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BMC Health Services Research Apr 2024Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review... (Meta-Analysis)
Meta-Analysis
Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA.
BACKGROUND
Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements.
METHODS
We systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10-24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety.
RESULTS
A total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors - providers' competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents.
CONCLUSION
This review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.
Topics: Adolescent; Humans; Australia; Canada; Health Services Accessibility; Health Services, Indigenous; New Zealand; Primary Health Care; United States; Indigenous Peoples
PubMed: 38693527
DOI: 10.1186/s12913-024-10796-5 -
MHealth 2024The virtual care model can be used in all aspects of healthcare, such as prevention, diagnosis, treatment, and follow-up of most medical and surgical conditions. The... (Review)
Review
BACKGROUND
The virtual care model can be used in all aspects of healthcare, such as prevention, diagnosis, treatment, and follow-up of most medical and surgical conditions. The objective of this study was to identify the current barriers to implementing and consolidating the virtual healthcare model, of "telemedicine", in Latin American countries.
METHODS
A systematic review was conducted through four databases: PubMed, Scopus, Web of Science, and Virtual Health, including articles in Spanish, Portuguese, and English. A combination of Boolean operators was used with the terms "telemedicine", "telehealth", "telecare", "home care services", "remote care" and the name of each Latin American country. Articles published from January 2020 to January 2023 that reported on the barriers and challenges of using the virtual care model were included.
RESULTS
Nineteen articles were included. Brazil (n=5) and Argentina (n=4) were the countries where there was the greatest interest to explore barriers to virtual care. The barriers identified were categorized into five main themes: (I) technological and technical issues; (II) absence of a physical examination; (III) patient's negative perceptions; (IV) negative perceptions among healthcare professionals; and (V) structural obstacles and those associated with the healthcare system. The main obstacles reported were connectivity problems, lack of a complete physical examination, issues of privacy, high risk of medical malpractice, and absence of local regulation.
CONCLUSIONS
The virtual care model is a safe and cost-effective alternative for the delivery of health services, with multiple benefits for patients and their families. The indication for the use of virtual care should be based on a risk model for patient prioritization. Likewise, the analysis of the main barriers and benefits is fundamental to consolidating this model of care and ensuring its expansion in the region.
PubMed: 38689618
DOI: 10.21037/mhealth-23-47 -
Diagnostic and Interventional Imaging 2024The purpose of this study was to systematically review the reported performances of ChatGPT, identify potential limitations, and explore future directions for its... (Review)
Review
PURPOSE
The purpose of this study was to systematically review the reported performances of ChatGPT, identify potential limitations, and explore future directions for its integration, optimization, and ethical considerations in radiology applications.
MATERIALS AND METHODS
After a comprehensive review of PubMed, Web of Science, Embase, and Google Scholar databases, a cohort of published studies was identified up to January 1, 2024, utilizing ChatGPT for clinical radiology applications.
RESULTS
Out of 861 studies derived, 44 studies evaluated the performance of ChatGPT; among these, 37 (37/44; 84.1%) demonstrated high performance, and seven (7/44; 15.9%) indicated it had a lower performance in providing information on diagnosis and clinical decision support (6/44; 13.6%) and patient communication and educational content (1/44; 2.3%). Twenty-four (24/44; 54.5%) studies reported the proportion of ChatGPT's performance. Among these, 19 (19/24; 79.2%) studies recorded a median accuracy of 70.5%, and in five (5/24; 20.8%) studies, there was a median agreement of 83.6% between ChatGPT outcomes and reference standards [radiologists' decision or guidelines], generally confirming ChatGPT's high accuracy in these studies. Eleven studies compared two recent ChatGPT versions, and in ten (10/11; 90.9%), ChatGPTv4 outperformed v3.5, showing notable enhancements in addressing higher-order thinking questions, better comprehension of radiology terms, and improved accuracy in describing images. Risks and concerns about using ChatGPT included biased responses, limited originality, and the potential for inaccurate information leading to misinformation, hallucinations, improper citations and fake references, cybersecurity vulnerabilities, and patient privacy risks.
CONCLUSION
Although ChatGPT's effectiveness has been shown in 84.1% of radiology studies, there are still multiple pitfalls and limitations to address. It is too soon to confirm its complete proficiency and accuracy, and more extensive multicenter studies utilizing diverse datasets and pre-training techniques are required to verify ChatGPT's role in radiology.
