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Chatbots, or conversational agents, have emerged as significant tools in health care, driven by advancements in artificial intelligence and digital technology. These programs are designed to simulate human conversations, addressing various health care needs. However, no comprehensive synthesis of health care chatbots' roles, users, benefits, and limitations is available to inform future research and application in the field. This review aims to describe health care chatbots' characteristics, focusing on their diverse roles in the health care pathway, user groups, benefits, and limitations. A rapid review of published literature from 2017 to 2023 was performed with a search strategy developed in collaboration with a health sciences librarian and implemented in the MEDLINE and Embase databases. Primary research studies reporting on chatbot roles or benefits in health care were included. Two reviewers dual-screened the search results. Extracted data on chatbot roles, users, benefits, and limitations were subjected to content analysis. The review categorized chatbot roles into 2 themes: delivery of remote health services, including patient support, care management, education, skills building, and health behavior promotion, and provision of administrative assistance to health care providers. User groups spanned across patients with chronic conditions as well as patients with cancer; individuals focused on lifestyle improvements; and various demographic groups such as women, families, and older adults. Professionals and students in health care also emerged as significant users, alongside groups seeking mental health support, behavioral change, and educational enhancement. The benefits of health care chatbots were also classified into 2 themes: improvement of health care quality and efficiency and cost-effectiveness in health care delivery. The identified limitations encompassed ethical challenges, medicolegal and safety concerns, technical difficulties, user experience issues, and societal and economic impacts. Health care chatbots offer a wide spectrum of applications, potentially impacting various aspects of health care. While they are promising tools for improving health care efficiency and quality, their integration into the health care system must be approached with consideration of their limitations to ensure optimal, safe, and equitable use.

Background Despite antiretroviral therapy (ART) controlling HIV viral replication, people with HIV (PWH) remain at risk for inflammatory non-AIDS comorbidities. Factors contributing to comorbidities in PWH on ART include spontaneous release of HIV products, CMV co-infection, microbial translocation, and gut dysbiosis, each driving systemic T-cell activation. In addition to ART, novel gut microbiota-modulating therapies could reduce epithelial gut permeability, microbial translocation, and immune activation. Fecal microbiota transplantation (FMT) from healthy volunteer is a promising therapy to counteract dysbiosis, protect from gut barrier damage, and lower systemic immune activation. Methods The Gutsy study is a single-blind, randomized, placebo-controlled clinical trial evaluating the effects of FMT in PWH on ART for more than 3 years, with a viral load below 50 copies/mL, a CD4 count above 200 cells/mL, and a CD4/CD8 ratio below 1.0. All participants undergo a bowel cleanse before receiving FMT or placebo capsules. In the treatment group, 10 participants receive a bowel cleanse then two high doses of FMT delivered via 30 to 40 capsules twice, 3 weeks apart. The placebo group of 10 participants receive a bowel cleanse and capsules filled with microcrystalline cellulose for equivalence in weight and color, administered under the same time course. Peripheral blood mononuclear cells (PBMCs) and stool samples are collected at each visit: before bowel cleanse (baseline 1), before the first (baseline 2) and the 2nd (visit 4) FMT/placebo, 6 weeks (visit 5) and 12 weeks (visit 6) after the first FMT/placebo; colon biopsies are obtained at visits 3 and 6 in an optional sub-study. The primary objective is to assess the effect of FMT on plasma markers of gut epithelial permeability. Secondary objectives include microbial translocation, immune activation, and HIV latent reservoir biomarkers. Discussion We hypothesize that large-dose FMT in capsules, but not placebo capsules, will increase the abundance of beneficial microbes in the gut of PWH on ART, leading to decreased gut damage markers and reduced immune activation. The results of the Gutsy pilot study will inform for the calculation of sample size of larger definitive randomized clinical trials assessing the influence of FMT on immune activation in PWH. Trial registration ClinicalTrials.gov NCT06022406. Registered on 2024-08-01. https://clinicaltrials.gov/study/NCT06022406?cond=HIV&term=Gutsy&rank=1 .

Patient engagement (PE) promotes collaboration between stakeholders (researchers, patients, clinicians, etc). It often faces challenges due to tensions between its ethical/political and scientific underpinnings. This article explores how stakeholders applied the guiding principles of a PE project (“co-build,” “support and mutual respect,” and “inclusiveness”) for an HIV clinical research program initiated in January 2016. Three researchers/clinicians, a PE agent, and 2 patients held 3 meetings (June-October 2018) to discuss challenges faced and how these impacted their approach to PE. Regular stakeholder discussions about PE in clinical research could be documented and help guide PE to better meet stakeholder needs.

