Journal of Primary Care and Community Health最新文献

{"title":"A 2-Year Retrospective Clinical Evaluation of a Novel Virtual Ward Model.","authors":"Juliana Pugmire, Abdul Ashish, Alison Chadwick, Matt Wilkes, Daniel Meekin, Ben Zaniello, Nicole Zahradka","doi":"10.1177/21501319251326750","DOIUrl":"10.1177/21501319251326750","url":null,"abstract":"<p><strong>Objective: </strong>The Wrightington, Wigan, and Leigh NHS Teaching Hospitals Foundation Trust (WWL) developed a novel virtual ward (VW) service that integrated with community and primary care, supported healthcare throughout a patient's journey, and had a clinical workflow that could step-up or step-down care as needed. We described their VW and evaluated clinical outcomes, adherence, safety, and patient satisfaction.</p><p><strong>Methods: </strong>Retrospective, single-center study of patients admitted to the WWL VW service from January 14, 2022 to January 31, 2024. Clinical data collected by WWL in their database for patients admitted to the VW, were matched to data captured automatically by the Current Health (CH) platform linked to the CH remote monitoring kits assigned to patients on the VW. The CH kits enabled the VW care at WWL and included a wearable device for continuous vital signs monitoring, a blood pressure cuff, and tablet. Evaluation metrics included clinical scope, clinical outcomes, adherence, safety, and patient satisfaction.</p><p><strong>Results: </strong>There were 1835 admissions and a 93% match rate between the clinical and CH databases. About 38% of referrals were step-up (31% ambulatory care and 7% primary care) and 62% of referrals were step-down (100% inpatients). Most specialty referrals were from thoracic and acute medicine (77%). The median length of stay on the VW was 8 days [IQR 5-13], 209 (12%) admissions were escalated to the hospital, 179 (11%) escalated to the emergency department out of hours, and 29 (2%) signposted to urgent medical services. Adherence to the wearable device was 92%. There were 38 minor safety incidents (typically hypersensitivity reactions or administrative errors) and 17 expected deaths. About 94% of admissions rated the VW experience as \"excellent\" or \"good.\" Results were similar between step-up and step-down referrals.</p><p><strong>Conclusion: </strong>We have shown the VW service yielded acceptable clinical outcomes, was safe with no serious adverse events or negative impact on mortality rate. Patient adherence to the technology and satisfaction with the VW service were high. The VW service was innovative in its acceptance of a broad range of patients, expanding services beyond respiratory medicine, and in developing a step-up pathway, preventing some patients from ever taking up an acute bed in the hospital.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251326750"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-Engaged Mental Health and Wellbeing Initiatives in Under-Resourced Settings: A Scoping Review of Primary Studies.","authors":"Muhammad Chutiyami, Natalie Cutler, Sopin Sangon, Tusana Thaweekoon, Patcharin Nintachan, Wilai Napa, Phachongchit Kraithaworn, Jo River","doi":"10.1177/21501319251332723","DOIUrl":"10.1177/21501319251332723","url":null,"abstract":"<p><strong>Introduction: </strong>Community-engaged initiatives are identified as promising to improve the health of communities with limited resources. This review aims to examine community-engaged mental health/wellbeing initiatives across Low- and Middle-Income Countries (LMIC) and under-resourced settings of High-Income Countries (HIC).</p><p><strong>Methods: </strong>We searched CINAHL, Embase, MEDLINE, PsycINFO, and Scopus databases to identify eligible primary studies until August 2024. Studies conducted in English language, involving community members in the initiatives' design or implementation and targeting 1 or more mental health/wellbeing outcomes, were included.</p><p><strong>Results: </strong>About 35 studies (n = 35) reporting 29 mental health/wellbeing initiatives across LMIC-(n = 24) and HIC-(n = 11) were included. Programmes with high community engagement, including community-led initiatives, consistently reported positive mental health and well-being outcomes, including reduced clinical symptoms and enhanced personal recovery and wellbeing. However, mixed outcomes on initiatives' impact on quality of life and diagnosed mental health conditions were evident. Various challenges, including cultural barriers, were noted, as was a lack of involvement of people with lived experience of mental health challenges.</p><p><strong>Conclusion: </strong>Community-engaged mental health and wellbeing initiatives in under-resourced settings have shown the potential to improve mental health outcomes and well-being when actively involving community members. Future work should focus on scalable initiatives and active inclusion of people with lived experience of mental health challenges.Review protocol registration at https://doi.org/10.17605/OSF.IO/367BK.