Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 8 appraisals
Journal of medical Internet research
Digital Health Technologies Are Bridging the Maternal Mortality Gap
Disparities in maternal outcomes along socioeconomic, racial, ethnic, and geographic lines are well established. In this News and Perspectives article, JMIR Correspondent Anika Nayak reports on the growth and potential of digital health interventions in bridging the rural-urban maternal mortality gap.
26 July 2026
Read appraisal →BMJ paediatrics open
Smartphone-based support for early childhood development in a rural low-resource setting: an individually randomised pilot feasibility trial from Guatemala
OBJECTIVE: To test the feasibility of a smartphone app, BebeApp, that provides evidence-based early childhood development (ECD) guidance in rural Guatemala and pilot procedures for an adequately powered randomised controlled trial. DESIGN: We conducted an individually randomised pilot feasibility trial to compare BebeApp to printed ECD guidance. SETTING: This trial was conducted in Tecpán, Chimaltenango, a semi-rural community that is 95% Kaqchikel Indigenous Maya. PATIENTS: First-time primary caregiver-infant (0-28 days) dyads. INTERVENTIONS: BebeApp provides age-dependent, evidence-based caregiver guidance for breastfeeding and complementary feeding, sleep and developmental support. MAIN OUTCOME MEASURES: A mixed-methods evaluation of BebeApp's implementation and acceptability using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. App usability, usefulness and satisfaction were assessed via questionnaires, semi-structured interviews and app interaction data. RESULTS: 41 infant-caregiver dyads were enrolled with 40 completing the study. Engagement was high with caregivers opening BebeApp a median (IQR) 11 (6-21) times per month. Usability was found to be acceptable but no difference was found between pre-measurements and post-measurements. In interviews, caregivers expressed some initial difficulty using BebeApp but were able to gain confidence with a training session. App usefulness and satisfaction responses were positive. Caregivers often noted that BebeApp was their only source of ECD information outside of their family. CONCLUSIONS: We found that caregivers in rural Guatemala responded positively to a smartphone ECD app and engaged with it throughout the trial. Given the urgent need for ECD programmes in low- and middle-income settings, smartphone apps may be a method to deliver services directly to caregivers.
14 June 2026
Read appraisal →BMJ open
Patterns and determinants of primary care virtual health service use among rural Aboriginal and Torres Strait Islander adults with chronic diseases: a cross-sectional study
OBJECTIVE: To examine virtual health service (VHS) device usage patterns and identify factors associated with VHS engagement among Indigenous Australian adults with chronic conditions. DESIGN: Cross-sectional survey. SETTING: An Aboriginal Community Controlled Health Organisation providing primary healthcare services across rural and remote Queensland, Australia. PARTICIPANTS: 74 consenting Indigenous Australian adults with at least one chronic condition who were registered VHS users. METHODS: Participants completed surveys assessing their use of four Bluetooth-enabled monitoring devices (pulse oximeter, blood glucose monitor, blood pressure monitor, weight scale) over a 2-week recall period. The primary outcome was VHS device usage status, categorised as active versus inactive users. Active users were defined as participants who reported any frequency of device use, while those reporting no use were classified as inactive users. All participants had access to Indigenous health coach support as part of the VHS model. Binary logistic regression was used to identify sociodemographic and geographical factors associated with VHS engagement. RESULTS: Sixty-four per cent (n=47) were active users, with 73% of these using all four devices concurrently. Among active users, blood pressure monitors showed the highest utilisation (98%), followed by weight scales (91%), blood glucose monitors (89%) and pulse oximeters (86%). Three factors were significantly associated with VHS usage using binary logistic regression: residing in medium rural towns (adjusted OR 4.71, 95% CI 1.23 to 17.94, p=0.02), age 18-65 years (adjusted OR 3.59, 95% CI 1.05 to 12.22, p=0.04) and having multiple chronic conditions (adjusted OR 10.95, 95% CI 1.25 to 95.87, p=0.03) compared with those in more remote areas, aged ≥66 years and with single condition, respectively. CONCLUSION: Indigenous-led VHS achieve substantial engagement through culturally grounded health coach support. However, addressing digital connectivity in remote areas, age-appropriate support for older adults and Indigenous workforce development is essential to ensure equitable access and sustained engagement.
