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Otten M, Djamei V, Augustin M. Development, Feasibility, and Acceptability of the Electronic Patient Benefit Index for Psoriasis in Clinical Practice: Mixed Methods Study. JMIR DERMATOLOGY 2024; 7:e54762. [PMID: 39121470 PMCID: PMC11344180 DOI: 10.2196/54762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Patient-reported outcomes are relevant in clinical practice showing patient benefits, supporting clinicians' decision-making, and contributing to the delivery of high standards of care. Digital monitoring of patient-reported outcomes is still rare. The Patient Benefit Index (PBI) measures benefits and goals from patients' views and may be relevant for regular documentation and shared decision-making. OBJECTIVE This study aimed to develop electronic versions of the PBI to examine their feasibility and acceptability in clinical practice for patients with psoriasis. METHODS We developed an app and a web version of the existing, valid PBI using focus groups and cognitive debriefings with patients before conducting a quantitative survey on its feasibility and acceptability. Conduction took part in an outpatient dermatology care unit in Germany. Descriptive and subgroup analyses were conducted. RESULTS A total of 139 patients completed the electronic PBIs (ePBIs) and took part in the survey. The ePBI was understandable (n=129-137, 92.8%-98.6%) and feasible, for example, easy to read (n=135, 97.1%) and simple to handle (n=137, 98.5%). Acceptability was also high, for example, patients can imagine using and discussing the ePBI data in practice (n=91, 65.5%) and documenting it regularly (n=88, 63.3%). They believe it could support treatment decisions (n=118, 84.9%) and improve communication with their physician (n=112, 81.3%). They can imagine filling in electronic questionnaires regularly (n=118, 84.9%), even preferring electronic over paper versions (n=113, 81.2%). Older and less educated people show less feasibility, but the latter expected the relationship with their physician to improve and would be more willing to invest time or effort. CONCLUSIONS The app and web version of the PBI are usable and acceptable for patients offering comprehensive documentation and patient participation in practice. An implementation strategy should consider patients' needs, barriers, and facilitators but also physicians' attitudes and requirements from the health care system.
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Affiliation(s)
- Marina Otten
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vahid Djamei
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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2
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Narvaez RA. Exploring the uses of digital health in palliative care in Southeast Asia. Int J Palliat Nurs 2024; 30:390-396. [PMID: 39028313 DOI: 10.12968/ijpn.2024.30.7.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND This integrative review explores the use of digital health technologies in palliative care within Southeast Asia. Despite extensive documentation of digital health in palliative care in Western nations, its application in Southeast Asia remains underdeveloped. METHOD The review includes a total of four papers meeting the eligibility criteria. FINDINGS The findings reveal limited studies of digital health adoption in palliative care. Key technologies include mobile health applications, electronic health records and telemedicine platforms. Challenges, such as health inequities, data security and the need for technology validation were identified. The review underscores the necessity for region-specific research to address these challenges and improve the integration of digital health in palliative care. CONCLUSION This study highlights the potential of digital health to enhance palliative care delivery and patient outcomes in Southeast Asia, advocating for increased adoption and tailored implementation strategies.
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Turnbull J, Prichard J, MacLellan J, Pope C. eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey. J Med Internet Res 2024; 26:e50376. [PMID: 38833297 PMCID: PMC11185907 DOI: 10.2196/50376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/21/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. "Digital first" may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. OBJECTIVE This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. METHODS A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. RESULTS Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). CONCLUSIONS These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand.
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Affiliation(s)
- Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Prichard
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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4
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Li Y, Gunasekeran DV, RaviChandran N, Tan TF, Ong JCL, Thirunavukarasu AJ, Polascik BW, Habash R, Khaderi K, Ting DSW. The next generation of healthcare ecosystem in the metaverse. Biomed J 2024; 47:100679. [PMID: 38048990 PMCID: PMC11245972 DOI: 10.1016/j.bj.2023.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/04/2023] [Accepted: 11/19/2023] [Indexed: 12/06/2023] Open
Abstract
The Metaverse has gained wide attention for being the application interface for the next generation of Internet. The potential of the Metaverse is growing, as Web 3·0 development and adoption continues to advance medicine and healthcare. We define the next generation of interoperable healthcare ecosystem in the Metaverse. We examine the existing literature regarding the Metaverse, explain the technology framework to deliver an immersive experience, along with a technical comparison of legacy and novel Metaverse platforms that are publicly released and in active use. The potential applications of different features of the Metaverse, including avatar-based meetings, immersive simulations, and social interactions are examined with different roles from patients to healthcare providers and healthcare organizations. Present challenges in the development of the Metaverse healthcare ecosystem are discussed, along with potential solutions including capabilities requiring technological innovation, use cases requiring regulatory supervision, and sound governance. This proposed concept and framework of the Metaverse could potentially redefine the traditional healthcare system and enhance digital transformation in healthcare. Similar to AI technology at the beginning of this decade, real-world development and implementation of these capabilities are relatively nascent. Further pragmatic research is needed for the development of an interoperable healthcare ecosystem in the Metaverse.
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Affiliation(s)
- Yong Li
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Dinesh Visva Gunasekeran
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Ting Fang Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | | | | | - Bryce W Polascik
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ranya Habash
- Bascom Palmer Eye Institute, University of Miami, Florida, USA
| | - Khizer Khaderi
- Department of Ophthalmology, Stanford University, California, USA
| | - Daniel S W Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore; Department of Ophthalmology, Stanford University, California, USA.
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5
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George PE, Kc D, Greenleaf M, Shah J, Lam WA, Hawkins CM. Bridging the Divide: Unintended Consequences of the Shift to Home-Based Telemedicine. J Pediatr 2024; 269:113719. [PMID: 37660973 DOI: 10.1016/j.jpeds.2023.113719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To evaluate the impact on health care access of the change in telemedicine delivery from a clinic-based model, in which patients connect with their healthcare provider from local telemedicine clinics, to a home-based model, in which patients independently connect from their homes. STUDY DESIGN In this retrospective analysis, we compared relative uptake in telemedicine services in Period 1 (01/01/2019 to 03/15/2020, prepandemic, clinic-based model) vs Period 2 (03/16/2020 to 06/30/2022, home-based model) within a tertiary pediatric hospital system. Using multivariable logistic regression, we investigated the influence of telemedicine delivery model on patient sociodemographic characteristics of completed telemedicine visits. RESULTS We analyzed 400 539 patients with 1 406 961 completed outpatient encounters (52% White, 35% Black), of which 62 920 (4.5%) were telemedicine. In the clinic-based model (Period 1), underserved populations had greater likelihoods of accessing telemedicine: Hispanic ethnicity (OR = 1.41, P = .028) vs reference group non-Hispanic, Medicaid (OR = 2.62, P < .001) vs private insurance, and low-income neighborhood (OR = 3.40, P < .001) vs medium-income. In aggregate, telemedicine utilization rapidly increased from Period 1 (1.5 encounters/day) to Period 2 (107.9 encounters/day). However, underserved populations saw less relative increase (Medicaid [OR = 0.28, P < .001], Hispanic [OR = 0.53, P < .001], low-income [OR = 0.23, P < .001]). CONCLUSIONS We observe that the clinic-based model offers more equitable access, while the home-based model offers more absolute access, suggesting that a hybrid model that offers both home-based and clinic-based services may result in more absolute and equitable access to telemedicine.
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Affiliation(s)
- Paul E George
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Diwas Kc
- Emory University Goizueta Business School, Atlanta, GA
| | - Morgan Greenleaf
- Emory University School of Medicine, Atlanta, GA; Georgia Clinical and Translational Science Alliance, Atlanta, GA
| | - Jay Shah
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Wilbur A Lam
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA; Georgia Institute of Technology, Coulter Department of Biomedical Engineering, Atlanta, GA
| | - C Matthew Hawkins
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
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Kim J, Cai ZR, Chen ML, Onyeka S, Ko JM, Linos E. Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022. JMIR Public Health Surveill 2024; 10:e51279. [PMID: 38669075 PMCID: PMC11087857 DOI: 10.2196/51279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/28/2023] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease's emergence. OBJECTIVE We aim to comprehensively assess telehealth use and its associated factors in the United States. METHODS This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (≥18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. RESULTS Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers' recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ≥75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth. CONCLUSIONS To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research.
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Affiliation(s)
- Jiyeong Kim
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Zhuo Ran Cai
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Michael L Chen
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Sonia Onyeka
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Justin M Ko
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Eleni Linos
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
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7
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Sah S, Liu R, Lai H, Agrawal M, Jain P, Agashe P, Gupta A, Madhan P, Chauhan R, Chourasiya K, Bansod S, Suman, Singh G, Sule A, Singh J, Puah M, Boon J, Rojas-Carabali W, Sen P, Lee B, Sobrin L, Sen A, Agrawal R. Improving Access to Eye Care in Rural Communities: PocDoc's Web-Based Visual Acuity Screening Tool. Telemed J E Health 2024; 30:763-770. [PMID: 37707995 DOI: 10.1089/tmj.2023.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Objective: Visual acuity (VA) testing is crucial for early intervention in cases of visual impairment, especially in rural health care. This study aimed to determine the potential of a web-based VA test (PocDoc) in addressing the unique health care needs of rural areas through the comparison in its effectiveness against the conventional VA test in identifying visual impairment among an Indian rural population. Methods: Prospective comparative study conducted in December 2022 at a tertiary referral eye care center in central India. We evaluated all patients with the PocDoc VA tests using three device types, and the conventional VA test. Bland-Altman plot (BAP) compared PocDoc and conventional VA tests. Fisher's exact tests evaluated associations between categorical parameters. Kruskal-Wallis tests followed by post hoc Dunn's tests identified association between categorical parameters and numerical parameters. Results: We evaluated 428 patients (792 measurements of VA) with mean age 36.7 (±23.3) years. PocDoc resulted in slightly worse VA scores (mean logMAR: 0.345) than conventional (mean logMAR: 0.315). Correlation coefficient between the conventional and PocDoc logMAR VA values was rho = 0.845 and rho2 = 0.7133 (p = 6.617 × 10-215; adjusted p = 2.205 × 10-214). Most data points fell within the interchangeable range of ±0.32 on BAP. Difference between the two methods increased with higher logMAR values, indicating poorer agreement for worse VA scores. Conclusions: Identifying and addressing the unique health care needs of rural populations is critical, including access to appropriate and effective VA testing methods. Validating and improving VA testing methods can ensure early intervention and improve the quality of life for individuals with visual impairment.
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Affiliation(s)
- Shreya Sah
- University of New South Wales (UNSW) Medicine, Sydney, New South Wales, Australia
| | - Renee Liu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - HaoXing Lai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahek Agrawal
- St Joseph's Institute International School, Singapore, Singapore
| | | | | | | | | | | | | | | | - Suman
- Sadguru Netra Chikatsalya, Chitrakoot, India
| | | | - Ashita Sule
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Marilyn Puah
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Joewee Boon
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Pradnya Sen
- Sadguru Netra Chikatsalya, Chitrakoot, India
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Alok Sen
- Sadguru Netra Chikatsalya, Chitrakoot, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
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8
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Hong W. Advances and Opportunities of Mobile Health in the Postpandemic Era: Smartphonization of Wearable Devices and Wearable Deviceization of Smartphones. JMIR Mhealth Uhealth 2024; 12:e48803. [PMID: 38252596 PMCID: PMC10823426 DOI: 10.2196/48803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/08/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Mobile health (mHealth) with continuous real-time monitoring is leading the era of digital medical convergence. Wearable devices and smartphones optimized as personalized health management platforms enable disease prediction, prevention, diagnosis, and even treatment. Ubiquitous and accessible medical services offered through mHealth strengthen universal health coverage to facilitate service use without discrimination. This viewpoint investigates the latest trends in mHealth technology, which are comprehensive in terms of form factors and detection targets according to body attachment location and type. Insights and breakthroughs from the perspective of mHealth sensing through a new form factor and sensor-integrated display overcome the problems of existing mHealth by proposing a solution of smartphonization of wearable devices and the wearable deviceization of smartphones. This approach maximizes the infinite potential of stagnant mHealth technology and will present a new milestone leading to the popularization of mHealth. In the postpandemic era, innovative mHealth solutions through the smartphonization of wearable devices and the wearable deviceization of smartphones could become the standard for a new paradigm in the field of digital medicine.
