Exploring Stakeholder Perceptions and Experience of Biosimilar Insulin Switching: A Scoping Review.

BackgroundThe interpretation of lung sounds plays a crucial role in the appropriate diagnosis and management of pediatric asthma. Applying artificial intelligence (AI) to this task has the potential to better standardize assessment and may even improve its predictive potential.ObjectiveThis study aims to objectively review the literature on AI-assisted lung auscultation for pediatric asthma and provide a balanced assessment of its strengths, weaknesses, opportunities, and threats.MethodsA scoping review on AI-assisted lung sound analysis in children with asthma was conducted across 4 major scientific databases (PubMed, MEDLINE Ovid, Embase, and Web of Science), supplemented by a gray literature search on Google Scholar, to identify relevant studies published from January 1, 2000, until May 23, 2023. The search strategy incorporated a combination of keywords related to AI, pulmonary auscultation, children, and asthma. The quality of eligible studies was assessed using the ChAMAI (Checklist for the Assessment of Medical Artificial Intelligence).ResultsThe search identified 7 relevant studies out of 82 (9%) to be included through an academic literature search, while 11 of 250 (4.4%) studies from the gray literature search were considered but not included in the subsequent review and quality assessment. All had poor to medium ChAMAI scores, mostly due to the absence of external validation. Identified strengths were improved predictive accuracy of AI to allow for prompt and early diagnosis, personalized management strategies, and remote monitoring capabilities. Weaknesses were the heterogeneity between studies and the lack of standardization in data collection and interpretation. Opportunities were the potential of coordinated surveillance, growing data sets, and new ways of collaboratively learning from distributed data. Threats were both generic for the field of medical AI (loss of interpretability) but also specific to the use case, as clinicians might lose the skill of auscultation.ConclusionsTo achieve the opportunities of automated lung auscultation, there is a need to address weaknesses and threats with large-scale coordinated data collection in globally representative populations and leveraging new approaches to collaborative learning.

IntroductionFalls from height are a leading cause of serious injury and fatality globally. In South Africa, work at heights is regulated by occupational health and safety legislation, which places responsibility...

Patient perception with fixed appliance orthodontic treatment is important to improve oral health-related quality of life. The main objective of this study was to evaluate the impact of labial fixed appliance orthodontic care on patient perception before, during, and after the treatment. Relevant systematic reviews investigating patient perception with fixed appliance orthodontic treatment were identified by searching electronic databases: MEDLINE via OVID (1946 to 31 December 2018), EMBASE (1974 to 31 December 2018), AMED (Allied and Complementary Medicine Database; 1985 to November 2018), PubMed (inception to 31 December 2018), Web of Science (1900 to 2018), and PsychINFO (1806 to 31 December 2018). Ongoing systematic reviews were searched using Prospero and a grey literature search was undertaken using Google Scholar and OpenGrey (www.opengrey.eu/). No language restriction was applied. Only studies investigating patient perception of fixed appliance orthodontic treatment were included. Screening, quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)], and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings. A total of 163 articles investigating patient expectation, experience, and satisfaction with conventional ligation labial fixed orthodontic appliances were obtained. Of these, 152 observational or interventional studies were excluded, resulting in 11 eligible systematic reviews. Two were excluded as earlier reports of a Cochrane review. The quality of the reviews was variable (critically low, low, and moderate). The findings were as follows: aesthetics represents a primary motive for orthodontic treatment; a temporary deterioration in the quality of life occurs during the initial phases of treatment; gender and ethnicity factors do not have an impact on patient perception of treatment; and a positive relationship between orthodontist-patient-parent is important to achieve patient compliance and satisfaction. There is a lack of high-quality studies in terms of systematic reviews and meta-analyses for assessing patient perception with fixed appliance orthodontic treatment. The aesthetic impact of malocclusion is the main motive for seeking orthodontic treatment. Quality of life reduces during the initial stages of orthodontic treatment but improves in the later stages of treatment. Assessment before, during, and after orthodontic treatment is necessary to comprehensively assess patient perception at all stages of care. CRD42019122653. None to declare.

