首页 > 最新文献

Journal of Medical Internet Research最新文献

英文 中文
Definitions and Characteristics of Patient Digital Twins Being Developed for Clinical Use: Scoping Review. 正在开发用于临床的患者数字双胞胎的定义和特征：范围审查。
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-13 DOI: 10.2196/58504
David Drummond, Apolline Gonsard
<p><strong>Background: </strong>The concept of digital twins, widely adopted in industry, is entering health care. However, there is a lack of consensus on what constitutes the digital twin of a patient.</p><p><strong>Objective: </strong>The objective of this scoping review was to analyze definitions and characteristics of patient digital twins being developed for clinical use, as reported in the scientific literature.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, Embase, IEEE, and Google Scholar for studies claiming digital twin development or evaluation until August 2023. Data on definitions, characteristics, and development phase were extracted. Unsupervised classification of claimed digital twins was performed.</p><p><strong>Results: </strong>We identified 86 papers representing 80 unique claimed digital twins, with 98% (78/80) in preclinical phases. Among the 55 papers defining "digital twin," 76% (42/55) described a digital replica, 42% (23/55) mentioned real-time updates, 24% (13/55) emphasized patient specificity, and 15% (8/55) included 2-way communication. Among claimed digital twins, 60% (48/80) represented specific organs (primarily heart: 15/48, 31%; bones or joints: 10/48, 21%; lung: 6/48, 12%; and arteries: 5/48, 10%); 14% (11/80) embodied biological systems such as the immune system; and 26% (21/80) corresponded to other products (prediction models, etc). The patient data used to develop and run the claimed digital twins encompassed medical imaging examinations (35/80, 44% of publications), clinical notes (15/80, 19% of publications), laboratory test results (13/80, 16% of publications), wearable device data (12/80, 15% of publications), and other modalities (32/80, 40% of publications). Regarding data flow between patients and their virtual counterparts, 16% (13/80) claimed that digital twins involved no flow from patient to digital twin, 73% (58/80) used 1-way flow from patient to digital twin, and 11% (9/80) enabled 2-way data flow between patient and digital twin. Based on these characteristics, unsupervised classification revealed 3 clusters: simulation patient digital twins in 54% (43/80) of publications, monitoring patient digital twins in 28% (22/80) of publications, and research-oriented models unlinked to specific patients in 19% (15/80) of publications. Simulation patient digital twins used computational modeling for personalized predictions and therapy evaluations, mostly for one-time assessments, and monitoring digital twins harnessed aggregated patient data for continuous risk or outcome forecasting and care optimization.</p><p><strong>Conclusions: </strong>We propose defining a patient digital twin as "a viewable digital replica of a patient, organ, or biological system that contains multidimensional, patient-specific information and informs decisions" and to distinguish simulation and monitoring digital twins. These proposed definitions and subtypes offer a framework to guide research into realizing t
背景：数字孪生（digital twins）的概念在工业领域被广泛采用，目前正进入医疗保健领域。然而，对于什么是病人的数字孪生，目前还缺乏共识：本范围综述旨在分析科学文献中报道的、正在开发用于临床的患者数字孪生的定义和特征：我们检索了 PubMed、Scopus、Embase、IEEE 和 Google Scholar 中截至 2023 年 8 月声称进行数字孪生开发或评估的研究。我们提取了有关定义、特征和开发阶段的数据。对声称的数字孪生进行了无监督分类：我们发现了 86 篇论文，代表了 80 个独特的数字孪生项目，其中 98% （78/80）处于临床前阶段。在55篇定义了 "数字孪生 "的论文中，76%（42/55）描述了数字复制品，42%（23/55）提到了实时更新，24%（13/55）强调了患者特异性，15%（8/55）包括了双向交流。在声称的数字孪生中，60%（48/80）代表了特定器官（主要是心脏：15/48，31%；骨骼或关节：10/48，21%；肺部：10/48，21%）：10/48，占 21%；肺：6/48，占 12%；动脉：5/48，占 10%）；14/48，占 21%；5/48，占 10%：5/48，10%）；14%（11/80）体现了免疫系统等生物系统；26%（21/80）对应其他产品（预测模型等）。用于开发和运行所声称的数字双胞胎的患者数据包括医学影像检查（35/80，占出版物的 44%）、临床笔记（15/80，占出版物的 19%）、实验室检测结果（13/80，占出版物的 16%）、可穿戴设备数据（12/80，占出版物的 15%）以及其他模式（32/80，占出版物的 40%）。关于患者与其虚拟对应物之间的数据流，16%（13/80）的研究称数字孪生不涉及从患者到数字孪生的数据流，73%（58/80）的研究使用了从患者到数字孪生的单向数据流，11%（9/80）的研究启用了患者与数字孪生之间的双向数据流。根据这些特征，无监督分类显示出三个群组：54%（43/80）的出版物使用模拟患者数字孪生，28%（22/80）的出版物使用监测患者数字孪生，19%（15/80）的出版物使用与特定患者无关的研究导向型模型。模拟患者数字孪生利用计算建模进行个性化预测和治疗评估，主要用于一次性评估；监测患者数字孪生则利用汇总的患者数据进行持续的风险或结果预测和护理优化：我们建议将患者数字孪生定义为 "患者、器官或生物系统的可视化数字复制品，其中包含多维度的患者特定信息并为决策提供依据"，并区分模拟数字孪生和监测数字孪生。这些拟议的定义和子类提供了一个指导研究的框架，以实现这些个性化综合技术在推进临床护理方面的潜力。
{"title":"Definitions and Characteristics of Patient Digital Twins Being Developed for Clinical Use: Scoping Review.","authors":"David Drummond, Apolline Gonsard","doi":"10.2196/58504","DOIUrl":"https://doi.org/10.2196/58504","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The concept of digital twins, widely adopted in industry, is entering health care. However, there is a lack of consensus on what constitutes the digital twin of a patient.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this scoping review was to analyze definitions and characteristics of patient digital twins being developed for clinical use, as reported in the scientific literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched PubMed, Scopus, Embase, IEEE, and Google Scholar for studies claiming digital twin development or evaluation until August 2023. Data on definitions, characteristics, and development phase were extracted. Unsupervised classification of claimed digital twins was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 86 papers representing 80 unique claimed digital twins, with 98% (78/80) in preclinical phases. Among the 55 papers defining \"digital twin,\" 76% (42/55) described a digital replica, 42% (23/55) mentioned real-time updates, 24% (13/55) emphasized patient specificity, and 15% (8/55) included 2-way communication. Among claimed digital twins, 60% (48/80) represented specific organs (primarily heart: 15/48, 31%; bones or joints: 10/48, 21%; lung: 6/48, 12%; and arteries: 5/48, 10%); 14% (11/80) embodied biological systems such as the immune system; and 26% (21/80) corresponded to other products (prediction models, etc). The patient data used to develop and run the claimed digital twins encompassed medical imaging examinations (35/80, 44% of publications), clinical notes (15/80, 19% of publications), laboratory test results (13/80, 16% of publications), wearable device data (12/80, 15% of publications), and other modalities (32/80, 40% of publications). Regarding data flow between patients and their virtual counterparts, 16% (13/80) claimed that digital twins involved no flow from patient to digital twin, 73% (58/80) used 1-way flow from patient to digital twin, and 11% (9/80) enabled 2-way data flow between patient and digital twin. Based on these characteristics, unsupervised classification revealed 3 clusters: simulation patient digital twins in 54% (43/80) of publications, monitoring patient digital twins in 28% (22/80) of publications, and research-oriented models unlinked to specific patients in 19% (15/80) of publications. Simulation patient digital twins used computational modeling for personalized predictions and therapy evaluations, mostly for one-time assessments, and monitoring digital twins harnessed aggregated patient data for continuous risk or outcome forecasting and care optimization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We propose defining a patient digital twin as \"a viewable digital replica of a patient, organ, or biological system that contains multidimensional, patient-specific information and informs decisions\" and to distinguish simulation and monitoring digital twins. These proposed definitions and subtypes offer a framework to guide research into realizing t","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e58504"},"PeriodicalIF":5.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621678","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}
引用次数: 0
Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England. 不同社会人口群体使用患者门户网站的差异：对英格兰国家医疗服务系统应用程序的观察研究。
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-13 DOI: 10.2196/56320
Sukriti Kc, Chrysanthi Papoutsi, Claire Reidy, Bernard Gudgin, John Powell, Azeem Majeed, Felix Greaves, Anthony A Laverty
<p><strong>Background: </strong>The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population.</p><p><strong>Objective: </strong>This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories.</p><p><strong>Methods: </strong>We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices).</p><p><strong>Results: </strong>We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=-34%, log-ins=-34.9%, appointments booked=-39.7%, medical record views=-32.3%, and prescriptions ordered=-9.9%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=-7.1%, log-in=-10.4%, and appointments booked=-36.4%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2%, log-ins=11.7%, appointments booked=73.4%, medical record views=23.9%, and prescriptions ordered=20.7%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9%, log-ins=9.1%, appointments booked=14.1%, medical record views=28.7%, and prescriptions ordered=130.4%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=-3.6%, appointments booked=-20%, and medical record views=6%; P≤.001).</p><p><strong>Conclusions: </strong>This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived a
背景：采用患者门户网站（如英国国家医疗服务系统（NHS）的应用程序）可提高患者对医疗服务的参与度。然而，对于不同社会人口群体在接受和使用患者门户网站各种功能方面存在的差异仍存在担忧，而这一问题尚未得到充分探讨。了解不同人群对各种功能的使用情况对于确保任何益处在人群中的平等分配至关重要：本研究旨在探讨不同年龄、性别、贫困程度、种族、长期医疗保健需求和全科医生（GP）规模类别的人群在使用 NHS App 功能方面的差异：我们使用了2020年3月至2022年6月期间英国6386名全科医生每周使用NHS应用程序的数据。负二项回归模型探讨了每周使用 NHS App 功能（注册、登录、订购处方、查看病历和预约）的比率变化。结果以每 1000 名全科医生注册患者的周使用率来衡量，我们针对每种结果分别建立了模型。回归模型包括了上述所有协变量，并得出了事件发生率比，为便于解释，我们在此将其表述为相对百分比。全科医生层面的社会人口变量协变量数据被用作分类变量，贫困程度分为 5 组（Q1=最贫困诊所，Q5=最贫困诊所），所有其他变量分为 4 组（Q1=最贫困诊所，Q4=最贫困诊所）：我们发现，不同特征的使用在总体上存在差异，在不同社会人口类别中也存在差异。经充分调整的回归模型发现，在较贫困的医疗机构中，功能的总体使用率较低（例如，Q5 vs Q1：注册=-34%，登录=-34.9%，预约=-39.7%，查看病历=-32.3%，订购处方=-9.9%；PC结论：本研究强调了医疗信息门户网站的使用率：本研究强调，不同社会人口群体对国民保健服务应用程序功能的使用各不相同。尤其是生活在贫困地区的人使用较少。需要采取有针对性的干预措施并为患者提供支持，以确保国民保健服务应用程序带来的任何益处都能平等地惠及全民。
