JMIR Publications

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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.

  • Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control.

    From: Journal of Medical Internet Research

    Date Submitted: Feb 9, 2017

    Open Peer Review Period: Feb 21, 2017 - Apr 18, 2017

    Background: Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or dev...

    Background: Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. Objective: We describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We describe the developed intervention in line with reporting guidelines for a structured and systematic description. Methods: We used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions. Results: We reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components. Conclusions: Our experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process. Clinical Trial: The trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386); Pan Africa Trial Register (PACTR201411000724141); ClinicalTrials.gov (NCT02019823).

  • A Mobile Application to Streamline the Development of Wearable Sensor Based Exercise Biofeedback Systems: System Development and Evaluation

    From: Journal of Medical Internet Research

    Date Submitted: Feb 7, 2017

    Open Peer Review Period: Feb 13, 2017 - Apr 10, 2017

    Background: Biofeedback systems which utilise inertial measurement units (IMUs) have been shown recently to have the ability to objectively assess exercise technique. However, there are a number of ch...

    Background: Biofeedback systems which utilise inertial measurement units (IMUs) have been shown recently to have the ability to objectively assess exercise technique. However, there are a number of challenges in developing such systems; vast amounts of IMU exercise datasets must be collected and manually labelled for each exercise variation and naturally-occurring technique deviations may not be well detected. One method of combatting these issues is through the development of personalised exercise technique classifiers. Objective: We aimed to create a tablet application for physiotherapists and personal trainers which would automate the development of personalised multiple and single IMU based exercise biofeedback systems for their clients. We also sought to complete a preliminary investigation of the accuracy of such individualised systems in a ‘real world’ evaluation. Methods: A tablet application was developed which automates the key steps in exercise technique classifier creation through synchronising video and IMU data collection, automatic signal processing, data segmentation, data labelling of segmented videos by an exercise professional, automatic feature computation and classifier creation. Fifteen volunteers (12 males, 3 females, age: 23.6 +/- 2 years, height: 1.79 +/- 0.07 m, body mass: 77.4 +/- 9.9 kg) then completed 4 lower-limb late stage rehabilitation exercises using a personalised single IMU based classification system. The real world accuracy of the systems was evaluated. Results: The tablet application successfully automated the process of creating individualised exercise biofeedback systems. The personalised systems achieved an average of 90% accuracy, with 90% sensitivity and 89% specificity for assessing aberrant and acceptable technique with a single IMU positioned on the left thigh. Conclusions: A tablet application was developed that automates the process required to create a personalised exercise technique classification system. This tool can be applied to any cyclical, repetitive exercise. The personalised classification model displayed excellent system accuracy even when assessing acute deviations in compound exercises with a single IMU. Clinical Trial: N/A.

  • ICT for health in the EU: the effect of multimorbidity

    From: Journal of Medical Internet Research

    Date Submitted: Feb 10, 2017

    Open Peer Review Period: Feb 18, 2017 - Apr 15, 2017

    Background: Multimorbidity is becoming increasingly common and is a key challenge that societies with ageing populations are now facing. The presence of multimorbidity entails the implication of patie...

    Background: Multimorbidity is becoming increasingly common and is a key challenge that societies with ageing populations are now facing. The presence of multimorbidity entails the implication of patients to coordinate, understand and use the information obtained from different health care professionals, in addition to striving to distinguish the symptoms of different diseases and self manage their sometimes conflicting health problems. Information and communications technology (ICT) tools are an opportunity for health information and education for both patients and health professionals, and hold promise for more efficient and cost-effective care processes. Objective: This study aims to analyze the use of ICT tools, particularly the Internet, for health purposes, taking into account the citizens’ socio-demographic and clinical characteristics, and above all, the presence of multimorbidity. Methods: Cross-sectional and exploratory research using online survey data from July-August 2011 was conducted, including a total of 14,000 citizens from 14 European countries between 16 and 74 years of age, and who had used the Internet in the previous three months. The variables of study were the questionnaire items related to how often the Internet was used for health purposes, the degree of morbidity and the ICT for health gradient. Chi-square tests were conducted to classify participants and examine the relationship between the sociodemographic and clinical variables of participants and the ICT user group. A one-way analysis of variance (Anova) made it possible to compare the ICT for health gradient average between different groups of individuals according to their morbidity level. A two-way between-groups Anova was performed to explore the effects of multimorbidity and age group on the ICT for health gradient. Results: According to the ICT for health gradient, most participants (68.1%; 9,541) were labelled as Rare Users, being the majority of them (55.1%) 25-54 years old, with upper secondary education (50.3%), employed (49.3%) and living in medium-sized cities (40.7%). Results of the one-way Anova showed that the number of health problems significantly affected the use of ICT for health purposes [F (2, 13996) = 11.584; p = .001]. A two-way ANOVA showed there was a statistically significant interaction between the effects of age and number of health problems on the ICT for health gradient, F (4, 11991) = 7.936, p = .001. Conclusions: Although multimorbidity patients can benefit from Internet use for health-related activities, there is a need to consider different strategies to make ICT for health tools more sensitive to the particularities of older people and to reduce digital disadvantages.

  • THE BENECA m-Health App: FEASIBILITY OF A MOBILE HEALTH APPLICATION FOR ASSESSING AND MONITORING DIET AND PHYSICAL ACTIVITY HABITS IN BREAST CANCER SURVIVORS

    From: Journal of Medical Internet Research

    Date Submitted: Feb 14, 2017

    Open Peer Review Period: Feb 19, 2017 - Apr 16, 2017

    Background: Despite the potential benefits described by international organizations, 68–80% of survivors do not meet the described guidelines in terms of diet and physical activity. This concern cou...

    Background: Despite the potential benefits described by international organizations, 68–80% of survivors do not meet the described guidelines in terms of diet and physical activity. This concern could be approached with a user-friendly mobile health (mHealth) application for assessing and monitoring healthy lifestyles in breast cancer survivors (BCS). Objective: The main aim is to investigate the test-retest reliability and concurrent validity against accelerometry and dietary records of a novel mHealth system called BENECA (ENErgy Balance on CAncer). Methods: We conducted a descriptive reliability study (N=20 BCS) who were recruited from the Virgen de las Nieves Hospital of the Andalusian Health Service in Granada (Spain) between December 2015 and April 2016. Test-retest reliability analysis used an overlap of approximately 2 hours between times. During an 8-day period tri-axial accelerometers (ActiGraphGT3X+, Pensacola, Fl., US) were worn by patients for concurrent validity analysis. Alike, at baseline 24-hour dietary recalls (also after 8-day period), sociodemographic questionnaire and daily dietary record questionnaires were recorded. For the inter-rater reliability trials, two-way random effect intra-class correlation coefficients (Rho) and their confidence intervals were calculated. Moreover, the agreement in diet between gold-standard and BENECA m-Health System was evaluated using a method described previously by Hillier. Finally, the accuracy of BENECA m-Health System was assessed using a linear regression analysis to determine the correlation coefficient and a Passing-Bablok regression to evaluate bias. Results: The compliance rates for all assessment methods were very high. All outcome measures showed reliability estimates (α)≥0.90; the lowest reliability was obtained for portions of the FV (α=0.94). The inter-rater reliability (gold standard method versus BENECA mHealth system) was very good (Rho≥0.90). The mean match rate between food items reported using BENECA and those registered by gold-standards was 93.51%, with a phantom rate of 3.35%. There were no substantial differences between the BENECA m-Health system and the gold standard assessment methods. There was no fised bias and mean differences between methods were -0.15 for FAT, -0.01 for fruits and vegetables and -8.89 for minutes of moderate-to-vigorous physical activity. There were not any adverse events. One breast cancer survivor could not use the BENECA m-Health System because she was using a previous version of the Android System with which BENECA was incompatible. Conclusions: The BENECA mHealth system is a simple, quick, reliable and low burden method to assess diet and physical activity in BCS. This novel option has potential implications in the cancer units to examine energy balance-related behaviours. Further research is now required to study the usage of both BENECA mHealth system and objective measurement of physical activity because it could suppose a major advance for a growing cancer population whose energy imbalance increases risk of some of the most prevalent cancer processes.

  • Machine or Human? Evaluating the Quality of a Language Translation Mobile App for Diabetes Education Material

    From: JMIR Diabetes

    Date Submitted: Feb 3, 2017

    Open Peer Review Period: Feb 6, 2017 - Apr 3, 2017

    Background: Diabetes is a major health crisis for Hispanics and Asian Americans. Moreover, Spanish and Chinese speakers, in particular, are more likely to have limited English proficiency in the U.S....

    Background: Diabetes is a major health crisis for Hispanics and Asian Americans. Moreover, Spanish and Chinese speakers, in particular, are more likely to have limited English proficiency in the U.S. One potential tool for facilitating language communication between diabetes patients and providers is technology, specifically smartphones. Objective: With regard to the machine translation quality, previous studies only assessed the translation product using writing inputs. To bridge such research gap, we conducted a pilot study to evaluate the quality of a mobile language translation app (iTranslate) with the voice recognition feature when translating diabetes patient education material. Methods: The pamphlet, “You are the heart of your family…take care of it,” is a health education sheet for diabetes patients that outlines three recommended questions for patients to ask their clinicians. Two professional translators interpreted the original English sentences into Spanish and Chinese. We recruited six certified medical translators (three Spanish and three Chinese) to conduct blinded evaluations of the following versions: (1) sentences interpreted by iTranslate, and (2) sentences interpreted by a professional human translator. Evaluators rated the sentences provided on four scales: Fluency, Adequacy, Meaning, and Severity ranged from 1 to 5. We performed descriptive analyses to examine differences between these two versions. Results: Cronbach’s alpha values exhibited high degrees of agreement on the rating outcome of both evaluator groups: 0.920 for the Spanish raters and 0.971 for the Chinese raters. The readability scores generated using Microsoft Word’s Flesch-Kincaid Grade Level for these sentences were 0.0, 1.0, and 7.1. We found that iTranslate generally provided comparable translation accuracy as human translators on simple sentences. However, iTranslate made more errors when translating difficult sentences, which might cause delayed patient care. Conclusions: iTranslate could supplement, but not supplant, human translators. Mobile translation apps should be used with precaution.

  • Ontology-based analysis of social media data related to adolescent depression

    From: Journal of Medical Internet Research

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 6, 2017 - Apr 3, 2017

    Background: Social network services (SNSs) contain abundant information about the feelings, thoughts, interests, and patterns of behavior of adolescents that can be obtained by analyzing SNS postings....

    Background: Social network services (SNSs) contain abundant information about the feelings, thoughts, interests, and patterns of behavior of adolescents that can be obtained by analyzing SNS postings. An ontology that expresses the shared concepts and their relationships in a specific field could be used as a semantic framework for social media data analytics. Objective: The aims of this study were to develop an ontology and terminology as a framework for analyzing social media data on adolescent depression and to evaluate a formal description of classes and relationships in the ontology and its applicability. Methods: The domain and scope of the ontology were defined using competency questions. Concepts constituting the ontology and terminology were collected from clinical practice guidelines, the literature, and social-media postings on adolescent depression. Class concepts, their hierarchy, and relationships among class concepts were defined. An internal structure of the ontology was designed using the entity-attribute-value (EAV) triplet data model, and superclasses of the ontology were aligned with the upper ontology. Description logics of the ontology were evaluated by competency questions using description logic queries. Applicability of the ontology was validated by examining the representability of 10 sentiment phrases using the ontology data model and conducting sentiment analyses of social media data using logistic regression, decision tree, and association rules. Results: The ontology consisted of five top-level classes with 438 subordinate classes arranged into three or four levels of hierarchy. In total, 443 classes with 1,682 synonyms had 19 different types of property relationships. All of the answers that were inferred from the ontology according to the queries were found to be correct. Regarding applicability, it was possible to represent the 10 sentiment phrases using the EAV triplet of the ontology class concepts. It was also found that ‘academic stresses’ and ‘suicide’ contributed negatively to the sentiment of adolescent depression. Conclusions: The ontology and terminology developed in this study provide a semantic foundation for analyzing social media data on adolescent depression. To be useful in social media data analysis, the ontology, especially the terminology, needs to be updated constantly to reflect rapidly changing terms used by adolescents in social media postings.

  • Computerised adaptive testing improves the reliability and efficiency of depression assessment using the CES-D scale

    From: Journal of Medical Internet Research

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 6, 2017 - Apr 3, 2017

    Background: The CES-D is a commonly-used measure of depression. We assess its performance as an item bank for measuring depression using a computer adaptive testing (CAT) administration protocol. Obje...

    Background: The CES-D is a commonly-used measure of depression. We assess its performance as an item bank for measuring depression using a computer adaptive testing (CAT) administration protocol. Objective: To provide evidence on the efficiency and accuracy of the CES-D when administer using CAT. Methods: We applied a battery of psychometric assessments to the legacy CES-D questionnaire. Dimensionality as assessed using confirmatory factor and Mokken analysis. Advanced psychometric properties were assessed using item response theory (IRT) including assessments of item and scale fit to the graded response model, local dependency and differential item functioning. Results: Confirmatory Factor analysis (CFA) was employed to investigate the unidimensionality of the CES-D scale. Initial CFA results indicate a poor fit to the model. Thus, Mokken analysis was employed to explore the dimensional structure of the CESD-D. Three items were eliminated to conform to a single dimension. The remaining 17 items to Samejima’s graded response model. Examination of the factor loadings revealed that all items loaded significantly on the single factor. Evaluation of local dependency resulted in no correlated residuals greater than 0.2. Significant differential item functioning was not found between age and gender groups. Estimates of the level of CES-D trait score provided by the simulated CAT algorithm and the original CES-D trait score derived from original scale were correlated highly. The CAT simulation conducted using real data found a downward trend in the length of items given to individuals, indicating higher precision at the extreme (higher) levels of the depression spectrum. Conclusions: In summary, the CES-D CAT is a precise and efficient measurement of a highly relevant psychological construct. Even in its current form, the CES-D CAT shows the immediate advantages which can be employed to measure depression that is more accurate, interpretable, and efficient than using a paper-based test.

