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Burns : Journal of the International... Aug 2024Evidence on the impact of virtual care for patients with burn injuries is variable. This review aims to evaluate its use in remote assessment, rounding, and follow-up...
INTRODUCTION
Evidence on the impact of virtual care for patients with burn injuries is variable. This review aims to evaluate its use in remote assessment, rounding, and follow-up through outcomes of efficacy, usability, costs, satisfaction, clinical outcomes, impacts on triage and other benefits/drawbacks.
METHODS
A PRISMA-compliant qualitative systematic review (PROSPERO CRD42021267787) was conducted in four databases and the grey literature for primary research published between 01/01/2010 and 12/31/2020. Study quality was appraised using three established tools. Evidence was graded by the Oxford classification.
RESULTS
The search provided 481 studies, of which 37 were included. Most studies (n = 30, 81%) were Oxford Level 4 (low-level descriptive/observational) designs and had low appraised risk-of-bias (n = 20, 54%). Most applications were for the acute phase (n = 26, 70%). High patient compliance, enhanced specialist access, and new educational/networking opportunities were beneficial. Concerns pertained to IT/connection, virtual communication barriers, privacy/data-security and logistical/language considerations. Low-to-moderate-level (Oxford Grade C) evidence supported virtual burn care's cost-effectiveness, ability to improve patient assessment and triage, and efficiency/effectiveness for remote routine follow-up.
CONCLUSION
We find growing evidence that virtual burn care has a place in acute-phase specialist assistance and routine outpatient follow-up. Low-to-moderate-level evidence supports its effectiveness, cost-effectiveness, usability, satisfactoriness, and capacity to improve triage.
Topics: Humans; Burns; Telemedicine; Triage
PubMed: 38490837
DOI: 10.1016/j.burns.2024.02.014 -
Neural Networks : the Official Journal... Jun 2024Unsupervised domain adaptation (UDA) via deep learning has attracted appealing attention for tackling domain-shift problems caused by distribution discrepancy across... (Review)
Review
Unsupervised domain adaptation (UDA) via deep learning has attracted appealing attention for tackling domain-shift problems caused by distribution discrepancy across different domains. Existing UDA approaches highly depend on the accessibility of source domain data, which is usually limited in practical scenarios due to privacy protection, data storage and transmission cost, and computation burden. To tackle this issue, many source-free unsupervised domain adaptation (SFUDA) methods have been proposed recently, which perform knowledge transfer from a pre-trained source model to the unlabeled target domain with source data inaccessible. A comprehensive review of these works on SFUDA is of great significance. In this paper, we provide a timely and systematic literature review of existing SFUDA approaches from a technical perspective. Specifically, we categorize current SFUDA studies into two groups, i.e., white-box SFUDA and black-box SFUDA, and further divide them into finer subcategories based on different learning strategies they use. We also investigate the challenges of methods in each subcategory, discuss the advantages/disadvantages of white-box and black-box SFUDA methods, conclude the commonly used benchmark datasets, and summarize the popular techniques for improved generalizability of models learned without using source data. We finally discuss several promising future directions in this field.
Topics: Benchmarking; Knowledge; Privacy
PubMed: 38490115
DOI: 10.1016/j.neunet.2024.106230 -
Frontiers in Public Health 2024To review and synthesize qualitative research exploring patients' safe experience and construct a model to present barriers and facilitators to feeling safe for...
OBJECTIVES
To review and synthesize qualitative research exploring patients' safe experience and construct a model to present barriers and facilitators to feeling safe for inpatients.
DESIGN
A qualitative met-synthesis.
METHODS
We conducted a systematic electronic search of articles published in English with no date limitation across five databases (Ovid MEDLINE, EMBASE, Web of Science, CINAIL via EBSCO, and PsyINFO) in May 2023. Qualitative research focused on the safe experiences of inpatients was considered. Systematic searches yielded 8,132 studies, of which 16 articles were included. Two reviewers independently extracted and analyzed data. Qualitative meta-synthesis was performed through line-by-line coding of original texts, organizing codes into descriptive themes, and generating analytical themes.
RESULTS
We identified four themes and 11 sub-themes. Across the four themes, control included a barrier (Uncertainty) and two facilitators (Patient participation and safe care); responsible included three facilitators (Confidence in the profession, care for, and responsive); dignity included two barriers (Privacy and Neglect); stability included a barrier (Potential risk), and two facilitators (Harmonious and safe culture). We constructed a model to present the logical connection between these themes and related barriers and facilitators.
CONCLUSION
Feeling safe for inpatients is a complex perception, including four themes: control, responsible, dignity, and stability. Surrounding four themes and related barriers and facilitators, we outline principles for creating a safe environment and present strategies for improving patients' hospitalization experience and ensuring patient safety.
