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Journal Description

JMIR Preprints contains pre-publication/pre-peer-review preprints intended for community review (FAQ: What are Preprints?). For a list of all preprints under public review click here. The NIH and other organizations and societies encourage investigators to use interim research products, such as preprints, to speed the dissemination and enhance the rigor of their work. JMIR Publications facilitates this by allowing its' authors to expose submitted manuscripts on its' preprint server with a simple checkbox when submitting an article, and the preprint server is also open for non-JMIR authors.

With the exception of selected submissions to the JMIR family of journals (where the submitting author opted in for open peer-review, and which are displayed here as well for open peer-review), there is no editor assigning peer-reviewers.

Submissions are open for anybody to peer-review. Once two peer-review reports of reasonable quality have been received, we will send these peer-review reports to the author, and may offer transfer to a partner journal, which has its own editor or editorial board.

The submission fee for that partner journal (if any) will be waived, and transfer of the peer-review reports may mean that the paper does not have to be re-reviewed. Authors will receive a notification when the manuscript has enough reviewers, and at that time can decide if they want to pursue publication in a partner journal.

If authors want to have the paper only considered/forwarded to specific journals, e.g. JMIR, PLOS, PEERJ, BMJ Open, Nature Communications etc) after peer-review, please specify this in the cover letter. Simply rank the journals and we will offer the peer-reviewed manuscript to these editors in the order of your ranking.

If authors do NOT wish to have the preprint considered in a partner journal (or a specific journal), this should be noted in the cover letter.

JMIR Preprints accepts manuscripts at no costs and without any formatting requirements (but if you intend the submission to be published eventually by a specific journal, it is of advantage to follow their instructions for authors). Authors may even take a WebCite snapshot of a blog post or "grey" online report. However, if the manuscript is already peer-reviewed and formally published elsewhere, please do NOT submit it here (this is a preprint server, not a postprint server!).

 

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    Peer-Review 2.0: Welcome to JMIR Preprints, an Open Peer-Review Marketplace for Scholarly Manuscripts

    Authors List:

    Abstract:

    JMIR Preprints is a preprint server and "manuscript marketplace" with manuscripts that are intended for community review. Great manuscripts may be snatched up by participating journals which will make offers for publication.There are two pathways for manuscripts to appear here: 1) a submission to a JMIR or partner journal, where the author has checked the "open peer-review" checkbox, 2) Direct submissions to the preprint server. For the latter, there is no editor assigning peer-reviewers, so authors are encouraged to nominate as many reviewers as possible, and set the setting to "open peer-review". Nominated peer-reviewers should be arms-length. It will also help to tweet about your submission or posting it on your homepage. For pathway 2, once a sufficient number of reviews has been received (and they are reasonably positive), the manuscript and peer-review reports may be transferred to a partner journal (e.g. JMIR, i-JMR, JMIR Res Protoc, or other journals from participating publishers), whose editor may offer formal publication if the peer-review reports are addressed. The submission fee for that partner journal (if any) will be waived, and transfer of the peer-review reports may mean that the paper does not have to be re-reviewed. Authors will receive a notification when the manuscript has enough reviewers, and at that time can decide if they want to pursue publication in a partner journal. For pathway 2, if authors do not wish to have the preprint considered in a partner journal (or a specific journal), this should be noted in the cover letter. Also, note if you want to have the paper only considered/forwarded to specific journals, e.g. JMIR, PLOS, PEERJ, BMJ Open, Nature Communications etc), please specify this in the cover letter. Manuscripts can be in any format. However, an abstract is required in all cases. We highly recommend to have the references in JMIR format (include a PMID) as then our system will automatically assign reviewers based on the references.

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Latest Submissions Open for Peer-Review:

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  • Pleural Effusion resembling a lung tumor: Phantom Tumor of the Lung.

    From: JMIR Preprints

    Date Submitted: Jul 3, 2016

    Open Peer Review Period: Oct 3, 2016 - Sep 18, 2017

    Background: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo...

    Background: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo are coined, for this unusual finding, because it resembles to a tumor on radiograph and vanishes after initiating diuretic therapy. Objective: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo are coined, for this unusual finding, because it resembles to a tumor on radiograph and vanishes after initiating diuretic therapy. Methods: Case report Results: We suggest that, Phantom tumor be always kept in differentials of mass-like finding on chest radiograph in patients with congestive heart failure; if there has been an increase in symptoms and signs of congestive heart failure. And treatment with diuretics be provided, before going for any other expensive and unnecessary investigations or procedures. Conclusions: We suggest that, Phantom tumor be always kept in differentials of mass-like finding on chest radiograph in patients with congestive heart failure; if there has been an increase in symptoms and signs of congestive heart failure. And treatment with diuretics be provided, before going for any other expensive and unnecessary investigations or procedures.

  • From e-mental health to i-mental health: transition to participatory and personalized medicine in mental health

    From: Journal of Medical Internet Research

    Date Submitted: Apr 11, 2017

    Open Peer Review Period: Apr 12, 2017 - Jun 7, 2017

    Clinical assessment in psychiatry is commonly based on findings from brief, regularly scheduled in-person appointments. Although critically important, this approach reduces assessment to cross-section...

    Clinical assessment in psychiatry is commonly based on findings from brief, regularly scheduled in-person appointments. Although critically important, this approach reduces assessment to cross-sectional observations that miss essential information about disease course. The mental health provider makes all medical decisions based on this limited information. Thanks to recent technological advances, electronic-health (e-health) data collection strategies now can provide access to real-time patient self-report data during the interval between visits. Intelligent-health (i-health) further builds on and expands e-health by adding novel built-in data analysis approaches to enhance medical decision-making.

  • Comparing the diagnostic accuracy of simple tests to screen for diabetic peripheral neuropathy

    From: JMIR Research Protocols

    Date Submitted: May 19, 2017

    Open Peer Review Period: May 21, 2017 - Jun 4, 2017

    Various tests are used to detect diabetic peripheral neuropathy (DPN) by assessing sense perception in the feet. The aim of this study is to estimate the diagnostic accuracy of VibraTip against the go...

    Various tests are used to detect diabetic peripheral neuropathy (DPN) by assessing sense perception in the feet. The aim of this study is to estimate the diagnostic accuracy of VibraTip against the gold standard of sural nerve conduction velocity (SNCV) measurement, to assess whether the VibraTip device offers superior diagnostic accuracy to other routine tests for DPN, and to examine whether diagnostic tests based on vibration, including VibraTip, offer superior diagnostic accuracy for peripheral neuropathy compared with touch based tests. The study will include adults with diabetes type 2 who are due for check-up at a follow up clinic. Patients will be prospectively recruited. A cross-sectional study design will be employed to assess the diagnostic accuracy of 5 standard index tests for peripheral neuropathy, including VibraTip. The reference test will be SNCV measurement. The outcomes assessed will be the diagnostic accuracy of the 5 index tests against SNCV measurement, including positive predictive value, negative predictive value, negative likelihood ratio and positive likelihood ratio. Receiver operating characteristic (ROC) curves will be constructed and compared for each test.

  • INVERT: Improving neuromuscular monitoring and reducing residual neuromuscular blockade with e-learning - A protocol for a multi-center interrupted time series study

    From: JMIR Research Protocols

    Date Submitted: May 8, 2017

    Open Peer Review Period: May 9, 2017 - May 23, 2017

    Background: Muscle relaxants are used in general anesthesia to facilitate endotracheal intubation and improve surgical conditions. Residual neuromuscular blockade occurs when the patient is still part...

    Background: Muscle relaxants are used in general anesthesia to facilitate endotracheal intubation and improve surgical conditions. Residual neuromuscular blockade occurs when the patient is still partially paralyzed when awakened after surgery. The condition is associated with subjective discomfort and increased risk of respiratory complications. Residual block may be prevented by using an objective neuromuscular monitoring device. Despite this, many anesthetists refrain from using the device. Efforts to increase the use of objective monitoring are time-consuming and requires presence of expert personnel. A neuromuscular monitoring e-learning module might support consistent use of neuromuscular monitoring devices. Objective: The aim of the study is to assess the effect of a neuromuscular monitoring e-learning module on the anesthesia staff’s use of objective neuromuscular monitoring and the incidence of residual neuromuscular blockade in surgical patients at six Danish teaching hospitals. Methods: In this interrupted time series study, data is collected repeatedly in consecutive 3-week periods before and after the intervention, and the effect is analyzed using segmented regression analysis. Anesthesia departments in the Zealand Region of Denmark are included and data from all patients receiving a muscle relaxant is collected from the anesthesia information management system MetaVision. The effect of the module is assessed on all levels of potential effect: staff´s knowledge and skills, patient care practice, and patient outcomes. Primary outcome is use of neuromuscular monitoring in patients, respective of the type of muscle relaxant received. Secondary outcomes include last recorded train-of-four (TOF) value, administration of reversal agents, time to discharge from the post-anesthesia care unit, as well as a multiple-choice test to assess knowledge. The e-learning module is developed based on a needs assessment process, including focus group interviews, surveys, and expert opinions. Results: Status The e-learning module was implemented in 6 anesthesia departments 21 November 2016. Currently, post-intervention data is being collected. Conclusions: With a dataset consisting of thousands of general anesthesia procedures, the INVERT study will assess whether anesthetists’ use of neuromuscular monitoring can be increased with the aid of an e-learning module. Clinical Trial: NCT02925143

  • Integrated Decentralised Training (I-DecT): A Proposal for UKZN, South Africa

    From: Journal of Medical Internet Research

    Date Submitted: Mar 24, 2017

    Open Peer Review Period: Mar 29, 2017 - May 24, 2017

    Background: This project is aligned to a current need for healthcare within a South African context to address resource poor climates in rural and peri-urban settings shifting focus from an overserved...

    Background: This project is aligned to a current need for healthcare within a South African context to address resource poor climates in rural and peri-urban settings shifting focus from an overserved urban region. The University of KwaZulu-Natal, in South Africa has embarked on a programme within the School of Health Sciences (SHS) to decentralise the clinical learning platform in order to address this disparity in healthcare in the country. Framed in a pragmatic stance, this proposal is geared towards informing the roll out of the decentralised training within the province of KwaZulu-Natal within the SHS. Whilst this vision is the driving force, there currently remains uncertainty as to how the implementation of this programme would unfold, especially for the diverse School which includes Audiology, Dentistry, Occupational Therapy, Optometry, Pharmacy, Physiotherapy, Speech-Language Pathology and Sport Science. Consequently, there is a need to carefully monitor and manage this DCT in order to ensure that the students exposed to this longitudinal placement have a positive learning experience and achieve expected academic outcomes and that the needs of the communities are addressed adequately. Objective: The study aims to explore the factors that will influence the roll-out of the DCT towards the development of an inclusive and context-specific model that would suit the SHS in the DCT programme at UKZN. Methods: Key role players, including, but not limited to, the ministry of health policy makers and clinicians, as well as policy makers in the university, and clinical educators, academicians and students of UKZN within the SHS will participate in this project. Once the infrastructural, staffing and pedagogical enablers and challenges are identified, together with a review of existing models of decentralised training, a context-specific model of decentralised training for the school will be proposed based on initial pilot data that will be tested within iterative cycles in an action learning action research process in this project. Results: The study was designed to fit within the existing structures and emerging framework and memorandum of understanding between the partners in this initiative, namely, the Ministry of Health and the UKZN. In embracing this call to develop healthcare professionals that are competent and prepared for the changing dynamics of healthcare in a developing world. Conclusions: It is envisaged that this study, the first to include a combination of health professionals in a decentralised clinical training platform at UKZN, would not only contribute to effective service delivery but may also serve to inform an inter-professional programme within the SHS and tertiary institutions in similar settings.

  • Smart Diet Management: Collecting Dietary Intake for Chinese Foods Using RFID Technology

    From: Journal of Medical Internet Research

    Date Submitted: May 5, 2017

    Open Peer Review Period: May 7, 2017 - Jul 2, 2017

    Background: Dietary intake assessment is important for personal health management. However, it is challenging to record food consumption information in an efficient, accurate and sustainable manner, p...

    Background: Dietary intake assessment is important for personal health management. However, it is challenging to record food consumption information in an efficient, accurate and sustainable manner, particularly for the Chinese food consumptions Objective: This study aims to develop an intelligent method for Chinese food consumption data collection and nutrient analysis. Methods: Radio Frequency Identification (RFID) technology was applied to collect group’s food records via intelligent plates embedded with RFID chips in place where people went to eat a meal. Chinese food name and quantity information were collected via the cooked dish recipes to exact the key ingredients and to estimate their weights. The Chinese foods were separated into three main types: staple food (e.g., rice, steamed buns), cooked dish (e.g., cooked tomato with eggs), and soup (e.g., egg drop soup). In addition, food ingredients, food quantity and cooking methods were obtained to calculate energy and nutrients (carbohydrate, fat, fiber and etc.) according to the Chinese recipe database and China Food Composition database. Results: We applied the system to collect Chinese dietary intake for a group of 1,0528 individuals in lunch during 25 weeks. A total of 489 Chinese dishes were identified. Based on a Chinese recipe database and China Food Composition database, the Chinese foods were transformed to food ingredients, food quantity, cooking method, as well as nutrient values. Given a Chinese dish (e.g., Garlic Puree Cooked Pork Leg), we compared its nutrient values calculated by our method with the chemical measurements. The mean absolute percentage deviation (MAPD) showed our method enable collecting dietary intake for Chinese foods. Conclusions: A smart dietary management system using RFID technology is useful and is capable to record Chinese food dietary information efficiently and effectively. It can be used for individuals and dietarians for setting up personalized nutrient plan in the future.

  • Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients with Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial

    From: Journal of Medical Internet Research

    Date Submitted: Apr 25, 2017

    Open Peer Review Period: Apr 25, 2017 - Jun 20, 2017

    Background: Depression is a significant challenge for safety-net primary care systems. Collaborative depression care is effective, but complex system factors impede adoption and result in persistent d...

    Background: Depression is a significant challenge for safety-net primary care systems. Collaborative depression care is effective, but complex system factors impede adoption and result in persistent disparities in depression outcomes. A care delivery model was evaluated that harnesses information and communication technologies to automate routine screening and monitoring of patient depressive symptoms and treatment adherence and to allow timely communication with providers. Objective: The aim of the study was to compare 6-month outcomes of the technology-facilitated care management (TC) model to usual care (UC) and a supported care (SC) model that involved team-based care management practice for safety-net primary care adult patients with type 2 diabetes. Methods: The Diabetes-Depression Care-Management Adoption Technologies Trial is a translational study in collaboration with Los Angeles County Department of Health Services, the second-largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: UC, SC, and TC. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. Results: A sample of 1,406 patients (484 in UC, 480 in SC, 442 in TC) was enrolled. A majority of the patients were Hispanic or Latino and female. Compared to UC, both SC and TC groups experienced significantly reduced depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate [LSE]: UC=6.35, SC=5.05, TC=5.16; P: SC vs. UC=.02, TC vs. UC=.02); decreased prevalence of major depression (odds ratio [OR]: SC vs. UC=0.45, TC vs. UC=0.33; P: SC vs. UC=.02, TC vs. UC=.007); and improved functional disability as measured by Sheehan Disability Scale scores (LSE: UC=3.21, SC=2.61, TC=2.59; P: SC vs. UC=.04, TC vs. UC=.03). Only TC, not SC, significantly improved depression remission (TC vs. UC: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: UC=3.20, TC=3.70; P=.05); reduced total cholesterol level (LSE: UC=176.40, TC=160.46; P=.01); improved satisfaction with diabetes care (LSE: UC=4.01, TC=4.20; P=.05); and increased the odds of taking an A1c test (TC vs. UC: OR=3.40, P<.001). Conclusions: Both the TC and SC delivery models can improve 6-month depression outcomes. Nevertheless, the TC model is more effective in improving depression remission, patient satisfaction, and diabetes care quality. Clinical Trial: ClinicalTrials.gov NCT01781013

  • Evaluation of a motivational interview delivered by NAO robot

    From: Journal of Medical Internet Research

    Date Submitted: Mar 24, 2017

    Open Peer Review Period: Mar 29, 2017 - May 24, 2017

    Background: Most people do not achieve the government’s minimum recommendations for physical activity and want help to increase their levels but are unable to gain access to face-to-face counselling...

    Background: Most people do not achieve the government’s minimum recommendations for physical activity and want help to increase their levels but are unable to gain access to face-to-face counselling to support motivation. Motivational interviewing (MI) is one of the most effective psychological interventions for supporting behaviour change and social robots that can deliver effective motivational support could offer a way to close this gap and help people develop and sustain more physically active lifestyles. Objective: We have developed a virtual health intervention with a robot counsellor based on MI for encouraging physical activity. We used a NAO robot programed with Choregraphe software to deliver a motivational interview designed to be comprehensible in the absence of an empathetic response from the interviewer. The intonation and speed of each sentence were carefully developed together with the choice of movements for the interview. We utilized a breathing function, in which the robot moves gently, for a natural apperance. The robot’s face-tracking mode enabled the robot to always gaze at the participant’s face, regardless of their movements during the course of the interview, giving a sense that NAO was paying attention to them. Methods: A total of 20 participants took part in the robot-delivered motivational interview, and evaluated it after one week. Each participant was left alone with the robot in a lab styled as a living room, and advanced through a series of questions by tapping the robot head sensor. Their evaluations were content analyzed utilizing Boyatzis’ (1998) steps which include (1) sampling and design, (2) developing themes and codes, and (3) validating and applying the codes. Categories originated from the text itself, generating themes focused on interaction with the robot, assessment of content, and motivation for change. Results: Participants found the instructions clear and the navigation easy to use. Most enjoyed the interaction but also found it was restricted by the lack of individualised response from the robot. Some found it off-putting to touch the robot’s head sensor to advance to the next question. Many participants positively appraised the non-judgemental aspect of the interview and how it gave space to articulate their motivation for change. Some participants felt that the intervention increased their activity levels. Conclusions: The NAO robot was effective at eliciting discussion from the participants about their goals and motivations. Because they are perceived as non-judgemental, robots may have advantages over humanoid avatars for delivering virtual support for behavioural change.

  • To what extent should patients control access to patient records? A trial by citizens’ jury

    From: Journal of Medical Internet Research

    Date Submitted: Mar 28, 2017

    Open Peer Review Period: Mar 29, 2017 - May 24, 2017

    Background: The secondary use of health data for societal and commercial benefit raises complex questions of privacy and governance. Such questions are ill-suited to opinion polling where citizens mus...

    Background: The secondary use of health data for societal and commercial benefit raises complex questions of privacy and governance. Such questions are ill-suited to opinion polling where citizens must choose quickly between multiple-choice answers based on little information. Objective: This project aims to extend knowledge about what control informed citizens would seek over health records after participating in a deliberative process, using "citizens’ juries". Methods: Two citizens’ juries, of 17 citizens each, were convened; each jury was chosen to reflect UK national demographics, from 355 eligible applicants. Juries met separately over three days, to address the charge “To what extent should patients control access to patient records for secondary use?”. Jurors heard from and questioned five expert witnesses (chosen either to inform the jury, or to argue for and against the secondary use of data), interspersed with structured opportunities to deliberate amongst themselves including discussion, and role-play. Jurors voted on a series of questions associated with the jury charge, giving their rationale. Individual views were polled using questionnaires at the beginning and end of the process. Results: At the end of the process, 33 out of 34 jurors voted in support of the secondary use of data, with 24 wanting individuals to be able to opt-out, 6 favouring opt-in and 3 voting that all records should be available without any consent process. When considering who should get access to data, both juries had very similar rationales. Both thought that public benefit was a key justification for access. Jury 1 was more strongly supportive of sharing patient records for public benefit, whilst Jury 2 was more cautious and sought to give patients more control. Many jurors changed their opinion about who should get access to health records: 17 people became more willing to support wider information sharing of health data for public benefit, whereas two people moved towards more patient control over patient records. Conclusions: The findings highlight that, when comprehensively informed of both risks and opportunities associated with data sharing, citizens believe an individual’s right to privacy should not prevent research that can benefit the general public. The juries also concluded that patients should be notified of any such scheme and have the right to ‘opt-out’ if they so choose. Many jurors changed their minds about this complex policy question when they became more informed. Many, but not all, jurors became less sceptical about health data sharing as they became better informed of its benefits and risks. Clinical Trial: N/A

  • Social Media Utilization Among Orthopedic Surgeons in a Large US City

    From: Journal of Medical Internet Research

    Date Submitted: Mar 27, 2017

    Open Peer Review Period: Mar 29, 2017 - May 24, 2017

    Background: Physician Internet and social media presence is increasingly common as a sophisticated patient population and referral base continues to seek information when selecting an orthopedic surge...

