Abstract Novel types of digital data, including internet search data, have potential to improve understanding of early predictors of serious health conditions and enable timely management. While many studies have used aggregate anonymized search trends in this way, what is less clear is the predictive or diagnostic value of online searches at the individual level. While an increasing number of studies have used these kinds of data, this research method is still emerging. We therefore undertook a systematic review of published research that has assessed the predictive or diagnostic value of individual internet search data. MEDLINE and Embase were searched through March 2024 for studies utilising individual internet search data to predict or diagnose patient disease status. Due to the heterogeneous nature of the design, methodology and reported outcomes of included studies, a narrative synthesis of studies and pre-specified outcomes was performed. Study quality was assessed with the Newcastle-Ottawa Scale and PROBAST tool. Twenty-three studies met the inclusion criteria. Conditions of interest encompassed mental health, neurological conditions, malignancies, and miscellaneous healthcare presentations. Data on individuals’ search history were obtained from search engines using anonymous search queries (Bing, Yahoo!) or from consented participants (Google) where consent rates ranged from 20–70%. Wide variability in AUROC (range: <0.53 to > 0.99), sensitivity (range: 0.44 to 0.81) and F1 score (0.36 to 0.80) were reported. Studies noted a range of predictive linguistic, temporal, and other features (e.g., spelling error frequency). This review demonstrated that the use of individual internet search data holds diagnostic and predictive potential, with evidence of strong associative features. However, there was significant variability regarding conditions of interest, methodology, and predictive models used. Given the common use of internet searches by patients as part of their healthcare journeys, individual search data holds significant potential, and justifies further research, including the use of established diagnoses.
Abstract Background Social media platforms, such as YouTube, are an integral means of disseminating information about health and wellness to the public. However, anecdotal reports have cited that the human gut microbiome has been a particular focus of dubious, misleading and, on occasion, harmful media content. Despite these claims, there have been no published studies investigating this phenomenon within popular social media platforms. Aim This study aims to (1) evaluate the accuracy and credibility of YouTube videos related to the human gut microbiome and (2) investigate the correlation between content engagement metrics and information quality, as defined by validated criteria. Methods In this cross-sectional study, videos about the human gut microbiome were searched on the UK version of YouTube on 20 th September 2021. The 600 most viewed videos were extracted and screened for relevance. Information content and characteristics were extracted and independently rated using the DISCERN quality criteria by two researchers. Results Overall, 319 videos accounting for 62,354,628 views were included. 73.4% of the videos were produced in North America, and over 78.6% were uploaded between 2019-2021. 41.0% of videos were produced by non-profit organizations. 16% of the videos had an advertisement for a product or promoted a health-related intervention for financial purposes. Videos by non-medical educational creators had the highest total and preferred viewership. Daily viewership was highest for videos by internet media sources. The average DISCERN and HONcode scores were 49.5 (0.68) out of 80 and 5.05 (2.52) out of 8, respectively. DISCERN scores for videos by medical professionals (53.2 (0.17)) were significantly higher than videos by independent content creators (39.1 (5.58)), (p<0.01). Videos with promotional material scored significantly lower DISCERN scores than videos without any advertisements or product promotion (p<0.01). There was no correlation between DISCERN scores and total viewership, daily viewership or preferred viewership (number of likes). Conclusions The overall credibility of information about human gut microbiome on YouTube is poor. Moreover, there was no correlation between the video information quality and the level of public engagement. The significant disconnect between reliable sources of information and the public suggests that there is an immediate need for cross-sector initiatives in order safeguard vulnerable viewers from the potentially harmful effects of misinformation and disinformation.
