The effect of personalized intelligent digital systems for self-care training on type II diabetes: a systematic review and meta-analysis of clinical trials

AIMS

Type 2 diabetes (T2D) is rising worldwide. Self-care prevents diabetic complications. Lack of knowledge is one reason patients fail at self-care. Intelligent digital health (IDH) solutions have a promising role in training self-care behaviors based on patients' needs. This study reviews the effects of RCTs offering individualized self-care training systems for T2D patients.

METHODS

PubMed, Web of Science, Scopus, Cochrane Library, and Science Direct databases were searched. The included RCTs provided data-driven, individualized self-care training advice for T2D patients. Due to the repeated studies measurements, an all-time-points meta-analysis was conducted to analyze the trends over time. The revised Cochrane risk-of-bias tool (RoB 2.0) was used for quality assessment.

RESULTS

In total, 22 trials met the inclusion criteria, and 19 studies with 3071 participants were included in the meta-analysis. IDH interventions led to a significant reduction of HbA1c level in the intervention group at short-term (in the third month: SMD = - 0.224 with 95% CI - 0.319 to - 0.129, p value < 0.0; in the sixth month: SMD = - 0.548 with 95% CI - 0.860 to - 0.237, p value < 0.05). The difference in HbA1c reduction between groups varied based on patients' age and technological forms of IDH services delivery. The descriptive results confirmed the impact of M-Health technologies in improving HbA1c levels.

CONCLUSIONS

IDH systems had significant and small effects on HbA1c reduction in T2D patients. IDH interventions' impact needs long-term RCTs. This review will help diabetic clinicians, self-care training system developers, and researchers interested in using IDH solutions to empower T2D patients.

An evaluation of the quality of COVID-19 websites in terms of HON principles and using DISCERN tool

BACKGROUND

As many people relied on information from the Internet for official scientific or academically affiliated information during the COVID-19 pandemic, the quality of information on those websites should be good.

OBJECTIVE

The main purpose of this study was to evaluate a selection of COVID-19-related websites for the quality of health information provided.

METHOD

Using Google and Yahoo, 36 English language websites were selected, in accordance with the inclusion criteria. The two tools were selected for evaluation were the Health on the Net (HON) Code and the 16-item DISCERN tool.

RESULTS

Most websites (39%) were related to information for the public, and a small number of them (3%) concerned screening websites in which people could be informed of their possible condition by entering their symptoms. The result of the evaluation by the HON tool showed that most websites were reliable (53%), and 44% of them were very reliable. Based on the assessment results of the Likert-based 16-item DISCERN tool, the maximum and minimum values for the average scores of each website were calculated as 2.44 and 4.25, respectively.

CONCLUSION

Evaluation using two widely accepted tools shows that most websites related to COVID-19 are reliable and useful for physicians, researchers and the public.

Medical Informaticians' Skills and Competencies to Achieve Roles and Opportunities: A Qualitative Study

For Medical Informatics graduates, there is no compatibility between the training knowledge and skills at universities and the job requirements. This study aimed to determine the skills and competencies requirements for medical informatics graduates and possible job positions in an emerging discipline. This qualitative study was conducted using a questionnaire developed by the researchers. Nine independent medical informatics professionals assessed the initial draft of this tool to determine its face and content validity, and reliability. The questionnaire was distributed among 80 medical informaticians with a doctorate or a master's degree. In this study, items with an average of 4 and higher were confirmed; out of the 78 items, 66 were approved. The highest number of unapproved items was related to managerial knowledge and skills. Research knowledge, training skills, individual skills, technical capacities, specific skills in the health industry, and managerial skills are the main areas that graduates must learn. This survey can help develop a curriculum and job descriptions for medical informatics.

Early Warning System for Emergency Care: Designing a Timely Monitoring Mobile-Based System

Early Warning Scores (EWSs) systems support the timely detection of patient deterioration and rapid response of the care team. Due to the mobility nature of healthcare settings, there has been a growing tendency to use mobile-based devices in these settings. This chapter aimed to design a mobile-based EWS application (app). This was a descriptive study to design the architecture of the proposed EWS app. The design of architecture was done using the Unified Modeling Language diagrams including a class diagram, use-case diagram, and activity diagram. We evaluated the architecture using the ARID scenario-based evaluation method. The proposed EWS application (app) was the integration of three EWSs, including NEWS2, PEWS, and MEOWS. The workflow of these EWSs systems was designed and integrated into a single app. Also, the static structure of the proposed EWS app was designed by class diagram and the behavioral structure was depicted by use-case and activity diagrams. The class diagram showed the system components and their relationships. However, the use-case diagram displayed the app's interaction with its environment, and the activity diagram illustrated how the EWS app processes were carried out. Evaluation results showed the possibility of designing the architecture for the proposed EWS app. In our app, the EWSs were designed in the clinician's workflow, and it was integrated with the patient's Electronic Health Record (EHR). These factors may lead to more use of EWSs. Considering the frequency of alerts represented to clinicians and the user-friendly design of the app, some suggestions can be considered by EWS systems developers in the future.

Telecardiology interventions for patients with cardiovascular Disease: A systematic review on characteristics and effects

INTRODUCTION

The prevalence and mortality of cardiovascular diseases are high worldwide. Telecardiology can be used to diagnose and treat these diseases. This paper aimed to review the effectiveness (positive and negative) of implemented telecardiology services in terms of clinical, economic, and patient-reported aspects.

METHODS

A comprehensive search was conducted in Medline (through PubMed), Scopus, ISI web of science, and IEEE Xplore databases from inception to April 7, 2021. the studies that examined the effectiveness of telecardiology interventions were included.

