Japan has universal coverage and designated pediatric oncology centers, yet the childhood cancer information ecosystem remains a "black box." The incidence is measurable, but treatment exposure and long-term follow-up are not reliably linked across hospitals, registries, and survivorship services. The World Health Organization (WHO) CureAll framework highlights information governance as a lever for equity. This study aims to propose a formative design for national digital governance connecting registries, clinical systems, and survivorship in Japan. We synthesized international guidance and Japanese statutes, plans, and registry reports. Drawing on operational experience, we specified a minimal pediatric dataset, an HL7 Fast Healthcare Interoperability Resources (FHIR)-based interoperability architecture, and governance to align standards, consent, and data use. No new empirical data were collected. We outline a 4-layer architecture. Source systems (electronic health records, laboratory and radiology systems, pathology, and cooperative group databases) feed an HL7 FHIR gateway. A national Pediatric Data Steward governs standards and interoperability (FHIR profiles and application programming interfaces), terminology and coding (International Classification of Diseases for Oncology and International Classification of Childhood Cancer, with mappings to Systematized Nomenclature of Medicine-Clinical Terms and Logical Observation Identifiers Names and Codes), privacy and consent, data-use agreements, data quality, and audit. Outputs flow to the National and Hospital-based Cancer Registries and a patient-facing Digital Survivorship Passport, with bidirectional clinic updates and linkage to the resident registry and vital statistics. Security, audit, and public reporting span all layers. We define pediatric indicators and a staged road map. Transforming Japan's pediatric oncology information into a learning system is chiefly a governance task. A Pediatric Data Steward, a harmonized pediatric data dictionary via FHIR, and a portable survivorship passport with layered consent can improve timeliness, completeness, follow-up, and transparency.
Background: In 2017, the US Department of Health and Human Services declared a national opioid crisis. In 2022, an estimated 81,806 overdose deaths involved an opioid. Emergency departments are critical in the pathway of care for providing resources and linkages to services. Studies investigating emergency medicine (EM) physicians' perspectives on the opioid crisis have largely focused on prescribing.
Objectives: To investigate EM physicians' perspectives on response strategies to the opioid crisis of biosurveillance and linkages to care. A secondary objective was to map reported challenges and recommendations using a sequential intercept model as an actionable framework.
Methods: This is a qualitative study. Six EM physicians in an academic health care system were interviewed through semi-structured interviews. Interviews were transcribed, then thematically coded and analyzed to identify cross-sector settings and barriers to care with corresponding recommendations. Settings and recommendations were mapped as a sequential intercept model.
Results: EM physicians identified 9 key settings as crucial touch points in the opioid crisis: home setting, emergency medical services, patient care, clinically relevant data and information, prescriptions and pain management, predischarge coordination, outpatient resources, biosurveillance sample collection, and the external partner and administrative environment. Biosurveillance challenges included concerns about collecting biological materials for state and regional monitoring, as well as the time burden for sample collection. Linkage to care challenges included social determinants of health and limited outpatient care access. Recommendations were specific to each setting and included care coordination and fostering cross-sector partnerships. A patient-centered approach and better integration of community resources were emphasized.
Conclusions: The service delivery culture is of acute and episodic care but needs to more seamlessly address care across its fragmented multicomponent complex system. EM physicians face systemic challenges and provide actionable recommendations to promote comprehensive care to patients presenting to the emergency department with opioid-related complaints.
Background: The sociopolitical crisis in Haiti affects health care center attendance, creating significant challenges in ensuring patient compliance with medical appointments.
Objective: This study aimed to assess the effectiveness of text message reminders on patient attendance in the context of the sociopolitical crisis of Haiti, examining the influence of patient perceptions, behaviors, and socioeconomic factors.
Methods: We conducted a cross-sectional study using a telephone survey of 386 randomly selected patients who had an appointment during the third quarter of 2024 at 2 health care centers in the Port-au-Prince metropolitan area. We collected appointment and socioeconomic data, as well as perceptions and behaviors toward text message reminders. We described patients' perceptions and behaviors toward text message reminders, as well as appointment attendance and patient characteristics. We performed bivariate and multivariate logistic regression models to assess whether receiving text message reminders and socioeconomic factors influenced overall appointment attendance.
Results: Among 386 patients, 259 attended their appointments on either the appointment day or at a later date for an overall attendance rate of 67.1 % ( 95% CI 62.4%-71.8%). Attendance rates were higher among the 147 patients who confirmed receiving a reminder (77.6%) compared to the 239 who did not (60.7%). SMS text messaging reading behavior varied among patients. Overall, 219/386 (56.7%) patients always, 66/386 (17%) often, 75/386 (19%) sometimes, 21/386 (5%) rarely, and 5/386 (1%) never read their SMS text messaging. All patients liked the initiative of sending reminders and found them helpful. In the multivariate analysis, patients who confirmed receiving a reminder were more likely to attend their appointment compared to those who did not (adjusted odds ratio [AOR] 2.0, 95% CI 1.18-3.39). A patient satisfaction rate of 8 or higher with their physicians was significantly associated with higher attendance rates, compared to 6 or lower, with AORs increasing with satisfaction. Travel time less than 30 minutes (AOR 2.31, 95% CI 1.03-5.19) and 30-60 minutes (AOR 2.78, 95% CI 1.24-6.21), and being with a chronic disease (AOR 0.42, 95% CI 0.23-0.79) were also associated with appointment attendance.
