The aim of this review was to explore the current evidence for conversational agents or chatbots in the field of psychiatry and their role in screening, diagnosis, and treatment of mental illnesses. Methods: A systematic literature search in June 2018 was conducted in PubMed, EmBase, PsycINFO, Cochrane, Web of Science, and IEEE Xplore. Studies were included that involved a chatbot in a mental health setting focusing on populations with or at high risk of developing depression, anxiety, schizophrenia, bipolar, and substance abuse disorders. Results: From the selected databases, 1466 records were retrieved and 8 studies met the inclusion criteria. Two additional studies were included from reference list screening for a total of 10 included studies. Overall, potential for conversational agents in psychiatric use was reported to be high across all studies. In particular, conversational agents showed potential for benefit in psychoeducation and self-adherence. In addition, satisfaction rating of chatbots was high across all studies, suggesting that they would be an effective and enjoyable tool in psychiatric treatment. Conclusion: Preliminary evidence for psychiatric use of chatbots is favourable. However, given the heterogeneity of the reviewed studies, further research with standardized outcomes reporting is required to more thoroughly examine the effectiveness of conversational agents. Regardless, early evidence shows that with the proper approach and research, the mental health field could use conversational agents in psychiatric treatment. Abré gé Objectif : Cette revue visait à explorer les données probantes actuelles sur les agents conversationnels ou les « chatbots » (robots parleurs) dans le domaine de la psychiatrie et le rô le que jouent ceux-ci dans le dépistage, le diagnostic, et le traitement des maladies mentales. Mé thode : Une recherche systématique de la littérature a été menée en juin 2018 dans PubMed, EmBase, PsycINFO, Cochrane, Web of Science, et IEEE Xplore. Les études incluses portaient sur un « chatbot » dans un milieu de santé mentale axé sur les populations souffrant de dépression, d'anxiété, de schizophrénie, du trouble bipolaire et des troubles d'abus de substances ou qui étaient à risque élevé de développer un de ces troubles. Ré sultats : Dans les bases de données choisies, 1466 dossiers ont été extraits et 8 études satisfaisaient aux critères d'inclusion. Deux études additionnelles ont été ajoutées après une sélection dans la liste de références, pour un total de 10 études incluses. En général, le potentiel de l'utilisation d'agents conversationnels en psychiatrie était estimé élevé dans toutes

Although clinical trials and real-world studies have affirmed the effectiveness and safety of the FDA-authorized COVID-19 vaccines, reports of breakthrough infections and persistent emergence of new variants highlight the need to vigilantly monitor the effectiveness of these vaccines. Here we compare the effectiveness of two full-length Spike protein-encoding mRNA vaccines from Moderna (mRNA-1273) and Pfizer/BioNTech (BNT162b2) in the Mayo Clinic Health System over time from January to July 2021, during which either the Alpha or Delta variant was highly prevalent. We defined cohorts of vaccinated and unvaccinated individuals from Minnesota (n = 25,589 each) matched on age, sex, race, history of prior SARS-CoV-2 PCR testing, and date of full vaccination. Both vaccines were highly effective during this study period against SARS-CoV-2 infection (mRNA-1273: 86%, 95%CI: 81-90.6%; BNT162b2: 76%, 95%CI: 69-81%) and COVID-19 associated hospitalization (mRNA-1273: 91.6%, 95% CI: 81-97%; BNT162b2: 85%, 95% CI: 73-93%). In July, vaccine effectiveness against hospitalization has remained high (mRNA-1273: 81%, 95% CI: 33-96.3%; BNT162b2: 75%, 95% CI: 24-93.9%), but effectiveness against infection was lower for both vaccines (mRNA-1273: 76%, 95% CI: 58-87%; BNT162b2: 42%, 95% CI: 13-62%), with a more pronounced reduction for BNT162b2. Notably, the Delta variant prevalence in Minnesota increased from 0.7% in May to over 70% in July whereas the Alpha variant prevalence decreased from 85% to 13% over the same time period. Comparing rates of infection between matched individuals fully vaccinated with mRNA-1273 versus BNT162b2 across Mayo Clinic Health System sites in multiple states (Minnesota, Wisconsin, Arizona, Florida, and Iowa), mRNA-1273 conferred a two-fold risk reduction against breakthrough infection compared to BNT162b2 (IRR = 0.50, 95% CI: 0.39-0.64). In Florida, which is currently experiencing its largest COVID-19 surge to date, the risk of infection in July after full vaccination with mRNA-1273 was about 60% lower than after full vaccination with BNT162b2 (IRR: 0.39, 95% CI: 0.24-0.62). Our observational study highlights that while both mRNA COVID-19 vaccines strongly protect against infection and severe disease, further evaluation of mechanisms underlying differences in their effectiveness such as dosing regimens and vaccine composition are warranted.