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Affiliation(s)
- Wonki Hong
- Department of Digital Healthcare, Daejeon University, Daejeon, Republic of Korea
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9
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Ong JCL, Seng BJJ, Law JZF, Low LL, Kwa ALH, Giacomini KM, Ting DSW. Artificial intelligence, ChatGPT, and other large language models for social determinants of health: Current state and future directions. Cell Rep Med 2024; 5:101356. [PMID: 38232690 PMCID: PMC10829781 DOI: 10.1016/j.xcrm.2023.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/12/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024]
Abstract
This perspective highlights the importance of addressing social determinants of health (SDOH) in patient health outcomes and health inequity, a global problem exacerbated by the COVID-19 pandemic. We provide a broad discussion on current developments in digital health and artificial intelligence (AI), including large language models (LLMs), as transformative tools in addressing SDOH factors, offering new capabilities for disease surveillance and patient care. Simultaneously, we bring attention to challenges, such as data standardization, infrastructure limitations, digital literacy, and algorithmic bias, that could hinder equitable access to AI benefits. For LLMs, we highlight potential unique challenges and risks including environmental impact, unfair labor practices, inadvertent disinformation or "hallucinations," proliferation of bias, and infringement of copyrights. We propose the need for a multitiered approach to digital inclusion as an SDOH and the development of ethical and responsible AI practice frameworks globally and provide suggestions on bridging the gap from development to implementation of equitable AI technologies.
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Affiliation(s)
- Jasmine Chiat Ling Ong
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore; SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore
| | - Benjamin Jun Jie Seng
- MOHH Holdings (Singapore) Pte., Ltd., Singapore, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | | | - Lian Leng Low
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore; Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore; Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
| | - Andrea Lay Hoon Kwa
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore; SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore; Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Shu Wei Ting
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research, Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; Byers Eye Institute, Stanford University, Stanford, CA, USA.
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10
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Than J, Sim PY, Muttuvelu D, Ferraz D, Koh V, Kang S, Huemer J. Teleophthalmology and retina: a review of current tools, pathways and services. Int J Retina Vitreous 2023; 9:76. [PMID: 38053188 DOI: 10.1186/s40942-023-00502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/02/2023] [Indexed: 12/07/2023] Open
Abstract
Telemedicine, the use of telecommunication and information technology to deliver healthcare remotely, has evolved beyond recognition since its inception in the 1970s. Advances in telecommunication infrastructure, the advent of the Internet, exponential growth in computing power and associated computer-aided diagnosis, and medical imaging developments have created an environment where telemedicine is more accessible and capable than ever before, particularly in the field of ophthalmology. Ever-increasing global demand for ophthalmic services due to population growth and ageing together with insufficient supply of ophthalmologists requires new models of healthcare provision integrating telemedicine to meet present day challenges, with the recent COVID-19 pandemic providing the catalyst for the widespread adoption and acceptance of teleophthalmology. In this review we discuss the history, present and future application of telemedicine within the field of ophthalmology, and specifically retinal disease. We consider the strengths and limitations of teleophthalmology, its role in screening, community and hospital management of retinal disease, patient and clinician attitudes, and barriers to its adoption.
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Affiliation(s)
- Jonathan Than
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Peng Y Sim
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Danson Muttuvelu
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- MitØje ApS/Danske Speciallaeger Aps, Aarhus, Denmark
| | - Daniel Ferraz
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
- Institute of Ophthalmology, University College London, London, UK
| | - Victor Koh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Josef Huemer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK.
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
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11
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Betzler BK, Chen H, Cheng CY, Lee CS, Ning G, Song SJ, Lee AY, Kawasaki R, van Wijngaarden P, Grzybowski A, He M, Li D, Ran Ran A, Ting DSW, Teo K, Ruamviboonsuk P, Sivaprasad S, Chaudhary V, Tadayoni R, Wang X, Cheung CY, Zheng Y, Wang YX, Tham YC, Wong TY. Large language models and their impact in ophthalmology. Lancet Digit Health 2023; 5:e917-e924. [PMID: 38000875 PMCID: PMC11003328 DOI: 10.1016/s2589-7500(23)00201-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 11/26/2023]
Abstract
The advent of generative artificial intelligence and large language models has ushered in transformative applications within medicine. Specifically in ophthalmology, large language models offer unique opportunities to revolutionise digital eye care, address clinical workflow inefficiencies, and enhance patient experiences across diverse global eye care landscapes. Yet alongside these prospects lie tangible and ethical challenges, encompassing data privacy, security, and the intricacies of embedding large language models into clinical routines. This Viewpoint highlights the promising applications of large language models in ophthalmology, while weighing up the practical and ethical barriers towards their real-world implementation. This Viewpoint seeks to stimulate broader discourse on the potential of large language models in ophthalmology and to galvanise both clinicians and researchers into tackling the prevailing challenges and optimising the benefits of large language models while curtailing the associated risks.
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Affiliation(s)
| | - Haichao Chen
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Ching-Yu Cheng
- Centre for Innovation and Precision Eye Health, National University of Singapore, Singapore; Department of Ophthalmology, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Cecilia S Lee
- University of Washington School of Medicine, Department of Ophthalmology, Seattle, WA, USA
| | - Guochen Ning
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Aaron Y Lee
- University of Washington School of Medicine, Department of Ophthalmology, Seattle, WA, USA
| | - Ryo Kawasaki
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan; Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Osaka, Japan
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, VA, Australia; Ophthalmology, University of Melbourne Department of Surgery, East Melbourne, Melbourne, VA, Australia
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Mingguang He
- Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Dawei Li
- College of Future Technology, Peking University, Beijing, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Kelvin Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | | | - Sobha Sivaprasad
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Varun Chaudhary
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ramin Tadayoni
- Université Paris Cité, AP-HP, Lariboisière, Saint Louis, and Rothschild Foundation Hospitals, Paris, France
| | - Xiaofei Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yih Chung Tham
- Centre for Innovation and Precision Eye Health, National University of Singapore, Singapore; Department of Ophthalmology, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Hattingh HL, Edmunds C, Gillespie BM. Medication management of COVID-19 patients during transition to virtual models of care: a qualitative study. J Pharm Policy Pract 2023; 16:127. [PMID: 37880768 PMCID: PMC10598939 DOI: 10.1186/s40545-023-00633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Expansion of hospital service models was one of the strategies implemented to manage the COVID-19 pandemic through virtual models of care. COVID-19 patients were hospital inpatients transferred to virtual wards and managed outside the hospital. Pharmacists had to provide distance medication management and support services. Virtual care patient support incorporated telehealth consultations by doctors, pharmacists and nurses. This study explored hospital clinicians' experiences and perspectives on medication management and safety issues of the COVID-19 patients transferred from inpatient units (IPUs) to virtual models of care at the time of transfer. METHODS Semi-structured qualitative interviews were conducted with purposively selected doctors, pharmacists and nurses involved in the management of COVID-19 patients in a virtual model of care (home or hotel). Clinicians were interviewed face-to-face or via MS Teams between March and May 2022. An interview schedule included 13 questions and prompts to explore perceptions of medication management and safety aspects. RESULTS Twenty clinicians were interviewed: six doctors, seven pharmacists, and seven nurses. The average interview time was 26 min (SD: 4.7; range 21-39). Four major medication management and safety themes emerged from the data: (1) complexities involved in efficient handover between IPU and virtual models of care; (2) lack of clarity on roles and responsibilities between hospital and primary care clinicians; (3) communication challenges when pharmacists work remotely; and (4) proactive management of specific medication safety risks. A common thread throughout the themes was concerns for potential impact on patient safety. CONCLUSION Overall, clinicians were supportive of the virtual models although patient safety issues were raised that need to be addressed in the development of future services. The results from this study may inform improvements in medication safety implementation of future virtual models of care.
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Affiliation(s)
- H Laetitia Hattingh
- Allied Health Research, Gold Coast Health, Gold Coast, QLD, 4215, Australia.
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, 4222, Australia.
- School of Pharmacy, The University of Queensland, Brisbane, QLD, 4102, Australia.
| | - Catherine Edmunds
- Medical Services, Clinical Governance and Research, Gold Coast Health, Gold Coast, QLD, 4215, Australia
| | - Brigid M Gillespie
- NHMRC Wiser Wounds CRE, MHIQ, Griffith University, Gold Coast, QLD, 4222, Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast Health, Gold Coast, QLD, 4215, Australia
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Wong KA, Ang BCH, Gunasekeran DV, Husain R, Boon J, Vikneson K, Tan ZPQ, Tan GSW, Wong TY, Agrawal R. Remote Perimetry in a Virtual Reality Metaverse Environment for Out-of-Hospital Functional Eye Screening Compared Against the Gold Standard Humphrey Visual Fields Perimeter: Proof-of-Concept Pilot Study. J Med Internet Res 2023; 25:e45044. [PMID: 37856179 PMCID: PMC10623222 DOI: 10.2196/45044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/01/2023] [Accepted: 05/31/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The growing global burden of visual impairment necessitates better population eye screening for early detection of eye diseases. However, accessibility to testing is often limited and centralized at in-hospital settings. Furthermore, many eye screening programs were disrupted by the COVID-19 pandemic, presenting an urgent need for out-of-hospital solutions. OBJECTIVE This study investigates the performance of a novel remote perimetry application designed in a virtual reality metaverse environment to enable functional testing in community-based and primary care settings. METHODS This was a prospective observational study investigating the performance of a novel remote perimetry solution in comparison with the gold standard Humphrey visual field (HVF) perimeter. Subjects received a comprehensive ophthalmologic assessment, HVF perimetry, and remote perimetry testing. The primary outcome measure was the agreement in the classification of overall perimetry result normality by the HVF (Swedish interactive threshold algorithm-fast) and testing with the novel algorithm. Secondary outcome measures included concordance of individual testing points and perimetry topographic maps. RESULTS We recruited 10 subjects with an average age of 59.6 (range 28-81) years. Of these, 7 (70%) were male and 3 (30%) were female. The agreement in the classification of overall perimetry results was high (9/10, 90%). The pointwise concordance in the automated classification of individual test points was 83.3% (8.2%; range 75%-100%). In addition, there was good perimetry topographic concordance with the HVF in all subjects. CONCLUSIONS Remote perimetry in a metaverse environment had good concordance with gold standard perimetry using the HVF and could potentially avail functional eye screening in out-of-hospital settings.
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Affiliation(s)
- Kang-An Wong
- National University of Singapore, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bryan Chin Hou Ang
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Dinesh Visva Gunasekeran
- National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Raffles Medical Group, Singapore, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Joewee Boon
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Krishna Vikneson
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Zyna Pei Qi Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Center, Singapore General Hospital, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Center, Singapore General Hospital, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Hattingh HL, Edmunds C, Buksh S, Cronin S, Gillespie BM. COVID-19 Patients' Medication Management during Transition of Care from Hospital to Virtual Care: A Cross-Sectional Survey and Audit. PHARMACY 2023; 11:157. [PMID: 37888502 PMCID: PMC10610024 DOI: 10.3390/pharmacy11050157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Virtual models of care were implemented to ease hospital bed pressure during COVID-19. We evaluated the medication management of COVID-19 patients transferred to virtual models of care. METHOD A retrospective audit of COVID-19 patients transferred from inpatient units to virtual care during January 2022 and surveys from patients transferred during December 2021-February 2022 was carried out. RESULTS One hundred patients were randomly selected: mean age 59 years (SD: 19.8), mean number of medicines at admission 4.3 (SD: 4.03), mean length of virtual ward stay 4.4 days (SD: 2.1). Pharmacists reviewed 43% (43/100) of patients' medications during their hospital stay and provided 29% (29/100) with discharge medicine lists at transfer. Ninety-two (92%) patients were prescribed at least one new high-risk medicine whilst in hospital, but this was not a factor considered to receive a pharmacist medication review. Forty patients (40%) were discharged on newly commenced high-risk medicines, and this was also not a factor in receiving a pharmacist discharge medication list. In total, 25% of patient surveys (96/378) were returned: 70% (66/96) reported adequate medicine information at transfer and 55% (52/96) during the virtual model period. CONCLUSION Patient survey data show overall positive experiences of medication management and support. Audit data highlight gaps in medication management during the transfer to a virtual model, highlighting the need for patient prioritisation.