    Background: Physician Internet and social media presence is increasingly common as a sophisticated patient population and referral base continues to seek information when selecting an orthopedic surgeon. Objective: We hypothesized that American Academy of Orthopedic Surgeons (AAOS) Fellows of fewer than 20 years would have a higher Internet and social media presence when compared to AAOS fellows of more than 20 years. We limited our analysis regionally to San Francisco, California. Methods: A current list of AAOS Fellows practicing in San Francisco was obtained from the AAOS Website. A total of 86 current fellows, not including candidate and resident members, were compiled. The list was divided into AAOS Fellows of fewer than 20 years and AAOS Fellows of more than 20 years. An investigation was made regarding Internet and social media presence via search engines for both individual physicians and for websites for physician practices (solo or group versus hospital or university-based). Additionally, the presence of physician and practice accounts for Facebook, LinkedIn, and Twitter, and physician accounts for Instagram, YouTube, and Google+ was identified. Internet and social media presence was compared between these two groups and percentage of participation was evaluated. Results: 94% of all San Francisco AAOS Fellows have an active Internet website accessible to the general public and 41% of Fellows have online appointment availability. Despite Fellows in the under 20-year group and private practice not having significantly more online appointment availability than the over 20-year group and university/hospital-based setting, there was a clear trend in that direction. The under 20-year group participated in an average of 1.2 more social media sites (4.1 vs 2.9 P=0.02). There was no significant difference between private practice and university/hospital-based practice with regard to social media usage. Google+ was the most likely utilized social media website followed by LinkedIn, YouTube, Facebook, Twitter, and Instagram. The under 20-year group utilized newer social media sites like Twitter and Instagram more frequently than the over 20-year group. Conclusions: Internet and social media presence is clearly and important component of physician practice amongst San Francisco orthopedic surgeons. Private practice physicians and surgeons with fewer years in practice are more likely to utilize online appointment software.

  • A Characterization of Patient Interest in Provider-Based Consumer Health Information Technology

    From: Journal of Medical Internet Research

    Date Submitted: Mar 30, 2017

    Open Peer Review Period: Mar 30, 2017 - May 25, 2017

    Background: Consumer Health Information Technology (CHIT) can improve patient engagement in their healthcare and assist in navigating the complexities of healthcare delivery. However, the CHIT offerin...

    Background: Consumer Health Information Technology (CHIT) can improve patient engagement in their healthcare and assist in navigating the complexities of healthcare delivery. However, the CHIT offerings of health systems are often driven by provider rather than patient perspectives, inadequately address patient needs, and are thus limited in adoption by patients. Consideration given to patients as stakeholders in the development of such technologies, may improve adoption, efficacy, and CHIT resource allocation. Objective: To measure patient interest in various health system CHIT applications, and determine the influence of patient characteristics on CHIT interest. Methods: Patients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different CHIT applications. A self-efficacy scale, PHQ-9 depression screen, and EQ-5D health-related quality of life scale, were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in CHIT in the categories of self-management, education, and communication. Results: The majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. Highest interest was in applications that allow patients to ask questions of providers (90.24% (3476/3852)) and to schedule appointments (83.64% (3211/3839). Patient interest in CHIT was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smart phone ownership (P<.001 for all listed). Conclusions: The majority of patients demonstrated a strong interest in CHIT involving education, communication, and self-management. Highest-interest technology applications include those allowing patients to ask questions of providers and schedule appointments. Interest in CHIT varies according to patient self-efficacy, health-related quality of life, and depression. This information can be used to help prioritize the development of CHIT applications and target implementation to the most appropriate patient populations.

  • Seeing the Whole Picture: Integrated Pre-Surgery Reports Using Optique

    From: Journal of Medical Internet Research

    Date Submitted: Mar 29, 2017

    Open Peer Review Period: Mar 29, 2017 - May 24, 2017

    Background: Information technology has transformed the way healthcare is conducted. There is a deluge of patient data dispersed in different systems that are commonly not interoperable. As a result, a...

    Background: Information technology has transformed the way healthcare is conducted. There is a deluge of patient data dispersed in different systems that are commonly not interoperable. As a result, access to patient data has become a major bottleneck for healthcare professionals that struggle to find the relevant information in a timely way and without missing critical clinical information. Objective: We propose a novel hybrid semantic and text-based system that was commissioned by a large hospital in Norway for providing integrated access to patient health records scattered in several databases and document repositories. Methods: We use OBDA technology for the seamless integration of the structured databases at the hospital through the Optique platform. We employ text analysis techniques to extract vital sign measures and clinical findings from patient documents. Results: The envisioned system was developed and deployed at the hospital. This solution demonstrates how OBDA technology can provide integrated data access to disparate structured sources in healthcare, without requiring the replacement of existing databases. Unstructured clinical text is also mined to extract patient findings, while the GUI provides a single access point that hides the underlying complexity of the system. We ran a usability study with 5 target users, obtaining a SUS score of 86. Further, participants in the study stressed the simplicity of the GUI and the integration of data sources enabled by the system. Conclusions: This pilot study showcases the use of OBDA technology and text analysis to enable the integration of patient data for supporting clinical surgery operations. The resulting system is usable and can be easily employed by medical personnel to find patient data in a timely way.

  • Towards m-health brief contact interventions in suicide prevention: A Case Series from the Suicide Intervention Assisted by Messages (SIAM) randomized controlled study

    From: Journal of Medical Internet Research

    Date Submitted: Apr 5, 2017

    Open Peer Review Period: Apr 6, 2017 - Jun 1, 2017

    Background: Research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from care services after a suicide attempt can reduce reattempt risk. Pilo...

    Background: Research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from care services after a suicide attempt can reduce reattempt risk. Pilot studies have demonstrated that interventions using mobile-health technologies are feasible in a suicide prevention setting. Objective: The aim of the current study is to report three cases of patients recruited in the Suicide Intervention Assisted by Messages (SIAM) study in order to describe how a mobile intervention may influence follow-up. Methods: SIAM is a two-year, multi-center randomized controlled trial conducted by the Brest University Hospital, France. Participants in the intervention group receive the SIAM text messages 48 hours after discharge, then at day 8, day 15, and months 1, 2, 3, 4, 5 and 6. The study includes participants aged 18 or over, who have attended a participating hospital for a suicide attempt, and have been discharged from the ED or a Psychiatric Unit (PU) for a stay of less than seven days. Eligible participants are randomized between the SIAM intervention messages and a control group. This study present a case series from the ongoing SIAM study, which demonstrates the capability of a mobile-based brief contact intervention triggering patient-initiated contact with a crisis support team at various time points through the study period. Results: Three cases from the randomized controlled study were chosen to illustrate the impact of the m-health on further suicide ideation. Participants initiated contact with the emergency crisis support service after receiving text messages up to six months following discharge from hospital. Contact was initiated immediately following receipt of a text message, up to six days following a message. Conclusions: This text-message based brief contact intervention has demonstrated the potential to reconnect suicidal individuals with crisis support services, while they are experiencing suicidal ideation as well as a period after receive messages. As follow-up phone calls over an extended period of time may not be feasible, this intervention has the potential to offer a simple technological support for individuals following discharge from the emergency department. Clinical Trial: NCT02106949

  • Facilitating factors and barriers to the use of new technologies for suicide prevention in Europe: a multi-country exploratory study

    From: Journal of Medical Internet Research

    Date Submitted: Mar 30, 2017

    Open Peer Review Period: Mar 30, 2017 - May 25, 2017

    Background: This study provides an analysis on the use of new technologies for prevention of suicide in eight different European countries. Objective: We want to analyse the potentiality of using new...

    Background: This study provides an analysis on the use of new technologies for prevention of suicide in eight different European countries. Objective: We want to analyse the potentiality of using new technologies in the area of suicide prevention based on the opinion of different professionals involved in suicide prevention. Methods: Opinions of three different groups of stakeholders were gathered using a specifically designed questionnaire to explore dimensions underlying perception of facilitating factors and barriers in relation to the use of new technologies for suicide prevention. Results: Goal 1: Facilitating factors for the use of new technologies in suicide prevention. Northern European countries, except for Belgium, attach greater relevance to those that optimize implementation and benefits. Southern European countries, on the other hand, attach greater importance to professionally-oriented and user-centred facilitating factors. The analysis of these facilitating factors according to different stakeholders evidences that professionals in the field of social work attach greater relevance to those that optimize implementation and those that optimize the benefits. However, professionals involved in the area of mental health, policy makers and political decision-makers give greater importance to professionally-oriented and user-centred facilitating factors. Goal 2: Barriers to the usability of new technologies for suicide prevention. Both countries and stakeholders attach greater importance to barriers associated with resource constraints than to those centred on personal limitations. There are no differences between countries or between stakeholders. Nevertheless, there is a certain stakeholders-countries interaction that indicates that the opinions on resource constraints expressed by the different stakeholders do not follow a uniform pattern in the different countries, but different ones depending on the country. Conclusions: While all countries and stakeholders agree in identifying resource constraints as the main barrier to the use of new technologies, factors facilitating their use in suicide prevention differ among countries and among stakeholders.

  • Stopping antidepressants and anxiolytics as Major concerns reported in Online Health Communities – A text-mining approach

    From: JMIR Mental Health

    Date Submitted: Mar 31, 2017

    Open Peer Review Period: Apr 3, 2017 - May 29, 2017

    Background: Internet is a particularly dynamic way to quickly capture the perceptions of a population in real time. Complementary to traditional face-to-face communication, online social networks help...

    Background: Internet is a particularly dynamic way to quickly capture the perceptions of a population in real time. Complementary to traditional face-to-face communication, online social networks help patients to improve self-esteem and self-help. Objective: The aim of this study was to use text mining on material from an online forum exploring patients’ concerns about treatment (antidepressants and anxiolytics). Methods: Concerns about treatment were collected from discussion titles in patients' online Community related to antidepressants and anxiolytics. To examine the content of these titles automatically, we used text-mining methods: word frequency in a document-term matrix, and co-occurrence of words using a network analysis. It was thus possible to identify topics discussed on the forum. Results: The forum included 2415 discussions on antidepressants and anxiolytics over a period of 3 years. After a preprocessing step, the text mining algorithm identified the 99 most frequently-occurring words in titles, among which were escitalopram, withdrawal, antidepressant, venlafaxine, paroxetine, and effect. Patients’ concerns related to antidepressant withdrawal, the need to share experience about symptoms, effects, and questions on weight gain with some drugs. Conclusions: Patient expression on the Internet is a potential additional resource in addressing patients' concerns about treatment. Patient profiles are close to that of patients treated in psychiatry.

  • Development and Validation of a Functional Behavioural Assessment Ontology to Support Behavioural Health Interventions

    From: Journal of Medical Internet Research

    Date Submitted: May 15, 2017

    Open Peer Review Period: May 18, 2017 - Jul 13, 2017

    Background: In the cognitive behavioural approach, Functional Behavioural Assessment is one of the most effective methods to identify the variables that determine a problem behaviour. In this context,...

    Background: In the cognitive behavioural approach, Functional Behavioural Assessment is one of the most effective methods to identify the variables that determine a problem behaviour. In this context, the use of modern technologies can encourage the collection and sharing of behavioural patterns, effective intervention strategies, and statistical evidences about antecedents and consequences of clusters of problem behaviours, encouraging the designing of function-based interventions. Objective: The paper describes the development and validation process used to design a specific Functional Behavioural Assessment Ontology (FBA-Ontology). The FBA-Ontology is a semantic representation of the variables that intervene in a behavioral observation process, facilitating the systematic collection of behavioral data, the consequential planning of treatment strategies and, indirectly, the scientific improvement in this field of study. Methods: The ontology has been developed deducing concepts and relationships of the ontology from a golden standard and then performing a machine-based validation and a human-based assessment to validate the Functional Behavioural Assessment Ontology. These validation and verification processes were aimed to verify how much the ontology is conceptually well founded and semantically and syntactically correct. Results: The Pellet reasoner checked the logical consistency and the integrity of classes and properties defined in the ontology, not detecting any violation of constraints in the ontology definition. In order to assess whether the ontology definition is coherent with the knowledge domain or not, a human evaluation of the ontology were performed asking 84 people to fill in a questionnaire composed by 13 questions assessing concepts, relations between concepts, and concepts’ attributes. The response rate for the survey was 34.52%. The domain experts confirmed that the concepts, the attributes, and the relationships between concepts defined in the FBA-Ontology are valid and well represent the Functional Behavioural Assessment process. Conclusions: The new ontology developed could be a useful tool to design new evidence-based systems in the Behavioral Interventions practices, encouraging the link with other Linked Open Data datasets and repositories to provide users with new models of e-health focused on the management of problem behaviours. Therefore, new researches and efforts are needed to develop and implement innovative strategies to improve the poor reproducibility and translatability of basic research findings in the field of behavioural assessment.

  • Internet-based cognitive behavioral therapy for children and adolescents with dental anxiety - an open trial

    From: Journal of Medical Internet Research

    Date Submitted: May 8, 2017

    Open Peer Review Period: May 9, 2017 - Jul 4, 2017

    Background: Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxi...

    Background: Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects. Objective: The aim of this study was to test the feasibility and efficacy of a newly developed ICBT for dental anxiety. Methods: This was an open, uncontrolled trial with assessments at baseline, post-treatment, and the 1-year follow-up. The study enrolled and treated 18 participants (8–15 years) with a diagnosis of dentistry-related specific phobia. The primary outcome measures constructed by our research team were the child and parent versions of the Picture-Guided Behavior Avoidance Test. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received online guidance from a psychologist. Treatment also included training at dental clinics. Results: The primary outcome measure according to picture guided behavioral test, self-efficacy improved (P<.001) and dental anxiety decreased significantly as a result of ICBT (P<.001). Within-group effect sizes for both the primary outcome (Cohen’s d = 1.5) and other outcomes were large in the range of 0,9 and 1.5. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. Over half the participants were free from diagnosable dental anxiety at the 1-year follow-up. Most of participants and their parents were satisfied with the treatment. Conclusions: ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies.

  • Using Mobile Health Services for the Dissemination of Sexually Transmissible Infection Information to Women in Bangladesh: Health Care Provider Perspectives

    From: JMIR mHealth and uHealth

    Date Submitted: Apr 2, 2017

    Open Peer Review Period: Apr 6, 2017 - Jun 1, 2017

    Background: As many as one-third of all pregnancies in Bangladesh are unplanned, and although 61% of married women in Bangladesh use contraceptive methods, the prevalence of contraceptive use is lower...

    Background: As many as one-third of all pregnancies in Bangladesh are unplanned, and although 61% of married women in Bangladesh use contraceptive methods, the prevalence of contraceptive use is lower in rural areas than in urban areas. As the data on Sexually Transmissible Infections (STI) cases are hardly reported in Bangladesh, the awareness level and knowledge of the correct ways to avoid HIV/AIDS among the general public in Bangladesh are quite low. Mobile health (mHealth) services present a strong platform for increasing the access to STI services for women at risk for contracting various reproductive tract infections. We sought to investigate the knowledge, attitudes and practices of mHealth STI clients from the formal sexual and reproductive healthcare providers’ perspectives. Objective: To explore the perceptions of mobile health care service providers to understand the usage of mobile health services for STI health information dissemination. Methods: 22 interviews were conducted with formal health care providers in a private mobile health service delivery organization. Interview data was coded and qualitatively analyzed for themes using standard qualitative research practices. Results: Our findings suggest that using the mobile network service system, majority of the women population were more responsive and interested in such services. There had been more number of STI clients than for other reproductive health services. There was a sudden sense of trust working amongst the women clients as they mostly preferred to share their health complications with the female medical graduates more. The consultation expense and timeliness and accessibility of the service also played a major role in availing the mHealth service. Conclusions: We report low utilization yet high acceptability of mHealth services among women clients in Bangladesh. This study found some similarities with other studies in terms of service accessibility, health literacy and service utilization, while there had been some unique findings about the women clients who are now mobile users and have been taking independent decisions in availing STI services in more patriarchal societal community settings. Service expansion is needed as it may help increase the dissemination of information about STI and other reproductive health complications, and connecting women with formal providers, more referral services, increased diagnosis appointments thorugh the application of mHealth. While in-person visits remain necessary for adequate treatment.

  • Examining Health App Use among U.S. Smartphone Users with Chronic Disease

    From: JMIR mHealth and uHealth

    Date Submitted: Apr 6, 2017

    Open Peer Review Period: Apr 6, 2017 - Jun 1, 2017

    Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chron...

    Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. Objective: The current study explores behaviors and perceptions about mobile phone based applications (apps) for health among individuals with CMC, and examines if behaviors and beliefs are different between individuals with and without CMCs. Methods: Data were collected from a national cross-sectional survey of 1,604 smartphone users in the U.S. assessing mobile health use, beliefs and preferences. The current study examined responses by CMC (no CMC, one CMC, and with two or more CMCs). Responses were summarized using descriptive statistics and the relationship between comorbidity and health app download was examined via regression. Results: Participants reported using health-related apps frequently (“two or more times daily” was reported by 29% of individuals without CMC, whereas 16% to 28% of individuals with CMC reported health app use “two or more times daily”). Reasons for downloading health apps varied, but “track activity/exercise” was among the most common reasons for download in all groups (46% among individuals without CMC, between 27% and 39% for individuals with CMC. Logistic regression revealed individuals with at least one CMC were less likely than individuals without CMC to download health apps (OR=0.46, 95%C[0.37-0.59],p<.001). Individuals with hypertension (OR=0.44, 95%CI[0.35-0.56],p<.001) and high cholesterol (OR=0.52, 95%CI[0.41-0.67),p<.001) were less likely than individuals without these conditions to report health app download. Finally, individuals with comorbidity were less likely than individuals without comorbidity to report health app download (OR=0.54, 95%CI[0.44-0.68],p<.001). Conclusions: Results from this study suggest that those who may benefit from health apps (individuals with CMC and/or comorbidity) were less likely to report download and use compared to individuals without these conditions. Results of this study identify beliefs and behaviors by CMC, and thus may be useful for designers and developers to create tailored programs for specific CMC needs.

  • An empirical study on the key influence factors of consumers’ intentions towards promoting the mobile health based on DDANPMV model

    From: Journal of Medical Internet Research

    Date Submitted: Apr 10, 2017

    Open Peer Review Period: Apr 12, 2017 - Jun 7, 2017

    Background: Mobile health industry for mobile device and market demand has a good development prospects. Mobile health service brings great social benefit and economic benefit because of its convenien...