  • Mutual Involvement in Families with Type 2-Diabetes through Internet-based Healthcare Solutions.

    From: JMIR Diabetes

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 19, 2017 - Apr 16, 2017

    Background: Type 2-diabetes (T2D) is a prevalent chronic disease that affects not just the patient but the entire family. Both the patient and the rest of the family may benefit from gaining knowledge...

    Background: Type 2-diabetes (T2D) is a prevalent chronic disease that affects not just the patient but the entire family. Both the patient and the rest of the family may benefit from gaining knowledge about the disease and from supportive interfamilial interaction. Since the Internet is becoming a widely-used resource for health information, an Internet-based solution could potentially promote awareness and knowledge on how to manage T2D as a family, while also providing support for the family. Objective: To assess patients’ with T2D and their relatives’ usage of online information on diabetes and explore the families’ needs and preferences in regards to online information on diabetes. Objective: To assess patients’ with T2D and their relatives’ usage of online information on diabetes and explore the families’ needs and preferences in regards to online information on diabetes. Methods: A quantitative questionnaire survey was performed with families where at least one family member was diagnosed with T2D. The survey consisted of 36 closed questions on demographics, usage of the Internet, preferences in the source of information, interest in online information on six problem domains within family life related to T2D, preferences towards the delivery format of online information and peer-to-peer communication. Two open-ended questions were also included to elicit any additional comments or suggestions on improving online information on T2D regarding family life. Results: 50 participants corresponding to 22 families with T2D answered the questionnaire individually. 89% of the relatives and 100% of the patients indicated that information on T2D is relevant for them and 89-95% indicated that the Internet is the first or second preferred source when in need of information on T2D. Still, only 32-46% indicated to have searched the Internet to gain knowledge on T2D regarding family life. In regards to the six problem domains, 73-95% of the participants indicated interest in the domains Support, Knowledge and Everyday Life while 46-73% were interested in the domains ‘Communication, Worries and Roles. 72-84% of the participants indicated a preference for watching videos or reading about experiences derived from health care professionals (HCPs) or other families, while 20-32% were interested in peer-to-peer communication. Conclusions: Despite an interest for online information on T2D, there appears to be an unsatisfied need for more supportive online information on T2D aimed at Danish families with T2D. Based on family preferences, online information should focus on the six problem domains and be presented through text and videos by HCPs and peers. Peer-to-peer communication elements may be beneficial but are only expected to be used by a very limited number of families.

  • Content Analysis of Smartphone Apps for Smoking Cessation in China

    From: Journal of Medical Internet Research

    Date Submitted: Feb 16, 2017

    Open Peer Review Period: Feb 19, 2017 - Apr 16, 2017

    Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone applications (apps) for smoking ces...

    Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone applications (apps) for smoking cessation are increasingly used in China to help smokers quit. Objective: This study analyzed and evaluated the contents of all smoking cessation apps (iOS & Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSSG; identical to the U.S. Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis. Methods: We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSSG. We also recorded the features of smoking cessation apps (e.g., release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality. Results: Chinese smoking cessation apps have low levels of adherence, with an average score of 11.1 for Android and 14.6 for iOS apps, on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score. Conclusions: Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China.

  • Development of a Context-Driven Dynamic XML Ophthalmologic Data Capture Application

    From: Journal of Medical Internet Research

    Date Submitted: Feb 7, 2017

    Open Peer Review Period: Feb 20, 2017 - Apr 17, 2017

    Background: The capture and integration of ophthalmologic data into electronic health records (EHRs) has historically been a challenge. However, the importance of this activity for patient care and re...

    Background: The capture and integration of ophthalmologic data into electronic health records (EHRs) has historically been a challenge. However, the importance of this activity for patient care and research is critical. Objective: The purpose of this study was to develop a context-driven dynamic XML ophthalmology data capture application for research and clinical care that could be easily integrated into an electronic health record system. Methods: Stakeholders in the medical, research, and informatics fields were interviewed and surveyed to determine data and system requirements for ophthalmologic data capture. Based on these requirements, an ophthalmology data capture application was developed to collect and store discrete data elements with important graphical information. Results: The context-driven data entry application supports several features including: ink-over drawing capability for documenting eye abnormalities, context-based web controls that guide data entry based on pre-established dependencies, and an adaptable database or XML schema that stores web form specifications and allows for immediate changes in form layout or content. The application utilizes web services to enable data integration with a variety of EHRs for retrieval and storage of patient data. Conclusions: This paper describes the development process used to create a context-driven dynamic XML data capture application for optometry and ophthalmology. The list of ophthalmologic data elements identified as important for care and research can be used as a baseline list for future ophthalmologic data collection activities.

  • Public Perceptions Regarding Use of Virtual Reality in Healthcare: A Social Media Ethnographic Analysis Using Facebook

    From: Journal of Medical Internet Research

    Date Submitted: Feb 7, 2017

    Open Peer Review Period: Feb 8, 2017 - Apr 5, 2017

    Background: Virtual reality (VR) technology provides an immersive, multisensory, and three-dimensional environment that enables users to have modified experiences of reality. VR is increasingly used t...

    Background: Virtual reality (VR) technology provides an immersive, multisensory, and three-dimensional environment that enables users to have modified experiences of reality. VR is increasingly used to manage patients with pain, disability, obesity, neurologic dysfunction, anxiety, or depression. However, public opinion regarding use of VR in healthcare has not been explored. Understanding public attitudes, concerns, beliefs, and recommended use cases for VR is critical to ensure effective implementation and appropriate dissemination of this emerging technology. Objective: We sought to examine public opinion about healthcare VR using digital ethnography, a qualitative analysis method that allows for exploration of unfiltered views of topics discussed online. Methods: In March 2016, NBC News produced a video depicting use of VR for patient care. The video was repackaged by NowThis, a social media news website, and distributed on Facebook by Upworthy, a news aggregator, yielding 4.3 million views and 2,401 comments. We used Microsoft Power Query and ATLAS.ti software to analyze the comments using thematic analysis and categorized the comments around first-, second-, and third-order concepts. We determined self-identified gender from the user’s Facebook page and performed sentiment analysis of language to analyze whether perception of VR differed by gender using Pearson’s chi-square tests. Results: Of the 1,614 analyzable comments, 1,021 (63.26%) were attributed to female Facebook users, 572 (35.44%) to male users, and 21 (1.30%) to users of unknown gender. There were 1,197 comments coded as expressing a positive perception about VR (74.16%), 251 as a negative perception and/or concern (15.55%), and 560 as neutral (34.70%). Respondents identified 20 use cases for VR in healthcare, including for pain and stress reduction, bed-bound individuals, women during labor, and patients undergoing chemotherapy, dialysis, radiation, or imaging procedures, among others. Negative comments expressed concerns about patient safety and overdependence on technology. Respondents also expressed concerns about radiation, infection risk, motion sickness, and the ubiquity of and overall dependence on technology. There was a statistically significant association between language valence and gender of the Facebook user; men were more likely to post negative perceptions about VR use for healthcare, while women were more likely to post positive perceptions (P < 0.001). Conclusions: This study provides a blueprint for healthcare organizations and the VR community regarding where to prioritize research and implementation of VR for patient care. Most respondents to this natural experiment expressed positive perceptions about the use of VR in a wide range of healthcare settings. However, many expressed concerns that should be acknowledged and addressed as healthcare VR continues to evolve. Our results provide guidance in determining whether, when, and where to implement VR in patient care, and offer a formal opportunity for public opinion to shape the VR research agenda.

  • Scaling up the adoption and use of health technologies: Insights from practice theory

    From: Journal of Medical Internet Research

    Date Submitted: Feb 10, 2017

    Open Peer Review Period: Feb 11, 2017 - Apr 8, 2017

    Background: The challenge of promoting the spread and scale of new health technologies (including mobile health, telemedicine, and telehealth technologies) is now widely recognized around the world. D...

    Background: The challenge of promoting the spread and scale of new health technologies (including mobile health, telemedicine, and telehealth technologies) is now widely recognized around the world. Despite the growing attention to methods to achieve successful spread and scale, many scale-up initiatives continue to yield disappointing results. One central reason for the continued failure of these scale-up initiatives is a lack of understanding of how context influences the diffusion of technologies. Objective: In this paper we describe the contributions of “practice theory” to informing efforts to scale-up health technologies across entire systems of health and social care. Methods: Drawing on an individual case study from the Studies in co-Creating Assisted Living Solutions (SCALS) research program in the United Kingdom, and a review of practice theory, we identify key considerations in the effort to scale and spread health technologies. After describing the key tenets of practice theory, we present data from a case study of the implementation of a Global Positioning System (GPS) “geo-fence” for a person living with dementia. We conclude by summarizing the key insights that practice theory brings to efforts to scale up this technology and others, and offer questions to guide further work in this important field. Results: Illustrated through the case of the GPS “geo-fence”, practice theory suggests that efforts to scale-up technologies must attend to three key insights. First, scaling up technologies is in part unpredictable as a result of the experience and judgment integrated into clinical decision-making. Second, the successful scale-up of technologies depends on existing social networks, and considering those social networks will enable stronger plans for the scale and spread of health technologies. Finally, scaling up new technologies means changing routines of a wide range of people, raising the importance of understanding which routines are most likely to change. Conclusions: If health care leaders, policymakers, and other figures driving the scaling up of health technologies continue to neglect the real-world contexts of individual experiences, social networks, and habitual routine practices, the scaling up process will continue to be thwarted by the more important stuff that dominates peoples’ everyday lives. Future work in this domain should include a focus on strategies by which new technologies can be tailored to individual needs, and system-level strategies to provide enabling contexts for the integrated of technologies into routine care delivery.

  • Barriers and facilitators to use eHealth in daily practice, perspectives of patients and professionals in dermatology

    From: Journal of Medical Internet Research

    Date Submitted: Feb 15, 2017

    Open Peer Review Period: Feb 18, 2017 - Apr 15, 2017

    Background: The number of eHealth interventions in the management of chronic diseases, such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interve...

    Background: The number of eHealth interventions in the management of chronic diseases, such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interventions is limited. Objective: This study aimed to assess opinions of most important stakeholders influencing the implementation and use of eHealth services in daily dermatology practice. Methods: A cross sectional survey based on the eHealth implementation toolkit (eHit) was conducted to explore factors influencing the adoption of eHealth interventions offering the possibility of e-consultations, online monitoring and online self-management training among dermatologists and dermatology nurses. Perspectives of patients with atopic dermatitis (AD) regarding the use of eHealth services were discussed in an online focus group. Results: Healthcare professionals (n=99) and patients (n=9) acknowledged the value of eHealth services and were willing to use these digital tools in daily dermatology practice. Key identified barriers in the implementation and adoption of eHealth interventions included concerns about the availability and allocation of resources; financial aspects; reliability, security and confidentially of the intervention itself and the lack of education and training. Conclusions: Healthcare professionals and patients acknowledge the benefits arising from the implementation and use of eHealth services in daily dermatology practice. However, we identified some important barriers that might be useful in addressing the implementation strategy in order to enhance the implementation success of eHealth interventions in dermatology.

  • Toward Timely Data for Cancer Research: Assessment and Re-engineering of Cancer Reporting Process.

    From: JMIR Cancer

    Date Submitted: Feb 15, 2017

    Open Peer Review Period: Feb 16, 2017 - Apr 13, 2017

    Background: Cancer registries systematically collect cancer-related data to support cancer surveillance activities. However, cancer data is often unavailable for months to years after diagnosis, limit...

    Background: Cancer registries systematically collect cancer-related data to support cancer surveillance activities. However, cancer data is often unavailable for months to years after diagnosis, limiting its utility. Objective: The goal of this study is to identify the barriers to rapid cancer reporting and identify ways to shorten the turnaround time. Methods: Certified cancer registrars reporting to the Indiana state cancer registry participated in a semi-structured interview. Registrars were asked to describe the reporting process, estimate the duration of each step, and identify any barriers that may impact the reporting speed. Qualitative data analysis was performed with the intent of generating recommendations for workflow redesign. The existing and redesigned workflow were simulated for comparison. Results: Barriers to rapid reporting included access to medical records from multiple facilities and the waiting period from diagnosis to treatment. The redesigned workflow focused on facilitating data sharing between registrars and applying a more efficient queuing technique while registrars await the delivery of treatment. The simulation results demonstrated that our recommendations to reduce the waiting period and share information could potentially improve the average reporting speed by 87 days. Conclusions: Knowing the time elapsing at each step within the reporting process helps in prioritizing the needs and estimating the impact of future interventions. Where some previous studies focused on automating some of the cancer reporting activities, we anticipate much shorter reporting by leveraging health information technologies to target this waiting period.