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Affiliation(s)
- H. Laetitia Hattingh
- Allied Health Research, Gold Coast Health, Gold Coast, QLD 4215, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy, the University of Queensland, Brisbane, QLD 4102, Australia
| | - Catherine Edmunds
- Medical Services, Clinical Governance and Research, Gold Coast Health, Gold Coast, QLD 4215, Australia;
| | - Saberina Buksh
- Pharmacy Department, Gold Coast Health, Gold Coast, QLD 4215, Australia; (S.B.); (S.C.)
| | - Sean Cronin
- Pharmacy Department, Gold Coast Health, Gold Coast, QLD 4215, Australia; (S.B.); (S.C.)
| | - Brigid M. Gillespie
- NHMRC Wiser Wounds CRE, MHIQ, Griffith University, Gold Coast, QLD 4222, Australia;
- Nursing and Midwifery Education and Research Unit, Gold Coast Health, Gold Coast, QLD 4215, Australia
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Man REK, Ho AXY, Lee EPX, Fenwick EKD, Aravindhan A, Ho KC, Wei Tan GS, Wei Ting DS, Wong TY, Yeo KK, Goh SY, Gupta P, Lamoureux EL. Awareness and attitudes of elderly Southeast Asian adults towards telehealth during the COVID-19 pandemic: a qualitative study. Singapore Med J 2023:384056. [PMID: 37675683 DOI: 10.4103/singaporemedj.smj-2022-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Introduction We aimed to understand the awareness and attitudes of elderly Southeast Asians towards telehealth services during the coronavirus disease 2019 (COVID-19) pandemic in this study. Methods In this qualitative study, 78 individuals from Singapore (51.3% female, mean age 73.0 ± 7.6 years) were interviewed via telephone between 13 May 2020 and 9 June 2020 during Singapore's first COVID-19 'circuit breaker'. Participants were asked to describe their understanding of telehealth, their experience of and willingness to utilise these services, and the barriers and facilitators underlying their decision. Transcripts were analysed using thematic analysis, guided by the United Theory of Acceptance Use of Technology framework. Results Of the 78 participants, 24 (30.8%) were able to describe the range of telehealth services available and 15 (19.2%) had previously utilised these services. Conversely, 14 (17.9%) participants thought that telehealth comprised solely home medication delivery and 50 (51.3%) participants did not know about telehealth. Despite the advantages offered by telehealth services, participants preferred in-person consultations due to a perceived lack of human interaction and accuracy of diagnoses, poor digital literacy and a lack of access to telehealth-capable devices. Conclusion Our results showed poor overall awareness of the range of telehealth services available among elderly Asian individuals, with many harbouring erroneous views regarding their use. These data suggest that public health education campaigns are needed to improve awareness of and correct negative perceptions towards telehealth services in elderly Asians.
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Affiliation(s)
- Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Aricia Xin Yi Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ester Pei Xuan Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Eva Katie Diana Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Amudha Aravindhan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kam Chun Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; School of Optometry and Vision Science, University of New South Wales, Sydney; Discipline of Optometry and Vision Science, Faculty of Health, University of Canberra, Canberra, Australia
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore; Discipline of Optometry and Vision Science, Faculty of Health, University of Canberra, Canberra, Australia
| | - Khung Keong Yeo
- Duke-NUS Medical School, National University of Singapore; Department of Cardiology, National Heart Centre, Singapore
| | - Su-Yen Goh
- Duke-NUS Medical School, National University of Singapore; Department of Endocrinology, Singapore General Hospital, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ecosse Luc Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School; Department of Ophthalmology, National University of Singapore, Singapore; Department of Surgery and Medicine, University of Melbourne, Melbourne, Australia
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Scanzera AC, Beversluis C, Potharazu AV, Bai P, Leifer A, Cole E, Du DY, Musick H, Chan RVP. Planning an artificial intelligence diabetic retinopathy screening program: a human-centered design approach. Front Med (Lausanne) 2023; 10:1198228. [PMID: 37484841 PMCID: PMC10361413 DOI: 10.3389/fmed.2023.1198228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Diabetic retinopathy (DR) is a leading cause of vision loss in the United States and throughout the world. With early detection and treatment, sight-threatening sequelae from DR can be prevented. Although artificial intelligence (AI) based DR screening programs have been proven to be effective in identifying patients at high risk of vision loss, adoption of AI in clinical practice has been slow. We adapted the United Kingdom Design Council's Double-Diamond model to design a strategy for care delivery which integrates an AI-based screening program for DR into a primary care setting. Methods from human-centered design were used to develop a strategy for implementation informed by context-specific barriers and facilitators. The purpose of this community case study is to present findings from this work in progress, including a system of protocols, educational documents and workflows created using key stakeholder input.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
| | - Cameron Beversluis
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Archit V. Potharazu
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Patricia Bai
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
| | - Ariel Leifer
- Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States
| | - David Yuzhou Du
- Segal Design Institute, Northwestern University, Evanston, IL, United States
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - R. V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
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Saxena SG, Godfrey T. India's Opportunity to Address Human Resource Challenges in Healthcare. Cureus 2023; 15:e40274. [PMID: 37448434 PMCID: PMC10336366 DOI: 10.7759/cureus.40274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
India's health indicators have improved in recent times but continue to lag behind those of its peer nations. The country with a population of 1.3 billion, has an estimated active health workers density of doctors and nurses/midwives of 5.0 and 6.0 respectively, for 10,000 persons, which is much lower than the WHO threshold of 44.5 doctors, nurses, and midwives per 10,000 population. The issue is compounded by the skewed inter-state, urban-rural, and public-private sector divide. Calls to urgently augment the skilled health workforce reinforce the central role human resources have in healthcare, which has evolved into a complex multifactorial issue. The paucity of skilled personnel must be addressed if India is to accelerate its progress toward achieving universal health coverage and its sustainable development goals (SDGs). The recent increase in the federal health budget offers an unprecedented opportunity to do this. This article utilizes the ready materials, extract and analyze data, distill findings (READ) approach to adding to the authors' experiential learning to analyze the health system in India. The growing divide between the public and the burgeoning private health sector systems, with the latter's booming medical tourism industry and medical schools, are analyzed along with the newly minted National Medical Council, to recommend policies that would help India achieve its SDGs.
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Affiliation(s)
| | - Thomas Godfrey
- Public Health Sciences, Penn State College of Medicine, Hershey, USA
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18
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Thirunavukarasu AJ, Hassan R, Mahmood S, Sanghera R, Barzangi K, El Mukashfi M, Shah S. Trialling a Large Language Model (ChatGPT) in General Practice With the Applied Knowledge Test: Observational Study Demonstrating Opportunities and Limitations in Primary Care. JMIR MEDICAL EDUCATION 2023; 9:e46599. [PMID: 37083633 PMCID: PMC10163403 DOI: 10.2196/46599] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Large language models exhibiting human-level performance in specialized tasks are emerging; examples include Generative Pretrained Transformer 3.5, which underlies the processing of ChatGPT. Rigorous trials are required to understand the capabilities of emerging technology, so that innovation can be directed to benefit patients and practitioners. OBJECTIVE Here, we evaluated the strengths and weaknesses of ChatGPT in primary care using the Membership of the Royal College of General Practitioners Applied Knowledge Test (AKT) as a medium. METHODS AKT questions were sourced from a web-based question bank and 2 AKT practice papers. In total, 674 unique AKT questions were inputted to ChatGPT, with the model's answers recorded and compared to correct answers provided by the Royal College of General Practitioners. Each question was inputted twice in separate ChatGPT sessions, with answers on repeated trials compared to gauge consistency. Subject difficulty was gauged by referring to examiners' reports from 2018 to 2022. Novel explanations from ChatGPT-defined as information provided that was not inputted within the question or multiple answer choices-were recorded. Performance was analyzed with respect to subject, difficulty, question source, and novel model outputs to explore ChatGPT's strengths and weaknesses. RESULTS Average overall performance of ChatGPT was 60.17%, which is below the mean passing mark in the last 2 years (70.42%). Accuracy differed between sources (P=.04 and .06). ChatGPT's performance varied with subject category (P=.02 and .02), but variation did not correlate with difficulty (Spearman ρ=-0.241 and -0.238; P=.19 and .20). The proclivity of ChatGPT to provide novel explanations did not affect accuracy (P>.99 and .23). CONCLUSIONS Large language models are approaching human expert-level performance, although further development is required to match the performance of qualified primary care physicians in the AKT. Validated high-performance models may serve as assistants or autonomous clinical tools to ameliorate the general practice workforce crisis.
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Affiliation(s)
| | - Refaat Hassan
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Shathar Mahmood
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Rohan Sanghera
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Kara Barzangi
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | | | - Sachin Shah
- Attenborough Surgery, Bushey Medical Centre, Bushey, United Kingdom
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Lawrie K, Giannopoulos E, Papadakos T, Addiss F, Christensen S, Cunningham L, Foster J, Mulato L, Siegel R, Sullivan C, Tanha J, Papadakos J. Impact of the COVID-19 Pandemic on Cancer Patient Educators. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:545-551. [PMID: 35233754 PMCID: PMC8888025 DOI: 10.1007/s13187-022-02151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 05/20/2023]
Abstract
Patient education (PE) is vital in reducing anxiety, increasing satisfaction with treatment, helping with self-management, and creating a sense of control for cancer patients. Patients access much of their material from health care providers through in-person visits, patient libraries, and in-person classes. Due to reductions in in-person visits throughout the pandemic, we sought to understand how PE programs responded under varying levels of COVID-19 restrictions to meet the information needs of patients and families. A cross-sectional survey was distributed to members of the Cancer Patient Education Network (CPEN) and the Health Care Education Association (HCEA) via the respective listservs. The survey consisted of five sections that included closed and opened questions. Participants were asked questions to describe their PE programs and how their duties were affected during the pandemic. Forty-two CPEN members completed the survey (N = 42, 66%) with a 35% response rate and a 55% completion rate, and 19 HCEA members completed the survey (N = 19, 30%) with a 5% response rate and 16% completion rate. The majority of staff surveyed were not furloughed (N = 57/64, 89%). Just under half reported a change in daily PE program activities (N = 23/52, 44%) and most reported a change in developing PE materials (e.g., pamphlets) (N = 10/26, 63%), finding information for patients/families (N = 11/19, 58%), and delivering classes (N = 12/21, 57%). COVID-19 has ushered in a new era in the delivery of PE with the rapid deployment of digital cancer patient education. Results can inform future directions for the delivery of PE post-pandemic.