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251332723"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Social Risk and Biomarkers of Systemic Inflammation: A Population-Based Study in Middle-Aged and Older Adults Living in Rural Communities.","authors":"Oscar H Del Brutto, Denisse A Rumbea, Emilio E Arias, Kleber Arriaga, Robertino M Mera","doi":"10.1177/21501319251344427","DOIUrl":"10.1177/21501319251344427","url":null,"abstract":"<p><strong>Background: </strong>The association between social risk and biomarkers of inflammation remains underexplored in low-resource communities, where social risk and levels of inflammation differ from those in industrialized urban centers. This study aims to assess the association between levels of social risk and biomarkers of inflammation in adults residing in remote rural settings.</p><p><strong>Methods: </strong>This population-based, cross-sectional study involved 1392 community-dwellers aged ≥40 years. Social risk was assessed using the social determinants of health (SDH) included in Gijon's Social Familial Evaluation Scale (SFES). Biomarkers of inflammation were measured through the Systemic Immune-Inflammation Index (SII) and the C-Reactive Protein (CRP)/albumin ratio. Both unadjusted and multivariate models were fitted to determine the independent association between SDH and biomarkers of inflammation, treated as dependent variables.</p><p><strong>Results: </strong>The mean (±SD) age of 1392 study participants was 53.8 ± 11.5 years (59% women). The mean Gijon's SFES score was 10.1 ± 2.6 points, the mean SII was 451.6 ± 240.5 × 10⁹ L, and the mean CRP/albumin ratio was 0.13 ± 0.29. Unadjusted generalized linear regression models demonstrated direct significant associations between SDH scores and both dependent variables, including SII (β: 6.12; 95% CI: 1.35-10.89) and the CRP/albumin ratio (β: 0.03; 95% CI: 0.01-0.05). These associations remained significant after adjusting for demographics, level of education, and cardiovascular risk factors for both, the SII (β: 7.24; 95% CI: 2.08-12.41) and the CRP/albumin ratio (β: 0.03; 95% CI: 0.01-0.05).</p><p><strong>Conclusions: </strong>Social risk is directly associated with biomarkers of inflammation in the study population, suggesting that inflammation may be associated with adverse health outcomes in individuals with high social risk. Study results demonstrate that this association is not only evident in high-income regions but in underserved rural communities as well.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251344427"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Trials to Practice: Implementing a Clinical Intervention in Community Settings.","authors":"Elizabeth M Vaughan, Xiaoying Yu, Victor J Cardenas, Craig A Johnston, Salim S Virani, Ashok Balasubramanyam, Christie M Ballantyne, Aanand D Naik","doi":"10.1177/21501319251339190","DOIUrl":"10.1177/21501319251339190","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Diabetes increases the risk of complications, especially for vulnerable populations. Our previous randomized clinical trial (RCT), TIME (<u>T</u>elehealth-supported, <u>I</u>ntegrated Community Health Workers (CHWs), <u>M</u>edication access, group visit <u>E</u>ducation), showed the efficacy of CHW-led diabetes care. This study aimed to gather data on transitioning TIME from clinical trials to practical implementation.</p><p><strong>Methods: </strong>We conducted a 12-month RCT at a nonprofit community clinic using the Consolidated Framework for Implementation Research (CFIR). Participants, Hispanic adults without insurance and with type 2 diabetes (N = 58; 29/arm), were randomized to TIME (intervention) or usual care (control). The intervention included monthly group visits and weekly CHW mHealth contact (6 months, Action Phase), followed by quarterly visits and bi-monthly mHealth contact (6 months, Maintenance Phase). The research team provided tele-mentoring to the clinic team throughout the intervention. Outcomes included implementation measures including acceptability, adoption, appropriateness, cost, feasibility, fidelity, satisfaction, and effectiveness.</p><p><strong>Key results: </strong>The program showed high levels of fidelity (direct observation), adoption (CHW-participant contact: 844 successes of 957 attempts [88.2%]), and feasibility (3.4% attrition). The intervention's net savings was $16,435 ($566/participant). At 6 months, intervention participants had greater HbA1c reductions (-0.85% vs 0.35% [δ = 1.2%]; <i>P</i> = .004; effectiveness) compared to the control. At month 12, more intervention participants improved HbA1c (-0.52% vs 0.25% [δ = 0.8%], <i>P</i> = .062) and preventive care adherence (<i>P</i> < .0001) compared to the control. Surveys revealed high appropriateness (mean = 4.8/5.0 and 5.95/6.0), satisfaction (mean = 4.6/5.0), and acceptability (mean = 4.9/5.0) among providers, CHWs, participants, and stakeholders.