Lancet Regional Health-Europe最新文献

{"title":"Artificial intelligence in oncology: ensuring safe and effective integration of language models in clinical practice","authors":"","doi":"10.1016/j.lanepe.2024.101064","DOIUrl":"10.1016/j.lanepe.2024.101064","url":null,"abstract":"<div><p>In this Personal View, we address the latest advancements in automatic text analysis with artificial intelligence (AI) in medicine, with a focus on its implications in aiding treatment decisions in medical oncology. Acknowledging that a majority of hospital medical content is embedded in narrative format, natural language processing has become one of the most dynamic research fields for developing clinical decision support tools. In addition, large language models have recently reached unprecedented performance, notably when answering medical questions. Emerging applications include prognosis estimation, treatment recommendations, multidisciplinary tumor board recommendations and matching patients to recruiting clinical trials. Altogether, we advocate for a forward-looking approach in which the community efficiently initiates global prospective clinical evaluations of promising AI-based decision support systems. Such assessments will be essential to validate and evaluate potential biases, ensuring these innovations can be effectively and safely translated into practical tools for oncological practice. We are at a pivotal moment, where continued advancements in patient care must be pursued with scientific rigor.</p></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266677622400231X/pdfft?md5=a6c9bd6accbe3b29497493a777676280&pid=1-s2.0-S266677622400231X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147924","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":"Refining the role of Contrast-enhanced Mammography in breast cancer screening: insights from the RACER trial– author's reply","authors":"","doi":"10.1016/j.lanepe.2024.101071","DOIUrl":"10.1016/j.lanepe.2024.101071","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224002382/pdfft?md5=709ba86fbd95f38e14db76de272afdb9&pid=1-s2.0-S2666776224002382-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148955","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":"Prevalence of Chagas disease among Latin American immigrants in non-endemic countries: an updated systematic review and meta-analysis","authors":"","doi":"10.1016/j.lanepe.2024.101040","DOIUrl":"10.1016/j.lanepe.2024.101040","url":null,"abstract":"<div><h3>Background</h3><p>Chagas disease (CD), endemic in 21 Latin American countries, has gradually spread beyond its traditional borders due to migratory movements and emerging as a global health concern. We conducted a systematic review and meta-analysis of available data to establish updated prevalence estimates of CD in Latin American migrants residing in non-endemic countries.</p></div><div><h3>Methods</h3><p>A systematic search was conducted in MEDLINE/PubMed, Embase, Cochrane Library, Scopus, Web of Science, and LILACS via Virtual Health Library (<em>Biblioteca Virtual em Saúde - BVS</em>), including references published until November 1st, 2023. Pooled prevalence estimates and 95% confidence intervals (CI) were calculated using random effect models. Heterogeneity was assessed by the chi-square test and the I² statistic. Subgroup analyses were performed to explore potential sources of heterogeneity among studies. The study was registered in the PROSPERO database (CRD42022354237).</p></div><div><h3>Findings</h3><p>From a total of 1474 articles screened, 51 studies were included. Studies were conducted in eight non-endemic countries (most in Spain), between 2006 and 2023, and involving 82,369 screened individuals. The estimated pooled prevalence of CD in Latin American migrants living in non-endemic countries was 3.5% (95% CI: 2.5–4.7; I²: 97.7%), considering studies in which screening was indicated simply because the person was Latin American. Per subgroups, the pooled CD prevalence was 11.0% (95% CI: 7.7–15.5) in non-targeted screening (unselected population in reference centers) (27 studies); in blood donors (4 studies), the pooled prevalence was 0.8% (95% CI: 0.2–3.4); among people living with HIV Latin American immigrants (4 studies) 2.4% (95% CI: 1.4–4.3) and for Latin American pregnant and postpartum women (14 studies) 3.7% (95 CI: 2.4–5.6). The pooled proportion of congenital transmission was 4.4% (95% CI: 3.3–5.8). Regarding the participants’ country of origin, 7964 were from Bolivia, of which 1715 (21,5%) were diagnosed with CD, and 21,304 were from other Latin American countries of which 154 (0,72%) were affected.</p></div><div><h3>Interpretation</h3><p>CD poses a significant burden of disease in Latin American immigrants in non-endemic countries, suggesting that CD is no longer a problem limited to the American continent and must be considered as a global health challenge.</p></div><div><h3>Funding</h3><p>This study was funded by the <span>World Heart Federation</span>, through a research collaboration with <span>Novartis Pharma</span> AG.