{"title":"Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England.","authors":"Sukriti Kc, Chrysanthi Papoutsi, Claire Reidy, Bernard Gudgin, John Powell, Azeem Majeed, Felix Greaves, Anthony A Laverty","doi":"10.2196/56320","DOIUrl":"https://doi.org/10.2196/56320","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=-34%, log-ins=-34.9%, appointments booked=-39.7%, medical record views=-32.3%, and prescriptions ordered=-9.9%; P&lt;.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=-7.1%, log-in=-10.4%, and appointments booked=-36.4%; P&lt;.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2%, log-ins=11.7%, appointments booked=73.4%, medical record views=23.9%, and prescriptions ordered=20.7%; P&lt;.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9%, log-ins=9.1%, appointments booked=14.1%, medical record views=28.7%, and prescriptions ordered=130.4%; P&lt;.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=-3.6%, appointments booked=-20%, and medical record views=6%; P≤.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived a","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e56320"},"PeriodicalIF":5.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621706","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}
引用次数: 0
Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study. 从临床医生和工作场所脑震荡患者的角度看远程脑震荡体能评估的障碍和促进因素：焦点小组研究。
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-13 DOI: 10.2196/56158
Keely Barnes, Heidi Sveistrup, Motahareh Karimijashni, Mark Bayley, Mary Egan, Martin Bilodeau, Michel Rathbone, Monica Taljaard, Shawn Marshall
<p><strong>Background: </strong>Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment.</p><p><strong>Objective: </strong>This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort.</p><p><strong>Methods: </strong>Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants' experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts.</p><p><strong>Results: </strong>A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8%) and 9/201 (4%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10%) of the time for patient participants); communication (mentioned 34/162 (21%) and 9/201 (4%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7%) of the time for patient and 15/201 (7%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27%) and 21/151 (14%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7%) of the time for patient participants); and having access to resources (mentioned 25/151 (17%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their res
背景：利用虚拟平台评估脑震荡的临床状态已变得越来越普遍。虽然虚拟治疗方法很有用，但有关虚拟脑震荡评估的障碍和促进因素的信息却很有限：本研究旨在从工作场所脑震荡患者的角度出发，确定与参与虚拟脑震荡评估相关的障碍和促进因素；从临床医生的角度出发，确定完成虚拟脑震荡评估的障碍和促进因素；确定最适合虚拟实践的 4 个临床领域的相关临床措施：一般神经系统检查和前庭、眼球运动和颈椎评估。我们还评估了所做的努力：我们分别与脑震荡临床专家和工作场所脑震荡患者进行了在线焦点小组讨论。主持人使用半结构化访谈指南领导焦点小组，讨论参与者在虚拟评估方面的经验。讨论由两名评审员使用内容分析法进行记录、转录和分析。与完成物理脑震荡检查相关的障碍和促进因素根据脑震荡检查的领域以及更普遍的障碍和促进因素进行了分类。临床医生选择的、被认为在虚拟实践中最有效的措施采用频率计数法进行描述：使用 Microsoft Teams 完成了由 15 名工作场所脑震荡患者参加的 4 个焦点小组和由 14 名临床医生参加的 3 个焦点小组。发现了一些障碍，如通过视频完成评估会引发相关症状（患者和临床医生参与者分别有 13/162 次（8%）和 9/201 次（4%）提及）；地点和设置方面的挑战（患者参与者有 16/162 次（10%）提及）；沟通（患者和临床医生参与者分别有 34/162 次（21%）和 9/201 次（4%）提及）；以及安全问题（患者参与者有 11/162 次（7%）和临床医生参与者有 15/201 次（7%）提及）。在患者和临床医生参与者的角度来看，有一些促进因素，如获得支持（分别占 42/154 次（27%）和 21/151 次（14%））；在整个评估过程中实施症状管理策略（占患者参与者 11/154 次（7%））；以及获得资源（占临床医生参与者 25/151 次（17%））。从参与本研究的临床医生的角度来看，最推荐用于虚拟实践的临床测量方法是指鼻测试、平衡测试、前庭/眼球运动筛查工具、眼球运动和颈椎活动范围，它们分别属于各自的领域（即神经系统检查、前庭、眼球运动和颈椎评估）：虚拟评估似乎对工作场所脑震荡患者和临床医生都很有用。虽然发现了一些障碍，如与接触屏幕有关的挑战，但虚拟评估也有好处，如改善了获得护理的途径。在即将开展的一项评估研究中，将对临床医生选择的被认为是虚拟实践中最佳的措施进行调查：RR2-10.2196/40446。
{"title":"Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study.","authors":"Keely Barnes, Heidi Sveistrup, Motahareh Karimijashni, Mark Bayley, Mary Egan, Martin Bilodeau, Michel Rathbone, Monica Taljaard, Shawn Marshall","doi":"10.2196/56158","DOIUrl":"https://doi.org/10.2196/56158","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants' experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8%) and 9/201 (4%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10%) of the time for patient participants); communication (mentioned 34/162 (21%) and 9/201 (4%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7%) of the time for patient and 15/201 (7%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27%) and 21/151 (14%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7%) of the time for patient participants); and having access to resources (mentioned 25/151 (17%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their res","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e56158"},"PeriodicalIF":5.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620599","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}
引用次数: 0
Comprehensive Symptom Prediction in Inpatients With Acute Psychiatric Disorders Using Wearable-Based Deep Learning Models: Development and Validation Study. 利用可穿戴式深度学习模型对急性精神障碍住院患者进行综合症状预测：开发与验证研究。
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-13 DOI: 10.2196/65994
Minseok Hong, Ri-Ra Kang, Jeong Hun Yang, Sang Jin Rhee, Hyunju Lee, Yong-Gyom Kim, KangYoon Lee, HongGi Kim, Yu Sang Lee, Tak Youn, Se Hyun Kim, Yong Min Ahn
<p><strong>Background: </strong>Assessing the complex and multifaceted symptoms of patients with acute psychiatric disorders proves to be significantly challenging for clinicians. Moreover, the staff in acute psychiatric wards face high work intensity and risk of burnout, yet research on the introduction of digital technologies in this field remains limited. The combination of continuous and objective wearable sensor data acquired from patients with deep learning techniques holds the potential to overcome the limitations of traditional psychiatric assessments and support clinical decision-making.</p><p><strong>Objective: </strong>This study aimed to develop and validate wearable-based deep learning models to comprehensively predict patient symptoms across various acute psychiatric wards in South Korea.</p><p><strong>Methods: </strong>Participants diagnosed with schizophrenia and mood disorders were recruited from 4 wards across 3 hospitals and prospectively observed using wrist-worn wearable devices during their admission period. Trained raters conducted periodic clinical assessments using the Brief Psychiatric Rating Scale, Hamilton Anxiety Rating Scale, Montgomery-Asberg Depression Rating Scale, and Young Mania Rating Scale. Wearable devices collected patients' heart rate, accelerometer, and location data. Deep learning models were developed to predict psychiatric symptoms using 2 distinct approaches: single symptoms individually (Single) and multiple symptoms simultaneously via multitask learning (Multi). These models further addressed 2 problems: within-subject relative changes (Deterioration) and between-subject absolute severity (Score). Four configurations were consequently developed for each scale: Single-Deterioration, Single-Score, Multi-Deterioration, and Multi-Score. Data of participants recruited before May 1, 2024, underwent cross-validation, and the resulting fine-tuned models were then externally validated using data from the remaining participants.</p><p><strong>Results: </strong>Of the 244 enrolled participants, 191 (78.3%; 3954 person-days) were included in the final analysis after applying the exclusion criteria. The demographic and clinical characteristics of participants, as well as the distribution of sensor data, showed considerable variations across wards and hospitals. Data of 139 participants were used for cross-validation, while data of 52 participants were used for external validation. The Single-Deterioration and Multi-Deterioration models achieved similar overall accuracy values of 0.75 in cross-validation and 0.73 in external validation. The Single-Score and Multi-Score models attained overall R² values of 0.78 and 0.83 in cross-validation and 0.66 and 0.74 in external validation, respectively, with the Multi-Score model demonstrating superior performance.</p><p><strong>Conclusions: </strong>Deep learning models based on wearable sensor data effectively classified symptom deterioration and predicted symptom severit
背景：对临床医生而言，评估急性精神障碍患者复杂而多方面的症状具有极大的挑战性。此外，急性精神病病房的工作人员面临着高强度的工作和职业倦怠的风险，但在这一领域引入数字技术的研究仍然有限。从患者身上获取的连续、客观的可穿戴传感器数据与深度学习技术相结合，有望克服传统精神病评估的局限性，为临床决策提供支持：本研究旨在开发和验证基于可穿戴设备的深度学习模型，以全面预测韩国各种急性精神病病房的患者症状：从 3 家医院的 4 个病房招募被诊断为精神分裂症和情绪障碍的参与者，并在他们入院期间使用腕戴式可穿戴设备进行前瞻性观察。训练有素的评定员使用简明精神病评定量表、汉密尔顿焦虑评定量表、蒙哥马利-阿斯伯格抑郁评定量表和青年躁狂评定量表进行定期临床评估。可穿戴设备收集患者的心率、加速计和位置数据。我们开发了深度学习模型，使用两种不同的方法预测精神症状：单独预测单一症状（Single）和通过多任务学习同时预测多个症状（Multi）。这些模型进一步解决了两个问题：主体内相对变化（恶化）和主体间绝对严重程度（得分）。因此，我们为每个量表开发了四种配置：单项恶化量表、单项得分量表、多项恶化量表和多项得分量表。对 2024 年 5 月 1 日之前招募的参与者的数据进行了交叉验证，然后使用其余参与者的数据对微调模型进行了外部验证：结果：在 244 名注册参与者中，191 人（78.3%；3954 人天）在应用排除标准后被纳入最终分析。参与者的人口统计学和临床特征以及传感器数据的分布在不同病房和医院之间存在很大差异。139 名参与者的数据用于交叉验证，52 名参与者的数据用于外部验证。在交叉验证和外部验证中，单一劣化和多重劣化模型的总体准确率分别为 0.75 和 0.73。单评分模型和多评分模型在交叉验证中的总体 R² 值分别为 0.78 和 0.83，在外部验证中分别为 0.66 和 0.74，其中多评分模型表现更优：结论：基于可穿戴传感器数据的深度学习模型能有效地对急性精神病病房参与者的症状恶化进行分类并预测症状严重程度。尽管计算成本较低，但多重模型表现出与单一模型相当或更优的性能，这表明多任务学习是一种很有前途的综合症状预测方法。然而，在不同病房中观察到的差异很大，这对开发急性精神病病房的临床决策支持系统提出了严峻的挑战。未来的研究可能会受益于反复进行的局部验证或联合学习，以解决普遍性问题。
