well as showing control of overall Type I error rates. Executing the transition between phases should be evaluated for issues related to accrual, drug production, and procedures to maintain trial integrity.
CONCLUSIONS
While there are unique statistical, regulatory, and operational considerations for seamless designs they are also uniquely suited to many development settings. These include, for example, addressing dose selection under FDA's Project Optimus and addressing the growing use of biomarkers and personalized medicine approaches in cancer treatment.
PubMed: 38861131
DOI: 10.1007/s43441-024-00670-1 -
BMJ Open Jun 2024Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living...
Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews.
OBJECTIVES
Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs.
DESIGN
Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
DATA SOURCES
Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline.
ELIGIBILITY CRITERIA
Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal.
DATA EXTRACTION AND SYNTHESIS
Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators.
RESULTS
Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients' aptitude with the technology (n=9/33), and technical issues (n=12/33).
CONCLUSIONS
The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.
Topics: Humans; Telemedicine; Remote Consultation; Health Personnel; Attitude of Health Personnel; Digital Technology
PubMed: 38858155
DOI: 10.1136/bmjopen-2023-075833 -
Value in Health : the Journal of the... Jun 2024This review sought to identify the qualitative methods and techniques researchers have employed in the past decade to develop attributes and inform health-related... (Review)
Review
OBJECTIVES
This review sought to identify the qualitative methods and techniques researchers have employed in the past decade to develop attributes and inform health-related discrete choice experiments (DCEs) surveys from a patient perspective.
METHODS
The review followed the PRISMA guidelines for reporting systematic reviews. An adapted appraisal tool following guidelines for reporting qualitative research for quantitative instruments and criteria for attribute development in DCEs was applied for quality assessment and data extraction. A narrative approach was used to synthesise data. This examination included consideration of issues pertaining to sampling, data collection, data analysis, attribute list reduction, wording, methodological adaptations to capture patient preferences, and testing the pre-experimental design decisions of the DCE survey.
RESULTS
Of 8,505 articles identified for abstract screening, 680 were included for full-text screening, 36 of which met the inclusion criteria. Practices to improve methodological robustness included pre-data collection materials to inform instruments, data collection methods specific for decision-making scenarios, purposeful selection of data analysis methods to address the research question, and participants' involvement in reducing the list of attributes. Examples of methodological adaptations for patients were noted.
CONCLUSIONS
DCEs have the potential to become a mixed-method approach where the qualitative phase informs a reduced list of attributes for a survey, serves the pre-design decisions of the experiment by testing trade-offs, overlapping, understandability, face, and content validity, and provides explanations of the quantitative results. Establishing guidelines for using qualitative methods for DCE attribute development may help to broadly enhance the methodological robustness of DCEs.
PubMed: 38851483
DOI: 10.1016/j.jval.2024.05.014 -
Artificial Intelligence in Medicine Jun 2024There is evidence that reducing modifiable risk factors and strengthening medical and health interventions can reduce early mortality and economic losses from... (Review)
Review
There is evidence that reducing modifiable risk factors and strengthening medical and health interventions can reduce early mortality and economic losses from non-communicable diseases (NCDs). Machine learning (ML) algorithms have been successfully applied to preventing and controlling NCDs. Reinforcement learning (RL) is the most promising of these approaches because of its ability to dynamically adapt interventions to NCD disease progression and its commitment to achieving long-term intervention goals. This paper reviews the preferred algorithms, data sources, design details, and obstacles to clinical application in existing studies to facilitate the early application of RL algorithms in clinical practice research for NCD interventions. We screened 40 relevant papers for quantitative and qualitative analysis using the PRISMA review flow diagram. The results show that researchers tend to use Deep Q-Network (DQN) and Actor-Critic as well as their improved or hybrid algorithms to train and validate RL models on retrospective datasets. Often, the patient's physical condition is the main defining parameter of the state space, while interventions are the main defining parameter of the action space. Mostly, changes in the patient's physical condition are used as a basis for immediate rewards to the agent. Various attempts have been made to address the challenges to clinical application, and several approaches have been proposed from existing research. However, as there is currently no universally accepted solution, the use of RL algorithms in clinical practice for NCD interventions necessitates more comprehensive responses to the issues addressed in this paper, which are safety, interpretability, training efficiency, and the technical aspect of exploitation and exploration in RL algorithms.
