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JMIR AI Jan 2024The evolution of artificial intelligence (AI) has significantly impacted various sectors, with health care witnessing some of its most groundbreaking contributions....
BACKGROUND
The evolution of artificial intelligence (AI) has significantly impacted various sectors, with health care witnessing some of its most groundbreaking contributions. Contemporary models, such as ChatGPT-4 and Microsoft Bing, have showcased capabilities beyond just generating text, aiding in complex tasks like literature searches and refining web-based queries.
OBJECTIVE
This study explores a compelling query: can AI author an academic paper independently? Our assessment focuses on four core dimensions: relevance (to ensure that AI's response directly addresses the prompt), accuracy (to ascertain that AI's information is both factually correct and current), clarity (to examine AI's ability to present coherent and logical ideas), and tone and style (to evaluate whether AI can align with the formality expected in academic writings). Additionally, we will consider the ethical implications and practicality of integrating AI into academic writing.
METHODS
To assess the capabilities of ChatGPT-4 and Microsoft Bing in the context of academic paper assistance in general practice, we used a systematic approach. ChatGPT-4, an advanced AI language model by Open AI, excels in generating human-like text and adapting responses based on user interactions, though it has a knowledge cut-off in September 2021. Microsoft Bing's AI chatbot facilitates user navigation on the Bing search engine, offering tailored search.
RESULTS
In terms of relevance, ChatGPT-4 delved deeply into AI's health care role, citing academic sources and discussing diverse applications and concerns, while Microsoft Bing provided a concise, less detailed overview. In terms of accuracy, ChatGPT-4 correctly cited 72% (23/32) of its peer-reviewed articles but included some nonexistent references. Microsoft Bing's accuracy stood at 46% (6/13), supplemented by relevant non-peer-reviewed articles. In terms of clarity, both models conveyed clear, coherent text. ChatGPT-4 was particularly adept at detailing technical concepts, while Microsoft Bing was more general. In terms of tone, both models maintained an academic tone, but ChatGPT-4 exhibited superior depth and breadth in content delivery.
CONCLUSIONS
Comparing ChatGPT-4 and Microsoft Bing for academic assistance revealed strengths and limitations. ChatGPT-4 excels in depth and relevance but falters in citation accuracy. Microsoft Bing is concise but lacks robust detail. Though both models have potential, neither can independently handle comprehensive academic tasks. As AI evolves, combining ChatGPT-4's depth with Microsoft Bing's up-to-date referencing could optimize academic support. Researchers should critically assess AI outputs to maintain academic credibility.
PubMed: 38875597
DOI: 10.2196/49082 -
JAMA Health Forum Jun 2024Millions of economically disadvantaged children depend on Medicaid for dental care, with states differing in whether they deliver these benefits using fee-for-service or...
IMPORTANCE
Millions of economically disadvantaged children depend on Medicaid for dental care, with states differing in whether they deliver these benefits using fee-for-service or capitated managed care payment models. However, there is limited research examining the association between managed care and the accessibility of dental services.
OBJECTIVE
To estimate the association between the adoption of managed care for dental services in Florida's Medicaid program and nontraumatic dental emergency department visits and associated charges.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used an event-study difference-in-differences design, leveraging Florida Medicaid's staggered adoption of managed care to examine its association with pediatric nontraumatic dental emergency department visits and associated charges. This study included all Florida emergency department visits from 2010 to 2014 in which the patient was 17 years or younger, the patient was a Florida resident, Medicaid paid for the visit, and a primary or secondary International Classification of Diseases, Ninth Revision, code was used to classify a nontraumatic dental condition. Analyses were conducted between May 2023 and April 2024.
EXPOSURE
The county of residence transitioning Medicaid dental services from fee-for-service to a fully capitated managed care program managed by a dental plan.
MAIN OUTCOMES AND MEASURES
The rate of nontraumatic dental emergency department visits per 100 000 pediatric Medicaid enrollees and the associated mean charges per visit. Nontraumatic dental emergency department visits are a well-documented proxy for access to dental care. Data on emergency department visit counts came from the Florida Agency for Health Care Administration. Medicaid population denominators were derived from the American Community Survey's 5-year estimates.