{"title":"Comprehensive Symptom Prediction in Inpatients With Acute Psychiatric Disorders Using Wearable-Based Deep Learning Models: Development and Validation Study.","authors":"Minseok Hong, Ri-Ra Kang, Jeong Hun Yang, Sang Jin Rhee, Hyunju Lee, Yong-Gyom Kim, KangYoon Lee, HongGi Kim, Yu Sang Lee, Tak Youn, Se Hyun Kim, Yong Min Ahn","doi":"10.2196/65994","DOIUrl":"https://doi.org/10.2196/65994","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Assessing the complex and multifaceted symptoms of patients with acute psychiatric disorders proves to be significantly challenging for clinicians. Moreover, the staff in acute psychiatric wards face high work intensity and risk of burnout, yet research on the introduction of digital technologies in this field remains limited. The combination of continuous and objective wearable sensor data acquired from patients with deep learning techniques holds the potential to overcome the limitations of traditional psychiatric assessments and support clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to develop and validate wearable-based deep learning models to comprehensively predict patient symptoms across various acute psychiatric wards in South Korea.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants diagnosed with schizophrenia and mood disorders were recruited from 4 wards across 3 hospitals and prospectively observed using wrist-worn wearable devices during their admission period. Trained raters conducted periodic clinical assessments using the Brief Psychiatric Rating Scale, Hamilton Anxiety Rating Scale, Montgomery-Asberg Depression Rating Scale, and Young Mania Rating Scale. Wearable devices collected patients' heart rate, accelerometer, and location data. Deep learning models were developed to predict psychiatric symptoms using 2 distinct approaches: single symptoms individually (Single) and multiple symptoms simultaneously via multitask learning (Multi). These models further addressed 2 problems: within-subject relative changes (Deterioration) and between-subject absolute severity (Score). Four configurations were consequently developed for each scale: Single-Deterioration, Single-Score, Multi-Deterioration, and Multi-Score. Data of participants recruited before May 1, 2024, underwent cross-validation, and the resulting fine-tuned models were then externally validated using data from the remaining participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 244 enrolled participants, 191 (78.3%; 3954 person-days) were included in the final analysis after applying the exclusion criteria. The demographic and clinical characteristics of participants, as well as the distribution of sensor data, showed considerable variations across wards and hospitals. Data of 139 participants were used for cross-validation, while data of 52 participants were used for external validation. The Single-Deterioration and Multi-Deterioration models achieved similar overall accuracy values of 0.75 in cross-validation and 0.73 in external validation. The Single-Score and Multi-Score models attained overall R² values of 0.78 and 0.83 in cross-validation and 0.66 and 0.74 in external validation, respectively, with the Multi-Score model demonstrating superior performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Deep learning models based on wearable sensor data effectively classified symptom deterioration and predicted symptom severit","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e65994"},"PeriodicalIF":5.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621287","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}
引用次数: 0
Clarifying the Concepts of Personalization and Tailoring of eHealth Technologies: Multimethod Qualitative Study. 厘清电子医疗技术的个性化和定制化概念：多方法定性研究
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-13 DOI: 10.2196/50497
Iris Ten Klooster, Hanneke Kip, Sina L Beyer, Lisette J E W C van Gemert-Pijnen, Saskia M Kelders
<p><strong>Background: </strong>Although personalization and tailoring have been identified as alternatives to a "one-size-fits-all" approach for eHealth technologies, there is no common understanding of these two concepts and how they should be applied.</p><p><strong>Objective: </strong>This study aims to describe (1) how tailoring and personalization are defined in the literature and by eHealth experts, and what the differences and similarities are; (2) what type of variables can be used to segment eHealth users into more homogeneous groups or at the individual level; (3) what elements of eHealth technologies are adapted to these segments; and (4) how the segments are matched with eHealth adaptations.</p><p><strong>Methods: </strong>We used a multimethod qualitative study design. To gain insights into the definitions of personalization and tailoring, definitions were collected from the literature and through interviews with eHealth experts. In addition, the interviews included questions about how users can be segmented and how eHealth can be adapted accordingly, and responses to 3 vignettes of examples of eHealth technologies, varying in personalization and tailoring strategies to elicit responses about views from stakeholders on how the two components were applied and matched in different contexts.</p><p><strong>Results: </strong>A total of 28 unique definitions of tailoring and 16 unique definitions of personalization were collected from the literature and interviews. The definitions of tailoring and personalization varied in their components, namely adaptation, individuals, user groups, preferences, symptoms, characteristics, context, behavior, content, identification, feedback, channel, design, computerization, and outcomes. During the interviews, participants mentioned 9 types of variables that can be used to segment eHealth users, namely demographics, preferences, health variables, psychological variables, behavioral variables, individual determinants, environmental information, intervention interaction, and technology variables. In total, 5 elements were mentioned that can be adapted to those segments, namely channeling, content, graphical, functionalities, and behavior change strategy. Participants mentioned substantiation methods and variable levels as two components for matching the segmentations with adaptations.</p><p><strong>Conclusions: </strong>Tailoring and personalization are multidimensional concepts, and variability and technology affordances seem to determine whether and how personalization and tailoring should be applied to eHealth technologies. On the basis of our findings, tailoring and personalization can be differentiated by the way that segmentations and adaptations are matched. Tailoring matches segmentations and adaptations based on general group characteristics using if-then algorithms, whereas personalization involves the direct insertion of user information (such as name) or adaptations based on individual-level i
背景：尽管个性化和量身定制已被认为是电子健康技术 "一刀切 "方法的替代方案，但人们对这两个概念以及如何应用这两个概念还没有达成共识：本研究旨在描述：(1) 文献和电子健康专家如何定义量身定制和个性化，两者有何异同；(2) 可使用哪类变量将电子健康用户划分为更同质的群体或个人；(3) 电子健康技术的哪些要素适用于这些细分群体；(4) 如何将细分群体与电子健康适应性相匹配：我们采用了多方法定性研究设计。为了深入了解个性化和量身定制的定义，我们从文献中收集了相关定义，并对电子健康专家进行了访谈。此外，访谈还包括有关如何细分用户以及如何相应调整电子健康的问题，以及对 3 个电子健康技术案例的回答，这些案例在个性化和量身定制策略方面各不相同，以征求利益相关者对在不同情况下如何应用和匹配这两个组成部分的看法：从文献和访谈中共收集到 28 个独特的定制定义和 16 个独特的个性化定义。量身定制和个性化的定义在组成要素上各不相同，即适应、个人、用户群体、偏好、症状、特征、环境、行为、内容、识别、反馈、渠道、设计、计算机化和结果。在访谈中，参与者提到了 9 种可用于细分电子健康用户的变量，即人口统计学、偏好、健康变量、心理变量、行为变量、个人决定因素、环境信息、干预互动和技术变量。与会者总共提到了可用于这些细分的 5 个要素，即渠道、内容、图形、功能和行为改变策略。与会者提到，证实方法和变量水平是将细分市场与调整相匹配的两个组成部分：结论：量身定制和个性化是多维概念，可变性和技术承受能力似乎决定了是否以及如何将个性化和量身定制应用于电子健康技术。根据我们的研究结果，定制和个性化可以通过细分和适应的匹配方式加以区分。量身定制使用 "如果-那么 "算法根据一般群体特征匹配细分和适应性，而个性化则涉及直接插入用户信息（如姓名）或根据个人推断进行适应性调整。我们认为，未来的研究应侧重于如何在个人层面进行推断，以进一步发展个性化电子健康领域。
{"title":"Clarifying the Concepts of Personalization and Tailoring of eHealth Technologies: Multimethod Qualitative Study.","authors":"Iris Ten Klooster, Hanneke Kip, Sina L Beyer, Lisette J E W C van Gemert-Pijnen, Saskia M Kelders","doi":"10.2196/50497","DOIUrl":"https://doi.org/10.2196/50497","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although personalization and tailoring have been identified as alternatives to a \"one-size-fits-all\" approach for eHealth technologies, there is no common understanding of these two concepts and how they should be applied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to describe (1) how tailoring and personalization are defined in the literature and by eHealth experts, and what the differences and similarities are; (2) what type of variables can be used to segment eHealth users into more homogeneous groups or at the individual level; (3) what elements of eHealth technologies are adapted to these segments; and (4) how the segments are matched with eHealth adaptations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used a multimethod qualitative study design. To gain insights into the definitions of personalization and tailoring, definitions were collected from the literature and through interviews with eHealth experts. In addition, the interviews included questions about how users can be segmented and how eHealth can be adapted accordingly, and responses to 3 vignettes of examples of eHealth technologies, varying in personalization and tailoring strategies to elicit responses about views from stakeholders on how the two components were applied and matched in different contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 28 unique definitions of tailoring and 16 unique definitions of personalization were collected from the literature and interviews. The definitions of tailoring and personalization varied in their components, namely adaptation, individuals, user groups, preferences, symptoms, characteristics, context, behavior, content, identification, feedback, channel, design, computerization, and outcomes. During the interviews, participants mentioned 9 types of variables that can be used to segment eHealth users, namely demographics, preferences, health variables, psychological variables, behavioral variables, individual determinants, environmental information, intervention interaction, and technology variables. In total, 5 elements were mentioned that can be adapted to those segments, namely channeling, content, graphical, functionalities, and behavior change strategy. Participants mentioned substantiation methods and variable levels as two components for matching the segmentations with adaptations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Tailoring and personalization are multidimensional concepts, and variability and technology affordances seem to determine whether and how personalization and tailoring should be applied to eHealth technologies. On the basis of our findings, tailoring and personalization can be differentiated by the way that segmentations and adaptations are matched. Tailoring matches segmentations and adaptations based on general group characteristics using if-then algorithms, whereas personalization involves the direct insertion of user information (such as name) or adaptations based on individual-level i","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e50497"},"PeriodicalIF":5.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620625","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}
引用次数: 0
An Electronic Medical Record-Based Prognostic Model for Inpatient Falls: Development and Internal-External Cross-Validation. 基于电子病历的住院病人跌倒预后模型：开发和内外部交叉验证。
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-13 DOI: 10.2196/59634
Rex Parsons, Robin Blythe, Susanna Cramb, Ahmad Abdel-Hafez, Steven McPhail