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Affiliation(s)
- Karen Lawrie
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Eleni Giannopoulos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Tina Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Faith Addiss
- Roswell Park Cancer Center, Patient Education, Buffalo, NY, USA
| | - Sarah Christensen
- Patient Education Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jackie Foster
- National Marrow Donor Program/Be The Match, Patient Services, Minneapolis, MN, USA
| | | | | | | | - Jila Tanha
- Patient Education Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Yang LWY, Ng WY, Lei X, Tan SCY, Wang Z, Yan M, Pargi MK, Zhang X, Lim JS, Gunasekeran DV, Tan FCP, Lee CE, Yeo KK, Tan HK, Ho HSS, Tan BWB, Wong TY, Kwek KYC, Goh RSM, Liu Y, Ting DSW. Development and testing of a multi-lingual Natural Language Processing-based deep learning system in 10 languages for COVID-19 pandemic crisis: A multi-center study. Front Public Health 2023; 11:1063466. [PMID: 36860378 PMCID: PMC9968846 DOI: 10.3389/fpubh.2023.1063466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
Purpose The COVID-19 pandemic has drastically disrupted global healthcare systems. With the higher demand for healthcare and misinformation related to COVID-19, there is a need to explore alternative models to improve communication. Artificial Intelligence (AI) and Natural Language Processing (NLP) have emerged as promising solutions to improve healthcare delivery. Chatbots could fill a pivotal role in the dissemination and easy accessibility of accurate information in a pandemic. In this study, we developed a multi-lingual NLP-based AI chatbot, DR-COVID, which responds accurately to open-ended, COVID-19 related questions. This was used to facilitate pandemic education and healthcare delivery. Methods First, we developed DR-COVID with an ensemble NLP model on the Telegram platform (https://t.me/drcovid_nlp_chatbot). Second, we evaluated various performance metrics. Third, we evaluated multi-lingual text-to-text translation to Chinese, Malay, Tamil, Filipino, Thai, Japanese, French, Spanish, and Portuguese. We utilized 2,728 training questions and 821 test questions in English. Primary outcome measurements were (A) overall and top 3 accuracies; (B) Area Under the Curve (AUC), precision, recall, and F1 score. Overall accuracy referred to a correct response for the top answer, whereas top 3 accuracy referred to an appropriate response for any one answer amongst the top 3 answers. AUC and its relevant matrices were obtained from the Receiver Operation Characteristics (ROC) curve. Secondary outcomes were (A) multi-lingual accuracy; (B) comparison to enterprise-grade chatbot systems. The sharing of training and testing datasets on an open-source platform will also contribute to existing data. Results Our NLP model, utilizing the ensemble architecture, achieved overall and top 3 accuracies of 0.838 [95% confidence interval (CI): 0.826-0.851] and 0.922 [95% CI: 0.913-0.932] respectively. For overall and top 3 results, AUC scores of 0.917 [95% CI: 0.911-0.925] and 0.960 [95% CI: 0.955-0.964] were achieved respectively. We achieved multi-linguicism with nine non-English languages, with Portuguese performing the best overall at 0.900. Lastly, DR-COVID generated answers more accurately and quickly than other chatbots, within 1.12-2.15 s across three devices tested. Conclusion DR-COVID is a clinically effective NLP-based conversational AI chatbot, and a promising solution for healthcare delivery in the pandemic era.
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Affiliation(s)
| | - Wei Yan Ng
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore,Duke-National University of Singapore Medical School, National University of Singapore, Singapore, Singapore
| | - Xiaofeng Lei
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Shaun Chern Yuan Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Zhaoran Wang
- Duke-National University of Singapore Medical School, National University of Singapore, Singapore, Singapore
| | - Ming Yan
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Mohan Kashyap Pargi
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Xiaoman Zhang
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jane Sujuan Lim
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Dinesh Visva Gunasekeran
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore,Duke-National University of Singapore Medical School, National University of Singapore, Singapore, Singapore
| | | | - Chen Ee Lee
- Division of Digital Strategy Office, Singapore Health Services, Singapore, Singapore
| | - Khung Keong Yeo
- Office of Innovation and Transformation, Singapore Health Services, Singapore, Singapore
| | - Hiang Khoon Tan
- Department of Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Henry Sun Sien Ho
- Duke-National University of Singapore Medical School, National University of Singapore, Singapore, Singapore,Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Benedict Wee Bor Tan
- Division of Digital Strategy Office, Singapore Health Services, Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore,Duke-National University of Singapore Medical School, National University of Singapore, Singapore, Singapore,Tsinghua Medicine, Tsinghua University, Beijing, China
| | | | - Rick Siow Mong Goh
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yong Liu
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore,Duke-National University of Singapore Medical School, National University of Singapore, Singapore, Singapore,*Correspondence: Daniel Shu Wei Ting ✉
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Borycki E, Taylor S, Yorke J, Dowding D. Assessing the Acceptability of Home Blood Monitoring for Patients With Cancer Who Are Receiving Systemic Anticancer Therapy From a Patient, Caregiver, and Clinician Perspective: Focus Group and Interview Study. JMIR Nurs 2023; 6:e39815. [PMID: 36607709 PMCID: PMC9862331 DOI: 10.2196/39815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Regular blood testing is an integral part of systemic anticancer therapy delivery. Blood tests are required before every administration of treatment to ensure that a patient is sufficiently well to receive it. Blood testing is burdensome for patients as they require either an extra visit within 48 hours of planned administration of treatment or a significantly long visit if performed on the day of treatment. The additional time for appointments can have a significant impact on the quality of life of someone who is living with cancer. In the United Kingdom, the COVID-19 pandemic created unprecedented disruption to the delivery of cancer care. Face-to-face hospital visits were reduced, resulting in the need to develop more innovative ways of working to minimize treatment interruptions. This led to significant uptake of digital technologies, with new models of care rapidly deployed across the UK health service to meet these challenges. OBJECTIVE This study aimed to explore the acceptability of a point-of-care home blood monitoring device for people with cancer who are receiving systemic anticancer therapy, which is being developed in response to the increased need for remote care for patients with cancer. METHODS Qualitative focus groups and semistructured interviews were conducted with patients (23/47, 49%), caregivers (6/47, 13%), and health care professionals (18/47, 38%) over a 19-month time frame from May 2019 to December 2020. Data were analyzed using framework analysis guided by the Unified Theory of Acceptance and Use of Technology model. RESULTS Analysis identified 4 overarching themes: performance expectancy, effort expectancy, social influence, and facilitating conditions. CONCLUSIONS This study found that patients with cancer, their caregivers, and health care professionals had positive perceptions about home blood monitoring. Although they are often considered synonymously, self-testing and self-management are not mutually exclusive, and this study illustrated some disparity in opinions regarding patient self-management. Home blood monitoring has the potential to provide patients with cancer with a convenient option for blood monitoring. It would minimize hospital attendances, decrease late treatment deferrals, and provide prompt recognition of cancer treatment toxicities, thus enhancing the existing nurse-led protocols and clinical pathways. Home blood monitoring would create a long-term sustainable transformation for the delivery of cancer care, using digital health to act as a facilitator to address a pertinent issue regarding improving the efficiency of hospital resources and increasing the delivery of personalized patient care. Further studies are needed to determine how and where home blood monitoring would fit within clinical pathways, in a way that is robust and equitable.
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Affiliation(s)
| | - Sally Taylor
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Manchester, United Kingdom.,Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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22
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Ricur G, Reyes J, Alfonso E, Marino RG. Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care. CURRENT OPHTHALMOLOGY REPORTS 2023; 11:1-12. [PMID: 36743397 PMCID: PMC9883823 DOI: 10.1007/s40135-023-00308-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/30/2023]
Abstract
Purpose of Review In this article, we reviewed the impact resulting from the COVID-19 pandemic on the traditional model of care in ophthalmology. Recent Findings Though virtual eye care has been present for more than 20 years, the COVID-19 pandemic has established a precedent to seriously consider its role in the evolving paradigm of vision and eye care. New hybrid models of care have enhanced or replaced traditional synchronous and asynchronous visits. The increased use of smart phoneography and mobile applications enhanced the remote examination of patients. Use of e-learning became a mainstream tool to continue accessing education and training. Summary Teleophthalmology has demonstrated its value for screening, examining, diagnosing, monitoring treatment, and increasing access to education. However, much of the progress made following the COVID-19 pandemic is at risk of being lost as society pushes to reestablish normalcy. Further studies during the new norm are required to prove a more permanent role for virtual eye care.
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Affiliation(s)
- Giselle Ricur
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Joshua Reyes
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Eduardo Alfonso
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Raul Guillermo Marino
- Facultad de Ciencias Exactas Y Naturales, Universidad Nacional de Cuyo, Mendoza, Argentina
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23
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Whiwon L, Salma S, Daniel A, Stephanie L, Marc C, Cherith S, Abby T, Angela S, Robin H, Yvonne B. Patient-facing digital tools for delivering genetic services: a systematic review. J Med Genet 2023; 60:1-10. [PMID: 36137613 DOI: 10.1136/jmg-2022-108653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
This study systematically reviewed the literature on the impact of digital genetics tools on patient care and system efficiencies. MEDLINE and Embase were searched for articles published between January 2010 and March 2021. Studies evaluating the use of patient-facing digital tools in the context of genetic service delivery were included. Two reviewers screened and extracted patient-reported and system-focused outcomes from each study. Data were synthesised using a descriptive approach. Of 3226 unique studies identified, 87 were included. A total of 70 unique digital tools were identified. As a result of using digital tools, 84% of studies reported a positive outcome in at least one of the following patient outcomes: knowledge, psychosocial well-being, behavioural/management changes, family communication, decision-making or level of engagement. Digital tools improved workflow and efficiency for providers and reduced the amount of time they needed to spend with patients. However, we identified a misalignment between study purpose and patient-reported outcomes measured and a lack of tools that encompass the entire genetic counselling and testing trajectory. Given increased demand for genetic services and the shift towards virtual care, this review provides evidence that digital tools can be used to efficiently deliver patient-centred care. Future research should prioritise development, evaluation and implementation of digital tools that can support the entire patient trajectory across a range of clinical settings. PROSPERO registration numberCRD42020202862.
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Affiliation(s)
- Lee Whiwon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shickh Salma
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Assamad Daniel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Luca Stephanie
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Clausen Marc
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Somerville Cherith
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tafler Abby
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shaw Angela
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Hayeems Robin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Bombard Yvonne
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Finding the sweet spot: a qualitative study exploring patients' acceptability of chatbots in genetic service delivery. Hum Genet 2023; 142:321-330. [PMID: 36629921 PMCID: PMC9838385 DOI: 10.1007/s00439-022-02512-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/10/2022] [Indexed: 01/12/2023]
Abstract
Chatbots, web-based artificial intelligence tools that simulate human conversation, are increasingly in use to support many areas of genomic medicine. However, patient preferences towards using chatbots across the range of clinical settings are unknown. We conducted a qualitative study with individuals who underwent genetic testing for themselves or their child. Participants were asked about their preferences for using a chatbot within the genetic testing journey. Thematic analysis employing interpretive description was used. We interviewed 30 participants (67% female, 50% 50 + years). Participants considered chatbots to be inefficient for very simple tasks (e.g., answering FAQs) or very complex tasks (e.g., explaining results). Chatbots were acceptable for moderately complex tasks where participants perceived a favorable return on their investment of time and energy. In addition to achieving this "sweet spot," participants anticipated that their comfort with chatbots would increase if the chatbot was used as a complement to but not a replacement for usual care. Participants wanted a "safety net" (i.e., access to a clinician) for needs not addressed by the chatbot. This study provides timely insights into patients' comfort with and perceived limitations of chatbots for genomic medicine and can inform their implementation in practice.
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25
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Effing TW. Developments in respiratory self-management interventions over the last two decades. Chron Respir Dis 2023; 20:14799731231221819. [PMID: 38129363 DOI: 10.1177/14799731231221819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
This paper describes developments in the fields of asthma and COPD self-management interventions (SMIs) over the last two decades and discusses future directions. Evidence around SMIs has exponentially grown. Efficacy on group level is convincing and both asthma and COPD SMIs are currently recommended by respiratory guidelines. Core components of asthma SMIs are defined as education, action plans, and regular review, with some discussion about self-monitoring. Exacerbation action plans are defined as an integral part of COPD management. Patient's adherence to SMI's is however inadequate and significantly reducing the intervention's impact. Adherence could be improved by tailoring of SMIs to patients' needs, health beliefs, and capabilities; the use of shared decision making; and optimising the communication between patients and health care providers. Due to the COVID-19 pandemic, digital health innovations have rapidly been introduced and expanded. Digital technology use may increase efficiency, flexibility, and efficacy of SMIs. Furthermore, artificial intelligence can be used to e.g., predict exacerbations in action plans. Research around digital health innovations to ensure evidence-based practice is of utmost importance. Current implementation of respiratory SMIs is not satisfactory. Implementation research should be used to generate further insights, with cost-effectiveness, policy (makers), and funding being significant determinants.
