JMIR Preprints
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!).
Recent Articles:
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Nov 11, 2015
Latest Submissions Open for Peer-Review:
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Biomedical Semantic Indexing using search and graph database technologies
From: Journal of Medical Internet Research
Date Submitted: Jun 12, 2017
Open Peer Review Period: Jun 16, 2017 - Aug 11, 2017
Background: Biomedical Semantic Indexing is a very useful support tool for human curators in their efforts for indexing and cataloguing the biomedical literature. Objective: This paper describes a sys...
Background: Biomedical Semantic Indexing is a very useful support tool for human curators in their efforts for indexing and cataloguing the biomedical literature. Objective: This paper describes a system to automatically assign Medical Subject Headings (MeSH) to biomedical articles from Medline. Methods: Our approach relies on the assumption that similar documents should be classified by similar MeSH terms. While previous work has already exploited the document similarity by using a k-Nearest-Neighbours (kNN) algorithm, we calculate document similarity using a search engine. In addition, we implement one of the main guidelines used by human curators to annotate Medline articles. To do this, the MeSH thesaurus is represented as a graph database, which allow us to employ graph search algorithms in order to faster and easily capture hierarchical relationships such as the shortest path between two terms or their lowest common ancestor. Results: Our experiments show promising results with an F1 of 70% on the test dataset, overcoming the top participating systems in the BioASQ 2016 task 4a. Conclusions: To the best of our knowledge, this is the first work that uses an approach based on search and graph database technologies for the task of biomedical semantic indexing.
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Low- and No-Cost Strategies to Recruit Women to a Mobile Health Smoking Cessation Trial
From: JMIR mHealth and uHealth
Date Submitted: Jan 19, 2017
Open Peer Review Period: May 31, 2017 - Jul 14, 2017
Background: Successful recruitment and retention of adequate numbers of participants to mobile health (mHealth) studies remains a challenge. Given that researchers must decide how to invest limited re...
Background: Successful recruitment and retention of adequate numbers of participants to mobile health (mHealth) studies remains a challenge. Given that researchers must decide how to invest limited recruitment resources, it is important to identify the most effective recruitment strategies, defined as those that incur low costs relative to participant yield. Objective: The objective of this manuscript is to describe the development and implementation process for the recruitment phase of an mHealth intervention designed to increase smoking cessation among weight-concerned women smokers. These recruitment methods could be applicable across a range of mHealth studies. Methods: Study information was released to the media in multiple phases. First, local city and state media were contacted, followed by national women’s health media, and finally outlets in states with high smoking rates. Stories and mentions resulting from the press releases (earned media) were disseminated via existing department and new study-specific social media accounts. Strategic hashtags were used in Facebook and Twitter posts to connect with broader smoking cessation campaigns. Posts were also made to third-party Facebook smoking cessation communities and Internet classifieds sites. Results: Media coverage was documented across 75 publications and radio/television broadcasts, 35 of which were local, 39 national, and 1 international. Between March 30th and July 31st, 2015, 151 participants were successfully recruited to the study. Conclusions: Leveraging social media, and coordinating with university public affairs offices were effective and low-cost strategies to earn media coverage, and reach potential participants. Clinical Trial: Not Applicable
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Smart Diet Management: Collecting Dietary Intake for Chinese Foods Using RFID Technology
From: Journal of Medical Internet Research
Date Submitted: May 5, 2017
Open Peer Review Period: May 7, 2017 - Jul 2, 2017
Background: Dietary intake assessment is important for personal health management. However, it is challenging to record food consumption information in an efficient, accurate and sustainable manner, p...
Background: Dietary intake assessment is important for personal health management. However, it is challenging to record food consumption information in an efficient, accurate and sustainable manner, particularly for the Chinese food consumptions Objective: This study aims to develop an intelligent method for Chinese food consumption data collection and nutrient analysis. Methods: Radio Frequency Identification (RFID) technology was applied to collect group’s food records via intelligent plates embedded with RFID chips in place where people went to eat a meal. Chinese food name and quantity information were collected via the cooked dish recipes to exact the key ingredients and to estimate their weights. The Chinese foods were separated into three main types: staple food (e.g., rice, steamed buns), cooked dish (e.g., cooked tomato with eggs), and soup (e.g., egg drop soup). In addition, food ingredients, food quantity and cooking methods were obtained to calculate energy and nutrients (carbohydrate, fat, fiber and etc.) according to the Chinese recipe database and China Food Composition database. Results: We applied the system to collect Chinese dietary intake for a group of 1,0528 individuals in lunch during 25 weeks. A total of 489 Chinese dishes were identified. Based on a Chinese recipe database and China Food Composition database, the Chinese foods were transformed to food ingredients, food quantity, cooking method, as well as nutrient values. Given a Chinese dish (e.g., Garlic Puree Cooked Pork Leg), we compared its nutrient values calculated by our method with the chemical measurements. The mean absolute percentage deviation (MAPD) showed our method enable collecting dietary intake for Chinese foods. Conclusions: A smart dietary management system using RFID technology is useful and is capable to record Chinese food dietary information efficiently and effectively. It can be used for individuals and dietarians for setting up personalized nutrient plan in the future.
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Development and Validation of a Functional Behavioural Assessment Ontology to Support Behavioural Health Interventions
From: Journal of Medical Internet Research
Date Submitted: May 15, 2017
Open Peer Review Period: May 18, 2017 - Jul 13, 2017
Background: In the cognitive behavioural approach, Functional Behavioural Assessment is one of the most effective methods to identify the variables that determine a problem behaviour. In this context,...
Background: In the cognitive behavioural approach, Functional Behavioural Assessment is one of the most effective methods to identify the variables that determine a problem behaviour. In this context, the use of modern technologies can encourage the collection and sharing of behavioural patterns, effective intervention strategies, and statistical evidences about antecedents and consequences of clusters of problem behaviours, encouraging the designing of function-based interventions. Objective: The paper describes the development and validation process used to design a specific Functional Behavioural Assessment Ontology (FBA-Ontology). The FBA-Ontology is a semantic representation of the variables that intervene in a behavioral observation process, facilitating the systematic collection of behavioral data, the consequential planning of treatment strategies and, indirectly, the scientific improvement in this field of study. Methods: The ontology has been developed deducing concepts and relationships of the ontology from a golden standard and then performing a machine-based validation and a human-based assessment to validate the Functional Behavioural Assessment Ontology. These validation and verification processes were aimed to verify how much the ontology is conceptually well founded and semantically and syntactically correct. Results: The Pellet reasoner checked the logical consistency and the integrity of classes and properties defined in the ontology, not detecting any violation of constraints in the ontology definition. In order to assess whether the ontology definition is coherent with the knowledge domain or not, a human evaluation of the ontology were performed asking 84 people to fill in a questionnaire composed by 13 questions assessing concepts, relations between concepts, and concepts’ attributes. The response rate for the survey was 34.52%. The domain experts confirmed that the concepts, the attributes, and the relationships between concepts defined in the FBA-Ontology are valid and well represent the Functional Behavioural Assessment process. Conclusions: The new ontology developed could be a useful tool to design new evidence-based systems in the Behavioral Interventions practices, encouraging the link with other Linked Open Data datasets and repositories to provide users with new models of e-health focused on the management of problem behaviours. Therefore, new researches and efforts are needed to develop and implement innovative strategies to improve the poor reproducibility and translatability of basic research findings in the field of behavioural assessment.
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Online primary care computerised medical record and associated service access for patients with Type 2 Diabetes: a systematic review.
From: Journal of Medical Internet Research
Date Submitted: May 4, 2017
Open Peer Review Period: May 4, 2017 - Jun 29, 2017
Background: Online access to medical records has the potential to support patient-centred care,improve convenience for patients and patient satisfaction. Enabling patients’ greater access to their m...
Background: Online access to medical records has the potential to support patient-centred care,improve convenience for patients and patient satisfaction. Enabling patients’ greater access to their medical records and linked online services may not only empower self-management, but also facilitate the organisation and delivery of care. Objective: To assess use and impact of online access to computerised medical record (CMR) systems and associated services in primary care by patients with Type 2 diabetes (T2DM). Methods: Multiple international databases including Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched between 2004 and 2016). No limitation was placed on study design, though we applied detailed inclusion and exclusion criteria. Thematic analysis was used to synthesise the evidence. Results: 917 studies were identified and 28 were included in this review. Five themes were identified: (1) Disparities in uptake of online record access and online services use by different patient groups. They varied by age, gender, ethnicity, educational attainment, and number of comorbidities. (2) Improved health outcomes: largely of surrogate makers of quality, glycaemic control, BP and cholesterol. (3) Self-management support included improved patient self-care and shared management, satisfaction, convenience and a generally positive effect on clinician-patient relationship. (4) Accessibility, patients valued more convenient access to health care where it worked efficiently. (5) Service design issues which may impact on online access and service use. Conclusions: Patients who accessed them valued these systems; and the improved access they offered. Professionals were cautious about using such systems primarily due to concerns about a rise in workload, patient safety, and maintaining confidentiality. CMR online access appears to be safe, popular though it may increase disparities and there is a lack of rigorous research showing positive impact on health outcomes.
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User Participation and Engagement with the See Me Smoke-Free mHealth App: Results of a Prospective Feasibility Trial
From: JMIR mHealth and uHealth
Date Submitted: Apr 21, 2017
Open Peer Review Period: May 31, 2017 - Jul 14, 2017
Background: The See Me Smoke-Free (SMSF) mobile health (mHealth) application (app) was developed to help women quit smoking by targeting concerns about body weight, body image, and self-efficacy throu...
Background: The See Me Smoke-Free (SMSF) mobile health (mHealth) application (app) was developed to help women quit smoking by targeting concerns about body weight, body image, and self-efficacy through cognitive behavioral techniques and guided imagery audio files addressing smoking, diet, and physical activity. A feasibility trial found associations between SMSF usage and positive treatment outcomes. This paper reports a detailed exploration of program use among those who downloaded the app, and the relationship between program use and treatment outcomes. Objective: To determine whether: 1) participants were more likely to set quit dates, be current smokers, and report higher levels of smoking at baseline than non-participants; 2) participants opened the app and listened to audio files more frequently than non-participants; and 3) participants with more app usage had a higher likelihood of smoking abstinence at follow-up. Methods: The SMSF feasibility trial was a single arm, within-subjects, prospective cohort study with assessments at baseline, 30- and 90-days post-enrollment. The SMSF app was deployed on the Google Play store for download, and basic profile characteristics were obtained for all app installers. Additional variables were assessed for study participants. Participants were prompted to use the app daily during study participation. Crude differences in baseline characteristics between trial participants and non-participants were evaluated using t-tests (continuous variables) and Fisher’s exact tests (categorical variables). Exact Poisson tests were used to assess group-level differences in mean usage rates over the full study period, using aggregate Google Analytics data on participation and usage. Negative binomial regression models were used to estimate associations of app usage with participant baseline characteristics, after adjustment for putative confounders. Associations between app usage and smoking abstinence were assessed using separate logistic regression models for each outcome measure. Results: Participants (n=151) were more likely than non-participants (n=96) to report female gender (P < 0.02) and smoking in the 30 days prior to enrollment (P < 0.0001). Participants and non-participants opened the app and updated quit dates at the same average rate (Rate ratio (RR) 0.98; 95% CI: 0.92, 1.04; P = 0.43), but participants started audio files (RR 1.07; 95% CI: 1.00, 1.13; P < 0.04) and completed audio files (RR 1.11; 95% CI: 1.03, 1.18; P < 0.003) at significantly higher rates than non-participants. Higher app usage among participants was generally associated with increased smoking cessation, and most effect sizes suggested strong associations, though generally without statistical significance. Conclusions: The current study suggests potential efficacy of the SMSF app, as increased usage was generally associated with higher smoking abstinence. A planned randomized controlled trial will assess the SMSF app’s efficacy as an intervention tool to help women quit smoking. Clinical Trial: ClinicalTrials.gov NCT02972515
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Development of a pilot mHealth MNCH communication intervention in a mountainous area of Thai Nguyen province, Vietnam
From: Journal of Medical Internet Research
Date Submitted: May 1, 2017
Open Peer Review Period: May 2, 2017 - Jun 27, 2017
Background: The mMom project piloted and implemented a cost-effective mHealth solution to a problem of longstanding concern in Vietnam: how to improve the maternal, newborn and child health (MNCH) of...
Background: The mMom project piloted and implemented a cost-effective mHealth solution to a problem of longstanding concern in Vietnam: how to improve the maternal, newborn and child health (MNCH) of ethnic minority women (EMW) living in mountainous and remote areas. Available evidence shows that EMW have disproportionately high infant and maternal mortality rates due to poverty and remoteness from poor quality health centres, and ethnographic fieldwork determined that current MNCH approaches in Thai Nguyen province in northern Vietnam fall short of providing effective antenatal and postnatal care. Objective: The project’s objective was to determine whether the implementation of an integrated mHealth intervention would improve access to MNCH services for women in remote areas of Thai Nguyen. Methods: The intervention created partnerships with the provincial health department to build an mHealth platform which was integrated into the existing health management information system (HMIS). The system sends active Behaviour Change Communication (BCC) health information SMS messages to local women via their mobile phones, and sends messages to health workers with the aim of increasing client-provider interactions and increasing demand for quality natal care. Results: The mMom intervention was able to effectively engage partners at the commune, district and provincial levels to integrate a novel mHealth system into an existing HMIS, and effectively train local health workers on its application for MNCH in Thai Nguyen. Conclusions: The pilot project demonstrates the feasibility of implementing an mHealth intervention in a remote area to provide MNCH health information and promote health service utilization.
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Determinants of a poor sleep based on data from 15 000 users of connected devices
From: Journal of Medical Internet Research
Date Submitted: May 2, 2017
Open Peer Review Period: May 2, 2017 - Jun 27, 2017
Background: Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or the burden of some chronic conditions...
Background: Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or the burden of some chronic conditions. Knowing the profiles of individuals with poor sleep patterns is therefore a prerequisite. Wearable devices have recently opened new perspectives in health. Objective: To identify the determinants of poor sleep, based on a data from a large population of users of connected devices. Methods: We analyzed data from 15,839 individuals (13,658 males and 2,181 females) considered as “highly connected” customers having purchased and used several Withings connected devices. Total and deep sleep durations, as well as the deep/total ratio as a proxy of sleep quality were analyzed in association with available data on age, sex, weight, heart rate, steps, diastolic and systolic blood pressure. Results: With respect to the deep/total sleep duration ratio used as a proxy of sleep quality, we have observed that those at risk of having a poor ratio (≤ 0.40) were more frequently males (ORfemale vs male = 0.45 [0.38-0.54]), younger individuals (OR>60 y vs 18-30 y = 0.47 [0.35-0.63]), those with elevated heart rate (OR>78 bpm vs ≤ 61 bpm= 1.18 [1.04-1.34]) and high systolic blood pressure (OR>133 mmHg vs ≤ 116 mmHg = 1.22 [1.04-1.43]). An association with weight was observed for total sleep duration exclusively. Conclusions: Wearables can provide useful information to target individuals at risk of poor sleep. Future alert or smartphone notification systems, based on poor sleep determinants measured with wearables, could be tested in intervention studies to evaluate the benefits. Clinical Trial: NA
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ADHD: is there an app for that? A suitability assessment of apps for the parents of children and young people with ADHD
From: JMIR mHealth and uHealth
Date Submitted: Apr 28, 2017
Open Peer Review Period: Apr 30, 2017 - Jun 25, 2017
Background: Attention Deficit Hyperactivity Disorder (ADHD) is a highly co-morbid disorder that can impact hugely on the individual and their family. ADHD is managed via pharmacological and non-pharma...
Background: Attention Deficit Hyperactivity Disorder (ADHD) is a highly co-morbid disorder that can impact hugely on the individual and their family. ADHD is managed via pharmacological and non-pharmacological interventions. Parents also gain support from parent support groups, which may include chat rooms as well as face-to-face meetings. With the growth of technology use over recent years, parents have access to more resources that ever before. A number of mobile applications (apps) have been developed to help parents manage ADHD in their children and young people. Unfortunately many of these apps are not evidence based and little is known of their suitability for the parents or whether they are helpful in ADHD management. Objective: To explore: 1.parents’ views of the suitability of the top ten listed apps for parents of children and young people (YP) with ADHD. 2. The views of clinicians that work with them on the suitability and value of the apps. Methods: The top ten listed apps specifically targeted towards the parents of children and YP with ADHD were identified via the Google Play (n=5) and iTunes Store (n=5). Interviews were then undertaken with seven parents of children/YP with ADHD and six clinicians who specialise in working with this population to explore their opinions of the ten apps identified and what they believe the key components are for apps to be suitable and valuable for this population. Results: Results: Four themes emerged from clinician and parent interviews: • the importance of relating to the app, • apps that address ADHD related difficulties, • how the apps can affect family relationships, • apps as an educational tool. Two additional themes emerged from the clinician interviews alone; monitoring ADHD symptoms and that apps should be practical. Parents also identified an additional theme; the importance of the technology. Overall, the characteristics of the currently most popular apps did not appear to match well to the views of our sample. Conclusions: Findings suggest that these apps may not fully meet the complex needs of this parent population. Further research is required in order to explore the value of apps with this population and how they can be tailored to their very specific needs. Clinical Trial: N/A
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Connected activity trackers have high feasibility in patients with rheumatoid arthritis or axial spondyloarthritis to assess physical activity patterns : a 3-months prospective study of 157 patients.
From: Journal of Medical Internet Research
Date Submitted: May 2, 2017
Open Peer Review Period: May 2, 2017 - Jun 27, 2017
Background: Physical activity can be traked using connected devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The World Health Organization recommends at lea...
Background: Physical activity can be traked using connected devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The World Health Organization recommends at least 150 min/week of moderate to vigorous physical activity (MVPA). Objective: The objectives were to assess physical activity and its patterns in RA and axSpA patients using an activity tracker and to assess the feasibility of connected devices in this population. Methods: This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a connected activity tracker, recording the number of steps per minute. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (i.e. adherence), the percentage of wearing time, and by an acceptability questionnaire. Results: 157 patients (83 RA, 74 axSpA) were analyzed: their mean age was 46 (+/-12) years, and mean disease duration 11 (+/-9) years; 57 (36%) were males. RA and axSpA patients had similar physical activity levels; respectively, 16 (+/-11) and 15 (+/-12) min/day of MVPA. Only 43 (27%) patients reached the recommendations (mean MVPA of 106 (+/-77) min/week). Three trajectories were identified with constant activity: low (54% of patients), moderate (43%) and high (3%) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% confidence interval [1.11, 1.14]). The activity trackers were worn during a mean of 79(+/-17) days, corresponding to a mean of 88(+/-19)% of days over the 3 months. Overall, patients considered the use of the watch very acceptable. Conclusions: RA and axSpA patients performed insufficient physical activity without differences depending on disease. Activity trackers allow accurate longitudinal assessment of physical activity. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a connected activity tracker in patients with rheumatic diseases.
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Use of social media in the assessment of relative effectiveness: An explorative review with examples from oncology. Hopeful or hopeless?
From: Journal of Medical Internet Research
Date Submitted: May 2, 2017
Open Peer Review Period: May 4, 2017 - Jun 29, 2017
Background: An element of health technology assessment (HTA) constitutes assessing the clinical effectiveness of drugs, generally called relative effectiveness assessment (REA). Directly after market...
Background: An element of health technology assessment (HTA) constitutes assessing the clinical effectiveness of drugs, generally called relative effectiveness assessment (REA). Directly after market access little evidence from the real world is available, therefore randomized controlled trials are used to inform REA. However, there is growing interest in using real world data (RWD) for REA. Social media may provide a source of RWD. Objective: We assessed the extent to which social media-generated health data could contribute to REA. Methods: An explorative literature review was conducted following PRISMA guidelines to identify examples in oncology where health data was collected using social media. Scientific and grey literature published between January 2010 and June 2016 was identified by two reviewers, who independently screened studies for eligibility and extracted data. A descriptive qualitative analysis was performed. Results: Of 1032 articles identified, 8 were included: 4 articles identified adverse events to cancer treatment, 3 articles disseminated quality of life (QoL) surveys, and 1 study assessed the occurrence of disease-specific symptoms. Several strengths of social media-generated health data were highlighted in the articles, such as efficient collection of patient experiences and recruiting patients with rare diseases. Conversely, limitations included validation of authenticity and presence of information and selection bias. Conclusions: Social media may provide a potential source of RWD for REA, particularly on aspects such as adverse events, symptom occurrence, QoL, and adherence behaviour. This potential has not yet been fully realised and the degree of usefulness for REA should be further explored.