Esophago-gastric malignancies are associated with a high recurrence rate; yet there is a lack of evidence to inform guidelines for the standardization and structure of postoperative surveillance after curatively intended treatment. This study aimed to capture the variation in postoperative surveillance strategies across the UK and Ireland, and enquire the opinions and beliefs around surveillance from practicing clinicians. A web-based survey consisting of 40 questions was sent to surgeons or allied health professionals performing or involved in surgical care for esophago-gastric cancers at high-volume centers in the UK. Respondents from each center completed the survey on what best represented their center. The first section of the survey evaluated the timing and components of follow-ups, and their variation between centers. The second section evaluated respondents perspective on how surveillance can be structured. Thirty-five respondents from 27 centers consisting 28 consultants, 6 senior trainees and 1 specialist nurse had completed the questionnaire; 45.7% of responders arranged clinical follow-up at 2-4 weeks. Twenty responders had a specific postoperative surveillance protocol for their patients. Of these, 31.4% had a standardized protocol for all patients, while 25.7% tailored it to patient needs. Patient preference, comorbidities and chance of recurrence were considered as major factors for necessitating more intense surveillance than currently practiced. There is a significant variation in how patients are monitored after surgery between centers in the UK. Randomized controlled trials are necessary to link surveillance strategies to both survival outcomes and quality of life of patients and to evaluate the prognostic value of different postoperative surveillance strategies.
Emerging evidence suggests that upwards of 20% of all SARS-CoV-2 positive individuals continue to experience chronic and debilitating symptoms, known either as 'long COVID' or 'post COVID syndrome', following the resolution of their initial infection [[1]Office for National Statistics (ONS). Coronavirus (COVID-19) Infection Survey. 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/4december2020 (accessed Dec 23, 2020).Google Scholar]. Despite this sizeable cohort, there have been limited coordinated attempts to understand the overall survivorship burden associated with this condition. The concept of 'survivorship' provides healthcare professionals, researchers and policy makers with a communal lens through which they may frame holistic interventions aimed at reducing the overall burden of living through a condition. This term encompasses the physiological, psychological, social, functional and economic impact of living with a chronic condition for an affected individual and their family members/caregivers [[2]Miller K.D. Pandey M. Jain R. Mehta R. Cancer survivorship and models of survivorship care a review.Am J Clin Oncol Cancer Clin Trials. 2015; 38: 627-633Crossref PubMed Scopus (29) Google Scholar]. Despite its predominant use in oncological literature, we can draw several parallels between the journey of long COVID and many cancers; both patient cohorts typically describe (i) the psychological impact of an unexpected diagnosis and duration of symptoms; (ii) a complex set of evolving physical symptoms; (iii) on-going changes in physical function; and (iv) an associated change in lifestyle, finances and interpersonal relationships [[3]Sounderajah V. Markar S. Darzi A. Defining domains of survivorship.Ann Surg. 2020; (published online May)https://doi.org/10.1097/SLA.0000000000003988Crossref Scopus (4) Google Scholar]. These themes have been distilled into nine distinct survivorship domains: treatment complications, physical function, co-morbidities, caregivers, employment & finance, relationships & family, mental health, social functioning and self-care [[3]Sounderajah V. Markar S. Darzi A. Defining domains of survivorship.Ann Surg. 2020; (published online May)https://doi.org/10.1097/SLA.0000000000003988Crossref Scopus (4) Google Scholar]. By focusing on these themes, we are able to characterise, evaluate, and form interventions to combat chronic conditions, such as long COVID. The majority of existing survivorship literature centres around 'complications' of post-COVID syndrome [[4]Michelen M. Manoharan L. Elkheir N. et al.Characterising long-term covid-19: a rapid living systematic review.medRxiv. 