  • Implementation Decisions and Design Trade-offs in Developing an EHR-linked Mobile Application to Reduce Parental Uncertainty Around Childhood Cancer

    From: Journal of Medical Internet Research

    Date Submitted: Feb 16, 2017

    Open Peer Review Period: Feb 20, 2017 - Apr 17, 2017

    Background: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to...

    Background: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to help reduce uncertainty is the provision of basic information. Families of newly diagnosed cancer patients are often bombarded with educational material, however. Technology has the potential to help families manage their informational needs and move towards normalization. Objective: We sought to create a mobile application that pulls together data from both the electronic health record (EHR) and vetted external information resources, in order to provide tailored information to parents of newly diagnosed children as one method to reduce the uncertainty around their child’s illness. This application was developed to be used by families in a National Institutes of Health (NIH)-funded randomized controlled trial (RCT) aimed at decreasing uncertainty and the subsequent psychological distress. Methods: A 2-phase qualitative study was conducted to elicit the features and content of the mobile application based on the needs and experience of parents of children newly diagnosed with cancer and their providers. Example functions include the ability to view laboratory results, look up appointments, and to access educational material. Educational material was obtained from databases maintained by the National Cancer Institute (NCI) and groups like the Children’s Oncology Group (COG) and care teams within Cincinnati Children’s Hospital Medical Center. The use of EHR-based web services was explored to allow data-like laboratory results to be retrieved in real-time. Results: The ethnographic design process resulted in an application framework that divided the content of the mobile application into 4 sections: 1) information about the patient’s current treatment and other information from the EHR; 2) educational background material; 3) a calendar to view upcoming appointments at their medical center; 4) a section where participants in the RCT document the study data. Integration with the NCI databases was straightforward, however, accessing the EHR web services posed a challenge, though the roadblocks were not technical in nature. The lack of a formal, end-to-end institutional process for requesting web service access and a mechanism to shepherd the request through all stages of implementation proved to be the biggest barrier. Conclusions: We successfully deployed a mobile application with a custom user interface that can integrate with the EHR to retrieve laboratory results and appointment information using vendor-provided web services. Developers should expect to face hurdles when integrating with the EHR, but many of them can be addressed with frequent communication and thorough documentation. Executive sponsorship is also a key factor for success. Clinical Trial: ClinicalTrials.gov NCT02505165

  • The digital divide: implications for expansion of e-Health in Sub-Saharan Africa

    From: JMIR mHealth and uHealth

    Date Submitted: Feb 16, 2017

    Open Peer Review Period: Feb 21, 2017 - Apr 18, 2017

    Background: Healthcare systems in Sub-Saharan Africa (SSA) are fraught with numerous governance and infrastructural issues including lack of access to quality care and health worker shortage. Policy m...

    Background: Healthcare systems in Sub-Saharan Africa (SSA) are fraught with numerous governance and infrastructural issues including lack of access to quality care and health worker shortage. Policy makers are becoming increasingly interested in adopting novel technologies such as web-based interventions within the scope of e-Health to bridge the gaps in care delivery in a cost-effective and sustainable manner. Successful implementation of these policies is reliant on evidences regarding people’s access to these technologies, which are scarce for countries in SSA. Objective: To 1) measure the prevalence of ever accessing computer and internet among adult population, 2) investigate the variation in the prevalence of accessing computer and internet across regional and socioeconomic groups, 3) assess association between ever accessing computer and internet and knowledge of routes and risk factors of HIV transmission in selected SSA countries. Methods: We analyzed cross-sectional datasets from UNICEF Multiple Indicator Cluster Surveys. Subjects were16,194 men and 39,121 women from Ghana, Guinea Bissau, Malawi and Zimbabwe. Main outcome variable was ever accessing computer and internet for any purpose. Associations were assessed by multivariable regression methods. Results: Lifetime experience of computer usage was respectively 21.5%, 13.4%, 12.3%, 28.4% among men, and 12.5%, 8.3%, 4.8%, 20.5% among women, and that of internet was 14.9%, 11.7%, 10.8%, 34% among men, and 6.4%, 6.9%, 4.2%, 21.6% among women in the aforementioned order. Participants who reported ever using computer and internet were more likely to have higher knowledge regarding the transmission of HIV compared to those who did not. Conclusions: Prevalence of lifetime access to computer and internet was considerably low in all four countries. Several socioeconomic factors appeared to be associated with the access to computer and internet, addressing which might prove beneficial for the successful expansion e-Health in these countries Clinical Trial: NA

  • Differentiation strategy in online physician competition: Does specialization matter?

    From: Journal of Medical Internet Research

    Date Submitted: Feb 19, 2017

    Open Peer Review Period: Feb 20, 2017 - Apr 17, 2017

    Background: A successful product differentiation strategy leads to competitive advantages and higher profits for firms, and this is also the case for the hospital industry. However, we do not know whe...

    Background: A successful product differentiation strategy leads to competitive advantages and higher profits for firms, and this is also the case for the hospital industry. However, we do not know whether a physician’s specialization differentiation strategy will have any impact on her online income in an e-Consultation market; nor do we know the market conditions under which this strategy will be more effective. Objective: We aim to investigate how a specialization differentiation strategy impacts a physician’s online income and the market conditions under which a specialization differentiation strategy has stronger effects. Methods: We employed secondary data in an econometric analysis of transactions obtained from an e-Consultation website (haodf.com) for four diseases (infantile pneumonia, diabetes, infertility, and pancreatic cancer) from 2008 to 2015. A total of 1160 physicians were included in the analysis. Results: Specialization, the differentiation strategy, has a significant positive impact on the physician’s online income (β =0.011, p < 0.001). Moreover, specialization will improve a physician’s competitive advantage when market competition is more intense (β =0.116, p < 0.001). Conclusions: Physicians whose expertise is differs from that of the majority have higher online incomes, and this impact will be stronger when market competition is more intense. Our study indicates that e-Consultations may accelerate the specialization trend observed in the health care industry because the online market favors more-specialized physicians, and competition in the online market is stronger than in the offline market. Such an impact may be positive for some very complicated diseases but less positive for some chronic diseases. Policy makers should be careful with the double-edged sword of e-Consultation.

  • Feasibility of online group-exercising among older adults in Siberia: Findings from two pilot trials

    From: Journal of Medical Internet Research

    Date Submitted: Feb 23, 2017

    Open Peer Review Period: Feb 24, 2017 - Apr 21, 2017

    Background: Regular physical activity has a positive effect on physical health, well-being and life satisfaction for older adults. However, engaging in regular physical activity can be challenging for...

    Background: Regular physical activity has a positive effect on physical health, well-being and life satisfaction for older adults. However, engaging in regular physical activity can be challenging for older adults due to reduced mobility, low motivation or lack of the proper infrastructures in their communities. Objective: The goal of this paper is to study the feasibility of home-based online group training - under different group cohesion settings - and its effects on adherence and well-being among Russian older adults. We focus particularly on the technology usability and usage, and on adherence to the training (in light of pre-measures of social support, enjoyment of physical activity and leg muscle strength). As a secondary objective we also explore the effects of the technology-supported intervention on the subjective well-being and loneliness. Methods: Two pilot trials were carried out exploring two different group cohesion settings (weak cohesion and strong cohesion) in the period 2015-2016, in Tomsk, Russian Federation. A total of 44 older adults (59-83 years old) participated in the two pilots, and followed a strength and balance training program (OTAGO) for eight weeks with the help of a tablet-based virtual gym application. Participants in each pilot were assigned to a Social condition, representing the online-group exercising, and a Control condition, representing a home-based individual training. Both conditions featured persuasion strategies but differed in the ability to socialise and train together. Results: Both Social and Control group reported on the high usability of the technology. Trainees showed a high level of application acceptance that also comprises the high score in intention to future use (4.2-5.0 on a 5-point Likert scale). Surprisingly, the Social group made significantly more use of private messages compared to public messages. However, joint participations to training sessions (co-presence) were higher for the Social group with higher cohesion. The overall adherence to the training (persistence rate) was of 74% (SD=27%). Higher levels of social support at baseline were associated with higher adherence in the study with low cohesion among trainees (F(1, 18)=5.23, p=.034), whereas in the high cohesion study the adherence was not significantly associated with the initial social support. Overall improvement in the satisfaction with life score was observed between pre and post measures (F(1,31)=5.85, p=.022), but no decrease in loneliness. Conclusions: Online group-exercising was proven feasible among healthy independently living older adults in Russia. The pilots suggest that a physical training performed in a virtual environment positively affect the life satisfaction of the trainees, but it does not provide support for a decrease in loneliness. High cohesion groups are preferable for group-exercising, especially to mitigate effects of low social support on adherence. Further research in motivating group interactions in training settings is needed.

  • Total knee replacement pathways: How can technology support patient cocreation for improved outcomes?

    From: Journal of Medical Internet Research

    Date Submitted: Feb 24, 2017

    Open Peer Review Period: Feb 24, 2017 - Apr 21, 2017

    Background: Total knee replacement (TKR) surgery is an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. Patients can improve their TKR outcom...

    Background: Total knee replacement (TKR) surgery is an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. Patients can improve their TKR outcomes through active participation or cocreation of their health service delivery. Patient cocreation in TKR can include activities such as active information seeking, shared decision making with clinicians, self-managing rehabilitation (e.g. physiotherapy), and self-monitoring (e.g. recovery/progress). Objective: Our aim was to investigate how information and communication technology (e.g. electronic health, mobile health) can enhance patient engagement as cocreators of their own health outcomes in the TKR journey. Methods: A multi-perspective qualitative study of user needs was conducted with Australian stakeholders (N= 34): surgeons (n = 12), physiotherapists (n = 3), patients (n = 11) and general practitioners (n = 8) to understand the opportunities for enhancing patient cocreation using information and communication technologies. Data from focus groups and interviews was recorded, transcribed and analysed using thematic analysis. Results: The current care delivery pathway for TKR is identified in terms of patient journey and information/communication flow. Numerous opportunities exist for technology to assist and enhance patient participation in, preparation for and recovery from TKR surgery. Technology could enhance the delivery of information to patients, as well as improve management and adherence to home exercise programs through instructional videos, reminders, and gamification. Self-monitoring of mobility, functional improvement, sleep quality, and detection of wound infection could be incorporated with wearable technology and self-management tools. Potential benefits for the healthcare system include reduced length of stay and reduced burden of disease associated with postoperative morbidity. Conclusions: Health outcomes are a result of collaboration between healthcare professionals and their patients. This multiple stakeholder needs analysis shows the potential for technology to enhance patient cocreation and improve TKR outcomes. For healthcare providers, empowering patients is about designing and delivering healthcare that is more inclusive of the patient to facilitate patient empowerment and cocreation.

  • 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.

  • Issues in Conducting Research on Social Media-Based Interventions for Health

    From: Journal of Medical Internet Research

    Date Submitted: Feb 27, 2017

    Open Peer Review Period: Feb 27, 2017 - Apr 24, 2017

    The use of social media platforms by healthcare professionals and public health organisations to deliver health care and support is in its early stages and challenges are emerging. While social media...

    The use of social media platforms by healthcare professionals and public health organisations to deliver health care and support is in its early stages and challenges are emerging. While social media platforms offer great potential to deliver health support development and testing of social media interventions for chronic disease management remains in its infancy, with ‘good practices’ not yet established. Designing social media interventions that are acceptable to users, practitioners and researchers is a challenge and there is a poor fit with traditional research and evaluation methods. Human research policy cannot match the rapid pace of change dictated by the commercially focused social media developers. While social media platforms reduce participant burden in engaging group support programs, they may create additional concerns for researchers in terms of intervention compliance, adherence an ethical practice.

  • How do ehealth programs for adolescents with depression work? A realist review of persuasive system design components in Internet-based psychological therapies

    From: Journal of Medical Internet Research

    Date Submitted: Mar 2, 2017

    Open Peer Review Period: Mar 6, 2017 - May 1, 2017

    Background: Major depressive disorders are common among adolescents and can impact all aspects of their daily life. Traditional therapies have been delivered face-to-face, however, Internet-based (onl...

    Background: Major depressive disorders are common among adolescents and can impact all aspects of their daily life. Traditional therapies have been delivered face-to-face, however, Internet-based (online) delivery of these therapies is emerging as an option for adolescents. Internet-based psychological therapies involve: 1) therapeutic content, 2) interaction between the user and the system, and 3) different technological features embedded into the online program (e.g., multi-media). Studies of Internet-based psychological therapies for adolescent depression differ on all three aspects, and variable, positive therapy effects have been reported. A better understanding of the conditions that influence therapy outcomes is important to designing and evaluating these novel therapies. Objective: To examine the human-technology interactions within Internet-based psychological therapies for adolescent depression, and document their relation to therapy outcomes. Methods: We performed a realist synthesis. We started with an extensive search of published and grey literature. We included intervention studies that evaluated an Internet-based psychological therapy for adolescent depression. We included mixed-methods and qualitative studies, theoretical papers, and policy/implementation documents if they included a focus on how Internet-based psychological therapy is proposed to work for adolescents with depression/depressive symptoms. We used the mixed-methods appraisal tool (MMAT) was used to assess the methodological quality of studies. We used the Persuasive System Design (PSD) model as a framework for data extraction and analysis to examine how technology-based systems influence the attitudes and behaviours of system users. PSD components described for each therapy were linked to therapy outcomes using a cross-case comparison method and thematic synthesis. Results: Nineteen Internet-based cognitive behavioural therapies (CBT) were identified in 59 documents. Seventy-one percent of studies were of moderate-to-high quality. The PSD features surface credibility (competent ‘look and feel’), dialogue support (online program + in-person support), liking and similarity (aesthetics and content appeal to adolescent users), the reduction and tunneling of therapeutic content (reducing online content into simple tasks, guiding users), and use of self-monitoring were present in therapies that resulted in improved therapy engagement, satisfaction and adherence, as well as symptom and functional impairments. Conclusions: When incorporated into Internet-based CBT for adolescent depression, PSD features may improve adolescent adherence, satisfaction and depression-related outcomes. Testing of these features using hypothesis-driven, dismantling approaches is recommended to advance our understanding of how these features contribute to therapy effectiveness.