IntroductionReviews of economic evaluations of telehealth interventions found that the current evidence is inconsistent with standard guidelines for conducting economic evaluation. The reviews conclude that most economic evaluations of telehealth...

BackgroundBiosimilars are highly similar, but not identical, versions of originator biologic medications. Switching patients to biosimilars presents an opportunity to mitigate rising drug costs and expand patient access to important biologic therapies. However, decreased patient acceptance and adherence to biosimilar medications have been reported, which can lead to loss of treatment response, adverse reactions, and inefficient resource utilization. Understanding patient perceptions of biosimilars and biosimilar switching is needed to inform patient-centered care strategies that promote efficient resource utilization.MethodsWe used democratic deliberation methods to solicit the informed and considered opinions of patients regarding biosimilar switching. Patients with inflammatory bowel disease (IBD; n = 29) from the Veterans Health Administration (VHA) participated in 5-hour deliberation sessions over two days. Following educational presentations with experts, participants engaged in facilitated small group discussions. Transcripts and facilitators’ notes were used to identify key themes. Participants completed surveys pre- and post-deliberation to collect sociodemographic and clinical features as well as to assess IBD treatment knowledge and attitudes toward care and approaches to biosimilar switching.ResultsFive major themes emerged from the small group discussions in the context of biosimilar switching: 1) concerns about adverse consequences and unclear risk-benefit balance; (2) importance of communication and transparency; (3) desire for shared decision making and patient involvement in treatment decisions; (4) balancing cost-saving with competing priorities; and (5) advocating for individualized care and prioritization based on risk levels. These views led participants to favor approaches that prioritize switching the sickest patients last (i.e., those with poorly controlled disease) and that offer patients control and choices around biosimilar switching. Participants also expressed preferences for combining elements of different approaches to maximize fairness.ConclusionsApproaches to biosimilar switching should consider patients’ desires for transparency and effective communication about biosimilar switching and engagement in their medical decision-making as part of patient-centered care. Incorporating patient preferences around biosimilar switching is critical when navigating the quality and affordability of care in resource constrained settings, both within the VHA and in other healthcare systems.

Medications are commonly used in suicide attempts. Pharmacists are inextricably linked to medications and may have roles in helping those at risk of suicide. We conducted a scoping review to characterize the existing literature and make recommendations about future research. We used a 6-step approach based on an existing scoping review methodological framework, including identifying the research question; identifying relevant studies and other literature; study and literature selection; data charting; collating, summarizing and reporting results; and dissemination of results. We searched electronic databases, various grey literature sources and mobile app stores. Thirty-five articles were included following screening of 1013 database citations. Of 1085 results from grey literature searches, we included 12. Most publications were opinion pieces (n = 22), followed by survey studies (n = 9), primarily assessing pharmacists' knowledge and attitudes. Themes included education and training to impact knowledge and attitudes, gatekeeping of medication supply, collaboration and integration, and role perception. Public perspectives on pharmacists' roles were limited. Research regarding pharmacists' roles in the care of people at risk for suicide is limited. The areas that have dominated the literature include legal liability, especially with respect to gatekeeping medications, ethical decision making and education and training. Research is needed to determine what methods, outcomes and measures are required to best serve in building the evidence base for policy and practice decisions in this area.

Backgroundduring the last hundred years, several major public health issues have already afflicted humanity. Most frequently cited definitions of public health have stemmed from long-standing definitions, which raises several concerns including whether these definitions can respond to today’s public health challenges. The present study aimed to identify and review available public health definitions in the first place.Methodsin this scoping review, we undertook an electronic search in four databases (PubMed, Web of Science, Embase, and EBSCOhost) from inception until June 06, 2022, and a grey literature search in Google Scholar. Moreover, reference lists of publications included in the scoping review were screened manually for additional relevant publications. All types of scientific publications, in English, that focused on the definition of public health and provided an original definition were included. Year, type, disciplinary fields of publications, objectives of publications, and public health definitions were extracted.Results5651 publications were identified through the scoping search, of which five were subjected to full-text review. Of these publications, two were included. An additional nine publications were identified through the manual screening. A total 11 of publications were included in the scoping review. Of the 11 definitions included in this review, the latest original definitions date back to about two decades ago.Conclusionsthere is a noticeable lack of updated definitions of public health. Considering our findings and the ever-changing nature of public health issues, there is an urgent need for re-assessing and updating public health definitions.

