Chenyu Sun, Yue Chen, Shaodi Ma, Mengqing Liu, Vicky Yau, Na Hyun Kim, Sujatha Kailas, Scott Lowe, Rachel Bentley, Shuya Chen, Jie Liu, Muzi Meng, Yuting Huang, Qin Zhou, Yuyan Wu
Background
Participation in colonoscopies is an essential aspect of endoscopic training. The purpose of this study was to explore the impact of fellow/trainee participation on colonoscopy outcomes.
Methods
This meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). From database inception to July 2022, studies investigating fellow involvement and colonoscopy outcomes were searched across Cochrane library, PubMed, and other databases. The random-effects model was applied to generate more conservative estimates. Sensitive analysis was conducted to explore whether the result would depend on a particular study. Egger's test and Begg's test were used to estimate the potential for publication bias.
Results
Seventeen studies including 30,062 participants were included. We found that fellow/trainee involvement enhanced the overall rates of adenoma detection and polyp detection (OR = 1.26, 95% CI = 1.14–1.40, p < 0.001; OR = 1.29, 95% CI = 1.02–1.63, p = 0.020, respectively). The mean number of adenoma/polyps per colonoscopy was also higher with fellow/trainee participation (MD = 0.12, 95% CI = 0.08–0.17, p < 0.001; MD = 0.15, 95% CI = 0.02–0.28, p = 0.020, respectively).
Conclusion
In addition to its educational purpose, fellow or trainee involvement is associated with beneficial effects on colonoscopy outcomes.
{"title":"You are not lab rats at teaching hospitals: A systematic review of resident and fellow participation leads to improved colonoscopy","authors":"Chenyu Sun, Yue Chen, Shaodi Ma, Mengqing Liu, Vicky Yau, Na Hyun Kim, Sujatha Kailas, Scott Lowe, Rachel Bentley, Shuya Chen, Jie Liu, Muzi Meng, Yuting Huang, Qin Zhou, Yuyan Wu","doi":"10.1111/jebm.12554","DOIUrl":"10.1111/jebm.12554","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Participation in colonoscopies is an essential aspect of endoscopic training. The purpose of this study was to explore the impact of fellow/trainee participation on colonoscopy outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). From database inception to July 2022, studies investigating fellow involvement and colonoscopy outcomes were searched across Cochrane library, PubMed, and other databases. The random-effects model was applied to generate more conservative estimates. Sensitive analysis was conducted to explore whether the result would depend on a particular study. Egger's test and Begg's test were used to estimate the potential for publication bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies including 30,062 participants were included. We found that fellow/trainee involvement enhanced the overall rates of adenoma detection and polyp detection (OR = 1.26, 95% CI = 1.14–1.40, <i>p</i> < 0.001; OR = 1.29, 95% CI = 1.02–1.63, <i>p</i> = 0.020, respectively). The mean number of adenoma/polyps per colonoscopy was also higher with fellow/trainee participation (MD = 0.12, 95% CI = 0.08–0.17, <i>p</i> < 0.001; MD = 0.15, 95% CI = 0.02–0.28, <i>p</i> = 0.020, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In addition to its educational purpose, fellow or trainee involvement is associated with beneficial effects on colonoscopy outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41134449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Mugisha, Laetitia Nyirazinyoye, Clarisse Marie Claudine Simbi, Faith Chesire, Ronald Senyonga, Matt Oxman, Allen Nsangi, Daniel Semakula, Christopher James Rose, Jenny Moberg, Astrid Dahlgren, Margaret Kaseje, Simon Lewin, Nelson K. Sewankambo, Sarah Rosenbaum, Andrew D Oxman
Aim
The aim of this trial was to evaluate the effects of the Informed Health Choices intervention on the ability of students in Rwandan to think critically and make Informed Health Choices.
Methods
We conducted a two-arm cluster-randomized trial in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools to the intervention or control. One class in each intervention school had ten 40-min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed within 2 weeks after the intervention. We conducted an intention-to-treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts.
