Medline

MEDLINE
  • 文章类型: Journal Article
    手术部位感染(SSIs)构成了重大的临床挑战,对于接受外科手术的糖尿病患者来说,风险增加,后果严重。本系统综述旨在综合当前有关有效预防策略的证据,以减轻该弱势群体的SSI风险。从成立到2024年3月,我们全面搜索了多个电子数据库(PubMed,Medline,Embase,科克伦图书馆,CINAHL)以确定评估糖尿病手术患者SSI预防策略的相关研究。我们的搜索策略遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目。利用与糖尿病相关的关键词和医学主题词(MeSH)术语的组合,手术部位感染,预防策略,和外科手术。纳入标准侧重于同行评审的临床试验,随机对照试验,以及以英文发表的荟萃分析。搜索产生了三项符合资格标准的研究,进行数据提取和定性综合。关键发现强调了干预措施的有效性,例如优化围手术期血糖控制,及时预防性使用抗生素,术前细致的皮肤防腐可降低糖尿病手术患者的SSI率。基于个体患者因素的个性化预防方法的潜力,比如糖尿病类型和手术复杂性,被探索了。这一系统的审查强调了多方面的重要性,基于证据的方法预防糖尿病手术患者的SSI,整合策略,如血糖控制,抗生素预防,术前皮肤防腐.此外,我们的研究结果表明,针对患者个体特征量身定制的个性化护理路径的潜在益处.实施这些干预措施需要跨学科合作,适应不同的医疗保健环境,通过文化敏感的教育举措和患者参与。这一综合分析为临床实践提供了信息,促进患者安全,并有助于全球努力提高这一高危人群的手术效果。
    Surgical site infections (SSIs) pose a significant clinical challenge, with heightened risks and severe consequences for diabetic patients undergoing surgical procedures. This systematic review aims to synthesize the current evidence on effective prevention strategies for mitigating SSI risk in this vulnerable population. From inception to March 2024, we comprehensively searched multiple electronic databases (PubMed, Medline, Embase, Cochrane Library, CINAHL) to identify relevant studies evaluating SSI prevention strategies in diabetic surgical patients. Our search strategy followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, utilizing a combination of keywords and Medical Subject Headings (MeSH) terms related to diabetes, surgical site infections, prevention strategies, and surgical procedures. Inclusion criteria focused on peer-reviewed clinical trials, randomized controlled trials, and meta-analyses published in English. The search yielded three studies meeting the eligibility criteria, subject to data extraction and qualitative synthesis. Key findings highlighted the efficacy of interventions such as optimized perioperative glycemic control, timely prophylactic antibiotic administration, and meticulous preoperative skin antisepsis in reducing SSI rates among diabetic surgical patients. The potential for personalized prevention approaches based on individual patient factors, such as diabetes type and surgical complexity, was explored. This systematic review underscores the importance of a multifaceted, evidence-based approach to SSI prevention in diabetic surgical patients, integrating strategies like glycemic control, antibiotic prophylaxis, and preoperative skin antisepsis. Furthermore, our findings suggest the potential benefits of personalized care pathways tailored to individual patient characteristics. Implementing these interventions requires interdisciplinary collaboration, adaptation to diverse healthcare settings, and patient engagement through culturally sensitive education initiatives. This comprehensive analysis informs clinical practice, fosters patient safety, and contributes to the global efforts to enhance surgical outcomes for this high-risk population.
