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Computers in Biology and Medicine Jun 2024Estimating treatment effects from observational data in medicine using causal inference is a very relevant task due to the abundance of observational data and the...
Estimating treatment effects from observational data in medicine using causal inference is a very relevant task due to the abundance of observational data and the ethical and cost implications of conducting randomized experiments or experimental interventions. However, how could we estimate the effect of a treatment in a hospital that has very restricted access to treatment? In this paper, we want to address the problem of distributed causal inference, where hospitals not only have different distributions of patients, but also different treatment assignment criteria. Furthermore, it is necessary to take into account that due to privacy restrictions, personal patient data cannot be shared between hospitals. To address this problem, we propose an adaptation of the federated learning algorithm FederatedAveraging to one of the most advanced models for the prediction of treatment effects based on neural networks, TEDVAE. Our algorithm adaptation takes into account the shift in the treatment distribution between hospitals and is therefore called Propensity WeightedFederatedAveraging (PW FedAvg). As the distributions of the assignment of treatments become more unbalanced between the nodes, the estimation of causal effects becomes more challenging. The experiments show that PW FedAvg manages to reduce errors in the estimation of individual causal effects when imbalances are large, compared to VanillaFedAvg and other federated learning-based causal inference algorithms based on the application of federated learning to linear parametric models, Gaussian Processes and Random Fourier Features.
PubMed: 38943946
DOI: 10.1016/j.compbiomed.2024.108779 -
Genetics in Medicine : Official Journal... Jun 2024Elective genomic testing (EGT) is increasingly available clinically. Limited real world evidence exists about attitudes and knowledge of EGT recipients.
BACKGROUND
Elective genomic testing (EGT) is increasingly available clinically. Limited real world evidence exists about attitudes and knowledge of EGT recipients.
METHODS
After web-based education, patients who enrolled in an EGT program at a rural nonprofit healthcare system completed a survey that assessed attitudes, knowledge, and risk perceptions.
RESULTS
From August 2020 to April 2022, 5,920 patients completed the survey and received testing. Patients most frequently cited interest in learning their personal disease risks as their primary motivation. Patients most often expected results to guide medication management (74.0%), prevent future disease (70.4%), and provide information about risks to offspring (65.4%). Patients were "very concerned" most frequently about the privacy of genetic information (19.8%) and how well testing predicted disease risks (18.0%). On average, patients answered 6.7 of 11 knowledge items correctly (61.3%). They more often rated their risks for colon and breast cancers as lower rather than higher than the average person, but more often rated their risk for a heart attack as higher rather than lower than the average person (all p<0.001).
CONCLUSION
Patients pursued EGT because of the utility expectations, but often misunderstood the test's capabilities.
PubMed: 38943480
DOI: 10.1016/j.gim.2024.101200 -
Genetics in Medicine : Official Journal... Jun 2024Germline testing in pediatric cancer presents opportunities and challenges. Understanding family perspectives, experiences, and preferences will optimize integration... (Review)
Review
PURPOSE
Germline testing in pediatric cancer presents opportunities and challenges. Understanding family perspectives, experiences, and preferences will optimize integration into routine care.
METHODS
Following PRISMA guidelines, we searched four databases for studies exploring perspectives, experiences, and preferences of parents/caregivers and/or patients regarding germline testing of children with cancer. Qualitative and quantitative data was extracted, organized, and summarized by research question and themes.
RESULTS
We identified 2286 unique articles, of which 24 were included. Interest in and uptake of testing was high. Families were motivated by altruism and a desire for inheritance/causation information. Testing barriers included psychological concerns, timing of the testing approach if offered at diagnosis or in a high-risk cancer setting and privacy/discrimination. Testing experiences highlighted challenges yet also positive impacts, with results providing psychological relief and informing proactive decision-making. Timing preferences varied, however allowing time to adjust to a new diagnosis was a common theme. Most wanted to receive as many germline sequencing-related results as possible.
CONCLUSION
Findings underscore the importance of integrating germline analyses into pediatric cancer care with flexibility and support for families facing challenges. Where possible, consent should be provided at a time that suits each family's situation with access to information aligning with their needs and preferences.
PROSPERO
CRD42023444890.
PubMed: 38943478
DOI: 10.1016/j.gim.2024.101197 -
BMC Nursing Jun 2024Childbirth reserves respect, as emphasized by the World Health Organization in 2018, and the focus towards the need for positive, dignified delivery experiences has...