CLINICAL RELEVANCE
This review provides valuable insight into the clinical practice and health policy and helps medical staff to identify and overcome the potential barriers to implementing interventions in safe care. In addition, the model comprehensively describes the nature and dimensions of feeling safe, informing high-quality care service and related research.
SYSTEMATIC REVIEW REGISTRATION
Identifier, CRD42023435489.
Topics: Humans; Inpatients; Medical Staff
PubMed: 38481849
DOI: 10.3389/fpubh.2024.1308258 -
Journal of Pharmacy & Pharmaceutical... 2024This review aimed to assess the current use and acceptance of real-world data (RWD) and real-world evidence (RWE) in health technology assessment (HTA) process. It...
Real-world data: a comprehensive literature review on the barriers, challenges, and opportunities associated with their inclusion in the health technology assessment process.
This review aimed to assess the current use and acceptance of real-world data (RWD) and real-world evidence (RWE) in health technology assessment (HTA) process. It additionally aimed to discern stakeholders' viewpoints concerning RWD and RWE in HTA and illuminate the obstacles, difficulties, prospects, and consequences associated with the incorporation of RWD and RWE into the realm of HTA. A comprehensive PRISMA-based systematic review was performed in July 2022 in PubMed/Medline, Scopus, IDEAS-RePEc, International HTA database, and Centre for Reviews and Dissemination with supplementary search in Google Scholar and international organization websites. The review included pre-determined inclusion criteria while the selection of eligible studies, the data extraction process and quality assessment were carried out using standardized and transparent methods. Twenty-nine ( = 29) studies were included in the review out of 2,115 studies identified by the search strategy. In various global contexts, disparities in RWD utilization were evident, with randomized controlled trials (RCTs) serving as the primary evidence source. RWD and RWE played pivotal roles, surpassing relative effectiveness assessments (REAs) and significantly influencing decision-making and cost-effectiveness analyses. Identified challenges impeding RWD integration into HTA encompassed limited local data access, complexities in non-randomized trial design, data quality, privacy, and fragmentation. Addressing these is imperative for optimal RWD utilization. Incorporating RWD/RWE in HTA yields multifaceted advantages, enhancing understanding of treatment efficacy, resource utilization, and cost analysis, particularly via patient registries. RWE complements assessments of advanced therapy medicinal products (ATMPs) and rare diseases. Local data utilization strengthens HTA, bridging gaps when RCT data is lacking. RWD aids medical device decision-making, cancer drug reassessment, and indirect treatment comparisons. Challenges include data availability, stakeholder acceptance, expertise, and privacy. However, standardization, training, collaboration, and guidance can surmount these barriers, fostering enhanced RWD utilization in HTA. This study highlights the intricate global landscape of RWD and RWE acceptance in HTA. Recognizing regional nuances, addressing methodological challenges, and promoting collaboration are pivotal, among others, for leveraging RWD and RWE effectively in healthcare decision-making.
Topics: Humans; Technology Assessment, Biomedical; Data Accuracy
PubMed: 38481726
DOI: 10.3389/jpps.2024.12302 -
International Journal of Molecular... Mar 2024This systematic review addresses the use of ( in the symptomatological intervention of neurodegenerative disease. The existence of gut microbiota dysbiosis has been... (Review)
Review
This systematic review addresses the use of ( in the symptomatological intervention of neurodegenerative disease. The existence of gut microbiota dysbiosis has been associated with systemic inflammatory processes present in neurodegenerative disease, creating the opportunity for new treatment strategies. This involves modifying the strains that constitute the gut microbiota to enhance synaptic function through the gut-brain axis. Recent studies have evaluated the beneficial effects of the use of on motor and cognitive symptomatology, alone or in combination. This systematic review includes 20 research articles ( = 3 in human and = 17 in animal models). The main result of this research was that the use of alone or in combination produced improvements in symptomatology related to neurodegenerative disease. However, one of the studies included reported negative effects after the administration of . This systematic review provides current and relevant information about the use of this probiotic in pathologies that present neurodegenerative processes such as Alzheimer's disease, Parkinson's disease and Multiple Sclerosis.
Topics: Animals; Humans; Neurodegenerative Diseases; Access to Information; Alzheimer Disease; Parkinson Disease; Lactobacillus plantarum; Probiotics
PubMed: 38474254
DOI: 10.3390/ijms25053010 -
HERD Mar 2024This study investigates the relationship between environmental quality and medical sociology in hospitals and suggests a conceptual framework for understanding their...