Over the past year, several payers, employers, and commercial vendors have announced personal health record projects. Few of these are widely deployed and few are fully integrated into ambulatory or hospital-based electronic record systems. The earliest adopters of personal health records have many lessons learned that can inform these new initiatives. We present three case studies--MyChart at Palo Alto Medical Foundation, PatientSite at Beth Israel Deaconess Medical Center, and Indivo at Children's Hospital Boston. We describe our implementation challenges from 1999 to 2007 and postulate the evolving challenges we will face over the next five years.

ABSTRACT:The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating the use of telemedicine in cardiovascular and stroke care and to provide consensus policy suggestions. We evaluate the effectiveness of telehealth in advancing healthcare quality, identify legal and regulatory barriers that impede telehealth adoption or delivery, propose steps to overcome these barriers, and identify areas for future research to ensure that telehealth continues to enhance the quality of cardiovascular and stroke care. The result of these efforts is designed to promote telehealth models that ensure better patient access to high-quality cardiovascular and stroke care while striving for optimal protection of patient safety and privacy. INTRODUCTION Telehealth: Opportunity to Reduce the Costs and Burden of Cardiovascular Disease and StrokeThe United States finds itself at a pivotal moment in the history of medicine when the annual growth in US healthcare spending increased to 5.3% in 2014, up from 2.9% in 2013, after 5 consecutive years of historically low growth.1 Spending on federal healthcare programs continues to grow significantly.2 Regardless, the need to provide high-quality care continues. More than 85 million Americans (≈26% of the US population) suffer from cardiovascular disease (CVD), and nearly 7 million (2.2%) are stroke survivors. CVD and stroke cost the US healthcare system more than $320 billion and $33 billion, respectively, each year, and by 2030, annual costs of CVD and stroke are projected to balloon to nearly $1 trillion.3 Now more than ever, strategies are needed to increase the value of health care by increasing the quality of care and lowering costs.Enhancing patient access to care via telehealth is an important strategy to help address this challenge. Telehealth, as defined by Office for the Advancement of Telehealth, comprises the use of telecommunications and information technologies to share information and to provide clinical care, education, public health, and administrative services at a distance. 4 Telehealth is a broad term that encompasses many digital health technologies, including telemedicine, eHealth, connected health, and mHealth. Telehealth is a new method of enabling care delivery that has the potential to help transform the healthcare system, to reduce costs, and to increase quality, patient-centeredness, and patient satisfaction. [5][6][7] In particular, telehealth may increase access and convenience for patients with CVD and stroke.8 This is especially true for vulnerable patients with CVD or stroke who, because of their geographical location, physical disability, advanced chronic disease, or difficulty with POLICY STATEMENTSsecuring transportation, may not otherwise access specialty healthcare services. 6,7 Yet, telehealth is underused for the management of CVD and stroke, and several barriers to the successful implementation of telehealth interventions for CVD and stroke exist, including cultural, financial, and legal or regulatory const...