Background: Effective fall prevention interventions in hospitals require appropriate allocation of resources early in admission. To address this, fall risk prediction tools and models have been developed with the aim to provide fall prevention strategies to patients at high risk. However, fall risk assessment tools have typically been inaccurate for prediction, ineffective in prevention, and time-consuming to complete. Accurate, dynamic, individualized estimates of fall risk for admitted patients using routinely recorded data may assist in prioritizing fall prevention efforts.

Objective: The objective of this study was to develop and validate an accurate and dynamic prognostic model for inpatient falls among a cohort of patients using routinely recorded electronic medical record data.

Methods: We used routinely recorded data from 5 Australian hospitals to develop and internally-externally validate a prediction model for inpatient falls using a Cox proportional hazards model with time-varying covariates. The study cohort included patients admitted during 2018-2021 to any ward, with no age restriction. Predictors used in the model included admission-related administrative data, length of stay, and number of previous falls during the admission (updated every 12 hours up to 14 days after admission). Model calibration was assessed using Poisson regression and discrimination using the area under the time-dependent receiver operating characteristic curve.

Results: There were 1,107,556 inpatient admissions, 6004 falls, and 5341 unique fallers. The area under the time-dependent receiver operating characteristic curve was 0.899 (95% CI 0.88-0.91) at 24 hours after admission and declined throughout admission (eg, 0.765, 95% CI 0.75-0.78 on the seventh day after admission). Site-dependent overestimation and underestimation of risk was observed on the calibration plots.

Conclusions: Using a large dataset from multiple hospitals and robust methods to model development and validation, we developed a prognostic model for inpatient falls. It had high discrimination, suggesting the model has the potential for operationalization in clinical decision support for prioritizing inpatients for fall prevention. Performance was site dependent, and model recalibration may lead to improved performance.

背景：在医院进行有效的跌倒预防干预需要在入院早期就分配适当的资源。为此，人们开发了跌倒风险预测工具和模型，旨在为高风险患者提供跌倒预防策略。然而，跌倒风险评估工具的预测通常并不准确，预防效果不佳，而且填写耗时。利用常规记录的数据对入院患者的跌倒风险进行准确、动态、个性化的估计，有助于确定预防跌倒工作的优先次序：本研究的目的是利用日常记录的电子病历数据，开发并验证一个准确、动态的住院病人跌倒预后模型：我们利用澳大利亚 5 家医院的常规记录数据，采用带有时变协变量的 Cox 比例危险模型，开发了住院患者跌倒预测模型，并进行了内外部验证。研究队列包括2018-2021年间入住任何病房的患者，无年龄限制。模型中使用的预测因子包括入院相关管理数据、住院时间和入院期间的跌倒次数（入院后每 12 小时更新一次，直至 14 天）。使用泊松回归对模型校准进行评估，并使用与时间相关的接收者操作特征曲线下面积对模型的区分度进行评估：共有 1,107,556 名住院患者、6004 次跌倒和 5341 名独特的跌倒者。入院 24 小时后，随时间变化的接收者操作特征曲线下面积为 0.899（95% CI 0.88-0.91），并在整个入院过程中下降（例如，入院后第七天为 0.765，95% CI 0.75-0.78）。在校准图上观察到风险的高估和低估与地点有关：我们利用来自多家医院的大型数据集和稳健的模型开发与验证方法，建立了一个住院病人跌倒预后模型。该模型具有很高的区分度，表明该模型有可能在临床决策支持中用于优先预防住院病人跌倒。模型的性能与医院有关，重新校准模型可能会提高模型的性能。
{"title":"An Electronic Medical Record-Based Prognostic Model for Inpatient Falls: Development and Internal-External Cross-Validation.","authors":"Rex Parsons, Robin Blythe, Susanna Cramb, Ahmad Abdel-Hafez, Steven McPhail","doi":"10.2196/59634","DOIUrl":"https://doi.org/10.2196/59634","url":null,"abstract":"<p><strong>Background: </strong>Effective fall prevention interventions in hospitals require appropriate allocation of resources early in admission. To address this, fall risk prediction tools and models have been developed with the aim to provide fall prevention strategies to patients at high risk. However, fall risk assessment tools have typically been inaccurate for prediction, ineffective in prevention, and time-consuming to complete. Accurate, dynamic, individualized estimates of fall risk for admitted patients using routinely recorded data may assist in prioritizing fall prevention efforts.</p><p><strong>Objective: </strong>The objective of this study was to develop and validate an accurate and dynamic prognostic model for inpatient falls among a cohort of patients using routinely recorded electronic medical record data.</p><p><strong>Methods: </strong>We used routinely recorded data from 5 Australian hospitals to develop and internally-externally validate a prediction model for inpatient falls using a Cox proportional hazards model with time-varying covariates. The study cohort included patients admitted during 2018-2021 to any ward, with no age restriction. Predictors used in the model included admission-related administrative data, length of stay, and number of previous falls during the admission (updated every 12 hours up to 14 days after admission). Model calibration was assessed using Poisson regression and discrimination using the area under the time-dependent receiver operating characteristic curve.</p><p><strong>Results: </strong>There were 1,107,556 inpatient admissions, 6004 falls, and 5341 unique fallers. The area under the time-dependent receiver operating characteristic curve was 0.899 (95% CI 0.88-0.91) at 24 hours after admission and declined throughout admission (eg, 0.765, 95% CI 0.75-0.78 on the seventh day after admission). Site-dependent overestimation and underestimation of risk was observed on the calibration plots.</p><p><strong>Conclusions: </strong>Using a large dataset from multiple hospitals and robust methods to model development and validation, we developed a prognostic model for inpatient falls. It had high discrimination, suggesting the model has the potential for operationalization in clinical decision support for prioritizing inpatients for fall prevention. Performance was site dependent, and model recalibration may lead to improved performance.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e59634"},"PeriodicalIF":5.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620329","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}
引用次数: 0
The Effects of Virtual Reality-Based Reminiscence Therapies for Older Adults With Cognitive Impairment: Systematic Review. 基于虚拟现实的回忆疗法对认知障碍老年人的影响：系统回顾
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-12 DOI: 10.2196/53348
Qian Mao, Zhen Zhao, Lisha Yu, Yang Zhao, Hailiang Wang

Background: Reminiscence therapy (RT) is a commonly used nonpharmaceutical treatment for cognitive impairment. Artifacts or conversations are used in RT to recall individuals' memories and past experiences. Virtual reality (VR) has increasingly been used as an assistive technology during RT. However, the effects of VR-based RT (VR-RT) methods remain unclear, and insights into the related benefits and challenges are urgently needed.

Objective: The study aims to systematically review the effects of VR-RTs for older adults with cognitive impairment.

Methods: Seven databases (MEDLINE, Academic Search Premier, CINAHL, Web of Science, PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect) were searched to identify relevant articles published from inception to August 10, 2023. Peer-reviewed publications that assessed the effect of VR-RTs (ie, using virtual clues to evoke participants' memories or past experiences) on cognitive-related outcomes were included. Two independent researchers conducted the literature search, review, and data extraction processes. A narrative synthesis approach was used to analyze the extracted data.