    Background: Mobile health industry for mobile device and market demand has a good development prospects. Mobile health service brings great social benefit and economic benefit because of its convenience and efficiency in regulating hospital resource allocation. However, the research conducted by Rock Health shows the result that although there are over 13,000 apps about fitness and health in app store, it is found out only 19% users download such applications. There is still a large space for consumers to accept and adopt mobile health. Objective: The significance of this study lies in analyzing influential factors of consumers’ adoption intention and making mobile health products a better promotion. On the process of promoting mobile health, there will be various obstacles. For instance, users’ queries on the safety and privacy of personal information, and the influence on medical reimbursement from e-payment. Previous researches about mobile health mostly focused on technology level and clinical expansion, and there is few researches on consumers’ adoption of medical health. Since mobile health needs to read personal information, it puts forward higher requirements for privacy and safety. The study on the influential factors of consumers’ adoption will be of a great importance in improving and promoting mobile health. Based on the key influential factors found in the research, decision-makers can take measures accordingly to promote consumers’ adoption of mobile health better. Methods: A new hybrid modified MCDM method can be adopted: Firstly, construct the influential network relation map (INRM) and determine the influential weights (IWs) of DANP (DEMATEL-based ANP) by using the influence relation matrix through DEMATEL technique; Then, combine the influential weights with the modified VIKOR method as integration weighting in criteria evaluation based on INRM for establishing the performance gap improvement strategies by systematics, called these processes as DDANPMV (DEMATEL + DANP + Modified VIKOR) model. Therefore, this study proposed DDANPMV model to solve this problem will be more effective. Results: Therefore, this study proposed DDANPMV model to solve this problem will be more effective. An empirical real case is illustrated to demonstrate the feasibility and effectiveness of proposed method, the paper selects four mobile health products (P1 is developed by a sensor company, P2 is a smart pill with an embedded chip in it developed by a start-up company, P3 is the smart health scanner launched by a health care products company, and P4 is a mobile electrocardiogram equipment developed by a biotechnology company) as examples in real cases. Conclusions: (1) Construct the evaluation index system of influential factors in consumers’ adoption of mobile health including three dimensions and eight criteria. A large of existing domestic/foreign researches on consumers' adoption of mobile health focus on the analysis of one or several certain factors, which lacks the construction of a scientific evaluation index system systematically. This paper analyzes the characteristics of mobile health and develops previous relevant studies on the basis of literature review, previous theories, discussion and summary. (2) Recognize the interrelationships among dimensions/criteria graphically through INRM, from which the paper concludes that technological dimension (D1) has directly influence on subjective dimension (D2) and environment dimension (D3), and subjective dimension (D2) also influences environment dimension (D3). Providers are able to improve their products more flexible and accurate based on the identification of cause-effect relationships among dimensions/criteria and the actual situation of their own products. (3) Verify the VIKOR method through an empirical case to identify performance gaps of four mobile health products and rank them for continuous improvement and products-development. The paper compares the traditional VIKOR method and the modified VIKOR method to illustrate the effectiveness of the latter. The modified VIKOR helps not only in products comparison within a specific criterion, the comparison among all criteria is also meaningful because of an unified reference point/benchmark. In this process, the paper provided guiding meanings in product improvement strategies for decision-makers as well as in consumers’ ranking and selection of different alternatives to better solve the problems in the real world. It conforms better to the logic and thoughts in real life because it assigns to represent the best value rather than “picks the best apple among a barrel of rotten apples”.

  • Use of the Internet to Communicate with Providers from 2003 to 2013: 10 years of Patient Engagement according to the Health Information National Trends Surveys (HINTS)

    From: Journal of Medical Internet Research

    Date Submitted: Apr 24, 2017

    Open Peer Review Period: Apr 25, 2017 - Jun 20, 2017

    Background: Communication is key in chronic disease management, and the Internet has altered the manner in which patient and providers can communicate. It is an additional avenue by which providers c...

    Background: Communication is key in chronic disease management, and the Internet has altered the manner in which patient and providers can communicate. It is an additional avenue by which providers can engage patients. Adoption of secure messaging differs among patients due to the digital divide (i.e., disparities in technology access based on socio-economic factors). Objective: To examine the current state of online patient-provider communication, exploring longitudinal trends over time in the use of online patient-provider communication. Methods: A three part analytic process was used: 1) reanalysis, 2) close replication across years, and 3) trend analysis extension. During the reanalysis stage, the publicly available HINTS 1 and 2 data was used with the goal of identifying the precise analytic methodology used by in the original 2007 paper. The original analysis was extended to add additional data years (i.e., 2008, 2011, and 2013) using the same analytic approach with the purpose of identifying trends over time. Multivariate logistic regression was used to analyze pooled data across all years with year as an added predictor in addition to a model for each individual data year. Results: The odds of Internet users to communicate online with health care providers was significantly and increasingly higher by year compared to 2003 (2005 OR=1.32, 2008 OR=2.14, 2011 OR=2.92, and 2013 OR=5.75). Statistically significant socio-economic factors found to decrease the likelihood of Internet users communicating online with providers included: age, no insurance, no history of cancer, and non-urban area of residence. Conclusions: The proportion of Internet users communicating online with their healthcare providers has significantly increased since 2003, and though these trends are encouraged to continue through health care policy (e.g., HITECH Act), access challenges remain making it difficult to use this means of communication to engage all patients in all areas.

  • Internet hospital in China: a cross-sectional survey

    From: Journal of Medical Internet Research

    Date Submitted: Apr 12, 2017

    Open Peer Review Period: Apr 17, 2017 - Jun 12, 2017

    Background: Internet hospital is rapidly developing in China, because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China’s Intern...

    Background: Internet hospital is rapidly developing in China, because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China’s Internet hospitals have not been systematically investigated. Objective: The aim of this study was to describe the characteristics and to assess the health service capacity of China’s Internet hospitals. Methods: We searched Baidu to identify Internet hospital up to March 31, 2017, using search terms such as Internet hospital, web hospital, or cloud hospital. All Internet hospitals in mainland China were eligible for inclusion if they have been officially registered. Results: We identified 68 Internet hospitals, of which 43 have been put into use and 25 are under construction. Of the 43 established Internet hospitals, 13 (30.2%) were in hospital informatization stage, 24 (55.8%) were in web ward stage, and 6 (14.0%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (n=32, 74.4%), app (n=18, 41.9%), or offline medical consultation facility (n=16, 37.2%) from the Internet hospital. 25 (58.1%) Internet hospitals asked doctor to deliver health service at specific web clinic, and 18 (41.9%) not required. The consulting methods include video chat (n=26, 60.5%), telephone (n=8, 18.6%), and graphic message (n=12, 27.9%), while 13 (30.2%) Internet hospitals cannot be consulted online now. Only six Internet hospitals are included in the coverage of health insurance. The median number of doctors available online was zero (interquartile [IQR] 0 to 5; max 16492). The median consultation fee per time was ¥20 (approximately US$2.90, IQR ¥0 to ¥200). Conclusions: Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature with various issues such as online doctor scarcity and not being covered by health insurance. China's Internet hospital is heading in the right direction to improve how health service is effectively provided, but much more remains to be done.

  • Online primary care computerised medical record and associated service access for patients with Type 2 Diabetes: a systematic review.

    From: Journal of Medical Internet Research

    Date Submitted: May 4, 2017

    Open Peer Review Period: May 4, 2017 - Jun 29, 2017

    Background: Online access to medical records has the potential to support patient-centred care,improve convenience for patients and patient satisfaction. Enabling patients’ greater access to their m...

    Background: Online access to medical records has the potential to support patient-centred care,improve convenience for patients and patient satisfaction. Enabling patients’ greater access to their medical records and linked online services may not only empower self-management, but also facilitate the organisation and delivery of care. Objective: To assess use and impact of online access to computerised medical record (CMR) systems and associated services in primary care by patients with Type 2 diabetes (T2DM). Methods: Multiple international databases including Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched between 2004 and 2016). No limitation was placed on study design, though we applied detailed inclusion and exclusion criteria. Thematic analysis was used to synthesise the evidence. Results: 917 studies were identified and 28 were included in this review. Five themes were identified: (1) Disparities in uptake of online record access and online services use by different patient groups. They varied by age, gender, ethnicity, educational attainment, and number of comorbidities. (2) Improved health outcomes: largely of surrogate makers of quality, glycaemic control, BP and cholesterol. (3) Self-management support included improved patient self-care and shared management, satisfaction, convenience and a generally positive effect on clinician-patient relationship. (4) Accessibility, patients valued more convenient access to health care where it worked efficiently. (5) Service design issues which may impact on online access and service use. Conclusions: Patients who accessed them valued these systems; and the improved access they offered. Professionals were cautious about using such systems primarily due to concerns about a rise in workload, patient safety, and maintaining confidentiality. CMR online access appears to be safe, popular though it may increase disparities and there is a lack of rigorous research showing positive impact on health outcomes.

  • Social media-promoted weight loss among occupational population: a WeChat smartphone application-based campaign

    From: Journal of Medical Internet Research

    Date Submitted: Apr 15, 2017

    Open Peer Review Period: Apr 15, 2017 - Jun 10, 2017

    Background: Being overweight and obesity are major risk factors for noncommunicable diseases such as diabetes and cardiovascular diseases. However, the prevalence of being overweight and obesity is hi...

    Background: Being overweight and obesity are major risk factors for noncommunicable diseases such as diabetes and cardiovascular diseases. However, the prevalence of being overweight and obesity is high throughout the world and these issues are very serious in the Shunyi District in China. As mobile technologies have rapidly developed, mobile apps such as WeChat have the potential to improve health behaviors and are well accepted. Objective: This study aims to evaluate the effectiveness of mobile app (WeChat) interventions on weight loss behavior. Methods: This study was conducted among occupational population from August 2015 to February 2016 in the Shunyi District of Beijing. Before the intervention, the Shunyi District Government released an official document for weight loss to all 134 government agencies and enterprises in Shunyi District. The participants who were willing to use our official WeChat account were enrolled in a WeChat group and received six months of interventions for weight loss, and those who were not willing to use the account were in the control group. Results: A total of 15,310 occupational participants were enrolled. A total of 3467 participants (32.6%) were in the control group and 11,843 participants (77.4%) were in the WeChat group. The mean weight loss and waist circumference in the control group were 1.78 kg (SD=2.96) and 2.39 cm (SD=3.91), respectively, while in the WeChat group, the weight and waist circumference decreased by 2.09 kg (SD=3.43) and 2.74cm (SD=4.48), respectively. In the control group, after six months, normal weight increased by 3.4% and in the WeChat group, it increased by 8.8%. The results of the stratified analysis show that for males, the weight loss difference was statistically significant. Participants who were female, older, and had educational levels of high school or below were more active in using WeChat for weight loss. The results of the stratified analysis indicate that among male participants aged 40 years and above with a university/college degree or above, those who were active in WeChat were more likely to lose weight than those who were inactive. For participants who were female and had a university/college degree or above, regardless of age, they were more active in using the app and lost more weight. Conclusions: The weight loss intervention campaign based on the official WeChat account among occupational population in Shunyi District was proven to be effective and well accepted.

  • Systematic Review of Information Architecture of Web-based Interventions to Improve Health Outcomes

    From: Journal of Medical Internet Research

    Date Submitted: Apr 19, 2017

    Open Peer Review Period: Apr 21, 2017 - Jun 16, 2017

    Background: The rise in usage of and access to new technologies in recent years has led to a growth of digital health behavior change interventions. However, as the shift to digital platforms continue...

    Background: The rise in usage of and access to new technologies in recent years has led to a growth of digital health behavior change interventions. However, as the shift to digital platforms continues to grow, it is increasingly important to consider how the field of information architecture (IA) can inform the development of digital health interventions. IA concerns the way in which digital content is organized and displayed, which strongly impacts users’ ability to find and use content. While many information architecture best practices exist, there is a dearth of empirical evidence on the role that information architecture plays in influencing behavior change and health outcomes. Objective: To conduct a systematic review synthesizing the existing literature on website information architecture and its effect on health outcomes, behavioral outcomes, and website engagement. Methods: To identify all existing information architecture and health behavior literature, we searched articles published in English in the following databases (all years/months were considered, i.e., filters restricting years of publication were not used): ACM Digital Library, CINAHL, Cochrane Library, Google Scholar, Ebsco, and PubMed. The search terms used included information terms (e.g. information architecture, interaction design, persuasive design), behavior terms (e.g. health behavior, behavioral intervention, ehealth), and health terms (e.g., smoking, physical activity, diabetes). The search results were subsequently reviewed to determine if they met predetermined inclusion and exclusion criteria created to identify empirical research that studied the effect of information architecture on health outcomes, behavioral outcomes, or website engagement. Data from articles that met inclusion criteria were extracted using a priori categories established by three reviewers. Results: The initial literature search yielded 688 results, which was narrowed down to three publications that examined the effect of information architecture on health outcomes, behavioral outcomes, or website engagement. One publication studied the isolated impact of information architecture on outcomes of interest (i.e., website use and engagement; health-related knowledge, attitudes, and beliefs, and health behaviors) while the other two publications studied the impact of information architecture, website features (e.g., interactivity, email prompts, and forums), and tailored content on these outcomes. The paper that investigated IA exclusively found a tunneled IA improved site engagement and behavior knowledge, but decreased perceived efficiency. One first study that did not isolate IA found an enhanced site condition improved site usage but not amount of content viewed. The second study that did not isolate IA found a tailored site condition improved site usage, behavior knowledge, and some behavior outcomes. Conclusions: No clear conclusion can be made about the relationship between information architecture and health outcomes, given limited evidence in the peer-reviewed literature connecting IA to behavioral outcomes and website engagement. We recommend improving the scientific evidence base such that additional, empirical studies investigate the impact of IA in isolation. Moreover, information from gray literature and expert opinion might be identified and added to the evidence base, in order to lay the groundwork for hypothesis generation to improve empirical evidence on information architecture and health and behavior outcomes.

  • A proof of concept study evaluating the variability and accuracy among scribes’ transcribed notes using EHR integrated simulation and qualitative evaluation of scribe simulation

    From: Journal of Medical Internet Research

    Date Submitted: Apr 21, 2017

    Open Peer Review Period: Apr 22, 2017 - Jun 17, 2017

    Background: Background: The increasing adoption of Electronic Health Records (EHRs) has been associated with a number of unintended negative consequences with provider efficiency and job satisfaction....

    Background: Background: The increasing adoption of Electronic Health Records (EHRs) has been associated with a number of unintended negative consequences with provider efficiency and job satisfaction. To address this, there has been a dramatic increase in the use of medical scribes to perform many of the required EHR functions. In spite of this rapid growth, little has been published on the training or assessment tools to appraise the safety and efficacy of scribe related EHR activities. Given the number of reports documenting that other professional groups suffer from a number of performance errors in EHR interface and data gathering, scribes likely suffer from similar challenges. This highlights the need for new assessment tools for medical scribes. Objective: To develop a virtual, video based simulation to demonstrate and quantify the variability and accuracy of scribes’ transcribed notes in the EHR. Methods: We created 3 simulated patient-provider scenarios. Each scenario contained a corresponding medical record in our simulation instance of our EHR. For each scenario, we video recorded a standardized patient-provider encounter. 5 scribes with at least 6 months experience both with our EHR and in the specialty of the simulated cases were recruited. Each scribe watched the simulated encounter and transcribed notes into a simulated electronic health record (EHR) environment. Transcribed notes were evaluated for inter-scribe variability and compared to a gold-standard for accuracy. Results: All scribes completed all simulated cases. There was significant inter-scribe variability in note structure and content. Overall, only 26% of all data elements were unique to the scribe writing them. Note length varied by 55, 85, and 115 fold differences between the 3 cases and word economy ranged between 23-71%. Overall, there was a wide inter- and intra-scribe variation in accuracy for each section of the notes with ranges from 50-76%. This resulting in an overall positive predictive value for each note between 38-81%. Conclusions: We created a high fidelity, video based EHR simulation, capable of assessing multiple performance indicators in medical scribes. In this cohort, we demonstrate significant variability both in terms of structure and accuracy in clinical documentation. This form of simulation can provide a valuable tool for future development of scribe curriculum and assessment of competency.

  • Patients’ Acceptance of Smartphone Health Technology for Chronic Disease Management: a Theoretical Model and Empirical Test

    From: Journal of Medical Internet Research

    Date Submitted: Apr 19, 2017

    Open Peer Review Period: Apr 21, 2017 - Jun 16, 2017

    Background: Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and...

    Background: Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective: This study developed and tested a theoretical model to predict and explain the factors influencing patients’ acceptance of smartphone health technology for chronic disease management. Methods: Multiple theories and factors that may influence patients’ acceptance of smartphone health technology have been reviewed. The technology acceptance model (TAM), the dual factor model, and the health belief model, along with a number of other factors have been used to build a hybrid theoretical model. Data collected from patient questionnaire surveys and computer log records from about 157 hypertensive patients’ actual use of a smartphone health application. The partial least square (PLS) method was used to test the theoretical model. Results: The model accounted for 41.2% of the variance in patients’ intention to adopt the smartphone health technology. Intention to use accounted for 11.1% of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients’ smartphone usage experience, relationship with the doctor, and self-efficacy. Although they did not have a significant effect on the intention to use, perceived ease of use, perceived threat, relationship with the doctor, and resistance to change had a positive influence on perceived usefulness. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients’ intentions to use the technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health applications for chronic disease management. Conclusions: This study developed a theoretical model to predict patients’ acceptance of smartphone health technology for chronic disease management. It suggests that the patients’ perceived usefulness of smartphone health technology is positively influenced by their perceived health threat, relationship with their doctor, and perceived ease of use, but negatively influenced by resistance to change. While being significantly influenced by resistance to change, perceived health threat and perceived usefulness, intention to use had a weak yet significant relationship with actual use of the technology. The finding suggests that to effectively use smartphone health technology for chronic disease management, three antecedent factors—resistance to change, perceived health threat, and relationship with the doctor—need to be carefully managed.

  • Telemedicine and mobile health solutions in oncology: an opinion poll of representatives of Polish medical societies

    From: Journal of Medical Internet Research

    Date Submitted: Apr 19, 2017

    Open Peer Review Period: Apr 21, 2017 - Jun 16, 2017

    Background: Telemedicine, or diagnosis/treatment of patients via telecommunications technology, and mobile health (mHealth) is increasingly gaining acceptance across numerous medical fields worldwide....

    Background: Telemedicine, or diagnosis/treatment of patients via telecommunications technology, and mobile health (mHealth) is increasingly gaining acceptance across numerous medical fields worldwide. Indeed, the World Health Organization strongly recommends that mHealth technologies should be implemented in health care systems across all Member States of the European Union. However, in Poland, the public health system has not yet implemented the institutional framework, including legislation, to facilitate an mHealth model. Objective: This study aimed to obtain the opinion from management representatives of Polish medical societies on the use and possibilities of telemedicine and mHealth solutions in Poland, particularly those relating to cancer. Methods: Eleven Polish medical societies, whose members perform tasks related to prevention, diagnosis, or treatment of cancer, were invited to participate in this study. A total of nine experts from seven medical societies accepted the invitation. The study was conducted using partially structured individual interviews, lasting 45 to 70 minutes. A qualitative analysis of the experts’ responses was performed. Results: We found telemedicine is currently more widely known and used among the oncology experts than mHealth technologies. According to the experts, widespread dissemination of telemedicine is expected across all medical fields, including oncology, in future; however, the use of mHealth applications (apps) may not be as easily accepted in the clinic. The biggest advantages of telemedicine stated by the respondents were its ability to save time and to improve the quality of health care. Challenges to mHealth solutions in clinical practice in Poland include low technological literacy, the threat to data security, and insufficient scientific evidence of efficacy and safety. Conclusions: Telemedicine and mHealth solutions can offer many advantages to both patients and health care professionals. However, there is a necessity to create a system of financing telemedicine and mHealth to achieve more widespread use of these technologies in Poland. We must also create a legal framework to support the health care professionals and to protect patients’ personal data. Patients must be educated prior to the implementation of mHealth apps to ensure an adequate use. App developers should involve health care professionals in their development process and consider the needs of older people and those with poor technology literacy. Finally, there should be more scientific validation of mHealth apps.

  • The effect of text messaging interventions on cancer screening rates: a systematic review.

    From: Journal of Medical Internet Research

    Date Submitted: Apr 20, 2017

    Open Peer Review Period: Apr 22, 2017 - Jun 17, 2017

    Background: Despite high quality evidence that demonstrates screening reduces mortality from breast, cervical, colorectal, and lung cancer, a substantial portion of the population remains inadequately...