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  • 文章类型: Journal Article
    背景:低收入或中等收入国家(LMIC)人道主义环境中的姑息治疗是一个新领域,近年来经历了一定程度的增长势头。审查有助于这种不断增长的知识体系,除了确定未来研究的差距。总体目标是系统地探索LMIC人道主义环境中患者和/或其家人姑息治疗需求的证据。
    方法:Arksey和O'Malley's(IntJSocResMethodol。8:19-32,2005)范围审查框架构成了研究设计的基础,遵循Levac等人的进一步指导。(实施科学5:1-9,2010),乔安娜·布里格斯研究所(JBI)彼得斯等人。(JBI审阅者手册JBI:406-452,2020年),以及Tricco等人的系统评价和Meta分析扩展的首选报告项目(PRISMA-ScR)。(安实习生医学169:467-73,2018)。这包括了一个五步的方法和人口,概念,和上下文(PCC)框架。使用已经确定的关键词/术语,从2012年1月到2022年10月,将使用数据库搜索已发表的研究和灰色文献(可能包括护理和联合健康累积指数(CINAHL),MEDLINE,Embase,全球卫生,Scopus,应用社会科学索引和摘要(ASSIA),WebofScience,政策共用,JSTOR,国际货币基金组织和世界银行图书馆网,Google高级搜索,和GoogleScholar)以及选定的预打印站点和网站。数据选择将根据纳入和排除标准进行,每个阶段将由两名审查人员进行审查。用三分之一来解决任何分歧。提取的数据将在表中绘制。此审查不需要道德批准。
    结论:调查结果将以表格和图表/图表的形式呈现,然后是叙述性描述。审查将于2022年10月下旬至2023年初进行。这是第一个系统范围审查,专门探讨患者和/或其家人的姑息治疗需求,在LMIC人道主义环境中。审查结果的论文将于2023年提交出版。
    BACKGROUND: Palliative care in low- or middle-income country (LMIC) humanitarian settings is a new area, experiencing a degree of increased momentum over recent years. The review contributes to this growing body of knowledge, in addition to identifying gaps for future research. The overall aim is to systematically explore the evidence on palliative care needs of patients and/or their families in LMIC humanitarian settings.
    METHODS: Arksey and O\'Malley\'s (Int J Soc Res Methodol. 8:19-32, 2005) scoping review framework forms the basis of the study design, following further guidance from Levac et al. (Implement Sci 5:1-9, 2010), the Joanna Briggs Institute (JBI) Peters et al. (JBI Reviewer\'s Manual JBI: 406-452, 2020), and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) from Tricco et al. (Ann Intern Med 169:467-73, 2018). This incorporates a five-step approach and the population, concept, and context (PCC) framework. Using already identified key words/terms, searches for both published research and gray literature from January 2012 to October 2022 will be undertaken using databases (likely to include Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, Embase, Global Health, Scopus, Applied Social Science Index and Abstracts (ASSIA), Web of Science, Policy Commons, JSTOR, Library Network International Monetary Fund and World Bank, Google Advanced Search, and Google Scholar) in addition to selected pre-print sites and websites. Data selection will be undertaken based on the inclusion and exclusion criteria and will be reviewed at each stage by two reviewers, with a third to resolve any differences. Extracted data will be charted in a table. Ethical approval is not required for this review.
    CONCLUSIONS: Findings will be presented in tables and diagrams/charts, followed by a narrative description. The review will run from late October 2022 to early 2023. This is the first systematic scoping review specifically exploring the palliative care needs of patients and/or their family, in LMIC humanitarian settings. The paper from the review findings will be submitted for publication in 2023.
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  • 文章类型: Journal Article
    背景:深部脑刺激(DBS)可用于治疗多种神经和精神疾病,例如帕金森氏病,癫痫和强迫症;然而,为评估DBS访问和实施方面的差异,已经做了有限的工作。本范围审查的目的是确定DBS临床提供差异的来源。
    方法:将根据系统审查的首选报告项目和范围审查方法的荟萃分析扩展进行范围审查。相关研究将从包括MEDLINE/PubMed在内的数据库中确定,EMBASE和WebofScience,以及保留文章的参考列表。最初的搜索日期是2023年1月,研究仍在进行中。将完成对可能符合条件的研究的标题和摘要的初步筛选,收集相关研究以供全文回顾。然后,主要研究者和共同作者将独立审查所有符合纳入标准的全文文章。将以表格格式提取和收集数据。最后,结果将在表格和叙述报告中进行综合。
    背景:对于拟议的范围界定审查,不需要机构委员会审查或批准。研究结果将提交给相关的同行评审期刊和会议发表。
    该协议已在开放科学框架(https://osf.io/cxvhu)上进行了前瞻性注册。
    BACKGROUND: Deep brain stimulation (DBS) can be used to treat several neurological and psychiatric conditions such as Parkinson\'s disease, epilepsy and obsessive-compulsive disorder; however, limited work has been done to assess the disparities in DBS access and implementation. The goal of this scoping review is to identify sources of disparity in the clinical provision of DBS.
    METHODS: A scoping review will be conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for Scoping Reviews methodology. Relevant studies will be identified from databases including MEDLINE/PubMed, EMBASE and Web of Science, as well as reference lists from retained articles. Initial search dates were in January 2023, with the study still ongoing. An initial screening of the titles and abstracts of potentially eligible studies will be completed, with relevant studies collected for full-text review. The principal investigators and coauthors will then independently review all full-text articles meeting the inclusion criteria. Data will be extracted and collected in table format. Finally, results will be synthesised in a table and narrative report.