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Presentation of laboratory test results in patient portals: influence of interface design on risk interpretation and visual search behaviour
From: Journal of Medical Internet Research
Date Submitted: May 9, 2017
Open Peer Review Period: May 12, 2017 - Jul 7, 2017
Background: Patient portals are often assumed to be valuable in self-management, however, there are concerns over how patients might interpret and act on the clinical information they access. Objectiv...
Background: Patient portals are often assumed to be valuable in self-management, however, there are concerns over how patients might interpret and act on the clinical information they access. Objective: To investigate how different online, portal-based presentations of laboratory test results may influence risk interpretation and visual search behaviours. Methods: We conducted a controlled study with 20 kidney transplant patients. Participants viewed three different graphical presentations in each of low, medium and high risk clinical scenarios composed of results for 28 laboratory tests. After viewing each clinical scenario, patients were asked how they would have acted in real life if the results were their own, as a proxy of their risk interpretation. They could choose between: 1) Calling their doctor immediately (high interpreted risk); 2) Trying to arrange an appointment within the next four weeks (medium interpreted risk); 3) Waiting for the next appointment in three months (low interpreted risk). For each presentation, we assessed accuracy of patients’ risk interpretation, and employed eye tracking to assess and compare visual search behaviour. Results: There was no statistically significant difference in the accuracy of risk interpretation between the different forms of presentation of results. Misinterpretation of risk was common, with 65% of participants underestimating the need for action across all presentations at least once. Participants found it particularly difficult to interpret medium risk clinical scenarios. Participants who consistently understood when action was needed showed a higher visual search efficiency, suggesting a better strategy to cope with information overload that helped them to focus on the laboratory tests most relevant to their condition. Conclusions: This study confirms patients’ difficulties in interpreting laboratories test results, with many patients underestimating the need for action, even when abnormal values were highlighted or grouped together. Our findings raise patient safety concerns and may limit the potential of patient portals to actively involve patients in their own healthcare.
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Information-seeking behaviour for Zika virus and microcephaly in Brazil: infodemiological study of Google Trends-based search queries
From: Journal of Medical Internet Research
Date Submitted: May 9, 2017
Open Peer Review Period: May 12, 2017 - Jul 7, 2017
Background: Google Trends (GT) has been used to provide real-time epidemiological trends of several diseases. Objective: We assessed the information-seeking behaviour for Zika virus and microcephaly i...
Background: Google Trends (GT) has been used to provide real-time epidemiological trends of several diseases. Objective: We assessed the information-seeking behaviour for Zika virus and microcephaly in Brazil using infodemiological data provided by GT. Methods: This was an observational infodemiology study of information and search activity on ZIKV and microcephaly in Brazil conducted using GT. Results: Data showed high search by the two topics between December 2015 and February 2016, coincident with the appearance of cases of microcephaly in Brazil and new findings on the subject. Conclusions: The current study demonstrates the potential of using search queries to assess the degree of the population concern for the ZIKV and microcephaly in Brazil and the strong influence of reports from local and international media and international organizations in the number of web search during the outbreak.
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Syndromic surveillance models using Web data: the case of Influenza in Greece and Italy using Google Trends
From: Journal of Medical Internet Research
Date Submitted: May 10, 2017
Open Peer Review Period: May 11, 2017 - Jul 6, 2017
Background: An extended discussion and research has been performed in recent years, using data collected through search queries submitted via Internet. It has been shown that the social activity in th...
Background: An extended discussion and research has been performed in recent years, using data collected through search queries submitted via Internet. It has been shown that the social activity in the internet is related to the number of cases of an infectious disease outbreak Objective: In our research, to define a similar correlation between data from Google Trends and data collected by the official authorities of Greece and Europe, we examine the development and the spread of seasonal influenza in Greece and Italy. Methods: We use multiple regressions of the terms submitted in the Google search engine related to influenza for the period 2011-2012 in Greece and Italy. We then use the Auto Regression Integrated Moving Average statistical model (ARIMA) to determine the correlation between the Google search data and the real influenza cases confirmed by the above-mentioned authorities. Two methods are used: a "flu score" was created for the case of Greece and another method by comparing data from a neighbor country of Greece, which is Italy. Results: The results show that there is a significant correlation that can help the prediction of the spread and the peak of the seasonal influenza, using data from Google searches. The correlation is .909, .831 for Greece and .979, .933 for Italy for 2011 and 2012 respectively. The prediction of the peak is quite precise and provides a forecast before it arrives to population Conclusions: We can create an internet surveillance system, based on Google Searches to track Influenza in Greece in Italy
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A web-based self-management application ‘Oncokompas’ including a breast cancer-specific module to facilitate access to optimal supportive care: a feasibility study among breast cancer survivors
From: Journal of Medical Internet Research
Date Submitted: May 11, 2017
Open Peer Review Period: May 13, 2017 - Jul 8, 2017
Background: Cancer survivors have to deal with symptoms and concerns related to cancer and its treatment. In Oncokompas, cancer survivors can monitor their quality of life by completing patient report...
Background: Cancer survivors have to deal with symptoms and concerns related to cancer and its treatment. In Oncokompas, cancer survivors can monitor their quality of life by completing patient reported outcome measures (PROMs) (‘Measure’), followed by personalized feedback and self-care advices (‘Learn’) and an overview of optimal supportive care options (‘Act’) to stimulate patient activation. To improve sustainable usage, we optimized Oncokompas by developing tumor-specific modules such as the Oncokompas breast cancer (BC) module. Objective: To investigate the feasibility and effects of Oncokompas including the newly developed BC specific module among BC survivors. Methods: A pretest-posttest design was used, conducting a survey before providing access to Oncokompas, and 1 week after. Feasibility was investigated by means of adoption (intention to use Oncokompas), usage (actual use of Oncokompas based on logging data), and satisfaction (mean score of two study-specific questions: general satisfaction and user friendliness (10-point scales) and the Net Promoter Score (NPS)). Several socio-demographic (age, health literacy, marital status, educational level, occupational status, need for supportive care) and clinical (treatment modality, time since diagnosis) factors, and health-related quality of life (HRQOL) were explored that might be associated with patient satisfaction. Barriers and facilitators of the feasibility of Oncokompas were investigated by evaluating reports from face-to-face consultations between BC survivors and their oncology nurses. The effects of Oncokompas on patient activation (Patient Activation Measure (PAM)) and on patient-physician interaction (Perceived Efficacy in Patient-Physician Interaction (PEPPI-5)) were investigated. Results: In total 101 BC survivors participated. Oncokompas had an adoption rate of 75%, a usage rate of 75-84%, a mean satisfaction score of 6.9 and a NPS of -36 (N=68). The BC module had a mean satisfaction score of 7.5. The most frequently consulted BC specific topics were lymphedema, (early) menopausal symptoms and sexuality. BC survivors who received surgery including chemotherapy and/or radiotherapy were significantly more satisfied than BC survivors with surgery alone (p = 0.013). Six facilitators (e.g. the well-being score in Oncokompas is congruent with participants’ own perception) and ten barriers (e.g. Oncokompas was considered too extensive) of the feasibility of Oncokompas were identified. After using Oncokompas, BC survivors scored significantly higher on patient activation (PAM) (p= .007; r = .24), but not on patient-physician interaction (PEPPI) (p = .75). Conclusions: Oncokompas including a BC module is considered feasible, but needs further optimization to increase user satisfaction. This study shows the value of tailoring eHealth applications for cancer survivors to their specific tumor type. Oncokompas including the BC module seems effective to improve patient activation among BC survivors. A randomized controlled trial is warranted to assess (cost-)effectiveness.
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Using Big Data to Understand Social Conversations about Electronic Cigarettes: Pre- and Post-FDA Electronic Cigarette Ruling (2016) Using Twitter Data
From: Journal of Medical Internet Research
Date Submitted: May 11, 2017
Open Peer Review Period: May 13, 2017 - Jul 8, 2017
Background: Electronic cigarette (e-cigarette) use has become a controversial public health issue that is now impacted by the FDA ruling on tobacco products. Social media such as Twitter has given ris...
Background: Electronic cigarette (e-cigarette) use has become a controversial public health issue that is now impacted by the FDA ruling on tobacco products. Social media such as Twitter has given rise to a form of Big Data (i.e., extremely large datasets) that provide a unique opportunity to approach public health and policy issues as viewed and disseminated by social media users. The application of machine learning methods to Big Data can help reveal the public’s organic reaction to and subsequent social conversations about health policies such as the FDA ruling. Objective: The purpose of this study was to compare Twitter-based social conversation themes about e-cigarettes in the U.S. pre- and post-FDA ruling using social networking data via Twitter. Methods: We sought to identify and separate a subset of e-cigarette related tweets for two time periods, before and after the legislative ruling event in early May 2016. The months before May 2016 represent a baseline of typical e-cigarette related tweets prior to the ruling. The months after reveal the impact the ruling had on this typical Twitter dialogue. The data collected was used to identify dominant themes in the tweets. Results: There were a total of 12,531 tweets collected from both time periods, with 7,416 in the pre-ruling period (period 1) January 1, 2016 to April 24, 2016 and 5,115 in the post-ruling period (period 2) April 25, 2016 to July 11, 2016. The Word Adjacency Graph (WAG) modeling applied to this large dataset was able to separate relevant from non-relevant tweets regarding e-cigarettes. The pre-ruling period revealed 10 relevant word clusters and four primary themes: safety, support, opposition, and smoking cessation. The post-ruling period was analyzed and six relevant word clusters and six themes were identified: safety, legislative communication, public health, support, marketing, and the FDA ruling. Conclusions: Examining public response to the FDA ruling on e-cigarettes using Twitter data provides valuable insight into the public perspective. While there are multiple perspectives and layers of complexity associated with the FDA ruling, social network analysis of Twitter data provides increased e-cigarette dialogue for health professionals to engage their patients, legislators, and the community. Clinical Trial: N/A
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Reduction of health disparities by increasing vegetables intake with a web-based nutrition education intervention among lower-income adults: a randomized-controlled trial
From: Journal of Medical Internet Research
Date Submitted: May 14, 2017
Open Peer Review Period: May 17, 2017 - Jul 12, 2017
Background: No existing web-based nutrition education interventions have yet been evaluated with consideration of socio-economic status. Objective: To investigate the effect of a randomized controlled...
Background: No existing web-based nutrition education interventions have yet been evaluated with consideration of socio-economic status. Objective: To investigate the effect of a randomized controlled trial on reducing vegetable intake disparities between lower- and middle household income with a web-based intervention. Methods: Randomized controlled trial. Participants were assessed at three timepoints: participants were assessed at baseline (T1), post intervention (5 weeks later; T2), and a follow-up after 3 months (T3) from October 2015 to March 2016. A web-based intervention survey was conducted via a Japanese online research service containing data including sociodemographic attributes for 8,564 adults aged 30–59 years. Participants (n = 1,500) were stratified per national population statistics for sex, age, and household income, and randomly divided into intervention and control groups. The intervention program content encouraged behavioral changes using behavioral theories and techniques tailored to assumed stages of behavioral change. The outcome was vegetable intake servings (350 g per day, 5 small bowls). Results: This study had the high levels of compliance (low income: 82.4%, middle income: 85.7% at T2). The vegetable intake increased in the low-income among intervention group from T1 to T2 (0.42 SV; 95% CI: 0.11–0.72). A two-way ANOVA showed that low-income households had significant main effects (Group: η2 = 0.04, p = .012, Time: η2 = 0.01, p < .001) and a significant interaction (η2 = 0.01, p = .009). Middle-income households also had a significant main effect (Time: η2 = 0.01, p = .006) and a significant interaction (η2 = 0.01, p = .046). Conclusions: Web-based nutritional education intervention could fill the vegetable intake gap between low- and middle-income and be expected to prevent non-communicable and lifestyle-related diseases. Further intervention program improvements are necessary to maintain and increase vegetables intake for other groups. Clinical Trial: Current Controlled Trials UMIN-ICDR UMIN000019376 (Registered October 16, 2015)
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Mobile Apps for Suicide Prevention: Review in Virtual Stores and Literature
From: JMIR mHealth and uHealth
Date Submitted: May 12, 2017
Open Peer Review Period: May 13, 2017 - Jul 8, 2017
Background: The best manner to prevent suicide is to recognize the suicidal signs and signals, and know how to respond to them. Objective: To study the existing mobile apps for suicide prevent in the...
Background: The best manner to prevent suicide is to recognize the suicidal signs and signals, and know how to respond to them. Objective: To study the existing mobile apps for suicide prevent in the literature and the most important virtual stores. Methods: Two reviews are carried out. The first is done by searching the most used commercial app stores such as iTunes and Google Play. The second is a review of mhealth apps in the published articles from the following 7 scientific databases: Science Direct, Medline, PsycINFO, Embase, The Cochrane Library, IEEE Xplore and Google Scholar from the last 10 years. Results: A total of 124 apps related to suicide were found in the cited virtual stores but only 20 apps were specifically for suicide prevention. All them are free and most are for Android. Furthermore, 6 relevant papers were found in the indicated scientific databases. Pilot experiences were commented where physicians and families have an important work. Conclusions: The number of apps about suicide prevention is small, mainly in literature. There was little information. Many of these apps provide no interactive features. It is important to verify the accuracy of the results of different apps that are available on iOS and Android. The confidence generated by these applications can benefit users who use it, either by improving their health monitoring or only to verify their body condition.
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The impact of mHealth interventions on breast cancer awareness and screening: systematic review protocol
From: JMIR Biomedical Engineering
Date Submitted: May 14, 2017
Open Peer Review Period: May 14, 2017 - Jul 9, 2017
Background: Mobile health (mHealth) is the use of mobile communication technologies to promote health by supporting healthcare practices (e.g. health data collection, delivery of healthcare informatio...
Background: Mobile health (mHealth) is the use of mobile communication technologies to promote health by supporting healthcare practices (e.g. health data collection, delivery of healthcare information etc.). mHealth technologies (such as mobile phones) can be used effectively by healthcare practitioners in the distribution of health information and has the potential to improve access to and quality of healthcare, as well as reduce the cost of health services. The literature shows limited scientific evidence on the benefits of mHealth intervention for breast cancer, which is the leading cause of cancer deaths in women worldwide, contributing a large proportion of all cancer deaths, especially in developing countries. The proposed systematic review will examine the impact of mHealth interventions on breast cancer awareness and screening among women aged 18yrs and older. Objective: The objectives of this study is to identify and describe the various mHealth intervention strategies used in breast cancer and assess the impact of mHealth strategies on breast cancer awareness and screening. Methods: Using the standard methods of a systematic review, literature will be sourced from various databases. A predefined search criterion will be applied. Two authors will apply the inclusion and exclusion criteria stipulated in this protocol. Results: The results from premilitary searches indicate that there are existing peer-reviewed articles relating to the use of mHealth in Breast Cancer. Conclusions: The knowledge derived will inform healthcare stakeholders including researchers, policy makers, investors, health professionals, technologists and engineers on the impact of mHealth in breast cancer screening and awareness.
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Smartphone Apps for Gestational Diabetes: A Scoping Review Examining Functionality, Implementation, Impact and the Role of Health Literacy
From: JMIR Diabetes
Date Submitted: May 14, 2017
Open Peer Review Period: May 17, 2017 - Jul 12, 2017
Background: The increasing ownership of smartphones and advances in hardware and software position these devices as cost-effective personalized tools for health promotion and management among women wi...
Background: The increasing ownership of smartphones and advances in hardware and software position these devices as cost-effective personalized tools for health promotion and management among women with gestational diabetes mellitus (GDM). Numerous smartphone apps are available online; however, no review has documented how these apps are developed and evaluated in relation to gestational diabetes. Objective: To answer the following two research questions: (1) What is known from the existing literature about the availability, functionality, and effectiveness of smartphone apps on GDM prevention and management? And (2) What is the role of health literacy in these apps? Methods: Seven relevant electronic databases were searched for original research documents using terms related to smartphone apps, GDM, and health literacy. Selected articles were thematically categorized using a framework adapted from Arksey & O'Malley. Results: Twelve articles related to seven app/systems were included in the final analysis. Articles were classified around two themes: (1) description of the development, feasibility or usability of the apps/systems, and (2) trial protocols. Varying degrees of personalization exist in the apps for GDM and decision support systems (DSSs) can be used to generate time-efficient personalized feedback for both patients and healthcare providers. Health literacy was considered during the development or measured as an outcome by some apps. Conclusions: There is a limited body of research on smartphone apps in relation to GDM prevention and management. Smartphone apps can provide time- and cost-efficient personalized interventions for GDM. Several randomized controlled trials (RCT) have been launched recently to evaluate the effectiveness of the apps. Consideration of health literacy should be improved when developing features of the apps.
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Getting to the Root of Reinvestment - An fNIRS study in Dentistry using Virtual Reality Haptic Simulation
From: Journal of Medical Internet Research
Date Submitted: May 15, 2017
Open Peer Review Period: May 18, 2017 - Jul 13, 2017
Background: Personality has been identified as a factor that influences learning in healthcare. Movement specific reinvestment is a dimension of personality that has been shown to influence psychomoto...
Background: Personality has been identified as a factor that influences learning in healthcare. Movement specific reinvestment is a dimension of personality that has been shown to influence psychomotor learning because it has a central role in conscious control of movements. Currently, there is little evidence considering the relationship between movement specific reinvestment and working memory in terms of functional brain activation of the dorsolateral prefrontal cortex (DLPFC) during motor skill performance. Objective: This study used functional near infrared spectroscopy (fNIRS) to examine the research gap between movement specific reinvestment and working memory using undergraduate dental students performing dental virtual reality (VR) psychomotor tasks. Methods: The propensity for movement specific reinvestment was assessed in 24 dental students, who completed two dental tasks (clinical, non-clinical) on a VR haptic simulator. Portable fNIRS equipment was used to assess oxygen demands in the left and right DLPFC hemispheres during performance. Results: Students with a high propensity for movement specific reinvestment displayed significantly greater oxyhaemoglobin demands in and area associated with working memory during the non-clinical task (Spearman correlation, rs = -0.49, p = 0.033). Conclusions: This small-scale study suggests that neurophysiological differences are evident between high and low reinvesters during a dental VR task in terms of oxyhaemoglobin demands in an area associated with working memory. The results contribute to understanding the neurological processes underpinning conscious control of movements and may assist in the design of individualized training plans for psychomotor skills.
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Using data cubes to construct a disease-gene-drug association network for diabetes mellitus
From: JMIR Diabetes
Date Submitted: May 16, 2017
Open Peer Review Period: May 19, 2017 - Jul 14, 2017
Background: In this post-genomic big-data era, genomic approaches are increasingly used to search for potential new drugs and treatments for diseases. Large-scale data mining of biomedical literature...
Background: In this post-genomic big-data era, genomic approaches are increasingly used to search for potential new drugs and treatments for diseases. Large-scale data mining of biomedical literature is an essential tool for investigating and predicting the relationships between causal genes and treatments of diabetes mellitus (DM). Objective: The objective of the study is to construct a disease-gene-drug association network for diabetes mellitus and predict some new associations. Methods: Based on textual data, we developed a novel, data cube–based approach for constructing a disease-gene-drug association network for DM. We used association rules to measure the associations between biological entities. Results: We obtained phenotypic, genotypic, and treatment drug data for DM from the PubMed database. After data preprocessing, we constructed the 0-D vertex cube, which we then filtered to construct three 1-D cubes consisting of 14 diseases, 23 genes, and 34 drugs. We found 194 associations between the 14 subclasses of DM and the 23 genes, 75 associations between 11 of the DM subclasses and 24 of the drugs, and 142 associations between 14 of the DM-related genes and 15 of the drugs. By applying association rules to quantify the correlation between the disease phenotypes, genes, and treatment drugs, we established three 2-D cubes and three relational networks. Finally, using the bottom-up computation algorithm, we constructed the 3-D disease-gene-drug network, which revealed 411 associations between 14 subclasses of DM, 23 genes, and 24 drugs. Based on this 3-D network, we constructed 8 optimal disease-gene-drug subnetworks of DM. Conclusions: We have implemented and validated a network-based approach to identifying and ranking the hidden associations between diseases, genes, and drugs. Our results provide new potential pathways in the search for DM treatment drugs.