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Affiliation(s)
- Tanja W Effing
- College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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26
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Behera RK, Bala PK, Panigrahi PK, Rana NP. Hospitality and COVID-19: a willingness to choose e-consultation owing to unemployment and home isolation. BENCHMARKING-AN INTERNATIONAL JOURNAL 2022. [DOI: 10.1108/bij-01-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PurposeCoronavirus disease (COVID-19) was declared as a pandemic since COVID-19's widespread outbreak and the hospitality industry has been the hardest hit due to lockdown. Consequently, hospitality workers are suffering from the negative aspects of mental health. In the event of such a crisis, this study aims to explore the link between unemployment and home isolation to the willingness to choose electronic consultation (e-consultation) by exploiting psychological ill-being and behavioural intention (BI) with marital status as a moderator.Design/methodology/approachA quantitative methodology is applied to primary data collected from 310 workers from the hospitality industry through an online survey.FindingsFindings of this study suggest that the usage of the e-consultation service can be adopted using three levels. There are valid reasons to conclude unemployment and home isolation are linked to higher rates of psychological health behaviours, which can result in stigma, loss of self-worth and increased mortality. The adverse effect is higher for single individuals than for married people.Originality/valueThe study focussed on e-consultation, BI coupled with the Fishbein scale and a classification model for the prediction of willingness to choose e-consultation with the extension of Theory of Planned Behaviour (TPB).
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27
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Vujosevic S, Limoli C, Luzi L, Nucci P. Digital innovations for retinal care in diabetic retinopathy. Acta Diabetol 2022; 59:1521-1530. [PMID: 35962258 PMCID: PMC9374293 DOI: 10.1007/s00592-022-01941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022]
Abstract
AIM The purpose of this review is to examine the applications of novel digital technology domains for the screening and management of patients with diabetic retinopathy (DR). METHODS A PubMed engine search was performed, using the terms "Telemedicine", "Digital health", "Telehealth", "Telescreening", "Artificial intelligence", "Deep learning", "Smartphone", "Triage", "Screening", "Home-based", "Monitoring", "Ophthalmology", "Diabetes", "Diabetic Retinopathy", "Retinal imaging". Full-text English language studies from January 1, 2010, to February 1, 2022, and reference lists were considered for the conceptual framework of this review. RESULTS Diabetes mellitus and its eye complications, including DR, are particularly well suited to digital technologies, providing an ideal model for telehealth initiatives and real-world applications. The current development in the adoption of telemedicine, artificial intelligence and remote monitoring as an alternative to or in addition to traditional forms of care will be discussed. CONCLUSIONS Advances in digital health have created an ecosystem ripe for telemedicine in the field of DR to thrive. Stakeholders and policymakers should adopt a participatory approach to ensure sustained implementation of these technologies after the COVID-19 pandemic. This article belongs to the Topical Collection "Diabetic Eye Disease", managed by Giuseppe Querques.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
- Eye Clinic, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, Italy.
| | - Celeste Limoli
- Eye Clinic, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, Italy
- University of Milan, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Chan SL, Lum E, Ong MEH, Graves N. Implementation science: A critical but undervalued part of the healthcare innovation ecosystem. HEALTH CARE SCIENCE 2022; 1:160-165. [PMID: 38938555 PMCID: PMC11080739 DOI: 10.1002/hcs2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 06/29/2024]
Abstract
Healthcare systems face many competing demands and insufficient resources. Service innovations to improve efficiency are important to address this challenge. Innovations can range from new pharmaceuticals, alternate models of care, novel devices, and the use other technologies. Suboptimal implementation can mean lost benefits. This review article aims to highlight the role of implementation science, summarize how settings have leveraged this methodology to promote translation of innovation into practice, and describe our own experience of embedding implementation science into an academic medical center in Singapore. Implementation science offers a range of methods to promote systematic uptake of research findings about innovations and is gaining recognition worldwide as an important discipline for health services researchers. Health systems around the world have tried to promote implementation research in their settings by establishing (1) dedicated centers/programs, (2) offering funding, and (3) building knowledge and capacity among staff. Implementation science is a critical piece in the translational pathway of "evidence to innovation." The three efforts we describe should be strengthened to integrate implementation science into the innovation ecosystem around the world.
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Affiliation(s)
- Sze Ling Chan
- Health Services Research Centre, SingHealthSingaporeSingapore
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Elaine Lum
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Marcus E. H. Ong
- Health Services Research Centre, SingHealthSingaporeSingapore
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
- Department of Emergency MedicineSingapore General HospitalSingaporeSingapore
| | - Nicholas Graves
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
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29
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Scanzera AC, Thermozier S, Chang AY, Kim SJ, Chan RP. Adherence to Urgent Eye Visits during the COVID-19 Pandemic: A Population Characteristics Study. Ophthalmic Epidemiol 2022; 29:613-620. [PMID: 34895007 PMCID: PMC9189247 DOI: 10.1080/09286586.2021.2015785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore individual and community factors associated with adherence to physician recommended urgent eye visits via a tele-triage system during the COVID-19 pandemic. METHOD We retrospectively reviewed acute visit requests and medical exam data between April 6, 2020 and June 6, 2020. Patient demographics and adherence to visit were examined. Census tract level community characteristics from the U.S. Census Bureau and zip code level COVID-19 related death data from the Cook County Medical Examiner's Office were appended to each geocoded patient address. Descriptive statistics, t-tests, and logistic regression analyses were performed to explore the effects of individual and community variables on adherence to visit. RESULTS Of 229 patients recommended an urgent visit, 216 had matching criteria on chart review, and 192 (88.9%) adhered to their visit. No difference in adherence was found based on individual characteristics including: age (p = .24), gender (p = .94), race (p = .56), insurance (p = .28), nor new versus established patient status (p = .20). However, individuals who did not adhere were more likely to reside in neighborhoods with a greater proportion of Blacks (59.4% vs. 33.4%; p = .03), greater unemployment rates (17.5% vs. 10.7%; p < .01), and greater cumulative deaths from COVID-19 (56 vs. 31; p = .01). Unemployment rate continued to be statistically significant after controlling for race and cumulative deaths from COVID-19 (p = .04). CONCLUSION We found that as community unemployment rate increases, adherence to urgent eye visits decreases, after controlling for relevant neighborhood characteristics. Unemployment rates were highest in predominantly Black neighborhoods early in the pandemic, which may have contributed to existing racial disparities in eye care.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Stephanie Thermozier
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Arthur Y. Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Sage J. Kim
- Division of Health Policy & Administration, School of Public Health, University of Illinois at Chicago, Chicago, United States
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
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Trenholm-Jensen EA, Burns L, Trenholm JE, Hand CJ. Beyond tingles: An exploratory qualitative study of the Autonomous Sensory Meridian Response (ASMR). PLoS One 2022; 17:e0277962. [PMID: 36454810 PMCID: PMC9714747 DOI: 10.1371/journal.pone.0277962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
This qualitative exploratory study investigated the embodied experiences and the meanings of Autonomous Sensory Meridian Response (ASMR) from the viewer's perspective. ASMR research has been sparse and largely quantitative, assuming it to be a predominantly fixed physiological response of "tingles", despite the acronym being rooted in pseudoscience. A qualitative research design was adopted to facilitate the exploratory nature of the study in this under-researched area. In contrast to the mostly survey-based research on ASMR, this study employed semi-structured interviews as a means to understand the lived experience of ASMR and to promote participant agency. Six self-identifying ASMR consumers were recruited using a mixture of snowball and opportunity sampling. Semi-structured interviews were conducted both in person and using Skype to facilitate transnational data collection. Interview transcripts were analysed using an inductive, data-driven approach to thematic analysis. The analysis suggests that ASMR is felt to provide a social environment of comfort rather than a solely physiological-based experience. Three key themes emerged: who and what defines ASMR? (reflecting the variety of what was classed as ASMR and what content was consumed to produce the response); "real" intimacy tailored to me (reflecting the idiosyncratic perception of intimacy made possible through ASMR); and emotional relief on my terms (reflecting the role of ASMR in self-soothing). The present data reflect a rich, complex experience of the ASMR consumer, pointing to potential wider applications and informing further research.
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Affiliation(s)
| | - Lindsey Burns
- Department of Psychology, Heriot-Watt University, Edinburgh, United Kingdom
| | - Jill Ellen Trenholm
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Linardon J, Westrupp EM, Macdonald JA, Mikocka-Walus A, Stokes MA, Greenwood CJ, Youssef GJ, Teague S, Hutchinson D, Sciberras E, Fuller-Tyszkiewicz M. Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic. Aust N Z J Psychiatry 2022; 56:1503-1514. [PMID: 34963330 DOI: 10.1177/00048674211065985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms. METHOD The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic. RESULTS More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship. CONCLUSION Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.
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Affiliation(s)
- Jake Linardon
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Elizabeth M Westrupp
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
| | - Antonina Mikocka-Walus
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Mark A Stokes
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Christopher J Greenwood
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Samantha Teague
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
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Marmo R, Pascale F, Diana L, Sicignano E, Polverino F. Lessons learnt for enhancing hospital resilience to pandemics: A qualitative analysis from Italy. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 81:103265. [PMID: 36061241 PMCID: PMC9419438 DOI: 10.1016/j.ijdrr.2022.103265] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has outlined the need to strengthen the resilience of healthcare systems. It has cost millions of human lives and has had indirect health impacts too. Hospital buildings have undergone extensive modifications and adaptations to ensure infection control and prevention measures, and, as it is happened following past epidemics, the COVID-19 experience might change the design of hospital buildings in the future. This paper aims to capitalise on the knowledge developed by the stakeholders directly involved with the hospital response during the pandemic to generate new evidence that will enhance resilience of hospital buildings to pandemics. The research adopted qualitative research methods, namely literature review and interviews with Italian experts including doctors and facility managers to collect data which were analysed through a thematic analysis. The findings include the identification of new needs for hospital buildings and the related actions to be taken or already performed at hospital building and service level which are viable for long term implementation and are aimed at improving hospital resilience to pandemics. The results specify how to improve resilience by means of structural modifications (e.g. placing filter zones among different wards, ensuring the presence of airborne infection isolation rooms at least in the emergency departments), technological changes (e.g. oversizing capacity such as medical gases, information technology improvement for delivering healthcare services remotely), and operational measures (e.g. assessing the risk of infection before admission, dividing acute-care from low-care assets). The needs discussed in this paper substantiate the urge to renovate the Italian healthcare infrastructures and they can be considered useful elements of knowledge for enhancing hospital resilience to pandemics in the extended and in the post-COVID-19 era.
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Affiliation(s)
- Rossella Marmo
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Federica Pascale
- Faculty of Science and Engineering, Anglia Ruskin University, CM1 1SQ, Chelmsford, UK
| | - Lorenzo Diana
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
| | - Enrico Sicignano
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Francesco Polverino
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
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Ahlstedt Karlsson S, Henoch I, Olofsson Bagge R, Wallengren C. Person-centred support programme (RESPECT intervention) for women with breast cancer treated with endocrine therapy: a feasibility study. BMJ Open 2022; 12:e060946. [PMID: 36198470 PMCID: PMC9535178 DOI: 10.1136/bmjopen-2022-060946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The peRson-cEntred Support Programme EndoCrine Therapy intervention is a complex intervention encompassing a person-centred support programme for patients with breast cancer being treated with endocrine therapy (ET). The aim of this study was to explore the feasibility of the trial design and patient acceptability of the intervention and outcome measures and to provide data to estimate the parameters required to design the final intervention. DESIGN A controlled before-and-after design following the Consolidated Standards of Reporting Trials 2010 statement for feasibility trials. SETTING A surgical outpatient clinic in Sweden. PARTICIPANTS Forty-one patients (aged 47-85) with breast cancer who were treated with ET. INTERVENTIONS Eligible patients were assigned to the control group or intervention group, which included individual education material, an individualised learning plan and a personalised reminder letter using a person-centred approach. The intervention could be delivered as a telephone or digital follow-up during a 12-week follow-up. OUTCOME MEASURES The aims were to determine the recruitment rate, assess the rate of retention, explore whether the intervention was delivered according to the protocol, assess the preferred form of educational support, rate of education sessions, length per education session and length between each education session, determine the distribution of education materials and assess completion rates of patient-reported instruments, including the General Self-efficacy Scale, the Quality of Care from the Patient's Perspective Questionnaire and the Memorial Symptom Assessment Scale. RESULTS Eighty-six per cent of the patients in the intervention group completed the intervention and questionnaires 3 months after their inclusion. The call attendance was 90%. During the intervention, the contact nurse complied with the intervention protocol. For self-efficacy, symptoms and quality of care, there were no differences in effect size between the control and intervention groups. CONCLUSIONS This intervention seems to be feasible and acceptable among patients.