    BACKGROUND: No institutional board review or approval is necessary for the proposed scoping review. The findings will be submitted for publication to relevant peer-reviewed journals and conferences.
    UNASSIGNED: This protocol has been registered prospectively on the Open Science Framework (https://osf.io/cxvhu).
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  • 文章类型: Review
    目标:像OpenAI的ChatGPT这样的大型语言模型(LLM)是强大的生成系统,可以快速合成自然语言响应。对LLM的研究揭示了它们的潜力和陷阱,尤其是在临床环境中。然而,医学LLM研究的不断发展的景观在他们的评估方面留下了几个空白,应用程序,和证据基础。
    目的:本范围综述旨在(1)总结当前有关LLM在医学应用中的准确性和有效性的研究证据,(2)商量伦理,legal,后勤,以及LLM在临床环境中使用的社会经济意义,(3)探索医疗保健中LLM实施的障碍和促进者,(4)提出一个评估LLM临床效用的标准化评估框架,(5)确定证据空白,并提出未来LLM在临床应用中的研究方向。
    方法:我们从MEDLINE筛选了4,036条记录,EMBASE,CINAHL,medRxiv,bioRxiv,和arXiv从2023年1月(搜索开始)到2023年6月26日的英文论文,并分析了55项全球研究的结果。根据牛津循证医学中心的建议报告证据质量。
    结果:我们的结果表明,LLM在编制患者笔记方面显示出希望,协助患者在医疗保健系统中导航,在某种程度上,当与人类监督相结合时,支持临床决策。然而,它们的利用受到可能伤害患者的训练数据偏见的限制,产生不准确但令人信服的信息,和道德,legal,社会经济,和隐私问题。我们还发现缺乏评估LLM有效性和可行性的标准化方法。
    结论:因此,这篇综述强调了解决这些局限性的潜在未来方向和问题,并进一步探索LLM在增强医疗保健服务方面的潜力。
    结论:问题大型语言模型(LLM)在临床环境中的应用现状如何?以及与它们的整合相关的主要挑战和机遇是什么?分析55项研究,表示当LLM,包括OpenAI的ChatGPT,在编制病人笔记方面显示出潜力,协助医疗保健导航,并支持临床决策,它们的使用受到数据偏见的限制,产生看似合理但不正确的信息,以及各种道德和隐私问题。研究的严谨性有很大差异,尤其是在评估LLM响应时,呼吁标准化的评估方法,包括既定的指标,如ROUGE,METEOR,G-Eval,和MultiMedQA。意义研究结果表明,在LLM研究中需要增强的方法,强调整合真实患者数据和考虑健康的社会决定因素的重要性,提高LLM在临床环境中的适用性和安全性。
    OBJECTIVE: Large language models (LLMs) like OpenAI\'s ChatGPT are powerful generative systems that rapidly synthesize natural language responses. Research on LLMs has revealed their potential and pitfalls, especially in clinical settings. However, the evolving landscape of LLM research in medicine has left several gaps regarding their evaluation, application, and evidence base.
    OBJECTIVE: This scoping review aims to (1) summarize current research evidence on the accuracy and efficacy of LLMs in medical applications, (2) discuss the ethical, legal, logistical, and socioeconomic implications of LLM use in clinical settings, (3) explore barriers and facilitators to LLM implementation in healthcare, (4) propose a standardized evaluation framework for assessing LLMs\' clinical utility, and (5) identify evidence gaps and propose future research directions for LLMs in clinical applications.
    METHODS: We screened 4,036 records from MEDLINE, EMBASE, CINAHL, medRxiv, bioRxiv, and arXiv from January 2023 (inception of the search) to June 26, 2023 for English-language papers and analyzed findings from 55 worldwide studies. Quality of evidence was reported based on the Oxford Centre for Evidence-based Medicine recommendations.
    RESULTS: Our results demonstrate that LLMs show promise in compiling patient notes, assisting patients in navigating the healthcare system, and to some extent, supporting clinical decision-making when combined with human oversight. However, their utilization is limited by biases in training data that may harm patients, the generation of inaccurate but convincing information, and ethical, legal, socioeconomic, and privacy concerns. We also identified a lack of standardized methods for evaluating LLMs\' effectiveness and feasibility.