Results: Of the 537 identified articles, 22 were ultimately included in the data analysis. The results revealed that VR-RTs could maintain cognitive status (4/4, 100%) and reduce anxiety (2/2, 100%) in older adults with cognitive impairment. Nevertheless, one study found a cognitive improvement after VR-RTs, whereas cognitive degradation was observed at a 3- to 6-month follow-up measure. Around 88% (7/8) of the included studies indicated that VR-RTs improved memory; however, the evidence regarding the beneficial effects of VR-RTs was limited in improving quality of life (1/4, 25%) and reducing apathy (0/2, 0%) and depression (1/3, 33%). The results indicated that VR-RTs are safe, engaging, acceptable, and satisfying for older adults with cognitive impairment. In VR scenarios, personalized stimulus materials related to the users' youth experiences were more effective for treating cognitive impairment than other stimulus materials.

Conclusions: The results of this systematic review demonstrate the potential benefits of VR-RT for older adults with cognitive impairment, especially in improving emotion and memory and maintaining cognitive status. VR-RT is also safe and enjoyable for older adults. However, due to the trial heterogeneity of included studies, we can only provide qualitative results instead of performing meta-analysis to quantify the effect size of VR-RTs. Thus, more randomized controlled trials are required to examine the designs and effects of VR-RTs for groups of older adults with specific needs.