Abstract Background Regenerating islet-derived protein 3α (REG3α) is an antimicrobial peptide secreted by intestinal Paneth cells. Circulating REG3α has been identified as a gut damage marker in inflammatory bowel diseases. People living with human immunodeficiency virus (PWH) on antiretroviral therapy (ART) present with an abnormal intestinal landscape leading to microbial translocation, persistent inflammation, and development of non-AIDS comorbidities. Herein, we assessed REG3α as a marker of gut damage in PWH. Methods Plasma from 169 adult PWH, including 30 elite controllers (ECs), and 30 human immunodeficiency virus (HIV)–uninfected controls were assessed. REG3α plasma levels were compared with HIV disease progression, epithelial gut damage, microbial translocation, and immune activation markers. Results Cross-sectionally, REG3α levels were elevated in untreated and ART-treated PWH compared with controls. ECs also had elevated REG3α levels compared to controls. Longitudinally, REG3α levels increased in PWH without ART and decreased in those who initiated ART. REG3α levels were inversely associated with CD4 T-cell count and CD4:CD8 ratio, while positively correlated with HIV viral load in untreated participants, and with fungal product translocation and inflammatory markers in all PWH. Conclusions Plasma REG3α levels were elevated in PWH, including ECs. The gut inflammatory marker REG3α may be used to evaluate therapeutic interventions and predict non-AIDS comorbidity risks in PWH.

The use of telehealth and digital health platforms has increased during the COVID-19 pandemic due to the implementation of physical distancing measures and restrictions. To address the pandemic threat, telehealth was promptly and extensively developed, implemented, and used to maintain continuity of care offered through multi-purpose technology platforms considered as virtual healthcare facilities. The aim of this paper is to define telehealth and discuss some aspects of its utilization, role, and impact, but also opportunities and future implications particularly during the COVID-19 pandemic. In order to support our reflection and consolidate our viewpoints, numerous bibliographical sources and relevant literature were identified through an electronic keyword search of four databases (PubMed, Web of Science, Google Scholar, and ResearchGate). In this paper, we consider that telehealth to be a very interesting approach which can be effective and affordable for health systems aiming to facilitate access to care, maintain quality and safety of care, and engage patients and health professionals and users of health services. However, we also believe that telehealth faces many challenges, such as the issue of lack of human contact in care, confidentiality, and data security, also accessibility and training in the use of platforms for telehealth. Despite the many challenges it faces, we believe telehealth has enormous potential for strengthening and improving healthcare services. In this paper, we also call for and encourage further studies to build a solid and broad understanding of telehealth challenges with its short-term and long-term clinical, organizational, socio-economic, and ethical impacts.

Adherence to antiretroviral therapy (ART) is a priority in HIV care. Our goal was to develop and validate a new, short patient-reported outcome measure to screen for barriers to daily oral ART adherence in HIV care in Canada and France. The overarching design was that of a multi-phase, multi-site instrument development project. It involved a previously published qualitative research synthesis (to develop a conceptual framework from which to generate items). Here, we present the results of cognitive interviews (for content validity testing of the preliminary items) and of a longitudinal survey-based study where the revised 7-item instrument (the I-Score) was administered at two timepoints (baseline, 4 weeks), along with five indirect measures of ART adherence, including self-reported HIV viral load and, for a subset of Montreal participants, plasma viral load. The survey data was used to analyze the instrument’s measurement properties, namely structural validity (e.g., with Pearson inter-item correlations); construct validity, including cross-cultural validity, for a variety of sociodemographic groups (with receiver operating curve (ROC) analyses and areas under the curve (AUC); reliability (with the intraclass correlation coefficient (ICC)); and measurement error (with the standard error of measurement (SEM)). Study participants were adults living with HIV on antiretroviral therapy recruited from hospital-based infectious disease centers and community-based organizations in Montreal, Toronto, and Paris. The qualitative synthesis of 41 studies led to a framework composed of 6 barrier domains. One item was generated per domain. The 6-item measure was submitted to cognitive testing with 12 adults living with HIV, leading to several changes, including the division of one item into two, creating a 7-item measure. Overall, 305 adults living with HIV participated in the survey. Inter-item correlations were low to moderate, suggesting no redundant items. Among conclusive results, AUC’s were all above the predefined threshold (≥ 0.70) for self-reported viral load and plasma viral load for the global sample and across all subgroups examined. The ICC, at 0.81, was also above the predefined threshold (≥ 0.70). The SEM was 0.43. Overall, the evidence generated supports the 7-item I-Score measure’s content validity, construct validity/cross-cultural validity, reliability, and acceptable measurement error, in its specified context of use.

Vaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons. Three maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive-deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy. Between May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and system-level factors were identified. Three were particularly relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling \"punished\" and stigmatized due to strict COVID-19 restrictions, and failed to identify personal benefits of vaccination due to the lack of incentives; 3) Universal distrust: participants expressed distrust in prison employees, including health care providers. Reasons for vaccine refusal among people in prison are multifaceted. Educational interventions could seek to address COVID-19 risk misconceptions in prison settings. However, impact may be limited if trust is not fostered and if incentives are not considered in vaccine promotion.