    CONCLUSIONS: This review thus highlights potential future directions and questions to address these limitations and to further explore LLMs\' potential in enhancing healthcare delivery.
    CONCLUSIONS: Question What is the current state of Large Language Models’ (LLMs) application in clinical settings, and what are the primary challenges and opportunities associated with their integration? Findings This scoping review, analyzing 55 studies, indicates that while LLMs, including OpenAI’s ChatGPT, show potential in compiling patient notes, aiding in healthcare navigation, and supporting clinical decision-making, their use is constrained by data biases, the generation of plausible but incorrect information, and various ethical and privacy concerns. A significant variability in the rigor of studies, especially in evaluating LLM responses, calls for standardized evaluation methods, including established metrics like ROUGE, METEOR, G-Eval, and MultiMedQA. Meaning The findings suggest a need for enhanced methodologies in LLM research, stressing the importance of integrating real patient data and considering social determinants of health, to improve the applicability and safety of LLMs in clinical environments.
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  • 文章类型: Journal Article
    背景:基于社区的参与式研究(CBPR)是一种合作研究方法,可在研究过程的所有步骤中平等地吸引研究人员和社区利益相关者,以促进社会变革并增加研究相关性。社区咨询委员会(CAB)是一个CBPR工具,其中具有生活经验和社区组织的个人被纳入研究过程,并确保工作与社区优先事项保持一致。我们寻求(1)探索招聘和参与具有CAB生活经验的人的最佳实践,以及(2)确定有关最小化组织和社区成员之间的动力动力动力的文献范围,这些成员具有在CAB上一起工作的生活经验。
    方法:此范围审查将遵循Arksey和O\'Malley方法框架,由Levac等人通知,并将使用PRISMA(系统审查和荟萃分析的首选报告项目)图进行报告。已经为Embase开发了详细和强大的搜索策略,Medline和PsychINFO。将考虑在1990年1月1日至2023年3月30日之间发表的灰色文献参考文献和参考文献列表。两名审稿人将在标题/摘要和全文筛选的两个连续阶段中独立筛选参考文献。冲突将由协商一致或第三审稿人决定。主题分析将分三个阶段应用:开放编码、轴向编码和抽象。提取的数据将以表格格式和/或图形摘要记录和显示,描述性概述,讨论研究结果与研究问题的关系。此时,已经对同行评审和灰色文献进行了初步搜索。同行评审文献的搜索结果已被上传到Covidence进行回顾和相关性评估。
    背景:本次审查不需要正式的伦理批准。审查结果将为正在进行和未来的CBPR社区咨询委员会动态提供信息。
    背景:该协议已在开放科学框架(https://doi.org/10.17605/OSF)上进行了前瞻性注册。IO/QF5D3)。
    BACKGROUND: Community-based participatory research (CBPR) is a collaborative research approach that equally engages researchers and community stakeholders throughout all steps of the research process to facilitate social change and increase research relevance. Community advisory boards (CABs) are a CBPR tool in which individuals with lived experience and community organisations are integrated into the research process and ensure the work aligns with community priorities. We seek to (1) explore the best practices for the recruitment and engagement of people with lived experiences on CABs and (2) identify the scope of literature on minimising power dynamics between organisations and community members with lived experience who work on CABs together.
    METHODS: This scoping review will follow the Arksey and O\'Malley methodological framework, informed by Levac et al, and will be reported using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram. Detailed and robust search strategies have been developed for Embase, Medline and PsychINFO. Grey literature references and reference lists of included articles published between 1 January 1990 and 30 March 2023 will be considered. Two reviewers will independently screen references in two successive stages of title/abstract and full-text screening. Conflicts will be decided by consensus or a third reviewer. Thematic analysis will be applied in three phases: open coding, axial coding and abstraction. Extracted data will be recorded and presented in a tabular format and/or graphical summaries, with a descriptive overview discussing how the research findings relate to the research questions. At this time, a preliminary search of peer-reviewed and grey literature has been conducted. Search results for peer-reviewed literature have been uploaded to Covidence for review and appraisal for relevance.
    BACKGROUND: Formal ethics approval is not required for this review. Review findings will inform ongoing and future CBPR community advisory board dynamics.
    BACKGROUND: The protocol has been registered prospectively on the Open Science Framework (https://doi.org/10.17605/OSF.IO/QF5D3).
