RESUMEN
OBJECTIVE: This study investigates the prevalence and determinants of awareness of precision medicine among a nationally representative sample of individuals with self-reported depression and anxiety in the United States." METHODS: Data were obtained from the Health Information National Trends Survey (HINTS) 5, Cycle 4, which is a study administered by the National Cancer Institute and is nationally representative. The survey, conducted between February and June 2020, targeted non-institutionalized, civilian US adults aged 18 years and older. Utilizing survey-weighted logistic regression, predictors of precision medicine awareness were assessed, encompassing sociodemographic, health-related, and technological factors. RESULTS: Among 890 individuals with self-reported depression and/or anxiety, approximately 15.3% reported awareness of precision medicine. Participants who had a higher level of education and those who had increased health-linked social media usage were three times more likely to be aware of precision medicine compared to those who did not. Old age was also positively associated with increased awareness. CONCLUSION: The present study's findings have disclosed an alarming lack of awareness of precision medicine, particularly among mentally ill persons with anxiety or depression, in which the targeted subgroups, including individuals with lower education levels and limited health-linked social media utilization, indicated lower levels of awareness. As such, it is recommended that such disparities be tackled using customized interventions along with educational initiatives, as this is likely to improve awareness levels while also ensuring equitable and increased access to precision medicine within the context of mental health.
RESUMEN
In healthcare, continuity of care is a crucial element, especially for patients in the field of psychiatry who have recently been discharged from a hospital. The shift from inpatient to outpatient care poses challenges for patients and healthcare providers, including openness to treatment, competing priorities, financial insecurity, concerns and dilemmas faced by patients regarding their post-hospitalization life after improvements in symptoms, lack of social support, poor patient-doctor relationships, lack of insight, and stigma associated with mental illness. Therefore, it is vital to employ effective strategies to ensure patients receive the required care and support during this transition. This review delves into the significance of continuity of care for psychiatric patients post-hospitalization, effective strategies for the transition, and the challenges and barriers to implementation from the perspective of a family medicine practice. To analyze physicians' role in managing psychiatric patients post-hospitalization, we developed a comprehensive search strategy. This involved extracting relevant data, updates, guidelines, and recommendations. Our search spanned various online repositories, such as PubMed and Google Scholar, specifically focusing on US-based guidelines aligned with our objectives. The search was conducted using medical subject headings (MeSH) and combinations of "OR," "AND," and "WITH." We crafted keywords to optimize our search strategy, including psychiatric illness, post-hospitalization, follow-up, follow-up care, primary care follow-up, and guidelines. Exploring online repositories yielded 132 articles, and we identified some guidelines that addressed our objectives. We established inclusion and exclusion criteria for our review and reviewed 21 papers. Post-hospitalization follow-up is a critical facet of psychiatric care, aligning with guidelines from the American Psychiatric Association and other relevant sources. Emphasizing continuity of care ensures a smooth transition from inpatient to outpatient settings, sustaining therapeutic momentum and minimizing the risk of relapse. This comprehensive approach involves careful medication management, regular mental health assessments, education on condition-specific coping strategies, and coordinated care between healthcare providers. It includes conducting risk assessments, safety planning, building social support and community integration, prompt post-hospitalization follow-up, and tailored treatment plans. Together, these measures enhance overall wellness for recently discharged patients. This holistic strategy tackles pressing short-term needs while facilitating long-term stability, promoting resilience and successful community reintegration, reducing readmission likelihood, and ultimately supporting sustained recovery.
RESUMEN
BACKGROUND: With an increase in the number of artificial intelligence (AI) and machine learning (ML) algorithms available for clinical settings, appropriate model updating and implementation of updates are imperative to ensure applicability, reproducibility, and patient safety. OBJECTIVE: The objective of this scoping review was to evaluate and assess the model-updating practices of AI and ML clinical models that are used in direct patient-provider clinical decision-making. METHODS: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist and the PRISMA-P protocol guidance in addition to a modified CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist to conduct this scoping review. A comprehensive medical literature search of databases, including Embase, MEDLINE, PsycINFO, Cochrane, Scopus, and Web of Science, was conducted to identify AI and ML algorithms that would impact clinical decision-making at the level of direct patient care. Our primary end point is the rate at which model updating is recommended by published algorithms; we will also conduct an assessment of study quality and risk of bias in all publications reviewed. In addition, we will evaluate the rate at which published algorithms include ethnic and gender demographic distribution information in their training data as a secondary end point. RESULTS: Our initial literature search yielded approximately 13,693 articles, with approximately 7810 articles to consider for full reviews among our team of 7 reviewers. We plan to complete the review process and disseminate the results by spring of 2023. CONCLUSIONS: Although AI and ML applications in health care have the potential to improve patient care by reducing errors between measurement and model output, currently there exists more hype than hope because of the lack of proper external validation of these models. We expect to find that the AI and ML model-updating methods are proxies for model applicability and generalizability on implementation. Our findings will add to the field by determining the degree to which published models meet the criteria for clinical validity, real-life implementation, and best practices to optimize model development, and in so doing, reduce the overpromise and underachievement of the contemporary model development process. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37685.