    Background: Despite high quality evidence that demonstrates screening reduces mortality from breast, cervical, colorectal, and lung cancer, a substantial portion of the population remains inadequately screened. There is a critical need to identify interventions that increase the uptake and adoption of evidence-based screening guidelines for preventable cancers at the community practice level. Text messaging has been effective in promoting behavioral change in various clinical settings, but the overall impact and reach of text messaging interventions on cancer screening is unknown. Objective: We performed a systematic review to assess the effect of text messaging interventions on screening for breast, cervical, colorectal, and lung cancer. Methods: We searched multiple databases for studies published between the years 2000-2017, including Pubmed, EMBASE, and the Cochrane Database of Systematic Reviews, to identify controlled trials that measured the effect of text messaging on screening for breast, cervical, colorectal, or lung cancer. Study quality was evaluated using the Cochrane risk of bias tool. Results: Our search yielded 2,238 citations, of which 31 underwent full review and nine met inclusion criteria. Five studies examined screening for breast cancer, one for cervical cancer, and three for colorectal cancer. No studies were found for lung cancer screening. Absolute screening rates for individuals who received text message interventions were 0.6% to 15.0% higher than for controls. Unadjusted relative screening rates for text message recipients were 4% to 63% higher compared to controls. Conclusions: Text messaging interventions appear to moderately increase screening rates for breast and cervical cancer and may have a small effect on colorectal cancer screening. Benefit was observed in various countries, including resource-poor and non-English speaking populations. Given the paucity of data, additional research is needed to better quantify the effectiveness of this promising intervention.

  • Comment on Wu et al. Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy. JMIR Mhealth Uhealth. 2017;5(3):e35

    From: JMIR mHealth and uHealth

    Date Submitted: Apr 20, 2017

    Open Peer Review Period: May 17, 2017 - Jul 12, 2017

    None...

    None

  • The Use of Virtual Reality in Patients with Eating Disorders: A Systematic Review.

    From: Journal of Medical Internet Research

    Date Submitted: Apr 28, 2017

    Open Peer Review Period: Apr 29, 2017 - Jun 24, 2017

    Background: Patients with eating disorders (EDs) are characterized by pathological eating habits and a tendency to overestimate their weight and body form. Virtual Reality (VR) shows an interest in th...

    Background: Patients with eating disorders (EDs) are characterized by pathological eating habits and a tendency to overestimate their weight and body form. Virtual Reality (VR) shows an interest in the evaluation and management of patients with eating disorders. This technology, accepted by this population, allows immersion in virtual environments, assessment and therapeutical approaches. Objective: To better understand the value of VR, we conducted a review of the literature including clinical studies proposing to use VR for the evaluation and management of patients suffering from EDs Methods: Pubmed, PsycINFO, Science Direct, Cochrane, Scopus and Web of Science databases were extensively searched in until April 2017. The list of keywords was created around the two domains "virtual reality" and "eating disorders". We included randomized controlled trials (RCTs) and non-randomized studies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)to identify, select, and critically appraise relevant research while minimizing bias. Results: The PRISMA flowchart summarizing the states of the review is shown in Figure 1. The initial database searches identified 311 articles, 149 of which were removed as duplicates. The resulting set of 27 unique studies which met the inclusion criteria, were analyzed. 9 studies were randomized controlled trials (RCT), 13 non-randomized studies and 5 clinical trials with one participant (n = 1). The majority of articles focus on clinical populations (20/27; 74%). The remainder corresponds to Case-control studies (7/27; 25.9%.The majority of the studies used visual immersive equipment (17/27; 62.9%) as head-mounted display (HDM) (16/17; 94.1%). Two main areas of interest emerge from these studies: virtual work on the body image of patients (7/27; 25.9%) and exposure to virtual food stimuli (10/27; 37%). Conclusions: We conducted a broad analysis of studies on the use of VR in patients with ED. This review of the literature shows that VR is an acceptable and promising therapeutic tool in ED.

  • ‘A Survey Of Medical Oncology Training In Australian Medical Schools: A pilot Study’

    From: JMIR Medical Education

    Date Submitted: Apr 26, 2017

    Open Peer Review Period: Apr 26, 2017 - Jun 21, 2017

    Background: Oncology is a rapidly evolving field with continuous advancements in the diagnosis and treatment of cancer. Therefore, it is important that medical students are provided with the knowledge...

    Background: Oncology is a rapidly evolving field with continuous advancements in the diagnosis and treatment of cancer. Therefore, it is important that medical students are provided with the knowledge and experience required to care for oncology patients and to enable them to diagnose and manage toxicities of novel therapeutic agents. Objective: This study was performed to understand the medical students’ perspective of the oncology education provided from universities across Australia, to identify areas of education that could potentially be modified or improved to ultimately attract more students to a career in oncology. Methods: This pilot cross-sectional study consisted of an 18-question survey that was submitted online to medical students in their final year and interns rotating to the Tamworth Hospital. Results: The survey was completed by 94 fifth-year medical students and interns. Oncology was taught both theoretically and clinically for 67.7% of participants and 47.8% had an exclusive oncology rotation. Both theoretical and clinical oncology assessments were conducted for only 20.6% of participants. Overall, 41.8% of participants were satisfied with their oncology education and 78.4% were unsatisfied with the number of oncology teaching hours. The importance of a career in oncology was rated as low by 45.6% of participants. Conclusions: This pilot study indicates that there are potential areas to further improve oncology teaching in Australian universities. The majority of surveyed students were unsatisfied with the number of teaching hours they receive in oncology. More global assessment of students and/or interns from other Australian institutes may yield further useful information.

  • Development of a pilot mHealth MNCH communication intervention in a mountainous area of Thai Nguyen province, Vietnam

    From: Journal of Medical Internet Research

    Date Submitted: May 1, 2017

    Open Peer Review Period: May 2, 2017 - Jun 27, 2017

    Background: The mMom project piloted and implemented a cost-effective mHealth solution to a problem of longstanding concern in Vietnam: how to improve the maternal, newborn and child health (MNCH) of...

    Background: The mMom project piloted and implemented a cost-effective mHealth solution to a problem of longstanding concern in Vietnam: how to improve the maternal, newborn and child health (MNCH) of ethnic minority women (EMW) living in mountainous and remote areas. Available evidence shows that EMW have disproportionately high infant and maternal mortality rates due to poverty and remoteness from poor quality health centres, and ethnographic fieldwork determined that current MNCH approaches in Thai Nguyen province in northern Vietnam fall short of providing effective antenatal and postnatal care. Objective: The project’s objective was to determine whether the implementation of an integrated mHealth intervention would improve access to MNCH services for women in remote areas of Thai Nguyen. Methods: The intervention created partnerships with the provincial health department to build an mHealth platform which was integrated into the existing health management information system (HMIS). The system sends active Behaviour Change Communication (BCC) health information SMS messages to local women via their mobile phones, and sends messages to health workers with the aim of increasing client-provider interactions and increasing demand for quality natal care. Results: The mMom intervention was able to effectively engage partners at the commune, district and provincial levels to integrate a novel mHealth system into an existing HMIS, and effectively train local health workers on its application for MNCH in Thai Nguyen. Conclusions: The pilot project demonstrates the feasibility of implementing an mHealth intervention in a remote area to provide MNCH health information and promote health service utilization.

  • The use of Facebook advertising to recruit healthy elderly people for a clinical trial: baseline metrics

    From: Journal of Medical Internet Research

    Date Submitted: May 9, 2017

    Open Peer Review Period: May 10, 2017 - Jul 5, 2017

    Background: This report provides data on the use of social media advertising as a clinical trial recruitment strategy targeting normal healthy volunteers over sixty years of age. The social media adv...

    Background: This report provides data on the use of social media advertising as a clinical trial recruitment strategy targeting normal healthy volunteers over sixty years of age. The social media advertising campaign focused on enrollment for a phase 1 clinical trial. Traditional means of recruiting--billboards, newspaper advertising, word of mouth, physician referrals, and direct mail--were not producing enough qualified participants. Objective: To demonstrate the effectiveness of using targeted advertising on the social networking site Facebook to recruit people age sixty and older for volunteer clinical trial participation. Methods: The trial sponsor used a proactive approach to recruit participants using advertising on social media. The sponsor placed and monitored an Institutional Review Board (IRB)-approved advertising campaign on Facebook to recruit potential candidates for a phase 1 clinical trial. The clinical trial required a ten-day residential (overnight) stay at a clinic in Michigan, with one follow-up visit. The sponsor of the clinical trial placed the advertising which directed interested respondents to a trial-specific landing page controlled by the Clinical Research Organization (CRO). The CRO provided all follow-up consenting, pre-screening, screening, and enrollment procedures. The campaign was waged over a seven-week period to supplement recruiting by the CRO. Results: A total of 621 people responded to a Facebook advertising campaign by completing an online form and the clinical trial was fully enrolled. Conclusions: Advertising placed on the social media platform Facebook is effective with the age 60 and older, normal healthy volunteer population. It can quickly and cost effectively reach qualified candidates for clinical trial recruitment as a supplement to traditional means of recruiting. Clinical Trial: www.Clinicaltrials.gov NCT02840279

  • Analysis of Content Shared in Online Cancer Communities: A Systematic Review.

    From: JMIR Cancer

    Date Submitted: Apr 26, 2017

    Open Peer Review Period: Apr 27, 2017 - Jun 22, 2017

    Background: Objective: The objective of this study was to systematically review all available literature that analyses user-generated content posted by cancer patients. We reviewed the quality of ava...

    Background: Objective: The objective of this study was to systematically review all available literature that analyses user-generated content posted by cancer patients. We reviewed the quality of available research and what kinds of content patients share with each other online. Objective: Objective: The objective of this study was to systematically review all available literature that analyses user-generated content posted by cancer patients. We reviewed the quality of available research and what kinds of content patients share with each other online. Methods: Methods: A computerized search of the literature via PubMed and Science Direct was performed. Last search was January 2017. Articles were included with the the following terms: cancer, patients, support group, health communities, internet, content analysis. Thirty one articles were selected and were subjected to a 14-item quality checklist independently scored by two investigators. Results: Results: The methodological quality of the selected studies varied; 18 were of high quality, 11 adequate and 2 of low quality. The number of analysed posts and posters ranged from 100 to 1,562,459 and from 15 to 90,000. The studies analysing large numbers of posts mainly related to breast cancer, whereas those analysing small numbers related to other types of cancers. Automatic analysis of user-generated content was conducted in 9 studies. All the authors referred to two main categories: informational support and emotional support. Eighteen studies only reported on the content, six studies explicitly referred also to social aspects and six studies focused on emotional changes. One study considered possible empowerment as a result of participating. Conclusions: Discussion and Conclusion: In the future, increasing amounts of user-generated content are available on the Internet. The results of content analysis, especially of the larger studies, reveal detailed information of patients’ worries, which can be used for improvements in cancer care. To make it useable, it is necessary to improve our automatic content analysis methods by interdisciplinary collaboration.

  • Acceptability of Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy

    From: JMIR mHealth and uHealth

    Date Submitted: Apr 26, 2017

    Open Peer Review Period: Apr 26, 2017 - Jun 21, 2017

    Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples, but ha...

    Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples, but have not yet been applied to marijuana use in pregnancy. Objective: To evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n= 10) and medical staff (n = 12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one on one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 1-5 Likert scale. Five of ten participants reported that they preferred working with the program versus their doctor and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: These findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation is justified. Clinical Trial: NC702191605

  • Determinants of a poor sleep based on data from 15 000 users of connected devices

    From: Journal of Medical Internet Research

    Date Submitted: May 2, 2017

    Open Peer Review Period: May 2, 2017 - Jun 27, 2017

    Background: Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or the burden of some chronic conditions...

    Background: Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or the burden of some chronic conditions. Knowing the profiles of individuals with poor sleep patterns is therefore a prerequisite. Wearable devices have recently opened new perspectives in health. Objective: To identify the determinants of poor sleep, based on a data from a large population of users of connected devices. Methods: We analyzed data from 15,839 individuals (13,658 males and 2,181 females) considered as “highly connected” customers having purchased and used several Withings connected devices. Total and deep sleep durations, as well as the deep/total ratio as a proxy of sleep quality were analyzed in association with available data on age, sex, weight, heart rate, steps, diastolic and systolic blood pressure. Results: With respect to the deep/total sleep duration ratio used as a proxy of sleep quality, we have observed that those at risk of having a poor ratio (≤ 0.40) were more frequently males (ORfemale vs male = 0.45 [0.38-0.54]), younger individuals (OR>60 y vs 18-30 y = 0.47 [0.35-0.63]), those with elevated heart rate (OR>78 bpm vs ≤ 61 bpm= 1.18 [1.04-1.34]) and high systolic blood pressure (OR>133 mmHg vs ≤ 116 mmHg = 1.22 [1.04-1.43]). An association with weight was observed for total sleep duration exclusively. Conclusions: Wearables can provide useful information to target individuals at risk of poor sleep. Future alert or smartphone notification systems, based on poor sleep determinants measured with wearables, could be tested in intervention studies to evaluate the benefits. Clinical Trial: NA

  • Does using plain language and adding communication technology to an existing health related questionnaire help to generate accurate information?

    From: JMIR mHealth and uHealth

    Date Submitted: Apr 28, 2017

    Open Peer Review Period: Apr 29, 2017 - Jun 24, 2017

    Background: Low educated patients are disadvantaged in using questionnaires within the health care setting, because most health related questionnaires are not taking educational background of patients...

    Background: Low educated patients are disadvantaged in using questionnaires within the health care setting, because most health related questionnaires are not taking educational background of patients into account. The ‘Dutch Talking Touch Screen Questionnaire’ (DTTSQ) was developed in an attempt to meet the needs of low educated patients by using plain language and adding communication technology to an existing paper-based questionnaire. For physical therapists to use the DTTSQ as part of their intake procedure it needs to generate accurate information from all of their patients, independent from educational level. Objective: The aim of this study was to get a first impression of the information that is generated by the DTTSQ. To achieve this goal, response processes of physical therapy patients with diverse levels of education were analyzed. Methods: The qualitative Three Step Test Interview method was used to collect observational data on actual response behavior of twenty-four physical therapy patients with diverse levels of education. The interviews included both think-a-loud and retrospective probing techniques. Results: Twenty of the twenty-four respondents encountered one or more problems during their response process. Almost three quarters of all problems were generated by two of the total of eight questions. No problems were experienced with comprehension of text or wording. No educational group in this research population stood out from the rest in the sort or amount of problems that arose. In spite of the fact that twenty respondents did not respond to each question in the way that was intended by its developers, all respondents recognized themselves in the outcomes of the questionnaire. Conclusions: The results of this study show that the DTTSQ, except for two questions, was reasonably successful in generating the information that it was meant to generate. On the basis of the results of this study developers are recommended to pre-test both the effects of formulation of text and the design of the user-interface on the response processes of the target population during the development of digital(ized) health related questionnaires.

  • ADHD: is there an app for that? A suitability assessment of apps for the parents of children and young people with ADHD

    From: JMIR mHealth and uHealth

    Date Submitted: Apr 28, 2017

    Open Peer Review Period: Apr 30, 2017 - Jun 25, 2017

    Background: Attention Deficit Hyperactivity Disorder (ADHD) is a highly co-morbid disorder that can impact hugely on the individual and their family. ADHD is managed via pharmacological and non-pharma...

    Background: Attention Deficit Hyperactivity Disorder (ADHD) is a highly co-morbid disorder that can impact hugely on the individual and their family. ADHD is managed via pharmacological and non-pharmacological interventions. Parents also gain support from parent support groups, which may include chat rooms as well as face-to-face meetings. With the growth of technology use over recent years, parents have access to more resources that ever before. A number of mobile applications (apps) have been developed to help parents manage ADHD in their children and young people. Unfortunately many of these apps are not evidence based and little is known of their suitability for the parents or whether they are helpful in ADHD management. Objective: To explore: 1.parents’ views of the suitability of the top ten listed apps for parents of children and young people (YP) with ADHD. 2. The views of clinicians that work with them on the suitability and value of the apps. Methods: The top ten listed apps specifically targeted towards the parents of children and YP with ADHD were identified via the Google Play (n=5) and iTunes Store (n=5). Interviews were then undertaken with seven parents of children/YP with ADHD and six clinicians who specialise in working with this population to explore their opinions of the ten apps identified and what they believe the key components are for apps to be suitable and valuable for this population. Results: Results: Four themes emerged from clinician and parent interviews: • the importance of relating to the app, • apps that address ADHD related difficulties, • how the apps can affect family relationships, • apps as an educational tool. Two additional themes emerged from the clinician interviews alone; monitoring ADHD symptoms and that apps should be practical. Parents also identified an additional theme; the importance of the technology. Overall, the characteristics of the currently most popular apps did not appear to match well to the views of our sample. Conclusions: Findings suggest that these apps may not fully meet the complex needs of this parent population. Further research is required in order to explore the value of apps with this population and how they can be tailored to their very specific needs. Clinical Trial: N/A

  • Connected activity trackers have high feasibility in patients with rheumatoid arthritis or axial spondyloarthritis to assess physical activity patterns : a 3-months prospective study of 157 patients.

    From: Journal of Medical Internet Research

    Date Submitted: May 2, 2017

    Open Peer Review Period: May 2, 2017 - Jun 27, 2017

    Background: Physical activity can be traked using connected devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The World Health Organization recommends at lea...

    Background: Physical activity can be traked using connected devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The World Health Organization recommends at least 150 min/week of moderate to vigorous physical activity (MVPA). Objective: The objectives were to assess physical activity and its patterns in RA and axSpA patients using an activity tracker and to assess the feasibility of connected devices in this population. Methods: This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a connected activity tracker, recording the number of steps per minute. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (i.e. adherence), the percentage of wearing time, and by an acceptability questionnaire. Results: 157 patients (83 RA, 74 axSpA) were analyzed: their mean age was 46 (+/-12) years, and mean disease duration 11 (+/-9) years; 57 (36%) were males. RA and axSpA patients had similar physical activity levels; respectively, 16 (+/-11) and 15 (+/-12) min/day of MVPA. Only 43 (27%) patients reached the recommendations (mean MVPA of 106 (+/-77) min/week). Three trajectories were identified with constant activity: low (54% of patients), moderate (43%) and high (3%) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% confidence interval [1.11, 1.14]). The activity trackers were worn during a mean of 79(+/-17) days, corresponding to a mean of 88(+/-19)% of days over the 3 months. Overall, patients considered the use of the watch very acceptable. Conclusions: RA and axSpA patients performed insufficient physical activity without differences depending on disease. Activity trackers allow accurate longitudinal assessment of physical activity. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a connected activity tracker in patients with rheumatic diseases.

  • Use of social media in the assessment of relative effectiveness: An explorative review with examples from oncology. Hopeful or hopeless?

    From: Journal of Medical Internet Research

    Date Submitted: May 2, 2017

    Open Peer Review Period: May 4, 2017 - Jun 29, 2017

    Background: An element of health technology assessment (HTA) constitutes assessing the clinical effectiveness of drugs, generally called relative effectiveness assessment (REA). Directly after market...

    Background: An element of health technology assessment (HTA) constitutes assessing the clinical effectiveness of drugs, generally called relative effectiveness assessment (REA). Directly after market access little evidence from the real world is available, therefore randomized controlled trials are used to inform REA. However, there is growing interest in using real world data (RWD) for REA. Social media may provide a source of RWD. Objective: We assessed the extent to which social media-generated health data could contribute to REA. Methods: An explorative literature review was conducted following PRISMA guidelines to identify examples in oncology where health data was collected using social media. Scientific and grey literature published between January 2010 and June 2016 was identified by two reviewers, who independently screened studies for eligibility and extracted data. A descriptive qualitative analysis was performed. Results: Of 1032 articles identified, 8 were included: 4 articles identified adverse events to cancer treatment, 3 articles disseminated quality of life (QoL) surveys, and 1 study assessed the occurrence of disease-specific symptoms. Several strengths of social media-generated health data were highlighted in the articles, such as efficient collection of patient experiences and recruiting patients with rare diseases. Conversely, limitations included validation of authenticity and presence of information and selection bias. Conclusions: Social media may provide a potential source of RWD for REA, particularly on aspects such as adverse events, symptom occurrence, QoL, and adherence behaviour. This potential has not yet been fully realised and the degree of usefulness for REA should be further explored.

  • A Clinician-Machine Collaborative Approach to Identifying Social Media Markers of Schizophrenia

    From: Journal of Medical Internet Research

    Date Submitted: May 2, 2017

    Open Peer Review Period: May 4, 2017 - Jun 29, 2017

    Background: Linguistic analysis of publicly available twitter feeds have achieved success in differentiating individuals who self-disclose online as having schizophrenia from healthy controls. To date...