  • Evaluation on physician-patient interactions in online medical consultations in China and the influencing factors on the interactions

    From: Journal of Medical Internet Research

    Date Submitted: Feb 24, 2017

    Open Peer Review Period: Feb 26, 2017 - Apr 23, 2017

    Background: In China, there are more than 100 million people that consult physicians on websites every year. But patients gained little from these superficial interactions that can easily cause a misu...

    Background: In China, there are more than 100 million people that consult physicians on websites every year. But patients gained little from these superficial interactions that can easily cause a misunderstanding. So the interaction degree can be viewed as an index to measure the influence of online medical consultations on the patients. Works about the investigations and evaluations on these interactions in China have not been carried out. Objective: Investigated and evaluated the interaction degree about the online medical consultations, analyzed the influences of the replies and the job title of the physicians on the interactions, and finally gave some advice on improving the interactions. Methods: (1) The Alexa top 5 medical websites in China were selected. A crawler was developed and with it the hierarchical data on the websites were obtained. 8,911,327 times consultations have been obtained by the end of December 2016. (2) according to the data patients asked and physicians replied several measures such as the words count of interactions and times of interactions were defined. With these indexes the influences on interactions were measured. (3) analyzed how the physicians’ replies influenced the interactions and how the job titles of the physicians influenced the interactions. Results: (1) in the studied medical websites, the average words count that patients asked is 74, the average words count that physicians replied is 107, the average times of patient-physician interactions is 1.19. (2) compared to the average times of interaction, (a) if physicians’ replies contained any questioning, such as “are there any other symptoms”, the interaction times increased by 60%; (b) if there were drugs and examinations in the replies of physicians, the patients made a detail inquiry that made interaction times increased by 31%; (c) if physicians’ replies contained caring for patients, such as “pay attention to rest”, the interaction times increased by 43%. (3) amount of chief physicians that take part in consultations is 8%, and 9% for deputy chief physicians, 17% for attending physicians, 65% for the physicians with other titles. (4) the average consultation times of attending physicians were 300, whereas those of chief physicians, deputy chief physicians, and other physicians were from 171-198. Conclusions: Statistical results showed that: (1) physician-patient interactions helped patients little, and could not satisfy them. (2) the medical consultation websites can increase physician-patient interactions with the following methods: (a) encourage physicians to ask patients’ illness in replies; (b) encourage the physicians to give a reference to drugs and examinations; (c) encourage physicians to show caring for patients; (d) attract physicians who have higher professional tiles to take part in consultations.

  • Long-term Weight Loss by mobile app: current status and future perspectives

    From: JMIR mHealth and uHealth

    Date Submitted: Feb 24, 2017

    Open Peer Review Period: Feb 26, 2017 - Apr 23, 2017

    Background: Weight loss interventions can be delivered through various mediums including, increasingly, mobile phones. The number of downloadable health-related apps for smartphones may already be of...

    Background: Weight loss interventions can be delivered through various mediums including, increasingly, mobile phones. The number of downloadable health-related apps for smartphones may already be of an order of hundred thousands. Objective: This review assesses the efficacy of mHealth weight loss interventions as well as the future perspectives of these new mobile technologies. Methods: text-mining qualitative studies on mHealth weight loss/management. Results: Interestingly, out of the huge number of downloadable apps, effective mHealth long-term weight loss interventions using scientifically-driven approaches was only associated with the app “One Click to Health”. Many areas of improvement are identified setting up the bases for further experimental studies and future mHealth developments. Conclusions: This review highlight the urge of implementing collaborative efforts for the future development and testing of high-quality scientifically-driven mobile apps applied to mHealth weight management interventions before they are distributed into commercial markets.

  • PubMed vs Google Scholar in Medicine: Future of Public Database

    From: JMIR Medical Education

    Date Submitted: Feb 26, 2017

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

    In the digital age, search strategy plays a vital role for academic purposes such thesis, scholarly article, scientific writing and presentation. To date, physicians and scientists have experienced wi...

    In the digital age, search strategy plays a vital role for academic purposes such thesis, scholarly article, scientific writing and presentation. To date, physicians and scientists have experienced with many search engines such PubMed, Google Scholar, Embase, Quertle, SciGlobe, Microsoft Academic or etc... Indeed, 2 search engines (PubMed and Google Scholar) are commonly being used for physicians. However, very few physicians can outline the advantage and disadvantage among those search engines. Therefore, the author reviewed the difference between PubMed and Google Scholar.

  • The use of technology in identifying hospital malnutrition: a scoping review

    From: JMIR Medical Informatics

    Date Submitted: Feb 27, 2017

    Open Peer Review Period: Feb 27, 2017 - Apr 24, 2017

    Background: A literature review assessed the effectiveness of the current method of malnutrition monitoring and assessment in the hospital setting. A recurring theme that was uncovered was that malnut...

    Background: A literature review assessed the effectiveness of the current method of malnutrition monitoring and assessment in the hospital setting. A recurring theme that was uncovered was that malnutrition in the acute hospital setting was largely an unrecognized problem, owing to insufficient monitoring, identification, and initial assessments of identifying both patients who are already malnourished and those who are at-risk of malnourishment [1, 2, 3, 4]. Studies went on to examine the effectiveness of healthcare workers (nurses and doctors) with a knowledge base focused on clinical care and their ability to accurately and consistently identify malnourished geriatric patients within that setting. Results showed that the current methods were suboptimal in recognizing and monitoring malnourished patients and those at-risk of malnutrition [1, 5]. Objective: To conduct a scoping review on the different forms of technology used in addressing hospital malnutrition for adults. Methods: A search strategy was designed and implemented in three databases (PubMed, Scopus, and CINAHL) which uncovered 19 research articles meeting criteria for review. A descriptive numerical summary and study characteristic analyses were completed. One reviewer independently extracted data from the databases. Results: A total of n=19 articles were retrieved and reviewed. Articles were categorized by the computerised tool/application type, which includes malnutrition assessment (n=14), food-intake monitoring (n=4), or both (n=1). Within those categories, different technologies were subcategorized as either hardware (n=4), software (n=12) or both (n=3). An additional subcategory included within software was cloud-based applications (n=1). Conclusions: The use of technology in monitoring food-intake and for malnutrition assessment are largely being considered to aid in identifying, diagnosing, and assessing hospital malnutrition. Many computerised tools and applications are being developed worldwide in order to address the problem of hospital malnutrition. A majority of articles report effectiveness in accurately increasing malnutrition detection/awareness. Computerised tool/applications may also help reduce the workload and time-spent assessing patients for malnutrition by healthcare workers. Hospitals may also benefit from implementing malnutrition technology through observing decreased LOS along with decreased foregone costs related to missing malnutrition diagnoses. It is beneficial to study the impact of these technologies in order to examine possible areas of improvement. A future systematic review would further contribute to the evidence and effectiveness on the use of technologies in assessing and monitoring hospital malnutrition.

  • Convergent validity of ecological momentary assessment of physical activity

    From: Journal of Medical Internet Research

    Date Submitted: Mar 1, 2017

    Open Peer Review Period: Mar 1, 2017 - Apr 26, 2017

    Background: Ecological momentary assessment (EMA) may elicit PA estimates that are less prone to bias than traditional self-report measures, while providing context. Objective: To examine the converge...

    Background: Ecological momentary assessment (EMA) may elicit PA estimates that are less prone to bias than traditional self-report measures, while providing context. Objective: To examine the convergent validity of EMA-assessed PA compared to accelerometry. Methods: Participants self-reported their PA (International Physical Activity Questionnaire [IPAQ] and Behavioral Risk Factor Surveillance System [BRFSS]), and wore an accelerometer while completing daily EMAs for 7 days. Weekly summary estimates included: sedentary time, moderate-, vigorous-, and moderate-to vigorous-intensity physical activity (MVPA). Spearman’s coefficients and Lin’s concordance correlation coefficients (LCC) examined the linear association and agreement for EMA and the questionnaires compared to accelerometry. Results: Participants were aged 43.3 (±13.1) years, more than half were African American (51.7%), 74.8% were overweight/obese, and 52.4% were low income. The linear associations of EMA and traditional self-reports with accelerometer estimates were statistically significant (p<0.05) for sedentary time (EMA: ρ=0.16), moderate intensity PA (EMA: ρ=0.29; BRFSS: ρ=0.17; IPAQ: ρ=0.24) and MVPA (EMA: ρ=0.31; BRFSS: ρ=0.17; IPAQ: ρ=0.20). Only EMA estimates were statistically significant compared to accelerometer for agreement. Conclusions: EMA showed better correlation and agreement to accelerometer estimates than traditional self-report methods. These findings suggest that EMA may be a practical alternative to accelerometers to assess PA in free-living settings.

  • The usefulness of mobile health technology to improve the health behaviors of Elderly person - a systematic review

    From: JMIR mHealth and uHealth

    Date Submitted: Mar 2, 2017

    Open Peer Review Period: Mar 3, 2017 - Apr 28, 2017

    Background: Demographic change 21st century, increasing number of elderly and diseade outbreaks that associated with this period, make new strategies for health care , change in behavior, and educatio...

    Background: Demographic change 21st century, increasing number of elderly and diseade outbreaks that associated with this period, make new strategies for health care , change in behavior, and education needs of older people. Despite the traditional training methods, innovative information and communications technology including mobile health also plays important role in maintenance and adherence to treatment of elderly patients at home and other environments. Objective: this study aimed to evaluate the usefulness of mobile health technology to improve health behaviors of elderly persons. Methods: This study was a systematic review of the Pubmed , Web of science , Science Direct , Embase database ,In order to benefit from new finding from 5 years to now, the years 2012 – 2016 were searched. We selected 436 sites from all articles.Most of search criteria focuses on interventional studies that between of the all studies, we choose 14 article as an appropriate article. Another studies because of methods , non-elderly age group and… was eliminated. Results: This finding are classifies in three subgroup; Mental health behaviors (3) , Physical activity and dietary behavior, increase eating consumption of fruit and vegetables behavior, behavior of blood pressure and blood sugar monitoring(6) , and Management of chronic diseases as diabetes and heart disease(6). In this studies mobile health technology has been used for change sleep behavior, self monitoring activities and self-efficancy of quality of life and depression in survival of older cancer patient , physical activity and development this activity in adults with cognitive disorders, Alzheimer, diabetic foot care, adherence to medication and treatment, improving eldery with cardiometabolic diseases and hypertension and acute coronary health syndrome. Conclusions: The use of mobile health technology is useful for disease prevention and adherence of treatment and change lifestyle and increased efficacy and improve health behavior in elderly population. It seems that M health technology facilitating behavior change but further research is needed in this area.

  • Using Relational Agents to Promote Exercise and Sun Protection: An assessment of Participants’ Experiences with two Interventions

    From: Journal of Medical Internet Research

    Date Submitted: Mar 6, 2017

    Open Peer Review Period: Mar 6, 2017 - May 1, 2017

    Background: Relational Agents (RAs) are electronic, computational figures designed to engage participants in the change process. A recent study tested the effectiveness of RAs, combined with existing...

    Background: Relational Agents (RAs) are electronic, computational figures designed to engage participants in the change process. A recent study tested the effectiveness of RAs, combined with existing computer-based interventions, to increase regular exercise and sun protection behaviors. Results showed these interventions can be effective but need further development Objective: This purpose of this study is to examine participants’ experiences using RA, using mixed methods approaches. Methods: A 25-question interview guide assessed different components of participants’ experiences with the intervention, including motivation, engagement, satisfaction/ dissatisfaction, quality of their interaction with the RA, and behavior change. Quantitative assessment of satisfaction was based a scale of 1 to 10, with 1 representing least satisfied and 10 representing most satisfied. A summative analytic approach was used to assess individuals’ qualitative responses. An analysis of variance (ANOVA) examined levels of satisfaction by gender. Results: Of the original 1354 participants enrolled in Project RAISE, 490 of 1354 (36.1%) were assigned to the RA group. 216 of 490 (44.0%) participants assigned to the RA group completed both 12-and 24-month follow-ups and were contact to participate in the semi-structured interview. 34 of 216 (15.7%) completed the semi-structured interview. Participants were motivated by and satisfied with the intervention, viewed the RA as supportive, informative, and caring, and reported positive behavior change in both exercise and sun protection. Some participants (15 of 34; 44%) noted the RA was less judgmental and less “overbearing” compared to a human counselor, other participants (12 of 34; 35%) said that the interaction was sometimes repetitive or overly general. The majority of participants (22 of 34; 65%) viewed the RA as an important contributor to their behavior change for exercise, sun protection, or both. Levels of satisfaction ranged between 7 and 10 and gender differences were not noted when analyzed (P=.51) Conclusions: : RAs provide an innovative and attractive platform to increase exercise and sun protection behaviors and potentially other health behaviors.

