Frontiers in digital health最新文献

Wearable sensor devices for continuous patient monitoring produce a large volume of data, necessitating scalable infrastructures for efficient data processing, management and security, especially concerning Patient Health Information (PHI). Adherence to the Health Insurance Portability and Accountability Act (HIPAA), a legislation that mandates developers and healthcare providers to uphold a set of standards for safeguarding patients' health information and privacy, further complicates the development of remote patient monitoring within healthcare ecosystems. This paper presents an Internet of Things (IoT) architecture designed for the healthcare sector, utilizing commercial cloud platforms like Microsoft Azure and Amazon Web Services (AWS) to develop HIPAA-compliant health monitoring systems. By leveraging cloud functionalities such as scalability, security, and load balancing, the architecture simplifies the creation of infrastructures adhering to HIPAA standards. The study includes a cost analysis of Azure and AWS infrastructures and evaluates data processing speeds and database query latencies, offering insights into their performance for healthcare applications.

Introduction: Generating quality data for decision-making at all levels of a health system is a global imperative. The assessment of the Ethiopian National Health Information System revealed that health information system resources, data management, dissemination, and their use were rated as "not adequate" among the six major components of the health system. Health extension workers are the frontline health workforce where baseline health data are generated in the Ethiopian health system. However, the data collected, compiled, and reported by health extension workers are unreliable and of low quality. Despite huge problems in data management practices, there is a lack of sound evidence on how to overcome these health data management challenges, particularly among health extension workers. Thus, this study aimed to assess data management practices and their associated factors among health extension workers in the Central Gondar Zone.

Method: An institution-based cross-sectional study was conducted among 383 health extension workers. A simple random sampling method was used to select districts, all health extension workers were surveyed in the selected districts, and a structured self-administered questionnaire was used for data collection. The data was entered using EpiData version 4.6 and analyzed using STATA, version 16. Bivariable and multivariable binary logistic regression analyses were executed. An odds ratio with a 95% confidence interval and a p-value of <0.05 was calculated to determine the strength of the association and to evaluate statistical significance, respectively.

Results: Of the 383 health extension workers enrolled, all responded to the questionnaire with a response rate of 100%. Furthermore, 54.7% of the respondents had good data management practices. In the multivariable logistic regression analysis, being a married woman, having good data management knowledge, having a good attitude toward data management, having 1-5 years of working experience, and having a salary ranging from 5,358 to 8,013 Ethiopian Birr were the factors significantly associated with good data management practices among health extension workers. The overall data management practice was poor with only five health extension workers out of ten having good data management practices.

Artificial Intelligence (AI) has the potential to revolutionize medical training, diagnostics, treatment planning, and healthcare delivery while also bringing challenges such as data privacy, the risk of technological overreliance, and the preservation of critical thinking. This manuscript explores the impact of AI and Machine Learning (ML) on healthcare interactions, focusing on faculty, students, clinicians, and patients. AI and ML's early inclusion in the medical curriculum will support student-centered learning; however, all stakeholders will require specialized training to bridge the gap between medical practice and technological innovation. This underscores the importance of education in the ethical and responsible use of AI and emphasizing collaboration to maximize its benefits. This manuscript calls for a re-evaluation of interpersonal relationships within healthcare to improve the overall quality of care and safeguard the welfare of all stakeholders by leveraging AI's strengths and managing its risks.

Background: Current atherosclerotic cardiovascular disease (ASCVD) risk assessment tools like the Pooled Cohort Equations (PCEs) and PREVENT™ scores offer long-term predictions but may not effectively drive behavior change. Short-term risk predictions using mobile health (mHealth) data and electronic health records (EHRs) could enhance clinical decision-making and patient engagement. The aim of this study was to develop a short-term ASCVD risk prediction model for hypertensive individuals using mHealth and EHR data and compare its performance to existing risk assessment tools.