Results
Between February 25 and March 29, 2022, we recruited 3,212 participants. We assigned 1,572 students and 42 teachers to the intervention arm and 1,556 students and 42 teachers to the control arm. The proportion of students who passed the test in the intervention arm was 915/1,572 (58.2%) compared to 302/1,556 (19.4%) in the control arm, adjusted odds ratio 10.6 (95% CI: 6.3–17.8), p < 0.0001, adjusted difference 37.2% (95% CI: 29.5%–45.0%).
Conclusions
The intervention is effective in helping students think critically about health choices. It was possible to improve students’ ability to think critically about health in the context of a competence-based curriculum in Rwanda, despite challenging postpandemic conditions.
{"title":"Effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices: A cluster-randomized trial","authors":"Michael Mugisha, Laetitia Nyirazinyoye, Clarisse Marie Claudine Simbi, Faith Chesire, Ronald Senyonga, Matt Oxman, Allen Nsangi, Daniel Semakula, Christopher James Rose, Jenny Moberg, Astrid Dahlgren, Margaret Kaseje, Simon Lewin, Nelson K. Sewankambo, Sarah Rosenbaum, Andrew D Oxman","doi":"10.1111/jebm.12551","DOIUrl":"10.1111/jebm.12551","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this trial was to evaluate the effects of the Informed Health Choices intervention on the ability of students in Rwandan to think critically and make Informed Health Choices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a two-arm cluster-randomized trial in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools to the intervention or control. One class in each intervention school had ten 40-min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed within 2 weeks after the intervention. We conducted an intention-to-treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between February 25 and March 29, 2022, we recruited 3,212 participants. We assigned 1,572 students and 42 teachers to the intervention arm and 1,556 students and 42 teachers to the control arm. The proportion of students who passed the test in the intervention arm was 915/1,572 (58.2%) compared to 302/1,556 (19.4%) in the control arm, adjusted odds ratio 10.6 (95% CI: 6.3–17.8), <i>p</i> < 0.0001, adjusted difference 37.2% (95% CI: 29.5%–45.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The intervention is effective in helping students think critically about health choices. It was possible to improve students’ ability to think critically about health in the context of a competence-based curriculum in Rwanda, despite challenging postpandemic conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12551","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41122370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Faith Chesire, Margaret Kaseje, Marlyn Ochieng, Benson Ngatia, Michael Mugisha, Ronald Ssenyonga, Matt Oxman, Allen Nsangi, Daniel Semakula, Christopher James Rose, Laetitia Nyirazinyoye, Astrid Dahlgren, Simon Lewin, Nelson K Sewankambo, Sarah Rosenbaum, Andrew D Oxman
There is an overabundance of claims about the advantages and disadvantages of health interventions. People need to be able to appraise the reliability of these claims. The aim of this two‐arm cluster‐randomized trial was to evaluate the Informed Health Choices secondary school intervention designed to teach students to assess claims about the effects of health actions and make informed decisions.
{"title":"Effects of the informed health choices secondary school intervention on the ability of students in Kenya to think critically about health choices: A cluster-randomized trial","authors":"Faith Chesire, Margaret Kaseje, Marlyn Ochieng, Benson Ngatia, Michael Mugisha, Ronald Ssenyonga, Matt Oxman, Allen Nsangi, Daniel Semakula, Christopher James Rose, Laetitia Nyirazinyoye, Astrid Dahlgren, Simon Lewin, Nelson K Sewankambo, Sarah Rosenbaum, Andrew D Oxman","doi":"10.1111/jebm.12556","DOIUrl":"10.1111/jebm.12556","url":null,"abstract":"There is an overabundance of claims about the advantages and disadvantages of health interventions. People need to be able to appraise the reliability of these claims. The aim of this two‐arm cluster‐randomized trial was to evaluate the Informed Health Choices secondary school intervention designed to teach students to assess claims about the effects of health actions and make informed decisions.","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41116756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ronald Ssenyonga, Andrew D Oxman, Esther Nakyejwe, Faith Chesire, Michael Mugisha, Allen Nsangi, Daniel Semakula, Matt Oxman, Christopher James Rose, Sarah E Rosenbaum, Jenny Moberg, Margaret Kaseje, Laetitia Nyirazinyoye, Astrid Dahlgren, Simon Lewin, Nelson K Sewankambo
Aim:
The aim was to evaluate the effect of the Informed Health Choices (IHC) educational intervention on secondary students’ ability to assess health-related claims and make informed choices.