RESUMEN
OBJECTIVE: To assess the use of health information technology (HIT) among adults with chronic low back pain (CLBP) in the United States and to evaluate the relationship between HIT use and self-rated health. METHODS: The independent variable was the use of the internet to (1) fill prescriptions, (2) communicate with a healthcare provider, (3) look up health information, and (4) schedule a medical appointment. Respondents rated their health in the last 12 months as worse, about the same, or better. A Chi-square analysis was used to assess the use of HIT among those with CLBP; a logistic regression was used to determine predictors of HIT use; and an ordinal logistic regression was used to assess the relationship between HIT and self-rated health. RESULTS: As compared to those without CLBP, those with CLBP are more likely to use the internet to look up health information (58.9 vs. 53.8%, p-value<.001), refill prescriptions (13.9% vs. 10.5%, p-value<.001), and communicate with a healthcare provider (19.8% vs.15.3%, p-value<.001). Being employed and having a higher level of education were positive predictors of HIT use. As compared to other uses of the internet, using the internet to communicate with a healthcare provider was associated with higher odds of rating health as better compared to worse or about the same within the last 12 months. CONCLUSION: Among adults with CLBP, a more affluent social status is associated with the use of HIT. Also, HIT is associated with a better health rating as compared to not using it at all. Further studies should assess the longitudinal relationship between HIT use and how adults with CLBP rate their health.
RESUMEN
Background and Objective In the United States, hypertension remains a significant cause of cardiovascular disease mortality and morbidity, affecting various racial and ethnic groups. High blood pressure is a common health concern, given its high frequency among all populations and racial groups in the United States; nevertheless, the condition remains untreated in most individuals. It affects a significant number of individuals in the African American community and contributes to a notable proportion of deaths. Arguably more prevalent, severe, and tends to occur earlier in African Americans compared to some other races. This lack of blood pressure control may contribute to the increasing mortality rates associated with hypertension-related cardiovascular diseases in the United States, while notable race and sex disparities persist. This study aims to compare the number of deaths caused by each cardiovascular disease (hypertension) in African Americans to those of people of other races. Methodology To understand the impact of hypertension on mortality rates among different racial groups, this study utilized the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) dataset, which includes death certificates filed in the United States. The research focused on individuals aged 25 years or older with a mention of hypertension and cardiovascular disease as the underlying cause of death between 1999 and 2019. The study analyzed hypertension-associated deaths by different cardiovascular disease subtypes, such as ischemic heart disease, heart failure (HF), and cerebrovascular diseases that include acute ischemic attacks, which are the most frequent in the United States, with specific assessments for African Americans, White, and other races' decedents. Results The study findings indicated that African American males had higher mortality rates from cardiovascular diseases compared to African American females. The prevalence of hypertension was also higher among African Americans (87.47%) compared to Whites (30.33%), Asian/Pacific Islanders (40.26%), and American Indians/Alaska Natives (61.18%). Additionally, the study identified regional variations in mortality rates, with states like Arizona, California, Texas, Florida, and Washington having higher rates, while Vermont, North Dakota, and Wyoming had lower rates. The northwest region had lower mortality compared to the western and southwestern regions. Conclusions Within the studied period, there was an increase in the prevalence of mortality due to hypertension amongst African Americans when compared to other races. These findings underscore the pressing need to address the increasing prevalence of hypertension and mortality rates among African American. More efforts should focus on prevention of CVD and hypertension and the associated risk factors based on the World Health Organization (WHO) recommendations, which include the promotion of healthy lifestyle behaviors, improvement of access to quality healthcare, and implementation of culturally sensitive interventions tailored for African American communities.