PURPOSE
This study investigates the relationship between environmental quality and medical sociology in hospitals and suggests a conceptual framework for understanding their interrelation.
BACKGROUND
Despite the importance of environmental properties in the sociological approach to users' health and the role of medical sociology research in the design of hospital environments, few studies have been conducted in the field of hospital environments and medical sociology interrelation. Therefore, this article attempts to fill this gap in our knowledge.
METHODS
A systematic review was carried out in five databases (Scopus, Web of Science, Google Scholar, MEDLINE, and ScienceDirect) based on PRISMA guidelines to survey how environmental quality and medical sociology factors are related in the medical/environmental sociology research and the hospital design.
RESULTS
The search yielded the final 17 potentially relevant articles after finding 3,840 records, screening 1,295 nonduplicate articles, and reviewing 158 full-text articles. The findings revealed that four main aspects of medical sociology (physical-biological, psychological, social, and economic) and hospital environmental quality (physical, social, and psychological dimensions) influence users' health and disease status. The hospital environment includes various social issues in medical sociology (like interactions, behavior patterns, lifestyle, work motivation, and culture). The physical and psychosocial factors of the hospital environment (such as spatial configuration, aesthetics, scale, privacy, and collective spaces) are associated with psychosocial aspects of medical sociology (like social class, behavior patterns, culture, and lifestyle).
CONCLUSION
Environmental features and psychosocial issues should be considered to improve users' health and experience in hospitals and to create a user-centered health-promoting environment.
PubMed: 38468153
DOI: 10.1177/19375867241237506 -
Nature Communications Mar 2024Cloud-based personal health records increase globally. The GPOC series introduces the concept of a Global Patient co-Owned Cloud (GPOC) of personal health records. Here,... (Meta-Analysis)
Meta-Analysis
Cloud-based personal health records increase globally. The GPOC series introduces the concept of a Global Patient co-Owned Cloud (GPOC) of personal health records. Here, we present the GPOC series' Prospective Register of Systematic Reviews (PROSPERO) registered and Preferred Reporting Items Systematic and Meta-Analyses (PRISMA)-guided systematic review and meta-analysis. It examines cloud-based personal health records and factors such as data security, efficiency, privacy and cost-based measures. It is a meta-analysis of twelve relevant axes encompassing performance, cryptography and parameters based on efficiency (runtimes, key generation times), security (access policies, encryption, decryption) and cost (gas). This aims to generate a basis for further research, a GPOC sandbox model, and a possible construction of a global platform. This area lacks standard and shows marked heterogeneity. A consensus within this field would be beneficial to the development of a GPOC. A GPOC could spark the development and global dissemination of artificial intelligence in healthcare.
Topics: Humans; Artificial Intelligence; Health Records, Personal; Privacy; Computer Security
PubMed: 38467643
DOI: 10.1038/s41467-024-46503-5 -
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 -
Digital Health 2024Electronic mental health interventions are effective but not well promoted currently among older adults. This study sought to systematically review and summarize the... (Review)
Review
OBJECTIVE
Electronic mental health interventions are effective but not well promoted currently among older adults. This study sought to systematically review and summarize the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults.
METHODS
We comprehensively retrieved six electronic databases from January 2012 to September 2022: PubMed, Web of Science, Embase, Scopus, PsycINFO, and CINAHL. The JBI-QARI was used to assess the quality of the research methodology of each publication. Eligible studies underwent data coding and synthesis aligned to inductive and deductive methods. The Consolidated Framework for Implementation Research 2.0 was used as a deductive framework to guide a more structured analysis.
RESULTS
The systematic review screened 4309 articles, 17 of which were included (eight with mixed methods and nine with qualitative methods). We identified and extracted the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults: (1) innovation: technology challenges, optimized functions, and contents, security and privacy; (2) outer setting: community engagement and partnerships, financing; (3) inner setting: leadership engagement, available resources, incompatibility, intergenerational support, training and guidance; (4) individuals: perceptions, capability, motivation of older adults and healthcare providers; and (5) implementation process: recruit, external assistance, and team.
CONCLUSION
These findings are critical to optimizing, promoting, and expanding electronic mental health interventions among older adults. The systematic review also provides a reference for better evidence-based implementation strategies in the future.
PubMed: 38444518
DOI: 10.1177/20552076241234628 -
BMC Medical Ethics Mar 2024Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease...
BACKGROUND
Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture.
METHODS
To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher's Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers.
RESULTS
After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals.
CONCLUSIONS
The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.
Topics: Humans; Reproducibility of Results; Ethical Analysis; Beneficence; Early Diagnosis; Health Policy
PubMed: 38443930
DOI: 10.1186/s12910-024-01012-4