  • An exploratory study of consumers’ health-related activities on social media

    From: Journal of Medical Internet Research

    Date Submitted: Mar 7, 2017

    Open Peer Review Period: Mar 8, 2017 - May 3, 2017

    Background: Although a number of studies have investigated how consumers use social media (SM) for health-related purposes, there is a paucity of studies in the Australian context. Objective: This stu...

    Background: Although a number of studies have investigated how consumers use social media (SM) for health-related purposes, there is a paucity of studies in the Australian context. Objective: This study, therefore, aimed to explore how Australian consumers used SM for health-related purposes, specifically how they identified SM platforms, which were used, and which health-related activities commonly took place. Methods: Five focus groups (n=36 participants), each lasting 60 to 90 minutes were conducted in the Sydney metropolitan area. The group discussions were audio-recorded and transcribed verbatim. The transcripts were coded line by line and thematically analysed. Results: Participants used general search engines to locate health-related SM platforms. They accessed a wide range of SM on a daily basis, using several electronic devices, in particular, mobile phones. Although privacy was a concern, it did not prevent consumers from fully engaging in SM for health-related purposes. Blogs were used to learn from other people’s experiences with the same condition. Facebook allowed consumers to follow health-related pages and to participate in disease-specific groups discussions. Wikipedia was used for factual information about diseases and treatments. YouTube was accessed to learn about medical procedures, such as surgery. No participant reported editing or contributing to Wikipedia, or posting YouTube videos related to health topics. Twitter was rarely used for health-related purposes. SM allowed consumers to obtain and provide disease and treatment-related information, and social and emotional support for those living with the same condition. Most considered their participation as observational, but some also contributed (e.g. responded to people’s questions). Conclusions: Participants used a wide range of SM for health-related purposes. Medical information exchange (e.g. disease and treatment) and social and emotional support were the cornerstones of their online activities. SM appears to be used as a key tool to support disease self-management.

  • The user acceptance of computerised cognitive behaviour therapy for depression – a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Mar 10, 2017

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

    Background: Computerised cognitive behaviour therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning t...

    Background: Computerised cognitive behaviour therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning the take-up and success of any treatment is its user acceptance. Objective: This paper aims to update and to expand on earlier work on user acceptance of cCBT for depression. Methods: This article systematically reviews quantitative and qualitative studies regarding the user acceptance of cCBT for depression. The initial search was conducted in January 2016 and involved the following databases: Web of Science, PubMed, the Cochrane Library and PsychInfo. Results: A total of 1.736 studies were identified, of which 29 studies were eligible for review. User acceptance was operationalised and analysed very heterogeneously. Eight studies reported a very high level of acceptance, 17 studies indicated a high level of acceptance and one study showed a moderate level of acceptance. Two qualitative studies considered the positive and negatives aspects concerning the user acceptance of cCBT. However, a substantial proportion of reviewed studies revealed several methodical shortcomings. Conclusions: In general, people experience cCBT for depression as predominantly positive which supports the potential role of these innovative treatments. However, methodological challenges do exist in terms of defining user acceptance, clear operationalisation of concepts and measurement.

  • Knowledge, Attitudes, Practices Regarding Zika:Results of a Paper- and Internet-Based Survey in Zhejiang, China

    From: Journal of Medical Internet Research

    Date Submitted: Mar 13, 2017

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

    Background: As public access to internet increase, many health workers prefer to carry out health education online, traditional way of health education in community was kind of ignored. From March 201...

    Background: As public access to internet increase, many health workers prefer to carry out health education online, traditional way of health education in community was kind of ignored. From March 2016, 4 Zika cases were confirmed in Zhejiang, China. Rapid assessment of people’s knowledge, attitudes and practices (KAP) regarding Zika is crucial to the prevention and control of it. Online survey to assess public KAP maybe a trend in the future. However, we have done little. Objective: This study aimed to explore people’s KAP regarding Zika in Zhejiang using both traditional and innovative internet-based investigation, and to compare the resources involved and the results of the two different methods. Methods: An anonymous questionnaire was designed by Zhejiang Provincial Center for Disease Control and Prevention. Paper-based survey in community and internet-based survey through Wechat, a smartphone application, were executed. Results: Eighty-three (892/1068) participants knew transmission route of Zika, 76.0% (813/1068) knew pregnant women are high-risk group for severe complications, 66.4%(709/1068) knew Zika virus infection during pregnancy may lead to newborn babies with microcephaly, 66.4%(709/1068) knew places where mosquitos usually haunted. Participants of online survey had a much higher level knowledge of Zika than participants from community. The proportion of participants that were worried of contracting Zika were much higher in internet-based survey (47.0%, 502/1068) than in paper-based survey (35.1%, 157/447) (=43.6, P<.0001). Over 95% participants from both internet and community took practices to preventive mosquito bites. Participants of online survey (93.6%, 581/624) intend to seek health information on Zika more willingly than paper-based survey (72.3%, 323/447) (=2.8, P=0.092). Online survey had higher proportion of younger (=144.7, P<.0001) and well-educated participants (=423.5, P<.0001) than paper-based survey. We spent over twice time (2 weeks vs. 1week) and money (45RMB VS. 20RMB on one questionnaire) in paper-based survey than in online survey. Conclusions: Participants of Internet-based survey had a higher level of basic knowledge, more positive attitudes and behaviors than paper-based survey in community. While providing online health information, the government should also ensure access to health information for older and less educated people in community to achieve greater health equity. Internet-based survey involves considerably fewer resources, including money, time, and human resources. Thus, in the outbreak of emerging infectious disease, online survey could be used for emergency assessment for health education needs.

  • Implementation of the blended care self-management program ‘Partner in Balance’ for caregivers of people with early-stage dementia: process evaluation of a randomized controlled trial

    From: Journal of Medical Internet Research

    Date Submitted: Mar 9, 2017

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

    Background: The blended care self-management program ‘Partner in Balance’ (PiB) for family caregivers was executed in Dutch dementia care organizations. The program combines face-to-face coaching...

    Background: The blended care self-management program ‘Partner in Balance’ (PiB) for family caregivers was executed in Dutch dementia care organizations. The program combines face-to-face coaching with tailored online modules. Next to an evaluation of program effectiveness, an evaluation of sampling and intervention quality is essential for the generalizability of results. Objective: A process evaluation of Partner in Balance (PiB) was performed from the perspective of both family caregivers (participants) and professionals delivering the intervention (coaches) to explore its credibility and generalizability. Methods: Implementation, sampling, and intervention quality were evaluated with quantitative and qualitative data from (1) logistical research data, (2) coach questionnaires (N=13), and (3) interviews with coaches (N=10) and participants (N=49). Goal attainment scaling was used to measure treatment-induced change. Analyses were performed with descriptive statistics and deductive content analysis. Results: Caregivers were recruited by clinicians (N=122); the Dutch Alzheimer Association (N=26); family members (N=4), or magazines and newspapers (N=11). The participation rate of eligible caregivers was (80/154) 52%. Recruitment barriers were no computer and no need for support. Recruitment facilitators were young age and being employed. Coaches (N=13) had a professional background as psychologist (N=7) or psychiatric nurse (N=6). All coaches received training and supervision in blended care self-management. They followed a structured protocol, but reported deviations on intervention time, structure and feedback. Coaches reported an intensified relationship with the caregiver post-intervention. Caregivers appreciated the tailored content and positive feedback and the blended structure increased their openness. The discussion forum was appreciated less. Implementation barriers included lack of financing, time and deviating target population. Overall, personal goals were attained after the program (T>50). Conclusions: Caregivers and coaches were satisfied with the intervention, but the content needs adaptation to fit the needs of younger caregivers. Awareness of benefits of blended care self-management and training is required for sufficient program implementation. Clinical Trial: Dutch Trial Register (NTR): NTR4217

  • Mobile health technologies for palliative care patients at the interface of in-patient to outpatient care: A feasibility study aiming to early predict deterioration of patient’s health status

    From: JMIR Research Protocols

    Date Submitted: Mar 10, 2017

    Open Peer Review Period: Mar 20, 2017 - Apr 3, 2017

    Background: Palliative care patients are a particularly vulnerable population and one of the critical phases in patients’ trajectories is discharge from specialized in-patient palliative care into o...

    Background: Palliative care patients are a particularly vulnerable population and one of the critical phases in patients’ trajectories is discharge from specialized in-patient palliative care into outpatient care, where availability of a palliative care infrastructure is highly variable. A relevant number of potentially avoidable re-admissions and emergency visits of palliative patients is observed due to rapid exacerbation of symptoms indicating the need for a closer patient monitoring. In the last years, different mobile health technology applications have been evaluated in many different patient groups. Objective: The aim of our study is to test feasibility of a remote physical and social tracking system in palliative care patients. Methods: Feasibility study with explorative, descriptive study design, comprising three work packages. Thirty patients will be recruited on the wards of the Clinic of Radiation-Oncology at the University Hospital Zurich, including the specialized palliative care ward and will receive a smartphone and a tracking bracelet before discharge. Aim of work package A is to evaluate if severely ill patients accept to be equipped with a tracking bracelet and a smartphone (by semiquantitative questionnaires and guideline interviews). Work package B evaluates the technical feasibility and quality of the acquired electronic health data. Work package C will demonstrate whether physical activity parameters such as step count, sleep duration, social activity patterns like making calls, and vital signs, e.g. heart rate, do correlate with subjective health data and can serve as indicator to early detect and predict changes in patients’ health status. Activity parameters will be extracted from the smartphone’s and wristband’s sensor data using signal processing methods. Subjective health data is captured via electronic version of VAS and Distress Thermometer as well as the EORTC – QLQ C30 in paper version. Results: Not applicable Conclusions: Our project will deliver relevant data on patients’ acceptance of activity and social tracking and test the correlation between subjective symptom assessment and objective activity in the vulnerable population of palliative care patients. The proposed study is meant to be preparatory work for an intervention study to test the effect of wireless monitoring of palliative care patients on symptom control and quality of life. Clinical Trial: NCT03038841

  • The assessment of quality of dental caries-related information in Brazilian websites

    From: Journal of Medical Internet Research

    Date Submitted: Mar 10, 2017

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

    Background: Health seekers can easily reach a vast range of contents in the Internet, such as dental caries knowledge. Dental caries is still considered the most common chronic oral disease, with an a...

    Background: Health seekers can easily reach a vast range of contents in the Internet, such as dental caries knowledge. Dental caries is still considered the most common chronic oral disease, with an average DMFT of 2.11, affecting 2.4 billion people worldwide. It impacts the patients socially and economically, threatening the quality of their lives. However, the comprehension of the multifactorial etiology of dental caries may be difficult for most people. It involves the interplay between the tooth surface, the dental biofilm, the availability of dietary fermentable carbohydrates, and genetic and behavioral factors. Therefore, a high-level of specialization is required to the production of materials addressed to the education and counseling of patients about this issue. In this sense, the publication of uncertain contents on the Internet might be connected with the low quality of dental caries-related information. Objective: The aim of this study was to assess the readability and the quality of dental caries-related information from Brazilian websites. Methods: Seventy-five websites were selected through Google, Bing, Yahoo!, and Baidu. The order that each website was ranked in these search machines was registered. Two independent examiners evaluated the quality of websites using the DISCERN questionnaire and JAMA benchmark criteria. The Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Férnandez-Huerta Readability Formula (FHRF) were employed to assess the readability of websites. The statistical analysis was performed with P<0.05 considered significant. Results: The digital contents were classified as of poor quality using both DISCERN (x̅=35.68, 19-64) and JAMA (x̅=1.12, 0-3) scores, being considered as high-difficulty reading materials by FRE scores and as simple and accessible by FHRF scores. A negative correlation was observed between the ranking and the quality scores (Spearman’s rank test). The quality of information of health and non-health websites was similar (Mann-Whitney U test); however, the websites with a greater variety of dental caries information were significantly better than those with limited contents (hierarchical clustering analysis by Ward’s minimum variance method, Kruskal Wallis and post-hoc Dunn’s test). Conclusions: Dental caries-related contents found in Brazilian websites were considered simple, accessible and of poor quality, without differences between health and non-health websites. These findings indicate the need of the development of policies for the production and publication of web health information, encouraging dentists to guide their patients in searching for recommended oral health websites.

  • Interactive Voice Response System: Data Considerations and Lessons Learned During a Rectal Microbicide Placebo Adherence Trial for Young Men Who Have Sex with Men

    From: Journal of Medical Internet Research

    Date Submitted: Mar 10, 2017

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

    Background: Rectal microbicides, if proven effective, may aid in reducing HIV incidence; however, demonstration of efficacy and effectiveness is contingent on accurate measurement of product adherence...