RESULTS

Fifty studies were included in this systematic review. Most investigations (22%) were conducted in the US. In 22% of studies, telecardiology intervention was used for patients with heart failure. Telecardiology has been used in most studies for tele-monitoring (n = 21, 42%) and tele-consultation (n = 17, 34%) and in 29 studies (58%), was applied for ECG transmission. The highest rate of effects reported by studies was clinical. Thirty-five studies (70%) reported the clinical effects; twenty-one studies reported the positive effects for the economic category, and fifteen studies reported the positive effect for patient-reported class. The most positive clinical effects of telecardiology were early diagnosis, early treatment, and mortality reduction. The most positive effect of the economic class was the reduction of health care costs. The most effects of the patient-reported category were improving the patient's quality of life and patient satisfaction.

CONCLUSION

Telecardiology can help early diagnosis and treatment of cardiovascular diseases. It also has great potential in reducing health care costs and increasing quality of life and patient satisfaction.

Enhanced childhood diseases treatment using computational models: Systematic review of intelligent experiments heading to precision medicine

INTRODUCTION

Precision or personalized Medicine (PM) is used for the prevention and treatment of diseases by considering a huge amount of information about individuals variables. Due to high volume of information, AI-based computational models are required. A large set of studies conducted to examine the PM approach to improve childhood clinical outcomes. Thus, the main goal of this study was to review the application of health information technology and especially artificial intelligence (AI) methods for the treatment of childhood disease using PM.

METHODS

PubMed, Scopus, Web of Science, and EMBASE databases were searched up to December 18, 2019. Articles that focused on informatics applications for childhood disease PM included in this study. Included papers were classified for qualitative analysis and interpreting results. The results were analyzed using Microsoft Excel 2019.

RESULTS

From 341 citations, 62 papers met our inclusion criteria. The number of published papers that used AI methods to apply for PM in childhood diseases increased from 2010 to 2019. Our results showed that most applied methods were related to machine learning discipline. In terms of clinical scope, the largest number of clinical articles are devoted to oncology. Besides, the analysis showed that genomics was the most PM approach used regarding childhood disease.

CONCLUSION

This systematic review examined papers that used AI methods for applying PM approaches in childhood diseases from medical informatics perspectives. Thus, it provided new insight to researchers who are interested in knowing research needs in this field.

Association between the cytotoxic T-lymphocyte antigen-4 mutations and the susceptibility to systemic lupus erythematosus; Contribution markers of inflammation and oxidative stress

The cytotoxic T lymphocyte antigen-4 (CTLA-4) also known as CD152 (cluster of differentiation 152) is a crucial negative regulator of the immune system. This protein receptor provides negative signals in order to suppress T-cell activation and immune attack against self-antigens, although its role is unclear.  The ability of CTLA-4 to limit T cell-mediated immune response has made it a major target in treatment of tumors and autoimmune diseases such as systemic lupus erythematosus (SLE). In this study, we investigated whether CTLA-4 G-1661A and CTLA-4 T-1722C mutations are associated with SLE. So one hundred nine SLE patients and 101 gender and age-matched unrelated healthy controls were recruited for this case-control study. The promoter mutations were detected by PCR-RFLP, neopterin, malondialdehyde (MDA) and serum lipid concentration were determined by HPLC and enzyme assay, respectively.

RESULT

We found that both codominant (AA vs. GG) and recessive (AA vs. GA+GG) CTLA-4 G-1661A mutation significantly decreased the risk of SLE by 1.7 and 3.7 times, respectively.  Interestingly, SLE patients with AA genotypes of CTLA-4 G-1661A have lower neopterin and MDA concentration compared with GA+GG genotypes. The overall distribution of CTLA-4 T-1722C genotypes and alleles in SLE patients were similar to those in control group. In conclusion, our findings showed, that there is an association between systemic inflammatory markers, oxidative stress and the CTLA-4 G-1661A GG+AG genotypes, MDA and neopterin which are the most conventional risk factors for coronary heart disease, therefore these mutations may be consider as a risk factor for susceptibility to heart disease in SLE patients.

Pharmacogenetics of drug metabolizing enzyme: thiopurine methyl transferase phenotypes and multidrug resistance 1 gene polymorphism in inflammatory bowel disease

Inflammatory bowel disease(IBD) is progressing rapidly in developing countries such as Iran. This research is intended to compile the frequency distribution of the drug metabolizing enzyme, thiopurine methyl transferase(TPMT) and the drug transporter, Multi drug resistance(MDR1) which are involved in metabolism of many therapeutics such as thiopurines in inflammatory bowel disease(IBD). Ethnicity is an important variable influencing drug response. The aims of this research were to investigate the association of TPMT phenotypes with MDR1 genotypes. TPMT activity was measured by using a non-extraction HPLC method and genotype for the C3435T polymorphism of MDR1 gene was determined in 215 unrelated IBD patients including of 85 males and 130 females and 212 unrelated healthy individuals consisted of 96 males and 116 females as control group by PCR-RFLP in Iran's western population. TPMT phenotypes demonstrated no frequency for deficient, 2.2% for low and 97.8% for normal activity that is different with results of other studies. Interestingly there were a significant negative correlation between TPMT activities as calculated based on nmol/grHb/h and positive correlation calculated in mU/L with Hb levels in IBD patients and control subjects. Dominant and codominant MDR1 C3435T gene polymorphism increased the risk of IBD by 1.45 and 1.46 times, respectively. IBD patients with MDR1 mutant genotypes C3435T, had lower TPMT activites and Hb concentrations. Using of mU/L is more appropriate than nmol6MTG/grHb/h for expressing TPMT activity. TPMT frequency of deficient and low activity in western Iran is low. The carriers of mutant C3435T MDR1 are not good TPMT methylators.