Topics: Humans; Radiology; Forecasting
PubMed: 38679540
DOI: 10.1016/j.diii.2024.04.003 -
Journal of Clinical Medicine Apr 2024: Several studies have shown a relation between obesity and cognitive decline, highlighting a significant global health challenge. In recent years, artificial... (Review)
Review
: Several studies have shown a relation between obesity and cognitive decline, highlighting a significant global health challenge. In recent years, artificial intelligence (AI) and machine learning (ML) have been integrated into clinical practice for analyzing datasets to identify new risk factors, build predictive models, and develop personalized interventions, thereby providing useful information to healthcare professionals. This systematic review aims to evaluate the potential of AI and ML techniques in addressing the relationship between obesity, its associated health consequences, and cognitive decline. : Systematic searches were performed in PubMed, Cochrane, Web of Science, Scopus, Embase, and PsycInfo databases, which yielded eight studies. After reading the full text of the selected studies and applying predefined inclusion criteria, eight studies were included based on pertinence and relevance to the topic. : The findings underscore the utility of AI and ML in assessing risk and predicting cognitive decline in obese patients. Furthermore, these new technology models identified key risk factors and predictive biomarkers, paving the way for tailored prevention strategies and treatment plans. : The early detection, prevention, and personalized interventions facilitated by these technologies can significantly reduce costs and time. Future research should assess ethical considerations, data privacy, and equitable access for all.
PubMed: 38673581
DOI: 10.3390/jcm13082307 -
Saudi Journal of Anaesthesia 2024This review article examines the utility of artificial intelligence (AI) in anesthesia, with a focus on recent developments and future directions in the field. A total... (Review)
Review
This review article examines the utility of artificial intelligence (AI) in anesthesia, with a focus on recent developments and future directions in the field. A total of 19,300 articles were available on the given topic after searching in the above mentioned databases, and after choosing the custom range of years from 2015 to 2023 as an inclusion component, only 12,100 remained. 5,720 articles remained after eliminating non-full text. Eighteen papers were identified to meet the inclusion criteria for the review after applying the inclusion and exclusion criteria. The applications of AI in anesthesia after studying the articles were in favor of the use of AI as it enhanced or equaled human judgment in drug dose decision and reduced mortality by early detection. Two studies tried to formulate prediction models, current techniques, and limitations of AI; ten studies are mainly focused on pain and complications such as hypotension, with a P value of <0.05; three studies tried to formulate patient outcomes with the help of AI; and three studies are mainly focusing on how drug dose delivery is calculated (median: 1.1% ± 0.5) safely and given to the patients with applications of AI. In conclusion, the use of AI in anesthesia has the potential to revolutionize the field and improve patient outcomes. AI algorithms can accurately predict patient outcomes and anesthesia dosing, as well as monitor patients during surgery in real time. These technologies can help anesthesiologists make more informed decisions, increase efficiency, and reduce costs. However, the implementation of AI in anesthesia also presents challenges, such as the need to address issues of bias and privacy. As the field continues to evolve, it will be important to carefully consider the ethical implications of AI in anesthesia and ensure that these technologies are used in a responsible and transparent manner.
PubMed: 38654854
DOI: 10.4103/sja.sja_955_23 -
Journal of Child Health Care : For... Apr 2024Adolescents face issues regarding physical health, mental health, sexual health, drug and alcohol problems, stress, and peer pressure. Little is known about adolescents'... (Review)
Review
Adolescents face issues regarding physical health, mental health, sexual health, drug and alcohol problems, stress, and peer pressure. Little is known about adolescents' help-seeking behaviours in relation to health concerns. The general practitioner (GP) is usually the first point of contact for adolescents. The aim of this systematic review was to identify, describe, and summarize evidence on barriers and enablers experienced by adolescents when accessing GP-led primary care services. Systematic searches using four electronic databases (PsycINFO, MEDLINE, CINAHL, and SocINDEX) were conducted and the quality of the included studies was appraised. Six studies were included in this review. Findings indicate that barriers to GP access relate to trust, confidentiality, privacy, and communication. Adolescents also reported barriers such as transport, cost, and lack of information. Adolescents reported enablers being services that are sensitive to their needs, healthcare professionals who understand them, and services that are flexible regarding out of hours access. Listening to and acting on the voice of adolescents is important to developing youth-friendly services.
PubMed: 38629615
DOI: 10.1177/13674935241239837 -
PloS One 2024The United States Institute of Medicine defines patient centred care (PCC), a core element of healthcare quality, as care that is holistic and responsive to individual...
INTRODUCTION
The United States Institute of Medicine defines patient centred care (PCC), a core element of healthcare quality, as care that is holistic and responsive to individual needs. PCC is associated with better patient satisfaction and improved clinical outcomes. Current conceptualizations of PCC are mainly from Europe and North America. This systematic review summarises the perceived dimensions of PCC among patients and healthcare workers within hospitals in sub-Saharan Africa (SSA).
METHODS
Without date restrictions, searches were done on databases of the Web of Science, Cochrane Library, PubMed, Embase, Global Health, and grey literature, from their inception up to 11th August 2022. Only qualitative studies exploring dimensions or perceptions of PCC among patients, doctors and/or nurses in hospitals in (SSA) were included. Review articles and editorials were excluded. Two independent reviewers screened titles and abstracts, and conducted full-text reviews with conflicts resolved by a third reviewer. The CASP (critical appraisal skills program) checklist was utilised to assess the quality of included studies. The framework synthesis method was employed for data synthesis.