31 May 2026
Read appraisal →International journal of circumpolar health
Artificial intelligence/machine learning in Alaska Native healthcare systems: symposium perspectives.
Artificial intelligence and machine learning (AI/ML) utilisation in Alaska Native and American Indian (AN/AI) healthcare presents an opportunity to address persistent health disparities and improve the well-being of Alaska Native communities. The 2025 Artificial Intelligence in Alaska Native Health Care Systems symposium occurred in Anchorage, Alaska, with 31 individuals participating in facilitated conversations between various stakeholders and specialists at the Alaska Native Tribal Health Consortium, Southcentral Foundation, Maniilaq Association and Stanford University. The overarching goal of the symposium was to bring together partners within the Alaska Tribal Health System (ATHS) to promote: (1) AN/AI peoples' guidance in support of Tribal sovereignty for AI/ML implementation within the ATHS, (2) expanded technical capacity and (3) centralised guidance and expertise to lead future AI/ML research and implementation with community-defined benefits. During the event, small group discussions focused on the following topics: (1) common AI/ML applications, (2) concerns surrounding AI/ML, (3) current or potential policies guiding AI/ML use and (4) how to build trust in AI/ML models. Themes discussed were data democratisation, AI/ML development and use needs to occur under the principles of data sovereignty, and AI/ML quality improvement and research are needed and distinct. The symposium was an important step in considering how to use AI/ML to optimise AN/AI health and well-being through collaborative partnerships and services.
25 May 2026
Read appraisal →Journal of medical Internet research
Combining Machine Learning Models and Screening to Enhance Suicide Risk Identification for American Indian Patients: Retrospective Cohort Study
BACKGROUND: American Indian and Alaska Native communities experience disproportionately high suicide rates. While machine learning (ML) models leveraging electronic health records have emerged as promising tools for suicide risk identification, the optimal integration of these models with existing screening practices remains unclear. OBJECTIVE: The objective of this study was to compare parallel and serial testing strategies that combine an ML suicide risk model and the Ask Suicide-Screening Questions (ASQ) against using the ASQ alone. To achieve this, we conducted a retrospective secondary analysis of electronic health record data. The cohort consisted of adult emergency department visits at an Indian Health Service facility between October 1, 2019, and October 2, 2021. METHODS: Sensitivity, specificity, predictive values, and 95% CIs were averaged across 10 cross-validated patient-level folds. The final sample included 7897 American Indian patients with 26,896 visits, 824 (3.1%) of which had a positive ASQ result and 102 (0.4%) of which had the outcome of suicide attempt or death within 90 days of the visit. The logistic regression ML model previously developed using Indian Health Service-specific data was operationalized at the 95th and 75th percentiles to evaluate high-risk and medium-risk thresholds, respectively. A sensitivity analysis was performed to evaluate identification approaches across all emergency department visits during this period. RESULTS: The ML medium-risk threshold alone identified the most true positives (sensitivity: 0.782, 95% CI 0.648-0.915; specificity: 0.751, 95% CI 0.725-0.777; positive predictive value [PPV]: 0.012, 95% CI 0.009-0.014; negative predictive value [NPV]: 0.999, 95% CI 0.998-0.999) in comparison to the ML high-risk threshold alone (sensitivity: 0.429, 95% CI 0.287-0.572; specificity: 0.955, 95% CI 0.948-0.961; PPV: 0.035, 95% CI 0.022-0.048; NPV: 0.998, 95% CI 0.997-0.999) or the ASQ alone (sensitivity: 0.178, 95% CI 0.073-0.282; specificity: 0.970, 95% CI 0.968-0.971; PPV: 0.022, 95% CI 0.010-0.034; NPV: 0.997, 95% CI 0.996-0.998). Combining the ML high-risk threshold with the ASQ in series yielded the greatest positive predictive ability (PPV: 0.050, 95% CI 0.014-0.086) at the cost of reduced sensitivity (0.129, 95% CI 0.036-0.221). Finally, the parallel testing approach using the ML medium-risk threshold yielded the greatest sensitivity (0.795, 95% CI 0.671-0.920; specificity: 0.742, 95% CI 0.716-0.767; PPV: 0.012, 95% CI 0.009-0.014; NPV: 0.999, 95% CI 0.998-0.999) without missing any cases identified through screening. CONCLUSIONS: Unlike existing studies that evaluate ML and screening tools in isolation, this study innovates by assessing combined parallel and serial testing strategies in a real-world setting. We demonstrated that, while serial testing maximizes predictive accuracy, it is often infeasible. Instead, parallel testing brings value as a clinical "safety net" to catch at-risk patients missed by standard practices. Ultimately, integrating ML in suicide prevention requires balancing statistical accuracy with setting-specific, real-world workflows.