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Needle in a haystack: A comparison of online survey recruitment platforms for hard-to-reach populations
From: Journal of Medical Internet Research
Date Submitted: May 26, 2017
Open Peer Review Period: May 26, 2017 - Jul 21, 2017
Background: Smoking during pregnancy is the leading cause of infant mortality and pregnancy complications. Effective smoking cessation programs can significantly reduce the negative health outcomes as...
Background: Smoking during pregnancy is the leading cause of infant mortality and pregnancy complications. Effective smoking cessation programs can significantly reduce the negative health outcomes associated with smoking while pregnant. This population, however, is difficult to recruit due to the social stigma surrounding the issue. Objective: To determine the feasibility of recruiting a hard-to-reach population of pregnant smokers using four different online platforms. Additionally, we aimed to describe the populations of participants available on each of the channels. Methods: A screener and survey were distributed online through Qualtrics Panel, Soapbox Sample, Reddit, and Amazon Mechanical Turk (mTurk). Descriptive statistics were used to summarize results of each recruitment channel, including eligibility yield, quality yield, income, race, age, and gestational age. Results: Of the 3,848 participants screened for eligibility across all four online platforms, 308 were eligible and completed the survey. Amazon mTurk yielded the least amount of completed responses (n=9), 93% of which passed several quality metrics verifying pregnancy and smoking status. Qualtrics Panel yielded 14 completed responses, 0.87% of which passed the quality screening. Soapbox Sample produced 107 completed surveys, 51.02% of which were found to be quality responses. Advertising through Reddit produced the highest completion rate (n=178) but only 29% of those surveys passed the quality metrics. Conclusions: Although each platform successfully recruited pregnant smokers, the results varied in quality, cost, and percentage of complete responses. Moving forward, investigators should pay careful attention to the percentage yield and cost of online recruitment channels to maximize internal and external validity.
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Patient Health Record Systems’ Scope and Functionalities: A Literature Review and Future Directions
From: Journal of Medical Internet Research
Date Submitted: May 19, 2017
Open Peer Review Period: May 21, 2017 - Jul 16, 2017
Background: A new generation of user-centric information systems is emerging in healthcare as Patient Health Record systems. These systems create a platform supporting the new vision of health service...
Background: A new generation of user-centric information systems is emerging in healthcare as Patient Health Record systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities; providing opportunities and challenges at the user, system and industry levels. Objective: To assess patient health records (PHR) data through a review of the literature, to inform the healthcare informatics community and provide recommendations for PHR design, research and practice. Methods: In this paper we review the literature to identify challenges associated with the development PHR systems. We survey PubMed, Embase and Medline databases from 1966 to 2015 for studies of personal health records resulting in 1822 articles, from which we select a total of 106 articles for a detailed review of PHR data content. We present several key findings related to the scope and functionalities in current PHR systems. We also present a functional taxonomy and chronological analyses of PHR data types and functionalities. Based on the evolution of prior PHR systems, we develop a maturity model for evaluation of multi-organizational systems such as PHR systems and identify implications on future health information systems research; improving understanding and providing insights for future directions. Results: Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices, and data types such as time series data. Chronological data analysis revealed an evolution of PHR systems’ functionalities over time from simple data access, to data modification, and more recently automated assessment, prediction and recommendation. Conclusions: Efforts are needed to improve PHR 1) data quality through patient-centered user interface design and standardized patient-generated data guidelines, 2) data integrity through consolidation of various types and sources, 3) functionality through application of new data analytics methods and 4) metrics to evaluate clinical outcomes associated with automated PHR systems’ use, and cost associated with PHR data storage and analytics.
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Cardiac patients’ experiences and perceptions of social media: a mixed methods study
From: Journal of Medical Internet Research
Date Submitted: May 22, 2017
Open Peer Review Period: May 24, 2017 - Jul 19, 2017
Background: Traditional in-person cardiac rehabilitation has substantial benefits for cardiac patients, which are offset by poor attendance. The rapid increase in social media use in older adults prov...
Background: Traditional in-person cardiac rehabilitation has substantial benefits for cardiac patients, which are offset by poor attendance. The rapid increase in social media use in older adults provides an opportunity to reach patients eligible for cardiac rehabilitation but who are unable to attend traditional face-to-face groups. However, there is a paucity of research on cardiac patient’s experiences and perspectives on using social media to support their health. Objective: This study aims to describe cardiac rehabilitation patient’s experiences in using social media in general and their perspective on using social media to support their cardiac health and secondary prevention efforts. Methods: A mixed methods study was undertaken among cardiac rehabilitation patients in both urban and rural areas which comprised a survey (n = 284) on social media use and six focus group interviews with current social media users (n = 18) to elucidate social media experience and perspectives. Results: Social media use was common (28%; 79/282) particularly in patients who were under 70 years of age, employed and had completed high school. Social media users accessed online information on general health issues (65%; 51/79), medications (56%; 44/79) and heart health (43%; 34/79). Patients were motivated to invest time in using social media for ‘keeping in touch’ with family and friends, and to be informed by expert cardiac health professionals and fellow cardiac patients if given the opportunity. Social media capability (understanding of features and the consequences of their use and efficiency in use) appears to influence the frequency and degree of engagement of social media use and the willingness to participate in a cardiac social media group. More capable users were more receptive to the use of social media for cardiac rehabilitation and more likely to express interest in providing peer support. Recommended features for a cardiac rehabilitation social media group using a Facebook platform included a closed group, expert cardiac professional involvement, provision of cardiac health information and ensuring trustworthiness of the group. Conclusions: Cardiac health professionals have an opportunity to capitalise on cardiac patients’ motivations and social media capability for supporting cardiac rehabilitation and secondary prevention. Patients’ favoured purposeful time spent on social media, and their cardiac health provides such a purpose for a social media intervention. The study results will inform the development of a social media intervention for secondary prevention of cardiovascular disease.
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Methods for Co-Designing a Collaborative Chronic Care Network (C3N)
From: Journal of Medical Internet Research
Date Submitted: May 20, 2017
Open Peer Review Period: May 21, 2017 - Jul 16, 2017
Background: Learning Health Systems (LHSs) are seen as a means to accelerate outcomes, improve care delivery, and further clinical research, yet few such systems exist. Objective: We describe the proc...
Background: Learning Health Systems (LHSs) are seen as a means to accelerate outcomes, improve care delivery, and further clinical research, yet few such systems exist. Objective: We describe the process of co-designing, with all relevant stakeholders, an approach for creating a collaborative chronic care network (C3N), a peer-produced networked LHS. Methods: The setting was ImproveCareNow, an improvement network for pediatric inflammatory bowel disease. In collaboration with patients and families, clinicians, researchers, social scientists, technologists, and designers, C3N leaders used a modified idealized design process to develop a design for a C3N. Results: Over 100 people participated in the design process, which resulted in: a) an overall “concept design” for the ImproveCareNow C3N, b) a logic model for bringing about this system, and c) thirteen potential innovations likely to increase awareness and agency, make it easier to collect and share information, and to enhance collaboration – that could be tested collectively to bring about the C3N. Conclusions: Our current healthcare system fails to deliver necessary results and incremental system improvements are not enough. We demonstrate methods that resulted in a design that has the potential to transform the chronic care system. Our experience suggests that employing structured co-design processes in collaboration with all relevant stakeholders can result in a potentially transformative design for the chronic care delivery system.
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Systematic adaptation of an eHealth intervention to promote physical activity and social network of single, chronically impaired older adults
From: Journal of Medical Internet Research
Date Submitted: May 24, 2017
Open Peer Review Period: May 26, 2017 - Jul 21, 2017
Background: Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus in...
Background: Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus intervention is a totally automated computer tailored eHealth intervention that has been proven effective to promote physical activity in the general population of older adults aged over 50. Objective: The aim of the present study is to report on the methods and results of the systematic adaptation of Active Plus to the narrower target population of single people over the age of 65 who have one or more chronic diseases, as this target population may encounter specific challenges regarding physical activity and social network. Methods: The Intervention Mapping Protocol is used to systematically adapt the existing intervention to optimally suit the new target population. A literature study is performed, and quantitative and qualitative data is derived from health care professionals (by questionnaires (n = 10)) and the target population (by focus group interviews (n = 14)), and systematically integrated into the adapted intervention. Results: Since the health problems and the targeted behaviour are largely the same in the original and adapted intervention, the performance objectives (i.e. the behaviour that the target population has to perform to reach the overall program objective) are not changed. As found in the literature study and in data derived from health professionals and the target population, the relative importance and operationalization of the relevant psychosocial determinants related to these objectives are different from the original intervention, resulting in a refinement of the change objectives (i.e. the intervention objectives specific for this intervention) to optimally fit the target population. This refinement - based on data derived from the target population - also resulted in changes in the practical applications, program components, intervention materials and in the evaluation- and implementation strategy. Conclusions: The present study demonstrates that the adaptation of an existing intervention is an intensive process in which adopting the Intervention Mapping protocol is an invaluable tool. The study provides a broad insight in adapting interventions aimed at single older adults with a chronic disease. It is concluded that even when the new target population is a sizable segment of the original target population, the adapted intervention still needs considerable changes to optimally fit the needs and situational differences of the narrower target population. Clinical Trial: Not applicable as this article does not report on the results of an intervention.
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Challenges during implementation of a patient-facing mobile app for surgical rehabilitation
From: Journal of Medical Internet Research
Date Submitted: Jun 6, 2017
Open Peer Review Period: Jun 7, 2017 - Aug 2, 2017
Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challe...
Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in healthcare settings. Objective: To report challenges experienced when implementing mobile apps for patients to support their post-surgical rehabilitation in an orthopaedic setting. Methods: A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-minute usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results: Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, IT infrastructure at home, privacy concerns, time limitations, the role of carer, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care include competing demands among clinicians, IT infrastructure in healthcare settings, identifying the ‘right’ time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions: Three insights were identified for mobile app implementation in routine care: 1) apps for patients need to reflect their journey over time, and in particular post-operative apps ought to be introduced as part of pre-operative care with opportunities for patients to learn and adopt the app during their postoperative journey; 2) strategies to address digital literacy issues among patients and clinicians are essential; and that 3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored and reviewed. Ultimately, digital health interventions should supplement but not replace patient interaction with clinicians.
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Web-based decision-aid to assist help-seeking choices for young people who self-harm: Outcomes from a randomised controlled feasibility trial
From: Journal of Medical Internet Research
Date Submitted: Jun 16, 2017
Open Peer Review Period: Jun 16, 2017 - Aug 11, 2017
Background: Adolescents who self-harm are often unsure how or where to get help. We developed a web-based personalised decision aid (DA), designed to support young people in decision-making about seek...
Background: Adolescents who self-harm are often unsure how or where to get help. We developed a web-based personalised decision aid (DA), designed to support young people in decision-making about seeking help for their self-harm. Objective: Our aim was to evaluate the feasibility and acceptability of the DA intervention and the randomised controlled trial (RCT) in a school setting. Methods: We conducted a 2-group, single blind, randomised controlled feasibility trial in a school setting. Participants aged 12-18 years who reported self-harm in the past 12 months were randomised to either an web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomisation and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision-making and help-seeking behaviour. Qualitative interviews were conducted with young people, parents/carers and staff, and subjected to thematic analysis to explore their views of the DA and study processes. Results: Parental consent was a significant barrier to young people participating in the trial, with only 208 (18%) of the 1,164 parent/guardians contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 82% (n=170) of young people into the study. Of those young people screened, 14% (n=23) had self-harmed in the past year. Ten participants were randomised to receiving the DA and 13 were randomised to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety and self-harm may be more beneficial. Conclusions: A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and/or the intervention are needed before generalisable research about DAs can be successfully conducted in a school setting. Clinical Trial: ISRCTN11230559
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Part of a system – the changing place of online activity within a sexual health economy
From: Journal of Medical Internet Research
Date Submitted: May 26, 2017
Open Peer Review Period: May 29, 2017 - Jul 24, 2017
Background: Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits, ordered online and delivered to the user in the post may increase us...
Background: Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits, ordered online and delivered to the user in the post may increase user choice, convenience and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users towards online or face-to face services according to clinical need. Objective: This paper investigates the impact of two interventions on testing activity across a whole sexual health economy a) the introduction of open access online STI testing services and b) a clinic policy of ‘triage and signpost’ online where users without symptoms who attended clinics for STI testing were supported to access the online service instead. Methods: Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed and clinical activity provided including test results. Clinical activity was categorised as a simple STI test (could be done in clinic or online), a complex visit (requiring face-to-face consultation) or other. Results: Introduction of online services increased total testing activity across the whole sexual health economy by 17.5%, suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the online service with simple STI testing in the clinic decreasing from 17% to 12% of total activity and complex activity in the clinic increasing from 69% to75% of total activity. This intervention created a new population of online users who were different age, sex, presence of symptoms and positivity from those who use online services spontaneously. Some triage and signposted users (29%) did not complete the online testing process with the potential for missed diagnoses. Conclusions: This evaluation shows that users can effectively be transitioned from online to face-to-face services and that this introduces a new population to online service use and changes the focus of clinic based activity. Further development is underway to optimise the triage and signposting process to support test completion.
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Thought Spot: Optimization of an eHealth solution through participatory action research with transition-aged youth in post-secondary settings
From: Journal of Medical Internet Research
Date Submitted: May 26, 2017
Open Peer Review Period: May 29, 2017 - Jul 24, 2017
Background: Seventy percent of lifetime cases of mental illness emerge prior to age 24, but many youth are unable to access the supports and services they require in a timely and appropriate way. With...
Background: Seventy percent of lifetime cases of mental illness emerge prior to age 24, but many youth are unable to access the supports and services they require in a timely and appropriate way. With most youth using the Internet, eHealth interventions are promising tools for reaching this population. Through participatory action research (PAR) and participatory design research (PDR) engagement methods, Thought Spot, a web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth in post-secondary settings. Objective: To describe the process of engaging with transition-aged youth through PAR and PDR approaches with the ultimate goal of optimizing the Thought Spot platform. Methods: Consistent with PAR and PDR approaches, five student-led workshops, attended by 41 students, were facilitated to obtain student feedback regarding help-seeking behaviours, the platform’s usability and functionality and its potential value in a post-secondary setting. The workshops were co-designed and co-facilitated by students to increase ownership by youth over the research process. Various creative engagement activities were delivered to provide opportunities for youth to share their experiences, including semi-structured focus groups, questionnaires, personas, journey mapping and a world café. Results: Participants discussed the following issues related to help-seeking throughout the workshops: feelings of confusion and vulnerability when accessing health or mental health services; concerns about stigma, taboos and labelling; and overall health care costs and time constraints. Innovative technological features and refinements were also brainstormed during the workshops. By using PAR methods of engagement, participants felt confident that their ideas and recommendations were welcomed and appreciated. There was also an overall sense of respect and care integrated into each group, which facilitated a genuine exchange of ideas and opinions. Conclusions: The process of engaging with transition-aged youth to redesign the Thought Spot digital platform through PAR and PDR has been effective. Findings from these workshops will significantly inform new technological features within the app that enable positive help-seeking behaviours among transition-aged youth. These behaviors will be further explored in the second phase that involves a randomized controlled trial.
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What is eHealth? The development of a conceptual model for eHealth based on qualitative interviews with key informants
From: Journal of Medical Internet Research
Date Submitted: May 29, 2017
Open Peer Review Period: May 30, 2017 - Jul 25, 2017
Background: Despite rapid growth in eHealth research, there remains a lack of consistency in defining, and using, terms related to eHealth. More widely cited definitions provide broad understanding of...
Background: Despite rapid growth in eHealth research, there remains a lack of consistency in defining, and using, terms related to eHealth. More widely cited definitions provide broad understanding of eHealth but lack sufficient conceptual clarity to operationalise eHealth and enable its implementation in healthcare practice, research, education and policy. Definitions that are more detailed are often context or discipline specific, limiting ease of translation of these definitions across the breadth of eHealth perspectives and situations. A conceptual model of eHealth that adequately captures its complexity and potential overlaps is required. This model must also be sufficiently detailed to enable eHealth operationalisation and hypothesis testing. Objective: This study aimed to develop a conceptual practice-based model of eHealth to support health professionals in applying eHealth to their particular professional or discipline contexts. Methods: Semi-structured interviews were conducted with key informants (n = 25) from organisations involved in health care delivery, research, education, practice, governance and policy to explore their perspectives on, and experiences with, eHealth. Purposeful sampling was used for maximum diversity. Interviews were coded and thematically analysed for emergent domains. Results: Thematic analyses revealed three prominent but overlapping domains of eHealth: (a) health in our hands (using eHealth technologies to monitor, track, and inform health), (b) interacting for health (using digital technologies to enable health communication among practitioners and between health professionals and clients/patients), and (c) data enabling health (collecting, managing and using health data). These domains formed a model of eHealth that addresses the need for clear definitions and a taxonomy of eHealth while acknowledging the fluidity of this area and the strengths of initiatives that span multiple eHealth domains. Conclusions: This model extends current understanding of eHealth by providing clearly defined domains of eHealth while highlighting the benefits of using digital technologies in ways that cross several domains. It provides the depth of perspectives and examples of eHealth use that is lacking in previous research. Based on this model, it is suggested that eHealth initiatives that are most impactful would include elements from all three domains.
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Web-based medical service: Technology attractiveness, medical creditability, information source, and behavior intention
From: Journal of Medical Internet Research
Date Submitted: May 30, 2017
Open Peer Review Period: May 31, 2017 - Jul 26, 2017
Web-based medical service (WBMS), defined as a cooperative relationship between medical service and Internet-related technology, has been called one of the most innovative services of the 21st century...
Web-based medical service (WBMS), defined as a cooperative relationship between medical service and Internet-related technology, has been called one of the most innovative services of the 21st century. However, the business promotion and implementation in medical industry have not been executed as well as manufacturers expected. Few studies have explored this phenomenon in terms of medical credibility and medical information sources from patient’s viewpoint. The primary goal of this study was to explore whether those factors could create users’ behavior intention. This study explored the related effects in web-based medical service by using three situations to manipulate medical information sources. Questionnaires were used to collect the relative item scores about acceptance of inexperienced users in each situation. The analyses were performed with SPSS software, using hierarchical regression to examine the mediation and moderated-mediation effects. Perceived ease of use and perceived usefulness are significantly positive to enhance behavior intentions, and medical credibility is a mediator, but are not significantly different under diverse manipulative information channels. The results indicate that medical credibility could explain extra variation between technology attractiveness and behavior, but no significant at different medical information sources.
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A Mixed-methods Evaluation of ‘Formulift’: a Wearable Sensor Based Exercise Biofeedback System
From: JMIR mHealth and uHealth
Date Submitted: May 30, 2017
Open Peer Review Period: Jun 4, 2017 - Jul 30, 2017
Background: ‘Formulift’ is a newly developed mHealth app which connects to a single inertial measurement unit (IMU), worn on the left thigh. The IMU captures users’ movements as they exercise an...
Background: ‘Formulift’ is a newly developed mHealth app which connects to a single inertial measurement unit (IMU), worn on the left thigh. The IMU captures users’ movements as they exercise and the app analyses the data to count repetitions in real-time and classify users’ exercise technique. The app also offers feedback and guidance to users on exercising safely and effectively. Objective: The aim of the study was to assess the ‘Formulift’ system, with 3 different and realistic types of potential users (beginner gym-goers, experienced gym-goers and qualified Strength & Conditioning coaches) under a number of categories: (a) Usability. (b) Functionality. (c) The perceived impact of the system. (d) The subjective quality of the system. It was also desired to discover suggestions for future improvements to the system. Methods: Fifteen healthy volunteers participated (12 males, 3 females, age: 23.8 +/- 1.8 years, height: 1.79 +/- 0.07 m, body mass: 78.4 +/- 9.6 kg). Five were beginner gym-goers, 5 were experienced gym goers and 5 were qualified and practising S&C coaches. IMU data was first collected from each participant in order to create individualised exercise classifiers for them. They then completed a number of non-exercise related tasks with the app. Following this a workout was completed using the system, involving squats, deadlifts, lunges and single leg squats. Participants were then interviewed about their user-experience and completed the System Usability Scale (SUS) and the user-Mobile Application Rating Scale (uMARS). Thematic analysis was completed on all interview transcripts and survey results were analysed. Results: Qualitative and quantitative analysis found the system has ‘good’ to ‘excellent’ usability. The system achieved a mean ± S.D. SUS usability score of 79.2 ± 8.8. Functionality was also deemed to be good with many users reporting positively on the systems rep counting, technique classification and feedback. A number of bugs were found and other suggested changes to the system were also made. The overall subjective quality of the app was good with a median star rating of 4/5 (IQR: 3-5). Participants also reported that the system would aid their technique, provide motivation, reassure them and help them avoid injury. Conclusions: This study demonstrated an overall positive evaluation of ‘Formulift’ in the categories of usability, functionality, perceived impact and subjective quality. Users also suggested a number of changes for future iterations of the system. These findings are the first of their kind and show great promise for wearable sensor based exercise biofeedback systems.