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Affiliation(s)
| | - Ingela Henoch
- Institute of Health and Care Sciences, Gothenburg University, Gothenburg, Sweden
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Ong J, Tan G, Ang M, Chhablani J. Digital Advancements in Retinal Models of Care in the Post-COVID-19 Lockdown Era. Asia Pac J Ophthalmol (Phila) 2022; 11:403-407. [PMID: 36094383 DOI: 10.1097/apo.0000000000000533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic introduced unique barriers to retinal care including limited access to imaging modalities, ophthalmic clinicians, and direct medical interventions. These unprecedented barriers were met with the robust implementation of digital advances to aid in monitoring and efficiency of retinal care while taking into the account of public safety. Many of these innovations have been successful in maintaining efficiency and patient satisfaction and are likely to stay to help preserve vision in the future. In this article we highlight these advances implemented during the pandemic including telescreening triage, virtual retinal imaging clinics, at-home optical coherence tomography, mobile phone self-monitoring, and virtual reality monitoring technology. We also discuss advancing innovations including Internet of Things and Blockchain technology that will be critical for further implementation and security of these digital advancements.
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Affiliation(s)
- Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Gavin Tan
- Surgical Retinal Department of the Singapore National Eye Centre, Singapore
- Clinician Scientist, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Marcus Ang
- Duke-NUS Department of Ophthalmology and Visual Sciences, Singapore
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Deveau N, Washington P, Leblanc E, Husic A, Dunlap K, Penev Y, Kline A, Mutlu OC, Wall DP. Machine learning models using mobile game play accurately classify children with autism. INTELLIGENCE-BASED MEDICINE 2022; 6:100057. [PMID: 36035501 PMCID: PMC9398788 DOI: 10.1016/j.ibmed.2022.100057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/10/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022]
Abstract
Digitally-delivered healthcare is well suited to address current inequities in the delivery of care due to barriers of access to healthcare facilities. As the COVID-19 pandemic phases out, we have a unique opportunity to capitalize on the current familiarity with telemedicine approaches and continue to advocate for mainstream adoption of remote care delivery. In this paper, we specifically focus on the ability of GuessWhat? a smartphone-based charades-style gamified therapeutic intervention for autism spectrum disorder (ASD) to generate a signal that distinguishes children with ASD from neurotypical (NT) children. We demonstrate the feasibility of using "in-the-wild", naturalistic gameplay data to distinguish between ASD and NT by children by training a random forest classifier to discern the two classes (AU-ROC = 0.745, recall = 0.769). This performance demonstrates the potential for GuessWhat? to facilitate screening for ASD in historically difficult-to-reach communities. To further examine this potential, future work should expand the size of the training sample and interrogate differences in predictive ability by demographic.
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Affiliation(s)
- Nicholas Deveau
- Biomedical Data Science, Stanford University, Stanford, 94305, California, United States
| | - Peter Washington
- Bioengineering, Stanford University, Stanford, 94305, California, United States
| | - Emilie Leblanc
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Arman Husic
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Kaitlyn Dunlap
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Yordan Penev
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Aaron Kline
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Onur Cezmi Mutlu
- Electrical Engineering, Stanford University, Stanford, 94305, California, United States
| | - Dennis P Wall
- Biomedical Data Science, Stanford University, Stanford, 94305, California, United States
- Pediatrics, Stanford University, Stanford, 94305, California, United States
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Ophthalmologic emergency room visits during COVID-19 lockdown–Characterization from Haifa, Israel. PLoS One 2022; 17:e0273033. [PMID: 35984780 PMCID: PMC9390934 DOI: 10.1371/journal.pone.0273033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To characterize quantitative differences among ophthalmologic emergency room (OER) encounters at Rambam Health Care Campus during a 6-week complete lockdown at the peak of the first COVID-19 wave as compared to a corresponding uneventful period a year earlier. Methods A retrospective chart analysis of all OER encounters during the lockdown and non-lockdown period was conducted. Patients were stratified into primary ophthalmological conditions (OER visits) and cases in which ophthalmologic consultations were requested by a non-ophthalmologist (OER consultations). The following parameters were compared: total number of cases, age, gender, chief complaint/diagnosis categorized into major entities, and discharge vs. hospitalization. For continuous variables a t-test was used and for categorical variables a chi-squared or Fisher’s exact test was used. A 2-sided p value <0.05 was considered statistically significant. Results The total number of patients in the lockdown and non-lockdown groups was 486 and 992, respectively, showing a 51% decrease in visits during lockdown. In the non-lockdown and lockdown groups 56% and 61% of patients were male (p = 0.07), with an average age of 42 (range 0–97, SD 23) and 43 (range 0–90, SD 22) years, respectively (p = 0.44). No statistically significant proportional increase was found for any diagnostic category between the OER visits (p = 0.07) and OER consultation groups (p = 0.77). Nevertheless, analysis revealed a non-significant increase in the proportion of eye trauma from 14.8% to 21.2%, and reduction in eyelid conditions from 10.7% to 5.8%. The total number of OER visits demanding urgent intervention on admission was 43 (non-lockdown) and 24 (lockdown), while hospitalization ratio (hospitalizations/visits) was 8.8% and 10.6%, respectively (p = 0.44). Conclusions During the COVID-19 lockdown the guideline for patients in Israel was to avoid unnecessary hospital visits. Since patients tended to avoid the OER rather uniformly regardless of their specific eye condition, determining the risk-benefit of such recommendations and identifying high-risk sub-populations are critical public health issues.
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Singh H, Gray CS, Nelson MLA, Nie JX, Thombs R, Armas A, Fortin C, Molla Ghanbari H, Tang T. A qualitative study of hospital and community providers’ experiences with digitalization to facilitate hospital-to-home transitions during the COVID-19 pandemic. PLoS One 2022; 17:e0272224. [PMID: 35980960 PMCID: PMC9387844 DOI: 10.1371/journal.pone.0272224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic has triggered substantial changes to the healthcare context, including the rapid adoption of digital health to facilitate hospital-to-home transitions. This study aimed to: i) explore the experiences of hospital and community providers with delivering transitional care during the COVID-19 pandemic; ii) understand how rapid digitalization in healthcare has helped or hindered hospital-to-home transitions during the COVID-19 pandemic; and, iii) explore expectations of which elements of technology use may be sustained post-pandemic. Methods Using a pragmatic qualitative descriptive approach, remote interviews with healthcare providers involved in hospital-to-home transitions in Ontario, Canada, were conducted. Interviews were analyzed using a team-based rapid qualitative analysis approach to generate timely results. Visual summary maps displaying key concepts/ideas were created for each interview and revised based on input from multiple team members. Maps that displayed similar concepts were then combined to create a final map, forming the themes and subthemes. Results Sixteen healthcare providers participated, of which 11 worked in a hospital, and five worked in a community setting. COVID-19 was reported to have profoundly impacted healthcare providers, patients, and their caregivers and influenced the communication processes. There were several noted opportunities for technology to support transitions. Interpretation Several challenges with technology use were highlighted, which could impact post-pandemic sustainability. However, the perceived opportunities for technology in supporting transitions indicate the need to investigate the optimal role of technology in the transition workflow.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle L. A. Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jason X. Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Rachel Thombs
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alana Armas
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christian Fortin
- Hennick Bridgepoint Hospital, Sinai Health, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | - Hedieh Molla Ghanbari
- Division of Hospital Medicine, Sinai Health System, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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Baskonus HM, Gao W. Investigation of optical solitons to the nonlinear complex Kundu-Eckhaus and Zakharov-Kuznetsov-Benjamin-Bona-Mahony equations in conformable. OPTICAL AND QUANTUM ELECTRONICS 2022; 54:388. [PMID: 35692261 PMCID: PMC9167627 DOI: 10.1007/s11082-022-03774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
This research manuscript focuses on the extraction of dark-bright solitons and periodic wave distributions of two models, namely, the Zakharov-Kuznetsov-Benjamin-Bona-Mahony equation and complex Kundu-Eckhaus equation with conformable derivative. To reach these important properties, the generalized exponential rational function method is considered. To observe wave distributions in periodic and singular sense, dynamical behaviour modulus of solutions are also archived. Strain conditions for validity of results obtained in this paper are also reported.
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Affiliation(s)
- Haci Mehmet Baskonus
- Faculty of Education, Department of Mathematics and Science Education, Harran University, Sanliurfa, Turkey
| | - Wei Gao
- School of Information Science and Technology, Yunnan Normal University, Yunnan, China
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A Systematic Literature Review and Bibliometric Analysis of Ophthalmology and COVID-19 Research. J Ophthalmol 2022; 2022:8195228. [PMID: 35646394 PMCID: PMC9133895 DOI: 10.1155/2022/8195228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/05/2022] [Indexed: 12/12/2022] Open
Abstract
This review is proposed to summarize the updates on COVID-19 and ophthalmology along with the bibliometric features of articles that have been published since the beginning of the COVID-19 outbreak. The databases, including PubMed, Scopus, and Web of Science, were searched using "Coronavirus," "COVID-19," "SARS-CoV-2," "pandemic," "ophthalmology," "ophthalmic," and "eye" keywords. All published articles except commentaries, errata, and corrigenda up to April 2021 were included. Titles and abstracts were screened, and ophthalmology-focused articles were collected. The bibliographic information of the articles, such as the name and country of the first author, type of study, date of publication, language, and journal name, were extracted. Included studies were assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. After systematic searching, 2,669 distinct articles were screened by title/abstract, and 1,174 ophthalmology-focused articles were selected to be reviewed. Ophthalmology-focused publications accounted for less than 0.5 percent of the total COVID-19-related articles. Most of the articles were published in the Indian Journal of Ophthalmology, and the main publication type was "original article." Almost 88% of the publications were in English. There was a decline in the publication rate during the initial months of 2021 compared with the middle and last months of 2020. Most of the publications were affiliated with the United States of America. However, Singapore and the United Kingdom were the countries with the highest number of publications after population adjustment. Furthermore, a comprehensive review on major topics including SARS-CoV-2 ocular tropism, ophthalmic manifestations, ocular complications due to COVID-19 treatment strategies, the pandemic effect on ophthalmology care and operations, myopia progression during the pandemic, and telemedicine was conducted.