背景：回忆疗法（RT）是治疗认知障碍的一种常用非药物疗法。回忆疗法中使用人工制品或对话来回忆个人的记忆和过去的经历。虚拟现实（VR）越来越多地被用作 RT 的辅助技术。然而，基于 VR 的 RT（VR-RT）方法的效果仍不明确，迫切需要深入了解相关的益处和挑战：本研究旨在系统回顾认知障碍老年人使用 VR-RT 的效果：检索了七个数据库（MEDLINE、Academic Search Premier、CINAHL、Web of Science、PubMed、Cochrane Central Register of Controlled Trials 和 ScienceDirect），以确定从开始到 2023 年 8 月 10 日发表的相关文章。经同行评议的、评估 VR-RTs （即使用虚拟线索唤起参与者的记忆或过往经历）对认知相关结果影响的出版物均被纳入检索范围。两名独立研究人员进行了文献检索、审查和数据提取过程。采用叙事综合法对提取的数据进行分析：在 537 篇已确定的文章中，有 22 篇最终纳入了数据分析。结果显示，VR-RT 可以维持认知障碍老年人的认知状态（4/4，100%）并减少焦虑（2/2，100%）。不过，有一项研究发现，VR-RT 治疗后认知能力有所改善，但在 3 至 6 个月的随访中却发现认知能力有所下降。在纳入的研究中，约有 88% （7/8）的研究表明，VR-RT 改善了记忆；然而，在改善生活质量（1/4，25%）、减少冷漠（0/2，0%）和抑郁（1/3，33%）方面，VR-RT 的有益效果证据有限。研究结果表明，VR-RT 对有认知障碍的老年人来说是安全的、有吸引力的、可接受的和令人满意的。在 VR 场景中，与用户青年时期经历相关的个性化刺激材料比其他刺激材料更能有效治疗认知障碍：本系统综述的结果表明，VR-RT 对患有认知障碍的老年人有潜在的益处，尤其是在改善情绪、记忆和维持认知状态方面。VR-RT 对老年人来说也是安全和愉快的。然而，由于纳入研究的试验存在异质性，我们只能提供定性结果，而不能进行荟萃分析来量化 VR-RT 的效应大小。因此，需要更多的随机对照试验来研究针对有特殊需求的老年人群体的 VR-RT 的设计和效果。
{"title":"The Effects of Virtual Reality-Based Reminiscence Therapies for Older Adults With Cognitive Impairment: Systematic Review.","authors":"Qian Mao, Zhen Zhao, Lisha Yu, Yang Zhao, Hailiang Wang","doi":"10.2196/53348","DOIUrl":"10.2196/53348","url":null,"abstract":"<p><strong>Background: </strong>Reminiscence therapy (RT) is a commonly used nonpharmaceutical treatment for cognitive impairment. Artifacts or conversations are used in RT to recall individuals' memories and past experiences. Virtual reality (VR) has increasingly been used as an assistive technology during RT. However, the effects of VR-based RT (VR-RT) methods remain unclear, and insights into the related benefits and challenges are urgently needed.</p><p><strong>Objective: </strong>The study aims to systematically review the effects of VR-RTs for older adults with cognitive impairment.</p><p><strong>Methods: </strong>Seven databases (MEDLINE, Academic Search Premier, CINAHL, Web of Science, PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect) were searched to identify relevant articles published from inception to August 10, 2023. Peer-reviewed publications that assessed the effect of VR-RTs (ie, using virtual clues to evoke participants' memories or past experiences) on cognitive-related outcomes were included. Two independent researchers conducted the literature search, review, and data extraction processes. A narrative synthesis approach was used to analyze the extracted data.</p><p><strong>Results: </strong>Of the 537 identified articles, 22 were ultimately included in the data analysis. The results revealed that VR-RTs could maintain cognitive status (4/4, 100%) and reduce anxiety (2/2, 100%) in older adults with cognitive impairment. Nevertheless, one study found a cognitive improvement after VR-RTs, whereas cognitive degradation was observed at a 3- to 6-month follow-up measure. Around 88% (7/8) of the included studies indicated that VR-RTs improved memory; however, the evidence regarding the beneficial effects of VR-RTs was limited in improving quality of life (1/4, 25%) and reducing apathy (0/2, 0%) and depression (1/3, 33%). The results indicated that VR-RTs are safe, engaging, acceptable, and satisfying for older adults with cognitive impairment. In VR scenarios, personalized stimulus materials related to the users' youth experiences were more effective for treating cognitive impairment than other stimulus materials.</p><p><strong>Conclusions: </strong>The results of this systematic review demonstrate the potential benefits of VR-RT for older adults with cognitive impairment, especially in improving emotion and memory and maintaining cognitive status. VR-RT is also safe and enjoyable for older adults. However, due to the trial heterogeneity of included studies, we can only provide qualitative results instead of performing meta-analysis to quantify the effect size of VR-RTs. Thus, more randomized controlled trials are required to examine the designs and effects of VR-RTs for groups of older adults with specific needs.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e53348"},"PeriodicalIF":5.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621906","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}
引用次数: 0
Internet Use Maintains Cognitive Function among middle- and old-aged Chinese: A Five-year Longitudinal Study. 中国中老年人使用互联网保持认知功能：一项为期五年的纵向研究
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-12 DOI: 10.2196/57301
Bowen Chen, Chun Yang, Shanshan Ren, Penggao Li, Jin Zhao
<p><strong>Background: </strong>Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the elderly population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet usage among middle-aged and elderly individuals.</p><p><strong>Objective: </strong>This study aims to explore the association between internet usage and age-related cognitive decline among middle- and old-aged Chinese. To gain a more comprehensive understanding of the effects of internet usage, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet usage on cognitive function for characteristics significantly linked to cognition in stratified analysis.</p><p><strong>Methods: </strong>We analyzed data based on 12,770 dementia-free participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study. We employed a fixed-effects model to assess the relationship between internet usage and cognitive decline, and further validated it using multiple linear regression, generalized estimating equations (GEE), propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW). We further examined the varying effects of internet device type and frequency on cognitive function using fixed-effects models and Spearman's rank correlation. The Karlson-Holm-Breen (KHB) method was used to estimate the mediating role of internet usage in the urban-rural cognitive gap.</p><p><strong>Results: </strong>Participants using the internet (n=1,005) were younger, more likely to be male, more educated, married, retired, living in an urban area, and had higher cognitive assessment scores compared with non-users (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391 to 0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases at 2.2% (15/671) compared with non-users at 5.3% (379/7,099; P<.001). The negative impact of aging (> 50) on cognitive function was consistently less pronounced among internet users compared to non-users. Furthermore, increased frequency of internet usage was associated with greater cognitive benefits for middle-aged and elderly individuals (rs = 0.378, P<.001). Among digital devices used for internet access, cellphones (β=0.398, 95% CI 0.283 to 0.495) seem to have a higher level of cognitive protection compared to computers (β=0.147, 95% CI 0.091 to 0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effects, P<0.001).</p><p><strong>Conclusions: </strong>This study revea
背景：认知能力衰退是全球健康和社会保健面临的最大挑战之一，尤其是在中国，老年人口的负担最为沉重。尽管互联网的使用范围迅速扩大，但人们对互联网使用对中老年人认知能力的长期影响的了解仍然有限：本研究旨在探讨中国中老年人使用互联网与年龄相关认知能力下降之间的关系。为了更全面地了解互联网使用的影响，我们还重点评估了互联网使用频率和互联网设备类型对认知的影响。此外，我们还通过分层分析评估了互联网使用对认知功能的中介作用，以了解与认知有显著关联的特征：我们分析了中国健康与退休纵向研究（China Health and Retirement Longitudinal Study）中年龄≥45岁的12770名无痴呆症参与者的数据。我们采用固定效应模型来评估互联网使用与认知能力下降之间的关系，并使用多元线性回归、广义估计方程（GEE）、倾向得分匹配（PSM）、逆概率治疗加权（IPTW）和重叠加权（OW）对其进行了进一步验证。我们还使用固定效应模型和斯皮尔曼秩相关性检验了互联网设备类型和频率对认知功能的不同影响。我们使用卡尔森-霍尔姆-布林（KHB）方法估计了互联网使用在城乡认知差距中的中介作用：与未使用互联网者（人数=11,765）相比，使用互联网者（人数=1,005）更年轻，更有可能是男性，受教育程度更高，已婚，退休，居住在城市地区，认知评估得分更高。在对人口统计学和健康相关风险因素进行调整后，互联网使用与认知功能之间呈正相关（β=0.551，95% CI 0.391 至 0.710）。在随访期间，持续使用互联网者的神经退行性疾病 5 年发病率为 2.2%（15/671），明显低于不使用互联网者的 5.3%（379/7,099；P 50）。此外，互联网使用频率的增加与中老年人认知能力的提高有关（rs = 0.378，PC结论：这项研究表明，45 岁及以上人群使用互联网与降低认知能力下降的风险有关。互联网的使用有可能成为治疗中老年人认知能力下降的一种可行、经济、非药物干预措施：
{"title":"Internet Use Maintains Cognitive Function among middle- and old-aged Chinese: A Five-year Longitudinal Study.","authors":"Bowen Chen, Chun Yang, Shanshan Ren, Penggao Li, Jin Zhao","doi":"10.2196/57301","DOIUrl":"https://doi.org/10.2196/57301","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the elderly population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet usage among middle-aged and elderly individuals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to explore the association between internet usage and age-related cognitive decline among middle- and old-aged Chinese. To gain a more comprehensive understanding of the effects of internet usage, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet usage on cognitive function for characteristics significantly linked to cognition in stratified analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed data based on 12,770 dementia-free participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study. We employed a fixed-effects model to assess the relationship between internet usage and cognitive decline, and further validated it using multiple linear regression, generalized estimating equations (GEE), propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW). We further examined the varying effects of internet device type and frequency on cognitive function using fixed-effects models and Spearman's rank correlation. The Karlson-Holm-Breen (KHB) method was used to estimate the mediating role of internet usage in the urban-rural cognitive gap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants using the internet (n=1,005) were younger, more likely to be male, more educated, married, retired, living in an urban area, and had higher cognitive assessment scores compared with non-users (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391 to 0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases at 2.2% (15/671) compared with non-users at 5.3% (379/7,099; P&lt;.001). The negative impact of aging (&gt; 50) on cognitive function was consistently less pronounced among internet users compared to non-users. Furthermore, increased frequency of internet usage was associated with greater cognitive benefits for middle-aged and elderly individuals (rs = 0.378, P&lt;.001). Among digital devices used for internet access, cellphones (β=0.398, 95% CI 0.283 to 0.495) seem to have a higher level of cognitive protection compared to computers (β=0.147, 95% CI 0.091 to 0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effects, P&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study revea","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622442","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}