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Feasibility and usability of a novel eHealth application for self-reports of sports-related injuries and illnesses in Paralympic sport
From: Journal of Medical Internet Research
Date Submitted: May 31, 2017
Open Peer Review Period: May 31, 2017 - Jul 26, 2017
Background: Few prospective studies have assessed sports-related injuries and illnesses in Paralympic sport (SRIIPS). Advances in smartphone technology and networking systems offer novel opportunities...
Background: Few prospective studies have assessed sports-related injuries and illnesses in Paralympic sport (SRIIPS). Advances in smartphone technology and networking systems offer novel opportunities to develop innovative eHealth applications for collection of data on SRIIPS directly from athletes. Using eHealth applications for collection of self-reports in populations of Paralympic athletes with a broad range of impairments is, however, an unexplored area. Before initiation of full-scale programs, the validity of the approach needs to be ascertained. Objective: The aim of this study is to evaluate the monitoring feasibility and system usability of a novel eHealth application for longitudinal epidemiological research on self-reported SRIIPS. Methods: A prototype eHealth application for routine collection of data from athletes was developed and adapted to Paralympic athletes. A four-week pilot study was performed where Paralympic athletes (n=28) were asked to weekly self-report sport exposure, training load, general well-being, pain, sleep, anxiety and possible SRIIPS. The data collection was followed by a post-study use assessment survey. Quantitative data related to the system use, for example completed self-reports and missing answers, were analysed using descriptive statistical methods. The qualitative feasibility and usability data provided by the athletes were condensed and categorized using thematic analysis methods. Results: The weekly response rate was 95%. The athletes were of the opinion that the eHealth application was sustainable and feasible, but they stated that it was not fully conceptually adapted to Paralympic athletes and their impairments. For example, it was found difficult to understand how a new injury or illness should be identified when the impairment was involved. More survey items asking for data related to the impairment were requested as it was perceived that incidents often occurred because of the impairment. Options for description of multifactorial incidents including an injury, an illness, and the impairment were also found to be insufficient. Relatively few technical usability issues were encountered, but athletes with visual impairment reported usability difficulties with the speech synthesizer. A cumulative incidence of 1.8 injuries and 1.7 illnesses/100 hours of athlete exposure were recorded. The weekly pain prevalence was 57% and the impairment contributed to 20% of the reported incidents. Conclusions: eHealth-based data collection of self-reports of SRIIPS is generally perceived as feasible and usable. With some adaptation to accommodate Paralympic athletes’ conceptual prerequisites and improved technical support for VI athletes, the eHealth application can be recommended for use in longitudinal studies of SRIIPS. Clinical Trial: ClinicalTrials.gov (Identifier: NCT02788500)
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Sleep Tracking and Exercise in Patients with Type 2 Diabetes Mellitus (STEP-D): A Pilot, Longitudinal Study to Determine Correlations between Fitbit Data and Patient Reported Outcomes Pertaining to Health Behaviors
From: JMIR mHealth and uHealth
Date Submitted: May 31, 2017
Open Peer Review Period: Jun 4, 2017 - Jul 30, 2017
Background: Background and Objective: Few studies assessing the correlation between patient related outcomes (PROs) and patient generated health data (PGHD) from wearable devices exist. We sought to d...
Background: Background and Objective: Few studies assessing the correlation between patient related outcomes (PROs) and patient generated health data (PGHD) from wearable devices exist. We sought to determine the direction and magnitude of associations between PGHD (from the Fitbit Charge HR) and PROs for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). Objective: Background and Objective: Few studies assessing the correlation between patient related outcomes (PROs) and patient generated health data (PGHD) from wearable devices exist. We sought to determine the direction and magnitude of associations between PGHD (from the Fitbit Charge HR) and PROs for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). Methods: Methods: STEP-D was a longitudinal, pilot study conducted on adult participants diagnosed with T2DM (n=86). All participants wore a Fitbit Charge HR for 14 consecutive days and completed internet-based surveys at three time points: Day 1, Day 7, and Day 14. PGHD included minutes asleep and number of steps taken. Questionnaires assessed number of days of exercise and nights of sleep problems per week and gym membership status. Means and standard deviations were calculated for all data and Pearson correlations used to measure associations between PROs and PGHD. All respondents provided informed consent prior to participating. Results: Results: On an average, participants took 4,955.0 steps and slept 6.7 hours per day. Participants self-reported an average of 2.0 days of exercise and 2.3 nights of sleep problems per week. The association between PROs and PGHD for physical activity was strong (r=0.60; p<0.01) while the association for sleep variability was moderate (r=0.28, p=<0.05). Conclusions: Conclusions: Fitbit and patient reported data are positively associated for both, physical activity as well as sleep. Physical activity is more closely correlated than sleep-related information. This may indicate that wearable devices are more valid for measuring certain types of health behaviors and could increase the amount and quality of health related behavioral data collected from chronic illness populations.
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A preliminary study to evaluate the perceived benefits of an artificial intelligence embedded mobile app for the self-management of chronic neck and back pain.
From: Journal of Medical Internet Research
Date Submitted: Jun 20, 2017
Open Peer Review Period: Jun 20, 2017 - Aug 15, 2017
Background: Chronic musculoskeletal neck and back pain are disabling conditions among adults. Use of technologies had been suggested to be an alternative way to increase exercise therapy uptake and ma...
Background: Chronic musculoskeletal neck and back pain are disabling conditions among adults. Use of technologies had been suggested to be an alternative way to increase exercise therapy uptake and may improve clinical outcomes. Objective: To evaluate the feasibility of an artificial intelligence embedded mobile app to self-manage chronic neck and back pain. Methods: 161 users responded to the invitation to take part. The evaluation questionnaire included 13 questions that were intended to discover if using the AI system may: 1) increase adherence and uptake of exercise therapy; 2) affect pain level; and 3) reduce the need for other interventions. Results: An increase in time spent on exercise therapy per day was observed. The average reduction of pain level was one point. Three-point reduction was reported from users who had used the system for over six months. Reduction in the usage of other interventions while using the AI system was also observed. Conclusions: This study supported the perceived beneficiary effect of the AI embedded mobile app to provide a personalized intervention. It showed the potential benefits to support the self-management of these conditions. The positive results suggested that it at least warrant further study to investigate the benefit of the AI system and how it compares with routine clinical care.
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What Clinical Information is of Value to Doctors using a Mobile Electronic Medical Record and When?
From: Journal of Medical Internet Research
Date Submitted: Jun 1, 2017
Open Peer Review Period: Jun 2, 2017 - Jul 28, 2017
Background: There is a lack of understanding regarding what specific clinical information is most valuable for doctors to access through mobile electronic medical records (m-EMRs). Furthermore, it has...
Background: There is a lack of understanding regarding what specific clinical information is most valuable for doctors to access through mobile electronic medical records (m-EMRs). Furthermore, it has not been discussed when the value of such information is high. Objective: The goal of this study is 1) to investigate what clinical information is most valuable for doctors to access through m-EMRs and 2) to discuss when such information is valuable. Methods: This study uses data from the usage logs of an m-EMR used by medical personnel in tertiary hospitals in South Korea. The study included 531,916 usage logs recorded during a ten-month period and demographics from 653 doctors. Several descriptive analyses were conducted to explore the overall usage patterns of the m-EMR. To assess the value of clinical information, the study first defined peak usage times as continuous intervals having normalized usage values of the m-EMR greater than 0.5. Second, usage logs were processed to be an indicator representing specific clinical information using factor analysis. Third, random intercept logistic regression was used to explore what clinical information is frequently accessed during the peak usage times. Based on the analyses results, the study discusses when particular information would be valuable. Results: The peak usage time of m-EMRs lasted between 6:00 a.m. and 10:00 a.m., and this was different from those of a hospital information system (HIS). Five factors representing types of clinical information were extracted through factor analysis based on the usage logs. Factors related to (1) patient investigation status and (2) patient conditions were associated with the peak usage times of m-EMRs (p < 0.01). Conclusions: Information on patient investigation status and patient conditions is highly demanded by doctors early in the morning, since the information is crucial for decision making in morning rounds. However, HIS access is highly limited around those hours. Thus, m-EMRs would best evolve in a manner that enhances the accessibility of specific clinical information helpful for decision making during rounds.
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MyMate&Me: A medication adherence app for children with sickle cell disease
From: JMIR mHealth and uHealth
Date Submitted: Jun 21, 2017
Open Peer Review Period: Jun 22, 2017 - Aug 17, 2017
Background: Haemoglobinopathies are very complex disorders with severe complications that can be alleviated with very simple basic preventive and therapeutic interventions, such as daily medication....
Background: Haemoglobinopathies are very complex disorders with severe complications that can be alleviated with very simple basic preventive and therapeutic interventions, such as daily medication. Yet young people with sickle cell disease (SCD) often demonstrate low medication adherence and low motivation for effectively self-managing their disorder. Additional support for this group of patients including encouraging them to adhere to their medication regime and doctors’ instructions, can be provided through the use of mobile health (mHealth) interventions such as smartphone apps. The popularity of smartphones among teenagers makes this approach highly promising, with gamification, or entertainment elements creating particular appeal. Objective: The aim of this study was to develop a theory and evidence-based, user-centered medication adherence app to support children and adolescents with sickle-cell disease. Methods: An existing mhealth development approach combining a theoretically-based intervention development framework (The Behaviour Change Wheel) a user-centred design (UCD) approach and collaboration with industry guided the development process. A Review of the literature, along with 10 interviews with children and adolescents with sickle-cell disease aged 12-18 years, and consultation with experts, informed app development. Thematic analysis of interviews provided relevant theoretical, user-centered and technological components to underpin the design and development of the app. Results: Inputs from patients helped to identify barriers and enablers to medication adherence in patients’ capability, motivation and opportunity and 10 associated theoretical domains Framework (TDF) domains. Findings suggested that some patients’ had: a limited knowledge of the disease as well as lapses in their memory for taking their medication (Capability); variation in beliefs towards the effectiveness of medication for treating their condition and confidence in self-managing their condition; variations in the perceived link between emotions and pain (Motivation); a limited time to take medication and; barriers and enablers within the changing context of social support during the transition into adulthood (Opportunity). User-centred findings revealed positive feedback to ideas for a quiz and a mood tracker and suggestions for inclusion of techniques and games to distract from pain episodes. Steps were taken to select the appropriate behaviour change techniques and translate them into engaging app features designed to overcome these barriers to medication adherence. Conclusions: Patients with SCD have complex barriers to medication adherence necessitating the need for comprehensive models of behaviours to analyse the problem. Children and adolescents require an app that goes beyond simple medication reminders: taking into account patient’s beliefs, emotions and environmental barriers to medication adherence. Considerations must also be afforded to their desires for techniques and games to manage and distract from their pain. Clinical Trial: N/A
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Validity and reliability of central and peripheral augmentation index estimated by a novel wrist-worn tonometer
From: Journal of Medical Internet Research
Date Submitted: Jun 1, 2017
Open Peer Review Period: Jun 2, 2017 - Jul 28, 2017
Background: Incorporation in clinical practice of pulse wave analysis (PWA) still have difficulties mainly due to training requires and time spent. Objective: Analyze the reliability and validity of P...
Background: Incorporation in clinical practice of pulse wave analysis (PWA) still have difficulties mainly due to training requires and time spent. Objective: Analyze the reliability and validity of Pulse Wave Analysis as reported by a novel wrist-worn device, easy and quick to use, comparing central and peripheral augmentation index (AIx) with the same measures from the SphygmoCor MM3. Additionally, we analyzed the association with other parameters of vascular structure and function, end-organ damage, and cardiovascular risk. Methods: Cross sectional study including 254 subjects. Mean age was 51.9±13.4 and the subject population was 53% women. Main measures reported are: Peripheral AIx (PAIx), Central AIx, (CAIx) by the wrist-worn device and SphygmoCor; carotid-femoral (cf) pulse wave velocity (PWV) by SphygmoCor MM3; cardio-ankle vascular index (CAVI), ankle-brachial index (ABI) y brachial-ankle (ba) PWV by the Vasera device; carotid intima media thickness (IMT) measured using ultrasound; other measures of cardiac and renal function and cardiovascular risk. Results: Intra-observer intra-class correlation coefficient (ICC) for PAIx was 0.886 (95%CI:0.803 to 0.934) and for CAIx was 0.943 (95%CI:0.901 to 0.968) with Bland Altman limits of agreement of -0.75 (-23.8 to 21.8) and 0.08 (-15.7 to 15.9) respectively. The inter-observer ICC for PAIx was 0.952 (95%CI 0.915 to 0.972) and CAIx was 0.893 (95%CI:0.811 to 0.939) with limits of agreement of -0.45 (-13.7 to 12.8) and 0.43 (-17.7 to 18.5) respectively. Comparing the wrist-worn device to SphygmoCor, we observed an ICC of 0.849 (95%CI:0.798 to 0.887) for PAIx, and 0.783 (95%CI:0.711 to 0.838) CAIx. In Bland Altman analysis, limits of agreement for PAIx were -1.03 (-22.73 to 20.67) and CAIx 2.14 (-20.50 to 24.79). PAIx, CAIx, and heart rate-adjusted CAIx (CAIx_HR75) correlated with age, CAVI, ABI, baPWV, cfPWV, IMT, glomerular filtration rate, and cardiovascular risk. Conclusions: The wrist-worn device shows a good intra-observer and inter-observer reliability and inter-device reliability when compared to the SphygmoCor MM3, and a good validity when compared with other clinical measures that evaluate arterial stiffness, end-organ damage and cardiovascular risk. Clinical Trial: Clinicaltrials.gov NCT02623894;https://clinicaltrials.gov/ct2/show/NCT02623894
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Disparities in using information and communication technologies especially video call for family life information sharing with family well-being: A population-based survey
From: Journal of Medical Internet Research
Date Submitted: Jun 2, 2017
Open Peer Review Period: Jun 2, 2017 - Jul 28, 2017
Background: The use of information and communication technologies (ICTs) for information sharing in family members is increasing dramatically. However, little was known about the associated factors an...
Background: The use of information and communication technologies (ICTs) for information sharing in family members is increasing dramatically. However, little was known about the associated factors and how it related to family well-being. Objective: We investigated the pattern and social determinants of family life information sharing with family and the associations of different methods of sharing with perceived family health, happiness and harmony (3Hs) in Hong Kong, where smartphone ownership and Internet access are among the most prevalent, easiest and fastest in the world. Methods: A territory-wide population-based telephone survey was conducted from January to August 2016 on different methods of family life information (information related to family communication, relationships with family members, emotion and stress management) sharing with family members, including face-to-face, phone, instant messaging (IM), social media sites, video call and email. Family well-being was assessed by three single items on perceived family health, happiness and harmony, with higher scores indicating better family well-being. Adjusted prevalence ratios were used to assess the associations of socio-demographic factors with family life information sharing, and adjusted beta coefficients (β) for family well-being. Results: Of 2017 respondents, face-to-face was the most common method to share family life information (74.45%, 1502/2017), followed by IM (40.86%, 824/2017), phone (28.10%, 567/2017), social media sites (11.91%, 240/2017), video call (5.89%, 119/2017) and email (5.48%, 111/2017). Younger age and higher education were associated with the use of any (at least one) method, face-to-face, IM, and social media sites for sharing family life information (all P for trend <.01). Higher education was most strongly associated with the use of video call (adjusted prevalence ratio =5.61, 95% CI 2.29-13.7). Higher household income was significantly associated with the use of any method, face-to-face and IM (all P for trend <.05). Sharing family life information was associated with a higher level of perceived family well-being (β=0.56, 95% CI 0.37-0.75), especially by face-to-face (β=0.62, 95% CI 0.45-0.80) and video call (β=0.34, 95% CI 0.04-0.65). The combination of face-to-face and video call was most strongly associated with a higher level of perceived family well-being (β=0.81, 95% CI 0.45-1.16). Conclusions: The differential use of ICT to share family life information supports the Inverse Information Law. The prevalence of video call was low but associated with much better family well-being. Intervention studies to promote the use of video call to communicate and share information with family, particularly in disadvantaged groups are warranted, and may reduce socioeconomic disparities.
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Using WhatsApp to support quality improvement teams: Experiences from an Indian hospital
From: Journal of Medical Internet Research
Date Submitted: Jun 7, 2017
Open Peer Review Period: Jun 7, 2017 - Aug 2, 2017
Background: Quality improvement involves four steps: 1) forming a team to work on this specific aim, 2) analyzing the reasons for current poor performance, 3) developing changes that could improve car...
Background: Quality improvement involves four steps: 1) forming a team to work on this specific aim, 2) analyzing the reasons for current poor performance, 3) developing changes that could improve care and testing these changes using plan-do-study-act (PDSA) cycles, and 4) putting place interventions to sustain the changes that work. Teamwork and group discussion are key for effective quality improvement, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective: An exploratory qualitative study was performed to examine experiences with WhatsApp as a communication tool which improving adherence to aseptic protocol and how WhatsApp can be used as a coaching tool to strengthen quality improvement team functioning. Methods: Ten quality improvement team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results: WhatsApp was effective for disseminating information, including guides on how to do quality improvement, clinical guidance, and performance indicator data. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (e.g., using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to share information, schedule site visits, and prompt action on behalf of the team. Conclusions: WhatsApp is a productive communication tool that can be used by teams and coaches to disseminate information and prompt action to improve the quality of care, but cannot replace in-person meetings.
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The SCI & U Story: Participatory Design of an Online Self-Management Tool for Spinal Cord Injured Users
From: Journal of Medical Internet Research
Date Submitted: Jun 6, 2017
Open Peer Review Period: Jun 7, 2017 - Aug 2, 2017
Background: Re-hospitalization rates resulting from secondary complications in individuals with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been asso...
Background: Re-hospitalization rates resulting from secondary complications in individuals with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital re-admissions. However, in the SCI community, evidence suggests satisfaction with traditional self-management programs to be low. Persons with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns and are led by peers with SCI. There is currently no program with all of these features and which addresses self-management of secondary complications after SCI. Objective: This study details a Participatory Design (PD) process for an internet-mediated self-management intervention for users with SCI (called SCI & U) and presents initial design and development products resulting from this process. Methods: Users were involved in development as co-designers, co-developers and key informants. Co-designers and co-developers were recruited from Ontario consumer advocacy groups and worked with a core University of Toronto-based development team. Key informants were recruited from geographically distributed consumer advocacy groups to form a product advisory group; this group has met regularly with the core team. During meetings, co-designers and informants have walked through phases of work that typify PD processes, namely exploration, discovery and prototyping. This paper focuses on ten meetings which took place between August 2015 and May 2016. Meetings were recorded, transcribed and analyzed using a qualitative descriptive methodology; resulting themes were then organized based on their relationship to PD phases and design products. Results: A total of 16 individuals participated in meeting discussions, including 7 researchers and 9 persons with SCI from 4 Canadian provinces. Group members with SCI reported using the internet to access self-management information, yet few had experience with interactive tools to promote community dialogue about health conditions, like forums or review sites. Review of existing tools elicited concerns related both to the credibility and volume of online information about self-care. To mitigate concerns, the group proposed and designed systems to filter and promote “credible” online information; these included: 1) community-based ratings and reviews; 2) access to online ‘peer navigators’; and 3) group conversations or chats. Selected design concepts are illustrated. Conclusions: A PD process engaging users as co-designers, co-developers and informants successfully identified key considerations related to the organization and presentation of online self-management information for the SCI community. A working prototype with systems and features proposed by the group is currently available online and is to serve as a baseline for further development.