Methods: This is a retrospective cohort study including 51,127 hypertensive participants aged ≥18 years old who enrolled in the Hello Heart CV risk self-management program between January 2015 and January 2024. A machine learning (ML) model was derived from EHR data and mHealth measurements of blood pressure (BP) and heart rate (HR) collected via at-home BP monitors. Its performance was compared to that of PCE and PREVENT.

Results: The XgBoost model incorporating 291 features outperformed the PCE and PREVENT scores in discriminating ASCVD risk for both prediction periods. For 90-day prediction, mean C-statistics were 0.81 (XgBoost) vs. 0.74 (PCE) and 0.65 (PREVENT). Similar findings were observed for 365-day prediction. mHealth measurements incrementally enhanced 365-day risk prediction (ROC-AUC 0.82 vs. 0.80 without mHealth).

Conclusion: An EHR and mHealth-based ML model offers superior short-term ASCVD prediction compared to traditional tools. This approach supports personalized preventive strategies, particularly for populations with incomplete features for PCE or PREVENT. Further research should explore this novel risk prediction framework, and particularly additional mHealth data integration for broader applicability and increased predictive power.

Background: Youth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care.

Methods: To that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research.

Results: Eleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes.

Conclusion: Key policy, training and practice implications are discussed.

Introduction: Non-attendance (NA) causes additional burden on the outpatient services due to clinician time and other resources being wasted, and it lengthens wait lists for patients. Telehealth, the delivery of health services remotely using digital technologies, is one promising approach to accommodate patient needs while offering more flexibility in outpatient services. However, there is limited evidence about whether offering telehealth consults as an option can change NA rates, or about the preferences of hospital outpatients for telehealth compared to in-person consults. We model patient preferences with a Maximum Entropy Inverse Reinforcement Learning (IRL) behaviour model, allowing for the calculation of general population- and demographic-specific relative preferences for consult modality. The aim of this research is to use real-world data to model patient preferences for consult modality using Maximum Entropy IRL behaviour model.

Methods: Retrospective data were collected from an immunology outpatient clinic associated with a large metropolitan hospital in Brisbane, Australia. We used IRL with the Maximum Entropy behaviour model to learn outpatient preferences for appointment modality (telehealth or in-person) and to derive demographic predictors of attendance or NA. IRL models patients as decision making agents interacting sequentially over multiple time-steps, allowing for present actions to impact future outcomes, unlike previous models applied in this domain.

Results: We found statistically significant (α = 0.05) within-group preferences for telehealth consult modality in privately paying patients, patients who both identify as First Nations individuals and those who do not, patients aged 50-60, who did not require an interpreter, for the general population, and for the female population. We also found significant within-group preferences for in-person consult modality for patients who require an interpreter and for patients younger than 30.

Discussion: Using the Maximum Entropy IRL sequential behaviour model, our results agree with previous evidence that non-attendance can be reduced when telehealth is offered in outpatient clinics. Our results complement previous studies using non-sequential modelling methodologies. Our preference and NA prediction results may be useful to outpatient clinic administrators to tailor services to specific patient groups, such as scheduling text message consult reminders if a given patient is predicted to be more likely to NA.

Introduction: The 2024 Voice AI Symposium, presented by the Bridge2AI-Voice Consortium, featured deep-dive educational workshops conducted by experts from diverse fields to explore the latest advancements in voice biomarkers and artificial intelligence (AI) applications in healthcare. Through five workshops, attendees learned about topics including international standardization of vocal biomarker data, real-world deployment of AI solutions, assistive technologies for voice disorders, best practices for voice data collection, and deep learning applications in voice analysis. These workshops aimed to foster collaboration between academia, industry, and healthcare to advance the development and implementation of voice-based AI tools.

