The interaction between social determinants of health and cervical cancer survival: A systematic review.

OBJECTIVE: This systematic review aimed to investigate what are the most relevant social determinants of health (SDH), how they are measured, how they interact among themselves and what is their impact on the outcomes of cervical cancer patients. METHODS: Search was performed in PubMed, Scopus, Web of Science, Embase, Cochrane, and Google Scholar databases from January 2001 to September 2022. The protocol was registered at PROSPERO (CRD42022346854). We followed the PICOS strategy: Population- Patients treated for cervical cancer in the United States; Intervention - Any SDH; Comparison- None; Outcome measures- Cancer treatment outcomes related to the survival of the patients; Types of studies- Observational studies. Two reviewers extracted the data following the PRISMA guidelines. Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for risk of bias (ROB) assessment. RESULTS: Twenty-four studies were included (22 had low and 2 had moderate ROB). Most manuscripts analyzed data from public registries (83.3%) and only one SDH (54.17%). The SDH category of Neighborhood was not included in any study. Although the SDH were measured differently across the studies, not being married, receiving treatment at a low-volume hospital, and having public insurance (Medicaid or Medicare) or not being insured was associated with shorter survival of cervical cancer patients in most studies. CONCLUSIONS: There is a deficit in the number of studies comprehensively assessing the impact of SDH on cervical cancer treatment-related outcomes. Marital status, hospital volume and health insurance status are potential predictors of worse outcome.

Prevalence and Prevention of Reproducibility Deficiencies in Life Sciences Research: Large-Scale Meta-Analyses.

BACKGROUND Studies have found that many published life sciences research results are irreproducible. Our goal was to provide comprehensive risk estimates of familiar reproducibility deficiencies to support quality improvement in research. MATERIAL AND METHODS Reports included were peer-reviewed, published between 1980 and 2016, and presented frequency data of basic biomedical research deficiencies. Manual and electronic literature searches were performed in seven bibliographic databases. For deficiency concepts with at least four frequency studies and with a sample size of at least 15 units in each, a meta-analysis was performed. RESULTS Overall, 68 publications met our inclusion criteria. The study identified several major groups of research quality defects: study design, cell lines, statistical analysis, and reporting. In the study design group of 3 deficiencies, missing power calculation was the most frequent (82.3% [95% Confidence Interval (CI): 69.9-94.6]). Among the 6 cell line deficiencies, mixed contamination was the most frequent (22.4% [95% CI: 10.4-34.3]). Among the 3 statistical analysis deficiencies, the use of chi-square test when expected cells frequency was <5 was the most prevalent (15.7% [95% CI: -3.2-34.7]). In the reporting group of 12 deficiencies, failure to state the number of tails was the most frequent (65% [95% CI: 39.3-90.8]). CONCLUSIONS The results of this study could serve as a general reference when consistently measurable sources of deficiencies need to be identified in research quality improvement.

Trajectories of biomedical research leading to Nobel Prize-winning discoveries.

Significant advancements in public health come from scientific discoveries, but more are needed to meet the ever-growing societal needs. Examining the best practices of outstanding scientists may help develop future researchers and lead to more discoveries. This study compared the comprehensive work of 49 Nobel laureates in Physiology or Medicine from 2000 to 2019 to a matched control of National Institutes of Health (NIH)-funded biomedical investigators. Our unique data set, comprising 11,737 publications, 571 US patents, and 1693 NIH research awards produced by pre-Nobel laureates, was compared to a similar data set of control researchers. Compared to control researchers, pre-Nobel laureates produce significantly more publications annually (median = 5.66; interquartile range [IQR] = 5.16); significantly fewer coauthors per publication (median = 3.32; IQR = 1.95); consistently higher Journal Impact Factor publications (median = 12.04; IQR = 6.83); and substantially more patents per researcher (median = 5; IQR = 14). Such differences arose from nearly identical cumulative NIH award budgets of pre-Nobel laureates (median $25.3 M) and control researchers. Nobel laureates are neither hyper-prolific (>72 papers per year) nor hyper-funded (>$100 M cumulative). An academic age-specific trajectory graph allows aspiring researchers to compare their productivity and collaboration patterns to those of pre-Nobel laureates.