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  • 文章类型: Journal Article
    背景:在护理教育中,弥合理论知识和实践技能之间的差距对于培养临床实践能力至关重要。护理学生在获得这些基本技能时遇到挑战,使自我效能感成为他们专业发展的重要组成部分。自我效能感与个人对执行任务和克服挑战的能力的信念有关,对临床技能获取和学术成功具有重要意义。先前的研究强调了护理专业学生的自我效能感与其临床能力之间的紧密联系。技术已经成为一种有前途的工具,通过实现个性化的学习体验和深入的讨论来增强自我效能感。然而,有必要进行全面的文献审查,以评估现有的知识体系并确定研究差距。
    目的:本研究的目的是系统地绘制和识别已发表的关于使用技术支持指导模式来激发护生在临床实践中的自我效能感的研究中的差距。
    方法:本范围审查遵循Arksey和O\'Malley的框架,并根据系统审查和范围审查荟萃分析的首选报告项目(PRISMA-ScR)进行报告。一个系统的,在ERIC进行了全面的文献检索,CINAHL,MEDLINE,Embase,PsycINFO,和WebofScience在2011年1月至2023年4月之间发表的研究。手动搜索所包含论文的参考列表以确定其他研究。成对的作者筛选了这些论文,评估合格,并提取数据。数据是按主题组织的。
    结果:共纳入8项研究,确定了四个主题组:(1)学习支持的技术解决方案,(2)临床实践中的学习重点,(3)自我效能感的教学策略和理论方法,(4)自我效能感和互补结果的评估。
    结论:指导模式采用多种技术方案,激发护生在临床实践中的自我效能感,导致积极的发现。8项研究中有7项结果没有统计学意义,强调需要进一步完善所应用的干预措施。护士教育者在应用学习策略和理论方法来提高护生的自我效能中起着举足轻重的作用。但是护士导师和同龄人的贡献不容忽视。未来的研究应考虑让用户参与干预过程,并使用适合研究干预目标的有效工具。确保相关性并实现跨研究的比较。
    In nursing education, bridging the gap between theoretical knowledge and practical skills is crucial for developing competence in clinical practice. Nursing students encounter challenges in acquiring these essential skills, making self-efficacy a critical component in their professional development. Self-efficacy pertains to individual\'s belief in their ability to perform tasks and overcome challenges, with significant implications for clinical skills acquisition and academic success. Previous research has underscored the strong link between nursing students\' self-efficacy and their clinical competence. Technology has emerged as a promising tool to enhance self-efficacy by enabling personalized learning experiences and in-depth discussions. However, there is a need for a comprehensive literature review to assess the existing body of knowledge and identify research gaps.
    The aim of this study is to systematically map and identify gaps in published studies on the use of technology-supported guidance models to stimulate nursing students\' self-efficacy in clinical practice.
    This scoping review followed the framework of Arksey and O\'Malley and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). A systematic, comprehensive literature search was conducted in ERIC, CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science for studies published between January 2011 and April 2023. The reference lists of the included papers were manually searched to identify additional studies. Pairs of authors screened the papers, assessed eligibility, and extracted the data. The data were thematically organized.
    A total of 8 studies were included and four thematic groups were identified: (1) technological solutions for learning support, (2) learning focus in clinical practice, (3) teaching strategies and theoretical approaches for self-efficacy, and (4) assessment of self-efficacy and complementary outcomes.
    Various technological solutions were adopted in the guidance models to stimulate the self-efficacy of nursing students in clinical practice, leading to positive findings. A total of 7 out of 8 studies presented results that were not statistically significant, highlighting the need for further refinement of the applied interventions. Nurse educators play a pivotal role in applying learning strategies and theoretical approaches to enhance nursing students\' self-efficacy, but the contributions of nurse preceptors and peers should not be overlooked. Future studies should consider involving users in the intervention process and using validated instruments tailored to the studies\' intervention objectives, ensuring relevance and enabling comparisons across studies.