RESULTS
Among the 34 414 pediatric nontraumatic dental emergency department visits that met inclusion criteria across Florida's 67 counties, the mean (SD) age of patients was 8.11 (5.28) years, and 50.8% of patients were male. Of these, 10 087 visits occurred in control counties and 24 327 in treatment counties. Control counties generally had lower rates of NTDC ED visits per 100 000 enrollees compared with treatment counties (123.5 vs 132.7). Over the first 2.5 years of implementation, the adoption of managed care was associated with an 11.3% (95% CI, 4.0%-18.4%; P = .002) increase in nontraumatic dental emergency department visits compared with pre-implementation levels. There was no evidence that the average charge per visit changed.
CONCLUSIONS AND RELEVANCE
In this cohort study, Florida Medicaid's adoption of managed care for pediatric dental services was associated with increased emergency department visits for children, which could be associated with decreased access to dental care.
Topics: Humans; Medicaid; Emergency Service, Hospital; United States; Florida; Child; Managed Care Programs; Male; Female; Adolescent; Child, Preschool; Health Services Accessibility; Cohort Studies; Infant; Dental Care for Children; Emergency Room Visits
PubMed: 38874960
DOI: 10.1001/jamahealthforum.2024.1472 -
Frontiers in Public Health 2024Currently, there are still many patients who require outpatient triage assistance. ChatGPT, a natural language processing tool powered by artificial intelligence... (Randomized Controlled Trial)
Randomized Controlled Trial
Currently, there are still many patients who require outpatient triage assistance. ChatGPT, a natural language processing tool powered by artificial intelligence technology, is increasingly utilized in medicine. To facilitate and expedite patients' navigation to the appropriate department, we conducted an outpatient triage evaluation of ChatGPT. For this evaluation, we posed 30 highly representative and common outpatient questions to ChatGPT and scored its responses using a panel of five experienced doctors. The consistency of manual triage and ChatGPT triage was assessed by five experienced doctors, and statistical analysis was performed using the Chi-square test. The expert ratings of ChatGPT's answers to these 30 frequently asked questions revealed 17 responses earning very high scores (10 and 9.5 points), 7 earning high scores (9 points), and 6 receiving low scores (8 and 7 points). Additionally, we conducted a prospective cohort study in which 45 patients completed forms detailing gender, age, and symptoms. Triage was then performed by outpatient triage staff and ChatGPT. Among the 45 patients, we found a high level of agreement between manual triage and ChatGPT triage (consistency: 93.3-100%, <0.0001). We were pleasantly surprised to observe that ChatGPT's responses were highly professional, comprehensive, and humanized. This innovation can help patients win more treatment time, improve patient diagnosis and cure rates, and alleviate the pressure of medical staff shortage.
Topics: Humans; Triage; Artificial Intelligence; Prospective Studies; Female; Male; Outpatients; Middle Aged; Adult; Natural Language Processing; Aged
PubMed: 38873307
DOI: 10.3389/fpubh.2024.1391906 -
JMIR Formative Research Jun 2024Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased...
BACKGROUND
Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP.
OBJECTIVE
The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students.
METHODS
College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test.
RESULTS
A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively).
CONCLUSIONS
Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses.
PubMed: 38869926
DOI: 10.2196/50557 -
Health Science Reports Jun 2024A humanitarian crisis means any event or series of events that are harmful to the health or security of the general population. The Niger Republic is currently facing a...
INTRODUCTION
A humanitarian crisis means any event or series of events that are harmful to the health or security of the general population. The Niger Republic is currently facing a serious crisis amid the military coup of July 26, 2023. We fear that if nothing is done about it quickly, there could be a civil war in Niger and other neighboring countries.
AIM
This present article aims to provide comprehensive knowledge about the ongoing humanitarian crisis in Niger, highlighting the factors that caused it and providing possible solutions for them.
METHODOLOGY
A literature search was conducted on the recent humanitarian crisis caused by the military coup in Niger Republic using databases such as PubMed, ResearchGate, Google Scholar, World Health Organization, United Nations, online newspapers, and reports from 2013 to 2023.
RESULT
We found that the humanitarian crisis amid the military coup in Niger Republic has further amplified the vulnerability of millions of Nigeriens to more problems in the Niger Republic. The number of Nigeriens in need of humanitarian assistance has reportedly increased by 65%, from 2.3 million in 2019 to 3.8 million in 2021. More than two million children in Niger have been impacted by the crisis in the country and need humanitarian assistance. Furthermore, other causes of the humanitarian crisis in the Niger Republic include sociodemographic factors, climate change, and other natural disasters.