FAIR reporting of clinical trials for public health practice.

The number of clinical trials is rapidly growing, and automation of literature processing is becoming desirable but unresolved. Our purpose was to assess and increase the readiness of clinical trial reports for supporting automated retrieval and implementation in public health practice. We searched the Medline database for a random sample of clinical trials of HIV/AIDS management with likely relevance to public health in Africa. Five authors assessed trial reports for inclusion, extracted data, and assessed quality based on the FAIR principles of scientific data management (findable, accessible, interoperable, and reusable). Subsequently, we categorized reported results in terms of outcomes and essentials of implementation. A sample of 96 trial reports was selected. Information about the tested intervention that is essential for practical implementation was largely missing, including personnel resources needed 32·3% (.95 CI: 22·9-41·6); material/supplies needed 33·3% (.95 CI: 23·9-42·8); major equipment/building investment 42·8% (CI: 33·8-53·7); methods of educating providers 53·1% (CI: 43·1-63·4); and methods of educating the community 27·1% (CI: 18·2-36·0). Overall, 65% of studies measured health/biologic outcomes, among them, only a fraction showed any positive effects. Several specific design elements were identified that frequently make clinical trials unreal and their results unusable. To sort and interpret clinical trial results easier and faster, a new reporting structure, a practice- and retrieval-oriented trial outline with numeric outcomes (PROTON) table was developed and illustrated. Many clinical trials are either inconsequential by design or report incomprehensible results. According to the latest expectations of FAIR scientific data management, all clinical trial reports should include a consistent and practical impact-oriented table of clinical trial results.

Disparities in survival of hematologic malignancies in the context of social determinants of health: a systematic review.

Social determinants of health (SDHs) have been reported as relevant factors responsible for health inequity. We sought to assess clinical data from observational studies conducted in the United States evaluating the impact of SDHs on the outcomes of patients with hematologic malignancies. Thus, we performed a systematic review in 6 databases on 1 September 2021, in which paired reviewers independently screened studies and included data from 41 studies. We assessed the risk of bias using the Joanna Briggs Institute appraisal tools and analyzed the data using a descriptive synthesis. The most common SDH domains explored were health care access and quality (54.3%) and economic stability (25.6%); others investigated were education (19%) and social and community context (7.8%). We identified strong evidence of 5 variables significantly affecting survival: lack of health insurance coverage or having Medicare or Medicaid insurance, receiving cancer treatment at a nonacademic facility, low household income, low education level, and being unmarried. In contrast, the reports on the effect of distance traveled to the treatment center are contradictory. Other SDHs examined were facility volume, provider expertise, poverty, and employment rates. We identified a lack of data in the literature in terms of transportation, debt, higher education, diet, social integration, environmental factors, or stress. Our results underscore the complex nature of social, financial, and health care barriers as intercorrelated variables. Therefore, the management of hematologic malignancies needs concerted efforts to incorporate SDHs into clinical care, research, and public health policies, identifying and addressing the barriers at a patient-based level to enhance outcome equity (PROSPERO CRD42022346854).

A review of questionnaires used for the assessment of telemedicine.

INTRODUCTION: Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. METHODS: We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. RESULTS AND DISCUSSION: We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.

Analysis of recurrent research pathways for assessing and improving effectiveness in life sciences laboratories.

Background: Life sciences research often turns out to be ineffective. Our aim was to develop a method for mapping repetitive research processes, detecting practice variations, and exploring inefficiencies. Methods: Three samples of R&I projects were used: companion diagnostics of cancer treatments, identification of COVID-19 variants, and COVID-19 vaccine development. Major steps involved: defined starting points, desired end points; measurement of transition times and success rates; exploration of variations, and recommendations for improved efficiency. Results: Over 50% of CDX developments failed to reach market simultaneously with new drugs. There were significant variations among phases of co-development (Bartlett test P<0.001). Length of time in vaccine development also shows variations (P<0.0001). Similarly, subject participation indicates unexplained variations in trials (Phase I: 489.7 (±461.8); Phase II: 857.3 (±450.1); Phase III: 35402 (±18079). Conclusion: Analysis of repetitive research processes can highlight inefficiencies and show ways to improve quality and productivity in life sciences.