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  • 文章类型: Journal Article
    背景:在过去的十年中,已经研究了几种机器学习(ML)算法,以评估其检测语音障碍的功效。文献表明,ML算法可以高精度检测语音障碍。这表明ML有可能帮助临床医生分析和评估语音障碍的治疗结果。然而,尽管进行了大量的研究,没有一种算法足够可靠,可用于临床.通过这次审查,我们的目标是通过识别标准音频任务来识别阻碍ML算法在临床环境中使用的关键问题,声学特征,处理算法和影响这些算法有效性的环境因素。
    方法:我们将搜索以下数据库:WebofScience,Scopus,Compendex,CINAHL,Medline,IEEE探索和Embase。我们的搜索策略是在大学图书馆工作人员的协助下制定的,以适应不同的语法要求。文献检索将包括2013年至2023年之间的时期,并且将仅限于以英语发表的文章。我们将排除社论,正在进行的研究和工作文件。的选择,搜索数据的提取和分析将使用“用于系统审查和Meta分析的首选报告项目扩展”系统进行范围审查。相同的系统也将用于合成结果。
    背景:本范围审查不需要伦理批准,因为审查仅由同行评审的出版物组成。研究结果将在与语音病理学相关的同行评审出版物中发表。
    BACKGROUND: Over the past decade, several machine learning (ML) algorithms have been investigated to assess their efficacy in detecting voice disorders. Literature indicates that ML algorithms can detect voice disorders with high accuracy. This suggests that ML has the potential to assist clinicians in the analysis and treatment outcome evaluation of voice disorders. However, despite numerous research studies, none of the algorithms have been sufficiently reliable to be used in clinical settings. Through this review, we aim to identify critical issues that have inhibited the use of ML algorithms in clinical settings by identifying standard audio tasks, acoustic features, processing algorithms and environmental factors that affect the efficacy of those algorithms.
    METHODS: We will search the following databases: Web of Science, Scopus, Compendex, CINAHL, Medline, IEEE Explore and Embase. Our search strategy has been developed with the assistance of the university library staff to accommodate the different syntactical requirements. The literature search will include the period between 2013 and 2023, and will be confined to articles published in English. We will exclude editorials, ongoing studies and working papers. The selection, extraction and analysis of the search data will be conducted using the \'Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews\' system. The same system will also be used for the synthesis of the results.
    BACKGROUND: This scoping review does not require ethics approval as the review solely consists of peer-reviewed publications. The findings will be presented in peer-reviewed publications related to voice pathology.
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  • 文章类型: Systematic Review
    背景:对大型健康数据集的分析越来越受到重视,以得出新的临床决策支持系统(CDSS)。然而,很少有数据驱动的CDSS被用于临床实践。对这些工具的信任被认为是接受和接受的基础,但迄今为止,对定义或评估临床环境中的信任的关注很少。
    目的:进行了范围审查,以探讨如何以及在何处从卫生专业人员的角度评估数据驱动的CDSS的可接受性和可信度。
    方法:Medline,Embase,PsycInfo,WebofScience,Scopus,ACM数字,IEEEXplore和GoogleScholar于2022年3月进行了搜索,使用的术语扩展自:“数据驱动”和“临床决策支持”和“可接受性”。纳入的研究集中在面向医疗从业者的数据驱动的CDSS,与临床护理直接相关。它们包括信任或代理作为结果,或者在讨论中。在本综述的报告中,遵循系统综述和荟萃分析扩展范围综述(PRISMA-ScR)的首选报告项目。
    结果:筛选了3291篇论文,85项主要研究研究符合纳入条件。研究涵盖了各种临床专长和预期背景,但假设的系统(24)超过了临床使用的系统(18)。25项研究衡量了信任,通过各种各样的定量,定性和混合方法。另外24个讨论了信任的主题,但没有明确评估,从这些,透明度的主题,可解释性,和支持证据被确定为影响医疗保健从业者对数据驱动的CDSS信任的因素。
    结论:关于数据驱动的CDSS的研究越来越多,但很少有研究深入探讨利益相关者的看法,对可信度的专注研究有限。对医疗保健从业者接受度的进一步研究,包括透明度和可解释性的要求,应告知临床实施。
    BACKGROUND: Increasing attention is being given to the analysis of large health datasets to derive new clinical decision support systems (CDSS). However, few data-driven CDSS are being adopted into clinical practice. Trust in these tools is believed to be fundamental for acceptance and uptake but to date little attention has been given to defining or evaluating trust in clinical settings.
    OBJECTIVE: A scoping review was conducted to explore how and where acceptability and trustworthiness of data-driven CDSS have been assessed from the health professional\'s perspective.
    METHODS: Medline, Embase, PsycInfo, Web of Science, Scopus, ACM Digital, IEEE Xplore and Google Scholar were searched in March 2022 using terms expanded from: \"data-driven\" AND \"clinical decision support\" AND \"acceptability\". Included studies focused on healthcare practitioner-facing data-driven CDSS, relating directly to clinical care. They included trust or a proxy as an outcome, or in the discussion. The preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) is followed in the reporting of this review.
