Title | Artificial Intelligence in Dermatology: A Primer. |
Authors | Young, AT; Xiong, M; Pfau, J; Keiser, MJ; Wei, ML |
Journal | The Journal of investigative dermatology |
Publication Date | 1 Aug 2020 |
Date Added to PubMed | 2 Apr 2020 |
Abstract | Artificial intelligence is becoming increasingly important in dermatology, with studies reporting accuracy matching or exceeding dermatologists for the diagnosis of skin lesions from clinical and dermoscopic images. However, real-world clinical validation is currently lacking. We review dermatological applications of deep learning, the leading artificial intelligence technology for image analysis, and discuss its current capabilities, potential failure modes, and challenges surrounding performance assessment and interpretability. We address the following three primary applications: (i) teledermatology, including triage for referral to dermatologists; (ii) augmenting clinical assessment during face-to-face visits; and (iii) dermatopathology. We discuss equity and ethical issues related to future clinical adoption and recommend specific standardization of metrics for reporting model performance. |
Link | http://doi.org/10.1016/j.jid.2020.02.026 |
Title | Public health digitalization in Europe. |
Authors | Odone, A; Buttigieg, S; Ricciardi, W; Azzopardi-Muscat, N; Staines, A |
Journal | European journal of public health |
Publication Date | 1 Oct 2019 |
Date Added to PubMed | 19 Nov 2019 |
Abstract | As digitalization is progressively permeating all aspects of society, how can be it fruitfully employed to sustain the public health goals of quality, accessibility, efficiency and equity in health care and prevention? In this paper, we reflect on the potential of applying digital tools to public health and discuss some key challenges. We first define 'digitalization' in its broader sense, as well as applied to public health. We then build a conceptual framework where key public health domains are associated to available digital technologies in a matrix that help to identify digital features that bolster public health action. We also provide illustrative data and evidence on the application of digital solutions on selected public health areas. In the second part, we identify the strategic pillars for a successful European strategy for public health digitalization and we outline how the approach being pursued by the European Public Health Association (EUPHA) applies to digital health. From a public health perspective, digitalization is being touted as providing several potential benefits and advantages, including support for the transition from cure to prevention, helping to put people and patients at the center of care delivery, supporting patient empowerment and making healthcare system more efficient, safer and cheaper. These benefits are enabled through the following features of digital technologies: (i) Personalization and precision; (ii) Automation; (iii) Prediction; (iv) Data analytics and (v) Interaction. A successful European strategy for public health digitalization should integrate the following pillars: political commitment, normative frameworks, technical infrastructure, targeted economic investments, education, research, monitoring and evaluation. EUPHA acknowledges digitalization is an asset for public health and is working both to promote the culture of "public health digitalization", as well as to enable its planning, implementation and evaluation at the research, practice and policy level. |
Link | http://doi.org/10.1093/eurpub/ckz161 |
Title | Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic. |
Authors | Solimini, R; Busardò, FP; Gibelli, F; Sirignano, A; Ricci, G |
Journal | Medicina (Kaunas, Lithuania) |
Publication Date | 30 Nov 2021 |
Date Added to PubMed | 25 Dec 2021 |
Abstract | Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional-patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested. |
Link | http://doi.org/10.3390/medicina57121314 |
Title | Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review. |
Authors | Wongvibulsin, S; Habeos, EE; Huynh, PP; Xun, H; Shan, R; Porosnicu Rodriguez, KA; Wang, J; Gandapur, YK; Osuji, N; Shah, LM; Spaulding, EM; Hung, G; Knowles, K; Yang, WE; Marvel, FA; Levin, E; Maron, DJ; Gordon, NF; Martin, SS |
Journal | Journal of medical Internet research |
Publication Date | 8 Feb 2021 |
Date Added to PubMed | 9 Feb 2021 |
Abstract | Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions. |
Link | http://doi.org/10.2196/18773 |
Title | Digital Health Equity: Addressing Power, Usability, and Trust to Strengthen Health Systems. |
Authors | Koehle, H; Kronk, C; Lee, YJ |
Journal | Yearbook of medical informatics |
Publication Date | 1 Aug 2022 |
Date Added to PubMed | 5 Dec 2022 |