Methods:
In a cluster-randomized trial, we randomized 80 secondary schools (students aged 13–17 years) in Uganda to the intervention or control (usual curriculum). The intervention included a 2-day teacher training workshop, 10 lessons accessed online by teachers and delivered in one school term. The lesson plans were developed for classrooms equipped with a blackboard or a blackboard and projector. The lessons addressed nine prioritized concepts. We used two multiple-choice questions for each concept to evaluate the students’ ability to assess claims and make informed choices. The primary outcome was the proportion of students with a passing score (≥9 of 18 questions answered correctly).
Results:
Eighty schools consented and were randomly allocated. A total of 2477 students in the 40 intervention schools and 2376 students in the 40 control schools participated in this trial. In the intervention schools, 1364 (55%) of students that completed the test had a passing score compared with 586 (25%) of students in the control schools (adjusted difference 33%, 95% CI 26%–39%).
Conclusions:
The IHC secondary school intervention improved students’ ability to think critically and make informed choices. Well-designed digital resources may improve access to educational material, even in schools without computers or other information and communication technology (ICT). This could facilitate scaling-up use of the resources and help to address inequities associated with limited ICT access.
{"title":"Use of the informed health choices educational intervention to improve secondary students’ ability to think critically about health interventions in Uganda: A cluster-randomized trial","authors":"Ronald Ssenyonga, Andrew D Oxman, Esther Nakyejwe, Faith Chesire, Michael Mugisha, Allen Nsangi, Daniel Semakula, Matt Oxman, Christopher James Rose, Sarah E Rosenbaum, Jenny Moberg, Margaret Kaseje, Laetitia Nyirazinyoye, Astrid Dahlgren, Simon Lewin, Nelson K Sewankambo","doi":"10.1111/jebm.12553","DOIUrl":"10.1111/jebm.12553","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim:</h3>\u0000 \u0000 <p>The aim was to evaluate the effect of the Informed Health Choices (IHC) educational intervention on secondary students’ ability to assess health-related claims and make informed choices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods:</h3>\u0000 \u0000 <p>In a cluster-randomized trial, we randomized 80 secondary schools (students aged 13–17 years) in Uganda to the intervention or control (usual curriculum). The intervention included a 2-day teacher training workshop, 10 lessons accessed online by teachers and delivered in one school term. The lesson plans were developed for classrooms equipped with a blackboard or a blackboard and projector. The lessons addressed nine prioritized concepts. We used two multiple-choice questions for each concept to evaluate the students’ ability to assess claims and make informed choices. The primary outcome was the proportion of students with a passing score (≥9 of 18 questions answered correctly).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>Eighty schools consented and were randomly allocated. A total of 2477 students in the 40 intervention schools and 2376 students in the 40 control schools participated in this trial. In the intervention schools, 1364 (55%) of students that completed the test had a passing score compared with 586 (25%) of students in the control schools (adjusted difference 33%, 95% CI 26%–39%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions:</h3>\u0000 \u0000 <p>The IHC secondary school intervention improved students’ ability to think critically and make informed choices. Well-designed digital resources may improve access to educational material, even in schools without computers or other information and communication technology (ICT). This could facilitate scaling-up use of the resources and help to address inequities associated with limited ICT access.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41119592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Several types of tools are used by researchers to assess the RoB and methodological quality of studies included in systematic reviews.1 This is the case of the Cochrane approach for randomized controlled trials (RCTs), which is based on domain assessment,2 and the Newcastle-Ottawa Scale (NOS) for assessing the methodological quality of nonrandomized studies in meta-analyses, including case-control and cohort studies.3 Other tools may have other purposes; for example, tools have been developed to assess how a study is reported in a scientific article. This is the case with the CONSORT4 and STROBE5 checklists for guiding the reporting of RCTs and observational studies, respectively. However, it appears that some researchers inappropriately use reporting checklists to assess the methodological quality and RoB of studies included in systematic reviews.6
The objective of this letter is to clarify different concepts related to the methodological assessment of the studies included in a systematic review. To support the arguments in this letter, the author also reported some examples of the use of reporting checklists to assess the methodological quality and RoB of studies included in systematic reviews of different biomedical disciplines.