    Background: Rectal microbicides, if proven effective, may aid in reducing HIV incidence; however, demonstration of efficacy and effectiveness is contingent on accurate measurement of product adherence. Delays in self-report, in particular, may affect the accuracy of behavioral data. Objective: Capitalizing on mobile phone use by young men who have sex with men (YMSM), we examined the use of an interactive voice response system (IVRS) by YMSM aged 18-30 years enrolled in a multisite, 12-week microbicide safety and acceptability trial. Methods: Ninety-five YMSM enrolled across three sites (Boston, Pittsburgh, San Juan) were asked to report their use of an applicator applied placebo rectal gel product during receptive anal intercourse (RAI) using the IVRS. IVRS was available in Spanish and English. After the 12-week trial, we examined whether IVRS problems were associated with YMSM’s sociodemographic characteristics (e.g., age, race/ethnicity, education), sexual behavior, or recruitment site. We used a multinomial logistic regression to compare YMSM who experienced no IVRS problems (N=40) to those who reported one IVRS problem (N=25) or two or more IVRS problems (N=30). Results: We recorded 1,494 IVRS calls over 12-weeks. Over half of participants (N=55; 57.9%) experienced challenges using the IVRS during the 12-week trial. YMSM reporting greater RAI occasions during the trial were more likely to experience IVRS challenges. Greater educational attainment was associated with multiple IVRS challenges. Participants in the Puerto Rico site were most likely to report multiple IVRS problems. Conclusions: Although IVRS was a useful data collection technology in our trial, several challenges experienced by English and Spanish speaking YMSM diminish its overall acceptability. We discuss strategies to optimize future development of IVRS data quality protocols based on lessons learned. Clinical Trial: ClinicalTrials.gov Registration Number: NCT01283360 https://clinicaltrials.gov/ct2/show/NCT01283360

  • Leveraging Social Networking Sites for an Autoimmune Hepatitis Research Study: A preliminary experience

    From: Journal of Medical Internet Research

    Date Submitted: Mar 21, 2017

    Open Peer Review Period: Mar 24, 2017 - May 19, 2017

    Background: Conventional study approaches are often inadequate in rare disease investigation. Social-networking sites, such as Facebook, may provide a vehicle to circumvent common research limitations...

    Background: Conventional study approaches are often inadequate in rare disease investigation. Social-networking sites, such as Facebook, may provide a vehicle to circumvent common research limitations and pitfalls. We report our preliminary experience with social media-based methodology for subject recruitment and participation into an ongoing study of autoimmune hepatitis (AIH). Objective: To test the hypothesis that a social media-based methodology is effective for recruiting participants into AIH patient-oriented research. Methods: We established a Facebook community, the Autoimmune Hepatitis Research Network (AHRN), in 2014 in order to provide a secure and reputable distillation of current literature and AIH research opportunities. Quarterly advertisements for our ongoing observational AIH study were posted on the AHRN over 2 years. Interested and self-reported AIH participants were subsequently enrolled after review of study materials and completion of an informed consent by our study coordinator. Participants returned completed study materials, including epidemiologic questionnaires and genetic material, to our facility via mail. Outside medical records were obtained and reviewed by a study physician. Results: We successfully obtained all study materials from 29 participants with self-reported AIH within 2 years from 20 different states. Liver biopsy results were available for 26 participants (90%), of which 21 (81%) had findings consistent with AIH, 4 (15%) were suggestive of AIH with features of primary biliary cholangitis (PBC), and one (4%) had PBC alone. Twenty-four of the participants (83%) had at least 2 of 3 proposed criteria: Positive autoimmune markers, consistent histologic findings of AIH on liver biopsy, and reported treatment with immunosuppressant medications. Self-reported and physician records were discrepant for immunosuppressant medications or for AIH/PBC diagnoses in 4 patients. Conclusions: Social networking sites can be effective ancillary tools for facilitating patient-oriented research in rare diseases. A social media-based approach transcends established limitations in rare disease research and can further develop research communities.

  • Study protocol for Power Up: A smartphone app to support young people to make shared decisions in therapy

    From: JMIR Research Protocols

    Date Submitted: Mar 14, 2017

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

    Background: Evidence suggests that young people want to be active participants in their care and involved in decisions about their treatment. However, there is a lack of digital shared decision-making...

    Background: Evidence suggests that young people want to be active participants in their care and involved in decisions about their treatment. However, there is a lack of digital shared decision-making tools available to support young people in Child and Adolescent Mental Health Services (CAMHS). Objective: The primary aim of this paper is to present the protocol of a feasibility trial of Power Up: a smartphone app to empower young people in CAMHS to make their voices heard and to participate in decisions around their care. Methods: In the development phase, 30 young people, parents and clinicians will take part in interviews and focus groups to elicit opinions on an early version of the app. In the feasibility testing phase, 120 young people from across seven London CAMHS services will take part in a trial, looking at the feasibility and acceptability of measuring the impact of Power Up on shared decision making. Results: Data collection for the development phase will take place between September 2016 and November 2016. Data collection for the feasibility testing phase will take place between January 2017 and August 2017. Conclusions: Findings will inform the planning of a cluster controlled trial and contribute to the development and implementation of a shared decision- making app to be integrated into CAMHS. Clinical Trial: The trial has been registered with the ISTCRN registry (ISRCTN77194423) and ClinicalTrials.gov (NCT02987608).

  • Is there a necessity for routine radiograph on the first day postoperatively following open reduction and internal fixation for distal radius- and ankle fractures: study protocol for a prospective, open label, randomized controlled trial

    From: JMIR Research Protocols

    Date Submitted: Mar 15, 2017

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

    Distal radius and ankle fractures are one of the most common operatively treated fractures. To date there is no consensus concerning the need of a standard postoperative radiograph. This leads to unde...

    Distal radius and ankle fractures are one of the most common operatively treated fractures. To date there is no consensus concerning the need of a standard postoperative radiograph. This leads to undesirable practice variation. A standardised radiograph in the department of radiology would theoretically be more reproducible and operator independent than an intra-operatively obtained fluoroscopic image. It is questionable however, if adequate intra-operative radiographs have been obtained, if these postoperative radiographs are necessarily and will lead to changes in the treatment strategy. If standard postoperative radiographs are no longer required, this would lead to a reduction in radiation exposure and health care costs. The hypothesis is that routine standardised postoperative radiographs do not influence the quality of care for patients operated for distal radius- and ankle fracture if adequate intra-operative standardised radiographs have been obtained. The primary aim of this study is therefore to evaluate if there is a need for routine postoperative radiographs after an osteosynthesis for distal radius and ankle fractures. In a prospective, randomized controlled, open label trial based on a non-inferiority design we will enroll 332 patients. Patients will be randomized either in the control- or the intervention group. The control group will be treated according to our current, standard protocol in which all patients receive a standard radiograph in two directions on the first postoperative day. Patients randomized to the intervention group will be treated without a standard postoperative radiograph. All (332) patients will have a routine clinical and radiographic control after 6 weeks in the outpatient clinic. Primary outcome is a change in treatment plan, defined as either additional imaging or a reoperation based on the postoperative imaging. Secondary outcome measure includes a SF-36, PRWE, FOAS, VAS and the range of motion. Those questionnaires will be filled out at the 6 weeks outpatient control. Our findings will be reported in peer-reviewed publications and may lead to a strong reduction in radiation exposure and health care costs. A preliminary, conservative estimation including employed patients suggest a yearly cost saving of 1.3 Million Swiss Franc in Switzerland. Human Research Ethics approval has been obtained from the „Ethikkomission Nordwest- und Zentralschweiz (EKNZ). The commission accepted this trial on the 4th of April 2016 (EKNZ BASEC 2016-00114).

  • Study protocol for a randomized control trial of an in-person vs eHealth mindfulness-based intervention for adolescents with chronic illness

    From: JMIR Research Protocols

    Date Submitted: Mar 24, 2017

    Open Peer Review Period: Mar 25, 2017 - Apr 8, 2017

    Background: Eight-week mindfulness meditation programs have been shown to have a positive impact on mental health and well-being in adolescents with chronic health conditions. Usually delivered in per...

    Background: Eight-week mindfulness meditation programs have been shown to have a positive impact on mental health and well-being in adolescents with chronic health conditions. Usually delivered in person in a group setting, these programs are difficult to access for teens with disabilities or who live in remote areas. Objective: To compare the impact of an adapted mindfulness-based intervention (MBI) delivered either in person or via eHealth on mindfulness skills acquisition in adolescents with a chronic health conditions. This study will also gather quantitative data on the effects of the MBI related to mood, anxiety, self-esteem, illness perception and stress (via salivary cortisol) as well as qualitative data on individual practice, participant appreciation and adaptation of the MBI for eHealth. Methods: This is a longitudinal, randomized non-inferiority study comparing two arms: in-person and eHealth. Participants are eligible to participate if they are 13-18 years old, have a diagnosis of chronic medical condition, live close enough to the recruitment hospital to participate in the in-person arm of the study and are currently followed by a healthcare provider. Each participant will receive an adapted eight-week MBI delivered either in person at a tertiary pediatric hospital or via a secure eHealth audio-visual platform allowing group interactions in real time. Groups will be facilitated by two experienced mindfulness providers. Quantitative and qualitative data will be collected through standardized research questionnaires administered via a secure, youth-friendly online platform, through semi-structured interviews, participant log books, facilitator log books and salivary cortisol analysis. Qualitative data will be analyzed using a grounded theory model. Results: Study recruitment is currently underway. The intervention and data collection will take place during the winter and spring of 2017. Conclusions: Based on previous results from in-person trials conducted in adolescents and eHealth trials conducted in adults, we anticipate that both modes of delivery will significantly improve mindfulness skills acquisition, mood, anxiety, self-esteem, illness perception and stress and that the magnitude of the effects will be correlated to the level of home practice. We predict that participants in both arms will show similar levels of home practice and that both modes of delivery will have high levels of feasibility and acceptability. If successful, this study could provide evidence for the use of eHealth in the delivery of eight-week MBIs in clinical adolescent populations, potentially increasing availability to MBIs for a large group of youth with mobility issues or living away from large urban centers. Clinical Trial: Trial registry: Clinicaltrials.org Trial number: NCT03067207 URL: https://clinicaltrials.gov/ct2/show/NCT03067207

  • Monitoring prevention impact of mother-to-child transmission of HIV in concentrated epidemics with programme and survey data

    From: JMIR Public Health and Surveillance

    Date Submitted: Mar 19, 2017

    Open Peer Review Period: Mar 20, 2017 - Apr 3, 2017

    Background: The prevention of HIV transmission from mother-to-child (PMTCT) program was introduced in Vietnam in 2005. Despite the scaling-up of PMTCT programs, the rate of mother-to-child HIV transmi...

    Background: The prevention of HIV transmission from mother-to-child (PMTCT) program was introduced in Vietnam in 2005. Despite the scaling-up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013. Objective: This study used survey and program data to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission, and infant survival in a high HIV burden province in Vietnam. Methods: This community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyse data using STATA. Results: A total of 172 HIV positive pregnant women were identified between 2008 and 2012. Most of these women acquired HIV from their husband (64.7%). Significant improvement in the PMTCT program was documented including reducing late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) has improved by an increase rate from 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. Infant early diagnosis within two month of birth reached 66.7% in 2012 compared to 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (OR 14.7; 95%CI: 1.8 – 121.4; P=0.01) while ARVs for mother and infant in combination with infant formula feeding was associated with reduced risk for HIV transmission (OR 0.01 (95%CI: 0.001 – 0.1; P<0.001). Overall survival rate for HIV exposed infants at 12 months was 97.7%. Conclusions: A combination of programme and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission such as late diagnosis remain to be addressed.

  • Evaluation of a mobile phone app to support patient self-management of diabetes and hypertension in a FQHC

    From: JMIR Human Factors

    Date Submitted: Mar 16, 2017

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

    Background: Thousands of mobile phone (mHealth) applications (apps) have been developed to support patient’s self-management of health conditions. Despite reporting improved outcomes, many studies...

    Background: Thousands of mobile phone (mHealth) applications (apps) have been developed to support patient’s self-management of health conditions. Despite reporting improved outcomes, many studies of mHealth apps are not adequately powered, have poor rates of retention, or have a high risk of bias in randomizing participants. mHealth technologies appear to hold promise for improving the self-management of chronic conditions across populations. Objective: The aim of this study was to evaluate the usability and clinical effectiveness of a commercial mHealth app used in the context of routine primary care practice in improving clinical outcomes for patients aged 18+ in a Federally Qualified Health Center (FQHC) with a uncontrolled diabetes and/or hypertension who had seen their provider within the past 6 months and/or were scheduled for an upcoming appointment. Methods: We used a quasi-experimental research design using a convenience sample recruited in person and by telephone in which the intervention group enrolled in the app and the comparison group did not. An a priori power analysis indicated we needed at least 64 patients per study group in order to have an effect size (Cohen’s d) of 0.5, desired statistical power level of .8. Clinical staff communicated with enrolled patients through the app as patients worked toward set goals. Results: Despite vigorous recruitment efforts, the trial was suspended due to low enrollment, and inconsistent participation by enrolled patients. To evaluate usability, we interviewed staff and enrolled patients using a published framework that addresses usability in user, task, and interface dimensions for the development of e-Health. Both groups noted that the app was “one more thing” to attend to, and that the app was not integrated with patients’ electronic health record. Conclusions: This brief trial underscores pitfalls in the utilization of mHealth apps for patients in FQHCs. Effective use of mHealth tools requires a good fit between the app, the treatment approach, and user characteristics, such as technological aptitude and motivation for change. Unlike similar trials, our treatment approach was routine primary care, and did not include clinical staff with dedicated time to work specifically with the patients using the app, an unreimbursed activity, but one that might meet with better results. Clinical Trial: None

  • Effectivity of Awareness Months in Increasing Internet Search Activity for Top Malignancies Among Women

    From: JMIR Public Health and Surveillance

    Date Submitted: Mar 19, 2017

    Open Peer Review Period: Mar 20, 2017 - Apr 3, 2017

    Dear Editor, We read with great interest, the recent article by Ling et al. who hypothesized that following the launch of a campaign for a medical condition, information seeking behavior pertaining...