    Background: Linguistic analysis of publicly available twitter feeds have achieved success in differentiating individuals who self-disclose online as having schizophrenia from healthy controls. To date, the majority of studies have utilized a computational approach to flag social media profiles of users who self-disclose with limited input from mental health clinicians in order to assess the authenticity of online disclosure. Objective: This study aims to move from noisy self-reports of schizophrenia on social media to more accurate identification of diagnoses by exploring a human-machine partnered approach, wherein computational linguistic analysis of shared content is combined with clinical appraisals. Methods: Twitter timeline data, extracted from 671 users with self-disclosed diagnoses of schizophrenia was appraised for authenticity by expert clinicians. Data from disclosures deemed true were used to build a classifier aiming to distinguish users with schizophrenia from healthy controls. Results from the classifier were compared to expert appraisals on new, unseen Twitter users. Results: Significant linguistic differences were identified in the schizophrenia group including greater use of interpersonal pronouns (p < 0.001), decreased emphasis on friendship (p < 0.001) and greater emphasis on biological processes (p < 0.001). The resulting classifier distinguished users with disclosures of schizophrenia deemed genuine from control users with an average accuracy of 88% using linguistic data alone. Compared to clinicians on new, unseen users, the classifier’s precision, recall and accuracy measures were 0.27, 0.77, and 0.59 respectively. Conclusions: These data reinforce the need for ongoing collaborations integrating expertise from multiple fields in order to strengthen our ability to accurately identify and effectively engage individuals with mental illness online. These collaborations are crucial in order to overcome some of mental illnesses’ biggest challenges using digital technology.

  • The Impact of Electronic Health Records on Long-term Care Facilities: A Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: May 2, 2017

    Open Peer Review Period: May 4, 2017 - Jun 29, 2017

    Background: Long-term care (LTC) facilities are an important part of the healthcare industry, providing care to the fastest-growing group of the population. However, the adoption of Electronic Health...

    Background: Long-term care (LTC) facilities are an important part of the healthcare industry, providing care to the fastest-growing group of the population. However, the adoption of Electronic Health Records (EHRs) in long-term care facilities lags behind other areas of the healthcare industry. One of the reasons in the U.S. for the lack of widespread adoption is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. Objective: The objective of this systematic review is to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. Methods: The authors conducted a systematic search of PubMed, CINAHL, and MEDLINE databases. The articles were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 30 articles was selected to be included in the systematic review. Results: Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in long-term care facilities and enhanced quality outcomes. Approximately 43% of the articles reported a mixed impact of EHRs on the management of documentation and 33% of articles reported positive quality outcomes using EHRs. Surprisingly, very few articles demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay and productivity using EHRs. Conclusions: Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making.

  • Presentation of laboratory test results in patient portals: influence of interface design on risk interpretation and visual search behaviour

    From: Journal of Medical Internet Research

    Date Submitted: May 9, 2017

    Open Peer Review Period: May 12, 2017 - Jul 7, 2017

    Background: Patient portals are often assumed to be valuable in self-management, however, there are concerns over how patients might interpret and act on the clinical information they access. Objectiv...

    Background: Patient portals are often assumed to be valuable in self-management, however, there are concerns over how patients might interpret and act on the clinical information they access. Objective: To investigate how different online, portal-based presentations of laboratory test results may influence risk interpretation and visual search behaviours. Methods: We conducted a controlled study with 20 kidney transplant patients. Participants viewed three different graphical presentations in each of low, medium and high risk clinical scenarios composed of results for 28 laboratory tests. After viewing each clinical scenario, patients were asked how they would have acted in real life if the results were their own, as a proxy of their risk interpretation. They could choose between: 1) Calling their doctor immediately (high interpreted risk); 2) Trying to arrange an appointment within the next four weeks (medium interpreted risk); 3) Waiting for the next appointment in three months (low interpreted risk). For each presentation, we assessed accuracy of patients’ risk interpretation, and employed eye tracking to assess and compare visual search behaviour. Results: There was no statistically significant difference in the accuracy of risk interpretation between the different forms of presentation of results. Misinterpretation of risk was common, with 65% of participants underestimating the need for action across all presentations at least once. Participants found it particularly difficult to interpret medium risk clinical scenarios. Participants who consistently understood when action was needed showed a higher visual search efficiency, suggesting a better strategy to cope with information overload that helped them to focus on the laboratory tests most relevant to their condition. Conclusions: This study confirms patients’ difficulties in interpreting laboratories test results, with many patients underestimating the need for action, even when abnormal values were highlighted or grouped together. Our findings raise patient safety concerns and may limit the potential of patient portals to actively involve patients in their own healthcare.

  • The Beliefs and Usage of Social Media among General Practitioner Trainers in China: A Cross-Sectional Survey

    From: JMIR mHealth and uHealth

    Date Submitted: May 5, 2017

    Open Peer Review Period: May 9, 2017 - Jul 4, 2017

    Background: It has become a new lifestyle of using SM to acquiring all kinds of information. Objective: The objectives of this study were to determine GP trainers’ current use of SM and their belief...

    Background: It has become a new lifestyle of using SM to acquiring all kinds of information. Objective: The objectives of this study were to determine GP trainers’ current use of SM and their beliefs and attitudes regarding use of social media in China. Methods: A cross-sectional questionnaire survey was taken in China. Data probing GP trainers’ use of SM, attitudes toward use of SM in clinical work and education were collected and analyzed. Results: 407 GP trainers participated in the survey, the response rate was 61.4%. All the respondents reported that they have at least a SM account, with the most common type is Wechat. (1) 99.3% respondents replied that they would add a colleague as a friend via SM; however, only 68.6% of them would add a patient. The respondents who worked for a long time were more likely to add a colleague as a friend (χ2 =48.030, P = 0.000). There is a significant difference between different gender (χ2 =5.540, P = 0.019) and working experience levels (χ2 =89.638, P = 0.000) on adding a patient as a friend. (2) More than half of respondents have been contacted by a patient more than 5 times per year, whereas 67.2% attempted to contact a patient by SM less than 3 times per year, and 52.3% of respondents have never visited their patients’ SM page to gather information. (3) 140 of 407 (34.4%) of respondents used SM daily to explore medical information, whereas 42 of 407 (10.3%) contributed new information via SM on a daily basis. There is a significant difference among different areas on using SM to seeking specific medical problems (χ2 =25.835, P = 0.011). (4) Most of respondents believed that the use of SM is useful and beneficial, but they took a neutral attitude on the quality of information from SM. Conclusions: SM is widely used among GP trainers in China. Most of the participants believed that SM is useful and beneficial on their work, but there are still some problems for them to use SM in health care and medical education.

  • Information-seeking behaviour for Zika virus and microcephaly in Brazil: infodemiological study of Google Trends-based search queries

    From: Journal of Medical Internet Research

    Date Submitted: May 9, 2017

    Open Peer Review Period: May 12, 2017 - Jul 7, 2017

    Background: Google Trends (GT) has been used to provide real-time epidemiological trends of several diseases. Objective: We assessed the information-seeking behaviour for Zika virus and microcephaly i...

    Background: Google Trends (GT) has been used to provide real-time epidemiological trends of several diseases. Objective: We assessed the information-seeking behaviour for Zika virus and microcephaly in Brazil using infodemiological data provided by GT. Methods: This was an observational infodemiology study of information and search activity on ZIKV and microcephaly in Brazil conducted using GT. Results: Data showed high search by the two topics between December 2015 and February 2016, coincident with the appearance of cases of microcephaly in Brazil and new findings on the subject. Conclusions: The current study demonstrates the potential of using search queries to assess the degree of the population concern for the ZIKV and microcephaly in Brazil and the strong influence of reports from local and international media and international organizations in the number of web search during the outbreak.

  • A Multi-site Semi-automated Clinical Data Repository for Duplication 15q Syndrome

    From: JMIR Research Protocols

    Date Submitted: May 8, 2017

    Open Peer Review Period: May 12, 2017 - May 26, 2017

    Background: Chromosome 15q11.2-q13.1 Duplication Syndrome (Dup15q syndrome) is a rare syndrome caused by duplications of chromosome 15q11.2-q13.1, resulting in a wide range of developmental disabiliti...

    Background: Chromosome 15q11.2-q13.1 Duplication Syndrome (Dup15q syndrome) is a rare syndrome caused by duplications of chromosome 15q11.2-q13.1, resulting in a wide range of developmental disabilities experienced by affected individuals. The Dup15q Alliance is an organization that funds and promotes research to improve the quality of life of patients living with Dup15q syndrome. Because of the low prevalence of this condition, the establishment of a single research repository would have been difficult and more time consuming without collaboration across multiple institutions. Objective: The goal of this project is to establish a national de-identified database with clinical and survey information on individuals diagnosed with Dup15q syndrome. Methods: The development of a multi-clinic site repository for clinical and survey data on individuals with Dup15q syndrome initiated and supported by the Dup15q Alliance. Using collaborative workflows, communication protocols, and stakeholder engagement tools, a comprehensive database of patient-centered information was built. Results: We successfully established a self-report populating, centralized repository for Dup15q research. This repository also resulted in the development of standardized instruments that can be used for other studies relating to developmental disorders. By standardizing the data collection instruments, it allows us integrate our data with other national databases, such as the National Database for Autism Research. A substantial portion of the data collected from the questionnaires was facilitated through direct engagement of participants and their families. This allowed for a more complete set of information to be collected with a minimal turnaround time. Conclusions: We developed a repository that can efficiently be mined for shared clinical phenotypes observed at multiple clinic sites and used as a springboard for future clinical and basic research studies.

  • A group of 500 women who seem much healthier than the norm: study protocol for a cross-sectional and longitudinal survey

    From: JMIR Research Protocols

    Date Submitted: May 7, 2017

    Open Peer Review Period: May 9, 2017 - May 23, 2017

    Background: Longitudinal studies of women’s health often seek to identify predictors of good health. One study has shown that following simple guidelines can halve mortality. The large-scale Women...

    Background: Longitudinal studies of women’s health often seek to identify predictors of good health. One study has shown that following simple guidelines can halve mortality. The large-scale Women’s Health initiative (WHI) did not show health benefits for particular interventions like hormone replacement therapy. The Australian Longitudinal Study of Women’s Health (ALSWH) shows Australian women are getting better at reducing the poisons of smoking and alcohol and are generally diligent about attending recommended health screenings, but are becoming less successful at dealing with obesity. These women typically do not improve their behaviour even after receiving a diagnosis of a chronic disease. There are communities of women who live unusually healthy lives (Rosetans, Seventh-Day Adventists, traditional Japanese women) but their lifestyles are unlikely to be adopted widely. Universal Medicine is a complementary-to-medicine approach that emphasizes personal empowerment and the importance of menstrual health symptoms. Objective: This survey investigates whether the approximately 500 women associated with Universal Medicine exhibit health status significantly above the norm. As part of this investigation, a newly developed menstrual attitude questionnaire will also be evaluated. Methods: A quantitative, cross-sectional, longitudinal, two-part survey of the women was designed with the help of three focus groups of women at three life stages: in menses, perimenopausal and menopausal. The first part of the survey is the menstrual attitude questionnaire, which incorporates the insights of these women regarding female health issues. The second part is 41 questions taken from the ALSWH, with 29 asked twice, once for the present and once for the time of their first Universal Medicine event. Results: Focus groups created additional questions about symptoms experienced and attitudes toward female health issues. ALSWH questions, including a range of health scales like the SF-36 and questions about experienced major health events, were investigated and incorporated if considered suitable. Conclusions: If these women are truly in substantially better health than the norm, further investigations may be worthwhile to see whether the women’s practices are generalizable. The collected data will also allow investigation of associations between changes in health and characteristics of this group. Clinical Trial: Not applicable

  • Evaluating the usability and usefulness of a mobile application for atrial fibrillation using qualitative methods: An exploratory pilot study

    From: Journal of Medical Internet Research

    Date Submitted: May 10, 2017

    Open Peer Review Period: May 11, 2017 - Jul 6, 2017

    Background: Atrial fibrillation (AFib) is the most common form of heart arrhythmia and a potent risk factor for stroke. Non-vitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed to...

    Background: Atrial fibrillation (AFib) is the most common form of heart arrhythmia and a potent risk factor for stroke. Non-vitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed to manage AFib stroke risk, however non-adherence to treatment is a concern. Additional tools that support self-care and medication adherence may benefit patients with AFib. Objective: To evaluate the perceived usability and usefulness of a mobile application (app) designed to support self-care and treatment adherence for AFib patients who are prescribed NOACs. Methods: A mobile app to support AFib patients was previously developed based on early stage interview and usability test data from clinicians and patients. An exploratory pilot study consisting of naturalistic app use, surveys, and semi-structured interviews was then conducted to examine patients’ perceptions and everyday use of the app. Results: Twelve individuals with an average age of 59 years and a diagnosis of AFib completed the four-week study. All participants somewhat or strongly agreed that the app was easy to use, and 92% (11/12) reported being satisfied or very satisfied with the app. Participant feedback identified changes that may improve app usability and usefulness for patients with AFib. Areas of usability improvement were organized by three themes: app navigation; clarity of app instructions and design intent; and software bugs. Perceptions of app usefulness were grouped by three key variables: core needs of the patient segment; patient workflow while managing AFib; and the app’s ability to support the patient’s evolving needs. Conclusions: The results of this study suggest that mobile tools that target self-care and treatment adherence can be helpful to AFib patients, particularly those who are newly diagnosed. Additionally, participant feedback provided insight into the varied needs and health experiences of AFib patients, which may improve the design and targeting of the intervention. Pilot studies that qualitatively examine patient perceptions of usability and usefulness, are a valuable and often underutilized method for assessing the real-world acceptability of an intervention. Additional research evaluating the AFib Connect mobile app over a longer period, and including a larger, more diverse sample of AFib patients, will be helpful for understanding whether the app is more broadly useful and effective in supporting patient self-care and medication adherence.

  • An Educational Module Intervention for Radiographers to Reduce Repetition Rate of Routine Digital Chest Radiography in Makkah Region of Saudi Arabia Tertiary Hospitals: Protocol of a Quasi Experimental Study

    From: JMIR Research Protocols

    Date Submitted: May 9, 2017

    Open Peer Review Period: May 12, 2017 - May 26, 2017

    Background: Repetition of an image is a critical event in Radiology Department. When repetition rate of routine digital chest radiography is high, it increases the radiation dose on staff and patients...

    Background: Repetition of an image is a critical event in Radiology Department. When repetition rate of routine digital chest radiography is high, it increases the radiation dose on staff and patients, consume the equipment lifetime, and affect the annual budget of the department. Objective: The aim of this study is to determine the impacts of intervention using printed educational module on the repetition rate of routine digital chest radiography among radiographers in Makkah Region tertiary hospitals. Methods: A quasi-experimental study measuring changes in the pre and post intervention, with a control group, will be conducted in Makkah Region’s tertiary hospitals for eight months starting from second quarter of 2017. Out of five hospitals in the region, four hospitals were selected. Then, the four hospitals are assigned to intervention and control groups. Simple random sampling technique will be utilised to sample 43 radiographers for each group. Pre and post intervention assessments will be conducted to determine radiographers’ knowledge, motivation and skills and repetition rate of chest radiography. Radiographs of the chest which are performed by radiographers in the selected hospitals will be collected for two weeks before and after intervention and piloted questionnaire will be distributed and collected by a researcher in both groups. One-way MANOVA and two-way repeated MANOVA will be utilised to analyse the data. Results: It is expected that the repetition rate in the intervention group will decline after implementation of the intervention and it will be statistically significant (p<0.05). Furthermore, it is expected that the knowledge, motivation and skills level will increase significantly among radiographers after implementing the intervention in the intervention group (p<0.05). Meanwhile, knowledge, motivation and skills in the control group will not change. Conclusions: Quasi-experimental pre-post with control will be conducted to investigate the effect of printed educational material in reducing the repetition rate of routine digital chest radiography among radiographers in Makkah Region of Saudi Arabia’ tertiary hospitals.

  • The effectiveness of exercise therapy on scapular position and motion in individuals with scapular dyskinesis: a systematic review protocol

    From: JMIR Research Protocols

    Date Submitted: May 10, 2017

    Open Peer Review Period: May 13, 2017 - May 27, 2017

    Background: Scapular dyskinesis is an alteration in normal scapular position and motion. Some researchers believe that altered kinematics of the scapula subsequent to dysfunction or weakness of scapul...

    Background: Scapular dyskinesis is an alteration in normal scapular position and motion. Some researchers believe that altered kinematics of the scapula subsequent to dysfunction or weakness of scapular stabilizing muscles contributes to impingement syndrome. Scapular muscle exercises are included in the rehabilitation of patients with subacromial impingement syndrome and scapular dyskinesis because the muscular system is one of the major contributors of scapular positioning both at rest and during shoulder movement, but there is considerable uncertainty relating to the relative effectiveness of such approaches on changing scapular position and motion Objective: the aim of this review is to systematically evaluate the effectiveness of exercise therapy on scapular position and motion in individuals with scapular dyskinesis Methods: A systematic review will be conducted using PubMed, Scopus, Web of Science, Elsevier, Ovid, ProQuest ,PEDro and Cochrane library. The reference lists of articles, other reviews, gray literature and key journals obtained in the search will be searched for relevant articles. Clinical trials reporting the effect of therapeutic exercises (scapular strengthening exercise, scapular stabilization exercise, scapular muscle stretching) with the aims of changing scapular position and motion in individuals with scapular dyskinesis will be included Results: Two independent reviewers will select studies, extract data and assess quality of primary studies. Any disagreement during the selection of studies will be discussed and decided by the whole team Conclusions: -This is the first systematic review aiming to examine the effectiveness of exercise therapy on scapular position and motion in individuals with scapular dyskinesis -The strength of this review is the highly sensitive search strategy -The quality of the included studies will be assessed by Cochrane Collaboration Risk of Bias Clinical Trial: CRD42017053923

  • Syndromic surveillance models using Web data: the case of Influenza in Greece and Italy using Google Trends

    From: Journal of Medical Internet Research

    Date Submitted: May 10, 2017

    Open Peer Review Period: May 11, 2017 - Jul 6, 2017

    Background: An extended discussion and research has been performed in recent years, using data collected through search queries submitted via Internet. It has been shown that the social activity in th...

    Background: An extended discussion and research has been performed in recent years, using data collected through search queries submitted via Internet. It has been shown that the social activity in the internet is related to the number of cases of an infectious disease outbreak Objective: In our research, to define a similar correlation between data from Google Trends and data collected by the official authorities of Greece and Europe, we examine the development and the spread of seasonal influenza in Greece and Italy. Methods: We use multiple regressions of the terms submitted in the Google search engine related to influenza for the period 2011-2012 in Greece and Italy. We then use the Auto Regression Integrated Moving Average statistical model (ARIMA) to determine the correlation between the Google search data and the real influenza cases confirmed by the above-mentioned authorities. Two methods are used: a "flu score" was created for the case of Greece and another method by comparing data from a neighbor country of Greece, which is Italy. Results: The results show that there is a significant correlation that can help the prediction of the spread and the peak of the seasonal influenza, using data from Google searches. The correlation is .909, .831 for Greece and .979, .933 for Italy for 2011 and 2012 respectively. The prediction of the peak is quite precise and provides a forecast before it arrives to population Conclusions: We can create an internet surveillance system, based on Google Searches to track Influenza in Greece in Italy

  • Home-based exercise improves sleep quality, and daytime sleepiness in elderly people: A protocol of randomized controlled clinical trial.

    From: JMIR Research Protocols

    Date Submitted: May 11, 2017

    Open Peer Review Period: May 13, 2017 - May 27, 2017

    Background: Background: Sleep-disordered breathing is associated with significant morbidity and mortality, presenting a high prevalence in the general population and being considered today as an impor...