CONCLUSION
The humanitarian crisis in Niger, caused by different factors such as socioeconomic stagnation, environmental causes, food insecurity, terrorist activities, and internal displacement, is an alarming situation that requires an urgent solution and a response from the international community. There is a need to analyze all the underlying causes of humanitarian crises and find long-lasting solutions for them.
PubMed: 38868540
DOI: 10.1002/hsr2.2180 -
Journal of Primary Care & Community... 2024Recruiting organizations (i.e., health plans, health systems, or clinical practices) is important for implementation science, yet limited research explores effective...
INTRODUCTION
Recruiting organizations (i.e., health plans, health systems, or clinical practices) is important for implementation science, yet limited research explores effective strategies for engaging organizations in pragmatic studies. We explore the effort required to meet recruitment targets for a pragmatic implementation trial, characteristics of engaged and non-engaged clinical practices, and reasons health plans and rural clinical practices chose to participate.
METHODS
We explored recruitment activities and factors associated with organizational enrollment in SMARTER CRC, a randomized pragmatic trial to increase rates of CRC screening in rural populations. We sought to recruit 30 rural primary care practices within participating Medicaid health plans. We tracked recruitment outreach contacts, meeting content, and outcomes using tracking logs. Informed by the Consolidated Framework for Implementation Research, we analyzed interviews, surveys, and publicly available clinical practice data to identify facilitators of participation.
RESULTS
Overall recruitment activities spanned January 2020 to April 2021. Five of the 9 health plans approached agreed to participate (55%). Three of the health plans chose to operate centrally as 1 site based on network structure, resulting in 3 recruited health plan sites. Of the 101 identified practices, 76 met study eligibility criteria; 51% (n = 39) enrolled. Between recruitment and randomization, 1 practice was excluded, 5 withdrew, and 7 practices were collapsed into 3 sites for randomization purposes based on clinical practice structure, leaving 29 randomized sites. Successful recruitment required iterative outreach across time, with a range of 2 to 17 encounters per clinical practice. Facilitators to recruitment included multi-modal outreach, prior relationships, effective messaging, flexibility, and good timing.
CONCLUSION
Recruiting health plans and rural clinical practices was complex and iterative. Leveraging existing relationships and allocating time and resources to engage clinical practices in pragmatic implementation research may facilitate more diverse representation in future trials and generalizability of research findings.
Topics: Humans; Early Detection of Cancer; Primary Health Care; United States; Rural Health Services; Patient Selection; Rural Population; Colorectal Neoplasms; Medicaid; Community-Institutional Relations
PubMed: 38864248
DOI: 10.1177/21501319241259915 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Jun 2024Trauma is recognized globally as a great public health challenge. It stands as the predominant cause of mortality among those under the age of 45 and is also ranked...
Trauma is recognized globally as a great public health challenge. It stands as the predominant cause of mortality among those under the age of 45 and is also ranked among the top five causes of death for both urban and rural populations within China. This stark reality underscores the critical urgency in establishing an efficient system for trauma care, which is pivotal for substantially enhancing the survival rates of patients. An optimally developed system for trauma care not only guarantees that patients promptly receive professional medical assistance but also facilitates significant improvements in the outcomes of trauma care through the strategic establishment of trauma centers. At present, a considerable variation exists in the quality of trauma care provided across various regions within China. The adoption of comprehensive quality management strategies for the medical processes involved in trauma care, alongside the standardized management of on-site rescue operations, pre-hospital emergency care, and in-hospital treatment protocols, stands as a fundamental approach to boost the capabilities of trauma care and, consequently, the survival rates of trauma patients. Serving as the cornerstone of comprehensive medical quality management, key quality control indicators possess the capacity to steer the development direction of trauma centers. In a concerted effort to further augment the medical quality management of trauma care, standardize clinical diagnosis and treatment methodologies, and advocate for the standardization and ho-mogenization of medical services, the Medical Quality Control Professional Committee of the National Center for Trauma Medicine has undertaken a detailed refinement and update of the 16 key quality control indicators for trauma centers. These were initially put forward in the "Notice on Further Enhancing Trauma Care Capabilities" disseminated by the National Health Commission in 2018.Consequent to this endeavor, a revised set of 19 quality control indicators has been devised. This comprehensive set, inclusive of the indicators' names, definitions, calculation methodologies, significance, and the subjects for quality control, is designed for utilization within the quality management and control operations of trauma centers across various levels. This initiative aims to furnish a concrete and executable roadmap for the quality control endeavors of trauma centers. Through the enactment of these quality control indicators, medical institutions are empowered to conduct more stringent monitoring and evaluative measures across all facets of trauma care. This not only facilitates the prompt identification and rectification of existing challenges but also substantially boosts the efficiency of internal collaboration. It enhances the synergy between different departments, thereby markedly improving the efficiency and quality of trauma care.