    Dear Editor, We read with great interest, the recent article by Ling et al. who hypothesized that following the launch of a campaign for a medical condition, information seeking behavior pertaining to the condition would increase as well1. They used data from Google Trends (Google Inc., CA) on 4 different diseases (including Colon Cancer) to conclude that the use of infoveillance shows promise as an alternative and inexpensive solution for disease surveillance and health care campaign evaluation. Cancer awareness has massively benefitted from rapid growth of internet and mass media and the evolution of social marketing strategies around the promotion of healthcare2,3. This has resulted in the development of cancer oriented societies, websites, public campaigns and specifically earmarked Cancer Awareness Months (CAMs) directed at changing public attitudes towards prevention, screening, treatment and informed decision making. However, despite the significant impact of cancer awareness on screening of preventable cancers4, the impact of CAMs on cancer-related internet search activity has not been well studied. Breast (BC), Lung (LC) and Colorectal Cancers (CRC) are the leading causes of cancer incidence and mortality among women 5 and have their respective CAMs during October, November and March respectively 6. Using Google Trends, a public web facility of Google Inc. based on Google Search, we compared the relative frequency of search of terms ‘Breast Cancer’,‘Lung Cancer’ and ‘Colon Cancer’ between 1st January 2004 and 31st January 2017 (n=158 months). The program assigns a reference value of 100 for the point of maximum popularity from among the search terms, and provides relative monthly scores for all terms, which we termed interest scores (IS). IS were then compared among cancers for the overall period (n=158 months) and specifically during their CAMs (n=13 months). Within each cancer, IS were then compared during the CAMs (n=13 months) as compared to the remaining months (n=145 months). Parametric and non-parametric analyses were carried out (wherever applicable) using ANOVA and Kruskal-Wallis tests respectively. A p-value of <0.05 was considered significant. We found that BC had higher IS (mean± S.D) than LC and CRC for the entire study period (38.83±14.46 vs14.71 ±4.56 and 11.98±2.13 respectively, p<0.0001*), including a peak IS of 100 in October, 2004. BC also had significantly higher IS during its CAM (October) than the CAMs for LC (November) and CRC (March); 69.92±11.75 vs 15.38±4.54 and 13.53±2.43 respectively, p<0.0001*. While BC (69.92±11.02 vs 36.04±11.02; p<0.0001*) and CRC (13.53±11.84 vs 11.85 ± 2.06; p=0.0036*) had higher IS during their CAMs as compared to other months, LC did not (15.38 ±4.53 vs 14.65±4.57; p=0.3019) (Table 1). We concluded that ongoing campaigns for BC awareness are very effective at driving internet search activity, not only at baseline (2.5-3 times) but even more so also during its CAM (4-5 times) as compared to the other two leading malignancies among women (CRC and LC). Despite having a higher mortality than CRC, the campaign for LC was unable to significantly impact internet search activity during its CAM. Reasons behind the success of the BC awareness campaign in driving internet search activity should be further explored and applied to those for other malignancies such as LC and CRC, which also continue to have high mortality.

  • An exploratory study of the use of new technologies in the prevention of suicide in Europe

    From: JMIR Mental Health

    Date Submitted: Mar 19, 2017

    Open Peer Review Period: Mar 20, 2017 - May 15, 2017

    Background: We analyse the use of new technologies in the prevention of suicide in eight different European countries. Objective: We want to assess the disposition of professionals to incorporate such...

    Background: We analyse the use of new technologies in the prevention of suicide in eight different European countries. Objective: We want to assess the disposition of professionals to incorporate such resources into the design of a suicide prevention program for the health area of Zamora (Spain). Methods: Methods: Using a specifically designed questionnaire, we collected the opinions of three different groups of stakeholders about the use, frequency of use, facilitators, contents, and format of new technologies for the prevention of suicide. Results: The utility of the new technologies is valued positively by the totality of the countries, although these resources are seldom or very seldom used in those countries. In all the countries, the factors that most contribute to facilitating the use of new technologies are accessibility and freedom of charge. About the new technologies format, the most widely preferred formats for use as a tool for the prevention of suicide are websites and e-mail. The availability of information about signs of alarm and risk factors would be the most relevant contents for the prevention of suicide through the use of new technologies, and the presence of a reference mental health professional is also considered to be a key aspect. The countries addressed differ in the evaluations given to the different formats, pointing to the need to take into account the cultural characteristics of the country. Conclusions: New technologies are a much appreciated resource, but one that is little used, in the prevention of suicide.

  • A smartphone app using psychological approaches for women with chronic pelvic pain (MEMPHIS): study protocol for a randomised feasibility trial

    From: JMIR Research Protocols

    Date Submitted: Mar 19, 2017

    Open Peer Review Period: Mar 20, 2017 - Apr 3, 2017

    Background: Chronic pelvic pain (CPP) is defined as intermittent or constant pelvic or lower abdominal pain occurring in a woman for at least 6 months. Up to a quarter of women are estimated to be aff...

    Background: Chronic pelvic pain (CPP) is defined as intermittent or constant pelvic or lower abdominal pain occurring in a woman for at least 6 months. Up to a quarter of women are estimated to be affected by CPP worldwide and it is responsible for one fifth of specialist gynaecological referrals in the UK. Psychological interventions are commonly utilized. As waiting times and funding capacity impede access to face-to-face consultations, supported self-management (SSM) has emerged as a viable alternative. Mindfulness meditation is a potentially valuable SSM tool, and in the era of mobile technology, this can be delivered to the individual user via a smartphone app. Objective: To assess the feasibility of conducting a trial of a mindfulness meditation intervention delivered by a mobile phone app for patients with CPP. Methods: MEMPHIS is a randomised feasibility trial taking place in two UK hospitals. Eligible participants are randomised in a 1:1:1 ratio to one of three treatment arms: (1) the intervention arm, consisting of a guided, spoken mindfulness meditation app; (2) an active control arm, consisting of a progressive muscle relaxation app; and (3) usual care (no app). Participants are followed up for 6 months. Key feasibility outcomes include time taken to recruit all patients for the study, adherence, and estimates to be used in the sample size calculation for a subsequent full-scale trial. On completion of the feasibility trial we will conduct focus groups to explore app usability and reasons for non-compliance. Results: The trial is currently in follow up phase. Conclusions: This feasibility trial will inform the design of a large multi-centred trial to assess the clinical effectiveness of mindfulness meditation delivered via a smartphone app for the treatment of CPP. Clinical Trial: Clinical trials.gov: NCT02721108 Biomed central ISRCTN10925965 DOI 10.1186/ISRCTN10925965

  • Reliability of women epilepsy related information from main web search engines in China:deceitful web search environment and illumination

    From: Journal of Medical Internet Research

    Date Submitted: Mar 20, 2017

    Open Peer Review Period: Mar 20, 2017 - May 15, 2017

    Background: All electronic health practices like app/software are involved in web search engine due to its convenience for receiving information. The success of electronic health has link with the suc...

    Background: All electronic health practices like app/software are involved in web search engine due to its convenience for receiving information. The success of electronic health has link with the success of web search engines in field of health. Yet information reliability from search engine results remains to be evaluated. A detail analysis can find out setbacks and bring inspiration. Objective: Find out reliability of women epilepsy related information from the searching results of main search engines in China. Methods: Six physicians conducted the search work every week. Search key words are one kind of AEDs (valproate acid/oxcarbazepine/levetiracetam/ lamotrigine) plus "huaiyun"/"renshen", both of which means pregnancy in Chinese. The search were conducted in different devices (computer/cellphone), different engines (Baidu/Sogou/360). Top ten results of every search result page were included. Two physicians classified every results into 9 categories according to their contents and also evaluated the reliability. Results: A total of 16411 searching results were included. 85.1% of web pages were with advertisement. 55% were categorized into question and answers according to their contents. Only 9% of the searching results are reliable, 50.7% are partly reliable, 40.3% unreliable. With the ranking of the searching results higher, advertisement up and the proportion of those unreliable increase. All contents from hospital websites are unreliable at all and all from academic publishing are reliable. Conclusions: Several first principles must be emphasized to further the use of web search engines in field of healthcare. First, identification of registered physicians and development of an efficient system to guide the patients to physicians guarantee the quality of information provided. Second, corresponding department should restrict the excessive advertisement sale trades in healthcare area by specific regulations to avoid negative impact on patients. Third, information from hospital websites should be carefully judged before embracing them wholeheartedly.

  • Beliefs, knowledge, implementation and integration of evidence-based practice among primary healthcare providers: protocol for a scoping review

    From: JMIR Research Protocols

    Date Submitted: Mar 21, 2017

    Open Peer Review Period: Mar 22, 2017 - Apr 5, 2017

    Background: The adoption of evidence-based practice (EBP) is promoted because it is widely recognised for improving the quality and safety of healthcare for patients as well reducing avoidable costs....

    Background: The adoption of evidence-based practice (EBP) is promoted because it is widely recognised for improving the quality and safety of healthcare for patients as well reducing avoidable costs. Providers of primary care face numerous challenges to ensuring effectiveness in their daily practice. Primary healthcare is defined as the entry level into a healthcare services system, providing a first point of contact for all new needs and problems, patient-focused (not disease-oriented) care over time, care for all but the most uncommon or unusual conditions, and coordination or integration of care, regardless of where or by whom that care is delivered. It is the primary means by which to approach the main goal of any healthcare services system: optimisation of health status. Objective: This review aims to scope publications examining beliefs, knowledge, implementation and integration of EBP among primary healthcare providers. Methods: We will conduct a systematic scoping review of published articles in the following electronic databases, from their start dates until 31 March 2017: in Medline via Pubmed (from 1946), Embase (from 1947), CINAHL (from 1937), the Cochrane Central Register of Controlled Trials (from 1992), PsycINFO (from 1806), Web of Science (from 1900), JBI database (from 1998), Dare (from 1996), Tripdatabase (from 1997) and relevant professional scientific journals (from their start dates). We will use the predefined search terms of “evidence-based practice” and “primary healthcare” combined with other terms, such as “beliefs”, “knowledge”, “implementation” and “integration”. We will also conduct a hand search of the bibliographies of all the relevant articles and a search for unpublished studies using Google Scholar, Proquest, Mednar and Worldcat. We will consider publications in English, French, Spanish and Portuguese. Results: The electronic database searches will be completed in April 2017. Retrieved articles are currently being screened, and the entire study is expected to be completed by November 2017. Conclusions: This systematic scoping review will provide a further understanding of the beliefs, knowledge, implementation and integration of EBP among primary healthcare providers. The findings will inform clinical practice and help to draw a global picture of the EBP research topics relevant to primary care providers.

  • “Usage of an exercise application in the care for people with osteoarthritis – a user-driven exploratory study”

    From: Journal of Medical Internet Research

    Date Submitted: Mar 22, 2017

    Open Peer Review Period: Mar 22, 2017 - May 17, 2017

    Background: Exercise has proven to reduce pain and increase quality of life in osteoarthritis (OA). However, one major challenge is the adherence to exercise once supervision ends. Objective: This st...

    Background: Exercise has proven to reduce pain and increase quality of life in osteoarthritis (OA). However, one major challenge is the adherence to exercise once supervision ends. Objective: This study aimed to identify mental and physical barriers, motivational and social aspects of training at home, and to test/further develop an exercise application Methods: The study was inspired from participatory design (PD), engaging users in the research process. Data was collected through focus group and workshops, and analysed by systematic text condensation. Results: Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training, had knowledge on exercise and pain, but found it hard to motivate themselves. They missed the observation, commenting and encouragement by the supervising physiotherapist, as well as their peers. Ways to optimize the training app was identified during the workshops as participants shared their experience. Conclusions: The conclusion of the study is that the long term continuation of exercising for patients with OA could be improved with the use of a technology tailored to user’s needs, including motivational and other behavioural factors.

  • The development of the ORALS (Open Recording Automated Logging System). Sharing annotated audio recordings of clinic visits with patients: A Study Protocol

    From: JMIR Research Protocols

    Date Submitted: Mar 24, 2017

    Open Peer Review Period: Mar 25, 2017 - Apr 8, 2017

    Background: Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and p...

    Background: Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. Objective: The aim of the current project is to develop and test an interoperable system to facilitate routine recording - the Open Recording Automated Logging System (ORALS) - with the aim of increasing patient and family engagement. ORALS will consist of 1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings. Tagging involves identifying elements of the clinic visit most important to patients (e.g. treatment plan) on the recording; and 2) a secure, easy to use web interface, enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. Methods: We will use a mixed methods approach to develop and formatively test ORALS in four iterative stages: a case study of pioneer clinics where recordings are currently offered to patients; ORALS design and user experience testing; ORALS software and user interface development; and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. The Dartmouth’s Informatics Collaboratory for design, development and dissemination (ic3d) team, patients, patient partners, caregivers and clinicians will assist in developing ORALS. Conclusions: Upon the completion of this project we will have developed a novel recording system (ORALS) that will be ready for large scale testing. Our long term goal is for ORALS to seamlessly fit into a clinic’s and patient’s daily routine, increasing levels of patient engagement and transparency of care.