This review aims to systematically map the literature reporting on oral health outcomes experienced by people with cerebral palsy. At present, there are no documented systematic reviews reporting on oral health outcomes for people of all ages with cerebral palsy. Subsequently, there are no clear guidelines, frameworks or detailed oral health recommendations for people with cerebral palsy. Considering the importance of oral health on general well-being and quality of life, it is important that it is not overlooked when focusing on patient-centered care for people with cerebral palsy. Studies that focus on oral health, including dental diagnosis, trauma and/or treatment, facial pain, saliva, and sleep apnea, and/or make statements regarding oral health pertaining to cerebral palsy will be considered for inclusion inthis scoping review. This review will be conducted in accordance with the guidelines outlined by JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Articles published in any language will be considered for inclusion, with no restriction on publication date. The search databases will include the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, Embase and Dentistry and Oral Science. A search of gray literature will also be conducted. Extracted data relevant to the scoping review will be performed by two reviewers.

BackgroundHaving a home is the foundation of most people’s lives. People with co-occurring substance use and mental health problems may experience challenges in acquiring and keeping housing. Many also have major health challenges. Supported housing is the subject of increasing interest, but there seems to be a lack of studies exploring supported housing’s potential for facilitating recovery and health promotion. Therefore, a scoping review was performed to answer our review question: What is known in the literature about the experiences of persons with co-occurring substance use and mental health problems with supported housing, including experiences of recovery and health promotion?MethodsSystematic searches were conducted in the Ovid MEDLINE, Embase, PsycInfo, CINAHL, Social Services s, Web of Science, Scopus, and Oria, and Idunn.no databases. The search terms were derived from the population, concepts, and context. The search for grey literature was conducted in various Norwegian sources.ResultsForty studies were included: 7 with quantitative design, 28 with qualitative design and 5 with mixed methods design. The studies were from Canada, Ireland, Norway, Scotland, and the USA.The review identified four themes related to tenants’ experiences with supported housing:1)The importance of a permanent and safe home; 2) Housing’s importance for physical health; 3) A shoulder to lean on – the importance of relationships and support; 4) the value of choice and independence.Factors that may influence physical health were poorly represented.ConclusionsLong-term housing and safety are prerequisites for recovery for people with co-occurring problems. Programmes such as Housing First and Assertive Community Teams, especially, were experienced to support recovery. Autonomy was valued, including access to individual and respectful support from service providers when needed.Supported housing may be a health-promoting arena, especially in relation to mental health. More attention should be given to how service providers can support tenants to protect their physical health, especially related to nutrition, meals and communal cooking. Further research is needed to tailor optimal services and support for people with co-occurring problems, including balancing support and autonomy with the aim of promoting health and recovery.Peer specialists’ contributions to supported housing are scarce and need further development.

The objective of the review is to map and analyze midwifery interventions to reduce fear of childbirth in pregnant women. Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy, as well as after childbirth. During the previous few decades, there has been a growing interest in research into interventions to reduce the fear of childbirth in childbearing women. Currently, providing an appropriate model of care for pregnant women with fear of childbirth is a challenge in midwifery care. Therefore, further efforts are needed to identify and examine the characteristics of different midwifery interventions to reduce fear of childbirth in pregnant women. This scoping review will consider studies that include interventions to reduce fear of childbirth in pregnant women, led and implemented by midwives, during the antenatal period, in all possible birth scenarios. Quantitative, qualitative, and mixed methods studies will be included. The JBI methodology for conducting scoping reviews will be employed. Published and unpublished literature in English, Portuguese, and Spanish, from 1981 to the present, will be included. MEDLINE, CINAHL Complete, Scopus, Web of Science, Embase, and Cochrane Library databases will be searched. Searches for gray literature will be performed. Data will be extracted using a tool developed specifically for the scoping review objectives.