2020; (2020.12.08.20246025)Google Scholar]. There seems to be an absence in the influence of existing co-morbidities on the course of post-COVID syndrome. Further work to establish relationships between post-COVID syndrome and common comorbidities (e.g. underlying lung pathology or immunosuppression therapies) would be merited. As such, the survivorship burden associated with co-morbidities remains unclear. EQ-5D index values, a surrogate for quality of life, were lower when compared to the country specific index population norm [[5]Szende A. Janssen B. Cabasés J. Self-reported population health: an international perspective based on eq-5d.2014https://doi.org/10.1007/978-94-007-7596-1Crossref Scopus (463) Google Scholar]. However, given that population changes are dynamic, initial reference values published in 2014 may poorly represent the 'physical function' domain. Additionally, the 'employment and finance' domain has been briefly described, but merits additional investigation with non-hospitalised individuals excluded during the acute infection [[6]Halpin S.J. McIvor C. Whyatt G. et al.Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation.J Med Virol. 2020; https://doi.org/10.1002/jmv.26368Crossref Scopus (709) Google Scholar]. Patient experiences of post-COVID syndrome have reported themes relating to enduring persisting symptoms, anxiety, difficulty in accessing care, and uncertainty [[7]Kingstone T. Taylor A.K. O'Donnell C.A. Atherton H. Blane D.N. Chew-Graham C.A. Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID.BJGP open. 2020; https://doi.org/10.3399/bjgpopen20X101143Crossref PubMed Scopus (120) Google Scholar]. Although qualitative literature has potential to relate to other domains, themes involving self-care, social function, relationships, and financial implications require further exploration alongside the growing body of work in the 'mental health' domain [[8]Liu D. Baumeister R.F. Veilleux J.C. et al.Risk factors associated with mental illness in hospital discharged patients infected with COVID-19 in Wuhan, China.Psychiatry Res. 2020; https://doi.org/10.1016/j.psychres.2020.113297Crossref Scopus (125) Google Scholar]. There is a pressing need for both breadth and longitudinal evidence in survivorship, particularly in the treatment complications, social function and self-care survivorship domains. As such, we are left with the following recommendations:1)Healthcare professionals must not only recognise the symptomatology of post-COVID syndrome but also understand the longer-term support that patients require in the community. For policy makers, it is only through objectively quantifying the impact of this condition on both an individual and societal level are they able to lobby for appropriate funding and resources at a governmental level. Once more, parallels can be drawn from cancer survivorship in which a strong foundation of evidence has driven the development of frameworks, such as the National Cancer Survivorship Initiative, now deemed essential for the provision of personalised care.2)There is also a responsibility for both researchers and patients in the coming months. Triallists should be urged to collaborate in order to develop 'joined up' research studies which are complimentary and avoid research waste. A promising first step has been undertaken by The National Institute for Health Research (NIHR) and the international long-term care policy network, who have formed dedicated steering groups to coordinate large scale international research studies [[9]Living with Covid19. 2020 DOI:10.3310/themedreview_41169.Google Scholar,[10]Emerging evidence – resources to support community and institutional long-term care responses to COVID-19. https://ltccovid.org/category/evidence/(accessed Dec 14, 2020).Google Scholar]. Patient and public education is also a key consideration in this process. In spite of the malaise that has developed amongst large sections of the public, continued efforts must be made to actively recruit people with long COVID into trials.3)Finally, public education concerning long COVID will help to dispel stigma around the condition thus reinforcing the previous two recommendations. There is a need for long COVID to be publicly recognised as a legitimate health condition, so that there will be support for allocation of public funds towards long COVID. Parallels can be drawn with mental illness where it is only relatively recently that mental illness has been commonly recognised as a genuine disease on a par with physical illness and thus resources for sufferers have been increased. Increasing awareness and reducing stigma around long COVID will also encourage recruitment of individuals to clinical trials. None Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC) and the NIHR Imperial Patient Safety Translational Research Centre (PSTRC). FMI conceptualised the idea. FMI, VS, KL drafted the manuscript. KL, VS, SE, HA, and AD all contributed to significant amendments to the final manuscript.