Methods: Each workshop featured a combination of lectures, case studies, and interactive discussions. Transcripts of audio recordings were generated using Whisper (Version 7.13.1) and summarized by ChatGPT (Version 4.0), then reviewed by the authors. The workshops covered various methodologies, from signal processing and machine learning operations (MLOps) to ethical concerns surrounding AI-powered voice data collection. Practical demonstrations of AI-driven tools for voice disorder management and technical discussions on implementing voice AI models in clinical and non-clinical settings provided attendees with hands-on experience.

Results: Key outcomes included the discussion of international standards to unify stakeholders in vocal biomarker research, practical challenges in deploying AI solutions outside the laboratory, review of Bridge2AI-Voice data collection processes, and the potential of AI to empower individuals with voice disorders. Additionally, presenters shared innovations in ethical AI practices, scalable machine learning frameworks, and advanced data collection techniques using diverse voice datasets. The symposium highlighted the successful integration of AI in detecting and analyzing voice signals for various health applications, with significant advancements in standardization, privacy, and clinical validation processes.

Discussion: The symposium underscored the importance of interdisciplinary collaboration to address the technical, ethical, and clinical challenges in the field of voice biomarkers. While AI models have shown promise in analyzing voice data, challenges such as data variability, security, and scalability remain. Future efforts must focus on refining data collection standards, advancing ethical AI practices, and ensuring diverse dataset inclusion to improve model robustness. By fostering collaboration among researchers, clinicians, and technologists, the symposium laid a foundation for future innovations in AI-driven voice analysis for healthcare diagnostics and treatment.

Objective: Artificial intelligence (AI) is revolutionizing healthcare, but less is known about how it may facilitate methodological innovations in research settings. In this manuscript, we describe a novel use of AI in summarizing and reporting qualitative data generated from an expert panel discussion about the role of electronic health records (EHRs) in implementation science.

Materials and methods: 15 implementation scientists participated in an hour-long expert panel discussion addressing how EHRs can support implementation strategies, measure implementation outcomes, and influence implementation science. Notes from the discussion were synthesized by ChatGPT (a large language model-LLM) to generate a manuscript summarizing the discussion, which was later revised by participants. We also surveyed participants on their experience with the process.

Results: Panelists identified implementation strategies and outcome measures that can be readily supported by EHRs and noted that implementation science will need to evolve to assess future EHR advancements. The ChatGPT-generated summary of the panel discussion was generally regarded as an efficient means to offer a high-level overview of the discussion, although participants felt it lacked nuance and context. Extensive editing was required to contextualize the LLM-generated text and situate it in relevant literature.

Discussion and conclusions: Our qualitative findings highlight the central role EHRs can play in supporting implementation science, which may require additional informatics and implementation expertise and a different way to think about the combined fields. Our experience using ChatGPT as a research methods innovation was mixed and underscores the need for close supervision and attentive human involvement.

Background: Remote care usefulness and climate change co-benefits should be addressed simultaneously to incentivize political action.

Objectives: To assess the changes in healthcare consumption, lung function and greenhouse gas (GHG) emissions during the COVID-19 pandemic in Dutch cystic fibrosis (CF) care.

Design: Retrospective multicentre observational study in five Dutch CF centres.

Methods: Eighty-one participants were included. Healthcare consumption was described alongside the COVID-19 Stringency Index (2019-2022). Travel related GHG emissions were calculated for every clinic visit. Changes in percentage predicted Forced Expiratory Volume in one second (ppFEV1) were assessed using a paired-samples T-test.

Results: Healthcare consumption patterns followed COVID-19 public health measure stringency but returned back to the "old normal". Emission of 5.450, 3 kg of carbon dioxide equivalents were avoided while quality of care was relatively preserved. ppFEV1 declined as expected (ΔMeans 3.69%, 95%CI 2.11-5.28).

Conclusion: Remote monitoring of lung function and symptoms and teleconsultations in CF can reduce GHG emissions while maintaining quality of care. As health sectors constitute a large share of national climate change footprints, digital health can partly alleviate this burden by reducing private travel.