    Background: Background: Sleep-disordered breathing is associated with significant morbidity and mortality, presenting a high prevalence in the general population and being considered today as an important public health problem worldwide, affecting about 45% of the world population. It is estimated that about from 50 to 75% of the elderly complain of difficulties in initiating or maintaining sleep. The regular practice of physical activity of mild to moderate intensity is associated with improved sleep quality in the elderly and has increased its recommendation as one of the main non-pharmacological resources of preventive and therapeutic action. Objective: Objective: to verify if the regular practice of semi-supervised home-based exercises increases adherence, which influences the improvement of self-reported sleep quality and the reduction of excessive daytime sleepiness in a sedentary elderly population. Methods: Methods: This randomized, controlled, blinded clinical trial was designed, is being conducted and will be reported according to the guidelines of the CONSORT (Consolidated Standards of Reporting Trials) Statement, and is being conducted from July 2016 to December 2017, involving elderly people of both sexes, over 60 years old, living in Senhor do Bonfim. The home physical exercise program is based on the recommendations of the American College of Sports Medicine for exercise and physical activity for the elderly. Results: Results: The first expected outcome is the improvement of self-reported sleep quality verified through the PSQI. The secondary outcomes are reduction in excessive daytime sleepiness among the sedentary elderly subjects undergoing the semi-supervised home-based physical exercise program, verified by the ESS, and the adherence of the subjects to the program. Conclusions: Conclusions: We hope that through this study, we can show that the regular practice of semi-supervised home exercises is effective in improving sleep quality and reducing excessive daytime sleepiness in sedentary elderly people and can be considered as a therapeutic, safe, easy-to-implement, and low-cost non-pharmacological resource. Clinical Trial: TRIAL REGISTRATION: This protocol study has been approved by the Research Ethics Committee of the Escola Baiana de Medicina e Saúde Pública (Brazil), process no 39072514.6.0000.5544, and was be registered on ensaiosclinicos.gov.br Identificator number: RBR-3cqzfy.

  • A web-based self-management application ‘Oncokompas’ including a breast cancer-specific module to facilitate access to optimal supportive care: a feasibility study among breast cancer survivors

    From: Journal of Medical Internet Research

    Date Submitted: May 11, 2017

    Open Peer Review Period: May 13, 2017 - Jul 8, 2017

    Background: Cancer survivors have to deal with symptoms and concerns related to cancer and its treatment. In Oncokompas, cancer survivors can monitor their quality of life by completing patient report...

    Background: Cancer survivors have to deal with symptoms and concerns related to cancer and its treatment. In Oncokompas, cancer survivors can monitor their quality of life by completing patient reported outcome measures (PROMs) (‘Measure’), followed by personalized feedback and self-care advices (‘Learn’) and an overview of optimal supportive care options (‘Act’) to stimulate patient activation. To improve sustainable usage, we optimized Oncokompas by developing tumor-specific modules such as the Oncokompas breast cancer (BC) module. Objective: To investigate the feasibility and effects of Oncokompas including the newly developed BC specific module among BC survivors. Methods: A pretest-posttest design was used, conducting a survey before providing access to Oncokompas, and 1 week after. Feasibility was investigated by means of adoption (intention to use Oncokompas), usage (actual use of Oncokompas based on logging data), and satisfaction (mean score of two study-specific questions: general satisfaction and user friendliness (10-point scales) and the Net Promoter Score (NPS)). Several socio-demographic (age, health literacy, marital status, educational level, occupational status, need for supportive care) and clinical (treatment modality, time since diagnosis) factors, and health-related quality of life (HRQOL) were explored that might be associated with patient satisfaction. Barriers and facilitators of the feasibility of Oncokompas were investigated by evaluating reports from face-to-face consultations between BC survivors and their oncology nurses. The effects of Oncokompas on patient activation (Patient Activation Measure (PAM)) and on patient-physician interaction (Perceived Efficacy in Patient-Physician Interaction (PEPPI-5)) were investigated. Results: In total 101 BC survivors participated. Oncokompas had an adoption rate of 75%, a usage rate of 75-84%, a mean satisfaction score of 6.9 and a NPS of -36 (N=68). The BC module had a mean satisfaction score of 7.5. The most frequently consulted BC specific topics were lymphedema, (early) menopausal symptoms and sexuality. BC survivors who received surgery including chemotherapy and/or radiotherapy were significantly more satisfied than BC survivors with surgery alone (p = 0.013). Six facilitators (e.g. the well-being score in Oncokompas is congruent with participants’ own perception) and ten barriers (e.g. Oncokompas was considered too extensive) of the feasibility of Oncokompas were identified. After using Oncokompas, BC survivors scored significantly higher on patient activation (PAM) (p= .007; r = .24), but not on patient-physician interaction (PEPPI) (p = .75). Conclusions: Oncokompas including a BC module is considered feasible, but needs further optimization to increase user satisfaction. This study shows the value of tailoring eHealth applications for cancer survivors to their specific tumor type. Oncokompas including the BC module seems effective to improve patient activation among BC survivors. A randomized controlled trial is warranted to assess (cost-)effectiveness.

  • Effect of Circumstance and Process on the Content of Chemical Components in Baishao

    From: JMIR Medical Informatics

    Date Submitted: May 11, 2017

    Open Peer Review Period: May 13, 2017 - Jul 8, 2017

    Background: P. lactiflora and P. lactiflora var. trichocarpa are all cultured in mostly locations of Baishao in China. Mostly farmer do not differentiate. P. lactiflora and P. lactiflora var. trichoca...

    Background: P. lactiflora and P. lactiflora var. trichocarpa are all cultured in mostly locations of Baishao in China. Mostly farmer do not differentiate. P. lactiflora and P. lactiflora var. trichocarpa. The contents of paeoniflorin in Baishao in different locations are diverse. However, there are many medicinal ingredients such as gallic acid and albiflorin in Baishao in addition to paeoniflorin. Their contents are related to locations. Furthermore, the processing affects the efficacy of Baishao. Therefore, there is differene between Baishao and the raw root of P. lactiflora in chemically active ingredients. Objective: The objective of this study was to study the effect of circumstance and process on the content of chemical components in Bai Shao (Radix paeoniae A1ba). Methods: The content of gallic acid, catechin, albiflorin, paeoniflorin, benzoic acid and paeonol in raw Bai Shao in difference locations and that processed were determined with RP-HPLC. Then, the difference between the content of chemical components in raw and processed Bai Shao is analyzed. The correlation between circumstance and the content of chemical components in Bai Shao is analyzed also. Results: The result showed that there are differences between the content of chemical components in Bai Shao in different locations. Circumstance and age of Bai Shao affect the content of chemical components in Bai Shao. The content of albiflorin in Bai Shao increases along with the decrease of rainfall, integral air temperature and the increase of age. Conclusions: The circumstance, age and process affect the quality of Bai Shao. The process facilitates the realization of medicinal property and function of Bai Shao.

  • MyHEART: Development and Dissemination of a Patient-Centered Website for Young Adults with Hypertension

    From: JMIR Cardio

    Date Submitted: May 11, 2017

    Open Peer Review Period: May 13, 2017 - Jul 8, 2017

    Background: Background: Young adults have the lowest rates of blood pressure control (achieving a blood pressure <140/90 mmHg) compared to other adult age groups. Approximately 1 in 15 young adults ha...

    Background: Background: Young adults have the lowest rates of blood pressure control (achieving a blood pressure <140/90 mmHg) compared to other adult age groups. Approximately 1 in 15 young adults have high blood pressure, increasing their risk of future heart attack, stroke, congestive heart failure, and/or chronic kidney disease. Many young adults have reported having few resources to address their needs for heart health education. Objective: Objective: Our goal was to develop and disseminate a website with evidence-based, clinical information and health behavior resources tailored to young adults with hypertension. Methods: Methods: In collaboration with young adults, health systems, and community stakeholders, the MyHEART (My Hypertension Education and Reaching Target) website was created (http://myheartmychoice.org/). A toolkit was also developed for clinicians and healthcare systems to disseminate the website within their organizations (https://www.hipxchange.org/MyHEART). The dissemination plan was guided by the Dissemination Planning Tool of the Agency for Healthcare Research and Quality (AHRQ). Results: Results: Google Analytics data were acquired for January 1, 2017 – March 6, 2017. The MyHEART website received a total of 269 visits with 806 page views; 39% were returning visitors. The majority of visitors (61%) approached the website directly with a remaining equal distribution among organic searches, social media links, and referrals from other sites. An increase in site visits paralleled the dissemination of our website. Conclusions: Conclusions: The successfully implemented MyHEART website and toolkit reflect collaborative input from community and healthcare stakeholders to provide evidence-based, portable hypertension education to a hard-to-reach population. The MyHEART website and toolkit can support healthcare providers’ education and counseling with young adults and organizations’ hypertension population health goals.

  • Using Big Data to Understand Social Conversations about Electronic Cigarettes: Pre- and Post-FDA Electronic Cigarette Ruling (2016) Using Twitter Data

    From: Journal of Medical Internet Research

    Date Submitted: May 11, 2017

    Open Peer Review Period: May 13, 2017 - Jul 8, 2017

    Background: Electronic cigarette (e-cigarette) use has become a controversial public health issue that is now impacted by the FDA ruling on tobacco products. Social media such as Twitter has given ris...

    Background: Electronic cigarette (e-cigarette) use has become a controversial public health issue that is now impacted by the FDA ruling on tobacco products. Social media such as Twitter has given rise to a form of Big Data (i.e., extremely large datasets) that provide a unique opportunity to approach public health and policy issues as viewed and disseminated by social media users. The application of machine learning methods to Big Data can help reveal the public’s organic reaction to and subsequent social conversations about health policies such as the FDA ruling. Objective: The purpose of this study was to compare Twitter-based social conversation themes about e-cigarettes in the U.S. pre- and post-FDA ruling using social networking data via Twitter. Methods: We sought to identify and separate a subset of e-cigarette related tweets for two time periods, before and after the legislative ruling event in early May 2016. The months before May 2016 represent a baseline of typical e-cigarette related tweets prior to the ruling. The months after reveal the impact the ruling had on this typical Twitter dialogue. The data collected was used to identify dominant themes in the tweets. Results: There were a total of 12,531 tweets collected from both time periods, with 7,416 in the pre-ruling period (period 1) January 1, 2016 to April 24, 2016 and 5,115 in the post-ruling period (period 2) April 25, 2016 to July 11, 2016. The Word Adjacency Graph (WAG) modeling applied to this large dataset was able to separate relevant from non-relevant tweets regarding e-cigarettes. The pre-ruling period revealed 10 relevant word clusters and four primary themes: safety, support, opposition, and smoking cessation. The post-ruling period was analyzed and six relevant word clusters and six themes were identified: safety, legislative communication, public health, support, marketing, and the FDA ruling. Conclusions: Examining public response to the FDA ruling on e-cigarettes using Twitter data provides valuable insight into the public perspective. While there are multiple perspectives and layers of complexity associated with the FDA ruling, social network analysis of Twitter data provides increased e-cigarette dialogue for health professionals to engage their patients, legislators, and the community. Clinical Trial: N/A

  • Digital Health for Medication Adherence in Adult Diabetes or Hypertension: An Integrative Review

    From: JMIR Diabetes

    Date Submitted: May 12, 2017

    Open Peer Review Period: May 13, 2017 - Jul 8, 2017

    Background: Optimal management of chronic diseases, such as type 2 diabetes (T2D) and hypertension (HTN) often include prescription medications. Medication adherence (MA)is one component of self-manag...

    Background: Optimal management of chronic diseases, such as type 2 diabetes (T2D) and hypertension (HTN) often include prescription medications. Medication adherence (MA)is one component of self-management. Optimization through digital health (eHealth and mHealth) could enhance patient awareness and/or communication between the patient and provider. Objective: Medication Adherence (MA) is a major issue that affects 50-60% of chronically ill adults. Digital health refers to eHealth and mHealth collectively [1] and as these technologies become more accessible, remote health delivery is increasingly available as an adjunct to improve medication adherence, communicate with patients and providers, and provide education to patients, families and communities. The objective of this integrative review was to examine the types of digital health technologies that targeted medication adherence in the adult population with diabetes or hypertension. Methods: An integrative review was conducted using databases within EbscoHost, PubMed, and Scopus. Eligible studies available as of September 2016 had to be written in English, and contain digital health interventions to improve medication adherence to prescription medications in adults (18 years or older), and focus on diabetes or hypertension. Results: Of the 337 located studies, 12 used a digital health intervention to promote medication adherence to prescribed medications for diabetes or hypertension and were assessed according to the Chronic Care Model. Conclusions: The twelve studies included in this review found no conclusive evidence of improved medication adherence using digital health interventions such as Interactive Voice Response (IVR), Short Message Service (SMS), telemonitoring, and interactive software technology. Among those are digital health interventions that foster medication adherence via one-way communication to the patient or two-way communication between the patient and healthcare provider for adjunct medication adherence strategies. More research is needed to determine which digital health interventions are most beneficial for individuals with diabetes or hypertension.

  • Reduction of health disparities by increasing vegetables intake with a web-based nutrition education intervention among lower-income adults: a randomized-controlled trial

    From: Journal of Medical Internet Research

    Date Submitted: May 14, 2017

    Open Peer Review Period: May 17, 2017 - Jul 12, 2017

    Background: No existing web-based nutrition education interventions have yet been evaluated with consideration of socio-economic status. Objective: To investigate the effect of a randomized controlled...

    Background: No existing web-based nutrition education interventions have yet been evaluated with consideration of socio-economic status. Objective: To investigate the effect of a randomized controlled trial on reducing vegetable intake disparities between lower- and middle household income with a web-based intervention. Methods: Randomized controlled trial. Participants were assessed at three timepoints: participants were assessed at baseline (T1), post intervention (5 weeks later; T2), and a follow-up after 3 months (T3) from October 2015 to March 2016. A web-based intervention survey was conducted via a Japanese online research service containing data including sociodemographic attributes for 8,564 adults aged 30–59 years. Participants (n = 1,500) were stratified per national population statistics for sex, age, and household income, and randomly divided into intervention and control groups. The intervention program content encouraged behavioral changes using behavioral theories and techniques tailored to assumed stages of behavioral change. The outcome was vegetable intake servings (350 g per day, 5 small bowls). Results: This study had the high levels of compliance (low income: 82.4%, middle income: 85.7% at T2). The vegetable intake increased in the low-income among intervention group from T1 to T2 (0.42 SV; 95% CI: 0.11–0.72). A two-way ANOVA showed that low-income households had significant main effects (Group: η2 = 0.04, p = .012, Time: η2 = 0.01, p < .001) and a significant interaction (η2 = 0.01, p = .009). Middle-income households also had a significant main effect (Time: η2 = 0.01, p = .006) and a significant interaction (η2 = 0.01, p = .046). Conclusions: Web-based nutritional education intervention could fill the vegetable intake gap between low- and middle-income and be expected to prevent non-communicable and lifestyle-related diseases. Further intervention program improvements are necessary to maintain and increase vegetables intake for other groups. Clinical Trial: Current Controlled Trials UMIN-ICDR UMIN000019376 (Registered October 16, 2015)

  • A protocol for a peer e-mentoring intervention to improve transition to employment for youth with physical disabilities

    From: JMIR Research Protocols

    Date Submitted: May 12, 2017

    Open Peer Review Period: May 17, 2017 - May 31, 2017

    Background: Although youth with disabilities have much to gain from employment readiness programs, they are often excluded from, or have limited access to vocational programs. One encouraging approach...

    Background: Although youth with disabilities have much to gain from employment readiness programs, they are often excluded from, or have limited access to vocational programs. One encouraging approach to address gaps in vocational programming is through peer e-mentoring, which may facilitate a smoother transition to adulthood by offering support to enhance coping skills. Despite the increase in online communities, little is known about their impact on vocational mentoring for youth with physical disabilities and their parents. Objective: To develop, implement, and assess the feasibility of an online peer mentor employment readiness intervention for youth with physical disabilities and their parents to improve their self-efficacy, career maturity, and social support. Methods: A mixed methods feasibility randomized controlled trial design will be conducted to develop and assess the feasibility, acceptability and initial efficacy of “Empowering youth towards Employment” intervention. Youth (aged 15-25) with physical disabilities and their parents will be randomly assigned to a control or experimental group (4-week, interactive intervention, moderated by peer mentors). Results: Data collection is in progress. Planned analyses include pre-post measures to determine the impact of the intervention on self-determination, career maturity and social support. A qualitative thematic analysis will be conducted to analyze the content of discussion forums. Conclusions: Our intervention includes evidence-informed content and was co-created by a multi-disciplinary group of researchers, and knowledge users. It has the potential for widespread implications as a cost-effective resource to supplement educational and vocational programming for youth with disabilities. Clinical Trial: # NCT02522507

  • Mobile Apps for Suicide Prevention: Review in Virtual Stores and Literature

    From: JMIR mHealth and uHealth

    Date Submitted: May 12, 2017

    Open Peer Review Period: May 13, 2017 - Jul 8, 2017

    Background: The best manner to prevent suicide is to recognize the suicidal signs and signals, and know how to respond to them. Objective: To study the existing mobile apps for suicide prevent in the...

    Background: The best manner to prevent suicide is to recognize the suicidal signs and signals, and know how to respond to them. Objective: To study the existing mobile apps for suicide prevent in the literature and the most important virtual stores. Methods: Two reviews are carried out. The first is done by searching the most used commercial app stores such as iTunes and Google Play. The second is a review of mhealth apps in the published articles from the following 7 scientific databases: Science Direct, Medline, PsycINFO, Embase, The Cochrane Library, IEEE Xplore and Google Scholar from the last 10 years. Results: A total of 124 apps related to suicide were found in the cited virtual stores but only 20 apps were specifically for suicide prevention. All them are free and most are for Android. Furthermore, 6 relevant papers were found in the indicated scientific databases. Pilot experiences were commented where physicians and families have an important work. Conclusions: The number of apps about suicide prevention is small, mainly in literature. There was little information. Many of these apps provide no interactive features. It is important to verify the accuracy of the results of different apps that are available on iOS and Android. The confidence generated by these applications can benefit users who use it, either by improving their health monitoring or only to verify their body condition.

  • The Box: using smart technology to improve outcome of myocardial infarction patients. Rationale and design of a randomized-controlled trial

    From: JMIR Research Protocols

    Date Submitted: May 15, 2017

    Open Peer Review Period: May 18, 2017 - Jun 1, 2017

    Background: Recent evidence suggests that frequent monitoring using smartphone compatible wearables might improve clinical effectiveness and patient satisfaction of care. Objective: The aim of this st...

    Background: Recent evidence suggests that frequent monitoring using smartphone compatible wearables might improve clinical effectiveness and patient satisfaction of care. Objective: The aim of this study is to investigate the clinical effectiveness and patient satisfaction of a smart technology intervention in patients admitted with a ST elevation myocardial infarction (STEMI) or non ST acute coronary syndrome (NST-ACS). Methods: In this single center, open, randomized controlled trial (RCT) patients who suffered from STEMI or NST-ACS are 1:1 randomized to an intervention group or control group. Both groups are followed up to 1 year after the index event. The intervention group will take daily measurements with a smartphone compatible electrocardiogram device, BP monitor, weight scale and activity tracker. Furthermore, two out of four outpatient clinic visits are replaced by e-visits (1 and 6 months after index event). The control group will receive regular care, consisting of four outpatient clinic visits (1, 3, 6 and 12 months after index event). All patients will be asked to fill in validated questionnaires about patients satisfaction, quality of life, propensity of medication adherence and physical activity. Results: Primary outcome of this trial is percentage of patients with regulated blood pressure. Secondary outcomes include patient satisfaction, healthcare utilization, major adverse cardiac events, medication adherence, physical activity, quality of life and percentage of patients in which a sustained arrhythmia is detected. Conclusions: Smart technology could potentially improve care in post-myocardial infarction patients. This trial will investigate whether usage of smart technology can improve clinical-, and cost-effectiveness of care. Clinical Trial: NCT02976376 (clinicaltrials.gov)

  • HIV Surveillance of Key Populations: Opportunities for Enhanced Strategic Use of Surveys, Health Records, and Program Data

    From: JMIR Public Health and Surveillance

    Date Submitted: May 14, 2017

    Open Peer Review Period: May 15, 2017 - May 29, 2017

    Background: The UNAIDS 90-90-90 targets pose a new challenge for HIV surveillance among key populations and offer new opportunities for better alignment of surveillance, program monitoring and evaluat...