RESULTS
5507 articles were retrieved. Thirty-eight studies met the inclusion criteria, of which 17 were in the specialty of obstetrics, while the rest were spread across different fields. The perceived dimensions reported in the studies included privacy and confidentiality, communication, shared decision making, dignity and respect, continuity of care, access to care, adequate infrastructure and empowerment. Separate analysis of patients' and providers' perspective revealed a difference in the practical understanding of shared-decision making. These dimensions were summarised into a framework consisting of patient-as-person, access to care, and integrated care.
CONCLUSION
The conceptualization of PCC within SSA was largely similar to findings from other parts of the world, although with a stronger emphasis on access to care. In SSA, both relational and structural aspects of care were significant elements of PCC. Healthcare providers mostly perceived structural aspects such as infrastructure as key dimensions of PCC.
TRIAL REGISTRATION
PROSPERO Registration number CRD42021238411.
Topics: Pregnancy; Female; Humans; Hospitals; Health Personnel; Africa South of the Sahara; Patient-Centered Care; Obstetrics
PubMed: 38626224
DOI: 10.1371/journal.pone.0299627 -
A systematic review of biobanks in Latin America: Strengths and limitations for biomedical research.The International Journal of Biological... Jun 2024Biobanks are valuable tools for developing and applying scientific research and international cooperation through the collection of biological materials and their... (Review)
Review
Biobanks are valuable tools for developing and applying scientific research and international cooperation through the collection of biological materials and their associated data. Systematic research following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was conducted in late 2022 in PubMed and Scopus, and generated 17 articles to be reviewed in depth and critically assessed using the Critical Appraisal Skills Programme Checklist due to the limited available data; 12 relevant health organizations and government websites outside of peer-reviewed journals were also included. Our research identified 44 biobanks in Latin America. In general, there is a lack of regulation and legislation guaranteeing the stored materials' quality and institutional collaboration. We believe a consensus needs to be reached regarding the terminology and definitions used for biobanks. The design for informed consent should also be agreed upon to ensure the privacy of the data shared among institutions. In conclusion, in Latin America, there is a clear need for government support in creating specific procedures for biobanks and providing further support for existing biobanks.
Topics: Latin America; Humans; Biological Specimen Banks; Biomedical Research
PubMed: 38613331
DOI: 10.1177/03936155241239672 -
Sensors (Basel, Switzerland) Mar 2024Data from the Internet of Things (IoT) enables the design of new business models and services that improve user experience and satisfaction. These data serve as... (Review)
Review
Data from the Internet of Things (IoT) enables the design of new business models and services that improve user experience and satisfaction. These data serve as important information sources for many domains, including disaster management, biosurveillance, smart cities, and smart health, among others. However, this scenario involves the collection of personal data, raising new challenges related to data privacy protection. Therefore, we aim to provide state-of-the-art information regarding privacy issues in the context of IoT, with a particular focus on findings that utilize the Personal Data Store (PDS) as a viable solution for these concerns. To achieve this, we conduct a systematic mapping review to identify, evaluate, and interpret the relevant literature on privacy issues and PDS-based solutions in the IoT context. Our analysis is guided by three well-defined research questions, and we systematically selected 49 studies published until 2023 from an initial pool of 176 papers. We analyze and discuss the most common privacy issues highlighted by the authors and position the role of PDS technologies as a solution to privacy issues in the IoT context. As a result, our findings reveal that only a small number of works (approximately 20%) were dedicated to presenting solutions for privacy issues. Most works (almost 82%) were published between 2018 and 2023, demonstrating an increased interest in the theme in recent years. Additionally, only two works used PDS-based solutions to deal with privacy issues in the IoT context.
PubMed: 38610408
DOI: 10.3390/s24072197 -
Sensors (Basel, Switzerland) Mar 2024The Internet of Things (IoT) is a critical component of smart cities and a key contributor to the achievement of the United Nations Sustainable Development Goal (UNSDG)... (Review)
Review
The Internet of Things (IoT) is a critical component of smart cities and a key contributor to the achievement of the United Nations Sustainable Development Goal (UNSDG) 11: Sustainable Cities and Communities. The IoT is an infrastructure that enables devices to communicate with each other over the Internet, providing critical components for smart cities, such as data collection, generation, processing, analysis, and application handling. IoT-based applications can promote sustainable urban development. Many studies demonstrate how the IoT can improve smart cities' sustainable development. This systematic literature review provides valuable insights into the utilization of the IoT in the context of smart cities, with a particular focus on its implications for sustainable urban development. Based on an analysis of 73 publications, we discuss the role of IoT in the sustainable development of smart cities, focusing on smart communities, smart transportation, disaster management, privacy and security, and emerging applications. In each domain, we have detailed the attributes of IoT sensors. In addition, we have examined various communication technologies and protocols suitable for transmitting sensor-generated data. We have also presented the methods for analyzing and integrating these data within the IoT application layer. Finally, we identify research gaps in the literature, highlighting areas that require further investigation.
PubMed: 38610286
DOI: 10.3390/s24072074