BACKGROUND
Childbirth reserves respect, as emphasized by the World Health Organization in 2018, and the focus towards the need for positive, dignified delivery experiences has become an integral aspect of Respectful Maternity Care (RMC). It is a known fact that RMC is pivotal for favourable birth outcomes and contributes to the satisfaction of maternity care. The absence of RMC negatively affects women's and newborns' rights. The study aimed to explore healthcare providers' perspectives on sustaining RMC actions that mothers previously reported.
METHODOLOGY
This study was conducted in five hospitals in the Eastern province of Rwanda, involving 5 Focus Group Discussions (FGDs) with midwives and nurses. For interviews, we purposively selected 5-unit managers and five physicians. Additionally, 40 midwives and nurses were recruited for the FGDs. The research utilized the Dream phase of Appreciative Inquiry (AI) for interviews and Focus Groups. Data collection aimed to gain insights into Healthcare Providers' perceptions of how RMC is provided and how to establish and sustain RMC in Rwandan health facilities. Nvivo 12 was employed for organizing codes and creating a codebook, and thematic analysis was applied.
RESULTS
Four themes with sub-themes emerged. Namely, 1) Women-centered care, with Compassionate care, Privacy and confidentiality maintenance, Information provision and Liberty in decision making, Effective communication, Family involvement, Cleanliness, and Equality care. 2) Professionalism compliance with Motivated staff, Teamwork, Continuous development, Quality work provision, and Community trust. 3) RMC encounters 4) RMC sustenance.
CONCLUSION AND RECOMMENDATIONS
The continuous pursuit of high RMC standards in Rwanda involves improving childbirth experiences through utilizing existing resources, ongoing improvement, and sustaining achievements. Key recommended actions in this study for sustaining RMC encompass promoting women-centred care, enhancing healthcare provider attitudes, ensuring professionalism, building community trust, maintaining conducive health facility environments, and involving leadership.
PubMed: 38943122
DOI: 10.1186/s12912-024-02017-5 -
Environmental Science and Pollution... Jun 2024Indoor air quality (IAQ) in the built environment is significantly influenced by particulate matter, volatile organic compounds, and air temperature. Recently, the... (Review)
Review
Indoor air quality (IAQ) in the built environment is significantly influenced by particulate matter, volatile organic compounds, and air temperature. Recently, the Internet of Things (IoT) has been integrated to improve IAQ and safeguard human health, comfort, and productivity. This review seeks to highlight the potential of IoT integration for monitoring IAQ. Additionally, the paper details progress by researchers in developing IoT/mobile applications for IAQ monitoring, and their transformative impact in smart building, healthcare, predictive maintenance, and real-time data analysis systems. It also outlines the persistent challenges (e.g., data privacy, security, and user acceptability), hampering effective IoT implementation for IAQ monitoring. Lastly, the global developments and research landscape on IoT for IAQ monitoring were examined through bibliometric analysis (BA) of 106 publications indexed in Web of Science from 2015 to 2022. BA revealed the most significant contributing countries are India and Portugal, while the top productive institutions and researchers are Instituto Politecnico da Guarda (10.37% of TP) and Marques Goncalo (15.09% of TP), respectively. Keyword analysis revealed four major research themes: IoT, pollution, monitoring, and health. Overall, this paper provides significant insights for identifying prospective collaborators, benchmark publications, strategic funding, and institutions for future IoT-IAQ researchers.
PubMed: 38943001
DOI: 10.1007/s11356-024-34075-2 -
Scientific Reports Jun 2024Cryptography is crucial in protecting sensitive information and ensuring secure transactions in a time when data security and privacy are major concerns. Traditional...
Cryptography is crucial in protecting sensitive information and ensuring secure transactions in a time when data security and privacy are major concerns. Traditional cryptography techniques, which depend on mathematical algorithms and secret keys, have historically protected against data breaches and illegal access. With the advent of quantum computers, traditional cryptography techniques are at risk. In this work, we present a cryptography idea using logical phi-bits, which are classical analogues of quantum bits (qubits) and are supported by driven acoustic metamaterials. The state of phi-bits displays superpositions similar to quantum bits, with complex amplitudes and phases. We present a representation of the state vector of single and multi-phi-bit systems. The state vector of multiple phi-bits system lies in a complex exponentially scaling Hilbert space and is used to encode information or messages. By changing the driving conditions of the metamaterial, the information can be encrypted with exceptional security and efficiency. We illustrate experimentally the practicality and effectiveness of encoding and encryption of a message using a 5 phi-bits system and emphasize the scalability of this approach to an N phi-bits system with the same processing time.