Abstract Aim Long-term functional outcomes and the associations to health-related quality of life (HRQOL) after esophagectomy is largely unknown. LASER is a multi-center European study aimed to identify the most prevalent symptoms, and those with the greatest impact upon HRQOL among patients surviving more than one-year after esophagectomy for cancer, and to develop a clinically relevant symptom-based tool to measure HRQOL. Background & Methods Between 2010 and 2016, patients from 20 European Centers who underwent esophagectomy for esophageal cancer, and were disease-free at least one year postoperatively were invited to complete the LASER questionnaire, EORTC-QLQ30 and OG25. Specific symptom questionnaire items that were associated with a poor HRQOL as identified by EORTC-QLQC30 and OG25 were identified by multivariable linear and logistic regression analysis and combined to form a tool, which was tested using receiver operating characteristics curve analysis. Results A total of 876 of 1081 invited patients responded to the questionnaire, giving a response rate of 81%. Of these, 66.9% stated in the last 6 months they had had symptoms associated with their esophagectomy and 52.4% of patients had sought medical treatment for their symptoms. Ongoing weight loss was reported by 10.4% of patients while 32.4% were struggling to maintain their body weight, and 18.8% of patients required supplemental oral nutrition. Only 13.8% of patients had returned to work with the same activities as before. Three LASER symptoms in multivariate analysis were correlated with poor HRQOL; pain on scars on chest (Odds ratio (OR) 1.27; 95% CI 0.97-1.65), low mood (OR 1.42; 95% CI 1.15-1.77) and reduced energy or activity tolerance (OR 1.37; 95% CI 1.18-1.59). The areas under the curves for the development and validation datasets were 0.81±0.02 and 0.82±0.09 respectively. Conclusions Two-thirds of patients experience symptoms related to their esophagectomy more than one year after surgery. The three key symptoms associated with poor HRQOL identified in this study should be further validated, and could be used in clinical practice to identify patients who require increased long-term term support.
Vascular surgery has one of the highest unplanned 30-day readmission rates of all surgical specialties. The degree to which these may be avoidable and the optimal strategies to reduce their occurrence are unknown. The aim of this study was to identify and classify avoidable 30-day readmissions in patients undergoing vascular surgery in order to plan targeted interventions to reduce their occurrence, improve outcomes and reduce cost. A retrospective analysis of discharges over a 12-month period from a single tertiary vascular unit was performed. A multidisciplinary panel conducted a manual case-note review to identify and classify those 30-day unplanned emergency readmissions deemed avoidable. An unplanned 30-day readmission occurred in 72 of 885 admissions (8·1 per cent). These unplanned readmissions were deemed avoidable in 36 (50 per cent) of these 72 patients, and were most frequently due to unresolved medical issues (19 of 36, 53 per cent) and inappropriate admission with the potential for outpatient management (7 of 36, 19 per cent). A smaller number were due to inadequate social care provision (4 of 36, 11 per cent) and the occurrence of other avoidable adverse events (4 of 36, 11 per cent). Half of all 30-day readmissions following vascular surgery are potentially avoidable. Multidisciplinary coordination of inpatient care and the transition from hospital to community care after discharge need to be improved. Many readmissions avoidable
ABSTRACT Objective To evaluate the accuracy of digital and online symptom checkers in providing diagnoses and appropriate triage advice. Design Systematic review. Data sources Medline and Web of Science were searched up to 15 February 2021. Eligibility criteria for study selection Prospective and retrospective cohort, vignette, or audit studies that utilised an online or application-based service designed to input symptoms and biodata in order to generate diagnoses, health advice and direct patients to appropriate services were included. Main outcome measures The primary outcomes were (1) the accuracy of symptom checkers for providing the correct diagnosis and (2) the accuracy of subsequent triage advice given. Data extraction and synthesis Data extraction and quality assessment (using the QUADAS-2 tool) were performed by two independent reviewers. Owing to heterogeneity of the studies, meta-analysis was not possible. A narrative synthesis of the included studies and pre-specified outcomes was completed. Results Of the 177 studies retrieved, nine cohort studies and one cross-sectional study met the inclusion criteria. Symptom checkers evaluated a variety of medical conditions including ophthalmological conditions, inflammatory arthritides and HIV. 50% of the studies recruited real patients, while the remainder used simulated cases. The diagnostic accuracy of the primary diagnosis was low (range: 19% to 36%) and varied between individual symptom checkers, despite consistent symptom data input. Triage accuracy (range: 48.8% to 90.1%) was typically higher than diagnostic accuracy. Of note, one study found that 78.6% of emergency ophthalmic cases were under-triaged. Conclusions The diagnostic and triage accuracy of symptom checkers are variable and of low accuracy. Given the increasing push towards population-wide digital health technology adoption, reliance upon symptom checkers in lieu of traditional assessment models, poses the potential for clinical risk. Further primary studies, utilising improved study reporting, core outcome sets and subgroup analyses, are warranted to demonstrate equitable and non-inferior performance of these technologies to that of current best practice. PROSPERO registration number CRD42021271022. SUMMARY BOXES What is already known on this topic Chambers et al. (2019) have previously examined the evidence underpinning digital and online symptom checkers, including the accuracy of the diagnostic and triage information, for urgent health problems and found that diagnostic accuracy was generally low and varied depending on the symptom checker used. Given the increased reliance upon digital health technologies by health systems in light of the ongoing COVID-19 pandemic, in addition to the marked increase in availability of similarly themed digital health products since the last systematic review, a contemporary and comprehensive reassessment of this class of technologies to ascertain their diagnostic and triage accuracy is warranted. What this study adds Our systematic review demonstrates that the diagnostic accuracy of symptom checkers remains low and varies significantly depending on the pathology or symptom checker used. The findings of this systematic review suggests that this class of technologies, in their current state, poses significant risk for patient safety, particularly if utilised in isolation.