    RESULTS: 3291 papers were screened, with 85 primary research studies eligible for inclusion. Studies covered a diverse range of clinical specialisms and intended contexts, but hypothetical systems (24) outnumbered those in clinical use (18). Twenty-five studies measured trust, via a wide variety of quantitative, qualitative and mixed methods. A further 24 discussed themes of trust without it being explicitly evaluated, and from these, themes of transparency, explainability, and supporting evidence were identified as factors influencing healthcare practitioner trust in data-driven CDSS.
    CONCLUSIONS: There is a growing body of research on data-driven CDSS, but few studies have explored stakeholder perceptions in depth, with limited focused research on trustworthiness. Further research on healthcare practitioner acceptance, including requirements for transparency and explainability, should inform clinical implementation.
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  • 文章类型: Journal Article
    背景:人工智能(AI)技术有可能改变医疗成像行业的医疗实践,并大大提高生产率和患者预后。然而,人工智能作为医疗专业人员的数字医疗干预措施的接受度低,有可能破坏用户的接受水平,阻碍有意义和最佳的增值参与,并最终阻止这些有希望的利益实现。了解支撑AI可接受性的因素对于医疗机构在其AI实施策略中查明不足和改进的领域至关重要。本范围审查旨在调查文献,以全面总结影响医学影像领域医疗保健专业人员AI可接受性的关键因素,以及调查它们的不同方法。
    方法:在包括Medline在内的五个学术数据库中进行了系统的文献检索,科克伦图书馆,WebofScience,Compendex,和Scopus从2013年1月到2023年9月。这是根据系统审查和Meta分析扩展范围审查的首选报告项目(PRISMA-ScR)指南进行的。总的来说,31篇文章被认为适合纳入范围审查。
    结果:文献已经汇聚到支持AI可接受性的三个总体因素类别,包括:涉及信任的用户因素,系统理解,人工智能素养,和技术接受性;系统使用因素带来价值主张,自我效能感,负担,和工作流程整合;以及包括社会影响的社会组织文化因素,组织准备,伦理,以及对职业身份的感知威胁。然而,许多研究忽视了这些因素中的一个有意义的子集,这些因素对于使用医疗人工智能系统是不可或缺的,例如对临床工作流程实践的影响,基于感知的风险和安全性的信任,以及与医学专业规范的兼容性。这归因于对理论框架或临时方法的依赖,这些理论框架或方法没有明确考虑医疗保健特定因素,人工智能作为软件作为医疗设备(SaMD)的新颖性,以及从医疗专业人员的角度而不是消费者或企业最终用户的角度来看人类与人工智能交互的细微差别。
    结论:这是第一次调查健康信息学文献中影响人工智能作为医学成像环境中数字医疗干预可接受性的关键因素的范围审查。本综述中确定的因素表明,用于研究AI可接受性的现有理论框架需要修改,以更好地捕捉医疗保健环境中AI部署的细微差别,其中用户是受专业知识和学科规范影响的医疗保健专业人员。在医疗专业人员中提高AI的可接受性将迫切需要设计以人为中心的AI系统,这些系统超越了高算法性能,以考虑具有不同程度AI素养的用户的可访问性。临床工作流程实践,机构和部署环境,和文化,伦理,和医疗保健行业的安全规范。随着对医疗保健AI的投资增加,对这些因素对医学专业人员实现高水平AI可接受性的因果贡献进行系统评价和荟萃分析将是有价值的.
    Artificial intelligence (AI) technology has the potential to transform medical practice within the medical imaging industry and materially improve productivity and patient outcomes. However, low acceptability of AI as a digital healthcare intervention among medical professionals threatens to undermine user uptake levels, hinder meaningful and optimal value-added engagement, and ultimately prevent these promising benefits from being realised. Understanding the factors underpinning AI acceptability will be vital for medical institutions to pinpoint areas of deficiency and improvement within their AI implementation strategies. This scoping review aims to survey the literature to provide a comprehensive summary of the key factors influencing AI acceptability among healthcare professionals in medical imaging domains and the different approaches which have been taken to investigate them.
    A systematic literature search was performed across five academic databases including Medline, Cochrane Library, Web of Science, Compendex, and Scopus from January 2013 to September 2023. This was done in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Overall, 31 articles were deemed appropriate for inclusion in the scoping review.