BackgroundThe treatment of multimorbid patients is one crucial task in general practice as multimorbidity is highly prevalent in this setting. However, there is little evidence how to treat these patients and consequently there are but a few guidelines that focus primarily on multimorbidity. Big data analytics are defined as a method that obtains results for high volume data with high variety generated at high velocity. Yet, the explanatory power of these results is not completely understood. Nevertheless, addressing multimorbidity as a complex condition might be a promising field for big data analytics.The aim of this scoping review was to evaluate whether applying big data analytics on patient data does already contribute to the treatment of multimorbid patients in general practice.MethodsIn January 2018, a review searching the databases PubMed, The Cochrane Library, and Web of Science, using defined search terms for “big data analytics” and “multimorbidity”, supplemented by a search of grey literature with Google Scholar, was conducted. Studies were not filtered by type of study, publication year or language. Validity of studies was evaluated independently by two researchers.ResultsIn total, 2392 records were identified for screening. After title and abstract screening, six articles were included in the full-text analysis. Of those articles, one reported on a model generated with big data techniques to help caring for one group of multimorbid patients. The other five articles dealt with the analysis of multimorbidity clusters. No article defined big data analytics explicitly.ConclusionsAlthough the usage of the phrase “Big Data” is growing rapidly, there is nearly no practical use case for big data analysis techniques in the treatment of multimorbidity in general practice yet. Furthermore, in publications addressing big data analytics, the term is rarely defined.However, possible models and algorithms to address multimorbidity in the future are already published.

BACKGROUND The interpretation of lung sounds plays a crucial role in the appropriate diagnosis and management of pediatric asthma. Applying artificial intelligence (AI) to this task has the potential to better standardize assessment and may even improve its predictive potential. OBJECTIVE This study aims to objectively review the literature on AI-assisted lung auscultation for pediatric asthma and provide a balanced assessment of its strengths, weaknesses, opportunities, and threats. METHODS A scoping review on AI-assisted lung sound analysis in children with asthma was conducted across 4 major scientific databases (PubMed, MEDLINE Ovid, Embase, and Web of Science), supplemented by a gray literature search on Google Scholar, to identify relevant studies published from January 1, 2000, until May 23, 2023. The search strategy incorporated a combination of keywords related to AI, pulmonary auscultation, children, and asthma. The quality of eligible studies was assessed using the ChAMAI (Checklist for the Assessment of Medical Artificial Intelligence). RESULTS The search identified 7 relevant studies out of 82 (9%) to be included through an academic literature search, while 11 of 250 (4.4%) studies from the gray literature search were considered but not included in the subsequent review and quality assessment. All had poor to medium ChAMAI scores, mostly due to the absence of external validation. Identified strengths were improved predictive accuracy of AI to allow for prompt and early diagnosis, personalized management strategies, and remote monitoring capabilities. Weaknesses were the heterogeneity between studies and the lack of standardization in data collection and interpretation. Opportunities were the potential of coordinated surveillance, growing data sets, and new ways of collaboratively learning from distributed data. Threats were both generic for the field of medical AI (loss of interpretability) but also specific to the use case, as clinicians might lose the skill of auscultation. CONCLUSIONS To achieve the opportunities of automated lung auscultation, there is a need to address weaknesses and threats with large-scale coordinated data collection in globally representative populations and leveraging new approaches to collaborative learning.

Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks. A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries. Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted. The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions. Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.