PubMed: 38838400
DOI: 10.1016/j.artmed.2024.102901 -
PloS One 2024To understand the experiences of informal carers and the impact of role and activity changes on their health and wellbeing. (Review)
Review
OBJECTIVE
To understand the experiences of informal carers and the impact of role and activity changes on their health and wellbeing.
METHODS
A systematic search of CINHAL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted. Studies were eligible if they included informal stroke carers (≥18 years), used a qualitative methodology, explored the roles and valued activities of stroke carers, and were published in English. The 10-item Critical Appraisal Skills Programme checklist for qualitative studies was used to assess methodological quality. The results of the included studies were thematically synthesised.
RESULTS
A total of 36 qualitative studies were included and four overarching themes were identified: (1) Life adjustment; (2) Changing role and identity; (3) Changing activities: From meaningful to purposeful; and (4) Understanding and supporting carers.
CONCLUSION
The sudden nature of stroke requires major readjustment in the carers life that has implications on their relationships, roles, and activities, subsequently impacting on their health and wellbeing. Health professionals and researchers should collaborate with stroke carers to identify their valued activities and implement realistic strategies to maintain these activities. Future interventions designed for carers should implement education about the importance of participating in valued activities and strategies to maintain these activities.
Topics: Humans; Caregivers; Stroke; Qualitative Research; Adaptation, Psychological; Quality of Life
PubMed: 38820455
DOI: 10.1371/journal.pone.0304501 -
The International Journal of... Feb 2024The purpose of this systematic review and meta-analysis was to compare the influence of fabrication method (conventional, subtractive, and additive procedures) and... (Meta-Analysis)
Meta-Analysis
Influence of the Manufacturing Trinomial (Technology, Printer, and Material) on the Marginal and Internal Discrepancies of Printed Metal Frameworks for the Fabrication of Tooth-Supported Prostheses: A Systematic Review and Meta-analysis.
PURPOSE
The purpose of this systematic review and meta-analysis was to compare the influence of fabrication method (conventional, subtractive, and additive procedures) and manufacturing trinomial (technology, printer, and material combination) on the marginal and internal fit of cobaltchromium (Co-Cr) tooth-supported frameworks.
MATERIALS AND METHODS
An electronic systematic review was performed in five data bases: MEDLINE/PubMed, Embase, World of Science, Cochrane, and Scopus. Studies that reported the marginal and internal discrepancies of tooth-supported Co-Cr additive manufacturing (AM) frameworks were included. Two authors independently completed the quality assessment of the studies by applying the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. A third examiner was consulted to resolve lack of consensus.
RESULTS
A total of 31 articles were included and classified based on the evaluation method: manufacturing accuracy, the dual- or triple-scan method, stereomicroscope, optical coordinate measurement machine, microCT, profilometer, and silicone replica. Six subgroups were created: 3D Systems, Bego, Concept Laser, EOS, Kulzer, and Sisma. Due to the heterogeneity and limited data available, only the silicone replica group was considered for meta-analysis. The metaanalysis showed a mean marginal discrepancy of 91.09 μm (I2 = 95%, P < .001) in the conventional group, 77.48 μm (I2 = 99%, P < .001) in the milling group, and 82.92 μm (I2 = 98%, P < .001) in the printing group. Additionally, a mean internal discrepancy of 111.29 μm (I2 = 94%, P < .001) was obtained in the conventional casting group, 121.96 μm (I2 = 100%, P < .001) in the milling group, and 121.25 μm (I2 = 99%, P < .001) in the printing group.
CONCLUSIONS
Manufacturing method and selective laser melting (SLM) metal manufacturing trinomial did not impact the marginal and internal discrepancies of Co-Cr frameworks for the fabrication of tooth-supported restorations.
Topics: Humans; Computer-Aided Design; Chromium Alloys; Dental Marginal Adaptation; Printing, Three-Dimensional; Denture Design; Dental Prosthesis Design; Technology, Dental; Dental Materials
PubMed: 38819942
DOI: 10.11607/ijp.8830