    The literature has converged towards three overarching categories of factors underpinning AI acceptability including: user factors involving trust, system understanding, AI literacy, and technology receptiveness; system usage factors entailing value proposition, self-efficacy, burden, and workflow integration; and socio-organisational-cultural factors encompassing social influence, organisational readiness, ethicality, and perceived threat to professional identity. Yet, numerous studies have overlooked a meaningful subset of these factors that are integral to the use of medical AI systems such as the impact on clinical workflow practices, trust based on perceived risk and safety, and compatibility with the norms of medical professions. This is attributable to reliance on theoretical frameworks or ad-hoc approaches which do not explicitly account for healthcare-specific factors, the novelties of AI as software as a medical device (SaMD), and the nuances of human-AI interaction from the perspective of medical professionals rather than lay consumer or business end users.
    This is the first scoping review to survey the health informatics literature around the key factors influencing the acceptability of AI as a digital healthcare intervention in medical imaging contexts. The factors identified in this review suggest that existing theoretical frameworks used to study AI acceptability need to be modified to better capture the nuances of AI deployment in healthcare contexts where the user is a healthcare professional influenced by expert knowledge and disciplinary norms. Increasing AI acceptability among medical professionals will critically require designing human-centred AI systems which go beyond high algorithmic performance to consider accessibility to users with varying degrees of AI literacy, clinical workflow practices, the institutional and deployment context, and the cultural, ethical, and safety norms of healthcare professions. As investment into AI for healthcare increases, it would be valuable to conduct a systematic review and meta-analysis of the causal contribution of these factors to achieving high levels of AI acceptability among medical professionals.
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  • 文章类型: Journal Article
    背景:公共政策制定者越来越多地参与参与模型构建过程,比如群模型建筑。了解决策者参与这些过程对决策者的影响很重要,因为他们的决策往往对影响健康的复杂系统的动态产生重大影响。对参与式模式建设对公共决策者的影响的评估程度或用于评估这些影响的方法和措施知之甚少。
    方法:制定了范围界定审查协议,其目标是:(1)范围界定研究,评估了促进的参与性模型构建过程对参与这些过程的公共政策制定者的影响;(2)描述用于评估影响的方法和措施以及这些评估的主要结果。乔安娜·布里格斯研究所的人口,概念,上下文框架用于制定文章识别过程。七个电子数据库-MEDLINE(Ovid),ProQuest健康与医疗,Scopus,WebofScience,Embase(Ovid),将搜索CINAHLComplete和PsycInfo。将根据纳入和排除标准筛选已确定的文章,并将使用和报告用于范围审查的系统审查和Meta分析扩展的首选报告项目清单。数据提取工具将跨三个领域收集信息:研究特征,方法和措施,和发现。审查将使用Covidence进行,一个系统的审查数据管理平台。
    背景:所产生的范围审查将概述公共政策制定者如何评估参与式模型构建过程。调查结果将通过同行评审的出版物传播,并传播给召集决策者参与参与性模型构建过程的实践社区。这项审查将不需要伦理批准,因为它不是人类主题研究。
    Public policymakers are increasingly engaged in participatory model building processes, such as group model building. Understanding the impacts of policymaker participation in these processes on policymakers is important given that their decisions often have significant influence on the dynamics of complex systems that affect health. Little is known about the extent to which the impacts of participatory model building on public policymakers have been evaluated or the methods and measures used to evaluate these impacts.
    A scoping review protocol was developed with the objectives of: (1) scoping studies that have evaluated the impacts of facilitated participatory model building processes on public policymakers who participated in these processes; and (2) describing methods and measures used to evaluate impacts and the main findings of these evaluations. The Joanna Briggs Institute\'s Population, Concept, Context framework was used to formulate the article identification process. Seven electronic databases-MEDLINE (Ovid), ProQuest Health and Medical, Scopus, Web of Science, Embase (Ovid), CINAHL Complete and PsycInfo-will be searched. Identified articles will be screened according to inclusion and exclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist for scoping reviews will be used and reported. A data extraction tool will collect information across three domains: study characteristics, methods and measures, and findings. The review will be conducted using Covidence, a systematic review data management platform.
    The scoping review produced will generate an overview of how public policymaker engagement in participatory model building processes has been evaluated. Findings will be disseminated through peer-reviewed publications and to communities of practice that convene policymakers in participatory model building processes. This review will not require ethics approval because it is not human subject research.
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