Data Integration for the Study of Outstanding Productivity in Biomedical Research.

Our goal is to analyze improvement of scientific performance in a multidimensional outcome space, with a focus on US-based biomedical research. With the growing diversity of research databases, limiting assessment of scientific productivity to bibliometric measures such as number of publications, impact factor of journals and number of citations, is increasingly challenged. Using a wider range of outcomes, from publications through practice improvements to entrepreneurial outcomes, overcomes many current limitations in the study of research growth. However, combining such heterogeneous datasets raise three challenges: 1. gathering in one common place a variety of data shared as csv, xml or xls files, 2. merging and linking this data, that sometimes overlap, 3. assessing the impact of research production and inclusive practices in a multidimensional space, that are often missing from the datasets. We would like to present our solution for the first of those challenges, and discuss our leads for the second and third challenges.

Athletic fitness development with electronic monitoring in older adult / Sportolás elektronikus monitorozással idoskorban.

Összefoglaló. Idosebb korban a testgyakorlás különösen fontos az izmok sorvadásának megelozése, valamint a vérnyomás és a testsúly kontrollja céljából. Ma már egyre gyakoribb az idoskorúak részvétele sportversenyeken is. Esettanulmányunk célja a késo felnottkori, illetve idoskori versenyszeru sportolás egészségi alkalmassági feltételeinek, kockázatainak és a teljesítoképesség változásainak bemutatása az elektronikus monitorozás és virtuális versenyzés korában. Esetünkben ez egy idoskorú személy 16 év során (54-70 éves kor) teljesített maratoni futóversenyeinek, valamint virtuális evezoversenyek részvételi és felkészülési adatainak elemzésével valósul meg. Esetünk illusztrálja, hogy az észszeru túlterhelés elve alapján az izmok adaptációja akkor következik be, amikor az edzés terhelése meghaladja az addig már elért terhelési szintet. A sportóra használata az elektronikus pulzusszám és a teljesítmény monitorozásával nemcsak a versenyek és edzések alatt a pulzusszám céltartományban tartására, de hosszabb távú tendenciák felismerésére is hasznosnak bizonyult. Az egészségi állapotnak megfelelo (sportág és intenzitás) idoskori testgyakorlás és sportversenyen való részvétel nemcsak az eronlét megtartását tuzheti ki célul, hanem értékes eronlétfejlesztést is. Orv Hetil. 2021; 162(51): 2061-2066. Summary. With advancing age, exercise becomes particularly important to prevent muscle atrophy and to control blood pressure and weight. Today, participation of aging people in athletic competitions is increasingly common. The aim of our case study is to explore and illustrate the health conditions, development and risk factors of competitive sporting activities of late adult and elderly athletes in the age of electronic monitoring and virtual racing. We processed the preparation and participation data of a total of 16 years of marathon races as well as rowing machine races of an elderly male person (age 54-70). Using a sports watch with electronic heart rate and performance monitoring has proved useful not only for keeping the heart rate in target range, but also for assessing trends in the long run. Our case underscores the value of reasonable overload with advancing age; beneficial muscle adaptation occurs when the workload of an exercise exceeds the previously reached level. Gradual exercise of older adults and participation in athletic competitions can not only maintain fitness but also develop valuable additional strength. Orv Hetil. 2021; 162(51): 2061-2066.

Healthcare via cell phones: a systematic review.