  • 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.

  • Methods for a Prospective Study on the Natural History of Spina Bifida

    From: JMIR Research Protocols

    Date Submitted: Mar 22, 2017

    Open Peer Review Period: Mar 24, 2017 - Apr 7, 2017

    Background: Background: Spina bifida (SB) is monitored through birth defects surveillance across the United States and in most developed countries. Although much is known about the management of SB an...

    Background: Background: Spina bifida (SB) is monitored through birth defects surveillance across the United States and in most developed countries. Although much is known about the management of SB and its many comorbid conditions in affected individuals, there are few systematic, longitudinal studies on population-based cohorts of children or adults, and the natural history of SB across the life course of persons with this condition is not well documented. Earlier identification of comorbidities and secondary conditions could allow for earlier intervention that might enhance the developmental trajectory for children with SB. Objective: Objective: The purpose of this project was to explore methods piloted by the Centers for Disease Control and Prevention and to collect baseline information to investigate the development, health status, and condition progression in young children who were born with SB for a prospective study conducted in two states, Arizona and Utah. Methods: Methods: Parents of children with SB aged between 3 and 6 years were eligible to participate in the study, in English or Spanish. Data on medical history were collected from medical records; family functioning, child behaviors, self-care, mobility and functioning, and health and well-being from parent report; and neuropsychological data from testing of the child. Results: Results: In total, 152 individuals with SB were identified as eligible and their parents were contacted by site personnel for enrollment in the study. Of those, 45 (30%) declined to participate and 6 (4%) consented but did not follow through. Among 101 parents willing to participate, 81 (80%) completed the full protocol and 20 (20%) completed the partial protocol. Utah enrolled 73 (72%) participants, predominately non-Hispanic (82%) and male (64%). Arizona enrolled 28 of the 50 participants they had permission to contact (56%), predominately Hispanic (64%) and male (57%). Conclusions: Conclusions: We observed differences by site for recruitment due to differences in identification and ascertainment of eligible cases and the required IRB processes. Restriction in recruitment and the proportion of minorities likely impacted participation rates in Arizona more than Utah.

  • The Use of Mobile Applications and SMS Messaging as Physical and Mental Health Interventions: A Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: Mar 23, 2017

    Open Peer Review Period: Mar 23, 2017 - May 18, 2017

    Background: The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition that the modern world has ever seen. Due to the abundance of devices and...

    Background: The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition that the modern world has ever seen. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments, eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals, be more cost effective to practises and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving SMS messages which entail psychoeducation, medication reminders and links to useful informative web pages can also be advantageous to a patient’s mental and physical wellbeing. Available mHealth apps and SMS services and their ever improving quality, necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention and usability. Objective: The review aimed to study the efficacy of mobile applications and SMS messages as mHealth interventions for self-guided care. Methods: A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE & SAGE. The search spanned from January 2008-January 2017. The primary outcome measures consisted of; weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Between group and within group effect sizes (Cohen’s d) for the mHealth intervention method group were determined. Results: Twenty seven studies, inclusive of 4658 participants were reviewed. The papers included RCT’s (n=19), within groups studies (n=7) and one within group study with qualitative aspect. Studies shown significant reductions on of anxiety, stress and depression. Within group and between groups effect sizes ranged from 0.05-3.37 (immediately post-test), 0.05-3.25 (one month follow up), 0.08-3.08 (two month follow up), 0.00-3.10 (three month follow up) and 0.02-0.27 (six month follow up).Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. Conclusions: The review shows the promising and emerging efficacy of using mobile applications and SMS messaging as mHealth interventions.

  • Feasibility, Acceptability and Usability of an mHealth Framework to Improve Birth Outcomes: Study Protocol

    From: JMIR Research Protocols

    Date Submitted: Mar 22, 2017

    Open Peer Review Period: Mar 24, 2017 - Apr 7, 2017

    Background: The unprecedented coverage of mobile technology across the globe have led to an increase in the use of mobile health applications and related strategies to make health information availabl...

    Background: The unprecedented coverage of mobile technology across the globe have led to an increase in the use of mobile health applications and related strategies to make health information available at the point-of-care. These strategies have the potential to improve birth outcomes but are limited by the availability of internet services especially in resource-limited settings. Objective: Our primary objective is to determine the feasibility of developing an integrated mobile health platform that is able to collect data from community-based programs, embed collected data into a smart card and read the smart card using a cell phone based application without the need for internet access. Our secondary objective is to determine (i) the acceptability of the smart card among pregnant women and (ii) usability of the smart cards by pregnant women and health facilities. Methods: We will leverage existing technology to develop a platform that integrates a database, smart card technology, and a cell phone-based application to read the smart cards. We will recruit 300 pregnant women with one of the three conditions (HIV, hepatitis B virus infection and sickle cell trait or disease) and four health facilities in their community. We will use the Glasgow’s RE-AIM framework as a guide to assess the implementation, acceptability, and usability of the mHealth platform. Results: We have recruited four health facilities and 300 pregnant women with at least one of the eligible conditions. Over the course of 3 months, we will complete the development of the mobile health platform and each participant will be offered a smart card and staff in each health facility will receive training on the use of the mobile health platform. Conclusions: Findings from this study could offer a new approach to making health data from pregnant women available at point of delivery without the need for an internet connection. This would allow clinicians to implement evidence-based interventions in real time to improve health outcomes. Clinical Trial: ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE)

  • Exploring the potential of a wearable camera to examine the early obesogenic home environment

    From: Journal of Medical Internet Research

    Date Submitted: Mar 25, 2017

    Open Peer Review Period: Mar 25, 2017 - May 20, 2017

    Background: The ‘obesogenic’ home environment is usually examined via self-report, and objective measures are required. Objective: This study explored whether the wearable camera ‘SenseCam’ ca...

    Background: The ‘obesogenic’ home environment is usually examined via self-report, and objective measures are required. Objective: This study explored whether the wearable camera ‘SenseCam’ can be used to examine the early obesogenic home environment, and whether it is useful for validation of self-report measures. Methods: Fifteen primary caregivers of young children (mean age of child 4 years) completed the Home Environment Interview (HEI). Seven to 19 days after the HEI, participants wore the SenseCam at home for 4 days. A semi-structured interview assessed participants’ experience of wearing the SenseCam. Intraclass correlation coefficients (ICCs), percent agreement, and kappa statistics were used as validity estimates for 54 home environment features. Results: Wearing the SenseCam was generally acceptable to participants. The SenseCam captured all 54 HEI features, but with varying detail. Thirty-six features (67%) had satisfactory validity (ICC or kappa ≥ 0.40; percent agreement 80 where kappa could not be calculated). Validity was good or excellent (ICC or kappa ≥ 0.60) for fresh fruit and vegetable availability, fresh vegetable variety, the display of food/drink (except sweet snacks), family meals, child eating lunch/dinner while watching TV, garden/play equipment, the number of TVs/DVD players, and media equipment in the child’s bedroom. Validity was poor for tinned and frozen vegetable availability/variety, and sweet snack availability. Conclusions: The SenseCam has the potential to objectively examine and validate multiple aspects of the obesogenic home environment. Further research should aim to replicate the findings in a larger, representative sample.

  • Real-World Treatment Sequences and Outcomes among Patients with NSCLC the US: The RESOUNDS Study Protocol

    From: JMIR Research Protocols

    Date Submitted: Mar 24, 2017

    Open Peer Review Period: Mar 25, 2017 - Apr 8, 2017

    Background: Survival outcomes are related to treatment choices in a line of therapy and treatment sequences across all lines of therapy. Objective: This study is designed to evaluate treatment sequenc...

    Background: Survival outcomes are related to treatment choices in a line of therapy and treatment sequences across all lines of therapy. Objective: This study is designed to evaluate treatment sequences used for patients who receive at least two lines of therapy for non-small cell lung cancer (NSCLC) in the US, and to evaluate patient outcomes in terms of progression-free and overall survival related to treatment sequencing. Additional objectives include the evaluation of symptoms, comorbidities, health care resource utilization and costs. Methods: Eligible patients are those diagnosed with NSCLC who initiate second line therapy between November 2015 and December 2017, insured by Anthem, Inc. and are captured in the HealthCore database. All data are de-identified and then retrospectively reviewed in a longitudinal manner from the enrollment date until death, disenrollment from their health plan, or end of the study period. Data collected from each patient include cost and resource utilization from administrative claims, clinical data collected through a Clinical Cancer Quality Program, death dates from national mortality databases, supplemented with detailed clinical reports from patient medical records. Descriptive analyses will be reported; survival times will be estimated using Kaplan-Meier methods. Patients will be censored at loss to follow-up due to leaving the health plan or reaching the end of the study period. Results: - Conclusions: The RESOUNDS cohort study is a novel approach to build a comprehensive dataset that mimics a prospective observational study using linked patient-level data from four real-world data sources. This study will provide timely information as to the sequencing of treatments for patients with NSCLC.

  • Recommending education materials for diabetic questions using information retrieval approaches

    From: Journal of Medical Internet Research

    Date Submitted: Mar 24, 2017

    Open Peer Review Period: Mar 25, 2017 - May 20, 2017

    Background: Self-management is crucial to diabetes care and providing expert-vetted content for answering patients’ questions is crucial in facilitating patient self-management. Objective: To invest...

    Background: Self-management is crucial to diabetes care and providing expert-vetted content for answering patients’ questions is crucial in facilitating patient self-management. Objective: To investigate the use of information retrieval (IR) techniques in recommending patient education materials for diabetic questions of patients.   Methods: We compared two retrieval algorithms, one based on LDA topic modeling (TMB) and one based on semantic group (SGB), with the baseline retrieval models, vector space model (VSM) in recommending diabetic patient education materials to diabetic questions posted on the TuDiabetes forum. The evaluation was based on a gold standard data set consisting of 50 randomly selected diabetic questions where the relevancy of diabetic education materials to the questions was manually assigned by two experts. The performance was assessed using precision of top ranked documents. Results: We retrieved 7,510 diabetic questions on the forum and 144 diabetic patient educational materials from the patient education database at Mayo Clinic. Corpus analysis indicates language used by diabetic questions is different from patient education materials. TMB outperformed other retrieval algorithms. For example, for the top retrieved document, the precision of TMB, SGB, and VSM models is 67.0%, 62.8%, and 54.3% respectively. Conclusions: The study demonstrated that topic modeling can mitigate the vocabulary difference and that it achieved the best performance in recommending education materials for answering patients’ questions. One direction for future work is to assess the generalizability of our findings and to extend our study to other disease areas, other patient education material resources, and online forums.

  • Study protocol for a randomised waiting list control trial, with embedded process evaluation, to investigate the impact of health promotion information on the wellbeing of people living with and beyond cancer.

    From: JMIR Research Protocols

    Date Submitted: Mar 25, 2017

    Open Peer Review Period: Mar 29, 2017 - Apr 12, 2017

    Background: Evidence suggests physical activity can improve many of the common side-effects of cancer treatments, such as cancer related fatigue, psychological distress, and body composition, as well...

    Background: Evidence suggests physical activity can improve many of the common side-effects of cancer treatments, such as cancer related fatigue, psychological distress, and body composition, as well as improving physical function and quality of life. Increased levels of physical activity have been shown to have a positive relationship with improved survival from cancer, and reduced recurrence of cancer. Despite the benefits, only 23% of UK cancer patients are active to recommended levels. Cancer patients are interested in lifestyle behaviour change, and home-based interventions offer a promising means for changing physical activity behaviours. Objective: This study protocol outlines the aims, methodology, study design, timelines for completion, and a brief discussion, of a waiting list randomised control trial into the impact of printed health promotion information, supported by online tools, on the physical activity behaviour, quality of life and self-efficacy of cancer patients. Method: This is a two arm, waiting list control study, with embedded process evaluation to understand the mechanisms for any change reported. The primary aim of this study is to test the effectiveness of a specifically designed printed health promotion resource, supported with access to online experts, e-newsletters, digital apps, online case studies, an online exercise to music video, and an online forum, in increasing physical activity in cancer patients. Baseline measures include physical activity, including pre-diagnosis levels of physical activity, self-efficacy, and quality of life. A sample of 82 participants per arm will be recruited through the channels of Macmillan Cancer Support. Participants will be randomised to receive very brief physical activity information, and the UK guidelines for physical activity, or very brief physical activity information, and the printed health promotion resource, supported by the online tools. The intervention and control groups will be followed up at 12 weeks to identify any changes in physical activity, self-efficacy, and quality of life. Sub group analysis will be carried out on the pre-diagnosis levels of physical activity and baseline self-efficacy, as possible predictors of successful behaviour change. The control group will receive the health promotion resources and online tools at 12 weeks, and followed up again at 24 weeks to monitor any change. The intervention group will be followed up at 24 weeks to see if changes are maintained. Results: Recruitment to this trail starts in March 2017 for one month. The planned completion of this 24 week study is October 2017. Conclusion: This study will investigate the effectiveness of an evidenced based printed health promotion resource, supported by online tools, in bringing about a change in the physical activity behaviour of cancer patients. It will identify the mechanisms for change, and in whom this intervention is most effective, in the context of self-efficacy and pre-diagnosis levels of physical activity.

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