</p></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224002072/pdfft?md5=f80c257d179b0a23cab64e70ecc2c24e&pid=1-s2.0-S2666776224002072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147811","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":"Refining the role of contrast-enhanced mammography in breast cancer screening: insights from the RACER trial","authors":"","doi":"10.1016/j.lanepe.2024.101068","DOIUrl":"10.1016/j.lanepe.2024.101068","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224002357/pdfft?md5=ae6baf95265a6d7bd933fa673c789a14&pid=1-s2.0-S2666776224002357-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142149066","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":"Effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children: a parallel group randomised controlled trial","authors":"","doi":"10.1016/j.lanepe.2024.101038","DOIUrl":"10.1016/j.lanepe.2024.101038","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Children whose parents have anxiety problems are at increased risk of developing anxiety themselves. Parenting behaviors are a contributing factor to intergenerational transmission. Interventions which seek to limit anxiogenic parenting behaviors have shown potential in reducing anxiety in offspring but are not widely accessible. This prevention trial aimed to establish the effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A parallel group, block-randomised controlled trial of unblinded participants in a 1:1 ratio was conducted to compare efficacy of the online course compared to a no-intervention control. The intervention comprised 8 modules, of approximately 20 min each, and participants progressed through the course at their own pace. The study was conducted entirely online with a self-referred UK-based community sample of parents (child 2–11 years) with substantial anxiety. The primary outcome measure was change in parent-reported child anxiety, as measured by the Spence Children's Anxiety Scale–Parent Report (SCAS-P) or Spence Pre-School Anxiety Scale–Parent Report (Preschool SCAS). Secondary outcomes were child internalising, externalising, and attentional symptoms (Pediatric Symptom Checklist), and parent anxiety (SCARED-Adult). Analyses using complete case analysis following intention to treat principles investigated intervention effects at 6 months (primary analysis) and additionally at 9 to 25-months’ follow-up. Trial registration: &lt;span&gt;&lt;span&gt;ClinicalTrials.Gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt; &lt;span&gt;&lt;span&gt;NCT04755933&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;https://clinicaltrials.gov/ct2/show/NCT04755933&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;p&gt;1811 participants (intervention = 900; control = 911; 92.7% (1677/1810) female; 85.3% (1535/1800) White-British; 66.8% (1201/1799) university educated). Participant retention (based on primary outcome completion) at T2 (6-months post consent) was 67.6% overall (n = 1224) and substantially lower in the intervention arm 57.3% ((516/900) control = 77.8% (708/910)). Child anxiety was lower in the intervention group compared to control at 6-month follow-up (adjusted effect size estimate −0.15 (95% CI: −0.23 to −0.08, p &lt; 0.001). There was very strong evidence that those in the intervention arm had lowered child anxiety (standardised SCAS score) compared to the control arm, with an effect size (Cohen's d) of −0.16 (95% CI: −0.23 to −0.08, p &lt; 0.001). The difference in standardised Spence Child Anxiety Scale score between the arms was −0.15 standard deviations. On the original scales for SCAS-P (0–114) and Preschool SCAS (0–112), this corresponds to a reduction of −2.38 (95% CI: −3.59 to −1.16) and −2.68 (95% CI: −4.05 to −1.31), respectively. No reported harms.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;p&gt;A clinically uns","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224002059/pdfft?md5=b33c272ffe239e6df9f90e2b866c57c2&pid=1-s2.0-S2666776224002059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136968","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":"Ongoing disruption of RSV epidemiology in children in Switzerland","authors":"","doi":"10.1016/j.lanepe.2024.101050","DOIUrl":"10.1016/j.lanepe.2024.101050","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224002175/pdfft?md5=72b41a6fa2915ed4c493ee457251d3ad&pid=1-s2.0-S2666776224002175-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142128287","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":"Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium","authors":"","doi":"10.1016/j.lanepe.2024.101005","DOIUrl":"10.1016/j.lanepe.2024.101005","url":null,"abstract":"<div><h3>Background</h3><p>Remote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) has been shown to reduce symptom burden and hospitalizations, increase dose intensity and improve quality of life of patients during systemic therapy being recommended by international guidelines in routine oncology practice. However, implementation in routine care has been slow and faces several challenges. In this study we report on the real-world multi-center implementation of a RPM pathway encompassing weekly patient symptom ePRO reporting with electronic alert notifications triggered to providers for severe or worsening symptoms.</p></div><div><h3>Methods</h3><p>An RPM pathway was implemented in 33 European cancer centers in France and Belgium between November 2021 and August 2023. The implementation process followed a standardized phasic process of Exploration, Preparation, Implementation and Sustainment. Patient-level and system-level implementation metrics were collected and evaluated according to the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.</p></div><div><h3>Findings</h3><p>Across the 33 cancer centers, the RPM pathway was implemented for 3015 patients cared for by 168 providers. The RPM pathway enabled effective and timely symptom management with 94.6% of all alerts (10,132/10,711) evolving to an improvement two weeks later, among which 88.4% (9468/10,711) showed ≥2 grades of improvement on the 5-point scale of the Patient-Reported Outcomes Common Terminology (PRO-CTCAE). The median time to alert management by the care team was 13 h 41 min (25th percentile: 1 h 42 min, 75th percentile: 1 day + 19 h 54 min), with 80% (36,269/45,334) of alerts managed by a nurse navigator telephone call. Patient adherence with weekly ePRO reporting was 82% (2472/3015). In an experience survey, 87% (32/38) of providers were satisfied with integrating the solution into their organization and 90% (276/307) of the patients felt that ePRO reporting positively impacted their care. As of March 2024, the pathway has been maintained in all participating centers, with activation of an additional 18 centers following data lock, and reimbursement for this RPM pathway approved in France in October 2023.