The terms methodological quality, RoB, and reporting quality still appear to create confusion in how they are being applied in the biomedical literature. Methodological quality involves the application of specific methodological safeguards in the planning and conduct of a study to avoid or reduce systematic errors.7 RoB is the chance of having a biased estimate, in other words, an overestimation or underestimation of the true effect estimate.2 The assessment of RoB requires the interpretation and judgment of how methodological flaws (or a lack of methodological safeguards) may affect a study's results. Methodological quality assessment typically checks whether safeguards were applied, but with no emphasis on understanding whether these safeguards were in fact able to ensure that the study produced accurate estimates (i.e., values that are not under- or overestimated).7 Reporting quality (or sometimes completeness of reporting) is a different concept. Reporting checklists, as the name implies, evaluate whether a study is reported in detail or not, or if important information is provided to allow reproducibility.8 However, reporting checklists do not assess whether the procedure reported was, in fact, the correct one to use. Hence, a tool designed to assess reporting does not have adequate content validity to assess whether a study is of good/bad quality or whether a study has high or low RoB. Figure 1 reports the objectives of the different tools.
{"title":"Methodological quality, risk of bias, and reporting quality: A confusion persists","authors":"Clovis Mariano Faggion Jr","doi":"10.1111/jebm.12550","DOIUrl":"10.1111/jebm.12550","url":null,"abstract":"<p>Several types of tools are used by researchers to assess the RoB and methodological quality of studies included in systematic reviews.<span><sup>1</sup></span> This is the case of the Cochrane approach for randomized controlled trials (RCTs), which is based on domain assessment,<span><sup>2</sup></span> and the Newcastle-Ottawa Scale (NOS) for assessing the methodological quality of nonrandomized studies in meta-analyses, including case-control and cohort studies.<span><sup>3</sup></span> Other tools may have other purposes; for example, tools have been developed to assess how a study is reported in a scientific article. This is the case with the CONSORT<span><sup>4</sup></span> and STROBE<span><sup>5</sup></span> checklists for guiding the reporting of RCTs and observational studies, respectively. However, it appears that some researchers inappropriately use reporting checklists to assess the methodological quality and RoB of studies included in systematic reviews.<span><sup>6</sup></span></p><p>The objective of this letter is to clarify different concepts related to the methodological assessment of the studies included in a systematic review. To support the arguments in this letter, the author also reported some examples of the use of reporting checklists to assess the methodological quality and RoB of studies included in systematic reviews of different biomedical disciplines.</p><p>The terms <i>methodological quality</i>, <i>RoB</i>, and <i>reporting quality</i> still appear to create confusion in how they are being applied in the biomedical literature. Methodological quality involves the application of specific methodological safeguards in the planning and conduct of a study to avoid or reduce systematic errors.<span><sup>7</sup></span> RoB is the chance of having a biased estimate, in other words, an overestimation or underestimation of the true effect estimate.<span><sup>2</sup></span> The assessment of RoB requires the interpretation and judgment of how methodological flaws (or a lack of methodological safeguards) may affect a study's results. Methodological quality assessment typically checks whether safeguards were applied, but with no emphasis on understanding whether these safeguards were in fact able to ensure that the study produced accurate estimates (i.e., values that are not under- or overestimated).<span><sup>7</sup></span> Reporting quality (or sometimes completeness of reporting) is a different concept. Reporting checklists, as the name implies, evaluate whether a study is reported in detail or not, or if important information is provided to allow reproducibility.<span><sup>8</sup></span> However, reporting checklists do not assess whether the procedure reported was, in fact, the correct one to use. Hence, a tool designed to assess reporting does not have adequate content validity to assess whether a study is of good/bad quality or whether a study has high or low RoB. Figure 1 reports the objectives of the different tools.</","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12550","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yixian Xu, Xinkai Zheng, Yuanjie Li, Xinmiao Ye, Hongtao Cheng, Hao Wang, Jun Lyu
Background
Increasingly, patient medication adherence data are being consolidated from claims databases and electronic health records (EHRs). Such databases offer an indirect avenue to gauge medication adherence in our data-rich healthcare milieu. The surge in data accessibility, coupled with the pressing need for its conversion to actionable insights, has spotlighted data mining, with machine learning (ML) emerging as a pivotal technique. Nonadherence poses heightened health risks and escalates medical costs. This paper elucidates the synergistic interaction between medical database mining for medication adherence and the role of ML in fostering knowledge discovery.