</p><p><strong>Conclusions: </strong>TIME met key early implementation measures, including strong engagement at both clinic and participant levels, while demonstrating cost savings and significant clinical improvements. These results support the transition of TIME from efficacy trials to practical, community-based diabetes care. Larger studies are needed to further evaluate these findings.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251339190"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Disadvantage and Genetic Testing Use Among a Nationally Representative Sample of US Adults.","authors":"Jemar R Bather, Melody S Goodman, Kimberly A Kaphingst","doi":"10.1177/21501319251342102","DOIUrl":"10.1177/21501319251342102","url":null,"abstract":"<p><strong>Introduction: </strong>Genetic testing helps individuals with disease management, family planning, and medical decision-making. Identifying individual-level factors related to the use of genetic services is essential but may only partially explain differential genetic service usage. To address this knowledge gap, we analyzed data on a national sample of US adults to evaluate whether higher neighborhood vulnerability is significantly associated with lower genetic testing utilization, controlling for sociodemographic and health characteristics.</p><p><strong>Methods: </strong>A 2024 nationally representative cross-sectional survey of 631 US adults recruited using NORC's probability-based AmeriSpeak panel. Genetic testing uptake was measured as self-reported ever use of ancestry, personal trait, specific disease, or prenatal genetic carrier testing. Secondary outcomes were indicator variables for each genetic testing type. Neighborhood vulnerability (low versus high) was measured by the Social Vulnerability Index, capturing socioeconomic factors affecting community resilience to natural hazards and disasters.</p><p><strong>Results: </strong>Forty-eight percent of the weighted sample used genetic testing services. Compared to those in low vulnerability areas, individuals in high vulnerability areas had 42% lower odds (adjusted OR: 0.58, 95% CI: 0.37-0.90) of using genetic testing services, controlling for individual-level characteristics. Secondary analyses showed no evidence of statistically significant relationships between neighborhood vulnerability and specific types of genetic testing services.</p><p><strong>Conclusion: </strong>Findings suggest that neighborhood vulnerability may contribute to differences in genetic testing uptake, which is crucial to increasing early detection of cancer susceptibility and reducing US cancer incidence. This study demonstrates the importance of going beyond examining individual characteristics to investigating structural factors negatively impacting genetic testing usage.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251342102"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hiding in the Folds: Case Report Highlighting the Role of Imaging in Detecting Dermatofibrosarcoma Protuberans.","authors":"Carlie A Aurubin, Lorvens Decosma, Olayemi Sokumbi, Aneesah P Garrett, Cara C Prier","doi":"10.1177/21501319251314855","DOIUrl":"10.1177/21501319251314855","url":null,"abstract":"<p><p>Dermatofibrosarcoma protuberans (DFSP) is a rare slow-growing skin cancer with a great capacity for local destruction. DFSP can manifest in a myriad of ways. This case report aims to contribute to the literature by increasing awareness of this condition, along with common diagnostic practices and treatment regimens. We present a 52-year-old Filipino woman who was evaluated for dyspnea with an incidental finding of an indeterminate nodule on imaging. A comprehensive diagnostic workup confirmed dermatofibrosarcoma protuberans (DFSP), which was ultimately treated with surgical resection. Clinically, about 52% of patients are misdiagnosed, leading to poor outcomes. Therefore, awareness, early detection, multidisciplinary treatment, and lifelong screening are essential for optimal outcomes.