Conclusions: Our study highlights the potential of text message reminders to improve appointment attendance in Haiti, despite the sociopolitical crisis. The overall acceptability and positive perceptions of SMS text messaging reminders suggest that they can be a valuable tool in health care settings, especially when adapted to the local context. We recommend that health care centers in Haiti consider integrating SMS text messaging reminder systems into routine patient management to enhance adherence and optimize care delivery.
Background: Digitalization has profoundly transformed health care delivery, including the increasing use of telemedical applications in pediatric care. While the economic benefits and improved access associated with telemedicine in rural regions are well documented, data on caregiver acceptance and demand in metropolitan areas remain limited.
Objective: This study aimed to assess caregivers' willingness to use telemedical tools in the context of pediatric surgery in a metropolitan area.
Methods: A 15-item survey was distributed to caregivers of pediatric surgical patients between May and November 2023 at the Department of Pediatric Surgery of the University Medical Center Hamburg-Eppendorf. The survey included questions on sociodemographic factors, previous experience with telemedicine, and preferences regarding telemedical support. Data were analyzed using descriptive statistics. Group comparisons were performed using the χ2 test or Fisher exact test, where appropriate.
Results: A total of 100 families participated in the study. The median age of the pediatric patients was 5 years (IQR 11.75), and the median age of caregivers was 37 years (IQR 14). Congenital conditions accounted for 65% (n=65) of the underlying diagnoses. Overall, 90% (n=88/98) of the interviewed families expressed interest in telemedicine as an integrative health care solution for their children, whereas only 15% (n=15) reported on previous experiences. A primary telemedical consultation was considered acceptable by 53% (n=50/95) of the participants. Caregivers' preferences were not significantly associated with distance to the nearest hospital (P=.77), employment status (P=.89), and family size (P=.59).
Conclusions: Caregivers in an urban pediatric surgical setting show substantial interest in telemedical care options. Acceptance appears to be independent of geographic proximity to health care facilities, suggesting that telemedicine may represent a relevant addition to pediatric surgical care even in metropolitan regions. Further studies are needed to evaluate practical implementation, including technical, legal, and compliance-related aspects.
Background: Vitiligo is a chronic skin disease with a global prevalence of approximately 1% to 2%, characterized by depigmented macules. Little is known about the public interest and medical needs of patients with vitiligo in Germany. However, understanding this is critical for a patient-centered holistic therapeutic management of the disease.
Objective: This study aimed to analyze vitiligo-related web search behavior across Germany as a proxy for public awareness. A retrospective longitudinal study was conducted using Google Ads Keyword Planner to collect monthly search volume data for vitiligo-related terms from October 2019 to May 2023.
Methods: Keywords were identified in the 7 most spoken languages in Germany (German, Turkish, English, Arabic, Russian, and Polish). Seasonal and regional variations were analyzed, along with correlations with population density, dermatologist availability, and weather patterns.
Results: In total, 7,764,080 vitiligo-related searches were recorded. Most searches (n=5,808,360, 74.81%) addressed general information. Search volume peaked during the summer months and correlated positively with temperature and sunshine hours (P<.001). Notable regional differences were observed, with the highest search rates in Hamburg, Berlin, and Bremen. Rural areas showed higher search volume per 100,000 inhabitants than urban areas.
Conclusions: The findings suggest a strong public interest in vitiligo, particularly during periods of increased skin exposure. The high demand for treatment-related information further reflects the need for accessible, effective care. Web search behavior can offer real-time insights into public awareness and unmet needs, supporting earlier disease recognition, stigma reduction, and targeted educational strategies.
Background: Diabetes is a chronic disease with a high global prevalence, increasing from 200 million people in 1990 to 830 million in 2022, with a higher burden in low- and middle-income regions and high mortality in Mexico and Veracruz. These inequalities limit access to treatment and nutritional education, requiring technological solutions such as interactive kiosks based on artificial intelligence (AI) that contribute to the nutritional management of people with diabetes in marginalized communities.
Objective: This study aimed to design and evaluate an interactive kiosk based on AI that generates culturally relevant and personalized meal plans for people with diabetes in marginalized communities.
Methods: A low-cost prototype was developed, with a database of local foods and a multilayer perceptron trained with synthetic data based on national clinical guidelines. Performance was tested through an experimental evaluation that measured (1) the accuracy of nutritional recommendations compared with ideal meal plans (accuracy, precision, sensitivity, and F1-score); (2) performance, measured by recording response time with 1 to 50 simultaneous requests; and (3) usability, assessed using heuristic evaluation and the System Usability Scale (SUS).
Results: The smart kiosk was experimentally evaluated in three dimensions: nutritional recommendations, system efficiency, and usability. The model achieved AI metrics of 87.3% overall accuracy, 90.5% precision, 92.1% sensitivity, and 91.3% F1-score. The average response time was 2.36 (SD 0.24) seconds in all load tests. A maximum time of 4 seconds was obtained in the simulation of 50 concurrent users. In the usability evaluation, an average score of 89 (SD 2.89) out of 100 was obtained on the SUS, which is considered excellent, along with a success rate of 98.3%.
Conclusions: The AI-based kiosk demonstrated technical feasibility, adequate performance, and satisfactory usability. Its ability to operate without the need for internet and its low cost make it an equitable option for diabetes self-management and a replicable model in public health.
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