Methods
We conducted a comprehensive review of EHR applications in the realm of medication adherence, leveraging ML techniques. We expounded on the evolution and structure of medical databases pertinent to medication adherence and harnessed both supervised and unsupervised ML paradigms to delve into adherence and its ramifications.
Results
Our study underscores the applications of medical databases and ML, encompassing both supervised and unsupervised learning, for medication adherence in clinical big data. Databases like SEER and NHANES, often underutilized due to their intricacies, have gained prominence. Employing ML to excavate patient medication logs from these databases facilitates adherence analysis. Such findings are pivotal for clinical decision-making, risk stratification, and scholarly pursuits, aiming to elevate healthcare quality.
Conclusion
Advanced data mining in the era of big data has revolutionized medication adherence research, thereby enhancing patient care. Emphasizing bespoke interventions and research could herald transformative shifts in therapeutic modalities.
{"title":"Exploring patient medication adherence and data mining methods in clinical big data: A contemporary review","authors":"Yixian Xu, Xinkai Zheng, Yuanjie Li, Xinmiao Ye, Hongtao Cheng, Hao Wang, Jun Lyu","doi":"10.1111/jebm.12548","DOIUrl":"10.1111/jebm.12548","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Increasingly, patient medication adherence data are being consolidated from claims databases and electronic health records (EHRs). Such databases offer an indirect avenue to gauge medication adherence in our data-rich healthcare milieu. The surge in data accessibility, coupled with the pressing need for its conversion to actionable insights, has spotlighted data mining, with machine learning (ML) emerging as a pivotal technique. Nonadherence poses heightened health risks and escalates medical costs. This paper elucidates the synergistic interaction between medical database mining for medication adherence and the role of ML in fostering knowledge discovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a comprehensive review of EHR applications in the realm of medication adherence, leveraging ML techniques. We expounded on the evolution and structure of medical databases pertinent to medication adherence and harnessed both supervised and unsupervised ML paradigms to delve into adherence and its ramifications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study underscores the applications of medical databases and ML, encompassing both supervised and unsupervised learning, for medication adherence in clinical big data. Databases like SEER and NHANES, often underutilized due to their intricacies, have gained prominence. Employing ML to excavate patient medication logs from these databases facilitates adherence analysis. Such findings are pivotal for clinical decision-making, risk stratification, and scholarly pursuits, aiming to elevate healthcare quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Advanced data mining in the era of big data has revolutionized medication adherence research, thereby enhancing patient care. Emphasizing bespoke interventions and research could herald transformative shifts in therapeutic modalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10279450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
KM Saif-Ur-Rahman, Md Shariful Islam, Joan Alaboson, Oluwadara Ola, Imran Hasan, Nazmul Islam, Shristi Mainali, Tina Martina, Eva Silenga, Mubita Muyangana, Taufique Joarder
Aim
Technology including artificial intelligence (AI) may play a key role to strengthen primary health care services in resource-poor settings. This systematic review aims to explore the evidence on the use of AI and digital health in improving primary health care service delivery.