Topics: Humans; Trauma Centers; China; Quality Control; Quality Indicators, Health Care; Wounds and Injuries; Consensus
PubMed: 38864144
DOI: 10.19723/j.issn.1671-167X.2024.03.025 -
BMC Health Services Research Jun 2024As the population ages, senior care for older adults in China has become increasingly important and has attracted the attention of both government and society. This...
BACKGROUND
As the population ages, senior care for older adults in China has become increasingly important and has attracted the attention of both government and society. This study aimed to explore preferences and influencing factors related to senior care among older Chinese adults and thus propose effective and targeted strategies for the development of a comprehensive care system for older adults in the aging Chinese population.
METHODS
Data were obtained from a cross-sectional survey conducted in sixteen communities or villages in Jiangsu Province, China, from July to September 2021. Guided by the Andersen Behavioral Model, multivariate logistic regression was conducted to identify factors associated with preferences for senior care arrangements.
RESULTS
A total of 870 respondents were included in the study, 60.11% of whom preferred receiving care in their own homes, while only 13.68% chose residential care facilities (RCFs). For predisposing factors, rural respondents preferred receiving care in their own homes compared to urban respondents (children's home: OR = 0.55, P < 0.01; RCF: OR = 0.58, P < 0.01). Concerning enabling factors, respondents who were not employed (OR = 2.30, P < 0.01) and those without financial support (OR = 2.73, P < 0.05) preferred RCFs to their own homes. Respondents receiving life assistance (sometimes: OR = 2.76, P < 0.001; regularly: OR = 2.57, P < 0.01; every day: OR = 3.57, P < 0.001) preferred their children's homes to their own homes. In terms of need factors, respondents with noncommunicable diseases (NCDs, OR > 1, P < 0.05), those who knew about RCFs (some: OR = 0.53, P < 0.005; no: OR = 0.10, P < 0.001) and those with a good impression of RCFs (fair: OR = 3.72, P < 0.05; good: OR = 11.91, P < 0.001) preferred receiving care in RCFs compared to their counterparts.
CONCLUSIONS
Older Chinese adults' senior care preferences were affected by predisposing factors, enabling factors, and need factors. Policy-makers should consider targeted measures to identify more precise senior care services and thus address aging challenges in China.
Topics: Humans; Cross-Sectional Studies; China; Aged; Male; Female; Aged, 80 and over; Patient Preference; Middle Aged; Surveys and Questionnaires; Rural Population
PubMed: 38862909
DOI: 10.1186/s12913-024-11168-9 -
Journal of the International AIDS... Jun 2024To achieve epidemic control of infectious diseases, engaging higher-burden populations with accessible diagnostic services is critical. HIV self-testing (HIVST) is a...
INTRODUCTION
To achieve epidemic control of infectious diseases, engaging higher-burden populations with accessible diagnostic services is critical. HIV self-testing (HIVST) is a promising option.
METHODS
We implemented an online HIVST programme for key populations across India. Eligible clients were 18 years or older, self-reported a negative or unknown HIV status and reported not taking antiretroviral therapy. Clients who reported a prior HIV diagnosis were not eligible to receive an HIVST kit. HIVST clients received kits via courier or in person at pre-determined pick-up points supported by trained counselling staff. Virtual counsellors engaged clients online and by phone and offered support to register, access, and complete HIVST free of cost. Virtual counsellors supported clients to report results and engage with follow-up services. Follow-up included linking clients with a positive result to confirmatory testing and HIV care services. We assessed programmatic data across HIV continuum outcomes and conducted a qualitative evaluation through interviews with purposively sampled clients.