13 May 2026
Read appraisal →BMJ open
'It's not just diabetes': implementation enablers and barriers of an indigenous-focused virtual diabetes care clinic using the Consolidated Framework for Implementation Research (CFIR) - a qualitative assessment.
INTRODUCTION: Indigenous peoples living with diabetes face unique challenges accessing comprehensive specialty diabetes care. A small diabetes virtual care clinic oriented towards Indigenous individuals, and those in rural and remote communities, has provided care to over 400 individuals. OBJECTIVES: We characterised the distinguishing features of care provided at this clinic and used the Consolidated Framework for Implementation Research 2.0 (CFIR) to explore the enablers and barriers to implementing this model of care, from the perspective of the clinic's staff and providers. RESEARCH METHODS AND DESIGN: Guided by CFIR, we conducted eight semi-structured interviews with six clinic staff members. Deductive thematic analysis was used to identify relevant enablers and barriers. RESULTS: The aspirational features of care were cultural safety, comprehensiveness and virtual delivery. The implementation of this model of care was enabled by an internal culture of relational care; a nimble, resourceful, pragmatic and client-centred approach to virtual delivery; wayfinding and resources from key external organisations; community engagement and a small team of motivated and independent providers. Key barriers included the lack of physical interactions and uncertain or limited resources and funding. CONCLUSION: The identified enablers and barriers to implementing an Indigenous-focused virtual diabetes care clinic have implications for future interventions to improve rural Indigenous chronic disease care, and for governments and adjacent organisations tasked with meeting Canada's Truth and Reconciliation Commission's calls to action in healthcare. Further research examining the effectiveness of virtual diabetes care at this clinic is ongoing.
19 Apr 2026
Read appraisal →International journal for equity in health
Community participation in responding to health misinformation
Responses to health misinformation increasingly emphasize the importance of community engagement, yet the role of participation and power sharing remains under-theorized and inconsistently described in the peer-reviewed literature. Drawing on findings from the systematic review Overcoming Health Misinformation in Marginalized Groups, which examined 32 studies evaluating approaches to tackling health misinformation, we reflect on how the depth and quality of community participation shape trust, engagement, and intervention success. We argue that sustained partnership, shared decision-making, and local ownership enhance message credibility and reach by embedding health information within trusted social contexts. We propose strengthening equity-focused responses through structured reporting tools that center power, trust, and co-production as practical design principles rather than implementation add-ons. Making participation visible is critical if community engagement is to move beyond rhetoric and contribute meaningfully to addressing health misinformation in contexts of low institutional trust.
11 Apr 2026
Read appraisal →Clin Dermatol
Chancroid.
Chancroid, caused by Haemophilus ducreyi, is a sexually transmitted genital ulcerative condition associated with inguinal bubo formation. The relative prevalence of chancroid has dramatically declined based on surveillance findings in those few endemic settings where the appropriate diagnostic tools exist; however, laboratory-based diagnostics are lacking to assist clinical management and support etiological surveillance in most parts of the world. Recent yaws surveys within the Western Pacific region indicate that H ducreyi has re-emerged as a frequent cause of chronic skin ulceration. Although there have been no antimicrobial susceptibility studies for three decades, it is assumed that a cure remains possible with extended-spectrum cephalosporins, macrolides, or fluoroquinolones. HIV-1-infected patients require careful followups due to reports of treatment failure with single-dose regimens. Buboes may need additional treatment with either aspiration or excision and drainage.
1 Jan 2026
Read appraisal →