Regular care and informational support are helpful in improving disease-related health outcomes. Communication technologies can help in providing such care and support. The purpose of this study was to evaluate the empirical evidence related to the role of cell phones and text messaging interventions in improving health outcomes and processes of care. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to provide care and disease management support. Searches identified 25 studies that evaluated cell phone voice and text messaging interventions, with 20 randomized controlled trials and 5 controlled studies. Nineteen studies assessed outcomes of care and six assessed processes of care. Selected studies included 38,060 participants with 10,374 adults and 27,686 children. They covered 12 clinical areas and took place in 13 countries. Frequency of message delivery ranged from 5 times per day for diabetes and smoking cessation support to once a week for advice on how to overcome barriers and maintain regular physical activity. Significant improvements were noted in compliance with medicine taking, asthma symptoms, HbA1C, stress levels, smoking quit rates, and self-efficacy. Process improvements were reported in lower failed appointments, quicker diagnosis and treatment, and improved teaching and training. Cost per text message was provided by two studies. The findings that enhancing standard care with reminders, disease monitoring and management, and education through cell phone voice and short message service can help improve health outcomes and care processes have implications for both patients and providers.

eHealth: Connecting Health Care and Public Health.

Reducing risks and improving benefits to the patients are requirements health professionals are faced with in their daily work. Furthermore, cuts in health funds and the competition for budgets require to enhancing efficacy and efficiency of health services. For meeting both challenges, adequate information and knowledge is needed, which can be gathered from documentation systems such as Electronic Health Records or Personal Health Records (PHRs), but also by performing dedicated clinical studies such as randomized controlled trials (RCTs) or cohort studies. Based on a literature analysis, quality of, and benefits from, RCTs have been analyzed. The benefits from connecting public health and PHRs are discussed in some details.

Road Map For Diffusion Of Innovation In Health Care.

New scientific knowledge and innovation are often slow to disseminate. In other cases, providers rush into adopting what appears to be a clinically relevant innovation, based on a single clinical trial. In reality, adopting innovations without appropriate translation and repeated testing of practical application is problematic. In this article we provide examples of clinical innovations (for example, tight glucose control in critically ill patients) that were adopted inappropriately and that caused what we term a malfunction. To address the issue of malfunctions, we review various examples and suggest frameworks for the diffusion of knowledge leading to the adoption of useful innovations. The resulting model is termed an integrated road map for coordinating knowledge transformation and innovation adoption. We make recommendations for the targeted development of practice change procedures, practice change assessment, structured descriptions of tested interventions, intelligent knowledge management technologies, and policy support for knowledge transformation, including further standardization to facilitate sharing among institutions.

Are university rankings useful to improve research? A systematic review.

INTRODUCTION: Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. METHODS: A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. RESULTS: A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. DISCUSSION: No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and "luxury" indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance.

The Citizen Health System (CHS): a modular medical contact center providing quality telemedicine services.

In the context of the Citizen Health System (CHS) project, a modular Medical Contact Center (MCC) was developed, which can be used in the monitoring, treatment, and management of chronically ill patients at home, such as diabetic or congestive heart failure patients. The virtue of the CHS contact center is that, using any type of communication and telematics technology, it is able to provide timely and preventive prompting to the patients, thus, achieving better disease management. In this paper, we present the structure of the CHS system, describing the modules that enable its flexible and extensible architecture. It is shown, through specific examples, how quality of healthcare delivery can be increased by using such a system.

Big Data Clinical Research: Validity, Ethics, and Regulation.

Electronic Health Records (EHR) promise improvement for patient care and also offer great value for biomedical research including clinical, public health, and health services research. Unfortunately, the full potential of EHR big data research has remained largely unrealized. The purpose of this study was to identify rate limiting factors, and develop recommendations to better balance unrestricted extramural EHR access with legitimate safeguarding of EHR data in retrospective research. By exploring primary, secondary, and tertiary sources, this review identifies external constraints and provides a comparative analysis of social influencers in retrospective EHR-based research. Results indicate that EHRs have the advantage of reflecting the reality of patient care but also show a frequency of between 4.3-86% of incomplete and inaccurate data in various fields. The rapid spread of alternative analytics for health data challenges traditional interpretations of confidentiality protections. A confusing multiplicity of controls creates barriers to big data EHR research. More research on the use of EHR big data is likely to improve accuracy and validity. Information governance and research approval processes should be simplified. Comprehensive regulatory policies that do not exclusively cover health care entities, are needed. Finally, new computing safeguards are needed to address public concerns, like research access only to aggregate data and not to individually identifiable information.