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Discovering Cohorts of Pregnant Women from Social Media for Safety Surveillance and Analysis
From: Journal of Medical Internet Research
Date Submitted: Jun 8, 2017
Open Peer Review Period: Jun 10, 2017 - Aug 5, 2017
Background: Pregnancy exposure registries are the primary sources of information about the safety of maternal usage of medications during pregnancy. Such registries enroll pregnant women in a voluntar...
Background: Pregnancy exposure registries are the primary sources of information about the safety of maternal usage of medications during pregnancy. Such registries enroll pregnant women in a voluntary fashion early on in pregnancy, and follow them until the end of pregnancy or longer to systematically collect information regarding specific pregnancy outcomes. While the model of pregnancy registries has distinct advantages over other study designs, they are faced with numerous challenges and limitations, such as low enrollment rate, high cost and selection bias. Objective: The primary objectives of this study were to systematically assess if social media (Twitter) can be used to discover cohorts of pregnant women, and to develop and deploy a natural language processing and machine learning pipeline for automatic collection of cohort information. In addition, we also attempted to ascertain, in a preliminary fashion, what types of longitudinal information may potentially be mined from the collected cohort information. Methods: Our discovery of pregnant women relies on detecting pregnancy-indicating tweets (PITs)—which are statements posted by pregnant women regarding their pregnancies. We use a set of 14 patterns to first detect potential PITs. We manually annotated a sample of 14,156 of the retrieved user posts to distinguish real PITs from false positives, and trained a supervised classification system to detect real PITs. We optimize the classification system via cross validation with features and settings targeted towards optimizing precision for the positive class. For users identified to be posting real PITs via automatic classification, our pipeline collects all their available past and future posts, from which other information (e.g., medication usage and fetal outcomes) may be mined. Results: Our rule-based PIT detection approach retrieved over 200,000 posts over a period of 18 months. Manual annotation agreement for three annotators was very high at κ=0.79. On a blind test set, the implemented classifier obtained overall F1-score of 0.84 (0.88 for the pregnancy class; 0.68 for the non-pregnancy class). Precision for the pregnancy class was 0.93, and recall was 0.84. Feature analysis showed that the combination of dense and sparse vectors for classification achieved optimal performance. Employing the trained classifier resulted in the identification of 71,954 users from the collected posts. Over 200 million posts were retrieved for these users, which provided a multitude of longitudinal information about them. Conclusions: Social media sources such as Twitter can be used to identify large cohorts of pregnant women, and to gather longitudinal information via automated processing of their postings. Considering the many drawbacks and limitations of pregnancy registries, social media mining may provide beneficial complementary information. While the cohort sizes identified over social media are large, future research will have to assess the completeness of the information available through them.
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Transforming literature on people’s health experience s into a co-design workshop card-tool to inspire interaction
From: Journal of Medical Internet Research
Date Submitted: Jun 22, 2017
Open Peer Review Period: Jun 23, 2017 - Aug 18, 2017
Background: Patient experiences are an essential focus when designing healthcare services, as they are linked to patient outcomes, safety, clinical effectiveness and more meaningful health interaction...
Background: Patient experiences are an essential focus when designing healthcare services, as they are linked to patient outcomes, safety, clinical effectiveness and more meaningful health interactions. A wealth of peer-reviewed data exists in the current literature that can help with understanding peoples’ experiences of health and health care services. Yet, health improvement teams are unable to find practical ways to use it and may therefore overlook its value. Objective: This study explored how the existing healthcare experience literature can be utilised in healthcare design. A card-tool was developed that can be used in healthcare collaborative design (co-design) workshops to make existing literature accessible and thereby enable understanding of health experiences, trigger discussion and facilitate human-centered healthcare improvements. Methods: Qualitative research, exploring the experience of living with diabetes and preventing diabetic eye disease, was gathered through a review of the literature. The findings were analysed through a process of affinity diagramming to identify insights into the health experience. These insights were developed into a card-tool, the Health Experience Insight Cards: Living with Diabetes edition that was used in a co-design workshop with participants who had relevant professional experience to discuss the future prevention of diabetic eye-disease. Results: The review identified papers 13 papers that fit the selection criteria. These were analysed to develop the Health Experience Insight Cards, Living with Diabetes Edition. Six Participants used the cards, in a co-design workshop. Analysis of the workshop identified three types of interaction that resulted from playing the cards in the design-game: (a) applying the insight from the card to the character/story, (b) discussing real life and (c) discussing experiences. Conclusions: A method was developed to transform patient experience literature into Health Experience Insight Cards. The method aids understanding of experiences, facilitates discussion and enables groups to work towards improving healthcare from a human-centred perspective.
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Sustainable Monitoring and Evaluation Systems to Improve HIV Programs
From: JMIR Public Health and Surveillance
Date Submitted: Jun 8, 2017
Open Peer Review Period: Jun 12, 2017 - Jun 26, 2017
HIV programs have provided a major impetus for investments in surveillance data, with 5-10% of HIV program budgets recommended to support data ( ). However there are questions concerning the sustain...
HIV programs have provided a major impetus for investments in surveillance data, with 5-10% of HIV program budgets recommended to support data ( ). However there are questions concerning the sustainability of these investments ( ). The Sustainable Development Goals (SDGs) have consolidated health into one goal and communicable diseases into one target 3.3. The SDGs now introduce targets focussed specifically on data (17.18 and 17.19). Data is seen as one of the three systemic issues (in goal 17) for implementing the SDGs, alongside policies and partnerships (2). This paper reviews the surveillance priorities agreed by partners in the context of the SDGs. Secondly, the paper highlights the shift from periodic measurement towards sustainable disaggregated, real time, case and patient data, which is used routinely to improve programs. Finally, the key directions in developing person-centred monitoring systems are assessed with country examples ( ). The directions contribute to the SDG focus on people centred development applied to data.
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Study Protocol of SALT: a retrospective multicenter cohort study for determination of the epidemiology of surgical site infections with Staphylococcus Aureus in Europe
From: JMIR Research Protocols
Date Submitted: Jun 16, 2017
Open Peer Review Period: Jun 19, 2017 - Jul 3, 2017
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Background: Surgical site infections (SSI) are among the most common hospital acquired infections. The incidence of SSI in certain indicator procedures is the subject of ongoing surveillance efforts i...
Background: Surgical site infections (SSI) are among the most common hospital acquired infections. The incidence of SSI in certain indicator procedures is the subject of ongoing surveillance efforts in hospitals and healthcare systems around the world. However, SSI rates vary markedly within surgical categories and are poorly represented by routinely surveilled indicator procedures, e.g. mastectomy or hernia surgery. Therefore, relying on indicator procedures to estimate the burden of SSI is imprecise and introduces bias as hospitals may take special precautions to achieve lower SSI rates. The most common cause of SSI is Staphylococcus aureus, as recently confirmed by a Europe-wide point-prevalence study conducted by the ECDC. Objective: The primary objective is to determine the overall and the procedure specific incidence of S. aureus surgical SSI in Europe. As secondary objectives the overall and the procedure specific outcomes as well as the economic burden of S. aureus SSI in Europe will be evaluated. Explorative objectives are to characterize the composition of the surgical patient population and to estimate the number of patients at risk for S. aureus SSI. Methods: We will conduct a retrospective multinational, multicenter cohort study with a nested case-control part. The study includes all surgical procedures at a participating center in order to prevent selection bias and strengthen the understanding of SSI risk by determining incidence for all common surgical procedures. Data will be assessed in two populations: the cohort, including 150.000 adult patients who underwent any surgical procedure in 2016, and the case-control population; we will match patients establishing S. aureus SSI 1:1 with controls from the same center. Regarding the cohort, we will export data on demographics, surgery and microbiology from electronic files. More detailed data will be captured from the case-control population. The SALT study will include 16 major or academic surgical centers in Europe: five in France, four in Germany, two in Italy, three in Spain and two in the UK. Sites were selected using a feasibility questionnaire. Results: The overall and the procedure specific incidence and outcome as well as the economic burden of S. aureus SSI in Europe will be determined. Furthermore, the composition of the surgical patient population in Europe will be characterized and the number of patients at risk for S. aureus SSI will be estimated. Conclusions: Results of the SALT study will help to better understand the precise risk of certain procedures. They will allow conclusions on the overall and the procedure specific incidence and outcome as well as the economic burden of S. aureus SSI in Europe. Findings of the study may help designing clinical trials for S. aureus vaccines. Clinical Trial: The study is registered at www.clinicaltrials.gov.
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Randomized controlled trial of balance training for fall reduction in individuals with COPD
From: JMIR Research Protocols
Date Submitted: Jun 9, 2017
Open Peer Review Period: Jun 12, 2017 - Jun 26, 2017
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Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Although COPD treatment has traditionally focused on respiratory function, secondary e...
Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Although COPD treatment has traditionally focused on respiratory function, secondary effects of the disease are increasingly recognized. A growing body of evidence shows that individuals with COPD have important deficits in balance control that may be associated with an increased risk of falls. Pulmonary rehabilitation (PR) is a key therapeutic intervention for individuals with COPD, however current international guidelines do not include balance training and fall prevention strategies. Objective: The primary aim of this trial is to determine the effects of PR with balance training compared to PR with no balance training on the 12-month rate of falls in patients with COPD. Secondary aims are to determine the effects of the intervention on balance, balance confidence and functional lower body strength, and to estimate the cost effectiveness of the program. Methods: A total of 400 individuals with COPD will be recruited to participate in an international multicenter randomized controlled trial. Individuals with COPD who have a self-reported decline in balance, a fall in the last two years or recent near fall will be randomly assigned to an intervention or control group. Participants will be recruited from nine PR centers across Canada, Europe and Australia. The intervention group will undergo tailored balance training in addition to PR and will receive a personalized home-based balance program. The control group will receive usual PR and a home program that does not include balance training. All participants will receive home visits by a physiotherapist at three, six and nine months to ensure proper technique and progression of home exercise programs as well as monthly phone calls to provide support and problem-solve any issues. The primary outcome will be incidence of falls at 12 months. Falls will be measured using a standardized definition and recorded using monthly self-report fall diary calendars. Participants will be asked to record falls and time spent performing their home exercise program on the fall diary calendars. Completed calendars will be returned to the research centers in pre-paid envelopes each month. Participants will be telephoned monthly to confirm the information, collect any missing data and gather healthcare utilization and loss of productivity data. Secondary measures collected by a blinded assessor at baseline (pre-PR), post-PR and 12 months will include clinical measures of balance, balance confidence, functional lower body strength and health status using the EQ-5D-5L. The cost effectiveness for the intervention group compared with the control group will be evaluated using the incremental cost per number of falls averted and the incremental cost per quality adjusted life years (QALY) gained. Results: Recruitment for the study began in January 2017 and is anticipated to be complete by December 2019. Results are expected to be available in 2020. Conclusions: Findings from this study will improve our understanding of the effectiveness and resource uses of tailored balance training for reducing falls in individuals with COPD. If effective, the intervention represents an opportunity to inform international guidelines and health policy for PR in individuals with COPD who are at risk of falling. Clinical Trial: NCT 02995681
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Heart Rate Monitoring Apps: the Rules Have Just Changed - or Have They? What Engineers and Researchers Ought to Know About Regulation (EU) 2017/745.
From: JMIR Cardio
Date Submitted: Jun 9, 2017
Open Peer Review Period: Jun 9, 2017 - Aug 4, 2017
Background: After years in the making, on 5 April 2017 the European Parliament and Council finally adopted Regulation (EU) 2017/745, the new Medical Device Regulation (MDR), repealing the existing Med...
Background: After years in the making, on 5 April 2017 the European Parliament and Council finally adopted Regulation (EU) 2017/745, the new Medical Device Regulation (MDR), repealing the existing Medical Device Directive (MDD) 93/42/EEC. Though long anticipated, this shift in policy will have strong and lasting effects in the medical devices industry. Objective: This Article focuses specifically on the classification of software as potential medical device under MDD and MDR and examines whether or not the regulatory framework for apps has changed substantially and what (if any) impact is to expected. It is aimed primarily at researchers and engineers unfamiliar with regulatory requirements for medical devices. This is of particular relevance as with the exponential growth of fitness and health-related apps the lines between toys, lifestyle products and medical devices have increasingly blurred. Methods: The recently published European Medical Device Regulation is analyzed and compared to the preceding MDD. Results: The previous regulatory framework already provided for the possibility of apps to fall under the definition of medical devices and classification rules for active medical devices applied. Under the new MDR the threshold for classifying as medical device has considerably been lowered. Conclusions: The adoption of the new European regulation on medical devices entails the serious risk that manufacturers previously unaffected by the medical devices regulatory framework may now unwillingly and unwittingly find themselves in the arena of medical device manufacturers.
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Mining the Posts with Unified Medical Language System Metathesaurus to Enhance Online Patients' Knowledge Support
From: Journal of Medical Internet Research
Date Submitted: Jun 13, 2017
Open Peer Review Period: Jun 13, 2017 - Aug 8, 2017
Background: Online health communities (OHCs) provide patients effective social healthcare services and a channel where patients can discuss their health conditions and share their experiences with oth...
Background: Online health communities (OHCs) provide patients effective social healthcare services and a channel where patients can discuss their health conditions and share their experiences with others. The posts contain a vast amount of biomedical information in natural language, including drugs, symptoms and conditions, but are hard for secondary use to provide better knowledge support to online patients in disease prevention and self-management due to the semantic complexity of the texts. Objective: The objective of this study is to propose a practical mining method to make the best use of explicit and implicit biomedical knowledge in the patient-reported posts to improve patients’ abilities of seeking knowledge support online. Methods: By integrating the biomedical knowledge sources including Unified Medical Language System (UMLS) Metathesaurus, Systematized Nomenclature of Medicine -- Clinical Terms (SNOMED CT), and MetaMap program, a new mining method is proposed. Furthermore, we collected 372,343 patient-reported posts from an OHC to test the proposed mining method in terms of information extraction and knowledge discovery. Three metrics, namely the Knowledge Richness Degree (KRD), the Potential Knowledge Conversion Rate (PKCR) and the Knowledge-Constrained Online Behavior Index (KC-OBI), are proposed to evaluate the performance of the proposed method to provide knowledge support. Results: The results of the experiment on 671 drug-related posts (0.18% of total 372,343 posts), show significant difference between our proposed mining method and traditional dictionary-based method according to the Mann-Whitney Test with α=.05 and P<.001. The distribution of the KRD falls in the range [0.20, 0.60] for the traditional method and in the range [0.03, 0.20] for our proposed method. According to the evaluation of the changes of PKCR , as the number of discovered biomedical concepts increases; however, the PKCR of the post reduces (Skewness=5.93, Kurtosis=40.47, P=.003<.05), which exponentially reduces. Conclusions: The results suggest that by integrating the biomedical domain knowledge into the process of mining online posts, the healthcare platforms are enhanced to implement the knowledge-based support for online patients in their disease prevention and continual self-management training. Therefore, the designers of the community should make use of the biomedical knowledge indicators to help the system to implement machine learning techniques to analyze the online health reports.
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Using Social Media Content to Assess the Population Impact of a New Paediatric Influenza Vaccination Programme in England
From: Journal of Medical Internet Research
Date Submitted: Jun 15, 2017
Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017
Background: A new childhood live attenuated influenza vaccine (LAIV) programme was launched in England in 2013, which consisted of a national campaign for all 2 and 3 year olds and several pilot locat...
Background: A new childhood live attenuated influenza vaccine (LAIV) programme was launched in England in 2013, which consisted of a national campaign for all 2 and 3 year olds and several pilot locations offering the vaccine to primary school (4-11 years) children during the influenza season. The 2014/15 influenza season saw the national programme extended and included additional pilot regions, some of which offered the vaccine to secondary school (11-13 years) children as well. Objective: We utilise social media content to obtain a complementary assessment of the programmes that were launched in England during the 2013/14 and 2014/15 flu seasons. The overall community-wide impact on transmission in pilot areas is estimated for the different age groups that were targeted for vaccination. Methods: A previously developed statistical framework is applied, which consists of a non-linear regression model that is learnt to infer influenza-like illness (ILI) rates from Twitter posts originating in pilot (vaccinated) and control areas. The control areas are then used to estimate ILI rates in pilot areas, had the intervention not taken place. These predictions are compared with their corresponding Twitter-based ILI estimates. Results: Results suggest a reduction in ILI rates of 14% (1%-25%) and 17% (2%-30%) across all ages in primary school age only vaccine pilot areas during the 2013/14 and 2014/15 influenza season, respectively. No significant impact is observed in areas where only two age cohorts of secondary school children were vaccinated. Conclusions: These findings corroborate independent assessments from traditional surveillance data, thereby informing on the most effective vaccination strategies for the campaign and providing evidence of the value of social media content as an additional syndromic surveillance tool.
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Are SMS based maternal health information messages cost effective in improving utilization of maternal and child health services in Gauteng, South Africa?
From: JMIR Medical Informatics
Date Submitted: Jun 11, 2017
Open Peer Review Period: Jun 13, 2017 - Aug 8, 2017
Background: Limited evidence exists on the value for money of SMS health information programs in low resource settings. Objective: Drawing from data collected as part of a retrospective study explorin...
Background: Limited evidence exists on the value for money of SMS health information programs in low resource settings. Objective: Drawing from data collected as part of a retrospective study exploring the effectiveness of messaging exposure on utilization of maternal and child health services, we modelled the incremental cost effectiveness of gradually scaling up messaging services to pregnant women throughout Gauteng province, South Africa from 2012-2017. Methods: Stage based maternal health SMSs were sent to pregnant women twice per week in pregnancy and continued until the infant's first birthday. Program costs, incremental costs to users and the health system, were measured along with changes in utilization of antenatal care (ANC) visits and childhood immunizations, and compared against a control group of pregnant women who received no SMS messages. Incremental changes in utilization were inputted into the Lives Saved Tool and used to forecast lives saved and DALYs averted of gradually scaling up program activities to reach 60% of pregnant women across Gauteng province within 5 years. Uncertainty was characterized using one way and probabilistic uncertainty analyses. Results: Five-year program costs are estimated to be $1.2 million USD; 17% of which were incurred by costs on program development and 31% on SMS message delivery costs. Costs to users were $1.66 to attend clinic based services; nearly 90% of which was attributed to wages lost. Costs to the health system included provider time costs to register MAMA users ($0.08) and provide ANC 1-4 ($4.36) and PNC 1-5 ($3.08) services. Incremental costs per DALY averted from a societal perspective ranged from $1,985 USD in the first year of implementation to $200 USD in the 5th year. At a willingness to pay threshold of $2,000 USD, the project had a 40% probability of being cost effective in year 1 versus 100% in all years thereafter. Conclusions: Study findings suggest that SMS health information messages delivered to pregnant women may be a cost-effective strategy for bolstering ANC and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modelled results. Clinical Trial: Not applicable
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Feasibility and acceptability of a mobile breast cancer survivorship care application: Pilot study
From: JMIR Cancer
Date Submitted: Jun 12, 2017
Open Peer Review Period: Jun 13, 2017 - Aug 8, 2017
Background: Background: Survivors living in rural areas experience unique challenges due to additional burdens such as travel and limited access to specialists. Rural survivors of breast cancer have r...
Background: Background: Survivors living in rural areas experience unique challenges due to additional burdens such as travel and limited access to specialists. Rural survivors of breast cancer have reported poorer outcomes, mental health and physical functioning, as well as lower than average quality of life compared to urban survivors. Objective: Objective: To explore the feasibility and acceptability of developing a mobile health survivorship care application to facilitate care coordination, support medical, psychosocial, and practical needs, and improve survivors' long-term health outcomes. Methods: Methods: An interactive prototype application, SmartSurvivor, that included recommended survivorship care plan components was developed. The prototype's feasibility and acceptability were tested by a sample of breast cancer survivors (n=6) and health care providers (n=5). Results: Results: Overall, both survivors and providers felt that SmartSurvivor was a potentially valuable tool to support long-term survivorship care plan objectives. Portability, accessibility, and having one place for all contact, treatment, symptom tracking, and medication summaries was highly valued. Conclusions: Conclusions: Our pilot indicates that SmartSurvivor is a feasible and acceptable approach to meeting survivorship care objectives and the needs of both breast cancer survivors and their health care providers. Exploration of mobile health options for supporting survivorship care plan needs is a promising area of research.