Antiretroviral treatment adherence barriers are major concerns in HIV care. They are multiple and change over time. Considering temporality in patients’ perceptions of adherence barriers could improve adherence management. We explored how temporality manifests itself in patients’ perceptions of adherence barriers. We conducted 2 semi-structured focus groups on adherence barriers with 12 adults with HIV which were analyzed with grounded theory. A third focus group served to validate the results obtained. Three temporal categories were manifest in HIV-positive patients’ perceptions of barriers: (1) imprinting (events with lasting impacts on patients), (2) domino effects (chain of life events), and (3) future shadowing (apprehension about long-term adherence). An overarching theme, weathering (gradual erosion of abilities to adhere), traversed these categories. These temporalities explain how similar barriers may be perceived differently by patients. They could be useful to providers for adapting their interventions and improving understanding of patients’ subjective experience of adherence.

The COVID-19 pandemic was an unprecedent challenge to public health systems, with 95% of cases in Quebec sent home for self-isolation. To ensure continuous care, we implemented an intervention supported by a patient portal (Opal) to remotely monitor at-home patients with COVID-19 via daily self-reports of symptoms, vital signs, and mental health that were reviewed by health care professionals. We describe the intervention's implementation, focusing on the (1) process; (2) outcomes, including feasibility, fidelity, acceptability, usability, and perceived response burden; and (3) barriers and facilitators encountered by stakeholders. The implementation followed a co-design approach operationalized through patient and stakeholder engagement. The intervention included a 14-day follow-up for each patient. In the mixed methods study at the McGill University Health Centre in Montreal, Quebec, participants completed questionnaires on implementation outcomes on days 1, 7, and 14. All scores were examined against predefined success thresholds. Linear mixed models and generalized estimating equations were used to assess changes in scores over time and whether they differed by sex, age, and race. Semistructured interviews were conducted with expert patients, health care professionals, and coordinators for the qualitative analysis and submitted to thematic analysis guided by the Consolidated Framework for Implementation Research. In total, 51 participants were enrolled between December 2020 and March 2021; 49 (96%) were included in the quantitative analysis. Observed recruitment and retention rates (51/52, 98% and 49/51, 96%) met the 75% feasibility success threshold. Over 80% of the participants found it \"quite easy/very easy\" to complete the daily self-report, with a completion rate (fidelity) of >75% and a nonsignificant decreasing trend over time (from 100%, 49/49 to 82%, 40/49; P=.21). Mean acceptability and usability scores at all time points exceeded the threshold of 4 out of 5. Acceptability scores increased significantly between at least 2 time points (days 1, 7, and 14: mean 4.06, SD 0.57; mean 4.26, SD 0.59; and mean 4.25, SD 0.57; P=.04). Participants aged >50 years reported significantly lower mean ease of use (usability) scores than younger participants (days 1, 7, and 14: mean 4.29, SD 0.91 vs mean 4.67, SD 0.45; mean 4.13, SD 0.89 vs mean 4.77, SD 0.35; and mean 4.24, SD 0.71 vs mean 4.72, SD 0.71; P=.004). In total, 28 stakeholders were interviewed between June and September 2021. Facilitators included a structured implementation process, a focus on stakeholders' recommendations, the adjustability of the intervention, and the team's emphasis on safety. However, Opal's thorough privacy protection measures and limited acute follow-up capacities were identified as barriers, along with implementation delays due to data security-related institutional barriers. The intervention attained targets across all studied implementation outcomes. Qualitative findings highlighted the importance of stakeholder engagement. Telehealth tools have potential for the remote follow-up of acute health conditions. RR2-10.2196/35760.

IntroductionThere is international interest in using patient-reported outcome measures in HIV care to improve the well-being of people with HIV, but the prioritisation of specific outcomes and measures remains unclear. This project’s objective is to engage both people with HIV and healthcare, social and community service providers to develop a French and English-language core set of patient-reported outcomes and measures for use in HIV care at the patient level in Montreal (Canada).Methods and analysisThis multimethod project will follow guidance from the Core Outcome Measures in Effectiveness Trials Initiative and involve two phases. Phase 1 will see the selection of the core set of outcomes (ie, the health concepts to target) and include a rapid scoping review to inform a Delphi study with a panel of 50 people with HIV and providers in Montreal. It will end with a multidisciplinary consensus meeting to make final decisions on the outcomes. Phase 2 will be devoted to choosing the measures to assess the selected outcomes. It will include a systematic search for instruments, an appraisal of the quality and feasibility of the identified instruments and a consensus meeting for the final selection.Ethics and disseminationResearch ethics board (REB) approval was obtained on 9 December 2024, from the institutional REB of the Research Institute of the McGill University Health Centre (reference number: 2024-9695). Findings will primarily be disseminated to (1) healthcare and social service providers through academic rounds and a provincial continuing education programme for HIV clinicians; (2) to people with HIV through partner community organisations and (3) a range of stakeholders at local, national and international conferences and through peer-reviewed publications.