Abstract | Without specific attention to health equity considerations in design, implementation, and evaluation, the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities. We explored known factors that increase digital health inequity to contextualize the need for equity-centered informatics. This work used a narrative review method to summarize issues about inequities in digital health and to discuss future directions for researchers and clinicians. We searched literature using a combination of relevant keywords (e.g., "digital health", "health equity", etc.) using PubMed and Google Scholar. We have highlighted strategies for addressing medical marginalization in informatics according to vectors of power such as race and ethnicity, gender identity and modality, sexuality, disability, housing status, citizenship status, and criminalization status. We have emphasized collaboration with user and patient groups to define priorities, ensure accessibility and localization, and consider risks in development and utilization of digital health tools. Additionally, we encourage consideration of potential pitfalls in adopting these diversity, equity, and inclusion (DEI)-related strategies. |
Link | http://doi.org/10.1055/s-0042-1742512 |
Title | Digital health, gender and health equity: invisible imperatives. |
Authors | Sinha, C; Schryer-Roy, AM |
Journal | Journal of public health (Oxford, England) |
Publication Date | 1 Dec 2018 |
Date Added to PubMed | 18 Oct 2018 |
Abstract | A growing body of evidence shows the use of digital technologies in health-referred to as eHealth, mHealth or 'digital health'-is improving and saving lives in low- and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind. |
Link | http://doi.org/10.1093/pubmed/fdy171 |
Title | Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. |
Authors | Chang, JE; Lai, AY; Gupta, A; Nguyen, AM; Berry, CA; Shelley, DR |
Journal | The Milbank quarterly |
Publication Date | 1 Jun 2021 |
Date Added to PubMed | 3 Jun 2021 |
Abstract | Policy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. The COVID-19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID-19 pandemic. The study analyzed data about small primary care practices' telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State's stay-at-home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low-income, minority or immigrant areas that were more severely impacted by COVID-19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high-SVI or low-SVI areas. We then characterized respondents' telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high-SVI areas were almost twice as likely as providers in low-SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P <.001). The opposite was true for video, which was used as the primary telehealth modality by 18.7% of providers in high-SVI areas and 33.7% of providers in low-SVI areas (P <0.001). Providers in high-SVI areas also faced more patient-related barriers and fewer provider-related barriers than those in low-SVI areas. Between April and June 2020, telehealth became a prominent mode of primary care delivery in New York City. However, the transition to telehealth did not unfold in the same manner across communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. |
Link | http://doi.org/10.1111/1468-0009.12509 |
Title | eHealth and mHealth Development in Spain: Promise or Reality? |
Authors | Mahou, X; Barral, B; Fernández, Á; Bouzas-Lorenzo, R; Cernadas, A |
Journal | International journal of environmental research and public health |
Publication Date | 10 Dec 2021 |
Date Added to PubMed | 25 Dec 2021 |
Abstract | In the last decades, the use of Information and Communication Technologies (ICTs) has progressively spread to society and public administration. Health is one of the areas in which the use of ICTs has more intensively developed through what is now known as eHealth. That area has recently included mHealth. Spanish health system has stood out as one of the benchmarks of this technological revolution. The development of ICTs applied to health, especially since the outbreak of the pandemic caused by SARS Cov-2, has increased the range of health services delivered through smartphones and the development of subsequent specialized apps. Based on the data of a Survey on Use and Attitudes regarding eHealth in Spain, the aim of this research was to conduct a comparative analysis of the different eHealth and mHealth user profiles. The results show that the user profile of eHealth an mHealth services in Spain is not in a majority. Weaknesses are detected both in the knowledge and use of eHealth services among the general population and in the usability or development of their mobile version. Smartphones can be a democratizing vector, as for now, access to eHealth services is only available to wealthy people, widening inequality. |
Link | http://doi.org/10.3390/ijerph182413055 |
Title | Routine Prenatal Care. |
Authors | Peahl, AF; Turrentine, M; Srinivas, S; King, T; Zahn, CM |
Journal | Obstetrics and gynecology clinics of North America |
Publication Date | 1 Sep 2023 |
Date Added to PubMed | 28 Jul 2023 |
Abstract | The one-size-fits-all model of prenatal care has remained largely unchanged since 1930. New models of prenatal care delivery can improve its efficacy, equity, and experience through tailoring prenatal care to meet pregnant people's medical and social needs. Key aspects of recently developed prenatal care models include visit schedules based on needed services, telemedicine, home measurement of routine pregnancy parameters, and interventions that address social and structural drivers of health. Several barriers that affect the individual, provider, health system, and policy levels must be addressed to facilitate implementation of new prenatal care delivery models. |
Link | http://doi.org/10.1016/j.ogc.2023.03.002 |