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251314855"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Learning Collaborative to Implement Postgraduate Nurse Practitioner (NP) and/or Physician Associate (PA) Residency or Fellowship Programs in a Community Health Center.","authors":"Meaghan Angers, Manjari Mishra, Amanda Schiessl, Margaret Flinter, Nicole Seagriff, Kerry Bamrick, Charise Corsino, May Oo","doi":"10.1177/21501319251329674","DOIUrl":"https://doi.org/10.1177/21501319251329674","url":null,"abstract":"<p><p>This paper presents findings from a study focused on establishing Postgraduate Nurse Practitioner (NP) and/or Physician Assistant (PA) Training Programs within federally funded health centers and look-alikes. The study aimed to identify facilitators and barriers encountered by participating health centers in the Health Resources and Services Administration (HRSA) funded Postgraduate NP and/or PA Training Programs Learning Collaborative. Of the 78 health centers that participated in the learning collaborative since 2016, 47.44% (n = 37) responded to the survey. The top facilitators for launching a program were leadership support, clinical support, and dedicated time for planning and implementation. The top barriers for not launching a program were lack of financial resources, competing priorities, and limited dedicated time for planning and implementation. Interviews echoed these findings, as well as highlighted additional facilitators of grant funding and mission-driven workforce pathway planning. Survey results from those that launched a training program revealed that 215 graduates have completed the program, with 86 employed within the health center. These findings provide valuable insights and guidance to support health centers in their journey towards building and launching a Postgraduate NP and/or PA Training Program, as well as informing future HRSA policies, programs, and funding.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251329674"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effectiveness of Parent Training Pamphlets: An Intervention Study Among Parents at Child Health Checkups.","authors":"Kazuko Akutsu, Aya Goto, Fareeda Abo-Rass, Hiroyuki Yokoyama","doi":"10.1177/21501319251317340","DOIUrl":"10.1177/21501319251317340","url":null,"abstract":"<p><strong>Introduction: </strong>Parent training (PT) programs are recognized as effective interventions that enhance parenting techniques and improve the parent-child relationship. In Japan, these programs are increasingly implemented to help parents manage behavioral issues in children. This study evaluated the effectiveness of PT pamphlets designed and distributed in Shioya Town, Japan, by comparing outcomes between the intervention and control groups and within subgroups of parents, categorized based on their children's need for follow-up health checkups.</p><p><strong>Methods: </strong>The study included an intervention group that received PT pamphlets during their 1.5-year health checkups and a control group that did not. Data were collected through self-administered questionnaires at the 3.5-year health checkups, assessing adherence to 3 recommended parenting techniques. The analysis focused on comparing intervention and control groups, evaluating adherence to 2 recommended parenting techniques versus one or none. The study also analyzed adherence to each recommended parenting technique within subgroups of parents whose children needed follow-up health checkups and those whose children did not.</p><p><strong>Results: </strong>The study included 114 participants, with 55 in the intervention group and 59 in the control group. Analysis revealed that 29.1% of the intervention group adhered to 2 recommended parenting techniques, compared with 24.6% in the control group. However, no significant differences were observed between the intervention and control groups in adherence to 2 recommended techniques versus one or none, or to any single technique among the 3. Subgroup analyses revealed significant differences in adherence among parents whose children were identified to have developmental concerns at the 1.5-year health checkup and were required to have follow-up checkups, specifically in the \"avoid immediate reactions\" approach between intervention and control groups.</p><p><strong>Conclusions: </strong>The PT pamphlets effectively increased adherence to recommended parenting techniques in the intervention group among children requiring follow-ups. This underscores the importance of culturally adapted PT programs and demonstrates the potential of simple educational interventions in improving parenting styles.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251317340"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Nobody Seemed to Notice My Work\": The Lived Experiences of Home Care Workers Assisting People With Chronic Diseases: A Phenomenological Study.","authors":"Valentina Cacciapuoti, Silvio Simeone, Michele Virgolesi, Medeline R Sterling, Elisa Dallago, Ercole Vellone, Rosaria Alvaro, Gianluca Pucciarelli","doi":"10.1177/21501319241276805","DOIUrl":"10.1177/21501319241276805","url":null,"abstract":"<p><strong>Introduction: </strong>Home care workers (HCWs) are paid caregivers who provide support to patients with chronic conditions and functional limitations. Additionally, they provide emotional support to patients and familial support. Although several qualitative studies have been conducted on HCWs, they focused more on studying prevalently the lived experiences about the workplace violence, the end of life, stressor and resilience, during the COVID-19 pandemic or focused more in dementia and heart failure, but not on feelings and working conditions.