The evolution of eHealth development has shifted from standalone tools to comprehensive digital health environments, fostering data exchange among diverse stakeholders and systems. Nevertheless, existing research and implementation frameworks have primarily emphasized technological and organizational aspects of eHealth implementation, overlooking the intricate legal, ethical, and financial considerations. It is essential to discover what legal, ethical, financial, and technological challenges should be considered to ensure successful and sustainable implementation of eHealth. This review aims to provide insights into barriers and facilitators of legal, ethical, financial, and technological aspects for successful implementation of complex eHealth technologies, which impacts multiple levels and multiple stakeholders. A scoping review was conducted by querying PubMed, Scopus, Web of Science, and ACM Digital Library (2018-2023) for studies describing the implementation process of eHealth technologies that facilitate data exchange. Studies solely reporting clinical outcomes or conducted outside Europe were excluded. Two independent reviewers selected the studies. A conceptual framework was constructed through axial and inductive coding, extracting data from literature on legal, ethical, financial, and technological aspects of eHealth implementation. This framework guided systematic extraction and interpretation. The search resulted in 7.308 studies that were screened for eligibility, of which 35 (0.48%) were included. Legal barriers revolve around data confidentiality and security, necessitating clear regulatory guidelines. Ethical barriers span consent, responsibility, liability, and validation complexities, necessitating robust frameworks. Financial barriers stem from inadequate funding, requiring (commercial) partnerships and business models. Technological issues include interoperability, integration, and malfunctioning, necessitating strategies for enhancing data reliability, improving accessibility, and aligning eHealth technology with existing systems for smoother integration. This research highlights the multifaceted nature of eHealth implementation, encompassing legal, ethical, financial, and technological considerations. Collaborative stakeholder engagement is paramount for effective decision-making and aligns with the transition from standalone eHealth tools to integrated digital health environments. Identifying suitable stakeholders and recognizing their stakes and values enriches implementation strategies with expertise and guidance across all aspects. Future research should explore the timing of these considerations and practical solutions for regulatory compliance, funding, navigation of responsibility and liability, and business models for reimbursement strategies.

Short Summary: Ireland, like other prosperous nations, has an ageing population who predominantly want to age well at home. However, home support services are struggling to recruit and retain home support workers. This scoping review of the international research literature drew together evidence and best practice to develop proposals for a comprehensive career pathway encompassing career structures, training and workforce development. The Issue/Challenge: Globally, healthcare systems are undergoing transformation, with a notable transition away from traditional institutions towards provision of integrated care and support in home settings. The challenges of delivering safe and sustainable models of home-based care and support are an international concern, particularly in relation to building workforce capacity and capabilities. In many nations, home support workers have historically lacked entitlements, access to training, and opportunities for career progression, resulting in high turnover, recruitment and retention challenges. In Ireland, these challenges have led to a mounting 'waiting list lottery' affecting over 6,000 vulnerable and elderly individuals. Aims and objectives: The aim was to produce recommendations for a career pathway for support workers in home care in Ireland based on the international research evidence. The research question was: “What is the evidence to inform the development of a career pathway for home support workers in Ireland?” Target Audience: This research is likely to be of interest to an international audience of health policymakers, commissioners of home support services, home support service providers, educators and training providers, as well as home support workers, clients and family caregivers. Stakeholders and their Contribution to this Research: National stakeholder consultations on the Green Paper include policymakers, service organisations, researchers, digital health/AI specialists, and voluntary organisations. Initiative/Intervention: A scoping review following Joanna Briggs Institute methodology was performed using structured searches of electronic databases (Web of Science, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, Social Care Online, and Social Sciences Citation Index) and grey literature (Sept-Nov 2023). Inclusion criteria and methods/relevance grading were applied. Data were analysed thematically and interpreted using a “what, works for whom, when and why” framing. Results and Impact: The 261 included articles highlight the global significance of the issues. Four overarching themes were identified: 1. Attract and develop a competent and motivated workforce, 2. Enhance working lives and retention, 3. Utilise career pathways for quality and impact, 4. Invest in data and digital for integrated home care and support. Drawing from the evidence, a Green Paper was developed outlining proposals and actions for change. The impact so far is to raise awareness of the challenges and create a shared vision for collaborative action. Learning for an International Audience: A career pathway for home support workers is essential for growing workforce capacity and skills, improving working lives and retention, and achieving the policy goal of providing home support for aging populations. Next steps: Advancing the Irish home support sector based on the proposals, necessitates collaborative action by policymakers, commissioners, employers, regulators, education and training organisations as well as the involvement of home support workers in plans for change. Funder: Leading Healthcare Providers Skillnet