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Towards developing consumer health vocabulary by mining health forum texts based on word vector space: a semi-automatic approach
From: Journal of Medical Internet Research
Date Submitted: Jun 15, 2017
Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017
Background: Vocabulary gap between consumers and professionals in medical domain hinders information seeking and communication. Objective: To explore the application of a distributed word vector space...
Background: Vocabulary gap between consumers and professionals in medical domain hinders information seeking and communication. Objective: To explore the application of a distributed word vector space model to identify new words in certain semantic categories, to build up a Chinese consumer health vocabulary, and to fill the gap between professional medical terminology and consumer vocabulary. Methods: Textual content from one of the largest Chinese online community, the Tianya community, was crawled and extracted. Word2vec was employed to construct a word vector for each word in the corpus. Then we used small sets of terms from ICD-10 and other human-curated dictionaries as seed words, from which we expand the vocabularies by calculating word-word similarities and word-category similarities. We explored how these word vectors help find synonyms for each term, and help identify new terms that belong to certain semantic categories. Results: The best precision for finding new words via the category representative word vector was 90%, and the coverage of words belong to the categories expanded as much as 14.51 times. Experimental results demonstrate that the method is able to identify common misspellings and abbreviations frequently used by consumers which does not exist in original professional terminologies. Conclusions: This study demonstrates the effectiveness of using distributed word vector as semantic representations of health-related consumer words in Chinese, and its capability to identify new words in certain semantic categories via calculating word-word similarities and word-category similarities. We show that our method has the potential to be employed to develop a Chinese consumer health vocabulary to improve consumers’ experiences in searching health information. Clinical Trial: None
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The effect of aging on physical performance among elderly craftsmen: A study protocol
From: JMIR Research Protocols
Date Submitted: Jun 13, 2017
Open Peer Review Period: Jun 13, 2017 - Jun 27, 2017
Background: In 2012, the Danish Parliament decided to increase retirement age. Unfortunately, craftsmen working in a physically demanding environment may be rendered unable to retain the ability to ad...
Background: In 2012, the Danish Parliament decided to increase retirement age. Unfortunately, craftsmen working in a physically demanding environment may be rendered unable to retain the ability to adequately perform the physical requirements of their jobs, due to the age-related decrease in physical performance. Therefore, increasing the retirement age may not necessarily lead to the goal of keeping everybody in the labour market for a longer time. To date, our knowledge about the changes in physical performance of the elderly workforce is limited. In this cross-sectional study we seek to investigate the effects of aging on physical performance among elderly craftsmen. Methods: Approximately 100 Danish craftsmen between 50-70 years old will be recruited. The main measurement outcomes include (I) inflammatory status from blood samples, (II) body composition, (III) lung function, (IV) static and dynamic balance, (V) reaction time, precision, and movement variability during a hammering task, (VI) handgrip strength, rate of force development and force tracking, and (VII) estimated maximal rate of oxygen consumption. Additionally, information regarding working conditions, physical activity levels, and health status will be assessed with a questionnaire. Discussion: This study will increase the knowledge regarding changes in physical performance in the elderly workforce and may identify potential workplace hazards. Moreover, this study might shed light on the potentially problematic decision to increase retirement age for all.
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“Eating chicken feet with pickled peppers cause avian influenza”? An observational case study on a hot topic in the Chinese social media during the avian influenza A (H7N9) outbreak
From: Journal of Medical Internet Research
Date Submitted: Jun 13, 2017
Open Peer Review Period: Jun 13, 2017 - Aug 8, 2017
Background: A hot topic on the relationship between a popular avian-origin food and avian influenza occurred in the social media during the outbreak of the emerging avian influenza A (H7N9). The misin...
Background: A hot topic on the relationship between a popular avian-origin food and avian influenza occurred in the social media during the outbreak of the emerging avian influenza A (H7N9). The misinformation generated from this topic had caused great confusion and public concern. Objective: Our goals were to explore the trend and contents of the relevant posts with the hot topic. We also aimed to understand the characteristics of the misinformation and to provide suggestion to reduce public misconception in the social media during the emerging disease outbreak. Methods: The original microblog posts were collected from China’s Sina Weibo and Tencent Weibo using a combination of key words between April 1, 2013 and June 2, 2013. We analyzed the weekly and daily trend of the relevant posts. Content analysis were applied to categorize the posts into four kinds with a unified sorting criteria. The posts’ characteristics and geographic locations were also analyzed in each category. We conducted further analysis on the top 5 most popular misleading posts. Results: A total of 1680 original microblog posts on the topic were retrieved and 341 (20.3%) of them were categorized as “misleading messages”. The number of relevant posts had not increased a lot during the first 2 weeks but rose to a high level in the next 2 weeks after the suddenly rising number of reported cases at the beginning of week 3. The posts under “misleading messages” also occurred and increased from the beginning of week 3, but their daily posting number decreased when the daily number of posts under “correcting messages” outnumbered them. The bloggers of the misleading posts had the lowest mean rank of followers and previous posts, but their posts had a higher mean rank of the replies or number of retweets. The proportion of “misleading messages” in the places with no reported cases was significantly higher than that in the epidemic areas (25.8%>16.4%). The most popular misleading posts appeared to be narrative and attractive. Conclusions: Our findings suggested the importance to respond to common questions and misconception in the social media from the beginning of disease outbreaks. Authorities need to release clear and reliable information related to the popular topics early. The bloggers posting correct information should be empowered and their posts could be promoted to clarify false information. Equal importance should be attached to clarify misinformation in both the outbreak and non-outbreak areas.
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High-yield HIV testing, facilitated linkage to care, and prevention for female youth in Kenya (GIRLS Study): An implementation science protocol for a priority population
From: JMIR Research Protocols
Date Submitted: Jun 13, 2017
Open Peer Review Period: Jun 14, 2017 - Jun 28, 2017
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Background: Sub-Saharan Africa (SSA) is the region with the highest HIV burden. Adolescent girls and young women (AGYW) aged 15-24 years are twice as likely as their male peers to be infected, making...
Background: Sub-Saharan Africa (SSA) is the region with the highest HIV burden. Adolescent girls and young women (AGYW) aged 15-24 years are twice as likely as their male peers to be infected, making females in SSA the most at risk group for HIV infection. Despite the need to increase knowledge of HIV status in this priority population, access, and uptake of testing remains low. High fertility, early coitarche, intergenerational sex and low likelihood of partner circumcision put many young women at increased risk. It is therefore critical to prioritize access to HIV testing, prevention, and treatment for this vulnerable population. Objective: Using an implementation science framework, the purpose of this research protocol is to describe the innovative approaches we propose to optimize engagement of AGYW in both the HIV prevention and care continuum. Methods: We will evaluate prevention-treatment continuum interventions to increase uptake of HIV testing, linkage to and retention in care, and high-impact prevention among AGYW. We will rigorously compare two ‘seek’ recruitment strategies, three ‘test’ strategies including a self-testing option, and pilot adaptive ‘linkage’ to care interventions (SMART design), among at-risk AGYW aged 15-24 years in Homa Bay County, western Kenya. Additionally, we will evaluate a scalable primary prevention messaging intervention to support identified high risk HIV-negative AGYW in reducing HIV risk and adhering to recommended HIV re-testing frequency. We will conduct cost effectiveness analyses to determine the relative utility of each seek, test, link, and prevention intervention. Results: Recruitment began the last week of May 2017, with anticipated 12 months of accrual and 12 months of follow-up. We expect to enroll 1,200 participants overall, with a random selection of 100 high risk HIV-negative AGYW for the prevention intervention (HIV-negative cohort) and approximately 108 HIV-positive AGYW for the SMART design pilot of adaptive linkage to care interventions (HIV-positive cohort). Conclusions: Lessons learned will inform best practices to increase adolescent girls and young women’s uptake of HIV prevention, testing, and linkage to care services in a high-HIV burden African setting. Clinical Trial: ClinicalTrials.gov identifier: NCT02735642 https://clinicaltrials.gov/ct2/show/NCT02735642
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Fall Detection in Individuals with Lower-limb Amputation using Mobile Phones: Machine Learning Enhances Robustness for Real-World Applications
From: Journal of Medical Internet Research
Date Submitted: Jun 13, 2017
Open Peer Review Period: Jun 14, 2017 - Aug 9, 2017
Background: Automatically detecting falls with smartphones provides an opportunity for rapid response to injuries and better knowledge of what precipitated the fall and its consequences. This is benef...
Background: Automatically detecting falls with smartphones provides an opportunity for rapid response to injuries and better knowledge of what precipitated the fall and its consequences. This is beneficial for populations that are prone to falling, such as people with lower limb amputations. Many prior studies have focused on fall detection in able-bodied individuals and using data from a lab-setting only. Such approaches may provide a limited ability to detect falls in amputees and in real-world scenarios. Objective: We sought to develop a classifier which uses data from able-bodied subjects to detect falls in individuals with a lower-limb amputation, as they freely carry the smartphone in different locations both in lab and at home. Methods: We obtained 861 simulated indoor and outdoor falls from 10 young able-bodied subjects and 6 individuals with a lower limb amputation. In addition, we recorded a broad database of activities of daily living (ADL), including data from 3 subjects’ free-living routine. Sensor readings (accelerometer and gyroscope) from a smartphone were recorded, as subjects freely carried it in three common locations – on the waist, in a pocket, and in the hand. A set of 40 features were computed from the sensors data and 4 classifiers were trained and combined through stacking to detect falls. We compared the performance of 2 population-specific models, trained and tested on either healthy or amputee subjects, with that of a model trained on healthy subjects and tested on amputees. A simple threshold-based classifier was used to benchmark our machine learning classifier. Results: The accuracy of fall detection in amputees for a model trained on able-bodied (Sens: 0.98 ± 0.02, Spec: 0.97 ± 0.03) was not statistically different (P = 0.69) from that of a model trained on the amputee population (Sens: 0.98 ± 0.02, Spec: 0.97 ± 0.02). Detection of falls in able-bodied yielded similar results (Sens: 0.98 ± 0.02, Spec: 0.99 ± 0.01). An average number of 2.2 ± 1.69 false alarms per day were obtained when evaluating the model (vs 122 ± 166 based on thresholds) on data recorded as subjects carried the phone during their daily routine for 2 or more days. Machine learning classifiers outperformed the threshold-based one (P < 0.002). Conclusions: A smartphone-based fall detection model can use data from able-bodied to detect falls in individuals walking with a prosthesis. We successfully detected falls when the mobile phone is carried across multiple locations and without a predetermined orientation. Furthermore, the number of false alarms yielded by the model over a longer period of time was reasonably low, considering that users carried and used the phone freely and without any specific instruction. This moves the application of smartphone-based fall detection systems closer to a real-world use case scenario.
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Development and Pretest of a Computer-assisted Personal Interview in REDCapTM to Administer Time Trade-off Surveys
From: Journal of Medical Internet Research
Date Submitted: Jun 13, 2017
Open Peer Review Period: Jun 16, 2017 - Aug 11, 2017
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Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represe...
Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality-of-life (HRQoL). Software applications exist to administer the TTO task; however, most of these applications are poorly documented and unavailable to researchers. Objective: To fill the void, we developed an online application to administer the TTO task for a research study that is examining general public proxy HRQoL estimates for persons with Alzheimer’s disease (AD). This manuscript describes the development and pretest of the application. Methods: We used Research Electronic Data Capture (REDCap™) to build the TTO application. The application’s modular structure and REDCap™’s object-oriented environment facilitated development. After the TTO application was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease-of-use. Results: Feedback from the pretest group was positive. Minor modifications included clarity enhancements, i.e., re-arranging some paragraph text into bullet points, labelling the application to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease (AD). Conclusions: We developed an online application to administer the TTO task. Other researchers may access and customize the application for their own research purposes.
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A cross-sectional study on the influence of fear of pain and coping strategies on health-related quality of life and patient-anticipated outcomes in chronic pain patients: A study protocol.
From: JMIR Research Protocols
Date Submitted: Jun 14, 2017
Open Peer Review Period: Jun 14, 2017 - Jun 28, 2017
Background: Fear of pain and coping strategies, are emotional behavioural responses to pain. Both are known to play an important role in development and maintenance of pain. It is highly likely that f...
Background: Fear of pain and coping strategies, are emotional behavioural responses to pain. Both are known to play an important role in development and maintenance of pain. It is highly likely that fear of pain and coping strategies influence each other, potentially affecting the course of chronic pain. To our knowledge, the relationship between pain, fear of pain and coping strategies and how they influence patient-anticipated outcomes and health-related quality of life has not been investigated. Objective: This study aims to test 2 hypotheses; (i) both fear of pain and coping strategies are sufficient causes for maintaining pain and (ii) fear of pain influences coping strategies and pain. The study will also examine the impact of fear of pain and coping strategies on health-related quality of life and patient-anticipated outcomes. Methods: The study will be conducted using a cross-sectional design - online survey. Three validated questionnaires; Fear of Pain questionnaire-III; Brief COPE questionnaire and EuroQoL-5d will be used to collect data. In addition, information pertaining to demographic factors, pain related factors and patient-anticipated outcomes will also be collected. The study has ethics approval from Human Research Ethics Committee, The University of Adelaide. The study participants will be individual’s aged 18 years and above who are experiencing pain for last 6 months. Effect measure modification technique will be used to examine if fear of pain acts as a moderator or mediator between coping strategies and pain. Simple and multinomial logistic regression analysis will be used to examine effect of fear of pain and coping strategies on health-related quality of life and patient-anticipated outcomes. Results: The findings from this study will help to extend our understanding on fear of pain and coping strategies; their interaction and their impact on health-related quality of life and patient-anticipated outcomes. Conclusions: This study findings may help health care professionals and researchers to tailor management strategies to suit individual patient framework.
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Clinical decision support systems for drug allergy checking: a systematic review
From: Journal of Medical Internet Research
Date Submitted: Jun 15, 2017
Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017
Background: Worldwide the burden of allergies, and in particular drug allergies, is growing. In the process of prescribing, dispensing or administering a drug, a medication error can occur, which can...
Background: Worldwide the burden of allergies, and in particular drug allergies, is growing. In the process of prescribing, dispensing or administering a drug, a medication error can occur, which can have adverse consequences, for example when a drug is given to a patient with a documented allergy to this particular drug. Computerized physician order entry systems (CPOE) with built-in clinical decision support systems (CDSS) have the potential to prevent these medication errors and consequent adverse events. Objective: In this systematic review, we provide a comprehensive overview regarding all aspects of CDSS for drug allergies including development, implementation, coding terminologies, and outcome evaluation. Methods: PRISMA guidelines were followed and searches were conducted in five databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Results: Of the 3,160 articles considered, 60 met the inclusion criteria. Nine additional articles were added based on expert opinion, resulting in a total of 69 articles. Large heterogeneity across study objectives, study designs, study populations and reported results was found. Several key findings were identified. Evidence of the usefulness of CDS for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of drug allergy information in the electronic health record is difficult, as it is often not clear for healthcare providers how and where to document drug allergies. Besides underreporting of drug allergies, outdated or inaccurate drug allergy information in the electronic health record poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is a lack of use of a generally accepted standard terminology for the structured documentation of allergy information. A last key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90% leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We only found one study specifically reporting on outcome related to CDSS for drug allergies. It showed that ADEs resulting from overridden drug allergy alerts do not occur frequently. Conclusions: Accurate and comprehensive recording of drug allergies is required for the good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergies are recorded in the EHR. It remains difficult to reduce drug allergy alert overload while keeping patient safety as highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Also the effect on patient outcome and the cost-effectiveness should be evaluated.
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Replacing Alumni Surveys with Extant Internet Data plus a Single-Question Survey
From: Journal of Medical Internet Research
Date Submitted: Jun 16, 2017
Open Peer Review Period: Jun 19, 2017 - Aug 14, 2017
Background: A standardized alumni survey that is short, provides program-specific feedback, and could allow programs to compare their performance to each other is not available. Objective: To test if...
Background: A standardized alumni survey that is short, provides program-specific feedback, and could allow programs to compare their performance to each other is not available. Objective: To test if a single-question survey, along with additional information readily available on the web, can be used to create a standardized alumni survey for academic programs. Methods: Alumni surveys were conducted for two programs: Master of Health Administration (MHA) and Master of Science in Health Informatics (MSHI). Most of the information collected through alumni surveys (demographic, emails, career information, industry, location of work, and estimated salary) were obtained by examining information available on the alumni on the web. Additional information (review of program content and courses) was obtained by emailing the alumni and asking them “Regarding your recent degree, what worked well and what needed improvement?” The available data and alumni responses were weighted to be representative of all alumni and not just the group whose information were on the web. Results: Among 41 MHA and 50 MSHI alumni 1-2 years out of the program, email information was available 43% and 55% of time respectively. Other information, including demographic (100%, 100%), current employer (89%, 82%), and estimated salary (78%, 74%) were also widely available. When available, the average estimated salary for MHA graduates 1-2 years out was $92,957 and for MSHI graduates was $72,904. In addition, among the MHA and MSHI who were contacted by email, 75% of MHA and 34% of MSHI alumni completed the free-text program review. Their comments were detailed and program specific. Independent reviewers classified comments into Curriculum, Program Organization, Capstone Related, Job Placement, External Relationships, Student Body, Personal Growth, and Value/Cost categories. Most comments (80% for MHA and 74% for MSHI) were positive and focused on program organization and program curriculum. Conclusions: The proposed alumni survey can be applied to different programs. Items in this survey had a high response/availability rate. The survey identified the impact of the program on employment and salary. Furthermore, the program review component of the survey provided useful insight on how programs could be improved in the future. Additionally, these procedures can be used to benchmark different programs against each other.
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User acceptance of smart wrist bands among community dwelling older adults: A mixed method study
From: JMIR mHealth and uHealth
Date Submitted: Jun 14, 2017
Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017
Background: Smart wrist bands are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer grade smart wrist bands are increasingly ubiquitous in the mark...
Background: Smart wrist bands are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer grade smart wrist bands are increasingly ubiquitous in the market but the acceptance, attitudes, and voluntary use among older adults are poorly understood. Objective: To assess acceptance and usage of smart wrist bands in Canadian community dwelling older adults using the potentially influential factors as identified in literature and technology acceptance model. Methods: A mixed methods design was used. Twenty older adults aged 55 and older were recruited from the Southwestern Ontario. Participants used two different smart wrist bands (Xiaomi Mi Band and Microsoft Band) separately for each segment in the cross-over design study for 21 days (i.e. 42 days total). A questionnaire was developed to capture acceptance and experience at the end of each segment, representing two different devices. Semi-structured interviews were conducted with 4 participants and a content analysis was performed. Results: Participants ranged in age from 55-84 (mean 64). The Mi Band gained higher levels of acceptance (80%) compared to the Microsoft Band (50%). Equipment characteristics dimension scored significantly higher for the Mi Band (p<0.05). The amount a participant was willing to pay for the device was highly associated with technology acceptance (p<0.05). Multivariate logistic regression with three covariates resulted in an area under the curve of 0.79. Content analysis resulted in the formation of four main themes: 1) smartphones as facilitators of smart wrist bands, 2) privacy is less of a concern for smart wrist bands, 3) value proposition: self-awareness and motivation, 4) subjective norm, social support, and sense of independence, and 5) equipment characteristics matter: display, battery, comfort and aesthetics. Conclusions: Older adults were mostly accepting of smart wrist bands and they had a clear understanding of its value for their lives. Smart wrist bands were uniquely considered more personal than other types of technologies, thereby its equipment characteristics including comfort, aesthetics, and price had significant impact on the acceptance. Results indicated that privacy was less of concern for older adults but it may have stemmed from a lack of understanding of the privacy risks and implications. These findings add to emerging research that investigates acceptance and factors that may influence acceptance of smart wrist bands among older adults.
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Mining Online Author’s Publication to Report the Core Research Domain with PubMed MeSH Terms: A Systematic Review for a Journal
From: Journal of Medical Internet Research
Date Submitted: Jun 15, 2017
Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017
Background: Identifying an author’s research domain (RD) using MeSH (Medical Subject Headings) terms is important for a journal’s development and for its readership, but no journal uses mining onl...