Methods
Three electronic databases were searched using a comprehensive search strategy without providing any restriction in June 2023. Retrieved articles were screened independently using the “Rayyan” software. Data extraction and quality assessment were conducted independently by two review authors. A narrative synthesis of the included interventions was conducted.
Results
A total of 4596 articles were screened, and finally, 48 articles were included from 21 different countries published between 2013 and 2021. The main focus of the included studies was noncommunicable diseases (n = 15), maternal and child health care (n = 11), primary care (n = 8), infectious diseases including tuberculosis, leprosy, and HIV (n = 7), and mental health (n = 6). Included studies considered interventions using AI, and digital health of which mobile-phone-based interventions were prominent. m-health interventions were well adopted and easy to use and improved the record-keeping, service deliver, and patient satisfaction.
Conclusion
AI and the application of digital technologies improve primary health care service delivery in resource-poor settings in various ways. However, in most of the cases, the application of AI and digital health is implemented through m-health. There is a great scope to conduct further research exploring the interventions on a large scale.
{"title":"Artificial intelligence and digital health in improving primary health care service delivery in LMICs: A systematic review","authors":"KM Saif-Ur-Rahman, Md Shariful Islam, Joan Alaboson, Oluwadara Ola, Imran Hasan, Nazmul Islam, Shristi Mainali, Tina Martina, Eva Silenga, Mubita Muyangana, Taufique Joarder","doi":"10.1111/jebm.12547","DOIUrl":"10.1111/jebm.12547","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Technology including artificial intelligence (AI) may play a key role to strengthen primary health care services in resource-poor settings. This systematic review aims to explore the evidence on the use of AI and digital health in improving primary health care service delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three electronic databases were searched using a comprehensive search strategy without providing any restriction in June 2023. Retrieved articles were screened independently using the “Rayyan” software. Data extraction and quality assessment were conducted independently by two review authors. A narrative synthesis of the included interventions was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4596 articles were screened, and finally, 48 articles were included from 21 different countries published between 2013 and 2021. The main focus of the included studies was noncommunicable diseases (<i>n</i> = 15), maternal and child health care (<i>n</i> = 11), primary care (<i>n</i> = 8), infectious diseases including tuberculosis, leprosy, and HIV (<i>n</i> = 7), and mental health (<i>n</i> = 6). Included studies considered interventions using AI, and digital health of which mobile-phone-based interventions were prominent. m-health interventions were well adopted and easy to use and improved the record-keeping, service deliver, and patient satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AI and the application of digital technologies improve primary health care service delivery in resource-poor settings in various ways. However, in most of the cases, the application of AI and digital health is implemented through m-health. There is a great scope to conduct further research exploring the interventions on a large scale.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12547","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10554313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cochrane review abstracts are getting longer, but this has no large impact on the reporting quality","authors":"Jasmin Helbach, Kathrin Wandscher, Dawid Pieper, Falk Hoffmann","doi":"10.1111/jebm.12545","DOIUrl":"10.1111/jebm.12545","url":null,"abstract":"To evaluate the reporting of abstracts of Cochrane Reviews according to PRISMA‐A and to investigate a possible association with the abstract´s length.","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12545","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10172967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yi Huang, Jing Zhao, Xintian Hua, Keren Luo, Yuan Shi, Zhenlang Lin, Jun Tang, Zhichun Feng, Dezhi Mu, Evidence-Based Medicine Group, Neonatologist Society, Chinese Medical Doctor Association
High-flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to setup, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The guidelines were formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence-based medicine experts. We have proposed 24 recommendations for 9 key questions. The guidelines aim to be a source of evidence and reference of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC.