PubMed: 38942907
DOI: 10.1038/s41598-024-65800-z -
Enfermeria Clinica (English Edition) 2024
Topics: Humans; Delivery of Health Care; Access to Information; Spain
PubMed: 38942531
DOI: 10.1016/j.enfcle.2024.06.002 -
Clinics in Dermatology Jun 2024The integration of teledermatology and artificial intelligence (AI) marks a significant advancement in dermatologic care. This study examines the synergistic interplay...
The integration of teledermatology and artificial intelligence (AI) marks a significant advancement in dermatologic care. This study examines the synergistic interplay between these two domains, highlighting their collective impact on enhancing the accuracy, accessibility, and efficiency of teledermatological services. Teledermatology expands dermatologic care to remote and underserved areas, while AI technologies show considerable potential in analyzing dermatologic images and performing various tasks involved in teledermatology consultations. This integration facilitates rapid, precise diagnoses, personalized treatment plans, and data-driven insights. Our explorative study involved designing a GPT-based chatbot named 'Dr. Dermbot' and exploring its performance in a teledermatologic consultation process. The design phase focused on the chatbot's ability to conduct consultations autonomously. The subsequent testing phase assessed its performance against the backdrop of current teledermatologic practices, exploring the potential of AI and chatbots to simulate and potentially enhance teledermatologic healthcare. This study demonstrates the promising future of combining teledermatology with AI. It also brings to light ethical and legal concerns, including the protection of patient data privacy and adherence to regulatory standards. The union of teledermatology and AI not only aims to enhance the precision of tele-dermatologic diagnoses but also broadens the accessibility of dermatologic services to previously underserved populations, benefiting patients, healthcare providers, and the overall healthcare system.
PubMed: 38942153
DOI: 10.1016/j.clindermatol.2024.06.020 -
Drug Safety Jun 2024While many pregnant individuals use prescription medications, evidence supporting product safety during pregnancy is often inadequate. Existing electronic healthcare...
While many pregnant individuals use prescription medications, evidence supporting product safety during pregnancy is often inadequate. Existing electronic healthcare data sources provide large, diverse samples of health plan members to allow for the study of medical product utilization during pregnancy, as well as pregnancy, maternal, and infant outcomes. The Sentinel System is a national medical product surveillance system that includes administrative claims and electronic health record databases from large national and regional health insurers. In addition to these data sources, Sentinel develops and maintains a sizeable selection of analytic tools to facilitate epidemiologic analyses in a way that protects patient privacy and health system autonomy. In this article, we provide an overview of Sentinel System infrastructure, including the Mother-Infant Linkage Table, parameterizable analytic tools, and algorithms to estimate gestational age and identify pregnancy outcomes. We also describe past and future Sentinel work that contributes to our understanding of the way medical products are used and the safety of these products during pregnancy.
PubMed: 38940904
DOI: 10.1007/s40264-024-01447-z -
Academic Emergency Medicine : Official... Jun 2024Precision health is a burgeoning scientific discipline that aims to incorporate individual variability in biological, behavioral, and social factors to develop...
BACKGROUND
Precision health is a burgeoning scientific discipline that aims to incorporate individual variability in biological, behavioral, and social factors to develop personalized health solutions. To date, emergency medicine has not deeply engaged in the precision health movement. However, rapid advances in health technology, data science, and medical informatics offer new opportunities for emergency medicine to realize the promises of precision health.
METHODS
In this article, we conceptualize precision emergency medicine as an emerging paradigm and identify key drivers of its implementation into current and future clinical practice. We acknowledge important obstacles to the specialty-wide adoption of precision emergency medicine and offer solutions that conceive a successful path forward.
RESULTS
Precision emergency medicine is defined as the use of information and technology to deliver acute care effectively, efficiently, and authentically to individual patients and their communities. Key drivers and opportunities include leveraging human data, capitalizing on technology and digital tools, providing deliberate access to care, advancing population health, and reimagining provider education and roles. Overcoming challenges in equity, privacy, and cost is essential for success. We close with a call to action to proactively incorporate precision health into the clinical practice of emergency medicine, the training of future emergency physicians, and the research agenda of the specialty.
CONCLUSIONS
Precision emergency medicine leverages new technology and data-driven artificial intelligence to advance diagnostic testing, individualize patient care plans and therapeutics, and strategically refine the convergence of the health system and the community.
PubMed: 38940478
DOI: 10.1111/acem.14962