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Linares AR, Bramstedt KA, Chilukuri MM, Doraiswamy PM. Physician perceptions of surveillance: Wearables, Apps, and Chatbots for COVID-19. DIGITAL MEDICINE 2022; 8:000010. [PMID: 36245571 PMCID: PMC9549767 DOI: 10.4103/digm.digm_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/02/2021] [Accepted: 07/28/2021] [Indexed: 11/04/2022]
Abstract
Background and Purpose To characterize the global physician community's opinions on the use of digital tools for COVID-19 public health surveillance and self-surveillance. Materials and Methods Cross-sectional, random, stratified survey done on Sermo, a physician networking platform, between September 9 and 15, 2020. We aimed to sample 1000 physicians divided among the USA, EU, and rest of the world. The survey questioned physicians on the risk-benefit ratio of digital tools, as well as matters of data privacy and trust. Statistical Analysis Used Descriptive statistics examined physicians' characteristics and opinions by age group, gender, frontline status, and geographic region. ANOVA, t-test, and Chi-square tests with P < 0.05 were viewed as qualitatively different. As this was an exploratory study, we did not adjust for small cell sizes or multiplicity. We used JMP Pro 15 (SAS), as well as Protobi. Results The survey was completed by 1004 physicians with a mean (standard deviation) age of 49.14 (12) years. Enthusiasm was highest for self-monitoring smartwatches (66%) and contact tracing apps (66%) and slightly lower (48-56%) for other tools. Trust was highest for health providers (68%) and lowest for technology companies (30%). Most respondents (69.8%) felt that loosening privacy standards to fight the pandemic would lead to misuse of privacy in the future. Conclusion The survey provides foundational insights into how physicians think of surveillance.
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Affiliation(s)
- Alexandra R Linares
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA
| | - Katrina A Bramstedt
- Department of Medicine, Bond University Medical Program, Queensland, Australia
| | - Mohan M Chilukuri
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - P. Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA
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Tan TF, Li Y, Lim JS, Gunasekeran DV, Teo ZL, Ng WY, Ting DS. Metaverse and Virtual Health Care in Ophthalmology: Opportunities and Challenges. Asia Pac J Ophthalmol (Phila) 2022; 11:237-246. [PMID: 35772084 DOI: 10.1097/apo.0000000000000537] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT The outbreak of the coronavirus disease 2019 has further increased the urgent need for digital transformation within the health care settings, with the use of artificial intelligence/deep learning, internet of things, telecommunication network/virtual platform, and blockchain. The recent advent of metaverse, an interconnected online universe, with the synergistic combination of augmented, virtual, and mixed reality described several years ago, presents a new era of immersive and real-time experiences to enhance human-to-human social interaction and connection. In health care and ophthalmology, the creation of virtual environment with three-dimensional (3D) space and avatar, could be particularly useful in patient-fronting platforms (eg, telemedicine platforms), operational uses (eg, meeting organization), digital education (eg, simulated medical and surgical education), diagnostics, and therapeutics. On the other hand, the implementation and adoption of these emerging virtual health care technologies will require multipronged approaches to ensure interoperability with real-world virtual clinical settings, user-friendliness of the technologies and clinical efficiencies while complying to the clinical, health economics, regulatory, and cybersecurity standards. To serve the urgent need, it is important for the eye community to continue to innovate, invent, adapt, and harness the unique abilities of virtual health care technology to provide better eye care worldwide.
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Affiliation(s)
- Ting Fang Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Yong Li
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jane Sujuan Lim
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | | | - Zhen Ling Teo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Wei Yan Ng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Daniel Sw Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Vuong QH, Le TT, La VP, Nguyen MH. The psychological mechanism of internet information processing for post-treatment evaluation. Heliyon 2022; 8:e09351. [PMID: 35506049 PMCID: PMC9047410 DOI: 10.1016/j.heliyon.2022.e09351] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/16/2022] [Accepted: 04/25/2022] [Indexed: 12/16/2022] Open
Abstract
Digital healthcare has been greatly benefiting the public health system, especially during the COVID-19 pandemic. In digital healthcare, information communication through the Internet is crucial. The current study explores how patients' accessibility and trust in Internet information influence their decisions and ex-post assessment of healthcare providers by employing the Bayesian Mindsponge Framework (BMF) on a dataset of 1,459 Vietnamese patients. We find that patients' accessibility to Internet information positively affects the perceived sufficiency of information for choosing a healthcare provider, and their trust in the information intensifies this effect. Internet information accessibility is negatively associated with post-treatment assessment of healthcare providers, and trust also moderates this effect. Moreover, patients considering professional reputation important while making a decision are more likely to regard their choices as optimal, whereas patients considering services important have contradicting tendencies. Based on these findings, a concern about the risk of eroding trust toward Internet sources about healthcare information is raised. Thus, quality control and public trust-building measures need to be taken to improve the effectiveness of healthcare-related communication through the Internet and facilitate the implementation of digital healthcare.
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Affiliation(s)
- Quan-Hoang Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia Ward, Ha Dong District, Hanoi, 100803, Viet Nam
| | - Tam-Tri Le
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia Ward, Ha Dong District, Hanoi, 100803, Viet Nam
| | - Viet-Phuong La
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia Ward, Ha Dong District, Hanoi, 100803, Viet Nam
| | - Minh-Hoang Nguyen
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia Ward, Ha Dong District, Hanoi, 100803, Viet Nam
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Acharya A, Black RC, Smithies A, Darzi A. Evaluating the impact of a digital leadership programme on national digital priorities: a mixed methods study. BMJ Open 2022; 12:e056369. [PMID: 35487747 PMCID: PMC9058758 DOI: 10.1136/bmjopen-2021-056369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aimed to determine the impact of the United Kingdom's National Health Service Digital Academy (NHSDA) Digital Health Leadership course on high-level recommendations in digital preparedness and the development of a proficient leadership to oversee digital transformation, which has been a longstanding priority within the NHS. DESIGN A mixed methods study incorporating an online questionnaire, in-depth interviews and focus groups that were then analysed through a thematic analysis, underpinned by a constructivist approach. SETTINGS An online mixed methods study of a defined cohort of participants who had completed the NHSDA course. PARTICIPANTS 26 participants were recruited to the study, of whom 50% were clinicians, 26.9% in management and 19.2% in data science. All had completed the 2-year NHSDA programme in Digital Health Leadership more than 6 months prior. RESULTS Interviews and focus groups elicited two key areas of impact of the course: loco-regional digitisation and the development of a network of change agents. The dissertation project had direct effects on local digital transformation efforts. Most of these projects focused on clinician (11.7%) or service user (10.3%) engagement, as oppose to de novo digital processes (9.4%). The development of a network of digital leaders has facilitated communication between organisations and improved the efficiency of the national digital infrastructure. CONCLUSIONS A bespoke course incorporating a dissertation of practice model for digital health leaders can have broader impact for the attainment of digital priorities. This includes helping trusts to successfully adopt digital solutions, as well as fostering shared organisational learning. These influences, however, are mediated by resource and cultural barriers, which continue to hinder transformation efforts.
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Affiliation(s)
- Amish Acharya
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ruth Claire Black
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alisdair Smithies
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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Francisco R, Brasil S, Pascoal C, Jaeken J, Liddle M, Videira PA, Dos Reis Ferreira V. The road to successful people-centric research in rare diseases: the web-based case study of the Immunology and Congenital Disorders of Glycosylation questionnaire (ImmunoCDGQ). Orphanet J Rare Dis 2022; 17:134. [PMID: 35331276 PMCID: PMC8944152 DOI: 10.1186/s13023-022-02286-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/14/2022] [Indexed: 01/25/2023] Open
Abstract
Background Congenital Disorders of Glycosylation (CDG) are a complex family of rare metabolic diseases. Robust clinical data collection faces many hurdles, preventing full CDG biological and clinical comprehension. Web-based platforms offer privileged opportunities for biomedical data gathering, and participant recruitment, particularly in rare diseases. The immunology and CDG electronic (e-) questionnaire (ImmunoCDGQ) explores this paradigm, proposing a people-centric framework to advance health research and participant empowerment. Objective The objectives of this study were to: (1) Describe and characterize the ImmunoCDGQ development, engagement, recruitment, participation, and result dissemination strategies; (2) To critically compare this framework with published literature and making recommendations. Methods An international, multistakeholder people-centric approach was initiated to develop and distribute the ImmunoCDGQ, a multi-lingual e-questionnaire able to collect immune-related data directly from patients and family caregivers. An adapted version was produced and distributed among the general “healthy” population (ImmunoHealthyQ), serving as the control group. Literature screening was performed to identify and analyze comparable studies. Results The ImmunoCDGQ attained high participation and inclusion rates (94.6%, 209 out of 221). Comparatively to the control, CDG participants also showed higher and more variable questionnaire completion times as well as increased English version representativeness. Additionally, 20% of the CDG group (42 out of 209) chose not to complete the entire questionnaire in one go. Conditional logic structuring guided participant data provision and accurate data analysis assignment. Multi-channel recruitment created sustained engagement with Facebook emerging as the most followed social media outlet. Still, most included ImmunoCDGQ questionnaires (50.7%, 106 out of 209) were submitted within the first month of the project’s launch. Literature search and analysis showed that most e-questionnaire-based studies in rare diseases are author-built (56.8%, 25 out of 44), simultaneously addressing medical and health-related quality of life (HRQoL) and/or information needs (79.5%, 35 out of 44). Also, over 68% of the studies adopt multi-platform recruitment (30 out of 44) actively supported by patient organizations (52.3%, 23 out of 44). Conclusions The ImmunoCDGQ, its methodology and the CDG Community served as models for health research, hence paving a successful and reproducible road to people-centricity in biomedical research. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02286-w.
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Affiliation(s)
- Rita Francisco
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Sandra Brasil
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Carlota Pascoal
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Jaak Jaeken
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Center for Metabolic Diseases, Department of Pediatrics, KU Leuven, 3000, Leuven, Belgium
| | - Merell Liddle
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Paula A Videira
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Vanessa Dos Reis Ferreira
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal. .,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal. .,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.