Background: Identifying an author’s research domain (RD) using MeSH (Medical Subject Headings) terms is important for a journal’s development and for its readership, but no journal uses mining online methods or social network analysis (SNA) to extract journal publication information to report an author’s contributions. Objective: To select prestigious authors and papers that have contributed most to a journal, we retrospectively (1) calculated an SCI (Science Citation Index) journal’s most recent impact factors (IF) and (2) used graphical representations that include MeSH terms of RDs for authors and journals. Methods: We collected 2053 papers published between July 1, 1999, and April 3, 2017, in the Journal of Medical Internet Research (JMIR) and cited by 673 journals, for which we also collected annual IFs for 394 SCI journals, including the JMIR. The prestigious authors and JMIR papers based on the weight of the 5-year SCI IFs from 394 cited-by papers in 2015. The JMIR core aims and scope are presented using major MeSH terms based on their corresponding average weighted scores. Social network analysis was used to create a graphical RD pattern for JMIR, and its prestigious papers and authors. Results: All JMIR 5-year IFs have not been less than 2.9 for the past 14 years. The authors who contributed most to JMIR in number of publications and in weighted citations are Gunther Eysenbach and My Hua. Their cohesion measures (ranging from 0 to 1.0) to JMIR are 34% and 5.7%, respectively. The highest prestige weighted contribution among papers published in JMIR is the one (PMID: 23567935 /DOI: 10.2196/jmir.2324 ) with a cohesion measure of 4.5%. Conclusions: An author’s research domain is required with an essential and graphical presentation along with the author’s submission to the target journal. Journal editors also look forward to evaluating an author’s research domain and the submitted paper’s cohesion measure for the journal.
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A Predictive Cognitive Model for Implementation Intention and Reminder Effects on Behavior Change in a Mobile Health System
From: Journal of Medical Internet Research
Date Submitted: Jun 21, 2017
Open Peer Review Period: Jun 21, 2017 - Jun 30, 2017
Background: Implementation intentions are mental representations of simple plans to translate goal intentions into behavior under specific conditions. Studies show implementation intentions can produc...
Background: Implementation intentions are mental representations of simple plans to translate goal intentions into behavior under specific conditions. Studies show implementation intentions can produce moderate to large improvements in behavioral goal achievement. Human associative memory mechanisms have been implicated in the processes by which implementation intentions produce effects. Based on the ACT-R theory of cognition, we hypothesized that the strength of implementation intention effect could be manipulated in predictable ways using reminders delivered by a mobile health (mHealth) application. Objective: The aim of this experiment was to manipulate the effects of implementation intentions on daily behavioral goal success in ways predicted by the ACT-R theory concerning concerning mHealth reminder scheduling. Methods: An incomplete factorial design was used in this mHealth study. All participants were asked to choose a healthy behavior goal associated with Eat Slowly, Walking, or Eating More Vegetables, and were asked to set implementation intentions. N = 66 adult participants were in the study for 28 days. Participants were stratified by Self-Efficacy and assigned to one of two Reminder conditions: Reminders-presented versus Reminders-absent. Self-Efficacy and Reminder conditions were crossed. Nested within the Reminders-presented condition was a crossing of Frequency of reminders sent (High, Low) by Distribution of reminders sent (Distributed, Massed). Participants in the Low Frequency condition got 7 reminders over 28 days; those in the High Frequency condition were sent 14. Participants in the Distributed conditions were sent reminders at uniform intervals. Participants in the Massed Distribution conditions were sent reminders in clusters. Results: There was a significant overall effect of reminders on achieving a daily behavioral goal (coefficient = 2.018, SE = 0.572, odds ratio = 7.52, 95% CI [0.9037, 3.2594], P < .001). As predicted by ACT-R, using default theoretical parameters, there was an interaction of reminder Frequency by Distribution on daily goal success (coefficient = 0.7994, SE = 0.2215, odds ratio = 2.2242, 95% CI [0.3656, 1.2341], P < .001). The total number of times a reminder was acknowledged as received by a participant had a marginal effect on daily goal success (coefficient = 0.0694, SE = 0.0410, odds ratio = 1.0717, 95% CI [-0.01116, 0.1505], P = 0.09) and the time since acknowledging receipt of a reminder was highly significant (coefficient = -0.0490, SE -= 0.0104, odds ratio, 95% CI [-0.0700, -0.2852], P < .001). A dual system ACT-R mathematical model was fit to individuals’ daily goal successes and reminder acknowledgments: A goal-striving system dependent on declarative memory and a habit-forming system that acquires automatic procedures for performance of behavioral goals. Conclusions: Computational cognitive theory, such as ACT-R, can be used to make precise quantitative predictions concerning daily health behavior goal success in response to implementation intentions and the dosing schedules of reminders.
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A comparison of self-reported telephone interview and online survey responses: findings from the Second Australian Young and Well National Survey
From: JMIR Mental Health
Date Submitted: Jun 16, 2017
Open Peer Review Period: Jun 16, 2017 - Aug 11, 2017
Background: Online self-report surveying has increased in popularity as it can rapidly yield large samples at low cost. Despite this popularity, in the area of youth mental health there is a distinct...
Background: Online self-report surveying has increased in popularity as it can rapidly yield large samples at low cost. Despite this popularity, in the area of youth mental health there is a distinct lack of research comparing the results of online self-report surveys to the more traditional and widely accepted computer-assisted telephone interview (CATI). Objective: The Second Australian Young and Well National Survey 2014 sought to compare differences in respondent response patterns using matched items on a CATI vs an online self-report survey. Additional objectives were to examine whether responses varied as a result of item sensitivity; that is, the item’s susceptibility to exaggeration on under-reporting, and to assess whether certain subgroups demonstrated this effect to a greater extent. Methods: A sub-sample of young people aged 16 to 25 years (N=101), recruited through the Second Australian Young and Well National Survey 2014, completed the identical items on two occasions, via CATI and online self-report survey. Respondents also rated perceived item sensitivity. Results: When comparing CATI to online self-report survey, a Wilcoxon signed-rank analysis showed that respondents answered 14 of the 42 matched items in a significantly different way, many of which were perceived as highly sensitive in nature (62.5% ‘high sensitivity’ items, 42.9% ‘neutral sensitivity’ items, 0% ‘low sensitivity’ items). The items which were perceived as highly sensitive by respondents and demonstrated variability included: sexting activities, body image concerns, experience of diagnosis and suicidal ideation. For ‘high sensitivity’ items, a regression analysis showed respondents who were male (β = -.19, P = .05) or were not in employment, education or training (NEET: β= -.32, P = .001) were significantly more likely to provide different responses on matched items when responding in the CATI as compared to online self-report survey. The online self-report survey, however, demonstrated some evidence of avidity and attrition bias. Conclusions: Compared to CATI, online self-report surveys are highly cost-effective and had higher rates of self-disclosure on sensitive items; particularly for respondents who identify as male and NEET. A drawback to online surveying methodologies, however, includes the limited control over avidity bias and the greater incidence of attrition bias. These findings have important implications for further development of survey methods in the area of health and wellbeing, especially when considering research topics (in this case mental health, sexting and body image) and groups that are being recruited (young people, males and NEET).
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Free-Living Validation of Fitbit Charge HR Wireless Heart Rate Monitor
From: JMIR mHealth and uHealth
Date Submitted: Jun 22, 2017
Open Peer Review Period: Jun 22, 2017 - Aug 17, 2017
Background: Many modern smart watches and activity trackers feature an optical sensor which estimates the wearer’s heart rate. Recent studies have evaluated the performance of these consumer devices...
Background: Many modern smart watches and activity trackers feature an optical sensor which estimates the wearer’s heart rate. Recent studies have evaluated the performance of these consumer devices in the laboratory. Objective: In this report we present our findings from a validation study conducted under free-living conditions. Methods: Ten healthy volunteers were recruited from a large university in Singapore to participate in a limited field-test followed by a month of continuous data collection. During the field-test each participant would wear one Fitbit Charge HRTM activity tracker and one Polar H6 heart rate monitor. Fitbit measures were accessed at full-minute intervals while Polar readings were available for ten-second intervals. We derived intraclass correlation coefficients (ICC) for individual participants comparing heart rate estimates. Paired t-tests were used to estimate the absolute difference in measures. We applied Centers for Disease Control heart rate zone cut-offs to ascertain the sensitivity and specificity of Fitbit in identifying one-minute epochs falling into the moderate-to-vigorous physical activity (MVPA) heart rate zone. Results: We collected paired heart rate data for 2509 one-minute epochs in ten individuals under free-living conditions of 3 to 6 hours. The overall ICC comparing one-minute Fitbit measures with average 10-second Polar H6 measures for the same epoch was 0.83 (95% CI 0.63, 0.91). On average the Fitbit tracker underestimated heart rate measures by -5.96 bpm (95%CI -6.33 to -5.60). At the low intensity heart rate zone the underestimate was smaller at -4.22 bpm (95% CI -4.50, -3.93). This underestimate grew to -15.0 bpm (95% CI -16.4, -13.5) in the moderate and -22.0 (95% CI -26.4, -17.5) in the vigorous heart rate zones respectively. Fitbit devices detected 53% of MVPA heart rate zone epochs correctly. Positive and negative predictive values were 86% and 92% respectively. During subsequent one month of continuous data collection (270 person-days) only 3.9% of one-minute epochs could be categorised as MVPA according to heart rate zones. This measure was affected by decreasing wear time and adherence over the period of follow-up. Conclusions: Under free-living conditions, Fitbit trackers are affected by significant systematic errors. Improvements in tracker accuracy and sensitivity when measuring MVPA are required before they can be considered for use in the context of exercise prescription to promote better health.
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User Needs in the Development of a Health App Ecosystem for Self-management of Cystic Fibrosis: A User Centred Development Approach
From: JMIR mHealth and uHealth
Date Submitted: Jun 19, 2017
Open Peer Review Period: Jun 19, 2017 - Aug 14, 2017
Background: Digital self-management in Cystic Fibrosis (CF) is foreseen as a means towards better under-standing of the disease and its treatment, and better adherence to the treatment. Mobile ap-plic...
Background: Digital self-management in Cystic Fibrosis (CF) is foreseen as a means towards better under-standing of the disease and its treatment, and better adherence to the treatment. Mobile ap-plications (apps) hold the potential to provide access to information and knowledge, moti-vate treatment and strengthen compliance. However, in order to develop high quality apps, the development should be based on thorough knowledge about user needs. Empirical re-search on the development of a user centred ecosystem of mobile applications in healthcare is however still limited. Objective: The research focuses on the development and evaluation of a mobile application ecosystem for self-management in CF. It addresses not only those directly affected by CF, but also par-ents and healthcare professionals involved in the treatment process. The focus of this paper is on the first step of the design process, which aims to analyse the context and the user re-quirements. We address the following research question: What digital support do patients and health professionals need in order to optimise their care or working routines, respec-tively? Methods: The research adopts a user centred design process in which future users are involved in the development process from the very beginning to ensure that the applications developed best suit the potential users. The study comprises semi-structured qualitative interviews involv-ing 71 participants in 7 European countries, group discussions among health professionals, research in Internet forums, observation, as well as a workshop with health professionals. Results: The results of the analysis phase show a strong need for individuality of the app, as well as for its adaptability to different contexts and age groups. The paper presents the concerns and needs of the participants in the study, and extracts a set of relevant features for the self-management App ecosystem. Functions related to enzyme management, diary keeping, treatment organisation and follow up, education, as well as guidelines for treatment were mentioned explicitly by the participants in this study. Conclusions: The large diversity of user requirements identified in this study reflects the crucial role user integration plays in developing applications for a chronic condition such as CF. The need for communication, not only among peers, but also with different health professionals, supports the idea of an application ecosystem including patients, parents as well as health profession-als.
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Time-Series Analysis of Newspaper Articles about HPV Vaccines
From: Journal of Medical Internet Research
Date Submitted: Jun 19, 2017
Open Peer Review Period: Jun 20, 2017 - Aug 15, 2017
Background: Media coverage and reports are also major factors in influencing individual vaccination and other health-related activities. People use the media to seek information and knowledge on healt...
Background: Media coverage and reports are also major factors in influencing individual vaccination and other health-related activities. People use the media to seek information and knowledge on health-related behaviors. people obtain health-related information from media such as television and newspapers, and they trust such information. While a number of studies have examined the relation between media coverage and individual health, there is a lack of studies that analyze media reports of health information. In particular, no analyses related to cervical cancer vaccine were found. Objective: This study aims to focus on reports pertaining to the Human Papillomavirus vaccine mentioned in Japan’s printed news media and reveal their characteristics. Methods: “Yomidasu Rekishikan,” which is Yomiuri Shinbun’s archival database, and “Kikuzo II Visual,” which is Asahi Shinbun’s archival database, were used for text mining. First, a database was created by extracting articles published between January 1, 2007, and December 31, 2014, which matched the terms “cervical cancer, vaccination” in a keyword search. Then, the extracted articles were tallied based on the month of publication, and number of characters to conduct a time-series analysis. Results: A total of 219 articles were extracted. Of these, 154 [70.3%] were positive, and 51 [23.3%] were negative. Of the 51 negative articles, 4 articles [8.0%] were published before June 2013, when routine vaccination was temporarily discontinued due to concerns regarding side effects, and 47 articles [92.0%] were published since then. The negative reports commonly cited side effects, although prior to June 2013, these issues were hardly mentioned. Although foreign media reports mentioned side effects before the routine vaccination was temporarily discontinued, fewer articles included side effects than articles recommending vaccinations. Furthermore, on June 13, 2013, WHO’s advisory body GACVS [Global Advisory Committee on Vaccine Safety] issued a statement regarding the safety of cervical cancer vaccine, but hardly any articles reported this statement. Rather, several articles were written about the side effects after June 2013. Conclusions: As we consider media coverage as a factor that affects human health behavior, the media should extensively report on the cost of not receiving cervical cancer vaccination, global trends concerning cervical cancer vaccination, and statements released by various agencies on the subject.
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Development of a Whole Slide Imaging System on Smartphones and Evaluation with Frozen Section Samples
From: Journal of Medical Internet Research
Date Submitted: Jun 19, 2017
Open Peer Review Period: Jun 20, 2017 - Aug 15, 2017
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Background: Whole slide scanners, which turn thousands of field-of-views (FoVs) under microscopes into virtual slides (VS's), is an essential but costly link in digital pathology and automatic analysi...
Background: Whole slide scanners, which turn thousands of field-of-views (FoVs) under microscopes into virtual slides (VS's), is an essential but costly link in digital pathology and automatic analysis. Utilizing capturing and processing capability of smartphones and existing optical microscopes for whole slide imaging has been a promising alternative but no commercial-quality products had been available. Objective: The aim was to develop scalable Whole Slide Imaging (sWSI), a whole slide imaging system based on smartphones coupled with optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry object lens of different magnification. All performance metrics should be evaluated by expert pathologists and match those of high-end scanners. Methods: In the sWSI design, the digitization process is split between clients on smartphones and cloud servers. The clients automatically capture FoVs at up to 12-mega-pixel resolution and process real-timely to give instant feedback of guidance. The servers computationally correct unknown non-linear distortion introduced by the lens of smartphones on-the-fly before combining all FoVs into one giga-pixel virtual slide for each scan. In the evaluation experiment, 100 frozen section slides from patients randomly selected among in-patients of the participating hospital are scanned both by a high-end Leica scanner and sWSI. All virtual slides were examined by senior pathologists whose diagnosis are compared against those made from optical microscopy as ground truth to evaluate the image quality. Results: The sWSI system is developed for both Android and iPhone smartphones and currently being offered to the public. The image quality is solid and throughput is approximately 1 FoV per second, yielding a 15-by-15 mm slide under 20X object lens around 30-35 minutes with little training for the operator. The expected cost for setup is about $100 and scanning each slide costs between $1 and $10, making sWSI highly cost-effective for infrequent or low-throughput usage. In the clinical evaluation on sample-wise diagnostic reliability, 0.78, 0.88, 0.68 and 0.50 average accuracy for breast, uterine corpus, thyroid and lung samples are achieved by sWSI-scan-based diagnosis, respectively. The respective low-sensitivity rates are 0.05, 0.05, 0.13 and 0.25 while the respective low-specificity rates are 0.18, 0.08, 0.20 and 0.25. The participating pathologists agreed that the overall quality is generally on par with that produced by high-end scanners, not affecting diagnosis in most cases. They confirmed that sWSI is reliable enough for standard diagnosis of most tissue categories while can be used for quick screening for the difficult ones. Conclusions: As an ultra-low-cost alternative to whole slide scanners, diagnosis-ready virtual slide quality and robustness for commercial usage is achieved in the sWSI solution. Operated on main-stream smartphones installed on normal optical microscopes, sWSI readily offers affordable and reliable whole slide imaging to resource-limited or infrequent clinical users.
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Characteristics of Adults Seeking Healthcare Provider Support Facilitated by Mobile Technology
From: JMIR mHealth and uHealth
Date Submitted: Jun 20, 2017
Open Peer Review Period: Jun 21, 2017 - Aug 16, 2017
Background: Mobile health technology is rapidly evolving with the potential to transform healthcare. Self-management of health facilitated by mobile technology can maximize long-term health trajectori...
Background: Mobile health technology is rapidly evolving with the potential to transform healthcare. Self-management of health facilitated by mobile technology can maximize long-term health trajectories of adults. Little is known about the characteristics of adults seeking online and offline support from healthcare providers facilitated by mobile technology. Objective: This study examined: 1) the characteristics of adults who seek human support from healthcare providers for health concerns using mobile technology, rather than from family members and friends or others with similar health conditions; and 2) the use of mobile health technology among adults with chronic health conditions. Findings of this study were interpreted in the context of the Efficiency Model of Support. Methods: We first described characteristics of adults seeking online and offline support from healthcare providers. Using chi-squared tests for categorical variables and t-test for the continuous variable of age, we compared adults seeking online and offline support by demographics. The primary aim was analyzed using multivariate logistic regression to examine whether chronic health conditions and demographic factors (e.g., sex, income, employment status, race, ethnicity, education, and age) were associated with seeking online support from healthcare providers. Results: The sample included adults (N=1,453), the majority of whom were female (58%), White (75%) and non-Hispanic (89%). The age of the participants ranged from 18 to 92 years (mean 48.6; SD 16.8). The majority (76%) of participants reported college or higher level of education. A disparity was found in access to health care providers via mobile technology based on socioeconomic status. Adults with annual income $30,000 to $100,000 were 1.72 times more likely to contact a healthcare provider online, and adults with an annual income above $100,000 were 2.41-2.46 times more likely to access a health care provider online, compared to those with an annual income below $30,000. After adjusting for other demographic covariates and chronic conditions, age was not a significant factor in online support seeking. Conclusions: In our study, the likelihood of seeking online support increased when adults had any or multiple chronic health conditions. A higher level of income and education than the general population was found to be related to the use of mobile health technology among adults in this survey. Future study is needed to better understand the disparity in online support seeking for health issues, and the clinicians’ role in promoting access and use of mobile health technology.
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Applying Social Network Analysis to Understand the Percentages of Keywords within Abstracts of Journals: A System Review of Three Journals
From: Journal of Medical Internet Research
Date Submitted: Jun 20, 2017
Open Peer Review Period: Jun 20, 2017 - Aug 15, 2017
Background: Academic literature suggests keywords that are retrieved from a paper’s title and abstract represent important concepts in that study. The percentage of keywords within an abstract (PKWA...
Background: Academic literature suggests keywords that are retrieved from a paper’s title and abstract represent important concepts in that study. The percentage of keywords within an abstract (PKWA) is required to investigate. Objective: To compare the PKWA in journals of medical informatics and the keyword network relationship in order to develop a self-examining policy for the journal. Methods: Selecting 5,985 abstracts and their corresponding keywords in three journals (JMIR, JAMIA, and BMC Med Inform Decis Mak.) published between 1995 to 2017(April) on the US National Library of Medicine National Institutes of Health (Pubmed.org), we computed the PKWA for each journal by using MS Excel modules and compared the percentage differences across journals and years via a two-way ANOVA. Social network analysis (SNA) was performed to explore the relations of keywords in journals. Results: The PKWA are 48.81, 41.59, and 56.84 for the three journals, respectively. A statistically significant difference (p < 0.05) is found in the percentages among journals selected. In contrast, no differences (p> 0.05) are found (1) between years (2016 and 2017) and (2) in interaction effects between journals and years. Three journals display significantly different patterns in network keywords and major cohesion measures. Conclusions: It is required to apply the computer module when inspecting whether keywords are within abstracts. The cohesion measure provides journal editors with a method of examining keywords within an abstract for a paper under review.