</p></div><div><h3>Interpretation</h3><p>These findings demonstrate the feasibility of implementing and maintaining an RPM pathway during routine care across a diverse group of cancer centers in the European setting, with high levels of patient and provider engagement, and positive clinical impact.</p></div><div><h3>Funding</h3><p>Part of this work was funded <span>Breast Cancer Research Foundation</span> (Career Development Award to Maria Alice Franzoi) and Resilience (nurse navigation and technology support).</p></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224001728/pdfft?md5=50069cac5954bd3fa98d23568fd366a6&pid=1-s2.0-S2666776224001728-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122512","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":"Current and future role of MRI in the diagnosis and prognosis of multiple sclerosis","authors":"","doi":"10.1016/j.lanepe.2024.100978","DOIUrl":"10.1016/j.lanepe.2024.100978","url":null,"abstract":"<div><p>In the majority of cases, multiple sclerosis (MS) is characterized by reversible episodes of neurological dysfunction, often followed by irreversible clinical disability. Accurate diagnostic criteria and prognostic markers are critical to enable early diagnosis and correctly identify patients with MS at increased risk of disease progression. The 2017 McDonald diagnostic criteria, which include magnetic resonance imaging (MRI) as a fundamental paraclinical tool, show high sensitivity and accuracy for the diagnosis of MS allowing early diagnosis and treatment. However, their inappropriate application, especially in the context of atypical clinical presentations, may increase the risk of misdiagnosis. To further improve the diagnostic process, novel imaging markers are emerging, but rigorous validation and standardization is still needed before they can be incorporated into clinical practice. This Series article discusses the current role of MRI in the diagnosis and prognosis of MS, while examining promising MRI markers, which could serve as reliable predictors of subsequent disease progression, helping to optimize the management of individual patients with MS. We also explore the potential of new technologies, such as artificial intelligence and automated quantification tools, to support clinicians in the management of patients. Yet, to ensure consistency and improvement in the use of MRI in MS diagnosis and patient follow-up, it is essential that standardized brain and spinal cord MRI protocols are applied, and that interpretation of results is performed by qualified (neuro)radiologists in all countries.</p></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224001455/pdfft?md5=7f491a61db04fc98245cf277006ea305&pid=1-s2.0-S2666776224001455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122414","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":"The 25th International AIDS conference (AIDS 2024)","authors":"","doi":"10.1016/j.lanepe.2024.101028","DOIUrl":"10.1016/j.lanepe.2024.101028","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224001959/pdfft?md5=b009af0a7e7146c0984d255cf7cabe11&pid=1-s2.0-S2666776224001959-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122511","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":"COVID-19 and multiple sclerosis: challenges and lessons for patient care","authors":"","doi":"10.1016/j.lanepe.2024.100979","DOIUrl":"10.1016/j.lanepe.2024.100979","url":null,"abstract":"<div><p>During the COVID-19 pandemic, people with multiple sclerosis (MS) and their healthcare providers have faced unique challenges related to the interaction between SARS-CoV-2, underlying neurological disease and the use of disease-modifying treatments (DMTs). Key concerns arose, primarily related to the possibility that SARS-CoV-2 infection could trigger the initial demyelinating event or exacerbate disease activity. Another major concern was the safety and efficacy of the COVID-19 vaccines, especially for patients undergoing specific treatments that could weaken their antibody responses. In the post-infection phase, identifying long COVID in patients with MS has been complicated due to the large overlap between post-infection sequelae and MS symptoms. In addition, disruptions in health and rehabilitation services have made it difficult for MS patients to access care. This Series article explores current evidence on the interaction between MS and SARS-CoV-2, identifies the challenges posed by the COVID-19 pandemic in the care of patients with MS, and discusses the significant adoption of digital health solutions, including telemedicine and new technology-based rehabilitation approaches. Based on lessons learned, recommendations and future directions are offered for managing patients with MS, rethinking healthcare systems and improving health outcomes in the post-COVID-19 pandemic era.</p></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":null,"pages":null},"PeriodicalIF":13.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666776224001467/pdfft?md5=5789b2ba7111b11da22d81b5b0a41423&pid=1-s2.0-S2666776224001467-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122416","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}