引用次数: 0
Telehealth Use and Legal Considerations in Drug Health Services During Pandemics: Systematic Scoping Review. 大流行期间药品保健服务中的远程保健使用和法律考虑因素：系统范围审查。
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-12 DOI: 10.2196/46394
Meryem Jefferies, Robert Graham, Marguerite Tracy, Scott Read, Mohammed Eslam, Mark W Douglas, Jacob George
<p><strong>Background: </strong>The COVID-19 pandemic impacted patients with substance use disorder (SUD) more than the general population and resulted in substantially increased emergency department admissions. Routine care of patients attending drug health services during the pandemic transitioned, with telehealth being important in delivering appropriate care. However, telehealth introduces unique risks such as privacy, confidentiality, and data safety. Providing health care through telehealth may fail if the legal impacts are not fully identified and acted on by health professionals. It also poses unintended risks for patients and can result in ineffectiveness, damages, medical negligence, and detracts from the best intentions of governments and health professionals. Understanding the legal framework ensures that medical professionals operate health care through telehealth within the law. Providing health care successfully through telehealth depends on the balance between innovation and legal compliance. By considering these aspects, clinicians and practitioners can provide effective and safe telehealth services during pandemics or any other natural disaster.</p><p><strong>Objective: </strong>We aimed to explore the legal impact of autonomy consent, confidentiality, privacy, data security, professional indemnity, and liability when delivering telehealth to patients with SUD. The scoping review also aimed to provide legal, ethical, and clinical considerations to minimize legal risks with using telehealth in drug health service outpatient settings.</p><p><strong>Methods: </strong>We performed a scoping review to provide an overview of existing research, statutes, and case laws for the incorporation of clinical, ethical, and legal considerations into telehealth use. Six databases for medical and 6 databases for legal publications were searched, as well as Australian national and selected international regulatory standards. Medical articles published up to June 2022 were included in this review. Our search yielded 1436 publications, 614 abstracts were reviewed, and 80 published studies met the inclusion criteria from 614 legal and medical search results. Current regulations related to technology use in drug health services, relevant cases, and international regulatory standards are discussed.</p><p><strong>Results: </strong>In total, 43 legal documents including 15 statutes, 4 case laws, and 37 medical publications were reviewed. The themes arising from the literature were consent and autonomy (20/80, 25%), confidentiality (8/80, 10%), privacy (8/80, 10%), data security (7/80, 9%), and professional indemnity issues (3/80, 4%) in telehealth use. Further, 24 studies identified legal issues associated with telehealth use in patients with SUD.</p><p><strong>Conclusions: </strong>Our review identified potential legal issues associated with telehealth use in patients with SUD. Several legal and medical research articles provide frameworks, codes of con
背景：COVID-19 大流行对药物使用障碍 (SUD) 患者的影响大于普通人群，导致急诊科入院人数大幅增加。在大流行期间，对接受药物保健服务的患者的常规护理发生了转变，远程保健在提供适当护理方面发挥了重要作用。然而，远程保健会带来独特的风险，如隐私、保密和数据安全。如果保健专业人员没有充分识别法律影响并采取相应行动，通过远程保健提供保健服务可能会失败。它还会给患者带来意想不到的风险，并可能导致效率低下、损害、医疗疏忽，使政府和医疗专业人员的良好意愿落空。了解法律框架可确保医疗专业人员在法律允许的范围内通过远程保健提供医疗服务。通过远程保健成功提供医疗服务取决于创新与守法之间的平衡。通过考虑这些方面，临床医生和从业人员可以在大流行病或任何其他自然灾害期间提供有效、安全的远程医疗服务：我们旨在探讨在向 SUD 患者提供远程保健服务时，自主同意、保密、隐私、数据安全、专业赔偿和责任等方面的法律影响。范围综述还旨在提供法律、伦理和临床方面的考虑因素，以最大限度地降低在药物健康服务门诊环境中使用远程保健的法律风险：我们进行了一次范围界定审查，以概述现有的研究、法规和案例法，从而将临床、伦理和法律方面的考虑因素纳入远程保健的使用中。我们检索了 6 个医学出版物数据库和 6 个法律出版物数据库，以及澳大利亚国内和部分国际监管标准。截至 2022 年 6 月发表的医学论文均被纳入本次综述。我们共搜索到 1436 篇出版物，审查了 614 篇摘要，从 614 篇法律和医学搜索结果中，有 80 篇已发表的研究符合纳入标准。文中讨论了与药品医疗服务中技术使用相关的现行法规、相关案例和国际监管标准：共审查了 43 份法律文件，包括 15 份法规、4 份案例法和 37 份医学出版物。文献中出现的主题是远程医疗使用中的同意和自主（20/80，25%）、保密（8/80，10%）、隐私（8/80，10%）、数据安全（7/80，9%）和专业赔偿问题（3/80，4%）。此外，有 24 项研究发现了与 SUD 患者使用远程保健相关的法律问题：我们的研究发现了与 SUD 患者使用远程保健相关的潜在法律问题。有几篇法律和医学研究文章提供了框架、行为准则或建议供临床医生参考，但几乎没有讨论或证据表明在药物保健服务机构提供远程保健咨询时如何应用法律考虑因素。临床医生在毒品健康服务机构通过远程保健提供医疗保健服务时，应了解其中涉及的法律问题。
{"title":"Telehealth Use and Legal Considerations in Drug Health Services During Pandemics: Systematic Scoping Review.","authors":"Meryem Jefferies, Robert Graham, Marguerite Tracy, Scott Read, Mohammed Eslam, Mark W Douglas, Jacob George","doi":"10.2196/46394","DOIUrl":"10.2196/46394","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The COVID-19 pandemic impacted patients with substance use disorder (SUD) more than the general population and resulted in substantially increased emergency department admissions. Routine care of patients attending drug health services during the pandemic transitioned, with telehealth being important in delivering appropriate care. However, telehealth introduces unique risks such as privacy, confidentiality, and data safety. Providing health care through telehealth may fail if the legal impacts are not fully identified and acted on by health professionals. It also poses unintended risks for patients and can result in ineffectiveness, damages, medical negligence, and detracts from the best intentions of governments and health professionals. Understanding the legal framework ensures that medical professionals operate health care through telehealth within the law. Providing health care successfully through telehealth depends on the balance between innovation and legal compliance. By considering these aspects, clinicians and practitioners can provide effective and safe telehealth services during pandemics or any other natural disaster.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to explore the legal impact of autonomy consent, confidentiality, privacy, data security, professional indemnity, and liability when delivering telehealth to patients with SUD. The scoping review also aimed to provide legal, ethical, and clinical considerations to minimize legal risks with using telehealth in drug health service outpatient settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a scoping review to provide an overview of existing research, statutes, and case laws for the incorporation of clinical, ethical, and legal considerations into telehealth use. Six databases for medical and 6 databases for legal publications were searched, as well as Australian national and selected international regulatory standards. Medical articles published up to June 2022 were included in this review. Our search yielded 1436 publications, 614 abstracts were reviewed, and 80 published studies met the inclusion criteria from 614 legal and medical search results. Current regulations related to technology use in drug health services, relevant cases, and international regulatory standards are discussed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 43 legal documents including 15 statutes, 4 case laws, and 37 medical publications were reviewed. The themes arising from the literature were consent and autonomy (20/80, 25%), confidentiality (8/80, 10%), privacy (8/80, 10%), data security (7/80, 9%), and professional indemnity issues (3/80, 4%) in telehealth use. Further, 24 studies identified legal issues associated with telehealth use in patients with SUD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our review identified potential legal issues associated with telehealth use in patients with SUD. Several legal and medical research articles provide frameworks, codes of con","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e46394"},"PeriodicalIF":5.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621903","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}
引用次数: 0
Concurrent Mentions of Vaping and Alcohol on Twitter: Latent Dirichlet Analysis. 在 Twitter 上同时提及吸烟和酒精：Latent Dirichlet Analysis.
IF 5.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2024-11-12 DOI: 10.2196/51870
Lynsie R Ranker, David Assefa Tofu, Manyuan Lu, Jiaxi Wu, Aruni Bhatnagar, Rose Marie Robertson, Derry Wijaya, Traci Hong, Jessica L Fetterman, Ziming Xuan