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User-centered design of a mobile app for weight and health management in adolescents with complex health needs: A qualitative needs assessment
From: Journal of Medical Internet Research
Date Submitted: Jun 23, 2017
Open Peer Review Period: Jun 25, 2017 - Aug 20, 2017
Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted towa...
Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted towards the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level healthcare. Objective: The aim of the present study was to conduct a user-centered needs assessment of adolescents with complex health needs requiring specialized healthcare services and interested in weight management, their parents and healthcare providers, to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from 2 tertiary healthcare centres. Separate audio-taped focus group interviews were conducted with adolescents, parents and healthcare providers. Interviews were transcribed and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVIVO 10.0. Results: 19 adolescents, 16 parents, and 21 healthcare providers were interviewed. Qualitative analysis revealed 7 major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with healthcare professionals, supporting mental health, gamification and incentives, and user interface design. Adolescents provided several ideas related to each feature, while parents’ views focused on assistance with meal planning and greater access to healthcare professionals. Healthcare providers viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with a healthcare professional. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized healthcare services towards the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to healthcare professionals, features to support mental health, and an attractive and engaging user interface. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs.
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Online communication strategies designed to improve intention to minimize risk for colorectal cancer: a randomized controlled trial to test an FAQ prototype for information targeted by age and gender
From: JMIR Research Protocols
Date Submitted: Jun 21, 2017
Open Peer Review Period: Jun 22, 2017 - Jul 6, 2017
Background: Increasingly, people seek information online for managing their health, including colorectal cancer (CRC) risk but retrieve much personally irrelevant material, impacting utility. Targetin...
Background: Increasingly, people seek information online for managing their health, including colorectal cancer (CRC) risk but retrieve much personally irrelevant material, impacting utility. Targeting people with information pertinent to their cohort via a Frequently Asked Questions (FAQ) format might improve commitment to action. Objective: We identified and prioritized CRC information for men and women aged 35−74 years (Study 1), to build a prototype website containing FAQs ordered by age and gender. In Study 2 we conducted a randomized controlled trial (RCT) to test whether information accessed through targeted FAQs was more influential on intention to act on CRC risk than the same information accessed via a generic topic list. Secondary aims compared preference for information via FAQs or LIST, usability, relevance and likelihood of recommendation of FAQ and LIST websites. Methods: Study 1 determined the CRC information needs of Australians (total N = 600) by sex and age group (35-49, 50-59, 60-74) through an online survey. Free text responses were categorized as FAQs with a focus on the “top 5” issues within each of 6 cohorts. Study 2 compared the impact of presentation as targeted FAQ links to information with links presented as a generic list (LIST), and a CONTROL (no information) condition. Participants (N=240) were block randomized by gender and age group to 1 of 3 conditions. We also tested preference for information presentation as FAQ or LIST by adding a CHOICE condition. Dependent measures were willingness to act on CRC risk and ratings of website usability, relevance and intention to recommend. Results: Study 1 showed considerable consistency in information priorities among all six cohorts with two main concerns; treatment of CRC and risk factors. Some differences included a focus on general risk factors, excluding diet and lifestyle, in the younger cohort, and on the existence of a test for CRC in the older cohorts. Study 2 demonstrated that although respondents preferred information ordered by FAQs over a list, presentation in this format had limited impact on readiness to act on CRC risk compared to the list or a no information control (p=.055). Both FAQ and LIST were evaluated as equally useable. Those aged 35–49 rated the information less relevant to them and others in their age group, and information ordered by FAQs was rated, across all age groups and both sexes, as less relevant to people outside the age group targeted within the FAQs. Conclusions: FAQs are preferred over a list as a strategy for presenting information about CRC. They may improve intention to act on risk although further research is required. Future research should aim to identify better the characteristics of information content and presentation that optimize perceived relevance and fully engage the target audience
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Comparison of the Effects of Exercise Therapy between Digital Video Disc and Web-site-based Interventions in Patients with Hip Osteoarthritis
From: Journal of Medical Internet Research
Date Submitted: Jun 23, 2017
Open Peer Review Period: Jun 23, 2017 - Aug 18, 2017
Background: Prevalence of developmental hip dysplasia is high in Japan, and morbidity associated with hip osteoarthritis has been reported as 1.0-4.3%. It is estimated that this figure will rise as th...
Background: Prevalence of developmental hip dysplasia is high in Japan, and morbidity associated with hip osteoarthritis has been reported as 1.0-4.3%. It is estimated that this figure will rise as the aging population grows. Exercise therapy has been proven effective to treat certain aspects of hip osteoarthritis. Moreover, therapy provided via DVDs and web sites, allows patients to exercise in the comfort of their own homes. However, no studies have evaluated the effectiveness of visual instructions in patients with hip disorders thus far. Objective: This study aimed to compare the effectiveness of exercise therapy administered via DVDs and that administered via web sites. Methods: We developed a six-step progressive exercise therapy program for patients with hip osteoarthritis, which included three kinds each of Open-Kinetic-Chain and Closed-Kinetic-Chain exercises. The exercise menu was designed such that patients could reach Step 6 in 3 months by advancing to a new step every 2 weeks, with 30 to 40 min of exercise daily. Once the program was developed, exercise DVDs were produced using easily comprehendible pictures, videos and relaxing music. The DVD users were shown the number of times each exercise should be performed, in order to promote exercise continuity. In addition to the six-step exercise program, our web site was enabled to count the number of exercises performed by each patient and was accessible via the internet at any time. We instructed the patients to start at an appropriate level and step up every two weeks unless they experienced pain, when they were asked to stop temporarily. Patients with hip osteoarthritis for whom surgery was not advised were enrolled by one university hospital. Clinical symptoms and hip function were quantified using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) and the Oxford Hip Score (OHS). Quality of life was measured using the SF-8 Health Survey, and self-efficacy for continued exercise was measured using the General Self-Efficacy Scale (GSES). Questionnaires were completed pre-intervention and after 6 months. Results: At 6-month follow-up, 10 DVD users (1 male, 9 female; mean age 51.3 [SD=16.1] years), and 18 web-site users (2 male, 16 female; mean age 52.3 [SD=10.4] years) were reachable. Small effect was observed for JHEQ-pain, SF-8 physical component summary (PCS) and SF-8 mental component summary in the DVD group, and for OHS, SF-8 (PCS) and GSES in the web-site group. Although we could not confirm a significant improvement, most parameters tended to improve over the 6 months. Conclusions: When comparing the effectiveness of exercise therapy between our DVD and web site, we found that, while both groups tended to improve in physical function, only the web-site group showed enhanced self-efficacy.
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Evaluation of the effectiveness of mhealth applications in self-care management of chronic lower back pain
From: Journal of Medical Internet Research
Date Submitted: Jun 21, 2017
Open Peer Review Period: Jun 22, 2017 - Aug 17, 2017
Background: Reviews of patient-targeted smartphone applications for pain management [22] showed that despite the large availability of applications for pain tracking, self-management, and exercise tra...
Background: Reviews of patient-targeted smartphone applications for pain management [22] showed that despite the large availability of applications for pain tracking, self-management, and exercise training, the science of implementation of mHealth technologies and self-management of chronic conditions are important areas for further research [2, 23]. There has been little research regarding methods associated with continued user engagement, or the effectiveness of adherence to certain health platforms [6,14,24] for improving health outcomes among those living with chronic diseases. Objective: This study investigated the interaction of patients with various features of Limbr, a modular mHealth compliance enhancement intervention for self-management of Chronic Lower Back Pain (CLBP). Limbr is comprised of self-directed rehabilitation tutorial videos, personalizable, visual self-report tools, health coach support, and sensor-assisted passive tracking of activity levels. The Limbr program aims to promote adherence to the BackRx exercise rehabilitation regimen [21], increase engagement in self-directed management of pain (including pain, medication and exercise tracking) and improve self-reported outcomes of pain. Methods: We assessed CLBP patients’ adherence to (1) a 3-month, self-directed, rehabilitation program, and (2) user engagement in both self-reporting Activities of Daily Living (ADLs), medication, affect, and pain function, and frequency of messages to and from the health care coach. In addition, we tested the association between scores derived from our visual self-report method, YADL (an image based tool for tracking patient reported ADLs), and the well established Oswestry Disability Index (ODI) obtained from the Oswestry Low Back Pain Questionnaire. Participants were a convenience sample recruited through their clinician in New York, NY. 98 patients agreed to participate, of which, 35 patients completed the full 3 month intervention. In aggregate over 202 data points per patient were collected and analyzed. Results: Study results indicate that the Limbr mHealth intervention promoted engagement in patient self-monitoring and management of pain through use of the mobile applications. The 35 participants who completed the full three months of engagement demonstrated a sustained intensity of use of the Limbr system, with 65% of participants interacting at least once a week. Roughly 50% of participants perceived the visual self-reports as helpful in tracking pain-related ADLs, medication, and affect. In particular, about 60% of participants found YADL helpful in keeping track of ADLs. About two-thirds (71% and 67%) of the participants agreed that the daily notifications were beneficial in reminding them to complete the daily surveys and exercises respectively. 50% of the participants perceived the engagement features as highly motivating and very useful. It was also found that the Limbr self-assessment, YADL, is correlated to the ODI Index (P < .001). Conclusions: These results indicate that mHealth interventions that consist of visual self-reporting, personalized health coach messaging, weekly user updates and sensor-assisted reminders, can be very effective in promoting adherence to the self-management of chronic LBP and to a self-directed rehabilitation regimen. Clinical Trial: NCT03040310
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Implementing a Mental Health Care Program and Home-based Training for Mothers of Children with Autism Spectrum Disorder in an urban population in Bangladesh: Protocol for a feasibility assessment study
From: JMIR Research Protocols
Date Submitted: Jun 22, 2017
Open Peer Review Period: Jun 22, 2017 - Jul 6, 2017
Background: Mothers of children with Autism Spectrum Disorder (ASD) have reported a higher level of depression than mothers of children with other neurodevelopmental disorders in both developed and de...
Background: Mothers of children with Autism Spectrum Disorder (ASD) have reported a higher level of depression than mothers of children with other neurodevelopmental disorders in both developed and developing countries. Mothers are the lifetime caregivers of children with ASD. A high burden of depression negatively impacts on the ability of the mothers to provide care to children at home. Mental health is not addressed in the primary care setting in Bangladesh, and there is a scarcity of qualified providers for supporting mental health care to mothers for supporting child care and improvement of child performances. We aim to pilot the feasibility of integrating mental health services for the mothers of children with ASD and offer a home-based training program for the mothers to improve skills of child care. We have obtained IRB approval from icddr,b. Objective: The primary objective of the study is to assess the feasibility of the proposed intervention at special schools for children with ASD that would provide mental health services and training to mothers suffering from a concurrent major depressive episode (MDE). The secondary aims of the project are to assess the change in the prevalence of MDE among mothers, as well as the any improvement in the degree of individual performance of the children with ASD. Additional project aims include assessment of incremental institutional costs incurred at schools, and out of pocket costs incurred by the families following the introduction of mental health services in combination with the maternal training program in the schools. The broader goal of the research is to assess the barriers to integrating the pilot intervention package with other types of facility-based services as well as prospect for scaling up of the intervention in other institutional settings in urban Bangladesh. Methods: The study will be conducted in two purposively selected schools in Dhaka city in Bangladesh that have been offering services for ASD for more than ten years. A trained female psychologist will be deployed at each of the two schools to offer non pharmacological interventions for mental health following a structured counseling module under the direct supervision of psychiatrists. About 52 to 78 mothers who would be diagnosed as having a depression will be recruited in the intervention (intervention mother) following a written voluntary informed consent. One educational psychologist with advanced training in ASD care (special educator) will provide training to the intervention mothers for enhancing their skills for child care and follow up at home every month. The proposed packaged intervention will be implemented over 4-6 months period, and feasibility of the intervention will be assessed through a pre-post intervention. The primary outcome will include assessment of acceptability, adaptability, demand, practicality, implementation, and integration of the package intervention in the school settings. The secondary outcomes will include assessment of (i) any change in the prevalence of current depression among the mothers of children with ASD following the intervention; (ii) the degree of individual performance of the children regarding behavioral, social and communication skills; and (iii) the costs incurred to institutions and families due to participation in the intervention. Results: Between January and June, 2017, 175 mothers were recruited for baseline information, and assessment of depression and quality of life. In depth interviews were conducted among 10 mothers and 8 various stakeholders. A psychosocial counseling module has been developed, and two psychologists deployed at the schools offered counseling to 41 mothers who have steeped in to the counseling centre on self will. A training module has been developed for mothers under the guidance of an expert working group and three special educators were trained. Data entry and data management are ongoing. Conclusions: The proposed research will provide essential estimates for designing a randomized control trial in order to evaluate the intervention package in a broader setting. Overall, the study will generate compelling evidence for scaling up of the intervention in other institutional settings in Bangladesh and in other countries with a similar situation of ASD and maternal depression. Clinical Trial: NCT03025646; https://clinicaltrials.gov/ct2/show/NCT03025646
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e-Vita: Effect of integration of self-management web platforms on health status in COPD disease management in primary care
From: Journal of Medical Internet Research
Date Submitted: Jun 22, 2017
Open Peer Review Period: Jun 22, 2017 - Aug 17, 2017
Background: Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves quality of life for COPD patients and can r...
Background: Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves quality of life for COPD patients and can reduce hospitalization. Self-management of COPD through eHealth is an effective method to improve IDM and clinical outcomes. Objective: The objective of this implementation study was to investigate the effect of three chronic obstructive pulmonary disease (COPD) eHealth programs applied in primary care on health status. The e-Vita COPD study compares different levels of integration of web-based self-management platforms in IDM in three primary care settings. Patients’ health status is examined using the Clinical COPD Questionnaire (CCQ). Methods: The parallel cohort design includes i) three levels of integration in IDM (groups 1, 2, 3) and ii) randomization of two levels of personal assistance for patients (group A high assistance, group B low assistance). Interrupted time series (ITS) design was used to collect CCQ data at multiple time points (before/after intervention) and multilevel linear regression modelling was used to analyse CCQ data. Results: Of the 702 invited patients, 215 (31%) registered to a platform. Of these, 82 participated in group 1 (high integration IDM), 36 in group 1A (high assistance), and 46 in group 1B (low assistance); 96 participated in group 2 (medium integration IDM), 44 in group 2A (high assistance) and 52 in group 2B (low assistance); also, 37 participated in group 3 (no integration IDM). In the total group, no significant difference was found in change in CCQ-trend (p=0.334) before (-0.47% per month) and after the intervention (-0.084% per month). Also, no significant difference was found in CCQ changes before vs. after the intervention between the groups with high vs. low personal assistance. In all subgroups, there was no significant change in the CCQ trend before and after the intervention (group 1A p=0.237; 1B p=0.991; 2A p=0.120; 2B p=0.166; group 3 p=0.945). Conclusions: The e-Vita eHealth-supported COPD programs had no beneficial impact on the health status of COPD patients. Also, no differences were found between the patient groups receiving different levels of personal assistance. Clinical Trial: NTR4098 (31072013)
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Web-based intervention to teach developmentally-supportive care to parents of preterm infants: feasibility study
From: JMIR Research Protocols
Date Submitted: Jun 23, 2017
Open Peer Review Period: Jun 25, 2017 - Jul 9, 2017
Background: Preterm birth affects 8-11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positiv...
Background: Preterm birth affects 8-11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally-supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included three in-person workshops that occurred prior to hospital discharge and a web-based platform with written and videotaped materials that addressed five main themes: (1) infant behavioural cues; (2) flexion positioning; (3) oral feeding support; (4) parent-infant interactions; (5) anticipation of developmental milestones. Objective: This study aimed to test the acceptability of the intervention by parents of preterm infants and to assess clinical benefits on child neurodevelopment and parental outcomes during the first year of life. Methods: One hundred seven infants born <30 weeks and admitted to Ste-Justine Hospital neonatal intensive care unit and their parents were enrolled in a nonrandomized controlled before-and-after interventional study (intervention n=55, comparison n=52). Acceptability of the program was assessed with a user satisfaction questionnaire. At 4 months’ corrected age, all parents completed questionnaires on infant temperament, parenting stress, sense of competence and parenting satisfaction. At 12 months’ corrected age, neurodevelopmental testing was performed on infants using the Alberta Infant Motor Scale and the Bayley scales 3rd edition. Comparisons between the two groups were done using independent t-test, Wilcoxon rank-sum test, and Fisher’s exact test. Results: Majority of parents (96%) were satisfied with the intervention program and all would recommend MAQ to others. MAQ responded to their need for evidence-based information that proved useful to support their child development. No difference in parental or child neurodevelopmental outcomes was detected in this pilot study for most outcomes except for higher median scores for parental coercive behaviours in the intervention group although proportions scoring in the coercive range did not differ. Conclusions: Acceptability of the program was high among parents thus supporting the relevance of such intervention. A larger study using a randomized controlled trial design is needed to better document impact on parent and children and to investigate how web-based technologies can efficiently complement individualized intervention to alleviate the burden on health care resources.
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Atrial fibrillation screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm—TELEHEALTH study group
From: JMIR mHealth and uHealth
Date Submitted: Jun 23, 2017
Open Peer Review Period: Jun 25, 2017 - Aug 20, 2017
Background: Atrial fibrillation (AF) is a common form of arrhythmia, which is associated with a five-fold risk of stroke and increased mortality. Detecting AF before the first complication occurs is a...
Background: Atrial fibrillation (AF) is a common form of arrhythmia, which is associated with a five-fold risk of stroke and increased mortality. Detecting AF before the first complication occurs is a recognized priority. Current guidelines for AF suggest undertaking opportunistic screening for AF by pulse taking or electrocardiography (ECG) rhythm strip in patients >65 years of age. As no previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm, we address this issue. Objective: to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm Methods: We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead ECG recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results: Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in a nonmetropolitan area. We found that 83.4% of ECGs contained no artifacts, and only 0.21% of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.45% (95% CI, 77.16%–99.88%) and specificity of 97.67% (95% CI, 96.49%–98.53%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions: AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible.
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Behavioral and medical mechanisms that link diabetes to disability depend on the intersection of place and gender
From: JMIR Diabetes
Date Submitted: Jun 23, 2017
Open Peer Review Period: Jun 25, 2017 - Aug 20, 2017
Background: The mechanisms that link diabetes to disability may vary across populations. Objective: This study investigated gender by place differences in the behavioral and medical mechanisms behind...
Background: The mechanisms that link diabetes to disability may vary across populations. Objective: This study investigated gender by place differences in the behavioral and medical mechanisms behind the link between diabetes (DM) and disability in eight countries. Methods: We borrowed data from Research on Early Life and Aging Trends and Effects (RELATE). This analysis included adults from eight countries including Barbados, Brazil, Costa Rica, Chile, Cuba, Puerto Rico, Mexico, and Uruguay. Diabetes was the independent variable, disability (activities of daily living) was the dependent variable, socioeconomics, obesity, health behaviors, and comorbidities were covariates, and gender was the moderator. We used country by gender specific- logistic regressions to test the effect of DM on disability after adjusting for socioeconomics (Model 1), socioeconomics, health behaviors, and obesity (Model 2), and socioeconomics, obesity, health behaviors, and medical comorbid conditions (Model 3). Results: Gender by country specific patterns of association between DM and disability were observed in Puerto Rico, Mexico, Brazil, Chile, and Cuba. In Puerto Rico, in men, DM – ADL could be explained by health behaviors and obesity, for women, however, the impact of DM on ADL was above all confounders for women. In Mexico, for men, DM was not associated with disability, however, for women, there was a link which could be explained by health behaviors and obesity. In Brazil, for men, DM – ADL limitation link could be fully explained by health behaviors and obesity, for women, however, DM was not associated with ADL at all. In Chile, for men, DM was not associated with ADL limitation, for women, however, there was an association between DM and ADL limitation which could not be explained by health behaviors, obesity, or comorbid medical conditions. In Cuba, for men, health behaviors and obesity fully mediated the effect of DM on ADL, for women, however, this link was mediated by comorbid medical conditions. Conclusions: Gender by place differences exist in the link between DM and disability, as well as behavioral and medical mechanisms behind such link. These findings advocate for the intersectionality approach in studying burden of illnesses such as DM.