Identifying cost management strategies in dialysis clinics: sustainable savings with positive outcomes.

OBJECTIVES: To examine whether cost management strategies are used in a revenue-constrained environment without compromising clinical effectiveness. STUDY DESIGN: Cross-sectional analysis of monthly cost and acuity-adjusted hospitalization data. METHODS: This research included longitudinal regression analyses involving 10 years of data, 1990 through 1999, from each of 6 dialysis centers. Two sets of regression models were used: one set examined cost interactions and cost trends (P < or = .001); the second set examined clinical outcomes (P < or = .001). Four cost management strategies were examined: (1) selective reductions in targeted cost categories, (2) cost reductions through improved efficiencies, (3) cost avoidance by shifting responsibilities to external parties, and (4) uniform reductions across all cost categories. RESULTS: Managers appeared to have limited opportunity to selectively or uniformly reduce costs because of cost "stickiness" and minimal resource substitutability. Improvements in operational efficiencies and cost shifting to external parties occurred. Over time, however, realized efficiencies increased at a decreasing rate, whereas cost shifting actually declined. Contrary to prior hospital studies, these results indicate significant economies of scale. No statistical correlation was found to indicate that the physician/clinic management teams' use of cost reduction strategies affected acuity-adjusted hospitalizations of dialysis patients. CONCLUSIONS: Strategic models that include both financial and outcomes data can enable healthcare managers to predict both positive and negative results of cost management proposals. These models can help identify aspects of an organization's cost structure that affect sustainable cost savings: cost stickiness, cost substitutability, institutional experience, realized operational improvements, and economies of scale.

eLearning: a review of Internet-based continuing medical education.

INTRODUCTION: The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes. METHODS: Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database of Systematic Reviews (third quarter, 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, and other information about educational content and format. RESULTS: Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; only three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME. DISCUSSION: The results demonstrate that Internet-based CME programs are just as effective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be performed to assess how long these new learned behaviors could be sustained. eLearning will continue to evolve as new innovations and more interactive modes are incorporated into learning.

From SARS to systems: developing advanced knowledge management for public health.

Historically, public health has been at the forefront of data processing applications but it is lagging behind other areas of health care in the application of advanced interconnected and mobile information technologies. Ready to use technologies are lacking not only for the management of emerging infections or bio-terrorism but also for the coordination of prevention and chronic care initiatives. Advanced information and knowledge management for community health should expedite the transfer of research evidence to practice and provide essential logistical support for action. We need to find ways to integrate new scientific knowledge into our environment in order to expedite the translation of research to practice.

Technology transfer from biomedical research to clinical practice: measuring innovation performance.

Studies documented 17 years of transfer time from clinical trials to practice of care. Launched in 2002, the National Institutes of Health (NIH) translational research initiative needs to develop metrics for impact assessment. A recent White House report highlighted that research and development productivity is declining as a result of increased research spending while the new drugs output is flat. The goal of this study was to develop an expanded model of research-based innovation and performance thresholds of transfer from research to practice. Models for transfer of research to practice have been collected and reviewed. Subsequently, innovation pathways have been specified based on common characteristics. An integrated, intellectual property transfer model is described. The central but often disregarded role of research innovation disclosure is highlighted. Measures of research transfer and milestones of progress have been identified based on the Association of University Technology Managers 2012 performance reports. Numeric milestones of technology transfer are recommended at threshold (top 50%), target (top 25%), and stretch goal (top 10%) performance levels. Transfer measures and corresponding target levels include research spending to disclosure (<$1.88 million), disclosure to patents (>0.81), patents to start-up (>0.1), patents to licenses (>2.25), and average per license income (>$48,000). Several limitations of measurement are described. Academic institutions should take strategic steps to bring innovation to the center of scholarly discussions. Research on research, particularly on pathways to disclosures, is needed to improve R&D productivity. Researchers should be informed about the technology transfer performance of their institution and regulations should better support innovators.