Background: Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use.

Objective: The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic.

Methods: Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described.

Results: Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre- and post-regulatory change and pre- and post-COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time.

Conclusions: Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances-particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility.

背景：同时使用酒精和电子烟（通常称为吸食）与长期健康后果有关，包括增加药物使用障碍的风险。COVID-19大流行可能加剧了共同使用的情况。社交网站可能有助于人们了解目前对多种物质使用的看法：本研究的目的是调查在美国电子烟法规变化和 COVID-19 大流行出现期间，Twitter（后改名为 X）上同时提及电子烟和酒精的情况：采用潜在 Dirichlet 分配建模法分析了 2019 年 10 月至 2020 年 9 月间发布的推文，其中包括与吸食电子烟和酒精相关的术语。结果：在 6437 条推文中发现了三个主题：在 6437 条推文中确定了三个主题：（1）香精和香精禁令（n=3334，占推文的 51.8%），（2）共同使用讨论（n=1119，占 17.4%），以及（3）可用性和获取监管（n=1984，占 30.8%）。关于共同使用的讨论通常将共同使用描述为积极和亲社会的行为。关注监管的推文通常使用酒精监管进行比较。一些推文侧重于认为对吸食电子烟的监管过度（与酒精相比），而另一些推文则支持限制青少年吸食电子烟，但不以牺牲成人吸食电子烟为代价（例如，加强年龄验证而非产品禁令）。在所有话题中，吸食电子烟通常被描述为比饮酒危害更小。人们还讨论了香精对成人戒烟的益处。不同时间段的话题分布在法规变更前后和COVID-19大流行宣布前后都有所不同，这表明不同时间段的话题重点突出程度有所变化：结论：在监管变化和社会动荡时期，社交媒体上的共同使用讨论通常从正面描述吸烟和饮酒。它还包括围绕这两种物质监管差异的辩论，特别是与限制青少年接触有关的辩论。分析中出现的主题表明，与吸食电子烟产品相比，酒精被认为危害更大，但监管较少，未成年青少年更容易获得。经常讨论和比较这两种物质的监管问题，凸显了仍在不断变化的吸食大麻的政策环境。在变革时期对社交媒体内容进行分析有助于监管者和政策制定者更好地理解和应对与毒品相关的政策和可获取性方面的常见问题和潜在误解。
{"title":"Concurrent Mentions of Vaping and Alcohol on Twitter: Latent Dirichlet Analysis.","authors":"Lynsie R Ranker, David Assefa Tofu, Manyuan Lu, Jiaxi Wu, Aruni Bhatnagar, Rose Marie Robertson, Derry Wijaya, Traci Hong, Jessica L Fetterman, Ziming Xuan","doi":"10.2196/51870","DOIUrl":"https://doi.org/10.2196/51870","url":null,"abstract":"<p><strong>Background: </strong>Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use.</p><p><strong>Objective: </strong>The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic.</p><p><strong>Methods: </strong>Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described.</p><p><strong>Results: </strong>Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre- and post-regulatory change and pre- and post-COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time.</p><p><strong>Conclusions: </strong>Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances-particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e51870"},"PeriodicalIF":5.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621444","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}
引用次数: 0
首页 上一页 下一页 尾页
类型
全部 化学•材料 生命科学 医学 物理 工程技术 环境•农林 材料科学 地球科学 法学 管理学 化学 环境科学与生态学 计算机科学 教育学 经济学 农林科学 人文科学 生物学 数学 物理与天体物理 心理学 综合性期刊 其他 工业工程 理学 历史学 农学 文学 信息工程
数据库
全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley
期刊
Journal of Medical Internet Research
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
﹀
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整，为了账户安全，请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号：481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们：info@booksci.cn
Book学术提供免费学术资源搜索服务，方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1