    Background: The UNAIDS 90-90-90 targets pose a new challenge for HIV surveillance among key populations and offer new opportunities for better alignment of surveillance, program monitoring and evaluation. Objective: To describe current objectives and challenges of the enhanced strategic information mandate as applied to key populations, provide an historical perspective, and identify future opportunities to better align and enhance the use of survey, health sector and program data to describe the epidemic among key populations and measure programmatic response Methods: Literature review and expert consultation. Results: Currently surveillance indicators rely primarily on data from independent special surveys of key populations that often are not well aligned with local programming needs, however, improvements in the quality and completeness of routinely collected health and program data could reduce dependence on independent and costly surveys. Conclusions: Current reliance on standard national and key-population specific surveys is still necessary until the quality and completeness of program and health record data for key populations is better established.

  • The impact of mHealth interventions on breast cancer awareness and screening: systematic review protocol

    From: JMIR Biomedical Engineering

    Date Submitted: May 14, 2017

    Open Peer Review Period: May 14, 2017 - Jul 9, 2017

    Background: Mobile health (mHealth) is the use of mobile communication technologies to promote health by supporting healthcare practices (e.g. health data collection, delivery of healthcare informatio...

    Background: Mobile health (mHealth) is the use of mobile communication technologies to promote health by supporting healthcare practices (e.g. health data collection, delivery of healthcare information etc.). mHealth technologies (such as mobile phones) can be used effectively by healthcare practitioners in the distribution of health information and has the potential to improve access to and quality of healthcare, as well as reduce the cost of health services. The literature shows limited scientific evidence on the benefits of mHealth intervention for breast cancer, which is the leading cause of cancer deaths in women worldwide, contributing a large proportion of all cancer deaths, especially in developing countries. The proposed systematic review will examine the impact of mHealth interventions on breast cancer awareness and screening among women aged 18yrs and older. Objective: The objectives of this study is to identify and describe the various mHealth intervention strategies used in breast cancer and assess the impact of mHealth strategies on breast cancer awareness and screening. Methods: Using the standard methods of a systematic review, literature will be sourced from various databases. A predefined search criterion will be applied. Two authors will apply the inclusion and exclusion criteria stipulated in this protocol. Results: The results from premilitary searches indicate that there are existing peer-reviewed articles relating to the use of mHealth in Breast Cancer. Conclusions: The knowledge derived will inform healthcare stakeholders including researchers, policy makers, investors, health professionals, technologists and engineers on the impact of mHealth in breast cancer screening and awareness.

  • Smartphone Apps for Gestational Diabetes: A Scoping Review Examining Functionality, Implementation, Impact and the Role of Health Literacy

    From: JMIR Diabetes

    Date Submitted: May 14, 2017

    Open Peer Review Period: May 17, 2017 - Jul 12, 2017

    Background: The increasing ownership of smartphones and advances in hardware and software position these devices as cost-effective personalized tools for health promotion and management among women wi...

    Background: The increasing ownership of smartphones and advances in hardware and software position these devices as cost-effective personalized tools for health promotion and management among women with gestational diabetes mellitus (GDM). Numerous smartphone apps are available online; however, no review has documented how these apps are developed and evaluated in relation to gestational diabetes. Objective: To answer the following two research questions: (1) What is known from the existing literature about the availability, functionality, and effectiveness of smartphone apps on GDM prevention and management? And (2) What is the role of health literacy in these apps? Methods: Seven relevant electronic databases were searched for original research documents using terms related to smartphone apps, GDM, and health literacy. Selected articles were thematically categorized using a framework adapted from Arksey & O'Malley. Results: Twelve articles related to seven app/systems were included in the final analysis. Articles were classified around two themes: (1) description of the development, feasibility or usability of the apps/systems, and (2) trial protocols. Varying degrees of personalization exist in the apps for GDM and decision support systems (DSSs) can be used to generate time-efficient personalized feedback for both patients and healthcare providers. Health literacy was considered during the development or measured as an outcome by some apps. Conclusions: There is a limited body of research on smartphone apps in relation to GDM prevention and management. Smartphone apps can provide time- and cost-efficient personalized interventions for GDM. Several randomized controlled trials (RCT) have been launched recently to evaluate the effectiveness of the apps. Consideration of health literacy should be improved when developing features of the apps.

  • Getting to the Root of Reinvestment - An fNIRS study in Dentistry using Virtual Reality Haptic Simulation

    From: Journal of Medical Internet Research

    Date Submitted: May 15, 2017

    Open Peer Review Period: May 18, 2017 - Jul 13, 2017

    Background: Personality has been identified as a factor that influences learning in healthcare. Movement specific reinvestment is a dimension of personality that has been shown to influence psychomoto...

    Background: Personality has been identified as a factor that influences learning in healthcare. Movement specific reinvestment is a dimension of personality that has been shown to influence psychomotor learning because it has a central role in conscious control of movements. Currently, there is little evidence considering the relationship between movement specific reinvestment and working memory in terms of functional brain activation of the dorsolateral prefrontal cortex (DLPFC) during motor skill performance. Objective: This study used functional near infrared spectroscopy (fNIRS) to examine the research gap between movement specific reinvestment and working memory using undergraduate dental students performing dental virtual reality (VR) psychomotor tasks. Methods: The propensity for movement specific reinvestment was assessed in 24 dental students, who completed two dental tasks (clinical, non-clinical) on a VR haptic simulator. Portable fNIRS equipment was used to assess oxygen demands in the left and right DLPFC hemispheres during performance. Results: Students with a high propensity for movement specific reinvestment displayed significantly greater oxyhaemoglobin demands in and area associated with working memory during the non-clinical task (Spearman correlation, rs = -0.49, p = 0.033). Conclusions: This small-scale study suggests that neurophysiological differences are evident between high and low reinvesters during a dental VR task in terms of oxyhaemoglobin demands in an area associated with working memory. The results contribute to understanding the neurological processes underpinning conscious control of movements and may assist in the design of individualized training plans for psychomotor skills.

  • Enhancing quality of life through exercise: A tele-rehabilitation approach

    From: JMIR Research Protocols

    Date Submitted: May 15, 2017

    Open Peer Review Period: May 18, 2017 - Jun 1, 2017

    Background: Despite the compelling evidence linking physical activity and quality of life among adults with spinal cord injury (SCI), physical activity participation rates are extremely low in this po...

    Background: Despite the compelling evidence linking physical activity and quality of life among adults with spinal cord injury (SCI), physical activity participation rates are extremely low in this population. Unfortunately, a lack of physical activity interventions, in particular theory-based randomized controlled trials (RCT), exists within the SCI literature. A pilot RCT is needed to first examine the feasibility to conduct such interventions, and determine the appropriate effect size to inform future full-scale interventions. Objective: The overall goal of this pilot RCT is to test an 8-week innovative, self-determination theory, video-based tele-rehabilitation intervention aimed at enhancing the basic psychological needs, motivation, physical activity and quality of life-related outcomes of adults with SCI. The objectives are to: (1) determine if individuals in the intervention group will have greater increases in their basic psychological needs and autonomous motivation and a decrease in controlled motivation compared to the control group; (2) determine whether the intervention group reports greater increases in physical activity and quality of life-related variables (e.g., life satisfaction, participation in daily/social activities, depressive symptoms) compared to the control group; and (3) examine if adults with SCI who received the intervention report improved scores on psychosocial predictors of physical activity (e.g., action planning) and well-being (e.g., positive affect) compared to the control group. We also aimed to examine the implementation characteristics of the intervention (e.g., satisfaction with the technology, counsellor’s ability to foster the psychological needs). Methods: Adults with SCI (N = 24) living in the community will be recruited. All participants will be invited to complete assessments of their psychological needs, motivation, physical activity, and quality of life-related variables at three time points (baseline, 6 weeks, and 10 weeks). Following the baseline assessment, participants will be randomly assigned to the intervention or control group. Participants in the intervention group will participate in 8 weekly, 1-hour video-based tele-rehabilitation sessions with a trained physical activity counsellor, while participants in the control group will be asked to continue with their regular routine. Results: We expect higher ratings of the basic psychological needs and autonomous motivation and lower scores for controlled motivation for the intervention group compared to the control group (objective 1). We also expect that our video-based intervention will have moderate effects on physical activity participation, as well as a small-to-moderate positive effects on the quality of life-related variables (objective 2). Finally, we expect the intervention to have a small positive effect on psychosocial predictors of physical activity and well-being (objective 3). Conclusions: We anticipate that the results will support that the intervention is appropriate for adults with SCI and feasible to test in a full-scale RCT. Clinical Trial: Enhancing Quality of Life Through Exercise: A Tele-Rehabilitation Approach (#NCT02833935 with ClinicalTrials.gov)

  • Motivations to play Pokémon GO and their influence on perceived outcomes and physical activity.

    From: Journal of Medical Internet Research

    Date Submitted: May 15, 2017

    Open Peer Review Period: May 16, 2017 - Jul 11, 2017

    Background: Pokémon GO (PG) is the most played augmented reality game in history. With more than 44 million players at the peak of its popularity, the game has sparked interest on its effects on the...

    Background: Pokémon GO (PG) is the most played augmented reality game in history. With more than 44 million players at the peak of its popularity, the game has sparked interest on its effects on the young population’s health. Objective: This study examined motivations to start playing PG among a sample of US college students and how they affected perceived outcomes of the playing experience and physical activity derived from playing. The paper aimed at understanding how the motivations drawing people to the game were determining the perceived outcomes of the game including the physical activity derived from playing. Methods: In November 2016, a sample of 74 US college students were asked to complete online surveys and install an ecological momentary assessment (EMA) tool and a step counter on their smartphones. The EMA tool prompted a set of questions on playing behavior and physical activity, three times a day (12pm, 7pm, 10pm), for seven days. A factorial analysis was used to come up with three distinctive groups of players, based on their motivation to start playing PG. Differences on group averages on a set of five different outcomes were tested using one-way ANOVA. Results: Three interpretable factors were extracted from the clustering of motivations to start playing PG: Pokémon and videogame fans (55% of the sample), physical activity seekers (17%), curious & social (28%). Significant differences between the clusters were detected on the enjoyment of different aspects of the game, particularly, battling (F=10.739 P<.001); discovering new places (F=7.085 P=.002) and meeting new people (F=17.613 P<.001) as well as with agreeing on the fact that playing had improved their mood and had made them become more social. All groups perceived traffic as a major threat to playing. PG was associated with higher steps reported at the end of the day (F=8.903 P=.048), especially among physical activity seekers (F=0.887 P=.021) but also for Pokémon and videogame fans (F=2.842 P=.044). Conclusions: Playing PG was found positively associated with a set of beneficial health outcomes particularly with higher physical activity levels, higher socialization and better mood. Results, however, depend on personal motivations and expectations when joining the game. These results highlight the importance of taking these factors into account when trying to extract conclusions from the PG phenomenon that may enhance future exergames’ designs or health interventions.

  • Using data cubes to construct a disease-gene-drug association network for diabetes mellitus

    From: JMIR Diabetes

    Date Submitted: May 16, 2017

    Open Peer Review Period: May 19, 2017 - Jul 14, 2017

    Background: In this post-genomic big-data era, genomic approaches are increasingly used to search for potential new drugs and treatments for diseases. Large-scale data mining of biomedical literature...

    Background: In this post-genomic big-data era, genomic approaches are increasingly used to search for potential new drugs and treatments for diseases. Large-scale data mining of biomedical literature is an essential tool for investigating and predicting the relationships between causal genes and treatments of diabetes mellitus (DM). Objective: The objective of the study is to construct a disease-gene-drug association network for diabetes mellitus and predict some new associations. Methods: Based on textual data, we developed a novel, data cube–based approach for constructing a disease-gene-drug association network for DM. We used association rules to measure the associations between biological entities. Results: We obtained phenotypic, genotypic, and treatment drug data for DM from the PubMed database. After data preprocessing, we constructed the 0-D vertex cube, which we then filtered to construct three 1-D cubes consisting of 14 diseases, 23 genes, and 34 drugs. We found 194 associations between the 14 subclasses of DM and the 23 genes, 75 associations between 11 of the DM subclasses and 24 of the drugs, and 142 associations between 14 of the DM-related genes and 15 of the drugs. By applying association rules to quantify the correlation between the disease phenotypes, genes, and treatment drugs, we established three 2-D cubes and three relational networks. Finally, using the bottom-up computation algorithm, we constructed the 3-D disease-gene-drug network, which revealed 411 associations between 14 subclasses of DM, 23 genes, and 24 drugs. Based on this 3-D network, we constructed 8 optimal disease-gene-drug subnetworks of DM. Conclusions: We have implemented and validated a network-based approach to identifying and ranking the hidden associations between diseases, genes, and drugs. Our results provide new potential pathways in the search for DM treatment drugs.

  • Longitudinal cohort study on self-management and self-efficacy in first spinal cord injury rehabilitation; study protocol of the SELF-SCI study

    From: JMIR Research Protocols

    Date Submitted: May 16, 2017

    Open Peer Review Period: May 19, 2017 - Jun 2, 2017

    Background: People with recently acquired spinal cord injury (SCI) experience changes in physical, social and psychological aspects of their lives. In the last decades, attention has grown for aspects...

    Background: People with recently acquired spinal cord injury (SCI) experience changes in physical, social and psychological aspects of their lives. In the last decades, attention has grown for aspects of self-management and self-efficacy in SCI research. However, we still do not know what the self-management and self-efficacy outcomes of first rehabilitation are and whether utilizing these skills may prevent secondary health conditions (SHCs) and increase participation and psychological adjustment early after SCI. Objective: To describe the course and determinants of self-management and self-efficacy during and after first SCI rehabilitation; and to determine theory-based associations between self-management and self-efficacy with SHCs, participation and psychological adjustment. Methods: Multicenter prospective longitudinal cohort study. All people with a newly acquired SCI admitted to one of the 8 specialized SCI rehabilitation centers in the Netherlands will be considered for inclusion in this study. Main assessments will take place during the first and last week of admission and 3, 6 and 12 months after discharge. The target sample is 250 participants. The primary outcomes are self-management (knowledge and execution of self-care) and self-efficacy (confidence in the ability to manage the consequences of SCI). Secondary outcome measures are SHCs, participation and psychological adjustment to SCI. Discussion: This protocol describes the SELF-SCI cohort study investigating self-management and self-efficacy of initial inpatient rehabilitation and associations with SHCs, participation and psychological adjustment of people with SCI early after onset of this condition. The results will be used to test theories about motivation to perform health-promoting behaviors and adjustment to SCI.

  • A Novel Measurement of Treatment Effect: Daily Activity Measured with Wearable Technology in Patients with Coronary Microvascular Dysfunction

    From: JMIR Research Protocols

    Date Submitted: May 16, 2017

    Open Peer Review Period: May 19, 2017 - Jun 2, 2017

    Background: Digital “wearable” devices provide a “real-world” assessment of physical activity and quantify intervention related changes in clinical trials, however the value of digital wearabl...

    Background: Digital “wearable” devices provide a “real-world” assessment of physical activity and quantify intervention related changes in clinical trials, however the value of digital wearable device recorded physical activity as a clinical trial outcome is unknown. Objective: Because late Na channel inhibition (ranolazine) improves stress laboratory exercise duration among angina patients, we proposed that this benefit could be quantified and translated during daily life by measuring digital wearable device determined step count in a clinical trial. Methods: We conducted a substudy in a randomized, double-blinded, placebo-controlled, cross-over trial of subjects with angina, no obstructive coronary artery disease (CAD) and coronary microvascular dysfunction (CMD) to evaluate the value of digital wearable device monitoring. Ranolazine or placebo was administered (500-1,000 mg BID) for 2 weeks with a subsequent 2 week washout followed by crossover to ranolazine or placebo (500-1,000mg BID) for an additional 2 weeks. The outcome of interest was within subject difference in Fitbit Flex daily step count during week 2 of ranolazine versus placebo during each treatment period. Secondary outcomes included within subject differences in angina, quality of life, myocardial perfusion reserve and diastolic function. Results: 43 subjects were enrolled in the substudy and 30 successfully completed the substudy for analysis. Digital wearable device protocol adherence was 90.7%. Overall, late Na channel inhibition reduced within subject daily step count vs. placebo (5757±3076 vs. 6593±3393, P=.01) but did not improve angina (SAQ-7) (P=.83). Among the subgroup with improved angina (SAQ-7), a direct correlation with increased step count (r= .42; P=.02) was observed, most evident among subjects with typical angina (r= .57; P=.05). Conclusions: We report one of the first studies to use digital wearable device determined step count as an outcome variable in a placebo controlled cross-over trial of late Na channel inhibition. We found in this substudy that late Na channel inhibition decreased step count overall during daily life in these subjects, although the subgroup with angina improvement had a step count increase. Our findings suggest digital wearable device technology may provide new insights in clinical trial research. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT01342029

  • Utilizing Consumer Health Informatics to Support Management of Hypertension by Clinical Pharmacists in Primary Care: Study Protocol.

    From: JMIR Research Protocols

    Date Submitted: May 17, 2017

    Open Peer Review Period: May 20, 2017 - Jun 3, 2017

    Background: Hypertension is a major public health concern in the United States given its wide prevalence, high cost, and poor rates of control. Multiple strategies to counter this growing epidemic hav...

    Background: Hypertension is a major public health concern in the United States given its wide prevalence, high cost, and poor rates of control. Multiple strategies to counter this growing epidemic have been studied, and home blood pressure monitoring, mobile health interventions, and referral to a clinical pharmacist for blood pressure management have all shown potential to be effective intervention strategies. Objective: The purpose of this study is to establish feasibility and acceptability of BPTrack, a clinical pharmacist-led mobile health intervention that aims to improve blood pressure control by supporting home blood pressure monitoring and medication adherence among patients with uncontrolled hypertension. BPTrack is an intervention that makes home monitored blood pressure data available to the clinical pharmacist for use in hypertension management. Secondarily, this study seeks to understand barriers to adoption of this intervention, as well as points of improvement among key stakeholders, so that larger scale dissemination of the intervention may be achieved and more rigorous research can be conducted. Methods: This study is recruiting up to 25 individuals who have poorly controlled hypertension from a Family Medicine clinic affiliated with a large Midwestern academic medical center. Participants complete a baseline visit, including installation and instruction in how to use BPTrack, the mobile health intervention. Participants are then asked to follow the blood pressure monitoring protocol for a period of twelve weeks, and subsequently complete a follow-up visit at the conclusion of the study period. Results: The recruitment period for the pilot study began in November 2016, and data collection is expected to conclude in mid-2017. Conclusions: This pilot study was designed to document the feasibility and acceptability of a clinical pharmacist-led mobile health approach to managing hypertension within a primary care setting. Through our 12-week pilot, we expect to lend support for this approach, as well as to lay the foundation for learning how to translate this approach into wider-scale implementation. This mobile health intervention seeks to leverage the multidisciplinary care team already in place within primary care, and to improve health-outcomes for patients with uncontrolled hypertension. Clinical Trial: NCT02898584

  • Classification of Twitter users who tweet about e-cigarettes

    From: JMIR Public Health and Surveillance

    Date Submitted: May 17, 2017

    Open Peer Review Period: May 17, 2017 - May 31, 2017

    Background: Despite concerns about their health risks, e cigarettes have gained in popularity in recent years. Concurrent with recent increases in e-cigarette use, social media sites like Twitter have...