RESULTS
Between 30 June 2021 and 30 September 2022, 5324 clients ordered an HIVST kit (76% men, 13% women, 7% transgender people, 4% unknown gender). Of the 4282 clients reporting results (94% of those who received a kit), 6% screened positive, among whom 72% (n = 184) completed confirmatory testing. Themes from 41 client interviews included satisfaction about the convenience and privacy of services and the discreet nature of kit delivery. Respondents were drawn to the convenience of HIVST and appreciated gaining courage and comfort throughout the process from virtual counsellor support. For respondents who screened positive, challenges to care linkage included fearing judgemental questions from public providers and wanting more time before starting treatment. Clients shared concerns about kit accuracy and suggested that instructional materials be provided with more diverse language options.
CONCLUSIONS
Web-based HIVST services with tailored support appeared to facilitate HIV service access and engagement of harder-to-reach populations across India. Assistance from a community-oriented counsellor proved important to overcome literacy barriers and mistrust in order to support the HIVST process and service linkage. Learnings can inform global efforts to improve the critical step of diagnosis in achieving epidemic control for HIV and other infectious diseases.
Topics: Humans; India; Male; HIV Infections; Female; Adult; Self-Testing; Middle Aged; Young Adult; Counseling; Adolescent; Counselors; Internet; HIV Testing
PubMed: 38861458
DOI: 10.1002/jia2.26302 -
JAMA Network Open Jun 2024Concern has been raised about persistent sex disparities after coronary artery bypass grafting, with female patients having higher mortality. However, whether these...
IMPORTANCE
Concern has been raised about persistent sex disparities after coronary artery bypass grafting, with female patients having higher mortality. However, whether these disparities persist across hospitals of different qualities is unknown.
OBJECTIVE
To evaluate sex disparities in 30-day mortality after coronary artery bypass grafting across high- and low-quality hospitals.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional, retrospective cohort study evaluated Medicare beneficiaries undergoing coronary artery bypass grafting between October 1, 2015, and March 31, 2020. Data analysis was performed from July 1, 2023, to December 1, 2023.
EXPOSURES
The primary exposures were hospital quality and sex. For hospital quality, hospitals were placed into rank order by their overall risk-adjusted mortality rate and divided into quintiles.
MAIN OUTCOME AND MEASURES
Risk-adjusted 30-day mortality using a logistic regression model accounting for patient factors, including sex, age, comorbidities, elective vs unplanned admission, number of bypass grafts, use of arterial graft, and year of surgery.
RESULTS
A total of 444 855 beneficiaries (mean [SD] age, 71.5 [7.5] years; 120 333 [27.1%] female and 324 522 [72.9%] male) were studied. Compared with male beneficiaries, female beneficiaries were more likely to have an unplanned admission (66 425 [55.2%] vs 157 895 [48.7%], P < .001) and receive care at low-quality (vs high-quality) hospitals (odds ratio, 1.26; 95% CI, 1.23-1.29; P < .001). Overall, risk-adjusted female mortality was 4.24% (95% CI, 4.20%-4.27%), and male mortality was 2.75% (95% CI, 2.75%-2.77%), with an absolute difference of 1.48 (95% CI, 1.45-1.51) percentage points (P < .001). At the highest-quality hospitals, male mortality was 1.57% (95% CI, 1.56%-1.59%), and female mortality was 2.58% (95% CI, 2.54%-2.62%), with an absolute difference of 1.01 (95% CI, 0.97-1.04) percentage points (P < .001). At the lowest-quality hospitals, male mortality was 4.94% (95% CI, 4.88%-5.01%), and female mortality was 7.02% (95% CI, 6.90%-7.13%), with an absolute difference of 2.07 (95% CI, 1.95-2.19) percentage points (P < .001). Female beneficiaries receiving care at low-quality hospitals had a higher mortality than male beneficiaries receiving care at the high-quality hospitals (7.02% vs 1.57%, P < .001).
CONCLUSIONS AND RELEVANCE
In this cohort study of Medicare beneficiaries undergoing coronary artery bypass grafting, female beneficiaries were more likely to receive care at low-quality hospitals, where the sex disparity in mortality was double that of high-quality hospitals. Quality improvement targeting low-quality hospitals as well as equitable referral of female beneficiaries to higher-quality hospitals may narrow the sex disparity after coronary artery bypass grafting.
Topics: Humans; Coronary Artery Bypass; Female; Male; Aged; Cross-Sectional Studies; Retrospective Studies; United States; Hospitals; Healthcare Disparities; Medicare; Quality of Health Care; Sex Factors; Hospital Mortality; Aged, 80 and over
PubMed: 38861261
DOI: 10.1001/jamanetworkopen.2024.14354