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de Thurah A, Marques A, de Souza S, Crowson CS, Myasoedova E. Future challenges in rheumatology - is telemedicine the solution? Ther Adv Musculoskelet Dis 2022; 14:1759720X221081638. [PMID: 35321119 PMCID: PMC8935581 DOI: 10.1177/1759720x221081638] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has become an unprecedented facilitator of rapid telehealth expansion within rheumatology. Due to demographic shifts and workforce shortages in the future, new models of rheumatology care will be expected to emerge, with a growing footprint of telehealth interventions. Telehealth is already being used to monitor patients with rheumatic diseases and initial studies show good results in terms of safety and disease progression. It is being used as a tool for appointment prioritization and triage, and there is good evidence for using telehealth in rehabilitation, patient education and self-management interventions. Electronic patient-reported outcomes (ePROs) offer a number of long-term benefits and opportunities, and a routine collection of ePROs also facilitates epidemiological research that can inform future healthcare delivery. Telehealth solutions should be developed in close collaboration with all stakeholders, and the option of a telehealth visit must not deprive patients of the possibility to make use of a conventional 'face-to-face' visit. Future studies should especially focus on optimal models for rheumatology healthcare delivery to patients living in remote areas who are unable to use or access computer technology, and other patient groups at risk for disparity due to technical inequity and lack of knowledge.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8240, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Marques
- Health Sciences Research Unit: Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Savia de Souza
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Cynthia S. Crowson
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Elena Myasoedova
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
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Soltan AAS, Yang J, Pattanshetty R, Novak A, Yang Y, Rohanian O, Beer S, Soltan MA, Thickett DR, Fairhead R, Zhu T, Eyre DW, Clifton DA, Watson A, Bhargav A, Tough A, Rogers A, Shaikh A, Valensise C, Lee C, Otasowie C, Metcalfe D, Agarwal E, Zareh E, Thangaraj E, Pickles F, Kelly G, Tadikamalla G, Shaw G, Tong H, Davies H, Bahra J, Morgan J, Wilson J, Cutteridge J, O'Byrne K, Farache Trajano L, Oliver M, Pikoula M, Mendoza M, Keevil M, Faisal M, Dole N, Deal O, Conway-Jones R, Sattar S, Kundoor S, Shah S, Muthusami V. Real-world evaluation of rapid and laboratory-free COVID-19 triage for emergency care: external validation and pilot deployment of artificial intelligence driven screening. Lancet Digit Health 2022; 4:e266-e278. [PMID: 35279399 PMCID: PMC8906813 DOI: 10.1016/s2589-7500(21)00272-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/22/2021] [Accepted: 11/24/2021] [Indexed: 12/14/2022]
Abstract
Background Uncertainty in patients' COVID-19 status contributes to treatment delays, nosocomial transmission, and operational pressures in hospitals. However, the typical turnaround time for laboratory PCR remains 12–24 h and lateral flow devices (LFDs) have limited sensitivity. Previously, we have shown that artificial intelligence-driven triage (CURIAL-1.0) can provide rapid COVID-19 screening using clinical data routinely available within 1 h of arrival to hospital. Here, we aimed to improve the time from arrival to the emergency department to the availability of a result, do external and prospective validation, and deploy a novel laboratory-free screening tool in a UK emergency department. Methods We optimised our previous model, removing less informative predictors to improve generalisability and speed, developing the CURIAL-Lab model with vital signs and readily available blood tests (full blood count [FBC]; urea, creatinine, and electrolytes; liver function tests; and C-reactive protein) and the CURIAL-Rapide model with vital signs and FBC alone. Models were validated externally for emergency admissions to University Hospitals Birmingham, Bedfordshire Hospitals, and Portsmouth Hospitals University National Health Service (NHS) trusts, and prospectively at Oxford University Hospitals, by comparison with PCR testing. Next, we compared model performance directly against LFDs and evaluated a combined pathway that triaged patients who had either a positive CURIAL model result or a positive LFD to a COVID-19-suspected clinical area. Lastly, we deployed CURIAL-Rapide alongside an approved point-of-care FBC analyser to provide laboratory-free COVID-19 screening at the John Radcliffe Hospital (Oxford, UK). Our primary improvement outcome was time-to-result, and our performance measures were sensitivity, specificity, positive and negative predictive values, and area under receiver operating characteristic curve (AUROC). Findings 72 223 patients met eligibility criteria across the four validating hospital groups, in a total validation period spanning Dec 1, 2019, to March 31, 2021. CURIAL-Lab and CURIAL-Rapide performed consistently across trusts (AUROC range 0·858–0·881, 95% CI 0·838–0·912, for CURIAL-Lab and 0·836–0·854, 0·814–0·889, for CURIAL-Rapide), achieving highest sensitivity at Portsmouth Hospitals (84·1%, Wilson's 95% CI 82·5–85·7, for CURIAL-Lab and 83·5%, 81·8–85·1, for CURIAL-Rapide) at specificities of 71·3% (70·9–71·8) for CURIAL-Lab and 63·6% (63·1–64·1) for CURIAL-Rapide. When combined with LFDs, model predictions improved triage sensitivity from 56·9% (51·7–62·0) for LFDs alone to 85·6% with CURIAL-Lab (81·6–88·9; AUROC 0·925) and 88·2% with CURIAL-Rapide (84·4–91·1; AUROC 0·919), thereby reducing missed COVID-19 cases by 65% with CURIAL-Lab and 72% with CURIAL-Rapide. For the prospective deployment of CURIAL-Rapide, 520 patients were enrolled for point-of-care FBC analysis between Feb 18 and May 10, 2021, of whom 436 received confirmatory PCR testing and ten (2·3%) tested positive. Median time from arrival to a CURIAL-Rapide result was 45 min (IQR 32–64), 16 min (26·3%) sooner than with LFDs (61 min, 37–99; log-rank p<0·0001), and 6 h 52 min (90·2%) sooner than with PCR (7 h 37 min, 6 h 5 min to 15 h 39 min; p<0·0001). Classification performance was high, with sensitivity of 87·5% (95% CI 52·9–97·8), specificity of 85·4% (81·3–88·7), and negative predictive value of 99·7% (98·2–99·9). CURIAL-Rapide correctly excluded infection for 31 (58·5%) of 53 patients who were triaged by a physician to a COVID-19-suspected area but went on to test negative by PCR. Interpretation Our findings show the generalisability, performance, and real-world operational benefits of artificial intelligence-driven screening for COVID-19 over standard-of-care in emergency departments. CURIAL-Rapide provided rapid, laboratory-free screening when used with near-patient FBC analysis, and was able to reduce the number of patients who tested negative for COVID-19 but were triaged to COVID-19-suspected areas. Funding The Wellcome Trust, University of Oxford Medical and Life Sciences Translational Fund.
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Telemedicine monitoring in the follow-up of kidney transplant recipients: consensus indications from an Italian panel of surgeons and nephrologists after the COVID-19 experience. J Nephrol 2022; 35:725-733. [PMID: 35175578 PMCID: PMC8995243 DOI: 10.1007/s40620-021-01193-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/21/2021] [Indexed: 12/17/2022]
Abstract
The quality of follow-up has clearly emerged as a key factor for long-term kidney graft survival. Currently, many clinics are facing difficulties in delivering optimal surveillance because of the increased number and complexity of kidney transplant recipients, and because of the COVID-19 pandemic. Additional ways of performing follow-up visits are needed and telemedicine has emerged as a tool to strengthen patient care intensity. Six Italian transplant surgeons and nephrologists convened via teleconference to develop a consensual model of video visits for the follow-up of kidney transplant recipients. Issues discussed were: profile of eligible patients; assessments that can be carried out; video visit organization and medical professionals involved; supporting tools and implementation. The video visit was consensually recognized as the most relevant for the follow-up of kidney transplant recipients. Eligible patients should have basic electronic devices and the skills to correctly use them and be in clinically stable condition. With the exception of physical and instrumental examination, and kidney biopsy, all other assessments are feasible during a video visit and can be implemented by specific training and use of supporting tools. The video visit model is simple and adaptable to most transplant patients. It is not intended to replace face-to-face examinations, but is an additional tool for improving the intensity of follow-up of kidney transplant recipients, which can be integrated into current monitoring protocols.
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Caskey J, McConnell IL, Oguss M, Dligach D, Kulikoff R, Grogan B, Gibson C, Wimmer E, DeSalvo TE, Nyakoe-Nyasani EE, Churpek MM, Afshar M. A Natural Language Processing Pipeline to Identify COVID-19 Outbreaks from Contact Tracing Interview Forms for Public Health Departments. JMIR Public Health Surveill 2022; 8:e36119. [PMID: 35144241 PMCID: PMC8906835 DOI: 10.2196/36119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Wisconsin, COVID-19 case interview forms contain free text fields that need to be mined to identify potential outbreaks for targeted policy making. We developed an automated pipeline to ingest the free text into a pre-trained neural language model to identify businesses and facilities as outbreaks. OBJECTIVE We aimed to examine the precision and recall of our natural language processing pipeline against existing outbreaks and potentially new clusters. METHODS Data on cases of COVID-19 were extracted from the Wisconsin Electronic Disease Surveillance System (WEDSS) for Dane County between July 1, 2020, and June 30, 2021. Features from the case interview forms were fed into a Bidirectional Encoder Representations from Transformers (BERT) model that was fine-tuned for named entity recognition (NER). We also developed a novel location mapping tool to provide addresses for relevant NERs. Precision and recall were measured against manually verified outbreaks and valid addresses in WEDSS. RESULTS There were 46,798 cases of COVID-19 with 4,183,273 total BERT tokens and 15,051 unique tokens. The recall and precision of the NER tool were 0.67 (95 % CI 0.66-0.68) and 0.55 (95 % CI: 0.54-0.57), respectively. For the location mapping tool, the recall and precision were 0.93 (95% CI: 0.92-0.95) and 0.93 (95% CI: 0.92-0.95), respectively. Across monthly intervals, the NER tool identified more potential clusters than were verified in the WEDSS system. CONCLUSIONS We developed a novel pipeline of tools that identified existing outbreaks and novel clusters with associated addresses. Our pipeline ingests data from a statewide database and may be deployed to assist local health departments for targeted interventions.
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Affiliation(s)
- John Caskey
- University of Wisconsin - Madison, 1685 Highland Avenue5158 Medical Foundation Centennial Building, Madison, US
| | - Iain L McConnell
- University of Wisconsin - Madison, 1685 Highland Avenue5158 Medical Foundation Centennial Building, Madison, US
| | - Madeline Oguss
- University of Wisconsin - Madison, 1685 Highland Avenue5158 Medical Foundation Centennial Building, Madison, US
| | | | | | | | | | | | - Traci E DeSalvo
- State of Wisconsin Department of Health Services, Madison, US
| | | | - Matthew M Churpek
- University of Wisconsin - Madison, 1685 Highland Avenue5158 Medical Foundation Centennial Building, Madison, US
| | - Majid Afshar
- University of Wisconsin - Madison, 1685 Highland Avenue5158 Medical Foundation Centennial Building, Madison, US
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Gunasekeran D, Chew AMK, Chandrasekar E, Rajendram P, Kandarpa V, Rajendram M, Chia A, Smith H, Leong CK. The impact and applications of social media platforms for public health responses before and during COVID-19. J Med Internet Res 2022; 24:e33680. [PMID: 35129456 PMCID: PMC9004624 DOI: 10.2196/33680] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 12/21/2022] Open
Abstract
Background Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions. Objective This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature. Methods We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health. Results The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy. Conclusions Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health.
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Affiliation(s)
| | | | | | | | | | - Mallika Rajendram
- National University of Singapore (NUS), 10 Medical Drive, Singapore, SG
| | - Audrey Chia
- National University of Singapore (NUS), 10 Medical Drive, Singapore, SG
| | - Helen Smith
- Lee Kong Chian School of Medicine (LKCMedicine), Singapore, SG
| | - Choon Kit Leong
- National University of Singapore (NUS), 10 Medical Drive, Singapore, SG.,Mission Medical Clinic, Singapore, SG
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Dubé L, Silveira PP, Nielsen DE, Moore S, Paquet C, Cisneros-Franco JM, Kemp G, Knauper B, Ma Y, Khan M, Bartlett-Esquilant G, Evans AC, Fellows LK, Armony JL, Spreng RN, Nie JY, Brown ST, Northoff G, Bzdok D. From Precision Medicine to Precision Convergence for Multilevel Resilience-The Aging Brain and Its Social Isolation. Front Public Health 2022; 10:720117. [PMID: 35865245 PMCID: PMC9294141 DOI: 10.3389/fpubh.2022.720117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laurette Dubé
- Desautels Faculty of Management, McGill Center for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Patricia P Silveira
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Daiva E Nielsen
- Faculty of Agricultural and Environmental Sciences, School of Human Nutrition, McGill University, Montreal, QC, Canada
| | - Spencer Moore
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Catherine Paquet
- Faculté des Sciences de l'Administration, Université Laval, Quebec City, QC, Canada
| | - J Miguel Cisneros-Franco
- Desautels Faculty of Management, McGill Center for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Gina Kemp
- Desautels Faculty of Management, McGill Center for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada.,Centre for Research in Neuroscience, The Research Institute of McGill University Health Center, Montreal, QC, Canada
| | - Bärbel Knauper
- Department of Psychology, Faculty of Arts, McGill University, Montreal, QC, Canada
| | - Yu Ma
- Desautels Faculty of Management, McGill Center for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Mehmood Khan
- Life Biosciences Chief Executive Officer (CEO), Boston, MA, United States.,Council on Competitiveness (Chairman of the Board), Washington, DC, United States
| | | | - Alan C Evans
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Laboratory of Brain and Cognition, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Lesley K Fellows
- Laboratory of Brain and Cognition, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Chronic Mental Illness Service, Montreal Neurological Institute, Montreal, QC, Canada
| | - Jorge L Armony
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - R Nathan Spreng
- Laboratory of Brain and Cognition, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada.,Departments of Psychiatry and Psychology, McGill University, Montreal, QC, Canada.,McConnell Brain Imaging Centre, McGill University, Montreal, QC, Canada
| | - Jian-Yun Nie
- Department of Computer Science and Operations Research, University of Montreal, Montreal, QC, Canada
| | - Shawn T Brown
- Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Georg Northoff
- Chronic Mental Illness Service, Montreal Neurological Institute, Montreal, QC, Canada.,Faculty of Medicine, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Danilo Bzdok
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), McGill University, Montreal, QC, Canada.,Mila-Quebec Artificial Intelligence Institute, Montreal, QC, Canada
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