    Background: Despite concerns about their health risks, e cigarettes have gained in popularity in recent years. Concurrent with recent increases in e-cigarette use, social media sites like Twitter have become a common platform for sharing information about and marketing of e-cigarettes. Monitoring trends in e-cigarette–related social media activity requires timely assessment of the content of posts and the types of users generating the content. However, little is known about the diversity of user types responsible for e-cigarette–related content on Twitter. Objective: The aim of this study was to demonstrate a novel methodology for automatically classifying Twitter users who tweet about e-cigarette–related topics into distinct categories of users. Methods: We collected approximately 11.5 million e-cigarette–related tweets posted between November 2014 and October 2016, and obtained a random sample of Twitter handles that have tweeted about e-cigarettes. Trained human coders examined the handles’ profiles and manually categorized each as one of the following user types: (1) individual (N = 2,168), (2) vaper enthusiast (N = 334), (3) informed agency (N = 622), (4) marketer (N = 752), and (5) spammer (N =1,021). Next, we gathered Twitter metadata and a sample of tweets for each labeled user and created features that reflect users’ metadata and tweeting behavior. Finally, we tested multiple machine learning algorithms to identify a model with the best performance in classifying user types. Results: Using a classification model that included metadata and tweeting behavior features, we were able to predict with relatively high accuracy five different types of Twitter users that tweet about e cigarettes (average F1 score = 83.5%). Accuracy varied by user type, with F1 scores ranging among individuals (91.7%), informed agencies (84.3%), marketers (80.9%), spammers (80.5%), and vaper enthusiasts (44.1%). Including additional tweet-derived features that capture tweeting behavior significantly improves the model performance—an overall F1 score gain of 11.2%—beyond metadata features alone. Conclusions: This study provides a method for classifying five different types of users who tweet about e-cigarettes. Our model achieved high levels of classification performance for most groups, and examining tweeting behavior was critical in improving the model performance. Results can help identify groups engaged in conversations about e-cigarettes online to help inform public health surveillance, education, and regulatory efforts.

  • Randomised controlled trial of an established direct to public peer support programme (Big White Wall) versus web-based information to aid self-management of depression and anxiety (The REBOOT* study). *Randomised Controlled Trial of the Effectiveness of Big White Wall Compared to Other Online SupporT

    From: JMIR Research Protocols

    Date Submitted: May 19, 2017

    Open Peer Review Period: May 21, 2017 - Jun 4, 2017

    Background: Regardless of geography or income, effective help for depression and anxiety only reaches a small proportion of those who might benefit from it. The scale of the problem suggests a role fo...

    Background: Regardless of geography or income, effective help for depression and anxiety only reaches a small proportion of those who might benefit from it. The scale of the problem suggests a role for effective, safe, anonymised public health driven online services such as Big White Wall which offers immediate peer support at low cost. The primary aim of the study is to determine the effectiveness of randomisation to Big White Wall (BWW) compared to online information compiled by the UK’s National Health Service (NHS Choices Moodzone) in people with mild to moderate depression and anxiety. The secondary aims are to determine cost effectiveness, the population reach of this service and adoption by services. Method/Design: A pragmatic, parallel group, single blind RCT is being conducted using a fully automated trial website in which eligible participants are randomised to receive either 6 months access to BWW or signposted to the NHS Moodzone site. The recruitment of 2200 people to the study will be facilitated by a public health engagement campaign involving general marketing and social media, primary care clinical champions, healthcare staff, large employers and third sector groups. People will refer themselves to the study and will eligible if they are over 16 years, have mild to moderate depression or anxiety and have access to the internet. The primary outcome will be mental well-being at six weeks. We will also explore secondary end points in terms of cost effectiveness from a health and social perspective. In addition, the reach and adoption of BWW will be recorded and possible mechanisms of action will be explored. Discussion: This will be the first fully digital trial of a direct to public peer support programme for common mental disorders. The potential advantages of adding this to current NHS mental health services and the challenges of designing a public health campaign and randomised controlled trial of two digital interventions using a fully automated digital enrolment and data collection process are considered for people with depression and anxiety.

  • Effectiveness of a technology-based supportive educational parenting programme on parental outcomes in Singapore: A study protocol for a randomized controlled trial

    From: JMIR Research Protocols

    Date Submitted: May 17, 2017

    Open Peer Review Period: May 20, 2017 - Jun 3, 2017

    Background: Supportive educational programmes during the perinatal period are scarce in Singapore. There is no continuity of care available in terms of support from community care nurses in Singapore....

    Background: Supportive educational programmes during the perinatal period are scarce in Singapore. There is no continuity of care available in terms of support from community care nurses in Singapore. Parents are left on their own most of the time, which results in a stressful transition to parenthood. There is a need for easily accessible technology-based educational programmes that can support needy parents during the crucial perinatal period. Objective: The aim of this study is to examine the effectiveness of a technology-based supportive educational parenting programme on parental outcomes and to evaluate the cost effectiveness of this intervention compared to routine perinatal care. Methods: A randomized controlled two-group pretest and repeated posttest experimental design will be used. The study will recruit 118 parents (59 couples) from the antenatal clinics of a tertiary public hospital in Singapore. Eligible parents will be randomly allocated to receive either the supportive educational parenting programme or routine perinatal care from the hospital. Outcome measures include parenting self-efficacy, parental bonding, postnatal depression, social support, parenting satisfaction, and cost evaluation. Data will be collected at the antenatal period, immediate postnatal period, one month, and three months post-childbirth. Results: Recruitment of the study participants commenced in December 2016 and is still ongoing. The current recruitment stands at 49 couples for both study arms including the intervention (n=27) and control (n=22) groups. Data collection is projected to finish within 12 months, by December 2017. Conclusions: This study will identify a potentially clinically useful, effective, and cost-effective supportive educational parenting programme to improve parental self-efficacy and bonding in newborn care, which will then improve parents’ social support seeking behaviors, emotional wellbeing, and satisfaction with parenting. It is hoped that better supported and satisfied parents will consider having more children, which may in turn influence Singapore’s ailing birth rate. Clinical Trial: ISRCTN48536064

  • Rationale and Design of Stick To It: An Intervention Using Gamification to Increase HIV and STI Screening Among Young Men Who Have Sex With Men in California

    From: JMIR Research Protocols

    Date Submitted: May 17, 2017

    Open Peer Review Period: May 18, 2017 - May 27, 2017

    Background: In the United States, young men who have sex with men (YMSM) remain disproportionately impacted by HIV and other sexually transmitted infections (STIs). Although routine HIV/STI screening...

    Background: In the United States, young men who have sex with men (YMSM) remain disproportionately impacted by HIV and other sexually transmitted infections (STIs). Although routine HIV/STI screening is pivotal to the timely diagnosis of HIV and STIs, initiation of appropriate treatment and reduced onward disease transmission, repeat screening is underutilized. Novel interventions that incorporate elements of games, an approach known as gamification, have potential to increase routinization of HIV/STI screening among YMSM. Objective: The study aims to test the hypothesis that an incentive-based intervention that incorporates elements of gamification can increase routine HIV/STI screening among YMSM in California. Methods: The study consists of a formative research phase to develop the intervention and an implementation phase where the intervention is piloted in a controlled research setting. In the formative research phase, we utilize an iterative development process to design the intervention, including gathering information about the feasibility, acceptability and expected effectiveness of potential game elements (e.g., points, leaderboards, rewards). These activities include staff interviews, focus group discussions with members of the target population and team meetings to strategize and develop the intervention. The final intervention is called Stick To It and consists of three components: 1) online enrollment, 2) online activities consisting primarily of quizzes and a countdown “timer” to facilitate screening reminders and 3) in-person activities that occur at the clinic. Participants earn points through the online activities that are then redeemed for chances to win various prizes during clinic visits. The pilot study is a quasi-experimental study with a minimum of 60 intervention group participants recruited via in-clinic recruitment, community-based events and online recruitment. We will compare outcomes in the intervention group to a historical control group consisting of individuals meeting the inclusion criteria who attended study clinics in the twelve months prior to intervention implementation. The study was pre-registered at clinicaltrials.gov: NCT02946164. Eligible participants in the pilot study are: 1) 18–26 years old, 2) born as and/or identify as male, 3) report male sexual partners, and 4) their zip code of residence is within defined areas in the vicinity of one of the two implementation sites. The primary outcome is repeat HIV/STI screening within 6 months. Results: This is an ongoing research project with initial results expected in the 4th quarter of 2017. Conclusions: We will develop and pilot test a gamification intervention to encourage YMSM to be regularly screened for HIV and STIs. The results from this research will provide preliminary evidence about the potential effectiveness of utilizing gamification to amplify health-related behavioral change interventions. Further, the research aims to determine the processes that are essential to developing and implementing future health-related gamification interventions.

  • The Use Of Social Media For The Promotion Of Education And Consultation In Adolescents Who Have Undergone Kidney Transplants: A Randomized Clinical Trial Comparing Knowledge, Satisfaction And Self-Esteem With The Group Undergoing Conventional Treatment.

    From: JMIR Research Protocols

    Date Submitted: May 17, 2017

    Open Peer Review Period: May 20, 2017 - Jun 3, 2017

    Background: Falling ill represents a traumatic experience especially in adolescence, since in addition to the moments of ambiguity and contradictions that this period bring, there is coping with the d...

    Background: Falling ill represents a traumatic experience especially in adolescence, since in addition to the moments of ambiguity and contradictions that this period bring, there is coping with the disease. Renal transplantation provides a better quality of life but the dependence on dialysis is replaced by the greater responsibility of self-care. With advances in technology, contemporary communication methods are a strategic mechanism for the approximation of the adolescent and the multi-professional team. In this perspective, this research may provide possible changes and propose alternatives, using social networks for the integration of the multi-professional team, promoting education within a virtual environment for adolescents who have undergone kidney transplants. Objective: To compare the knowledge, satisfaction and self-esteem of adolescent renal transplant patients of two groups: patients undergoing conventional treatment versus patients undergoing conventional treatment, plus the full time use of social networks to aid in education and consultation. Methods: Non-blind randomized clinical trial with 128 adolescents (age 13 to 21) divided in two groups: the first group will receive the conventional care and the second group will be invited to participate in a secret group of the social network "Facebook". This group will be used as a new education platform to involve young renal transplant patients to participate in the guidelines provided to them by the multi-professional team. Outcome Knowledge : a ten question multiple choice questionnaire will be applied. Each question is worth 1 point. This questionnaire will be applied by the researcher, before and three months after the beginning of the study. Self-esteem: A validated version for Brazil of the Rosenberg Scale (1965) is used in order to evaluate self-esteem. Satisfaction: A structured questionnaire with closed questions will be used. It will be applied before and after the end of the study, where all participants will be subjected to the same questions and possible answers. Statistical analysis The Student's t Test will be utilized to analyze the statistics for the comparison of the groups. Results: Hypothesis: Low cost intervention. Strategies for self-care education. Improvement in self-esteem. Space for the exchange of experiences, exposing ideas and doubts. Improvements in team and patient interaction. Education using a language geared toward adolescents. Conclusions: Health professionals need to seek alternatives when educating patients, focusing on easily understandable ways for effective guidance. In the adolescent population, it is understood that the use of technology as support in education is a fundamental tool for this age group. The proposed project will directly benefit adolescent renal transplant patients as it uses language aimed directly at the target demographic. It attempts to overcome the traditional model by being more in contact with the current generation. This approach makes the content easier to assimilate and, consequently, increases understanding.

  • Patient Health Record Systems’ Scope and Functionalities: A Literature Review and Future Directions

    From: Journal of Medical Internet Research

    Date Submitted: May 19, 2017

    Open Peer Review Period: May 21, 2017 - Jul 16, 2017

    Background: A new generation of user-centric information systems is emerging in healthcare as Patient Health Record systems. These systems create a platform supporting the new vision of health service...

    Background: A new generation of user-centric information systems is emerging in healthcare as Patient Health Record systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities; providing opportunities and challenges at the user, system and industry levels. Objective: To assess patient health records (PHR) data through a review of the literature, to inform the healthcare informatics community and provide recommendations for PHR design, research and practice. Methods: In this paper we review the literature to identify challenges associated with the development PHR systems. We survey PubMed, Embase and Medline databases from 1966 to 2015 for studies of personal health records resulting in 1822 articles, from which we select a total of 106 articles for a detailed review of PHR data content. We present several key findings related to the scope and functionalities in current PHR systems. We also present a functional taxonomy and chronological analyses of PHR data types and functionalities. Based on the evolution of prior PHR systems, we develop a maturity model for evaluation of multi-organizational systems such as PHR systems and identify implications on future health information systems research; improving understanding and providing insights for future directions. Results: Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices, and data types such as time series data. Chronological data analysis revealed an evolution of PHR systems’ functionalities over time from simple data access, to data modification, and more recently automated assessment, prediction and recommendation. Conclusions: Efforts are needed to improve PHR 1) data quality through patient-centered user interface design and standardized patient-generated data guidelines, 2) data integrity through consolidation of various types and sources, 3) functionality through application of new data analytics methods and 4) metrics to evaluate clinical outcomes associated with automated PHR systems’ use, and cost associated with PHR data storage and analytics.

  • Beneficiaries’ Willingness to Pay for Resuscitation Provided by Ambulance Attendants: A Survey Using the Contingent Valuation Approach

    From: Interactive Journal of Medical Research

    Date Submitted: May 20, 2017

    Open Peer Review Period: May 23, 2017 - Jun 1, 2017

    Background: Japanese emergency medical services (EMS) can be used by anyone for free. Recently, EMS usage has increased; the increased costs and the prolonged time for ambulance transport have become...

    Background: Japanese emergency medical services (EMS) can be used by anyone for free. Recently, EMS usage has increased; the increased costs and the prolonged time for ambulance transport have become recent social problems. Objective: We surveyed the willingness to pay (WTP) for resuscitation provided by EMS. Methods: In November 2011, men and women (3,160) aged 20–59 years were asked to assume that they were experiencing a cardiopulmonary arrest (CPA), and their WTP for EMS services was assessed in the following three situations: Case A, ambulance transport alone; Case B, chest compression in addition to ambulance transport; and Case C, mechanical ventilation through chest compression and intratracheal intubation, in addition to ambulance transport. We calculated the mean WTP for each case. Results: The WTP for Case A, B, and C was 6,696 ($65.0), 16,081 ($156.1), and 27,505 ($267.0), respectively. The WTP for Case B was significantly higher in respondents aged 40–59 years compared to those aged 20-39 years. The WTP for case B and C were significantly higher in males compared to females. WTP was significantly lower in students than it was in private employees. Although women’s intention to pay was higher than that of men, their WTP was lower than that of men. Public employees’ and students’ intention to pay was significantly lower than that of private employees. Conclusions: We investigated the WTP for EMS by asking respondents to assume that they were experiencing CPA. Our study provides information about the optimal fee for EMS, which will be useful for discussions on the feasibility of introducing a fee for EMS in Japan.

  • The effects of the daily PM2.5 concentration on the public awareness of lung cancer risk in China: Evidence from the Internet big data platform

    From: Journal of Medical Internet Research

    Date Submitted: May 23, 2017

    Open Peer Review Period: May 23, 2017 - May 31, 2017

    Background: In October 2013, the International Agency for Research on Cancer (IARC) classified the particulate matter from outdoor air pollution as a Class 1 carcinogen and declared that the particula...

    Background: In October 2013, the International Agency for Research on Cancer (IARC) classified the particulate matter from outdoor air pollution as a Class 1 carcinogen and declared that the particulate matter could cause lung cancer. PM2.5 pollution is becoming a serious public health concern in urban cities of China. It is essential to emphasize the importance of the awareness and knowledge of modifiable risk factors of lung cancer for prevention. Objective: To explore the public awareness of the association of PM2.5 with lung cancer risk in China by analyzing the relationship between the daily PM2.5 concentration and the searches for the term “lung cancer” via the Internet big data platform. Methods: We collected the daily PM2.5 concentration data and the daily Baidu index data in 31 Chinese capital cities between January 1, 2014 and December 31, 2016. We used the Spearman correlation analysis to explore the correlations between the daily Baidu Index for the term “lung cancer” and the daily average PM2.5 concentration. Granger causality test was used to analyze the causal relationship between the two time series variables. Results: In 23 of 31 cities, the pairwise correlation coefficients, by Spearman’s Rho, between the daily Baidu Index for the term “lung cancer” and the daily average PM2.5 concentration, were positive and statistically significant (p<0.05). However, the correlation between the daily Baidu Index for the term “lung cancer” and the daily average PM2.5 concentration was poor (All r2s<0.1). The results of Granger causality test illustrated that there was no unidirectional causality running from the daily PM2.5 concentration to the daily Baidu index for the term “lung cancer” statistically significant at the 5% level for each city. Conclusions: In conclusion, the daily average PM2.5 concentration has a weak positive impact on the daily search interest for the term of “lung cancer” via Baidu search engine. Well-designed awareness campaigns are needed to enhance the general public awareness of the association of PM2.5 with lung cancer risk, and to lead the public to seek more information about PM2.5 and its hazards, and to cope with their environment and its risks correctly.

  • The association of health and ehealth literacy with self-efficacy, coping and caregiving perceptions among carers of people with dementia: a research protocol for a descriptive correlational study

    From: JMIR Research Protocols

    Date Submitted: May 20, 2017

    Open Peer Review Period: May 23, 2017 - Jun 6, 2017

    Background: eHealth literacy has drawn the attention of the scientific community in the last decade as it influences the self-management of patients with chronic diseases, the quality and the cost of...

    Background: eHealth literacy has drawn the attention of the scientific community in the last decade as it influences the self-management of patients with chronic diseases, the quality and the cost of care. It is estimated that eighty percent of people with chronic diseases are cared for at home by a family member, friend or relative. Informal Carers are susceptible to physical and mental health problems and social and financial hardships. Nevertheless, there seems to be a research gap between carers’ needs and the new technologies with the vital role of eHealth literacy to remain unexplored. Objective: The study aims to explore the associations between self-efficacy, coping, caring perceptions, health and eHealth literacy amongst primary carers and secondary carers of people with dementia Methods: A sample of 165 primary carers (the carers who supports the people with dementia in activities of everyday living) and secondary carers (named family member, friend or other person in the social network assisting the primary carer in their role) will be recruited from dementia Day care centres and Alzheimer’s Associations in Greece and Cyprus. The study will be a cross sectional correlational descriptive study. Tools to be used include eHeals adapted for carers to measure ehealth literacy, Health Literacy Scale –EU Questionnaire 16, Single Item Literacy Screening, Revised Scale of Caregiving Self Efficacy, COPE index for caregiving perceptions and COPE brief to measure coping. Descriptive statistics will be reported and correlations between different variables will be explored with parametric and non-parametric measures. Results: During this period, Health Literacy Scale –EU-Questionnaire 16 has been validated in 107 older people. The recruitment of participants will start in May 2017. Conclusions: . Carers’ ehealth literacy is a new field. Researchers have well studied the impact of low ehealth literacy and health literacy among older adults without taking into consideration this specific population. We assume a moderating role of the ehealth literacy and health literacy level to carers’ perceptions about caregiving role, carers’ self-efficacy and coping strategies. Another possible moderator, secondary carers’ ehealth and health literacy level will be also discussed. By confirming the above assumptions, tailored ehealth literacy interventions for carers of people with dementia will be developed as a direct outcome of this research. Clinical Trial: N/A

  • Methods for Co-Designing a Collaborative Chronic Care Network (C3N)

    From: Journal of Medical Internet Research

    Date Submitted: May 20, 2017

    Open Peer Review Period: May 21, 2017 - Jul 16, 2017

    Background: Learning Health Systems (LHSs) are seen as a means to accelerate outcomes, improve care delivery, and further clinical research, yet few such systems exist. Objective: We describe the proc...

    Background: Learning Health Systems (LHSs) are seen as a means to accelerate outcomes, improve care delivery, and further clinical research, yet few such systems exist. Objective: We describe the process of co-designing, with all relevant stakeholders, an approach for creating a collaborative chronic care network (C3N), a peer-produced networked LHS. Methods: The setting was ImproveCareNow, an improvement network for pediatric inflammatory bowel disease. In collaboration with patients and families, clinicians, researchers, social scientists, technologists, and designers, C3N leaders used a modified idealized design process to develop a design for a C3N. Results: Over 100 people participated in the design process, which resulted in: a) an overall “concept design” for the ImproveCareNow C3N, b) a logic model for bringing about this system, and c) thirteen potential innovations likely to increase awareness and agency, make it easier to collect and share information, and to enhance collaboration – that could be tested collectively to bring about the C3N. Conclusions: Our current healthcare system fails to deliver necessary results and incremental system improvements are not enough. We demonstrate methods that resulted in a design that has the potential to transform the chronic care system. Our experience suggests that employing structured co-design processes in collaboration with all relevant stakeholders can result in a potentially transformative design for the chronic care delivery system.

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