There is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation.To evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change.An online survey of colorectal cancer service change globally in May and June 2020.Attending or consultant surgeons involved in the care of patients with colorectal cancer.Changes in the delivery of diagnostics (diagnostic endoscopy), imaging for staging, therapeutics and surgical technique in the management of colorectal cancer. Predictors of change included increased hospital bed stress, critical care bed stress, mortality and world region.191 responses were included from surgeons in 159 centers across 46 countries, demonstrating widespread service reduction with global variation. Diagnostic endoscopy was reduced in 93% of responses, even with low hospital stress and mortality; whilst rising critical care bed stress triggered complete cessation (p = 0.02). Availability of CT and MRI fell by 40-41%, with MRI significantly reduced with high hospital stress. Neoadjuvant therapy use in rectal cancer changed in 48% of responses, where centers which had ceased surgery increased its use (62 vs 30%, p = 0.04) as did those with extended delays to surgery (p<0.001). High hospital and critical care bed stresses were associated with surgeons forming more stomas (p<0.04), using more experienced operators (p<0.003) and decreased laparoscopy use (critical care bed stress only, p<0.001). Patients were also more actively prioritized for resection, with increased importance of co-morbidities and ICU need.The COVID-19 pandemic was associated with severe restrictions in the availability of colorectal cancer services on a global scale, with significant variation in behaviours which cannot be fully accounted for by hospital burden or mortality.
Summary Background Paraesophageal hernias (PEH) present with a range of symptoms affecting physical and mental health. This systematic review aims to assess the quality of reporting standards for patients with PEH, identify the most frequently used quality of life (QOL) and symptom severity assessment tools in PEH and to ascertain additional symptoms reported by these patients not captured by these tools. Methods A systematic literature review according to PRISMA protocols was carried out following a literature search of MEDLINE, Embase and Cochrane databases for studies published between January 1960 and May 2020. Published abstracts from conference proceedings were included. Data on QOL tools used and reported symptoms were extracted. Results This review included 220 studies reporting on 28 353 patients. A total of 46 different QOL and symptom severity tools were used across all studies, and 89 different symptoms were reported. The most frequently utilized QOL tool was the Gastro-Esophageal Reflux Disease-Health related quality of life questionnaire symptom severity instrument (47.7%), 57.2% of studies utilized more than 2 QOL tools and ‘dysphagia’ was the most frequently reported symptom, in 55.0% of studies. Notably, respiratory and cardiovascular symptoms, although less common than GI symptoms, were reported and included ‘dyspnea’ reported in 35 studies (15.9%). Conclusions There lacks a QOL assessment tool that captures the range of symptoms associated with PEH. Reporting standards for this cohort must be improved to compare patient outcomes before and after surgery. Further investigations must seek to develop a PEH specific tool, that encompasses the relative importance of symptoms when considering surgical intervention and assessing symptomatic improvement following surgery.
Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.
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