{"title":"Guidelines for high-flow nasal cannula oxygen therapy in neonates (2022)","authors":"Yi Huang, Jing Zhao, Xintian Hua, Keren Luo, Yuan Shi, Zhenlang Lin, Jun Tang, Zhichun Feng, Dezhi Mu, Evidence-Based Medicine Group, Neonatologist Society, Chinese Medical Doctor Association","doi":"10.1111/jebm.12546","DOIUrl":"10.1111/jebm.12546","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>High-flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to setup, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The guidelines were formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence-based medicine experts. We have proposed 24 recommendations for 9 key questions. The guidelines aim to be a source of evidence and reference of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10167986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shiyu Li, Ji Lin, Lijuan Ye, Fu Qiao, Wenzhi Huang, Yalan Peng, Jin Huang
Objective
To assess the incidence and risk factors of surgical site infection after open pulmonary lobectomy and to quantify their clinical and economic burden.
Methods
A prospective nested case-control study was performed on patients with lung cancer who underwent open lobectomy in the lung cancer center of West China Hospital from January 2017 to December 2019. Demographic, clinical data and medical costs were recorded. Logistic regression was used to evaluate risk factors associated with surgical site infection. A Mann-Whitney U test was carried out to evaluate the differences in medical costs.
Results
A total of 1395 patients were eligible, and the surgical site infection incidence was 13.47% (188/1395). Of the 188 instances of surgical site infection, 171 (90.96%) were classified as organ/space infection, 8 (4.25%) as superficial incisional infection and 9 (4.79%) as deep incisional infection. The patients with surgical site infection had significantly higher mortality (3.19% vs. 0.41%, p < 0.001), higher median medical cost (90774.95 yuan vs. 63079.38 yuan, p < 0.001), and longer postoperative length of stay (15 days vs. 9 days, p < 0.001). Multivariate logistic regression analysis indicated that age (odds ratio (OR) = 1.560, p = 0.007), respiratory failure (OR = 5.984, p = 0.0012), American Society of Anesthesiologists score (OR = 1.584, p = 0.005), operating time (OR = 1.950, p < 0.001), and operation team (OR = 1.864, p < 0.001) were independent risk factors for surgical site infection.
Conclusions
The high incidence of surgical site infection indicates that postoperative infections remain a significant clinical burden in patients who underwent open lobectomy. Identifying risk factors timely through prospective surveillance may assist clinical decisions against surgical site infection.
{"title":"Surgical site infection following open lobectomy in patients with lung cancer: A prospective study","authors":"Shiyu Li, Ji Lin, Lijuan Ye, Fu Qiao, Wenzhi Huang, Yalan Peng, Jin Huang","doi":"10.1111/jebm.12544","DOIUrl":"10.1111/jebm.12544","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the incidence and risk factors of surgical site infection after open pulmonary lobectomy and to quantify their clinical and economic burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective nested case-control study was performed on patients with lung cancer who underwent open lobectomy in the lung cancer center of West China Hospital from January 2017 to December 2019. Demographic, clinical data and medical costs were recorded. Logistic regression was used to evaluate risk factors associated with surgical site infection. A Mann-Whitney U test was carried out to evaluate the differences in medical costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1395 patients were eligible, and the surgical site infection incidence was 13.47% (188/1395). Of the 188 instances of surgical site infection, 171 (90.96%) were classified as organ/space infection, 8 (4.25%) as superficial incisional infection and 9 (4.79%) as deep incisional infection. The patients with surgical site infection had significantly higher mortality (3.19% vs. 0.41%, <i>p</i> < 0.001), higher median medical cost (90774.95 yuan vs. 63079.38 yuan, <i>p</i> < 0.001), and longer postoperative length of stay (15 days vs. 9 days, <i>p</i> < 0.001). Multivariate logistic regression analysis indicated that age (odds ratio (OR) = 1.560, <i>p</i> = 0.007), respiratory failure (OR = 5.984, <i>p</i> = 0.0012), American Society of Anesthesiologists score (OR = 1.584, <i>p</i> = 0.005), operating time (OR = 1.950, <i>p</i> < 0.001), and operation team (OR = 1.864, <i>p</i> < 0.001) were independent risk factors for surgical site infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The high incidence of surgical site infection indicates that postoperative infections remain a significant clinical burden in patients who underwent open lobectomy. Identifying risk factors timely through prospective surveillance may assist clinical decisions against surgical site infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9800537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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