</p><p><strong>Methods: </strong>The study was carried out using Cohen's phenomenological methodology. The subjects were enrolled in several cities of Central Italy and interviewed with open questions to allow them full freedom of expression and asked to describe their lived experience of HCWs who helped people with chronic diseases. Each interview was recorded audio and lasted between 20 and 60 min. Researchers involved in the analysis were independently immersed in the data by reading and rereading the transcripts to gain a sense of the entire data set. The extrapolation of the themes followed. The individual researchers compared the various extrapolated themes.</p><p><strong>Results: </strong>Seventeen HCWs, all women, with a mean age of 54 years were enrolled in this study. All had more than a year (from 4 to 26 years) of experience in Italy, and almost the whole sample lived with the person they were assisting. Three themes were identified in the interviews: (1) feeling inadequate as a nurse, (2) feeling valued in this role, and (3) uncertain future. Feeling inadequate due to lack of training, difficulties related to the Italian language, or uncertainty about their future were topics identified by the HCWs.</p><p><strong>Conclusions: </strong>Since HCWs represent an important resource which, if properly trained, could positively influence the quality of life of the elderly population and a valid support for their families, understanding the lived experience can suggest interventions that could be implemented by a health care professional and provide evidence to inform political decision makers to increase the support for HCWs.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319241276805"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DERM-SUCCESS FDA Pivotal Study: A Multi-Reader Multi-Case Evaluation of Primary Care Physicians' Skin Cancer Detection Using AI-Enabled Elastic Scattering Spectroscopy.","authors":"Laura K Ferris, Erik Jaklitsch, Elizabeth V Seiverling, Thomas Agresta, Peggy Cyr, Laurie Caines, Na Wang, Daniel M Siegel","doi":"10.1177/21501319251342106","DOIUrl":"10.1177/21501319251342106","url":null,"abstract":"<p><strong>Background: </strong>Elastic Scattering Spectroscopy (ESS), an optical tissue sampling technique, distinguishes between benign and malignant tissue in vivo without the need to perform a surgical biopsy. A handheld device that employs ESS enabled with an artificial intelligence algorithm was developed as an objective tool to aid primary care physicians (PCPs) in their management of lesions suspicious for skin cancer. The aim of this study was to assess and compare the diagnostic and management performance of PCPs with and without the use of the ESS device in detecting skin cancer.</p><p><strong>Methods: </strong>In this clinical utility study, 108 PCPs evaluated 100 skin lesion cases (50 aided with the device output and 50 unaided by the device). For each case, PCPs provided a diagnosis, management decision, and level of confidence in that decision initially without, and then subsequently with, device output. Sensitivity, specificity, AUC, and confidence in their assessment prior to, and then with, device output were compared.</p><p><strong>Results: </strong>With visual assessment assisted by device output, diagnostic sensitivity increased significantly from 71.1% to 81.7% (<i>P</i> = .0085) and referral sensitivity increased significantly from 82.0% to 91.4% (<i>P</i> = .0027) compared to visual assessment only. Device-aided diagnostic specificity decreased from 60.9% to 54.7% (<i>P</i> = .1896), and referral specificity decreased from 44.2% to 32.4% (<i>P</i> = .0256). Overall management performance (ie, AUC) also increased from 0.708 to 0.762, and increased from 0.567 to 0.682 for lesions which physicians reported low confidence in their unassisted management decision. Physicians reporting high confidence in their management assessment increased from 36.8% to 53.4%.</p><p><strong>Conclusion: </strong>Use of the ESS device output by PCPs significantly improved their diagnostic and management sensitivities as well as their overall management performance. The findings suggest the ESS device can improve PCP skin cancer detection and confidence in their skin lesion evaluation and management.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251342106"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}